[CARE OF CHRONIC DISEASE].
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Chronic Disease↗
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Interactive voice response systems in the diagnosis and management of chronic disease.
OBJECTIVE: To assess the feasibility, reliability, validity, and potential clinical impact of interactive voice response (IVR) systems in the diagnosis and management of chronic disease. STUDY DESIGN: Literature review. RESULTS: Interactive voice response assessment systems have been implemented in the treatment of patients with chronic health problems such as heart failure, diabetes, hypertension, and mental health disorders. The information patients report during IVR assessments is at least as reliable as information obtained via structured clinical interviews or medical record reviews. Patients often are more inclined to report health problems to an IVR system than directly to a clinician. The few outcome evaluations of IVR-supported chronic illness management services indicate that they can have moderate impacts on some health and health behavior outcomes. CONCLUSIONS: Future research should evaluate the extent to which IVR assessment data can improve the prediction of clinical problems over and above what is possible using data usually available to primary care providers. Studies also should evaluate the outcomes of IVR-supported chronic disease management and the use of IVR assessments to measure variation in patient-centered treatment outcomes.
Chronic Disease↗
[INTRODUCTION TO HEALTH INSURANCE: FEES FOR RE-EXAMINATION, FOR MEDICAL CARE ADVICE, FOR ATTENDANCE DURING CHILDBIRTH, AND FOR ADVICE IN CHRONIC DISEASE].
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Chronic Disease↗
Chronic disease and disadvantage: the new politics of HIV infection.
HIV infection is now perceived as the end stage of a chronic disease that is spreading most rapidly among blacks and Hispanics. The politics of the HIV epidemic in the 1980s were dominated by four interacting factors: fear and fascination; who had the disease and to whom it seemed to be spreading; the endemic problems of United States social policy; and the impact on policy of advances in scientific knowledge. This paper analyzes the political history of each of these factors and describes the dominant policies of the federal government and the states regarding HIV in the areas of surveillance, prevention, research, and financing. Four uncertainties will have a profound influence on the future politics of the HIV epidemic: how the states and the federal government will address the general problems of paying for the care of people with chronic diseases and providing access to care for the uninsured and the underinsured; the number and distribution of the sexual behaviors that transmit infection with HIV and the effectiveness of policies to persuade people to modify these behaviors; precisely who uses addictive drugs and the effectiveness of measures to change their behavior; and the natural history of the virus.
Chronic Disease↗
Complementary and alternative medicine use in patients with chronic diseases in primary care is associated with perceived quality of care and cultural beliefs.
OBJECTIVES: The purpose of our study was to determine the prevalence of complementary and alternative medicine (CAM) use and its clinical and psycho-social correlates, including perceived satisfaction with care and cultural health beliefs. METHODS: A cross-sectional study was carried out in public sector primary care clinics in Singapore using a random sample of 488 adult patients with chronic diseases. The measures were CAM use, satisfaction with care and traditional health beliefs. RESULTS: The 1 year prevalence of CAM use was 22.7%. In univariate analyses, factors associated with CAM use included: middle age, arthritis, musculoskeletal disorders and stroke, multiple conditions, poor perceived health, family use of CAM, recommendation by close social contacts, strong adherence to traditional health beliefs and perceived satisfaction with care. Patients who were dissatisfied/very dissatisfied with the cost of treatment [odds ratio (OR) = 1.79, 95% confidence interval (CI) 1.15-2.82] and waiting time (OR = 1.96, 95% CI 1.20-3.19) were more likely to use CAM. Patients who were very satisfied with the benefit from treatment were much less likely to use CAM (OR = 0.49, 95% CI 0.29-0.83). Satisfaction with doctor-patient interaction was not associated with CAM use. Being 'very satisfied' on overall care satisfaction was significantly associated with much less CAM use (OR = 0.30, 95% CI 0.14-0.68). Multivariate analyses confirmed that CAM use was significantly and independently predicted by the 'chronic disease triad' (arthritis/musculoskeletal disorders/stroke) (OR = 4.08, 95% CI 2.45-6.83), overall satisfaction with care (OR = 0.32, 95% CI 0.14-0.74) and strong adherence to traditional health beliefs (OR = 1.88, 95% CI 1.07-3.31). CONCLUSION: CAM use in Asian patients is prevalent and associated with the 'chronic disease triad' (of arthritis, musculoskeletal disorders and stroke), satisfaction with care and cultural beliefs. In particular, CAM use is not associated with the quality of doctor-patient interaction.
Adult↗
Screening for risk factors as a component of a chronic disease prevention program for youth.
Screening for risk factors within the framework of a chronic disease prevention program for youth can enhance both the educational and evaluative impact of the program. Screening results can provide the focus for curriculum development and the impetus for health-related behavior change. Program evaluation is facilitated by the use of screening results as objective outcome data regarding health status. The implementation of medical screening as a component of a chronic disease prevention program is described, and issues related to educational and evaluative impact are discussed.
Adolescent↗
A tailored program for the promotion of physical exercise among Korean adults with chronic diseases.
This study evaluated the effect of a tailored stage-matched intervention designed to increase exercise among Korean adults with chronic diseases. A physician and a nurse collaborated to deliver the intervention to 21 patients; the control group (CG) consisted of 20 patients. A nonequivalent CG pretest-posttest design was used. On follow-up, commitment to a plan for exercise was significantly greater in the intervention group (IG) than in the CG. Furthermore, the proportion of the IG in the active stage was significantly increased compared to that of the CG. The results suggest the potential of a stage-matched intervention program for increasing commitment to physical activity and for promoting progress through stages of exercise among patients with chronic diseases in a physician-based Korean clinic.
Adult↗
[Correlation between educational status, chronic diseases and cardiovascular risk factors in young adults 18-29 years of age: results of a 1998 comprehensive German health survey].
OBJECTIVES: The aim of the study is to investigate the association between educational attainment and the prevalence of chronic diseases and cardiovascular risk factors for the German population aged 18-29 years. METHODS: The data source is the Federal Health Survey 1998 (BGS98), which is representative for Germany. The response rate for the survey is 61.4%. Included in the analysis are 616 females and 637 males. Indicator for educational atteinment is the highest achieved school degree ("Abitur" n = 375, "mittlere Reife" n = 566, "Hauptschule" n = 312). RESULTS: For eight of the 43 items for self-reported diseases in the BGS98-questionnaire persons in the age group 18-29 yielded a higher prevalence than older adults. For altogether 11 diseases, which showed a prevalence greater than 3% in the age group 18-29 years, only minor associations with educational attainment were observed. Statistically significantly increased prevalences are observed for allergic disorders in persons with higher education and for long-term headache in persons with lower education. Regarding smoking, obesity and lack of sports activities remarkably and statistically significant education related differences are observed. The percentage of persons showing simultaneously two or three of these risk factors was 33% for study subjects with "Hauptschulabschluss" compared to only 8% for study subjects with "Abitur". CONCLUSIONS: Educational attainment is still a strong predictor for health behaviour. This finding should be considered in future health promotion compaigns.
Adolescent↗
Lay understanding of familial risk of common chronic diseases: a systematic review and synthesis of qualitative research.
PURPOSE: Although the family history is increasingly used for genetic risk assessment of common chronic diseases in primary care, evidence suggests that lay understanding about inheritance may conflict with medical models. This study systematically reviewed and synthesized the qualitative literature exploring understanding about familial risk held by persons with a family history of cancer, coronary artery disease, and diabetes mellitus. METHODS: Twenty-two qualitative articles were found after a comprehensive literature search and were critically appraised; 11 were included. A meta-ethnographic approach was used to translate the studies across each other, synthesize the translation, and express the synthesis. RESULTS: A dynamic process emerged by which a personal sense of vulnerability included some features that mirror the medical factors used to assess risk, such as the number of affected relatives. Other features are more personal, such as experience of a relative's disease, sudden or premature death, perceived patterns of illness relating to gender or age at death, and comparisons between a person and an affected relative. The developing vulnerability is interpreted using personal mental models, including models of disease causation, inheritance, and fatalism. A person's sense of vulnerability affects how that person copes with, and attempts to control, any perceived familial risk. CONCLUSIONS: Persons with a family history of a common chronic disease develop a personal sense of vulnerability that is informed by the salience of their family history and interpreted within their personal models of disease causation and inheritance. Features that give meaning to familial risk may be perceived differently by patients and professionals. This review identifies key areas for health professionals to explore with patients that may improve the effectiveness of communication about disease risk and management.
Chronic Disease↗
The role of statins in chronic kidney disease.
Chronic kidney disease is associated with cardiovascular event rates that are at least as high as in patients with established atherosclerotic cardiovascular disease or in those with diabetes mellitus. Chronic kidney disease is therefore considered a cardiovascular disease risk equivalent. Treatment of dyslipidemia, which is very common in this population and reflects the pattern seen in the metabolic syndrome, reduces cardiovascular events in patients with chronic kidney disease. Thus, patients with chronic kidney disease should be evaluated and treated for dyslipidemia. Dyslipidemia is a risk factor for the development of impaired kidney function. Dyslipidemia is also associated with progressive renal disease in subjects with no overt renal disease, as well as those with diabetic and nondiabetic kidney disease. Although definitive randomized controlled trials are lacking, the collective evidence suggests that treatment of dyslipidemia is associated with less decline in renal function. The use of potent statins in high doses can lead to transient proteinuria via impairment of proximal tubular receptor--mediated endocytosis, in a dose-dependent manner. Over the long term, however, the use of statins results in a reduction in proteinuria and in the rate of decline of renal function. Several large definitive trials that are currently underway to examine the safety and efficacy of statins in cardiovascular and renal protection should provide more definitive answers on the role of these drugs in this very high risk population.
Arteriosclerosis↗
The prevalence of selected chronic diseases among the Mexican-American elderly: data from the 1982-1984 Hispanic Health and Nutrition Examination Survey.
Although the Mexican-American elderly represent a large and rapidly growing subgroup of the ethnic aged, national prevalence data of major chronic diseases among this population are sparse. Data based on physical examinations from three older groups of the southwestern portion of the 1982-1984 Hispanic Health and Nutrition Examination Survey (HHANES) were reviewed to determine rates of hypertension, diabetes mellitus, arthritis, and heart disease. The results show a higher prevalence of diabetes and lower prevalence of heart disease and hypertension when compared with the general population, coinciding with data from previous studies. Findings for the prevalence of arthritis varied widely from other studies, however, and proportions were lower than expected. Further research on arthritis in the Mexican-American elderly is necessary to determine whether protective mechanisms that may lead to a lower prevalence of this disease exist in this ethnic subgroup.
Age Factors↗
Long-term follow-up of 82 patients with chronic disease of the thoracic aorta using spin-echo and cine gradient magnetic resonance imaging.
The objective of this study to examine the clinical impact of magnetic resonance imaging in long-term follow-up of patients (pts) with chronic disease of the thoracic aorta such as coarctation of the aorta, chronic aortic dissection and true aortic aneurysm. A total of 322 magnetic resonance examinations obtained in 82 pts with chronic disease of the thoracic aorta (31 pts with coarctation of the aorta (CoA), 29 pts with chronic aortic dissection and 22 pts with true aneurysm) over a period of 0.25 to 13.5 (mean +/- SD: 6.5 +/- 3.4) years were retrospectively reviewed. Diameters of the thoracic aorta were measured at predefined levels and morphological and functional parameters of special interest were analysed in each patient group. Pts were classified as having constant or progressive disease and clinical end-points were defined as (re-)operation or death. 43 pts (52%) (CoA 15 pts, chronic dissection 16 pts, true aneurysm 12 pts) had constant findings. None of them underwent (re-)operation and seven patients (16%) died, three of them from their aortic disease more than five years later after their last magnetic resonance examination, one from an arrhythmogenic event, and in the remaining 3 pts the cause of death could not be definitely established. 39 pts (48%) (CoA 16 pts, chronic dissection 13 pts, true aneurysm 10 pts) had progressive disease as demonstrated by repetitive magnetic resonance imaging. Of these 39 pts 24 pts underwent (re-)operation, in 15 pts operation was postponed. Four pts died from their aortic disease. Repetitive magnetic resonance imaging is a clinically feasible technique for long-term follow-up of pts with chronic disease of the thoracic aorta because it can detect progressive disease in a large subset of pts requiring elective surgery. The results of magnetic resonance imaging provided the rationale for either (re-)operation or conservative management, thus guiding patient management.
Adolescent↗
Self-management training for people with chronic disease: a shared learning experience.
The lay-led, Chronic Disease Self-Management Course (CDSMC) is designed to train people in self-management. The present study focused on the experiences of a group of participants attending the CDSMC. Data were collected via interviews with nine participants four months and twelve months after attending the CDSMC. Results showed that participants appreciated the opportunity to share experiences in a reassuring environment. Goal setting was critical in making changes. The CDSMC provided participants with the confidence to select the self-management technique that would meet their needs at a given point in time.
Aged↗
The use of group programs to improve medication compliance in patients with chronic diseases.
Non-compliance with medication is one of the major factors in the failure of therapeutic programs for patients having a chronic disease. The good results of a controlled study on the evolution of schizophrenic patients, who participated in a medication group program aimed at diminishing affective components of negative attitudes towards neuroleptics, are discussed. The building up of specific questionnaires could help in understanding the nature of the prejudices towards the use of medication in patients with chronic diseases. The organization of group programs could diminish patients' prejudices, thus improving compliance.
Attitude to Health↗
[Adult mortality from chronic diseases in Chile, 1968-1990].
"The paper starts with a brief analysis of the sources and the quality of the data and the mortality indices [for trends in adult mortality from chronic diseases in Chile]....A comparison is made of mortality among the 13 regions of the country and an attempt is made to relate the observed differences to some environmental and life-style factors. Rural-urban and educational differences of mortality by cause of death are also analyzed. The paper ends by comparing mortality by chronic disease in Chile with that of other countries of the Latin American region, noting some difficulties [in] such a comparison and proposing hypotheses for future studies." (SUMMARY IN ENG)
Adult↗
Chemopreventive effects of cocoa polyphenols on chronic diseases.
We have explored the causes of the major chronic diseases prevailing in the world and the relevant mechanisms as a sound basis for recommendations for their prevention. Research shows that the cocoa bean, and tasty products derived from the cocoa bean such as chocolate, and the beverage cocoa, popular with many people worldwide, is rich in specific antioxidants, with the basic structure of catechins and epicatechin, and especially the polymers procyanidins, polyphenols similar to those found in vegetables and tea. Metabolic epidemiological studies indicate that regular intake of such products increases the plasma level of antioxidants, a desirable attribute as a defense against reactive oxygen species (ROS). The antioxidants in cocoa can prevent the oxidation of LDL-cholesterol, related to the mechanism of protection in heart disease. Likewise, a few studies show that ROS associated with the carcinogenic processes is also inhibited, although there have not been many studies on a possible lower risk of various types of cancer either in humans or in animal models consuming cocoa butter or chocolates. Based on the knowledge acquired thus far, it would seem reasonable to suggest inhibition of the several phases of the complex processes leading to cancer, as a function of quantitative intake of antioxidants, including those from cocoa and chocolates. Cocoa and chocolate also contain fats from cocoa butter. These are mainly stearic triglycerides (C18:0) that are less well absorbed than other fats, and are excreted in the feces. Thus, cocoa butter is less bioavailable and has minimal effect on serum cholesterol.
Antioxidants↗
Mental and physical distress is modulated by a polymorphism in the 5-HT transporter gene interacting with social stressors and chronic disease burden.
Previous studies have yielded conflicting results as to the putative role of the functional polymorphism of the promoter region of the serotonin transporter gene (SLC6A4) in the etiology of anxiety-related traits and depressive disorders. Recently, a significant gene-environment interaction was found between life stressors, the short allele of the SLC6A4 polymorphism and depression. The aim of the present study was to investigate if such a gene-environment interaction could be replicated within a different population with a different risk structure. A total of 1005 subjects from a general population sample (Study of Health in Pomerania) were genotyped. Mental and physical distress were assessed on 38 items of the modified complaint scale (BL-38). The interaction between the SLC6A4 genotype, social stressors and chronic diseases with regard to the BL-38 score was evaluated by ANOVA. There was no independent association of genotype with mental and physical distress. However, significant interactions between genotype, unemployment and chronic diseases (F = 6.6; df = 3, 671; P < 0.001) were found in females but not in males. The genotype explained 2% of the total variance of the BL-38 score and 9.1% of the explained variance. The results partly confirm previous findings of a significant gene-environment interaction of the short allele, indicating a higher mental vulnerability to social stressors and chronic diseases. The relevance of this finding is sustained by the fact that the sample characteristics and the risk structure were highly different from previous studies.
Adaptation, Physiological↗
[Problems and solutions in health care for chronic diseases. A qualitative study with patients and doctors].
BACKGROUND: Chronic diseases represent a challenge for health systems and the professionals most involved in chronic care. Despite biomedical advances, the results of care for chronic problems are not as good as they should be. OBJECTIVE: To find out what doctors and patients think of care for some of the main chronic illnesses; to detect concrete areas of deficit and lack of satisfaction felt by both sides and possible lines of improvement; to raise mutual understanding between patients and doctors. PARTICIPANTS: Forty-one patients with fibromyalgia or diabetes mellitus, carers for people with Alzheimer's and breast cancer patients. Forty-three family doctors involved in health care delivery to this kind of patient. METHODS: Four discussion groups. Transcription and syntactical, semantic and pragmatic contents analysis, with both pre-established and emerging categories of consensus. RESULTS: Patients thought, with different nuances as a function of the problem put forward, that questions of respectful, human and integrated care, clear and suitable information, and consistent follow-up were important and insufficiently covered by doctors and health services. Doctors thought that many of their efforts in caring for these patients were useless, and thought it important to reconsider their clinical responsibilities and the patient-doctor relationship. Doctors highlighted the limitations in the health care resources available for working with these patients. CONCLUSIONS: To tackle prevalent chronic problems requires, in the view of doctors and patients, important modifications that are related mainly to the kind of relationship between the two, with new clinical responsibilities and certain organisational care delivery features.
Adult↗