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Sample records for frequent chronic health

  1. The Chronic Disease Self-Management Program: the experience of frequent users of health care services and peer leaders.

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    Hudon, Catherine; Chouinard, Maud-Christine; Diadiou, Fatoumata; Bouliane, Danielle; Lambert, Mireille; Hudon, Émilie

    2016-04-01

    Large amount of evidence supports the contribution of the Stanford Chronic Disease Self-Management Program (CDSMP) to a global chronic disease management strategy. However, many studies have suggested further exploring of the factors influencing acceptance and completion of participants in this program. This study aimed to describe and examine factors associated with acceptance and completion rates of the CDSMP among frequent users of health care services, and to highlight the experience of patients and peer leaders who facilitated the program. A descriptive design with mixed sequential data was used. Acceptance and completion rates were calculated and their relationship with patient characteristics was examined in regression analysis (n = 167). Interviews were conducted among patients who accepted (n = 11) and refused (n = 13) to participate and with the program coordinator. Focus groups were held with the seven peer leaders who facilitated the program. Data were analysed using thematic analysis. Of the 167 patients invited, 60 (36%) accepted to participate in the program. Group format was the most frequent reason to decline the invitation to participate. Twenty-eight participants (47%) completed the program. Participants who dropped out during the program raised different reasons such as poor health and too much heterogeneity among participants. Factors such as location, schedule, content, group composition and facilitation were considered as important elements contributing to the success of the program. The CDSMP could therefore be considered as a self-management support option for this vulnerable clientele, while taking measures to avoid too much heterogeneity among participants to improve completion rates. © The Author 2016. Published by Oxford University Press.

  2. Mental health, life functioning and risk factors among people exposed to frequent natural disasters and chronic poverty in Vietnam.

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    Pollack, Amie Alley; Weiss, Bahr; Trung, Lam Tu

    2016-06-01

    People living in low- and middle-income countries (LMIC) are at increased risk for exposure to major natural disasters, which places them at increased risk for mental health problems. Evidence is less clear, however, regarding the effects of less severe but more frequent natural disasters, which are likely to increase due to global climate change. To examine the mental health and life functioning, and their predictors, of people living in central coastal Vietnam, an area characterized by high risk for natural disasters and poverty. 1000 individuals were randomly selected from 5 provinces in central coastal Vietnam. Individuals were assessed cross-sectionally for exposure to major storms and other traumatic events (Post-traumatic Diagnostic Scale; PDS), financial stress (Chronic Financial Stress Scale), depression (PHQ-9), anxiety (GAD-7), PTSD (PDS), somatic syndrome (SCL-90-R), alcohol dependency (ICD-10), self-perceived general physical health (SF 36), and functional impairment (PDS life functioning section); caseness was determined using the various measures' algorithms. 22.7% percent of the sample ( n =227) met caseness criteria in one or more mental health domains, and 22.1% ( n =221) reported moderate to severe functional impairment. Lifetime exposure to typhoons and other major storms was 99% ( n =978), with 77% ( n =742) reporting traumatic major storm exposure. Moderate to high levels of financial stress were reported by 30% ( n =297). Frequency of exposure to major storms was not associated with increased risk for mental health problems but traumatic exposure to a major storm was. Overall, the strongest predictor of mental health problems was financial stress. Number of traumatic typhoons and other major storms in turn were significant predictors (r 2 = .03) of financial stress. The primary predictor of alcohol dependency was male gender, highlighting the importance of gender roles in development of alcohol abuse in countries like Vietnam. Individuals

  3. Mental health, life functioning and risk factors among people exposed to frequent natural disasters and chronic poverty in Vietnam

    OpenAIRE

    Pollack, Amie Alley; Weiss, Bahr; Trung, Lam Tu

    2016-01-01

    Background People living in low- and middle-income countries (LMIC) are at increased risk for exposure to major natural disasters, which places them at increased risk for mental health problems. Evidence is less clear, however, regarding the effects of less severe but more frequent natural disasters, which are likely to increase due to global climate change. Aims To examine the mental health and life functioning, and their predictors, of people living in central coastal Vietnam ? an area char...

  4. Frequent job change and associated health.

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    Metcalfe, Chris; Davey Smith, George; Sterne, Jonathan A C; Heslop, Pauline; Macleod, John; Hart, Carole

    2003-01-01

    The contemporary labour market is widely regarded as having become more "flexible". It is proposed that such flexibility is a characteristic of employment histories which will have effects on psychosocial status, health-related behaviour, and physical health. Recent increases in flexibility are unlikely to have accumulated over sufficient portions of individual employment histories for any effect on health to be apparent, but a "preview" of these effects may be gained from study of older cohorts. This cross-sectional study is based on data collected in the early 1970s from 5399 men and 945 women in paid work, recruited from 27 workplaces in the west of Scotland. A flexible employment history was defined as one encompassing a large number of changes between jobs. Perceived psychological stress, health behaviour (cigarette smoking, alcohol consumption, physical exercise), physiology (diastolic blood pressure, body mass index, forced expiratory volume, plasma cholesterol concentration) and current health (angina, myocardial ischaemia) were assessed. Those individuals who reported having experienced frequent job change were more likely to smoke, consume greater amounts of alcohol, and perhaps to exercise less. Similar findings were observed in both males and females, and for different age and socio-economic groups. We found no suggestion that this association was due to higher levels of psychosocial stress, and the expected consequences for health were not observed. Interpretation of these findings is not straightforward due to an uncertain direction of causation, and a possible selection bias. However, the observed relationship between frequent job changing and a higher incidence of health risk behaviours, in the absence of a relationship with poorer health, invites further research.

  5. Frequently Asked Questions about Personal Health Records

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    ... kept by your health plan, contact the plan’s customer service department. Ask for an "authorization for the ... and healthcare provider have a confidential relationship. However, access to parents may be permitted in ...

  6. Antibody deficiency in patients with frequent exacerbations of Chronic Obstructive Pulmonary Disease (COPD).

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    McCullagh, Brian N; Comellas, Alejandro P; Ballas, Zuhair K; Newell, John D; Zimmerman, M Bridget; Azar, Antoine E

    2017-01-01

    Chronic Obstructive Pulmonary Disease is the third leading cause of death in the US, and is associated with periodic exacerbations, which account for the largest proportion of health care utilization, and lead to significant morbidity, mortality, and worsening lung function. A subset of patients with COPD have frequent exacerbations, occurring 2 or more times per year. Despite many interventions to reduce COPD exacerbations, there is a significant lack of knowledge in regards to their mechanisms and predisposing factors. We describe here an important observation that defines antibody deficiency as a potential risk factor for frequent COPD exacerbations. We report a case series of patients who have frequent COPD exacerbations, and who were found to have an underlying primary antibody deficiency syndrome. We also report on the outcome of COPD exacerbations following treatment in a subset with of these patients with antibody deficiency. We identified patients with COPD who had 2 or more moderate to severe exacerbations per year; immune evaluation including serum immunoglobulin levels and pneumococcal IgG titers was performed. Patients diagnosed with an antibody deficiency syndrome were treated with either immunoglobulin replacement therapy or prophylactic antibiotics, and their COPD exacerbations were monitored over time. A total of 42 patients were identified who had 2 or more moderate to severe COPD exacerbations per year. Twenty-nine patients had an underlying antibody deficiency syndrome: common variable immunodeficiency (8), specific antibody deficiency (20), and selective IgA deficiency (1). Twenty-two patients had a follow-up for at least 1 year after treatment of their antibody deficiency, which resulted in a significant reduction of COPD exacerbations, courses of oral corticosteroid use and cumulative annual dose of oral corticosteroid use, rescue antibiotic use, and hospitalizations for COPD exacerbations. This case series identifies antibody deficiency as a

  7. [Frequent attendance in a Primary Health Care District].

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    Menéndez Granados, Nicolás; Vaquero Abellán, Manuel; Toledano Estepa, Manuel; Pérez Díaz, Manuel Modesto; Redondo Pedraza, Rosa

    2017-10-09

    To describe the distribution of frequent attenders (FA) through the different primary care practices in Cordoba-Guadalquivir Health District (Córdoba, Spain). An ecological study was performed, including data from 2011 to 2015. Defining FA as those subjects who made12 or more appointments per year; independently analysed for nursing, general practice and paediatrics. Prevalence of frequent attendance and FA/professional ratio were used as dependent variables. Demographic characteristics from district population, number of health professionals and use of general facilities were also examinated. Aiming to understand FA distribution, primary health settings were classified according to facility size and environmental location (urban, suburban and rural). The mean prevalence for FA was 10.86% (0.5 SE) for nursing; general practice 21.70% (0.7 SE) and for paediatrics 16.96% (0.7 SE). FA/professional ratios for the different professional categories were: 101.07 (5.0 SE) for nursing, 239.74 (9.0 SE) for general practice and 159.54 (9.8 SE) for paediatrics. A major part of primary health care users make a high number of consultations. From this group, women overuse nursing and general practitioner services more compared to men. A higher prevalence of FAs was observed in smaller settings, in rural areas. Although taking the FAs:professional ratio as the bar, medium-size practices are more highly overused. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Aromaphytobalneotherapy in Treatment and Prophylaxis of Frequent Respiratory Infections in Children with Chronic and Disabling Diseases

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    O. M. Konova

    2016-01-01

    Full Text Available In children with chronic pathologies, co-occurring frequent respiratory infections of a prolonged course obstructs and reduce the effectiveness of rehabilitation measures, and adversely affect the adaptation reserves. Hydrotherapeutic factors are widely used for the prevention of colds in children from the first days of life. Addition to the water of medicinal and phytoaromatic preparations increases their efficiency. For patients with chronic pathology, when prescribing balneotherapeutic factors for treatment and prophylaxis of respiratory infections, it is important to take into account the potential risk of adverse effects on the symptoms of the underlying disease. Researches in patients with orthopedic, chronic gastroenterological diseases, spastic forms of cerebral palsy, with co-occurring frequent respiratory infections of a prolonged course in history revealed that addition of medicinal baths based on phytoaromatic preparation, containing eucalyptus oil, to the rehabilitation complex is an effective method of preventing and stopping initial symptoms of respiratory infections. It also contributes to the adaptation reserves of the organism, without adversely affecting the course of the underlying disease.

  9. Cannabis withdrawal in chronic, frequent cannabis smokers during sustained abstinence within a closed residential environment.

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    Lee, Dayong; Schroeder, Jennifer R; Karschner, Erin L; Goodwin, Robert S; Hirvonen, Jussi; Gorelick, David A; Huestis, Marilyn A

    2014-01-01

    Chronic, frequent cannabis smokers may experience residual and offset effects, withdrawal, and craving when abstaining from the drug. We characterized the prevalence, duration, and intensity of these effects in chronic frequent cannabis smokers during abstinence on a closed research unit. Non-treatment-seeking participants (N = 29 on admission, 66% and 34% remaining after 2 and 4 weeks) provided subjective effects data. A battery of five instruments was computer-administered daily to measure psychological, sensory, and physical symptoms associated with cannabinoid intoxication and withdrawal. Plasma and oral fluid specimens were concurrently collected and analyzed for cannabinoids. Outcome variables were evaluated as change from admission (Day 0) with regression models. Most abstinence effects, including irritability and anxiety were greatest on Days 0-3 and decreased thereafter. Cannabis craving significantly decreased over time, whereas decreased appetite began to normalize on Day 4. Strange dreams and difficulty getting to sleep increased over time, suggesting intrinsic sleep problems in chronic cannabis smokers. Symptoms likely induced by residual drug effects were at maximum intensity on admission and positively correlated with plasma and oral fluid cannabinoid concentrations on admission but not afterward; these symptoms showed overall prevalence higher than cannabis withdrawal symptoms. The combined influence of residual/offset drug effects, withdrawal, and craving was observed in chronic cannabis smokers during monitored abstinence. Abstinence symptoms were generally more intense in the initial phase, implying importance of early intervention in cannabis quit attempts. Sleep disturbance persisting for an extended period suggests that hypnotic medications could be beneficial in treating cannabis dependence. © American Academy of Addiction Psychiatry.

  10. A search for covert precipitating clinical parameters in frequent exacerbators of chronic obstructive pulmonary disease

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    Ankit Bhatia

    2016-01-01

    Full Text Available Introduction: Acute exacerbations are a significant source of morbidity and mortality associated with chronic obstructive pulmonary disease (COPD. Some patients suffer an inordinate number of exacerbations while others remain relatively protected. The aim of this study was to evaluate the potentially modifiable precipitating parameters of frequent severe exacerbations requiring hospital admission in COPD. Materials and Methods: Consecutive patients admitted with acute exacerbation of COPD for a period of one year in a tertiary care hospital were evaluated prospectively. Data regarding the number of exacerbations in the previous year, current comorbidities, medications, and clinical and functional status of COPD patients were evaluated. Results: We included 98 COPD patients (81.63% men admitted consecutively with exacerbations in our department. The mean number of severe exacerbations was (2.42 per patient/per year, and 65% of the patients had frequent severe exacerbations. Multivariate analysis indicated that serum uric acid, serum total IgE, depression and anxiety, gastroesophageal reflux disease symptoms, air pollution, poor adherence to inhaled therapy, and irregular outpatient followup visits were independent predictors of frequent severe exacerbations. Conclusion: COPD patients with frequent exacerbations should be carefully assessed for modifiable confounding risk factors regardless of poor lung function to decrease exacerbation frequency and related poor prognosis. Raised serum total IgE levels may point towards atopy as an additional comorbidity in COPD while uric acid can have a clinically useful role in risk stratification in a primary care setting.

  11. Negative perceptions of illness and health are associated with frequent use of physiotherapy in primary healthcare.

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    Opseth, Gro; Wahl, Astrid Klopstad; Bjørke, Gustav; Mengshoel, Anne Marit

    2018-03-01

    There is growing concern that an ageing population and increasing number of patients with chronic illnesses in the future will foster a need for health services beyond the resources available in society. Patients with chronic illnesses are reported to be frequent users of physicians' services in the primary health sector. Therapies for patients with chronic musculoskeletal illnesses are delivered by physiotherapists in this sector. However, we know little about the use of physiotherapy services and the factors that may explain their use. The aim of the present study was to examine the association between the regular/non-regular use of physiotherapy services, impacts of illness, and perceptions of illness and health. A cross-sectional survey included patients between 18 and 70 years of age who visited a physiotherapy outpatient clinic in Oslo during one randomly chosen week. Patient characteristics and use of physiotherapy were mapped. The Brief Illness Perception Questionnaire (BIPQ), a single item of the Short Form Health Survey (SF-12) and the Ørebro Musculoskeletal Pain Questionnaire (ØMPQ) were used to assess perceptions of illness and health, and impacts of illness. Data were analysed using independent sample t-tests and logistic regression analysis. A total of 507 patients with a mean age of 46 (standard deviation 12) years participated, of whom 54% were regular users of physiotherapy. BIPQ (p = 0.02; β = 0.03) and the single-item on general health perception (p = 0.001; β = 0.44,) were the only significant variables in the final equation associated with regular use of physiotherapy. About half of the participants were regular, high consumers of physiotherapy, and negative perceptions of illness and health were associated with this regular use. Copyright © 2017 John Wiley & Sons, Ltd.

  12. Frequently Asked Questions about Cell Phones and Your Health

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    ... and health? Scientists are continuing to study the possible health effects of cell phone use. For example, the World Health Organization (WHO) is currently looking into how cell phones may affect: Some types of tumors (a lump or ... are looking into a possible link between cell phone use and certain types ...

  13. Do frequent moderate exacerbations contribute to progression of chronic obstructive pulmonary disease in patients who are ex-smokers?

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    Dreyse J

    2015-03-01

    Full Text Available Jorge Dreyse,1 Orlando Díaz,1 Paula Repetto,2 Arturo Morales,1 Fernando Saldías,1 Carmen Lisboa11Department of Pulmonary Diseases, School of Medicine, 2School of Psychology, Pontificia Universidad Católica de Chile, Santiago, ChileBackground: In addition to smoking, acute exacerbations are considered to be a contributing factor to progression of chronic obstructive pulmonary disease (COPD. However, these findings come from studies including active smokers, while results in ex-smokers are scarce and contradictory. The purpose of this study was to evaluate if frequent acute moderate exacerbations are associated with an accelerated decline in forced expiratory volume in one second (FEV1 and impairment of functional and clinical outcomes in ex-smoking COPD patients.Methods: A cohort of 100 ex-smoking patients recruited for a 2-year follow-up study was evaluated at inclusion and at 6-monthly scheduled visits while in a stable condition. Evaluation included anthropometry, spirometry, inspiratory capacity, peripheral capillary oxygen saturation, severity of dyspnea, a 6-minute walking test, BODE (Body mass index, airflow Obstruction, Dyspnea, Exercise performance index, and quality of life (St George’s Respiratory Questionnaire and Chronic Respiratory Disease Questionnaire. Severity of exacerbation was graded as moderate or severe according to health care utilization. Patients were classified as infrequent exacerbators if they had no or one acute exacerbation/year and frequent exacerbators if they had two or more acute exacerbations/year. Random effects modeling, within hierarchical linear modeling, was used for analysis.Results: During follow-up, 419 (96% moderate acute exacerbations were registered. At baseline, frequent exacerbators had more severe disease than infrequent exacerbators according to their FEV1 and BODE index, and also showed greater impairment in inspiratory capacity, forced vital capacity, peripheral capillary oxygen saturation

  14. Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy.

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    Sellman, A; Katzman, P; Andreasson, S; Löndahl, M

    2018-05-23

    To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers. Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes. Despite similar age and diabetes duration, severe non-proliferative or proliferative diabetic retinopathy was present in 41% of the people in the diabetic foot ulcer group as compared to 15% in the control group (Pdiabetic foot ulcer group was without any diabetic retinopathy as compared to 34% among controls. Proliferative diabetic retinopathy was more common in the diabetic foot ulcer group (31% vs 8%; Pdiabetic retinopathy did not differ between groups. Clinically significant macular oedema was more frequently present, and the diabetic foot ulcer group exhibited significantly worse results in best and worst eye visual acuity testing. In this northern European setting almost all people with Type 2 diabetes and chronic diabetic foot ulcers had diabetic retinopathy. Almost one-third had proliferative diabetic retinopathy as compared to diabetic retinopathy was linked to worse visual acuity. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

  15. Anemia of chronic disease is the more frequent type of anemia seen in patients with chronic idiopathic neutropenia of adults.

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    Papadaki, H A; Eliopoulos, D G; Valatas, V; Eliopoulos, G D

    2001-04-01

    This study describes the frequency and the type of anemia seen in patients with nonimmune chronic idiopathic neutropenia of adults (NI-CINA). We found that NI-CINA patients had low hemoglobin levels and increased serum concentrations of erythropoietin (EPO), tumor necrosis factor-alpha (TNF-alpha), and interleukin-1beta (IL-1beta). The hemoglobin levels correlated positively with the number of circulating neutrophils and inversely with the levels of EPO and TNF-alpha but not of IL-1beta. Anemia, defined as the reduction of the hemoglobin below 12.0 g/dl for women and 13.3 g/dl for men, was found in 23 out of 148 patients studied, a proportion of 15.5%. Two of the anemic patients had iron deficiency anemia (8.7%), 11 had anemia of chronic disease (ACD; 47.8%) presenting with normal or slightly reduced erythrocytic indices, low serum iron, and increased serum ferritin, and the remaining ten had anemia of undefined pathogenesis (AUP; 43.5%) with normal or slightly decreased erythrocytic indices, serum iron ranging from 43 to 88 microg/dl, and ferritin values ranging from 12 to 50 ng/ml. We conclude that ACD is the more frequent type of anemia seen in patients with NI-CINA, and that pro-inflammatory cytokines, notably TNF-alpha, may be involved in the pathogenesis of both ACD and AUP, given that serum levels of the cytokine were significantly increased and that the EPO response to anemia was blunted in these patients. These findings further support our previously reported suggestion for the possible existence, in NI-CINA patients, of an unrecognized low-grade chronic inflammatory process that may be involved in the pathogenesis of the disorder.

  16. Dementia and depression: two frequent disorders of the aged in primary health care in Greece.

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    Argyriadou, S; Melissopoulou, H; Krania, E; Karagiannidou, A; Vlachonicolis, I; Lionis, C

    2001-02-01

    Dementia and depression are very common disorders among elderly people and their presence decreases the well-being of the aged. The purpose of this study was to assess the magnitude of dementia and depression among elderly people living in different settings in the catchment area of the Chrisoupolis health centre (HCCh) in northern Greece. A total of 536 patients aged 65 years and over, including 48 subjects living in an old people's home, 75 subjects who were taking part in the activities of the open centre for the elderly and 413 subjects randomly selected from those visiting the HCCh, were interviewed by the primary health care team of the HCCh. Medical and family history data were recorded, while cognitive and mood disorders were assessed by using the Mini Mental State Examination and Geriatric Depression Screening Scale. At the time of the examination, 37.6% of the men and 41.6% of the women showed various degrees of cognitive impairment, while 29.9% of the women and 19.6% of the men showed mild to moderate depression. Diabetes mellitus and hypertension frequently were found to co-exist with depression and dementia. The results reaffirm that there is a high prevalence of the studied mental disorders in older patients in the out-patient setting in Greece. A set of recommendations to Greek GPs has now been formulated, with specific emphasis on the use of different screening tools and the appropriate treatment of the most frequently co-existing chronic diseases.

  17. The relationship between health literacy and quality of life among frequent users of health care services: a cross-sectional study.

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    Couture, Éva Marjorie; Chouinard, Maud-Christine; Fortin, Martin; Hudon, Catherine

    2017-07-06

    Although health literacy and quality of life are important concepts in health care, the link between them is unclear, especially for a population of frequent users of health care services with chronic diseases. Low health literacy is a common problem that has been linked to several negative health outcomes. Quality of life is an important health outcome in patient-centered care. Frequent users of health care services are a vulnerable population that deserves attention due to high costs and negative outcomes such as lower quality of life and higher mortality. The objective of this study was to examine the relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services with chronic diseases. This study presents the cross-sectional analysis of data collected through the V1SAGES project, a randomized controlled trial on the effectiveness of a case management intervention in primary care in Quebec, Canada. Participants (n = 247) were frequent users of health care services presenting at least one chronic condition. Health literacy was measured by the Newest Vital Sign (NVS), and the physical and mental components of quality of life were evaluated by the Short Form Health Survey Version 2 (SF-12v2). The association between health literacy (independent variable) and the physical and mental components of quality of life was examined using biserial correlation. No association was found between health literacy and quality of life (physical component: r = 0.108, ρ = 0.11; mental component: r = 0.147, ρ = 0.15). This study suggests that there is no relationship between health literacy and the physical and mental components of quality of life among frequent users of health care services. NCT01719991 . Registered October 25, 2012.

  18. Frequent Surfing on Social Health Networks is Associated With Increased Knowledge and Patient Health Activation.

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    Grosberg, Dafna; Grinvald, Haya; Reuveni, Haim; Magnezi, Racheli

    2016-08-10

    The advent of the Internet has driven a technological revolution that has changed our lives. As part of this phenomenon, social networks have attained a prominent role in health care. A variety of medical services is provided over the Internet, including home monitoring, interactive communications between the patient and service providers, and social support, among others. This study emphasizes some of the practical implications of Web-based health social networks for patients and for health care systems. The objective of this study was to assess how participation in a social network among individuals with a chronic condition contributed to patient activation, based on the Patient Activation Measure (PAM). A prospective, cross-sectional survey with a retrospective component was conducted. Data were collected from Camoni, a Hebrew-language Web-based social health network, participants in the diabetes mellitus, pain, hypertension, and depression/anxiety forums, during November 2012 to 2013. Experienced users (enrolled at least 6 months) and newly enrolled received similar versions of the same questionnaire including sociodemographics and PAM. Among 686 participants, 154 of 337 experienced and 123 of 349 newly enrolled completed the questionnaire. Positive correlations (Psocial relationships, and chronic disease knowledge. Men surfed longer than women (χ²3=10.104, Psocial health network use were correlated with increased knowledge about a chronic disease. Experienced surfers had higher PAM than newly enrolled, suggesting that continued site use may contribute to increased activation. Web-based social health networks offer an opportunity to expand patient knowledge and increase involvement in personal health, thereby increasing patient activation. Further studies are needed to examine these changes on other aspects of chronic illnesses such as quality of life and costs.

  19. Acute and chronic toxicity of four frequently used UV filter substances for Desmodesmus subspicatus and Daphnia magna.

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    Sieratowicz, Agnes; Kaiser, Dominic; Behr, Maximilian; Oetken, Matthias; Oehlmann, Jörg

    2011-01-01

    As a consequence of growing public concern about UV radiation effects on human health chemical and physical UV filters are increasingly used in personal care and other products. The release of these lipophilic and often persistent compounds into surface waters may pose a risk for aquatic organisms. The aim of the study was to determine effects of four frequently used UV filters on primary aquatic producers and consumers, the green alga Desmodesmus subspicatus and the crustacean Daphnia magna. Exposure to benzophenone 3 (BP3), ethylhexyl methoxycinnamate (EHMC), 3-benzylidene camphor (3-BC) and 3-(4'-methylbenzylidene)-camphor (4-MBC) resulted in growth inhibition of D. subspicatus with 72 h IC(10) values of 0.56 mg/L (BP 3), 0.24 mg/L (EHMC), 0.27 mg/L (3-BC) and 0.21 mg/L (4-MBC). EC(50) concentrations in the acute test with D. magna were 1.67, 0.57, 3.61 and 0.80 mg/L for BP3, EHMC, 3-BC and 4-MBC, respectively. Chronic exposure of D. magna resulted in NOECs of 0.04 mg/L (EHMC) and 0.1 mg/L (3-BC and 4-MBC). BP 3 showed no effects on neonate production or the length of adults. Rapid dissipation of these substances from the water phase was observed indicating the need for more frequent test medium renewal in chronic tests or the use of flow-through test systems.

  20. Clinical and pulmonary functions profiling of patients with chronic obstructive pulmonary disease experiencing frequent acute exacerbations

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    Prem Parkash Gupta

    2018-01-01

    Full Text Available Purpose: The present study aimed at clinical and pulmonary functions profiling of patients with chronic obstructive pulmonary disease (COPD to anticipate future exacerbations. Methods: The study included 80 COPD patients; 40 patients had ≥2 acute exacerbations during preceding 1 year (frequent exacerbation [FECOPD] group and 40 patients had <2 acute exacerbations during preceding 1 year (infrequent exacerbation [I-FECOPD] group. Clinical profile, sputum microbiology, blood gas analysis, spirometric indices, and diffusion capacity (transfer test variables were assessed. Groups' comparison was performed using an independent t-test for numeric scale parameters and Chi-square test for nominal parameters. Pearson's and Spearman's correlation coefficients were derived for numeric scale parameters and numeric nominal parameters, respectively. Multinomial logistic regression analysis was done using SPSS software. Results: FECOPD group contained younger patients than in I-FECOPD group although the difference was not statistically significant. There was no significant difference between two groups regarding smoking pack-years and duration of illness. FECOPD group had significantly more expectoration score and Modified Medical Research Council dyspnea scores. Cough score and wheeze score did not differ significantly between two groups. More patients in FECOPD group (12/40 vs. 4/40 had lower airway bacterial colonization. Arterial blood gas parameters were more deranged in FECOPD group. Spirometric indices (forced expiratory volume during 1st s as well as transfer test (both diffusing capacity for carbon monoxide and transfer coefficient of the lung values were significantly reduced in FECOPD group. Conclusions: The patients in FECOPD group had clinical, spirometric, and transfer test profiling suggestive of a severe COPD phenotype, the recognition will help in predicting future exacerbations and a better management.

  1. Frequent flyer business travelers. The role of the occupational health nurse.

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    Tompkins, Olga S; Randolph, Susan A; Ostendorf, Judith S

    2005-03-01

    When managing frequent flyer business travelers, occupational health nurses focus on health promotion and health protection goals. The three types of prevention (i.e., primary, secondary, tertiary) follow a timeline beginning with complete prevention, and proceeding through and ending with management of a disease process. Occupational health nurses design and implement practice strategies based on this progression. Travel health nursing is rapidly expanding as the number of travelers, immunizations, and modes of transportation increase. Physicians focus on disease, industrial hygienists focus on hazard exposure, and safety professionals address occupational issues related to illnesses and injuries. Occupational health nurses are the professionals who focus on all three areas, in addition to health promotion and health protection. Frequent flyer business travelers have specific and complex needs that occupational health nurses are in a unique position to address.

  2. Extremely frequent behavior in consumer research: theory and empirical evidence for chronic casino gambling.

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    Perfetto, Ralph; Woodside, Arch G

    2009-09-01

    The present study informs understanding of customer segmentation strategies by extending Twedt's heavy-half propositions to include a segment of users that represent less than 2% of all households-consumers demonstrating extremely frequent behavior (EFB). Extremely frequent behavior (EFB) theory provides testable propositions relating to the observation that few (2%) consumers in many product and service categories constitute more than 25% of the frequency of product or service use. Using casino gambling as an example for testing EFB theory, an analysis of national survey data shows that extremely frequent casino gamblers do exist and that less than 2% of all casino gamblers are responsible for nearly 25% of all casino gambling usage. Approximately 14% of extremely frequent casino users have very low-household income, suggesting somewhat paradoxical consumption patterns (where do very low-income users find the money to gamble so frequently?). Understanding the differences light, heavy, and extreme users and non-users can help marketers and policymakers identify and exploit "blue ocean" opportunities (Kim and Mauborgne, Blue ocean strategy, Harvard Business School Press, Boston, 2005), for example, creating effective strategies to convert extreme users into non-users or non-users into new users.

  3. Association between perceived insufficient sleep, frequent mental distress, obesity and chronic diseases among US adults, 2009 behavioral risk factor surveillance system

    Directory of Open Access Journals (Sweden)

    Liu Yong

    2013-01-01

    Full Text Available Abstract Background Although evidence suggests that poor sleep is associated with chronic disease, little research has been conducted to assess the relationships between insufficient sleep, frequent mental distress (FMD ≥14 days during the past 30 days, obesity, and chronic disease including diabetes mellitus, coronary heart disease, stroke, high blood pressure, asthma, and arthritis. Methods Data from 375,653 US adults aged ≥ 18 years in the 2009 Behavioral Risk Factor Surveillance System were used to assess the relationships between insufficient sleep and chronic disease. The relationships were further examined using a multivariate logistic regression model after controlling for age, sex, race/ethnicity, education, and potential mediators (FMD and obesity. Results The overall prevalence of insufficient sleep during the past 30 days was 10.4% for all 30 days, 17.0% for 14–29 days, 42.0% for 1–13 days, and 30.6% for zero day. The positive relationships between insufficient sleep and each of the six chronic disease were significant (p  Conclusions Assessment of sleep quantity and quality and additional efforts to encourage optimal sleep and sleep health should be considered in routine medical examinations. Ongoing research designed to test treatments for obesity, mental distress, or various chronic diseases should also consider assessing the impact of these treatments on sleep health.

  4. Efficacy of inosine pranobex in frequently ill children with chronic Epstein–Barr virus infection: randomized study

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    E.N. Simovanyan

    2011-01-01

    Full Text Available High incidence of acute respiratory infections (ARI in immunocompromised frequently ill children with chronic Epstein–Barr infection forces the prescription of drugs with complex antivirus and immunocorrecting effect. The objective: to study the efficacy of inosine pranobex (Isoprinosine in treatment of active Epstein–Barr virus infection in frequently ill children. Methods: patients were randomized in group of standard treatment (n = 24 and standard treatment + inosine pranobex 50 mg/kg of body weight divided to 3–4 parts daily (3 courses of 10 days every other 10 days. Primary efficacy criterion was the incidence of ARI episodes during 12 months of observation. Results: the treatment with inosine pranobex resulted in decrease of incidence (4 and 25% and duration of ARI (5.6 ± 1.2 and 8.8 ± 3.3 days compared to standard treatment. Besides, inosine pranobex decreased the frequency of lymphoproliferation, arthralgic and cardiac syndromes, favored to rapid elimination of serologic markers of Epstein–Barr virus replication and normalization of blood concentrations of interferon _ and interleukine 4. Side effects of treatment with inosine pranobex were not registered. Conclusion: inosine pranobex is efficient and safe drug in treatment of active form of chronic Epstein–Barr virus infection in frequently ill children.Key words: frequently ill children, Epstein–Barr virus, inosine pranobex, treatment.

  5. Naloxone Induces Frequent Jumping after Chronic Morphine and Methamphetamine Co-Administration in Rats

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    Gholamreza Kaka

    2014-02-01

    Full Text Available Combined use of an opioid with a psychostimulant is popular among drug abusers. Such “polydrug use” may increase drug effects or attenuate adverse effects of either drug alone. We proposed that a combination of methamphetamine (meth and morphine may change physical opioid withdrawal symptoms. Adult male rats were chronically injected with cumulative subcutaneous (s.c. doses of morphine, meth or a combination of both drugs within five days. On day six, a challenge dose of the same drug was injected. Two hours later, precipitated withdrawal symptoms were scored within 30 minutes after naloxone (1mg/kg, i.p. injection. Both frequency and incidence of jumping significantly increased in combined treated animals (P<0.05. The sole emergent symptom in combined treated animals was digging which we consider as another escaping behavior in addition to jumping. Our findings imply that combined use of meth and morphine may exacerbate averseness of morphine withdrawal which may cause more intense opioid dependence

  6. Delayed recognition of Wolfram syndrome frequently misdiagnosed as type 1 diabetes with early chronic complications.

    Science.gov (United States)

    Zmyslowska, A; Borowiec, M; Fichna, P; Iwaniszewska, B; Majkowska, L; Pietrzak, I; Szalecki, M; Szypowska, A; Mlynarski, W

    2014-01-01

    Improvements in diagnostic methods and greater genetic awareness have brought remarkable progress in the recognition of monogenic forms of diabetes, including Wolfram syndrome (WFS). WFS is diagnosed based on clinical criteria of coexistence of diabetes mellitus and optic atrophy, and confirmed by molecular analysis; however, the condition is still sometimes misdiagnosed. To begin to understand the reasons for misdiagnosis, we conducted a retrospective analysis of WFS patients who were originally misdiagnosed. The medical histories of 13 pediatric patients with clinical misdiagnosis of type 1 diabetes and early chronic complications made in the years 1995-2010 and who were subsequently correctly diagnosed with WFS based on genetic testing in 2008-2011 were analyzed. The average age of the patients at diabetes onset was 5 (4.4-6.3) years, and the mean HbA1c level at diagnosis was 9.1±2.3%. Initially, all of these patients were treated as having type 1 diabetes with progressive visual impairment despite good metabolic control (mean HbA1c 7.5±1.3%). Diagnosis of optic atrophy was made at an average age of 9 (5.9-11.5) years, which corresponds to 4 years after diabetes recognition (p=0.002). At the time of genetic analysis, the average age of the patients was 16 (12-18.7) years, which corresponds to 7 years after recognition of coexistence of diabetes mellitus and optic atrophy (p=0.007). Delays of at least 7 years occurred before recognition of WFS among a cohort of pediatric patients with diabetes. All patients with WFS were primarily misdiagnosed as having type 1 diabetes. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York.

  7. Advice and Frequently Asked Questions (FAQs) for Citizen-Science Environmental Health Assessments.

    Science.gov (United States)

    Barzyk, Timothy M; Huang, Hongtai; Williams, Ronald; Kaufman, Amanda; Essoka, Jonathan

    2018-05-11

    Citizen science provides quantitative results to support environmental health assessments (EHAs), but standardized approaches do not currently exist to translate findings into actionable solutions. The emergence of low-cost portable sensor technologies and proliferation of publicly available datasets provides unparalleled access to supporting evidence; yet data collection, analysis, interpretation, visualization, and communication are subjective approaches that must be tailored to a decision-making audience capable of improving environmental health. A decade of collaborative efforts and two citizen science projects contributed to three lessons learned and a set of frequently asked questions (FAQs) that address the complexities of environmental health and interpersonal relations often encountered in citizen science EHAs. Each project followed a structured step-by-step process in order to compare and contrast methods and approaches. These lessons and FAQs provide advice to translate citizen science research into actionable solutions in the context of a diverse range of environmental health issues and local stakeholders.

  8. Chronic hyper-hemolysis in sickle cell anemia: association of vascular complications and mortality with less frequent vasoocclusive pain.

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    James G Taylor

    2008-05-01

    Full Text Available Intravascular hemolysis in sickle cell anemia could contribute to complications associated with nitric oxide deficiency, advancing age, and increased mortality. We have previously reported that intense hemolysis is associated with increased risk of vascular complications in a small cohort of adults with sickle cell disease. These observations have not been validated in other populations.The distribution of serum lactic dehydrogenase (LDH values was used as a surrogate measure of intravascular hemolysis in a contemporaneous patient group and an historical adult population from the Cooperative Study of Sickle Cell Disease (CSSCD, all with sickle cell anemia. Chronic hyper-hemolysis was defined by the top LDH quartile and was compared to the lowest LDH quartile.Hyper-hemolysis subjects had higher systolic blood pressure, higher prevalence of leg ulcers (OR 3.27, 95% CI 1.92-5.53, P<0.0001, priapism (OR 2.62, 95% CI 1.13-6.90, P = 0.03 and pulmonary hypertension (OR 4.32, 95% CI 2.12-8.60, P<0.0001, while osteonecrosis (OR 0.32, 95% CI 0.19-0.54, P<0.0001 and pain (OR 0.23, 95% CI 0.09-0.55, P = 0.0004 were less prevalent. Hyper-hemolysis was influenced by fetal hemoglobin and alpha thalassemia, and was a risk factor for early death in the CSSCD population (Hazard Ratio = 1.97, P = 0.02.Steady state LDH measurements can identify a chronic hyper-hemolysis phenotype which includes less frequent vasooclusive pain and earlier mortality. Clinicians should consider sickle cell specific therapies for these patients, as is done for those with more frequent acute pain. The findings also suggest that an important class of disease modifiers in sickle cell anemia affect the rate of hemolysis.

  9. Physical activity in the prevention of the most frequent chronic diseases: an analysis of the recent evidence.

    Science.gov (United States)

    Kruk, Joanna

    2007-01-01

    Physical activity is widely recognized as a means for the primary prevention of chronic diseases as well as in patients' treatment and rehabilitation. Moreover, activity has beneficial effects on an individual's health and well-being. Despite the benefits of regular physical activity, the percentage of physically inactive adults in the world is high. Environmental and policy approaches aimed to increase physical activity require continual stress of the epidemiological evidence from studies investigating disease mechanisms as well as controlled clinical trials. To update the evidence that physical activity/exercise is important for reducing the chronic diseases (cardiovascular and heart, diabetes, cancer, obesity, osteoporosis, and fall-related injuries, depression and emotional stress) and for mechanisms that may operate in the relation between physical activity and a disease risk. Research studies published from 2004 through to March 2007 were identified through a review of the literature available on the NLM PubMed, Medline, Current Contents, and Elsevier-Science Direct databases. Recent evidence on physical activity/exercise and reduction of chronic major diseases incidence and rehabilitation of patients replicates previous findings. The strongest evidence exists for colon cancer, breast cancer, and cardiovascular diseases. The maximal magnitudes of the risk reduction reported were: 75% for breast cancer, 49% for cardiovascular and heart diseases, 35% for diabetes, 22% for colorectal cancer. Increased physical activity also prevented the weight gain associated with aging at least 2-times greater in individuals who were more active compared with those who were inactive. Limited new findings has been reported for the beneficial role of physical activity in fall-related injures, depression and emotional distress. Recent evidence confirms previous findings that engaging in moderate physical activity is very important for the primary prevention of chronic diseases

  10. [Chronic wounds as a public health problem].

    Science.gov (United States)

    Situm, Mirna; Kolić, Maja; Redzepi, Gzim; Antolić, Slavko

    2014-10-01

    Chronic wounds represent a significant burden to patients, health care professionals and the entire health care system. Regarding the healing process, wounds can be classified as acute or chronic wounds. A wound is considered chronic if healing does not occur within the expected period according to the wound etiology and localization. Chronic wounds can be classified as typical and atypical. The majority of wounds (95 percent) are typical ones, which include ischemic, neurotrophic and hypostatic ulcers and two separate entities: diabetic foot and decubital ulcers. Eighty percent of chronic wounds localized on lower leg are the result of chronic venous insufficiency, in 5-10 percent the cause is of arterial etiology, whereas the rest are mostly neuropathic ulcers. Chronic wounds significantly decrease the quality of life of patients by requiring continuous topical treatment, causing immobility and pain in a high percentage of patients. Chronic wounds affect elderly population. Chronic leg ulcers affect 0.6-3 percent of those aged over 60, increasing to over 5 percent of those aged over 80. Emergence of chronic wounds is a substantial socioeconomic problem as 1-2 percent of western population will suffer from it. This estimate is expected to rise due to the increasing proportion of elderly population along with the diabetic and obesity epidemic. It has been proved that chronic wounds account for the large proportion of costs in the health care system, even in rich societies. Socioeconomically, the management of chronic wounds reaches a total of 2-4 percent of the health budget in western countries. Treatment costs for some other diseases are not irrelevant, nor are the method and materials used for treating these wounds. Considering etiologic factors, a chronic wound demands a multidisciplinary approach with great efforts of health care professionals to treat it more efficiently, more simply and more painlessly for the patient, as well as more inexpensively for

  11. Nativity, Chronic Health Conditions, and Health Behaviors in Filipino Americans.

    Science.gov (United States)

    Bayog, Maria L G; Waters, Catherine M

    2018-05-01

    Nearly half of Americans have a chronic health condition related to unhealthful behavior. One in four Americans is an immigrant; yet immigrants' health has been studied little, particularly among Asian American subpopulations. Years lived in United States, hypertension, diabetes, smoking, walking, adiposity, and fruit/vegetable variables in the 2011-2012 California Health Interview Survey were analyzed to examine the influence of nativity on chronic health conditions and health behaviors in 555 adult Filipinos, the second largest Asian American immigrant subpopulation. Recent and long-term immigrant Filipinos had higher odds of having hypertension and diabetes, but lower odds of smoking and overweight/obesity compared with second-generation Filipinos. Being born in the United States may be protective against chronic health conditions, but not for healthful behaviors among Filipinos. Chronic disease prevention and health promotion strategies should consider nativity/length of residence, which may be a more consequential health determinant than other immigration and acculturation characteristics.

  12. Is frequent attendance of longer duration related to less transient episodes of care? A retrospective analysis of transient and chronic episodes of care

    NARCIS (Netherlands)

    Smits, F.T.; Brouwer, H.J.; Schene, A.H.; van Weert, H.C.; ter Riet, G.

    2016-01-01

    OBJECTIVES: Frequent attenders (FAs) suffer more and consult general practitioners (GPs) more often for chronic physical and psychiatric illnesses, social difficulties and distress than non-FAs. However, it is unclear to what extent FAs present transient episodes of care (TECs) compared with

  13. Work disability resulting from chronic health conditions.

    Science.gov (United States)

    Lerner, Debra; Allaire, Saralynn H; Reisine, Susan T

    2005-03-01

    To describe current programs and policies for addressing work disability among adults with chronic health conditions, and to identify opportunities for new research aimed at reducing the problem. The authors conducted secondary data analysis and a literature review. Millions of Americans with a chronic health condition have a work disability or are at risk of developing one. This public health problem is costing hundreds of billions of dollars a year nationally in lost productivity and diminishing the quality of life of millions of Americans. The medical care system, employers, and government--three traditional sources of help for adults with chronic health problems--are not sufficiently oriented toward the primary or secondary prevention of work disability. New research is urgently needed to reduce the burden of work disability on individuals and society.

  14. Frequent exacerbator” is a phenotype of poor prognosis in Japanese patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Tomioka R

    2016-02-01

    Full Text Available Ryusuke Tomioka,1,2 Tomotaka Kawayama,1 Masashi Suetomo,1,2 Takashi Kinoshita,1 Yoshihisa Tokunaga,1 Haruki Imaoka,1 Kazuko Matsunaga,1 Masaki Okamoto,1 Tomoaki Hoshino1 1Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Kurume, 2Respiratory Medicine, Chikugo City Hospital, Chikugo, JapanBackground: The prognosis of Japanese patients with COPD who suffer repeated exacerbations is unclear, although Westerners with such episodes have a poor prognosis.Materials and methods: We conducted a 1-year prospective observational trial involving 90 Japanese patients with COPD: 58 nonexacerbators, 12 infrequent exacerbators, and 20 frequent exacerbators classified on the basis of exacerbation frequency (zero, one, and two or more exacerbations/year, respectively, during the previous year were observed prospectively for 1 year. The characteristics of frequent exacerbators, the frequency of exacerbation, and the period until the first event were then compared among the groups.Results: A total of 78 patients completed the study. Frequent exacerbators had a significantly higher risk of frequent exacerbation in the following year than the case for nonexacerbators (odds ratio [95% confidence interval] 2.94 [1.21–7.17], P=0.0340, but not in comparison with infrequent exacerbators (1.51 [0.49–4.63], P>0.05. The mean annual frequency of exacerbations in the following year was significantly (P=0.0020 higher in the frequent exacerbators (1.4 exacerbations/year than in the nonexacerbators (0.4, but not in the infrequent exacerbators (0.9, P>0.05. The mean period until the first exacerbation was significantly shorter in the frequent exacerbators than in the infrequent or nonexacerbators (P=0.0012. Independent risk factors for future frequent exacerbation included the presence of gastroesophageal reflux disease, more severe airflow obstruction, and use of inhaled corticosteroids.Conclusion: Our present

  15. [Would the Screening of Common Mental Disorders in Primary-Care Health Services Hyper-Frequent Patients Be Useful?].

    Science.gov (United States)

    Rincón-Hoyos, Hernán G; López, Mérida R Rodríguez; Ruiz, Ana María Villa; Hernández, Carlos Augusto; Ramos, Martha Lucía

    2012-12-01

    Hyper-frequentation in health services is a problem for patients, their families and the institutions. This study is aimed at determining the frequency and characteristics of common mental disorders in hyper-frequent patients showing vague symptoms and signs at a primary healthcare service during the year 2007 in the city of Cali (Colombia). Cross sectional. The most frequent mental disorders in hyper-frequent patients were detected through a telephone interview which included several modules of the PRIME MD instrument. In general, healthcare service hyper-frequenters are working women, 38,7-year old in average. Basically, the consultation is due to cephalalgia but they also exhibit a high prevalence of common mental disorders (somatization, depression and anxiety) not easily diagnosed by physicians in primary care. Expenses for additional health activities generated by these patients are attributed basically to medical consultation and required procedures. Considering hyper-frequenters in health care services as a risk group in terms of common mental disorders involves screening as an efficient strategy to prevent abuse in service use and to improve satisfaction with the attention received. Copyright © 2012 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

  16. Improving Chronic Disease Self-Management by Older Home Health Patients through Community Health Coaching

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    Cheryl Dye

    2018-04-01

    Full Text Available The purpose of the study was to pilot test a model to reduce hospital readmissions and emergency department use of rural, older adults with chronic diseases discharged from home health services (HHS through the use of volunteers. The study’s priority population consistently experiences poorer health outcomes than their urban counterparts due in part to lower socioeconomic status, reduced access to health services, and incidence of chronic diseases. When they are hospitalized for complications due to poorly managed chronic diseases, they are frequently readmitted for the same conditions. This pilot study examines the use of volunteer community members who were trained as Health Coaches to mentor discharged HHS patients in following the self-care plan developed by their HHS RN; improving chronic disease self-management behaviors; reducing risk of falls, pneumonia, and flu; and accessing community resources. Program participants increased their ability to monitor and track their chronic health conditions, make positive lifestyle changes, and reduce incidents of falls, pneumonia and flu. Although differences in the ED and hospital admission rates after discharge from HHS between the treatment and comparison group (matched for gender, age, and chronic condition were not statistically significant, the treatment group’s rate was less than the comparison group thus suggesting a promising impact of the HC program (90 day: 263 comparison vs. 129 treatment; p = 0.65; 180 day 666.67 vs. 290.32; p = 0.19. The community health coach model offers a potential approach for improving the ability of discharged older home health patients to manage chronic conditions and ultimately reduce emergent care.

  17. Frequent attenders without organic disease in a gastroenterology clinic. Patient characteristics and health care use.

    Science.gov (United States)

    Bass, C; Bond, A; Gill, D; Sharpe, M

    1999-01-01

    We used a hospital computer to identify 50 patients (35 women, 15 men) satisfying research criteria for "frequent attenders" at a gastroenterology outpatient clinic (four or more visits to a general hospital clinic in the previous 12 months). Their mean duration of symptoms was 5 years, and 80% reported fatigue as a significant complaint. Thirteen (37%) of the women were also consulting a gynecologist, and in nine of these their status was normal. Seven (21%) of the 35 women who were interviewed had a history of childhood sexual abuse, and these patients reported significantly more lifetime somatic symptoms (9.7, SD = 3.8) than those without such a history (5.4, SD = 3.5, p = 12 visits over the previous 12 months), and the patients reported a mean number of 5.7 (SD = 2.1) specialist appointments in the previous year. There may be a case for using the hospital computer to identify frequent attenders proactively at an earlier stage of their hospital visits so that appropriate management can be instituted. If such patients can be identified in this way, their assessment and management might be more appropriately supervised in designated clinics by more experienced gastroenterology staff.

  18. Test-retest of computerized health status questionnaires frequently used in the monitoring of knee osteoarthritis

    DEFF Research Database (Denmark)

    Gudbergsen, Henrik; Bartels, Else M.; Krusager, Peter

    2011-01-01

    ABSTRACT: BACKGROUND: To compare data based on touch screen to data based on traditional paper versions of questionnaires frequently used to examine patient reported outcomes in knee osteoarthritis patients and to examine the impact of patient characteristics on this comparison METHODS: Participa......ABSTRACT: BACKGROUND: To compare data based on touch screen to data based on traditional paper versions of questionnaires frequently used to examine patient reported outcomes in knee osteoarthritis patients and to examine the impact of patient characteristics on this comparison METHODS...... subgroups, completing either the paper or touch screen version first. Mean, mean differences (95% CI), median, median differences and Intraclass Correlation Coefficients (ICCs) were calculated for all questionnaires. RESULTS: ICCs between data based on computerized and paper versions ranged from 0.86 to 0.......99. Analysis revealed a statistically significant difference between versions of the ADL Taxonomy, but not for the remaining questionnaires. Age, computer experience or education-level had no significant impact on the results. The computerized questionnaires were reported to be easier to use. CONCLUSION...

  19. Psychiatric status, somatisation, and health care utilization of frequent attenders at the emergency department: a comparison with routine attenders.

    Science.gov (United States)

    Williams, E R; Guthrie, E; Mackway-Jones, K; James, M; Tomenson, B; Eastham, J; McNally, D

    2001-03-01

    Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.

  20. Effect of adrenal medullectomy on metabolic responses to chronic intermittent hypoxia in the frequently sampled intravenous glucose tolerance test.

    Science.gov (United States)

    Shin, Mi-Kyung; Han, Woobum; Joo, Hoon; Bevans-Fonti, Shannon; Shiota, Masakazu; Stefanovski, Darko; Polotsky, Vsevolod Y

    2017-04-01

    Obstructive sleep apnea is associated with type 2 diabetes. We have previously developed a mouse model of intermittent hypoxia (IH) mimicking oxyhemoglobin desaturations in patients with sleep apnea and have shown that IH increases fasting glucose, hepatic glucose output, and plasma catecholamines. We hypothesize that adrenal medulla modulates glucose responses to IH and that such responses can be prevented by adrenal medullectomy. We performed adrenal medullectomy or sham surgery in lean C57BL/6J mice, which were exposed to IH or intermittent air (control) for 4 wk followed by the frequently sampled intravenous glucose tolerance test (FSIVGTT) in unanesthetized unrestrained animals. IH was administered during the 12-h light phase (9 AM to 9 PM) by decreasing inspired oxygen from 21 to 6.5% 60 cycles/h. Insulin sensitivity (S I ), insulin independent glucose disposal [glucose effectiveness (S G )], and the insulin response to glucose (AIR G ) were determined using the minimal model method. In contrast to our previous data obtained in restrained mice, IH did not affect fasting blood glucose and plasma insulin levels in sham-operated mice. IH significantly decreased S G but did not affect S I and AIR G Adrenal medullectomy decreased fasting blood glucose and plasma insulin levels and increased glycogen synthesis in the liver in hypoxic mice but did not have a significant effect on the FSIVGTT metrics. We conclude that, in the absence of restraints, IH has no effect on glucose metabolism in lean mice with exception of decreased S G , whereas adrenal medullectomy decreases fasting glucose and insulin levels in the IH environment. NEW & NOTEWORTHY To our knowledge, this is the first study examining the role of adrenal catecholamines in glucose metabolism during intermittent hypoxia (IH) in unanesthetized unrestrained C57BL/6J mice. We report that IH did not affect fasting glucose and insulin levels nor insulin sensitivity and insulin secretion during, whereas glucose

  1. Health Effects of Chronic Arsenic Exposure

    Directory of Open Access Journals (Sweden)

    Young-Seoub Hong

    2014-09-01

    Full Text Available Arsenic is a unique element with distinct physical characteristics and toxicity whose importance in public health is well recognized. The toxicity of arsenic varies across its different forms. While the carcinogenicity of arsenic has been confirmed, the mechanisms behind the diseases occurring after acute or chronic exposure to arsenic are not well understood. Inorganic arsenic has been confirmed as a human carcinogen that can induce skin, lung, and bladder cancer. There are also reports of its significant association to liver, prostate, and bladder cancer. Recent studies have also suggested a relationship with diabetes, neurological effects, cardiac disorders, and reproductive organs, but further studies are required to confirm these associations. The majority of research to date has examined cancer incidence after a high exposure to high concentrations of arsenic. However, numerous studies have reported various health effects caused by chronic exposure to low concentrations of arsenic. An assessment of the health effects to arsenic exposure has never been performed in the South Korean population; thus, objective estimates of exposure levels are needed. Data should be collected on the biological exposure level for the total arsenic concentration, and individual arsenic concentration by species. In South Korea, we believe that biological exposure assessment should be the first step, followed by regular health effect assessments.

  2. Comorbidities are frequent in patients with gastroesophageal reflux disease in a tertiary health care hospital

    Directory of Open Access Journals (Sweden)

    Joaquim Prado P Moraes-Filho

    2009-01-01

    Full Text Available INTRODUCTION: Several aspects of gastroesophageal reflux disease (GERD have been studied, but the frequency of comorbidities is not yet fully understood. OBJECTIVES: To study the prevalence of GERD comorbidities in a tertiary care hospital. METHODS: We prospectively studied 670 consecutive adult patients from the outpatient department of our facility. A diagnosis was established using clinical, endoscopic and/or pHmetry-related findings. Each patient's medical file was reviewed with respect to the presence of other medical conditions and diagnoses. RESULTS: Of the 670 patients, 459 (68.6% were female, and the mean age was 55.94 (17-80 years. We registered 316 patients (47.1% with the erosive form of GERD and 354 patients (52.9% with the non-erosive form. A total of 1,664 instances of comorbidities were recorded in 586 patients (87.5%, with the most common being arterial hypertension (21%, hypercholesterolemia (9%, obesity (9%, type II diabetes mellitus (5% and depression (4%. Two or more comorbidities were present in 437 individuals (64.8%. The occurrence of comorbidities increased with age and was higher in patients with the non-erosive form of GERD. CONCLUSIONS: In a tertiary referral population, comorbidities were very common, and these may have worsened the already impaired health-related quality of life of these patients. Clinicians caring for GERD patients in this setting must be aware of the likelihood and nature of comorbid disorders and their impact on disease presentation and patient management.

  3. Review series: Examples of chronic care model: the home-based chronic care model: redesigning home health for high quality care delivery.

    Science.gov (United States)

    Suter, Paula; Hennessey, Beth; Florez, Donna; Newton Suter, W

    2011-01-01

    Individuals with chronic obstructive pulmonary disease (COPD) face significant challenges due to frequent distressing dyspnea and deficits related to activities of daily living. Individuals with COPD are often hospitalized frequently for disease exacerbations, negatively impacting quality of life and healthcare expenditure burden. The home-based chronic care model (HBCCM) was designed to address the needs of patients with chronic diseases. This model facilitates the re-design of chronic care delivery within the home health sector by ensuring patient-centered evidence-based care. This HBCCM foundation is Dr. Edward Wagner s chronic care model and has four additional areas of focus: high touch delivery, theory-based self management, specialist oversight and the use of technology. This article will describe this model in detail and outline how model use for patients with COPD can bring value to stakeholders across the health care continuum.

  4. Frequent fliers, school phobias, and the sick student: school health personnel's perceptions of students who refuse school.

    Science.gov (United States)

    Torrens Armstrong, Anna M; McCormack Brown, Kelli R; Brindley, Roger; Coreil, Jeannine; McDermott, Robert J

    2011-09-01

    This study explored school personnel's perceptions of school refusal, as it has been described as a "common educational and public health problem" that is less tolerated due to increasing awareness of the potential socioeconomic consequences of this phenomenon. In-depth interviews were conducted with school personnel at the middle school (N = 42), high school (N = 40), and district levels (N = 10). The findings focus on emergent themes from interviews with school health personnel (N = 12), particularly those themes related to their perceptions of and role in working with school-refusing students. Personnel, especially school health services staff, constructed a typification of the school-refusing student as "the sick student," which conceptualized student refusal due to reasons related to illness. Personnel further delineated sick students by whether they considered the illness legitimate. School health personnel referenced the infamous "frequent fliers" and "school phobics" within this categorization of students. Overarching dynamics of this typification included parental control, parental awareness, student locus of control, blame, and victim status. These typifications influenced how personnel reacted to students they encountered, particularly in deciding which students need "help" versus "discipline," thus presenting implications for students and screening of students. Overall, findings suggest school health personnel play a pivotal role in screening students who are refusing school as well as keeping students in school, underscoring policy that supports an increased presence of school health personnel. Recommendations for school health, prevention, and early intervention include the development of screening protocols and staff training. © 2011, American School Health Association.

  5. Chronic-disease patients and their use of out-of-hours primary health care

    DEFF Research Database (Denmark)

    Flarup, Lone; Moth, Grete; Christensen, Morten Bondo

    2014-01-01

    that patients with chronic diseases are frequent users of out-of-hours primary care services (OOH), but knowledge is limited on reasons for encounter (RFE), severity of symptoms, and OOH patient handling. We aimed to describe contacts to the OOH services from patients with chronic heart disease, lung disease...... in the Central Denmark Region. A cohort of patients with one or more of the five selected chronic diseases were identified by linking data on the Danish civil registration number (CPR) through specific nationwide Danish health registers. Results Out of 13,930 identified unique patients, 4,912 had at least one...

  6. Theory in Chronic Disease Prevention and Health Promotion

    Science.gov (United States)

    Hall, Michael; Elise, Eifert

    2016-01-01

    Morbidity and mortality related to chronic diseases are a primary concern of health professionals, including Health Educators. According to the Centers for Disease Control and Prevention, over one half of the adult population in the United States suffer from one or more chronic conditions. Understanding the health risk behaviors that contribute to…

  7. Health Technologies for the Improvement of Chronic Disease Management

    Science.gov (United States)

    Nikitovic, M; Brener, S

    2013-01-01

    Background As part of ongoing efforts to improve the Ontario health care system, a mega-analysis examining the optimization of chronic disease management in the community was conducted by Evidence Development and Standards, Health Quality Ontario (previously known as the Medical Advisory Secretariat [MAS]). Objective The purpose of this report was to identify health technologies previously evaluated by MAS that may be leveraged in efforts to optimize chronic disease management in the community. Data Sources The Ontario Health Technology Assessment Series and field evaluations conducted by MAS and its partners between January 1, 2006, and December 31, 2011. Review Methods Technologies related to at least 1 of 7 disease areas of interest (type 2 diabetes, coronary artery disease, atrial fibrillation, chronic obstructive pulmonary disease, congestive heart failure, stroke, and chronic wounds) or that may greatly impact health services utilization were reviewed. Only technologies with a moderate to high quality of evidence and associated with a clinically or statistically significant improvement in disease management were included. Technologies related to other topics in the mega-analysis on chronic disease management were excluded. Evidence-based analyses were reviewed, and outcomes of interest were extracted. Outcomes of interest included hospital utilization, mortality, health-related quality of life, disease-specific measures, and economic analysis measures. Results Eleven analyses were included and summarized. Technologies fell into 3 categories: those with evidence for the cure of chronic disease, those with evidence for the prevention of chronic disease, and those with evidence for the management of chronic disease. Conclusions The impact on patient outcomes and hospitalization rates of new health technologies in chronic disease management is often overlooked. This analysis demonstrates that health technologies can reduce the burden of illness; improve patient

  8. An exploratory study of the health harms and utilisation of health services of frequent legal high users under the interim regulated legal high market in central Auckland.

    Science.gov (United States)

    Wilkins, Chris; Prasad, Jitesh; Wong, K C; Rychert, Marta; Graydon-Guy, Thomas

    2016-03-11

    To explore health problems and the accessing of health services by frequent legal high users under an interim regulated legal market in central Auckland. Frequent legal high users (monthly+) were recruited from outside eight randomly-selected, licensed, legal high stores in central Auckland from 23 April-7 May, 2014. Eligible participants were emailed a unique invitation to complete an on-line survey; 105 completed the survey. Twenty-seven percent had suffered mental illness during their lifetimes. Eighty percent used synthetic cannabinoids (SC), and 20% 'party pills'. Forty-seven percent of SC users used daily or more often. Other drugs used included alcohol (80%), cannabis (59%), 'ecstasy' (18%) and methamphetamine (15%). Fifty-eight percent of SC users were classified as SC dependent. The most common problems reported from SC use were: insomnia (29%); 'vomiting/nausea' (25%); 'short temper/agitation' (21%); 'anxiety' (21%); 'strange thoughts' (16%); and 'heart palpitations' (14%). The health services most commonly accessed by SC users were: a 'doctor/GP' (9%); 'counsellor' (9%); 'DrugHelp/MethHelp' websites (7%); 'Alcohol & Drug Helpline' (4%); 'ambulance' (3%); 'A&E' (3%); and hospitalisation (3%). Frequent use of interim licensed SC products was associated with health problems, including dependency. Further research is required to determine the health risks of these products.

  9. Longitudinal interrelationships between frequent geographic relocation and personality development: results from the Amsterdam Growth and Health Longitudinal Study.

    Science.gov (United States)

    Lin, Kuan-Chia; Twisk, Jos W R; Rong, Jiin-Ru

    2011-04-01

    This study is part of the Amsterdam Growth and Health Longitudinal Study, which was undertaken to assess the long-term interrelationships between cumulative frequency of geographic relocation (CFGR) and the development of personality characteristics (i.e., Inadequacy, Rigidity, Social Inadequacy, Dominance, Self-sufficiency, Self-esteem, and Hostility). We found that participants who had more mobility experiences had lower consistency in their personality characteristics (the exception being Rigidity). Residential mobility from different life stages was positively associated with the continuity and change of Inadequacy and Dominance. In addition, young adults with higher Rigidity personality experienced fewer geographic moves during the transition from young adulthood to mid-life. Our study provides evidence that CFGR in different life stages may be associated with the development of personality characteristics from young adulthood to mid-life in different ways. Increased awareness of the potential interrelationships between frequent geographic relocation and personality development may have positive consequences for adult psychological health. © 2011 American Orthopsychiatric Association.

  10. Correlation of digital health use and chronic pain coping strategies.

    Science.gov (United States)

    Ranney, Megan L; Duarte, Cassandra; Baird, Janette; Patry, Emily J; Green, Traci C

    2016-01-01

    Digital health is an increasingly popular tool for patient engagement, having shown great success in arenas such as medication adherence, management of chronic conditions, and patient safety. Given the growth of chronic pain diagnoses, it is imperative to find new technologies to improve care for this particular population. Little research has catalogued the use of digital health in the chronic pain patient population. This manuscript's objective was to describe current patterns of digital health usage among chronic pain patients and how digital health use correlates with health care utilization and health outcomes. A cross-sectional survey was administered to patients with a self-identified chronic pain diagnosis participating in 'Patients Like Me' ® (PLM), an organization that directly collects data from patients experiencing chronic health conditions, with emphasis on patient-centered outcomes and experiences interacting with the health care system. Validated measures of healthcare utilization, chronic pain management, and digital health use were adapted for the survey. Digital health was defined as the use of online sites, social media, and mobile phone applications before, during, or after healthcare utilization. Descriptive statistics, chi square tests, logistic regression, and linear regression were used as appropriate for analysis. Among 565 respondents (mean age 51.3, 87.2% female, 45.7% publicly insured), most participants (89.5%) reported some digital health use. Females and users below the age of 50 were more likely to use multiple forms of digital health. Healthcare utilization, education level, and race/ethnicity did not correlate with digital health use. Patients using more types of digital health reported significantly higher levels of pain coping skills in the realms of social support, relaxation, and exercise. Digital health use is common among a wide range of patients with chronic pain diagnoses. The use of multiple forms of digital health is

  11. Focus Group Study Exploring Factors Related to Frequent Sickness Absence.

    Science.gov (United States)

    Notenbomer, Annette; Roelen, Corné A M; van Rhenen, Willem; Groothoff, Johan W

    2016-01-01

    Research investigating frequent sickness absence (3 or more episodes per year) is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves. We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R) model as theoretical framework. Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills) were regarded as solutions to reduce frequent sickness absence. The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance.

  12. Chronic Childhood Trauma, Mental Health, Academic Achievement, and School-Based Health Center Mental Health Services

    Science.gov (United States)

    Larson, Satu; Chapman, Susan; Spetz, Joanne; Brindis, Claire D.

    2017-01-01

    Background: Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers…

  13. Health Care Utilization and Costs Associated with Pediatric Chronic Pain.

    Science.gov (United States)

    Tumin, Dmitry; Drees, David; Miller, Rebecca; Wrona, Sharon; Hayes, Don; Tobias, Joseph D; Bhalla, Tarun

    2018-03-30

    The population prevalence of pediatric chronic pain is not well characterized, in part due to lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0-17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. On multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (OR=2.01, 95% CI: 1.62, 2.47; pcomplementary and alternative medicine (OR=2.32, 95% CI: 1.79, 3.03; pchronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use. Copyright © 2018. Published by Elsevier Inc.

  14. Blood borne viral infections among Danish Health Care Workers - frequent blood exposure but low prevalence of infection

    International Nuclear Information System (INIS)

    Fisker, Niels; Mygind, Lone H.; Krarup, Henrik B.; Licht, Dorthe; Georgsen, Jorgen; Christensen, Peer B.

    2004-01-01

    Denmark is a country with low prevalence and incidence of blood borne viral infections. Among health care workers (HCWs) vaccination for hepatitis B is only offered to high-risk groups. The aims of this cross sectional survey were to determine the prevalence of hepatitis B, -C, and human immunodeficiency virus (HIV) among the staff at a Danish University hospital and to correlate this with risk factors for transmission. Additionally, we wanted to examine the current frequency of blood exposure, reporting habits and hepatitis B vaccination status in the staff. Of 1439 eligible hospital staffs included, 960 (67%) were HCWs. The overall human immunodeficiency virus (HIV)-, hepatitis C Virus (HCV)- and hepatitis B Virus (HBV)-prevalence was 0% (0/1439), 0.14% (2/1439) and 1.6% (23/1439), respectively. Twenty-three percent of HCWs were vaccinated against HBV. Age, blood transfusion and stay in endemic areas were associated independently to HBV infection as opposed to job-category, duration of employment, HBV vaccination status and blood exposure. Based on a 4-week recall period, the incidence of percutaneous blood exposure was 1.5/person-year. In conclusion the HIV and hepatitis prevalence was low despite frequent blood exposure and the principal risk factors were unrelated to work. Danish HCWs do not seem to be at increased risk of hepatitis B even though universal HBV vaccination has not been implemented

  15. Chronic Childhood Trauma, Mental Health, Academic Achievement, and School-Based Health Center Mental Health Services

    OpenAIRE

    Larson, S; Chapman, S; Spetz, J; Brindis, CD

    2017-01-01

    Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities.Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if rese...

  16. Multiple chronic health conditions and their link with wealth assets.

    Science.gov (United States)

    Schofield, Deborah J; Callander, Emily J; Shrestha, Rupendra N; Passey, Megan E; Kelly, Simon J; Percival, Richard

    2015-04-01

    There has been little research on the economic status of those with multiple health conditions, particularly on the relationship between multiple health conditions and wealth. This paper will assess the difference in the value and type of wealth assets held by Australians who have multiple chronic health conditions. Using Health&WealthMOD, a microsimulation model of the 45-64-year-old Australian population in 2009, a counterfactual analysis was undertaken. The actual proportion of people with different numbers of chronic health conditions with any wealth, and the value of this wealth was estimated. This was compared with the counterfactual values had the individuals had no chronic health conditions. There was no change in the proportion of people with one health condition who actually had any wealth, compared to the counterfactual proportion had they had no chronic health conditions. Ninety-four percent of those with four or more health conditions had some accumulated wealth; however, under the counterfactual, 100% would have had some accumulated wealth. There was little change in the value of non-income-producing assets under the counterfactual, regardless of number of health conditions. Those with four or more chronic health conditions had a mean value of $17 000 in income-producing assets; under the counterfactual, the average would have been $78 000. This study has highlighted the variation in the value of wealth according to number of chronic health conditions, and hence the importance of considering multiple morbidities when discussing the relationship between health and wealth. © The Author 2014. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  17. Health-related behavior, profile of health locus of control and acceptance of illness in patients suffering from chronic somatic diseases.

    Directory of Open Access Journals (Sweden)

    Konrad Janowski

    Full Text Available PURPOSE: The purpose of the study was to determine health-related behaviors, profile of health locus of control (HLC, and to assess the relationships between these constructs among patients suffering from chronic somatic diseases. MATERIAL AND METHODS: Three-hundred adult patients suffering from various chronic diseases participated in the study. The patients' mean age was 54.6 years (SD = 17.57. RESULTS: No statistically significant differences were found between the different clinical groups in health-related behavior, acceptance of illness, internal HLC or chance HLC. Patients with neurologic conditions showed slightly lower powerful others HLC than did some other clinical groups. Health-related behavior was significantly positively related to all three categories of HLC, with most prominent associations observed with powerful others HLC. Only one type of health-related behavior--preventive behavior--correlated significantly and negatively with acceptance of illness. Differences in the frequency of health-related behavior were also found due to gender (women showing more healthy nutritional habits than men, age (older subjects showing more frequent health-promoting behavior, education (higher education was associated with less frequent health-promoting behavior and marital status (widowed subjects reporting more frequent health-promoting behavior. CONCLUSIONS: Health-related behavior in patients with chronic diseases seems to be unrelated to a specific diagnosis; however it shows associations with both internal and external HLC. Sociodemographic factors are also crucial factors determining frequency of health-related behavior in such patients.

  18. Health information technology: transforming chronic disease management and care transitions.

    Science.gov (United States)

    Rao, Shaline; Brammer, Craig; McKethan, Aaron; Buntin, Melinda B

    2012-06-01

    Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety. Copyright © 2012 Elsevier Inc. All rights reserved.

  19. Chronic health conditions and school performance among children and youth.

    Science.gov (United States)

    Crump, Casey; Rivera, Diana; London, Rebecca; Landau, Melinda; Erlendson, Bill; Rodriguez, Eunice

    2013-04-01

    Chronic health conditions are common and increasing among U.S. children and youth. We examined whether chronic health conditions are associated with low school performance. This retrospective cohort study of 22,730 children and youth (grades 2-11) in San Jose, California, was conducted from 2007 through 2010. Health conditions were defined as chronic if reported in each of the first 2 years, and school performance was measured using standardized English language arts (ELA) and math assessments. Chronic health conditions were independently associated with low ELA and math performance, irrespective of ethnicity, socioeconomic status, or grade level. Adjusted odds ratios for the association between any chronic health condition and low ("basic or below") performance were 1.25 (95% confidence interval [CI], 1.16-1.36; P absenteeism had little effect on these results. The strongest associations were found for ADHD, autism, and seizure disorders, whereas a weak association was found for asthma before but not after adjusting for absenteeism, and no associations were found for cardiovascular disorders or diabetes. Chronic neurodevelopmental and seizure disorders, but not cardiovascular disorders or diabetes, were independently associated with low school performance among children and youth. Copyright © 2013 Elsevier Inc. All rights reserved.

  20. Chronic Health Conditions Managed by School Nurses. Position Statement. Revised

    Science.gov (United States)

    Morgitan, Judith; Bushmiaer, Margo; DeSisto, Marie C.; Duff, Carolyn; Lambert, C. Patrice; Murphy, M. Kathleen; Roland, Sharon; Selser, Kendra; Wyckoff, Leah; White, Kelly

    2012-01-01

    It is the position of the National Association of School Nurses that students with chronic health conditions have access to a full-time registered professional school nurse (hereinafter referred to as school nurse). School districts should include school nurse positions in their full-time instructional support personnel to provide health services…

  1. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study.

    Directory of Open Access Journals (Sweden)

    Jung Hoon Woo

    Full Text Available The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1% were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p < 0.001 for each. Moreover, frequent ED users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED.

  2. Sexual health communication between cancer survivors and providers: how frequently does it occur and which providers are preferred?

    Science.gov (United States)

    Sporn, Nora J; Smith, Kelly B; Pirl, William F; Lennes, Inga T; Hyland, Kelly A; Park, Elyse R

    2015-09-01

    Sexual health concerns in cancer survivors are often unaddressed by providers. Study objectives were to assess cancer survivors' reported rates of communication with oncology providers about sexual health, preference for such communication with their oncology or primary care providers (PCPs), and factors associated with these communication rates and preferences. Sixty-six patients attending a cancer survivorship clinic were asked how often their oncologist addressed and initiated discussion about sexual functioning and whether they wanted their oncologist or PCP to ask about their sexual health. We also assessed whether various sociodemographic characteristics and levels of depression, anxiety, and sexual satisfaction were associated with survivors' sexual health communication rates and preferences. 41% of patients wanted their oncologist to ask about sexual health and 58% of patients wanted their PCP to ask about sexual health. Over 90% of patients reported that their oncologist infrequently addressed sexual health concerns and that their oncologist was unlikely to initiate such discussions. Education level influenced whether patients wanted their oncologist to ask about sexual health. Age, education level, and insurance type influenced whether patients wanted their PCP to ask about sexual health. Levels of depression, anxiety, and sexual satisfaction were not associated with communication rates or preferences. Patients attending a survivorship clinic reported infrequent communication about sexual health with their oncology providers, despite wanting their providers to ask about sexual health concerns. Copyright © 2014 John Wiley & Sons, Ltd.

  3. Frequent Users of Hospital Emergency Departments in Korea Characterized by Claims Data from the National Health Insurance: A Cross Sectional Study

    Science.gov (United States)

    Woo, Jung Hoon; Grinspan, Zachary; Shapiro, Jason; Rhee, Sang Youl

    2016-01-01

    The Korean National Health Insurance, which provides universal coverage for the entire Korean population, is now facing financial instability. Frequent emergency department (ED) users may represent a medically vulnerable population who could benefit from interventions that both improve care and lower costs. To understand the nature of frequent ED users in Korea, we analyzed claims data from a population-based national representative sample. We performed both bivariate and multivariable analyses to investigate the association between patient characteristics and frequent ED use (4+ ED visits in a year) using claims data of a 1% random sample of the Korean population, collected in 2009. Among 156,246 total ED users, 4,835 (3.1%) were frequent ED users. These patients accounted for 14% of 209,326 total ED visits and 17.2% of $76,253,784 total medical expenses generated from all ED visits in the 1% data sample. Frequent ED users tended to be older, male, and of lower socio-economic status compared with occasional ED users (p users had longer stays in the hospital when admitted, higher probability of undergoing an operative procedure, and increased mortality. Among 8,425 primary diagnoses, alcohol-related complaints and schizophrenia showed the strongest positive correlation with the number of ED visits. Among the frequent ED users, mortality and annual outpatient department visits were significantly lower in the alcohol-related patient subgroup compared with other frequent ED users; furthermore, the rate was even lower than that for non-frequent ED users. Our findings suggest that expanding mental health and alcohol treatment programs may be a reasonable strategy to decrease the dependence of these patients on the ED. PMID:26809051

  4. Understanding stigma in chronic health conditions: implications for nursing.

    Science.gov (United States)

    Engebretson, Joan

    2013-10-01

    This article explores the social processes in stigmatization and the theoretical background on the impact in chronic illness. Review of literature from social sciences and applications to health issues. Understanding the social utility of stigmatization in preserving social cohesion and protecting the social order is an important function. However, this process can be harmful when applied to persons with chronic illness, such as HIV-AIDS, and psychiatric illness. These individuals often become shamed, ostracized, isolated, discredited, and socially and economically marginalized. Recent theoretical work on stigma has identified several issues and patient responses that may have implications in many other chronic conditions. Stigma is based on visible or nonvisible health conditions and can be both externally imposed or perceived in a process of self-stigma. Understanding stigma can aid clinicians in providing supportive help for patients with chronic illness. Stigma has been well researched in a few chronic illnesses; however, future studies in other conditions are much needed. Recognizing the underlying social factors has potential use in health-promoting behaviors. Sensitivity to stigma allows health professionals to critically reflect on ways the healthcare environment may add to stigma for their patients. ©2013 The Author(s) ©2013 American Association of Nurse Practitioners.

  5. Most frequent emotional states in convalescent patients of myocardial infarction and its relationship to cardiovascular health state

    Directory of Open Access Journals (Sweden)

    María C. García Martín

    2016-03-01

    Conclusions: There was a predominance of partially offset somatic state of health. High levels of anxiety and depression states were identified and it was found the existence of an important relation between anxiety-depression emotional states, and the somatic state of health relating to the cardiovascular system in patients convalescent from myocardial infarction.

  6. Open source electronic health records and chronic disease management.

    Science.gov (United States)

    Goldwater, Jason C; Kwon, Nancy J; Nathanson, Ashley; Muckle, Alison E; Brown, Alexa; Cornejo, Kerri

    2014-02-01

    To study and report on the use of open source electronic health records (EHR) to assist with chronic care management within safety net medical settings, such as community health centers (CHC). The study was conducted by NORC at the University of Chicago from April to September 2010. The NORC team undertook a comprehensive environmental scan, including a literature review, a dozen key informant interviews using a semistructured protocol, and a series of site visits to CHC that currently use an open source EHR. Two of the sites chosen by NORC were actively using an open source EHR to assist in the redesign of their care delivery system to support more effective chronic disease management. This included incorporating the chronic care model into an CHC and using the EHR to help facilitate its elements, such as care teams for patients, in addition to maintaining health records on indigent populations, such as tuberculosis status on homeless patients. The ability to modify the open-source EHR to adapt to the CHC environment and leverage the ecosystem of providers and users to assist in this process provided significant advantages in chronic care management. Improvements in diabetes management, controlled hypertension and increases in tuberculosis vaccinations were assisted through the use of these open source systems. The flexibility and adaptability of open source EHR demonstrated its utility and viability in the provision of necessary and needed chronic disease care among populations served by CHC.

  7. Chronic pain among patients with opioid use disorder: Results from electronic health records data.

    Science.gov (United States)

    Hser, Yih-Ing; Mooney, Larissa J; Saxon, Andrew J; Miotto, Karen; Bell, Douglas S; Huang, David

    2017-06-01

    To examine the prevalence of comorbid chronic pain among patients with opioid use disorder (OUD) and to compare other comorbidities (substance use disorder (SUD), mental health disorders, health/disease conditions) among patients in four categories: no chronic pain (No Pain), OUD prior to pain (OUD First), OUD and pain at the same time (Same Time), or pain condition prior to OUD (Pain First). Using an electronic health record (EHR) database from 2006-2015, the study assessed 5307 adult patients with OUD in a large healthcare system; 35.6% were No Pain, 9.7% were OUD First, 14.9% were Same Time, and 39.8% were Pain First. Most OUD patients (64.4%) had chronic pain conditions, and among them 61.8% had chronic pain before their first OUD diagnosis. Other SUDs occurred more frequently among OUD First patients than among other groups in terms of alcohol (33.4% vs. 25.4% for No Pain, 20.7% for Same Time, and 20.3% for Pain First), cocaine (19.0%, vs. 13.8%, 9.4%, 7.1%), and alcohol or drug-induced disorders. OUD First patients also had the highest rates of HIV (4.7%) and hepatitis C virus (HCV; 28.2%) among the four groups. Pain First patients had the highest rates of mental disorder (81.7%), heart disease (72.0%), respiratory disease (68.4%), sleep disorder (41.8%), cancer (23.4%), and diabetes (19.3%). The alarming high rates of chronic pain conditions occurring before OUD and the associated severe mental health and physical health conditions require better models of assessment and coordinated care plans to address these complex medical conditions. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents.

    Directory of Open Access Journals (Sweden)

    Soffia M Hrafnkelsdottir

    Full Text Available Few studies have explored the potential interrelated associations of screen time and physical activity with mental health in youth, particularly using objective methods. We examined cross-sectional associations of these variables among Icelandic adolescents, using objective and subjective measurements of physical activity.Data were collected in the spring of 2015 from 315 tenth grade students (mean age 15.8 years in six elementary schools in metropolitan Reykjavík, Iceland. Participants reported, via questionnaire, on demographics, weekly frequency of vigorous physical activity, daily hours of screen time and mental health status (symptoms of depression, anxiety and somatic complaints, self-esteem and life satisfaction. Total physical activity was measured over one week with wrist-worn accelerometers. Body composition was determined by DXA-scanning. Poisson regression analysis was used to explore independent and interactive associations of screen time and physical activity with mental health variables, adjusting for gender, body fat percentage and maternal education.Less screen time (below the group median of 5.3 h/day and more frequent vigorous physical activity (≥4x/week were each associated with reporting fewer symptoms of depression, anxiety, low self-esteem, and life dissatisfaction. No significant associations were observed between objectively measured physical activity and mental health outcomes. Interactive regression analysis showed that the group reporting both less screen time and more frequent vigorous physical activity had the lowest risk of reporting symptoms of depression, anxiety, low self-esteem, and life dissatisfaction.Reports of less screen time and more frequent vigorous physical activity were associated with lower risk of reporting mental health problems among Icelandic adolescents. Those who reported a combination of engaging in less screen time and more frequent vigorous physical activity had the lowest risk

  9. Focus Group Study Exploring Factors Related to Frequent Sickness Absence.

    Directory of Open Access Journals (Sweden)

    Annette Notenbomer

    Full Text Available Research investigating frequent sickness absence (3 or more episodes per year is scarce and qualitative research from the perspective of frequent absentees themselves is lacking. The aim of the current study is to explore awareness, determinants of and solutions to frequent sickness absence from the perspective of frequent absentees themselves.We performed a qualitative study of 3 focus group discussions involving a total of 15 frequent absentees. Focus group discussions were audiotaped and transcribed verbatim. Results were analyzed with the Graneheim method using the Job Demands Resources (JD-R model as theoretical framework.Many participants were not aware of their frequent sickness absence and the risk of future long-term sickness absence. As determinants, participants mentioned job demands, job resources, home demands, poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Managing these factors and improving communication (skills were regarded as solutions to reduce frequent sickness absence.The JD-R model provided a framework for determinants of and solutions to frequent sickness absence. Additional determinants were poor health, chronic illness, unhealthy lifestyles, and diminished feeling of responsibility to attend work in cases of low job resources. Frequent sickness absence should be regarded as a signal that something is wrong. Managers, supervisors, and occupational health care providers should advise and support frequent absentees to accommodate job demands, increase both job and personal resources, and improve health rather than express disapproval of frequent sickness absence and apply pressure regarding work attendance.

  10. Chronic diseases risk factors and access to health exams among ...

    African Journals Online (AJOL)

    Using data from the World Health Survey (WHS) carried out in South Africa in 2003, the aim of this study is to establish chronic diseases risk factors and access to preventive exams for cervical and breast cancer among South African women. The sample included in this analysis included 1236 women 18 years and above.

  11. Children with disabling chronic conditions in the Western health ...

    African Journals Online (AJOL)

    Background. Children with disabling chronic conditions often have extensive, complex and unmet healthcare and educational needs. ... such children that access specialist health and special educational services, particularly in an urban setting, and what services exist for them. ..... Kromberg J, Zwane E, Manga P, et al.

  12. Reproductive health in young male adults with chronic diseases in childhood.

    Science.gov (United States)

    De Sanctis, Vincenzo; Soliman, Ashraf; Mohamed, Yassin

    2013-01-01

    The Centres for Disease Control and Prevention have defined a chronic diseases as an "illnesses that are prolonged, do not resolve spontaneously, and are rarely cured completely". Approximately 20% of all children have a chronic illness and 65% of them the illness is severe enough to interfere with daily activities. Failure of pubertal growth, delay or absence of sexual development, infertility and sexual dysfunction due to hypogonadism and defective spermatogenesis are well recognized disturbances among adolescents and young male adult patients with chronic diseases. The causes are multifactorial and can be due to disease itself, associated complications or drugs. Haemoglobinopathies, endocrine disorders, gastrointestinal and renal diseases are some examples that frequently cause some degree of disability. Infertility affects the future quality of life of these patients and is a predictor of stress in current and future relationships. Health care providers often neglect the reproductive health of chronically ill adolescents and young adults, although many studies indicate that they are sexually active and interested in knowing about their future fertility. This review article provides an overview of the literature concerning the impact of some chronic diseases in adolescents and young adults on reproductive health but will not address patients with cancer because it has been tackled adequately in the literature.MEDLINE database search of English-language medical journal articles published between 1975 and 2012 for papers related to reproductive health in adolescents and young adults with chronic diseases since childhood was done. Several Authors, recommend that all young adult patients with severe/prolonged chronic disease in childhood should be offered reproductive health care in a specialized center with appropriate expertise, involving a multidisciplinary team, including endocrinologists, andrologists, geneticists, psychologists, urologists and specialist

  13. Frequent Fliers, School Phobias, and the Sick Student: School Health Personnel's Perceptions of Students Who Refuse School

    Science.gov (United States)

    Torrens Armstrong, Anna M.; McCormack Brown, Kelli R.; Brindley, Roger; Coreil, Jeannine; McDermott, Robert J.

    2011-01-01

    Background: This study explored school personnel's perceptions of school refusal, as it has been described as a "common educational and public health problem" that is less tolerated due to increasing awareness of the potential socioeconomic consequences of this phenomenon. Methods: In-depth interviews were conducted with school personnel…

  14. Health effect of chronic exposure to carbon disulfide (CS 2 on women employed in viscose industry

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    Krzysztof Sieja

    2018-05-01

    Full Text Available Many women are exposed to carbon disulfide (CS 2 hazards at work every day. Working with CS 2 may cause some women to experience abnormalities in their reproductive health. Until now obtained data is generally concentrated on the health effects of CS 2 observed in the viscose industry. To date, CS 2 has not been studied precisely for its potential to have damaging effects on female reproductive system, especially the frequency of menstrual disturbances and the course of menopause. The aim of the study was to sum up female reproductive health hazards amongst women chronically exposed to CS 2 in their workplace in the viscose industry. In order to study the effect of CS 2 in the contemporary viscose industry, exposure measurements should be collected in prospective or cross-sectional studies. In conclusion, reproductive health hazards for women chronically exposed to CS 2 in the workplace in the viscose industry are the following: 1 menstrual disorders essentially are more frequent than in the case of the healthy women, 2 for women chronically exposed to CS 2 the average menopausal age is statistically earlier, as compared to healthy women, 3 complex disturbances in neurohormonal system for women exposed to CS 2 , resulting from toxic influences of CS 2 , which cause the secretion of estrogens and progesterone in ovaries and dehydroepiandrosterone sulfate in the adrenal gland to diminish. Med Pr 2018;69(3:329–335

  15. Frequent binge drinking five to six years after exposure to 9/11: Findings from the World Trade Center Health Registry

    Science.gov (United States)

    Welch, Alice E.; Caramanica, Kimberly; Maslow, Carey B.; Cone, James E.; Farfel, Mark R.; Keyes, Katherine M.; Stellman, Steven D.; Hasin, Deborah S.

    2014-01-01

    Background Exposure to 9/11 may have considerable long-term impact on health behaviors, including increased alcohol consumption. We examined the association between frequent binge drinking, posttraumatic stress disorder (PTSD), and number of 9/11-specific experiences among World Trade Center Health Registry (Registry) enrollees five-to-six years after 9/11. Methods Participants included 41,284 lower Manhattan residents, workers, passers-by, and rescue/recovery workers aged 18 or older without a pre-9/11 PTSD diagnosis who completed Wave 1 (2003–2004) and Wave 2 (2006–2007) interviews. Frequent binge drinking was defined as consuming five or more drinks on five or more occasions in the prior 30 days at Wave 2. Probable PTSD was defined as scoring 44 or greater on the PTSD Checklist. 9/11 exposure was measured as the sum of 12 experiences and grouped as none/low (0–1), medium (2–3), high (4–5) and very high (6+). Results Frequent binge drinking was significantly associated with increasing 9/11 exposure and PTSD. Those with very high and high exposures had a higher prevalence of frequent binge drinking (13.7% and 9.8%, respectively) than those with medium and low exposures (7.5% and 4.4%, respectively). Upon stratification, very high and high exposures were associated with frequent binge drinking in both the PTSD and no PTSD subgroups. Conclusions Our findings suggest that 9/11 exposure had an impact on frequent binge drinking five-to-six years later among Registry enrollees. Understanding the effects of traumatic exposure on alcohol use is important to identify risk factors for post-disaster alcohol misuse, inform policy, and improve post-disaster psychological and alcohol screening and counseling. PMID:24831753

  16. Public Health Burden of Chronic Stress in a Transforming Society

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    Mária S. Kopp

    2007-12-01

    Full Text Available In this paper chronic stress is proposed as an integrating model that can be applied to the explanation of the suddenly changing patterns of premature mortality rates in transforming societies of Central-Eastern-Europe, especially in Hungary. The temporal factor in existing stress models is often neglected. Chronic stress has been shown to lead to typical pathogenetic results in animal experiments. Literature and the different models in the field of psychology, behavioural sciences, and epidemiology are reviewed in terms of the chronic stress theory. There are several conceptual bridges between psychological alterations and the risks, onset and prognosis of chronic disorders of great epidemiological significance. Depending on the field of research there are several parallel concepts which analyse practically the same phenomena. These are the stress theories in physiology, learned helplessness and control theory in psychology, depression research in psychiatry, the concept of vital exhaustion and the psychosocial risk research in sociology. Because chronic stress results in adverse health effects through biological, social and behavioural pathways, this theory might also havethe best explanatory power to understand the premature male morbidity and mortality crisis in Central and Eastern Europe in the last decades. The special features of premature mortality and morbidity crisis in Hungary might be regarded as an experimental model to understand better the human consequences of chronic stress and those processes where psychology meets physiology.

  17. Family physician-patient relationship and frequent attendance of primary and specialist health care: Results from a German population-based cohort study.

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    Dinkel, Andreas; Schneider, Antonius; Schmutzer, Gabriele; Brähler, Elmar; Häuser, Winfried

    2016-07-01

    To investigate the association between the quality of the family physician-patient relationship and frequent attendance of primary and specialist health care. Cross-sectional survey of a representative German population sample (N=2.266). Family physician-patient relationship was assessed with the Patient Doctor Relationship Questionnaire (PDRQ-9). Determinants of frequent attendance were analyzed using logistic regression. Frequent attendance of family physicians was associated with lower income (OR 1.43, 95% CI 1.02-2.00), not being in paid work (OR 1.58, CI 1.08-2.30), psychological distress (OR 1.14, CI 1.07-1.22), somatic symptoms (OR 1.07, CI 1.04-1.11), and physical comorbidity (OR 1.54, CI 1.36-1.74) in the multivariate analysis. Frequent attendance of specialists was related to psychological distress (OR 1.12, CI 1.04-1.20), somatic symptoms (OR 1.08, CI 1.04-1.11), and physical comorbidity (OR 1.69, CI 1.48-1.93) in the multivariate analysis. Quality of the relationship was associated with frequent attendance only in the univariate analyses. A stronger relationship with the family physician was not associated with reduced contact with specialists. The quality of the family physician-patient relationship is not independently associated with frequent attendance. Family physicians should be aware that need factors, i.e. symptom burden and physical comorbidities, are main drivers of frequent attendance. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  18. Tricyclic and Tetracyclic Antidepressants for the Prevention of Frequent Episodic or Chronic Tension-Type Headache in Adults: A Systematic Review and Meta-Analysis.

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    Jackson, Jeffrey L; Mancuso, Josephine M; Nickoloff, Sarah; Bernstein, Rebecca; Kay, Cynthia

    2017-12-01

    Tension-type headaches are a common source of pain and suffering. Our purpose was to assess the efficacy of tricyclic (TCA) and tetracyclic antidepressants in the prophylactic treatment of tension-type headache. We searched the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the ISI Web of Science, and clinical trial registries through 11 March 2017 for randomized controlled studies of TCA or tetracyclic antidepressants in the prevention of tension-type headache in adults. Data were pooled using a random effects approach. Among 22 randomized controlled trials, eight included a placebo comparison and 19 compared at least two active treatments. Eight studies compared TCAs to placebo, four compared TCAs to selective serotonin reuptake inhibitors (SSRIs), and two trials compared TCAs to behavioral therapies. Two trials compared tetracyclics to placebo. Single trials compared TCAs to tetracyclics, buspirone, spinal manipulation, transcutaneous electrical stimulation, massage, and intra-oral orthotics. High-quality evidence suggests that TCAs were superior to placebo in reducing headache frequency (weighted mean differences (WMD): -4.8 headaches/month, 95% CI: -6.63 to -2.95) and number of analgesic medications consumed (WMD: -21.0 doses/month, 95% CI: -38.2 to -3.8). TCAs were more effective than SSRIs. Low-quality studies suggest that TCAs are superior to buspirone, but equivalent to behavioral therapy, spinal manipulation, intra-oral orthotics, and massage. Tetracyclics were no better than placebo for chronic tension-type headache. Tricyclic antidepressants are modestly effective in reducing chronic tension-type headache and are superior to buspirone. In limited studies, tetracyclics appear to be ineffective in the prophylactic treatment of chronic tension-type headache.

  19. The association of generalized anxiety disorder and Somatic Symptoms with frequent attendance to health care services: A cross-sectional study from the Northern Finland Birth Cohort 1966.

    Science.gov (United States)

    Kujanpää, Tero S; Jokelainen, Jari; Auvinen, Juha P; Timonen, Markku J

    2017-03-01

    Objective Generalized anxiety disorder is associated with higher rate of physical comorbities, unexplained symptoms, and health care utilization. However, the role of somatic symptoms in determining health care utilization is unclear. The present study aims to assess the association of frequent attendance of health care services between generalized anxiety disorder symptoms and somatic symptoms. Method This study was conducted cross-sectionally using the material of the 46-year follow-up survey of the Northern Finland Birth Cohort 1966. Altogether, 5585 cohort members responded to the questionnaires concerning health care utilization, illness history, physical symptoms, and generalized anxiety disorder-7 screening tool. Odds ratios belonging to the highest decile in health care utilization were calculated for generalized anxiety disorder symptoms and all (n = 4) somatic symptoms of Hopkins Symptom Checklist-25 controlled for confounding factors. Results Adjusted Odds ratios for being frequent attender of health care services were 2.29 (95% CI 1.58-3.31) for generalized anxiety disorder symptoms and 1.28 (95% CI 0.99-1.64), 1.94 (95% CI 1.46-2.58), 2.33 (95% CI 1.65-3.28), and 3.64 (95% CI 2.15-6.18) for 1, 2, 3, and 4 somatic symptoms, respectively. People with generalized anxiety disorder symptoms had on average a higher number of somatic symptoms (1.8) than other cohort members (0.9). Moreover, 1.6% of people without somatic symptoms tested positive for generalized anxiety disorder, meanwhile 22.6% of people with four somatic symptoms tested positive for generalized anxiety disorder. Conclusions Both generalized anxiety disorder symptoms and somatic symptoms are associated with a higher risk for being a health care frequent attender.

  20. Primary care patients reporting concerns about their gambling frequently have other co-occurring lifestyle and mental health issues

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    Shepherd Robin

    2006-04-01

    Full Text Available Abstract Background Problem gambling often goes undetected by family physicians but may be associated with stress-related medical problems as well as mental disorders and substance abuse. Family physicians are often first in line to identify these problems and to provide a proper referral. The aim of this study was to compare a group of primary care patients who identified concerns with their gambling behavior with the total population of screened patients in relation to co-morbidity of other lifestyle risk factors or mental health issues. Methods This is a cross sectional study comparing patients identified as worrying about their gambling behavior with the total screened patient population for co morbidity. The setting was 51 urban and rural New Zealand practices. Participants were consecutive adult patients per practice (N = 2,536 who completed a brief multi-item tool screening primary care patients for lifestyle risk factors and mental health problems (smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger. Data analysis used descriptive statistics and non-parametric binomial tests with adjusting for clustering by practitioner using STATA survey analysis. Results Approximately 3/100 (3% answered yes to the gambling question. Those worried about gambling more likely to be male OR 1.85 (95% CI 1.1 to 3.1. Increasing age reduced likelihood of gambling concerns – logistic regression for complex survey data OR = 0.99 (CI 95% 0.97 to 0.99 p = 0.04 for each year older. Patients concerned about gambling were significantly more likely (all p Conclusion Our questionnaire identifies patients who express a need for help with gambling and other lifestyle and mental health issues. Screening for gambling in primary care has the potential to identify individuals with multiple co-occurring disorders.

  1. Frequently Asked Questions about Chiropractic

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    ... Marketing Patient Fact Sheets Contact the ACA State Licensing Boards Research JMPT Abstracts Latest Issue Evidence in ... Chiropractic Posture Backpack Safety Spinal Health Winter Activities Kids and Sports Exercising Outdoors with Baby Gardening Chronic ...

  2. Effects of an emergency medical services-based resource access program on frequent users of health services.

    Science.gov (United States)

    Tadros, Anthony S; Castillo, Edward M; Chan, Theodore C; Jensen, Anne Marie; Patel, Ekta; Watts, Kerin; Dunford, James V

    2012-01-01

    demonstrated that an EMS-based case management and referral program was an effective means of decreasing EMS transports by frequent users, but had only a limited impact on use of hospital services.

  3. Gingival crevicular fluid proteomes in health, gingivitis and chronic periodontitis.

    Science.gov (United States)

    Huynh, A H S; Veith, P D; McGregor, N R; Adams, G G; Chen, D; Reynolds, E C; Ngo, L H; Darby, I B

    2015-10-01

    The aim of this study was to compare the proteome composition of gingival crevicular fluid obtained from healthy periodontium, gingivitis and chronic periodontitis affected sites. Owing to its site-specific nature, gingival crevicular fluid is ideal for studying biological processes that occur during periodontal health and disease progression. However, few studies have been conducted into the gingival crevicular fluid proteome due to the small volumes obtained. Fifteen males were chosen for each of three different groups, healthy periodontium, gingivitis and chronic periodontitis. They were categorized based on clinical measurements including probing depth, bleeding on probing, plaque index, radiographic bone level, modified gingival index and smoking status. Gingival crevicular fluid was collected from each patient, pooled into healthy, gingivitis and chronic periodontitis groups and their proteome analyzed by gel electrophoresis and liquid chromatography electrospray ionization ion trap tandem mass spectrometry. One hundred and twenty-one proteins in total were identified, and two-thirds of these were identified in all three conditions. Forty-two proteins were considered to have changed in abundance. Of note, cystatin B and cystatin S decreased in abundance from health to gingivitis and further in chronic periodontitis. Complement proteins demonstrated an increase from health to gingivitis followed by a decrease in chronic periodontitis. Immunoglobulins, keratin proteins, fibronectin, lactotransferrin precursor, 14-3-3 protein zeta/delta, neutrophil defensin 3 and alpha-actinin exhibited fluctuations in levels. The gingival crevicular fluid proteome in each clinical condition was different and its analysis may assist us in understanding periodontal pathogenesis. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. Lifestyle and Risk of Chronic Prostatitis/Chronic Pelvic Pain Syndrome in a Cohort of United States Male Health Professionals.

    Science.gov (United States)

    Zhang, Ran; Sutcliffe, Siobhan; Giovannucci, Edward; Willett, Walter C; Platz, Elizabeth A; Rosner, Bernard A; Dimitrakoff, Jordan D; Wu, Kana

    2015-11-01

    Although chronic prostatitis/chronic pelvic pain syndrome is a prevalent urological disorder among men of all ages, its etiology remains unknown. Only a few previous studies have examined associations between lifestyle factors and chronic prostatitis/chronic pelvic pain syndrome, of which most were limited by the cross-sectional study design and lack of control for possible confounders. To address these limitations we performed a cohort study of major lifestyle factors (obesity, smoking and hypertension) and chronic prostatitis/chronic pelvic pain syndrome risk in the HPFS (Health Professionals Follow-up Study), a large ongoing cohort of United States based male health professionals. The HPFS includes 51,529 men who were 40 to 75 years old at baseline in 1986. At enrollment and every 2 years thereafter participants have completed questionnaires on lifestyle and health conditions. In 2008 participants completed an additional set of questions on recent chronic prostatitis/chronic pelvic pain syndrome pain symptoms modified from the NIH (National Institutes of Health)-CPSI (Chronic Prostatitis Symptom Index) as well as questions on approximate date of symptom onset. The 653 participants with NIH-CPSI pain scores 8 or greater who first experienced symptoms after 1986 were considered incident chronic prostatitis/chronic pelvic pain syndrome cases and the 19,138 who completed chronic prostatitis/chronic pelvic pain syndrome questions but did not report chronic prostatitis/chronic pelvic pain syndrome related pain were considered noncases. No associations were observed for baseline body mass index, waist circumference, waist-to-hip ratio, cigarette smoking and hypertension with chronic prostatitis/chronic pelvic pain syndrome risk (each OR ≤1.34). In this large cohort study none of the lifestyle factors examined was associated with chronic prostatitis/chronic pelvic pain syndrome risk. As the etiology of chronic prostatitis/chronic pelvic pain syndrome remains unknown

  5. A Nationally Scaled Telebehavioral Health Program for Chronic Pain: Characteristics, Goals, and Psychological Outcomes.

    Science.gov (United States)

    Mochari-Greenberger, Heidi; Peters, Aimee; Vue, Lee; Pande, Reena L

    2017-08-01

    Millions of U.S. adults suffer from chronic pain with a high prevalence of comorbid mental health issues. Telehealth-delivered behavioral therapy for chronic pain has been evaluated in the research setting. The purpose of this study was 1) to describe a nationally scaled, standardized, telebehavioral therapy program for patients with chronic pain and behavioral comorbidities, and 2) evaluate characteristics, goals, and psychosocial outcomes among program participants. This was mixed-methods retrospective cohort analysis among consecutive program graduates (mean age 53y; 24% male). The 8-week program was delivered by a licensed therapist and a behavior coach through telephone/secure video and tailored to each participant's behavioral health needs and goals. Participant chief complaints, behavioral goals, and mood triggers were abstracted by deidentified clinical record review using structured qualitative research methods. Depression, anxiety, and stress symptom data were collected at baseline and program graduation using the validated Depression Anxiety Stress Scales 21. Back pain (42%) and hip/leg/knee pain (28%) comprised the most common chief complaints. Pain management (44%) and weight loss (43%) were the most frequently cited goals. At baseline, approximately half of participants had elevated depression (59%), anxiety (54%), and/or stress (48%) scores. Triggers for depressed, anxious, or stressed mood included severe pain (47%), health concerns (46%), and interpersonal relationship challenges (45%). At graduation, significant improvement in median depression (-54%), anxiety (-50%), and stress (-33%) symptom scores was observed among those with non-normal baseline values (p health program for chronic pain experienced significant improvement in depression, anxiety, and stress symptoms and shared several complaints, goals, and mood triggers.

  6. Health behaviour changes and onset of chronic health problems in later life

    Directory of Open Access Journals (Sweden)

    Marijke Veenstra

    2012-11-01

    Full Text Available Objectives: To assess five-year changes in health behaviours in later life and associations with onset of chronic health problems. The results may inform policy and interventions to promote healthy life years in ageing populations.Methods: Data are derived from the Norwegian study on Life-course, Ageing and Generation (NorLAG, a five-year (2002-2007 panel survey comprising a nation wide community sample. The present analyses include a sample of 1,019 respondents aged 60 years and older. Five-year changes in smoking, alcohol use, physical exercise and Body Mass Index (BMI are assessed according to prevalent and incident chronic health problems. Multivariate logistic analyses of “healthy” behavioural changes are conducted.Results: A total of 453 respondents (45% reported at least one chronic condition and 13% (N=133 reported onset of chronic conditions in the course of the past five years. Over a five-year period, there was an overall reduction in smoking rates and a decrease in regular physical activity. Alcohol consumption in older people slightly increased over time, but the incidence of chronic health problems tended to reduce alcohol intake. Older persons experiencing chronic health problems were less likely to initiate physical activity.Conclusions: The results provide limited support for the assumption that the onset of a chronic health condition triggers improved health behaviours. This suggests that the health care system could do more in targeting a potential “window of opportunity” for individuals to adopt new healthy behaviours in later life.

  7. The Use of Complementary and Alternative Medicine Is Less Frequent in Patients with Inflammatory Bowel Disease Than in Patients with Other Chronic Gastrointestinal Disorders

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    Anna Fábián

    2018-01-01

    Full Text Available Background and Aims. Complementary and alternative medicine (CAM is commonly used among patients with inflammatory bowel diseases (IBD, but evidence about its real-life use is limited. We aimed to assess and compare CAM use in outpatients with IBD and other gastrointestinal diseases. Materials and Methods. The use of herbs and botanicals, lifestyle modifications and mind/body therapies, patient satisfaction, and continuous use of conventional medicine were assessed with an anonymous questionnaire at a tertiary IBD unit in Hungary. 396 IBD patients (207 with Crohn’s disease, 185 with ulcerative colitis, and 4 with indeterminate colitis and 164 patients with gastric acid-related diseases, premalignant and malignant colorectal diseases, lactose intolerance, celiac disease, dysbacteriosis, and so on were included. Results. IBD patients reported significantly lower usage of herbs than did controls (25% versus 42%, p<0.001. More than 90% of responding IBD patients continued conventional medication besides herbal remedies (83% in unaltered doses. IBD patients were more likely to implement lifestyle modifications (77% versus 63%, p=0.0011, but not body/mind therapies (20% versus 15%, p=0.1516. Younger age was a significant predictor of lifestyle modifications (p=0.0246. Conclusions. CAM use (especially that of herbal remedies in IBD is less frequent than that in other gastrointestinal diseases. It is more a complementary than an alternative to conventional medicine in IBD. There is no significant difference between CAM use in patients with Crohn’s disease and that in patients with ulcerative colitis, although the latter tend to choose herbs; the benefit of which is supported by scientific evidence. This study is registered at the Medical Research Council, Hungary. This trial is registered with 3769/2010/1018EKU.

  8. ChronicOnline: Implementing a mHealth solution for monitoring and early alerting in chronic obstructive pulmonary disease.

    Science.gov (United States)

    Bitsaki, Marina; Koutras, Christos; Koutras, George; Leymann, Frank; Steimle, Frank; Wagner, Sebastian; Wieland, Matthias

    2017-09-01

    Lack of time or economic difficulties prevent chronic obstructive pulmonary disease patients from communicating regularly with their physicians, thus inducing exacerbation of their chronic condition and possible hospitalization. Enhancing Chronic patients' Health Online proposes a new, sustainable and innovative business model that provides at low cost and at significant savings to the national health system, a preventive health service for chronic obstructive pulmonary disease patients, by combining human medical expertise with state-of-the-art online service delivery based on cloud computing, service-oriented architecture, data analytics, and mobile applications. In this article, we implement the frontend applications of the Enhancing Chronic patients' Health Online system and describe their functionality and the interfaces available to the users.

  9. [Health valuations for patients with chronic ischemic heart disease].

    Science.gov (United States)

    Meder, M; Farin, E

    2011-08-01

    The study deals with the question of how patients with chronic ischemic heart disease assess different health situations that can be achieved by rehabilitation. Furthermore it examines which factors influence these health valuations and whether the predictors vary depending on the level of education. The health valuations of n = 331 patients with chronic ischemic heart disease are compiled using visual analogue scales (VAS). In addition to sociodemographic questions, generic and illness-specific scales (SF-12, MacNew) for the health-related quality of life (HRQOL) are used as potential predictors of the health valuations. Additional basic medical data were provided by the physician. Hierarchical regression analyses are conducted; the sociodemographic, medical and HRQOL variables are included stepwise. Since many variables are observed for the regression models, an imputation of missing values is made. The health dimensions "Self-care and domestic life" and "Mobility" are assigned the highest values on the VAS. The lowest preference is assigned to the dimensions "Reduction of symptoms" and "Information about the disease". The differences between the health dimensions are statistically significant. Sociodemographic variables explain up to 3.6% of the variance of health valuations, with level of education and living with a partner being the most important predictors. The medical variables included in the second step explain between 2.1 and 6.8% incremental variance; the most important predictor is the operation performed prior to rehabilitation (bypass, heart valve). The HRQOL variables in the third block provide 7.1-24.9% incremental explanation of variance, by far the highest percentage. This is mainly achieved using the 3 MacNew scales (emotional, social and physical functioning). The overall explanation of variance for the health valuations is 17.1-28.8%. For patients with a higher level of education, the total explanation of variance is about 9.2% higher on

  10. Defining and targeting health disparities in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Pleasants RA

    2016-10-01

    Full Text Available Roy A Pleasants,1–3 Isaretta L Riley,1–3 David M Mannino4 1Duke Asthma, Allergy, and Airways Center, 2Division of Pulmonary, Allergy, and Critical Care Medicine, Duke University School of Medicine, 3Durham VA Medical Center, Durham, NC, 4Division of Pulmonary, Critical Care, and Sleep Medicine, Pulmonary Epidemiology Research Laboratory, University of Kentucky, Lexington, KY, USA Abstract: The global burden of chronic obstructive pulmonary disease (COPD continues to grow in part due to better outcomes in other major diseases and in part because a substantial portion of the worldwide population continues to be exposed to inhalant toxins. However, a disproportionate burden of COPD occurs in people of low socioeconomic status (SES due to differences in health behaviors, sociopolitical factors, and social and structural environmental exposures. Tobacco use, occupations with exposure to inhalant toxins, and indoor biomass fuel (BF exposure are more common in low SES populations. Not only does SES affect the risk of developing COPD and etiologies, it is also associated with worsened COPD health outcomes. Effective interventions in these people are needed to decrease these disparities. Efforts that may help lessen these health inequities in low SES include 1 better surveillance targeting diagnosed and undiagnosed COPD in disadvantaged people, 2 educating the public and those involved in health care provision about the disease, 3 improving access to cost-effective and affordable health care, and 4 markedly increasing the efforts to prevent disease through smoking cessation, minimizing use and exposure to BF, and decreasing occupational exposures. COPD is considered to be one the most preventable major causes of death from a chronic disease in the world; therefore, effective interventions could have a major impact on reducing the global burden of the disease, especially in socioeconomically disadvantaged populations. Keywords: health disparities

  11. The association of chronic neck pain, low back pain, and migraine with absenteeism due to health problems in Spanish workers.

    Science.gov (United States)

    Mesas, Arthur Eumann; González, Alberto Durán; Mesas, Cézar Eumann; de Andrade, Selma Maffei; Magro, Isabel Sánchez; del Llano, Juan

    2014-07-01

    Cross-sectional. To examine whether 3 types of chronic pain are associated with absenteeism and with the number of days absent from work in the general population of Spain. Chronic pain has been associated with absenteeism, but most of the evidence is based on unadjusted analyses and on specific professional categories. A cross-sectional analysis was performed on the basis of data of 8283 Spanish workers. Chronic pain was ascertained from self-reported information on frequent symptoms of pain in the low back and neck and/or migraine in the last 12 months. Absenteeism was defined as missing at least 1 day from work because of health problems. Multivariate regression models were adjusted for the main confounders. Health-related absenteeism was reported by 27.8% of subjects. The prevalence of chronic pain was reported to be 12.3% in the neck, 14.1% in the low back, and 10.3% migraine. In adjusted analyses, absenteeism was associated with chronic neck pain (odds ratio: 1.20; 95% confidence interval [CI], 1.02-1.40), low back pain (odds ratio: 1.22; 95% CI, 1.06-1.42), and migraine (odds ratio: 1.22; 95% CI, 1.04-1.44). These associations were strongest in younger (18-34 yr) rather than in older workers. Furthermore, those who reported frequent pain in the neck and low back were 44% more likely to be absent for more than 30 days in the past year than those who did not report these symptoms. Spanish workers with chronic pain were more likely to be absent from work and to stay absent from work for longer. These associations are independent of sociodemographic characteristics, occupation, lifestyle, health status, and analgesics use. N/A.

  12. Racial/Ethnic Disparities in Chronic Diseases of Youths and Access to Health Care in the United States

    Directory of Open Access Journals (Sweden)

    James H. Price

    2013-01-01

    Full Text Available Racial/ethnic minorities are 1.5 to 2.0 times more likely than whites to have most of the major chronic diseases. Chronic diseases are also more common in the poor than the nonpoor and this association is frequently mediated by race/ethnicity. Specifically, children are disproportionately affected by racial/ethnic health disparities. Between 1960 and 2005 the percentage of children with a chronic disease in the United States almost quadrupled with racial/ethnic minority youth having higher likelihood for these diseases. The most common major chronic diseases of youth in the United States are asthma, diabetes mellitus, obesity, hypertension, dental disease, attention-deficit/hyperactivity disorder, mental illness, cancers, sickle-cell anemia, cystic fibrosis, and a variety of genetic and other birth defects. This review will focus on the psychosocial rather than biological factors that play important roles in the etiology and subsequent solutions to these health disparities because they should be avoidable and they are inherently unjust. Finally, this review examines access to health services by focusing on health insurance and dental insurance coverage and access to school health services.

  13. Evaluation of Medicare Health Support chronic disease pilot program.

    Science.gov (United States)

    Cromwell, Jerry; McCall, Nancy; Burton, Joe

    2008-01-01

    The Medicare Program is conducting a randomized trial of care management services among fee-for-service (FFS) beneficiaries called the Medicare Health Support (MHS) pilot program. Eight disease management (DM) companies have contracted with CMS to improve clinical quality, increase beneficiary and provider satisfaction, and achieve targeted savings for chronically ill Medicare FFS beneficiaries. In this article, we present 6-month intervention results on beneficiary selection and participation rates, mortality rates, trends in hospitalizations, and success in achieving Medicare cost savings. Results to date indicate limited success in achieving Medicare cost savings or reducing acute care utilization.

  14. 5 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices

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    ... X Y Z 6 Things You Should Know: The Science of Chronic Pain and Complementary Health Practices Share: Reviews of research on acupuncture, massage, and spinal manipulation for chronic ... manipulation : The most recent guidelines from the American Pain Society ...

  15. Prevalence and intensity of chronic pain and self-perceived health among elderly people: a population-based study

    Directory of Open Access Journals (Sweden)

    Lilian Varanda Pereira

    2014-08-01

    Full Text Available OBJECTIVE: to identify the prevalence and intensity of chronic pain among elderly people of the community and to analyze associations with the self-perceived health status.METHOD: cross-sectional study with a populational sample (n=934, conducted through household interviews in the city of Goiânia, Brazil. The intensity of chronic pain (existing for 6 months or more was measured using a numerical scale (0-10 and the self-perceived health through a verbal scale (very good, good, fair, poor, very poor. For the statistical analysis, the absolute frequency and percentage, CI (95%, Chi-square test, Odds ratio, and regression analysis were used. Significance of 5%.RESULTS: The prevalence of chronic pain was 52.8% [CI (95%:49.4-56.1]; most frequently located in the lower limbs (34.5% and lumbar region (29.5%; with high or the worst possible intensity for 54.6% of the elderly people. The occurrence of chronic pain was associated with (p<0.0001 a worse self-perception of health (OR=4.2:2.5-7.0, a greater number of chronic diseases (OR=1.8:1.2-2.7, joint disease (OR=3.5:2.4-5.1 and the female gender (OR=2.3:1.7-3.0. A lower intensity of chronic pain was associated with a better self-perception of health (p<0.0001.CONCLUSION: the majority of the elderly people of the community reported chronic pain, of a severe intensity, and located in areas related to movement activities, thus influencing the morbidity and mortality of this population.

  16. Health Promotion Behaviors and Chronic Diseases of Aging in the Elderly People of Iranshahr*- IR Iran.

    Science.gov (United States)

    Pishkar Mofrad, Zahra; Jahantigh, Mozhgan; Arbabisarjou, Azizollah

    2015-07-13

    promotion behaviors was in the range of 0-11 and 54.9% of them got the score of the inappropriate health promotion behavior. The most frequent chronic diseases of older people were respectively joint problems (78.9%), sensory problems (64.1%), and hypertension (56.6%). No significant relationship was observed between the score of health promotion behaviors and "the gender, lifestyle and marital status of the older people", but there was statistically a significant relationship between the score of health promotion behaviors and "the age, education, and job of the older people". Providing training programs for health promotion behaviors in elderly people can improve these behaviors and enhance their health and quality of life and reduce the incidence of chronic diseases in them. The goal of health promotion behaviors is to maintain performance, independence and quality of life; and many studies have demonstrated that the elderly people who aged 60 years and over benefit from health promotion behaviors more than middle-aged people.

  17. [Using eHealth in the Continuity Care of Chronic Kidney Disease: Opportunities and Considerations].

    Science.gov (United States)

    Chen, Yu-Chi; Chang, Polun

    2016-04-01

    Kidney disease is a common complication of chronic diseases among adult and elderly populations. As early-stage chronic kidney disease (CKD) is asymptomatic, CKD patients are frequently unaware of their condition and fail to implement requisite self-care in a timely fashion. Furthermore, the shortage of case-management manpower and difficulties in follow-up have led to high incidence rates for CKD worldwide. Integrative and continuous care is key to preventing CKD. How to implement this care effectively is a challenge. However, innovative technologies, online information, and cloud technology are increasingly providing access to good-quality healthcare beyond the traditional limitations of time and location. This environment is not only increasing the participation of patients in their care and collaboration among healthcare team members but is also improving the continuity, accessibility, and promptness of care service in order to promote the effectiveness of disease management. While the primary aim of innovative technologies is to make healthcare more cost-effective, it is also causing disparities in healthcare. Within the high-tech e-healthcare system, the ability of patients to utilize these new services relates directly to their health behaviors and quality of care. Thus, emergent e-healthcare system services should be made as patient-centered as possible in order to maximize the benefits in terms of both cost and patient care. Furthermore, improving the eHealth literacy of patients is crucial to promoting innovative technology within healthcare services.

  18. Health Status Measurement Instruments in Chronic Obstructive Pulmonary Disease

    Directory of Open Access Journals (Sweden)

    Yves Lacasse

    1997-01-01

    Full Text Available Chronic obstructive pulmonary disease (COPD is associated with primary respiratory impairment, disability and handicap, as well as with secondary impairments not necessarily confined to the respiratory system. Because the primary goals of managing patients with COPD include relief of dyspnea and the improvement of health-related quality of life (HRQL, a direct measurement of HRQL is important. Fourteen disease-specific and nine generic questionnaires (four health profiles and five utility measures most commonly used to measure health status in patients with COPD were reviewed. The measures were classified according to their domain of interest, and their measurement properties - specifications, validity, reliability, responsiveness and interpretability - were described. This review suggests several findings. Currently used health status instruments usually refer to the patients’ perception of performance in three major domains of HRQL - somatic sensation, physical and occupational function, and psychological state. The choice of a questionnaire must be related to its purpose, with a clear distinction being made between its evaluative and discriminative function. In their evaluative function, only a few instruments fulfilled the criteria of responsiveness, and the interpretability of most questionnaires is limited. Generic questionnaires should not be used alone in clinical trials as evaluative instruments because of their inability to detect change over time. Further validation and improved interpretability of existing instruments would be of greater benefit to clinicians and scientists than the development of new questionnaires.

  19. Supporting self-management of chronic health conditions: common approaches.

    Science.gov (United States)

    Lawn, Sharon; Schoo, Adrian

    2010-08-01

    The aims of this paper are to provide a description of the principles of chronic condition self-management, common approaches to support currently used in Australian health services, and benefits and challenges associated with using these approaches. We examined literature in this field in Australia and drew also from our own practice experience of implementing these approaches and providing education and training to primary health care professionals and organizations in the field. Using common examples of programs, advantages and disadvantages of peer-led groups (Stanford Courses), care planning (The Flinders Program), a brief primary care approach (the 5As), motivational interviewing and health coaching are explored. There are a number of common approaches used to enhance self-management. No one approach is superior to other approaches; in fact, they are often complimentary. The nature and context for patients' contact with services, and patients' specific needs and preferences are what must be considered when deciding on the most appropriate support mode to effectively engage patients and promote self-management. Choice of approach will also be determined by organizational factors and service structures. Whatever self-management support approaches used, of importance is how health services work together to provide support. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  20. Smoking is the most frequent risk factor for cardiovascular diseases in Croatian Western region: findings of the Croatian health survey 2003

    Directory of Open Access Journals (Sweden)

    Henrietta Benčević-Striehl,

    2009-08-01

    Full Text Available Aim To estimate the prevalence of selected behavioral risk factorsfor cardiovascular diseases in the western region of Croatia and todetermine the differences based on age and gender.Methods A national survey on health status and health behavior ofthe adult population has been conducted. The representative sampleof 10,766 households for six officially defined regions of Croatiahas been determined, and Western region has been included with1,562 inhabitants, aged 18 years and older. The overall responserate of administered face-to-face questionnaire was 85-6%. Prevalencerates per 100 inhabitants (smoking, eating habits, alcoholconsumption, physical activity, socio-economic characteristics,chronic conditions have been determined.Results Nearly half (46.3% of the adults were smokers or hadquit smoking less than 10 years ago. Prevalence of high bloodpressure was high amounting to 40.6% and it was higher in middleaged males (46.7%, p<0.01 and young males (13.7%, p<0.01.Prevalence of obesity was 38.9%, highest in females aged 35-64(51.2%, p<0.001 and 65 and older (73.8%, p<0.01.Almost a quarter of respondents (23.3% has been insufficientlyphysically active, especially young females 22.5%, p<0.01.Conclusion There was a significant difference in the prevalenceof all observed behavioral risk factors according to the gender andage. Moreover, smoking tobacco has been found as the most frequentrisk factor in the observed population.

  1. Frequent Questions on Recycling

    Science.gov (United States)

    This is a list of frequent questions on recycling, broken down into five categories. These are answers to common questions that EPA has received from press and web inquiries. This list is located on the Reduce, Reuse, Recycle website.

  2. Scalable Frequent Subgraph Mining

    KAUST Repository

    Abdelhamid, Ehab

    2017-01-01

    Given an input graph, the Frequent Subgraph Mining (FSM) task finds all subgraphs with frequencies exceeding a given threshold. FSM is crucial for graph analysis, and it is an essential building block in a variety

  3. Health-Related Quality of Life among Chronic Opioid Users, Nonchronic Opioid Users, and Nonopioid Users with Chronic Noncancer Pain.

    Science.gov (United States)

    Hayes, Corey J; Li, Xiaocong; Li, Chenghui; Shah, Anuj; Kathe, Niranjan; Bhandari, Naleen Raj; Payakachat, Nalin

    2018-02-25

    Evaluate the association between opioid therapy and health-related quality of life (HRQoL) in participants with chronic, noncancer pain (CNCP). Medical Expenditure Panel Survey Longitudinal, Medical Conditions, and Prescription Files. Using a retrospective cohort study design, the Mental Health Component (MCS12) and Physical Health Component (PCS12) scores of the Short Form-12 Version 2 were assessed to measure mental and physical HRQoL. Chronic, noncancer pain participants were classified as chronic, nonchronic, and nonopioid users. One-to-one propensity score matching was employed to match chronic opioid users to nonchronic opioid users plus nonchronic opioid users and chronic opioid users to nonopioid users. A total of 5,876 participants were identified. After matching, PCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = -0.98, 95% CI: -2.07, 0.10), chronic versus nonopioid users (LSM Diff = -2.24, 95% CI: -4.58, 0.10), or chronic versus nonchronic opioid users (LSM Diff = -2.23, 95% CI: -4.53, 0.05). Similarly, MCS12 was not significantly different between nonchronic versus nonopioid users (LSM Diff = 0.76, 95% CI: -0.46, 1.98), chronic versus nonopioid users (LSM Diff = 1.08, 95% CI: -1.26, 3.42), or chronic versus nonchronic opioid users (LSM Diff = -0.57, 95% CI: -2.90, 1.77). Clinicians should evaluate opioid use in participants with CNCP as opioid use is not correlated with better HRQoL. © Health Research and Educational Trust.

  4. State of the science: chronic periodontitis and systemic health.

    Science.gov (United States)

    Otomo-Corgel, Joan; Pucher, Jeffery J; Rethman, Michael P; Reynolds, Mark A

    2012-09-01

    Inflammatory periodontal diseases exhibit an association with multiple systemic conditions. Currently, there is a lack of consensus among experts on the nature of these associations and confusion among health care providers and the public on how to interpret this rapidly growing body of science. This article overviews the current evidence linking periodontal diseases to diabetes, cardiovascular disease, osteoporosis, preterm low birth weight babies, respiratory diseases, and rheumatoid arthritis. Evidence was taken from systematic reviews, clinical trials, and mechanistic studies retrieved in searches of the PubMed electronic database. The available data provide the basis for applied practical clinical recommendations. Evidence is summarized and critically reviewed from systematic reviews, primary clinical trials, and mechanistic studies Surrogate markers for chronic periodontitis, such as tooth loss, show relatively consistent but weak associations with multiple systemic conditions. Despite biological plausibility, shorter-term interventional trials have generally not supported unambiguous cause-and-effect relationships. Nevertheless, the effective treatment of periodontal infections is important to achieve oral health goals, as well as to reduce the systemic risks of chronic local inflammation and bacteremias. Inflammatory periodontal diseases exhibit an association with multiple systemic conditions. With pregnancy as a possible exception, the local and systemic effects of periodontal infections and inflammation are usually exerted for many years, typically among those who are middle-aged or older. It follows that numerous epidemiological associations linking chronic periodontitis to age-associated and biologically complex conditions such as diabetes, cardiovascular disease, osteoporosis, respiratory diseases, rheumatoid arthritis, certain cancers, erectile dysfunction, kidney disease and dementia, have been reported. In the coming years, it seems likely that

  5. [The Utilization of Health-Related Applications in Chronic Disease Self-Management].

    Science.gov (United States)

    Kao, Chi-Wen; Chuang, Hui-Wan; Chen, Ting-Yu

    2017-08-01

    The dramatic increase in smartphone usage has spurred the development of many health-related mobile applications (apps). On the other hand, population aging and the associated rise in the incidence of chronic disease is increasing the demand for long-term care. Effective chronic disease self-management has been shown to help patients improve their health condition. Numerous smartphone applications currently support patient self-management of chronic disease, facilitating health management and health promotion. The purpose of the present article was to introduce the definition, contents, and types of health-related apps; to discuss the effectiveness of self-management health-related apps in promoting chronic disease management; and to assess and evaluate these apps. We hope that the present article helps give to healthcare professionals and patients who are willing to manage their diseases a general understanding of health-related apps and their potential to facilitate the self-management of chronic diseases.

  6. Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan.

    Science.gov (United States)

    Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Oweis, Arwa; Al Ward, Nada; Burton, Ann

    2016-01-01

    The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings. A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9%) of care-seekers; the remainder received care in the private (29.6%) and NGO/charity (16.6%) sectors. Individuals with non-communicable diseases (NCDs) in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD), excluding cost of medications. Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.

  7. Health Service Utilization among Syrian Refugees with Chronic Health Conditions in Jordan.

    Directory of Open Access Journals (Sweden)

    Shannon Doocy

    Full Text Available The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system, particularly in treating chronic health conditions. This study was undertaken to assess utilization of health services for chronic health conditions among Syrian refugees in non-camp settings.A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care for hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, and arthritis. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households.Of 1363 cases with a chronic health condition diagnosis, 84.7% had received care in Jordan. Public facilities faced a heavy burden serving over half (53.9% of care-seekers; the remainder received care in the private (29.6% and NGO/charity (16.6% sectors. Individuals with non-communicable diseases (NCDs in the central region of Jordan and with arthritis had the lowest rates of care-seeking when compared to other regions and conditions. Overall, 31.6% of care-seekers had an out-of-pocket payment for the most recent care-seeking event which averaged 18.8 USD (median = 0 USD, excluding cost of medications.Forced displacement presents major challenges to those with NCDs, which have the potential to seriously impact both the quality of life and life expectancy amongst refugees. NCD patterns among Syrian refugees indicate the importance of continuing support to public sector services in Jordan to adequately meet expanding needs and ensure appropriate prevention and control of priority NCDs.

  8. Impact of Chronic Diseases and Multimorbidity on Health and Health Care Costs: The Additional Role of Musculoskeletal Disorders

    NARCIS (Netherlands)

    Zee-Neuen, A. van der; Putrik, P.; Ramiro, S.; Keszei, A.; Bie, R. de; Chorus, A.; Boonen, A.

    2016-01-01

    Objective: Chronic diseases are increasingly prevalent and often occur as multimorbidity. This study compares the impact of musculoskeletal disorders (MSKDs) on health and health care costs with other chronic diseases, and assesses the additional impact of MSKDs on these outcomes when occurring as

  9. Community Health Worker Impact on Chronic Disease Outcomes Within Primary Care Examined Using Electronic Health Records.

    Science.gov (United States)

    Ingram, Maia; Doubleday, Kevin; Bell, Melanie L; Lohr, Abby; Murrieta, Lucy; Velasco, Maria; Blackburn, John; Sabo, Samantha; Guernsey de Zapien, Jill; Carvajal, Scott C

    2017-10-01

    To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = -0.24, -0.06), body mass index decreased 0.29 kilograms per meter squared (CI = -0.39, -0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = -13.5, -10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = -0.7, -0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = -0.14, -0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = -39.0, -6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = -6.6, -0.6) in health center 1 was the only improvement tied to CHW contact. Although patients' chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs' evolution may elucidate CHW contributions moving forward.

  10. Health care costs, work productivity and activity impairment in non-malignant chronic pain patients

    DEFF Research Database (Denmark)

    Kronborg, Christian; Handberg, Gitte; Axelsen, Flemming

    2009-01-01

    This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs be...... before pain onset. The majority of chronic pain patients incur the costs of alternative treatments. Chronic pain causes production losses at work, as well as impairment of non-work activities.......This study explores the costs of non-malignant chronic pain in patients awaiting treatment in a multidisciplinary pain clinic in a hospital setting. Health care costs due to chronic pain are particular high during the first year after pain onset, and remain high compared with health care costs...

  11. The Oslo Health Study: A Dietary Index Estimating Frequent Intake of Soft Drinks and Rare Intake of Fruit and Vegetables Is Negatively Associated with Bone Mineral Density

    Science.gov (United States)

    Høstmark, Arne Torbjørn; Søgaard, Anne Johanne; Alvær, Kari; Meyer, Haakon E.

    2011-01-01

    Background. Since nutritional factors may affect bone mineral density (BMD), we have investigated whether BMD is associated with an index estimating the intake of soft drinks, fruits, and vegetables. Methods. BMD was measured in distal forearm in a subsample of the population-based Oslo Health Study. 2126 subjects had both valid BMD measurements and answered all the questions required for calculating a Dietary Index = the sum of intake estimates of colas and non-cola beverages divided by the sum of intake estimates of fruits and vegetables. We did linear regression analyses to study whether the Dietary Index and the single food items included in the index were associated with BMD. Results. There was a consistent negative association between the Dietary Index and forearm BMD. Among the single index components, colas and non-cola soft drinks were negatively associated with BMD. The negative association between the Dietary Index and BMD prevailed after adjusting for gender, age, and body mass index, length of education, smoking, alcohol intake, and physical activity. Conclusion. An index reflecting frequent intake of soft drinks and rare intake of fruit and vegetables was inversely related to distal forearm bone mineral density. PMID:21772969

  12. [Chronic health conditions related to quality of life for federal civil servants].

    Science.gov (United States)

    Saraiva, Luciana Eduardo Fernandes; Medeiros, Lays Pinheiro de; Melo, Marjorie Dantas Medeiros; Tiburcio, Manuela Pinto; Costa, Isabelle Katherinne Fernandes; Torres, Gilson de Vasconcelos

    2015-06-01

    The aim of this study is to correlate the QOL domains of the civil servants to the type and number of chronic health conditions. A transversal, quantitative study, conducted at the Department of Civil Servant Assistance of the Federal University of Rio Grande do Norte with 215 civil servants, during the period from March to May 2011. Among the chronic health conditions studied, there was significant relationship between non-communicable chronic disease and QOL scores, correlating weakly (r civil servants is negatively influenced by chronic health conditions, compromising, in general, their daily work and life activities.

  13. Mining frequent binary expressions

    NARCIS (Netherlands)

    Calders, T.; Paredaens, J.; Kambayashi, Y.; Mohania, M.K.; Tjoa, A.M.

    2000-01-01

    In data mining, searching for frequent patterns is a common basic operation. It forms the basis of many interesting decision support processes. In this paper we present a new type of patterns, binary expressions. Based on the properties of a specified binary test, such as reflexivity, transitivity

  14. Health-related needs of people with multiple chronic diseases: differences and underlying factors.

    NARCIS (Netherlands)

    Hopman, P.; Schellevis, F.G.; Rijken, M.

    2016-01-01

    Purpose: To examine the health-related needs of people with multiple chronic diseases in the Netherlands compared to people with one chronic disease, and to identify different subgroups of multimorbid patients based on differences in their health problems. Methods: Participants were 1092 people with

  15. Frequent hemodialysis in children.

    Science.gov (United States)

    Warady, Bradley A; Fischbach, Michel; Geary, Denis; Goldstein, Stuart L

    2007-07-01

    Frequent hemodialysis is currently conducted in a limited number of pediatric dialysis centers. However, the preliminary experience with children who have undergone procedures such as "daily" intensive hemodiafiltration and nocturnal hemodialysis has been positive, with the allowance for unrestricted diets and fluid intake, the lack of need for phosphate binders, excellent metabolic and blood pressure control, and, in the case of hemodiafiltration, excellent growth. The provision of frequent daily hemodialysis with the NxStage System has also recently been introduced to pediatrics. An overview about what is currently understood regarding the technical and clinical application of these approaches to therapy for children with end-stage renal disease form the basis for this article and highlight the impact of the procedures to date and the need for additional experience and collaborative data collection.

  16. Relationship between sleep duration and self-reported health-related quality of life among US adults with or without major chronic diseases, 2014.

    Science.gov (United States)

    Liu, Yong; Wheaton, Anne G; Croft, Janet B; Xu, Fang; Cunningham, Timothy J; Greenlund, Kurt J

    2018-06-01

    To assess the association between sleep duration and health-related quality of life (HRQOL) among adults with or without chronic conditions. Using the 2014 Behavioral Risk Factor Surveillance System, we analyzed self-reported data from adult respondents aged ≥18 years with (n=277,757, unhealthy group) and without (n=172,052. healthy group) reported history of any of nine chronic conditions (coronary heart disease, stroke, cancer, chronic obstructive pulmonary disease, diabetes, asthma, arthritis, depression, chronic kidney disease). Multivariable logistic regressions were separately constructed to assess the associations between sleep duration and four self-reported HRQOL measures after adjustment for sociodemographics, leisure-time physical activity, body mass index, and smoking status among unhealthy and healthy adults. The prevalence of poor/fair health, frequent physical distress, frequent mental distress, frequent activity limitation, and short sleep duration was 27.9%, 19.3%, 17.0%, 13.6%, and 38.3% in the unhealthy group and 6.9%, 4.0%, 5.3%, 2.1%, and 31.0% in the healthy group, respectively. U-shaped relationships of sleep duration to all four HRQOL indicators were observed among the unhealthy group and to poor/fair health, frequent mental distress, and frequent activity limitation among the healthy group. The relationships further varied by sex, age, race/ethnicity, and BMI category among the healthy group. Relationships between extreme sleep duration and HRQOLs were observed among both healthy and unhealthy groups. These results can help inform public awareness campaigns and physician-counseling regarding the importance of sleep for mental health and well-being. Copyright © 2018. Published by Elsevier Inc.

  17. Directed use of the internet for health information by patients with chronic kidney disease: prospective cohort study.

    Science.gov (United States)

    Diamantidis, Clarissa Jonas; Fink, Wanda; Yang, Shiming; Zuckerman, Marni R; Ginsberg, Jennifer; Hu, Peter; Xiao, Yan; Fink, Jeffrey C

    2013-11-15

    Health information technology has become common in the care of patients with chronic diseases; however, there are few such applications employed in kidney disease. The aim of the study was to evaluate the use of a website providing disease-specific safety information by patients with predialysis chronic kidney disease. As part of the Safe Kidney Care (SKC) study, an educational website was designed to provide information on safety concerns in chronic kidney disease. Phase I study participants were provided a medical alert accessory with a unique ID number, the Safe Kidney Care website, and an in-person tutorial on the use of the Internet and accessing the SKC website at baseline. Participants were asked to visit the website and enter their unique ID as frequently as they desired over the next 365 days or until their annual follow-up visit, whichever occurred first. Participants' visits and dwell times on specific safety modules were tracked using embedded webpage PHP scripts linked to a MySQL database, enabling the collection of website usage statistics. Of 108 Phase I participants, 28.7% (31/108) visited the website from 1-6 times during the observation period (median follow-up 365 days). Median access time was 7 minutes per visit (range <1-46) and 13 minutes per person (range <1-123). The three most frequently visited pages were "Renal function calculator", "Pills to avoid", and "Foods to avoid". High school education and frequent Internet use were significantly associated with website entry (P=.02 and P=.03, respectively). Preliminary results show general interest in a Web-based platform designed to improve patient safety in chronic kidney disease. Clinicaltrials.gov NCT01407367; http://clinicaltrials.gov/show/NCT01407367 (Archived by WebCite at http://www.webcitation.org/6KvxFKA6M).

  18. Evolution in obesity and chronic disease prevention practice in California public health departments, 2010.

    Science.gov (United States)

    Schwarte, Liz; Ngo, Samantha; Banthia, Rajni; Flores, George; Prentice, Bob; Boyle, Maria; Samuels, Sarah E

    2014-11-13

    Local health departments (LHDs) are dedicating resources and attention to preventing obesity and associated chronic diseases, thus expanding their work beyond traditional public health activities such as surveillance. This study investigated practices of local health departments in California to prevent obesity and chronic disease. We conducted a web-based survey in 2010 with leaders in California's LHDs to obtain diverse perspectives on LHDs' practices to prevent obesity and chronic disease. The departmental response rate for the 2010 survey was 87% (53 of California's 61 LHDs). Although staff for preventing obesity and chronic disease decreased at 59% of LHDs and stayed the same at 26% of LHDs since 2006, LHDs still contributed the same (12%) or a higher (62%) level of effort in these areas. Factors contributing to internal changes to address obesity and chronic disease prevention included momentum in the field of obesity prevention, opportunities to learn from other health departments, participation in obesity and chronic disease prevention initiatives, and flexible funding streams for chronic disease prevention. LHDs that received foundation funding or had a lead person or organizational unit coordinating or taking the lead on activities related to obesity and chronic disease prevention were more likely than other LHDs to engage in some activities related to obesity prevention. California LHDs are increasing the intensity and breadth of obesity and chronic disease prevention. Findings provide a benchmark from which further changes in the activities and funding sources of LHD chronic disease prevention practice may be measured.

  19. A 3-year follow-up study of Swedish youths committed to juvenile institutions: Frequent occurrence of criminality and health care use regardless of drug abuse.

    Science.gov (United States)

    Ståhlberg, Ola; Boman, Sofia; Robertsson, Christina; Kerekes, Nóra; Anckarsäter, Henrik; Nilsson, Thomas

    This 3-year follow-up study compares background variables, extent of criminality and criminal recidivism in the form of all court convictions, the use of inpatient care, and number of early deaths in Swedish institutionalized adolescents (N=100) with comorbid substance use disorders (SUD) and Attention-Deficit/Hyperactivity Disorder (ADHD) (n=25) versus those with SUD but no ADHD (n=30), and those without SUD (n=45). In addition it aims to identify whether potential risk factors related to these groups are associated with persistence in violent criminality. Results showed almost no significant differences between the three diagnostic groups, but the SUD plus ADHD group displayed a somewhat more negative outcome with regard to criminality, and the non-SUD group stood out with very few drug related treatment episodes. However, the rate of criminal recidivism was strikingly high in all three groups, and the use of inpatient care as well as the number of untimely deaths recorded in the study population was dramatically increased compared to a age matched general population group. Finally, age at first conviction emerged as the only significant predictor of persistence in violent criminality with an AUC of .69 (CI (95%) .54-.84, p=.02). Regardless of whether SUD, with or without ADHD, is at hand or not, institutionalized adolescents describe a negative course with extensive criminality and frequent episodes of inpatient treatment, and thus requires a more effective treatment than present youth institutions seem to offer today. However, the few differences found between the three groups, do give some support that those with comorbid SUD and ADHD have the worst prognosis with regard to criminality, health, and untimely death, and as such are in need of even more extensive treatment interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

  20. Chronic health conditions and work ability in the ageing workforce: the impact of work conditions, psychosocial factors and perceived health.

    Science.gov (United States)

    Koolhaas, Wendy; van der Klink, Jac J L; de Boer, Michiel R; Groothoff, Johan W; Brouwer, Sandra

    2014-05-01

    The aim of this study was to determine the influence of work conditions, psychosocial factors and perceived health on the association between the presence of a chronic health condition and (single-item) work ability among workers aged 45 years and older. In addition, we aimed to examine variables associated with work ability for workers with and without a chronic health condition separately. The data of this cross-sectional study were obtained from 5,247 workers aged 45 years and older in five different work sectors. Work ability was assessed with the first item of the Work Ability Index. The presence of a chronic health condition was assessed by self-report. Independent variables in the multivariable linear regression analysis were work conditions, psychosocial factors and perceived health status. The presence of a chronic health condition was negatively associated with work ability (B = -0.848). The strength of this association slightly attenuated after subsequently adding individual characteristics (B = -0.824), work conditions (B = -0.805) and more so after adding psychosocial factors (B = -0.704) and especially perceived health variables (B = -0.049) to the model. Variables associated with work ability for workers with and without a chronic health condition were similar. Perceived health and psychosocial factors, rather than work conditions, explained the association between the presence of a chronic health condition and work ability. Substantial differences in variables associated with work ability for workers with and without a chronic health condition were not found. Based on the lower mean scores for workers with a chronic health condition and work ability as well for predictors, these workers might have the most benefit by a policy focussing on enhancing these associated variables.

  1. Chronic health conditions and school performance in first graders: A prospective cohort study.

    Science.gov (United States)

    Hoffmann, Isabell; Diefenbach, Christiane; Gräf, Christine; König, Jochem; Schmidt, Martina F; Schnick-Vollmer, Kathleen; Blettner, Maria; Urschitz, Michael S

    2018-01-01

    Children with chronic health conditions may perform poorer at school. Associations may be confounded by numerous social factors. We aimed to estimate the effects of a chronic health condition on overall school performance in first graders with an emphasis on rigorous adjustment for potential confounders. A population-based cohort study was performed in the area of Mainz-Bingen (Germany). In 2015 all preschoolers were approached and the presence of a chronic health condition was assessed by parental questionnaires and preschool health examination data. The identification of a chronic health condition was based on special health care needs and presence of a doctor's diagnosis out of 24 school-relevant diseases. At the end of the first school year, overall school performance was assessed by teachers and rated on a 5-item scale ranging from -10 to +10. Of 3683 children approached, 2003 were enrolled. Overall school performance was available for 1462 children (51% boys). Of these, 52% suffered from a chronic health condition. Compared to children without a chronic health condition, children with special health care needs (15%) performed worse at school (adjusted mean difference: -0.95, 95% CI: [-1.55; -0.35], P = 0.002). Children with a doctor's diagnosis but without special health care needs (37%) did not perform worse at school. The effect was further analysed considering the extent of special health care needed. Chronic health conditions affect overall school performance early in primary school. To identify academically at-risk children, a chronic health condition identification based on special health care needs may be used.

  2. Epidemiology of frequent attenders: a 3-year historic cohort study comparing attendance, morbidity and prescriptions of one-year and persistent frequent attenders

    Directory of Open Access Journals (Sweden)

    ter Riet Gerben

    2009-01-01

    Full Text Available Abstract Background General Practitioners spend a disproportionate amount of time on frequent attenders. So far, trials on the effect of interventions on frequent attenders have shown negative results. However, these trials were conducted in short-term frequent attenders. It would be more reasonable to target intervention at persistent frequent attenders. Typical characteristics of persistent frequent attenders, as opposed to 1-year frequent attenders and non-frequent attenders, may generate hypotheses regarding modifiable factors on which new randomized trials may be designed. Methods We used the data of all 28,860 adult patients from 5 primary healthcare centers. Frequent attenders were patients whose attendance rate ranked in the (age and sex adjusted top 10 percent during 1 year (1-year frequent attenders or 3 years (persistent frequent attenders. All other patients on the register over the 3-year period were referred to as non-frequent attenders. The lists of medical problems coded by the GP using the International Classification of Primary Care (ICPC were used to assess morbidity. First, we determined which proportion of 1-year frequent attenders was still a frequent attender during the next two consecutive years and calculated the GPs' workload for these patients. Second, we compared morbidity and number of prescriptions for non-frequent attenders, 1-year frequent attenders and persistent frequent attenders. Results Of all 1-year frequent attenders, 15.4% became a persistent frequent attender equal to 1.6% of all patients. The 1-year frequent attenders (3,045; 10.6% were responsible for 39% of the face-to-face consultations; the 470 patients who would become persistent frequent attenders (1.6% were responsible for 8% of all consultations in 2003. Persistent frequent attenders presented more social problems, more psychiatric problems and medically unexplained physical symptoms, but also more chronic somatic diseases (especially diabetes

  3. Relationship Between Frequent Recreational Cannabis (Marijuana and Hashish) Use and Periodontitis in Adults in the United States: National Health and Nutrition Examination Survey 2011 to 2012.

    Science.gov (United States)

    Shariff, Jaffer A; Ahluwalia, Kavita P; Papapanou, Panos N

    2017-03-01

    Recreational use of cannabis, following its legalization in some countries, poses emergent oral and periodontal health concerns. The objective of this study is to examine the relationship between frequent recreational cannabis (FRC) (marijuana and hashish) use and periodontitis prevalence among adults in the United States. Data from the National Health and Nutrition Examination Survey (NHANES) 2011 to 2012 were analyzed. Primary outcome (periodontitis) was defined using the Centers for Disease Control and Prevention/American Academy of Periodontology classification as well as continuous measurements of probing depth (PD) and clinical attachment loss (AL). Exposure of interest was self-reported cannabis use, defined as "FRC use" versus "non-FRC use." Bivariate and multivariable regression models were performed using the entire analytical sample (model 1) as well as those who had never used tobacco (never-users) (model 2). Of 1,938 participants with available cannabis use data and essential covariates, 26.8% were FRC users. Mean number of sites per participant with PD ≥4, ≥6, and ≥8 mm and AL ≥3, ≥5, and ≥8 mm was significantly higher among FRC users than among non-FRC users (mean difference in number of PD sites: 6.9, 5.6, and 5.6; P <0.05; mean difference in number of AL sites: 12.7, 7.6, and 5.6; P <0.05). Average AL was higher among FRC users than among non-FRC users (1.8 versus 1.6 mm; P = 0.004). Bivariate analysis revealed positive (harmful) association between FRC use and severe periodontitis in the entire sample (odds ratio [OR]: 1.7, 95% confidence interval [CI]: 1.3 to 2.4; P = 0.002) as well as in never-smokers (OR: 2.0, 95% CI: 1.2 to 3.5; P = 0.01). This association was retained in multivariable models adjusted for demographics (age, sex, race/ethnicity, and income level), alcohol and tobacco use, diabetes mellitus, and past periodontal treatment (model 1: adjusted OR [aOR]: 1.4, 95% CI: 1.1 to 1.9; P = 0.07; model 2: aOR: 1.9, 95% CI: 1

  4. Health implications of chronic hepatosplenomegaly in Kenyan school-aged children chronically exposed to malarial infections and Schistosoma mansoni

    DEFF Research Database (Denmark)

    Wilson, Shona; Vennervald, Birgitte J; Kadzo, Hilda

    2010-01-01

    Hepatosplenomegaly among school-aged children in sub-Saharan Africa is highly prevalent. Two of the more common aetiological agents of hepatosplenomegaly, namely chronic exposure to malaria and Schistosoma mansoni infection, can result in similar clinical presentation, with the liver and spleen...... being chronically enlarged and of a firm consistency. Where co-endemic, the two parasites are thought to synergistically exacerbate hepatosplenomegaly. Here, two potential health consequences, i.e. dilation of the portal vein (indicative of increased portal pressure) and stunting of growth, were...... with hepatosplenomegaly. Children who presented with hepatosplenomegaly had the lowest height-for-age Z-scores. This study shows that hepatosplenomegaly associated with chronic exposure to malaria and schistosomiasis is not a benign symptom amongst school-aged children but has potential long-term health consequences....

  5. Measuring financial protection for health in families with chronic conditions in Rural China.

    Science.gov (United States)

    Jiang, Chunhong; Ma, Jingdong; Zhang, Xiang; Luo, Wujin

    2012-11-16

    As the world's largest developing country, China has entered into the epidemiological phase characterized by high life expectancy and high morbidity and mortality from chronic diseases. Cardiovascular diseases, chronic obstructive pulmonary diseases, and malignant tumors have become the leading causes of death since the 1990s. Constant payments for maintaining the health status of a family member who has chronic diseases could exhaust household resources, undermining fiscal support for other necessities and eventually resulting in poverty. The purpose of this study is to probe to what degree health expenditure for chronic diseases can impoverish rural families and whether the New Cooperative Medical Scheme can effectively protect families with chronic patients against catastrophic health expenditures. We used data from the 4th National Health Services Survey conducted in July 2008 in China. The rural sample we included in the analysis comprised 39,054 households. We used both households suffering from medical impoverishment and households with catastrophic health expenditures to compare the financial protection for families having a chronic patient with different insurance coverage statuses. We used a logistic regression model to estimate the impact of different benefit packages on health financial protection for families having a chronic patient. An additional 10.53% of the families with a chronic patient were impoverished because of healthcare expenditure, which is more than twice the proportion in families without a chronic patient. There is a higher catastrophic health expenditure incidence in the families with a chronic patient. The results of logistic regression show that simply adding extra benefits did not reduce the financial risks. There is a lack of effective financial protection for healthcare expenditures for families with a chronic patient in rural China, even though there is a high coverage rate with the New Cooperative Medical Schemes. Given the

  6. Modeling a Mobile Health Management Business Model for Chronic Kidney Disease.

    Science.gov (United States)

    Lee, Ying-Li; Chang, Polun

    2016-01-01

    In these decades, chronic kidney disease (CKD) has become a global public health problem. Information technology (IT) tools have been used widely to empower the patients with chronic disease (e.g., diabetes and hypertension). It is also a potential application to advance the CKD care. In this project, we analyzed the requirements of a mobile health management system for healthcare workers, patients and their families to design a health management business model for CKD patients.

  7. Adolescent overweight, obesity and chronic disease-related health practices: mediation by body image.

    Science.gov (United States)

    Farhat, Tilda; Iannotti, Ronald J; Caccavale, Laura J

    2014-01-01

    To examine whether body image mediates the association between overweight/obesity and chronic disease-related health practices (CDRHP), including lack of physical activity (PA), infrequent breakfast consumption (IBC), screen-based media use (SBM), and smoking. The 2006 Health Behaviors in School-Age Children survey was administered to a nationally representative sample of US students (n = 8,028) in grades 6-10 (mean age = 14.3 years). Outcome variables included self-reported measures of PA, SBM, IBC, and smoking. Body image was assessed with 5 items from the Body Investment Scale (α = 0.87) asking for agreement/disagreement with statements about one's body. Stratifying on gender, an initial regression model estimated the association between overweight/obesity and CDRHP. Mediation models that included body image were then compared to the initial model to determine the role of body image in the relationship between overweight/obesity and CDRHP. Among boys, body image mediated the relationships of overweight/obesity with SBM, and of obesity with IBC. Among girls, it mediated the relationships of obesity with PA, IBC, and smoking, and of overweight with SBM. As the prevalence of overweight/obesity among adolescent boys and girls remains high, efforts to improve their body image could result in less frequent engagement in CDRHP. © 2013 S. Karger GmbH, Freiburg.

  8. Adolescent Overweight, Obesity and Chronic Disease-Related Health Practices: Mediation by Body Image

    Directory of Open Access Journals (Sweden)

    Tilda Farhat

    2013-12-01

    Full Text Available Background/Aims: To examine whether body image mediates the association between overweight/obesity and chronic disease-related health practices (CDRHP, including lack of physical activity (PA, infrequent breakfast consumption (IBC, screen-based media use (SBM, and smoking. Methods: The 2006 Health Behaviors in School-Age Children survey was administered to a nationally representative sample of US students (n = 8,028 in grades 6-10 (mean age = 14.3 years. Outcome variables included self-reported measures of PA, SBM, IBC, and smoking. Body image was assessed with 5 items from the Body Investment Scale (α = 0.87 asking for agreement/disagreement with statements about one's body. Stratifying on gender, an initial regression model estimated the association between overweight/obesity and CDRHP. Mediation models that included body image were then compared to the initial model to determine the role of body image in the relationship between overweight/obesity and CDRHP. Results: Among boys, body image mediated the relationships of overweight/obesity with SBM, and of obesity with IBC. Among girls, it mediated the relationships of obesity with PA, IBC, and smoking, and of overweight with SBM. Conclusion: As the prevalence of overweight/obesity among adolescent boys and girls remains high, efforts to improve their body image could result in less frequent engagement in CDRHP.

  9. Lesbian, gay, & bisexual older adults: linking internal minority stressors, chronic health conditions, and depression.

    Science.gov (United States)

    Hoy-Ellis, Charles P; Fredriksen-Goldsen, Karen I

    2016-11-01

    This study aims to: (1) test whether the minority stressors disclosure of sexual orientation; and (2) internalized heterosexism are predictive of chronic physical health conditions; and (3) depression; (4) to test direct and indirect relationships between these variables; and (5) whether chronic physical health conditions are further predictive of depression, net of disclosure of sexual orientation and internalized heterosexism. Secondary analysis of national, community-based surveys of 2349 lesbian, gay, and bisexual adults aged 50 and older residing in the US utilizing structural equation modeling. Congruent with minority stress theory, disclosure of sexual orientation is indirectly associated with chronic physical health conditions and depression, mediated by internalized heterosexism with a suppressor effect. Internalized heterosexism is directly associated with chronic physical health conditions and depression, and further indirectly associated with depression mediated by chronic physical health conditions. Finally, chronic physical health conditions have an additional direct relationship with depression, net of other predictor variables. Minority stressors and chronic physical health conditions independently and collectively predict depression, possibly a synergistic effect. Implications for depression among older sexual minority adults are discussed.

  10. The eHealth Enhanced Chronic Care Model: a theory derivation approach.

    Science.gov (United States)

    Gee, Perry M; Greenwood, Deborah A; Paterniti, Debora A; Ward, Deborah; Miller, Lisa M Soederberg

    2015-04-01

    Chronic illnesses are significant to individuals and costly to society. When systematically implemented, the well-established and tested Chronic Care Model (CCM) is shown to improve health outcomes for people with chronic conditions. Since the development of the original CCM, tremendous information management, communication, and technology advancements have been established. An opportunity exists to improve the time-honored CCM with clinically efficacious eHealth tools. The first goal of this paper was to review research on eHealth tools that support self-management of chronic disease using the CCM. The second goal was to present a revised model, the eHealth Enhanced Chronic Care Model (eCCM), to show how eHealth tools can be used to increase efficiency of how patients manage their own chronic illnesses. Using Theory Derivation processes, we identified a "parent theory", the Chronic Care Model, and conducted a thorough review of the literature using CINAHL, Medline, OVID, EMBASE PsychINFO, Science Direct, as well as government reports, industry reports, legislation using search terms "CCM or Chronic Care Model" AND "eHealth" or the specific identified components of eHealth. Additionally, "Chronic Illness Self-management support" AND "Technology" AND several identified eHealth tools were also used as search terms. We then used a review of the literature and specific components of the CCM to create the eCCM. We identified 260 papers at the intersection of technology, chronic disease self-management support, the CCM, and eHealth and organized a high-quality subset (n=95) using the components of CCM, self-management support, delivery system design, clinical decision support, and clinical information systems. In general, results showed that eHealth tools make important contributions to chronic care and the CCM but that the model requires modification in several key areas. Specifically, (1) eHealth education is critical for self-care, (2) eHealth support needs to be

  11. Association between nutritional status and subjective health status in chronically ill children attending special schools.

    Science.gov (United States)

    Joosten, Koen; van der Velde, Kelly; Joosten, Pieter; Rutten, Hans; Hulst, Jessie; Dulfer, Karolijn

    2016-04-01

    In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the association between nutritional status and subjective health status in chronically ill children attending special schools. Overall, 642 children, median age 9.8 years (IQR 7.7-11.5), 60 % male, 72 % Caucasian, were included in this prospective study in nine special schools for chronically ill children in the Netherlands. Overall malnutrition was assessed as: acute malnutrition (nutritional risk-screening tool STRONGkids. Subjective health status was assessed with EQ-5D. Overall, 16 % of the children had overall malnutrition: 3 % acute and 13 % chronic malnutrition. Nurses reported 'some/severe problems' on the health status dimensions mobility (15 %), self-care (17 %), usual activities (19 %), pain/discomfort (22 %), and anxiety/depression (22 %) in chronically ill children. Their mean visual analogue scale score (VAS) was 73.0 (SD 11.1). Malnutrition, medication usage, and younger age explained 38 % of the variance of the VAS score. The presence of overall malnutrition in chronically ill children attending special schools was associated with lower subjective health status, especially in younger children and in those with chronic medication usage. Therefore, it is important to develop and use profile-screening tools to identify these children.

  12. Does trust in health care influence the use of complementary and alternative medicine by chronically ill people.

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Rijken, P.M.

    2006-01-01

    Background: People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that chronically ill people turn to

  13. Negotiating health and chronic illness in Filipino-Australians: a qualitative study with implications for health promotion.

    Science.gov (United States)

    Maneze, Della; Ramjan, Lucie; DiGiacomo, Michelle; Everett, Bronwyn; Davidson, Patricia Mary; Salamonson, Yenna

    2018-08-01

    In spite of the healthy immigrant effect, the prevalence of lifestyle-related chronic diseases among migrants is reported to approximate that of the host country with longer duration of stay. For example, higher rates of chronic diseases such as Type 2 diabetes and hypertension have been observed among Filipino migrants and these have been linked to acculturation. The aim of this study was to explore the experiences of Filipino-Australian migrants in managing their chronic health conditions in a Western host country. This paper reports on qualitative findings of a mixed methods study that used an explanatory sequential design. Nine focus group discussions were undertaken with 58 Filipino-Australian migrants with chronic disease. Thematic analysis was undertaken using a five-stage general purpose thematic framework ensuring that themes closely identified key participants' experiences . Findings revealed that health benefits provided by the health system in Australia were considered advantageous. However, a lack of social and instrumental support compounded isolation and disempowerment, limiting self-management strategies for chronic illnesses. Cultural beliefs and practices influenced their knowledge, attitude to and management of chronic disease, which health service providers overlooked because of perceived acculturation and English language skills. Overall this study has clearly identified recognition of cultural beliefs, language needs and support as three core needs of Filipino-Australian migrants with the elderly the most vulnerable. This paper highlights that self-management of chronic disease among elderly Filipino immigrants may be adversely affected by host language difficulties, a lack of social support and cultural issues, impacting on access to services, health-seeking behaviours and participation in health promotion initiatives. Language, culture-specific health interventions and resources and enhancing social support are likely important strategies in

  14. Absenteeism and Employer Costs Associated With Chronic Diseases and Health Risk Factors in the US Workforce

    OpenAIRE

    Asay, Garrett R. Beeler; Roy, Kakoli; Lang, Jason E.; Payne, Rebecca L.; Howard, David H.

    2016-01-01

    Introduction Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). Methods We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measur...

  15. Oral health in patients with chronic kidney disease - emphasis on periodontitis

    OpenAIRE

    Nylund, Karita

    2017-01-01

    ORAL HEALTH IN PATIENTS WITH CHRONIC KIDNEY DISEASE - EMPHASIS ON PERIODONTITIS Background: Periodontitis is a common bacteria-induced chronic inflammatory disease with mild symptoms. It leads to destruction of the periodontium and finally to tooth loss in a susceptible patient. Periodontitis is associated with many systemic diseases such as diabetes, atherosclerosis, cardiovascular diseases, and chronic kidney disease (CKD) through low-grade systemic inflammation. However, no causality c...

  16. Innovative Approaches in Chronic Disease Management: Health Literacy Solutions and Opportunities for Research Validation.

    Science.gov (United States)

    Villaire, Michael; Gonzalez, Diana Peña; Johnson, Kirby L

    2017-01-01

    This chapter discusses the need for innovative health literacy solutions to combat extensive chronic disease prevalence and costs. The authors explore the intersection of chronic disease management and health literacy. They provide specific examples of successful health literacy interventions for managing several highly prevalent chronic diseases. This is followed by suggestions on pairing research and practice to support effective disease management programs. In addition, the authors discuss strategies for collection and dissemination of knowledge gained from collaborations between researchers and practitioners. They identify current challenges specific to disseminating information from the health literacy field and offer potential solutions. The chapter concludes with a brief look at future directions and organizational opportunities to integrate health literacy practices to address the need for effective chronic disease management.

  17. Illness cognitions as a pathway between religiousness and subjective health in chronic cardiac patients.

    Science.gov (United States)

    Karademas, Evangelos C

    2010-03-01

    The aim of this study was to examine the role of illness cognitions as a possible pathway between religiousness and subjective health in chronic illness. A sample of 135 chronic cardiac patients completed questionnaires about intrinsic religiousness, frequency of church service attendance, basic illness cognitions (i.e., helplessness, illness acceptance, perceived benefits), and physical and emotional well-being. According to the results, religiousness was significantly associated with subjective health. However, this relationship was indirect, with helplessness and illness acceptance serving as mediators between intrinsic religiousness and health. This finding is significant for understanding the complex relation of religiousness to chronic patients' well-being.

  18. Health literacy, self-perceived health and self-reported chronic morbidity among older people in Kosovo.

    Science.gov (United States)

    Toci, Ervin; Burazeri, Genc; Jerliu, Naim; Sørensen, Kristine; Ramadani, Naser; Hysa, Bajram; Brand, Helmut

    2015-09-01

    The aim was to describe health literacy among the older population of Kosovo, an Albanian speaking post-war country in the Western Balkans, in the context of self-perceived health status and self-reported chronic morbidity. A cross-sectional study was conducted in Kosovo in 2011 including 1753 individuals aged ≥ 65 years (886 men, 867 women; mean age 73.4 ± 6.3 years; response rate: 77%). Participants were asked to assess, on a scale from 1 to 5, their level of difficulty with regard to access, understanding, appraisal and application of health information. Sub-scale scores and an overall health literacy score were calculated for each participant. Information on self-perceived health status, presence and number of chronic diseases and socioeconomic characteristics was also collected. Mean values of the overall health literacy score and all sub-scale scores (access, understanding, appraisal and application) were lower among older people who reported a poorer health status or at least one chronic condition compared with individuals who perceived their health status as good or had no chronic conditions (p association between health literacy levels and self-perceived health and chronic morbidity in this post-war European population. The putative link with chronic morbidity and lower adherence to health services is hard to establish through this cross-sectional study. Prospective population-based studies should be conducted in Kosovo and other transitional settings to replicate these findings and properly address the causal relationship between health literacy and health status. © The Author (2014). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Comparison of Health Information Technology Use Between American Adults With and Without Chronic Health Conditions: Findings From The National Health Interview Survey 2012.

    Science.gov (United States)

    Zhang, Yan; Lauche, Romy; Sibbritt, David; Olaniran, Bolanle; Cook, Ronald; Adams, Jon

    2017-10-05

    Health information technology (HIT) is utilized by people with different chronic conditions such as diabetes and hypertension. However, there has been no comparison of HIT use between persons without a chronic condition, with one chronic condition, and multiple (≥2) chronic conditions (MCCs). The aim of the study was to assess the difference in HIT use between persons without a chronic condition, with one chronic condition, and with MCCs, to describe the characteristics of HIT use among those with chronic conditions and to identify the predictors of HIT use of the persons with one chronic condition and MCCs. A secondary data analysis was conducted in spring 2017 using the National Health Interview Survey (NHIS) 2012 Family Core and Sample Adult Core datasets that yielded 34,525 respondents aged 18 years and older. Measures included overall HIT use (ie, any use of the following five HIT on the Internet: seeking health information, ordering prescription, making appointment, emailing health provider, and using health chat groups), as well as sociodemographic and health-related characteristics. Sociodemographic and health characteristics were compared between HIT users and nonusers among those who reported having at least one chronic condition using chi-square tests. Independent predictors of HIT use were identified using multiple logistic regression analyses for those with one chronic condition, with MCCs, and without a chronic condition. Analyses were weighted and performed at significance level of .005. In 2012, adults with one health chronic condition (raw count 4147/8551, weighted percentage 48.54%) was significantly higher than among those with MCCs (3816/9637, 39.55%) and those with none of chronic condition (7254/16,337, 44.40%, PHIT use. Chi-square tests revealed that among adults with chronic conditions, those who used HIT were significantly different from their counterpart peers who did not use HIT in terms of sociodemographic and health characteristics

  20. Frequently Asked Questions (FAQs)

    Science.gov (United States)

    are the potential health risks from transportation of depleted uranium metal or oxide? Other Skip Navigation Depleted UF6 Logo (Go to Home Page) Uranium Quick Fact Energy from Uranium One ton of natural uranium can produce more than 40 million kilowatt-hours of electricity. This is equivalent

  1. Frequent flyer business travelers: major exposure hazards.

    Science.gov (United States)

    Tompkins, Olga S; Randolph, Susan A; Ostendorf, Judith S

    2005-02-01

    Bagshaw (2004) notes "the modern commercial aircraft cabin is maintained with adequate environmental control for the comfort of most healthy individuals" (p. 417). Occupational health nurses frequently deal with a population that may include unhealthy individuals or those with pre-existing conditions. It is critical for occupational health nurses to stay current with major hazards faced by frequent flyer business travelers to assist in identifying and preventing adverse health effects associated with these exposures.

  2. Effects of a Self-Directed Nutrition Intervention among Adults with Chronic Health Conditions

    Science.gov (United States)

    Baruth, Meghan; Wilcox, Sara; Jake-Schoffman, Danielle E.; Schlaff, Rebecca A.; Goldufsky, Tatum M.

    2018-01-01

    Chronic diseases are common among adults. A healthy diet may be beneficial for managing the consequences of such conditions. The purpose of this study was to evaluate the effects of a self-directed nutrition program on dietary behaviors among adults with chronic health conditions. As part of a larger trial examining the effects of a self-directed…

  3. Association between nutritional status and subjective health status in chronically ill children attending special schools

    NARCIS (Netherlands)

    K.F.M. Joosten (Koen); K. van der Velde (Kelly); P. Joosten (Pieter); H. Rutten (Hans); J.M. Hulst (Jessie); K. Dulfer (Karolijn)

    2016-01-01

    textabstractPurpose: In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the

  4. The South Australia Health Chronic Disease Self-Management Internet Trial

    Science.gov (United States)

    Lorig, Kate; Ritter, Philip L.; Plant, Kathryn; Laurent, Diana D.; Kelly, Pauline; Rowe, Sally

    2013-01-01

    Objectives: To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method: Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures,…

  5. Forging partnerships between rural women with chronic conditions and their health care providers.

    Science.gov (United States)

    Cudney, Shirley; Weinert, Clarann; Kinion, Elizabeth

    2011-03-01

    Successful adaptation to chronic illness is enhanced by active client-health care provider partnerships. The purposes of this article are to (a) examine the health care partnership needs of western rural women with chronic illness who participated in a computer-based support and education project, (b) describe how the role of the women in the partnership can be maximized by the use of a personal health record and improving health literacy, and (c) discuss ways health care providers can enhance their role in the partnership by careful listening and creating environments conducive to forging productive client-provider partnerships.

  6. Chronic pain epidemiology: from aetiology to public health

    National Research Council Canada - National Science Library

    Croft, Peter, Prof; Blyth, Fiona M; Windt, Danielle van der

    2010-01-01

    "Chronic pain is a major cause of distress, disability, and work loss, and it is becoming increasingly prevalent through the general move towards an ageing population, which impacts dramatically upon...

  7. Chronic Lymphocytic Leukemia Treatment (PDQ®)—Health Professional Version

    Science.gov (United States)

    Chronic lymphocytic leukemia (CLL) treatment options can include observation, steroids, chemotherapy, targeted therapy, and/or stem cell transplant. Get detailed information about newly diagnosed and recurrent CLL and available treatment modalities in this summary for clinicians.

  8. Obstetric Outcomes and Delivery-Related Health Care Utilization and Costs Among Pregnant Women With Multiple Chronic Conditions

    Science.gov (United States)

    Winkelman, Tyler N. A.; Heisler, Michele; Dalton, Vanessa K.

    2018-01-01

    Our objective was to measure obstetric outcomes and delivery-related health care utilization and costs among pregnant women with multiple chronic conditions. We used 2013–2014 data from the National Inpatient Sample to measure obstetric outcomes and delivery-related health care utilization and costs among women with no chronic conditions, 1 chronic condition, and multiple chronic conditions. Women with multiple chronic conditions were at significantly higher risk than women with 1 chronic condition or no chronic conditions across all outcomes measured. High-value strategies are needed to improve birth outcomes among vulnerable mothers and their infants. PMID:29420168

  9. Introduction to Health Promotion for People with Chronic Illness and Disability

    Science.gov (United States)

    Chan, Fong; Chiu, Chung-Yi; Bezyak, Jill L.; Keegan, John

    2012-01-01

    Health promotion has received increasing attention in rehabilitation counseling research. Health promotion research contributes to theory building and provides the foundation for empirically supported interventions that can improve the health-related quality of life and employment outcomes of people with chronic illness and disability. In this…

  10. Research Priorities to Advance the Health and Health Care of Older Adults with Multiple Chronic Conditions.

    Science.gov (United States)

    Tisminetzky, Mayra; Bayliss, Elizabeth A; Magaziner, Jay S; Allore, Heather G; Anzuoni, Kathryn; Boyd, Cynthia M; Gill, Thomas M; Go, Alan S; Greenspan, Susan L; Hanson, Leah R; Hornbrook, Mark C; Kitzman, Dalane W; Larson, Eric B; Naylor, Mary D; Shirley, Benjamin E; Tai-Seale, Ming; Teri, Linda; Tinetti, Mary E; Whitson, Heather E; Gurwitz, Jerry H

    2017-07-01

    To prioritize research topics relevant to the care of the growing population of older adults with multiple chronic conditions (MCCs). Survey of experts in MCC practice, research, and policy. Topics were derived from white papers, funding announcements, or funded research projects relating to older adults with MCCs. Survey conducted through the Health Care Systems Research Network (HCSRN) and Claude D. Pepper Older Americans Independence Centers (OAICs) Advancing Geriatrics Infrastructure and Network Growth Initiative, a joint endeavor of the HCSRN and OAICs. Individuals affiliated with the HCSRN or OAICs and national MCC experts, including individuals affiliated with funding agencies having MCC-related grant portfolios. A "top box" methodology was used, counting the number of respondents selecting the top response on a 5-point Likert scale and dividing by the total number of responses to calculate a top box percentage for each of 37 topics. The highest-ranked research topics relevant to the health and healthcare of older adults with MCCs were health-related quality of life in older adults with MCCs; development of assessment tools (to assess, e.g., symptom burden, quality of life, function); interactions between medications, disease processes, and health outcomes; disability; implementation of novel (and scalable) models of care; association between clusters of chronic conditions and clinical, financial, and social outcomes; role of caregivers; symptom burden; shared decision-making to enhance care planning; and tools to improve clinical decision-making. Study findings serve to inform the development of a comprehensive research agenda to address the challenges relating to the care of this "high-need, high-cost" population and the healthcare delivery systems responsible for serving it. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  11. Physiological health parameters among college students to promote chronic disease prevention and health promotion

    Directory of Open Access Journals (Sweden)

    David R. Black

    2017-09-01

    Full Text Available This study aimed to provide physiologic health risk parameters by gender and age among college students enrolled in a U.S. Midwestern University to promote chronic disease prevention and ameliorate health. A total of 2615 college students between 18 and 25 years old were recruited annually using a series of cross-sectional designs during the spring semester over an 8-year period. Physiologic parameters measured included body mass index (BMI, percentage body fat (%BF, blood serum cholesterol (BSC, and systolic (SBP and diastolic (DBP blood pressure. These measures were compared to data from NHANES to identify differences in physiologic parameters among 18–25 year olds in the general versus college-enrolled population. A quantitative instrument assessed health behaviors related to physical activity, diet, and licit drug use. Results suggest that average physiologic parameters from 18 to 25 year olds enrolled in college were significantly different from parameters of 18–25 year olds in the general population. Generally, men reported higher percentiles for BMI, SBP, and DBP than women, but lower %BF and BSC percentiles than women at each age. SBP and DBP significantly increased with age and alcohol use. Students in the lowest (5th and highest percentiles (95th and 75th, for most age groups, demonstrated DBP, BMI, and %BF levels potentially problematic for health and future development of chronic disease based on percentiles generated for their peer group. Newly identified physiologic parameters may be useful to practitioners serving college students 18–25 years old from similar institutions in determining whether behavior change or treatment interventions are appropriate.

  12. Health Care Autonomy in Children with Chronic Conditions: Implications for Self Care and Family Management

    Science.gov (United States)

    Beacham, Barbara L.; Deatrick, Janet A.

    2013-01-01

    Synopsis Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review will link the three concepts and discuss implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed. PMID:23659815

  13. Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems

    OpenAIRE

    Rosen, David L.; Grodensky, Catherine A.; Holley, Tara K.

    2016-01-01

    Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative samp...

  14. Strategy to fight against malnutrition in chronic patients with complex health needs

    OpenAIRE

    Burgos, Rosa; Joaquin, Clara; Blay, Carles; Ledesma, Albert; Figueiras, Guadalupe; Pérez-Portabella, Cleofe; Granados, Antonio; Gómez, Mª Dolores; González, Asunción; Sarquella, Esther; Amil, Paloma; Vaqué, Cristina

    2016-01-01

    Disease-related malnutrition (DRM) is a prevalent condition amongst older people as well as patients in all healthcare settings around the world. Chronic patients with complex health needs (CPCHN defined as those with complex chronic conditions that involve multiple health requirements, complex social support needs, or both) are especially vulnerable to malnutrition. Malnutrition is associated with increased morbidity, a higher hospital admission and readmission rate, increased needs for soci...

  15. Scalable Frequent Subgraph Mining

    KAUST Repository

    Abdelhamid, Ehab

    2017-06-19

    A graph is a data structure that contains a set of nodes and a set of edges connecting these nodes. Nodes represent objects while edges model relationships among these objects. Graphs are used in various domains due to their ability to model complex relations among several objects. Given an input graph, the Frequent Subgraph Mining (FSM) task finds all subgraphs with frequencies exceeding a given threshold. FSM is crucial for graph analysis, and it is an essential building block in a variety of applications, such as graph clustering and indexing. FSM is computationally expensive, and its existing solutions are extremely slow. Consequently, these solutions are incapable of mining modern large graphs. This slowness is caused by the underlying approaches of these solutions which require finding and storing an excessive amount of subgraph matches. This dissertation proposes a scalable solution for FSM that avoids the limitations of previous work. This solution is composed of four components. The first component is a single-threaded technique which, for each candidate subgraph, needs to find only a minimal number of matches. The second component is a scalable parallel FSM technique that utilizes a novel two-phase approach. The first phase quickly builds an approximate search space, which is then used by the second phase to optimize and balance the workload of the FSM task. The third component focuses on accelerating frequency evaluation, which is a critical step in FSM. To do so, a machine learning model is employed to predict the type of each graph node, and accordingly, an optimized method is selected to evaluate that node. The fourth component focuses on mining dynamic graphs, such as social networks. To this end, an incremental index is maintained during the dynamic updates. Only this index is processed and updated for the majority of graph updates. Consequently, search space is significantly pruned and efficiency is improved. The empirical evaluation shows that the

  16. Oppositional behavior and longitudinal predictions of early adulthood mental health problems in chronic tic disorders.

    Science.gov (United States)

    Thériault, Marie-Claude G; Bécue, Jean-Cyprien; Lespérance, Paul; Chouinard, Sylvain; Rouleau, Guy A; Richer, Francois

    2018-03-16

    Chronic tic disorders (TD) are associated with a number of psychological problems such as attention-deficit hyperactivity disorder (ADHD), obsessive-compulsive behavior (OCB), oppositional-defiant disorder (ODD) as well as anxious and depressive symptoms. ODD is often considered a risk factor for many psychological symptoms and recent work suggests that different ODD dimensions show independent predictions of later psychological problems. This study examined the longitudinal predictions between ODD dimensions of Irritability and Defiance and the most frequent comorbidities in TD from childhood to early adulthood. From an initial sample of 135, parent reports were obtained on 58 participants with TD using standard clinical questionnaires and semi-structured interviews. Defiance symptoms decreased from baseline to follow-up whereas Irritability symptoms were more stable over time. In multiple regressions, Irritability in childhood predicted anxiety and OCB in early adulthood while Defiance in childhood predicted ADHD and conduct disorder symptoms in early adulthood. No developmental link was found for depressive symptoms. Results indicate that ODD dimensions are developmentally linked to both internalizing and externalizing adult mental health symptoms in TD. Copyright © 2018. Published by Elsevier B.V.

  17. Results from a national survey on chronic care management by health plans.

    Science.gov (United States)

    Mattke, Soeren; Higgins, Aparna; Brook, Robert

    2015-05-01

    The growing burden of chronic disease necessitates innovative approaches to help patients and to ensure the sustainability of our healthcare system. Health plans have introduced chronic care management models, but systematic data on the type and prevalence of different approaches are lacking. Our goal was to conduct a systematic examination of chronic care management programs offered by health plans in the commercial market (ie, in products sold to employers and individuals. We undertook a national survey of a representative sample of health plans (70 plans, 36% response rate) and 6 case studies on health plans' programs to improve chronic care in the commercial market. The data underwent descriptive and bivariate analyses. All plans, regardless of size, location, and ownership, offer chronic care management programs, which identify eligible members from claims data and match them to interventions based on overall risk and specific care gaps. Plans then report information on care gaps to providers and offer self-management support to their members. While internal evaluations suggest that the interventions improve care and reduce cost, plans report difficulties in engaging members and providers. To overcome those obstacles, plans are integrating their programs into provider work flow, collaborating with providers on care redesign and leveraging patient support technologies. Our study shows that chronic care management programs have become a standard component of the overall approach used by health plans to manage the health of their members.

  18. Effective behavioral intervention strategies using mobile health applications for chronic disease management: a systematic review.

    Science.gov (United States)

    Lee, Jung-Ah; Choi, Mona; Lee, Sang A; Jiang, Natalie

    2018-02-20

    Mobile health (mHealth) has continuously been used as a method in behavioral research to improve self-management in patients with chronic diseases. However, the evidence of its effectiveness in chronic disease management in the adult population is still lacking. We conducted a systematic review to examine the effectiveness of mHealth interventions on process measures as well as health outcomes in randomized controlled trials (RCTs) to improve chronic disease management. Relevant randomized controlled studies that were published between January 2005 and March 2016 were searched in six databases: PubMed, CINAHL, EMBASE, the Cochrane Library, PsycINFO, and Web of Science. The inclusion criteria were RCTs that conducted an intervention using mobile devices such as smartphones or tablets for adult patients with chronic diseases to examine disease management or health promotion. Of the 12 RCTs reviewed, 10 of the mHealth interventions demonstrated statistically significant improvement in some health outcomes. The most common features of mHealth systems used in the reviewed RCTs were real-time or regular basis symptom assessments, pre-programed reminders, or feedbacks tailored specifically to the data provided by participants via mHealth devices. Most studies developed their own mHealth systems including mobile apps. Training of mHealth systems was provided to participants in person or through paper-based instructions. None of the studies reported the relationship between health outcomes and patient engagement levels on the mHealth system. Findings from mHealth intervention studies for chronic disease management have shown promising aspects, particularly in improving self-management and some health outcomes.

  19. The role of culture in health literacy and chronic disease screening and management.

    Science.gov (United States)

    Shaw, Susan J; Huebner, Cristina; Armin, Julie; Orzech, Kathryn; Orzech, Katherine; Vivian, James

    2009-12-01

    Cultural and language differences and socioeconomic status interact with and contribute to low health literacy, defined as the inability to understand or act on medical/therapeutic instructions. Health literacy is increasingly recognized as an important factor in patient compliance, cancer screening utilization, and chronic disease outcomes. Commendable efforts have been initiated by the American Medical Association and other organizations to address low health literacy among patients. Less work has been done, however, to place health literacy in the broader context of socioeconomic and cultural differences among patients and providers that hinder communication and compliance. This review examines cultural influences on health literacy, cancer screening and chronic disease outcomes. We argue that cultural beliefs around health and illness contribute to an individual's ability to understand and act on a health care provider's instructions. This paper proposes key aspects of the intersection between health literacy and culturally varying beliefs about health which merit further exploration.

  20. The value of personal health records for chronic disease management: what do we know?

    Science.gov (United States)

    Tenforde, Mark; Jain, Anil; Hickner, John

    2011-05-01

    Electronic personal health records (PHRs) allow patients access to their medical records, self-management tools, and new avenues of communication with their health care providers. They will likely become a valuable component of the primary care Patient-centered Medical Home model. Primary care physicians, who manage the majority of chronic disease, will use PHRs to help patients manage their diabetes and other chronic diseases requiring continuity of care and enhanced information flow between patient and physician. In this brief report, we explore the evidence for the value of PHRs in chronic disease management. We used a comprehensive review of MEDLINE articles published in English between January 2000 and September 2010 on personal health records and related search terms. Few published articles have described PHR programs designed for use in chronic disease management or PHR adoption and attitudes in the context of chronic disease management. Only three prospective randomized trials have evaluated the benefit of PHR use in chronic disease management, all in diabetes care. These trials showed small improvements in some but not all diabetes care measures. All three trials involved additional interventions, making it difficult to determine the influence of patient PHR use in improved outcomes. The evidence remains sparse to support the value of PHR use for chronic disease management. With the current policy focus on meaningful use of electronic and personal health records, it is crucial to investigate and learn from new PHR products so as to maximize the clinical value of this tool.

  1. The health system burden of chronic disease care: an estimation of provider costs of selected chronic diseases in Uganda.

    Science.gov (United States)

    Settumba, Stella Nalukwago; Sweeney, Sedona; Seeley, Janet; Biraro, Samuel; Mutungi, Gerald; Munderi, Paula; Grosskurth, Heiner; Vassall, Anna

    2015-06-01

    To explore the chronic disease services in Uganda: their level of utilisation, the total service costs and unit costs per visit. Full financial and economic cost data were collected from 12 facilities in two districts, from the provider's perspective. A combination of ingredients-based and step-down allocation costing approaches was used. The diseases under study were diabetes, hypertension, chronic obstructive pulmonary disease (COPD), epilepsy and HIV infection. Data were collected through a review of facility records, direct observation and structured interviews with health workers. Provision of chronic care services was concentrated at higher-level facilities. Excluding drugs, the total costs for NCD care fell below 2% of total facility costs. Unit costs per visit varied widely, both across different levels of the health system, and between facilities of the same level. This variability was driven by differences in clinical and drug prescribing practices. Most patients reported directly to higher-level facilities, bypassing nearby peripheral facilities. NCD services in Uganda are underfunded particularly at peripheral facilities. There is a need to estimate the budget impact of improving NCD care and to standardise treatment guidelines. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  2. Health-related quality of life and health care use in cancer survivors compared with patients with chronic diseases.

    Science.gov (United States)

    Heins, Marianne J; Korevaar, Joke C; Hopman, Petra E P C; Donker, Gé A; Schellevis, François G; Rijken, Mieke P M

    2016-03-15

    The number of cancer survivors is steadily increasing and these patients often experience long-lasting health problems. To make care for cancer survivors sustainable for the future, it would be relevant to put the effects of cancer in this phase into perspective. Therefore, the authors compared health-related quality of life (HRQOL) and health care use among cancer survivors with that of patients with chronic diseases. Patients diagnosed at age >18 years with a cancer with a 5-year survival rate > 20% and no distant metastases at the time of diagnosis and patients aged >18 years with physician-diagnosed somatic chronic diseases without cancer were sent a questionnaire. HRQOL was measured with the RAND-36, a measure of HRQOL. Self-reported health care use was measured for general practitioner care, specialist care, rehabilitative care, physical therapy, ambulatory mental health care, and occupational health care. A total of 601 cancer survivors and 1052 patients with chronic diseases without cancer were included in the current study. Multimorbidity was observed in 63% of the cancer survivors and 61% of the patients with chronic diseases. The HRQOL of the cancer survivors was significantly better than that of patients with chronic diseases after adjustment for age and sex. For the mental functioning subscale, no significant differences were found between the 2 groups. Cancer survivors were found to be less likely to have visited a general practitioner or cardiologist compared with patients with chronic diseases. When considering physical HRQOL and health care use, cancer survivors appear to fare better than the average patient with chronic diseases. No difference in mental functioning was observed in the current study. © 2016 American Cancer Society.

  3. Does trust in health care influence the use of complementary and alternative medicine by chronically ill patients?

    NARCIS (Netherlands)

    Brink-Muinen, A. van den; Rijken, M.

    2006-01-01

    Background: Patients’ trust in health care (professionals) is essential for the effectiveness of health care, especially for chronically ill patients, since chronic diseases are by definition (partly) incurable. Therefore, it may be understandable that the chronically ill turn to complementary and

  4. Psychosocial and environmental factors in the prognosis of individuals with chronic pain and comorbid mental health.

    Science.gov (United States)

    Hruschak, Valerie; Cochran, Gerald

    2017-08-01

    Chronic pain has considerable medical, social, and economic implications as its high prevalence rate and negative societal burden provides justification that it is a major health issue. The value of understanding psychological, social, and environmental factors in chronic pain has become widely recognized and accepted as a biopsychosocial phenomenon in which the social work perspective offers a valuable lens. Through the critical application of systems theory and ecological perspective, accompanied with the diathesis stress model, this article examines psychosocial and environmental influences as being contributory factors in the prognosis of individuals with chronic pain and comorbid mental health disorders. The social work profession will also be explored as playing a definite role in addressing elements pertaining to pain management depicted from these theories. Lastly, implications for research, policy, and practice will be reviewed to better understand the association between psychosocial and environmental influences of individuals with chronic pain and comorbid mental health issues.

  5. Use of Health Information and Communication Technologies to Promote Health and Manage Behavioral Risk Factors Associated with Chronic Disease: Applications in the Field of Health Education

    Science.gov (United States)

    Stellefson, Michael; Alber, Julia M.; Wang, Min Qi; Eddy, James M.; Chaney, Beth H.; Chaney, J. Don

    2015-01-01

    This special issue provides real-world examples of the diverse methods health education researchers are using to expand existing applications of information and communication technologies (ICTs) for health promotion and chronic disease management. The original and review articles presented in this special issue investigate eHealth, mHealth, and…

  6. The Community Child Health Network Life Stress Interview: a brief chronic stress measure for community health research.

    Science.gov (United States)

    Tanner Stapleton, Lynlee R; Dunkel Schetter, Christine; Dooley, Larissa N; Guardino, Christine M; Huynh, Jan; Paek, Cynthia; Clark-Kauffman, Elizabeth; Schafer, Peter; Woolard, Richard; Lanzi, Robin Gaines

    2016-07-01

    Chronic stress is implicated in many theories as a contributor to a wide range of physical and mental health problems. The current study describes the development of a chronic stress measure that was based on the UCLA Life Stress Interview (LSI) and adapted in collaboration with community partners for use in a large community health study of low-income, ethnically diverse parents of infants in the USA (Community Child Health Network [CCHN]). We describe the instrument, its purpose and adaptations, implementation, and results of a reliability study in a subsample of the larger study cohort. Interviews with 272 mothers were included in the present study. Chronic stress was assessed using the CCHN LSI, an instrument designed for administration by trained community interviewers to assess four domains of chronic stress, each rated by interviewers. Significant correlations ranging from small to moderate in size between chronic stress scores on this measure, other measures of stress, biomarkers of allostatic load, and mental health provide initial evidence of construct and concurrent validity. Reliability data for interviewer ratings are also provided. This relatively brief interview (15 minutes) is available for use and may be a valuable tool for researchers seeking to measure chronic stress reliably and validly in future studies with time constraints.

  7. Health Services for Management of Chronic Non-Cancer Pain in Kuwait: A Case Study Review.

    Science.gov (United States)

    Lakha, S Fatima; Pennefather, Peter; Badr, Hanan E; Mailis-Gagnon, Angela

    2016-01-01

    The experience of chronic pain is universal, yet pain management services delivered by health professionals vary substantially, depending on the context and patient. This review is a part of a series that has examined the issue of chronic non-cancer pain services and management in different global cities. The review is structured as a case study of the availability of management services for people living with chronic non-cancer pain within the context of the Kuwaiti health systems, and the cases are built from evidence in the published literature identified through a comprehensive review process. The evolution of the organizational structure of the public and private health systems in Kuwait is described. These are discussed in terms of their impact on the delivery of comprehensive chronic pain management service by health professionals in Kuwait. This review also includes a description of chronic pain patient personas to highlight expected barriers as well as compliance issues with services likely to be encountered in Kuwait. The case study analysis and persona descriptions illustrate a need to move beyond pain symptom management towards considering the entire person and his/her individual experience of pain such that health care success is judged by enhancement of patient well-being rather than access to services. A road map for improving integrative chronic pain management in Kuwait is discussed. © 2015 S. Karger AG, Basel.

  8. Managing chronic pathologies with a stepped mHealth-based approach in clinical psychology and medicine

    Directory of Open Access Journals (Sweden)

    Gianluca eCastelnuovo

    2015-04-01

    Full Text Available Chronic diseases and conditions typically require long-term monitoring and treatment protocols both in traditional settings and in out-patient frameworks. The economic burden of chronic conditions is a key challenge and new and mobile technologies could offer good solutions. mHealth could be considered an evolution of ehealth and could be defined as the practice of medicine and public health supported by mobile communication devices. mHealth approach could overcome limitations linked with the traditional, restricted and highly expensive in-patient treatment of many chronic pathologies. Possible applications include stepped mHealth approach, where patients can be monitored and treated in their everyday contexts. Unfortunately, many barriers for the spread of mHealth are still present. Due the significant impact of psychosocial factors on disease evolution, psychotherapies have to be included into the chronic disease protocols. Existing psychological theories of health behavior change have to be adapted to the new technological contexts and requirements. In conclusion, clinical psychology and medicine have to face the chronic care management challenge in both traditional and mHealth settings.

  9. Acute physiological and chronic health evaluation II score and its ...

    African Journals Online (AJOL)

    Introduction: Ileal perforation peritonitis is a common surgical emergency in the Indian subcontinent and in tropical countries. It is reported to constitute the fifth common cause of abdominal emergencies due to high incidence of enteric fever and tuberculosis in these management based on Acute Physiological and Chronic ...

  10. Emotional Distress Among Indonesian Youth with Chronic Disease: Challenge of Youth Health Program

    Directory of Open Access Journals (Sweden)

    Isfandari Isfandari

    2014-08-01

    Full Text Available Background: Emotional distress and chronic diseases are the highest contributors of Year Life with Disability (YLD in Indonesia. Youth age 15–24 comprised of 14% Indonesian population. It is important to have information on their mental health status and the magnitude of chronic disease they experience. The information is useful as inputs for estimating the disease burden in the years to come. Objective: Obtain information on the magnitude of emotional distress and chronic diseases among Indonesian youth. The information can be used as inputs for the health sector in designing health service for youth. Method: Emotional distress and chronic diseases data from 2007 Riskesdas were analysed using frequency to obtain the prevalence of emotional distress and several chronic diseases. Cross tabulation was performed to obtain theprevalence of emotional distress among youth with asthma, heart, diabetic, joint and stroke defined as ever diagnosed or having the symptoms. Emotional distress is defined as having score of more than 5 in the Self Report Questionnaire. Inclusion criteria was those age 15–24 years. Results: Nine out of ten Indonesian youth were free of emotional distress orchronic disease as defined. Only one out of ten youth experienced the condition. Emotional distress prevalence among youtwith chronic disease is higher among those with chronic disease, the highest is in those with co-morbidity. Conclusion: It istime for health sector to give more attention for mental health especially youth with chronic diseases. Recommendation:In addition to prioritize on prevention and promotion, youth health service should also provide information, expert and resources as well as guidance on youth care.

  11. Chronic health conditions and work ability in the ageing workforce: the impact of work conditions, psychosocial factors and perceived health

    NARCIS (Netherlands)

    Koolhaas, W.; van der Klink, J.J.L.; de Boer, M.R.; Groothoff, J.W.; Brouwer, S.

    2014-01-01

    Purpose: The aim of this study was to determine the influence of work conditions, psychosocial factors and perceived health on the association between the presence of a chronic health condition and (single-item) work ability among workers aged 45 years and older. In addition, we aimed to examine

  12. Chronic health conditions and work ability in the ageing workforce : the impact of work conditions, psychosocial factors and perceived health

    NARCIS (Netherlands)

    Koolhaas, Wendy; van der Klink, Jac J. L.; de Boer, Michiel R.; Groothoff, Johan W.; Brouwer, Sandra

    The aim of this study was to determine the influence of work conditions, psychosocial factors and perceived health on the association between the presence of a chronic health condition and (single-item) work ability among workers aged 45 years and older. In addition, we aimed to examine variables

  13. The Role of School Health Services in Addressing the Needs of Students with Chronic Health Conditions: A Systematic Review

    Science.gov (United States)

    Leroy, Zanie C.; Wallin, Robin; Lee, Sarah

    2017-01-01

    Children and adolescents in the United States spend many hours in school. Students with chronic health conditions (CHCs) may face lower academic achievement, increased disability, fewer job opportunities, and limited community interactions as they enter adulthood. School health services provide safe and effective management of CHCs, often for…

  14. Suicide and self-injury among children and youth with chronic health conditions.

    Science.gov (United States)

    Barnes, Andrew J; Eisenberg, Marla E; Resnick, Michael D

    2010-05-01

    Chronic conditions may be associated with suicide risk. This study aimed to specify the extent to which youth chronic conditions are at risk for suicidality and self-harm. Logistic regression was used to estimate odds of self-harm, suicidal ideation, and suicide attempts in 10- to 19-year-olds with and without chronic physical and/or mental health conditions. Independent of race, socioeconomic status, absent parent, special education status, substance use, and emotional distress, youth with co-occurring chronic physical and mental conditions (n = 4099) had significantly higher odds of self-harm (odds ratio [OR]: 2.5 [99% confidence interval (CI): 2.3-2.8), suicidal ideation (OR: 2.5 [99% CI: 2.3-2.8), and suicide attempts (OR: 3.5 [99% CI: 3.1-3.9]) than healthy peers (n = 106,967), as did those with chronic mental conditions alone (n = 8752). Youth with chronic physical conditions alone (n = 12,554) were at slightly elevated risk for all 3 outcomes. Findings were similar among male and female youth, with a risk gradient by grade. Chronic physical conditions are associated with a slightly elevated risk for self-harm, suicidal thinking, and attempted suicide; chronic mental conditions are associated with an increased risk for all 3 outcomes. Co-occurring chronic physical and mental conditions are associated with an increased risk for self-harm and suicidal ideation that is similar to the risk in chronic mental conditions and with an attempted suicide risk in excess of that predicted by the chronic mental health conditions alone. Preventive interventions for these youth should be developed and evaluated.

  15. The assessment of chronic health conditions on work performance, absence, and total economic impact for employers.

    Science.gov (United States)

    Collins, James J; Baase, Catherine M; Sharda, Claire E; Ozminkowski, Ronald J; Nicholson, Sean; Billotti, Gary M; Turpin, Robin S; Olson, Michael; Berger, Marc L

    2005-06-01

    The objective of this study was to determine the prevalence and estimate total costs for chronic health conditions in the U.S. workforce for the Dow Chemical Company (Dow). Using the Stanford Presenteeism Scale, information was collected from workers at five locations on work impairment and absenteeism based on self-reported "primary" chronic health conditions. Survey data were merged with employee demographics, medical and pharmaceutical claims, smoking status, biometric health risk factors, payroll records, and job type. Almost 65% of respondents reported having one or more of the surveyed chronic conditions. The most common were allergies, arthritis/joint pain or stiffness, and back or neck disorders. The associated absenteeism by chronic condition ranged from 0.9 to 5.9 hours in a 4-week period, and on-the-job work impairment ranged from a 17.8% to 36.4% decrement in ability to function at work. The presence of a chronic condition was the most important determinant of the reported levels of work impairment and absence after adjusting for other factors (P < 0.000). The total cost of chronic conditions was estimated to be 10.7% of the total labor costs for Dow in the United States; 6.8% was attributable to work impairment alone. For all chronic conditions studied, the cost associated with performance based work loss or "presenteeism" greatly exceeded the combined costs of absenteeism and medical treatment combined.

  16. Putting Chronic Disease on the Map: Building GIS Capacity in State and Local Health Departments

    Science.gov (United States)

    Casper, Michele; Tootoo, Joshua; Schieb, Linda

    2013-01-01

    Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention’s Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants’ experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments. PMID:23786907

  17. Putting chronic disease on the map: building GIS capacity in state and local health departments.

    Science.gov (United States)

    Miranda, Marie Lynn; Casper, Michele; Tootoo, Joshua; Schieb, Linda

    2013-06-20

    Techniques based on geographic information systems (GIS) have been widely adopted and applied in the fields of infectious disease and environmental epidemiology; their use in chronic disease programs is relatively new. The Centers for Disease Control and Prevention's Division for Heart Disease and Stroke Prevention is collaborating with the National Association of Chronic Disease Directors and the University of Michigan to provide health departments with capacity to integrate GIS into daily operations, which support priorities for surveillance and prevention of chronic diseases. So far, 19 state and 7 local health departments participated in this project. On the basis of these participants' experiences, we describe our training strategy and identify high-impact GIS skills that can be mastered and applied over a short time in support of chronic disease surveillance. We also describe the web-based resources in the Chronic Disease GIS Exchange that were produced on the basis of this training and are available to anyone interested in GIS and chronic disease (www.cdc.gov/DHDSP/maps/GISX). GIS offers diverse sets of tools that promise increased productivity for chronic disease staff of state and local health departments.

  18. Late health effects of chronic radiation exposure of bone marrow

    Energy Technology Data Exchange (ETDEWEB)

    Yarmoshenko, Ilia V.; Malinovsky, Georgy P.; Konshina, Lidia G.; Zhukovsky, Michael V. [Institute of Industrial Ecology UB RAS, 620219, 20, Sophy Kovalevskoy St., Ekaterinburg (Russian Federation); Tuzankina, Irina A. [Institute of Immunology and Physiology UB RAS, 620049, 106, Pervomayskaya St., Ekaterinburg (Russian Federation)

    2014-07-01

    Accidental explosion of waste storage tank at former soviet plutonium production plant 'Mayak' in 1957 resulted in emission of considerable amount of radioactive substances to the atmosphere. Atmospheric transfer and fallout caused contamination of the environment by Sr-90 and short-lived radionuclides (East-Ural Radioactive Trace, EURT). Due to consumption of contaminated food and milk some internal organs were affected to relatively high radiation exposure. Archive data of causes of deaths of rural population of EURT northern part for period 1957-2000 were used to create the Register on causes of deaths. Register records related to the settlements where initial surface contamination by Sr-90 was above and below 3.7 kBq/m2 were included to exposed (4 844 records) and unexposed (6 158 records) group respectively. Basing on the Register the analysis of cancer and non-cancer health effects of radiation exposure was conducted. By estimating proportionate mortality ratios statistically significant excess mortality due to the groups of causes of death as follow was observed in exposed population: stomach, liver and cervix cancers; group consisted only of stomach cancer; non-cancer deceases of infectious etiology. Non-significant but remarkably high risk was observed for the following groups of causes of death: bone cancer; leukemia; liver cancer; cervix cancer. Insignificant, virtually zero risk was found for: non-gastrointestinal solid cancers; colon and lung cancers; non-infectious non-cancer deceases. At the same time, considerable radiation doses were absorbed in bone (mean bone surface dose about 0.1 Gy) and colon (mean dose about 0.07 Gy). Doses absorbed in other organs and tissues were negligible and amounted less than 0.01 Gy for most tissues. It can be seen that some disagreement between observed effects and absorbed doses is revealed. Most remarkable is the high excess risks of stomach, liver and cervix cancers as well as non-cancer deceases of

  19. Perceived conflict in the couple and chronic illness management: Preliminary analyses from the Quebec Health Survey

    Directory of Open Access Journals (Sweden)

    Hudon Catherine

    2006-10-01

    Full Text Available Abstract Background The quality of the relationship with the spouse/partner appears crucial among patients with multiple chronic conditions where illness management is complex and multifaceted. This study draws on data from the Quebec Health Survey (QHS to examine, among patients with one or more chronic conditions, the relation between marital status, the perceived conflict with the spouse/partner, and what the patients do to manage their illness as well as how they perceive their health. Methods Data from the QHS 1998 were used. The sample included 7547 coupled adults who had one or more chronic health problems lasting more than 6 months. Independent variables included marital status, perceived conflict with the spouse/partner, and the number of chronic conditions. Illness management was defined broadly as a measure of the patient's efforts at self-care and an illness status indicator, including visits to the generalist and the specialist, the use of telephone health line in the last 12 months, self-rated general health, mental health, and a measure of psychological distress. Linkages between the independent variables and illness management were assessed for males and females separately with logistic regressions, while accounting for the survey sampling design and household clustering. Results Female patients who did not live with their partner and had never been married were more likely to report a negative perception of their general health and a higher psychological distress than those who were married. Perceived conflict with the partner was linked to a negative perception of mental health and a higher psychological distress among both men and women. Compared to patients with only one chronic condition, males who reported more than one chronic condition were more likely to have consulted a generalist prior to the survey and used the telephone health line, whereas females were more likely to have consulted a specialist. Both males and

  20. Chronic Kidney Disease, Basal Insulin Glargine, and Health Outcomes in People with Dysglycemia: The ORIGIN Study.

    Science.gov (United States)

    Papademetriou, Vasilios; Nylen, Eric S; Doumas, Michael; Probstfield, Jeff; Mann, Johannes F E; Gilbert, Richard E; Gerstein, Hertzel C

    2017-12-01

    hospitalization (59%), or a major coronary artery disease event (56%). Furthermore, in patients with chronic kidney disease and early diabetes mellitus type 2, the primary end point occurred 83% more frequently as compared with nonchronic kidney disease participants (HR 1.83; 95% CI, 1.67-2.01; P chronic kidney disease 67% more frequently (HR 1.67; 95% CI,1.25-2.24; P chronic kidney disease significantly increased cardiovascular events. Copyright © 2017. Published by Elsevier Inc.

  1. How frequent are non-evidence-based health care beliefs in chiropractic students and do they vary across the pre-professional educational years.

    Science.gov (United States)

    Innes, Stanley I; Leboeuf-Yde, Charlotte; Walker, Bruce F

    2018-01-01

    Evidence suggests that a students' beliefs already prior to entering a program may be important as a determinant in sustaining unsuitable health care beliefs. Our objectives were to investigate the proportion of Australian chiropractic students who hold non-evidence-based beliefs in the first year of study and the extent to which they may be involved in non-musculoskeletal health conditions. Finally, to see if this proportion varies over the course of the chiropractic program. In 2016, students from two Australian chiropractic programs answered a questionnaire on how often they would give advice on five common health conditions in their future practices as well as their opinion on whether chiropractic spinal adjustments could prevent or help seven health-related conditions. From a possible 831 students, 444 responded (53%). Students were highly likely to offer advice (often/quite often) on a range of non-musculoskeletal conditions. The proportions were lowest in first year and highest the final year. Also, high numbers of students held non-evidence-based beliefs about 'chiropractic spinal adjustments' which tended to occur in gradually decreasing in numbers in sequential years, except for fifth year when a reversal of the pattern occurred. New strategies are required for chiropractic educators if they are to produce graduates who understand and deliver evidence-based health care and able to be part of the mainstream health care system.

  2. Organizational capacity for chronic disease prevention: a survey of Canadian public health organizations.

    Science.gov (United States)

    Hanusaik, Nancy; O'Loughlin, Jennifer L; Kishchuk, Natalie; Paradis, Gilles; Cameron, Roy

    2010-04-01

    There are no national data on levels of organizational capacity within the Canadian public health system to reduce the burden of chronic disease. Cross-sectional data were collected in a national survey (October 2004 to April 2005) of all 216 national, provincial and regional-level organizations engaged in chronic disease prevention through primary prevention or healthy lifestyle promotion. Levels of organizational capacity (defined as skills and resources to implement chronic disease prevention programmes), potential determinants of organizational capacity and involvement in chronic disease prevention programming were compared in western, central and eastern Canada and across three types of organizations (formal public health organizations, non-governmental organizations and grouped organizations). Forty percent of organizations were located in Central Canada. Approximately 50% were formal public health organizations. Levels of skill and involvement were highest for activities that addressed tobacco control and healthy eating; lowest for stress management, social determinants of health and programme evaluation. The few notable differences in skill levels by provincial grouping favoured Central Canada. Resource adequacy was rated low across the country; but was lowest in eastern Canada and among formal public health organizations. Determinants of organizational capacity (organizational supports and partnerships) were highest in central Canada and among grouped organizations. These data provide an evidence base to identify strengths and gaps in organizational capacity and involvement in chronic disease prevention programming in the organizations that comprise the Canadian public health system.

  3. Increased prevalence of chronic physical health disorders in Australians with diagnosed mental illness.

    Science.gov (United States)

    Scott, David; Burke, Karena; Williams, Susan; Happell, Brenda; Canoy, Doreen; Ronan, Kevin

    2012-10-01

    To compare chronic physical health disorder prevalence amongst Australian adults with and without mental illness. Total n=1,716 participants (58% female) with a mean age of 52 ± 13 years (range: 18 to 89 years) completed an online survey of Australian adults in 2010. Outcome measures including prevalence of chronic physical conditions and self-reported body mass index (BMI) in n=387 (23%) with a self-reported mental illness diagnosis were compared to respondents without mental illness. A significantly higher proportion of participants with mental illness were obese (BMI ≥ 30; 31 vs 24%, p=0.005). Adjusted odds ratios (OR) for coronary heart disease, diabetes, chronic bronchitis or emphysema, asthma, irritable bowel syndrome, and food allergies or intolerances (OR range: 1.54-3.19) demonstrated that chronic physical disorders were significantly more common in participants with a mental illness. Australian adults with a diagnosis for mental illness have a significantly increased likelihood of demonstrating chronic physical health disorders compared to persons without mental illness. Health professionals must be alert to the increased likelihood of comorbid chronic physical disorders in persons with a mental illness and should consider the adoption of holistic approaches when treating those with either a mental or physical illness. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

  4. A review of factors associated with mental health in siblings of children with chronic illness.

    Science.gov (United States)

    Incledon, Emily; Williams, Lauren; Hazell, Trevor; Heard, Todd R; Flowers, Alexandra; Hiscock, Harriet

    2015-06-01

    This article reviews the literature on modifiable factors associated with mental health in siblings of children with chronic illness. Three clinical databases were searched. A total of 17 studies met the inclusion criteria. Several key themes emerged from the review. Better sibling mental health was associated with camp attendance, perceived parent/peer support, illness education and enhancing control through cognitive coping strategies and routine. Parental and sibling psychoeducation interventions and social support may enhance children's mental health when their sibling has a chronic illness. © The Author(s) 2013.

  5. Cyber-Management of People with Chronic Disease: A Potential Solution to eHealth Challenges

    Science.gov (United States)

    Laakso, E-Liisa; Armstrong, Kylie; Usher, Wayne

    2012-01-01

    The evolving eHealth agenda presents a range of potential opportunities for the management and prevention of chronic disease. This paper identifies issues and barriers to the uptake of eHealth and describes a strategy ("Healthy Outcomes for Australians"[C]-HOFA) for creating a central knowledge filter and cyber space method for tracking…

  6. Association between Organizational Capacity and Involvement in Chronic Disease Prevention Programming among Canadian Public Health Organizations

    Science.gov (United States)

    Hanusaik, Nancy; Sabiston, Catherine M.; Kishchuk, Natalie; Maximova, Katerina; O'Loughlin, Jennifer

    2015-01-01

    In the context of the emerging field of public health services and systems research, this study (i) tested a model of the relationships between public health organizational capacity (OC) for chronic disease prevention, its determinants (organizational supports for evaluation, partnership effectiveness) and one possible outcome of OC (involvement…

  7. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    de Clercq, Paul A.; Hasman, Arie; Wolffenbuttel, Bruce H. R.

    2003-01-01

    OBJECTIVES: To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. METHODS: A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  8. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    Clercq, de P.A.; Hasman, A.; Wolffenbuttel, B.H.R.

    2003-01-01

    Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  9. Introduction to the Special Section: Sustainability of Work with Chronic Health Conditions

    NARCIS (Netherlands)

    Shaw, W.S.; Tveito, T.H.; Boot, C.R.L.

    2013-01-01

    Background The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and

  10. Motivational factors in discussing sexual health with young people with chronic conditions or disabilities

    NARCIS (Netherlands)

    A.P. Visser; Dr. A.L. van Staa; Dr. H.A. van der Stege; Dr. S.R. Hilberink

    2014-01-01

    The objective of this study was to identify determinants of professionals’ intention to use the new board game SeCZ TaLK to facilitate sexual health discussions with young people with chronic health conditions and disabilities, and to gauge whether intention led to actual use. A cross-sectional

  11. A consumer health record for supporting the patient-centered management of chronic diseases

    NARCIS (Netherlands)

    De Clercq, Paul A; Hasman, Arie; Wolffenbuttel, Bruce H R

    Objectives : To design and implement a shareable consumer health record system to investigate whether the system can assist in the management of chronic diseases. Methods : A toolkit was designed for constructing the consumer health record system in an evolutionary way. An ethnographic-like approach

  12. Sense of Coherence: Learning to Live with Chronic Illness through Health Education

    Science.gov (United States)

    Førland, Georg; Eriksson, Monica; Silèn, Charlotte; Ringsberg, Karin

    2018-01-01

    Objective: This study examines people's experiences of how to live with a chronic disease, their learning needs and their reasons for participating in a health education programme. The aim of the study was to examine if and how a Sense of Coherence (SOC) might guide an understanding of learning processes in health education. Methods: This study…

  13. An integrated chronic disease management model: a diagonal approach to health system strengthening in South Africa.

    Science.gov (United States)

    Mahomed, Ozayr Haroon; Asmall, Shaidah; Freeman, Melvyn

    2014-11-01

    The integrated chronic disease management model provides a systematic framework for creating a fundamental change in the orientation of the health system. This model adopts a diagonal approach to health system strengthening by establishing a service-linked base to training, supervision, and the opportunity to try out, assess, and implement integrated interventions.

  14. Do health-status measures play a role in improving treatment in chronic obstructive pulmonary disease?

    NARCIS (Netherlands)

    van der Molen, T; Kocks, JWH

    During the past few decades, health status has become increasingly important in the clinical research of chronic obstructive pulmonary disease. The use of health-status questionnaires in routine practice can enhance understanding about the impact of the disease on the patient, improve

  15. Do Work Characteristics Predict Health Deterioration Among Employees with Chronic Diseases?

    NARCIS (Netherlands)

    Wind, A. de; Boot, C.R.L.; Sewdas, R.; Scharn, M.; Heuvel, S.G. van den; Beek, A.J. van der

    2017-01-01

    Purpose In our ageing workforce, the increasing numbers of employees with chronic diseases are encouraged to prolong their working lives. It is important to prevent health deterioration in this vulnerable group. This study aims to investigate whether work characteristics predict health deterioration

  16. Do work factors modify the association between chronic health problems and sickness absence among older employees?

    NARCIS (Netherlands)

    F.R.M. Leijten (Fenna); S.G. van den Heuvel (Swenneke); J.F. Ybema (Jan Fekke); S.J.W. Robroek (Suzan); A. Burdorf (Alex)

    2013-01-01

    textabstractObjectives The aim of this study was to (i) assess how common chronic health problems and work-related factors predict sickness absence and (ii) explore whether work-related factors modify the effects of health problems on sickness absence. Methods A one-year longitudinal study was

  17. Introduction to the special section: Sustainability of work with chronic health conditions

    NARCIS (Netherlands)

    Shaw, W.S.; Tveito, T.H.; Boot, C.R.L.

    2013-01-01

    Background The increasing prevalence of older workers and chronic health conditions represents a growing occupational health concern. More research is needed to understand risk factors, apply and adapt theories, and test workplace-focused interventions that might prevent work disability and

  18. Maintaining the balance: older adults with chronic health problems manage life in the community.

    Science.gov (United States)

    Jacelon, Cynthia S

    2010-01-01

    The purpose of this research was to identify themes in the daily lives of community-dwelling older adults with chronic health problems. Qualitative descriptive methods based on symbolic interaction were used. Data were generated through unstructured interviews, participant diaries, and researcher logs. Participants were interviewed twice and kept diaries in between. Measures to enhance trustworthiness included bracketing, multiple data sources, repeated interviews, prolonged engagement, an audit trail, participant checking, and consultation with an expert qualitative researcher. Ten older adults 75-98 years of age living in their own homes with at least one self-reported chronic health problem participated in the research. Participants' health problems varied, and they developed strategies to maintain balance in activity, attitude, autonomy, health, and relationships. This research provides a new perspective on living with chronic illness, and the model may provide a framework for rehabilitation nurses who work with older adults.

  19. Strength training improves fatigue resistance and self-rated health in workers with chronic pain

    DEFF Research Database (Denmark)

    Sundstrup, Emil; Jakobsen, Markus Due; Brandt, Mikkel

    2016-01-01

    of a randomized controlled trial investigates the effect of strength training on muscular fatigue resistance and self-rated health among workers with chronic pain. Sixty-six slaughterhouse workers with chronic upper limb pain and work disability were randomly allocated to 10 weeks of strength training or usual...... (Spearman's rho = -0.40; P = 0.01). In conclusion, specific strength training improves muscular fatigue resistance and self-rated health and reduces pain of the hand/wrist in manual workers with chronic upper limb pain. This trial is registered with ClinicalTrials.gov NCT01671267.......-rated health and pain. Time to fatigue, muscle strength, hand/wrist pain, and self-rated health improved significantly more following strength training than usual care (all P

  20. [Mental Health Promotion Among the Chronic Disabled Population in the Community].

    Science.gov (United States)

    Huang, Hui-Chuan; Wang, Li-Hua; Chang, Hsiu-Ju

    2015-08-01

    Societal ageing and the rising prevalence of chronic disease are important causes that underlie the growth in the number of disabled individuals. The disease-induced psychological distress experienced by this population not only decreases quality of life but also increases demand for healthcare. The healthcare policy for the disabled population currently focuses on community healthcare. Therefore, developing appropriate programs to promote mental health among the disabled population in community settings is a critical issue. The present paper reviews current mental health promotion initiatives that target the disabled population in the community and addresses mental healthcare issues that are prevalent among the chronically disabled; strategies of mental health promotion that use music therapy, reminiscence therapy, and horticultural therapy; and the roles and responsibilities of community professionals in mental healthcare. We offer these perspectives as a reference to promote mental health and to establish holistic community healthcare for chronically disabled individuals.

  1. The duality of health technology in chronic illness: how designers envision our future.

    Science.gov (United States)

    Lehoux, Pascale

    2008-06-01

    This essay critically explores the role of technological innovation in the constitution of chronic states and illness. Drawing on the co-construction of technology and society perspective, it focuses more specifically on the way in which innovation designers envisage the enhancement of the chronically ill and build certain kinds of socio-technical configuration to deal with chronic illness. Using the case of ;intelligent distance patient monitoring' as an illustration, the paper argues that technology creates as much as it solves the problem of chronic illness. Technology is recursively embedded in chronic illness and it generates dual effects: it constrains and sustains users' daily practices. Only by recognizing technology's duality and eventually transcending it will research and policy initiatives be able to deal creatively and responsibly with the design of our future health experiences.

  2. Stability of the frequent COPD exacerbator in the general population

    DEFF Research Database (Denmark)

    Reilev, Mette; Lykkegaard, Jesper; Halling, Anders

    2017-01-01

    Exacerbation frequency is central in treatment strategies for chronic obstructive pulmonary disease. However, whether chronic obstructive pulmonary disease patients from the general population with frequent exacerbations continue to have frequent exacerbations over an extended period of time is c...... considerably over time. This could hold implications for COPD treatment and challenge assumptions made about disease progression....... is currently unknown. In this study, we aimed to investigate the stability of the frequent exacerbator in a population-based setting. To this end, we conducted a nationwide register-based descriptive study with a 10-year follow-up period of chronic obstructive pulmonary disease patients with at least one...... obstructive pulmonary disease treatment guidelines and their practical application. CHRONIC OBSTRUCTIVE LUNG DISEASE: VARIATIONS IN DISEASE PROGRESSION: Patients with chronic obstructive pulmonary disease (COPD) who suffer from frequent exacerbations do not necessarily persist with such severity over time...

  3. Frequent use of emergency departments by older people: a comparative cohort study of characteristics and outcomes.

    Science.gov (United States)

    Street, Maryann; Berry, Debra; Considine, Julie

    2018-04-12

    To characterise older people who frequently use emergency departments (EDs) and compare patient outcomes with older non-frequent ED attenders. Retrospective comparative cohort study. Logistic regression modelling of patient characteristics and health service usage, comparing older frequent ED attenders (≥4 ED attendances in 12 months) to non-frequent ED attenders. Three Australian public hospital EDs, with a total of 143 327 emergency attendances in the 12 months. People aged ≥65 years attending the ED in financial year 2013/2014. The primary outcome was frequent ED use; secondary outcomes were ED length of stay, discharge destination from ED, hospital length of stay, re-presentation within 48 h, hospital readmission within 30 days and in-hospital mortality. Five percent of older people were frequent attenders (n = 1046/21 073), accounting for 16.9% (n = 5469/32 282) of all attendances by older people. Frequent ED attenders were more likely to be male, aged 75-84 years, arrive by ambulance and have a diagnosis relating to chronic illness. Frequent attenders stayed 0.4 h longer in ED (P < 0.001), were more likely to be admitted to hospital (69.2% vs 67.2%; P = 0.004), and had a 1 day longer hospital stay (P < 0.001). In-hospital mortality for older frequent ED attenders was double that of non-frequent attenders (7.0% vs 3.2%, P < 0.001) over 12 months. Older frequent ED attenders had more chronic disease and care needs requiring hospital admission than non-frequent attenders. A new approach to care planning and coordination is recommended, to optimise the patient journey and improve outcomes.

  4. Depression and Chronic Health Conditions Among Latinos: The Role of Social Networks.

    Science.gov (United States)

    Soto, Sandra; Arredondo, Elva M; Villodas, Miguel T; Elder, John P; Quintanar, Elena; Madanat, Hala

    2016-12-01

    The purpose of this study was to examine the "buffering hypothesis" of social network characteristics in the association between chronic conditions and depression among Latinos. Cross-sectional self-report data from the San Diego Prevention Research Center's community survey of Latinos were used (n = 393). Separate multiple logistic regression models tested the role of chronic conditions and social network characteristics in the likelihood of moderate-to-severe depressive symptoms. Having a greater proportion of the network comprised of friends increased the likelihood of depression among those with high cholesterol. Having a greater proportion of women in the social network was directly related to the increased likelihood of depression, regardless of the presence of chronic health conditions. Findings suggest that network characteristics may play a role in the link between chronic conditions and depression among Latinos. Future research should explore strategies targeting the social networks of Latinos to improve health outcomes.

  5. Association between chronic periodontitis and oral health-related quality of life in Sri Lankan adults.

    Science.gov (United States)

    Wellapuli, Nimali; Ekanayake, Lilani

    2016-12-01

    To determine the impact of chronic periodontitis on oral health-related quality of life in Sri Lankan adults. A cross-sectional study was conducted among 1,400 participants, 35-60 years of age, residing in the Colombo district of Sri Lanka. Data were collected using two interviewer-administered questionnaires and an oral examination. The prevalence, extent and severity of oral impacts increased with the increase in severity of chronic periodontitis. The most commonly experienced impacts were within the domain of physical pain. The adjusted Poisson regression model indicated that chronic periodontitis was significantly associated with the prevalence of oral impacts. The prevalence of oral impacts was 48% and 69% higher in those with moderate and severe periodontitis, respectively, compared with those with no/mild periodontitis. Oral health-related quality of life deteriorates with the increase in severity of chronic periodontitis. © 2016 FDI World Dental Federation.

  6. What characterizes individuals developing chronic whiplash?: The Nord-Trøndelag Health Study (HUNT).

    Science.gov (United States)

    Myrtveit, Solbjørg Makalani; Wilhelmsen, Ingvard; Petrie, Keith J; Skogen, Jens Christoffer; Sivertsen, Børge

    2013-05-01

    Most individuals experiencing whiplash accidents recover rapidly. A considerable proportion, however, develop chronic symptoms. Psychological factors may slow recovery, possibly by increasing the likelihood of other symptoms being misattributed to, and amplified by the whiplash injury. We aimed to investigate how pre-injury mental and somatic symptoms, self-rated health, use of health-services and medications, health-behavior and socio-demographics predict the development of chronic whiplash. Data from two waves of a large, population based study (HUNT2 (baseline) and HUNT3) were used. Individuals reporting no whiplash at baseline were identified in HUNT3. Characteristics reported at baseline were compared between those who had developed chronic whiplash in HUNT3 (n=199) and those who had not (n=20,600), using Pearson's chi-squared tests, independent sample t-tests and logistic regression analyses. Individuals developing chronic whiplash reported worse baseline health than those reporting no chronic whiplash. Poor self-rated health was a strong risk factor for subsequent chronic whiplash (OR=2.26, 95%CI: 1.68-3.04). Musculoskeletal pain also increased the risk (OR=1.21, 95%CI: 1.15-1.26), as did diffuse somatic symptoms (OR=2.09, 95%CI: 1.47-2.96), use of different health services (OR=1.31, 95%CI: 1.19-1.45), high use of medications (OR=1.28, 95%CI: 1.14-1.43) and symptoms of anxiety (OR=1.93, 95%CI: 1.39-2.68). Physical activity was protective (OR=0.67, 95%CI: 0.49-0.91). Most socio-demographic variables were not significantly associated with chronic whiplash. Poor somatic and mental pre-injury health increased the risk of subsequent chronic whiplash. This suggests that chronic whiplash is not merely an organic disorder, and highlights the importance of individual expectations, symptom reattribution and amplification in development of chronic whiplash. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems.

    Directory of Open Access Journals (Sweden)

    David L Rosen

    Full Text Available Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA. We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18-64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827 had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the "coverage gap" and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services.

  8. Federally-Assisted Healthcare Coverage among Male State Prisoners with Chronic Health Problems.

    Science.gov (United States)

    Rosen, David L; Grodensky, Catherine A; Holley, Tara K

    2016-01-01

    Prisoners have higher rates of chronic diseases such as substance dependence, mental health conditions and infectious disease, as compared to the general population. We projected the number of male state prisoners with a chronic health condition who at release would be eligible or ineligible for healthcare coverage under the Affordable Care Act (ACA). We used ACA income guidelines in conjunction with reported pre-arrest social security benefits and income from a nationally representative sample of prisoners to estimate the number eligible for healthcare coverage at release. There were 643,290 US male prisoners aged 18-64 with a chronic health condition. At release, 73% in Medicaid-expansion states would qualify for Medicaid or tax credits. In non-expansion states, 54% would qualify for tax credits, but 22% (n = 69,827) had incomes of ≤ 100% the federal poverty limit and thus would be ineligible for ACA-mediated healthcare coverage. These prisoners comprise 11% of all male prisoners with a chronic condition. The ACA was projected to provide coverage to most male state prisoners with a chronic health condition; however, roughly 70,000 fall in the "coverage gap" and may require non-routine care at emergency departments. Mechanisms are needed to secure coverage for this at risk group and address barriers to routine utilization of health services.

  9. Effect of General Health Status on Chronicity of Low Back Pain in Industrial Workers

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Seyedmehdi

    2016-04-01

    Full Text Available Recognizing patients at a higher risk of developing chronic low back pain (LBP is important in industrial medicine. This study aimed to assess the power and quality of General Health Questionnaire (GHQ for prediction of the odds of chronicity of acute LBP. This study was conducted on industrial workers. All subjects with acute LBP who met the inclusion criteria were enrolled. Demographic characteristics, occupational, physical, and mental parameters and the general health status of subjects were evaluated;  they were followed up for developing chronic LBP for one year. Cigarette smoking, high body mass index, job stress, physical load and high GHQ scores were found to be the risk factors for the progression of acute LBP to chronic LBP (P<0.05. Standing position while working, age, work experience, exercise, level of education, weekly work hours and shift work were not the risk factors for chronic LBP (P>0.05.High GHQ score can be a risk factor for progression of acute LBP to chronic LBP. The GHQ in combination with the Job Content Questionnaire can be used as a quick and simple screening tool for detection of subjects at high risk of chronic LBP when evaluating acute LBP in an occupational setting.

  10. Managing chronic diseases in the malaysian primary health care - a need for change.

    Science.gov (United States)

    Ramli, As; Taher, Sw

    2008-01-01

    Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. The WHO in its report Preventing Chronic Disease: A Vital Investment has highlighted the inaction of most governments of the low and middle income countries in tackling the problem urgently, is clear and unacceptable. The acute care paradigm is no longer adequate for the changing pattern of diseases in today's and tomorrow's world. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases and its crushing burden resulting in escalating healthcare costs. Compelling evidence from around the world showed that there are innovative and cost-effective community-based interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. This paper describes the current situation of chronic disease management in the Malaysian primary care setting - to highlight the need for change, discuss the barriers to the implementation of effective chronic disease management programmes in the community, and consider fundamental solutions needed to instigate the change in our setting.

  11. MANAGING CHRONIC DISEASES IN THE MALAYSIAN PRIMARY HEALTH CARE – A NEED FOR CHANGE

    Directory of Open Access Journals (Sweden)

    TAHER SW

    2008-01-01

    Full Text Available Chronic diseases are the major cause of death and disability in Malaysia, accounted for 71% of all deaths and 69% of the total burden of disease. The WHO in its report Preventing Chronic Disease: A Vital Investment has highlighted the inaction of most governments of the low and middle income countries in tackling the problem urgently, is clear and unacceptable. The acute care paradigm is no longer adequate for the changing pattern of diseases in today’s and tomorrow’s world. An evolution of primary health care system beyond the acute care model to embrace the concept of caring for long term health problems is imperative in the wake of the rising epidemic of chronic diseases and its crushing burden resulting in escalating healthcare costs. Compelling evidence from around the world showed that there are innovative and cost-effective community-based interventions to reduce the morbidity and mortality attributable to chronic diseases, but these are rarely translated into high quality population-wide chronic disease care. This paper describes the current situation of chronic disease management in the Malaysian primary care setting - to highlight the need for change, discuss the barriers to the implementation of effective chronic disease management programmes in the community, and consider fundamental solutions needed to instigate the change in our setting.

  12. Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation

    OpenAIRE

    Cocosila, Mihail; Archer, Norm

    2014-01-01

    Objective To develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those who report being well. Materials and methods A model of PHR use motivators and barriers was built and tested through a national survey across Canada. Data were collected from 800 individuals, 18 years or older. Half reported having a chronic illness or disability and half reported being well. An...

  13. Doença renal crônica: frequente e grave, mas também prevenível e tratável Chronic kidney diseases: common and harmful, but also preventable and treatable

    Directory of Open Access Journals (Sweden)

    Marcus Gomes Bastos

    2010-01-01

    Full Text Available A doença renal crônica é considerada problema de saúde pública em todo o mundo. No Brasil, a incidência e a prevalência de falência de função renal estão aumentando; o prognóstico ainda é ruim e os custos do tratamento da doença são altíssimos. Independentemente da etiologia da doença de base, os principais desfechos em pacientes com DRC são as suas complicações (anemia, acidose metabólica, desnutrição e alteração do metabolismo de cálcio e fósforo, decorrentes da perda funcional renal, óbito (principalmente, por causas cardiovasculares e perda de função renal. Estudos recentes indicam que estes desfechos indesejados podem ser prevenidos ou retardados se a DRC for diagnosticada precocemente e as medidas nefro e cardioprotetoras implementadas o mais rápido possível. O atual estagiamento da doença e uma descrição dessas medidas preventivas são apresentados na presente revisão.Chronic kidney disease (CKD is a public health problem worldwide. In Brazil incidence and prevalence of end stage renal failure are increasing; prognosis is still poor and costs of disease treatment are very high. Regardless of the etiology, main outcomes in patients with CKD are its complications (anemia, metabolic acidosis, malnutrition and alteration in mineral metabolism, death (mainly due to cardiovascular causes and loss of renal function. Recent studies indicate that these outcomes may be postponed with specific treatment if the CKD is diagnosed early and renoprotective and cardioprotective measures are implemented early in the course of the disease. The current definition and staging of CKD, as well as the discussion of the main preventive measures are addressed in this review.

  14. Using Spot Biomarker Data to Inform Chronic Exposure and Health Risk

    Science.gov (United States)

    The U.S. NHANES and other health surveys frequently collect and analyze spot biological specimens to inform chemical exposures. These spot measurements can be compared to biomarker-based reference levels, such as “Biomonitoring Equivalents” (BEs), to evaluate health r...

  15. Influence of worldview on health care choices among persons with chronic pain.

    Science.gov (United States)

    Buck, Tina; Baldwin, Carol M; Schwartz, Gary E

    2005-06-01

    The aim of this research was to examine relationships between the Pepperian worldviews of people with chronic pain and the health care choices that they make. A convenience sample survey was done. University Medical Center Pain Clinic, Tucson, Arizona. Men and women patients (n = 96) with nonmalignant chronic pain. World Hypothesis Scale; Health Care Choice List. Findings indicate that the combination of age and formistic worldview are statistically significant predictors of conventional health care choices by participants in this study. Older patients and persons with a predominantly formistic worldview were less likely to use complementary and alternative medicine (CAM) as a choice among this sample with chronic nonmalignant pain. Borderline significant associations were noted between persons with formistic or mechanistic worldviews and conventional health care choices, and persons with contextualistic, organismic, or equal scores in two worldview categories and CAM health care choices. Although rates of CAM use did not significantly differ from conventional choices, the prevalence rate for CAM use was high (55.2%) based on national findings. Results of this study provide a link to understanding how underlying philosophies can contribute to the reasons people with chronic pain make health care decisions. Further exploration of worldviews might very well contribute to best practices for consumer health care by engaging in communication styles and belief systems consistent with consumers' personal schemas.

  16. [The spa-and-health resort-based rehabilitation of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation].

    Science.gov (United States)

    Efimenko, N V; Kaĭsinova, A S

    2014-01-01

    To develop a new medical technology for the spa-and-health resort-based treatment of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation. A total of 100 patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation were available for the examination that included detailed investigations of the clinical picture, characteristics of the immune status, and psychological testing before and after a course of the spa-and-health resort-based treatment. The effectiveness of two therapeutic modalities was evaluated. One of them (control) prescribed to 50 patients consisted of standard antiulcer pharmacotherapy in combination with Essentuki Novaya drinking mineral water and carbon dioxide mineral baths, the other given to 50 patients included radon baths instead of carbon dioxide mineral baths. The combined application of drinking mineral waters, radon baths, and standard antiulcer pharmacotherapy produced the most conspicuous clinical effect in the framework of spa-and-health resort-based rehabilitation of the patients presenting with frequently recurring erosive and ulcerative lesions in the oesophagus, stomach, and duodenum in the phase of subsiding exacerbation as confirmed by positive dynamics of their psychoemotional status in 97.7% of the cases, regression of pain syndrome (91.5%), and improvement of humoral and cellular immunity (94%). An important result of the spa-and-health resort-based rehabilitation is the intensification of the reparative processes in gastroduodenal mucosa responsible for the healing of ulcers and erosions in 94.7% of the patients. The spa-and-health resort-based rehabilitation is a pathogenetically sound and efficacious approach to the management of the patients presenting with frequently recurring erosive and ulcerative lesions in the

  17. Integration of Mobile Health Technology in the Treatment of Chronic Pain: A Critical Review.

    Science.gov (United States)

    Sundararaman, Lalitha V; Edwards, Robert R; Ross, Edgar L; Jamison, Robert N

    This article provides a critical overview and best-evidence synthesis of the use of mobile health (mHealth) technology among persons with chronic pain and their health care providers and examines the future benefits and barriers of implementing mHealth technology in clinical care. We critically review articles about electronic pain diaries, pain assessment programs, text messaging, and smartphone pain apps for management of persons with pain. Also presented are findings on the utility of activity trackers and use of telehealth to deliver cognitive behavioral therapy. Finally, barriers, study gaps, and future challenges of incorporating mobile technology for chronic pain are discussed. Although the future of mHealth technology and telemedicine in clinical practice is promising, this critical review highlights the need for rigorous studies to establish an association of the use of mHealth technology with improved quality of life, functional autonomy, and decreased hospital use.

  18. Adaptations of Personal Health Record Platform for Medical Research on Chronic Diseases

    Directory of Open Access Journals (Sweden)

    A. Krukowski

    2015-05-01

    Full Text Available The article reports on experiences in e-Health platforms and services for supporting medical research into the causes and relationships among physiological parameters and health problems concerning different chronic diseases. The Personal Health Record (PHR is a way of standardizing electronic management of medical information between patients and their physicians, including medical bodies collaborating in providing integrated medical care services. We describe roles and aims behind electronic health records, follow with applicable legal and standardizations frameworks and relevant European activities, leading to the presentation of common commercial and open-source implementations of such systems, concluding with the indication of specific adaptations enabling a use of stored personal health data for scientific research into causes and evaluation of chronic illnesses. We describe ethical and privacy concerns that are relevant to using and exchanging electronic health information.

  19. Associations Between Periodontitis and Chronic Obstructive Pulmonary Disease: The 2010 to 2012 Korean National Health and Nutrition Examination Survey.

    Science.gov (United States)

    Chung, Jae Ho; Hwang, Hee-Jin; Kim, Sun-Hyun; Kim, Tae Ho

    2016-08-01

    The aim of this study is to examine whether oral hygiene and self-care, particularly in periodontal health, are associated with chronic obstructive pulmonary disease (COPD) in the Korean population. Data from the Korean National Health and Nutrition Examination Survey from 2010 to 2012 were used to assess the community periodontal index (CPI) of 5,878 participants (normal lung function: n = 5,181; obstructive spirometric pattern: n = 697) aged ≥40 years, who underwent spirometry. Participants with COPD brushed their teeth less frequently and used the following less frequently: 1) dental floss and/or interdental brush; 2) mouthwash; and 3) electric toothbrush (P periodontitis in patients with COPD (58.1%) was significantly higher than in those without COPD (34.0%, P periodontal severity. Periodontitis (CPI 3 and 4) was associated in males with COPD after adjustment for: 1) age; 2) income; 3) education; 4) smoking; 5) alcohol consumption; 6) exercise; 7) body mass index; 8) toothbrushing frequency; 9) diabetes mellitus; and 10) number of teeth (CPI 3: relative risk [RR] = 1.38, 95% confidence interval [CI] = 1.12 to 2.05; CPI 4: RR = 1.23, 95% CI = 1.06 to 1.56). Findings of this cross-sectional study suggest that COPD in males may be associated with severe periodontitis and indicates the importance of promoting dental care in patients with COPD.

  20. Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test.

    Science.gov (United States)

    Dou, Kaili; Yu, Ping; Deng, Ning; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

    2017-12-06

    Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use

  1. Patients’ Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test

    Science.gov (United States)

    Dou, Kaili; Yu, Ping; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

    2017-01-01

    Background Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients’ acceptance of smartphone health technology for chronic disease management. Methods Multiple theories and factors that may influence patients’ acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients’ acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients’ actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results The model accounted for .412 of the variance in patients’ intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients’ smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients’ intentions to use the technology. Age and gender had no significant influence on patients’ acceptance of smartphone technology. The study also

  2. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    Science.gov (United States)

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  3. Children with disabling chronic conditions in the Western health ...

    African Journals Online (AJOL)

    scientific quality. ... The purpose of this study was to count the number of children with ... 2 School of Child and Adolescent Health, Faculty of Health Sciences, University of Cape Town, .... any direct medical support in the form of a full-time nursing sister ... realistic figure as comparison, because the current study was biased.

  4. Data Quality in Online Health Social Networks for Chronic Diseases

    Science.gov (United States)

    Venkatesan, Srikanth

    2017-01-01

    Can medical advice from other participants in online health social networks impact patient safety? What can we do alleviate this problem? How does the accuracy of information on such networks affect the patients?. There has been a significant increase , in recent years, in the use of online health social network sites as more patients seek to…

  5. Health coaching interventions for persons with chronic conditions: a systematic review and meta-analysis protocol.

    Science.gov (United States)

    Boehmer, Kasey R; Barakat, Suzette; Ahn, Sangwoo; Prokop, Larry J; Erwin, Patricia J; Murad, M Hassan

    2016-09-01

    Chronic conditions are increasingly more common and negatively impact quality of life, disability, morbidity, and mortality. Health coaching has emerged as a possible intervention to help individuals with chronic conditions adopt health supportive behaviors that improve both quality of life and health outcomes. We planned a systematic review and meta-analysis of the contemporary health coaching literature published in the last decade to evaluate the effect of health coaching on clinically important, disease-specific, functional, and behavioral outcomes. We will include randomized controlled trials or quasi-experimental studies that compared health coaching to alternative interventions or usual care. To enable adoption of effective interventions, we aim to explore how the effect of intervention is modified by the intervention components, delivering personnel (i.e., health professionals vs trained lay or peer persons), dose, frequency, and setting. Analysis of intervention outcomes will be reported and classified using an existing theoretical framework, the Theory of Patient Capacity, to identify the areas of patients' capacity to access and use healthcare and enact self-care where coaching may be an effective intervention. This systematic review and meta-analysis will identify and synthesize evidence to inform the practice of health coaching by providing evidence on components and characteristics of the intervention essential for success in individuals with chronic health conditions. PROSPERO CRD42016039730.

  6. Return Migration among Elderly, Chronically Ill Bosnian Refugees: Does Health Matter?

    Science.gov (United States)

    Handlos, Line Neerup; Olwig, Karen Fog; Bygbjerg, Ib Christian; Kristiansen, Maria; Norredam, Marie Louise

    2015-10-12

    Elderly migrants constitute a considerable share of global return migration; nevertheless, literature on the health aspects of the return migration among these migrants is still scarce. This study explores the significance of return migration among elderly, chronically ill Bosnian refugees from Denmark and the role of health issues in their decision to return. It is based on semi-structured interviews with 33 elderly, chronically ill Bosnian refugees who have moved back to Bosnia and Herzegovina, and 10 elderly, chronically ill Bosnian refugees who have remained in Denmark. The interviews show that physical health, in the sense of the absence of illness and easy access to necessary health-care services and medicines, was not highly prioritized when the decision was made whether or not to return. However, if health is regarded more broadly as involving more than mere physical health and the absence of illness, health did matter. Viewed as physical, social and mental well-being in line with WHO's definition of health, health was indeed one of the most important factors when the decision to return was made.

  7. Exploring the relationship between frequent internet use and health and social care resource use in a community-based cohort of older adults: an observational study in primary care.

    Science.gov (United States)

    Clarke, Caroline S; Round, Jeff; Morris, Stephen; Kharicha, Kalpa; Ford, John; Manthorpe, Jill; Iliffe, Steve; Goodman, Claire; Walters, Kate

    2017-07-21

    Given many countries' ageing populations, policymakers must consider how to mitigate or reduce health problems associated with old age, within budgetary constraints. Evidence of use of digital technology in delaying the onset of illness and reducing healthcare service use is mixed, with no clear consensus as yet. Our aim was to investigate the relationship between frequent internet use and patterns of health or social care resource use in primary care attendees who took part in a study seeking to improve the health of older adults. Participants recruited from primary care, aged >65 and living in semirural or urban areas in the south of England, were followed up at 3 and 6 months after completing a comprehensive questionnaire with personalised feedback on their health and well-being. We performed logistic regression analyses to investigate relationships between frequent internet use and patterns of service use, controlling for confounding factors, and clustering by general practitioner practice. Four categories of service use data were gathered: use of primary National Health Service (NHS) care; secondary NHS care; other community health and social care services; and assistance with washing, shopping and meals. Our results show, in this relatively healthy population, a positive relationship (OR 1.72, 95% CI 1.33 to 2.23) between frequent internet use and use of any other community-based health services (physiotherapist, osteopath/chiropractor, dentist, optician/optometrist, counselling service, smoking cessation service, chiropodist/podiatrist, emergency services, other non-specific health services) and no relationship with the other types of care. No causal relationship can be postulated due to the study's design. No observed relationship between frequent internet use and primary or secondary care use was found, suggesting that older adults without internet access are not disadvantaged regarding healthcare use. Further research should explore how older people use

  8. Predictors of health-related quality of life in children with chronic heart disease.

    Science.gov (United States)

    Niemitz, Mandy; Gunst, Diana C M; Hövels-Gürich, Hedwig H; Hofbeck, Michael; Kaulitz, Renate; Galm, Christoph; Berger, Felix; Nagdyman, Nicole; Stiller, Brigitte; Borth-Bruhns, Thomas; Konzag, Ines; Balmer, Christian; Goldbeck, Lutz

    2017-10-01

    Chronic paediatric heart disease is often associated with residual symptoms, persisting functional restrictions, and late sequelae for psychosocial development. It is, therefore, increasingly important to evaluate the health-related quality of life of children and adolescents with chronic heart disease. The aim of this study was to determine medical and socio-demographic variables affecting health-related quality of life in school-aged children and adolescents with chronic heart disease. Patients and methods The Pediatric Cardiac Quality of Life Inventory was administered to 375 children and adolescents and 386 parental caregivers. Medical information was obtained from the charts. The socio-demographic information was provided by the patients and caregivers. Greater disease severity, low school attendance, current cardiac medication, current parental employment, uncertain or limited prognosis, history of connection to a heart-lung machine, number of nights spent in a hospital, and need for treatment in a paediatric aftercare clinic independently contributed to lower health-related quality of life (self-report: R2=0.41; proxy-report: R2=0.46). High correlations between self-reports and parent-proxy reports indicated concordance regarding the evaluation of a child's health-related quality of life. Beyond medical treatment, integration into school is important to increase health-related quality of life in children and adolescents surviving with chronic heart disease. Regular screening of health-related quality of life is recommended to identify patients with special needs.

  9. The Bodies Politic: Chronic Health Conditions and Voter Turnout in the 2008 Election.

    Science.gov (United States)

    Gollust, Sarah E; Rahn, Wendy M

    2015-12-01

    Health policy researchers often evaluate the social and economic consequences of chronic illness, but rarely have they considered the implications of chronic illness on one important form of political participation: voting. However, if chronic illnesses--already unequally distributed in society--are associated with differential rates of voter turnout, then these inequalities in democratic representation could, in turn, produce further health inequity. In this study, we use data from eight states from the 2009 Behavioral Risk Factor Surveillance Survey to examine the associations between having diagnoses of five chronic conditions and turnout in the 2008 US presidential election. After adjusting for sociodemographic characteristics and some health-related confounding factors, we find that individuals with cancer diagnoses are more likely to vote, while those with heart disease diagnoses are less likely to vote. These associations differ by race and educational status; notably, African Americans and those with lower education with cancer are even more likely to turn out to vote than whites and those with more education with cancer. We discuss the implications of our findings in the context of health social movements and the role of health organizations in shaping political processes, important directions for the study of health politics. Copyright © 2016 by Duke University Press.

  10. How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?—a scoping review

    Science.gov (United States)

    Francis, Linda; Dunt, David; Cadilhac, Dominique A

    2016-01-01

    Objectives Programmes to address chronic disease are a focus of governments worldwide. Despite growth in ‘implementation science’, there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field. Settings A scoping review of the literature spanning 1985–2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health. Participants Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases. Primary and secondary outcome measures Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types. Results Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with ‘maintenance of programme activities’ most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found. Conclusions Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to

  11. How is the sustainability of chronic disease health programmes empirically measured in hospital and related healthcare services?-a scoping review.

    Science.gov (United States)

    Francis, Linda; Dunt, David; Cadilhac, Dominique A

    2016-05-31

    Programmes to address chronic disease are a focus of governments worldwide. Despite growth in 'implementation science', there is a paucity of knowledge regarding the best means to measure sustainability. The aim of this review was to summarise current practice for measuring sustainability outcomes of chronic disease health programmes, providing guidance for programme planners and future directions for the academic field. A scoping review of the literature spanning 1985-2015 was conducted using MEDLINE, CINAHL, PsychINFO and The Cochrane Library limited to English language and adults. Main search terms included chronic disease, acute care, sustainability, institutionalisation and health planning. A descriptive synthesis was required. Settings included primary care, hospitals, mental health centres and community health. Programmes included preventing or managing chronic conditions including diabetes, heart disease, depression, respiratory disease, cancer, obesity, dental hygiene and multiple chronic diseases. Outcome measures included clarifying a sustainability definition, types of methodologies used, timelines for assessment, criteria levels to determine outcomes and how methodology varies between intervention types. Among 153 abstracts retrieved, 87 were retained for full article review and 42 included in the qualitative synthesis. Five definitions for sustainability outcome were identified with 'maintenance of programme activities' most frequent. Achieving sustainability was dependent on inter-relationships between various organisational and social contexts supporting a broad scale approach to evaluation. An increasing trend in use of mixed methods designs over multiple time points to determine sustainability outcomes was found. Despite the importance and investment in chronic disease programmes, few studies are undertaken to measure sustainability. Methods to evaluate sustainability are diverse with some emerging patterns in measurement found. Use of mixed

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

    Directory of Open Access Journals (Sweden)

    Nguyen Kim M

    2003-10-01

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

  13. Does trust in health care influence the use of complementary and alternative medicine by chronically ill people?

    Directory of Open Access Journals (Sweden)

    Rijken PM

    2006-07-01

    Full Text Available Abstract Background People's trust in health care and health care professionals is essential for the effectiveness of health care, especially for chronically ill people, since chronic diseases are by definition (partly incurable. Therefore, it may be understandable that chronically ill people turn to complementary and alternative medicine (CAM, often in addition to regular care. Chronically ill people use CAM two to five times more often than non-chronically ill people. The trust of chronically ill people in health care and health care professionals and the relationship of this with CAM use have not been reported until now. In this study, we examine the influence of chronically ill people's trust in health care and health care professionals on CAM use. Methods The present sample comprises respondents of the 'Panel of Patients with Chronic Diseases' (PPCD. Patients (≥25 years were selected by GPs. A total of 1,625 chronically ill people were included. Trust and CAM use was measured by a written questionnaire. Statistical analyses were t tests for independent samples, Chi-square and one-way analysis of variance, and logistic regression analysis. Results Chronically ill people have a relatively low level of trust in future health care. They trust certified alternative practitioners less than regular health care professionals, and non-certified alternative practitioners less still. The less trust patients have in future health care, the more they will be inclined to use CAM, when controlling for socio-demographic and disease characteristics. Conclusion Trust in future health care is a significant predictor of CAM use. Chronically ill people's use of CAM may increase in the near future. Health policy makers should, therefore, be alert to the quality of practising alternative practitioners, for example by insisting on professional certification. Equally, good quality may increase people's trust in public health care.

  14. Health care autonomy in children with chronic conditions: implications for self-care and family management.

    Science.gov (United States)

    Beacham, Barbara L; Deatrick, Janet A

    2013-06-01

    Health care autonomy typically occurs during late adolescence but health care providers and families often expect children with chronic health conditions to master self-care earlier. Few studies have examined the development of health care autonomy as it pertains to self-care and family management. This review links the 3 concepts and discusses the implications for families and health care providers. Case studies are provided as exemplars to highlight areas where intervention and research is needed. Copyright © 2013 Elsevier Inc. All rights reserved.

  15. Nonemergency medical transportation and health care visits among chronically ill urban and rural medicaid beneficiaries.

    Science.gov (United States)

    Thomas, Leela V; Wedel, Kenneth R

    2014-01-01

    Inaccessibility to health care services due to lack of transportation affects the most vulnerable segments of the society. The effect of Medicaid-provided nonemergency medical transportation (NEMT) in Oklahoma on health care visits for the management of chronic illnesses is examined. Analyses of claims data show that African Americans are the highest users of NEMT. Medicaid beneficiaries who use NEMT services are significantly more likely to make the recommended number of annual visits for the management of chronic conditions than those who do not use NEMT. Increased use of NEMT by making the services more accommodating and convenient for beneficiaries is proposed.

  16. Experiences of community health agents in the care of the elderly affected by chronic diseases

    Directory of Open Access Journals (Sweden)

    Marinês Tambara Leite

    2016-01-01

    Full Text Available Objective: to understand which are the experiences of community health agents in the care of patients with chronic diseases. Methods: qualitative research carried out through the interview of 20 community health agents. Data were analyzed following the steps of content analysis. Results: the care for the elderly has limitations due to their low educational level, resistance to adhere to drug therapy and low frequency of visits to health facilities. Another reason is the aging process in itself that may compromise the ability of self-care and the development of daily activities. Conclusion: difficulties of community health agents were identified in the care of elderly people with chronic diseases due to low adherence to treatment and to the health service.

  17. Women, weight, poverty and menopause: understanding health practices in a context of chronic disease prevention.

    Science.gov (United States)

    Audet, Mélisa; Dumas, Alex; Binette, Rachelle; Dionne, Isabelle J

    2017-11-01

    Socioeconomic inequalities in health persist despite major investments in illness prevention campaigns and universal healthcare systems. In this context, the increased risks of chronic diseases of specific sub-groups of vulnerable populations should be further investigated. The objective of this qualitative study is to examine the interaction between socioeconomic status (SES) and body weight in order to understand underprivileged women's increased vulnerability to chronic diseases after menopause. By drawing specifically on Pierre Bourdieu's sociocultural theory of practice, 20 semi-structured interviews were conducted from May to December of 2013 to investigate the health practices of clinically overweight, postmenopausal women living an underprivileged life in Canada. Findings emphasise that poor life conditions undermine personal investment in preventive health and weight loss, showing the importance for policy makers to bring stronger consideration on upstream determinants of health. © 2017 Foundation for the Sociology of Health & Illness.

  18. Measuring public health practice and outcomes in chronic disease: a call for coordination.

    Science.gov (United States)

    Porterfield, Deborah S; Rogers, Todd; Glasgow, LaShawn M; Beitsch, Leslie M

    2015-04-01

    A strategic opportunity exists to coordinate public health systems and services researchers' efforts to develop local health department service delivery measures and the efforts of divisions within the Centers for Disease Control and Prevention's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP) to establish outcome indicators for public health practice in chronic disease. Several sets of outcome indicators developed by divisions within NCCDPHP and intended for use by state programs can be tailored to assess outcomes of interventions within smaller geographic areas or intervention settings. Coordination of measurement efforts could potentially allow information to flow from the local to the state to the federal level, enhancing program planning, accountability, and even subsequent funding for public health practice.

  19. Dystonia: Emotional and Mental Health

    Science.gov (United States)

    ... Support Frequently Asked Questions Faces of Dystonia Emotional & Mental Health Although dystonia is a movement disorder that impacts ... emotion as well as muscle movement. For years, mental health professionals have recognized that coping with a chronic ...

  20. The role of disease management programs in the health behavior of chronically ill patients.

    Science.gov (United States)

    Cramm, Jane Murray; Adams, Samantha A; Walters, Bethany Hipple; Tsiachristas, Apostolos; Bal, Roland; Huijsman, Robbert; Rutten-Van Mölken, Maureen P M H; Nieboer, Anna Petra

    2014-04-01

    Investigate the effects of disease management program (DMP) implementation on physical activity, smoking, and physical quality of life among chronically ill patients. This study used a mixed-methods approach involving qualitative (35 interviews with project managers) and quantitative (survey of patients from 18 DMPs) data collection. Questionnaire response rates were 51% (2010; 2619/5108) at T0 and 47% (2011; 2191/4693) at T1. Physical activity and the percentage of smokers improved significantly over time, whereas physical quality of life declined. After adjusting for patients' physical quality of life at T0, age, educational level, marital status, and gender, physical activity at T0 (pmanagers reported that DMPs improved patient-professional interaction. The ability to set more concrete targets improved patients' health behaviors. DMPs appear to improve physical activity among chronically ill patients over time. Furthermore, (changes in) health behavior are important for the physical quality of life of chronically ill patients. Redesigning care systems and implementing DMPs based on the chronic care model may improve health behavior among chronically ill patients. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  1. Perceived discrimination and chronic health in adults from nine ethnic subgroups in the USA.

    Science.gov (United States)

    Carlisle, Shauna K

    2015-01-01

    This comparative analysis examines the association between chronic cardiovascular, respiratory and pain conditions, race, ethnicity, nativity, length of residency, and perceived discrimination among three racial and nine ethnic subgroups of Asian Americans (Vietnamese, Filipino, and Chinese), Latino-American (Cuban, Portuguese, and Mexican), and Afro-Caribbean American (Haitian, Jamaican, and Trinidadian/Tobagonian) respondents. Analysis used weighted Collaborative Psychiatric Epidemiology Surveys-merged data from the National Latino and Asian American Study and the National Survey of American Life. Logistic regression analysis was conducted to determine which groups within the model were more likely to report perceived discrimination effects. Afro-Caribbean subgroups were more likely to report perceived discrimination than Asian American and Latino-American subgroups were. Logistic regression revealed a significant positive association with perceived discrimination and chronic pain only for Latino-American respondents. Significant differences in reports of perceived discrimination emerged by race and ethnicity. Caribbean respondents were more likely to report high levels of perceived discrimination; however, they showed fewer significant associations related to chronic health conditions compared to Asian Americans and Latino-Americans. Examination of perceived discrimination across ethnic subgroups reveals large variations in the relationship between chronic health and discrimination by race and ethnicity. Examining perceived discrimination by ethnicity may reveal more complex chronic health patterns masked by broader racial groupings.

  2. Perceived Benefits and Challenges of Coordinated Approaches to Chronic Disease Prevention in State Health Departments

    Science.gov (United States)

    Sequeira, Sonia; Best, Leslie; Jones, Ellen; Baker, Elizabeth A.; Brownson, Ross C.

    2014-01-01

    Introduction Chronic disease prevention efforts have historically been funded categorically according to disease or risk factor. Federal agencies are now progressively starting to fund combined programs to address common risk. The purpose of this study was to inform transitions to coordinated chronic disease prevention by learning views on perceived benefits and challenges of a coordinated approach to funding. Methods A national survey on evidence-based public health was conducted from March through May 2013 among state health department employees working in chronic disease prevention (N = 865). Participants were asked to rank the top 3 benefits and top 3 challenges in coordinating chronic disease approaches from provided lists and could provide additional responses. Descriptive analyses, χ2 tests, and analysis of variance were conducted. Results The most common perceived benefits of coordinated approaches to chronic disease prevention were improved health outcomes, common risk factors better addressed, and reduced duplication of program efforts. The most common perceived challenges were funding restrictions, such as disease-specific performance measures; competing priorities; lack of communication across programs; funding might be reduced; agency not structured for program coordination; and loss of disease-specific partner support. Rankings of benefits and challenges were similar across states and participant roles; the perceived challenges “lack of communication across programs” (P = .02) and “funding might be reduced” differed by program area (P organizational support for coordinated approaches, and create benefits for organizational partners. PMID:24809362

  3. Changes in chronic disease management among community health centers (CHCs) in China: Has health reform improved CHC ability?

    Science.gov (United States)

    Wang, Zhaoxin; Shi, Jianwei; Wu, Zhigui; Xie, Huiling; Yu, Yifan; Li, Ping; Liu, Rui; Jing, Limei

    2017-07-01

    Since the 1980s, China has been criticized for its mode of chronic disease management (CDM) that passively provides treatment in secondary and tertiary hospitals but lacks active prevention in community health centers (CHCs). Since there are few systematic evaluations of the CHCs' methods for CDM, this study aimed to analyze their abilities. On the macroperspective, we searched the literature in China's largest and most authoritative databases and the official websites of health departments. Literature was used to analyze the government's efforts in improving CHCs' abilities to perform CDM. At the microlevel, we examined the CHCs' longitudinal data after the New Health Reform in 2009, including financial investment, facilities, professional capacities, and the conducted CDM activities. A policy analysis showed that there was an increasing tendency towards government efforts in developing CDM, and the peak appeared in 2009. By evaluating the reform at CHCs, we found that there was an obvious increase in fiscal and public health subsidies, large-scale equipment, general practitioners, and public health physicians. The benefited vulnerable population in this area also rose significantly. However, rural centers were inferior in their CDM abilities compared with urban ones, and the referral system is still not effective in China. This study showed that CHCs are increasingly valued in managing chronic diseases, especially after the New Health Reform in 2009. However, we still need to improve collaborative management for chronic diseases in the community and strengthen the abilities of CHCs, especially in rural areas. Copyright © 2017 John Wiley & Sons, Ltd.

  4. Health literacy and chronic disease management: drawing from expert knowledge to set an agenda.

    Science.gov (United States)

    Poureslami, Iraj; Nimmon, Laura; Rootman, Irving; Fitzgerald, Mark J

    2017-08-01

    Understanding the nature and impact of health literacy is a priority in health promotion and chronic disease prevention and treatment. Health literacy comprises the application of a broad set of skills to access, comprehend, evaluate, communicate and act on health information for improved health and well-being. A complex concept, it involves multiple participants and is enacted across a wide variety of contexts. Health literacy's complexity has given rise to challenges achieving a standard definition and developing means to measure all its dimensions. In May 2013, a group of health literacy experts, clinicians and policymakers convened at an Expert Roundtable to review the current state of health literacy research and practice, and make recommendations about refining its definition, expanding its measurement and integrating best practices into chronic disease management. The four-day knowledge exchange concluded that the successful integration of health literacy into policy and practice depends on the development of a more substantial evidence base. A review of the successes and gaps in health literacy research, education and interventions culminated in the identification of key priorities to further the health literacy agenda. The workshop was funded by the UBC Peter Wall Institute for Advanced Studies, Vancouver. © The Author 2016. Published by Oxford University Press.

  5. Do Work Characteristics Predict Health Deterioration Among Employees with Chronic Diseases?

    Science.gov (United States)

    de Wind, Astrid; Boot, Cécile R L; Sewdas, Ranu; Scharn, Micky; van den Heuvel, Swenne G; van der Beek, Allard J

    2017-06-29

    Purpose In our ageing workforce, the increasing numbers of employees with chronic diseases are encouraged to prolong their working lives. It is important to prevent health deterioration in this vulnerable group. This study aims to investigate whether work characteristics predict health deterioration over a 3-year period among employees with (1) chronic diseases, and, more specifically, (2) musculoskeletal and psychological disorders. Methods The study population consisted of 5600 employees aged 45-64 years with a chronic disease, who participated in the Dutch Study on Transitions in Employment, Ability and Motivation (STREAM). Information on work characteristics was derived from the baseline questionnaire. Health deterioration was defined as a decrease in general health (SF-12) between baseline and follow-up (1-3 years). Crude and adjusted logistic regression analyses were performed to investigate prediction of health deterioration by work characteristics. Subgroup analyses were performed for employees with musculoskeletal and psychological disorders. Results At follow-up, 19.2% of the employees reported health deterioration (N = 1075). Higher social support of colleagues or supervisor predicted health deterioration in the crude analyses in the total group, and the groups with either musculoskeletal or psychological disorders (ORs 1.11-1.42). This effect was not found anymore in the adjusted analyses. The other work characteristics did not predict health deterioration in any group. Conclusions This study did not support our hypothesis that work characteristics predict health deterioration among employees with chronic diseases. As our study population succeeded continuing employment to 45 years and beyond, it was probably a relatively healthy selection of employees.

  6. Chronic disease health risk behaviours amongst people with a mental illness.

    Science.gov (United States)

    Bartlem, Kate M; Bowman, Jennifer A; Bailey, Jacqueline M; Freund, Megan; Wye, Paula M; Lecathelinais, Christophe; McElwaine, Kathleen M; Campbell, Elizabeth M; Gillham, Karen E; Wiggers, John H

    2015-08-01

    Amongst people with a mental illness, modifiable health risk behaviours contribute substantially to increased chronic disease morbidity and mortality. This study examined the prevalence of and interest in changing such behaviours amongst community mental health service clients in Australia. A telephone interview was undertaken with Australian community mental health service clients. Participants reported engagement in four health risk behaviours: tobacco smoking, fruit and vegetable consumption, alcohol consumption, and physical activity. Participants were classified as at risk based upon Australian national guidelines. At-risk participants were asked whether they were considering improving their health risk behaviour within the next month. The association between psychiatric diagnosis and risk, and interest in improving health risk behaviours was examined. Risk prevalence was highest for inadequate vegetable consumption (78.3%), followed by inadequate fruit consumption (60%), smoking (50.7%), physical inactivity (46.8%), short-term alcohol risk (40.3%) and chronic alcohol risk (35.3%). A majority of at-risk participants were considering improving their health risk behaviour for smoking, physical inactivity and inadequate fruit and vegetable consumption (65.1%, 71.1%, and 53.3%, respectively). After adjusting for demographic factors, no diagnostic categories were associated with risk for any behaviour. Those with a diagnosis of depression were more likely to be interested in quitting smoking and increasing physical activity. Regardless of diagnosis, a high prevalence of chronic disease health risk behaviours was identified, with many participants expressing an interest in improving these behaviours. Such findings reinforce recommendations that preventive care addressing the chronic disease risks of clients be provided routinely by mental health clinicians. Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000693729. URL: www.anzctr.org.au/. © The

  7. Chronically ill patients’ expectations of therapeutic education and their health locus of control

    Directory of Open Access Journals (Sweden)

    Małgorzata Anna Basińska

    2015-12-01

    Full Text Available Background Beliefs as cognitive components of personality indicate what we consider as true or false and help us to answer questions concerning others, the world surrounding us and situations that we encounter. Beliefs about the health locus of control and their relations with expectations pertaining to therapeutic education seem to be of vital importance in the case of occurrence of a chronic illness. The aim of this paper is to verify whether expectations concerning therapeutic education in chronically ill patients demonstrate a relation with beliefs about the health locus of control and whether they vary according to gender, age and health, and to present the results of research that applies the Polish OE-15 scale for the evaluation of therapeutic education expectations depending on the health condition. Participants and procedure Two hundred and ninety-one persons were examined, including 180 patients and 111 healthy controls (the control group, 187 women and 104 men. The average age of subjects was 45.71 (SD = 13.51 years, ranging from 21 to 80 years. The OE-15 Therapeutic Education Expectations Scale and the Multidimensional Health Locus of Control Scale in versions relevant for patients and healthy controls as well as demographics were used. Results Age, gender and beliefs about the health locus of control are related to expectations of therapeutic education. Conclusions When providing therapeutic education for chronically ill patients, one should assess their expectations and pay attention to patients’ beliefs about the health locus of control.

  8. Effect Of Ventilation On Chronic Health Risks In Schools And Offices

    Energy Technology Data Exchange (ETDEWEB)

    Parthasarathy, Srinandini [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); Fisk, William J. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States); McKone, Thomas E. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2013-01-04

    This study provides a risk assessment for chronic health risks from inhalation exposure to indoor air pollutants in offices and schools with a focus how ventilation impacts exposures to, and risks from, volatile organic compounds (VOCs) and particulate matter (PM2.5). We estimate how much health risks could change with varying ventilation rates under two scenarios: (i) halving the measured ventilation rates and (ii) doubling the measured ventilation rates. For the hazard characterization we draw upon prior papers that identified pollutants potentially affecting health with indoor air concentrations responsive to changes in ventilation rates. For exposure assessment we determine representative concentrations of pollutants using data available in current literature and model changes in exposures with changes in ventilation rates. As a metric of disease burden, we use disability adjusted life years (DALYs) to address both cancer and non-cancer effects. We also compare exposures to guidelines published by regulatory agencies to assess chronic health risks. Chronic health risks are driven primarily by particulate matter exposure, with an estimated baseline disease burden of 150 DALYs per 100,000 people in offices and 140 DALYs per 100,000 people in schools. Study results show that PM2.5-related DALYs are not very sensitive to changes in ventilation rates. Filtration is more effective at controlling PM2.5 concentrations and health effects. Non-cancer health effects contribute only a small fraction of the overall chronic health burden of populations in offices and schools (<1 DALY per 100,000 people). Cancer health effects dominate the disease burden in schools (3 DALYs per 100,000) and offices (5 DALYs per 100,000), with formaldehyde being the primary risk driver. In spite of large uncertainties in toxicological data and dose-response modeling, our results support the finding that ventilation rate changes do not have significant impacts on estimated chronic disease

  9. Complete mental health in adult siblings of those with a chronic illness or disability.

    Science.gov (United States)

    Hallion, Madeleine; Taylor, Amanda; Roberts, Rachel

    2018-02-01

    Sibling relationships have lifelong significance and childhood chronic illness and disability can have considerable impacts on healthy siblings, influencing development into adulthood. Research has not yet assessed well-being in this population using measures of both mental health and mental illness. Thus, this study assessed well-being in a comprehensive manner using the complete mental health (CMH) model. Participants (N = 144) included both adult siblings of those with chronic illness or disability and adults with healthy siblings. Measures of positive social, psychological and emotional well-being were used to assess mental health and a measure of depression, anxiety, and stress was used to assess mental illness. A high proportion of participants, both with and without siblings with a chronic illness or disability, were experiencing symptoms of mental illness, accompanied by high wellbeing. This indicates that many participants fit into the struggling category of the CMH model. The present research highlights the need for early intervention services to ensure that siblings of those with a chronic illness or disability are well supported in developing strengths, as well as managing difficulties. Results also indicate that targeting students in mental health promotion is important to encourage participation in services. Implications for rehabilitation Siblings of those with a chronic illness or disability need to be included in assessments in order to understand the experience of the family unit. It is important for families and clinicians to be aware of the needs of healthy siblings and encourage them to interact with support services in order to maximise and maintain well-being. Skills-based support could be beneficial, particularly for providing caregivers with strategies to meet the needs of both their child with a chronic illness or disability and their healthy children.

  10. Adverse childhood experiences, chronic diseases, and risky health behaviors in Saudi Arabian adults: a pilot study.

    Science.gov (United States)

    Almuneef, Maha; Qayad, Mohammed; Aleissa, Majid; Albuhairan, Fadia

    2014-11-01

    Adverse childhood experiences (ACEs) have been linked with risky health behaviors and the development of chronic diseases in adulthood. This study examined associations between ACEs, chronic diseases, and risky behaviors in adults living in Riyadh, Saudi Arabia in 2012 using the ACE International Questionnaire (ACE-IQ). A cross-sectional design was used, and adults who were at least 18 years of age were eligible to participate. ACEs event scores were measured for neglect, household dysfunction, abuse (physical, sexual, and emotional), and peer and community violence. The ACE-IQ was supplemented with questions on risky health behaviors, chronic diseases, and mood. A total of 931 subjects completed the questionnaire (a completion rate of 88%); 57% of the sample was female, 90% was younger than 45 years, 86% had at least a college education, 80% were Saudi nationals, and 58% were married. One-third of the participants (32%) had been exposed to 4 or more ACEs, and 10%, 17%, and 23% had been exposed to 3, 2, or 1 ACEs respectively. Only 18% did not have an ACE. The prevalence of risky health behaviors ranged between 4% and 22%. The prevalence of self-reported chronic diseases ranged between 6% and 17%. Being exposed to 4 or more ACEs increased the risk of having chronic diseases by 2-11 fold, and increased risky health behaviors by 8-21 fold. The findings of this study will contribute to the planning and development of programs to prevent child maltreatment and to alleviate the burden of chronic diseases in adults. Copyright © 2014 Elsevier Ltd. All rights reserved.

  11. Relation between perceived health and sick leave in employees with a chronic illness

    NARCIS (Netherlands)

    Boot, C.R.L.; Koppes, L.L.J.; Bossche, S.N.J. van den; Anema, J.R.; Beek, A.J. van der

    2011-01-01

    Introduction: To improve work participation in individuals with a chronic illness, insight into the role of work-related factors in the association between health and sick leave is needed. The aim of this study was to gain insight into the contribution of work limitations, work characteristics, and

  12. Patient reported outcomes in chronic skin diseases: eHealth applications for clinical practice

    NARCIS (Netherlands)

    van Cranenburgh, O.D.

    2016-01-01

    The overall aim of this thesis was to examine and integrate patient reported outcomes (PROs) in dermatological care. In part I, we specifically examined health-related quality of life (HRQoL), treatment satisfaction, and experiences with care in patients with chronic skin diseases. Our results

  13. Many Survivors of Adolescent and Young Adult Cancers Have Chronic Health Problems

    Science.gov (United States)

    A 2012 study showed that people who’d had cancer as adolescents and young adults were more likely to be current smokers, be obese, have various chronic conditions, be disabled, and have poor mental and physical health. The findings highlight the importance of addressing the special needs and concerns of this population.

  14. Design of a consumer health record for supporting the patient-centered management of chronic diseases.

    NARCIS (Netherlands)

    de Clerq, P.A.; Hasman, A.; Wolffenbuttel, B.H.R.

    2001-01-01

    : Medinfo 2001;10(Pt 2):1445-9 Related Articles, Books, LinkOut Design of a consumer health record for supporting the patient-centered management of chronic diseases. de Clercq PA, Hasman A, Wolffenbuttel BH. Department of Medical Informatics, University of Maastricht, Maastricht, The Netherlands.

  15. eHealth to stimulate physical activity in patients with chronic obstructive pulmonary disease

    NARCIS (Netherlands)

    Vorrink, S.N.W.

    2016-01-01

    Persons with Chronic Obstructive Pulmonary Disease (COPD) demonstrate reduced physical activity (PA) levels compared to healthy age-matched controls. Regular PA is associated with positive health outcomes. Inactivity leads to deconditioning, which leads to increased symptoms and a further reduction

  16. Chronic particulate exposure, mortality and cardiovascular outcomes in the nurses health study

    Science.gov (United States)

    Adverse health effects of exposures to acute air pollution have been well studied. Fewer studies have examined effects of chronic exposure. Previous studies used exposure estimates for narrow time periods and were limited by the geographic distribution of pollution monitors. This...

  17. Pet Dogs and Children's Health: Opportunities for Chronic Disease Prevention?

    Science.gov (United States)

    Gadomski, Anne M; Scribani, Melissa B; Krupa, Nicole; Jenkins, Paul; Nagykaldi, Zsolt; Olson, Ardis L

    2015-11-25

    Positive associations between having a pet dog and adult health outcomes have been documented; however, little evidence exists regarding the benefits of pet dogs for young children. This study investigates the hypothesis that pet dogs are positively associated with healthy weight and mental health among children. This cross-sectional study accrued a consecutive sample of children over 18 months in a pediatric primary care setting. The study enrolled 643 children (mean age, 6.7 years); 96% were white, 45% were female, 56% were privately insured, and 58% had pet dogs in the home. Before an annual visit, parents of children aged 4 to 10 years completed the DartScreen, a comprehensive Web-based health risk screener administered using an electronic tablet. The screener domains were child body mass index (BMI), physical activity, screen time, mental health, and pet-related questions. Children with and children without pet dogs did not differ in BMI (P = .80), screen time of 2 hours or less (P = 0.99), or physical activity (P = .07). A lower percentage of children with dogs (12%) met the clinical cut-off value of Screen for Child Anxiety and Related Disorders (SCARED-5) of 3 or more, compared with children without dogs (21%, P = .002). The mean SCARED-5 score was lower among children with dogs (1.13) compared with children without dogs (1.40; P = .01). This relationship was retained in multivariate analysis after controlling for several covariates. Having a pet dog in the home was associated with a decreased probability of childhood anxiety. Future studies need to establish whether this relationship is causal and, if so, how pet dogs alleviate childhood anxiety.

  18. Role of maternal vitamins in programming health and chronic disease

    OpenAIRE

    Pannia, Emanuela; Cho, Clara E.; Kubant, Ruslan; S?nchez-Hern?ndez, Diana; Huot, Pedro S.P.; Harvey Anderson, G.

    2016-01-01

    Vitamin consumption prior to and during pregnancy has increased as a result of proactive recommendations by health professionals, wide availability of vitamin supplements, and liberal food-fortification policies. Folic acid, alone or in combination with other B vitamins, is the most recommended vitamin consumed during pregnancy because deficiency of this vitamin leads to birth defects in the infant. Folic acid and other B vitamins are also integral components of biochemical processes that are...

  19. Missed Opportunities for Chronic Diseases Prevention in a Primary Health Care Center in Istanbul

    OpenAIRE

    Ahmet Topuzoglu; Seyhan Hidiroglu; M.Fatih Onsuz; Gulsen Polat

    2011-01-01

    Aim: The aim of the study was to investigate missed opportunities about chronic diseases and related risk factors in a primary health care center in Istanbul. Method: This cross sectional study was held in a Primary Health Care Center in Istanbul with the study population consisted of 500 people which were applicated in one month period. Participants were asked; if they were questioned by their physician about major risk factors (smoking, obesity, diabetes mellitus, hypertension, coroner hear...

  20. Men's health: non-communicable chronic diseases and social vulnerability.

    Science.gov (United States)

    Bidinotto, Daniele Natália Pacharone Bertolini; Simonetti, Janete Pessuto; Bocchi, Silvia Cristina Mangini

    2016-08-15

    to evaluate the relationship between absences in scheduled appointments and the number of non-communicable chronic diseases and to investigate the relationship between spatial distribution of these diseases and social vulnerability, using geoprocessing. a quantitative study of sequential mixed approach by analyzing 158 medical records of male users to relate the absences and 1250 medical records for geoprocessing. the higher the number of absences in the scheduled medical appointments, the less were the number of non-communicable chronic diseases and the ones listed in the International Classification of Diseases in single men. There were 21 significant geostatistically cases of glucose intolerance in the urban area. Of these, 62% lived in a region with a social vulnerability rating of Very Low, Medium 19%, 14% Low and 5% High. it was observed that the older the men, the greater is the number of chronic diseases and the less they miss scheduled appointments. Regarding the use of geoprocessing, we obtained a significant number of cases of glucose intolerance in urban areas, the majority classified as Very Low social vulnerability. It was possible to relate the spatial distribution of these diseases with the social vulnerability classification; however, it was not possible to perceive a relationship of them with the higher rates of social vulnerability. avaliar a relação entre as faltas em consultas agendadas e o número de doenças crônicas não transmissíveis e averiguar a relação entre distribuição espacial dessas doenças e vulnerabilidade social, utilizando-se o geoprocessamento. estudo quantitativo, de abordagem mista sequencial, sendo analisados 158 prontuários de usuários do sexo masculino para se relacionar as faltas e 1250 prontuários para o geoprocessamento. quanto maior o número de faltas nas consultas médicas agendadas, menores foram a quantidade de doenças crônicas não transmissíveis e as listadas na Classificação Internacional de

  1. ls with Chronic Conditions Want More Guidance from Health Professionals in Finding Quality Online Health SourcesIndividua

    Directory of Open Access Journals (Sweden)

    Cari Merkley

    2016-04-01

    Full Text Available Objective – To explore how and when individuals with chronic health conditions seek out health information online, and the challenges they encounter when doing so. Design – Qualitative study employing thematic analysis. Setting – Urban Western Australia. Subjects – 17 men and women between 19 and 85 years of age with at least 1 chronic health condition. Methods – Participants were recruited in late 2013 at nine local pharmacies, through local radio, media channels, and a university's social media channels. Participants were adult English speakers who had looked for information on their chronic health condition(s using the Internet. Semi-structured face-to-face interviews were conducted with each participant, audio recorded, and transcribed. The transcripts were coded in QSR Nvivo using two different processes – an initial data-driven inductive approach to coding, followed by a theory driven analysis of the data. Main Results – Three major themes emerged: trust, patient activation, and relevance. Many of the participants expressed trust both in health professionals and in the efficacy of search engines like Google. However, there was uncertainty about the quality of some of the health information sources found. Searching for information online was seen by some participants as a way to feel more empowered about their condition(s and treatment, but they reported frustration in finding information that was relevant to their specific condition(s given the volume of information available. Low health literacy emerged in participant interviews as an intrinsic barrier to effective online searches for health information, along with low patient motivation and lack of time. The many extrinsic barriers identified included difficulty determining the quality of information found, the accessibility of the information (e.g., journal paywalls, and poor relationships with health care providers. Conclusion – Individuals look for online health

  2. What do health interview surveys tell us about the prevalences of somatic chronic diseases?: a study into concurrent validity.

    NARCIS (Netherlands)

    Velden, J. van der; Abrahamse, H.P.H.; Donker, G.; Steen, J. van der; Sonsbeek, J.L.A. van; Bos, G.A.M. van den

    1998-01-01

    This study examines the concurrent validity of a list of chronic conditions used in health interview surveys. The results regarding the prevalence of chronic diseases from three health interview surveys, carried out in The Netherlands during the 1980s, were compared. In addition, the results for

  3. Aligning health information technologies with effective service delivery models to improve chronic disease care.

    Science.gov (United States)

    Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

    2014-09-01

    Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. An assessment of the relationships between overweight, obesity, related chronic health conditions and worker absenteeism.

    Science.gov (United States)

    Howard, Jeffrey T; Potter, Lloyd B

    2014-01-01

    Worker absenteeism is an important area of study within the field of occupational health. Prior studies have linked the presence of obesity to higher rates of absenteeism, but have not examined whether or not the relationship is moderated by the presence of other chronic health conditions or whether or not the relationships have been stable over time. Data from the 2000 and 2010 National Health Interview Survey, a nationally representative sample of the US population, were analyzed to determine the extent to which the presence of 5 obesity-related chronic health conditions moderates the relationship between overweight/obesity and worker absenteeism, and whether or not these relationships are stable over time. Logistic regression was used to examine the relationships between overweight/obesity, the obesity-related chronic health conditions and worker absenteeism, while controlling for demographic, socio-economic, occupational, health related and behavioral variables. The findings suggest that obesity (p absenteeism, and that the effect is doubled for those with both class III obesity (BMI ≥ 40) and diabetes. The moderating effect between class III obesity and diabetes was observed only in 2010, indicating that this may be a relatively new phenomenon. © 2014 Asian Oceanian Association for the Study of Obesity . Published by Elsevier Ltd. All rights reserved.

  5. Leveraging electronic health records to support chronic disease management: the need for temporal data views.

    Science.gov (United States)

    Samal, Lipika; Wright, Adam; Wong, Bang T; Linder, Jeffrey A; Bates, David W

    2011-01-01

    The ageing population worldwide is increasingly acquiring multiple chronic diseases. The complex management of chronic diseases could be improved with electronic health records (EHRs) tailored to chronic disease care, but most EHRs in use today do not adequately support longitudinal data management. A key aspect of chronic disease management is that it takes place over long periods, but the way that most EHRs display longitudinal data makes it difficult to trend changes over time and slows providers as they review each patient's unique course. We present five clinical scenarios illustrating longitudinal data needs in complex chronic disease management. These scenarios may function as example cases for software development. For each scenario, we describe and illustrate improvements in temporal data views. Two potential solutions are visualisation for numerical data and disease-oriented text summaries for non-numerical data. We believe that development and widespread implementation of improved temporal data views in EHRs will improve the efficiency and quality of chronic disease management in primary care.

  6. Leisure as a resource for successful aging by older adults with chronic health conditions.

    Science.gov (United States)

    Hutchinson, Susan L; Nimrod, Galit

    2012-01-01

    Drawing on the model of Selective Optimization with Compensation (SOC) (Baltes & Baltes, 1990), the purpose of this article is to examine leisure-related goals of older adults with chronic conditions and the strategies they use to not only successfully manage their chronic health conditions but live well with them. Semi-structured in-person interviews were conducted with 18 community-dwelling older adults (nine males, nine females, ages 58-87 years) with a variety of chronic conditions. Inductive and deductive within and cross-case thematic analyses resulted in descriptions of changes and continuity in participants' leisure participation following the onset of their chronic condition and construction of four themes: drawing on existing resources for continued involvement, setting leisure-based goals, using strategies to get more out of life, and more than managing: living a life of meaning. Implications for promoting successful aging are discussed, specifically the benefits of incorporating information and skill-building to help older adults recognize that leisure can be a resource for healthy aging and self-managing their chronic health condition.

  7. Chronic morbidity and health care seeking behaviour amongst elderly population in rural areas of Uttarakhand

    Directory of Open Access Journals (Sweden)

    Surekha Kishore

    2015-06-01

    Full Text Available Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity,   especially those arising from chronic diseases also increases. On the contrary, health care delivered at household level has definitely   gone down due to financial constraints and increasing cost of living, thus posing a problem for the elderly.  Aims & Objective: To find out the prevalence of chronic morbidity and health care seeking behaviour amongst the elderly in rural areas of Uttarakhand. Material and Methods: A cross-sectional study was carried out in rural areas of Uttarakhand to assess the chronic morbidity amongst elderly population. All the persons above the age group of 60 years of the eight villages were interviewed using a pre-defined, pre-tested, semi-structured and indigenously developed questionnaire. Results: The study group suffered from various chronic morbidities like hypertension, diabetes, cardiovascular diseases. Men were greater in number (158, 62.2%. Participants belonging mostly to nuclear families (156, 61.9%. Below the poverty line were (98, 38.9%. Half of the study population had one or the other chronic morbid condition. Majority of the elderly men contacted the health care facility whereas majority of the elderly women chose to use remedies. Conclusion: There is definitely a need of   provision of health care services for poor geriatric population. In addition to this government should take up some program for social security of this population along with creating an awareness about the same.

  8. Early growth and chronic disease: a public health overview.

    Science.gov (United States)

    Law, Catherine

    2005-07-01

    Infant and childhood growth result from and reflect a range of influences in pre- and postnatal life. These include nutrition, burden of infection and the psycho-social environment. Nutrition in young children is dependent on individual level factors such as fetal experience, infant feeding and weaning practices, and on societal factors such as education of women and economic conditions. The relationship of early postnatal growth to adult disease may be indicative or causal, and may reveal both biological and sociological processes. Although non-insulin-dependent diabetes mellitus (NIDDM) and obesity are risk factors for ischaemic heart disease, the relationships of these three conditions to infant growth differ. Poor infant growth has been associated with higher levels of NIDDM and ischaemic heart disease, but lower levels of adult obesity. Most research has been of populations living in developed countries at different stages of nutritional transition. However, differences in context are not simply limited to the stage of the nutritional transition. They also need to consider the nature of that transition and its social correlates, which may result in the clustering of aetiological influences such as increased body mass and poverty. The size of effect of the relationship of infant growth to adult disease is important not only to determine its relative aetiological importance but also for its potential for public health policy. Such policy also needs to consider the relationships of infant growth to a range of outcomes, both health and human capital, which are not the subject of this workshop.

  9. Chronic fatigue syndrome and fibromyalgia in Canada: prevalence and associations with six health status indicators

    Directory of Open Access Journals (Sweden)

    C. Rusu

    2015-03-01

    Full Text Available Introduction: Few studies have considered the factors independently associated with chronic fatigue syndrome (CFS and/or fibromyalgia (FM or considered the impact of these conditions on health status using population-based data. Methods: We used data from the nationally representative 2010 Canadian Community Health Survey (n= 59 101 to describe self-reported health professional-diagnosed CFS and/or FM, and their associations with 6 health status indicators. Results: In 2010, diagnosed CFS and FM are reported by 1.4% (95% confidence interval [CI]: 1.3%–1.6% and 1.5% (1.4%–1.7%, respectively, of the Canadian household population aged 12 years and over, with comorbid CFS and FM affecting 0.3% (0.3%–0.4% of that population. Prevalent CFS and/or FM were more common among women, adults aged 40 years and over, those with lowest income, and those with certain risk factors for chronic disease (i.e. obesity, physical inactivity and smoking. After controlling for differences between the groups, people with CFS and/or FM reported poorer health status than those with neither condition on 5 indicators of health status, but not on the measure of fair/poor mental health. Having both CFS and FM and having multiple comorbid conditions was associated with poorer health status. Conclusion: Co-occurrence of CFS and FM and having other chronic conditions were strongly related to poorer health status and accounted for much of the differences in health status. Understanding factors contributing to improved quality of life in people with CFS and/or FM, particularly in those with both conditions and other comorbidities, may be an important area for future research.

  10. Winter Weather Frequently Asked Questions

    Science.gov (United States)

    ... Extreme Heat Older Adults (Aged 65+) Infants and Children Chronic Medical Conditions Low Income Athletes Outdoor Workers Pets Hot Weather Tips Warning Signs and Symptoms FAQs Social Media How to Stay Cool Missouri Cooling Centers Extreme ...

  11. HealthNavigator: a mobile application for chronic disease screening and linkage to services at an urban Primary Health Network.

    Science.gov (United States)

    Seneviratne, Martin G; Hersch, Fred; Peiris, David P

    2018-03-26

    Mobile applications (apps) are promising tools to support chronic disease screening and linkage to health services. They have the potential to increase healthcare access for vulnerable populations. The HealthNavigator app was developed to provide chronic disease risk assessments, linkage to local general practitioners (GPs) and lifestyle programs, and a personalised health report for discussion with a GP. Assessments were either self-administered or facilitated by community health workers through a Primary Health Network (PHN) initiative targeting ethnically diverse communities. In total, 1492 assessments (80.4% self-administered, 19.6% facilitated) were conducted over a 12-month period in Queensland, Australia. Of these, 26% of people screened came from postcodes representing the lowest quartile of socioeconomic disadvantage. When compared against self-administered assessments, subjects screened by the facilitated program were more likely to be born outside Australia (80.5 v. 33.2%, P<0.001), and to fall within a high risk category based on cardiovascular risk scores (19.8 v. 13.7%, P<0.01) and type 2 diabetes mellitus risk scores (58.0 v. 40.1%, P<0.001). Mobile apps embedded into PHN programs may be a useful adjunct for the implementation of community screening programs. Further research is needed to determine their effect on health service access and health outcomes.

  12. Using online health communication to manage chronic sorrow: mothers of children with rare diseases speak.

    Science.gov (United States)

    Glenn, Adriana D

    2015-01-01

    Families affected by rare disease experience psychosocial reactions similar to families with prevalent chronic diseases. The ability to respond and manage the condition depends on psychosocial factors. This phenomenological study of 16 mothers of children with Alagille syndrome explored their lived experience in using online health communications to manage their chronic sorrow. Data consisted of semi-structured interviews analyzed using techniques described by van Manen. Analysis yielded four essential themes: connectedness, online triggers, empowerment, and seasons of online use contributed to online communication essential to a rare disease community. Findings suggest mothers need emotional support and help accessing appropriate online resources. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Treatment of Anthrax Disease Frequently Asked Questions

    Energy Technology Data Exchange (ETDEWEB)

    Judd, Kathleen S.; Young, Joan E.; Lesperance, Ann M.; Malone, John D.

    2010-05-14

    This document provides a summary of Frequently Asked Questions (FAQs) on the treatment of anthrax disease caused by a wide-area release of Bacillus anthracis spores as an act bioterrorism. These FAQs are intended to provide the public health and medical community, as well as others, with guidance and communications to support the response and long-term recovery from an anthrax event.

  14. Developing educational material on chronic kidney disease using best practices in health literacy.

    Science.gov (United States)

    Santos, Luanda Thaís Mendonça; Bastos, Marcus Gomes

    2017-03-01

    Based in the precepts of Health Literacy (HL), an educational booklet "Do you know the Chronic Kidney Disease?" was written. It was used as a basic text for development of a Brazilian instrument for Assessment of Health Literacy (Teste de Avaliação de Letramento em Saúde or TALES). The guideline used to create the TALES obeyed four steps: systematization of content; creation and drawing of images by an expert designer; submission to a Committee of Experts on nephrology and linguistics; and editing and printing of the content. The content covering six aspects of chronic kidney disease (definition, diagnosis, signs and symptoms, prevention, risk factors and treatment) was developed utilizing multimodality techniques such as: creation of personages; verbal and visual metaphors; metonymy; personifications; direct dialogue; and plain language avoided of technicalities. During the development of TALES, the booklet proved to be useful in translating complicated scientific concepts on kidney disease into meaningfuly health messages. In conclusion, besides of being used as basic text for the development of TALES, the booklet "Do you know chronic kidney disease?", based in best practices in HL, can assist health professionals in communicating to patients using consumer-friendly educational materials that might impact positive health-related behaviors and results.

  15. Developing educational material on chronic kidney disease using best practices in health literacy

    Directory of Open Access Journals (Sweden)

    Luanda Thaís Mendonça Santos

    Full Text Available Abstract Based in the precepts of Health Literacy (HL, an educational booklet "Do you know the Chronic Kidney Disease?" was written. It was used as a basic text for development of a Brazilian instrument for Assessment of Health Literacy (Teste de Avaliação de Letramento em Saúde or TALES. The guideline used to create the TALES obeyed four steps: systematization of content; creation and drawing of images by an expert designer; submission to a Committee of Experts on nephrology and linguistics; and editing and printing of the content. The content covering six aspects of chronic kidney disease (definition, diagnosis, signs and symptoms, prevention, risk factors and treatment was developed utilizing multimodality techniques such as: creation of personages; verbal and visual metaphors; metonymy; personifications; direct dialogue; and plain language avoided of technicalities. During the development of TALES, the booklet proved to be useful in translating complicated scientific concepts on kidney disease into meaningfuly health messages. In conclusion, besides of being used as basic text for the development of TALES, the booklet "Do you know chronic kidney disease?", based in best practices in HL, can assist health professionals in communicating to patients using consumer-friendly educational materials that might impact positive health-related behaviors and results.

  16. Alcohol and Public Health: Frequently Asked Questions

    Science.gov (United States)

    ... influenced by many factors, such as: Age. Sex. Race or ethnicity. Physical condition (e.g. weight, fitness ... which are all skills needed to drive a car safely. 2 The more alcohol consumed, the greater ...

  17. Women Veterans Health Care: Frequently Asked Questions

    Science.gov (United States)

    ... Accountability & Whistleblower Protection Transparency Media Room Inside the Media Room Public Affairs News Releases Speeches Videos Publications National Observances Veterans Day Memorial Day Celebrating America's Freedoms Special Events Adaptive Sports Program Creative Arts Festival ...

  18. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Stewart Allison

    2008-05-01

    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

  19. A game plan: Gamification design principles in mHealth applications for chronic disease management.

    Science.gov (United States)

    Miller, Aaron S; Cafazzo, Joseph A; Seto, Emily

    2016-06-01

    Effective chronic disease management is essential to improve positive health outcomes, and incentive strategies are useful in promoting self-care with longevity. Gamification, applied with mHealth (mobile health) applications, has the potential to better facilitate patient self-management. This review article addresses a knowledge gap around the effective use of gamification design principles, or mechanics, in developing mHealth applications. Badges, leaderboards, points and levels, challenges and quests, social engagement loops, and onboarding are mechanics that comprise gamification. These mechanics are defined and explained from a design and development perspective. Health and fitness applications with gamification mechanics include: bant which uses points, levels, and social engagement, mySugr which uses challenges and quests, RunKeeper which uses leaderboards as well as social engagement loops and onboarding, Fitocracy which uses badges, and Mango Health, which uses points and levels. Specific design considerations are explored, an example of the efficacy of a gamified mHealth implementation in facilitating improved self-management is provided, limitations to this work are discussed, a link between the principles of gaming and gamification in health and wellness technologies is provided, and suggestions for future work are made. We conclude that gamification could be leveraged in developing applications with the potential to better facilitate self-management in persons with chronic conditions. © The Author(s) 2014.

  20. Do work factors modify the association between chronic health problems and sickness absence among older employees?

    Science.gov (United States)

    Leijten, Fenna R M; van den Heuvel, Swenne G; Ybema, Jan Fekke; Robroek, Suzan J W; Burdorf, Alex

    2013-09-01

    The aim of this study was to (i) assess how common chronic health problems and work-related factors predict sickness absence and (ii) explore whether work-related factors modify the effects of health problems on sickness absence. A one-year longitudinal study was conducted among employed persons aged 45-64 years from the Study on Transitions in Employment, Ability and Motivation (N = 8984). The presence of common chronic health problems and work-related factors was determined at baseline and self-reported sickness absence at one-year follow-up by questionnaire. Multinomial multivariate logistic regression analyses were conducted to assess associations between health, work factors, and sickness absence, and relative excess risk due to interaction (RERI) techniques were used to test effect modification. Common health problems were related to follow-up sickness absence, most strongly to high cumulative sickness absence (> 9 days per year). Baseline psychological health problems were strongly related to high sickness absence at follow-up [odds ratio (OR) 3.67, 95% confidence interval (95% CI) 2.80-4.82]. Higher job demands at baseline increased the likelihood of high sickness absence at follow-up among workers with severe headaches [RERI 1.35 (95% CI 0.45-2.25)] and psychological health problems [RERI 3.51 (95% CI 0.67-6.34)] at baseline. Lower autonomy at baseline increased the likelihood of high sickness absence at follow-up among those with musculoskeletal [RERI 0.57 (95% CI 0.05-1.08)], circulatory [RERI 0.82 (95% CI 0.00-1.63)], and psychological health problems [RERI 2.94 (95% CI 0.17-5.70)] at baseline. Lower autonomy and higher job demands increased the association of an array of common chronic health problems with sickness absence, and thus focus should be placed on altering these factors in order to reduce sickness absence and essentially promote sustainable employability.

  1. [School choice and vocational guidance for schoolchildren with chronic diseases and other health problems].

    Science.gov (United States)

    Lancić, Franciska; Majski-Cesarec, Slavenka; Musil, Vera

    2010-09-01

    By following a child's growth, development, and health, school medicine specialist can see opportunities for career choice. Special attention is needed for schoolchildren with chronic diseases and developmental difficulties, because of limited occupation choices. Studies report 10 % to 15 % prevalence of chronic diseases among schoolchildren. Parents and children should be informed about child's limitations before career choice. It would be helpful for the students to develop interests for occupations that are not contraindicated for their condition. Physical examination gives an insight into the psycho-physical abilities of an eighth-grade primary school student for further education. During examination, counselling and vocational guidance is provided for all students with chronic diseases and other health problems. All procedures are oriented to personal abilities and preferences. The aim of this study was to analyse the reasons for vocational guidance in the Varazdin County of Croatia. It included eighth-grade students from ten primary schools from 1998/99 to 2007/08. Of 4939 students, 458 (9.3 %) with chronic diseases and health difficulties were referred to vocational guidance. Of these, 41.3 % were referred due to mental and behavioural disorders. These students were assessed and received a recommendation for at least two occupations. Forty-eight students (10.5 %) did not follow the recommendation.In a coordinated effort, school physicians, vocational guidance experts, and school and local authorities should secure enrollment of students with chronic diseases and health difficulties in secondary schools and follow their development and education to provide them the best available career opportunities.

  2. Climate Leadership Awards Frequent Questions

    Science.gov (United States)

    Provides answers to frequently asked questions regarding the Climate Leadership Awards, sponsored by EPA's Center for Corporate Climate Leadership with co-sponsorship from the Center for Climate and Energy Solutions and The Climate Registry.

  3. Role of maternal vitamins in programming health and chronic disease.

    Science.gov (United States)

    Pannia, Emanuela; Cho, Clara E; Kubant, Ruslan; Sánchez-Hernández, Diana; Huot, Pedro S P; Harvey Anderson, G

    2016-03-01

    Vitamin consumption prior to and during pregnancy has increased as a result of proactive recommendations by health professionals, wide availability of vitamin supplements, and liberal food-fortification policies. Folic acid, alone or in combination with other B vitamins, is the most recommended vitamin consumed during pregnancy because deficiency of this vitamin leads to birth defects in the infant. Folic acid and other B vitamins are also integral components of biochemical processes that are essential to the development of regulatory systems that control the ability of the offspring to adapt to the external environment. Although few human studies have investigated the lasting effects of high vitamin intakes during pregnancy, animal models have shown that excess vitamin supplementation during gestation is associated with negative metabolic effects in both the mothers and their offspring. This research from animal models, combined with the recognition that epigenetic regulation of gene expression is plastic, provides evidence for further examination of these relationships in the later life of pregnant women and their children. © The Author(s) 2016. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  4. Chronic Pancreatitis in Children

    Science.gov (United States)

    ... E-News Sign-Up Home Patient Information Children/Pediatric Chronic Pancreatitis in Children Chronic Pancreatitis in Children What symptoms would my child have? Frequent or chronic abdominal pain is the most common symptom of pancreatitis. The ...

  5. A case study examination of structure and function in a state health department chronic disease unit.

    Science.gov (United States)

    Alongi, Jeanne

    2015-04-01

    I explored the structural and operational practices of the chronic disease prevention and control unit of a state health department and proposed a conceptual model of structure, function, and effectiveness for future study. My exploratory case study examined 7 elements of organizational structure and practice. My interviews with staff and external stakeholders of a single chronic disease unit yielded quantitative and qualitative data that I coded by perspective, process, relationship, and activity. I analyzed these for patterns and emerging themes. Chi-square analysis revealed significant correlations among collaboration with goal ambiguity, political support, and responsiveness, and evidence-based decisions with goal ambiguity and responsiveness. Although my study design did not permit conclusions about causality, my findings suggested that some elements of the model might facilitate effectiveness for chronic disease units and should be studied further. My findings might have important implications for identifying levers around which capacity can be built that may strengthen effectiveness.

  6. Absenteeism and Employer Costs Associated With Chronic Diseases and Health Risk Factors in the US Workforce

    Science.gov (United States)

    Roy, Kakoli; Lang, Jason E.; Payne, Rebecca L.; Howard, David H.

    2016-01-01

    Introduction Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). Methods We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measured as the number of workdays missed because of sickness or injury. We used zero-inflated Poisson regression to estimate excess absenteeism as the difference in the number of days missed from work by those who reported having a risk factor or chronic disease and those who did not. Covariates included demographics (eg, age, education, sex) and employment variables (eg, industry, union membership). We quantified absenteeism costs in 2011 and adjusted them to reflect growth in employment costs to 2015 dollars. Finally, we estimated absenteeism costs for a hypothetical small employer (100 employees) and a hypothetical large employer (1,000 employees). Results Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease. Except for the physical inactivity and obesity estimates, disease- and risk-factor–specific estimates were similar in MEPS and MarketScan. Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year. Conclusion Absenteeism costs associated with chronic diseases and health risk factors can be substantial. Employers may incur these costs through lower productivity, and employees could incur costs through lower wages. PMID:27710764

  7. Sexual orientation measurement and chronic disease disparities: National Health and Nutrition Examination Survey, 2009-2014.

    Science.gov (United States)

    Patterson, Joanne G; Jabson, Jennifer M

    2018-02-01

    To examine chronic disease disparities by sexual orientation measurement among sexual minorities. We pooled data from the 2009-2014 National Health and Nutrition Examination Survey to examine differences in chronic disease prevalence between heterosexual and sexual minority people as defined by sexual identity, lifetime sexual behavior, 12-month sexual behavior, and concordance of lifetime sexual behavior and sexual identity. Self-identified lesbian women reported greater odds of asthma (adjusted odds ratio [aOR], 3.19; 95% confidence intervals [CI], 1.37-7.47) and chronic bronchitis (aOR, 2.64; 95% CI, 1.21-5.72) than self-identified heterosexual women. Self-identified sexual minority women with a history of same-sex sexual behavior reported greater odds of arthritis (aOR, 1.67; 95% CI, 1.02-2.74). Compared with heterosexual men, gay men reported greater odds of chronic bronchitis when sexual orientation was defined by sexual identity (aOR, 4.68; 95% CI, 1.90-11.56) or 12-month sexual behavior (aOR, 3.22; 95% CI, 1.27-8.20), as did bisexual men defined by lifetime sexual behavior (aOR, 2.36; 95% CI, 1.14-4.89). Bisexual men reported greater odds of asthma when measured by lifetime sexual behavior (aOR, 1.90; 95% CI, 1.12-3.19), as did self-identified heterosexual men with a history of same-sex sexual behavior (aOR, 2.21; 95% CI, 1.10-4.46). How we define sexual orientation influences our understanding of chronic disease prevalence. Capturing subgroups of sexual minority people in health surveillance is essential for identifying groups most at risk and developing targeted interventions to reduce chronic disease disparities. Copyright © 2017 Elsevier Inc. All rights reserved.

  8. Absenteeism and Employer Costs Associated With Chronic Diseases and Health Risk Factors in the US Workforce.

    Science.gov (United States)

    Asay, Garrett R Beeler; Roy, Kakoli; Lang, Jason E; Payne, Rebecca L; Howard, David H

    2016-10-06

    Employers may incur costs related to absenteeism among employees who have chronic diseases or unhealthy behaviors. We examined the association between employee absenteeism and 5 conditions: 3 risk factors (smoking, physical inactivity, and obesity) and 2 chronic diseases (hypertension and diabetes). We identified 5 chronic diseases or risk factors from 2 data sources: MarketScan Health Risk Assessment and the Medical Expenditure Panel Survey (MEPS). Absenteeism was measured as the number of workdays missed because of sickness or injury. We used zero-inflated Poisson regression to estimate excess absenteeism as the difference in the number of days missed from work by those who reported having a risk factor or chronic disease and those who did not. Covariates included demographics (eg, age, education, sex) and employment variables (eg, industry, union membership). We quantified absenteeism costs in 2011 and adjusted them to reflect growth in employment costs to 2015 dollars. Finally, we estimated absenteeism costs for a hypothetical small employer (100 employees) and a hypothetical large employer (1,000 employees). Absenteeism estimates ranged from 1 to 2 days per individual per year depending on the risk factor or chronic disease. Except for the physical inactivity and obesity estimates, disease- and risk-factor-specific estimates were similar in MEPS and MarketScan. Absenteeism increased with the number of risk factors or diseases reported. Nationally, each risk factor or disease was associated with annual absenteeism costs greater than $2 billion. Absenteeism costs ranged from $16 to $81 (small employer) and $17 to $286 (large employer) per employee per year. Absenteeism costs associated with chronic diseases and health risk factors can be substantial. Employers may incur these costs through lower productivity, and employees could incur costs through lower wages.

  9. [Prevalence and factors associated with frequent attendence in family medicine clinic].

    Science.gov (United States)

    Parejo Maestre, N; Lendínez-de la Cruz, J M; Bermúdez-Torres, F M; Gónzalez-Contero, L; Gutierrez-Espinosa de Los Monteros, M P; Espejo-Almazán María, T

    2016-01-01

    The use of health services has seen a steep rise. The frequent users are responsible for significant economic, human and social impact. The objective is to analyze the characteristics of frequent attenders in our Health Center, in order to evaluate the possibility of taking corrective measures to improve the quality of care and efficiency in the use of resources. Descriptive observational study of a sample of 379 patients over 18 years old. The dependent variables were attendance (number of visits to their family doctor during the previous year), frequent attendance (10 or more visits to the family doctor in the last year), and persistent frequent attenders (10 or more visits to the family doctor in each of the last two years). Data were collected from medical records and by telephone interview. The mean attendance was 6.83 (95%CI: 6.13-7.53), frequent attendance reached 25.4% (95%CI: 21.4-29.6), and persistent frequent attenders, 1.6% (95%CI: 0.5-2.9). Frequent attendance was associated with sex, age, marital status, educational level, family structure, existence of chronic disease, use of anxiolytic and antidepressants, request for additional tests, and referrals to other specialists, proximity to the health center, and level of satisfaction with their family doctor. The low persistent frequent attenders found suggests that frequent attendance could be largely due to factors related to professional and organization. Studies are required to address the high level of consumption of psychotropic drugs, and improving professional skills in dealing with mental problems. Copyright © 2014 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.

  10. Users and non-users of web-based health advice service among Finnish university students – chronic conditions and self-reported health status (a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Castrén Johanna

    2008-01-01

    Full Text Available Abstract Background The Internet is increasingly used by citizens as source of health information. Young, highly educated adults use the Internet frequently to search for health-related information. Our study explores whether reported chronic conditions or self-reported health status differed among Finnish university students using the Finnish Student Health Services web-based health advice service compared with those not using the service. Methods Cross-sectional study performed by a national postal survey in 2004. Material: A random sample (n = 5 030 of a population of 101 805 undergraduate Finnish university students aged 19–35. The response rate: 63% (n = 3 153. Main outcome measures: Proportion of university students reporting use a of web-based health advice service, diagnosed chronic conditions, and self-reported health status of users and non-users of a web-based health advice service. Statistical methods: Data were presented with frequency distributions and cross-tabulations and the χ2 test was used. Results 12% (n = 370 of Finnish undergraduate students had used the web-based health advice service and were identified as 'users'. The proportion of male students reporting allergic rhinitis or conjunctivitis was greater among users than non-users (24%, n = 22 vs. 15%, n = 154, χ2, P = .03. The proportion of female students reporting chronic mental health problems was greater among users than non-users (12%, n = 34 vs. 8%, n = 140, χ2, P = .03. There was no statistical significance between the group differences of male or female users and non-users in self-reported health status (good or fairly good, average, rather poor or poor. Conclusion Among young, highly educated adults the use of a web-based health advice service is not associated with self-reported health status. However, a web-based health advice service could offer support for managing several specific chronic conditions. More research data is needed to evaluate the role of

  11. Connected health and integrated care: Toward new models for chronic disease management.

    Science.gov (United States)

    Chouvarda, Ioanna G; Goulis, Dimitrios G; Lambrinoudaki, Irene; Maglaveras, Nicos

    2015-09-01

    The increasingly aging population in Europe and worldwide brings up the need for the restructuring of healthcare. Technological advancements in electronic health can be a driving force for new health management models, especially in chronic care. In a patient-centered e-health management model, communication and coordination between patient, healthcare professionals in primary care and hospitals can be facilitated, and medical decisions can be made timely and easily communicated. Bringing the right information to the right person at the right time is what connected health aims at, and this may set the basis for the investigation and deployment of the integrated care models. In this framework, an overview of the main technological axes and challenges around connected health technologies in chronic disease management are presented and discussed. A central concept is personal health system for the patient/citizen and three main application areas are identified. The connected health ecosystem is making progress, already shows benefits in (a) new biosensors, (b) data management, (c) data analytics, integration and feedback. Examples are illustrated in each case, while open issues and challenges for further research and development are pinpointed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  12. Racial and gender discrimination, early life factors, and chronic physical health conditions in midlife.

    Science.gov (United States)

    McDonald, Jasmine A; Terry, Mary Beth; Tehranifar, Parisa

    2014-01-01

    Most studies of perceived discrimination have been cross-sectional and focused primarily on mental rather than physical health conditions. We examined the associations of perceived racial and gender discrimination reported in adulthood with early life factors and self-reported physician diagnosis of chronic physical health conditions. We used data from a racially diverse birth cohort of U.S. women (n = 168; average age, 41 years) with prospectively collected early life data (e.g., parental socioeconomic factors) and adult reported data on perceived discrimination, physical health conditions, and relevant risk factors. We performed modified robust Poisson regression owing to the high prevalence of the outcomes. Fifty percent of participants reported racial and 39% reported gender discrimination. Early life factors did not have strong associations with perceived discrimination. In adjusted regression models, participants reporting at least three experiences of gender or racial discrimination had a 38% increased risk of having at least one physical health condition (relative risk, 1.38; 95% confidence interval, 1.01-1.87). Using standardized regression coefficients, the magnitude of the association of having physical health condition(s) was larger for perceived discrimination than for being overweight or obese. Our results suggest a substantial chronic disease burden associated with perceived discrimination, which may exceed the impact of established risk factors for poor physical health. Copyright © 2014 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

  13. The Relationship between Health-Promoting Behaviors and Resilience in Patients with Chronic Kidney Disease

    Directory of Open Access Journals (Sweden)

    Li-Ching Ma

    2013-01-01

    Full Text Available This cross-sectional research study explored differences in health-promoting behavior and resilience among three groups of chronic kidney disease patients (high-risk, early chronic kidney disease; early CKD and pre-end stage renal disease; pre-ESRD treated at the Nephrology outpatient clinic in northern Taiwan. A total of 150 CKD outpatients were interviewed using structured questionnaires including a CKD Health to Promote Lifestyle Scale, and resilience scale. We found that the pre-ESRD group had lower resilience than either high-risk or early CKD groups. Factors affecting pre-ESRD resilience were gender, occupational status, diabetes and health-promoting behaviors. Factors affecting resilience of the high-risk group included level of education and health-promoting behaviors while factors affecting resilience in the early CKD group involved whether they are employed and health promoting behaviors. A significant positive correlation was found between health promoting behavior and resilience in all study subjects. Multiple regression analysis found that factors which could effectively predict resilience in patients at high-risk for CKD were gender, whether the patient had a job, nutrition, self-actualization, and stress level, accounting for 69.7% of the variance. Therefore, nursing education should focus on health promotion advocacy throughout the life of not only patients but also their families.

  14. Using Health Utility Index (HUI for Measuring the Impact on Health-Related Quality of Life (HRQL Among Individuals with Chronic Diseases

    Directory of Open Access Journals (Sweden)

    Frank Mo

    2004-01-01

    Full Text Available 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 (≤ 0.5 and 0.06

  15. The longitudinal relationship between mental health disorders and chronic disease for older adults: a population-based study.

    Science.gov (United States)

    Chen, Chun-Min; Lee, I-Chen; Su, Yung-Yu; Mullan, Judy; Chiu, Herng-Chia

    2017-09-01

    Although mental health disorders in older adults are common, their relationship with chronic disease and the influence of chronic disease on the development of mental health disorders over time is not well understood. This longitudinal study investigated the change in status of mental health disorders and chronic disease, as well as their interrelationships, over time. Participants included community-dwelling older adults living in Taiwan, aged 65 years or older, who completed six waves of survey interviews. Mental health disorders were scored using the Short Psychiatric Evaluation Schedule, and chronic disease(s) status was recorded during consecutive biennial data collection waves. The autoregressive latent trajectory model and parallel latent growth curve model were used for data analysis. The study findings suggest that in older people pre-existing mental health disorders and/or chronic disease(s) will predispose them to developing significantly more mental health disorders and/or chronic diseases respectively. The study findings also suggest that pre-existing mental health disorders can significantly contribute to the development of chronic disease over time, and that pre-existing chronic disease(s) significantly can contribute to the development of mental health disorders over time, indicating a reciprocal interrelationship. Our study findings suggest that it in addition to monitoring and treating chronic disease(s) in older people, it is also important to monitor and treat their mental health disorders. Doing so will result in overall better health outcomes and will facilitate a better quality of life as they age. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

  16. Community perceptions of health and chronic disease in South Indian rural transitional communities: a qualitative study.

    Science.gov (United States)

    Hayter, Arabella K M; Jeffery, Roger; Sharma, Chitra; Prost, Audrey; Kinra, Sanjay

    2015-01-01

    Chronic diseases are now the leading cause of death and disability worldwide; this epidemic has been linked to rapid economic growth and urbanisation in developing countries. Understanding how characteristics of the physical, social, and economic environment affect behaviour in the light of these changes is key to identifying successful interventions to mitigate chronic disease risk. We undertook a qualitative study consisting of nine focus group discussions (FGDs) (n=57) in five villages in rural Andhra Pradesh, South India, to understand people's perceptions of community development and urbanisation in relation to chronic disease in rural transitional communities. Specifically, we sought to understand perceptions of change linked to diet, physical activity, and pollution (because these exposures are most relevant to chronic diseases), with the aim of defining future interventions. The transcripts were analysed thematically. Participants believed their communities were currently less healthy, more polluted, less physically active, and had poorer access to nutritious food and shorter life expectancies than previously. There were contradictory perceptions of the effects of urbanisation on health within and between individuals; several of the participants felt their quality of life had been reduced. In the present study, residents viewed change and development within their villages as an inevitable and largely positive process but with some negative health consequences. Understanding how these changes are affecting populations in transitional rural areas and how people relate to their environment may be useful to guide community planning for health. Measures to educate and empower people to make healthy choices within their community may help reduce the spread of chronic disease risk factors in future years.

  17. Perceptions of chronically ill and healthy consumers about electronic personal health records: a comparative empirical investigation.

    Science.gov (United States)

    Cocosila, Mihail; Archer, Norm

    2014-07-23

    To develop a model of consumer perceptions of electronic personal health records (PHRs) and validate it in a comparative study between consumers who report having a chronic illness and those who report being well. A model of PHR use motivators and barriers was built and tested through a national survey across Canada. Data were collected from 800 individuals, 18 years or older. Half reported having a chronic illness or disability and half reported being well. Analyses were performed with structural equation modelling techniques. A total of 389 answers from chronically ill and 383 from well participants were collected. Perceived usefulness was the key explanation of the intention to use PHRs for both ill and well people (total effect of 0.601 and 0.565, respectively) followed by security, privacy and trust in PHRs (total effect of 0.377 and 0.479, respectively). Conversely, computer anxiety was perceived as a significant barrier (total effect of -0.327 for ill individuals and -0.212 for well individuals). The model proposed was appropriate in explaining key consumer positive and negative perceptions on electronic PHR use. We found little difference in perceptions of electronic PHRs between chronically ill and well individuals, although self-reporting their health status might have influenced the results. To increase the adoption rate of electronic PHRs among both chronically ill and well consumers it is necessary to reinforce consumer perceptions of the usefulness of and trust in these eHealth technologies while mitigating their anxieties about computer use in general. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. A study of National Health Service management of chronic osteoarthritis and low back pain.

    Science.gov (United States)

    Hart, Oliver R; Uden, Ruth M; McMullan, James E; Ritchie, Mark S; Williams, Timothy D; Smith, Blair H

    2015-04-01

    To describe treatment and referral patterns and National Health Service resource use in patients with chronic pain associated with low back pain or osteoarthritis, from a Primary Care perspective. Osteoarthritis and low back pain are the two commonest debilitating causes of chronic pain, with high health and social costs, and particularly important in primary care. Understanding current practice and resource use in their management will inform health service and educational requirements and the design and optimisation of future care. Multi-centre, retrospective, descriptive study of adults (⩾18 years) with chronic pain arising from low back pain or osteoarthritis, identified through primary care records. Five general practices in Scotland, England (two), Northern Ireland and Wales. All patients with a diagnosis of low back pain or osteoarthritis made on or before 01/09/2006 who had received three or more prescriptions for pain medication were identified and a sub-sample randomly selected then consented to an in-depth review of their medical records (n=264). Data on management of chronic pain were collected retrospectively from patients' records for three years from diagnosis ('newly diagnosed' patients) or for the most recent three years ('established' patients). Patients received a wide variety of pain medications with no overall common prescribing pattern. GP visits represented the majority of the resource use and 'newly diagnosed' patients were significantly more likely to visit their GP for pain management than 'established' patients. Although 'newly diagnosed' patients had more referrals outside the GP practice, the number of visits to secondary care for pain management was similar for both groups. This retrospective study confirmed the complexity of managing these causes of chronic pain and the associated high resource use. It provides an in-depth picture of prescribing and referral patterns and of resource use.

  19. Multimorbidity in chronic disease: impact on health care resources and costs

    Directory of Open Access Journals (Sweden)

    McPhail SM

    2016-07-01

    Full Text Available Steven M McPhail1,2 1Centre for Functioning and Health Research, Metro South Health, 2Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia Abstract: Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied. There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to

  20. Modeling best practices in chronic disease management: the Arthritis Program at Southlake Regional Health Centre.

    Science.gov (United States)

    Bain, Lorna; Mierdel, Sandra; Thorne, Carter

    2012-01-01

    Researchers, hospital administrators and governments are striving to define competencies in interprofessional care and education, as well as to identify effective models in chronic disease management. For more than 25 years The Arthritis Program (TAP) at Southlake Regional Health Centre in Newmarket, Ontario, has actively practiced within these two interrelated priorities, which are now at the top of the healthcare agenda in Ontario and Canada. The approximately 135 different rheumatic conditions are the primary cause of long-term disability in Canada, affecting those from youth to the senior years, with an economic burden estimated at $4.4 billion (CAD$) annually, and growing. For the benefit of healthcare managers and their clients with chronic conditions, this article discusses TAP's history and demonstrable success, predicated on an educational model of patient self-management and self-efficacy. Also outlined are TAP's contributions in supporting evidence-based best practices in interprofessional collaboration and chronic disease management; approaches that are arguably understudied and under-practiced. Next steps for TAP include a larger role in empirical research in chronic-disease management and integration of a formal training program to benefit health professionals launching or expanding their interprofessional programs using TAP as the dynamic clinical example.

  1. Creating a sustainable collaborative consumer health application for chronic disease self-management.

    Science.gov (United States)

    Johnson, Constance M; McIlwain, Steve; Gray, Oliver; Willson, Bradley; Vorderstrasse, Allison

    2017-07-01

    As the prevalence of chronic diseases increase, there is a need for consumer-centric health informatics applications that assist individuals with disease self-management skills. However, due to the cost of development of these applications, there is also a need to build a disease agnostic architecture so that they could be reused for any chronic disease. This paper describes the architecture of a collaborative virtual environment (VE) platform, LIVE©, that was developed to teach self-management skills and provide social support to those individuals with type 2 diabetes. However, a backend database allows for the application to be easily reused for any chronic disease. We tested its usability in the context of a larger randomized controlled trial of its efficacy. The usability was scored as 'good' by half of the participants in the evaluation. Common errors in the testing and solutions to address initial usability issues are discussed. Overall, LIVE© represents a usable and generalizable platform that will be adapted to other chronic diseases and health needs in future research and applications. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Choir singing and creative writing enhance emotion regulation in adults with chronic mental health conditions.

    Science.gov (United States)

    Dingle, Genevieve A; Williams, Elyse; Jetten, Jolanda; Welch, Jonathon

    2017-11-01

    Adults with mental health conditions commonly experience difficulties with emotion regulation which affect their social functioning. Arts-based groups provide opportunities for shared emotional experiences and emotion regulation. This study explores emotion regulation strategies and the emotional effects of arts-based group participation in adults with mental health problems and in controls. The 62 participants included 39 adults with chronic mental health problems who were members of arts-based groups (ABG) and 23 comparison choir (CC) members who were not specifically experiencing mental health problems. The repeated measures design included self-reports of emotion upon waking (T1), the hour before group (T2), end of the group (T3), and evening (T4), as well as participant notes to explain their emotion ratings at each time. They also completed measures of individual and interpersonal emotion regulation. The ABG participants engaged marginally more in affect worsening strategies than CC (p = .057 and .08), but there were no other group differences. All participants reported a significant increase in positive emotions, F (3, 180) = 28.044, p emotions during the arts-based activity: F (2.637, 155.597) = 21.09, p emotions was short-lived, while the effect on negative emotions lasted until evening. Findings show that participation in arts-based groups benefits the emotions of both healthy adults and those experiencing mental health conditions through individual and interpersonal processes. Individuals with chronic mental health conditions often experience difficulties in emotion processing Participation in arts-based groups was associated with significant increases in positive emotions although these were short-lived Negative emotion was significantly decreased during arts-based group activities, and sustained to the evening assessment Adults with chronic mental health conditions were equally able to derive emotional benefits as healthy adults. © 2017 The

  3. Effectiveness of Telephone-Based Health Coaching for Patients with Chronic Conditions: A Randomised Controlled Trial.

    Directory of Open Access Journals (Sweden)

    Martin Härter

    Full Text Available Chronic diseases, like diabetes mellitus, heart disease and cancer are leading causes of death and disability. These conditions are at least partially preventable or modifiable, e.g. by enhancing patients' self-management. We aimed to examine the effectiveness of telephone-based health coaching (TBHC in chronically ill patients.This prospective, pragmatic randomized controlled trial compares an intervention group (IG of participants in TBHC to a control group (CG without TBHC. Endpoints were assessed two years after enrolment. Three different groups of insurees with 1 multiple conditions (chronic campaign, 2 heart failure (heart failure campaign, or 3 chronic mental illness conditions (mental health campaign were targeted. The telephone coaching included evidence-based information and was based on the concepts of motivational interviewing, shared decision-making, and collaborative goal setting. Patients received an average of 12.9 calls. Primary outcome was time from enrolment until hospital readmission within a two-year follow-up period. Secondary outcomes comprised the probability of hospital readmission, number of daily defined medication doses (DDD, frequency and duration of inability to work, and mortality within two years. All outcomes were collected from routine data provided by the statutory health insurance. As informed consent was obtained after randomization, propensity score matching (PSM was used to minimize selection bias introduced by decliners. For the analysis of hospital readmission and mortality, we calculated Kaplan-Meier curves and estimated hazard ratios (HR. Probability of hospital readmission and probability of death were analysed by calculating odds ratios (OR. Quantity of health service use and inability to work were analysed by linear random effects regression models. PSM resulted in patient samples of 5,309 (IG: 2,713; CG: 2,596 in the chronic campaign, of 660 (IG: 338; CG: 322 in the heart failure campaign, and of

  4. Multidimensional Poverty and Health Status as a Predictor of Chronic Income Poverty.

    Science.gov (United States)

    Callander, Emily J; Schofield, Deborah J

    2015-12-01

    Longitudinal analysis of Wave 5 to 10 of the nationally representative Household, Income and Labour Dynamics in Australia dataset was undertaken to assess whether multidimensional poverty status can predict chronic income poverty. Of those who were multidimensionally poor (low income plus poor health or poor health and insufficient education attainment) in 2007, and those who were in income poverty only (no other forms of disadvantage) in 2007, a greater proportion of those in multidimensional poverty continued to be in income poverty for the subsequent 5 years through to 2012. People who were multidimensionally poor in 2007 had 2.17 times the odds of being in income poverty each year through to 2012 than those who were in income poverty only in 2005 (95% CI: 1.23-3.83). Multidimensional poverty measures are a useful tool for policymakers to identify target populations for policies aiming to improve equity and reduce chronic disadvantage. Copyright © 2014 John Wiley & Sons, Ltd.

  5. The chronic care model and relationships to patient health status and health-related quality of life.

    Science.gov (United States)

    Hung, Dorothy Y; Glasgow, Russell E; Dickinson, L Miriam; Froshaug, Desireé B; Fernald, Douglas H; Balasubramanian, Bijal A; Green, Larry A

    2008-11-01

    The chronic care model (CCM) is a system-level framework used to guide quality improvement efforts in health care. However, little is known about its relationship to patient-level health measures. This study describes the implementation of the CCM as adapted for prevention and health behavior counseling in primary care practices, and examines relationships between the CCM and patient health measures, including general health status and health-related quality of life (HRQOL). Baseline data from Round 2 of the Prescription for Health initiative (2005-2007) were used to assess CCM implementation in 57 practices located nationwide. Relationships between the CCM and three separate measures of health among 4735 patients were analyzed in 2007. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate categories of general health status, unhealthy days, and activity-limiting days, adjusting for patient covariates and clustering effects. Outcome variances were significantly accounted for by differences in practice characteristics (pPractices that used individual or group planned visits were more likely to see patients in lower health categories across all measures (OR=0.74-0.81, pPractices that used patient registries, health promotion champions, evidence-based guidelines, publicly reported performance measures, and support for behavior change were associated with higher patient health levels (OR=1.28-1.98, ppractice's implementation of the CCM was significantly related to patient health status and HRQOL. Adapting the CCM for prevention may serve to reorient care delivery toward more proactive behavior change and improvements in patient health outcomes.

  6. Disparities in chronic conditions and health status by type of disability.

    Science.gov (United States)

    Horner-Johnson, Willi; Dobbertin, Konrad; Lee, Jae Chul; Andresen, Elena M

    2013-10-01

    Prior research has established health disparities between people with and without disabilities. However, disparities within the disability population, such as those related to type of disability, have been much less studied. To examine differences in chronic conditions and health status between subgroups of people with different types of disability. We analyzed Medical Expenditure Panel Survey annual data files from 2002 to 2008. Logistic regression analyses considered disparity from three perspectives: 1) basic differences, unadjusted for other factors; 2) controlling for key demographic and health covariates; and 3) controlling for a larger set of demographic variables and socioeconomic status as well as health and access to healthcare. Individuals with vision, physical, cognitive, or multiple disability types fared worse than people with hearing impairment on most health outcomes. This was most consistently true for people with multiple disabilities. Even when all covariates were accounted for, people with multiple types of disability were significantly more likely (p disability types were reduced when controlling for other factors, some differences remained significant. This argues for a more individualized approach to understanding and preventing chronic conditions and poor health in specific disability groups. Copyright © 2013 Elsevier Inc. All rights reserved.

  7. There's More Than Catastrophizing in Chronic Pain: Low Frustration Tolerance and Self-Downing Also Predict Mental Health in Chronic Pain Patients.

    Science.gov (United States)

    Suso-Ribera, Carlos; Jornet-Gibert, Montsant; Ribera Canudas, Maria Victoria; McCracken, Lance M; Maydeu-Olivares, Alberto; Gallardo-Pujol, David

    2016-06-01

    Among the potential range of irrational beliefs that could be used as predictors of physical and mental health, catastrophizing is the process that has received most attention in chronic pain research. Other irrational processes such as demandingness, low frustration tolerance, and self-downing have rarely been studied. The goal of this study was to explore whether this wider range of beliefs is associated with health in chronic pain patients beyond catastrophizing. A total of 492 chronic pain patients completed a measure of irrational beliefs, a measure of physical and mental health, and a numerical rating scale designed to assess pain intensity and interference. Irrational processes were more strongly associated with mental than with physical health. Low frustration tolerance and self-downing were found to be significantly related to mental health even after controlling for the effect of catastrophizing. Processes other than catastrophizing appear to have potentially important relationships with the mental health of people with chronic pain. These results may offer new intervention targets for practitioners.

  8. Using health trainers to promote self-management of chronic pain: can it work?

    Science.gov (United States)

    Harris, Janet; Williams, Tim; Hart, Ollie; Hanson, Chris; Johnstone, Gareth; Muthana, Aziz; Nield, Chris

    2014-02-01

    In 2011, the Sheffield Primary Care Trust piloted a Health Trainer (HT) programme targeted specifically to people with chronic pain. The programme aimed to determine whether patients presenting to primary care with chronic pain would benefit from self-management support, thereby reducing the burden on primary care and secondary care services. We conducted a formative mixed-methods evaluation of the pilot programme, focusing on four aspects of implementation: general practitioner (GP) referral to the programme, HT's ability to use cognitive behavioural (CB) approaches, short-term outcomes for clients and adequacy of resources. Qualitative data were collected via interviews with GPs, HTs and the chronic pain team; supervision sessions with HTs; and client case studies. Quantitative data were collected on satisfaction with training, HT's self-reported confidence to implement CB and clients' self-rated well-being before and after participation. A total of 143 clients with pain for 1 year or more were referred, exceeding the projected 90 referrals by over 50%. A total of 70% of the clients came from the most deprived areas of Sheffield, 40% were listed as permanently sick/disabled and only 20% were working. Qualitative analysis indicated that the CB training was delivered as intended. Clients reported that 75% of their goals were either achieved or partly achieved, and at follow-up 43% of them reported maintaining strategies for self-management. Financial resources were supplemented by indirect resources, including GP 'champions' with a special interest in pain, and a multidisciplinary chronic pain team. The prior history of working with community organizations was critical in ensuring credibility in client communities and addressing client needs. A HT programme promoting self-management of chronic pain can be successfully implemented when supported by community organisations. Preliminary data indicate that the programme can be instrumental in helping clients to

  9. Integrating a mobile health setup in a chronic disease management network.

    Science.gov (United States)

    Ding, Hang; Ireland, Derek; Jayasena, Rajiv; Curmi, Jamie; Karunanithi, Mohan

    2013-01-01

    Supporting self management of chronic disease in collaboration with primary healthcare has been a national priority in order to mitigate the emerging disease burden on the already strained healthcare system. However, in practice, the uptake of self-management programs and compliance with clinical guidelines remain poor. Time constraints due to work commitments and lack of efficient monitoring tools have been the major barrier to the uptake and compliance. In this paper, we present a newly integrated mobile health system with a clinical chronic disease management network called cdmNet, which has already been validated to facilitate General Practitioners (GPs) to provide collaborative disease management services. The newly integrated solution takes advantage of the latest mobile web and wireless Bluetooth communication techniques to enable patients to record health data entries through ubiquitous mobile phones, and allows the data to be simultaneously shared by multidisciplinary care teams. This integration would enable patients to self-manage their chronic disease conditions in collaboration with GPs and hence, improve the uptake and compliance. Additionally, the proposed integration will provide a useful framework encouraging the translation of innovative mobile health technologies into highly regulated healthcare systems.

  10. The effect of acceptance training on psychological and physical health outcomes in elders with chronic conditions.

    Science.gov (United States)

    McDonald, Patricia E; Zauszniewski, Jaclene A; Bekhet, Abir K; DeHelian, Laura; Morris, Diana L

    2011-12-01

    This pilot trial investigated the short and long-term effects of Acceptance Training (ACT) intervention on acceptance, perceived health, functional status, anxiety, and depression in elders with chronic conditions living in retirement communities (RCs). The ACT intervention combined Rational Emotive Behavior Therapy with music, relaxation, and guided imagery during six weekly 2-hour sessions. Face-to-face interviews were conducted with 16 African-American and 46 White elders across four data collection points in six randomly selected RCs using well-established measures of perceived health, functional status, anxiety, and depression, and a measure of acceptance of chronic conditions adapted from a previous measure of acceptance of diabetes. While changes were found in perceived health, functional status, anxiety, and depression, the most significant changes occurred in the elders' acceptance of chronic conditions immediately after the intervention (t = -2.62, p < .02), and these changes persisted for 6 and 12 weeks (t's = -2.74, -3.32, p's < .01), respectively. Although a 40% attrition rate reduced the sample size from 62 (N = 62) to 37 (N = 37), the significant increases in acceptance over time provide initial evidence for the fidelity of the ACT intervention.

  11. Chronic Pain and Mental Health Disorders: Shared Neural Mechanisms, Epidemiology, and Treatment.

    Science.gov (United States)

    Hooten, W Michael

    2016-07-01

    Chronic pain and mental health disorders are common in the general population, and epidemiological studies suggest that a bidirectional relationship exists between these 2 conditions. The observations from functional imaging studies suggest that this bidirectional relationship is due in part to shared neural mechanisms. In addition to depression, anxiety, and substance use disorders, individuals with chronic pain are at risk of other mental health problems including suicide and cigarette smoking and many have sustained sexual violence. Within the broader biopsychosocial model of pain, the fear-avoidance model explains how behavioral factors affect the temporal course of chronic pain and provides the framework for an array of efficacious behavioral interventions including cognitive-behavioral therapy, acceptance-based therapies, and multidisciplinary pain rehabilitation. Concomitant pain and mental health disorders often complicate pharmacological management, but several drug classes, including serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and anticonvulsants, have efficacy for both conditions and should be considered first-line treatment agents. Copyright © 2016 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  12. Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases

    Directory of Open Access Journals (Sweden)

    Lu Meng

    2017-06-01

    Full Text Available Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity (n = 13, cardiovascular diseases (n = 8, and diabetes (n = 6. Intervention strategies included instructional education/counseling (n = 20, workplace environmental change (n = 6, physical activity (n = 10, use of technology (n = 10, and incentives (n = 13. Self-reported data (n = 21, anthropometric measurements (n = 17, and laboratory tests (n = 14 were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

  13. Strategies for Worksite Health Interventions to Employees with Elevated Risk of Chronic Diseases.

    Science.gov (United States)

    Meng, Lu; Wolff, Marilyn B; Mattick, Kelly A; DeJoy, David M; Wilson, Mark G; Smith, Matthew Lee

    2017-06-01

    Chronic disease rates have become more prevalent in the modern American workforce, which has negative implications for workplace productivity and healthcare costs. Offering workplace health interventions is recognized as an effective strategy to reduce chronic disease progression, absenteeism, and healthcare costs as well as improve population health. This review documents intervention and evaluation strategies used for health promotion programs delivered in workplaces. Using predetermined search terms in five online databases, we identified 1,131 published items from 1995 to 2014. Of these items, 27 peer-reviewed articles met the inclusion criteria; reporting data from completed United States-based workplace interventions that recruited at-risk employees based on their disease or disease-related risk factors. A content rubric was developed and used to catalogue these 27 published field studies. Selected workplace interventions targeted obesity ( n   =  13), cardiovascular diseases ( n   =  8), and diabetes ( n   =  6). Intervention strategies included instructional education/counseling ( n   =  20), workplace environmental change ( n   =  6), physical activity ( n   =  10), use of technology ( n   =  10), and incentives ( n   =  13). Self-reported data ( n   =  21), anthropometric measurements ( n   =  17), and laboratory tests ( n   =  14) were used most often in studies with outcome evaluation. This is the first literature review to focus on interventions for employees with elevated risk for chronic diseases. The review has the potential to inform future workplace health interventions by presenting strategies related to implementation and evaluation strategies in workplace settings. These strategies can help determine optimal worksite health programs based on the unique characteristics of work settings and the health risk factors of their employee populations.

  14. Care provision to prevent chronic disease by community mental health clinicians.

    Science.gov (United States)

    Bartlem, Kate M; Bowman, Jennifer A; Freund, Megan; Wye, Paula M; McElwaine, Kathleen M; Wolfenden, Luke; Campbell, Elizabeth M; Gillham, Karen E; Wiggers, John H

    2014-12-01

    People with a mental illness have higher prevalence of behavioral risks for chronic disease than the general population. Despite recommendations regarding the provision of preventive care by mental health services, limited research has examined the extent to which such care is provided. To examine mental health clinician provision of care for preventable chronic disease risks, and whether such care was associated with the availability of practice support strategies. A cross-sectional survey was undertaken of 151 community mental health clinicians in New South Wales, Australia regarding the provision of three elements of preventive care (i.e., assessment, brief advice, and referral/follow-up) for four health risk behaviors (i.e., tobacco smoking, inadequate fruit and vegetable consumption, harmful alcohol consumption, and inadequate physical activity). Clinicians reported the availability of 16 strategies to support such care delivery. Data were collected in 2010 and analyzed in 2012-2013. Preventive care provision varied by both care element and risk behavior. Optimal care (each care element provided to at least 80% of clients for all health behaviors) was provided by few clinicians: assessment (8.6%), brief advice (24.5%), and referral/follow-up (9.9%). Less than half of clinicians reported more than four support strategies were available (44.4%). The availability of five or more strategies was associated with increased optimal preventive care. The provision of preventive care focused on chronic disease prevention in community mental health services is suboptimal. Interventions to increase the routine provision of such care should involve increasing the availability of evidence-based strategies to support care provision. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

  15. The Most Frequent English Homonyms

    Science.gov (United States)

    Parent, Kevin

    2012-01-01

    This article distinguishes homonymy, homophony, homography and polysemy, and provides a list of the most frequent homonyms using corpus-derived data. For most of the homonyms, the most common meaning accounts for 90% or more of the total uses of the form. The pedagogical and research implications of these findings are discussed. (Contains 5…

  16. Corporate Governance Frequently Asked Questions

    OpenAIRE

    International Finance Corporation

    2016-01-01

    This guidebook is designed to address common questionson corporate governance that are frequently asked byowners and managers of companies in the Middle Eastand North Africa (MENA) region. It familiarizes readerswith the basic concepts of corporate governance,providing a comprehensive overview of the subject matter,using case studies as practical examples of corporategovernance application...

  17. Psychological interventions for mental health disorders in children with chronic physical illness: a systematic review.

    Science.gov (United States)

    Bennett, Sophie; Shafran, Roz; Coughtrey, Anna; Walker, Susan; Heyman, Isobel

    2015-04-01

    Children with chronic physical illness are significantly more likely to develop common psychiatric symptoms than otherwise healthy children. These children therefore warrant effective integrated healthcare yet it is not established whether the known, effective, psychological treatments for symptoms of common childhood mental health disorders work in children with chronic physical illness. EMBASE, MEDLINE, PsycINFO and CINAHL databases were searched with predefined terms relating to evidence-based psychological interventions for psychiatric symptoms in children with chronic physical illness. We included all studies (randomised and non-randomised designs) investigating interventions aimed primarily at treating common psychiatric symptoms in children with a chronic physical illness in the review. Two reviewers independently assessed the relevance of abstracts identified, extracted data and undertook quality analysis. Ten studies (209 children, including 70 in control groups) met the criteria for inclusion in the review. All studies demonstrated some positive outcomes of cognitive behavioural therapy for the treatment of psychiatric symptoms in children with chronic physical illness. Only two randomised controlled trials, both investigating interventions for symptoms of depression, were found. There is preliminary evidence that cognitive behavioural therapy has positive effects in the treatment of symptoms of depression and anxiety in children with chronic physical illness. However, the current evidence base is weak and fully powered randomised controlled trials are needed to establish the efficacy of psychological treatments in this vulnerable population. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  18. Demographics and health care seeking behavior of Singaporean women with chronic constipation: implications for therapeutic management.

    Science.gov (United States)

    Gwee, Kok Ann; Setia, Sajita

    2012-01-01

    Chronic constipation is significantly more prevalent in women than men in Singapore. We carried out a survey to study patient demographics, symptom prevalence, healthcare-seeking behavior, and patient satisfaction with available treatment options in women with chronic constipation. Responses were collected predominantly via a web-based survey from a panel representative of Singapore's women population. Eligibility was established using a nine-question screener. A total of 1006 invited females took part in an online screener survey, of which 911 respondents did not meet the eligibility requirements for the chronic constipation survey. Of the total panelists consenting to participate (via both online and face-to-face interviews), 100 women met eligibility requirements and took the 22-question survey. Eligible respondents were skewed to younger patients but well mixed in terms of marital status. The majority of them were not keen on doing exercise and were working women, especially white collar females. The majority complained of straining and hard stools as the most common constipation symptoms (88% and 80% respectively) and rated constipation symptoms as severe or moderate. On average, respondents experienced constipation symptoms for 6 to 7 months in the last year. In more than two-thirds of respondents, constipation symptoms were frequent (at least 1 in 3 times). Most of the patients had attempted to treat constipation themselves and 80% had tried laxatives before visiting the doctor. Satisfaction with fiber supplements and laxatives was average and many of the users were not satisfied with their effect. Ineffectiveness and prolonged time taken for the treatment to take effect were the most common reasons for dissatisfaction. Nearly all respondents (97%) were interested in considering alternative prescriptive medication that is proven more effective. Chronic constipation symptoms in women are often severe and bothersome, and many patients are dissatisfied with

  19. Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries

    DEFF Research Database (Denmark)

    Sentenac, Mariane; Gavin, Aoife; Nic Gabhainn, Saoirse

    2013-01-01

    BACKGROUND: To compare the strength of the association between peer victimization at school and subjective health according to the disability or chronic illness (D/CI) status of students across countries. METHODS: This study used data from 55 030 students aged 11, 13 and 15 years from 11 countries...... reporting D/CI were more likely to report being victims of bullying. Victims of bullying reported more negative subjective health outcomes regardless of their D/CI status. Although inclusive education is currently a major topic of educational policies in most countries, additional efforts should be made...

  20. Investigating the relationships between chronic ill health and educational outcomes in children

    Directory of Open Access Journals (Sweden)

    Michael Fleming

    2017-04-01

    Compared to peers, children who had ADHD or depression were most adversely affected experiencing poorer educational outcomes in all five of the educational domains investigated. Children with epilepsy experienced poorer outcomes across four domains. Children with diabetes and asthma experienced more absence and increased SEN and asthmatic children experienced poorer attainment. Children who have these chronic illnesses at school appear to be at an educational disadvantage therefore further understanding of the intricate relationships between health and education is an on-going important area of public health.

  1. Frequent Exertion and Frequent Standing at Work, by Industry and Occupation Group - United States, 2015.

    Science.gov (United States)

    Shockey, Taylor M; Luckhaupt, Sara E; Groenewold, Matthew R; Lu, Ming-Lun

    2018-01-12

    Repeated exposure to occupational ergonomic hazards, such as frequent exertion (repetitive bending or twisting) and frequent standing, can lead to injuries, most commonly musculoskeletal disorders (1). Work-related musculoskeletal disorders have been estimated to cost the United States approximately $2.6 billion in annual direct and indirect costs (2). A recent literature review provided evidence that prolonged standing at work also leads to adverse health outcomes, such as back pain, physical fatigue, and muscle pain (3). To determine which industry and occupation groups currently have the highest prevalence rates of frequent exertion at work and frequent standing at work, CDC analyzed data from the 2015 National Health Interview Survey (NHIS) Occupational Health Supplement (OHS) regarding currently employed adults in the United States. By industry, the highest prevalence of both frequent exertion and frequent standing at work was among those in the agriculture, forestry, fishing, and hunting industry group (70.9%); by occupation, the highest prevalence was among those in the construction and extraction occupation group (76.9%). Large differences among industry and occupation groups were found with regard to these ergonomic hazards, suggesting a need for targeted interventions designed to reduce workplace exposure.

  2. Comparison of US and Indian College Students' Health Behaviors That Contribute to the Development of Chronic Diseasess

    Science.gov (United States)

    Rhodes, Darson; Kramer, Alaina; Whitlock, Alyssa; Cox, Carol

    2016-01-01

    Heart disease, cancer, stroke, diabetes, and respiratory diseases are the leading chronic diseases worldwide. For American college students, specifically, behavioral risk factors for chronic disease include: insufficient sleep, inactivity, unhealthy eating habits, poor mental health, substance abuse, unhealthy relationships, and unsafe sexual…

  3. An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

    Directory of Open Access Journals (Sweden)

    Chan Brian T

    2011-10-01

    Full Text Available Abstract Background Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. Methods We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. Results Six key lessons emerge from this analysis: (i the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv effective strategies for HIV/AIDS care in other settings should be

  4. [Affordability and availability of drugs for treatment of chronic diseases in the public health care system].

    Science.gov (United States)

    Helfer, Ana Paula; Camargo, Aline Lins; Tavares, Noemia Urruth Leão; Kanavos, Panos; Bertoldi, Andréa Dâmaso

    2012-03-01

    To assess the affordability by workers of drugs used for treatment of chronic diseases, as well as the availability of the reference, similar, or generic forms of these drugs in the public health care system. We employed the methodology recommended by the World Health Organization (WHO) and Health Action International (HAI) for the standardized collection of information on selling prices in the private sector and availability in the public health care system of drugs in six cities in the state of Rio Grande do Sul, Brazil. Data were collected from November 2008 to January 2009. Affordability was estimated as the number of salary days required for a worker receiving the national minimum wage to buy, in a private pharmacy, the amount of medication required for one month of treatment. Availability was assessed by the presence of these drugs in public health care system facilities. Twenty-two public facilities and 30 private pharmacies were studied. Of 21 drugs used for the treatment of seven chronic disorders, only nine were available free of charge in the six cities. Mean availability ranged from 83.3% (São Leopoldo) to 97.6% (Caxias do Sul). Affordability ranged from 0.4 to 10.5 salary days for reference drugs, 0.2 to 8.4 salary days for similar drugs, and 0.3 to 3.8 salary days for generic drugs. The overall availability of the drugs surveyed was higher than the 80% recommended by WHO. However, some treatments were not available, or had limited availability in the public system. Concerning affordability, the number of salary days required to buy these drugs may affect the continuation of drug treatments for chronic diseases.

  5. Impact of obesity on health-related quality of life in patients with chronic illness.

    Science.gov (United States)

    Katz, D A; McHorney, C A; Atkinson, R L

    2000-11-01

    To determine the association between overweight and obesity and health-related quality of life (HRQOL) in patients with chronic conditions typical of those seen in general medical practice, after accounting for the effects of depression and medical comorbidities. Cross-sectional analysis of data from the Medical Outcomes Study. Offices of physicians practicing family medicine, internal medicine, endocrinology, cardiology, and psychiatry in three U.S. cities. We surveyed 2,931 patients with chronic medical and psychiatric conditions. The patients completed a self-administered questionnaire at enrollment and had complete data on height and weight. Body mass index (BMI), chronic medical conditions, and depression were obtained by structured interview. Health-related quality of life was measured by the SF-36 Health Survey. Patients who were overweight (BMI 25.0-29.9 kg/m2), patients with class I obesity (BMI 30.0-34.9 kg/m2), and patients with class II-III obesity (BMI > or = 35 kg/m2) had significantly lower adjusted physical function scores (by 3.4, 7.8, and 13.8 points, respectively) compared with nonoverweight patients. Patients with class I and class II-III obesity also had significantly lower adjusted general health perceptions scores (by 2.8 and 4.4 points, respectively) and lower adjusted vitality scores (by 4.0 and 7.1 points, respectively), compared with nonoverweight patients. No significant differences between nonoverweight, overweight, and obese patients were observed for the mental health scale. Women with elevated BMI had significantly lower HRQOL scores compared with the scores of obese men in several domains. Additionally, blacks with elevated BMI had significantly lower scores than whites in several domains of HRQOL. Overweight and obesity have the largest association with physical function measures. Recent national standards, which have lowered the threshold for defining overweight, identify patients who are more likely to have clinically significant

  6. Identification of relevant ICF categories in patients with chronic health conditions: a Delphi exercise.

    Science.gov (United States)

    Weigl, Martin; Cieza, Alarcos; Andersen, Christina; Kollerits, Barbara; Amann, Edda; Stucki, Gerold

    2004-07-01

    To identify the most typical and relevant categories of the International Classification of Functioning, Disability and Health (ICF) for patients with low back pain, osteoporosis, rheumatoid arthritis, osteoarthritis, chronic generalized pain, stroke, depression, obesity, chronic ischaemic heart disease, obstructive pulmonary disease, diabetes mellitus, and breast cancer. An international expert survey using the Delphi technique was conducted. Data were collected in 3 rounds. Answers were linked to the ICF and analysed for the degree of consensus. Between 21 (osteoporosis, chronic ischaemic heart disease, and obstructive pulmonary disease) and 43 (stroke) experts responded in each of the conditions. In all conditions, with the exception of depression, there were categories in all ICF components that were considered typical and/or relevant by at least 80% of the responders. While all conditions had a distinct typical spectrum of relevant ICF categories, there were also some common relevant categories throughout the majority of conditions. Lists of ICF categories that are considered relevant and typical for specific conditions by international experts could be created. This is an important step towards identifying ICF Core Sets for chronic conditions.

  7. Public assessment of key performance indicators of healthcare in a Canadian province: the effect of age and chronic health problems.

    Science.gov (United States)

    Nurullah, Abu Sadat; Northcott, Herbert C; Harvey, Michael D

    2014-01-15

    This study explores the effect of age and chronic conditions on public perceptions of the health system, as measured by the Key Performance Indicators (KPIs) of healthcare, in the province of Alberta in Canada. Drawing from data collected by Government of Alberta's Department of Health and Wellness, this research examines two key questions: (1) Do people in the 65+ age group rate the KPIs of healthcare (i.e., availability, accessibility, quality, outcome, and satisfaction) more favorably compared to people in younger age groups in Alberta? (2) Does the rating of KPIs of healthcare in Alberta vary with different chronic conditions (i.e., no chronic problem, chronic illnesses without pain, and chronic pain)? The findings indicate that people in the older age group tend to rate the KPIs of healthcare more favorably compared to younger age groups in Alberta, net of socio-demographic factors, self-reported health status, and knowledge and utilization of health services. However, people experiencing chronic pain are less likely to rate the KPIs of healthcare favorably compared to people with no chronic health problem in Alberta. Discussion includes implications of the findings for the healthcare system in the province.

  8. Chronic Stress and Adolescents' Mental Health : Modifying Effects of Basal Cortisol and Parental Psychiatric History. The TRAILS Study

    NARCIS (Netherlands)

    Zandstra, Anna Roos E.; Hartman, Catharina A.; Nederhof, Esther; van den Heuvel, Edwin R.; Dietrich, Andrea; Hoekstra, Pieter J.; Ormel, Johan

    Large individual differences in adolescent mental health following chronic psychosocial stress suggest moderating factors. We examined two established moderators, basal cortisol and parental psychiatric history, simultaneously. We hypothesized that individuals with high basal cortisol, assumed to

  9. Mental Health Service Use for Patients with Co-occurring Mental and Physical Chronic Health Care Needs in Primary Care Settings

    Science.gov (United States)

    Haynes-Maslow, Lindsey; Roberts, Megan C.; Dusetzina, Stacie B.

    2016-01-01

    Background Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Subjects Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Measures Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (pneeded on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model. PMID:26147863

  10. Health-related quality of life (HRQL) for individuals with self-reported chronic physical and/or mental health conditions

    DEFF Research Database (Denmark)

    Bayliss, Martha; Rendas-Baum, Regina; White, Michelle K

    2012-01-01

    In the US, approximately 53% of adults have at least one chronic condition. Comorbid physical and mental health conditions often have an incremental negative impact on health-related quality of life (HRQL). Primary study objectives were to quantify the impact on HRQL of a) ≥ 1 physical condition...... , b) ≥ 1 comorbid mental health conditions added to a physical one, c) ≥ 1 mental health condition, and d) ≥ 1 comorbid physical conditions added to at least one related to mental health. Decrements were based on a "Healthy" reference group reporting no chronic conditions....

  11. Developing a framework to generate evidence of health outcomes from social media use in chronic disease management.

    Science.gov (United States)

    Merolli, Mark; Gray, Kathleen; Martin-Sanchez, Fernando

    2013-01-01

    While there is an abundance of evidence-based practice (EBP) recommendations guiding management of various chronic diseases, evidence suggesting best practice for using social media to improve health outcomes is inadequate. The variety of social media platforms, multiple potential uses, inconsistent definitions, and paucity of rigorous studies, make it difficult to measure health outcomes reliably in chronic disease management. Most published investigations report on an earlier generation of online tools, which are not as user-centered, participatory, engaging, or collaborative, and thus may work differently for health self-management. The challenge to establish a sound evidence base for social media use in chronic disease starts with the need to define criteria and methods to generate and evaluate evidence. The authors' key objective is to develop a framework for research and practice that addresses this challenge. This paper forms part of a larger research project that presents a conceptual framework of how evidence of health outcomes can be generated from social media use, allowing social media to be utilized in chronic disease management more effectively. Using mixed methods incorporating a qualitative literature review, a survey and a pilot intervention, the research closely examines the therapeutic affordances of social media, people with chronic pain (PWCP) as a subset of chronic disease management, valid outcome measurement of patient-reported (health) outcomes (PRO), the individual needs of people living with chronic disease, and finally translation of the combined results to improve evidence-based decision making about social media use in this context. Extensive review highlights various affordances of social media that may prove valuable to understanding social media's effect on individual health outcomes. However, without standardized PRO instruments, we are unable to definitively investigate these effects. The proposed framework that we offer outlines

  12. Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease.

    Science.gov (United States)

    Harwood, Lori; Clark, Alexander M

    2012-03-01

    Understanding health decisions using critical realism: home-dialysis decision-making during chronic kidney disease This paper examines home-dialysis decision making in people with Chronic Kidney Disease (CKD) from the perspective of critical realism. CKD programmes focus on patient education for self-management to delay the progression of kidney disease and the preparation and support for renal replacement therapy e.g.) dialysis and transplantation. Home-dialysis has clear health, societal and economic benefits yet service usage is low despite efforts to realign resources and educate individuals. Current research on the determinants of modality selection is superficial and insufficient to capture the complexities embedded in the process of dialysis modality selection. Predictors of home-dialysis selection and the effect of chronic kidney disease educational programmes provide a limited explanation of this experience. A re-conceptualization of the problem is required in order to fully understand this process. The epistemology and ontology of critical realism guides our knowledge and methodology particularly suited for examination of these complexities. This approach examines the deeper mechanisms and wider determinants associated with modality decision making, specifically who chooses home dialysis and under what circumstances. Until more is known regarding dialysis modality decision making service usage of home dialysis will remain low as interventions will be based on inadequate epistemology. © 2011 Blackwell Publishing Ltd.

  13. Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings

    OpenAIRE

    Diez-Canseco, Francisco; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. Psicólogo, magíster en Salud Pública.; Ipince, Alessandra; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. antropóloga.; Toyama, Mauricio; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. Facultad de Letras y Ciencias Humanas, Pontificia Universidad Católica del Perú, Lima, Perú. estudiante de Psicología.; Benate-Galvez, Ysabel; Gerencia de Prestaciones Primarias de Salud, Gerencia Central de Prestaciones de Salud, Seguro Social del Perú. médico geriatra.; Galán-Rodas, Edén; Gerencia de Prestaciones Primarias de Salud, Gerencia Central de Prestaciones de Salud, Seguro Social del Perú, EsSalud. Lima, Perú. médico cirujano.; Medina-Verástegui, Julio César; Gerencia de Prestaciones Primarias de Salud, Gerencia Central de Prestaciones de Salud, Seguro Social del Perú, EsSalud. Lima, Perú. médico pediatra.; Sánchez-Moreno, David; Centro de Salud “El Progreso”, Microrred de Salud Carabayllo, Red de Salud Túpac Amaru, DISA V Lima Ciudad, Ministerio de Salud, Lima, Perú. psicólogo.; Araya, Ricardo; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine. Londres, Reino Unido. médico psiquiatra, doctor en Epidemiología Psiquiátrica.; Miranda, J. Jaime; CRONICAS Centro de Excelencia en Enfermedades Crónicas, Universidad Peruana Cayetano Heredia, Lima, Perú. Facultad de Medicina, Universidad Peruana Cayetano Heredia. Lima, Perú. médico, magíster y doctor en Epidemiología.

    2014-01-01

    In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Addition...

  14. Impact of exercise capacity on dyspnea and health-related quality of life in patients with chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Jacobsen, Ramune; Frølich, Anne; Godtfredsen, Nina S

    2012-01-01

    To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD).......To assess the impact of the amount of exercise training during pulmonary rehabilitation (PR) program for improvements in dyspnea and health-related quality of life (HRQOL) in patients with chronic obstructive pulmonary disease (COPD)....

  15. Chronic care model and cost reduction in initial health: a new approach for satisfaction and improvement of chronicity

    Directory of Open Access Journals (Sweden)

    Stefano Marcelli

    2017-10-01

    Full Text Available Nowadays, the number of elderly is growing, with consequent increase of chronic diseases. An effective approach to reduce the costs incurred is required. The Chronic Care Model has proven to be a good starting point for a better management of economic and human resources.

  16. Knowledge, use and attitude toward eHealth among patients with chronic lung diseases.

    Science.gov (United States)

    Hofstede, J; de Bie, J; van Wijngaarden, B; Heijmans, M

    2014-12-01

    Despite high expectations and numerous initiatives in the area of eHealth, implementation and use of eHealth applications on a national level is no common practice yet. There is no full understanding of patients' attitude on eHealth yet. Aim of this study is to gain insight into the level of knowledge and experiences with eHealth of people with chronic lung diseases. A telephone survey among 400 people with a medical diagnosis of asthma or COPD was conducted. All patients participated in the larger research program National Panel of people with Chronic diseases or Disabilities (NPCD) conducted by NIVEL. Eight percent of the asthma and COPD patients knew of the term eHealth. Knowledge of specific eHealth applications (e.g. electronic medical record, electronic consultations, monitoring from a distance) was higher and ranged from 21 to 88%. Most available applications were used by less than 20% of the patients, although figures differ by age and educational level. People who have used applications were in general rather positive about their use. Non-users did not see clear advantages of using eHealth applications. A majority thought that eHealth decreases human contact in health care and will not contribute to a higher quality of care. On the contrary, almost half of the patients considered eHealth as a possibility to take more responsibility in their own care. Asthma and COPD patients were unanimous that the use of eHealth should always be a free choice. Although most asthma and COPD patient know of one or more eHealth applications, actual use remains low. Patients who do have experience with the use of eHealth are on the whole positive. However, patients without experience have no clear ideas about the advantages. They should be convinced first, and stressing the possibilities for more personal control might be an important argument to persuade them. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  17. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

    Directory of Open Access Journals (Sweden)

    Shantanu Nundy

    2012-01-01

    Full Text Available Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

  18. A mHealth Application for Chronic Wound Care: Findings of a User Trial

    Directory of Open Access Journals (Sweden)

    Marcia R. Friesen

    2013-11-01

    Full Text Available This paper reports on the findings of a user trial of a mHealth application for pressure ulcer (bedsore documentation. Pressure ulcers are a leading iatrogenic cause of death in developed countries and significantly impact quality of life for those affected. Pressure ulcers will be an increasing public health concern as the population ages. Electronic information systems are being explored to improve consistency and accuracy of documentation, improve patient and caregiver experience and ultimately improve patient outcomes. A software application was developed for Android Smartphones and tablets and was trialed in a personal care home in Western Canada. The software application provides an electronic medical record for chronic wounds, replacing nurses’ paper-based charting and is positioned for integration with facility’s larger eHealth framework. The mHealth application offers three intended benefits over paper-based charting of chronic wounds, including: (1 the capacity for remote consultation (telehealth between facilities, practitioners, and/or remote communities, (2 data organization and analysis, including built-in alerts, automatically-generated text-based and graph-based wound histories including wound images, and (3 tutorial support for non-specialized caregivers. The user trial yielded insights regarding the software application’s design and functionality in the clinical setting, and highlighted the key role of wound photographs in enhancing patient and caregiver experiences, enhancing communication between multiple healthcare professionals, and leveraging the software’s telehealth capacities.

  19. Use of telehealth for health care of Indigenous peoples with chronic conditions: a systematic review.

    Science.gov (United States)

    Fraser, Sarah; Mackean, Tamara; Grant, Julian; Hunter, Kate; Towers, Kurt; Ivers, Rebecca

    2017-01-01

    Telehealth may be a cost effective modality in healthcare delivery, but how well used or how appropriate it is for the care of Indigenous peoples is unclear. This review examines the evidence for telehealth in facilitating chronic conditions management with Indigenous peoples. Databases were systematically searched for qualitative or quantitative primary research studies that investigated telehealth use for chronic conditions management with Indigenous peoples worldwide. Evidence of effectiveness was by consumer health outcomes, evidence of acceptability was through consumer and user perception, and health service feasibility was evident by service impact. Data were assessed for quality and data extracted using pre-defined tools. Articles (n=32) examined effectiveness (n=11), critiqued telehealth from the perspectives of the client (n=10) and healthcare professionals (n=8), and examined feasibility (n=12). Studies reported Indigenous people tend to be satisfied with telehealth, but are sceptical about its cultural safety. Evidence for the effectiveness of telehealth from a western biomedical perspective was found. Telehealth is promising; however, a lack of robust studies in this review make tangible conclusions difficult. A better overall understanding of telehealth use with Indigenous peoples, including delivery of culturally competent health care, true consultation and cultural competency of the professionals involved, would be helpful. Telehealth may have the potential to improve health care for Indigenous people, however the modality needs to be culturally competent and the care received must be culturally safe.

  20. Costs and epidemiological changes of chronic diseases: implications and challenges for health systems.

    Science.gov (United States)

    Arredondo, Armando; Aviles, Raul

    2015-01-01

    The need to integrate economic and epidemiological aspects in the clinical perspective leads to a proposal for the analysis of health disparities and to an evaluation of the health services and of the new challenges which are now being faced by health system reforms in middle income countries. To identify the epidemiological changes, the demand for health services and economic burden from chronic diseases (diabetes and hypertension) in a middle income county. We conducted longitudinal analyses of costs and epidemiological changes for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was used, based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2014-2016, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95%, and the Box-Pierce test. Regarding epidemiological changes expected in both diseases for 2014 vs. 2016, an increase is expected, although results predict a greater increase for diabetes, 8-12% in all three studied institutions, (p management per patient in the case of diabetes, and from $485 to $622 in patients with hypertension. Comparing financial consequences of health services required by insured and uninsured populations, the greater increase (23%) will be for the insured population (p financial requirements of both diseases will amount to 19.5% of the total budget for the uninsured and 12.5% for the insured population. If the risk factors and the different health care models remain as they currently are, the economic impact of expected epidemiological changes on the social security system will be particularly strong. Another relevant challenge is the appearance of internal competition in the use and allocation of financial resources with programs for other chronic and infectious diseases.

  1. Readiness of Ugandan health services for the management of outpatients with chronic diseases.

    Science.gov (United States)

    Katende, David; Mutungi, Gerald; Baisley, Kathy; Biraro, Samuel; Ikoona, Eric; Peck, Robert; Smeeth, Liam; Hayes, Richard; Munderi, Paula; Grosskurth, Heiner

    2015-10-01

    Traditionally, health systems in sub-Saharan Africa have focused on acute conditions. Few data exist on the readiness of African health facilities (HFs) to address the growing burden of chronic diseases (CDs), specifically chronic, non-communicable diseases (NCDs). A stratified random sample of 28 urban and rural Ugandan HFs was surveyed to document the burden of selected CDs by analysing the service statistics, service availability and service readiness using a modified WHO Service Availability and Readiness Assessment questionnaire. Knowledge, skills and practice in the management of CDs of 222 health workers were assessed through a self-completed questionnaire. Among adult outpatient visits at hospitals, 33% were for CDs including HIV vs. 14% and 4% at medium-sized and small health centres, respectively. Many HFs lacked guidelines, diagnostic equipment and essential medicines for the primary management of CDs; training and reporting systems were weak. Lower-level facilities routinely referred patients with hypertension and diabetes. HIV services accounted for most CD visits and were stronger than NCD services. Systems were weaker in lower-level HFs. Non-doctor clinicians and nurses lacked knowledge and experience in NCD care. Compared with higher level HFs, lower-level ones are less prepared and little used for CD care. Health systems in Uganda, particularly lower-level HFs, urgently need improvement in managing common NCDs to cope with the growing burden. This should include the provision of standard guidelines, essential diagnostic equipment and drugs, training of health workers, supportive supervision and improved referral systems. Substantially better HIV basic service readiness demonstrates that improved NCD care is feasible. © 2015 The Authors. Tropical Medicine & International Health Published by John Wiley & Sons Ltd.

  2. Strategies to improve chronic disease management in seven metro Boston community health centers.

    Science.gov (United States)

    Ndumele, Chima D; Russell, Beverley E; Ayanian, John Z; Landon, Bruce E; Keegan, Thomas; O'Malley, A James; Hicks, Leroi S

    2009-01-01

    The Community, Health Center, and Academic Medicine Partnership Project (CHAMPP) is a partnership between medical researchers, community health centers (CHCs), and a community advisory committee focused on reducing cardiovascular morbidity related to hypertension and diabetes for non-Hispanic Black and Hispanic populations in Boston, Massachusetts. We conducted site visits at seven participating CHCs, located in Boston. The visits were to solicit health center staff opinions about site-specific barriers and enabling factors for optimum preventative cardiovascular care for racial/ethnic minority patients receiving hypertension and diabetes care at their centers. Site visits included a tour of each health center and a series of directed interviews with center personnel. Site visit notes were reviewed to identify themes that emerged during the course of each site visit. A summary matrix was developed for each health center, which included information regarding the most salient and persistent themes of the visit. Site visits uncovered several patient-, provider-, CHC-, and community-based factors that either facilitate or hinder optimal care of chronic disease patients. Commonly referenced barriers included the need for improved patient adherence to provider recommendations; insufficient time for providers to address complex health issues presented by patients and the need for a broader range of healthier food options in surrounding communities. Interactive patient groups and community health workers (CHWs) have been well received when implemented. Recommendations included adopting case management as a part of usual care for chronic disease patients; additionally, widespread implementation of CHWs may to provide a platform for more comprehensive care for patients.

  3. Beliefs about health, illness and acceptance of the limitations of chronic somatic disease inpeople with psoriasis

    Directory of Open Access Journals (Sweden)

    Joanna Miniszewska

    2014-09-01

    Full Text Available Introduction: Occurrence of a chronic disease means for an affected person significant changes in life and the disease itself can be seen in various categories. Assessment of the disease often affects its acceptance, which in turn affects the choice of coping strategies in dealing with it. Beliefs about psoriasis, a chronic skin disease that causes numerous psychosocial consequences, may influence its acceptance. Aim of the study: To determine the relationship between the way the disease is perceived, beliefs about having an impact on one’s own health, and acceptance of limitations of the disease. Material and methods: The study included 61 psoriasis patients. The following measures were employed: Acceptance of Illness Scale (AIS, Disease-Related Appraisals Scale (SOWC, Multidimensional Health Locus of Control Scale (MHLC, Self-Administered Psoriasis Area and Severity Index (SAPASI. Results: Sex and occurrence of the disease in family members did not differentiate the respondents in terms of the level of acceptance of the disease. Their perception of the disease as a threat, harm, obstacles and imbalances of life and treatment of health in terms of a chance, and severity of psoriasis measured with SAPASI correlated negatively with the disease acceptance. Internal health locus of control affected it positively. Two homogeneous subgroups were separated. Assessment of the disease in terms of an obstacle/loss, internal health locus of control and treatment of health in terms of a chance allow to predict the level of psoriasis acceptance. Conclusions: People’s beliefs relating to their own illness and their belief in having (or not an influence on their own health are associated with the level of accepting the disease. In other words, beliefs about a disease correlate with adaptation to it.

  4. Using Electronic Health Record Data to Measure Care Quality for Individuals with Multiple Chronic Medical Conditions.

    Science.gov (United States)

    Bayliss, Elizabeth A; McQuillan, Deanna B; Ellis, Jennifer L; Maciejewski, Matthew L; Zeng, Chan; Barton, Mary B; Boyd, Cynthia M; Fortin, Martin; Ling, Shari M; Tai-Seale, Ming; Ralston, James D; Ritchie, Christine S; Zulman, Donna M

    2016-09-01

    To inform the development of a data-driven measure of quality care for individuals with multiple chronic conditions (MCCs) derived from an electronic health record (EHR). Qualitative study using focus groups, interactive webinars, and a modified Delphi process. Research department within an integrated delivery system. The webinars and Delphi process included 17 experts in clinical geriatrics and primary care, health policy, quality assessment, health technology, and health system operations. The focus group included 10 individuals aged 70-87 with three to six chronic conditions selected from a random sample of individuals aged 65 and older with three or more chronic medical conditions. Through webinars and the focus group, input was solicited on constructs representing high-quality care for individuals with MCCs. A working list was created of potential measures representing these constructs. Using a modified Delphi process, experts rated the importance of each possible measure and the feasibility of implementing each measure using EHR data. High-priority constructs reflected processes rather than outcomes of care. High-priority constructs that were potentially feasible to measure included assessing physical function, depression screening, medication reconciliation, annual influenza vaccination, outreach after hospital admission, and documented advance directives. High-priority constructs that were less feasible to measure included goal setting and shared decision-making, identifying drug-drug interactions, assessing social support, timely communication with patients, and other aspects of good customer service. Lower-priority domains included pain assessment, continuity of care, and overuse of screening or laboratory testing. High-quality MCC care should be measured using meaningful process measures rather than outcomes. Although some care processes are currently extractable from electronic data, capturing others will require adapting and applying technology to

  5. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have?

    Science.gov (United States)

    Mackey, Laura M; Doody, Catherine; Werner, Erik L; Fullen, Brona

    2016-08-01

    Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented. © The Author

  6. Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010.

    Science.gov (United States)

    Jolles, Mónica Pérez; Haynes-Maslow, Lindsey; Roberts, Megan C; Dusetzina, Stacie B

    2015-08-01

    Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3000 physicians in office-based settings. Office visits from 2007 to 2010 were pooled for adults aged 35-85 with a depression diagnosis at the time of visit (N=3659 visits). Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least 1 physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (Phealth conditions, particularly as the health care system moves toward an integrated care model.

  7. Perceptions of Smartphone User-Centered Mobile Health Tracking Apps Across Various Chronic Illness Populations: An Integrative Review.

    Science.gov (United States)

    Birkhoff, Susan D; Smeltzer, Suzanne C

    2017-07-01

    This integrative review presents a synthesis of the current qualitative research addressing the motivating factors, usability, and experiences of mobile health tracking applications (apps) across various chronic disease populations. Integrative review of the literature. Databases used to conduct this integrative review included: PubMed Plus, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Google Scholar, Science Direct, and EBSCO megafile. The following search terms were used in all five databases: smartphone apps, apps, mHealth, eHealth, mobile health apps, health tracking apps, user-centered apps, wireless technology, engagement, qualitative, and usability. The initial literature review yielded 689 results. Once inclusion and exclusion criteria were employed, 11 studies met the criteria set forth for this review. The reviewed studies provided insight into users' perceptions, experiences, and motivations to incorporate smartphone mobile health apps into their daily lives when living with chronic illnesses. This review indicates the growing interest in user-centered mobile health tracking apps, but with little understanding of motivating factors that foster sustained app use. Mobile health tracking apps targeted to users with chronic conditions need to have a high level of usability in order to motivate users to sustain engagement with their mobile health tracking app. User-centered mobile health tracking app technology is being used with increasing frequency to potentially provide individualized support to chronic illness populations. © 2017 Sigma Theta Tau International.

  8. Chronic disease management for depression in US medical practices: results from the Health Tracking Physician Survey.

    Science.gov (United States)

    Zafar, Waleed; Mojtabai, Ramin

    2011-07-01

    Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs). To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use. Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression. CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11). The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.

  9. Emergency Department Frequent Users for Acute Alcohol Intoxication.

    Science.gov (United States)

    Klein, Lauren R; Martel, Marc L; Driver, Brian E; Reing, Mackenzie; Cole, Jon B

    2018-03-01

    A subset of frequent users of emergency services are those who use the emergency department (ED) for acute alcohol intoxication. This population and their ED encounters have not been previously described. This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters. We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169). Frequent users were older (47 years vs. 39 years), and more commonly male (86% vs. 71%). Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder. In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.

  10. Emergency Department Frequent Users for Acute Alcohol Intoxication

    Directory of Open Access Journals (Sweden)

    Marc L. Martel

    2018-02-01

    Full Text Available Introduction: A subset of frequent users of emergency services are those who use the emergency department (ED for acute alcohol intoxication. This population and their ED encounters have not been previously described. Methods: This was a retrospective, observational, cohort study of patients presenting to the ED for acute alcohol intoxication between 2012 and 2016. We collected all data from the electronic medical record. Frequent users for alcohol intoxication were defined as those with greater than 20 visits for acute intoxication without additional medical chief complaints in the previous 12 months. We used descriptive statistics to evaluate characteristics of frequent users for alcohol intoxication, as well as their ED encounters. Results: We identified 32,121 patient encounters. Of those, 325 patients were defined as frequent users for alcohol intoxication, comprising 11,370 of the encounters during the study period. The median maximum number of encounters per person for alcohol intoxication in a one-year period was 47 encounters (range 20 to 169. Frequent users were older (47 years vs. 39 years, and more commonly male (86% vs. 71%. Frequent users for alcohol intoxication had higher rates of medical and psychiatric comorbidities including liver disease, chronic kidney disease, ischemic vascular disease, dementia, chronic obstructive pulmonary disease, history of traumatic brain injury, schizophrenia, and bipolar disorder. Conclusion: In this study, we identified a group of ED frequent users who use the ED for acute alcohol intoxication. This population had higher rates of medical and psychiatric comorbidities compared to non-frequent users.

  11. Understanding and benchmarking health service achievement of policy goals for chronic disease

    Science.gov (United States)

    2012-01-01

    Background Key challenges in benchmarking health service achievement of policy goals in areas such as chronic disease are: 1) developing indicators and understanding how policy goals might work as indicators of service performance; 2) developing methods for economically collecting and reporting stakeholder perceptions; 3) combining and sharing data about the performance of organizations; 4) interpreting outcome measures; 5) obtaining actionable benchmarking information. This study aimed to explore how a new Boolean-based small-N method from the social sciences—Qualitative Comparative Analysis or QCA—could contribute to meeting these internationally shared challenges. Methods A ‘multi-value QCA’ (MVQCA) analysis was conducted of data from 24 senior staff at 17 randomly selected services for chronic disease, who provided perceptions of 1) whether government health services were improving their achievement of a set of statewide policy goals for chronic disease and 2) the efficacy of state health office actions in influencing this improvement. The analysis produced summaries of configurations of perceived service improvements. Results Most respondents observed improvements in most areas but uniformly good improvements across services were not perceived as happening (regardless of whether respondents identified a state health office contribution to that improvement). The sentinel policy goal of using evidence to develop service practice was not achieved at all in four services and appears to be reliant on other kinds of service improvements happening. Conclusions The QCA method suggested theoretically plausible findings and an approach that with further development could help meet the five benchmarking challenges. In particular, it suggests that achievement of one policy goal may be reliant on achievement of another goal in complex ways that the literature has not yet fully accommodated but which could help prioritize policy goals. The weaknesses of QCA can be

  12. Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD).

    Science.gov (United States)

    Stellefson, Michael L; Shuster, Jonathan J; Chaney, Beth H; Paige, Samantha R; Alber, Julia M; Chaney, J Don; Sriram, P S

    2017-09-05

    Many people living with Chronic Obstructive Pulmonary Disease (COPD) have low general health literacy; however, there is little information available on these patients' eHealth literacy, or their ability to seek, find, understand, and appraise online health information and apply this knowledge to address or solve disease-related health concerns. A nationally representative sample of patients registered in the COPD Foundation's National Research Registry (N = 1,270) was invited to complete a web-based survey to assess socio-demographic (age, gender, marital status, education), health status (generic and lung-specific health-related quality of life), and socio-cognitive (social support, self-efficacy, COPD knowledge) predictors of eHealth literacy, measured using the 8-item eHealth literacy scale (eHEALS). Over 50% of the respondents (n = 176) were female (n = 89), with a mean age of 66.19 (SD = 9.47). Overall, participants reported moderate levels of eHealth literacy, with more than 70% feeling confident in their ability to find helpful health resources on the Internet. However, respondents were much less confident in their ability to distinguish between high- and low-quality sources of web-based health information. Very severe versus less severe COPD (β = 4.15), lower lung-specific health-related quality of life (β = -0.19), and greater COPD knowledge (β = 0.62) were significantly associated with higher eHealth literacy. Higher COPD knowledge was also significantly associated with greater knowledge (ρ = 0.24, p = .001) and use (ρ = 0.24, p = .001) of web-based health resources. Findings emphasize the importance of integrating skill-building activities into comprehensive patient education programs that enable patients with severe cases of COPD to identify high-quality sources of web-based health information. Additional research is needed to understand how new social technologies can be used to help medically underserved COPD patients

  13. Occupational Therapy and Management of Multiple Chronic Conditions in the Context of Health Care Reform

    Science.gov (United States)

    Fogelberg, Donald J.; Halle, Ashley D.; Mroz, Tracy M.

    2017-01-01

    One in four individuals living in the United States has multiple chronic conditions (MCCs), and the already high prevalence of MCCs continues to grow. This population has high rates of health care utilization yet poor outcomes, leading to elevated concerns about fragmented, low-quality care provided within the current health care system. Several national initiatives endeavor to improve care for the population with MCCs, and occupational therapy is uniquely positioned to contribute to these efforts for more efficient, effective, client-centered management of care. By integrating findings from the literature with current policy and practice, we aim to highlight the potential role for occupational therapy in managing MCCs within the evolving health care system. PMID:28027031

  14. Impacts of species introductions on the health of fish communities receiving chronic radionuclide exposures

    International Nuclear Information System (INIS)

    Yankovich, T.L.; Casselman, J.M.; Cornett, R.J.J.

    2006-01-01

    A study was conducted to evaluate the potential impacts of a northern pike introduction on the health of a fish community receiving chronic radionuclide exposure, primarily from 90 Sr. Overall, although significant changes occurred in the community composition and the health of fish populations following the pike introduction, these were not linked to radionuclide dose to fishes. This finding was further supported by assessing the health of forage fishes, which did not significantly change in the pre-versus post-pike fish communities and were comparable in condition to forage fishes inhabiting lakes with background radionuclide levels. Application of such resilient species as 'baseline organisms' can provide a useful tool in the routine monitoring of ecosystems affected by multiple stressors. (author)

  15. Attentional bias towards health-threat information in chronic fatigue syndrome.

    Science.gov (United States)

    Hou, Ruihua; Moss-Morris, Rona; Bradley, Brendan P; Peveler, Robert; Mogg, Karin

    2008-07-01

    To investigate whether individuals with chronic fatigue syndrome (CFS) show an attentional bias towards health-threat information. Attentional bias (AB) was assessed in individuals with CFS and healthy controls using a visual probe task which presented health-threat and neutral words and pictures for 500 ms. Self-report questionnaires were used to assess CFS symptoms, depression, anxiety, and social desirability. Compared to a healthy control group, the CFS group showed an enhanced AB towards heath-threat stimuli relative to neutral stimuli. The AB was not influenced by the type of stimulus (pictures vs. words). The finding of an AB towards health-threat information in individuals with CFS is supportive of models of CFS which underlie cognitive behavior therapy.

  16. The health and social costs of chronic kidney disease in Italy

    Directory of Open Access Journals (Sweden)

    Americo Cicchetti

    2011-03-01

    Full Text Available Chronic kidney disease is growing as a global public health problem throughout the world. In Italy, CKD is becoming increasingly common with 52,777 patients treated with dialysis in 2010, about 10,000 new patients/years in dialysis from 2010.  The impact on the health care system includes € 2.1 billion/year for dialysis plus € 338 million for indirect costs. Aim of the present analysis was to explore socio-economical variables in the management of CKD, and assess direct and indirect health costs and NHS resources consumption. The overall cost for patients in dialysis is about 44,000 €/years for hemodialysis and 30,000 €/years for peritoneal dialysis with different resources consumption over the different stage disease. The possibility of reducing the progression of renal damaging and beginning of dialysis may induce a low expenditure for the Italian NHS.

  17. Chronic obstructive pulmonary disease involves substantial health-care service and social benefit costs

    DEFF Research Database (Denmark)

    Jensen, Martin Bach; Fenger-Grøn, Morten; Fonager, Kirsten

    2013-01-01

    INTRODUCTION: The present study compared health carerelated costs and the use of social benefits and transfer payments in participants with and without chronic obstructive pulmonary disease (COPD), and related the costs to the severity of the COPD. MATERIAL AND METHODS: Spirometry data from...... a cohort study performed in Denmark during 2004-2006 were linked with national register data that identified the costs of social benefits and health-care services. The cohort comprised 546 participants with COPD (forced expiratory volume in the first sec. (FEV1)/forced vital capacity (FVC) ratio ....7 following bronchodilator administration] and 3,995 without COPD (in addition, 9,435 invited participants were non-responders and 331 were excluded). The costs were adjusted for gender, age, co-morbidity and educational level. RESULTS: Health care-related costs were 4,779 (2,404- 7,154) Danish kroner (DKK...

  18. Peer victimization and subjective health among students reporting disability or chronic illness in 11 Western countries.

    Science.gov (United States)

    Sentenac, Mariane; Gavin, Aoife; Gabhainn, Saoirse Nic; Molcho, Michal; Due, Pernille; Ravens-Sieberer, Ulrike; Matos, Margarida Gaspar de; Malkowska-Szkutnik, Agnieszka; Gobina, Inese; Vollebergh, Wilma; Arnaud, Catherine; Godeau, Emmanuelle

    2013-06-01

    To compare the strength of the association between peer victimization at school and subjective health according to the disability or chronic illness (D/CI) status of students across countries. This study used data from 55 030 students aged 11, 13 and 15 years from 11 countries participating in the 2005-06 Health Behaviour in School-aged Children survey. Self-completed questionnaires were administered in classrooms. Multivariate models of logistic regression (controlled for confounding factors and countries) were used to investigate differences in the association between peer victimization and poor subjective health according to the D/CI status. Overall, 13.5% of the students reported having been bullied at least two or three times a month. The percentage of victims was significantly higher among those reporting D/CI than among others in all countries studied. Victims of bullying were more likely to report poor self-rated health, low life satisfaction and multiple health complaints. However, there were no differences in the associations between peer victimization and subjective health indicators according to the D/CI status. In all countries studied, students reporting D/CI were more likely to report being victims of bullying. Victims of bullying reported more negative subjective health outcomes regardless of their D/CI status. Although inclusive education is currently a major topic of educational policies in most countries, additional efforts should be made to improve the quality of the integration of students with D/CI.

  19. Hazard-ranking of agricultural pesticides for chronic health effects in Yuma County, Arizona.

    Science.gov (United States)

    Sugeng, Anastasia J; Beamer, Paloma I; Lutz, Eric A; Rosales, Cecilia B

    2013-10-01

    With thousands of pesticides registered by the United States Environmental Protection Agency, it not feasible to sample for all pesticides applied in agricultural communities. Hazard-ranking pesticides based on use, toxicity, and exposure potential can help prioritize community-specific pesticide hazards. This study applied hazard-ranking schemes for cancer, endocrine disruption, and reproductive/developmental toxicity in Yuma County, Arizona. An existing cancer hazard-ranking scheme was modified, and novel schemes for endocrine disruption and reproductive/developmental toxicity were developed to rank pesticide hazards. The hazard-ranking schemes accounted for pesticide use, toxicity, and exposure potential based on chemical properties of each pesticide. Pesticides were ranked as hazards with respect to each health effect, as well as overall chronic health effects. The highest hazard-ranked pesticides for overall chronic health effects were maneb, metam-sodium, trifluralin, pronamide, and bifenthrin. The relative pesticide rankings were unique for each health effect. The highest hazard-ranked pesticides differed from those most heavily applied, as well as from those previously detected in Yuma homes over a decade ago. The most hazardous pesticides for cancer in Yuma County, Arizona were also different from a previous hazard-ranking applied in California. Hazard-ranking schemes that take into account pesticide use, toxicity, and exposure potential can help prioritize pesticides of greatest health risk in agricultural communities. This study is the first to provide pesticide hazard-rankings for endocrine disruption and reproductive/developmental toxicity based on use, toxicity, and exposure potential. These hazard-ranking schemes can be applied to other agricultural communities for prioritizing community-specific pesticide hazards to target decreasing health risk. Copyright © 2013 Elsevier B.V. All rights reserved.

  20. Hazard-Ranking of Agricultural Pesticides for Chronic Health Effects in Yuma County, Arizona

    Science.gov (United States)

    Sugeng, Anastasia J.; Beamer, Paloma I.; Lutz, Eric A.; Rosales, Cecilia B.

    2013-01-01

    With thousands of pesticides registered by the United States Environmental Protection Agency, it not feasible to sample for all pesticides applied in agricultural communities. Hazard-ranking pesticides based on use, toxicity, and exposure potential can help prioritize community-specific pesticide hazards. This study applied hazard-ranking schemes for cancer, endocrine disruption, and reproductive/developmental toxicity in Yuma County, Arizona. An existing cancer hazard-ranking scheme was modified, and novel schemes for endocrine disruption and reproductive/developmental toxicity were developed to rank pesticide hazards. The hazard-ranking schemes accounted for pesticide use, toxicity, and exposure potential based on chemical properties of each pesticide. Pesticides were ranked as hazards with respect to each health effect, as well as overall chronic health effects. The highest hazard-ranked pesticides for overall chronic health effects were maneb, metam sodium, trifluralin, pronamide, and bifenthrin. The relative pesticide rankings were unique for each health effect. The highest hazard-ranked pesticides differed from those most heavily applied, as well as from those previously detected in Yuma homes over a decade ago. The most hazardous pesticides for cancer in Yuma County, Arizona were also different from a previous hazard-ranking applied in California. Hazard-ranking schemes that take into account pesticide use, toxicity, and exposure potential can help prioritize pesticides of greatest health risk in agricultural communities. This study is the first to provide pesticide hazard-rankings for endocrine disruption and reproductive/developmental toxicity based on use, toxicity, and exposure potential. These hazard-ranking schemes can be applied to other agricultural communities for prioritizing community-specific pesticide hazards to target decreasing health risk. PMID:23783270

  1. Relationship between sleep quality and mental health according to demographics of 850 patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    Eslaminejad, Alireza; Safa, Mitra; Ghassem Boroujerdi, Fatemeh; Hajizadeh, Farzaneh; Pashm Foroush, Maryam

    2017-10-01

    We aimed to study sleep problems in hospitalized chronic obstructive pulmonary disease patients and assess the relationship of sleep quality with mental health and demographics of patients. Our study sample consisted of 850 chronic obstructive pulmonary disease patients hospitalized in Masih Daneshvari Hospital. Demographic data were collected and the Pittsburgh Sleep Quality and mental health questionnaires were filled out for patients. The results showed that 5.9 percent were suffering from severe sleep problems, while 4.7 percent had severe mental problems. A strong positive correlation was found between the total scores of mental health and sleep quality ( p mental health problems was higher in females compared to males. Mental health and sleep quality play important roles in quality of life of chronic obstructive pulmonary disease patients.

  2. [Care of the chronically ill: strategic challenge, macro-management and health policies].

    Science.gov (United States)

    Gómez-Picard, Patricia; Fuster-Culebras, Juli

    2014-01-01

    The prevalence of chronic diseases is increasing, with the patients who suffer from them having greater need for healthcare. This fact forces a redirection in the health system, currently focused on the acute diseases, to achieve an efficient care. For this reason, it is necessary to work at all levels, starting with political decisions. These decisions should be based on the technical and scientific evidence available. Health planning is essential to establish care strategies, defining the actions to ensure the coordination and continuity of care, and also the redefinition of professional roles, where primary care nurses assume more competencies, becoming key professionals in the care of the chronic patient. The new model should include the professionalization of the management of health services. Information and communication technologies will play an important role in the development of strategies, but considering them as the tools that they are, allowing for the patient to be the focus of attention, and ensuring the privacy and the confidentiality. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  3. Health outcomes of children born to mothers with chronic kidney disease: a pilot study

    Directory of Open Access Journals (Sweden)

    Indrani Banerjee

    2010-05-01

    Full Text Available This study aimed to study the health of children born to mothers with chronic kidney disease. Twenty-four children born to mothers with chronic kidney disease were compared with 39 matched control children born to healthy mothers without kidney disease. The well-being of each child was individually assessed in terms of physical health, neurodevelopment and psychological health. Families participating with renal disease were more likely to be from lower socio-economic backgrounds. Significantly fewer vaginal deliveries were reported for mothers with renal disease and their infants were more likely to experience neonatal morbidity. Study and control children were comparable for growth parameters and neurodevelopment as assessed by the Griffiths scales. There was no evidence of more stress amongst mothers with renal disease or of impaired bonding between mother and child when compared to controls. However, there was evidence of greater externalizing behavioral problems in the group of children born to mothers with renal disease. Engaging families in such studies is challenging. Nonetheless, families who participated appreciated being asked. The children were apparently healthy but there was evidence in this small study of significant antenatal and perinatal morbidity compared to controls. Future larger multi-center studies are required to confirm these early findings.

  4. Mental health and quality of life in patients with chronic otitis media.

    Science.gov (United States)

    Bakir, Salih; Kinis, Vefa; Bez, Yasin; Gun, Ramazan; Yorgancilar, Ediz; Ozbay, Musa; Aguloglu, Bülent; Meric, Faruk

    2013-02-01

    The present study focused on the comparison of mental health and quality of life (QoL) between chronic otitis media (COM) patients and the hearing population. The patients with chronic otitis media and healthy control group were enrolled in the study. The duration and severity of the auditory impairment were recorded. In addition to hearing loss (HL), the findings of each patient's other ear disorders (ear discharge and tinnitus) were also recorded. In both the groups, psychological symptom profile and health-related QoL were evaluated and compared using a sociodemographic questionnaire, the Symptom Check List 90-Revised Form (SCL-90-R), and the Short Form-36 (SF-36). According to SCL-90-R, somatization (p sensitivity (p anxiety (p social functioning (p < 0.001), and mental health (p < 0.017) than those of control subjects. Our results indicated that COM patients with mild or moderate HL have poorer life quality and higher psychological problems. Psychological well being should be also considered in assessment of COM patients in addition to the clinical evaluation and audiological tests.

  5. Missed Opportunities for Chronic Diseases Prevention in a Primary Health Care Center in Istanbul

    Directory of Open Access Journals (Sweden)

    Ahmet Topuzoglu

    2011-12-01

    Full Text Available Aim: The aim of the study was to investigate missed opportunities about chronic diseases and related risk factors in a primary health care center in Istanbul. Method: This cross sectional study was held in a Primary Health Care Center in Istanbul with the study population consisted of 500 people which were applicated in one month period. Participants were asked; if they were questioned by their physician about major risk factors (smoking, obesity, diabetes mellitus, hypertension, coroner heart disease in family, glysemic level, cholesterol level and regular exercise practice according to Primary Care 2006 Guidelines. The data was evaluated by descriptive statatistics, chi square test. Results: The median age of the participants were 40 (25.p; 32-75.p;52 and 76.4% of them were female. 50.4% of participants were overweight, 20.8% of them were obese. 36.2% of them were smoking, 22.0% were hypertensive, 10.4% were hiperglysemic. There were around 90.0% missing opportunities screening and management of obesity and blood cholesterol level, 70.0% about hypertension and 85.0% about diabetes. Conclusion: Opportunities about chronic diseases and their risk factors are being missed and asking about risk factors are neglected in primary health care center. [TAF Prev Med Bull 2011; 10(6.000: 665-674

  6. Impact of mHealth chronic disease management on treatment adherence and patient outcomes: a systematic review.

    Science.gov (United States)

    Hamine, Saee; Gerth-Guyette, Emily; Faulx, Dunia; Green, Beverly B; Ginsburg, Amy Sarah

    2015-02-24

    Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ("mAdherence"), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%). There is potential for mHealth tools to

  7. Patient-centered activity monitoring in the self-management of chronic health conditions.

    Science.gov (United States)

    Chiauzzi, Emil; Rodarte, Carlos; DasMahapatra, Pronabesh

    2015-04-09

    As activity tracking devices become smaller, cheaper, and more consumer-accessible, they will be used more extensively across a wide variety of contexts. The expansion of activity tracking and personal data collection offers the potential for patient engagement in the management of chronic diseases. Consumer wearable devices for activity tracking have shown promise in post-surgery recovery in cardiac patients, pulmonary rehabilitation, and activity counseling in diabetic patients, among others. Unfortunately, the data generated by wearable devices is seldom integrated into programmatic self-management chronic disease regimens. In addition, there is lack of evidence supporting sustained use or effects on health outcomes, as studies have primarily focused on establishing the feasibility of monitoring activity and the association of measured activity with short-term benefits. Monitoring devices can make a direct and real-time impact on self-management, but the validity and reliability of measurements need to be established. In order for patients to become engaged in wearable data gathering, key patient-centered issues relating to usefulness in care, motivation, the safety and privacy of information, and clinical integration need to be addressed. Because the successful usage of wearables requires an ability to comprehend and utilize personal health data, the user experience should account for individual differences in numeracy skills and apply evidence-based behavioral science principles to promote continued engagement. Activity monitoring has the potential to engage patients as advocates in their personalized care, as well as offer health care providers real world assessments of their patients' daily activity patterns. This potential will be realized as the voice of the chronic disease patients is accounted for in the design of devices, measurements are validated against existing clinical assessments, devices become part of the treatment 'prescription', behavior

  8. Finding joy in poor health: The leisure-scapes of chronic illness.

    Science.gov (United States)

    McQuoid, Julia

    2017-06-01

    Globally, increasing numbers of people face the challenge of enjoying life while living with long-term illness. Little research addresses leisure participation for people with chronic illness despite its links with mental and physical health and self-rated quality of life. I use a space-time geographical approach to explore experiences with leisure in everyday life for 26 individuals with chronic kidney disease (CKD) in Australia. I examine ways in which the spatial and temporal characteristics of illness management and symptoms shape where, when, and how participants can enjoy leisure, focusing on: 1) logistical conflicts between illness and leisure; 2) rhythmic interferences with the force of habit in skilful leisure performance; and 3) absorbing experiences of encounter with self and place through leisure. Data were collected from 2013 to 2014. Participants kept diaries over two sample days and then participated in semi-structured interviews. Findings show that the voluntary nature of leisure offered participants important benefits in coping with and managing illness over the long-term, including opportunities to experience greater sense of control, an alternative experience of one's body to the 'sick body', and knowledge creation that supports adaptation to the uncertainties of illness trajectories. The ability to engage in meaningful leisure was constrained by the shaping forces of illness symptoms and management on participants' leisure-scapes. Illness treatment regimens should therefore be adapted to better accommodate leisure participation for chronically ill patients, and leisure should be explicitly incorporated into illness management plans negotiated between patients and health practitioners. Finally, greater understanding of the transformative capacity of habit in activities of experimentation and play may have wider-reaching implications for leisure's potential applications in public health. Leisure should be taken seriously as a vehicle for enhancing

  9. Finding joy in poor health: The leisure-scapes of chronic illness

    Science.gov (United States)

    2017-01-01

    Globally, increasing numbers of people face the challenge of enjoying life while living with long-term illness. Little research addresses leisure participation for people with chronic illness despite its links with mental and physical health and self-rated quality of life. I use a space-time geographical approach to explore experiences with leisure in everyday life for 26 individuals with chronic kidney disease (CKD) in Australia. I examine ways in which the spatial and temporal characteristics of illness management and symptoms shape where, when, and how participants can enjoy leisure, focusing on: 1) logistical conflicts between illness and leisure; 2) rhythmic interferences with the force of habit in skilful leisure performance; and 3) absorbing experiences of encounter with self and place through leisure. Data were collected from 2013 to 2014. Participants kept diaries over two sample days and then participated in semi-structured interviews. Findings show that the voluntary nature of leisure offered participants important benefits in coping with and managing illness over the long-term, including opportunities to experience greater sense of control, an alternative experience of one’s body to the ‘sick body’, and knowledge creation that supports adaptation to the uncertainties of illness trajectories. The ability to engage in meaningful leisure was constrained by the shaping forces of illness symptoms and management on participants’ leisure-scapes. Illness treatment regimens should therefore be adapted to better accommodate leisure participation for chronically ill patients, and leisure should be explicitly incorporated into illness management plans negotiated between patients and health practitioners. Finally, greater understanding of the transformative capacity of habit in activities of experimentation and play may have wider-reaching implications for leisure’s potential applications in public health. Leisure should be taken seriously as a vehicle for

  10. Organ Transplantation: Frequently Asked Questions

    Science.gov (United States)

    ... After the transplant Preventing rejection Post-transplant medications Types of immunosuppressants Switching immunosuppressants Side effects Other medications Generic and brand name drugs Post-transplant tests Infections and immunity Lifestyle changes Health concerns Back to work or ...

  11. CIFSRF 2015 Frequently Asked Questions

    International Development Research Centre (IDRC) Digital Library (Canada)

    Helen Raij

    Are international organizations eligible for funding? .... plant biotechnology, for use in agriculture, urban and public health settings. .... To test and assess the effectiveness of creative and bold scaling up models, delivery mechanisms.

  12. Health literacy and patient outcomes in chronic kidney disease: a systematic review.

    Science.gov (United States)

    Taylor, Dominic M; Fraser, Simon; Dudley, Chris; Oniscu, Gabriel C; Tomson, Charles; Ravanan, Rommel; Roderick, Paul

    2017-11-20

    Limited health literacy affects 25% of people with chronic kidney disease (CKD), and may reduce self-management skills resulting in poorer clinical outcomes. By disproportionately affecting people with low socio-economic status and non-white ethnicity, limited health literacy may promote health inequity. We performed a systematic review of quantitative studies of health literacy and clinical outcomes among adults with CKD. A total of 29 studies (13 articles; 16 conference abstracts) were included. One included non-USA patients. Of the 29 studies, 5 were cohort studies and 24 were cross-sectional. In all, 18 300 patients were studied: 4367 non-dialysis CKD; 13 202 dialysis; 390 transplant; 341 unspecified. Median study size was 127 [interquartile range (IQR) 92-238)], but 480 (IQR 260-2392) for cohort studies. Median proportion of non-white participants was 48% (IQR 17-70%). Six health literacy measures were used. Outcomes included patient attributes, care processes, clinical/laboratory parameters and 'hard' clinical outcomes. Limited health literacy was significantly, independently associated with hospitalizations, emergency department use, missed dialysis sessions, cardiovascular events and mortality (in cohort studies). Study quality was high (1 study), moderate (3 studies) and poor (25 studies), limited by sampling methods, variable adjustment for confounders and reduced methodological detail given in conference abstracts. There is limited robust evidence of the causal effects of health literacy on patient outcomes in CKD. Available evidence suggests associations with adverse clinical events, increased healthcare use and mortality. Prospective studies are required to determine the causal effects of health literacy on outcomes in CKD patients, and examine the relationships between socio-economic status, comorbidity, health literacy and CKD outcomes. Intervention development and evaluation will determine whether health literacy is a modifiable determinant of

  13. A qualitative study examining health literacy and chronic illness self-management in Hispanic and non-Hispanic older adults

    Directory of Open Access Journals (Sweden)

    Jacobs RJ

    2017-04-01

    Full Text Available Robin J Jacobs,1 Raymond L Ownby,2 Amarilis Acevedo,3 Drenna Waldrop-Valverde4 1Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, 2College of Osteopathic Medicine, 3College of Psychology, Nova Southeastern University, Fort Lauderdale, FL, 4Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA Purpose: Chronic illness and low levels of health literacy affect health outcomes for many individuals, particularly older adults and racial/ethnic minorities. This study sought to understand the knowledge, strengths, and areas of need regarding self-management of chronic illness in order to lay the groundwork for content development of an intervention to increase health literacy and maximize patient engagement in chronic disease self-care.Patients and methods: In-depth, qualitative interviews were conducted in Spanish and English with 25 older adults with various chronic illnesses. Topics included knowledge and understanding of chronic conditions, medications, and disease self-management skills. Qualitative data were coded by searching text and conducting cross-case analysis. An inductive analysis was then employed to allow for the patterns and themes to emerge.Results: Emerged themes included 1 social support, 2 coping strategies, 3 spirituality, 4 chronic disease health literacy, 5 anger, and 6 depression. While participants had a general overall knowledge of chronic illness, they had deficits in knowledge regarding their own illnesses and medications.Conclusion: Chronic illness self-management is a complex and dynamic behavioral process. This study identified themes that leverage patient motivation to engage in self-care in a personalized manner. This information will guide the development of an intervention to promote health literacy and optimal disease self-management. Keywords: health disparities, older adults, resilience, computer interventions, comorbidity, multimorbidity

  14. Health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease.

    Science.gov (United States)

    Jimenez-Garcia, Rodrigo; de Miguel-Díez, Javier; Rejas-Gutierrez, Javier; Martín-Centeno, Antonio; Gobartt-Vázquez, Elena; Hernandez-Barrera, Valentin; Gil de Miguel, Angel; Carrasco-Garrido, Pilar

    2009-08-01

    To describe the health, treatment and health care resources consumption profile among Spanish adults with diabetes and chronic obstructive pulmonary disease (COPD), and compare it with that of non-diabetic COPD patients. An observational and descriptive epidemiological study (EPIDEPOC study). The study included patients with stable COPD and aged > or =40 years, evaluated in primary care. Data were collected relating to sociodemographic variables, health profile, quality of life (SF-12), treatment and health care resources consumption. The results corresponding to diabetic and non-diabetic patients were compared. A total of 10,711 patients (75.6% males) with COPD were evaluated. The prevalence of diabetes was 16.9%. The diabetic patients were significantly older, with a larger percentage of women, and a lesser educational level compared with the non-diabetic patients. In addition, the diabetics were more sedentary, smoked less, and presented a higher percentage of obesity (33.6% versus 19.7%) than the non-diabetic patients. The severity of airways obstruction was greater among the diabetics than in the non-diabetic patients (54.57+/-13.37% versus 57.92+/-13.39%, respectively, pconsumption of drugs for COPD. In addition, they consumed significantly more health care (and thus economical) resources than the non-diabetic patients. The results of the multivariate logistic regression analysis showed that the variables that were independently associated to COPD among diabetic patients were: higher age, higher BMI, concomitant chronic heart disease, use of inhaled corticoids, SF-12 mental component, SF-12 physical component and total cost of COPD. The presence of diabetes in patients with COPD shows in the bivariate analysis a more severe lung disease, greater co-morbidity, poorer quality of life, and a greater consumption of resources, as well as a less favorable course in the previous year. However, the multivariate logistic regression shows that the variables that are

  15. Chronic effects of air pollution on respiratory health in Southern California children: findings from the Southern California Children's Health Study.

    Science.gov (United States)

    Chen, Zhanghua; Salam, Muhammad T; Eckel, Sandrah P; Breton, Carrie V; Gilliland, Frank D

    2015-01-01

    Outdoor air pollution is one of the leading contributors to adverse respiratory health outcomes in urban areas around the world. Children are highly sensitive to the adverse effects of air pollution due to their rapidly growing lungs, incomplete immune and metabolic functions, patterns of ventilation and high levels of outdoor activity. The Children's Health Study (CHS) is a continuing series of longitudinal studies that first began in 1993 and has focused on demonstrating the chronic impacts of air pollution on respiratory illnesses from early childhood through adolescence. A large body of evidence from the CHS has documented that exposures to both regional ambient air and traffic-related pollutants are associated with increased asthma prevalence, new-onset asthma, risk of bronchitis and wheezing, deficits of lung function growth, and airway inflammation. These associations may be modulated by key genes involved in oxidative-nitrosative stress pathways via gene-environment interactions. Despite successful efforts to reduce pollution over the past 40 years, air pollution at the current levels still brings many challenges to public health. To further ameliorate adverse health effects attributable to air pollution, many more toxic pollutants may require regulation and control of motor vehicle emissions and other combustion sources may need to be strengthened. Individual interventions based on personal susceptibility may be needed to protect children's health while control measures are being implemented.

  16. Processes of Metastudy: A Study of Psychosocial Adaptation to Childhood Chronic Health Conditions

    Directory of Open Access Journals (Sweden)

    David B. Nichola

    2006-03-01

    Full Text Available Metastudy introduces a systematically aggregated interpretive portrayal of a body of literature, based on saturation and the synthesis of findings. In this metastudy, the authors examined qualitative studies addressing psychosocial adaptation to childhood chronic health conditions, published over a 30-year period (1970–2000. They describe metastudy processes, including study identification, strategies for study search and retrieval, adjudication of difference in study design and rigor, and analysis of findings. They also illustrate metastudy components through examples drawn from this project and discuss implications for practice and recommendations.

  17. Intersectional health-related stigma in persons living with HIV and chronic pain: implications for depressive symptoms.

    Science.gov (United States)

    Goodin, Burel R; Owens, Michael A; White, Dyan M; Strath, Larissa J; Gonzalez, Cesar; Rainey, Rachael L; Okunbor, Jennifer I; Heath, Sonya L; Turan, Janet M; Merlin, Jessica S

    2018-05-30

    "Intersectional health-related stigma" (IHRS) refers to stigma that arises at the convergence of multiple health conditions. People living with HIV (PLWH) and chronic pain have two highly stigmatized health conditions, and thus may be at especially high risk for internalizing these stigmas and consequently experiencing depression. This study examined the intersectionality of internalized HIV and chronic pain stigma in relation to depressive symptoms in a sample of PLWH and chronic pain. Sixty participants were recruited from an HIV clinic in the Southeastern United States. Chronic pain was defined as pain that has been present for at least three consecutive months, and that has been an ongoing problem for at least half the days in the past six months. All participants completed the HIV Stigma Mechanisms Scale, Internalized Stigma in Chronic Pain Scale, the Short-Form Brief Pain Inventory, and the Center for Epidemiological Studies - Depression Scale. Clinical data was collected from medical records. An intersectional HIV and chronic pain composite variable was created and participants were categorized as either high (28%), moderate (32%), or low (40%). Results revealed that intersectional HIV and chronic pain stigma was significantly associated with severity of depressive symptoms (p = .023). Pairwise contrasts revealed that participants with high (p = .009) and moderate (p = .033) intersectional stigma reported significantly greater mean depressive symptom severity than those with low intersectional stigma. Participants who reported the highest levels of internalized HIV and chronic pain stigma also reported the greatest severity of depressive symptoms. This suggests that the experience of both HIV and chronic pain stigma (i.e., IHRS) among PLWH and chronic pain may synergistically perpetuate negative mood in a more profound manner than experiencing either one stigma alone.

  18. The effect of health education in patients with chronic low back pain.

    Science.gov (United States)

    Zhang, Yan; Wan, Li; Wang, Xueqiang

    2014-06-01

    To assess the value of health education (active management and postural hygiene) over and above exercise alone, in patients with chronic low back pain. Adults (aged 18-30 years) with low back pain of ≥ 3 months' duration were randomized to undergo a 12-week programme of lumbar strengthening exercise and health education or exercise alone. Pain, disability (Oswestry Disability Index, ODI), static and dynamic muscle endurance, and health-related quality-of-life (short form-36, SF-36) were assessed at baseline and after completion of treatment. At the end of the 12-week intervention period, pain, disability, SF-36 physical component and SF-36 mental component were significantly better in the health education group (n = 25) than in the control group (n = 24). There were no significant between-group differences in static or dynamic endurance. Health education provides additional benefits to exercise alone for improving pain, disability and mental and physical health-related quality-of-life. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  19. Childhood Trauma and Chronic Illness in Adulthood: Mental Health and Socioeconomic Status as Explanatory Factors and Buffers

    OpenAIRE

    Mock, Steven E.; Arai, Susan M.

    2011-01-01

    Experiences of traumatic events in childhood have been shown to have long-term consequences for health in adulthood. With data from the 2005 Canadian Community Health Survey we take a life course perspective of cumulative disadvantage and examine the potential role of mental health and socioeconomic status in adulthood as multiple mediators of the link between childhood trauma and chronic illness in adulthood. Mental health and socioeconomic status are also tested as buffers against the typ...

  20. Health-related quality of life of Southern Chinese with chronic hepatitis B infection

    Directory of Open Access Journals (Sweden)

    Lam Elegance TP

    2009-06-01

    Full Text Available Abstract Background Few studies have evaluated the health-related quality of life (HRQOL of Southern Chinese with chronic hepatitis B (CHB infection. Aim To evaluate the HRQOL of Chinese patients at different stages of CHB infection and to find out factors associated with HRQOL. Methods 520 Chinese adult CHB patients of whom 156 were uncomplicated, 102 had impaired liver function, 139 had cirrhosis and 123 had hepatocellular carcinoma (HCC were interviewed with a structured questionnaire, the SF-36 Health Survey version 2 (SF-36v2, and the Chronic Liver Disease Questionnaire (CLDQ. The differences in SF-6D health preference values and SF-36v2 scores between each CHB group and Hong Kong population norms were assessed by t-test. ANOVA was used to compare the mean SF-6D health preference, SF-36v2 scores, and CLDQ scores among CHB groups. Multiple linear regressions were performed to identify determinants of HRQOL. Results CHB patients had significantly lower SF-36v2 scores than the population norm. The SF-6D values of CHB patients with uncomplicated disease, impaired liver function, HCC and cirrhosis were 0.755, 0.745, 0.720 and 0.701, respectively, all significantly lower than the population norm of 0.787. Advanced stage of CHB illness, anti-viral treatment, bilirubin level, psychological co-morbidity, younger age and female were associated with poorer HRQOL. Conclusion CHB infection had a negative impact on HRQOL. There was a progressive decrease in health preference values with CHB disease progression. The results can be used for the estimation of quality adjusted life years (QALYs for CHB patients in cost effectiveness or cost utility studies. Trial Registration http://www.hkclinicaltrials.com; HKCTR-151.

  1. Prevalence of Multiple Chronic Conditions Among US Adults: Estimates From the National Health Interview Survey, 2010

    Science.gov (United States)

    Schiller, Jeannine S.

    2013-01-01

    Preventing and ameliorating chronic conditions has long been a priority in the United States; however, the increasing recognition that people often have multiple chronic conditions (MCC) has added a layer of complexity with which to contend. The objective of this study was to present the prevalence of MCC and the most common MCC dyads/triads by selected demographic characteristics. We used respondent-reported data from the 2010 National Health Interview Survey (NHIS) to study the US adult civilian noninstitutionalized population aged 18 years or older (n = 27,157). We categorized adults as having 0 to 1, 2 to 3, or 4 or more of the following chronic conditions: hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, weak or failing kidneys, chronic obstructive pulmonary disease, or current asthma. We then generated descriptive estimates and tested for significant differences. Twenty-six percent of adults have MCC; the prevalence of MCC has increased from 21.8% in 2001 to 26.0% in 2010. The prevalence of MCC significantly increased with age, was significantly higher among women than men and among non-Hispanic white and non-Hispanic black adults than Hispanic adults. The most common dyad identified was arthritis and hypertension, and the combination of arthritis, hypertension, and diabetes was the most common triad. The findings of this study contribute information to the field of MCC research. The NHIS can be used to identify population subgroups most likely to have MCC and potentially lead to clinical guidelines for people with more common MCC combinations. PMID:23618545

  2. “What we want”: chronically ill adolescents’ preferences and priorities for improving health care

    Directory of Open Access Journals (Sweden)

    van Staa A

    2011-06-01

    Full Text Available AnneLoes van Staa1,2, Susan Jedeloo1, Heleen van der Stege1, On Your Own Feet Research Group1,31Expertise Center Transitions of Care, Rotterdam University, 2Institute of Health Policy and Management, Erasmus University Rotterdam, 3Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The NetherlandsBackground: As important users of health care, adolescents with chronic conditions deserve to be consulted about their experiences and expectations. This study aimed to explore chronically ill adolescents’ preferences regarding providers' qualities, and outpatient and inpatient care. Furthermore, suggestions for improvement of service delivery were collected.Methods: This research was a sequential mixed methods study in adolescents aged 12–19 years with various chronic conditions treated in a university children’s hospital. Methods comprised 31 face-to-face interviews at home, a hospital-based peer research project in which nine adolescents interviewed 34 fellow patients, and a web-based questionnaire (n = 990. Emerging qualitative themes were transformed into questionnaire items.Results: Having “a feeling of trust” and “voice and choice” in the hospital were central to these adolescents. Regarding providers’ qualities, “being an expert” and “being trustworthy and honest” were ranked highest, followed by "being caring and understanding”, "listening and showing respect", and “being focused on me”. Regarding outpatient consultations, preferences were ranked as follows: “answering all questions”; “attending to my and my parents’ needs”; and “clear communication”, while “limited waiting times” and “attractive outpatient surroundings” scored lowest. Regarding hospitalization, adolescents most preferred to “avoid pain and discomfort”, “keep in touch with home”, and “be entertained”, while “being hospitalized with peers” and “being heard

  3. Somatic versus cognitive symptoms of depression as predictors of all-cause mortality and health status in chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Pelle, Aline J; Smith, Otto R F

    2009-01-01

    Depression is a predictor of adverse health outcomes in chronic heart failure (CHF), but it is not known whether specific symptoms drive this relationship. We examined the impact of somatic/affective, cognitive/affective, and total depressive symptoms on all-cause mortality and health status in CHF....

  4. The distressed (type D) personality is independently associated with impaired health status and increased depressive symptoms in chronic heart failure

    DEFF Research Database (Denmark)

    Schiffer, Angélique A; Pedersen, Susanne S.; Widdershoven, Jos W

    2005-01-01

    Chronic heart failure (CHF) is a serious condition that is associated with impaired health status and a high prevalence of depressive symptoms. To date, little is known about the determinants of health status and depressive symptoms in CHF. Therefore, the aim of this study was to assess whether T...

  5. Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management.

    NARCIS (Netherlands)

    Heijmans, M.; Waverijn, G.; Rademakers, J.; Vaart, R. van der; Rijken, M.

    2015-01-01

    Objective: To provide insight into the level of health literacy among chronic disease patients in the Netherlands, to identify subgroups with low literacy and to examine the associations between health literacy and self-management. Methods: Self-report questionnaires were sent to a nationwide sample

  6. Perceptions of patients with chronic obstructive pulmonary disease and their physiotherapists regarding the use of an eHealth intervention

    NARCIS (Netherlands)

    Vorrink, S.N.W.; Huisman, C.; Kort, H.S.M.; Troosters, T.; Lammers, J.J.

    2017-01-01

    Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their

  7. Time to Talk: 5 Things To Know About Chronic Low-Back Pain and Complementary Health Practices

    Science.gov (United States)

    ... Y Z 5 Things To Know About Chronic Low-Back Pain and Complementary Health Practices Share: Low-back pain is a very common condition, but often the ... complementary health approaches often used by people with low-back pain. They are all included in a longer list ...

  8. Congruence or Discrepancy? Comparing Patients' Health Valuations and Physicians' Treatment Goals for Rehabilitation for Patients with Chronic Conditions

    Science.gov (United States)

    Nagl, Michaela; Farin, Erik

    2012-01-01

    The aim of this study was to test the congruence of patients' health valuations and physicians' treatment goals for the rehabilitation of chronically ill patients. In addition, patient characteristics associated with greater or less congruence were to be determined. In a questionnaire study, patients' health valuations and physicians' goals were…

  9. Effect on health-related quality of life of a multimodal physiotherapy program in patients with chronic musculoskeletal disorders

    Directory of Open Access Journals (Sweden)

    Cuesta-Vargas Antonio Ignacio

    2013-02-01

    Full Text Available Abstract Background Musculoskeletal disorders are major causes of morbidity in the world, and these conditions have a strong negative influence in terms of health-related quality of life. The purpose of this study was to evaluate the effect of an 8-week multimodal physical therapy program on general health state and health-related quality of life in patients with chronic musculoskeletal disorders. Methods There were 244 participants in this prospective cohort analysis with 8-week follow-up. The primary outcome was general health state (physical and mental components, determined with the Short Form-12 Health Survey (SF-12. The secondary outcome was health related quality of life, determined with the EuroQoL-5D and VAS. The intervention was evaluated by comparing pre- and post-outcome measurements. T-tests were performed for paired data. Results Differences were statistically significant for physical health state: +1.68 (p  Conclusions Eight weeks of a Multimodal Physical Therapy Program seemed to moderately enhance the general health state and HRQoL of patients with chronic musculoskeletal diseases. This kind of therapeutic exercise can be recommended to patients with chronic low back pain, chronic neck pain and osteoarthritis, at least in the short term.

  10. The association between mental health, chronic disease and sleep duration in Koreans: a cross-sectional study.

    Science.gov (United States)

    Lee, Min-Su; Shin, Joon-Shik; Lee, Jinho; Lee, Yoon Jae; Kim, Me-riong; Park, Ki Byung; Shin, Dongjin; Cho, Jae-Heung; Ha, In-Hyuk

    2015-12-01

    Sleep duration holds considerable importance as an indicator of mental/physical health. The objective of this study was to investigate the association between sleep duration, mental health, and chronic disease prevalence in Koreans. Of 31,596 subjects eligible for the Korean National Health and Nutrition Examination Survey V (2010-2012), 17,638 participants who answered items on sleep duration (aged ≥ 19 yrs) were analyzed in a cross-sectional study. Association between sleep duration, mental health, and chronic disease prevalence was assessed using logistic regression, and adjusted for various socioeconomic and lifestyle characteristics. Short or long sleep duration showed correlations with mental health, and items of significance showed gender-specific patterns. Women displayed significant associations with stress and depressive symptoms, and men with stress, thoughts of suicide, and psychiatric counseling. While stress was related with short sleep duration in both genders, depressive symptoms showed a relationship with long duration in men, and short duration in women. Prevalence of any chronic disease was associated with ≤ 6 h sleep when adjusted for factors including mental health, and among chronic diseases, cancer and osteoarthritis showed associations with short sleep duration, while diabetes and dyslipidemia were associated with normal sleep duration. Mental health problems were associated with sleep duration with gender-specific patterns. Associations with osteoarthritis, cancer, diabetes, dyslipidemia and abnormal sleep duration persisted after adjustment for mental health.

  11. [Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings].

    Science.gov (United States)

    Diez-Canseco, Francisco; Ipince, Alessandra; Toyama, Mauricio; Benate-Galvez, Ysabel; Galán-Rodas, Edén; Medina-Verástegui, Julio César; Sánchez-Moreno, David; Araya, Ricardo; Miranda, J Jaime

    2014-01-01

    In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Additionally, the gap between access to mental health care in Peru is analyzed. Lastly, the alternatives to reduce the gap are explored. Of these alternatives, the integration of mental health into primary care services is emphasized; as a feasible way to meet the care needs of the general population, and people with chronic diseases in particular, in the Peruvian context.

  12. Health Effect of Forest Bathing Trip on Elderly Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Jia, Bing Bing; Yang, Zhou Xin; Mao, Gen Xiang; Lyu, Yuan Dong; Wen, Xiao Lin; Xu, Wei Hong; Lyu, Xiao Ling; Cao, Yong Bao; Wang, Guo Fu

    2016-03-01

    Forest bathing trip is a short, leisurely visit to forest. In this study we determined the health effects of forest bathing trip on elderly patients with chronic obstructive pulmonary disease (COPD). The patients were randomly divided into two groups. One group was sent to forest, and the other was sent to an urban area as control. Flow cytometry, ELISA, and profile of mood states (POMS) evaluation were performed. In the forest group, we found a significant decrease of perforin and granzyme B expressions, accompanied by decreased levels of pro-inflammatory cytokines and stress hormones. Meanwhile, the scores in the negative subscales of POMS decreased after forest bathing trip. These results indicate that forest bathing trip has health effect on elderly COPD patients by reducing inflammation and stress level. Copyright © 2016 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.

  13. How subchronic and chronic health effects can be neglected for GMOs, pesticides or chemicals.

    Science.gov (United States)

    Séralini, Gilles-Eric; de Vendômois, Joël Spiroux; Cellier, Dominique; Sultan, Charles; Buiatti, Marcello; Gallagher, Lou; Antoniou, Michael; Dronamraju, Krishna R

    2009-06-17

    Chronic health effects are increasing in the world such as cancers, hormonal, reproductive, nervous, or immune diseases, even in young people. During regulatory toxicological subchronic tests to prevent these on mammalian health, prior commercialization of chemicals, including pesticides and drugs, or GMOs, some statistically significant findings may be revealed. This discussion is about the need to investigate the relevant criteria to consider those as biologically significant. The sex differences and the non linear dose or time related effects should be considered in contrast to the claims of a Monsanto-supported expert panel about a GMO, the MON 863 Bt maize, but also for pesticides or drugs, in particular to reveal hormone-dependent diseases and first signs of toxicities.

  14. A review of chronic pain impact on patients, their social environment and the health care system.

    Science.gov (United States)

    Dueñas, María; Ojeda, Begoña; Salazar, Alejandro; Mico, Juan Antonio; Failde, Inmaculada

    2016-01-01

    Chronic pain (CP) seriously affects the patient's daily activities and quality of life, but few studies on CP have considered its effects on the patient's social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient's daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient's life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives.

  15. Health-related quality of life measurement in patients with chronic respiratory failure.

    Science.gov (United States)

    Oga, Toru; Windisch, Wolfram; Handa, Tomohiro; Hirai, Toyohiro; Chin, Kazuo

    2018-05-01

    The improvement of health-related quality of life (HRQL) is an important goal in managing patients with chronic respiratory failure (CRF) receiving long-term oxygen therapy (LTOT) and/or domiciliary noninvasive ventilation (NIV). Two condition-specific HRQL questionnaires have been developed to specifically assess these patients: the Maugeri Respiratory Failure Questionnaire (MRF) and the Severe Respiratory Insufficiency Questionnaire (SRI). The MRF is more advantageous in its ease of completion; conversely, the SRI measures diversified health impairments more multi-dimensionally and discriminatively with greater balance, especially in patients receiving NIV. The SRI is available in many different languages as a result of back-translation and validation processes, and is widely validated for various disorders such as chronic obstructive pulmonary disease, restrictive thoracic disorders, neuromuscular disorders, and obesity hypoventilation syndrome, among others. Dyspnea and psychological status were the main determinants for both questionnaires, while the MRF tended to place more emphasis on activity limitations than SRI. In comparison to existing generic questionnaires such as the Medical Outcomes Study 36-item short form (SF-36) and disease-specific questionnaires such as the St. George's Respiratory Questionnaire (SGRQ) and the Chronic Respiratory Disease Questionnaire (CRQ), both the MRF and the SRI have been shown to be valid and reliable, and have better discriminatory, evaluative, and predictive features than other questionnaires. Thus, in assessing the HRQL of patients with CRF using LTOT and/or NIV, we might consider avoiding the use of the SF-36 or even the SGRQ or CRQ alone and consider using the CRF-specific SRI and MRF in addition to existing generic and/or disease-specific questionnaires. Copyright © 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

  16. Self-administered foot reflexology for the management of chronic health conditions: a systematic review.

    Science.gov (United States)

    Song, Hyun Jin; Choi, Sun Mi; Seo, Hyun-Ju; Lee, Heeyoung; Son, Heejeong; Lee, Sanghun

    2015-02-01

    To systematically review the effect of self-administered foot reflexology in patients with chronic health conditions. Electronic databases were searched for literature published from 1948 to January 2014. The databases included MEDLINE, EMBASE, the Cochrane Library, CINAHL, CNKI, J-STAGE, Koreamed, Kmbase, KISS, NDSL, KISTI, and OASIS. Key search terms were "exp/relaxation therapy," "foot," "reflexology," "zone therapy," and "self." All study designs were included. Two raters independently extracted data and assessed study quality by using the Cochrane risk of bias tool (for randomized controlled trials) and the risk of bias assessment tool for nonrandomized studies (for nonrandomized and before-and-after studies). A qualitative and descriptive analysis was performed because of the clinical diversity associated with chronic health conditions. Of the 224 records assessed, 4 trials met the inclusion criteria: 3 nonrandomized controlled trials and 1 before-and-after study without comparison. Self-administered foot reflexology might have a positive effect in type 2 diabetes, but the low quality of the included study and the lack of adequately reported clinical outcomes obscure the results. Two studies of hypertensive patients and 1 study of patients with urinary incontinence showed that self-performed foot reflexology may exert a beneficial effect on lowering blood pressure and urinary incontinence; however, given the small sample size and the lack of any description of medications and other cointerventions, there was insufficient evidence to conclusively determine whether foot reflexology had any effect. The included studies on self-administered foot reflexology in patients with type 2 diabetes, hypertension, or urinary incontinence provided insufficient evidence to determine a treatment effect. Therefore, a well-designed, large-scale, and randomized controlled trial is needed to confirm the effect of self-administered foot reflexology for chronic conditions.

  17. Mockup design of personal health diary app for patients with chronic kidney disease.

    Science.gov (United States)

    Lin, Hsiu-Wen; Wang, Yu-Jen; Jing, Ling-Fang; Chang, Polun

    2014-01-01

    Health self-management is important in the care of patients with chronic kidney disease. It is possible to improve the efficiency of patient self-management through the use of mobile technology and related software. This study is divided into three stages: 1. analysis of need: through observation, interview and content analysis of the chronic kidney disease health management manual; 2. design of system prototype: establish interface and system function; 3. prototype evaluation: evaluate whether the prototype designed by this study meets user needs. The system prototype includes: daily record, laboratory examination results, trend graphs, information search, sharing, communications and settings. Prototyping is done with Pencil Project for interface design and linking. The prototype is then exported in PDF format for mock-up simulation. Evaluation results: overall score was 4.01±0.60 leaning towards "agree", the highest score was ease of use (4.25±0.6), followed by easy to learn (4.15±0.68), acceptance (4.01±0.61), reliability (3.87±0.6) and functionality (3.83±0.49). The results show positive attitude towards the system.

  18. Quality of life related to health chronic kidney disease: Predictive importance of mood and somatic symptoms.

    Science.gov (United States)

    Perales Montilla, Carmen M; Duschek, Stefan; Reyes Del Paso, Gustavo A

    2016-01-01

    To compare the predictive capacity of self-reported somatic symptoms and mood (depression and anxiety) on health-related quality of life (HRQOL) in patients with chronic renal disease. Data were obtained from 52 patients undergoing haemodialysis. Measures included a) the SF-36 health survey, b) the somatic symptoms scale revised (ESS-R) and c) the hospital anxiety and depression scale (HADS). Multiple regression was the main method of statistical analysis. Patients exhibited HRQOL levels below normative values, with anxiety and depression prevalence at 36.5% and 27%, respectively. Mood was the strongest predictor of physical (β=-.624) and mental (β=-.709) HRQOL. Somatic symptoms were also associated with physical HRQOL, but their predictive value was weaker (β=-.270). These results indicate that mood is a superior predictor of the physical and mental components of HRQOL in patients compared with the number and severity of physical symptoms. The data underline the importance of assessing negative emotional states (depression and anxiety) in kidney patients as a basis for intervention, which may facilitate reduction of the impact of chronic renal disease on HRQOL. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  19. [Chronic home-care patients and their primary health care environment].

    Science.gov (United States)

    Bilbao Curiel, I; Gastaminza Santacoloma, A M; García García, J A; Quindimil Vázquez, J A; López Rivas, J L; Huidobro Fernández, L

    1994-03-15

    Describing the primary level of attention to chronic home patients (CHP), their quality or life and the one of their home carers. Descriptive transverse study. Teaching Unit of Family of Sestao (Vizcaya) urban environment. 197 CHP patients with subacute, chronic illnesses or in terminal stages or handicapped, that is to say, people who cannot attend the Medical Centre and needing constant home care (longer than 4 weeks) although they do not need to be in hospital at the moment. A questionnaire made up by the researching group. April-June 1992. The clinical histories and home interviews. Mean age (78 +/- 23) years old; 70% were women; average of health problems of patients (4.2 +/- 4); average of drug consumption by patients (3.6 +/- 4); average of one visit to each patient per two months; 75% did not need derivation. The average age of people looking after them was (58 +/- 28) years old and 77.3% of them were women. Their average QL index was (9 +/- 2.4) out of 10, 9.2% had a QL index between 4 and 7 although there was nobody under 3. We have found an old population, mostly women with an average of health problems of (4.24 +/- 4) and who are polymedicated. 9.4 of them are not looked after by anybody. Generally their homes are habitable enough. In 77.3% of the cases the carers are women and 65.6% do not receive any domiciliary help.

  20. Impact of aggressive periodontitis and chronic periodontitis on oral health-related quality of life.

    Science.gov (United States)

    Llanos, Alexandre Hugo; Silva, Carlos Guillermo Benítez; Ichimura, Karina Tamie; Rebeis, Estela Sanches; Giudicissi, Marcela; Romano, Marcelo Munhóes; Saraiva, Luciana

    2018-01-01

    The purpose of this cross-sectional study was to investigate the effect of different forms of periodontal diseases on Oral Health-Related Quality of Life (OHRQoL). Fifty-two patients with Aggressive Periodontitis (AP) or Chronic Periodontitis (CP) were included: nine patients with Localized Aggressive Periodontitis (LAP), thirty-three patients with Generalized Aggressive Periodontitis (GAP) and ten patients with Generalized Chronic Periodontitis (GCP). Oral Health Impact Profile questionnaires (OHIP-14) were distributed after a clinical examination that measured the following periodontal parameters: tooth loss, bleeding on probing (BoP), probing depth (PD), gingival recession (REC) and clinical attachment level (CAL). The global OHIP-14 score means were 10.6 for LAP, 16.5 for GAP, and 17.5 for GCP. A statistically significant difference (p periodontitis. LAP, GAP and GCP have an impact on patient quality of life when measured using the OHIP-14. Patients with GAP and GCP had poorer OHRQoL than LAP patients.

  1. Size acceptance and intuitive eating improve health for obese, female chronic dieters.

    Science.gov (United States)

    Bacon, Linda; Stern, Judith S; Van Loan, Marta D; Keim, Nancy L

    2005-06-01

    Examine a model that encourages health at every size as opposed to weight loss. The health at every size concept supports homeostatic regulation and eating intuitively (ie, in response to internal cues of hunger, satiety, and appetite). Six-month, randomized clinical trial; 2-year follow-up. White, obese, female chronic dieters, aged 30 to 45 years (N=78). Free-living, general community. Six months of weekly group intervention (health at every size program or diet program), followed by 6 months of monthly aftercare group support. Anthropometry (weight, body mass index), metabolic fitness (blood pressure, blood lipids), energy expenditure, eating behavior (restraint, eating disorder pathology), and psychology (self-esteem, depression, body image). Attrition, attendance, and participant evaluations of treatment helpfulness were also monitored. Analysis of variance. Cognitive restraint decreased in the health at every size group and increased in the diet group, indicating that both groups implemented their programs. Attrition (6 months) was high in the diet group (41%), compared with 8% in the health at every size group. Fifty percent of both groups returned for 2-year evaluation. Health at every size group members maintained weight, improved in all outcome variables, and sustained improvements. Diet group participants lost weight and showed initial improvement in many variables at 1 year; weight was regained and little improvement was sustained. The health at every size approach enabled participants to maintain long-term behavior change; the diet approach did not. Encouraging size acceptance, reduction in dieting behavior, and heightened awareness and response to body signals resulted in improved health risk indicators for obese women.

  2. Comparative analysis of gingival crevicular fluid β-glucuronidase levels in health, chronic gingivitis and chronic periodontitis.

    Science.gov (United States)

    Sanara, P P; Shereef, Mohammed; Hegde, Shashikanth; Rajesh, K S; Arun Kumar, M S; Mohamed, Shabeer

    2015-08-01

    Current methods available for periodontal disease diagnosis are seriously deficient in terms of accuracy, in the ability to predict ongoing or future disease activity and indeed in determining whether previously diseased sites are in an arrested phase or still active. One area that is receiving a great deal of attention is the biochemical investigation of gingival crevicular fluid (GCF). β-glucuronidase (βG) is one of the enzymes found in GCF that is involved in degradation of the ground substance and fibrillar components of host connective tissue. GCF βG activity might be a good indicator or predictor of periodontal disease activity. This study was conducted to estimate and compare the GCF βG levels in patients with healthy periodontium, chronic gingivitis, and chronic periodontitis. Subjects were classified into three groups of 20 patients each; healthy individuals, chronic gingivitis, and chronic periodontitis. After recording the plaque index, gingival index and probing pocket depth, 1 μL GCF was collected by placing a calibrated microcapillary pipette extracrevicularly and transferred to sterile plastic vials containing 350 μL of normal saline with 1% bovine serum albumin. Analysis of βG was done by spectrophotometry. βG levels in GCF were significantly higher in chronic periodontitis group (mean value - 2.04743), followed by chronic gingivitis group (mean - 1.11510) and healthy group (0.53643). Increased βG levels were observed in patients with increased periodontal destruction, hence GCF βG levels can be used as biochemical marker for periodontal disease activity.

  3. Duloxetine in the management of chronic musculoskeletal pain

    OpenAIRE

    Smith, Howard; Smith,; Smith,

    2012-01-01

    Howard S Smith,1 Eric J Smith,2 Benjamin R Smith21Department of Anesthesiology, Albany Medical College, Albany, NY; 2The Pharmaceutical Research Institute, Albany College of Pharmacy and Health Sciences, Rensselaer, NY, USAAbstract: Chronic musculoskeletal pain is among the most frequent painful complaints that healthcare providers address. The bulk of these complaints are chronic low back pain and chronic osteoarthritis. Osteoarthritis is the most common form of arthritis in the United State...

  4. The effects on health behavior and health outcomes of Internet-based asynchronous communication between health providers and patients with a chronic condition: a systematic review.

    Science.gov (United States)

    de Jong, Catharina Carolina; Ros, Wynand Jg; Schrijvers, Guus

    2014-01-16

    In support of professional practice, asynchronous communication between the patient and the provider is implemented separately or in combination with Internet-based self-management interventions. This interaction occurs primarily through electronic messaging or discussion boards. There is little evidence as to whether it is a useful tool for chronically ill patients to support their self-management and increase the effectiveness of interventions. The aim of our study was to review the use and usability of patient-provider asynchronous communication for chronically ill patients and the effects of such communication on health behavior, health outcomes, and patient satisfaction. A literature search was performed using PubMed and Embase. The quality of the articles was appraised according to the National Institute for Health and Clinical Excellence (NICE) criteria. The use and usability of the asynchronous communication was analyzed by examining the frequency of use and the number of users of the interventions with asynchronous communication, as well as of separate electronic messaging. The effectiveness of asynchronous communication was analyzed by examining effects on health behavior, health outcomes, and patient satisfaction. Patients' knowledge concerning their chronic condition increased and they seemed to appreciate being able to communicate asynchronously with their providers. They not only had specific questions but also wanted to communicate about feeling ill. A decrease in visits to the physician was shown in two studies (P=.07, P=.07). Increases in self-management/self-efficacy for patients with back pain, dyspnea, and heart failure were found. Positive health outcomes were shown in 12 studies, where the clinical outcomes for diabetic patients (HbA1c level) and for asthmatic patients (forced expiratory volume [FEV]) improved. Physical symptoms improved in five studies. Five studies generated a variety of positive psychosocial outcomes. The effect of

  5. The Financial Burden of Non-Communicable Chronic Diseases in Rural Nigeria: Wealth and Gender Heterogeneity in Health Care Utilization and Health Expenditures

    NARCIS (Netherlands)

    Janssens, Wendy; Goedecke, Jann; de Bree, Godelieve J.; Aderibigbe, Sunday A.; Akande, Tanimola M.; Mesnard, Alice

    2016-01-01

    Better insights into health care utilization and out-of-pocket expenditures for non-communicable chronic diseases (NCCD) are needed to develop accessible health care and limit the increasing financial burden of NCCDs in Sub-Saharan Africa. A household survey was conducted in rural Kwara State,

  6. Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes.

    Science.gov (United States)

    Harvey, Peter W; Petkov, John N; Misan, Gary; Fuller, Jeffrey; Battersby, Malcolm W; Cayetano, Teofilo N; Warren, Kate; Holmes, Paul

    2008-05-01

    The Sharing Health Care SA chronic disease self-management (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess self-management skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led self-management education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.

  7. Survey of health status, nutrition and geography of food selection of chronic liver disease patients.

    Science.gov (United States)

    Leslie, Timothy; Pawloski, Lisa; Kallman-Price, Jillian; Escheik, Carey; Hossain, Noreen; Fang, Yun; Gerber, Lynn H; Younossi, Zobair M

    2014-01-01

    Obesity, a complex disease determined both by genetic and environmental factors, is strongly associated with NAFLD, and has been demonstrated to have a negative impact on HCV and other chronic liver diseases (CLD). This study assessed the association between type and location of food sources and chronic liver disease (CLD) using Geographic Information Systems (GIS). CLD patients completed surveys [267 subjects, 56.5% female, age 55.8 ± 12.0, type of CLD: 36.5% hepatitis C (HCV), 19.9% hepatitis B (HBV), 19.9% non-alcoholic fatty liver disease (NAFLD); primary food source (PFS): 80.8% grocery store, secondary: 26.2% bulk food store, tertiary: 20.5% restaurants; fresh food (FF): 83%, pre-packaged (PP) 8.7%, already prepared (AP) 8.3%]. FF consumers had significantly fewer UEH servings/month (p = 0.030) and lived further away from convenience stores (1.69 vs. 0.95 km, p = 0.0001). Stepwise regression reveals the lowest FF consumers were NAFLD patients, subjects with UEH or restaurants and ethnic food stores as their PFS (R = 0.557, p = 0.0001). Eating already-packaged foods and utilizing restaurants or ethnic food stores as the PFS positively correlated with NAFLD (R = 0.546, p = 0.0001). Environmental food source measures, including type and density, should be included when examining areas hyper-saturated with a variety of food options. In hyper-saturated food environments, NAFLD patients consume more prepared food and less FF. CLD patients with UEH also eat significantly more prepared food and frequent restaurants and ethnic food stores as their PFS.

  8. Costs and epidemiological changes of chronic diseases: implications and challenges for health systems.

    Directory of Open Access Journals (Sweden)

    Armando Arredondo

    Full Text Available The need to integrate economic and epidemiological aspects in the clinical perspective leads to a proposal for the analysis of health disparities and to an evaluation of the health services and of the new challenges which are now being faced by health system reforms in middle income countries.To identify the epidemiological changes, the demand for health services and economic burden from chronic diseases (diabetes and hypertension in a middle income county.We conducted longitudinal analyses of costs and epidemiological changes for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was used, based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2014-2016, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95%, and the Box-Pierce test.Regarding epidemiological changes expected in both diseases for 2014 vs. 2016, an increase is expected, although results predict a greater increase for diabetes, 8-12% in all three studied institutions, (p < .05. Indeed, in the case of diabetes, the increase was 41469 cases for uninsured population (SSA and 65737 for the insured population (IMSS and ISSSTE. On hypertension cases the increase was 38109 for uninsured vs 62895 for insured. Costs in US$ ranged from $699 to $748 for annual case management per patient in the case of diabetes, and from $485 to $622 in patients with hypertension. Comparing financial consequences of health services required by insured and uninsured populations, the greater increase (23% will be for the insured population (p < .05. The financial requirements of both diseases will amount to 19.5% of the total budget for the uninsured and 12.5% for the insured population.If the risk factors and the different health care models remain as they currently are, the economic

  9. Developing an indicator for the chronic health impact of traffic-related pollutant emissions

    International Nuclear Information System (INIS)

    Lépicier, Véronique; Chiron, Mireille; Joumard, Robert

    2013-01-01

    The goal of this study is to develop an emission based indicator for the health impact of the air pollution caused by traffic. This indicator must make it possible to compare different situations, for example different Urban Travel Plans, or technical innovations. Our work is based on a literature survey of methods for evaluating health impacts and, more particularly, those which relate to the atmospheric pollution caused by transport. We then define a health impact indicator based on the traffic emissions, named IISCEP for Chronic health impact indicator of pollutant emission. Here health is understood in a restricted meaning, excluding well-being. Only primary pollutants can be considered, as the inputs are emission data and an indicator must be simple. The indicator is calculated as the sum of each pollutant emission multiplied by a dispersion and exposition factor and a substance specific toxicity factor taking account of the severity. Last, two examples are shown using the IISCEP: comparison between petrol and diesel vehicles, and Nantes urban district in 2008 vs 2002. Even if it could still be improved, IISCEP is a straightforward indicator which can be used to gauge the chronic effects of inhaling primary pollutants. It can only be used in comparisons, between different scenarios or different technologies. The quality of the emissions data and the choice of the pollutants that are considered are the two essential factors that determine its validity and reliability. - Highlights: ► The goal of the study is to develop an emission based indicator for the health impact of the air pollution caused by traffic. ► It is based on a literature survey of methods for evaluating health impacts related to the atmospheric pollution. ► We define a composite indicator based on the traffic emissions and on local data as dispersion conditions and population. ► The indicator is a combination of pollutant emission, dispersion, exposition factor, and substance specific

  10. Chronic care model in primary care: can it improve health-related quality of life?

    Directory of Open Access Journals (Sweden)

    Aryani FMY

    2016-01-01

    Full Text Available Faridah Md Yusof Aryani,1 Shaun Wen Huey Lee,2 Siew Siang Chua,3 Li Ching Kok,4 Benny Efendie,2 Thomas Paraidathathu5 1Pharmaceutical Services Division, Ministry of Health Malaysia, Petaling Jaya, 2School of Pharmacy, Monash University Malaysia, Bandar Sunway, 3Department of Pharmacy, Faculty of Medicine, University of Malaya, 4Clinical Research Centre, Kuala Lumpur Hospital, Kuala Lumpur, 5School of Pharmacy, Taylor’s University, Subang Jaya, Selangor, Malaysia Purpose: Chronic diseases such as hypertension, diabetes mellitus, and hyperlipidemia are public health concerns. However, little is known about how these affect patient-level health measures. The aim of the study was to examine the impact of a chronic care model (CCM on the participant’s health-related quality of life (QoL. Patients and methods: Participants received either usual care or CCM by a team of health care professionals including pharmacists, nurses, dietitians, and general practitioners. The participants in the intervention group received medication counseling, adherence, and dietary advice from the health care team. The QoL was measured using the EQ-5D (EuroQoL-five dimension, health-related quality of life questionnaire and comparison was made between usual care and intervention groups at the beginning and end of the study at 6 months. Results: Mean (standard deviation EQ-5D index scores improved significantly in the intervention group (0.92±0.10 vs 0.95±0.08; P≤0.01, but not in the usual care group (0.94±0.09 vs 0.95±0.09; P=0.084. Similarly, more participants in the intervention group reported improvements in their QoL compared with the usual care group, especially in the pain/discomfort and anxiety/depression dimensions. Conclusion: The implementation of the CCM resulted in significant improvement in QoL. An interdisciplinary team CCM approach should be encouraged, to ultimately result in behavior changes and improve the QoL of the patients. Keywords: diabetes

  11. The frequent occurrence of MIC

    Energy Technology Data Exchange (ETDEWEB)

    Graff, Matthias [Gesellschaft fuer Technische Mikrobiologie und Hygieneueberwachung - Dr. Graff und Partner, Stadtweg 9, D-38176 Wendeburg (Germany); Neubert, Volkmar [Institut fuer Materialpruefung und Werkstofftechnik Dr. Doelling und Dr. Neubert GmbH, Freiberger Strasse 1, D-38678 Clausthal-Zellerfeld (Germany)

    2004-07-01

    Microbial induced corrosion (MIC) is not as rare as many materials scientist and corrosion practitioners do believe. It is not an exotic and scarce event, but can be found frequently in many fields of corrosion research, provided that it is looked for. The reason for the relatively few descriptions of MIC cases seems to be the fact, that the microbiological approach is not widely known and applied in the world of materials science. MIC is not so much a corrosion mechanism on its own, but it enhances the corrosion rates of the 'normal' mechanisms to such an extent, that in some cases 'incredible' fast corrosion progress can be observed. The reason is the microorganisms' function as bio-catalysts: Chemical reactions, which are very slow under normal chemical conditions can be highly accelerated by living organisms. Besides that, several microorganisms do produce very corrosive substances which in natural environments do not occur without the activity of microorganisms, e. g. sulfuric or nitric acid. We want to point out, that it can be very worthy to take microbial induced corrosion into account. MIC is not the general answer for all unsolved corrosion problems, but to think about it helps in many corrosion cases as the authors had to experience. The initial indication for the presence of MIC are markedly increased corrosion rates. In the following, some of our 'lessons' are presented as short case studies: Two of them deal with steel corrosion characterized by increased corrosion rates. The third example presents corrosion damage of aluminium structures, where from a technical point of view corrosion was not expected, least of all microbial induced corrosion. (authors)

  12. Childhood trauma and chronic illness in adulthood: mental health and socioeconomic status as explanatory factors and buffers.

    Science.gov (United States)

    Mock, Steven E; Arai, Susan M

    2010-01-01

    Experiences of traumatic events in childhood have been shown to have long-term consequences for health in adulthood. With data from the 2005 Canadian Community Health Survey we take a life course perspective of cumulative disadvantage and examine the potential role of mental health and socioeconomic status in adulthood as multiple mediators of the link between childhood trauma and chronic illness in adulthood. Mental health and socioeconomic status are also tested as buffers against the typically adverse consequences of childhood trauma. The results suggest mental health and socioeconomic status partially explain the association of childhood trauma with chronic illness in adulthood, with mental health showing a stronger effect. In addition, an analysis of the interactions suggested higher socioeconomic status is a potential protective factor for those with a history of trauma. Results also suggest cumulative disadvantage following trauma may lead to chronic illness and suggest the need for public health expenditures on resources such as counseling and income supports to prevent or reduce psychological harm and chronic illness resulting from traumatic events.

  13. Childhood trauma and chronic illness in adulthood: mental health and socioeconomic status as explanatory factors and buffers

    Directory of Open Access Journals (Sweden)

    Steven E Mock

    2011-01-01

    Full Text Available Experiences of traumatic events in childhood have been shown to have long-term consequences for health in adulthood. With data from the 2005 Canadian Community Health Survey we take a life course perspective of cumulative disadvantage and examine the potential role of mental health and socioeconomic status in adulthood as multiple mediators of the link between childhood trauma and chronic illness in adulthood. Mental health and socioeconomic status are also tested as buffers against the typically adverse consequences of childhood trauma. The results suggest mental health and socioeconomic status partially explain the association of childhood trauma with chronic illness in adulthood, with mental health showing a stronger effect. In addition, an analysis of the interactions suggested higher socioeconomic status is a potential protective factor for those with a history of trauma. Results also suggest cumulative disadvantage following trauma may lead to chronic illness and suggest the need for public health expenditures on resources such as counseling and income supports to prevent or reduce psychological harm and chronic illness resulting from traumatic events.

  14. The association between diabetes mellitus, glucose, and chronic musculoskeletal complaints. Results from the Nord-Trøndelag Health Study

    Directory of Open Access Journals (Sweden)

    Zwart John-Anker

    2008-12-01

    Full Text Available Abstract Background The relationship between diabetes mellitus (DM and chronic musculoskeletal complaints (MSCs is unclear. The aim of this study was to investigate the association between DM, non-fasting glucose and chronic MSCs defined as pain and/or stiffness ≥ 3 months during the past year in the general adult population. Methods The results were based on cross-sectional data from 64,785 men and women (aged ≥ 20 years who participated in the Nord-Trøndelag Health Survey, which included 1,940 individuals with known DM. Associations were assessed using multiple logistic regression, estimating prevalence odds ratio (OR with 95% confidence intervals (CIs. Results High non-fasting glucose was associated with a lower prevalence of chronic MSCs compared to a low glucose level. DM was associated with higher prevalence of chronic MSCs, in particular chronic widespread MSCs. In the multivariate analysis, adjusting for glucose level, BMI, age, gender and physical activity, chronic widespread MSCs was 1.6 times more likely (OR = 1.6, 95% CI 1.2–2.2 among individuals Conclusion In this cross-sectional study a high non-fasting glucose was associated with lower prevalence of chronic MSCs. Among individuals with known DM chronic widespread MSCs were more likely.

  15. Young adult outcomes of children growing up with chronic illness: an analysis of the National Longitudinal Study of Adolescent Health.

    Science.gov (United States)

    Maslow, Gary R; Haydon, Abigail A; Ford, Carol Ann; Halpern, Carolyn Tucker

    2011-03-01

    To examine young adult outcomes in a nationally representative US cohort of young adults growing up with a chronic illness. Secondary analysis of nationally representative data from wave III (in 2001) of the National Longitudinal Study of Adolescent Health. United States. The analytic sample comprised 13 236 young adults aged 18 to 28 years at wave III. Self-report of a chronic physical illness (asthma, cancer, diabetes mellitus, or epilepsy) in adolescence. Respondents with asthma or nonasthmatic chronic illness (cancer, diabetes mellitus, or epilepsy) were compared with individuals without these conditions. Self-report of high school graduation, ever having employment, currently having employment, living with a parent/guardian, and ever receiving public assistance. Three percent of young adults had nonasthmatic chronic illness (cancer, diabetes, or epilepsy), and 16.0% had asthma. Most young adults with chronic illness graduated high school (81.3%) and currently had employment (60.4%). However, compared with healthy young adults, those with nonasthmatic chronic illness were significantly less likely to graduate high school, ever have had employment, or currently have employment and were more likely to receive public assistance. Compared with young adults with asthma, those with nonasthmatic chronic illness again had significantly worse young adult outcomes on all measures. Most young adults growing up with a chronic illness graduate high school and have employment. However, these young adults are significantly less likely than their healthy peers to achieve these important educational and vocational milestones.

  16. Disentangling the Sleep-Pain Relationship in Pediatric Chronic Pain: The Mediating Role of Internalizing Mental Health Symptoms

    Directory of Open Access Journals (Sweden)

    Maria Pavlova

    2017-01-01

    Full Text Available Background. Pediatric chronic pain often emerges in adolescence and cooccurs with internalizing mental health issues and sleep impairments. Emerging evidence suggests that sleep problems may precede the onset of chronic pain as well as anxiety and depression. Studies conducted in pediatric populations with pain-related chronic illnesses suggest that internalizing mental health symptoms may mediate the sleep-pain relationship; however, this has not been examined in youth with primary pain disorders. Objective. To examine whether anxiety and depressive symptoms mediated relationships between sleep quality and pain outcomes among youth with chronic pain. Methods. Participants included 147 youth (66.7% female aged 8–18 years who were referred to a tertiary-level chronic pain program. At intake, the youth completed psychometrically sound measures of sleep quality, pain intensity, pain interference, and anxiety and depressive symptoms. Results. As hypothesized, poor sleep quality was associated with increased pain intensity and pain interference, and anxiety and depressive symptoms mediated these sleep-pain relationships. Discussion. For youth with chronic pain, poor sleep quality may worsen pain through alterations in mood and anxiety; however, prospective research using objective measures is needed. Future research should examine whether targeting sleep and internalizing mental health symptoms in treatments improve pain outcomes in these youth.

  17. Public health impact of global heating due to climate change: potential effects on chronic non-communicable diseases.

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    Kjellstrom, Tord; Butler, Ainslie J; Lucas, Robyn M; Bonita, Ruth

    2010-04-01

    Several categories of ill health important at the global level are likely to be affected by climate change. To date the focus of this association has been on communicable diseases and injuries. This paper briefly analyzes potential impacts of global climate change on chronic non-communicable diseases (NCDs). We reviewed the limited available evidence of the relationships between climate exposure and chronic and NCDs. We further reviewed likely mechanisms and pathways for climatic influences on chronic disease occurrence and impacts on pre-existing chronic diseases. There are negative impacts of climatic factors and climate change on some physiological functions and on cardio-vascular and kidney diseases. Chronic disease risks are likely to increase with climate change and related increase in air pollution, malnutrition, and extreme weather events. There are substantial research gaps in this arena. The health sector has a major role in facilitating further research and monitoring the health impacts of global climate change. Such work will also contribute to global efforts for the prevention and control of chronic NCDs in our ageing and urbanizing global population.

  18. Chronic pain and pattern of health care utilization among Malaysian elderly population: National Health and Morbidity Survey III (NHMS III, 2006).

    Science.gov (United States)

    Mohamed Zaki, Lily R; Hairi, Noran N

    2014-12-01

    The aims of this study were to report prevalence of chronic pain and to examine whether chronic pain influence healthcare usage among elderly Malaysian population. This was a sub-population analysis of the elderly sample in the Malaysia's Third National Health and Morbidity Survey (NHMS III) 2006, a nation-wide population based survey. A subset of 4954 elderly aged 60 years and above was used in the analysis. Chronic pain, pain's interference and outcome variables of healthcare utilization (hospital admission and ambulatory care service) were all measured and determined by self-report. Prevalence of chronic pain among elderly Malaysian was 15.2% (95% CI: 14.5, 16.8). Prevalence of chronic pain increased with advancing age, and the highest prevalence was seen among the old-old group category (21.5%). Across young-old and old-old groups, chronic pain was more prevalent among females, Indian ethnicity, widows/widowers, rural residency and those with no educational background. Our study showed that chronic pain alone increased hospitalization but not visits to ambulatory facilities. Presence of chronic pain was significantly associated with the frequency of hospitalization (aIRR 1.11; 95% CI 1.02, 1.38) but not ambulatory care service. Chronic pain is a prevalent health problem among the elderly in Malaysia and is associated with higher hospitalization rate among the elderly population. This study provides insight into the distribution of chronic pain among the elderly and its relationship with the patterns of healthcare utilization. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  19. Acute and chronic disability among U.S. farmers and pesticide applicators: the National Health Interview Survey (NHIS).

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    Gómez-Marín, O; Fleming, L E; Lee, D J; LeBlanc, W; Zheng, D; Ma, F; Jané, D; Pitman, T; Caban, A

    2004-11-01

    The National Health Interview Survey (NHIS) is a multipurpose household survey of the U.S. civilian non-institutionalized population conducted annually since 1957. From 1986 to 1994, over 450,000 U.S. workers, age 18 years and older, participated in a probability sampling of the entire non-institutionalized U.S. population; variables collected included a range of measures of acute and chronic disability. The objective of the present study was to assess predictors of health status, and acute and chronic disability for farmers and pesticide applicators (pesticide-exposed workers) compared to all other U.S. workers using the 1986-1994 NHIS. After adjustment for sample weights and design effects using SUDAAN, several measures of acute and chronic disability and health status were modeled with multiple logistic regression. Farmers (n = 9576) were significantly older compared to all other U.S. workers (n = 453,219) and pesticide applicators (n = 180). Farmers and pesticide applicators had a higher proportion of males, whites, and Hispanics and were less educated. After adjusting for age, gender, race-ethnicity, and education, compared to all other workers, farmers were significantly less likely to report acute and chronic disability and health conditions, while pesticide applicators were more likely to report chronic disability, health conditions, and poor health. Given the cross-sectional nature of the data and the significant job demands of farming, both leading to a relative healthy worker effect, the present results indicate that at any point in time, farmers report less acute and chronic disability, compared to other U.S. workers, whereas pesticide applicators report similar or poorer health.

  20. [Meningococcal disease: frequently asked questions].

    Science.gov (United States)

    Cofré, José

    2012-12-01

    On account of an increase of serogroup W135 meningococcal disease (M.D.) observed in Santiago, Chile, during last two years the medical community has experienced an avidity to update their knowledge about M.D. treatment and its prevention. In a queries and answers mode, the following topics on M.D. are presented: nasopharyngeal carriage and its importance, immunity and protection against the disease, reasons to choice ceftriaxone as the first line antibiotic in treatment, rationality and indications of chemoprophylaxis, fundamentals and advantages of conjugate vaccines, its indications, schedules, contraindications and decisions making in public health.

  1. Health-related quality of life as measured with EQ-5D among populations with and without specific chronic conditions: a population-based survey in Shaanxi Province, China.

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    Tan, Zhijun; Liang, Ying; Liu, Siming; Cao, Wenjun; Tu, Haibo; Guo, Lingxia; Xu, Yongyong

    2013-01-01

    The aim of this study was to examine health-related quality of life (HRQoL) as measured by EQ-5D and to investigate the influence of chronic conditions and other risk factors on HRQoL based on a distributed sample located in Shaanxi Province, China. A multi-stage stratified cluster sampling method was performed to select subjects. EQ-5D was employed to measure the HRQoL. The likelihood that individuals with selected chronic diseases would report any problem in the EQ-5D dimensions was calculated and tested relative to that of each of the two reference groups. Multivariable linear regression models were used to investigate factors associated with EQ VAS. The most frequently reported problems involved pain/discomfort (8.8%) and anxiety/depression (7.6%). Nearly half of the respondents who reported problems in any of the five dimensions were chronic patients. Higher EQ VAS scores were associated with the male gender, higher level of education, employment, younger age, an urban area of residence, access to free medical service and higher levels of physical activity. Except for anemia, all the selected chronic diseases were indicative of a negative EQ VAS score. The three leading risk factors were cerebrovascular disease, cancer and mental disease. Increases in age, number of chronic conditions and frequency of physical activity were found to have a gradient effect. The results of the present work add to the volume of knowledge regarding population health status in this area, apart from the known health status using mortality and morbidity data. Medical, policy, social and individual attention should be given to the management of chronic diseases and improvement of HRQoL. Longitudinal studies must be performed to monitor changes in HRQoL and to permit evaluation of the outcomes of chronic disease intervention programs.

  2. Stakeholders' perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms.

    Science.gov (United States)

    Van Durme, Thérèse; Macq, Jean; Anthierens, Sibyl; Symons, Linda; Schmitz, Olivier; Paulus, Dominique; Van den Heede, Koen; Remmen, Roy

    2014-04-18

    Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders' perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium. Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care. Informants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today's health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines. Our study's methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire other countries faced with the challenge of

  3. Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms

    Science.gov (United States)

    2014-01-01

    Background Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders’ perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium. Methods Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care. Results Informants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today’s health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines. Conclusion Our study’s methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire

  4. The MyHealthService approach for chronic disease management based on free open source software and low cost components.

    Science.gov (United States)

    Vognild, Lars K; Burkow, Tatjana M; Luque, Luis Fernandez

    2009-01-01

    In this paper we present an approach to building personal health services, supporting following-up, physical exercising, health education, and psychosocial support for the chronically ill, based on free open source software and low-cost computers, mobile devices, and consumer health and fitness devices. We argue that this will lower the cost of the systems, which is important given the increasing number of people with chronicle diseases and limited healthcare budgets.

  5. The broad scope of health effects from chronic arsenic exposure: update on a worldwide public health problem.

    Science.gov (United States)

    Naujokas, Marisa F; Anderson, Beth; Ahsan, Habibul; Aposhian, H Vasken; Graziano, Joseph H; Thompson, Claudia; Suk, William A

    2013-03-01

    Concerns for arsenic exposure are not limited to toxic waste sites and massive poisoning events. Chronic exposure continues to be a major public health problem worldwide, affecting hundreds of millions of persons. We reviewed recent information on worldwide concerns for arsenic exposures and public health to heighten awareness of the current scope of arsenic exposure and health outcomes and the importance of reducing exposure, particularly during pregnancy and early life. We synthesized the large body of current research pertaining to arsenic exposure and health outcomes with an emphasis on recent publications. Locations of high arsenic exposure via drinking water span from Bangladesh, Chile, and Taiwan to the United States. The U.S. Environmental Protection Agency maximum contaminant level (MCL) in drinking water is 10 µg/L; however, concentrations of > 3,000 µg/L have been found in wells in the United States. In addition, exposure through diet is of growing concern. Knowledge of the scope of arsenic-associated health effects has broadened; arsenic leaves essentially no bodily system untouched. Arsenic is a known carcinogen associated with skin, lung, bladder, kidney, and liver cancer. Dermatological, developmental, neurological, respiratory, cardiovascular, immunological, and endocrine effects are also evident. Most remarkably, early-life exposure may be related to increased risks for several types of cancer and other diseases during adulthood. These data call for heightened awareness of arsenic-related pathologies in broader contexts than previously perceived. Testing foods and drinking water for arsenic, including individual private wells, should be a top priority to reduce exposure, particularly for pregnant women and children, given the potential for life-long effects of developmental exposure.

  6. Quality of life and use of health care resources among patients with chronic depression

    Science.gov (United States)

    Villoro, Renata; Merino, María; Hidalgo-Vega, Alvaro

    2016-01-01

    Purpose This study estimates the health-related quality of life and the health care resource utilization of patients diagnosed with chronic depression (CD) in Spain. Patients and methods We used the Spanish National Health Survey 2011–2012, a cross-sectional survey representative at the national level, that selects people aged between 18 and 64 years (n=14,691). We estimated utility indices through the EuroQol five-dimensional descriptive system questionnaire included in the survey. We calculated percentage use of health care resources (medical visits, hospitalizations, emergency services, and drug consumption) and average number of resources used when available. A systematic comparison was made between people diagnosed with CD and other chronic conditions (OCCs). The chi-square test, Mann–Whitney U-test, and Kruskal–Wallis test were used to determine the statistical significance of differences between comparison groups. Multivariate analyses (Poisson regression, logistic regression, and linear regression) were also carried out to assess the relationship between quality of life and consumption of health care resources. Results Approximately, 6.1% of the subjects aged between 18 and 64 years were diagnosed with CD (average age 48.3±11 years, 71.7% females). After controlling for age, sex, and total number of comorbidities, a diagnosis of CD reduced utility scores by 0.09 (P<0.05) vs OCCs, and increased the average number of hospitalizations by 15%, the average number of days at hospital by 51%, and the average number of visits to emergency services by 15% (P<0.05). CD also increased the average number of visits to secondary care by 14% and visits to general practitioners by 4%. People with CD had a higher probability of consuming drugs than people with OCCs (odds ratio [OR]: 1.24, P<0.05), but only 38.6% took antidepressants. Conclusion People with CD had significantly lower health-related quality of life than people with OCCs. CD was associated with

  7. Predictors of Frequent Emergency Room Visits among a Homeless Population.

    Directory of Open Access Journals (Sweden)

    Kinna Thakarar

    Full Text Available Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use.A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH. This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits.In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, p<0.01. HIV seropositivity was not predictive of frequent ER visits. In patients with history of illicit drug use, mental health (OR 2.53, 95% CI 1.07-5.95 and hepatitis C (OR 2.85, 95% CI 1.37-5.93 were predictors of frequent ER use. HIV seropositivity did not predict ER use (OR 0.45, 95% CI 0.21 - 0.97.In a HCH population, hepatitis C predicted frequent ER visits in homeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

  8. A review of chronic pain impact on patients, their social environment and the health care system

    Directory of Open Access Journals (Sweden)

    Dueñas M

    2016-06-01

    Full Text Available María Dueñas,1 Begoña Ojeda,2 Alejandro Salazar,2 Juan Antonio Mico,3 Inmaculada Failde,2 1Nursing Faculty “Salus Infirmorum”, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 2Preventive Medicine and Public Health Area, The Observatory of Pain, University of Cádiz, Cádiz, Spain; 3Department of Neuroscience, Pharmacology, and Psychiatry, CIBER of Mental Health, CIBERSAM, Institute of Health Carlos III, University of Cádiz, Cádiz, Spain Abstract: Chronic pain (CP seriously affects the patient’s daily activities and quality of life, but few studies on CP have considered its effects on the patient’s social and family environment. In this work, through a review of the literature, we assessed several aspects of how CP influences the patient’s daily activities and quality of life, as well as its repercussions in the workplace, and on the family and social environment. Finally, the consequences of pain on the health care system are discussed. On the basis of the results, we concluded that in addition to the serious consequences on the patient’s life, CP has a severe detrimental effect on their social and family environment, as well as on health care services. Thus, we want to emphasize on the need to adopt a multidisciplinary approach to treatment so as to obtain more comprehensive improvements for patients in familial and social contexts. Accordingly, it would be beneficial to promote more social- and family-oriented research initiatives. Keywords: pain, everyday problems, social relationships, family environment, health services

  9. [Chronic kidney disease in Primary Health Care: prevalence and associated risk factors].

    Science.gov (United States)

    Salvador González, Betlem; Rodríguez Pascual, Mercedes; Ruipérez Guijarro, Laura; Ferré González, Antonia; Cunillera Puertolas, Oriol; Rodríguez Latre, Luisa M

    2015-04-01

    To determine the prevalence of chronic kidney disease and associated risk factors in subjects over 60 years of age, as well as its staging by determining the glomerular filtration rate (GFR). Cross-sectional observational study. Primary Health Care. Patients≥60 years of age who were seen in 40 Primary Health Care centres with serum creatinine measured in a central laboratory between January 1 and December 31, 2010. kidney transplant, home care. Social-demographic and anthropometric data, cardiovascular risk factors, and diseases established according to electronic clinical records. Serum creatinine was measured using standardised Jaffe kinetic method, and GFR estimated with MDRD-4-IDMS and CKD-EPI. A total of 97,665 subjects (57.3% women, median age 70.0 years [Q1: 65.0, Q3: 77.0]). GFR-MDRD prevalence<60=15.1% (16.6% in women, 13.2% in men; P<.001) and increased with age. Multivariate analysis showed a positive association between GFR-MDRD<60 and age (OR=1.74; 95% CI 1.70 to 1.77), hypertension (OR=2.18; 95% CI 2.08 to 2.30), heart failure (OR=2.03; 95% CI 1.83 to 2.25), atrial fibrillation (OR=1.57; 95% CI 1.41 to 1.76), ischaemic heart disease (OR=1.40; 95% CI 1.30 to 1.50), peripheral arterial disease (OR=1.31; 95% CI 1.09 to 1.57), dyslipidaemia (OR=1.28; 95% CI 1.23 to 1.33), diabetes (OR=1.26; 95% CI 1.17 to 1.34), and stroke (OR=1.17; 95% CI 1.09 to 1.25). The GFR-CKD-EPI model showed an increase in OR with age and male sex, that became significant as a chronic kidney disease risk factor. Chronic kidney disease has considerable prevalence in subjects≥60 years seen in Primary Health Care, more in women, and increasing with age. Hypertension, more than diabetes, was the main associated cardiovascular risk factor. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  10. Health Self-Efficacy Among Populations with Multiple Chronic Conditions: the Value of Patient-Centered Communication.

    Science.gov (United States)

    Finney Rutten, Lila J; Hesse, Bradford W; St Sauver, Jennifer L; Wilson, Patrick; Chawla, Neetu; Hartigan, Danielle B; Moser, Richard P; Taplin, Stephen; Glasgow, Russell; Arora, Neeraj K

    2016-08-01

    Using cross-sectional survey data, we assessed the association between chronic illness burden and health-related self-efficacy, evaluating whether patient-centered communication is associated with self-efficacy and if that relationship varies by chronic illness burden. Data were from the Health Information National Trends Survey, a cross-sectional survey of the US adult population collected in 2012-2013 (n = 3630). Health-related self-efficacy was measured with the item: "Overall, how confident are you about your ability to take good care of your health?" and the prevalence of six chronic conditions and depression/anxiety was assessed. Patient-centered communication was measured as the frequency with which respondents perceived their healthcare providers allowed them to ask questions, gave attention to their emotions, involved them in decisions, made sure they understood how to take care of their health, helped them to deal with uncertainty, and if they felt they could rely on their healthcare providers to take care of their healthcare needs. Health-related self-efficacy was significantly lower among individuals with greater illness burden. In adjusted analysis, individuals who experienced more positive patient-centered communication reported higher levels of self-efficacy (β = 0.26, P self-efficacy were observed among patients reporting more positive patient-centered communication; the observed association was stronger among those with greater chronic illness burden.

  11. Reverse iontophoresis of urea in health and chronic kidney disease: a potential diagnostic and monitoring tool?

    Science.gov (United States)

    Ebah, Leonard M; Read, Ian; Sayce, Andrew; Morgan, Jane; Chaloner, Christopher; Brenchley, Paul; Mitra, Sandip

    2012-01-01

    Background Patients with chronic kidney disease (CKD) need regular monitoring, usually by blood urea and creatinine measurements, needing venepuncture, frequent attendances and a healthcare professional, with significant inconvenience. Noninvasive monitoring will potentially simplify and improve monitoring. We tested the potential of transdermal reverse iontophoresis of urea in patients with CKD and healthy controls. Methods Using a MIC 2® Iontophoresis Controller, reverse iontophoresis was applied on the forearm of five healthy subjects (controls) and 18 patients with CKD for 3–5 h. Urea extracted at the cathode was measured and compared with plasma urea. Results Reverse iontophoresis at 250 μA was entirely safe for the duration. Cathodal buffer urea linearly correlated with plasma urea after 2 h (r = 0·82, P urea (y) from cathodal urea after 2 and 3 h, respectively. Cathodal urea concentration in controls was significantly lower than in patients with CKD after a minimum current application of 2 h (P urea cut-off of 30 μM gave a sensitivity of 83·3% and positive predictive value of 87% CKD. During haemodialysis, the fall in cathodal urea was able to track that of blood urea. Conclusion Reverse iontophoresis is safe, can potentially discriminate patients with CKD and healthy subjects and is able to track blood urea changes on dialysis. Further development of the technology for routine use can lead to an exciting opportunity for its use in diagnostics and monitoring. PMID:22409780

  12. Building on transformative learning and response shift theory to investigate health-related quality of life changes over time in individuals with chronic health conditions and disability.

    Science.gov (United States)

    Barclay-Goddard, Ruth; King, Judy; Dubouloz, Claire-Jehanne; Schwartz, Carolyn E

    2012-02-01

    A major goal of treatment for people living with chronic illness or disability is self-management leading to optimized health-related quality of life. This change process has been described in the adult education literature as transformative learning, while in health-related quality of life research, response shift has emerged as a key concept. Response shift and transformative learning literature were reviewed, and the theoretical frameworks of the 2 concepts were compared and contrasted. Response shift is described as a change in internal standards, values, or definition of a construct (eg, health-related quality of life) over time, commonly seen in individuals with chronic illness. In the context of chronic illness, transformative learning is described as a complex process of personal change including beliefs, feelings, knowledge, and values. Transformative learning is often triggered by the diagnosis of a chronic illness. This results in a critical reflection of taken-for-granted assumptions and leads to new ways of thinking, influencing personal changes in daily living. Comparing the models of response shift and transformative learning in chronic illness, the catalyst in response shift appears comparable with the trigger in transformational learning; mechanisms to process of changing; and perceived quality of life to outcomes. Both transformative learning and response shift have much to offer health care providers in understanding the learning process for the person living with chronic illness or disability to optimize their quality of life. Suggestions for future research in response shift and transformative learning in individuals with chronic health conditions and disability are proposed. Copyright © 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  13. Lifestyle in progression from hypertensive disorders of pregnancy to chronic hypertension in Nurses' Health Study II: observational cohort study.

    Science.gov (United States)

    Timpka, Simon; Stuart, Jennifer J; Tanz, Lauren J; Rimm, Eric B; Franks, Paul W; Rich-Edwards, Janet W

    2017-07-12

    Objectives  To study the association between lifestyle risk factors and chronic hypertension by history of hypertensive disorders of pregnancy (HDP: gestational hypertension and pre-eclampsia) and investigate the extent to which these risk factors modify the association between HDP and chronic hypertension. Design  Prospective cohort study. Setting  Nurses' Health Study II (1991-2013). Participants  54 588 parous women aged 32 to 59 years with data on reproductive history and without previous chronic hypertension, stroke, or myocardial infarction. Main outcome measure  Chronic hypertension diagnosed by a physician and indicated through nurse participant self report. Multivariable Cox proportional hazards models were used to investigate the development of chronic hypertension contingent on history of HDP and four lifestyle risk factors: post-pregnancy body mass index, physical activity, adherence to the Dietary Approaches to Stop Hypertension (DASH) diet, and dietary sodium/potassium intake. Potential effect modification (interaction) between each lifestyle factor and previous HDP was evaluated with the relative excess risk due to interaction. Results  10% (n=5520) of women had a history of HDP at baseline. 13 971 cases of chronic hypertension occurred during 689 988 person years of follow-up. Being overweight or obese was the only lifestyle factor consistently associated with higher risk of chronic hypertension. Higher body mass index, in particular, also increased the risk of chronic hypertension associated with history of HDP (relative excess risk due to interaction Psodium/potassium intake on the association between HDP and chronic hypertension. Conclusion  This study suggests that the risk of chronic hypertension after HDP might be markedly reduced by adherence to a beneficial lifestyle. Compared with women without a history of HDP, keeping a healthy weight seems to be especially important with such a history.

  14. Predicting changes in hypertension control using electronic health records from a chronic disease management program

    Science.gov (United States)

    Sun, Jimeng; McNaughton, Candace D; Zhang, Ping; Perer, Adam; Gkoulalas-Divanis, Aris; Denny, Joshua C; Kirby, Jacqueline; Lasko, Thomas; Saip, Alexander; Malin, Bradley A

    2014-01-01

    Objective Common chronic diseases such as hypertension are costly and difficult to manage. Our ultimate goal is to use data from electronic health records to predict the risk and timing of deterioration in hypertension control. Towards this goal, this work predicts the transition points at which hypertension is brought into, as well as pushed out of, control. Method In a cohort of 1294 patients with hypertension enrolled in a chronic disease management program at the Vanderbilt University Medical Center, patients are modeled as an array of features derived from the clinical domain over time, which are distilled into a core set using an information gain criteria regarding their predictive performance. A model for transition point prediction was then computed using a random forest classifier. Results The most predictive features for transitions in hypertension control status included hypertension assessment patterns, comorbid diagnoses, procedures and medication history. The final random forest model achieved a c-statistic of 0.836 (95% CI 0.830 to 0.842) and an accuracy of 0.773 (95% CI 0.766 to 0.780). Conclusions This study achieved accurate prediction of transition points of hypertension control status, an important first step in the long-term goal of developing personalized hypertension management plans. PMID:24045907

  15. [Psychiatric case management. Chronic Disease Management application experience in a public Mental Health Service].

    Science.gov (United States)

    Pompili, Enrico; Silvestrini, Cristiana; Nicolò, Giuseppe; Pitino, Annalisa; Bernabei, Laura

    2014-01-01

    Aim of this study is to investigate the possible effectiveness of a specific program management needs of patients at high impact health care, case management (CM). The welfare impact is evaluated in terms of the severity of the presented disorder or to other characteristic factors of the individual patient, such as: adherence to the proposed treatments, possible resistance to drug treatment, cognitive structure, the presence of comorbid medical pathologies, abuse/addiction and, more generally, all bio-psycho-social functioning variables that can complicate the treatment of the patient. Twenty five outpatients with chronic schizophrenia (age mean 49,5 yrs) were evaluated through the Camberwell Assessment of Need (CAN20) and Life Skill Profile (LSP) before and after 1 year of CM treatment. General psychopathology was assessed by the Clinical Global Impression (CGI) and the Brief Psychiatric Rating Scale (BPRS). Demographic data were collected, as well as data related to the severity of the disorder: number of hospitalizations and number of switch in drug treatment in the year before the study. Between T0 and T1 there is a significant improvement on CGI-G, BPRS (total and HOST factor), LSP and CAN TOT in patients treated with CM. Moreover, in CM treated patients a 58% reduction of hospitalizations is noted in the year of study. There is a possible effectiveness of CM in improving patient's clinical and social needs in chronic psychiatric diseases. The CM reduces the number of hospitalizations.

  16. Predicting changes in hypertension control using electronic health records from a chronic disease management program.

    Science.gov (United States)

    Sun, Jimeng; McNaughton, Candace D; Zhang, Ping; Perer, Adam; Gkoulalas-Divanis, Aris; Denny, Joshua C; Kirby, Jacqueline; Lasko, Thomas; Saip, Alexander; Malin, Bradley A

    2014-01-01

    Common chronic diseases such as hypertension are costly and difficult to manage. Our ultimate goal is to use data from electronic health records to predict the risk and timing of deterioration in hypertension control. Towards this goal, this work predicts the transition points at which hypertension is brought into, as well as pushed out of, control. In a cohort of 1294 patients with hypertension enrolled in a chronic disease management program at the Vanderbilt University Medical Center, patients are modeled as an array of features derived from the clinical domain over time, which are distilled into a core set using an information gain criteria regarding their predictive performance. A model for transition point prediction was then computed using a random forest classifier. The most predictive features for transitions in hypertension control status included hypertension assessment patterns, comorbid diagnoses, procedures and medication history. The final random forest model achieved a c-statistic of 0.836 (95% CI 0.830 to 0.842) and an accuracy of 0.773 (95% CI 0.766 to 0.780). This study achieved accurate prediction of transition points of hypertension control status, an important first step in the long-term goal of developing personalized hypertension management plans.

  17. Effects of unstable shoes on chronic low back pain in health professionals: a randomized controlled trial.

    Science.gov (United States)

    Armand, Stéphane; Tavcar, Ziva; Turcot, Katia; Allet, Lara; Hoffmeyer, Pierre; Genevay, Stéphane

    2014-12-01

    The aim of this study was to evaluate the effectiveness of unstable shoes in reducing low back pain in health professionals. Of a volunteer sample of 144 participants, 40 with nonspecific chronic low back pain were eligible and enrolled in this study. Participants were randomized to an intervention group, who wore unstable shoes (model MBT Fora), or a control group, who wore conventional sports shoes (model Adidas Bigroar). The participants had to wear the study shoes during their work hours, and at least 6 hours per workday, over a period of 6 weeks. The primary outcome was low back pain assessed on a Visual Analog Scale. The secondary outcomes were patient satisfaction, disability evaluated using Roland-Morris questionnaire and quality of life evaluated using EQ-VAS. The intervention group showed a significant decrease in pain scores compared to the control group. The rate of satisfaction was higher in the intervention group (79%) compared to the control group (25%). There was no significant difference for the Roland-Morris disability questionnaire score and the EQ-VAS scale. The results of this clinical trial suggest that wearing unstable shoes for 6 weeks significantly decreases low back pain in patients suffering from chronic low back pain but had no significant effect on quality of life and disability scores. Copyright © 2014 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.

  18. Determinants of Health Information Use for Self-Efficacy in Lifestyle Modification for Chronic Disease Patients

    Directory of Open Access Journals (Sweden)

    Ebele N. Anyaoku

    2016-04-01

    Full Text Available Objectives – Various efforts are being made to disseminate lifestyle modification information. What is the role of health information in building patients self-efficacy in lifestyle modification? The research examined level of access to lifestyle modification information for patients with chronic diseases in two Federal Government Teaching Hospitals in South East Nigeria. It explored the relationship between self-efficacy and access to lifestyle modification information and also factors that are associated with self-efficacy when patients have access to lifestyle modification information. Methods – The research is a cross-sectional correlation study that used a questionnaire to collect data. (See Appendix A. Sample was 784 patients with chronic diseases. Questionnaires were distributed to the patients as they attended clinics in the medical and surgical outpatients’ clinics of the hospitals. Results – Findings showed access to lifestyle modification information was significantly and positively correlated with self-efficacy. Multiple Regression analysis suggest that age, type of illness, and length of treatment in the teaching hospitals were associated with self-efficacy when patients have access to lifestyle modification information. Conclusion – It will be pertinent that demographic and disease factors are considered when making lifestyle modification information available to patients for greater self-efficacy.

  19. Strategic approaches to enhanced health service delivery for Aboriginal and Torres Strait Islander people with chronic illness: a qualitative study

    Directory of Open Access Journals (Sweden)

    Aspin Clive

    2012-06-01

    Full Text Available Abstract Background Aboriginal and Torres Strait Islander people with chronic illness confront multiple challenges that contribute to their poor health outcomes, and to the health disparities that exist in Australian society. This study aimed to identify barriers and facilitators to care and support for Aboriginal and Torres Strait Islander people with chronic illness. Methods Face-to-face in-depth interviews were conducted with Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease (n-16 and family carers (n = 3. Interviews were transcribed verbatim and the transcripts were analysed using content analysis. Recurrent themes were identified and these were used to inform the key findings of the study. Results Participants reported both negative and positive influences that affected their health and well-being. Among the negative influences, they identified poor access to culturally appropriate health services, dislocation from cultural support systems, exposure to racism, poor communication with health care professionals and economic hardship. As a counter to these, participants pointed to cultural and traditional knowledge as well as insights from their own experiences. Participants said that while they often felt overwhelmed and confused by the burden of chronic illness, they drew strength from being part of an Aboriginal community, having regular and ongoing access to primary health care, and being well-connected to a supportive family network. Within this context, elders played an important role in increasing people’s awareness of the impact of chronic illness on people and communities. Conclusions Our study indicated that non-Indigenous health services struggled to meet the needs of Aboriginal and Torres Strait Islander people with chronic illness. To address their complex needs, health services could gain considerably by recognising that Aboriginal and Torres Strait

  20. Continuity of care for children with complex chronic health conditions: parents' perspectives

    Directory of Open Access Journals (Sweden)

    Shaw Nicola

    2009-12-01

    Full Text Available Abstract Background Continuity of care has been explored largely from academic and service provider perspectives, and in relation to adult patient/client groups. We interviewed parents of children with complex chronic health conditions to examine how their experiences and perceptions of continuity of care fit with these perspectives; and to identify the salient factors in the experience of, and factors contributing to, continuity in this population. Methods Parents of 47 elementary school-aged children with spina bifida, Down syndrome, attention-deficit/hyperactivity disorder, Duchenne muscular dystrophy or cystic fibrosis participated in semi-structured interviews. Parents described and mapped the pattern of their interactions with service providers over time in all domains relevant to their child's health, well-being, and development (medical, rehabilitational, educational, and social supportive services, with particular attention paid to their perceptions of connectedness or coherency in these interactions. Verbatim transcripts were analyzed thematically using a framework approach to impose structure regarding parents' perspectives on continuity of care. Results Existing academic concepts of relational, informational and management continuity were all discernable in parents' narratives. A thorough knowledge of the child on the part of service providers emerged as extremely important to parents; such knowledge was underpinned by continuity of personal relationships, principally, and also by written information. For this population, notions of continuity extend to the full range of service providers these children and families need to achieve optimal health status, and are not limited to physicians and nurses. Communication among providers was seen as integral to perceived continuity. Compartmentalization of services and information led to parents assuming a necessary, though at times, uncomfortable, coordinating role. Geographic factors

  1. Health Coaching and Chronic Obstructive Pulmonary Disease Rehospitalization. A Randomized Study.

    Science.gov (United States)

    Benzo, Roberto; Vickers, Kristin; Novotny, Paul J; Tucker, Sharon; Hoult, Johanna; Neuenfeldt, Pamela; Connett, John; Lorig, Kate; McEvoy, Charlene

    2016-09-15

    Hospital readmission for chronic obstructive pulmonary disease (COPD) has attracted attention owing to the burden to patients and the health care system. There is a knowledge gap on approaches to reducing COPD readmissions. To determine the effect of comprehensive health coaching on the rate of COPD readmissions. A total of 215 patients hospitalized for a COPD exacerbation were randomized at hospital discharge to receive either (1) motivational interviewing-based health coaching plus a written action plan for exacerbations (the use of antibiotics and oral steroids) and brief exercise advice or (2) usual care. We evaluated the rate of COPD-related hospitalizations during 1 year of follow-up. The absolute risk reductions of COPD-related rehospitalization in the health coaching group were 7.5% (P = 0.01), 11.0% (P = 0.02), 11.6% (P = 0.03), 11.4% (P = 0.05), and 5.4% (P = 0.24) at 1, 3, 6, 9, and 12 months, respectively, compared with the control group. The odds ratios for COPD hospitalization in the intervention arm compared with the control arm were 0.09 (95% confidence interval [CI], 0.01-0.77) at 1 month postdischarge, 0.37 (95% CI, 0.15-0.91) at 3 months postdischarge, 0.43 (95% CI, 0.20-0.94) at 6 months postdischarge, and 0.60 (95% CI, 0.30-1.20) at 1 year postdischarge. The missing value rate for the primary outcome was 0.4% (one patient). Disease-specific quality of life improved significantly in the health coaching group compared with the control group at 6 and 12 months, based on the Chronic Respiratory Disease Questionnaire emotional score (emotion and mastery domains) and physical score (dyspnea and fatigue domains) (P coaching may represent a feasible and possibly effective intervention designed to reduce COPD readmissions. Clinical trial registered with www.clinicaltrials.gov (NCT01058486).

  2. Predictors of Frequent Emergency Room Visits among a Homeless Population.

    Science.gov (United States)

    Thakarar, Kinna; Morgan, Jake R; Gaeta, Jessie M; Hohl, Carole; Drainoni, Mari-Lynn

    2015-01-01

    Homelessness, HIV, and substance use are interwoven problems. Furthermore, homeless individuals are frequent users of emergency services. The main purpose of this study was to identify risk factors for frequent emergency room (ER) visits and to examine the effects of housing status and HIV serostatus on ER utilization. The second purpose was to identify risk factors for frequent ER visits in patients with a history of illicit drug use. A retrospective analysis was performed on 412 patients enrolled in a Boston-based health care for the homeless program (HCH). This study population was selected as a 2:1 HIV seronegative versus HIV seropositive match based on age, sex, and housing status. A subgroup analysis was performed on 287 patients with history of illicit drug use. Chart data were analyzed to compare demographics, health characteristics, and health service utilization. Results were stratified by housing status. Logistic models using generalized estimating equations were used to predict frequent ER visits. In homeless patients, hepatitis C was the only predictor of frequent ER visits (OR 4.49, phomeless patients. HIV seropositivity did not predict frequent ER visits, likely because HIV seropositive HCH patients are engaged in care. In patients with history of illicit drug use, hepatitis C and mental health disorders predicted frequent ER visits. Supportive housing for patients with mental health disorders and hepatitis C may help prevent unnecessary ER visits in this population.

  3. Frequently Asked Questions about Measles in the U.S.

    Science.gov (United States)

    ... Pan American Health Organization Frequently Asked Questions about Measles in the U.S. Language: English (US) Español (Spanish) ... I’ve been exposed to someone who has measles. What should I do? A: Immediately call your ...

  4. Public health service options for affordable and accessible noncommunicable disease and related chronic disease prevention and management

    Directory of Open Access Journals (Sweden)

    Brownie S

    2014-11-01

    Full Text Available Sharon Brownie,1,2 Andrew P Hills,3,4 Rachel Rossiter51Workforce and Health Services, Griffith Health, Griffith University, Gold Coast, QLD, Australia; 2Oxford PRAXIS Forum, Green Templeton College, Oxford University, Oxford, United Kingdom; 3Allied Health Research, Mater Research Institute – The University of Queensland and Mater Mothers' Hospital, South Brisbane, QLD, Australia; 4Griffith Health Institute, Griffith Health, Griffith University, Gold Coast, QLD, Australia; 5MMHN and Nurse Practitioner Programs, School of Nursing and Midwifery, University of Newcastle, Callaghan, NSW, AustraliaAbstract: Globally, nations are confronted with the challenge of providing affordable health services to populations with increasing levels of noncommunicable and chronic disease. Paradoxically, many nations can both celebrate increases in life expectancy and bemoan parallel increases in chronic disease prevalence. Simply put, despite living longer, not all of that time is spent in good health. Combined with factors such as rising levels of obesity and related noncommunicable disease, the demand for health services is requiring nations to consider new models of affordable health care. Given the level of disease burden, all staff, not just doctors, need to be part of the solution and encouraged to innovate and deliver better and more affordable health care, particularly preventative primary health care services. This paper draws attention to a range of exemplars to encourage and stimulate readers to think beyond traditional models of primary health service delivery. Examples include nurse-led, allied health-led, and student-led clinics; student-assisted services; and community empowerment models. These are reported for the interest of policy makers and health service managers involved in preventative and primary health service redesign initiatives.Keywords: primary health care planning, community health care, nurse-led clinics, allied health personnel

  5. Clinical drug development using dynamic biomarkers to enable personalized health care in Chronic Obstructive Pulmonary Disease

    DEFF Research Database (Denmark)

    Bihlet, Asger R; Karsdal, Morten A; Bay-Jensen, Anne-Christine

    2015-01-01

    Despite massive investments in development of novel treatments for heterogeneous diseases such as Chronic Obstructive Pulmonary Disease (COPD), the resources spent have only benefitted a fraction of the population treated. Personalized Health Care to guide selection of a suitable patient population...... at higher risk of progression. We review the role of extra-cellular matrix proteins found to be upregulated in COPD. Novel biomarkers of connective tissue remodeling which may provide added value for a personalized approach by detecting subgroups of patients with active disease suitable for pharmacological...... already in the clinical development of new compounds could offer a solution. In this review, we discuss past successes and failures in drug development and biomarker research in COPD. We describe research in COPD phenotypes, and the required characteristics of a suitable biomarker for identifying patients...

  6. The Coconstruction of Couples' Roles in Parenting Children With a Chronic Health Condition.

    Science.gov (United States)

    McNeill, Ted; Nicholas, David; Beaton, John; Montgomery, Gert; MacCulloch, Radha; Gearing, Robin; Selkirk, Enid

    2014-08-01

    In this study we explored the ways that mothers and fathers of children who have a chronic health condition coconstructed their parenting roles. We wanted to move beyond the standard focus on individual parenting behaviors and use a grounded theory approach to better capture the dyadic and interpersonal gestalt of how parents worked out their roles. We explored multiple factors that influenced their decision making and the unique models that each couple developed. We held conjoint qualitative interviews with 20 couples from the Toronto area, as well as follow-up interviews with individual partners in five of these couples. Our findings introduce several concepts (such as role negotiation, complementarity and symmetry of roles, and "good enough" role performance) that form an explanatory model. A key finding is the diversity of ways in which couples adapted to the parenting challenges they faced. Implications in conceptual, clinical, and research areas are presented. © The Author(s) 2014.

  7. The health status of grandchildren of subjects occupationally exposed to chronic radiation. Communication 2. Morphofunctional parameters

    International Nuclear Information System (INIS)

    Petrushkina, N.P.; Musatkova, O.B.

    1996-01-01

    The study was aimed at investigation of the parameters of physical development and specific features in the development of psychomotor habits and peripheral blood parameters in children aged 0 to 7 grandchildren of exposed individuals. A dynamic follow-up of physical and psychomotor development, as well as regular check-ups of peripheral blood were carried out in 877 grandchildren of test subjects occupationally exposed to chronic radiation before conception. Multifactorial analysis did not show a correlation between the deviations in the physical development of children in the studied cohort and exposure of their grandparents and/or parents. Factors other than radiation (poor health status of mother, gestosis) did influence the studied parameters. The mean levels of hemoglobin, red cells, platelets, and leukocytes in the test group were virtually the same as in controls and coincided with published data [ru

  8. A Chronic Disease Management Student-Faculty Collaborative Practice: Educating Students on Innovation in Health Care Delivery.

    Science.gov (United States)

    Remus, Kristin E; Honigberg, Michael; Tummalapalli, Sri Lekha; Cohen, Laura P; Fazio, Sara; Weinstein, Amy R

    2016-07-01

    In the current transformative health care landscape, it is imperative that clinician educators inspire future clinicians to practice primary care in a dynamic environment. A focus on patient-centered, goal-oriented care for patients with chronic conditions is critical. In 2009, Harvard Medical School founded the Crimson Care Collaborative, a student-faculty collaborative practice (SFCP) network. With the aim of expanding clinical and educational opportunities for medical students and improving patient control of chronic disease (i.e., hypertension, obesity, and diabetes) in an innovative learning environment, in 2012, the authors developed a novel SFCP at their hospital-based academic primary care practice. In this SFCP, students learn to explore patient priorities, provide focused counseling and education, and assist patients with self-management goals during clinical visits. From 2012 to 2014, 250 student volunteers participated in the SFCP as clinicians, innovators, educators, and leaders, with between 80 and 95 medical students engaging each semester. Between January 2012 and March 2014, there were 476 urgent care or chronic disease management visits. Patients with chronic diseases were seen at least twice on average, and by 2014, chronic disease management visits accounted for approximately 74% of visits. Work is under way to create assessment tools to evaluate the practice's educa tional impact and student understanding of the current health care system, develop interdisciplinary care teams, expand efforts in registry management and broaden the patient recruitment scope, further emphasize patient engage ment and retention, and evaluate chronic disease management and patient satisfaction effectiveness.

  9. The impact of a proactive chronic care management program on hospital admission rates in a German health insurance society.

    Science.gov (United States)

    Hamar, Brent; Wells, Aaron; Gandy, William; Haaf, Andreas; Coberley, Carter; Pope, James E; Rula, Elizabeth Y

    2010-12-01

    Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with coronary artery disease, heart failure, diabetes, or chronic obstructive pulmonary disease who consented to participate in the chronic care management program. Intervention (n  = 17,319) and Comparison (n  = 5668) groups were defined based on records of participating (or not participating) in telephonic interactions. Changes in admission rates were calculated from the year prior to (Base) and year after program commencement. Comparative analyses were adjusted for age, sex, region of residence, and disease severity (stratification of 3 [least severe] to 1 [most severe]). Overall, the admission rate in the Intervention group decreased by 6.2% compared with a 14.9% increase in the Comparison group (P  management care calls can help reduce hospital admissions among German health insurance members with chronic disease.

  10. Physical activity, health status and risk of hospitalization in patients with severe chronic obstructive pulmonary disease.

    Science.gov (United States)

    Benzo, Roberto P; Chang, Chung-Chou H; Farrell, Max H; Kaplan, Robert; Ries, Andrew; Martinez, Fernando J; Wise, Robert; Make, Barry; Sciurba, Frank

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) is a leading cause of death and 70% of the cost of COPD is due to hospitalizations. Self-reported daily physical activity and health status have been reported as predictors of a hospitalization in COPD but are not routinely assessed. We tested the hypothesis that self-reported daily physical activity and health status assessed by a simple question were predictors of a hospitalization in a well-characterized cohort of patients with severe emphysema. Investigators gathered daily physical activity and health status data assessed by a simple question in 597 patients with severe emphysema and tested the association of those patient-reported outcomes to the occurrence of a hospitalization in the following year. Multiple logistic regression analyses were used to determine predictors of hospitalization during the first 12 months after randomization. The two variables tested in the hypothesis were significant predictors of a hospitalization after adjusting for all univariable significant predictors: >2 h of physical activity per week had a protective effect [odds ratio (OR) 0.60; 95% confidence interval (95% CI) 0.41-0.88] and self-reported health status as fair or poor had a deleterious effect (OR 1.57; 95% CI 1.10-2.23). In addition, two other variables became significant in the multivariate model: total lung capacity (every 10% increase) had a protective effect (OR 0.88; 95% CI 0.78-0.99) and self-reported anxiety had a deleterious effect (OR 1.75; 95% CI 1.13-2.70). Self-reported daily physical activity and health status are independently associated with COPD hospitalizations. Our findings, assessed by simple questions, suggest the value of patient-reported outcomes in developing risk assessment tools that are easy to use.

  11. Chronic arsenic poisoning in drinking water in Inner Mongolia and its associated health effects.

    Science.gov (United States)

    Guo, Juan X; Hu, Lin; Yand, Peng Z; Tanabe, Kimiko; Miyatalre, Munetoshi; Chen, Yao

    2007-10-01

    Since 1990, a large number of people have been experiencing various health problems from drinking arsenic contaminated water (50-1860 microg/L) in 13 counties of Inner Mongolia, China, most of which are located in the Hetao Plain area. It is calculated that 411,243 people are currently at risk from arsenic poisoning. Clinical and epidemiological investigations were carried out on 13,021 people to ascertain the nature and degree of morbidity that occurred due to chronic arsenic toxicity. In all of the studied patients, 22% had typical hyperkeratosis on the palms or soles and some had raindrop-like hyperpigmentation and depigmentation on the trunk. Other data recorded included subjective and objective symptoms, such as chronic cough (35.0%) and insomnia (37.5%). During physical checkups of 680 villagers in arsenic affected areas, liver function tests showed elevated globulin levels in 6.8% (P value=0.006) of the subjects. Neurotoxicity manifesting as loss of hearing 5.88 (P value=0.005), loss of taste 5.44% (P value=0.001), blurred vision 17.35% (P value=0.000), tingling and numbness of the limbs 33.53% (P value=0.000) and hypertension 8.09% (P value=0.000) were significantly higher in the arsenic affected villages and arsenic pollution also seemed to affect patients' social life and mental health. To solve the problem of arsenic exposure, the quality of drinking water needs to be improved by reducing the arsenic content. We also plan to carry out a survey to detect the incidence and types of cancer among this population.

  12. Health related vulnerability due to chronic diseases: Impact on clinical services across emergency shelters in mass disasters

    Science.gov (United States)

    Koleva, Yordanka Nikolova

    Chronic diseases are increasingly recognized as major contributors to the global burden of disease. Individuals with chronic disease are particularly vulnerable during mass emergencies as they may suffer an interruption in their therapeutic programs, leading to life-threatening conditions and complications. Based on the individual and community risk factors framework, three categories are defined as the most vulnerable to extreme natural events: physically, psychologically, and socially vulnerable. Complex emergencies that occurred in the recent decade have provided evidence that these groups suffer more pronounced effects than others. Individuals seeking community support during emergencies have been predominantly medically dependent, elderly, children, people with chronic health conditions, and lower socioeconomic status. The purpose of this study was to investigate the effect of health-related vulnerability on shelter operations, and to estimate the burden of chronic disease on community resources following catastrophic events. A comprehensive survey data collection conducted by the United States Public Health Service in 2005 was used to evaluate clinical services for populations with health conditions accommodated by Louisiana temporary disaster shelters. Correlation and multiple regression analyses determined the relationship between shelter characteristics and the factors predicting shelters' needs for short-term assistance. Significant predictors were identified in all three explored domains: structural shelter characteristics (sponsor, interpreter needed); clinical characteristics (access to health providers, clinic on site, staff had no days off); population characteristics (census, compromised mental health alone, or in combination with chronic conditions and diseases with epidemic potential). Shelters sponsored by faith-based organizations were less likely to be in risk of rapid resource depletion. Shelters with large census demonstrated association with

  13. Feasibility study of geospatial mapping of chronic disease risk to inform public health commissioning.

    Science.gov (United States)

    Noble, Douglas; Smith, Dianna; Mathur, Rohini; Robson, John; Greenhalgh, Trisha

    2012-01-01

    To explore the feasibility of producing small-area geospatial maps of chronic disease risk for use by clinical commissioning groups and public health teams. Cross-sectional geospatial analysis using routinely collected general practitioner electronic record data. Tower Hamlets, an inner-city district of London, UK, characterised by high socioeconomic and ethnic diversity and high prevalence of non-communicable diseases. The authors used type 2 diabetes as an example. The data set was drawn from electronic general practice records on all non-diabetic individuals aged 25-79 years in the district (n=163 275). The authors used a validated instrument, QDScore, to calculate 10-year risk of developing type 2 diabetes. Using specialist mapping software (ArcGIS), the authors produced visualisations of how these data varied by lower and middle super output area across the district. The authors enhanced these maps with information on examples of locality-based social determinants of health (population density, fast food outlets and green spaces). Data were piloted as three types of geospatial map (basic, heat and ring). The authors noted practical, technical and information governance challenges involved in producing the maps. Usable data were obtained on 96.2% of all records. One in 11 adults in our cohort was at 'high risk' of developing type 2 diabetes with a 20% or more 10-year risk. Small-area geospatial mapping illustrated 'hot spots' where up to 17.3% of all adults were at high risk of developing type 2 diabetes. Ring maps allowed visualisation of high risk for type 2 diabetes by locality alongside putative social determinants in the same locality. The task of downloading, cleaning and mapping data from electronic general practice records posed some technical challenges, and judgement was required to group data at an appropriate geographical level. Information governance issues were time consuming and required local and national consultation and agreement. Producing

  14. Physiotherapy students' perspectives of online e-learning for interdisciplinary management of chronic health conditions: a qualitative study.

    Science.gov (United States)

    Gardner, Peter; Slater, Helen; Jordan, Joanne E; Fary, Robyn E; Chua, Jason; Briggs, Andrew M

    2016-02-16

    To qualitatively explore physiotherapy students' perceptions of online e-learning for chronic disease management using a previously developed, innovative and interactive, evidence-based, e-learning package: Rheumatoid Arthritis for Physiotherapists e-Learning (RAP-eL). Physiotherapy students participated in three focus groups in Perth, Western Australia. Purposive sampling was employed to ensure maximum heterogeneity across age, gender and educational background. To explore students' perspectives on the advantages and disadvantages of online e-learning, ways to enhance e-learning, and information/learning gaps in relation to interdisciplinary management of chronic health conditions, a semi-structured interview schedule was developed. Verbatim transcripts were analysed using inductive methods within a grounded theory approach to derive key themes. Twenty-three students (78 % female; 39 % with previous tertiary qualification) of mean (SD) age 23 (3.6) years participated. Students expressed a preference for a combination of both online e-learning and lecture-style learning formats for chronic disease management, citing flexibility to work at one's own pace and time, and access to comprehensive information as advantages of e-learning learning. Personal interaction and ability to clarify information immediately were considered advantages of lecture-style formats. Perceived knowledge gaps included practical application of interdisciplinary approaches to chronic disease management and developing and implementing physiotherapy management plans for people with chronic health conditions. Physiotherapy students preferred multi-modal and blended formats for learning about chronic disease management. This study highlights the need for further development of practically-oriented knowledge and skills related to interdisciplinary care for people with chronic conditions among physiotherapy students. While RAP-eL focuses on rheumatoid arthritis, the principles of learning apply to

  15. Mental