Body composition and late-occurring chronic health conditions after autologous stem cell transplantation for lymphoma.

BACKGROUND: Autologous peripheral blood stem cell transplantation (aPBSCT) is the standard of care for adults with relapsed lymphoma, yet recipients remain at risk of developing chronic health conditions (CHCs). It was hypothesized that body composition measurements of skeletal muscle and fat are associated with late-onset CHCs and nonrelapse mortality after aPBSCT. METHODS: Leveraging the Blood or Marrow Transplant Survivor Study, we examined association between pre-aPBSCT body composition and new-onset grade 3-5 CHCs among 187 adults with lymphoma treated with aPBSCT (2011-2014) surviving ≥2 years after aPBSCT. Using computed tomography scans at the L3 level, skeletal muscle mass (skeletal muscle area and skeletal muscle density [SMD]) and body fat (subcutaneous adipose tissue and visceral adipose tissue) were measured and quantified as sex-specific z-scores. Competing risk models were built to study the impact of body composition on incident grade 3 through 5 CHCs and nonrelapse mortality (NRM) adjusting for confounders. RESULTS: The study cohort had a median age at aPBSCT of 57 years with 63% males, 77% non-Hispanic Whites and 81% with non-Hodgkin lymphoma. The 5-year cumulative incidence of grade 3 through 5 CHCs was 47% (95% Confidence Interval, CI, 38%-56%). Each SD increase in SMD was associated with 30% reduced risk of grade 3 through 5 CHCs (95% CI, 0.50-0.96). The 10-year cumulative incidence of NRM was 16% (95% CI, 10-22). No body composition measure was associated with NRM. CONCLUSIONS: The association between SMD and grade 3 through 5 CHCs following aPBSCT could inform development of prognostic models to identify adults with lymphoma at greatest risk of morbidity following aPBSCT.

Nature-based interventions for physical health conditions: A systematic review and meta-analysis.

Nature-based interventions (NBIs) are activities, strategies, or programs taking place in natural settings, such as exercising in greenspaces, to improve the health and well-being of people by integrating the benefits of nature exposure with healthy behaviours. Current reviews on NBIs do not report the effects on different groups of physical health conditions. The purpose of this systematic review and meta-analysis was to identify and synthesize the evidence of the effect of NBIs on physical health outcomes and biomarkers of physical health conditions. Overall, 20,201 studies were identified through searching MEDLINE, Embase, CINAHL, SPORTDiscus, and CENTRAL databases up to June 7, 2024. Inclusion criteria were: 1) randomized controlled intervention studies; 2) population with a physical health condition; 3) NBIs vs. different intervention or no intervention; and 4) measuring physical health outcomes and/or biomarkers. Twenty-six studies were included in the review, 15 of which contributed to the meta-analysis. Compared to control groups, NBIs groups showed significant improvements in: diastolic blood pressure (MD -3.73 mmHg [-7.46 to -0.00], I2 = 62%) and heart rate (MD -7.44 bpm [-14.81 to -0.06], I2 = 0%) for cardiovascular conditions, fatigue (SMD -0.50 [-0.82 to -0.18], I2 = 16%) for central nervous system conditions, and body fat percentage (MD -3.61% [-5.05 to -2.17], I2 = 0%) for endocrine conditions. High effect heterogeneity was found in several analyses and the included studies had moderate-to-high risk of bias (RoB). The non-significant outcomes showed a direction of effect in favour of NBI groups for cardiovascular, central nervous system, endocrine, musculoskeletal, and respiratory conditions. This review found some beneficial effects in favour of NBIs for health outcomes in at least three condition groups though RoB and inconsistent effects limited some interpretations. NBIs are promising therapies that healthcare professionals can consider integrating into clinical practice.

Household chaos and childhood obesity-related health outcomes.

OBJECTIVE: Household chaos, defined as a lack of organization, structure, and predictability, has been linked to deleterious childhood health outcomes and may hinder attempts to initiate and maintain healthy lifestyle changes. This study examined the associations of household chaos and obesity-related health conditions in a sample of youth being treated for obesity. METHODS: Participants were 715 patients (61.8% girls; Mage = 12.3 years; 68.7% non-Hispanic Black; M% of 95th BMI %-ile = 146.9%) enrolled in a pediatric weight management clinic. Caregiver report of household chaos was measured using the Confusion, Hubbub and Order Scale (CHAOS). Physiological obesity-related comorbidities (e.g., insulin resistance, hypertension, dyslipidemia) were assessed by a medical clinician and abstracted from electronic medical records; health conditions were dichotomized as present or not present. Psychological functioning was measured with the Pediatric Symptom Checklist, a caregiver-completed mental health screen that assesses internalizing, externalizing, and attention concerns. RESULTS: The Wilcoxon rank-sum test was used to test differences in household chaos scores for each obesity-related health condition. Caregivers of youth diagnosed with hypertension and obstructive sleep apnea reported significantly lower levels of household chaos, while caregivers who reported clinical levels of psychological dysfunction reported higher levels of chaos. CONCLUSIONS: Traditional management of childhood obesity requires changes across multiple health domains (e.g., dietary, exercise, sleep), and such change may be facilitated by structure and consistency. Present findings suggest that psychological resources within pediatric weight management settings should address individual patient-level factors associated with physiological and mental health as well as household functioning.

Investigating municipal and company influences on employment of people with chronic health conditions.

AIMS: In many countries, people with chronic health conditions have a weaker attachment to the labour market and fewer chances of re-employment. Much of the existing literature estimates the importance of institutional factors at the level of the municipality of residence or employer accommodation at the company level individually. This study examined the two levels simultaneously to disentangle the separate effects of municipal-level and of company-level factors. METHODS: Using full population data from Denmark, we estimated cross-classified multilevel models for people newly diagnosed with chronic conditions in 2010-2013 (more than 60,000 individuals in 20,000 companies). We tracked their employment outcomes for up to 5 years after diagnosis. RESULTS: The findings suggest that, in the short term, factors at the company level explain differences in the employment levels of individuals with chronic conditions more than institutional factors at the municipal level. A combination of average wage, company-level seniority, company size, and industry seem to explain much of company-level influence. In the longer term, the importance of company-level factors seemed to decline. Company-level factors explained blue collar workers' employment rates better than those of white collar workers, which is in line with the notion that blue collar workers expend more physical effort in their work so that they may be more reliant on company accommodation than white collar workers in the case of chronic conditions. CONCLUSIONS: Company-level factors affected the employment of persons newly diagnosed with chronic health conditions in the short term (in particular among workers in blue collar jobs), while municipal-level factors did not.

Exploring attitudes of people with chronic health conditions towards the use of group-based telerehabilitation: A qualitative study.

OBJECTIVE: The study explores the attitudes of people with chronic health conditions towards the use of group-based telerehabilitation. DESIGN: A qualitative research study. SETTING: The setting involved semi-structured focus groups via videoconferencing software. PARTICIPANTS: A purposive sample of 18 people with chronic health conditions including cardiorespiratory, neurological and musculoskeletal conditions was recruited via national patient advocacy and support groups in Ireland and clinical contacts. The sample included both those who had, and had not, previously engaged in telerehabilitation programmes. PROCEDURES: An online questionnaire collected demographic information and data regarding previous telerehabilitation participation and telerehabilitation preferences. Focus groups were conducted using videoconferencing software, in accordance with the Consolidated Criteria for Reporting Qualitative Research (COREQ) Checklist, and analysed using thematic analysis following Braun and Clarke's methodology. Findings were triangulated with quantitative questionnaire data. RESULTS: Four focus groups were conducted including participants with chronic cardiorespiratory (n = 8), neurological (n = 6) and musculoskeletal (n = 4) conditions. Three themes were identified regarding telerehabilitation: (a) benefits and facilitators (including convenience, increased service accessibility, social connection and technological support), (b) challenges and barriers (including technological access and literacy, limited 'hands-on' therapy, safety concerns and social limitations), and (c) preferences (regarding mode of delivery, content, duration and generic programmes for mixed-condition groups). CONCLUSIONS: Telerehabilitation is convenient for people with chronic conditions; however, concerns exist regarding the use of technology and the limitations of this healthcare delivery method. The role of telerehabilitation is valued, and future programmes should acknowledge patient preferences including a hybrid model of care, exercise and educational content, social interaction and synchronous components.

Using the Functional Comorbidity Index with administrative workers' compensation data: Utility, validity, and caveats.

BACKGROUND: Chronic health conditions impact worker outcomes but are challenging to measure using administrative workers' compensation (WC) data. The Functional Comorbidity Index (FCI) was developed to predict functional outcomes in community-based adult populations, but has not been validated for WC settings. We assessed a WC-based FCI (additive index of 18 conditions) for identifying chronic conditions and predicting work outcomes. METHODS: WC data were linked to a prospective survey in Ohio (N = 512) and Washington (N = 2,839). Workers were interviewed 6 weeks and 6 months after work-related injury. Observed prevalence and concordance were calculated; survey data provided the reference standard for WC data. Predictive validity and utility for control of confounding were assessed using 6-month work-related outcomes. RESULTS: The WC-based FCI had high specificity but low sensitivity and was weakly associated with work-related outcomes. The survey-based FCI suggested more comorbidity in the Ohio sample (Ohio mean = 1.38; Washington mean = 1.14), whereas the WC-based FCI suggested more comorbidity in the Washington sample (Ohio mean = 0.10; Washington mean = 0.33). In the confounding assessment, adding the survey-based FCI to the base model moved the state effect estimates slightly toward null (<1% change). However, substituting the WC-based FCI moved the estimate away from null (8.95% change). CONCLUSIONS: The WC-based FCI may be useful for identifying specific subsets of workers with chronic conditions, but less useful for chronic condition prevalence. Using the WC-based FCI cross-state appeared to introduce substantial confounding. We strongly advise caution-including state-specific analyses with a reliable reference standard-before using a WC-based FCI in studies involving multiple states.

Long-Run Impacts of an Early-life Nutrition Program: Evidence from the Introduction of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

OBJECTIVES: To study how access to the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) during the prenatal and early childhood periods affects long-term health outcomes of the affected cohorts. METHODS: In order to identify the effects of the WIC program, we exploit variations in the timing of its introduction in different counties and analyze future health indicators of affected cohorts. We use the restricted version of the Panel Study of Income Dynamics, which includes county-level identifiers through the interview year 2019. RESULTS: Our findings suggest that extending WIC access by one month correlates with a 0.2-0.3% point decrease in asthma incidence (p < 0.1 to p < 0.01) of affected cohorts. Although the connection between WIC and asthma is not fully understood, existing studies suggest potential pathways. Micronutrient deficiencies during early life can impact immune function and inflammation, both relevant to asthma. Moreover, adopting healthier dietary habits may improve microbiome composition, lowering asthma risk. Other indirect benefits of WIC, such as increased use of preventive healthcare services, may also contribute to the prevention of asthma. Despite uncertainties, these estimates remain robust across various model specifications. CONCLUSIONS FOR PRACTICE: Our study implies that early-life nutritional support programs such as WIC may alleviate the burden of asthma, although the specific mechanisms and effect sizes remain unclear. Given the substantial impact of asthma in the U.S., our findings underscore the potential long-term benefits of early-life nutritional support programs for lifelong health.

User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review.

BACKGROUND: There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies. OBJECTIVE: This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point? METHODS: Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically. RESULTS: A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8%), involved people with diabetes (51/292, 17.5%), targeted medication adherence (98/292, 33.6%), and comprised apps (220/292, 75.3%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; "use" (102/292, 34.9%) and "engagement" (94/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56/292) of the studies. CONCLUSIONS: The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022289693.

Interpersonal Processes in the Duration of Sick Leave of Workers with Chronic Diseases: A Dyadic Analysis.

PURPOSE: Although there is increasing awareness that significant others' perceptions and behavior can affect health outcomes, the role of interpersonal processes between sick-listed workers and significant others in sick leave and return to work (RTW) has hardly been studied. This study aims to examine the associations between illness perceptions, RTW expectations, and behaviors of significant others (engagement, buffering and overprotection) with sick leave duration within dyads of sick-listed workers with chronic diseases and their significant others. METHODS: We used survey data linked with sick leave registry data of 90 dyads. Pearson correlations were used to study the interdependence within dyads. Multiple linear regression analyses were conducted to examine associations between survey data of both dyad members and sick leave duration. RESULTS: We found moderate to strong correlations between workers and significant others, indicating interdependence within dyads regarding illness perceptions, RTW expectations and perceived significant other behaviors. Dyad members' illness perceptions (R2 = .204, p = .001) and RTW expectations (R2 = .326, p = < .001) were associated with sick leave duration, explaining respectively 12.3% and 24.5% of the variance. We found no associations between sick leave duration and active engagement, protective buffering and overprotection. CONCLUSIONS: This study indicates that negative illness perceptions and RTW expectations of both workers and their significant others are associated with a longer sick leave duration. Considering the interdependence within dyads, involving significant others when intervening on maladaptive illness perceptions and RTW expectations may be more effective than solely focusing on the worker's perceptions and expectations.

Increasing teachers' confidence during health emergencies: A hands-on quality improvement program led by the school nurse.

INTRODUCTION: One in four school-age children has a chronic health condition, with approximately 6% of them having multiple chronic health conditions. These students are at an elevated risk of individual health emergencies during school hours. While teachers receive online training to assist in these emergencies, they lack practicing with rescue medications. METHODS: We developed a Quality Improvement (QI) program that had a) a live presentation; b) a hands-on workshop to practice using rescue medications for allergies, asthma, seizures, and diabetes; c) fliers with first-aid guidelines; and d) a web-based reference toolkit. Teachers' confidence and knowledge were measured using the Learning Self-Efficacy Scale and a knowledge questionnaire with a pre- and post-intervention survey. We also assessed their clinical skills using the rescue medications. RESULTS: 129 teachers took part in this QI program. We collected 95 pre- and 81 post-surveys, with 47 matched. We saw statistically significant increases in confidence, as well as in the individual cognitive, affective, and psychomotor domains. Teachers also increased their overall knowledge. Collaterally, other district-wide improvements developed. CONCLUSION: This evidence-based, hands-on QI program provided teachers the opportunity to put into practice clinical skills, increasing their confidence to help students when experiencing an individual health emergency. Furthermore, changes beyond the primary goal of this QI program were implemented, highlighting the lead role of the registered nurse as the public health advocate. IMPLICATION TO PRACTICE: Laypeople benefit from hands-on training to learn clinical skills. This program serves as a basis for improving health emergencies preparedness in schools.

[Fatigue in chronic physical diseases]. / Fatigue bei chronisch körperlichen Erkrankungen.

The term fatigue is used to describe states of unusual tiredness and exhaustion that can occur in connection with various chronic diseases, particularly cancer, multiple sclerosis, Parkinson's disease and rheumatoid arthritis. In contrast to states of exhaustion in healthy people, fatigue is characterized by the fact that it can last for long periods, is disproportionate to previous activities and does not subside after recovery phases. Fatigue is described as a multidimensional problem that encompasses physical, emotional and cognitive aspects and is associated with a high level of subjective suffering. Depending on the severity and course of the symptoms, fatigue is associated with a severely reduced quality of life and it impairs participation and coping with everyday life. It also makes professional reintegration and reemployment more difficult. Although we cannot yet fully explain the aetiology and pathogenesis, fatigue in physical illnesses must be understood based on a multifactorial biopsychosocial model. The possibilities of diagnostics and an overview of various measures for clarifying fatigue are presented. The challenges for medical care are also outlined and advice is given on how to deal with them in everyday clinical practice.

Early-life impairments, chronic health conditions, and income mobility.

Individuals who have congenital conditions or become disabled early in life tend to have poorer educational and occupational outcomes than non-disabled individuals. Disability is known to be a complex entity with multiple causations, involving, inter alia, physiological, social, economic, and cultural factors. It is established that social factors can influence educational and occupational attainment for disabled people, and current disability policy in many countries, particularly in the Global North, stress the importance of equality of opportunity. However, there is a scarcity of research that explores the specific degrees to which advanced welfare states contribute to the equalization of life chances for individuals with early-life impairments and chronic health conditions. In this study, we use a Norwegian sample of high-quality register data on individuals with vision loss, hearing loss, physical impairment, type 1 diabetes, asthma, and Down syndrome diagnosed early in life and compare their intergenerational income mobility trajectories with a random sample drawn from the country's entire population. We find that individuals' early-life diagnoses are linked to significantly worse income outcomes in adulthood than what is observed among the general population. We conclude that even in one of the most advanced egalitarian welfare states, such as Norway, much remains to be done to equalize life chances for individuals with early-life impairments and chronic health conditions.

Chronic Health Condition Management and School-Based Health Centers in New York: Findings From the 2020 School Health Profiles Survey.

School-based health centers (SBHCs) are associated with numerous positive aspects of student health services. Many schools in the United States (US) do not have transparent policies on chronic health condition (CHC) management. Of particular concern is the underreporting of the delivery of health services in U.S. schools concerning CHC management and its relationship with the presence or absence of a SBHC. Data from the 2020 School Health Profiles (SHP) Survey were examined in New York public secondary schools. Specific health services were reviewed, together with the presence or absence of a SBHC, including daily medication administration, stock rescue medication, case management services, community partners, chronic disease-specific education, and assurance that students with CHCs were enrolled in an insurance program. A significantly greater proportion of schools with a SBHC compared with schools without a SBHC provided: (1) daily medication administration (92.9% vs. 86.5%; p < .001), (2) stock or rescue medication (84.9% vs. 77.4%; p < .001), (3) case management services (83.1% vs. 67.2%; p < .001), (4) disease-specific education for families (63.1% vs. 57.2%; p = .022), (5) student and family connection to community health services (84.2% vs. 76.5%; p < .001), and (6) ensured that a protocol existed whereby students with a CHC were enrolled in an insurance plan if eligible (79.6% vs. 66.8%; p < .001). Findings suggest that data on a national scale include essential facts for states to consider concerning school health policies and practices. Additional research should examine the intricacy of elements connected with school-based health care to understand better the care provided to children with CHCs.

Incontinence and homelessness.

The fundamental principles of why specific people become homeless, can be grounded in a simple rationale or founded within sophisticated reasoning. For instance, people who suffer from substance abuse, addiction, alcohol, gambling, have mental health concerns or financial difficulties may be susceptible to homelessness. It is also identified that persons who experienced violence in their childhood or abuse by a partner are at a higher risk of becoming homeless. Homelessness knows no ethnic, cultural, religious or gender boundaries, and can impact all individuals' health and well-being. A health problem and worldwide phenomenon that affects all cohorts of the population, including the homeless, is urinary incontinence. The aim of this article is to increase the awareness of incontinence and highlight the impact it has on the lives of people that experience homelessness.

Chronic health conditions among long-term survivors of adolescent and young adult cancer: A comparison of outcomes in Israel and the United States.

BACKGROUND: There is a paucity of information on health outcomes of adolescent and young adult (AYA) cancer survivors living outside North America and Europe. This study compared outcomes in AYA cancer survivors in Israel with individuals without cancer and similar demographics and access to health care, and to AYA cancer survivors living in the United States. METHODS: This study included 12,674 2-year survivors of AYA (aged 15-39 years) cancer diagnosed between 2000 and 2018 at Clalit Health Services (CHS) in Israel. CHS participants without cancer (N = 50,696) were matched 4:1 to survivors on age, sex, ethnicity, and membership duration. Poisson regression was used to determine incidence rate ratios (IRRs) for chronic conditions. The US Kaiser Permanente Southern California AYA cohort (N = 6778) was used to estimate weighted (age, sex) standardized incidence ratios (SIRs) for CHS survivors. RESULTS: CHS AYA cancer survivors were more likely to have any chronic condition (IRR, 1.6 95% CI, 1.5-1.7), compared with participants without cancer. Survivors had an increased risk across nearly all conditions examined, with especially elevated risks for osteoporosis (IRR, 4.7; 95% CI, 4.1-5.5) and cardiomyopathy (IRR, 4.2 95% CI, 3.4-5.3). Compared with the Kaiser Permanente Southern California cohort, CHS survivors had an overall lower (SIR, 0.68; 95% CI, 0.65-0.72) incidence of developing any health condition, with noticeably lower incidence of hyperlipidemia (SIR, 0.7; 95% CI, 0.64-0.75). CONCLUSION: AYA cancer survivors in Israel are at increased risk for developing chronic conditions compared with individuals without cancer, but the overall incidence was lower than in US survivors. These findings may allow for refinement of surveillance recommendations for AYA survivors, taking into consideration regional differences in sociodemographic characteristics and cancer care. PLAIN LANGUAGE SUMMARY: The burden of chronic conditions was consistently greater in Israeli adolescent and young adult cancer survivors compared with individuals without cancer, with clear differences in risk of specific conditions by cancer diagnosis. However, the overall incidence of chronic conditions in Israeli survivors was generally lower than in US survivors.

Caregiver strain among non-Hispanic Black and Hispanic male caregivers with self-reported chronic health conditions.

OBJECTIVES: Caregiver strain often stems from unmet needs and is a risk factor for poor physical and psychological health. This study aims to identify factors associated with caregiver strain among middle-aged and older non-Hispanic Black and Hispanic male caregivers living with one or more chronic conditions. DESIGN: Data were analyzed from 418 male caregivers collected through Qualtrics Online Panels using an internet-delivered survey instrument (55.7% non-Hispanic Black, 44.3% Hispanic). Three ordinal regression models were fitted to assess factors associated with Caregiver Strain Scale tertiles: one for all men, one for non-Hispanic Black men only; and one for Hispanic men only. RESULTS: Similarities and differences were observed between the two groups in terms of factors associated with higher caregiver strain (i.e. lower disease self-management efficacy scores, providing ≥20 h of care per week). Uniquely for Non-Hispanic Black male caregivers, higher caregiver strain was associated with living with more children under the age of 18 (ß = 0.35, P = 0.011) and feeling more socially disconnected (ß = 0.41, P = 0.008). Uniquely for Hispanic male caregivers, higher caregiver strain levels were associated with experiencing lower pain levels (ß = -0.14, P = 0.040) and higher fatigue levels (ß = 0.23, P < 0.001). CONCLUSION: Findings from this study suggest that non-Hispanic Black and Hispanic men with chronic conditions have differing caregiving experiences. While bolstering social connectedness and caregiver support services may offset caregiver strain, tailored mental health and disease management programming are needed to meet the specific needs of non-Hispanic Black and Hispanic male caregivers.

Questionnaires Measuring Physical Activity in Clinical Pediatric Populations: A Systematic Review.

PURPOSE: Regular physical activity (PA) is a cornerstone therapy for many childhood chronic health conditions, and questionnaires offer a simple method for monitoring PA and identifying children who do not meet clinical practice guidelines. The purpose of this systematic review is to determine which questionnaires are most efficacious for assessing PA in children with chronic health conditions. METHODS: Systematic literature searches were conducted through ProQuest, MEDLINE, Scopus, and SPORTDiscus from January 2010 to August 2020 to identify studies that measured PA with a validated questionnaire in children and adolescents aged 3-18 years old with chronic health conditions. In eligible studies, the validity and reliability of questionnaires were identified, and the modified COnsensus-based Standards for the selection of health status Measurement INstruments checklist and Grading of Recommendations, Assessment, Development, and Evaluations were used to assess the quality and strength of evidence and risk of bias. RESULTS: Four thousand four hundred and seventy-eight references were extracted, and 10 articles were included for review. From 10 eligible studies, 6 questionnaires were identified, none of which adequately measure PA in clinical pediatric populations. CONCLUSION: Questionnaires to adequately measure PA in children with chronic conditions are lacking. This compromises the identification of those who do not meet PA guidelines, limiting the opportunity to identify and address factors contributing to low PA levels.

Towards reduction of preventable hospital readmission: Older people and family members' views on planned self-management of care at home.

AIMS AND OBJECTIVES: To reduce the likelihood of preventable readmissions, the aim was to investigate how older people (with their family members) managed their chronic health conditions at home following hospital discharge. The objectives explored older people and their family members' perspectives on how discharge plans assisted self-management of their chronic conditions, their recognition of deterioration and when to seek treatment/re-attend hospital. BACKGROUND: Chronic conditions have challenged older adults' self-management, particularly after hospital discharge and can impact on preventable readmission. Few studies have examined patients' and their family members' perspectives on the management of their conditions at home after hospitalisation. DESIGN: A qualitative exploratory design known as Interpretive Description was utilised. METHODS: Purposeful sampling involved 27 community-dwelling older adults; nineteen were discharged patients with one or more chronic health conditions. Eight nominated family members were also recruited to enhance understanding of the older persons' self-management at home. Interviews were undertaken and thematic data analysis followed the COREQ guidelines. RESULTS: Five themes emerged: (1) Post-Discharge Advice; (2) Managing at Home; (3) Recognition and Response to Deterioration; (4) Community Care and Support; and (5) The "Burden" on Others of Post-Discharge Care. CONCLUSION: Older people sought a clear plan for self-management at home prior to discharge. This plan should contain potential signs of deterioration and guidance on future action. We found that support given to older people from family and friends was critical to prevent readmission. In addition, their local General Practitioner and Pharmacist played an essential part in the support of their care. For some, social support services were also important. Nurse telephone follow-up in the week following discharge was mostly absent. However, this strategy would be strongly recommended. RELEVANCE TO CLINICAL PRACTICE: To mitigate against preventable readmission, we recommend the above strategies to assist the older person at home with self-management of their chronic conditions.

Caregiver engagement interventions on reducing the anxiety and depression of children with chronic health conditions and their caregivers: A meta-analysis of randomized controlled trials.

BACKGROUND: Anxiety and depression are common debilitating mental health issues in families of children with chronic health conditions. It is essential to consider the mediating role of caregivers between children and healthcare workers. Previous research has evaluated the effectiveness of caregiver engagement interventions in reducing anxiety and depression in chronically ill children and their caregivers, but their overall impact awaits a synthesis of the available evidence. METHODS: We performed a comprehensive search using PubMed, Embase, Web of Science, Cochrane Library, Ovid, PsycINFO, APA PsycArticles, and Cumulative Index of Nursing and Allied Health Literature (CINAHL). RESULTS: Twenty-nine studies were included. The results demonstrated that caregiver engagement interventions significantly decreased anxiety (standardized mean difference [SMD] = -0.49; 95% confidence interval [CI], -0.77 to -0.22; P < 0.001) and depression (SMD = -0.37; 95% CI, -0.55 to -0.18; P < 0.001) among caregivers, particularly in developing countries. However, no improvements in the anxiety (SMD = 0.00; 95% CI, -0.46 to 0.46; P = 0.99) and depression (SMD = -0.14; 95% CI, -0.32 to 0.04; P = 0.14) of children were observed. CONCLUSIONS: Significant evidence exists regarding the positive effects of caregiver engagement interventions on caregivers' anxiety and depression. Further recommendations for future research should focus on engagement interventions that reduce the anxiety and depression for children with chronic conditions. IMPLICATIONS: Clinicians should concentrate on the mental health of chronically ill children and their caregivers and extend caregiver engagement therapies to improve anxiety and depression resulting from managing the disease.

Translation and validation of the STARx questionnaire in transitioning Chinese adolescents and young adults with chronic health conditions.

BACKGROUND: Adolescent/young adults (AYAs) with chronic conditions must undergo healthcare transition (HCT) preparation until their mid-twenties. Valid HCT readiness measures are lacking in China. METHODS: The present study translated, back-translated, and adapted the Self-Management and Transition to Adulthood with Rx = Treatment (STARx) Questionnaire. We examined the psychometric properties of this tool in a relatively large in-patient sample of AYAs with various chronic health conditions at a Chinese tertiary general hospital. RESULTS: We enrolled 624 AYAs aged 10-25 years (19.66 ±â€¯3.64) with various chronic health conditions. The Chinese version of the STARx Questionnaire demonstrated excellent internal consistency (Cronbach's alpha = 0.83) and reliability with a two-week test-retest (ICC = 0.88, p < .001). Furthermore, the Chinese version revealed a three-factor structure (self-management, disease knowledge, and provider communication) consistent with the revised English version of the STARx Questionnaire. In terms of discriminant validity, the total score of the Chinese STARx Questionnaire showed a significant positive correlation with age but no gender differences were found. In terms of predictive validity, the Chinese STARx Questionnaire was significantly correlated with shorter length of hospitalization and higher frequency of emergency room visit, but the correlations became insignificant after controlling for age. CONCLUSIONS: The results suggest that the Chinese version of the STARx Questionnaire is a robust HCT readiness tool in AYAs with chronic conditions and clinicians may find it useful to develop individualized interventions.