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Riegel B, Page SD, Aryal S, Lee CS, Belfiglio A, Freedland KE, Stromberg A, Vellone E, Westland H, van Rijn MM, Pettersson S, Wiebe DJ, Jaarsma T. Symptom characteristics, perceived causal attributions, and contextual factors influencing self-care behaviors: An ecological daily assessment study of adults with chronic illness. Patient Educ Couns 2024; 123:108227. [PMID: 38430731 DOI: 10.1016/j.pec.2024.108227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE Insights into how symptoms influence self-care can guide patient education and improve symptom control. This study examined symptom characteristics, causal attributions, and contextual factors influencing self-care of adults with arthritis, asthma, chronic obstructive pulmonary disease, diabetes, or heart failure. METHODS Adults (n = 81) with a symptomatic chronic illness participated in a longitudinal observational study. Using Ecological Daily Assessment, participants described one symptom twice daily for two weeks, rating its frequency, severity, bothersomeness, duration, causes, and self-care. RESULTS The most frequent symptoms were fatigue and shortness of breath. Pain, fatigue, and joint stiffness were the most severe and bothersome. Most participants engaged in active self-care, but those with fatigue and pain engaged in passive self-care (i.e., rest or do nothing), especially when symptoms were infrequent, mild, somewhat bothersome, and fleeting. In people using passive self-care, thoughts, feelings, and the desire to conceal symptoms from others interfered with self-care. CONCLUSION Most adults with a chronic illness take an active role in managing their symptoms but some conceal or ignore symptoms until the frequency, severity, bothersomeness, or duration increases. PRACTICE IMPLICATIONS When patients report symptoms, asking about self-care behaviors may reveal inaction or ineffective approaches. A discussion of active self-care options may improve symptom control.
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Affiliation(s)
- Barbara Riegel
- Center for Home Care Policy & Research at VNS Health, New York, NY, USA; University of Pennsylvania, School of Nursing, Philadelphia, PA, USA.
| | | | - Subhash Aryal
- Johns Hopkins University, School of Nursing, Baltimore, MD, USA
| | - Christopher S Lee
- Boston College, William F. Connell School of Nursing, Chestnut Hill, MA, USA
| | - Andrew Belfiglio
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Anna Stromberg
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | - Ercole Vellone
- University of Roma Tor Vergata, Rome, Italy; Wroclaw Medical University, Department of Nursing and Obstetrics, Wroclaw, Poland
| | | | | | - Sara Pettersson
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden
| | | | - Tiny Jaarsma
- Linkoping University, Department of Health, Medicine and Caring Sciences, Linkoping, Sweden; University Medical Center Utrecht, Utrecht, the Netherlands
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Fang C, Baz SA, Sheard L, Carpentieri JD. "They seemed to be like cogs working in different directions": a longitudinal qualitative study on Long COVID healthcare services in the United Kingdom from a person-centred lens. BMC Health Serv Res 2024; 24:406. [PMID: 38561719 PMCID: PMC10986002 DOI: 10.1186/s12913-024-10891-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 03/22/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has presented significant challenges to the already over-stretched healthcare system in the United Kingdom (UK). These challenges are particularly pronounced for people living with the novel condition of Long COVID (LC) as they often face persistent and fluctuating symptoms, encountering prolonged uncertainty when seeking medical support. Despite a growing understanding of the healthcare challenges associated with LC, existing qualitative studies have predominantly focused on individual experiences rather than examining the structural aspects of healthcare. METHODS A longitudinal qualitative study with 80 participants and 12 healthcare practitioners was conducted in the UK to explore the healthcare experiences of those with LC. In total, 178 interviews (with attrition) were collected across two rounds, from November 2021 to March 2022, and from June to October 2022. RESULTS Embracing a person-centred framework that recognises and nurtures interconnected individual, relational, and existential needs, we investigated healthcare experiences related to LC across primary, secondary, and specialist integrated care. Using this perspective, we identified three overarching themes. Theme 1 addresses the persistent hurdle of accessing primary care as the initial point of contact for LC healthcare; Theme 2 underscores the complexity of navigating secondary care; and Theme 3 encapsulates the distinctive challenges of developing LC integrated care. These themes are interlinked, as people with LC often had to navigate or struggle between the various systems, with practitioners seeking to collaborate across the breadth of their professional responsibilities. CONCLUSION From a person-centred approach, we were able to identify the needs of those affected by lasting LC symptoms and comprehend how health services intricately influence these needs. The focus on healthcare systems also captures the nuanced impact that continuing healthcare struggles can have on people's identity. As such, our findings provide evidence to inform a more effective and sustainable delivery of person-centred care for people with LC across various healthcare settings and over time.
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Affiliation(s)
- Chao Fang
- Department of Sociology, Social Policy and Criminology, University of Liverpool, Liverpool, UK.
| | | | - Laura Sheard
- Department of Health Sciences, University of York, York, UK
| | - J D Carpentieri
- Department of Education, Practice and Society, Institute of Education, University College London, London, UK
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Guo J, Wister A, Wang J, Li S. Life Course Risk and Protective Factors of Multimorbidity Resilience Among Older Adults in Rural China: A Longitudinal Study in Anhui Province Before and During COVID-19. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbad196. [PMID: 38150350 DOI: 10.1093/geronb/gbad196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVES Multimorbidity resilience reflects older adults' ability to cope with, adapt to, and rebound from its adverse effects through mobilizing resources. This study revised the multidomain Multimorbidity Resilience Index based on the Lifecourse Model of Multimorbidity Resilience referring to the life situations of older adults in rural China to measure the multimorbidity resilience from 2018 to 2021 and to explore factors influencing multimorbidity resilience from the perspective of Life Course theory. METHODS This study used the seventh and eighth waves of longitudinal data (2018-2021) collected in Anhui, China. Older adults (945) with 2 or more chronic diseases were selected, and 1,201 (person-year) observations were collected and studied. A mixed linear model examined the effects of early- and later-factors on multimorbidity resilience. RESULTS Multimorbidity resilience was negatively correlated with age and decreased faster with age after the outbreak of the coronavirus disease-2019 (COVID-19) pandemic. Married older adults have higher multimorbidity resilience. Exposure to hunger was associated with lower multimorbidity resilience when later factors were considered. Self-reported health before age 15, access to medical resources, and multimorbidity resilience were positively correlated. In addition, this study verified the relationship between multimorbidity resilience and the number of chronic diseases, exercise frequency, religious beliefs, self-reported health, and economic satisfaction, among other factors. DISCUSSION The associations between life course factors and multimorbidity resilience emphasize the long-term impact of early-life experience and the adverse effects of increasing age, especially after the outbreak of the COVID-19 pandemic. The findings will drive policy development from a life course perspective encompassing prevention and follow-up treatment to promote active aging.
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Affiliation(s)
- Jin Guo
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Andrew Wister
- Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Jie Wang
- School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
| | - Shuzhuo Li
- Center for Aging and Health Research, Xi'an Jiaotong University, Xi'an, Shaanxi, People's Republic of China
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Feigin R, Drory M, Dori N, Krulik T, Kedar R. Wellness in Chronic Care (WCC) families, illness & disability: an integrative clinical intervention model. Soc Work Health Care 2024; 63:272-284. [PMID: 38479401 DOI: 10.1080/00981389.2024.2321530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 01/31/2024] [Indexed: 04/17/2024]
Abstract
This paper describes the Wellness in Chronic Care (WCC) model, an innovative integrative clinical intervention method aimed at helping social workers manage the care of patients living with chronic illnesses and their families. The goal is to propose appropriate clinical responses to the changing reality of the health system. This new reality poses new challenges that require caregivers (social work practitioners and family members) to develop suitable skills and expertise. The intervention method we developed offers a new paradigm that entails partnership and the need to assume responsibility in decision-making while coping with the illness over time. The intervention provides practical tools and methods for coping and managing the illness. These factors have contributed to building a specifically tailored intervention program for patient and family care to achieve an effective and meaningful wellbeing. An assessment of the training program of the intervention model and its implementation is presented. The model was found to be essential yet some found it difficult to make the needed changes.
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Affiliation(s)
- Rena Feigin
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Margalit Drory
- Tel Aviv Sourasky Medical Center, Social Work Department, Tel Aviv, Israel
| | - Nechama Dori
- Tel Aviv Sourasky Medical Center, Social Work Department, Tel Aviv, Israel
| | - Tamar Krulik
- Department of Nursing, Tel Aviv University, Tel Aviv, Israel
| | - Ricky Kedar
- Tel Aviv Sourasky Medical Center, Social Work Department, Tel Aviv, Israel
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5
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Aksoy O, Wu AFW, Aksoy S, Rivas C. Social support and mental well-being among people with and without chronic illness during the Covid-19 pandemic: evidence from the longitudinal UCL covid survey. BMC Psychol 2024; 12:136. [PMID: 38468353 DOI: 10.1186/s40359-024-01596-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 02/15/2024] [Indexed: 03/13/2024] Open
Abstract
PURPOSE An immediate research priority recovering from the COVID-19 pandemic is well-being among some of our most vulnerable-people with chronic illness. We studied how mental health changed among people with and without chronic illness throughout the pandemic and the mediating role of social support. METHODS We used the 3-waves of COVID-19 survey within the Millennium Cohort Study (MCS, age 19, N = 5522) and MCS Parent (MCSP, age > > 19, N = 7479) samples, with additional pre-pandemic measures of some outcomes and exposure. Using Structural Equation Panel Models with Full Information Maximum Likelihood estimation to address missing data, we studied differences between respondents with a chronic illness and without, regarding depressive symptoms and mental well-being, with social provision, social support, and loneliness as potential mediators. RESULTS Mental well-being (SWEMWBS) and psychological distress (Kessler-6) worsened significantly during the pandemic relative to baseline for people with and without chronic illness, while the latter group had substantially better well-being at all waves and the baseline regarding both outcomes. When the lockdown was lifted during wave-2, mental well-being temporarily rebounded, and distress waned among people without chronic illness but continued to worsen among people with chronic illness. Social support partially mediated the link between chronic illness and mental well-being. CONCLUSIONS The large mental well-being gap between people with and without chronic illness persisted during the pandemic. However, social support and provision can partially narrow this gap, hence should be employed in future pandemic management.
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Affiliation(s)
- Ozan Aksoy
- UCL Social Research Institute, University College London, 55-59 Gordon Square, WC1H 0NU, London, UK.
| | - Alison Fang-Wei Wu
- UCL Social Research Institute, University College London, 55-59 Gordon Square, WC1H 0NU, London, UK
| | - Sevgi Aksoy
- University of Greenwich, Old Royal Naval College, Park Row, SE10 9LS, London, UK
| | - Carol Rivas
- UCL Social Research Institute, University College London, 55-59 Gordon Square, WC1H 0NU, London, UK
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Murteira D, Rego F. Integrating palliative care in patients with advanced multiple sclerosis: a scoping review. Ann Palliat Med 2024; 13:386-396. [PMID: 38584475 DOI: 10.21037/apm-23-455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 11/01/2023] [Indexed: 04/09/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) often presents a long and uncertain evolution. Treatment decisions in advanced MS are supported by robust evidence, but recent guidelines have suggested a shift to a palliative approach as the disease progresses. This study aims to describe what is known about the integration of palliative care (PC) in patients with severe MS (cost-effectiveness, moment of reference, and perspective of stakeholders). METHODS A scoping review was developed, and the Scopus, Medline (PubMed), ISI Web of Knowledge, and SAGE databases were consulted, using the key terms: "multiple sclerosis" AND "palliative care". Studies on the perspectives of patients, caregivers, and health professionals regarding the integration of PC in MS were included. No restrictions were applied regarding the subtype of MS, gender, ethnicity, frequency of use of health services, and language. RESULTS Of 158 articles identified, 19 were included in the review. Key factors were identified, such as the effectiveness of PC intervention in severe MS, the financial impact of providing PC compared to conventional care, the reduction of symptoms and caregiver burden, and the perception of unmet needs by users, health professionals, and caregivers during the PC approach. CONCLUSIONS Patients with MS should have access to specialized PC when they reach the severe phase of the disease. Providing a multidisciplinary team to provide targeted consultations based on the patient's needs may be most appropriate. These issues have important implications for the future planning and provision of PC services.
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Affiliation(s)
- Diana Murteira
- Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Francisca Rego
- Faculty of Medicine of the University of Porto, Porto, Portugal
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Igler EC, Austin JE, Sejkora EKD, Davies WH. Friends' Perspective: Young Adults' Reaction to Disclosure of Chronic Illness. J Clin Psychol Med Settings 2024; 31:197-207. [PMID: 37195582 PMCID: PMC10189708 DOI: 10.1007/s10880-023-09956-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 05/18/2023]
Abstract
Chronic illness can negatively impact adolescents' and young adults' social support. Social support can buffer the negative impact of living with chronic illness. The purpose of this study was to test the acceptability of a hypothetical message to promote social support after a recent diagnosis of a chronic illness. Young adults (18-24; m = 21.30; N = 370), the majority of which were Caucasian, college-students, and female, were asked to read one of four vignettes and to imagine this situation happened while they were in high school. Each vignette contained a hypothetical message from a friend diagnosed with a chronic illness (cancer, traumatic brain injury, depression, or eating disorder). Participants answered forced-choice and free-response questions asking about the likelihood they would contact or visit the friend, and feelings about receiving the message. A general linear model was used to assess quantitative results, and qualitative responses were coded using the Delphi coding method. Participants responded positively, reporting a high likelihood to contact the friend, and feeling glad to receive the message regardless of vignette viewed; however, those who read the eating disorder vignette were significantly more likely to express discomfort. In qualitative responses, participants described positive emotions associated with the message and desire to support the friend. However, participants reported significantly greater discomfort with the eating disorder vignette. The results provide evidence for the potential of a short, standardized disclosure message to promote social support following chronic illness diagnosis with some additional considerations for those recently diagnosed with an eating disorder.
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Affiliation(s)
- Eva C Igler
- Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
- Department of Psychology, Minnesota Epilepsy Group PA, 2427 Fairview Ave N, Suite 100, Roseville, MN, USA.
| | - Jillian E Austin
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ellen K D Sejkora
- Department of Psychiatry, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - W Hobart Davies
- Psychology Department, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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8
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Cluley V, Burton JO, Hull KL, Eborall H. The paradox of haemodialysis: the lived experience of the clocked treatment of chronic illness. Health Sociol Rev 2024; 33:24-42. [PMID: 38471040 DOI: 10.1080/14461242.2024.2319189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 02/11/2024] [Indexed: 03/14/2024]
Abstract
Studies exploring the relationship between time and chronic illness have generally focused on measurable aspects of time, also known as linear time. Linear time follows a predictable, sequential order of past, present and future; measured using a clock and predicated on normative assumptions. Sociological concepts addressing lifecourse disruption following diagnosis of chronic illness have served to enhance the understanding of lived experience. To understand the nuanced relationship between time and chronic illness, however, requires further exploration. Here, we show how the implicit assumptions of linear time meet in tension with the lived experience of chronic illness. We draw on interviews and photovoice work with people with end-stage kidney disease in receipt of in-centre-daytime haemodialysis to show how the clocked treatment of chronic illness disrupts experiences of time. Drawing on concepts of 'crip' and 'chronic' time we argue that clocked treatment and the lived experience of chronic illness converge at a paradox whereby clocked treatment allows for the continuation of linear time yet limits freedom. We use the concept of 'crip time' to challenge the normative assumptions implicit within linear concepts of time and argue that the understanding of chronic illness and its treatment would benefit from a 'cripped' starting point.
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Affiliation(s)
- Victoria Cluley
- School of Sociology and Social Policy, University of Nottingham, England
| | - James O Burton
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester and John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Katherine L Hull
- Department of Cardiovascular Sciences, College of Life Sciences, University of Leicester and John Walls Renal Unit, University Hospitals of Leicester NHS Trust, Leicester, England
| | - Helen Eborall
- Critical Public Health, The University of Edinburgh, Scotland
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9
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Sasaki K, Wakimizu R. Development and validation of a Japanese version of The Quality of Discharge Teaching Scale-Parent Form (JQDTS-PF): A cross-sectional observational study. J Pediatr Nurs 2024; 75:133-139. [PMID: 38157784 DOI: 10.1016/j.pedn.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/20/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Advances in medical care have enabled home treatment and advanced medical care for children with chronic illnesses. Nurses are not only required to teach their caregivers skills but also understand the families' needs and identify their anxieties in discharge teaching. However, no measure is currently available in Japan to evaluate the quality of discharge teaching provided by nurses. Therefore, this study aimed to develop a Japanese version of the Quality of Discharge Teaching Scale Parent-Form (JQDTS-PF) developed by Weiss et al. METHODS: A Japanese version of the scale was created after obtaining permission from the original author. The questionnaire was then distributed to caregivers of children discharged from hospitals in Japan who required some form of medical care after discharge. FINDINGS The study population comprised 113 respondents (response rate: 93.3%). The reliability of the scale was 0.88 for "need," 0.86 for "receive," and 0.93 for "delivery." Significant positive correlations were found between the JQDTS-PF subscale and the Japanese version of Readiness for Hospital Discharge Scale (JRHDS-PF). Significant correlations were also found between child and family characteristics and subscales of the JQDTS-PF. DISCUSSION The developed Japanese version of the scale was found to be sufficiently reliable. Validity of the scale was also sufficiently confirmed by correlation analysis, which yielded results similar to those of previous studies. APPLICATION TO PRACTICE This scale would be useful in improving and evaluating the quality of discharge teaching by nurses in Japan in the future.
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Affiliation(s)
- Keita Sasaki
- Department of Child Health and Development Nursing, Doctoral Program in Nursing Science, University of Tsukuba, 1-1-1, Tennodai, Tsukuba-city 305-8575, Japan.
| | - Rie Wakimizu
- Department of Child Health and Development Nursing, Division of Health Innovation and Nursing, Institute of Medicine, University of Tsukuba, 1-1-1, Tennodai, Tsukuba-city 305-8575, Japan.
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Noordman J, Meurs M, Poortvliet R, Rusman T, Orrego-Villagran C, Ballester M, Ninov L, de Guzmán EN, Alonso-Coello P, Groene O, Suñol R, Heijmans M, Wagner C. Contextual factors for the successful implementation of self-management interventions for chronic diseases: A qualitative review of reviews. Chronic Illn 2024; 20:3-22. [PMID: 36744382 DOI: 10.1177/17423953231153337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify and describe the most relevant contextual factors (CFs) from the literature that influence the successful implementation of self-management interventions (SMIs) for patients living with type 2 diabetes mellitus, obesity, COPD and/or heart failure. METHODS We conducted a qualitative review of reviews. Four databases were searched, 929 reviews were identified, 460 screened and 61 reviews met the inclusion criteria. CFs in this paper are categorized according to the Tailored Implementation for Chronic Diseases framework. RESULTS A great variety of CFs was identified on several levels, across all four chronic diseases. Most CFs were on the level of the patient, the professional and the interaction level, while less CFs were obtained on the level of the intervention, organization, setting and national level. No differences in main themes of CFs across all four diseases were found. DISCUSSION For the successful implementation of SMIs, it is crucial to take CFs on several levels into account simultaneously. Person-centered care, by tailoring SMIs to patients' needs and circumstances, may increase the successful uptake, application and implementation of SMIs in real-life practice. The next step will be to identify the most important CFs according to various stakeholders through a group consensus process.
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Affiliation(s)
- Janneke Noordman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Maaike Meurs
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Rune Poortvliet
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Tamara Rusman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Carola Orrego-Villagran
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Ballester
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | | | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Rosa Suñol
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Monique Heijmans
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Cici AM, Özdemir FK. Examining resilience and burnout in parents of children with chronic disease. J Pediatr Nurs 2024; 75:e176-e183. [PMID: 38245385 DOI: 10.1016/j.pedn.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 12/22/2023] [Accepted: 01/09/2024] [Indexed: 01/22/2024]
Abstract
AIM The study determines the relationship between resilience and burnout in parents of children with chronic diseases and the influencing factors. METHOD The study was conducted with a descriptive design. The study population consisted of the parents of children with any chronic illness who applied to the pediatric outpatient clinics of a state hospital located in a province in the northeast of Turkey. The study sample consisted of 207 parents who came to the hospital between October 2020 and June 2022, who met the criteria, and agreed to participate. "Descriptive Information Form," "Family Resilience Scale (FRS)," and "Burnout Inventory (BI)" were employed to collect data. The data were analyzed using the SPSS for Windows 22 package program. RESULTS 37.2% of the parents participating in the study were in the age group of 30-39 years, 52.2% were female, 93.2% had no other children with chronic diseases, 20.3% were diagnosed with asthma, and the duration of the diagnosis was between 1 and 4 years in 44.4%. The participants scored 130.64 ± 25.73 points in the Family Resilience Scale and 36.16 ± 7.78 points in the overall Burnout Inventory. CONCLUSION It was determined that parents' resilience was high and their burnout was moderate. Burnout decreases as resilience increases in parents of children with chronic diseases. PRACTICE IMPLICATIONS To strengthen family resilience and reduce parental burnout, nurses should support and provide holistic care to parents with chronically ill children.
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Lundberg DJ, Chen JA. Structural ableism in public health and healthcare: a definition and conceptual framework. Lancet Reg Health Am 2024; 30:100650. [PMID: 38188095 PMCID: PMC10770745 DOI: 10.1016/j.lana.2023.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 11/24/2023] [Accepted: 11/28/2023] [Indexed: 01/09/2024]
Affiliation(s)
- Dielle J. Lundberg
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, WA, USA
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Jessica A. Chen
- Health Services Research & Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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Lewis S, Willis K, Smith L, Dubbin L, Rogers A, Moensted ML, Smallwood N. There but not really involved: The meanings of loneliness for people with chronic illness. Soc Sci Med 2024; 343:116596. [PMID: 38246108 DOI: 10.1016/j.socscimed.2024.116596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/01/2024] [Accepted: 01/10/2024] [Indexed: 01/23/2024]
Abstract
Loneliness is one of the most pressing and rapidly growing contemporary social challenges around the world. Yet we still lack a good understanding of how loneliness is constituted and experienced by those most affected. We conducted semi-structured interviews with 40 people with chronic illness who were experiencing loneliness to explore what loneliness means to them and how it impacts in their daily lives. Drawing on ideas around liquidity and performativity, we identified the relational, temporal and social layers of loneliness. Our analysis revealed the interconnectedness of chronic illness and loneliness in participants' daily lives, as well as how chronic illness shifts temporal orientation, and transforms interpersonal relationships and relationship with self, contributing to the experiences of loneliness. Though participants described the many social conditions that restricted their opportunities for social participation, giving them a sense of being left behind and spectating the social life of others, a rhetoric of loneliness as a problem and responsibility of the individual was still prominent. A narrative of the need to perform social connection emerged in the absence of meaningful social bonds with others. We argue that normative ideals of wellness and positivity circulating in chronic illness communities and society more broadly are implicated in the experience of loneliness for people with chronic conditions. We conclude by considering how more expansive representations of how to live well with chronic illness may be important in reducing personal and collective loneliness.
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Affiliation(s)
- Sophie Lewis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia.
| | - Karen Willis
- Public Health, Institute for Health & Sport, Victoria University, Victoria, Australia
| | - Lorraine Smith
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | | | - Anne Rogers
- University of Southampton, Southampton, United Kingdom
| | - Maja Lindegaard Moensted
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Natasha Smallwood
- Central Clinical School, The Alfred, Monash University, Victoria, Australia
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Kvale G, Søfteland E, Jürgensen M, Wilhelmsen-Langeland A, Haugstvedt A, Hystad SW, Ødegaard-Olsen ØT, Aarli BB, Rykken S, Frisk B. First trans-diagnostic experiences with a novel micro-choice based concentrated group rehabilitation for patients with low back pain, long COVID, and type 2 diabetes: a pilot study. BMC Med 2024; 22:12. [PMID: 38200486 PMCID: PMC10782659 DOI: 10.1186/s12916-023-03237-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 12/19/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted. In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes. METHODS Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up. The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3-4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up. RESULTS Of the 241 included participants (57% women, mean age 48 years, range 19-84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P<0.001. CONCLUSIONS Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial. TRIAL REGISTRATION ClinicalTrials.gov NCT05234281.
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Affiliation(s)
- Gerd Kvale
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Eirik Søfteland
- Helse i Hardanger, Kvam, Norway.
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Science, University of Bergen, Bergen, Norway.
| | - Marte Jürgensen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Helse i Hardanger, Kvam, Norway
| | - Ane Wilhelmsen-Langeland
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Helse i Hardanger, Kvam, Norway
| | - Anne Haugstvedt
- Helse i Hardanger, Kvam, Norway
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | | | | | - Bernt Bøgvald Aarli
- Helse i Hardanger, Kvam, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Bente Frisk
- Helse i Hardanger, Kvam, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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15
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Letén HM, Karterud HN, Mengshoel AM. Individuals' invisible work continues after epilepsy surgery: A qualitative interview study. Epilepsy Res 2024; 199:107281. [PMID: 38101177 DOI: 10.1016/j.eplepsyres.2023.107281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE How do persons with epilepsy (PWE) experience their everyday lives after epilepsy surgery? METHODS Qualitative thematic interviews were conducted with eight PWEs (30 to 60 years old). They were recruited when coming for post-operative control 1 to 5 years after epilepsy surgery. The interviews were transcribed. They were analysed by thematic analysis and inspired by Goffman who examines everyday life activities as a theatre play. RESULTS Before surgery, a substantial invisible and hidden work of adjustments was performed to prevent seizures, to secure help from others if seizures occurred, and to protect oneself from others' gaze during a seizure. This invisible work continued after surgery even for those who became seizure-free; but now for the purpose of protecting oneself from relapse of epilepsy. From the participants perspective there was no or minor change in daily activities among those not becoming seizure-free after surgery. In contrast, those who became seizure-free enjoyed the freedom to participate in social activities without planning or restrictions. CONCLUSIONS A striking finding was that daily life after surgery comprises considerably invisible work to protect a social self, and this preventive and protective invisible work continued, although those who became seizure-free were living an ordinary socially healthy life.
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Affiliation(s)
- Helene Myklebust Letén
- National Centre for Epilepsy (SSE), Neurological clinic, Oslo University Hospital, Norway.
| | - Hilde Nordahl Karterud
- National Centre for Epilepsy (SSE), Neurological clinic, Oslo University Hospital, Norway
| | - Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Institute of Health and Society, Medical Faculty, University of Oslo, Norway
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16
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Abdulla S, Pillai HPG, Ramachandran R. Concerns of Primary Caregivers of Children with Complex Chronic Conditions in Kerala: A Qualitative Analysis. Indian J Palliat Care 2024; 30:47-55. [PMID: 38633683 PMCID: PMC11021057 DOI: 10.25259/ijpc_9_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 10/19/2023] [Indexed: 04/19/2024] Open
Abstract
Objectives Exploring data on primary caregiver experiences of dealing with chronically ill children (CIC) strengthens the ability of paediatricians to improve the quality of care by detecting unmet needs in paediatric palliative care and understanding their original concerns instead of presumed needs. Hence, this study aims to identify and describe the primary concerns and challenges faced by caregivers of children with complex chronic conditions in a tertiary care hospital in Kerala. Materials and Methods Primary caregivers of 25 children aged <13 years with non-malignant life-limiting illnesses, admitted to the paediatric department of a government medical college in Kerala between 1 July 2021 and 28 February 2022, underwent in-depth interviews to analyse their most worrisome issues. Thematic analysis was the method chosen for qualitative data analysis. Results The main themes identified were medical issues, unmet needs, caregiver health issues, and social and financial issues. Among the medical issues, poor seizure control and infected bedsores, sleep deprivation in both patient as well as caregivers, and difficulty in maintaining the personal hygiene of patients were the major issues. Parents of almost all the CICs reported that they required diapers more than any other material or device. Maternal depression was the major caregiver health issue. The unavailability of antiepileptic drugs in peripheral health centres resulted in missing doses and undue expenses for travel to tertiary centres to obtain the same. Caregivers reported their dismay when they finally realised that they were given false hopes of a cure by different systems of medicine. Conclusion The challenges faced by caregivers of children with complex chronic conditions are multifaceted. Their most problematic issues related to medical issues are the occurrence of breakthrough seizures and development of infected bedsores. The most important material hardship reported was diaper needs. Caregiver issues such as sleep deprivation and maternal depression must be identified and addressed while providing comprehensive palliative care.
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Affiliation(s)
- Sajida Abdulla
- Department of Pediatrics, Government Medical College, Ernakulam, Kerala, India
| | | | - Reshmi Ramachandran
- Department of Community Medicine, Government Medical College, Ernakulam, Kerala, India
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17
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Zelvin LB. Wait for Me: Chronic Mental Illness and Experiences of Time During the Pandemic. J Med Humanit 2023:10.1007/s10912-023-09829-7. [PMID: 38146014 DOI: 10.1007/s10912-023-09829-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/06/2023] [Indexed: 12/27/2023]
Abstract
As someone diagnosed with severe chronic mental illness early in my adolescence, I have spent over half of my life feeling out of step with the rest of the world due to hospitalizations, treatment programs, and the disruptions caused by anxiety, anorexia, depression, and obsessive-compulsive disorder. The effect of my mental health conditions compounded by these treatment environments means I often feel that I experience time passing differently, which results in sensations of removal and isolation from those around me. The global shutdown caused by the COVID-19 pandemic seemed a way for normative bodies to experience the passing of time the way I always have. In this paper, I extend Dr. Sara Wasson's analysis of the ways in which chronic pain resists narrative coherence to my own temporal experience of chronic mental illness, specifically my embodied experience of the pandemic. I use that embodied experience as a case study for examining how the reciprocal nature of time and narrativity, as outlined by Dr. Paul Ricoeur, can create isolation for those struggling with their temporality due to chronic mental illness. To acknowledge and grapple with the ramifications of discursive and material privilege involved in such situations, I include an analysis of Robert Desjarlais's 1994 article "Struggling Along: The Possibilities for Experience among the Homeless Mentally Ill," in which he investigates a similar phenomenon of being outside of structured sequential narrative time in the residents of a Boston shelter for the mentally ill.
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Affiliation(s)
- Lindsey Beth Zelvin
- School of English, Division of Arts and Humanities, University of Kent in Canterbury, Canterbury, UK.
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18
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Alenazi AM, Alanazi MF, Elnaggar RK, Alshehri MM, Alqahtani BA, Alhowimel AS, Alhwoaimel NA, Alanazi AD, Alotaibi MA, Almutairi SM, Alghamdi MS, Bindawas SM. Prevalence and risk factors for falls among community-dwelling adults in Riyadh area. PeerJ 2023; 11:e16478. [PMID: 38077414 PMCID: PMC10710170 DOI: 10.7717/peerj.16478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
Objectives This study aimed to assess fall prevalence, identify related risk factors, and establish cut-off scores for fall risk measures among community-dwelling adults in Riyadh region of Saudi Arabia. Methods A cross-sectional study was conducted in community, Riyadh city, Saudi Arabia. A sample of 276 Saudi citizens aged ≥40 years who were able to read and write in Arabic. Fall history and number of falls in the past 12 months were determined via self-reports. Variables assessed included demographic information, self-reported chronic diseases, depressive symptoms, and back pain severity. Results Participants were classified as either fallers (n = 28, 10.14%) or non-fallers. Fallers were more likely to have arthritis (odds ratio [OR]: 7.60, p = 0.001), back pain (OR: 5.22, p = 0.002), and higher depressive symptom scores (OR: 1.09, p = 0.013) than non-fallers. The number of reported falls was significantly associated with an elevated body mass index (incidence rate ratio [IRR]: 1.09, p = 0.045), arthritis (IRR: 8.74, p < 0.001), back pain (IRR: 4.08, p = 0.005), neurological diseases (IRR: 13.75, p < 0.007), and depressive symptoms (IRR: 1.08, p = 0.005). Cut-off scores predictive of falls associated with back pain and depressive symptoms were 1.5 (sensitivity: 0.61; specificity: 0.79; area under the curve [AUC]: 0.70) and 11.5 score (sensitivity: 0.57; specificity: 0.76; AUC: 0.66), respectively. Conclusions The prevalence of falls was relatively low among the individuals considered in this study. Chronic conditions, back pain severity, and depressive symptoms were determined to be associated with falls among community-dwelling individuals in Saudi Arabia.
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Affiliation(s)
- Aqeel M. Alenazi
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Maram F. Alanazi
- Occupational Therapy, Sydney University, Sydney, New South Wales, Australia
| | - Ragab K. Elnaggar
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
- Department of Physical Therapy for Pediatrics, Cairo University, Cairo, Giza, Egypt
| | | | - Bader A. Alqahtani
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Ahmed S. Alhowimel
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Norah A. Alhwoaimel
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Ahmad D. Alanazi
- Department of Rehabilitation Science, Majmaah University, Majmaah, Riyadh, Saudi Arabia
| | - Mazyad A. Alotaibi
- Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Riyadh, Saudi Arabia
| | - Sattam M. Almutairi
- Department of Physical Therapy, College of Medical Rehabilitation, Qassim University, Buraydah, Qassim, Saudi Arabia
| | - Mohammed S. Alghamdi
- Department of Medical Rehabilitation Sciences, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Saad M. Bindawas
- Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia
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19
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Thomas S, Byrne LK, Ryan NP, Hendrieckx C, White V. Unmet supportive care needs in families of children with chronic health conditions: an Australian cross-sectional study. World J Pediatr 2023; 19:1181-1191. [PMID: 37246167 PMCID: PMC10225288 DOI: 10.1007/s12519-023-00730-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/01/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND The aim of this study was to identify similarities and differences in the unmet supportive care needs (USCN) of families of children with major chronic health conditions (CHCs) using a universal need assessment tool. METHODS A cross-sectional online survey involving parents of children with congenital heart disease (CHD), type 1 diabetes mellitus (T1D), cancer, and asthma diagnosed within the last 5 years recruited via social media and support organizations. Thirty-four items assessing the USCN across six domains (care needs, physical and social needs, informational needs, support needs, financial needs, child-related emotional needs) were responded to on a 4-point Likert scale [no need (1) to high need (4)]. Descriptive statistics identified the level of need, and linear regressions identified factors associated with higher need domain scores. Due to small numbers, the asthma group was excluded from comparisons across CHCs. RESULTS One hundred and ninety-four parents completed the survey (CHD: n = 97, T1D: n = 50, cancer: n = 39, and asthma: n = 8). Parents of children with cancer were most likely to report at least one USCN (92%), followed by parents of children with T1D (62%). The five most commonly reported USCN across CHCs were drawn from four domains: child-related emotional, support, care, and financial. Three need items were included in the top five needs for all conditions. A higher USCN was associated with a greater frequency of hospital visits and the absence of parental support. CONCLUSIONS Using a universal need assessment tool, this is one of the first studies to characterize USCN in families of children diagnosed with common CHCs. While proportions endorsing different needs varied across conditions, the most endorsed needs were similar across the illness groups. This suggests that support programs or services could be shared across different CHCs. Video Abstract.
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Affiliation(s)
- Sangeetha Thomas
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia.
| | - Linda K Byrne
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
| | - Nicholas P Ryan
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Christel Hendrieckx
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia
- Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia
- Institute of Health Transformation, Deakin University, Melbourne, VIC, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Melbourne, VIC, 3125, Australia.
- Cancer Council Victoria, Melbourne, VIC, Australia.
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20
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Rivero Calle I, Del Rosal Rabes T, Garrote Llanos E, Núñez Cuadros E, Navarro Gómez ML, Ramos Amador JT, Calvo C, Álvarez García F. Consensus document of the Spanish Society of Paediatric Infectious Diseases and the Advisory Committee on Vaccines of the Spanish Association of Pediatrics for vaccination of immunosuppressed individuals. An Pediatr (Barc) 2023; 99:403-421. [PMID: 38057232 DOI: 10.1016/j.anpede.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/13/2023] [Indexed: 12/08/2023] Open
Abstract
The number of people with immunosuppression is increasing considerably due to their greater survival and the use of new immunosuppressive treatments for various chronic diseases. This is a heterogeneous group of patients in whom vaccination as a preventive measure is one of the basic pillars of their wellbeing, given their increased risk of contracting infections. This consensus, developed jointly by the Sociedad Española de Infectología Pediátrica (Spanish Society of Pediatric Infectious Diseases) and the Advisory Committee on Vaccines of the Asociación Española de Pediatría (Spanish Association of Paediatrics), provides guidelines for the development of a personalised vaccination schedule for patients in special situations, including general recommendations and specific recommendations for vaccination of bone marrow and solid organ transplant recipients, children with inborn errors of immunity, oncologic patients, patients with chronic or systemic diseases and immunosuppressed travellers.
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Affiliation(s)
- Irene Rivero Calle
- Servicio de Pediatría, Hospital Clínico Universitario de Santiago de Compostela, Grupo Genética, Vacunas, Infecciones y Pediatría (GENVIP), Instituto de Investigación Hospital Clínico Universitario de Santiago de Compostela (IdiCHUS), CIBERes Ciber de Respiratorio, Santiago de Compostela, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP.
| | - Teresa Del Rosal Rabes
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, Instituto de Investigación Hospital Universitario La Paz (IdiPaz), CIBERER U767, Instituto de Salud Carlos III, Madrid, Spain; Sociedad Española de Infectología Pediátrica
| | - Elisa Garrote Llanos
- Sección de Infectología, Servicio de Pediatría, Hospital Universitario, OSI Bilbao-Basurto, Bilbao, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - Esmeralda Núñez Cuadros
- Sección de Reumatología Pediátrica, UGC Pediatría, Hospital Regional Universitario de Málaga, Grupo multidisciplinar pediátrico IBIMA, Málaga, Spain; Sociedad Española de Infectología Pediátrica
| | - María Luisa Navarro Gómez
- Servicio de Pediatría, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Hospital Gregorio Marañón (IISGM), CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Complutense, Madrid, Spain; Sociedad Española de Infectología Pediátrica; Comité Asesor de Vacunas de la AEP
| | - José Tomás Ramos Amador
- Servicio Pediatría y Áreas Específicas, Hospital Clínico San Carlos, Madrid, Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Departamento de Salud Pública y Maternoinfantil, Universidad Complutense, CIBERINFEC Ciber de Enfermedades Infecciosas, Madrid, Spain; Comité Asesor de Vacunas de la AEP
| | - Cristina Calvo
- Servicio de Pediatría, Enfermedades Infecciosas y Tropicales, Hospital Universitario La Paz, CIBERINFEC Ciber de Enfermedades Infecciosas, Universidad Autónoma de Madrid, Madrid, Spain; Sociedad Española de Infectología Pediátrica
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Jaworsky M, Tao X, Pan L, Pokhrel SR, Yong J, Zhang J. Interrelated feature selection from health surveys using domain knowledge graph. Health Inf Sci Syst 2023; 11:54. [PMID: 37981989 PMCID: PMC10654272 DOI: 10.1007/s13755-023-00254-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 10/17/2023] [Indexed: 11/21/2023] Open
Abstract
Finding patterns among risk factors and chronic illness can suggest similar causes, provide guidance to improve healthy lifestyles, and give clues for possible treatments for outliers. Prior studies have typically isolated data challenges from single-disease datasets. However, the predictive power of multiple diseases is more helpful in establishing a healthy lifestyle than investigating one disease. Most studies typically focus on single-disease datasets; however, to ensure that health advice is generalized and contemporary, the features that predict the likelihood of many diseases can improve health advice effectiveness when considering the patient's point of view. We construct and present a novel knowledge-based qualitative method to remove redundant features from a dataset and redefine the outliers. The results of our trials upon five annual chronic disease health surveys demonstrate that our Knowledge Graph-based feature selection, when applied to many machine learning and deep learning multi-label classifiers, can improve classification performance. Our methodology is compatible with future directions, such as graph neural networks. It provides clinicians with an efficient process to select the most relevant health survey questions and responses regarding single or many human organ systems.
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Affiliation(s)
- Markian Jaworsky
- School of Mathematics, Physics, and Computing, University of Southern Queensland, Toowoomba, QLD Australia
| | - Xiaohui Tao
- School of Mathematics, Physics, and Computing, University of Southern Queensland, Toowoomba, QLD Australia
| | - Lei Pan
- School of Information Technology, Deakin University, Waurn Ponds, VIC 3216 Australia
| | - Shiva Raj Pokhrel
- School of Information Technology, Deakin University, Waurn Ponds, VIC 3216 Australia
| | - Jianming Yong
- School of Mathematics, Physics, and Computing, University of Southern Queensland, Toowoomba, QLD Australia
| | - Ji Zhang
- School of Mathematics, Physics, and Computing, University of Southern Queensland, Toowoomba, QLD Australia
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Croniger B, Grudzien M, Imtiaz R, Kabbani D, Mendez J. Best Practices in Patient Education: Medical Students' Perceptions and Implementations. Med Sci Educ 2023; 33:1323-1327. [PMID: 38188397 PMCID: PMC10767124 DOI: 10.1007/s40670-023-01887-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 01/09/2024]
Abstract
Effective patient education can help achieve better clinical outcomes, especially when a patient is managing a chronic illness. Despite patient education being an important skill in the professional formation of physicians, little is known about medical students' perceptions and implementations of such strategies. After completing a chronic illness educational module, second-year medical students were asked to rate the importance of specific patient education strategies and to assess their use of said strategies in the module's project assignment. Results indicated students utilized different patient education strategies from those they initially identified as most effective.
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Affiliation(s)
| | | | - Rubab Imtiaz
- School of Medicine, Wayne State University, Detroit, USA
| | - Dana Kabbani
- Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, USA
| | - Jennifer Mendez
- Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, USA
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23
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Näverlo S, Strigård K, Gunnarsson U, Edin-Liljegren A. Patients' experiences of living with a stoma in rural areas in Northern Sweden. Int J Circumpolar Health 2023; 82:2221767. [PMID: 37300840 DOI: 10.1080/22423982.2023.2221767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 05/31/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
Introduction: Stoma complications are common and interfere with many aspects of everyday life. Stoma problems are usually managed by a specialised stoma nurse, a service not present in the rural areas of South Lapland in Sweden. The aim of this study was to describe how stoma patients in rural areas experience living with a stoma.Methods: A qualitative descriptive study with semi-structured interviews were conducted with 17 stoma patients living in rural municipalities and who received a part of their care at the local cottage hospital. Qualitative content analysis was employed.Results: Initially, the stoma was experienced as very depressing. Participants had difficulties in properly managing the dressing. Over time they learned how to properly care for their stoma, making their life easier. Both satisfaction and dissatisfaction with the healthcare were experienced. Those who were dissatisfied expressed a lack of competence in dealing with stoma-related problems.Conclusions: Living with a stoma in a rural area in northern Sweden is experienced as a learning process and acceptance of the stoma's existence is important. This study emphasises the need for increased knowledge of stoma-related problems in rural primary healthcare in order to help patients cope with everyday life.
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Affiliation(s)
- Simon Näverlo
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Karin Strigård
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Ulf Gunnarsson
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
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Durán-Gómez N, López-Jurado CF, Martín-Parrilla MÁ, Montanero-Fernández J, Pérez-Civantos D, Cáceres MC. Self-care nursing assessment: cross-cultural adaptation and validation of the Spanish version of the Self-care of chronic illness inventory. BMC Nurs 2023; 22:442. [PMID: 37993838 PMCID: PMC10664672 DOI: 10.1186/s12912-023-01605-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 11/10/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Self-care is the primary means of caring for a chronic condition. Therefore, it is necessary to assess it by using a good validity and reliability instrument. The Self-Care of Chronic Illness Inventory (SC-CII) is a generic instrument developed to measure self-care processes behaviors using three separate scales in patients with chronic illness. The original cross-cultural assessment concluded the need for future studies sampling patients from different sites to increase the generalizability of the psychometric evaluation results. It was unclear whether this tool had sound psychometrics properties in the context of Spanish culture. The purpose of this study was to cross-culturally adapt the SC-CII, test its psychometric properties and validate its use among Spanish people with chronic diseases. METHODS A cross-cultural translation of the SC-CII was performed from English to Spanish. The psychometric evaluation was conducted in a sample of 350 patients with chronic conditions through a multicenter cross-sectional study based on the STROBE guideline. Data were collected from face-to-face interviews during 2022. Internal validity was assessed with Confirmatory Factor Analysis, internal consistency reliability with Cronbach alpha for unidimensional scales and McDonald's Omega reliability coefficient for multidimensional scales. RESULTS Most (63.4%) participants were older adults aged 65 years or older with a mean age of 65.45 ± 14.97. The average number of chronic conditions reported was 2.81%; the most common conditions were hypertension (52.3%), musculoskeletal disorders (46.3%) and diabetes (38.9%). Patients reported adequate self-care behaviors in all three scales of the SC-CII. The Self-Care Maintenance and Management scales were multidimensional, and the Self-Care Monitoring scale was unidimensional. In Confirmatory Factor Analysis, the Self-Care Maintenance and Monitoring scales had satisfactory fit indices. The Self-care Management scale had acceptable fit indices. The Omega reliability coefficient for multidimensional scales was 0.75 (Self-Care Maintenance) and 0.72 (Self-Care Management). The Cronbach alpha coefficient of the Self-Care Monitoring scale was 0.85. Item-total correlations were all significant except one. Test-retest reliability showed an intraclass correlation coefficient of 0.92. CONCLUSIONS The SC-CII has appropriate psychometrics characteristics and is a culturally suitable and reliable instrument for assessing to the self-care behaviors of patients with chronic disease in Spain. The scale provides a simple and rapid solution to assess the self-care process.
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Affiliation(s)
- Noelia Durán-Gómez
- Departamento de Enfermería, Universidad de Extremadura, Facultad de Medicina y Ciencias de La Salud, 06006, Badajoz, Spain.
| | - Casimiro Fermín López-Jurado
- Departamento de Enfermería, Universidad de Extremadura, Facultad de Medicina y Ciencias de La Salud, 06006, Badajoz, Spain
| | - Miguel Ángel Martín-Parrilla
- Departamento de Enfermería, Universidad de Extremadura, Centro Universitario de Plasencia, 10600, Plasencia, Spain
| | - Jesús Montanero-Fernández
- Departamento de Matemáticas, Universidad de Extremadura, Facultad de Medicina y Ciencias de La Salud, 06006, Badajoz, Spain
| | - Demetrio Pérez-Civantos
- Facultad de Medicina y Ciencias de La Salud, Universidad de Extremadura Hospital Universitario de Badajoz, 06006, Badajoz, Spain
| | - Macarena C Cáceres
- Departamento de Enfermería, Universidad de Extremadura, Facultad de Medicina y Ciencias de La Salud, 06006, Badajoz, Spain
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Nittari G, Ricci G, Savva D, Gibelli F, Bailo P, Ausania F, De Leo D. Telemedicine in diabetic ulcer management: A pilot study with exploration of medico-legal aspects. Nutr Metab Cardiovasc Dis 2023; 33:2280-2286. [PMID: 37591741 DOI: 10.1016/j.numecd.2023.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/05/2023] [Accepted: 07/15/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND AND AIMS This study aimed to evaluate the quality and efficiency of telemedicine in managing patients with chronic diabetic ulcers and provide an overview of the main medico-legal implications associated with telemedicine management of diabetic foot complications. METHODS AND RESULTS A total of 50 patients with type 2 diabetes mellitus were enrolled from a diabetic foot outpatient clinic in Cyprus between March and May 2022. Participants completed a survey concerning telemedicine services, and the demographic variables and average responses to the PACIC (Patient Assessment of Chronic Illness Care) questions were examined using descriptive analysis. The majority of patients (84%) were male, with a mean age of 60.9 ± 13.05 years. The average PACIC score was 4.42 (min. 2.7 and max. 5.0). Voice calls were the most preferred method of telemedicine delivery, accounting for 53% of all services. CONCLUSION Telemedicine can effectively manage chronic patients, such as those with diabetic ulcers, by reducing the burden on resources and maintaining service quality. However, healthcare professionals must be well-versed in medico-legal implications to adhere to legal and ethical guidelines, protect patient privacy, and maintain high standards of care while using telemedicine for chronic condition treatment.
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Affiliation(s)
- Giulio Nittari
- Telemedicine and Telepharmacy Centre, School of Medicinal and Health Products Sciences, University of Camerino, Camerino, 62032, Italy
| | - Giovanna Ricci
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, 62032, Italy
| | - Demetris Savva
- Plastic, Reconstructive and Aesthetic Surgery, Nicosia General Hospital, Nicosia, 2055, Cyprus
| | - Filippo Gibelli
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, 62032, Italy.
| | - Paolo Bailo
- Section of Legal Medicine, School of Law, University of Camerino, Camerino, 62032, Italy
| | - Francesco Ausania
- Department of Diagnostic and Public Health, Section of Forensic Medicine, University of Verona, Verona, 36134, Italy
| | - Domenico De Leo
- Department of Diagnostic and Public Health, Section of Forensic Medicine, University of Verona, Verona, 36134, Italy
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Ramay BM, Sierra AGE, Enríquez AL, Espel C, Zelaya C, Gonzalez ALA, Lou-Meda R. A multimedia program for caregivers of pediatric patients with chronic kidney disease in Guatemala. J Pediatr Nurs 2023; 73:67-71. [PMID: 37647790 DOI: 10.1016/j.pedn.2023.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 08/13/2023] [Accepted: 08/14/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVES A multimedia medication training program for parents and legal guardians of children with chronic kidney disease (CKD) aimed to improve comprehension CKD and general information about medications used in pediatric patients attending The Foundation for Children with Kidney Disease (FUNDANIER, Guatemala City). METHODS A quasi-experimental study was carried out to measure the impact of the educational intervention on medication knowledge, at FUNDANIER from September to October 2019. Means and standard deviations was used to described test results. A Wilcoxon test was performed, to compare scores of pre and post-tests. Odds Ratio (OR) was used to determine if there was an improvement in the knowledge score before and after the intervention. Results There was significant improvement in knowledge scores knowledge before and after the intervention(27/35 versus 33/35, P < 0.005). Mestizo participants had higher odds of improvement before and after the intervention (OR 7, CI: 0.6-78). Parent-guardians with prior education, and who spoke Spanish had higher odds of improved knowledge scores (OR 3.2, CI:0.3-35; OR 1.1 CI: 0.1-14 respectively). CONCLUSION Caregivers who participated in the educational workshop improved and retained information related to CKD comprehension and medications used. This study provides a model for educational modules that can be used, tested, and applied in other chronic disease settings in low to middle income countries. PRACTICE IMPLICATIONS A culturally relevant multimedia CKD educational platform was effective in improving medication knowledge among parent/guardians of children with CKD in a low literacy setting.
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Affiliation(s)
- Brooke M Ramay
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala; Center for Health Studies, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala; Paul G. Allen School for Global Health, Washington State University, 1155 NE College Ave, Pullman, WA 99164, United States.
| | - Ana Gabriela Espinoza Sierra
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala
| | - Ana Lucía Enríquez
- Department of Pharmaceutical Chemistry, Universidad del Valle de Guatemala, 18 Avenida 11-95, Guatemala City, Guatemala 01015, Guatemala
| | - Celeste Espel
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala
| | - Cristina Zelaya
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala
| | - Angie Lizet Aguilar Gonzalez
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala.
| | - Randall Lou-Meda
- Fundación para el Niño Enfermo Renal-FUNDANIER, 5ta. Avenida 6-22 z.11, Emergencia de Pediatría, Hospital Roosevelt, Guatemala City, Guatemala
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Calvi C, Sherman KA, Pham D. Loneliness and Perceived Social Support in Endometriosis: The Roles of Body Image Disturbance and Anticipated Stigma. Int J Behav Med 2023:10.1007/s12529-023-10230-w. [PMID: 37884852 DOI: 10.1007/s12529-023-10230-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/28/2023]
Abstract
BACKGROUND Research has identified that living with the chronic inflammatory disease endometriosis adversely impacts social functioning and interpersonal relationships, specifically, feelings of loneliness and a lack of perceived social support. Commonly experienced body image disturbance (BID), combined with the anticipation of endometriosis-related stigma from others, may result in further social withdrawal. This study aimed to quantitatively investigate the association between BID and social functioning (loneliness and diminished perceived social support), and the potential moderating effect of anticipated stigma on these associations. METHOD Participants (N = 212) with a self-reported endometriosis diagnosis completed an online questionnaire measuring social and emotional loneliness, perceived social support, BID, anticipated stigma and demographic and medical characteristics. RESULTS Mean scores indicated high levels of BID, emotional loneliness and diminished perceived social support. Bootstrapped multivariable regression analyses indicated that BID was significantly associated with greater emotional loneliness and lower perceived social support. BID was also associated bivariately with greater social loneliness. Anticipated stigma from healthcare workers moderated the association of BID with perceived social support, such that poorer perceived support was reported when anticipated stigma was high, despite the presence of minimal BID. CONCLUSION These findings highlight the psychological challenges of living with endometriosis in terms of highly prevalent BID, in the context of feeling lonely and poorly supported. The further negative impact of anticipated stigma suggests that psychosocial interventions may benefit from additionally targeting these perceptions of stigma.
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Affiliation(s)
- Catherine Calvi
- Lifespan Health and Wellbeing Research Centre, Macquarie University, 16 University Avenue, Sydney, NSW, 2109, Australia
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Kerry A Sherman
- Lifespan Health and Wellbeing Research Centre, Macquarie University, 16 University Avenue, Sydney, NSW, 2109, Australia.
- School of Psychological Sciences, Macquarie University, Sydney, Australia.
- Smart Green Cities Research Centre, Macquarie University, Sydney, Australia.
| | - Dione Pham
- School of Psychological Sciences, Macquarie University, Sydney, Australia
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Kukay A, McKinney C. Chronic illness and psychological problems in emerging adults: Moderation by perceived parental distress. Chronic Illn 2023:17423953231210121. [PMID: 37885196 DOI: 10.1177/17423953231210121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Abstract
OBJECTIVE The aim of the current study was to better understand if perceived parental distress moderates the effects of having a chronic illness and poor physical quality of life on psychological problems reported by emerging adults. METHODS Participants consisted of 538 college-attending emerging adults (53.5% women; 46.5% men). Participants completed an online study that was composed of questions regarding chronic illness, the World Health Organization Quality of Life - Brief, the Adult Self-Report scale, and the Adult Behavior Checklist. RESULTS In both emerging adult women and men, endorsing a chronic illness is significantly associated with psychological problems. Psychological problems in both emerging adult women and men were significantly predicted by the three-way interaction between endorsing a chronic illness, physical quality of life, and perceived maternal distress. Specifically, increased perceived maternal distress was associated with higher psychological problems in both emerging adult women and men with chronic illnesses and low physical quality of life. DISCUSSION For emerging adult women and men with a chronic illness, higher perceived maternal distress was associated with poorer psychological adjustment, while lower perceived maternal distress was associated with better psychological adjustment.
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Affiliation(s)
- Abigail Kukay
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
| | - Cliff McKinney
- Department of Psychology, Mississippi State University, Mississippi State, Mississippi, USA
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Nicoloro-SantaBarbara J, Lobel M. Loneliness and Its Predictors in Rare Versus Common Chronic Illnesses. Int J Behav Med 2023:10.1007/s12529-023-10231-9. [PMID: 37845486 DOI: 10.1007/s12529-023-10231-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Loneliness is a growing public health concern associated with substantial negative mental and physical health outcomes. Loneliness is especially relevant for individuals with a chronic illness, perhaps more so if their illness is rare. Little is known about the psychosocial experience of individuals with a rare chronic illness, and whether and how it may differ from the experience of individuals with common chronic illnesses. We compared the magnitude of loneliness in persons with a rare or common chronic illness and examined theoretically guided predictors of loneliness as follows: stigma, illness intrusiveness, social comparison, social support, support from healthcare providers, and self-efficacy. METHOD Individuals with a chronic illness (common or rare) completed an anonymous online survey (N = 952). RESULTS Individuals with common chronic illnesses were as lonely as those with a rare chronic illness. Loneliness in both groups was higher than that in population norms. Regression analyses reveal that independent of other predictors, loneliness was especially high among people who feel stigmatized by others, those who have less social support available, and people whose functioning is more disrupted by their illness (all p values < 0.01). CONCLUSION The similarity of loneliness in these groups reinforces the value of further systematic research to identify the needs of individuals with any type of chronic illness. Study findings highlight the importance of examining internalized stigma and social support as possible targets of intervention to reduce loneliness among individuals with a chronic illness, recognizing some of the unique features and challenges of their disorders, whether common or rare.
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Affiliation(s)
- Jennifer Nicoloro-SantaBarbara
- Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, 02115, USA.
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, 11794-2500, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, USA
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Galvan MJ, Payne BK, Hannay J, Georgeson AR, Muscatell KA. What Does the MacArthur Scale of Subjective Social Status Measure? Separating Economic Circumstances and Social Status to Predict Health. Ann Behav Med 2023; 57:929-941. [PMID: 37742041 DOI: 10.1093/abm/kaad054] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Subjective socioeconomic status is robustly associated with many measures of health and well-being. The MacArthur Scale of Subjective Social Status (i.e., the MacArthur ladder) is the most widely used measure of this construct, but it remains unclear what exactly the MacArthur ladder measures. PURPOSE The present research sought to explore the social and economic factors that underlie responses to the MacArthur ladder and its relationship to health. METHODS We investigated this issue by examining the relationship between scores on the MacArthur ladder and measures of economic circumstances and noneconomic social status, as well as health and well-being measures, in healthy adults in the USA. RESULTS In three studies (total N = 1,310) we found evidence that economic circumstances and social status are distinct constructs that have distinct associations with scores on the MacArthur ladder. We found that both factors exhibit distinct associations with measures of health and well-being and accounted for the association between the MacArthur ladder and each measure of health and well-being. CONCLUSIONS Our findings suggest that the MacArthur ladder's robust predictive validity may result from the fact that it measures two factors-economic circumstances and social status-that are each independently associated with health outcomes. These findings provide a novel perspective on the large body of literature that uses the MacArthur ladder and suggests health researchers should do more to disentangle the social and economic aspects of subjective socioeconomic status.
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Affiliation(s)
- Manuel J Galvan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - B Keith Payne
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jason Hannay
- University of South Carolina Upstate, Spartanburg, South Carolina, USA
| | | | - Keely A Muscatell
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Padhy M, Hariharan M, Pandey P, Maryam R, Anand V. Chronic illness adjustment scale (CIAS): Development and validation. Chronic Illn 2023:17423953231205911. [PMID: 37801510 DOI: 10.1177/17423953231205911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
OBJECTIVES The objectives of this study were to (i) develop a self-report instrument to measure adjustment to chronic illness, (ii) evaluate its core structure and (iii) study various psychometric properties in the development of this instrument. METHOD The entire process of developing and validating the instrument is conducted in different phases: item writing and content validation; exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) to extract dimensions of the instrument; reliability and validity testing. A total of 1095 participants were included in the study. The EFA was run using IBM SPSS 23 and CFA was done by AMOS 21. RESULTS The Cronbach alpha of the chronic illness adjustment scale was found to be .70. The instrument correlates positively with illness perception and well-being which supports the notion that the chronic illness adjustment scale has satisfactory convergent validity. DISCUSSION The multifaceted nature of the chronic illness adjustment scale can serve as a global indicator of adjustment to chronic illness, allowing various interventions to flow toward the healthcare arena.
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Affiliation(s)
| | | | | | - Riswana Maryam
- Centre for Health Psychology, School of Medical Science, University of Hyderabad, Hyderabad, India
| | - Varsha Anand
- Centre for Health Psychology, School of Medical Science, University of Hyderabad, Hyderabad, India
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Thomsen EL, Boisen KA, Andersen A, Jørgensen SE, Teilmann G, Michelsen SI. Low Level of Well-being in Young People With Physical-Mental Multimorbidity: A Population-Based Study. J Adolesc Health 2023; 73:707-714. [PMID: 37389522 DOI: 10.1016/j.jadohealth.2023.05.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/16/2023] [Accepted: 05/10/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE We aimed to examine whether wellbeing, health behavior, and youth life among young people (YP) with co-occurrence of physical-mental conditions, that is, multimorbidity differ from YP with exclusively physical or mental conditions. METHODS The population included 3,671 YP reported as having a physical or/and mental condition from a Danish nationwide school-based survey (aged 14-26 years). Wellbeing was measured by the five-item World Health Organization Well-Being Index and life satisfaction by the Cantril Ladder. YP's health behavior and youth life were evaluated in seven domains: home, education, activities/friends, drugs, sleep, sexuality, and self-harm/suicidal thoughts, in accordance with the Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide and depression, and Safety acronym. We performed descriptive statistics and multilevel logistic regression analysis. RESULTS A total of 52% of YP with physical-mental multimorbidity reported a low level of wellbeing, compared to 27% of YP with physical conditions and 44% with mental conditions. YP with multimorbidity had significantly higher odds of reporting poor life satisfaction, compared to YP with exclusively physical or mental conditions. YP with multimorbidity had significantly higher odds for psychosocial challenges and health risk behavior, compared to YP with physical conditions, along with increased odds for loneliness (23.3%), self-harm (63.1%), and suicidal thoughts (54.2%), compared to YP with mental conditions. DISCUSSION YP with physical-mental multimorbidity had higher odds for challenges and low wellbeing and life satisfaction. This is an especially vulnerable group and systematic screening for multimorbidity and psychosocial wellbeing is needed in all healthcare settings.
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Affiliation(s)
- Ena Lindhart Thomsen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Denmark, Copenhagen, Denmark.
| | - Kirsten Arntz Boisen
- Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Denmark
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Denmark
| | | | - Grete Teilmann
- Department for Children and Adolescents, Nordsjaellands Hospital, Hilleroed, Denmark
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Koen LW, Ravensbergen SJ, Schoormans D, Hoogendijk WJG, Grootendorst-van Mil NH. The association between parental chronic physical illness and adolescent functional somatic symptoms. J Affect Disord 2023; 338:262-269. [PMID: 37308000 DOI: 10.1016/j.jad.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 02/23/2023] [Accepted: 06/04/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Previous studies have found that adolescents with a chronically ill parent may experience more internalizing problems. It is less clear if this association is sex-related, and whether it is specific for functional somatic symptoms (FSSs) or concerns other internalizing or externalizing problems. METHODS In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 841; mean age 14.9 years), we examined the association between parental chronic illness and adolescent's FSSs, and internalizing and externalizing problems. Adolescent's internalizing and externalizing symptoms were measured using the Youth Self Report; parental chronic physical illness was reported during an interview. Associations were tested using linear regression analyses taking into account socio-demographic confounders. We also explored gender-interaction effects. RESULTS Having a chronically ill parent (n = 120; 14.3 %) was associated with more FSS in girls (B = 1.05, 95%CI = [0.23, 1.88], p = .013), but not in boys (sex-interaction: p = .013). In girls, an association was also found between parental chronic illness and more internalizing problems (B = 2.68, 95%CI = [0.41, 4.95], p = .021), but this association disappeared when FSSs were excluded from the Internalizing problem scores. LIMITATIONS The current study has a cross-sectional design and relied on self-reported parental chronic physical illness what may have induced misclassification. CONCLUSION Findings suggest that having a chronically ill parent is associated with more FSSs in adolescent girls and that this association is specific for FSSs instead of general internalizing problems. Girls with a chronically ill parent may profit from interventions to prevent the development of FSSs.
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Affiliation(s)
- Lotte W Koen
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Susan J Ravensbergen
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Dounya Schoormans
- Department of Medical and Clinical Psychology, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Tilburg University, the Netherlands
| | - Witte J G Hoogendijk
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Nina H Grootendorst-van Mil
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, the Netherlands; Department of Psychiatry, Epidemiological and Social Psychiatric Research Institute (ESPRi), Erasmus MC University Medical Center, Rotterdam, the Netherlands.
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Rainer MA, Palmer PH, Xie B. Sleep Duration and Chronic Disease Among Older Native Hawaiians or Other Pacific Islanders and Asians: Analysis of the Behavioral Risk Factor Surveillance System. J Racial Ethn Health Disparities 2023; 10:2302-2311. [PMID: 36109435 DOI: 10.1007/s40615-022-01409-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 08/30/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Older adults are particularly vulnerable to unhealthy sleep. This study examines the relationship between sleep duration and chronic diseases among older Native Hawaiians or Other Pacific Islanders (NHOPIs) and identifies variations with older Asians. METHODS In this cross-sectional study, data were analyzed using the 2016 Behavioral Risk Factor Surveillance System. The total sample of adults 50 years and older included 1277 NHOPIs and 4655 Asians. Weighted, survey logistic regressions were employed to analyze the relationship between sleep duration (i.e., short, healthy, and long) and seven chronic diseases: coronary heart disease, stroke, heart attack/myocardial infarction, pre-diabetes, diabetes, chronic obstructive pulmonary disease, and depressive disorder. Sleep duration was categorized into short sleep (SS; ≤ 6 h), healthy sleep (7-8 h), and long sleep (LS; ≥ 9 h), with healthy sleep as the reference group. RESULTS Among NHOPIs, SS and LS were significantly related to stroke (OR 3.19, 95% CI: 1.35-7.53 for SS and OR 9.52, 95% CI: 2.99-30.34 for LS) and SS was associated with pre-diabetes (OR 2.22 CI: 1.07-4.59), after adjusting for all covariates. In contrast, Asians with SS and LS reported higher odds of depression (OR 2.40, 95% CI: 1.20-4.79 and OR 5.03, 95% CI: 1.57-16.13, respectively). CONCLUSIONS Findings suggest older NHOPIs with SS or LS experience worse health. NHOPIs and Asians varied on the relationship between sleep and chronic disease, underscoring the need to disaggregate Asian/NHOPI data to understand health disparities.
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Affiliation(s)
- Michelle A Rainer
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA.
| | - Paula Healani Palmer
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA
| | - Bin Xie
- School of Community and Global Health, Claremont Graduate University, 150 E 10th St, Claremont, CA, 91711, USA
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Brown MT, Wikiera J, Albarran M, Partap A, Ahmed C, Brock V, Beard S, Siegler EL. Using Community-Based Participatory Research to Develop Care Recommendations for People Aging With HIV. Innov Aging 2023; 7:igad107. [PMID: 37941828 PMCID: PMC10629937 DOI: 10.1093/geroni/igad107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 11/10/2023] Open
Abstract
Background and Objectives Over 50% of New Yorkers living with human immunodeficiency virus (HIV) are 50 years old or older, and the emotional and physical consequences of being a long-term survivor are significant. This study aimed to identify the practical needs of long-term survivors and older people with HIV (consumers) in New York State and develop recommendations addressing those needs. Research Design and Methods The HIV + Aging/LTS/Perinatally Diagnosed Subcommittee of the Consumer Advisory and Quality Advisory committees in the New York State AIDS Institute used community-based participatory research (CBPR) methods to design a statewide survey about the care needs of consumers in New York State. This survey, open to consumers, clinicians, and supportive services providers, was launched in June 2021 using Qualtrics. Participants provided demographic data and chose the 3 most important barriers and recommendations from each of 10 categories of issues affecting health care and supportive services. Consumers provided information about their HIV diagnosis and other health conditions. Responses were characterized using basic descriptive statistics. Results Participants included 124 consumers from 26 counties, 20 clinicians, and 24 supportive service providers. Among consumers, 67% were cisgender men, 27% were African American, and 65% were both long-term survivors and older people with HIV. On average consumers had been diagnosed with HIV for 27 years. Participants were concerned with clinical care coordination, housing needs, cultural representation in mental health services, and financial support of consumers. Discussion and Implications CBPR is an effective approach to developing consumer-generated recommendations to improve HIV care for long-term survivors and older people with HIV. Town hall formats informed survey design, enabled broad coverage of topics, and ensured that focus remained on priorities most important to consumers. The first quality initiative arising from the study was a routine screening of long-term survivors of HIV to identify functional decline and enhance referral pathways and care linkages.
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Affiliation(s)
- Maria T Brown
- School of Social Work, Syracuse University, Syracuse, New York, USA
| | - John Wikiera
- New York State Department of Health AIDS Institute, Albany, New York, USA
| | | | - Angie Partap
- Stony Brook Medical University, Stony Brook, New York, USA
| | - Courtney Ahmed
- New York State Department of Health AIDS Institute, Albany, New York, USA
| | | | - Sheriden Beard
- New York State Department of Health AIDS Institute, Albany, New York, USA
| | - Eugenia L Siegler
- The Center on Aging, Weill Cornell Medicine, New York, New York, USA
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Ward JH, Weir E, Allison C, Baron-Cohen S. Increased rates of chronic physical health conditions across all organ systems in autistic adolescents and adults. Mol Autism 2023; 14:35. [PMID: 37730651 PMCID: PMC10510241 DOI: 10.1186/s13229-023-00565-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/18/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND The poorer physical health of autistic adults compared to non-autistic adults has been highlighted by several epidemiological studies. However, research has so far been limited to specific geographical areas and has primarily focused on young autistic individuals (aged 35 years and younger). Recent studies indicate a higher rate of mortality in autistic people, as well as poorer quality of self-reported healthcare interactions. This study aims to determine, first, whether autistic people experience greater levels of non-communicable health conditions and second, whether these are explained by differences in demographics (i.e. sex, country of residence, ethnicity, education level), alcohol use, smoking, body mass index (BMI), or family history of medical conditions. METHOD We employed a cross-sectional, convenience-sampling study via an anonymous, online survey of autistic and non-autistic adults (n = 2305, mean age = 41.6, 65.9% female, 49% autistic). The survey asked participants to self-report information about their demographics, autism diagnosis, diet, exercise, sleep, sexual health, substance use, personal medical history, and family medical history (for all first-degree, biological relatives). Binomial logistic regression across four iterative models of increasing complexity was applied to assess rates of physical health conditions. The Benjamini-Hochberg correction was used to account for multiple testing, and only physical health conditions that achieved at least 1% endorsement within the overall sample (n > 22) were included in the analysis to reduce risk of Type I errors. We also used novel network analysis methods to test whether there are increased levels of multimorbidity between autistic and non-autistic people. RESULTS There were significantly elevated rates of non-communicable conditions across all organ systems in autistic people, including gastrointestinal, neurological, endocrine, visual, ear/nose/throat, skin, liver and kidney, and haematological conditions. We confirmed previous findings by showing highly significant differences in rates of neurological and gastrointestinal symptoms (p < 0.0001). In addition, we established in the largest sample to date that Ehler-Danlos Syndrome (EDS) was more likely to occur among autistic females compared to non-autistic females. Finally, we found a higher prevalence of Coeliac's disease among autistic individuals compared to non-autistic individuals after controlling for sex, ethnicity, country of residence, alcohol use, smoking, and BMI, but these results became non-significant after accounting for family history. LIMITATIONS Our study is biased towards females, white individuals, highly educated people, and UK residents, likely due to sampling biases. Our self-report study design may also exclude those who lack access to computers, or those with intellectual disability. Our network analysis is also limited in size. CONCLUSIONS This study provides evidence of widespread, physical health comorbidity that spans nearly all major organ systems in autistic adults compared to non-autistic adults, using both binary logistic regression and network models. Healthcare professionals must be made aware of the range of co-occurring physical health conditions that may be more common among autistic people. However, our findings also point towards potential avenues requiring further exploration, such as the association of autism with both Coeliac's disease and EDS.
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Affiliation(s)
- John H Ward
- Royal Devon University NHS Foundation Trust, Exeter, Devon, UK
- University of Exeter Medical School, Devon, UK
- University of Oxford, Department of Psychiatry, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Elizabeth Weir
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK.
| | - Carrie Allison
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK
| | - Simon Baron-Cohen
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Douglas House, 18b Trumpington Road, CB2 8AH, Cambridge, UK
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Splane J, Doucet S, Luke A. Transitioning from paediatric to adult healthcare: Exploring the practices and experiences of care providers. J Child Health Care 2023:13674935231202870. [PMID: 37728067 DOI: 10.1177/13674935231202870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
Complex paediatric health conditions are increasingly associated with survival into adulthood resulting in more youth with complex care needs (CCN) transitioning from paediatric to adult healthcare. Current transition practices, when present, are disorganized, resulting in health status deterioration and complications due to unmet needs. The aim of this qualitative descriptive study is to develop a broader understanding of the current transition practices and experiences, as well as recommendations of care providers who support youth with CCN in the transition from paediatric to adult healthcare. Fifteen care providers from two Eastern Canadian provinces were interviewed using a semi-structured interview guide. The data collected were analyzed using inductive thematic analysis following the six phases outlined by Braun and Clarke (2006). The findings from this research demonstrate (1) a shortage of care providers, (2) inconsistent timing for transition initiation, and (3) lack of available community resources and services. Participant recommendations include (1) a designated transition coordinator; (2) transition policy implementation; (3) improved collaboration between and across care teams; and (4) the integration of virtual care to facilitate the transition process. The results of this study can potentially improve transition practices and policies and guide future research in this area.
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Affiliation(s)
- Jennifer Splane
- Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Shelley Doucet
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
| | - Alison Luke
- Department of Nursing & Health Sciences, University of New Brunswick Saint John, Saint John, NB, Canada
- Centre for Research in Integrated Care, University of New Brunswick Saint John, Saint John, NB, Canada
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Kukay A, McKinney C. Chronic illness and psychopathology in emerging adults: Moderation by parent-child relationship quality. Chronic Illn 2023:17423953231200681. [PMID: 37700608 DOI: 10.1177/17423953231200681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
OBJECTIVE The current study aimed to better understand how parent-child relationships might moderate the effects of the presence and severity (as measured by physical quality of life) of a chronic illness on psychological problems in emerging adulthood. METHODS The participants included 538 emerging adults (53.5% women) with a mean age of 19.04. The participants completed an online study including chronic illness questions, the World Health Organization Quality of Life-Brief, the Parental Environment Questionnaire, and the Adult Self-Report scale. RESULTS Endorsing a health condition significantly associated with psychological problems in emerging adult men. The three-way interaction between endorsing a health condition, physical quality of life, and maternal parent-child relationship quality significantly predicted psychological problems in emerging adult men and women. Specifically, higher maternal relationship quality was associated with a weaker relation between psychological problems and having a health condition with a low physical quality of life. DISCUSSION The emerging adults who reported the most psychological problems also reported having a health condition, low physical quality of life, and low maternal relationship quality, highlighting that the combination of these variables predicted the highest rate of psychological problems. A low maternal relationship quality contributes to poor psychological adjustment while a high maternal relationship quality contributes to good psychological adjustment.
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Affiliation(s)
- Abigail Kukay
- Mississippi State University, Mississippi State, MS, USA
| | - Cliff McKinney
- Mississippi State University, Mississippi State, MS, USA
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Ge L, Heng BH, Yap CW. Understanding reasons and determinants of medication non-adherence in community-dwelling adults: a cross-sectional study comparing young and older age groups. BMC Health Serv Res 2023; 23:905. [PMID: 37620970 PMCID: PMC10464472 DOI: 10.1186/s12913-023-09904-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 08/10/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Medication non-adherence has become a striking problem among patients with chronic diseases worldwide. However, literature on prevalence, reasons and factors associated with medication non-adherence in Singapore general population is still lacking. This study aimed to (1) estimate the prevalence of intentional and unintentional medication non-adherence in young (aged 21-64 years) and older adults (aged ≥ 65 years), respectively; (2) identify and compare the main reasons for non-adherence; and (3) examine the association between potential factors and non-adherence in each group. METHODS This study sampled 1,528 community-dwelling adults on medications (young adults:766, older adults: 762) from a cross-sectional population health survey conducted in the northern and central regions of Singapore in 2018/2019. Self-reported medication non-adherence and its reasons were collected using a modified questionnaire and compared between the two groups. Multiple logistic regressions were conducted to examine the association between potential factors (e.g., social-demographic factors, smoking and drinking status, presence of diabetes, hypertension, or dyslipidaemia, and presence of depressive symptoms) and medication non-adherence in each group. RESULTS The prevalence of non-adherence was 38.4% and 22.3% in young and older adults, respectively, with young adults reporting higher unintentional and intentional non-adherence rates than older adults. "Afraid of developing drug dependence" was the most common reason in both groups (young:74.8% vs. old:73.5%). Compared to young adults (3.7%), "Not understanding medication labels" was more prevalent in older adults (8.8%). Presence of depressive symptoms was associated with non-adherence in both young (odds ratio [95% confidence interval]: 3.00 [1.79, 5.05]) and older adults (4.16 [2.31, 7.51]). Being employed (2.92 [1.76, 4.84]) and taking ≥ 2 medications (1.42 [1.04, 1.95]) had positive association while personal income of SGD1,000-4,000 (0.53 [0.36, 0.77]) and current smoking (0.61 [0.39, 0.95]) had inverse association with non-compliance in young adults. Diagnosis of diabetes, hypertension, or dyslipidaemia (2.63 [1.25, 5.53]) was associated with higher odds of non-compliance in older adults. CONCLUSIONS Young adults had higher prevalence of medication non-adherence than older adults. The main reasons for non-adherence reported by young and older adults were generally comparable. Presence of depressive symptoms was a risk factor of medication non-adherence in both groups.
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Affiliation(s)
- Lixia Ge
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore.
| | - Bee Hoon Heng
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
| | - Chun Wei Yap
- Health Services and Outcomes Research, National Healthcare Group, 3 Fusionopolis Link #03-08, Nexus@one-north, Singapore, 138543, Singapore
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Muellers KA, Harris YT, Wisnivesky JP, Lin JJ. Assessing the Effect of Cancer Diagnosis on Beliefs about Comorbid Diabetes. Semin Oncol Nurs 2023; 39:151436. [PMID: 37137768 PMCID: PMC10524088 DOI: 10.1016/j.soncn.2023.151436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 03/21/2023] [Accepted: 03/29/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Increasingly, patients diagnosed with cancer also live with chronic comorbidities, and it is important to understand the impact of a new cancer diagnosis on perceptions about preexisting conditions. This study assessed the effect of cancer diagnosis on beliefs about comorbid diabetes mellitus and assessed changes in beliefs about cancer and diabetes over time. DATA SOURCES We recruited 75 patients with type 2 diabetes who were newly diagnosed with early-stage breast, prostate, lung, or colorectal cancer and 104 age-, sex-, and hemoglobin A1c-matched controls. Participants completed the Brief Illness Perception Questionnaire four times over 12 months. The authors examined within-patient and between-group differences in cancer and diabetes beliefs at baseline and over time. RESULTS Overall, diabetes beliefs did not differ between cancer patients and controls at baseline. Cancer patients' beliefs about diabetes varied significantly over time; they reported less concern about cancer, less emotional effect, and greater cancer knowledge over time. Participants without cancer were significantly more likely to report that diabetes affected their life across all time points, though this effect did not persist after adjustment for sociodemographic variables. CONCLUSION While all patients' diabetes beliefs were similar at baseline and 12 months, cancer patients' beliefs about both illnesses fluctuated during the months following cancer diagnosis. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can play a key role in recognizing the effects of cancer diagnosis on beliefs about comorbid conditions and fluctuations in these beliefs during treatment. Assessing and communicating patient beliefs between oncology and other practitioners could produce more effective care plans based on patients' current outlook on their health.
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Affiliation(s)
- Kimberly A Muellers
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Department of Psychology, Pace University, New York, New York.
| | - Yael T Harris
- Department of Endocrinology, Feinstein Institute for Medical Research, Great Neck, New York
| | - Juan P Wisnivesky
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York; Division of Pulmonary and Critical Care Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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Woods SP, Teixeira AL, Martins LB, Fries GR, Colpo GD, Rocha NP. Accelerated epigenetic aging in older adults with HIV disease: associations with serostatus, HIV clinical factors, and health literacy. GeroScience 2023; 45:2257-2265. [PMID: 36820957 PMCID: PMC10651616 DOI: 10.1007/s11357-023-00759-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/18/2023] [Indexed: 02/24/2023] Open
Abstract
The prevalence of older persons with HIV (PWH) disease has increased considerably in the last 20 years, but our understanding of biological factors of aging and their clinical correlates among PWH remains limited. Study participants were 149 persons aged 50 and older, including 107 PWH and 42 seronegatives. All participants completed a blood draw, research medical evaluation, structured psychiatric interview, neurocognitive assessment, questionnaires, and measures of health literacy. Four epigenetic clocks were generated from stored blood samples using standardized laboratory methods. In regression models adjusting for sex and smoking status, PWH had significantly higher epigenetic aging acceleration values than seronegatives on all four indicators. Within the PWH sample, higher levels of epigenetic aging acceleration were moderately associated with lower current CD4 count, AIDS diagnoses, higher scores on the Veterans Aging Cohort Study Index, and lower telomere values. Higher epigenetic aging acceleration indices were also associated with lower health literacy among PWH. PWH experience accelerated aging as measured by a series of epigenetic clocks, which may be linked to immune compromise and risk of all-cause mortality. Health literacy may be a modifiable target for mitigating the risk of accelerated aging among older PWH.
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Affiliation(s)
- Steven Paul Woods
- Department of Psychology, University of Houston, 3695 Cullen Blvd., 126 Heyne Bldg. (Ste. 239d), Houston, Texas, 77004, USA.
| | - Antonio L Teixeira
- Department of Psychiatry & Behavioral Science, University of Texas Health Sciences Center at Houston, 1941 East Rd., Houston, Texas, 77054, USA
| | - Lais B Martins
- Department of Psychiatry & Behavioral Science, University of Texas Health Sciences Center at Houston, 1941 East Rd., Houston, Texas, 77054, USA
| | - Gabriel R Fries
- Department of Psychiatry & Behavioral Science, University of Texas Health Sciences Center at Houston, 1941 East Rd., Houston, Texas, 77054, USA
| | - Gabriela D Colpo
- Department of Neurology, University of Texas Health Sciences Center at Houston, 6431 Fannin St., Houston, Texas, 77030, USA
| | - Natalia P Rocha
- Department of Neurology, University of Texas Health Sciences Center at Houston, 6431 Fannin St., Houston, Texas, 77030, USA
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Andersen AH, Illes Z, Roessler KK. Regaining Autonomy in a Holding Environment: Patients' Perspectives on the Existential Communication with Physicians When Suffering from a Severe, Chronic Illness: A Qualitative Nordic Study. J Relig Health 2023; 62:2375-2390. [PMID: 36071298 DOI: 10.1007/s10943-022-01658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2022] [Indexed: 06/15/2023]
Abstract
Patients experience existential themes as pivotal in their lives, in order to be able to live with a severe, chronic illness; however, physicians report a hesitative approach to existential communication. The current study investigated Nordic patients' experiences of existential communication with their physicians related to the treatment of multiple sclerosis or chronic pain. Semi-structured interviews with 23 patients were analyzed following Interpretative Phenomenological Analysis. Physicians focusing on medical aspects at the expense of psychological and existential aspects of being ill was experienced by patients as challenging their treatment and well-being. For making a shared decision with the physician on their treatment, patients needed a transition from being dependent to being autonomous. A holding environment and existential communication about transitional objects such as relationships with something bigger than themselves, as nature or religion, supported this autonomy. The analysis showed that existential communication not only supported patients in developing and regaining autonomy but also functioned as a moderator for illness-related distress, as a prevention of withdrawal from treatment, and as significant for patients in relation to living with chronic illness. Further education in existential communication is desirable, to support physicians integrating existential dimensions in consultations and shared decision-making with patients suffering from a severe, chronic illness.
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Affiliation(s)
- Aida Hougaard Andersen
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
| | - Zsolt Illes
- Department of Neurology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Kirsten Kaya Roessler
- Department of Psychology, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
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Schwartz CE, Borowiec K, Rapkin BD. Depression trajectories during the COVID-19 pandemic: a secondary analysis of the impact of cognitive-appraisal processes. J Patient Rep Outcomes 2023; 7:67. [PMID: 37439964 DOI: 10.1186/s41687-023-00600-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 06/04/2023] [Indexed: 07/14/2023] Open
Abstract
PURPOSE This study characterized depression trajectories during the COVID pandemic and investigated how appraisal and changes in appraisal over time related to these depression trajectories. METHODS This longitudinal study of the psychosocial impact of the COVID-19 pandemic included 771 people with data at three timepoints over 15.5 months. The depression index was validated using item-response-theory methods and receiver-operating-characteristic curve analysis. The Quality of Life (QOL) Appraisal Profilev2 Short-Form assessed cognitive-appraisal processes. Sequence analysis characterized depression-trajectory groups, and random effects models examined appraisal main effects, appraisal-by-group, and appraisal-by-group-by-time interactions. RESULTS Sequence analysis generated six trajectory groups: Stably Well (n = 241), Stably Depressed (n = 299), Worsening (n = 79), Improving (n = 83), Fluctuating Pattern 1 (No-Yes-No; n = 41), and Fluctuating Pattern 2 (Yes-No-Yes; n = 28). While all groups engaged in negative appraisal processes when they were depressed, the Stably Depressed group consistently focused on negative aspects of their life. Response-shift effects were revealed such that there were differences in the appraisal-depression relationship over time for standards of comparison and recent changes for the Stably Depressed, and in health goals for those Getting Better. CONCLUSION The present work is, to our knowledge, the first study of response-shift effects in depression. During these first 15.5 pandemic months, group differences highlighted the connection between negative appraisals and depression, and response-shift effects in these relationships over time. Egregious life circumstances may play a lesser role for the Stably Depressed but a greater role for people who have transient periods of depression as well as for those with improving trajectories (i.e., endogenous vs. reactive depression). How one thinks about QOL is intrinsically linked to mental health, with clear clinical implications.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA.
- Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA.
| | - Katrina Borowiec
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
- Department of Measurement, Evaluation, Statistics, and Assessment, Boston College Lynch School of Education and Human Development, Chestnut Hill, MA, USA
| | - Bruce D Rapkin
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
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Rikl L. Reflective practice "If your illness were a landscape: What would it look like?". Patient Educ Couns 2023; 112:107744. [PMID: 37059026 DOI: 10.1016/j.pec.2023.107744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 05/09/2023]
Abstract
"If we want something to change with our patients, maybe we should ask the questions differently?" Maybe it helps if we get more creative in asking questions. If we ask patients, "If your illness was a landscape: What would it look like?" or encourage them to name their illnesses, just like you name things that stay, like pets, cars, objects.
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Affiliation(s)
- Lea Rikl
- Faculty for Health, Witten/Herdecke University, Germany.
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45
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Kaba D, Salwi SM, Daniel NR, Polenick CA. 'I feel like this will never end': mental health during the COVID-19 pandemic among older adults with chronic conditions. Aging Ment Health 2023; 27:1576-1583. [PMID: 37020428 PMCID: PMC10524161 DOI: 10.1080/13607863.2023.2193553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES The COVID-19 pandemic may have a negative impact on mental health, especially among older adults with chronic conditions who are more vulnerable to severe illness. In this qualitative study, we evaluated how the pandemic has impacted the ways that adults aged 50 and older with chronic conditions managed their mental health. METHODS A total of 492 adults (M = 64.95 years, SD = 8.91, range = 50-94) who lived in Michigan (82.1%) and 33 other U.S. states completed one anonymous online survey between 14 May 14 and 9 July 2020. Open-ended responses were coded to ascertain relevant concepts and were reduced to develop major themes. RESULTS We determined four main themes. The COVID-19 pandemic impacted how participants took care of their mental health through: (1) pandemic-related barriers to social interaction; (2) pandemic-related routine changes; (3) pandemic-related stress; and (4) pandemic-related changes to mental health service use. CONCLUSION This study indicates that older adults with chronic conditions experienced various challenges to managing their mental health in the early months of the COVID-19 pandemic, but also showed considerable resilience. The findings identify potential targets of personalized interventions to preserve their well-being during this pandemic and in future public health crises.
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Affiliation(s)
- Diarratou Kaba
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Shreya M. Salwi
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Nikita R. Daniel
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
| | - Courtney A. Polenick
- Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109
- Aging & Biopsychosocial Innovations Program, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI 48104
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Cuneo AA, Outram S, Marsac ML, Vendlinski S, Heyman MB, Ly N, von Scheven E, Perito ER. Medical traumatic stress in cystic fibrosis: A qualitative analysis. J Cyst Fibros 2023; 22:763-771. [PMID: 36925385 DOI: 10.1016/j.jcf.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/18/2022] [Accepted: 12/16/2022] [Indexed: 03/16/2023]
Abstract
BACKGROUND People living with cystic fibrosis (PwCF) face a lifetime of potentially traumatic illness-related experiences that can lead to posttraumatic stress symptoms. Existing criteria for this type of posttraumatic stress, called medical traumatic stress (MTS), may not fully capture the CF experience. In this study we aimed to explore: 1) illness-related experiences perceived as traumatic in the setting of CF, 2) perceived MTS symptoms in PwCF, and 3) perceived health-related functional impairments from MTS. METHODS Informed by our aims, we developed and piloted guides for semi-structured interviews and focus groups with PwCF, family members of PwCF, and CF medical providers. We then conducted a series of interviews and focus groups. The qualitative analytical process followed Deterding and Waters' three stages of flexible coding for in-depth interviews, generating key themes and sub-themes in each domain of study inquiry. RESULTS We recruited 51 participants, including 24 PwCF, 7 family members of PwCF, and 20 CF care team members. Illness-related experiences perceived as traumatic were often characterized by themes of loss of agency, threats of bodily harm, and shifts in identity. Prominent MTS symptoms included shame, survivor guilt, burden guilt, germaphobia, and symptom panic. Health-related themes of functional impairments perceived to result from MTS included poor adherence and strained relationships between providers and patients/families. CONCLUSIONS This is the first study to explore the specific experiences of MTS in PwCF. It highlights the need for screening that includes these specific exposure types and symptoms, which may be mitigatable with medical trauma-focused interventions.
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Affiliation(s)
- Addison A Cuneo
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA.
| | - Simon Outram
- School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Meghan L Marsac
- Department of Pediatrics, Kentucky Children's Hospital, Lexington, KY, USA
| | - Siena Vendlinski
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Melvin B Heyman
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Ngoc Ly
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Emily von Scheven
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
| | - Emily R Perito
- Department of Pediatrics, University of California San Francisco, San Francisco, CA, USA
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Benson A, Rawdon C, Tuohy E, Murphy N, McDonnell C, Swallow V, Gallagher P, Lambert V. Relationship between parent-adolescent communication and parent involvement in adolescent Type 1 diabetes management, parent/family wellbeing and glycaemic control. Chronic Illn 2023:17423953231184423. [PMID: 37386763 DOI: 10.1177/17423953231184423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
OBJECTIVES This study investigated the relationship between parent-reported degree of openness and extent of problems in parent-adolescent communication and parent involvement in adolescent Type 1 diabetes management, parent and family wellbeing and adolescent glycaemic control. METHODS A cross-sectional quantitative survey was conducted. Parents completed measures of parent-adolescent communication, parent monitoring of diabetes care, diabetes family responsibility, parent knowledge of diabetes care, parent activation, parent diabetes distress, and diabetes family conflict. RESULTS In total, 146 parents/guardians (121 mothers, mean age 46.56 years, SD 5.18) of adolescents aged 11-17 years (mean age 13.9 years, SD 1.81) with Type 1 diabetes completed the survey. Open parent-adolescent communication was significantly correlated to adolescents' voluntarily disclosing diabetes-specific information to their parents more frequently, increased parental knowledge of their adolescent's diabetes care completion, parents feeling more capable and willing to take action in relation to their adolescent's diabetes health, lower levels of diabetes-related parental distress, less diabetes-specific family conflict, and optimal glycaemic control. DISCUSSION Parent-adolescent communication has an important role to play in Type 1 diabetes healthcare management and psychosocial wellbeing during adolescence. Optimising open parent-adolescent communication represents a potentially useful target for interventional research and should be considered by healthcare professionals during healthcare encounters.
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Affiliation(s)
- Ailbhe Benson
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Caroline Rawdon
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Ella Tuohy
- School of Psychology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Nuala Murphy
- Diabetes and Endocrine Unit, Children's Health Ireland, Dublin, Ireland
| | - Ciara McDonnell
- Diabetes and Endocrine Unit, Children's Health Ireland, Dublin, Ireland
- Trinity Research in Childhood Centre, School of Medicine, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - Veronica Swallow
- College of Health, WellBeing and Life Sciences, Sheffield Hallam University, Sheffield, UK
| | - Pamela Gallagher
- School of Psychology, Faculty of Science and Health, Dublin City University, Dublin, Ireland
| | - Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Faculty of Science and Health, Dublin City University, Dublin, Ireland
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O'Neill AS, Newsom JT, Trubits EF, Elman MR, Botoseneanu A, Allore HG, Nagel CL, Dorr DA, Quiñones AR. Racial, ethnic, and socioeconomic disparities in trajectories of morbidity accumulation among older Americans. SSM Popul Health 2023; 22:101375. [PMID: 36941895 PMCID: PMC10024041 DOI: 10.1016/j.ssmph.2023.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Multimorbidity, the presence of multiple chronic health conditions, generally starts in middle and older age but there is considerable heterogeneity in the trajectory of morbidity accumulation. This study aimed to clarify the number of distinct trajectories and the potential associations between race/ethnicity and socioeconomic status and these trajectories. Methods Data from 13,699 respondents (age ≥51) in the Health and Retirement Study between 1998 and 2016 were analyzed with growth mixture models. Nine prevalent self-reported morbidities (arthritis, cancer, cognitive impairment, depressive symptoms, diabetes, heart disease, hypertension, lung disease, stroke) were summed for the morbidity count. Results Three trajectories of morbidity accumulation were identified: low [starting with few morbidities and accumulating them slowly (i.e., low intercept and low slope); 80% of sample], increasing (i.e., low intercept and high slope; 9%), and high (i.e., high intercept and low slope; 11%). Compared to non-Hispanic (NH) White adults in covariate-adjusted models, NH Black adults had disadvantages while Hispanic adults had advantages. Our results suggest a protective effect of education for NH Black adults (i.e., racial health disparities observed at low education were ameliorated and then eliminated at increasing levels of education) and a reverse pattern for Hispanic adults (i.e., increasing levels of education was found to dampen the advantages Hispanic adults had at low education). Compared with NH White adults, higher levels of wealth were protective for both NH Black adults (i.e., reducing or reversing racial health disparities observed at low wealth) and Hispanic adults (i.e., increasing the initial health advantages observed at low wealth). Conclusion These findings have implications for addressing health disparities through more precise targeting of public health interventions. This work highlights the imperative to address socioeconomic inequalities that interact with race/ethnicity in complex ways to erode health.
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Affiliation(s)
- AnnaMarie S. O'Neill
- VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA
- Corresponding author. VA Center to Improve Veteran Involvement in Care (CIVIC), VA Portland Health Care System, Portland, OR, USA. AnnaMarie.O'
| | - Jason T. Newsom
- Department of Psychology, Portland State University, OR, USA
| | - Em F. Trubits
- Department of Psychology, Portland State University, OR, USA
| | - Miriam R. Elman
- OHSU-PSU School of Public Health, Oregon Health and Science University, Portland, OR, USA
| | - Anda Botoseneanu
- Department of Health and Human Services, University of Michigan, Dearborn, MI, USA
| | - Heather G. Allore
- Department of Internal Medicine, School of Medicine, Yale University, New Haven, CT, USA
| | - Corey L. Nagel
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - David A. Dorr
- Department of Medical Informatics and Clinical Epidemiology, OHSU, Portland, OR, USA
| | - Ana R. Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, USA
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Reed D, Wolfe I, Greenwood J, Lignou S. Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of the experiences of parents and carers of children with chronic illness to inform future policies in times of crisis. BMC Health Serv Res 2023; 23:530. [PMID: 37221508 DOI: 10.1186/s12913-023-09452-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/26/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND The purpose of thispaper is to explore the experiences of parents and carers of children with chronic health conditions in accessing healthcare during the Covid-19 pandemic. Children with chronic conditions typically rely on both planned and unplanned care, and contact with healthcare professionals over extensive periods of time. Their distinct care needs render these children vulnerable to even to minor changes in healthcare provision. The wide-ranging care disruptions during the pandemic were therefore likely drastically to affect their health and wellbeing; an assessment of the effects of Covid-19 policies on healthcare access and quality of care delivered for this group is needed. METHODS From 25/01/2022 to 25/05/2022, four focus groups were held with parents/carers of children with diabetes, neurodivergence, mental health conditions, and medical complexities to explore their experiences in navigating the healthcare system during the pandemic. Interviews were transcribed and then subjected to thematic analysis using NVivo qualitative research software. RESULTS Our results indicate that children with chronic health conditions (and their parents/carers) experienced difficulties accessing healthcare during the pandemic. Problems with late diagnosis, prolonged waiting times, and deficiencies with telemedicine were identified, as were impacts of healthcare disruptions on children's wellbeing, and the wellbeing of wider families. We found that children with neurodivergence and those with mental health conditions were particularly affected with their health needs repeatedly de-prioritised. Furthermore, the loss of contact with multi-specialty clinical teams profoundly affected parents and carers, leaving them feeling isolated in managing their children's health. These diminished relationships became another vector for uncertainty in supporting children's health. CONCLUSION The effects of healthcare disruptions on the welfare of children with chronic conditions (and their families), are well evidenced in this work, providing deeper understandings of the relationships between these children, their families and clinicians. The evidence in this paper aims to inform future policy and ethical guidelines so that the needs of children with long-term health conditions can be properly considered in times of crisis.
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Affiliation(s)
- Dominic Reed
- Institute of Women and Children's Health, King's College London, 1 Lambeth Palace Rd, South Bank, SE1 7EU, London, UK
| | - Ingrid Wolfe
- Institute of Women and Children's Health, King's College London, 1 Lambeth Palace Rd, South Bank, SE1 7EU, London, UK
| | - Jenny Greenwood
- Institute of Women and Children's Health, King's College London, 1 Lambeth Palace Rd, South Bank, SE1 7EU, London, UK
| | - Sapfo Lignou
- Ethox Centre and Wellcome Centre for Ethics and Humanities, Nuffield Department of Population Health, University of Oxford, Big Data Institute, Old Road Campus, Oxford, OX3 7LF, UK.
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Maunick B, Skvarc D, Olive L, Mikocka-Walus A. Effects of acceptance and commitment therapy on fatigue for patients with cancer and other chronic health conditions: A systematic review and meta-analysis. J Psychosom Res 2023; 171:111366. [PMID: 37270911 DOI: 10.1016/j.jpsychores.2023.111366] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 05/06/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Fatigue is significantly more prevalent in the chronically ill compared to healthy individuals. Fatigue is one of the most reported and debilitating symptoms in individuals with chronic health conditions. Despite this, there is limited evidence examining the efficacy of psychological interventions to reduce fatigue, with the majority having focused on Cognitive Behaviour Therapy. As Acceptance and Commitment Therapy (ACT) has shown to be efficacious in improving other outcomes for people with chronic health conditions, this systematic review and meta-analysis aimed to determine the efficacy of ACT in reducing fatigue for this population. METHODS A systematic search in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Library, US National Library of Medicine Clinical Trial Register and reference lists of relevant papers was conducted to obtain relevant studies. Inclusion criteria specified the study needed to be a randomised controlled trial which implemented an ACT predominant intervention and measured fatigue in adults with a chronic health condition. Data was pooled using the inverse-variance random effects model, with restricted maximum likelihood estimation, providing the standardized mean difference between control and experimental groups post intervention. RESULTS The current systematic review and meta-analysis included eight RCTs. Participants with a chronic condition (including cancer and fibromyalgia) who received ACT interventions, displayed reduced levels of fatigue, indicative of a small effect (SMD = -0.16, 95% CI [-0.30, -0.01], p = 0.03). CONCLUSION While the evidence is limited to cancer and fibromyalgia, ACT shows promise in reducing fatigue. Future research should examine ACT for fatigue in other chronic health condition populations to broaden the scope of these findings.
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Affiliation(s)
| | - David Skvarc
- School of Psychology, Deakin University Geelong, Australia
| | - Lisa Olive
- School of Psychology, Deakin University Geelong, Australia; IMPACT Institute, Faculty of Health, Deakin University Geelong, Australia
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