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PubMed1986

[A systemic-like disease: chronic vitamin A poisoning].

A 22-year-old man, had ingested more than 300 10(6) I.U. of vitamin A over a 2-year period. He presented with diffuse arthralgia, weight loss, low-grade fever, dryness and peeling of the skin, hair loss, liver enlargement with ascites and pleural effusion. He had a raised E.S.R., hypercalcemia and acute renal failure. Plasma levels of vitamin A and retinol-binding-protein were in the normal range. All symptoms disappeared after withdrawal of vitamin A except for the liver enlargement. Iliac bone biopsy showed cortical thickening, numerous resorptive lacunae and no index of bone formation. Liver biopsy showed obliteration of the space of Disse by swollen fat-storing cells (Ito cells). Tissue levels of vitamin A were very high in the liver. A second biopsy, 6 months later, showed a decrease of fat storage in the Ito cells but the development of a fibrosis.

Adult↗
PubMedDate not supplied

Progression of chronic renal disease.

Chronic diseases of the kidney are characterized by progression once a certain portion of renal function is lost. End-stage kidneys, the result of progressive chronic renal disease, are characterized by sclerosis, tubulointerstitial scarring, and collapse of glomerular capillary tufts. The mechanisms and risk factors responsible for the progression of renal disease have been studied intensively in the past decade, and it now appears that multiple nonimmunologic factors are responsible. These factors include systemic hypertension, hyperlipidemia, proteinuria, excessive intake of protein, and adaptive changes in nephron function as a consequence of nephron loss. The latter adaptations, increased intraglomerular pressure, increased excretion of ammonia, "hypermetabolism," decreased afferent arteriolar tone, and renal hypertrophy, may also be responsible for the progression of renal disease. A complete understanding of the factors responsible for the progression of renal disease should permit rational development of appropriate therapeutic interventions.

Humans↗
PubMedDate not supplied

The expert patient: a new approach to chronic disease management for the twenty-first century.

The expert patient: a new approach to chronic disease management for the twenty-first century, produced by the Department of Health, recommends the introduction of 'user-led self management' for chronic diseases to all areas of the NHS by 2007. The premise is that many patients are expert in managing their disease, and this could be used to encourage others to become 'key decision makers in the treatment process'. Furthermore, these expert patients could 'contribute their skills and insights for the further improvement of services'. It is hypothesised that self-management programmes could reduce the severity of symptoms and improve confidence, resourcefulness and self-efficacy. It is stressed that this is more than just patient education to improve compliance. Instead there should be 'a cultural change...so that user-led self management can be fully valued and understood by healthcare professionals'. I point out that these ideas, while welcome, are not particularly new. Achieving the desired culture change will not be easy.

Chronic Disease↗
PubMed1995

[Prevalence of chronic diseases in the elderly; the ERGO study (Erasmus Rotterdam Health and the Elderly)].

In the Rotterdam Study, prevalence and determinants of chronic diseases in the elderly (age > or = 55 years), were investigated in inhabitants of Ommoord, a suburb of Rotterdam. The study focused on cardiac diseases (myocardial infarction, angina pectoris, cardiovascular risk factors), glaucoma, macular degeneration, osteoporosis, osteoarthrosis and invalidity, dementia (Alzheimer's disease, vascular dementia, Parkinson's disease), epilepsy, cerebrovascular accident. The number of participants was 7983 (3105 men, 4878 women), a response of 78%. The participants were interviewed and were twice examined in an out-patient clinic. The results will be described in subsequent issues of this journal.

Aged↗
PubMed1982

Social factors in the etiology of chronic disease: an overview.

Our intention in this introductory article is to emphasize what we consider to be certain critical points in the current state of research into the social epidemiology of chronic disease. As will be outlined, these critical points need to be considered in future research. To begin with we provide a mild critique of research in this area which has had its tradition specified by social epidemiology, a term which has recently come into favor to describe research concerned with social factors in the etiology of chronic disease. Next we briefly summarize critical available evidence on an etiological relationship between social factors and cardiovascular disease, cancer and multiple disease outcomes. Following this a major emphasis will be placed on issues which directly relate to problems of methodology in social factors assessment. Finally, an emphasis will be given to the critical question of mechanisms which need to be clarified in this type of multivariate research.

Adrenocorticotropic Hormone↗
PubMed1980

Epidemiological studies in the Upernavik district, Greenland. Incidence of some chronic diseases 1950-1974.

An epidemiological survey of several chronic diseases in the Upernavik district, Northwest Greenland, is reported. The study population (approx. 1800 inhabitants) is one of the remaining whaling and sealing populations in Greenland. It was observed over the 25-year period 1950-74 as to the incidence of the diseases, which was based on all cases diagnosed in hospital during this period. The disease pattern of the Greenlanders differs from that of West-European populations, having a higher frequency of apoplexy and epilepsy but a lower frequency or absence of acute myocardial infarction, diabetes mellitus, thyrotoxicosis, bronchial asthma, multiple sclerosis and psoriasis. The distribution of cancer types differs from that of the Danish population, but the total incidence of cancer is of the same magnitude. Further comparable studies should be performed in Greenlandic districts that are characterized by more profound changes in life style, in order to elucidate the effect of these changes on the disease pattern.

Adolescent↗
PubMed1997

[Factors contributing to survival of elderly inpatients with chronic disease].

Clinical assessment and laboratory testing are important in predicting longevity and the outcomes of chronic diseases in the elderly. We therefore studied the prognostic utility of clinical and laboratory findings. A group of 168 elderly patients (70-97 years of age) with chronic diseases who were admitted to Kashiwazaki Kosei Hospital was studied. Data on 13 potentially prognostic factors were analyzed: dementia, being bedridden, anorexia, edema of the lower limbs, urinary incontinence, dyspnea fever, hepatic dysfunction, renal dysfunction, anemia, hypoalbuminemia, inflammation, and electrocardiographic abnormality. Kaplan-Meier survival curves were constructed, and either the log-rank or Wilcoxon method was used to look for significant differences in survival between patients with and without the factors listed above. Regression analysis was then done with the Coxproportional-hazards model to study the factors that contributed to the shortest survival. Patients lived longer if they were not bedridden, anorexic, incontinent of urine, hypoalbuminemic, or if they had no inflammation (p < 0.05): being bedridden, anorexia, urinary incontinence, hepatic dysfunction, hypoalbuminemia, inflammation, and electrocardiographic abnormalities. The survival curve obtained by using these factors as independent variables in the proportional-hazards model was similar to the Kaplan-Meier survival curve.

Aged↗
PubMed2004

Chronic diseases, locomotor activity limitation and social participation in older women: cross sectional survey of British Women's Heart and Health Study.

OBJECTIVES: To examine the association of chronic degenerative diseases with locomotor activity limitation and social participation among older British women. METHODS: Cross-sectional survey of 4,286 women aged 60-79 years from 23 towns in England, Scotland and Wales. RESULTS: The prevalence of locomotor activity limitation was 37.2% and 33.5% of women had difficulty with some aspect of social participation. This prevalence of locomotor activity limitation and difficulties with social participation increased with increasing age and with increasing number of chronic diseases. All chronic diseases assessed were independently (of each other and confounding factors) associated with locomotor activity limitation. Associations were particularly strong for stroke (OR 5.44, 95% CI 3.38-8.75), arthritis (OR 3.95, 95% CI 3.25-4.81) and coronary heart disease (OR 2.26, 95% CI 1.77-2.88). The population attributable fraction for locomotor activity limitation was greatest for arthritis: 37.8% (95% CI 32.0-43.1) and coronary heart disease: 6.7% (95% CI 4.8-8.8). Locomotor activity limitation was strongly associated with social participation. Most chronic diseases of ageing were independently (of locomotor activity limitation, other chronic diseases and confounding factors) associated with reduced social participation. CONCLUSIONS: Locomotor activity limitation and difficulties in social participation are common. Arthritis and coronary heart disease contribute importantly to locomotor activity limitation and difficulties with social participation. Effective strategies to prevent or limit the disabling impact of these conditions are essential to improving the quality of life of older women.

Aged↗
PubMed1998

Serum folate and chronic disease risk: findings from a cohort of United States adults.

BACKGROUND: Previous studies have suggested that folate may provide protection against various chronic conditions. METHODS: We examined the effect of serum folate concentration on mortality and chronic disease incidence in a nationally representative sample of 3059 adults of the National Health and Nutrition Examination Survey Epidemiologic Follow-up Study who were first examined from 1971 through 1975 and who were followed for about 19 years through 1992. Proportional hazards regression was used to estimate hazard ratios for the lowest quintile of serum folate compared with the highest quintile for selected causes of death and disease incidence. RESULTS: The hazards ratio for all-cause mortality was 1.18 (95% CI: 0.91-1.52); for mortality for diseases of the circulatory system, 1.31 (95% CI: 0.82-2.12); and for cancer mortality, 0.99 (95% CI: 0.46-2.11). The hazard ratio for incidence of diseases of the circulatory system was 1.04 (95% CI: 0.86-1.26); and for cancer incidence, 1.00 (95% CI: 0.61-1.66). The hazards ratio for all-cause mortality was 1.26 (95% CI: 1.01-1.57) for participants with a serum folate of <9.3 nmol/l compared with other participants. CONCLUSIONS: Low levels of serum folate may be associated with mortality from all-causes and cardiovascular disease. However, the study lacked power to adequately examine the association between folate and disease-specific endpoints. Additional studies, using serum and other measures of folate nutritional status, are needed to examine the relationship between folate nutrition and other more specifically defined health outcomes.

Adolescent↗
PubMed2003

Glycemic load and chronic disease.

The glycemic index (GI) has proven to be a useful nutritional concept, providing new insights into the relationship between foods and chronic disease. Observational studies suggest that diets with a high glycemic load (GI x carbohydrate content) are independently associated with increased risk of type 2 diabetes and cardiovascular disease. Postprandial hyperglycemia plays a direct pathogenic role in the disease process. Lower glucose and insulin levels are associated with improved risk profile, including high-density lipoprotein cholesterol, glycosylated proteins, oxidative status, hemostatic variables, and endothelial function. Limited evidence suggests that a low-GI diet may also protect against obesity, colon cancer, and breast cancer. Diets with a high glycemic load may affect health differently in insulin-resistant and insulin-sensitive individuals. Improvements in postprandial hyperglycemia can be brought about by manipulating either the type (i.e., GI) or amount of dietary carbohydrate, or both; at present, the GI appears to be more effective.

Blood Glucose↗
PubMed2004

Interdisciplinary management of chronic disease in primary practice.

Primary care physicians are often challenged by the complex needs of patients with chronic disease. Unfortunately, many solo and small group practices lack the interdisciplinary resources essential to chronic disease management. To address this, clinicians and researchers at Rush University Medical Center, Chicago, developed the "Virtual Integrated Practice," a process that creates virtual patient care teams. Preliminary results in four practice sites using it have shown increased referrals to dietitians and improved nutritional compliance but less extensive involvement of social workers and pharmacy team members.

Chronic Disease↗
PubMed2004

A life course approach to diet, nutrition and the prevention of chronic diseases.

OBJECTIVE: To briefly review the current understanding of the aetiology and prevention of chronic diseases using a life course approach, demonstrating the life-long influences on the development of disease. DESIGN: A computer search of the relevant literature was done using Medline-'life cycle' and 'nutrition' and reviewing the articles for relevance in addressing the above objective. Articles from references dated before 1990 were followed up separately. A subsequent search using Clio updated the search and extended it by using 'life cycle', 'nutrition' and 'noncommunicable disease' (NCD), and 'life course'. Several published and unpublished WHO reports were key in developing the background and arguments. SETTING: International and national public health and nutrition policy development in light of the global epidemic in chronic diseases, and the continuing nutrition, demographic and epidemiological transitions happening in an increasingly globalized world. RESULTS OF REVIEW: There is a global epidemic of increasing obesity, diabetes and other chronic NCDs, especially in developing and transitional economies, and in the less affluent within these, and in the developed countries. At the same time, there has been an increase in communities and households that have coincident under- and over-nutrition. CONCLUSIONS: The epidemic will continue to increase and is due to a lifetime of exposures and influences. Genetic predisposition plays an unspecified role, and with programming during fetal life for adult disease contributing to an unknown degree. A global rise in obesity levels is contributing to a particular epidemic of type 2 diabetes as well as other NCDs. Prevention will be the most cost-effective and feasible approach for many countries and should involve three mutually reinforcing strategies throughout life, starting in the antenatal period.

Aging↗
PubMed1985

Primary prevention of chronic disease in childhood: changes in risk factors after one year of intervention.

A five-year intervention study of the feasibility and effectiveness of a program aimed at the primary prevention of chronic disease was initiated in 1980 among children in 22 elementary schools in the Bronx, New York. Schools randomly were assigned either to the intervention program or to a control group. The intervention program consists of a curriculum focusing on nutrition, physical fitness, and cigarette smoking prevention. The study population at baseline comprised 2,283 fourth-graders. Subjects were eligible at baseline and at one-year follow-up for participation in a medical examination in which the following target risk factors were measured: systolic and diastolic blood pressures, plasma total and high-density lipoprotein (HDL) cholesterol, serum thiocyanate, ponderosity index, triceps skinfold thickness, and postexercise pulse recovery rate. After one year of intervention, systolic pressure increased less in the intervention group than among controls. Diastolic pressure decreased in both groups, but more in the intervention subjects than in controls. Total cholesterol decreased in the intervention group while increasing among controls. Significant net changes in the favorable direction also were observed for total cholesterol/HDL cholesterol ratio and for thiocyanate. These observations indicate that it is feasible to implement a school-based program aimed at the primary prevention of chronic disease. The intervention program appears to have had a favorable effect on several target risk factors. Although the effects were relatively small, intervention programs in schools may prove to be effective in lowering chronic disease risk.

Blood Pressure↗
PubMed1993

Common chronic disease in Vietnam-era veterans and nonveterans.

Little research has been conducted investigating the general experience of military service during Vietnam and its long-term relation to common nonpsychiatric problems. The relationship between Vietnam-era veteran status and common chronic disease was examined using data from the 1987 National Health Interview Survey. Compared to a cohort of nonveterans, Vietnam-era veterans were not more likely to have common chronic disease. Moreover, veterans were not significantly more likely than nonveterans to have limitations in activity. The findings indicate that military service during the Vietnam conflict does not place veterans at greater risk for common chronic disease.

Adult↗