WorldWideScience

Sample records for chronic medical illness

  1. The self-efficacy model of medication adherence in chronic mental illness.

    Science.gov (United States)

    McCann, Terence V; Clark, Eileen; Lu, Sai

    2008-11-01

    In this position paper, the self-efficacy model of medication adherence in chronic mental illness is presented, and its application to antipsychotic medication adherence is considered. Poor adherence to antipsychotic medications is common in chronic mental illness. Major implications of this are relapse and re-hospitalisation. Several conceptual frameworks have been developed about adherence and, in some instances, have been incorporated in medication taking studies, but have resulted in inconsistent outcomes. This paper draws on a review of literature from databases to inform the development of the self-efficacy model of medication adherence. Inclusion and exclusion criteria were developed from primary and secondary research questions. The model places the person with chronic mental illness as an active participant central to the process of medication taking. It has three components: core factors, contextual influences and a continuum. The factors comprise a central factor, self-efficacy and four interrelated supporting influences: perceived medication efficacy; access to, and relationships with, health professionals; significant other support and supported living circumstances. The factors are affected by three broad contextual influences - personal issues, medication side-effects and complexity, and social stigma - which affect the way individuals take their medications. A continuum exists between adherence and non-adherence. The model positions service users at the heart of adherence by giving prominence to self-efficacy, medication efficacy and to immediate social, psychological and environmental supports. Further work is needed to validate, refine and extend the model. For practitioners involved in prescribing and medication management in people with chronic mental illness, the model provides a theoretical framework to strengthen adherence. It highlights the need to consider broader influences on medication taking. Moreover, it places the person with chronic

  2. Quality of life, treatment adherence, and locus of control: multiple family groups for chronic medical illnesses.

    Science.gov (United States)

    López-Larrosa, Silvia

    2013-12-01

    The Multiple Family Groups (MFGs) approach for patients with a chronic medical illness and their families is a structured psychoeducational program that unfolds in six weekly 90-minute sessions. In the MFGs, patients and family members explore new ways to balance illness and nonillness priorities in family life (Steinglass, 1998; Steinglass, 2000 Cuadernos de Terapia Familiar, 44-45, 11; Steinglass, Ostroff, & Steinglass, 2011 Family Process, 50, 393). © FPI, Inc.

  3. [Medical inpatient rehabilitation influences on self-esteem and self-efficacy of chronically ill adolescents].

    Science.gov (United States)

    Kiera, S; Stachow, R; Petermann, F; Tiedjen, U

    2010-08-01

    In this article the development of self-esteem and self-efficacy in adolescents with chronic physical illness with and without psychological symptoms is measured over one year, following a medical inpatient rehabilitation treatment of four to six weeks. Gender- and diagnosis-related differences are analyzed. 243 chronically ill adolescents were interviewed at the beginning of their rehabilitation treatment. After one year data of 99 chronically ill adolescents are available (age: M=14.6; SD=1.70), 50 boys. Self-esteem was measured using the revised Rosenberg Self-Esteem Scale. The revised Allgemeine Selbstwirksamkeitsskala was chosen for assessing self-efficacy at school and other social contexts. At the beginning of rehabilitation, psychological symptoms were identified using the German version of the Strengths and Difficulties Questionnaire. Therapy of chronically ill adolescents in medical rehabilitation affects their self-esteem positively, with differences in self-esteem found between adolescents who show clinically relevant psychological symptoms and those who do not. Only minor changes are however noticed in ratings of self-efficacy at school and other social contexts. Gender- and diagnosis-related differences have not been found. Copyright Georg Thieme Verlag KG Stuttgart New York.

  4. Patient Experience of Chronic Illness Care and Medical Home Transformation in Safety Net Clinics.

    Science.gov (United States)

    Tung, Elizabeth L; Gao, Yue; Peek, Monica E; Nocon, Robert S; Gunter, Kathryn E; Lee, Sang Mee; Chin, Marshall H

    2018-02-01

    To examine the relationship between medical home transformation and patient experience of chronic illness care. Thirteen safety net clinics located in five states enrolled in the Safety Net Medical Home Initiative. Repeated cross-sectional surveys of randomly selected adult patients were completed at baseline (n = 303) and postintervention (n = 271). Questions from the Patient Assessment of Chronic Illness Care (PACIC) (100-point scale) were used to capture patient experience of chronic illness care. Generalized estimating equation methods were used to (i) estimate how differential improvement in patient-centered medical home (PCMH) capability affected differences in modified PACIC scores between baseline and postintervention, and (ii) to examine cross-sectional associations between PCMH capability and modified PACIC scores for patients at completion of the intervention. In adjusted analyses, high PCMH improvement (above median) was only marginally associated with a larger increase in total modified PACIC score (adjusted β = 7.7, 95 percent confidence interval [CI]: -1.1 to 16.5). At completion of the intervention, a 10-point higher PCMH capability score was associated with an 8.9-point higher total modified PACIC score (95 percent CI: 3.1-14.7) and higher scores in four of five subdomains (patient activation, delivery system design, contextual care, and follow-up/coordination). We report that sustained, 5-year medical home transformation may be associated with modest improvement in patient experience of chronic illness care for vulnerable populations in safety net clinics. © Health Research and Educational Trust.

  5. Self-reported barriers to medication adherence among chronically ill adolescents

    DEFF Research Database (Denmark)

    Hanghøj, Signe; Boisen, Kirsten A

    2014-01-01

    , forgetfulness, organization, medicine complexity, and financial costs. Most reported barriers to adherence were not unique to specific diseases. CONCLUSION: Some barriers seem to be specific to adolescence; for example, relations to parents and peers and adolescent development. Knowledge and assessment......PURPOSE: To investigate self-reported barriers to medication adherence among chronically ill adolescents, and to investigate whether barriers are unique to specific chronic diseases or more generic across conditions. METHODS: A systematic search of Web of Science, PubMed, Embase, Psyc...

  6. The Effect of Opioid Use and Mental Illness on Chronic Disease Medication Adherence in Superutilizers.

    Science.gov (United States)

    Surbhi, Satya; Graetz, Ilana; Wan, Jim Y; Gatwood, Justin; Bailey, James E

    2018-03-01

    Nonadherence to essential chronic medications has been identified as a potential driver of high health care costs in superutilizers of inpatient services. Few studies, however, have documented the levels of nonadherence and factors associated with nonadherence in this high-cost, vulnerable population. To examine the factors associated with nonadherence to essential chronic medications, with special emphasis on mental illness and use of opioid medications. This study was a retrospective panel analysis of 2-year baseline data for Medicare Part D beneficiaries eligible for the SafeMed care transitions program in Memphis, Tennessee, from February 2013 to December 2014. The 2-year baseline data for each patient were divided into four, 6-month patient periods. The study included Medicare superutilizers (defined as patients with ≥ 3 hospitalizations or ≥ 2 hospitalizations with ≥ 2 emergency visits in 6 months) with continuous Part D coverage who had filled at least 1 drug class used to treat hypertension, diabetes mellitus, congestive heart failure, coronary artery disease, or chronic lung disease. The outcome included medication nonadherence assessed using proportion of days covered (PDC), with PDC mental illness (defined as a diagnosis of depression or anxiety or ≥ 1 anxiolytic or antidepressant fill) and opioid medication fills assessed in each 6-month period. Pooled observations from the four 6-month periods were used for multivariable analyses using the patient periods as the unit of analysis. A random effects model with robust standard errors and a binary distribution were used to examine associations between independent variables (time invariant and time variant factors) and medication nonadherence. The model included lagged effects of time variant factors measured in each period. Overall nonadherence to essential chronic medications ranged from 39.3% to 58.4%, with the highest for chronic lung disease medications (49.1%-64.4%). Factors associated with

  7. [Perspectives of chronically ill patients concerning medical care in Guadalajara, Mexico: a qualitative study].

    Science.gov (United States)

    Mercado Martínez, F J; Ramos Herrera, I M; Valdez Curiel, E

    2000-01-01

    This paper reports partial findings from a broader study on the experience of people with chronic diseases. The objective was to explore the perspectives of diabetic patients towards medical care. A qualitative study was conducted in a poor neighborhood of Guadalajara, Mexico. Thirty subjects with diabetes mellitus participated in the study. Data was gathered by open and semi-open interviews in the subjects' homes and over the course of one year. Data were analyzed using a combination of content and conversational analyzing techniques. Three perspectives predominated when participants evaluated medical care: some define it as good, some as ambivalent, and the rest as bad. These perspectives were closely linked to their disease experience and available medical options according to their material resources. These perspectives change with time, are specific to each available service and type of medical care, and are constructed in terms of all the subjects' present chronic illnesses. Those treated through the social security system evaluate the care in negative terms, with the opposite occurring with those treated in public health care centers and private facilities. Implications regarding health care reform are discussed.

  8. Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results

    OpenAIRE

    Koenig, Harold G.

    2012-01-01

    This paper (1) reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2) discusses research on the relationship between religion and depression-induced physiological changes, (3) describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a) overcome physical and religious barriers to CBT and (b) compare the efficacy of religious versus secular C...

  9. Effects of Rural Medical Insurance on Chronically Ill Patients' Choice of the Same Hospital Again in Rural Northern China.

    Science.gov (United States)

    Jiang, Ke; You, Daming; Li, Zhendong; Wei, Wei; Mainstone, Mitchell

    2018-04-12

    The emergence of rural health insurance plays a crucial role in alleviating the pressure on rural medical expenditure. Under the current medical system in northern China, rural medical insurance may reduce the free referral of patients with chronic diseases among hospitals. This study was carried out based on the results of an investigation of rural chronically-ill patients in eight county hospitals in northern China, as well as through the comparison and analysis of patients with chronic diseases, considering whether they were with or without rural health insurance. The main results showed that both age ( χ 2 = 22.9, p rural peoples' willingness to buy health insurance. Meanwhile, both the quality of the hospital's treatment ( B = 0.555, p rural health insurance had weakened the three relationships upon which the aforementioned correlations were based.

  10. Medication cost problems among chronically ill adults in the US: did the financial crisis make a bad situation even worse?

    Directory of Open Access Journals (Sweden)

    Piette JD

    2011-04-01

    Full Text Available John D Piette1, Ann Marie Rosland1, Maria J Silveira1, Rodney Hayward1, Colleen A McHorney21Ann Arbor VA Healthcare System, Ann Arbor, MI, USA; 2US Outcomes Research, Merck and Co, Inc, North Wales, PA, USAAbstract: A national internet survey was conducted between March and April 2009 among 27,302 US participants in the Harris Interactive Chronic Illness Panel. Respondents reported behaviors related to cost-related medication non-adherence (CRN and the impacts of medication costs on other aspects of their daily lives. Among respondents aged 40–64 and looking for work, 66% reported CRN in 2008, and 41% did not fill a prescription due to cost pressures. More than half of respondents aged 40–64 and nearly two-thirds of those in this group who were looking for work or disabled reported other impacts of medication costs, such as cutting back on basic needs or increasing credit card debt. More than one-third of respondents aged 65+ who were working or looking for work reported CRN. Regardless of age or employment status, roughly half of respondents reporting medication cost hardship said that these problems had become more frequent in 2008 than before the economic recession. These data show that many chronically ill patients, particularly those looking for work or disabled, reported greater medication cost problems since the economic crisis began. Given links between CRN and worse health, the financial downturn may have had significant health consequences for adults with chronic illness.Keywords: medication adherence, cost-of-care, access to care, chronic disease

  11. [Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain)].

    Science.gov (United States)

    Prieto Rodríguez, M Ángeles; Danet Danet, Alina; Escudero Carretero, María J; Ruiz Azarola, Ainhoa; Pérez Corral, Olivia; García Toyos, Noelia

    2012-01-01

    To identify the attributes used by chronically-ill patients to describe physicians' competence in the public healthcare system in Andalucia. A total of 147 chronically-ill patients and their relatives were included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests) with interpersonal skills related to communication, information (informing, listening, trust, prompting questions) and attention (courtesy, cordiality, respect, interest and approachability). Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

  12. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Kale, Minal S; Federman, Alex D; Krauskopf, Katherine; Wolf, Michael; O'Conor, Rachel; Martynenko, Melissa; Leventhal, Howard; Wisnivesky, Juan P

    2015-01-01

    Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD. We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ) and Beliefs about Medications Questionnaire (BMQ). Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs. We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (pliteracy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42), and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17). In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94). In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37) though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04). In this cohort of urban individuals with COPD, low health literacy was prevalent, and associated with illness beliefs that predict decreased adherence. Our results suggest that targeted strategies to address low health

  13. The Association of Health Literacy with Illness and Medication Beliefs among Patients with Chronic Obstructive Pulmonary Disease.

    Directory of Open Access Journals (Sweden)

    Minal S Kale

    Full Text Available Low health literacy is associated with low adherence to self-management in many chronic diseases. Additionally, health beliefs are thought to be determinants of self-management behaviors. In this study we sought to determine the association, if any, of health literacy and health beliefs among elderly individuals with COPD.We enrolled a cohort of patients with COPD from two academic urban settings in New York, NY and Chicago, IL. Health literacy was measured using the Short Test of Functional Health Literacy in Adults. Using the framework of the Self-Regulation Model, illness and medication beliefs were measured with the Brief Illness Perception Questionnaire (B-IPQ and Beliefs about Medications Questionnaire (BMQ. Unadjusted analyses, with corresponding Cohen's d effect sizes, and multiple logistic regression were used to assess the relationships between HL and illness and medication beliefs.We enrolled 235 participants, 29% of whom had low health literacy. Patients with low health literacy were more likely to belong to a racial minority group (p<0.001, not be married (p = 0.006, and to have lower income (p<0.001 or education (p<0.001. In unadjusted analyses, patients with low health literacy were less likely to believe they will always have COPD (p = 0.003, Cohen's d = 0.42, and were more likely to be concerned about their illness ((p = 0.04, Cohen's d = 0.17. In analyses adjusted for sociodemographic factors and other health beliefs, patients with low health literacy were less likely to believe that they will always have COPD (odds ratio [OR]: 0.78, 95% confidence interval [CI]: 0.65-0.94. In addition, the association of low health literacy with expressed concern about medications remained significant (OR: 1.20, 95% CI: 1.05-1.37 though the association of low health literacy with belief in the necessity of medications was no longer significant (OR: 0.92, 95% CI: 0.82-1.04.In this cohort of urban individuals with COPD, low health literacy was

  14. [Medical diagnosis of pain between myth and reality--chronic lower back pain, as an illness of upright walking].

    Science.gov (United States)

    Albrecht, H

    2001-10-01

    Chronic therapy-resistant low back pain is a major problem in medical care. In Germany there are many millions concerned, and the treatment expenses range at the top. Many of these patients underwent non-successful operations at the vertebral column and suffered a long-lasting odyssey of therapies before they are treated psychosomatically for the first time. Chronic low back pain is a disease including social, psychological as well as physiological aspects, and not only a problem of bones, muscles, or intervertebral disks. The problem is similar to that of fibromyalgia. On the basis of 9,000 case reports obtained during psychosomatic orthopedic treatment, character structures, unsolved problems of life and repressed emotional disturbances such as anger, jealousy, fear, and mourning could be identified as major psychosomatic risk factors for chronic low back pain. There is a high coincidence with other psychosomatically influenced diseases such as gastric and duodenal ulcera, asthma bronchiale, migraine with depressions, anxiety disorders, character neuroses, and narcissistic and other structural disturbances of the self. Exclusively somatic treatments without considering the existential situation and psychological methods hold the danger of a symptom shifting. The inpatient treatment from 9 a.m. to 5 p.m. ('Tagesklinik') with a combination of medical, physiotherapeutic and psychotherapeutic methods promotes a social training that counteracts the increasing constrictions in the accustomed life surroundings caused by low back pain. Chronic low back pain is an 'illness of the upright walk' in an anthropological, ethical sense. Considering low back pain as a strictly somatic disease is a modern myth of a medical treatment without existential understanding of human illness. It provokes failure of treatment and an enhancement of treatment cost. Copyright 2001 S. Karger GmbH, Freiburg

  15. Medical adherence and childhood chronic illness: family daily management skills and emotional climate as emerging contributors.

    Science.gov (United States)

    Fiese, Barbara H; Everhart, Robin S

    2006-10-01

    To describe recent research that examines family factors that promote or derail adherence to medical regimens for children with chronic health conditions, primarily asthma, diabetes, and cystic fibrosis. From the past 2 years, eight correlational studies were identified which specifically examined the links between family management strategies, family climate and medical adherence. Findings from the studies suggest that team-based management strategies and cohesive family climate promote adherence to medical treatments over time. Family interactions that are characterized by conflict and disengagement tend to disrupt adherence and inevitably cause a decline in child health. Moreover, these findings seem to be moderated by child age in that poorer adherence often occurs when a child reaches adolescence and is searching for greater autonomy. Future research should consider the challenges in measuring medical adherence in the family context as well as incorporating more naturalistic studies of family interactions. Randomized controlled trials using family-based interventions may consider focusing on medical adherence as an important mediator between family process and child health outcomes.

  16. EFFECTS OF RELIGIOUS VERSUS STANDARD COGNITIVE-BEHAVIORAL THERAPY ON OPTIMISM IN PERSONS WITH MAJOR DEPRESSION AND CHRONIC MEDICAL ILLNESS.

    Science.gov (United States)

    Koenig, Harold G; Pearce, Michelle J; Nelson, Bruce; Daher, Noha

    2015-11-01

    We compared the effectiveness of religiously integrated cognitive behavioral therapy (RCBT) versus standard CBT (SCBT) on increasing optimism in persons with major depressive disorder (MDD) and chronic medical illness. Participants aged 18-85 were randomized to either RCBT (n = 65) or SCBT (n = 67) to receive ten 50-min sessions remotely (94% by telephone) over 12 weeks. Optimism was assessed at baseline, 12 and 24 weeks by the Life Orientation Test-Revised. Religiosity was assessed at baseline using a 29-item scale composed of religious importance, individual religious practices, intrinsic religiosity, and daily spiritual experiences. Mixed effects growth curve models were used to compare the effects of treatment group on trajectory of change in optimism. In the intention-to-treat analysis, both RCBT and SCBT increased optimism over time, although there was no significant difference between treatment groups (B = -0.75, SE = 0.57, t = -1.33, P = .185). Analyses in the highly religious and in the per protocol analysis indicated similar results. Higher baseline religiosity predicted an increase in optimism over time (B = 0.07, SE = 0.02, t = 4.12, P optimism predicted a faster decline in depressive symptoms over time (B = -0.61, SE = 0.10, t = -6.30, P optimism in persons with MDD and chronic medical illness. While baseline religiosity does not moderate this effect, religiosity predicts increases in optimism over time independent of treatment group. © 2015 Wiley Periodicals, Inc.

  17. Chronic conditions, fluid states: chronicity and the anthropology of illness

    National Research Council Canada - National Science Library

    Manderson, Lenore; Smith-Morris, Carolyn

    2010-01-01

    .... Breaking new ground in medical anthropology by challenging the chronic/acute divide in illness and disease, the editors, along with a group of rising scholars and some of the most influential minds...

  18. Self-management of chronic illness: the role of 'habit' versus reflective factors in exercise and medication adherence.

    Science.gov (United States)

    Phillips, L Alison; Cohen, Joshua; Burns, Edith; Abrams, Jessica; Renninger, Steffi

    2016-12-01

    Non-adherence to health behaviors required for chronic illness self-management is pervasive. Advancing health-behavior theory to include behavioral initiation and maintenance factors, including reflective (e.g., belief- and feedback-based) and automatic (e.g., habit-based) mechanisms of adherence to different treatment-related behaviors could improve non-adherence prediction and intervention efforts. To test behavioral initiation and maintenance factors from an extended common sense self-regulation theoretical framework for predicting medication adherence and physical activity among patients with Type 2 diabetes. Patients (n = 133) in an in-person (n = 80) or online (n = 53) version of the study reported treatment-related (1) barriers, (2) beliefs and experiential feedback (reflective mechanisms of treatment-initiation and short-term repetition), and (3) habit strength (automatic mechanism of treatment-maintenance) for taking medication and engaging in regular physical activity at baseline. Behaviors were assessed via self-reports (n = 133) and objectively (electronic monitoring pill bottles, accelerometers; n = 80) in the subsequent month. Treatment-specific barriers and habit strength predicted self-reported and objective adherence for both behaviors. Beliefs were inconsistently related to behavior, even when habits were "weak". Experiential feedback from behavior was not related to adherence. Among patients with Type 2 diabetes diagnosis, medication and physical activity adherence were better predicted by their degree of automatic behavioral repetition than their beliefs/experiences with the treatment-actions. Habit strength should be an intervention target for chronic illness self-management; assessing it in practice settings may effectively detect non-adherence to existing treatment-regimens. However, future research and further refining of CS-SRM theory regarding the processes required for such habit development are needed.

  19. Religious versus Conventional Psychotherapy for Major Depression in Patients with Chronic Medical Illness: Rationale, Methods, and Preliminary Results

    Directory of Open Access Journals (Sweden)

    Harold G. Koenig

    2012-01-01

    Full Text Available This paper (1 reviews the physical and religious barriers to CBT that disabled medically ill-depressed patients face, (2 discusses research on the relationship between religion and depression-induced physiological changes, (3 describes an ongoing randomized clinical trial of religious versus secular CBT in chronically ill patients with mild-to-moderate major depression designed to (a overcome physical and religious barriers to CBT and (b compare the efficacy of religious versus secular CBT in relieving depression and improving immune and endocrine functions, and (4 presents preliminary results that illustrate the technical difficulties that have been encountered in implementing this trial. CBT is being delivered remotely via instant messaging, telephone, or Skype, and Christian, Jewish, Muslim, Buddhist, and Hindu versions of religious CBT are being developed. The preliminary results described here are particular to the technologies employed in this study and are not results from the CBT clinical trial whose findings will be published in the future after the study ends and data are analyzed. The ultimate goal is to determine if a psychotherapy delivered remotely that integrates patients’ religious resources improves depression more quickly than a therapy that ignores them, and whether religious CBT is more effective than conventional CBT in reversing depression-induced physiological changes.

  20. Use of medications by people with chronic fatigue syndrome and healthy persons: a population-based study of fatiguing illness in Georgia.

    Science.gov (United States)

    Boneva, Roumiana S; Lin, Jin-Mann S; Maloney, Elizabeth M; Jones, James F; Reeves, William C

    2009-07-20

    Chronic fatigue syndrome (CFS) is a debilitating condition of unknown etiology and no definitive pharmacotherapy. Patients are usually prescribed symptomatic treatment or self-medicate. We evaluated prescription and non-prescription drug use among persons with CFS in Georgia and compared it to that in non-fatigued Well controls and also to chronically Unwell individuals not fully meeting criteria for CFS. A population-based, case-control study. To identify persons with possible CFS-like illness and controls, we conducted a random-digit dialing telephone screening of 19,807 Georgia residents, followed by a detailed telephone interview of 5,630 to identify subjects with CFS-like illness, other chronically Unwell, and Well subjects. All those with CFS-like illness (n = 469), a random sample of chronically Unwell subjects (n = 505), and Well individuals (n = 641) who were age-, sex-, race-, and geographically matched to those with CFS-like illness were invited for a clinical evaluation and 783 participated (48% overall response rate). Clinical evaluation identified 113 persons with CFS, 264 Unwell subjects with insufficient symptoms for CFS (named ISF), and 124 Well controls; the remaining 280 subjects had exclusionary medical or psychiatric conditions, and 2 subjects could not be classified. Subjects were asked to bring all medications taken in the past 2 weeks to the clinic where a research nurse viewed and recorded the name and the dose of each medication. More than 90% of persons with CFS used at least one drug or supplement within the preceding two weeks. Among users, people with CFS used an average of 5.8 drugs or supplements, compared to 4.1 by ISF and 3.7 by Well controls. Persons with CFS were significantly more likely to use antidepressants, sedatives, muscle relaxants, and anti-acids than either Well controls or the ISF group. In addition, persons with CFS were significantly more likely to use pain-relievers, anti-histamines and cold/sinus medications than

  1. Mechanisms in Chronic Multisympton Illnesses

    Science.gov (United States)

    2007-10-01

    total hip arthroplasty : an outcome measure of hip osteoarthritis? J Rheumatol 1999;26: 855–61. 3506 BINGHAM ET AL 53. Adami S, Pavelka K, Cline GA...have recruited 125 new subjects. This brings our total number of subjects for the Registry to 504. We have continued to schedule and screen...accepted with revisions . 13 Title: Mechanisms in Chronic Multisymptom Illnesses PI: Clauw *Petrou M, Harris RE, Foerster BR, Mclean SA, Sen A

  2. Psychodynamics in medically ill patients.

    Science.gov (United States)

    Nash, Sara Siris; Kent, Laura K; Muskin, Philip R

    2009-01-01

    This article explores the role of psychodynamics as it applies to the understanding and treatment of medically ill patients in the consultation-liaison psychiatry setting. It provides historical background that spans the eras from Antiquity (Hippocrates and Galen) to nineteenth-century studies of hysteria (Charcot, Janet, and Freud) and into the twentieth century (Flanders Dunbar, Alexander, Engle, and the DSM). The article then discusses the effects of personality on medical illness, treatment, and patients' ability to cope by reviewing the works of Bibring, Kahana, and others. The important contribution of attachment theory is reviewed as it pertains the patient-physician relationship and the health behavior of physically ill patients. A discussion of conversion disorder is offered as an example of psychodynamics in action. This article highlights the important impact of countertransference, especially in terms of how it relates to patients who are extremely difficult and "hateful," and explores the dynamics surrounding the topic of physician-assisted suicide, as it pertains to the understanding of a patient's request to die. Some attention is also given to the challenges surrounding the unique experience of residents learning how to treat medically ill patients on the consultation-liaison service. Ultimately, this article concludes that the use and understanding of psychodynamics and psychodynamic theory allows consultation-liaison psychiatrists the opportunity to interpret the life narratives of medically ill patients in a meaningful way that contributes importantly to treatment.

  3. A Narrative: Meditation In The Lives Of Children With Chronic Illness

    Directory of Open Access Journals (Sweden)

    Taunya WIDEMAN-JOHNSTON

    2012-07-01

    Full Text Available The presence of chronic illness in ones life often entails endless appointments, tests, medications, treatments, and procedures. In the instances of children with chronic illness, they do not know what life consists of without their illness, and consequently, have lived with many restrictions. Children with chronic illness and their families are not only in need of traditional methods and strategies from the medical model but are often in need of additional strategies to support and cope with the nature and effects of the chronic illness. This paper focuses on how mediation, mindfulness, and visualization strategies aid individuals with chronic illness.

  4. Illness Identity in Adults with a Chronic Illness.

    Science.gov (United States)

    Oris, Leen; Luyckx, Koen; Rassart, Jessica; Goubert, Liesbet; Goossens, Eva; Apers, Silke; Arat, Seher; Vandenberghe, Joris; Westhovens, René; Moons, Philip

    2018-02-21

    The present study examines the concept of illness identity, the degree to which a chronic illness is integrated into one's identity, in adults with a chronic illness by validating a new self-report questionnaire, the Illness Identity Questionnaire (IIQ). Self-report questionnaires on illness identity, psychological, and physical functioning were assessed in two samples: adults with congenital heart disease (22-78 year old; n = 276) and with multisystem connective tissue disorders (systemic lupus erythematosus or systemic sclerosis; 17-81 year old; n = 241). The IIQ could differentiate four illness identity states (i.e., engulfment, rejection, acceptance, and enrichment) in both samples, based on exploratory and confirmatory factor analysis. All four subscales proved to be reliable. Rejection and engulfment were related to maladaptive psychological and physical functioning, whereas acceptance and enrichment were related to adaptive psychological and physical functioning. The present findings underscore the importance of the concept of illness identity. The IIQ, a self-report questionnaire, is introduced to measure four different illness identity states in adults with a chronic illness.

  5. Chronic illness and poverty in The Netherlands

    NARCIS (Netherlands)

    van Agt, H. M. E.; Stronks, K.; Mackenbach, J. P.

    2000-01-01

    Background: The actual financial situation of chronically ill people is not known. Methods: A postal questionnaire was conducted among a sample of the non-institutionalised population (4,206 respondents). Results: Fourteen percent of chronically ill people were found to be poor as compared to 5% of

  6. Mind-Body Approaches and Chronic Illness: Status of Research

    Science.gov (United States)

    Riccio, Cynthia A.; Pliego, Jessica; Rae, William A.

    2016-01-01

    An increasing number of children experience chronic health issues that affect their academic and behavioral functioning, as well as psychological well-being. At the same time, psychological stress can exacerbate the chronic illness. The first line of treatment most often is medical (e.g., pharmacology, surgery, radiation). Even when the medical…

  7. Reducing medical students' stigmatization of people with chronic mental illness: a field intervention at the "living museum" state hospital art studio.

    Science.gov (United States)

    Cutler, Janis L; Harding, Kelli J; Hutner, Lucy A; Cortland, Clarissa; Graham, Mark J

    2012-05-01

    The authors designed an intervention to reduce beginning medical students' stigmatization of people with chronic mental illness (CMI). Pre-clinical medical students visited a state psychiatric facility's "Living Museum," a combination patient art studio/display space, as the intervention. During the visit, students interacted with artist-guides who showed their work and discussed their experiences creating art. Students completed a self-assessment survey developed to measure attitudes and feelings toward people with CMI after half of the class visited the Living Museum, constituting a Visit/No-Visit cross-sectional comparison. Students who visited the Living Museum (N=64), as compared with those who did not visit (N=110), endorsed more positive attitudes toward people with CMI. Among the students who visited, however, those who reported having spoken individually with a patient-artist (N=44), paradoxically, indicated less-positive feelings toward people with CMI. An intervention in which pre-clinical medical students visited patient-artist guides in an art-studio setting generally improved students' attitudes toward people with CMI. Thus, nontraditional psychiatric settings offer a valuable adjunct to more traditional clinical settings to reduce stigma when introducing medical students to the field of psychiatry.

  8. Depression in medically ill patients.

    Science.gov (United States)

    Rackley, Sandra; Bostwick, J Michael

    2012-03-01

    In medically ill patients, given the many entities the phenotype of depression may represent, clinicians must be prepared to cast their diagnostic nets widely, not settling for the obvious but frequently incorrect choice of major depressive episode and throwing antidepressants at it willy nilly. Having chosen the correct diagnosis from among a broad differential of depression “look-alikes,” clinicians can draw upon a broad swath of treatment modalities including medications, psychotherapy, social supports, and spiritual interventions. Working as a psychiatrist in the medical arena requires the curiosity and analytic skills of a detective and the breadth of knowledge of a polymath adapting therapeutic tools from across the biopsychosociospiritual spectrum to the specific needs of the patient.

  9. Benefits of Medical Home Care Reaching Beyond Chronically Ill Teens: Exploring Parent Health-Related Quality of Life.

    Science.gov (United States)

    Chavez, Laura J; Grannis, Connor; Dolce, Millie; Chisolm, Deena J

    2018-03-15

    Caring for teens with special health care needs places physical and mental health burdens on parents, which can be exacerbated by the stresses of transitions to independence. Medical homes can improve teen transitions to greater self-management and reduce health care-related time and financial burdens for families. We examined the association between parent-reported teen medical home status and caregiver health-related quality of life (HRQOL). The study sample included parents or caregivers of teens with special health care needs aged 15 to 18 recruited from a pediatric Medicaid accountable care organization who participated in a survey (response rate, 40.5%). The primary outcome was parent HRQOL scores (0-100 points) measured using the Pediatric Quality of Life Inventory Family Impact Module. Medical home status was based on parent report of teen's health care meeting medical home criteria. Linear regression models were used to estimate HRQOL scores, adjusted for demographic characteristics, health literacy, and teen functional limitation. Among 488 parents, 27% reported their teen received care consistent with a medical home. Adjusted parent HRQOL scores were significantly higher among those whose teens had a medical home (74.40; 95% confidence interval, 71.31-77.48), relative to those whose teens did not (65.78; 95% confidence interval, 63.92-67.65). Medical home subscale analyses showed HRQOL scores had significant positive associations with family-centered care and coordinated care, but not other subscales. Teen medical home status was positively associated with caregiver HRQOL, suggesting that the medical home may benefit overall caregiver well-being. In particular, receiving care that was family centered and coordinated appeared to be the most beneficial. Copyright © 2018 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

  10. [Health insurance discount contracts: problems and risks for the general practitioner in the medical care of patients with chronic illness].

    Science.gov (United States)

    Leutgeb, R; Mahler, C; Laux, G; Weschnetz, Artenetz; Szecsenyi, J

    2009-01-01

    The German federal Health Insurance law to strengthen competition between the pharmaceutical companies commits pharmacies to hand out drugs from discount contract drug suppliers of a patient's health insurance company. Thus patients are confronted with constantly changing drug packets. This study aimed at exploring whether patients have been properly informed about the new discount contracts and if they have experienced changes and problems in their long- term medications. Between May and June 2008 male and female patients older than 50 years who had a statutory health insurance and had been diagnosed with coronary heart disease for at least one year answered a standardized questionnaire filled in by doctors' assistants or general practitioners in the doctors' network "Weschnitztal". Of the 188 patients participated in this study 63,8% were informed about health insurance discount contracts. 31,3% of the patients reported that a positive effect due to the discount contracts was that they were discharged from paying the drug prescription fee, 22,2% mentioned that cost saving for the health insurance could also be positive. 120 patients (63,8%) knew that the names of their long-term drugs could change.101 of the questioned patients (53,7%) identified a change in their long-term drugs, 51,5% felt insecure about the permanent changes. 21,7% experienced adverse e effects due to the new drugs. 19% of the patients had serious problems regarding medication intake. This study demonstrates that the information which patients have on the new health insurance law is not adequate enough. Many of them felt insecure because of the changes of long-term medications. One fifth of the patients reported errors in their drug intake or their confusion about their drugs. There is a high risk that these circumstances may trigger further diseases or complications. The cost savings as intended by the health insurance companies may therefore not be achieved by discount contracts.

  11. A basic residency curriculum concerning the chronically mentally ill.

    Science.gov (United States)

    Faulkner, L R; Cutler, D L; Krohn, D D; Factor, R M; Goldfinger, S M; Goldman, C R; Lamb, H R; Lefley, H; Minkoff, K; Schwartz, S R

    1989-10-01

    In this paper a group of knowledgeable individuals with expertise in psychiatric education present their recommendations for a basic psychiatric residency curriculum concerning the chronically mentally ill. The proposed curriculum consists of knowledge, skill, and attitude educational objectives, as well as clinical experiences, faculty supervision, didactics and seminars, and evaluation mechanisms. Recommendations are also made concerning changes in the Accreditation Council for Graduate Medical Education's Special Requirements for Residency Training in Psychiatry, which would require residency programs to place more emphasis on training to meet the needs of the chronically mentally ill. Obstacles to the implementation of the proposed recommendations are presented and possible solutions are discussed.

  12. Chronic Pain Among Homeless Persons with Mental Illness.

    Science.gov (United States)

    Vogel, Marc; Frank, Anastasia; Choi, Fiona; Strehlau, Verena; Nikoo, Nooshin; Nikoo, Mohammadali; Hwang, Stephen W; Somers, Julian; Krausz, Michael R; Schütz, Christian G

    2017-12-01

    Chronic pain is an important public health issue. However, characteristics and needs of marginalized populations have received limited attention. Studies on prevalence and correlates of chronic pain among homeless persons are lacking. We assessed chronic pain among homeless persons with mental illness in the At Home/Chez Soi study. Cross-sectional data from a randomized controlled trial on homelessness and mental health. Data collected between 2009 and 2013 in three Canadian cities. One thousand two hundred eighty-seven homeless persons with mental illness. Data on chronic pain and utilization of prescribed and nonprescribed interventions was assessed using a chronic pain screening instrument. Mental illness was diagnosed with the Mini-International Neuropsychiatric Interview. Forty-three percent reported moderate to severe chronic pain, interfering with general daily activities (80%), sleep (78%), and social interactions (61%). Multivariate analysis indicated that increasing age and diagnoses of major depressive disorder, mood disorder with psychotic features, panic disorder, and post-traumatic stress disorder (PTSD) were independent predictors of chronic pain. Chronic pain was further associated with increased suicidality. Among participants reporting chronic pain, 64% had sought medical treatment and 56% treated pain with prescribed drugs, while 38% used illicit drugs for pain relief. Chronic pain is very common among homeless persons with mental illness and affects activities of daily living. Clinicians treating this population should be aware of the common connections between chronic pain, depression, panic disorder, PTSD, and substance use. While the data indicate the contribution of chronic pain to complex treatment needs, they also indicate a clear treatment gap. © 2017 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. Approaches to self-management in chronic illness.

    Science.gov (United States)

    Novak, Marta; Costantini, Lucia; Schneider, Sabrina; Beanlands, Heather

    2013-01-01

    Management of a chronic medical condition is a complex process and requires coordinated action between healthcare providers and patients. This process is further complicated by the fact that an increasing number of patients suffer from multiple chronic conditions. Self-management involves active participation of the patients in the everyday care of the symptoms of their illness(es) and medical treatments, as well as maintaining general health and prevention of progression of medical conditions. Managing the psychosocial consequences of illness is also an important component of self-management. Data have demonstrated that enhancing self-management improves quality of life, coping, symptom management, disability, and reduces healthcare expenditures and service utilization. To foster self-management, potential barriers to implementation as well as facilitators and supports for this approach must be acknowledged. In this article, we review various aspects of self-management in chronic illness, focusing on chronic kidney disease. Better understanding of these concepts will facilitate patient-provider collaboration, improve patient care with increased patient and staff satisfaction, and may ultimately result in better clinical outcomes and enhanced quality of life for both the patients and their families. © 2013 Wiley Periodicals, Inc.

  14. Quality of life and affective well-being in middle-aged and older people with chronic medical illnesses: a cross-sectional population based study.

    Directory of Open Access Journals (Sweden)

    Anna Wikman

    2011-04-01

    Full Text Available There has been considerable research into the impact of chronic illness on health-related quality of life. However, few studies have assessed the impact of different chronic conditions on general quality of life (QOL. The objective of this paper was to compare general (rather than health-related QOL and affective well-being in middle aged and older people across eight chronic illnesses.This population-based, cross-sectional study involved 11,523 individuals aged 50 years and older, taking part in wave 1 of the English Longitudinal Study of Ageing. General QOL was assessed using the CASP-19, happiness was evaluated using two items drawn from the GHQ-12, and depression was measured with the CES-D. Analysis of covariance and logistic regression, adjusting for age, gender and wealth, were performed. General QOL was most impaired in people with stroke (mean 37.56, CI 36.73-38.39, and least in those reporting cancer (mean 41.78, CI 41.12-42.44, respectively, compared with no illness (mean 44.15, CI 43.92-44.39. Stroke (mean 3.65, CI 3.58-3.73 was also associated with the greatest reduction in positive well-being whereas diabetes (mean 3.81, CI 3.76-3.86 and cancer were least affected (3.85, CI 3.79-3.91, compared with no illness (mean 3.97, CI 3.95-4.00. Depression was significantly elevated in all conditions, but was most common in chronic lung disease (OR 3.04, CI 2.56-3.61, with more modest elevations in those with osteoarthritis (OR 2.08, CI 1.84-2.34 or cancer (OR 2.07, CI 1.69-2.54. Multiple co-morbidities were associated with greater decrements in QOL and affective well-being.The presence of chronic illness is associated with impairments in broader aspects of QOL and affective well-being, but different conditions vary in their impact. Further longitudinal work is needed to establish the temporal links between chronic illness and impairments in QOL and affective well-being.

  15. Comorbid medical illness in bipolar disorder.

    Science.gov (United States)

    Forty, Liz; Ulanova, Anna; Jones, Lisa; Jones, Ian; Gordon-Smith, Katherine; Fraser, Christine; Farmer, Anne; McGuffin, Peter; Lewis, Cathryn M; Hosang, Georgina M; Rivera, Margarita; Craddock, Nick

    2014-12-01

    Individuals with a mental health disorder appear to be at increased risk of medical illness. To examine rates of medical illnesses in patients with bipolar disorder (n = 1720) and to examine the clinical course of the bipolar illness according to lifetime medical illness burden. Participants recruited within the UK were asked about the lifetime occurrence of 20 medical illnesses, interviewed using the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and diagnosed according to DSM-IV criteria. We found significantly increased rates of several medical illnesses in our bipolar sample. A high medical illness burden was associated with a history of anxiety disorder, rapid cycling mood episodes, suicide attempts and mood episodes with a typically acute onset. Bipolar disorder is associated with high rates of medical illness. This comorbidity needs to be taken into account by services in order to improve outcomes for patients with bipolar disorder and also in research investigating the aetiology of affective disorder where shared biological pathways may play a role. Royal College of Psychiatrists.

  16. Psychological and Spiritual Factors in Chronic Illness.

    Science.gov (United States)

    Leifer, Ron

    1996-01-01

    Asserts the importance of psychological and spiritual factors in the treatment of chronic illness. Discusses the inevitably of sickness, old age, and death, as well as the presence of the physician, patience, pain, and hope. Maintains that reflection on these qualities can benefit both the physician and patient. (MJP)

  17. Coping with Chronic Illness in Childhood and Adolescence

    Science.gov (United States)

    Compas, Bruce E.; Jaser, Sarah S.; Dunn, Madeleine J.; Rodriguez, Erin M.

    2012-01-01

    Chronic illnesses and medical conditions present millions of children and adolescents with significant stress that is associated with risk for emotional and behavioral problems and interferes with adherence to treatment regimens. We review research on the role of child and adolescent coping with stress as an important feature of the process of adaptation to illness. Recent findings support a control-based model of coping that includes primary control or active coping (efforts to act on the source of stress or one’s emotions), secondary control or accommodative coping (efforts to adapt to the source of stress), and disengagement or passive coping (efforts to avoid or deny the stressor). Evidence suggests the efficacy of secondary control coping in successful adaptation to chronic illness in children and adolescents, disengagement coping is associated with poorer adjustment, and findings for primary control coping are mixed. Avenues for future research are highlighted. PMID:22224836

  18. Sleep quality in patients with chronic illness.

    Science.gov (United States)

    Kemple, Mary; O'Toole, Sinead; O'Toole, Conor

    2016-11-01

    To explore sleep quality in patients with chronic illness in primary care. Many people suffer from chronic illness with the numbers increasing. One common issue arises from problems that people have with their quality of sleep: a largely under-researched topic. This study exploring poor quality sleep allowed patients to describe their daily struggles with poor sleep in their own lives. This allowed the development of a deeper understanding of what it means to sleep poorly and find out how participants cope with not sleeping well. A qualitative approach enabling a deep exploration of patient's experiences of sleep quality was used. Interviews were conducted with a purposive sample of nine participants from a primary care clinic. Analysis utilised an interpretative approach. Data analysed produced four recurrent themes that were grouped into two categories. First, themes that identified the recognition by participants that 'something was wrong' were abrupt beginning and impact on their life. Second, themes that identified that the participants considered there was 'nothing wrong' were I am fine and I just carry on. Data revealed that poor quality sleep can have a profound effect on quality of life. Participants lived without good quality sleep for years. They had come to accept two seemingly irreconcilable ideas that not being able to sleep is an enduring problem with a distinct starting point, and paradoxically, this is not a problem that deserves much professional attention. Important original data were generated on the impact of poor quality sleep indicating that chronically disturbed sleep can increase the disease burden on patients with chronic illness. The results of this study suggest healthcare professionals need to understand how sleep quality issues impact on patient's experience of chronic illness. Data from this study will help nurses and other health professionals to deepen their understanding of the profound impact of poor quality sleep on patients with

  19. Economic hardship associated with managing chronic illness: a qualitative inquiry

    Directory of Open Access Journals (Sweden)

    Jan Stephen

    2009-10-01

    Full Text Available Abstract Background Chronic illness and disability can have damaging, even catastrophic, socioeconomic effects on individuals and their households. We examined the experiences of people affected by chronic heart failure, complicated diabetes and chronic obstructive pulmonary disease to inform patient centred policy development. This paper provides a first level, qualitative understanding of the economic impact of chronic illness. Methods Interviews were conducted with patients aged between 45 and 85 years who had one or more of the index conditions and family carers from the Australian Capital Territory and Western Sydney, Australia (n = 66. Content analysis guided the interpretation of data. Results The affordability of medical treatments and care required to manage illness were identified as the key aspects of economic hardship, which compromised patients' capacity to proactively engage in self-management and risk reduction behaviours. Factors exacerbating hardship included ineligibility for government support, co-morbidity, health service flexibility, and health literacy. Participants who were on multiple medications, from culturally and linguistically diverse or Indigenous backgrounds, and/or not in paid employment, experienced economic hardship more harshly and their management of chronic illness was jeopardised as a consequence. Economic hardship was felt among not only those ineligible for government financial supports but also those receiving subsidies that were insufficient to meet the costs of managing long-term illness over and above necessary daily living expenses. Conclusion This research provides insights into the economic stressors associated with managing chronic illness, demonstrating that economic hardship requires households to make difficult decisions between care and basic living expenses. These decisions may cause less than optimal health outcomes and increased costs to the health system. The findings support the necessity

  20. Economic hardship associated with managing chronic illness: a qualitative inquiry.

    Science.gov (United States)

    Jeon, Yun-Hee; Essue, Beverley; Jan, Stephen; Wells, Robert; Whitworth, Judith A

    2009-10-09

    Chronic illness and disability can have damaging, even catastrophic, socioeconomic effects on individuals and their households. We examined the experiences of people affected by chronic heart failure, complicated diabetes and chronic obstructive pulmonary disease to inform patient centred policy development. This paper provides a first level, qualitative understanding of the economic impact of chronic illness. Interviews were conducted with patients aged between 45 and 85 years who had one or more of the index conditions and family carers from the Australian Capital Territory and Western Sydney, Australia (n = 66). Content analysis guided the interpretation of data. The affordability of medical treatments and care required to manage illness were identified as the key aspects of economic hardship, which compromised patients' capacity to proactively engage in self-management and risk reduction behaviours. Factors exacerbating hardship included ineligibility for government support, co-morbidity, health service flexibility, and health literacy. Participants who were on multiple medications, from culturally and linguistically diverse or Indigenous backgrounds, and/or not in paid employment, experienced economic hardship more harshly and their management of chronic illness was jeopardised as a consequence. Economic hardship was felt among not only those ineligible for government financial supports but also those receiving subsidies that were insufficient to meet the costs of managing long-term illness over and above necessary daily living expenses. This research provides insights into the economic stressors associated with managing chronic illness, demonstrating that economic hardship requires households to make difficult decisions between care and basic living expenses. These decisions may cause less than optimal health outcomes and increased costs to the health system. The findings support the necessity of a critical analysis of health, social and welfare policies to

  1. Normalizing fibromyalgia as a chronic illness.

    Science.gov (United States)

    Clauw, Daniel J; D'Arcy, Yvonne; Gebke, Kevin; Semel, David; Pauer, Lynne; Jones, Kim D

    2018-01-01

    Fibromyalgia (FM) is a complex chronic disease that affects 3-10% of the general adult population and is principally characterized by widespread pain, and is often associated with disrupted sleep, fatigue, and comorbidities, among other symptoms. There are many gaps in our knowledge of FM, such that, compared with other chronic illnesses including diabetes, rheumatoid arthritis, and asthma, it is far behind in terms of provider understanding and therapeutic approaches. The experience that healthcare professionals (HCPs) historically gained in developing approaches to manage and treat patients with these chronic illnesses may help show how they can address similar problems in patients with FM. In this review, we examine some of the issues around the management and treatment of FM, and discuss how HCPs can implement appropriate strategies for the benefit of patients with FM. These issues include understanding that FM is a legitimate condition, the benefits of prompt diagnosis, use of non-drug and pharmacotherapies, patient and HCP education, watchful waiting, and assessing patients by FM domain so as not to focus exclusively on one symptom to the detriment of others. Developing successful approaches is of particular importance for HCPs in the primary care setting who are in the ideal position to provide long-term care for patients with FM. In this way, FM may be normalized as a chronic illness to the benefit of both patients and HCPs.

  2. The Relationship of Chronic Medical Illnesses, Poor Health-Related Lifestyle Choices, and Health Care Utilization to Recovery Status in Borderline Patients over a Decade of Prospective Follow-up

    Science.gov (United States)

    Keuroghlian, Alex S.; Frankenburg, Frances R.; Zanarini, Mary C.

    2013-01-01

    Background The interaction of borderline personality disorder (BPD) with physical health has not been well characterized. In this longitudinal study, we investigated the long-term relationship of chronic medical illnesses, health-related lifestyle choices, and health services utilization to recovery status in borderline patients over a decade of prospective follow-up. Method 264 borderline patients were interviewed concerning their physical health at 6-year follow-up in a longitudinal study of the course of BPD. This sample was then reinterviewed five times at two-year intervals over the next ten years. We defined recovery from BPD based on a Global Assessment of Functioning score of 61 or higher, which required BPD remission, one close relationship, and full-time competent and consistent work or school attendance. We controlled for potentially confounding effects of time-varying major depressive disorder. Results Never-recovered borderline patients were significantly more likely than ever-recovered borderline patients to have a medical syndrome, obesity, osteoarthritis, diabetes, urinary incontinence, or multiple medical conditions (p borderline patients were significantly more likely than ever-recovered borderline patients to undergo a medical emergency room visit, medical hospitalization, X-ray, CT scan, or MRI scan (p < 0.0063). Conclusions Over a decade of prospective follow-up, failure to recover from BPD seems to be associated with a heightened risk of chronic medical illnesses, poor health-related lifestyle choices, and costly health services utilization. PMID:23856083

  3. Cost-of-illness of chronic leg ulcers in Germany.

    Science.gov (United States)

    Purwins, Sandra; Herberger, Katharina; Debus, Eike Sebastian; Rustenbach, Stephan J; Pelzer, Peter; Rabe, Eberhard; Schäfer, Elmar; Stadler, Rudolf; Augustin, Matthias

    2010-04-01

    Chronic wounds are important because of their frequency, their chronicity and high costs of treatment. However, there are few primary data on the cost-of-illness in Germany. The aim was to determine the cost-of-illness of venous leg ulcers (VLU) in Germany. Prospective cost-of-illness study was performed in 23 specialised wound centres throughout Germany. Direct, medical, non medical and indirect costs to the patient, statutory health insurers and society were documented. Thereover, health-related quality of life (QoL) was recorded as intangible costs using the Freiburg quality of life assessment for wounds (FLQA-w, Augustin). A total of 218 patients (62.1% female) were recruited consecutively. Mean age was 69.8 +/- 12.0 years. The mean total cost of the ulcer per year and patient was 9569 euros, [8658.10 euros (92%) direct and 911.20 euros (8%) indirect costs]. Of the direct costs, 7630.70 euros was accounted for by the statutory health insurance and 1027.40 euros by the patient. Major cost factors were inpatient costs, outpatient care and non drug treatments. QoL was strikingly reduced in most patients. In Germany, VLU are associated with high direct and indirect costs. As a consequence, there is a need for early and qualified disease management. Deeper-going cost-of-illness-studies and cost-benefit analyses are necessary if management of chronic wounds is to be improved.

  4. Systematic review of character development and childhood chronic illness.

    Science.gov (United States)

    Maslow, Gary R; Hill, Sherika N

    2016-05-08

    To review empirical evidence on character development among youth with chronic illnesses. A systematic literature review was conducted using PubMed and PSYCHINFO from inception until November 2013 to find quantitative studies that measured character strengths among youth with chronic illnesses. Inclusion criteria were limited to English language studies examining constructs of character development among adolescents or young adults aged 13-24 years with a childhood-onset chronic medical condition. A librarian at Duke University Medical Center Library assisted with the development of the mesh search term. Two researchers independently reviewed relevant titles (n = 549), then abstracts (n = 45), and finally manuscripts (n = 3). There is a lack of empirical research on character development and childhood-onset chronic medical conditions. Three studies were identified that used different measures of character based on moral themes. One study examined moral reasoning among deaf adolescents using Kohlberg's Moral Judgement Instrument; another, investigated moral values of adolescent cancer survivors with the Values In Action Classification of Strengths. A third study evaluated moral behavior among young adult survivors of burn injury utilizing the Tennessee Self-Concept, 2(nd) edition. The studies observed that youth with chronic conditions reasoned at less advanced stages and had a lower moral self-concept compared to referent populations, but that they did differ on character virtues and strengths when matched with healthy peers for age, sex, and race/ethnicity. Yet, generalizations could not be drawn regarding character development of youth with chronic medical conditions because the studies were too divergent from each other and biased from study design limitations. Future empirical studies should learn from the strengths and weaknesses of the existing literature on character development among youth with chronic medical conditions.

  5. Older Adults’ Perception of Chronic Illness Management in South Korea

    Directory of Open Access Journals (Sweden)

    Minah Kang

    2014-07-01

    Full Text Available Objectives: Despite the recent emphasis on a patient-centered chronic care model, few studies have investigated its use in older adults in South Korea. We explored how older Korean adults perceive and cope with their chronic illness. Methods: We conducted focus group interviews in Seoul, Korea in January 2010. Focus groups were formed by disease type (hypertension and type 2 diabetes and gender using purposive sampling. Inclusion criteria were patients aged 60 and over who had been diagnosed with diabetes or hypertension and received care at a community health center for at least six months prior to participation. Interview data were analyzed through descriptive content analysis. Results: Among personal factors, most participants felt overwhelmed when they received their diagnosis. However, with time and control of their acute symptoms using medication, their worry diminished and participants tended to denying being identified as a patient or sick person. Among socio-familial factors, participants reported experiencing stigma with their chronic illness and feeling it was a symbol of weakness. Instead of modifying their lifestyles, which might interfere with their social relationships, they resorted to only following their medicine regime prescribed by their doctor. Participants also reported feeling that their doctor only prescribed medications and acted in an authoritative and threatening manner to induce and reinforce participants’ compliance with treatment. Conclusions: For successful patient-centered management of chronic illnesses, supportive environments that include family, friends, and healthcare providers should be established.

  6. The relationship between chronic illness, chronic pain, and socioeconomic factors in the ED.

    Science.gov (United States)

    Hanley, Owen; Miner, James; Rockswold, Erik; Biros, Michelle

    2011-03-01

    The study aimed to determine the prevalence of chronic illness and chronic pain in emergency department (ED) patients across demographic backgrounds. This was a cross-sectional study at an urban, level I trauma center with 98,000 annual visits. This was a prospective sample of adult patients presenting to the ED during a randomized distribution of daily 8-hour periods between June 4 and August 26, 2007. Prevalence of chronic illness was compared to subject demographics using logistic regression, and prevalence of chronic pain was compared using ordinal logistic regression. Six thousand nine hundred sixty-one patients presented during the data collection periods; 3882 were eligible, and 3132 (82%) were enrolled (51.7% male; age, 41.1 ± 15.8 years; range, 18-98 years). Chronic illness was reported in 36.3% of patients and chronic pain in 34.9% of patients. Chronic illness was associated with homelessness (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.17-2.61), family income less than $25,000 (OR, 2.27; 95% CI, 1.60-3.22), and lack of access to primary care facilities (OR, 2.68; 95% CI, 2.25-3.21). Chronic pain was associated with homelessness (OR, 2.56; 95% CI, 1.79-3.64), family income less than $25,000 (OR, 2.54; 95% CI, 1.91-3.39), and lack of access to primary care facilities (OR, 1.47; 95% CI, 1.26-1.70). Patient housing situation, family income, and perceived access to primary care medical facilities were associated with higher self-reported rates of chronic illness and chronic pain. Copyright © 2011 Elsevier Inc. All rights reserved.

  7. Prospectively surveying health-related quality of life and symptom relief in a lot-based sample of medical cannabis-using patients in urban Washington State reveals managed chronic illness and debility.

    Science.gov (United States)

    Aggarwal, S K; Carter, G T; Sullivan, M D; Zumbrunnen, C; Morrill, R; Mayer, J D

    2013-09-01

    To characterize health-related quality of life (HRQoL) in medical cannabis patients. Short Form 36 (SF-36) Physical Health Component Score and Mental Health Component Score (MCS) surveys as well has CDC (Centers for Disease Control) HRQoL-14 surveys were completed by 37 qualified patients. Mean SF-36 PCS and MCS, normalized at 50, were 37.4 and 44.2, respectively. Eighty percent of participants reported activity/functional limitations secondary to impairments or health problems. Patients reported using medical cannabis to treat a wide array of symptoms across multiple body systems with relief ratings consistently in the 7-10/10 range. The HRQoL results in this sample of medical cannabis-using patients are comparable with published norms in other chronically ill populations. Data presented provide insight into medical cannabis-using patients' self-rated health, HRQoL, disease incidences, and cannabis-related symptom relief.

  8. Labour participation of the chronically ill: a profile sketch.

    NARCIS (Netherlands)

    Baanders, A.N.; Rijken, P.M.; Peters, L.

    2002-01-01

    To improve our understanding of the problematic labour market position of people with a chronic disease, this paper describes the participation rates of several subgroups of the chronically ill in the Netherlands, as well as the aspects by which the working chronically ill differ from those who are

  9. Attributions about cause of illness in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Hoth, Karin F; Wamboldt, Frederick S; Bowler, Russell; Make, Barry; Holm, Kristen E

    2011-05-01

    Patients' beliefs about the causes of their illness have been associated with emotional adjustment and behavioral outcomes in several medical conditions; however, few studies have examined illness attributions among patients with chronic obstructive pulmonary disease (COPD). In the current study, patterns of patients' causal attributions for COPD were identified and examined in relation to health behaviors and symptoms. Three-hundred and ninety-four patients with COPD and >10 pack year history of smoking completed a self-report questionnaire that included the Illness Perception Questionnaire-Revised (IPQ-R). A factor analysis of the IPQ-R cause items using principal axis factoring yielded four individual items (i.e., smoking, heredity, pollution, and personal behavior) and one large factor that was primarily driven by psychological attributions. Ninety-three percent of patients agreed or strongly agreed that smoking was a cause of their COPD. Higher scores on the large IPQ-R factor were associated with reduced quality of life (r=.25, PIPQ-R in other chronic illness populations. This difference may be due to the importance of smoking, environmental exposures, and heredity in the development of COPD. Future research should expand upon these specific attributions in COPD. Copyright © 2010 Elsevier Inc. All rights reserved.

  10. [Chronic illnesses and education. Diabetes mellitus as a paradigm].

    Science.gov (United States)

    Viniegra-Velázquez, Leonardo

    2006-01-01

    The purpose of this essay is to controvert ideas that prevail about chronic illnesses, using type 2 diabetes mellitus as an example, and to propose another way of thinking, perceiving, and acting towards them. Initially the dominant vision of the disease as a deviation from the health path is confronted with another one that considers it as a specific way of being of certain groups of persons. It brings out how the idea of deviation, when favoring the technical aspects of medical practice, often compares the organism with a machine. On the other hand, the idea of disease as a way of being when rescuing the most distinctive qualities of life, allows a more penetrating understanding of the patient and his illness. Trying to overcome the limitations that the notion of natural history of disease impose, the concept of cultural history of disease is proposed, showing how culture has a determining role in the expression of illnesses. The role and type of education within the strategies of health care in chronic diseases are discussed. Participatory education--particularly in the therapeutic communities of patients--is proposed as the most powerful resource to bring the patient closer to better life circumstances and healthier habits that allow the self-control of the illness.

  11. Medication adherence for patients with mental illness.

    Science.gov (United States)

    Varshney, Upkar; Vetter, Ron

    2012-01-01

    Medication adherence has been studied for some time; however most research has focused on able-bodied patients or the elderly living independently. What has not been studied nearly as much is medication adherence for people with psychiatric or mental illnesses. In this paper, we present a framework that includes the specific challenges in medication adherence for patients with mental illness, algorithms and protocols for evaluating adherence, and some on-going work in developing effective solutions. The architectural framework and associated algorithms leverage the context-aware computing capabilities available on many mobile devices. The system is designed to be able to collect and offer situation-aware information on medication use and adherence for healthcare professionals and other designated persons.

  12. [Chronic illness from the perspective of patients and health professionals: a qualitative study in Mexico].

    Science.gov (United States)

    Mercado-Martínez, Francisco J; Hernández-Ibarra, Eduardo

    2007-09-01

    Chronic diseases are leading causes of morbidity, mortality, and increasing expenditures in numerous countries. However, little is known about how chronic diseases are perceived and managed by social actors. This article aims to compare the perspectives of health professionals and patients towards chronic diseases, besides analyzing the relationship between these two groups. A qualitative, multi-center study was conducted in three Mexican cities: Guadalajara, San Luis Potosí, and Mexico City. Participants included chronically ill individuals, physicians, and other health professionals from primary and secondary health care centers. Data collection used focus groups and interviews. The data were analyzed using discourse analysis. Participants' perceptions varied, from the medicalized view of physicians to that of patients focused on illness and the lifeworld. The participants agreed that there are unequal relationships between health professionals, families, and the chronically ill, but that relationships are more equal among the chronically ill themselves. The article includes by discussing various implications of the findings.

  13. Loneliness and Quality of Life in Chronically Ill Rural Older Adults

    Science.gov (United States)

    Theeke, Laurie A.; Mallow, Jennifer

    2015-01-01

    Background Loneliness is a contributing factor to various health problems in older adults, including complex chronic illness, functional decline, and increased risk of mortality. Objectives A pilot study was conducted to learn more about the prevalence of loneliness in rural older adults with chronic illness and how it affects their quality of life. The purposes of the data analysis reported here were twofold: to describe loneliness, chronic illness diagnoses, chronic illness control measures, prescription medication use, and quality of life in a sample of rural older adults; and to examine the relationships among these elements. Methods A convenience sample of 60 chronically ill older adults who were community dwelling and living in Appalachia was assessed during face-to-face interviews for loneliness and quality of life, using the University of California, Los Angeles (UCLA) Loneliness Scale (version 3) and the CASP-12 quality of life scale. Chronic illness diagnoses, chronic illness control measures, and medication use data were collected through review of participants’ electronic medical records. Results Overall mean loneliness scores indicated significant loneliness. Participants with a mood disorder such as anxiety or depression had the highest mean loneliness scores, followed by those with lung disease and those with heart disease. Furthermore, participants with mood disorders, lung disease, or heart disease had significantly higher loneliness scores than those without these conditions. Loneliness was significantly related to total number of chronic illnesses and use of benzodiazepines. Use of benzodiazepines, diuretics, nitrates, and bronchodilators were each associated with a lower quality of life. Conclusions Nurses should assess for loneliness as part of their comprehensive assessment of patients with chronic illness. Further research is needed to design and test interventions for loneliness. PMID:23958674

  14. Fever in the critically ill medical patient.

    Science.gov (United States)

    Laupland, Kevin B

    2009-07-01

    Fever, commonly defined by a temperature of >or=38.3 degrees C (101 degrees F), occurs in approximately one half of patients admitted to intensive care units. Fever may be attributed to both infectious and noninfectious causes, and its development in critically ill adult medical patients is associated with an increased risk for death. Although it is widespread and clinically accepted practice to therapeutically lower temperature in patients with hyperthermic syndromes, patients with marked hyperpyrexia, and selected populations such as those with neurologic impairment, it is controversial whether most medical patients with moderate degrees of fever should be treated with antipyretic or direct cooling therapies. Although treatment of fever may improve patient comfort and reduce metabolic demand, fever is a normal adaptive response to infection and its suppression is potentially harmful. Clinical trials specifically comparing fever management strategies in neurologically intact critically ill medical patients are needed.

  15. Validity of the Greek version of the PHQ 15-item Somatic Symptom Severity Scale in patients with chronic medical conditions and correlations with emergency department use and illness perceptions.

    Science.gov (United States)

    Hyphantis, Thomas; Kroenke, Kurt; Papatheodorou, Eugenia; Paika, Vassiliki; Theocharopoulos, Nicholaos; Ninou, Aggeliki; Tomenson, Barbara; Carvalho, Andre F; Guthrie, Elspeth

    2014-11-01

    The PHQ-15 is a brief measure assessing the severity of somatic symptoms and is widely used in different health care settings. We aimed to assess the psychometric properties of its Greek version in patients with chronic physical illnesses seeking urgent or unscheduled care in the Accident and Emergency Department (AED). The PHQ-15 was translated into Greek using back-translation, and it was administered to 303 patients with diabetes, COPD and rheumatic diseases visiting our AED during a one-year period. Patients were interviewed with the MINI. Depressive (PHQ-9) and somatization symptoms (SCL-12), illness perceptions (B-IPQ) and health-related quality of life (WHOQOL-BREF) were also assessed to test criterion and concurrent validity. The Greek version of the PHQ-15 showed acceptable internal consistency. Convergent validity was established by the strong associations observed between PHQ-15 scores and functional status, depressive symptom severity and AED visits during the previous year. PHQ-15 scores were also associated with the patients' concerns about personal and treatment illness's control and their beliefs regarding the number of bodily symptoms attributed to their illness (illness identity). The highly acceptable convergent and discriminant validity of the five individual bodily symptoms assessed by both the PHQ-15 and SCL-12 is a further construct validity indicator. The present findings support the applicability of the Greek version of PHQ-15 in assessing common somatic symptoms either medically explained or unexplained in patients seeking care in the AED, further confirming that it can be considered suitable for use in a broad range of populations in clinical research. Copyright © 2014 Elsevier Inc. All rights reserved.

  16. Illness Uncertainty and Illness Intrusiveness as Predictors of Depressive and Anxious Symptomology in College Students with Chronic Illnesses

    Science.gov (United States)

    Mullins, Alexandria J.; Gamwell, Kaitlyn L.; Sharkey, Christina M.; Bakula, Dana M.; Tackett, Alayna P.; Suorsa, Kristina I.; Chaney, John M.; Mullins, Larry L.

    2017-01-01

    Objective: To examine predictors of psychological functioning in college students with chronic illnesses. Participants: Participants (N = 1413) included 364 students with self-reported diagnoses of asthma or allergies, 148 students with other chronic illnesses (eg, epilepsy, type 1 diabetes), and 901 healthy students. Data were collected between…

  17. Peer interaction in adolescents with a chronic illness

    NARCIS (Netherlands)

    Meijer, SA; Sinnema, G; Bijstra, JO; Mellenbergh, GJ; Wolters, WHG

    2000-01-01

    This study examined behavioural, cognitive and affective aspects of peer interaction of adolescents with a chronic illness. The aim of the study was twofold: (1) describe peer interaction of adolescents with a chronic illness in comparison with norms of healthy adolescents; (2) examine the

  18. Health Care Hassles of Caregivers to the Chronically Ill

    Science.gov (United States)

    Keith, Pat M.

    2009-01-01

    This research investigated variables that influenced hassles with the health care system among 320 informal caregivers of the chronically ill. Caregivers of the chronically ill usually have considerable contact with the health care system. The research shifted the focus from strain in the caregiver-recipient dyad to hassles with the health care…

  19. Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases

    NARCIS (Netherlands)

    Evers, A. W.; Kraaimaat, F. W.; van Lankveld, W.; Jongen, P. J.; Jacobs, J. W.; Bijlsma, J. W.

    2001-01-01

    The literature on chronic diseases recognizes the role of illness cognition as a mediator between stress and illness. Few conceptualizations and instruments, however, give an indication of both unfavorable and favorable ways of adjusting to an uncontrollable long-term stressor, such as a chronic

  20. Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases.

    NARCIS (Netherlands)

    Evers, A.W.M.; Kraaimaat, F.W.; Lankveld, W.G.J.M. van; Jongen, P.J.H.; Jacobs, J.W.; Bijlsma, J.W.J.

    2001-01-01

    The literature on chronic diseases recognizes the role of illness cognition as a mediator between stress and illness. Few conceptualizations and instruments, however, give an indication of both unfavorable and favorable ways of adjusting to an uncontrollable long-term stressor, such as a chronic

  1. Chronically ill employees in the context of organizational culture

    NARCIS (Netherlands)

    Kopnina, Helen; Haafkens, Joke

    2009-01-01

    In this article, the differences in implementation of policies in relation to chronically ill employees are discussed in the context of organizational culture. It appears that an appropriate organizational culture is required to be able to take measures to retain chronically ill employees. Various

  2. Self-management and support needs of chronically ill people

    NARCIS (Netherlands)

    van Houtum, L.

    2016-01-01

    Over the past decade, self-management by patients has been recognized an important aspect of chronic illness care, as it can help avoid preventable mortality and morbidity and improve the quality of life of patients and their families. However, not all people with a chronic illness are able to

  3. Close relationship and chronic illness : The interrelations between illness perceptions and social support

    NARCIS (Netherlands)

    Salewski, Christel; Vollmann, Manja

    2014-01-01

    The aims of this study were (1) to explore the degree of concordance/discordance between the illness perceptions of patients with a chronic illness and those of their partners, and (2) to examine the relationship between the concordance/discordance of couples’ illness perceptions and social support

  4. Integrated and consumer-directed care: a necessary paradigm shift for rural chronic ill health.

    Science.gov (United States)

    Ranson, Nicole E; Terry, Daniel R; Glenister, Kristen; Adam, Bill R; Wright, Julian

    2016-01-01

    Chronic ill health has recently emerged as the most important health issue on a global scale. Rural communities are disproportionally affected by chronic ill health. Many health systems are centred on the management of acute conditions and are often poorly equipped to deal with chronic ill health. Cardiovascular disease (CVD) is one of the most prominent chronic ill health conditions and the principal cause of mortality worldwide. In this paper, CVD is used as an example to demonstrate the disparity between rural and urban experience of chronic ill health, access to medical care and clinical outcomes. Advances have been made to address chronic ill health through improving self-management strategies, health literacy and access to medical services. However, given the higher incidence of chronic health conditions and poorer clinical outcomes in rural communities, it is imperative that integrated health care emphasises greater collaboration between services. It is also vital that rural GPs are better supported to work with their patients, and that they use consumer-directed approaches to empower patients to direct and coordinate their own care.

  5. Management of chronic illness: voices of rural women.

    Science.gov (United States)

    Sullivan, Therese; Weinert, Clarann; Cudney, Shirley

    2003-12-01

    The prevalence and cost of chronic illness globally and in the United States of America continue to escalate and the day-to-day management of these conditions presents a major challenge. The burden of chronic illness disproportionately affects vulnerable populations such as women and those living in rural areas. To add to the knowledge base of illness management by chronically ill rural women through examining their individual perceptions of the illness experience. The Women to Women project provided a nursing research-based computer intervention model for conducting support groups, providing health education, and fostering self-care, via personal computers and evaluated its effect on the women's psychosocial health. Fatigue and pain were the major physical symptoms that impacted the women's quality of life, with depression and stress being the primary emotions they experienced. The characteristics of humour, hope, and courage were key in their successful adaptation to living with chronic illness. The women's voices relate how they manage their illness responses and adaptation mechanisms. The data provide nurses with information to heighten their sensitivity to clients' day-to-day needs and experiences. It will assist them in their designing and planning of interventions that will enable clients to adapt and to have the best quality of life possible within the limitations of their chronic illnesses. The data are also important to nurses involved in rural research and theory development concerning self-management and adaptation to chronic illnesses.

  6. Methylphenidate for Treatment of Depressive Symptoms, Apathy, and Fatigue in Medically Ill Older Adults and Terminally Ill Adults

    Science.gov (United States)

    Hardy, Susan E.

    2009-01-01

    Background Depressive symptoms, apathy, and fatigue are common symptoms among medically ill older adults and patients with advanced disease, and are associated with morbidity and mortality. Methylphenidate has been used to treat these symptoms because of its rapid effect. Objective To review the literature regarding the efficacy and safety of methylphenidate to treat depressive symptoms, apathy, and fatigue in medically ill older adults and in palliative care. Methods English-language articles presenting systematic reviews, clinical trials, or case series describing use of methylphenidate to treat depressive symptoms, fatigue, or apathy in medically ill older adults or in palliative care were identified. The keywords “methylphenidate” and either “depressive”, “depression”, “fatigue”, or “apathy” were used to search the Cochrane Database, MEDLINE, PsycINFO, and International Pharmaceutical Abstracts. Included articles addressed depressive symptoms, apathy, or fatigue in 1) older adults (generally age 65 years or older), particularly those with comorbid medical illness; 2) adult patients receiving palliative care; and 3) adults with other chronic illnesses. We excluded articles regarding 1) treatment of depression in healthy young adults; 2) treatment of bipolar disorder or attention-deficit hyperactivity disorder; and 3) treatment of narcolepsy, chronic fatigue syndrome and related disorders. Results 19 controlled trials of methylphenidate in medically ill older adults or in palliative care were identified. Unfortunately, their conflicting results, small size, and poor methodologic quality limit our ability to draw inferences regarding the efficacy of methylphenidate, although the evidence of its safety is stronger. The available evidence suggests possible effectiveness of methylphenidate for depressive symptoms, fatigue, apathy, and cognitive slowing in various medically ill populations. Conclusions In the absence of definitive evidence of

  7. Chronic illness in the workplace: stigma, identity threat and strain.

    Science.gov (United States)

    McGonagle, Alyssa K; Barnes-Farrell, Janet L

    2014-10-01

    Chronic illness affects a large and growing number of workers in the United States and globally. Stigmatization (devaluation) at work based on chronic illness may be stressful for individuals and therefore may lead to negative psychological consequences (i.e. strains). In order to better understand stressful experiences of stigma for workers with chronic illnesses, a model of stigma-related identity threat (perceptions that one is at risk of being treated negatively at work because of chronic illness) was tested on a sample of 203 working adults with chronic illnesses. The following variables related to workers' perceptions of chronic illness-related identity threat: workers' boundary flexibility (flexibility in managing their work and life), their meta-perceptions of devaluation (perceptions of others' devaluation of them based on illness) and their job self-efficacy (feelings of confidence related to performing their job). In turn, perceptions of identity threat related to both feelings of psychological strain and (lower levels of) perceived work ability. Surprisingly, neither stigma centrality (how fundamental illness is to one's identity) nor supervisor support related to workers' identity threat perceptions. Copyright © 2013 John Wiley & Sons, Ltd.

  8. Cultural expressions of bodily awareness among chronically ill Filipino Americans.

    Science.gov (United States)

    Becker, Gay

    2003-01-01

    To describe Filipino Americans' cultural traditions surrounding bodily awareness, especially how the principle of balance informs their views, and the link to self-management of chronic illness. This qualitative study used semistructured interviews with 85 Filipino Americans between the ages of 46 and 97 years. Volunteers were recruited from numerous health care sites in 1 geographic location in the United States. Respondents had 1 or more chronic illnesses. Taped and transcribed interviews were coded and evaluated for themes. The concept of balance was central to Filipino Americans' portrayal of bodily awareness of signs and symptoms related to chronic illnesses, as well as to actions they took to manage their chronic illnesses. Efforts were made to control chronic illnesses through a variety of self-care practices. Diet posed a particular challenge because of the symbolic importance of food in Filipino culture and its use in the maintenance of social relationships. The ways in which Filipino Americans combine attention to the body, values of balance and harmony, and emphasis on social well-being result in heightened attention to bodily processes. Filipino Americans' emphasis on bodily awareness suggests that this particular cultural strength can be used to enhance chronic illness management. Awareness of the cultural traditions of Filipino Americans can facilitate patient education about how to manage chronic illnesses.

  9. Psychosocial characteristics of chronically ill child

    OpenAIRE

    Tomažič, Tjaša

    2016-01-01

    In this thesis, I would like to draw attention to the impact of long-term illness and prolonged hospitalization on the life of the ill child and his family. The effects of the illness are often overlooked and people do not receive the assistance they need to deal with it. In the theoretical part of the thesis, I define the term »long-term« illness and I pay attention to different strategies to cope with it. I indicate signs that show the presence of consequences of the long-term illness and p...

  10. A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness

    OpenAIRE

    Kreyenbuhl, Julie; Leith, Jaclyn; Medoff, Deborah R.; Fang, LiJuan; Dickerson, Faith B.; Brown, Clayton H.; Goldberg, Richard W.; Potts, Wendy; Dixon, Lisa B.

    2011-01-01

    Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication manage...

  11. Return Migration among Elderly, Chronically Ill Bosnian Refugees

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Olwig, Karen Fog; Bygbjerg, Ib Christian

    2015-01-01

    Elderly migrants constitute a considerable share of global return migration; nevertheless, literature on the health aspects of the return migration among these migrants is still scarce. This study explores the significance of return migration among elderly, chronically ill Bosnian refugees from...... Denmark and the role of health issues in their decision to return. It is based on semi-structured interviews with 33 elderly, chronically ill Bosnian refugees who have moved back to Bosnia and Herzegovina, and 10 elderly, chronically ill Bosnian refugees who have remained in Denmark. The interviews show...

  12. An intelligent partner system for improving chronic illness care

    Directory of Open Access Journals (Sweden)

    Tibor Deutsch

    2003-02-01

    Full Text Available Chronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS, which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care.

  13. Perceived quality of chronic illness care is associated with self-management: Results of a nationwide study in the Netherlands.

    Science.gov (United States)

    van Houtum, L; Heijmans, M; Rijken, M; Groenewegen, P

    2016-04-01

    Healthcare providers are increasingly expected to help chronically ill patients understand their own central role in managing their illness. The aim of this study was to determine whether experiencing high-quality chronic illness care and having a nurse involved in their care relate to chronically ill people's self-management. Survey data from 699 people diagnosed with chronic diseases who participated in a nationwide Dutch panel-study were analysed using linear regression analysis, to estimate the association between chronic illness care and various aspects of patients' self-management, while controlling for their socio-demographic and illness characteristics. Chronically ill patients reported that the care they received was of high quality to some extent. Patients who had contact with a practise nurse or specialised nurse perceived the quality of the care they received as better than patients who only had contact with a GP or medical specialist. Patients' perceptions of the quality of care were positively related to all aspects of their self-management, whereas contact with a practise nurse or specialised nurse in itself was not. Chronically ill patients who have the experience to receive high-quality chronic illness care that focusses on patient activation, decision support, goal setting, problem solving, and coordination of care are better self-managers. Having a nurse involved in their care seems to be positively valued by chronically ill patients, but does not automatically imply better self-management. Copyright © 2016. Published by Elsevier Ireland Ltd.

  14. Association between nutritional status and subjective health status in chronically ill children attending special schools.

    Science.gov (United States)

    Joosten, Koen; van der Velde, Kelly; Joosten, Pieter; Rutten, Hans; Hulst, Jessie; Dulfer, Karolijn

    2016-04-01

    In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the association between nutritional status and subjective health status in chronically ill children attending special schools. Overall, 642 children, median age 9.8 years (IQR 7.7-11.5), 60 % male, 72 % Caucasian, were included in this prospective study in nine special schools for chronically ill children in the Netherlands. Overall malnutrition was assessed as: acute malnutrition (nutritional risk-screening tool STRONGkids. Subjective health status was assessed with EQ-5D. Overall, 16 % of the children had overall malnutrition: 3 % acute and 13 % chronic malnutrition. Nurses reported 'some/severe problems' on the health status dimensions mobility (15 %), self-care (17 %), usual activities (19 %), pain/discomfort (22 %), and anxiety/depression (22 %) in chronically ill children. Their mean visual analogue scale score (VAS) was 73.0 (SD 11.1). Malnutrition, medication usage, and younger age explained 38 % of the variance of the VAS score. The presence of overall malnutrition in chronically ill children attending special schools was associated with lower subjective health status, especially in younger children and in those with chronic medication usage. Therefore, it is important to develop and use profile-screening tools to identify these children.

  15. Living as a family in the midst of chronic illness.

    Science.gov (United States)

    Årestedt, Liselott; Persson, Carina; Benzein, Eva

    2014-03-01

    The aim of the study was to illuminate the meaning of lived experience of living as a family in the midst of chronic illness. Chronic illness implies a change for both the individual and the family. In this changed situation, all family members seem to benefit from sharing experiences and receiving support. Current research highlights the individual patient's or family member's perspectives on chronic illness, but family systems nursing (FSN) studies are warranted. A qualitative design with a FSN approach was chosen. Repeated qualitative narrative interviews with seven families living with chronic illness were performed. A phenomenological hermeneutic analysis, inspired by Ricoeur, was used to interpret the data. The phenomenon can be described as an ongoing movement towards well-being. The results included two themes and five sub-themes. The first theme was 'Co-creating a context for living with illness' with the subthemes; 'learning to live with the expressions of illness' and 'communicating the illness within and outside the family'. The second theme was 'Co-creating alternative ways for everyday life' with the subthemes; 'adapting to a new life rhythm', 'altering relationships' and 'changing roles and tasks in the family'. Living as a family in the midst of chronic illness can be described as an ongoing process where the family members co-create a context for living with illness. They also co-create a context for alternative ways of everyday life. Knowledge about lived experience of living as a family in the midst of chronic illness can help nurses to adopt a FSN care perspective. This can increase the chances of taking advantage of the ways family members manage situations together, as well as highlight resources within the family. © 2013 The Authors Scandinavian Journal of Caring Sciences © 2013 Nordic College of Caring Science.

  16. Nutrition support and the chronic critical illness syndrome.

    Science.gov (United States)

    Hollander, Jason M; Mechanick, Jeffrey I

    2006-12-01

    Critical illness can be viewed as consisting of 4 distinct stages: (1) acute critical illness (ACI), (2) prolonged acute critical illness, (3) chronic critical illness, and (4) recovery. ACI represents the evolutionarily programmed response to a stressor. In ACI, substrate is shunted away from anabolism and toward vital organ support and inflammatory proteins. Nutrition support in this stage is unproven and may ultimately prove detrimental. As critical illness progresses, there is no evolutionary precedent, and man owes his life to modern critical care medicine. It is at this point that nutrition and metabolic support become integral to the care of the patient. This paper (1) delineates and develops the 4 stages of critical illness using current evidence, clinical experience, and new hypotheses; (2) defines the chronic critical illness syndrome (CCIS); and (3) details an approach to the metabolic and nutrition support of the chronically critically ill patient using the metabolic model of critical illness as a guide. It is our hope that this clinical model can generate testable hypotheses that can improve the outcome of this unique population of patients.

  17. [Illness perception questionnaire (IPQ-r): an useful paradigm in chronic disease].

    Science.gov (United States)

    Trovato, Guglielmo M; Catalano, Daniela; Martines, Giuseppe Fabio; Spadaro, Davide; Garufi, Giuliana; Di Corrado, Donatella; Di Nuovo, Santo

    2006-03-01

    The Illness Perception Questionnaire (IPQr) is a validated psycho-social tool. Chronic illness out-patients, 48 women and 42 men, 61.36 +/- 14.55 yrs, showed a social stigma related to illness condition, even common and scarcely invalidating, more evident with a lower degree of instruction, associated to limited cognitive representation and to inappropriate control. Duration of illness directly influences perception of "chronicity"; age, instead, positively influences compliance and trust of patients. The study of illness perception, aimed to foresee, interprets and modifies behavioural patterns in health and disease, according to implicit and/or hidden personal and/or social theories, it can improve quality of clinical medical approach.

  18. Identity and psychological ownership in chronic illness and disease state.

    Science.gov (United States)

    Karnilowicz, W

    2011-03-01

    Psychological ownership is rarely considered in health discourse related to chronic illness or disease state. Construction of identity is an important consideration within this framework. This autoethnographic study explores psychological ownership and identity related to prostate cancer and chronic illness. Conclusions about the nature of psychological ownership and identity were gathered from the relevant literature and personal experience. Themes include the patient-healthcare professional relationship and that psychological ownership is personal and grounded in an individual's sense of identity, control and perceived capacity to control illness or disease. Personal reflection through autoethnography guides discussion of psychological ownership and identity. © 2010 Blackwell Publishing Ltd.

  19. Illness perceptions and medication adherence in adolescents with ...

    African Journals Online (AJOL)

    They completed self-report questionnaires about their demographic and medical data, their illness perception using the Illness Perception Questionnaire-Revised (IPQ-R) and their medication adherence using the Medication Adherence Report Scale-5 (MARS5). The outcome of the analysis using the Pearson Product ...

  20. Impact of childhood chronic illnesses on siblings: a literature review.

    LENUS (Irish Health Repository)

    O' Brien, Irene

    2012-02-01

    BACKGROUND: Childhood illness can have a significant impact on families, particularly on the ill child\\'s siblings. There is a dearth of published literature focusing on the needs of siblings of ill children. AIM: This literature review aims to provide an overview of the current healthcare literature in relation to the impact of childhood chronic illness or disability on siblings. METHOD: A literature review was undertaken by searching the databases CINAHL, PsycINFO, ProQuest and Cochrane Library for relevant articles in English using the search terms: \\'siblings\\

  1. Return Migration among Elderly, Chronically Ill Bosnian Refugees

    DEFF Research Database (Denmark)

    Handlos, Line Neerup; Olwig, Karen Fog; Bygbjerg, Ib Christian

    2015-01-01

    Elderly migrants constitute a considerable share of global return migration; nevertheless, literature on the health aspects of the return migration among these migrants is still scarce. This study explores the significance of return migration among elderly, chronically ill Bosnian refugees from...... Denmark and the role of health issues in their decision to return. It is based on semi-structured interviews with 33 elderly, chronically ill Bosnian refugees who have moved back to Bosnia and Herzegovina, and 10 elderly, chronically ill Bosnian refugees who have remained in Denmark. The interviews show...... that physical health, in the sense of the absence of illness and easy access to necessary health-care services and medicines, was not highly prioritized when the decision was made whether or not to return. However, if health is regarded more broadly as involving more than mere physical health and the absence...

  2. Prevalence of chronic illnesses and characteristics of chronically ill informal caregivers of persons with dementia.

    Science.gov (United States)

    Wang, Xiao Rong; Robinson, Karen M; Carter-Harris, Lisa

    2014-01-01

    to examine the prevalence of and the link of chronic illnesses (CIs) to informal caregivers of persons with dementia (PWDs), as well as to identify characteristics of caregivers with CIs. the sample included 124 caregivers of PWDs from a caregiver programme of research. Sociodemographic information and caregivers CIs were collected by an in-person interview. Descriptive statistics, t-tests, chi-square analysis and binary logistic regressions were performed for data analysis. approximately 81.5% (n = 101) of caregivers reported having at least one CI, 60.5% (n = 75) reported two or more CIs. Caregivers with CIs were more likely to be older and unemployed; advanced age and female gender were risk factors for CIs. The link of CIs to caregivers was stronger in younger caregivers but weaker in older caregivers when compared with the general population. targeted interventions based on this study need to be developed to improve the health of caregivers of PWDs.

  3. Hypothalamic inflammation and food intake regulation during chronic illness

    NARCIS (Netherlands)

    Dwarkasing, J.T.; Marks, D.L.; Witkamp, R.F.; Norren, van K.

    2016-01-01

    Anorexia is a common symptom in chronic illness. It contributes to malnutrition and strongly affects survival and quality of life. A common denominator of many chronic diseases is an elevated inflammatory status, which is considered to play a pivotal role in the failure of food-intake regulating

  4. Psychological adjustment in young children with chronic medical conditions.

    Science.gov (United States)

    Immelt, Susan

    2006-10-01

    Children with chronic medical conditions are at higher risk for behavioral and emotional problems compared to physically healthy children. This study used a conceptual model to examine factors associated with psychological adjustment in children aged 7-11 years old with any of four chronic illnesses. The variables most closely associated with child adjustment included the following: mothers' evaluation of the impact of the child's illness on the family; child's perceptions of parental acceptance; and child's self-perceptions of physical appearance, social acceptance, and athletic competence. These findings confirm the importance of maternal and child perceptions in understanding the psychological adjustment of children with chronic conditions.

  5. Chronic mentally ill women: emergence and legitimation of program issues.

    Science.gov (United States)

    Bachrach, L L

    1985-10-01

    Program development for chronic mentally ill women is emerging in a climate where more general concerns relating to women's health and mental health are increasingly being examined. Although in the past the special needs of chronic mentally ill women have received scant attention in the professional literature, there is evidence today of a growing commitment to serving this population. The author traces the emergence and legitimation of three specific issues--homelessness, skills training, and family planning--that reflect the complexity of program development for this population. As specific issues in service delivery to chronic mentally ill women come to the fore and move toward relevant solutions, we may anticipate a sharpening of planning concepts. Both male and female chronic mental patients stand to benefit from these developments.

  6. A center for self-management of chronic illnesses in diverse groups.

    Science.gov (United States)

    Inouye, Jillian; Boland, Mary G; Nigg, Claudio R; Sullivan, Kathleen; Leake, Anne; Mark, Debra; Albright, Cheryl L

    2011-01-01

    Prevention and successful treatment of chronic disease require a scientific understanding of the impacts and interactions of ethnicity, culture, and illness on self-management interventions. This article presents one approach to developing effective methods to address the needs of ethnic minorities living with chronic illnesses. Described is the University of Hawaii Center for Ohana Self-Management of Chronic Illnesses (COSMCI) located in the School of Nursing & Dental Hygiene and funded by the National Institute of Nursing Research (Award Number P20NR010671). The interdisciplinary center focuses on family and community self-management interventions in ethnically diverse populations with chronic illnesses. Areas discussed are: 1) the operational structure for creating an environment conducive to interdisciplinary ohana self-management chronic illness research in ethnically diverse populations; and 2) the development of sustainable interdisciplinary, biobehavioral research capacity. The COSMCI uses a social cognitive theory framework to guide the application of established self-management interventions to Asian and Pacific Island populations (API) through three conceptually linked research projects on HIV infection, type 2 diabetes, and chronic obstructive pulmonary disease. COSMI addresses the feasibility of sharing of lessons learned among the approaches taken. The interdisciplinary nature of COSMCI increases the potential success of the intervention efforts. Hawaii Medical Journal Copyright 2010.

  7. Cost-of-illness of chronic hepatitis B infection in Vietnam

    NARCIS (Netherlands)

    Tu, H.A.T.; Riewpaiboon, A.; Woerdenbag, H.J.; Postma, M.J.; Li, S.C.

    2010-01-01

    OBJECTIVES: To quantify the financial burden of chronic hepatitis B (CHB) infection and its complications in a cost-of-illness study in Vietnam, a highly endemic country of hepatitis B virus (HBV) infection. METHODS: The study adopted the micro-costing approach. For direct medical cost estimation,

  8. La perspectiva de enfermos crónicos sobre la atención médica en Guadalajara, México. Un estudio cualitativo Perspectives of chronically ill patients concerning medical care in Guadalajara, Mexico. A qualitative study

    Directory of Open Access Journals (Sweden)

    Francisco J. Mercado Martínez

    2000-09-01

    ambivalent, and the rest as bad. These perspectives were closely linked to their disease experience and available medical options according to their material resources. These perspectives change with time, are specific to each available service and type of medical care, and are constructed in terms of all the subjects' present chronic illnesses. Those treated through the social security system evaluate the care in negative terms, with the opposite occurring with those treated in public health care centers and private facilities. Implications regarding health care reform are discussed.

  9. Visibility and invisibility in chronic illness

    NARCIS (Netherlands)

    Hoppe, S.

    2010-01-01

    Does the visibility of a condition necessarily lead to stigmatization? Is it easier to suffer from an invisible than a visible condition? And what are the consequences of living with an invisible or visible illness? In this article the author draws on the concepts of stigma and concealability to

  10. [Impact of chronic illness on hospital nursing workloads].

    Science.gov (United States)

    Vallés, S; Valdavida, E; Menéndez, C; Natal, C

    2018-01-10

    To evaluate the short-term impact of chronic illness in hospital units and to establish a method that allows nursing workloads to be adapted according to the care needs of patients. A descriptive study of the evolution of workloads of nursing staff associated with the care needs of patients between 1 July 2014 and 30 June 2016, in a county hospital. The care needs of the patients were assessed daily using an adaptation of the Montesinos scheme. The estimated times of nursing care and auxiliary nursing required by the patients, based on their level of dependence for time distribution, were based on the standards and recommendations of the Ministry of Health, Social Services and Equality. During the study period, there was a change in the patient care needs, with no increase in activity, which resulted in an increase in the nursing staffing needs of 1,396 theoretical hours per year. This increase implies an increase in the workforce of 5 nurses in the second period. In the study period, the needs for direct nursing care increased by 7%, this increase is not related to the increase in activity, but to the level of dependency of the patients with chronic diseases. This increase occurred in both medical and surgical units. Copyright © 2017 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.

  11. Skin disorders in chronic psychiatric illness

    NARCIS (Netherlands)

    Mookhoek, E. J.; van de Kerkhof, P. C. M.; Hovens, J. E. J. M.; Brouwers, J. R. B. J.; Loonen, A. J. M.

    2010-01-01

    Background Chronic psychiatric patients are prone to develop skin diseases. However, epidemiological data are scarce. Objective To describe the prevalence of skin complaints and dermatological disorders in residential psychiatric patients. Methods Ninety-one randomly chosen patients of the

  12. Collaborative decision-making and promoting treatment adherence in pediatric chronic illness

    Directory of Open Access Journals (Sweden)

    Dennis Drotar

    2010-03-01

    Full Text Available Dennis Drotar, Peggy Crawford, Margaret BonnerCincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USAAbstract: Collaborative or shared decision-making between health care providers and families can facilitate treatment adherence, health outcomes, and satisfaction with care in the management of pediatric chronic illness, but raises special challenges. Barriers such as authoritarian models of medical care as well as absence of time and opportunity for dialogue limit collaborative decision making and can disrupt treatment adherence. However, models of provider-family communication that emphasize communication and shared goal-setting inform an anticipatory guidance model of collaborative decision-making that can enhance treatment adherence. Salient challenges and strategies involved in implementing collaborative decision-making in pediatric chronic illness care are described. Research is needed to: 1 describe the communication and decision-making process in the management of pediatric chronic illness; and 2 evaluate the impact of interventions that enhance collaborative decision-making on provider-family communication, illness management, and treatment adherence.Keywords: collaborative decision-making, shared decision-making, treatment adherence, pediatric chronic illness

  13. Integration of Biosensors and Drug Delivery Technologies for Early Detection and Chronic Management of Illness

    Directory of Open Access Journals (Sweden)

    Viness Pillay

    2013-06-01

    Full Text Available Recent advances in biosensor design and sensing efficacy need to be amalgamated with research in responsive drug delivery systems for building superior health or illness regimes and ensuring good patient compliance. A variety of illnesses require continuous monitoring in order to have efficient illness intervention. Physicochemical changes in the body can signify the occurrence of an illness before it manifests. Even with the usage of sensors that allow diagnosis and prognosis of the illness, medical intervention still has its downfalls. Late detection of illness can reduce the efficacy of therapeutics. Furthermore, the conventional modes of treatment can cause side-effects such as tissue damage (chemotherapy and rhabdomyolysis and induce other forms of illness (hepatotoxicity. The use of drug delivery systems enables the lowering of side-effects with subsequent improvement in patient compliance. Chronic illnesses require continuous monitoring and medical intervention for efficient treatment to be achieved. Therefore, designing a responsive system that will reciprocate to the physicochemical changes may offer superior therapeutic activity. In this respect, integration of biosensors and drug delivery is a proficient approach and requires designing an implantable system that has a closed loop system. This offers regulation of the changes by means of releasing a therapeutic agent whenever illness biomarkers prevail. Proper selection of biomarkers is vital as this is key for diagnosis and a stimulation factor for responsive drug delivery. By detecting an illness before it manifests by means of biomarkers levels, therapeutic dosing would relate to the severity of such changes. In this review various biosensors and drug delivery systems are discussed in order to assess the challenges and future perspectives of integrating biosensors and drug delivery systems for detection and management of chronic illness.

  14. Integration of Biosensors and Drug Delivery Technologies for Early Detection and Chronic Management of Illness

    Science.gov (United States)

    Ngoepe, Mpho; Choonara, Yahya E.; Tyagi, Charu; Tomar, Lomas Kumar; du Toit, Lisa C.; Kumar, Pradeep; Ndesendo, Valence M. K.; Pillay, Viness

    2013-01-01

    Recent advances in biosensor design and sensing efficacy need to be amalgamated with research in responsive drug delivery systems for building superior health or illness regimes and ensuring good patient compliance. A variety of illnesses require continuous monitoring in order to have efficient illness intervention. Physicochemical changes in the body can signify the occurrence of an illness before it manifests. Even with the usage of sensors that allow diagnosis and prognosis of the illness, medical intervention still has its downfalls. Late detection of illness can reduce the efficacy of therapeutics. Furthermore, the conventional modes of treatment can cause side-effects such as tissue damage (chemotherapy and rhabdomyolysis) and induce other forms of illness (hepatotoxicity). The use of drug delivery systems enables the lowering of side-effects with subsequent improvement in patient compliance. Chronic illnesses require continuous monitoring and medical intervention for efficient treatment to be achieved. Therefore, designing a responsive system that will reciprocate to the physicochemical changes may offer superior therapeutic activity. In this respect, integration of biosensors and drug delivery is a proficient approach and requires designing an implantable system that has a closed loop system. This offers regulation of the changes by means of releasing a therapeutic agent whenever illness biomarkers prevail. Proper selection of biomarkers is vital as this is key for diagnosis and a stimulation factor for responsive drug delivery. By detecting an illness before it manifests by means of biomarkers levels, therapeutic dosing would relate to the severity of such changes. In this review various biosensors and drug delivery systems are discussed in order to assess the challenges and future perspectives of integrating biosensors and drug delivery systems for detection and management of chronic illness. PMID:23771157

  15. Coping with chronic illness: the mediating role of biographic and illness-related factors.

    Science.gov (United States)

    Viney, L L; Westbrook, M T

    1982-01-01

    The aim of this research was to examine the mediating roles played by a range of biographic and illness-related factors in preferences for strategies for coping with chronic illness. Chronically-ill patients assessed their own coping strategy preference by ranking six clusters of strategies. Information was also obtained about their demographic characteristics, life styles, illness roles, the degree of their disability, their perceived handicaps and their perceived achievement of their rehabilitation goals. Multiple regression analyses of each of these six sets of variables on each coping strategy were carried out to identify patterns of association between them. (1) Preferences for action strategies were found to be associated with patient-related factors (demographic characteristics, life style and illness role). (2) Control strategies were associated with illness-related factors (illness role, degree of disability, perceived handicap and achievement of rehabilitation goals). (3) Escape strategies were ranked higher by women than by men, sex being their only significant predictor. (4) Preferences for fatalism, unlike those for action strategies, were associated with relatively low social status and relatively little interpersonal involvement or social commitment. (5) Preferences for optimism were related only to patients' perceptions of their handicaps. (6) Interpersonal coping was not found to be associated with any of this wide range of biographic illness-related factors.

  16. Understanding the impact of chronic childhood illness on families.

    Science.gov (United States)

    Sabbeth, B

    1984-02-01

    A great deal has been written about mothers and their relationships with their ill children. Fathers, however, have been relatively excluded from the research, as they have been from many pediatrician-mother-child interactions. Although it has been noted that some fathers tend to withdraw from the family, in fact very little is known about the impact of childhood illness on their lives. In general, studies of mothers, fathers, siblings, marriage, and families emphasize psychopathology and other psychosocial problems. Yet, there is a growing awareness in the social sciences that we have much to learn from the capacity to adjust. How is it that some families of chronically ill children survive so well? This question has not been addressed. Most studies focus on individual constituents of the family. Minuchin and others have taught us about aberrant family systems that sometimes develop around chronically ill children. Such systems are characterized by high cohesion and conformity, and the absence of apparent friction. How frequently do such systems develop? How can they be prevented? Finally, understanding the impact of chronic childhood illness on families is a difficult task. Parents have reasons for obscuring the impact, and particularly their distress, from the view of their pediatrician. Physicians are often uncertain how much understanding they ought to offer. Careful attention to the parent-pediatrician relationship is essential to a thorough understanding of the impact of childhood illness on the family.

  17. Medication Overuse in Chronic Pain.

    Science.gov (United States)

    Hsu, Eric S

    2017-01-01

    Chronic pain is usually managed by various pharmacotherapies after exhausting the conservative modalities such as over-the-counter choices. The goal of this review is to investigate current state of opioids and non-opioid medication overuse that includes NSAIDs, skeletal muscle relaxants, antidepressants, membrane stabilization agents, and benzodiazepine. How to minimize medication overuse and achieve better outcome in chronic pain management? Although antidepressants and membrane stabilization agents contribute to the crucial components for neuromodulation, opioids were frequently designated as a rescue remedy in chronic pain since adjunct analgesics usually do not provide instantaneous relief. The updated CDC guideline for prescribing opioids has gained widespread attention via media exposure. Both patients and prescribers are alerted to respond to the opioid epidemic and numerous complications. However, there has been overuse of non-opioid adjunct analgesics that caused significant adverse effects in addition to concurrent opioid consumption. It is a common practice to extrapolate the WHO three-step analgesic ladder for cancer pain to apply in non-cancer pain that emphasizes solely on pharmacologic therapy which may result in overuse and escalation of opioids in non-cancer pain. There has been promising progress in non-pharmacologic therapies such as biofeedback, complementary, and alternative medicine to facilitate pain control instead of dependency on pharmacologic therapies. This review article presents the current state of medication overuse in chronic pain and proposes precaution to balance the risk and benefit ratio. It may serve as a premier for future study on clinical pathway for comprehensive chronic pain management and reduce medication overuse.

  18. Advance directives lessen the decisional burden of surrogate decision-making for the chronically critically ill.

    Science.gov (United States)

    Hickman, Ronald L; Pinto, Melissa D

    2014-03-01

    To identify the relationships between advance directive status, demographic characteristics and decisional burden (role stress and depressive symptoms) of surrogate decision-makers (SDMs) of patients with chronic critical illness. Although the prevalence of advance directives among Americans has increased, SDMs are ultimately responsible for complex medical decisions of the chronically critically ill patient. Decisional burden has lasting psychological effects on SDMs. There is insufficient evidence on the influence of advance directives on the decisional burden of surrogate decision-makers of patients with chronic critical illness. The study was a secondary data analysis of cross-sectional data. Data were obtained from 489 surrogate decision-makers of chronically critically ill patients at two academic medical centres in Northeast Ohio, United States, between September 2005-May 2008. Data were collected using demographic forms and questionnaires. A single-item measure of role stress and the Center for Epidemiological Studies Depression (CESD) scale were used to capture the SDM's decisional burden. Descriptive statistics, t-tests, chi-square and path analyses were performed. Surrogate decision-makers who were nonwhite, with low socioeconomic status and low education level were less likely to have advance directive documentation for their chronically critically ill patient. The presence of an advance directive mitigates the decisional burden by directly reducing the SDM's role stress and indirectly lessening the severity of depressive symptoms. Most SDMs of chronically critically ill patients will not have the benefit of knowing the patient's preferences for life-sustaining therapies and consequently be at risk of increased decisional burden. Study results are clinically useful for patient education on the influence of advance directives. Patients may be informed that SDMs without advance directives are at risk of increased decisional burden and will require

  19. The Role of Adult Learning in Coping with Chronic Illness

    Science.gov (United States)

    Baumgartner, Lisa M.

    2011-01-01

    Nearly half the U.S. population copes with a chronic disease or condition. A chronic disease is "one lasting three months or more that generally cannot be prevented by vaccines or cured by medication." Heart disease, cancer, diabetes, and obesity are the most common chronic diseases in developed countries. By 2030, it is estimated that…

  20. Voting preferences of outpatients with chronic mental illness in Germany.

    Science.gov (United States)

    Bullenkamp, Jens; Voges, Burkhard

    2004-12-01

    Outpatients with chronic mental illness living in therapeutic residential facilities in Mannheim, Germany (N=110) responded to an opinion poll to determine their voting preferences for the 2002 federal election to the Bundestag. The poll found that the outpatients were significantly more likely than the general population in Mannheim to prefer left-wing parties (78 percent compared with 56 percent). This finding is in contrast to earlier reports; however, it seems to better reflect common beliefs about the political preferences of this population. In conclusion, persons with chronic mental illness seem to prefer political parties that they believe will best serve their perceived specific interests.

  1. Development of disaster pamphlets based on health needs of patients with chronic illnesses.

    Science.gov (United States)

    Motoki, Emi; Mori, Kikuko; Kaji, Hidesuke; Nonami, Yoko; Fukano, Chika; Kayano, Tomonori; Kawada, Terue; Kimura, Yukari; Yasui, Kumiko; Ueki, Hiroko; Ugai, Kazuhiro

    2010-01-01

    The aim of this research was to develop a pamphlet that would enable patients with diabetes, rheumatic diseases, chronic respiratory disease, and dialysis treatment to be aware of changes in their physical conditions at an early stage of a disaster, cope with these changes, maintain self-care measures, and recover their health. Illness-specific pamphlets were produced based on disaster-related literature, news articles, surveys of victims of the Great Hanshin-Awaji Earthquake Disaster and Typhoon Tokage, and other sources. Each pamphlet consisted of seven sections-each section includes items common to all illnesses as well as items specific to each illness. The first section, "Physical Self-Care", contains a checklist of 18 common physical symptoms as well as symptoms specific to each illness, and goes on to explain what the symptoms may indicate and what should be done about them. The main aim of the "Changes in Mental Health Conditions" section is to detect posttraumatic stress disorder (PTSD) at an early stage. The section "Preventing the Deterioration of Chronic Illnesses" is designed to prevent the worsening of each illness through the provision of information on cold prevention, adjustment to the living environment, and ways of coping with stress. In the sections, "Medication Control" and "Importance of Having Medical Examinations", spaces are provided to list medications currently being used and details of the hospital address, in order to ensure the continued use of medications. The section, "Preparing for Evacuations" gives a list of everyday items and medical items needed to be prepared for a disaster. Finally, the "Methods of Contact in an Emergency" section provides details of how to use the voicemail service. The following content-specific to each illness also was explained in detail: (1) for diabetes, complications arising from the deterioration of the illness, attention to nutrition, and insulin management; (2) for rheumatic diseases, a checklist of

  2. Cost of Illness of Chronic Hepatitis B Infection in Vietnam

    NARCIS (Netherlands)

    Tu, Hong Anh T.; Woerdenbag, Herman J.; Riewpaiboon, Arthorn; Kane, Sumit; Le, Diep M.; Postma, Maarten J.; Li, Shu Chuen

    2012-01-01

    To estimate the total financial burden of chronic hepatitis B virus (HBV) infection for Vietnam by quantifying the direct medical, the direct nonmedical, and indirect costs among patients with various stages of chronic HBV infection. Direct medical cost data were retrieved retrospectively from

  3. Medications Frequently Used To Treat Persons with Mental Illness.

    Science.gov (United States)

    Danser, Helen Lisanby

    The manual is intended to assist the rehabilitation professional in planning services for persons with disabilities, such as long-term mental illness, which require treatment with medication, especially psychotropic medications. The compilation of data groups similar medications together and includes such information as purpose of medication, side…

  4. Serving persons with severe mental illness in primary care-based medical homes.

    Science.gov (United States)

    Domino, Marisa E; Wells, Rebecca; Morrissey, Joseph P

    2015-05-01

    Primary care-based medical homes are rapidly disseminating through populations with chronic illnesses. Little is known about how these models affect the patterns of care for persons with severe mental illness who typically receive much of their care from mental health specialists. This study examined whether enrollment in a primary care medical home alters the patterns of care for Medicaid enrollees with severe mental illness. The authors conducted a retrospective secondary data analysis of medication adherence, outpatient and emergency department visits, and screening services used by adult Medicaid enrollees with diagnoses of schizophrenia (N=7,228), bipolar disorder (N=13,406), or major depression (N=45,000) as recorded in North Carolina Medicaid claims from 2004-2007. Participants not enrolled in a medical home (control group) were matched by propensity score to medical home participants on the basis of demographic characteristics and comorbidities. Those dually enrolled in Medicare were excluded. Results indicate that medical home enrollees had greater use of both primary and specialty mental health care, better medication adherence, and reduced use of the emergency department. Better rates of preventive lipid and cancer screening were found only for persons with major depression. Enrollment in a medical home was associated with substantial changes in patterns of care among persons with severe mental illness. These changes were associated with only a modest set of incentives, suggesting that medical homes can have large multiplier effects in primary care of persons with severe mental illness.

  5. Impact of childhood chronic illnesses on siblings: a literature review.

    Science.gov (United States)

    O' Brien, Irene; Duffy, Anita; Nicholl, Honor

    Childhood illness can have a significant impact on families, particularly on the ill child's siblings. There is a dearth of published literature focusing on the needs of siblings of ill children. This literature review aims to provide an overview of the current healthcare literature in relation to the impact of childhood chronic illness or disability on siblings. A literature review was undertaken by searching the databases CINAHL, PsycINFO, ProQuest and Cochrane Library for relevant articles in English using the search terms: 'siblings', 'chronic illness', 'disability', 'cancer', 'sibling relations', 'sibling adjustment', 'coping', 'family-centred care', 'sibling interventions', 'camps', 'autism', 'Down's syndrome'. Seventeen research studies in total were reviewed. This review focuses on three sibling groups related to children suffering from autism, cancer and Down's syndrome, and are discussed under the following headings: sibling adjustment; family functioning and sibling's coping resources; and intervention programmes. The literature revealed that siblings of children with Down's syndrome were well adjusted to living with their brother or sister. However, there was conflicting information on the adjustment of siblings of children with cancer and autism. An awareness of the harmful effect that living with childhood illness and disability can have on some siblings is essential to enable healthcare professionals to provide supportive interventions to protect siblings' physical and emotional wellbeing.

  6. AIDS as chronic illness: epidemiological transition and health care ...

    African Journals Online (AJOL)

    This paper suggests that people in south-eastern Botswana experience the AIDS epidemic as part of a recent epidemiological transition in which rates of chronic debilitating illness have risen, even as the degree of acute infectious disease has fallen (HIV/AIDS aside). Whereas international health programmes and ...

  7. Psychosocial Adaptation to Chronic Illness and Disability: A Conceptual Framework.

    Science.gov (United States)

    Livneh, Hanoch

    2001-01-01

    Reviews the fundamental components inherent in the process of psychosocial adaptation to chronic illness and disability. It is proposed that psychosocial outcomes correspond to specific or global indicators of quality of life and may be categorized according to their functional domains, content areas, technologies or methods of assessment, and…

  8. Rethinking 'risk' and self-management for chronic illness.

    Science.gov (United States)

    Morden, Andrew; Jinks, Clare; Ong, Bie Nio

    2012-02-01

    Self-management for chronic illness is a current high profile UK healthcare policy. Policy and clinical recommendations relating to chronic illnesses are framed within a language of lifestyle risk management. This article argues the enactment of risk within current UK self-management policy is intimately related to neo-liberal ideology and is geared towards population governance. The approach that dominates policy perspectives to 'risk' management is critiqued for positioning people as rational subjects who calculate risk probabilities and act upon them. Furthermore this perspective fails to understand the lay person's construction and enactment of risk, their agenda and contextual needs when living with chronic illness. Of everyday relevance to lay people is the management of risk and uncertainty relating to social roles and obligations, the emotions involved when encountering the risk and uncertainty in chronic illness, and the challenges posed by social structural factors and social environments that have to be managed. Thus, clinical enactments of self-management policy would benefit from taking a more holistic view to patient need and seek to avoid solely communicating lifestyle risk factors to be self-managed.

  9. The economic impact of the insured patients with severe chronic and acute illnesses: a qualitative approach

    Directory of Open Access Journals (Sweden)

    Budi Aji

    2014-10-01

    Full Text Available Background: Little research has focused on the economic hardship among the insured with severe illnesses and high treatment costs, in particular, the consequence of poorer insurance coverage for high-cost illnesses. Therefore, we presented the case for identifying the experiences of insured patients with severe chronic and acute illnesses. This study identified a qualitative understanding of the economic impact of severe chronic and acute illnesses and household strategies to deal with high treatment costs. Design: Interviews were conducted with 19 insured households of three different health insurance programs with a family member that had been hospitalized for severe chronic or acute illnesses in either Banyumas or Margono Sukarjo hospitals in Banyumas, Central Java, Indonesia. A thematic analysis was applied to guide the interpretation of the data. Results: Insured households with a family member that had been hospitalized for severe chronic and acute illnesses were greatly affected by the high treatment costs. Four major issues emerged from this qualitative study: insured patients are still burdened with high out-of-pocket payments, households adopt various strategies to cope with the high cost of treatments, households experience financial hardships, and positive and negative perceptions of the insured regarding their health insurance coverage for acute and chronic illnesses. Conclusions: Askes and Jamsostek patients faced financial burdens from high cost sharing for hospital amenities, non-covered drugs, and treatments and other indirect costs. Meanwhile, Jamkesmas beneficiaries faced no financial burden for related medical services but were rather burdened with indirect costs for the carers. Households relied on internal resources to cover hospital bills as the first strategy, which included the mobilization of savings, sale of assets, and borrowing of money. External support was tapped secondarily and included financial support from

  10. Chronic conditions, fluid states: chronicity and the anthropology of illness

    National Research Council Canada - National Science Library

    Manderson, Lenore; Smith-Morris, Carolyn

    2010-01-01

    ... in the field, address the concept of chronicity, an idea used to explain individual and local life-worlds, question public health discourse, and consider the relationship between health and the globalizing forces that shape it."--pub. desc.

  11. Hospital-to-School Transition for Children with Chronic Illness: Meeting the New Challenges of an Evolving Health Care System

    Science.gov (United States)

    Shaw, Steven R.; McCabe, Paul C.

    2007-01-01

    Chronic illness is common and has a profound impact on the education of affected children. A variety of approaches and programs to facilitate the transition from hospital to school for children with chronic health problems has been described in the literature. Traditional transition plans may no longer be effective because medical service delivery…

  12. Systematic review of positive youth development programs for adolescents with chronic illness.

    Science.gov (United States)

    Maslow, Gary R; Chung, Richard J

    2013-05-01

    The Positive Youth Development (PYD) framework has been successfully used to support at-risk youth. However, its effectiveness in fostering positive outcomes for adolescents with chronic illness has not been established. We performed a systematic review of PYD-consistent programs for adolescents with chronic illness. Data sources included PubMed, CINAHL, and PsychINFO. Guided by an analytic framework, we searched for studies of PYD-consistent programs serving adolescents and young adults aged 13 through 24 with chronic illness. References were screened iteratively with increasing depth until a focused cohort was obtained and reviewed in full. The authors separately reviewed the studies using structured analysis forms. Relevant study details were abstracted during the review process. Fifteen studies describing 14 programs were included in the analysis. Three comprehensive programs included all 3 core components of a PYD program, including opportunities for youth leadership, skill building, and sustained connections between youth and adults. Four programs were primarily mentoring programs, and 7 others focused on youth leadership. Programs served youth with a variety of chronic illnesses. The quality and type of evaluation varied considerably, with most reporting psychosocial outcomes but only a few including medical outcomes. The PYD-consistent programs identified in this review can serve as models for the development of youth development programs for adolescents with chronic illness. Additional study is needed to evaluate such programs rigorously with respect to both psychosocial and health-related outcomes. PYD-consistent programs have the potential to reach youth with chronic illness and promote positive adult outcomes broadly.

  13. Do everyday problems of people with chronic illness interfere with their disease management? Chronic Disease epidemiology

    NARCIS (Netherlands)

    Van Houtum, Lieke; Rijken, Mieke; Groenewegen, Petrus

    2015-01-01

    Background: Being chronically ill is a continuous process of balancing the demands of the illness and the demands of everyday life. Understanding how everyday life affects self-management might help to provide better professional support. However, little attention has been paid to the influence of

  14. Mental Illness among Us: A New Curriculum to Reduce Mental Illness Stigma among Medical Students

    Science.gov (United States)

    Aggarwal, Anuj K.; Thompson, Maxwell; Falik, Rebecca; Shaw, Amy; O'Sullivan, Patricia; Lowenstein, Daniel H.

    2013-01-01

    Objectives: Medical students have been shown to have high levels of psychological distress, including self-stigmatization and unwillingness to seek care. The authors hypothesized that a student-led curriculum involving personal mental illness experience, given during the first-year neuroscience course, and titled "Mental Illness Among Us…

  15. Communicating the experience of chronic pain and illness through blogging.

    Science.gov (United States)

    Ressler, Pamela Katz; Bradshaw, Ylisabyth S; Gualtieri, Lisa; Chui, Kenneth Kwan Ho

    2012-10-23

    Although more individuals are sharing their experiences with chronic pain or illness through blogging (writing an Internet web log), research on the psychosocial effects and motivating factors for initiating and maintaining a blog is lacking. The objective was to examine via online questionnaire the perceived psychosocial and health benefits of blogging among patients who use this media to communicate their experience of chronic pain or illness. A 34-item online questionnaire was created, tested, and promoted through online health/disease forums. The survey employed convenience sampling and was open from May 5 to July 2, 2011. Respondents provided information regarding demographics, health condition, initiation and upkeep of blogs, and dynamics of online communication. Qualitative data regarding respondents' blogging experiences, expectations for blogging, and the perceived effects from blogging on the blogger's health, interpersonal relationships, and quality of life were collected in the form of written narrative. Out of 372 respondents who started the survey, 230 completed the entire questionnaire. Demographic data showed survey respondents to be predominantly female (81.8%) and highly educated (97.2% > high school education and 39.6% with graduate school or professional degrees). A wide spectrum of chronic pain and illness diagnoses and comorbidities were represented. Respondents reported that initiating and maintaining an illness blog resulted in increased connection with others, decreased isolation, and provided an opportunity to tell their illness story. Blogging promoted accountability (to self and others) and created opportunities for making meaning and gaining insights from the experience of illness, which nurtured a sense of purpose and furthered their understanding of their illness. Results suggest that blogging about chronic pain and illness may decrease a sense of isolation through the establishment of online connections with others and increases a

  16. Chronic illness and consumer inequality: the impact of health costs on people with chronic illnesses in rural and regional Australia.

    Science.gov (United States)

    Walker, Christine

    2007-05-01

    This paper presents the results of a survey undertaken in rural and regional Victoria in 2003 on the total costs faced by households caring for people with chronic illnesses. The impact of these costs for the households is discussed in the context of neo-liberal policy development by Australian governments and the effects of those policies on such households.

  17. Apixaban versus enoxaparin for thromboprophylaxis in medically ill patients

    DEFF Research Database (Denmark)

    Goldhaber, Samuel Z; Leizorovicz, Alain; Kakkar, Ajay K

    2011-01-01

    The efficacy and safety of prolonging prophylaxis for venous thromboembolism in medically ill patients beyond hospital discharge remain uncertain. We hypothesized that extended prophylaxis with apixaban would be safe and more effective than short-term prophylaxis with enoxaparin....

  18. [Strategies of coping with chronic illness in adolescents].

    Science.gov (United States)

    Flores-Carvajal, Daniel; Urzúa M, Alfonso

    2016-01-01

    To develop a tool to evaluate coping strategies for chronic illness in adolescents. Based on a theoretical review and semi-structured interviews with adolescents, a questionnaire was prepared that was finally evaluated by judges experienced in in understanding, relevance and viability. A scale is proposed that consists of 60 items grouped into 12 coping families. The scale may be a useful clinical tool to provide key information about the experience and ways to cope with illness in adolescents. Copyright © 2015 Sociedad Chilena de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.

  19. Differential outcomes of adolescents with chronically ill and healthy parents

    NARCIS (Netherlands)

    Sieh, D.S.; Visser-Meily, J.M.A.; Meijer, A.M.

    2013-01-01

    Approximately 10% of children grow up with a parent who has been diagnosed with a chronic medical condition (CMC) and seem to be at risk for adjustment difficulties. We examined differences in behavioral, psychosocial and academic outcomes between 161 adolescents from 101 families with a chronically

  20. Chronotope disruption as a sensitizing concept for understanding chronic illness narratives.

    Science.gov (United States)

    Gomersall, Tim; Madill, Anna

    2015-04-01

    This article aims to elaborate chronotope disruption--a changed relation to time and space--as a sensitizing concept for understanding chronic illness narratives. Sixteen men and 16 women with Type 2 diabetes were purposefully sampled. Each was interviewed about his or her experience of diabetes self-management using the biographical-narrative interview method. Transcripts were inspected for key moments defined as emotionally laden stories relevant to the purpose of the research. We present dialogically inflected discursive analysis of exemplar extracts. The analysis demonstrates how the concept of chronotope disruption helps identify, and understand, important aspects of patients' chronic illness narratives. First, we investigate how medical advice can conflict with embodied experience and how progressive bodily deterioration can provoke a reevaluation of past illness (self-mis)management. Second, the increasing temporal and spatial intrusion of chronic illness into participants' lives is examined. Finally, we focus on the masquerade of health as an attempt to manage, hide, or deny that one is physically challenged. Chronotope disruption offers a useful sensitizing concept for approaching chronic illness narratives and around which to organize analytical insights and to develop practice. Chronotope analysis fills an important gap in the science through compensating current health sciences' focus on rationality, cognition, and prospective time (prediction) with a patient-oriented focus on emotionality, embodiment, and retrospective time (nostalgia). Chronotope disruption could be used to develop practice by gaining empathic understanding of patients' life-worlds and provides a tool to examine how new technologies change the way in which the chronically ill have "being" in the world. (c) 2015 APA, all rights reserved).

  1. Chronotope Disruption as a Sensitizing Concept for Understanding Chronic Illness Narratives

    Science.gov (United States)

    2014-01-01

    Objectives: This article aims to elaborate chronotope disruption —a changed relation to time and space— as a sensitizing concept for understanding chronic illness narratives. Methods: Sixteen men and 16 women with Type 2 diabetes were purposefully sampled. Each was interviewed about his or her experience of diabetes self-management using the biographical-narrative interview method. Transcripts were inspected for key moments defined as emotionally laden stories relevant to the purpose of the research. We present dialogically inflected discursive analysis of exemplar extracts. Results: The analysis demonstrates how the concept of chronotope disruption helps identify, and understand, important aspects of patients’ chronic illness narratives. First, we investigate how medical advice can conflict with embodied experience and how progressive bodily deterioration can provoke a reevaluation of past illness (self-mis)management. Second, the increasing temporal and spatial intrusion of chronic illness into participants’ lives is examined. Finally, we focus on the masquerade of health as an attempt to manage, hide, or deny that one is physically challenged. Conclusions: Chronotope disruption offers a useful sensitizing concept for approaching chronic illness narratives and around which to organize analytical insights and to develop practice. Chronotope analysis fills an important gap in the science through compensating current health sciences’ focus on rationality, cognition, and prospective time (prediction) with a patient-oriented focus on emotionality, embodiment, and retrospective time (nostalgia). Chronotope disruption could be used to develop practice by gaining empathic understanding of patients’ life-worlds and provides a tool to examine how new technologies change the way in which the chronically ill have “being” in the world. PMID:25197985

  2. Chronic Neurodegenerative Illnesses and Epilepsy in Danish Adventists and Baptists

    DEFF Research Database (Denmark)

    Thygesen, Lau Caspar; Gimsing, Louise Nørreslet; Bautz, Andrea

    2017-01-01

    are neurodegenerative, whereas epilepsy can occur at any age. METHODS: We compared hospital admission rates for some major neurological diseases among members of the Danish Religious Societies Health Study comprising 6,532 SDA and 3,720 Baptists with the general Danish population. Standardized incidence rates (SIR......BACKGROUND: Limited knowledge of the influence of lifestyle risk factors and religious living on chronic neurological diseases exist. Seventh-day Adventists (SDA) do not consume tobacco, alcohol, or pork, and many adhere to lacto-ovo-vegetarian diet, and Baptists discourage excessive use of alcohol...... and tobacco. OBJECTIVE: We investigated whether the incidence of four common chronic neurological illnesses: dementia, Alzheimer's disease, Parkinson's disease, and epilepsy in a large cohort of Danish Adventists and Baptists was different compared to the general Danish population. Three of the illnesses...

  3. Rural women, technology, and self-management of chronic illness.

    Science.gov (United States)

    Weinert, Clarann; Cudney, Shirley; Hill, Wade G

    2008-09-01

    The objective of this study was to determine the differences in the psychosocial status of 3 groups of chronically ill rural women participating in a computer intervention. The 3 groups were: intense intervention, less-intense intervention, and control. At baseline and following the intervention, measures were taken for social support, self-esteem, empowerment, self-efficacy, depression, stress, and loneliness. ANCOVA results showed group differences for social support and self-efficacy among the overall group. The findings differed for a vulnerable subgroup, with significant between-group differences for social support and loneliness. It was concluded that a computer-delivered intervention can improve social support and self-efficacy and reduce loneliness in rural women, enhancing their ability to self-manage and adapt to chronic illness.

  4. Facilitating critical reflection in mothers of chronically ill children.

    Science.gov (United States)

    Gibson, C H

    1999-05-01

    The hybrid model, developed by Schwartz-Barcott & Kim guided the conduct of a study of empowerment in mothers of chronically ill children. Integral to the model of empowerment that emerged from the study was an ongoing process of critical reflection. Through this process, mothers became aware of their strengths, abilities and resources. This paper is an in-depth analysis of the process of critical reflection, which corroborates recent theory on women's development. The process of critical reflection is illuminated by women's ways of knowing, as exemplified in the story of one mother, and by elements of maternal thinking. Implications for nursing practice in working with mothers of chronically ill children are highlighted.

  5. Attitudes toward people with mental illness among medical students

    Directory of Open Access Journals (Sweden)

    Vijayalakshmi Poreddi

    2015-01-01

    Full Text Available Background: Globally, people with mental illness frequently encounter stigma, prejudice, and discrimination by public and health care professionals. Research related to medical students′ attitudes toward people with mental illness is limited from India. Aim: The aim was to assess and compare the attitudes toward people with mental illness among medical students′. Materials and Methods: A cross-sectional descriptive study design was carried out among medical students, who were exposed (n = 115 and not exposed (n = 61 to psychiatry training using self-reporting questionnaire. Results: Our findings showed improvement in students′ attitudes after exposure to psychiatry in benevolent (t = 2.510, P < 0.013 and stigmatization (t = 2.656, P < 0.009 domains. Further, gender, residence, and contact with mental illness were the factors that found to be influencing students′ attitudes toward mental illness. Conclusion: The findings of the present study suggest that psychiatric education proved to be effective in changing the attitudes of medical students toward mental illness to a certain extent. However, there is an urgent need to review the current curriculum to prepare undergraduate medical students to provide holistic care to the people with mental health problems.

  6. A comparison of adherence to hypoglycemic medications between Type 2 diabetes patients with and without serious mental illness

    Science.gov (United States)

    Kreyenbuhl, Julie; Leith, Jaclyn; Medoff, Deborah R.; Fang, LiJuan; Dickerson, Faith B.; Brown, Clayton H.; Goldberg, Richard W.; Potts, Wendy; Dixon, Lisa B.

    2011-01-01

    Inadequate self-management of chronic medical conditions like Type 2 diabetes may play a role in the poor health status of individuals with serious mental illnesses. We compared adherence to hypoglycemic medications and blood glucose control between 44 diabetes patients with a serious mental illness and 30 patients without a psychiatric illness. The two groups did not differ in their ability to manage a complex medication regimen as assessed by a performance-based measure of medication management capacity. However, significantly fewer patients with a mental illness self-reported nonadherence to their hypoglycemic regimens compared to those without a mental illness. Although individuals with mental illnesses also had better control of blood glucose, this metabolic parameter was not correlated with adherence to hypoglycemic medications in either patient group. The experience of managing a chronic mental illness may confer advantages to individuals with serious mental illnesses in the self-care of co-occurring medical conditions like Type 2 diabetes. PMID:21459458

  7. DIFFERENCES IN ILLNESS REPRESENTATIONS IN PATIENTS WITH CHRONIC KIDNEY DISEASE.

    Science.gov (United States)

    Pagels, Agneta A; Söderquist, Birgitta Klang; Heiwe, Susanne

    2015-09-01

    To explore the impact of chronic kidney disease (CKD) on individual illness representations, including symptoms and causal attributions. Fifty-four patients responded to the Illness Perception Questionnaire (IPQ-R) and a further seven patients undertook cognitive interviews regarding the IPQ-R. All respondents had CKD stage 2-5, not undergoing renal replacement therapy. Those in earlier CKD stages and those with fewer symptoms perceived a significantly different understanding of their condition than those in more advanced disease stages or with more symptoms. Behavioural and psychological attributions were commonly referred to as contributing causes to CKD. These attributions were associated to negative illness representations. An uncertainty assessing symptoms attributed to CKD was indicated, especially in earlier disease stages. Illness representations differ with CKD stages and symptom burden. The patients in earlier disease stages or with fewer symptoms did not hold as strong beliefs about their illness as being a threat as those in advanced stages or with more symptoms. Self-blame emerged as a common causal attribution. Patients did not always relate symptoms to CKD, therefore this study identifies a gap in patients' disease knowledge, especially in earlier stages of the condition. © 2015 European Dialysis and Transplant Nurses Association/European Renal Care Association.

  8. Psychiatric diagnoses and psychoactive medication use among nonsurgical critically ill patients receiving mechanical ventilation

    DEFF Research Database (Denmark)

    Wunsch, Hannah; Christiansen, Christian Fynbo; Johansen, Martin B

    2014-01-01

    IMPORTANCE: The relationship between critical illness and psychiatric illness is unclear. OBJECTIVE: To assess psychiatric diagnoses and medication prescriptions before and after critical illness. DESIGN, SETTING, AND PARTICIPANTS: Population-based cohort study in Denmark of critically ill patien...

  9. Illness progression in chronic fatigue syndrome: a shifting immune baseline.

    Science.gov (United States)

    Russell, Lindsey; Broderick, Gordon; Taylor, Renee; Fernandes, Henrique; Harvey, Jeanna; Barnes, Zachary; Smylie, AnneLiese; Collado, Fanny; Balbin, Elizabeth G; Katz, Ben Z; Klimas, Nancy G; Fletcher, Mary Ann

    2016-03-10

    Validation of biomarkers for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) across data sets has proven disappointing. As immune signature may be affected by many factors, our objective was to explore the shift in discriminatory cytokines across ME/CFS subjects separated by duration of illness. Cytokine expression collected at rest across multiple studies for female ME/CFS subjects (i) 18 years or younger, ill for 2 years or less (n = 18), (ii) 18-50 years of age, ill for 7 years (n = 22), and (iii) age 50 years or older (n = 28), ill for 11 years on average. Control subjects were matched for age and body mass index (BMI). Data describing the levels of 16 cytokines using a chemiluminescent assay was used to support the identification of separate linear classification models for each subgroup. In order to isolate the effects of duration of illness alone, cytokines that changed significantly with age in the healthy control subjects were excluded a priori. Optimal selection of cytokines in each group resulted in subsets of IL-1α, 6, 8, 15 and TNFα. Common to any 2 of 3 groups were IL-1α, 6 and 8. Setting these 3 markers as a triple screen and adjusting their contribution according to illness duration sub-groups produced ME/CFS classification accuracies of 75-88 %. The contribution of IL-1α, higher in recently ill adolescent ME/CFS subjects was progressively less important with duration. While high levels of IL-8 screened positive for ME/CFS in the recently afflicted, the opposite was true for subjects ill for more than 2 years. Similarly, while low levels of IL-6 suggested early ME/CFS, the reverse was true in subjects over 18 years of age ill for more than 2 years. These preliminary results suggest that IL-1α, 6 and 8 adjusted for illness duration may serve as robust biomarkers, independent of age, in screening for ME/CFS.

  10. A narrative literature review regarding job retention strategies for people with chronic illnesses.

    Science.gov (United States)

    Koch, Lynn C; Rumrill, Phillip D; Conyers, Liza; Wohlford, Sarah

    2013-01-01

    Job retention is a major concern for individuals with chronic illnesses, who represent a rapidly growing vocational rehabilitation (VR) consumer population. The purpose of this article is to examine selected job retention considerations for consumers with chronic illnesses. The authors (a) describe distinguishing characteristics of chronic illnesses in terms of populations affected and psychosocial implications, (b) discuss the vocational implications of chronic illnesses, (c) provide general considerations for the provision of job retention services, and (d) examine job retention strategies aimed at improving employment outcomes for individuals with chronic illnesses.

  11. Anticipated stigma in chronic illness patients in Cambodia, Myanmar and Vietnam.

    Science.gov (United States)

    Peltzer, Karl; Pengpid, Supa

    2016-12-01

    The aim of this study was to explore the prevalence and relationship of anticipated chronic illness stigma among patients diagnosed with a variety of chronic diseases in three Southeast Asian countries (Cambodia, Myanmar and Vietnam). A cross-sectional survey was conducted in 4,803 adult chronic disease patients (mean age 49.3 years; SD=16.5) recruited systematically from health facilities. Overall, the results indicate that 20.7% of patients reported that for any of the 12 stigma items, they anticipated they were likely or very likely to experience chronic disease stigma. A multivariate analysis of sociodemographics revealed the following were associated with anticipated chronic disease stigma: older versus younger age, OR (odds ratio) = 0.71; 95% Confidence Interval (CI) [0.58, 0.87]; higher versus lower education, OR = 2.23; 95% CI [1.81, 2.75]; origin from Myanmar or Vietnam, being single, divorced or widowed, rural residence, and health status (having three or more chronic conditions versus having one chronic condition), OR = 1.93; 95% CI [1.58, 2.35]; lower versus higher quality of life, OR = 0.73; 95% CI [0.63, 0.85]); health risk behavior (physical inactivity, poor diet, current smoking, and problem drinking) and low versus medium or high medication adherence (OR = 0.69; 95% CI [0.55,0.86]). This study demonstrated the possible consequences of anticipated stigma on the health and behavior of people living with chronic diseases, and several factors for chronic disease stigma were identified that can help guide interventions to reduce chronic illness stigma in this population.

  12. Mental illness among us: a new curriculum to reduce mental illness stigma among medical students.

    Science.gov (United States)

    Aggarwal, Anuj K; Thompson, Maxwell; Falik, Rebecca; Shaw, Amy; O'Sullivan, Patricia; Lowenstein, Daniel H

    2013-11-01

    Medical students have been shown to have high levels of psychological distress, including self-stigmatization and unwillingness to seek care. The authors hypothesized that a student-led curriculum involving personal mental illness experience, given during the first-year neuroscience course, and titled "Mental Illness Among Us (MIAU)," would reduce stigma of mental illness. In 2010 and 2011, students completed voluntary pre- and post-MIAU surveys measuring attitudes regarding mental illness in relation to MIAU. Also, in 2011, the authors categorized topics mentioned in student responses to an open-ended, free-response question on the course final examination. Of 298 enrolled students, 250 submitted surveys that were matched pre- and post-intervention. Participants in the curriculum showed a significant difference in Social Distance, indicating an increased willingness to interact with individuals with mental illness, and a significant difference in the Mental Illness: Clinicians' Attitudes (MICA) score representing a stronger agreement with positive statements regarding mental illness. The non-participants' scores showed no changes in measures from pre- to post. Respondents most frequently reported that the neuroscience course prepared them to be a physician because it taught about compassion and the importance of treating the whole patient. The results indicate that participation in MIAU leads to a decrease in stigmatization of mental illness and a greater sense of compassion among UCSF medical students. This finding is consistent with previous research suggesting social and cognitive congruence among peers and peer-teachers can result in meaningful learning experiences. MIAU may represent a sustainable model to supplement current systems to promote well-being of medical trainees.

  13. Agitation in the medically ill elderly

    African Journals Online (AJOL)

    Treatment of agitation is therefore imperative in order to prevent potential danger to patients and caregivers as well as to prevent excessive use of physical restraints and psychotropic medications. Classification of agitation. Agitation has been classified in several ways. Most commonly, it is classified as either mild or severe.

  14. What Influences Mental Illness? Discrepancies Between Medical Education and Conception

    Directory of Open Access Journals (Sweden)

    Evan Hy Einstein

    2017-04-01

    Full Text Available Objective: This preliminary study examined the differences between what was taught during a formal medical education and medical students’ and psychiatry residents’ conceptions of notions regarding the causes and determinants of mental illness. Methods: The authors surveyed 74 medical students and 11 residents via convenience sampling. The survey contained 18 statements which were rated twice based on truthfulness in terms of a participant’s formal education and conception, respectively. Descriptive statistics and a Wilcoxon signed rank test determined differences between education and conception. Results: Results showed that students were less likely to perceive a neurotransmitter imbalance to cause mental illness, as opposed to what was emphasized during a formal medical education. Students and residents also understood the importance of factors such as systemic racism and socioeconomic status in the development of mental illness, which were factors that did not receive heavy emphasis during medical education. Furthermore, students and residents believed that not only did mental illnesses have nonuniform pathologies, but that the Diagnostic and Statistical Manual of Mental Disorders also had the propensity to sometimes arbitrarily categorize individuals with potentially negative consequences. Conclusions: If these notions are therefore part of students’ and residents’ conceptions, as well as documented in the literature, then it seems appropriate for medical education to be further developed to emphasize these ideas.

  15. Achieving harmony with oneself: life with a chronic illness.

    Science.gov (United States)

    Delmar, Charlotte; Bøje, Trine; Dylmer, Dorrit; Forup, Lisbeth; Jakobsen, Christina; Møller, Majbritt; Sønder, Hanne; Pedersen, Birthe D

    2005-09-01

    This paper presents partial findings of a larger research project focusing on what it means to live with a chronic illness. Getting in harmony with oneself is a movement towards, and a form of, acceptance of the chronic suffering and disease. Some patients achieve this level of acceptance, while for others the obstacles of everyday life make this movement towards acceptance difficult. Achieving harmony with oneself is conditioned by the existence of hope and spirit of life/life courage and by the pressure of doubts on this hope. Doubts can shake this hope so that instead of moving towards acceptance, the patient drifts towards hopelessness and despair. The research design is qualitative and uses a phenomenological-hermeneutic approach. A total of 18 patients were interviewed, divided into three groups of six patients diagnosed with 'type I' diabetes, colitis ulcerosa and patients with coronary occlusion in the rehabilitation phase. The goal of the research was to derive patterns/themes common to the three diagnosed groups regarding the patients' view of health and disease in connection with chronic illness and to elucidate the significance of this view for how the patients coped with everyday life. The research method is inspired by Paul Ricoeur.

  16. An evaluation of a positive youth development program for adolescents with chronic illness.

    Science.gov (United States)

    Maslow, Gary; Adams, Cathleen; Willis, Matthew; Neukirch, Jodie; Herts, Kate; Froehlich, Wendy; Calleson, Diane; Rickerby, Michelle

    2013-02-01

    Youth with chronic illness often struggle transitioning to adulthood and adult medical care. This article examines the outcomes of a group mentoring program called The Adolescent Leadership Council (TALC) that brings together high school participants and college mentors, all with chronic illness. TALC uses a positive youth development (PYD) approach, emphasizing strong relationships between youth and adults in an environment where youth can learn important life skills and take a leadership role. A pre-/postprogram participant survey was conducted for high school participants using a loneliness scale and a transition readiness survey. An alumni survey was conducted with all high school and college mentor graduates to assess educational-, vocational-, and health care-related outcomes. Program records review and the alumni survey indicated that TALC was consistent with the PYD program model. Twenty high school students participated in the pre-/postprogram outcomes evaluation, which demonstrated a decrease in loneliness from 46 to 38.5 (p < .001) and an increase in health care self-advocacy from 3.8 to 4.2 (p < .001). Thirty-four alumni participated in the alumni survey. All high school and college mentor alumni had graduated from high school and college, respectively, and all were either currently in school or working. The majority of alumni were seeing adult providers for medical care. The TALC program applies the principles of PYD to support positive educational, vocational, and health care outcomes for youth with chronic illness. Program development using the PYD perspective is an important new approach for supporting adult development of youth with chronic illness. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  17. Family caregivers: Competence in the care of the chronically ill

    Directory of Open Access Journals (Sweden)

    Olga Marina Vega Angarita

    2018-01-01

    Full Text Available Introduction: Because of the high demand and costs of care, chronic diseases have shown an increasing number of caregivers who develop their role without the required training and skill. Objective: To describe the capacity for home care of caregivers of patients with chronic illness in a service provider institution of San José de Cúcuta. Materials and methods: Descriptive quantitative cross-sectional study, developed in the fi rst half of 2017. The sample was composed by 360 caregivers of patients with chronic disease. We used the instruments developed by the Chronic Patient Care Group of the Faculty of Nursing of the National University of Colombia called: GCPC-UN-C © - technical characterization chart for family caregivers of patients with chronic non-transferable disease and the instrument “Caring” - short version to measure the competence of care at home. Results: In the study, low and medium levels of competence of the caregivers were reported in the exercise of their role, and the categories Knowledge and Enjoyment (Welfare were more affected. It is important to note that caregivers with a high level of competence were not reported. Conclusion: The results show that the need for nursing intervention in strengthening the competence of caregivers remains an important constant of professional performance.

  18. Community residential options for the chronically mentally ill.

    Science.gov (United States)

    Cutler, D L

    1986-01-01

    We have discussed the problems of the new young chronic patients, deinstitutionalized old chronic patients now living in the community, and some of the groups of hard to place patients. We have talked about problems with community barriers, staff training, a spectrum of facilities, and we have looked at what new sorts of facilities may need to be developed. It seems clear that we have not yet developed a spectrum which can deal with all varieties of the chronically mentally ill. Pepper (1985) has suggested a different, more ideal spectrum of housing particularly suited to the young adult chronic patient. These include crisis residences, supervised 14-bed residences, growth house for 14 beds; support house for 14 beds; supervised apartments (satellite apartments), 14 beds; supportive apartments, 14 beds; (these have less intensive staffing than supervised ones); open community living; and residential congregate care for adults (RCCAs). These RCCAs are large facilities located either in old state hospitals or nursing homes which are primarily oriented towards the homeless mentally ill. According to Pepper, if a program can plan a spectrum of housing situations in the immediate catchment area, it can then actually meet the specific needs of each patient with a specific sort of residential facility. The challenge for community residences is certainly much greater than a decade ago and, with the homeless mentally ill population continuing to grow (Bachrach, 1985), one might be tempted to regard our present situation as one of crisis proportions. Clearly, there is little doubt that a need exists for a wide spectrum of living situations to be made available to the deinstitutionalized or never institutionalized young adult chronic patient. Yet very few incentives exist for those who would try to meet this challenge. To do this effectively will undoubtedly require the development of sizeable amounts of public funding through existing and new channels to provide support for

  19. The Impact of Chronic Illness on Psychosocial Stages of Human Development.

    Science.gov (United States)

    Lapham, E. Virginia, Ed.; Shevlin, Kathleen M., Ed.

    This book addresses critical issues regarding the impact of chronic illness and disability on human development. It was written for health care professionals who help chronically ill and disabled persons deal with the psychological and social as well as the biological aspects of their illness or disability. An expanded version of Erik Erikson's…

  20. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care.

    LENUS (Irish Health Repository)

    Cullen, Walter

    2012-02-01

    BACKGROUND: Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched \\'controls\\' and to develop and pilot test a valid study instrument. METHODS: A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status. RESULTS: Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation. CONCLUSION: Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words).

  1. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care.

    LENUS (Irish Health Repository)

    Cullen, Walter

    2009-01-01

    BACKGROUND: Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched \\'controls\\' and to develop and pilot test a valid study instrument. METHODS: A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status. RESULTS: Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation. CONCLUSION: Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words).

  2. Sri Lankan doctors' and medical undergraduates' attitudes towards mental illness.

    Science.gov (United States)

    Fernando, Sunera Mayanthi; Deane, Frank P; McLeod, Hamish J

    2010-07-01

    Stigmatizing attitudes towards mental illness can impede help-seeking and adversely affect treatment outcomes, especially if such attitudes are endorsed by medical personnel. In order to help identify targets for anti-stigma interventions, we comprehensively examined negative attitudes towards mental illness displayed by Sri Lankan doctors and medical students and compared these with equivalent UK and other international data. A self-report questionnaire originally developed in the UK was completed by medical students (n = 574) and doctors (n = 74) from a teaching hospital in Colombo. The questions assessed the presence and intensity of stigmatizing attitudes towards patients with schizophrenia, depression, panic disorder, dementia and drug and alcohol addiction. The study revealed higher levels of stigma towards patients with depression, alcohol and drug addiction in this Sri Lankan sample compared to UK data but attitudes towards schizophrenia were less stigmatized in Sri Lanka. Blaming attitudes were consistently high across diagnoses in the Sri Lankan sample. Sri Lankan medical students displayed more negative attitudes than doctors (P addiction, followed by, alcohol addiction, schizophrenia, depression, panic disorder and dementia. Sri Lankan doctors and undergraduates endorse stigmatizing attitudes towards mental illnesses and are especially prone to see patients as blameworthy. As such attitudes are likely to affect the engagement of patients in treatment and specific interventions that modify negative attitudes towards people with mental illnesses are needed. Ensuring that medical students have contact with recovered patients in community psychiatry settings may be one way of decreasing stigmatizing attitudes.

  3. A qualitative study examining health literacy and chronic illness self-management in Hispanic and non-Hispanic older adults

    Directory of Open Access Journals (Sweden)

    Jacobs RJ

    2017-04-01

    Full Text Available Robin J Jacobs,1 Raymond L Ownby,2 Amarilis Acevedo,3 Drenna Waldrop-Valverde4 1Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 2College of Osteopathic Medicine, 3College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, 4Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA Purpose: Chronic illness and low levels of health literacy affect health outcomes for many individuals, particularly older adults and racial/ethnic minorities. This study sought to understand the knowledge, strengths, and areas of need regarding self-management of chronic illness in order to lay the groundwork for content development of an intervention to increase health literacy and maximize patient engagement in chronic disease self-care.Patients and methods: In-depth, qualitative interviews were conducted in Spanish and English with 25 older adults with various chronic illnesses. Topics included knowledge and understanding of chronic conditions, medications, and disease self-management skills. Qualitative data were coded by searching text and conducting cross-case analysis. An inductive analysis was then employed to allow for the patterns and themes to emerge.Results: Emerged themes included 1 social support, 2 coping strategies, 3 spirituality, 4 chronic disease health literacy, 5 anger, and 6 depression. While participants had a general overall knowledge of chronic illness, they had deficits in knowledge regarding their own illnesses and medications.Conclusion: Chronic illness self-management is a complex and dynamic behavioral process. This study identified themes that leverage patient motivation to engage in self-care in a personalized manner. This information will guide the development of an intervention to promote health literacy and optimal disease self-management. Keywords: health disparities, older adults, resilience, computer interventions, comorbidity, multimorbidity

  4. Chronic unremitting headache associated with Lyme disease-like illness

    Directory of Open Access Journals (Sweden)

    Pedro Andre Kowacs

    2013-07-01

    Full Text Available The Brazilian Lyme-disease-like illness (BLDLI or Baggio-Yoshinari syndrome is a unique zoonosis found in Brazil. It reproduces all the clinical symptoms of Lyme disease except for the high frequencies of relapse and the presence of autoimmune manifestations. Two cases of borreliosis manifesting with unremitting headache, which is a symptom associated with late-stage BLDLI, were presented. Clinical, therapeutic, and prognostic aspects of the BLDLI and its associated headaches were showed and discussed in this article. BLDLI diagnosis requires additional attention by physicians, since the disease has a tendency to progress to the late, recurrent stage or the chronic form, and the associated headache can be confused with chronic primary headache or with analgesic-overuse one. Special attention should be paid to patients with headaches who have traveled to endemic areas.

  5. How medical technologies shape the experience of illness.

    Science.gov (United States)

    Hofmann, Bjørn; Svenaeus, Fredrik

    2018-02-03

    In this article we explore how diagnostic and therapeutic technologies shape the lived experiences of illness for patients. By analysing a wide range of examples, we identify six ways that technology can (trans)form the experience of illness (and health). First, technology may create awareness of disease by revealing asymptomatic signs or markers (imaging techniques, blood tests). Second, the technology can reveal risk factors for developing diseases (e.g., high blood pressure or genetic tests that reveal risks of falling ill in the future). Third, the technology can affect and change an already present illness experience (e.g., the way blood sugar measurement affects the perceived symptoms of diabetes). Fourth, therapeutic technologies may redefine our experiences of a certain condition as diseased rather than unfortunate (e.g. assisted reproductive technologies or symptom based diagnoses in psychiatry). Fifth, technology influences illness experiences through altering social-cultural norms and values regarding various diagnoses. Sixth, technology influences and changes our experiences of being healthy in contrast and relation to being diseased and ill. This typology of how technology forms illness and related conditions calls for reflection regarding the phenomenology of technology and health. How are medical technologies and their outcomes perceived and understood by patients? The phenomenological way of approaching illness as a lived, bodily being-in-the-world is an important approach for better understanding and evaluating the effects that medical technologies may have on our health, not only in defining, diagnosing, or treating diseases, but also in making us feel more vulnerable and less healthy in different regards.

  6. Tolerance and illness: the politics of medical and psychiatric classification.

    Science.gov (United States)

    Glackin, Shane Nicholas

    2010-08-01

    In this paper, I explore the links between liberal political theory and the evaluative nature of medical classification, arguing for stronger recognition of those links in a liberal model of medical practice. All judgments of medical or psychiatric "dysfunction," I argue, are fundamentally evaluative, reflecting our collective willingness or reluctance to tolerate and/or accommodate the conditions in question. Illness, then, is "socially constructed." But the relativist worries that this loaded phrase evokes are unfounded; patients, doctors, and communities will agree in the vast majority of cases about what counts as illness. Where they cannot come to agreement, however, we are faced with precisely the sort of dispute about values and ways of life that the institutions of the liberal state are designed to accommodate. I accordingly sketch a model of medical practice, based loosely on Jürgen Habermas's political theories, designed to maximize both our awareness and our understanding of these disputes.

  7. Chronic hepatitis | Hift | South African Medical Journal

    African Journals Online (AJOL)

    However, in some instances inflammation does not settle but becomes established as a chronic illness. Although the patient may be asymptomatic, the transaminases are intermittently or permanently elevated, liver biopsy shows continuing damage, and there may be evidence of ongoing viral replication. The whole process ...

  8. Rivaroxaban for Thromboprophylaxis in Acutely Ill Medical Patients

    NARCIS (Netherlands)

    Cohen, Alexander T.; Spiro, Theodore E.; Büller, Harry R.; Haskell, Lloyd; Hu, Dayi; Hull, Russell; Mebazaa, Alexandre; Merli, Geno; Schellong, Sebastian; Spyropoulos, Alex C.; Tapson, Victor; Cohen, A. T.; Haskell, L.; Hu, D.; Hull, R.; Mebazaa, A.; Merli, G.; Schellong, S.; Spiro, T.; Spyropoulos, A. C.; Tapson, V.; Francis, C.; Kobayashi, S.; Leizorovicz, A.; Lowe, G.; Roberts, R.; Brandges, D.; Kolbach, D.; Limburg, M. L.; Mac Gillavry, M. R.; Otten, H. M.; Peters, R. G. J.; Prins, M. [=Martin H.; Robben, S.; Voorend, M.; Hemmrich, M.; Li, L.; Meng, I.; Mühlhofer, E.; Beckmann, H.; Desanctis, Y.; Duszczyszyn, A.; Fielding, L.; Twomey, T.; Müller, K.; Byra, W.; Nessel, C.; Atkinson, Sarah; Bottaro, F. J.; Caberlotto, O.; Grand, B.; Hendler, H.; Hojman, M.; Mykietiuk, A.; Salerno, R.; Baker, R.; Carroll, P.; Chong, B.; Colquhoun, D.; Gan, E.; Hall, S.; Jackson, D.; Leyden, M.; Salem, H.; Serisier, D.; Balcke, P.; Bauer, B.; Bauer, N. C.; Erlacher, L.; Fortunat, W.; Grafl, E.; Keil, F.; Kirchmair, P.; Pilger, E.; Schönherr, H.-R.; Siostrzonek, P.; Weidinger, F.; Weltermann, A.; Wenisch, C.; Blockmans, D.; Delobbe, A.; Hendrickx, K.; Jacquy, C.; Soupart, A.; Striekwold, H.; van Hoof, M.-E.; Vanden Abeele, A.; van Roey, G.; van Zandweghe, L.; Bizzacchi, J. M. A.; Cavalheiro, C.; Chamone, D.; Fiss, E.; Garicochea, B.; Lopes, A. C.; Rocha Moreira, R. C.; van Bellen, B.; Dimov, D.; Ivanov, Y.; Lyubenov, L.; Milanov, S.; Mincheva, V.; Nenkova, S.; Popov, D.; Taseva, M.; Bergeron, C.; Boulanger, J.-M.; Buck, B.; Daneault, N.; Desai, H.; Dube, F.; Kutsogiannis, D. J.; Miron, M.-J.; Moddel, G.; Shuaib, A.; Silver, F.; Stotts, G.; Verreault, S.; Bugedo, G.; Torres, H.; Chen, K.-N.; Chen, P.; Chen, R. C.; Chen, Y.; Gai, L.; Gao, Q.; Guo, S.; Hu, T.; Hua, Q.; Li, H.; Li, J.; Li, W.; Li, Y.-S.; Liu, C.; Liu, J.; Liu, Y.; Qi, G.; Qin, X.; Shen, C.; Sun, S.; Sun, Y.; Wan, Q.; Wang, C.; Wang, H.; Wang, Y.; Wu, C.; Wu, J.; Wu, S.; Xian, S.; Xiu, Q.; Xu, B.; Yan, X.; Yang, K.; Yang, L.; Yang, Y.; Zhang, D. P.; Zhang, J.; Zhang, S.; Zhao, Y.; Zhao, Z.; Zhou, Y.; Botero, R.; Cedano, J. E.; Fajardo, D.; Gómez, L. F.; Jaramillo, C. F.; Rada, R.; Uribe, L. G.; Velásquez, J. C.; Bergovec, M.; Hajnsek, S.; Knezevic, A.; Samarzija, M.; Steiner, R.; Zupancic-Salek, S.; Fiksa, J.; Gorican, K.; Linhart, A.; Macel, I.; Mayer, O.; Prochazka, V.; Sedlacek, J.; Avnstrøm, S.; Nielsen, H.; Nielsen, T.; Østergaard, O. V.; Tuxen, C.; Kolbassova, O.; Lember, M.; Marandi, T.; Uuetoa, T.; Karmakoski, J.; Lassila, R.; Aquilanti, S.; Bergmann, J.-F.; Brisot, D.; Debourdeau, P.; Duchemin, A.; Farge-Bancel, D.; Fournier, C.; Galinier, M.; Lacroix, P.; Lambert, M.; Le Jeunne, C.; Lorcerie, B.; Mahe, I.; Marquette, C.-H.; Mismetti, P.; Mottier, D.; Proust, A.; Quere, I.; Rihani, R.; Schmidt, J.; Stephan, D.; Vital-Durand, D.; Barth, J.; Beyer-Westendorf, J.; Borst, M.; Dormann, A.; Drouven, F.-M.; Espinola-Klein, C.; Heintges, T.; Hindahl, H.; Klotz, T.; Lawall, H.; Leschke, M.; Milstrey, H.-R.; Möbius-Winkler, S.; Mühlbauer, B.; Niederau, C.; Petermann, W.; Pohl, C.; Ringe, J.-D.; Sanner, B.; Scharrer, I.; Schmidt-Lucke, J. A.; Schöffauer, I.; Stoelben, E.; Theelen, W.; Veltkamp, R.; vom Dahl, J.; Apsokardos, S.; Babalis, D.; Bassaris, H.; Karafoulidou, A.; Katsivas, A.; Panoutsopoulos, G.; Patsilinakos, S.; Skoutelis, A.; Toubis, M.; Vlastos, F.; Wong, L. K. S.; Wong, R. S. M.; Frankfurter, Z.; Nagy, F.; Jakab, G.; Kondakor, I.; Nikl, J.; Nyirati, G.; Szakacs, Z.; Szegedi, N.; Avvaru, G.; Bhairappa, S.; Cheviri, A. N.; Gadkari, M.; Grant, P.; Kuchimanchi, K.; Kumar, K. P.; Mahajan, A.; Naik, A.; Oomman, A.; Raghu, C.; Ramanathan, R. M. P. L.; Talwar, D.; Whig, J.; Kalim, H.; Machfoed, M. H.; Tambunan, K. L.; Elias, M.; Elias, N.; Hayek, T.; Lishner, M.; Oren, S.; Osamah, H.; Sthoeger, Z.; Telman, G.; Zeltser, D.; Zimlichman, R.; Ageno, W.; Agnelli, G.; Berrettini, M.; Bondi, M.; Buzzoni, R.; Castaman, G.; de Blasio, A.; de Gaudenzi, E.; Falanga, A.; Fontanella, A.; Giorgi Pierfranceschi, M.; Landolfi, R.; Lodigiani, C.; Morra, E.; Parise, P.; Pini, M.; Pizzini, A.; Poggio, R.; Quintavalla, R.; Siragusa, S.; Violi, F.; Ando, S.; Fujimoto, K.; Fukui, K.; Funada, J.; Hataji, O.; Ibata, H.; Ichinose, T.; Ikefuji, H.; Imai, S.; Ito, K.; Kani, H.; Kato, M.; Momiyama, Y.; Nishi, S.; Mekaru, S.; Mio, T.; Nagaoka, M.; Nakagawa, H.; Nakamura, Y.; Okazaki, O.; Oshiro, K.; Ozawa, T.; Saito, T.; Sakagami, S.; Shimizu, A.; Shiohira, Y.; Tanaka, E.; Uchiyama, T.; Utsugisawa, K.; Tsuji, T.; Wada, A.; Yamada, N.; Bang, S.-M.; Chung, C.-S.; Kang, D. W.; Kim, Y.-K.; Lee, Y.-S.; YeunOh, D.; Yoon, B.-W.; Aizsilniece, I.; Krievins, D.; Kupcs, U.; Pontaga, N.; Rozitis, V.; Stukena, I.; Alekniene, B.; Bagdonas, A.; Basijokiene, V.; Butkiene, Z.; Griskeviciene, V.; Gumbrevicius, G.; Norviliene, R.; Petrauskiene, R.; Stonkus, S.; Vitkauskas, A.; Muller, P.; Rauh, S.; Chin, S. P.; Sim, K. H.; Wan Azman, B. W. A.; Cardoza Amador, J. I.; Gallegos Martínez, J.; Gómez Lara, M.; González Garza, J.; Hernández Gaeta, D. E.; Herver Cabrera, M. J.; Nares Ochoa, F.; Perea Sánchez, R. A.; Romero López, C.; Tanaka Chávez, A.; Vázquez López, M. Á; Velasco Rodríguez, V. M.; Dees, A.; de Kreuk, A. M.; Fijnheer, R.; ten Cate, H.; Jackson, S.; Ockelford, P.; Simpson, D.; Ghanima, W. K.; Schjesvold, F. H.; Stokstad, I.; Torp, R.; Aziz, Z.; Rizvi, N.; Tayyab, G. N.; Arrieta Días, F.; Castillo Leon, R.; Cotrina, R.; Moncada Vilela, Z.; Salas Pérez, M.; Salazar Candiotti, O. C.; Ulloa Pérez, V. R.; Biedrzycka, M.; Bojarska-Los, M.; Goch, A.; Gorska, M.; Gutowska-Jablonska, M.; Jahnz-Rozyk, K.; Krysiak, W.; Mirek-Bryniarska, E.; Ogorek, M.; Sydor, A.; Szczeklik, A.; Walasek, L.; Wrzesinski, K.; Zechowicz, T.; Bettencourt, P.; Ducla Soares, J.; Ferreira, A.; Ferreira, F.; Gomes, F.; Martins, A.; Mello e Silva, A.; Providência, L.; Rodrigues, T.; Santos, F.; Aroutynov, G.; Ershova, O.; Fedorova, T.; Glezer, M. G.; Khatkova, S.; Moiseev, V.; Shilkina, N.; Sotnikov, A.; Chua, G.; Gan, H. W.; Ng, A. W. K.; Ong, T. H.; Tan, R. S.; Tang, O. T.; Gaspar, L.; Kovar, F.; Spisak, V.; Stevlik, J.; Szentivanyi, M.; Flezar, M.; Gorjup, V.; Jereb, M.; Sok, M.; Tratar, G.; Zvan, B.; Adler, D.; Bloy, B.; Dreosti, L. M.; Engelbrecht, J. M.; Janse van Rensburg, H.; Koegelenberg, C. F. N.; Nortje, H.; Quinton, S.; Rabie, W. J.; Rapoport, B. L.; Roodt, A.; Smith, C.; Steenkamp, F. W. F. J.; van Nieuwenhuizen, E.; van Zyl, L.; Bisbe, J.; Castro, A.; Cereto Castro, F.; Conget, F.; Guil, M.; Monreal, M.; Nieto Rodríguez, J.-A.; Tirado Miranda, R.; Tolosa, C.; Trujillo Santos, J.; Villalta, J.; Bertholds, E.; Cwikiel, M.; Laska, A.-C.; Östergren, J.; Själander, A.; Svensson, P.; Timberg, I.; Torstensson, I.; Wiklund, P. G.; Banyai, M.; Baumgartner, I.; Imhof, A.; Jeanneret, C.; Nussbaumer, P.; Schifferli, J. A.; Chuang, K. Y.-C.; Guo, B.-F.; Lee, J. T.; Lin, Y.-H.; Shyu, K.-G.; Permpikul, C.; Pothirat, C.; Wattanathum, A.; Goker, E.; Ilerigelen, B.; Kucukoglu, S.; Nalbantgil, S.; Sirin, H.; Yilmaz, U.; Genyk, S.; Goncharova, Y.; Karpenko, O.; Korzh, O.; Koval, V.; Legkonogov, O.; Perepeliuk, M.; Polyakov, A.; Ryabichenko, T.; Skrebkov, V.; Sorkin, V.; Svyshchenko, Y.; Tseluyko, V.; Vakaliuk, I.; Vatutin, M.; Voronkov, L.; Cohen, A.; Durairaj, R.; Elliott, M.; Kesteven, P.; Luckit, J. K.; Rafferty, P.; Scully, M.; Albrecht, C. R.; Anderson, S.; Benninghoff, M.; Bidair, M.; Birch, T. A.; Brensilver, J.; Chastain, S.; Chen, D.; Comerota, A. J.; Concha, M.; Conrad, S. A.; Cox, M. J.; Daboul, N. Y.; Dexter, J.; Dietrich, D. W.; Fei, R. H.; Fontes, M. L.; French, W. J.; Gonzales, E.; Hazelrigg, M. R.; Heller, B. N.; Heyder, A. M.; Hill, G. T.; Jaffer, A. K.; Jetty, P.; Johnson, G.; Kaatz, S.; Kazimir, M.; Lavender, R. C.; Lawton, C. B.; Lerner, R.; Light, R. W.; Ling, T. G.; Mahal, S.; Manos, P.; Masson, J.; Maynor, K.; McLafferty, R. B.; Mehra, P.; Merli, G. J.; Minkowitz, H. S.; Murray, R. M.; Nadar, V.; Nathanson, A.; Patton, W. F.; Peberdy, M.; Plautz, M.; Pokharel, P.; Quintana, O. E.; Rajamani, K.; Rastogi, P.; Reiter, W. M.; Reyes, J. A.; Schuller, D.; Seibert, A.; Sharma, A.; Simmons, J.; Soff, G. A.; Stein, R. W.; Stoltz, S.; Suen, J.; Thurm, C.; Toe, W.; Updegrove, J. D.; Ward, J. A.; Waxman, K.; Welker, J.; Whittier, F. C.; Wright, P. E.; Wun, T.; Yusen, R. D.; Ziedalski, T. M.

    2013-01-01

    Background The clinically appropriate duration of thromboprophylaxis in hospitalized patients with acute medical illnesses is unknown. In this multicenter, randomized, double-blind trial, we evaluated the efficacy and safety of oral rivaroxaban administered for an extended period, as compared with

  9. Chronic cough postacute respiratory illness in children: a cohort study.

    Science.gov (United States)

    O'Grady, Kerry-Ann F; Drescher, Benjamin J; Goyal, Vikas; Phillips, Natalie; Acworth, Jason; Marchant, Julie M; Chang, Anne B

    2017-11-01

    Data on the aetiology of persistent cough at the transitional stage from subacute to chronic cough (>4 weeks duration) are scarce. We aimed to (1) identify the prevalence of chronic cough following acute respiratory illness (ARI) and (2) determine the diagnostic outcomes of children with chronic cough. Prospective cohort study. A paediatric emergency department (ED) in Brisbane, Australia. Children aged cough. Children were followed weekly for 28 days;those with a persistent cough at day 28 were reviewed by a paediatric pulmonologist. Cough persistence at day 28 and pulmonologist diagnosis. 2586 children were screened and 776 (30%) were ineligible; 839 children (median age=2.3 years, range=0.5 months to 14.7 years, 60% male) were enrolled over 2 years. Most children (n=627, 74.8%) had cough duration of cough irrespective of cough duration at enrolment. The cough was wet in 59/171 (34.5%), dry in 45/171 (26.4%) and variable in 28/171 (16.1%). Of these 117 children , 117 (68.4%) were reviewed by a paediatric pulmonologist. A new and serious chronic lung disease was diagnosed in 36/117 (30.8%) children; 55/117 (47.0%) were diagnosed with protracted bacterial bronchitis. When chronic cough develops post-ARI, clinical review is warranted, particularly if parents report a history of prolonged or recurrent cough. Parents of children presenting acutely to ED with cough should be counselled about the development of chronic cough, as an underlying respiratory condition is not uncommon. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  10. 78 FR 6404 - Agency Information Collection (Survey of Chronic Gastrointestinal Illness in Persian Gulf...

    Science.gov (United States)

    2013-01-30

    ... whether eradication of these bacteria reduces symptoms of chronic diarrhea. An agency may not conduct or... AFFAIRS Agency Information Collection (Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans....'' SUPPLEMENTAL INFORMATION: Titles: a. Survey of Chronic Gastrointestinal Illness in Persian Gulf Veterans, VA...

  11. Parental Involvement of Mothers with Chronic Illness and Children's Academic Achievement

    Science.gov (United States)

    Chen, Yung-Chi; Fish, Marian C.

    2013-01-01

    This study examined how maternal chronic illnesses may affect children's academic achievement through parental involvement. A total of 189 mothers diagnosed with chronic illnesses, such as multiple sclerosis, diabetes, cancer, HIV/AIDS, chronic pain, asthma, myelodysplasic syndrome, and fibromyalgia, and with a child in middle school or high…

  12. Psychological interventions for parents of children and adolescents with chronic illness

    Science.gov (United States)

    Eccleston, Christopher; Palermo, Tonya M; Fisher, Emma; Law, Emily

    2012-01-01

    group was fewer than 10 at post-treatment. Data collection and analysis We included 35 RCTs involving a total of 2723 primary trial participants. Two review authors extracted data from 26 studies. We analysed data using two categories. First, we analysed data by each medical condition across all treatment classes at two time points (immediately post-treatment and the first available follow-up). Second, we analysed data by each treatment class (cognitive behavioural therapy (CBT), family therapy (FT), problem solving therapy (PST) and multisystemic therapy (MST)) across all medical conditions at two time points (immediately post-treatment and the first available follow-up). We assessed treatment effectiveness on six possible outcomes: parent behaviour, parent mental health, child behaviour/disability, child mental health, child symptoms and family functioning. Main results Across all treatment types, psychological therapies that included parents significantly improved child symptoms for painful conditions immediately post-treatment. Across all medical conditions, cognitive behavioural therapy (CBT) significantly improved child symptoms and problem solving therapy significantly improved parent behaviour and parent mental health immediately post-treatment. There were no other effects at post-treatment or follow-up. The risk of bias of included studies is described. Authors' conclusions There is no evidence on the effectiveness of psychological therapies that include parents in most outcome domains of functioning, for a large number of common chronic illnesses in children. There is good evidence for the effectiveness of including parents in psychological therapies that reduce pain in children with painful conditions. There is also good evidence for the effectiveness of CBT that includes parents for improving the primary symptom complaints when available data were included from chronic illness conditions. Finally, there is good evidence for the effectiveness of problem

  13. Psychological interventions for parents of children and adolescents with chronic illness.

    Science.gov (United States)

    Eccleston, Christopher; Palermo, Tonya M; Fisher, Emma; Law, Emily

    2012-08-15

    RCTs involving a total of 2723 primary trial participants. Two review authors extracted data from 26 studies. We analysed data using two categories. First, we analysed data by each medical condition across all treatment classes at two time points (immediately post-treatment and the first available follow-up). Second, we analysed data by each treatment class (cognitive behavioural therapy (CBT), family therapy (FT), problem solving therapy (PST) and multisystemic therapy (MST)) across all medical conditions at two time points (immediately post-treatment and the first available follow-up). We assessed treatment effectiveness on six possible outcomes: parent behaviour, parent mental health, child behaviour/disability, child mental health, child symptoms and family functioning. Across all treatment types, psychological therapies that included parents significantly improved child symptoms for painful conditions immediately post-treatment. Across all medical conditions, cognitive behavioural therapy (CBT) significantly improved child symptoms and problem solving therapy significantly improved parent behaviour and parent mental health immediately post-treatment. There were no other effects at post-treatment or follow-up. The risk of bias of included studies is described. There is no evidence on the effectiveness of psychological therapies that include parents in most outcome domains of functioning, for a large number of common chronic illnesses in children. There is good evidence for the effectiveness of including parents in psychological therapies that reduce pain in children with painful conditions. There is also good evidence for the effectiveness of CBT that includes parents for improving the primary symptom complaints when available data were included from chronic illness conditions. Finally, there is good evidence for the effectiveness of problem solving therapy delivered to parents on improving parent problem solving skills and parent mental health. All effects are

  14. Anatomical brain images alone can accurately diagnose chronic neuropsychiatric illnesses.

    Directory of Open Access Journals (Sweden)

    Ravi Bansal

    Full Text Available OBJECTIVE: Diagnoses using imaging-based measures alone offer the hope of improving the accuracy of clinical diagnosis, thereby reducing the costs associated with incorrect treatments. Previous attempts to use brain imaging for diagnosis, however, have had only limited success in diagnosing patients who are independent of the samples used to derive the diagnostic algorithms. We aimed to develop a classification algorithm that can accurately diagnose chronic, well-characterized neuropsychiatric illness in single individuals, given the availability of sufficiently precise delineations of brain regions across several neural systems in anatomical MR images of the brain. METHODS: We have developed an automated method to diagnose individuals as having one of various neuropsychiatric illnesses using only anatomical MRI scans. The method employs a semi-supervised learning algorithm that discovers natural groupings of brains based on the spatial patterns of variation in the morphology of the cerebral cortex and other brain regions. We used split-half and leave-one-out cross-validation analyses in large MRI datasets to assess the reproducibility and diagnostic accuracy of those groupings. RESULTS: In MRI datasets from persons with Attention-Deficit/Hyperactivity Disorder, Schizophrenia, Tourette Syndrome, Bipolar Disorder, or persons at high or low familial risk for Major Depressive Disorder, our method discriminated with high specificity and nearly perfect sensitivity the brains of persons who had one specific neuropsychiatric disorder from the brains of healthy participants and the brains of persons who had a different neuropsychiatric disorder. CONCLUSIONS: Although the classification algorithm presupposes the availability of precisely delineated brain regions, our findings suggest that patterns of morphological variation across brain surfaces, extracted from MRI scans alone, can successfully diagnose the presence of chronic neuropsychiatric disorders

  15. Continuity in care trajectories of older chronically ill patients in a battlefield of competing rationales.

    Science.gov (United States)

    Kjerholt, Mette; Wagner, Lis; Delmar, Charlotte; Clemensen, Jane; Lindhardt, Tove

    2014-12-01

    Continuity is crucial when caring for older chronically ill patients. Research has shown that the integration of patients' own perspectives on their situation is of utmost importance for continuity and quality of care. Studies have, however, demonstrated a number of problems with health professionals' communication concerning older patients, leading to lack of continuity and integration of the patient perspective in care and treatment. In spite of these problems being well investigated, they continue to prevail. To examine conditions for continuity and integration of the patient perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients. Explorative Participatory Action Research (PAR). An acute, general medical ward at a Danish university hospital. Hospital and municipality nurses (n = 29). Nursing records (n = 12). Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis. Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient perspective in care trajectories of older, chronically ill patients. Although they adhered to these ideals, they rarely pursued them in practice. Hindering factors were: organisational values, episodic focus on patients and lack of time. They felt caught in a value conflict between nursing professional values and system values, which caused a feeling of powerlessness, maintaining status quo in their clinical practice. The prevailing episodic focus and the competing rationales on the ward constituted a barrier to continuity and integration of the patient perspective in a comprehensive way. © 2013 Blackwell Publishing Ltd.

  16. Questioning the Search for Illness Narratives in Medical Anthropology: Can we talk about actual pain experiences?

    DEFF Research Database (Denmark)

    Tørring, Marie Louise

    BACKGROUND: This critique stems from a self-experienced frustration with the perspectives offered by current medical anthropology, when faced with informants in severe, acute pain. AIM: By shifting between discussing former and current academic approaches to pain in anthropology and examining...... to be of therapeutic value in it-self. However captivating, this dual approach may bring severe limitations to the field of medical anthropology by 1) guiding our choice of study objects, e.g., people in chronic pain in preference to people in acute pain, and 2) by promoting equivocal ideas of a fundamental...... (the urge to escape cultural essentialism) but also reflects a current epistemological trend in much medical anthropology, namely the fascination by illness narratives. The illness narrative (of the patient) is said to offer unique insights into the human experience of pain, and is equally believed...

  17. Accuracy of triage for children with chronic illness and infectious symptoms.

    Science.gov (United States)

    Seiger, Nienke; van Veen, Mirjam; Steyerberg, Ewout W; van der Lei, Johan; Moll, Henriëtte A

    2013-12-01

    This prospective observational study aimed to assess the validity of the Manchester Triage System (MTS) for children with chronic illnesses who presented to the emergency department (ED) with infectious symptoms. Children (diarrhea/vomiting, or fever were included. Chronic illness was classified on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification, codes. The validity of the MTS was assessed by comparing the urgency categories of the MTS with an independent reference standard on the basis of abnormal vital signs, life-threatening working diagnosis, resource utilization, and follow-up. Overtriage, undertriage, and correct triage were calculated for children with and without a chronic illness. The performance was assessed by sensitivity, specificity, and diagnostic odds ratios, which were calculated by dichotomizing the MTS into high and low urgency. Of the 8592 children who presented to the ED with infectious symptoms, 2960 (35%) had a chronic illness. Undertriage occurred in 16% of children with chronic illnesses and in 11% of children without chronic illnesses (P children with chronic illnesses was 58% (95% confidence interval [CI]: 53%-62%) and was 74% (95% CI: 70%-78%) for children without chronic illnesses. There was no difference in specificity between the 2 groups. The diagnostic odds ratios for children with and without chronic illnesses were 4.8 (95% CI: 3.9-5.9) and 8.7 (95% CI: 7.1-11), respectively. In children presenting with infectious symptoms, the performance of the MTS was lower for children with chronic illnesses than for children without chronic illnesses. Nurses should be particularly aware of undertriage in children with chronic illnesses.

  18. Strategies of normalization used by parents of chronically ill school age children.

    Science.gov (United States)

    Bossert, E; Holaday, B; Harkins, A; Turner-Henson, A

    1990-01-01

    The concept of normalization is examined in relation to chronically ill children. From this conceptual base, the responses of 365 parents in a survey of chronically ill children's use of time out of school, were analyzed to determine the normalization strategies used pertaining to the life of the child and family. This article discusses the appropriateness and importance of normalization, and presents implications for the professional nurse working with families of chronically ill children.

  19. Uricosuric medications for chronic gout.

    Science.gov (United States)

    Kydd, Alison S R; Seth, Rakhi; Buchbinder, Rachelle; Edwards, Christopher J; Bombardier, Claire

    2014-11-14

    Uricosuric agents have long been used in the treatment of gout but there is little evidence regarding their benefit and safety in this condition. To assess the benefits and harms of uricosuric medications in the treatment of chronic gout. We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 4, 2013), Ovid MEDLINE and Ovid EMBASE for studies to the 13 May 2013. We also searched the World Health Organization Clinical Trials Registry, ClinicalTrials.gov and the 2011 to 2012 American College of Rheumatology and European League against Rheumatism abstracts. WE considered black box warnings and searched drug safety databases to identify and describe rare adverse events. We considered all randomised controlled trials (RCTs) or quasi-randomised controlled trials (controlled clinical trials (CCTs)) that compared uricosuric medications (benzbromarone, probenecid or sulphinpyrazone) alone or in combination with another therapy (placebo or other active uric acid-lowering medication, or non-pharmacological treatment) in adults with chronic gout for inclusion. Two review authors independently selected the studies for inclusion, extracted data and performed a risk of bias assessment. Main outcomes were frequency of acute gout attacks, serum urate normalisation, study participant withdrawal due to adverse events, total adverse events, pain reduction, function and tophus regression. The search identified four RCTs and one CCT that evaluated the benefit and safety of uricosurics for gout. One study (65 participants) compared benzbromarone with allopurinol for a duration of four months; one compared benzbromarone with allopurinol (36 participants) for a duration of nine to 24 months; one study (62 participants) compared benzbromarone with probenecid for two months and one study (74 participants) compared benzbromarone with probenecid. One study (37 participants) compared allopurinol with probenecid. No study was completely free from bias

  20. What the Classroom Teacher Needs to Know about Children with Chronic Medical Problems.

    Science.gov (United States)

    Frieman, Barry B.; Settel, Joanne

    1994-01-01

    Explains the causes and symptoms of four chronic diseases (asthma, diabetes, epilepsy, and sickle cell anemia) that afflict large numbers of children, and discusses specific classroom medical procedures that teachers can use to help children with these diseases. Also provides suggestions for working with parents of chronically ill children and…

  1. Access to Mobile Communication Technology and Willingness to Participate in Automated Telemedicine Calls Among Chronically Ill Patients in Honduras

    Science.gov (United States)

    Mendoza-Avelares, Milton O.; Milton, Evan C.; Lange, Ilta; Fajardo, Roosevelt

    2010-01-01

    Abstract Objectives: Patients in underdeveloped countries may be left behind by advances in telehealthcare. We surveyed chronically ill patients with low incomes in Honduras to measure their use of mobile technologies and willingness to participate in mobile disease management support. Materials and Methods: 624 chronically ill primary care patients in Honduras were surveyed. We examined variation in telephone access across groups defined by patients' sociodemographic characteristics, diagnoses, and access to care. Logistic regression was used to identify independent correlates of patients' interest in automated telephonic support for disease management. Results: Participants had limited education (mean 4.8 years), and 65% were unemployed. Eighty-four percent had telephone access, and 78% had cell phones. Most respondents had voicemail (61%) and text messaging (58%). Mobile technologies were particularly common among patients who had to forego clinic visits and medications due to cost concerns (each p 80%) reported that they would be willing to receive automated calls focused on appointment reminders, medication adherence, health status monitoring, and self-care education. Patients were more likely to be willing to participate in automated telemedicine services if they had to cancel a clinic appointment due to transportation problems or forego medication due to cost pressures. Conclusions: Even in this poor region of Honduras, most chronically ill patients have access to mobile technology, and most are willing to participate in automated telephone disease management support. Given barriers to in-person care, new models of mobile healthcare should be developed for chronically ill patients in developing countries. PMID:21062234

  2. Pre-travel advice seeking from GPs by travellers with chronic illness seen at a travel clinic.

    Science.gov (United States)

    Gagneux-Brunon, Amandine; Andrillat, Carole; Fouilloux, Pascale; Daoud, Fatiha; Defontaine, Christiane; Charles, Rodolphe; Lucht, Frédéric; Botelho-Nevers, Elisabeth

    2016-03-01

    Travellers are ageing and frequently report chronic illness. Pre-travel health advice is crucial, particularly in this subgroup, and general practitioners (GPs) are first in line for treatment adjustment before departure. Our aim is to evaluate pre-travel health advice seeking from GPs by travellers with chronic illness seen at a travel clinic. A cross-sectional observational survey using a questionnaire was conducted between August 2013 and July 2014 in travellers attending the travel medicine clinic of a tertiary university hospital in France. During the study, 2019 travellers were included. Mean age was 39.4 years (±18.8). Three hundred and ninety-one (19.4%) travellers reported a history of a chronic illness. Arterial hypertension and diabetes mellitus were the most frequently reported illnesses, affecting, respectively, 168 (8.3%) travellers and 102 (5.1%). Hajj pilgrims were more likely to report a history of chronic illness than other travellers. Only 810 (40.1%) travellers sought pre-travel advice from their GP. Six hundred and fifty-two (40.1%) healthy travellers and 158 (40.5%) travellers reporting chronic illness sought pre-travel advice from their GP (P = 0.96). Travellers with a history of chronic illness do not seek pre-travel health advice from their GP more frequently than healthy travellers. Travel health specialists are generally not the best practitioners to manage the care of underlying medical conditions presenting risks during travel. However, GPs offer continuity and disease management expertise to improve the specificity of pre-travel planning. Thus, ongoing collaboration between the traveller, GP and travel health specialist is likely to yield the best outcomes. © International Society of Travel Medicine, 2016. All rights reserved. Published by Oxford University Press. For permissions, please e-mail: journals.permissions@oup.com.

  3. Health Vlogs as Social Support for Chronic Illness Management.

    Science.gov (United States)

    Huh, Jina; Liu, Leslie S; Neogi, Tina; Inkpen, Kori; Pratt, Wanda

    2014-08-01

    Studies have shown positive impact of video blogs (vlogs) on patient education. However, we know little on how patient-initiated vlogs shape the relationships among vloggers and viewers. We qualitatively analyzed 72 vlogs on YouTube by users diagnosed with HIV, diabetes, or cancer and 1,274 comments posted to the vlogs to understand viewers' perspectives on the vlogs. We found that the unique video medium allowed intense and enriched personal and contextual disclosure to the viewers, leading to strong community-building activities and social support among vloggers and commenters, both informationally and emotionally. Furthermore, the unique communication structure of the vlogs allowed ad hoc small groups to form, which showed different group behavior than typical text-based social media, such as online communities. We provide implications to the Health Care Industry (HCI) community on how future technologies for health vlogs could be designed to further support chronic illness management.

  4. Chronical Illness and the Issue of Context in Dietary Counselling

    DEFF Research Database (Denmark)

    Kristensen, Søren Tange

    In dietary counselling contextual food and eating issues are increasingly considered important when trying to promote dietary change. Besides transferring knowledge on healthy eating based on an assessment of the nutritional adequacy of clients diet priority is given to obtain the full dietary...... food and eating issues are taken into account in dietary counselling and how this reflects broader epistemological and political issues related to the prevention and management of chronic illness. A concluding statement from the study is that in order to empower clients, the complexity and contextual...... nature of food and eating needs to be addressed in a more systematic and critical way than is usually the case in dietary counselling. A narrative approach informed by insights from qualitative research on food and eating is suggested as a more context sensitive approach....

  5. Management of Chronic Kidney Disease Patients in the Intensive Care Unit: Mixing Acute and Chronic Illness.

    Science.gov (United States)

    De Rosa, Silvia; Samoni, Sara; Villa, Gianluca; Ronco, Claudio

    2017-01-01

    Patients with chronic kidney disease (CKD) are at high risk for developing critical illness and for admission to intensive care units (ICU). 'Critically ill CKD patients' frequently develop an acute worsening of renal function (i.e. acute-on-chronic, AoC) that contributes to long-term kidney dysfunction, potentially leading to end-stage kidney disease (ESKD). An integrated multidisciplinary effort is thus necessary to adequately manage the multi-organ damage of those kidney patients and contemporaneously reduce the progression of kidney dysfunction when they are critically ill. The aim of this review is to describe (1) the pathophysiological mechanisms underlying the development of AoC kidney dysfunction and its role in the progression toward ESKD; (2) the most common clinical presentations of critical illness among CKD/ESKD patients; and (3) the continuum of care for CKD/ESKD patients from maintenance hemodialysis/peritoneal dialysis to acute renal replacement therapy performed in ICU and, vice-versa, for AoC patients who develop ESKD. © 2017 S. Karger AG, Basel.

  6. Building a measure of fatigue: the functional assessment of Chronic Illness Therapy Fatigue Scale.

    Science.gov (United States)

    Smith, Eleanor; Lai, Jin-Shei; Cella, David

    2010-05-01

    The shared goal of all clinical disciplines is to optimize the well-being of people who become patients and find themselves diminished by illness and recovery. This goal relies on sound tools to evaluate both real and perceived deficits in a way that can be used for a particular patient over time and also across medical disciplines and patient populations. Fatigue is a critical and notoriously subjective aspect of many illnesses. Although the soundness of research is often correlated with the objectivity of data, certain clinical measures must, by definition, be patient centered, with all the complexities and challenges of patient-reported evaluations. Measurement of fatigue has been an important and evolving component of symptom management in the field of oncology. The Functional Assessment of Chronic Illness Therapy Fatigue Scale is a self-administered fatigue-assessment tool that has found wide application across diverse medical fields and that has demonstrated validity and utility across a broad range of populations. The Functional Assessment of Chronic Illness Therapy Fatigue Scale has become one in a repository of tools in the item banks that are accumulating under the auspices of The Patient-Reported Outcomes Measurement Information System, a National Institutes of Health initiative to deploy the most clinically relevant and technologically agile tools that we have to advance research in medicine and patient care. As much as with any other discipline, physical medicine and rehabilitation stands to gain from the collective knowledge and creative horizons in the assessment and treatment of fatigue. Copyright (c) 2010 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.

  7. Mental illness and the right to refuse lifesaving medical treatment.

    Science.gov (United States)

    Lang, Kathryn

    2002-01-01

    The legal and ethical debate surrounding the right of mentally ill patients to refuse life saving medical treatment is one area in the spectrum of patient rights that the medical community has failed to fully explore. To better investigate this concept, it is important to first focus on the history of the right to refuse treatment for all patients. Case studies then explore arguments on both sides of the issue, and focus discussion on the inadequacies of the current standards, a need for further study and universal testing principles in order to provide all patients with the rights they deserve.

  8. Mental illness stigma among medical students and teachers.

    Science.gov (United States)

    Janoušková, Miroslava; Weissová, Aneta; Formánek, Tomáš; Pasz, Jiří; Bankovská Motlová, Lucie

    2017-12-01

    Medical school curriculum contributes to future doctors' attitude formation towards people with mental illness. The purpose of this study was to compare stigmatizing attitudes between medical students and faculty, analyse stigmatizing attitudes among students from different years of study and identify factors predicting stigma. A cross-sectional study with the use of scales measuring attitudes and social distance was designed. Online questionnaires were distributed to all students and teachers at a medical faculty in the Czech Republic. The response rate was 32.1% ( n = 308) among students and 26.7% ( n = 149) among teachers. Teachers had a greater prevalence of stigmatizing attitudes than students. Increased tolerant attitudes in students were detected after the fourth year, that is, following introduction to psychiatry. Preferred specialization in psychiatry and attending two psychiatry courses predicted more tolerant attitudes. Among both students and teachers, men possessed more stigmatizing attitudes towards people with mental illness. Age was an important predictor of stigmatizing attitudes among teachers. Educators should pay closer attention to the role of medical psychology and communication training implementation, which may be beneficial to improving skills and increasing medical students' self-esteem and feeling of competence throughout their psychiatry rotation.

  9. Thinking positively about chronic illness: An exploration of optimism, illness perceptions and well-being in patients with Parkinson's disease.

    Science.gov (United States)

    Hurt, Catherine S; Burn, David J; Hindle, John; Samuel, Mike; Wilson, Ken; Brown, Richard G

    2014-05-01

    Holding positive beliefs about illness and having an optimistic outlook have been associated with increased well-being across a range of health conditions. However, research has indicated that being very optimistic may not actually be beneficial, and holding a realistic attitude is more adaptive in some forms of chronic illness, for example, Parkinson's disease (PD). This study aimed to explore the nature of relationships between illness perceptions, optimism and well-being: specifically, whether a linear or non-linear relationship best described the data. Additionally, the proposed moderating effect of optimism on the relationship between illness perceptions and well-being was tested. A total of 109 participants with idiopathic PD completed questionnaire measures of illness perception, optimism, mood and health-related quality of life (HRQoL). Multiple regression analyses were used to explore relationships between illness perceptions, optimism, mood and HRQoL. The potential curvilinear effects of illness perceptions and optimism were modelled using squared variables and linear and quadratic curve estimation. Holding positive illness perceptions predicted better well-being. Some evidence for a non-linear relationship between optimism and mood was found. Optimism had a significant moderating effect on the relationship between specific illness perceptions and outcome. Optimism appears to provide protection against some negative perceptions of illness and was associated with better mood and HRQoL. The findings indicate that specific illness perceptions may be beneficial targets for therapy. Therapeutic interventions should focus on enhancing positive perceptions of PD but potentially more importantly general optimistic attitude to maximize well-being. What is already known on this subject? Positive illness perceptions and high optimism are associated with better well-being in a range of conditions, both chronic and acute. Preliminary studies suggest that in chronic

  10. Seen through the patients' eyes: Safety of chronic illness care.

    Science.gov (United States)

    Desmedt, Melissa; Petrovic, Mirko; Bergs, Jochen; Vandijck, Dominique; Vrijhoef, Hubertus; Hellings, Johan; Vermeir, Peter; Cool, Lieselot; Dessers, Ezra

    2017-11-01

    Due to the increasing burden of chronic diseases, a considerable part of care delivery will continue to shift from secondary to primary care, and home care settings. Despite the growing importance of primary care, concerns about the safety of patients in hospitals have thus far driven most research in the field. Therefore, the present study sought to explore patients' perceptions and experiences of the safety of primary chronic care. An observational, cross-sectional study design was applied. Participants were recruited from the Flemish Patients' Platform, an independent organization that defends patients' rights and strives for more care quality. An online questionnaire was designed to assess: socio-demographic characteristics, medical consumption and patients' perspectives of the quality and safety of chronic care. Respondents (n = 339) had positive perceptions of the safety of primary chronic care as they indicated to receive safe care at home (68.1%), receive enough care support at home (70.8%) and experience good communication between their healthcare professionals (51.6%). Almost one quarter of respondents experienced an incident, mainly related to self-reported fall incidents (50.4%), wrong diagnoses or treatments (37.8%) and adverse drug events (11.8%). Also, more than half of respondents who experienced an incident (64.9%) indicated that poor communication between their healthcare professionals was the main cause. Information on patients' experiences is critical to identify patient safety incidents and to ultimately reduce patient harm. More research is needed to fully understand patient safety in primary chronic care to further improve patient safety. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  11. Early detection of influenza like illness through medication sales.

    Science.gov (United States)

    Socan, Maja; Erculj, Vanja; Lajovic, Jaro

    2012-06-01

    Monitoring sales of medications is a potential candidate for an early signal of a seasonal influenza epidemic. To test this theory, the data from a traditional, consultation-oriented influenza surveillance system were compared to medication sales and a predictive model was developed. Weekly influenza-like incidence rates from the National Influenza Sentinel Surveillance System were compared to sales of seven groups of medications (nasal decongestants, medicines for sore throat (MST), antitussives, mucolytics, analgo-antipyretics, non-steroidal anti-inflamatory drugs (NSAIDs), betalactam antibiotics, and macrolide antibiotics) to determine the correlation of medication sales with the sentinel surveillance system - and therefore their predictive power. Poisson regression and regression tree approaches were used in the statistical analyses. The fact that NSAIDs do not exhibit any seasonality and that prescription of antibiotics requires a visit to the doctor's office makes the two medication groups inappropriate for predictive purposes. The influenza-like illness (ILI) curve is the best matched by the mucolytics and antitussives sales curves. Distinct seasonality is also observed with MST and decongestants. The model including these four medication groups performed best in prediction of ILI incidence rate using the Poisson regression model. Sales of antitussives proved to be the best single predictive variable for regression tree model. Sales of medication groups included in the model were demonstrated to have a predictive potential for early detection of influenza season. The quantitative information on medication sales proves to be a useful supplementary system, complementing the traditional consultation-oriented surveillance system.

  12. Quick screening tool for patients with severe negative emotional reactions to chronic illness: psychometric study of the negative emotions due to chronic illness screening test (NECIS).

    Science.gov (United States)

    Huang, Yun-Hsin; Wu, Chih-Hsun; Chen, Hsiu-Jung; Cheng, Yih-Ru; Hung, Fu-Chien; Leung, Kai-Kuan; Lue, Bee-Horng; Chen, Ching-Yu; Chiu, Tai-Yuan; Wu, Yin-Chang

    2018-01-16

    Severe negative emotional reactions to chronic illness are maladaptive to patients and they need to be addressed in a primary care setting. The psychometric properties of a quick screening tool-the Negative Emotions due to Chronic Illness Screening Test (NECIS)-for general emotional problems among patients with chronic illness being treated in a primary care setting was investigated. Three studies including 375 of patients with chronic illness were used to assess and analyze internal consistency, test-retest reliability, criterion-related validity, a cut-off point for distinguishing maladaptive emotions and clinical application validity of NECIS. Self-report questionnaires were used. Internal consistency (Cronbach's α) ranged from 0.78 to 0.82, and the test-retest reliability was 0.71 (P emotions, with a sensitivity and specificity of 83.3 and 69.0%, and 68.5 and 83.0%, respectively. The clinical application validity analysis revealed that low NECIS group showed significantly better adaptation to chronic illness on the scales of subjective health, general satisfaction with life, self-efficacy of self-care for disease, illness perception and stressors in everyday life. The NECIS has satisfactory psychometric properties for use in the primary care setting. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  13. Outcomes in critically ill chronic lymphocytic leukemia patients.

    Science.gov (United States)

    Xhaard, Aliénor; Epelboin, Loic; Schnell, David; Vincent, François; Levy, Vincent; Malphettes, Marion; Azoulay, Elie; Darmon, Michaël

    2013-07-01

    Although recent studies have demonstrated an improvement in the prognosis of critically ill cancer patients, little is known regarding the prognosis of patients with non-aggressive underlying malignancies. The aims of this study were to assess the prognosis of critically ill patients with chronic lymphocytic leukemia (CLL) and to evaluate risk factors for hospital mortality. In retrospective mono-center cohort study, consecutive adult patients with CLL requiring ICU admission from 1997 to 2008 were included. Sixty-two patients of 67 years (62-75) were included. Median time interval between CLL diagnosis and ICU admission was 6.7 years (2.6-10.8). Nine patients (15 %) had stage C disease at the time of ICU admission, and seven patients (11 %) had Richter syndrome. Most ICU admissions were related to bacterial or fungal pulmonary infections (n = 47; 76 %). ICU, in-hospital, and 90-day mortality were 35 % (n = 22), 42 % (n = 26), and 58 % (n = 36), respectively. Only three factors were independently associated with in-hospital mortality: oxygen saturation lower than 95 % when breathing room air (odds ratio (OR) 5.80; 95 % confidence interval (CI) 1.23-27.33), need for vasopressors (OR 27.94; 95 % CI 5.37-145.4), and past history of infection (OR 6.62; 95 % CI 1.34-32.68). The final model did not change when disease-related variables (Binet classification, Richter syndrome, long-term steroids) or treatment-related variables (fludarabine, rituximab, or alemtuzumab) were included. Acute pulmonary infections remain the leading cause of ICU admission in patients with CLL. The severity at ICU admission and past history of infection were the only factors associated with hospital mortality. Neither disease characteristics nor previous cancer treatments were associated with outcome.

  14. Perceptions of Chronic Illness Care Among Veterans With Multiple Chronic Conditions.

    Science.gov (United States)

    Balbale, Salva N; Etingen, Bella; Malhiot, Alex; Miskevics, Scott; LaVela, Sherri L

    2016-05-01

    Given the burden of multiple chronic conditions (MCCs) in the Veterans Affairs (VA) Health Care System, understanding perspectives of Veterans with MCC is essential to evaluate chronic care and ensure that care and quality improvement efforts align with patient needs. The purpose of this study was to use the Patient Assessment of Chronic Illness Care (PACIC) instrument to examine perceptions of chronic care among Veterans with MCC. We conducted a nation-wide, cross-sectional mailed survey. Study inclusion criteria were Veteran patients with MCC who receive care from eight VA facilities. The survey included questions on patient demographics, recent hospital or doctor visits, and the PACIC instrument. Chronic condition and health care utilization data were extracted from VA administrative databases. The sample (n = 3,519) was mostly male; average age was 68.1 years. Mean PACIC summary score was 3.05 (standard deviation [SD] = 1.12). Respondents achieved higher scores (favorable perceptions) in the Delivery System Design and Patient Activation subscales, and lowest scores (unfavorable perceptions) in the Follow-up/Coordination subscale. Characteristics associated with higher scores included non-white race, recent VA doctor visit, and high school or less education. Perceptions of chronic care were high; however, quality improvements are needed to enhance care continuity and coordination. Reprint & Copyright © 2016 Association of Military Surgeons of the U.S.

  15. Writing about an experience of illness in medical students.

    Science.gov (United States)

    Hwang, Kun; Fan, Huan; Hwang, Se Won

    2013-01-01

    Pathography is defined as "historical biography from a medical, psychological, and psychiatric viewpoint." We thought that writing about an experience of illness might help students understand patients' experience and in turn grow in terms of self-understanding. Participants included 151 medical students. Students wrote about their own experience of illness and were asked to answer questions from the Likert scale. Most students wrote about themselves (79.2%); however, some students (20.8%) wrote about the illness of others. Among the 149 pathographies, ecopathography was most frequent (30.9%), followed by testimonial pathography (25.5%); angry pathography (13.4%) and alternative pathography (12.1%) were relatively less frequent. Eighty-eight pathographies (59.1%) showed 120 expressions of family relationship. Among the 120 cases, worrying about family members was most frequent (47.5%), followed by reliance on a family member (32.5%). All students wrote about the enlightenment experienced on returning to daily life. The sense of belonging together was most frequent (38.3%), followed by gratitude for living (20.8%), resolution to be a good doctor (18.1%), and a will to live and be healthy (12.1%). Answers on the Likert scale (total 5) for pathography beneficence were very high in understanding desirable doctor image (4.46), attaining morals and personality as a health care professional (4.49), and understanding basic communication skills (4.46). Writing about an experience of illness allows students to better understand patients' experience and to grow in self-understanding.

  16. Health-related financial catastrophe, inequality and chronic illness in Bangladesh.

    Directory of Open Access Journals (Sweden)

    Md Mizanur Rahman

    Full Text Available BACKGROUND: Bangladesh has a high proportion of households incurring catastrophic health expenditure, and very limited risk sharing mechanisms. Identifying determinants of out-of-pocket (OOP payments and catastrophic health expenditure may reveal opportunities to reduce costs and protect households from financial risk. OBJECTIVE: This study investigates the determinants of high healthcare expenditure and healthcare- related financial catastrophe. METHODS: A cross-sectional household survey was conducted in Rajshahi city, Bangladesh, in 2011. Catastrophic health expenditure was estimated separately based on capacity to pay and proportion of non-food expenditure. Determinants of OOP payments and financial catastrophe were estimated using double hurdle and Poisson regression models respectively. RESULTS: On average households spent 11% of their total budgets on health, half the residents spent 7% of the monthly per capita consumption expenditure for one illness, and nearly 9% of households faced financial catastrophe. The poorest households spent less on health but had a four times higher risk of catastrophe than the richest households. The risk of financial catastrophe and the level of OOP payments were higher for users of inpatient, outpatient public and private facilities respectively compared to using self-medication or traditional healers. Other determinants of OOP payments and catastrophic expenses were economic status, presence of chronic illness in the household, and illness among children and adults. CONCLUSION: Households that received inpatient or outpatient private care experienced the highest burden of health expenditure. The poorest members of the community also face large, often catastrophic expenses. Chronic illness management is crucial to reducing the total burden of disease in a household and its associated increased risk of level of OOP payments and catastrophic expenses. Households can only be protected from these situations by

  17. The importance of productive patient–professional interaction for the well-being of chronically ill patients

    NARCIS (Netherlands)

    J.M. Cramm (Jane); A.P. Nieboer (Anna)

    2014-01-01

    markdownabstract__Abstract__ Objective To investigate patient–professional interactions and identify the association between quality of care, productivity of patient–professional interaction, and chronically ill patients’ well-being. Methods Questionnaires were distributed to chronically ill

  18. Gratitude uniquely predicts lower depression in chronic illness populations: A longitudinal study of inflammatory bowel disease and arthritis.

    Science.gov (United States)

    Sirois, Fuschia M; Wood, Alex M

    2017-02-01

    Although gratitude has been identified as a key clinically relevant trait for improving well-being, it is understudied within medical populations. The current study addressed this gap and extended previous and limited cross-sectional research by examining the longitudinal associations of gratitude to depression in 2 chronic illness samples, arthritis and inflammatory bowel disease (IBD). Two chronic illness samples, arthritis (N = 423) and IBD (N = 427), completed online surveys at Time 1 (T1). One hundred sixty-three people with arthritis and 144 people with IBD completed the 6-month follow-up survey (T2). Depression, gratitude, illness cognitions, perceived stress, social support, and disease-related variables were assessed at T1 and T2. At T2, 57.2% of the arthritis sample and 53.4% of the IBD sample met the cut off scores for significant depression. T1 gratitude was negatively associated with depressive symptoms at T1 and T2 in both samples (rs from -.43 to -.50). Regression analyses revealed that T1 gratitude remained a significant and unique predictor of lower T2 depression after controlling for T1 depression, relevant demographic variables, illness cognitions, changes in illness-relevant variables, and another positive psychological construct, thriving, in both samples. As the first investigation of the longitudinal associations of gratitude to psychological well-being in the context of chronic illness, the current study provides important evidence for the relevance of gratitude for health-related clinical populations. Further intervention-based research is warranted to more fully understand the potential benefits of gratitude for adjustment to chronic illness. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  19. Oral health impacts of medications used to treat mental illness.

    Science.gov (United States)

    Cockburn, N; Pradhan, A; Taing, M W; Kisely, S; Ford, P J

    2017-12-01

    Many psychotropic medications affect oral health. This review identified oral side effects for antidepressant, antipsychotic, anticonvulsant, antianxiety and sedative drugs that are recommended in Australia for the management of common mental illnesses and provides recommendations to manage these side-effects. The Australian Therapeutic Guidelines and the Australian Medicines Handbook were searched for medications used to treat common mental health conditions. For each medication, the generic name, class, and drug company reported side-effects were extracted from the online Monthly Index of Medical Specialties (eMIMs) and UpToDate databases. Meyler's Side Effect of Drugs Encyclopaedia was used to identify additional oral adverse reactions to these medications. Fifty-seven drugs were identified: 23 antidepressants, 22 antipsychotics or mood stabilisers, and 12 anxiolytic or sedative medications. Xerostomia (91%) the most commonly reported side effect among all classes of medications of the 28 identified symptoms. Other commonly reported adverse effects included dysguesia (65%) for antidepressants, and tardive dyskinesia (94%) or increased salivation (78%) for antipsychotic medications. While xerostomia has often been reported as a common adverse effect of psychotropic drugs, this review has identified additional side effects including dysguesia from antidepressants and tardive dyskinesia and increased salivation from antipsychotics. Clinicians should consider oral consequences of psychotropic medication in addition to other side-effects when prescribing. For antidepressants, this would mean choosing duloxetine, agomelatine and any of the serotonin re-uptake inhibitors except sertraline. In the case of antipsychotics and mood stabilisers, atypical agents have less oral side effects than older alternatives. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. A tool for tracking and assessing chronic illness care in prison (ACIC-P).

    Science.gov (United States)

    Wang, Emily A; Aminawung, Jenerius A; Ferguson, Warren; Trestman, Robert; Wagner, Edward H; Bova, Carol

    2014-10-01

    Chronic disease care is being transformed in correctional settings, given an aging inmate population, ongoing quality improvement efforts, litigation, and rising costs. The Chronic Care Model, established for chronic disease care in the community, might be a suitable framework to transform chronic disease care in prison, but it has not been systematically adapted for the correctional health care setting. We employed cognitive interviewing to adapt an extant survey used to measure the delivery of chronic illness care in the community, Assessment of Chronic Illness Care, for a prison setting. Results from the cognitive interviews and the modified Assessment of Chronic Illness Care-Prison (ACIC-P) instrument are presented in this article. Future studies will need to test the reliability and psychometric properties of the adapted ACIC-P. © The Author(s) 2014.

  1. Growing up with a chronic illness: social success, educational/vocational distress.

    Science.gov (United States)

    Maslow, Gary R; Haydon, Abigail; McRee, Annie-Laurie; Ford, Carol A; Halpern, Carolyn T

    2011-08-01

    We compared adult educational, vocational, and social outcomes among young adults with and without childhood-onset chronic illness in a nationally representative U.S. sample. We used data from Wave IV (2008) of the National Longitudinal Study of Adolescent Health. We compared respondents who reported childhood-onset cancer, heart disease, diabetes, or epilepsy with young adults without these chronic illnesses in terms of marriage, having children, living with parents, romantic relationship quality, educational attainment, income, and employment. Multivariate models controlled for sociodemographic factors and adult-onset chronic illness. As compared with those without childhood chronic illness, respondents with childhood chronic illness had similar odds of marriage (odds ratios [OR] = .89, 95% CI: .65-1.24), having children (OR = .99, 95% CI: .70-1.42), and living with parents (OR = 1.49, 95% CI .94-2.33), and similar reports of romantic relationship quality. However, the chronic illness group had lower odds of graduating college (OR = .49, 95% CI: .31-.78) and being employed (OR = .56, 95% CI: .39-.80), and higher odds of receiving public assistance (OR = 2.13, 95% CI: 1.39-3.25), and lower mean income. Young adults growing up with chronic illness succeed socially, but are at increased risk of poorer educational and vocational outcomes. Copyright © 2011 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

  2. Online Peer-to-Peer Communities in the Daily Lives of People With Chronic Illness: A Qualitative Systematic Review.

    Science.gov (United States)

    Kingod, Natasja; Cleal, Bryan; Wahlberg, Ayo; Husted, Gitte R

    2017-01-01

    This qualitative systematic review investigated how individuals with chronic illness experience online peer-to-peer support and how their experiences influence daily life with illness. Selected studies were appraised by quality criteria focused upon research questions and study design, participant selection, methods of data collection, and methods of analysis. Four themes were identified: (a) illness-associated identity work, (b) social support and connectivity, (c) experiential knowledge sharing, and (d) collective voice and mobilization. Findings indicate that online peer-to-peer communities provide a supportive space for daily self-care related to chronic illness. Online communities provided a valued space to strengthen social ties and exchange knowledge that supported offline ties and patient-doctor relationships. Individuals used online communities to exchange experiential knowledge about everyday life with illness. This type of knowledge was perceived as extending far beyond medical care. Online communities were also used to mobilize and raise collective awareness about illness-specific concerns. © The Author(s) 2016.

  3. Chronic illness self-management: a mechanism behind the relationship between neighbourhood social capital and health?

    Science.gov (United States)

    Waverijn, Geeke; Heijmans, Monique; Groenewegen, Peter P

    2017-08-01

    Neighbourhood social capital might provide resources that can benefit chronic illness self-management. Improved self-management is a possible mechanism behind the relationship between neighbourhood social capital and health of people with chronic illness. To test this mechanism, we collected data on self-management and self-rated health among a sample of 2091 people with chronic illness in 2013. Data on neighbourhood social capital were collected among 69 336 people in 3425 neighbourhoods between May 2011 and September 2012. A social capital measure was estimated with ecometric measurements. We conducted mediation analyses to examine whether the relationship between neighbourhood social capital and self-rated health was mediated through chronic illness self-management. We found that neighbourhood social capital is related to chronic illness self-management only for people with chronic illness and mild physical disabilities and that, for this group, self-management mediates the relationship between neighbourhood social capital and health. Improved self-management is a mechanism behind the relationship between neighbourhood social capital and health for people with chronic illness and mild physical disabilities. It is possible that the self-management support needs of people with chronic illness with moderate or severe physical disabilities cannot be met by the resources provided in neighbourhoods, but more tailored support is necessary. More research is needed to discover mechanisms behind the relationship between neighbourhood social capital and health and elucidate which resources in neighbourhoods can benefit specific groups of people with chronic illness. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  4. Easing Chronic Pain: Better Treatments and Medications

    Science.gov (United States)

    ... Bar Home Current Issue Past Issues Easing Chronic Pain: Better Treatments and Medications Past Issues / Fall 2007 Table of Contents For an enhanced version of this page please turn Javascript on. What Is Pain? You know it at once. It may be ...

  5. An assessment tool for acutely ill medical patients.

    LENUS (Irish Health Repository)

    Gleeson, Margaret

    2012-01-26

    This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.

  6. An assessment tool for acutely ill medical patients.

    LENUS (Irish Health Repository)

    Gleeson, Margaret

    2012-01-31

    This article reports the implementation and impact of a standardized systematic evidence-based predictive score for the initial assessment of acutely ill medical patients. The Simple Clinical Score (SCS) was introduced in the A&E department and the medical floor of the authors\\' hospital between June 2007 and July 2008. The SCS was well received by the staff - 67% felt it greatly improved patient assessment and was very valuable for ensuring appropriate placement of the patient after admission and improved the quality of care. This article describes the change process, the pilot evaluation and the training programme undertaken during the implementation of the SCS. It is hoped that this experience will be of value to other project teams who are undertaking similar initiatives.

  7. Self-esteem of children and adolescents with chronic illness: a meta-analysis.

    Science.gov (United States)

    Pinquart, M

    2013-03-01

    Chronic illness may be a risk factor for low self-esteem; however, previous meta-analyses are inconclusive whether children with a chronic illness have lower self-esteem than their healthy peers. The goal of the present study was to summarize available research in order to compare the self-esteem of children and adolescents with a chronic illness with that of healthy children. Random-effects meta-analysis was used to integrate the results of 621 empirical studies that compare levels of self-esteem of children with a chronic physical illness with healthy peers or general test norms. Studies were identified via the electronic databases Adolesc, Embase, Google Scholar, MEDLINE, PSNYDEX, PSYCINFO, and cross-referencing. Children with chronic illnesses have lower self-esteem than healthy peers or test norms (g = -0.18 standard deviation units). The lowest levels of self-esteem were observed in children with chronic fatigue syndrome and chronic headaches. Lower levels of self-esteem in children with a chronic illness were found in girls than in boys, in adolescents than in children, in children from developing or threshold countries, when results were collected from observer ratings rather than child reports, in studies published in the 1990s, and when children with chronic illnesses were directly compared with healthy children instead of test norms. Paediatricians, parents, and teachers should promote experiences of success and positive peer-relations, which are important sources of self-esteem. In addition, psychosocial interventions for children with chronic illnesses should be offered for children with reduced self-esteem. © 2012 Blackwell Publishing Ltd.

  8. An application of the transactional model to the analysis of chronic illness narratives.

    Science.gov (United States)

    Lee, Andrea M; Poole, Gary

    2005-03-01

    The authors' aim in this study was to describe the chronic illness experience and its relationship to the concept to finding meaning. They conducted interviews using a narrative approach with 15 adults experiencing various chronic illnesses and analyzed narrative data using a combination of holistic-content and categorical-content approaches. The three major categories were the context of the chronic illness experience, personal reactions, and coping efforts. These categories were best interpreted in terms of a transactional model. The authors categorized finding meaning under cognitive coping strategies and described it as a strategy that was part of a larger coping repertoire.

  9. A Middle-Range Theory of Self-Care of Chronic Illness

    OpenAIRE

    Riegel, Barbara; Jaarsma, Tiny; Strömberg, Anna

    2012-01-01

    Nearly 50% of adults have one or more chronic illnesses. Self-care is considered essential in the management of chronic illness, but the elements of self-care in this context have not been specified in a middle-range theory. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. The key concepts include self-care maintenance, self-care monitor...

  10. Preserving Self: Medication-Taking Practices and Preferences of Older Adults With Multiple Chronic Medical Conditions.

    Science.gov (United States)

    Vandermause, Roxanne; Neumiller, Joshua J; Gates, Brian J; David, Prabu; Altman, Molly; Healey, Daniel J; Benson, Patricia; Sunwold, Duane; Burton, Gail; Tuttle, Katherine R; Corbett, Cynthia F

    2016-11-01

    To examine the experiences of older adults with multiple chronic medical conditions when a new medication was added to their existing multiple medication regimen. A multimethod qualitative design was used. Thirty adults 60 years of age with (a) at least three chronic medical diagnoses, (b) at least five medications at baseline, and (c) a new medication prescription were enrolled in a prospective study of 30 days duration, participating from their homes. In-depth hermeneutic interviews (2 per 15 participants) and self-assessment diaries recorded on electronic tablets (daily per 30 participants) were completed. Transcribed interviews and self-recorded survey data were analyzed using hermeneutical analysis and ecological momentary assessment and content analysis, respectively. Common reasons participants did not take medications as prescribed included tolerability, transportation, access to medications, and forgetting. The overarching pattern, "preserving self," was supported by two patterns that subsumed several themes: (a) engaging the powerful hold of my illness, and (b) engaging providers in visioning health. A deeper understanding of the impact of receiving a new prescription and of managing medication reveals the challenges patients experience in preserving a sense of self. Healthcare providers of all disciplines should understand the meaning of medication prescribing and medication taking to ameliorate medication-taking difficulties. The provider-patient relationship is often cited as an area that needs to be addressed in healthcare practice. Our study emphasized the patients' voices and their profound needs around medication management. The emphasis on preservation of self is an important finding that focalizes the concern. © 2016 Sigma Theta Tau International.

  11. Parent Preferences for Shared Decision-making in Acute Versus Chronic Illness.

    Science.gov (United States)

    Tom, Dina M; Aquino, Christian; Arredondo, Anthony R; Foster, Byron A

    2017-10-01

    The goal of this study was to examine preferences for shared decision-making (SDM) in parents of acutely ill versus chronically ill children in the inpatient setting. Additionally, we explored the effect of parental perception of illness severity and uncertainty in illness on decision-making preference. In this cross-sectional study, we surveyed parents of children admitted to pediatric inpatient units at an academic, tertiary-care hospital. Surveys were administered in person and used validated tools to assess SDM preferences and uncertainty in illness. Descriptive statistics evaluated associations stratified by acute versus chronic illness, and multivariable analyses were performed. Of the 200 parents who participated, the majority were women (78%), Hispanic (81.5%), English speaking (73%), between 30 and 39 years old (37.5%), and had an education achievement of less than a college degree (77%). The mean age of hospitalized children was 8.1 years, and half reported a chronic illness. Most parents preferred an active (43%) or collaborative (40%) role in SDM. There was no association with SDM preference by demographics, number of previous hospitalizations, perception of illness severity, or uncertainty. However, parents of chronically ill children significantly preferred a passive role in SDM when they perceived a high level of uncertainty in illness. Most parents of hospitalized children prefer to take an active or collaborative role in SDM. However, parents of chronically ill children who perceive high levels of uncertainty surrounding their children's illness prefer a passive role, thus illustrating the complexity in decision-making among this parent population. Copyright © 2017 by the American Academy of Pediatrics.

  12. Women's self-management of chronic illnesses in the context of caregiving: a grounded theory study.

    Science.gov (United States)

    Martinez-Marcos, Mercedes; De la Cuesta-Benjumea, Carmen

    2015-06-01

    Uncover how women self-manage their own chronic illness while taking care of a dependent relative. International policies place special emphasis in promoting interventions addressed to control, prevent and care for people with chronic health conditions. Self-management is a crucial part of this care. Caregivers are more prone to have chronic illness than non-caregivers. They are confronted with dilemmas about taking care of themselves while taking care of their dependent relative and the rest of their families. Caregivers articulate strategies to enable them to focus their energy on caring. Qualitative study using constructivist grounded theory. Thirty-nine women caregivers with a chronic illness participated in the study. Twenty-three semi-structured interviews and two focus groups were carried out between April 2010-December 2011. Data were analysed using grounded theory procedures. Self-management helps women caregivers with a chronic illness to balance the demands of their own illness and those of the dependent relative. They self-manage their illness by self-regulating the treatment, by regulating their strength and by controlling their emotions. Women caregivers integrate effectively and creatively the management of their chronic illnesses within the complexities of family care. This renders their health needs invisible and reaffirms them as capable caregivers. Identifying self-management strategies of women caregivers allow health professionals to acknowledge and reinforce effective self-care measures and to deter those that are ineffective and lessen their quality of life. © 2014 John Wiley & Sons Ltd.

  13. Socioeconomic variation in the financial consequences of ill health for older people with chronic diseases: a systematic review.

    Science.gov (United States)

    Valtorta, Nicole K; Hanratty, Barbara

    2013-04-01

    Chronic disease has financial consequences for older adults, but it is unclear how this varies between conditions with different disease trajectories. The aim of this study was to review evidence on the financial burden associated with cancer, heart failure or stroke in older people, to identify those most at risk of financial adversity. We systematically searched nine databases for studies with data on the illness-related financial burden (objective), or on the perception of financial hardship (subjective), of older patients and/or their informal caregivers in high-income countries. We identified thirty-eight papers published in English between 1984 and 2012. Studies fell into three categories: those reporting direct, out of pocket, costs (medical and/or non-medical); studies of the indirect costs associated with illness (such as wage or income loss); and papers reporting general financial or economic burdens secondary to illness. Three out of four studies focused on people with cancer. More affluent people had greater out of pocket costs, but were less financially burdened by illness, compared with older adults from lower socioeconomic backgrounds. Disadvantaged patients and families were more likely to report experiences of financial hardship, and spend a higher proportion of their income on all expenses related to their diagnoses. This review illustrates how little is known about the financial adversity experienced by patients with some common chronic conditions. It raises the possibility that higher expenditure by more affluent older people may be creating inequalities in how chronic illness is experienced. The development of effective strategies for financial protection at older ages will require more information on who is affected and at which point in their illness trajectory. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  14. Selective responsiveness of chronically ill children to assessments of depression.

    Science.gov (United States)

    Worchel, F F; Rae, W A; Olson, T K; Crowley, S L

    1992-12-01

    Many investigators have noted that depression is a common symptom among pediatric cancer patients. However, prevalence rates vary widely across studies. This variation in prevalence rates may be due, in part, to selective reporting of patients based on measures used and environmental cues. In this study, we evaluated 50 chronically ill pediatric patients (19 cancer and 31 diabetic patients) for their use of selective reporting of depression. Factors in the 2 x 2 design were Intervention (disclosure videotape and cartoon videotape) and Examiner (familiar examiner and unfamiliar examiner). In the Intervention manipulation, subjects were shown either a videotape prompting the child that self-disclosure was appropriate or a tape of a cartoon (control condition). In the Examiner manipulation, subjects were administered the experimental measures by either a familiar (parent) or unfamiliar (research assistant) examiner. Dependent variables were the Children's Depression Inventory (CDI; Kovacs, 1981), the Depression scale of the Roberts Apperception Test for Children (RATC; McArthur & Roberts, 1982), and a depression measure taken from the Child Behavior Checklist (CBCL; Achenbach & Edelbrock, 1983). As hypothesized, the Examiner x Intervention interaction revealed that children who did not view the disclosure videotape and who were tested by an unfamiliar examiner gave significantly lower self-reports of depression on the CDI than children in the other conditions. However, parent and child projective reports of depression did not vary as a function of experimental condition. The results are interpreted as selective responding on the part of pediatric patients. Limitations of assessing internal psychological states in children are discussed.

  15. Blood Biomarkers of Chronic Inflammation in Gulf War Illness.

    Directory of Open Access Journals (Sweden)

    Gerhard J Johnson

    Full Text Available More than twenty years following the end of the 1990-1991 Gulf War it is estimated that approximately 300,000 veterans of this conflict suffer from an unexplained chronic, multi-system disorder known as Gulf War Illness (GWI. The etiology of GWI may be exposure to chemical toxins, but it remains only partially defined, and its case definition is based only on symptoms. Objective criteria for the diagnosis of GWI are urgently needed for diagnosis and therapeutic research.This study was designed to determine if blood biomarkers could provide objective criteria to assist diagnosis of GWI.A surveillance study of 85 Gulf War Veteran volunteers identified from the Department of Veterans Affairs Minnesota Gulf War registry was performed. All subjects were deployed to the Gulf War. Fifty seven subjects had GWI defined by CDC criteria, and 28 did not have symptomatic criteria for a diagnosis of GWI. Statistical analyses were performed on peripheral blood counts and assays of 61 plasma proteins using the Mann-Whitney rank sum test to compare biomarker distributions and stepwise logistic regression to formulate a diagnostic model.Lymphocyte, monocyte, neutrophil, and platelet counts were higher in GWI subjects. Six serum proteins associated with inflammation were significantly different in GWI subjects. A diagnostic model of three biomarkers-lymphocytes, monocytes, and C reactive protein-had a predicted probability of 90% (CI 76-90% for diagnosing GWI when the probability of having GWI was above 70%.The results of the current study indicate that inflammation is a component of the pathobiology of GWI. Analysis of the data resulted in a model utilizing three readily measurable biomarkers that appears to significantly augment the symptom-based case definition of GWI. These new observations are highly relevant to the diagnosis of GWI, and to therapeutic trials.

  16. Longitudinal Model Predicting Self-Concept in Pediatric Chronic Illness.

    Science.gov (United States)

    Emerson, Natacha D; Morrell, Holly E R; Neece, Cameron; Tapanes, Daniel; Distelberg, Brian

    2018-04-16

    Although self-concept has been identified as salient to the psychosocial adjustment of adolescents dealing with a chronic illness (CI), little research has focused on its predictors it. Given that depression and parent-child attachment have been linked to self-concept in the population at large, the goal of this study was to evaluate these relationships longitudinally in a sample of adolescents with CI. Using participant data from the Mastering Each New Direction (MEND) program, a 3-month psychosocial, family based intensive outpatient program for adolescents with CI, we employed multilevel modeling to test longitudinal changes in self-concept, as predicted by depressive symptoms and parent-child attachment, in a sample of 50 youths (M age  = 14.56, SD age  = 1.82) participating in MEND. Both "time spent in the program" and decreases in depressive symptoms were associated with increases in self-concept over time. Higher baseline levels of avoidant attachment to both mother and father were also associated with greater initial levels of self-concept. Targeting depressive symptoms and supporting adaptive changes in attachment may be key to promoting a healthy self-concept in pediatric CI populations. The association between avoidant attachment and higher baseline self-concept scores may reflect differences in participants' autonomy, self-confidence, or depression. Limitations of the study include variability in the amount of time spent in the program, attrition in final time point measures, and the inability to fully examine and model all potential covariates due to a small sample size (e.g. power). © 2018 Family Process Institute.

  17. Attitudes towards mental illness among medical students in China: Impact of medical education on stigma.

    Science.gov (United States)

    Zhu, Yifan; Zhang, Hanwen; Yang, Ge; Hu, Xinran; Liu, Zhening; Guo, Na; He, Hongbo; Sun, Bin; Rosenheck, Robert

    2017-09-12

    Stigma towards people with mental illness impedes effective treatment. A recent study found that Chinese students were less socially accepting of people with mental illness than counterparts from other countries. The current study examined stigma among Chinese medical students at different levels of training. Medical students (N = 1372 from 12 Chinese schools) were surveyed with a questionnaire addressing attitudes and beliefs about people with mental illness. Analysis of variance was used to compare responses from students: (1) with no psychiatry training; (2) who had only taken a didactic course; and (3) who had completed both a course and a clinical rotation. Specific attitudes were identified through factor analysis. Interest in further training and other personal experience were also examined. Factor analysis revealed attitudes favoring: (1) social acceptance of people with mental illness, (2) not believing in supernatural causes of mental illness, (3) bio-psycho-social causation, (4) rehabilitation, and (5) social integration. The absence of consistent trends across training levels suggested that education did not increase nonstigmatized attitudes. Areas of most stigmatization were low social acceptance and little favor for social integration. Measures most strongly correlated with nonstigmatized attitudes were as follows: interest in clinical psychiatry, belief that psychiatry should be more valued, and having friends with mental illness. Although medical school education showed little effect on attitudes, students with more individual experiences such as planning to continue clinical psychiatric training, believing psychiatry should be more valued, and having friends with mental illness had less stigmatized attitudes than others. © 2017 John Wiley & Sons Australia, Ltd.

  18. Use of creative arts as a complementary therapy by rural women coping with chronic illness.

    Science.gov (United States)

    Kelly, Catherine G; Cudney, Shirley; Weinert, Clarann

    2012-03-01

    To investigate the spontaneous use of creative arts as a complementary therapy by rural women in the Western United States who are coping with chronic illness. Women to Women Project was an 11-week research-based computer intervention that provided health education and support to rural women with chronic illnesses in an effort to help them better adapt to living with chronic conditions. Through the use of text queries, messages posted to an unprompted, online support and health education forum were examined for references to the spontaneous use of creative arts and their influence as a complementary therapy for dealing with chronic illness. In three identified themes-coping with pain, relaxation/quality of life, and giving back to others-participants strongly suggested that creative activity was an important strategy for coping with chronic illness and that it contributed to reduced pain and increased overall well-being, regardless of whether it was the expression of a previously learned skill or a practice established after the onset of chronic illness. The use of creative arts and developing art-making interventions could significantly benefit rural individuals coping with chronic illness. Discovering methods of implementing creative arts interventions in rural populations warrants further study.

  19. Do illness perceptions of people with chronic low back pain differ from people without chronic low back pain?

    NARCIS (Netherlands)

    van Wilgen, C. Paul; van Ittersum, Miriam W.; Kaptein, Ad A.

    Objectives To determine why some people develop chronic low back pain, and whether illness perceptions are an important risk factor in the transition from acute to chronic low back pain. Design Cross-sectional study. Participants Four hundred and two members of the general Dutch population, with and

  20. Say 'trouble's gone': chronic illness and employability in job training programmes.

    Science.gov (United States)

    Tsui, Emma K

    2013-01-01

    The concept of biographical disruption has unique relevance for socioeconomically disadvantaged groups who participate in entry-level job training programmes. In these programmes trainees often suffer from various forms of chronic illness and must arrange these illnesses into a picture of employability. In this article I use ethnographic data and narrative analysis to examine closely two trainees' illness-related experiences, expressions and talk, and find that their ability to present their illnesses in ways that are consistent with programmatic goals is strongly influenced by family support, responsibilities and roles, as well as particular aspects of illness, like the interpretability of symptoms. I also find that the concept of biographical disruption has a curious traction in the world of job training, particularly among job training programme staff who would like to see trainees mobilise a variety of resources to help manage their illness. However, for trainees, many of whom have lived with chronic illness for years, the concept of biographical disruption may be more limited as a tool for understanding the experiences of illness. A more meaningful disruptive force in the lives of trainees appears to be the programme itself and the strategies for dealing with illness that programme staff may extend. © 2012 The Author. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

  1. Suicidal Behaviour Among Adolescents and Young Adults with Self-Reported Chronic Illness.

    Science.gov (United States)

    Ferro, Mark A; Rhodes, Anne E; Kimber, Melissa; Duncan, Laura; Boyle, Michael H; Georgiades, Katholiki; Gonzalez, Andrea; MacMillan, Harriet L

    2017-12-01

    The aims of this study were to estimate the: (1) 12-mo prevalence of suicidal thoughts, plans, and attempts in a population sample of adolescents and young adults with and without chronic illness; (2) associations among chronic illness and suicidal thoughts and behaviour (STB); and, (3) moderating roles of mood and substance use disorder on this association. Individuals were aged 15 to 30 y ( n = 5,248) from the Canadian Community Health Survey-Mental Health. Twelve-month STB and psychiatric disorder were measured using the World Health Organization Composite International Diagnostic Interview 3.0. Multinomial logistic regression examined associations between chronic illness and STB, adjusting for relevant sociodemographic and health characteristics. Product term interactions among chronic illness, mood, and substance use disorders were included in the regression models to examine potential moderating effects. Prevalence of suicidal thoughts, plans, and attempts was higher in individuals with chronic illness ( P < 0.01 for all). After adjustment, chronic illness increased the odds for suicidal thoughts [OR = 1.28 (1.01 to 1.64)], plans [OR = 2.34 (1.22 to 4.39)], and attempts [OR = 4.63 (1.52 to 14.34)]. In the presence v. absence of a mood disorder, the odds for suicidal thoughts were higher among individuals with chronic illness [OR = 1.89 (1.06 to 5.28)]. Suicidal thoughts and behaviours are common among adolescents and young adults with chronic illness, particularly among those with comorbid mood disorders. Health professionals should routinely ask about STB during assessments of their adolescent and young adult patients.

  2. Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation

    OpenAIRE

    Cocosila, Mihail; Archer, Norm

    2014-01-01

    Objective To develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those who report being well. Materials and methods A model of PHR use motivators and barriers was built and tested through a national survey across Canada. Data were collected from 800 individuals, 18 years or older. Half reported having a chronic illness or disability and half reported being well. An...

  3. Do everyday problems of people with chronic illness interfere with their self-management?

    NARCIS (Netherlands)

    Houtum, L. van; Rijken, M.; Groenewegen, P.

    2015-01-01

    Background: Being chronically ill is a continuous process of balancing the demands of the illness and the demands of everyday life. Understanding how everyday life affects self-management might help to provide better professional support. However, little attention has been paid to the influence of

  4. Cognitive Treatment of Illness Perceptions in Patients With Chronic Low Back Pain : A Randomized Controlled Trial

    NARCIS (Netherlands)

    Siemonsma, Petra C.; Stuive, Ilse; Roorda, Leo D.; Vollebregt, Joke A.; Walker, Marion F.; Lankhorst, Gustaaf J.; Lettinga, Ant T.

    Background. Illness perceptions have been shown to predict patient activities. Therefore, studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain (CLBP) are needed. Objective. The purpose of this study was to compare the effectiveness of

  5. Cognitive Treatment of Illness Perceptions in Patients With Chronic Low Back Pain: A Randomized Controlled Trial

    NARCIS (Netherlands)

    Siemonsma, P.C.; Stuive, I.; Roorda, L.D.; Vollebregt, J.A.; Walker, M.F.; Lankhorst, G.J.; Lettinga, A.T.

    2013-01-01

    Background. Illness perceptions have been shown to predict patient activities. Therefore, studies of the effectiveness of a targeted illness-perception intervention on chronic nonspecific low back pain (CLBP) are needed. Objective. The purpose of this study was to compare the effectiveness of

  6. Health risk behavior among chronically ill adolescents : a systematic review of assessment tools

    NARCIS (Netherlands)

    Ssewanyana, Derrick; Nyongesa, Moses Kachama; Van Baar, Anneloes; Newton, Charles R; Abubakar, Amina

    2017-01-01

    Background Adolescents living with chronic illnesses engage in health risk behaviors (HRB) which pose challenges for optimizing care and management of their ill health. Frequent monitoring of HRB is recommended, however little is known about which are the most useful tools to detect HRB among

  7. Mediators for internalizing problems in adolescents of parents with chronic medical condition

    NARCIS (Netherlands)

    Sieh, D.S.; Oort, F.J.; Visser-Meily, J.M.A.; Meijer, A.M.

    2014-01-01

    Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is

  8. Experiences of case management with chronic illnesses: a qualitative systematic review.

    Science.gov (United States)

    Joo, J Y; Liu, M F

    2018-03-01

    This qualitative systematic review aimed to identify and synthesize recent qualitative studies to improve understanding of the experiences and perceptions of case management interventions that individuals with chronic illnesses and their caregivers have. Case management has been shown to be effective at improving quality of care and lowering costs for individuals with chronic illnesses. However, no qualitative review has been synthesized with recent qualitative studies about case management experiences by individual with chronic illnesses. This qualitative systematic review uses a thematic synthesis method to review 10 qualitative studies published within the last 10 years, from 2007 to 2016, thereby identifying and discussing the understandings that individuals with chronic illnesses and their caregivers have about case management. From this synthesis, three themes were identified as facilitators of case management (access to healthcare resources, health status supports and emotional aid) and two themes were identified as barriers to it (low information about case management and time constraints). This is the first qualitative systematic review of the perceptions and experiences that individuals with chronic illnesses and their caregivers have about case management. The facilitators of case management can be employed to inform patients about the benefits of case management and to improve population health. The findings about barriers to case management can be used to reform case management for populations with chronic illnesses. These factors should be considered by nursing researchers and healthcare policymakers when implementing case management. © 2018 International Council of Nurses.

  9. [Driving ability, mental illness and psychotropic medication in the elderly].

    Science.gov (United States)

    Serra, Anne-Laure; von Gunten, Armin; Mosimann, Urs; Favrat, Bernard

    2014-04-30

    Fitness to drive in elderly drivers is most commonly discussed with a focus on cognitive impairment. Therefore, this article is focussing on mental illness and the use of psychotropic drugs in elderly drivers, which can both interfere with fitness to drive. Based on a detailed literature review and on clinical judgement, we propose signposts and "red flags" to judge the individual risks. Health professionals dealing with elderly patients should in particular be aware of the dangers related to cumulative risks and need to inform the patients appropriately. For medico-legal reasons the information provided to patients must be written down in the medical record. Individual counselling is important as fitness to drive is a complex topic.

  10. Medication Treatment Efficacy and Chronic Orofacial Pain.

    Science.gov (United States)

    Clark, Glenn T; Padilla, Mariela; Dionne, Raymond

    2016-08-01

    Chronic pain in the orofacial region has always been a vexing problem for dentists to diagnose and treat effectively. For trigeminal neuropathic pain, there are 3 medications (gabapentinoids, tricyclic antidepressants, and serotonin-norepinephrine reuptake inhibitors) to use plus topical anesthetics that have therapeutic efficacy. For chronic daily headaches (often migraine in origin), 3 prophylactic medications have reasonable therapeutic efficacy (β-blockers, tricyclic antidepressants, and antiepileptic drugs). The 3 Food and Drug Administration-approved drugs for fibromyalgia (pregabalin, duloxetine, and milnacipran) are not robust, with poor efficacy. For osteroarthritis, nonsteroidal anti-inflammatory drugs have therapeutic efficacy and when gastritis contraindicates them, corticosteriod injections are helpful. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. "Because somebody cared about me. That's how it changed things": homeless, chronically ill patients' perspectives on case management.

    Science.gov (United States)

    Davis, Elizabeth; Tamayo, Aracely; Fernandez, Alicia

    2012-01-01

    Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants' perspectives on case management interventions. This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program. FOUR RECURRENT THEMES EMERGED: (1) Participants described profound social isolation prior to case management program enrollment; (2) Participants perceived that caring personal relationships with case managers were key to the program; (3) Participants valued assistance with navigating medical and social systems; and (4) Participants perceived that their health improved through both the interpersonal and the practical aspects of case management. Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.

  12. [Chronic gastritis: Instructions for use of medications].

    Science.gov (United States)

    Simanenkov, V I; Vyalov, S S

    The paper highlights the features of drug use in the legal aspect. It analyzes instructions for medical use of proton pump inhibitors (PPIs) and gastric protective agents. Taking into account the characteristics of indications registered in the instruction, the authors discuss the possibility of using various PPIs. The instruction for medical application is an official document approved by the Ministry of Health, the basis of which is the data of trials carried out by a manufacturer, and it should be a key or fundamental source for a physician in choosing a medication. The use of a drug with no indications given in the manual (the so-called 'off-label' use in foreign practice), is a clinical trial of a sort conducted by a physician individually, by taking upon himself/herself a legal liability. If arguments break out over the correct choice of this or that drug in treating the specific patient, the instruction containing the indications for use of specific medications to treat a specific disease is one of the proofs that the physician has correctly chosen the drug or a criterion for skilled medical care. The inclusion of chronic gastritis as a primary and only diagnosis into the primary documentation substantially limits the possibilities of using PPIs. When a PPI is indicated for therapy of erosive gastritis, a formal rationale is contained only in the instruction for use of Controloc. There are no registered indications for PPI use to treat chronic non-erosive gastritis; the gastric protective agent Rebagit is indicated.

  13. Anemia of chronic disease: illness or adaptive mechanism.

    Science.gov (United States)

    Županić-Krmek; Sučić, Mirna; Bekić, Dinko

    2014-09-01

    The anemia of chronic disease (ACD) is the most prevalent anemia after iron deficiency anemia. It is associated with infectious, inflammatory and neoplastic disease. ACD is a medical condition caused by the release of cytokines which mediate inflammatory and immune response (tumor necrosis factor, interleukins 1 and 6, and interferon). Abnormal iron metabolism with iron trapping in reticuloendothelial cells is primarily the cause of this condition, making iron unavailable for erythropoiesis although iron tissue reserves are elevated. Disorder in erythropoietin secretion and shortening of red cell life span also play a role in the pathogenesis of ACD. The main therapy is treatment of the underlying disorder and red cell transfusions in severe anemia. In more severe (protracted) anemias that lead to impaired quality of life and have an impact on the mortality and survival rate, erythropoiesis stimulating agents are used. Recently, new possibilities are being evaluated in terms of therapy for ACD in defined conditions, such as chelating agents, as well as hepcidin antagonist and other erythropoiesis stimulating agents.

  14. Differences in illness perception between children with cancer and other chronic diseases and their parents.

    Science.gov (United States)

    Szentes, Annamária; Kökönyei, Gyöngyi; Békési, Andrea; Bokrétás, Ildikó; Török, Szabolcs

    2017-10-01

    The purpose of this study was to explore the differences in illness perception between children with cancer and other chronic diseases. A secondary aim was to examine the similarities and differences between the illness perception of these children and their parents. The Revised Illness Perception Questionnaire (IPQ-R) was used to measure the children's and parents' illness perceptions. In this study, 184 children (ages 8-18 years) and their caregivers completed the questionnaires. This study shows that children with cancer feel that they have greater control over their treatment compared to the other two groups. The children's parents have more pessimistic views of the illness than their children. Examinations of illness perceptions among paediatric cancer patients and their families are essential in designing psychosocial interventions for these families. The clinical value of our results can help better understand the cancer-specific features of illness perceptions.

  15. Complete mental health in adult siblings of those with a chronic illness or disability.

    Science.gov (United States)

    Hallion, Madeleine; Taylor, Amanda; Roberts, Rachel

    2018-02-01

    Sibling relationships have lifelong significance and childhood chronic illness and disability can have considerable impacts on healthy siblings, influencing development into adulthood. Research has not yet assessed well-being in this population using measures of both mental health and mental illness. Thus, this study assessed well-being in a comprehensive manner using the complete mental health (CMH) model. Participants (N = 144) included both adult siblings of those with chronic illness or disability and adults with healthy siblings. Measures of positive social, psychological and emotional well-being were used to assess mental health and a measure of depression, anxiety, and stress was used to assess mental illness. A high proportion of participants, both with and without siblings with a chronic illness or disability, were experiencing symptoms of mental illness, accompanied by high wellbeing. This indicates that many participants fit into the struggling category of the CMH model. The present research highlights the need for early intervention services to ensure that siblings of those with a chronic illness or disability are well supported in developing strengths, as well as managing difficulties. Results also indicate that targeting students in mental health promotion is important to encourage participation in services. Implications for rehabilitation Siblings of those with a chronic illness or disability need to be included in assessments in order to understand the experience of the family unit. It is important for families and clinicians to be aware of the needs of healthy siblings and encourage them to interact with support services in order to maximise and maintain well-being. Skills-based support could be beneficial, particularly for providing caregivers with strategies to meet the needs of both their child with a chronic illness or disability and their healthy children.

  16. Mad, homeless, and unwanted. A history of the care of the chronic mentally ill in America.

    Science.gov (United States)

    Grob, G N

    1994-09-01

    governments, an uninformed public, or an obsolete system that failed to incorporate the findings of medical science. If American society is to deal effectively, compassionately, and humanely with the seriously mentally ill, several elements must be taken into account. First, the seriously mentally ill include individuals with quite different disorders, prognoses, and needs. Secondly, outcomes vary considerably over time. Some schizophrenics, for example, have reasonably good outcomes; others lapse into chronicity and become progressively more disabled. Finally, serious mental disorders are often exacerbated by poverty, racism, and substance abuse. Although psychiatric therapies can alleviate symptoms and permit individuals to live in the community, there is no "magic bullet" that will cure all cases of serious mental illnesses in the same way that antibiotic drugs are effective against acute infectious diseases.(ABSTRACT TRUNCATED AT 400 WORDS)

  17. Leave for illness/accident or in the event of illness of a close relative - New medical certificate templates

    CERN Multimedia

    HR department

    2016-01-01

    Medical certificate templates are now available in the Admin e-guide (follow the “Forms and templates” link):    Medical certificate for illness/accident Medical certificate for a medical examination or treatment Medical certificate in the event of illness of a close relative These templates are provided for the convenience of members of the personnel and their use is recommended but not compulsory. Other forms of medical certificates issued by a medical doctor may also be submitted, provided they contain the same items of information as those given in the templates. More information on the applicable rules and on the way leave is managed at CERN can be found in the Admin e-guide web pages. Human Resources department HR.leave@cern.ch

  18. Impact of Illness and Medical Expenditure on Household Consumptions: A Survey in Western China

    Science.gov (United States)

    Fang, Kuangnan; Jiang, Yefei; Shia, BenChang; Ma, Shuangge

    2012-01-01

    Background The main goal of this study is to examine the associations between illness conditions and out-of-pocket medical expenditure with other types of household consumptions. In November and December of 2011, a survey was conducted in three cities in western China, namely Lan Zhou, Gui Lin and Xi An, and their surrounding rural areas. Results Information on demographics, income and consumption was collected on 2,899 households. Data analysis suggested that the presence of household members with chronic diseases was not associated with characteristics of households or household heads. The presence of inpatient treatments was significantly associated with the age of household head (p-value 0.03). The level of per capita medical expense was significantly associated with household size, presence of members younger than 18, older than 65, basic health insurance coverage, per capita income, and household head occupation. Adjusting for confounding effects, the presence of chronic diseases was negatively associated with the amount of basic consumption (p-value 0.02) and the percentage of basic consumption (p-value 0.01), but positively associated with the percentage of insurance expense (p-value 0.02). Medical expenditure was positively associated with all other types of consumptions, including basic, education, saving and investment, entertainment, insurance, durable goods, and alcohol/tobacco. It was negatively associated with the percentage of basic consumption, saving and investment, and insurance. Conclusions Early studies conducted in other Asian countries and rural China found negative associations between illness conditions and medical expenditure with other types of consumptions. This study was conducted in three major cities and surrounding areas in western China, which had not been well investigated in published literature. The observed consumption patterns were different from those in early studies, and the negative associations were not observed. This

  19. Experiences of depression and illness behavior in patients with intractable chronic pain.

    Science.gov (United States)

    Stein, N; Fruchter, H J; Trief, P

    1983-01-01

    Studied the relationships between depth of depression, anaclitic and introjective depressive experiences, and dimensions of illness behavior in 37 chronic pain patients. Depth of depression and degree of introjective depressive experiences showed similar positive covariation with a broad range of illness behavior: Namely, hypochondriasis, disease conviction, affective inhibition, affective disturbance, and irritability. The findings suggest that depression characterized by feelings of guilt, worthlessness, and self-doubt, rather than themes of abandonment, is associated differentially with disturbances in the illness behavior of chronic pain patients.

  20. Families of Children with Chronic Illness and the Relational Family Model

    Directory of Open Access Journals (Sweden)

    Tanja Pate

    2016-09-01

    Full Text Available Families of children with chronic illness experience persistent stress. Facing the diagnosis and learning how to cope with it is a stressful experience not only for the child but also for the parents and for the whole family. The illness, with its unpredictability and treatment, disturbs their daily routine and threatens the whole family system. Parental involvement in the child’s disease management and their emotional support are crucial for effective coping and adaptation to the child’s chronic illness. The aim of this article is to present the importance of the parental role in these families through theoretical findings of the relational family model.

  1. A Self-Study Of My Life With A Chronic Illness

    Directory of Open Access Journals (Sweden)

    Taunya WIDEMAN-JOHNSTON

    2015-07-01

    Full Text Available The following paper is a self-study identifying and examining obstacles I have encountered from living with a chronic illness (CI. In particular, I intend to connect my life experiences as both an individual and educator in academia. The focus of this paper is to reveal my life experiences with a CI, the challenges I encounter, and how I learn I can foster change in the community. A serious failure in my health from the rare chronic gastrointestinal illness I have been diagnosed with initiated a journey of questioning both my knowledge and understandings regarding my life. I was forced to reconnect with my body and yet again, accept the illness inside me. The findings from my recovery included four main themes that illuminate transformative learning with a chronic illness. The themes are betrayed by my body, trying to live, societal differences, and seeking wellness.

  2. Theory of planned behavior and adherence in chronic illness: a meta-analysis

    NARCIS (Netherlands)

    Rich, A.; Brandes, K.; Mullan, B.; Hagger, M.S.

    2015-01-01

    Social-cognitive models such as the theory of planned behavior have demonstrated efficacy in predicting behavior, but few studies have examined the theory as a predictor of treatment adherence in chronic illness. We tested the efficacy of the theory for predicting adherence to treatment in chronic

  3. 77 FR 64597 - Proposed Information Collection (Survey of Chronic Gastrointestinal Illness in Persian Gulf...

    Science.gov (United States)

    2012-10-22

    ... of Chronic Gastrointestinal Illness in Persian Gulf Veterans (Irritable Bowel Syndrome--Diarrhea... diarrhea-predominant irritable bowel syndrome. The data collected from the survey will assist VA in... bacteria in the intestines and whether eradication of these bacteria reduces symptoms of chronic diarrhea...

  4. A meta-ethnographic synthesis on phenomenographic studies of patients’ experiences of chronic illness

    Directory of Open Access Journals (Sweden)

    Marta Röing

    2015-02-01

    Full Text Available Phenomenography is a qualitative research approach developed within an educational framework, focusing on the qualitative experience of learning. It is also being used, to a lesser degree, in healthcare research. In the present study, we conducted a meta-ethnographic synthesis of phenomenographic studies on chronic illness, in order to give a broader perspective of how chronic illness can be experienced. Our aim was not to describe patients’ various individual experiences of illness, but instead to identify the different ways chronic illness can be experienced by patients. Our synthesis and phenomenographic interpretation of 12 selected articles found that patients’ experiences of chronic illness can be described in terms of a different lived body, a struggle with threat to identity and self-esteem, a diminished lifeworld, and a challenging reality. These experiences relate to each other in a process of recurring loops, where the different ways of experiencing continue to influence each other over time. According to these findings, the use of phenomenography as a research approach has the potential to add to the understanding of how chronic illness can be experienced. Patients may benefit from seeing that their illness can be experienced in many different ways and that it has many aspects, which then can lead to a better understanding and coping with their illness. We suggest that it may be worthwhile to expand the scope of phenomenography outside pedagogics. This presupposes a revision of the application to include a wider and more comprehensive description, for instance, of the different ways illness and healthcare phenomena can be experienced, and how these different ways are related to each other, with less focus on hierarchical relations.

  5. Time spent on health related activities associated with chronic illness: a scoping literature review

    Directory of Open Access Journals (Sweden)

    Jowsey Tanisha

    2012-12-01

    Full Text Available Abstract Background The management of health care, particularly for people with chronic conditions, combines the activities of health professionals, patients, informal carers and social networks that support them. Understanding the non-professional roles in health management requires information about the health related activities (HRA that are undertaken by patients and informal carers. This understanding allows management planning that incorporates the capacity of patients and informal carers, as well as identifying the particular skills, knowledge and technical support that are necessary. This review was undertaken to identify how much time people with chronic illness and their informal carers spend on HRA. Methods Literature searches of three electronic databases (CINAHL, Medline, and PubMed and two journals (Time and Society, Sociology of Health and Illness were carried out in 2011 using the following search terms (and derivatives: chronic illness AND time AND consumer OR carer. The search was aimed at finding studies of time spent on HRA. A scoping literature review method was utilised. Results Twenty-two peer reviewed articles published between 1990 and 2010 were included for review. The review identified limited but specific studies about time use by people with a chronic illness and/or their carers. While illness work was seen as demanding, few studies combined inquiry about both defined tasks and defined time use. It also identified methodological issues such as consistency of definition and data collection methods, which remain unresolved. Conclusions While HRA are seen as demanding by people doing them, few studies have measured actual time taken to carry out a comprehensive range of HRA. The results of this review suggest that both patients with chronic illness and informal carers may be spending 2 hours a day or more on HRA. Illnesses such as diabetes may be associated with higher time use. More empirical research is needed to

  6. Do everyday problems of people with chronic illness interfere with their disease management?

    Science.gov (United States)

    van Houtum, Lieke; Rijken, Mieke; Groenewegen, Peter

    2015-10-01

    Being chronically ill is a continuous process of balancing the demands of the illness and the demands of everyday life. Understanding how everyday life affects self-management might help to provide better professional support. However, little attention has been paid to the influence of everyday life on self-management. The purpose of this study is to examine to what extent problems in everyday life interfere with the self-management behaviour of people with chronic illness, i.e. their ability to manage their illness. To estimate the effects of having everyday problems on self-management, cross-sectional linear regression analyses with propensity score matching were conducted. Data was used from 1731 patients with chronic disease(s) who participated in a nationwide Dutch panel-study. One third of people with chronic illness encounter basic (e.g. financial, housing, employment) or social (e.g. partner, children, sexual or leisure) problems in their daily life. Younger people, people with poor health and people with physical limitations are more likely to have everyday problems. Experiencing basic problems is related to less active coping behaviour, while experiencing social problems is related to lower levels of symptom management and less active coping behaviour. The extent of everyday problems interfering with self-management of people with chronic illness depends on the type of everyday problems encountered, as well as on the type of self-management activities at stake. Healthcare providers should pay attention to the life context of people with chronic illness during consultations, as patients' ability to manage their illness is related to it.

  7. Time spent on health related activities associated with chronic illness: a scoping literature review.

    Science.gov (United States)

    Jowsey, Tanisha; Yen, Laurann; W, Paul Mathews

    2012-12-03

    The management of health care, particularly for people with chronic conditions, combines the activities of health professionals, patients, informal carers and social networks that support them. Understanding the non-professional roles in health management requires information about the health related activities (HRA) that are undertaken by patients and informal carers. This understanding allows management planning that incorporates the capacity of patients and informal carers, as well as identifying the particular skills, knowledge and technical support that are necessary. This review was undertaken to identify how much time people with chronic illness and their informal carers spend on HRA. Literature searches of three electronic databases (CINAHL, Medline, and PubMed) and two journals (Time and Society, Sociology of Health and Illness) were carried out in 2011 using the following search terms (and derivatives): chronic illness AND time AND consumer OR carer. The search was aimed at finding studies of time spent on HRA. A scoping literature review method was utilised. Twenty-two peer reviewed articles published between 1990 and 2010 were included for review. The review identified limited but specific studies about time use by people with a chronic illness and/or their carers. While illness work was seen as demanding, few studies combined inquiry about both defined tasks and defined time use. It also identified methodological issues such as consistency of definition and data collection methods, which remain unresolved. While HRA are seen as demanding by people doing them, few studies have measured actual time taken to carry out a comprehensive range of HRA. The results of this review suggest that both patients with chronic illness and informal carers may be spending 2 hours a day or more on HRA. Illnesses such as diabetes may be associated with higher time use. More empirical research is needed to understand the time demands of self-management, particularly for

  8. Latex Allergy, a Special Risk for Patients with Chronic Illness and Health Care Workers

    Directory of Open Access Journals (Sweden)

    A.Zafer Caliskaner

    2008-06-01

    Full Text Available Natural rubber latex allergy is a new illness whose prevalence has reached epidemic proportions in highly exposed populations such as health care workers and who has chronic illness. After anaphylactic type reactions due to latex has been shown as case reports. The major risk factors in latex are intense exposure to latex allergens (surgical gloves, catheters, etc, atopy, hand eczema, female gender, history of multiple operations and dental interventions. An association between latex allergy and allergy to various fruits (banana, kiwi, avocado, pineapple, etc has been reported. Latex allergy is responsible for a wide spectrum of clinical symptoms ranging from a mild dermatitis to severe anaphylaxis. In this report, we present that latex related systemic allergic reactions cases; the first one is 24 years old nurse woman who is working at the blood bank in our hospital and the other one is 32 years old woman patient who has repeatative medical examination, and in vitro fertilisation therapy plan and suffered for systemic allergic reaction due to latex gloves which was used in her last concha operations. [TAF Prev Med Bull 2008; 7(3.000: 265-268

  9. Chronic pain patients' perspectives of medical cannabis.

    Science.gov (United States)

    Piper, Brian J; Beals, Monica L; Abess, Alexander T; Nichols, Stephanie D; Martin, Maurice W; Cobb, Catherine M; DeKeuster, Rebecca M

    2017-07-01

    Medical cannabis (MC) is used for a variety of conditions including chronic pain. The goal of this report was to provide an in-depth qualitative exploration of patient perspectives on the strengths and limitations of MC. Members of MC dispensaries (N = 984) in New England including two-thirds with a history of chronic pain completed an online survey. In response to "How effective is medical cannabis in treating your symptoms or conditions?," with options of 0% "no relief" to 100% "complete relief," the average was 74.6% ± 0.6. The average amount spent on MC each year was $3064.47 ± 117.60, median = $2320.23, range = $52.14 to $52,140.00. Open-ended responses were coded into themes and subthemes. Analysis of answers to "What is it that you like most about MC?" (N = 2592 responses) identified 10 themes, including health benefits (36.0% of responses, eg, "Changes perception and experience of my chronic pain."), the product (14.2%, eg, "Knowing exactly what strain you are getting"), nonhealth benefits (14.1%), general considerations (10.3%), and medications (7.1%). Responses (N = 1678) to "What is it that you like least about MC?" identified 12 themes, including money (28.4%, eg, "The cost is expensive for someone on a fixed income"), effects (21.7%, eg, "The effects on my lungs"), the view of others (11.4%), access (8.2%), and method of administration (7.1%). These findings provide a patient-centered view on the advantages (eg, efficacy in pain treatment, reduced use of other medications) and disadvantages (eg, economic and stigma) of MC.

  10. Neighbourly support of people with chronic illness; is it related to neighbourhood social capital?

    Science.gov (United States)

    Waverijn, Geeke; Heijmans, Monique; Groenewegen, Peter P

    2017-01-01

    The neighbourhood may provide resources for health. It is to date unknown whether people who live in neighbourhoods with more social capital have more access to practical and emotional support by neighbours, or whether this is a resource only available to those who are personally connected to people in their neighbourhood. We investigated whether support by neighbours of people with chronic illness was related to neighbourhood social capital and to individual neighbourhood connections. Furthermore, we investigated whether support received from neighbours by people with chronic illness differed according to demographic and disease characteristics. We collected data on support by neighbours and individual connections to neighbours among 2272 people with chronic illness in 2015. Data on neighbourhood social capital were collected among 69,336 people in 3425 neighbourhoods between May 2011 and September 2012. Neighbourhood social capital was estimated with ecometric measurements. We conducted multilevel regression analyses. People with chronic illness were more likely to receive practical and emotional support from neighbours if they had more individual connections to people in their neighbourhood. People with chronic illness were not more likely to receive practical and emotional support from neighbours if they lived in a neighbourhood with more social capital. People with chronic illness with moderate physical disabilities or with comorbidity, and people with chronic illness who lived together with their partner or children, were more likely to receive support from neighbours. To gain more insight into the benefits of neighbourhood social capital, it is necessary to differentiate between the resources only accessible through individual connections to people in the neighbourhood and resources provided through social capital on the neighbourhood level. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Compliance to treatment in patients with chronic illness: A concept exploration

    Science.gov (United States)

    Rafii, Forough; Fatemi, Naima Seyed; Danielson, Ella; Johansson, Christina Melin; Modanloo, Mahnaz

    2014-01-01

    Background: Patients’ compliance to treatment is an important indicator for evaluating the successful management in chronic illnesses. Despite the fact an applicable definition of compliance is required to suitable intervention and research, this concept is not clear and there is no consensus concerning its meaning, definition, and measurement. The aim of this study was to explore the concept of compliance and to formulate a working definition. Materials and Methods: Theoretical phase of Schwartz-Barcott and Kim's Hybrid Model of concept analysis was used to analyze the concept of compliance. Data were collected by using literature reviews. Medline, CINAHL, Ovid, Elsevier, Pro Quest and Blackwell databases were searched from 1975 to 2010 using the keywords “Compliance,” “Non-compliance,” “Adherence,” and “Concordance.” Articles published in English were selected if they included adult patients with chronic illnesses and reported attributes of compliance; 23 such relevant articles were chosen. Results: The attributes of compliance included patient obedience, ability to implement medical advice, flexibility, responsibility, collaboration, participation, and persistence in implementing the advices. Antecedents are organized into two interacting categories: Internal factors refer to the patient, disease, and treatment characteristics and external factors refer to the healthcare professionals, healthcare system, and socioeconomic factors. Compliance may lead to desirable and undesirable consequences. A working definition of compliance was formulated by comparing and contrasting the existing definitions with regard to its attributes which are useful in clinical practice and research. Conclusions: This finding will be useful in clinical practice and research. But this working definition has to be tested in a clinical context and a broad view of its applicability has to be obtained. PMID:24834085

  12. Evaluating Diabetes Care for Patients With Serious Mental Illness Using the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Kelly Vaez

    2017-10-01

    Full Text Available People with serious mental illness (SMI have a higher incidence of type 2 diabetes mellitus (T2DM and shorter life span due to medical health problems. The chronic care model (CCM has been used to improve care of patients with T2DM. One clinical organization that provided primary care to patients with SMI had excellent diabetes outcomes but did not have information on how they achieved those outcomes. Thus, we conducted a pilot study chart review for 30 patients with T2DM and SMI to determine how well the clinic’s system aligned with the overall CCM components and which components correlated with diabetes control. We also evaluated use of the CCM using the Assessment of Chronic Illness Care provider survey. Results showed that the clinic had an overall basic implementation level of the CCM, which allows opportunity for improvement. Two elements of the CCM were correlated with hemoglobin A 1C and both were in an unexpected direction: self-management support in the variable of percentage of visits that included patient-specific goal-setting ( r s = .52; P = .004 and delivery system design in the variable of number of nurse practitioner visits per study period ( r s = .43; P = .02. These findings suggest that the clinic may have made more concentrated efforts to manage diabetes for patients who were not in good diabetes control. Providers noted the influence of SMI and social service organization support on these patients’ clinical outcomes. The findings will be reexamined after a fuller implementation of the CCM to further improve management in this population.

  13. Independence/dependence--a contradictory relationship? Life with a chronic illness.

    Science.gov (United States)

    Delmar, Charlotte; Bøje, Trine; Dylmer, Dorrit; Forup, Lisbeth; Jakobsen, Christina; Møller, Majbritt; Sønder, Hanne; Pedersen, Birthe D

    2006-09-01

    This study shows that self-responsibility and self-control are meaningful values in the activities and decisions of everyday life. Dignity and being respected as an individual are closely connected to being able to manage on one's own and being independent of others' help. The study also shows that including other people into one's life situation can be an important sign of self-management. However, the critical interpretation shows that it is the view of the human being which determines whether help from others and self-managing on one's own can be combined. With a relational view of the human being, i.e. the basic condition that people always enter into relations of dependence, there is no contradiction between independence and dependence. In contrast, an individualist, liberalist view of the human being promotes an attitude of blaming oneself with the potential for feelings of inadequacy and guilt. The study also shows that seeking out treatment in the alternative medical sector maintain a form of continued self-control and self-responsibility. The study concludes that the nurse must work to qualify her/his sensory-based, situationally determined attentiveness and her/his view of the human being, which will include directing her/his attention towards the patient's view of the human being, values and ways of relating to oneself and to one's choices. The research design is qualitative and takes a phenomenological-hermeneutic approach. The data are based on interviews with 18 chronically ill patients, divided into three groups of six patients diagnosed with 'type I' diabetes, colitis ulcerosa and patients with coronary occlusion in the rehabilitation phase. Regardless of the diagnosis, the objective of the interview study was to highlight themes in the patients' views of health and illness related to their chronic condition and the significance of these views have for their mastery of everyday life. The research method is inspired by Paul Ricoeur.

  14. ECG changes in patients on chronic psychotropic medication

    Directory of Open Access Journals (Sweden)

    M Y H Moosa

    2006-09-01

    Full Text Available Objectives. To determine the ECG changes in a group of outpatients on chronic psychotropic medication, and the association, if any, with factors such as gender, age, co- morbid illness and the use of concomitant medication. Methods. Study subjects included patients 18 years and older attending the outpatient departments of Chris Hani Baragwanath and Johannesburg hospitals. The subjects’ demographic and clinical characteristics were obtained and a resting ECG was recorded. Results. Eighty patients were included in the study. The mean age of the subjects was 45.4 (standard deviation (SD =18.2 years, with a minimum age of 18 and a maximum of 86 years. Fifty-four subjects (67.5% had evidence of some ECG abnormalities. There was no significant difference between the occurrence of ECG abnormalities and the different age groups (p > 0.05, gender (p > 0.05, and different race groups (p > 0.05. Sixty-one subjects (76.3% had no co-morbid medical illness and were on psychotropic medication only; of these patients 43 (70.5% had abnormal ECG tracings (p > 0.05. The ECG abnormalities recorded included abnormal rate (28.8%, abnormal ST segment (20.5%, abnormal QRS complex (17.8%, abnormal T wave (15.4%, prolonged or borderline corrected QT interval (8.2%, irregular rhythm (5.5% and prolonged PR interval (2.7%. There was a significant positive correlation between the corrected QT interval and age (r = 0.43, p 0.05. Conclusion. The use of psychotropic drugs is associated with ECG changes in ordinary doses. However, this study serves to strengthen previous evidence that, although common, most of these changes are of a benign nature.

  15. Metabolic syndrome in patients with severe mental illness undergoing psychiatric rehabilitation receiving high dose antipsychotic medication.

    Science.gov (United States)

    Ravindranath, Bapu V

    2012-07-01

    To review evidence of chronic antipsychotic medication and the association with metabolic syndrome in mentally ill patients. This evidence was used to analyse a cohort of patients with severe mental illness and to deduce a correlation between the prevalence of metabolic syndrome and their dose regimens. Twenty-four male patients undergoing Psychiatric rehabilitation underwent a review of current medication and assessment of risk factors for metabolic syndrome. Assessment criteria was based upon National Cholesterol Education Programme expert panel on detection, evaluation and treatment of high blood cholesterol in adults (Adult Treatment Panel III) (NCEP ATP III) criteria, incorporating waist circumference, raised triglycerides, reduced high density lipoprotein, raised blood pressure and fasting blood glucose. PubMed, Nature and Science Direct databases have been used to compile the medical and scientific background on metabolic syndrome and antipsychotic medication and the effect on patients particularly on high dose. Out of 24 patients, 10 patients (41.7%) were receiving high dose antipsychotics (HDA) and four were on maximum dosage limits of 100%. 8.3% (2/24) patients were receiving only one first generation antipsychotics (FGA), 37.5% (9/24) patients were receiving only one second generation antipsychotic (SGA), 45.8% patients (11/24) were receiving two or more SGA only, and only one patient was receiving two or more FGA. One patient was receiving a combination of FGA and SGA. PRN ("as needed") therapy was not included in this study as their usage was limited. Clozapine was mostly prescribed in these patients (10/24, 41.6%). Four out of the 24 patients refused blood tests therefore were excluded from the following results. In the patients evaluated, 55% (11/20) had confirmed metabolic syndrome. In these patients with metabolic syndrome, 45.4% (5/11) were on HDA and 27.3% (3/11) were on maximum British National Formulary (BNF) limits of 100% of dosage. Four out

  16. Psychometric Testing of an Arabic Translation of the Revised-Illness Perception Questionnaire (IPQ-R) for Chronic Illness Patients.

    Science.gov (United States)

    Aberkane, Salah

    2017-08-01

    Researchers lack a properly validated instrument to measure perceptions of chronic disease in Arabic language contexts. This study aimed to adapt and validate the Revised-Illness Perception Questionnaire (IPQ-R) for Arabic speaking chronic illness patients. A cross-sectional design was conducted to examine the psychometric properties of the adapted English version of the IPQ-R for Arabic speaking chronic illness patients. The study instrument was an Arabic version of the IPQ-R prepared through a translation process. The reliability and validity of the instrument were assessed using exploratory and confirmatory factor analysis and Cronbach's alpha coefficient. Three hundred and sixteen participants (ages 16-79) from the Batna region in Algeria completed the IPQ-R. A total of 316 (100%) patients responded to this study. Regarding internal consistency, Cronbach's alpha a coefficient was consistently higher than 0.45. Several areas of fit were identified and substantial changes to the measurement model were made, such as the deletion of 22 items from the original 38-item IPQ-R and two items from the original 18 causal items this accounted for 64.63% of the total variance, and the respecification of indicators had to be applied to achieve acceptable model fit. The final model consists of two sections: The 16-item Arabic IPQ-R, which had a good fit; (CMIN/Df = 1.30, P < 0.001, CFI = 0.93, RMSEA = 0.08, SRMR = 0.03), and was similar to the Arabic 16 causal items (CMIN/DF = 1.11, P < 0.001, CFI = 0.95, RMSEA = 0.080, SRMR = 0.02). The factor structure concurred with prior finding despite differences to the type of sample and cultural considerations that might explain these findings. Replication of this study in Algerian patients with specific illness, such as silicosis, breast cancer and multiple sclerosis. Further psychometric testing on other large samples is recommended.

  17. Predicting declines in physical function in persons with multiple chronic medical conditions: What we can learn from the medical problem list

    OpenAIRE

    Bayliss, Elizabeth A; Bayliss, Martha S; Ware, John E; Steiner, John F

    2004-01-01

    Abstract Background Primary care physicians are caring for increasing numbers of persons with comorbid chronic illness. Longitudinal information on health outcomes associated with specific chronic conditions may be particularly relevant in caring for these populations. Our objective was to assess the effect of certain comorbid conditions on physical well being over time in a population of persons with chronic medical conditions; and to compare these effects to that of hypertension alone. Meth...

  18. Peer Attachment, Perceived Parenting Style, Self-concept, and School Adjustments in Adolescents with Chronic Illness.

    Science.gov (United States)

    Ahn, Jeong-Ah; Lee, Sunhee

    2016-12-01

    The purpose of this study was to identify how peer attachment and parenting style differentially affect self-concept and school adjustment in adolescents with and without chronic illness. A cross-sectional study using multiple group analysis on the Korean panel data was used. A nationwide stratified multistage cluster sampling method was used and the survey was conducted in 2013 on 2,092 first-year middle school students in Korea. We used standardized instruments by the National Youth Policy Institute to measure peer attachment, parenting style, self-concept, and school adjustment. Multiple-group structural equation modeling was used to evaluate the difference of relations for peer attachment, parenting style, self-concept, and school adjustment variable between adolescents with chronic illness and those without chronic illness. The model fit of a multiple-group structural equation modeling was good. The difference of the path from negative parenting style to self-concept between the two groups was significant, and a significant between-group difference in the overall path was found. This indicated that self-concept in adolescents with chronic illness was more negatively affected by negative parenting style than in adolescents without chronic illness. Healthcare providers can promote the process of school adjustment in several ways, such as discussing this issue directly with adolescent patients, along with their parents and peers, examining how the organization and content of the treatment can be modified according to the adolescents' school life. Copyright © 2016. Published by Elsevier B.V.

  19. Noninvasive ventilation during the weaning process in chronically critically ill patients

    Directory of Open Access Journals (Sweden)

    Jesus Sancho

    2016-10-01

    Full Text Available Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71% patients achieved weaning success (mean weaning time 25.45±16.71 days, of whom 40 (21.4% needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15, p=0.013, with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97. NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning.

  20. Race, unemployment rate, and chronic mental illness: a 15-year trend analysis.

    Science.gov (United States)

    Lo, Celia C; Cheng, Tyrone C

    2014-07-01

    Before abating, the recession of the first decade of this century doubled the US unemployment rate. High unemployment is conceptualized as a stressor having serious effects on individuals' mental health. Data from surveys administered repeatedly over 15 years (1997-2011) described changes over time in the prevalence of chronic mental illness among US adults. The data allowed us to pinpoint changes characterizing the White majority--but not Black, Hispanic, or Asian minorities--and to ask whether such changes were attributable to economic conditions (measured via national unemployment rates). We combined 1.5 decades' worth of National Health Interview Survey data in one secondary analysis. We took social structural and demographic factors into account and let adjusted probability of chronic mental illness indicate prevalence of chronic mental illness We observed, as a general trend, that chronic mental illness probability increased as the unemployment rate rose. A greater increase in probability was observed for Blacks than Whites, notably during 2007-2011, the heart of the recession Our results confirmed that structural risk posed by the recent recession and by vulnerability to the recession's effects was differentially linked to Blacks. This led to the group's high probability of chronic mental illness, observed even when individual-level social structural and demographic factors were controlled. Future research should specify the particular kinds of vulnerability that created the additional disadvantage experienced by Black respondents.

  1. Noninvasive ventilation during the weaning process in chronically critically ill patients

    Science.gov (United States)

    Servera, Emilio; Barrot, Emilia; Sanchez-Oro-Gómez, Raquel; Gómez de Terreros, F. Javier; Martín-Vicente, M. Jesús; Utrabo, Isabel; Núñez, M. Belen; Binimelis, Alicia; Sala, Ernest; Zamora, Enrique; Segrelles, Gonzalo; Ortega-Gonzalez, Angel; Masa, Fernando

    2016-01-01

    Chronically critically ill patients often undergo prolonged mechanical ventilation. The role of noninvasive ventilation (NIV) during weaning of these patients remains unclear. The aim of this study was to determine the value of NIV and whether a parameter can predict the need for NIV in chronically critically ill patients during the weaning process. We conducted a prospective study that included chronically critically ill patients admitted to Spanish respiratory care units. The weaning method used consisted of progressive periods of spontaneous breathing trials. Patients were transferred to NIV when it proved impossible to increase the duration of spontaneous breathing trials beyond 18 h. 231 chronically critically ill patients were included in the study. 198 (85.71%) patients achieved weaning success (mean weaning time 25.45±16.71 days), of whom 40 (21.4%) needed NIV during the weaning process. The variable which predicted the need for NIV was arterial carbon dioxide tension at respiratory care unit admission (OR 1.08 (95% CI 1.01–1.15), p=0.013), with a cut-off point of 45.5 mmHg (sensitivity 0.76, specificity 0.67, positive predictive value 0.76, negative predictive value 0.97). NIV is a useful tool during weaning in chronically critically ill patients. Hypercapnia despite mechanical ventilation at respiratory care unit admission is the main predictor of the need for NIV during weaning. PMID:28053973

  2. Report on Honduras: ripples in the pond--the financial crisis and remittances to chronically ill patients in Honduras.

    Science.gov (United States)

    Piette, John D; Mendoza-Avelares, Milton O; Chess, Laura; Milton, Evan C; Matiz Reyes, Armando; Rodriguez-Saldaña, Joel

    2012-01-01

    The U.S. financial crisis has affected employment opportunities for Latino immigrants, and this could affect their ability to send financial assistance, or "remittances", to chronically ill family members in their home country. In a cross-sectional survey of 624 chronically ill adults conducted in Honduras between June and August 2009, respondents reported their receipt of remittances, health service use, and cost-related access barriers. Fifty-four percent of respondents reported relatives living outside the country, and of this group, 66 percent (37% of the overall sample) received remittances. Seventy-four percent of respondents receiving remittances reported a decrease over the prior year, mostly due to job losses among their relatives abroad. Respondents reporting reductions in remittances received significantly less per month, on average, than those without a reduction (US $170 vs. $234; p = 0.01). In multivariate models, respondents experiencing a reduction in remittances used fewer health services and medications due to cost concerns. Remittance payments from relatives resident in the United States are a major source of income for chronically ill individuals in Latin America. Most recipients of remittances reported a reduction during the financial downturn that affected their access to care.

  3. Protocol of a Pilot Study of Technology-Enabled Coproduction in Pediatric Chronic Illness Care.

    Science.gov (United States)

    Kaplan, Heather C; Thakkar, Sunny Narendra; Burns, Lisa; Chini, Barbara; Dykes, Dana Mh; McPhail, Gary L; Moore, Erin; Saeed, Shehzad Ahmed; Eslick, Ian; Margolis, Peter A; Opipari-Arrigan, Lisa

    2017-04-28

    Pediatric chronic illness care models are traditionally organized around acute episodes of care and may not meet the needs of patients and their families. Interventions that extend the patient-clinician interaction beyond the health care visit, allow for asynchronous and bidirectional feedback loops that span visits and daily life, and facilitate seamless sharing of information are needed to support a care delivery system that is more collaborative, continuous, and data-driven. Orchestra is a mobile health technology platform and intervention designed to transform the management of chronic diseases by optimizing patient-clinician coproduction of care. The aim of this study is to assess the feasibility, acceptability, and preliminary impact of the Orchestra technology and intervention in the context of pediatric chronic illness care. This study will be conducted in the cystic fibrosis and inflammatory bowel disease clinics at Cincinnati Children's Hospital Medical Center. We will enroll interested patients and their caregivers to work with clinicians to use the Orchestra technology platform and care model over a 6-month period. In parallel, we will use quality improvement methods to improve processes for integrating Orchestra into clinic workflows and patient/family lifestyles. We will use surveys, interviews, technology use data, and measures of clinical outcomes to assess the feasibility, acceptability, and preliminary impact of Orchestra. Outcome measures will include assessments of: (1) enrollment and dropout rates; (2) duration of engagement/sustained use; (3) symptom and patient-reported outcome tracker completion rates; (4) perceived impact on treatment plan, communication with the clinical team, visit preparation, and overall care; (5) changes in disease self-efficacy and engagement in care; and (6) clinical outcomes and health care utilization. Participant recruitment began in mid-2015, with results expected in 2017. Chronic disease management needs a

  4. Routine pre-admission screening for a medical illness in aggressive ...

    African Journals Online (AJOL)

    2009-10-03

    Oct 3, 2009 ... patients to access medical care once they have been labelled as mentally ill. However, observations from previous studies support screening because: (i) failure to screen may result in the admission of inappropriate medically ill patients to the psychiatric ward;13 and. (ii) aggressive, agitated patients ...

  5. Living with a chronic illness - dealing with feelings

    Science.gov (United States)

    ... on the Internet, at a library, and from social networks, support groups, national organizations, and local hospitals. Ask ... 2016:chap 3. Wagner EH. Comprehensive chronic disease management. In: Goldman L, Schafer AI, eds. Goldman's Cecil ...

  6. Playful intervention with chronically-ill children: promoting coping

    Directory of Open Access Journals (Sweden)

    Flávia Moura de Moura

    Full Text Available Chronic diseases can adversely affect the development process of children. This qualitative, action-research study had the aim to analyze the effects of activities in the manual "Como Hóspede no Hospital" (As a patient in the hospital on the coping process of children with chronic diseases. Study participants included six children and adolescents aged seven to 13 years, who suffered from a chronic disease. Data were collected in the pediatric clinic of a public hospital in the Brazilian state of Paraíba, through participant observation and individual sessions with activities from the manual. Data interpretation followed the principles of thematic analysis. The activities from the manual encouraged participants' search for information about their disease and treatment, and increased their interest and participation in their health care process, thereby contributing to better coping. The study points to the need for comprehensive care for children with chronic diseases.

  7. Definición de competencia médica según pacientes crónicos del sistema sanitario público de Andalucía Definition of medical competence. The point of view of chronically-ill patients in the Andalusian public healthcare system (Spain

    Directory of Open Access Journals (Sweden)

    M. Ángeles Prieto Rodríguez

    2012-10-01

    included in this qualitative study. Focal groups and in-depth interviews were performed in health centers and outpatient centers in Granada, Malaga, Seville, Cadiz and Cordoba between 2007 and 2008. Content analysis was carried out using Nudist Vivo. Results: The participants defined medical competence as combining elements of technical ability and knowledge (awareness of and interest in the disease, continuity of follow-up and requesting specific tests with interpersonal skills related to communication, information (informing, listening, trust, prompting questions and attention (courtesy, cordiality, respect, interest and approachability. Primary care was expected to provide a close relationship, personalized treatment, information, drug prescription, and referral to specialized care. Specialized care was expected to provide an accurate diagnosis and appropriate treatment, information and follow-up. Highly valued aspects of emergency care were symptom relief, accurate diagnosis, referral to specialists and courtesy. Conclusions: Chronically-ill patients based their evaluation of medical competence on technical and interpersonal skills.

  8. Multi-label classification of chronically ill patients with bag of words and supervised dimensionality reduction algorithms.

    Science.gov (United States)

    Bromuri, Stefano; Zufferey, Damien; Hennebert, Jean; Schumacher, Michael

    2014-10-01

    This research is motivated by the issue of classifying illnesses of chronically ill patients for decision support in clinical settings. Our main objective is to propose multi-label classification of multivariate time series contained in medical records of chronically ill patients, by means of quantization methods, such as bag of words (BoW), and multi-label classification algorithms. Our second objective is to compare supervised dimensionality reduction techniques to state-of-the-art multi-label classification algorithms. The hypothesis is that kernel methods and locality preserving projections make such algorithms good candidates to study multi-label medical time series. We combine BoW and supervised dimensionality reduction algorithms to perform multi-label classification on health records of chronically ill patients. The considered algorithms are compared with state-of-the-art multi-label classifiers in two real world datasets. Portavita dataset contains 525 diabetes type 2 (DT2) patients, with co-morbidities of DT2 such as hypertension, dyslipidemia, and microvascular or macrovascular issues. MIMIC II dataset contains 2635 patients affected by thyroid disease, diabetes mellitus, lipoid metabolism disease, fluid electrolyte disease, hypertensive disease, thrombosis, hypotension, chronic obstructive pulmonary disease (COPD), liver disease and kidney disease. The algorithms are evaluated using multi-label evaluation metrics such as hamming loss, one error, coverage, ranking loss, and average precision. Non-linear dimensionality reduction approaches behave well on medical time series quantized using the BoW algorithm, with results comparable to state-of-the-art multi-label classification algorithms. Chaining the projected features has a positive impact on the performance of the algorithm with respect to pure binary relevance approaches. The evaluation highlights the feasibility of representing medical health records using the BoW for multi-label classification

  9. Online self-management interventions for chronically ill patients: cognitive impairment and technology issues.

    Science.gov (United States)

    Archer, Norm; Keshavjee, Karim; Demers, Catherine; Lee, Ryan

    2014-04-01

    As the fraction of the population with chronic diseases continues to grow, methods and/or technologies must be found to help the chronically ill to take more responsibility to self-manage their illnesses. Internet based and/or mobile support for disease self-management interventions have often proved effective, but patients with chronic illnesses may have co-occurring cognitive impairment, making it more difficult for them to cope with technologies. Many older patients are also not familiar with technologies or they may have cognitive disabilities or dementia that reduce their ability to self-manage their healthcare. On-line solutions to the needs of chronically ill patients must be investigated and acted upon with care in an integrated manner, since resources invested in these solutions will be lost if patients do not adopt and continue to use them successfully. To review the capabilities of online and mobile support for self-management of chronic illnesses, and the impacts that age and disease-related issues have on these interventions, including cognitive impairment and lack of access or familiarity with Internet or mobile technologies. This study includes a review of the co-occurrence of cognitive impairment with chronic diseases, and discusses how cognitive impairment, dyadic caregiver patient support, patient efficacy with technology, and smart home technologies can impact the effectiveness and sustainability of online support for disease self-management. Disease self-management interventions (SMIs) using online patient centered support can often enable patients to manage their own chronic illnesses. However, our findings show that cognitive impairment often co-occurs in patients with chronic disease. This, along with age-related increases in multiple chronic illnesses and lack of technology efficacy, can be obstacles to Internet and mobile support for chronic disease self-management. Patients with chronic diseases may have greater than expected difficulties

  10. Online Peer-to-Peer Communities in the Daily Lives of People With Chronic Illness

    DEFF Research Database (Denmark)

    Kingod, Natasja; Cleal, Bryan; Wahlberg, Ayo

    2017-01-01

    This qualitative systematic review investigated how individuals with chronic illness experience online peer-to-peer support and how their experiences influence daily life with illness. Selected studies were appraised by quality criteria focused upon research questions and study design, participant...... selection, methods of data collection, and methods of analysis. Four themes were identified: (a) illness-associated identity work, (b) social support and connectivity, (c) experiential knowledge sharing, and (d) collective voice and mobilization. Findings indicate that online peer-to-peer communities...... provide a supportive space for daily self-care related to chronic illness. Online communities provided a valued space to strengthen social ties and exchange knowledge that supported offline ties and patient–doctor relationships. Individuals used online communities to exchange experiential knowledge about...

  11. Does chronic illness cause adverse social and economic consequences among Swedes?

    DEFF Research Database (Denmark)

    Lindholm, C; Burström, B; Diderichsen, F

    2001-01-01

    question raised here is therefore to examine chronic illness (defined as limiting longstanding illness. LLSI) as a causal factor contributing adverse financial conditions, unemployment or labour market exclusion. METHODS: A longitudinal design was employed with data from a sample of 27,773 people......BACKGROUND: In an international comparison, the Swedish welfare system has been known for universal coverage and high benefit levels. Perhaps this is the reason why very few studies recently have dealt with the social and economic consequences of long-term illness in Sweden. AIMS: The research...... interviewed twice (Swedish Surveys of Living Conditions performed by Statistics Sweden), including subjects (n = 12,556) at interview I, without chronic illness or adverse socioeconomic conditions. RESULTS: The odds ratios for labour market exclusion, unemployment, and financial difficulties among people who...

  12. Perceived conflict in the couple and chronic illness management: Preliminary analyses from the Quebec Health Survey

    Directory of Open Access Journals (Sweden)

    Hudon Catherine

    2006-10-01

    Full Text Available Abstract Background The quality of the relationship with the spouse/partner appears crucial among patients with multiple chronic conditions where illness management is complex and multifaceted. This study draws on data from the Quebec Health Survey (QHS to examine, among patients with one or more chronic conditions, the relation between marital status, the perceived conflict with the spouse/partner, and what the patients do to manage their illness as well as how they perceive their health. Methods Data from the QHS 1998 were used. The sample included 7547 coupled adults who had one or more chronic health problems lasting more than 6 months. Independent variables included marital status, perceived conflict with the spouse/partner, and the number of chronic conditions. Illness management was defined broadly as a measure of the patient's efforts at self-care and an illness status indicator, including visits to the generalist and the specialist, the use of telephone health line in the last 12 months, self-rated general health, mental health, and a measure of psychological distress. Linkages between the independent variables and illness management were assessed for males and females separately with logistic regressions, while accounting for the survey sampling design and household clustering. Results Female patients who did not live with their partner and had never been married were more likely to report a negative perception of their general health and a higher psychological distress than those who were married. Perceived conflict with the partner was linked to a negative perception of mental health and a higher psychological distress among both men and women. Compared to patients with only one chronic condition, males who reported more than one chronic condition were more likely to have consulted a generalist prior to the survey and used the telephone health line, whereas females were more likely to have consulted a specialist. Both males and

  13. Collaborative Chronic Care Networks (C3Ns) to transform chronic illness care.

    Science.gov (United States)

    Margolis, Peter A; Peterson, Laura E; Seid, Michael

    2013-06-01

    Despite significant gains by pediatric collaborative improvement networks, the overall US system of chronic illness care does not work well. A new paradigm is needed: a Collaborative Chronic Care Network (C3N). A C3N is a network-based production system that harnesses the collective intelligence of patients, clinicians, and researchers and distributes the production of knowledge, information, and know-how over large groups of people, dramatically accelerating the discovery process. A C3N is a platform of "operating systems" on which interconnected processes and interventions are designed, tested, and implemented. The social operating system is facilitated by community building, engaging all stakeholders and their expertise, and providing multiple ways to participate. Standard progress measures and a robust information technology infrastructure enable the technical operating system to reduce unwanted variation and adopt advances more rapidly. A structured approach to innovation design provides a scientific operating system or "laboratory" for what works and how to make it work. Data support testing and research on multiple levels: comparative effectiveness research for populations, evaluating care delivery processes at the care center level, and N-of-1 trials and other methods to select the best treatment of individual patient circumstances. Methods to reduce transactional costs to participate include a Federated IRB Model in which centers rely on a protocol approved at 1 central institutional review board and a "commons framework" for organizational copyright and intellectual property concerns. A fully realized C3N represents a discontinuous leap to a self-developing learning health system capable of producing a qualitatively different approach to improving health.

  14. Illness beliefs and self-management in children and young people with chronic illness: a systematic review.

    Science.gov (United States)

    Law, Gary Urquhart; Tolgyesi, Charlotte Sarah; Howard, Ruth A

    2014-01-01

    To review the extent to which illness representations, based on Leventhal's Common Sense Model, relate to self-management in children and young people with chronic physical health conditions. A systematic literature review was carried out to identify relevant studies and each included paper was assessed for risk of bias. Fifteen papers met criteria for inclusion within the review. The majority of studies were cross-sectional, and small sample sizes for some studies made it difficult to generalise findings. The method of measuring both illness representations and outcomes varied. Timeline, identity, control and consequences beliefs were the most frequently assessed domains of illness representations included within the studies. While there is variability, there are indications that control beliefs, specifically treatment control beliefs, are more consistently and strongly associated with self-management than other representation domains. Control beliefs should be targeted for intervention in studies trying to improve adolescent self-management. In addition, the relationship between illness representations and self-management needs to be considered within both developmental and systemic contexts. It is likely that the variation in self-management will be more fully explained in future research that explores the combined effects of individual representations and the influence of wider contexts.

  15. Character Development Pilot Evaluation of Two Programs for Youth with Chronic Illness

    Directory of Open Access Journals (Sweden)

    Gary Maslow

    2016-05-01

    Full Text Available This article describes the pilot evaluation of two Positive Youth Development (PYD programs for youth with child onset chronic illness (COCI, reporting how the programs influenced participants’ character development. College students with COCI led high school students with COCI through activities pertaining to different aspects of growing up with a chronic illness. Participants completed the Positive Youth Development Inventory-Short Form (PYDI-S, which measures seven domains of youth perceptions of the contribution to their development from the program. Participants reported that both programs helped them the most with personal standards, which corresponds well to character development on the full version of the Positive Youth Development Inventory (PYDI. They also had high scores on prosocial behavior and future orientation, both important domains for character development. We discuss the idea that interventions promoting character development for youth with COCI are critical for promoting a positive narrative for chronically-ill youth, their parents, and society.

  16. [Development of Empowerment Program for Persons with Chronic Mental Illness and Evaluation of Impact].

    Science.gov (United States)

    Kim, Mijung; Lee, Kyunghee

    2015-12-01

    This study was done to develop an empowerment program for people with chronic mental illness and to analyze effects of the program on level of empowerment. The research was conducted using a nonequivalent control group pretest-posttest design. Participants were 37 people with chronic mental illness (experimental group: 18, control group: 19). The empowerment program was provided for 8 weeks (15 sessions). Data were collected between July 21 and October 17, 2014. Data were analyzed using Chi-square, Fisher's exact test, Sapiro-Wilk test, and Repeated measure ANOVA with SPSS/WIN 18.0. Quantitative results show that self-efficacy, interpersonal relationships, attitudes in the workplace, occupational performance capacity, and levels of empowered execute were significantly better in the experimental group compared to the control group. Study findings indicate that this empowerment program for persons with chronic mental illness is effective for improving self efficacy, interpersonal skills, attitudes in the workplace, occupational performance capacity, levels of empowered execute.

  17. A middle-range theory of self-care of chronic illness.

    Science.gov (United States)

    Riegel, Barbara; Jaarsma, Tiny; Strömberg, Anna

    2012-01-01

    Nearly 50% of adults have one or more chronic illnesses. Self-care is considered essential in the management of chronic illness, but the elements of self-care in this context have not been specified in a middle-range theory. This article describes a middle-range theory of self-care that addresses the process of maintaining health with health promoting practices within the context of the management required of a chronic illness. The key concepts include self-care maintenance, self-care monitoring, and self-care management. Assumptions and propositions of the theory are specified. Factors influencing self-care including experience, skill, motivation, culture, confidence, habits, function, cognition, support from others, and access to care are described.

  18. Alagille Syndrome: A Case Report Highlighting Dysmorphic Facies, Chronic Illness, and Depression

    Directory of Open Access Journals (Sweden)

    James J. Bresnahan

    2016-01-01

    Full Text Available Alagille syndrome is a rare multisystem disorder affecting the liver, heart, vertebrae, eyes, and face. Alagille syndrome shares multiple phenotypic variants of other congenital or chronic childhood illnesses such as DiGeorge syndrome, Down syndrome, spina bifida, type 1 diabetes mellitus, and cystic fibrosis. All of these chronic illnesses have well-established links to psychiatric conditions. There are few community resources for Alagille patients, as it is an extremely rare condition. Despite the overlap with other chronic childhood illnesses, the psychiatric manifestations of Alagille syndrome have not been previously discussed in literature. The current study is a case report of a twelve-year-old female hospitalized in our pediatric psychiatric hospital for suicidal ideation with intent and plan. The patient had major depressive disorder, anxiety, other specified feeding and eating disorder, and attention-deficit/hyperactive disorder.

  19. The influence of frailty syndrome on acceptance of illness in elderly patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Uchmanowicz I

    2016-09-01

    Full Text Available Izabella Uchmanowicz,1 Beata Jankowska-Polanska,1 Mariusz Chabowski,2 Bartosz Uchmanowicz,1 Andrzej M Fal3 1Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 2Division of Nursing in Surgical Procedures, Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, 3Department of Healthcare Organisation and Economics, National Institute of Public Health, National Institute of Hygiene, Warsaw, Poland Abstract: COPD is one of the most debilitating diseases. Frailty syndrome and advanced age may decrease the acceptance of illness, quality of life, and worsen health conditions in these patients, as well as lead to an increase in health care expenses. The aim of the study was to assess how the level of frailty affects the acceptance of illness in elderly patients with COPD. We also aimed to evaluate the associations between sociodemographic and clinical factors and the level of acceptance of illness, anxiety, and frailty in this group of patients. The study included 102 COPD patients with a mean age of 63.2 (standard deviation =6.5 years and grades I (3%, II (37%, III (52%, and IV (8% by Global Initiative for Chronic Obstructive Lung Disease. The Polish versions of the Acceptance of Illness Scale and Tilburg frailty indicator were used. Frailty syndrome was found in 77 (75.5% patients, with an average score of 7.42 (standard deviation =2.24. Coexisting diseases such as hypertension (46.07%, coronary artery disease (32.35%, heart failure (28.43%, diabetes (18.63%, and heart arrhythmia (9.8% were found among the subjects. The overall level of acceptance of illness was 20.6 (standard deviation =7.62. A lower level of acceptance of illness was associated with a higher level of frailty, especially in the physical and social domain. Elderly patients with severe COPD are more prone to frailty and decreased acceptance of their disease in comparison to patients with other chronic diseases

  20. Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation.

    Science.gov (United States)

    Cocosila, Mihail; Archer, Norm

    2014-07-23

    To develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those who report being well. A model of PHR use motivators and barriers was built and tested through a national survey across Canada. Data were collected from 800 individuals, 18 years or older. Half reported having a chronic illness or disability and half reported being well. Analyses were performed with structural equation modelling techniques. A total of 389 answers from chronically ill and 383 from well participants were collected. Perceived usefulness was the key explanation of the intention to use PHRs for both ill and well people (total effect of 0.601 and 0.565, respectively) followed by security, privacy and trust in PHRs (total effect of 0.377 and 0.479, respectively). Conversely, computer anxiety was perceived as a significant barrier (total effect of -0.327 for ill individuals and -0.212 for well individuals). The model proposed was appropriate in explaining key consumer positive and negative perceptions on electronic PHR use. We found little difference in perceptions of electronic PHRs between chronically ill and well individuals, although self-reporting their health status might have influenced the results. To increase the adoption rate of electronic PHRs among both chronically ill and well consumers it is necessary to reinforce consumer perceptions of the usefulness of and trust in these eHealth technologies while mitigating their anxieties about computer use in general. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  1. Impact of health insurance status and a diagnosis of serious mental illness on whether chronically homeless individuals engage in primary care.

    Science.gov (United States)

    Chwastiak, Lydia; Tsai, Jack; Rosenheck, Robert

    2012-12-01

    We evaluated the impact of a diagnosis of serious mental illness on use of a primary care provider (vs the emergency department [ED]) as a source of care by people who were chronically homeless. We used data from 750 chronically homeless adults enrolled in the 11-site Collaborative Initiative to Help End Chronic Homelessness and identified demographic and clinical characteristics independently associated with using a primary care provider rather than an ED. The factor most strongly associated with using the ED as a regular source of medical care was previous-year lack of health insurance. Despite high rates of serious mental illness, neither a diagnosis of serious mental illness nor increased severity of psychiatric symptoms was associated with such use. Findings suggest that people who are chronically homeless and have chronic medical illness would be more likely to access care if they had health insurance. Individual states' deciding not to expand Medicaid coverage will likely have a tremendous impact on the health outcomes and health care costs associated with this and other vulnerable populations.

  2. Post-millennial trends of socioeconomic inequalities in chronic illness among adults in Germany.

    Science.gov (United States)

    Hoebel, Jens; Kuntz, Benjamin; Moor, Irene; Kroll, Lars Eric; Lampert, Thomas

    2018-03-27

    Time trends in health inequalities have scarcely been studied in Germany as only few national data have been available. In this paper, we explore trends in socioeconomic inequalities in the prevalence of chronic illness using Germany-wide data from four cross-sectional health surveys conducted between 2003 and 2012 (n = 54,197; ages 25-69 years). We thereby expand a prior analysis on post-millennial inequality trends in behavioural risk factors by turning the focus to chronic illness as the outcome measure. The regression-based slope index of inequality (SII) and relative index of inequality (RII) were calculated to estimate the extent of absolute and relative socioeconomic inequalities in chronic illness, respectively. The results for men revealed a significant increase in the extent of socioeconomic inequalities in chronic illness between 2003 and 2012 on both the absolute and relative scales (SII 2003  = 0.06, SII 2012  = 0.17, p-trend = 0.013; RII 2003  = 1.18, RII 2012  = 1.57, p-trend = 0.013). In women, similar increases in socioeconomic inequalities in chronic illness were found (SII 2003  = 0.05, SII 2012  = 0.14, p-trend = 0.022; RII 2003  = 1.14, RII 2012  = 1.40, p-trend = 0.021). Whereas in men this trend was driven by an increasing prevalence of chronic illness in the low socioeconomic group, the trend in women was predominantly the result of a declining prevalence in the high socioeconomic group.

  3. Chronic illness and family: impact of schizophrenia and Crohn's disease on the family quality of life.

    Science.gov (United States)

    Loga, Slobodan; Sošić, Bojan; Kulenović, Alma Džubur; Svraka, Emira; Bosankić, Nina; Kučukalić, Abdulah; Cemalović, Omer; Hadžić, Alma

    2012-12-01

    Quality of life assessments are increasingly present in health research. Chronic and progressive illness of a family member unavoidably affects quality of life of a family as a whole. The goals of this study were to gain insight into the family burden of chronic disorders, especially possible differences in family quality of life (FQOL) in families that have members suffering from either schizophrenia or Crohn's disease, and families in which none of the members have chronic somatic or mental illness, as well as to pilot an instrument for this purpose. The sample consisted of 53 families with a member suffering from schizophrenia, 50 families with a member suffering from Crohn's disease, and 45 families with no identifiable chronic illnesses. An informant from each family underwent a structured face to face interview, using a questionnaire specially adapted from Family Quality of Life Survey, an instrument widely used to assess FQOL in families with members with disabilities, and which addresses nine areas of family life. In the domain of health, both groups of families with chronic illnesses believe they have significantly different conditions when compared to members of the Control group. In the Crohn's disease group, families had a great deal more of challenges in accessing healthcare services; and see themselves at a disadvantage when compared to both other groups in the domain of finances. Control group offered lowest rating in the domain of support from others. Overall measures of FQOL show significant variation among the three groups, Crohn's disease group offering lowest ratings, followed by families of mental health service users. Overall, FQOL seems to be lower in families that have members diagnosed with Crohn's disease than in families with members suffering from schizophrenia. Illness-specific studies are required, as well as instruments with stronger psychometric properties and studies of determinants of FQOL. Qualitative approach should be emphasised

  4. Illness representations in patients with chronic kidney disease on maintenance hemodialysis.

    Science.gov (United States)

    Fowler, Christopher; Baas, Linda S

    2006-01-01

    A sample of patients with chronic kidney disease on maintenance hemodialysis participated in a study to explore the relationship between illness perception and quality of life. Illness perception was examined based on the Common-Sense Model of Illness as described by Leventhal. Forty-two participants completed the Revised Illness Perception Questionnaire (IPQ-R), the Index of Well-being (IWB) and a brief demographic form. All of the subscales of the IPQ-R and the IWB demonstrated adequate reliability (alpha levels > or = .70) except for the treatment control subscale (alpha = .46). More perceived consequences of kidney disease and higher scores on the emotional representation scale were negatively correlated with scores on the IWB. Future research is needed to assess the influence of factors such as coping strategies on illness representations and on well-being. Nephrology nurses are in an optimal position to identify the illness perceptions of patients on chronic hemodialysis and can introduce specific coping mechanisms to enhance overall well-being. As well nephrology nurses can function as part of the overall health care team to identify the resources available to minimize the perceived consequences of chronic kidney disease.

  5. Psychosocial status in chronic illness. A comparative analysis of six diagnostic groups.

    Science.gov (United States)

    Cassileth, B R; Lusk, E J; Strouse, T B; Miller, D S; Brown, L L; Cross, P A; Tenaglia, A N

    1984-08-23

    Assumptions that psychological attributes are specific to particular diagnoses characterize many investigations of chronically ill patients. We studied 758 patients, each of whom had one of six different chronic illnesses, to determine and compare their scores on the Mental Health Index. Five groups of physically ill patients (with arthritis, diabetes, cancer, renal disease, or dermatologic disorders) did not differ significantly from one another or from the general public, but all had significantly higher scores for psychological status when compared with the sixth group, patients under treatment for depression. There was a significant direct relation between higher mental-health scores and advancing age across all patient populations. Patients with recently diagnosed illness in all groups had poorer mental-health scores than did patients whose illness had been diagnosed more than four months previously. A direct relation between declining physical status and mental-health scores was observed. These results suggest that psychological adaptation among patients with chronic illnesses is remarkably effective and fundamentally independent of specific diagnosis.

  6. Paradise regained: how elderly people who are chronically mentally ill reinvent a social self.

    Science.gov (United States)

    van Dongen, E

    2001-01-01

    Throughout their lives, chronic mentally ill people go through a series of disruptive events and periods of suffering. In general, the literature suggests that people with long-standing mental illnesses are extremely vulnerable and cannot maintain themselves without assistance. When old age is added to this mix, the result is a heavy burden for both the patient and the caregiver. While the negative consequences, for both patient and caregiver, of suffering chronic illness during old age must not be ignored, neither should the positive periods in these people's lives. There are times when the mutual identification between cold and young yields vivid examples of the latter's ability to reconstitute a social self. In this paper I look at chronic illness in old age as a struggle on the part of the sufferer to reconcile her/his experiences of suffering in the light of approaching death. I attempt to show that the process of aging with a chronic mental illness involves not only decay and suffering, but also resilience and vitality.

  7. Patient-Assessed Chronic Illness Care (PACIC scenario in an Indian homeopathic hospital

    Directory of Open Access Journals (Sweden)

    Munmun Koley

    2016-01-01

    Full Text Available Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC 0.57–0.75; positive to strong positive correlations; p0.05; however, monthly household income had a significant influence (p<0.05 on the subscales except for “delivery system or practice design.” Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital.

  8. Increased risk of treatment with antidepressants in stroke compared with other chronic illness

    DEFF Research Database (Denmark)

    Dam, Henrik; Harhoff, Mette; Andersen, Per Kragh

    2007-01-01

    The prevalence of depression and anxiety is higher in patients with stroke than in the general population but it is unclear whether patients with stroke are at an increased risk of being treated for depression and anxiety compared with patients with other chronic illness. The objective...... of the present study was to investigate whether the rate of treatment with antidepressants is increased in patients with stroke compared with patients with other chronic illness and compared with the general population. By linkage of nationwide case registers, all patients who received a main diagnosis of stroke...

  9. A Self-Study Of My Life With A Chronic Illness

    OpenAIRE

    Taunya WIDEMAN-JOHNSTON

    2015-01-01

    The following paper is a self-study identifying and examining obstacles I have encountered from living with a chronic illness (CI). In particular, I intend to connect my life experiences as both an individual and educator in academia. The focus of this paper is to reveal my life experiences with a CI, the challenges I encounter, and how I learn I can foster change in the community. A serious failure in my health from the rare chronic gastrointestinal illness I have been diagnosed with initiat...

  10. The social course of epilepsy: chronic illness as social experience in interior China.

    Science.gov (United States)

    Kleinman, A; Wang, W Z; Li, S C; Cheng, X M; Dai, X Y; Li, K T; Kleinman, J

    1995-05-01

    Findings are reported from a collaborative research project on the experience of epilepsy and treatment among patients and family members in Shanxi and Ningxia Provinces in China. Family, marriage, financial and moral consequences of the social experience of epilepsy support the conceptualization of chronic illness as possessing a social course. Beyond traditional concern with stigma, application of concepts of delegitimation, sociosomatic processes, coping as resistance, contestation in the evaluation of efficacy and compliance, and the cultural ontology of suffering illustrate other ways that social theory is useful in research on chronic illness and disability.

  11. Social, Psychological, and Medical Aspects of Chronic Pain.

    Science.gov (United States)

    Sparks, Jayne A.; Clark, Donald W.

    1981-01-01

    Discusses certain factors that contribute to the development of chronic pain. Psychosocial factors are explored with a summary of their implications for treatment. Medical treatment for chronic pain is reviewed and holistic treatment is surveyed. (Author)

  12. Frequency of MMPI Profile Types in Three Chronic Illness Populations.

    Science.gov (United States)

    Naliboff, Bruce D.; And Others

    1983-01-01

    Developed sorting rules to identify Minnesota Multiphasic Personality Inventory configurations and applied these to patients with chronic low back pain, migraine headaches, hypertension, and diabetes (N=157). Results showed that profile types did not differ in frequency among the groups but were more elevated in the back pain patients. (LLL)

  13. Facilitating job retention for chronically ill employees: perspectives of line managers and human resource managers.

    Science.gov (United States)

    Haafkens, Joke A; Kopnina, Helen; Meerman, Martha G M; van Dijk, Frank J H

    2011-05-17

    Chronic diseases are a leading contributor to work disability and job loss in Europe. Recent EU policies aim to improve job retention among chronically ill employees. Disability and occupational health researchers argue that this requires a coordinated and pro-active approach at the workplace by occupational health professionals, line managers (LMs) and human resource managers (HRM). Little is known about the perspectives of LMs an HRM on what is needed to facilitate job retention among chronically ill employees. The aim of this qualitative study was to explore and compare the perspectives of Dutch LMs and HRM on this issue. Concept mapping methodology was used to elicit and map statements (ideas) from 10 LMs and 17 HRM about what is needed to ensure continued employment for chronically ill employees. Study participants were recruited through a higher education and an occupational health services organization. Participants generated 35 statements. Each group (LMs and HRM) sorted these statements into six thematic clusters. LMs and HRM identified four similar clusters: LMs and HRM must be knowledgeable about the impact of chronic disease on the employee; employees must accept responsibility for work retention; work adaptations must be implemented; and clear company policy. Thematic clusters identified only by LMs were: good manager/employee cooperation and knowledge transfer within the company. Unique clusters identified by HRM were: company culture and organizational support. There were both similarities and differences between the views of LMs and HRM on what may facilitate job retention for chronically ill employees. LMs perceived manager/employee cooperation as the most important mechanism for enabling continued employment for these employees. HRM perceived organizational policy and culture as the most important mechanism. The findings provide information about topics that occupational health researchers and planners should address in developing job retention

  14. Facilitating job retention for chronically ill employees: perspectives of line managers and human resource managers

    Directory of Open Access Journals (Sweden)

    Meerman Martha GM

    2011-05-01

    Full Text Available Abstract Background Chronic diseases are a leading contributor to work disability and job loss in Europe. Recent EU policies aim to improve job retention among chronically ill employees. Disability and occupational health researchers argue that this requires a coordinated and pro-active approach at the workplace by occupational health professionals, line managers (LMs and human resource managers (HRM. Little is known about the perspectives of LMs an HRM on what is needed to facilitate job retention among chronically ill employees. The aim of this qualitative study was to explore and compare the perspectives of Dutch LMs and HRM on this issue. Methods Concept mapping methodology was used to elicit and map statements (ideas from 10 LMs and 17 HRM about what is needed to ensure continued employment for chronically ill employees. Study participants were recruited through a higher education and an occupational health services organization. Results Participants generated 35 statements. Each group (LMs and HRM sorted these statements into six thematic clusters. LMs and HRM identified four similar clusters: LMs and HRM must be knowledgeable about the impact of chronic disease on the employee; employees must accept responsibility for work retention; work adaptations must be implemented; and clear company policy. Thematic clusters identified only by LMs were: good manager/employee cooperation and knowledge transfer within the company. Unique clusters identified by HRM were: company culture and organizational support. Conclusions There were both similarities and differences between the views of LMs and HRM on what may facilitate job retention for chronically ill employees. LMs perceived manager/employee cooperation as the most important mechanism for enabling continued employment for these employees. HRM perceived organizational policy and culture as the most important mechanism. The findings provide information about topics that occupational health

  15. Facilitating job retention for chronically ill employees: perspectives of line managers and human resource managers

    Science.gov (United States)

    2011-01-01

    Background Chronic diseases are a leading contributor to work disability and job loss in Europe. Recent EU policies aim to improve job retention among chronically ill employees. Disability and occupational health researchers argue that this requires a coordinated and pro-active approach at the workplace by occupational health professionals, line managers (LMs) and human resource managers (HRM). Little is known about the perspectives of LMs an HRM on what is needed to facilitate job retention among chronically ill employees. The aim of this qualitative study was to explore and compare the perspectives of Dutch LMs and HRM on this issue. Methods Concept mapping methodology was used to elicit and map statements (ideas) from 10 LMs and 17 HRM about what is needed to ensure continued employment for chronically ill employees. Study participants were recruited through a higher education and an occupational health services organization. Results Participants generated 35 statements. Each group (LMs and HRM) sorted these statements into six thematic clusters. LMs and HRM identified four similar clusters: LMs and HRM must be knowledgeable about the impact of chronic disease on the employee; employees must accept responsibility for work retention; work adaptations must be implemented; and clear company policy. Thematic clusters identified only by LMs were: good manager/employee cooperation and knowledge transfer within the company. Unique clusters identified by HRM were: company culture and organizational support. Conclusions There were both similarities and differences between the views of LMs and HRM on what may facilitate job retention for chronically ill employees. LMs perceived manager/employee cooperation as the most important mechanism for enabling continued employment for these employees. HRM perceived organizational policy and culture as the most important mechanism. The findings provide information about topics that occupational health researchers and planners should

  16. An online approach to providing chronic illness self-management information.

    Science.gov (United States)

    Cudney, Shirley; Weinert, Clarann

    2012-02-01

    The purpose of this article was to describe an online approach to providing chronic illness self-management information to rural women with chronic illness. To self-manage chronic illness, individuals require information about their conditions. For those in rural areas who have limited access to health services, computer-based interventions are a means of providing this information. Participants were randomly assigned either to an 11-week computer intervention in which they completed nine online self-study health teaching units related to self-management, or to a control group. The health teaching units were positively rated as being helpful in managing their chronic illnesses, with scores ranging from 4.09 to 4.84 on a six-point scale. Perceptions of computer skills increased significantly for the intervention group, with no increase in the control group. Computer-based programs can be an effective approach to providing health information to rural women with chronic conditions that will assist them in their self-management efforts.

  17. The role of disease management programs in the health behavior of chronically ill patients.

    Science.gov (United States)

    Cramm, Jane Murray; Adams, Samantha A; Walters, Bethany Hipple; Tsiachristas, Apostolos; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P M H; Nieboer, Anna Petra

    2014-04-01

    Investigate the effects of disease management program (DMP) implementation on physical activity, smoking, and physical quality of life among chronically ill patients. This study used a mixed-methods approach involving qualitative (35 interviews with project managers) and quantitative (survey of patients from 18 DMPs) data collection. Questionnaire response rates were 51% (2010; 2619/5108) at T0 and 47% (2011; 2191/4693) at T1. Physical activity and the percentage of smokers improved significantly over time, whereas physical quality of life declined. After adjusting for patients' physical quality of life at T0, age, educational level, marital status, and gender, physical activity at T0 (pmanagers reported that DMPs improved patient-professional interaction. The ability to set more concrete targets improved patients' health behaviors. DMPs appear to improve physical activity among chronically ill patients over time. Furthermore, (changes in) health behavior are important for the physical quality of life of chronically ill patients. Redesigning care systems and implementing DMPs based on the chronic care model may improve health behavior among chronically ill patients. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  18. Telephone-based health coaching for chronically ill patients: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Dwinger, Sarah; Dirmaier, Jörg; Herbarth, Lutz; König, Hans-Helmut; Eckardt, Matthias; Kriston, Levente; Bermejo, Isaac; Härter, Martin

    2013-10-17

    The rising prevalence of chronic conditions constitutes a major burden for patients and healthcare systems and is predicted to increase in the upcoming decades. Improving the self-management skills of patients is a strategy to steer against this burden. This could lead to better outcomes and lower healthcare costs. Health coaching is one method for enhancing the self-management of patients and can be delivered by phone. The effects of telephone-based health coaching are promising, but still inconclusive. Economic evaluations and studies examining the transferability of effects to different healthcare systems are still rare. Aim of this study is to evaluate telephone-based health coaching for chronically ill patients in Germany. The study is a prospective randomized controlled trial comparing the effects of telephone-based health coaching with usual care during a 4-year time period. Data are collected at baseline and after 12, 24 and 36 months. Patients are selected based on one of the following chronic conditions: diabetes, coronary artery disease, asthma, hypertension, heart failure, COPD, chronic depression or schizophrenia. The health coaching intervention is carried out by trained nurses employed by a German statutory health insurance. The frequency and the topics of the health coaching are manual-based but tailored to the patients' needs and medical condition, following the concepts of motivational interviewing, shared decision-making and evidence-based-medicine. Approximately 12,000 insurants will be enrolled and randomized into intervention and control groups. Primary outcome is the time until hospital readmission within two years after enrolling in the health coaching, assessed by routine data. Secondary outcomes are patient-reported outcomes like changes in quality of life, depression and anxiety and clinical values assessed with questionnaires. Additional secondary outcomes are further economic evaluations like health service use as well as costs and

  19. Attitudes of college students toward mental illness stigma and the misuse of psychiatric medications.

    Science.gov (United States)

    Stone, Amanda M; Merlo, Lisa J

    2011-02-01

    Mental illness stigma remains a significant barrier to treatment. However, the recent increase in the medical and nonmedical use of prescription psychiatric medications among college students seems to contradict this phenomenon. This study explored students' attitudes and experiences related to psychiatric medications, as well as correlates of psychiatric medication misuse (ie, attitudes toward mental illness and beliefs about the efficacy of psychiatric medications). Data were collected anonymously via self-report questionnaires from April 2008 to February 2009. Measures included the Michigan Alcoholism Screening Test, the Drug Abuse Screening Test, Day's Mental Illness Stigma Scale, the Attitudes Toward Psychiatric Medication scale, and the Psychiatric Medication Attitudes Scale. Participants included 383 university students (59.2% female), recruited on the campus of a large state university or through online classes offered through the same university. High rates of psychiatric medication misuse were shown (13.8%) when compared to rates of medical use (6.8%), and students with prescriptions for psychiatric drugs were also more likely to be misusers (χ(2) = 20.60, P medication misusers reported less stigmatized beliefs toward mental illness, including lower anxiety around the mentally ill (t = 3.26, P medications (t = 2.78, P mental illness (t = -2.11, P medications and less favorable beliefs regarding their effectiveness. Reasons for misuse varied by medication class, with 57.1% of stimulant misusers noting help with studying as their primary reason for use and 33.3% of benzodiazepine misusers noting attempts to get high or "party" as their primary reason for misuse. Results suggest the need for improved education regarding the nature of mental illness, the appropriate use of psychiatric medications, and the potential consequences associated with abuse of these potent drugs. © Copyright 2011 Physicians Postgraduate Press, Inc.

  20. Beliefs about antipsychotic versus hypoglycemic medications among individuals with serious mental illness and type 2 diabetes.

    Science.gov (United States)

    Aakre, Jennifer M; Medoff, Deborah R; Dixon, Lisa B; Kreyenbuhl, Julie A

    2012-01-01

    This study compared the beliefs held by individuals with coexisting serious mental illness and type 2 diabetes regarding the necessity and risks of taking antipsychotic versus hypoglycemic medications. We also investigated whether nonadherent patients differed from adherent patients in their beliefs about medications. Forty-four individuals with type 2 diabetes and serious mental illness who were prescribed hypoglycemic and antipsychotic medications completed a cross-sectional assessment of medication beliefs and adherence for both medication types. Patients perceived a greater need for hypoglycemic versus antipsychotic medications; however, their beliefs were not associated with nonadherence to either medication type. These results suggest that individuals with coexisting serious mental illness and type 2 diabetes have stronger convictions regarding the necessity of their diabetes medication for maintaining their health.

  1. Medical care utilization during 1 year prior to death in suicides motivated by physical illnesses.

    Science.gov (United States)

    Cho, Jaelim; Lee, Won Joon; Moon, Ki Tae; Suh, Mina; Sohn, Jungwoo; Ha, Kyoung Hwa; Kim, Changsoo; Shin, Dong Chun; Jung, Sang Hyuk

    2013-05-01

    Many epidemiological studies have suggested that a variety of medical illnesses are associated with suicide. Investigating the time-varying pattern of medical care utilization prior to death in suicides motivated by physical illnesses would be helpful for developing suicide prevention programs for patients with physical illnesses. Suicides motivated by physical illnesses were identified by the investigator's note from the National Police Agency, which was linked to the data from the Health Insurance Review and Assessment. We investigated the time-varying patterns of medical care utilization during 1 year prior to suicide using repeated-measures data analysis after adjustment for age, gender, area of residence, and socioeconomic status. Among 1994 suicides for physical illness, 1893 (94.9%) suicides contacted any medical care services and 445 (22.3%) suicides contacted mental health care during 1 year prior to suicide. The number of medical care visits and individual medical expenditures increased as the date of suicide approached (psuicide significantly increased only in 40- to 64-year-old men (p=0.002), women suicides motivated by physical illnesses contacted medical care during 1 year prior to suicide, but many of them did not undergo psychiatric evaluation. This underscores the need for programs to provide psychosocial support to patients with physical illnesses.

  2. Attitudes of Students at a US Medical School Toward Mental Illness and Its Causes.

    Science.gov (United States)

    Chiles, Catherine; Stefanovics, Elina; Rosenheck, Robert

    2017-06-01

    Stigma among health care providers toward people with mental illness is a worldwide problem. This study at a large US university examined medical student attitudes toward mental illness and its causes, and whether student attitudes change as they progress in their education. An electronic questionnaire focusing on attitudes toward people with mental illness, causes of mental illness, and treatment efficacy was used to survey medical students at all levels of training. Exploratory factor analysis was used to establish attitudinal factors, and analysis of variance was used to identify differences in student attitudes among these factors. Independent-samples t tests were used to assess attitudes toward efficacy of treatments for six common psychiatric and medical conditions. The study response rate was 42.6 % (n = 289). Exploratory factor analysis identified three factors reflecting social acceptance of mental illness, belief in supernatural causes, and belief in biopsychosocial causes. Stages of student education did not differ across these factors. Students who had completed the psychiatry clerkship were more likely to believe that anxiety disorders and diabetes could be treated effectively. Students reporting personal experiences with mental illness showed significantly more social acceptance, and people born outside the USA were more likely to endorse supernatural causes of mental illness. Sociocultural influences and personal experience with mental illness have a greater effect than medical education on attitudes toward people with mental illness. Psychiatric education appears to have a small but significant effect on student attitudes regarding treatment efficacy.

  3. Individual care plans for chronically ill patients within primary care in the Netherlands: Dissemination and associations with patient characteristics and patient-perceived quality of care.

    Science.gov (United States)

    Jansen, Daphne L; Heijmans, Monique; Rijken, Mieke

    2015-06-01

    To examine the use of individual care plans (ICPs) within primary chronic illness care in the Netherlands, and to explore the relationships between ICP use, patient characteristics, and patient-perceived quality of care. Cross-sectional study using survey data from a panel of chronically ill patients and medical registration data provided by their general practices. A sample of 1377 patients with somatic chronic disease(s) randomly selected in general practices throughout the Netherlands, supplemented with a sample of 225 COPD patients, also recruited from general practices. (i) Percentage of ICP use based on self-report by chronically ill patients, and (ii) patient-perceived quality of care as assessed using the Patient Assessment of Chronic Illness Care (PACIC). ICP use among the total generic sample was low (9%), but slightly higher (13%) among patients diagnosed with diabetes or COPD, diseases for which disease management programmes have been set up in the Netherlands. Patients with a low educational level and patients with poor(er) self-rated health were more likely to have an ICP. Compared with patients without an ICP, patients with an ICP more often reported that the care they received was patient-centred, proactive, planned, and included collaborative goal setting, problem-solving, and follow-up support. Findings reveal a discrepancy between practice and policy aspirations regarding ICP use in primary chronic illness care. More research is needed to gain insight into the effectiveness of ICPs to improve the quality of chronic illness care in various patient populations.

  4. Attitude towards Mental illness and Psychiatry among the Medical students and Interns in a University Medical College

    Directory of Open Access Journals (Sweden)

    Ajay Risal

    2013-06-01

    Full Text Available Introduction: Medical students tend to have a neutral or negative attitude to Psychiatry as a discipline. This study was initiated to explore the attitude towards Mental illness and Psychiatry among the Medical students and Interns in Kathmandu University School of Medical Sciences (KUSMS. Method: A cross-sectional Questionnaire based study was conducted among the Medical students and Interns at Dhulikhel Hospital (Kathmandu University Hospital. Two self-rating scales; Attitudes towards psychiatry (ATP-30 and Attitudes to mental illness (AMI were used to assess attitudes towards mental illness and Psychiatry among the total 159 subjects. Descriptive statistics and independent sample t-test applied using SPSS-16 for analysis. Results: Among the total 159 subjects, 56.6% were males and 27.7% were Interns. Comparison of means of each item in ATP-30 and AMI was done between Males and Females, Medical students and Interns, First semester and Ninth semester students. Most of the subjects showed neutral attitude towards all the scoring items; though there were a few significant differences in mean scores of some items in group wise comparison. Conclusions: Overall attitudes towards Mental illness and Psychiatry among the Medical students and Interns in our Medical School were positive or neutral. A further study with medical students from different institutions is needed to get a detail nationwide picture. Key words: Attitude, Interns, Medical Students, Mental illness, Psychiatry.

  5. Predictors of good-quality counselling from the perspective of hospitalised chronically ill adults.

    Science.gov (United States)

    Kaakinen, Pirjo; Kyngäs, Helvi; Kääriäinen, Maria

    2013-10-01

    To determine the factors that predict the quality of patient counselling from the perspective of hospitalised chronically ill adults. In view of the growing number of adults with chronic diseases and a lack of resources in health care, it would be valuable for healthcare professionals to know which factors result in good-quality counselling for such individuals. The study used a cross-sectional, descriptive design. Data were collected from chronically ill adults (n = 106) in northern Finland and were analysed using logistic regression. Counselling implementation was perceived to be of good quality if it was preplanned (odds ratio = 24·07) and patient-centred (odds ratio = 16·03) and if interaction during counselling (odds ratio = 13·27) was good. Counselling about social support (odds ratio = 14·78), preplanned counselling (odds ratio = 9·69), counselling about the results of investigations (odds ratio = 7·84) and counselling about disease progression (odds ratio = 7·66) were statistically significant predictors of the content being considered good quality. The effects of counselling on disease treatment (odds ratio = 11·33), patient-centred counselling (odds ratio = 9·75) and counselling about the effects of attitudes (odds ratio = 9·52) were statistically significant predictors of highly beneficial counselling. Counselling about the effects of disease treatment (odds ratio = 9·71) and interaction during counselling (odds ratio = 4·91) predicted the quality of counselling materials and methods. The results could be used to help healthcare professionals to ensure good-quality counselling by highlighting the areas that are most important to meet the expectations of chronically ill adults. The results can be used to develop the quality of chronically ill adults' counselling as well as to educate staff to focus better on chronically ill patients' counselling because it is necessary to develop new ways to offer more patient-centred counselling in order to

  6. Paediatric chronic illness and educational failure: the role of emotional and behavioural problems.

    Science.gov (United States)

    Layte, Richard; McCrory, Cathal

    2013-08-01

    Chronic illness in childhood is associated with worse educational outcomes. The association is usually explained via lowered cognitive development, decreased readiness to learn and school absence. However, this paper examines whether worse psychological adjustment may also play a role. We use data from the Growing Up in Ireland study, a cohort study, which collected data on 8,568 nine-year-old children through the Irish national school system using a two-stage sampling method. Maximum likelihood path analytic models are used to assess the direct effect of child chronic illness on reading and maths test scores and the mediating role of emotional and behavioural problems. In unadjusted analyses, children with a mental and behavioural condition scored 14.5 % points less on reading tests and 16.9 % points less on maths tests than their healthy peers. Children with non-mental and behavioural conditions scored 3 % points less on both tests, a significant difference. Mental and behavioural (OR, 9.58) and other chronic conditions (OR, 1.61) were significantly more likely to have 'high' levels of difficulties on the SDQ. Path analysis models showed that the association between chronic illness and educational test scores was completely mediated by emotional and behavioural problems controlling for school absence and bullying by peers. Child and adolescent chronic illness can have significant effects on educational development and a long-lasting impact on future life-chances. The psychological adjustment of the child is important in mediating the effect of chronic illness on educational outcomes. Interventions should target this developmental pathway.

  7. Return Migration among Elderly, Chronically Ill Bosnian Refugees: Does Health Matter?

    Science.gov (United States)

    Handlos, Line Neerup; Olwig, Karen Fog; Bygbjerg, Ib Christian; Kristiansen, Maria; Norredam, Marie Louise

    2015-10-12

    Elderly migrants constitute a considerable share of global return migration; nevertheless, literature on the health aspects of the return migration among these migrants is still scarce. This study explores the significance of return migration among elderly, chronically ill Bosnian refugees from Denmark and the role of health issues in their decision to return. It is based on semi-structured interviews with 33 elderly, chronically ill Bosnian refugees who have moved back to Bosnia and Herzegovina, and 10 elderly, chronically ill Bosnian refugees who have remained in Denmark. The interviews show that physical health, in the sense of the absence of illness and easy access to necessary health-care services and medicines, was not highly prioritized when the decision was made whether or not to return. However, if health is regarded more broadly as involving more than mere physical health and the absence of illness, health did matter. Viewed as physical, social and mental well-being in line with WHO's definition of health, health was indeed one of the most important factors when the decision to return was made.

  8. Effects of loneliness on illness perception in persons with a chronic disease.

    Science.gov (United States)

    Özkan Tuncay, Fatma; Fertelli, Tülay; Mollaoğlu, Mukadder

    2018-04-01

    To determine the effects of loneliness on illness perception in persons with a chronic disease. How an illness is perceived not only affects all dimensions of a person's life but also plays an important role in his/her coping with the complications and consequences of the disease. One of the factors that influence the illness perception is loneliness. The study is a descriptive study. The study sample included 206 individuals over the 18 years of age, conscious, having had a chronic illness at least 1 year, having no communication problems and agreeing to participate in the study after being informed about the study. Data were collected with the Personal Information Form, the Illness Perception Questionnaire and the University of California Los Angeles Loneliness Scale. The forms were administered to the participants in an unoccupied patient room, and the data were collected through face-to-face interviews. The results of the study revealed that individuals with a chronic disease perceived emotional symptoms accompanying the disease more intensely that they accepted their disease was a chronic one and that their personal control and treatment control of the disease were at a middle level. The mean score the participants obtained from the University of California Los Angeles Loneliness Scale was 38.49 ± 11.15. There was a significant negative correlation between this mean score and the mean scores obtained from the following subscales consequences, treatment control, illness perception and emotional representations. In this study, it was concluded that the participants perceived their loneliness level as moderate and that their illness perception was negatively affected as their loneliness levels increased. The knowledge of clinical nurses about perception of patients with chronic illnesses and conditions affecting that perception will enhance compliance with the illness management or treatment strategies. Clinical nurses should observe residents closely for

  9. Educational Functioning of Children of Parents with Chronic Physical Illness: A Systematic Review

    Science.gov (United States)

    Chen, Cliff Yung-Chi

    2016-01-01

    A systematic review of the literature was performed to answer the question: What are the effects of parental chronic physical illness on children's educational functioning? Thirteen studies that met the inclusion criteria for the purpose of this review were identified, indicating the paucity of research on the topic. The results found that…

  10. Psychosocial Adaptation to Chronic Illness and Disability: A Primer for Counselors

    Science.gov (United States)

    Livneh, Hanoch; Antonak, Richard F.

    2005-01-01

    In this article, the authors discuss 3 broad domains of psychosocial adaptation to chronic illness and disability. These include the dynamics (basic concepts, psychosocial responses, and coping strategies) typically associated with the process of adaptation to disabling conditions, assessment of adaptation as evidenced by 6 commonly used measures,…

  11. Topical Review: Adolescent Self-Regulation as a Foundation for Chronic Illness Self-Management

    Science.gov (United States)

    Lansing, Amy Hughes

    2014-01-01

    Objective To illustrate adolescent self-regulation as a foundation for both individual and interpersonal processes in adolescent chronic illness self-management. Method Literature review. Results Research has identified multiple individual (e.g., self-efficacy, coping, and adherence) and interpersonal factors (parental monitoring and friend support) that are sources of risk and resilience to adolescent chronic illness self-management. In this article, we highlight literature consistent with the idea that self-regulation (including cognitive, emotional, and behavioral regulation) underlies both individual and interpersonal sources of risk and resilience across development. Conclusions This self-regulation approach has multiple benefits: A parsimonious construct for explaining both individual and interpersonal processes that contribute to risk and resilience for chronic illness self-management, the incorporation of methods used in developmental and health psychology research, including performance-based, physiological, daily, and ecological momentary assessment, and a new look to interventions that target self-regulation as a way to improve individual and interpersonal processes in chronic illness self-management. PMID:25214646

  12. A photo elicitation study on chronically ill adolescents' identity constructions during transition

    DEFF Research Database (Denmark)

    Hanghøj, Signe; Schmiegelow, K.; Boisen, Kirsten A.

    2016-01-01

    Adolescence is an important phase of life with increasing independence and identity development, and a vulnerable period of life for chronically ill adolescents with a high occurrence of insufficient treatment adherence. We conducted four photo elicitation focus group interviews with 14 adolescents...

  13. Accuracy of triage for children with chronic illness and infectious symptoms

    NARCIS (Netherlands)

    N. Seiger (Nienke); M.V. Veen (Mirjam Van); E.W. Steyerberg (Ewout); J. van der Lei (Johan); H.A. Moll (Henriëtte)

    2013-01-01

    textabstractOBJECTIVE: This prospective observational study aimed to assess the validity of the Manchester Triage System (MTS) for children with chronic illnesses who presented to the emergency department (ED) with infectious symptoms. METHODS: Children (<16 years old) presenting to the ED of a

  14. A Multi-Modal Digital Game-Based Learning Environment for Hospitalized Children with Chronic Illnesses.

    Science.gov (United States)

    Chin, Jui-Chih; Tsuei, Mengping

    2014-01-01

    The aim of this study was to explore the digital game-based learning for children with chronic illnesses in the hospital settings. The design-based research and qualitative methods were applied. Three eight-year-old children with leukemia participated in this study. In the first phase, the multi-user game-based learning system was developed and…

  15. Quality of Life and School Absenteeism in Children with Chronic Illness

    Science.gov (United States)

    Emerson, Natacha D.; Distelberg, Brian; Morrell, Holly E. R.; Williams-Reade, Jackie; Tapanes, Daniel; Montgomery, Susanne

    2016-01-01

    Objective: Children and adolescents with a chronic illness (CI) tend to demonstrate diminished physical and social functioning, which contribute to school attendance issues. We investigated the role of social and physical functioning in reducing school absenteeism in children participating in Mastering Each New Direction (MEND), a family-based…

  16. Integrated care programmes for chronically ill patients: a review of systematic reviews.

    NARCIS (Netherlands)

    Ouwens, M.M.T.J.; Wollersheim, H.C.H.; Hermens, R.P.M.G.; Hulscher, M.E.J.L.; Grol, R.P.T.M.

    2005-01-01

    OBJECTIVE: To investigate effectiveness, definitions, and components of integrated care programmes for chronically ill patients on the basis of systematic reviews. DESIGN: Literature review from January 1996 to May 2004. MAIN MEASURES: Definitions and components of integrated care programmes and all

  17. Adults Living with Limited Literacy and Chronic Illness: Patient Education Experiences

    Science.gov (United States)

    King, Judy; Taylor, Maurice C.

    2010-01-01

    The purpose of this study was to investigate how Canadian adults living with limited literacy and chronic illness made meaning of their patient education experiences. The study used a hermeneutic phenomenological research design and employed three data sources over a nine-month period. Data was interpreted and analyzed as it was collected,…

  18. Efficacy of Psychosocial Group Intervention for Children With Chronic Illness and Their Parents

    NARCIS (Netherlands)

    Scholten, Linde; Willemen, Agnes M.; Last, Bob F.; Maurice-Stam, Heleen; van Dijk, Elisabeth M.; Ensink, Elske; Zandbelt, Noortje; van der Hoop-Mooij, Aafke; Schuengel, Carlo; Grootenhuis, Martha A.

    2013-01-01

    OBJECTIVE: To investigate the efficacy of a cognitive-behavioral group intervention for children with chronic illnesses and to test the effect of an added parent component. METHODS: Children (n = 194) and their parents participated in a multi-center randomized clinical trial comparing a child-only

  19. The Impact of Family Behaviors and Communication Patterns on Chronic Illness Outcomes: A Systematic Review

    Science.gov (United States)

    Rosland, Ann-Marie; Heisler, Michele; Piette, John D.

    2013-01-01

    In general, social support from family members affects chronic illness outcomes, but evidence on which specific family behaviors are most important to adult patient outcomes has not been summarized. We systematically reviewed studies examining the effect of specific family member behaviors and communication patterns on adult chronic illness self-management and clinical outcomes. Thirty studies meeting inclusion criteria were identified, representing 22 participant cohorts, and including adults with arthritis, chronic cardiovascular disease, diabetes, and/or end stage renal disease. Family emphasis on self-reliance and personal achievement, family cohesion, and attentive responses to symptoms were associated with better patient outcomes. Critical, overprotective, controlling, and distracting family responses to illness management were associated with negative patient outcomes. Study limitations included cross-sectional designs (11 cohorts), however results from longitudinal studies were similar. Findings suggest that future interventions aiming to improve chronic illness outcomes should emphasize increased family use of attentive coping techniques and family support for the patient’s autonomous motivation. PMID:21691845

  20. Living with a Chronic Disabling Illness and Then Some: Data from the 1998 Ice Storm

    Science.gov (United States)

    Gignac, Monique A. M.; Cott, Cheryl A.; Badley, Elizabeth M.

    2003-01-01

    This study examined the impact of the 1998 Canadian ice storm on the physical and psychological health of older adults (age greater than 55 years) living with a chronic physical illness, namely osteoarthritis and/or osteoporosis. Although disasters are relatively rare, they are a useful means of examining the impact of a single stressor on a group…

  1. Relation between perceived health and sick leave in employees with a chronic illness

    NARCIS (Netherlands)

    Boot, C.R.L.; Koppes, L.L.J.; Bossche, S.N.J. van den; Anema, J.R.; Beek, A.J. van der

    2011-01-01

    Introduction: To improve work participation in individuals with a chronic illness, insight into the role of work-related factors in the association between health and sick leave is needed. The aim of this study was to gain insight into the contribution of work limitations, work characteristics, and

  2. Rethinking ‘risk' and self-management for chronic illness

    Science.gov (United States)

    Morden, Andrew; Jinks, Clare; Ong, Bie Nio

    2012-01-01

    Self-management for chronic illness is a current high profile UK healthcare policy. Policy and clinical recommendations relating to chronic illnesses are framed within a language of lifestyle risk management. This article argues the enactment of risk within current UK self-management policy is intimately related to neo-liberal ideology and is geared towards population governance. The approach that dominates policy perspectives to ‘risk' management is critiqued for positioning people as rational subjects who calculate risk probabilities and act upon them. Furthermore this perspective fails to understand the lay person's construction and enactment of risk, their agenda and contextual needs when living with chronic illness. Of everyday relevance to lay people is the management of risk and uncertainty relating to social roles and obligations, the emotions involved when encountering the risk and uncertainty in chronic illness, and the challenges posed by social structural factors and social environments that have to be managed. Thus, clinical enactments of self-management policy would benefit from taking a more holistic view to patient need and seek to avoid solely communicating lifestyle risk factors to be self-managed. PMID:23226974

  3. Loneliness, depression, social support, and quality of life in older chronically ill Appalachians.

    Science.gov (United States)

    Theeke, Laurie A; Goins, R Turner; Moore, Julia; Campbell, Heather

    2012-01-01

    This study's purpose was to describe loneliness and to examine the relationships between loneliness, depression, social support, and QOL in chronically ill, older Appalachians. In-person interviews were conducted with a convenience sample of 60 older, chronically ill, community-dwelling, and rural adults. Those with dementia or active grief were excluded. The UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1985), Geriatric Depression Scale (Shiekh & Yesavage, 1986), Katz ADL scale (Katz, Down, & Cash, 1970), MOS Social Support Scale (Sherbourne & Stewart, 1991), and a visual analog scale for Quality of Life (Spitzer et al., 1981) scale were used. Diagnoses were obtained through chart reviews. SPSS was used for data analyses. The majority of the 65% female sample (M age = 75 years) were married and impoverished. Participants' number of chronic illnesses averaged more than 3. Over 88% of participants reported at least 1 area of functional impairment. Loneliness was prevalent with UCLA loneliness scores indicating moderate to high loneliness, ranging from 39 to 62 (possible scores were 20-80). Higher loneliness scores correlated with depression, lower Qol, and lower social support, particularly lower emotional support. This study provides evidence that loneliness is a significant problem for older chronically ill Appalachian adults and that it may be related to low emotional support. Further, it provides evidence that this population may be significantly lonely and may not self-identify as lonely. Screening for loneliness and designing interventions that target the emotional aspects of loneliness could be important in this population.

  4. Introduction to Health Promotion for People with Chronic Illness and Disability

    Science.gov (United States)

    Chan, Fong; Chiu, Chung-Yi; Bezyak, Jill L.; Keegan, John

    2012-01-01

    Health promotion has received increasing attention in rehabilitation counseling research. Health promotion research contributes to theory building and provides the foundation for empirically supported interventions that can improve the health-related quality of life and employment outcomes of people with chronic illness and disability. In this…

  5. Does chronic illness cause adverse social and economic consequences among Swedes?

    DEFF Research Database (Denmark)

    Lindholm, C; Burström, B; Diderichsen, F

    2001-01-01

    had acquired LLSI at interview II varied between 1.4 and 4.0 for the outcomes. The elevated OR decreased after testing for the mediating effect of social context and the labour market position for financial difficulties but remained significantly elevated. CONCLUSIONS: The results suggest that LLSI...... question raised here is therefore to examine chronic illness (defined as limiting longstanding illness. LLSI) as a causal factor contributing adverse financial conditions, unemployment or labour market exclusion. METHODS: A longitudinal design was employed with data from a sample of 27,773 people...... interviewed twice (Swedish Surveys of Living Conditions performed by Statistics Sweden), including subjects (n = 12,556) at interview I, without chronic illness or adverse socioeconomic conditions. RESULTS: The odds ratios for labour market exclusion, unemployment, and financial difficulties among people who...

  6. Coping styles and locus of control as predictors for psychological adjustment of adolescents with a chronic illness

    NARCIS (Netherlands)

    Meijer, SA; Sinnema, G; Bijstra, JO; Mellenbergh, GJ; Wolters, WHG

    This study examines the way coping styles and locus of control contribute to the prediction of psychosocial adjustment in adolescents with a chronic illness. Psychosocial adjustment of 84 adolescents aged 13-16 years with a chronic illness was assessed with measures of social adjustment. global

  7. Young adult outcomes of children growing up with chronic illness: an analysis of the National Longitudinal Study of Adolescent Health.

    Science.gov (United States)

    Maslow, Gary R; Haydon, Abigail A; Ford, Carol Ann; Halpern, Carolyn Tucker

    2011-03-01

    To examine young adult outcomes in a nationally representative US cohort of young adults growing up with a chronic illness. Secondary analysis of nationally representative data from wave III (in 2001) of the National Longitudinal Study of Adolescent Health. United States. The analytic sample comprised 13 236 young adults aged 18 to 28 years at wave III. Self-report of a chronic physical illness (asthma, cancer, diabetes mellitus, or epilepsy) in adolescence. Respondents with asthma or nonasthmatic chronic illness (cancer, diabetes mellitus, or epilepsy) were compared with individuals without these conditions. Self-report of high school graduation, ever having employment, currently having employment, living with a parent/guardian, and ever receiving public assistance. Three percent of young adults had nonasthmatic chronic illness (cancer, diabetes, or epilepsy), and 16.0% had asthma. Most young adults with chronic illness graduated high school (81.3%) and currently had employment (60.4%). However, compared with healthy young adults, those with nonasthmatic chronic illness were significantly less likely to graduate high school, ever have had employment, or currently have employment and were more likely to receive public assistance. Compared with young adults with asthma, those with nonasthmatic chronic illness again had significantly worse young adult outcomes on all measures. Most young adults growing up with a chronic illness graduate high school and have employment. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones.

  8. Are We overestimating the prevalence of depression in chronic illness using questionnaires? Meta-analytic evidence in obstructive sleep apnoea

    DEFF Research Database (Denmark)

    Nanthakumar, Shenooka; Bucks, Romola S.; Skinner, Timothy C.

    2016-01-01

    Depression is common in chronic illness, albeit prevalence can be highly variable. This variability may be a function of symptom overlap between depression and chronic illness. Using Obstructive Sleep Apnoea (OSA) as an exemplar, this meta-analysis explored whether the proportion of overlapping s...

  9. Chronic illness and disordered eating: a discussion of the literature.

    Science.gov (United States)

    Quick, Virginia M; Byrd-Bredbenner, Carol; Neumark-Sztainer, Dianne

    2013-05-01

    This paper describes the prevalence of eating disorders and disordered eating behaviors, the reasons why these practices are endorsed, and the potential consequences in youths and young adults with selected diet-related chronic health conditions (DRCHCs) and provides recommendations for eating disorder prevention interventions and research efforts. Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions.

  10. Continuity of Care for Older Adults with Chronic Illness in China: An Exploratory Study.

    Science.gov (United States)

    Cheng, Shu-Ling; Zhao, Jin-Zhi; Bai, Jinbing; Zang, Xiao-Ying

    2015-01-01

    To explore nurses' understanding of continuity of care and existing problems in implementation of continuity of care for Chinese elders with chronic illnesses. Cross-sectional survey and semi-structured interview were performed on 15 nurses and older patients and 1,902 older patients between July 2010 and February 2011. Semi-structured interview guideline and four-section scale were used. The interviews showed nurses lacked knowledge of continuity of care, and nurses from small towns or rural areas had less understanding of continuity of care and discharge planning than nurses from central cities. Significant differences were found among patients located in referred areas in selection of medical institutions for treatment, suggesting older adults were more likely to choose general hospitals for treatment. Self-reported surveys demonstrated more than 70% of hospitalized elders chose community hospitals for further recovery after discharge from general hospitals. Chinese nurses lack knowledge of continuity of care, and significant discontinuity exists between health care provided by general hospitals, community hospitals and other institutions for elders. A further model for the development of continuity of care should be established that addresses older patients' demands and current barriers in China. © 2014 Wiley Periodicals, Inc.

  11. 'I have cystic fibrosis': an analysis of web-based disclosures of a chronic illness.

    Science.gov (United States)

    Ravert, Russell D; Crowell, Toni L

    2008-11-01

    This study examined instances where individuals with cystic fibrosis disclosed their illness on the World Wide Web, better understand their experiences and needs across stages of the lifespan. Disclosing one's chronic illness is typically done purposefully, so examining those disclosures allows a naturalistic window into individuals' experiences and needs. This study is unique to Internet-based studies of chronic illness in that data are not limited to interactions at health-related websites, but include disclosure instances gathered across a variety of Internet contexts. Qualitative content analysis with a summative component was used. A web-based search engine was used to identify all web pages containing the phrases 'I have cystic fibrosis' and 'I have cf' (n = 277). Constant comparative analysis methods were used to identify thematic categories of context. Quantitative methods were used to examine age-related differences in the distribution of those disclosure statements. Findings were interpreted within a framework of Erikson's lifespan psychosocial theory. Adolescents (13-18 years) most frequently expressed psychosocial concerns and enlisted social support. Emerging adults (19-25 years) tended to present cystic fibrosis as just one of many self-characteristics. Adults (>25 years) tended to reach out to support others with cystic fibrosis. The study identified age-related differences in the types of illness disclosures found among individuals with cystic fibrosis. It also demonstrated that web-based research into chronic illness need not be limited to analysis of illness-specific online communities. Findings suggest that psychosocial interventions for individuals with cystic fibrosis across the lifespan might focus on (a) facilitating social support and incorporating illness into one's emerging identity among adolescents, (b) supporting emerging adults in presenting and incorporating themselves into larger social networks and (c) partnering with

  12. Psychosocial well-being in young adults with chronic illness since childhood: the role of illness cognitions

    Science.gov (United States)

    2014-01-01

    Background More and more pediatric patients reach adulthood. Some of them are successfully integrating in adult life, but many others are not. Possibly Illness cognitions (IC) - the way people give meaning to their illness/disability – may play a role in individual differences on long-term adjustment. This study explored the association of IC with disease–characteristics and Health Related Quality of Life (HRQoL), anxiety and depression in young adults with a disability benefit due to childhood-onset chronic condition. Methods In a cross-sectional study, young adults (22–31 years, N = 377) who claimed a disability benefit because of a somatic condition since childhood, completed the Illness Cognition Questionnaire (acceptance-helplessness-benefits), RAND-36 (HRQoL) and HADS (anxiety and depression) online. Besides descriptive statistics, linear regression analyses were conducted to predict (1) illness cognitions by age, gender and disease-characteristics, and (2) HRQoL (Mental and Physical Component Scale), Anxiety and Depression by illness cognitions, controlling for disease-characteristics, age and gender. Results Respectively 90.2%, 83.8% and 53.3% of the young adults with a disability benefit experienced feelings of acceptance, benefits and helplessness. Several disease-characteristics were associated with IC. More acceptance and less helplessness were associated with better mental (β = 0.31; β = −0.32) and physical (β = 0.16; β = −0.15) HRQoL and with less anxiety (β = −0.27; β = 0.28) and depression (β = −0.29; β = 0.31). Conclusions IC of young adult beneficiaries were associated with their HRQoL and feelings of anxiety and depression. Early recognition of psychological distress and negative IC might be a key to the identification of pediatric patients at risk for long-term dysfunction. Identification of maladaptive illness cognitions enables the development of psychosocial interventions to optimise

  13. Measuring Children's Decision-Making Involvement Regarding Chronic Illness Management

    Science.gov (United States)

    Harris, Diana

    2012-01-01

    Objectives To develop a measure of decision-making involvement in children and adolescents with cystic fibrosis, diabetes, and asthma. Methods Parent–child dyads completed the Decision-Making Involvement Scale (DMIS) and measures of locus of control and family communication. DMIS items were subjected to exploratory and confirmatory factor analysis (CFA). Temporal stability and construct validity were assessed. Results The parent form was reduced to 20 items representing five factors. CFA showed that the five factors were an acceptable fit to the parent- and child-report data. Internal consistency values ranged from 0.71 to 0.91. Temporal stability was supported by moderate–substantial intraclass correlation coefficients. DMIS subscales were associated with child age, child locus of control, and family communication. Conclusions The DMIS can be used to inform our understanding of the transition to greater independence for illness management. Additional research is needed to examine outcomes of decision-making involvement, including treatment adherence and responsibility. PMID:22138318

  14. How Mental Illness is Perceived by Iranian Medical Students: A Preliminary Study

    Science.gov (United States)

    Amini, Homayoun; Majdzadeh, Reza; Eftekhar-Ardebili, Hasan; Shabani, Amir; Davari-Ashtiani, Rozita

    2013-01-01

    The study aimed to assess medical students' attitudes toward mental illness following a 4-week psychiatry clerkship. All fifth-year medical students from three academic centers in Tehran were asked to participate in the study. They completed the questionnaire on the last day of their 4-week psychiatry clerkship. A self-administered questionnaire was used to examine participants' Attitudes Toward Mental Illness (ATMI). One hundred and sixty eight students completed the questionnaires (88.9% response rate). In general, the students had favorable attitudes toward mental illness at the end of their clerkship, with mean (± SD) ATMI total score of 78.6 (± 8.1) (neutral score, 66.0). The students showed the most favorable opinion (95.2%) about Category 5 (stereotypic attitude toward people with mental illness) whilst they revealed the least favorable opinion (64.3%) regarding Category 1 (social relations with people affected by mental illness). In addition, the students thought that movies were on the top of influential media on shaping the attitudes toward mental illness. Overall, most of Iranian medical students had generally favorable attitudes toward people with mental illness at the end of their clerkship. Therefore, it may be expected next generation of medical doctors show more favorable attitude toward mental illness. PMID:23878611

  15. The importance of relational coordination and reciprocal learning for chronic illness care within primary care teams.

    Science.gov (United States)

    Noël, Polly Hitchcock; Lanham, Holly J; Palmer, Ray F; Leykum, Luci K; Parchman, Michael L

    2013-01-01

    Recent research from a complexity theory perspective suggests that implementation of complex models of care, such as the Chronic Care Model (CCM), requires strong relationships and learning capacities among primary care teams. Our primary aim was to assess the extent to which practice member perceptions of relational coordination and reciprocal learning were associated with the presence of CCM elements in community-based primary care practices. We used baseline measures from a cluster randomized controlled trial testing a practice facilitation intervention to implement the CCM and improve risk factor control for patients with Type 2 diabetes in small primary care practices. Practice members (i.e., physicians, nonphysician providers, and staff) completed baseline assessments, which included the Relational Coordination Scale, Reciprocal Learning Scale, and the Assessment of Chronic Illness Care (ACIC) survey, along with items assessing individual and clinic characteristics. To assess the association between Relational Coordination, Reciprocal Learning, and ACIC, we used a series of hierarchical linear regression models accounting for clustering of individual practice members within clinics and controlling for individual- and practice-level characteristics and tested for mediation effects. A total of 283 practice members from 39 clinics completed baseline measures. Relational Coordination scores were significantly and positively associated with ACIC scores (Model 1). When Reciprocal Learning was added, Relational Coordination remained a significant yet notably attenuated predictor of ACIC (Model 2). The mediation effect was significant (z = 9.3, p < .01); 24% of the association between Relational Coordination and ACIC scores was explained by Reciprocal Learning. Of the individual- and practice-level covariates included in Model 3, only the presence of an electronic medical record was significant; Relational Coordination and Reciprocal Learning remained significant

  16. Psychotropic Medication Adherence among Community-Based Individuals with Developmental Disabilities and Mental Illness

    Science.gov (United States)

    Tan, Xi; Marshall, Vincent D.; Balkrishnan, Rajesh; Patel, Isha; Chang, Jongwha; Erickson, Steven R.

    2015-01-01

    Psychotropic medications are a common treatment for mental illness in people with developmental disabilities. Medication adherence is a critical determinant of the effectiveness of psychotropic drugs, but psychotropic medication adherence research specific to this population remains limited. This retrospective study analyzed Marketscan®…

  17. Disease-management partnership functioning, synergy and effectiveness in delivering chronic-illness care.

    Science.gov (United States)

    Cramm, Jane Murray; Nieboer, Anna Petra

    2012-06-01

    This study explored associations among disease-management partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. This study had a cross-sectional design. The study sample consists of 218 professionals (out of 393) participating in 22 disease-management partnerships in various regions of the Netherlands. We assessed the relationships among partnership functioning, synergy and effectiveness in the delivery of chronic-illness care. Partnership functioning was assessed through leadership, resources, administration and efficiency. Synergy was considered the proximal outcome of partnership functioning, which, in turn, influenced the effectiveness of disease-management partnerships [measured with the Assessment of Chronic Illness Care (ACIC) survey instrument]. Overall ACIC scores ranged from 3 to 10, indicating basic/intermediate to optimal/comprehensive delivery of chronic-illness care. The results of the regression analysis demonstrate that partnership effectiveness was positively associated with leadership (β = 0.25; P≤ 0.01), and resources (β = 0.31; P≤ 0.001). No significant relationship was found between administration, efficiency and partnership effectiveness. Partnership synergy acted as a mediator for partnership functioning and was statistically significantly associated with partnership effectiveness (β = 0.25; P≤ 0.001). Disease-management partnerships seemed better able to deliver higher levels of chronic-illness care when synergy is created between partners. Synergy was more likely to emerge with boundary-spanning leaders who understood and appreciated partners' different perspectives, could bridge their diverse cultures and were comfortable sharing ideas, resources and power. In addition, the acknowledgement of and ability to use members' resources are valuable in engaging partners' involvement and achieving synergy in disease-management partnerships.

  18. Emergency and disaster preparedness for chronically ill patients: a review of recommendations

    Directory of Open Access Journals (Sweden)

    Tomio J

    2014-12-01

    Full Text Available Jun Tomio,1 Hajime Sato2 1Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; 2Department of Health Policy and Technology Assessment, National Institute of Public Health, Wako, Japan Abstract: Recent disasters, especially those in developed countries, have highlighted the importance of disaster preparedness measures for chronic diseases. A number of surviving patients experienced the exacerbation of a chronic illness, such as hypertension, diabetes, cancer, and chronic respiratory diseases, due to disaster-related stress, interruption of care, or both; for some patients, these exacerbations resulted in death. Here, we review reports from recent disasters in developed countries and summarize the recommendations for disaster preparedness of chronically ill patients. A considerable number of recommendations based on the lessons learned from recent disasters have been developed, and they provide practical and essential steps to prevent treatment interruption during and after a disaster. To improve preparedness efforts, we suggest that health care providers should be aware of the following three suggestions: 1 recommendations should be evidence-based; 2 recommendations should contain consistent messages; and 3 recommendations should be feasible. Keywords: disaster, chronic illness, preparedness

  19. Using zero-inflated models to explain chronic illness, pain, and complementary and alternative medicine use.

    Science.gov (United States)

    Ayers, Stephanie L; Kronenfeld, Jennie J

    2011-07-01

    To extend knowledge of complementary and alternative medicine (CAM) use by understanding how poor health influences both trying CAM and number of CAM types used. Using the 2002 National Health Interview Survey's Supplemental Section, zero-inflated models were employed to examine CAM use across 5 domains. Results indicate that level of pain is the only consistent predictor of both the likelihood of trying CAM and how many types of CAM are used. Pain increased the odds ratio and number of CAM types used across all domains. Findings, however, were mixed for health status and chronic conditions. Only prayer was associated with higher odds ratio (OR=1.705, PCAM types used for chronic illnesses (OR=1.024, PCAM use behaviors. Pain is the only consistent predictor of both trying CAM and the number of CAM types used. Chronic illness is only consistently influential for prayer.

  20. Cardiovascular disease among severe mental illness and psychiatric medication

    Directory of Open Access Journals (Sweden)

    Sileshi Demelash

    2017-01-01

    Full Text Available People with mental illness are more likely to have serious coexisting physical health problems than the general population. Although lifestyle and genetics may contribute independent risks of cardiovascular dysfunction in schizophrenia and other serious mental illness, antipsychotic treatment also represents an important contributor to risk of cardiovascular disorder, particularly for certain drugs and for vulnerable patients. Mental health professionals and other health care provider must give emphasis to recognize the clinical signposts indicating mental health related cardiovascular problems to forestall progression to type II diabetes, cardiovascular events and premature death.

  1. Personal strengths reported by people with chronic illness: A qualitative study.

    Science.gov (United States)

    Kristjansdottir, Olöf Birna; Stenberg, Una; Mirkovic, Jelena; Krogseth, Tonje; Ljoså, Tone Marte; Stange, Kurt C; Ruland, Cornelia M

    2018-02-25

    Self-management of chronic illness can be highly demanding and people need to mobilize their personal strengths to live well with their condition. More knowledge is needed about how people with chronic illness perceive and use their personal strengths as a basis for better integrating empowering person-centred approaches into health care. To explore what people with chronic illness describe as their strengths relevant to their health and well-being. Thirty-nine participants (11 men) from 4 outpatient self-management programmes were recruited to individual or group interviews. Participants included patients with chronic respiratory disease (n = 7), chronic pain (n = 18) and morbid obesity (n = 14). Interviews were analysed using content analysis. A number of personal strengths were reported and categorized into 3 domains: (i) Internal strengths, (ii) External strengths and (iii) Self-management strategies. Internal strengths included being persistent, having a positive outlook, being kind and caring, experiencing positive emotions, being kind towards oneself, reconciling oneself with the situation, having courage and having knowledge and insight. External strengths included support from family, friends, peers and health-care providers. Self-management strategies included being active, planning and prioritizing, reducing stress, goal setting and seeking knowledge and help. The study provides insights into personal strengths as reported by people with chronic illness. The results complement prior findings on strengths in people with health challenges and can aid in incorporating person-centred approaches into health care. © 2018 The Authors Health Expectations published by John Wiley & Sons Ltd.

  2. Adaptations of Personal Health Record Platform for Medical Research on Chronic Diseases

    Directory of Open Access Journals (Sweden)

    A. Krukowski

    2015-05-01

    Full Text Available The article reports on experiences in e-Health platforms and services for supporting medical research into the causes and relationships among physiological parameters and health problems concerning different chronic diseases. The Personal Health Record (PHR is a way of standardizing electronic management of medical information between patients and their physicians, including medical bodies collaborating in providing integrated medical care services. We describe roles and aims behind electronic health records, follow with applicable legal and standardizations frameworks and relevant European activities, leading to the presentation of common commercial and open-source implementations of such systems, concluding with the indication of specific adaptations enabling a use of stored personal health data for scientific research into causes and evaluation of chronic illnesses. We describe ethical and privacy concerns that are relevant to using and exchanging electronic health information.

  3. Acute high-altitude illness | Hofmeyr | South African Medical Journal

    African Journals Online (AJOL)

    A substantial proportion of South Africa (SA)'s population lives at high altitude (>1 500 m), and many travel to very high altitudes (>3 500 m) for tourism, business, recreation or religious pilgrimages every year. Despite this, knowledge of acute altitude illnesses is poor among SA doctors. At altitude, the decreasing ambient ...

  4. Fathers' coping mechanisms related to parenting a chronically ill child: implications for advanced practice nurses.

    Science.gov (United States)

    Broger, Brenda; Zeni, Mary Beth

    2011-01-01

    The presence of a father has been positively associated with outcomes in several aspects of a child's life. This descriptive study investigated coping methods used by fathers of chronically ill children, fathers' perceived severity of the child's illness, and demographic differences related to coping mechanisms. A sample of 54 fathers of chronically ill children completed measurements of demographics, coping processes, and severity levels of their child's chronic condition. Data were analyzed with SPSS 14.0 using parametric and nonparametric tests to examine relationships and coping behaviors used by fathers in northwest Florida. A majority of fathers used an emotion-focused coping process with a religious dimension. No association was found between perceived level of severity of their child's illness and eight subscales used to measure coping methods; however, statistical significance was found between the age and marital status of fathers with seven of the subscales. Married and older fathers more often used "positive" coping mechanisms than did younger, unmarried fathers. The findings emphasize the need for practitioners, clinicians, and educators to assess, support, and provide appropriate resources to fathers in order to promote positive effective coping and increase the level of involvement in the child's life. Copyright © 2011 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  5. Paliperidone Palmitate Once-Monthly Treatment in Recent Onset and Chronic Illness Patients With Schizoaffective Disorder.

    Science.gov (United States)

    Bossie, Cynthia A; Turkoz, Ibrahim; Alphs, Larry; Mahalchick, Lucy; Fu, Dong-Jing

    2017-04-01

    Data from a multiphase schizoaffective disorder study (NCT01193153) were used to examine the effects of paliperidone palmitate once-monthly (PP1M) by subjects' illness duration, defined as recent onset (≤5 years since first psychiatric diagnosis; n = 206) and chronic illness (>5 years; n = 461). Symptom and functioning scores, as measured during open-label PP1M acute and stabilization treatment phases, improved in both subpopulations, with greater improvements in recent onset than chronic illness subjects (p ≤ 0.022). Relapse rates, examined during the double-blind, placebo-controlled phase, were higher with placebo than PP1M: 30.0% vs. 10.2% (p = 0.014; hazard ratio [HR]: 2.8; 95% confidence interval [CI]: 1.11-7.12; p = 0.029) in the recent onset subpopulation and 35.5% vs. 18.1% (p = 0.001; HR: 2.38; 95% CI: 1.37-4.12; p = 0.002) in the chronic illness subpopulation. Growing evidence in the treatment of schizophrenia and schizoaffective disorder supports early intervention with long-acting antipsychotics.

  6. Mental health in adolescents with chronic physical illness versus controls in Northern Russia.

    Science.gov (United States)

    Zashikhina, A; Hagglof, B

    2007-06-01

    To study the behaviour/emotional problems and depression in adolescents with and without physical illnesses; to compare the same psychological parameters in adolescents with different disorders. The sample consisted of 148 adolescents aged 13-16 years with one of the following physical chronic conditions: diabetes (n = 55), asthma (n = 59), or epilepsy (n = 59). Comparative data were obtained from a group of 301 schoolchildren. Test batteries (Child Behaviour Check-List, Youth Self Report, Beck Depression Inventory, socio-economic status questions) were individually completed by adolescents and their mothers. Overall adolescents with physical illness had more behaviour/emotional problems and were more depressed compared to controls although results varied according to the informants and the disease severity. Two risk groups were revealed: girls with asthma and boys with epilepsy. Our results suggest that mental health in adolescents with chronic physical illnesses is poorer than in controls and their mental health state is very much associated with the disease severity. The findings of the study can help to develop disease targeted and comprehensive interventions in outpatient clinics of Northern Russia in order to reduce behaviour and mood disorders in adolescents with chronic physical illnesses and therefore to smooth the transition through their teenage years.

  7. The Role of Hope for Adolescents with a Chronic Illness: An Integrative Review.

    Science.gov (United States)

    Griggs, Stephanie; Walker, Rachel K

    2016-01-01

    Hope is a human strength essential for adolescents' enduring and coping with chronic illness however, the role of hope is not well understood in this population. This integrative review describes what is currently known about the role of hope in adolescents with a chronic illness. A methodological review using an integrative approach by R. Whittemore and K. Knafl (2005) was performed. MEDLINE via Pubmed; CINAHL; PyscINFO and Google scholar were searched for articles published in peer-reviewed journals from 1995 to 2015, using search terms 'hope and chronic illness' with age limiters for all except Google scholar (title search of "hope and adolescents"). Of the 197 studies initially retrieved: a total of 27 quantitative studies, 8 qualitative studies and 19 theoretical works were selected for review. Seven themes emerged including that hope: (i) promotes health (ii) facilitates coping and adjustment, (iii) enhances quality of life, (iv) is essential in purpose in life and illness (v) improves self-esteem, (vi) is an important factor in resilience and (vii) affects maturation. Persons reporting higher levels of hope find multiple routes to goals, view setbacks as challenges, and better manage psychological symptoms. Although theory and a limited body of empirical research to date suggest a link between hopeful thinking and physical health, the specific mechanisms remain unclear. As hope is linked to resilience, further research should explore whether adolescents with higher hope return to baseline faster than their lower hope counterparts. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. Chronic Illness-Related Shame: Development of a New Scale and Novel Approach for IBD Patients' Depressive Symptomatology.

    Science.gov (United States)

    Trindade, Inês A; Ferreira, Cláudia; Pinto-Gouveia, José

    2017-01-01

    The aims of the present study were to develop and validate a scale specifically focused on shame feelings derived from chronic illness-related experiences, the Chronic Illness-related Shame Scale (CISS) and to fill a gap in literature and analyse the role of this construct in the association between inflammatory bowel disease (IBD) symptomatology and depressed mood. This study comprised two samples: a sample of 161 IBD patients and a mixed sample of 65 chronic patients that reported medical data and completed self-report measures. The CISS's unidimensional seven-item structure was evaluated through confirmatory factor analyses. These analyses revealed good to excellent global and local adjustments in both samples. Results also showed that the CISS presents excellent internal consistencies and convergent, concurrent and divergent validity, being a valid, short and robust scale. Furthermore, the present study explored through path analyses, the role of CISS and self-judgement in the relationship between IBD symptomatology and depressed mood. Results showed that, although the level of IBD symptomatology directly predicted patients' depressive symptoms, the majority of this effect was mediated by CISS and self-judgement. Possible explanations for these findings are discussed in more detail in the succeeding text. The present study seems to highlight the pertinence of developing IBD patients' self-compassionate abilities to adaptively deal with symptomatology and related shame feelings. It thus may represent an avenue for the development of compassionate-based interventions for IBD patients and for the conduction of future studies exploring the shame phenomenon in other chronic illnesses. Copyright © 2016 John Wiley & Sons, Ltd. A new measure, the Chronic Illness-related Shame Scale (CISS), was developed CISS was revealed to be robust instrument in samples of inflammatory bowel disease (IBD) and cancer patients CISS and self-judgement mediate the relationship between

  9. Development and validation of a printed information brochure for families of chronically critically ill patients.

    Science.gov (United States)

    Carson, Shannon S; Vu, Maihan; Danis, Marion; Camhi, Sharon L; Scheunemann, Leslie P; Cox, Christopher E; Hanson, Laura C; Nelson, Judith E

    2012-01-01

    Families and other surrogate decisionmakers for chronically critically ill patients often lack information about patient prognosis or options for care. This study describes an approach to develop and validate a printed information brochure about chronic critical illness aimed at improving comprehension of the disease process and outcomes for patients' families and other surrogate decisionmakers. Investigators reviewed existing literature to identify key domains of informational needs. Content of these domains was incorporated in a draft brochure that included graphics and a glossary of terms. Clinical sensibility, balance, and emotional sensitivity of the draft brochure were tested in a series of evaluations by cohorts of experienced clinicians (n = 49) and clinical content experts (n = 8) with revisions after each review. Cognitive testing of the brochure was performed through interviews of ten representative family members of chronically critically ill patients with quantitative and qualitative analysis of responses. Clinical sensibility and balance were rated in the two most favorable categories on a five-point scale by more than two thirds of clinicians and content experts. After review, family members described the brochure as clear and readable and recommended that the brochure be delivered to family members by clinicians followed by a discussion of its contents. They indicated that the glossary was useful and recommended supplementation by additional lists of local resources. After reading the brochure, their prognostic estimates became more consistent with actual outcomes. We have developed and validated a printed information brochure that may improve family comprehension of chronic critical illness and its outcomes. The structured process that is described can serve as a template for the development of other information aids for use with seriously ill populations.

  10. Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses.

    Science.gov (United States)

    Knaul, Felicia Marie; Bhadelia, Afsan; Atun, Rifat; Frenk, Julio

    2015-09-01

    Health systems in low- and middle-income countries were designed to provide episodic care for acute conditions. However, the burden of disease has shifted to be overwhelmingly dominated by chronic conditions and illnesses that require health systems to function in an integrated manner across a spectrum of disease stages from prevention to palliation. Low- and middle-income countries are also aiming to ensure health care access for all through universal health coverage. This article proposes a framework of effective universal health coverage intended to meet the challenge of chronic illnesses. It outlines strategies to strengthen health systems through a "diagonal approach." We argue that the core challenge to health systems is chronicity of illness that requires ongoing and long-term health care. The example of breast cancer within the broader context of health system reform in Mexico is presented to illustrate effective universal health coverage along the chronic disease continuum and across health systems functions. The article concludes with recommendations to strengthen health systems in order to achieve effective universal health coverage. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Medication preferences and adherence among individuals with severe mental illness and psychiatric advance directives.

    Science.gov (United States)

    Wilder, Christine M; Elbogen, Eric B; Moser, Lorna L; Swanson, Jeffrey W; Swartz, Marvin S

    2010-04-01

    Psychiatric advance directives allow patients with severe mental illness to document their preferences for particular medications. This study investigated the role of psychiatric advance directives in treatment choice and medication adherence. A total of 123 persons with severe mental illness recorded medication preferences in psychiatric advance directives. The authors compared medication preferences to prescribed medications over 12 months, determined concordance between preferred and prescribed medications, and examined the effect of concordance on medication adherence at 12 months. Participants requested a median of two medications in their psychiatric advance directives (range from zero to six) and refused a median of one medication (range from zero to ten). Between baseline and follow-up there was a 27% increase in the number of medications prescribed that had been requested on the psychiatric advance directive (Wilcoxon matched pairs, pmedications listed in the psychiatric advance directive, a 10% increase in concordance remained significant (pmedication requested in the psychiatric advance directive predicted higher medication adherence at 12 months, after the analysis controlled for relevant covariates (odds ratio=7.8, 95% confidence interval=1.8-34.0). Providing information about medication preferences in psychiatric advance directives may increase prescribing of patient-preferred medications even in noncrisis settings. Patients who were prescribed medications that they requested in advance were significantly more likely to adhere to medications, supporting the benefit of patient participation in medication choice. Psychiatric advance directives appear to be a clinically useful conduit for communicating patient medication preferences.

  12. [Medical students' attitudes towards mental illness: a matter of studies or personality?].

    Science.gov (United States)

    Neumann, Eva; Obliers, Rainer; Albus, Christian

    2012-02-01

    Stigmatization of mental illness is a widespread phenomenon even among health professionals. To explore the origins of this inappropriate attitude, medical students at the beginning and in the end of their studies were examined with self-report measures of social distance towards mentally ill persons, beliefs about etiology of mental disorders, valuation of psychotherapy and the personality features empathy and narcissism. While the students' attitudes turn out to be unrelated to the personality features, significant differences between the two groups were found indicating that distance towards mentally ill patients in the medical role and ambivalence about the etiological factors of mental disorders are stronger pronounced in the end of the studies compared to the beginning. These findings underline the need to prepare medical students better for contacts with mentally ill patients. © Georg Thieme Verlag KG Stuttgart · New York.

  13. More concerns and stronger beliefs about the necessity of medication in patients with acromegaly are associated with negative illness perceptions and impairment in quality of life.

    Science.gov (United States)

    Andela, Cornelie D; Biermasz, Nienke R; Kaptein, Adrian A; Pereira, Alberto M; Tiemensma, Jitske

    2015-10-01

    Patients with acromegaly can be treated with surgery, radiotherapy and/or medical treatment. In general, patients' beliefs about medication are associated with illness perceptions, a contributory factor of Quality of Life (QoL). At present, there are no quantitative studies on medication beliefs in patients with acromegaly. Here, we aimed to examine possible associations between medication beliefs, illness perceptions, and QoL. Furthermore we aimed to explore whether illness perceptions of patients with remission of acromegaly receiving medical treatment differ from patients without medical treatment. Cross-sectional evaluation of 73 patients with remission of acromegaly (n = 28 patients with medication, n = 45 without medication). The Beliefs about Medicines Questionnaire (BMQ), Illness Perception Questionnaire-Revised (IPQ-R), EuroQoL-5D, and AcroQoL were used for the assessment. Stronger beliefs about the necessity of medical treatment and stronger concerns about the adverse effects were associated with attributing more symptoms to acromegaly, perceiving more negative consequences, and having a stronger belief in a cyclical timeline (BMQ, all P IPQ-R, P = 0.002). Negative medication beliefs were related to more negative illness perceptions and worse disease-specific QoL. Patients receiving medical treatment for acromegaly tend to perceive a more chronic timeline of their disease, compared to patients with remission without medical treatment. These psychological factors need to be taken into account when treating patients and developing a psychosocial education program aiming to improve QoL. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Releasing terminally ill prisoners on medical parole in South Africa ...

    African Journals Online (AJOL)

    The release on medical parole of a prominent and influential South African businessman, Mr Schabir Shaik, who served less than 3 years of his 15-year prison term, put the issue of medical parole under the spotlight with several newspaper articles, radio stations and television channels expressing different views regarding ...

  15. Mental Illness and Psychotropic Medication use Among People Assessed for Bariatric Surgery in Ontario, Canada.

    Science.gov (United States)

    Hensel, Jennifer; Selvadurai, Melanie; Anvari, Mehran; Taylor, Valerie

    2016-07-01

    Studies completed outside of Canada have reported a high rate of mental illness and psychotropic medication use among bariatric surgery candidates with variable impacts on surgical and mental health outcomes. To our knowledge, there has been no published Canadian data on this issue. We conducted a secondary analysis of de-identified data from the Ontario Bariatric Registry for all individuals who completed both a baseline and psychological assessment between April 1, 2010, and February 9, 2015 (N = 10,698). We determined the rates of reported mental illness and psychotropic medication use overall and by fiscal year of assessment. A past or present mental illness, most commonly depression, was recorded for 51 % of individuals. At baseline, 38 % were taking at least one psychotropic medication, most commonly antidepressants. Only a small proportion of the population were taking psychotropic medications known to be associated with high potential for weight gain. Although the prevalence of mental illness increased steadily from 35 % in 2010/2011 to 63 % in 2014/2015, there was no corresponding increase in reported medication use. Of those taking psychotropic medications, 13 % did not have a recorded history of mental illness. Consistent with other international studies, our results indicate a high prevalence of mental illness and psychotropic medication use among people referred for bariatric surgery in Ontario, Canada. This supports that accurate screening practices, knowledge about how to manage psychotropic medication pre- and post-operatively and recognition for opportunities to change medications that may be associated with weight gain are required.

  16. A qualitative content analysis of peer mentoring video calls in adolescents with chronic illness.

    Science.gov (United States)

    Ahola Kohut, Sara; Stinson, Jennifer; Forgeron, Paula; van Wyk, Margaret; Harris, Lauren; Luca, Stephanie

    2018-05-01

    This article endeavored to determine the topics of discussion during open-ended peer mentoring between adolescents and young adults living with chronic illness. This study occurred alongside a study of the iPeer2Peer Program. Fifty-two calls (7 mentor-mentee pairings) were audio recorded, transcribed verbatim, and analyzed using inductive coding with an additional 30 calls (21 mentor-mentee pairings) coded to ensure representativeness of the data. Three categories emerged: (1) illness impact (e.g., relationships, school/work, self-identity, personal stories), (2) self-management (e.g., treatment adherence, transition to adult care, coping strategies), and (3) non-illness-related adolescent issues (e.g., post-secondary goals, hobbies, social environments). Differences in discussed topics were noted between sexes and by diagnosis. Peer mentors provided informational, appraisal, and emotional support to adolescents.

  17. A prospective study of symptoms, function, and medication use during acute illness in nursing home residents: design, rationale and cohort description

    Directory of Open Access Journals (Sweden)

    Liu Sophia

    2010-07-01

    Full Text Available Abstract Background Nursing home residents are at high risk for developing acute illnesses. Compared with community dwelling adults, nursing home residents are often more frail, prone to multiple medical problems and symptoms, and are at higher risk for adverse outcomes from acute illnesses. In addition, because of polypharmacy and the high burden of chronic disease, nursing home residents are particularly vulnerable to disruptions in transitions of care such as medication interruptions in the setting of acute illness. In order to better estimate the effect of acute illness on nursing home residents, we have initiated a prospective cohort which will allow us to observe patterns of acute illnesses and the consequence of acute illnesses, including symptoms and function, among nursing home residents. We also aim to examine the patterns of medication interruption, and identify patient, provider and environmental factors that influence continuity of medication prescribing at different points of care transition. Methods This is a prospective cohort of nursing home residents residing in two nursing homes in a metropolitan area. Baseline characteristics including age, gender, race, and comorbid conditions are recorded. Participants are followed longitudinally for a planned period of 3 years. We record acute illness incidence and characteristics, and measure symptoms including depression, pain, withdrawal symptoms, and function using standardized scales. Results 76 nursing home residents have been followed for a median of 666 days to date. At baseline, mean age of residents was 74.4 (± 11.9; 32% were female; 59% were white. The most common chronic conditions were dementia (41%, depression (38%, congestive heart failure (25% and chronic obstructive lung disease (27%. Mean pain score was 4.7 (± 3.6 on a scale of 0 to 10; Geriatric Depression Scale (GDS-15 score was 5.2 (± 4.4. During follow up, 138 acute illness episodes were identified, for an

  18. Psychometric Properties of the Self-Perception Profile for Children in Children with Chronic Illness.

    Science.gov (United States)

    Ferro, Mark A; Tang, Jennie

    2017-07-01

    The Self-Perception Profile for Children (SPPC) is a commonly used measure of self-concept in children, but little research has examined its psychometric properties in children newly-diagnosed with chronic illness. Confirmatory factor analysis and examination of reliability and convergent and discriminant validity of the SPPC was conducted in 31 children newly-diagnosed with asthma, diabetes, epilepsy, food allergy, or juvenile arthritis. The unidimensionality of each domain of the SPPC was confirmed, internal reliability was robust (α=.83-.95), and inter-domain polychoric correlations ranged from weak to strong (ρ=.05-.85) Convergent validity was demonstrated with measures of global self-concept and domains of quality of life. The Global Self-worth domain showed discriminant validity between children with and without comorbid mental disorder. Findings extend the psychometric properties of the SPPC as a valid and reliable scale in children newly-diagnosed with chronic illness.

  19. Prediction of chronic critical illness in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Sérgio H. Loss

    2013-06-01

    Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

  20. Prediction of chronic critical illness in a general intensive care unit.

    Science.gov (United States)

    Loss, Sérgio H; Marchese, Cláudia B; Boniatti, Márcio M; Wawrzeniak, Iuri C; Oliveira, Roselaine P; Nunes, Luciana N; Victorino, Josué A

    2013-01-01

    To assess the incidence, costs, and mortality associated with chronic critical illness (CCI), and to identify clinical predictors of CCI in a general intensive care unit. This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI. Copyright © 2013 Elsevier Editora Ltda. All rights reserved.

  1. Double trouble: does co-morbid chronic somatic illness increase risk for recurrence in depression? A systematic review.

    Directory of Open Access Journals (Sweden)

    Gemma D Kok

    Full Text Available OBJECTIVE: To perform a systematic review, and if possible a meta-analysis, to establish whether depressed patients with co-morbid chronic somatic illnesses are a high risk "double trouble" group for depressive recurrence. METHOD: The databases PubMed, EMbase and PsycINFO were systematically searched until the 4(th of December 2012 by using MeSH and free text terms. Additionally, reference lists of retrieved publications and treatment guidelines were reviewed, and experts were consulted. Inclusion criteria were: depression had to be measured at least twice during the study with qualified instruments and the chronic somatic illness had to be assessed by self-report or by a medical professional. Information on depressive recurrence was extracted and additionally risk ratios of recurrence were calculated. RESULTS: The search generated four articles that fulfilled our inclusion criteria. These studies showed no differences in recurrence over one- two- three- and 6.5 years of follow-up for a total of 2010 depressed patients of which 694 patients with a co-morbid chronic somatic illness versus 1316 patients without (Study 1: RR = 0.49, 95% CI, 0.17-1.41 at one year follow-up and RR = 1.37, 95% CI, 0.78-2.41 at two year follow-up; Study 2: RR = 0.94, 95% CI, 0.65-1.36 at two year follow-up; Study 3: RR = 1.15, 95% CI, 0.40-3.27 at one year follow-up; RR = 1.07, 95% CI, 0.48-2.42 at two year follow-up and RR = 0.99, 95% CI,0.55-1.77 at 6.5 years follow-up; Study 4: RR = 1.16, 95% CI, 0.86-1.57 at three year follow-up. CONCLUSION: We found no association between a heightened risk for depressive recurrence and co-morbid chronic somatic illnesses. There is a need for more longitudinal studies to justify the current specific treatment advice such as long-term pharmacological maintenance treatment for this presumed "double trouble" group.

  2. Evidence supporting a link between dental amalgams and chronic illness, fatigue, depression, anxiety, and suicide.

    Science.gov (United States)

    Kern, Janet K; Geier, David A; Bjørklund, Geir; King, Paul G; Homme, Kristin G; Haley, Boyd E; Sykes, Lisa K; Geier, Mark R

    2014-01-01

    The purpose of this review is to examine the evidence for a relationship between mercury (Hg) exposure from dental amalgams and certain idiopathic chronic illnesses--chronic fatigue syndrome (CFS), fibromyalgia (FM), depression, anxiety, and suicide. Dental amalgam is a commonly used dental restorative material that contains approximately 50% elemental mercury (Hg0) by weight and releases Hg0 vapor. Studies have shown that chronic Hg exposure from various sources including dental amalgams is associated with numerous health complaints, including fatigue, anxiety, and depression--and these are among the main symptoms that are associated with CFS and FM. In addition, several studies have shown that the removal of amalgams is associated with improvement in these symptoms. Although the issue of amalgam safety is still under debate, the preponderance of evidence suggests that Hg exposure from dental amalgams may cause or contribute to many chronic conditions. Thus, consideration of Hg toxicity may be central to the effective clinical investigation of many chronic illnesses, particularly those involving fatigue and depression.

  3. Discipline and the Chronically Ill Child: What Are the Management Strategies To Promote Positive Patient Outcomes?

    Science.gov (United States)

    Richardson, Rita C.

    This paper reviews various discipline models and applies them to obtaining cooperation and compliance with medical treatment of children with chronic and acute medical conditions, especially End-Stage Renal Disease (ESRD). The definition of Other Health Impairments in the Individuals with Disabilities Education Act is cited and related to the…

  4. Are children with chronic illnesses requiring dietary therapy at risk for disordered eating or eating disorders? A systematic review.

    Science.gov (United States)

    Conviser, Jenny H; Fisher, Sheehan D; McColley, Susanna A

    2018-03-01

    Pediatric chronic illnesses (CI) can affect a child's mental health. Chronic illnesses with treatment regimens that specify a therapeutic diet may place the child at increased risk for disordered eating and specific eating disorders (ED). The aim of this review is to examine the relation between diet-treated CI and disordered eating and to determine the order of onset to infer directionality. Diet-treated CI is hypothesized to precede and to be associated with disordered eating. A comprehensive search of empirical articles that examine the relation between diet-treated CI (diabetes, cystic fibrosis, celiac disease, gastrointestinal disorders, and inflammatory bowel diseases) and disordered eating was conducted in Medline and PsycINFO using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A table of the sample's characteristics, ED measures, major pertinent findings, and the onset of CI in relation to ED were provided. Diet-treated CI was associated with disordered eating and ED. Diet-treated CI had onset prior to disordered eating in most studies, except for inflammatory bowel diseases. Disordered eating and unhealthy weight management practices put children at risk for poor medical outcomes. Interventions for diet-treated CI require a focus on diet and weight, but may increase the risk for disordered eating. Future research is needed to elucidate the mechanisms that transform standard treatment practices into pathological eating, including characteristics and behaviors of the child, parents/care providers, family, and treatment providers. © 2018 Wiley Periodicals, Inc.

  5. Oriental Medical Treatment of chronic Acalculous Cholecystitis

    Directory of Open Access Journals (Sweden)

    Hae-Yeon Lee

    2004-12-01

    Full Text Available Chronic acalculous cholecystitis gets possession of about 12 to 13 percent of patients with chronic cholecystitis. Pathologically it is characterised by chronic inflammation and thickening of the gallbladder wall but doesn't come across stones. Clinical symptoms are vague and include abdominal discomfort and distension, nausea, flatulence and intolerance of fatty foods. A patient on chronic acalculous cholecystitis diagnosed from his clinical symtoms and abdominal ultrasonogram was treated by Geonbihwan, acupuncture and herbal acupuncture. Satisfactory symptomatic improvement was achieved and findings of abdominal ultrasonogram came also normal.

  6. Self-esteem in adolescents with chronic physical illness vs. controls in Northern Russia

    OpenAIRE

    Zashikhina, Anna; Hägglöf, Bruno

    2014-01-01

    Objective: This work aims to study self-esteem in adolescents with diabetes, asthma and epilepsy; compare the results with those of the representative sample of healthy adolescents; and evaluate the predictive value of certain demographic, family-related, and disease-related factors on self-esteem. Methods: A total of 148 chronically ill adolescents and 301 matched healthy counterparts completed the Rosenberg Self Esteem Scale and the "I think I am" questionnaire. Adolescents' parents answere...

  7. Vitamin D deficiency in children with chronic illnesses: Predisposing and protecting factors

    OpenAIRE

    Koskivirta, Panu

    2011-01-01

    This thesis assesses clinical differences in patients with low and high vitamin D levels. The factors analyzed included the underlying disease, body size, age, ethnic background, use of vitamin D supplements and the season when the blood sample was taken. Fifty patients with the lowest and 50 patients with the highest vitamin D concentrations were selected from a cohort of 1351 chronically ill children and adolescents who had had their vitamin D status assessed at Children's Hospital. Protect...

  8. Psychological interventions for parents of children and adolescents with chronic illness

    OpenAIRE

    Eccleston, Chris; Palermo, T M; Fisher, Emma; Law, E

    2012-01-01

    Psychological therapies have been developed for parents of children and adolescents with a chronic illness. Such therapies include parent only or parent and child/adolescent, and are designed to treat parent behaviour, parent mental health, child behaviour/disability, child mental health, child symptoms and/or family functioning. No comprehensive, meta-analytic reviews have been published in this area. To evaluate the effectiveness of psychological therapies that include coping strategies for...

  9. Work right to right work: An automythology of chronic illness and work.

    Science.gov (United States)

    Vijayasingham, Lavanya

    2018-03-01

    Objectives Chronic illness is known to disrupt and redirect the usual course of work trajectories. This article aims to portray the longitudinal course of negotiating work after multiple sclerosis. Methods Using therapy and personal journals to reconstruct memories and experience, an autoethnography is produced and narrated within Campbell's "Hero's Journey" automythology framework. Results The narrative highlights the intrasubjectivity of illness meaning-the changing internal meaning-making and external behavior and decision-making dynamics. The journey of being inhibited to "Work Right", to "Looking for the Right" and ultimately, finding "Right Work" is charted; portrayed as a bittersweet maneuver to achieve work-illness equilibrium. Discussion This journey traverses a spectrum of negative coping-the exhibition of deviant work behaviors, disengagement and depression; to recalibration and renewal; culminating in living the "new normal", and finding moral and meaningful work engagements. Life trajectories with chronic illness are often skewed and redirected; but longitudinal narratives of normalization and coping also highlight the pursuits to secure and maintain a life of meaning and value.

  10. Correlates of Problem Resolution during Parent-Child Discussions about Chronic Illness Management

    Science.gov (United States)

    Friedrich, Elizabeth; Jawad, Abbas F.; Miller, Victoria A.

    2016-01-01

    Families impacted by pediatric chronic illness must navigate treatment regimens that can present multiple problems and decisions to be addressed on a daily basis. The extent to which parents and children are able to solve such problems is likely to have implications for health behaviors and outcomes. The aims of this study were to examine correlates of problem resolution in families of children with a chronic illness. Participants were 167 children (ages 8-16) with type 1 diabetes or cystic fibrosis and a parent. Parent-child dyads recounted a recent discussion they had related to illness management and completed questionnaires. The research team coded the discussions for topic and outcome (i.e., did the dyad come up with a plan to address the problem). The results indicated that the majority of dyads in both illness groups came up with a plan during their discussions. Lack of problem resolution during the discussion was associated with higher parent coercion, more child resistance to the regimen, and worse adherence. Parent coercion and child resistance could be the targets of interventions to enhance problem solving and improve adherence. PMID:28133408

  11. Personal growth in chronic illness - a biographical case study of living with fibromyalgia.

    Science.gov (United States)

    Kalitzkus, Vera; Matthiessen, Peter F

    2010-01-01

    Chronic illness can be distressing for patients. It confronts them with the challenge of having to cope with their life and of having to adjust their self-image. Nevertheless, patients often experience that they go through a process of personal growth. Although there is empirical proof of the potential that coping with severe illness has with regard to personal growth, fairly little is known about the conditions that bring about such a development. Based on a singlecase study of fibromyalgia (FM) from Germany, the paper reveals the potential of a biographical approach for understanding the process of personal growth in chronic illness. The case is part of a qualitative study on the occurrence of biographical transformation in severe illnesses. A narrative, biographical interview was conducted with the patient. The analysis takes objective biographical data as well as the subjective experience of the patient into account. Our analysis is confirmed by qualitative studies on the subjective experience of FM. Although these studies report a favorable development with some FM sufferers, they neither investigate its significance for the life of the patient nor the factors that make personal growth possible. We tried to identify biographical resources and personal strategies of the patient that facilitated her inner growth. A biographical approach is a way towards understanding individual growth in the face of severe suffering. By including the patients' objective life data as well as their subjective experiences, deeper insights into the process of personal growth can be gained. Copyright 2010 S. Karger AG, Basel.

  12. What Features of Smartphone Medication Applications Are Patients with Chronic Diseases and Caregivers Looking for?

    Science.gov (United States)

    Liu, Yisi; Wang, Liuyu; Chang, Polun; Lamb, Karen V; Cui, Yanyan; Wu, Ying

    2016-01-01

    We explored the desired features of medication applications for patients with chronic disease and their caregivers with a questionnaire survey, 50 from patients and 50 from their caregivers. Although the majority of people (75%) are willing to use medication apps, the actual usage rate is quite low (11%). Worrying about privacy of personal information seems to be the main reason of not using applications. The overall score desired for use was 3.29 ± 1.02 (out of 5). Searching medications and diseases and assistance with making doctors' appointments are the most wanted categories. Online shopping for drugs and delivery were the least desired items. The main concerns for people who do not want certain features include: they are not useful, worrying about buying counterfeit drugs and reliability of content. Compared with patients, caregivers seems to be more concerned on nutrition tips for chronic illness, fall detection, and privacy protection (P < 0.05 for all).

  13. [Perception in chronic illnesses: linguistic validation of the revised Illness Perception Questionnaire and the Brief Illness Perception Questionnaire for a Spanish population].

    Science.gov (United States)

    Pacheco-Huergo, Valeria; Viladrich, Carme; Pujol-Ribera, Enriqueta; Cabezas-Peña, Carmen; Núñez, Montserrat; Roura-Olmeda, Pilar; Amado-Guirado, Ester; Núñez, Esther; Del Val, José Luis

    2012-05-01

    To obtain adapted versions for the Spanish population of a specific version of the Revised Illness Perception Questionnaire Revised (IPQ-R(e)) and the Brief Illness Perception Questionnaire (BIPQ), conceptually and linguistically equivalent to the original questionnaires. Cultural adaptation of questionnaires: linguistic validation. Five primary care centres and a tertiary hospital. A multidisciplinary team was selected. A pilot study was performed on 30 people with chronic diseases (hypertension, diabetes mellitus, stable ischaemic heart disease, asthma, chronic obstructive pulmonary disease or osteoarthritis) The project proceeded in 3 phases: I) Double forward-translation, II) Pilot study and III) Double back-translation. Three consensus meetings were held, one in each phase. Another meeting was held with one of the authors of the original questionnaire, where we knew about a short version, the BIPQ. It was also included in the study. Double forward and back-translations were performed and consensus was reached in both stages. Phase I) The majority of IPQ-R(e) items did not raise problems of translation. Phase II) In the pilot study we detected that patients found some difficulties in connection with the comprehension and self administration of some items. Therefore it was decided to employ trained interviewers, to introduce changes in the IPQ-R(e) format and vocabulary and to adapt a specific version with fewer items that solved most of these difficulties Phase III) Back-translations were very similar to the original version. The BIPQ forward and back-translation process caused no difficulties. After lingüistic validation, IPQ-R(e) and BIPQ versions conceptually and lingüistically equivalent to original instruments were obtained. Copyright © 2010 Elsevier España, S.L. All rights reserved.

  14. Burden of treatment for chronic illness: a concept analysis and review of the literature.

    Science.gov (United States)

    Sav, Adem; King, Michelle A; Whitty, Jennifer A; Kendall, Elizabeth; McMillan, Sara S; Kelly, Fiona; Hunter, Beth; Wheeler, Amanda J

    2015-06-01

    Treatment burden, the burden associated with the treatment and management of chronic illness, has not yet been well articulated. Using Rodgers' (1989, Journal of Advanced Nursing, 14, 330-335) method of concept analysis, this review describes the ways in which treatment burden has been conceptualized to define the concept and to develop a framework for understanding its attributes, antecedents and consequences. Leading databases were searched electronically between the years 2002 and 2011. To ensure the review focused on actual observations of the concept of interest, articles that did not measure treatment burden (either qualitatively or quantitatively) were excluded. An inductive approach was used to identify themes related to the concept of treatment burden. Thirty articles, identified from 1557 abstracts, were included in the review. The attributes of treatment burden include burden as a dynamic process, as a multidimensional concept, and comprising of both subjective and objective elements. Prominent predisposing factors (antecedents) include the person's age and gender, their family circumstances, possible comorbidity, high use of medications, characteristics of treatment and their relationship with their health-care provider. The most dominant consequences are poor health and well-being, non-adherence to treatment, ineffective resource use and burden on significant others. Furthermore, many of these consequences can also become antecedents, reflecting the cyclic and dynamic nature of treatment burden. The findings underscore the need for researchers and health-care professionals to engage in collaborative discussions and make cooperative efforts to help alleviate treatment burden and tailor treatment regimens to the realities of people's daily lives. © 2013 Blackwell Publishing Ltd.

  15. The articulation of neoliberalism: narratives of experience of chronic illness management in Bulgaria and the UK.

    Science.gov (United States)

    Vassilev, Ivaylo; Rogers, Anne; Todorova, Elka; Kennedy, Anne; Roukova, Poli

    2017-03-01

    The shift from social democratic to a neoliberal consensus in modern welfare capitalist states is characterised by an emphasis on individual responsibility, consumer choice, market rationality and growing social inequalities. There has been little exploration of how neoliberalism has shaped the environment within which chronic illness is experienced and managed. This article explores the different articulations of neoliberalism manifest in the arena of personal illness management in Bulgaria and the UK. People with type 2 diabetes discussed their experiences in terms of struggling with diet, diabetes as a personal failure, integrating illness management and valued activities, and the trustworthiness of the healthcare system. The UK narratives were framed within an individual responsibility discourse while in Bulgaria lack of resources dominated discussions, which were framed as structurally generated and unrelated to individual capabilities and choices. Respondents faced personal management challenges related to consumer and healthcare market failures in both countries. Differences in market regulation and emerging stakeholder and interest coalitions influenced users' expectations and their navigation and adaption to market failures in managing their everyday illnesses. The UK and Bulgarian articulations of neoliberalism can be described differently: the first as a logic of managed choice and the second as a logic of unmanaged consumerism. © 2016 Foundation for the Sociology of Health & Illness.

  16. Stigma towards mental illness among medical students in Australia and Ghana.

    Science.gov (United States)

    Lyons, Zaza; Laugharne, Jonathan; Laugharne, Richard; Appiah-Poku, John

    2015-06-01

    Stigma towards mental illness has been found to impact adversely on medical students' attitudes towards psychiatry. This study aimed to assess the impact of stigma among final year students at the University of Science and Technology in Kumasi, Ghana, and the University of Western Australia. A 28-item "Attitudes and stigma towards mental health" questionnaire was distributed to final year students at both universities. There was a significant difference in questionnaire scores, with Australian students showing more positive attitudes towards mental illness and lower levels of stigma compared with Ghanaian students. Stigmatization was expressed by Australian and Ghanaian students. A combination of medical school experiences and wider societal and cultural beliefs could be responsible for students' attitudes towards mental illness. Educators can develop locally relevant anti-stigma teaching resources throughout the psychiatry curriculum to improve students' attitudes towards psychiatry as a discipline and mental illness in general.

  17. Peer-Led Self-Management of General Medical Conditions for Patients With Serious Mental Illnesses: A Randomized Trial.

    Science.gov (United States)

    Druss, Benjamin G; Singh, Manasvini; von Esenwein, Silke A; Glick, Gretl E; Tapscott, Stephanie; Tucker, Sherry Jenkins; Lally, Cathy A; Sterling, Evelina W

    2018-02-01

    Individuals with serious mental illnesses have high rates of general medical comorbidity and challenges in managing these conditions. A growing workforce of certified peer specialists is available to help these individuals more effectively manage their health and health care. However, few studies have examined the effectiveness of peer-led programs for self-management of general medical conditions for this population. This randomized study enrolled 400 participants with a serious mental illness and one or more chronic general medical conditions across three community mental health clinics. Participants were randomly assigned to the Health and Recovery Peer (HARP) program, a self-management program for general medical conditions led by certified peer specialists (N=198), or to usual care (N=202). Assessments were conducted at baseline and three and six months. At six months, participants in the intervention group demonstrated a significant differential improvement in the primary study outcome, health-related quality of life. Specifically, compared with the usual care group, intervention participants had greater improvement in the Short-Form Health Survey physical component summary (an increase of 2.7 versus 1.4 points, p=.046) and mental component summary (4.6 versus 2.5 points, p=.039). Significantly greater six-month improvements in mental health recovery were seen for the intervention group (p=.02), but no other between-group differences in secondary outcome measures were significant. The HARP program was associated with improved physical health- and mental health-related quality of life among individuals with serious mental illness and comorbid general medical conditions, suggesting the potential benefits of more widespread dissemination of peer-led disease self-management in this population.

  18. Beliefs about antipsychotic versus hypoglycemic medications among individuals with serious mental illness and type 2 diabetes

    OpenAIRE

    Aakre, Jennifer M; Medoff, Deborah R; Dixon, Lisa B; Kreyenbuhl, Julie A

    2012-01-01

    Jennifer M Aakre,1 Deborah R Medoff,1,2 Lisa B Dixon,1,2 Julie A Kreyenbuhl1,21VA Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore VA Medical Center, 2Division of Services Research, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USABackground: This study compared the beliefs held by individuals with coexisting serious mental illness and type 2 diabetes regarding the necessity and risks of taking antipsychotic ve...

  19. Prescription writing ability of interns for common illnesses-Sari Medical School-Summer 2004

    OpenAIRE

    N. Motamed; A. Kashi; M.J. Safar; Sh. Alian; M. Khademloo; R. Eslamiyan

    2006-01-01

    AbstractBackground and purpose: It is now clearly acknowledged that unjustified prescription habit can lead to ineffective or incomplete treatment and may extend the course of illness or time to recovery. At present, there is no taught course available on prescription writing method specifically for common illnesses. Consequently, students learn through experience. In these circumstances, it seems essential to teach medical students the prescription techniques and insight into national pharma...

  20. Mental ill health in the elderly: medical students’ social representations in the United Kingdom

    OpenAIRE

    Medeiros, Bruno; Foster, Juliet

    2014-01-01

    Objective This study aims to explore medical students’ social representations of mental ill health in older adults. Method It comprises an exploratory and qualitative investigation based on the theory of social representations. Two focus groups with pre-clinical medics (group 1, N=4; group 2, N=4) and 10 individual interviews with clinical medical students were conducted. Thematic analysis at a latent level explored meanings and differences between groups. Results Three overarching themes ref...

  1. Medical marijuana use for chronic pain: risks and benefits.

    Science.gov (United States)

    Greenwell, Garth T

    2012-01-01

    Questions from patients about medical marijuana use for chronic pain are becoming more common. The information in this report will help patients understand the potential risks and benefits of using this substance for painful conditions.

  2. Mind's response to the body's betrayal: Gestalt/Existential therapy for clients with chronic or life-threatening illnesses.

    Science.gov (United States)

    Imes, Suzanne A; Clance, Pauline Rose; Gailis, Andra T; Atkeson, Ellen

    2002-11-01

    In the literature on chronic or life-threatening illness, there is an overriding emphasis on clients' psychological coping styles and how they relate to psychological functioning. By contrast, in our approach, we look at the subjective mind/body experiences that clients have of their illness and how their lives are impacted by their illness. As psychotherapists, we address their existential distress, pain, body experience, thoughts, and feelings, as well as their efforts to cope or find meaning in their illness. We summarize Gestalt/Existential therapy for chronic illness, illustrate the approach with three case-vignettes, and stress the importance of attending to each client's unique responses to illness. Copyright 2002 Wiley Periodicals, Inc.

  3. [Social and organizational innovation to tackle the challenge of integrated care of the chronically ill].

    Science.gov (United States)

    Nuño-Solinís, Roberto

    2014-01-01

    The increase in life expectancy, coupled with other factors, has led to an increase in the prevalence of chronic diseases and multiple morbidity. This has led to the need to develop new health and social care models, which will allow managing these efficiently and in a sustainable manner. In particular, there seems to be consensus on the need to move towards integrated, patient-centered, and more proactive care. Thus, in recent years, chronic care models have been developed at international, national and regional level, as well as introducing strategies to tackle the challenge of chronic illness. However, the implementation of actions facilitating the change towards this new model of care does not seem to be an easy task. This paper presents some of the strategic lines and initiatives carried out by the Department of Health of the Basque Government. These actions can be described within a social and organizational innovation framework, as a means for effective implementation of interventions and strategies that shape the model required for the improved care of chronic illnesses within a universal and tax-funded health system. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  4. Impact of psychiatry training on attitude of medical students toward mental illness and psychiatry

    Science.gov (United States)

    Gulati, Prannay; Das, Subhash; Chavan, B. S.

    2014-01-01

    Context: Attitude of fresh graduates toward psychiatric patients is important to bridge the treatment gap due to mental illness. Psychiatry as a subject has been neglected in the undergraduates of MBBS. Aims: (1) To compare the attitude of medical students and interns in a medical college toward mental illness and psychiatry. (2) To assess the impact of psychiatric training on attitude toward the mentally ill person and mental illness. Settings and Design: Cross-sectional, single assessment study conducted at a tertiary hospital. Subjects and Methods: Participants consisted of medical students of 1st and 2nd year who didn’t have any exposure to psychiatry and interns, who had completed their compulsory 2 week clinical posting in psychiatry. Participants were individually administered sociodemographic proforma, General Health Questionnaire-12 (GHQ-12), opinion about mental illness (OMI) scale, and attitude to psychiatry-29 (ATP-29) scale. Statistical Analysis: Standard descriptive statistics (mean, percentage), Chi-square test. Results: A total of 135 participants formed the study sample, with 48, 47, and 40 participants from 1st year, 2nd year and interns, respectively. Mean GHQ score was 14.03 for the entire sample. There was better outlook of interns toward psychiatry and patients with mental disorders in comparison to fresh graduate students in some areas. Overall, negative attitude toward mental illness and psychiatry was reflected. Conclusions: Exposure to psychiatry as per the current curriculum seems to have a limited influence in bringing a positive change in OMI and psychiatry. PMID:25316938

  5. Body image of children and adolescents with chronic illness: a meta-analytic comparison with healthy peers.

    Science.gov (United States)

    Pinquart, M

    2013-03-01

    This meta-analysis integrates results from 330 studies on differences between body image of children and adolescents with and without chronic physical illness. Young people with a chronic illness had a less positive body image than their healthy peers although the average size of differences was small (g=-.30 standard deviation units). A comparison of diseases showed that young people with obesity (g=-.79), cystic fibrosis (g=-.50), scoliosis (g=-.41), asthma (g=-.37), growth hormone deficits (g=-.35), spina bifida (g=-.23), cancer (g=-.20), and diabetes (g=-.17) evaluated their body less positively than their healthy peers. Furthermore, levels of body dissatisfaction varied by age at onset of the disease, method for assessing body image, ethnicity, year of publication, and comparison group. Recommendations are stated for reducing effects of chronic illness on the body image of people with chronic illness. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Communication and cybercoping: coping with chronic illness through communicative action in online support networks.

    Science.gov (United States)

    Kim, Jeong-Nam; Lee, Seungyoon

    2014-01-01

    Computer-mediated communication, specifically blogs, has expanded the range of the communicative action of patients with chronic disease from information seeking to information forwarding. The authors examine the effects of these 2 types of communicative action on perceived affective and physical coping outcomes. Using a survey dataset of 254 chronic disease patients, the authors tested 2 models using structural equation modeling: first, the effects of communicative action about chronic illness on coping outcomes; and second, the mediating role of emotion-focused and problem-focused coping processes. Findings indicate overall positive effects of communicative action on coping processes and outcomes, yet with different magnitudes of effects depending on the dimensions of communication behavior, the coping process, and outcome. Implications for patients and health care providers are discussed.

  7. Acute Care Use for Ambulatory Care-Sensitive Conditions in High-Cost Users of Medical Care with Mental Illness and Addictions.

    Science.gov (United States)

    Hensel, Jennifer M; Taylor, Valerie H; Fung, Kinwah; Yang, Rebecca; Vigod, Simone N

    2018-01-01

    The role of mental illness and addiction in acute care use for chronic medical conditions that are sensitive to ambulatory care management requires focussed attention. This study examines how mental illness or addiction affects risk for repeat hospitalization and/or emergency department use for ambulatory care-sensitive conditions (ACSCs) among high-cost users of medical care. A retrospective, population-based cohort study using data from Ontario, Canada. Among the top 10% of medical care users ranked by cost, we determined rates of any and repeat care use (hospitalizations and emergency department [ED] visits) between April 1, 2011, and March 31, 2012, for 14 consensus established ACSCs and compared them between those with and without diagnosed mental illness or addiction during the 2 years prior. Risk ratios were adjusted (aRR) for age, sex, residence, and income quintile. Among 314,936 high-cost users, 35.9% had a mental illness or addiction. Compared to those without, individuals with mental illness or addiction were more likely to have an ED visit or hospitalization for any ACSC (22.8% vs. 19.6%; aRR, 1.21; 95% confidence interval [CI], 1.20-1.23). They were also more likely to have repeat ED visits or hospitalizations for the same ACSC (6.2% vs. 4.4% of those without; aRR, 1.48; 95% CI, 1.44-1.53). These associations were stronger in stratifications by mental illness diagnostic subgroup, particularly for those with a major mental illness. The presence of mental illness and addiction among high-cost users of medical services may represent an unmet need for quality ambulatory and primary care.

  8. Providing healthcare for people with chronic illness: the views of Australian GPs.

    Science.gov (United States)

    Oldroyd, John; Proudfoot, Judith; Infante, Fernando A; Powell Davies, Gawaine; Bubner, Tanya; Holton, Chris; Beilby, Justin J; Harris, Mark F

    2003-07-07

    To explore general practitioners' views on chronic-disease care: the difficulties and rewards, the needs of patients, the impact of government incentive payments, and the changes needed to improve chronic-disease management. Qualitative study, involving semi-structured questions administered to 10 focus groups of GPs, conducted from April to October 2002. 54 GPs from both urban and rural practices in New South Wales and South Australia. Consistent themes emerged about the complex nature of chronic-disease management, the tension between patients' and GPs' goals for care, the time-consuming aspects of care (exacerbated by federal government requirements), and the conflicting pressures that prevent GPs engaging in structured multidisciplinary care (ie, team-based care involving systems for patient monitoring, recall, and care planning). Structured multidisciplinary care for people with chronic conditions can be difficult to provide. Barriers include the lack of fit between systems oriented towards acute care and the requirements of chronic-disease care, and between bureaucratic, inflexible structures and the complex, dynamic nature of GP-patient relationships. These problems are exacerbated by administrative pressures associated with federal government initiatives to improve chronic-illness management. Changes are needed in both policies and attitudes to enable GPs to move from episodic care to providing structured long-term care as part of a multidisciplinary team.

  9. Illness and treatment perceptions are associated with adherence to medications, diet, and exercise in diabetic patients.

    Science.gov (United States)

    Broadbent, Elizabeth; Donkin, Liesje; Stroh, Julia C

    2011-02-01

    To investigate diabetic patients' perceptions of illness and treatments, and explore relationships to adherence and blood glucose control. Forty-nine type 1 and one hundred and eight type 2 diabetic patients completed questionnaires assessing illness perceptions, treatment beliefs, and adherence to medications, diet, and exercise. Blood glucose control was assessed from blood tests. Patients rated medication more important than diet and exercise, and reported higher adherence to medications. Insulin was perceived as more helpful for diabetes, while antihypertensives and cholesterol medication were perceived more helpful for preventing heart problems. Perceptions were associated with adherence to insulin, cholesterol and antihypertensive medications, exercise, and diet. Blood glucose control in type 1 diabetic patients was associated with insulin adherence and perceived personal control, and in type 2 diabetic patients to being prescribed insulin or antihypertensives, and perceived personal control. Patients hold specific mental models about diabetes treatments, which are associated with adherence.

  10. Identity work and illness careers of patients with medically unexplained symptoms

    DEFF Research Database (Denmark)

    Rossen, Camilla Blach; Buus, Niels; Stenager, Elsebeth

    2018-01-01

    This article reports a case study of the illness career and identity work of patients who have had medically unexplained symptoms for many years with a particular emphasis on their interactions with a specialized and standardized health care system. Patients with medically unexplained symptoms...... often experience being met with mistrust and feel their identity threatened as a consequence of being illegitimately ill. There is a strong tendency in health care towards assessment thorough standardized so-called assessment packages. The study used a case study approach. Ethnographic fieldwork...

  11. [Coping with chronic illness and multiple medicines in older age: self-management support as an obligation in nursing].

    Science.gov (United States)

    Müller-Mundt, G; Schaeffer, D

    2011-02-01

    In later stages of chronic disease and especially in older age, chronically ill people are often dependent on multiple medicines. Coming to terms with complex medication regimes in everyday life is a challenging task. To provide the support actually needed, patient-centered interventions are essential, not only taking into account the patients' needs and preferences, but also promoting their ability to self manage their disease(s) and their medication regime. This paper outlines the results of a research project aimed at developing and evaluating an intervention to integrate self-management support into primary care, based on a qualitative exploration of the patients' and professionals' views. The findings stress that home care nurses should take an active part in self-management support but need to be prepared adequately. Therefore, a two-tier intervention was developed and evaluated in a prospective control study, consisting of a qualified training and guidelines for practice. The intervention serves to expand the nurses' professional competence to provide the needed individually tailored self-management support in home care.

  12. Evaluating the Illness Perception Questionnaire on patients with chronic kidney disease in Sweden.

    Science.gov (United States)

    Pagels, Agneta; Söderquist, Birgitta Klang; Heiwe, Susanne

    2012-09-01

    The Revised Illness Perception Questionnaire (IPQ-R) measures illness perception according to the Common Sense Model of Self-Regulation. Illness perception relates to coping, health management, treatment outcomes and health-related quality of life. IPQ-R has been used in many contexts. However, there is yet no Swedish version evaluated for validity, reliability and usability in the context of a Swedish, adult population with Chronic Kidney Disease (CKD). To evaluate usability and psychometric properties of a Swedish translation of IPQ-R on a group of adults in different stages of CKD. Usability evaluation was carried out through cognitive interviews and psychometrics was assessed by internal consistency, test-retest, inter-correlations, correlations to health-related quality of life and coping and testing for concurrent validity. Content validity was strongly supported, but an uncertainty assessing symptoms attributed to CKD was indicated. All dimensions showed internal consistency, except the treatment control dimension. The IPQ-R showed good stability over time except the personal control dimension. Most IPQ-R dimensions distinguished illness representations between groups of different disease stages and symptom burden. The most supported IPQ-R dimensions for inter-correlations and convergent validity were identity, timeline cyclical, consequences and emotional representations. The evaluation of the Swedish version of IPQ-R on patients with CKD showed support for construct validity, except for the dimensions controllability, illness coherence and timeline, which were less supported. These dimensions should therefore be interpreted with care in CKD patients. There is a need to capture uncertainty regarding illness identity. IPQ-R should be interpreted with care in earlier stages of CKD or if few symptoms are reported. IPQ-R may be applicable and useful as a tool in nursing practice to support healthy behaviour as well as assessing clinical interventions in

  13. Acute and long-term survival in chronically critically ill surgical patients: a retrospective observational study.

    Science.gov (United States)

    Hartl, Wolfgang H; Wolf, Hilde; Schneider, Christian P; Küchenhoff, Helmut; Jauch, Karl-Walter

    2007-01-01

    Various cohort studies have shown that acute (short-term) mortality rates in unselected critically ill patients may have improved during the past 15 years. Whether these benefits also affect acute and long-term prognosis in chronically critically ill patients is unclear, as are determinants relevant to prognosis. We conducted a retrospective analysis of data collected from March 1993 to February 2005. A cohort of 390 consecutive surgical patients requiring intensive care therapy for more than 28 days was analyzed. The intensive care unit (ICU) survival rate was 53.6%. Survival rates at one, three and five years were 61.8%, 44.7% and 37.0% among ICU survivors. After adjustment for relevant covariates, acute and long-term survival rates did not differ significantly between 1993 to 1999 and 1999 to 2005 intervals. Acute prognosis was determined by disease severity during ICU stay and by primary diagnosis. However, only the latter was independently associated with long-term prognosis. Advanced age was an independent prognostic determinant of poor short-term and long-term survival. Acute and long-term prognosis in chronically critically ill surgical patients has remained unchanged throughout the past 12 years. After successful surgical intervention and intensive care, long-term outcome is reasonably good and is mainly determined by age and underlying disease.

  14. Integrative Review of Mobile Phone Contacts and Medication Adherence in Severe Mental Illness.

    Science.gov (United States)

    Bright, Cordellia E

    2018-02-01

    Poor medication adherence is a significant problem in individuals with severe mental illness (SMI). About 50% of people with SMI become nonadherent to treatment in the first month following discharge from the hospital. This study examined literature in the past decade (2006-2016) on the use of mobile phone contacts in individuals with SMI to improve medication adherence post hospital discharge. This integrative review used the search terms texting, text messaging, SMS, cell/mobile phone, medication adherence, medication compliance, and mental illness. Databases (CINAHL, PubMed, PsycINFO, and Scopus) and manual searching of reference lists were done. The main inclusion criteria were the use of mobile phone contacts on medication adherence in individuals with SMI. Adults 18 years and older, studies conducted from 2006 to 2016, and studies conducted in English were also criteria for inclusion. Only five studies met criteria for inclusion. Outcomes from the review showed that mobile phone contacts have been used to improve medication adherence in individuals with SMI and able to provide the four types of social support (instrumental, informational, emotional, and, appraisal). When phone contacts especially text messaging was used as an adjunct to other interventions, it yielded better medication adherence than when used alone. However, results on medication adherence rates were mixed in participants on both psychiatric and nonpsychiatric medications. Although mobile phone contacts are a promising tool to enhance medication adherence after hospital discharge, its effectiveness to increase medication adherence in this population remains inconclusive.

  15. The medication experience: preliminary evidence of its value for patient education and counseling on chronic medications.

    Science.gov (United States)

    Shoemaker, Sarah J; Ramalho de Oliveira, Djenane; Alves, Mateus; Ekstrand, Molly

    2011-06-01

    To describe medication therapy management (MTM) pharmacists' encounters with patients' medication experiences, to examine the utility of the medication experience in practice, and to explore the value of the medication experience in patient education and counseling on medications. A focus group of 10 MTM pharmacists, and 1 pharmacist's 9-month practice diary were analyzed to reveal patients' medication experiences and the utility and value of the medication experience in practice. MTM pharmacists commonly encountered patients' medication experiences in their practices. The medication experience was often at the root of drug therapy problems (DTPs) the practitioners identified. The pharmacists identified several examples of drug therapy problems with an associated medication experience at the root. The medication experience was a meaningful construct to guide patient education and counseling on new chronic medications to ultimately prevent DTPs, and valuable for tailoring patient education and counseling on medications to resolve DTPs. Our study provides preliminary evidence of the value of the medication experience for patient education and counseling on chronic medications in practice. The medication experience is a valuable tool for practitioners to understand patients' needs, identify and resolve DTPs, and tailor patient education and counseling for chronic medications. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  16. A controlled trial of mental illness related stigma training for medical students

    Directory of Open Access Journals (Sweden)

    Leese Morven

    2011-07-01

    Full Text Available Abstract Background The evidence base for mental illness related stigma interventions in health care professionals and trainees is underdeveloped. This study aimed to examine the impact of mental illness related stigma training on third year medical students' knowledge, attitudes and behaviour related to people with mental illness. Methods A non-randomised controlled trial was conducted with 110 third year medical students at a medical school in England to determine the effectiveness of a mental illness related stigma training package that targeted their knowledge, attitudes and behaviour. Results We detected a significant positive effect of factual content and personal testimonies training upon an improvement in knowledge, F(1, 61 = 16.3, p = 0.0002. No such difference was determined with attitudes or for behaviour. Conclusions Knowledge, attitudes and behaviour may need to be separately targeted in stigma reduction interventions, and separately assessed. The inter-relationships between these components in mental health promotion and medical education warrant further research. The study next needs to be replicated with larger, representative samples using appropriate evaluation instruments. More intensive training for medical students may also be required.

  17. Comparative effectiveness trial of family-supported smoking cessation intervention versus standard telephone counseling for chronically ill veterans using proactive recruitment

    Directory of Open Access Journals (Sweden)

    Bastian LA

    2012-09-01

    Full Text Available Lori A Bastian,1–3 Laura J Fish,4 Jennifer, M Gierisch,3,5 Lesley D Rohrer,3 Karen M Stechuchak,3 Steven C Grambow3,61Veterans Affairs Connecticut, West Haven, CT, USA; 2Department of Medicine, University of Connecticut Health Center, Farmington, CT, USA; 3Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA; 4Duke Comprehensive Cancer Center, 5Department of Medicine, 6Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC, USAObjectives: Smoking cessation among patients with chronic medical illnesses substantially decreases morbidity and mortality. Chronically ill veteran smokers may benefit from interventions that assist them in harnessing social support from family and friends.Methods: We proactively recruited veteran smokers who had cancer, cardiovascular disease, or other chronic illnesses (diabetes, chronic obstructive pulmonary disease, hypertension and randomized them to either standard telephone counseling or family-supported telephone counseling focused on increasing support for smoking cessation from family and friends. Participants each received a letter from a Veterans Affairs physician encouraging them to quit smoking, a self-help cessation kit, five telephone counseling sessions, and nicotine replacement therapy, if not contraindicated. The main outcome was 7-day point prevalent abstinence at 5 months.Results: We enrolled 471 participants with mean age of 59.2 (standard deviation [SD] = 7.9 years. 53.0% were white, 8.5% were female, and 55.4% were married/living as married. Overall, 42.9% had cardiovascular disease, 34.2% had cancer, and 22.9% had other chronic illnesses. At baseline, participants were moderately dependent on cigarettes as measured by the Heaviness of Smoking Index (mean = 2.8, SD = 1.6, expressed significant depressive symptoms as measured by the Center for Epidemiological Studies Depression scale (54.8% > 10, and

  18. Personality variables in coping with the stress of a spouse's chronic illness.

    Science.gov (United States)

    Schoeneman, S Z; Reznikoff, M; Bacon, S J

    1983-05-01

    Identified systematically those spouses of male VA hemodialysis patients who are at risk for experiencing difficulties in adapting to their husband's chronic kidney failure and hemodialysis treatment. To this end, an exploration was made of personality variables that might enhance a spouse's ability to cope with the unique stress of living with chronic illness. Fifty-six wives of VA dialysis patients were administered the Rotter Internal-External Locus of Control Scale (I-E), the Multidimensional Locus of Control Scale (MLC), the Multidimensional Health Locus of Control Scale (MHLC), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). Significant relationships were found between I-E scores and all measures of emotional adjustment (state anxiety, trait anxiety, and depression) for the entire sample of spouses in general, and also for a subgroup of home dialysis spouses who were analyzed separately. Results were discussed in terms of the role that locus of control orientation plays in mediating the stress of living with chronic illness, as well as the failure to find relationships between adjustment and the MLC or the area-specific MHLC.

  19. Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial

    Science.gov (United States)

    2013-01-01

    Background The stigma of mental illness among medical students is a prevalent concern that has far reaching negative consequences. Attempts to combat this stigma through educational initiatives have had mixed results. This study examined the impact of a one-time contact-based educational intervention on the stigma of mental illness among medical students and compared this with a multimodal undergraduate psychiatry course at the University of Calgary, Canada that integrates contact-based educational strategies. Attitudes towards mental illness were compared with those towards type 2 diabetes mellitus (T2DM). Method A cluster-randomized trial design was used to evaluate the impact of contact-based educational interventions delivered at two points in time. The impact was assessed by collecting data at 4 time points using the Opening Minds Scale for Health Care Providers (OMS-HC) to assess changes in stigma. Results Baseline surveys were completed by 62% (n=111) of students before the start of the course and post-intervention ratings were available from 90 of these. Stigma scores for both groups were significantly reduced upon course completion (p mental illness and interest in a psychiatric career was increased at the end of the course. Stigma towards mental illness remained greater than for T2DM at all time points. Conclusions Psychiatric education can decrease the stigma of mental illness and increase student confidence. However, one-time, contact-based educational interventions require further evaluation in this context. The key components are postulated to be contact, knowledge and attention to process, where attending to the student’s internal experience of working with people with mental illness is an integral factor in modulating perceptions of mental illness and a psychiatric career. PMID:24156397

  20. Human Milk for Ill and Medically Compromised Infants: Strategies and Ongoing Innovation.

    Science.gov (United States)

    DiLauro, Sara; Unger, Sharon; Stone, Debbie; O'Connor, Deborah L

    2016-08-01

    The use of human milk (mother's own milk and/or donor milk) in ill or medically compromised infants frequently requires some adaptation to address medical diagnoses and/or altered nutrition requirements. This tutorial describes the nutrition and immunological benefits of breast milk as well as provides evidence for the use of donor milk when mother's own milk is unavailable. Several strategies used to modify human milk to meet the medical and nutrition needs of an ill or medically compromised infant are reviewed. These strategies include (1) the standard fortification of human milk to support adequate growth, (2) the novel concept of target fortification in preterm infants, (3) instructions on how to alter maternal diet to address cow's milk protein intolerance and/or allergy in breast milk-fed infants, and (4) the removal and modification of the fat in breast milk used in infants diagnosed with chylothorax. © 2016 American Society for Parenteral and Enteral Nutrition.

  1. Patients with heart failure and their partners with chronic illness: interdependence in multiple dimensions of time

    Directory of Open Access Journals (Sweden)

    Nimmon L

    2018-03-01

    Full Text Available Laura Nimmon,1,2 Joanna Bates,1,3 Gil Kimel,4,5 Lorelei Lingard6 On behalf of the Heart Failure/Palliative Care Teamwork Research Group 1Centre for Health Education Scholarship, 2Department of Occupational Science and Occupational Therapy, 3Department of Family Practice, Faculty of Medicine, University of British Columbia, 4Palliative Care Program, St Paul’s Hospital, 5Department of Medicine, Division of Internal Medicine, University of British Columbia, Vancouver, BC, 6Centre for Education Research and Innovation, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada Background: Informal caregivers play a vital role in supporting patients with heart failure (HF. However, when both the HF patient and their long-term partner suffer from chronic illness, they may equally suffer from diminished quality of life and poor health outcomes. With the focus on this specific couple group as a dimension of the HF health care team, we explored this neglected component of supportive care. Materials and methods: From a large-scale Canadian multisite study, we analyzed the interview data of 13 HF patient–partner couples (26 participants. The sample consisted of patients with advanced HF and their long-term, live-in partners who also suffer from chronic illness. Results: The analysis highlighted the profound enmeshment of the couples. The couples’ interdependence was exemplified in the ways they synchronized their experience in shared dimensions of time and adapted their day-to-day routines to accommodate each other’s changing health status. Particularly significant was when both individuals were too ill to perform caregiving tasks, which resulted in the couples being in a highly fragile state. Conclusion: We conclude that the salience of this couple group’s oscillating health needs and their severe vulnerabilities need to be appreciated when designing and delivering HF team-based care. Keywords

  2. The Functional Assessment of Chronic Illness Therapy (FACIT Measurement System: properties, applications, and interpretation

    Directory of Open Access Journals (Sweden)

    Yost Kathleen

    2003-12-01

    Full Text Available Abstract The Functional Assessment of Chronic Illness Therapy (FACIT Measurement System is a collection of health-related quality of life (HRQOL questionnaires targeted to the management of chronic illness. The measurement system, under development since 1987, began with the creation of a generic CORE questionnaire called the Functional Assessment of Cancer Therapy-General (FACT-G. The FACT-G (now in Version 4 is a 27-item compilation of general questions divided into four primary QOL domains: Physical Well-Being, Social/Family Well-Being, Emotional Well-Being, and Functional Well-Being. It is appropriate for use with patients with any form of cancer, and extensions of it have been used and validated in other chronic illness condition (e.g., HIV/AIDS; multiple sclerosis; Parkinson's disease; rheumatoid arthritis, and in the general population. The FACIT Measurement System now includes over 400 questions, some of which have been translated into more than 45 languages. Assessment of any one patient is tailored so that the most-relevant questions are asked and administration time for any one assessment is usually less than 15 minutes. This is accomplished both by the use of specific subscales for relevant domains of HRQOL, or computerized adaptive testing (CAT of selected symptoms and functional areas. FACIT questionnaires can be administered by self-report (paper or computer or interview (face-to-face or telephone. Available scoring, normative data and information on meaningful change now allow one to interpret results in the context of a growing literature base.

  3. Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial.

    Science.gov (United States)

    Sadowski, Laura S; Kee, Romina A; VanderWeele, Tyler J; Buchanan, David

    2009-05-06

    Homeless adults, especially those with chronic medical illnesses, are frequent users of costly medical services, especially emergency department and hospital services. To assess the effectiveness of a case management and housing program in reducing use of urgent medical services among homeless adults with chronic medical illnesses. Randomized controlled trial conducted at a public teaching hospital and a private, nonprofit hospital in Chicago, Illinois. Participants were 407 social worker-referred homeless adults with chronic medical illnesses (89% of referrals) from September 2003 until May 2006, with follow-up through December 2007. Analysis was by intention-to-treat. Housing offered as transitional housing after hospitalization discharge, followed by placement in long-term housing; case management offered on-site at primary study sites, transitional housing, and stable housing sites. Usual care participants received standard discharge planning from hospital social workers. Hospitalizations, hospital days, and emergency department visits measured using electronic surveillance, medical records, and interviews. Models were adjusted for baseline differences in demographics, insurance status, prior hospitalization or emergency department visit, human immunodeficiency virus infection, current use of alcohol or other drugs, mental health symptoms, and other factors. The analytic sample (n = 405 [n = 201 for the intervention group, n = 204 for the usual care group]) was 78% men and 78% African American, with a median duration of homelessness of 30 months. After 18 months, 73% of participants had at least 1 hospitalization or emergency department visit. Compared with the usual care group, the intervention group had unadjusted annualized mean reductions of 0.5 hospitalizations (95% confidence interval [CI], -1.2 to 0.2), 2.7 fewer hospital days (95% CI, -5.6 to 0.2), and 1.2 fewer emergency department visits (95% CI, -2.4 to 0.03). Adjusting for baseline covariates

  4. Management of Medication-Related Cardiometabolic Risk in Patients with Severe Mental Illness.

    Science.gov (United States)

    Lang, Donna J; Barr, Alasdair M; Procyshyn, Ric M

    2013-08-01

    Severe psychotic disorders, which on their own may be a risk factor for metabolic disorder and cardiovascular illness, are clinically compounded by the significant adverse side effects of antipsychotic medications. The majority of patients with severe psychotic disorders (i.e., schizophrenia, bipolar disorder, mania, and depression) must take antipsychotic medications to treat their psychoses and, subsequently, will require efficacious interventions to manage the metabolic consequences of pharmacologic treatment to mitigate excessive mortality associated with cardiovascular illness. We have reviewed the metabolic consequences of antipsychotic treatment and discussed pilot findings from a new nonpharmacologic intervention study looking at the clinical benefits of regular exercise as a management tool for the cardiometabolic risk factors in a cohort with severe mental illness.

  5. Patient-perceived self-management tasks and support needs of people with chronic illness: generic or disease specific?

    NARCIS (Netherlands)

    Houtum, L. van; Rijken, M.; Heijmans, M.; Groenewegen, P.

    2015-01-01

    Background: Self-management is widely accepted as an essential component of chronic care. Nevertheless, little is known about patients’ perceptions of self-management. Purpose: This study aims to explore which self-management tasks and support needs people with chronic illness perceive for

  6. Family reinforcement of illness behavior: a comparison of adolescents with chronic fatigue syndrome, juvenile arthritis, and healthy controls.

    Science.gov (United States)

    Brace, M J; Scott Smith, M; McCauley, E; Sherry, D D

    2000-10-01

    Parental encouragement of illness behavior is hypothesized to correlate with psychosocial dysfunction in adolescents with chronic illness. To explore this hypothesis, adolescents aged 11 to 17 years with chronic fatigue syndrome (CFS) (n = 10), juvenile rheumatoid arthritis (JRA) (n = 16), and healthy adolescents (n = 14) were recruited for the study. Measures included the Achenbach parent and youth self report forms, the Family Adaptability and Cohesion Evaluation Scale-II (FACES II), the Children's Depression Rating Scale, and number of days absent from school. The Illness Behavior Encouragement Scale (IBES) generated measures of parental reinforcement of illness behavior. As predicted, the teens with CFS scored statistically higher on measures of depression, total competence, and number of days of school missed in the previous 6 months (mean = 40). Children with JRA scored significantly lower than the CFS group on the measure of parental reinforcement of illness behavior. The healthy group produced intermediate scores. Results and implications for future clinical and research activity are discussed.

  7. Mediating role of illness representation among social support, therapeutic alliance, experience of medication side effects, and medication adherence in persons with schizophrenia.

    Science.gov (United States)

    Rungruangsiripan, Malatee; Sitthimongkol, Yajai; Maneesriwongul, Wantana; Talley, Sandra; Vorapongsathorn, Thavatchai

    2011-08-01

    The purpose of this cross-sectional research study was to examine factors affecting medication adherence in Thai individuals with schizophrenia. The Common-Sense Model of Illness Representation was used to guide the study. Two hundred twenty-five subjects met the inclusion criteria and were interviewed. Variables of interest focused on experience of medication side effects, therapeutic alliance, social support, illness representation, and behavior change with medication adherence. Results indicated that therapeutic alliance and the experience of medication side effects enhanced illness representation, which in turn led to an intention to change adherence behavior. Social support did not alter illness representation or adherence behavior. Because illness representation positively influenced patients' intention to change adherence behavior, mental health nurses should promote patients' perception about their illness to enhance medication adherence. Copyright © 2011 Elsevier Inc. All rights reserved.

  8. Shamanism: Indications and Use by Older Hmong Americans with Chronic Illness

    Directory of Open Access Journals (Sweden)

    Linda A. Gerdner

    2012-01-01

    Full Text Available This article reports qualitative interviews from an ethnographic study that explored in part, the health seeking behaviors of and for older Hmong Americans with chronic illness. The study occurred over a 36-month period in the St. Paul / Minneapolis area of Minnesota. The majority of interviews were conducted in the Hmong language and lasted approximately three hours. Participants included 35 older Hmong Americans living independently with chronic illness. Themajority of these older adults were female (n=25, 80% with a mean age of 78.43 years. Interviews also included 33 family members (n=25 female,75.75% with a mean age of 75.75 years, who provided a minimum of eight hours of in-home care for an older Hmong American with chronic illness. Due to the significant role of shamans in the spiritual well-being of older adults, three shamans (two male, and one female were also interviewed. All (mean age 83, range65-99 had been “chosen” to become a shaman while living in Laos and had resided in the United States an average of 4 years 5 months (range: 1 month to 13 years. All shamans reported havingan active practice, with comments such as “I have so many [patients] I do not count.” More specifically, one shaman stated that he performed 20 to 40 healing ceremonies per year. One shaman explained his role by stating “I heal the weak and the lost spirit.” The majority of older Hmong Americans (74.29% and family caregivers (57.58 had retained the spiritual beliefs of animism and ancestor worship. Findings report that 18 (51.43% older Hmong Americanscompared to 21 (63.3% family caregivers sought the services of both a physician and a shaman for treatment of the older person’s chronic illness. Fourteen (40% older Hmong Americans compared to ten (30.30% family caregivers sought the services of a physician alone. Only 3 (8.57% older Hmong Americans compared to 2 (6.06% caregivers consulted the services of a shaman alone. Many older adults and

  9. Improving medical students' attitudes towards the chronic sick: a role for social science research.

    Science.gov (United States)

    Mullen, Kenneth; Nicolson, Malcolm; Cotton, Philip

    2010-11-22

    Many medical students are negatively disposed toward the elderly and chronic sick. The present study assessed the impact of a community-based teaching initiative, the Life History Project, on students' attitudes to these groups. A questionnaire including Likert based responses and free text comments was distributed to all first-year MBChB students after completion of their Life History coursework. Data was analysed using SPSS and content analysis. A high proportion of students believed the Life History Project had increased their understanding of both psychological and social aspects of health and illness and the role of the humanistic social sciences within this. We discovered that the Life History Project not only gave students first-hand experience of the elderly and chronic sick but also had a positive effect on their attitudes towards these groups. The qualitative free text comments corroborated these views. It is possible to positively influence medical students' attitudes towards these stigmatised groups; it is therefore important that we continue to enhance opportunities for learning about the impact of chronic illness on individuals and society throughout the curriculum.

  10. Agitation in the medically ill elderly | Aloa | West African Journal of ...

    African Journals Online (AJOL)

    Agitation is a common and significant problem in the medically ill elderly. It is responsible for diminished quality of life for not only the patient, but the caregivers as well as the patient\\'s relatives. This paper will illustrate the concept of agitation and different modes of classification. The major emphasis will be placed on ...

  11. Routine pre-admission screening for a medical illness in aggressive ...

    African Journals Online (AJOL)

    Objectives. To determine the need for routine screening for exclusion of a medical illness causing or contributing to the aggression in aggressive patients who required sedation in the emergency department (ED). The value of the individual components of the screening process was also investigated. Methods. The charts of ...

  12. Pattern of self-medication for acute febrile illness in the outpatient ...

    African Journals Online (AJOL)

    Pattern of self-medication for acute febrile illness in the outpatient clinic of an urban tertiary hospital in Jos. ... cross-sectional study at the GOPD of BHUTH, Jos from October 2012 to February 2013. The participants were drawn from all patients with fever or history of fever of not more than two weeks duration at presentation.

  13. Unmet need for medical care among homeless adults with serious mental illness.

    Science.gov (United States)

    Desai, Mayur M; Rosenheck, Robert A

    2005-01-01

    The objective of this study was to determine the rates and predictors of unmet medical needs among homeless adults with serious mental illness entering a community-based case management program and those of receipt of medical care in the subsequent 3-month period. We analyzed baseline and follow-up data for 7213 homeless clients in the multisite Access to Community Care and Effective Services and Supports program. Overall, 43.6% of the sample reported having an unmet need for medical care at baseline; of these subjects, only 36.1% received medical services during the 3 months following program entry. Using multivariate logistic regression modeling, we found that, at baseline, independent correlates of an unmet medical need included lower educational level, increased depressive and psychotic symptoms and greater number of potentially competing needs. None of these variables, however, adversely affected the likelihood of receiving medical care during follow-up. Factors associated with receiving medical services in the 3 months following program entry included receiving outpatient psychiatric services and reporting stronger therapeutic alliance with one's case manager. Collaborative case management may play an important role in meeting mentally ill homeless persons' medical needs. Greater efforts are needed to identify and link at-risk clients with appropriate medical services.

  14. Building a new life: a chaplain's theory based case study of chronic illness.

    Science.gov (United States)

    Risk, James L

    2013-01-01

    This article presents the case study of spiritual care for a patient suffering from Parkinson's disease who was referred to the chaplain in an out-patient depression research program. The chaplain's interventions were informed by an application of narrative theory, and the article demonstrates how this theory enabled the chaplain to help a patient develop new coping strategies for dealing with chronic disease. Using narrative theory, the chaplain assisted the patient to develop a new sense of identity as a spiritual, contingent self as the disease eroded his physical self and former life. The article includes a description of a patient's spiritual needs, chaplain interventions, and an outcomes measure of those interventions. The author argues that narrative theory provides chaplains with a language to identify and craft the unique intervention that spiritual care has in the life trajectory of this Parkinson's patient and other patients dealing with chronic illnesses.

  15. Sidney Katz, MD: a new paradigm for chronic illness and long-term care.

    Science.gov (United States)

    Noelker, Linda S; Browdie, Richard

    2014-02-01

    Dr. Sidney Katz's legacy to the field of gerontology is internationally recognized as his success at developing standardized measures and processes, beginning with the activities of daily living index, for the functional assessment of older adults with chronic conditions necessitating long-term services and supports. That work served as the bedrock for his subsequent major accomplishments, which improved rehabilitation services through interdisciplinary team work and attention to the patient-family constellation; reformed the regulation of nursing homes, refocusing it on resident outcomes and quality of life; and promulgated the concept of active life expectancy as a new approach to measuring the quality of later life. Few other scholars and researchers in the history of the field of aging can claim one, much less multiple monumental contributions leading to major advances in the treatment of chronic illness and the quality of long-term care.

  16. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

    Science.gov (United States)

    Fattori, A.; Neri, L.; Aguglia, E.; Bellomo, A.; Bisogno, A.; Camerino, D.; Carpiniello, B.; Cassin, A.; Costa, G.; De Fazio, P.; Di Sciascio, G.; Favaretto, G.; Fraticelli, C.; Giannelli, R.; Leone, S.; Maniscalco, T.; Marchesi, C.; Mauri, M.; Mencacci, C.; Polselli, G.; Quartesan, R.; Risso, F.; Sciaretta, A.; Vaggi, M.; Vender, S.; Viora, U.

    2015-01-01

    Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p < 0.01; SF-12 MCS: 59.4% versus 74.3%, p < 0.01). The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions. PMID:26557692

  17. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions

    Directory of Open Access Journals (Sweden)

    A. Fattori

    2015-01-01

    Full Text Available Background. Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Methods. Participants (N=1717 with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. Results. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p<0.01; SF-12 MCS: 59.4% versus 74.3%, p<0.01. The adjusted marginal overall productivity cost of workplace bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP 2010 US$ 4182–5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Conclusions. Our findings demonstrate that the burden on workers’ quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

  18. Estimating the Impact of Workplace Bullying: Humanistic and Economic Burden among Workers with Chronic Medical Conditions.

    Science.gov (United States)

    Fattori, A; Neri, L; Aguglia, E; Bellomo, A; Bisogno, A; Camerino, D; Carpiniello, B; Cassin, A; Costa, G; De Fazio, P; Di Sciascio, G; Favaretto, G; Fraticelli, C; Giannelli, R; Leone, S; Maniscalco, T; Marchesi, C; Mauri, M; Mencacci, C; Polselli, G; Quartesan, R; Risso, F; Sciaretta, A; Vaggi, M; Vender, S; Viora, U

    2015-01-01

    Although the prevalence of work-limiting diseases is increasing, the interplay between occupational exposures and chronic medical conditions remains largely uncharacterized. Research has shown the detrimental effects of workplace bullying but very little is known about the humanistic and productivity cost in victims with chronic illnesses. We sought to assess work productivity losses and health disutility associated with bullying among subjects with chronic medical conditions. Participants (N = 1717) with chronic diseases answered a self-administered survey including sociodemographic and clinical data, workplace bullying experience, the SF-12 questionnaire, and the Work Productivity Activity Impairment questionnaire. The prevalence of significant impairment was higher among victims of workplace bullying as compared to nonvictims (SF-12 PCS: 55.5% versus 67.9%, p bullying ranged from 13.9% to 17.4%, corresponding to Italian Purchase Power Parity (PPP) 2010 US$ 4182-5236 yearly. Association estimates were independent and not moderated by concurrent medical conditions. Our findings demonstrate that the burden on workers' quality of life and productivity associated with workplace bullying is substantial. This study provides key data to inform policy-making and prioritize occupational health interventions.

  19. [Concept analysis of medication adherence in patients with chronic disease].

    Science.gov (United States)

    Huang, Jen-Ying; Chen, Hsing-Mei

    2014-06-01

    Pharmacotherapy plays an important role in the management of chronic diseases. However, many patients with chronic disease do not adhere to their medication regimen. This results in worsening symptoms and frequent re-hospitalizations. As a result, healthcare providers may view these patients as bad. Medication adherence is a complex concept. Analyzing this concept may assist nurses to improve patient-centered care. This paper uses Walker & Avant's method to conduct a concept analysis of medication adherence. Results show the defining attributes of medication adherence as: (1) knowing and agreeing to the medication; (2) communicating and negotiating the regimen; and (3) active, continuous involvement in and appraisal of the treatment effect. Identified antecedents of medication adherence included the patient having: (1) a prescribed medication regimen; (2) cognitive and action abilities in her / his role as a patient; and (3) level of preparation for medication treatment. Identified consequences of medication adherence include: (1) improving symptom control; (2) decreasing re-hospitalizations and mortality; (3) reducing medical care costs; (4) restoring self-esteem; and (5) diminishing depression. It is hoped that this concept analysis provides a reference for nurses to achieve a better understanding of medication adherence and further improve nursing practice.

  20. Secondary Traumatic Stress and Burnout Among Muslim Nurses Caring for Chronically Ill Children in a Turkish Hospital.

    Science.gov (United States)

    Günüşen, Neslihan Partlak; Wilson, Marian; Aksoy, Burcu

    2018-03-01

    This study investigated secondary traumatic stress and its relationship to burnout among nurses working at a Turkish hospital. A mixed-methods design included a cross-sectional survey administering the Professional Quality of Life instrument and Maslach Burnout Inventory to 106 nurses. Interviews with a subgroup of eight participants explored nurses' experiences and coping strategies related to caring for chronically ill pediatric patients. High risk levels of secondary traumatic stress existed among 40.6% participants, and those over the age of 40 years were at greater risk. Two main interview themes emerged that identified (a) consequences and (b) coping strategies while caring for chronically ill children. Nurses experience emotional burdens and may purposefully distance themselves from chronically ill children. Social support from nurse colleagues and spiritual beliefs assist coping. Workplaces should acknowledge stressors inherent in chronic pediatric nursing care. Environments that welcome spiritual practices and actively encourage social support could address job hazards.

  1. Illness Severity and Work Productivity Loss Among Working Adults With Medically Attended Acute Respiratory Illnesses: US Influenza Vaccine Effectiveness Network 2012-2013.

    Science.gov (United States)

    Petrie, Joshua G; Cheng, Caroline; Malosh, Ryan E; VanWormer, Jeffrey J; Flannery, Brendan; Zimmerman, Richard K; Gaglani, Manjusha; Jackson, Michael L; King, Jennifer P; Nowalk, Mary Patricia; Benoit, Joyce; Robertson, Anne; Thaker, Swathi N; Monto, Arnold S; Ohmit, Suzanne E

    2016-02-15

    Influenza causes significant morbidity and mortality, with considerable economic costs, including lost work productivity. Influenza vaccines may reduce the economic burden through primary prevention of influenza and reduction in illness severity. We examined illness severity and work productivity loss among working adults with medically attended acute respiratory illnesses and compared outcomes for subjects with and without laboratory-confirmed influenza and by influenza vaccination status among subjects with influenza during the 2012-2013 influenza season. Illnesses laboratory-confirmed as influenza (ie, cases) were subjectively assessed as more severe than illnesses not caused by influenza (ie, noncases) based on multiple measures, including current health status at study enrollment (≤7 days from illness onset) and current activity and sleep quality status relative to usual. Influenza cases reported missing 45% more work hours (20.5 vs 15.0; P productivity as impeded to a greater degree (6.0 vs 5.4; P productivity loss were noted for vaccinated subjects. Influenza illnesses were more severe and resulted in more missed work hours and productivity loss than illnesses not confirmed as influenza. Modest reductions in illness severity for vaccinated cases were observed. These findings highlight the burden of influenza illnesses and illustrate the importance of laboratory confirmation of influenza outcomes in evaluations of vaccine effectiveness. © The Author 2015. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  2. Reliability and validity of a Thai version of assessment of chronic illness care (ACIC).

    Science.gov (United States)

    Gomutbutra, Patama; Aramrat, Apinun; Sattapansri, Worapoj; Chutima, Siam; Tooprakai, Dusida; Sakarinkul, Pokin; Sangkhasilapin, Yaowapa

    2012-08-01

    The Assessment Chronic Illness Care (ACIC), developed in the United States, is a quality-improvement tool used to help organization evaluate the strengths and weaknesses of their delivery of care for chronic illness in six areas, community linkages, self-management support, decision support, delivery system design, information systems, and organization of care. These areas of care are influenced by the Chronic Care Model. The questionnaire scale ranges from 0 to 11. Translate in Thai language and validate the ACIC as a practical tool to measure the quality of chronic illness care in Thailand. In a cross-sectional study, the content validity was examined by public health experts. The original ACIC was translated into Thai with permission from The MacColl Institute for Healthcare Innovation at Group Health's Center for Health Studies. The translation process followed the World Health Organization (WHO) process of translation and adaptation of instruments, including forward translation, expert panel and synthesis of the translation, back translation, pre-testing, and cognitive interviewing. The pre-testing was done by distributing the questionnaire to a sample of 12 organizations with cognitive interviewing, followed by revision and finalization of the questionnaire. The reliability and validity of the translated version was then examined by distributing the questionnaire to 172 organizations (84 district hospitals and 88 community health center primary care units within the upper northern part of Thailand)focusing on care of cerebrovascular disease. The response rate was approximately 70% or 120 organizations. The results from these organizations 'self-assessment showed that the Thai version of ACIC achieved good levels of reliability and validity, with the range of Cronbach's alpha coefficients being 0.846 to 0.972 in each aspect of ACIC. However ACIC inablility to detect statistical significant difference in score for each dimension though the self

  3. Prescription pain medications and chronic headache in Denmark

    DEFF Research Database (Denmark)

    Westergaard, Maria Lurenda; Hansen, Ebba Holme; Glümer, Charlotte

    2015-01-01

    PURPOSE: The aim of the present paper is to study which prescription pain medications are most commonly dispensed to people with chronic headache (CH), particularly those with medication-overuse headache (MOH). METHODS: This cross-sectional study analysed prescription pain medications dispensed...... medication per month (depending on the drug) were classified as having MOH. Associations between CH and other chronic pain conditions were analysed by logistic regression. RESULTS: Among those with CH (adjusted prevalence 3.3 %, CI 3.2-3.5 %), pain medications most commonly dispensed were paracetamol...... within 1 year to 68,518 respondents of a national health survey. Participants with headache ≥15 days per month for 3 months were classified as having CH. Those with CH and over-the-counter analgesic use ≥15 days per month or purchase of ≥20 or ≥30 defined daily doses (DDDs) of prescription pain...

  4. An assessment of attitudes towards people with mental illness among medical students and physicians in Ibadan, Nigeria.

    Science.gov (United States)

    Ighodaro, Adesuwa; Stefanovics, Elina; Makanjuola, Victor; Rosenheck, Robert

    2015-06-01

    The authors surveyed attitudes towards mental illness among Nigerian medical personnel at three different levels of training and experience: medical students who had not completed their psychiatry rotation, medical students who had competed their psychiatry rotation, and graduate physicians. Six questions addressed beliefs about the effectiveness of treatments for four specific mental illnesses (schizophrenia, bipolar disorder, depression, and anxiety) and two medical illnesses (diabetes and hypertension) among the three groups. A self-report questionnaire including 56 dichotomous items was used to compare beliefs about and attitudes towards people with mental illness. Factor analysis was used to identify key attitudes and analysis of covariance (ANCOVA) was used to compare the groups adjusting for age and personal experience with people with mental illness. There were no significant trends in attitudes towards the effectiveness of medication. Exploratory factor analysis of the beliefs and attitudes items identified four factors: (1) comfort socializing with people with mental, illness; (2) non-superstitious beliefs about the causes of mental illness; (3) neighborly feelings towards people with mental illness; and (4) belief that stress and abuse are part of the etiology of mental illness. ANCOVA comparing attitudes among the three groups showed that on three (1, 2, and 4) of the four factors medical students who had completed a rotation in psychiatry had significantly higher scores than the medical students who had not completed a rotation in psychiatry. Graduate physicians showed a similar pattern scoring higher than the medical students who had not completed a rotation in psychiatry in two factors (1 and 4) but showed no differences from students who had completed their psychiatry rotation. While beliefs about medication effectiveness do not differ between medical trainees and graduate professionals, stigmatizing attitudes towards people with mental illness seem

  5. Using Freire's Participatory Educational Method to Understand the Experience of Living With Chronic Illness in the Current Age of Globalization.

    Science.gov (United States)

    Camargo Plazas, Maria del Pilar; Cameron, Brenda L

    2015-06-01

    Many approaches and efforts have been used to better understand chronic diseases worldwide. Yet, little is known about the meaning of living with chronic illness under the pressures of globalization and neoliberal ideologies. Through Freire's participatory educational method, this article presents an innovative approach to understanding the multiple dimensions of living with chronic illness. In this way, we hope to use an innovative approach to address the impact of globalization on the daily life of chronically ill people and thus expand to the body of knowledge on nursing. This article uses Freire's participatory educational method to understand the multiple dimensions of living with chronic illness. This qualitative study follows an interpretive inquiry approach and uses a critical hermeneutic phenomenological method and critical research methodologies. Five participants were recruited for this participatory educational activity. Data collection methods included digitally recorded semistructured individual interviews and a Freire's participatory educational method session. Data analysis included a thematic analysis. Participants reported lacking adequate access to healthcare services because of insurance policies; a general perception that they were an unwanted burden on the healthcare system; and a general lack of government support, advocacy, and political interest. This research activity assisted participants to gain a new critical perspective about the condition of others with chronic diseases and thus provided an enlightening opportunity to learn about the illnesses and experiences of others and to realize that others experienced the same oppression from the healthcare system. Participants became agents of change within their own families and communities. Chronic diseases cause many economic and social consequences in their victims. These findings urge us to move from merely acknowledging the difficulties of people who live with chronic illness in an age of

  6. Development of a measure of the impact of chronic parental illness on adolescent and adult children. The parental illness impact scale (Parkinson's disease).

    Science.gov (United States)

    Schrag, Anette; Morley, David; Quinn, Niall; Jahanshahi, Marjan

    2004-10-01

    Although chronic illness is likely to affect the well-being of patients' children, no assessment tools are currently available to measure this impact of parental illness. We therefore developed such an instrument based on interviews with children of patients with Parkinson's disease (PD). This questionnaire and other measures of psychological well-being were completed by 89 children, aged 12-48, years of patients with PD. Factor analysis revealed six domains with 38 questions. These six domains of the 'Parental Illness Impact Scale (Parkinson's disease)' or PIIS (PD) had satisfactory internal consistency and validity. Its six sub-scales correlated significantly and differentially with corresponding measures, including the Quality of Life in Epilepsy Inventory for Adolescents (QOLIE-AD-48; r = -0.2 to 0.85), the Beck Depression Inventory (r = -0.07 to -0.40) or Birleson Depression Self-Rating Scale (r = 0.04 to -0.62), and the Rosenberg Self-Esteem Scale (r = -0.01 to 0.33) as well as age (r = -0.37 to 0.28) and parent's disease duration (r = -0.31 to 0.34). The PIIS is the first instrument to assess the impact of parental illness on children. Its psychometric properties should be tested further in larger samples, including children of patients with other chronic disorders such as multiple sclerosis or chronic heart disease.

  7. Chronic idiopathic constipation | Epstein | Continuing Medical ...

    African Journals Online (AJOL)

    Continuing Medical Education. Journal Home · ABOUT THIS JOURNAL · Advanced Search · Current Issue · Archives · Journal Home > Vol 27, No 5 (2009) >. Log in or Register to get access to full text downloads. Username, Password, Remember me, or Register · Download this PDF file. The PDF file you selected should ...

  8. Development and Validation of an Instrument for Assessing Patient Experience of Chronic Illness Care

    Directory of Open Access Journals (Sweden)

    José Joaquín Mira

    2016-08-01

    Full Text Available Introduction: The experience of chronic patients with the care they receive, fuelled by the focus on patient-centeredness and the increasing evidence on its positive relation with other dimensions of quality, is being acknowledged as a key element in improving the quality of care. There are a dearth of accepted tools and metrics to assess patient experience from the patient’s perspective that have been adapted to the new chronic care context: continued, systemic, with multidisciplinary teams and new technologies. Methods: Development and validation of a scale conducting a literature review, expert panel, pilot and field studies with 356 chronic primary care patients, to assess content and face validities and reliability. Results: IEXPAC is an 11+1 item scale with adequate metric properties measured by Alpha Chronbach, Goodness of fit index, and satisfactory convergence validity around three factors named: productive interactions, new relational model and person’s self-management. Conclusions: IEXPAC allows measurement of the patient experience of chronic illness care. Together with other indicators, IEXPAC can determine the quality of care provided according to the Triple Aim framework, facilitating health systems reorientation towards integrated patient-centred care.

  9. Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder'

    NARCIS (Netherlands)

    Post, R.M.; Altshuler, L.; Leverich, G.S.; Frye, M.A.; Suppes, T.; McElroy, S.L.; Keck, P.E.; Nolen, W.A.; Kupka, R.W.; Grunze, H.; Rowe, M.

    2015-01-01

    Background Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated. Methods The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900

  10. Relationship of clinical course of illness variables to medical comorbidities in 900 adult outpatients with bipolar disorder'

    NARCIS (Netherlands)

    Post, Robert M.; Altshuler, Lori; Leverich, Gabriele S.; Frye, Mark A.; Suppes, Trish; McElroy, Susan L.; Keck, Paul E.; Nolen, Willem A.; Kupka, Ralph W.; Grunze, Heinz; Rowe, Mike

    2015-01-01

    BACKGROUND: Medical illnesses are highly comorbid with bipolar disorder, but their relationship to illness characteristics has not been previously delineated. METHODS: The incidence of 34 medical conditions and 6 poor prognosis factors (PPFs) was derived from answers to a questionnaire in over 900

  11. Low knowledge of physical health behaviours is associated with poor diet and chronic illness in adults.

    Science.gov (United States)

    Stanton, Robert; Scott, David; Happell, Brenda

    2016-01-01

    Governments invest heavily in health promotion strategies to improve physical health behaviours. However, the dietary and physical activity practices of many Australians fail to meet minimum levels for health, leading to the unacceptably high prevalence of chronic and complex illness. Health literacy is known to impact on health behaviour, and to be related to health knowledge; however, no studies have specifically examined knowledge of physical health behaviours in an Australian context. We assessed knowledge of physical health behaviours in 1244 adults in Queensland, Australia. Almost two-thirds of respondents had a 'Good' knowledge of physical health behaviour. People with 'Good' knowledge of physical health behaviours were more likely to be female, educated beyond secondary school, be employed and have an annual household income of >$52000 (Pphysical health behaviours were significantly more likely to report insufficient intake of vegetables and have at least one chronic illness (Passociation with low knowledge of physical health behaviours. Given the association between health knowledge and health literacy, assessment of the knowledge of physical health behaviours may provide considerable insight into the effectiveness of future health promotion interventions.

  12. Translation and adaptation of "Perception of Severity of Chronic Illness" to the Brazilian culture for adolescents.

    Science.gov (United States)

    Lopes, Isabel de Moraes; Apolinario, Priscila Peruzzo; Lima, Maria Helena de Melo

    2017-05-29

    To translate, adapt, and evaluate the applicability of the "Perception of Severity of Chronic Illness" questionnaire to the Brazilian culture for diabetic adolescents. This is a methodological study consisting of the stages of translation, synthesis of translations, back translation, review by an expert committee, and pre-test. The expert judges evaluated semantic, idiomatic, conceptual, and cultural equivalences. The judges' concordance was quantified using the Content Validity Index. The translation and back translation were performed successfully. After the synthesised translation was reviewed by the committee, the items were altered to ensure equivalence between the original and translated instrument. After the pre-test, some statements were reformulated to make them clearer and easier to understand. The preliminary data of the instrument's reliability calculated using Cronbach's alpha was 0.66. The Brazilian version of the instrument Perception of Severity of Chronic Illness proved satisfactory in terms of the translation, cultural adaptation, and practicality, and it was considered an easily applicable and viable tool for clinical practice.

  13. Theory of planned behavior and adherence in chronic illness: a meta-analysis.

    Science.gov (United States)

    Rich, Antonia; Brandes, Kim; Mullan, Barbara; Hagger, Martin S

    2015-08-01

    Social-cognitive models such as the theory of planned behavior have demonstrated efficacy in predicting behavior, but few studies have examined the theory as a predictor of treatment adherence in chronic illness. We tested the efficacy of the theory for predicting adherence to treatment in chronic illness across multiple studies. A database search identified 27 studies, meeting inclusion criteria. Averaged intercorrelations among theory variables were computed corrected for sampling error using random-effects meta-analysis. Path-analysis using the meta-analytically derived correlations was used to test theory hypotheses and effects of moderators. The theory explained 33 and 9 % of the variance in intention and adherence behavior respectively. Theoretically consistent patterns of effects among the attitude, subjective norm, perceived behavioral control, intention and behavior constructs were found with small-to-medium effect sizes. Effect sizes were invariant across behavior and measurement type. Although results support theory predictions, effect sizes were small, particularly for the intention-behavior relationship.

  14. Persistent Delirium in Chronic Critical Illness as a Prodrome Syndrome before Death.

    Science.gov (United States)

    DeForest, Anna; Blinderman, Craig D

    2017-05-01

    Chronic critical illness (CCI) patients have poor functional outcomes, high risk of mortality, and significant sequelae, including delirium and cognitive dysfunction. The prognostic significance of persistent delirium in patients with CCI has not been well described. We report a case of a patient with CCI following major cardiac surgery who was hemodynamically stable following a long course in the cardiothoracic intensive care unit (CTICU), but had persistent and unremitting delirium. Despite both pharmacological and nonpharmacological approaches to improve his delirium, the patient ultimately continued to have symptoms of delirium and subsequently died in the CTICU. Efforts to reconsider the goals of care, given his family's understanding of his values, were met with resistance as his cardiothoracic surgeon believed that he had a reasonable chance of recovery since his organs were not in failure. This case description raises the question of whether we should consider persistent delirium as a prodrome syndrome before death in patients with CCI. Study and analysis of a case of a patient with CCI following major cardiothoracic surgery who was hemodynamically stable with persistent delirium. Further studies of the prevalence and outcomes of prolonged or persistent agitated delirium in patients with chronic critical illness are needed to provide prognostic information that can assist patients and families in receiving care that accords with their goals and values.

  15. Treatment participation and medication adherence: effects on criminal justice costs of persons with mental illness.

    Science.gov (United States)

    Robertson, Allison G; Swanson, Jeffrey W; Van Dorn, Richard A; Swartz, Marvin S

    2014-10-01

    Little empirical research has directly examined the extent to which early and consistent participation in outpatient services and adherence to prescribed psychotropic medications after a psychiatric hospitalization can help people with serious mental illnesses avoid arrest and incarceration and what impact this might have on state and local costs. The authors examined effects of medication adherence in the first 90 days after a psychiatric hospitalization among 1,367 adults with schizophrenia or bipolar disorder served by the public behavioral health systems of Miami-Dade County and Pinellas County in Florida. Better adherence was associated with lower subsequent criminal justice costs and greater use of treatment services. A modest investment in promoting treatment participation and medication adherence may reduce criminal justice involvement and costs for persons with serious mental illness.

  16. A review of behavioral tailoring strategies for improving medication adherence in serious mental illness.

    Science.gov (United States)

    Kreyenbuhl, Julie; Record, Elizabeth J; Palmer-Bacon, Jessica

    2016-06-01

    Nonadherence to psychopharmacological treatments poses a significant challenge to treatment success in individuals with serious mental illness, with upwards of 60% of people not taking their psychiatric medications as prescribed. Nonadherence is associated with adverse outcomes, including exacerbation of psychiatric symptoms, impaired functioning, increased hospitalizations and emergency room use, and increased health care costs. Whereas interventions using psychoeducation or cognitive approaches, such as motivational interviewing, have largely proven ineffective in improving adherence, approaches employing behavioral tailoring that incorporate medication taking into the daily routine and/or use environmental supports have shown promise. Recently, adherence-enhancing behavioral tailoring interventions that utilize novel technologies, such as electronic monitors and mobile phones, have been developed. Although interventions utilizing these platforms have the potential for widespread dissemination to a broad range of individuals, most require further empirical testing. This paper reviews selected behavioral tailoring strategies that aim to improve medication adherence and other functional outcomes among individuals with serious mental illness.

  17. Mental ill health in the elderly: medical students’ social representations in the United Kingdom

    Directory of Open Access Journals (Sweden)

    Bruno Medeiros

    2014-12-01

    Full Text Available Objective This study aims to explore medical students’ social representations of mental ill health in older adults. Method It comprises an exploratory and qualitative investigation based on the theory of social representations. Two focus groups with pre-clinical medics (group 1, N=4; group 2, N=4 and 10 individual interviews with clinical medical students were conducted. Thematic analysis at a latent level explored meanings and differences between groups. Results Three overarching themes reflect participants’ representations of mental health problems in later life – mental ill health in old age, polarisation of care, and challenges to care. Primary health care appears as an important strategy to overcome barriers to mental health care in the community. Nevertheless, disqualifying representations, stigma and organization of services constitute the main challenges to quality mental health care in later life. Conclusion This paper highlights the need to address cultural and organizational barriers to promote quality care.

  18. The effect of hospitalization with medical illnesses on the suicide risk in the oldest old

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Vach, Werner; Jeune, Bernard

    2005-01-01

    OBJECTIVES: To compare the effect of hospitalization with medical illnesses on the suicide risk in the oldest old (> or = 80) with that in the old (65-79) and middle-aged (52-64) using nationwide data. DESIGN: Event-history analysis using time-varying covariates based on prospective individual......-level register data. SETTING: Population-based record linkage. PARTICIPANTS: All persons aged 52 and older living in Denmark during 1996 to 1998 (N=1,684,205). MEASUREMENTS: The studied event is completed suicide. The following time-varying variables are included in the analysis: current age, hospitalization...... with medical illnesses within previous 2 years, and number of different medical diagnoses given at hospitalizations within previous 2 years. Relative suicide risks were calculated using event-history analysis. The proportional attributable risk was calculated to assess to which extent hospitalization can...

  19. Treatment recidivism in adolescents with mental illness: A focused applied medical ethnography.

    Science.gov (United States)

    Ekwemalor, Chukwudi C; Rozmus, Cathy L; Engebretson, Joan C; Marcus, Marianne T; Casarez, Rebecca L; Harper, Andrew R

    2017-02-01

    Treatment recidivism, described as frequent unplanned relapse readmissions, is a national problem predominant in adolescents with mental illness. Because the main triggers of treatment recidivism are not fully understood, the purpose of this study was to explore treatment recidivism (i) to better understand treatment recidivism from the perspectives of recidivist adolescents with mental illness, (ii) to describe major factors that contribute to treatment recidivism and how best to minimize them from the perspectives of these adolescents, and (iii) to describe their interaction with the medical culture. A focused applied medical ethnography was used to study 16 purposively selected adolescents. Interviews were conducted together with unobtrusive unit observation of the participants and collection of demographic and clinical information. The participants were nearly unanimous in identifying the "additional stressors" of problematic parental relations and school bullying as the main triggers of treatment recidivism over and above their "routine stressors" of adolescence and mental illness. They had mixed perceptions of treatment recidivism and described their interaction with the medical culture as positive. Further research is needed to determine the impact of parental relations and school bullying on recidivism in adolescents with mental illness. © 2017 Wiley Periodicals, Inc.

  20. Rehabilitation, weaning and physical therapy strategies in chronic critically ill patients.

    Science.gov (United States)

    Ambrosino, N; Venturelli, E; Vagheggini, G; Clini, E

    2012-02-01

    In critically ill patients, a prolonged hospital stay, due to the initial acute insult and adverse side-effects of drug therapy, may cause severe late complications, such as muscle weakness, prolonged symptoms, mood alterations and poor health-related quality of life. The clinical aims of physical rehabilitation in both medical and surgical intensive care units (ICUs) are focussed on the patient to improve their short- and even long-term care. The purpose of this article is to review the currently available evidence on comprehensive rehabilitation programmes in critically ill patients, and describe the key components and techniques used, particularly in specialised ICUs. Despite the literature suggesting that several techniques have led to beneficial effects and that muscle training is associated with weaning success, scientific evidence is limited. Due to limitations in undertaking comparative studies in ICUs, further studies with solid clinical short- and long-term outcome measures are now welcomed.

  1. Psychosocial well-being in young adults with chronic illness since childhood: the role of illness cognitions

    NARCIS (Netherlands)

    Verhoof, Eefje J. A.; Maurice-Stam, Heleen; Heymans, Hugo S. A.; Evers, Andrea W. M.; Grootenhuis, Martha A.

    2014-01-01

    Background: More and more pediatric patients reach adulthood. Some of them are successfully integrating in adult life, but many others are not. Possibly Illness cognitions (IC) - the way people give meaning to their illness/disability - may play a role in individual differences on long-term

  2. Use of psychotropic medication groups in people with severe mental illness and stressful childhood experiences.

    Science.gov (United States)

    Schneeberger, Andres R; Muenzenmaier, Kristina; Castille, Dorothy; Battaglia, Joseph; Link, Bruce

    2014-01-01

    Stressful childhood experiences (SCE) are associated with a variety of health and social problems. In people with severe mental illness (SMI) traumatic childhood experiences have been linked to more severe and treatment refractory forms of psychiatric symptoms, including psychotic symptoms. This study evaluates the use of psychotropic medication groups in a population of people with SMI and SCE, testing the association between SCE and prescription medication in an SMI population. A sample of 183 participants with SMI was divided into 2 exposure groups: high SCE (4 to 7 categories of SCE) and low SCE (0 to 3 categories of SCE). Both groups were compared in regard to prescribed dosing of psychotropic medications (antipsychotics, mood stabilizers, antidepressants, and anxiolytics/hypnotics). Participants who endorsed high SCE received higher doses of antipsychotic medications and mood stabilizers than those with low exposure. The results demonstrate that people with higher SCE categories received a higher dosing of psychotropic medication, specifically antipsychotic medication and mood stabilizers.

  3. Illness perceptions of Libyans with T2DM and their influence on medication adherence: a study in a diabetes center in Tripoli

    Directory of Open Access Journals (Sweden)

    Sana Taher Ashur

    2015-12-01

    Full Text Available Background: The surrounding environment influences the constitution of illness perceptions. Therefore, local research is needed to examine how Libyan diabetes patients perceive diabetes and how their perceptions influence their medication adherence. Methods: A cross-sectional study was conducted at the National Centre for Diabetes and Endocrinology in Tripoli, Libya, between October and December 2013. A total of 523 patients with type 2 diabetes participated in this study. A self-administered questionnaire was used for data collection; this included the Revised Illness Perception Questionnaire and the eight-item Morisky Medication Adherence Scale. Results: The respondents showed moderately high personal control and treatment control perceptions and a moderate consequences perception. They reported a high perception of diabetes timeline as chronic and a moderate perception of the diabetes course as unstable. The most commonly perceived cause of diabetes was Allah's will. The prevalence of low medication adherence was 36.1%. The identified significant predictors of low medication adherence were the low treatment control perception (p=0.044, high diabetes identity perception (p=0.008, being male (p=0.026, and employed (p=0.008. Conclusion: Diabetes illness perceptions of type 2 diabetic Libyans play a role in guiding the medication adherence and could be considered in the development of medication adherence promotion plans.

  4. Candidemia in critically ill patients: difference of outcome between medical and surgical patients.

    Science.gov (United States)

    Charles, Pierre Emmanuel; Doise, Jean Marc; Quenot, Jean Pierre; Aube, Hervé; Dalle, Frédéric; Chavanet, Pascal; Milesi, Nadine; Aho, Ludwig Serge; Portier, Henri; Blettery, Bernard

    2003-12-01

    Candidemia is increasingly encountered in critically ill patients with a high fatality rate. The available data in the critically ill suggest that patients with prior surgery are at a higher risk than others. However, little is known about candidemia in medical settings. The main goal of this study was to compare features of candidemia in critically ill medical and surgical patients. Ten-year retrospective cohort study (1990-2000). Medical and surgical intensive care units (ICUs) of a teaching hospital. Fifty-one patients with at least one positive blood culture for Candida species. Risk factors were retrieved in all of the patients: central venous catheter (92.1%), mechanical ventilation (72.5%), prior bacterial infection (70.6%), high fungal colonization index (45.6%). Candida albicans accounts for 55% of all candidemia. The overall mortality was 60.8% (85% and 45.2% in medical and surgical patients, respectively). Independent factors associated with survival were prior surgery (hazard ratio [HR] =0.25; 0.09-0.67 95% confidence interval [CI], p<0.05), antifungal treatment (HR =0.11; 0.04-0.30 95% CI, p<0.05) and absence of neutropenia (HR =0.10; 0.02-0.45 95% CI, p<0.05). Steroids, neutropenia and high density of fungal colonization were more frequently found among medical patients compared to surgical ones. Candidemia occurrence is associated with a high mortality rate among critically ill patients. Differences in underlying conditions could account for the poorer outcome of the medical patients. Screening for fungal colonization could allow identification of such high-risk patients and, in turn, improve outcome.

  5. A shared respite--The meaning of place for family well-being in families living with chronic illness.

    Science.gov (United States)

    Årestedt, Liselott; Benzein, Eva; Persson, Carina; Rämgård, Margareta

    2016-01-01

    Living with chronic illness is a family affair that involves ongoing changes and challenges in everyday life. When life changes, the environment is important for family health and well-being. The relation between a place and a family is rarely described, and therefore the aim of this study was to explore the meaning of place for family well-being in families living with chronic illness. A qualitative design was chosen. Data were collected by photovoice combined with narrative family research interviews with 10 families living with chronic illness. A phenomenological hermeneutic analysis was used to interpret the data. The results showed that the meaning of place for family well-being in families living with chronic illness can be described as "a shared respite." This main theme included three subthemes: "a place for relief," "a place for reflection," and "a place for re-creation." These results were further understood by means of the concept place security. Feeling well means having place security in these families. Through knowledge about the meaning of place for family well-being, health care personnel can stimulate families living with chronic illness to find respite in places that contribute to well-being, both in familiar and new places.

  6. [Chronic lead intoxication associated with Ayurvedic medication].

    Science.gov (United States)

    Kanen, B L J; Perenboom, R M

    2005-12-24

    A 46-year-old man with multiple sclerosis had severe generalised pain for which treatment with paracetamol, ibuprofen, gabapentin and methyl-prednisolone had been unsuccessful. In addition normocytic anaemia without haemolysis and with a normal iron load was found. Due to bright red rectal blood loss and nausea, vomiting, weight loss, anorexia, abdominal pain and constipation a colonoscopy was planned. However, before this was performed, manual slide differentiation of a blood smear showed basophilic stippling and it turned out that the patient had been taking Ayurvedic medication up to one month before presentation. A moderately severe lead intoxication was diagnosed: 0.77 mg/l. The herbal medication had a very high lead content. The patient was successfully treated with the oral lead chelator 23-dimercaptosuccinic acid. Traditional and folk remedies often are important causes of lead poisoning.

  7. Increased training of general practitioners in Ireland may increase the frequency of exercise counselling in patients with chronic illness: a cross-sectional study.

    Science.gov (United States)

    Joyce, Ciarán L; O'Tuathaigh, Colm M

    2014-12-01

    Recent systematic reviews have established that brief interventions in primary care are effective and economic at promoting physical activity. Lack of training has previously been identified as a barrier to lifestyle counselling in Ireland. This study evaluates frequency of exercise counselling (EC), in patients with six chronic illnesses (type 2 diabetes mellitus, stable coronary heart disease, hypertension, depression, obesity, osteoarthritis) and healthy adults, by general practitioners (GPs) in the mid-west of Ireland, as well as, whether training in EC influences the frequency of EC. A questionnaire survey of GPs based in the mid-west of Ireland was conducted during February and March 2012. The questionnaire was distributed to 39 GPs at two continuing medical education meetings and posted to 120 other GPs in the area. The questionnaire assessed the frequency of EC, use of written advice and frequency of recommending resistance exercise in the above patient groups. It also assessed training in EC. 64% of GPs responded (n = 102). Frequency of EC varied among the chronic illnesses evaluated. Use of written advice and advice on resistance exercise in EC was low. Only 17% of GPs had previous training in EC. If available, 94% of GPs would use guidelines to prescribe exercise in chronic illness. The association of previous training in EC with frequency of EC was variable, with significantly higher counselling rates found in T2DM, obesity and healthy adults. Improved training of GPs and development of guidelines may increase the frequency of EC in Ireland.

  8. Research Review: Childhood chronic physical illness and adult emotional health - a systematic review and meta-analysis.

    Science.gov (United States)

    Secinti, Ekin; Thompson, Ellen J; Richards, Marcus; Gaysina, Darya

    2017-07-01

    Childhood chronic physical illness is associated with a greater vulnerability for emotional problems (i.e. depression and anxiety) in childhood. However, little is known about life-long effects of childhood chronic physical illness on mental health. The present study aims to systematically review evidence for associations between eight chronic physical illnesses with childhood onset (arthritis, asthma, cancer, chronic renal failure, congenital heart disease, cystic fibrosis, type 1 diabetes, and epilepsy) and adult emotional problems. A database search of MEDLINE, PsycARTICLES, PsycINFO, and ScienceDirect was undertaken, and random effects meta-analyses were used to synthesise evidence from eligible studies. In total, 37 studies were eligible for the systematic review (n = 45,733) and of these, 34 studies were included in the meta-analyses (n = 45,358). There were overall associations between childhood chronic physical illness and adult depression (OR = 1.31; 95% CI [1.12, 1.54]) and anxiety (OR = 1.47; 95% CI [1.13, 1.92]). Separate meta-analyses for childhood asthma, type 1 diabetes and cancer were also conducted, with cancer being significantly associated with adult depression (OR = 1.19; 95% CI [1.00, 1.42]). The effects of childhood chronic physical illness on the risk of emotional problems persist beyond childhood and adolescence. Mental health prevention and intervention strategies targeting children with chronic physical illnesses can have long-term benefits. © 2017 Association for Child and Adolescent Mental Health.

  9. The experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings: a feminist poststructural approach: A qualitative study that explores negotiation of patient care between patients and chronically ill patients in hospital settings.

    Science.gov (United States)

    Griscti, Odette; Aston, Megan; Martin-Misener, Ruth; Mcleod, Deborah; Warner, Grace

    2016-07-01

    The aim of this study was to understand the experiences of chronically ill patients and registered nurse in negotiating patient care in hospital. Specifically, we explored how social and institutional discourses shaped power relations and negotiation of patient care. Current literature indicates that although nurses embrace this notion, such partnerships are not easily implemented. Most existing studies focus on the role of the nurse as the leader of the partnership with little attention paid to how social and institutional values, beliefs and practices shape nurse/patient power relations; or how these relationships are negotiated between nurses and patients. The theoretical and methodological approaches used in this study are based on the precepts of Foucault and feminist poststructural theorists. In depth interviews were conducted with eight chronically ill patients and 10 registered nurses. Both nurses and patients commented about the relationships that develop between nurses and chronically ill patients and how these relationships facilitate negotiation of patient care. Both parties described challenging moments and how institutional discourses may hinder positive negotiations of care. In this paper we highlight three themes that emerged: getting to know each other, they are not the sickest patients and finding time to listen. This study offers an innovative way of unpacking negotiation of care between chronically ill patients and registered nurses. It exposes how social and institutional discourses play a pivotal role in shaping negotiations between nurses and chronically ill patients. Negotiating care with chronically ill patients is not as asymmetric as portrayed in some of the literature and tends to be based on mutual agreements between nurses and patients. Nurses make it a point to listen to patients' needs and resist institutional discourses that preclude them from spending time with patients. © 2016 John Wiley & Sons Ltd.

  10. Comparing medication attitudes and reasons for medication nonadherence among three disparate groups of individuals with serious mental illness.

    Science.gov (United States)

    Levin, Jennifer B; Seifi, Nasim; Cassidy, Kristin A; Tatsuoka, Curtis; Sams, Johnny; Akagi, Kouri K; Sajatovic, Martha

    2014-11-01

    This analysis compared medication attitudes and reasons for nonadherence in three distinct groups of patients with serious mental illness (SMI). Cohort 1 had 43 patients with bipolar disorder (BD) treated in a community mental health setting, cohort 2 had 43 patients with BD taking an atypical antipsychotic and treated in an academic medical center, and cohort 3 had 30 patients with schizophrenia or schizoaffective disorder who had been homeless in the last year. Standardized attitudinal scales found generally negative attitudes toward medication and limited illness insight. Although the three cohorts differed with regard to severity of symptoms, age of onset, education, baseline adherence, and race, the groups had similar medication attitudes before and after treatment. Despite group differences in demographic and clinical variables, our analyses found more similarities than differences in medication attitudes among these three discrete groups of poorly adherent, symptomatic patients with SMI. The common attitudinal characteristics have implications for delivery of health care services that can enhance treatment adherence in high-risk SMI patients.

  11. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Stewart Allison

    2008-05-01

    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

  12. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Science.gov (United States)

    Si, Damin; Bailie, Ross; Cunningham, Joan; Robinson, Gary; Dowden, Michelle; Stewart, Allison; Connors, Christine; Weeramanthri, Tarun

    2008-01-01

    Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1) organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2) community linkages – facilitated by working together with community organisations (e.g. local stores) and running community-based programs (e.g. "health week"), but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3) self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4) decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design

  13. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory - use of the Chronic Care Model.

    Science.gov (United States)

    Si, Damin; Bailie, Ross; Cunningham, Joan; Robinson, Gary; Dowden, Michelle; Stewart, Allison; Connors, Christine; Weeramanthri, Tarun

    2008-05-28

    Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Participating health centres had distinct areas of strength and weakness in each component of systems: 1) organisational influence - strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2) community linkages - facilitated by working together with community organisations (e.g. local stores) and running community-based programs (e.g. "health week"), but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3) self management - promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4) decision support - facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5) delivery system design - strengthened by provision of transport for

  14. Impermanence and Sense of Coherence: Lessons Learned From the Adaptive Behaviors of Sri Lankan Buddhist Nuns With a Chronic Illness.

    Science.gov (United States)

    Wijesinghe, Sunny; Parshall, Mark B

    2016-03-01

    The purpose of this study was to explore the influence of traditional Buddhist spiritual beliefs and practices on coping with chronic illness. The study was a descriptive ethnography. Participant observation and semistructured interviews were used with 45 Sri Lankan Buddhist nuns with a chronic illness and 20 secondary informants. Cultural domains and taxonomies were explored to uncover themes pertaining to traditional Buddhist spirituality and experiences of chronic illness. A repeating cultural theme, responsibility, was identified. Responsibility took four forms: to the Buddha, to the social circle, to self-liberation through meditation, and to finding security in old age. Nuns shaped spiritual practices (some with folk origins) to fulfill these responsibilities. Coping ranged from health-seeking to resigned acceptance. Responsibilities and coping were situated in a context of Buddhist spiritual beliefs about impermanence. Findings were congruent with Antonovsky's model of salutogenesis, in particular, the construct of sense of coherence. © The Author(s) 2014.

  15. Sexual behavior, body image, and partnership in chronic illness: a comparison of Huntington's disease and multiple sclerosis.

    Science.gov (United States)

    Reininghaus, Eva; Reininghaus, Bernd; Fitz, Werner; Hecht, Karen; Bonelli, Raphael Maria

    2012-08-01

    Huntington's disease (HD) and multiple sclerosis (MS) are both chronic progressive illnesses posing a serious challenge to affected patients and families. Sexual dysfunction in HD as well as in MS is a very common problem, although it is unclear whether the dysfunction is caused by the chronic illness itself or by the sociopsychiatric burden related to the illness. Twenty-nine patients with HD and 27 patients with MS each participated in a semistructured interview and several standardized questionnaires concerning partnership, sexual function, and body image. The results display significant differences in both patient groups, displaying higher sexual desire and activity in HD patients, but MS patients also reported fewer sexual problems compared to the norming values. Conversely, the MS patients' relationships seemed to be stable despite subjectively perceived lower initiative on sexual activities. The results are discussed under the possible influences of the underlying organic changes and the psychosocial consequences of chronic progressive disorders.

  16. [Illness, culture and religion--issues of intercultural medical ethics and nursing ethics].

    Science.gov (United States)

    Körtner, Ulrich H J

    2007-01-01

    Should modern medicine be allowed to do what it is capable of? And what role are religious norms and attitudes to play in both the medical course of life and the bioethical discourse of modern societies? Questions like these are subject of current intercultural medical and nursing ethics. Religious attitudes not only influence the cultural and political surroundings of medical research but also exert a practical influence on the health and illness attitudes of the individual. Coming before moral judgement should be the endeavour to understand one's counterpart, namely the patient, and his/her socio-cultural background. The question to be answered is how therapy and nursing can best be applied within the given socio-cultural framework without those responsible denying their own medical premises or their own concepts of nursing. Intercultural medical and nursing ethics provide an important contribution to the current debate on integration.

  17. Patient self-management and chronic illness: evaluating outcomes and impacts of information technology.

    Science.gov (United States)

    Cummings, Elizabeth; Turner, Paul

    2009-01-01

    Chronic illness is increasing in Australia and throughout the world. It is proving to be a large burden upon health systems. In response, a number of approaches are being tried including the introduction of self-management programmes to assist people in improving their health outcomes. There are also claims that the introduction of information and communications technology (ICT) tools can improve the management of these chronic conditions.This paper investigates the influence of ICT on the health outcomes and experiences of patients with chronic obstructive pulmonary disease (COPD) participating in a mentored self-management programme. It utilises a combined quantitative and qualitative methodology and introduces the use of triad interviews to provide a broader evaluation of the experiences of individuals within a controlled trial. Two sub-groups of participants within the controlled trial were examined, both received mentoring but one sub-group was also supported with access to an ICT symptom monitoring tool. This research highlights the need for more holistic perspectives on patients and towards the use of a variety of methodological approaches in designing and evaluating e-health projects. Critically, this research highlights the need to expand our understanding of participant's outcomes beyond conventional clinical or cohort based measures.

  18. Regoaling: a conceptual model of how parents of children with serious illness change medical care goals.

    Science.gov (United States)

    Hill, Douglas L; Miller, Victoria; Walter, Jennifer K; Carroll, Karen W; Morrison, Wynne E; Munson, David A; Kang, Tammy I; Hinds, Pamela S; Feudtner, Chris

    2014-03-13

    Parents of seriously ill children participate in making difficult medical decisions for their child. In some cases, parents face situations where their initial goals, such as curing the condition, may have become exceedingly unlikely. While some parents continue to pursue these goals, others relinquish their initial goals and generate new goals such as maintaining the child's quality of life. We call this process of transitioning from one set of goals to another regoaling. Regoaling involves factors that either promote or inhibit the regoaling process, including disengagement from goals, reengagement in new goals, positive and negative affect, and hopeful thinking. We examine these factors in the context of parental decision making for a seriously ill child, presenting a dynamic conceptual model of regoaling. This model highlights four research questions that will be empirically tested in an ongoing longitudinal study of medical decision making among parents of children with serious illness. Additionally, we consider potential clinical implications of regoaling for the practice of pediatric palliative care. The psychosocial model of regoaling by parents of children with a serious illness predicts that parents who experience both positive and negative affect and hopeful patterns of thought will be more likely to relinquish one set of goals and pursue a new set of goals. A greater understanding of how parents undergo this transition may enable clinicians to better support them through this difficult process.

  19. Patient-Centered Medical Home in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Ortiz G

    2011-10-01

    Full Text Available Gabriel Ortiz1, Len Fromer21Pediatric Pulmonary Services, El Paso, TX; 2Department of Family Medicine, David Geffen School of Medicine, UCLA, Los Angeles, CA, USAAbstract: Chronic obstructive pulmonary disease (COPD is a progressive and debilitating but preventable and treatable disease characterized by cough, phlegm, dyspnea, and fixed or incompletely reversible airway obstruction. Most patients with COPD rely on primary care practices for COPD management. Unfortunately, only about 55% of US outpatients with COPD receive all guideline-recommended care. Proactive and consistent primary care for COPD, as for many other chronic diseases, can reduce hospitalizations. Optimal chronic disease management requires focusing on maintenance rather than merely acute rescue. The Patient-Centered Medical Home (PCMH, which implements the chronic care model, is a promising framework for primary care transformation. This review presents core PCMH concepts and proposes multidisciplinary team-based PCMH care strategies for COPD.Keywords: Patient-Centered Medical Home, chronic care model, chronic obstructive pulmonary disease, patient education, physician assistants, nurse practitioners

  20. Mandatory physical exercise for the prevention of mental illness in medical students

    Directory of Open Access Journals (Sweden)

    Robert A. Bitonte

    2014-09-01

    Full Text Available Medical students experience higher rates of mental illness than the general population. With competition rising for success in medical school, and residency, increasing incidence of distress are leading this population to experience higher rates of thoughts of dropping out of school, and even suicide. Since many stigmas deter medical students from receiving mental health counseling, such as the perceived inability to handle the stresses of medical school, and the potential lack of competitiveness for residencies if reported, prevention of mental illness may be a better course to take in reducing prevalence in this population. Regular exercise has demonstrated a positive effect on not only promoting physical health, but also mental health. Exercise encourages a healthy mood, positive self esteem, and better cognition, while decreasing the chances of depression, anxiety, and burnout. Implementing exercise time into medical school curriculums, just like the basic sciences, albeit for less time in the day, could provide a feasible way to ensure that all students are taking time to partake in this important activity for their well being. Though medical schools are rigid with attempts to make changes in their curriculum, thirty minutes a day, three to five times a week of exercise of the students’ choice not only is more cost effective than counseling, but it also reduces the chances that they will experience burnout, which if left untreated could transcend into a compromised training experience.

  1. Mood and anxiety disorders as early manifestations of medical illness: a systematic review.

    Science.gov (United States)

    Cosci, Fiammetta; Fava, Giovanni A; Sonino, Nicoletta

    2015-01-01

    Affective disturbances involving alterations of mood, anxiety and irritability may be early symptoms of medical illnesses. The aim of this paper was to provide a systematic review of the literature with qualitative data synthesis. MEDLINE, PsycINFO, EMBASE, Cochrane, and ISI Web of Science were systematically searched from inception to February 2014. Search terms were 'prodrome/early symptom', combined using the Boolean 'AND' operator with 'anxiety/depression/mania/hypomania/irritability/irritable mood/hostility', combined with the Boolean 'AND' operator with 'medical illness/medical disorder'. PRISMA guidelines were followed. A total of 21 studies met the inclusion criteria and were analyzed. Depression was found to be the most common affective prodrome of medical disorders and was consistently reported in Cushing's syndrome, hypothyroidism, hyperparathyroidism, pancreatic and lung cancer, myocardial infarction, Wilson's disease, and AIDS. Mania, anxiety and irritability were less frequent. Physicians may not pursue medical workup of cases that appear to be psychiatric in nature. They should be alerted that disturbances in mood, anxiety and irritability may antedate the appearance of a medical disorder.

  2. Pediatric palliative care for children with complex chronic medical conditions.

    Science.gov (United States)

    Schwantes, Scott; O'Brien, Helen Wells

    2014-08-01

    Children with complex chronic medical conditions are at risk for significant distress during multiple points in their life. Pediatric palliative care can meaningfully assist in providing support to the child and family throughout their complex care, managing distressing symptoms, anticipating future decision points, and helping the child and family to thrive in their local community. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Attachment in medical care: A review of the interpersonal model in chronic disease management.

    Science.gov (United States)

    Jimenez, Xavier F

    2017-03-01

    Objective Patient-physician interaction is continually examined in an era prioritizing patient-centered approaches, yet elaboration beyond aspects of communication and empathy is lacking. Major chronic conditions would benefit tremendously from understanding interpersonal aspects of patient-physician encounters. This review intends to provide a concise introduction to the interpersonal model of attachment theory and how it informs both the patient-physician interaction and medical outcomes in chronic care. Methods A narrative review of the theoretical, neurobiological, epidemiological, investigational, and clinical literature on attachment theory and its impact on medical outcomes was conducted, utilizing a variety of key words as searched on PubMed database. Studies and reviews included were of a variety of sources, including textbooks and peer-reviewed journals. Reports in languages other than English were excluded. Results Measurable, discrete attachment styles and behavioral patterns correlate with poor medical outcomes, including nonadherence in insecure dismissing attachment and care overutilization in insecure preoccupied attachment. Furthermore, insecure dismissing attachment is associated with significant mortality. These variables can be easily assessed, and their effects are reversible, as evidenced by collaborative care outcome data. Discussion Attachment theory is useful a model with application in clinical and investigational aspects of chronic illness care. Implications and guidelines are explored.

  4. Effectiveness of neurofeedback therapy for anxiety and stress in adults living with a chronic illness: a systematic review protocol.

    Science.gov (United States)

    Blaskovits, Farriss; Tyerman, Jane; Luctkar-Flude, Marian

    2017-07-01

    The objective of this review is to systematically examine the effectiveness of neurofeedback therapy for managing anxiety and stress in adults living with a chronic illness.The specific objectives are to identify which neurofeedback systems and/or protocols demonstrate effectiveness and determine the level of supporting evidence.The review question is as follows: What is the effectiveness of neurofeedback therapy for managing anxiety and stress in an adult population aged 18 years of age or older living with a chronic illness?

  5. Impact of obesity on health-related quality of life in patients with chronic illness.

    Science.gov (United States)

    Katz, D A; McHorney, C A; Atkinson, R L

    2000-11-01

    To determine the association between overweight and obesity and health-related quality of life (HRQOL) in patients with chronic conditions typical of those seen in general medical practice, after accounting for the effects of depression and medical comorbidities. Cross-sectional analysis of data from the Medical Outcomes Study. Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in three U.S. cities. We surveyed 2,931 patients with chronic medical and psychiatric conditions. The patients completed a self-administered questionnaire at enrollment and had complete data on height and weight. Body mass index (BMI), chronic medical conditions, and depression were obtained by structured interview. Health-related quality of life was measured by the SF-36 Health Survey. Patients who were overweight (BMI 25.0-29.9 kg/m2), patients with class I obesity (BMI 30.0-34.9 kg/m2), and patients with class II-III obesity (BMI > or = 35 kg/m2) had significantly lower adjusted physical function scores (by 3.4, 7.8, and 13.8 points, respectively) compared with nonoverweight patients. Patients with class I and class II-III obesity also had significantly lower adjusted general health perceptions scores (by 2.8 and 4.4 points, respectively) and lower adjusted vitality scores (by 4.0 and 7.1 points, respectively), compared with nonoverweight patients. No significant differences between nonoverweight, overweight, and obese patients were observed for the mental health scale. Women with elevated BMI had significantly lower HRQOL scores compared with the scores of obese men in several domains. Additionally, blacks with elevated BMI had significantly lower scores than whites in several domains of HRQOL. Overweight and obesity have the largest association with physical function measures. Recent national standards, which have lowered the threshold for defining overweight, identify patients who are more likely to have clinically significant

  6. A systematic review and quantitative analysis of neurocognitive outcomes in children with four chronic illnesses.

    Science.gov (United States)

    Moser, Joanna J; Veale, Pamela M; McAllister, Debbie L; Archer, David P

    2013-11-01

    Concern has been expressed that infants and children exposed to uneventful surgery and anesthesia may incur neurological injury that becomes manifest in poor scholastic performance or future learning difficulties. A recent meta-analysis of seven clinical studies examined the relationship between learning or behavior difficulties and pediatric exposure to anesthesia/surgery and reported an odds ratio of 1.4; however, the level of association and causal factors remain unclear. The purpose of our study is to provide context to the pediatric anesthesia neurotoxicity question by reviewing the evidence linking four childhood illnesses with neurocognitive development. In the present review, we have sought to quantify the magnitude of the impact of chronic illness on neurocognitive development through a systematic review of publications that report the developmental trajectory of patients with four childhood diseases: cystic fibrosis (CF), hemophilia A, end-stage renal disease (ESRD) and end-stage liver disease (ESLD). Studies were identified by searching the electronic databases OVID MEDLINE and Pubmed and scanning reference lists of articles by two authors. Limits were applied to the English language and to humans. We used the following search terms: CF, hemophilia A, ESRD, ESLD in combination with academic performance, educational status, educational measurement, learning, achievement, developmental delay, learning disabilities, intellectual disabilities, behavioral disorders, intelligence quotient (IQ), cognition, school problems, absenteeism, school attendance, anxiety, learning regression, or developmental regression. The search strategy was reviewed independently by all four authors. Eligibility assessment was performed independently in an unblinded standardized manner by two authors who chose relevant articles from the overall search results by scanning the titles and abstracts of articles and from the references within citations. The full-text publications were

  7. Illness representations as mediators of the relationship between dispositional optimism and depression in patients with chronic tinnitus: A cross-sectional study.

    NARCIS (Netherlands)

    Vollmann, Manja; Scharloo, Margreet; Langguth, Berthold; Kalkouskaya, Natallia; Salewski, Christel

    2014-01-01

    Objective: Both dispositional optimism and illness representations are related to psychological health in chronic patients. In a group of chronic tinnitus sufferers, the interplay between these two variables was examined. Specifically, it was tested to what extent the relationship between

  8. Determinants of receipt of ambulatory medical care in a national sample of mentally ill homeless veterans.

    Science.gov (United States)

    Desai, Mayur M; Rosenheck, Robert A; Kasprow, Wesley J

    2003-02-01

    This study used the Behavioral Model for Vulnerable Populations to identify determinants of receipt of outpatient medical care within 6 months of initial contact with a national homeless veterans outreach program. Prospective study. Homeless veterans contacted through the program in 1999 (n = 26,926). Data from structured interviews conducted at the time of program intake were merged with Veterans Affairs administrative data to determine subsequent medical service use. Logistic regression modeling was used to identify predisposing, enabling, and need factors from traditional and vulnerable domains predictive of receiving medical care. Overall, 41.8% of subjects received at least one medical visit in the 6 months after program intake; of these, 48.7% had three or more visits. In multivariate analyses, the likelihood of receiving medical care was, among other things, positively associated with age, female gender, and placement in residential treatment and negatively associated with duration of homelessness and being contacted through outreach versus referred or self-referred into the homeless program. Mental illness did not appear to be an additional barrier to initiating medical care; however, a diagnosis of substance abuse or schizophrenia was associated with a decreased likelihood of receiving three or more visits. A majority of homeless veterans contacted through a national outreach program failed to receive medical services within 6 months of program entry. Vulnerable-domain factors were important supplements to traditional variables in predicting use of medical services in the homeless population. Greater efforts are needed to ensure that mentally ill homeless persons are successfully linked with and engaged in medical treatment.

  9. Psychosocial Adaptation to Chronic Illness and Disability: A Virtue Based Model.

    Science.gov (United States)

    Kim, Jeong Han; McMahon, Brian T; Hawley, Carolyn; Brickham, Dana; Gonzalez, Rene; Lee, Dong-Hun

    2016-03-01

    Psychosocial adaptation to chronic illness and disability (CID) is an area of study where a positive psychology perspective, especially the study of virtues and character strengths, can be implemented within the rehabilitation framework. A carefully developed theory to guide future interdisciplinary research is now timely. A traditional literature review between philosophy and rehabilitation psychology was conducted in order to develop a virtue-based psychosocial adaptation theory, merging important perspectives from the fields of rehabilitation and positive psychology. The virtue-based psychosocial adaptation model (V-PAM) to CID is proposed in the present study. The model involves five qualities or constructs: courage, practical wisdom, commitment to action, integrity and emotional transcendence. Each of these components of virtue contributes to an understanding of psychosocial adaptation. The present study addresses the implications and applications of V-PAM that will advance this understanding.

  10. Youth friendly communication in a transition clinic aimed at adolescents with chronic illness

    DEFF Research Database (Denmark)

    Hanghøj, Signe; Boisen, Kirsten A.; Schmiegelow, Kjeld

    2017-01-01

    Good communication skills are considered a cornerstone in a "youth friendly approach". However, research in the field as well as transition guidelines only sparsely explain what doctor-patient communication involves. Furthermore, only few guidelines exist regarding concrete communication skills...... for health professionals who want to apply a youth friendly communication approach to their practice. To examine how health professionals trained in adolescent medicine practise a youth friendly approach when communicating with adolescents with chronic illness. Data from 10 non-participation observations...... in the transition clinic positioned the adolescent patients as independent interlocutors, children, and adolescents, and they positioned themselves as imperfect/untraditional, appreciative and non-judgmental. The positionings were based on a number of linguistic tools such as affirmation, recognition, examples...

  11. Feasibility of a transition intervention aimed at adolescents with chronic illness

    DEFF Research Database (Denmark)

    Hanghøj, Signe; Boisen, Kirsten A; Schmiegelow, Kjeld

    2018-01-01

    intervention aimed at adolescents with chronic illness focusing on declines, drop-outs, no-shows and advantages and disadvantages of participating. METHODS: We invited 236 adolescents (12-20 years) with juvenile idiopathic arthritis (JIA) to participate in a randomised controlled trial (RCT) transition...... intervention. Reasons for decline and drop-outs were calculated. Adolescents' experiences of advantages and disadvantages of participating and reasons for no-shows were investigated through focus groups and telephone interviews, which were analysed using thematic analysis. RESULTS: One hundred and twenty...... and being too busy. Advantages of participating were stated as 'participating without parents', 'trust and confidentiality', 'being able to set the agenda' and 'responsiveness'. Disadvantages were 'unclear aim of the study', 'meeting others with JIA', 'too few conversations' and 'transport issues...

  12. A role for communities in primary prevention of chronic illness? Case studies in regional Australia.

    Science.gov (United States)

    Taylor, Judy; Braunack-Mayer, Annette; Cargo, Margaret; Larkins, Sarah; Preston, Robyn

    2013-08-01

    In regional Australia "communities of place," defined as bounded geographic locations with a local society, undertake community-wide primary prevention programs. In helping to prevent chronic illness, communities provide valuable resources to the health system. To understand the role of community-health sector partnerships for primary prevention and the community contextual factors that affect them, we studied eight partnerships. We used an embedded multiple case study design and collected data through interviews, nonparticipant observation, and document analysis. These data were analyzed using a typology of community-health sector partnerships and community interaction theory to frame the key community contextual factors that affected partnerships. The dominant factor affecting all partnerships was the presence of a collective commitment that communities brought to making the community a better place through developing health. We call this a communitarian approach. Additional research to investigate factors influencing a communitarian approach and the role it plays in partnerships is required.

  13. Macroergonomic Factors in the Patient Work System: Examining the Context of Patients with Chronic Illness

    Science.gov (United States)

    Holden, Richard J.; Valdez, Rupa S.; Schubert, Christiane C.; Thompson, Morgan J.; Hundt, Ann S.

    2017-01-01

    Human factors/ergonomics recognizes work as embedded in and shaped by levels of social, physical, and organizational context. This study investigates the contextual or macroergonomic factors present in the health-related work performed by patients. We performed a secondary content analysis of findings from three studies of the work of chronically ill patients and their informal caregivers. Our resulting consolidated macroergonomic patient work system model identifies seventeen factors across physical, social, and organizational domains and household and community levels. These factors are illustrated with examples from the three studies and discussed as having positive, negative, or varying effects on health and health behavior. We present three brief case studies to illustrate how macroergonomic factors combine across domains and levels to shape performance in expected and unexpected ways. Findings demonstrate not only the importance of context for patients’ health-related activities but also specific factors to consider in future research, design, and policy efforts. PMID:27164171

  14. Telephone technical support: an essential adjunct to a computer intervention for rural chronically ill women.

    Science.gov (United States)

    Cudney, Shirley A; Weinert, Clarann; Phillips, Larry D

    2007-01-01

    The purposes of this article are to describe the telephone technical support system used in the Women to Women support and health education computer outreach project for chronically ill rural women, discuss the preparation and role of the information systems specialist, and examine the nature and quality of telephone support requested and received. Telephone support records were tallied and categorized to determine the number of participants requiring assistance and the nature of problems described. The quality of telephone support received was assessed through a postintervention mail survey. About one third of participants sought telephone support, most frequently for problems related to impaired Internet service provider delivery and the university's Web-application platform. The quality of telephone support was rated highly by 96% of respondents. It was concluded that telephone technical support is a useful adjunct to a computer-based intervention and that quality support can be provided by including a competent information systems specialist on the research team.

  15. Power and resistance within the hospital's hierarchical system: the experiences of chronically ill patients.

    Science.gov (United States)

    Griscti, Odette; Aston, Megan; Warner, Grace; Martin-Misener, Ruth; McLeod, Deborah

    2017-01-01

    To explore experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings. Specifically, we explored how social and institutional discourses shape power relations during the negotiation process. The hospital system is embedded in a hierarchical structure where the voice of the healthcare provider as expert is often given more importance than the patient. This system has been criticised as being oppressive to patients who are perceived to be lower in the hierarchy. In this study, we illustrate how the hospital's hierarchical system is not always oppressing but can also create moments of empowerment for patients. A feminist poststructuralist approach informed by the teaching of Foucault was used to explore power relations between nurses and patients when negotiating patient care in hospital settings. Eight individuals who suffered from chronic illness shared their stories about how they negotiated their care with nurses in hospital settings. The interviews were tape-recorded. Discourse analysis was used to analyse the data. Patients recounted various experiences when their voices were not heard because the current hospital system privileged the healthcare provider experts' advice over the patients' voice. The hierarchical structure of hospital supported these dynamics by privileging nurses as gatekeepers of service, by excluding the patients' input in the nursing notes and through a process of self-regulation. However, patients in this study were not passive recipients of care and used their agency creatively to resist these discourses. Nurses need to be mindful of how the hospital's hierarchical system tends to place nurses in a position of power, and how their authoritative position may positively or adversely affect the negotiation of patient care. © 2016 John Wiley & Sons Ltd.

  16. Concept development of family resilience: a study of Korean families with a chronically ill child.

    Science.gov (United States)

    Lee, Insook; Lee, Eun-Ok; Kim, Hesook Suzie; Park, Young Sook; Song, Misoon; Park, Youn Hwan

    2004-07-01

    To clarify and delineate the concept of family resilience in the context of the chronic illness of a child. This study also investigated the concept of family resilience in relation to family functioning in order to compare and contrast family resilience and family functioning. Three phases of the hybrid model of concept development were applied: theoretical, fieldwork and final analytical. In the theoretical phase, a working definition of family resilience was developed by a literature review. The fieldwork phase comprised in-depth interviews with 11 parents with a chronically ill child, in the paediatric oncology unit of a university hospital in South Korea. The qualitative data obtained from the interviews were analysed to find attributes of family resilience. The final analytical phase compared and interpreted the findings from the theoretical and fieldwork phases in order to clarify and refine the concept of resilience. The definition of family resilience was of an enduring force that leads a family to change its functioning dynamics in order to solve problems encountered. Twenty-one conceptual attributes of family resilience emerging from this study were differentiated into four dimensions: (i) intrinsic family characteristics, (ii) family member orientation related to family characteristics, (iii) responsiveness to stress and (iv) external orientation. Family resilience is an enduring force that leads a family to change its dynamics of functioning in order to solve problems associated with stresses encountered. This conceptualization led to the development of a model of family coping that incorporates both family resilience and family functioning, as the property and as the process of change, respectively. In order to build a family that functions better under stress, it is necessary for nurses to focus more attention on family resilience, especially in terms of the development of intervention strategies to strengthen family resilience.

  17. Migraine in Gulf War Illness and Chronic Fatigue Syndrome: Prevalence, potential mechanisms, and evaluation

    Directory of Open Access Journals (Sweden)

    Rakib eRayhan

    2013-07-01

    Full Text Available Objective: To assess the prevalence of headache subtypes in Gulf War Illness and Chronic Fatigue Syndrome compared to controls. Background: Migraines are reported in Chronic Fatigue Syndrome (CFS. Approximately, 25% of the military personnel who served in the 1990-1991 Persian Gulf War have developed Gulf War Illness (GWI. Symptoms in GWI share considerable overlap with CFS, including headache complaints. The type and prevalence of headaches in GWI have not been adequately assessed.Methods: 50 GWI, 39 CFS and 45 controls were examined. Participants had structured headache evaluations based on the 2004 International Headache Society criteria. All subjects had history and physical examinations, measurements of systemic hyperalgesia (dolorimetry, assessments for exclusionary indicators, fatigue and symptom related questionnaires. Results: Migraines were detected in 64% of GWI (odds ratio, 11.6, [±95% CI, 4.1 to 32.5] and 82% of CFS subjects (odds ratio, 22.5, [±95% CI, 7.8 to 64.8] compared to only 13% of controls. There was a predominance of females in the CFS compared to GWI and controls. However, gender did not influence migraine status (x2= 2.7; P = 0.101. Measures of fatigue, pain, and other ancillary criteria were comparable between GWI and CFS subjects with and without headache. Conclusion: Results validate previous findings of migraine in CFS and confirms similar increased prevalence in GWI compared to controls. This suggests GWI and CFS subjects share pathophysiological mechanisms that underlie migraine attacks and contribute to the extensive overlap of symptom constructs and disease pathophysiology. The high migraine prevalence warrants the inclusion of a structured headache evaluation that coincides with clinical assessments of GWI and CFS diagnosis.

  18. General illness and psychological factors in patients with chronic nasal symptoms.

    Science.gov (United States)

    Kara, N; Yao, A C; Newton, J; Deary, V; O'Hara, J; Wilson, J A

    2018-04-01

    Only a minority of patients referred to specialists with sinonasal symptoms have clear evidence of chronic rhinosinusitis (CRS). This study aims to estimate the prevalence of and associations between (i) general illness factors (fatigue, autonomic dysfunction) and (ii) psychological factors (anxiety, depression, somatisation, personality traits) in patients presenting with sinonasal symptoms. The following validated questionnaires were administered to patients: the Sino-Nasal Outcome Test-22 (SNOT-22) identifying symptom burden, Composite Autonomic Symptom Score-31 (COMPASS-31) measuring autonomic function, Chalder Fatigue Questionnaire, Patient Health Questionnaire-15 (PHQ-15) addressing somatisation symptoms, Hospital Anxiety and Depression Scale (HADS), and the International Personality Item Pool-50 (IPIP-50). Comparisons were made with normative and general population data, and relationships were analysed using nonparametric correlation. Secondary care ENT outpatients. Adults referred with chronic sinonasal symptoms. SNOT-22, COMPASS-31, Chalder, PHQ-15, HADS, and IPIP-50 questionnaire scores. Sixty-one patients were included. There was a high prevalence of all general and psychological factors assessed compared with controls. Total SNOT-22 scores showed significant correlation with Chalder fatigue scores, total autonomic dysfunction score, anxiety, depression, somatisation tendencies and the emotionally unstable personality trait. Emotional instability and psychological dysfunction correlated significantly with sleep and psychological subscales of SNOT-22 but not the rhinological or ear/facial subscales. Patients with sinonasal symptoms demonstrate high prevalence and complex associations of general illness factors, psychological distress and certain personality traits. The SNOT-22 is a valuable tool, but its utility is limited by correlations with these confounding factors (eg psychological factors) that may exaggerate the total score. The use of the SNOT-22

  19. Psychiatric morbidity and cognitive representations of illness in chronic daily headache.

    Science.gov (United States)

    Page, L A; Howard, L M; Husain, K; Tong, J; Dowson, A J; Weinman, J; Wessely, S C

    2004-12-01

    We studied patients with chronic daily headache (CDH) attending a headache clinic. Our hypothesis was that patients with anxiety or depression would have poorer functional status and differing cognitive representations of illness than would those without psychiatric morbidity. The sample consisted of 144 consecutive new patients. Patients underwent a semistructured interview and completed a prospective headache diary, the Hospital Anxiety and Depression Scale (HADS) and other health-related questionnaires. Sixty patients (42%) were probable cases of anxiety or depression on the basis of their HADS score. These HADS-positive cases had longer, more severe headaches, were more worried about them, were more functionally impaired and believed that their illness would last longer. Principal components analysis revealed that the HADS-positive cases believed that psychological factors play a role in their headaches. Psychological morbidity is high amongst CDH patients who attend specialist clinics. In addition to identifying those with high levels of psychological distress, the HADS can be used to predict those likely to have worse headaches and poorer functional ability.

  20. Through the Looking Glass: Estimating Effects of Medical Homes for People with Severe Mental Illness.

    Science.gov (United States)

    Domino, Marisa Elena; Kilany, Mona; Wells, Rebecca; Morrissey, Joseph P

    2017-10-01

    To examine whether medical homes have heterogeneous effects in different subpopulations, leveraging the interpretations from a variety of statistical techniques. Secondary claims data from the NC Medicaid program for 2004-2007. The sample included all adults with diagnoses of schizophrenia, bipolar disorder, or major depression who were not dually enrolled in Medicare or in a nursing facility. We modeled a number of monthly service use, adherence, and expenditure outcomes using fixed effects, generalized estimating equation with and without inverse probability of treatment weights, and instrumental variables analyses. Data were received from the Carolina Cost and Quality Initiative. The four estimation techniques consistently revealed generally positive associations between medical homes and access to primary care, specialty mental health care, greater medication adherence, slightly lower emergency room use, and greater expenditures. These findings were consistent across all three major severe mental illness diagnostic groups. Some heterogeneity in effects were noted, especially in preventive screening. Expanding access to primary care-based medical homes for people with severe mental illness may not save money for insurance providers, due to greater access for important outpatient services with little cost offset. Health services research examining more of the treatment heterogeneity may contribute to more realistic projections about medical homes outcomes. © Health Research and Educational Trust.

  1. Social networks, the 'work' and work force of chronic illness self-management: a survey analysis of personal communities.

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    Vassilev, Ivaylo; Rogers, Anne; Blickem, Christian; Brooks, Helen; Kapadia, Dharmi; Kennedy, Anne; Sanders, Caroline; Kirk, Sue; Reeves, David

    2013-01-01

    Self-management support forms a central aspect of chronic Illness management nationally and globally. Evidence for the success of self-management support has mainly focussed on individually-centred outcomes of behavioural change. While it is recognised that social network members play an important role there is currently a gap in knowledge regarding who provides what type of support and under what circumstances. This is relevant for understanding the division of labour and the meeting of needs for those living with a long-term condition. We therefore took a network approach to explore self-management support conceptualising it as types of illness 'work' undertaken within peoples' social networks. 300 people from deprived areas and with chronic illnesses took part in a survey conducted in 2010 in the North West of England. A concentric circles diagram was used as a research tool with which participants identified 2,544 network members who contributed to illness management. The results provide an articulation of how social network members are substantially involved in illness management. Whilst partners and close family make the highest contributions there is evidence of inputs from a wide range of relationships. Network member characteristics (type of relationship, proximity, frequency of contact) impact on the amount of illness work undertaken in peoples' networks. In networks with 'no partner' other people tend to contribute more in the way of illness related work than in networks with a partner. This indicates a degree of substitutability between differently constituted networks, and that the level and type of input by different members of a network might change according to circumstances. A network perspective offers an opportunity to redress the balance of an exclusively individual focus on self-management because it addresses the broader set of contributions and resources available to people in need of chronic illness management and support.

  2. Effectiveness of LISTEN on loneliness, neuroimmunological stress response, psychosocial functioning, quality of life, and physical health measures of chronic illness

    Directory of Open Access Journals (Sweden)

    Laurie A. Theeke

    2016-09-01

    Conclusions: LISTEN can effectively diminish loneliness and decrease the systolic blood pressure in community-dwelling, chronically ill, older adults. Results indicate that this population, if left with untreated loneliness, may experience functional impairment over a period as short as 4 months. Further studies on LISTEN are needed with larger samples, in varied populations, and over longer periods of time to assess the long-term effects of diminishing loneliness in multiple chronic conditions.

  3. Sociodemographic and clinical profile of homeless mentally ill inpatients in a north Indian medical university.

    Science.gov (United States)

    Tripathi, A; Nischal, A; Dalal, P K; Agarwal, V; Agarwal, M; Trivedi, J K; Gupta, B; Arya, A

    2013-10-01

    Homeless mentally ill (HMI) persons are a highly vulnerable and socially disadvantaged population, deprived of even the basic minimal human rights. Data on HMI in India is scarce. This retrospective chart review aimed to evaluate socio-demographic, socio-cultural and clinical profile of HMI patients, and to study reasons of homelessness and outcome related variables in these patients. One hundred and forty homeless persons were admitted to the department of psychiatry of a north Indian medical university from February 2005 to July 2011. Of these, one hundred and twenty-seven (90.7%) had psychiatric illness and six had only intellectual disabilities. The majority of HMI persons were illiterate/minimally literate, adult, male, and from low socioeconomic and rural backgrounds. Most of the patients (55.7%) had more than one psychiatric diagnosis. HMI had considerably high rates of co-morbid substance abuse (44.3%), intellectual disabilities (38.6%) and physical problems (75.4%). Most (84.3%) were mentally ill before leaving home and 54.3% left home themselves due to the illness. Most HMI responded to the treatment. After treatment of mental illness, it was possible to reintegrate about 70% of the patients into their families. Families were willing to accept and support them. Untreated/inadequately treated mental illness was the most common reason for homelessness. Easily accessible treatment and rehabilitation facilities at low cost can improve the plight of such patients. Further research in this area is required. Copyright © 2013 Elsevier B.V. All rights reserved.

  4. Unemployment risk among individuals undergoing medical treatment for chronic diseases.

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    Nakaya, N; Nakamura, T; Tsuchiya, N; Tsuji, I; Hozawa, A; Tomita, H

    2016-03-01

    Chronic diseases increase the risk of unemployment even in non-disaster settings; therefore, in post-disaster settings, special attention needs to be paid to the employment status of those suffering from chronic diseases. To examine the association between chronic disease and the risk of unemployment in a disaster area. This cross-sectional study was conducted in Shichigahama Town, Miyagi, north-eastern Japan, where had been severely inundated by the 2011 tsunami. Logistic regression analyses were used to evaluate the association between undergoing medical treatment for a combination of chronic diseases (stroke, cancer, myocardial infarction and angina) and unemployment risk. Confounders such as psychological distress and levels of daily life activity were considered. Among the 2588 individuals studied, there was a statistically significant association between undergoing medical treatment for chronic disease and the risk of unemployment [odds ratio (OR) = 1.7, 95% confidence interval (CI) 1.02-2.7, P unemployment risk was observed only in participants with a higher degree of psychological distress and/or poorer levels of daily life activity. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  5. Chronic Stress and Suicidal Thinking Among Medical Students

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    Rosiek, Anna; Rosiek-Kryszewska, Aleksandra; Leksowski, Łukasz; Leksowski, Krzysztof

    2016-01-01

    Introduction: The subject of chronic stress and ways of dealing with it are very broad. The aim of this study was to analyze stress and anxiety and their influence on suicidal thinking among medical students. Materials and Methods: The study was conducted in the years 2014 to 2015 in Poland, at the Medical University—Nicolaus Copernicus University, Collegium Medicum. The objective of this study was to assess chronic stress and suicidal thinking among students and how students cope with this huge problem. Descriptive statistics and chi-square analyses were conducted to detect differences. Results: Analyses showed that students’ life is full of stressors. Students toward the end of their education cope better with stress than students starting their university studies. Chronic stress has a strong impact on mental health and suicidal thinking among students. Conclusions: The results of the study confirmed that chronic stress and anxiety have a negative influence on mental health and also confirm a relation to suicidal thinking in medical students. Students cope with stress by listening to music, talking to relatives or people close to them, resting or engaging in sports, with cycling, running and swimming being the most common methods used to affect suicidal thinking. PMID:26891311

  6. Psychotropic Medication and Substance Use during Pregnancy by Women with Severe Mental Illness.

    Science.gov (United States)

    Brameld, Kate J; Jablensky, Assen; Griffith, Jenny; Dean, John; Morgan, Vera A

    2017-01-01

    Sociodemographic factors, alcohol and drug intake, and maternal health are known to be associated with adverse outcomes in pregnancy for women with severe mental illness in addition to their use of psychotropic medication. In this study, we describe the demographic characteristics of women hospitalized for severe mental illness along with their use of medication and other drugs during the pregnancy period. A clinical case note review of women with psychosis who were hospitalized at the State Psychiatric Hospital in Western Australia during 1966-1996, gave birth between 1980 and 1992, and received psychiatric treatment during the pregnancy period. The mother's clinical information was available from the case notes and the midwives record. The demographic characteristics of the mothers were described together with their hospitalization pattern and their medication and substance use during the pregnancy period. A total of 428 mothers with a history of severe mental illness were identified who gave birth during 1980-1992. Of these, 164 mothers received psychiatric care during the pregnancy period. One hundred thirty-two had taken psychotropic medication during this period. Mothers who were married, of aboriginal status or living in regional and remote areas appeared less likely to be hospitalized during the pregnancy period, while older mothers and those with a diagnosis of schizophrenia were more likely to be hospitalized. The number of mothers taking psychotropic medication in the first trimester of pregnancy was reduced compared to the previous 6 months. The decline in the number taking substances over the same period was not significant. In all, 16% of the women attempted suicide during the pregnancy period and 10% non-suicidal self-injury. The women demonstrate a pattern of decreased use of psychotropic medication use from the period before pregnancy to the first trimester of pregnancy. Our data highlight the importance of women with severe mental illness

  7. The effect of mental illness and psychotropic medication on gametes and fertility: a systematic review.

    Science.gov (United States)

    Worly, Brett L; Gur, Tamar L

    2015-07-01

    Psychiatric disorders during the reproductive years and their treatment with psychotropic medications are increasingly common, and their effect on the reproductive system is an important area of research. To review the effect of mental illness and psychotropic medication on gametes and fertility. Searches of the PubMed database were conducted for English-language articles containing the keywords gametes, fertility, psychotropic, oocyte, sperm, mental illness, depression, and/or anxiety, in the title or abstract. The searches yielded 3,603 citations. Studies were evaluated for relevance. Those not pertinent to the clinical question, not written in English, and focusing on invertebrates were excluded. Full texts of 50 articles were obtained for further evaluation. Additional articles were identified from reference lists. Ultimately, a total of 37 studies were deemed suitable and reviewed. Clinical studies have not demonstrated a deleterious effect of psychotropic medication on oocytes in terms of retrieval and pregnancy rates. Clinical studies demonstrate inconclusive results regarding the effect on sperm, with several studies suggesting increased sperm motility and quantity with certain psychotropics. Decreased sperm quantity and motility are described in a number of studies, including in vitro and in vivo studies. Maternal psychiatric illness is associated with decreased reproductive success, including lower rates of oocyte retrieval, lower rates of ongoing pregnancy, and dysregulation of the stress system in a majority (n = 11) but not all (n = 3) studies reviewed. Male depression did not appear to affect sperm, but anxiety did have an effect (n = 1). Given the detrimental effect of untreated mental illness, current literature is not robust enough to influence the use of psychotropics in males or females who are considering reproduction. © Copyright 2015 Physicians Postgraduate Press, Inc.

  8. Risk of Injury According to Attention Deficit Hyperactivity Disorder, Comorbid Mental Illness, and Medication Therapy.

    Science.gov (United States)

    Merrill, R M; Thygerson, S M; Palmer, C A

    2016-03-01

    We identify the risk of selected types of injuries among patients with ADHD or ADHD and comorbid mental illness. We also assess whether selected medications used by patients with ADHD increase the risk of comorbid mental illness or influence the association between ADHD and injury. A retrospective cohort study design was conducted using medical claims data from the Deseret Mutual Benefit Administrators (DMBA). ADHD diagnosis, injury, medication, and demographic data were extracted from claims files during 2001-2013. Rate ratios were adjusted for age, sex, and calendar year. Patients with ADHD were 7.9 (95% CI 7.6-8.2) times more likely to have psychosis, 5.5 (3.9-7.8) times more likely to have alcohol- or drug-induced psychosis, and 6.0 (5.9-6.2) times more likely to have neurotic or personality disorder. Therapy with amphetamine was positively associated with neurotic or personality disorder (rate ratio=1.08, 1.02-1.15); methylphenidate was negatively associated with neurotic or personality disorder (0.90, 0.84-0.97); and atomoxetine was positively associated with psychosis (1.33, 1.21-1.46), alcohol- or drug-induced psychosis (2.38, 1.04-5.43), and neurotic or personality disorder (2.38, 1.04-5.43). ADHD was associated with an increased risk of injury, with ADHD and comorbid mental illness having a stronger increased risk of injury. Psychostimulants ameliorated the increased risk of injury for patients with ADHD. Patients with ADHD have an increased risk of injury, significantly more so for those with ADHD and comorbid mental illness. Psychostimulants can lower the risk of injury among patients with ADHD. © Georg Thieme Verlag KG Stuttgart · New York.

  9. A study of depression in medically ill elderly patients with respect to coping strategies and spirituality as a way of coping

    Directory of Open Access Journals (Sweden)

    Deepika Singh

    2014-01-01

    Conclusion: The present study shows that 72% of medically ill elderly patients have depression and compared to those with one medical illness, the prevalence of depression is more among those who have 2 or more medical illnesses. Compared with those without depression, patients with depression more often used emotion based coping, less often used task and avoidance coping mechanisms and were less spiritual.

  10. Prescribing Antidepressants and Benzodiazepines in the Netherlands: Is Chronic Physical Illness Involved?

    Directory of Open Access Journals (Sweden)

    Jacques Th. M. van Eijk

    2010-01-01

    Full Text Available In this study we assessed differences in new and repeat prescriptions of psycho-tropics between patients receiving prescriptions for drugs to treat a common chronic disease and people without such prescriptions. The study used the databases of two Dutch health insurance companies (3 million people. We selected all Dutch men and women aged 45 and older who were registered for six consecutive years (1999–2004. Our analyses both found a consistent relation between psycho-tropics on the one hand and physical illness on the other. People with multi-morbidity were prescribed these drugs most often, especially men and those younger than 65. Epidemiological studies showed a prevalence of depression among people with multi-morbidity to be twice as high as among people without such conditions. According to recent guidelines non-drug treatment may be the first therapy option for patients with non severe depression. If prescribed for a long time, benzodiazepine prescriptions are especially known to be addictive. Our data raise the question to what extent patients with a chronic physical disease suffering from co-occurring mental problems are prescribed psycho-tropics in accord with the guidelines that also advise mental support in case of non severe mental problems. Further research can answer this important question.

  11. The utility of the records medical: factors associated with the medication errors in chronic disease 1

    Science.gov (United States)

    da Cruz, Hellen Lilliane; Mota, Flávia Karla da Cruz; Araújo, Lorena Ulhôa; Bodevan, Emerson Cotta; Seixas, Sérgio Ricardo Stuckert; Santos, Delba Fonseca

    2017-01-01

    ABSTRACT Objective: This study describes the development of the medication history of the medical records to measure factors associated with medication errors among chronic diseases patients in Diamantina, Minas Gerais. Methods: retrospective, descriptive observational study of secondary data, through the review of medical records of hypertensive and diabetic patients, from March to October 2016. Results: The patients the mean age of patient was 62.1 ± 14.3 years. The number of basic nursing care (95.5%) prevailed and physician consultations were 82.6%. Polypharmacy was recorded in 54% of sample, and review of the medication lists by a pharmacist revealed that 67.0% drug included at least one risk. The most common risks were: drug-drug interaction (57.8%), renal risk (29.8%), risk of falling (12.9%) and duplicate therapies (11.9%). Factors associated with medications errors history were chronic diseases and polypharmacy, that persisted in multivariate analysis, with adjusted RP chronic diseases, diabetes RP 1.55 (95%IC 1.04-1.94), diabetes/hypertension RP 1.6 (95%CI 1.09-1.23) and polypharmacy RP 1.61 (95%IC 1.41-1.85), respectively. Conclusion: Medication errors are known to compromise patient safety. This has led to the suggestion that medication reconciliation an entry point into the systems health, ongoing care coordination and a person focused approach for people and their families. PMID:29236841

  12. The impact of experiential avoidance on the relations between illness representations, pain catastrophising and pain interference in chronic pain.

    Science.gov (United States)

    Karademas, Evangelos C; Karekla, Maria; Flouri, Magdalini; Vasiliou, Vasilis S; Kasinopoulos, Orestis; Papacostas, Savvas S

    2017-12-01

    The aim of this study was to examine the effects of experiential avoidance (EA) on the indirect relationship of chronic pain patients' illness representations to pain interference, through pain catastrophising Design and main outcome measure: The sample consisted of 162 pa