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Copyright of Selcuk University Social Sciences Institute Journal is the property of Selcuk University Social Sciences Institute Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Limited data are available on the costs of evidence-based community-wide prevention programs. The objective of this study was to estimate the per-person costs of strategies that support policy, systems, and environmental changes implemented under the Community Transformation Grants (CTG) program. We collected cost data from 29 CTG awardees and estimated program costs as spending on labor; consultants; materials, travel, and services; overhead activities; partners; and the value of in-kind contributions. We estimated costs per person reached for 20 strategies. We assessed how per-person costs varied with the number of people reached. Data were collected in 2012-2015, and the analysis was conducted in 2015-2016. Two of the tobacco-free living strategies cost less than $1.20 per person and reached over 6 million people each. Four of the healthy eating strategies cost less than $1.00 per person, and one of them reached over 6.5 million people. One of the active living strategies cost $2.20 per person and reached over 7 million people. Three of the clinical and community preventive services strategies cost less than $2.30 per person, and one of them reached almost 2 million people. Across all 20 strategies combined, an increase of 10,000 people in the number of people reached was associated with a $0.22 reduction in the per-person cost. Results demonstrate that interventions, such as tobacco-free indoor policies, which have been shown to improve health outcomes have relatively low per-person costs and are able to reach a large number of people. [ABSTRACT FROM AUTHOR]

This study intended to examine the role of social support groups in coping with chronic diseases such as cancer and AIDS. Mainly there are three objectives of this study, i.e., (A) Examine the role of social support groups and coping strategies in terms of positive outlook, optimism and health-esteem. (B) Examine the role of social support groups and coping with feelings associated with the diseases in terms of negative feelings and pessimism/hopelessness. (C) Examine the relationships between coping strategies in terms of positive outlook, optimism and health-esteem and feelings associated with the disease (negative feelings & pessimism/hopelessness), and (D) Find out the best predictor of coping strategies that determines maximum contribution in lowering the impact of negative feelings and a sense of pessimism/hopelessness associated with patients' disease among member and non-members of social support groups. The sample consists of 100 people suffering from chronic diseases. There were three kinds of people taken as a sample in this study. First, who were suffering from cancer (25), second, who were suffering from HIV+/AIDS (25) and they were the people who had not joined any support-group and they were only depends on their family and friends.While, third groups were people who were suffering from HIV+/AIDS (50) but they had joined the social-support groups for such people and not only depends on theirfamily and friends.Bothmale and female fromrural and urban settings were taken for this study within the age range of 20 to 80 years with mean score of 35.73 years.Two type of the scale were used in this study. Firstscale of coping strategies which was the combination of three sub scales i.e. positive outlook, optimism and health esteem. Second scale for assess the feelings associated with disease was comprises of scale of negative feelings and pessimism/hopelessness. All these scales were based on Likert 5-point rating scale.The following results were found:(a) optimismand health esteem as coping strategies is higher in patients who were the members of social support groups in comparison to patients who didn't join such support groups, (b) negative feelings and pessimism/hopelessness were found significant difference in patients who are the member and non-member of such social support groups, (c) positive outlook, optimism, and health esteem is lowering the impact of negative feelings and pessimism/hopelessness, and (d) optimism as a coping strategy is found more reliable (best predictor) in case of patients who belongs to social support groups and health esteem is found more reliable in case of patients who doesn't belongs to such social support groups for reducing or coping with negative feelings and pessimism/hopelessness associated with their disease. [ABSTRACT FROM AUTHOR]

Introduction: Individuals living with hepatitis C experience a series of changes in their lives, caused by either the disease itself or its treatment or both. In this sense, living with a chronic disease such as hepatitis C implies that patients must change their lifestyles, which requires that they rethink their habits in light of the new reality. To comprehend chronic hepatitis C patients' perceptions, meanings, and quality-of-life effects. Methodology: Qualitative research; interviews with 12 patients at a specialized outpatient clinic from February to July 2012. The cohort size was determined by theoretical saturation and the interviews were analyzed by means of content analysis. Results: Data were organized into four categories: on medication, referenced fears, impact on sexuality, and coping with the new reality. The categorized data were discussed around the following themes: "Becoming sick" due to treatment and perceived aspects and Undergoing treatment and how to cope with it. Conclusion: Patients' everyday lives and quality of life in general are affected especially by adverse side effects of hepatitis C medication and an assortment of feelings and uncertainties about the disease prognosis. Notwithstanding, most patients manage to find ways to cope with the treatment and complete it expecting a satisfactory outcome. [ABSTRACT FROM AUTHOR]

The article discusses the contribution of corporations in spreading chronic diseases. Topics include the industry practices investigated by journalists in the tobacco industry, the impact on people's health of the adverse practices followed by industries, and the role of scientific evidence in educating youth about gaining information on the practices followed by various companies.

There is at present a huge disconnect between levels of funding for basic research on fundamental mechanisms of biological aging and, given demographic projections, the anticipated enormous social and economic impacts of a litany of chronic diseases for which aging is by far the major risk factor: One valuable approach, recently instigated by Felipe Sierra & colleagues at the US National Institute on Aging, is the development of a Geroscience Interest Group among virtually all of the NIH institutes. A complementary approach would be to seek major escalations of private funding. The American Federation for Aging Research, the Paul Glenn Foundation and the Ellison Medical Foundation pioneered efforts by the private sector to provide substantial supplements to public sources of funding. It is time for our community to organize efforts towards the enhancements of such crucial contributions, especially in support of the emerging generation of young investigators, many of whom are leaving our ranks to seek alternative employment. To do so, we must provide potential donors with strong economic, humanitarian and scientific rationales. An initial approach to such efforts is briefly outlined in this manuscript as a basis for wider discussions within our community. [ABSTRACT FROM AUTHOR]

The research presented here investigates potential psychological and health consequences of concealing a chronic illness. Data were collected from 2,500 individuals living with multiple sclerosis (MS), as part of an ongoing longitudinal research project. Questions on identity concealment and psychosocial reserve (a broad measure of well-being) were embedded in a semi-annual national survey. Responses were linked to each participant's concurrent responses to questions about their disability status, and prospectively to the same measure of disability status 1 year later. Just over 16% of respondents indicated that it was mostly true to very true that they actively concealed their MS and most indicated at least some degree of concealment. For people at lower levels of disability, decisions to conceal or disclose were not related to their levels of psychosocial reserve. However, with rising disability, concealment predicted lower levels of psychosocial reserve. Concealment was also associated with improved disability status 1 year later. A mediation analysis suggests that this may be in part because people who concealed were more likely to be employed. Taken together, the current research adds to the evidence that consequences of concealment often may be multifaceted and depend on a variety of moderators, including degree of disability. [ABSTRACT FROM AUTHOR]

With the advent of aging society, the population with chronic diseases also increases accordingly. Chronic diseases require monitoring on physical parameters at regular intervals so as to understand the conditions of disease control for an individual case. It is expected to achieve the goal of early detection and early treatment so that the expenses for medical treatments can be reduced. With the advance of technologies and with the application of communication technology and electronic medical devices, providing human-centered and diversified health care services has gradually become the development trend of the care services for the elderly. The external form design of wearable products for medical treatments affects consumers' willingness to buy and operation convenience. Therefore, the development gradually moves toward designing products based on a user-centered model. This study is to investigate the elder consumers' perception of product forms. Wearable devices which monitor sleeps were selected as the target product for investigation. Tests were conducted by questionnaire surveys and the classification of groups was implemented by factor analysis and cluster analysis. After that, the analysis of variance was conducted so as to understand the condition of deviations. The results indicated that groups of different life patterns generated significant differences on the vocabularies for different forms of wearable devices. [ABSTRACT FROM AUTHOR]

Purpose: Interest in assessing denial is still present, despite the criticisms concerning its definition and measurement. We tried to develop a questionnaire (Illness Denial Questionnaire, IDQ) assessing patients' and caregivers' denial in relation to their illness/disturbance. Patients and methods: After a preliminary study, a final version of 24 dichotomous items (true/false) was selected. We hypothesized a theoretical model with three dimensions: denial of negative emotions, resistance to change, and conscious avoidance, the first two composing the actual Denial and the last representing an independent component of the illness denial behavior. The IDQ was administered to 400 subjects (219 patients and 181 caregivers) together with the Anxiety-Depression Questionnaire - Reduced form (AD-R), in order to assess concurrent validity. Confirmatory factor analysis (CFA), internal consistency indices (Cronbach's α and McDonald's ω), and test-retest analysis were performed. Results: CFA and internal consistency indices (Cronbach's α: 0.87-0.96) indicated a clear and meaningful three-factor structure of IDQ, for both patients and caregivers. Further analyses showed good concurrent validity, with Denial and its subscale negatively associated with anxiety and depression and avoidance positively associated with anxiety and depression. The IDQ also showed a good stability (r from 0.71 to 0.87). Conclusion: The IDQ demonstrated good psychometric properties. Denial of negative emotions and resistance to change seem to contribute to a real expression of denial, and conscious avoidance seems to constitute a further step in the process of cognitive-affective elaboration of the illness. [ABSTRACT FROM AUTHOR]

Chronic conditions and their resultant difficulties in daily living frequently occur with other health problems, sometimes due to interactions or complications at a biological level, or as a result of common pathogens or risk factors. On other occasions, they develop independently. Drawing on research conducted with Australian women that began in the mid-2000s and is still ongoing, we highlight how chronic structural factors shape the risk factors of "chronic" conditions, influencing health seeking, continuity of care, and health outcomes. Institutional, economic, and other circumstantial factors pertain and impact health trajectories as much in highly industrialized as in resource poor settings. In illustrating how poverty and social exclusion create the preconditions of multiple chronic health problems, and how chronic health problems increase such disadvantages for individuals and their households, we introduce the idea of "recursive cascades" to capture the often inevitable trajectory of increasing ill health and growing empoverishment. [ABSTRACT FROM AUTHOR]

The biomedical definition of comorbidity belies the complexity of its lived experience. This article draws on case studies of women with diabetes and various comorbidities in New Delhi, India, to explore intergenerational transactions surrounding suffering in contexts of comorbidity. The analysis synthesizes sociological theories of chronic disease work, psychological theories of caregiver burnout, and anthropological approaches to suffering and legitimacy to explore how, when, and by whom women's comorbid sources of suffering become routinized in everyday life. The analysis demonstrates, first, that comorbid suffering is not simply a matter of the addition of a second source of suffering to an existing one; rather, it comprises complex interactions between suffering, disability, family dynamics, and quality of life. Second, it illustrates several social routes through which comorbid suffering can fade into the background of everyday life, even when it is severe. Close attention to how suffering works in cases of comorbidity will be important as comorbid conditions become increasingly commonplace around the world. [ABSTRACT FROM AUTHOR]

Current literature focusing on young people's digital technology use often reflects concerns that they may live virtual lives and withdraw from locally geographically situated spaces. It assumes the existence of a split between offline and online 'worlds' corresponding to 'real 'and 'non-real' respectively. This article reports research findings on how young people locate new social media technologies in their daily lives with particular focus on the relationship between their online and offline experiences. The voices of the young people guided the research, which found that their social media use contradicts conventional narratives of moral panic about the alleged unreality and fearful dangers of online spaces for young people. [ABSTRACT FROM AUTHOR]

Background: Persons with multiple chronic conditions receive multiple guideline-recommended medications to improve outcomes such as mortality. Our objective was to estimate the longitudinal average attributable fraction for 3-year survival of medications for cardiovascular conditions in persons with multiple chronic conditions and to determine whether heterogeneity occurred by age.Methods: Medicare Current Beneficiary Survey participants (N = 8,578) with two or more chronic conditions, enrolled from 2005 to 2009 with follow-up through 2011, were analyzed. We calculated the longitudinal extension of the average attributable fraction for oral medications (beta blockers, renin-angiotensin system blockers, and thiazide diuretics) indicated for cardiovascular conditions (atrial fibrillation, coronary artery disease, heart failure, and hypertension), on survival adjusted for 18 participant characteristics. Models stratified by age (≤80 and >80 years) were analyzed to determine heterogeneity of both cardiovascular conditions and medications.Results: Heart failure had the greatest average attributable fraction (39%) for mortality. The fractional contributions of beta blockers, renin-angiotensin system blockers, and thiazides to improve survival were 10.4%, 9.3%, and 7.2% respectively. In age-stratified models, of these medications thiazides had a significant contribution to survival only for those aged 80 years or younger. The effects of the remaining medications were similar in both age strata.Conclusions: Most cardiovascular medications were attributed independently to survival. The two cardiovascular conditions contributing independently to death were heart failure and atrial fibrillation. The medication effects were similar by age except for thiazides that had a significant contribution to survival in persons younger than 80 years. [ABSTRACT FROM AUTHOR]

Studying the impact of parental physical illness on adolescents is a key component of psychological interventions designed to increase resilience. Our study examined the relationship between stress induced by parental chronic illness, overall family functioning, perceived social support, and psychosocial adjustment in adolescents. It has been pressumed that family functioning and perceived social support moderate the adverse impact of parental chronic ilness on adolescents' psychosocial adjustment. One hundred and twenty six Romanian adolescents completed a set of standardized measures. Data were analyzed using multiple linear regression and moderation analysis with IBM SPSS. Compared to boys, girls reported a higher score on internalizing problems. The gender difference in externalizing problems was statistically marginal. Gender, stress associated with parental chronic illness, and perceived social support were predictors of internalizing problems, while general family functioning was a negative predictor of externalizing problems. Neither overall family functioning, nor perceived social support moderated the relationship between stress associated with parental chronic illness and psychosocial adjustment in our study sample. Stress induced by parental chronic illness is a risk factor for internalizing problems in adolescents, while healthy family functioning and availability of social support are protective factors. Moreover, the positive family functioning may be a protective factor against externalizing problems. Psychological interventions must pay attention to provide adolescents and their families with key abilities that contribute to resilient coping with stress. [ABSTRACT FROM AUTHOR]

The article offers information in promoting online presence for people with chronic illness. The author highlights the definition of chronic illness according to the U.S. National Center for Health Statistics and the impact of social media in promoting and helping people with chronic illness to cope up with their diseases and employment opportunities. Social media sites that may provide support for people with chronic illness including LinkedIn and Facebook are also presented.

Background: Socially disadvantaged people have an increased need for medical care due to a higher burden of health problems and chronic diseases. In Germany, outpatient care is chiefly provided by office-based general practitioners and specialists in private practice. People are free to choose the physician they prefer. In this study, national data were used to examine differences in the use of outpatient medical care by socioeconomic status (SES). Methods: The analyses were based on data from 6,754 participants in the Robert Koch Institute’s German Health Interview and Examination Survey for Adults (DEGS1) aged between 18 and 69 years. The number of outpatient physician visits during the past twelve months was assessed for several medical specializations. SES was determined based on education, occupation, and income. Associations between SES and physician visits were analysed using logistic regression and zero-truncated negative binomial regression for count data. Results: After adjusting for sociodemographic factors and health indicators, outpatients with low SES had more contacts with general practitioners than outpatients with high SES (men: incidence rate ratio [IRR] = 1.25; 95% confidence interval [CI] = 1.08–1.46; women: IRR = 1.20; 95% CI = 1.07–1.34). The use of specialists was lower in people with low SES than in those with high SES when sociodemographic factors and health indicators were adjusted for (men: odds ratio [OR] = 0.68; 95% CI = 0.51–0.91; women: OR = 0.56; 95% CI = 0.41–0.77). This applied particularly to specialists in internal medicine, dermatology, and gynaecology. The associations remained after additional adjustment for the type of health insurance and the regional density of office-based physicians. Conclusion: The findings suggest that socially disadvantaged people are seen by general practitioners more often than the socially better-off, who are more likely to visit a medical specialist. These differences may be due to differences in patient preferences, physician factors, physician-patient interaction, and potential barriers to accessing specialist care. [ABSTRACT FROM AUTHOR]

Background: Owing to a scarcity of data or other causes, patient research on the orphan population is lacking in most societies. Consequently, the primary goal of this study was to explore quality of life (QOL) and quality of care (QOC) among orphan patients (OPs) receiving tertiary healthcare services in Saudi Arabia (SA).Method: This study used a cross-sectional, quantitative survey design. Participants included 216 OPs either currently undergoing or who had undergone treatment for common chronic diseases (CDs) (e.g. cardiovascular disease, cancer, stroke and arthritis) during the past 12 months. The survey utilised the brief form from the World Health Organization Quality of Life (WHOQOL-BREF) tool and evaluated healthcare access and effectiveness domains to scrutinise the socio-medical patterns of OPs based on their current medical episodes.Results: The descriptive analysis indicated that OPs' overall QOL reached a moderate level (M = 3.90). Similarly, participants reported relatively high levels of healthcare access and treatment effectiveness (M = 4.14 and M = 4.29, respectively). Stroke patients reported the highest QOL score (M = 3.95), and groups of patients with other CDs reported greater access to healthcare and more effective treatment maintenance compared to the other groups (M = 4.19 and M = 4.43, respectively). Regression analysis was conducted to predict overall QOL based on perceived QOC, and access explained only 6.5 % of the variance. An analysis of variance showed significant differences only between OPs with cardiovascular disease and cancer (P = .001), with the former reporting better access to tertiary healthcare services than the latter.Conclusions: Although some CD patients reported relatively acceptable levels of access to healthcare and receipt of effective treatment, the improvement of OPs' QOL and QOC poses a serious challenge for health policymakers. [ABSTRACT FROM AUTHOR]

There is an association between chronic disease and geography, and there is evidence that the environment plays a critical role in this relationship. Yet at the same time, there is known to be substantial geographic variation by ancestry across the United States. Resulting geographic genetic variation—that is, the extent to which single nucleotide polymorphisms (SNPs) related to chronic disease vary spatially—could thus drive some part of the association between geography and disease. We describe the variation in chronic disease genetic risk by state of birth by taking risk SNPs from genome-wide association study meta-analyses for coronary artery disease, diabetes, and ischemic stroke and creating polygenic risk scores. We compare the amount of variability across state of birth in these polygenic scores to the variability in parental education, own education, earnings, and wealth. Our primary finding is that the polygenic risk scores are only weakly differentially distributed across U.S. states. The magnitude of the differences in geographic distribution is very small in comparison to the distribution of social and economic factors and thus is not likely sufficient to have a meaningful effect on geographic disease differences by U.S. state. [ABSTRACT FROM AUTHOR]

Background: Being chronically ill is a continuous process of balancing the demands of the illness and the demands of everyday life. Understanding how everyday life affects self-management might help to provide better professional support. However, little attention has been paid to the influence of everyday life on self-management. The purpose of this study is to examine to what extent problems in everyday life interfere with the self-management behaviour of people with chronic illness, i.e. their ability to manage their illness.Methods: To estimate the effects of having everyday problems on self-management, cross-sectional linear regression analyses with propensity score matching were conducted. Data was used from 1731 patients with chronic disease(s) who participated in a nationwide Dutch panel-study.Results: One third of people with chronic illness encounter basic (e.g. financial, housing, employment) or social (e.g. partner, children, sexual or leisure) problems in their daily life. Younger people, people with poor health and people with physical limitations are more likely to have everyday problems. Experiencing basic problems is related to less active coping behaviour, while experiencing social problems is related to lower levels of symptom management and less active coping behaviour.Discussion: The extent of everyday problems interfering with self-management of people with chronic illness depends on the type of everyday problems encountered, as well as on the type of self-management activities at stake.Conclusions: Healthcare providers should pay attention to the life context of people with chronic illness during consultations, as patients' ability to manage their illness is related to it. [ABSTRACT FROM AUTHOR]

Chronic diseases result in an enormous burden of morbidity and mortality worldwide, projected to continuously increase over the next decades. Cardiovascular diseases, followed by cancers, chronic respiratory diseases and diabetes mellitus, represent the main causes of death caused by chronic conditions. The majority of chronic diseases are multifactor disorders, the main etiological role being played by various behavioral or environmental risk factors. Social factors such as education, employment status, income, familial and social stress have also a major role in determining chronic diseases, both directly and indirectly, by increasing the susceptibility to behavioral risk factors. Chronic pathology results in chronic symptoms which dramatically impairs the patient quality of life and working capacity, also resulting in a significant social and economic burden. Social problems develop with the progressive exercise capacity alteration, resulting in limited mobility, home-bounding, self-care disability and bed-bounding, the ultimate consequences being social isolation, family conflicts and even stigma. Chronic diseases prevention focuses on behavioral risk modifying, mainly implying specific social interventions, as long as most behavioral risk factors are represented by socially mediated activities. Considering the magnitude of the problems currently determined by chronic diseases, a coherent strategy for the management of these conditions, should be a high priority at both levels of society and health care systems. This strategy must provide an efficient risk control, the optimal medical care for the patient, by applying a holistic patient-centered approach, and specific social assistance. [ABSTRACT FROM AUTHOR]

An introduction is presented which discusses various reports within the issue on topics including the effects of chronic illness on peer relationships, social competence of children with and without chronic illness, and the association of peer relations and social functioning with health.

Copyright of Culture & Society: Journal of Social Research / Kultūra ir Visuomenė: Socialinių Tyrimų Žurnalas is the property of Vytautas Magnus University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Culture & Society: Journal of Social Research / Kultūra ir Visuomenė: Socialinių Tyrimų Žurnalas is the property of Vytautas Magnus University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Information about the National Institute for Health and Disability Insurance (NIHDI) 50th Anniversary event meeting that was held in Brussels, Belgium on April 2, 2014 is presented. Topics include the vision of the health care system and assessment of chronic diseases in Belgium. The meeting featured several policy-makers, managers, health care worldwide including Jo De Cock of Belgium, Hans Kluge of Europe and Hans Vlek of the Netherlands.

Nowadays, in Mexico, we find ourselves in an epidemiologic and demographic transition distinguished, among other things, by the ageing of population and the increase of the chronic and degenerative diseases as causes of morbidity and mortality. All of this demands a different health care model, to the one already created, to deal with acute and contagious diseases, in which the sick person can regain health in relatively short time, not so in chronic degenerative diseases, in which the sick person "suffers" the diseases for a long time, affecting his familiar, occupational and social life. In this paper, we propose to use the term "patient" (paciente, in Spanish) for individuals with acute or contagious disease and "sufferer" (padeciente, in Spanish) for those with chronic conditions which involves the exploration of new alternatives for effective health care. [ABSTRACT FROM AUTHOR]

Objective This meta-analysis examined the effectiveness of recent adherence-promoting interventions for youth with chronic health conditions. Methods Peer-reviewed randomized controlled trials of adherence-promoting interventions for youth with a chronic illness published between 2007 and 2013 (n = 23) were reviewed. Intervention delivery (in-person vs. technology-based) and outcome measurement (e.g., self-report) were examined as potential moderators of treatment effects. Results Mean effect sizes were small at posttreatment (d = 0.20, 95% confidence interval (CI): 0.08, 0.31, n = 23) and follow-up (d = 0.29, 95% CI: 0.15, 0.43, n = 9). Intervention delivery and outcome measurement did not account for variation in treatment effects (p > .05). Conclusions The small treatment effects of recent adherence-promoting intervention (APIs) reflect the methodological limitations of the included studies and the need to reexamine the delivery and mechanisms of adherence-promoting interventions. [ABSTRACT FROM AUTHOR]

Many people worldwide suffer from pain and a portion of these sufferers are diagnosed with a chronic pain condition. The management of chronic pain continues to be a challenge, and despite taking prescribed medication for pain, patients continue to have pain of moderate severity. Current pain therapies are often inadequate, with side effects that limit medication adherence. There is a need to identify novel therapeutic targets for the management of chronic pain. One potential candidate for the treatment of chronic pain is therapies aimed at modulating the vasoactive peptide endothelin-1. In addition to vasoactive properties, endothelin-1 has been implicated in pain transmission in both humans and animal models of nociception. Endothelin-1 directly activates nociceptors and potentiates the effect of other algogens, including capsaicin, formalin, and arachidonic acid. In addition, endothelin-1 has been shown to be involved in inflammatory pain, cancer pain, neuropathic pain, diabetic neuropathy, and pain associated with sickle cell disease. Therefore, endothelin-1 may prove a novel therapeutic target for the relief of many types of chronic pain. [ABSTRACT FROM AUTHOR]

Abstract: Individuals with psychotic illnesses are known to have a reduced fertility. It is unclear whether this is due to biological or social factors. Most fertility studies have been conducted in chronic schizophrenia, where confounders like medication and hospitalisation make this difficult to elicit. A less severe reduction of fertility has been observed in some ethnic minorities, but results are inconsistent. We sought to investigate pre-morbid fertility in an ethnically diverse sample of individuals with first-onset psychosis. Data were derived from 515 people with a first psychotic episode (FEP) and 383 controls. We made case–control comparisons of differences in the proportion of those with children (fertility rates) and mean number of children (MNC). Analyses were then stratified by diagnosis, gender and ethnicity, and adjusted for potential confounders. We found that FEP showed a reduced fertility rate (age-adjusted OR of having children 0.47 [95% CI=0.39, 0.56]), irrespective of diagnosis, and there was little evidence of confounding by gender, ethnicity, religious background, education level, or history of past relationships (fully adjusted OR=0.55, 95% CI=0.37, 0.80). Women had a somewhat greater reduction in fertility rates than men (Men: age-adjusted OR 0.61 [95% CI 0.42, 0.89]; Women: age-adjusted OR 0.46 [95% CI 0.31, 0.69]) and we could not find any evidence of ethnic differences in the degree of fertility reduction. FEP who had previously experienced a stable relationship had an MNC that was comparable to that of the general population and had a later onset of illness. This is the largest case–control study to date to investigate fertility in first-onset psychosis. Our data suggests that fertility is affected, even prior to the onset of a psychotic illness, and there are likely to be biological and environmental factors involved, but the former seem to have a stronger influence. [Copyright &y& Elsevier]

The article discusses aspects of active life expectancy or active life of people with chronic condition in the U.S. from 1999-2008. Topics include the disparities in years of life free of activity limitations (YFAL) due to chronic condition as examined by the U.S. Centers for Disease Control & Prevention (CDC), activity status based from National Health Interview Survey (NHIS) data, and total life expectancy percentage.

Although the better-educated are more likely to practice healthy behaviors when measured at one point in time, there is no clear evidence regarding whether more educated people are more likely to initiate healthy behavior changes in the face of new chronic conditions and whether they are better able to adhere to these healthy changes, once made. I use data from the Health and Retirement Study (HRS) (1992-2010) to examine smoking cessation and starting physical activity by educational attainment over an 18-year period among 16,606 respondents ages 50 to 75. The more-educated are the least likely to smoke and most likely to be physically active in middle age. They are also most likely to make healthy changes overall and better adhere to them. Education also shapes behavior change after a new diagnosis, which likely contributes to socioeconomic status differences in chronic disease management and health outcomes. [ABSTRACT FROM PUBLISHER]

The resiliency of families, based on family functioning and family hardiness, may influence caregivers' anxiety while their child is in the hospital undergoing treatment for his or her chronic illness. The current study assessed the relationship among these factors for caregivers of children with various chronic illnesses who were residing at a local Ronald McDonald House (RMH). Caregivers completed paper-based questionnaires to assess family hardiness, functioning, and parent state anxiety and interviews to identify positive and negative strategies and behaviors affecting how they were coping with their child's illness. Findings indicated that family functioning mediated the relationship between family hardiness and caregiver anxiety as a resilience factor that further reduced caregiver anxiety. During interviews, caregivers suggested that support from family members strengthened their coping abilities. Negative interactions with their child's medical team and not knowing how or being equipped to help their child live with his or her illness heightened caregiver stress. Future research should focus on developing, implementing, and measuring the effectiveness of interventions to improve caregiver support, such as by holding caregiver support groups at local RMHs, especially during a child's hospitalization. [ABSTRACT FROM AUTHOR]

Objective. To examine health care provided to chronically ill people in the Popular Health Insurance (Seguro Popular) from the perspective of patients and health professionals. Materials and methods. A qualitative study was carried out in Guadalajara, Mexico. 40 chronically ill people, and 14 health professionals of primary health centers participated in the study. Information was gathered using semi-structured interviews; critical discourse analysis was carried out. Results. Seguro Popular has meant gains and losses to participants. Cronically ill people value it positively since it is perceived as a gift, not a social right. Some obstacles impede participants accessing health care, obtaining medications and analysis. Conflictive relations also cause tensions between patients and health professionals. Conclusion. The initial goals of Seguro Popular are not achieved regarding health care to chronically ill people. The perspectives of sick people should be prioritized. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This research aimed at identifying inequalities in morbidity from chronic diseases. It was an analytical cross-sectional study based on data taken from the National Health Survey of Colombia, 2007. Differences in proportions and prevalence rates were calculated. Linear regression models were constructed and Chaid analysis and classification analysis were performed. A higher risk was found in women and in people with no schooling than in university students. Explanatory variables for hypertension were gender, age, wealth index; Diabetes variables were age, area of residence and wealth index. Risk factors for hypertension were gender, wealth index and area of residence and for diabetes were body mass index, gender and wealth index. As a conclusion, inequality in hypertension is characterized by the structural determinants: gender, age, wealth index and region. Inequality in diabetes is also characterized by the area of residence. The intermediate determinant for both diseases was the body mass index. [ABSTRACT FROM AUTHOR]

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The relevance of nutrition during pregnancy and early infancy in defining short-term health and survival has been well established. However, the Developmental Origins of Health and Disease (DOHaD) paradigm provides a framework to assess the effect of early nutrition and growth on long-term health. This body of literature shows that early nutrition has significant consequences on later health and well-being. In this article, we briefly present the main consequences of malnutrition that affect human growth and development and consider how the DOHaD paradigm, with its evolutionary implications, might contribute to better addressing the challenge of improving nutrition. We examine how this paradigm is particularly appropriate in understanding the health and nutrition transition in countries that face the double burden of nutrition-related diseases (acute malnutrition coexisting with obesity and other chronic diseases). We focus on stunting (low height-for-age) to examine the short- as well as long-term consequences of early malnutrition with a life-course, transgenerational, and multidisciplinary perspective. We present current global and regional prevalence of stunting and discuss the need to reposition maternal and infant nutrition not only in health and nutrition intervention programs but also in consideration of the emerging research questions that should be resolved to better orient program and policy decisions. [ABSTRACT FROM AUTHOR]

Background: Health statistics frequently identify minority groups as vulnerable to chronic illness. Turkish Germans are said to be almost twice as likely to suffer from type 2 diabetes as Germans or Turks in Turkey. Aim: Turkish migrants' experiences with diabetes are explored, in particular the role of family in shaping responses to chronic illness. Subjects and methods: This paper draws on ethnographic fieldwork from September 2006 to August 2007 in Berlin, Germany. Interviews and participant observation were conducted with Turkish migrants with diabetes and their families, who were members of a Turkish self-help group, and with health professionals. Results: Family shapes Turkish Berliners' experience with diabetes in several ways and settings. The time of diagnosis is narrated as ''family histories''; subsequent attempts of lifestyle changes are negotiated as family practices, in particular with regard to food; and diabetes self-management, inside and outside the home, as day-to-day management practices, peer support and clinical consultations, affect and involve the whole family. Conclusion: Family and other social relationships are inherently tied to efforts of diabetes self-care. While research often focuses simplistically on family as ''social support'' or a ''barrier'', families share complex lifeworlds and negotiate shared practices to make these experiences habitable. [ABSTRACT FROM AUTHOR]

Perceptions of children with chronic illness may influence their peer relationships. This study examined the impact of illness visibility (i.e., an illness characteristic visible to other people) and medical explanation (i.e., a condition with a documented medical cause) on peer perceptions. Fifty healthy children (33 girls and 17 boys) aged 8 to 12 years (M = 9.34, SD = 1.26) were presented with vignettes describing hypothetical children with a visible-medically explained, non-visible-non-medically explained, visible-non-medically explained, or non-visible-medically explained condition. Perceptions of the hypothetical peer along affective, behavioral, and cognitive dimensions were assessed. Children with visible, non-medically explained conditions were perceived more negatively, suggesting that these children may be at risk for peer difficulties. [ABSTRACT FROM AUTHOR]

Biographical accounts of illness offer useful insights into the social and adaptive processes of living with chronic illness. Yet there are concerns that the underlying theoretical assumptions of a reflexive self seeking to maintain meaning may not reflect the lived experience of individuals. A narrative emphasis may neglect the importance of emotional/felt experiences; while an analytical focus on disruptive processes may not adequately reflect the totality of actual events. In this study, we explored how well biographical theory supports understanding of individual lived experience. Narratives from 19 individuals identified from General Practice lists with a terminal diagnosis of cancer were analysed using the holistic-form approach described by Lieblich. Participants described an ongoing process of living their life, 'managing' disruptive events and maintaining an overall sense of well-being (narrative form = biographical flow). For a minority, continuity was lost when people's capacity to continue living their everyday lives was overwhelmed (narrative form = fracture). The identified emphasis was on individual creative capacity in the face of terminal illness, highlighting the importance of embodied experience in understanding outcome and need. Maintaining continuity was draining: exhaustion precipitated fracture and thus need for external help to restore continuity. By focusing on feelings associated with overall narrative form, rather than individual disruptive events, we highlight the context in which disruptive events are experienced, and individual perceptions of their relative importance. We conclude that combining narrative and emotion offers new insights into the value of understanding of biographical accounts of illness in the context of individual creative capacity. We discuss the possibilities for new approaches to clinical assessment and management of need. [ABSTRACT FROM AUTHOR]

Background: Given escalating rates of chronic disease, broad-reach and cost-effective interventions to increase physical activity and improve dietary intake are needed. The cost-effectiveness of a Telephone Counselling intervention to improve physical activity and diet, targeting adults with established chronic diseases in a low socio-economic area of a major Australian city was examined. Methodology/Principal Findings: A cost-effectiveness modelling study using data collected between February 2005 and November 2007 from a cluster-randomised trial that compared Telephone Counselling with a ''Usual Care'' (brief intervention) alternative. Economic outcomes were assessed using a state-transition Markov model, which predicted the progress of participants through five health states relating to physical activity and dietary improvement, for ten years after recruitment. The costs and health benefits of Telephone Counselling, Usual Care and an existing practice (Real Control) group were compared. Telephone Counselling compared to Usual Care was not cost-effective ($78,489 per quality adjusted life year gained). However, the Usual Care group did not represent existing practice and is not a useful comparator for decision making. Comparing Telephone Counselling outcomes to existing practice (Real Control), the intervention was found to be cost-effective ($29,375 per quality adjusted life year gained). Usual Care (brief intervention) compared to existing practice (Real Control) was also cost-effective ($12,153 per quality adjusted life year gained). Conclusions/Significance: This modelling study shows that a decision to adopt a Telephone Counselling program over existing practice (Real Control) is likely to be cost-effective. Choosing the 'Usual Care' brief intervention over existing practice (Real Control) shows a lower cost per quality adjusted life year, but the lack of supporting evidence for efficacy or sustainability is an important consideration for decision makers. The economics of behavioural approaches to improving health must be made explicit if decision makers are to be convinced that allocating resources toward such programs is worthwhile. Trial Registration: This paper uses data collected in a previous clinical trial registered at the Australian Clinical Trials Registry, Australian New Zealand Clinical Trials Registry: Anzcrt.org.au ACTRN012607000195459. [ABSTRACT FROM AUTHOR]

Abstract: Recent work in biodemography has suggested that lifetime exposure to infection and inflammation may be an important determinant of later-life morbidity and mortality. Early exposure to infections during critical periods can predispose individuals to chronic disease, in part through the reallocation of energy away from development needed for immune and inflammatory responses. Furthermore, markers of inflammation are known to vary by socioeconomic status in adults and may contribute to overall socioeconomic health inequalities, but little is known about how the sources of this inflammation differ over the life course. This paper uses novel biomarker data from the Third National Health and Nutrition Examination Survey (NHANES III) to test the association of the burden of common chronic infections (Helicobacter pylori (H. pylori), cytomegalovirus (CMV), herpes simplex virus-1 (HSV-1), hepatitis A and hepatitis B) with height-for-age and asthma/chronic respiratory conditions in U.S. children ages 6 and older, and the association of these chronic infections to children''s socioeconomic status. A higher burden of infection is found to be associated with lower height-for-age as well as an increased likelihood of asthma net of race/ethnicity, family income, and parental education. Children with lower family income, lower parental education, and non-white race/ethnicity have a higher likelihood of infection with several individual pathogens as well as the overall burden of infection. Differential exposure and/or susceptibility to infections may be one mechanism through which early social factors get embodied and shape later-life health outcomes. [Copyright &y& Elsevier]

Cancer-specific primary prevention efforts for the geriatric population are not understood well and currently are underused despite the rapidly growing elderly population. It has been established that lifestyle changes, such as smoking cessation, dietary changes, and increasing physical activity, decrease the incidence of cancer in younger populations. However, a multitude of conceptual, methodological, and dissemination challenges arise when the objective is to apply primary prevention of cancer to the elderly. For this article, the state of the science was reviewed to reveal barriers in the uptake of cancer-specific primary prevention practices, including the lack of data for the applicability of clinical research findings to older populations. Under-representation of older adults in behavioral trials and research programs is hindering progress in understanding the physical health and lifestyle choices of older individuals. Efforts directed toward prevention in terms of promoting health behaviors may be not only clinically advantageous but also cost-effective. In addition, models for translating research findings on primary prevention from younger individuals to the elderly population needs to be addressed. Practitioners need to gain a better understanding of the opportunities for cancer-specific primary prevention, because such an understanding could enhance the management of chronic disease. [ABSTRACT FROM AUTHOR]

The article presents an analysis on the religious perspective and practice of persons with chronic illness. A study was conducted to determine the meaning of spirituality of for eleven nonreligious participants with a chronic illness. It is mentioned that spirituality among the participants were directly related to beliefs, spiritual awakening, and spiritual enhancement.

Background/aims: Low socio-economic status is increasingly being identified as a risk marker for chronic diseases, but few studies have investigated the link between socio-economic factors and age-related macular degeneration (AMD). The present study aimed to assess the association between socio-economic status and the prevalence of AMD. Methods: A population-based cross-sectional study of 3280 (78.7% response rate) Malay adults aged 40-80 years residing in 15 south-western districts of Singapore. AMD was graded from retinal photographs at a central reading centre using the modified Wisconsin AMD scale. Early and late AMD signs were graded from retinal photographs following the Wisconsin grading system. Socio-economic status including education, housing type and income were determined from a detailed interview. Results: Of the participants, 3265 had photographs of sufficient quality for grading of AMD. Early AMD was present in 168 (5.1%) and late AMD in 21(0.6%). After adjusting for age, gender, smoking, hypertension, diabetes and body mass index, participants with lower educational levels were significantly more likely to have early AMD (multivariate OR 2.2, 95% Cl 1.2 to 4.0). This association was stronger in persons who had never smoked (multivariate OR 3.6, 95% confidence Cl 1.4 to 9.4). However, no association with housing type or income was seen. Conclusions: Low educational level is associated with a higher prevalence of early AMD signs in our Asian population, independent of age, cardiovascular risk factors and cigarette smoking. [ABSTRACT FROM AUTHOR]

Objective: We assessed the prevalence of perceived stigma among persons with mental disorders and chronic physical conditions in an international study. Method: Perceived stigma (reporting health-related embarrassment and discrimination) was assessed among adults reporting significant disability. Mental disorders were assessed with Composite International Diagnostic Interview (CIDI) 3.0. Chronic conditions were ascertained by self-report. Household-residing adults (80 737) participated in 17 population surveys in 16 countries. Results: Perceived stigma was present in 13.5% (22.1% in developing and 11.7% in developed countries). Suffering from a depressive or an anxiety disorder (vs. no mental disorder) was associated with about a twofold increase in the likelihood of stigma, while comorbid depression and anxiety was even more strongly associated (OR 3.4, 95%CI 2.7–4.2). Chronic physical conditions showed a much lower association. Conclusion: Perceived stigma is frequent and strongly associated with mental disorders worldwide. Efforts to alleviate stigma among individuals with comorbid depression and anxiety are needed. [ABSTRACT FROM AUTHOR]

This paper estimates the disease burden and loss of economic output associated with chronic diseases--mainly cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes--in 23 selected countries which account for around 80% of the total burden of chronic disease mortality in developing countries. In these 23 selected low-income and middle-income countries, chronic diseases were responsible for 50% of the total disease burden in 2005. For 15 of the selected countries where death registration data are available, the estimated age-standardised death rates for chronic diseases in 2005 were 54% higher for men and 86% higher for women than those for men and women in high-income countries. If nothing is done to reduce the risk of chronic diseases, an estimated US$84 billion of economic production will be lost from heart disease, stroke, and diabetes alone in these 23 countries between 2006 and 2015. Achievement of a global goal for chronic disease prevention and control--an additional 2% yearly reduction in chronic disease death rates over the next 10 years--would avert 24 million deaths in these countries, and would save an estimated $8 billion, which is almost 10% of the projected loss in national income over the next 10 years. [ABSTRACT FROM AUTHOR]

Early diagnosis and treatment are recognized strategies to reduce the long-term functional effects of chronic diseases, including psychotic disorders such as schizophrenia. Treatment may be delayed if youth, young adults and parents are not aware of the early signs and symptoms of psychosis, the need for early diagnosis and treatment and where and how to get help. This article describes the use of the PRECEDE component of PRECEDE-PROCEED model as a conceptual framework in the development of an early psychosis public education program's objectives designed to meet the learning needs of the target population (youth and young adults ages 15-30 years and their parents). The PRECEDE framework provided a strong conceptual model in the program's planning. [ABSTRACT FROM AUTHOR]