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PubMed2001

[Psychosocial adaptation and compliance in chronic diseases in childhood].

A chronic disease in childhood often entails multidimensional, medical, psychosocial and financial risks which empede efficient adaptation to the disease for the whole family. Aim of this review is to describe possible strategies for effective coping with the chronic disease with the main focus on self-help-competence for the affected child and his family. Furthermore, there are proposals regarding practical handling of therapeutical noncompliance in the chronically ill infant. The family of a child with a chronic disease often contacts nurses for further, non-medical information. Therefore the aim of the review is to inform nurses of the biopsychosocial risks and consequences for every day life as well as to provide them with supportive self-help-strategies of the affected family.

Adaptation, Psychological↗
PubMed2001

Beyond unfavorable thinking: the illness cognition questionnaire for chronic diseases.

The literature on chronic diseases recognizes the role of illness cognition as a mediator between stress and illness. Few conceptualizations and instruments, however, give an indication of both unfavorable and favorable ways of adjusting to an uncontrollable long-term stressor, such as a chronic disease. The authors propose 3 generic illness cognitions that reflect different ways of reevaluating the inherently aversive character of a chronic condition: helplessness as a way of emphasizing the aversive meaning of the disease, acceptance as a way to diminish the aversive meaning, and perceived benefits as a way of adding a positive meaning to the disease. A self-report instrument, the Illness Cognition Questionnaire, was developed to assess these cognitions across different chronic diseases. The results support the reliable and valid assessment of these illness cognitions in patients with rheumatoid arthritis and multiple sclerosis and indicate the maladaptive function of helplessness and the adaptive function of acceptance and perceived benefits for the long-term physical and psychological health of patients with a chronic disease.

Adolescent↗
PubMed2003

IL-10 is crucial for the transition from acute to chronic disease state during infection of mice with Schistosoma mansoni.

After infection of mice with Schistosoma mansoni, deposition of eggs in the walls of the intestine and liver provokes an intense (acute) T cell response that peaks at week 8 and, thereafter, down-modulates as the disease becomes chronic. Egg antigen-stimulated proliferation of mesenteric lymph node and spleen cells in vitro was intense at week 8 in both IL-10(-/-) and wild-type (WT) mice, while proliferative responses were markedly reduced at week 15 in WT mice, but undiminished in IL-10(-/-) animals. Moreover, in the absence of IL-10 production, levels of both IFN-gamma and IL-4 remained elevated at week 15. Granulomas around eggs embolized in the livers of WT mice were significantly smaller at week 15 than week 8, whereas those in IL-10(-/) animals were larger at week 8, showed no reduction in size at week 15, and were less sharply demarcated by peripheral collagen. There was also a greater leukocytic infiltration and necrosis of the hepatic parenchyma. These data suggest that in mice IL-10 regulates not only the intensity of hepatic inflammation, but also granuloma organization and cohesiveness. It is a crucial agent in the down-modulation of immune responses and immunopathology that defines the transition from acute to chronic disease.

Acute Disease↗
PubMed1999

Media coverage of chronic diseases in the Netherlands.

OBJECTIVE: Little is known about the quantity or quality of information on rheumatic diseases provided by the mass media. The aim of this study was to gain insight into the media coverage of rheumatic diseases compared with other chronic diseases in the Netherlands. MATERIALS AND METHODS: Newspaper articles, magazine articles, and medical television programs that appeared or were broadcast during a 1-year period, and contained information on rheumatic diseases, heart disease, cancer, chronic lung disease, or diabetes mellitus, were selected for content analysis. For each article and program, it was determined whether coverage concentrated on treatment, influence of lifestyle, scientific progress, or disease consequences. It was also determined whether professional experts and patients were featured. RESULTS: Nine hundred seventeen newspaper articles, 304 magazine articles, and 163 medical programs were found. Most dealt with cancer (43%) and heart disease (37%). The amount of media attention given to each of the five disease categories was found to correspond with mortality but not with prevalence. The contents of the articles and programs differed significantly according to disease topic. The main focus in rheumatic diseases was on patients' experiences, as well as regular and alternative medications. In heart disease and cancer, the main focus was on professional medical viewpoints, operations, and mortality, whereas in chronic lung disease and diabetes it was on treatments in the context of regular medications, scientific progress, and incurability. The influence of lifestyle on the disease process was mentioned most often in connection with diabetes, rheumatic disease, and chronic lung disease. CONCLUSIONS: The amount of attention a disease category received from the media depended on its fatality rates and not on its prevalence. Heart disease and cancer were portrayed as being more serious than the more lingering diseases. Surprisingly, the proportion of articles and programs that included the influence of lifestyle in their coverage was lowest for cancer and heart disease. More frequent and more accurate coverage of chronic diseases, especially rheumatic diseases, is needed if their image is to be brought into line with their importance for and impact on the community.

Chronic Disease↗
PubMedDate not supplied

Effect of a self-management program on patients with chronic disease.

CONTEXT: For patients with chronic disease, there is growing interest in "self-management" programs that emphasize the patients' central role in managing their illness. A recent randomized clinical trial demonstrated the potential of self-management to improve health status and reduce health care utilization in patients with chronic diseases. OBJECTIVE: To evaluate outcomes of a chronic disease self-management program in a real-world" setting. STUDY DESIGN: Before-after cohort study. PATIENTS AND SETTING: Of the 613 patients from various Kaiser Permanente hospitals and clinics recruited for the study, 489 had complete baseline and follow-up data. INTERVENTION: The Chronic Disease Self-Management Program is a 7-week, small-group intervention attended by people with different chronic conditions. It is taught largely by peer instructors from a highly structured manual. The program is based on self-efficacy theory and emphasizes problem solving, decision making, and confidence building. MAIN OUTCOME MEASURES: Health behavior, self-efficacy (confidence in ability to deal with health problems), health status, and health care utilization, assessed at baseline and at 12 months by self-administered questionnaires. RESULTS: At 1 year, participants in the program experienced statistically significant improvements in health behaviors (exercise, cognitive symptom management, and communication with physicians), self-efficacy, and health status (fatigue, shortness of breath, pain, role function, depression, and health distress) and had fewer visits to the emergency department (ED) (0.4 visits in the 6 months prior to baseline, compared with 0.3 in the 6 months prior to follow-up; P = 0.05). There were slightly fewer outpatient visits to physicians and fewer days in hospital, but the differences were not statistically significant. Results were of about the same magnitude as those observed in a previous randomized, controlled trial. Program costs were estimated to be about $200 per participant. CONCLUSIONS: We replicated the results of our previous clinical trial of a chronic disease self-management program in a "real-world" setting. One year after exposure to the program, most patients experienced statistically significant improvements in a variety of health outcomes and had fewer ED visits.

California↗
PubMed2002

Inappropriate expression of hepcidin is associated with iron refractory anemia: implications for the anemia of chronic disease.

The anemia of chronic disease is a prevalent, poorly understood condition that afflicts patients with a wide variety of diseases, including infections, malignancies, and rheumatologic disorders. It is characterized by a blunted erythropoietin response by erythroid precursors, decreased red blood cell survival, and a defect in iron absorption and macrophage iron retention, which interrupts iron delivery to erythroid precursor cells. We noted that patients with large hepatic adenomas had severe iron refractory anemia similar to that observed in anemia of chronic disease. This anemia resolved spontaneously after adenoma resection or liver transplantation. We investigated the role of the adenomas in the pathogenesis of the anemia and found that they produce inappropriately high levels of hepcidin mRNA. Hepcidin is a peptide hormone that has been implicated in controlling the release of iron from cells. We conclude that hepcidin plays a major, causative role in the anemia observed in our subgroup of patients with hepatic adenomas, and we speculate that it is important in the pathogenesis of the anemia of chronic disease in general.

Adenoma, Liver Cell↗
PubMed2002

Pathogenesis and treatment of anaemia of chronic disease.

Anaemia of chronic disease (ACD), the most frequent anaemia among hospitalized patients, develops under chronic inflammatory disorders such as chronic infections, cancer or autoimmune diseases. A number of different pathways contribute to ACD, such as diversion of iron traffic, a diminished erythropoiesis, a blunted response to erythropoietin, erythrophagocytosis and bone marrow invasion by tumour cells and pathogens. Nevertheless, ACD is a reflection of an activated immune system and possibly results from an innovative defence strategy of the body in order to withdraw the essential growth factor iron from invading pathogens and to increase the efficacy of cell-mediated immunity. Diagnosis of ACD can be assessed by examination of chances in serum iron parameters with low to normal serum iron, transferrin saturation and transferrin concentrations on the one hand and normal to increased ferritin, zinc protoporphyrin IX and cytokine levels on the other side. Therapy of ACD includes the cure of the underlying the disease. Apart from this transfusions for rapid correction of haemoglobin levels, and human recombinant erythropoietin for prolonged therapy are used. However, response rates to recombinant erythropoietin are sometimes low. Iron alone should be strictly avoided due to its growth-promoting effect towards micro-organisms and tumour cells and because of it capacity to inhibit T-cell-mediated immune effector pathways. We urgently need prospective clinical trials to gain knowledge about the effects of anaemia correction and/or the use of erythropoietin towards the course of the underlying disease, to find out if a combination therapy with erythropoietin and iron may be beneficial in ACD and to define therapeutic end-points.

Anemia↗
PubMed2004

The vital link between chronic disease and depressive disorders.

INTRODUCTION: Chronic diseases have assumed an increasingly important role in public health research and intervention. Without treatment, depressive disorders characteristically assume a chronic course and are expected, by 2020, to be second only to heart disease in the global burden of disease. Thus, understanding the relationship between depressive disorders and chronic disease appears vital to public health assessment and health care delivery. METHODS: Articles for review were primarily identified by a Medline search emphasizing the subject headings mental disorders or depression crossed with selected chronic diseases and conditions including asthma, arthritis, cardiovascular disease, cancer, diabetes, and obesity. RESULTS: Mental illnesses - most specifically, depressive disorders - were associated with increased prevalence of chronic diseases. This association between depression and chronic disease appears attributable to depressive disorders precipitating chronic disease and to chronic disease exacerbating symptoms of depression. The complex interrelationship between depressive disorders and chronic disease has important implications for both chronic disease management and the treatment of depression. CONCLUSION: Depressive disorders assume an important role in the etiology, course, and outcomes associated with chronic disease. Multivariate community-based research and intervention fostering the detection and treatment of depressive disorders is needed, as is further examination of the role exerted by mental illnesses other than depression in the pathogenesis of chronic disease.

Chronic Disease↗
PubMed2004

The global burden of chronic diseases: overcoming impediments to prevention and control.

Chronic diseases are the largest cause of death in the world. In 2002, the leading chronic diseases--cardiovascular disease, cancer, chronic respiratory disease, and diabetes--caused 29 million deaths worldwide. Despite growing evidence of epidemiological and economic impact, the global response to the problem remains inadequate. Stakeholders include governments, the World Health Organization and other United Nations bodies, academic and research groups, nongovernmental organizations, and the private sector. Lack of financial support retards capacity development for prevention, treatment, and research in most developing countries. Reasons for this include that up-to-date evidence related to the nature of the burden of chronic diseases is not in the hands of decision makers and strong beliefs persist that chronic diseases afflict only the affluent and the elderly, that they arise solely from freely acquired risks, and that their control is ineffective and too expensive and should wait until infectious diseases are addressed. The influence of global economic factors on chronic disease risks impedes progress, as does the orientation of health systems toward acute care. We identify 3 policy levers to address these impediments elevating chronic diseases on the health agenda of key policymakers, providing them with better evidence about risk factor control, and persuading them of the need for health systems change. A more concerted, strategic, and multisectoral policy approach, underpinned by solid research, is essential to help reverse the negative trends in the global incidence of chronic disease.

Chronic Disease↗
PubMed1999

Iron and anemia of chronic disease.

Anemia of chronic disease (ACD) is the most frequent anemia found in hospitalized patients, often occurring in subjects suffering from chronic inflammatory disorders. The underlying diversion of iron traffic leads to a withdrawal of the metal from the sites of erythropoiesis and the circulation to the storage compartment in the reticuloendothelial system, thus resulting, at the same time, in hypoferremia and hyperferritinemia. Proinflammatory and antiinflammatory cytokines, acute-phase proteins, and radicals are prominently involved in causing these disturbances of iron homeostasis. The role of these factors, as well as the pathophysiological reasons for the development of ACD, is discussed in this review.

Acute-Phase Proteins↗
PubMedDate not supplied

Public investment in providing information for chronic disease prevention for adults in Alberta.

BACKGROUND: The World Health Organization in 2000 cited specific chronic diseases (chronic obstructive pulmonary disease, heart disease, diabetes and certain cancers) as major and preventable health hazards. There have subsequently been calls for increased investment in prevention activities. Currently there is no information on the economic magnitude of these promotion activities. In this study, we present an estimate of the investment in Alberta, by public organization, for chronic disease prevention activities which provide information that promotes behaviour changes in adults at risk. METHODS: We surveyed board members of the Alberta Healthy Living Network (AHLN) to obtain economic data and information on activities related to chronic disease (primary) prevention. We also asked for further contacts on programs in other agencies. We continued the ("snowball") process until no new agencies were identified. Agencies provided the information on a survey form. RESULTS: In 2003 in Alberta, the cost of publicly provided information to change risk behaviours related to chronic diseases for persons over 20 was dollars 24.9 million. This investment was diffused over a large number of bodies. Anti-smoking programs used the largest proportion of the money. The total cost per person at risk was about dollars 15. Regional Health Authorities spend about 1/10th of 1% of their budget on these activities. DISCUSSION: There are difficulties in collecting and organizing society-level data on chronic disease prevention. Nevertheless, all indications are that the amount of resources devoted in this area is small, and much smaller than has been suggested.

Adult↗
PubMed2006

Dysregulated monocyte iron homeostasis and erythropoietin formation in patients with anemia of chronic disease.

Anemia of chronic disease (ACD) is frequently found in patients with chronic immune activation. Since most studies on ACD pathophysiology were performed with cell culture or animal models but not in humans, we examined 37 ACD patients suffering from autoimmune diseases or infections, 10 subjects with iron-deficiency anemia (IDA), 10 anemic patients with hereditary spherocytosis (HS), and 27 age-matched controls. Although hemoglobin concentrations were comparable between ACD and IDA patients, the latter presented with significantly higher serum erythropoietin concentrations than ACD patients. The significant negative correlation between erythropoietin and hemoglobin levels observed in IDA patients was also found in a group of anemic but not hypoferremic hereditary spherocytosis subjects, but not in ACD patients. Increased serum concentrations of the hepcidin precursor prohepcidin were paralleled by a decreased expression of the iron exporter ferroportin in circulating monocytes of ACD patients. In the latter cells, increased amounts of the iron storage protein ferritin and a reduced activity of iron-regulatory protein indicated monocyte iron accumulation. Our data indicate that hypoferremia in ACD may result from downregulation of ferroportin expression by hepcidin and cytokines with subsequent iron retention in monocytes. Together with a diminished erythropoietin formation, the impaired iron recirculation from monocytes may be central in the pathophysiology of ACD in humans.

Aged↗
PubMed2003

Modeling patient-specific therapeutic strategy in the guideline-based management of a chronic disease.

Like any chronic disease, hypertension is complex to manage. Despite the availability of evidence-based clinical practice guidelines in most countries, a lot of hypertensive patients remain inadequately managed. One difficulty lies in the synchronization of a patient's own therapeutic history with the guideline strategy. We propose a formal model to represent guideline-based therapeutic strategies as bi-dimensional matrices. We built the knowledge base as a two-level decision tree to be read during an hypertextual navigation. The first level is used to identify a patient-specific clinical situation on the basis of key elements of clinical examination (complication of hypertension, associated diseases). The second level aims at dynamically refining the theoretical strategy, a priori established in the guideline for the corresponding clinical situation, by the specific therapeutic history of the patient. Finally, depending on the patient's response to the ongoing treatment, the system provides a recommendation consistent with the guideline strategy, whatever the patient's past treatments. A first evaluation of the system on simulated cases has been well accepted by general practitioners.

Chronic Disease↗
PubMed2005

The relationship between specific anxiety syndromes and somatic symptoms in adolescents with asthma and other chronic diseases.

BACKGROUND: The impact of a chronic disease on the emotional well-being of children and adolescents is controversial in the literature. This study tested the hypotheses that 1) a specific approach is required to assess emotional deviations in adolescents with chronic diseases and 2) specific anxiety symptoms are predictive of excessive somatic symptoms. METHODS: Emotional and somatic symptoms were measured in four groups, selected from a community sample of 897 adolescents: 32 with asthma, 20 with other severe chronic diseases, 30 with median scores (the true comparison group), and 29 with minimal scores on common measures of trait anxiety and depression. RESULTS: The asthma and chronic disease groups scored not significantly higher than the true comparison group on trait anxiety, depression, negative affectivity, five anxiety syndromes, anxiety-related physical, and miscellaneous somatic symptoms. The asthma and chronic disease groups scored only higher than the true comparison group on panic attacks and respiration symptoms. Regression analyses showed that severity of asthma was no significant factor, and the minimal group scored consistently lower than the other groups, except on physical injury fears. There were no group differences in positive affect. Girls scored higher than boys on specific anxiety syndromes (except on obsessive-compulsive disorder) and also on respiration symptoms. CONCLUSION: Adolescents with severe chronic diseases deviated from a true comparison control group on panic attacks, but not on other negative and positive emotions.

Adolescent↗
PubMed1994

Clinical application of recombinant erythropoietin in the anemia of chronic disease.

The anemia of chronic disease is a consequence of the abnormal production of cytokines associated with chronic inflammatory, infectious, and neoplastic disorders. rhEPO can correct the impaired erythropoiesis encountered with this syndrome in vitro and in the clinical setting. Although most patients with the anemia of chronic disease will not require specific intervention to increase their hemoglobin and hematocrit, certain subsets of patients may benefit from rhEPO therapy. These include patients with anemia sufficiently severe to require transfusion, and patients for whom autologous blood donation is precluded by anemia.

Anemia↗