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Chronic Conditions: Issues and Challenges

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Behavior, Chronic Disease and Health Promotion".

Deadline for manuscript submissions: closed (1 June 2022) | Viewed by 20293

Special Issue Editors


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Guest Editor
Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
Interests: health inequalities; health outcomes; primary care; epidemiology; cardiovascular disease
Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
Interests: alcohol; mental health; non-communicable disease epidemiology

Special Issue Information

Dear Colleagues,

Chronic conditions are a major concern worldwide. The impact of long-term health problems is far reaching, with negative impacts economically, socially, as well as on health. Multimorbidity and the need to take a holistic view of health is of increasing importance, including the impact of chronic health problems on mental health which, in turn, may impact on disease management. The burden of chronic conditions is growing rapidly in low- and middle-income countries and, thus, timely research on optimal approaches for the identification and management of chronic conditions in diverse global populations is welcomed. Furthermore, the explosion of large-scale real-world data is facilitating the rapid progression of precision and stratified medicine approaches toward managing chronic conditions, and these consider the role of genetics, biological phenotypes, ethnicity, and social and environmental contexts. We welcome epidemiological and clinical studies describing the prevalence and incidence of chronic conditions, risk factors and outcomes, and approaches to pharmacological and non-pharmacological management of these conditions.

We would welcome papers on but not limited to:

  • Multimorbidity
  • Mental health in chronic disease
  • Management of chronic conditions in low- and middle-income countries
  • Social and ethnic inequalities in burden, treatment, and outcomes of chronic conditions
  • Challenges and opportunities in health service provision for chronic disease and multimorbidity
  • Treatment strategies for long-term conditions, including issues related to polypharmacy and drug interactions

Dr. Rohini Mathur
Dr. Sarah Cook
Guest Editors

Manuscript Submission Information

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Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • public health
  • epidemiology
  • chronic conditions
  • noncommunicable disease
  • multimorbidity
  • global health
  • disease management

Published Papers (9 papers)

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Research

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12 pages, 788 KiB  
Article
Awareness Status of Schistosomiasis among School-Aged Students in Two Schools on Pemba Island, Zanzibar: A Cross-Sectional Study
by Yiyun Liu, Wenjun Hu, Juma Saleh, Yuyan Wang, Qingkai Xue, Hongchu Wu, Kun Yang and Yuzheng Huang
Int. J. Environ. Res. Public Health 2023, 20(1), 582; https://doi.org/10.3390/ijerph20010582 - 29 Dec 2022
Viewed by 2779
Abstract
Schistosomiasis elimination has been set as a target in the Neglected Tropical Disease Roadmap of 2021 to 2030. The present study assessed the level of understanding, awareness and behaviors of schistosomiasis among students in Zanzibar and explored the influencing factors as the basis [...] Read more.
Schistosomiasis elimination has been set as a target in the Neglected Tropical Disease Roadmap of 2021 to 2030. The present study assessed the level of understanding, awareness and behaviors of schistosomiasis among students in Zanzibar and explored the influencing factors as the basis for reliable suggestions for the follow-up policy on schistosomiasis prevention and control. A Knowledge, Attitude and Practices (KAP) survey on students’ perceptions of schistosomiasis was conducted on students from grades 4–9 at two selected schools on Pemba, Zanzibar, from May through September in 2021. A total of 217 valid participants responded to the questionnaires. T-test and chi-squared tests were used to examine the association between the dependent and explanatory variables. Multiple linear regressions were used to analyze the influencing factors of KAP. The findings indicated a lack of knowledge about schistosomiasis among the participants. Although respondents were aware of the risks of infection, they continued to engage in high-risk activities. Age, family size and presence of hematuria were found as contributing factors. Elder students performed better on knowledge (p = 0.02) and attitude (p < 0.01) scores, and students with a smaller family received higher attitude scores (p = 0.04). Practice was significantly correlated with gender (p < 0.01) and hematuria (p < 0.01). Several kinds of health education should be adopted to raise students’ basic knowledge of schistosomiasis. It is also critical to make the community aware regarding schistosomiasis. Future efforts for the prevention and control of schistosomiasis should employ an integrated strategy combining communities with schools to encourage behavioral change. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
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13 pages, 1016 KiB  
Article
Sulfonylurea Use in Patients with Type 2 Diabetes and COPD: A Nationwide Population-Based Cohort Study
by Fu-Shun Yen, James Cheng-Chung Wei, Teng-Shun Yu, Chung Y. Hsu, Chih-Cheng Hsu and Chii-Min Hwu
Int. J. Environ. Res. Public Health 2022, 19(22), 15013; https://doi.org/10.3390/ijerph192215013 - 15 Nov 2022
Cited by 2 | Viewed by 1241
Abstract
We conducted this study to investigate the long-term outcomes of sulfonylurea (SU) use in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D). We used propensity-score matching to identify 6008 pairs of SU users and nonusers from Taiwan’s National Health [...] Read more.
We conducted this study to investigate the long-term outcomes of sulfonylurea (SU) use in patients with chronic obstructive pulmonary disease (COPD) and type 2 diabetes (T2D). We used propensity-score matching to identify 6008 pairs of SU users and nonusers from Taiwan’s National Health Insurance Research Database from 1 January 2000 to 31 December 2017. Cox proportional hazard models were used to compare the risks of mortality, cardiovascular events, non-invasive positive pressure ventilation, invasive mechanical ventilation, bacterial pneumonia, lung cancer, and hypoglycemia between SU users and nonusers. In the matched cohorts, the mean follow-up time for SU users and nonusers was 6.57 and 5.48 years, respectively. Compared with nonusers, SU users showed significantly lower risks of mortality [aHR 0.53(0.48–0.58)], cardiovascular events [aHR 0.88(0.81–0.96)], non-invasive positive pressure ventilation [aHR 0.74(0.6–0.92)], invasive mechanical ventilation [aHR 0.57(0.5–0.66)], and bacterial pneumonia [aHR 0.78(0.7–0.87)]. A longer cumulative duration of SU use was associated with a lower risk of these outcomes. This nationwide cohort study demonstrated that SU use was associated with significantly lower risks of cardiovascular events, ventilation use, bacterial pneumonia, and mortality in patients with COPD and T2D. SU may be a suitable option for diabetes management in these patients. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
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20 pages, 693 KiB  
Article
Chronic Kidney Disease as a Cardiovascular Disorder—Tonometry Data Analyses
by Mateusz Twardawa, Piotr Formanowicz and Dorota Formanowicz
Int. J. Environ. Res. Public Health 2022, 19(19), 12339; https://doi.org/10.3390/ijerph191912339 - 28 Sep 2022
Cited by 2 | Viewed by 1583
Abstract
Tonometry is commonly used to provide efficient and good diagnostics for cardiovascular disease (CVD). There are many advantages of this method, including low cost, non-invasiveness and little time to perform. In this study, the effort was undertaken to check whether tonometry data hides [...] Read more.
Tonometry is commonly used to provide efficient and good diagnostics for cardiovascular disease (CVD). There are many advantages of this method, including low cost, non-invasiveness and little time to perform. In this study, the effort was undertaken to check whether tonometry data hides valuable information associated with different stages of chronic kidney disease (CKD) and end-stage renal disease (ESRD) treatment. For this purpose, six groups containing patients at different stages of CKD following different ways of dialysis treatment, as well as patients without CKD but with CVD and healthy volunteers were assessed. It was revealed that each of the studied groups had a unique profile. Only the type of dialysis was indistinguishable a from tonometric perspective (hemodialysis vs. peritoneal dialysis). Several techniques were used to build profiles that independently gave the same outcome: analysis of variance, network correlation structure analysis, multinomial logistic regression, and discrimination analysis. Moreover, to evaluate the classification potential of the discriminatory model, all mentioned techniques were later compared and treated as feature selection methods. Although the results are promising, it could be difficult to express differences as simple mathematical relations. This study shows that artificial intelligence can differentiate between different stages of CKD and patients without CKD. Potential future machine learning models will be able to determine kidney health with high accuracy and thereby classify patients. ClinicalTrials.gov Identifier: NCT05214872. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
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11 pages, 355 KiB  
Article
Sex Differences of Sarcopenia in an Elderly Asian Population: The Prevalence and Risk Factors
by Jongseok Hwang and Soonjee Park
Int. J. Environ. Res. Public Health 2022, 19(19), 11980; https://doi.org/10.3390/ijerph191911980 - 22 Sep 2022
Cited by 29 | Viewed by 2881
Abstract
The loss of muscle mass is widespread in age-related health phenomena in the elderly population. This study examined the prevalence of sarcopenia in a community-dwelling elderly population according to gender. The study also identified gender-specific risk factors in older people aged 75–84 years [...] Read more.
The loss of muscle mass is widespread in age-related health phenomena in the elderly population. This study examined the prevalence of sarcopenia in a community-dwelling elderly population according to gender. The study also identified gender-specific risk factors in older people aged 75–84 years old. One thousand two hundred and ninety-three participants aged between 75 and 84 years from the National Health and Nutrition Examination Surveys in Korea were investigated. The prevalence of sarcopenia in males and females in the weighted-value sample was 41.2% (95%CI: 35.8–46.8) and 37.2% (32.7–41.9), respectively. Gender-specific clinical risk factors in males were height, weight, body mass index, waist circumference, skeletal muscle mass index, fasting glucose, and triglyceride levels. Height, weight, body mass index, waist circumference, skeletal muscle mass index, and total cholesterols were clinical risk factors for females. These outcomes would be crucial to primary care clinicians and health care professionals when patients require a referral for early detection and treatment. Health care professionals and clinicians can quickly identify potential sarcopenic patients by acknowledging the gender-specific prevalence and risk factors. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
12 pages, 323 KiB  
Article
Screening for Diabetes Complications during the COVID-19 Outbreak in South Korea
by Yu shin Park, Soo Young Kim, Eun-Cheol Park and Sung-In Jang
Int. J. Environ. Res. Public Health 2022, 19(9), 5436; https://doi.org/10.3390/ijerph19095436 - 29 Apr 2022
Viewed by 1956
Abstract
This study aimed to investigate the implementation of diabetes complications screening in South Korea during the coronavirus disease (COVID-19) outbreak. Data from the Korea Community Health Surveys conducted in 2019 and 2020 were used. This study included 51,471 participants. Multiple level analysis was [...] Read more.
This study aimed to investigate the implementation of diabetes complications screening in South Korea during the coronavirus disease (COVID-19) outbreak. Data from the Korea Community Health Surveys conducted in 2019 and 2020 were used. This study included 51,471 participants. Multiple level analysis was used to investigate the relationships between screening for diabetic retinopathy and diabetic nephropathy and variables of both individual- and community-level factors in 2019 and 2020, before and after the COVID-19 outbreak. Diabetes nephropathy complications screening in 2020 had a lower odds ratio. However, regions heavily affected by COVID-19 showed a negative association with diabetes complications screening after the COVID-19 outbreak. For those being treated with medication for diabetes, there was a significant negative association with diabetic nephropathy screening after the outbreak. The COVID-19 outbreak was associated with a reduction in the use of diabetes nephropathy complications screening. Additionally, only regions heavily affected by COVID-19 spread showed a negative association with diabetes complications screening compared to before the COVID-19 outbreak. In this regard, it appears that many patients were unable to attend outpatient care due to COVID-19. As such, these patients should be encouraged to visit clinics for diabetes complications screening. Furthermore, alternative methods need to be developed to support these patients. Through these efforts, the development of diabetes-related complications should be prevented, and the costs associated with these complications will be reduced. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
12 pages, 744 KiB  
Article
Incidence and Risk Factors for Progression to Diabetes Mellitus: A Retrospective Cohort Study
by Min Kyung Hyun, Jong Heon Park, Kyoung Hoon Kim, Soon-Ki Ahn and Seon Mi Ji
Int. J. Environ. Res. Public Health 2022, 19(1), 123; https://doi.org/10.3390/ijerph19010123 - 23 Dec 2021
Cited by 5 | Viewed by 2542
Abstract
(1) Objective: This study examined the incidence and risk factors contributing to the progression to diabetes mellitus (DM) in a seven-year follow-up study of non-diabetic National Health Examinees. (2) Methods: For this retrospective observational cohort study, we used two national representative databases: the [...] Read more.
(1) Objective: This study examined the incidence and risk factors contributing to the progression to diabetes mellitus (DM) in a seven-year follow-up study of non-diabetic National Health Examinees. (2) Methods: For this retrospective observational cohort study, we used two national representative databases: the National Health Screening (HEALS) database 2009 and the National Health Insurance Service (NHIS) database 2009–2015. The eligible subjects without DM with blood sugar levels of <126 mg/dL were selected using the HEALS database. The subsequent follow-up and clinical outcomes were evaluated using the NHIS database. Cox proportional hazard regression was applied to examine the effects of the covariates on progression to diabetes. (3) Results: Among those who took part in the national health screening in 2009, 4,205,006 subjects who met the eligibility criteria were selected. Of these, 587,015 were diagnosed with DM during the follow-up by 2015. The incidence of progression from non-diabetes to DM was 14.0%, whereas that from impaired fasting glucose (IFG) to DM was 21.9%. Compared to the normal group, the newly diagnosed DM group was more likely to comprise older, female, currently smoking, and high-risk drinking participants and participants with IFG, hypertension, dyslipidemia, and metabolic syndrome. (4) Conclusions: This epidemiological study in the Republic of Korea found risk factors similar to those of other studies, but the incidence of progression to DM was 22.8 per 1000 person-years, which is higher than that previously reported. Hence, more care is needed to prevent DM. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
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14 pages, 366 KiB  
Article
Relationship between Diabetes Family Conflicts or Problem Recognition in Illness Self-Management and Quality of Life of Adolescents with T1DM and Their Parents
by Mi-Kyoung Cho and Mi Young Kim
Int. J. Environ. Res. Public Health 2021, 18(20), 10710; https://doi.org/10.3390/ijerph182010710 - 13 Oct 2021
Cited by 1 | Viewed by 1956
Abstract
This study aimed to investigate the relationship between diabetes family conflicts or problem recognition in illness self-management (PRISM) and the parental perceived quality of life (QoL) of adolescents with type 1 diabetes mellitus (T1DM) and their parents. This was a cross-sectional study, and [...] Read more.
This study aimed to investigate the relationship between diabetes family conflicts or problem recognition in illness self-management (PRISM) and the parental perceived quality of life (QoL) of adolescents with type 1 diabetes mellitus (T1DM) and their parents. This was a cross-sectional study, and the participants comprised 111 parents of type 1 diabetes adolescents; data were collected via an online survey and analyzed by descriptive statistics, correlation, and multiple linear regression analysis using the IBM SPSS 25.0 program. The explanatory power of the QoL model in parents of adolescents with T1DM, constructed using three variables—diabetes family conflict (B = −0.56), regimen pain and bother (B = −11.25), and peer interactions (B = −7.48), which are PRISM barriers—was 35.7% (F = 5.70, p < 0.001). Diabetes family conflicts (B = −0.86) and peer interactions (B = −9.04) explained 57.3% of the variance in the parental perceived QoL of adolescents with T1DM (F = 12.33, p < 0.001). In order to improve the QoL in parents and adolescents with type 1 diabetes, interventions to effectively manage diabetes family conflicts and improve peer interactions are necessary. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)

Review

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15 pages, 6187 KiB  
Review
Integrated Care as a Model for Interprofessional Disease Management and the Benefits for People Living with HIV/AIDS
by Helmut Beichler, Igor Grabovac and Thomas E. Dorner
Int. J. Environ. Res. Public Health 2023, 20(4), 3374; https://doi.org/10.3390/ijerph20043374 - 15 Feb 2023
Cited by 5 | Viewed by 2529
Abstract
Introduction: Today, antiretroviral therapy (ART) is effectively used as a lifelong therapy to treat people living with HIV (PLWH) to suppress viral replication. Moreover, PLWH need an adequate care strategy in an interprofessional, networked setting of health care professionals from different disciplines. HIV/AIDS [...] Read more.
Introduction: Today, antiretroviral therapy (ART) is effectively used as a lifelong therapy to treat people living with HIV (PLWH) to suppress viral replication. Moreover, PLWH need an adequate care strategy in an interprofessional, networked setting of health care professionals from different disciplines. HIV/AIDS poses challenges to both patients and health care professionals within the framework of care due to frequent visits to physicians, avoidable hospitalizations, comorbidities, complications, and the resulting polypharmacy. The concepts of integrated care (IC) represent sustainable approaches to solving the complex care situation of PLWH. Aims: This study aimed to describe the national and international models of integrated care and their benefits regarding PLWH as complex, chronically ill patients in the health care system. Methods: We conducted a narrative review of the current national and international innovative models and approaches to integrated care for people with HIV/AIDS. The literature search covered the period between March and November 2022 and was conducted in the databases Cinahl, Cochrane, and Pubmed. Quantitative and qualitative studies, meta-analyses, and reviews were included. Results: The main findings are the benefits of integrated care (IC) as an interconnected, guideline- and pathway-based multiprofessional, multidisciplinary, patient-centered treatment for PLWH with complex chronic HIV/AIDS. This includes the evidence-based continuity of care with decreased hospitalization, reductions in costly and burdensome duplicate testing, and the saving of overall health care costs. Furthermore, it includes motivation for adherence, the prevention of HIV transmission through unrestricted access to ART, the reduction and timely treatment of comorbidities, the reduction of multimorbidity and polypharmacy, palliative care, and the treatment of chronic pain. IC is initiated, implemented, and financed by health policy in the form of integrated health care, managed care, case and care management, primary care, and general practitioner-centered concepts for the care of PLWH. Integrated care was originally founded in the United States of America. The complexity of HIV/AIDS intensifies as the disease progresses. Conclusions: Integrated care focuses on the holistic view of PLWH, considering medical, nursing, psychosocial, and psychiatric needs, as well as the various interactions among them. A comprehensive expansion of integrated care in primary health care settings will not only relieve the burden on hospitals but also significantly improve the patient situation and the outcome of treatment. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
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15 pages, 887 KiB  
Review
Effects of Anodal Cerebellar Transcranial Direct Current Stimulation on Movements in Patients with Cerebellar Ataxias: A Systematic Review
by Shu-Mei Wang, Ying-Wa Chan, Yiu-On Tsui and Fong-Yung Chu
Int. J. Environ. Res. Public Health 2021, 18(20), 10690; https://doi.org/10.3390/ijerph182010690 - 12 Oct 2021
Cited by 5 | Viewed by 2046
Abstract
Cerebellar transcranial direct current stimulation (cerebellar tDCS) is a promising therapy for cerebellar ataxias and has attracted increasing attention from researchers and clinicians. A timely systematic review focusing on randomized sham-controlled trials and repeated measures studies is warranted. This study was to systematically [...] Read more.
Cerebellar transcranial direct current stimulation (cerebellar tDCS) is a promising therapy for cerebellar ataxias and has attracted increasing attention from researchers and clinicians. A timely systematic review focusing on randomized sham-controlled trials and repeated measures studies is warranted. This study was to systematically review existing evidence regarding effects of anodal cerebellar tDCS on movements in patients with cerebellar ataxias. The searched databases included Web of Science, MEDLINE, PsycINFO, CINAHL, EMBASE, Cochrane Library, and EBSCOhost. Methodological quality of the selected studies was assessed using the Physiotherapy Evidence Database scale. Five studies with 86 patients were identified. Among these, four studies showed positive effects of anodal cerebellar tDCS. Specifically, anodal cerebellar tDCS decreased disease severity and improved finger dexterity and quality of life in patients, but showed incongruent effects on gait control and balance, which may be due to heterogeneity of research participants and choices of measures. The protocols of anodal cerebellar tDCS that improved movements in patients commonly placed the anode over the whole cerebellum and provided ten 2-mA 20-min stimulation sessions. The results may show preliminary evidence that anodal cerebellar tDCS is beneficial to reducing disease severity and improving finger dexterity and quality of life in patients, which lays the groundwork for future studies further examining responses in the cerebello-thalamo-cortical pathway. An increase in sample size, the use of homogeneous patient groups, exploration of the optimal stimulation protocol, and investigation of detailed neural mechanisms are clearly needed in future studies. Full article
(This article belongs to the Special Issue Chronic Conditions: Issues and Challenges)
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