Journal of chronic diseases最新文献

As soon as the first clinico-epidemiology reports appeared describing an association of herpes virus infection with genital cancer, relevant questions were introduced into an ongoing follow-up of a cohort already being studied for psychosocial risk factors in cancer. The study, which was initiated in 1966, comprised 1353 persons; disease incidence was determined in 1976.

Incidences of cancer (including extragenital cancer) were found to be directly related to the reported prevalence of genital herpes symptoms, but were related inversely to extragenital herpes prevalence and to previous fever episodes. With regard to the relatively common incidence of “fever blisters”, i.e. facial herpes, attributed to HSV-type 1, the latter finding is less surprising than the strong association of HSV type 2 lesions with overall cancer incidence. This association was particularly noticeable in individuals who had not reported episodes of fever earlier. These findings indicate the predictive role of certain host factors which are possibly related to systematic responses of the organism, including a diminished protection against (latent) herpes genitalis infection (recurrences). Further prospective studies are needed to investigate the proper time-relationship between clinically-overt herpes genitalis and the manifestation of cancer and its possible role in provoking the recurrent eruption of latent infections.

Surgery asks patients to trade present discomfort and risk for future gains. Although research reports on the effectiveness of surgery have largely focused on mortality, length of hospital stay, major complications, and laboratory analyses, the principal criteria guiding surgeons' clinical decisions and patients' acceptance of treatment are most often the patients' subjective feelings and capabilities, the quality of their lives. This is true for both major and minor surgical procedures. We discuss the role of information on functional capacity, overall well-being, and quality of life in the assessment of surgical outcomes. Broadening the choice of endpoints beyond traditional, so-called “hard” variables in surgical studies has advantages for both surgeons and patients.

Diabetes mellitus is a multifaceted disease which intervenes in the personal lives of those afflicted in many different ways. In this study prescription drug use among diabetics was analyzed in order to shed light on the characteristics of diabetic morbidity. Prescription drug use among diabetics and non-diabetics in a total population of 21,000 inhabitants in a defined geographic area were studied. The diabetic population was categorized according to the type of treatment received: insulin treatment, oral anti-diabetic treatment or dietary treatment only. The pattern of prescription drug use differed between diabetics and non-diabetics and important differences were observed also between diabetics according to type of treatment. Drug use among those treated with insulin and those treated orally was substantially higher than among non-diabetics while the difference between diabetics on dietary regimen and non-diabetics was much smaller. All three treatment groups had considerably higher consumption of cardiovascular drugs than non-diabetics. Additional findings include more frequent antibiotic use among diabetics treated orally and on diet only than among non-diabetics. The use of these drugs was also common among insulin treated diabetics but did not differ significantly from among non-diabetics. Use of psychotropics was more common among diabetics treated with insulin and orally than among non-diabetics.

This study describes and compares the perceived sickness-related behavioral dysfunction of 859 end-stage renal disease (ESRD) patients from 11 centers according to treatment modality via the Sickness Impact Profile (SIP). The unadjusted functional status of ESRD patients differed significantly by treatment modality. Transplantation patients were least functionally limited followed in order by home dialysis, continuous peritoneal dialysis, and in-center dialysis patients. The largest overall differences were for the sleep and rest, work, recreation and pastimes, and home management SIP categories. Regression analysis revealed that many of the large observed intermodality differences in functional status may have resulted from casemix variations (e.g. age and comorbidity differences). Only SIP score differences between transplantation and other treatment modality patients remained significant following the introduction of casemix controls. Results do not justify choosing one dialysis modality over another because of differences in perceived dysfunction.

In gauging the achievements of surgical treatment it is important to try to measure the quality of functional result vouchsafed to the patient and his capacity for work and recreation. Because the impairments of function that may occur after different operations very considerably, an operation-specific assessment for each type of procedure is essential.

To assess the impact of medical care on children we have developed a conceptual model based on both theoretical considerations and empirical research. Child health is viewed as the ability to participate fully in developmentally appropriate activities and requires physical, psychological, and social energy. The medical system influences health through interventions addressing these domains.

Many methodologie issues are unique to the measurement of medical care processes and outcomes for children. Problems in measuring the process of medical interviews include developing systems that capture the dynamics of interactions, assess the cognitive appropriateness and metaphorical interpretation of language, and reflect the emotional impact of certain incidents. Issues that confound measurement of children's views include position bias, acquiescence response bias, and limited understanding of negatively worded items. Further, the concordance between parent and children reports or health constructs varies widely, which suggests the need to include children's reports to obtain a comprehensive view of their health.

The COOP Project, a primary care research network, has begun development of a Chart method to screen function quickly. The COOP Charts, analogous to Snellen Charts, were pretested in two practices on adult patients (N = 117) to test feasibility, clinical utility, and validity. Patients completed questionnaires containing validated health status scales and sociodemographic variables. Practice staff filled out forms indicating COOP Chart scores and clinical data. We held debriefing interviews with staff who administered the Charts, The results indicate the Charts take 1–2 minutes to administer, are easy to use, and produce important clinical data. The patterns of correlations between the Charts and validity indicator variables provide evidence for both convergent and discriminant validity. We conclude that new measures are needed to assess function in a busy office practice and that the COOP Chart system represents one promising strategy.

The relationship of behavioral factors and resting blood pressure was assessed in a random sample of 192 young middle class black adults. Framingham Type A behavior was positively associated with diastolic blood pressure (r = 0.17, p < 0.05) among the women. Also, anger-in and trait anxiety were positively correlated with diastolic blood pressure for the women, r = 0.20, p < 0.05 and r = + 0.28 and p < 0.01, respectively. After control for body mass index, trait anxiety and anger-in remained independent predictors of diastolic blood pressure among the women. For men, marijuana use was positively associated with blood pressure. Marijuana use was an independent predictor for systolic blood pressure after adjusting for body mass index among the males. The present study demonstrated a sex difference related to behavioral factors and blood pressure in young middle class blacks.