Central issues in future research and policy for chronic diseases

In our ageing societies, with effective health care systems,more and more people will live till old age. It is an achievementof which we can be proud. However, it has implications for thefuture demand for health care services and financial consequencesthat need the attention of policy makers. It also has consequencesfor the main health care problems in future populations thatwill need the attention of the medical profession. These centralissues for future policy at the level of the individual patientand of the population raise questions that need to be addressedin research today. Using a computer simulation model, PREVENT,some of these issues are examined. It is shown that even withextensive preventive interventions absolute numbers of elderlypatients with chronic diseases will increase. In fact, effectiveprevention of mortality in middle-age will exacerbate this effect.Most of the current research on risk factors or clinical trialsdo not include elderly patients which greatly complicates cost-effectivenessanalyses or guidelines for both preventive and curative services.Policy measures will need to take into account the rise in demandand the shift towards more elderly patients. Research needsto shift attention to avoiding or averting disabilities andincreasing the quality of life.     

The future of mosquito-borne diseases in the world

The future of mosquito-borne diseases will depend on the improvements and implementation of chemotherapy and vaccination, as well as on biological and integrated control measures. Bacillus thuringiensis H-14, B. sphaericus, Lagenidium giganteum and other fungi are promising biological mosquito control agents. Other control measures include parasitoids, nematodes, larvivorous fish, Toxorhynchites mosquitoes, insect viruses, growth hormones, sex attractants, natural products, sanitation, and water management. Vector control should be combined with training of personnel and carried out on an international scale.     

Current status and future perspectives in telecare for elderly people suffering from chronic diseases

We reviewed the literature on home telecare for elderly patients suffering from chronic diseases. Articles published between 1990 and 2007 were identified via the PubMed database. The literature search yielded 485 papers. After reviewing the title and abstract from each, 54 were selected for closer examination. They were published in 37 different journals. The number of papers increased from one in 1997 to 14 in 2006. The diseases in which home telecare had been used were diabetes (14 studies), heart failure (13 studies), cognitive impairment (dementia and/or Alzheimer's disease, 10 studies), chronic obstructive pulmonary disease (5 studies), chronic wounds (4 studies) and mobility disabilities (4 studies). Patients were generally satisfied with home telecare, but they preferred a combination of home telecare with conventional health-care delivery. Health-care professionals were positive about telecare. Users felt that on many occasions telecare led to a reduction in costs due to time savings and avoidance of travelling. Even though there were important benefits from home telecare, there are organizational, ethical, legal, design, usability and other matters that need to be resolved before widespread implementation can occur.     

饮酒与慢性病关系的探讨

饮酒对身体健康有一定的影响,有研究认为适量饮酒具有和血益气,保护心脑血管的作用;但也有大量研究表明,过量饮酒会对肝脏、心血管系统、中枢神经系统等重要脏器造成严重损害,甚至危及生命。本文通过阅读相关文献资料,对饮酒与慢性疾病的关系进行探讨。     

Comorbidity of chronic diseases

Although much research has been done on the impact of chronic illness on quality of life, still relatively little is known about the role of comorbidity. Given the growing number of (older) people with multiple chronic conditions, more information is needed on the effects of specific disease combinations for preventive purposes. In a nationwide representative sample of 1673 non-institutionalized chronic disease patients (recruited in 56 general practices) in The Netherlands, we assessed the separate and joint effects of cardiovascular disease, cancer, arthritis, chronic respiratory disease, diabetes mellitus, and thyroid dysfunction on physical and mental functioning. Data on medical diagnoses were provided by the general practitioners; data on physical and mental functioning were collected by a patient survey (SF-36). Compared to reference data of the general population, physical functioning appeared to be worse in all six diagnostic groups, whereas mental functioning was more or less comparable. Patients with arthritis or those suffering from comorbidity reported the lowest levels of physical functioning. Synergistic effects of combinations of diabetes, cardiovascular disease and/or chronic respiratory disease were found, indicating that patients suffering from these disease combinations run a higher risk of physical disability than could be expected from their separate effects.     

The impact of chronic diseases: the partner's perspective

A chronic physical disease not only has direct consequences for the chronically ill person but can also distort the life of the healthy partner. This study of a representative sample of chronically ill persons and their partners in the Netherlands presents quantitative information on the proportion of partners who experience consequences in 4 distinguished areas (personal life strain, social relations, financial burden, and intrinsic rewards) and provides insight into the factors related to this. Data were derived from a subsample (N = 1,093) of participants in the Dutch Panel of Patients With Chronic Diseases. Linear regression analysis was used to determine the relative effect of caregiving and of disease characteristics to explain the variance in the 4 impact factors. The most prevailing consequences, experienced by more than half of the partners, were related to personal life strain and intrinsic rewards. An impact on social relations and financial situation was reported by 20% of the partners. The regression analyses showed that the time spent on caregiving is the main predictor for all 4 impact measures in this study. However, the findings also make clear that the impact on the partner's life does not arise entirely from the amount of caregiving. An independent effect of specific disease characteristics is observed in addition to the effect of caregiving; that is, we found that physical impairments in the patient are related to higher personal life strain and higher financial burden whereas social impairments are related to higher impact on all 4 factors. When the patient's disease is accompanied with fatigue, the partner reports higher impact on personal life, on social relations, and on intrinsic rewards, and pain significantly affects the partner's social relations. Partners of patients with cancer, musculoskeletal, or digestive disorders are more vulnerable for the consequences of the chronic disease. The impact on female partners is higher for all 4 impact factors. The findings make clear that living with a chronically ill person has an impact on the partner's life that goes beyond the consequences of caregiving.     

The global epidemiology of tobacco and related chronic diseases

A new paradigm is needed for the epidemics of the 21st century. The tobacco epidemic has shown that the curative-based medical model is insufficient to reduce the use of tobacco, and that this will only be achieved by prevention and public health measures. The magnitude of the health risks and the economic factors can only lead to one conclusion: there needs to be hard-hitting, well-funded campaigns in all countries and at all levels to avert initiation, decrease consumption, assist with cessation, and protect non-smokers. We must embrace the spirit of the Framework Convention on Tobacco Control by implementing robust, effective, cost-effective measures to protect people's health and the wealth of nations. We stand at a critical juncture in the unfolding pandemic.     

The impact of childhood chronic neurological diseases on Greek families

BACKGROUND: Although the impact of childhood chronic neurological diseases (CND) on patients' psychological well-being has been increasingly addressed, little attention has been given to the influence of these conditions on family members and family functioning. The purpose of the present study was to investigate the family characteristics of Greek children suffering from CND. METHODS: A total of 52 parents of children with CND were studied by using the Family Environmental Scale (FES), the Family Burden Scale, the General Health Questionnaire (GHQ-28) and a questionnaire on the knowledge of their children's illness, their coping strategies and their satisfaction with our services. During the same period, 30 parents of hospitalized children for common paediatric illnesses completed the FES. In both groups social and demographic features were registered. Appropriate statistical processes were applied to compare the above-mentioned family groups and to study the differences between the families of children with epilepsy (n=37) and the families of children with other CND (n=15). RESULTS: Parents of children with CND discuss their problems less freely, talk less openly around home, score highly on FES subscale of Conflict and, pay more attention to ethical and religious issues and values. Furthermore, the families of children with other CND were more burdened regarding the financial state and the health status of other family members in comparison with families of children with epilepsy. In addition, families of children with epilepsy were more involved in social and recreational activities, appeared to be more knowledgeable on the availability of help in critical conditions and were more satisfied with rendered medical services, in comparison with families of children with other CND. CONCLUSION: These preliminary findings provide important information concerning the special characteristics of Greek families of children suffering from CND, which may prove especially helpful in organizing specific support services.     

The future of epidemiology in Poland in twenty first century. Communicable diseases

Material collected from various institutions on activities in the field of epidemiological trials and education was analized and evaluated. Institutions were divided into the following groups: sanitary-epidemiological stations, medical faculties, scientific and research instituts with the hygienic profile and instituts with epidemiological profile (National Institute of Hygiene, Institute of Tuberculosis and Chest Diseases and Institute of Sexual Transmitted Diseases). Majority of activities in the country connected with epidemiology are performed in these three instituts.     

Active immunotherapy for chronic diseases

With the effective control of infectious diseases in many parts of the world, chronic, non-communicable diseases have become the major cause of death and disability. Monoclonal antibodies (mAbs) have become an important class of drugs for the treatment of such diseases. Nevertheless, mAbs suffer from major shortcomings in a chronic setting: most notably, generation of anti-antibodies and high cost of goods. Here, we discuss a novel approach to treat chronic diseases based on active rather than passive immunization and contrast the 2 treatment modalities to highlight their respective advantages and disadvantages.