Onset of Multiple Chronic Conditions and Depressive Symptoms: A Life Events Perspective.

Background: While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions. Methods: Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWL Results: Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic conditions had significantly higher levels of depressive symptoms than people who did not make this transition. The diagnosis of arthritis, diabetes, heart disease, and pulmonary disease, but not hypertension had independent effects, increasing depressive symptoms. Conclusions: Having a diagnosis of multiple chronic conditions leads to increases in depressive symptoms, but not all illnesses have the same effect. Findings highlight the need for clinicians to be aware of mental health risks in patients diagnosed with multiple chronic conditions, particularly those with a diagnosis of arthritis, diabetes, heart disease, and pulmonary disease. Clinical care providers should take account of these findings, encouraging psychosocial supports for older adults who develop multiple chronic conditions to minimize the negative psychological impact of illness diagnosis

African-American patients with cancer Talking About Clinical Trials (TACT) with oncologists during consultations: evaluating the efficacy of tailored health messages in a randomised controlled trial—the TACT study protocol

Introduction Low rates of accrual of African-American (AA) patients with cancer to therapeutic clinical trials (CTs) represent a serious and modifiable racial disparity in healthcare that impedes the development of promising cancer therapies. Suboptimal physician–patient consultation communication is a barrier to the accrual of patients with cancer of any race, but communication difficulties are compounded with AA patients. Providing tailored health messages (THM) to AA patients and their physician about CTs has the potential to improve communication, lower barriers to accrual and ameliorate health disparities. Objective (1) Demonstrate the efficacy of THM to increase patient activation as measured by direct observation. (2) Demonstrate the efficacy of THM to improve patient outcomes associated with barriers to AA participation. (3) Explore associations among preconsultation levels of: (A) trust in medical researchers, (B) knowledge and attitudes towards CTs, (C) patient-family member congruence in decision-making, and (D) involvement/information preferences, and group assignment. Methods and analysis First, using established methods, we will develop THM materials. Second, the efficacy of the intervention is determined in a 2 by 2 factorial randomised controlled trial to test the effectiveness of (1) providing 357 AA patients with cancer with THM with 2 different ‘depths’ of tailoring and (2) either providing feedback to oncologists about the patients\u27 trial THM or not. The primary analysis compares patient engaged communication in 4 groups preconsultation and postconsultation. Ethics and dissemination This study was approved by the Virginia Commonwealth University Institutional Review Board. To facilitate use of the THM intervention in diverse settings, we will convene ‘user groups’ at 3 major US cancer centres. To facilitate dissemination, we will post all materials and the implementation guide in publicly available locations

Depressive Symptoms and Marital Satisfaction in the Context of Chronic Disease: A Longitudinal Dyadic Analysis

These analyses examined the longitudinal relationships between depressive symptoms and marital satisfaction over a 2-year period as experienced by 315 patients with end-stage renal disease and their spouses. Using multilevel modeling, the authors examined both individual and cross-partner effects of depressive symptoms and marital satisfaction on patients and spouses, testing bidirectional causality. Results indicate that mean and time-varying depressive symptoms of both patients and spouses were associated with their own marital satisfaction. Although mean marital satisfaction was associated with own depressive symptoms for both patients and spouses, time-varying marital satisfaction did not affect depressive symptoms for either patients or spouses. Significant cross-partner effects reveal that both mean enduring and time-varying depressive symptoms of the spouse affected marital satisfaction of the patient. Findings highlight the complex nature of the relationship between depressive symptoms and marital satisfaction in late-life couples

Effects of Caregiver Burden and Satisfaction on Affect of Older End-Stage Renal Disease Patients and Their Spouses

We examined the extent to which a 2-factor model of affect explains how the burdens and satisfactions experienced by caregivers influence their own well-being and that of the spouses for whom they provide care. Using data from 315 older patients with end-stage renal disease and their spouses, we extended tests of Lawton et al.\u27s (1991) 2-factor model both longitudinally and dyadically. Multilevel modeling analyses partially support the 2-factor model. Consistent with the model, mean caregiver burden has a stronger effect on both caregiver and patient negative affect than does mean caregiver satisfaction. Contrary to the model, mean caregiver satisfaction has an effect on caregiver positive affect that is similar to that of mean caregiver burden, and it has no effect on patient positive affect. Time-varying effects of caregiver burden are consistent with the 2-factor model for caregiver but not patient negative affect. Time-varying effects of caregiver satisfaction are not consistent with the 2-factor model for either patients or caregivers. Results highlight the powerful role of caregiver burden for both caregivers and patients and suggest important new directions for conducting health-related research with late-life marital dyads

Agreement between mothers and children with malocclusion in rating children's oral health-related quality of life

Introduction: The aim of this study was to compare the assessment of oral health-related quality of life (OH-QoL) between children with malocclusion and their mothers, by using responses to the child perceptions questionnaire and the parental-caregivers perceptions questionnaire. Methods: The study was conducted in 90 children, aged 11 to 14 years, with a malocclusion grade of 4 or 5 according to the index of orthodontic treatement need dental health component. The children and their mothers completed the questionnaires independently. Results: The mean ratings were similar for total scores (children, 20.4; mothers, 20.1), oral symptoms (children, 5.2; mothers, 4.7), and social well-being (children, 4.3; mothers, 4.8). However, the mothers group had a lower mean score for functional limitations (children, 5.3; mothers, 3.6) and a higher mean score for emotional well-being (children, 5.6; mothers, 7.1). The correlations between children's and mothers' responses ranged from rs = 0.545 for total score and emotional well-being to rs = 0.357 for functional limitations. There were good correlations between their responses to global (rs = 0.466) and life overall (rs = 0.427) questions, but poor correlations between the 2 questions, suggesting that these concepts were considered differently. Conclusions: Maternal opinions were similar to those of their children for the overall impact on OH-QoL of malocclusion, but mothers were more dissatisfied with the appearance of their children's teeth and overestimated the emotional impact of malocclusion. It would be useful to develop a specific measure to assess OH-QoL in children with malocclusion. (Am J Orthod Dentofacial Orthop 2010;137:631-8

Determinants of Counseling for Children in Manhattan After the September 11 Attacks

Objective: After the September 11 terrorist attacks, many adults and children received counseling. The authors assessed the prevalence and correlates of counseling for experiences related to the disaster received by children aged four to 18 years living in Manhattan. Methods: From a representative sample of 1,008 adult residents of Manhattan who were living below 110th Street five to eight weeks after the attacks, the authors interviewed 112 parents or primary caretakers about their child’s level of exposure to the disaster, the extent of loss, receipt of counseling services, and behavioral reaction. Results: Overall, 22 percent of the children had received some form of counseling related to their experiences after the disaster. More than half of the counseling received (58 percent) was delivered in schools. Predictors of counseling in a multivariate model were male sex (odds ratio=5.3), having a parent with current posttraumatic stress disorder related to the attacks (OR=4.3), and having at least one sibling living in the household (OR=3.6). Conclusions: Parents’ own level of posttraumatic stress was associated with whether their children received counseling related to the September 11 attacks. This finding has important implications, because parents act as decision makers for their children in seeking health care. After the terrorist attacks, school and health care personnel provided early intervention counseling in Manhattan.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40295/2/Stuber_Determinants of Counseling for Children_2002.pd

Parent-Reported Family Functioning among Children with Cleft Lip/Palate

To examine family functioning related to sociodemographic and clinical characteristics in youth with cleft lip and/or palate (CL/P)

Change in children's oral health-related quality of life following dental treatment under general anaesthesia for the management of dental caries: a systematic review.

BACKGROUND: Dental caries has significant impact on children and their families and may necessitate treatment under general anaesthesia (GA). The use of oral health-related quality-of-life (OHRQoL) measures enables evaluation of dental treatment from a patient's perspective. OBJECTIVE: This systematic review aimed to assess change in OHRQoL in children following treatment under GA for the management of dental caries. METHODS: A comprehensive search was conducted to identify articles which were assessed against inclusion criteria before data extraction. Studies involving children under 16 years, having treatment for dental caries under GA, were considered eligible. Included studies were quality assessed. RESULTS: Twenty studies were included, which demonstrated significant heterogeneity. Most studies employed a pre-test-post-test design. All but one study relied on proxy reports of OHRQoL. Only half the studies used instruments validated in the study population. Whereas all studies reported improved OHRQoL overall, some subscales showed changes which were not significant or worsened OHRQoL. The scientific quality of the studies varied considerably. CONCLUSION: Heterogeneity of included papers limited the conclusions which could be drawn. Treatment under GA appears to result in overall improvements in proxy-reported OHRQoL; however, there is a need for further high-quality studies employing validated, child-reported measures of OHRQoL