Telephone-Delivered Physiotherapy Interventions Improve Physical Function for Adults With a Chronic Condition: A Systematic Review and Meta-analysis.

OBJECTIVE: To investigate the efficacy of telephone-delivered physiotherapy interventions to improve lower extremity physical function and walking in adults aged ≥45 years with a chronic condition. DATA SOURCES: A literature search was conducted using health databases (MEDLINE, PsychINFO, EMBASE, The Allied and Complementary Medicine Database, Web of Science, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature) up to April 26, 2020. Reference lists of relevant studies were explored to identify additional studies. STUDY SELECTION: The original search resulted in 3465 studies. Five other studies were included from hand searches. After duplicates were removed, 2820 studies remained. Title and abstract screening was completed independently by 2 authors and resulted in the exclusion of 2596 studies. The full-texts of the remaining 224 articles were assessed and 204 studies were excluded. Twenty articles were examined. DATA EXTRACTION: Data were extracted independently by 2 authors, including study, population, and intervention details; assessment timings; outcome characteristics; appropriateness of statistical methods; adverse events; and reasons for loss to follow-up. Study quality was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach. DATA SYNTHESIS: Twenty studies were included in the systematic review. One study was not meta-analyzed owing to insufficient data. Telephone-delivered physiotherapy had a small to moderate effect on distance walked compared with control groups with no exercise intervention (standardized mean difference [SMD], 0.28; 95% confidence interval [CI], 0.00-0.56; I2, 45%) and no effect when compared with control groups with an exercise intervention not delivered by telephone (SMD, 0.08; 95% CI, -0.19 to 0.36; I2, 0%). CONCLUSION: Telephone-delivered physiotherapy may be an effective method to improve walking. Further research is required to validate these findings.

Randomised controlled trial of an augmented exercise referral scheme using web-based behavioural support for inactive adults with chronic health conditions: the e-coachER trial.

OBJECTIVE: To determine whether adding web-based support (e-coachER) to an exercise referral scheme (ERS) increases objectively assessed physical activity (PA). DESIGN: Multicentre trial with participants randomised to usual ERS alone (control) or usual ERS plus e-coachER (intervention). SETTING: Primary care and ERS in three UK sites from 2015 to 2018. PARTICIPANTS: 450 inactive ERS referees with chronic health conditions. INTERVENTIONS: Participants received a pedometer, PA recording sheets and a user guide for the web-based support. e-coachER interactively encouraged the use of the ERS and other PA options. MAIN OUTCOME MEASURES: Primary and key secondary outcomes were: objective moderate-to-vigorous PA (MVPA) minutes (in ≥10 min bouts and without bouts), respectively, after 12 months. Secondary outcomes were: other accelerometer-derived and self-reported PA measures, ERS attendance, EQ-5D-5L, Hospital Anxiety and Depression Scale and beliefs about PA. All outcomes were collected at baseline, 4 and 12 months. Primary analysis was an intention to treat comparison between intervention and control arms at 12-month follow-up. RESULTS: There was no significant effect of the intervention on weekly MVPA at 12 months between the groups recorded in ≥10 min bouts (mean difference 11.8 min of MVPA, 95% CI: -2.1 to 26.0; p=0.10) or without bouts (mean difference 13.7 min of MVPA, 95% CI: -26.8 to 54.2; p=0.51) for 232 participants with usable data. There was no difference in the primary or secondary PA outcomes at 4 or 12 months. CONCLUSION: Augmenting ERS referrals with web-based behavioural support had only a weak, non-significant effect on MVPA. TRIAL REGISTRATION NUMBER: ISRCTN15644451.

Nested graft for chronic ulcer in scar tissue after heroin extravasation in a drug addict.

INTRODUCTION: Nested graft is a surgical technique that allows to manage difficult-to-treat medical conditions such as chronic cutaneous ulcers, thanks to the high efficacy it has in reverting the fibroblasts senescence. Because of its peculiar regenerative property, nested graft is a surgical technique suitable also for the treatment of cutaneous ulcers developing on fibrotic scar tissue. CASE REPORT: We reported the case of a 45-year-old man, drug-addict, with a large ulcer on the back of the right forearm in the context of scar fibrotic tissue. This lesion resulted from a previous heroin extravasation treated with a dermo-epidermal skin graft, that was accidentally scratched away by mechanical trauma. After several therapeutic failures with topical medications, we decided to treat the ulcer performing a skin graft using the nested graft technique. No adverse events were reported by the patient during or after the surgery. At the clinical evaluation performed three years later the wound was completely healed. CONCLUSIONS: Nested graft represents a safe and easy-to-use technique that can be successfully used to treat ulcers on scar tissue, ensuring the achievement and the long-term maintenance of optimal resistance and aesthetic results.

Participation of young people with disabilities and/or chronic conditions in low- and middle-income countries: a scoping review.

AIM: The purpose of this scoping review was to describe and map the literature available on the participation of young people (0-21y) with disabilities and/or chronic conditions living in low- and middle-income countries (LMICs). METHOD: A systematic search and selection process identified 78 publications. Descriptive data were extracted using a data-charting form, and studies were mapped using the family of participation-related constructs framework. RESULTS: The findings demonstrated that, although the published evidence is steadily increasing, the participation research on this vulnerable population is still either absent or very scarce in the majority of LMICs, and very little is known about the participation of children with chronic health conditions. Most studies included in this review focused on attendance or 'being there'. INTERPRETATION: Although attendance is an important aspect, more needs to be done to understand children's experiences or involvement while attending, thus capturing both dimensions of participation. WHAT THIS PAPER ADDS: There is an increasing trend in research on participation patterns of children with disabilities in low- and middle-income countries. Most research focuses on children's attendance, or 'being there'. We know very little about children's involvement, or experience, while attending daily activities.

The COVID-19 rehabilitation pandemic.

The coronavirus disease 2019 (COVID-19) pandemic and the response to the pandemic are combining to produce a tidal wave of need for rehabilitation. Rehabilitation will be needed for survivors of COVID-19, many of whom are older, with underlying health problems. In addition, rehabilitation will be needed for those who have become deconditioned as a result of movement restrictions, social isolation, and inability to access healthcare for pre-existing or new non-COVID-19 illnesses. Delivering rehabilitation in the same way as before the pandemic will not be practical, nor will this approach meet the likely scale of need for rehabilitation. This commentary reviews the likely rehabilitation needs of older people both with and without COVID-19 and discusses how strategies to deliver effective rehabilitation at scale can be designed and implemented in a world living with COVID-19.

Risk Factors for Relapse of Childhood B Cell Acute Lymphoblastic Leukemia.

BACKGROUND B cell acute lymphoblastic leukemia (B-ALL) is the most common type of ALL. This study aimed to explore risk factors for relapse of childhood B-ALL. MATERIAL AND METHODS Total of 102 pediatric B-ALL patients were included in this study. B-ALL patients were divided into a relapse group and a non-relapse group. Chemotherapy-induced agranulocytosis time, fusion gene, and minimal residual disease (MRD) were assessed. White blood cell (WBC) count in peripheral blood and risk stratification were evaluated in newly-diagnosed patients. Kaplan-Meier plots were used to evaluate the correlation between risk factors and relapse rates. Multivariate analysis was performed with Cox proportional hazard model to estimate relative risk (RR), 95% confidence interval (95% CI), and hazard ratio (HR). Finally, 99 cases of B-ALL were included in this study. RESULTS There were significant differences between the relapse group and the non-relapse group in age (p=0.004), chemotherapy-induced agranulocytopenia (p=0.001), WBC count in peripheral blood of newly diagnosed patients (p=0.016), risk stratification (p=0.000), and MRD at 12th week (p=0.007). Age over 10 years, high-risk stratification, long period of agranulocytopenia, higher WBC counts, and MRD more than 10⁻4 were correlated with higher B-ALL relapse rate (p<0.05). Multivariate analysis showed significantly higher relapse rates for age ≥10 years, high-risk stratification, and MRD at 12th week >10⁻4, with RR (95% CI) of 4.001 (1.005-15.930), 4.964 (1.050-23.456), and 4.646 (1.383-15.614), respectively. CONCLUSIONS Agranulocytopenia ≤7 days, peripheral blood WBC >100×109/L, and MRD at 33rd day >10⁻4 were associated with B-ALL relapse. Age ≥10 years, high-risk stratification, and MRD at 12th week >10⁻4 were independent risk factors for relapse.

Contextual factors of self-regulation in children and adolescents with chronic diseases - a qualitative analysis.

BACKGROUND: In recent decades, the prevalence of chronic diseases in children and adolescents has increased significantly. Contextual factors play a central role in the self-regulation of chronic diseases. They influence illness and treatment representations, disease management, and health outcomes. While previous studies have investigated the influence of contextual factors on children's beliefs about their illness, little is known about subjective contextual factors of treatment representations of children and adolescents with chronic diseases, especially in the context of rehabilitation. Therefore, the aim of this qualitative analysis was to examine the contextual factors reported by chronically ill children and adolescents in relation to their treatment representations. Furthermore, we aimed to assign the identified themes to classifications of environmental and personal contextual factors in the context of the International Classification of Functioning, Disability and Health (ICF). METHODS: Between July and September 2018, semi-structured interviews were conducted with N = 13 children and adolescents in rehabilitation to explore their rehab-related treatment representations and associated contextual factors. The interviews started with an open narrative question about expectations and beliefs about rehabilitation, followed by further detailed questions. The interviews were recorded on audio tape, transcribed, and analysed using thematic content analysis. RESULTS: Participants raised six themes associated with their rehab-related treatment representations that were interpreted as contextual factors: the living situation before rehabilitation, the idea of rehabilitation, previous solution attempts, rehab pre-experiences, information that the children and adolescents received from the clinic or sought themselves, and the assumed attitudes of their parents concerning rehabilitation. All the themes could be assigned to the classification of environmental and personal factors in the context of the ICF for children and youth. CONCLUSIONS: Although contextual factors have an important impact on self-regulation, little attention is paid to their investigation. Personal and environmental factors probably influence patients' treatment representations in terms of expectations and concerns as well as emotions regarding the treatment. Considering contextual factors could lead to the more appropriate allocation of medical care and the better customisation of treatment.

Predictive validity of a customized functional capacity evaluation in patients with musculoskeletal disorders.

PURPOSE: To examine whether the performance-based work-related functional capacity evaluation (German title: Einschätzung körperlicher Leistungsfähigkeiten bei arbeitsbezogenen Aktivitäten-ELA) can predict return to work (RTW) in patients with musculoskeletal disorders (MSD). METHODS: A multicenter cohort study was conducted on 162 employed or self-employed patients with various injury-related and chronic MSD, recruited from four outpatient rehabilitation clinics. Patient-reported data on health and work ability were collected at discharge. The FCE test was performed subsequently. The overall FCE-based estimation of the ability to cope with the physical demands of work (positive vs. negative) was used to predict RTW. Successful RTW was defined as a combination of (self-)employment at the 3-month follow-up and a low level of sick leave (< 1.5 weeks) due to MSD. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated using logistic regression models to evaluate the predictive validity of the adjusted FCE results. RESULTS: Based on the FCE test, 82% of the patients were estimated as being able to cope with the physical demands of work. 77% of the patients with a positive FCE outcome returned to work (positive predictive value) and 83% with a negative FCE outcome did not (negative predictive value). Patients whose functional capacity was estimated to match the job demands were associated with sixfold higher odds of returning to work after adjusting for patient-reported data on health and work ability. The agreement between the FCE result and RTW differed only on a low to moderate level between the therapists who administered the FCE (72-89%). CONCLUSION: The FCE test at discharge predicts RTW among patients with musculoskeletal disorders.

Effectiveness of Serious Games to Increase Physical Activity in Children With a Chronic Disease: Systematic Review With Meta-Analysis.

BACKGROUND: Physical activity (PA) is important for children with a chronic disease. Serious games may be useful to promote PA levels among these children. OBJECTIVE: The primary purpose of this systematic review was to evaluate the effectiveness of serious games on PA levels in children with a chronic disease. METHODS: PubMed, EMBASE, PsycINFO, ERIC, Cochrane Library, and CINAHL were systematically searched for articles published from January 1990 to May 2018. Both randomized controlled trials and controlled clinical trials were included to examine the effects of serious games on PA levels in children with a chronic disease. Two investigators independently assessed the intervention, methods, and methodological quality in all articles using the Cochrane risk of bias tool. Both qualitative and quantitative analyses were performed. RESULTS: This systematic review included 9 randomized controlled trials (886 participants). In 2 of the studies, significant between-group differences in PA levels in favor of the intervention group were reported. The meta-analysis on PA levels showed a nonsignificant effect on moderate to vigorous PA (measured in minutes per day) between the intervention and control groups (standardized mean difference 0.30, 95% CI -0.15 to 0.75, P=.19). The analysis of body composition resulted in significantly greater reductions in BMI in the intervention group (standardized mean difference -0.24, 95% CI -0.45 to 0.04, P=.02). CONCLUSIONS: This review does not support the hypothesis that serious games improve PA levels in children with a chronic disease. The meta-analysis on body composition showed positive intervention effects with significantly greater reductions in BMI in favor of the intervention group. A high percentage of nonuse was identified in the study of serious games, and little attention was paid to behavior change theories and specific theoretical approaches to enhance PA in serious games. Small sample sizes, large variability between intervention designs, and limited details about the interventions were the main limitations. Future research should determine which strategies enhance the effectiveness of serious games, possibly by incorporating behavior change techniques.

Work-focused interventions that promote the labour market transition of young adults with chronic disabling health conditions: a systematic review.

OBJECTIVE: Young adulthood is an important transitional life phase where careers are established. Young adults with chronic disabling health conditions are underrepresented in the labour market. Our study aims to examine the effectiveness of work-focused interventions that support the labour market transition of young adults with chronic disabling health conditions; and to examine whether the effectiveness of work-focused interventions differ across work transition phase (eg, preparation, entry and sustaining work, employment advancement) and disability type. METHODS: A systematic review of articles published between January 1990 and July 2018 was conducted. Medline, EMBASE and PsycInfo were searched, and titles/abstracts and full texts of articles were reviewed for eligibility. Relevant articles were appraised for methodological quality. A best evidence synthesis was applied to medium-quality/high-quality studies to develop recommendations. RESULTS: 5816 articles were identified; 10 articles were relevant and of moderate-high methodological quality. Six intervention categories were identified which focused on young adults with mental health or intellectual/learning disabilities (n=3) and addressed employment preparation (n=10) and/or work entry (n=9). No interventions addressed at-work issues or career advancement. Strong evidence existed for tailored supported employment (SE) interventions having a positive impact on preparation and entry into competitive employment. Also, moderate evidence existed for the positive impact of SE on preparation and entry into competitive employment for young adults with mental health conditions. CONCLUSIONS: Tailored SE is recommended to foster preparation and entry into the labour market. Evidence-based interventions are needed to facilitate sustained work and career advancement of young adults living with different disabling health conditions.

A Systematic Review of Behavioral Intervention Technologies for Youth With Chronic Health Conditions and Physical and Intellectual Disabilities: Implications for Adolescents and Young Adults With Spina Bifida.

OBJECTIVE: Behavioral intervention technologies (BITs) stand as a promising delivery mechanism that overcomes multiple condition-specific and access barriers for self-management interventions for adolescents and young adults with spina bifida (AYA-SB). The purpose of the current review was to synthesize the behavioral and self-management intervention literature in conditions that have overlapping symptoms with youth with SB and to develop a model of likely user needs for AYA-SB that promotes self-management. METHOD: The search strategy was conducted by a medical research librarian in the following databases: MEDLINE (Ovid), EMBASE (Elsevier), PsycINFO (EbscoHost), the Cochrane Library (Wiley), and Web of Science (Thomson Reuters) databases. The review was based on a systematic narrative synthesis framework and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number CRD42018092342). RESULTS: In total, 18 articles were included in the current BIT review. The majority of included studies (1) targeted the management of chronic health conditions, (2) were informed by evidence-based approaches, (3) relied on content delivery, (4) were Web-based, (5) used linear or user-driven workflows, (6) included professional human support, and (7) included a control condition. CONCLUSIONS: Many of the evaluated BITs resulted in acceptable usage and maintained or improved targeted symptoms. A user needs model for AYA-SB is proposed with the intention that future research will promote further refinement and ultimate deployment of a BIT for AYA-SB to promote self-management.

A Systematic Review of Therapeutic Recreation Camp Impact on Families of Children With Chronic Health Conditions.

OBJECTIVE: Parents and siblings of children with chronic illnesses are at increased risk for experiencing psychosocial difficulties. Therapeutic recreation camps have become increasingly popular among these families. The current systematic literature review provides a synthesis of research on how these camps impact the parents and siblings of children facing a variety of chronic health conditions. METHODS: Databases searched: PubMed, PsycInfo, SportDISCUS, and Health Source Nursing/Academic Edition. Inclusion criteria included publication in a peer-reviewed journal between January 2000 and May 2018, written in the English language, and assessment of parent, sibling, or family outcomes. RESULTS: Twenty-one studies were included. Results indicated that camp attendance relates to positive changes in parent and sibling psychosocial outcomes. Additionally, parents report camp to be a place of social support and respite from daily life, and siblings find camp to be enjoyable and a place of belonging. Given the limited number of methodologically sound studies examining family functioning, it is not yet clear the extent to which camp influences family-level outcomes. CONCLUSION: Overall, camp appears to have a positive impact on parents and siblings across chronic illness populations. Future research should specifically assess family outcomes, including communication and family functioning, and the impact of incorporating well-defined interventions and education programming into the traditional therapeutic recreation camp experience.

Prevalence of Medical and Psychiatric Comorbidities Following Traumatic Brain Injury.

OBJECTIVE: To examine the prevalence of selected medical and psychiatric comorbidities that existed prior to or up to 10 years following traumatic brain injury (TBI) requiring acute rehabilitation. DESIGN: Retrospective cohort. SETTING: Six TBI Model Systems (TBIMS) centers. PARTICIPANTS: In total, 404 participants in the TBIMS National Database who experienced TBI 10 years prior. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Self-reported medical and psychiatric comorbidities and the onset time of each endorsed comorbidity. RESULTS: At 10 years postinjury, the most common comorbidities developing postinjury, in order, were back pain, depression, hypertension, anxiety, fractures, high blood cholesterol, sleep disorders, panic attacks, osteoarthritis, and diabetes. Comparing those 50 years and older to those younger than 50 years, diabetes (odds ratio [OR] = 3.54; P = .0016), high blood cholesterol (OR = 2.04; P = .0092), osteoarthritis (OR = 2.02; P = .0454), and hypertension (OR = 1.84; P = .0175) were significantly more prevalent in the older cohort while panic attacks (OR = 0.33; P = .0022) were significantly more prevalent in the younger cohort. No significant differences in prevalence rates between the older and younger cohorts were found for back pain, depression, anxiety, fractures, or sleep disorders. CONCLUSIONS: People with moderate-severe TBI experience other medical and mental health comorbidities during the long-term course of recovery and life after injury. The findings can inform further investigation into comorbidities associated with TBI and the role of medical care, surveillance, prevention, lifestyle, and healthy behaviors in potentially modifying their presence and/or prevalence over the life span.

Connected for health: Examining the use of a health-related social media platform for children with chronic medical conditions.

BACKGROUND: Children with chronic medical conditions often experience limited opportunities for social experiences due to frequent hospitalizations and medical appointments. Computer technology can provide valuable opportunities for social inclusion through online communities. However, moderation has been shown to be an important component of safe and successful use. This paper explores the potential of a social media platform technology, Upopolis, to promote social connection and health-related management for children with chronic medical conditions, as well as the role of the coordinators who support children's use. METHODS: This study conducted qualitative in-depth, semi-structured telephone interviews with hospital-based child life specialists across Canada who acted as coordinators for Upopolis. Thematic analysis was employed on verbatim interview transcripts. RESULTS: Seven Upopolis coordinators (n = 7 female) from across Canada participated in six telephone interviews. Four themes were identified: First, Upopolis offered opportunities for connection (social and emotional) through receiving and giving support to others in similar situations. Second, Upopolis was considered safe and reliable for younger children (under 12) within the broader social media landscape. Third, Upopolis was a helpful resource for children to learn about medical diagnoses and procedures, as well as for expressing their experiences and reducing isolation. Fourth, participants identified that time, misuse of technology, and technical problems were challenges to the successful coordination of Upopolis. CONCLUSIONS: Children with chronic medical conditions were reported to use Upopolis to develop a greater social community. Specialized websites such as Upopolis have the potential to offer a safe online social networking opportunity where children can discuss what is happening to them, compared with other mainstream social media platforms. Given the increase in technology use in health and high usage of social media among children generally, these data can potentially inform the development and implementation of other specialist health-related online platforms for children with chronic medical conditions.

The experiences of young people with chronic illness in New Zealand: A qualitative study.

BACKGROUND: Around 10% of young people suffer from chronic health conditions, and their health care needs are different from those of children or adults. Most research about young people's chronic illness focuses on specific conditions, on younger children's experience, and on the perspectives of parents. This study explored the experiences of young people with two very different chronic conditions (asthma and cancer) and their perception of the New Zealand health system's response to their needs. METHODS: This was a collaborative research process where eight young co-researchers who had asthma or cancer were employed to work alongside the research team to develop protocols, interview peers, and assist with analysis. The challenges of this process are described in the article. Twenty-one young people between ages 15 and 27 from two urban areas of New Zealand participated in semistructured open-ended interviews about their health care experiences. Sixteen participants were female, and five male. Eleven of the participants had finished cancer treatment (with an average of 3.6 years since diagnosis), and 10 had asthma. Purposeful sampling meant that 80% of the participants with asthma were identified as Maori and the other participants identified with a range of other ethnic groups. Data were thematically coded, and coresearchers were consulted to derive the ultimate findings. RESULTS: Chronic illness disrupted the trajectory of young people's lives and had significant effects on their relationships. The New Zealand health system generally did not respond well to the needs of these young people, but many encountered extraordinary individuals who supported them effectively. The experiences of some indigenous participants indicate that health professionals require effective cultural competence training. CONCLUSIONS: This study provides insights into how young people with very different conditions experience the health system. Young people should be consulted and actively included in decision making about making health systems responsive to their diverse needs.

Getting Ready for Adult Healthcare: Designing a Chatbot to Coach Adolescents with Special Health Needs Through the Transitions of Care.

OBJECTIVE: The AAP, AFP, and ACP have authored statements and recommendations to clinicians about the importance of the transition from pediatric to adult care. The Got Transition program provides a framework and resources based on AAP, AFP and ACP recommendations to promote skill attainment in self-care. Engaging adolescents along the transition journey has proven challenging. Use of smartphones, text messaging, and social media are prevalent among teenagers, offering a unique opportunity to engage teenagers in their preferred channel to provide tools and resources to help them successfully transition to adult focused care. METHODS: A multidisciplinary team of clinicians, quality improvement facilitators, and human-centered designers at the University of Vermont (UVM) Children's Hospital designed tools for teens with chronic conditions that support the Got Transition recommendations. Using a co-creative design process, we created a novel tool to increase engagement among teenagers. We conducted a pilot study of 13 teenagers with a chronic medical condition using a text messaging platform (chatbot) with scripted interactions to increase engagement and deliver educational content according to Got Transition. RESULTS: Mean engagement was 97% during the study period. Qualitative feedback from study participants suggests our chatbot should be extended and shows promise to help teenagers attain self-care skills on the transition journey. CONCLUSIONS: A scripted text messaging platform is feasible and appears to be well-received by patients and caregivers. Furthermore, our approach emphasizes the need to engage teenagers through multiple platforms to effectively serve as "coaches" during the transition to adult care.

Childhood Disability and Educational Outcomes: A Systematic Review.

PROBLEM: Graduation from high school is an important milestone for all adolescents and affects future health in adulthood. Children with chronic illnesses have additional challenges that affect school attendance, grade retention and graduation. If children with chronic conditions are not able to participate fully in education, this may limit their opportunities for future health. The aim of this study was to integrate the evidence in the past 28 years about educational outcomes of children and adolescents with chronic conditions causing disability. ELIGIBILITY CRITERIA: Quantitative studies reporting on a chronic condition and attendance, grade retention, or high school graduation, from a peer-reviewed journal in the English language, data collection since 1990, and research conducted with a population in the United States were eligible for review. SAMPLE: Forty-three studies from a literature search of CINAHL, MEDLINE, ERIC, Teacher Reference Center, Psychology & Behavioral Science Collection, and Academic Search Elite databases, followed by ancestry searches, were included in this review. RESULTS: In general, chronic conditions are significantly associated with increased absenteeism, grade repetition and not completing high school within four years, although hemophilia does not follow this pattern. Additionally, increased severity of the condition is associated with poorer educational outcomes. CONCLUSIONS: Nurses and other healthcare providers should include an educational assessment as part of psychosocial assessment of children and adolescents to identify risk, intervene early and limit risk.

Improvements in Hope and Beliefs about Illness Following a Summer Camp for Youth with Chronic Illnesses.

This study evaluated changes in hope, attitude toward illness, and perceptions of illness benefit and burden following participation in a summer camp designed for youth with a variety of chronic illnesses. Participants were 62 youth campers (Age M = 13.45 years, SD = 2.41) with a variety of chronic illnesses. For youth who began camp low in hope about future goal attainment, participation in optional camp activities negatively predicted post-camp hope about future goal attainment. This relation was nonsignificant for campers who began camp high in hope. We found no significant changes in attitude toward illness or perceptions of illness benefit or burden. This study provides an important contribution to burgeoning research on summer camps designed for children with varying chronic illnesses. Findings were inconsistent with previous studies on chronic illness summer camp outcomes. Further work is needed to identify camp components that are related to desirable psychosocial outcomes for youth with chronic illnesses.

Heightening Person-Centered Care Processes in the Delivery of Nursing Restorative Care.

The objective of the current study was to investigate the perspectives of nursing home (NH) providers regarding the requirements to achieve reimbursement for nursing restorative care (NRC) services and propose recommendations to state agencies to assist NH providers to conduct NRC programs that are person-centered and able to achieve full reimbursement. Methods included a survey of NH providers in one state and a stakeholder focus group to discuss survey findings and develop recommendations. Key findings are that NH providers perceive value to residents from the provision of NRC; providers do not associate these benefits with the stringent reimbursement requirements; and NHs often provide NRC that is individualized, based on resident goals and activity tolerance, as well as realistic given competing demands on staff, even when doing so means giving up reimbursement for NRC services. Recommendations include basing reimbursement for NRC on outcomes rather than the process; reconsideration of the frequency and intensity requirements for NRC components; and increased availability of NRC training/education and resources for providers and case-mix reviewers. [Journal of Gerontological Nursing, 45(5), 5-10.].

Expanding Self-Management Support From Chronic to Acute Care: Implications for Value.

In this article, I advocate the expansion of self-management support from chronic to acute care as a means of increasing the value of services and highlighting the value of occupational therapy. Like people with chronic conditions, clients with acute conditions (1) need to participate in their own care, (2) require support for participation, (3) engage in care outside of traditional medical behaviors, and (4) benefit from a focus of care that extends beyond discrete episodes. Self-management support can facilitate adherence, promote holistic conceptualizations of health, and address long-term outcomes and costs. Given that self-management support aligns with occupational therapy's philosophical roots, expansion of self-management support to acute care highlights the profession's contribution to health promotion in this practice area.