Major Chronic Health Conditions Research Articles

Changes in the provision and utilisation of health care services for chronic health conditions during the COVID-19 pandemic in rural northeast South Africa: an interrupted time series analysis.

The COVID-19 pandemic has impacted the provision and utilisation of health care services with varying magnitude across settings due to spatial temporal variation in the burden of COVID-19 cases and the roll-out of local COVID-19 response policies. This study assesses changes in the provision and utilisation of health care services for three major chronic health conditions (HIV/AIDS, hypertension, and diabetes) over the pre-COVID-19 and COVID-19 pandemic periods in a rural South African sub-district of Agincourt. Segmented interrupted time series regression models are applied to assess changes in the number of medication collection visits and new diagnoses for HIV/AIDS, hypertension, and diabetes from 1 January 2018 to 30 September 2021 covering the pre- COVID-19 period and the first three waves of the COVID-19 pandemic. The number of medication collection visits for HIV/AIDS, hypertension, and diabetes dropped following the imposition of level 5 lockdown. Despite some improvements over the course of the pandemic, by the end of the third wave in September 2021, visits remained below the pre-COVID-19 era. The number of clinic visits for new diagnoses of HIV/AIDS and hypertension also fell after the introduction of level 5 lockdown. Although the number of new visits for HIV/AIDS bounced back to the pre-COVID-19 trends by the end of the third wave, the number of visits for new hypertension diagnoses remained significantly lower than expected. Referrals for collection of medications from the Central Chronic Medicines Dispensing and Distribution (CCMDD) programme, as an alternative to collection from clinics, increased exponentially over the course of the pandemic. Although the increased adoption of the CCMDD programme can in part account for decreased medication collection visits which persisted well after lockdown measures were lifted, marked reductions in the number of newly diagnosed cases of hypertension warrant concern. A deeper assessment of the appropriateness of referrals to the CCMDD programme as well as the longer-term effects on morbidity and mortality of missed treatment and/or delayed diagnosis is needed for a more granular understanding of the true ramifications of the COVID-19 pandemic and associated lockdown policies in the Agincourt subdistrict and other rural African settings.

Effectiveness, cost-effectiveness, and positive externalities of integrated chronic care for adults with major depressive disorder in Malawi (IC3D): a stepped-wedge, cluster-randomised, controlled trial

In low-income and middle-income countries, individuals with major depressive disorder often do not receive screening and treatment. We assessed effectiveness and cost-effectiveness of an integrated care model for treating major depressive disorder in Malawi, accounting for two sets of positive externalities: household benefits and improvements in comorbidities. In this stepped-wedge, cluster-randomised, controlled trial, 14 health facilities in Neno District, Malawi, introduced screening, diagnosis, and treatment for people with major depressive disorder, using a stepped-care model of group Problem Management Plus and antidepressant therapy. Adults (ie, aged ≥18 years) residing in facility catchment areas, newly diagnosed with major depressive disorder, and actively enrolled in an integrated chronic care clinic were eligible for inclusion. People identified with high suicidal risk or psychotic symptoms were excluded. Health facilities were categorised into two strata (ie, health centres or secondary hospitals) and randomly allocated to one of five trial sequences, with intervention initiation staggered across sequences in 3-month periods. Participants were masked to trial sequence, data collectors were masked to treatment assignment, and the chief statistician was masked to treatment assignment until analysis. Services were delivered by counsellors and clinical officers at integrated chronic care clinics, and assessments took place at 3-month intervals over 27 months. Primary outcomes were changes in depressive symptom severity (measured with the Patient Health Questionnaire-9 [PHQ-9]), current depressive episode (PHQ-9 score of >10), and functioning (measured with the WHO Disability Assessment Schedule 2.0) over the 27-month period. Longitudinal mixed-effects regression analyses assessed outcomes from an intention-to-treat perspective. The trial was registered with ClinicalTrials.gov (NCT04777006) and is completed. Between Sept 1, 2021, and April 28, 2022, we conducted 15 562 screenings, resulting in 506 (3%) adults identified with major depressive disorder and 487 (3%) enrolled (395 [81%] women and 92 [19%] men). Assignment to IC3D corresponded to a 2·60-point (95% CI -3·35 to -1·86; d -0·61) reduction in depressive symptoms and 1·69-point (-2·73 to -0·65; -0·27) improvement in functioning, reflecting a reduced odds of depression after treatment roll-out (adjusted odds ratio 0·62, 95% CI 0·51 to 0·74). Integrated care for people with major depressive disorder and chronic health conditions is effective at reducing depressive symptoms, improving functioning, and reducing the odds of depression, and facilitates expansion of services through existing infrastructure. National Institute of Mental Health.

Drug development for major chronic health conditions—aligning with growing public health needs: Proceedings from a multistakeholder think tank

The global pharmaceutical industry portfolio is skewed towards cancer and rare diseases due to more predictable development pathways and financial incentives. In contrast, drug development for major chronic health conditions that are responsible for a large part of mortality and disability worldwide is stalled. To examine the processes of novel drug development for common chronic health conditions, a multistakeholder Think Tank meeting, including thought leaders from academia, clinical practice, non-profit healthcare organizations, the pharmaceutical industry, the Food and Drug Administration (FDA), payors as well as investors, was convened in July 2022. Herein, we summarize the proceedings of this meeting, including an overview of the current state of drug development for chronic health conditions and key barriers that were identified. Six major action items were formulated to accelerate drug development for chronic diseases, with a focus on improving the efficiency of clinical trials and rapid implementation of evidence into clinical practice.

HEALTH AND AGING AMONG LATIN AMERICAN OLDER ADULTS: FINDINGS FROM STUDIES IN BRAZIL, CHILE, COLOMBIA, AND MEXICO

Abstract Aging in Latin America is occurring rapidly, in a context of high levels of poverty, low education and limited knowledge on the health conditions of older adults. This symposium is focused on heath-disparities found in some of Latin America’s largest middle-income countries, Mexico, Brazil, Chile, and Colombia. The symposium explores various health-related topics associated with aging, that may have significant implications for longevity, overall health, and disease risk. The papers in this symposium examine a variety of health-related dimensions and disparities among older Latinos that include major chronic health conditions, such as diabetes, hypertension, cardiovascular diseases and cognition. Using data from the Brazilian Longitudinal Study of Aging, Farina examines the relationship between childhood conditions and older adult health. Using the Mexican Health and Aging Study (MHAS) and the Health and Retirement study (HRS), Cantu compares cognitive measures and their association with gender in Mexico and the US. Using mortality data, Sandoval studies how healthy life expectancy varies among the largest indigenous group in Chile compared to non-indigenous populations. Lastly, Osuna uses data from the Colombian Survey of Health, Well-Being, and Aging to examine how diseased life expectancy varies from self-reported data compared to measured data among older Colombians. Results underline what populations in Latin American have increased risk of experiencing poorer health outcomes and disparities that may exist. The findings highlight the importance of understanding the conditions under which Latin American older adults are aging and the implications this can have in the future.

Associations between adult cannabis use and chronic health conditions in a nationally representative sample of the United States

ABSTRACT Background This study examined associations between cannabis use among U.S. adults with chronic health conditions in a nationally representative sample. Methods Four cross-sectional waves of data from the BRFSS were used, spanning 2017–2020. Multivariate logistic regression analyses assessed (a) whether number of self-reported chronic health conditions was associated with current cannabis use in the past 30-days, and (b) whether type of major chronic health conditions reported was associated with using cannabis for medical reasons in the past 30-days. Results From 2017 to 2020, the prevalence of past month cannabis use increased among all age groups, with the largest percent change occurring in the middle-aged adult group (6.5% to 10.8%). Individuals with more chronic health conditions had higher odds of using cannabis in the past month. Individuals who had arthritis, cancer (other than skin cancer), HIV/AIDS, COPD, and/or depressive disorder had higher odds of using cannabis for medical reasons. Conclusions As states across America weigh the implications of making medical and/or recreational cannabis use legal, future research should specifically explore persons with chronic diseases who are cannabis users, as these individuals may represent a high-risk population that is self-medicating to mask symptoms and may need more attention from medical and public health professionals.

Unmet supportive care needs in families of children with chronic health conditions: an Australian cross-sectional study

BackgroundThe aim of this study was to identify similarities and differences in the unmet supportive care needs (USCN) of families of children with major chronic health conditions (CHCs) using a universal need assessment tool.MethodsA cross-sectional online survey involving parents of children with congenital heart disease (CHD), type 1 diabetes mellitus (T1D), cancer, and asthma diagnosed within the last 5 years recruited via social media and support organizations. Thirty-four items assessing the USCN across six domains (care needs, physical and social needs, informational needs, support needs, financial needs, child-related emotional needs) were responded to on a 4-point Likert scale [no need (1) to high need (4)]. Descriptive statistics identified the level of need, and linear regressions identified factors associated with higher need domain scores. Due to small numbers, the asthma group was excluded from comparisons across CHCs.ResultsOne hundred and ninety-four parents completed the survey (CHD: n = 97, T1D: n = 50, cancer: n = 39, and asthma: n = 8). Parents of children with cancer were most likely to report at least one USCN (92%), followed by parents of children with T1D (62%). The five most commonly reported USCN across CHCs were drawn from four domains: child-related emotional, support, care, and financial. Three need items were included in the top five needs for all conditions. A higher USCN was associated with a greater frequency of hospital visits and the absence of parental support.ConclusionsUsing a universal need assessment tool, this is one of the first studies to characterize USCN in families of children diagnosed with common CHCs. While proportions endorsing different needs varied across conditions, the most endorsed needs were similar across the illness groups. This suggests that support programs or services could be shared across different CHCs.6HwnNHzZjxfpKxjvdPHjVTVideo

Biomarkers, disability and health care demand

Using longitudinal data from a representative UK panel, we focus on a group of apparently healthy individuals with no history of disability or major chronic health condition at baseline. A latent variable structural equation model is used to analyse the predictive role of latent baseline biological health, indicated by a rich set of biomarkers, and other personal characteristics, in determining the individual’s disability state and health service utilisation five years later. We find that baseline biological health affects future health service utilisation very strongly, via progression to functional disability channel. We also find systematic income gradients in future disability risks, with those of higher income experiencing a lower progress to disability. Our model reveals that observed pro-rich inequity in health care utilisation, is driven by the fact that higher-income people tend to make greater use of health care treatment, for any given biological health and disability status; this is despite the lower average need for treatment shown by the negative association of income with both baseline ill biological health and disability progression risk. Factor loadings for latent baseline health show that a broader set of blood-based biomarkers, rather than the current focus mainly on blood pressure, cholesterol and adiposity, may need to be considered for public health screening programs.

Long-Term Outcomes of Pediatric Enterovirus Infection in Taiwan: A Population-Based Cohort Study.

Introduction: The major burden of diseases in childhood has shifted from infectious diseases to chronic health conditions in recent decades. Although the rates of infectious diseases have decreased, the incidence of chronic diseases stemming from infectious agents continues to grow. Enterovirus is a major infectious disease of childhood and has been linked to numerous chronic diseases. We analyzed population-based data from Taiwan's National Health Insurance Research Database (NHIRD) to investigate the correlations between enterovirus infection and major chronic health conditions in children.Method: Children diagnosed with enterovirus (EV) infection during 1999–2003 were identified from the Longitudinal Health Insurance Database 2000 (LHID 2000), a subdataset of Taiwan's National Health Insurance Research Database (NHIRD). A total of 14,168 patients were selected after excluding patients with existing chronic diseases and missing data. Another 14,168 children matched by age and sex were selected as the control group. Five primary outcomes, including attention deficit and hyperactivity disorder (ADHD), epilepsy, asthma, allergic rhinitis, and atopic dermatitis, were recorded.Results: The risks of ADHD, asthma, allergic rhinitis, and epilepsy were significantly increased in the EV group compared with the control group. The risk of atopic dermatitis was significantly increased in the crude model. However, there were no significant differences in the adjusted model. The risks of ADHD, asthma, allergic rhinitis, and epilepsy were also significantly increased in patients with severe EV infection compared with patients with non-severe EV infection.Conclusion: Chronic diseases, such as ADHD, epilepsy, asthma, allergic rhinitis, and atopic dermatitis were shown to be associated with enterovirus infection during childhood. EV infection during early childhood might have long-term public health implications and thus prevention strategies should be implemented.

Telenursing of Osteoporosis Self-Management for Women Health

Osteoporosis is a global health and economic burden. It is a major chronic health condition that affects women more than men and it is incurable disease. Postmenopausal women are among those at greatest risk of osteoporosis, but any one of either gender or any race can develop this disease. Effective disease management ultimately lies in the hands of the individual patient, who must take responsibility for key health behaviors related to bone health. One behavior modification strategy that has proven effective to osteoporosis is self-management. The self-management program for osteoporosis, choices for better bone health, helps to educate people about the disease and to promote behavioral strategies for maximizing bone health. Telenursing bridges the access gap to specialized osteoporosis care in remote areas. Improving coordination of investigations, access to allied health members, and future initiatives may improve morbidity and mortality related to osteoporosis in this population. Mobile health (m-Health) interventions hold promise to effect engagement in health behavior change related to calcium and vitamin D intake, balance, core and leg strength, and physical activity.

Needs of Women with Osteoporosis in Disease Self-Management: A Qualitative Study

Background: Osteoporosis is a major chronic health condition that affects women more than men. A few qualitative studies have been conducted to investigate what women with osteoporosis need to manage their disease. Objectives: The aim of the study was to determine the needs of women with osteoporosis in disease self-management. Methods: This qualitative study was conducted at the osteoporosis screening units of three private and governmental centers in Sanandaj, the West of Iran. A purposive sample was recruited from among all eligible women who attended the osteoporosis screening units from November 2015 to June 2016. The inclusion criteria were osteoporosis diagnosis by the woman’s attending physician for at least six months and prescribed osteoporosis medication. The exclusion criterion was a T-score of above -2.5. Data were collected by individual semi-structured interviews, focus group discussion, and drawings. The data were analyzed by conventional content analysis. To confirm the accuracy and strength of the data, credibility, confirmability, and transferability components were taken into account. Results: Four themes emerged from the data analysis, including “social support”, “cultural-economic factors”, “improved implementation of health education”, and “having a normal living”. Conclusions: The results of the study showed that women with osteoporosis are in need of engagement and active participation of primary care physicians, regular review of patient’s care plan, planned care visits, improving the quality of care and patient outcomes, patient education and self-management education, the cooperation of the public media and relevant organizations, and emotional and informational support to improve their osteoporosis self-management.

Associations between depression, chronic physical health conditions, and disability in a community sample: A focus on the persistence of depression

BackgroundPrevious research has demonstrated that comorbid depression and chronic physical health conditions are associated with disability. The distinction between persistent and transient depression in the relationship between physical health conditions and disability, however, is poorly understood. The present study examined the interactive effects of major depressive disorder (MDD) and chronic physical health conditions on disability in a community sample; the effects of persistent or transient depression on disability were also examined. MethodsParticipants were from the Epidemiological Catchment Area of Montreal South-West Study (total N=2202). Past 12-month MDD, chronic physical conditions, functional disability, and disability days experienced within the past month were concurrently assessed. A subsample (n=1226) was used to examine the persistence of depression across three waves of data collection over approximately six years. ResultsIndividuals with comorbid MDD and chronic physical health conditions were approximately thirteen times more likely to have moderate to severe functional disability and had the highest mean number of disability days compared to those without MDD or a chronic physical health condition. Persistent MDD was most strongly associated with functional disability and disability days, and persistence of MDD interacted with physical health conditions to increase likelihood of concurrent disability. LimitationsOur study is limited by a single assessment point for disability and chronic health conditions and by the use of self-report. ConclusionsOur findings suggest that MDD, particularly when persistent, is associated with disability among individuals with a broad range of chronic physical health conditions.

Dropping out of school and chronic disease in the United States.

Despite links between education and health, it is unclear to what extent dropping out of school is associated with major chronic health conditions. Data from the 2006-2010 United States National Survey on Drug Use and Health (NSDUH) was employed and examined associations between dropping out of school and major chronic health conditions among individuals 18 years or older (N=189,896). Analyses show that dropout status is associated with increased odds of reporting a major chronic health condition; however, the effect is stronger for Whites and African-Americans than Hispanics. Study findings suggest that one important strategy to prevent and reduce health disparities is increased education in general including high school completion. Policies and practices that reduce dropout may in turn impact the prevalence of chronic disease.

Prevalence of Major Chronic Conditions among Older Chinese Adults: The Study on Global AGEing and Adult Health (SAGE) Wave 1

BackgroundThe likely corresponding increase in prevalence of chronic disease will be a major challenge for the health care system. Few nationwide epidemiological studies include a large enough sample of older adults to provide estimates of chronic conditions in the older adult population. This study aimed to estimate the prevalence of eight common chronic health conditions and examine socioeconomic inequalities in the diseases among older adults in China.MethodData are from SAGE-China Wave 1, including 13,157 people aged 50-plus years. Respondents were asked if they had been diagnosed with any of the following chronic medical conditions: angina, arthritis, asthma, stroke, diabetes, depression, chronic lung disease and hypertension. A set of validated symptom-based questions and related diagnostic algorithms were also used to estimate disease prevalence for angina, arthritis, asthma and depression. Multivariate logistic regression was performed to examine the probability of developing chronic conditions in relation to sociodemographic variables such as gender, age, urban/rural setting and household wealth level.ResultsFifty percent of respondents reported having one of the selected chronic conditions, 18.9% two conditions, 5.8% three conditions, and 1.4% reported having four or more chronic conditions. Self-reported prevalence was generated for angina (8%), arthritis (22%), asthma (2%), stroke (3%), diabetes (7%), depression (0.3%), chronic lung disease (8%) and hypertension (27%). The symptom-based prevalence of angina, arthritis, asthma and depression was 10%, 20%, 4% and 2%, respectively.ConclusionThis study provides the best available prevalence estimates for major chronic health conditions among older Chinese adults. Findings from this study indicated that major chronic conditions were common, so prevention and early intervention targeting adults aged 50 years and older should be prioritized.

The potential effect of vanadium compounds on glucose-6-phosphatase

Type 2 diabetes is a major chronic health condition in which hyperglycaemia has significant impact on morbidity and mortality, and its ever-increasing incidence has made the production of therapeutic agents for type 2 diabetes more necessary. Vanadium compounds are known to control hyperglycaemia but the exact focus of where they work is a matter of debate. A proposed mechanism of action is that it inhibits glucose-6-phosphatase, a key enzyme in the development of insulin resistance and thus type 2 diabetes. This paper looks at the inhibitory effects of vanadium salts on glucose-6-phosphatase and also studies the mechanism of inhibition, the hypothesis being that the two vanadium compounds, vanadyl sulphate (VOSO4) and vanadyl acetylacetonate (Vace) will inhibit glucose-6-phosphatase. This was achieved by using a proof of principle study by extracting glucose-6-phosphatase from bovine liver microsomes using differential centrifugation, and then the enzyme was assayed in the presence and absence of vanadium compounds. The study found that vanadyl compounds inhibit glucose-6-phosphatase, as mean specific enzyme activity was calculated which showed that VOSO4 at a concentration of 48 µM inhibited glucose-6-phosphatase activity by 36.9% (P < 0.0003) and Vace at a concentration of 200 µM inhibited glucosse-6-phosphatase activity by 50% (P < 0.0001) similar to findings in the previous research. However, this study also found using Lineweaver–Burk plot analysis that VOSO4 is a competitive inhibitor of glucose-6-phophatase and Vace is a mixed: non-competitive and uncompetitive inhibitors of glucose-6-phosphatase. The mechanism of inhibitory action of these vanadyl compounds had not been reported previously. The difference in the concentration of inhibitor required may be due to the type of inhibition. This supports the hypothesis to some extent as the results were found to be statistically significant; however, further data will be required to clarify these findings.

The prevalence of diabetes, pre-diabetes and the metabolic syndrome in an Irish regional homeless population

Diabetes is a major chronic health condition. Prevalence is rising, superseding public health estimates. Chronic diseases are more common among lower socioeconomic groups, for example, the homeless population. There is paucity of data on the health status of the homeless population in Ireland, and the prevalence of diabetes and associated cardiovascular risk factors is unknown. We aimed to assess the prevalence of diabetes, pre-diabetes and the metabolic syndrome (MetS) in an Irish regional homeless population. This study is a cross-sectional study of the homeless population living in a regional university city of Ireland. After informed consent and following an overnight fast, blood was drawn for fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein and glycosylated haemoglobin (HbA1c). A 75 g glucose load was given orally and an oral glucose tolerance test completed. Anthropometric measurements and blood pressure were recorded. Smoking, alcohol and drug status were noted. Of the 252 participants, 8% (n = 20), 10% (n = 24) and 21% (n = 54) were diagnosed with type 2 diabetes, pre-diabetes and MetS, respectively. Obesity (body mass index >30) was present in 22%, while 90% displayed abdominal obesity. Participants who screened positive for diabetes, pre-diabetes and MetS demonstrated an inferior cardiovascular risk profile. The prevalence of diabetes, pre-diabetes and MetS in this homeless population is in keeping with national estimates. As this cohort is less likely to seek health care, this may result in later diagnosis and a greater risk of diabetic complications at presentation.

Things Fall Apart: Health Consequences of Mass Imprisonment for African American Women

In this article, we examine the possible impact of mass imprisonment on the physical health of African American women. Specifically, we focus on a variety of mechanisms through which mass imprisonment may increase the risk of having three major chronic health conditions that are risk factors for cardiovascular disease (CVD): hypertension, diabetes, and obesity. This approach is distinctive in that it provides a broad theoretical framework through which mass imprisonment might harm the physical health of African American women in ways separate from the pathways linking mass imprisonment to their risk of contracting infectious diseases (especially HIV and other STIs), which has been the emphasis of most research in this area. In order to draw these connections, we begin by briefly discussing what mass imprisonment is and its social consequences. We then discuss our three CVD risk factors, documenting disparities between white and African American women in these risk factors and discussing mechanisms through which mass imprisonment might contribute to these disparities. We close by discussing the data needed to test our hypotheses and suggesting some avenues for future research.

Race and Unhealthy Behaviors: Chronic Stress, the HPA Axis, and Physical and Mental Health Disparities Over the Life Course

We sought to determine whether unhealthy behaviors play a stress-buffering role in observed racial disparities in physical and mental health. We conducted logistic regressions by race on data from the first 2 waves of the Americans' Changing Lives Survey to determine whether unhealthy behaviors had buffering effects on the relationship between major stressors and chronic health conditions, and on the relationship between major stressors and meeting the criteria for major depression. Among Whites, unhealthy behaviors strengthened the relationship between stressors and meeting major-depression criteria. Among Blacks, however, the relationship between stressors and meeting major-depression criteria was stronger among those who had not engaged in unhealthy behaviors than among those who had. Among both race groups there was a positive association between stressors and chronic health conditions. Among Blacks there was an additional positive association between number of unhealthy behaviors and number of chronic conditions. Those who live in chronically stressful environments often cope with stressors by engaging in unhealthy behaviors that may have protective mental-health effects. However, such unhealthy behaviors can combine with negative environmental conditions to eventually contribute to morbidity and mortality disparities among social groups.

Experience and Management of Chronic Pain Among Patients With Other Complex Chronic Conditions

Managing multiple chronic health conditions is a significant challenge. The purpose of this study was to examine the experience and management of chronic pain among adult patients with other complex chronic conditions, specifically diabetes and heart failure (HF). We surveyed 624 US Department of Veterans Affairs primary care patients in 3 study groups: 184 with HF, 221 with diabetes, and 219 general primary care users. We compared health status and function between those with and without chronic pain within the 3 study groups. Among those with chronic pain, we compared pain location, severity, and treatment across groups. More than 60% in each group reported chronic pain, with the majority reporting pain in the back, hip, or knee. In all groups, patients with chronic pain were more likely to report fair or poor health than those without pain (P<0.05). In the HF and diabetes groups, a higher percentage of patients with pain were not working because of health reasons. Of those with pain, more than 70% in each group took medications for pain; more than one-half managed pain with rest or sedentary activities; and less than 50% used exercise for managing their pain. Chronic pain is a prevalent problem that is associated with poor functioning among multimorbid patients. Better management of chronic pain among complex patients could lead to significant improvements in health status, functioning, and quality of life and possibly also improve the management of their other major chronic health conditions.

Chronic Disease in the Childhood Cancer Survivor Study Cohort: A Review of Published Findings

A primary objective of the Childhood Cancer Survivor Study (CCSS) is to characterize the major chronic health conditions faced by childhood cancer survivors, and to determine the risk factors for those conditions. In order to characterize these conditions, at entry into the study, participants completed questionnaires that documented self-reported chronic illnesses, symptoms, and medications. Over time, follow-up questionnaires (administered approximately every 2 to 3 years) have allowed analysis of changes in symptoms and disease burden. To date, analyses have been completed which describe the profile of chronic disease in the cohort at first entry into the study and for specific subgroups, defined by primary cancer, by specific exposures, and by demographic factors.1,2 Generally, these analyses estimate risk of chronic disease by calculating a risk estimate for self-reported symptoms or conditions. Relative risks for chronic disease or specific conditions are calculated comparing the survivor cohort with the sibling cohort or population norms. In addition, relative risk for an outcome in a subgroup with a specific treatment exposure or demographic characteristic is calculated relative to a comparison group without that specific factor of interest. Cumulative incidence of specific chronic illnesses is estimated in many of the reports, and analyses of chronic illnesses in each of the survivor groups by primary diagnosis are completed (acute lymphoblastic leukemia [ALL],3 acute myeloid leukemia [AML],4 and rhadbdomyosarcoma5) or in progress (neuroblastoma, bone sarcoma, renal tumors, lymphomas, and brain tumors). This review presents the completed analyses of overall chronic illness in the original cohort and then describes findings by organ system. Specific chronic diseases reported here will include: endocrinologic disorders (including thyroid disease, disorders of growth, weight, and pubertal regulation), osteonecrosis, cardiac disease, pulmonary conditions, and neurosensory/neurologic adverse outcomes. Adverse outcomes in some domains which might be considered chronic illnesses—secondary cancers, emotional and psychological disorders, pain—are not covered herein, but are reviewed separately in other articles within this issue of Journal of Clinical Oncology. For some outcomes, only subsets of the cohort have been analyzed, often because a hypothesis regarding a specific exposure or disease (eg, weight regulation in leukemia survivors or stroke after neck radiation therapy [RT]) has been explored. Analyses in progress, and not included in this report, include risk of renal and urinary disorders, gastrointestinal diseases, and more in depth cohort-wide characterizations of cardiovascular disease. Additional studies to characterize further longitudinal changes in risk as the cohort ages are planned.

Monitoring of quality of life in congestive heart failure populations.

The health care system has traditionally focused on treating disease at the point of failure, such as life-saving surgery or intensive medical therapy. As demographics shift more to an aging population, management of health-related quality of life and life-restricting disease becomes more necessary. Prominent among such diseases is congestive heart failure, which must be addressed as a major chronic health condition with its consequent effect on quality of life. This paper examines the methods of monitoring the quality of life in congestive heart failure. Particular attention is paid to congestive heart failure-related questionnaires to derive lifestyle information directly from patients. Comparison is made with general quality of life instruments. Most commonly, these questionnaires are applied to small populations in limited situations. New technology, such as the Internet, has greatly expanded the breadth and depth of health monitors by tracking status directly in patients' homes. This promises new levels of population management for heart disease. (c)2001 by CHF, Inc.