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PubMed2005

Using the State Plan Index to evaluate the quality of state plans to prevent obesity and other chronic diseases.

INTRODUCTION: Implicit in public health planning models is the assumption that good public health plans lead to good programs, and good programs lead to desired health outcomes. Despite considerable resources that are devoted to developing plans, public health agencies and organizations have lacked a tool for evaluating the finished product of their planning efforts -- the written plan itself -- as an important indicator of progress. To address the need for an instrument to assess the quality of state plans designed to prevent and control chronic diseases, we created and tested the State Plan Index and used it to evaluate the quality of nine state plans aimed at preventing and reducing obesity. METHODS: The State Plan Index was developed under the auspices of the Centers for Disease Control and Prevention (CDC) in collaboration with public health experts in federal, state, and academic settings. The State Plan Index included 55 items related to plan quality arranged into nine components. Each item was rated on a Likert scale from 0 to 5, with 5 being the highest rating. Each plan also received a separate overall plan quality score using the same scale. Each state plan was evaluated by four or five raters using the State Plan Index. For each plan, the 55 items were averaged to calculate an item average score, and a subscore was calculated for each State Plan Index component. Finally, five states also self-rated their own plans (self score). RESULTS: The mean item average score for all plans was 2.4 out of 5.0. The range of item average scores was 1.0 to 3.0. The component of the State Plan Index with the highest mean component score (3.3) was Presentation of Epidemiologic Data on Disease Burden. The components with the lowest component scores were Resources for Plan Implementation (0.7); Integration of Obesity Efforts with Other Chronic Disease Efforts (1.7); and Program Evaluation (2.0). Plan quality was rated higher when based on the single overall plan quality score assigned by raters. In addition, self scores were consistently and substantially higher than rater-assigned scores. CONCLUSION: Evaluation of plans early in the life of programs can be used to strengthen existing programs and to guide programs newly engaged in chronic disease prevention planning. The CDC has used the State Plan Index evaluation results to guide technical assistance, plan training sessions, and enhance communication with state staff about plan content, quality, and public health approach. Some state program directors self-evaluated their obesity draft plan and used the evaluation results to strengthen their planning process and to guide plan revisions. Other states have adapted the State Plan Index as a framework for new planning efforts to prevent obesity as well as other chronic diseases.

Centers for Disease Control and Prevention, U.S.↗

PubMed1977

Chronic disease and short stature.

Careful graphing of the anthropometric measurements of children with chronic disease and short stature should be done to determine height and weight growth velocities. In addition, a detailed history can provide information helpful in determining the expected growth curve. If the chronic disease can be effectively treated (eg, malnutrition, emotional deprivation, celiac disease, asthma, rheumatoid arthritis), a period of rapid "catch-up" growth can be anticipated. The prognosis with regard to adult stature depends on the timing, duration, and severity of the growth-inhibiting influence.

Anthropometry↗

PubMed2003

Proxy reporting in after-death interviews: the use of proxy respondents in retrospective assessment of chronic diseases and symptom burden in the terminal phase of life.

This study evaluates the quality of data obtained from after-death interviews with significant others of deceased older persons regarding the prevalence of chronic diseases and symptoms in the terminal phase of life. These data are compared with reports from physicians and earlier self-reports from the deceased person. There were significant increases in nonresponse and nonavailability of significant others for decedents who had been divorced or had never been married, thus introducing some selection bias. At the level of the total sample, significant others seem to give accurate information about the prevalence of chronic diseases when compared with self-reports and reports from physicians. At the level of the individual sample member, after-death interviews with significant others provide valid information for the assessment of the prevalence of malignant neoplasms, diabetes mellitus, chronic obstructive pulmonary disease and cerebrovascular disease, but not for osteo- and rheumatoid arthritis and artherosclerotic disease. At the level of the total sample, the prevalence of symptoms assessed by significant others did not differ greatly from the assessment made by physicians. However, at the level of the individual sample member, the validity of symptom assessment by significant others could not be supported by data obtained from the physicians. With regard to the type of significant others interviewed, children reported more symptoms than partners. The use of significant others in after-death interviews can be a valid method with regard to the assessment of chronic diseases and symptoms on a group level. On an individual level this can be concluded only for chronic diseases with clearly observable consequences.

Aged↗

PubMed2006

[HIV/AIDS--from lethal syndrome to chronic disease].

BACKGROUND: At its discovery in 1981, AIDS was a fatal syndrome that rapidly led to death. Combination treatment with at least three drugs has radically improved the prognosis. MATERIAL AND METHODS: The study includes all HIV-patients controlled at the Department of Infectious Diseases, Ullevål University Hospital from 1982 to 2005. Development of immune deficiency, morbidity and causes of death were registered prospectively. Possible connections between death and HIV-infection and treatment were evaluated. RESULTS: 1632 patients were followed at our department. 32 % of these patients have died. The number of patients who died annually during the 5 years from 1986 to 1990 was 47 % and this was reduced to 11 % in 2001 - 05. Many patients still die because they either present too late for treatment or have received insufficient treatment. 22 patients have died during the last 10 years irrespective of starting treatment with at least 3 antiretroviral drugs: 7 died from cancers, 6 from treatment failure, one from unknown cause and 8 from other causes. The 6 patients who died from treatment failure had very low CD4 counts and serious opportunistic infections that could not be treated effectively at the time of diagnosis. INTERPRETATION: Patients who start and adhere to treatment with 3 HIV-medications have a good prognosis, but they may still have an increased risk of non-AIDS defining cancers and cardiovascular disease. HIV/AIDS has become a chronic disease with a good prognosis.

Acquired Immunodeficiency Syndrome↗

PubMed1999

Advances in the anemia of chronic disease.

The anemia found in patients with chronic infectious, inflammatory, and neoplastic disorders, known as the anemia of chronic disease (ACD), is one of the most common syndromes in medicine. A characteristic finding of the disorders associated with ACD is increased production of the cytokines that mediate the immune or inflammatory response, such as tumor necrosis factor, interleukin-1, and the interferons. All the processes involved in the development of ACD can be attributed to these cytokines, including shortened red cell survival, blunted erythropoietin response to anemia, impaired erythroid colony formation in response to erythropoietin, and abnormal mobilization of reticuloendothelial iron stores. In this review, advances in the understanding of the diagnostic, pathophysiologic, and therapeutic aspects of this syndrome are summarized.

Anemia↗

PubMed2006

Opportunities and challenges in the prevention and control of cancer and other chronic diseases: children's diet and nutrition and weight and physical activity.

OBJECTIVE: The purpose of this article is to review the role of behavioral research in disease prevention and control, with a particular emphasis on lifestyle- and behavior-related cancer and chronic disease risk factors--specifically, relationships among diet and nutrition and weight and physical activity with adult cancer, and tracking developmental origins of these health-promoting and health-compromising behaviors from childhood into adulthood. METHOD: After reviewing the background of the field of cancer prevention and control and establishing plausibility for the role of child health behavior in adult cancer risk, studies selected from the pediatric published literature are reviewed. Articles were retrieved, selected, and summarized to illustrate that results from separate but related fields of study are combinable to yield insights into the prevention and control of cancer and other chronic diseases in adulthood through the conduct of nonintervention and intervention research with children in clinical, public health, and other contexts. RESULTS: As illustrated by the evidence presented in this review, there are numerous reasons (biological, psychological, and social), opportunities (school and community, health care, and family settings), and approaches (nonintervention and intervention) to understand and impact behavior change in children's diet and nutrition and weight and physical activity. CONCLUSIONS: Further development and evaluation of behavioral science intervention protocols conducted with children are necessary to understand the efficacy of these approaches and their public health impact on proximal and distal cancer, cancer-related, and chronic disease outcomes before diffusion. It is clear that more attention should be paid to early life and early developmental phases in cancer prevention.

Body Weight↗

PubMed1999

Evidence suggesting that a chronic disease self-management program can improve health status while reducing hospitalization: a randomized trial.

OBJECTIVES: This study evaluated the effectiveness (changes in health behaviors, health status, and health service utilization) of a self-management program for chronic disease designed for use with a heterogeneous group of chronic disease patients. It also explored the differential effectiveness of the intervention for subjects with specific diseases and comorbidities. METHODS: The study was a six-month randomized, controlled trial at community-based sites comparing treatment subjects with wait-list control subjects. Participants were 952 patients 40 years of age or older with a physician-confirmed diagnosis of heart disease, lung disease, stroke, or arthritis. Health behaviors, health status, and health service utilization, as determined by mailed, self-administered questionnaires, were measured. RESULTS: Treatment subjects, when compared with control subjects, demonstrated improvements at 6 months in weekly minutes of exercise, frequency of cognitive symptom management, communication with physicians, self-reported health, health distress, fatigue, disability, and social/role activities limitations. They also had fewer hospitalizations and days in the hospital. No differences were found in pain/physical discomfort, shortness of breath, or psychological well-being. CONCLUSIONS: An intervention designed specifically to meet the needs of a heterogeneous group of chronic disease patients, including those with comorbid conditions, was feasible and beneficial beyond usual care in terms of improved health behaviors and health status. It also resulted in fewer hospitalizations and days of hospitalization.

Adult↗

PubMed2003

Tumor necrosis factor alpha, its soluble receptor I, and -308 gene promoter polymorphism in patients with rheumatoid arthritis with or without amyloidosis: implications for the pathogenesis of nephropathy and anemia of chronic disease in reactive amyloidosis.

OBJECTIVE: To study tumor necrosis factor alpha (TNFalpha) -308 gene promoter polymorphism and circulating levels of TNFalpha and soluble TNF receptor type I (sTNFRI) in rheumatoid arthritis (RA) patients with and without reactive amyloidosis. METHODS: In a retrospective study, we examined 55 RA patients with biopsy-proven reactive amyloidosis and 55 control RA patients without amyloidosis (matched for age, sex, rheumatoid factor titer, and RA duration). Inflammatory activity was assessed by measuring the erythrocyte sedimentation rate and C-reactive protein level. TNFalpha gene promoter polymorphism was studied using polymerase chain reaction-restriction fragment length polymorphism assay. Cytokine and receptor levels were measured by enzyme-linked immunoassays. RESULTS: Patients with RA and amyloidosis had significantly higher TNFalpha and sTNFRI levels than did the control RA patients. The increased circulating levels of TNFalpha correlated with interleukin-18 levels, but not with the serum amyloid A protein levels or with TNFalpha -308 gene promoter polymorphism (reported to be associated with high TNFalpha levels and certain disease susceptibilities). In the patients with RA and amyloidosis, those with anemia had significantly higher TNFalpha and sTNFRI levels than did those without anemia, and circulating TNFalpha and sTNFRI levels correlated negatively with hemoglobin concentrations. In the patients with RA and amyloidosis, those with nephropathy had significantly higher TNFalpha and sTNFRI levels than did those without nephropathy; in patients with isolated proteinuria (but no creatinine elevation) the TNFalpha level was also significantly increased, indicating that the TNFalpha elevation was not merely a consequence of impaired renal function. CONCLUSION: This study shows that circulating levels of TNFalpha and sTNFRI are significantly increased in RA patients with amyloidosis as compared with control RA patients without amyloidosis and that the increased levels may be implicated in the pathogenesis of certain disease manifestations, including anemia of chronic disease and renal pathology in reactive amyloidosis.

Adult↗

PubMed1976

What is the function of a hospital for geriatric and chronic diseases?

The functioning of a hospital for chronic diseases was examined in terms of the type of patient referred, the course in the hospital and the eventual outcome, in a prospective study of a year's admissions to one department of Harzfeld Hospital in Israel. Of the 191 patients admitted, 55 percent were assessed as possible candidates for rehabilitation, and two-thirds were discharged. Among those admitted primarily for nursing reasons, the mortality was 76 percent. The average stay was 68 days for the 47 percent who were discharged and 95 days for the 45 percent who died; 8.4 percent remained as long-stay patients. Mobility improved in 37 percent and deteriorated in 8 percent; independence in self-care increased from 13 percent on admission to 51 percent on discharge. Thirty percent of the discharges occurred in the first month, and further 30 percent in the second month; 85 percent of these patients returned to their own homes. The hospital stay exceeded 6 months in 18 percent, of whom 7 percent died and 3 percent were later discharged. The possibility of release from the hospital was influenced by the degree of disability rather than the social circumstances. The best change for improvement was among the patients who required only partial help on admission. The most important tasks of the hospital were: intensive and sometimes prolonged rehabilitation; basic nursing care; medical reevaluation and sometimes referral for surgical salvage operations; attention to acute and subacute medical problems, some of which occurred as complications, including accidents; and the concentration of physiotherapy and occupational therapy where most needed. Achievement of these aims was based on fostering a cooperative spirit between patients and staff, adjusting to the problem of re-integrating the long-stay patient, and coordinating specialist services from other hospitals when needed.

Chronic Disease↗

PubMed2000

Tackling the burden of high-cost but uncommon chronic diseases.

Consider the high-cost impact of uncommon diseases. It's not cost-efficient for most health plans to develop disease management programs for uncommon chronic diseases such as lupus, seizure disorders, or MS, but that doesn't mean patients with these ailments don't need the support services a DM approach would provide. See how one DM vendor is successfully filling this gap in care.

Chronic Disease↗

PubMedDate not supplied

Disease chronicity and quality of care in hospital readmissions.

The study described in this article examined disease chronicity and quality of care and their relationship to hospital readmissions during a 3-month period. Results showed that readmissions due to disease chronicity were significantly more prevalent than for other categories. Illnesses, including pulmonary disease, heart failure, and cancer, ranked as leading causes for readmission, whereas readmissions due to quality of care or complications most often resulted from a previous admission for surgery. This study's findings demonstrate that using readmission rates alone as indicators of poor care can be misleading.

Aged↗

PubMed2003

Using information technology to improve the management of chronic disease.

Information and communications technology (ICT) is increasingly being used in management of chronic illness to facilitate shared services (virtual health networks and electronic health records), knowledge management (care rules and protocols, scheduling, information directories), as well as consumer-based health education and evidence-based clinical protocols. Common applications of ICT include home monitoring of vital signs for patients with chronic disease, as well as replacing home visits by nurses in person with telemedicine videophone consultations. A patient-managed Home Telecare System with integrated clinical signs monitoring, automated scheduling and medication reminders, as well as access to health education and daily logs, is presented as an example of ICT use for chronic disease self-management. A clinical case study demonstrates how early identification of adverse trends in clinical signs recorded in the home can either avoid hospital readmission or reduce the length of hospital stay.

Australia↗

PubMed2005

[Chronic diseases among and social benefits to four-to-five-year-old children].

BACKGROUND: The purpose of this study was to estimate the prevalence of chronic diseases among four-to-five-year-old children in a Norwegian county in order to identify significant prognostic factors and to investigate the use of social benefits. METHODS: In the context of ordinary medical examinations in a Norwegian county, a questionnaire was given to 2430 parents, of whom 1913 (79%) responded. Children with chronic disease and with frequent episodes of disease were selected for further examination. Of the 391 children selected, 263 (69%) attended. The parents answered questions about diagnosis, prognosis, marital status, parents' health, use of social benefits, and the development of the disease. RESULTS: Almost half of the 263 children who met for further examination had airway diseases, nearly all of them asthma. Of the remaining, 17% had congenital malformations, 13% had neurological development disorders, 10% had skin and joint diseases, and 12% various conditions including gastrointestinal diseases and hormonal disorders. One third had recovered, one third had diminishing problems, and one third was unchanged or worse. Parents of 15 children born in 1991 who received basic or supplementary benefits stated that the child had recovered or had a diminishing problem. However, 53 children who had a stable or deteriorating condition did not receive any benefits. In 22 of these, the parents stated that their child's general functioning was significantly affected. It is possible that they would have met criteria for supplementary and/or basic benefits. INTERPRETATION: The results suggest that in 1996, 13% of four-to-five-year-old children in this county had a chronic disease. This finding is in line with other studies. Overuse and, more frequently, underuse of social benefits for these children was disclosed.

Child Welfare↗

PubMedDate not supplied

Chronic disease management for patients with respiratory disease.

National and international awareness of the heavy burden of chronic disease has led to the development of new strategies for managing care. Elisabeth Bryant explains how self-care, education and support for more patients with complex needs should be built into planned care delivery, and emphasises that the patient is the key member of the care team.

Adult↗

PubMed1993

[Food poisonings as a risk factor for the development of acute and the exacerbation of chronic diseases].

The authors observed 32448 cases of alimentary toxoinfection (AT), 96.8% of which were females. Acute surgical abdominal conditions arose in 3.6% of them: appendicitis, cholecystitis, pancreatitis. Aggravation of chronic diseases occurred in 11.6% of the patients, hypertension and cholelithiasis being most frequent. 119 patients developed myocardial infarction, 266 hypertension crisis. The occurrence of acute and chronic diseases were analyzed in relation to common pathogenetic features, role of infection, intoxication, microcirculatory disturbances and hemostatic impairment. AT are suggested as risk factors of certain diseases likely to deteriorate prognosis.

Acute Disease↗

PubMed1997

Incidence of major coronary heart disease events: the experience of the Project "Community Control of Chronic Diseases".

Data on incidence of first major coronary heart disease (CHD) event have been collected in a population sample studied in the control area, the municipality of Priverno in Central Italy, 100 km South-East of Rome as part of a Community Control Project of Chronic Diseases run in nearby communities. Men and women aged 40-69 years, examined in population screenings, were followed-up for variable periods of time ranging from 1 month to 11 years, after exclusion of those already carrier of a previous major CHD event. A total of 1427 men and 1675 women corresponding to a maximum of 9590 and 11499 person/years respectively were followed-up. Diagnostic criteria were based on a number of different items including history and ECG data, from screening examinations; discharge records from local hospitals; causes of death from death certificates; and information from mail questionnaires. Four hundred and forty-six men and 501 women were considered partially non respondent since they were examined only once, they did not answer the postal questionnaire, although they were surely alive at the end of the observation period. Incidence estimates were based on different denominators, including or excluding these non respondents. The age adjusted lower incidence estimate was of 40.7 per 10000 person/years among men and 19.7 among women; the higher estimate was of 51.3 and 24.4 per 10000 person/years respectively. Rates were higher among men than among women and were increasing with aging. These incidence rates were slightly lower than those reported from other population studies conducted in Italy in the 1970's and the 1980's, but were in line with the hypothesis of a declining incidence paralleling the decline in CHD mortality. These data, including also estimates in women, represent a reference point for the early 1990's of the frequency and distribution of major CHD events.

Adult↗

PubMed1992

Anaemia of chronic disease in rheumatoid arthritis: effect of the blunted response to erythropoietin and of interleukin 1 production by marrow macrophages.

Anaemia in rheumatoid arthritis (RA) is a common and debilitating complication. The most common causes of this anaemia are iron deficiency and anaemia of chronic disease. Investigations have suggested that interleukin 1 (IL-1) or tumour necrosis factor (TNF), or both, from monocytes associated with chronic inflammation are responsible for the anaemia of chronic disease. On bone marrow examination anaemia of chronic disease is characterised by the diversion of iron from the erythropoietic compartment into marrow macrophages. This phenomenon is termed failure of iron utilisation. In this study, CFU-E (colony forming unit erythroid; late red cell precursors) and BFU-E (burst forming unit erythroid; early red cell precursors) stem cells were cultured from 10 normal marrow samples and 12 marrow samples from patients with RA with iron deficiency anaemia and 10 samples from patients with RA with failure of iron utilisation. All patients with RA were anaemic (haemoglobin less than 100 g/l), Potential accessory or inhibitory cells of erythropoiesis (CD4, CD8, or CD14 positive cells) were removed before culture. Control marrow samples were studied in a similar manner. Normal marrow samples yielded 377 (17) CFU-E and 133 (6) BFU-E (mean (SD)) colonies for each 2 x 10(5) light density cells plated. CD4 ablation caused reductions of 62 and 100% in CFU-E and BFU-E colonies respectively. CD14 removal resulted in considerable but lesser reductions of 46% for CFU-E and 25% for BFU-E. In both groups of patients with RA, CFU-E colony numbers were significantly lower than those seen in normal control subjects, 293 (17) for patients with iron deficiency anaemia and 242 (35) for patients with failure of iron utilisation. BFU-E colony numbers were 102 (13) and 108 (20) respectively. In patients with RA, CD4 removal caused a significantly greater loss of CFU-E colonies compared with normal control subjects. Cytolysis of CD14 positive cells caused a reduction in CFU-E colonies in the two RA groups which was similar to that seen in normal subjects. In conclusion, patients with RA seem to have fewer CFU-E progenitors but essentially normal numbers of BFU-E stem cells. Our data suggest a stimulatory role for marrow CD4 and CD14 cells in erythropoiesis in patients with RA. Monocytes-macrophages (CD14 positive) are known to be producers of IL-1 or TNF, or both, however, the predicted increase in the CFU-E colonies on removal of CD14 cells is not seen. Therefore, if IL-1 or TNF, or both, are responsible for the impairment of erythropoiesis in patients with RA, marrow macrophages are unlikely to be the source. Moreover, these results indicate the probability of erythropoietin resistance on the basis of diminished CFU-E colony formation in patients with RA.

Anemia↗

PubMed1987

Patient reports of health status as predictors of physiologic health measures in chronic disease.

Accurate assessment of health status and forecasting of risk for poor outcomes in chronic disease require a broad representation of health measures. To support this conclusion, the health of patients with diabetes (N = 73) and hypertension (N = 105) was assessed using measures of physical and role functioning, perceived health, and disease severity (blood sugar or diastolic blood pressure, respectively, for diabetes and hypertension). Health questionnaires measuring functional limitations, overall health rating, level of health concern, perceived susceptibility to illness, and number of health problems were administered at study enrollment. Laboratory tests for blood sugar (hemoglobin A1) and diastolic blood pressures were performed at enrollment and were repeated at a subsequent clinic visit, from 3 to 6 months later. Functional limitations correlated significantly with elevated blood sugar (r = 0.57) and blood pressure (r = 0.49) at study enrollment. Perceived poor health was not substantially related to either physiologic measure at enrollment. Using ordinary least squares regression, the best predictor of both blood sugar and blood pressure at follow-up was baseline blood sugar and blood pressure, respectively. However, both functional limitations and perceived poor health made significant and independent contributions to the prediction of blood sugar and blood pressure at follow-up. The results underscore the value of both health survey measures and clinical measures in studies of chronic disease.

Blood Glucose↗