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PubMed1956

The challenge of chronic disease.

The increasing millions of people with chronic disease constitute the greatest challenge to American medicine today. It is only during the very few years just past that any comprehensive answer to this challenge has been initiated. To physicians the most pressing needs in the total care of the chronically ill are:1. Research in the care of the chronically ill as well as in the specific diseases causing chronic illness.2. Coordination of all the services available in our communities.3. Recognition by physicians of responsibility for the care of the chronically ill person, himself, as well as for treatment of his disease.

Chronic Disease↗

PubMedDate not supplied

[Methodological perspectives for the assessment of adaptation in chronic diseases, exemplified by asthma bronchiale in childhood].

BACKGROUND: Regarding the measurement of psychosocial adaptation due to chronic diseases in childhood and adolescence, there is a shift from a more reductionist and biomedical oriented disease-model towards a more integrated, biopsychosocial view of chronic diseases. The three paradigms in measuring psychosocial adaptation (psychopathology, coping, health related quality of life) will be discussed at the example of corresponding empirical studies in children with asthma bronchiale. The psychopathology-oriented research emphasizes the risk of the induced psychopathological comorbidity, whereas the more coping-oriented paradigm primarily includes the dynamic process of the perceived stress and the corresponding coping efforts due to a chronic disease. The third paradigm, the quality of life paradigm, sets its main focus on the subjective view of the chronically ill subject. CONCLUSIONS: In future studies, all three paradigms--each measuring different aspects of psychosocial adaptation--should be simultaneously included to come to a more complex view of adaptation in chronic diseases in general and asthma bronchiale in particular.

Adaptation, Psychological↗

PubMed2000

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

BACKGROUND: Little is known about the overall health effects of adherence to the Dietary Guidelines for Americans. The healthy eating index (HEI), developed at the US Department of Agriculture, measures how well Americans' diets conform to these guidelines. OBJECTIVE: We tested whether the HEI (scores range from 0 to 100; 100 is best) calculated from food-frequency questionnaires (HEI-f) would predict risk of major chronic disease in women. DESIGN: A total of 67272 US female nurses who were free of major disease completed detailed questionnaires on diet and chronic disease risk factors in 1984 and repeatedly over 12 y. Major chronic disease was defined as fatal or nonfatal cardiovascular disease (myocardial infarction or stroke, n = 1365), fatal or nonfatal cancer (n = 5216), or other nontraumatic deaths (n = 496), whichever came first. We also examined cardiovascular disease and cancer as separate outcomes. RESULTS: After adjustment for smoking and other risk factors, the HEI-f score was not associated with risk of overall major chronic disease in women [relative risk (RR) = 0.97; 95% CI: 0.89, 1.06 comparing the highest with the lowest quintile of HEI-f score]. Being in the highest HEI-f quintile was associated with a 14% reduction in cardiovascular disease risk (RR = 0.86; 95% CI: 0.72, 1. 03) and was not associated with lower cancer risk (RR = 1.02; 95% CI: 0.93, 1.12). CONCLUSION: These data suggest that adherence to the 1995 Dietary Guidelines for Americans, as measured by the HEI-f, will have limited benefit in preventing major chronic disease in women.

Adult↗

PubMed1996

Effect of recombinant human erythropoietin on anaemia and disease activity in patients with rheumatoid arthritis and anaemia of chronic disease: a randomised placebo controlled double blind 52 weeks clinical trial.

OBJECTIVE: To study whether recombinant human erythropoietin (r-hu-Epo) improves anaemia and reduces disease activity in patients with rheumatoid arthritis and anaemia of chronic disease (ACD). METHODS: A 52 week placebo controlled randomised double blind trial with r-hu-Epo was performed in 70 patients with active rheumatoid arthritis and ACD. Thirty four patients were treated with 240 U kg-1 r-hu-Epo subcutaneously, initially three doses weekly, while 36 patients received placebo. RESULTS: A significant increase of haemoglobin from a median of 112 to 135 g litre-1 occurred in the Epo group within six weeks and could be sustained with reduced doses (median 240 U kg-1 once weekly). Sustained benefit compared to placebo was also apparent by six weeks for disease activity, as indicated by the Paulus 20% response rate. Of patients in the Epo group, 32% eventually showed a Paulus 20% response, compared to 8% of the placebo group (P = 0.016). Significant differences in favour of the Epo group were also observed in the secondary disease activity measures Ritchie index, number of swollen joints, pain score, ESR, and patients' global assessment of disease activity. C reactive protein concentrations did not change significantly. CONCLUSIONS: Treatment of ACD in rheumatoid arthritis with r-hu-Epo is effective in restoring normal haemoglobin levels and also exerts a beneficial effect on disease activity.

Adult↗

PubMed2006

Use of breath carbon monoxide measurements to assess erythrocyte survival in subjects with chronic diseases.

Anemia is very common in patients with chronic diseases. To determine the role of increased red blood cell (RBC) turnover in such subjects, we estimated RBC survival in three groups of chronically ill patients using a simple technique in which RBC life span is estimated via measurements of breath carbon monoxide concentration. The study groups consisted of subjects with: (1) osteoarthritis, (2) rheumatoid arthritis, and (3) anemia who were hospitalized for treatment of a variety of chronic illnesses. None of the anemic subjects had evidence of hemorrhage, a deficiency state, or a marrow abnormality to account for their reduced hemoglobin concentration. Subjects with osteoarthritis had a mean RBC life span (127 +/- 25 days) that did not differ significantly from normal (122 +/- 23 days). In contrast, RBC life span was significantly reduced (P < 0.001) in both the rheumatoid arthritis subjects (90 +/- 15 days) and the anemic, hospitalized patients (87 +/- 33 days). The hemoglobin concentration of the rheumatoid patients was near normal (13.5 +/- 1.5 g/dl), indicating that the marrow was compensating for the reduced RBC life span, whereas no such compensation was apparent in the anemic, chronically ill subjects. We conclude that a modest (approximately 25%) reduction in RBC life span commonly occurs in patients with chronic disease, and this reduction becomes clinically relevant in subjects whose marrow cannot respond with increased RBC output.

Aged↗

PubMed2004

Socioeconomic inequalities in mobility decline in chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, low back pain): only a minor role for disease severity and comorbidity.

OBJECTIVE: This study examined the association between socioeconomic status and mobility decline and whether this could be explained by disease severity and comorbidity in four different chronic disease groups (asthma/COPD, heart disease, diabetes mellitus, and low back pain). It is not clear, whether the adverse course of physical functioning in persons with a low socioeconomic status can be explained by a higher prevalence of more severe disease or comorbidity in these persons. DESIGN: Dutch GLOBE study: prospective cohort study. SETTING: Region of Eindhoven (south east of the Netherlands). PARTICIPANTS: 1384 persons suffering from at least one of the four chronic diseases were selected. The number of respondents in each group was: asthma/COPD 465, heart disease 788, diabetes mellitus 137, and low back pain 707. There were 580 respondents who suffered from more than one condition. MAIN RESULTS: Odds ratios of mobility decline between 1991 and 1997, adjusted for age, sex, marital status, and baseline mobility, were significantly higher in low socioeconomic groups in comparison with high socioeconomic groups. Only very little of this association could be explained by the higher disease severity and comorbidity in these patients. Findings were similar in patients with asthma/COPD, heart disease, diabetes mellitus, and chronic low back pain. CONCLUSION: These findings indicate that to reduce physical disabilities and particularly the socioeconomic differences therein, it may not be sufficient to solely intervene upon the risks of severe disease and comorbidities.

Activities of Daily Living↗

PubMed1984

Hypoalbuminemia associated with diffuse hypergammaglobulinemia in chronic diseases: lack of diagnostic specificity.

Although elevated gamma globulin is known to produce hypoalbuminemia both experimentally and in disease, a low albumin concentration in chronic liver disease often is assumed to reflect impaired liver synthetic function. Albumin and gamma globulin measurements in a series of 200 patients with a variety of chronic diseases (including cirrhosis, connective tissue disease, chronic inflammation, and malignancy) associated with diffuse hypergammaglobulinemia were combined with similar measurements from a previous study (Am J Med 1959; 29:596-616). The mean serum albumin concentration correlated inversely with mean gamma globulin, irrespective of disease category. Double reciprocal plot analysis showed that the relationship fits a rectangular hyperbola (r = -0.915, P less than 0.001), with the mean albumin concentration approaching 2.31 g/dL at infinite gamma globulin. This suggests that serum albumin decreases to a similar extent in various chronic diseases and that hypoalbuminemia has no diagnostic implications, except to the extent that it reflects the severity of hypergammaglobulinemia.

Chronic Disease↗

PubMed1984

Projecting chronic disease prevalence.

Health and long-term care planning for an aging population is an important and necessary function for both the public and private sector. Unfortunately, efforts at planning have often been limited by difficulties in making estimates and forecasts of chronic disease prevalence in the population. These difficulties are a direct result of the natural history of chronic diseases that normally have long presymptomatic stages. Because of this characteristic, predictions of the magnitude of chronic disease prevalence in the United States often fail to reflect an important dimension of the health state of the population: that there is a sizeable proportion of chronic disease prevalence and risk existing in the population in a preclinical phase. The authors present a strategy for obtaining more complete estimates of chronic disease prevalence. This approach entails the creation of an illness--death model representing the natural history of individual chronic diseases and the application of the model to infer morbidity incidence and prevalence patterns from national mortality statistics. They illustrate the approach with an example of lung cancer and discuss the applications of the outputs of the modeling strategy for health care resource planning.

Actuarial Analysis↗

PubMedDate not supplied

Chronic disease risk factors among healthy adolescents attending public schools in the state of Morelos, Mexico.

BACKGROUND: Little research (and fewer interventions) has been done on longitudinal exposure to risk factors for chronic diseases in young people in Latin America, including Mexico, although chronic diseases constitute the first cause of death in Mexico. Our objective was to document the prevalence of chronic disease risk factors among adolescents as a baseline measurement for a cohort study and to develop educational interventions. METHODS: Questionnaires, blood samples, and anthropometric measurements were collected from 13,293 public school students of both sexes, ages 11-24 years in Morelos, Mexico. This constitutes the baseline measurement for a cohort study. Twenty focus groups and 10 in-depth interviews were done with girls aged 12-17 years. Two educational interventions promoting physical activity and sexual health were designed. RESULTS: Prevalence of obesity was 21.2%. On average, participants spent 0.5 h/day on vigorous physical activity and 3.7 h/day watching television. Sexual initiation was reported by 14.5% (girls = 9.1%, boys = 21.5%); 52.3% of whom reported using condoms. Young women demonstrated correct condom use and perceived themselves at risk for HIV/AIDS but did not have condom negotiation skills. Prevalence of experimenting with tobacco was 15.1% (girls = 10.4%, boys = 21.1%); current smoking was 14.4% (girls = 10.6%) and boys = 19.2%), while 6.3% of participants reported monthly intoxication with alcohol, and 4.5% reported past and 2.1% reported current illegal drug use. CONCLUSIONS: Results indicate substantial exposure to risk factors for chronic diseases and reproductive health problems in this population. The study will generate interventions and constitutes initiation of a longitudinal study able to explore causal associations between risk factors and chronic diseases in this population.

Adolescent↗

PubMed2004

Comorbidity of somatic chronic diseases and decline in physical functioning:; the Longitudinal Aging Study Amsterdam.

OBJECTIVE: To assess the association of decline in physical functioning with number of chronic diseases and with specific comorbidity in different index diseases. METHODS: A longitudinal design was employed using data from 2,497 older adults participating in the Longitudinal Aging Study Amsterdam. Logistic regression analyses were used to determine influence of chronic diseases on change in physical functioning, operationalized using the Edwards-Nunnally index. RESULTS: Decline in physical functioning was associated with number of chronic diseases (adjusted ORs from 1.58 for 1, to 4.05 for > or =3 diseases). Comorbidity of chronic nonspecific lung disease and malignancies had the strongest exacerbating influence on decline. An exacerbating effect was also found for arthritis in subjects with diabetes or malignancies and for stroke in subjects with chronic nonspecific lung disease or malignancies. A weaker effect than expected was observed for diabetes in subjects with stroke, malignancies, cardiac disease, or peripheral atherosclerosis. CONCLUSION: Comorbidities involving chronic diseases that share etiologic factors or pathophysiologic mechanisms appear to have a weaker negative influence on decline in physical functioning than expected. Results indicate that combinations of diseases that both influence physical functioning, but through different mechanisms (locomotor symptoms vs. decreased endurance capacity) may be more detrimental than other combinations.

Aged↗

PubMed2006

Estimating chronic disease deaths and hospitalizations due to alcohol use in Canada in 2002: implications for policy and prevention strategies.

INTRODUCTION: Alcohol consumption is a factor that increases risk of chronic disease. This study estimates various indicators of alcohol-attributable premature chronic-disease morbidity and mortality for Canada in 2002. METHODS: Information on mortality and morbidity was obtained from Statistics Canada and from the Canadian Institute for Health Information database. Data on alcohol use were obtained from the Canadian Addiction Survey and weighted for per capita consumption. Risk information was taken from published literature and combined with alcohol consumption information to calculate age- and sex-specific alcohol-attributable chronic disease morbidity and mortality. RESULTS: In Canada in 2002, there were 1631 chronic disease deaths among adults aged 69 years and younger attributed to alcohol consumption, and these deaths were 2.4% of the deaths in Canada for this age group. The net number of deaths comprised 2577 deaths caused and 947 deaths prevented by alcohol consumption. Moderate drinking was involved in 25% of deaths caused and 85% of deaths prevented by alcohol. There were 42,996 years of life lost prematurely in Canada due to alcohol consumption in 2002, 28,890 for men and 14,106 for women. In Canada in 2002, there were 91,970 net chronic disease hospitalizations attributed to alcohol consumption among individuals aged 69 years and younger. The net numbers were 124,621 hospitalizations caused and 32,651 hospitalizations prevented by alcohol consumption. CONCLUSION: With rising rates of alcohol consumption and extensive high-risk drinking, both chronic and acute damage from alcohol are expected to increase. Attention is needed to 1) create effective policies and interventions; 2) control access to alcohol; 3) reduce high-risk drinking; and 4) provide brief interventions for high-risk drinkers.

Adolescent↗

PubMed2004

Chronic disease medication administration rates in a public school system.

Anecdotal reports suggest school nurses and staff treat increasing numbers of public school students with chronic diseases. However, professionals know little about actual disease burden in schools. This study measured prevalence of chronic disease medication administration rates in a large, urban midwestern school district. Data from daily medication logs were recorded by school nurses during a single week. Medications and administrations were sorted by disease type. Prevalence rates were calculated for six chronic diseases: asthma, diabetes, seizures, attention deficit/hyperactivity disorder, other mental/behavioral disorders, and other diseases/conditions. Separate rates stratified by school grade, poverty level, and type of school were calculated. Overall, 3.12% of students received medication for chronic diseases, including 2.13% for psychiatric/mental disorders and 1.91% for attention deficit/hyperactivity disorder alone. These rates were lower than estimates from other states. Factors that contributed to this finding are reviewed.

Adolescent↗

PubMed2002

Diet quality and major chronic disease risk in men and women: moving toward improved dietary guidance.

BACKGROUND: Adherence to the Dietary Guidelines for Americans, measured with the US Department of Agriculture Healthy Eating Index (HEI), was associated with only a small reduction in major chronic disease risk. Research suggests that greater reductions in risk are possible with more specific guidance. OBJECTIVE: We evaluated whether 2 alternate measures of diet quality, the Alternate Healthy Eating Index (AHEI) and the Recommended Food Score (RFS), would predict chronic disease risk reduction more effectively than did the HEI. DESIGN: A total of 38 615 men from the Health Professional's Follow-up Study and 67 271 women from the Nurses' Health Study completed dietary questionnaires. Major chronic disease was defined as the initial occurrence of cardiovascular disease (CVD), cancer, or nontraumatic death during 8-12 y of follow-up. RESULTS: High AHEI scores were associated with significant reductions in risk of major chronic disease in men [multivariate relative risk (RR): 0.80; 95% CI: 0.71, 0.91] and in women (RR: 0.89; 95% CI: 0.82, 0.96) when comparing the highest and lowest quintiles. Reductions in risk were particularly strong for CVD in men (RR: 0.61; 95% CI: 0.49, 0.75) and in women (RR: 0.72; 95% CI: 0.60, 0.86). In men but not in women, the RFS predicted risk of major chronic disease (RR: 0.93; 95% CI: 0.83, 1.04) and CVD (RR: 0.77; 95% CI: 0.64, 0.93). CONCLUSIONS: The AHEI predicted chronic disease risk better than did the RFS (or the HEI, in our previous research) primarily because of a strong inverse association with CVD. Dietary guidelines can be improved by providing more specific and comprehensive advice.

Adult↗

PubMed1996

The nutritional status of Finnish home-living elderly people and the relationship between energy intake and chronic diseases.

The nutritional status and the impact of non-progressive chronic diseases on energy intake were determined in 90 home-living people aged from 73 to 94 years. The nutritional status was assessed by dietary, anthropometric, biochemical and haematological methods. Energy intake (6.0, SD 1.7 MJ) in women was low compared with the Nordic Nutrient Recommendation but in men it (8.0, SD 2.1 MJ) was in keeping with this recommendation. Despite the low energy intake the mean BMI value of women was moderately high (27, SD 5.3 kg/m2). In men the mean was 26, SD 4.0 kg/m2. The intakes of vitamins and minerals met the recommendation, except for those of folic acid and zinc. The blood levels of both these two nutrients were within reference limits. Men suffering from chronic diseases received less (p < 0.015) energy (7.5, SD 1.76 MJ) than other men (8.9, SD 2.0 MJ). This relationship was not found in women. In conclusion, the nutritional status of people aged over 70 years old living at home was good. The presence of chronic diseases affected the energy intake in men but not in women.

Aged↗

PubMed1995

Omission of day 11 methotrexate does not appear to influence the incidence of moderate to severe acute graft-versus-host disease, chronic graft-versus-host disease, relapse rate or survival after HLA-identical sibling bone marrow transplantation.

Sixty-five patients with haematological malignancy received high-dose chemotherapy or chemoradiotherapy followed by a T replete, HLA-identical sibling bone marrow transplant. All were scheduled to receive a standard cyclosporine/methotrexate immune suppressive regimen to minimise the risk of graft-versus-host disease post-transplant. Forty-six patients received all four scheduled doses of methotrexate, while in nineteen the day 11 dose was omitted due to marked oropharyngeal mucositis or febrile neutropenia. There was a slight increase in the incidence of acute graft-versus-host disease (GVHD) grades I-IV in those not receiving compared to those receiving day 11 methotrexate (84 vs 71% (P = 0.04)). However, there was no difference in the incidence of acute GVHD grades II-IV (14 vs 22%), in the incidence of chronic GVHD (38 vs 47%), in transplant-related mortality (21 vs 24%), in relapse rate (42 vs 51%), in 4-year survival (38 vs 48%), or in disease-free survival (38 vs 42%). These findings suggest that the day 11 methotrexate dose could be omitted without a major deleterious effect on the outcome of HLA-identical sibling marrow transplantation.

Acute Disease↗

PubMedDate not supplied

Is there time for management of patients with chronic diseases in primary care?

PURPOSE: Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause. METHODS: We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions. The result was compared with time available for patient care for the average primary care physician. RESULTS: Eight hundred twenty-eight hours per year, or 3.5 hours a day, were required to provide care for the top 10 chronic diseases, provided the disease is stable and in good control. We recalculated this estimate based on increased time requirements for uncontrolled disease. Estimated time required increased by a factor of 3. Applying this factor to all 10 diseases, time demands increased to 2,484 hours, or 10.6 hours a day. CONCLUSIONS: Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.

Adolescent↗

PubMed1997

An estimate of chronic disease burden and some economic consequences among the elderly Hong Kong population.

OBJECTIVES: To estimate the burden of chronic disease for an elderly Chinese population aged 70 years and over, and to illustrate the use of this information in estimating the economic consequences of disease burden using stroke as an example. PARTICIPANTS: A total of 1902 subjects recruited by random sampling of the old age and disability allowance schemes, which cover over 90% of the Hong Kong elderly population, stratified by sex and five year age groups from age 70 years onwards. METHOD: Information was collected on 10 medical conditions at baseline: arthritis, hypertension, cardiac disease, stroke, chronic obstructive airways disease, peptic ulcer, diabetes mellitus, osteoporotic fracture, malignancy, and dementia. A follow up survey was carried out after 18 months to determine the occurrence of new disease and the number with disease who had died. Disease burden is calculated as the number with disease at baseline plus the number developing new disease minus the number who had died. RESULTS: Disease burden figures were highest for arthritis, hypertension, cardiac disease, and peptic ulcer, and were higher in the 70-79 age group than the 80+ age group for some diseases. For stroke, the economic cost based on a population projection for 2001 was estimated to be around HK$1,900,000,000, or US$250 million. CONCLUSION: Information on the burden of chronic disease is important. It enables the economic consequences to be estimated so that strategies can be developed to prevent diseases with high costs and known effective preventive methods.

Age Distribution↗

PubMed2004

[Intake of soy isoflavones and its correlation with prevalence of chronic diseases among rural women in Weichang County and Lanzhou City in China].

To evaluate the average intake of soy isoflavones and the correlation between this intake and prevalence of chronic diseases among Chinese rural women, soy food consumption and medical history of 1188 recruited rural adult women from Weichang County (Hebei Province) and Lanzhou City (Gansu Province) were collected using food frequency questionnaire. The results showed that the intake of soy isoflavones by Weichang and Lanzhou women was (15.3 +/- 18.9) mg/d (M = 8.8) and (19.5 +/- 32.9) mg/d (M = 10.1), respectively. There had statistically significant difference (P < 0.05). The distribution of soy isoflavones intake was skewed to the right. The reported disease prevalence in Weichang was 25.6% and higher than that in Lanzhou (18.8%). The average intake of soy isoflavones by healthy women was (17.8 +/- 22.8) mg/d (M = 9.5), which was higher than that by women who reported to have one of chronic diseases [(15.7 +/- 22.5) mg/d (M = 8.3)] and significantly higher than that by women who reported to have cardiovascular diseases or chronic digestive system diseases (P < 0.05). These findings indicated an inverse correlation between soy isoflavones intakes and the prevalence of chronic diseases, suggesting that soy isoflavones may play a potential role in the prevention for chronic diseases.

Adult↗