Living with economic hardship at the end of life.

BACKGROUND: Dying patients and their families often face an added burden of economic hardship, especially if they have become ill in the years before expected retirement. In Australia, patients can fall through the cracks of the national system of social protection because there are gaps in the access to and provision of healthcare and social assistance at the end of life. DESIGN: A mixed-method, prospective case study of individuals and their family carers, recruited from a specialist palliative care service in Melbourne, Australia, is presented. Participants were interviewed and followed up over 6 months and completed a 2-week diary of all services used and out-of-pocket costs. RESULTS: Mean out-of-pocket spending was $A369 per month (median: $A176, IQR: 356) ($A1=US$1=€0.73=£0.62; January 2011). Households with economic hardship were more likely to have a patient who was male, had ceased paid employment earlier than expected due to illness, reported a reduction in income due to illness, had less access to financial resources and used significantly fewer health-related community services. Three factors shaped the participants' experience of hardship: (1) the premature loss of employment capacity and income; (2) the affordability of care and; (3) a welfare system that could not accommodate their complex needs. CONCLUSIONS: These results demonstrate the multidimensional nature of the economic burden experienced at the end of life and imply the need for nuanced solutions to better support patients and their families. If terminally ill people wish to die at home and are to be supported to do so, policies must take account of the shift in economic burden from the health system onto families.

Transmission of brucellosis from elk to cattle and bison, Greater Yellowstone area, U.S.A., 2002-2012.

Bovine brucellosis has been nearly eliminated from livestock in the United States. Bison and elk in the Greater Yellowstone Area remain reservoirs for the disease. During 1990-2002, no known cases occurred in Greater Yellowstone Area livestock. Since then, 17 transmission events from wildlife to livestock have been investigated.

Issues, challenges, and solutions in translating study instruments.

Cross-cultural adaptation of study instruments is a difficult, time-consuming, but arguably cost-effective process. If conducted properly, it has the advantage that the translated study instruments are accurate, easy to understand, accessible, and culturally appropriate to the target audience and produce reliable and valid data. This article explores issues, challenges, and solutions for translating a set of research instruments used in a randomized, controlled trial for four separate community languages (Chinese, Vietnamese, Greek, Italian).

A randomised control trial of a self-management program for people with a chronic illness from Vietnamese, Chinese, Italian and Greek backgrounds.

OBJECTIVE: This study investigated the effectiveness of the Chronic Disease Self-management Program (CDSMP) when delivered to for people from Vietnamese, Chinese, Italian and Greek backgrounds living in Victoria, Australia. METHOD: The CDSMP was administered to 320 people with chronic illnesse(es) in selected low income areas in the State of Victoria, Australia. At 6 months, they were compared with randomised wait-list control subjects (n=154) using analyses of covariance. RESULTS: Participants in the intervention group had significantly better outcomes on energy, exercise, symptom management, self-efficacy, general health, pain, fatigue and health distress. There were no significant effects for health services utilisation. Interactions across language groups were observed with the Vietnamese and Chinese speaking participants gaining greater benefit. CONCLUSION: Self-management programs can be successfully implemented with culturally and linguistically diverse populations in Australia. Further research is needed to evaluate long-term outcomes; explore effects on service utilisation; and to determine whether the benefits obtained from participating in a self-management program can be maintained. PRACTICE IMPLICATIONS: Self-management programs should be considered for people from culturally and linguistically diverse backgrounds. Care also needs to be taken in designing recruitment strategies to minimize withdrawal rates and to ensure harder to reach people are given encouragement to participate.

Self-management: its place in the management of chronic illnesses.

Self-management programs are now regarded as important facets in the overall care of people with chronic illnesses. They are seen as producing long-lasting benefits both to participants and to the health system in terms of reduced hospitalisations and reduced lengths of stay, as well as decreasing medication usage. In this article we examine what constitutes self-management and the evidence supporting the views that the benefits are unequivocal. We argue that greater attention to research design is required before the benefits can be assessed. We also argue that greater attention must be paid to access issues for people from culturally and linguistically diverse backgrounds (CALD) and lower socioeconomic status.