Prevalence Of Chronic Illness Research Articles

Older adolescent presentations to a children's hospital emergency department.

To describe the characteristics, diagnoses and outcomes of older adolescents, aged 16-19years, presenting to a paediatric ED. A retrospective review of total ED presentations by older adolescents to a tertiary paediatric hospital between 2010 and 2012, inclusive, was undertaken to determine if behavioural or mental health problems were common. A total of 1184 ED presentations by 730 older adolescents were identified. Injury and abdominal pain were the most common complaints for presentations by older adolescents to the ED. The median length of stay in ED was 241 (range: 0-3873) min. More than 60% of the older adolescent ED presentations were triaged urgent or semi-urgent, and 39% of all these presentations resulted in hospital admission. Two-thirds of these older adolescents had a chronic illness, which accounted for 77% of all ED presentations by older adolescents. The history of chronic illness was considered related or relevant in the evaluation and management of over 80% of older adolescents. Of all the ED presentations by older adolescents with chronic illness, only one quarter had transition planning documentation. A high prevalence of chronic illness was found in older adolescents attending the paediatric ED. There was no evidence that behavioural and mental health issues dominated. These findings reflect admission policy.

Prevalence of Chronic Illnesses among Medical Students Atking Faisal University (KFU) and their Impact on Academic Performance

Prevalence of Chronic Illnesses among Medical Students Atking Faisal University (KFU) and their Impact on Academic Performance

An epidemiological study of protein energy malnutrition among children below six years' age in an urban slum of Gurgaon, Haryana, India

Background: Poorly nourished child grows less rapidly during first 6 years of age. In India, around 43% of fewer than five children were underweight. Child protein energy malnutrition reflects a number of intermediately processes such as household access to food, access to health service and caring practices. The present study was undertaken to assess prevalence of PEM as well as the nutritional status of children below six years’ age group and to explore most probable risk factors influencing PEM. Methods: The study was a community based cross-sectional study carried out in 500 randomly selected households in a slum area of Gurgaon among the children below 6 years of age using pretested Performa which contained details regarding socio-demographic, nutritional conditions and utilization of health care services. Nutritional status was assessed by Physical examination, anthropometric measurement, haemoglobin and parasitological (stool) tests. Nutritional grading was done according to by physical and anthropometric examination of child using Indian Academy of Pediatrics (IAP) classification and supplemented by WHO growth chart. Data was entered in the MS Excel sheet and analyzed using Epi info Ver 7. Results: During survey acute illness detected among 0.25% children and chronic illness prevalence was 25%. Prevalence of PEM was found to be 43.86% (37.73% among males, 50.0 % among females). Clinical signs of nutritional deficiency were detected among 31.48 % of children. Common types of nutrition deficiency were anemia, PEM, and vitamin A and B complex deficiencies. Main reasons of PEM were attributed to female sex, poor literacy of parents, low socioeconomic status, higher No. siblings and large family, recurrent diarrhea and other infections, prolonged breast feeding with delayed introduction of supplements particularly semisolid and poor quality of supplements. Intestinal parasite detected among 38.43% of children, commonest parasite being giardia, ascariasis and thread worms; existing health services utilized in 30.72% of total illness. This was identified not due to lack of knowledge but other domestic problems. Conclusions: Prevalence of PEM was attributed to poor living conditions, poor literacy status of parents, higher No. of siblings, poor utilization of health services, poor nutritional services of children and faulty breast feeding and weaning practices in the family. Public health specialists should plan interventions focusing on these issues.

Integrating mental health into chronic care in South Africa: the development of a district mental healthcare plan.

BackgroundIn South Africa, the escalating prevalence of chronic illness and its high comorbidity with mental disorders bring to the fore the need for integrating mental health into chronic care at district level.AimsTo develop a district mental healthcare plan (MHCP) in South Africa that integrates mental healthcare for depression, alcohol use disorders and schizophrenia into chronic care.MethodMixed methods using a situation analysis, qualitative key informant interviews, theory of change workshops and piloting of the plan in one health facility informed the development of the MHCP.ResultsCollaborative care packages for the three conditions were developed to enable integration at the organisational, facility and community levels, supported by a human resource mix and implementation tools. Potential barriers to the feasibility of implementation at scale were identified.ConclusionsThe plan leverages resources and systems availed by the emerging chronic care service delivery platform for the integration of mental health. This strengthens the potential for future scale up.

Psychosocial health coaching for chronically ill in a telehealth context: a pilot study

Psychosocial health coaching for chronically ill in a telehealth context: a pilot study

Medical rehabilitation in low and middle income countries for adult acquired disability: challenges posed by rapidity of health system change and position on the individualistic/collectivist axis.

Chronic illness prevalence has rapidly increased in low or middle income countries (LMIC) and with it, the need for medical rehabilitation for adults with acquired conditions that stem from aging and long-term conditions. While Western medical rehabilitation programs have had at least two generations to develop, in LMIC, post-acute health care delivery change has been much more rapid. As a result, there has been little opportunity for models of medical rehabilitation to deliberately emerge in LMIC that reflect societal values. While adaptation of an independence-foremost model of medical rehabilitation may succeed in non-Western societies, there is a risk that adaptation of such a model will be ineffective where many value collectivism more than individualism. The rapid change in medical rehabilitation service delivery in LMIC gives Christian providers and organizations an opportunity to pause and reflect whether the dominant Western medical rehabilitation paradigm serves LMIC cultures and reflects Biblical principles.

Measured outcomes of chronic care programs for older adults: a systematic review.

BackgroundWagner’s Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease. Given the high prevalence of chronic illness in older persons, these frameworks can play a valuable role in reorienting the health care system to better serve the needs of seniors. We aimed to identify and assess the measured goals of E/CCM interventions in older populations. In particular, our objective was to determine the extent to which published E/CCM initiatives were evaluated based on population, community, system and individual-level outcomes (including clinical, functional and quality of life measures).MethodsWe conducted a systematic search of the Science Citation Index Web of Knowledge search tool to gather articles published between January 2003 and July 2014. We included published CCM interventions that cited at least one of the fundamental papers that introduced and described the CCM and ECCM. Studies retained for review reported evaluations of senior-focused E/CCM initiatives in community-based settings, with the topic of “older adults” OR senior* OR elder* OR geriatric OR aged. The resulting 619 published articles were independently reviewed for inclusion by two researchers. We excluded the following: systematic reviews, meta-analyses, descriptions of proposed programs, and studies whose populations did not focus on seniors.ResultsWe identified 14 articles that met inclusion criteria. Studies used a wide range of measures, with little consensus between studies. All of the included studies used the original CCM. While a range of system-level and individual patient outcomes have been used to evaluate CCM interventions, no studies employed measures of population or community health outcomes.ConclusionsFuture efforts to test E/CCM interventions with seniors would be aided by more consistent outcome measures, greater attention to outcomes for the caregivers of older persons with chronic illness, and a greater focus on population and community impacts.

Outcome of the elderly patient in intensive care: a cohort study

The world population is ageing, by 2050 the percentage of the population older than 80 years will double. Older age is associated with higher prevalence of chronic illness and functional impairment, contributing to an increased rate of hospitalization and admission to Intensive Care Units.

DRUG CLASSES PROFILE AMONG ELDERLY PATIENTS ADMITTED TO GERIATRIC UNIT

Background Elderly people have a higher prevalence of chronic illness, disability and dependency and are more likely to be on medication than younger people. They are often taking several drugs at once to treat concomitant disease processes. Aim To identify and classify different types of drugs and comorbid diseases encountered among hospitalized elderly patients. Methods Data were prospectively collected from 320 patients aged ≥ 65 hospitalized at the Department of Geriatrics and Gerontology at a university teaching hospital in Egypt among 17 month study period. Patient’s medical profiles were studied carefully for identification and classification of different types of drugs and comorbid diseases encountered among hospitalized elderly patients. Results There were different types of comorbid diseases encountered among the patients, with a median of five per patient and a range of 1-11 per patient. The most common medical disorders among the studied patients were hypertension (52.8%), diabetes (42.5%) and chronic liver diseases (40.3%). The total number of medications prescribed was 2985; median number of medications per patient was nine (range 2-20). The most commonly prescribed medications were antacids and peptic ulcer medications (78.1%), antiplatelet and anticoagulants (77.2%) and antibiotics (68.1%). While the less frequently prescribed drugs were skeletal muscle relaxant (0.6%) and antifungal drugs (0.3%). Conclusion Results of the current study have reported the presence of poly-pharmacy and poly-morbidity among this Egyptian elderly patient’s profile.

Inherent Tensions Between Population Aging and Health Care Systems: What Might the Canadian Health Care System Look Like in Twenty Years?

This paper attempts to elucidate the dynamics and inherent tensions of population aging as it relates to age-period-cohort changes in health status and health care utilization, and attainable system-level transformations. Using the Canadian context, we specifically address three interlocking problems: 1) the paradox of increasing life expectancy with compression of morbidity, concurrent with the rise in the prevalence of chronic illnesses and comorbidity; 2) the complex interactive relationship between baby boomer health status change and temporal improvements in health care efficiency; and 3) the disconnect between health care system efficiency and increasing demands, including patient expectations and end-of-life decision-making. These issues are investigated using interdisciplinary evidence, and applying a set of assumptions to scientific forecasting of modern health care system transformations over the next 20 years, the period in which population aging will peak. Two extreme scenarios positioned at opposite ends of a continuum are advanced that differ on the timing and extensiveness of policy reform versus system-level inertia.

Creating A Serious Game for Health

The prevalence of chronic illnesses continues to increase as does the cost of such care. Teaching self-management skills is more effective than solely providing information and teaching technical skills at improving health outcomes. Serious games for health provide an opportunity to support learning and health-related behavior change using messages and experiences in an engaging and entertaining format. We developed eSMART-HD with the intention of improving interactions between patients with chronic disorders and their health care providers. This paper describes the factors that we considered when creating eSMART-HD, a serious game for health.

Inflammaging: A Concept Analysis

In this report we assess the concept of inflammaging. As the population ages, the prevalence of chronic illness will dramatically increase. Inflammaging describes the chronic inflammatory state associated with aging. Antecedents include immunosenescence, genetics, gonadasenescence, adrenosenescence, somatosenescence, calcium senescence, and lifestyle factors. The defining characteristics are an age-related chronic, systemic, asymptomatic, low-grade inflammation. Frailty, morbidity, and mortality are the consequences. Clinical indicators are serum levels of C-reactive protein, interleukin-6, tumor necrosis factor-α, and interleukin-1β. This concept attempts to unify disparate diseases that affect the elderly by suggesting they have similar etiology. Inflammaging has significant research and clinical implications for nurse practitioners.

Contested professional role boundaries in health care: a systematic review of the literature

BackgroundAcross the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and professional hierarchies. Population ageing is known to be associated with a rise in prevalence of chronic illnesses which, coupled with a reducing workforce, now places much greater demands on healthcare provision. Role flexibility within the health professions has been identified as one of the key innovative practice developments which may mitigate the effects of these demographic changes and help to ensure a sustainable health provision into the future. However, it is clear that policy drives to encourage and enable greater role flexibility among the health professions may also lead to professional resistance and inter-professional role boundary disputes. In the foot and ankle arena, this has been evident in areas such as podiatric surgery, podiatrist prescribing and extended practice in diabetes care, but it is far from unique to podiatry.MethodsA systematic review of the literature identifying examples of disputed role boundaries in health professions was undertaken, utilising the STARLITE framework and adopting a focus on the specific characteristics and outcomes of boundary disputes. Synthesis of the data was undertaken via template analysis, employing a thematic organisation and structure.ResultsThe review highlights the range of role boundary disputes across the health professions, and a commonality of events preceding each dispute. It was notable that relatively few disputes were resolved through recourse to legal or regulatory mandates.ConclusionsWhilst there are a number of different strategies underpinning boundary disputes, some common characteristics can be identified and related to existing theory. Importantly, horizontal substitution invokes more overt role boundary disputes than other forms, with less resolution, and with clear implications for professions working within the foot and ankle arena.

Managing care for people with chronic conditions: an overview of evidence and experiences

Background The rising prevalence of chronic illness poses considerable challenges to health systems globally. Part of this challenge is that chronic conditions create a spectrum of needs that require multifaceted responses over extended periods from a range of professionals as well as active patient engagement. The need to develop coordinated or integrated approaches to service delivery has been widely recognised but it has been difficult to …

Examining the Structural Relationship of Chronic Illness, Physical Function, Life Satisfaction, and Social Support in the Development of Depression Among Filipino Elderly in Institutionalized Settings

Considering the increasing prevalence of chronic illness in the Filipino elderly, this study seeks to test a model that describes the relationship between chronic illness and depression and how this link might interact with physical functioning, life satisfaction, and social support. Structural equation modeling was used to examine the causalities among these variables. With the participation of 151 respondents, data were gathered using a five-part instrument consisting of the robotfoto, Katz Index of Independence in Activities of Daily Living, Life Satisfaction Checklist, Social Support Scale, and Geriatric Depression Scale. Data were analyzed using AMOS version 19. Results showed that the duration and number of present chronic illness will not lead to an increase in social support, although those things proved to have a negative effect on physical functioning and life satisfaction. Social support from the family also showed to have a direct impact on life satisfaction while social support from the caregivers revealed a negative effect on physical functioning. Life satisfaction had a negative influence on depression while other suggested variables have no impact on depression at all. Through this model examining the variables relating to depression, holistic care must be provided to manage not only the medical conditions of the elderly but also their physical, social, and psychological well-being.

College Freshmen with Chronic Illness: A Comparison With Healthy First-Year Students

Over the past four decades, advances in medicine have decreased the mortality rates of many previously fatal chronic diseases (American Academy of Pediatrics, 2002). Children who would have died early in life are now living well into adulthood, and many are matriculating as college students (Maslow, Haydon, McRee, Ford, & Halpern, 2011). Each year in the US, more than 500,000 youth with chronic conditions, ranging from diabetes to bipolar disorder, turn 18 years old (Lotstein, McPherson, Strickland, & Newacheck, 2005), and colleges must adapt to face this new challenge. In high school, although children with chronic illness have greater absenteeism than their healthy peers, the vast majority are able to graduate (Maslow et al. 2011; Suris, Michaud, & Viner, 2004). Despite their having similar high school graduation rates, data from the National Longitudinal Study of Adolescent Health indicate that youth with chronic illness are only half as likely to graduate from college as their healthy peers (18% vs. 32%; Maslow et al., 2011; Olson, 2004). Data regarding the prevalence of chronic illness among college students, the college experience of chronically ill students, and why such students are at greater risk of failing to graduate from college are limited. One study found that one third of college respondents reported some form of long-standing illness (Stewart-Brown et al., 2000). Bishop (2005) examined quality of life and psychosocial adaptation for college students with chronic illness in a sample of 72 students, most with physical disabilities or psychiatric conditions. From these data, Bishop theorized that healthrelated quality of life is linked to positive adaptation to student life for college students with chronic illness. Non-health-related challenges facing chronically ill students can be extrapolated from studies of chronically ill adolescents, such as one by Shiu (2001) that suggests that disruptions in peer relationships may increase educational drop-out rates. Loneliness is one construct that has been examined for college students in general and has been found to be an important mediator of health behavior correlated with depression (Ponzetti, 1990; Wisemann & Guttfreund, 1995; Yarcheski, Mahone, Yarcheski, & Canella, 2004). Youth with chronic illness may be at particular risk for isolation and loneliness. Taken together, this evidence suggests that important factors that may affect the adaptation to college for youth with chronic illness include lower quality of life and greater isolation as compared to healthy peers,

Body composition and its association with health outcomes among elderly South Koreans

Sarcopenic obesity (SO) in the elderly is associated with a loss of independence and the occurrence of metabolic complications. Despite this clinical importance, the associations of SO with various health outcomes in Asian elders are unclear. This study aimed to examine the association of SO with the prevalence of chronic illness and mobility limitations among 1204 subjects (576 men and 628 women) over the age of 60 from the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-1, 2010). The patients were placed in four categories based on body composition: normal, sarcopenic non-obese, normal obese, and SO. Data regarding functional dimensions were extracted from the EQ-5D in the KNHANES data (i.e., mobility, self-care, and usual activities). Pain/discomfort data were also extracted. The prevalence of SO was higher among the women than the men (7.2% vs. 4.1%). Hypertension and arthritis were associated with increased likelihoods of SO. People with SO were more likely to report problems in mobility (OR: 3.34, 95% CI, 1.97–5.65), self-care (men: OR: 2.92, 95% CI, 1.05–8.07, women: OR: 2.33, 95% CI, 1.29–4.21), and usual activity (men: OR: 2.28, 95% CI, 1.02–5.08, women: OR: 2.13, 95% CI, 1.29–3.52). In conclusion, our results showed that SO was associated with mobility, self-care, and usual activity problems. With the rapid ageing that is occurring in Korea, more attention should be given to the prevention and management of sarcopenic obese seniors.

Practitioner perspectives from seven health professional groups on core competencies in the context of chronic care

The prevalence of chronic illness is growing worldwide and management is increasingly undertaken by interprofessional teams, yet education is still generally provided in separate professions. The aim of this study was to explore the perspectives of New Zealand healthcare practitioners from seven professional groups involved in chronic care (general practice medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech language therapy) on the core competencies required of those working in this area. The study was set in the context of the chronic care and shared decision-making (SDM) models. The core competencies for chronic care practitioners proposed by the World Health Organisation were used to shape the research questions. Focus groups with expert clinicians (n = 20) and semi-structured interviews with practitioners (n = 32) were undertaken. Findings indicated a high level of agreement that the core competencies were appropriate and relevant for chronic care practitioners but that many educational and practice gaps existed and interprofessional education in New Zealand was not currently addressing these gaps. Among the key issues highlighted for attention by educators and policy-makers were the following: teams and teamwork, professional roles and responsibilities, interprofessional communication, cultural competence, better engagement with patients, families, and carers, and common systems, information sharing and confidentiality.

The Changing Face of General Internal Medicine and Lessons Learned from Geriatric Medicine

This issue of JGIM contains a collection of articles focused on geriatrics that is being published at a significant juncture in United States healthcare, perhaps not seen since the introduction of Medicare in the 1960s. As the need to address the complex intersection of an aging, sicker population is compounded by potential limitations of staffing, healthcare delivery, reimbursement, and policies, these articles help frame the discussion of the future role of general internal medicine. Older adults (people 65 and older) currently comprise 13 % of the US population and account for 43% of annual inpatient care spending. That portion of the population is expected to continue using more health care services, and to increase from 13 % to 19 % of the population by 2030.1 Older adults are at greater post-hospitalization risk; one in 20 die during hospitalization and another 20–30 % die within one year following hospital discharge.2 Since this population has the highest prevalence of chronic illness and highest per capita health care spending, effective and efficient care of older adults is critical to controlling future federal spending. Areas addressed by the authors of these articles include: further evaluating the training of primary care providers; re-evaluating methods for health care delivery; and continuing down the path of new funding and research mechanisms in geriatrics. Additional commentary regarding these topics is provided below.

The impact of workforce redesign policies on role boundaries in 'generalist' podiatry practice: expert views within the professional body.

BackgroundDemographic changes and a predicted rise in the prevalence of chronic illness have led to a range of health policies in the UK (and elsewhere) focused on workforce flexibility and extended roles for the allied health professions. Whilst much academic attention has been paid to extended specialised roles for allied health professionals such as podiatrists, little work has addressed the likely impact of these policy changes on non-specialist, ‘generalist’ podiatry practice. This study aimed to explore expert professional views on the impact of role flexibility on generalist podiatry practice.MethodsExpert podiatry practitioners drawn from within the professional body, the Society of Chiropodists and Podiatrists/College of Podiatry were recruited to 3 focus groups and 4 individual semi structured interviews and the data subject to a thematic analysis.ResultsThree key themes emerged, reflecting concerns about the future of generalist podiatry practice in the NHS, a perceived likelihood that generalist care will move inexorably towards private sector provision, and a growth in support worker grades undermining the position of generalist practice in the mainstream health division of labour. Up skilling generalist practitioners was viewed as the strongest defence against marginalisation.ConclusionsAn emphasis on enhanced and specialised roles in podiatry by NHS commissioners and profession alike may threaten the sustainability of generalist podiatry provision in the state funded NHS. Non-specialist general podiatry may increasingly become the province of the private sector.