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PubMed2005

[Prevalence of a set of risk factors for chronic diseases in the city of São Paulo, Brazil].

OBJECTIVE: To estimate the prevalence of a set of risk factors for non-transmissible chronic diseases and compare it to that found 15-16 years ago in a similar survey. METHODS: A cross-sectional household survey was carried out comprising a random sample of people aged 15-59 years in the city of São Paulo between 2001 and 2002. The total of 2,103 people answered a questionnaire and had their blood pressure, weight, height, waist and hip circumferences measured. For a third of these participants, their total cholesterol, HDL-cholesterol, triglycerides and glucose levels were determined. RESULTS: The total age-adjusted prevalences in the study age group were as follows: smoking, 22.6%; uncontrolled blood pressure, 24.3%; obesity, 13.7%; increased waist circumference, 19.7%; total cholesterol >or =240 mg/dL, 8.1%; HDL-cholesterol <40 mg/dL, 27.1%; triglycerides > or =200 mg/dL, 14.4%; and blood glucose > or =110 mg/dL, 6.8%. Smoking, uncontrolled blood pressure, high total cholesterol, low HDL-cholesterol and high triglycerides were significantly more prevalent in men than women. CONCLUSIONS: The prevalences of a set of risk factors for chronic diseases showed men to have a poorer condition than women. In comparison to the previous survey, the prevalence of uncontrolled blood pressure remained unchanged but the prevalence of smoking has significantly lowered.

Adolescent↗
PubMed1998

Dealing with obesity as a chronic disease.

There are major efforts underway to educate the primary care physician about the health risks of obesity. Obesity is a chronic disease that requires chronic management. We must establish models that allow primary care physicians to participate in the chronic management of obesity, while recognizing that the interest and ability of primary care physicians to participate in obesity management will vary. Three general models of obesity management are proposed for the primary care physician, ranging from minimal evaluation to complete evaluation and treatment. In order for the models to be implemented, we must consider establishing a category of obesity specialists who can develop comprehensive treatment programs to which patients with obesity can be referred, and who can provide leadership and guidance for primary care physicians who are involved in obesity management. The North American Association for the Study of Obesity (NAASO) could help establish obesity specialists and provide a structure to allow them to provide leadership for obesity treatment.

Chronic Disease↗
PubMed2002

Chronic disease, functional status, and self-ascribed causes of disabilities among noninstitutionalized older people in Spain.

BACKGROUND: A major component of disability is related to chronic disease, but the study of self-reported causes of disability could add new aspects in understanding this process. The main objective of this work was to determine the associations between chronic diseases and disability and to describe the pattern of self-reported causes of the disabilities present in older persons. METHODS: We carried out a survey in a probabilistic sample of people aged 65 and older of the city of Madrid. The initial sample size was 1001. Subjects were interviewed in their homes. We asked about the presence of 14 chronic conditions. Self-reported difficulty and dependence in 9 noninstrumental activities of daily living (ADLs) were ascertained. Subjects were asked to report the main cause responsible for the disability. Multivariate logistic regression models were constructed to estimate the association of each chronic condition with the probability of having disability. RESULTS: Final sample size was 772 people (overall response rate 77.0%). Interviews answered by proxies were 7.5%. Only 4.5% declared no chronic condition. Osteoarthitis/rheumatism was the most prevalent condition (56.8%). In addition, 63.2% were independent, 21.3% were independent with difficulty (in at least one ADL), and 15.5% were dependent (in at least one ADL). Subjects attributed to osteoarthitis and to aging 41.8% and 17.1% of all disabilities, respectively. Chronic conditions strongly associated with disability were cerebrovascular disease (adjusted odds ratio [OR]: 3.51 [95% confidence interval: 1.44-8.60]), depression/anxiety disorders (OR: 2.72 [1.83-4.05]), and diabetes (OR: 2.18 [1.24-3.83]). CONCLUSIONS: Cerebrovascular diseases, depression/anxiety disorders, and diabetes were the conditions more clearly related to disability. On the other hand, a large proportion of subjects attribute their disabilities to osteoarthritis and old age.

Activities of Daily Living↗
PubMed2005

Disparities in chronic disease risk factors and health status between American Indian/Alaska Native and White elders: findings from a telephone survey, 2001 and 2002.

We compared prevalence estimates of chronic disease risk factors and health status between American Indian/Alaska Native (AIAN) and White elders. We used 2001 and 2002 Behavioral Risk Factor Surveillance System data to estimate the prevalence of smoking, physical inactivity, obesity, diagnosed diabetes, and general health status. For all health behavior and status measures, American Indians/Alaska Natives reported greater risk than did Whites. Risk factors among AIAN elders need to be addressed to eliminate disparities in chronic diseases.

Alaska↗
PubMed2006

Understanding the success of promotoras in increasing chronic diseases screening.

The purpose of this qualitative study was to elicit information on why a promotora (or, community health worker (CHW)) increased adherence to chronic disease screening among women along the U.S.-Mexico border. After completion of the intervention, women and clinic staff who participated in the promotora phase of a randomized, controlled study answered structured, open-ended questionnaires. Clinicians from two non-participating clinics were also interviewed. Content analysis found that the promotora's roles included health education and the facilitation of routine and follow-up care. Clients appreciated the promotora's socio-cultural characteristics, as well as her personal skills and qualities, and described her as a trained, natural helper whose personalized support removed barriers to health care and helped women to take care of themselves. Most clinicians recommended working with a CHW to increase adherence to chronic disease prevention practices. A CHW can play a crucial role on a health care team and interventions should tap into this resource.

Chronic Disease↗
PubMed2003

The link between childhood undernutrition and risk of chronic diseases in adulthood: a case study of Brazil.

Obesity, cardiovascular disease, and type 2 diabetes mellitus are now prevalent among adults living in developing countries; these chronic diseases affect socioeconomically disadvantaged adults living in impoverished families with undernourished children. This review summarizes data from Brazil--a developing country undergoing the nutrition transition--suggesting an association between childhood undernutrition and obesity and chronic degenerative disease. Potential mechanisms for the association include long-term effects of childhood undernutrition on energy expenditure, fat oxidation, regulation of food intake, susceptibility to the effects of high-fat diets, and altered insulin sensitivity. The combination of childhood undernutrition and adult chronic degenerative disease results in enormous social and economic burdens for developing countries. Further research is urgently needed to examine the effect of childhood undernutrition on risk of obesity and chronic degenerative diseases; one goal of such research would be to determine and provide low-cost methods for prevention and treatment.

Adipose Tissue↗
PubMed2004

Chronic disease ideas. Too tight a spotlight?

Greater emphasis on chronic-disease management is welcome, but focusing too much on US models may mean overlooking valuable lessons from the UK, including those on diabetes.

Chronic Disease↗
PubMed2002

The epidemiology, pathophysiology, and natural history of chronic venous disease.

Chronic venous disease includes a spectrum of clinical presentations ranging from varicose veins through chronic lower extremity pain and edema to venous skin changes and ulceration. Such manifestations may result from primary venous insufficiency or be secondary to other disorders, primarily acute deep venous thrombosis. Regardless of etiology, chronic venous disease has significant socioeconomic consequences and is among the most common problems encountered in surgical practice. Ambulatory venous hypertension underlies most of the sequelae of chronic venous disease, although such hemodynamic derangements may result from either valvular incompetence or venous obstruction. Unfortunately, the factors responsible for the progression of disease from mild to severe manifestations are only beginning to be understood. However, a thorough understanding of the pathophysiology and natural history of chronic venous disease is essential in its management.

Chronic Disease↗
PubMed1995

Cancer is a chronic disease.

Improved prevention and detection methods, as well as advances in medical treatment have resulted in a trend of increasing numbers of cancer survivors. Today, there are over 8 million cancer survivors, 5 million of whom were diagnosed 5 or more years ago. Cancer, once thought of as an acute disease, is increasingly being classified as a chronic disease. This article reviews physical, psychological, and social aspects of cancer survivorship, as well as other issues related to a diagnosis of cancer.

Adaptation, Psychological↗
PubMed1994

Revealing the causes of chronic disease epidemics: from research to prevention.

Descriptive epidemiology, with support from metabolic epidemiology and other laboratory studies, has demonstrated a causative relationship between lifestyles--what we smoke, drink and eat, use of illicit drugs, and unsafe sexual practices--and the morbidity and mortality from chronic diseases. What immunization, sanitation and hygiene have done to reduce the scourges of infectious diseases must also be done to reduce the incidence of chronic diseases that have man-made causes. The challenge of applied epidemiology and preventive medicine is to improve health-related behaviours beginning with children's health education, extending to economic incentives for adult populations for good health behaviour, and engaging responsible industry, media and governmental influences to manufacture and promote safer products, and to provide a social and economic environment that is conductive to greater self-esteem and enables people to make the right health decisions. There is ample research to prove that our lifestyles are responsible for much of our health care costs. The challenge of improving the health of all people and of reducing health care cost can be most effectively met by practising disease prevention. After all, the history of medicine shows that the elimination of disease has rarely been the result of therapy, but rather, a consequence of prevention.

Chronic Disease↗
PubMed1986

Socioeconomic determinants of continuing functional disablement from chronic disease episodes.

Functional disablement of persons with chronic disease is a complex outcome shaped by a variety of medical and socioeconomic factors, including those influencing the competing risk of death from the disease. The increasingly important task of explaining trends in the functional health status of various populations requires more detailed knowledge about the respective roles of these disability determinants. This paper reports the results of an analysis of the determinants of continuing functional incapacity after an episode of heart disease. A proportional hazards regression model is used to estimate the relative effects of socioeconomic and disease factors on the duration of work disablement and functional incapacitation of 976 surviving and nonsurviving patients hospitalized for presumptive myocardial infarction. The analysis shows that socioeconomic variables play a prominent role in disability outcomes, especially in work resumption. Evidence of aging effects on disability prevalence is also found.

Activities of Daily Living↗
PubMed1987

Chronic disease: effect on health cognition and health locus of control.

An assessment of health cognition and health locus of control (HLOC) was obtained in 85 healthy and 81 chronically ill children, using instruments adapted from Piaget's work and standard HLOC measures. A relationship between HLOC and compliance was sought in a subset of children with spina bifida taught self-catheterization. Evidence of the developmental nature of health cognition and HLOC was documented. Contrary to the effect of experience in formal learning, experience with chronic disease did not alter developmental progression in these health-related areas. Our results suggest that in communicating with children about illness, the pediatrician's approach should not be altered by an appearance of superficial sophistication that some children may acquire as part of their experience with chronic disease.

Adolescent↗
PubMedDate not supplied

Identifying infectious etiologies of chronic disease.

Available information regarding possible infectious etiologies of insulin-dependent diabetes mellitus, rheumatoid arthritis, and systemic lupus erythematosus is reviewed. The problems and limitations of classic methods in trying to prove a causal relationship between an infectious agent and a chronic disease are summarized. The authors suggest that these disease occur as a result of persistent infection triggering an immunologic response (which is destructive of host tissue) in genetically susceptible individuals. Prospective studies within families (wherein individuals most at risk for disease can be identified) before the onset or diagnosis of the chronic disease may offer the best approach to elucidating potential infectious etiologies.

Adult↗
PubMedDate not supplied

Impact of multi-tiered pharmacy benefits on attitudes of plan members with chronic disease states.

OBJECTIVE: To evaluate the effects of 2- and 3-tiered pharmacy benefit plans on member attitudes regarding their pharmacy benefits. METHODS: We performed a mail survey and cross-sectional comparison of the outcome variables in a large managed care population in the western United States. Participants were persons with chronic disease states who were in 2- or 3-tier copay drug plans. A random sample of 10,662 was selected from a total of 25,008 members who had received 2 or more prescriptions for a drug commonly used to treat one of 5 conditions: hypertension, diabetes, dyslipidemia, gastroesophageal reflux disease (GERD), or arthritis. Statistical analysis included bivariate comparisons and regression analysis of the factors affecting member attitudes, including satisfaction, loyalty, health plan choices, and willingness to pay a higher out-of-pocket cost for medications. RESULTS: A response rate of 35.8% was obtained from continuously enrolled plan members. Respondents were older, sicker, and consumed more prescriptions than nonrespondents. There were significant differences in age and health plan characteristics between 2- and 3-tier plan members: respondents aged 65 or older represented 11.7% of 2-tier plan members and 54.7% of 3-tier plan members, and 10.0% of 2-tier plan members were in Medicare+Choice plans versus 61.4% in Medicare+Choice plans for 3-tier plan members (P<0.05). Controlling for demographic characteristics, number of comorbidities, and the cost of health care, 2-tier plan members were more satisfied with their plan, more likely to recommend their plan to others, and less likely to switch their current plans to obtain better prescription drug coverage than 3-tier plan members. While members were willing to purchase higher cost nonformulary and brand-name medications, in general, they were not willing to pay more than 10 dollars (in addition to their copayment amount) for these medications. Older respondents and sicker individuals (those with higher scores on the Chronic Disease Indicator) appeared to have more positive attitudes toward their pharmacy benefit plans in general. Higher reported incomes by respondents were also associated with greater satisfaction with prescription drug coverage and increased loyalty toward the pharmacy benefit plan. Conversely, the more individuals spent for either their health care or prescription medications, the less satisfied they were with their prescription drug coverage and less loyalty they appeared to have for their health plans. An inverse relationship also appeared to exist between the out-of-pocket costs for prescription medications and members' willingness to pay for nonformulary medications. CONCLUSIONS: Three-tier members had lower reported satisfaction with their plans compared to members in 2-tier plans. The financial resources available to members (which may be a function of being older and having more education and higher incomes), the number of chronic disease states that members have, and other factors may influence their attitudes toward their prescription drug coverage.

Journal Article↗
PubMed1997

[Polypharmacy in the elderly with chronic diseases: conflicting interests].

Polypharmacy patients are elderly people with multiple chronic diseases, such as hypertension, heart failure, atrial fibrillation, diabetes mellitus and chronic obstructive pulmonary disease. Many specialists are involved, each of them trying to optimise the function of a particular organ system. The general practitioner has the overall picture and assesses the consequences for the quality of life of the patient. Specialists and pharmacists should consult with the general practitioner, who ought to be in charge of treatment.

Aged↗
PubMed2006

Inflammatory, autoimmune, chronic diseases: bad diet and physical inactivity are causes or effects?

It is now well established that most chronic diseases, especially those identified as inflammatory, are statistically correlated with some typical dietary excesses and physical inactivity. But do really these habits cause the diseases, or they result from them? Current opinion favours the first option, but fails to explain why the satisfaction of eating, naturally evolved in our brains to produce health, apparently induces countless millions of people to eat unrestrictedly until becoming mortally sick, whereas trying to keep a theoretically healthy diet is most often a real torture. The inverse explanation makes much more sense: since inflammation produces much heat, calorie-rich diets are required. An inflamed digestive tract lacks digestive power and is easily irritated or damaged by solid objects, therefore requiring a refined, concentrated, low-fibre diet. And inflamed or merely sick organisms are easily exhausted by physical effort, hence physical inactivity. This study confirms that, most probably, the primary causes of inflammatory diseases are always external inflammatory agents, like infectious micro-organisms or toxic substances, of which a particularly ubiquitous example is nicotine. High-calorie/low-fibre diets and physical inactivity are direct consequences of generalised inflammation. Inversely, in most cases, physical exercise and moderation in eating, by themselves, cannot substantially suppress inflammations, but they can prevent them from being further reinforced by the neural reward system. Moreover, diets and exercise causing important suffering will usually do more harm than good, especially to children and young people, not to mention pregnant or nursing women. Only the identification and elimination of the inflammatory agents can efficiently prevent and cure inflammatory diseases, and currently nicotine, absorbed intentionally or passively, from tobacco or other sources, must be considered the chief suspect because of its inflammatory power, ubiquity and addictive properties.

Autoimmune Diseases↗