Carrie M. Kuehn

The Burden of Influenza B: A Structured Literature Review

We reviewed the epidemiology, clinical characteristics, disease severity, and economic burden of influenza B as reported in the peer-reviewed published literature. We used MEDLINE to perform a systematic literature review of peer-reviewed, English-language literature published between 1995 and 2010. Widely variable frequency data were reported. Clinical presentation of influenza B was similar to that of influenza A, although we observed conflicting reports. Influenza B-specific data on hospitalization rates, length of stay, and economic outcomes were limited but demonstrated that the burden of influenza B can be significant. The medical literature demonstrates that influenza B can pose a significant burden to the global population. The comprehensiveness and quality of reporting on influenza B, however, could be substantially improved. Few articles described complications. Additional data regarding the incidence, clinical burden, and economic impact of influenza B would augment our understanding of the disease and assist in vaccine development.

Getting the work done: a qualitative study of individuals with multiple sclerosis

The Problem : Work can be defined as an activity performed to accomplish something in the presence of obstacles that may make accomplishing the goal difficult. For individuals with MS, work is not only limited by physical impairments but also by factors such as fatigue and cognitive changes Purpose : The aim of this study is to examine the experiences of individuals with mild to moderate MS as they carry out everyday work activities both inside and outside the home. Method : Eleven women and three men were recruited from the community to participate in a series of semi-structured interviews. Using qualitative research methodology that examined the experiences of the participants, two major themes and seven subthemes emerged. Results : The first theme, Defining the work, included Priorities : seeing whats important; Plans : learning about resources and requirements; and Perspectives : fixing it yourself. The second theme, Changing how things get done, includes Precipitating factors; Awareness; Constructing the strategies; and Evaluating the strategies. Conclusions : Individuals with MS develop strategies and utilize resources in order to get the work done. Comparisons are made between existing intervention theories or programmes and the experiences described by participants in this study.

Assistive Technology Use Among Adolescents and Young Adults With Spina Bifida

OBJECTIVES We sought to determine the use of assistive technology among a population of individuals with spina bifida. METHODS We performed a descriptive analysis of individuals aged 13 to 27 years diagnosed with myelomeningocele (n=348) using data obtained from an existing database at Childrens Hospital and Regional Medical Center, Seattle, Washington. We summarized disease characteristics, utilization of assistive technology, community and self-care independence, and other variables. RESULTS Eighty-four percent of the respondents lived with at least 1 of their natural parents. Fifty-seven percent used wheelchairs, 35% used braces, and 23% used walking aids. Independent self-care was a common skill, but 72% reported limited participation in structured activities. Half were aged 18 years or older; of those, only 50% had completed high school and 71% were unemployed. Those aged younger than 18 years were all still in school (100%). CONCLUSIONS Adolescents and young adults with spina bifida rely on assistive technology and specialized care routines to maintain their health. Assistive technology use for mobility is common; little is known about secondary complications associated with use of these technologies or the use of assistive technology to address learning disabilities and other societal barriers. Underutilization of assistive technology could delay successful transitions to independent living and community participation.

Antidepressant use in multiple sclerosis: epidemiologic study of a large community sample

Depressive symptoms and disorders among individuals with multiple sclerosis (MS) are more common when compared to other chronic illnesses and the general population, but relatively little is known about the use of antidepressant medication in this population. In this cross-sectional study of 542 community-dwelling adults with MS, we examined the prevalence of antidepressant use and employed multivariate logistic regression modeling to identify factors significantly associated with antidepressant use. Thirty-five percent of the sample reported currently using at least one antidepressant medication. Gender, marital status, insurance status, fatigue, and use of disease modifying therapies were all significantly associated with antidepressant use. Just over half of the sample endorsed a clinically significant level of depressive symptoms, and the majority of this group was not currently taking an antidepressant. Conversely, 41% of those with depressive symptoms reported taking at least one antidepressant medication. More research is needed to better understand why people with MS and depressive symptoms use or do not use antidepressant medications and to further explore the possibility of an under-treatment of depressive disorder in this population. Rigorous studies testing the feasibility, acceptability, and efficacy of currently available therapies for depression in the MS population should also be conducted. Multiple Sclerosis 2007; 13: 1046—1053. http://msj.sagepub.com

Measuring participation in people living with multiple sclerosis: A comparison of self-reported frequency, importance and self-efficacy

Purpose. To compare three dimensions related to participation in everyday situations in community-dwelling adults with multiple sclerosis (MS). Methods. Mail survey was obtained from 112 respondents. Data were analyzed using Kendalls tau-b correlation coefficients between responses to participation items relative to three question dimensions (importance, frequency, and self-efficacy) and criterion variables (mobility, depression, general health, fatigue and pain). Results. No significant associations were found between item responses in the importance dimension and the criterion variables. Weak associations were found for items in the frequency dimension, and stronger associations were found for items in the self-efficacy dimension. Conclusions. Different dimensions of participation in specific life situations yielded different responses and associations of those responses with key criterion measures. Subjective importance of participating in everyday situations is relatively independent of measures of mobility, general health, depression, fatigue and pain. Subjective judgments of self-efficacy for participation are more closely linked to these criterion measures. Caution is warranted when interpreting scales of participation because participation is a complex construct, potentially composed of several dimensions.

Patient Perspectives on Disease-Modifying Therapy in Multiple Sclerosis

The purpose of this study was to understand factors contributing to the decision-making processes of individuals with multiple sclerosis (MS) regarding the use of disease-modifying therapy (DMT). S...

Fetal Deaths and Proximity to Hazardous Waste Sites in Washington State

Background The in utero period is one of increased susceptibility to environmental effects. The effects of prenatal exposure to environmental toxicants on various adverse pregnancy outcomes, including fetal death, are not well understood. Objective We examined the risk of fetal death in relation to maternal residential proximity to hazardous waste sites. Methods We conducted a population-based case–control study using Washington State vital records for 1987–2001. Cases were women with fetal deaths at ≥ 20 weeks (n = 7,054). Ten controls per case were randomly selected from live births. Locations of 939 hazardous waste sites were identified from the Department of Ecology registry. We measured distance from maternal residence at delivery to the nearest hazardous waste site, and calculated odds ratios (ORs) and 95% confidence intervals (CIs). Results The risk of fetal death for women residing ≤ 0.5 miles, relative to > 5 miles, from a hazardous waste site was not increased (adjusted OR = 1.06; 95% CI, 0.90–1.25). No associations were observed for any proximity categories ≤ 5 miles from sites with contaminated air, soil, water, solvents, or metals; however, fetal death risk increased among women residing ≤ 1 mile from pesticide-containing sites (OR = 1.28; 95% CI, 1.13–1.46). Conclusion These results do not suggest that fetal death is associated with residential proximity to hazardous waste sites overall; however, close proximity to pesticide-containing sites may increase the risk of fetal death.

The cost and benefits of employment: a qualitative study of experiences of persons with multiple sclerosis 1 1No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

OBJECTIVE To attain a better understanding of the benefits and barriers faced by persons with multiple sclerosis (MS) in the workplace. DESIGN Qualitative research methodology comprising a series of semistructured interviews. SETTING Community-based setting. PARTICIPANTS Fourteen women and 2 men with MS living in the community who were employed or recently employed at the time of interviews. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Accounts of personal experiences related to employment. RESULTS Four themes emerged: the cost-benefit economy of working; fatigue and cognitive changes; stress in the workplace; and accommodations made to address barriers. Although participants valued work highly, they were also aware of the cost of being employed. The consequences of unemployment or changing jobs were considered negative and appeared stressful. For persons with MS, employment had both costs and significant benefits. Accommodations in the workplace and modifications of roles and responsibilities at home made it possible for individuals to continue working. CONCLUSIONS Health care providers must consider the complexity and timing of decisions by people with MS to continue or leave employment before recommending either action. Identifying critical periods of intervention to stabilize this cost-benefit balance is a critical next step for understanding issues of employment and MS.