Background According to the Americans with Disabilities Act, an individual with a disability has a physical or mental impairment that substantially limits one or more major life activities (ADA, 2014). A large body of literature indicates a strong relationship between disability and poor health. Adults with disabilities are more likely to suffer from chronic conditions than adults with no limitations. Thus, this vulnerable population with disabilities should be targeted for health promotion efforts. Healthy People 2020 calls for the inclusion of people with disabilities in U.S. health promotion efforts (Dixon, 2014). According to the Center for Disease Control and Prevention (CDC), individuals with disabilities that begin during the developmental period and last throughout their lifetime causing impairment in physical, learning, language, or behavior areas, are defined as having developmental disabilities (DD) (CDC, 2014). Despite the increasing prevalence of DD in the US, there is little known about the association of DD and chronic health conditions such as obesity, cancer, hypertension and diabetes mellitus. Developmental disability can impact healthy eating habits and physical activity; thus, people living with DD are a vulnerable population at risk of becoming overweight and/or obese and developing a multitude of chronic diseases. Emerging research supports an association between childhood obesity and ASD, one type of DD, documenting that the problem of overweight/obesity in children with ASD is at least as common, if not higher, than in the general pediatric population (Curtin, Anderson, Must, & Bandini, 2010). Although there are some studies that document the association of chronic diseases and intellectual disability among adults (Bhaumik, Watson, Thorp, Tyrer, & McGrother, 2008; de Winter, Bastiaanse, Hilgenkamp, Evenhuis, & Echteld, 2012b; de Winter, Magilsen, van Alfen, Penning, & Evenhuis, 2009; Melville, Hamilton, Hankey, Miller, & Boyle, 2007; Morin, Merineau-Cote, Ouellette-Kuntz, Tasse, & Kerr, 2012; Reichard & Stolzle, 2011; Rimmer & Wang, 2005), limited research has examined whether adults diagnosed with DD are more likely to become obese or have other chronic diseases. This is increasingly important as most recent data suggest that approximately 1 in 6 children in the U.S. have been diagnosed with a DD, ranging from mild disabilities such as speech and language impairments to more pervasive DDs, such as intellectual disability, cerebral palsy, and autism spectrum disorder (ASD) (CDC, 2014). Based on the paucity of research examining the relationship between DDs, including ASD, and chronic diseases that emerge during adolescence and adulthood, the purpose of this study is to examine these relationships, and to provide information about the health status of children and adolescents with DDs as they transition into adulthood. In order to achieve this purpose, an evaluation project was adopted that examined a health promotion program for adults with DDs that aimed to improve or maintain current health status, increase knowledge about healthy food and exercise choices and improve overall health behavior of adults with DDs.

Opioid prescribing within the workers’ compensation system in general has been a cause for concern. The objective of the study was to estimate the prevalence of opioid users among injured workers, referred at a Tertiary Care Pain Clinic, in 2008-2009. A cross-sectional retrospective study of 110 consecutive workers; male/female ratio was 2.3:1; mean age 45.5 years; mean pain ratings were 7.1±1.8. 21% of the workers were diagnosed with a biomedical problem (Group I), 51% with medical/psychological factors (Group II) and 25.5% had identifiable psychological factors but no physical pathology (Group III). Opioids were prescribed in 81.8%; of those 32.2% were on >200mg of daily morphine or equivalent (MED). A higher proportion of opioid users were in Group II and Group III than Group I. The vast majority of referred injured workers in this study were on opioid therapy with 1 in 3 exceeding the “watchful” dose of 200 mg MED

Chronic Lymphocytic Leukaemia (CLL) is a disease of B-lymphocytes that account for significant morbidity and mortality in mostly elderly patients (aged ≥ 70 years). The relative survival of patients with CLL has been shown to decrease with patient age, and this age-related reduction in survival was found to correlate with the levels of two inflammatory cytokine levels in the patients’ plasma. The levels of two inflammatory cytokines, interleukin-6 and -8 (IL-6, IL-8) were found to correlate positively with patient age, and increased levels were associated with lower overall survival. Addition of IL-6 or IL-8 to a co-culture system of CLL cells with bone marrow stromal cells increased the CLL-stromal cell adhesion, and co-culturing increased IL-8 secretion. In a search of a treatment regimen that may be effective and readily tolerated by elderly patients, we examined the combination of fludarabine with valproic acid (VPA), an epileptic that was found to inhibit histone deacetylases (HDACs). The combination was synergistic against human leukaemic cells, including primary CLL cells. In a phase II clinical trial where six elderly patients with relapsed, previously treated CLL were enrolled (half of whom were clinically refractory to fludarabine), the VPAfludarabine combination induced reduction in the peripheral and lymph node tumour loads. Mechanistically, the fludarabine treatment induced disruption of the lysosomes, while VPA induced increase in the level and activity of cathepsin B, a lysosomal protease. The VPA-induced increase in cathepsin B levels was observed in in cell lines (in vitro), primary CLL cells (ex vivo) and in patients treated with VPA (in vivo). Chemical inhibition of cathepsin B was sufficient to dampen the VPA-fludarabine cytotoxicity, and the addition activated cathepsin B to leukaemic cell lysates was sufficient to induce caspase cleavage and reduction in anti-apoptotic protein levels. The VPA-fludarabine combination also lowered phospho-Akt levels and ATM activation, which also contributed to the VPA-fludarabine synergy, and VPA treatment lowered ATM levels and phospho-Akt levels in vivo. In summary, there lies a biological explanation for the poor survival observed with elderly patients, and the VPA-fludarabine may be a useful regimen for these patients.

Opioid prescribing within the workers’ compensation system in general has been a cause for concern. The objective of the study was to estimate the prevalence of opioid users among injured workers, referred at a Tertiary Care Pain Clinic, in 2008-2009. A cross-sectional retrospective study of 110 consecutive workers; male/female ratio was 2.3:1; mean age 45.5 years; mean pain ratings were 7.1±1.8. 21% of the workers were diagnosed with a biomedical problem (Group I), 51% with medical/psychological factors (Group II) and 25.5% had identifiable psychological factors but no physical pathology (Group III). Opioids were prescribed in 81.8%; of those 32.2% were on >200mg of daily morphine or equivalent (MED). A higher proportion of opioid users were in Group II and Group III than Group I. The vast majority of referred injured workers in this study were on opioid therapy with 1 in 3 exceeding the “watchful” dose of 200 mg MED

This is an integrative literature review of the utilisation of reflexology as complementary and alternative treatment modality in adults with chronic disease. Anecdotal evidence has claimed potential health benefits of reflexology for patients with various chronic diseases. In this study, selected databases that were accessible were searched using keywords such as reflexology therapy, zone therapy and combinations thereof. Databases such as SA Nexus, SAePublications, ProQuest, Web of Knowledge, EBSCOhost Platform, ScienceDirect, Cochrane Library and Google Advanced Scholar were searched for primary studies and reviews of primary studies from 2000 until the end of 2008 (N = 1171). Primary experimental and non-experimental studies in any language with an abstract in English were identified. Only studies that complied with the inclusion criteria were reviewed and appraised (n = 35) for study quality with appropriate tools from the Critical Appraisal Skills Programme (CASP) and the American Dietetic Association's (ADA) Evidence analysis manual. Evidence extraction, analysis and synthesis were done to review available evidence by means of the evidence class rating and evidence grading of strength prescribed in the ADA's manual. Study findings represent a statistical significant reduction in the frequency of seizures of patients with intractable epilepsy, an improvement of sensory and urinary symptoms associated with multiple sclerosis and a clinical significant reduction of pain and anxiety in patients with cancer and fibromyalgia syndrome to increase overall well-being and quality of life. No statistical significant evidence was reported on benefits of reflexology for irritable bowel syndrome, menopausal symptoms, chronic low back pain and asthma. Thus there appears to be fair evidence of the effectiveness of reflexology, in addition clinical evidence supports the utilisation of reflexology to promote well-being and quality of life in adults with chronic disease. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010

Self-rated health (SRH) is a commonly used measure in surveys. The associations of SRH in Canadian First Nations populations have not previously been fully studied. Univariate, bivariate, and multivariate analyses were conducted to determine how participants rated their health and what factors associated with SRH in a Manitoba First Nation. Respondents rated their health substantially worse than the general Canadian population. Men rated their health worse than women, and older adults rated their health worse than younger adults. In multivariate analyses, sex, hypertension, arthritis, the metabolic syndrome, number of chronic conditions, vision and mobility difficulties, perceived stress, perceived control over health and life, and community conditions were independently associated with SRH. These results suggest that asymptomatic conditions may be incorporated into the SRH of community members and suggest a complex interaction of health-related factors, stressors, and psychosocial factors that contribute to community members’ SRH.

A new design of dual-functional polyurea microcapsules was proposed for chronic wound dressings to provide both non-leaching infection control and sustained topical drug delivery functionalities. Quaternary ammonium functionalized polyurea microcapsules (MCQs) were synthesized under mild conditions through an interfacial crosslinking reaction between branched polyethylenimine (PEI) and 2,4-toluene diisocyanate (TDI) in a dimethylformamide/cyclohexane emulsion. An in-situ modification method was developed to endow non-leaching surface antimicrobial properties to MCQs via bonding antimicrobial surfactants to surface isocyanate residues on the polyurea shells. The resultant robust MCQs with both non-leaching antimicrobial properties and sustained drug releasing properties have potential applications in medical textiles, such as chronic wound dressings, for infection control and drug delivery.

This is an integrative literature review of the utilisation of reflexology as complementary and alternative treatment modality in adults with chronic disease. Anecdotal evidence has claimed potential health benefits of reflexology for patients with various chronic diseases. In this study, selected databases that were accessible were searched using keywords such as reflexology therapy, zone therapy and combinations thereof. Databases such as SA Nexus, SAePublications, ProQuest, Web of Knowledge, EBSCOhost Platform, ScienceDirect, Cochrane Library and Google Advanced Scholar were searched for primary studies and reviews of primary studies from 2000 until the end of 2008 (N = 1171). Primary experimental and non-experimental studies in any language with an abstract in English were identified. Only studies that complied with the inclusion criteria were reviewed and appraised (n = 35) for study quality with appropriate tools from the Critical Appraisal Skills Programme (CASP) and the American Dietetic Association's (ADA) Evidence analysis manual. Evidence extraction, analysis and synthesis were done to review available evidence by means of the evidence class rating and evidence grading of strength prescribed in the ADA's manual. Study findings represent a statistical significant reduction in the frequency of seizures of patients with intractable epilepsy, an improvement of sensory and urinary symptoms associated with multiple sclerosis and a clinical significant reduction of pain and anxiety in patients with cancer and fibromyalgia syndrome to increase overall well-being and quality of life. No statistical significant evidence was reported on benefits of reflexology for irritable bowel syndrome, menopausal symptoms, chronic low back pain and asthma. Thus there appears to be fair evidence of the effectiveness of reflexology, in addition clinical evidence supports the utilisation of reflexology to promote well-being and quality of life in adults with chronic disease. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2010

Context: Modifiable risk factors in older methadone maintenance treatment (MMT) patients may put them at a greater risk of acquiring chronic diseases. The paucity of literature regarding the well-being and service needs of older MMT patients required investigation to determine whether these patients are treated for and adhere to chronic disease medications(s) comparably to those not on MMT. Objective: This study compared the proportion of MMT patients to a matched control group treated with first-line medications for four chronic diseases: hypertension, chronic obstructive pulmonary disease (COPD), diabetes mellitus and depression. As a secondary outcome measure, this study also examined the adherence comparability between the two groups. Method: This case control study used prescription claims data from the BC Ministry of Health’s PharmaNet database from October 1, 2008 to December 31, 2009. Each MMT patient was individually matched with a control subject in terms of age, sex, social assistance coverage and local health area. Both groups consisted of 143 men and 56 women for a total of 400 participants. Persons 50 years of age and older, residents of BC, and had prescriptions filled during October 1, 2008 to December 31, 2009, were randomly selected from the PharmaNet database. Results: Odds ratios (ORs) were calculated to compare the odds of MMT patients to non-MMT patients on a first-line medication for each chronic disease under investigation. ORs were 0.865 for hypertension (ns), 0.738 for diabetes (ns) and 4.176 for depression (p <0.001). For COPD the OR could not be calculated as no controls were treated for COPD; however, 11.6% of the MMT group were prescribed COPD medications which was significantly higher than the controls (p<.001). Adherence was calculated using continuous measures of medication availability (CMA) “by patient” and “by medication class” during patients’ persistent periods (continuous use periods) CMA(1), as well as the entire study period CMA(2). By patient, the mean CMA(1) showed no difference between the groups (non-MMT group: 91.9%, SD=15.8, CI=95% vs MMT group: 89.7%, SD=22.2, CI=95%). The mean CMA(2) was statistically different (p<0.05) between the groups (non-MMT group: 70.5%, SD=25.3, CI=95% vs MMT group: 60.8%, SD=29.1, CI=95%). By medication class, CMA(1) was 80-100% for most medication classes for both groups except for insulins and inhalers in the MMT group which fell between 40-79%. The CMA(2) for most medication classes was 60-86% in the non-MMT group and 30-76% in the MMT group. However, the differences between the groups were not statistically significant. Conclusion: Odds ratios for the treatment of all four chronic diseases differed. Therefore, looking at each chronic disease separately may be worthwhile to suggest potential targets for intervention. Disease-specific tailored interventions related to lifestyle risk factors, comorbid medical conditions, and adherence to chronic medications could potentially improve the overall health of older MMT patients. However, development of appropriate interventions and treatments requires research that properly recognizes the physical and mental health problems faced by older MMT patients (Rosen, Hunsaker, Albert, Cornelius, & Reynolds III, 2010). / Graduate

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