Editorial: Improving Wellbeing in Patients With Chronic Conditions: Theory, Evidence, and Opportunities.
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ABSTRACT:
SUBMITTER: Kemp AH
PROVIDER: S-EPMC8964137 | biostudies-literature | 2022
REPOSITORIES: biostudies-literature
Publications
Editorial: Improving Wellbeing in Patients With Chronic Conditions: Theory, Evidence, and Opportunities.
Kemp Andrew H AH Tree Jeremy J Gracey Fergus F Fisher Zoe Z
Frontiers in psychology 20220314
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Project description: Not available
| S-EPMC9082597 | biostudies-literature
Project description:BackgroundRelationships between genetic risks for chronic diseases and long-run wellbeing are largely unexplored. We examined the associations between genetic predispositions to several chronic conditions and long-term functional health and socioeconomic status (SES).MethodsWe used data on a nationally representative sample of 9,317 adults aged 65 years or older from the 1992 to 2012 Health and Retirement Survey (HRS) in the US. Survey data were linked to genetic data on nearly 2 million single-nucleotide polymorphisms (SNPs). We measured individual-level genetic predispositions for coronary-artery disease, type 2 diabetes (T2D), obesity, rheumatoid arthritis (RA), Alzheimer's disease, and major depressive disorder (MDD) by polygenic risk scores (PRS) derived from genome-wide association studies (GWAS). The outcomes were self-rated health, depressive symptoms, cognitive ability, activities of everyday life, educational attainment, and wealth. We employed regression analyses for the outcomes including all polygenic scores and adjusting for gender, birth period, and genetic ancestry.ResultsThe polygenic scores had important associations with functional health and SES. An increase in genetic risk for all conditions except T2D was significantly (p < .01) associated with reduced functional health and socioeconomic outcomes. The magnitudes of functional health declines were meaningful and in many cases equivalent in magnitude to several years of aging. These associations were robust to several sensitivity checks for ancestry and adjustment for parental educational attainment and age at death or the last interview if alive.ConclusionStronger genetic predispositions for leading chronic conditions are related to worse long-run health and SES outcomes, likely reflecting the adverse effects of the onset of these conditions on one's wellbeing.
| S-EPMC5861924 | biostudies-literature
Project description:ObjectiveTo devise and test a self-management course for chronic pain patients based on evidence and underpinned by theory using the Medical Research Council (MRC) framework for developing complex interventions.DesignWe used a mixed method approach. We conducted a systematic review of the effectiveness of components and characteristics of pain management courses. We then interviewed chronic pain patients who had attended pain and self-management courses. Behavioural change theories were mapped onto our findings and used to design the intervention. We then conducted a feasibility study to test the intervention.SettingPrimary care in the inner city of London, UK.ParticipantsAdults (18 years or older) with chronic musculoskeletal pain.OutcomesRelated disability, quality of life, coping, depression, anxiety, social integration and healthcare resource use.ResultsThe systematic reviews indicated that group-based courses with joint lay and healthcare professional leadership and that included a psychological component of short duration (<8 weeks) showed considerable promise. The qualitative research indicated that participants liked relaxation, valued social interaction and course location, and that timing and good tutoring were important determinants of attendance. We used behavioural change theories (social learning theory and cognitive behaviour approaches (CBA)) to inform course content. The course addressed: understanding and accepting pain, mood and pain, unhelpful thoughts and behaviour, problem solving, goal setting, action planning, movement, relaxation and social integration/reactivation. Attendance was 85%; we modified the recruitment of patients, the course and the training of facilitators as a result of testing.ConclusionsThe MRC guidelines were helpful in developing this intervention. It was possible to train both lay and non-psychologists to facilitate the courses and deliver CBA. The course was feasible and well received.
| S-EPMC3831098 | biostudies-literature
Project description: Not available
| S-EPMC10660652 | biostudies-literature
Project description:Objectives. As in many settings, patients in community health centers in Ecuador do not complete previsit forms or receive assistance to identify questions and concerns they would like to address in brief clinic visits with physicians. We examined the comparative effectiveness of providing (1) a previsit form to complete; (2) a previsit form along with assistance in completing the form; and (3) usual care. Methods. Parallel, three-arm randomized controlled trial in two health centers serving indigent to low-income communities in Quito, Ecuador, among 199 adult patients who took medications for at least one chronic condition. Outcome measures were self-reported satisfaction with the visit, confidence in asking questions, and extent to which patients' objectives were met. Results. Patients who received assistance in completing a previsit form were more than twice as likely as participants in usual care to report achieving everything they wanted during their visit (AOR 2.2, P = 0.039). There were no differences in any outcomes between the groups who received the previsit form with no assistance and usual care. Conclusions. For high-quality patient-centered primary care, it is important to develop and test innovative and scalable interventions for patients and physicians to make the best use of limited clinic time.
| S-EPMC4390100 | biostudies-literature
Project description: Not available
| S-EPMC8420997 | biostudies-literature
Project description:Background and objectiveThis study determined whether practitioners specializing in keratoconus (KC) adhere to published guidelines for disease management and to what extent comorbid conditions of dry eye, contact lens tolerance, and psychological consequences of KC are formally assessed as part of long-term management.Materials and methodsThis cross-sectional study used an IRB-approved, Internet-based, REDCap platform. Descriptive statistics are presented.ResultsA total of 222 participants qualified for participation. Most 134 (60%) followed young and unstable patients every 6 months and less frequent follow-up examinations for patients with stable findings, with 142 (64%) recommending annual examinations. Scleral lenses were the preferred optical correction method (36%), followed by corneal gas permeable lenses (21%). A total of 118 (55%, n=216) participants recommend crosslinking to any patient with documented disease progression regardless of age. Fewer than 25% of patients were referred for surgical correction of KC. Half of respondents, 114 (51%), reported testing for tear film dysfunction, while 108 (49%) never tested. No participants used a depression screening instrument.ConclusionPractitioners managing patients with KC largely adhere to current consensus recommendations. This survey identified several potentially high-impact, low-cost improvements to current practice patterns, including screening for dry eye and depression.
| S-EPMC11753081 | biostudies-literature
Project description:Almost 80% of the 4 billion projected increase in world population by 2100 comes from 37 Mid-African Countries (MACs), caused mostly by slow declines in Total Fertility Rate (TFR). Historically, TFR has declined in response to increases in wellbeing associated with economic development. We show that, when Infant Survival Rate (ISR, a proxy for wellbeing) has increased, MAC fertility has declined at the same rate, in relation to ISR, as it did in 61 comparable Other Developing Countries (ODCs) whose average fertility is close to replacement level. If MAC ISR were to increase at the historic rate of these ODCs, and TFR declined correspondingly, then the projected world population in 2100 would be decreasing and 1.1 billion lower than currently projected. Such rates of ISR increase, and TFR decrease, are quite feasible and have occurred in comparable ODCs. Increased efforts to improve the wellbeing of poor MAC populations are key.
| S-EPMC6135380 | biostudies-literature
Project description: Not available
| S-EPMC5951621 | biostudies-literature
Project description:ObjectivesEvolution of multiple chronic conditions (MCC) follows a complex stochastic process, influenced by several factors including the inter-relationship of existing conditions, and patient-level risk factors. Nearly 20% of citizens aged 18 years and older are burdened with two or more (multiple) chronic conditions (MCC). Treatment for people living with MCC currently accounts for an estimated 66% of the Nation's healthcare costs. However, it is still not known precisely how MCC emerge and accumulate among individuals or in the general population. This study investigates major patterns of MCC transitions in a diverse population of patients and identifies the risk factors affecting the transition process.MethodsA Latent regression Markov clustering (LRMCL) algorithm is proposed to identify major transitions of four MCC that include hypertension (HTN), depression, Post- Traumatic Stress Disorder (PTSD), and back pain. A cohort of 601,805 individuals randomly selected from the population of Iraq and Afghanistan war Veterans (IAVs) who received VA care during three or more years between 2002-2015, is used for training the proposed LRMCL algorithm.ResultsTwo major clusters of MCC transition patterns with 78% and 22% probability of membership respectively were identified. The primary cluster demonstrated the possibility of improvement when the number of MCC is small and an increase in probability of MCC accumulation as the number of co- morbidities increased. The second cluster showed stability (no change) of MCC overtime as the major pattern. Age was the most significant risk factor associated with the most probable cluster for each IAV.ConclusionsThese findings suggest that our proposed LRMCL algorithm can be used to describe and understand MCC transitions, which may ultimately allow healthcare systems to support optimal clinical decision- making. This method will be used to describe a broader range of MCC transitions in this and non-VA populations, and will add treatment information to see if models including treatments and MCC emergence can be used to support clinical decision-making in patient care.
| S-EPMC5875179 | biostudies-literature