The Myth of the Supercrip

The dominant narrative of ableism can result in persons with a physical impairment or chronic illness being othered, excluded and discriminated within fitness spaces. Fitness instructors with a physical impairment or chronic illness can challenge these disabling narratives and promote inclusion within fitness spaces, but such individuals are representative of only a small percentage of fitness instructors. Thus, it is imperative that fitness instructors without an impairment are able to promote the inclusion of persons with a physical impairment or chronic illness within these spaces. The purpose of this research was to explore how staff in a community-based fitness centre, the Lakeshore Foundation, were able to promote inclusion of persons with a physical impairment or chronic illness, despite the majority of staff being non-impaired. Utilizing narrative methodology, we conducted semi-structured interviews with 15 members of staff then subjected these data to dialogical narrative analysis (DNA). We crafted a narrative typology representing the narrative environment of Lakeshore; (i) Lakeshore is a place of empowerment, (ii) Lakeshore is a community of acceptance, and (iii) Lakeshore is a social equalizer. Staff were cognizant of the importance of providing a cultural menu for members to choose from to make sense of their experiences, promoting these narratives in an immersive fashion, being facilitators and allies of the disability community, and working together towards a common goal to ensure the needs of their members were met. Through this research, we provide practical recommendation for instructors without physical impairments seeking to promote inclusion within exercise spaces.

"This therapy aims to address this complex comorbidity so that physically impaired elders can reverse the depression-disability spiral and build a satisfactory life for themselves."

Chronic illnesses are common and have detrimental effects not only on the affected individuals but also on their families. These negative consequences on the physical and psychological health of caregivers constitute the burden of care. We investigate the predictors of perceived burden of care among relatives of people with any chronic physical or mental illness using secondary data from a nationwide survey in Singapore. A cross-sectional household survey was conducted among adult residents of age 18 years and above and data were analysed to explore the predictors of high perceived burden of care. Two thousand four hundred and fifty-eight respondents having at least 1 close relative with any chronic physical and/or mental illness were included. Majority of the respondents had at least 1 close family member with physical illness (88.3%)--the most common illnesses reported were memory problems (86.9%), physical disability (74.8%), heart problems (70.1%) and cancer (62.2%). About 30.9% (n = 723) perceived high burden resulting from their relatives' health condition. Logistic analysis showed that women were more likely (OR 1.58, P = 0.0026) and Malays were less likely (OR 0.68, P = 0.0044) to perceive burden. Those who were able to open up to their family or friends (OR 1.65, P = 0.0162) and those who had dysthymia had higher odds (OR 4.91, respectively, P =0.0364) of perceiving burden. Our results suggest that regardless of the nature of the chronic illnesses, gender or ethnicity, the capacity to open up to family or friends and the mental health status of caregivers can predict their perceived burden. The results provide valuable preliminary information for planning social policies and interventions for improving the well-being of caregivers.

Inflammation is a risk factor for chronic physical illnesses. Evidence is building that inflammation is also a risk factor for mental illnesses making inflammation a common mechanism which could explain the high comorbidity between mental and physical illnesses. Based on a systematic search, a review on factors associated with inflammation in the depressed chronically ill has been conducted. Relevant articles have been selected according to the methodological considerations (scope, sample size, type of analysis and bias). Five categories of factors mediate the association between chronic physical and mental illnesses: (1) social-demographic factors, (2) social-economic background, (3) adverse health behaviours, (4) psychological stress and (5) genetics. Psychological therapies and medication also moderate this association. A theoretical model of the interplay between inflammation, depression and chronic physical illness is then presented. Inflammation contribute to both chronic physical and mental illnesses. These conclusions support future advances in clinical and research practice, as well as training and education.

Frequent attenders are believed to represent a problem in Primary Care, with human, economic and social impact. The present study aimed to describe these patients' sociodemographic and pathological characteristics. A cross-sectional study with analytical component was conducted in the population of frequent attenders in a Portuguese Primary Health Care Practice, between January 2007 and December 2009, allocated to six General Practitioners. Sociodemographic characteristics as well as data related to physical and mental illness were collected from clinical records. Associations between variables were tested with χ-square and t-test. The top quartile of frequent attenders was compared with the remaining population. The adopted significance level was 0.05. Of the 582 individuals evaluated, with a mean age of 55.4 years (men 58.6 and women 54.3; p = 0.006), 85% had chronic physical illness and 42% had chronic psychiatric illness. In the upper quartile of frequent attenders was observed a higher prevalence of chronic psychiatric illness (p < 0.001), as well as multiple pathology (p = 0.01), when compared to the remaining population. Individuals with physical illness were older (mean age: 58.0 years vs 40.1 years; p < 0.001) while those with chronic psychiatric illness were younger (mean age 53.7 years vs 56.6; p = 0.035). It was drawn a profile of the frequent attender consistent with international literature, at a time when there are no studies in Portuguese Primary Care settings. Information and selection bias were detected and minimized. In order to discriminate between frequent attenders, the upper quartile was compared with the remaining population. Some features seemed to be more associated with frequent attendance, such as advanced age, low educational level and the presence of chronic psychiatric illness. The frequent attender of this Portuguese Primary Care Practice is a female, in the sixth decade of life, with low educational level, married or living as a couple, coming from a nuclear family, and often with chronic illness. Knowledge of these patients may allow the development of strategies that lead to more cost-effective health care services. This study shows some guidelines for studies on this important population.

BackgroundChronic physical illness increases the risk of subsequent depressive symptoms, but we know little about the mechanisms underlying this association that interventions can target. We investigated whether loneliness might explain associations between chronic illness and subsequent depressive symptoms. MethodsWe used English Longitudinal Study of Ageing data, a prospective cohort of adults over 50. Our exposure was chronic illnesses (wave two) including arthritis, cancer, diabetes, cardiovascular disease, stroke, and chronic obstructive pulmonary disease. Loneliness scores were a mediator on the short University of California, Los Angeles Loneliness Scale at wave three. Depressive symptom scores (outcome) were measured using the Centre for Epidemiologic Studies Depression Scale (wave four). We examined associations of chronic physical illness with loneliness and depressive symptoms in univariable and multivariable regression models. ResultsFully-adjusted models included 2436 participants with the depression outcome and 2052 participants with the loneliness outcome. Chronic physical illness was associated with 21 % (incident rate ratio = 1.21, 95%CI = 1.03–1.42) higher depression scores at follow-up. We found no evidence of an association between chronic physical illness and loneliness and therefore did not proceed to analyses of mediation. LimitationsMore prevalent chronic illnesses could have driven our results, such as cardiovascular disease. ConclusionsChronic physical illnesses increase the risk of depressive symptoms in older adults. However, we did not find any that chronic physical illnesses were associated with an increased risk of subsequent loneliness. Therefore, interventions targeting loneliness to reduce depression in older adults with chronic physical illness may be insufficient.

In research with community samples, children with chronic physical illnesses have shown elevated anxiety and depressive symptoms, compared to healthy peers. Less is known about whether physical illnesses are associated with elevated internalizing symptoms even among children referred for mental health treatment-a pattern that would indicate distinctive treatment needs among physically ill children receiving mental health care. We investigated the relationship between chronic physical illness and internalizing symptomatology among children enrolling in outpatient mental health treatment. A total of 262 treatment-seeking children ages 7-15 and their caregivers completed a demographic questionnaire, Child Behavior Checklist, and Youth Self-Report during a pre-treatment assessment. Physical illnesses were identified through caregiver report. There was no overall association between the presence/absence of chronic physical illness and parent- or child-reported symptoms. However, number of chronic physical illnesses was related to parent- and child-reported affective symptoms. Children with two or more chronic physical illnesses had more severe depressive symptoms than those with fewer physical illnesses. Having multiple chronic illnesses may elevate children's risk of depression symptomatology, even in comparison to other children seeking mental health care. This suggests a need to identify factors that may exacerbate depression symptoms in physically ill children who are initiating therapy and to determine whether different or more intensive services may be helpful for this group. The findings suggest the potential utility of screening for depression in youth with chronic physical illnesses, as well as addressing mental and physical health concerns during treatment.

Because physical illness may influence quality of life, we assessed its impact on functional status and treatment outcome in older depressed patients who participated in a clinical trial, which showed a significantly higher remission rate for fluoxetine over placebo (31.6% vs 18.6%, P < .001). Six-week, randomized, double-blind, placebo-controlled trial of fluoxetine, 20 mg daily. Multiple clinical sites, both university and private. Outpatients (N = 671) were > or = 60 years (mean +/- SD = 67.7 +/- 5.7), met DSM-III-R criteria for unipolar major depression and had baseline scores > or = 16 on the Hamilton Depression Rating Scale. The 36-item short-form health survey (SF-36) was used to measure baseline and posttreatment functional health and well-being. Physical illness was rated by number of current chronic or historical illnesses. Change from baseline to endpoint in the Hamilton Depression Rating Scale total score was used to measure depression outcome. Most patients reported physical illness: 83% had one or more chronic illness, and 89% had one or more historical illness. Greater numbers of baseline chronic illness indicated worse physical functioning, general health perceptions, and vitality and greater bodily pain and role limitation from physical problems. Historical physical illness was associated with worse physical functioning, vitality, general health perceptions, social functioning, and mental health. Although the number of chronic illnesses did not influence treatment response, historical physical illness was associated with greater fluoxetine response and lower placebo response. These findings suggest that both current and previous physical illness are associated with lower quality of life in geriatric depression and that depressed older patients with chronic physical illness respond to antidepressants as well as those without such illness. Recovery from previous physical illness should be explored as a potential predictor of antidepressant treatment outcome.

Putting Adolescent Health at the Heart of Pediatrics

PurposeThis paper aims to examine whether the health education and health promotion literature is inclusive of people with physical mobility impairments. The English government Department of Health statistics indicate that the number of people living with physical mobility impairments is increasing and this is largely a result of chronic illness survival. The current UK Government has set targets to reduce inequalities that disproportionally affect those with disabilities. In light of the above points, it was expected that this interest would be reflected by a growing health promotion literature.Design/methodology/approachIn order to achieve an overview of health promotion offered for those with physical mobility impairments, a literature review was conducted. The literature was systematically reviewed using keywords and inclusion criteria. The range of published literature searched included research journals, health promotion texts, health and disability policy documents, as well as web sites offered on the internet.FindingsThere is a dearth in the information and development of health promotion for those with physical mobility impairments. Health policy documents offer little that is specifically focused for this group of people in particular. The majority of the relevant literature comes from the USA. Two theoretical positions are offered in the literature: one argues that those with physical impairments require a medical model approach to support individual's adjustment to society; and the other argues that emphasis should be placed on social change to accommodate those with physical impairments. While there are a range of initiatives in legislation and policy that utilise the social model position, the lack of UK health promotion interventions and the small number of US studies for improving the health of those with physical mobility impairments tends to encourage the medical model approach.Research limitations/implicationsThis review focuses particularly on health promotion for those with physical mobility impairments. Although not exhaustive, it highlights the need for further research into effective development of health promotion for those with physical mobility impairments in the UK.Practical implicationsFar more needs to be done to promote the health of those with physical mobility impairments. Both the medical model and social change approaches are required to deliver health promotion for this segment of the population.Originality/valueThere are no other reviews of the literature with a focus on physical mobility impairment and health promotion. This paper considers an often‐neglected group of people and identifies a need for effective health promotion information and resources.

Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization. This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization. The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01). Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types.

Psychological stress is associated with physical illnesses like asthma or infections. For an infant, situations perceived as stressful are highly dependent on the relationship with the caregiver. Constantly poor mother-infant interaction increases the child's vulnerability to stressful conditions and experiences. The aim of the study was to investigate the impact of the quality of early mother-infant interaction on the subsequent physical health of the child. Poor mother-infant interaction was hypothesized to be associated with chronic or recurrent health problems in the child. Fifty-seven mother-infant dyads from families at risk of psychosocial problems and 63 from non-risk families, altogether 120 dyads, participated in the study. Families were drawn from normal population, from well-baby clinics in the city of Tampere, Finland. Infants were full-term and healthy, families with severe risks like psychotic illnesses of the parents or a history of child protection concerns were excluded from the study. After the initial interview with the mother, the mother-infant interaction was videotaped when the infants were 8-11 weeks of age and the interaction was assessed using the Global Rating Scale for Mother-Infant Interaction (Murray et al. 1996a). After the 2-year follow-up mothers were interviewed again and the health problems of the child were elicited. Poor dyadic mother-infant interaction and infant's poor interactive behaviour assessed at two months were separately associated with the physical health of the child during the two-year follow-up. After adjusting for other factors in the logistic regression analysis infant's poor interactive behaviour remained as a significant predictor of chronic or recurrent health problems in the child. Infant's health problems at the time of the initial interview and day care centre attendance were also significant predictors. The results suggest that interactional issues between a mother and her infant are related to the child's subsequent physical health. Children with recurrent or chronic health problems may have relationship difficulties with which they need help. Also, early avoidant behaviour of the infant should be regarded as an indicator of the infant's distress with possibly adverse outcomes in the child's physical health, among other consequences.

This study's objectives are to: investigate potential additive and multiplicative influences of rurality and race/ethnicity on chronic physical illness in a nationally representative sample of youth; and examine intra-Latino processes using a Latino sub-sample. Specifically, we examine how rurality and individual psychosocial processes reflected by acculturation proxies (generational status and use of the English language at home) link to chronic physical illness of Latino youth. Finally, we examine whether these associations and the levels of chronic illness differ across Latino subgroups. Logistic-normal (binomial) modeling analyses examine multilevel influences on physical health using longitudinal data from a nationally representative sample (N = 13,905) of white, African American, Latino, Asian, and Native American adolescents between the ages of 12 and 19 participating in the National Longitudinal Study of Adolescent Health. Prevalence rates of certain chronic illnesses (obesity, asthma, and high cholesterol) among Latino adolescents exceed rates for the same illnesses among white adolescents. Comparisons between rural and non-rural youth reveal a rurality disadvantage in terms of any chronic illness likelihood among Latino, Asian, and Native American youth not evident among whites or African Americans. Among Latino youth (N = 2,505), Mexican Americans show lower health risk for any chronic illness compared to other Latino groups. However, third generation Latinos and those who primarily speak English at home experience higher risk for any chronic illness than do those of first or second generation status, with amplification of the risk linked to English use at home among Latino youth living in rural areas.

This article focuses on individuals who are growing old with chronic illnesses and early onset impairments. Their experience of illness complications, bodily and functional losses is similar to what Bury has referred to as a biographical disruption. However, whereas Bury argues that a chronic illness amounts to a critical situation for the individual, partly due to its unexpected nature, this does not apply to the participants in our two studies. A second difference concerns Bury's implicit suggestion that the disruption is a single event that is characteristic of the early stage of a chronic illness. Repeated disruptions seemed to shape the lives of several of those interviewed. At the same time, this article challenges studies which suggest that the notion of disruption is less relevant to people in later life and to those who have experienced difficult lives, and also questions the argument that continuity rather than change characterises the lives of people who have had chronic conditions since their early years. In its approach, the article responds to Williams' request for studies in the sociology of chronic illness that extend the predominant biographical focus on the middle years of life to both ends of the life course.

DEPRESSION AND CHRONIC PHYSICAL ILLNESS ARE IN RECIPROCAL RELATIONSHIP WITH ONE ANOTHER: not only do many chronic illnesses cause higher rates of depression, but depression has been shown to antedate some chronic physical illnesses. Depression associated with physical illness is less well detected than depression occurring on its own, and various ways of improving both the detection and treatment of depression accompanying physical illness are described. This paper is in four parts, the first dealing with the evidence for depression having a special relationship with physical disorders, the second dealing with detection of depression in physically ill patients, the third with the treatment of depression, and the fourth describing the advantages of treating depression among physically ill patients.