Caregiver burden and disability in somatization disorder

Objective

Authors assessed disability and caregiver burden in patients with somatization disorder (SOM-D), and compared it with that in patients with schizophrenia and chronic depression.

Methods

The sample consisted of 30 patients diagnosed as SOM-D as per ICD 10 Diagnostic Criteria for Research (ICD-10-DCR), and 30 age- and gender-matched patients each of schizophrenia and depression, who served as comparison groups. Disability and caregiver burden were assessed using WHO's Disability Assessment Schedule (WHO-DAS) and the Family Burden Assessment Schedule (FBAS) respectively. Functioning and severity of illness were assessed on the Global Assessment of Functioning scale (GAF) and Clinical Global Impression scale (CGI) respectively.

Results

Severity of illness in patients with SOM-D was comparable to that in the comparison groups. Patients with SOM-D scored higher on total disability on WHO-DAS than the patients with schizophrenia and depression, though scores on family burden were comparable. Disability in patients with SOM-D was more in females, less educated, older and those working at home, compared to the other demographic groups.

Conclusion

Patients with SOM-D suffer considerable disability due to illness and impose significant burden on their caregivers, comparable to that seen in severe mental illnesses like schizophrenia and chronic depression.     

Attachment and psychological well-being among adolescents with and without disabilities in Kenya: The mediating role of identity formation

The current study is aimed at evaluating the relationship between attachment and identity development, and their influence on psychological well-being in adolescents with and without disabilities in Kenya. The sample was composed of 296 adolescents (151 with disabilities and 145 without any disability). The mean age in our sample was 16.84 years (SD = 1.75). Adolescents with disabilities had significantly lower scores in identity formation, paternal attachment, and life satisfaction. A path model indicated that identity formation partially mediated the relationship between secure attachment and psychological well-being. Our findings indicate that both parent and peer attachment play an important role in the identity formation and psychological well-being of adolescents in Kenya, irrespective of a disabling condition. A multigroup analysis indicated that while the structure of the relationship between variables held for groups, the pattern and strength of the relationships differed. Implications for practice, especially the guidance and counseling services in schools, are discussed.     

Addressing career barriers for high risk adolescent girls: The PATHS curriculum intervention

The study evaluated a gender-specific comprehensive career development curriculum designed to target career barriers faced by high risk adolescent girls – those with disabilities and at risk for school failure. The goal of the curriculum was to promote social cognitive career and self determination outcomes associated with adaptive career development and adjustment. A pre-post control group design was used to evaluate the curriculum. Findings suggest that participation in the curriculum resulted in significant and large gains in autonomy and in disability and gender-related knowledge. Meaningful gains were noted in perceptions of social support and relevance of school. Participants in a high fidelity sample made significant and large gains in vocational skills self-efficacy and disability and gender-related knowledge. Meaningful improvements were noted in self-advocacy, autonomy, and vocational outcome expectations. The findings suggest that the curriculum can improve important indicators of positive career development and adjustment in high risk adolescent girls.     

Association between anxiety,health-related quality of life and functional impairment in primary care patients with chronic pain

Objective

Anxiety and chronic pain are prevalent and frequently co-occur. Our purpose was to examine the association between anxiety, health-related quality of life (HRQL) and functional impairment in primary care patients with chronic musculoskeletal pain.

Methods

Data were drawn from baseline interviews of the 250 primary care patients enrolled in the Stepped Care to Optimize Pain care Effectiveness trial. Validated measures were used to determine the proportion of patients screening positive for five common anxiety disorders: generalized anxiety, panic, social anxiety, posttraumatic stress and obsessive–compulsive disorder. Bivariate analyses examined associations between the type and number of anxiety disorders for which patients screened positive and representative pain, psychological and other HRQL outcomes. Multivariable models controlling for major depression and other covariates examined the association between the number of screen-positive anxiety conditions and functional impairment in psychological [SF-12 mental component summary (MCS) score], pain [Brief Pain Inventory (BPI) interference score] and work (disability days) domains.

Results

One hundred fourteen (45%) patients screened positive for at least one anxiety disorder and, compared to the 136 screen-negative patients, had significantly worse scores across multiple pain, psychological and other HRQL domains. Substantial impairment was seen for each of the five screen-positive anxiety conditions and progressively worsened as the number of conditions increased from one (n= 54) to two (n= 26) to ≥ 3 (n= 34). The number of screen-positive anxiety conditions was strongly associated (P< .0001) with worse BPI interference and MCS scores and more disability days in models adjusting for age, sex and medical comorbidity. After further adjusting for major depression, associations were attenuated but remained significant for BPI interference (P< .0001) and MCS (P= .018) and marginally significant for disability days (P= .062).

Conclusion

Nearly half of primary care patients with chronic pain screen positive for one or more anxiety disorders, which in turn are adversely associated with impairment across multiple domains of HRQL. Detecting and treating anxiety may be an important component of pain management.     

Association between antidepressant side effects and functional impairment in patients with major depressive disorders

Patients with depression may not well be aware of antidepressant adverse events (AEs); however, no studies have assessed how these AEs affect their daily function. Therefore, to evaluate the relationship between the quality of AEs and functional impairment, we studied 482 outpatients with depressive disorders who were not receiving any antidepressant treatment prior to the baseline visit and started it thereafter in usual clinical settings. The Quick Inventory for Depressive Symptomatology Self-Report Japanese version and antidepressant AEs for subjective assessment (antiAS) were performed at baseline and 10 days after antidepressant initiation (i.e. second visit). Functional impairment was evaluated with the Sheehan Disability Scale (SDS) on the second visit. As a result, the SDS was positively associated with the number of AEs (β=0.089, p=0.022) in multiple linear regression analysis (adjusted R²=0.357, p<0.001). Subjects who experienced vertigo, nausea and insomnia had significantly more functional impairment than those who did not. Additionally, the number of severe AEs (β=0.151, p<0.001) was associated with a higher SDS score, and those AEs with a negative causal attribution to antidepressants in the antiAS significantly affected the SDS (β=0.105, p=0.008). AEs of antidepressants should be carefully monitored since they could negatively affect their daily function.     

Dominant narratives: Complicity and the need for vigilance in the creative arts therapies

We live in societies in which we are shaped and positioned by dominant/subjugating narratives including patriarchy, Eurocentricism, heterosexism, capitalism, psychiatry/psychology, and medical science. This paper explores the ways in which our understandings of ourselves and others are fundamentally shaped by such narratives. These narratives shape how creative arts therapists understand concepts such as therapy, health and wellness, and issues of identity such as gender, race, ability, and sexuality. The author contends that it is imperative that creative arts therapists examine all aspects of identity in therapy, not only aspects of the client's identity, but also those of the therapist, and how these aspects of identity impact, structure, and mediate the therapeutic relationship. That is, as therapists we are not above the fray of complex identity formation shaped by dominant/subjugating narratives. The author discusses the need for creative arts therapists to examine how dominant/subjugating narratives are communicated through the art forms that we engage in within the therapeutic process. Also explored are the ways in which creative arts therapists are complicit with these dominant/subjugating narratives through our educational and research practices. Finally, the author discusses the need for constant vigilance against such dominant/subjugating narratives in order to work toward anti-oppressive practice and social justice.     

Disability as a risk factor? Development of psychopathology in children with disabilities

Empirical research has established that children with disabilities are more likely to develop psychopathology than children without disabilities. But too little is known about the association between disability and psychopathology. The aim of this article is to discuss developmental psychopathological models that conceptualise the connection between childhood disability and psychopathology. Empirical studies of psychopathology among children with a congenital hearing impairment and children with cerebral palsy will be reviewed, representing in-depth examples of association between disability and psychopathology. Both a congenital hearing impairment and cerebral palsy were found to be dominating risk factors for all types of psychopathology, but no relationship was identified between degree of disability and risk of psychopathology. The higher risk cannot be explained by biological impairments alone. To explain the contradictory findings, developmental models of disability and psychopathology are applied. Within a multi-factorial developmental psychopathological perspective and a dialectical model of disability (Vygotsky, 1993), it is suggested that disability can be understood as an incongruence between the individual development of the child and demands and expectations in the specific relations and institutions in which the child participates. This incongruence creates and strengthens negative factors for the child with disability and results in a higher risk of psychopathology.     

An exploratory study of health behaviors and the risks for triple H (hypertension,hyperlipidemia, and hyperglycemia) in young adults with disabilities between 20 and 39 years of age

Metabolic syndrome is highly prevalent and has important implications for the health care sector. However, information on the implications of metabolic syndrome for people with disabilities is limited. The purpose of this study was to explore the relationship between health behaviors and the risk for triple H (hypertension, hyperlipidemia, and hyperglycemia) in young adults with disabilities. The present study analyzed the annual health examination charts of 705 young adults with disabilities between ages 20 and 39 in Taiwan. Results found that the prevalence of hyperglycemia, hyperlipidemia, and hypertension in adults with disabilities was 5%, 15% and 17.7%, respectively. These prevalence figures were higher than those for the general population of the same age group in Taiwan. Multivariate logistic regression analyses revealed that almost none of the health behaviors were significantly correlated with the occurrence of triple H disorders among young adults with disabilities. Only one factor, BMI, independently predicted the occurrence of triple H disorders. We suggest that future studies should scrutinize the effects of health behaviors on triple-H disorders in people with disabilities to initiate personalize health promotion programs for this group.     

Percutaneous Ozone Treatment for Herniated Lumbar Discs: 1-Year Follow-up of a Multicenter Pilot Study of a Handheld Disposable Ozone-Generating Device

PurposeTo evaluate the safety and efficacy of oxygen-ozone treatment delivered via a novel, handheld ozone-generating device for improving pain and function in herniated disc patients.Materials and MethodsA total of 39 patients with contained herniated lumbar discs received oxygen-ozone treatment at 1 of 3 centers. Treatment consisted of injection of 2% ozone (10 mL): 3 mL delivered into the nucleus pulposus and 7 mL delivered into the adjacent paravertebral tissues. The first 8 patients received only ozone injections, whereas subsequent patients also received periganglionic methylprednisolone (40 mg) and 0.5% bupivacaine (1 mL) injections. Patients were evaluated at baseline and at 1 month, 6 months, and 12 months after treatment using the Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for leg pain and for back pain. Analgesic medication use was also assessed at each timepoint.ResultsOverall, 91% (32/35) of the per-protocol patients (those who completed follow-up and did not have significant protocol deviations) showed detectable improvement in ODI at 1-month follow-up; this increased to 93% (26/28) of patients at 12-months follow-up. At 1 month after treatment, 60% (21/35) of patients showed significant improvement in ODI scores (P = .01); 54% (19/35) showed significant improvement in VAS scores for leg pain (P = .05); and 49% (17/35) showed significant improvement in VAS scores for back pain (P = .12). At 6 months after treatment, 67% (22/33) of patients showed significant improvement in ODI scores (P = .02); 64% (21/33) showed significant improvement in VAS scores for leg pain (P = .01); and 52% (17/33) showed significant improvement in VAS scores for back pain (P = .12). At 12 months after treatment, 68% (19/28) of patients showed significant improvement in ODI scores (P < .01); 64% (18/28) showed significant improvement in VAS scores for leg pain (P < .01); and 61% (17/28) showed significant improvement in VAS scores for back pain (P = .09). Leg pain typically subsided more quickly than back pain. Use of analgesic medications also significantly decreased at all follow-up timepoints compared to baseline (P < .01). There were no adverse events or device-related issues.ConclusionsAt 1, 6, and 12 months after treatment, patients experienced significant improvements in pain and function as well as significantly decreased use of analgesic medication. Taken together with the absence of adverse events at 1-year follow-up, these data suggest that oxygen-ozone treatment is a safe and effective therapy for contained herniated discs.     

1990-2019年中国早产患病率及疾病负担变化趋势研究

目的描述1990-2019年中国早产患病率及疾病负担变化趋势。方法数据来源于2019年全球疾病负担数据库, 采用早产患病率(%)和伤残调整寿命年(DALYs)率, 分性别评估早产的患病和疾病负担分布情况, 并将中国、全球及世界银行定义的高收入、中高收入、中低收入和低收入国家的平均早产患病率和DALYs率进行对比。采用Joinpoint对数线性回归模型检验变化趋势。结果 2019年我国早产患病率为6.34%[95%不确定区间(UI):6.23%～6.44%], 低于全球平均水平(11.24%, 95%UI:11.16%～11.32%)及低收入(13.15%, 95%UI:12.97%～13.33%)、中低收入(12.53%, 95%UI:12.39%～12.68%)、中高收入(8.22%, 95%UI:8.15%～8.29%)、高收入(8.75%, 95%UI:8.67%～8.84%)国家平均水平;早产DALYs率(人年/10万)为217.12(95%UI:191.30～246.69), 低于全球(886.81, 95%UI:762.12～1 034.49)、低收入(1 905.24, ...