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PubMed2001

[Assessing the quality of life of people with chronic diseases using SF-36].

OBJECTIVE: To analyze the influence of chronic diseases on the quality of life by using short form of 36 (SF-36). METHODS: Four hundred and thirty-eight people with chronic diseases were surveyed in a township and a city in Sichuan Province. The diseases were classified according to ICD-9 and the quality of life of people with chronic diseases of different systems was analyzed. RESULTS: The quality of life of people with chronic diseases of different systems was lower than that of general people aged 40 or above. The quality of life varied among people with chronic diseases of different systems in four fields, namely PF, SF, VT and MH. The main diseases that influenced the quality of life were mental disorders, infectious and parasitic diseases, the diseases of blood and blood-forming organs. CONCLUSION: The chronic diseases have decreased the quality of life. The diseases of different systems have had different influences on the quality of life. SF-36 is suitable for assessing the quality of life of people with chronic diseases. Quality of life should be taken as an important health index in chronic disease control and prevention.

China↗
PubMed2006

The potential impact of anaemia of chronic disease in COPD.

Anaemia of chronic disease (ACD), with chronically low levels of circulating haemoglobin, is an immune driven abnormality that occurs in many inflammatory diseases, and also in chronic heart failure. Although chronic obstructive pulmonary disease (COPD) is "traditionally" associated with polycythaemia, the systemic inflammation that is now recognised as a feature of COPD makes it a possible cause of ACD. If present in COPD, anaemia could worsen dyspnoea and limit exercise tolerance. Preliminary evidence suggests that anaemia in COPD patients may be more prevalent than expected, concerning 10-15% of patients suffering from severe forms of the disease. A database study conducted in 2,524 COPD patients being prescribed long-term oxygen therapy has shown that a low haematocrit is a strong predictor of survival in this population, before body mass index, and is associated with more hospitalisations and a longer cumulative duration of hospitalisation. COPD patients with low haemoglobin levels have a poorer prognosis than COPD patients with normal haemoglobin levels in the event of acute gastrointestinal bleeding or after elective aneurysm repair. Raising haemoglobinaemia through transfusion decreases minute ventilation and work of breathing in COPD patients. These preliminary evidences point to the need to study the prevalence of anaemia, and its physiological and clinical impact in chronic obstructive pulmonary disease. When this body of knowledge is available, the question of the putative benefits of raising haemoglobinaemia in chronic obstructive pulmonary disease will have to be addressed.

Anemia↗
PubMed2006

The evolution of integrated chronic disease prevention in Alberta, Canada.

BACKGROUND: Recognition of the common risk factors for leading chronic diseases in Canada has contributed to the development of integrated chronic disease prevention and health promotion approaches. The Alberta Heart Health Project studied the capacity of health organizations in Alberta, Canada, to engage in heart health promotion. This article describes how the Alberta Heart Health Project acted on emerging research findings describing the preliminary stages of integrated chronic disease prevention in Alberta to provide leadership to encourage provincial chronic disease prevention efforts. CONTEXT: Political support for integrated chronic disease prevention was evident at the provincial and federal levels in Canada. As a result of organizational restructuring, loss of key health promotion champions, and decreased funding allocations, Alberta's regional health authorities sought increased efficiency in their chronic disease prevention efforts. METHODS: Descriptive data were derived from a brief questionnaire on regional health authorities' chronic disease prevention priorities and activities, an inventory of regional health authority health promotion programs and services, content analysis of key regional health authority documents, and focus groups with regional health authority staff, management, and policymakers. CONSEQUENCES: In 2002, the Alberta Heart Health Project data revealed that many regional health authorities were beginning to engage in integrated chronic disease prevention. However, little collaboration occurred across the health organizations; provincial leadership to facilitate collaboration and networking for integrated chronic disease prevention was needed. INTERPRETATION: Results supported the growing momentum for provincial leadership to enhance collaboration for integrated chronic disease prevention, which contributed to the development of the Alberta Healthy Living Network. The government's assistance is also needed to support the intersectoral collaborations essential for integrated chronic disease prevention.

Alberta↗
PubMed2002

Managing chronic disease: evidence-based medicine or patient centred medicine?

Chronic diseases are recognized as a leading cause of mortality, morbidity, health care utilization and cost. A constant tailoring of care to the actual needs of individual patients, complexity and long duration are the distinguishing features of chronic disease management. Given the rapid development and high use of services providing complex management, the number of controlled clinical trials in this field is limited. The information from the few available controlled clinical trials may be difficult to interpret, mainly due to a large variety in the interventions being studied, differences in 'control treatments' and a confined set of outcome measures that are used. The ethical issue with this observation is, that in the absence of randomised clinical trial information on clinical effectiveness and in consequence of the lack of additional data that are crucial for therapeutic decisions in the process of caring, specific patient groups, such as patients with chronic diseases, may become disadvantaged. The scarcity and incompleteness of controlled trial information can partly be explained by difficulties in conducting this type of research in the field of chronic disease management. To avoid that patients with chronic diseases become disadvantaged, the use of alternative designs such as observational studies to evaluate chronic disease management must be accepted and supported. Moreover, in chronic disease management the process of caring needs to emphasized and appraised appropriately. For that purpose, new measurement methods, focussing on concepts of caring that are not included in the majority of current clinical trials, need to be developed.

Arthritis, Rheumatoid↗
PubMed1999

Development of a chronic disease indicator score using a Veterans Affairs Medical Center medication database. IMPROVE Investigators.

OBJECTIVE: Develop a chronic disease index that approximates the number of chronic diseases a patient has using a medication database. METHODS: An expert panel determined whether specific medication classes could be indicative of a chronic disease. Those classes identified were incorporated into a computer program and then used to screen the medication records of 246 randomly selected patients to estimate the number of chronic diseases present in each patient. This number was designated as the chronic disease index (CDI). The CDI was then validated against chart review. The CDI and a measure of disease severity, the chronic disease score (CDS) also were compared. The sensitivity and specificity of the computer program was analyzed for seven common chronic diseases. RESULTS: The expert panel designated 54 drug classes containing medications used to treat chronic diseases. The CDI correlated moderately with the number of chronic diseases found via chart review (r = 0.65; P = 0.001) and highly with the CDS (r = 0.81; P = 0.001). The index predicted the presence of three common diseases with a sensitivity of > or = 75%, and of six common diseases with a specificity of > or = 75%. CONCLUSIONS: The CDI correlates moderately well with the actual number of chronic disease states present. This tool may be useful for researchers when trying to identify patients with specific diseases and also for risk adjustment.

Chronic Disease↗
PubMed2001

Prevalence of selected chronic diseases in Israel.

BACKGROUND: Knowledge of the prevalence of chronic disease in the population is essential for health planners and providers. OBJECTIVES: To present the results of a concentrated effort by the largest health maintenance organization in Israel (Clalit Health Services) in order to develop a comprehensive register of chronic diseases. METHODS: In 1998, all 2,704 primary care physicians in Israel's largest health provider were requested to report on all patients with selected chronic diseases. In addition, all the filled prescriptions for medications relevant to the investigated diseases and all relevant hospitalization events were added to the database. Prevalence rates were calculated based on the reporting practices only (1,653 physicians responsible for a total of 1,409,725 adults). RESULTS: Hypertension (10.2/100), diabetes (6.1/100), hyperlipidemia (5.7/100), peptic ulcer (4.7/100) and ischemic heart disease (4.3/100) were the most prevalent. Females had significantly higher rates of hypothyroidism, psychoses, neuroses and malignancies, and lower rates of ischemic heart disease, chronic obstructive pulmonary disease, heart failure and asthma. Arabs had higher rates of diabetes mellitus and lower rates of ischemic heart disease, hypertension and hyperlipidemia than Jews. About 20% of the adult population had one or more of the selected chronic diseases. CONCLUSIONS: Differences in rates noted between physicians, not explainable by population characteristics, may reflect differences in the quality and delivery of health services. Rate differences between demographic subgroups call for further studies on the etiology, susceptibility and natural history of these diseases.

Adolescent↗
PubMed2000

Chronic disease self-management: improving health outcomes.

Chronic disease has become pandemic in the United States, and estimates are that it will affect 148 million people by the year 2030. Patients with chronic illnesses cost the health care system over three times more than individuals without chronic conditions. The US Department of Veterans' Affairs (VA) Sunshine HealthCare Network, composed of VA health care facilities in Florida and Puerto Rico, recognized that the needs of its increasing number of veterans with chronic diseases were unmet by traditional medical interventions. The Network implemented a chronic disease self-management pilot program to evaluate its value for the veteran population. Results of the pilot indicate that this program will make a positive, lasting change in the health status and quality of life for veterans with chronic disease.

Adult↗
PubMed2004

Antioxidants and prevention of chronic disease.

The generation of reactive oxygen species (ROS) and other free radicals (R) during metabolism is a necessary and normal process that ideally is compensated for by an elaborate endogenous antioxidant system. However, due to many environmental, lifestyle, and pathological situations, excess radicals can accumulate, resulting in oxidative stress. Oxidative stress has been related to cardiovascular disease, cancer, and other chronic diseases that account for a major portion of deaths today. Antioxidants are compounds that hinder the oxidative processes and thereby delay or prevent oxidative stress. This article examines the process of oxidative stress and the pathways by which it relates to many chronic diseases. We also discuss the role that endogenous and exogenous antioxidants may play in controlling oxidation and review the evidence of their roles in preventing disease.

Aging↗
PubMed1990

The role of the GP in the management of chronic disease. Diabetes as a model.

Chronic disease is increasing as a percentage of all illnesses in Australia's health care system, in part because of the ageing of the population. New strategies are required to help manage these often incurable diseases. The general practitioner is well equipped to provide management expertise for chronic disease, provided he or she has access to community based allied health professionals.

Chronic Disease↗
PubMed2005

A life course approach to chronic disease epidemiology.

A life course approach to chronic disease epidemiology uses a multidisciplinary framework to understand the importance of time and timing in associations between exposures and outcomes at the individual and population levels. Such an approach to chronic diseases is enriched by specification of the particular way that time and timing in relation to physical growth, reproduction, infection, social mobility, and behavioral transitions, etc., influence various adult chronic diseases in different ways, and more ambitiously, by how these temporal processes are interconnected and manifested in population-level disease trends. In this review, we discuss some historical background to life course epidemiology and theoretical models of life course processes, and we review some of the empirical evidence linking life course processes to coronary heart disease, hemorrhagic stroke, type II diabetes, breast cancer, and chronic obstructive pulmonary disease. We also underscore that a life course approach offers a way to conceptualize how underlying socio-environmental determinants of health, experienced at different life course stages, can differentially influence the development of chronic diseases, as mediated through proximal specific biological processes.

Age Distribution↗
PubMed2003

The association between chronic diseases and fatigue in the working population.

OBJECTIVE: The aims of this study were to examine (a) whether employees with a chronic disease report more fatigue than employees without a chronic disease, (b) whether number or type of chronic disease is related to fatigue, and (c) whether differences in fatigue level in various types of chronic diseases are related to psychological distress. METHODS: Data were taken from 12,137 employees. Fatigue was measured with the Checklist Individual Strength (CIS). RESULTS: Employees with a chronic disease reported more fatigue (OR=2.9, 95% CI=2.7-3.2). Small differences were observed in the level of fatigue in various types of diseases. A strong linear association between the number of chronic diseases and fatigue was found. Psychological distress explained the higher level of fatigue in some chronic diseases (gastrointestinal diseases and migraine). CONCLUSIONS: Fatigue is more common in employees with a chronic disease. A strong association between number of chronic diseases and fatigue exists. Fatigue in employees with a chronic disease can partly be explained by psychological distress. Some chronic diseases show a stronger association between psychological distress and fatigue.

Adolescent↗
PubMedDate not supplied

[Chronic diseases in adolescence].

INTRODUCTION: The prevalence of chronic diseases in adolescence is constantly increasing, especially in the last two decades. Adolescence is a period of important changes: body growth and development, sexual development, development of cognitive abilities, change in family relations and between peers, formation of personal identity and personal system of values, making decisions on future occupation etc. CHRONIC DISEASES IN ADOLESENCE: Chronic disorders affect all development issues and represent an additional burden for adolescents. The interaction between chronic disorders and various development issues is complex and two-way: the disease may affect development, and development may affect the disease. Developmental, psychosocial and family factors are of great importance in the treatment of adolescents with chronic disorders. Chronic disorders affect all aspects of adolescent life, including relations with peers, school, nutrition, learning, travelling, entertainment, choice of occupation, plans for the future. Physicians should keep in mind that chronic diseases and their treatment represent only one aspect of person's life. Adolescents with chronic diseases have other needs as well, personal priorities, social roles and they expect these needs to be recognised and respected. Adolescent health care should be adjusted to the life style of adolescents.

Adolescent↗
PubMed2001

Stanford Health Partners: rationale and early experiences in establishing physician group visits and chronic disease self-management workshops.

Chronic disease is a major public health problem. The day-to-day management of a chronic illness requires accurate patient reporting and timely medical response. Patient group visits with the primary care physician and lay-led patient education workshops improve the provider-physician relationship, promote patient self-efficacy and self-management of chronic diseases, and facilitate positive health care outcomes. This article describes how group visits are being integrated into the clinical routine of a health care system.

Adult↗
PubMed2002

[Vitamin D deficiency in children with chronic diseases evaluated because of osteopenia].

BACKGROUND: Chronic diseases in children may determine limited sun exposure, use of drugs, and other risk factors of osteopenia. OBJECTIVE: To evaluate vitamin D deficiency and their risk factor, in children with chronic diseases with suspected osteopenia. METHODS: We measured bone mineral density, bone remodeling markers, calcium, phosphate, parathormone, and 25 hydroxyvitamin D levels, and wrist X-ray. RESULTS: We found 8 children of 25 with suspected osteopenia, with biochemical abnormalities suggestive of vitamin D deficiency. All children had low levels of 25 hydroxyvitamin D, 5 had reduced bone mineral density, 4 had hyperparathyroidism, 2 had hyperphosphatasemia, and 1 hypocalcemia and hypophosphatemia. None had rickets. DISCUSSION: Osteopenia in chronic sick children is due to multiple factors; however, vitamin D deficiency is a preventable disorder. We recommend that all children with a chronic disease with risk factors for vitamin D deficiency should be monitored with 25 hydroxyvitamin D serum levels.

25-Hydroxyvitamin D 2↗
PubMed2005

[Can we improve influenza vaccination rates in older people with chronic diseases?].

OBJECTIVE: To determine the proportion of older patients (>or= 65 years) with chronic diseases served by the health center studied here who were not vaccinated during the 2001-2002 influenza vaccination campaign, and to find out why they were not vaccinated. DESIGN: Observational, descriptive, retrospective study. SETTING: The urban health center serving Area 19 in the Community of Valencia (eastern Spain). PARTICIPANTS: Of the 29757 inhabitants served by this center (10.4% >or= 65 years), we included 3868 patients registered in chronic disease care programs and 2980 registered in the influenza vaccination program. We found 853 older patients with chronic diseases who were not vaccinated. MAIN MEASURES: Vaccination rate for patients with chronic diseases, for older patients, and for older patients with chronic diseases. Audit of the medical records to identify the reasons why some patients in the latter group were not vaccinated. RESULTS: The vaccination rates were 52.12% (95% CI, 50.4-53.9) for older patients, 26.96% (95% CI, 25.6-28.4) for patients with chronic diseases, and 54.43% (95% CI, 51.4-57.5) for older patients with chronic diseases. Of the 853 older patients with chronic diseases who were not vaccinated, 48.17% came to the center at least once during the vaccination campaign, 27.34% had not come to the center since more than 1 year before the campaign, and the cause for nonvaccination was recorded for only 10.4%. CONCLUSIONS: Coverage for influenza vaccination in older patients with chronic diseases was low. Intervention to increase vaccination rates is possible in groups of patients for whom accessibility is good.

Aged↗