Medical Management Of Chronic Disease Research Articles

Pandemics, policy, and the power of paradigm: will COVID-19 lead to a new scientific revolution?

Critical historical analysis of the 19th-century cholera and 21st-century coronavirus-19 (COVID-19) pandemics suggests that in conflicts over pandemic-mitigation policies, the professional backgrounds of principal opponents reveal dominant and minority scientific paradigms, presaging possible epistemological shifts. Epistemic conflict over cholera helped spur biomedical expertise as the dominant paradigm for U.S. public health science and policy beginning in the 20th century. This paradigm was reflected in federal government reliance on infectious disease physicians as the primary scientific decision makers in the COVID-19 pandemic. Similarly, epistemic conflict over challenges to behavioral and social well-being in 2020 may highlight discordance between the dominant biomedical paradigm used in making federal policy and the inherently holistic impact of that policy on population health, suggesting need for a new paradigm of multidisciplinary scientific engagement. Because population-wide public health initiatives affect many aspects of health—physiological, psychological, behavioral, and social—that are best measured and interpreted by experts in these respective fields, multidisciplinary scientific engagement would facilitate optimal, holistic evaluation of policy benefits and harms. This multidisciplinary approach, analogous to that currently recommended in medical management of chronic disease, would advance epidemiological research to inform evidence-based policy for public health crises in which U.S. population-wide interventions are contemplated.

Statistical Analysis of Metagenomics Data.

Understanding the role of the microbiome in human health and how it can be modulated is becoming increasingly relevant for preventive medicine and for the medical management of chronic diseases. The development of high-throughput sequencing technologies has boosted microbiome research through the study of microbial genomes and allowing a more precise quantification of microbiome abundances and function. Microbiome data analysis is challenging because it involves high-dimensional structured multivariate sparse data and because of its compositional nature. In this review we outline some of the procedures that are most commonly used for microbiome analysis and that are implemented in R packages. We place particular emphasis on the compositional structure of microbiome data. We describe the principles of compositional data analysis and distinguish between standard methods and those that fit into compositional data analysis.

An Ethnographic Study on the Factors Affecting Adherence to Directly Observed Treatment Short-Course in Typical Indian Settings

Efficient management of chronic illness remains a common clinical problem. Non-adherence to a prescribed medical regimen remains a tremendous barrier to the effective medical management of chronic diseases and is considered one of the most serious problems that the medical world faces in the present. Tuberculosis is one such chronic disease which has been a prevalent problem in most of the developing nations, including India. In this paper, we describe an ethnographic study conducted in the state of Assam, with the objective of deciphering the multiple factors that are associated with the failure of the treatment regimen of Tuberculosis, viz. the DOTS (Directly Observed Treatment Short course) programme under RNTCP (Revised National Tuberculosis Control Programme).

Principe et réalisation pratique de l’éducation thérapeutique du patient (ETP)

The Therapeutic Patient Education (PE) is an integral part of the medical management of chronic diseases in the field of Rheumatology. TPE has been structured during the recent years, particularly in France in the form of various laws, including the Law HPST who put real solid foundations of this concept. To be implemented, a therapeutic patient education program must meet a number of conditions, in particular, to be authorized by the Regional Health Agency (ARS). The TPE program must meet four steps defined by the National Health Authority (HAS), (the educational diagnosis, development of a personalized program, implementation of the program, and evaluation). Management of education must be an integral part of the course of patient care. TPE program should theoretically aim acting to act on three levels: information, coping and know-how to change patient's behaviour in order to improve adherence, health status and therefore, his quality of life. TPE has a stronghold in France, and as such, it is part of the criteria for accreditation of healthcare facilities. The French rheumatology is well represented in this national approach (rank 6 in authorized programs). In the future, challenge is clearly the financing including the ability to develop an offer of TPE close to the patient's places of residence.

일부 노인의 보완대체요법 이용행태와 영향요인

= Abstract = Objectives: The aim of this study is to analyze the utilization behaviour and influencing factors of complementary and alternative medicine (CAM) therapies among elderly people with chronic diseases. Methods: The study population was selected among 9 welfare facilities for the aged in 2 cities among Daegu Metropolitan City & Gyeongsangnam Province by two-stage cluster sampling. 250 senior citizens participated in a face-to-face interview using a structured questionnaire. Logistic regression analysis was performed to examine the association between the utilization of CAM therapies and various characteristics of the elderly. All statistics were analyzed using the PASW (ver 18.0). Results: Among 233 elderly peoples, 70.4% (164 persons) had used various kinds of CAM therapies (including nutritional methods, pharmacologic and biologic treatments, etc.) more than once during the last year. 48.8% (64 persons) ∼ 60.7% (88 persons) of the elderly used CAM therapies without health and medical experts' counsel. The elderly with perceptions of CAM therapy used it 2 times more than those without knowledge of CAM therapies. The number of chronic diseases was more likely to increase the usage of nutritional methods (OR=2.92, 95% CI: 1.07-7.97), manipulative and body-based practices (OR=5.85, 95% CI: 1.97-17.34), pharmacologic and biologic treatments (OR=2.92, 95% CI: 1.49-8.17). Elderly with diabetes used nutritional methods 3.76 (95% CI: 1.49-9.47) more than elderly without diabetes. Conclusions: CAM therapies use in the aged with chronic diseases appears common. The findings suggest that the clinical efficacy and safety of CAM therapies on medical management of chronic disease may be investigated and that patient-physician communication need to be strengthened.

Nutrition impacts the prevalence of peripheral arterial disease in the United States

Traditional recommendations for peripheral arterial disease (PAD) risk factor reduction include smoking cessation, low-fat/low-salt diet, exercise, and optimal medical management of chronic disease. Little attention has been paid to the role of dietary supplementation of specific nutrients in the prevention of PAD. This cross-sectional study used the National Health and Nutrition Examination Survey (NHANES) to determine specific nutrients that are associated with prevalent PAD in the United States (US) population. NHANES data include nationwide sampling of the US population, using physical examination, questionnaire, and laboratory testing. PAD status was defined by an ankle-brachial index (ABI) of <0.9. Nutritional information was collected by 24-hour dietary recall using the US Department of Agriculture dietary collection instrument. Data were linked to a database of foods and their nutrient composition. Univariate and multivariate logistic regression analyses were performed to evaluate associations between specific nutrient intake and the presence of PAD. Multivariate models adjusted for the effects of age, gender, hypertension, coronary vascular disease, diabetes, and smoking. NHANES data for 1999 to 2004 included 7203 lower extremity examinations, of which 422 individuals had prevalent PAD (5.9%). Examinees with PAD had significantly higher rates of hypertension, coronary artery disease, diabetes, and smoking than those without PAD. Univariate analysis revealed that consumption of all nutrients considered were associated with lower odds of PAD, including antioxidants (vitamins A, C, and E), folate, other B vitamins (B(6), B(12)), fiber, and polyunsaturated and saturated fatty acids. After adjustment for traditional risk factors, nutrients associated with reduced prevalence of PAD were vitamin A (odds ratio [OR], 0.79; P = .036), vitamin C (OR, 0.84; P < .001), vitamin E (OR, 0.78; P = .011), vitamin B(6) (OR, 0.71; P = .023), fiber (OR, 0.65; P < .001), folate (OR, 0.67; P = .006), and omega-3 (alpha-linolenic) fatty acid (OR, 0.79; P = .028). Improved nutrition is associated with a reduced prevalence of PAD in the US population. Higher consumption of specific nutrients, including antioxidants (vitamin A, C, and E), vitamin B(6), fiber, folate, and omega-3 fatty acids have a significant protective effect, irrespective of traditional cardiovascular risk factors. These findings suggest specific dietary supplementation may afford additional protection, above traditional risk factor modification, for the prevention of PAD.

The management of Peyronie's disease.

Peyronie's disease has no known cause; recent understanding of the molecular mechanisms involved and the development of an animal model will aid the medical management of early disease. The medical management of chronic disease is futile as the delicate tunical architecture cannot regenerate. Surgical correction of the penile deformity is required in a minority of patients, and a choice lies between a Nesbit operation and a plaque incision and venous patch in patients who are concerned with penile shortening.

Modifying and developing health behavior.

The literatures on both behavior modification and behavioral development have engendered innovations in public health programs, addressing problems of patient adherance to preventive and therapeutic regimens, delay in seeking diagnosis of illness symptoms, risk-taking behavior, and other aspects of lifestyle associated with health. Because most of this literature derives from psychology, there has been a distinct bias in the construction of interventions, pointing them directly at individuals, usually in a counseling or small group mode of delivery. These developments served public health well enough during a decade or so when the preoccupation was with utilization of health services and medical management of chronic diseases. With the publication of the Lalonde Report in Canada in 1974, the passage of Public Law 94-317 in 1976 in the United States, and similar initiatives in other English-speaking and European countries, the recognition of the greater complexities of lifestyle development and modification in the absence of symptoms has taken hold. Policy makers and public health workers seek a more efficient and equitable set of strategies to meet the behavioral health challenges of modern society without placing the entire weight of responsibility for behavior on the individual or on therapeutic practitioners. Concurrently, on a more global scale and in the developing countries, a concern has emerged for strategies that give individuals, families, and communities a greater role in deciding their own health priorities. The convergence of these two trends--one seeking to distribute responsibility for lifestyle more equitably and the other seeking to distribute responsibility for planning health programs more equitably --calls for policies, strategies, and interventions that will place similar emphasis on health education and organizational, economic, and environmental supports for health behavior. The combination of these elements of support for behavior calls, in turn, for research and more inventive applications of theory from sociology, political science, economics, and anthropology. Public health workers will need to become more conversant and facile in these social sciences, as they have in psychology and its applications in the recent past.