Intimate partner violence in women with disabilities: perception of healthcare and attitudes of health professionals

Purpose: Intimate partner violence (IPV) is a major social problem and public health issue, but we still have a relatively small amount of data about partner violence in women with disabilities. The main objective of this study was to understand the experiences of women with disabilities who are or have been abused by their partners and to explore the knowledge, views and training requirements of primary care professionals.

Method: Qualitative study using semi-structured interviews with women with disabilities who had experienced IPV (n?=?14), and focus groups with healthcare professionals (n?=?16).

Results: Women with disabilities suffer specific forms of abuse. Because they depend on the people around them to take action, they are subordinate and this can prolong the abuse. The healthcare staff frequently mentioned that it is often difficult to notice that women with disabilities are being abused. Their lack of training about disabilities and gender-based violence makes them less sure of their ability to identify and deal with any possible cases of abuse.

Conclusions: The difficulties described by the women interviewed are broadly speaking the same as those described by the healthcare professionals consulted. A number of suggestions for improvements are provided based on the results found.

• Implications for Rehabilitation

• The rehabilitation of abused disabled women implies that women perceive the health system as a resource to resolve their situation.

• Healthcare professionals should be trained on how to detect, treat and communicate with disabled women who experience partner violence.

• Is needed to establish a comprehensive system of coordination between services involved in caring for abused women and with disabilities.

     

Factors promoting sustainable work in women with fibromyalgia

Abstract

Purpose: To examine and describe the factors promoting sustainable work in women with fibromyalgia (FM). Methods: A qualitative interview study. Twenty-seven gainfully employed women with FM participated in five focus group interviews. Their median age was 52 years, ranging from 33 to 62. The interviews were recorded, transcribed verbatim and analysed by qualitative latent content analysis. Results: Four categories were identified describing factors promoting sustainable work: the meaning of work and individual strategies were individual promoters while a favourable work environment and social support outside work were environmental promoters. The meaning of work included individual meaning and social meaning. The individual strategies included handling symptoms, the work day and long-term work life. A favourable work environment included the physical and psychosocial work environment. Social support outside work included societal and private social supports. Conclusions: Promoting factors for work were identified, involving individual and environmental factors. These working women with FM had developed advanced well-functioning strategies to enhance their work ability. The development of such strategies should be supported by health-care professionals as well as employers to promote sustainable work in women with FM.

• Implications for Rehabilitation

• Work disability is a common consequence of fibromyalgia (FM).

• Working women with FM appear to have developed advanced well-functioning individual strategies to enhance their work ability.

• The development of individual strategies should be supported by health-care professionals as well as employers to promote sustainable work and health in women with FM.

     

Examination of contraction-induced muscle pain as a behavioral correlate of physical activity in women with and without fibromyalgia

Abstract

Purpose: This study aimed to compare muscle pain intensity during a sustained isometric contraction in women with and without fibromyalgia (FM), and examine the association between muscle pain and self-reported levels of physical activity. Methods: Fourteen women with FM and 14 healthy women completed the study, where muscle pain ratings (MPRs) were obtained every 30?s during a 3?min isometric handgrip task at 25% maximal strength, and self-reported physical activity was quantified using the Baecke Physical Activity Questionnaire. Results: Women with FM were less physically active than healthy controls. During the isometric contraction, MPR progressively increased in both groups at a comparable rate, but women with FM generally reported a greater intensity of muscle pain than healthy controls. Among all women, average MPR scores were inversely associated with self-reported physical activity levels. Conclusions: Women with FM exhibit augmented muscle pain during isometric contractions and reduced physical activity than healthy controls. Furthermore, contraction-induced muscle pain is inversely associated with physical activity levels. These observations suggest that augmented muscle pain may serve as a behavioral correlate of reduced physical activity in women with FM.

• Implications for Rehabilitation

• Women with fibromyalgia experience a greater intensity of localized muscle pain in a contracting muscle compared to healthy women.

• The intensity of pain during muscle contraction is inversely associated with the amount of physical activity in women with and without fibromyalgia.

• Future studies should determine whether exercise adherence can be improved by considering the relationship between contraction-induced muscle pain and participation in routine physical activity.

     

The intersection of disability and healthcare disparities: a conceptual framework

Abstract

Purpose: This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. Methods: This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)’s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. Results: While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman’s utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. Conclusion: We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to healthcare among individuals with disabilities. The Model of Healthcare Disparities and Disability (MHDD) provides a framework for conceptualizing how healthcare disparities impact disability and specifically, how a mismatch between personal and environmental factors may result in reduced healthcare access and quality, which in turn may lead to reduced functioning, activity and participation among individuals with impairments and chronic health conditions. Researchers, health providers, policy makers and community advocate groups who are engaged in devising interventions aimed at reducing healthcare disparities would benefit from the discussions.

• Implications for Rehabilitation

• Evaluates the main models of healthcare disparity and disability to create an integrated framework.

• Provides a comprehensive conceptual model of healthcare disparity that specifically targets issues related to individuals with disabilities.

• Conceptualizes how personal and environmental factors interact to produce disparities in access to healthcare and healthcare quality.

• Recognizes and targets modifiable factors to reduce disparities between and within individuals with disabilities.

     

A qualitative study of immigrant women on long-term sick leave and their experience of dignity

Purpose: The purpose of this study was to explore if and how immigrant women suffering from chronic pain experience and maintain their dignity, during rehabilitation.

Methods: The study was designed as a field study, with participant observation and in-depth interviews. Participant observations were carried out during a rehabilitation course for 14 immigrant women on an outpatient clinic at a rehabilitation hospital in southern Norway. In-depth interviews were performed after the rehabilitation period. Hermeneutic analysis was applied to interpret the data.

Results: Findings show that the immigrant women experienced dignity by being seen, respected and believed by family-members, healthcare personnel and other patients at the outpatient clinic. Moreover, they maintained their dignity through a sense of their own value, integrity, religious faith and hope for the future.

Conclusions: The immigrant women maintained and protected their dignity by finding strength, pride, and self-worth in their religion and through their family-members’ affection. Taking responsibility for themselves and others and experiencing fellowship and equality with other women, they enhanced their dignity during their rehabilitation process. The caring attitudes and behavior of some healthcare personnel promoted patient dignity. They also gained hope and dignity by experiencing goodness, cultural competence, and sensitivity from healthcare personnel.

• Implications for rehabilitation

• This study shows that the family role is more important for the immigrant women than the role as an employee, although financial independence and being able to help relatives financially also were central.

• Fellowship and equality with other patients, together with a rehabilitation program, which is facilitated for different language levels, were understood as important factors for an effective recovery.

• Enough time to get to know the patients and cultural competence seems to be central components for the health care personnel to give efficient help to immigrants in rehabilitation.

• Immigrants from low/middle-income countries appear to apply their religiousness as a resource in their lives to a greater extent than native Norwegians do, and should be taken into consideration when planning and implementing rehabilitation programs for immigrants.

     

Bladder dysfunction and quality of life for people with multiple sclerosis

Abstract

Purpose: Bladder dysfunction affects 75% of people with multiple sclerosis (MS). People with MS are reluctant to seek treatment for this distressing symptom. This is the first-known study to explore in depth how bladder dysfunction interferes with quality of life for people with MS. Methods: Nineteen individual semi-structured interviews were conducted (M?=?8, F?=?11). Participants had a definite diagnosis of MS, aged between 37 and 64 years and had at least one bladder dysfunction symptom. The audio-recorded interviews lasted up to 90?min and were transcribed verbatim. Results: Thematic analysis within NVivo10 yielded two key themes: (1) Disruptions and loss and (2) ways of knowing. “Disruptions and Loss” explores how bladder dysfunction interrupted daily living activities and how this contributed to experiencing loss. “Ways of knowing” portrays the types of knowledge that existed around bladder dysfunction. Participants described using their experiential knowledge to self-manage bladder symptoms without advice from healthcare providers. Conclusions: Bladder dysfunction imposes major disruptions on daily life. People with MS attempt to self-manage their bladder symptoms, despite current barriers to navigating existing healthcare infrastructure. Understanding these barriers and the individual strategies employed by people with MS are the first steps in facilitating independent management of bladder dysfunction.

• Implications for Rehabilitation

• Each individual’s experience of bladder dysfunction is unique.

• Healthcare professionals must be prepared to discuss all disruptions and losses associated with bladder dysfunction for people with MS.

• People with MS have a vast range of knowledge in relation to their own bladder symptoms and healthcare professionals need to explore their existing self-management strategies during assessment.

• People with MS and healthcare professionals need to be educated on the wider health implications relating to bladder dysfunction.

     

Associations between socio-demographic factors,encounters with healthcare professionals and perceived ability to return to work in people sick-listed due to heart failure in Sweden: a cross-sectional study

Purpose: The aim of this study was to investigate associations between socio-demographic factors, experiences of positive/negative encounters with healthcare professionals, and the encounters' impact on the ability to return to work in a population of people on sick leave due to heart failure. Methods: This was a cross-sectional study. Data were collected from two official registries in Sweden and from a postal questionnaire. In all, 590 people with heart failure responded to the questionnaire. Associations between variables were calculated with bivariate correlation analyses and logistic regression analyses. Results: For people on sick leave due to heart failure, positive encounters with healthcare professionals are associated with being Swedish-born, female gender, and high income. People with high income are more likely to be supported back to work by positive encounters with healthcare professionals. To perceive that healthcare professionals believe in person's ability to return to work can be facilitating. Conclusions: Women, people who are not foreign-born, and people with high income are more likely to perceive encounters with healthcare professionals as positive. Healthcare professionals who work with rehabilitation for people with heart failure need to be aware of social inequalities and that being on sick leave is a process of change.

• Implications for Rehabilitation

• A failing heart limits everyday life implying risk for long-term sick leave. Even though there are rehabilitation programs for people with heart failure, vocational rehabilitation is often over-looked. The knowledge about factors associated with sick leave due to heart failure is scarce.

• Experiences of positive encounters with healthcare professionals were associated with being Swedish-born, female gender, and high income. People with high income were more likely to be supported back to work by positive encounters with healthcare professionals.

• Healthcare professionals who work with rehabilitation for people with heart failure can support patients with heart failure by showing them confidence and trust. However, they need to be aware that sick leave implies a process of change.

     

Healthcare professional experiences with patients who participate in multimodal pain rehabilitation in primary care – a qualitative study

Purpose: Exploring healthcare professional experiences of Multimodal rehabilitation (MMR) in primary care.

Methods: Fourteen healthcare professionals (11 women, 3 men) were individually interviewed about their work with MMR in primary care. Interviews covered experiences of assessing patients and work with patients in the programme. Transcribed interviews were analysed by qualitative content analysis.

Results: The analysis resulted in four categories: select patients for success; a multilevel challenge; ethical dilemmas and considering what is a good result. MMR work was experienced as useful and efficient, but also challenging because of patient complexity. Preconceptions about who is a suitable patient for MMR influenced the selection of patients (e.g. gender, different culture). Interviewees were conflicted about not to being able to offer MMR to patients who were not going to return to work. They thought that there were more factors to evaluate MMR than by the proportion that return to work.

Conclusions: Healthcare professionals perceive MMR as a helpful method for treating chronic pain patients. At the same time, they thought that only including patients who would return to work conflicted with their ethical views on equal healthcare for all patients. Preconceptions can influence selection for, and work with, MMR.

• Implications for rehabilitation

• Multimodal pain rehabilitation in primary healthcare is challenging because of the complexity of the patients.

• Healthcare professionals must deal with conflicting emotions in regard to different commitments from healthcare legislation and the goals of multimodal rehabilitation.

• Healthcare professionals should be aware that stereotypes regarding gender and immigrants can lead to bias when selecting patients for multimodal rehabilitation.

     

Negotiating disability in everyday life: ethnographical accounts of women with rheumatoid arthritis

Abstract

Purpose: Drawing on data from a larger study, the aim of this paper is to illuminate how the everyday doings of women with disabilities are coordinated to and shaped by organizational processes and social context, particularly as these relate to the potential of being labelled disabled. Methods: An institutional ethnography was conducted with seven Austrian women diagnosed with rheumatoid arthritis (RA). Interviews and participant observations were conducted, and texts about the historical development of disability policies were identified. Data analysis included grouping similar doings of participants together to subsequently explore links between what the women did and how their doings are shaped by disability policies and the social context. Results: The women, who participated in this study, spent time and effort to keep the disease invisible, resist disability and negotiate a disability pass. By drawing upon the historical development of Austrian disability policies, the interpretation reveals how this development infiltrates into participants’ lives and shapes their everyday doing. Conclusion: This study furthers understanding of how broader policies and practices, shaped over historical time, infiltrate into the daily lives of women with disabilities. It illustrates how full participation may not necessarily be a lived reality for people with disabilities at this point in Austria.

• Implications for Rehabilitation

• Maximising full participation for people with rheumatoid arthritis is important.

• This requires focusing not only on the bodily health of people with rheumatoid arthritis but also on their interaction with the social, cultural and political context in their daily lives.

• This requires also understanding how knowledge about disability is passed on from previous generations.

     

Auditory rehabilitation after stroke: treatment of auditory processing disorders in stroke patients with personal frequency-modulated (FM) systems

Purpose: Auditory disability due to impaired auditory processing (AP) despite normal pure-tone thresholds is common after stroke, and it leads to isolation, reduced quality of life and physical decline. There are currently no proven remedial interventions for AP deficits in stroke patients. This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP. Methods: Fifty stroke patients had baseline audiological assessments, AP tests and completed the (modified) Amsterdam Inventory for Auditory Disability and Hearing Handicap Inventory for Elderly questionnaires. Nine out of these 50 patients were diagnosed with disordered AP based on severe deficits in understanding speech in background noise but with normal pure-tone thresholds. These nine patients underwent spatial speech-in-noise testing in a sound-attenuating chamber (the “crescent of sound”) with and without FM systems. Results: The signal-to-noise ratio (SNR) for 50% correct speech recognition performance was measured with speech presented from 0° azimuth and competing babble from?±90° azimuth. Spatial release from masking (SRM) was defined as the difference between SNRs measured with co-located speech and babble and SNRs measured with spatially separated speech and babble. The SRM significantly improved when babble was spatially separated from target speech, while the patients had the FM systems in their ears compared to without the FM systems. Conclusions: Personal FM systems may substantially improve speech-in-noise deficits in stroke patients who are not eligible for conventional hearing aids. FMs are feasible in stroke patients and show promise to address impaired AP after stroke.

• Implications for Rehabilitation

• This is the first study to investigate the benefits of personal frequency-modulated (FM) systems in stroke patients with disordered AP.

• All cases significantly improved speech perception in noise with the FM systems, when noise was spatially separated from the speech signal by 90° compared with unaided listening.

• Personal FM systems are feasible in stroke patients, and may be of benefit in just under 20% of this population, who are not eligible for conventional hearing aids.

     

Communicating about obesity and weight-related topics with children with a physical disability and their families: spina bifida as an example

Purpose: The purpose of this study was to explore the experiences of children with spina bifida (SB), their families and healthcare professionals (HCPs) when discussing weight-related topics. Method: In-depth qualitative interviews were conducted with HCPs from Canadian outpatient SB clinics (n?=?13), children aged 6–18 years with SB (n?=?17) and their parents (n?=?20). Data were analyzed using a phenomenological approach within an interpretative paradigm. Results: Many HCPs were not confident talking about weight, concerned that they would damage relationships with children and families. Parents wanted routine weight surveillance, but were worried about their children’s self-esteem if their weight was discussed. They wanted HCPs to acknowledge the challenges of weight management in children with a physical disability and provide specialized solutions. Children wanted a positively framed and tailored approach to weight discussions, although this had generally not been their experience. Conclusions: Stakeholders describe therapeutic relationships that are currently disconnected around the issue of weight and obesity. However, children, parents and HCPs all believed that discussing this topic was critical. Positively framed, strengths-based and tailored approaches to weight-related discussions are warranted.

• Implications for Rehabilitation

• Rates of overweight and obesity in children and youth with physical disabilities are substantially higher than their typically developing peers.

• Healthcare professionals, children with physical disabilities and families often find weight-related discussions challenging and disconnected.

• Weight-related discussions should be tailored to the child and family’s circumstances and priorities.

• Positively framed and strengths-based approaches to weight-related discussions are warranted.

     

“Governed by the pain”: narratives of fibromyalgia

Purpose: Fibromyalgia (FM) is a chronic syndrome characterized by pain and fatigue. The aim of this study was to explore how individuals with FM make sense of the illness experience and integrate it into their personal biographies. Method: Ten women from a pain management service in the north west of England were interviewed for the study. A chronological summary of each life story was produced and narrative features such as plot, tone, imagery and metaphors were identified and compared. Results: Findings are presented in the form of a meta-narrative incorporating all 10 narratives over five phases: (1) making sense of FM: when I was younger, I didn’t have any problems at all; (2) onset and diagnosis: you just feel like you’re constantly complaining; (3) invasion of FM: you’re just trapped; trapped in this body; (4) coping with FM: you try to do things in a pattern it will obey and (5) ongoing struggle: I refuse to give in to it. Conclusions: The narrative is characterized by a lack of movement and resolution, with participants engaged in an enduring struggle against the challenges of FM. Psychological approaches that facilitate this ongoing adjustment process may prove beneficial in FM treatment and rehabilitation.

Implications for Rehabilitation

• Fibromyalgia (FM) is a chronic syndrome characterized by pain and fatigue.

• This study shows women with FM are engaged in an enduring struggle against the challenges this presents.

• Psychological approaches which acknowledge and facilitate the adjustment process may prove beneficial in terms of assisting rehabilitation for this client group.

     

Factors related to the indecision of older adults with knee osteoarthritis about receiving physician-recommended total knee arthroplasty

Purpose: To explore factors related to the indecision of older adults with knee osteoarthritis (OA) about receiving physician-recommended total knee arthroplasty (TKA) and their needs during the decision-making process.

Method: Older outpatients with knee OA and undecided about physician-recommended TKA (N?=?26) were recruited by convenience from two medical centers and one regional hospital in northern Taiwan. Data were collected in individual interviews using a semi-structured guide and analyzed by thematic analysis.

Results: Participants’ indecision about receiving physician-recommended TKA was due to four major concerns: treatment-related concerns, physical condition-related concerns, surgery-related concerns, and postsurgical care concerns. The few participants (n?=?6) who expressed needs during the decision-making process wanted more information about preparing for surgery, postsurgical care, rehabilitation, and medicines.

Conclusions: Healthcare providers are challenged to respect the decision-making process of older adults with OA regarding recommended TKA while maintaining their quality of life. These adults need appropriate information not only about the relationship between OA suffering and quality of life, but also TKA. While these patients are deciding whether to undergo physician-recommended TKA, they also need information about preparations for surgery, postsurgical care, rehabilitation, and medicines.

• Implications for Rehabilitation

• Total knee arthroplasty (TKA) can significantly relieve pain and improve function for older adults with knee osteoarthritis (OA), but many are unwilling to receive the surgery.

• Our older adult participants with knee OA ascribed their indecision about receiving physician-recommended TKA to treatment-related, physical condition-related, surgery-related, and postsurgical care-related concerns.

• Healthcare providers need to provide appropriate information to older adults with knee OA not only about the relationship between OA suffering and quality of life, but also about TKA.

• Healthcare providers should also provide these patients information about preparing for surgery, postsurgical care, rehabilitation, and medicines while they are deciding whether to undergo TKA.

     

Patient safety culture in out-of-hours primary care services in the Netherlands: a cross-sectional survey

Objective: To examine patient safety culture in Dutch out-of-hours primary care using the safety attitudes questionnaire (SAQ) which includes five factors: teamwork climate, safety climate, job satisfaction, perceptions of management and communication openness.

Design: Cross-sectional observational study using an anonymous web-survey. Setting Sixteen out-of-hours general practitioner (GP) cooperatives and two call centers in the Netherlands. Subjects Primary healthcare providers in out-of-hours services. Main outcome measures Mean scores on patient safety culture factors; association between patient safety culture and profession, gender, age, and working experience.

Results: Overall response rate was 43%. A total of 784 respondents were included; mainly GPs (N?=?470) and triage nurses (N?=?189). The healthcare providers were most positive about teamwork climate and job satisfaction, and less about communication openness and safety climate. The largest variation between clinics was found on safety climate; the lowest on teamwork climate. Triage nurses scored significantly higher than GPs on each of the five patient safety factors. Older healthcare providers scored significantly higher than younger on safety climate and perceptions of management. More working experience was positively related to higher teamwork climate and communication openness. Gender was not associated with any of the patient safety factors.

Conclusions: Our study showed that healthcare providers perceive patient safety culture in Dutch GP cooperatives positively, but there are differences related to the respondents’ profession, age and working experience. Recommendations for future studies are to examine reasons for these differences, to examine the effects of interventions to improve safety culture and to make international comparisons of safety culture.

• Key Points

• Creating a positive patient safety culture is assumed to be a prerequisite for quality and safety. We found that:

• ??healthcare providers in Dutch GP cooperatives perceive patient safety culture positively;

• ??triage nurses scored higher than GPs, and older and more experienced healthcare professionals scored higher than younger and less experienced professionals – on several patient safety culture factors; and

• ??within the GP cooperatives, safety climate and openness of communication had the largest potential for improvement.

     

The impact of mobility assistive technology devices on participation for individuals with disabilities

Aim: This study aims to address the gap in research and contribute to the body of knowledge on the perspectives assistive technology device users have toward their devices. Method: Mixed methods were used to better understand the impact of mobility assistive technology devices (MATDs) on participation for individuals with disabilities. The Functional Mobility Assessment was administered in conjunction with two qualitative questions developed by the research team allowing participants to expound on the impact of their MATD experience. Participants were recruited online via the National Spinal Cord Injury Association website and in-person at Abilities Expo in Atlanta, Georgia, and the International Seating Symposium in Nashville, Tennessee. Results: Results are consistent with findings from prior research regarding accessibility for individuals with disabilities. Corresponding findings were found in both the quantitative and qualitative data and are categorized into several major themes: environment (indoor and outdoor), surface heights, transportation, dependence, independence, quality of life and participation. Conclusion: Quantitative data from this study indicate that users of MATD are satisfied with the way in which their devices enable maneuvering indoors, while qualitative data suggest otherwise. Implications for healthcare practitioners are described and future recommendations are provided.

• Implications for Rehabilitation

• Healthcare professionals should advocate for proper mobility assistive technology devices (MATDs) for their patients in order to enable increased independence, safety and efficiency.

• Healthcare professionals must be cognizant of the impact of the environment and/or environmental barriers when prescribing MATD.

• Additional areas of interest for future research may include investigating the impact of MATD in association with date of onset of disability, according to diagnoses, or specific to length of time since acquiring the device.

     

The use of a Swedish telephone medical advice service by the elderly – a population-based study

Objective: The present study aimed to describe contact made by the elderly to Sweden’s nationwide medical helpline, Healthcare Guide 1177 by Phone (HGP). Other objectives were to study potential gender differences and the association between different HGP referral levels and acute visits to hospital-based emergency departments and acute visits to primary care centres.

Design: De-identified data from recorded calls to HGP was extracted for analysis (n?=?7477 for the oldest age group). Information about acute visits to emergency departments and to primary care reception was extracted from the patient administration system.

Setting: Västerbotten County, Sweden.

Subjects: Patients over 80 years.

Main outcome measures: Calling and visiting frequencies for different age groups as well as reasons for contact and individual recommendations.

Results: The utilisation rate of the telephone advice service for the oldest age group was high, with an incidence rate of 533 per 1000 person-years. Women had a 1.17 times higher incidence rate compared with men. The most common reason for contact was drug-related questions (17% of all contacts). Calls that were recommended to care by a medical specialist correlated with total emergency department visits (r?=?0.30, p?r?=?0.38, p?=?0.005).

Conclusion: The high utilisation of the telephone advice service by the elderly gives the telephone advice service a unique ability to function as a gatekeeper to further healthcare. Our data suggest that with the telephone advice service’s present guidelines, a significant proportion of all calls are being directed to further medical help. The high frequency of drug-related questions raises concerns about the elderly’s medication regimens.

• Key points

• Patients over 80 years of age had a high utilisation of the telephone medical advice service compared with other age groups.

• Drug-related questions were the most common reason for contact.

• A significant proportion of all calls made resulted in further heatlhcare contacts.

     

Association of employment and working conditions with physical and mental health symptoms for people with fibromyalgia

Purpose: This study examines physical and mental health symptoms among people with fibromyalgia (FM) by employment status and working conditions. Method: Secondary data analysis of the 2007 National Fibromyalgia Association Questionnaire study resulted in employment and symptom information for 1702 people of working age with FM. In this cross-sectional internet study, six factors of symptom clusters (physical, mental health, sleeping, concentration, musculoskeletal, support) were seen in the data. Linear regression models used employment, age, income, gender, and education to predict symptom clusters. Among those employed, working conditions were also associated with symptom severity. Results: In the predominately female sample, 51% were working. Of these, 70% worked over 30 hours/week and half had flexible hours. Employment, higher income, and education were strongly associated with fewer symptoms. Working conditions, including level of physical and mental exertion required on the job as well as coworkers’ understanding of FM, were related to symptoms, particularly physical and mental health symptoms. Many participants reported modifying their work environment (66%) or changing occupations (33%) due to FM. Conclusions: Work modifications could allow more people with FM to remain employed and alleviate symptoms. Persons with FM should be counseled to consider what elements of their work may lead to symptom exacerbation.

Implications for Rehabilitation

• People with fibromyalgia (FM) are at increased risk for unemployment.

• People with FM who remain working experience benefits, including fewer physical and mental health symptoms, higher income, and more social support.

• To remain working, people with FM may require an altered work situation, such as flexible or reduced hours.

• Persons with FM should be counselled upon diagnosis to consider which elements of their work may lead to symptom exacerbation or problems with work productivity.

     

Extending knowledge of the public awareness of aphasia in the Balkans: Serbia and Montenegro

Purpose: Public awareness of aphasia has been surveyed in a number of countries revealing that it is universally low. We report results of surveys in the Balkan countries Serbia and Montenegro and compare results with data from Croatia and Slovenia.

Methods: Convenience surveys of the general public were conducted in public places like shopping centers/malls and parks in Serbia (N?=?400) and Montenegro (N?=?500) using an adapted version of the public awareness of aphasia survey questionnaire. Respondents were asked whether they have heard of aphasia and tested with questions about aphasia. Information on gender, age, occupation and education was recorded.

Outcomes: Twelve percent (Serbia) and 11% (Montenegro) had heard of aphasia, but just 4% (Serbia) and 3.2% (Montenegro) had a basic knowledge of aphasia. Age, gender and occupation interacted variably with awareness. Between 16% (Slovenia) and 60% (Croatia) said they had heard of aphasia (10.5% overall mean for the four countries) and basic knowledge of aphasia across the four countries ranged between 3.2 and 7%.

Conclusions: Levels of awareness of aphasia in the Balkans are low and variably associated with age, gender, socio-economic and educational levels. Respondents with some knowledge of aphasia gained it through personal or professional interaction with aphasia or the media. The data provide a basis for awareness raising in Balkan countries to reduce stigmatization, improve community access and understanding.

• Implications for rehabilitation

• Awareness of aphasia is low universally, even among healthcare workers.

• Low public awareness of a condition, like aphasia, results in under-funded research and service provision.

• In order to raise public awareness of aphasia we need to know how many members of the general public know about it.

• Improvements in public awareness could positively affect funding, the quality of services, and the public understanding and acceptance of individuals with aphasia in the community.

• Improving awareness of aphasia in those who come into contact with aphasic people, like healthcare workers, could significantly improve the healthcare experience of people with aphasia and their families.

     

The potential benefits of applying a narrative analytic approach for understanding the experience of fibromyalgia: a review

Purpose: People with fibromyalgia (FM), a medically unexplained illness, habitually experience widespread pain and fatigue. While some qualitative research has aimed to understand the experiences of people with FM, studies from a specific narrative perspective are particularly lacking. This review argues that future research could be significantly enhanced by studies which analyse the narratives of people with FM. Method: This argument is made through reference to an examination of the extant qualitative literature on the experience of FM and theories and narrative studies on chronic illnesses and identity. Results: The empirical literature is reviewed from a narrative perspective; this assumes that the stories people tell reveal much about their identities and social worlds. As such, it is proposed that narrative analysis is particularly well suited for exploring issues of self and culture and for appreciating how meanings evolve over time. Further, it is also argued that consideration of these issues is particularly relevant for understanding the experience of FM given the enigmatic nature of the syndrome and its chronic course. Conclusions: The review concludes by emphasizing that narrative analysis is a valuable method which offers the potential for uncovering novel insights about the illness experience for these individuals.

Implications for Rehabilitation

• Fibromyalgia is a chronic syndrome characterised by pain and fatigue.

• Previous research has neglected the social context within which experience of fibromyalgia develops.

• Narrative studies have the potential to reveal how people make sense of illness.

• It is important for health professionals to acknowledge and validate the uncertainly of the illness experience in fibromyalgia.