Profile of arthritis disability

Using the 1994-95 National Health Interview Supplement Disability Supplement, the authors study levels of disabilities and accommodations among US adults with arthritis disability, compared to people with disability due to other conditions. Arthritis-disabled people are defined in two ways. One definition covers a broad range of arthritis and rheumatic conditions, and the other concentrates solely on arthritis. The authors find that arthritis-disabled people have more total disabilities than other-disabled peop e. However, their disabilities are less severe, have shorter durations, and accumulate more gradually over time. Despite more disabilities, people with arthritis disability use fewer assistive and service accommodations than other-disabled people. They do use more mobility aids. Because arthritis is the leading chronic condition for middle-aged and older adults, th s profile of extensive but mild-to-moderate disability is experienced by many millions of adults. Accommodations for arthritis may also be extensive but aimed more toward self-care than toward assistive and medical services.     

Patterns and determinants of influenza and pneumococcal immunisation among adults with chronic disease living in Queensland, Australia

Using findings from a random, computer assisted telephone survey of households, this paper examines influenza and pneumococcal immunisation coverage and predictors of immunisation in 2203 adults with asthma, diabetes or a cardiovascular condition living in Queensland, Australia. 47% and 31% of high-risk persons were immunised against influenza and pnemococcus respectively. Immunisation coverage varied across chronic conditions and increased with age, being significantly higher for those aged 65 years and older and consequently eligible for free vaccination. Poor self reported health status was an independent predictor of pneumococcal vaccination status for people with asthma, diabetes or a cardiovascular condition; however it was only an independent predictor of influenza immunisation status for people with diabetes. Extending free vaccination to all people at risk may increase immunisation rates for younger people with a chronic condition     

Fibromyalgia, cognitive problems and independence: physical activity may be useful in home health care

Home health care providers often deal with older clients who have cognitive deficits. Cognitive problems have a negative impact on independence. Certain chronic pain conditions present with cognitive dysfunction as a co-morbidity. Fibromyalgia syndrome is one such condition. Home health care providers need to know that mild-moderate exercise may positively affect fibromyalgia-related cognitive deficits at very low cost. All of the above is discussed in this paper along with advice concerning the provision of exercise for older, home bound people.     

Comorbidity and its impact on disability

Older people often suffer from comorbidity, or several chronic conditions simultaneously. Disability rises rapidly as the number of chronic conditions grows, although very ill people who acquire another condition experience attenuated increases. High prevalence conditions such as arthritis tend to have a low or occasionally moderate impact for community residents, while low prevalence ones such as osteoporosis have a high impact; paired conditions sometimes give extra propulsion to disability, as when cerebrovascular disease and hip fracture co-occur. Further research is needed to pin-point combinations of conditions posing great risks and to identify demographic segments in which comorbidity has elevated effects.     

Behavioral Aspects of Arthritis and Rheumatic Disease Self-Management

Chronic diseases such as arthritis and related conditions have no ‘cure’, and thus require ongoing management. The long term nature of chronic disease gives the individual a crucial role, if not the most crucial role, in managing their condition. Day-to-day self-management is extremely important in achieving optimal health outcomes, and indeed, people with arthritis use a variety of strategies to relieve symptoms or manage disease consequences.This review identifies and discusses 6 different domains of arthritis self-management behaviors: (i) medical management; (ii) joint protection strategies; (iii) physical activity and exercise; (iv) topical applications; (v) complementary and alternative strategies; and (vi) stress and mind/body practices. Conceptualizing arthritis self-management in this manner enables a discussion of a range of practices that may be used to manage arthritis conditions.The literature on several established arthritis self-management programs that are designed to improve either self-care and/or exercise behaviors is also reviewed. Despite evidence of cost containment and improved health outcomes, these programs reach only a small percentage of people with arthritis who may benefit from them.Clinical intervention for people with arthritis may be enhanced if self-management is approached from a broad perspective and, if established, self-management programs are integrated into clinical interventions.     

Coverage and predictors of vaccination against 2009 pandemic H1N1 influenza in Madrid, Spain

This study aimed to ascertain the coverage of vaccination against pandemic influenza in individuals aged over 6 months for whom vaccination is indicated due to a chronic health condition using as data source clinical information recorded in the primary care clinical history.Of all those for whom vaccination was indicated (1,114,632), 14.6% (162,616) finally received the vaccine. There were statistically significance differences in coverage for sex (16.5% for men and 13.1% for women), age groups (5% for people under 30 years and 20% for those over 60), number of chronic conditions (11.1% for one condition, 22.5% for two conditions, and 31.3% for three or more conditions) and depending on the chronic health condition considered.The probability of being vaccinated increased with male sex, age, number of indications, type of medical card (lower among no income) and having been vaccinated against 2009 season influenza.We concluded that the coverage finally reached for those people with an indication due to chronic health condition in the H1N1 campaign was much lower than expected and wished. It is essential to investigate the different factors that could have intervened in the behavior of the population so that more efficient approaches can be adopted in future influenza pandemics.     

Various health professions groups' beliefs about people with arthritis

This study was conducted among physical therapy students, nursing students, and interns and residents to compare beliefs about people with arthritis among these groups; compare the groups' beliefs about people with arthritis to their beliefs about people with five other handicapping conditions; and explore associations of the groups' beliefs about people with arthritis with their age, sex, and personal experience with the condition. For purposes of comparison with the health professions study groups, undergraduate students in an interpersonal communications class were also surveyed. Respondents answered a ten-item questionnaire for each of the six handicapping conditions. Through factor analysis, the ten items were reduced to two factors--one dealing with the emotionality and sensitivity of people with a handicapping condition and the other concerning the extent to which people with a handicapping condition are similar to "normal" people. Although beliefs about people with arthritis were not profoundly negative, such people were clearly viewed as being different from non-handicapped people. To the extent that negative, stereotypic beliefs held by health professionals may result in the stigmatization of people with handicapping conditions, such beliefs may ultimately have an adverse effect on the patient's response to treatment.     

187名农村老年人生活状况调查和分析

目的：了解农村老人的生活质量。方法：用问卷调查法，获取农村老人的身体、心理、经济状况、社会支持的状况。结果：44．3％老人未能确定是否患有慢性病，59．4％老人生活自理有不同程度下降，17．1％活动受限。月经济收入在50～200元内的占64．17％，43.32％自认经济状况较差，77．54％老人表示医疗费用承担有困难。就医困难的首位原因是经济困难。老年人大部分有负性情绪，主要是孤独感、衰老感、忧郁感。绝大部分老人健康保健意识差。结论：应提高老年人对疾病的预防和治疗意识，重视提高老年人的心理健康水平和基本生活条件。     

What are the special needs of chronically ill young people?

Although significant advances have been made in the treatment of serious disease, there remains much scope for assisting young people in adjusting to life with a chronic medical condition. Commonly, chronically ill young people experience lower emotional well being than their healthy peers. Conventional approaches to promoting emotional well being have involved referring young people and their families to an appropriate public mental health service or psychologist/psychiatrist in private practice. However, there is increasing interest in the use of peer support programs. Support groups such as the ChIPS program aim to promote positive adjustment to chronic illness by bring together young people facing similar circumstances. It is maintained that by increasing connections between chronically ill young people, emotional well being can be enhanced.     

‘Doing’ chronic illness? Complementary medicine use among people living with HIV/AIDS in Australia

This article takes the use of complementary medicine by a group of people living with HIV/AIDS as the starting point for exploring the options for living with chronic illness in contemporary western societies. Some authors have suggested that the situation of living with chronic illness may not be a significant departure from the process of negotiating choice that is theorised to be a defining feature of late-modern society and that there are now many ways of living with or 'doing' chronic illness. This article uses these theoretical concepts to explore the experiences of people who have lived with HIV/AIDS for a number of years. It is argued that while different options for managing chronic illness may exist, it is not always possible or desirable for individuals to put these choices into practice. The article is based on 18 qualitative interviews with people living with HIV/AIDS who were using complementary medicine.     

Perceptions of Healthy Children Toward Peers With a Chronic Condition

Perceptions of children with chronic illness may influence their peer relationships. This study examined the impact of illness visibility (i.e., an illness characteristic visible to other people) and medical explanation (i.e., a condition with a documented medical cause) on peer perceptions. Fifty healthy children (33 girls and 17 boys) aged 8 to 12 years (M = 9.34, SD = 1.26) were presented with vignettes describing hypothetical children with a visible–medically explained, non-visible–non-medically explained, visible–non-medically explained, or non-visible–medically explained condition. Perceptions of the hypothetical peer along affective, behavioral, and cognitive dimensions were assessed. Children with visible, non-medically explained conditions were perceived more negatively, suggesting that these children may be at risk for peer difficulties.     

Patterns of comorbidity and the use of health services in the Dutch population.

BACKGROUND: The study objective was to examine the relation between combinations of chronic conditions in the same person and the volume and variety of health care utilization. METHODS: Analysis of continuous Netherlands Health Interview Survey data (1990-1997). The study population consisted of adults (16 years and older) reporting at least one chronic condition from the following six disease clusters: musculoskeletal diseases, lung diseases, neurological disorders, heart diseases, diabetes, and cancer (n = 13,806). Health care utilization is categorized in terms of contacts in the preceding year with a general practitioner (GP), medical specialist, physiotherapist, home help and/or home nursing, and hospital admission. Utilization was adjusted for age, gender and year of interview. Statistical methods used are contingency table analysis and (logistic) multiple regression. RESULTS: Almost one-fifth of the study population reported more than one chronic condition. Musculoskeletal disease, in addition to being the most common single condition, was found to be the condition most likely to occur with one of the remaining five disease clusters. Seven per cent reported not having used any services at all. Two-thirds of the study population used at least two different services in the previous year. In contrast, 26% of the study population reported comprehensive utilization patterns (GP and/or home care and/or physiotherapist and/or medical specialist and/or hospitalization: minimum of three types). Persons with more than one chronic condition reported having used more services, in terms of volume and variety, than those with only one condition. CONCLUSIONS: There is a strong association between comorbidity and the volume and variety of health care services that are used. Since many people have comorbid conditions, their use of health services is more complex than would be suggested by a one-disease approach. New disease management systems need to be developed to reflect the multiplicity of health care needs of the growing number patients with more than one chronic condition.     

Understanding kidney disease in rural central Uganda – Findings from a qualitative study

ABSTRACT

As part of a multicentre study on kidney disease (ARK) undertaken in Malawi, South Africa and Uganda we undertook a social science component in Uganda to gather information on people’s understandings and perceptions of a diagnosis of kidney dysfunction, treatment and treatment seeking. We recruited 46 people who had been given information about kidney dysfunction and had been found to have some, usually early, signs of mild impairment. Data were collected during two in-depth interviews. Most participants had heard of the condition, but half denied knowledge of the health status of their kidneys or receiving results of tests from the clinic team. This response may have been linked to a lack of symptoms, for those with early stage kidney dysfunction. The treatment people reported receiving caused some uncertainty about condition severity. This may be because several people were treated for other conditions (such as urinary tract infections) and did not require treatment specifically for kidney disease. In our study, participants assessed illness severity based on symptoms and treatment and compared with the progression of other conditions.     

Estimating health needs: the impact of a checklist of conditions and quality of life measurement on health information derived from community surveys

BACKGROUND: Prevalence estimates of chronic disease vary according to the technique used. Questionnaire surveys may be susceptible to inaccuracies, which may be overcome by addition of a checklist of conditions. This paper presents SF-36 scores and NHS consultation rates for people reporting individual chronic diseases or disabilities in two questionnaire surveys, one of which employed a checklist and one of which did not. We aimed to document differences in estimates of disease prevalence, and to determine whether or not subjective impact on quality of life is the same in people recruited by a checklist as in those who volunteer that they have a chronic disease or disability without the prompt of a checklist. We use these data to estimate the contribution that different chronic diseases and disabilities make to the burden of disease in the community. METHODS: Data were collected in two postal questionnaire surveys conducted in 1991 and 1997 with response rates of 72 per cent and 64 per cent. Both questionnaires included a question on long-standing illness, disability or infirmity, together with the SF-36 health status measure. Respondents to the 1991 survey were asked to specify their illness in a free text response, whereas the 1997 survey offered a checklist of conditions. Prevalence rates of each condition were calculated, together with an 'escalation factor' representing the increase in reporting of specific diseases between the surveys. SF-36 domain and component summary scores were calculated overall and for the groups reporting individual chronic diseases or disabilities. Disease-specific NHS consultation rates were calculated for both surveys. RESULTS: The overall reported rate of chronic disease and disability increased from 28 per cent in 1991 to 42 per cent in 1997. Reported levels of mental health problems and of conditions with a perceived psychosomatic element increased substantially, whereas rates of well-defined conditions were similar. The pattern of SF-36 scores for those reporting chronic disease or disability was similar in the two surveys in spite of very different prevalence rates, and respondents reporting chronic disease had similar levels of health service use. This suggests that they were reporting conditions with similar levels of impact on quality of life. Heart disease, arthritis and mental health problems had the greatest impact on quality of life, and asthma and hypertension the least. CONCLUSIONS: Evidence from SF-36 scores and NHS consultation rates suggests that addition of a checklist of conditions to this community health survey encouraged reporting of illnesses by the genuinely ill and not merely by those who are less severely affected by their disease. This method appears to give a more accurate reflection of health needs than information derived from routine data sources. The combination of prevalence data combined with subjective assessment of quality of life allows an alternative perspective of health needs. This approach highlights the relative importance of musculo-skeletal problems, particularly back pain, and mental health problems to the burden of disease, and the relative lack of importance of conditions such as asthma. It presents a contrast to studies based on other methods of health needs assessment.     

Sexuality and Physical Disability: Exploring the Barriers and Solutions in Healthcare

People with physical disability and/or chronic illness are more likely to seek medical help than their typical peers. Once pressing matters related to their condition are addressed clients may pay attention to how to incorporate the management of their health condition into other aspects of their lives (i.e., sexuality). This paper discusses inhibitory and facilitative experiences that people with physical disabilities may encounter in their interactions with healthcare workers and systems when adapting to changes in their sexuality. Sexual health models (i.e., PLISSIT, Kaplan, ALLOW and Bitzer et al.) for people with chronic illness or disability are summarized and analysed for their value in relation to contemporary health needs. This paper posits that healthcare providers and people with physical disabilities can learn from and teach each other in order to promote positive and agentic constructions of sexuality with significant disability.     

Supporting pupils in mainstream school with an illness or disability: young people''s views

To date, little research has focused directly on health-related support in school for children with a chronic illness or physical disability, yet these children are known to be at increased risk for psychosocial and academic problems. In addition, few studies have sought the views of pupils directly: those which have report a wide range of problems with school life. The increasing numbers of children surviving and managing their health conditions, together with UK policy for inclusive education, means that a growing proportion of pupils in mainstream schools require understanding of their special health needs and may need service support from education and health professionals. This paper presents findings from semistructured interviews with 33 mainstream secondary school pupils with a variety of illnesses and disabilities on the impact of their health condition on school life. Results show that young people valued school and were actively managing the effects of their condition, but needed support from others. Informal support was most frequently cited, including parents--particularly mothers--teachers and close friends. The main difficulties were implications of school absence, exclusion from school life, teachers' reactions to the illness or disability, and peer relationships. The discussion focuses on ways in which health professionals can play a part in supporting pupils both directly and indirectly, through helping others in school understand the condition and its impact on school life.     

Risk adjustment for people with chronic conditions in private sector health plans.

BACKGROUND: Although the problem of adverse selection into more generous health insurance plans has been the focus of previous work, risk adjustment systems have only recently begun to be implemented to blunt its effect. OBJECTIVES: This study examines the ability of the leading risk adjustment systems to predict health care expenditures for people with chronic conditions, using claims and enrollment data from 2 large employers. RESEARCH DESIGN: Predictive errors and total financial losses/gains are compared for different risk adjustment approaches (primarily hierarchical condition categories [HCCs] and adjusted clinical groups) for several chronic conditions. RESULTS: One of the best performing risk adjustment systems was a regression-based HCC method, which had an average under-prediction error rate of 9% or 6%, depending on the employer. In comparison, more typical actuarial risk adjustments based on just age, gender, and prevailing area wages lead to a prediction error of at least 50%. We did not find evidence that payments for particular chronic conditions would be consistently and significantly under- or overestimated. CONCLUSION: The leading risk adjustment approaches substantially reduce the incentives for adverse selection but do not eliminate them.     

Using pharmacy data to identify those with chronic conditions in Emilia Romagna, Italy

BACKGROUND AND OBJECTIVES: Automated pharmacy data have been used to develop a measure of chronic disease status in the general population. The objectives of this project were to refine and apply a model of chronic disease identification using Italian automated pharmacy data; to describe how this model may identify patterns of morbidity in Emilia Romagna, a large Italian region; and to compare estimated prevalence rates using pharmacy data with those available from a 2000 Emilia Romagna disease surveillance study. METHODS: Using the Chronic Disease Score, a list of chronic conditions related to the consumption of drugs under the Italian pharmaceutical dispensing system was created. Clinical review identified medication classes within the Italian National Therapeutic Formulary that were linked to the management of each chronic condition. Algorithms were then tested on pharmaceutical claims data from Emilia Romagna for 2001 to verify the applicability of the classification scheme. RESULTS: Thirty-one chronic condition drug groups (CCDGs) were identified. Applying the model to the pharmacy data, approximately 1.5 million individuals (37.1%) of the population were identified as having one or more of the 31 CCDGs. The 31 CCDGs accounted for 77% (E556 million) of 2001 pharmaceutical expenditures. Cardiovascular diseases, rheumatological conditions, chronic respiratory illness, gastrointestinal diseases and psychiatric diseases were the most frequent chronic conditions. External validation comparing rates of the diseases found through using pharmacy data with those of a 2000 Emilia Romagna disease surveillance study showed similar prevalence of illness. CONCLUSIONS: Using Italian automated pharmacy data, a measure of population-based chronic disease status was developed. Applying the model to pharmaceutical claims from Emilia Romagna 2001, a large proportion of the population was identified as having chronic conditions. Pharmacy data may be a valuable alternative to survey data to assess the extent to which large populations are affected by chronic conditions.     

'Pressure of life': ethnicity as a mediating factor in mid-life and older peoples' experience of high blood pressure

Hypertension is a common condition which disproportionately affects African Caribbean people in England, yet this experience is rarely reported in the literature. Whilst a body of literature exists that explores chronic illness experience, little attention is paid to hypertension, nor to ethnicity as a mediating concept in chronic illness experience. This paper explores the meaning and consequences of hypertension for African Caribbean people residing in England. The study conducted was a qualitative study, informed by the ethnographic tradition. The study methods included the conduct of two focus group interviews (10 participants), 21 in-depth interviews and five vignette interviews. Thirty-six people in total participated in the study, both men and women, aged between 37 and 82 years (median age = 59.5 years) in two English cities. The sample was generated by contacting GP surgeries, community groups and associations and included economically active and retired people. The narrative accounts provided illuminate the personal biographies of the mid-life and older participants in the study, providing evidence as to how issues such as ethnicity, migration, cultural adaptation, racism and discrimination may impact upon the chronic illness experience. Participants' understandings of their self-defined condition of high blood pressure differed greatly from medical conceptualisations of the condition of hypertension. The implications of the study are that in order to provide effective health and social care for individuals of African Caribbean origin with hypertension, care-providers require insight into how migration and cultural adaptation may create major disruption to an individual's life trajectory, to which the subsequent diagnoses of chronic illness are relative in terms of the individual's response and adaptation.     

Chronic condition and normality: towards the movement that broadens the power of acting and being happy

This article is an epistemological-theoretical study of the health-disease process, whose central discussion is the frontier between health-disease and between the normal-abnormal of the person in chronic condition. It emphasizes the importance of the subjective dimension, without denying the objective dimension of this process. It shows that, when considering the objective aspect of the health-disease process, the definition of normality is based on the biological indicators grounded on statistic parameters, which are applied as a reference for all individuals. When considering the subjective aspect of the health-disease process, different normalities appear, as people with chronic conditions deal with daily demands in different ways, since the way they lead their life oscillates between expansion and introspection. Thus, having a chronic condition and being able, active and powerful in life means to be awake, open and always moving, creating new ways of being happy.