Background: There currently exists a vast amount of literature concerning chronic illness self-management, however the developmental patterns and sustainability of self-management over time remain largely unknown. This paper aims to describe the patterns by which different chronic illness self-management behaviors develop and are maintained over time. Method: Twenty-one individuals newly diagnosed with chronic illnesses (e.g., diabetes, rheumatism, ischemic heart disease, multiple sclerosis, chronic renal disease, inflammatory bowel disease) were repeatedly interviewed over two-and-a-half years. The interviews were conducted in Sweden from 2006 to 2008. A total of 81 narrative interviews were analyzed with an interpretive description approach. Results: The participants’ self-management behaviors could be described in four different developmental patterns: consistent, episodic, on demand, and transitional. The developmental patterns were related to specific self-management behaviors. Most participants took long-term medications in a consistent pattern, whereas exercise was often performed according to an episodic pattern. Participants managed health crises (e.g., angina, pain episodes) according to an on demand pattern and everyday changes due to illness (e.g., adaptation of work and household activities) according to a transitional pattern. All of the participants used more than one self-management pattern. Conclusion: The findings show that self-management does not develop as one uniform pattern. Instead different self-management behaviors are enacted in different patterns. Therefore, it is likely that self-management activities require support strategies tailored to each behavior’s developmental pattern. / Exploring individuals’ conceptions as a way to understand self-management among people living with long term medical conditions

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

Health risk assessment tools compute an individual’s risk of developing a disease. They are potentially useful in chronic disease prevention mediated by family physicians. We sought to learn family physicians’ awareness, and perspectives on the usefulness, usability and feasibility of implementation of risk assessment tools. Focus groups, discussion with key informants, and usability testing with an EMR-embedded risk assessment tool were conducted with family physicians (n=30) from academic and community-based practices. Analysis following grounded theory methodology was used to generate categories and themes. Our findings indicate that participants are aware of the implications of risk assessment calculations though very few tools are used regularly. Tool integration with EMR systems was felt to be essential in assisting tool usability, uptake and efficiency of use. Results provide insight into current risk assessment tool use and the facilitation of wider implementation of risk assessment tools in family practice settings.

Background: Since the discovery of oil in 1962, the United Arab Emirates (UAE) has experienced far-reaching social and economic changes. As a result, the physical and social environment of the UAE is moving away from the traditional Bedouin lifestyle to one that is more westernized. Given this recent trend toward a westernized lifestyle, chronic diseases are becoming more prevalent, impacting the rates of chronic disease among children, adolescents, and young adults residing in the UAE as well. Null hypothesis 1: There is no association between the level of physical activity and overweight/obesity, and hypertension. Null hypothesis 2: There is no association between the frequency of fruit and vegetable intake and overweight/obesity, and hypertension. Null hypothesis 3: There is no association between smoking status and overweight/obesity, and hypertension. Objectives: • to assess the prevalence of fruit and vegetable intake, physical activity, smoking, overweight/obesity, and hypertension among Arab college students in the UAE; • to determine the associations between fruit and vegetable intake, physical activity, smoking, overweight/obesity, and hypertension Methods: Participants included men and women college students of Arab descent attending the American University of Sharjah, UAE. A questionnaire was used to assess demographics, tobacco use, physical activity, and diet of participants. A qualitative food frequency questionnaire was used to assess frequency of fruit and vegetable consumption, including fruit juice, fruit, lettuce, white potatoes, beans, tomato sauce, vegetable soup, and other vegetables. Height, weight, and blood pressure were measured and BMI was determined. Results: The study sample included 145 men (n=73) and women (n=72) age 18-25 years. The prevalence of smoking was higher among men compared to women (65.8% vs. 30.6%; p<0.001). The prevalence of physical activity was higher among men compared to women (84.9% vs. 55.6%; p<0.001). The prevalence of overweight was higher among men compared to women (31.5 vs. 16.7%; p=0.01). The prevalence of obesity was higher among men compared to women (11.0 vs. 2.8%; p=0.01). The prevalence of high blood pressure was higher among men compared to women (56.9 vs. 17.1%; p<0.001). Among men and women, the contribution of fruit juice to the total daily frequency of fruit consumption was 57%. Of the total study population, 25.2% reported a frequency of fruit and vegetable intake ≥ 5 times/day. For women, frequency of fruit and vegetable intake had a significant negative association with physical activity. Among men, fruit and vegetable intake ≥ 5 times/day was found to be negatively associated with hypertension. A positive association was found between BMI and hypertension for men. Conclusions: The results of the study uphold the hypothesis that fruit and vegetable intake is inversely associated with hypertension among men. Compared to women, men exhibited a greater prevalence of high blood pressure, smoking, overweight/obesity, and physical activity. Men and women did not differ in the frequency of fruit and vegetable consumption. For the total study population, fruit juice contributed to 57% of the total fruit daily fruit intake. Women who reported engaging in physical activity were more likely to report a frequency of consumption of fruits and vegetables < 5 times per day. 65.8% of men and 48.4% of the total study population reported smoking either cigarettes or sheesha. Smoking was found to be more prevalent among students reporting a country of origin in middle and low income categories. More information is needed on the energy intake of college-age Arab women and their exercise patterns to determine if an intervention is warranted to prevent disordered eating. More information is needed on the consumption of fruit juice among this population to determine if an intervention is needed to promote intake of whole fruits and vegetables to replace fruit juice consumption. Interventions that target smoking habits among Arab college students need to incorporate sheesha smoking, since this habit was found to be common among both men and women.

No description available.

In this study, the factors affecting the acceptance of mobile homecare system were examined. These factors were assessed by taking Unified Theory of Acceptance and Use of Technology (UTAUT) as a theoretical model. The main feature of this thesis (differing from the other studies in the literature) is that the user acceptance study model is analyzed on a system that is not realized yet. So, this study has two dfferent perspectives. The first one is the examination the results of UTAUT for a system in the design phase. The other one is the investigation of the relations of factors that affect the acceptance of mobile homecare by patients with chronic diseases. For these purposes, a homecare system model was formulated based on similar studies in the literature. A quantitative research was conducted on this formulated system. The results were evaluated by Structural Equation Model. According to the results of structural model, all hypotheses were supported and consistent with the earlier study results, which were based on completed and in-use systems. Therefore, this study shows that, for systems in the design level, the acceptance models can also be applicable and may give similar results. The results also show that performance expectance was the most significant predictor for patients

Despite the efficacy of pulmonary rehabilitation programs which assist patients in managing chronic obstructive pulmonary disease (COPD), the high costs and lack of availability of such programs pose considerable barriers for underserved COPD patients, such as those living in rural communities. Because of this, patients are encouraged to actively self-manage COPD. Unfortunately, COPD patients have reported dissatisfaction with the self-management education they are provided. This mixed methods study assessed the self-management learning needs of COPD patients treated at a Certified Federal Rural Health Clinic through conducting focus group interviews (n = 2) to inform the development a targeted self-management education DVD. The effectiveness of 3 distinct educational treatments (DVD vs. Pamphlet vs. DVD Pamphlet) was evaluated by comparing outcomes related to informational needs, self-management self-efficacy, and generic/lung-specific HRQoL in a randomly-assigned, multiple-group pretestposttest design with a control group (n = 41). Focus group data was analyzed using three qualitative analysis tools. Findings from the interviews indicated that patients viewed self-management as simply taking prescribed medications and reducing activity. Patients reported a lack of knowledge and skill development related to rehabilitative activities such as controlled breathing and stress reduction. A multivariate analysis of covariance was conducted to determine the effect of 3 educational treatments on multiple outcome measures. Three nontrend orthogonal planned contrasts were tested to determine selected contrast effects. The data analysis revealed that participants receiving a DVD reported statistically significantly higher levels of lung-specific physical functioning as compared to those in the Pamphlet group. Additionally, the DVD group revealed clinically significant improvements on the physical ( 19.01) and emotional ( 10.74) functioning dimensions of lung-specific HRQoL; whereas, no such improvement occurred within the Pamphlet and control groups. Results also suggested that providing patients with a Pamphlet alone was more effective than providing participants with both interventions concurrently to increase self-management self-efficacy. The simultaneous provision of both interventions did, however, enhance generic HRQoL more so than the provision of one of the two treatments alone. Finally, any type of self-management education as compared to usual care did not statistically significantly improve outcome variables among this small sample of rural patients.

Chronic liver disease (CLD) is a leading cause of morbidity and mortality in HIV-infected individuals. The purposes of this study were to determine the prevalence and etiologies of CLD in an urban HIV-infected population and to identify CLD risk factors. We conducted a retrospective chart review of 799 HIV-infected patients seen at four New Haven health centers from 2002 to 2003. We applied the New Haven County Liver Study definition to identify patients with CLD. 65% were male, 44% were African American, and 23% were of Hispanic ethnicity. The mean age was 45 years. 30% had a history of alcohol abuse. 35% reported injection drug use as their HIV risk factor. Heterosexual contact and men having sex with men (MSM) were reported in 31% and 16% of cases. 50% of patients had a diagnosis of AIDS. 60% percent of patients had CLD. Over 50% of cases of CLD were attributed to chronic hepatitis C (HCV), either alone or with coexisting alcoholic liver disease. Alcoholic liver disease alone, hepatitis B virus (HBV), HAART-induced liver disease, and non-alcoholic liver disease (NAFLD) accounted for smaller percentages. 84% of patients were on HAART, but only 3.6% of patients with positive HCV or HBV serologies were on treatment for CLD. 75% of patients received pneumococcal and influenza vaccines, but only half of eligible patients received hepatitis A and B vaccines. In multivariate analysis, alcohol abuse and positive HCV status were associated with CLD. CLD is prevalent in our population. Preventive care and treatment for CLD are being overlooked in many. Vaccines, treatment for viral hepatitis, and strategies for reducing drug and alcohol abuse are priorities.

Ein lebendes System kann man in seiner Vielfalt und Vitalität nicht verbessern, indem man nur vereinzelte sichtbare Defekte beseitigt. Es kommt vielmehr darauf an, die Struktur des gesamten Systems, also seine Gesamtkonstellation zu verbessern, zu stabilisieren, dafür zu sorgen, dass das System nicht überlastet und starr wird, sondern auf Störungen reagieren, sie auffangen und mit Ihnen fertig werden kann. (aus dem Vorwort)

Thesis--University of Oklahoma. / Includes bibliographical references (leaves 39-41).