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PubMed2006

The coalition process at work: Building care coordination models to control chronic disease.

Asthma is a highly prevalent and frequently misunderstood chronic disease with significant morbidity. Integrating client services at the patient-centered level and using coalitions to build coordinated, linked systems to affect care may improve outcomes. All seven Allies Against Asthma coalitions identified inefficient, inconsistent, and/or fragmented care as issues for their communities. In response, the coalitions employed a collaborative process to identify and address problems related to system fragmentation and to improve coordination of care. Each coalition developed a variety of interventions related to its specific needs and assets, stakeholders, stage of coalition formation, and the dynamic structure of its community. Despite common barriers in forming alliances with busy providers and their staff, organizing administrative structures among interinstitutional cultures, enhancing patient and/or family involvement, interacting with multiple insurers, and contending with health system inertia, the coalitions demonstrated the ability to produce coordinated improvements to existing systems of care.

Asthma↗
PubMed2004

Chronic diseases: what are they? How are they inherited?

BACKGROUND: Chronic diseases (CD), miasms or reactional modes, remain one of the darkest concepts of homeopathy. They are supposed to be heritable and originate after suppression of other diseases. Besides this nothing is known about how they might produce the large number of diseases mentioned in homeopathic books. They have been described in a variety of terms, ranging from Kent and Gathak's spiritual or metaphysic conception; the biological-allergic by Paschero, and, Robert's materialist-nutritional point of view. Flores-Bejar et al have outlined an approach to CD from a cellular and bioenergetic point of view. RESULTS: Cellular pathology has led to an understanding of the basic repair mechanisms of every cell and tissue. These mechanisms exist in order to avoid necrosis or cell death. The main mechanisms are molecular repair, apoptosis and cell proliferation. Failure of these mechanisms leads to 'dysrepair'. Consequences of these 'dysrepair' mechanisms resemble the homeopathic reactional modes or miasms. These abnormal or 'dysrepair' mechanisms are probably the basis of miasms or reactional modes. A new interpretation of miasms is proposed: Psora corresponds to the dysmolecular reactional mode. Syphilis corresponds to dysapoptotic reactional mode. Sycosis corresponds to dysproliferative reactional mode.

Apoptosis↗
PubMed2000

The development of an instrument to measure the compliance of adolescents with a chronic disease.

The purpose of this paper was to describe the process of developing an instrument for measuring the compliance of adolescents with a chronic disease. The aim was to develop an instrument that could be used in a clinical setting to evaluate the compliance of young people with a chronic disease and to test a theoretical model of compliance, which had been developed along with the instrument. The instrument was originally developed to measure the compliance of adolescents with diabetes and later adjusted to measure the compliance of adolescents with asthma, rheumatoid arthritis and epilepsy. To test and develop the instrument, face and criterion validity, factor analyses, linear structural relations (LISREL) analyses, correlation coefficients and Cronbach's alpha were used. The instrument has 13 background questions and 41 items to measure compliance and factors connected to it.

Adolescent↗
PubMed2002

Diminished T cell numbers in patients with chronic granulomatous disease.

Chronic granulomatous disease is a neutrophil disorder in which phagocytic cells fail to produce a respiratory burst. Five genetic types of chronic granulomatous disease have been described and in each case the clinical manifestations relate to the inability to effectively kill catalase-positive organisms. It is classically described as a pure disorder of intracellular killing, with preservation of other aspects of phagocytic function such as migration and phagocytosis and normal function of nonmyeloid cells. This article describes a heretofore unrecognized feature of chronic granulomatous disease. Fifty-three patients with chronic granulomatous disease and 42 age-matched controls were studied by flow cytometry. Total T cell numbers and CD4 and CD8 T cell numbers were compared between patients and controls. Patients with chronic granulomatous disease had diminished T cell numbers compared to controls after 3 years of age. The difference increased with age. It is not known whether diminished T cell numbers influence the susceptibility to infections in these patients, but T cell effects could represent a significant cofactor for infection.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Chronic disease prevention in Laredo, Texas.

The Laredo-Webb County Health Department began planning a health promotion program for the prevention of chronic diseases during the late 1970s. After receiving a 4-year grant from the W.K. Kellogg Foundation, the Department initiated the program in 1983 by conducting an epidemiologic survey in Laredo, Texas, to determine the major risk factors for chronic disease. A comprehensive health education program was then initiated to reduce the prevalence of these factors in targeted low-income neighborhoods. Health information was disseminated among the population in small neighborhood groups using a variety of techniques to promote favorable changes in health behavior. An evaluation of the program in one neighborhood 1 year later showed an overall reduction in health risk practices of approximately 10%.

Chronic Disease↗
PubMed2005

Childhood idiopathic thrombocytopenic purpura in the Nordic countries: epidemiology and predictors of chronic disease.

AIM: To describe the epidemiology of idiopathic thrombocytopenic purpura (ITP) in the Nordic countries, to define clinical subgroups and to investigate factors predicting chronic disease. METHODS: A prospective registration was done from 1998 to 2000, including all children with newly diagnosed ITP aged 0-14 y and at least one platelet count <30 x 10(9)/l. RESULTS: 506 children were registered and 423 followed for 6 mo. The incidence was 4.8/10(5) per year. Most children were aged 0-7 y (78%), with a predominance of boys, while patients aged 8-14 y had equal representation of the two sexes. There were seasonal variations determined by variations in postinfectious cases with sudden onset. The platelet count was <10 x 10(9)/l in 58%, but bleeding manifestations were mild or moderate in 97%. The insidious form (symptoms for more than 2 wk) was more frequent in older children and girls, showed little seasonal variation, had milder manifestations and ran a chronic course in more than half the cases. Intracranial haemorrhages did not occur in the first 6 mo after diagnosis. Chronic ITP developed in 25%. The strongest predictor of chronic disease was insidious onset of symptoms (OR 5.97). CONCLUSION: In the Nordic countries, ITP mainly affects children aged 0-7 y, with a winter bulk of postinfectious cases superimposed on a steady occurrence of non-infectious cases. Clinically, it may be useful to distinguish between children with sudden versus insidious onset of symptoms rather than between different age groups.

Acute Disease↗
PubMed1993

Health promotion counseling of chronic-disease patients during primary care visits.

OBJECTIVES: This study was designed to provide an empirical description, based on a review of visit audiotapes, of primary care practice with chronic-disease patients. METHODS: We analyzed 439 interactions between adult patients with chronic disease and 49 physicians. We explored the content, frequency, intensity, and dynamics of health promotion discussion during these routine visits. RESULTS: There was evidence of health promotion discussion in more than half (53%) of the audiotapes reviewed. When life-style topics were discussed, the discussion lasted a mean of 4 1/2 minutes, or 20% of the length of the visit. Diet/weight control was the most frequently discussed topic, followed by exercise, stress, smoking, and alcohol. Stress was by far the most time-consuming topic; stress-related discussion took an average of 6 minutes. CONCLUSIONS: Nearly 60% of the discussion that took place were not merely perfunctory but were attempts to counsel or encourage behavior change in the patient. Physicians used a wide range of behavioral counseling strategies, including providing a rationale for the recommended change and specific instructions to facilitate change. Other strategies noted as "effective" in the literature, however, were used infrequently and indicate obvious areas of weakness in physician performance.

Adult↗
PubMed2006

Nutrition and chronic disease prevention: priorities for US minority groups.

Persistent disparities affecting US racial/ethnic minorities present a continuing challenge within the larger picture of chronic disease prevention, in part because of the socio-political disadvantages that affect minority populations. Many of these disparities are nutrition related. Complementary approaches to identifying priorities for nutrition assessment and intervention in minority populations include: 1) a dietary perspective that considers eating patterns in relation to current dietary guidelines, and 2) a chronic disease perspective that considers dietary implications of population risk profiles. Integrating these perspectives requires additional considerations of feasibility and relative priority for the population in question.

Chronic Disease↗
PubMed2006

Evolutionary aspects of diet, the omega-6/omega-3 ratio and genetic variation: nutritional implications for chronic diseases.

Anthropological and epidemiological studies and studies at the molecular level indicate that human beings evolved on a diet with a ratio of omega-6 to omega-3 essential fatty acids (EFA) of approximately 1 whereas in Western diets the ratio is 15/1 to 16.7/1. A high omega-6/omega-3 ratio, as is found in today's Western diets, promotes the pathogenesis of many diseases, including cardiovascular disease, cancer, osteoporosis, and inflammatory and autoimmune diseases, whereas increased levels of omega-3 polyunsaturated fatty acids (PUFA) (a lower omega-6/omega-3 ratio), exert suppressive effects. Increased dietary intake of linoleic acid (LA) leads to oxidation of low-density lipoprotein (LDL), platelet aggregation, and interferes with the incorporation of EFA in cell membrane phospholipids. Both omega-6 and omega-3 fatty acids influence gene expression. Omega-3 fatty acids have anti-inflammatory effects, suppress interleukin 1beta (IL-1beta), tumor necrosis factor-alpha (TNFalpha) and interleukin-6 (IL-6), whereas omega-6 fatty acids do not. Because inflammation is at the base of many chronic diseases, dietary intake of omega-3 fatty acids plays an important role in the manifestation of disease, particularly in persons with genetic variation, as for example in individuals with genetic variants at the 5-lipoxygenase (5-LO). Carotid intima media thickness (IMT) taken as a marker of the atherosclerotic burden is significantly increased, by 80%, in the variant group compared to carriers with the common allele, suggesting increased 5-LO promoter activity associated with the (variant) allele. Dietary arachidonic acid (AA) and LA increase the risk for cardiovascular disease in those with the variants, whereas dietary intake of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) decrease the risk. A lower ratio of omega-6/omega-3 fatty acids is needed for the prevention and management of chronic diseases. Because of genetic variation, the optimal omega-6/omega-3 fatty acid ratio would vary with the disease under consideration.

Biological Evolution↗
PubMed2004

A regional health care system partnership with local communities to impact chronic disease.

Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project. In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases. The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.

Academies and Institutes↗
PubMed1989

Transmission of Alpers' disease (chronic progressive encephalopathy) produces experimental Creutzfeldt-Jakob disease in hamsters.

We successfully and serially transmitted to outbred and inbred strains of hamsters the brain tissue of a 2 1/2-year-old girl with a chronic progressive encephalopathy (Alpers' disease) characterized postmortem as a spongiform encephalopathy. In all hamster strains we produced a spongiform encephalopathy. The light and ultrastructural changes in the brain of hamsters, as well as the clinical signs of experimental disease, are identical to those obtained in transmission experiments of human Creutzfeldt-Jakob disease (CJD). CJD infection may be more widespread than previously recognized and can be manifested in infancy.

Animals↗
PubMedDate not supplied

DIABCARD a smart card for patients with chronic diseases.

Within the European Union-sponsored project DIABCARD, the core of a chip-card-based medical information system for patients with chronic diseases, exemplified on diabetes mellitus, has been developed. The long-term goal of the project is to improve the medical record and the quality of care for patients with chronic diseases. The basic idea is to have a portable electronic medical record on a smart card. This will improve the communication between the different healthcare personnel and between different institutions and, at the same time, promote shared care. The DIABCARD chip-card-based medical information system will offer controlled access to the necessary and up-to-date patient record to everyone involved in the patient's treatment, and it will help reduce the constantly rising healthcare expenditure. The system first was implemented in a small version. The system architecture contains hardware, software, and orgware. It considers especially the memory of the chip card, the processor, the data structure, security functions, the operating system on the chip card, the interface between the chip card and the application, and various application areas. The DIABCARD dataset was defined via an information model, which describes the different communication processes, via acknowledged diabetes datasets and medical scenarios. It includes, among others, emergency data, data for quality assurance, and data for blood glucose self-monitoring. The first prototype has been developed, and a pilot was run for 3 months.

Chronic Disease↗
PubMed2005

Transtheoretical model-chronic disease care for obesity in primary care: a randomized trial.

OBJECTIVE: To compare health benefits achieved in a transtheoretical model-chronic disease (TM-CD) minimal intervention for obesity vs. augmented usual care (AUC). RESEARCH METHOD AND PROCEDURES: This was a 2-year, randomized clinical trial with overweight or obese men and women from 15 primary care sites. AUC (n = 336) included dietary and exercise advice, prescriptions, and three 24-hour dietary recalls every 6 months. TM-CD care (n = 329) included AUC elements plus "stage of change" (SOC) assessments for five target behaviors every other month, mailed SOC and target behavior-matched workbooks, and monthly telephone calls from a weight-loss advisor. Weight change was the primary outcome. RESULTS: Repeated measures models under the missing at random assumption yielded nonsignificant adjusted differences between the AUC and TM-CD groups for weight change, waist circumference, energy intake or expenditure, blood pressure, and blood lipids. The pattern of change over time suggested that TM-CD participants were trying harder to impact target behaviors during the first 6 to 12 months of the trial but relapsed afterward. Sixty percent of trial participants maintained their baseline weights for 18 to 24 months. DISCUSSION: A combination of mailed patient materials and monthly telephone calls based on the transtheoretical model and some elements of chronic disease care is not powerful enough, relative to AUC, to alter target behaviors among overweight primary care patients in an obesogenic environment. AUC may be sufficient to maintain weights among at-risk primary care patients.

Adult↗
PubMed1999

Growth retardation in chronic diseases: possible mechanisms.

Multiple and complex mechanisms are likely to be involved in producing the growth retardation that occurs in children with chronic disease. The principal mechanisms in the pathway leading to growth arrest include too little substrate available to the child, excessive need for and over-consumption of substrate, and inefficient management of body components needed for growth. It is proposed that alterations in the growth hormone (GH)-insulin-like growth factor (IGF) system play a major role at each of the steps between insult from chronic disease and growth retardation. When substrate is insufficient, the production and action of IGF-I are attenuated at multiple points in the GH-IGF cascade. When over-consumption of substrate occurs, a situation of 'internal starvation' probably develops--leading to events similar to those that take place when substrate supply is inadequate. Finally, conditions that cause inefficient management of body components needed for growth, as characterized by increased proteolysis, appear to be attenuated by GH and IGF-I.

Adolescent↗