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PubMed1996

The association between fruit and vegetable intake and chronic disease risk factors.

Understanding the associations between fruit and vegetable intake and other health behaviors is important for properly interpreting the rapidly growing number of studies that link low intakes of fruits and vegetables to the risk of cancer and cardiovascular disease. To examine the association between fruit and vegetable intake and behavioral risk factors for chronic diseases, we analyzed data from a population-based behavioral risk factor survey. Data were collected in 1990 from 21,892 adults in 16 states by a random-digit-dial telephone survey. Respondents answered questions about behaviors related to chronic disease risk, including their frequency of intake of fruits and vegetables, using a six-item questionnaire. Consumption of fruits and vegetables was lowest among those who also reported that they were sedentary, heavy smokers, heavy drinkers, or had never had their blood cholesterol checked. Because fruit and vegetable intake covaries with several other chronic disease risk factors, it is important to account for possible confounding between fruit and vegetable intake and other behaviors in etiologic studies of the risk of cancer and cardiovascular disease.

Adolescent↗

PubMed2003

Chronic disease medication use in managed care and indemnity insurance plans.

OBJECTIVE: To evaluate the impact of managed care on the use of chronic disease medications. DATA SOURCE: Claims data from 1997 from two indemnity and three independent practice association (IPA) model managed care insurance plans. RESEARCH DESIGN: Cross-sectional analysis of claims data. DATA COLLECTION: Adult patients with diabetes mellitus (DM, n = 26,444), congestive heart failure (CHF, n = 7,978), and asthma (n = 9,850) were identified by ICD-9 codes. Chronic disease medication use was defined through pharmacy claims for patients receiving one or more prescriptions for drugs used in treating these conditions. Using multiple logistic regression we adjusted for patient case mix and the number of primary care visits. PRINCIPAL FINDINGS: With few exceptions, managed care patients were more likely to use chronic disease medications than indemnity patients. In DM, managed care patients were more likely to use sulfonylureas (43 percent versus 39 percent for indemnity), metformin (26 percent versus 18 percent), and troglitazone (8.8 percent versus 6.4 percent), but not insulin. For CHF patients, managed care patients were more likely to use loop diuretics (45 percent versus 41 percent), ACE inhibitors or angiotensin receptor blockers (50 percent versus 41 percent), and beta-blockers (23 percent versus 16 percent), but we found no differences in digoxin use. In asthma, managed care patients were more likely to use inhaled corticosteroids (34 percent versus 30 percent), systemic corticosteroids (18 percent versus 16 percent), short-acting beta-agonists (42 percent versus 33 percent), long-acting beta-agonists (9.9 percent versus 8.6 percent), and leukotriene modifiers (5.4 percent versus 4.1 percent), but not cromolyn or methylxanthines. Statistically significant differences remained after multivariate analysis that controlled for age, gender, and severity. CONCLUSIONS: Chronic disease patients in these managed care plans are more likely to receive both inexpensive and expensive medications. Exceptions included older medications partly supplanted by newer therapies. Differences may be explained by the fact that patients in indemnity plans face higher out-of-pocket costs and managed care plans promote more aggressive medication use. The relatively low likelihood of condition-specific medications in both plan types is a matter of concern, however.

Adult↗

PubMed2004

[Epidemiological investigations of the chances of preventing, recognizing early and optimally treating chronic diseases in an elderly population (ESTHER study)].

BACKGROUND AND OBJECTIVE: Demographic changes in Germany will result in a marked rise in the prevalence of chronic diseases, presenting a central challenge in the coming decades. The ESTHER study on this question has as its objective to bring about innovative ways for the early recognition and prevention of diseases in the elderly. We herein give the concept of the study and the results of the basic enquiry. PATIENTS AND METHODS: The ESTHER study includes 9961 persons, aged between 50 and 74 years, who had a health check-up by their general practitioner. Standardized questionnaires for doctors and patients were used in addition to the check-up test to provide extensive basic data on risk factors, previous illnesses, family history and relevant items on life style. Blood, urine and stool samples were kept for later testing RESULTS: This cohort had a high prevalence of known risk factors for various chronic diseases, especially of the cardiovascular system. 42% of the cohort already had a history of hypertension, 40% of hyperlipidaemia, 11% had diabetes mellitus and 9% coronary heart disease. There was an association with obesity (present in many). The check-up test newly diagnosed one of the diseases or the presence of relevant risk factors in 13.4%. CONCLUSION: The high prevalence of risk factors for chronic diseases in the elderly underlines the urgency of stressing preventive measures. The ESTHER study - because of its long-term follow-up and saved specimens for later testing - provides an excellent basis for identifying new risk factors and risk indicators of chronic diseases.

Aged↗

PubMed2001

Management of chronic disease by patients.

Chronic conditions dominate health care in most parts of the world, including the United States. Management of a disease by the patient is central to control of its effects. A wide range of influences in the person's social and physical environments enhance or impede management efforts. Interventions to improve management by patients can produce positive outcomes including better monitoring of a condition, fewer symptoms, enhanced physical and psychosocial functioning, and reduced health care use. Successful programs have been theory based. Self-regulation is a promising framework for the development of interventions. Nonetheless, serious gaps in understanding and improving disease management by patients remain because of an emphasis on clinical settings for program delivery, neglect of the factors beyond patient behavior that enable or deter effective management, limitations of study designs in much work to date, reliance on short-term rather than long-term assessments, and failure to evaluate the independent contribution of various program components.

Chronic Disease↗

PubMed2003

[Chronic diseases, psychological distress and coping -- challenges for psychosocial care in medicine].

Due to the increase of chronic diseases within the last decades the need and demand for psychosocial treatment in medicine has been realized. This review focuses on the psychosocial aspects of chronic diseases and discusses selected topics of medical and rehabilitation psychology. Recent developments in quantitative and qualitative methods have allowed the systematic analysis of psychosocial distress and coping with chronic disease as well as the consequences on social relationships. The need for psychosocial treatment in acute care and rehabilitation can be diagnosed by differential assessment tools for coping and psychiatric morbidity. Specific approaches of psychology and psychotherapy for patients with somatic diseases have been developed and may be regarded as an integrative part of medical treatment in acute care and rehabilitation. In rehabilitation, the traditional individualistic view of psychotherapy has been broadened towards vocational integration and participation in social activities as outcome criteria. Evaluation research as well as the rehabilitation sciences have provided empirical data on psychosocial treatment of chronically ill patients. Under increasing financial restrictions and problems of the health care systems there is a need for quality assurance and the proof of scientific evidence to guarantee psychosocial treatment as an integrated part of medical care in the future.

Adaptation, Psychological↗

PubMed2006

[Female sexual function and chronic disease].

Female sexual dysfunction (FSD) is a multifactorial set of conditions associated with multiple anatomical, physiological, biological, medical and psychological factors that can have major impact on self-esteem, quality of life, mood and relationships. Studies indicate that FSD is commonly seen in women who report a low level of satisfaction with partner relationship and in women with male partners who have erectile dysfunction. This complexity of FSD is augmented by the presence of chronic disease. Negative sexual effects are widely reported in studies of women with chronic diseases (such as metabolic syndrome, diabetes mellitus, chronic kidney disease, cancer, spinal cord injury, lupus, rheumatic diseases, Parkinson's disease, fibromyalgia and chronic pain) as compared to a general healthy female population. Physical problems, emotional problems and partnership difficulties arising from disease-related stress contribute to less active and less enjoyable sex life. Chronic pain, fatigue, low self-esteem as well as use of medications might reduce sexual function. These effects of chronic diseases on female sexual function still remain largely unstudied. The study by Manor and Zohar published in this issue of Harefuah draws our attention to the sexual dysfunction of women with breast cancer and examines their needs for information regarding their sexual function. In the absence of definite treatment evidence, psychological counseling, improved vaginal lubrication, low dose of hormonal therapy can be used to relieve FSD. Physicians must consider integrating diagnosis of their female patients' sexual needs and dysfunction, especially women with chronic diseases. Patients' education and counseling may contribute to a better quality of life in spite of their chronic disease.

Breast Neoplasms↗

PubMed1997

Do disease specific characteristics add to the explanation of mobility limitations in patients with different chronic diseases? A study in The Netherlands.

STUDY OBJECTIVES: To determine whether disease specific characteristics, reflecting clinical disease severity, add to the explanation of mobility limitations in patients with specific chronic diseases. DESIGN AND SETTING: Cross sectional study of survey data from community dwelling elderly people, aged 55-85 years, in the Netherlands. PARTICIPANTS AND METHODS: The additional explanation of mobility limitations by disease specific characteristics was examined by logistic regression analyses on data from 2830 community dwelling elderly people. MAIN RESULTS: In the total sample, chronic non-specific lung disease, cardiac disease, peripheral atherosclerosis, diabetes mellitus, stroke, arthritis and cancer (the index diseases), were all independently associated with mobility limitations. Adjusted for age, sex, comorbidity, and medical treatment disease specific characteristics that explain the association between disease and mobility mostly reflect decreased endurance capacity (shortness of breath and disturbed night rest in chronic non-specific lung disease, angina pectoris and congestive heart failure in cardiac disease), or are directly related to mobility function (stiffness and lower body complaints in arthritis). For atherosclerosis and diabetes mellitus, disease specific characteristics did not add to the explanation of mobility limitations. CONCLUSIONS: The results provide evidence that, to obtain more detailed information about the differential impact of chronic diseases on mobility, disease specific characteristics are important to take into account.

Activities of Daily Living↗

PubMed1999

Stress, coping, and adjustment in children with a chronic disease: a review of the literature.

PURPOSE: To review the literature on the consequences of having a chronic disease on the child's functioning in daily life. METHOD: A wide search of the literature resulted in the location of around 200 empirical studies with a focus on chronically ill children. This body of literature is discussed in three parts: (1) the academic and psychosocial adjustment of chronically ill children, (2) the ways chronically ill children cope with disease-related stress and other stressors, and (3) the effectiveness of coping strategies. RESULTS: Children with a chronic disease do not show lower school performance despite higher absence rates (an exception is epilepsy). Their self-concept is similar to that of healthy children. However, they show more behaviour problems, especially internalizing problems such as depression and social withdrawal. The authors could not find evidence for the claim that children with a chronic disease are more frequently confronted with stress than their healthy peers. Children with a chronic disease use a variety of coping strategies to deal with various disease-related and common stressors. The coping strategies they use in relation to common stressors appear to be similar to those of healthy children. CONCLUSION: Incidences of maladjustment vary across studies and different chronic diseases. Most studies on coping lack situational sensitivity, which makes it impossible to compare results. Findings on the effectiveness of these children's coping strategies are still scarce and inconclusive. Recommendations for future research on coping with chronic disease in childhood are given.

Adaptation, Psychological↗

PubMed2003

The possession of technical aids among persons with a somatic chronic disease.

PURPOSE: Previous research has highlighted disability as a determinant of the need for technical aids; surprisingly, disease as a potential determinant has been ignored. The goal of the present study was to determine whether the possession of technical aids is dependent on the type of chronic disease, illness duration, co-morbidity, disability, age, and several other factors. METHODS: The study was performed in a representative sample of persons with a somatic chronic disease (n=2262). Type of chronic disease, time post-diagnosis and co-morbidity were assessed by the patient's general practitioner. Disability was assessed with the Sickness Impact Profile. The possession of technical aids and other characteristics were assessed by questionnaire. RESULTS: Type of chronic disease (osteoarthritis, rheumatoid arthritis, diabetes and COPD), disability, age and gender were significantly and independently associated with the possession of technical aids. CONCLUSIONS: Apart from disability, disease-, age-, and gender-related characteristics determine the possession of technical aids. A detailed assessment of these characteristics is required in order to ensure that technical aids meet personal needs.

Activities of Daily Living↗

PubMedDate not supplied

Effect of pregnancy on pre-existing liver disease: chronic viral hepatitis.

Women with viral chronic hepatitis generally do quite well during pregnancy, providing that they have not progressed to decompensated cirrhosis. As a general rule, a stable liver equals a safe pregnancy. However, concern is about how pre-existing chronic liver disease may affect the pregnancy and the unborn baby. This review plans to answer some key questions regarding this issue in order to provide to healthcare professionals updated information of the current knowledge in this field. Besides, a synopsis of the following subject matters are reviewed, for instance, the main risk factors associated with vertical transmission of HBV and HCV in pregnant women chronically infected, the influence of pregnancy on HBV and HCV viral load and the effect of pregnancy on the clinical course of chronic hepatitis. Lastly, it is included a list of recommendations to decrease vertical transmission rates of chronic viral hepatitis as well as some information for the reproduction team.

Antiviral Agents↗

PubMed2004

Correction of iron-deficient erythropoiesis in the treatment of anemia of chronic disease with recombinant human erythropoietin.

Anemia of chronic disease (ACD) is a frequent complication of chronic inflammation in rheumatoid arthritis (RA). Recombinant human erythropoietin (rHuEpo) has been shown to be effective in correcting ACD, although with a variable rate of nonresponders. The first aim of this trial was to improve the response to rHuEpo by parenteral iron supplementation in cases of iron-deficient erythropoiesis (IDE). An additional goal was the evaluation of the zinc protoporphyrin content of erythrocytes (ZnPP), the soluble transferrin receptor (sTrfR) serum concentration, and the hemoglobin (Hb) content of reticulocytes (CHr) in stimulated erythropoiesis as diagnostic and prognostic parameters. Thirty RA patients with ACD were treated with subcutaneous 150 IU rHuEpo/kg body weight twice weekly. Intravenous iron supplementation (200 mg iron sucrose once weekly) was added in cases of IDE (n=23), which was defined by the presence of two of three criteria: saturation of transferrin (TrfS) < or =15%, hypochromic erythrocytes (HypoE) > or =10%, and a serum ferritin (Fn) concentration < or =50 microg/l. All 28 completers met the treatment goal, with an increase of the median Hb concentration from 10.3 g/dl to 13.3 g/dl. Epo treatment and iron supplementation was safe and well tolerated in all patients. Monitoring of Fn, TrfS, and HypoE every other week allowed a successful correction of anemia. Retrospective analysis of the evaluable parameters (CHr, sTrfR, and ZnPP) revealed no additional benefit for predicting or monitoring IDE in this setting, although the one or other may be advantageous in other therapeutic situations.

Adult↗

PubMed1993

A chronic disease prevention program.

In a pilot chronic disease prevention program at the Hinds County Health Department in Jackson, Mississippi, 1030 patients were evaluated with yearly complete physical evaluation, Pap Smears, screening mammography, and other appropriate tests and procedures. The patients were also provided with nutritional and healthy lifestyle education. The study lasted for 3 1/2 years. It was done in conjunction with a pre-existing hypertension program. Although the benefits of the educational effort were more intangible in the relatively short period of time of the study, it is significant that mammography identified eight (8) occult breast cancers. We believe this pilot study only touches the surface of what could be done with more extensive preventive measures.

Chronic Disease↗

PubMed2001

The interaction between risk factors and self-regulation in the development of chronic diseases.

Most established risk factors for chronic disease incidence and mortality from cancer, such as cigarette smoke, alcohol drinking, occupational and environmental hazards and dietary factors, have been shown to vary in their importance in terms of relative risk. In studies which addressed the individual level of behaviour, but also coping and self-regulation, a strong modifying effect of long-lasting hopelessness and helplessness has been found to depend on personality. Autonomy and healthful self-regulation have been defined as the regulation of behaviour in those activities which are carried out in the physical and social environment and lead to stimulated feeling, pleasure, perception of inner and social security, and competence. Persons with such well-regulated behaviour are capable of coping with sources of listlessness, uncertainty and instability. Those individuals showing a well-regulated behaviour arrive at a psycho-neuro-physiological basis for better competence and defence against health hazards. The capability determined by the degree of self-regulation is measured with different instruments. The experience with a questionnaire for the assessment of self-regulation, its quantification and predictive value is presented here. The method of study is by prospective approach, which permits the demonstration of causal associations (promotion, co-causality) and facilitates the experimental approach through intervention. A causal association is likely if the effect of a modifier is not only found in a prospective (observational) follow-up but also if the (experimental) intervention shows an effect. The method of intervention by stimulation of self-regulation is the autonomy training developed by Grossarth-Maticek. Using several examples presenting the method, the modifying effect is shown by referring to four risk factors. If the risk factors are associated with an inhibited self-regulation, then the effect in terms of disease and pathological outcome is stronger. This was shown with the hazardous effects of smoking, alcohol drinking and dietary malnutrition as well as with automobile exhaust. It may be important, for example, whether a person feels self-determined when driving a car for hours but does not need to consume ethanol-containing drinks for feeling well. One's own capability to regulate well over time apparently modulates functions of the body and hence modifies the effects of physical factors. In epidemiological studies, which assess mostly only exogenous factors (so called established risk factors) this evidence has to be considered by including the pertinent data on the relevant questions in each field study.

Alcohol Drinking↗

PubMed1991

[Non transmissible chronic diseases. A preventive approach].

Non transmissible chronic diseases, accidents and violence cause 70-80% of deaths in developed countries and 40-50% in underdeveloped ones, including Chile. Their relative contribution to mortality in Chile has increased from 34% to 64% in the last 30 years. Prevention is possible by controlling risk factors such as smoking, alcohol, obesity, hypertension and hypercholesterolemia. Preventive programs should be implemented based on available studies of the epidemiology of risk factors in our country. Population intervention to obtain better health habits and special actions for individuals with risks factors must be employed. Local health services, the community and the media must participate, the cornerstone of the program being population education, particularly those of younger age. A model to be followed is the Interhealth Project, sponsored by WHO and led by Finland (North Karelia).

Adolescent↗

PubMed1990

[Registration of patients with chronic diseases].

The authors describe registers of chronic diseases, provisions regarding their contents and organizational aspects. They make the reader familiar with the collection, storage and evaluation of data and some problems with their safeguarding. They report their experience with recommended questionnaires and the structure of forms. They describe the activities of the doctor completing the forms as well as the activities associated with recording in the centre. The authors demonstrate possible types of outputs and whom they serve. They illustrate the results of their work on the example of data from the register for diabetes mellitus of the juvenile type I and rheumatic fever. They discuss the role of registers in the health services, their role in ensuring the health status of the population, planning and management of the health services. In the conclusion they mention new technical possibilities.

Adolescent↗

PubMed1984

Measuring functional outcomes in therapeutic trials for chronic disease.

For clinical trials of many chronic diseases, the outcome of greatest interest may be patient function. Unfortunately, most scales for measuring functional status are crude and rarely consider important psychosocial impacts of disease. This paper briefly considers the pressures for improving functional status measurement, proposes six criteria for assessing functional or "health status" scales, and selectively reviews representative instruments using these criteria. Older functional classifications and many scales used for quality-of-care assessment are narrowly focussed on physical function. Their reliability, validity, and sensitivity to clinical changes are generally unknown. Traditional scales of "Activities of Daily Living" are similarly focussed on physical function, and are most appropriate for severely disabled inpatients. A new generation of "health status" instruments offers wider applicability, more comprehensiveness, and feasibility for clinical applications. Their validity and reliability are generally quite good. None of the instruments reviewed, however, has yet demonstrated convincing success as a "transition" variable (sensitivity to small but clinically important changes). Based on this analysis, future investigation should seek to (1) define the optimal balance between brevity on the one hand, and comprehensiveness and reliability on the other, (2) describe the sensitivity of scales to clinically important changes, and (3) directly compare existing instruments to aid selection by investigators who are considering their use in clinical trials.

Activities of Daily Living↗

PubMed2004

Fruit and vegetable intake and risk of major chronic disease.

BACKGROUND: Studies of fruit and vegetable consumption in relation to overall health are limited. We evaluated the relationship between fruit and vegetable intake and the incidence of cardiovascular disease and cancer and of deaths from other causes in two prospective cohorts. METHODS: A total of 71 910 female participants in the Nurses' Health study and 37,725 male participants in the Health Professionals' Follow-up Study who were free of major chronic disease completed baseline semiquantitative food-frequency questionnaires in 1984 and 1986, respectively. Dietary information was updated in 1986, 1990, and 1994 for women and in 1990 and 1994 for men. Participants were followed up for incidence of cardiovascular disease, cancer, or death through May 1998 (women) and January 1998 (men). Multivariable-adjusted relative risks were calculated with Cox proportional hazards analysis. RESULTS: We ascertained 9329 events (1964 cardiovascular, 6584 cancer, and 781 other deaths) in women and 4957 events (1670 cardiovascular diseases, 2500 cancers, and 787 other deaths) in men during follow-up. For men and women combined, participants in the highest quintile of total fruit and vegetable intake had a relative risk for major chronic disease of 0.95 (95% confidence interval [CI] = 0.89 to 1.01) times that of those in the lowest. Total fruit and vegetable intake was inversely associated with risk of cardiovascular disease but not with overall cancer incidence, with relative risk for an increment of five servings daily of 0.88 (95% CI = 0.81 to 0.95) for cardiovascular disease and 1.00 (95% CI = 0.95 to 1.05) for cancer. Of the food groups analyzed, green leafy vegetable intake showed the strongest inverse association with major chronic disease and cardiovascular disease. For an increment of one serving per day of green leafy vegetables, relative risks were 0.95 (95% CI = 0.92 to 0.99) for major chronic disease and 0.89 (95% CI = 0.83 to 0.96) for cardiovascular disease. CONCLUSIONS: Increased fruit and vegetable consumption was associated with a modest although not statistically significant reduction in the development of major chronic disease. The benefits appeared to be primarily for cardiovascular disease and not for cancer.

Adult↗

PubMed1990

Excess deaths from nine chronic diseases in the United States, 1986.

To assess excess mortality from chronic disease in the United States, state age-adjusted combined mortality rates for nine chronic diseases in 1986 were compared with three "minimum" rates--two calculated from rates actually achieved in states and a third estimated as the mortality remaining after elimination of one risk factor for each disease. Hawaii had the lowest mortality rate of combined diseases (305/100,000); state excesses ranged from 0% to 37%. The sum of lowest disease-specific rates in any state was 284 per 100,000, indicating excesses of between 7% and 41%. A minimum mortality rate of 224 per 100,000 was estimated to result from elimination of one risk factor for each of the nine diseases, indicating state excesses from 26% to 54%, or 524,000 US deaths. Reduction of US mortality from the nine diseases to the risk factor--eliminated rate is estimated to be associated with an increased life expectancy at birth of 4 years.

Chronic Disease↗