Living with disability: patterns of health problems and symptom mediation of health consequences

Disability acceptance and depressive symptoms: the moderating role of social support

Purpose: This study aims to estimate (a) the relationship between disability acceptance and depressive symptoms, and (b) how the quality and quantity of social support might moderate the link between disability acceptance and depressive symptoms.Materials and methods: The data for this study included information from 5165 individuals with disability who participated in 3 waves of the Disability and Life Dynamic Panel spanning years 2018 to 2020. This study employed fixed effects models to estimate the association between disability acceptance and depressive symptoms. Interaction models were used to assess the moderating effects of both the quantity and quality of social support.Results: A lower acceptance of disability was positively associated with depressive symptoms. Moreover, both the quantity and quality of social support were associated with a decrease in depressive symptoms. Only the quality of social support played a significant role in moderating the relationship between disability acceptance and depressive symptoms.Conclusion: A lower acceptance of disability increases depressive symptoms in individuals with disabilities. This study underscores the need for interventions to focus on enhancing the quality of social support to mitigate the link between disability acceptance and depressive symptoms.

[New considerations on the health of the persons with intellectual developmental disorders]

Recent literature indicates that people with Disorders of Intellectual Development (DID) experience health disparities in the pathologies that they present, and a worst access to health care. However, current evidence-based knowledge is still sparse outside the Anglo-Saxon countries. The POMONA-I and POMONA-II European projects aimed to collect information on the health status of people with DID in Europe. The POMONA-ESP project in Spain is meant to collect health information in a wide and representative sample of persons with DID. Also, there are studies that claim for the need of specialized services for people with DID at the public health system. There are also studies about the current state of the education and training about DID for students within the health sector. In this paper we review the latest evidences about the health of the persons with DID and we present the main research activities and care initiatives about this issue.

Health profiles in people with intellectual developmental disorders

Objective. To better understand the health profiles of people with intellectual disability (ID), focusing on the variables that are associated with a poorer health status. Materials and methods. Data were collected from the Survey on Disability, Personal Autonomy and Dependency (EDAD 2008) of the Spanish National Statistics Institute (INE). The health data of 2 840 subjects with IDD were analyzed in order to verify the impact of different variables on their health profiles. Results. People with severe and profound levels of IDD presented a higher number of medical diagnoses.At residence centers there was a larger proportion of individuals with a higher prevalence of chronic diseases and more severe conditions; age also was an important factor. Conclusion. The health profiles of individuals with IDD differ depending on the severity level of their IDD and their degree of institutionalization. Further research is needed to provide better health care for people with IDD.

Somatic Symptoms: Prevalence, Co-Occurrence and Associations with Self-Perceived Health and Limitations Due To Physical Health - A Danish Population-Based Study

A high number of somatic symptoms have been associated with poor health status and increased health care use. Previous studies focused on number of symptoms without considering the specific symptoms. The aim of the study was to investigate 1) the prevalence of 19 somatic symptoms, 2) the associations between the symptoms, and 3) the associations between the somatic symptoms, self-perceived health and limitations due to physical health accounting for the co-occurrence of symptoms. Information on 19 somatic symptoms, self-perceived health and limitations due to physical health was achieved from a population-based questionnaire survey of 36,163 randomly selected adults in the Capital Region of Denmark in 2006/07. Chain graph models were used to transparently identify and describe the associations between symptoms, self-perceived health and limitations due to physical health. In total, 94.9% of the respondents were bothered by one or more of the 19 somatic symptoms. The symptoms were associated in a complex structure. Still, recognisable patterns were identified within organ systems/body parts. When accounting for symptom co-occurrence; dizziness, pain in legs, respiratory distress and tiredness were all strongly directly associated with both of the outcomes (γ>0.30). Chest pain was strongly associated with self-perceived health, and other musculoskeletal symptoms and urinary retention were strongly associated with limitations due to physical health. Other symptoms were either moderate or not statistically associated with the health status outcomes. Opposite, almost all the symptoms were strongly associated with the two outcomes when not accounting for symptom co-occurrence. In conclusion, we found that somatic symptoms were frequent and associated in a complex structure. The associations between symptoms and health status measures differed between the symptoms and depended on the co-occurrence of symptoms. This indicates an importance of considering both the specific symptoms and symptom co-occurrence in further symptom research instead of merely counting symptoms.

Medication therapy management and complex patients with disability: a randomized controlled trial

BACKGROUND

Drug therapy problems, adverse drug events (ADEs), and symptom burden are high among adults with disabilities.

OBJECTIVE

To compare the effects of a modified medication therapy management (MTM) program within a self-efficacy workshop versus the workshop alone or usual care on symptom burden among adults with activity limitations.

METHODS

Three-group randomized controlled trial among adults (age 40 and older) with self-reported activity limitations in community practice.

INTERVENTIONS

8 weekly Living Well With a Disability (LWD) 2-hour workshop sessions with and without a collaborative medication management (CMM) module.

PRIMARY OUTCOME

mean number of moderate to very severe symptoms from a list of 11 physical and mental symptoms. Process measures: changes in medication regimens and self-reported ADEs.

ANALYSIS

general linear mixed models (continuous outcomes) and generalized estimating equations (categorical outcomes).

RESULTS

Participants had high symptom burden, low physical health, and took many medications. There was a significant increase in ADE reporting in the LWD + CMM group relative to the other 2 groups (Study group × Time P = .014), and there were significantly more changes in medication regimens in the LWD + CMM group (P = .013 LWD only vs LWD + CMM). The oldest third of participants had significantly fewer mean symptoms but received more intense CMM. There was no difference between the LWD-only, LWD + CMM, and usual care groups in symptom burden over time.

CONCLUSION

Pharmacist MTM practices and MTM guidelines may need to be modified to affect symptom burden in a population with physical activity limitations.

Associations between sitting time and a range of symptoms in mid-age women

OBJECTIVE

The aim of this study was to explore longitudinal associations between sitting and physical and psychological symptoms in mid-age women.

METHOD

Mid-age (53-58 years) participants in the Australian Longitudinal Study on Women's Health completed mail surveys in 2004 (n=10,286), 2007 (n=10,128) and 2010 (n=9452) with questions about sitting time (<6, 6-9, and ≥ 9 h/day) and frequency of 19 symptoms in the preceding 12 months (often vs. never/rarely/sometimes). Associations between sitting and symptoms were examined using two logistic generalized estimating equations models: (a) sequential cross-sectional data from 3 surveys, and (b) prospective model with a 3-year time lag (significance level=0.01).

RESULTS

Approximately 53%, 30% and 17% of the women were classified as sitting <6, 6-9 and ≥ 9 h/day in 2004. In adjusted cross-sectional models, women sitting ≥ 9 h/day had significantly higher odds of breathing difficulties (OR=1.52, 99% CI=1.17-2.00), tiredness (OR=1.21, CI=1.05-1.40), bowel problems (OR=1.26, CI=1.02-1.56), eyesight problems (OR=1.16, CI=1.01-1.34), and depression (OR=1.39, CI=1.15-1.68) than women sitting <6h/day. Adjusted prospective models showed higher odds of breathing difficulties (OR=1.94, CI=1.40-2.69), chest pain (OR=2.04, CI=1.14-3.70), and tiredness (OR=1.24, CI=1.04-1.48). Associations with breathing difficulties and chest pain remained significant after excluding participants with chronic conditions in 2004.

CONCLUSION

Prolonged sitting may a determinant of breathing difficulties and chest pain three years later in mid-age women.