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PubMed2001

Knowledge and attitudes of high school teachers towards pupils suffering from chronic diseases.

Fifty-eight high school teachers participated in a study about their knowledge and attitudes concerning chronic disease in children and adolescents. The level of knowledge of the 58 teachers was 62%. The head teachers did not have a higher score for their knowledge (63.3%) as compared with vocational teachers (60.3%). The presence of chronic diseases among children of staff teachers correlated with higher knowledge. Head teachers did not show a more tolerant attitude toward pupils with chronic diseases than the vocational teachers (14.9% vs. 13.7%). Ninety percent of teachers are ready and willing to spend extra time teaching their chronically ill pupils. The head teachers meet more frequently with chronically ill pupils, as well as with their parents, than do vocational teachers. All teachers believe and expect that they should know details about the pupil's chronic condition; more head teachers than vocational think it is important and beneficial if other pupils in class would know about the chronic condition and handicaps of the specific pupils in their class. Three quarters of the teachers consider it important and mandatory to increase awareness of chronic disease and disability in the school setting.

Adolescent↗

PubMedDate not supplied

Problems in assessing the relative predictive value of internal markers versus external exposure in chronic disease epidemiology.

Epidemiology traditionally has relied on measures of "external" exposure in determining the association between exposure and disease. Recently, there has been increasing reliance on internal markers reflecting internal dose and/or early stages of disease. In the context of observational studies of chronic disease in which there is a known exposure-disease association, the question arises whether the external exposure or the internal marker is a better predictor of eventual disease outcome. Here we describe some simple approaches to evaluate the relative predictive value of the internal marker (or biomarker, defined in the most general sense) versus the exposure, as well as their limitations. The problems of assessing the predictive value of internal markers for chronic disease are illustrated via two examples: (a) carcinogens, cytogenetic outcomes, and cancer; and (b) asbestos, asbestosis, and lung cancer. We conclude that it is unlikely that observational epidemiology will allow a full assessment of the predictive value of cytogenetic outcomes versus exposure for cancer in humans exposed to known carcinogens in the near future, although animal studies could provide important complementary information. For asbestos, data to date indicate that the presence or absence of asbestosis is a better predictor of lung cancer in an exposed population than is the level of exposure to asbestos itself. In general, the most useful markers for predicting chronic disease are ones which persist over time.

Animals↗

PubMed1993

Self-rated health, mortality, and chronic diseases in elderly men. The Zutphen Study, 1985-1990.

The value of self-rated health in predicting mortality and the incidence of chronic diseases was studied in a cohort of 783 elderly Dutch men in the Zutphen Study. In 1985, 48% of the men felt "healthy," while 12% felt "moderately healthy" or "not healthy." As of 1990, 23% of the 783 men had died. Survival analysis showed that self-rated health was highly predictive of subsequent 5-year mortality from all causes (p < 0.001). When adjusted for the presence of major chronic diseases, age, medication use, smoking, alcohol consumption, physical activity, body mass index, systolic blood pressure, serum cholesterol, education, marital status, and family history of chronic diseases, the relative risk for "moderately healthy" or "not healthy" men compared with "healthy" men was 2.7 (95% confidence interval (CI) 1.8-4.3). Analysis of cause-specific mortality revealed that self-rated health was associated with cardiovascular mortality (crude relative risk (RR) = 2.7), but this finding resulted mainly from confounding by baseline prevalence of cardiovascular diseases (adjusted RR = 1.9, 95% CI 0.9-3.8). However, self-rated health was an independent risk factor for cancer mortality (adjusted RR = 4.2, 95% CI 1.9-9.4) and mortality due to other causes (adjusted RR = 3.0, 95% CI 1.2-7.8). Self-rated health did not independently predict the incidence of chronic diseases. This suggests that self-rated health especially affects fatality from chronic diseases rather than their onset, and this issue should be pursued further.

Aged↗

PubMedDate not supplied

[Chronic diseases in childhood: an approximate measurement of their impact].

As an approach to measurement of the importance of chronic diseases in childhood, type and frequency of diagnoses in children admitted to the pediatric wards of a general metropolitan hospital at Santiago, Chile, were reviewed and recorded along hospitalization and at the time of discharge from March 1 through June 30, 1989 (n: 426). Newborns were excluded. Main problems of the study were lacks of uniform national criteria to define chronic illness and of modern technology to certify diagnoses. Ninety five hospital discharged children (23.3%) were considered to have a definitive, confirmed chronic disease (CCD), other 51 (12%) were cases of possibly chronic disease (PCD) while the remainder were thought to be carriers of acute illness. Among 146 patients taken as CCD or PCD cases, 126 (87.7%) were considered to have single organic system diseases as defined by areas of medical interest or specialty; other 3 cases (8.9%) had two affected systems and 5 children (3.4%) had three or more involved systems. More frequently affected systems (in number of cases) and their corresponding proportions of CCD were as follows: neurologic (31 cases and 58.1% CCD), oncohematologic (28 cases and 96.4% CCD) and gastrointestinal (26 cases and 26.9% CCD). More extensive studies, covering other medical care providing settings are desirable and necessary to measure the magnitude and features of chronic disease entities in chilean childhood.

Age Factors↗

PubMed2003

Health related quality of life in pregeriatric patients with chronic diseases at urban, public supported clinics.

BACKGROUND: Understanding health-related quality of life (HRQOL) leads to more effective and focused healthcare. America's growing health disparities makes it is increasingly necessary to understand the HRQOL of pregeriatric individuals who are now 55-64 years old, i.e. before they are eligible for federally mandated health care at age 65. Our study measured the self-perceived HRQOL of pregeriatric, poor patients with multiple chronic diseases treated at 2 public clinics. METHODS: Consecutive patients aged 55-64 years, many with multiple chronic diseases, responded in an interview to the 36-Item Short-Form Health Survey (SF-36) as a general measure of HRQOL during a regular visit to one of two university-staffed urban public clinics. RESULTS: The perceived physical and mental functioning of 316 pregeriatric patients was tabulated from SF-36 scores to yield their HRQOL. Their scores were statistically significantly lower than those of the general US pregeriatric population and lower than averages for US patients with multiple chronic diseases. All eight subscale scores of SF-36 were 16% to 36% lower compared with the averages of the general US pregeriatric population. Further, as the number of chronic diseases increased, the lower was the HRQOL. Lower physical and mental scores were associated with a lower income, unemployment, and higher numbers of multiple chronic diseases. CONCLUSION: Chronic diseases have a powerful negative impact on perceived mental and physical functioning in pregeriatric patients. HRQOL information can assist health care providers to gain a more complete picture of their pregeriatric patients' health.

Aging↗

PubMed1989

Computer held chronic disease registers in general practice: a validation study.

Lists of patients receiving repeat prescriptions for epilepsy, diabetes, thyroid disease and asthma were compared with chronic disease registers stored on seven practice computers. Diabetes was the most accurately recorded disease: the names of 72% of patients receiving medication for this condition appeared on the relevant disease registers. Agreement between the two data sources was 68% for thyroid disease, 58% for asthma and 49% for epilepsy. The levels of accuracy are not yet high enough for the computerised chronic disease registers to provide an accurate estimate of the prevalence of these conditions, but new system developments suggest a more optimistic outlook for the future.

Asthma↗

PubMed2006

Molecular pathogenesis of anemia of chronic disease.

Most patients suffering from chronic infections, chronic inflammatory diseases, and some malignancies develop a mild to moderate anemia designated anemia of chronic disease or anemia of inflammation. Patients with this anemia have low serum iron, low to normal transferrin, and high to normal serum ferritin concentration. The anemia is caused by increased inflammatory cytokines, especially IL-6, inducing increased production of the iron-regulatory hormone hepcidin by hepatocytes. Hepcidin blocks the release of iron from macrophages, hepatocytes, and enterocytes, causing the characteristic hypoferremia associated with this anemia and iron-deprivation of the developing erythrocytes.

Anemia↗

PubMed1996

[Insufficient vaccination status of children with a chronic disease].

OBJECTIVE: To determine whether the vaccination status of children with a chronic disease in adequate, what amount of delay occurs and whether vaccination opportunities are missed. DESIGN: Retrospective descriptive. SETTING: Department of Pediatrics, University Hospital, Groningen, the Netherlands. METHODS: Vaccination data of all 79 children with chronic diseases admitted to the infant and toddler ward of the Beatrix Children's Hospital between January 1 and December 31 1993 were obtained through review of hospital admission charts and local Vaccination Administration records, as well as through telephone contacts with the parents. The data of 71 children were complete; these were compared with the vaccination guidelines with respect to diphtheria-tetanus-pertussis-poliomyelitis (DTPP) vaccination and mumps-measles-rubella (MMR) vaccination. RESULTS: Vaccination coverage for DTPP reached over 90% although for DTPP 3 and 4 with a delay of more than 3 months. MMR vaccination coverage was 86%. Only 21% of the patients received all vaccinations within a period of 1 month after the recommended age. Among the remaining 79% of children 56 opportunities were missed to administer vaccines during admission. Twenty-one times the possibility to administer DTPP and MMR simultaneously was missed. CONCLUSION: Children with a chronic disease run a high risk of incomplete and delayed immunization.

Child, Preschool↗

PubMed2003

Unmet need for chronic disease and end-of-life care at urban family health centers in the Bronx, NY.

BACKGROUND AND OBJECTIVES: With population demographic shifts and as people live longer with progressive incurable illnesses, there will be a growing need for community-based chronic disease and end-of-life care services. Family practice sites could be strategic community-based settings in which to offer chronic disease and end-of-life care. This study determined whether two urban family health centers were meeting the chronic disease and end-of-life care needs of health center users, their families, and the local community. METHODS: Using a brief structured interview instrument, we interviewed a convenience sample of 218 patients at two hospital-affiliated family health centers in the Bronx, NY, about their recent experiences with serious illness and death of immediate family members. In addition, we developed geographically defined medical service areas for each health center and compared the age distribution of residents of the geographic areas with that of actual health center users. RESULTS: Of 218 health center users, 18% (n=39) had experienced the death of an immediate family member in the past year, of whom only 8% (n=3) stated that their family member had received end-of-life/chronic disease care at the health center, and only 23% (n=9) knew that their family member could have received such care. Of 26% (n=56) of study subjects who reported having an immediate family member who was currently seriously ill, 18% (n=10) stated that their family members were receiving care at the health center, and 23% (n=13) knew that their family members could have received such care. Eighty percent (n=174) of study subjects stated that they themselves would be interested in receiving end-of life/ chronic disease care at the health center in the event that they needed such care. The age distribution of health center users significantly differed from that of the residents of the geographically defined medical service areas, with an underrepresentation of people over the age of 75 among the health center users. CONCLUSIONS: We identified a potential unmet need for chronic disease and end-of-life care among families of health center users and the larger community served by two family health centers in the Bronx, NY. Despite the frequent occurrence of serious illness and recent death among close family members, relatively small proportions of these family members had received care at the health centers, and few actual users were aware that such services could be provided there. Moreover, there was a significant demographic mismatch in age distribution between health center users and the surrounding community. These findings signal an important opportunity for the discipline of family medicine and its training programs to define and respond to the chronic disease and end-of-life care needs of patients and their families in community-based settings.

Adolescent↗

PubMed1992

Criteria for the use of Sartwell's incubation period model to study chronic diseases with uncertain etiology.

This study explores the conditions under which Sartwell's incubation period model may be appropriate for identifying a primary time period of etiologic risk for chronic diseases with uncertain etiology. The investigation begins with a description of the evolution of the application of Sartwell's model from infectious to chronic diseases. The model's underlying assumptions and some concerns about its use in the chronic disease context are specified. These concerns are addressed by data simulations and analyses of empirical data from the Connecticut Tumor Registry and the Radiation Effects Research Foundation. The results indicate that the distribution of age at diagnosis (i.e. onset) for chronic diseases is not necessarily lognormal. However, the representativeness of age distribution of the case series can affect the distribution's form; hence, it is important to determine the extent of "missing" cases, particularly those lost through truncation. Moreover, a lognormal age distribution may occur with both prenatal and age-related postnatal exposures. These findings suggest that only under certain conditions will Sartwell's model be useful in the study of chronic diseases of uncertain etiology, and indicate some caveats for interpretation of the results.

Chronic Disease↗

PubMed1998

[Strategy on the prevention and treatment of chronic diseases among residents in Dongcheng District, Beijing].

Chronic diseases, in particular, circulatory diseases characterized by high mortality, morbidity, and lack of special treatment have become serious problems to the residents living in the Beijing communities. To learn the above mentioned diseases among people at the community level and to investigate treatment and preventive method concerned studies on chronic circulatory system diseases among people living in communities in Dongcheng where few disease were under special control studies were carried out between 1981 and 1997. We found that the studied residents who had received and adopted a series of preventive measures as health education, giving up smoking, reducing alcohol and salt consumption, diet balance and practicing physical exercises, had greatly improved their health condition. Because of the positive results, we addressed some long-termed suggestions on the treatment and prevention for chronic patients with circulatory system diseases which is believed to have established a solid ground for the future.

Cardiovascular Diseases↗

PubMed2005

Depression and its associated factors among patients attending chronic disease clinics in southwest Trinidad.

This study determined the prevalence of depression and associated factors, among patients attending chronic disease clinics in Southwest Trinidad. This was a cross-sectional survey using a sample of consecutive patients at four large clinics. To determine the presence of depression, an interviewer-applied modified Zung Scale was validated The modified Zung scale, at the cut-off index of 60, has a sensitivity of 60% and a specificity of 94%. Seven hundred and thirty-four completed questionnaires were received, a response rate of 76%. The patients were primarily Indo-Trinidadian (70%), over 50 years (76.4%) and female (72.3%). The prevalence of depression was 28.3%. There were statistically significant differences in the level of depression by age, gender, educational level achieved and occupation (p < 0.05). There were also statistically significant differences in the level of depression by the number of presenting complaints, the number of chronic diseases, the presence of arthritis, the presence of diabetes mellitus with another chronic disease and the presence of ischaemic heart disease (p < 0.05). No significant differences were found with respect to ethnicity (p = 0.97) or the presence of diabetes mellitus by itself (p = 0.34). Results of logistic regression indicate that the independent predictors of depression (p < 0.05) were the level of education achieved, those with higher levels of education had less depression; the number of presenting complaints, those with more presenting complaints were more likely to be depressed and the presence of arthritis and female gender. It is imperative that policy be developed to address the mental health problems of patients attending these chronic disease clinics.

Adolescent↗

PubMed1994

The relationship of chronic diseases and health status to the health services utilization of older Americans.

OBJECTIVE: To study simultaneously the relationships among chronic diseases and physical health status as they affect health services utilization of older adults. DESIGN: Secondary analysis of a large, cross-sectional health interview survey, the Supplement on Aging of the 1984 National Health Interview Survey, using multiple equation methods to evaluate disease-specific impacts on physical health status, the direct impact of specific diseases on utilization of physician services and hospital care, and the indirect impact of specific diseases on utilization, mediated through physical health status. PARTICIPANTS: A total of 11,497 people aged 65 and older, representing a complex, multistage sample of the noninstitutionalized, older adult population of the United States. MEASUREMENTS: Predictor variables included specific chronic diseases (hypertension, arthritis, diabetes, cancer, and atherosclerotic heart disease), self-rated health status, and total number of disabilities. Control variables included age, gender, race, education, social integration. Outcome variables were physician visits and hospital stays. MAIN RESULTS: It was shown that different diseases have different relative impacts on physical health status, probability of utilization, and amount of utilization, if any, and different chronic diseases have a different mix of direct and indirect effects on utilization. CONCLUSION: The impact of chronic disease on health services utilization in a community-dwelling population is not a simple or direct relationship. Diseases vary according to their impact on different types of utilization, their impact on the probability of any health services use versus the amount of use, and on how much their effect on utilization is mediated through health status.

Aged↗

PubMed2000

Dietary guidelines for chronic disease prevention.

In developed nations, diet is related directly or indirectly to the most prevalent chronic diseases. Research has helped clarify diet-disease relationships and enabled the promulgation of dietary recommendations for chronic disease prevention. We reviewed epidemiologic study results, clinical trial data, and general dietary recommendations from various agencies to develop a set of overall dietary guidelines for the prevention of the most common chronic diseases in the United States, including coronary heart disease, hypertension, cancer, and osteoporosis. Intake of monounsaturated fats, fiber, calcium, vegetables and fruits, and whole grains should be promoted. Consumption of saturated and trans fats, sodium, and refined grains should be minimized. Moderation in alcohol and caloric intake should be encouraged. Although research into associations between diet and disease is constantly in flux, our guidelines are based on replicated findings and provide a starting point for assisting patients in improving their diets.

Adult↗

PubMed2004

Support network of adolescents with chronic disease: adolescents' perspective.

The purpose of this study was to describe the support network of adolescents with a chronic disease from their own perspective. Data were collected by interviewing adolescents with asthma, epilepsy, juvenile rheumatoid arthritis (JRA) and insulin-dependent diabetes mellitus (IDDM). The sample consisted of 40 adolescents aged between 13 and 17 years. Interview data were examined using content analysis. Six main categories were established to describe the support network of adolescents with a chronic disease: parents, peers, school, health care providers, technology and pets. Peers were divided into two groups: fellow sufferers and peers without a chronic disease. At school, teachers, school nurses and classmates were part of the support network. Health care providers included nurses, physicians and physiotherapists. Technology was also part of the support network and included four techniques that may be used to communicate: computers, mobile telephones, television and videos. The results provided a useful insight into the social network of adolescents with chronic disease and serve to raise awareness of the problems and opinions experienced by adolescents with this condition.

Adolescent↗

PubMed1977

Levels of erythropoietin in patients with the anemias of chronic diseases and liver failure.

Two mechanisms are felt to be responsible for the production of anemia in patients with chronic diseases. The first is failure to produce adequate amounts of erythropoietin (EP), and the second is failure to deliver iron to the bone marrow in amounts sufficient to support normal erythropoiesis. In order to evaluate these hypotheses we studied urine and serum EP levels and levels of 2,3-diphosphoglycerate in normal subjects, in patients with the anemia of chronic diseases, in patients with chronic liver disease, and in patients with a variety of other anemias. Based on the results, we propose first that insufficient production of EP is one of the major mechanisms responsible for anemia in patients with chronic diseases. Second, insufficient production of EP is, in part, responsible for anemia seen in patients with chronic liver disease. Third, serum and urine EP levels decrease with aging, and this correlates with the fall of hemoglobin levels seen in older normal subjects.

Aging↗

PubMedDate not supplied

Mentorship and competencies for applied chronic disease epidemiology.

To understand the potential and establish a framework for mentoring as a method to develop professional competencies of state-level applied chronic disease epidemiologists, model mentorship programs were reviewed, specific competencies were identified, and competencies were then matched to essential public health services. Although few existing mentorship programs in public health were identified, common themes in other professional mentorship programs support the potential of mentoring as an effective means to develop capacity for applied chronic disease epidemiology. Proposed competencies for chronic disease epidemiologists in a mentorship program include planning, analysis, communication, basic public health, informatics and computer knowledge, and cultural diversity. Mentoring may constitute a viable strategy to build chronic disease epidemiology capacity, especially in public health agencies where resource and personnel system constraints limit opportunities to recruit and hire new staff.

Chronic Disease↗

PubMed1996

[Non-communicable chronic diseases in Brazil: from risk factors to social impact].

The current epidemiologic profile of Brazil includes both the diseases of underdevelopment and those associated with modern life. Consequently, the country faces the difficult task of carrying out health promotion and protection activities aimed at controlling communicable diseases as well as noncommunicable chronic diseases (NCDs). This study sought to describe the epidemiologic situation of Brazilian adults with regard to NCDs and to present available data on the quality of care provided for these diseases and their social impact. To these ends, a literature review was conducted for the period 1964-1995--that is, since the beginning of the production and dissemination of data on cardiovascular diseases, cancer, and diabetes. Of the 153 bibliographic references that were discovered, 97 were used. The social, political, economic, and health inequities that exist among Brazil's geographic regions are reflected in the national scientific production, which is concentrated in the Southeast and South. Most of the studies based on primary data come from those regions. Information is scarce from the North-east, except the city of Salvador. Therefore, the health profile of adults--including risk factors and morbidity and mortality--can be better delineated for residents of the South and Southeast of the country, whereas for the other regions the necessary information is practically nonexistent. Risk factors linked to life-style are as widespread and important in Brazil as they are in industrialized countries. Prevalence and mortality rates among persons with or without certain socio-environmental risks (such as low level of schooling or unskilled occupations) indicate that NCDs predominate in the lowest social strata. Inter-regional differences in the prevalence of arterial hypertension and diabetes mellitus, the most common fatal cardiovascular causes, and the predominant cancers, as well as morbidity and mortality in both sexes, illustrate the political, social, and economic inequities of development in each region. Comparisons with other countries of the incidence of cardiovascular diseases in a capital in the Northeast or mortality from cardiovascular diseases in the capitals in the South and Southeast show, in the first case, that Salvador has the highest incidence among the Western countries analyzed and, in the second case, that the mortality data rank among the top seven. Cardiovascular diseases and diabetes show increasing trends, with the exception of a small decline for ischemic heart disease and cerebrovascular disease in the municipality of São Paulo. Deaths rates in hospitals from specific cardiovascular diseases and avoidable complications of diabetes are high, especially among indigent patients as opposed to private patients. Premature mortality, as measured by productive years of life lost, reflects the poor quality of medical care and the absence of targeted control programs. These data, combined with other sources of information, such as consents for treatment and pensions paid for illness, give some idea of the impact of NCDs on the society. The authors point to the basic research that could be done in all the country's regions to serve as a basis for planning and implementing populational strategies to reduce risk factors and to treat and control chronic noncommunicable diseases in Brazil.

Adolescent↗