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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The use of chronic disease probabilistic models to calculate patient prognosis is presented. The method relies on the calculation of transition probabilities between discrete disease states from a patient data bank. Maximum likelihood estimates are used for each age and unwanted fluctuations are removed by a moving average. An interactive computer program was written and the method applied to the calculation of the probability of stroke and myocardial infarction for male patients on antihypertensive therapy. A clinician could obtain the prognostic information for a patient in less than one minute. Applications in medical student education are also discussed.
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PMID:The assessment of patient prognosis using an interactive computer program. 62 22

Accumulated literature over the past 25 years about the team approach to chronic disease can be divided into three broad categories: (1) the opinion base which reflects statements of belief and faith, (2) the descriptive base which contains details and personal testimony of programs using team concepts and (3) the study base which includes serious research efforts to investigate the effectiveness of team care in various settings. An analysis of the articles in the last category provides a useful insight into the problems and possibilities associated with this neglected area of health care research. The populations studied include patients with heart disease, hypertension, stroke, hip fracture, rheumatoid arthritis, diabetes and groups referred for comprehensive rehabilitation. The majority of the studies demonstrated improved outcomes in one or more areas for patients receiving coordinated team care when compared with control groups. Although these studies serve as a useful guide, the extent to which the findings can be generalized is open to serious question. In the absence of additional research, team care will remain as it is today, largely a matter of faith and the subject of many platitudes. An outline is proposed of the major methodological features which should be considered in the planning and/or evaluation of future studies in this area.
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PMID:Team care in chronic illness: a critical review of the literature of the past 25 years. 98 51

Mortality due to chronic diseases has been increasing in all regions of Brazil with corresponding decreases in mortality from infectious diseases. The geographical variation in proportionate mortality for chronic diseases for 17 Brazilian state capitals for the year 1985 and their association with socio-economic variables and infectious disease was studied. Calculations were made of correlation coefficients of proportionate mortality for adults of 30 years or above due to ischaemic heart disease, stroke and cancer of the lung, the breast and stomach with 3 socio-economic variables, race, and mortality due to infectious disease. Linear regression analysis included as independent variables the % of illiteracy, % of whites, % of houses with piped water, mean income, age group, sex, and % of deaths caused by infectious disease. The dependent variables were the % of deaths due to each one of the chronic diseases studied by age-sex group. Chronic diseases were an important cause of death in all regions of Brazil. Ischaemic heart diseases, stroke and malignant neoplasms accounted for more than 34% of the mortality in each of the 17 capitals studied. Proportionate cause-specific mortality varied markedly among state capitals. Ranges were 6.3-19.5% for ischaemic heart diseases, 8.3-25.4% for stroke, 2.3-10.4% for infections and 12.2-21.5% for malignant neoplasm. Infectious disease mortality had the highest (p < 0.001) correlation with all the four socio-economic variables studied and ischaemic heart disease showed the second highest correlation (p < 0.05). Higher socio-economic level was related to a lower % of infectious diseases and a higher % of ischaemic heart diseases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Geographical patterns of proportionate mortality for the most common causes of death in Brazil. 134 34

The Honolulu Heart Program (HHP) is a long-term prospective epidemiologic study of cardiovascular disease (CVD) in male descendants of Japanese migrants to Hawaii. The article is a review of data from recent and past HHP studies relevant to the Seventeenth Pacific Science Congress symposium "Changes in Disease Patterns in the Western Pacific and Southeast Asia." The Ni-Hon-San Study, which compared CVD rates and risk factors in Japanese men living in Japan, Hawaii (HHP), and California, showed that coronary heart disease (CHD) and stroke mortality rates in Hawaii were intermediate between rates in Japan and California. Gradients in CVD risk factors were similar to the gradients in disease rates. From 1966 to 1984 trends in incidence rates for CHD, stroke, and cause-specific mortality were compared for the 8006 participants and 3130 non-participants in the HHP. CHD and stroke rates declined by about 40% for the total HHP cohort. There was a larger decline for CHD mortality (over 60%) in the nonparticipants. There was also a much greater decline in total mortality and cancer mortality rates in the nonparticipants. The results of the reviewed studies show that the subjects, although sharing a common ethnic background, experience different rates of disease when living in diverse geographic and cultural locales. This finding supports evidence that environmental and behavioral factors influence chronic disease rates and provides a basis for intervention and prevention. The finding that nonparticipants in epidemiologic studies can show different incidence trends suggests that caution should be used in interpreting trends limited only to participants.
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PMID:Studies of cardiovascular disease and cause-specific mortality trends in Japanese-American men living in Hawaii and risk factor comparisons with other Japanese populations in the Pacific region: a review. 142 39

A 64-year-old man developed hallucinations, delusions, and agitation after a right hemispheric cerebrovascular accident (CVA) in the occipital, inferior temporal, and parietal regions of the posterior cerebral artery. A review of the literature suggests that psychotic behavior is rare after CVA, but when such behavior does occur, the lesion is usually in the right hemisphere. Two clinical presentations are seen. One presentation involves patients free of chronic disease who develop episodic psychotic behavior at a time remote from their CVA. Electroencephalogram often demonstrates epileptogenic foci, and these patients often improve with anticonvulsant medication. Another presentation involves patients with one or more chronic diseases, often resulting in brain atrophy, who display continuous abnormal behavior soon after their CVA; these patients respond variably to antipsychotic agents.
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PMID:Psychotic behavior after right hemispheric cerebrovascular accident: a case report. 155 13

Laboratory Initiative For The Year 2000 (LIFT), the laboratory response to the Healthy People 2000 program, includes the following in its definition of chronic disease: cancer, diabetes, hypertension, end-stage renal disease, stroke, and cardiovascular disease. All are priority health targets for which the laboratory must play an active support role if we are to achieve the goal of controlling these diseases by the year 2000. What are the laboratory procedures needed to assist in the prevention and detection of chronic disease? In this review I consider the traditional tests now used in these efforts, emphasize how and where screening for diabetes, cardiovascular disease, and cancer is now done, and describe the current status of the clinical laboratory in supporting these activities, including new and promising procedures that may be useful in identifying individuals at high risk for disease. It is important to initiate good clinical laboratory practice for these new tests as they are transferred from the research laboratory to the clinical laboratory. The laboratory will be required to provide for this need rapidly and at the same time comply with federal and state controls and regulations.
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PMID:The role of the laboratory in the prevention and detection of chronic disease. 164 36

Worldwide, locally prevailing nutritional traditions account for the occurrence of specific types of cancer. In the Orient, the custom of eating salted, pickled or smoked food parallels the risk of stomach cancer and hypertension-stroke. The underlying mechanisms and relevant carcinogens are partially known. In the Western world, the usual high-fat, low-fiber food is related to risk of cancer of the colon, pancreas, breast, prostate, ovary, and endometrium. The fat component translates to specific promoting mechanisms and fibers reduce risk of colon cancer through dilution of promoters. The associated genotoxic carcinogens may be the heterocyclic amines formed during cooking of meat. Methods have been developed to inhibit their formation. In all situations, a higher intake of vegetables and fruits has led to a lower risk for diverse types of cancer, through varied mechanisms. Based on current knowledge, more wholesome dietary traditions for chronic disease prevention in most countries can be developed.
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PMID:Carcinogenesis in our food and cancer prevention. 165 31

This population-based study examines all carotid endarterectomies (CE) performed by all surgeons in a single state over a 10-year period. The methodology is designed to determine morbidity rate, mortality rate, cost, and length of stay, as well as to understand the effect of pre-existing chronic disease, physician, and hospital volume on these outcome variables. The data source consisted of hospital discharge abstract data uniformly collected on all admissions (N = 5.9 million) to acute care hospitals in the state. In the decade 1979 to 1988, 11,199 patients underwent CE. Mortality rate from CE was 2.1%, and the postoperative stroke rate was 3.7% over this period. High physician volume decreased the mortality rate (p less than 0.05) and stroke rate (p less than 0.01) by 50% and significantly (p less than 0.001) reduced hospital cost and length of stay independent of patient complexity. Examination of cost data, adjusted for inflation, showed a decrease in mean cost for CE over the decade. Thus physicians are providing better care for less hospital dollars. Both patient and payor outcome is improved by concentrating CE patients in the hands of high-volume surgeons. Although the data suggests this trend is already evolving, the pace of this evolution can be expected to increase as payors recognize that regionalization of this procedure lowers costs.
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PMID:Evaluating quality, cost-effective health care. Vascular database predicated on hospital discharge abstracts. 202 63

The Kubicek thoracic cylinder model of impedance cardiography (IC) for measuring beat-by-beat stroke volume (SV) was evaluated in controlled studies using the electromagnetic flowmeter (FM) as the reference technique. Assuming the validity of the Kubicek equation for stroke volume calculation, IC stroke volume was found to be a linear function of EM values at any one haematocrit over a wide range of SV, but the slope of the relationship fell as haematocrit fell. Experiments using the same equation in dogs, in which blood resistivity in vivo (rho tau) was made the dependent variable, and the EM-derived value was used for stroke volume, showed that rho tau was almost constant over a wide range of haematocrits. These findings were supported by studies in man and rabbit where Fick and thermodilution-derived values were used for stroke volume. When these data were applied to normotensive and hypertensive human subjects with normal hearts and lungs in controlled studies at rest, during tilting, with drug therapy and on exercise, IC measured stroke volume and cardiac output with a variability at least as good as the 9-11% acceptable for clinical use. This conclusion applied to thoracic configurations of different sizes and shapes from adult man to the neonate. In chronic disease states, while assessments of relative changes are valuable, absolute data are questionable. Further research is required under these conditions, as it is also for other models of IC, which are based on different assumptions.
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PMID:Impedance cardiography for cardiac output measurement: an evaluation of accuracy and limitations. 209 94

The usefulness of surveillance in relating chronic disease trends to recent changes in risk exposures is often questioned on the grounds that these trends respond slowly, reflecting long periods between aetiological exposures and clinical onset of disease. We challenge this preconception on the basis of a review of several important risk factors and diseases: alcohol and liver cirrhosis; tobacco and stroke, cardiovascular disease, and lung cancer; and oestrogens and endometrial cancer. Data from cohort, cross-sectional, and modelling studies demonstrate that the time between removal of exposures and the onset of decline in morbidity or mortality is not defined by the time between initial exposure and disease occurrence. Rather, the pattern of lifetime exposures (with recent exposures often having a dominant effect), the dynamics of the disease process, and the segment of the population with reduced exposures determine how soon the decline begins.
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PMID:Public health surveillance of non-infectious chronic diseases: the potential to detect rapid changes in disease burden. 226 57


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