Chronic Illness最新文献

Objectives: This pilot study aimed to: (a) understand the experiences of Indian patients with type 2 diabetes mellitus and their expectations of their physicians during a medical consultation, (b) serve as a preliminary study to inform the development of a larger project exploring and improving patients' communication experiences, and (c) assess whether the pilot study findings indicate the viability of using the Relationship: Establishment, Development, and Engagement model of communication as the conceptual framework for the larger project.

Methods: Using convenience sampling, 11 patients participated in a focus group discussion. Conventional content analysis was used.

Results: Two themes were generated: (a) A plethora of negative feelings: experiences of the physician's verbal and nonverbal communication styles, and (b) 'I know what I want': Expectations of communication by patients from their physician.

Conclusions: The medical encounter with the physician elicited a range of negative experiences and clear expectations from the patients with type 2 diabetes mellitus. This pilot points to the need for (a) a mixed methods approach to comprehensively examine the communication needs of patients with type 2 diabetes mellitus from their physician, (b) understand physicians' communication practices, and (c) using these findings, culturally adapt and test the Relationship: Establishment, Development, and Engagement to improve physicians' communication skills in India.

Objective: The clinical aspects of lung cancer patients are well-studied. However, healthcare charge patterns have yet to be explored through a large-scale representative population-based sample investigating differences by socioeconomic factors and comorbidities.

Aim: To identify how comorbidities associated with healthcare charges among lung cancer patients.

Methods: We examined the characteristics of the patient sample and the association between comorbidity status (diabetes, hypertension, or both) and healthcare charge. Multivariate survey linear regression models were used to estimate the association. We also investigated sub-group association through various patient and socioeconomic factors.

Results: Of 212,745 lung cancer patients, 68.5% had diabetes and/or hypertension. Hospital charges were higher in the population with comorbidities. The results showed that lung cancer patients with comorbidities had 9.4%, 5.1%, and 12.0% (with diabetes, hypertension, and both, respectively) higher hospital charges than those without comorbidities. In sub-group analysis, Black patients also showed a similar trend across socioeconomic (i.e. household income and primary payer) and racial (i.e. White, Black, Hispanic, and Asian/Pacific Islander) factors.

Discussion: Black patients may be significantly financially burdened because of the prevalence of comorbidities and low-income status. More work is required to ensure healthcare equality and promote access to care for the uninsured, low-income, and minority populations because comorbidities common in these populations can create more significant financial barriers.

Objectives: To identify perceptions and experiences related to caring science and collaborative care in intervention participants of the Collaborative Care to Alleviate Symptoms and Adjust to Illness (CASA) study, a randomized, multi-site clinical trial for patients with chronic heart failure and reduced health status.

Methods: Forty-five participants completed semi-structured, telephone interviews with a focus on intervention components, impact of the intervention on participants' lives, and recommendations for intervention change. Data were analyzed using an inductive content analysis approach focusing on the presence and frequency of text to identify patterns, categories, and themes across participants without an a priori code book. The validity of the identified categories was enhanced through triangulation.

Results: Three themes were identified: (1) intervention providers' caring/helping attitude and caring/helping communication; (2) care team availability to respond to concerns or questions; and (3) help with understanding and navigating the healthcare system.

Discussion: Patients highly value caring attitudes and communication, availability, and empowerment to understand and navigate healthcare systems. These attitudes and behaviors may be important mediators of the success of collaborative care programs. These are consistent with the theory of caring science, a framework that is relevant more broadly to patient-centered and team-based care models.

Introduction: The current study was conducted to determine the impact of health literacy and factors related to adherence to drug treatment, using the model proposed by the World Health Organization, in older adults with hypertension residing in informal settlements in Hamadan.

Methods: This cross-sectional study was conducted on 405 patients in Hamadan city, located in the western part of Iran. Data were collected using an interviewer-administered questionnaire that included the 5-dimensional model proposed by the World Health Organization, Health Literacy for Iranian Adults, and Morisky Medication Adherence Scale-8. A two-stage sampling procedure was used to select patients from 14 comprehensive health service centers and health bases. The data were analyzed using SPSS v.24.

Results: The study found that medication adherence was suboptimal in 63% of the participants. Additionally, 87.5% of patients had inadequate or insufficient health literacy. Factors related to medication adherence included age (odds ratio (OR) = 1.07), annual income (OR = 0.17), duration of hypertension (OR = 7.33), health literacy (OR = 1.03), self-reported health status (P < 0.05), and regular medication use (P < 0.008).

Conclusion: The results of this study indicate that more than half of the older adults in the study had suboptimal medication adherence and insufficient health literacy. The study also found that various factors, such as socioeconomic status, disease and treatment-related factors, and patient-related factors, influence medication adherence among older adults.

Objectives: Childhood obesity has become a global threat due to its serious negative consequences. We aimed to determine the patterns of metabolic syndrome and cardio-metabolic risk factors in Turkish children with obesity.

Methods: We examined 169 schoolchildren with obesity in April and May 2019 in Samsun, Turkey. After clinical evaluation and anthropometric measurements, fasting blood samples were collected to measure total cholesterol, low and high-density lipoprotein, fasting blood glucose, triglycerides, and insulin levels.

Results: The proportion of those who met the metabolic syndrome criteria in boys was 14.3%, but it was twice as high in girls (28.2%). The most prevalent component of cardio-metabolic risk factor was increased waist circumference (96.4%) followed by a high homeostasis model assessment insulin resistance index (74.6%) and high blood pressure (29.0%). While the average high-density lipoprotein was higher in boys than in girls, on the contrary, insulin, HbA1c, and homeostasis model assessment insulin resistance concentrations were higher in girls. The prevalence of dyslipidemia was also higher in girls (67.1%) than in boys (47.6%), as were all impaired metabolic syndrome components.

Conclusions: One in five children with obesity was at risk of metabolic syndrome. For early intervention and prevention, children with obesity should be monitored in terms of cardio-metabolic risk factors, but obese girls are more prioritized.

Objectives: Chronic diseases contribute significantly to healthy years lost (HYLs). It is critical to investigate which are the most contributing diseases to enable enhancing health programs' effectiveness in improving health expectancy. This paper investigates disease-specific contributions to years lived with chronic diseases in Algeria and examines their recent evolution.

Methods: We used morbidity data from the last three waves of the Multiple Indicator Cluster Surveys of 2006, 2012-13, and 2018-19. The studied chronic diseases included hypertension, cardiovascular diseases (CVDs), joint diseases, respiratory diseases, and diabetes. We calculated disease-specific contributions using the cause-deleted health expectancy approach. Then, we analyzed time changes and gender-based differences in contributions.

Results: The leading cause of HYLs in women is hypertension, followed by diabetes, joint diseases, CVDs, and respiratory diseases. The same ranking applies to men, with joint diseases coming last. The time evolution of relative disease-specific contributions shows an increase in CVDs for women and diabetes for both genders, against a decrease for the other diseases.

Discussion: To improve chronic disease-free life expectancy in Algeria, effective prevention programs must be implemented, with an emphasis on hypertension and diabetes. Further investigation into the risk factors affecting the prevalence and incidence of these diseases is also required.

Objective: Pain is the most debilitating and subjective experience of cancer patients. This study examines the severity, interference, characteristics, and associations of severe pain in Sri Lankan cancer patients.

Methods: A descriptive study was conducted in Sri Lanka on 384 patients at age 18 or older who had cancer pain for 3 months or more due to the initial lesion, secondaries, radiation, or chemotherapy. Patients with non-cancerous pain or brain metastases were excluded. Data was collected using a validated Sinhala version of the Short-Form Brief Pain Inventory and the Short-Form McGill Pain Questionnaire-2. Logistic regression was used to identify severe pain correlations.

Results: The mean of the "worst pain" experience was 7.97, and 73.2% reported their "worst pain" as severe. The "normal works" (62.5%) and "sleep" (58.3%) were severely influenced by pain. "Aching pain," was the most reported pain quality. A statistically significant association was shown between severe pain and male gender (adjusted odds ratio (AOR) = 1.723), being in marriage (AOR = 1.947), absence of family commitments (AOR = 1.8), and pain of 3 months or more duration (AOR = 1.76).

Conclusion: The experiences of cancer pain vary, with the majority suffering from severe pain.

Objectives: To examine the impact of social and emotional support on serious psychological distress (SPD) in individuals with type 2 diabetes (T2DM) and functional disabilities after controlling for socio-demographic factors and health status. Findings provide information for healthcare providers to enhance patients' psychological well-being.

Methods: Data from 529 adults were obtained from the 2021 National Health Interview Survey, including those who had T2DM and also reported significant difficulty or inability to perform an activity in any of the following domains: seeing, hearing, walking or climbing stairs, communicating, remembering or concentrating, or practicing self-care. Descriptive analysis and a hierarchical regression model of SPD were used.

Results: The mean age of participants was 67.88 years old, and the mean duration of diabetes diagnosis was 16.88 years. Notably, 12.5% of individuals reported SPD. A decreased likelihood of reporting SPD occurrence was associated with older age (odds ratio (OR) = 0.95), a longer duration of T2DM diagnosis (OR = 0.97), having at least a high school education (OR = 0.54), and receiving social and emotional support.

Discussion: Social and emotional support likely mitigates psychological distress, suggesting that social and emotional support resources should be enhanced, especially among individuals who are younger and those more recently diagnosed with T2DM.

Objective: To examine the association between food insecurity and achieving glycemic goals among Medicare beneficiaries with type 2 diabetes.

Methods: This study analyzed the nationally representative 2019 Medicare Current Beneficiary Survey of 1340 beneficiaries aged ≥65 years with type 2 diabetes. The binary dependent variable was whether beneficiaries' blood glucose was at target (A1C ≤ 7.5% or average fasting blood glucose of ≤140 mg/dL, all/most of the time). Food insecurity, a binary variable, was adapted based on the USDA's food security questions. A survey-weighted multivariable logistic model, adjusted for sociodemographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having above-target blood glucose levels across groups.

Results: Of study beneficiaries, 20.9% reported not achieving glycemic targets. The predictive marginal prevalence of having higher than target blood glucose levels was significantly greater in females over males (23.8% [95% confidence interval [CI], 20.1-27.4] vs 17.6% [14.3-20.9]); those with less than high school education over those with college education (31.0% [23.6-38.3] vs 18.6% [14.8-22.3]); and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs 19.1% [16.6-21.7]).

Conclusions: Sociodemographic disparities related to achieving blood glucose goals were observed. Screening for food insecurity and related interventions should be considered for at-risk beneficiaries with diabetes.

Objectives: To assess the quality assurance of a specialist palliative care clinic focused on chronic diseases and explore the satisfaction and acceptability of the telemedicine model amongst patients and caregivers.

Methods: A cross-sectional 23-item survey was developed by the clinical team, approved by ethics and distributed to patients and caregivers. Data collection ran between September 2021 and February 2022, and SPSS was used for data analysis. Demographics were collected from hospital records.

Results: Thirty-five surveys were returned. The cohort had a median age of 82 years, and the most common primary diagnosis was renal failure. Participants rated telemedicine as easier to access than face-to-face appointments due to convenience. Telemedicine was rated highly for future utility, with video consultations being perceived as more useful than telephone consultations. Participants responded overwhelmingly well towards the clinic.

Discussion: Findings demonstrated high levels of satisfaction with the Supportive Care Clinic model and for telemedicine. However, logistical challenges and the desire for face-to-face appointments were also identified. The study highlights the importance of offering a range of modalities for patient engagement in healthcare services and suggests that telemedicine should complement, rather than replace, face-to-face consultations. Future investigations should explore patient and caregiver sentiment towards telemedicine platforms alongside patient deterioration.