Female children of alcoholics and chronic back pain

OBJECTIVE AND DESIGN

A case-controlled retrospective design was used in the present investigation with adult women to explore the relationship between chronic and persistent back pain and a history of being raised by an alcoholic caretaker.

PARTICIPANTS

A sample of 112 females was obtained from a large university primary care health center. Fifty-nine back pain patients served as cases, while 53 females without histories of chronic pain served as controls.

OUTCOME MEASURES

Outcome measures consisted of a seven-question physician back pain checklist. The independent variable, being raised by an alcoholic caretaker, was measured by the Children of Alcoholics Screening Test (CAST).

RESULTS

Chronic back pain patients scored significantly higher than the nonpain group on the CAST.

CONCLUSIONS

The results suggest that additional research should explore and further define the relationship between a childhood history of being raised by an alcoholic parent and the development of chronic back pain as an adult.

Use of the Internet for health information by the chronically ill

INTRODUCTION

Chronic conditions are among the leading causes of death and disability in the United States. The Internet is a source of health information and advice for individuals with chronic conditions and shows promise for helping individuals manage their conditions and improve their quality of life.

METHODS

We assessed Internet use for health information by people who had one or more of five common chronic conditions. We conducted a national survey of adults aged 21 and older, then analyzed data from 1980 respondents who had Internet access and who reported that they had hypertension, diabetes, cancer, heart problems, and/or depression.

RESULTS

Adjusted rates for any Internet use for health information ranged from 33.8% (heart problems only) to 52.0% (diabetes only). A sizable minority of respondents - particularly individuals with diabetes - reported that the Internet helped them to manage their condition themselves, and 7.9% said information on the Internet led them to seek care from a different doctor.

CONCLUSION

Use of the Internet for health information by chronically ill patients is moderate. Self-reported effects on choice of treatment or provider are small but noteworthy.

Gender differences in physical disability among an elderly cohort

OBJECTIVES

We analyzed the role of sociodemographic factors, chronic-disease risk factors, and health conditions in explaining gender differences in disability among senior citizens.

METHODS

We compared 1348 men and women (mean age = 79 years) on overall disability and compared their specific activities of daily living, instrumental activities of daily living (IADL), and mobility limitations. Analysis of covariance adjusted for possible explanatory factors.

RESULTS

Women were more likely to report limitations, use of assistance, and a greater degree of disability, particularly among IADL categories. However, these gender differences were largely explained by differences in disability-related health conditions.

CONCLUSIONS

Greater prevalence of nonfatal disabling conditions, including fractures, osteoporosis, back problems, osteoarthritis and depression, contributes substantially to greater disability and diminished quality of life among aging women compared with men.

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

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.

METHODS

We conducted a secondary analysis of 4-year longitudinal data from the Medical Outcomes Study. A heterogeneous population of 1574 patients with either hypertension alone (referent) or one or more of the following conditions: diabetes, coronary artery disease, congestive heart failure, respiratory illness, musculoskeletal conditions and/or depression were recruited from primary and specialty (endocrinology, cardiology or mental health) practices within HMO and fee-for-service settings in three U.S. cities. We measured categorical change (worse vs. same/better) in the SF-36(R) Health Survey physical component summary score (PCS) over 4 years. We used logistic regression analysis to determine significant differences in longitudinal change in PCS between patients with hypertension alone and those with other comorbid conditions and linear regression analysis to assess the contribution of the explanatory variables.

RESULTS

Specific diagnoses of CHF, diabetes and/or chronic respiratory disease; or 4 or more chronic conditions, were predictive of a clinically significant decline in PCS.

CONCLUSIONS

Clinical recognition of these specific chronic conditions or 4 or more of a list of chronic conditions may provide an opportunity for proactive clinical decision making to maximize physical functioning in these populations.

The context of health care communication in chronic illness

Patient-professional communication is a critically important element of effective chronic illness care. However, the dynamics of health care communication in supporting self-care management and effective coping with various chronic diseases is not well understood. The present study examined health care communication from the perspective of 38 patients with four distinct chronic conditions: end-stage renal disease (ESRD), non-insulin dependent diabetes mellitus (NIDDM), multiple sclerosis (MS), and fibromyalgia (FM). Analysis revealed the dimensions of courtesy, respect, and engagement to be inherent in communication priorities across conditions. However, distinct "disease worlds" among and between these chronic conditions illuminated salient differences within these dimensions, thereby illustrating the way in which relevant variables such as legitimacy, the availability of conventional treatments, and lifestyle implications shape the meaning of health care communication. The findings enlarge upon patient-centered approaches to health care communication and inform further analysis of the interactional dynamics associated with chronic conditions.

Outcomes associated with participation in a therapeutic recreation camping programme for children from 15 European countries: Data from the ‘Barretstown Studies’

In recent years, specialised camping programmes, based largely on the premise of therapeutic recreation, have emerged as a form of intervention for children with chronic illnesses, and their siblings. Although these programmes are proliferating, little systematic evaluation of their outcomes has been undertaken, particularly within a European context. The aim of this research was to investigate the symptom and psychosocial outcomes of The Barretstown Gang Camp therapeutic recreation programme in Ireland, a programme aimed at European children with chronic illnesses and their siblings, in the short and longer term. Measures assessing children's physical, psychological and social functioning, specifically their self-reported physical symptoms, affect, self-esteem and quality of life, were translated into 12 European languages and administered at 3 time periods: 2 weeks before each child participated in the programme (Time 1), 2 weeks after participation (Time 2) and at 6 months following participation (Time 3). Benefits were noted in their experience of physical symptoms, affect pertaining to physiological hyperarousal and quality of life in the short and longer term. Positive changes were also noted in relation to self-esteem as it pertains to global self-worth and physical attractiveness though these were, for the most part, in the longer term only and were preceded by adverse effects in the short term. While some of these positive changes were global, there were group differences based mostly on children's age, and patient/sibling status and to a lesser extent on their nationality. However, no benefits were evident in many aspects of children's functioning, either at a global or a group level, in the short and longer term. These findings clarify previous research and suggest that camping programmes have an important role to play as a complementary intervention in facilitating adjustment to chronic illness.

Medical screening in the emergency department for psychiatric admissions: a procedural analysis

Patients who are admitted to psychiatric inpatient wards often undergo a medical screening examination in the emergency department to rule out serious or underlying medical conditions that may be better treated elsewhere. Unfortunately, prior research has been conflicting on the relative merits of various screening procedures, making it difficult to implement guidelines. A systematic review of the literature was undertaken to research the current state of knowledge in medical screening procedures. Electronic searches were conducted in PubMed, MEDLINE, and the Cochrane Library for publication years 1966-2003. No restrictions were placed on language or on quality of publications. Twelve studies were found that reported specific yields of various screening procedures. Results indicate that medical history, physical examination, review of systems, and tests for orientation have relatively high yields for detecting active medical problems in patients presenting with psychiatric complaints. Routine laboratory investigations generally have a low yield for clinically significant findings. However, these should be added selectively for four groups at higher risk of serious medical conditions, i.e., the elderly, substance users, patients with no prior psychiatric history, and patients with preexisting medical disorders and/or concurrent medical complaints.

Long-term treatment with the antioxidant drug EGb 761 at senescence restored some neurobehavioral effects of chronic ultramild stress exposure seen in young mice

In this study, we compared the effects of chronic ultramild stress (CUMS) exposure on decision-making behavior in a validated test, and on the stress responsive serotoninergic and dopaminergic systems in four age groups of B6D2F1 female mice (5-6, 11-12, 17-18 and 23-24 months old). The levels of serotonin (5-HT) and its metabolite 5-hydroxyindolacetic acid (5-HIAA) were measured in the brain stem, the cortex, the striatum and the hippocampus; the levels of dopamine (DA) and its metabolite dihydroxyphenylacetic acid (DOPAC) were measured in the brain stem and the striatum. The influence of a long-term treatment with the extract of Ginkgo biloba leaves EGb 761 (Tanakan) on age- and stress-related changes was also investigated in the two oldest age groups. In the absence of drug treatment, middle-age mice were the least efficient in making a decision, and senescent mice exhibited reduced levels of both 5-HT and DA and their metabolites in all the brain areas examined. CUMS facilitated evaluation and choice behavior in all age groups, but induced age-dependent reduction of hesitation, acceleration of information processing and reduction in serotoninergic neurotransmission. In senescent mice, EGb 761 reduced the impact of stress on evaluation and hesitation, and restored some stress-related neurobehavioral changes that were only seen in young mice, i.e. acceleration of information processing and reduction in brain 5-HIAA levels. Restoration of some plasticity of the serotoninergic systems might contribute to the stress alleviating influence of EGb 761 in old age.

Acute and chronic psychological stress in coronary disease

PURPOSE OF REVIEW

Coronary artery disease (CAD) is the leading cause of death in the United States and other developed countries. Along with a number of other factors thought to contribute to the high prevalence of CAD in developed societies (longer life expectancy, obesity, sedentary lifestyles), various psychological and social factors appear to promote the development or worsening of heart disease. It is well recognized that stress can be harmful to the cardiovascular system. The combination of the preexisting vulnerability and the major stressor are believed to result in cardiac arrhythmias and/or plaque rupture leading to death.

RECENT FINDINGS

Recently, the epidemiologic evidence of a link between stress and CAD is very convincing, yet the biopsychosocial pathway that would explain how stress can lead to disease is less clear. Different types of psychological stress have been found to be associated with increased cardiovascular events. Evidence regarding the efficacy of psychosocial interventions is also presented.

SUMMARY

It is suggested that, taken as a whole, evidence for a psychological and social impact on CAD morbidity and mortality is convincing.

Transition of care: health care professionals' view

There is much anxiety regarding the transfer of adolescents with chronic illness to adult services. Transfer of patients can be haphazard if the transition has not been planned. Problems and obstacles to transition have been identified and discussed by various authors. The purpose of this small study was to explore the views and needs of health care professionals from one National Health Service trust regarding the transition of care for adolescents with a chronic condition from children's to adult services and to identify possible ways to improve the current services for this particular group of young adults. The sample comprised 40 health care professionals, nurses from the children's department and adult ward, doctors, psychologists, physiotherapists and pharmacists currently working in the same hospital trust. A postal survey was conducted. The data were analysed using descriptive statistics and content analysis. The main findings suggest that there is a need for a planned transition programme, supported by a clinical protocols and a specialist unit for adolescents. Health care professionals' views of patients and family/carers' needs and how such needs may be met were identified.

Positivity in illness: self-delusion or existential growth?

OBJECTIVES

This study investigated the relationship between a measure of positivity in illness, the Silver Lining Questionnaire (SLQ), and measures of personality and spirituality/religious beliefs as a way of determining whether positivity in illness is a delusion or existential growth.

METHOD

This is a cross-sectional study comparing response to the SLQ, to the Eysenck Personality Questionnaire (EPQ-R), breathlessness, illness type, and spiritual and religious beliefs in a final total sample of 194 respiratory outpatients.

RESULTS

The SLQ was associated positively with extraversion (r =.16, p<.05), unrelated to neuroticism (r =.11, n.s.) and repression (r =.10, n.s.) and was positively associated with spiritual and religious beliefs, F(2; 187) = 7.12, p < 001, as predicted by the existential growth but not the delusion interpretation. There was no relationship between positivity and age, r(194) =.09, n.s., or between positivity and gender t(192) = -1.27, n.s., and nor were there relationships with type of illness, F(4, 188) = 2.17, n.s., or breathlessness, F (5, 173) = 0.42, n.s.

CONCLUSIONS

The results suggest that positivity in illness is associated with existential growth, though the cross-sectional nature of the study precludes a conclusion of causal direction. The non-significant correlation between the SLQ and neuroticism is in the opposite direction predicted by the delusion explanation, but the non-significant relationship between the SLQ and repression is in the predicted direction. We cannot rule out the possibility that some positivity is delusion.

Coping competence as predictor and moderator of depression among chronic disease patients

This tested the utility of the "Coping Competence Questionnaire" (CCQ) in predicting depression among chronic disease patients. Coping competence is defined as a dispositional stress resistance factor based on helplessness and hopelessness theory. Predictive power and buffering effects of the CCQ were tested in three patient samples scheduled for Coronary Artery Bypass Surgery (N = 272), other heart surgeries (N = 109), or lung tumor surgery (N = 203). Coping competence, symptom stress, and depression were assessed before and 6-months following surgery. Hierarchical multiple regressions indicated moderator effects of coping competence in the relationship between symptom stress and depression, supporting the stress-buffer hypothesis. Symptom stress was strongly correlated with depression among patients who were low in coping competence only. Among patients high in coping competence, depression was low and unaffected by symptom stress. The results suggest that the 12-item coping competence scale may qualify as useful tool for the prediction of depression in chronic disease populations.

The symptom burden of chronic critical illness

OBJECTIVE

To assess self-reported symptom burden of chronic critical illness.

DESIGN

Prospective cohort study.

SETTING

Respiratory care unit for treatment of chronically critically ill patients at an academic, tertiary-care, urban medical center.

PATIENTS

Fifty patients who underwent elective tracheotomy and transfer from an adult intensive care unit to the respiratory care unit for weaning from mechanical ventilation.

INTERVENTIONS

Assessment of physical and psychological symptoms through patients' self-reports using a modification of the Condensed Form of the Memorial Symptom Assessment Scale.

MEASUREMENTS AND MAIN RESULTS

We measured self-reported symptom burden, ventilator outcomes, and vital status and functional status at discharge and 3 and 6 months after discharge. Half of the patients were successfully liberated from mechanical ventilation, but most hospital survivors were discharged to skilled nursing facilities and more than half of the cohort was dead at 3 months after discharge. Seventy-two percent (36 of 50) of patients were able to self-report symptoms during the period of respiratory care unit treatment. Among patients responding to symptom assessment, approximately 90% were symptomatic. Forty-four percent of patients reported pain at the highest levels. More than 60% reported psychological symptoms at these levels, and approximately 90% of patients reported severe distress due to difficulty communicating.

CONCLUSIONS

Physical and psychological symptom distress is common and severe among patients receiving treatment for chronic critical illness. The majority of these patients die soon after hospital discharge. Given the level of distress in our study patients and the high mortality rate that we and others have observed, greater attention should be given to relief of pain and other distressing symptoms and to assessment of burdens and benefits of treatment for the chronically critically ill.

Genes and geneticization? The social construction of autosomal dominant polycystic kidney disease

Critics of the new genetics argue that contemporary understandings of health and illness are becoming increasingly 'geneticized.' Salient implications of this critique are explored here within the context of Autosomal Dominant Polycystic Kidney Disease (PKD), a life-threatening genetic disease that causes fluid-filled cysts in the kidneys and progressive loss of renal function. Although PKD is very common, public awareness of the disease remains low and there is little clinical emphasis on hereditary aspects. Drawing upon qualitative interviews with 16 healthcare providers, 13 patients and 15 family members, this paper examines the social construction and clinical management of PKD. In particular, interviewees' perceptions of the role of genetics in PKD and views on presymptomatic testing are considered. Finding little impetus toward early diagnosis and/or presymptomatic identification of mutation carriers, we conclude that careful empirical study of PKD (or other neglected hereditary conditions) contributes new insights into factors mitigating geneticization.

Models of adjustment to chronic illness: Using the example of rheumatoid arthritis

There are a number of theoretical frameworks that attempt to explain how individuals may adjust to threats to health and serious physical illness. The three major paradigms that attempt to organize key components of health and adaptation to illness include the following: the biomedical model which emphasizes disease; psychological models of adaptation to illness; and biopsychosocial models with the latter two emphasizing health, functioning, and well-being. Each of these three major paradigms, including biomedical, psychosocial, and biopsychosocial frameworks, is discussed and critiqued in turn, and contributions and theoretical issues in terms of adjustment to chronic illness, particularly rheumatoid arthritis (RA), are highlighted. Furthermore, a biopsychosocial framework for conceptualizing adjustment to physical illness is proposed that incorporates elements from key existing biomedical and psychosocial models of adaptation to chronic physical health issues.

Coping strategies and quality of life of adolescents with inflammatory bowel disease

OBJECTIVE

This study aims to compare generic coping styles adopted by adolescents suffering from inflammatory bowel disease (IBD) to styles used by their healthy peers, and to assess the association between coping styles and health-related quality of life (HRQoL).

METHODS

A generic coping style instrument, a disease-related coping style instrument and a disease-specific HRQoL instrument were administered to 65 adolescents (12-18 years old) with IBD. Normative data from the generic instrument were available. Mean domain scores of IBD patients were compared to normative scores. Multivariate linear regression analyses were performed on models with HRQoL domains as dependent, and preselected demographic and disease-related characteristics and coping styles as independent variables.

RESULTS

Adolescents with IBD use more avoidant coping styles than their healthy peers. HRQoL is associated with disease-related coping styles and with disease activity. More use of a predictive coping style (having positive expectations about the disease) and less use of a depressive reaction pattern are associated with better HRQoL in three out of six HRQoL domains.

CONCLUSION

This study suggests an association between coping styles and HRQoL.

Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project

CONTEXT

Few studies and no international comparisons have examined the impact of multiple chronic conditions on populations using a comprehensive health-related quality of life (HRQL) questionnaire.

OBJECTIVE

The impact of common chronic conditions on HRQL among the general populations of eight countries was assessed.

DESIGN

Cross-sectional mail and interview surveys were conducted.

PARTICIPANTS AND SETTING

Sample representatives of the adult general population of eight countries (Denmark, France, Germany, Italy, Japan, The Netherlands, Norway and the United States) were evaluated. Sample sizes ranged from 2031 to 4084.

MAIN OUTCOME MEASURES

Self-reported prevalence of chronic conditions (including allergies, arthritis, congestive heart failure, chronic lung disease, hypertension, diabetes, and ischemic heart disease), sociodemographic data and the SF-36 Health Survey were obtained. The SF-36 scale and summary scores were estimated for individuals with and without selected chronic conditions and compared across countries using multivariate linear regression analyses. Adjustments were made for age, gender, marital status, education and the mode of SF-36 administration.

RESULTS

More than half (55.1%) of the pooled sample reported at least one chronic condition, and 30.2% had more than one. Hypertension, allergies and arthritis were the most frequently reported conditions. The effect of ischemic heart disease on many of the physical health scales was noteworthy, as was the impact of diabetes on general health, or arthritis on bodily pain scale scores. Arthritis, chronic lung disease and congestive heart failure were the conditions with a higher impact on SF-36 physical summary score, whereas for hypertension and allergies, HRQL impact was low (comparing with a typical person without chronic conditions, deviation scores were around -4 points for the first group and -1 for the second). Differences between chronic conditions in terms of their impact on SF-36 mental summary score were low (deviation scores ranged between -1 and -2).

CONCLUSIONS

Arthritis has the highest HRQL impact in the general population of the countries studied due to the combination of a high deviation score on physical scales and a high frequency. Impact of chronic conditions on HRQL was similar roughly across countries, despite important variation in prevalence. The use of HRQL measures such as the SF-36 should be useful to better characterize the global burden of disease.