Association of use of Chinese herbal medicines and the risk of fracture in patients with osteoporosis: a population-based cohort study.

After utilizing a large population-based claims database and the application of propensity score match approach to reduce the confounding effects, we found that the use of Chinese herbal medicines (CHMs) was related to the lower risk of sequent osteoporotic fracture by 27% among the individuals with osteoporosis. The predominant effect was observed in those receiving CHMs for more than two years. INTRODUCTION: Osteoporosis (OS) is a highly disabling condition that can lead to fragility fracture, thus posing greater burdens of functional limitations for the affected individuals. It is unclear if the use of Chinese herbal medicines (CHMs) could reduce the risk of fracture due to OS. This study aimed to investigate the association of CHMs and the subsequent osteoporotic fracture risk among OS patients. METHODS: This longitudinal cohort study used the Taiwanese National Health Insurance Research Database to identify 250,699 newly diagnosed OS patients aged 20 years or older between 1998 and 2010. We recruited 103,325 CHM users following the onset of OS (CHM users) and randomly selected 103,325 subjects without CHM usage as controls (non-CHM users) by propensity score matching according to the demographic characteristics and comorbidities at enrollment. All enrollees were followed until the end of 2012 to record the incidence of osteoporotic fracture. We applied the Cox proportional hazard regression model to compute the hazard ratio (HR) of the risk of osteoporotic fracture. RESULTS: During the 15-year follow-up period, 7208 CHM users and 11,453 non-CHM users sustained osteoporotic fracture, with an incidence rate of 9.26 and 12.96, respectively, per 1000 person-years. We found that CHM users had a significantly reduced risk of osteoporotic fracture compared to non-CHM users (adjusted HR 0.73; 95% confidence interval [CI] = 0.70-0.75). Those treated with CHMs for longer than 730 days had a lower fracture risk by 54%. Some commonly used CHMs, such as Yan hu suo (Rhizoma Corydalis), Huang Qin (Scutellaria Baicale), Jie Geng (Platycodon grandifloras), Xiang Fu (Cyperus rotundus), Hai Piao Xiao (Cuttlebone Sepium), Jia-Wei-Xiao-Yao-San, Ge-Gen-Tang, Shao-Yao-Gan-Cao-Tang, and Du-Huo-Ji-Sheng-Tang, are related to the lower risk of fracture. CONCLUSIONS: The use of CHMs was associated with lower risk of osteoporotic fracture for OS patients, suggesting that it could be integrated into conventional therapy to prevent subsequent bone fracture.

Association of use of rehabilitation services with development of osteoporosis among patients with rheumatoid arthritis: a nationwide population-based cohort study.

This is the first study that has found that rehabilitation services (RS) intervention, following the onset of rheumatoid arthritis (RA), may significantly reduce the risk of osteoporosis in RA patients. Those patients who received more than five sessions of RS had the greatest benefit for the prevention of osteoporosis. INTRODUCTION: People with rheumatoid arthritis have increased risk of developing osteoporosis (OP). It remains unclear whether use of rehabilitation services can reduce the risk of developing OP. We conducted a longitudinal cohort study to compare the effect of RS on the risk of OP in Taiwanese individuals with RA. METHODS: A national health insurance database was used to identify 2693 newly diagnosed RA patients, 20-70 years old, between 1998 and 2007. Among them, 808 received RS after the onset of RA (RS users) and 1885 patients did not receive RS (non-RS users). All enrollees were followed until the end of 2012 to record incident cases of OP. A Cox proportional hazards regression model was used to compute adjusted hazard ratios (aHRs) for the relationship of use of RS with OP. RESULTS: During the 15-year follow-up, 358 RS users and 1238 non-RS users developed OP, corresponding to incidence rates of 87.24 and 129.27 per 1000 person-years, respectively. Use of RS was significantly associated with a lower risk of OP (aHR 0.62; 95% confidence interval [CI] = 0.56-0.71). Those who received more than five sessions of RS had the greatest benefit (aHR 0.47; 95% CI = 0.38-0.56). CONCLUSIONS: The integration of RS into the clinical management of patients with RA may decrease their risk of developing OP.

Death anxiety as a predictor of future time orientation among individuals with spinal cord injuries.

PURPOSE: The purpose of this study was to examine the relationship between death anxiety and future time orientation among individuals who sustained spinal cord injuries (SCI). METHODS: Participants were 317 individuals with SCI, of whom 57.4% were US veterans. Data were obtained by means of mailed questionnaires and included responses to the Death Anxiety Scale (DAS), the Future Time Orientation (FTOS) measure, as well as information on participants' personal and disability-related characteristics. RESULTS: A hierarchical multiple regression analysis was conducted to examine the influence of a set of demographic variables, followed by a set of disability-related variables, and finally two factorially-derived measures of death anxiety (denial of death and distressed awareness of death) on future time orientation. Two disability-related variables (pain level and existence of pressure ulcers) and one of the two death anxiety measures (distressed awareness of death) significantly predicted future time orientation. A post-hoc analysis, adding depression as a predictor, was also significant, indicating that an increased level of depression uniquely contributed to a truncated future time orientation. CONCLUSIONS: Distressed anxiety and depression may be important factors affecting goals and plans of people with SCI. Future research should attempt to clarify the intricate relationships among negative affectivity, future time orientation, and psychosocial adaptation to SCI.

Multidimensional investigation of the structure of coping among people with amputations.

In this study, the responses of 61 people with amputations to a measure of coping strategies were submitted to multidimensional scaling and cluster analysis. Interpretations of the three-dimensional solution, aided by the emergence of five coping clusters, suggested that respondents' perceptions of their coping with amputation-related stress were best explained by the following three dimensions: 1) active/confrontive versus passive/avoidance coping; 2) pessimistic/fatalistic versus optimistic/positivistic coping: and 3) social/emotional versus cognitive coping.

Measurement of attitudes towards persons with disabilities.

PURPOSE: The purpose of this paper is to assist those engaged in research dealing with attitudes towards persons with disabilities by presenting a catalogue of various attitude measurement methods. METHOD: A review of the methodological and psychological literatures on the measurement of attitudes towards persons with disabilities. RESULTS: The review uncovered 10 direct methods to measure attitudes, in which the respondents are aware that they are participating in an experiment and 14 indirect methods in four categories that are not plagued by attitude-distorting influences because the respondents are not aware that their attitudes are being measured. A discussion of each method with examples is provided, followed by implications for rehabilitation practitioners, rehabilitation education and training, and rehabilitation researchers. CONCLUSIONS: The investigation of attitudes towards persons with disabilities requires innovative experimental methods and psychometrically sound instruments that are reliable, valid, and multidimensional. Without such instruments, it will not be possible to obtain conclusive answers to important research questions concerning the relationship between these attitudes and the acceptance and integration of persons with disabilities into society.

Psychosocial adaptation to amputation: the role of sociodemographic variables, disability-related factors and coping strategies.

This study examined the roles of sociodemographic variables, disability-related factors, and coping strategies as predictors of the psychosocial adaptation of 61 persons with amputations. Psychosocial adaptation was conceptualized as a multifaceted outcome criterion and was measured by seven scales from the Reactions to Impairment and Disability Inventory (RIDI) and the Acceptance of Disability (AD) scale. A series of multiple regression analyses indicated that both a set of sociodemographic variables and disability-related factors (age, duration of amputation, type of amputation) and a set of coping strategies (action problem-solving, emotion-focusing, behavioral/problem disengagement, cognitive disengagement) accounted, albeit differentially, for significant portions of the variance in the outcome measures of psychosocial adaptation to amputation. Of the various coping strategies, active problem-solving was negatively associated with the psychosocial reactions of depression and internalized anger (RIDI) but it was positively associated to adjustment (RIDI) and acceptance of disability (AD). Emotion-focusing and cognitive disengagement were positively associated with anxiety, depression, and externalized hostility (RIDI) and negatively associated with acceptance of disability (AD). Measurement and theoretical implications are briefly outlined.

A preliminary study of coping styles of applicants for counselor education and their relations to admission criteria.

Responses of 100 applicants to a counselor education program were analyzed for their coping styles and the relations of these coping styles to a set of sociodemographic, academic, and experiential variables obtained during the application process. Seven factor-analytically derived coping styles are described. No significant relationships were found between these coping styles and the remaining variables.

A multidimensional approach to the study of the structure of coping with stress.

This article described a study in which the responses of 199 respondents to measures of coping with stress were submitted to multidimensional scaling. The three-dimensional solution suggests that respondents' perceptions of coping with stress are best explained along the following dimensions: (a) active coping versus denial/escape, (b) turning to interpersonal support versus seeking religious comfort, and (c) instrumental/cognitive disengagement versus affective/spiritual engagement.

Progeria: medical aspects, psychosocial perspectives, and intervention guidelines.

This article discusses progeria, a rare genetic childhood disorder that invariably results in the individual's death during early adolescence. The article begins by describing the major medical aspects of progeria. This is followed by a discussion of the psychosocial implications of the disorder with particular emphasis upon grief-triggered reactions. The article concludes with an overview of psychosocial intervention guidelines for caregivers who work with families of dying children and adolescents.

Psychosocial adaptation to disability and its investigation among persons with multiple sclerosis.

This review begins with a general discussion of the concept of psychosocial adaptation to disability, reaction phases that the adaptation process is thought to comprise, instruments to measure adaptation and the basic research questions that need to be addressed to construct a theoretical model for the process. The research literature concerning psychosocial adaptation to disability among persons with multiple sclerosis is reviewed as an illustration. Research problems identified in this review are then listed, with suggestions for future research.

A hierarchy of reactions to disability.

The responses of 118 individuals with non-congenital physical disabilities to the 60-item Reactions to Impairment and Disability Inventory (RIDI) were submitted to an ordering-theoretic data analysis procedure. The RIDI provides information on eight patterns of psychosocial reactions to disability, namely: shock, anxiety, denial, depression, internalized anger, externalized hostility, acknowledgement and adjustment. The resultant nonlinear multidimensional hierarchy of contingent relationships among the eight scales was interpreted with reference to the clinical literature and to previous investigations designed to validate the existence of patterns of reactions to disability (e.g. Livneh and Antonak, 1990). It is recommended that subsequent research should compare hierarchies derived from data obtained from other, more homogeneous samples to clarify the multidimensional, nonlinear structure of the process of adaptation to disability.

Person-environment congruence: a rehabilitation perspective.

The present paper outlines a model of person-environment congruence within a rehabilitation context. The model suggests the following: a) The person component may be conceptualized as being composed of two separate dimensions, namely, the functional or activity level involved, e.g., Sub-Body, Self, and Exterio Self-Systems and an operational context within which these functions are performed, e.g., Biophysical, Mental and Affective Contexts. b) The environment component is comprised of a single dimension, that of environmental settings, e.g., treatment, home, work, and community settings. Environmental settings are further noted for their physical, personal, and social properties. The resulting three-dimensional model was, then, utilized in a discussion aimed at clarifying the concepts of disease, impairment, disability and handicap. The paper concludes with a brief suggestion of the nature of the relationship between the concept of functional assessment and the present model.

Manifest anxiety: a cluster analytic study.

Subjects in graduate classes voluntarily completed the Manifest Anxiety Scale. A cluster analysis assessed the internal structure of the scale. Three clusters presented as the most parsimonious and meaningful solution given the data: Cluster I, a generalized anxiety cluster including 60% of the items; Cluster II, physiological concomitants of anxiety; and Cluster III, a worry-tension component. The solution is discussed in relation to prior work on both the scale and anxiety, in general.

A factor analytic study of manifest anxiety: a transsituational, transtemporal investigation.

In this study, we investigated the factorial structure of the Manifest Anxiety Scale (MAS) among American, counseling graduate students (N = 227). The MAS was administered across transsituational and transtemporal conditions. The following four factors were yielded following orthogonal rotation: General Worries, Physiological Correlates of Anxiety, Distractibility, and Embarrassment. These four factors, however, explained less than one quarter of the common variance extracted. Following a comparison with previous factor analytic studies of the MAS, we discuss factors possibly contributing to the discrepant findings, with particular attention to the MAS's item content and psychometric properties and the nature of the population used.

The Disability Factor Scale--General: second-order factor structure.

This study examined the second-order factor structure of Siller's (1969) Disability Factor Scale--General. Factor analysis of the seven attitudinal factors toward disabled individuals, based on the responses of 200 college students, yielded two major second-order factors. These two second-order factors of Net Affect and Authoritarian Virtuousness are further discussed in light of their intrafactor and interfactor relationships.

Regressional analysis of attitudes toward male nurses.

This study examined the relationship between six demographic variables of 174 respondents and acceptance of males in the nursing profession. Multiple regression analysis indicated that only two variables, respondents' educational level and sex, significantly predicted attitudes toward male nurses. The implications inherent in these findings are discussed in light of the minority role status occupied by male nurses.