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Non-government organisations to combine for work on chronic disease in Aboriginal peoples, Torres Strait Islanders and rural and remote populations.

As a result of the National Health Priority Area Report on Cardiovascular Health and in particular, its remote and indigenous section, a consortium of five organisations ran a national workshop in Townsville in October 1999 on heart disease in Aboriginal peoples, Torres Strait Islanders and rural and remote populations. One of the priority areas identified at this workshop was the need for a more coordinated approach to chronic diseases and for the formation of an alliance of non-government organisations (NGOs) to work towards this and to undertake a lobbying and advocacy role. A meeting of a wide range of NGOs working in chronic disease, led by the National Heart Foundation of Australia, was held in Sydney in May 2000. At the Sydney meeting it was agreed that an alliance of NGOs could be formed for the development of a chronic disease strategy for Aboriginal peoples, Torres Strait Islanders and rural and remote populations. The NGOs drafted a 'Statement of Intent', which would inform their work on both heart disease and on broader work to address chronic preventable disease in the target populations. There is a considerable amount of procedural work to be done before the proposed alliance becomes a reality but the prospect of closer collaboration between the NGOs working in chronic disease has much to offer, especially for the population groups that were the focus of the Townsville workshop. This 'alliance' initiative comes at a time when there are national and State/Territory moves on broader aspects of what could become a 'national chronic disease prevention and management strategy'.

Australia↗

[Study on the relationship between body mass index and risk factors of chronic diseases of Beijing urban residences].

UNLABELLED: This study aimed to analysis the relationship among body mass index (BMI) and waist circumference (WC) with chronic diseases risk factors--serum total cholesterol (TC), triglyceridaemia(TG), high density lipoprotein cholesterol (HDL-C), fasting blood glucose (FBG), systolic blood pressure (SBP), diastolic blood pressure (DBP) and the prevalence of chronic diseases. The data was collected from 1995 to 1998 in the study of community base integrated intervention of non-communicable chronic diseases. RESULTS: The prevalence of overweight and obesity in male was 41.7% and 14.6%, in female was 32.0% and 20.4% in this population, respectively. BMI and WC had significant positive relationship with TC, TG, SBP and DBP but negative with HDL-C and HDL-C/TC. WC had significant positive relation with FBG. The prevalence of dyslipidaemia hypertension and diabetes were significantly increased in overweight and obese groups. For early prevention, we have to pay more attention to the population with BMI > 24.0 kg/m2, they had increased risk factors of non-communicable chronic diseases.

Adult↗

Prevalence of selected risk factors for chronic disease and injury among American Indians and Alaska Natives--United States, 1995-1998.

Since the 1950s, morbidity and mortality attributable to infectious diseases among American Indians and Alaska Natives (AIs/ANs) have declined and chronic diseases, especially diabetes, and injury have remained important determinants of poor health (1). Knowledge of the prevalence of behavioral risk factors for chronic disease and injury can be used to form policies and programs to improve the health of AIs/ANs. Based on data obtained from the Behavioral Risk Factor Surveillance System (BRFSS) from 1993 through 1996, CDC published regional estimates of the prevalence of 10 behavioral risk factors for AIs/ANs (2). This report updates data from the earlier report and focuses on three of the 10 risk factors for chronic disease and injury among AIs/ANs.

Chronic Disease↗

The impact of chronic diseases on the health-related quality of life (HRQOL) of Chinese patients in primary care.

BACKGROUND: Ageing of the population results in an increasing number of people living with chronic diseases that can adversely affect their quality of life. Information on the impact of chronic diseases on quality of life can make health services more patient-centred. OBJECTIVES: The aim of this study was to determine the impact of eight chronic diseases on the health-related quality of life (HRQOL) of Chinese patients. METHODS: A cross-sectional case-control study was carried out on 760 adult Chinese patients of a family medicine clinic in Hong Kong. Each subject answered the COOP/WONCA charts and a standard questionnaire on demographic and morbidity data. The likelihood of sub-optimal COOP/WONCA scores of each disease group was compared with that of patients without any of the surveyed diseases. The independent effects of each disease on the COOP/WONCA scores were analysed by multivariate logistic regression, controlling for demographic variables and co-morbidity. RESULTS: Depression increased the risks for sub-optimal scores in all but one COOP/WONCA chart with odds ratios (OR) ranging from 2.1818 to 3.8645. Hypertension increased the risk of a sub-optimal physical fitness score (OR 1.7263). Increased risk of limitations in daily activities was associated with stroke (OR = 1.8771), osteoarthritis of the knee (OR = 1.5867), diseases of joints other than the knees (OR 2.0187) and asthma/COPD (OR 2.1679). Osteoarthritis of the knees also increased the risk of sub-optimal overall health (OR = 1.7927). CONCLUSIONS: Depression was the most disabling disease, and osteoarthritis of the knee had more impact on the HRQOL than many other chronic diseases. The lack of adverse effects of diabetes mellitus and heart disease on the HRQOL of Chinese patients deserves further studies.

Activities of Daily Living↗

Is China facing an obesity epidemic and the consequences? The trends in obesity and chronic disease in China.

BACKGROUND: Over the past two decades, China has enjoyed impressive economic development, and her citizens have experienced many remarked changes in their lifestyle. These changes are often associated with an increase in obesity and chronic disease. METHODS: In this meta-analysis, based on nationally representative data, we studied the current prevalence of obesity and the trends in obesity, mortality and morbidity in China. RESULTS: Between 1992 and 2002, the prevalence of overweight and obesity increased in all gender and age groups and in all geographic areas. Using the World Health Organization body mass index cut points, the combined prevalence of overweight and obesity increased from 14.6 to 21.8%. The Chinese obesity standard shows an increase from 20.0 to 29.9%. The annual increase rate was highest in men aged 18-44 years and women aged 45-59 years (approximately 1.6 and 1.0% points, respectively). In general, male subjects, urban residents, and high-income groups had a greater increase. With the increase in overweight and obesity, obesity-, and diet-related chronic diseases (e.g., hypertension, cardiovascular disease (CVD), and type 2 diabetes) also increased over the past decade and became a more important preventable cause of death. Hypertension increased from 14.4% in 1991 to 18.8% in 2002 in adults; in older adults aged 35-74 years, it increased from 19.7 to 28.6%. Between 1993 and 2003, the prevalence of CVD increased from 31.4 to 50.0%; diabetes increased from 1.9 to 5.6%. During 1990-2003, although total mortality rate (per 100 000) decreased, overall the mortality rate and contribution (as percentages) to total death of obesity-related chronic disease increased, in particular, in rural areas. Mortality rate (per 100 000) of CVD increased from 128 to 145 and its contribution to total death, 27 to 32%, in rural areas; the figures decreased slightly in urban areas. The mortality rate of 'nutrition, endocrinology and metabolism-related disease' (NEMD) increased in both rural and urban areas between 1990 and 2000, 8.0 to 10.6 and 4.9 to 5.3, respectively. The current prevalence of hypertension, dyslipidaemia, metabolic syndrome, and diabetes among Chinese adults is approximately 20, 20, 15, and 3%, respectively. CONCLUSION: The prevalence of overweight and obesity and obesity-related chronic diseases have increased in China in the past decade. Our findings provide useful information for the projection of future trends and the formulation of national strategies and programmes that can address the challenges of the growing obesity and chronic disease epidemic.

Adolescent↗

The effects of a worksite chronic disease prevention program.

OBJECTIVE: This study determined the behavioral and clinical impact of a worksite chronic disease prevention program. METHODS: Working adults participated in randomized clinical trial of an intensive lifestyle intervention. Nutrition and physical activity behavior and several chronic disease risk factors were assessed at baseline, 6 weeks, and 6 months. RESULTS: Cognitive understanding of the requirements for a healthy lifestyle increased at the end of the program. Program participants significantly improved their cognitive understanding of good nutrition and physical activity and had significantly better nutrition and physical activity behavior at both 6 weeks and 6 months. Participants had significantly lower body fat, blood pressure, and cholesterol. CONCLUSIONS: This worksite chronic disease prevention program can significantly increase health knowledge, can improve nutrition and physical activity, and can improve many employee health risks in the short term.

Adult↗

Case report: severe microcytosis associated with the anemia of chronic disease.

When microcytosis is present in patients with anemia of chronic disease, the mean corpuscular volume (MCV) rarely if ever falls below 70 fL. The lowest MCV previously reported is 67 fL. We describe a patient with anemia of chronic disease with severe microcytosis and an MCV of 61 fL. After correction of the chronic disorder, complete correction of the hematologic values occurred. In patients with a low total iron binding capacity, iron therapy should not be instituted without clearly establishing the presence of iron deficiency irrespective of the degree of microcytosis.

Anemia↗

Quality of care: a comparison of preferences between medical specialists and patients with chronic diseases.

UNLABELLED: In this study, we have looked for differences between medical specialists and patients with chronic diseases (COPD, rheumatoid arthritis and diabetes mellitus) in preferences of aspects of care in relation to the quality of care. Firstly, to enumerate relevant aspects for chronic diseases, open interviews and a concept mapping were conducted among patients with chronic disease, and medical specialists treating them. Here, the respondents have been asked to evaluate statements in relation to the quality of care. Secondly, a final questionnaire, including statements of nine relevant aspects of care, was presented to patients and medical specialists. The response rate among patients was 96% (N = 260) and among medical specialists 67% (N = 340). Both study populations ranked 'effectiveness of care' the highest. However, the difference in opinion between the two populations was significant, mainly due to the patient's giving a higher ranking to 'continuity of care' and a lower ranking to 'efficiency'. Significant differences were also found between the three patient groups on the aspects 'knowledge' and 'waiting time for treatment'. Patients with rheumatoid arthritis ranked 'knowledge' higher and 'waiting time for treatment' lower than did the other two patient groups. A lower level of education, having state-regulated health insurance and being older were associated with a higher preference for 'continuity'. Between the three groups of the medical specialists, no significant differences were found regarding to the profession, age, and sex. IN CONCLUSION: the patients and medical specialists researched did not show wide differences of opinion on preferences of care in relation to quality. The only exception to this concerned 'continuity of care' which was ranked higher by patients.

Adolescent↗

Impact of vertebral deformities, osteoarthritis, and other chronic diseases on quality of life: a population-based study.

Vertebral deformities and spinal osteoarthritis are common disorders in elderly persons and are associated with back pain, impaired physical functioning, and loss of quality of life. The objectives of this study were to assess the impact of vertebral deformities and osteoarthritis on quality of life in a population-based sample, and to compare this with the impact of six other important chronic diseases on quality of life. The study was performed as a substudy of the Longitudinal Aging Study Amsterdam. Vertebral deformities and osteoarthritis were assessed by spinal radiographs; chronic diseases were assessed by self-report; quality of life was estimated by the SF-12, EQ-5D (EuroQol) and Qualeffo-41 (n = 336). In univariate analyses, severe osteoporosis of the vertebrae significantly worsened the physical component summary scale of the SF-12 and the total score of Qualeffo-41, while osteoarthritis of the spine did not significantly reduce quality of life. The other chronic diseases reduced quality of life, although not all changes reached statistical significance. In multivariate analyses, severe osteoporosis of the vertebrae, cardiac disease, peripheral arterial disease, and diabetes mellitus significantly reduced quality of life. In conclusion, most persons in an elderly population suffer from one or more chronic diseases, and therefore experience loss of quality of life. After adjustment for age, sex, and other chronic diseases, severe osteoporosis of the vertebrae, cardiac disease, peripheral arterial disease, and diabetes mellitus significantly reduced quality of life in the general population.

Activities of Daily Living↗

The triple threat for chronic disease: obesity, race, and depression.

The authors investigated the interrelationships between race, obesity, depression, and chronic disease by abstracting data from all primary-care patients seen at a family-medicine clinic over a 3-year period. A total of 8,197 patients were included in the analysis. Sixty-three percent of patients were either overweight (26%) or obese (37%). African-American race, obesity, and having a diagnosis of depression each independently and significantly increased the likelihood of having a chronic disease. Also, these risk factors interacted to create an increased likelihood of disease prevalence. Thus, obesity, race, and depression interacted to create a "triple threat" of developing certain chronic diseases.

Adult↗

Chronic disease and dietary management in the elderly: alive and kicking!

The paper reviews progress in chronic disease prevention and dietary management strategies in the elderly to help them remain independent with a high quality of life for as long as possible. Progress in public health over the past century is briefly reviewed. The similarities and differences in preventive measures for elders and younger adults are summarized. The goals for the prevention and management of chronic disease in the elderly are similar, but the strategies may differ, and quality of life is especially important. Especially effective preventive strategies for the elderly are discussed. Selected strategies to manage conditions already present by delaying or controlling diet-related disease progression while maintaining an acceptable quality of life are discussed. Finally, selected new research on managing chronic disease in elders is reviewed. Taken together, these strategies promise to keep our elders "alive and kicking" for as long as possible.

Aged↗

[Case management for school students with chronic disease: the current situation and future direction].

This paper aims to investigate the importance of management of chronic illness in schools epidemiological data. By examining the current state of such management, we found that school nurses, family members, mentors and school administrators lack sufficient knowledge to conduct effective case management for students with chronic diseases. This paper seeks to indicate principles for the conduct of case management of chronic disease in Taiwan. Incorporating practices, regulations, information systems, policy, and evaluation systems, recommendations are made with the hope that a well-planned system of case management of chronic disease can be established in schools to further enhance the quality of health care and life generally for school children.

Adolescent↗

Patient self-management of chronic disease in primary care.

Patients with chronic conditions make day-to-day decisions about--self-manage--their illnesses. This reality introduces a new chronic disease paradigm: the patient-professional partnership, involving collaborative care and self-management education. Self-management education complements traditional patient education in supporting patients to live the best possible quality of life with their chronic condition. Whereas traditional patient education offers information and technical skills, self-management education teaches problem-solving skills. A central concept in self-management is self-efficacy--confidence to carry out a behavior necessary to reach a desired goal. Self-efficacy is enhanced when patients succeed in solving patient-identified problems. Evidence from controlled clinical trials suggests that (1) programs teaching self-management skills are more effective than information-only patient education in improving clinical outcomes; (2) in some circumstances, self-management education improves outcomes and can reduce costs for arthritis and probably for adult asthma patients; and (3) in initial studies, a self-management education program bringing together patients with a variety of chronic conditions may improve outcomes and reduce costs. Self-management education for chronic illness may soon become an integral part of high-quality primary care.

Chronic Disease↗

Strategies to enhance chronic disease self-management: how can we apply this to stroke?

PURPOSE: Social Cognition Theory and the cognitive construct of self-efficacy often form the theoretical basis for many chronic disease self-management programmes. Self-efficacy can be influenced through these programmes and has been shown to be predictive of greater levels of functioning and psychological well-being. Stroke is regarded as a complex chronic disability, and individuals may share many of the same concerns as those living with other chronic diseases such as arthritis and chronic pulmonary disease. However there has been minimal reported research on the utility of self-management programmes following stroke. SEARCH STRATEGY: To comprehend the composition of chronic disease self-management programmes which could be applied to stroke, this paper examined the theoretical basis of self-management and particularly the evidence relating to interventions which have utilized self-efficacy enhancing strategies. Selected papers were retrieved from an extensive search of literature using Medline, Cinahl, PsychInfo and Web of Science databases and the Cochrane Collaboration. The search request focused on literature that specifically related to chronic disease, self-management and self-efficacy that had been published since 1995. However, seminal literature on self-efficacy produced prior to this date was also included. DISCUSSION AND CONCLUSIONS: There is strong evidence to support the use of self-management programmes and their effect on self-efficacy and associated health outcomes. While there are differences in the nature of each chronic condition, there are similarities in the core skills required for self-management. Many effective strategies could be incorporated into current stroke rehabilitation programmes or used to develop targeted self-management interventions. Future research which informs stroke rehabilitation should utilize the evidence relating to other chronic conditions. This could be used to develop the most effective methods of equipping individuals following stroke to cope confidently with the transition from being discharged from therapy towards effective self-management in the longer term.

Chronic Disease↗

[Prevalence of chronic diseases in young postpartum women].

Five hundred women 20 to 29 years of age were evaluated 48 hr after delivery to detect the presence of chronic diseases. An overall prevalence of 14.4% was found. Circulatory, osteo muscular, connective tissue and endocrine, metabolic and immune related disorders constituted the main groups of diseases detected. Leading diagnosis were hypertension, scoliosis, gallstones and goiter. No differences were found in type of delivery when comparing healthy and chronic disease affected women. Chronic disease in younger females should be further studied in order to avoid complications, sequelae and to improve reproductive conditions in this population.

Adult↗

Pain syndromes, disability, and chronic disease in childhood.

Childhood disability and chronic disease are common, and their prevalence is increasing as children survive with conditions that were previously fatal. It is important that physicians in training learn about disability and handicap, and the functioning of multidisciplinary teams to manage these problems. Chronic ill-health is often very expensive to manage, and some serious and creative thinking about the best way to fund such health care is urgently needed. Pediatric rheumatologists are involved with the care of many children with chronic and recurrent musculoskeletal pain; however, they have not perhaps focused enough research effort on the investigation of pain and its management. Whether reflex neurovascular dystrophy, fibromyalgia, and chronic fatigue syndrome are part of a disease continuum is unclear, but it seems probable that psychosocial problems are often important contributing factors in all three conditions. Immunoglobulin subclass deficiencies are being increasingly delineated, occurring in chronic fatigue syndrome as well as many other disease states. Their clinical relevance still remains, for the most part, uncertain. Short stature occurs in many chronic illnesses, and the role of growth hormone treatment in these conditions is beginning to be investigated.

Body Height↗

Psychometric evaluation of the exercise self-efficacy scale among Korean adults with chronic diseases.

The purpose of this study was to assess the psychometric properties, appropriateness, and demographic response patterns of an exercise self-efficacy scale for Korean adults with chronic diseases. After assessment of face validity by an expert Korean panel, 249 Korean adults with chronic diseases, ages 18-79 years, were recruited from hospitals or health centers in five Korean cities and surrounding rural areas to complete the questionnaire. In a factor analysis the original 18-item exercise self-efficacy scale converged to one factor without rotation and to three subfactors with rotation: situational/interpersonal factor, competing demands factor, and internal feelings factor. Descriptive analysis showed that Korean adults with chronic diseases perceived they had relatively low exercise self-efficacy, with the situational/interpersonal factor as the lowest factor. Exercise self-efficacy was significantly correlated with gender, education, regular exercise, and frequency of exercise. The exercise self-efficacy scale was shown to be a useful measure of exercise beliefs of Korean adults with chronic diseases.

Adolescent↗