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PubMed2004

Discrimination ratio analysis of inflammatory markers: implications for the study of inflammation in chronic disease.

To understand the role of inflammation in chronic disease it is important to have a reliable measure of habitual inflammatory status. A number of acute-phase response markers have been used as measures of inflammatory status, but the ability of a single measure to appropriately reflect habitual inflammatory status has not been assessed. This study compares the ability of different inflammatory markers to characterize habitual inflammatory status in overweight women. A single fasting blood sample was taken from 86 overweight women (mean body mass index [BMI], 35.2 kg/m2; range, 26.2 to 47.6 kg/m2) and a number of inflammatory markers (both acute-phase response markers and cytokines) were measured. A randomly selected subpopulation of 15 women attended on 2 further occasions for further blood samples. Using the subpopulation, discrimination ratios (DRs) were calculated for each inflammatory marker to assess the within-subject variability. The DRs were then used to determine the relationship between these markers, adjusted for within-subject variability, in the whole population. In this highly controlled experimental environment, interleukin-6 (IL-6), with a DR of 3.71, was the cytokine with the greatest ability to discriminate between subjects, suggesting that it is best able to characterize habitual inflammatory status. Sialic acid was the acute-phase response marker with the highest DR (3.16), and showed stronger correlations with other inflammatory markers, including C-reactive protein (CRP), than IL-6. This study suggests that use of some inflammatory markers, such as CRP, with large within-individual variability, will underestimate the relationship between inflammation and disease, and thus relationships between inflammation and chronic disease may be stronger than previously appreciated. Future studies should consider IL-6 or sialic acid to provide a more robust measure of inflammatory status.

Acute-Phase Proteins↗
PubMed2001

Patient education in Switzerland: from diabetes to chronic diseases.

The Division of Therapeutic Education for Chronic Diseases at the University Hospital of Geneva has been playing an important role in the field of therapeutic patient education for more than 25 years. More than 16,000 patients have been hospitalised and an excess of 75,000 h have been spent with a rather novel interdisciplinary approach involving doctors, nurses, dieticians, psychologists, podiatrists and pedagogues. For the past 12 years, our division has held over 50 seminars of 1-week postgraduate training attended by over 3000 participants coming from more than 60 countries worldwide. In 1998, the faculty of medicine at the University of Geneva implemented a 3-year curriculum on therapeutic patient education leading to a postgraduate university diploma. In 1983, the WHO designated the Swiss teaching division as a WHO Collaborating Center for reference and research in diabetes education. In 1998, a WHO-Euro Working Group Report entitled "Therapeutic Patient Education. Continuing education programmes for health care providers in the field of prevention of chronic diseases" was published.

Chronic Disease↗
PubMed1987

Mechanisms of erythroid suppression in the anemia of chronic disease.

The mechanism underlying the hypoproliferative anemia in patients with chronic diseases has not been clearly defined. We have examined the effects of marrow macrophages from anemic patients with chronic diseases and normals to determine if they suppress erythroid progenitors in vitro. We found that marrow macrophages from patients with the anemia of chronic disease (ACD) significantly suppressed erythroid progenitor cell growth, whereas marrow macrophages from normals did not. Since ACD is seen in conditions that activate macrophages, we then determined if activated macrophages could suppress erythroid progenitor cell growth. Peritoneal macrophages activated by chronic Cryptococcus neoformans infection significantly suppressed erythroid progenitor cell growth, although resting macrophages did not. We then examined the effects of a product of activated macrophages, tumor necrosis factor (TNF), for its effects on CFU-E and BFU-E. TNF significantly suppressed CFU-E and BFU-E growth in concentrations as low as 10(-11)-10(-12) M. Preincubation of marrow samples with TNF for as little as 15 minutes was sufficient to suppress CFU-E and BFU-E growth. Addition of TNF, after the onset of culture could only suppress CFU-E and BFU-E if added within the first 48 hours. TNF (10(-10)-10(-11) M) also inhibited the growth of hematopoietic cell lines K562, HL60, and HEL cells. These cell lines expressed low numbers of high affinity TNF receptors, with 80%-90% of the cells expressing TNF receptors.

Anemia↗
PubMed1997

The patient and family adjustment to chronic disease in the home.

The increase in chronic disease with shortened hospitalizations has led to an increase in home care, with added adjustment problems for patients and their families. The majority of families cope satisfactorily, although most have periods of instability or difficulties which require appropriate support. In considering the impact of chronic illness, cognizance must be taken of the patient, the illness, the caregiving system, the medical care system, the interrelationship between them and the effect of the environment on all of them. The adjustment to chronic illness depends on the complementary meshing of the life and time cycles of the above factors during the alternating periods of crises and chronic maintenance. It is apparent that, in a pluralistic multicultural society, a broad range of diverse family forms and functioning is compatible with adjustment to a member with chronic disease. Finally, a scheme for the medical team's assessment and care is presented.

Adaptation, Psychological↗
PubMed1995

Human body composition and the epidemiology of chronic disease.

Obesity and body fat distribution (FD) are established risk factors for chronic diseases. The body mass index (BMI) and the waist/hip circumference ratio (WHR) are used conventionally as indices of obesity and FD in epidemiological studies. Although some general limitations of these indices are recognized, others that affect their use in relative risks for disease are not well recognized. These include effects of sex, ethnicity, and especially age on the relationships between these indices and body composition, which can result in substantial misclassification of obesity and FD. There is considerable variability in body composition for any BMI, and some individuals with low BMIs have as much fat as those with high BMIs. This results in poor sensitivity for classifying levels of body fatness (e.g., too many "false negatives," or overweight individuals classified as not overweight), and relative risks are attenuated across all categories of BMI. A more serious problem, however, is that at different ages the same levels of BMI correspond to different amounts of fat and fat-free mass. Data from the Rosetta Study and the New Mexico Aging Process Study show that older adults have, on average, more fat than younger adults at any BMI, due to the loss of muscle mass with age. As a result, the sensitivity of BMI cutpoints with respect to body fatness decreases with age, and the use of a fixed cutpoint for all ages results in "differential misclassification bias." Taken together, these issues suggest that the increases with age in the prevalences of overweight and obesity, and in the risks for chronic diseases, may be mis-estimated using BMI. Similar issues may affect the use of WHR for estimating prevalences and associated risks of FD. New field methods for estimating body composition are available that can be applied in large, epidemiologic follow-up studies of chronic diseases. These methods will allow epidemiologists to consider, for example, whether it is increased fat, or the replacement of fat-free mass with fat, with age that is associated with risk for chronic disease.

Adipose Tissue↗
PubMed2006

The Indiana Chronic Disease Management Program.

The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation.

Chronic Disease↗
PubMed1991

Community Intervention Trial for Smoking Cessation (COMMIT): opportunities for community psychologists in chronic disease prevention.

Opportunities for participation in chronic disease prevention programs are discussed in the context of a description and analysis of the National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT). COMMIT involves 11 matched pairs of communities with random assignment to the intervention condition within each pair. The 4-year intervention is guided by a partly standardized protocol and embodies a number of community psychology principles. The relative congruence of COMMIT with community psychology principles and methods is discussed with particular emphasis on Kelly's (1988) model of community research. Community psychology's participation in chronic disease prevention trials requires understanding of the programmatic framework of National Institutes of Health prevention research and recognition of the constraints imposed by the framework on community psychology practices.

Community Mental Health Services↗
PubMed2000

Waging war on modern chronic diseases: primary prevention through exercise biology.

In this review, we develop a blueprint for exercise biology research in the new millennium. The first part of our plan provides statistics to support the contention that there has been an epidemic emergence of modern chronic diseases in the latter part of the 20th century. The health care costs of these conditions were almost two-thirds of a trillion dollars and affected 90 million Americans in 1990. We estimate that these costs are now approaching $1 trillion and stand to further dramatically increase as the baby boom generation ages. We discuss the reaction of the biomedical establishment to this epidemic, which has primarily been to apply modern technologies to stabilize overt clinical problems (e.g., secondary and tertiary prevention). Because this approach has been largely unsuccessful in reversing the epidemic, we argue that more emphasis must be placed on novel approaches such as primary prevention, which requires attacking the environmental roots of these conditions. In this respect, a strong association exists between the increase in physical inactivity and the emergence of modern chronic diseases in 20th century industrialized societies. Approximately 250,000 deaths per year in the United States are premature due to physical inactivity. Epidemiological data have established that physical inactivity increases the incidence of at least 17 unhealthy conditions, almost all of which are chronic diseases or considered risk factors for chronic diseases. Therefore, as part of this review, we present the concept that the human genome evolved within an environment of high physical activity. Accordingly, we propose that exercise biologists do not study "the effect of physical activity" but in reality study the effect of reintroducing exercise into an unhealthy sedentary population that is genetically programmed to expect physical activity. On the basis of healthy gene function, exercise research should thus be viewed from a nontraditional perspective in that the "control" group should actually be taken from a physically active population and not from a sedentary population with its predisposition to modern chronic diseases. We provide exciting examples of exercise biology research that is elucidating the underlying mechanisms by which physical inactivity may predispose individuals to chronic disease conditions, such as mechanisms contributing to insulin resistance and decreased skeletal muscle lipoprotein lipase activity. Some findings have been surprising and remarkable in that novel signaling mechanisms have been discovered that vary with the type and level of physical activity/inactivity at multiple levels of gene expression. Because this area of research is underfunded despite its high impact, the final part of our blueprint for the next millennium calls for the National Institutes of Health (NIH) to establish a major initiative devoted to the study of the biology of the primary prevention of modern chronic diseases. We justify this in several ways, including the following estimate: if the percentage of all US morbidity and mortality statistics attributed to the combination of physical inactivity and inappropriate diet were applied as a percentage of the NIH's total operating budget, the resulting funds would equal the budgets of two full institutes at the NIH! Furthermore, the fiscal support of studies elucidating the scientific foundation(s) targeted by primary prevention strategies in other public health efforts has resulted in an increased efficacy of the overall prevention effort. We estimate that physical inactivity impacts 80-90% of the 24 integrated review group (IRG) topics proposed by the NIH's Panel on Scientific Boundaries for Review, which is currently directing a major restructuring of the NIH's scientific funding system. Unfortunately, the primary prevention of chronic disease and the investigation of physical activity/inactivity and/or exercise are not mentioned in the almost 200 total subtopics comprising t

Cardiovascular Diseases↗
PubMed2003

Prevalence of selected risk factors for chronic disease--Jordan, 2002.

In Jordan, the average life expectancy in 2002 was 72 years, and chronic diseases are becoming increasingly prevalent. Because personal behavior can influence the occurrence and progression of many chronic diseases, the Jordan Ministry of Health (JMoH) established surveillance for behavioral risk factors, particularly those related to cardiovascular diseases and diabetes. This report summarizes the key findings of the 2002 Behavioral Risk Factor Survey, the first reporting segment in Jordan's surveillance program for chronic diseases. The findings indicate that smoking, physical inactivity, and obesity contribute substantially to the burden of chronic disease in Jordan and underscores the need for effective public health interventions.

Chronic Disease↗
PubMed1997

Does family support buffer the impact of specific chronic diseases on mobility in community-dwelling elderly?

The present study explores whether different structural (presence of partner and children) and functional (amounts of instrumental and emotional support provided by partner and children) family characteristics buffer the influence of chronic diseases on physical functioning. Logistic regression analyses were performed in a population-based sample of 2830 community-dwelling elderly people with chronic diseases as independent variable, and mobility difficulties as dependent variable, for separate strata of family characteristics. The presence of buffer effects was ascertained by comparing the associations between disease variables and mobility difficulties across the strata of family characteristics, using the odds ratios and 95% confidence intervals. Living together with a partner appears to buffer the association between the presence of one chronic disease and mobility difficulties, but no such effect is present among subjects with more than one disease. Regarding specific chronic diseases, partner presence has a beneficial influence only on the association between stroke and mobility difficulties, regardless of whether the partner provides little or much support. For patients with chronic non-specific lung disease (asthma, chronic bronchitis or pulmonary emphysema), a small amount of instrumental support (help with daily chores in and around the house) received from the partner is associated with a higher risk for mobility difficulties, compared to patients who receive a large amount of instrumental support and to patients who are not living with a partner. Neither the presence of children, nor the amounts of support received from them, influences associations between specific chronic diseases and mobility difficulties. The present study provides limited evidence supporting a buffer effect of family characteristics on the association between chronic diseases and mobility. Only in elderly people with a relatively low burden of disease does family support mitigate the adverse effects of disease on physical functioning.

Activities of Daily Living↗
PubMedDate not supplied

The role of epidemiology in chronic disease prevention and health promotion programs.

Although the role for epidemiology is widely accepted in public health programs in general, its role in chronic disease programs is not as widely recognized. One possible barrier to improving epidemiologic capacity in chronic disease prevention and health promotion programs is that chronic disease program managers and public health decision makers may have a limited understanding of basic chronic disease epidemiology functions. We describe the assessment process of data collection, analysis, interpretation, and dissemination, and, using examples from two states, illustrate how this approach can be used to support program and policy development in three areas: by defining the problem, finding programs that work, and evaluating the effects of the program over time. Given the significant burden of chronic diseases in the United States, the scientific guidance provided by epidemiology is essential to help public health leaders identify priorities and intervene with evidence-based and effective prevention and control programs.

Chronic Disease↗
PubMed2006

Chronic disease prevention in general practice--Applying the family history.

BACKGROUND: The family history has a potentially important role in general practice for risk prediction and tailored disease prevention for several common chronic diseases. OBJECTIVE: This article discusses the potential role of the family history in general practice including current risk assessment guidelines and approaches to supporting family history taking. DISCUSSION: Family history reflects shared genetic and environmental risks and can be used to identify individuals at increased risk of common chronic disease who may benefit from tailored preventive management. General practitioners need to develop skills in taking a full family history, creating a pedigree and using this to determine disease risk. Future developments in this area include family history screening tools, computerised risk assessment and, in the longer term, identification of common genetic mutations that are reflected in a person's family history.

Chronic Disease↗
PubMed1986

Self-esteem and perceived stress in young adolescents with chronic disease. Unexpected findings.

This pilot study was designed to investigate the relationship between perceived stress, self-esteem and "functional" pain in young adolescents with and without chronic disease. Twenty children with chronic disease and 15 without who were seen in a pediatric outpatient clinic completed a symptom survey, the Piers-Harris Self-Concept Survey, and Lewis's Feel-Bad Scale. Adolescents with significant self-reported complaints of abdominal pain, chest pain, and headaches (without documented organic cause) scored higher on the Feel-Bad scale (p less than 0.002) and lower on the self-concept scale (p less than 0.02) than those without functional complaints. Patients with chronic disease scored higher on the self-esteem measure (61 +/- 14 versus 48 +/- 14, p less than 0.01) and lower on the stress measure (80 +/- 40 versus 120 +/- 54, p less than 0.02) than those without a chronic disease. These findings of lower stress and higher self-esteem in adolescents with chronic illness were unexpected. Possible explanations are discussed.

Adolescent↗
PubMed1984

The chronic disease data bank: first principles to future directions.

Chronic diseases represent the major illness burden of developed nations. A chronic disease databank system consists of parallel longitudinal data sets from diverse locations describing the courses of thousands of patients with chronic illness over many years. Illustrated by ARAMIS (The American Rheumatism Association Medical Information System), such data resources facilitate analysis of long term health outcomes and the factors associated with particular outcomes. A model for clinical investigation of contemporary disease is presented, based on the overwhelming prevalence of chronic illness, the variability, complexity, and uniqueness of the individual patient course, the difficulties of traditional univariate reductionist approaches, and the time span required for study. In this model, data are systematically accrued and continually analyzed, and the data collected are gradually modified based upon evolving anticipation of future needs. The strategies underlying the development of ARAMIS are described, investigational results summarized, and future directions outlined.

Arthritis, Rheumatoid↗
PubMed2000

Adherence to the Dietary Guidelines for Americans and risk of major chronic disease in men.

BACKGROUND: The Dietary Guidelines for Americans and the food guide pyramid aim to reduce the risk of major chronic disease in the United States, but data supporting their overall effectiveness are sparse. The healthy eating index (HEI) measures the concordance of dietary patterns with these guidelines. OBJECTIVE: We tested whether a high HEI score (range: 0-100; 100 is best) calculated from a validated food-frequency questionnaire (HEI-f) could predict lower risk of major chronic disease in men. DESIGN: A cohort of US male health professionals without major disease completed detailed questionnaires on food intake and other risk factors for heart disease and cancer in 1986 and repeatedly during the 8-y follow-up. Major chronic disease outcome was defined as incident major cardiovascular disease (stroke or myocardial infarction, n = 1092), cancer (n = 1661), or other non-trauma-related deaths (n = 366). RESULTS: The HEI-f was weakly inversely associated with risk of major chronic disease [comparing highest with lowest quintile of the HEI-f, relative risk (RR) = 0.89; 95% CI: 0.79, 1.00; P: < 0.001 for trend]. The HEI-f was associated with moderately lower risk of cardiovascular disease (RR = 0.72; 95% CI: 0.60, 0.88; P: < 0.001) but was not associated with lower cancer risk. CONCLUSIONS: The HEI-f was only weakly associated with risk of major chronic disease, suggesting that improvements to the HEI may be warranted. Further research on the HEI could have implications for refinements to the Dietary Guidelines for Americans and the food guide pyramid.

Alcohol Drinking↗
PubMed2002

Flavonoid intake and risk of chronic diseases.

BACKGROUND: Flavonoids are effective antioxidants and may protect against several chronic diseases. OBJECTIVE: The association between flavonoid intake and risk of several chronic diseases was studied. DESIGN: The total dietary intakes of 10 054 men and women during the year preceding the baseline examination were determined with a dietary history method. Flavonoid intakes were estimated, mainly on the basis of the flavonoid concentrations in Finnish foods. The incident cases of the diseases considered were identified from different national public health registers. RESULTS: Persons with higher quercetin intakes had lower mortality from ischemic heart disease. The relative risk (RR) between the highest and lowest quartiles was 0.79 (95% CI: 0.63, 0.99: P for trend = 0.02). The incidence of cerebrovascular disease was lower at higher kaempferol (0.70; 0.56, 0.86; P = 0.003), naringenin (0.79; 0.64, 0.98; P = 0.06), and hesperetin (0.80; 0.64, 0.99; P = 0.008) intakes. Men with higher quercetin intakes had a lower lung cancer incidence (0.42; 0.25, 0.72; P = 0.001), and men with higher myricetin intakes had a lower prostate cancer risk (0.43; 0.22, 0.86; P = 0.002). Asthma incidence was lower at higher quercetin (0.76; 0.56, 1.01; P = 0.005), naringenin (0.69; 0.50, 0.94; P = 0.06), and hesperetin (0.64; 0.46, 0.88; P = 0.03) intakes. A trend toward a reduction in risk of type 2 diabetes was associated with higher quercetin (0.81; 0.64, 1.02; P = 0.07) and myricetin (0.79; 0.62, 1.00; P = 0.07) intakes. CONCLUSION: The risk of some chronic diseases may be lower at higher dietary flavonoid intakes.

Adult↗
PubMed2002

Common chronic diseases and general impairments as determinants of walking disability in the oldest-old population.

OBJECTIVES: Walking disability affects older people's autonomy and well-being. We investigated the relative effect of common chronic diseases and general impairments on walking disability in the general oldest-old population. DESIGN: Population-based cohort study. SETTING: Leiden 85-plus Study, the Netherlands. PARTICIPANTS: Five hundred ninety-nine persons aged 85, response rate 87%. MEASUREMENTS: Walking disability was assessed using a 6-meter walking test. Persons with a walking time below the 25th percentile and those who were physically unable to perform the walking test were categorized as having a walking disability. Information on common chronic diseases was obtained from records of subjects' general practitioners and pharmacies. General impairments were assessed with functional tests and standardized questions during face-to-face interviews. We expressed the effect of common chronic diseases and general impairments as the population attributable risk (PAR), indicating how much disability can be prevented when the identified risk factor is eliminated from the population. RESULTS: One hundred ninety-two persons (33%) had a walking disability. This disability was highly associated with poor mobility in daily life, recurrent falls, and poor well-being (all P <.001). Of the common chronic diseases, stroke, angina pectoris, diabetes mellitus, and hip fracture but not arthritis contributed most (PARs from 6% to 15%) to walking disability in the population at large. General impairments had higher prevalence rates and higher PARs than common chronic diseases. Cognitive impairment, depressive symptoms, and dizziness upon rising contributed most (PARs between 22 to 27%) to walking disability. In multivariate regression analyses of all common chronic diseases and general impairments, associations remained significant. CONCLUSION: Within the general oldest-old population, general impairments contribute more substantially to walking disability than do common chronic diseases. The diagnosed diseases did not explain the impairments that led to walking disability. Especially in the oldest old, clinicians should focus not merely on common chronic diseases but particularly on general impairments as targets for diagnostic analysis and treatment to decrease walking disability.

Aged↗
PubMed1992

The chronic disease data bank model: a conceptual framework for the computer-based medical record.

The principles underlying the chronic disease data bank model are straight-forward: (1) the purpose of medical care is to improve patient outcomes; (2) patient outcomes in contemporary developed societies are overwhelmingly linked to chronic illnesses and degenerative processes and will become increasingly so; (3) such outcomes have multiple determinants including the psychological and social, as well as the biologic; (4) outcome antecedents (risk factors) may precede clinical illness by years or decades; and (5) these complex characteristics require for their study (a) computer aid and (b) longitudinal data. The chronic disease data bank provides an important resource, available to many investigators, for examination of the complex set of clinical and policy questions arising with long-term illness and addressing the questions of lifetime health. The chronic disease data bank consecutively enrolls eligible subjects, follows them for life, and amasses time-oriented, multidisciplinary data including clinical findings, medical history, demographics, treatments, resource utilization and disease outcomes, and assessing both the quality of life and its duration. Analyses are longitudinal and time-series in type, examining changes in trends and tempo of the disease, and are focused upon long-term outcomes. Outcomes are regularly and carefully assessed, and include the outcome dimensions of death, disability, discomfort, iatrogenic toxicity, and dollar cost. Specific studies address the description of the disease from biologic, demographic, economic, and social viewpoints, identify the factors associated with good and bad outcomes, and assess the effects of treatment, both good and ill. The clinical and policy goals are focused upon delaying transitions from more benign disease states to more serious ones, thus improving both longevity and the quality of life. The time is appropriate to consider generalization of the chronic disease data bank model to the usual clinical care situation, with large rewards in improvement of the quality of care. The traditional medical record lacks systematic documentation of end results and of important covariates related to health risks. As such, it cannot readily be used to assess the ultimate quality of care and to establish a feedback loop to change behaviors and thereby improve outcomes. It is weak where the chronic disease data bank is strong. The technology is transferable.

Chronic Disease↗