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PubMed2001

The construction and evaluation of the reliability and validity of a life attitude scale for elderly with chronic disease.

The elderly with chronic diseases face numerous impacts which influence their life attitudes. The purpose of this study was to construct, and evaluate the reliability and validity of a life attitude scale for elderly with chronic disease. Initially, the 27 items of the Life Attitude Scale were constructed by in depth interview of 48 elderly with chronic diseases. Then, the construct validity was established by factor analysis with 663 samples. Six factors: Congeniality of Family Life, Life Meaning, Dignity of Life, Struggle with Adversities, Hollow Existence, and Destiny to Life, which included 20 items, explained 59.7% of total variances. Content validity was found to be well established by 6 experts. Correlation of inter-rater reliability among 6 data collectors was 0.96. Cronbach's alpha of internal consistency was above 0.89 for 148 samples. Correlation of test-retest reliability was above 0.87 for 37 samples with 2-week interval. This study presents what the Taiwan elderly with chronic diseases are undergoing and their views on life and its value. There are highly culture-based and philosophy-based knowing about life attitude of elderly with chronic disease in Taiwan, and it is imperative to inspire nurses to promote the quality of spiritual care for elderly with chronic disease.

Aged↗
PubMed2002

Iron and the anemia of chronic disease.

The anemia of chronic disease traditionally is defined as a hypoproliferative anemia of no apparent cause that occurs in association with an inflammatory, infectious, or neoplastic disorder, and resolves when the underlying disorder is corrected. Disordered iron metabolism as manifested by a low serum iron, decreased serum transferrin, decreased transferrin saturation, increased serum ferritin, increased reticuloendothelial iron stores, increased erythrocyte-free protoporphyrin, and reduced iron absorption, is a characteristic feature of the anemia of chronic disease and has been thought to be a major factor contributing to the syndrome. A mild shortening of red cell life span also occurs. However, we now know that impaired erythropoietin production and impaired responsiveness of erythroid progenitor cells to this hormone are also important abnormalities contributing to the anemia of chronic disease, and appear to be due to the effects of inflammatory cytokines. Increased intracellular iron may also have a role in the inhibition of erythropoietin production, since the oxygen sensor is a hemoprotein. While the role of inflammatory cytokines in the pathogenesis of anemia of chronic disease appears unequivocal, it has become apparent that disordered iron metabolism, while characteristic of this form of anemia, may not be central to its pathogenesis. It is undisputed that iron absorption is reduced, and that iron administered intravenously is rapidly sequestered in the reticuloendothelial system; however, iron delivery to the bone marrow is not impaired, and erythroid iron utilization is not markedly depressed in anemia of chronic disease. Importantly, recombinant erythropoietin therapy can correct the anemia of chronic disease, but it cannot correct the anemia due to iron deficiency. This refutes the concept that the lack of available iron is central to the pathogenesis of the syndrome. Indeed, it is highly likely that abnormalities such as reduced iron absorption and decreased erythroblast transferrin-receptor expression largely result from decreased erythropoietin production and inhibition of its activity by inflammatory cytokines.

Anemia↗
PubMed2004

Using Health Utility Index (HUI) for measuring the impact on health-related quality of Life (HRQL) among individuals with chronic diseases.

Quality of life is an important indicator in assessing the burden of disease, especially for chronic conditions. The Health Utilities Index (HUI) is a recently developed system for measuring the overall health status and health-related quality of life (HRQL) of individuals, clinical groups, and general populations. Using the HUI (constructed based on eight attributes: vision, hearing, speech, mobility, dexterity, cognition, emotion, and pain/discomfort) to measure the HRQL for chronic disease patients and to detect possible associations between HUI system and various chronic conditions, this study provides information to improve the management of chronic diseases. This study is of interest to data analysts, policy makers, and public health practitioners involved in descriptive clinical studies, clinical trials, program evaluation, population health planning, and assessments. Based on the Canadian Community Health Survey (CCHS) for 2000-01, the HUI was used to measure the quality of life for individuals living with various chronic conditions (Alzheimer/other dementia, effects of stroke, urinary incontinence, arthritis/rheumatism, bowel disorder, cataracts, back problems, stomach/intestinal ulcers, emphysema/COPD, chronic bronchitis, epilepsy, heart disease, diabetes, migraine headaches, glaucoma, asthma, fibromyalgia, cancers, high blood pressure, multiple sclerosis, thyroid condition, and other remaining chronic diseases). Logistic Regression Model was employed to estimate the associations between the overall HUI scores and various chronic conditions. The HUI scores ranged from 0.00 (corresponding to a state close to death) to 1.00 (corresponding to perfect health); negative scores reflect health states considered worse than death. The mean HUI score by sex and age group indicated the typical quality of life for persons with various chronic conditions. Logistic Regression results showed a strong relationship between low HUI scores (< or = 0.5 and 0.06-1.0) and certain chronic conditions. Age- and sex-adjusted Odds Ratio (OR) and p values showed an effect among individuals diagnosed with each chronic disease on the overall HUI score. Results of this study showed that arthritis/rheumatism, heart disease, high blood pressure, cataracts, and diabetes had a severe impact on HRQL. Urinary incontinence, Alzheimer/other dementia, effects of stroke, cancers, thyroid condition, and back problems have a moderate impact. Food allergy, allergy other than food, asthma, migraine headaches, and other remaining chronic diseases have a relatively mild effect. It is concluded that major chronic diseases with significant health burden were associated with poor HRQL. The HUI scores facilitate the measurement and interpretation of results of health burden and the HRQL for individuals with chronic diseases and can be useful for development of strategies for the prevention and control of chronic diseases.

Adolescent↗
PubMed2000

Comprehensive versus holistic care. Case studies of chronic disease.

Persons with chronic disease often experience an involvement of multiple body systems. A comprehensive care approach to patient care is often used with the belief that a health care team will ensure that a patient's needs will be covered. Instead, this approach is reductionist in practice and leads to fragmentation of care, and the difficult patients often slip through the cracks of the health care system. However, a holistic theory-based approach puts a patient's perceived needs first and offers care not only for the body but also for the human spirit. Two case studies of patients with chronic disease are reviewed, both of whom began in a comprehensive care model and ended up with holistic care. Suggestions for assisting in the movement of a comprehensive care model toward a holistic model are offered for the practicing nurse.

Alcoholism↗
PubMed1994

Pathogenesis and treatment of the anemia of chronic disease.

The anemia of chronic disease may be viewed simply as the anemia that accompanies chronic inflammatory, infectious, or neoplastic disorders. Because these conditions are very common, the anemia of chronic disease is one of the most frequent anemias encountered, and is only second in incidence to iron-deficiency anemia. The anemia of chronic disease is primarily an anemia due to underproduction of red cells, with low reticulocyte production, and is most often a normochromic, normocytic anemia. However, in 30% to 50% of patients, the red cells are hypochromic and microcytic and, most often, the serum iron, total iron-binding capacity, and transferrin saturation are reduced in the presence of adequate iron stores. Although the differential diagnosis includes other underproduction anemias, such as those caused by vitamin and mineral deficiencies, renal failure, endocrinopathies, and myelodysplasia, it generally is easily distinguished from these conditions. Nevertheless, an understanding of the pathogenesis of this condition, as well as a means of alleviating the anemia when the chronic disorder persists, has remained elusive. Recently, major advances have occurred toward understanding the pathogenesis of the anemia of chronic disease and its treatment, and these advances are reviewed.

Acquired Immunodeficiency Syndrome↗
PubMed2000

Energetic adaptation to chronic disease in the elderly.

Several chronic diseases occur with increased prevalence in the elderly. Body weight loss is a common feature of many chronic diseases. Weight loss increases the risk for morbidity and mortality and contributes to decreased functional independence and poor quality of life. Thus, an understanding of the effect of chronic disease on energy balance has important implications for nutritional supplementation and clinical outcome. This brief review will consider recent studies that have examined the effect of several chronic diseases (i.e., Alzheimer's disease, Parkinson's disease, and congestive heart failure) on daily energy expenditure in elderly individuals. Additionally, we put forth a model to explain the energetic adaptation to chronic disease in the elderly that is based on measurements of daily energy expenditure and its components. Studies suggest that chronic disease decreases daily energy expenditure in elderly individuals due to a marked reduction in physical activity energy expenditure. Moreover, these changes in daily energy expenditure often occur in the presence of increased resting energy expenditure. Thus, the net effect of chronic disease is to decrease daily energy expenditure. These results do not favor the hypothesis that increased energy expenditure contributes to disease-related weight loss. Instead, reduced energy intake appears to be a more likely mediator of the negative energy imbalance and weight loss that frequently accompany chronic disease in the elderly.

Aged↗
PubMed1995

[The family burden in chronic diseases. The study of validity and reproducibility of the questionnaire on the impact of the chronic disease on the family (IMPAT)].

OBJECTIVE: The "Questionario sull'Impatto della Malattia Cronica sulla Famiglia" (IMPAT) ("Impact-on-Family Scale", by Stein & Reissman) in its Italian version (by Casari & Fantino, modified) has been used to evaluate family burden in relatives of chronic patients with cancer, chronic patients with other internistic pathology and acute patients. The aims of the study were to evaluate validity and reliability of the Impat and to compare family burden and anxoius/depressive symptoms in the three groups of relatives. METHOD: 35 relatives of cancer patients, 20 relatives of patients with chronic, non neoplastic illness and 20 relatives of acute patients were studied. 85% of relatives of cancer patients was assisted continuously by volunteers and psychiatrists with regard to their psychological problems. Impat questionnaire, Beck Depression Inventory and State-Trait Anxiety Inventory were used for psychological evaluation. RESULTS: Validity of the Impat was confirmed. Mean scores from relatives of chronic patients were higher than scores from relatives of acute patients (ANOVA, f = 38.0; df = 2,72; p < 0.0001). Test-retest analysis was satisfactory (Person's test, N = 20 r = 0.77, p < 0.0001). Both groups of relatives of chronic patients showed higher level of anxious-depressive symptoms compared to relatives of acute subjects. No differences were found between relatives of neoplastic and non neoplastic chronic patients. CONCLUSIONS: The italian version of Impat has been confirmed as a useful and simple means of evaluation of family burden in this context. Psychosocial support seems to reduce distress in relatives of cancer patients.

Adaptation, Psychological↗
PubMed1997

Resources and priorities for chronic disease prevention and control, 1994.

Chronic diseases (e.g., heart disease, cancer, stroke, diabetes, chronic obstructive pulmonary disease, and chronic liver disease) are the major causes of death, disability, and medical expenditures in the United States. Although these six diseases accounted for 73% of all U.S. deaths in 1993, characterization of the capacity and priorities of public health agencies to prevent or control these chronic diseases has been limited. To assess the resources, needs, and priorities in chronic disease prevention and control for fiscal year (FY) 1994, the Association of State and Territorial Chronic Disease Program Directors (ASTCDPD) conducted a national survey of state and territorial health agencies; this survey updates a similar survey that collected data for FY 1989. This report summarizes the survey findings for 1994 which indicate that, during 1989-1994, expenditures for state-specific chronic disease activities increased modestly but remained disproportionately low in relation to the public health burden of chronic diseases.

Chronic Disease↗
PubMed2000

The association between mortality from ischaemic heart disease and mortality from leading chronic diseases.

AIMS: Coronary risk factors raise the risk of other chronic disorders. We therefore tested the hypothesis that the geographic distribution of ischaemic heart disease mortality is associated with that of other chronic diseases with which it shares risk factors. METHODS AND RESULTS: For the 50 provinces of Spain, we collected mortality data for the period 1980-1995 from the national vital statistics. We calculated age-adjusted mortality rates for the leading causes of death in quintiles of provincial distribution of ischaemic heart disease mortality, and correlation coefficients with respect to provincial ischaemic heart disease mortality. As expected, because they share risk factors with ischaemic heart disease, mortality from cerebrovascular disease, malignant tumours, lung cancer, respiratory diseases, chronic obstructive pulmonary disease, diseases of the digestive system, cirrhosis of the liver and all causes, increase with the rise from lower to higher quintiles of ischaemic heart disease mortality. Ischaemic heart disease mortality registered correlations over 0.5 (P<0.001) with mortality from many of the above diseases in the periods 1980-1984 and 1991-1995. Expectations were similarly borne out for disorders not sharing risk factors with ischaemic heart disease, in that mortality from prostate and breast cancer, injury and poisoning, traffic accidents and ill-defined causes in most cases did not show a provincial association with ischaemic heart disease mortality. In general, these results were observed for both sexes and across all age groups. CONCLUSION: Ischaemic heart disease mortality is associated with mortality from chronic diseases which share coronary risk factors, across provinces of Spain over the period 1980-1995. This suggests that the geographic variation in such chronic diseases is due to common factors, potentially susceptible to similar preventive interventions.

Adult↗
PubMed1976

[Clinical Significance of Different Tests for the Diagnosis of Chronic Diseases of the Pancreas].

Enzymatic, functional and morphological test are used for the diagnosis of pancreatic diseases. The enzymatic tests-amylase is the enzyme activity most frequently investigated-are best suited to the diagnosis of acute diseases. In chronic inflammations of the pancreas the serum enzymes do not usually increase because of the destruction of the parenchyma. The provocation test with pancreozymin secretin is especially indicated in chronic diseases of the pancreas. Digestion and absorption are only disturbed in the late stages of the disease. It is important to investigate them to determine the necessary susbtitution therapy. No method should be used alone, only series of tests give satisfactory results.

Acute Disease↗
PubMed2003

Globalisation and the prevention and control of non-communicable disease: the neglected chronic diseases of adults.

The growing global burden of non-communicable diseases in poor countries and poor populations has been neglected by policy makers, major multilateral and bilateral aid donors, and academics. Despite strong evidence for the magnitude of this burden, the preventability of its causes, and the threat it poses to already strained health care systems, national and global actions have been inadequate. Globalisation is an important determinant of non-communicable disease epidemics since it has direct effects on risks to populations and indirect effects on national economies and health systems. The globalisation of the production and marketing campaigns of the tobacco and alcohol industries exemplify the challenges to policy makers and public health practitioners. A full range of policy responses is required from government and non-governmental agencies; unfortunately the capacity and resources for this response are insufficient, and governments need to respond appropriately. The progress made in controlling the tobacco industry is a modest cause for optimism.

Developing Countries↗
PubMed2007

Clinical trials and observational studies to assess the chronic disease benefits and risks of multivitamin-multimineral supplements.

Multivitamin-multimineral (MVM) supplements are widely used in the United States, often in the hope of reducing the risk of cancer, cardiovascular disease, or other chronic disease. This article assesses the potential of randomized controlled trials and epidemiologic cohort studies for yielding reliable information on the effects of MVMs on chronic disease. A brief review of the available literature on MVMs in relation to incidence and mortality rates from prominent cancers and cardiovascular diseases is also provided along with a discussion of needed research. Specifically, the strengths and weaknesses of epidemiologic cohort studies and randomized controlled trials are summarized and discussed in the context of single-vitamin supplements when both types of studies are available. Recent review articles that include an assessment of MVMs in relation to cancer and cardiovascular disease are updated to provide a summary of available data. Few randomized controlled trials and few cohort studies of MVMs that are directly pertinent to cancer or cardiovascular disease are available. The data are not compelling concerning a role for MVMs in preventing cancer or cardiovascular disease morbidity or mortality, although some interesting leads merit further evaluation. Investigators responsible for cohort studies that assessed MVMs should be encouraged to report available data on MVMs and chronic disease. Depending in part on the results of such additional reports, a full-scale randomized controlled trial of well-selected MVMs in women may be warranted on public health grounds.

Cardiovascular Diseases↗