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The prevalence of chronic disease based on a mailed questionnaire was estimated as part of a continuing epidemiological study of a retirement community. The prevalence of eight chronic diseases (high blood pressure, angina, myocardial infarction, stroke, diabetes, rheumatoid arthritis, glaucoma, and cancer) was determined across all age and sex groups. The relationships between these diseases and several health related life-style practices were assessed. A health index summarizing five practices (smoking, alcohol consumption, exercise, sleep and obesity) was clearly related to the prevalence of disease.
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PMID:Prevalence of chronic disease and health practices in a retirement community. 373 24

We compared epidemiologic data collected from medical records and by interview for 462 subjects who were part of a case-control study of a chronic disease (cancer of the breast). The collected data included such clinical and pharmaceutical features as history of lactation, hysterectomy, diabetes mellitus, type of menopause, and whether a woman had used exogenous estrogens. We found that agreements between medical record and interview data are variable, and depend on the type of data examined and the strategy for handling incomplete or ambiguous (indeterminate) responses. For variables that represent inherent features of the patients' clinical condition, such as gynecologic surgical procedures and a family history of breast cancer, we found excellent agreement between the medical record and interview. For pharmaceutical features, however, we discovered considerable variability between the two data sources. We also detected substantial problems with a common tactic in which information from individual data sources are pooled to form a new "combined data source". In this analysis, combining data sources creates estimates for the proportion exposed that are different from estimates in either of the original information sources.
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PMID:Comparison of epidemiologic data from multiple sources. 379 40

While the existence of age-related Mg deficiency is difficult to prove, intake of Mg by old people tends to be suboptimal, and the finding of decreased intestinal Mg absorption with progressive age provides evidence for the fact that the Mg requirement may be higher in elderly people than young adults. Chronic diseases, such as diabetes, congestive heart failure and alcoholism, common among elderly people, may further contribute to Mg depletion. A number of the drugs used in aged patients are also known to promote Mg loss. On the other hand, long-term Mg deficiency may play a role in the aging process, by affecting neurotransmitter activity, hormone synthesis and immune function, and/or may enhance cardiovascular disease, which is the most common cause of morbidity and mortality in old age. Despite this type of evidence, there is a lack of data concerning the effects of Mg supplementation in the aged.
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PMID:Effects of aging, chronic disease, and multiple supplements on magnesium requirements. 382 Nov 76

Although several risk factors for heart disease including high blood pressure, diabetes mellitus, and lipid and lipoprotein abnormalities are associated with overweight, overweight is not consistently associated with coronary heart disease risk. Some prospective studies of white men (life insurance cohorts, airline pilots, cancer study volunteers, and the Framingham population) have shown a positive linear relationship of weight to coronary heart disease. Other epidemiologic studies show a negative association, no association, a U-shaped relationship, or a threshold effect. The inconsistencies do not appear to be explained by differences in the definition or distribution of obesity, duration of follow-up, or risk factor distribution. Neither misclassification bias nor confounding by cigarette smoking or chronic disease appears to explain the inconsistencies. No known protective effect of obesity could explain these divergent findings. Inconsistent results with regard to the nature, strength, and linearity of the association between obesity and atherosclerosis do not support the hypothesis that obesity causes atherosclerosis, despite its biological plausibility.
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PMID:Obesity, atherosclerosis, and coronary artery disease. 390 65

Behavioral research on patient compliance with regimens to manage diabetes has suffered from lack of conceptual rigor, although a handful of recent studies and reviews are more theoretically oriented. The present review proposes a comprehensive conceptual framework in the context of learning theory to explain patient compliance and to derive approaches for enhancing compliance. The conceptual framework is the health belief model (HBM) expanded to include the concept of perceived self-efficacy. This expanded model may both serve as an agenda for future research as well as a set of guidelines for the education of patients with diabetes. A variety of educational interventions is recommended for use in patient education provided they succeed in reinforcing relevant health beliefs, behavioral skills, and the sense of self-efficacy. The problem of long-term maintenance, of particular significance in chronic disease management, is addressed by the relapse prevention model derived from social learning theory and emphasizing self-efficacy and the learning of coping skills.
Diabetes Care
PMID:Understanding and enhancing patient compliance with diabetic regimens. 390 28

The assessment of obesity by anthropometry or body composition in studies of chronic disease epidemiology is not always feasible. In this paper we test the accuracy and validity of two alternative methods: body silhouettes and reported weights and heights in a sample of Mexican American adults (n = 166) participating in the Diabetes Alert Study. The body silhouettes were those developed by A. Stunkard and colleagues. We compared the silhouettes obtained independently by three different observers, one with minimal experience in assessing obesity, the other two skilled in anthropometry. Correlations between the expert observers were 0.89-0.90. Those between the expert and less skilled observers were lower (0.64 to 0.85) and were better for female than male subjects. Results suggest an acceptable level of precision for persons with some training in obesity assessment. Body silhouettes compared well with the body mass index (r = 0.85 to 0.92 for the expert vs r = 0.65 to 0.84 for the less skilled observer), being higher for female subjects. The body silhouettes are thus useful for categorizing normal, overweight and obese individuals. The poorer performance on male subjects may relate to the female-like obesity depicted in both sexes in this particular set of silhouettes. A substantial proportion of subjects could not recall their weight or height. For those who could recall their measurements, accuracy was good but measurement error higher than that for measured variables. These problems of recall in this sample from rural Texas point to the potential usefulness of the body silhouette method when actual height and weight measurements cannot be made.
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PMID:Alternative measurements of obesity: accuracy of body silhouettes and reported weights and heights in a Mexican American sample. 405 26

Fifty-one couples in which one partner has insulin-treated diabetes were studied in a combined questionnaire/interview procedure. Focus was the emotional aspects in having a chronic disease seen from both the patient's and the partner's point of view. The diabetics complained more often of fear and anxiety about future, fluctuations in mood and were finding their daily life more troublesome. Further the diabetics claimed to be more tired and diabetic males had more sexual concerns. We find the emotional considerations crucial to the management of diabetes and suggest better efforts should be made in coping with these problems including both the patient and the spouse.
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PMID:Emotional aspects in diabetes mellitus: a study of somatopsychological reactions in 51 couples in which one partner has insulin-treated diabetes. 405 23

Alcoholism is an illness that constitutes a major health problem at all levels of society. The physician should accept his responsibility to prevent it and to care for the alcoholic. If he knows that one of his patients is drinking immoderately, he should warn him of the outlook. A patient's acquired dependence on alcohol may be overt, or revealed only on examination for organic disease or emotional disturbance. The diagnosis may be accepted reluctantly, or denied despite positive evidence, but the patient should be persuaded to give up drinking. He may require psychiatric help or advice from a social worker. He may be so ill as to require treatment in hospital, and hospitals must recognize the urgency of such admissions. Discharge from hospital does not end treatment, for alcoholism is a chronic disease, requiring long-term planning, persistent follow-up and enduring sympathy by the physician, who must always be as available to his alcoholic patient as he is to his patient with diabetes, epilepsy or cardiac disease.
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PMID:Medical care of the alcoholic patient. 592 54

Available information regarding possible infectious etiologies of insulin-dependent diabetes mellitus, rheumatoid arthritis, and systemic lupus erythematosus is reviewed. The problems and limitations of classic methods in trying to prove a causal relationship between an infectious agent and a chronic disease are summarized. The authors suggest that these disease occur as a result of persistent infection triggering an immunologic response (which is destructive of host tissue) in genetically susceptible individuals. Prospective studies within families (wherein individuals most at risk for disease can be identified) before the onset or diagnosis of the chronic disease may offer the best approach to elucidating potential infectious etiologies.
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PMID:Identifying infectious etiologies of chronic disease. 637 35

Chronic diseases like diabetes may be a disadvantage in several professions. The aim of the study was to analyse the situation of juvenile diabetics searching for apprenticeship in Austria. 177 individuals (30 adolescent diabetics, 50 healthy adolescents of the same age and 97 masters) were asked by a special questionnaire about their opinions concerning employment and professional changes of juvenile diabetics. Following dimensions were tested: subjective knowledge about juvenile diabetes, objective knowledge about juvenile diabetes, physical capacity, psychological factors, life expectation, stay at home because of illness--admittance to hospital, diabetes--profession, exceptions necessary at work because of diabetes, attitude of the state towards the professional situation of the diabetics.
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PMID:[The status of diabetic adolescents in search of apprenticeship]. 670 Sep 93


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