Worsening Of Chronic Disease Research Articles

Importance of hydration in people with dysphagia and its consequences

dysphagia involves a difficulty in the displacement of food or drink from the mouth to the stomach, which may consist of a delay or an impossibility of transit or an-error in the direction, with the consequent passage to the airway. Dysphagia increases the risk of malnutrition and dehydration in the patient. However, dehydration, although one of the most common complications of dysphagia and associated with significant risks, including hospitalization and mortality, has been little studied in terms of its relationship and associated risk factors. a review of the scientific literature on the hydration of people with dysphagia and the dangers of inadequate hydration in them was carried out. the dietary and nutritional approach in patients with dysphagia requires a multidisciplinary and personalized approach and is essential to improve the quality of life of patients with dysphagia. Dehydration is a frequent and serious complication in patients with dysphagia, which can lead to problems such as urinary tract infections, constipation, confusion, and worsening of chronic diseases. Therefore, it is crucial to carefully evaluate and monitor the fluid intake of these patients, and strategies to improve hydration include the use of thickened liquids, stimulating appetite, and adapting the texture and presentation of foods. Conclusión: adequate and protocolized management, from a dietary and nutritional point of view, can have a significant impact on the quality of life of patients, improving their well-being and preventing complications associated with this condition. The comprehensive approach to dysphagia, which includes adequate assessment and management of hydration, is essential to prevent serious complications.

The timing of death in burn patients.

When treating burn patients, some patients die in the chronic phase, even if they overcome the acute phase of the burn. To elucidate the timing of death and its underlying causes among burn patients. Patients evaluated were admitted to our burn center between January 2015, and December 2019. Patient information, time, and cause of death were retrospectively collected from their medical records. Among 342 admitted patients, 49 died. The time of death was as follows: within 24 h (n = 9), within 3 days (n = 7), within 1 week (n = 5), within 2 weeks (n = 4), within 3 weeks (n = 3), within 30 days (n = 6), within 60 days (n = 5), and after 60 days (n = 9). The causes of death within 3 days were hypoxic encephalopathy, extensive burns (>80%), severe heat stroke, and acute coronary syndrome. The causes of death after 3 days were sepsis, pneumonia, intestinal ischemia, pancreatitis, and worsening of chronic diseases. The mortality rate was similar for patients ≥65 years of age and those with a burn area of ≥20%, with both groups showing a particularly poor prognosis. The timing of death in hospitalized burn patients showed a bimodal distribution as approximately 40% of patients who survived the resuscitation period died after 30 days. Elderly patients were at particularly high risk for mortality. In burn care, treatment planning should consider not only the short-term but also the long-term prognosis.

Effects of COVID-19 lockdown on metabolic control in patients with type 2 diabetes in Sri Lanka

Introduction: The COVID-19 pandemic has led to an island-wide lockdown in Sri Lanka, leading to restrictions in daily routines. The ensuing lifestyle changes have drastically influenced the prevalence and worsening of chronic diseases like diabetes with poor metabolic control of the disease.Objectives: To evaluate the immediate impact of the lockdown on the metabolic parameters associated with diabetes control in individuals with type-2 diabetes mellitus (T2DM).Methodology: A single center cross-sectional descriptive study was conducted on 157 T2DM patients attending a diabetes clinic in the private sector. Pre- and post-lockdown data on metabolic control of the study population was collected from patient records. Patients’ perceptions of diet/exercise and access to medication/medical care during the lockdown were collected through a telephone interview.Results: Pre- and post-lockdown data of 157 male (Females 88; mean age-58.68±SD 13.44 years) patients belonging to the age group 48-72 were evaluated. Of the patients who had a HbA1c of ≤ 7% pre-lockdown, 80% had shown to maintain their HbA1c. Of the patients with HbA1c > 7% pre-lockdown, 27.9% showed a reduction of their HbA1c below 7%.The majority of the responders had no difference in their diet (69.2%) and exercise (65.4%) during the lockdown. Among those with improved HbA1c (n=101;63% of cohort), 16.9% and 13% had better diet and exercise respectively while none in worsened HbA1c group had improved diet or exercise.Conclusions: Lockdown in Sri Lanka has not been associated with worsening of glycaemic control in the studied cohort of patients with type 2 diabetes. Adherence to the recommended diet and exercise regime during lockdown is associated with better glycaemic control in patients with type 2 diabetes.

A literature review on the impact of COVID-19 pandemic towards patients living with chronic diseases

The coronavirus disease 2019 (COVID-19) has changed the daily living of people, especially those with chronic diseases. This study aimed to review the recent evidences on the impact of COVID-19 pandemic towards patients living with chronic diseases. The database and search engines used for this literature review are PubMed and Google Scholar. Abstracts were reviewed for relevance to the topic and a total of 17 articles were deemed pertinent to be summarised. Cancellation or postponement of medical consultations or procedures for chronic diseases was reported. Patients with chronic diseases also suffer worsening mental health. COVID-19 has also impacted the lifestyle of patients with chronic diseases due to reduced opportunity to go outdoors, inaccessible to fresh food, and disrupted sleep. Some pharmaceutical manufacturers shifted their focus to producing medical equipment and pharmaceutical preparations to fight against COVID-19. Difficulties in medication distributions owing to lockdown measures had been reported, as well as shortage of healthcare resources in delivering care for chronic diseases. A relationship between COVID-19 pandemic and worsening of chronic diseases was also reported. Evidence-based strategies are needed to better direct the management of chronic diseases during this unprecedented time and beyond, such as the use of telehealth and education on self-management of chronic diseases.

Editorial] Gut microbiota modulation: A tailored approach for the prevention of chronic diseases

Editorial] Gut microbiota modulation: A tailored approach for the prevention of chronic diseases

The human genome requires physical activity: What are we learning from COVID-19?

Aim: The primary cause for the development and worsening of chronic diseases is physical inactivity. This article aims to present a proposal for the negative impacts of physical inactivity during social distancing caused by the COVID-19 pandemic. Results: Global levels of physical activity are decreasing, and this behavior can be the start to increase the prevalence and incidence of chronic diseases such as diabetes, high blood pressure, obesity, and mental illness after the COVID-19 pandemic. Conclusion: Staying physically active is a fundamental behavior during the COVID-19 pandemic and social distancing.

Clinical characteristics and in-hospital outcomes of patients coinfected with Chagas disease and SARS-CoV-2

Abstract Background Underlying comorbidities have been widely associated with a worse prognosis for COVID-19 patients, since viral infections could act as triggers for worsening of chronic diseases. Although Chagas disease (CD) is endemic in Latin America, it has been recognized that the disease is now a worldwide concern. Information on the interplay between COVID-19 and CDis lacking. Purpose To assess clinical characteristics and in-hospital outcomes of patients with CD and COVID-19, and to compare it to non-CD patients. Methods Patients with COVID-19 diagnosis were selected from the Brazilian COVID-19 Registry, a prospective multicenter cohort, from March to September, 2020. CD diagnosis was based on hospital record at the time of admission. Study data were collected by trained hospital staff using Research Electronic Data Capture (REDCap) tools. Genetic matching for sex, age, hypertension, DM and hospital was performed in a 4:1 ratio. Results Of the 7,018 patients who had confirmed infection with SARS-CoV-2 in the registry, 31 patients with CD and 124 matched controls were included. Overall, the median age was 72 (64.-80) years-old and 44.5% were male. At baseline, heart failure (25.8% vs. 9.7%) and atrial fibrillation (29.0% vs. 5.6%) were more frequent in CD patients than in the controls (p<0.05 for both). C-reactive protein levels were lower in CD patients compared with the controls (55.5 [35.7, 85.0] vs. 94.3 [50.7, 167.5] mg/dL). Seventy-two (46.5%) patients required admission to the intensive care unit. In-hospital management, outcomes and complications were similar between the groups (Table 1). Conclusions In this large Brazilian COVID-19 Registry, CD patients had a higher prevalence of atrial fibrillation and chronic heart failure compared with non-CD controls, with no differences in-hospital outcomes. The lower C-reactive protein levels in CD patients require further investigation. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This study was supported in part by Minas Gerais State Agency for Research and Development (Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG) [grant number APQ-00208-20], National Institute of Science and Technology for Health Technology Assessment (Instituto de Avaliação de Tecnologias em Saúde – IATS)/ National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnolόgico - CNPq) [grant number 465518/2014-1], Table 1. Clinical outcomes

Visualizing and forecasting the association of air quality and health outcomes in Ontario, Canada

Research has shown that air pollution is associated with risks of development and worsening of chronic diseases. The Air Quality Health Index (AQHI) is a numerical scale that reports air quality and health risk, and includes messages that advise on health risk reduction actions according to AQHI levels. Our study aimed to (1) characterize geographical variations between air pollution (AQHI) and health outcomes (incidence, prevalence, and health services use) of asthma, COPD, diabetes, and hypertension; (2) forecast the trend of associations using observed data; and (3) develop visualization tools that help the public identify risks of air pollution and health outcomes. Observed trends of AQHI and health outcomes from 2003 to 2014 were plotted and forecasted up to 2025, while maps showed their geographical variations. Overall, the highest incidence and prevalence of each disease were observed in regions with higher annual mean AQHI. Chronic diseases' acute health services use was higher in northern Ontario, while physician office visits were higher in southern Ontario. The positive correlations between AQHI and health outcomes in Ontario suggests that increasing public awareness of potential health risks of air pollution is important, especially among people with chronic diseases.

Understanding and predicting health behaviour change: a contemporary view through the lenses of meta-reviews

Research on health behaviour change examines how to help people engage in healthy behaviours to prevent the development or worsening of chronic disease and early mortality and to improve mental hea...

Assessment of the risk of undernutrition in institutionalized patients under the degree of dependence

Background: there is a high number of dependent older adults with risk of malnutrition in the institutionalized geriatric population. Among others, the related factors are weight loss inherent to age, which favors frailty and sarcopenia, low body mass index (BMI) and the worsening of chronic diseases, which entails a deterioration in the quality of life. Objective: to analyze the relationship between dependence and nutritional status in elderly institutionalized people. Method: prospective observational and descriptive study in a sample of elderly institutionalized people. Dependence was studied by the Barthel index, sex, BMI, presence of chronic diseases and nutritional status with the Mini Nutritional Assessment (MNA). The association between the different variables was made with the Spearman correlation. Results: one hundred and sixty-four patients were included in the study; 45.10% (n = 74) of the patients had a total dependence and 18.30% (n = 30) had a moderate dependence. Women had a higher risk of total dependence than men (p < 0.0001). There was a significant relationship between the level of dependence and nutritional status, so that greater dependence increased the risk of malnutrition (p < 0.0001). Patients who were underweight had a greater risk of total dependence (RR 11.05 [95% CI 4.41, 27.7]). Patients with dementia were more dependent (p < 0.0001). Conclusion: most of the institutionalized elderly people presented some degree of dependence, which supposed a risk for the nutritional status that was aggravated if they suffered dementia and low weight.

Projeto Rondon no município de Caridade – CE: avaliação dos resultados obtidos com as feiras da saúde

http://dx.doi.org/10.5007/1807-0221.2016v13n21p152A Feira da Saúde foi uma das oficinas do Projeto Rondon em Caridade – CE durante a Operação Mandacaru de Janeiro de 2015. As ações basearam-se na realização de um circuito de atendimento, no qual o paciente foi acolhido e a seguir, foram registradas, em uma ficha desenvolvida para a feira, informações de saúde desses indivíduos. Ao final do circuito, cada paciente recebeu orientações feitas pelos rondonistas baseadas nos resultados encontrados na ficha do indivíduo, enfatizando as orientações para o autocuidado que, de acordo com as evidências científicas, reduzem a mortalidade. Ao se avaliar o perfil de saúde desses indivíduos, perceberam-se os hábitos de vida desfavoráveis para o aparecimento e/ou agravamento das doenças crônicas, como a Hipertensão Arterial Sistêmica e o Diabetes Mellitus. Portanto, acredita-se que as Feiras da Saúde foram de suma importância para a conscientização da população desse município para o autocuidado orientado através de hábitos de vida saudáveis.

(A171) Daily Crude Mortality Rate (DCMR) as an Indicator to Measure the Success of Provision of Services to Internally Displaced Population (IDP) in Sri Lanka

BackgroundSri Lanka's 28 year protracted civil conflict between the government forces and Liberation Tigers of Tamil Eelam (LTTE) in the North of country saw dramatic end by May 2009 when the military forces succeeded in crushing the LTTE. Around 300,000 people were displaced due to the conflict and they were settled in welfare villages established in the North.DiscussionThe Government of Sri Lanka working in partnership with all other actors mounted a major humanitarian response to address the needs of the war displaced population. The Ministry of Health took a leading role in coordinating the health care programs for the Internally Displaced Population(IDP).ObservationsHigher morbidity and mortality observed during early phase of settlement of IDPs was due to the results of two scenarios, one being the conflict situation and its direct consequences that have caused injuries, disabilities and mental trauma among the population. The second being the result of the collapse of the health system in conflict affected areas, long period of displacement of people and the disruption of social structures that have led to the indirect consequences of increase of infectious diseases and worsening of chronic diseases. Ministry of Health used Daily Crude Mortality Rate (DCMR) to measure the success of the response. According to the Sphere Project guidelines that developed a set of minimum standards in a disaster situation, the DCMR should be 0.25 per 10 000 population for South East Asia. The emergency threshold level is 0.5 per 10 000 per day for this region.ConclusionsOf the number of people reaching the IDP welfare villages in early stages of emergency phase in May, DCMR averaged to 0.7. The figure settled to less than 0.5 per 10000 in June 2009. Thereafter daily DCMR remained less than 0.5 indicating success of the provision of care for IDPS.

Access To Care Among Displaced Mississippi Residents In FEMA Travel Trailer Parks Two Years After Katrina

The health care needs of Gulf Coast residents displaced by Hurricane Katrina in 2005 who remain in travel trailer parks nearly three years later have not been evaluated. We conducted a population-based assessment of the health care access of residents of these travel trailer parks in Mississippi. Our findings indicate a worsening of chronic disease, mental illness, and barriers to health care access since displacement. Meeting both the chronic disease and the mental health needs of people displaced by the hurricanes of 2005 is essential for ensuring their full recovery and that of the region.

Reingreso hospitalario en Medicina Interna

The readmission rate could be a valuable tool as measurement of hospital quality. Readmissions are due to several factors: clinical, hospital related and patient related. We analyze readmission to internal medicine in a hospital of third level. During 11 months in 1988 we counted all readmissions (R) defined as every previous admission occurred in a span of five years into an area of internal medicine composed by 8 beds. We counted number of readmssions, time from the last readmission, living area (city vs country), sort of primary care physician (GP vs family care specialist), living way (single, with family, institution, homeless). Precipitating factors were observed as well as diseases causing it. R were classified as R related (RR) when readmission was provoked by the same pathological condition or a complication. Multi-readmission (MR), those R caused by the same disease process and treated in different areas and services of the hospital. Avoidable R (AR), those R which did not fullfil AEP criteria. Early readmission (ER) those R occurring before 30 days after last discharge. Three hundred and eleven patients (mean age 67.93 (SD 15.51), males 64%, mean length of stay 7.75 (SD 4.35), 93% admitted from emergency yard, mortality rate 3.5%) were included. R were 111 (35.5%), RR 83 (26 and 75% of RR), MR 68 (82% of RR), ER 33 (39.7% of RR) and AR 16 (19.2% of RR) patients. The most frequent diseases were heart failure and chronic respiratory diseases. Main causes of R were worsening of chronic disease 41 (37%), non-appropriale ambulatory management 24 (22%) erroneous diagnosis 8 (7%), iatrogenic effect 7 (6%), new disease 29 (26%) and others 2 (2%). Mortality rate in R patients was 7.2% (confidence interval 95% 2 to 9%). Number of readmissions were 3.22 (SD 2.25) and time to readmission 8.99 (SD 11.96) months. Living in city (p < 0.05) and to be cared by family physician (p < 0.01) both were factors accelerating readmission. Patients with RR had a higher number of readmissions (3.55 SD 2.23 p < 0.001) and they occurred sooner (8.03 SD 11.85) (p < 0.01). There was a trend to higher readmission rate in female (p 0.052). Fifty-seven percent of RR patients did not have consultation with primary care physician (p < 0.05) (confidence interval 95% 3 to 39%). Consultation with primary care yielded a delay in readmission of 5 months (p < 0.01). Patients with MR had an increased number of readmissions (p < 0.01). Associated factors were iatrogenic effect (p < 0.05), non-appropriate ambulatory management (p < 0.001) and worsening chronic disease (p < 0.001). Patients with ER were readmitted 0.45 (SD 0.30) months after the last discharge and they had a higher mortality rate (p < 0.05). Patients with AR had a mean length of stay shorter (p < 0.05), a trend to higher readmission rate (p = 0.06) and sooner (p = 0.08) with a null mortality rate (p < 0.01). As risk factors for RR in logistic regression were identified MR, AR, ER and causes of readmission consisting in worsening of chronic disease, non-appropriate ambulatory management, erroneous diagnosis and iatrogenic effect. Our readmission rate is 26%, chronic respiratory diseases and heart failure being the main diseases. Over 39% of causes of readmission could be preventable and there is a facilitation phenomenon in number and time to readmission caused by previous readmissions. Risk factors for readmission in internal medicine are multi-readmission, early and avoidable readmission and as specific causes worsening of chronic disease, non-appropriate ambulatory management, erroneous diagnosis and iatrogenic effect.