Background
In the UK, general practitioners/family physicians receive pay for performance on management of long‐term conditions, according to best‐practice indicators.
Method
Management of long‐term ...conditions was compared between 721 adults with intellectual disabilities and the general population (n = 764,672). Prevalence of long‐term conditions was determined, and associated factors were investigated via logistic regression analyses.
Results
Adults with intellectual disabilities received significantly poorer management of all long‐term conditions on 38/57 (66.7%) indicators. Achievement was high (75.1%–100%) for only 19.6% of adults with intellectual disabilities, compared with 76.8% of the general population. Adults with intellectual disabilities had higher rates of epilepsy, psychosis, hypothyroidism, asthma, diabetes and heart failure. There were no clear associations with neighbourhood deprivation.
Conclusions
Adults with intellectual disabilities receive poorer care, despite conditions being more prevalent. The imperative now is to find practical, implementable means of supporting the challenges that general practices face in delivering equitable care.
Modern lifestyles increase the risk of chronic diseases, in part by modifying the microbiome, but the health effects of lifestyles enforced on ethnic minorities are understudied
. Lifestyle affects ...the microbiome early in life, when the microbiome is assembled and the immune system is undergoing maturation
. Moreover, the influence of lifestyle has been separated from genetic and geographic factors by studies of genetically similar populations and ethnically distinct groups living in the same geographic location
. The lifestyle of Irish Travellers, an ethnically distinct subpopulation, changed with legislation in 2002 that effectively ended nomadism and altered their living conditions. Comparative metagenomics of gut microbiomes shows that Irish Travellers retain a microbiota similar to that of non-industrialized societies. Their microbiota is associated with non-dietary factors and is proportionately linked with risk of microbiome-related metabolic disease. Our findings suggest there are microbiome-related public health implications when ethnic minorities are pressured to change lifestyles.
Diets for Health: Goals and Guidelines Locke, Amy; Schneiderhan, Jill; Zick, Suzanna M
American family physician,
06/2018, Letnik:
97, Številka:
11
Journal Article
Recenzirano
Diet is the single most significant risk factor for disability and premature death. Patients and physicians often have difficulty staying abreast of diet trends, many of which focus primarily on ...weight loss rather than nutrition and health. Recommending an eating style can help patients make positive change. Dietary patterns that support health include the Mediterranean diet, the Dietary Approaches to Stop Hypertension diet, the 2015 Dietary Guidelines for Americans, and the Healthy Eating Plate. These approaches have benefits that include prevention of cardiovascular disease, cancer, type 2 diabetes mellitus, and obesity. These dietary patterns are supported by strong evidence that promotes a primary focus on unprocessed foods, fruits and vegetables, plant-based fats and proteins, legumes, whole grains, and nuts. Added sugars should be limited to less than 5% to 10% of daily caloric intake. Vegetables (not including potatoes) and fruits should make up one-half of each meal. Carbohydrate sources should primarily include beans/legumes, whole grains, fruits, and vegetables. An emphasis on monounsaturated fats, such as olive oil, avocados, and nuts, and omega-3 fatty acids, such as flax, cold-water fish, and nuts, helps prevent cardiovascular disease, type 2 diabetes, and cognitive decline. A focus on foods rather than macronutrients can assist patients in understanding a healthy diet. Addressing barriers to following a healthy diet and utilizing the entire health care team can assist patients in following these guidelines.
There is ample scientific evidence suggesting that the health benefits of eating the right amounts of a variety of vegetables and fruit are the consequence of the combined action of different ...phytochemicals. The present review provides an update of the scientific literature on additive and synergistic effects of mixtures of phytochemicals. Most research has been carried out in in vitro systems in which synergistic or additive effects have been established on the level of cell proliferation, apoptosis, antioxidant capacity, and tumor incidence, accompanied by changes in gene and protein expression in relevant pathways underlying molecular mechanisms of disease prevention. The number of human dietary intervention studies investigating complex mixtures of phytochemicals is relatively small, but showing promising results. These studies have demonstrated that combining transcriptomic data with phenotypic markers provide insight into the relevant cellular processes which contribute to the antioxidant response of complex mixtures of phytochemicals. Future studies should be designed as short‐term studies testing different combinations of vegetables and fruit, in which markers for disease outcome as well as molecular (‘omics)‐markers and genetic variability between subjects are included. This will create new opportunities for food innovation and the development of more personalized strategies for prevention of chronic diseases.
Complex mixtures of bioactive compounds (phytochemicals) in vegetables and fruits are thought to be responsible for their beneficial health effects. Future studies should test different combinations of vegetables and fruit, in which markers for disease outcome, molecular (‘omics)‐markers and genetic variability included. This will create opportunities for food innovation and the development of personalized strategies for prevention of chronic diseases.
Abstract
Objectives
A meta-analysis examined family functioning and medical adherence in children and adolescents with chronic health conditions. Family functioning was evaluated at the level of the ...family unit, as well as parent–child interactions.
Methods
We conducted literature searches using PubMed, PsycINFO, SCOPUS, Web of Science, and Cochrane. After reviewing 764 articles, 62 studies met eligibility criteria. Pearson’s r correlations were the effect size of interest. We conducted both omnibus and domain-specific (e.g., family conflict, cohesion) meta-analyses. Meta-regressions examined whether relevant covariates related to the magnitude of the effect.
Results
The omnibus meta-analysis showed that family functioning was significantly related to medical adherence across a variety of pediatric chronic health conditions. Lower family conflict, greater family cohesion, greater family flexibility, more positive communication, and better family problem-solving were each associated with better adherence. There were no significant differences in the magnitude of the omnibus effect based on child age, measurement features (subjective vs. objective or bioassay adherence; family unit vs. parent–child interactions), or study quality.
Conclusions
Consistent with social–ecological frameworks, findings supported links between family functioning and medical adherence. This study highlights several limitations of the extant research, including absence of a guiding theoretical framework and several methodological weaknesses. We offer clinical and research recommendations for enhancing scientific understanding and promotion of adherence within the family context.
Noncommunicable diseases (NCDs), including cardiovascular disease, diabetes, chronic lung disease, allergy, some forms of cancer, cognitive decline, osteoporosis, sarcopenia, and affective disorders, ...are the world's biggest killers. Eighty percent of these deaths occur in low- and middle-income countries, especially as these countries undergo socioeconomic improvement after reductions in infectious disease. The World Health Organization predicts a global increase of 17% in NCDs over the next decade. NCDs are preventable, but new initiatives are needed to institute such prevention, especially in early life. In this article, we emphasize that all children are affected by their early developmental conditions, not just children exposed to a very deficient environment, and that this has long-term consequences for their predisposition to NCDs. We highlight the biomedical implications of this developmental origins of health and disease (DOHaD) concept of NCDs and discuss the implications for health policy.
OBJECTIVE:To determine the incidence and risk factors of chronic critical illness after severe blunt trauma.
DESIGN:Prospective observational cohort study (NCT01810328).
SETTING:Two-level one trauma ...centers in the United States.
PATIENTS:One hundred thirty-five adult blunt trauma patients with hemorrhagic shock who survived beyond 48 hours after injury.
INTERVENTIONS:None.
MEASUREMENTS AND MAIN RESULTS:Chronic critical illness was defined as an ICU stay lasting 14 days or more with evidence of persistent organ dysfunction. Three subjects (2%) died within the first 7 days, 107 (79%) exhibited rapid recovery and 25 (19%) progressed to chronic critical illness. Patients who developed chronic critical illness were older (55 vs 44-year-old; p = 0.01), had more severe shock (base deficit, –9.2 vs –5.5; p = 0.005), greater organ failure severity (Denver multiple organ failure score, 3.5 ± 2.4 vs 0.8 ± 1.1; p < 0.0001) and developed more infectious complications (84% vs 35%; p < 0.0001). Chronic critical illness patients were more likely to be discharged to a long-term care setting (56% vs 34%; p = 0.008) than to a rehabilitation facility/home. At 4 months, chronic critical illness patients had higher mortality (16.0% vs 1.9%; p < 0.05), with survivors scoring lower in general health measures (p < 0.005). Multivariate analysis revealed age greater than or equal to 55 years, systolic hypotension less than or equal to 70 mm Hg, transfusion greater than or equal to 5 units packed red blood cells within 24 hours, and Denver multiple organ failure score at 72 hours as independent predictors of chronic critical illness (area under the receiver operating curve, 0.87; 95% CI, 0.75–0.95).
CONCLUSIONS:Although early mortality is low after severe trauma, chronic critical illness is a common trajectory in survivors and is associated with poor long-term outcomes. Advancing age, shock severity, and persistent organ dysfunction are predictive of chronic critical illness. Early identification may facilitate targeted interventions to change the trajectory of this morbid phenotype.
Objective
To examine associations between clinics’ extent of patient‐centered medical home (PCMH) implementation and improvements in chronic illness care quality.
Data Source
Data from 808 Veterans ...Health Administration (VHA) primary care clinics nationwide implementing the Patient Aligned Care Teams (PACT) PCMH initiative, begun in 2010.
Design
Clinic‐level longitudinal observational study of clinics that received training and resources to implement PACT. Clinics varied in the extent they had PACT components in place by 2012.
Data Collection
Clinical care quality measures reflecting intermediate outcomes and care processes related to coronary artery disease (CAD), diabetes, and hypertension care were collected by manual chart review at each VHA facility from 2009 to 2013.
Findings
In adjusted models containing 808 clinics, the 77 clinics with the most PACT components in place had significantly larger improvements in five of seven chronic disease intermediate outcome measures (e.g., BP < 160/100 in diabetes), ranging from 1.3 percent to 5.2 percent of the patient population meeting measures, and two of eight process measures (HbA1c measurement, LDL measurement in CAD) than the 69 clinics with the least PACT components. Clinics with moderate levels of PACT components showed few significantly larger improvements than the lowest PACT clinics.
Conclusions
Veterans Health Administration primary care clinics with the most PCMH components in place in 2012 had greater improvements in several chronic disease quality measures in 2009–2013 than the lowest PCMH clinics.
We sought to examine the relationship between health literacy and knowledge of disease among patients with a chronic disease. A total of 653 new Medicare enrollees aged 65 years or older who had at ...least one chronic disease (115 asthma, 266 diabetes, 166 congestive heart failure, 214 hypertension), completed both the in-person and telephone survey. Health literacy measured by the short test of functional health literacy in adults (S-TOFHLA) and demographic information were collected during the in-person survey. Knowledge of disease was assessed by questions based on key elements in educational materials during a telephone survey. Overall, 24% of patients had inadequate and 12% had marginal health literacy skills. Respondents with inadequate health literacy knew significantly less about their disease than those with adequate literacy. Multivariate analysis indicated that health literacy was independently related to disease knowledge. There are many opportunities to improve patients’ knowledge of their chronic disease(s), and efforts need to consider their health literacy skills.
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