Secondary Health Problems Research Articles

Improving Physical Activity Through Adjunct Telerehabilitation Following Total Knee Arthroplasty: Randomized Controlled Trial Protocol.

Physical activity remains low and nearly unchanged from preoperative levels following total knee arthroplasty (TKA), and this is thought to underlie long-term functional limitations, secondary health problems, and higher health care costs after TKA. Our objective is to determine whether a telehealth-based intervention could improve physical activity and functional outcomes after TKA. The design is a 2-arm, parallel, assessor-blinded, randomized controlled trial with baseline, midintervention, postintervention, and 6-month follow-up assessments. The setting is one academic medical center and one Veterans Affairs health care system. One hundred US military veterans (aged 50-85 years) scheduled for unilateral TKA will participate in this study. The telehealth-based intervention to change physical activity behavior will be delivered through 10 sessions each of 30 minutes over a 12-week period. Participants will be provided with a wearable physical activity monitor to receive feedback on step count and guide goal-setting. Control participants will receive telehealth-based education on nonbehavioral aspects of health for the same frequency and duration as the intervention group. For both groups, telehealth sessions will occur concurrently with standardized outpatient rehabilitation. The primary outcome will be change in physical activity, assessed as daily step counts measured using an accelerometer-based sensor. Secondary outcomes will be measured using the Life-Space Assessment questionnaire and change in physical function (30-Second Chair-Stand Test, Timed "Up & Go" Test, Six-Minute Walk Test, Western Ontario and McMaster Universities Osteoarthritis Index, and Veterans RAND 12-Item Health Survey). Participant and interventionist blinding is not possible. This trial will assess the efficacy of a novel behavior-change intervention to improve physical activity and physical function in patients after TKA. Effective physical activity behavior change could provide clinicians with a technique to augment current practice and resolve poor physical activity outcomes, long-term health problems, and high costs following TKA.

Prevalence of health problems experience by persons with spinal cord injury in Malaysia

Spinal cord injury (SCI) is known to have a risk of developing secondary health problems which can be debilitating and increases the burden of care on patient and their caregiver. Our aim is to address the prevalence of health problems experience by people with SCI that living in the community and to investigate the relationship between secondary health problems with SCI characteristics. This is a database analysis of International Spinal Cord Injury (InSCI) Survey, which was carried out in Malaysia from March 2017 to February 2018. Total of eight rehabilitation centres nationwide participated in this study. However as of this point of this study analysis was conducted, only data from four centres were included for analysis. Data were extracted and analysed based on 3 items: personal background (PB), lesion characteristics (LC) and health problems (HP). We conducted analysis on 7 out of 10 sub-items from PB, all sub-items from LC and 15 out of 16 sub-items from HP. A total of 117 eligible participants were included in this study. More than half of the participants are from the age group of 25–44 years old (52%), most were single (47%). As for education, 73% of participants reported to at least completed Upper Secondary level. In relation to hierarchy of associated health problems, sexuality is the highest number of health concerns with 67% participants classified as high severity. This is followed by contractures and spasticity with percentage of 59 and 56% respectively. Except for prevalence of joint contractures, there is no difference in the prevalence of secondary health problems between participants with paraplegia and tetraplegia. Sexuality, contractures and spasticity are the top three health problems reported in persons with SCI. The occurrence of health problems among persons with paraplegia and tetraplegia is similar.

Impact of upper crossed syndrome on pulmonary function among the recreational male players: A preliminary report

Background: The upper crossed syndrome (UCS) is the one where participants present with rounded shoulders and a poked chin posture due to muscular imbalance that affects head position, spine, and shoulder girdle. The presence of this syndrome leads to secondary health problems such as myofascial trigger points, cervicogenic headache, impingement syndromes, neck pain, rotator cuff injury, and reduced lung capacity. Objective: The objective of this study is to find the impact of UCS on respiration among the recreational male players. Methodology: Sixty recreational male players were recruited in two stratified age groups, 21–30 years (Group A) and 31–40 years (Group B), and were recruited for this cross-sectional study. Among them, 30 were healthy male recreational male players while thirty recreational male players with UCS. The lung function in both the groups was compared with the two stratified age groups and analyzed. Results: Recreational male players with UCS in both the stratified age groups, 21–30 years and 30–40 years, have reduced maximum voluntary ventilation when compared to their healthy counterparts. Conclusion: Recreational male players with UCS have lower pulmonary performance when compared with their age-matched normal individuals.

Distance education and diabetes empowerment: A single-blind randomized control trial

AimsDiabetes is one of the biggest problems in healthcare systems and kills many people every year. Diabetes management is impossible when only utilizing medication. So, patients must be educated to manage their diabetes. This study aims to assess the effect of education by telephone and short message service on empowering patients with type 2 diabetes (primary outcome). Materials and methodsA single-blind randomized controlled trial was conducted in the Urmia diabetes association in Iran. Sixty six participants with definitive diagnosis of type 2 diabetes entered into the study. Patients with secondary health problems were excluded. Patients were selected by simple random sampling then allocated into intervention (n=33) and control (n=33) groups. The intervention group received an educational text message daily and instructive phone calls three days a week for three months along with usual care. The Diabetes Empowerment Scale (DES) with confirmed validity and reliability was used for collecting data. Data was analyzed using SPSS V6.1. Independent t-test, paired t-test and chi-square were used to analyze the data. ResultsThe empowerment of the intervention group compared with the control group significantly improved after three months of distance education (p<0.00, EF=1. 16). ConclusionsThe study findings show that the distance education has a significant effect on empowering patients with type 2 diabetes. Therefore, using distance education along with other diabetes management intervention is highly effective and should be part of the care in diabetes treatment.

Individualised approach to health promotion is needed for individuals with mild-to-moderate intellectual disability.

Commentary on: Kuijken NM, Naaldenberg J, Nijhuis-van der Sanden MW, et al. Healthy living according to adults with intellectual disabilities: towards tailoring health promotion initiatives. J Intellect Disabil Res 2016;60:228–41.[OpenUrl][1][CrossRef][2][PubMed][3] Across the international literature it is recognised that people with intellectual disability have poorer health and significantly more health problems than the general population.1 Many health and secondary health problems can be prevented or improved through health promotion. However, given the complexity of intellectual disability (pre-existing conditions/syndromes, comorbidities), personalised health promotion interventions are needed to promote healthy lifestyles.1 Without … [1]: {openurl}?query=rft.jtitle%253DJ%2BIntellect%2BDisabil%2BRes%26rft.volume%253D60%26rft.spage%253D228%26rft_id%253Dinfo%253Adoi%252F10.1111%252Fjir.12243%26rft_id%253Dinfo%253Apmid%252F26625732%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1111/jir.12243&link_type=DOI [3]: /lookup/external-ref?access_num=26625732&link_type=MED&atom=%2Febnurs%2F19%2F4%2F122.atom

ANALYSIS OF CLINICAL, ANAMNESTIC AND IMMUNOLOGICAL CHARACTERISTICS OF WOMEN OF REPRODUCTIVE AGES HAVING HIV INFECTION AND CHRONIC VIRAL HEPATITIS C

Socio-epidemiological characteristics, somatic anamneses, and immunological parameters were analyzed in a group of reproductive-age female HIV patients having or having no HCV coinfection. Half of the subjects received secondary education and were married. Two thirds of them were employed, 34,4% had children, and 41% had secondary somatic health problems, mainly involving the urinary system. No significant differences in socio-epidemiological characteristics between the two groups were found, except for among HIV/HCV-coinfected women there were more IDUs (96,7% vs. 93,3%) and more registered criminal cases (16,7% vs. 13,3%). In the coinfected women, blood CD4 cell counts were below 350 ml -1 before HAART and remained low over 12 months of HAART suggesting that in this group the recovery of immunity is slowed probably because of indirect effects of HCV on CD4 lymphocytes.

Are our cornea waiting lists dynamic enough?

The purpose of this study was to evaluate the dynamic reality of the corneal transplant (CT) waiting list and if the CT candidates are really eager to operation. We evaluated the response of consecutive 96 CT candidates to call for operation. The age, functional visual acuity, CT indication, waiting period, and the excuse of refusal for candidates that postponed the operation were also evaluated. The patients were classified into two groups according to the availability (Group 1, available; Group 2, unavailable). To find an available candidate for transplantation of 48 consecutive corneal tissues, 96 patients had to be called. The mean age of the patients was 57.49±18.75. The mean age of Group 1 and Group 2 was 54.28±18.12 (13-80) and 60.44±19.01 (9-88) years, respectively (p=0.108). It was found that the call refusal was higher in patients elder than age 70 (p=0.04). The mean time between being added to the list and the call was 22.96±7.80 (9-39) months for Group 1, 27.02±8.25 (9-53) months for Group 2 (p=0.015). The estimation point for waiting period was 22months (p=0.044). The most common reasons of excuse were inconvenience of timing, giving up operation, and secondary health problems, whereas anticoagulant use was the most common reason for postponement. As the waiting period gets longer and CT candidates get older, they tend to give up operation. The secondary health problems and use of systemic anticoagulants are important problems that might cause postponing the CT surgery and ruin the dynamicity of the waiting lists.

Bax deficiency extends the survival of Ku70 knockout mice that develop lung and heart diseases.

Ku70 (Lupus Ku autoantigen p70) is essential in nonhomologous end joining DNA double-strand break repair, and ku70−/− mice age prematurely because of increased genomic instability and DNA damage responses. Previously, we found that Ku70 also inhibits Bax, a key mediator of apoptosis. We hypothesized that Bax-mediated apoptosis would be enhanced in the absence of Ku70 and contribute to premature death observed in ku70−/− mice. Here, we show that ku70−/− bax+/− and ku70−/− bax−/− mice have better survival, especially in females, than ku70−/− mice, even though Bax deficiency did not decrease the incidence of lymphoma observed in a Ku70-null background. Moreover, we found that ku70−/− mice develop lung diseases, like emphysema and pulmonary arterial (PA) occlusion, by 3 months of age. These lung abnormalities can trigger secondary health problems such as heart failure that may account for the poor survival of ku70−/− mice. Importantly, Bax deficiency appeared to delay the development of emphysema. This study suggests that enhanced Bax activity exacerbates the negative impact of Ku70 deletion. Furthermore, the underlying mechanisms of emphysema and pulmonary hypertension due to PA occlusion are not well understood, and therefore ku70−/− and Bax-deficient ku70−/− mice may be useful models to study these diseases.

Unmet health and rehabilitation needs of people with long-term neurological conditions in Queensland, Australia.

The survival and life expectancy rates of people with traumatic and degenerative neurological conditions are increasing, sometimes up to several decades. Yet compared to the general population, people with a disability continue to experience poorer health and are at greater risk of developing secondary health problems and facing barriers to services they require. These trends have significant implications for provision of health and rehabilitation services. In this study, the adequacy of health and rehabilitation services provided to people with long-term neurological conditions and their unmet needs were explored from the perspectives of individual users, their nominated family members and key service providers. A qualitative research design with maximum variation sampling was used. Data were collected from semi-structured interviews with 65 participants comprising 25 long-term care service users, nominated family members or friends (n = 22) and care service providers (n = 18) in Queensland, Australia. All service users needed assistance with usual daily activities, and 22 were wheelchair dependent. The hours of funded personal care ranged from 2 to 201 hours per week. Data were analysed using framework analysis. Participants generally perceived that specialist medical and hospital services were adequate and satisfactory. They valued supportive health and rehabilitation professionals and receiving client-centred physical rehabilitation. However, the majority of participants (n = 17) had perceived unmet needs for physical rehabilitation (n = 14), other health or rehabilitation services (n = 10) or counselling (n = 6). Community-based physical maintenance rehabilitation was often perceived as inadequate, costly or inconveniently located. Participants highlighted the importance of personal and family counselling and information provision at time points such as diagnosis. The findings contribute to the limited international evidence on the gaps in health and rehabilitation services for people with neurological conditions receiving lifetime care services in the community. A continuum of integrated rehabilitation services to minimise avoidable impairments, optimise independence and functioning, and sustain quality of life is warranted.

Urologic health condition of spinal cord-injured patients living in Turkey

To determine the urologic health condition of spinal cord-injured (SCI) patients living in Turkey, and to analyze the relationship between the prevalence of urologic health condition parameters and the patient's characteristics. Telephone call survey was conducted with a structured questionnaire among all members of Turkish Society of Spinal Cord Injured Patients. Data were obtained from 300 patients. Mean age was 42 years with a male/female ratio of 2.3, while the most common cause of injury was transport (35.3%). Although 70% were aware of potential kidney and bladder problems after injury >60% of the patients were not under regular urologic follow-up. Secondary health problems experienced as being most important was urination problems (50%). Of the patients 72.7% (83% in females vs 68% in males) had urinary incontinence (UI) during last 3 months, and 64.3% used clean intermittent catheterization (CIC) (68% in males vs. 56% in females), while 73%, 57% and 26% of incontinent patients used diaper/pad, medication and condom catheter, respectively, and the use of CIC decreased with time. Surgical procedures on urinary tract were performed in 22.6% of the patients; stone surgeries were the most frequent ones. This study demonstrated that the UI rate was high among SCI patients, and more common in females with fairly good proportion of patients using incontinence medication. Main bladder management method was CIC and more prevalent in males, although the use of CIC decreased with time. Urinary stone surgery was the leading surgical procedure.

Cardiovascular control and stabilization via inclination and mobilization during bed rest

Cardiovascular deconditioning has long been recognized as a characteristic of the physiological adaptation to long-term bed rest in patients. The process is thought to contribute to orthostatic intolerance and enhance secondary complications in a significant way. Mobilization is a cost-effective and simple method to maintain the cardiovascular parameters (i.e., blood pressure, heart rate) stable, counter orthostatic intolerance and reduce the risk of secondary problems in patients during long-term immobilization. The aim of this project is to control the cardiovascular parameters such as heart rate and blood pressure of bed rest patients via automated leg mobilization and body tilting. In a first step, a nonlinear model predictive control strategy was designed and evaluated on five healthy subjects and 11 bed rest patients. In a next step, a clinically feasible study was conducted on two patients. The mean values differed on average less than 1 bpm from the predetermined heart rate and less than 2.5 mmHg from the desired blood pressure values. These results of the feasibility study are promising, although heterogeneous disease etiologies and individual medication strongly influence the mechanically induced reactions. The long-term goal is an automation of the control of physiological signals and the mobilization of bed rest patients in an early phase of the rehabilitation process. Therefore, this new approach could help to strengthen the cardiovascular system and prevent secondary health problems arising from long-term bed rest.

Mental health status and gender as risk factors for onset of physical illness over 10 years

BackgroundThere is a growing interest in understanding the connection between mental illness (MI) and the onset of new physical illnesses among previously physically healthy individuals. Yet the role of gender...

Paralytic poliomyelitis: Quality of life of adolescent survivors

Abstract Polio survivors are prone to secondary health problems that may negatively affect their quality of life (QoL), but the impact of paralytic poliomyelitis on QoL of its Nigerian survivors has not been reported in literature. We investigated and compared the QoL of Nigerian paralytic polio survivors (PPS) and age- and sex-matched apparently healthy controls (AHC). Seventy-three (45 males and 28 female) consecutive adolescent PPS and an equal number of AHC participated in the cross-sectional survey. Participants' QoL was assessed using the Comprehensive Quality of Life Scale—Adolescent. Data were analyzed with Mann-Whitney U-test and two-sample t-test at the 0.05 alpha level. There were no significant differences between the ages of PPS (14.16 ± 2.01 years) and AHC (14.18 ± 2.02 years), and between the ages of male (13.93 ± 2.16 years) and female PPS (14.30 ± 2.02 years). Polio survivors scored significantly lower than AHC in health, productivity, community, emotion and spiritual domains, and overall QoL. The PPS scored significantly higher (p

The Cost of Chronic Stress in Childhood: Understanding and Applying the Concept of Allostatic Load

This article explores the concept of allostatic load and its utility as an integrative framework for thinking about the impact of chronic stress on children and adolescents. Allostatic load refers to the failure or exhaustion of normal physiologic processes that occurs in response to severe, frequent, or chronic stressors. This persistent physiologic dysregulation may lead to secondary health problems such as immunosuppression, obesity, atherosclerosis, and hypertension. Allostatic load can be measured and followed as a composite index of a group of physiologic parameters which fall outside of a normal range. Although research regarding allostatic load in children is limited, this article explores relevant studies and identifies ways in which the concept of allostatic load can be used to broaden approaches to assessment, case formulation, and treatment in children. The concept of allostatic load may be of particular interest to psychodynamic psychiatrists in recognizing the ways in which chronic stress and adverse childhood experiences lead not only to negative psychological sequelae but also to long-term health consequences including the possibility of premature death. It underscores the importance of monitoring patients' physical as well as psychological health and thinking about the complex interrelations between the two.

Peer victimization and depression in children with and without motor coordination difficulties

AbstractDevelopmental coordination disorder (DCD) is a chronic disability that impacts children's performance of everyday motor‐based activities and is associated with the development of secondary social and mental health problems. The purpose of this study was to investigate peer victimization and depression in children who were and were not at risk for DCD. Selected from a population‐based sample, 159 at‐risk fifth graders were matched for age and gender to 159 controls. Children completed measures of depression and frequency of peer victimization. Results showed that children at risk for DCD reported more symptoms of depression and more frequent verbal and relational victimization than their peers. Being at risk for DCD and being bullied more frequently, especially relationally, significantly predicted increased depression symptoms. Findings highlight the importance of school psychologists remaining aware that children with DCD are at increased risk of experiencing bullying and depression. © 2012 Wiley Periodicals, Inc.

The effect of aerobic exercise on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy.

244 Background: Current literature suggests that weight gain during treatment for breast cancer is associated with a poorer prognosis and an increased risk of developing secondary health problems such as the metabolic syndrome (MetSyn). Physical activity (PA) can alter features of the MetSyn and improve body composition by reducing abdominal adiposity. We report metabolic results of a prospective randomized controlled trial (PEACH trial; Walsh JM, et al. [2010] BMC Cancer. 10[42]) which examines the effect of an exercise intervention on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy. Methods: All subjects gave written informed consent and were randomized to an 8-week, twice weekly aerobic exercise intervention programme or a usual care control group consisting of routine medical advice about PA. The five clinical features of the MetSyn were measured: waist circumference (WC), resting blood pressure (BP), triglycerides, high-density lipoprotein cholesterol (HDL-C) and fasting glucose. Insulin resistance was estimated by the homeostatic model assessment (HOMA). Statistical analysis was carried out using independent sample t-tests with significance set at p &lt; 0.05. Results: Twenty-six breast cancer survivors participated (mean (± SD) age 48.13 (8.75) years). At baseline, 50% (n = 13) of subjects were overweight and 23.1% (n = 6) were obese, with 73.1% (n = 19) centrally obese. 34.6% (n = 9) of subjects were classified with the MetSyn. There were no significant differences between groups at baseline. Intention-to-treat analysis showed no significant changes, however, analysis of those who adhered to &gt; 70% of the supervised exercise intervention showed a significant improvement in WC when compared to the control group (p &lt; 0.05). Conclusions: Results show that an 8-week aerobic exercise intervention significantly reduced WC but did not modify other features of the MetSyn. The decrease in WC demonstrated by this short intervention may have important implications in terms of improving survival and the metabolic risk profile of breast cancer survivors. Final follow-up assessments are ongoing and will enable change in WC over time to be evaluated further.

Consequences of Stroke in Community-Dwelling Elderly

Stroke survivors are at risk of developing comorbidities that further reduce their quality of life. The purpose of this study was to determine the risk of developing a secondary health problem after stroke. We performed a case-control analysis using 6 biennial interview waves (1998 to 2008) of the Health and Retirement Study. We compared 631 noninstitutionalized individuals who had a single stroke with 631 control subjects matched for age, gender, and interview wave. We studied sleep problems, urinary incontinence, motor impairment, falls, and memory deficits among the 2 groups. Stroke survivors frequently developed new or worsened motor impairment (33%), sleep problems (up to 33%), falls (30%), urinary incontinence (19%), and memory deficits (9%). As compared with control subjects, the risk of developing a secondary health problem was highest for memory deficits (OR, 2.45; 95% CI, 1.34 to 4.46) followed by urinary incontinence (OR, 1.86; 95% CI, 1.31 to 2.66), motor impairment (OR, 1.61; 95% CI, 1.16 to 2.24), falls (OR, 1.5; 95% CI, 1.12 to 2.0), and sleep disturbances (OR, 1.49; 95% CI, 1.09 to 2.03). In contrast, stroke survivors were not more likely to injure themselves during a fall (OR, 1.14; 95% CI, 0.72 to 1.79). After adjusting for cardiovascular risk factors, social status, psychiatric symptoms, and pain, the risks of falling or developing sleep problems were not different from the control subjects. The risk of developing a secondary health problem that can impact daily life is markedly increased after stroke. A better understanding of frequencies and risks for secondary health problems after stroke is necessary for designing better preventive and rehabilitation strategies.

Symptom Clusters in Traumatic Spinal Cord Injury

Chronic pain, spasticity, and depression are three common secondary health problems experienced by persons living with traumatic spinal cord injury. Limited research exists related to the interaction of these symptoms and their cumulative effect on patient outcomes and quality of life. This article is a report of an exploratory literature review that uses the conceptual approach of symptom clustering to classify secondary health problems in spinal cord injury. CINAHL, MEDLINE, and PsycINFO databases were searched for studies published in English between 1990 and 2008. Eleven articles met the inclusion criteria for review. Studies were categorized by levels of evidence defined by the American Association of Neuroscience Nurses Clinical Practice Guidelines. Research on the interaction of the symptom pair chronic pain and depression was evident. Several surveys reported the occurrence of multiple symptoms, but none specifically addressed the management of the interactive effects of the symptom cluster chronic pain, spasticity, and depression. Increased disciplinary knowledge of symptom clusters in the spinal cord injury population is needed for research and practice. Furthermore, determining symptom clusters in this population may assist clinicians in providing targeted interventions to simultaneously treat multiple symptoms.

Training Caregivers to Provide Virtual Reality Intervention for Adults With Severe Intellectual and Developmental Disability

Background. Individuals with intellectual and developmental disabilities (IDD) are in need of effective physical fitness training programs, leisure time opportunities, and strategies to improve their participation in daily life activities. Purpose. This study sought to present an educational program that enabled the implementation of a virtual reality (VR) program operated by in-house caregivers for adults at a severe level of IDD. Methods. During the initial stages of this series of studies, 2 groups of participants underwent a video-capture, VR-based, game-like, exercise program. The first study group (N = 33; mean age = 28.1 ± 5.3 years; moderate IDD) was trained by an experienced occupational therapist, and the second study group (N = 30; mean age = 52.3 ± 5.8 years; moderate IDD) was trained by occupational therapy students. Changes in physical fitness were monitored for all participants in comparison to matched control groups. A third study group (N = 20; mean age = 48.1 ± 8.6 years; severe IDD) was trained by in-house caregiver staff. An educational program including gathering appropriate caregivers, presenting theoretical background for the program, as well as providing on going technical support was implemented. Results. The strategy used to enable the implementation of a VR program by inhouse caregivers was shown to be feasible. The VR intervention program promoted activity and was motivating to and enjoyable by all participants with mild to moderate IDD and to most individuals with severe IDD. Significant (P Conclusion. VR technology was found as fully effective tool to engage adults with mild to moderate IDD, and some with severe levels of IDD, in a variety of activities by caregivers from different educational backgrounds and professions. Key Words: Intellectual disability, Developmental disability, Virtual reality, Physical fitness, Best practices. BACKGROUND AND PURPOSE The fact that many individuals with intellectual and developmental disability (IDD) maintain a sedentary life style, experience poorer health and have less access to health care than the general population,1 suggest that these individuals are at risk for a multitude of secondary health problems. However, the physical condition of this population may improve with appropriate intervention.2 Previous studies reveal that provision of additional leisure opportunities and participation in leisure activities by individuals with cognitive limitations contributes to improvement in self-confidence and self-concept, improvement in social and motor skills, increased communication abilities, greater physical fitness and weight reduction.3-5 Although participation in vigorous leisure activities has been shown to improve participants' physical fitness, coping skills, level of stress, and adjustment to a life with disabilities, the majority of leisure pastimes available for people with severe cognitive and physical limitations is often extremely limited, tending to involve sedentary activities.6,7 A review of the literature on leisure activities for people with disabilities highlights the need for increased exposure to augmented leisure opportunities and documents a positive relationship between satisfaction with leisure and self-esteem, companionship, enjoyment and relaxation.8 At the same time, the pervasive lack of opportunities for a wide choice of independent leisure activities may contribute to the development of dependent behavioral patterns, learned helplessness and depression.8-11 For individuals with IDD, some limitations initially must be overcome to take part in demanding physical activities. These limitations include: * Physical environment: Adults living in nursing homes were less likely to exercise than the non-nursing home residents12; therefore, in order to enhance participation, activity programs must be made available for this population. …

The Preventive Health Behaviors of Long-Term Survivors of Cancer and Hematopoietic Stem Cell Transplantation Compared with Matched Controls

Little is known about the health promotion, prevention, and disease screening behaviors of cancer survivors treated with hematopoietic cell transplantation (HCT), who undergo arduous treatment and may be at particular risk for late effects and secondary malignancies. The purposes of this study were to examine the current health and secondary prevention behaviors of long-term HCT survivors compared with matched controls without cancer, and to identify sociodemographic and clinical factors associated with appropriate preventive practices. HCT survivors (n = 662) were drawn from 40 North American transplantation centers. Peer-nominated acquaintances of survivors matched on sex, age, education, and marital status served as controls (n = 158). Data were collected a mean of 6.7 years post-HCT (range, 1.8-22.6 years). Despite a greater frequency of physical exams, the HCT survivors had similar health and screening behaviors as the matched controls. Sociodemographic factors were associated with health prevention behaviors in expected ways. Some differences between disease group and type of transplant were found, with survivors of acute leukemia less likely to report regular exercise, autologous transplant survivors more likely than allogeneic transplant survivors to report screenings for breast and cervical cancer, and allogeneic transplant survivors more likely than autologous transplant survivors to report undergoing a skin exam in the previous year. Despite higher levels of engagement with health care providers, HCT survivors had similar health behaviors as matched controls and comparable to those reported by cancer survivors who did not undergo HCT. There remains considerable room for improvement. These findings support the need for further education of both HCT survivors and health practitioners.