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Results for “CHRONIC DISEASE”

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At least 631 records · Page 35Linked to original sources

PubMed1999

Influenza and pneumococcal vaccine receipt in older persons with chronic disease: a population-based study.

OBJECTIVE: To identify factors associated with receipt of the pneumococcal and influenza vaccines among community-dwelling older persons with chronic disease. METHODS: A population-based sample of urban and rural Iowa adults age 65 years and older with one or more self-reported target medical conditions were interviewed by telephone. Information was obtained on aspects of health care access, which were examined as potential determinants of receipt of recommended vaccines. RESULTS: A total of 787 interviews were completed (response rate = 68%; completion rate for screened, eligible subjects = 91%). Two-thirds (n = 531, 68%) reported influenza vaccination in the last year, and one-half (51%, n = 393) reported ever receiving the pneumococcal vaccine. Both vaccines were received at recommended intervals by 347 subjects (44%). Multivariable logistic regression identified the following factors independently associated with receipt of both vaccines: age 70 or greater (OR = 1.64, CI95 = 1.15, 2.32); married (OR = 1.41, CI95 = 1.03, 1.92); self-owned residence (OR = 0.57, CI95 = 0.33, 0.97); working (OR = 2.94, CI95 = 1.38, 6.18); increased number of target medical conditions (OR = 1.3 for each, CI95 = 1.09, 1.54); current prescription medication (OR = 2.04, CI95 = 1.32, 3.14); and a physician visit in the last year (OR = 2.53, CI95 = 1.52-4.19). Receipt of the vaccines was unrelated to geographic location in a rural area. CONCLUSIONS: Despite their proven safety and efficacy, many persons with at least two indications to receive either vaccine remain unvaccinated. Among the elderly with chronic disease, predisposing and need factors were independently associated with receipt of both vaccines. Enabling factors assessed appeared less important in this population. Targeting of the elderly and those with chronic disease to receive recommended vaccines is needed to adequately protect these populations at risk.

Aged↗

PubMed2003

Diet, nutrition and the prevention of chronic diseases.

Shifting dietary patterns, a decline in energy expenditure associated with a sedentary lifestyle, an ageing population--together with tobacco use and alcohol consumption--are major risk factors for noncommunicable diseases and pose an increasing challenge to public health. This report of a Joint WHO/FAO Expert Consultation reviews the evidence on the effects of diet and nutrition on chronic diseases and makes recommendations for public health policies and strategies that encompass societal, behavioural and ecological dimensions. Although the primary aim of the Consultation was to set targets related to diet and nutrition, the importance of physical activity was also emphasized. The Consultation considered diet in the context of the macro-economic implications of public health recommendations on agriculture and the global supply and demand for fresh and processed foodstuffs. In setting out ways to decrease the burden of chronic diseases such as obesity, type 2 diabetes, cardiovascular diseases (including hypertension and stroke), cancer, dental diseases and osteoporosis, this report proposes that nutrition should be placed at the forefront of public health policies and programmes. This report will be of interest to policy-makers and public health professionals alike, in a wide range of disciplines including nutrition, general medicine and gerontology. It shows how, at the population level, diet and exercise throughout the life course can reduce the threat of a global epidemic of chronic diseases.

Aging↗

PubMed2006

Setting up chronic disease programs: perspectives from Aboriginal Australia.

OBJECTIVE: To share some perspectives on setting up programs to improve management of hypertension, renal disease, and diabetes in high-risk populations, derived from experience in remote Australian Aboriginal settings. PRINCIPLES: Regular integrated checks for chronic disease and their risk factors and appropriate treatment are essential elements of regular adult health care. Programs should be run by local health workers, following algorithms for testing and treatment, with back up from nurses. Constant evaluation is essential. COMPONENTS: Theses include testing, treatment, education for individuals and communities, skills and career development for staff, ongoing evaluation, program modification, and advocacy. Target groups, elements, and frequency of testing, as well as the reagents and treatment modalities must be designed for local circumstances, which include disease burden and impact, competing priorities, and available resources. Pilot surveys or record reviews can define target groups and conditions. Opportunistic testing will suffice if people are seen with some regularity for other conditions; otherwise, systematic screening is needed, preferably embedded in primary care streams. The chief goal of treatment is to lower blood pressure, and if the patient is diabetic, to control hyperglycemia. Many people will need multiple drugs for many years. CHALLENGES: Challenges include lack of resources, competing demands of acute care, the burden of treatment when disease rates are high, problems with information systems, and in our setting, health worker absenteeism. FUNDING: Businesses, altruistic organizations, and pharmaceutical and biotechnology companies might fund feasibility studies. Where governments or insurance companies already support health services, they must ultimately commit to chronic disease services over the long- term. Effective advocacy requires the presentation of an integrated view of chronic disease and a single cross-disciplinary program for its containment. Arguments based on preserving the economic base of societies by preventing or delaying premature death will carry most weight, as will the costs of dialysis avoided in countries that already support open-access programs.

Adult↗

PubMed2007

Expression of biomarkers of interferon type I in patients suffering from chronic diseases.

Interferons (IFNs) are used widely in the treatment of viral infections, tumours and neurological disorders. The aim of this study was to evaluate the endogenous expressions of various IFN-induced compounds [specifically: neopterin (NPT), beta2microglobulin (beta2mg) and 2-5 oligoadenylate synthetase (2-5 OAS)] in patients with various chronic diseases requiring treatment with IFN type I. The results showed that patients with such chronic diseases as hepatitis C virus-associated type II mixed cryoglobulinaemia (MC), chronic hepatitis C (CHC) and relapsing-remitting multiple sclerosis (RRMS) are characterized by different activations of the IFN system. Furthermore, the interindividual variability in baseline levels of IFN-induced biomarkers was higher in patients with chronic diseases than in healthy individuals. When levels of the above biomarkers were measured 24 h after the first injection of IFN in patients with CHC or RRMS, significant increases in expression levels of IFN-induced compounds were recorded but, again, there is a broad range of variability in the degree of increase. Further, a significant inverse correlation between baseline levels of NPT, beta2mg and 2-5 OAS activity and their relative increases after IFN administration was found in patients with CHC or RRMS. Together, the results are consistent with the observation that there is considerable interindividual heterogeneity in the clinical response to IFNs, which suggests that host factors other than disease markers must be taken into account in order to manage and optimize the IFN therapy.

2',5'-Oligoadenylate Synthetase↗

PubMed2006

Positive effects of a psycho-educational group intervention for children with a chronic disease: first results.

OBJECTIVE: To determine the effectiveness of a psycho-educational group intervention for chronically ill children. METHODS: Based on principles from cognitive behavior therapy and information from previous research about children's experiences with coping with a chronic disease we developed an intervention to be used for children with different chronic diseases. The program, called Op Koers (OK), with six sessions for different age groups, was evaluated by standardised and researcher-developed psychological measures. RESULTS: A total of 109 patients participated in the study on the effects of the psycho-educational intervention. Improvements in behavioral-emotional outcomes, social competence, information seeking, relaxation and positive thinking were found both in short and medium term. Additionally, the sessions received positive appraisals. CONCLUSIONS: The program appears to have a significant and positive impact on chronically children. Further research is needed to establish the effects of the intervention. PRACTICE IMPLICATIONS: Beneficial effects can be expected from the implementation of a psycho-educational group intervention for children with heterogeneous chronic health conditions.

Adaptation, Psychological↗

PubMed2005

Printed patient education interventions to facilitate shared management of chronic disease: a literature review.

BACKGROUND: Printed materials for patient self-education are a comparatively low cost, flexible and potentially useful aid for dealing with the growing burden of chronic disease in our society. A comprehensive review of existing trials is required. AIMS: We conducted a comprehensive review which aimed to (i) evaluate the evidence for effectiveness of print-only interventions in increasing patient participation in chronic disease management and (ii) identify disease or intervention characteristics associated with success. METHODS: Medline, the Cochrane Central Register of Controlled Trials, EMBASE and CINAHL were searched for the period 1992 to January 2005 for reports of controlled trials of printed patient materials in chronic disease. The quality of both studies and interventions was assessed. RESULTS: Seven studies were found. They focussed on inflammatory bowel disease, arthritis, asthma and diabetes. Few studies named primary outcomes, continued beyond 6 months or included process evaluations. Few reports gave the behaviour-change rationale of the intervention. Few interventions were reported as having been designed using testing and improvement, psychosocial theory, checks of patient understanding or other patient input. A variety of outcomes was measured. Statistically significant change was found for few. Knowledge improved in three studies, adherence improved in two and quality of life declined in one. CONCLUSIONS: We found that printed interventions as currently designed appear to produce, at best, modest benefits. The design of interventions, studies and study reports all need improvement before decisions can be made about effectiveness and characteristics associated with success.

Arthritis↗

PubMed1997

Occupational therapy for patients with chronic diseases: CVA, rheumatoid arthritis and progressive diseases of the central nervous system.

A substantial proportion of the patients treated by occupational therapists have a chronic disease. The aim of this study was to describe the outlines of occupational therapy treatment for three specific groups of chronic diseases: progressive neurological diseases, cerebrovascular accident and rheumatoid arthritis. A total of 143 therapists, working in 49 occupational therapy departments in The Netherlands, were asked to complete a standard registration from based on the ICIDH. This form consisted of three sections: (a) patient characteristics, (b) occupational therapy diagnosis and treatment goals in terms of ICIDH and (c) treatment characteristics. The present study concerns 507 patients: 102 had progressive neurological diseases (PND), 338 had a CVA and 67 had rheumatoid arthritis (RA). Our results showed that each patient group was characterized by a specific treatment approach. Especially at the level of treatment programmes substantial differences between groups were observed. Besides the clear differences, similarities in approaches were found between the PND and RA group, e.g. total time spent on therapy differed largely between the PND and RA patients (both averages 6 h) and the CVA patients (average 14 h).

Adult↗

PubMed1999

Models for forecasting chronic disease processes in adult and elderly populations: effects of stochasticity.

BACKGROUND: Forecasting the population health burden of chronic diseases requires models consistent with the relation, over time and in an uncertain environment, of risk factors and diseases at the individual level. There is now sufficient longitudinal data, and scientific understanding, of some chronic diseases to construct detailed process-models to better predict their population health burden and more realistically describe the effects of interventions. A crucial clement in constructing models is the way in which stochastic influences are described, e.g. are they allowed to interact over time with deterministic model features? METHODS: A review of statistical and forecasting models aimed to establish what ancillary data and scientific insights are necessary to describe multivariate stochastic health processes and their response to interventions. For circulatory diseases and cancer there exists sufficient longitudinal data and biological insight to construct stochastic multivariate process models. For other diseases, biological knowledge is less complete and there are fewer data sets where multiple risk factors are assessed longitudinally. Forecasting models for those diseases will then rely more heavily on theoretical assumptions about disease behaviour.

Chronic Disease↗

PubMed2004

The burden of symptoms among community-dwelling older persons with advanced chronic disease.

BACKGROUND: Little is known about the frequency and range of symptoms experienced by community-dwelling older persons with advanced chronic disease who are not enrolled in hospice. The objectives of our study were to determine (1) the prevalence of a range of symptoms among older persons with advanced chronic disease and (2) whether the prevalence of symptoms is similar across diagnoses. METHODS: This was a cross-sectional study of the symptoms reported by 226 community-dwelling persons 60 years or older with advanced chronic obstructive pulmonary disease (COPD), cancer, or congestive heart failure (CHF). Symptoms were assessed using the Edmonton Symptom Assessment System. RESULTS: Virtually all participants (86%) experienced at least 1 symptom that rated moderate or severe, and most (69%) experienced 2 or more symptoms. The symptoms reported by the greatest proportion of participants were limited activity (61%), fatigue (47%), and physical discomfort (38%). Participants with COPD had a higher unadjusted mean +/- SD number of moderate or severe symptoms (3.3 +/- 2.1) than did participants with cancer (2.6 +/- 1.8; P = .03) or CHF (2.0 +/- 1.7; P<.001). After we adjusted for sociodemographic factors, compared with participants with CHF, participants with cancer experienced 38% (95% confidence interval, 9%-75%) more moderate or severe symptoms and participants with COPD experienced 71% (95% confidence interval, 37%-114%) more moderate or severe symptoms. CONCLUSIONS: Most community-dwelling older persons with advanced COPD, cancer, or CHF experienced multiple moderate or severe symptoms. The clinical care of community-dwelling older persons with advanced chronic illnesses would be enhanced by the identification and alleviation of the range of symptoms they experience.

Aged↗

PubMedDate not supplied

The stress-disequilibrium theory: chronic disease development, low social control, and physiological de-regulation.

The Stress-Disequilibrium Theory is based on a new generalized analytic three-level model based on thermodynamics to describe the process of physiological risk development. This approach explains how low social control could cause chronic disease through chronic de-regulation of our highly integrated physiological systems. Could low external social control lead to low internal physiological control: i.e. compromised self-regulation--and then disease? The theory implicitly explores the evidence for the physiological causes of chronic diseases, including cardiovascular diseases, at a high level (i.e. a non-reductionist level) and in a unifying manner--to provide a potentially easier linkage to the broad social policy consequences implied by the global economy. Evidence from our own recent Heart Rate Variability monitoring and job strain research (5) is presented which assesses the effect of low control on autonomic regulation on the heart. The theory is consistent with the Demand/Control Model, and could be considered its underlying theoretical explanation.

Adult↗

PubMed1991

Long-term ambient concentrations of total suspended particulates and oxidants as related to incidence of chronic disease in California Seventh-Day Adventists.

Cancer incidence and mortality in a cohort of 6000 nonsmoking California Seventh-Day Adventists were monitored for a 6-year period, and relationships with long-term cumulative ambient air pollution were observed. Total suspended particulates (TSP) and ozone were measured in terms of numbers of hours in excess of several threshold levels corresponding to national standards as well as mean concentration. For all malignant neoplasms among females, risk increased with increasing exceedance frequencies of all thresholds of TSP except the lowest one, and those increased risks were highly statistically significant. For respiratory cancers, increased risk was associated with only one threshold of ozone, and this result was of borderline significance. Respiratory disease symptoms were assessed in 1977 and again in 1987 using the National Heart, Lung and Blood Institute respiratory symptoms questionnaire on a subcohort of 3914 individuals. Multivariate analyses which adjusted for past and passive smoking and occupational exposures indicated statistically significantly (p less than 0.05) elevated relative risks ranging up to 1.7 for incidence of asthma, definite symptoms of airway obstructive disease, and chronic bronchitis with TSP in excess of all thresholds except the lowest one but not for any thresholds of ozone. A trend association (p = 0.056) was noted between the threshold of 10 pphm ozone and incidence of asthma. These results are presented within the context of standards setting for these constituents of air pollution.

Air Pollutants↗

PubMed2001

The end-stage renal disease program. Experience with a chronic disease capitated health plan.

The ESRD program has demonstrated the potential for a capitated, disease-oriented, total care method of patient support. Given both the increasing age and complexity of the patient population, not only has the cost per patient decreased over the life of the program, but the standardized mortality rates have also declined. Technology has bridged the gap and made the relative cost per treatment more affordable and science has developed medications and techniques that have enhanced both patient comfort and longevity. As more complex patients enter the fold of the ESRD program, an increased awareness of enhanced coordination of care needs to be recognized.

Humans↗

PubMed2003

Induction of oral tolerance as treatment or prevention of chronic diseases associated with Chlamydia pneumoniae infection--hypothesis.

BACKGROUND: Chlamydia pneumoniae infection is associated with chronic diseases such as asthma, reactive arthritis, and atherosclerosis. Several investigations and experimental results indicate an excessive immune response to heat shock protein (hsp) 60 as a possible common pathogenetic link between Chlamydia pneumoniae infection and the associated chronic diseases. CASE REPORT: A 46-year old woman with persistent C. pneumoniae infection and Reiter's syndrome had been treated for three years with antibiotics and nonsteroidal anti-inflammatory drugs without success. However, she was repeatedly free of complaints for several months following two-week cycles taking oral dilutions of Chlamydia trachomatis daily. CONCLUSIONS: The placebo effect does not seem sufficient to explain the clinical benefits obtained repeatedly by drinking dilutions of C. trachomatis. Induction of oral tolerance (immune modulation) to hsp60 may have occurred, leading to the clinical benefits. The known risk factors for atherosclerosis do not account for all cases of atherosclerosis. If autoimmunity to hsp60 is involved in the pathogenesis of atherosclerosis, so natural acquisition of oral tolerance to hsp60 may contribute to the geographical differences in atherosclerosis prevalence.

Administration, Oral↗

PubMed1997

Chronic disease in children. A cross-sectional perspective based on an analysis of the Australian Morbidity and Treatment Survey (AMTS) 1990-1991.

OBJECTIVE: To investigate general practitioner's (GPs) involvement in childhood chronic disease care. METHOD: An analysis of GP consultations which involved chronic childhood disease, using the national AMTS survey of encounter morbidity and treatments. RESULTS: Almost 16% of childhood encounters included a chronic disease diagnosis. Asthma accounted for 50%. Major reasons for encounter included: common respiratory and other childhood problems; prescriptions; and immunisation. Chronic disease encounters had multiple diagnoses with high levels of continuity. Specialist referral (but not referral to other agencies) was common. Psychosocial and general physical care were rarely recorded in these encounters. CONCLUSIONS: General practitioners provide the broad range of care for children with chronic conditions. Interpretation of possible gaps is problematic because the study represents a cross-sectional picture of longitudinal care. However, with the current coordinated care reforms, it is imperative that GPs reappraise and demonstrate the extent of their involvement in all aspects of chronic care.

Adolescent↗

PubMed2002

Provider-patient roles in chronic disease management.

Health care provider-patient role relationships can influence patient satisfaction, adherence to treatment, and health outcomes positively. Existing models of role relationships reflect one of three approaches to clinical management--paternalism, consumerism, or shared decision making. These models may or may not reflect the reality of chronic disease management in clinical practice. To characterize the nature of chronic disease management from the perspectives of primary care providers, we asked four nurse practitioners and four internists to describe the roles they saw for themselves and for their patients. A qualitative approach using a descriptive mode supported the formulation of a narrative description of these roles. The roles reflected a paternalistic approach to chronic disease management. The shared decision making approach supported in the literature was not evident. This finding is important for health professional education and practice.

Chronic Disease↗

PubMed1990

[Quantitative evaluation of screening programs for chronic diseases].

This paper addresses an epidemiologic approach to the quantitative evaluation of screening programs for chronic diseases. A new formula is advanced for the quantitative relationship between the yield of a screening program and the natural history of chronic disease, based on the two stage model of disease progression. The formula was applied to follow-up data of the participants and the proportions of cases detected by the screening were estimated as 15.3% for all diseases and 43.8% for hypertensive disorders. The formula is useful for continuous monitoring of ongoing screening programs as well as for potential impact evaluation of hypothetical programs.

Adult↗

PubMed2006

Therapy insight: Use of melanocortin antagonists in the treatment of cachexia in chronic disease.

Cachexia is a process that accompanies many chronic diseases, and consists of a combination of wasting of lean body mass, increased energy expenditure, and a paradoxical loss of appetite. Cachexia both worsens quality of life and negatively affects treatment of the underlying disease. Conditions as diverse as cancer, renal failure, and heart failure show a remarkable similarity in their associated cachexia, exhibiting changes in metabolism and endocrinology, including marked increases in levels of cytokines that accompany these diseases. So far, it has been difficult to treat disease-associated cachexia successfully. One treatment that has shown promise in animal trials, however, involves antagonism of the central melanocortin system, an anorexigenic pathway in the hypothalamus and brainstem. Humans who have genetic mutations involving pro-opiomelanocortin or the melanocortin 4 receptor in this pathway exhibit increased appetite and increased lean body mass. Recent research has shown that in rodent models of cancer and renal failure, administration of melanocortin 4 receptor antagonists results in an attenuation of symptoms of cachexia, including maintenance of appetite, lean body mass, and basal energy expenditure. Although this research needs to be substantiated in humans, it provides a promising direction for treating the wasting that is associated with a variety of disease states.

Animals↗

PubMed2000

Association of Helicobacter pylori infection with lifestyle, chronic disease, body-indices, and age at menarche in Danish adults.

This study examines the association between lifestyle factors, chronic disease, body-indices, and the seroprevalence of Helicobacter pylori infection in Danish adults. The relationship between age at menarche and H. pylori infection is also assessed. A random sample of 3,608 Danish adults completed a questionnaire about lifestyle factors (smoking habits, alcohol consumption, and coffee and tea intake), doctor diagnosed chronic diseases (heart conditions, diabetes, chronic bronchitis, and hypertension), menarche, and socio-demographic factors. A total of 2,913 participants were eligible for the present study. Electrocardiographs were recorded and blood pressure and serum lipid levels (HDL cholesterol, triglyceride, and cholesterol) were measured. Height and weight were determined and body mass index (BMI) calculated. Sera were analysed with an enzyme-linked immunosorbent assay for the presence of H. pylori specific IgG antibodies. The seroprevalence of H. pylori infection was associated with weekly alcohol intake > or = 6 drinks (odds ratio 0.7, 95% confidence interval 0.6-0.9) due to a low rate of H. pylori infection among wine drinkers (odds ratio 0.6, 95% confidence interval 0.5-0.7). No associations were found with smoking habits or serum lipids. People with upper quartile BMI (> or = 26.8 kg/m2) were more likely to be seropositive for antibodies to H. pylori (odds ratio 1.6, 95% confidence interval 1.1-2.4). Chronic bronchitis (odds ratio 1.6, 95% confidence interval 1.1-2.5) and unspecified heart condition (odds ratio 2.0, 95% confidence interval 1.1-3.3) was more often seen in IgG seropositive women than in uninfected women. The likelihood of being seropositive for IgG antibodies to H. pylori increased with age at menarche (odds ratio per year 1.10, 95% confidence interval 1.02-1.19). Previously reported associations with age and socioeconomic status were confirmed. We conclude that wine drinking is associated with lower rates of H. pylori infection in Danish adults. The seroprevalence of H. pylori infection is increased in people with high BMI. H. pylori infection may relate to a history of late menarche and chronic bronchitis in Danish women.

Adolescent↗