Early retirement for workers in physically demanding jobs? An ageing society conundrum

Health care office staff and providers may discriminate against people of low socioeconomic status, even in the absence of economic incentives to do so. We sought to determine whether socioeconomic status affects the response a patient receives when seeking a primary care appointment. In a single unannounced telephone call to a random sample of family physicians and general practices (n = 375) in Toronto, Ontario, a male and a female researcher each played the role of a patient seeking a primary care physician. Callers followed a script suggesting either high (i.e., bank employee transferred to the city) or low (i.e., recipient of social assistance) socioeconomic status, and either the presence or absence of chronic health conditions (diabetes and low back pain). We randomized the characteristics of the caller for each office. Our primary outcome was whether the caller was offered an appointment. The proportion of calls resulting in an appointment being offered was significantly higher when the callers presented themselves as having high socioeconomic status than when they presented as having low socioeconomic status (22.6% v.14.3%, p = 0.04) and when the callers stated the presence of chronic health conditions than when they did not (23.5% v. 12.8%, p = 0.008). In a model adjusted for all independent variables significant at a p value of 0.10 or less (presence of chronic health conditions, time since graduation from medical school and membership in the College of Family Physicians of Canada), high socioeconomic status was associated with an odds ratio of 1.78 (95% confidence interval 1.02-3.08) for the offer of an appointment. Socioeconomic status and chronic health conditions had independent effects on the likelihood of obtaining an appointment. Within a universal health insurance system in which physician reimbursement is unaffected by patients' socioeconomic status, people presenting themselves as having high socioeconomic status received preferential access to primary care over those presenting themselves as having low socioeconomic status.

IntroductionTo examine the relationship between chronic health conditions and out-of-pocket costs (OOPC) and medical debt.MethodsSecondary data from the 2013 Panel Study of Income Dynamics (PSID) was used. Households whose head of household and spouse (for married households) were 18 to 64 years old were included.ResultsHouseholds with 1 to 3 chronic conditions had higher odds of having any OOPC compared to households with no chronic conditions (AOR 1.74, 95% CI 1.39, 2.17) (p < .01). Households with 1 to 3 and 4 or more chronic health conditions were associated with higher odds of having any medical debt (AOR 2.24, 95% CI 1.75 to 2.87; AOR 5.04, 95% CI 3.04 to 8.34) compared to those with no chronic conditions (p < 0.01). Similarly, 1 to 3 and 4 or more chronic health conditions was associated with higher amounts of OOPC (Exponentiated Coefficient 1.18, 95% CI 1.03 to 1.36; Exponentiated Coefficient 1.56, 95% CI 1.17 to 2.07) and medical debt (Exponentiated Coefficient 1.69, 95% CI 1.23 to 2.34; Exponentiated Coefficient 2.73, 95% CI 1.19 to 6.25) compared to households with no chronic conditions (p < 0.05).ConclusionsFindings from this study show that the presence of chronic health conditions impose a large financial burden on some households.

PROTOCOL: Education Support Services for Improving School Engagement and Academic Performance of Children and Adolescents with a Chronic Health Condition: A Systematic Review

This study investigated associations between chronic developmental/behavioral and physical health conditions and social connectedness of adolescents using rich population-based data from a national U.S. birth cohort study. Potentially disabling health conditions were reported by caregivers and categorized by our team as developmental/behavioral or physical. Social connectedness was assessed using a validated scale that measured adolescents' reports of positive social connectedness across relevant contexts (family, friends, school). Of the 3,207 adolescents included, over one third had at least one chronic health condition. Unadjusted and adjusted linear and logistic regression models of associations between the presence of chronic health conditions (any developmental/behavioral health condition and any physical health condition, compared to no conditions) and adolescents' social connectedness outcomes were estimated. Compared to those with no chronic health conditions, adolescents with developmental/behavioral health conditions had lower odds of high positive social connectedness scores (adjusted odds ratio [AOR]: 0.80; CI [0.67, 0.94]), having friends they really care about (AOR: 0.76; CI [0.61, 0.94]), having people who care (AOR: 0.65; CI [0.50, 0.84]), and having people with whom to share good news (AOR: 0.77; CI [0.63, 0.94]). Adolescents with chronic physical health conditions had lower odds of reporting having people who care about them (AOR: 0.72; CI [0.55, 0.94]). The findings point to the need for interventions designed to foster the development of positive interpersonal relationships, reduce loneliness, and increase positive social identity among adolescents with chronic health conditions, particularly those with developmental/behavioral health conditions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Chronic health conditions affect over 100 million Americans (Cano and Leonard in J Clin Psychol 62(11):1409–1418, 2006). Many clinicians are not integrating chronic physical health symptoms into psychotherapy. There is a complexity of issues that arise within the context of chronic health conditions. Making more need for couple and family therapists, whose primary focus is on a systemic family perspective, to understand how chronic health conditions are impacting family systems when they present for therapy (Canavarro and Dattilio in Contemp Fam Ther 33:87–90, 2011; Poleshuck et al. in Prof Psychol 41(4):312–318, 2010). The correlation of chronic health conditions on marriages and relationships has received limited attention in clinical research. This secondary data analysis examines the differences in overall well-being and psychological distress of individuals and couples seeking therapy who report a presence of chronic health conditions. Original research on the relationship between chronic health conditions and well-being, as measured by comparison of means, will be presented. Few studies investigate how chronic health conditions, when not the primary reason for seeking therapy, influence wellbeing and distress upon entering therapy. This study included 2742 participants from a clinical sample of individuals and couple seeking therapy in a family therapy clinic at a university training clinic. Independent t-tests, as well as ANOVA, were run to compare well-being and psychological distress of individuals and couples in the sample. Results showed significant differences in both overall wellbeing and psychological distress for both individuals who reported chronic illness for themselves, or their partners, than those that reported no chronic illness. There were also significant differences between groups on both well-being and psychological distress [F (2, 2706) = 47.55, p = .00, F (2, 2697) = 54.59, p = .00]. This results showed significant differences in well-being when no member of the couple has chronic health conditions, one member, or both members, with both members decreasing wellbeing significantly. This study demonstrates that chronic health conditions impact both the individual diagnosed, their partners, and is especially impactful if both members of a couple are diagnosed with chronic health conditions. Study limitations and clinical implications are also discussed.

Depression and chronic health conditions in parents of children with and without developmental disabilities: The growing up in Ireland cohort study

To assess the presence of chronic health conditions (CHCs) among a nationally representative sample of children investigated by child welfare agencies. The study included 5872 children, aged 0 to 17.5 years, whose families were investigated for maltreatment between February 2008 and April 2009. Using data from the second National Survey of Child and Adolescent Well-Being, we examined the proportion of children who had CHC. We developed 2 categorical and 2 noncategorical measures of CHC from the available data and analyzed them by using bivariate and multivariable analyses. Depending on the measure used, 30.6% to 49.0% of all children investigated were reported by their caregivers to have a CHC. Furthermore, the children identified by using diverse methods were not entirely overlapping. In the multivariable analyses, children with poorer health were more likely to be male, older, and receiving special educational services but not more likely to be in out-of-home placements. The finding that a much higher proportion of these children have CHC than in the general population underscores the substantial health problems of children investigated by child welfare agencies and the need to monitor their health carefully, regardless of their placement postinvestigation.

Individuals with Down syndrome are predisposed to a number of chronic health conditions, but the relationship between these conditions and cognitive ability is not clear. The primary objective of this systematic review is to assess this relationship by evaluating studies that measure cognitive performance in the context of Down syndrome-associated chronic health conditions. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies included in this review (1) included children, adolescent, and young adult participants with Down syndrome and one or more co-occurring health conditions; (2) were quantitative; and (3) reported outcomes related to both chronic health conditions and cognitive performance. A set of predetermined chronic health conditions that are common in Down syndrome (e.g. sleep disorders, congenital heart disease, thyroid disease, seizure disorders, and pulmonary hypertension) were selected based on prevalence rates in Down syndrome. Fifteen studies met inclusion criteria. The majority these of studies assessed cognitive performance in association with sleep disorders (47%) and congenital heart disease (47%). Fewer studies reported on the effect of thyroid disease (7%) and seizure disorders (7%) on cognitive ability. None of the studies reported cognitive outcomes related to pulmonary hypertension. Of the chronic health conditions evaluated, associations between sleep disorders and cognitive dysfunction were most common among individuals with Down syndrome. Individuals with Down syndrome exhibit deficits in cognitive ability, particularly related to attention, executive function and verbal processing. These deficits may be further exacerbated by the presence of chronic health conditions, particularly sleep disorders. Individuals with Down syndrome and co-occurring sleep disorders may benefit from early interventions to mitigate their risk for adverse cognitive outcomes.

Additive associations of number of chronic health conditions and disabilities with flourishing among adolescents in the U.S.

Association between transition readiness and mental health comorbidity in youth with chronic health conditions

Differential Morbidity by Ethnicity in Long-Term Survivors of Hematopoietic Cell Transplantation (HCT): A Report from the Bone Marrow Transplant Survivor Study (BMTSS)

Retrospective analysis of self-report and administrative billing data. (1) Identify the self-reported prevalence of seven chronic health conditions (CHCs) in adults with chronic, traumatic spinal cord injury (SCI), (2) Examine the relationships between the presence of CHC with future hospital admissions and total number of inpatient days and (3) identify predictors of utilization. Data were collected from participants living in and utilizing hospitals in South Carolina, USA. Participants were identified through the South Carolina SCI Surveillance System Registry. Between 2010 and 2013, 963 adults ( > 18 years old) with chronic ( > 1-year), traumatic SCI completed self-report assessments (SRAs); this analysis includes data from 787 individuals. The presence/absence of the seven CHC was assessed using self-report data. Administrative billing data were used to assess hospital utilization in non-federal, South Carolina hospitals in the year following the SRA. In all, 40.5% reported no CHC; 23.4% reported one CHC and 36.1% reported having two or more CHC. The most commonly reported CHCs were hypertension (43.1%), high cholesterol (32.2%) and diabetes (15.8%). In total, 59% had at least one hospital admission in the year following the SRA (mean 3 ± 5; range 0-45; median = 1). The mean total inpatient days was 15.7 ± 43 days (range 0-365; median = 1). Predictors of hospital admission included CHC, pressure sores, education, prior hospitalization and injury severity. With the exception of CHC, each was also associated with total number of inpatient days. CHC are prevalent and associated with hospital admissions in adults with chronic, traumatic SCI.

Background: Individuals with chronic health conditions (CHCs) experience more anxiety and depression symptoms than those without CHCs. However, there is a dearth of research examining these relationships among low-income and minoritized populations. This current study investigated whether specific CHCs (i.e., diabetes, hypertension, hyperlipidemia) are linked to greater depression and anxiety symptoms among low-income, uninsured, and primarily Latine adults seen at a student-run free clinic (SRFC). Methods: Participants were 149 adults (aged 19-78 years) seen at a SRFC serving low-income community members. Participants were primarily female (63.0%) and Spanish-speaking (67.0%). Anxiety and depressive symptoms were measured using the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9). The presence of CHCs were extracted from participant medical records. Results: The presence of CHCs were associated with lower anxiety symptoms and the presence of hypertension and hyperlipidemia were linked to lower depression symptoms. Conclusions: Overall, this study demonstrates the importance of investigating relationships between mental and physical health conditions using understudied samples as findings observed among mostly White, higher income samples may not generalize. Research conducted in SRFCs may improve knowledge of understudied populations, such as low-income and ethnically diverse patients. Cultural factors may have contributed to these unexpected results (e.g., stigma-related underreporting of mental health symptoms, inadequate methods to assess culture-specific symptoms). These findings suggest the need for future research to explore alternative methods of assessing mental health symptoms among low income, ethnically diverse populations.

BackgroundIndividuals with Down syndrome are predisposed to a number of chronic health conditions, but the relationship between these conditions and cognitive ability is not clear. The primary objective of this systematic review is to assess this relationship by evaluating studies that measure cognitive performance in the context of Down syndrome-associated chronic health conditions.MethodsA systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. Studies included in this review (1) included children, adolescent, and young adult participants with Down syndrome and one or more co-occurring health conditions; (2) were quantitative; and (3) reported outcomes related to both chronic health conditions and cognitive performance. A set of predetermined chronic health conditions that are common in Down syndrome (e.g. sleep disorders, congenital heart disease, thyroid disease, seizure disorders, and pulmonary hypertension) were selected based on prevalence rates in Down syndrome.ResultsFifteen studies met inclusion criteria. The majority these of studies assessed cognitive performance in association with sleep disorders (47%) and congenital heart disease (47%). Fewer studies reported on the effect of thyroid disease (7%) and seizure disorders (7%) on cognitive ability. None of the studies reported cognitive outcomes related to pulmonary hypertension. Of the chronic health conditions evaluated, associations between sleep disorders and cognitive dysfunction were most common among individuals with Down syndrome.ConclusionsIndividuals with Down syndrome exhibit deficits in cognitive ability, particularly related to attention, executive function and verbal processing. These deficits may be further exacerbated by the presence of chronic health conditions, particularly sleep disorders. Individuals with Down syndrome and co-occurring sleep disorders may benefit from early interventions to mitigate their risk for adverse cognitive outcomes.

Aims: To describe the decline in injury rates between 1990 and 2000 within occupations stratified across three levels of physical demands and gender, adjusting for industry, in Canada’s largest province....