Effects Of Illness Research Articles

P445 Patients with active perianal fistulas have a reduced physical health compared with Crohn’s patients without perianal fistulas

Perianal fistulas are a common complication in patients with Crohn’s disease (CD). We compared illness perceptions, coping strategies, health-related quality of life and work productivity between CD patients without fistulas and CD patients with active perianal fistulas. CD patients with fistulas from our outpatient clinic (n = 151) were asked to complete questionnaires on health-related quality of life (SF-12 and sIBDQ), work/activity impairment (WPAI), illness perceptions (IPQ-R) and coping strategies (CORS). Patients with active fistulas, defined as self-reported fistula production, and who returned all the questionnaires, were included in this study. CD patients without perianal fistulising disease were selected from the JOINT cohort1 and used as a control group (n = 112). Crude differences in each questionnaire between the two groups were analysed using the Mann–Whitney U test. Linear regression models were used to stabilise adjusted associations correcting by gender, age at diagnosis, disease duration and the presence of a stoma. Our cohort included 30 patients with active perianal fistulas. All patients had a long IBD disease history. Mean duration of perianal fistulising disease was 149 (SD = 99) months. Baseline characteristics between the two groups were comparable, although patients with active perianal fistulas were more likely to have a stoma (Table 1). Physical health (PCS-12) scores for patients with active fistulas were significantly lower compared with patients without fistulas (adjusted β = −5.5; CI(95%) = −10.6 to −0.5, p = 0.032). No differences in the mental health scores (MCS-12) or sIBDQ were detected between the two groups. Patients with active fistulas had significantly more work impairment (median 0.20 vs. 0.10, p = 0.010). Furthermore, patients with active fistulas held more negative views concerning the effects of their illness on daily functioning (adjusted β = 0.78; CI(95%) = 0.28 to 1.27 (95% CI), p = 0.003). No differences were found in coping strategies between the two groups. Patients with active perianal fistulas have a lower physical health, experience more work impairment and perceived more illness consequences compared with CD patients without perianal fistulas, which is important for the gastroenterologist to consider when treating these patients. 1. van Erp SJ et al. Classifying back pain and peripheral joint complaints in inflammatory bowel disease patients: a prospective longitudinal follow-up study. J Crohns Colitis, 2016;10:166–175.

Universal Health Coverage: Public Health's Safe Haven or Beautiful Illusion?

In 2005, World Health Organization proposed Universal Health Coverage (UHC) as a powerful tool to achieve “the right to health”. UHC is a prepaid healthcare financing system aiming to provide accessible quality healthcare for all and protect population from economic consequences of illness. Ever since, UHC is a priority for many countries, which lowmiddle income ones are on the run to achieve, big players like America or UK still debate over many unresolved problems. So what can UHC achieve and is it truly the flawless pathway to global health?

Action Anthropology in a Free Clinic

In this article, we describe a mixed methods study in a free clinic for uninsured, impoverished, and medically vulnerable persons in Syracuse, New York. Our model, Community Action Research and Education, draws on Action Anthropology, as developed by Sol Tax, in which faculty, students, and community members work together to develop and conduct the research. The study includes a quantitative review of 600 patients' charts and two rounds of qualitative patient interviews on health literacy and life history. The findings indicate that the patients had higher than expected education. For many, the consequences of mental illness and substance dependence led to job loss, incarceration, homelessness, and burning bridges with family members. This study provides information for policymakers in light of the present challenges to the Affordable Care Act. In addition, the study provided data for the clinic administrators to use in funding requests and fine-tuning their services. Students benefitted as well by learni...

Factors Influencing on Mental Health Help-seeking Behavior Among Korean Women: A Path Analysis

PurposeThe purpose of the study was to identify factors influencing mental health help-seeking behavior among women in the community. MethodsA cross-sectional design was used. Participants were 402 women in South Korea. Data were analyzed using descriptive statistics, Pearson's correlation coefficient, and a path analysis by IBM SPSS 21.0 and AMOS 21.0. ResultsThere was a significant, but weak positive correlation between perceived need and help-seeking intentions for formal mental health help (r=0.09, p<0.05). In the path analysis, significant the factors influencing help-seeking intentions were perceived need, attitude, and belief toward mental illness, and the attitude of them had the greatest effect. These factors accounted for 12.2% of the total variance, and the model fit was acceptable. ConclusionThe findings of the study reveal that positive mental illness interpretation and consequence can predict mental health help-seeking behavior of women as well as the perceived need for mental health help.

Financial Consequences of Illness: Evidence From Slums

Financial Consequences of Illness: Evidence From Slums

Knowledge, Awareness and Attitude Related to First Aid among Iium Kuantan Campus Students

Introduction: Accidental injuries are one of the leading causes of morbidity and mortality worldwide. Approximately 1.25 million lives are cut short because of road traffic accident every year. As the incidences of emergencies is steadily increasing in recent years, it is important to ensure that individuals are adequately trained to deal with such events including university students. First aid is given to preserve life and minimize the consequences of injury and illness until help is obtained from health care practitioners. This study aimed to assess the level of knowledge, awareness and attitude related to first aid among IIUM Kuantan campus students. Materials and method: A quantitative cross-sectional survey with stratified random sampling was conducted among 348 IIUM Kuantan undergraduate students who met the study inclusion criteria. Data were collected by using the self-administered questionnaire which was adapted from Hong Kong Red Cross. Results: A total of 316 participants had positive awareness and attitude towards first aid knowledge. Nevertheless, 149 participants had moderate level of first aid knowledge. There were significant associations (p value of 0.05) between gender, faculty, year of study, and first aid training experience and their level of first aid knowledge. However, 55.4% of study participants did not have experience in taking first aid course and they have little knowledge on first aid. Conclusion: Although the majority of participants had positive awareness and attitude towards first aid, their knowledge and experience in taking first aid course were unsatisfactory. Therefore, there is a need of proper and regular educational programs to raise awareness in the student community about the importance of first aid.

Frequency and predictors of psychological distress after a diagnosis of epilepsy: A community-based study

ObjectiveThe objective of the study was to determine the frequency and predictors of psychological distress after a diagnosis of epilepsy. MethodsThe Sydney Epilepsy Incidence Study to Measure Illness Consequences (SEISMIC) was a prospective, multicenter, community-based study of people of all ages with newly diagnosed epilepsy in Sydney, Australia. Analyses involved multivariate logistic regression and multinomial logit regression to identify predictors of psychological distress, assessed using the Hospital Anxiety and Depression Scale (HADS) and the Strengths and Difficulties Questionnaire (SDQ), as part of structured interviews. ResultsPsychological distress occurred in 33% (95% confidence interval [CI] 26 to 40%) and 24% (95% CI 18 to 31%) of 180 adults at baseline and 12months, respectively, and 23% (95% CI 14 to 33%) of 77 children at both time points. Thirty adults and 7 children had distress at baseline who recovered at 12months, while 15 adults and 7 children had new onset of distress during this period. History of psychiatric or behavioral disorder (for adults, odds ratio [OR] 6.82, 95% CI 3.08 to 15.10; for children, OR 28.85, 95% CI 2.88 to 288.60) and higher psychosocial disability (adults, OR 1.17, 95% CI 1.07 to 1.27) or lower family functioning (children, OR 1.80, 95% CI 1.08 to 3.02) were associated with psychological distress (C statistics 0.80 and 0.78). ConclusionsPsychological distress is common and fluctuates in frequency after a diagnosis of epilepsy. Those with premorbid psychological, psychosocial, and family problems are at high risk of this adverse outcome.

A Return to Wisdom: Using Sickness Behaviors to Integrate Ecological and Translational Research.

Sickness is typically characterized by fever, anorexia, cachexia, and reductions in social, pleasurable, and sexual behaviors. These responses can be displayed at varying intensities both within and among individuals, and the adaptive nature of sickness responses can be demonstrated by the context-dependent nature of their expression. The study of sickness has become an important area of investigation for researchers in a wide range of areas, including psychoneuroimmunology (PNI) and ecoimmunology (EI). The general goal of PNI is to identify key interactions among the nervous, endocrine and immune systems and behavior, and how disruptions in these processes might contribute to disease states. EI, in turn, has been established more recently within the perspectives of ecology and evolutionary biology, and is aimed more at understanding natural variation in immune function and sickness responses within a broadly integrative, organismal, and evolutionary context. The goal of this review is to examine the literature on sickness from both basic and biomedical perspectives within PNI and EI and to demonstrate how the integrative study of sickness behavior can serve as an integrating agent to connect ecological and translational approaches to the study of disease. By focusing on a set of specific exemplars, including the energetics of sickness, social context, and environmental influences on sickness, we hope to accomplish the larger goal of developing a common synthetic framework to understand sickness from multiple levels of analysis and varying perspectives across the fields of PNI and EI. By applying this integrative approach to sickness, we will be able to develop a more comprehensive view of sickness as a suite of adaptive responses rather than the simply deleterious consequences of illness.

Relationship Between Spiritual Well-Being and Hope in Patients with Cardiovascular Disease

Spirituality and hope have been identified as important constructs in health research, since both are thought to enhance a person's ability to cope with the consequences of serious illness. The aim of this study was to examine the relationship between spiritual well-being and hope in patients with cardiovascular disease. Using descriptive, correlational methodology, the investigator gathered data on a convenience sample of 500 patients with cardiovascular disease who were hospitalized in a medical institution in Iran. The study was conducted over a four-month period. Participants completed a demographic questionnaire, the Spiritual Well-Being Scale (SWBS) and the Herth Hope Index (HHI). The mean score on the SWBS and HHI was 86.21 (SD 12.46) and 34.80 (SD 5.05), respectively. Multivariate predictors for spiritual well-being were female gender (p=0.047), religiosity (p=0.018), and hope (p<0.001). Significant predictors of hope were marital status (p<0.001), educational status (p<0.001), economic status (p<0.001), and spiritual well-being (p<0.001). Findings suggest that multiple factors may impact spiritual well-being and hope. Therefore, this study has implications for those providing care to patients with cardiovascular disease.

Health profile for Danish adults with activity limitation: a cross-sectional study

BackgroundStudies have indicated that people with disabilities die earlier and may experience a poorer health than the general population. This study investigated 31 factors related to health and well-being, health behaviour and social relations among Danish adults with activity limitation (AL).MethodsThis study was based on data from the Danish Health and Morbidity Survey (DHMS) 2013 where 25,000 men and women aged 16 years or older were selected randomly from the adult Danish population. A total of 14,265 individuals answered the self-administered questionnaire including 100 questions on health-related quality of life, health behaviour, morbidity, consequences of illness and social relations. Based on an international standard question on AL, 888 individuals (6%) were defined as having profound AL and 4180 (29%) as having some AL. Multiple logistic regression analyses were used to analyse the associations between activity limitation and 31 indicators of health. The results were presented as relative risks 95% confidence intervals.ResultsTwenty-eight of 31 indicators showed consistently poorer health and well-being, health behaviour and social relations among individuals with AL as compared to individuals without AL. The increased relative risks were in a range of 7-661% the risk among individuals without AL. An example is obesity where RR (95% CI) was 2.07 (1.82–2.37).Only contact with internet friends was significantly higher among individuals with AL as compared to individuals with no AL. There was no association between alcohol and AL and no association between fast food and some AL.ConclusionDanish adults with AL experience a poorer health and well-being, and have an unhealthier lifestyle and poorer social relations than adults without AL. People with activity limitation should be prioritized in public health and efforts done to secure availability and flexibility of health care services and primary prevention programs. Policies should address accessibility, availability and affordability of health care and health behaviour among people with activity limitation.

Occurrence of Clinical Bone Fracture Following a Prolonged Stay in Intensive Care Unit: A Retrospective Controlled Study.

Clinical consequences of critical illness and critical care (CC) on bone health remain largely unexplored. This retrospective study aimed to assess the number of new bone fractures (BF) following a prolonged length of stay (LOS) in intensive care unit (ICU). Adults admitted in our tertiary ICU during 2013 with a stay >7days were included (CC group). Patients who died in ICU or lost to follow-up were excluded. For each CC patient still alive after 2years of follow-up, 2 control patients, scheduled for surgery during 2013, were recruited and matched for gender and age. Basal fracture risk before admission was calculated using FRAX tool. General practitioners were phoned to check out new bone fracture (BF) during 2years after admission. Of the 457 enrolled CC patients, 207 did not meet inclusion criteria and 72 died during FU (median age 72 [65-77]years). New BF occurred in 9 of the 178 patients still alive at the end of FU (5%). Median age of these patients was 64 [53-73]years. Fractured patients did not differ from non-fractured ones based on demographic and clinical characteristics, excepting for FRAX risks that were higher in fractured patients. In the control group, 327 patients were analyzed. Their rate of BF was 3.4% without statistical significance compared to the CC group. FRAX risks were similar in both groups. The risk of new BF in CC group, expressed as an odds ratio, was 50% higher than in the control group without achieving statistical significance (odds ratio 1.53; 95% confidence interval 0.62-3.77; p=0.35). When comparing ICU survivors to patients who underwent uncomplicated surgery in the present preliminary study included limited cohorts, the fracture risk in the 2years following prolonged ICU stay was not statistically higher. However, CC fractured patients had higher FRAX risks than non-fractured patients. Such screening could help to target prevention and appropriate treatment strategies.

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Nutrition Screening: Coding after Discharge Underestimates the Prevalence of Undernutrition

Psychometric Properties of the Revised Illness Perception Questionnaire for Oral Health

Aims: The aim of this study was to test the hypothesis that, for patients with dental caries, the Spanish version of the Revised Illness Perception Questionnaire for Oral Health (IPQ-R-OH) has 7 dimensions, including personal and treatment control, timeline-acute/chronic and timeline-cyclical, illness coherence, consequences, and emotional representations. Methods: A Spanish adaptation of the IPQ-R, with a self-reported 38-item scale, was developed. Exploratory and confirmatory factor analyses were conducted using data from 520 patients with dental caries attending the Dental Clinic at Universidad Cooperativa de Colombia, Pasto, Colombia. Results: Exploratory factor analysis revealed 7 dimensions with 36 items (2 items were removed because of poor factor loadings or discriminant ability). The internal consistency coefficients of each factor ranged from 0.72 to 0.91, and all item loadings were >0.52. Confirmatory factor analysis indicated that a 7-factor model with 36 items had superior fit compared to the 38-item original model: χ² = 1,784.291 (df = 573, p < 0.001); nonnormal fit index = 0.941; comparative fit index = 0.946; root mean square error of approximation = 0.062 (90% CI = 0.057-0.066); standardized root mean square residual = 0.072; and Akaike information criterion = 638.291. Control (integrated by items from personal control, treatment control, and timeline-acute factors) and hopelessness (PC15 and PC17) were the 2 reconfigured factors that were identified. Conclusions: These findings suggest that the modified 36-item model has satisfactory reliability and construct factorial validity; therefore, it could be a valuable instrument in the screening of illness perceptions in oral health.

High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country.

The mental health treatment gap for youth in low- and middle-income countries (LMICs) is substantial; strategies for redress are urgently needed to mitigate the serious health and social consequences of untreated mental illness in youth. To estimate the burden of major depressive episode (MDE) and posttraumatic stress disorder (PTSD) as well as utilization of care among Haitian youth in order to describe the mental health treatment gap in a LMIC setting. We estimated the point prevalence of MDE, PTSD, and subthreshold variants in a school-based sample of youth ( n = 120, ages 18-22 years) using a modified Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID)-based interview and examined treatment utilization among those receiving one of these diagnoses. We assessed additional psychopathology with self-report measures to examine validity of study diagnostic assignments. The combined prevalence of full-syndrome or subthreshold MDE or PTSD was high (36.7%). A large majority of affected individuals (88.6%) had accessed no mental health services in the health sector, and 36.4% had accessed no care of any kind in either the health or folk sectors in the past year. Findings demonstrate a high mental health burden among Haiti's youth and that many youth with MDE and PTSD are not accessing mental health care.

Illness representation as a factor of quality of life in youth with mental illnesses

IntroductionCognitive perspective considers beliefs as key factors of compliance and adjustment in mental disorders (Beck, 2011) that are especially important in youth. In psychosis illness, representation is related to CBT efficacy.ObjectivesWe suggest that in different mental disorders different illness-related beliefs are important for quality of life domains.AimTo reveal relationships between illness representation and quality of life in mental disorders controlling for psychopathological symptoms.MethodsOne hundred and eighteen male patients 17 – 27 years old : 33 with mood disorders, 26 with personality disorders, 27 with schizotypal disorder and 32 with schizophrenia recovering after first episode of psychosis filled Illness Perception Questionnaire, Symptom Checklist 90-R, Quality of Life and Enjoyment Questionnaire (version for mental illnesses).ResultsAfter statistical control for psychopathological symptoms, in personality disorders feeling of personal and treatment control (β = .43–.52, P &lt; .01) as well as belief in longer (β = .42, P &lt; .05) but not cyclic (β = –.65, P &lt; .05) illness duration predicted satisfaction with health while belief in longer duration and less consequences correlated with better satisfaction with leisure time (β = .87, P &lt; .01). In mood disorders, feeling of treatment control (β = .32, P &lt; .05) and belief in shorter illness duration (β = –.37, P &lt; .05) were related to better satisfaction in emotional sphere.ConclusionsBeliefs about illness duration, consequences and control could be important in assessment and CBT for youth with personality disorders while treatment control and illness duration are important in work with youth with mood disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Kaleidoscope

We open with some major and significant randomised controlled trials exploring interventions in resource-poor societies. Two papers by the same team writing in the Lancet explore the use of non-specialist ‘lay counsellor’ health workers to deliver brief psychological interventions for excessive alcohol consumption and depression in India. Male harmful drinkers in ten primary health centres were randomised to receive either enhanced usual care (EUC), or EUC and Counselling for Alcohol Problems (CAP). The active intervention produced significantly greater remission and abstinence rates, with an incremental cost per additional remission of $217. A Healthy Activity Program (HAP) for moderately to severely depressed men and women was evaluated in a different cohort, with a parallel design of EUC compared with EUC plus therapy. Once again, the active intervention produced significant improvements, with reductions in depression symptomatology and remission, as well as decreased illness consequences such as days out of work and intimate partner violence. Both interventions were reported to be acceptable to patients and practical for delivery in primary care settings.

Doing it hard in the bush: Aligning what gets measured with what matters.

What gets measured gets managed. Funding of health services is substantially determined by operational activity and specific outcome indicators. In day-to-day clinical decision-making, surrogate markers, such as glycosylated haemoglobin and blood pressure, are commonly used to modify risks of 'hard' outcomes that include kidney failure, ischaemic cardiac events, stroke and all-cause mortality. In many settings, surrogates are all we have to go on. As a consequence, current health funding models heavily rely on surrogate-based key performance indicators [KPIs]. While surrogates are convenient and provide immediate information, there is an obligation to ensure that they are appropriate, reliable and validated in context. In contrast, hard outcomes, the real consequences of illness, are usually realised over an extended timeframe. Additionally, and for a host of reasons, hard endpoints have the greatest social, emotional and economic impact for people at the far end of the health system; those in rural and remote settings - 'in the bush' - especially Indigenous Australians. We propose a health service assessment approach that aligns short-term decision-making with patient-centred and longer term hard outcomes, one that takes into account community, cultural and environmental factors, especially remoteness. Communities should have a major say in determining what health indicators are measured and managed.

The Greek-Orthodox version of the Brief Religious Coping (B-RCOPE) instrument: psychometric properties in three samples and associations with mental disorders, suicidality, illness perceptions, and quality of life

BackgroundThe B-RCOPE is a brief measure assessing religious coping. We aimed to assess the psychometric properties of its Greek version in people with and without long-term conditions (LTCs). Associations between religious coping and mental illness, suicidality, illness perceptions, and quality of life were also investigated.MethodsThe B-RCOPE was administered to 351 patients with diabetes, chronic pulmonary obstructive disease (COPD), and rheumatic diseases attending either the emergency department (N = 74) or specialty clinics (N = 302) and 127 people without LTCs. Diagnosis of mental disorders was established by the MINI. Associations with depressive symptom severity (PHQ-9), suicidal risk (RASS), illness perceptions (B-IPQ), and health-related quality of life (WHOQOL-BREF) were also investigated.ResultsThe Greek version of B-RCOPE showed a coherent two-dimensional factor structure with remarkable stability across the three samples corresponding to the positive (PRC) and negative (NRC) religious coping dimensions. Cronbach’s alphas were 0.91–0.96 and 0.77–0.92 for the PRC and NRC dimensions, respectively. Furthermore, NRC was associated with poorer mental health, greater depressive symptom severity and suicidality, and impaired HRQoL. In patients with LTCs, PRC correlated with lower perceived illness timeline, while NRC was associated with greater perceived illness consequences, lower perceived treatment control, greater illness concern, and lower illness comprehensibility.ConclusionsThese findings indicate that the Greek-Orthodox B-RCOPE version may reliably assess religious coping. In addition, negative religious coping (i.e., religious struggle) is associated with adverse illness perceptions, and thus may detrimentally impact adaptation to medical illness. These findings deserve replication in prospective studies.

The Illness Experience of Undocumented Immigrants With End-stage Renal Disease

The exclusion of undocumented immigrants from Medicare coverage for hemodialysis based on a diagnosis of end-stage renal disease (ESRD) requires physicians in some states to manage chronic illness in this population using emergent-only hemodialysis. Emergent-only dialysis is expensive and burdensome for patients. To understand the illness experience of undocumented immigrants with ESRD who lack access to scheduled hemodialysis. A qualitative, semistructured, interview study was conducted in a Colorado safety-net hospital from July 1 to December 31, 2015, with 20 undocumented immigrants (hereinafter referred to as undocumented patients) with ESRD and no access to scheduled hemodialysis. Demographic information was collected from the participants' medical records. The interviews were audiorecorded, translated, and then transcribed verbatim. The interviews were analyzed using inductive qualitative theme analysis by 4 research team members from March 1 to June 30, 2016. Themes and subthemes from semistructured interviews. All 20 undocumented patients included in the study (10 men and 10 women; mean [SD] age, 51.4 [13.8] years) had been in the United States for at least 5 years preceding their diagnosis with ESRD. They described the following 4 main themes: (1) a distressing symptom burden and unpredictable access to emergent-only hemodialysis, (2) death anxiety associated with weekly episodes of life-threatening illness, (3) family and social consequences of accommodating emergent-only hemodialysis, and (4) perceptions of the health care system. Undocumented patients with ESRD experience debilitating, potentially life-threatening physical symptoms and psychosocial distress resulting from emergent-only hemodialysis. States excluding undocumented immigrants with ESRD from scheduled dialysis should reconsider their policies.

A psychometric evaluation of the Dutch Short Health Anxiety Inventory in the general population.

Distress or anxiety about health is known as health anxiety. One of the most widely used scales to measure health anxiety is the Short Health Anxiety Inventory (SHAI; Salkovskis, Rimes, Warwick, & Clark, 2002). The current study contributes to both the applicability and understanding of the SHAI by making 5 interrelated methodological contributions: (a) developing a Dutch translation of the SHAI, (b) validating this translation in the Dutch general population, (c) comprehensively examining its factor structure, (d) examining predictive validity and test-retest reliability of test scores, and (e) testing measurement invariance across subsamples and over time and comparing SHAI scores in subsamples of healthy and ill individuals and males and females. Data were collected from 5,310 respondents in 2 consecutive waves with a 2-month time gap. The results revealed that the SHAI comprises 2 factors: Illness Likelihood (14 Items) and Negative Consequences of Illness (4 Items). Further empirical evidence for the measurement invariance of this factor structure across subsamples and over time was revealed, as well as predictive validity, internal consistency and test-retest reliability of test scores, thereby proving that it is a useful tool for measuring health anxiety in the general Dutch population. On the basis of our results, we recommend that the 14-item SHAI, that is, the Illness Likelihood subscale, be adopted to measure health anxiety in future studies. We suggest slight adaptations to some answer options and argue that the benefit of adding the Negative Consequences of Illness subscale is debatable. (PsycINFO Database Record