Prevalence Of Chronic Medical Conditions Research Articles

Clinical application of pulsatility index

Pulsatility index (PI) is defined as the difference between the peak systolic flow and minimum diastolic flow velocity, divided by the mean velocity recorded throughout the cardiac cycle. It is a non-invasive method of assessing vascular resistance with the use of Doppler ultrasonography. It was first introduced in 1974 by Gosling and King and is also known as the Gosling Index. PI as a method of examining macrocirculation has a variety of clinical applications. For instance, in diabetic patients, it has been measured on the common carotid, middle cerebral or renal arteries to help predict complications such as cerebrovascular disease or nephropathy. In hypertensive patients, it has been used to assess complications and assess the chronicity of the disease. To our knowledge, despite the diverse use of this ultrasonographic parameter, there is a deficiency in reports that would comprehensively summarize its clinical applications. Based on our extensive review of the literature and the gathered information, we conclude that pulsatility index (PI) is an easy to obtain parameter with a broad range of both, research and clinical applications. It has been widely used in the assessment of macrocirculation in highly prevalent chronic medical conditions, such as hypertension, both type 1 and type 2 diabetes and thyroid disorders.

A pilot study to identify the longitudinal serum metabolite profiles to predict the development of hyperuricemia in essential hypertension

BackgroundEssential hypertension (EHT) is the most prevalent chronic medical condition and a major risk factor for cardiovascular morbidity and mortality. EHT often progresses and combines with hyperuricemia (HU) in clinical cases, which increases organ damage in patients with EHT. We compared serum metabolites in EHT patients with EHT + HU patients and to find metabolic markers and related pathways in the progression of EHT to EHT + HU. MethodsA longitudinal study was carried out in 35 patients (initially EHT and EHT + HU one year later). With 10 metabolites in EHT + HU identified as potential biomarkers, linoleic acid metabolism, sphingolipid metabolism, steroid hormone biosynthesis, starch and sucrose metabolism and purine metabolism interacted with EHT + HU. ResultsDistinct changes in the metabolomics profile of sera were observed among healthy controls (HC), EHT and EHT + HU groups. Uric acid (UA), L-lactic acid, and quinolinic acid may play important roles in the progression from EHT to EHT + HU. They were mainly involved in pyruvate metabolism, purine metabolism and nicotinate and nicotinamide metabolism pathways. ConclusionsThe continuous elevation of L-lactic acid and quinolinic acid might be useful for understanding the mechanisms of pathogenesis in EHT + HU and provide prospects for preventing the development of EHT and HU.

Improving Health Equity for Women Involved in the Criminal Legal System.

Improving Health Equity for Women Involved in the Criminal Legal System.

Examining Inequities Associated With Changes in Obstetric and Gynecologic Care Delivery During the Coronavirus Disease 2019 (COVID-19) Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency requiring significant changes in obstetric and gynecologic health care delivery to minimize the risk of transmission to healthy patients and health care workers. Although these changes are necessary, they will differentially affect patients in a way that highlights and exacerbates existing inequities in health care access and outcomes. Socially vulnerable groups are already disproportionately affected by COVID-19 infection and more likely to experience severe morbidity and mortality. Some reasons for this include a limited ability to practice risk-reducing behaviors such as physical distancing, higher prevalence of chronic medical conditions, and less access to medical care. Additionally, the structural changes now taking place in health care delivery have negatively affected the ability of socially vulnerable groups to obtain necessary obstetric and gynecologic care, which may lead to poorer outcomes. As physician-leaders enact new policies to respond to the COVID-19 public health crisis, it is important to consider the potential for exacerbating existing health inequities and to be proactive in creating policies that promote equity.

Scuba diving fatalities in Australia, 2001 to 2013: Diver demographics and characteristics.

This study identified characteristics of victims of fatal scuba diving incidents to determine contributing factors and inform appropriate countermeasures. The National Coronial Information System (NCIS) was searched to identify scuba diving deaths for 2001-2013, inclusive. Data were extracted from witness and police reports, medical histories and autopsies. Descriptive statistics were used to analyse these data. There were 126 scuba diving-related fatalities identified during the study period. The mean age was 44 years, 99 (79%) victims were male and 83 (77%) were either overweight or obese. Most deaths occurred in New South Wales and Queensland, often in a commercial setting. Twenty-three (79%) Queensland victims were overseas tourists. At least 52 (41%) were novices and 17 (13%) died during training or an introductory scuba experience. Only 35 (28%) were with a buddy when the incident occurred and at least 81 (64%) were still wearing weights when recovered. The age of these victims may reflect an older cohort of participants and the associated higher prevalence of chronic medical conditions. The high prevalence of obesity suggests that this may be a risk factor. The high proportion of deaths in overseas tourists highlights an on-going need for appropriate screening and monitoring in what may be a higher risk cohort. The number of deaths that occurred under instruction highlights the importance of careful assessment of the site, prevailing conditions, an appropriate instructor-student ratio and close supervision.

COST EFFECTIVE HEART FAILURE MANAGEMENT PROGRAM IN A SAFETY NET HOSPITAL: IS IT FEASIBLE?

Heart failure is a prevalent chronic progressive medical condition characterized by recurrent hospitalization and high cost burden. Nationally, about a million heart failure hospitalizations occur annually and 68% of the $30.7 billion annual expenditure is attributable to direct cost such as

Emergency healthcare needs in the Lavender Hill suburb of Cape Town, South Africa: a cross-sectional, community-based household survey

ObjectiveEmergency care is a key component of healthcare systems, but little is known about its real impact on communities. This study evaluated access, utilisation and barriers to healthcare, and specifically...

"That's all Fake": Health professionals stigma and physical healthcare of people living with Serious Mental Illness.

BackgroundPeople living with a Serious Mental Illness (SMI) die earlier than the general population due to preventable medical conditions. Latinos living with SMI are a particularly vulnerable population with higher prevalence of chronic medical conditions. Stigma has been identified as a factor that fosters health inequities for Latinos/as with SMI, particularly Puerto Ricans. Although personal and social consequences of stigmatization have been well documented, research regarding the role of cultural factors on healthcare interactions is scarce. Furthermore, little research has focused on addressing stigma from the perspective of healthcare professionals.MethodsWe investigated this process through a qualitative design using semi-structured individual interviews with 11 healthcare professionals (8 physicians and 3 nurses) in Puerto Rico. We conducted a thematic analysis to analyze the data.ResultsFollowing a thematic analysis, we found three main themes and nine sub-themes related to the stigmatization process. Some participants reported perceptions of dangerousness and uneasiness, social distance and inadequate care. Participants also emphasized a lack of medical training regarding SMI within the Puerto Rican context.ConclusionsThese findings support the need to develop culturally appropriate public health interventions targeting healthcare professionals in order to address stigma and eliminate health disparities among Latinos/as with SMI.

Chronic medical conditions based obesity phenotypes: A two-step cluster analysis of a representative sample of obese American adults

Background and objectiveAlthough obesity is a heterogeneous disease, little is known regarding chronic medical conditions (CMCs) that defines variability in obese populations. The characterization of obese populations using CMCs rather than categorization using BMI alone can advance understanding of obesity. The aims of this study are to phenotype obesity in a large representative sample of non-Hispanic White (NHW), non-Hispanic Black (NHB) and Mexican American (MA) obese adults using CMCs, and assess relationship between resulting phenotypes and self-rated health (SRH). MethodsSex-specific two-step cluster analysis was used to phenotype obese participants (n = 12,547) to CMC-based clusters. The prevalence of CMCs and lifestyle risk factors in each cluster was assessed. Sex and race/ethnic specific association between cluster membership and SRH was determined using odds ratio (OR) from logistic regression analysis. ResultsDistinct subgroups of obese men and women were observed: moderate dyslipidemic healthy young obese men, hypertensive-dyslipidemic middle-age obese men, hypertensive young obese men, hypertensive-dyslipidemic-asthmatic middle-age obese men, and syndemic elderly obese men, healthy young obese women, hypertensive-dyslipidemic middle-age obese women, dyslipidemic young adult obese women, syndemic middle-age obese women, and syndemic elderly obese women. Participants in the more CMCs symptomatic clusters reported high rates of behavioral risk factors and showed significantly greater odds of poor SRH than participants in the less symptomatic clusters. Compared to obese persons who are asymptomatic for CMCs, syndemic elderly obese and women men had much higher increased ORs for poor SRH with values of 3.88 [95% CI = 2.41–6.26], 3.96 [95% CI = 1.86–8.30] and 7.25 [95% CI = 2.41–9.6] for NHW, NHB and MA men, respectively. The corresponding ORs for women are 4.08 [95% CI = 2.71–6.14], 4.01 [95% CI = 2.40–6.69], and 2.62 [95% CI = 1.32–5.19], respectively. ConclusionObesity treatment and intervention should consider heterogeneity within obese persons and pay greater attention to obesity related co-morbidities and metabolic manifestations.

Targeted neurotransmitter metabolomics profiling of oleanolic acid in the treatment of spontaneously hypertensive rats.

Essential hypertension (EH) is a prevalent chronic medical condition and a major risk factor for cardiovascular morbidity and mortality. Neurotransmitters are involved in the physiological process of blood pressure regulation in the body. Studies have shown that oleanolic acid (OA) can effectively regulate neurotransmitter-related metabolic disorders caused by EH, but the mechanism is still unclear. Here, we studied the neurotransmitter metabolic profiles in five brain regions by targeted metabolomics approaches in spontaneously hypertensive rats (SHRs) treated with OA and vehicle. Samples from five brain regions (hippocampus, striatum, hypothalamus, temporal lobe, and frontal lobe) were collected from the control group, the spontaneously hypertensive rat (SHR) group, and the OA group. Targeted metabolomics based on UPLC-Q-Exactive-MS was employed to characterize the dramatically changed neurotransmitters in the brain regions of SHRs treated with OA and vehicle. The expressions of the key enzymes involved in the neurotransmitter metabolism were detected by the reverse transcription-polymerase chain reaction (RT-PCR). The metabolomic profiles of SHRs pre-protected by OA were significantly different from those of unprotected SHRs. A total of 18 neurotransmitters could be confirmed as significantly altered metabolites, which were involved in tyrosine and glutamate metabolism as well as other pathways. The results showing seven key enzymes in neurotransmitter metabolism further validated the changes in the metabolic pathways. OA could effectively restore tyrosine metabolism in the striatum and hypothalamus, glutamate metabolism in the hippocampus, striatum and temporal lobe, cholinergic metabolism in the striatum, and histidine metabolism in the hypothalamus due to its inhibition of inflammatory reactions, structural damage of the neuronal cells, and increase in sedative activity. This study indicated that brain region-targeted metabolomics can provide a powerful tool to further investigate the possible mechanism of OA in EH.

Lifestyle behaviours and perceived well-being in different fire service roles.

Aspects of the work environment influence employee well-being. However, it is unclear how employee lifestyle behaviours, health characteristics and well-being may differ within a broader occupational sector. To investigate the health characteristics, lifestyle behaviours and well-being of three Fire and Rescue Service (FRS) occupational groups that differ in shift work and occupational demands: operational firefighters (FF), emergency control (EC) and administrative support (AS) workers. Data were obtained via an online survey using previously validated questionnaires to assess health characteristics, lifestyle behaviours and perceived well-being. Differences between groups were explored, controlling for confounding variables, using analysis of covariance (ANCOVA) methods. Effect sizes are reported where appropriate to demonstrate clinical significance. Four thousand five hundred and sixty-four FRS personnel volunteered, with 3333 (73%) completing the survey out of a total workforce of 60000 (8%). FF reported the lowest prevalence of chronic medical conditions (10%), compared with AS (21%) and EC (19%) workers. Total physical activity (PA) was 66% higher among FF compared with EC and AS workers. Components of sleep and self-rated health were independent predictors of well-being irrespective of FRS role. FF reported the highest levels of PA and highest perceptions of well-being, and the lowest prevalence of obesity and chronic medical conditions, compared with other FRS occupational groups. These findings may be used to inform FRS workplace intervention strategies.

Chronic Medical Conditions in Criminal Justice Involved Populations

Nationally representative data collected by the Bureau of Justice Statistics (BJS) have shown increasing and elevated prevalence of a number of non-infectious chronic medical conditions in criminal justice populations relative to the non-institutionalized population. Prevalence of these conditions, including hypertension and arthritis, are especially high among elderly and female prisoners and jail inmates. State- and site-specific prevalence estimates, however, have revealed patterns that are somewhat inconsistent with BJS national data. We summarize the extant literature regarding prevalence of chronic medical conditions in U.S. prison and jail settings, determinants of these conditions across the phases of criminal justice involvement, and potential opportunities for reducing and managing the burden of chronic medical conditions in criminal justice populations. We provide research and policy recommendations for improving measurement of the burden of chronic medical conditions in criminal justice populations, provision of healthcare in correctional settings, and post-release continuity of care and community reentry.

Cluster analysis of multiple chronic conditions associated with urinary incontinence among women in the USA.

To identify patterns of prevalent chronic medical conditions among women with urinary incontinence (UI). We combined cross-sectional data from the 2005-2006 to 2011-2012 US National Health and Nutrition Examination Surveys, and identified 3 800 women with UI and data on 12 chronic conditions. Types of UI included stress UI (SUI), urgency UI (UUI), and mixed stress and urgency UI (MUI). We categorized UI as mild, moderate or severe using validated measures. We performed a two-step cluster analysis to identify patterns between clusters for UI type and severity. We explored associations between clusters by UI subtype and severity, controlling for age, education, race/ethnicity, parity, hysterectomy status and adiposity in weighted regression analyses. Eleven percent of women with UI had no chronic conditions. Among women with UI who had at least one additional condition, four distinct clusters were identified: (i) cardiovascular disease (CVD) risk-younger; (ii) asthma-predominant; (iii) CVD risk-older; and (iv) multiple chronic conditions (MCC). In comparison to women with UI and no chronic diseases, women in the CVD risk-younger (age 46.7 ± 15.8years) cluster reported the highest rate of SUI and mild UI severity. In the asthma-predominant cluster (age 51.5 ± 10.2years), women had more SUI and MUI and more moderate UI severity. Women in the CVD risk-older cluster (age 57.9 ± 13.4years) had the highest rate of UUI, along with more severe UI. Women in the MCC cluster (age 61.0 ± 14.8years) had the highest rates of MUI and the highest rate of moderate/severe UI. Women with UI rarely have no additional chronic conditions. Four patterns of chronic conditions emerged with differences by UI type and severity. Identification of women with mild UI and modifiable conditions may inform future prevention efforts.

Maggot debridement therapy: A practical review

Maggot debridement therapy (MDT) has a long and well-documented history. Once a popular wound care treatment, especially prior to the discovery of antibiotics, modern dressings or debridement techniques, MDT fell out of favor after the 1940s. With the increasing prevalence of chronic medical conditions and associated complex and difficult-to-treat wounds, new approaches have become necessary to address emerging issues such as antibiotic resistance, bacterial biofilm persistence and the high cost of advanced wound therapies. The constant search for a dressing and/or medical device that will control pain, remove bacteria/biofilm, and selectively debride necrotic wound material, all while promoting the growth of healthy new tissue, remains elusive. On review of the current literature, MDT comes very close to addressing all of the previously mentioned factors, while at the same time remaining cost-effective. Complications of MDT are rare and side effects are minimal. If patients and providers can look past the obvious anxiety associated with the management and presence of larvae, they will quickly see the benefits of this underutilized modality for healing multiple types of wounds. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.

Disease Burden and Etiologic Distribution of Community-Acquired Pneumonia in Adults: Evolving Epidemiology in the Era of Pneumococcal Conjugate Vaccines.

Pneumonia is the leading cause of morbidity and mortality, particularly in old adults. The incidence and etiologic distribution of community-acquired pneumonia is variable both geographically and temporally, and epidemiology might evolve with the change of population characteristics and vaccine uptake rates. With the increasing prevalence of chronic medical conditions, a wide spectrum of healthcare-associated pneumonia could also affect the epidemiology of community-acquired pneumonia. Here, we provide an overview of the epidemiological changes associated with community-acquired pneumonia over the decades since pneumococcal conjugate vaccine introduction.

Chronic Medical Conditions and Sleep in the Older Adult.

Demographic changes in developed countries are leading to an aging population with a high prevalence of chronic medical conditions, disability, and sleep disorders. Evidence suggests that medical conditions and comorbid sleep disorders interact. This article aims to review frequently encountered medical conditions and examine their consequences on sleep in the older adult, and to review the possible impact of sleep disturbances on these common medical conditions. These medical conditions include pain, falls, cancer, and chronic heart failure. Strategies to improve sleep disturbances in older patients with comorbid medical conditions are provided according to available data and clinical experience.

Adult asthma: Diagnosis and treatment.

Adult asthma is a prevalent chronic medical condition that is associated with high morbidity, mortality, and cost. Early identification, evidence-based diagnosis, and step-wise management can lead to improvements in patient outcomes, decrease exacerbations, and eliminate respiratory function decline as the patient ages.

Chronic Illness, Placement Stability, and Hospitalizations within Child Welfare: The Role of Initial Living Arrangement

Despite the high prevalence of chronic medical conditions among youth in child welfare, there is a paucity of research examining placement stability and frequency of medically-related hospitalizations for this vulnerable subpopulation. These questions are explored, with an emphasis on understanding the impact of initial living arrangement on each outcome. This study assessed 945 youth (ages 5–17) in out-of-home care within the Illinois child welfare system, using a matched sample of youth with (n = 318) and without (n = 627) a chronic medical illness. Placement stability and number of medically-related hospitalizations were compared between the two groups. Additionally, negative binomial regressions were used to assess the relationship between participant characteristics, type of living arrangement, and both placement stability and medically-related hospitalizations. Placement stability was not associated with having a chronic medical illness. However, stability was associated with initial living arrangement, with youth in kinship care having a lower likelihood of subsequent placement changes than youth in foster care or residential placements. Number of medically-related hospitalizations was significantly associated with having a chronic medical illness. Number of medically-related hospitalizations was also associated with type of initial living arrangement: kinship care showed a lower likelihood of hospitalizations than foster care or residential placements. Results provide preliminary evidence that kinship care should be prioritized for youth with a chronic medical illness over placement in foster care or residential settings, as kinship care showed higher placement stability and lower rates of medically-related hospitalizations for youth with chronic medical illness.

Use of the Control of Allergic Rhinitis and Asthma Test and pulmonary function tests to assess asthma control in pregnancy.

Asthma is one of the most prevalent chronic medical conditions to complicate pregnancy. Similarly, active management strategies that prioritise asthma control in this vulnerable population can have a far-reaching impact. To describe lung function parameters and results of the Control of Allergic Rhinitis and Asthma Test (CARAT) questionnaire in pregnant asthmatics and to analyse correlations between lung function tests and CARAT results. All pregnant asthmatics who performed spirometry and CARAT between September 2014 and August 2015 were included. A medical records review was performed and data regarding demographics, sensitisation and medical prescriptions were recorded. Control of asthma and rhinitis was defined by CARAT total score (CARAT (T))≥24; upper airways (U) control if CARAT (U)>8; lower airways (L) control if CARAT (L)>15. Forty-two pregnant asthmatics were included, with a median age (interquartile range)of 32 (27-34) years; all had a previous medical diagnosis of asthma and rhinitis, 76% were atopic, 94% sensitised to dust mites and 43% were polissensitised. More than 80% presented poor control (CARAT (T)<24) in the first assessment and 15% had a percentage forced expiratory volume in the first second <80%. There were significant negative correlations between CARAT (L) and CARAT (T) scores and step-up of controller medication, (correlation coefficients =-0.453 and -0.392, respectively). The use of tools such as spirometry and validated questionnaires to objectively assess asthma control during pregnancy should be routinely applied to assist in the management of these patients. These data reinforce the importance of close monitoring of pregnant asthmatics to achieve and maintain better disease control.

Data summarization method for chronic disease tracking

ObjectivesBearing in mind the rising prevalence of chronic medical conditions, the chronic disease management is one of the key features required by medical information systems used in primary healthcare. Our research group paid a particular attention to this specific area by offering a set of custom data collection forms and reports in order to improve medical professionals’ daily routine. The main idea was to provide an overview of history for chronic diseases, which, as it seems, had not been properly supported in previous administrative workflows. After five years of active use of medical information systems in more than 25 primary healthcare institutions, we were able to identify several scenarios that were often end-user-action dependent and could result in the data related to chronic diagnoses being loosely connected. An additional benefit would be a more effective identification of potentially new patients suffering from chronic diseases. MethodsFor this particular reason, we introduced an extension of the existing data structures and a summarizing method along with a specific tool that should help in connecting all the data related to a patient and a diagnosis. The summarization method was based on the principle of connecting all of the records pertaining to a specific diagnosis for the selected patient, and it was envisaged to work in both automatic and on-demand mode. The expected results were a more effective identification of new potential patients and a completion of the existing histories of diseases associated with chronic diagnoses. ResultsThe current system usage analysis shows that a small number of doctors used functionalities specially designed for chronic diseases affecting less than 6% of the total population (around 11,500 out of more than 200,000 patients). In initial tests, the on-demand data summarization mode was applied in general practice and 89 out of 155 users identified more than 3000 new patients with a chronic disease over a three-month test period. During the tests, more than 100,000 medical documents were paired up with the existing histories of diseases. Furthermore, a significant number of physicians that accepted the standard history of disease helped with the identification of the additional 22% of the population. Applying the automatic summarization would help identify all patients with at least one record related to the diagnosis usually marked as chronic, but ultimately, this data had to be filtered and medical professionals should have the final say. Depending on the data filter definition, the total percentage of newly discovered patients with a chronic disease is between 35% and 53%, as expected. ConclusionsAlthough the medical practitioner should have the final say about any medical record changes, new, innovative methods which can help in the data summarization are welcome. In addition to being focused on the summarization in relation to the patient, or to the diagnosis, this proposed method and tool can be effectively used when the patient-diagnosis relation is not one-to-one but many-to-many. The proposed summarization principles were tested on a single type of the medical information system, but can easily be applied to other medical software packages, too. Depending on the existing data structure of the target system, as well as identified use cases, it is possible to extend the data and customize the proposed summarization method.