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BACKGROUND/OBJECTIVES: Children with chronic medical conditions (CCMC) have high rates of mental health (MH) conditions. This study examines associations between MH educational resources during fellowship and 3 dependent variables: fellows' interest, perceived responsibility, and self-reported competence in assessing MH concerns of CCMC. METHODS: Subspecialty fellows taking the American Board of Pediatrics in-training examinations in February 2020 were invited to participate in a survey inquiring about MH educational resources. Logistic regression examined associations between MH educational resources and the 3 dependent variables, adjusting for demographics and program-level characteristics. RESULTS: Of the 97.7% (4216) fellows who responded, 3870 were included in analyses. About 37.5% reported formal MH teaching sessions; 36.7% reported on-site MH professionals engaged in teaching; 41.6% reported co-assessing patients with MH specialists; and 28.3% reported performance evaluation of their MH skills. All 4 resources were significantly and positively associated with self-reported competence in adjusted analyses, with odds ratios (OR) ranging from 1.28 (95% confidence interval (95% CI): 1.03--1.58) for formal teaching sessions to 2.14 (95% CI: 1.73--2.65) for performance evaluation. Resources were positively associated with the dependent variables in a "dose-response" pattern. Respondents who reported having all 4 educational resources compared to zero resources had an OR of 2.20 (95% CI: 1.74--2.78) for high MH interest, 3.18 (95% CI: 2.45--4.12) for high perceived responsibility, and 4.38 (95% CI: 3.43--5.60) for high self-reported competence CONCLUSIONS: Access to mental health educational resources was associated with higher interest, perceived responsibility, and self-reported competence; investing in these resources may improve fellows' skills in addressing the emotional needs of CCMC. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic diseases (PWCDs) were severely affected by the coronavirus disease 2019 (COVID-19) pandemic, as they were prevented from making the necessary visits to health facilities for medical review and to collect their medication. The emergence of the health crisis and inadequate access to quality care affected chronic care management. The perspectives of PWCDs are not known, and therefore the research on which this paper is based sought to investigate the lived experiences of these patients during the COVID-19 pandemic. Methods: A qualitative phenomenological design was used to obtain the lived experiences of PWCDs identified for participation in the study by means of purposive sampling. Patients' experiences were obtained during individual structured interviews, and a checklist was used to gather patient characteristics from their files. Results: Three themes emerged from the study findings, namely poor healthcare services, the socio-economic impact of the COVID-19 pandemic, and the psychological impact of the COVID-19 pandemic. The COVID-19 pandemic had devastating effects on PWCDs, in that they experienced barriers to accessing quality chronic care services and suffered psychological and financial difficulties that affected their health, life, needs and expectations. Conclusion: Policymakers should consider PWCDs when responding to a public health concern in the future. Contribution: The study findings may have an impact on future policies regulating the management of chronic diseases during epidemics, in order to improve patient health outcomes and satisfaction with healthcare services and the chronic care model based on the experiences of PWCDs. [ABSTRACT FROM AUTHOR]

BACKGROUND: Electronic cigarettes (e-cigarettes) are known to cause adverse pulmonary effects, yet paradoxically, the prevalence of e-cigarette use has increased among individuals with chronic lung disease. We assessed the relationship between chronic lung disease and the susceptibility to e-cigarette use in adults and determined if specific behavioral, social, and environmental factors influence this relationship. METHODS: We enrolled adults age ≥ 18 y in Alabama with chronic lung disease from university medical clinics (n = 140) and individuals without chronic lung disease (n = 123, reference group) from January 2020-March 2021. A cross-sectional design was used where we administered questionnaires to collect sociodemographic information and assessed susceptibility to e-cigarette use, exposure to social and environmental factors (ie, advertisements, warning labels, special prices, others' e-cigarette vapors, use of an e-cigarette by others in the home, and visiting a web site or online discussion), and behavioral factors (ie, alcohol and cannabis use). Moderation analyses were conducted to determine if any of these factors would modify the association between chronic lung disease and susceptibility to e-cigarette use. RESULTS: Susceptibility to e-cigarette use was higher among adults without chronic lung disease than among those with chronic lung disease. Noticing e-cigarette warning labels and visiting a web site or online discussion about e-cigarettes were significantly associated with an increased likelihood of susceptibility to using e-cigarettes in both groups. Exposure to e-cigarette vapor from close contacts, special pricing, living with someone who uses e-cigarettes, and cannabis use were significantly associated with an increased likelihood of susceptibility to e-cigarette use in individuals without chronic lung disease. However, our analyses did not indicate a statistically significant interaction between chronic lung disease and any social, environmental, or behavioral factors on susceptibility to e-cigarette use. CONCLUSIONS: Individuals without chronic lung disease were more susceptible to e-cigarette use than those with chronic lung disease. Although the prevalence of some behavioral and environmental factors differed among individuals with and without chronic lung disease, these factors did not moderate the association between chronic lung disease and susceptibility to e-cigarette use. Longitudinal investigations are warranted to better test the temporal relationships between chronic lung disease, substance use, social and environmental factors, and the susceptibility to e-cigarette use among individuals with chronic lung disease to identify prevention strategies for this population. [ABSTRACT FROM AUTHOR]

Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Individuals with chronic conditions are susceptible to stress-related health complications. Left unattended, chronic stress exacerbates inflammation, diminishes quality of life (QOL), and increases all-cause mortality. Here, we suggest a theoretical framework promoting the use of mindfulness-based interventions (MBIs) in patients with chronic conditions and a conceptual model of how MBIs may influence stress and QOL. [ABSTRACT FROM AUTHOR]

Background Existing evidence suggests that adherence to treatment plans and long-term lifestyle modifications could reduce costly complications associated with diabetes, such as diabetic foot ulcers (DFU). Applying biopsychosocial models and theories to practice can help clinicians understand why individuals adopt or reject certain health behaviours. Aims This review explores the dynamic between patients' psychosocial behaviours and their levels of commitment to treatment plans, discusses approaches for improving the therapeutic relationship between health care professionals (HCPs) and patients through collaborative healthcare planning and raises awareness of the importance of identifying the psychological barriers to managing outcomes of chronic illnesses. Methods This is a narrative exploration of health belief theories applied to managing diabetes and DFU, including a discussion of 'compliance', 'adherence' and 'concordance'; health psychology theories on adherence behaviours; and the role of emotional responses in influencing the acceptance of long-term treatments. Findings Evidence highlighted the role of psychosocial factors in influencing a person's decision-making process and noted individual differences in the willingness to conform to certain health and treatment recommendations, based on prior assumptions and knowledge extending beyond a longer-term conception of the benefits and risks of behaviours or disease progression. Conclusions Healthcare planning should shift from labelling patients as 'non-compliant' toward promoting collaborative conversations that inform choices and actions. HCPs should acknowledge the importance of patients' knowledge and views about their health and create treatment plans that best suit these individual needs. Future research should develop health belief models to incorporate patients' emotional responses to chronic illness. [ABSTRACT FROM AUTHOR]

Objective: The Tinnitus Cognitions Questionnaire (TCQ) is a scale designed to assess the positive and negative cognitions associated with tinnitus. The purpose of this study was to validate the Japanese version of the TCQ and to analyze the relationship between cognition and the severity of chronic tinnitus. Methods: This was a cross-sectional, multicenter study. Patients with chronic tinnitus persisting for longer than 3 months were included. Participants completed the TCQ, the Tinnitus Handicap Inventory (THI), and the Hospital Anxiety and Depression Scale (HADS). They also completed the TCQ a second time 3-7 days later. The questionnaire was translated into Japanese. A factor analysis was performed and the convergent and discriminant validity, internal consistency, and test-retest reliability were evaluated. Results: The total sample consisted of 75 participants. We obtained high Cronbach’s α coefficients for the total score and subscales, ranging from 0.933 to 0.974. The total score and subscale interclass correlation coefficients for test-retest reliability ranged from 0.631 to 0.963. The factor analysis yielded a two-factor structure: negative and positive subscales. The convergent and discriminative validity was sufficiently clear. The negative subscale of the TCQ was strongly correlated with the THI and the HADS. Conclusion: The Japanese version of the TCQ was validated here. It also exhibited a two-factor structure that was well matched with previous data. And it was a highly consistent and reliable measure that can be used to evaluate cognitions in patients with chronic tinnitus. Negative cognition for tinnitus was greatly related to handicap and psychological state. [ABSTRACT FROM AUTHOR]

Copyright of Nosileftiki is the property of Hellenic Nurses' Association and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Children from birth to 3 years old with complex medical needs often experience psychological issues, but there are limited services and supports to meet their needs. To bridge this gap, the authors created the Pediatric Birth to Three Clinic and Early Childhood Mental Health Program at the University of Minnesota. They describe the toxic stress framework of their approach and the relationship-based and trauma-informed treatment modalities used to support the young children and their families in their care. [ABSTRACT FROM AUTHOR]

Copyright of Investigacion en Enfermeria: Imagen y Desarrollo is the property of Pontificia Universidad Javeriana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of SCENARIO: Official Italian Journal of ANIARTI is the property of ANIARTI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Importance: Collaborative care is an intensive care model involving several health care professionals working together, typically a physician, a case manager, and a mental health professional. Meta-analyses of aggregate data have shown that collaborative care is particularly effective in people with depression and comorbid chronic physical conditions. However, only participant-level analyses can rigorously test whether the treatment effect is influenced by participant characteristics, such as chronic physical conditions.Objective: To assess whether the effectiveness of collaborative care for depression is moderated by the presence, type, and number of chronic physical conditions.Data Sources: Data were obtained from MEDLINE, EMBASE, PubMed, PsycINFO, CINAHL Complete, and Cochrane Central Register of Controlled Trials, and references from relevant systematic reviews. The search and collection of eligible studies was ongoing until May 22, 2015.Study Selection: This was an update to a previous meta-analysis. Two independent reviewers were involved in the study selection process. Randomized clinical trials that compared the effectiveness of collaborative care with usual care in adults with depression and reported measured changes in depression severity symptoms at 4 to 6 months after randomization were included in the analysis. Key search terms included depression, dysthymia, anxiety, panic, phobia, obsession, compulsion, posttraumatic, care management, case management, collaborative care, enhanced care, and managed care.Data Extraction and Synthesis: Individual participant data on baseline demographics and chronic physical conditions as well as baseline and follow-up depression severity symptoms were requested from authors of the eligible studies. One-step meta-analysis of individual participant data using appropriate mixed-effects models was performed.Main Outcomes and Measures: Continuous outcomes of depression severity symptoms measured using self-reported or observer-rated measures.Results: Data sets from 31 randomized clinical trials including 36 independent comparisons (N = 10 962 participants) were analyzed. Individual participant data analyses found no significant interaction effects, indicating that the presence (interaction coefficient, 0.02 [95% CI, -0.10 to 0.13]), numbers (interaction coefficient, 0.01 [95% CI, -0.01 to 0.02]), and types of chronic physical conditions do not influence the treatment effect.Conclusions and Relevance: There is evidence that collaborative care is effective for people with depression alone and also for people with depression and chronic physical conditions. Existing guidance that recommends limiting collaborative care to people with depression and physical comorbidities is not supported by this individual participant data meta-analysis. [ABSTRACT FROM AUTHOR]

Compliance with supportive periodontal therapy (SPT) depends on many factors but is generally poor. We compared SPT compliance among patients with aggressive and chronic periodontitis. This single-center longitudinal observational study enrolled 101 patients with generalized aggressive periodontitis (GAP; n = 52) or generalized chronic periodontitis (GCP; n = 49) to compare SPT compliance. All participants were studied for 1 year before the close of data collection. Compliance was classified as complete (100% of programmed visits), erratic (≥50% of programmed visits), or noncompliant (<50% of programmed visits). The proportion of compliant participants was greater among patients with GAP (57.7%) than among those with GCP (30.6%) (P < 0.003); 44.9% of patients with GCP and 15.4% of those with GAP were noncompliant. Compliance was significantly associated with age and sex among patients with GAP. In conclusion, SPT compliance was better in patients with GAP than in those with GCP. Patient attitude and self-belief appear to be important factors in SPT compliance. [ABSTRACT FROM AUTHOR]

Objectives: The transition from adolescence to young adulthood is traditionally a time of self-discovery, career establishment, and the development of relationships. However, for young adults with a chronic illness this time in life can be very challenging, and the management of the transition is crucial for these young adults to reach their potential. The purpose of this study was to explore the lived experiences, perceptions, and challenges of young adults with a chronic neurological condition undergoing the transition from adolescence to adulthood. The Quality of Life model was used to inform the interview schedule and explored two specific areas: identity and condition. Methods: Six participants with chronic neurological conditions (age 18–25 years) took part in the study. Audio-recorded semi-structured interviews were transcribed verbatim and analyzed using Interpretive Phenomenological Analysis. Results: The findings revealed a number of interlinking superordinate themes across the participants: 'condition', 'support', 'strive for independence', and 'transition'. Conclusions: The findings of this exploratory study provide a visible indication of the specific needs of the participant group, including informational and social support needs, and removal of barriers for successful participation. They also highlight holistic service requirements and the interlinking relationships of the direction of support which could be provided to meet these needs. [ABSTRACT FROM AUTHOR]

This research aims to increase awareness of the lived experiences of parents and siblings of a family member with Dravet syndrome (DS) and the impact of DS on the family's engagement of meaningful occupations for the development of family-centered and occupation-based occupational therapy interventions. [ABSTRACT FROM AUTHOR]

Purpose: In this article, we describe how four recent models of psychosocial adaptation to chronic illness and disability (CID) could be fruitfully conceptualized and compared by resorting to the general framework of Lewin's field theory—a theory frequently regarded as a precursor and the primary impetus to the development of the field of somatopsychology. Method: Based on a comprehensive literature review and theoretical integration, we have provided the reader with a brief review of Lewin's field theory and its applications to rehabilitation and psychosocial adaptation to CID, highlighted the main components of the four models of psychosocial adaptation to CID, and reviewed the models through the theoretical lens of Lewin's theory. Results: Lewin's field theory provides a robust and viable theory to conceptualize psychosocial adjustment for CID. Research and clinical implications to practicing rehabilitation counselors and researchers based on the conceptual and practical synergy formed through the understanding of psychosocial adaptation to CID within Lewin's theoretical framework have also been provided. Conclusions: Lewin's field theory provides a theoretical framework for understanding research and clinical implications related to psychosocial adaptation for individuals with CID. [ABSTRACT FROM AUTHOR]

Little is known about the psychological mechanisms underlying the clinical benefits of mindfulness-based interventions (MBIs), In the present review, we suggest that mindfulness-based interventions may enhance positive emotional regulation strategies, as well as self-compassion levels, and decrease rumination and experiential avoidance. These changes are, in turn, associated with several clinical benefits including the reduction of stress and depression levels, as well as the enhancement of positive emotions. Limitations and potential applications of these findings are discussed. [ABSTRACT FROM AUTHOR]

Copyright of Contextos Clínicos is the property of Universidade do Vale do Rio dos Sinos and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Eletrônica de Enfermagem is the property of Revista Eletronica de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Chronic illness and sickness includes more than just the physical treatment of a disease process. Health care relational models emphasize that adequate care for an illness involves ensuring that a patient's emotional health and well-being is addressed along with one's physical well-being. During a health care assessment, a doctorally prepared advanced practice nurse (APN) should take into consideration the patient's physiological, social, neurological, and spiritual health. Today's health care arena does not allow or reimburse for lengthy assessments or extensive health histories, practices, and support systems. The time allotted instead is spent listening to each patient's current issues, making an assessment and diagnosis, and formulating a treatment plan and educating the patient accordingly. Because of the drive for efficiency, mainly because of reimbursement reductions, providers may doubt the necessity to discuss spirituality in the management of chronic illness. Patients that lack a social support system especially may benefit from a doctorally prepared APN's nurturing of their spirituality for emotional comfort. Spirituality influences the ability of the patient to cope with chronic pain, either negatively or positively, and is acknowledged by doctorally prepared APNs as an important coping mechanism. For these reasons, doctorally prepared APNs should be aware of community resources to support patients with their spiritual growth and well-being. [ABSTRACT FROM AUTHOR]

Purpose: To develop and test the validity and reliability of the Korean version of the Family Management Measure (Korean FaMM) to assess applicability for families with children having chronic illnesses. Methods: The Korean FaMM was articulated through forward-backward translation methods. Internal consistency reliability, construct and criterion validity were calculated using PASW WIN (19.0) and AMOS (20.0). Survey data were collected from 341 mothers of children suffering from chronic disease enrolled in a university hospital in Seoul, South Korea. Results: The Korean version of FaMM showed reliable internal consistency with Cronbach's alpha for the total scale of .69-.91. Factor loadings of the 53 items on the six sub-scales ranged from 0.28-0.84. The model of six subscales for the Korean FaMM was validated by expiratory and confirmatory factor analysis (χ2<.001, RMR<.05, GFI, AGFI, NFI, NNFI>.08). Criterion validity compared to the Parental Stress Index (PSI) showed signifi- cant correlation. Conclusion: The findings of this study demonstrate that the Korean FaMM showed satisfactory construct and criterion validity and reliability. It is useful to measure Korean family's management style with their children who have a chronic illness. [ABSTRACT FROM AUTHOR]

Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Ciencia, Cuidado e Saude is the property of Universidade Estadual de Maringa and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: Though studies abound on the quality of life (QoL) in chronic illnesses, there has been little focus on children and adolescents. This study investigated the determinants of QoL in children and adolescents with epilepsy in a Nigerian Tertiary Mental Health Institution. Methods: The study involved 67 adolescents between 11 and 18 years of age, diagnosed with epilepsy. Depression was assessed using the Centre for Epidemiology Study Depression Scale, and their QoL was assessed using the Comprehensive QoL Scale (ComQol-S). Data was analysed using Spearman's Correlation Coefficients and linear regression (p<0.05). Results: The mean age of the participants was 14.5±4.0 years. Twenty-two (32.8%) of them were depressed. Participants scored significantly higher (p<0.00) in health, productivity, community participation and emotional domains and total QoL scores in the subjective axis than in the objective axis of QoL. When controlled for age and gender, the lower the educational attainments of the participants, the higher was their depression scores. Depression, seizure frequency at presentation at the clinic, seizure frequency at onset and age predicted poor QoL. Parents' socio-economic status predicted seizure frequency. Conclusion: There is a high prevalence of depression in Nigerian adolescents with epilepsy. Epilepsy has a negative impact on their QoL. Therefore, it is necessary to pay more attention to the condition in order to reduce the frequency of seizures and improve their psycho-social well-being. [ABSTRACT FROM AUTHOR]

When people in contemporary society have to leave paid employment because they are too ill to continue, the impact is greater than the loss of income and daily activity, as social identity is bound up with paid employment. Loss of a chosen identity may be accompanied by the assumption of an unwanted identity. This article explores the value of reconsidering Parsons' "sick role" in relation to deviance. While the "sick role" has been dismissed because it does not appear relevant to chronic illnesses, the author argues that in the current political economic context of neoliberalism, people who cannot be responsible for their own welfare now assume a deviant status. People with chronic illnesses who are unable to work are examples of this form of deviance. The deviant status of being unable to work explains why many chronically ill people adopt behaviors described by Goffman in Stigma. [ABSTRACT FROM AUTHOR]

Copyright of Revista Eletrônica de Enfermagem is the property of Revista Eletronica de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The article discusses how to assess a patient for suicidal ideation (SI) in a chiropractic setting. The risk for suicide increases when individuals are experiencing periods of increased stress such as unemployment, chronic pain, psychological problems such as depression and medical illness. The author notes that if a chiropractor suspects a patient is suicidal, they should initiate a referral for mental health treatment. The author describes the increased suicide risk among military personnel.

This essay argues that the generally accepted view of Ostalgie as a form of chronic psychological incapacity on the part of East Germans to 'arrive in the West' is too simplistic a reading. Instead it diagnoses a situation in which the general crisis of modernity which hit the western world in the 1970s and the end of communism in the 1990s have robbed us of the ability to either look forward or believe in anything. Equally the view that the GDR was simply an Unrechtsstaat with no regard for the sorts of social cohesion which it generated — mostly in spite of the SED — is also challenged. Drawing on the ideas of Ernst Bloch and Slavoj Žižek I attempt to show that the people of the ex-GDR are actually mourning the passing of a Heimat which never was by investing retrospective hope in its unrealized utopian promise. [ABSTRACT FROM AUTHOR]

As chronic illness takes its rightful place as an imperative for planners and policy makers globally, the obligation to provide appropriate self-care management support and promote optimal health among the chronically ill is attracting considerable attention. A generation of insider research into the chronic illness experience has yielded powerful evidence of the critical importance of communication between the chronically ill and those who provide their healthcare services. In this article, insights gained from the body of chronic illness research shape recommendations for attitudinal and structural adjustments that might steer our course toward promoting improved health for those affected by a chronic disease. [ABSTRACT FROM AUTHOR]

Background: Management of chronic conditions entails numerous activities in both clinical and daily living settings. Activities across these settings interact, creating a high potential for a gap to occur if there is an inconsistency or disconnect between controlled clinical settings and complex daily living environments.Objective: The aim of this study is to characterize gaps (from the patient's perspective) between health-related activities across home-based and clinical settings using anticoagulation treatment as an example. The causes, consequences, and mitigation strategies (reported by patients) were identified to understand these gaps. We conceptualized gaps as latent phenomena (ie, a break in continuity).Methods: Patients (n=39) and providers (n=4) from the anticoagulation clinic of an urban, western mountain health care system were recruited. Data were collected through primary interviews with patients, patient journaling with tablet computers, exit interviews with patients, and provider interviews. Data were analyzed qualitatively using a theory-driven approach and framework method of analysis.Results: The causes of gaps included clinician recommendations not fitting into patients' daily routines, recommendations not fitting into patients' living contexts, and information not transferred across settings. The consequences of these gaps included increased cognitive and physical workload on the patient, poor patient satisfaction, and compromised adherence to the therapy plan. We identified resources and strategies used to overcome these consequences as patient-generated strategies, routines, collaborative management, social environment, and tools and technologies.Conclusions: Understanding gaps, their consequences, and mitigating strategies can lead to the development of interventions that help narrow these gaps. Such interventions could take the form of collaborative health information technologies, novel patient and clinician education initiatives, and programs that strongly integrate health systems and community resources. Current technologies are insufficient to narrow the gaps between clinical and daily living settings due to the limited number and types of routines that are tracked. [ABSTRACT FROM AUTHOR]

There is compelling evidence in the literature that anxiety and depression affect high percentages of people with long-term physical conditions and that these often go undiagnosed. This can result in high use of general medical services in people's attempts to have their psychological needs met. This opinion piece explores some of the challenges and implications of this for occupational therapists, who have been educated to work occupationally alongside biological, psychological and sociological factors. It concludes that in a changing National Health Service, occupational therapists need to be able to deliver the true holistic occupational work required by those with long-term conditions, thus meeting biopsychosocial needs. This way, occupational therapists will take into account the complexity of components needed to engage in a variety of activities, and the economic benefits of this return to the profession's philosophy may benefit their standing in the new commissioning climate. [ABSTRACT FROM AUTHOR]

Background: Person-centered care is critical for delivering high-quality diabetes care. Shared decision making (SDM) is central to person-centered care, and in diabetes care, it can improve decision quality, patient knowledge, and patient risk perception. Delivery of person-centered care can be facilitated with the use of patient decision aids (PtDAs). We developed MyDiabetesPlan, an interactive SDM and goal-setting PtDA designed to help individualize care priorities and support an interprofessional approach to SDM.Objective: This study aims to assess the impact of MyDiabetesPlan on decisional conflict, diabetes distress, health-related quality of life, and patient assessment of chronic illness care at the individual patient level.Methods: A two-step, parallel, 10-site cluster randomized controlled trial (first step: provider-directed implementation only; second step: both provider- and patient-directed implementation 6 months later) was conducted. Participants were adults 18 years and older with diabetes and 2 other comorbidities at 10 family health teams (FHTs) in Southwestern Ontario. FHTs were randomly assigned to MyDiabetesPlan (n=5) or control (n=5) through a computer-generated algorithm. MyDiabetesPlan was integrated into intervention practices, and clinicians (first step) followed by patients (second step) were trained on its use. Control participants received static generic Diabetes Canada resources. Patients were not blinded. Participants completed validated questionnaires at baseline, 6 months, and 12 months. The primary outcome at the individual patient level was decisional conflict; secondary outcomes were diabetes distress, health-related quality of life, chronic illness care, and clinician intention to practice interprofessional SDM. Multilevel hierarchical regression models were used.Results: At the end of the study, the intervention group (5 clusters, n=111) had a modest reduction in total decisional conflicts compared with the control group (5 clusters, n=102; -3.5, 95% CI -7.4 to 0.42). Although there was no difference in diabetes distress or health-related quality of life, there was an increase in patient assessment of chronic illness care (0.7, 95% CI 0.4 to 1.0).Conclusions: Use of goal-setting decision aids modestly improved decision quality and chronic illness care but not quality of life. Our findings may be due to a gap between goal setting and attainment, suggesting a role for optimizing patient engagement and behavioral support. The next steps include clarifying the mechanisms by which decision aids impact outcomes and revising MyDiabetesPlan and its delivery.Trial Registration: ClinicalTrials.gov NCT02379078; https://clinicaltrials.gov/ct2/show/NCT02379078. [ABSTRACT FROM AUTHOR]

Background: Physical activity (PA) is important for children with a chronic disease. Serious games may be useful to promote PA levels among these children.Objective: The primary purpose of this systematic review was to evaluate the effectiveness of serious games on PA levels in children with a chronic disease.Methods: PubMed, EMBASE, PsycINFO, ERIC, Cochrane Library, and CINAHL were systematically searched for articles published from January 1990 to May 2018. Both randomized controlled trials and controlled clinical trials were included to examine the effects of serious games on PA levels in children with a chronic disease. Two investigators independently assessed the intervention, methods, and methodological quality in all articles using the Cochrane risk of bias tool. Both qualitative and quantitative analyses were performed.Results: This systematic review included 9 randomized controlled trials (886 participants). In 2 of the studies, significant between-group differences in PA levels in favor of the intervention group were reported. The meta-analysis on PA levels showed a nonsignificant effect on moderate to vigorous PA (measured in minutes per day) between the intervention and control groups (standardized mean difference 0.30, 95% CI -0.15 to 0.75, P=.19). The analysis of body composition resulted in significantly greater reductions in BMI in the intervention group (standardized mean difference -0.24, 95% CI -0.45 to 0.04, P=.02).Conclusions: This review does not support the hypothesis that serious games improve PA levels in children with a chronic disease. The meta-analysis on body composition showed positive intervention effects with significantly greater reductions in BMI in favor of the intervention group. A high percentage of nonuse was identified in the study of serious games, and little attention was paid to behavior change theories and specific theoretical approaches to enhance PA in serious games. Small sample sizes, large variability between intervention designs, and limited details about the interventions were the main limitations. Future research should determine which strategies enhance the effectiveness of serious games, possibly by incorporating behavior change techniques. [ABSTRACT FROM AUTHOR]

Background: As the population ages, many more people will be in need of long-term care. According to a recent report by Alzheimer's Disease International and the Karolinska Institute, 84% of people with dementia are cared for at home and 16% in nursing homes. Several Web-based interventions have been developed to assist the work of carers at home. Measuring the levels of electronic health (eHealth) literacy is of top priority to facilitate inclusion of this population and develop training programs to enhance eHealth literacy skills.Objective: This study aimed to adapt the eHealth Literacy Scale (eHeals) for carers of people with dementia, who speak Greek as their native language and live in Greece and Cyprus, and to test the reliability and validity of the scale for carers.Methods: The content validity of the eHealth Literacy Scale for Carers of People With Chronic Diseases (eHeals-Carer) was assessed with an expert panel (N=10). A descriptive study with face-to-face interviews among 101 primary carers of people with dementia was conducted. In addition to the eHeals-Carer to assess their perceived eHealth literacy, participants responded to a brief questionnaire regarding characteristics of internet use and provided sociodemographic data. The internal consistency of the tool and the construct validity via an exploratory factor analysis (EFA) were explored.Results: The Mean Item-Level Content Validity Index (CVI) and Scale-Level CVI Average was 0.93. The participants were mostly women (75.2%, 76/101), aged less than 60 years (67.3%, 68/101) with secondary education. The internal consistency was estimated at a Cronbach alpha of .83. Two factors were extracted from the EFA: information seeking questions 1 to 5 (factor 1) and evaluation questions 6 to 8 (factor 2).Conclusions: eHeals-Carer is the first perceived eHealth literacy tool adapted for carers of people with dementia. The use of Web-based services available for carers could help them and improve the health care system in the long term. In Greece and Cyprus, there is a lack of services, and improving the digital skills of carers could provide them with the means to support themselves at home and improve care provision.International Registered Report Identifier (irrid): RR2-10.2196/resprot.8080. [ABSTRACT FROM AUTHOR]

The use of Facebook groups by health care researchers and professionals for chronic disease management, namely type 2 diabetes mellitus and coronary heart disease, is in its early stages and challenges are emerging. While Facebook groups offer great potential to deliver health support, research of Facebook groups for chronic disease management remains in its infancy, with robust evidence not yet available. Designing Facebook groups that are acceptable to users, health care researchers as well as health care professionals is a challenge, and there is a poor fit with traditional research and evaluation methods. Key recommendations for future research of Facebook groups for chronic disease management include: (1) iterative content development with input from the target patient population; (2) further understanding of the potential role of group "champions"; (3) ensuring the social media policies of health care institutions allow for real time online communication; and (4) utilizing comprehensive evaluation strategies, including the use of process evaluations. [ABSTRACT FROM AUTHOR]

Abstract: Background: Adjusting to chronic disease is a complex process and one that, in the case of inflammatory bowel disease (IBD), has received very little attention. The objectives of this study were to identify coping strategies used by patients with IBD and to explore how these strategies are related to psychological characteristics. Methods: A transversal study was designed in which 875 patients with IBD were prospectively enrolled. Independent variables were evaluated using a sociodemographic questionnaire and a clinical questionnaire—the Hospital Anxiety and Depression Scale (HADS) and the Perceived Stress Scale (PSS); dependent variables were evaluated using the COPE Inventory (Coping Orientation to Problems Experienced), a multidimensional scale for evaluating general coping styles. Multiple linear regression was used to identify the variables associated with the type of coping used. Results: The participation rate was 91.3%. The most common coping strategy was emotion-focused coping (; 95% CI=2.61–2.69), with no differences in relation to type of disease. The highest scores for anxiety were associated with emotion-focused coping (β=0.164, p=0.001) whereas, for depression, the highest scores were associated with escape–avoidance (β=0.108, p=0.044). No correlation was found between stress levels and type of coping. Conclusions: Patients with IBD have a tendency to focus on emotions in their coping process, and this process appears to be related not only to sociodemographic characteristics or features of the disease itself but also to psychological factors—anxiety and depression, primarily. [Copyright &y& Elsevier]

Reports on a study suggesting that chronic pain patients who perceive that someone is responsible for their condition have greater emotional distress and behavioral disturbance. Attribution of blame as an under-appreciated correlate of poor treatment outcome.