Chronic Illness最新文献

Objective: To examine the association between food insecurity and achieving glycemic goals among Medicare beneficiaries with type 2 diabetes.

Methods: This study analyzed the nationally representative 2019 Medicare Current Beneficiary Survey of 1340 beneficiaries aged ≥65 years with type 2 diabetes. The binary dependent variable was whether beneficiaries' blood glucose was at target (A1C ≤ 7.5% or average fasting blood glucose of ≤140 mg/dL, all/most of the time). Food insecurity, a binary variable, was adapted based on the USDA's food security questions. A survey-weighted multivariable logistic model, adjusted for sociodemographics and comorbidities, was conducted to estimate predictive margins for comparing prevalence of having above-target blood glucose levels across groups.

Results: Of study beneficiaries, 20.9% reported not achieving glycemic targets. The predictive marginal prevalence of having higher than target blood glucose levels was significantly greater in females over males (23.8% [95% confidence interval [CI], 20.1-27.4] vs 17.6% [14.3-20.9]); those with less than high school education over those with college education (31.0% [23.6-38.3] vs 18.6% [14.8-22.3]); and those reporting food insecurity over their counterparts (33.4% [24.5-42.3] vs 19.1% [16.6-21.7]).

Conclusions: Sociodemographic disparities related to achieving blood glucose goals were observed. Screening for food insecurity and related interventions should be considered for at-risk beneficiaries with diabetes.

Objectives: To review the effect of telemedicine interventions on cardiovascular risk factors control in people with arterial hypertension (AH), type 2 diabetes (T2D), or both in primary care.

Methods: We conducted a systematic review in February 2024 using PubMed/MEDLINE, Cochrane Library, and EMBASE databases. We included randomised controlled trials from 2010 onwards, lasting ≥3 months, comparing telemedicine to standard care for managing cardiovascular risk factors in adults with AH, T2D, or both.

Results: Among 1803 records, 54 were included. Telemonitoring with teleconsultations showed the best outcomes. For AH, systolic blood pressure decreased by -5.63 mmHg (95% CI -9.13 to -2.13) at 6 months and -5.59 mmHg (95% CI -10.03 to -1.14) at 12 months compared to standard care. For T2D, HbA1c decreased by -0.45% (95% CI -0.90 to 0.00) at 6 months and -0.18% (95% CI -0.41 to 0.05) at 12 months compared to standard care. Blood glucose self-monitoring was as effective as telemonitoring for T2D at 6 months. The effect on diastolic blood pressure, low-density lipoprotein, triglycerides, and body mass index was non-significant.

Discussion: Telemedicine offers short-term benefits but lacks long-term effectiveness. Optimal outcomes require a combined telemedicine approach, health education co-intervention, ≥12-month follow-up, and careful patient selection.

Objective: Cancer survivors have unique healthcare needs. An important consideration for survivorship is chronic diseases and health risk factors. The purpose of this study is to describe demographics, risk factors, and comorbid health conditions in adult cancer survivors.

Method: We analyzed 2019 Arizona Behavioral Risk Factor Surveillance System data to compare cancer survivors to non-cancer survivors (aged 18 or older) to assess differences between the two populations. Adjusted and unadjusted population-based estimates and 95% confidence intervals were calculated, and multivariable logistic regression models were performed.

Results: Eight thousand nine-hundred and twenty (8920) respondents (1007 survivors; 7913 non-cancer survivors) were included. Compared to non-cancer survivors, cancer survivors were more likely to be female, 65 years and older, non-Hispanic white, veterans, and less likely to be employed. Survivors had higher rates of coronary heart disease, stroke, chronic obstructive pulmonary disease, kidney disease, hypertension, arthritis, multiple chronic conditions, being overweight, and being a former smoker. Survivors were more likely to report fair/poor health than non-cancer survivors.

Discussion: These findings can be used by healthcare and public health practitioners to evaluate the programmatic efforts and resources, implement targeted interventions toward cancer survivors, and improve health and quality of life.

Chronic kidney disease (CKD) is described as a global health crisis. Hemodialysis (HD) is a treatment that helps CKD patients prolong their lives. However, not all patients accept HD. To date, there is limited understanding of the factors for this resistance, especially in developing countries. This Phenomenological study employed individual telephone interviews with 35 CKD patients. The interview questions were related to the refusal factors of HD. Thematic analysis revealed six themes-concerns about becoming a burden to others, cost, age considerations, advice from others, fear regarding HD treatment, and self-healing plans. This study is vital to support medical social workers in strategizing early interventions to improve hemodialysis acceptance among CKD patients. The ability of medical social workers to understand these factors and tailor appropriate interventions will help improve the treatment acceptance and outcomes.

Objectives: Severe chronic obstructive pulmonary disease affects and changes the lives of both affected persons and next of kin. There is a need for support and a sense of coherence to manage the life situation and minimize the symptom and caregiver burden. The aim of this study was to diverge or converge views of symptom burden, caregiver burden, the need for support, and sense of coherence in persons with chronic obstructive pulmonary disease and their next of kin to gain a deeper and broader knowledge and understanding.

Methods: A mixed methods study with data from interviews and four validated questionnaires from persons affected by chronic obstructive pulmonary disease in GOLD stages III and IV and their next of kin.

Results: Questionnaires from 112 persons affected by chronic obstructive pulmonary disease, and 71 next of kin, together with 25 and 21 interviews, show that; there is a difference between estimated symptoms and caregiver burden and experiences expressed in their own words. There is also a defect regarding meaningfulness, comprehensibility, and manageability affecting daily life. Symptoms and caregiver burden, together with the sense of coherence, strengthen the need for support.

Discussion: The complexity of the life situation leads to a need for supportive interventions to strengthen internal and external resources.

Objectives: We intended to assess changes in pain-related outcomes among rural adults who completed 6-week self-management programs offered remotely during the COVID-19 pandemic.

Methods: We offered the Chronic Pain Self-Management Program and Chronic Disease Self-Management Program between May 2020 and December 2021. Delivery mode options included 2½-hour weekly videoconference, mailed toolkit plus 1-hour weekly conference call, and mailed toolkit alone. We conducted pre- and post-workshop surveys including questions on patient activation, self-efficacy, depression and pain disability. We used paired t-tests to compare pre-post differences in outcomes among participants completing 4 or more sessions.

Results: Among 218 adults reporting chronic pain, mean age was 57; 83.6% were female; and 49.5% participated via videoconference, 23.4% by phone and 27.1% via mailed toolkit alone. Completion rates were higher among phone (88.2%) versus videoconference (60.2%) workshop participants. Among completers, patient activation (mean change  =  3.61, p  =  0.01) and self-efficacy (mean change  =  3.72, p < 0.0001) increased while depression scores (mean change  =  -1.03, p  =  0.01), pain disability (mean change  =  -0.93, p  =  0.003) and pain symptoms (mean change  =  -0.61, p  =  0.001) decreased over the 6-week period.

Discussion: Self-management programs offered remotely during the pandemic were successful in improving patient activation, self-efficacy, depression, pain disability, and pain symptoms among rural adults experiencing chronic pain.

Objectives: To assess characteristics of hospitalized adolescents facing chronic diseases, correlating the perceptions of their illness, quality of life and the prevalence of risk behaviors, considering gender and the diseases' durations.

Methods: The sample consisted of 61 adolescents, aged between 10 and 19 years, with chronic diseases, hospitalized at the University Hospital of the State University of Londrina. They answered a questionnaire and the scales World Health Organization Quality of Life (WHOQOL-BREF) and Illness Perception Questionnaire (IPQ). They were divided in groups, according to the durations of the disease: group 1 (up to 4 years) and group 2 (5 years or more).

Results: Group 2 demonstrated higher leisure activity (p = 0.02) and more painful symptoms (p = 0.02). In WHOQOL-BREF, group 2 had a higher quality of life in the domain on environment (p = 0.02) and a higher total score (p = 0.04). Lower scores on the IPQ were associated with higher scores on the WHOQOL-BREF. Positive correlation was found between WHOQOL-BREF total score and years of disease, in which male presented higher scores.

Conclusions: These findings may alert to the need for more knowledge about the diseases and the importance of encouraging ways to improve quality of life and care to reduce risky behaviors.

Objectives: This service evaluation explored the experiences of families receiving care in a paediatric chronic fatigue service. The evaluation aimed to improve service provision across paediatric chronic fatigue services more widely.

Methods: Children and young people aged 7-18 years (n  =  25) and parents/carers (n  =  25) completed a postal survey exploring experiences of a paediatric chronic fatigue service. Quantitative data were analysed descriptively, and qualitative data were analysed using thematic analysis.

Results: Most service usersand parents/carers (88%) agreed that the service met their needs, that they felt supported by staff, and most notably, a large portion (74%) reported the team increased their activity levels. A small number disagreed (7%) with statements relating to positive links with other services, ease of talking to staff and suitability of appointment type. The thematic analysis revealed three themes: help managing chronic fatigue syndrome, experience of professional support and accessibility of service. Families reported benefiting from increased understanding of chronic fatigue syndrome, learning new strategies, the team linking with schools, feeling validated and mental health support. Accessibility was a particular problem including the service location, setup of appointments and difficulty contacting the team.

Discussion: The evaluation presents recommendations for paediatric Chronic Fatigue services to improve service user experiences.

Objective: A consideration of chronic illness according to illness labels that are medically understood as opposed to being outside of medical understanding may reveal unique differences in how individuals understand their illness and how such lay understandings relate to health-related quality of life. Study aims are framed according to the commonsense model of self-regulation with a focus on characterizing illness representations according to chronic illness diagnosis type.

Methods: Individuals suffering from symptomatic chronic illnesses (n  =  192) completed measures of illness representations, coping, and general health. Participants were categorized into one of two groups based on reported diagnosis/symptoms: (a) conventional diagnosis (CD) or (b) functional somatic syndrome (FSS).

Results: FSS participants reported lower illness coherence and greater illness identity than CD participants. Overall, illness coherence predicted negative coping which mediated the relationship between illness coherence and general health.

Conclusions: Minimal differences were found in illness representations across FSS and CD groups with distinctions found only for illness coherence and identity. Illness coherence stands out as particularly important for coping and health-related quality of life for individuals with ongoing symptoms. Healthcare professionals should work carefully with chronically ill populations to address potential impacts of illness coherence, especially among FSS patients.

Objectives: The aim of the present study is to evaluate the impact of Covid-19 on utilization of chronic diseases services.

Methods: Interrupted time-series design was used to examine the utilization of chronic diseases services before and during the Covid-19 pandemic among hospitals in Iran. Chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, heart failure, and chemotherapy were selected as a proxy to indicate the impact of Covid-19 on utilization of chronic diseases services. Data were collected in 24 sites from 12 months before the onset of Covid-19 (from March 2019 to February 2020) to 12 months during the Covid-19 pandemic (February 2020 to March 2021).

Results: A total of 7,039,378 services were provided, of which 51.92% were provided for women and 62.73% for >65 age group. A sudden decrease was observed in monthly utilization of services during the Covid-19 pandemic; ranging from 13.91 (95% CI = -21.73, 6.10, P = 0.001) for chemotherapy to 606.39 (95% CI = -1040.72, 172.06, P = 0.009) for heart failure services per 100 thousand population. A decrease was observed in COPD services; 15.28 services compared with the period before Covid-19. Subsequently, the monthly utilization trends of asthma, type 2 diabetes, and chemotherapy services increased significantly (P < 0.05).

Discussion: Although chronic diseases are a factor in more severe form of Covid-19, their failure to seek diagnostic, prevention and treatment services has somewhat complicated the issue.