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PubMed2004

Coping competence as predictor and moderator of depression among chronic disease patients.

This tested the utility of the "Coping Competence Questionnaire" (CCQ) in predicting depression among chronic disease patients. Coping competence is defined as a dispositional stress resistance factor based on helplessness and hopelessness theory. Predictive power and buffering effects of the CCQ were tested in three patient samples scheduled for Coronary Artery Bypass Surgery (N = 272), other heart surgeries (N = 109), or lung tumor surgery (N = 203). Coping competence, symptom stress, and depression were assessed before and 6-months following surgery. Hierarchical multiple regressions indicated moderator effects of coping competence in the relationship between symptom stress and depression, supporting the stress-buffer hypothesis. Symptom stress was strongly correlated with depression among patients who were low in coping competence only. Among patients high in coping competence, depression was low and unaffected by symptom stress. The results suggest that the 12-item coping competence scale may qualify as useful tool for the prediction of depression in chronic disease populations.

Adaptation, Psychological↗
PubMed2002

The role of nutrition and nutrients in the prevention of chronic diseases.

The nutritional factors that increase risk of heart disease, many cancers, and diabetes are identical. Controlling body weight, being physically active, limiting intake of saturated fats, and eating ample amount of fruits and vegetables can all reduce the risk for many different chronic diseases. Physicians have many opportunities to assist their patients in reducing their nutritional risk of chronic diseases.

Body Weight↗
PubMedDate not supplied

Psychometric properties of a new measure of fathers' involvement in the management of pediatric chronic diseases.

OBJECTIVE: Despite theoretical and empirical reasons suggesting its potential importance, paternal involvement in the management of pediatric chronic diseases has rarely been a primary focus of research on family adaptation to pediatric disease. This may be due to a lack of appropriate tools to measure relevant behaviors. This study assessed the reliability and validity of the Dads' Active Disease Support scale (DADS), which was designed to measure male and female caregivers' estimates of the amount and helpfulness of paternal involvement in managing six pediatric chronic diseases. METHOD: A sample of 224 heterosexual couples completed the DADS and measures of mother, child, and family functioning, yielding 190 who completed data sets. Of these, 91 mothers and 88 fathers completed the DADS again after a 1-month interval. RESULTS: Results confirmed DADS internal consistency, test-retest reliability, and interparent agreement. Confirmatory factor analysis supported its construct validity: A two-factor model (amount and helpfulness of fathers' involvement) best accounted for participants' responses. Significant correlations with scores on the Family Assessment Device supported DADS convergent validity. DADS scores of mothers and fathers suggest substantial room for improvement in both the amount and the helpfulness of paternal involvement in disease management. Mothers provided significantly higher ratings of the helpfulness of fathers' involvement than did fathers. CONCLUSIONS: The DADS appears to be a reliable and valid measure for studies of the associations between paternal involvement in disease management and child, maternal, and family adaptation to pediatric chronic medical conditions.

Adaptation, Psychological↗
PubMed1992

The impact of chronic diseases of lifestyle and their major risk factors on mortality in South Africa.

The purpose of this study was to determine the impact of chronic diseases of lifestyle on the mortality pattern of South Africans and to estimate the number of South Africans affected by major risk factors for these diseases. The proportion of deaths due to chronic diseases of lifestyle was calculated from the deaths reported to the Central Statistical Services. This group of diseases was responsible for 24.5% of deaths of all South Africans and 28.5% of those aged 35-64 years whose deaths were reported in 1988. The major causes of death contributing to these figures were cerebrovascular diseases (7.2% of all deaths and 7.9% of deaths of persons aged 35-64 years) and ischaemic heart disease (8.7% of all deaths and 9.6% of deaths of persons aged 35-64 years). The age-standardised prevalence rates for the major risk factors reported in five cross-sectional studies in different areas and groups are compared. Estimates from the reported prevalence rates, based on the size of the South African population recorded in the 1985 census figures, were calculated for the major risk factors. Overall 4.88 million South Africans smoked, the largest group of smokers being black males (2.6 million). for hypertension 5.5 million South Africans had blood pressures above 140/90 mmHg; again the largest groups were blacks (3.0 million). For hypercholesterolaemia and raised low-density lipoprotein cholesterol levels, 4.8 million and 3.1 million South Africans respectively had an increased risk for ischaemic heart disease, blacks having the lowest levels.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

The relationship between fat distribution and some chronic diseases in 11,825 women participating in the DOM-project.

The prevalence of reported chronic diseases was studied in quintiles of waist/hip ratio and Quetelet index in 11,825 women aged 40-73 presenting for mammographic screening in the DOM-project. After adjustment for age and Quetelet index, increased waist/hip ratio was found to be associated with an increased prevalence of diabetes mellitus, hypertension, cholecystectomy and a lower prevalence of varicose veins. No associations were observed between waist/hip ratio and the prevalence of angina pectoris, gout and rheumatism. The odds ratios, adjusted for age and Quetelet index, of the highest versus the lowest quintile of waist/hip ratio were 3.4 (95% CI 1.4-8.3) for diabetes mellitus; 2.2 (95% CI 1.7-2.8) for hypertension; 2.0 (95% CI 1.2-3.4) for cholecystectomy, and 0.81 (95% CI 0.68-0.95) for varicose veins. After adjustment for waist/hip ratio and age, Quetelet index was found to be associated with an increased prevalence of hypertension, cholecystectomy and varicose veins. Quetelet index, however, was not found to be related to diabetes, gout or rheumatism. We conclude that in a representative sample of Dutch women older than 40 years, fat distribution in addition to overweight is related to important chronic diseases.

Adipose Tissue↗
PubMed1993

Evaluation of the appropriateness of plain chest film in chronic diseases.

OBJECTIVE: To improve continuity of care and appropriateness of plain chest film orders in patients suffering from chronic diseases (hypertension, chronic obstructive pulmonary disease (COPD) and lung tuberculosis. DESIGN: Retrospective evaluation study using explicit and normative consensued criteria. SETTING: Urban health center. RESULTS: Compliance with the continuity criteria was 48%, 65% and 76% in three successive evaluations. Compliance with the appropriateness criteria was 52% and 62%. Orders from patients with COPD were responsible for most of the lack of compliance. Causes of non-compliance with the continuity criteria were attitude and organizational problems; with regard to appropriateness, the main cause was external to the Health Center. CONCLUSIONS: (1) Difficulty in improving registers, reflecting a defect in the continuity of care. (2) Usefulness of evaluation in discovering the causes of the problems, in these cases an external one. (3) Difficulty of improvement when the cause of the problem is external to our own setting. (4) Partial effectiveness of continuing education measures because of professional changes in the Health Center.

Adolescent↗
PubMed1990

Public health surveillance of non-infectious chronic diseases: the potential to detect rapid changes in disease burden.

The usefulness of surveillance in relating chronic disease trends to recent changes in risk exposures is often questioned on the grounds that these trends respond slowly, reflecting long periods between aetiological exposures and clinical onset of disease. We challenge this preconception on the basis of a review of several important risk factors and diseases: alcohol and liver cirrhosis; tobacco and stroke, cardiovascular disease, and lung cancer; and oestrogens and endometrial cancer. Data from cohort, cross-sectional, and modelling studies demonstrate that the time between removal of exposures and the onset of decline in morbidity or mortality is not defined by the time between initial exposure and disease occurrence. Rather, the pattern of lifetime exposures (with recent exposures often having a dominant effect), the dynamics of the disease process, and the segment of the population with reduced exposures determine how soon the decline begins.

Chronic Disease↗
PubMed2001

Clinical review 138: Anabolic-androgenic steroid therapy in the treatment of chronic diseases.

The purpose of this study was to review the preclinical and clinical literature relevant to the efficacy and safety of anabolic androgen steroid therapy for palliative treatment of severe weight loss associated with chronic diseases. Data sources were published literature identified from the Medline database from January 1966 to December 2000, bibliographic references, and textbooks. Reports from preclinical and clinical trials were selected. Study designs and results were extracted from trial reports. Statistical evaluation or meta-analysis of combined results was not attempted. Androgenic anabolic steroids (AAS) are widely prescribed for the treatment of male hypogonadism; however, they may play a significant role in the treatment of other conditions as well, such as cachexia associated with human immunodeficiency virus, cancer, burns, renal and hepatic failure, and anemia associated with leukemia or kidney failure. A review of the anabolic effects of androgens and their efficacy in the treatment of these conditions is provided. In addition, the numerous and sometimes serious side effects that have been known to occur with androgen use are reviewed. Although the threat of various side effects is present, AAS therapy appears to have a favorable anabolic effect on patients with chronic diseases and muscle catabolism. We recommend that AAS can be used for the treatment of patients with acquired immunodeficiency syndrome wasting and in severely catabolic patients with severe burns. Preliminary data in renal failure-associated wasting are also positive. Advantages and disadvantages should be weighed carefully when comparing AAS therapy to other weight-gaining measures. Although a conservative approach to the use of AAS in patients with chronic diseases is still recommended, the utility of AAS therapy in the attenuation of severe weight loss associated with disease states such as cancer, postoperative recovery, and wasting due to pulmonary and hepatic disease should be more thoroughly investigated.

Anabolic Agents↗
PubMedDate not supplied

External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases.

CONTEXT: Organized care management processes (CMPs) can improve health care quality for patients with chronic diseases. The Institute of Medicine of the National Academy of Sciences has called for public and private purchasers of health care to create incentives for physician organizations (POs) to use CMPs and for the government to assist POs in implementing information technology (IT) to facilitate CMP use. Research is lacking about the extent to which POs use CMPs or about the degree to which incentives, IT, or other factors are associated with their use. OBJECTIVES: To determine the extent to which POs with 20 or more physicians use CMPs and to identify key factors associated with CMP use for 4 chronic diseases (asthma, congestive heart failure, depression, and diabetes). DESIGN, SETTING, AND PARTICIPANTS: One thousand five hundred eighty-seven US POs (medical groups and independent practice associations) with 20 or more physicians were identified using 5 large databases. One thousand one hundred four of these POs (70%) agreed to participate in a telephone survey conducted between September 2000 and September 2001. Sixty-four responding POs were excluded because they did not treat any of the 4 diseases, leaving 1040 POs. MAIN OUTCOME MEASURES: Extent of use of CMPs as calculated on the basis of a summary measure, a PO care management index (POCMI; range, 0-6) and factors associated with CMP use. RESULTS: Physician organizations' mean use of CMPs was 5.1 of a possible 16; 50% used 4 or fewer. External incentives and clinical IT were most strongly associated with CMP use. Controlling for other factors, use of the 2 most strongly associated incentives-public recognition and better contracts for health care quality-was associated with use of 1.3 and 0.7 additional CMPs, respectively (P<.001 and P =.007). Each additional IT capability was associated with 0.37 additional CMPs (P<.001). However, 33% of POs reported no external incentives and 50% reported no clinical IT capability. CONCLUSIONS: The use of CMPs varies greatly among POs, but it is low on average. Government and private purchasers of health care may increase CMP use by providing external incentives for improvement of health care quality to POs and by assisting them in improving their clinical IT capability.

Asthma↗
PubMed2004

Refining the measurement of the economic burden of chronic diseases in Canada.

This article presents an analysis of the economic burden of a number of chronic diseases in Canada. In the analysis, we adjusted our measure of utilization of physician and hospital services for co-existing chronic diseases, which we found to be widely prevalent and to have an impact on resource use. Using data from the 1999 National Population Health Survey, we developed resource use rankings for several chronic conditions and decomposed these measures into prevalence and per-person utilization components. Our results indicate that, for the diseases with the greatest impact, resource use measures are driven more by disease prevalence than intensity of resource use. The diseases with the highest overall degree of resource use are back pain, arthritis or rheumatism, high blood pressure and migraines for people under 60; and arthritis or rheumatism and high blood pressure for people over 60. Our methods can be used to forecast the overall relative impact of resource use due to disease prevalence and per-person resource use intensity for various conditions.

Adult↗
PubMed1997

The delivery of preventive services in primary care practices according to chronic disease status.

OBJECTIVES: The current study examined the relationship between chronic disease status and the receipt of cancer preventive services over a 3-year period. METHODS: Adults (n = 4320) cared for by 167 nonacademic physicians in 42 primary care group practices were studied. Medical records were audited for each patient, as were patient responses to two questionnaires assessing health and sociodemographic characteristics. RESULTS: While the odds of having received counseling to obtain regular checkups were increased for men (1.56) and women (1.46) with hypertension, the odds were reduced (range = 0.32 to 0.81) for having received a sigmoidoscopy (women with diabetes or hypertension, men with hypertension or heart disease), fecal occult blood test (men with diabetes or heart disease, women with heart disease), mammogram or counseling about smoking (women with diabetes), clinical breast exam (women with heart disease), and Pap test (women with diabetes or heart disease). CONCLUSIONS: The presence of common chronic health problems in older adults is associated with lower levels of cancer screening services.

Adult↗
PubMedDate not supplied

[Prevalence and interrelations of noncommunicable chronic diseases and cardiovascular risk factors in Mexico. Final outcomes from the National Health Survey 2000].

PURPOSE: To determine the prevalence and interrelation of noncommunicable chronic diseases (NCCD), obesity, smoking, and proteinuria in the adult population (between 20 and 69 years of age) of Mexico, and their stratification according to age, gender, and geographical area. METHOD: During the year 2000, a probabilistic national survey was performed in 45,300 persons. The sample size was calculated to approach NCCD with a minimal estimated prevalence of 6%. The survey corresponds to type III of the step-by-step method described by WHO. Data were weighted for the distribution of the population and gender, according to the national survey of population and housing (National Institute of Statistics and Geography, INEGI). RESULTS: A total of 38,377 (98.8%) of individuals were included in the analysis; 69.4% were women. Average age for men was 39.4 +/- 12.9 and for women 38.6 +/- 13.0. National average prevalence for hypertension was 30.05%, for diabetes of 10.7%, for obesity of 24.4%, for abnormal capillary glucose of 12.7%, and for proteinuria of 9.2%. Prevalence for hypertension and diabetes were directly related with age, body mass index, and waist perimeter. The pyramidal distribution of the Mexican population determined that the greatest proportion of prevalence of NCCD was given by those under 54 years of age with a statistical significance (> 75%). CONCLUSION: ENSA 2000 demonstrates the marked increase in NCCD prevalence in the Mexican population and alerts on the urgent need of national strategies to restrain this important public health problem. Strategies must be oriented towards an integrated approach of the NCCD, since their clinical and physiopathological interrelation is clearly demonstrated through ENSA 2000.

Adult↗
PubMedDate not supplied

Biochemical pharmacology of functional foods and prevention of chronic diseases of aging.

The major mechanisms and consequences of free radicals in foods and biological systems that result in the occurrence of chronic diseases of aging (atherosclerosis, cataract, cancers, diabetes, neurological diseases, immune-inflammatory disorders) are described. The main antioxidant defense mechanisms from foods and cells and tissues are also reported. Many nutraceutical substances, with their respective beneficial actions (antioxidant, detoxifying, apoptotic actions) and effects, and most common food sources are also described. There are many options of foods to prevent cancer and chronic diseases, to improve life's quality in maturity.

Aged↗
PubMed1984

Exercise in the management and rehabilitation of selected chronic diseases.

The effects of exercise on the progression of eight chronic diseases or medical conditions are reviewed. In the case of coronary artery disease (CAD), there is some suggestive evidence that exercise is associated with a survival advantage. Exercise does not consistently increase blood flow in peripheral vascular disease, nor does it improve lung function in patients with chronic obstructive pulmonary disease. However, it is associated with increased physical work capacity in these two conditions. Preliminary studies suggest that exercise may be beneficial in the management of pulmonary secretions in patients with cystic fibrosis. Exercise has no therapeutic role in acute exacerbations of rheumatoid arthritis, but in the chronic stages, exercise that does not cause pain may be beneficial. Exercise is the focal point of chronic pain syndrome programs. With exercise programs, patients with chronic pain can increase physical work capacity with a decrease in complaints of pain. Patients with osteoporosis appear to benefit from a carefully programmed low-level exercise program that avoids back flexion exercises. Blood glucose, hypertension, and serum lipid levels improve with exercise in patients with dialysis-dependent renal failure.

Adolescent↗
PubMed2001

Use of the chronic disease score to measure comorbidity in the Canadian Study of Health and Aging.

Most older adults have multiple chronic diseases. Consideration of these conditions can improve the performance of statistical models in epidemiological analyses. The Chronic Disease Score (CDS) is a measure of comorbidity derived from medication usage, which may have some advantages over measures derived from other sources. The calculation of the CDS from data contained in the Canadian Study of Health and Aging (CSHA) is described. This measure can be used to estimate comorbidity within the CSHA database.

Aged↗
PubMedDate not supplied

Spitting into the wind: the irony of treating chronic disease.

OBJECTIVE: To propose a paradigm shift in the role of the pharmacist by encouraging pharmacists' involvement in the achievement and maintenance of healthy lifestyles in their patients, thus reducing the need for long-term medications. DATA SOURCES: Peer-reviewed medical literature, contemporary lay literature, news releases from health organizations/associations, United States health standards, and professional experiences of the authors. SUMMARY: Our current paradigm for the management of chronic disease is malaligned. The medications we use are helpful for many patients with chronic disorders, but they are not curative and leave many individuals with unwanted adverse effects that are often treated with additional medication. The more effective approach to managing many patients with chronic diseases induced through unhealthy lifestyles would be to eat properly, exercise to maintain ideal body weight, and abstain from harmful substances. Managing the root causes of chronic disease would eliminate most of the unhealthy consequences and perhaps reduce the need for long-term medication. Pharmacists have the knowledge and capacity to assist in this endeavor. CONCLUSION: Influencing patients to achieve ideal body weight through proper diet and exercise, encouraging people to stay well, and then helping them to keep well are roles for the pharmacist. If pharmacists made wellness and disease prevention part of their practices, they would have greater impact on improving patients' overall health. Without treating the primary cause of a condition and only treating the symptoms of unhealthy lifestyles, we are in many ways "spitting into the wind."

Chronic Disease↗