Diagnosis with a serious chronic illness is a powerful lived experience that touches all aspects of the individual’s life and which necessitates great adaptation across the lifespan. Ambiguity is a lived dimension of illness that is often expressed in illness stories, capturing the new state between health and illness which has also been described as a ‘liminal’ or in-between state of being (Little, Jordens, Paul, Montgomery & Philipson, 1998). Health care providers hold socially prescribed roles in which they are expected to be professionally competent and immune to personal illness. The lived experiences of health care providers who have been diagnosed with serious chronic illness were explored in this study to better attempt to describe the phenomenon. Six health care providers from various professional backgrounds participated in the research. A semi-structured interview guided the conversation between the researcher and the participant. The participants were encouraged to tell the story of what has happened to them and to reflect on the impact to their lives and practice. Participants were also asked to reflect on their perceived level of support and preparedness via their professional training, and to share any recommendations they might have for others going through this experience. The data gathered were found to be rich in both depth and detail. The data were analyzed using van Manen’s interpretive phenomenological method. Significant statements created formulated meanings or categories, which became organized around eight themes. The themes formed several clusters. The theme clusters were then developed into a recognizable pattern of sub-themes which helped to further 7 describe the essence of the experience of health care providers living with serious, chronic illness. The findings of the research were found to be consistent with the literature that describes the lived experience of seriously ill health care providers as liminal in essence. Based on the research findings recommendations for social work practice, administration and policy, educational training reform and future research were outlined.

Introduction: The effects of chronic pain on health-related Quality of Life (HRQoL) among older Canadian adults with disability was not well known. Study Objectives: This study was conducted to examine the relationship between chronic pain and HRQoL among older Canadian adults with disability aged 55+. Methods: This study was a secondary analysis of cross-sectional data from the 2006 Participation and Activity Limitation Survey (PALS). Weighted data was used to examine the relationship between chronic pain and HRQoL using multivariate logistic regression techniques. Results: An estimated 68% of older Canadian adults with disability reported having chronic pain. Multivariate regression analysis confirmed a significant independent effect of chronic pain on self-reported HRQoL. Conclusion: Our results highlight the importance of pain assessment and management for older adults with disabilities in general and in particular among those with limited communication abilities.

The problems and high medical costs associated with chronic wounds necessitate an economical bioactive wound dressing. A new strategy was investigated to inhibit MMP-9 proteases and to release epidermal growth factor (EGF) to enhance healing. Doxycycline (DOX) and EGF were encapsulated on polyacrylic acid modified polyurethane film (PAA-PU) using Layer-by-Layer (LbL) assembly. The number of bilayers tuned the concentration of DOX and EGF released over time with over 94% bioactivity of EGF retained over 4 days. A simple wound model in which MMP-9 proteases were added to cell culture containing fibroblast cells demonstrated that DOX inhibited the proteases providing a protective environment for the released EGF to stimulate cell migration and proliferation at a faster healing rate. In the presence of DOX, only small amounts of the highly bioactive EGF are sufficient to close the wound. Results show that this is new and promising bioactive dressing for effective wound management.

This thesis is a report of a study on patients suffering one of two painful chronic illnesses (rheumatoid arthritis (RA) or migraine), and attempts to discover possible determinants of psychological reactions to long term painful illness. One hundred and sixty chronically ill individuals were interviewed, (80 migraine and 80 RA sufferers). In keeping with other evidence, the extent of psychological disturbance was found to be higher for chronically ill individuals than for general population samples. There were no zero order correlations between reported pain and psychological distress. Age and length of suffering have often been cited as possible factors influencing mood state, but no evidence was found for this in the data gained in this survey. The results provide no evidence for the use of coping strategies as a method of adapting to the demands of the painful chronic illnesses studied here. Beliefs in control over illness have been posited as possible factors that may influence psychological state, and were measured in this research using a health locus of control scale. However locus of control scores were not found to be associated with mood state, although, in keeping with other research, scores were found to be associated with age and social class, with both lower social class and older sufferers scoring higher on externality than those from higher social classes, or whom were younger. The strongest association was found between aspects of subjective health status and mood state. The major finding of this study is that patients assessment of their own health state, in both illnesses, is the major factor associated with psychological state.

Chronic disease is a major health burden in the United States, affecting about half of adults, and leading to poor health, disability, and death. However, the burden of chronic disease is not shared equally among Americans, with some groups (created by determinants such as race/ethnicity and socioeconomic resources) experiencing higher rates of morbidity and mortality. When measures of health and socioeconomic resources are examined together, a stepwise gradient pattern emerges. This social gradient has been established for individual measures, such as household income and social class, and several measures of morbidity and mortality. However, nationally, little research has been conducted using area-level measures, such as county economics, to examine its relationship with chronic disease. Three studies were completed using data from the Behavioral Risk Factor Surveillance System (BRFSS). County economic status was determined using unemployment, per capita market income, and poverty. The first study examined the relationship between county economic status and chronic disease and risk factors, both nationally and by metropolitan classification, using data from BRFSS 2013. Further, the social gradient was explored. The second study also used data from BRFSS 2013 to examine county economic status and prevalence of hypertension, arthritis, and poor health, after controlling for known risk factors. This study also examined results by US region. Finally, the third study assessed changes in disparities between persistently poor and persistently affluent counties for heart disease, hypertension, arthritis, and diabetes using data from BRFSS 2001-2010.

Cryprosporidium parvum is a coccidian protozoan that colonizes epithelial cells lining respiratory and digestive tracts of animals and humans. Cryptosporidiosis is a well-recognized zoonotic disease infecting primarily neonates and immunocompromised hosts, including human immunodeficiency virus-infected patients. Clinical disease is manifested as a chronic diarrheal illness that is self-limiting in immunocompetent hosts and prolonged and often life-threatening in hosts with compromised immune systems.The lack of a suitable small animal model for screening anti-cryptosporidial drugs and for examining the pathogenicity and immunobiology of chronic cryptosporidiosis was the impetus for this research effort. The objectives of the present study were three-fold: to characterize chronic Cryptosporidium parvum infections in dexamethasone-immunosuppressed mice; evaluate the effects of Cryprosporidium parvum and dexamethasone on B and T lymphocyte proliferation; and determine the effects of the immunomodulator dehydroepiandrosterone on oocyst shedding intensities of mice infected with Cryptosporidium parvum. Adult C57BL/6N mice were immunosuppressed with the synthetic glucocorticoid dexamethasone, then infected with Cryprosporidium parvum (106 oocysts/mouse) investigated for their ability to sustain a four-month chronic infection. Dexamethasone was administered intraperitoneally (125 Jlg/mouse/day) or orally (8 Jlg/ml) in the drinking water ad libitum. Infection chronicity was characterized by evaluating mouse monality, oocyst excretion in the feces, tissue distribution of the parasite, and parasite-induced pathology. A progressive infection with Cryptosporidium parvum occurred in mice immunosuppressed intraperitoneally and orally as long as dexameth sone was administered. Mice receiving dexamethasone given intraperitoneally had a shoner prepatent period and a more consistent, although cyclic, oocyst shedding pattern when compared with mice given dexamethasone orally. Mice given dexamethasone orally exhibited a delayed prepatent period, with a steady increase in oocyst shedding. All mice receiving dexamethasone orally died within three months following oocyst inoculation. Clinical signs included dehydration, icterus, and reduction in spleen and body weights. Clinical signs were more abrupt in mice receiving oral dexamethasone. Parasite colonization involved the entire intestinal tract, including the pyloric ring and Peyer's patches, but was the heaviest in the terminal ileum. Parasites were present in the lungs, gallbladder, and pancreatic ducts. Pathologic abnormalities were isolated to the terminal small intestine and included blunting and fusion of intestinal villi and crypt hyperplasia. Cryptosporidium parvum and dexamethasone administered in vivo reduced B and T lymphocyte responses to the mitogens lipopolysaccharide and concanavalin A. Dehydroepiandrosterone and dehydroepiandrosterone-sulfate resulted in no significant reductions in cryptosporidial activity as determined by oocyst shedding in the feces.

No description available.

Background: High serum phosphorus (hPhos) is common in chronic kidney disease (CKD) and increases the risk of metastatic calcification. Guidelines advise patients with hPhos to restrict dietary phoshorus intake to 800-1000mg/day, and compliance with this diet can be challenging. Innovative education may improve compliance. Hypothesis: Intensive dietary education using the Phosphorus Point System Tool© (PPS) will result in lower serum phosphorus levels compared to standard education (SE). Methods: This study compared the effectiveness of the PPS to SE on 1) serum phosphorus, 2) dietary phosphate intake, knowledge and satisfaction in pre-dialysis CKD. Results: The PPS reduced 12 week serum phosphorus by 0.16 mmol/L (95% CI 0.37 to -0.05, p=0.130) when controlling for baseline. Dietary phosphorus and protein intake decreased significantly at week 6 on PPS compared to SE (p= 0.026, p=0.050; respectively). Summary: Although there was a trend indicating the tool may reduce serum phosphorus levels, further research is needed.

Background: High serum phosphorus (hPhos) is common in chronic kidney disease (CKD) and increases the risk of metastatic calcification. Guidelines advise patients with hPhos to restrict dietary phoshorus intake to 800-1000mg/day, and compliance with this diet can be challenging. Innovative education may improve compliance. Hypothesis: Intensive dietary education using the Phosphorus Point System Tool© (PPS) will result in lower serum phosphorus levels compared to standard education (SE). Methods: This study compared the effectiveness of the PPS to SE on 1) serum phosphorus, 2) dietary phosphate intake, knowledge and satisfaction in pre-dialysis CKD. Results: The PPS reduced 12 week serum phosphorus by 0.16 mmol/L (95% CI 0.37 to -0.05, p=0.130) when controlling for baseline. Dietary phosphorus and protein intake decreased significantly at week 6 on PPS compared to SE (p= 0.026, p=0.050; respectively). Summary: Although there was a trend indicating the tool may reduce serum phosphorus levels, further research is needed.

We investigated the role of two intracellular second messengers, extracellular signal-regulated protein kinase (ERK), and protein kinase C (PKC) in a model of persistent pain, using intrathecal (i.t) (R,S )-DHPG to induce spontaneous nociceptive behaviours (SNBs). SNBs were measured in animals that were treated with an ERK inhibitor (PD 98059), and a PKC inhibitor (GF 109203X) compared with controls. Mechanical allodynia, was measured using paw withdrawal thresholds in the von Frey test, and thermal hyperalgesia was measured using response latencies in the plantar test. In study 1, it was shown that spinal administration of PD 98059, dose-dependently decreased SNBs, and reduced mechanical allodynia and thermal hyperalgesia. In study 2, it was shown that i.t. pretreatment with the GF 109203X, reduced SNBs and thermal hyperalgesia, but not mechanical allodynia. These results suggest that both ERK and PKC are involved in SNBs and the concomitant and thermal hyperalgesia and possibly mechanical allodynia.