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      Correlates of Depressive and Anxiety Symptoms in Young Adults with Spina Bifida *

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          Abstract

          Objective Based on social ecological theory, this study was designed to examine the unique relationships between multi-level ecological factors and psychological symptoms in young adults with spina bifida (SB).  Method A sample of 61 individuals with SB, 18–25 years of age, completed standardized self-report measures of attitude toward SB, satisfaction with family functioning, Chronic Care Model (CCM) services, and depressive and anxiety symptoms. A chart review yielded SB clinical data.  Results High rates of depressive and anxiety symptoms were found. Hierarchical regression analysis identified the proximal individual (attitude toward SB) and family (satisfaction with family functioning) factors as more strongly related to depressive symptoms than the distal healthcare system factor (CCM services). Self-reported pain was the only ecological factor associated with anxiety symptoms.  Conclusions Study findings provide a potential foundation for multi-factor screening of young adults with SB at risk for psychological symptoms.

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          The family APGAR: a proposal for a family function test and its use by physicians.

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            Development and validation of the Patient Assessment of Chronic Illness Care (PACIC).

            There is a need for a brief, validated patient self-report instrument to assess the extent to which patients with chronic illness receive care that aligns with the Chronic Care Model-measuring care that is patient-centered, proactive, planned and includes collaborative goal setting; problem-solving and follow-up support. A total of 283 adults reporting one or more chronic illness from a large integrated health care delivery system were studied. Participants completed the 20-item Patient Assessment of Chronic Illness Care (PACIC) as well as measures of demographic factors, a patient activation scale, and subscales from a primary care assessment instrument so that we could evaluate measurement performance, construct, and concurrent validity of the PACIC. The PACIC consists of 5 scales and an overall summary score, each having good internal consistency for brief scales. As predicted, the PACIC was only slightly correlated with age and gender, and unrelated to education. Contrary to prediction, it was only slightly correlated (r = 0.13) with number of chronic conditions. The PACIC demonstrated moderate test-retest reliability (r = 0.58 during the course of 3 months) and was correlated moderately, as predicted (r = 0.32-0.60, median = 0.50, P < 0.001) to measures of primary care and patient activation. The PACIC appears to be a practical instrument that is reliable and has face, construct, and concurrent validity. The resulting questionnaire is in the public domain, and recommendations for its use in research and quality improvement are outlined.
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              Improving chronic illness care: translating evidence into action.

              The growing number of persons suffering from major chronic illnesses face many obstacles in coping with their condition, not least of which is medical care that often does not meet their needs for effective clinical management, psychological support, and information. The primary reason for this may be the mismatch between their needs and care delivery systems largely designed for acute illness. Evidence of effective system changes that improve chronic care is mounting. We have tried to summarize this evidence in the Chronic Care Model (CCM) to guide quality improvement. In this paper we describe the CCM, its use in intensive quality improvement activities with more than 100 health care organizations, and insights gained in the process.
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                Author and article information

                Journal
                J Pediatr Psychol
                jpepsy
                jpepsy
                Journal of Pediatric Psychology
                Oxford University Press
                0146-8693
                1465-735X
                August 2010
                30 October 2009
                30 October 2009
                : 35
                : 7
                : 778-789
                Affiliations
                1University of Maryland, 2Johns Hopkins University, 3University of Pittsburgh Medical Center, 4SUNY Upstate Medical University, 5Gillette Children's Specialty Healthcare, and 6Loyola University Chicago
                Author notes

                *Portions of this article were presented at the First World Congress on Spina Bifida Research and Care (Orlando, 2009).

                All correspondence concerning this article should be addressed to Melissa H. Bellin, University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201. E-mail: mbellin@ 123456ssw.umaryland.edu
                Article
                jsp094
                10.1093/jpepsy/jsp094
                2908707
                19880443
                7d5fb85f-ed78-4ea4-97f7-29ba73d318fc
                © The Author 2009. Published by Oxford University Press on behalf of the Society of Pediatric Psychology.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/2.5/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 9 June 2009
                : 25 September 2009
                : 26 September 2009
                Categories
                Section: Parental Mental Health and Child Outcomes

                Pediatrics
                psychosocial functioning,social ecological perspective,spina bifida
                Pediatrics
                psychosocial functioning, social ecological perspective, spina bifida

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