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PubMed1999

The health benefits of physical activity in children and adolescents: implications for chronic disease prevention.

UNLABELLED: Clinical, epidemiological and basic research evidence clearly supports the inclusion of regular physical activity as a tool for the prevention of chronic disease and the enhancement of overall health. In children, activities of a moderate intensity may enhance overall health, and assist in preventing chronic disease in at-risk youth. The numerous health benefits of regular exercise are dependent on the type, intensity and volume of activity pursued by the individual. These benefits include reduction of low density lipoproteins while increasing high density lipoprotein; improvement of glucose metabolism in patients with type II diabetes; improved strength, self esteem and body image; and reduction in the occurrence of back injuries. In addition, a progressive, moderate-intensity exercise program will not adversely effect the immune system and may have a beneficial effect on the interleukin-2/natural killer cell system. Furthermore, by decreasing sedentary behaviors and, thus, increasing daily physical activity, individuals may experience many stress-reducing benefits, which may enhance the immune system. CONCLUSION: Moderate intensity exercise of a non-structured nature seems to facilitate most of the disease prevention goals and health promoting benefits. With new guidelines promoting a less intense and more time-efficient approach to regular physical activity, it is hoped that an upward trend in the physical activity patterns, and specifically children at risk for chronic disease, will develop in the near future.

Adolescent↗
PubMed2005

A disease-specific self-help program compared with a generalized chronic disease self-help program for arthritis patients.

OBJECTIVE: Both the Arthritis Self-Management Program (ASMP) and the generic Chronic Disease Self-Management Program (CDSMP) have been shown to be successful in improving conditions in patients with arthritis. This study compared the relative effectiveness of the 2 programs for individuals with arthritis. METHODS: Patients whose primary disease was arthritis were randomized to the ASMP (n = 239) or to the CDSMP (n = 116). Analyses of covariance were used to compare the outcome measures for the 2 programs at 4 months and 1 year. Measures included quality of life outcomes (self reported, health distress, disability, activity limitation, global health, pain, and fatigue), health behaviors (practice of mental stress management, stretching and strength exercise, aerobic exercise), self efficacy, and health care utilization (physician visits and hospitalizations). RESULTS: Both programs showed positive results. The disease-specific ASMP appeared to have advantages over the more generic CDSMP for patients with arthritis at 4 months. These advantages had lessened slightly by 1 year. CONCLUSION: The disease-specific ASMP should be considered first where there are sufficient resources and participants. However, both programs had positive effects, and the CDSMP should be considered a viable alternative.

Activities of Daily Living↗
PubMed2005

Use of cultural probes for representation of chronic disease experience: exploration of an innovative method for design of supportive technologies.

Chronic diseases do not only manifest themselves as sets of pathophysiological factors. They bring about an equally important psychosocial impact. Unfortunately, it is difficult to account for this impact in the development of supportive technologies. This study describes and explores a method for elicitation of requirements on technologies supporting self-management including emotional aspects. The method takes advantage of a self-documentary media kit for collection of data from the everyday context of chronic disease. The resulting contextual data can contribute new insights to multi-disciplinary teams in the design of supporting technologies.

Adolescent↗
PubMed2004

[Distribution of respiratory nosocomial infection pathogen on geriatric (correction of geratic) people with chronic diseases and its antibiotic resistance].

OBJECTIVE: To detect respiratory nosocomial infection pathogen on geriatric (corrected) people with chronic disease and its antibiotic resistance. METHODS: Standard culture and antibiotic resistance method was used. RESULTS: Two hundred and fifty strains of species germ which caused nosocomial infection were cultured in 202 geratic people with chronic diseases, of which 144 strains were gram-negative bacill (55%); 44 strains were gram-positive coccus (17%); and 62 strains were Yeastlike Fungi (28%). The ESBL positive rate for Escherichiacol and Klebsiella was 37.8% and 39.6%. MRS positive rate for staphylococcus was 67%. Vancomycin resistance in Enterococcus was 6%. CONCLUSION: Geratic people with chronic disease are more easily to infect opportunistic pathogen and cause nosocomical infection. The more care we give for geratic people, the lower the nosocomial infection rate.

Aged↗
PubMed2003

Preliminary report of association of chronic diseases and erectile dysfunction in middle-aged men in Japan.

OBJECTIVES: To investigate the effect of chronic diseases on erectile dysfunction (ED) in Japanese middle-aged men using the International Index of Erectile Function, 5-item version (IIEF-5). METHODS: The subjects consisted of 640 healthy men and 396 men with chronic disease who responded to the IIEF-5 questionnaire (mean age 43.6 +/- 8.3 years, range 30 to 59). The incidence and severity of ED were calculated in three age groups (30 to 39, 40 to 49, and 50 to 59 years). RESULTS: The incidence of hypertension, cardiac disease, diabetes mellitus, and chronic renal failure was associated with the incidence and severity of ED, as was age. In stepwise multivariate logistic regression analysis, cardiac disease was the strongest independent risk factor (odds ratio [OR] 6.5), followed by diabetes mellitus (OR 5.9), chronic renal failure (OR 3.9), hypertension (OR 2.0), and age (OR 1.8). CONCLUSIONS: The results of this study demonstrated that the risk of ED increases with the presence of cardiac disease, diabetes mellitus, chronic renal failure, and hypertension in middle-aged men in Japan.

Adult↗
PubMed2001

[Health status of the population in six cities in the Czech Republic: prevalence and therapy of various chronic diseases].

BACKGROUND: The aim of the study was to describe health status of the urban middle-age population in six cities of the Czech Republic, which were included into the System of Population Health Survey in Relation to the Environment. METHODS AND RESULTS: From the population of cities Brno, Ceské Budĕjovice, Hradec Králové, Karviná, Kolín, Ustí nad Labem 400 males and 400 females in the age of 45 to 54 years were included into the study. All respondents filled out a question-form, half of them also underwent a medical check up. Results has shown that 52.8% of males and 51.6% of females had their cholesterol level elevated (> 5.2 mmol/l), 47.3% of males and 38.3% if females had higher blood pressure (SBP > = 140 mmHg and/or DBP > = 90 mmHg) or they were cured of hypertension, 39.4% of males and 22.5% of females were obese. Significant differences were observed in the prevalence of hypercholesterolemia, hypertension and smoking habits among the cities in study. According to the case histories, 55.6% of males and 57.8% of females complained of long-lasting ill-being, 37.0% of males and 45.2% of females were treated for a chronic disease, 13.3% of males and 12.4% of females considered their health during the previous year as bad or very bad. 45.4% of males and 57.9% of females underwent long-term pharmacological treatment, most frequently on a cardiovascular disease. Above described parameters differed significantly among cities in study. CONCLUSION: In the middle-aged population in six Czech cities the high prevalence of chronic diseases, health troubles and risk factors of chronic disease were found. Though the death rate in CR has been declining, chronic diseases have became a serious problem. Since most of these health problems can be improved by correct regimen, high attention should be given to their prevention.

Chronic Disease↗
PubMed1985

Approaches to taxonomy and measurement of adaptation in chronic disease.

The concept of adaptation has gained central importance in research on chronic disease. The article reviews recent developments in the major theoretical concepts, coping, defense and social support. A schema for classification is introduced distinguishing coping and defense processes at the individual (cognitive-emotional and behavioral), interpersonal and institutional levels. Some often neglected aspects of the evaluation (concerning temporal orientation, level, areas and perspective of rater) are pointed out. Underlying methodological aspects are briefly reviewed. Applying conceptual demands of theories of adaptation to research on chronic disease shows major research deficits, especially a lack of accepted definitions of adjustment, a preference for static, one-dimensional and cross-sectional research and a lack of adequate assessment procedures. Desiderata for future research are suggested.

Adaptation, Psychological↗
PubMed1985

Solutions to the problems of chronic disease management in rural settings.

Recent changes in disease patterns in the United States from acute to chronic disorders and the maldistribution of medical manpower have disproportionately affected rural residents. Programmatic attempts to alter the medical care system in rural areas have traditionally centered on increasing the number of primary providers. In central Mississippi, two innovative alternative models of chronic disease management have been evaluated. The disease focus was high blood pressure and the two management models emphasized: the use of local residents as health facilitators or health counselors, and the use of self-help groups in family and church settings. Eighteen months of outcome data indicated that the health facilitator model was controlling 80 percent of the hypertensives participating; the family-based self-help groups were controlling 90 percent; and, the church-based self-help groups were controlling 79.9 percent. These community-based models of chronic disease management have broad implications for other geographic areas and other chronic disorders.

Chronic Disease↗
PubMed2001

Anemia of chronic disease is the more frequent type of anemia seen in patients with chronic idiopathic neutropenia of adults.

This study describes the frequency and the type of anemia seen in patients with nonimmune chronic idiopathic neutropenia of adults (NI-CINA). We found that NI-CINA patients had low hemoglobin levels and increased serum concentrations of erythropoietin (EPO), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta (IL-1beta). The hemoglobin levels correlated positively with the number of circulating neutrophils and inversely with the levels of EPO and TNF-alpha but not of IL-1beta. Anemia, defined as the reduction of the hemoglobin below 12.0 g/dl for women and 13.3 g/dl for men, was found in 23 out of 148 patients studied, a proportion of 15.5%. Two of the anemic patients had iron deficiency anemia (8.7%), 11 had anemia of chronic disease (ACD; 47.8%) presenting with normal or slightly reduced erythrocytic indices, low serum iron, and increased serum ferritin, and the remaining ten had anemia of undefined pathogenesis (AUP; 43.5%) with normal or slightly decreased erythrocytic indices, serum iron ranging from 43 to 88 microg/dl, and ferritin values ranging from 12 to 50 ng/ml. We conclude that ACD is the more frequent type of anemia seen in patients with NI-CINA, and that pro-inflammatory cytokines, notably TNF-alpha, may be involved in the pathogenesis of both ACD and AUP, given that serum levels of the cytokine were significantly increased and that the EPO response to anemia was blunted in these patients. These findings further support our previously reported suggestion for the possible existence, in NI-CINA patients, of an unrecognized low-grade chronic inflammatory process that may be involved in the pathogenesis of the disorder.

Adolescent↗
PubMed1988

Aging, stress, and chronic disease interact to suppress plasma testosterone in Syrian hamsters.

The effects of old age, chronic disease, and stress on testicular function were examined in Syrian hamsters living on a 12-hr photoperiod. Plasma testosterone concentrations and testes weights were maintained in healthy hamsters 16-19 months of age, but chronic stress decreased plasma testosterone in these old hamsters and not in younger ones (8-11 months of age). Chronic disease in the form of congestive heart failure (CHF) in cardiomyopathic hamsters also decreased plasma testosterone and testes weights, although it is not clear what aspects of this disease affected testicular function. There was an interaction between disease and stress, in that chronic stress produced lower plasma testosterone and testes weights in hamsters with heart failure than in age-matched stressed, healthy hamsters. It appears that younger hamsters can maintain reproductive function during stress, but older ones may not be able to do so. Congestive heart failure in hamsters clearly impairs normal reproductive function by itself; it also makes them more susceptible to stress, so that combining stress and disease results in almost complete suppression of plasma testosterone levels.

Aging↗
PubMed1990

Age, chronic disease, sepsis, organ system failure, and mortality in a medical intensive care unit.

We retrospectively studied relations between age, pre-existing chronic disease, sepsis, organ system failure, and mortality in 487 patients from a medical ICU. Single organ system failure (SOSF) occurred in 136 (28%) and multiple (greater than or equal to 2) organ system failure (MOSF) in 187 (38%) patients. Cardiovascular and pulmonary failure predominated. Overall mortality was 27%. SOSF mortality was 16% and for MOSF 58%. Eighty-three percent of nonsurvivors had MOSF. Hence, MOSF is common and a major cause of death in critically ill medical patients. Advancing age and prior chronic disease may diminish physiologic reserve and predispose to sepsis and MOSF. Although sepsis is a major risk factor for MOSF, a nonspecific host response to critical illness may contribute to the syndrome in 35% of patients. Advancing age, chronic disease, and the number of failing organs, particularly failure of cardiovascular, pulmonary, renal, and neurologic systems, are major determinants of overall mortality, but sepsis is not an independent contributor.

Adolescent↗
PubMed2001

Stress in chronic disease: do the perceptions of patients and their general practitioners match?

OBJECTIVE: To compare the stressors accompanying chronic disease as perceived by patients and their GPs and to explore how incongruence in patients' and GPs' ideas influences patients' health status and use of health care. METHOD: A total of 580 patients with a diagnosis of diabetes or osteoarthritis and their GPs were interviewed by questionnaire about the stressors accompanying a patient's illness. In addition, information was obtained from each patient on health status and use of health care. RESULTS: The results show that patient and GP diverge in the way they think about chronic illness. Incongruence was larger in the case of osteoarthritis. In both diabetes and osteoarthritis, incongruence between patient and GP was associated with a worse health status of the patient and an increase in health-care use, although the pattern of correlation differed by type of disease. CONCLUSIONS: A chronic disease requires an ongoing relationship between patient and GP over years. Therefore, it is especially important that providers recognize the problems with which chronic disease patients are faced. Too often, providers are one-sided focused on the medical aspects of disease, neglecting the personal impact that a chronic disease has on the patient's life. In this way, successful treatment is complicated.

Journal Article↗
PubMed2006

Healthy endothelium: the scientific basis for cardiovascular health promotion and chronic disease prevention.

The vascular endothelium plays a critical role both in health and in the pathogenesis of chronic diseases, including cardiovascular disease. This review explores the underlying role of normal endothelial function in core public health interventions for health promotion and in the prevention and control of cardiovascular disease and its risk factors, as well as the application of endothelial science toward innovative public health programs and further research. Increased collaboration among basic scientists, clinician-investigators, prevention research centers, and all public health practitioners is needed to facilitate the translation of the endothelial science into practice.

Animals↗
PubMed2004

Sleep disturbances and chronic disease in older adults: results of the 2003 National Sleep Foundation Sleep in America Survey.

OBJECTIVE: To assess the association between sleep problems and chronic disease in older adults. METHODS: Self-reported standardized questionnaire data from 1506 community-dwelling men and women aged 55-84 years in the continental United States who completed a 20-min telephone interview when contacted from lists of randomly selected telephone numbers. RESULTS: A majority of the participants (83%) reported one or more of 11 medical conditions and nearly one in four elderly respondents (age 65-84 years) had major comorbidity (i.e. four or more conditions). Depression, heart disease, bodily pain and memory problems were associated with more prevalent symptoms of insomnia. Other conditions such as obesity, arthritis, diabetes, lung diseases, stroke and osteoporosis were associated with other sleep-related problems such as breathing pauses, snoring, daytime sleepiness, restless legs or insufficient sleep (<6 h nightly). CONCLUSIONS: Poll findings are consistent with epidemiological studies of sleep, aging and chronic disease. These results suggest that the sleep complaints common in older adults are often secondary to their comorbidities and not to aging per se. These types of studies may be useful in promoting sleep awareness among health professionals and among older adults, especially those with heart disease, depression, chronic bodily pain or major comorbidity.

Aged↗
PubMed2003

Law as a tool for preventing chronic diseases: expanding the range of effective public health strategies.

Law, which is a fundamental element of effective public health policy and practice, played a crucial role in many of public health's greatest achievements of the 20th century. Still, conceptual legal frameworks for the systematic application of law to chronic disease prevention and control have not been fully recognized and used to address public health needs. Development and implementation of legal frameworks could broaden the range of effective public health strategies and provide valuable tools for the public health workforce, especially for state and local health department program managers and state and national policy makers. In an effort to expand the range of effective public health interventions, the Centers for Disease Control and Prevention will work with its partners to explore the development of systematic legal frameworks as a tool for preventing chronic diseases and addressing the growing epidemic of obesity, heart disease, stroke, and other chronic diseases and their risk factors.

Chronic Disease↗
PubMed2004

Group medical visits for low-income women with chronic disease: a feasibility study.

BACKGROUND: Group medical visits (GMVs) have been proposed as a means of providing comprehensive primary care services to patients with chronic disease. We studied the feasibility of implementing a GMV model with low-income women in an innercity clinic setting. METHODS: The intervention consisted of six GMV sessions cofacilitated by a physician/nurse practitioner team. Participants included 28 women with at least one chronic disease diagnosis (71% Latina). Thematic analysis of open-ended interviews assessed participants' experiences in the GMV. Patient charts and provider logs provided information on health service utilization patterns and provider productivity. RESULTS: An average of 7 women attended each session, with 16 women attending three or more sessions. In open-ended interviews, the most commonly mentioned positive aspects of the GMV were personalized attention (77%), self-care education (69%), access to medication refills and examinations (69%), and advice from peers (62%). Negative aspects included insufficient personal attention (23%), logistical barriers (8%), and loss of confidentiality (4%). On average, patients required 20 minutes of physician time plus 21 minutes of nurse practitioner time per session. Medical record reviews revealed a significant decrease in urgent care visits (p < 0.05) during the 9 months of the intervention compared with a prior 9-month period. CONCLUSIONS: In this innercity clinic setting, the GMV model was well tolerated by patients, did not alter provider productivity, and may have encouraged participants to avoid more expensive urgent care services. The results of this pilot study suggest that GMVs represent a cost-effective ambulatory care alternative that is acceptable to low-income women with chronic disease.

California↗
PubMed1992

Progetto ATENA, a study on the etiology of major chronic diseases in women: design, rationale and objectives.

In spite of their important impact on populations, a number of diseases--all types of cancer and coronary heart disease in women--are "rare" events for statistical analysis and often analyzed in designs affected by selection and information biases, such as case-control studies. Large cohort studies based on the storage of biological specimens appear to be the most suitable solution for identifying risks for those diseases. Progetto ATENA, a study on the etiology of major chronic diseases in women is based on this design. Ten thousand women, aged 30-69 years, living in the area of the city of Naples, free of cancer and cardiovascular disease, are being recruited over a four-year period. Ten per cent of the cohort is being randomly selected from the electoral roles, the rest will be volunteers. Information on dietary habits, reproductive history, familiarity for chronic disease, active smoking habits and passive smoking exposure, physical activity, and socio-demographic data are being collected. Clinical data such as blood pressure, anthropometry, and electrocardiogram are also taken. All the participants provide biological samples of blood (fasting drawing) and urine (timed morning spot). The biological samples are processed in order to explore the main areas under study (nutritional markers, metabolism, endocrinology, genetics, environmental exposure markers, thrombogenesis). The samples are stored in liquid nitrogen (-196 degrees C) as soon as the blood and urine processing have been finished. An appropriate follow-up information system on the health status of the participants is being set up to estimate incidence and mortality rates.

Adult↗