Determinants of self rated health for Canadians with chronic disease and disability. (57/5627)

OBJECTIVE: To identify the factors associated with self rated health of people with and without chronic health conditions or long term disability. SETTING: Canadian household population. DESIGN: Analysis of 1994/95 National Population Health Survey interview data with 13,995 respondents aged 20 years and older. Determinants of poor and good compared with excellent health were examined using multivariate nominal logistic regression. Factors included in the analyses were illness related (chronic disease, long and short-term disability, and pain) demographic, lifestyle (smoking, physical activity, drinking), and social psychological resources (mastery, chronic stress, distress, self esteem, and social support). RESULTS: Illness related variables were associated with poor health, with smaller but significant contributions from demographic and lifestyle factors. Psychological resources, especially high mastery and self esteem, are associated with better health in those with chronic conditions or disability. CONCLUSION: The determinants of self rated health for people with chronic illness and disability make the greatest contribution to the findings for the overall population.  (+info)

Developing a managed care delivery system for people with HIV/AIDS. (58/5627)

Capitated managed care is now a significant part of the healthcare landscape in the United States. Consequently, states across the country are looking to it as a means of lowering their costs for Medicaid recipients. Implementing Medicaid managed care plans, however, requires considerable planning and research to ensure that providers are fairly reimbursed and that patients continue to receive quality care. Efforts to ensure adequate reimbursement and quality care are particularly important for persons with HIV/AIDS and those with other chronic conditions, populations that require considerable healthcare resources and often are covered by Medicaid. The transition to Medicaid managed care can be smoothed through stakeholder input and consideration of the overall healthcare marketplace and political climate, the structure of managed care organizations, the means of informing consumers of their managed care choices, the potential size of the Medicaid patient base, and the need to integrate clinical and social services for patients with HIV/AIDS.  (+info)

Sons as sole caregivers for their elderly parents. How do they cope? (59/5627)

OBJECTIVE: To examine the experiences of men who are sole caregivers for their elderly parents. DESIGN: Semistructured in-depth interviews. SETTING: Family practice clinic attached to a large tertiary care centre in north central Toronto. PARTICIPANTS: A convenience sample of 10 men who identified themselves as sole caregivers in that they had no particular women assisting them with caregiving. METHOD: Interviews were analyzed by standard qualitative methods. MAIN FINDINGS: Emerging themes were the spectrum of caregiving, the experience of caregiving, and the use of formal support systems. Scope of care varied from very little to total care, including personal care. Participants described positive and negative aspects of and the nature of their relationships with those for whom they cared. Avoiding institutionalization was seen as positive; effects on work and social life were negative. Use of more than homemaking services was associated with previous hospitalization; participants complained about difficulties accessing services. CONCLUSIONS: The nature of sons' relationships with their parents and the amount of time they have available can predict how much caregiving they can undertake. Information about community support services is not readily accessible to these men.  (+info)

Caregivers for people with dementia. What is the family physician's role? (60/5627)

OBJECTIVE: To examine the role of family physicians in providing support and care to caregivers for people with dementia. QUALITY OF EVIDENCE: Data were obtained from Alzheimer Society guidelines, published consensus statements, and guidelines for family physicians caring for people with dementia and their caregivers. Most of the reported findings and recommendations are based on information from expert consensus statements and opinion. MAIN MESSAGE: Caring for people with dementia causes substantial psychological and physical morbidity. Services developed for caregivers (in-home respite and individual psychological interventions) and comprehensive support programs are helpful in relieving caregiver distress. There is a role for family physicians in following caregivers longitudinally to assess their physical and emotional health and coping skills, to provide information and assistance in dealing with problems as they arise, to assist caregivers in mobilizing family and friends, and to facilitate referrals to appropriate services and resources. CONCLUSIONS: Family physicians have an important role in identifying caregiver problems and providing direct and ongoing support to caregivers in their day-to-day role.  (+info)

Family support in general practice. (61/5627)

At a time when social services are overburdened in Britain, family support in general practice offers one way to fill the gap. In the Well Family Project, a 'family support coordinator' worked within a general practice in Hackney, London. In the first eighteen months she saw 113 clients. Evaluation was by semistructured interviews with a sample of these clients and with professional workers. Comments from those interviewed indicate that the family support was valued. The general practice base was convenient and non-stigmatizing. By adopting a proactive approach, the project was able to work with clients who had previously 'slipped through the net'. Some of the professionals interviewed would have liked to provide the same help, but were unable to do so because of time and other constraints. Family support provided through general practice was well received by vulnerable families. Although there was overlap with the remit of health visitors and social workers, the protected time and the independence of the coordinator enabled clients to obtain the help they wanted. The replicability of this strategy now needs to be assessed.  (+info)

Guidelines for a genetic risk based approach to advising women with a family history of breast cancer. UK Cancer Family Study Group (UKCFSG). (62/5627)

A family history of breast cancer has long been recognised as a significant risk factor for breast cancer. Quantifying that risk has been approached in publications and practically in a number of different ways. Increasingly regional genetics departments are called upon to help clarify guidelines for referral of women with a family history of breast cancer for genetic testing and to clarify breast cancer risk for women seeking early mammographic screening. This paper represents the current consensus guidelines from the UK Cancer Family Study Group and discusses some of the difficulties surrounding genetic risk estimation.  (+info)

A study of stress in medical students at Seth G.S. Medical College. (63/5627)

BACKGROUND: It is usually observed that medical students undergo tremendous stress during various stages of the MBBS course. There is a high rate of suicide among them. METHODS: To determine incidence of stress and factors controlling stress in medical students at various stages of MBBS course at Seth G S Medical college, 238 students (First year 98, Second 76, Third 64) were asked to complete a questionnaire on personal data (gender, stay at hostel, mode of travel, time spent in travel every day, medium of study in school, place of school education.), Stress inducing factors, Zung's depression scale, ways of coping, stress relievers, perceived social support and personality type. Statistical tests used were ANOVA, critical ratio and Student's 't' test. RESULTS: Majority of medical students (175/238--73%) perceived stress. Stress was found to be significantly more in Second and Third MBBS students rather than First MBBS levels (p < 0.05). Stress was not found to differ significantly on the basis of sex, stay at hostel, model of travel, time spent in travel every day, medium of study in school, place of school education. Stress was found to be significantly more in students having more than 95% of marks at 12th Standard as compared to others. Academic factors were greater perceived cause of stress in medical students. There was no significant difference in the students at different levels of MBBS regarding academic factors and social factors as a stress inducing factors. Physical factors were found to be significantly more in Second and Third MBBS students as compared to First MBBS students. Emotional factors were found to be significantly more in First MBBS students as compared to Second & Third MBBS students. Stress was more common in medical students who have dominant strategy of coping as positive reappraisal, accepting responsibility and planful problem solving. Stress was less common in medical students at Seth G S Medical College who have dominant strategy of coping as escaping and distancing from difficult situation. Family and Friend as perceived social supports were more in Second MBBS than First MBBS medical students. Stress was not found to be significantly more in students having their personality factor contributing to stress (Type A--52/67) as compared to others (Type B--123/171). This indicates that the stress was not trait oriented but was process oriented (p = NS). CONCLUSION: Stress in medical students is common and is process oriented. It is more in second and third year. Academic factors are greater perceived cause of stress in medical students at Seth G S medical college. Emotional factors are found to be significantly more in First MBBS. It is dependent on person's ways of coping and social support.  (+info)

Psychological, behavioural, and social adjustment in children and adolescents with juvenile chronic arthritis. (64/5627)

OBJECTIVE: To assess the psychological, behavioural and social adjustment of children (7-11 years) and adolescents (12-16 years) with juvenile chronic arthritis (JCA). Higher rates of maladjustment were expected to be found in these patients. METHODS: Self report questionnaires were used within the context of personal interviews. Family functioning and social support were studied as well. Forty seven patients with JCA, 52 healthy peers and their respective parents participated in the study. RESULTS: Self esteem, perceived competence and body image in patients with JCA were as positive as they were in healthy participants. There were no differences between ill and healthy youngsters with respect to the incidence of psychopathology. Patients with JCA, in general, perceived themselves as socially competent, but they seemed to have somewhat less opportunity or energy to participate in social activities. Children with JCA showed a high level of aspiration to cope with social expectations. This aspiration seemed to be even stronger in case the disease caused more strains, for example, in periods of inflammation and in the systemic onset type. The high level of social adjustment in children with JCA seemed to be supported by highly cohesive family structures. Generally, adolescents with JCA experienced much social support. CONCLUSIONS: In contrast with our expectation, children and adolescents with JCA seemeed to cope quite well with the psychological and social consequences of their long term condition. For future studies, it is hypothesised that the high levels of adaptation might imply an enduring psychological strain, which is reflected in an altered function of the autonomic nervous system.  (+info)