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At least 811 records · Page 45Linked to original sources
PubMed2002

Regulation of muscle cathepsin B proteolytic activity in protein-depleted patients with chronic diseases.

BACKGROUND & AIMS: The lysosomal cathepsin system contributes to degrading cellular skeletal muscle proteins in many catabolic diseases. We have assessed the relationships between cathepsin B mRNA levels and the enzyme activity for this protease in the skeletal muscle of acutely ill patients with severe trauma (n=7) and in patients with a variety of chronic disease states (hemodialysis, n=3; nervous anorexia, n=1; type 2 diabetes, n=2; prolonged immobilization, n=1). METHODS: Muscle biopsies were taken from the vastus lateralis muscle in patients and controls to assess tissue levels of cathepsin B mRNA by competitive-quantitative polymerase chain reaction, cathepsin B proteolytic activity and myofibrillar protein content as alkali-soluble protein to DNA ratio (ASP/DNA). In the trauma patients, muscle protein loss was assessed by the arteriovenous balance technique as rate of phenylalanine release from leg muscle. RESULTS: The acute trauma patients exhibited a significant net phenylalanine release from leg muscle (33+/-4 nmol phenylalanine/min/100 ml leg volume) despite a continuous nutritional support. The muscle ASP/DNA ratio was lower (P<0.05) in the patients with chronic diseases (383+/-33) than in groups of healthy controls (554+/-41) or of uncomplicated, moderately obese subjects (525+/-26). Cathepsin B mRNA levels were 6-10 times greater (P<0.05) in the patients with acute trauma or chronic catabolic diseases than in the healthy subjects. Cathepsin B enzymatic activity were 2-3 times greater (P<0.05) in the chronic and acute patients than in the group of uncomplicated, moderately obese subjects. Regression analysis between cathepsin B mRNA and cathepsin B enzymatic activity indicates a significant direct correlation (r=0.84; P<0.05) in the chronic catabolic conditions, but not in the acute trauma patients (r=-0.05). CONCLUSIONS: In skeletal muscle of patients with stable chronic catabolic diseases, cathepsin B activity is directly related to cathepsin B mRNA levels, suggesting that in these patients this enzyme could be mainly regulated at the level of gene transcription.

Analysis of Variance↗
PubMed1991

[The status of stomatologic prevention and therapy in children with chronic diseases].

In Children with chronic disorders the motivation for oral health is not sufficiently strong. Neither the quantity nor the quality of the oral hygiene for their deciduous and permanent teeth is adequate to counteract the specific demands of the diseases. Regular paediatric dental care for chronically sick children in close cooperation with the attending paediatrician can make oral health a reality throughout childhood and adolescence.

Child↗
PubMed2006

A logic model for the integration of mental health into chronic disease prevention and health promotion.

Mental illnesses such as depression or anxiety affect an individual's ability to undertake health-promoting behaviors. Chronic diseases can have a profound impact on an individual's mental health; in turn, mental health status affects an individual's ability to participate in treatment and recovery. A group of mental health and public health professionals convened to develop a logic model for addressing mental health as it relates to chronic disease prevention and health promotion. The model provides details on inputs, activities, and desired outcomes, and the designers of the model welcome input from other mental health and public health practitioners.

Algorithms↗
PubMed2003

Low-glycemic-load diets: impact on obesity and chronic diseases.

Historically, carbohydrates have been thought to play only a minor role in promoting weight gain and in predicting the risk of development of chronic disease. Most of the focus had been on reducing total dietary fat. During the last 20 years, fat intake decreased, while the number of individuals who were overweight or developed a chronic conditions have dramatically increased. Simultaneously, the calories coming from carbohydrate have also increased. Carbohydrates can be classified by their post-prandial glycemic effect, called the glycemic index or glycemic load. Carbohydrates with high glycemic indexes and high glycemic loads produce substantial increases in blood glucose and insulin levels after ingestion. Within a few hours after their consumption, blood sugar levels begin to decline rapidly due to an exaggerated increase in insulin secretion. A profound state of hunger is created. The continued intake of high-glycemic load meals is associated with an increased risk of chronic diseases such as obesity, cardiovascular disease, and diabetes. In this review, the terms glycemic index and glycemic load are defined, coupled with an overview of short- and long-term changes that occur from eating diets of different glycemic indexes and glycemic loads. Finally, practical strategies for how to design low-glycemic-load diets consisting primarily of low-glycemic carbohydrates are provided.

Adolescent↗
PubMed2004

Cochlear implantation in the chronically diseased ear.

PURPOSE OF REVIEW: The presence of chronic ear disease in patients with profound SNHL presents a challenge to the otologic surgeon and was considered, in the past, a contraindication to cochlear implantation. This review discusses options for cochlear implantation in patients with chronically diseased ears. RECENT FINDINGS: Several management options are available for cochlear implantation in patients with chronic suppurative otitis media (CSOM) and severe to profound sensorineural hearing loss (SNHL). CONCLUSION: Cochlear implantation can be safely achieved in patients with CSOM. The approach chosen should be individualized based on clinical findings.

Adolescent↗
PubMed2004

Platelet count, previous infection and FCGR2B genotype predict development of chronic disease in newly diagnosed idiopathic thrombocytopenia in childhood: results of a prospective study.

About 25-30% of children with acute idiopathic thrombocytopenia (ITP) develop chronic disease. It is not well known which patient characteristics influence the course of the ITP. A prospective study in 60 children with newly diagnosed ITP was performed. The aim of the study was to identify patient characteristics at the onset of thrombocytopenia that predicts the progression to chronic ITP. Clinical data and blood samples were collected at several time points during the first 6 months of the disease. Variables predicting chronic disease, as calculated in a multivariate logistic regression analysis, were a platelet count >10 x 10(9)/l at the onset [odds ratio (OR) 1.1, 95% confidence interval (CI) 1.01-1.14], the absence of infection shortly before the onset of the disease (OR 4.8, CI 1.16-19.57) and FGR2B-232I/T genotype (OR 7.9, CI 0.96-65.27). The latter may point at an immune-modulating role of Fc gamma RIIb in ITP. Although only three patients had serious bleeds, 35 patients received immune-modulating treatment for low platelet counts only. Seventeen patients were treated with intravenous immunoglobulin (IVIG) and 18 patients received corticosteroids. Patient variables did not differ between these treatment groups. However, patients receiving IVIG had significantly lower risk for chronic disease.

Adolescent↗
PubMed2005

Statewide community-based health promotion: a North Carolina model to build local capacity for chronic disease prevention.

BACKGROUND: Public health faces major challenges to building state and local infrastructure with the capacity to address the underlying causes of chronic disease. We describe a structured statewide approach to providing technical assistance for local communities to support and develop health promotion capacity. CONTEXT: Over the last two decades, the North Carolina Statewide Health Promotion program has supported local approaches to the prevention and control of chronic disease. In 1999, a major change in the program required local health departments to focus on policy-change and environmental-change strategies for addressing three major risk factors: physical inactivity, poor diet, and tobacco use. METHODS: State program consultants provided technical assistance and training opportunities to local programs on effective policy-change and environmental-change strategies and interventions, based on needs defined by a statewide monitoring and evaluation system. CONSEQUENCES: The percentage of health departments in North Carolina with interventions addressing at least one of three targeted risk factors in 2004 approached 100%; in 2001, this percentage was 62%. Additionally, between 2001 and 2004, the number of health departments reporting policy or environmental outcomes related to these risk factors almost doubled. INTERPRETATION: Requiring local programs to implement policy-change and environmental-change interventions that address the three major behavioral risk factors provides an organized framework for accountability. An established reporting system guides technical assistance efforts and monitors their effectiveness based on standardized objectives that address the full scope of the socioecologic model.

Chronic Disease↗
PubMed1992

Anemias of chronic disease in the aged: diagnosis and treatment.

The classic anemia of chronic disease is sideropenic and is the result of subacute or chronic inflammatory illness, including malignancy. Nonsideropenic anemias, by contrast, are the result of failure of vital organs or endocrine glands. The pathophysiology of these anemias is multifactorial, but underlying all of them is absolute or relative hypoerythropoietinemia. Therapy consists of treating the underlying illness and, if necessary, providing packed red blood cell transfusions. Some patients will respond to recombinant erythropoietin injections, which have been shown to result in improved hemoglobins and hematocrits and an enhanced quality of life.

Aged↗
PubMedDate not supplied

Epilogue. Establishment of the Center for Chronic Disease Prevention and Health Promotion.

The establishment of the Center for Chronic Disease Prevention and Health Promotion (CCDPHP) at the Centers for Disease Control (CDC) following the Conferences on the State of the Art in Quality Control Measures for Diagnostic Cytology Laboratories is briefly discussed. The CCDPHP is expected to play a major role in the CDC's cancer control program, including participation in establishing effective screening programs and assuring the quality of such methodologies as the Papanicolaou test and mammography.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

[Cardiovascular and pupillary autonomic and somatosensory neuropathy in chronic diseases with autoimmune phenomena. A comparative study of patients with Crohn disease, ulcerative colitis, systemic lupus erythematosus, progressive systemic sclerosis and type I diabetes mellitus].

BACKGROUND: During the last years, examination of autonomic nervous function and of autonomic neuropathy has attracted attention not only in diabetes mellitus research but also in other areas of internal medicine. However, patients with various chronic diseases with autoimmune phenomenons have never been investigated in a comparative study with standardized examination techniques. Hence, the aim of the study was to examine the prevalence and the severity of autonomic neuropathy in patients with the following chronic diseases. PATIENTS AND METHODS: We investigated 28 patients with Crohn's disease (CD: age: 32.4 +/- 2.0 y), 17 patients with ulcerative colitis (UC: 39.7 +/- 3.6 y), 39 patients with systemic lupus erythematosus (SLE: 34.9 +/- 2.0 y), 38 patients with progressive systemic sclerosis (pSS; 51.5 +/- 2.4 y) and 65 patients with insulin-dependent diabetes mellitus (IDDM: 35.5 +/- 1.6 y). Cardiovascular autonomic (cANP), pupillary autonomic (pANP), and sensorimotor (ssNP) neuropathy were assessed by standardized techniques. RESULTS: Prevalence rates for cANP, pANP and ssNP were found to be 0%, 19%, and 7% in CD, 6%, 25%, and 18% in UC, 5%, 29%, and 10% in SLE, 11%, 16%, and 32% in pSS, and 26%, 66%, and 29% in IDDM, respectively. CONCLUSION: The study demonstrated patients with IDDM to have the highest prevalence rates of cANP and pANP. Patients with other chronic diseases, particularly SLE, pSS and UC, had high prevalence rates of pANP. This may be due to alterations of structures of the central nervous system in these patients. cANP was rare in patients with inflammatory bowel disease and ssNP was found very often in patients with pSS, probably due to local fibrotic lesions. The various disease groups differ in the pattern and severity of autonomic and sensorimotor neuropathy, which indicates that different structures and neuropathogenic mechanisms may be involved.

Adult↗
PubMed2006

Admission-specific chronic disease scores as alternative predictors of surgical site infection for patients undergoing coronary artery bypass graft surgery.

OBJECTIVE: To evaluate the admission chronic disease score (ACDS) and a variant of the ACDS as predictors of surgical site infection (SSI) for study participants who underwent coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective case-control study. SETTING: A 750-bed academic medical center. PARTICIPANTS: All participants with an SSI that was identified through hospital-based surveillance (defined as case patients) and a random sample of participants without SSI following CABG surgery (defined as control subjects) between July 1, 1999, and June 30, 2001. RESULTS: An ACDS based on medications ordered on the day of hospital admission was determined for 264 study participants admitted prior to the day of the surgical procedure. A preadmission chronic disease score (PACDS) based on outpatient medications was calculated for 281 participants, using the record of preadmission medications in the patient's discharge summary. The ACDS and PACDS were significantly higher for case patients, compared with control subjects (P=.03 and P=.05, respectively). American Society of Anesthesiologists (ASA) score and the standard National Nosocomial Infection Surveillance system (NNIS) risk index were not significant predictors of SSI. In logistic regression models, only the ACDS (odds ratio, 1.02 per 100 ACDS points), the PACDS (odds ratio, 1.02 per 100 PACDS points), the highest PACDS quintile (odds ratio, 2.89 [compared with lowest quintile]), and a modified NNIS-PACDS score of 2 (odds ratio, 3.5 [compared with a score of 0]) were significant predictors of SSI. CONCLUSIONS: Because preoperative medications are likely to reflect comorbidities that influence the risk of SSI, medication-based scoring systems such as the ACDS and PACDS may allow for better risk stratification than the standard NNIS risk index, particularly for patient populations with relatively homogenous wound classification and ASA score distributions.

Aged↗
PubMed2002

Puberty in chronically diseased patients.

Delayed onset of puberty and a reduced pubertal growth spurt are often reported in patients suffering from chronic diseases. The basis of abnormal puberty in these patients is multifactorial. Nutritional deficiency may contribute to growth disorders and delayed puberty. Insufficient food supply and/or eating disorders and/or malabsorption of nutrients can be observed in these patients. Moreover, increased energy supplies are often needed in patients with chronic lung disease, infection or inflammation. More specific factors due to the disease itself may be involved in growth and puberty disorders. Abnormalities of the growth hormone (GH)-insulin-like growth factor (IGF)1 axis and gonadotrophin secretion have been described in patients with chronic renal failure, cystic fibrosis and Crohn's disease. More recently, it has been shown that cytokines produced during chronic diseases such as juvenile idiopathic arthritis may affect the GH-IGF1 axis. Finally, concomitant medication, namely corticosteroids, which are often given to these patients, may contribute to delayed puberty and poor pubertal growth.

Adolescent↗
PubMed2006

Chronic disease - related behaviors and health among African Americans and Hispanics in the REACH Detroit 2010 communities, Michigan, and the United States.

OBJECTIVES: To compare chronic disease risk factors and their correlates for African American and Hispanic residents of REACH Detroit, Michigan, and the United States. METHOD: Behavioral Risk Factor Survey data from 2001-2003 were used for comparisons and regression models. RESULTS: Several chronic disease risk factors were more prevalent among REACH Detroit residents than their Michigan and U.S. counterparts. In REACH Detroit, greater fruit and vegetable consumption was associated with more than high school education and older age among Hispanics, and meeting exercise guidelines and older age among African Americans. Less than high school education, smoking, and male gender were associated with lower consumption among African Americans. Greater physical activity was associated with younger age, male gender, and more fruit and vegetable consumption among African Americans, and unemployment among Hispanics. CONCLUSIONS: Surveillance of health behaviors in high-risk communities contributes to planning interventions and policies for reducing racial and ethnic disparities.

Adolescent↗
PubMed2005

Natural health products, modulation of immune function and prevention of chronic diseases.

The immune system is increasingly found to be involved in the development of several chronic illnesses, for which allopathic medicine has provided limited tools for treatment and especially prevention. In that context, it appears worthwhile to target the immune system in order to modulate the risk of certain chronic illnesses. Meanwhile, natural health products (NHPs) are generating renewed interest, particularly in the prevention and treatment of several chronic diseases. Over 20 scientists from fields related to immune function and NHPs were thus convened to establish the state of knowledge on these subjects and to explore future research directions. This review summarizes the result of discussions held during the symposium. It thus seeks to be thought provoking rather than to comprehensively cover such broad areas of research. Notably, a brief overview of the immune system is presented, including potentially useful targets and strategies to keep it in an equilibrated state, in order to prevent certain disorders. The pertinence and limitations of targeting the immune system to prevent chronic diseases is also discussed. The paper then discusses the usefulness and limitations of current experimental tools available to study the immune modulating effects of NHPs. Finally, a concise review of some of the most studied NHPs showing promising immunomodulatory activity is given, and avenues for future research are described.

Journal Article↗
PubMed1980

Evaluation of a decentralized system for chronic disease care: seven years of observation.

Observations of a publicly-financed system for the medical care of a large number of persons with chronic diseases have been made over seven years. The system combines decentralized, nurse-staffed neighborhood clinics, operated by a public health department, with a central referral clinic for consultations and the management of complicated problems. After seven years in the chronic disease program 55% of 1,004 patients with diagnoses of diabetes mellitus, hypertension, and cardiac diseases were still receiving care, 19% had died, and 26% had been lost to the program. In the seventh year, the mean diastolic blood pressure in hypertensives was 84 mm Hg and the mean serum glucose in diabetics was 203 mg/dl. For the group under care, hospital days/1000/year were 74% of the rate during the year before referral to the program and out-patient visits/1000/year were approximately the same as before referral. However, two-thirds of the visits, formerly made to a public hospital, were now being made to neighborhood clinics. The system appears to be an effective method of providing medical services for persons who formerly used the public hospital as their source of outpatient care.

Chronic Disease↗
PubMedDate not supplied

[Children and adolescents with chronic disease: living with changes].

This study concerns descriptive and exploratory, with aimed at apprehending by means of interviews the experiences of children and adolescents with a chronic disease, as it is felt by them. The results show that the lives of children and adolescents are changed by frequent hospitalizations and by the limitations imposed by the disease, which causes alterations particularly in their schooling process. Considering that children and adolescents experience complex feelings and situations in the everyday routine of living with a chronic disease, it is important that health care professionals learn about such needs and incorporate them to care planning, aiming at providing effective intervention in order to promote growth and development.

Adaptation, Psychological↗
PubMed1998

A longitudinal study of hospitalization rates for patients with chronic disease: results from the Medical Outcomes Study.

OBJECTIVE: To prospectively compare inpatient and outpatient utilization rates between prepaid (PPD) and fee-for-service (FFS) insurance coverage for patients with chronic disease. DATA SOURCE/STUDY SETTING: Data from the Medical Outcomes Study, a longitudinal observational study of chronic disease patients conducted in Boston, Chicago, and Los Angeles. STUDY DESIGN: A four-year prospective study of resource utilization among 1,681 patients under treatment for hypertension, diabetes, myocardial infarction, or congestive heart failure in the practices of 367 clinicians. DATA COLLECTION/EXTRACTION METHODS: Insurance payment system (PPD or FFS), hospitalizations, and office visits were obtained from patient reports. Disease and severity indicators, sociodemographics, and self-reported functional status were used to adjust for patient mix and to compute expected utilization rates. PRINCIPAL FINDINGS: Compared to FFS, PPD patients had 31 percent fewer observed hospitalizations before adjustment for patient differences (p = .005) and 15 percent fewer hospitalizations than expected after adjustment (p = .078). The observed rate of FFS hospitalizations exceeded the expected rate by 9 percent. These results are not explained by system differences in patient mix or trends in hospital use over four years. Half of the PPD/FFS difference in hospitalization rate is due to intrinsic characteristics of the payment system itself. CONCLUSIONS: PPD patients with chronic medical conditions followed prospectively over four years, after extensive patient-mix adjustment, had 15 percent fewer hospitalizations than their FFS counterparts owing to differences intrinsic to the insurance reimbursement system.

Adult↗