A Population-Based Investigation of Health-Care Needs and Preferences in American Adults With Multiple Sclerosis.

BACKGROUND: Comprehensive and effective multiple sclerosis (MS) health care requires understanding of patients' needs, preferences, and priorities. OBJECTIVE: To evaluate priorities of patients with MS for their MS care. METHODS: Participants included 3003 Americans with MS recruited through the National MS Society and the North American Research Committee on Multiple Sclerosis patient registry. Participants completed a comprehensive questionnaire on aspects of their health-care experiences. RESULTS: Participants identified the top 3 health-care priorities as (1) the affordability of MS health care, (2) ensuring that non-MS health-care providers have more education about MS and how it can interact with other conditions, and (3) access to an MS center or specialized MS clinic with MS health-care professionals together in one place. Participants receiving care in an MS center rated the quality and their satisfaction with care higher than those receiving care in other settings. Although having the opportunity to evaluate their health-care quality was important to the participants, only 36.4% had been provided the opportunity in the past year. CONCLUSIONS: This study identifies health-care priorities and concerns for Americans with MS.

Descriptive analysis of free-text comments on healthcare priorities and experiences in a national sample of people with multiple sclerosis.

BACKGROUND: People with multiple sclerosis (PwMS) often require care from multiple healthcare services and providers to fulfill their physical and psychological healthcare needs, including those related to their MS and those due to co-occurring disorders. However, they often experience barriers to accessing healthcare specialists, providers, and services. OBJECTIVE: The purpose of this study is to understand patients' healthcare preferences, perceived importance of elements of their care, and encountered barriers through analyzing patients' free-text comments. METHODS: We used content analysis to analyze 7105 text responses. RESULTS: We recruited 3,003 participants with MS across the U.S. Of those, 82.9% were females. The mean age was 58.49 years (a range of 18-96 years). The participants self-reported their MS course as relapsing remitting (54.8%) or progressive (30.0%). The healthcare professionals most frequently identified as being most important to PwMS included neurologists, physicians/general practitioners, and physical/occupational therapists. Commonly identified barriers to accessing healthcare included the high cost of healthcare services, insufficient health insurance coverage, limited mobility, and transportation. Approximately 36% of respondents expressed a preference for receiving care from a comprehensive MS center, an MS research center, or an MS specialist as their main healthcare provider. Regarding priorities for improving healthcare quality, about 10% of participants stated that healthcare professionals should focus more time and attention on communicating, consulting, and understanding patients' needs and questions. CONCLUSION: PwMS prioritize accessibility, affordability, insurance coverage, and comprehensiveness in MS healthcare services.

Varying Levels of Food Insecurity Associated with Clinically Relevant Depressive Symptoms in U.S. Adults Aged 60 Years and Over: Results from the 2005-2014 National Health and Nutrition Survey.

Food insecurity refers to restricted or uncertain access to and ineffective utilization of nutritious and safe foods. Although food insecurity is linked to poorer physical health consequences among older adults, national estimates are not well known on food insecurity and depression. Using the 2005-2014 National Health and Nutrition Examination Survey, this study examines the associations between varying food insecurity levels and clinically relevant depressive symptoms (defined by PHQ-9 ≥ 10) among adults ≥60 years old (n = 7969). Rates of clinically relevant depressive symptoms in marginal, low, and very low food security were 12.3, 16.3, and 25.2%, respectively. Marginal, low, and very low food security were significantly associated with clinically relevant depressive symptoms: odds ratio (OR) = 1.12 (95% confidence intervals [CI] 1.07-1.18), OR = 1.07 (95% CI 1.03-1.12), and OR = 1.24 (95% CI 1.16-1.32), respectively. Given the intersection of food insecurity and depression, geriatric health professionals should work to improve health and nutrition programs for older adults at risk for or experiencing both public health concerns.

Validation of the Social Provisions Scale in people with multiple sclerosis.

OBJECTIVE: This study examined the factorial and construct validity of the Social Provisions Scale (SPS) in a sample of people with multiple sclerosis (MS). METHOD: Participants included 292 individuals with MS (83.9% women) recruited from the Greater Illinois, Gateway, and Indiana chapters of the National Multiple Sclerosis Society. Participants completed the SPS and pain, fatigue, depression, anxiety, MS self-efficacy, quality of life, and satisfaction with life measures. Factorial validity was tested using confirmatory factor analysis (CFA), and construct validity was examined based on the strength of bivariate correlations with scores on related measures. RESULTS: Findings from the CFA indicated that a first-order, 6-factor measurement model provided a good fit for the 24 items of the SPS (CFI = .94, TLI = .93, RMSEA = 0.07) and that the 6 factors could be described by a single, second-order factor of the overall social provisions (CFI = .93, TLI = .92, RMSEA = 0.08). Cronbach's alpha was .89 for the global score and between .66 and .81 for the 6 subscales. The SPS global and subscale scores correlated significantly with satisfaction with life, depression, anxiety, MS self-efficacy, and quality of life measures. CONCLUSIONS: Findings from this study support the factorial validity, construct validity, and reliability of the SPS as a measure of social provisions for use with people with MS. (PsycINFO Database Record

Nutrient intake and use of dietary supplements among US adults with disabilities.

BACKGROUND: Physical, mental, social, and financial hurdles in adults with disabilities may limit their access to adequate nutrition. OBJECTIVE: To examine the impact of dietary supplement use on daily total nutrient intake levels among US adults 20 years and older with disabilities. METHODS: Study sample came from 2007-2008 and 2009-2010 waves of the National Health and Nutrition Examination Survey, a nationally representative repeated cross-sectional survey. Disability was classified into 5 categories using standardized indices. Nutrient intakes from foods and dietary supplements were calculated from 2 nonconsecutive 24-hour dietary recalls. Two-sample proportion tests and multiple logistic regressions were used to examine the adherence rates to the recommended daily nutrient intake levels between dietary supplement users and nonusers in each disability category. The association between sociodemographic characteristics and dietary supplement use was assessed using multiple logistic regressions, accounting for complex survey design. RESULTS: A substantial proportion of the US adult population with disabilities failed to meet dietary guidelines, with insufficient intakes of multiple nutrients. Over half of the US adults with disabilities used dietary supplements. Dietary supplement use was associated with higher adherence rates for vitamin A, vitamin B1, vitamin B2, vitamin B6, vitamin B12, vitamin C, vitamin D, vitamin E, calcium, copper, iron, magnesium, and zinc intake among adults with disabilities. Women, non-Hispanic Whites, older age, higher education, and higher household income were found to predict dietary supplement use. CONCLUSIONS: Proper use of dietary supplements under the guidance of health care providers may improve the nutritional status among adults with disabilities.

State vocational rehabilitation services and employment in multiple sclerosis.

BACKGROUND: Obtaining and maintaining suitable employment can be a significant challenge for people with multiple sclerosis (MS). OBJECTIVE: The objective of this article is to identify what vocational rehabilitation (VR) services helped MS clients obtain and maintain employment, after controlling for the effect of demographic covariates and disability-related government benefits. METHODS: We retrieved data from the Rehabilitation Services Administration (RSA) 911 database in the fiscal year (FY) 2009, and used VR services as predictors to predict employment outcomes of people with MS by hierarchical logistic regression. RESULTS: A total of 924 out of 1920 MS clients (48.1%) were successfully employed after receiving VR services. Logistic regression analysis results indicated that cash benefits (OR =0.51, p < 0.001) and public medical benefits (OR =0.76, p < 0.01) were negatively associated with employment outcomes, whereas counseling and guidance (OR = 1.68, p < 0.001), job placement assistance (OR = 2.43, p < 0.001), on-the-job supports (OR = 1.62, p < 0.01), maintenance services (OR = 1.59, p < 0.01), and assistive technology services (OR =2.09, p < 0.001) were significant predictors of positive employment outcomes. CONCLUSION: VR services were found to be associated with employment status. MS patients experiencing problems obtaining or maintaining employment should be encouraged to pursue services from state VR agencies.

The association of stress-coping variables to quality of life among caregivers of individuals with traumatic brain injury.

The purpose of this study was to determine the degree to which stress-coping variables contribute to quality of life (QOL) among caregivers of individuals with traumatic brain injury (TBI). This study examined the direct effects of the following variables: functional competency, caregiving appraisal, coping, perceived social support, and family needs on QOL. In addition, the unique variance accounted for in QOL by each set was investigated, and whether perceived social support, coping, and family needs mediate or moderate the relationship between caregiving appraisal and QOL. The sample consisted of 108 caregivers recruited from support groups who were predominantly white females. The majority of care-recipients had a severe head injury. Measures administered were the Interpersonal Support Evaluation List, Family Needs Questionnaire, Modified Caregiving Appraisal Scale, and the World Health Organization Quality of Life--Brief Version. Results showed that the full model accounted for 68% of the variance in QOL; caregiving appraisal, perceived social support and family needs remained significant after other stress-coping variables were partialled; and of these sets, emotional social support, social needs, and perceived burden were the significant individual predictors. Emotional social support and social needs mediated the relationship between perceived burden and QOL.

Vocational services associated with competitive employment in 18-25 year old cancer survivors.

BACKGROUND: Young adult cancer survivors report difficulties related to employment. This study investigated the association of vocational services on work in young cancer survivors unemployed prior to receipt of services. METHODS: Administrative data obtained for years 2004 and 2005 from the Rehabilitation Services Administration (RSA) database was used in the analyses. A total of 368 cases aged 18-25 who were closed during the 2 years with a diagnosis of cancer were identified. All cancer survivors were unemployed at the time of application. Data on demographic characteristics, employment and vocational services were extracted and analyzed in relation to employment. Multivariate logistic regression was used to examine the relationship among services provided and work outcomes accounting for demographic characteristics. RESULTS: Cancer survivors represented 0.4% of the total population that received vocational services in the state-federal vocational rehabilitation system. Of the unemployed cancer survivors who received services, 190 (51.6%) achieved successful employment while 178 (48.4%) were not employed following receipt of vocational rehabilitation services. Gender (woman) (OR = 1.79; 95% CI: 1.16 to 2.76), vocational training (OR = 2.03; 95% CI: 1.03 to 4.00), miscellaneous training (OR = 4.01; 95% CI: 1.80 to 8.97), job search assistance (OR = 4.01; 95% CI: 1.80 to 8.97), job placement services (OR = 2.24; 95% CI: 1.11 to 4.52), on-the-job support (OR = 4.20; 95% CI: 1.66 to 10.63), and maintenance services (OR = 2.85; 95% CI: 1.38 to 5.90) were all related to an increased odds for employment. Provision of cash or medical benefits (e.g., Social Security Disability Insurance benefits) (OR = 0.43; 95% CI: 0.28 to 0.67) was associated with lower employment following vocational services. CONCLUSION: Very few young adult cancer survivors were involved in the state-federal rehabilitation program. Despite this, the provision of certain vocational rehabilitation services was related to increased employment in this group. Those who received job search assistance and on the job support were four times more likely to be employed following such services. While those in receipt of benefits were less likely to be employed, it is very likely that those receiving such benefits are the more severe cases. It is worth noting that the exact direction of these relationships can not be determined with the current design. IMPLICATIONS FOR CANCER SURVIVORS: Young adult cancer survivors who are seeking employment and can qualify for such services may benefit from certain services offered by state vocational rehabilitation agencies. This represents another service to consider when employment is a goal.