What's the Risk? Older Women Report Fewer Symptoms for Suspected Acute Coronary Syndrome than Younger Women.

The purpose of the study was to determine whether older (≥65 years) and younger (<65 years) women presenting to the emergency department (ED) with symptoms suggestive of acute coronary syndrome (ACS) varied on risk factors, comorbid conditions, functional status, and symptoms that have implications for emergent cardiac care. Women admitted to five EDs were enrolled. The ACS Symptom Checklist was used to measure symptoms. Comorbid conditions and functional status were measured with the Charlson Comorbidity Index and Duke Activity Status Index. Logistic regression models were used to evaluate symptom differences in older and younger women adjusting for ACS diagnosis, functional status, body mass index (BMI), and comorbid conditions. Analyses were stratified by age, and interaction of symptom by age was tested. Four hundred women were enrolled. Mean age was 61.3 years (range 21-98). Older women (n = 163) were more likely to have hypertension, hypercholesterolemia, never smoked, lower BMI, more comorbid conditions, and lower functional status. Younger women (n = 237) were more likely to be members of minority groups, be college-educated, and have a non-ACS discharge diagnosis. Younger women had higher odds of experiencing chest discomfort, chest pain, chest pressure, shortness of breath, nausea, sweating, and palpitations. Lack of chest symptoms and shortness of breath (key symptoms triggering a decision to seek emergency care) may cause older women to delay seeking treatment, placing them at risk for poorer outcomes. Younger African American women may require more comprehensive risk reduction strategies and symptom management

Evaluation of a Dutch version of the AIMS2 for patients with rheumatoid arthritis

DUTCH-AIMS2, a Dutch version of AIMS2 and successor to DUTCH-AIMS, is an instrument to assess health status among patients with rheumatic diseases. It provides measurements of 12 areas of health status on scales for health status proper, satisfaction, attribution and arthritis impact. We assessed the reliability of its scales in terms of internal consistency and their validity according to both internal standards and external standards. Correctly completed questionnaires were returned by 231 RA patients and 131 controls. Internal consistency coefficients for the health status scales ranged from 0.66 and 0.89, but most exceeded 0.80. Within-scale factor analyses produced single factors in all composite health status scales for both patients and controls, with only two exceptions. Factor analysis also identified a physical, social and psychological dimension among 11 areas of health. External validity was established by strong correlations between DUTCH-AIMS2 health status scales and functional class, laboratory parameters, and self-assessments of fatigue, loneliness, pain, functional disability and social support. DUTCH-AIMS2 is acceptably reliable and valid for use in a variety of settings

Living with Fibromyalgia (FM): The Salience ofClinical Subgroups

Fibromyalgia (FM) is an elusive syndrome that affects 2% of the United States population, with health care costs exceeding $20 billion in 1998. FM alters lives with its symptoms and by interfering with everyday life. This dissertation explored the association between subgroups of women with FM and their functional status. The first study examined the effectiveness of an Internet-based health promotion intervention to improve the clinical outcomes for two subgroups of women with FM: those with high Fibromyalgia Impact Questionnaire (FIQ) scores (n = 5) and those with low FIQ scores (n = 5). Single subject design and grouped data revealed that the intervention had mixed results for the two subgroups. The clinical response to the intervention depended on the method of analysis (individual versus group) and the target behavior of interest. The second study examined the associations among objective and subjective measures, and two target outcomes: physical activity and functional status (FIQ total score), and then used the data to classify FM subgroups (n = 72). Using Exhaustive Chi-square Automatic Interaction Detector (Exhaustive CHAID), we developed two models. Model I, with the target outcome of physical activity, yielded 9 distinct subgroups, whose members had characteristics that were significantly associated with very unfavorable to very favorable physical activity outcomes. Model II, with the target outcome of the FIQ total score, yielded 5 distinct subgroups whose members had characteristics that were significantly associated with very unfavorable to very favorable functional status outcomes. The third study used qualitative and quantitative methods to identify clinically relevant triggers of FM flares, experienced by three subgroups women with low (n = 6), average (n = 5), and high (n = 4) FM impact, to explore the effect of triggers on their functional status. Using mixed methods, we were able to substantiate, quantify, and qualify the affects of FM on the lives of persons with FM and the direct consequences of those affects on activities. Overall activity, FM symptoms, and weather were the most prominent triggers. Findings from these studies suggest that the influence of FM on functional status affects women differently based on subgroup membership

The Effect of Acceptance Training on Psychological and Physical Health Outcomes in Elders with Chronic Conditions

This pilot trial investigated the short and long-term effects of Acceptance Training (ACT) intervention on acceptance, perceived health, functional status, anxiety, and depression in elders with chronic conditions living in retirement communities (RCs). The ACT intervention combined Rational Emotive Behavior Therapy with music, relaxation, and guided imagery during six weekly 2-hour sessions. Face-to-face interviews were conducted with 16 African-American and 46 White elders across four data collection points in six randomly selected RCs using well-established measures of perceived health, functional status, anxiety, and depression, and a measure of acceptance of chronic conditions adapted from a previous measure of acceptance of diabetes. While changes were found in perceived health, functional status, anxiety, and depression, the most significant changes occurred in the elders\u27 acceptance of chronic conditions immediately after the intervention (t = -2.62, P \u3c .02), and these changes persisted for 6 and 12 weeks (t\u27s = -2.74, -3.32, p\u27s \u3c .01), respectively. Although a 40% attrition rate reduced the sample size from 62 (N = 62) to 37 (N = 37), the significant increases in acceptance over time provide initial evidence for the fidelity of the ACT intervention

Vocational perspectives after spinal cord injury

Objective: To give insight into the vocational situation several years after a traumatic spinal cord injury (SCI) and describe the personal experiences and unmet needs; to give an overview of health and functional status per type of SCI and their relationship with employment status. Design: Descriptive analysis of data from a questionnaire. Setting: Dutch rehabilitation centre with special department for patients with spinal cord injuries. Subjects: Fifty-seven patients with a traumatic SCI, aged 18-60 years, admitted to the rehabilitation centre from 1990 to 1998. Main measures: Questionnaire with items related to vocational outcome, job experiences, health and functional status. Results: Of 49 patients who were working at the moment of SCI 60% currently had a paid job. Vocational outcome was related to a higher educational level. A significant relation between the SCI-specific health and functional status and employment was not found. The respondents who changed to a new employer needed more time to resume work, but seemed more satisfied with the job and lost fewer working hours than those who resumed work with the same employer. In spite of reasonable to good satisfaction with the current work situation, several negative experiences and unmet needs were reported. Conclusions: Despite a high participation in paid work following SCI, the effort of the disabled worker to have and keep a job should not be underestimated

Functional Urban Areas as the Focus of Development Policy in Poland

This article presents the premises, current status and the prospects of using functional urban areas as the focus of Poland's development policy. For the past 10 years, cities, especially large ones, have been increasingly impacting on their surrounding areas defined as functional urban areas. The size of those areas is determined by the process of suburbanisation. The article emphasises the issue of uncoordinated development of functional urban areas surrounding core cities and on grassroot and top-down attempts to integrate their development

Functional status in ICU survivors and out of hospital outcomes: a cohort study

OBJECTIVES: Functional status at hospital discharge may be a risk factor for adverse events among survivors of critical illness. We sought to examine the association between functional status at hospital discharge in survivors of critical care and risk of 90-day all-cause mortality after hospital discharge. DESIGN: Single-center retrospective cohort study. SETTING: Academic Medical Center. PATIENTS: Ten thousand three hundred forty-three adults who received critical care from 1997 to 2011 and survived hospitalization. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The exposure of interest was functional status determined at hospital discharge by a licensed physical therapist and rated based on qualitative categories adapted from the Functional Independence Measure. The main outcome was 90-day post hospital discharge all-cause mortality. A categorical risk-prediction score was derived and validated based on a logistic regression model of the function grades for each assessment. In an adjusted logistic regression model, the lowest quartile of functional status at hospital discharge was associated with an increased odds of 90-day postdischarge mortality compared with patients with independent functional status (odds ratio, 7.63 [95% CI, 3.83-15.22; p < 0.001]). In patients who had at least 7 days of physical therapy treatment prior to hospital discharge (n = 2,293), the adjusted odds of 90-day postdischarge mortality in patients with marked improvement in functional status at discharge was 64% less than patients with no change in functional status (odds ratio, 0.36 [95% CI, 0.24-0.53]; p < 0.001). CONCLUSIONS: Lower functional status at hospital discharge in survivors of critical illness is associated with increased postdischarge mortality. Furthermore, patients whose functional status improves before discharge have decreased odds of postdischarge mortality.L30 TR001257 - NCATS NIH HH

Patient Perceptions of Patient-Empowering Nurse Behaviours, Patient Activation and Functional Health Status in Postsurgical Patients with Life-Threatening Long-Term Illnesses

Aim To explore the trajectory of associations between the nursing care process of patient empowerment during postsurgical hospitalization and postdischarge patient self-management outcomes, specifically patient activation and functional health status. Background Patient-centred care models advocate for patient empowerment in long-term illness care. Postsurgical patients with life-threatening long-term illnesses frequently feel powerless, have unmet needs, decreased functional health status and high readmission rates; however, previous studies of patient empowerment have conceptualized empowerment as an outcome primarily in outpatient settings, with little attention paid to provider processes used to empower patients during hospitalizations. Design A non-experimental, prospective, correlational study. Methods This sample consisted of 113 postsurgical cancer and cardiac patients enrolled between August 2012–February 2013. Patient perceptions of patient-empowering nurse behaviours and baseline patient activation were measured prior to discharge. Patient activation and functional health status were measured 6 weeks following discharge. Data were analysed with multiple linear regression using a simultaneous equation approach. Results Patients reported high perceptions of patient-empowering nurse behaviours and patient activation levels. Functional health status scores were below population norms. Patient perceptions of empowering nurse behaviours were positively associated with postdischarge patient activation, which was positively associated with mental functional health status. Length of stay was the only significant predictor of physical functional health status. Conclusion This study provides further quantitative evidence supporting the relationship between quality nursing care and postdischarge patient outcomes. Intentional use of patient-empowering nurse behaviours could lead to improved patient activation and functional health status in postsurgical patients with life-threatening long-term illnesses