The impact of chronic disease on the family

Haemophilia is a chronic disease, affecting patients and their families. The impact of such a disease upon each family is dependent upon family type and characteristics and adjustment to it varies with time, in concordance with the family's lifecycle. In the National Hemophilia Center in Israel we lead a special support system and conduct group therapy from the very early stage of haemophilia diagnosis throughout the lifetime of patients. The general definitions of a family's lifecycle, the effect of the disease and the required adjustment to it are described in this paper. We refer to special difficulties associated with haemophilia as a chronic, genetic disease and describe ways to cope, discussing the support systems that have been established in our centre.     

The impact of nutritional depletion in chronic obstructive pulmonary disease

Nutritional depletion is prevalent in patients with advanced chronic obstructive pulmonary disease (COPD). These nutritional abnormalities are pronounced in patients with the "emphysematous" form of COPD on chronic corticosteroid therapy. The pathophysiologic mechanisms for the involuntary weight loss appear to be multifactorial. Clinical research has revealed that nutritional depletion in advanced COPD is associated with an increased morbidity and mortality. This review will address the implications of nutritional depletion in addition to potential therapeutic options.     

The impact of alcohol and chronic liver disease of micronutrients metabolism

Liver disease, alcohol and malnutrition are combinations usually associated with micronutrient impairment. Chronic liver disease courses with lower storage and activation of vitamin-coenzymes related to their malabsorption. Alcohol worsens the picture by reducing food intake, increasing micronutrients utilization and decreasing their absorption secondary to either intestinal or pancreatic injuries. Other concurrent causes would be drug treatments, urinary losses, protein deficiency and oxidative stress. As consequences the clinical signs are anemia, liver steatosis, oxidative stress and immunosuppression.     

The potential impact of anaemia of chronic disease in COPD.

Anaemia of chronic disease (ACD), with chronically low levels of circulating haemoglobin, is an immune driven abnormality that occurs in many inflammatory diseases, and also in chronic heart failure. Although chronic obstructive pulmonary disease (COPD) is "traditionally" associated with polycythaemia, the systemic inflammation that is now recognised as a feature of COPD makes it a possible cause of ACD. If present in COPD, anaemia could worsen dyspnoea and limit exercise tolerance. Preliminary evidence suggests that anaemia in COPD patients may be more prevalent than expected, concerning 10-15% of patients suffering from severe forms of the disease. A database study conducted in 2,524 COPD patients being prescribed long-term oxygen therapy has shown that a low haematocrit is a strong predictor of survival in this population, before body mass index, and is associated with more hospitalisations and a longer cumulative duration of hospitalisation. COPD patients with low haemoglobin levels have a poorer prognosis than COPD patients with normal haemoglobin levels in the event of acute gastrointestinal bleeding or after elective aneurysm repair. Raising haemoglobinaemia through transfusion decreases minute ventilation and work of breathing in COPD patients. These preliminary evidences point to the need to study the prevalence of anaemia, and its physiological and clinical impact in chronic obstructive pulmonary disease. When this body of knowledge is available, the question of the putative benefits of raising haemoglobinaemia in chronic obstructive pulmonary disease will have to be addressed.     

慢性肾病对冠心病发病和预后的影响

近年,慢性肾病发病率和病死率逐年升高．已成为世界范围内危害人们身体健康的重要疾病。心血管疾病往往伴发慢性肾病．慢性肾病患者多因心血管疾病而死亡,并非进展为肾功能衰竭而死亡。美国国家肾脏基金会(NKF)的报告显示,慢性肾病伴心血管疾病病死率是普通人群的10～30倍。     

抗胆碱能药物治疗慢性阻塞性肺疾病作用的新进展

近年来,有关COPD相关药物的临床研究逐渐增多.支气管舒张剂是目前治疗COPD的基本药物,其中抗胆碱能药物对COPD的治疗作用是研究的热点之一.     

抗胆碱能药物治疗慢性阻塞性肺疾病作用的新进展

近年来,有关COPD相关药物的临床研究逐渐增多.支气管舒张剂是目前治疗COPD的基本药物,其中抗胆碱能药物对COPD的治疗作用是研究的热点之一.     

Epidemiology and global impact of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease that causes a heavy health and increasing economic burden both in the United States and around the world. Most of the risk factors for COPD are well known and include smoking, occupational exposures, air pollution, airway hyperresponsiveness, asthma, and certain genetic variations, although many questions, such as why a minority of smokers develop significant airway obstruction, remain. Major medical organizations have agreed on a common definition of COPD, although newer measures, such as functional status or exercise capability, have emerged as important in determining the prognosis of COPD patients. In most of the world, COPD prevalence and mortality are still increasing and will likely continue to rise in response to increases in smoking, particularly by women and adolescents. Resources aimed at smoking cessation and prevention, COPD education and early detection, and better treatment will be of the most benefit in our continuing efforts against this important cause of morbidity and mortality.     

Chronic kidney disease: psychosocial impact of chronic pain

Chronic kidney disease (CKD) affects more than 19 million people in the United States, and prevalance of CKD is expected to double within 10 years. Additionally, a significant number of predominantly elderly patients have end stage renal disease, necessitating dialysis or kidney transplant. Perception of chronic pain, especially in elderly dialysis patients, may be greatly underrecognized. As a result management of pain, as well as depression, and other physical and mental symptoms, may not be adequately addressed in the primary care setting. Clinical interventions such as psychiatric evaluation, pain management, and therapy to improve physical and mental symptoms, may markedly impact wellbeing for CKD patients. Constant reassessment is critical when treating CKD patients. Such an approach may significantly better elderly patients health-related quality of life.     

The economic impact of chronic prostatitis

BACKGROUND: Little information exists on the economic impact of chronic prostatitis. The objective of this study was to determine the direct and indirect costs associated with chronic prostatitis. METHODS: Outcomes were assessed using a questionnaire designed to capture health care resource utilization. Resource estimates were converted into unit costs with direct medical cost estimates based on hospital cost-accounting data and indirect costs based on modified labor force, employment, and earnings data from the US Census Bureau. RESULTS: The total direct costs for the 3 months prior to entry into the cohort, excluding hospitalization, were $126 915 for the 167 study participants for an average of $954 per person among the 133 consumers. Of the men, 26% reported work loss valued at an average of $551. The average total costs (direct and indirect) for the 3 months was $1099 per person for those 137 men who had resource consumption with an expected annual total cost per person of $4397. For those study participants with any incurred costs, tests for association revealed that the National Institutes of Health Chronic Prostatitis Symptom Index (P<.001) and each of the 3 subcategories of pain (P =.003), urinary function (P =.03), and quality-of-life (P =.002) were significantly associated with resource use, although the quality-of-life subscale score from the National Institutes of Health Chronic Prostatitis Symptom Index was the only predictor of resource consumption. CONCLUSIONS: Chronic prostatitis is associated with substantial costs and lower quality-of-life scores, which predicted resource consumption. The economic impact of chronic prostatitis warrants increased medical attention and resources to identify and test effective treatment strategies.     

The impact of chronic obstructive pulmonary disease on work loss in the United States

Chronic obstructive pulmonary disease (COPD) is a rapidly growing public health problem in the United States and elsewhere. Although direct costs of COPD are well documented, the impact of COPD and its severity on labor force participation is not well known. Using population-based data from the Third National Health and Nutrition Examination Survey (NHANES III), we determined the adjusted relationship between COPD (and its severity) and labor force participation in the U.S. We used data from 12,436 participants involved in NHANES III; 1,073 of these participants (8.6% of the total) reported COPD. These participants were 3.9% (95% confidence interval, 1.3% to 6.4%) less likely to be in the labor force than those without COPD. Increasing severity of COPD was associated with decreased probability of being in the labor force (p for linear trend = 0.001). Mild, moderate, and severe COPD was associated with a 3.4%, 3.9%, and 14.4% reduction in the labor force participation rate relative to those without COPD. These data suggest that COPD has a considerable adverse impact on work force participation. Based on these data, we estimate that, in 1994, COPD was responsible for work loss of approximately $9.9 billion in the U.S.     

The impact of cerebrovascular disease

Stroke may be affected by pathologic conditions such as atherosclerosis, vascular injury, coagulopathy, and increased platelet aggregability. Knowledge of the pathophysiology of stroke is critical in order to effectively prevent or treat this disabling state. Cerebrovascular disease is the third leading cause of death in the USA. It is also associated with significant morbidity, leading to extremely high health care costs and lost productivity. Total estimated costs of stroke are estimated to be more than $45 billion annually. This is an especially important issue for patients with diabetes, who are at higher risk for stroke and have a worse clinical outcome than non-diabetic patients. This review describes the impact of vascular disease, particularly cerebrovascular disease, and describes the pathophysiology of the disease. Interventions that result in reduction of stroke will likely result in decreased health care costs and improved clinical outcomes.