Determinants of self-reported health status in a population-based sample of persons with radiographic knee osteoarthritis

Knee osteoarthritis (OA) is highly prevalent and disabling. Patients with radiographic knee OA may experience pain and functional impairment, which can diminish their health status. Our objective was to determine factors associated with self-reported health status in a national population-based sample with radiographic knee OA

Professionalism and Evolving Concepts of Quality

For much of the twentieth century, quality of care was defined specifically in terms of physician characteristics and behaviors. High-quality physicians were well trained, knowledgeable, skillful, and compassionate. More recently, quality of care has been defined in terms of systems of care. High-quality organizations develop and adopt practices to reduce adverse events and optimize outcomes. This essay discusses this transformation from physician-based to organization-based concepts of quality and the consequences for patient care and medical professionalism

Mindful Living in Older Age: a Pilot Study of a Brief, Community-Based, Positive Aging Intervention

Although mindfulness-based interventions have been successfully used with older adults, there have been few interventions that, (a) are created specifically for older adults, (b) are delivered in the community, and (c) aim to promote ‘successful aging’ (rather than just treating dysfunction/disorder). To this end, the current study piloted a brief ‘positive aging’ intervention, comprising two 150 minute sessions, with six female older adults living in the community. Data were gathered through focus groups that were interwoven throughout the intervention. Using thematic analysis, four main themes were identified: (a) aging as a mixed blessing; (b) understanding mindfulness; (c) the challenges of mindfulness; and (d) the benefits of mindfulness. Overall, the intervention was successful in introducing participants to mindfulness and potentially forming the basis of a longer term practice. However, the study also highlighted important points on the challenges of practising mindfulness, in relation to which the paper makes recommendations pertaining to the teaching of mindfulness with older adults

Milwaukee Health Report 2013: Health Disparities in Milwaukee by Socioeconomic Status

The Milwaukee Health Report 2013 is based upon the population health framework and the foundational work of the University of Wisconsin Population Health Institute\u27s Wisconsin County Health Rankings. In that framework, health outcomes are considered the result of a set of health determinants (e.g., healthcare access and quality, health behaviors, physical environment, and socioeconomic determinants such as income and education). Thus, the distribution of health outcomes and health disparities result from differences in the distribution of the determinants in the population. The Milwaukee Health Report 2013 provides information regarding health disparities among the SES groups within the city, and offers comparisons of health outcomes and health determinants between the City of Milwaukee, the State of Wisconsin and the United States. The goal of this report is to provide policy makers and community organizations with meaningful information that can be used in addressing Milwaukee’s health issues

Testing Longitudinal Relationships Between Binge Drinking, Marijuana Use, and Depressive Symptoms and Moderation by Sex

PURPOSE: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. We examined the longitudinal associations between substance use frequency and depressive symptoms from adolescence into young adulthood, and whether the associations were moderated by sex. METHODS: With data from Waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (n=9816), we used growth curve models to test if depressive symptoms predicted marijuana use or binge drinking frequency (Self-Medication Model) or if substance use frequency predicted depressive symptoms (Stress Model). Moderation by sex and age was tested for both potential pathways. RESULTS: Increases in adolescent depressive symptoms, compared to no symptoms, were associated with a steeper predicted increase in marijuana use frequency from adolescence to young adulthood. Increases in persistent binge drinking or marijuana use frequency had concurrent positive associations with depressive symptoms from adolescence to young adulthood, and these associations were significantly stronger for females compared to males. CONCLUSIONS: The results support the Self-Medication Model for marijuana use but also provide modest support for the Stress Model, that substance use is associated with depressive symptoms, especially for females

Struck by lightning or slowly suffocating – gendered trajectories into depression

<p>Abstract</p> <p>Background</p> <p>In family practice depression is a common mental health problem and one with marked gender differences; women are diagnosed as depressed twice as often as men. A more comprehensive explanatory model of depression that can give an understanding of, and tools for changing, this gender difference is called for. This study explores how primary care patients experience, understand and explain their depression.</p> <p>Methods</p> <p>Twenty men and women of varying ages and socioeconomic backgrounds diagnosed with depression according to ICD-10 were interviewed in-depth. Data were assessed and analyzed using Grounded Theory.</p> <p>Results</p> <p>The core category that emerged from analysis was "Gendered trajectories into depression". Thereto, four categories were identified – "Struck by lightning", "Nagging darkness", "Blackout" and "Slowly suffocating" – and presented as symbolic illness narratives that showed gendered patterns. Most of the men in our study considered that their bodies were suddenly "struck" by external circumstances beyond their control. The stories of study women were more diverse, reflecting all four illness narratives. However, the dominant pattern was that women thought that their depression emanated from internal factors, from their own personality or ways of handling life. The women were more preoccupied with shame and guilt, and conveyed a greater sense of personal responsibility and concern with relationships.</p> <p>Conclusion</p> <p>Recognizing gendered narratives of illness in clinical consultation may have a salutary potential, making more visible depression among men while relieving self-blame among women, and thereby encouraging the development of healthier practices of how to be a man or a woman.</p