Perceived Burden Of Illness Research Articles

Childhood Adversities as Determinants of Cardiovascular Disease Risk and Perceived Illness Burden in Adulthood: Comparing Retrospective and Prospective Self-Report Measures in a Longitudinal Sample of African Americans.

A large body of evidence suggests that exposure to childhood adversities increases risk for poor quality physical health in adulthood. Much of this evidence is based on retrospective measures which are believed to be contaminated by the limitations and biases of autobiographical memory. Using longitudinal data on 454 African Americans (61 percent female) this study examines the corroboration between prospective and retrospective measures of childhood adversities gathered approximately two decades apart, and the relative ability of the measures to predict self-reported illnesses and a biomarker of 30-year cardiovascular disease risk. Comparisons indicated that the retrospective and prospective measures demonstrated weak convergence and did not provide completely equivalent information about self-reported adverse childhood experiences. A series of regression models indicated that the two measures of adversities exhibited similar associations with the cardiovascular disease biomarker but divergent associations with self-reported illnesses. Furthermore, both the prospective and retrospective measures simultaneously predicted cardiovascular disease risk in adulthood. That the prospective measure did not significantly predict perceived illnesses after adjusting for the retrospective measure is evidence that childhood adversities predict self-reported health burden insofar as respondents remember those adversities as adults. The findings provide evidence that retrospective self-report measures of childhood adversities do not closely converge with prospective measures, and that retrospective measures may not provide valid estimates of the association between childhood adversities and perceived illnesses in adulthood.

How Do Pain Characteristics, Comorbidity Severity and Patient Characteristics Influence Chronic Pain Patients’ Self-Management Priorities?

POSTER ABSTRACTIntroduction/Aim: More than half of chronic pain patients suffer from other chronic health conditions. This study aims to 1) examine the degree to which pain management is a priority among individuals with multiple medical conditions and 2) identify predictors of pain prioritization.Methods: The sample is comprised of 99 patients suffering from chronic pain (≥ 3 months) and ≥ 1 other medical condition recruited through patient associations and social/conventional media. Self-report questionnaires (pain characteristics, patient characteristics, type and severity of comorbidities) were completed at baseline and a pain prioritization diary was completed twice weekly for 6 weeks. Univariate regression models were used to identify pain, patient and comorbidity variables (p > 0.20) that would be included in a final multivariate model to examine pain management priority (model 1) and stability of prioritization (model 2).Results: Pain management prioritization scores ranged from 1.67 to 4.92 out of 5 (SD = 0.76) and 16.2% of participants reported ≥ 20% increase or decrease in the priority given to pain management over a six-week period. Model 1: Perceived illness burden was the only predictor retained in the univariate analysis (p = 0.074) to predict levels of pain management prioritization. Model 2: None of the characteristics examined were significantly associated with stability of prioritization of pain management symptoms.Discussion/Conclusions: Prioritization of pain management is a dynamic process that does not seem to be influenced by severity of pain, individual characteristics or severity of comorbidities. The next step is to examine time-varying predictors of pain management prioritization.

Change in self-rated general health is associated with perceived illness burden: a 1-year follow up of patients newly diagnosed with type 2 diabetes.

BackgroundDiabetic patients’ lifestyle adaptations to improve glycaemic control are not always followed by improvements in self-rated general health (SRH). The perceived impact of diabetes on patients’ daily lives may influence changes in their SRH. This paper examines the association of illness severity, treatment, behavioural, and coping-related factors with changes in SRH from diagnosis of type 2 diabetes until one year later, in a population-based sample of 599 patients aged 40 years or over who were treated in general practice.MethodsChange in SRH was estimated by a cumulative probit model with the inclusion of covariates related to SRH (e.g. illness severity at diagnosis, behaviour, treatment, and the perceived impact of diabetes on patients’ daily lives one year later).ResultsAt diagnosis, 11.6% of patients reported very good, 35.1% good, 44.6% fair and 8.5% poor SRH. Physical inactivity, many diabetes-related symptoms, and cardiovascular disease were related to lower SRH ratings. On average SRH improved by 0.46 (95% CI: 0.37; 0.55) during the first year after diagnosis without inclusion of covariates. Mental and practical illness burden was the only factor associated with change in SRH, independent of patients’ diabetes severity and medical treatment (p = 0.03, multivariate analysis). Compared to otherwise similar patients without illness burden, increase in SRH was marginally smaller among patients who expressed minor illness burden, but much smaller among patients with more pronounced illness burden.ConclusionsMuch as one would expect, many patients increased their SRH during the first year after diabetes diagnosis. This increase in SRH was not associated with indicators of illness severity or factors reflecting socio-demographic circumstances, but patients experiencing illness burden had a smaller increase than those who reported no illness burden. We suggest that during the diabetes consultation, general practitioners explore further how patients manage their illness burden. We further suggest that diabetes guidelines extend their current focus on clinical and social aspects of diabetes to include questions on patient’s perceived illness burden and SRH.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1790-6) contains supplementary material, which is available to authorized users.

Medication adherence in a sample of elderly suffering from hypertension: evaluating the influence of illness perceptions, treatment beliefs, and illness burden.

Although many advances in the management of hypertension have been made, success in hypertension control in real-life practice is limited. Control of hypertension is paramount in primary as well as secondary prevention of cardiovascular disease. Poor adherence to antihypertensive medication is one possible reason why success in clinical trials has not been translated into everyday practice. Despite many years of study, questions remain about why patients do or do not take medicines and what can be done to change their behavior. Although trends in adherence patterns across hypertensive patients is briefly documented in the literature, the role of perceived illness burden in addition to illness perceptions and medication beliefs in elderly people with hypertension is unclear. To assess the collective influence of illness perceptions, medications beliefs, and illness burden on medication adherence of a sample of elderly people suffering from hypertension. A cross-sectional questionnaire survey research design, utilizing convenience sampling strategies and a battery of self-administered health surveys, was adapted to address key study objectives. Previously validated instruments, such as the Brief Illness Perception Questionnaire, Pictorial Representation of Illness and Self Measure Revised II, Beliefs about Medicines Questionnaire, and Morisky Medication Adherence Scale, were utilized to assess illness perceptions, perceived illness burden, medication beliefs, and medication adherence, respectively. Conceptualized associations among the study variables were explored and tested to assess their individual, as well as collective, impact on medication adherence. In addition, combined predictive abilities of key variables in explaining the variations in medication adherence were determined using appropriate bivariate and multivariate statistics. The majority of the sample was white (76.9%); 52.1% was over aged 65 years of which 47.9% attended some college, while 70.1% accessed adult day care centers. A usable sample of 117 respondents was retained for statistical analysis. From multiple linear regression analysis, it was observed that perceptions about illness, perceived illness burden, and beliefs about medication jointly played a significant role in the prediction of medication adherence (R-squared = 0.328). Significant bivariate correlations among study variables further indicated that threatening view of illness translated into higher levels of self-reported adherence with hypertensive medications (r = 0.332, P < 0.001), which in turn was associated with lower perceived illness burden (r = 0.423, -0.444, P < 0.001). The respondents reported illness-related “Stress” (49.1%) as a primary cause of hypertension in their opinion, followed by “Lifestyle” (43.8%) and “Heredity” (7.1%) factors. Perceived concerns about the benefits of medication played a more significant role in the prediction of adherence and perceived illness burden than the risks associated with their use. This study provides insights into how perceptions of illness and burden relate to medication adherence in hypertension. More benign perceptions of illness and greater perceived illness burden translate to lower medication adherence. Positive beliefs regarding medications are also crucial for shaping adherence behavior of elderly hypertensive individuals. Threatening views of illness and stronger beliefs of the necessity of medications contribute substantially to positive medication adherence. Interventions and programs aimed at building adherence in elderly hypertension patients need to recognize the value and importance of patient perceptions of illness and medications in shaping adherence behavior.

Couples and Diabetes: A 30-Year Narrative Review of Dyadic Relational Research

Diabetes is a chronic condition that affects both members of a couple. However, relatively few studies have focused on the entire couple system as the unit of observation when examining the psychosocial impact of this disease. This narrative review examines the literature between 1980 and 2010 that uses the couple as the unit of observation. A total of 49 articles were identified for review. Articles were grouped by their central themes or outcomes: (1) sexual functioning, (2) relationship adjustment and support, (3) culture and spirituality, (4) treatment/education programs, and (5) diabetes as a risk factor. Research and clinical implications such as increasing the utilization of dyadic analytical strategies and the importance of assessing illness burden from each partners’ perspective are discussed. Identified benefits of incorporating the couple dyad for future research and clinical practice included: (1) understanding the influence of variables such as a non-diabetic partner and gender have on diabetes adjustment and management, (2) the role disease severity and management of diabetes by the partner living with diabetes has on spousal support and non-diabetic partner emotional wellbeing, (3) the interdependent nature of couple outcomes in the areas of adjustment to sexual dysfunction, perceived illness burden, and couple satisfaction, as well as, (4) disease as both an individual and a shared experience among couples.

Immunologic Status Correlates with Severity of Physical Symptoms and Perceived Illness Burden in Chronic Fatigue Syndrome Patients

ABSTRACTThe purpose of the present study was to investigate the relationship between immunologic status and physical symptoms in Chronic Fatigue Syndrome (CFS) patients. Twenty-seven patients diagnosed with CFS were included. Participants completed a questionnaire including selected subscales of the Sickness Impact Profile, the Cognitive Difficulties Scale, and frequency and severity of CFS-related physical symptoms. Cellular immune markers measured included number and percent of T-helper/inducer cells (CD3+CD4+), T-cytotoxic/ suppressor cells (CD3+CD8+), activated T-lymphocytes (CD26+CD2+ CD3+), activated T cytotoxic/suppressor cells (CD38+HLA-DR+CD8+), and CD4/CD8 ratio. Spearman's correlation coefficients revealed significant associations between a number of immunologic measures and severity of illness suggesting that the degree of cellular immune activation was associated with the severity of CFS-related physical symptoms, cognitive complaints, and perceived impairment secondary to CFS. Specifically, ...