Differences in correlates of fatigue between relapsing and progressive forms of multiple sclerosis.

BACKGROUND: Fatigue is one of the most prevalent and impactful symptoms for people with multiple sclerosis (MS). Yet, fatigue is less understood in progressive forms of MS, and few studies have explored the extent to which MS disease course is associated with fatigue. The current study aimed to (1) describe fatigue severity and fatigue interference (the extent to which fatigue interferes with individuals' physical, mental, and social activities) in people with progressive MS (primary progressive MS and secondary progressive MS); (2) compare fatigue severity and fatigue interference in people with progressive forms of MS to people with relapsing-remitting MS (RRMS); and (3) identify factors associated with fatigue severity and fatigue interference in people with progressive forms of MS and RRMS. METHODS: Secondary analysis of baseline data from participants with MS (N = 573; progressive forms of MS n = 142; RRMS n = 431) in a survey-based longitudinal study on healthy aging in people with a physical disability. Primary outcomes were average fatigue severity (0-10 Numerical Rating Scale), and fatigue interference (PROMIS Fatigue Short Form). Correlates were variables across the demographic and biopsychosocial domains, collected with validated self-reported measures. Statistical methods included t-test and chi-square analyses to compare fatigue severity and fatigue interference in people with progressive MS to those with RRMS, and multiple regression analyses to examine the association of variables with fatigue severity and fatigue interference. RESULTS: Participants with progressive forms of MS reported moderate to severe levels of average fatigue severity (5.9 ± 2.8) and elevated levels of fatigue interference (T-Score of 58.2 ± 7.9). There were no group differences between people with progressive MS and RRMS in average fatigue severity or fatigue interference. Common factors associated with greater fatigue severity were lower income, being unemployed, shorter disease duration, greater disability, and greater sleep disturbance. Common factors associated with fatigue interference were younger age, lower income, being unemployed, greater disability, lower alcohol consumption, being a smoker, and greater sleep disturbance. For those with progressive forms of MS, longer MS disease duration was associated with lower average fatigue severity (b = -0.08, t(532) = -3.69, p < .001) and having a college degree or higher was associated with higher fatigue interference (b = 2.84, t(520) = 2.23, p = .026). CONCLUSION: In this sample, fatigue severity and fatigue interference were similar for progressive forms of MS and RRMS. Future research should consider if interventions that work for fatigue management in people with relapsing forms of MS work similarly for people with progressive forms of MS.

Implicit associations related to physical disability among nursing students.

BACKGROUND: Negative beliefs about disability are associated with poorer outcomes for individuals with disabilities; understanding disability-related attitudes is critical for clinical care. Recently, interest in attitudes toward people with disabilities has increased; however, most studies focus on explicit attitudes. In contrast, the Disability Attitude Implicit Association Test (DA-IAT) is designed to evaluate respondents' underlying automatic preferences regarding physical ability. OBJECTIVE: The aim of this pilot study was to expand the literature on health professionals' implicit disability attitudes by analyzing the DA-IAT in a sample of nursing students. METHODS: A cross-sectional design was utilized with a sample of nursing students (n = 95; 88.7% female). Respondents completed the DA-IAT online before responding to some basic demographic questions. RESULTS: Participants associated able-bodied status with positive descriptors more quickly than disability related stimuli. CONCLUSIONS: Most participants in this sample of nursing students (87%) mentally associated able-bodiedness with desirable traits in a more efficient manner than disability. Future research should focus on developing models to better understand the relationship between automatic processing, disability-related attitudes, and how this relationship informs clinician behavior.

Promoting equity at the population level: Putting the foundational principles into practice through disability advocacy.

Rehabilitation psychology is based on foundational principles that can guide us toward health equity among disabled and nondisabled communities. We summarize the literature on disparities in the disability community and underscore the urgency to address underlying inequities to eliminate disparities. We include examples of population-level interventions that promote equity in the disability community. We conclude with a call for a broader mission for rehabilitation psychologists based on the field's foundational principles, and outline emerging opportunities to widen our impact and advance equity. Our foundational principles, built on systems theory, call on rehabilitation psychologist to work at macrosystemic levels. As rehabilitation psychologists, we need to widen our focus from the micro (individual) to the macro (population) level. We need to bring the respect, dignity, and collaborative spirit that inspire our work with individuals to the broader community by advocating for structures and policies that promote equity for disabled persons. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Healthcare coverage and utilization among caregivers in the United States: Findings from the 2015 Behavioral Risk Factor Surveillance System.

PURPOSE/OBJECTIVE: Caregivers are vital to our health care system and its sustainability, yet extensive literature has recognized caregivers' vulnerabilities for experiencing financial, physical, and emotional difficulties-compromising the sustainability of their services. The risks associated with being a caregiver are not well-defined and warrant further exploration to guide national health initiatives underway. This brief report sought to identify risks that may be associated with the wide-ranging secondary effects of being a caregiver. Specifically, health care coverage and utilization were compared between caregivers and noncaregivers in a large national sample. METHOD: A cross-sectional study design was used with data from the 2015 Behavioral Risk Factor Surveillance System. Risk ratio analyses were conducted to assess how many times more likely unpaid adult caregivers were for experiencing specific risks related to health care access, relative to noncaregivers. RESULTS: Caregivers (n = 24,034; 64.5% female; 69.6% preretirement age) were more at risk for lacking health care coverage and underutilizing needed health care service due to cost, when compared to noncaregivers (n = 84,412; 57.3% female; 61.8% preretirement age). Caregivers were also at an increased risk for lifetime diagnosis of a depressive disorder and activity limitations due to a health challenge. CONCLUSIONS: Our findings highlight the need for the development of low-cost and accessible clinical services available to caregivers. Rehabilitation psychology can offer unique and instrumental contributions for addressing this growing population's health care needs by informing disability-focused public health agendas and incorporating caregivers into rehabilitation programs for care recipients. (PsycINFO Database Record (c) 2020 APA, all rights reserved).