Work disability and the experience of pain and depression in rheumatoid arthritis

People with rheumatoid arthritis (RA) who are work disabled report more pain and depression than do those who are able to continue in paid employment. This paper explores the connections between work ability, clinical disease factors and symptom reports among people with this chronic disease. Using the expanded Biopsychosocial model of disease and illness it is shown that both work ability and clinical factors have independent, additive effects on pain and depression. The paid work effect is found even after controlling for the large and significant effect of pain on depression and depression on pain. This suggests that the pain and depression experience associated with RA is a function of both the underlying disease and the structural barriers that prevent continued participation in the workplace. It also suggests that contrary to popular notions of how disease severity affects symptoms, one does not have to be in the highest categories of disease severity to be in the highest levels of depression and/or pain.     

Communicating an evolutionary diagnosis of disability to parents

Communicating a diagnosis of disability to parents, when the diagnosis and prognosis are unclear, is problematic. This is discussed in the light of information received from mothers of such children who attended a counselling and support group. It is concluded that dissatisfaction with diagnosis is not inevitable, if similar guidelines to those suggested for children with Down's syndrome are used. It is essential that parents are involved in management and feel they have something practical to do to help their children. Clinics must organize themselves to avoid swamping parents with information and to provide regular ongoing support.     

Communicating about breast cancer: rural women's experience of interacting with their surgeon

Objective: This study examined rural women's satisfaction with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Differences in satisfaction were investigated between treatment groups (mastectomy and breast conservation surgery) and demographic variables (age, marital status, education level, employment status and place of residence). Practice was compared with clinical practice guidelines. Design: The study was designed as a cross‐sectional survey. Setting: The study was set in Eastern regional Victoria, Australia. Participants: Seventy women diagnosed with early breast cancer participated in the study. Main outcome measures: The main outcome measures used by the study were satisfaction in three areas of practice: (i) telling a woman she has breast cancer; (ii) providing information and involving the woman in the decision‐making; and (iii) preparing the woman for specific management. Results: No differences in satisfaction were found between treatment groups and demographic variables. Overall, women in this study were highly satisfied (>93%) with the interaction and communication with their surgeon. Women reported that the surgeon created a supportive environment for discussion, that they were provided with adequate information and referrals, and that they were actively involved in the decision‐making. Practice could have been improved for women who were alone at diagnosis as women without a partner made a quicker decision about treatment. Conclusion: Rural women in Victoria Australia were largely satisfied with the interaction and communication with their surgeon during diagnosis and treatment planning for early breast cancer. Current practice was predominately in line with clinical practice guidelines.     

Dynamics of work disability and pain

This paper investigates the role of pain dynamics in subsequently affecting dynamics in self-reported work disability and the dynamics of employment patterns of older workers in the US. Not only is pain prevalence quite high, there also are many transitions in and out of pain at these ages. We investigate pain and its relationship to health (work disability) and work in a dynamic panel data model, using six biennial waves from the Health and Retirement Study. We find that the dynamics of the presence of pain are central to understanding the dynamics of self-reported work disability and through this pathway, pain dynamics are also a significant factor in the dynamic patterns of employment.     

Communicating with the sedated patient: experience of the caretakers

How can we interact with sedated patients who are seemingly unable to express themselves? On the basis of these questions, we chose to realize a qualitative phenomenological study aimed at comprehending communication with the sedated patient from the perspective of the nurses who take care of those patients. Ten individual interviews were realized with intensive nurses from a Hospital School in S o Paulo. After data analysis, four general thematic categories were revealed: communication with sedated patient x sedation degree; communication with sedated patient x attributed perception capacity; valuation of communication with sedated patient; forms of communication with the sedated patient. This research concluded that the communication with the sedated patient exists and occurs at different moments and in different ways through verbal and non-verbal communication.     

Arthritis and the role of the physician in nonmalignant pain and disability

Most adults will experience at least one episode of low back pain. It is the second most common symptom that prompts visits to the doctor's office. Back pain is subjective and often presents with few objective findings on a physical exam. It remains a diagnostic and therapeutic challenge to many practitioners. Psychosocial and economic issues, such as litigation, workers' compensation claims and depression may have an impact on the management and treatment outcomes (Helfgott, MD, Simon M., 2001). Workers' compensation programs have a mandate to compensate only those who deserve compensation. Therefore, disability rating exists to sort out those who cannot work from those who will not work (Sullivan, MD, 1992). When treating chronic nonmalignant pain the physician should make a decision to either function as the patient's advocate or the rater of the patient's limitations. This will increase the likelihood of a healthy patient-physician relationship during what may be a very vulnerable and stressful period. It is very important to obtain sound acceptable documentation of the diseased patient's limitations by choosing the proper cost effective diagnostic studies, which are appropriate for each individual case. This will result in establishing an accurate and correct diagnosis. This process should lead to offering the patient treatment options designed to achieve pain reduction and improvement of his/her activity of daily living.     

Communicating about sex: adolescents and parents in Kenya

To guide the development of adolescent reproductive health programs in Kenya, a national IEC survey was conducted with 1476 adolescents 15-19 years of age and 2894 of their parents. The survey was conducted in 1994 by the Johns Hopkins University Population Communication Services, in collaboration with the Kenyan National Council for Population Development and the Central Bureau of Statistics. Both parents and children were most likely to report having discussed school, future careers, and alcohol/drug use during the year preceding the survey; topics least likely to be discussed included boy-girl relationships, acquired immunodeficiency syndrome (AIDS), sexual relations, abortion, contraception, and puberty. Mothers were more likely to discuss reproductive health issues with their children than fathers. Both male and female adolescents indicated they would be most comfortable discussing sexual matters with their same-sex siblings, friends, and health care workers. Over 75% of children and adults were supportive of school-based family life education programs. In many cases, parents lacked correct information about reproductive health issues. Interventions designed to facilitate parent-child communication include a weekly call-in radio program, a comic book that encourages teens to talk to their parents, and a booklet for parents suggesting ways of initiating discussions on sexual issues.     

Impairment and disability rating in low back pain

Many publications emphasize the theoretical relationship between impairment, disability, and the workplace. This article intended to provide the reader with some framework in this regard, but its main intent is to create a practical how-to-guide in the evaluation of impairment and disability that result from low back pain.     

Psychosocial factors and risk of pain and disability

This article reviews the research on the risk of pain and disability due to psychosocial variables. Variables such as general distress, psychopathology, depression, abuse, and catastrophizing are discussed in relation to the risk of disability. Ways to conceptualize the complex relationships among pain, disability, and several psychosocial variables are also explored. In addition, the identification of adaptive and of protective ways to manage pain and decrease the risk of disability is highlighted. Finally, the authors recommend areas for future research.     

Communicating a diagnosis of developmental disability to parents: multiprofessional negotiation frameworks

It is a hard task for professionals to give and parents to receive the bad news about a child's developmental disability. This study describes how findings about four preschool children, with difficulties suspected to lie within the autistic spectrum, were negotiated with parents by two multiprofessional groups, one in a Medical (Site M) and one in an Education setting (Site E). Each assessment was undertaken over half a day, the professionals jointly interacting with the child and family. All assessment discussions were audiotaped and each participant was interviewed after the assessment. Conversation analysis showed the activation of three major social-interaction frameworks: professionals at both sites applied a parent-friendly frame, but this was complemented by a hopeful-diagnostic-formulation frame at Site M, and a defocusing-of-bad-news frame at Site E.     

Ethnic differences in the experience of pain

Investigations of ethnic differences in pain experience have been largely confined to the hospital or laboratory. Such studies are limited by the potentially confounding effects of the expectation of pain in the former and of little or no pain in the latter. The present investigation overcomes some of these methodological problems by studying ethnic differences in pain experience following ear-piercing. Afro-West Indian, Anglo-Saxon and Asian subjects (n = 84) completed a pain questionnaire and two rating scales after ear-piercing. Half the subjects were told the study was about pain and half that it was concerned with sensation. There were highly significant ethnic differences in pain ratings. The pain condition produced higher ratings than the sensation condition but there were no significant sex differences. The results are discussed in the context of subjects' ratings of their parents' attitudes to minor injury and their own ability to cope with pain. It is argued that investigation of the bases of ethnic differences in pain experience is important in order to develop maximally efficient pain control regimes for all sections of the populations.     

Communicating a merger: BJC's experience in the St. Louis market

When BJC merged five well-known healthcare organizations in the St. Louis area, leaders developed a communications plan for establishing its new identity in the community. But setbacks forced modifications to the plan along the way. Why did setbacks happen, and how did the plan get back on track? These excerpts from the publication Anatomy of a Merger: BJC Health System provide some answers.     

DR在疲劳骨折中的应用

目的：探讨DR在疲劳骨折诊断中，与普通X线摄影相比有哪些优势。方法：收集应用DR和普通X线摄影检查、并经临床确诊为疲劳骨折各30例，对2组X线表现进行对比、研究。结果：应用DR检查组，骨折线、骨髓腔内横行致密带（内骨痂）及骨膜增生的显示率分别为86．7％、80．0％、100．0％；应用普通X线检查组，三者的显示率分别为43．0％、33．0％、66．7％。结论：DR和普通X线摄影相比，图像更加清晰，诊断信息明显增加，同时可以较大幅度减少X线辐射荆量，实现图像网络化。     

Perceptions of disability and occupational stress as discriminators of work disability in patients with chronic pain

Pain-related work disability can be influenced by a number of medical, physical, and psychosocial factors. The present study investigated the role of perceived disability, occupational stress, pain, and distress in patients with chronic pain disorders who work despite pain and patients who are work disabled. A total of 165 patients referred to a multidisciplinary pain treatment center for chronic pain (> 6 months) were studied. The two groups were compared on age, gender, education, marital status, duration of pain problem, pain severity, psychological distress, perceived disability, and perception of the work environment. A discriminant function analysis was computed entering pain severity, distress, perceived disability (physical and psychosocial) and work environment variables. The two groups were equivalent on age, gender, education, marital status, and duration of pain problem. The groups differed on diagnosis and insurance coverage with the work-disabled group diagnosed with low back pain and receiving Workers Compensation coverage more frequently than working controls. Univariate analyses indicated that the work-disabled group reported higher pain severity, perceived physical and psychosocial disability, and job stress than their working cohorts. The discriminant function analysis indicated that the perception of physical disability, supervisor support, distress, and work pressure were capable of correctly classifying patients with chronic pain who continued to work from those who were work disabled. These findings indicate the importance of evaluating perceived disability and job stress, and if present, directing intervention effort at these factors in order to facilitate work re-entry.     

Jürgen Habermas and the dilemmas of experience of disability

The article addresses Jürgen Habermas’ theory of communicative action, which offers very productive tools for analysing disability. The Habermasian division of social reality helps examine positive and negative effects of tensions between the lifeworld of a person with disability and the system. By exploring such an individual's communicative action, one can obtain an insight into his/her validity claims and disruptions in the communication process and self‐understandings inscribed in group narratives. The study reported in the article used in‐depth interviews, which narratively reveal the experiences of a person with disability in family, education, sports and labour. The key findings are, first, that the rationalization of lifeworlds of people with disability increases while processes in which they are colonized by the system intensify; second, that education and family are significant factors in the raising of validity claims; and third, that validity claims as tools of verbal communication should be augmented with arguments from non‐verbal language (e.g. gesture, empathy).     

Management of chronic pain and control of long-term disability

Chronic pain has become a major public health problem. Often, the availability of entitlement programs as well as psychosocial, occupational, and other nonmedical factors-rather than objective pathophysiology-are major contributors to disability. In this chapter, the authors discuss the relationship between impairment and disability and detail factors likely to predict or contribute to adverse clinical outcome and disability. Guidelines for disability prevention also are examined.