Depression and Chronic Illness: A Test of Competing Hypotheses
by Hui Liew
No Indonesian studies have addressed the relationship between chronic illness and depression. Using simultaneous... more No Indonesian studies have addressed the relationship between chronic illness and depression. Using simultaneous equation modeling, this study modeled the joint dependency of depression and chronic illness. The findings showed that the odds of having at least two chronic health conditions increase with the level of depression and individuals with at least two chronic health conditions have higher odds of being in a higher depression category. The health benefits of education are greater among Indonesian women after controlling for mobility, age, marital status, and smoking. Policies directed toward reducing gender differences in education are crucial to reduce persistent health inequalities.
Download (.pdf) Processes of Self-Management in Chronic Illness
by Faith Martin
Co-authored as part of research visit to Yale, Scool of Nursing
Purpose: Self-management is a dynamic process in which individuals actively manage a chronic illness. Self-management... more
Purpose: Self-management is a dynamic process in which individuals actively manage a chronic illness. Self-management models are limited in their specification of the processes of self-management. The purpose of this article is to delineate processes of self-management in order to help direct interventions and improve health outcomes for individuals with a chronic illness.
Design: Qualitative metasynthesis techniques were used to analyze 101 studies published between January 2000 and April 2011 that described processes of self-management in chronic illness.
Methods: Self-management processes were extracted from each article and were coded. Similar codes were clustered into categories. The analysis continued until a final categorization was reached.
Findings: Three categories of self-management processes were identified: focusing on illness needs; activating resources; and living with a chronic illness. Tasks and skills were delineated for each category.
Conclusions: This metasynthesis expands on current descriptions of self-management processes by specifying a more complete spectrum of self-management processes.
Clinical Relevance: Healthcare providers can best facilitate self-management by coordinating self-management activities, by recognizing that different self-management processes vary in importance to patients over time, and by having ongoing communication with patients and providers to create appropriate self-management plans.
Children and young people in hospitals
by Scott Yates
Published in Rix, J., Nind, M., Sheehy, K.Simmons K. (eds.) (2010) Equality, Participation and Inclusion: Diverse contexts. Open University Press
Co-authored with Malcolm Payne and Simon Dyson
Children and young people in hospitals: doing youth work in medical settings
by Scott Yates
Published in Journal of Youth Studies
Co-authored with Malcolm Payne and Simon Dyson
Young people in hospitals face a range of challenging issues. Many have chronic conditions and experience... more Young people in hospitals face a range of challenging issues. Many have chronic conditions and experience stigmatisation, anxiety and family conflict. They may also experience social isolation in hospitals, separation from local peer groups and sources of support, and separation from trusted carers during transition to adult care. These issues can require careful handling. However, there is evidence that clinical staff often do not communicate effectively with young patients, that relationships can become contested, especially around ‘adherence’ to treatment regimens, and that important underlying difficulties that young people face are not addressed, leading to resistance and disengagement from care. This paper explores this range of challenges, and presents some research evidence to argue that youth work is particularly well placed to engage with such issues. Although youth work in UK hospitals is currently very rare and under-researched, we contend that what evidence is available suggests that it can be effective in addressing the challenges of young people’s experience, and may have important health and wider-ranging general benefits for young people, health staff and hospitals.
Epidemiology of depression and distress in patients with inflammatory bowel disease (IBD) and validation of an indicator scale of perceived stress for psychosocial impairments.
Hardt J, Conrad S, Muche-Borowski C, Raspe H. Epidemiology of depression and distress in patients with inflammatory bowel disease (IBD) and validation of an indicator scale of perceived stress for psychosocial impairments. European Psychiatry 2011;26(S1):2217-2218
Correlating pharmaceutical data with a national health survey as a proxy for estimating rural population health
by Ron Cossman
Open Access at Population Health Metrics
Background
Chronic disease accounts for nearly three-quarters of US deaths, yet prevalence rates are not... more
Background
Chronic disease accounts for nearly three-quarters of US deaths, yet prevalence rates are not consistently reported at the state level and are not available at the sub-state level. This makes it difficult to assess trends in prevalence and impossible to measure sub-state differences. Such county-level differences could inform and direct the delivery of health services to those with the greatest need.
Methods
We used a database of prescription drugs filled in the US as a proxy for nationwide, county-level prevalence of three top causes of death: heart disease, stroke, and diabetes. We tested whether prescription data are statistically valid proxy measures for prevalence, using the correlation between prescriptions filled at the state level and comparable Behavioral Risk Factor Surveillance System (BRFSS) data. We further tested for statistically significant national geographic patterns.
Results
Fourteen correlations were tested for years in which the BRFSS questions were asked (1999-2003), and all were statistically significant. The correlations at the state level ranged from a low of 0.41 (stroke, 1999) to a high of 0.73 (heart disease, 2003). We also mapped self-reported chronic illnesses along with prescription rates associated with those illnesses.
Conclusions
County prescription drug rates were shown to be valid measures of sub-state estimates of diagnosed prevalence and could be used to target health resources to counties in need. This methodology could be particularly helpful to rural areas whose prevalence rates cannot be estimated using national surveys. While there are no spatial statistically significant patterns nationally, there are significant variations within states that suggest unmet health needs.
Organisational quality, nurse staffing and the quality of chronic disease management in primary care: Observational study using routinely collected data
with Jill maben and Trevor Murrells Published in the International Journal of Nursing Studies (on line early 2011). Pre print available from http://eprints.soton.ac.uk/171855/
Background An association between quality of care and staffing levels, particularly registered nurses, has been... more Background An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately.Aims and objectives We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors.Method We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software.Results Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient experience surveys.Conclusions Organisational factors contribute significantly to observed variation in the quality of care in English general practices. Levels of nurse staffing have an independent association with quality but also interact with organisational factors. The observed relationships are not necessarily causal but a causal relationship is plausible. The benefits and importance of education, training and personal development of nursing and other practice staff was clearly indicated.
Complex adaptive chronic care
Martin CM and Sturmberg JP - Journal of Evaluation in Clinical Practice 2009
Background
The Chronic Care Model (CCM) is widely taken up as the universal operational framework for... more
Background
The Chronic Care Model (CCM) is widely taken up as the universal operational framework for redesigning health systems to address the increasing chronic disease burden of an ageing population. Chronic care encompasses health promotion, prevention, self management, disease control, treatment and palliation to address 'chronicity' of long journeys through disease, illness and care in the varying contexts of complex health systems. Yet at an operational level, CCM activities are predominantly based on an evidence-base of discreet chronic disease interventions in specific settings; and their demonstrable impact is limited to processes of select disease management such as diabetes in specific disease management programs.
Aims
This paper proposes a framework that makes sense of the nature of chronicity and its multiple dimensions beyond disease and argues for a set of building blocks and leverage points that should constitute the starting points for 'redesign'?
Findings
Complex Adaptive Chronic Care is proposed as an idea for an explanatory and implementation framework for addressing chronicity in existing and future chronic care models. Chronicity is overtly conceptualized to encompass the phenomena of an individual journey, with simple and complicated, complex and chaotic phases, through long term asymptomatic disease to bodily dysfunction and illness, located in family and communities. Chronicity encompasses trajectories of self-care and health care, as health, illness and disease co-exist and co-evolve in the setting of primary care, local care networks and at times institutions. A systems approach to individuals in their multi-layered networks making sense of and optimizing experiences of their chronic illness would build on core values and agency around a local vision of health, empowerment of individuals and adaptive leadership, and it responds in line with the local values inherent in the community's disease-based knowledge and the local service's history and dynamics. Complex Adaptive Chronic Care exceeds the current notions of disease management as an endpoint. Primary care team members are system adaptors in partnership with individuals constructing their care and system leadership in response to chronic illness, and enable healthy resilience as well as personal healing and support. Outcomes of complex adaptive chronic care are the emergence of health in individuals and communities through adaptability, self-organization and empowerment.
Discussion
Chronic care reform from within a complex adaptive system framework is bottom up and emergent and stands in stark contrast to (but has to co-exist with) the prevailing protocol based disease care rewarding selective surrogate indicators of disease control. Frameworks such as the Chronic Care Model provide guidance, but do not replace individual experience, local adaptive leadership and responsiveness. The awareness of complexity means opening up problems to a different reality demanding different set of questions and approaches to answer them.
Navigating the twilight zone
by Michael Dunn
Dunn, M. (under review) 'Navigating the twilight zone'.
SUMMARY
A commentary arguing that society's obligations towards individuals with chronic diseases ought to... more
SUMMARY
A commentary arguing that society's obligations towards individuals with chronic diseases ought to be orientated towards responding to the transformative impact that these diseases have on those individuals' varied and everyday experiences of living with chronic ill-health.
INTRODUCTION
Issues raised by the care and treatment of chronic diseases currently languish in the backwaters of biomedical ethical discourse. Slow, progressive decline heralds none of the bells and whistles of life and death decision-making, or radical technological advancement, that has proven to be so seductive to contemporary bioethicists. Nevertheless, there is an extensive body of evidence showing how chronic diseases are posing, and will continue to pose, significant political and practical challenges to public service infrastructures within both developed and developing nations that are already straining under economic and demographic pressures. It is to their credit, then, that Berlinger and Gusmano interrogate the ethical question of how healthcare organisations – and society more generally – ought to respond to the challenges of chronic disease.
For Berlinger and Gusmano, identifying the obligations we have in relation to those living with chronic health conditions depends, first, on being clear about what we mean when we invoke the concept of ‘chronicity’, and, second, on determining how different ways of conceptualising chronicity establish different normative pathways for ascribing responsibility in the treatment and care of chronic diseases. In this paper, it is argued that, however chronicity is defined, and whatever chronic condition is being described, chronic disease can be distinguished from other health conditions on the differential – and morally significant – kinds of impact that they have on individuals’ everyday lives. I claim, on the basis of this argument, that Berlinger and Gusmano’s directions for reforms in both policy and practice relating to the management of chronic disease point us in the right kinds of directions, but do not go far enough.
How Much Can Money Buy Happiness? Is the Debate Over for the Easterlin Paradox?
I published this through an essay competition with the Radical Statistics journal (2008).
In April last year, The New York Times published an article with the title ‘Maybe Money Does Buy Happiness After All’... more
In April last year, The New York Times published an article with the title ‘Maybe Money Does Buy Happiness After All’ (Leonhardt, 2008). A month later, the Times of London followed suit with, ‘If you’re richer, you’re happier’ (Finkelstein, 2008). As suggested by their titles, these articles reported that more money equals more happiness. The source for this assertion was a recent paper by two economists, Betsey Stevenson and Justin Wolfers (2008) who purport to refute the long- standing claim, commonly attributed to Richard Easterlin, that money does not ‘buy’ happiness.
In this essay I consider the validity of the journalists’ reports by reviewing the findings of Stevenson and Wolfers. If indeed their statements have been too bold, I offer potential explanations for the diminishing effect of national economy on happiness. I expand with a wider framework of well-being by including the economy’s effects on health. This is in light of the fact that both health and happiness are affected by the economic and social environment in similar ways. Thus, an examination of the literature on health and its shared social determinants with happiness may help to settle the dispute.
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Living With Hepatitis C: The Medical Encounter
New Zealand Sociology, 2005.
This paper is based on interviews with twenty individuals with
hepatitis C living in the Auckland region. A... more
This paper is based on interviews with twenty individuals with
hepatitis C living in the Auckland region. A primary theme that arose from these interviews was that of the participants’ interaction with medical professionals. The stigmatised and ambiguous nature of hepatitis C often made for an unsatisfactory and harrowing encounter. I argue that the biomedical model is flawed in its attitude towards chronic illness. Instead of a one‑dimensional focus on treatment and cure there needs to be renewed focus on helping patients “live a good life while being ill”. Necessary for the attainment of this goal are ongoing models of care that take into account the experiential nature of illness and the social context of the individual.
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Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk
Armstrong, N. and Murphy, E. (2008) ‘Weaving meaning? An exploration of the interplay between lay and professional understandings of cervical cancer risk’ Social Science and Medicine Vol.67 No.7 pp. 1074-1082
In line with the increasing emphasis on informed choice, women invited for cervical cancer screening in England... more
In line with the increasing emphasis on informed choice, women invited for cervical cancer screening in England receive a leaflet containing information on the risk factors and
causation of the condition. However, data from a qualitative interview study with 35 women suggest that the ways in which women make sense of this information can vary and frequently do not correspond to the causal pathways and explanations which characterise contemporary professional medical explanations. This paper examines the complex
interplay between lay and professional understandings that takes place as women attempt to weave the information they receive, their prior understandings and contextual factors
together into some kind of coherent framework, in which each piece of information makes sense in relation to everything else.We conclude by arguing that, while presenting full and
accurate information about orthodox medical understandings of cervical cancer causation in an accessible way maybe challenging, partial presentation of ‘the facts’ is likely to be
ineffective.