There are still many questions to be addressed in chronic disease and health care. Cancer is the second leading cause of death in the United States and is expected to become the leading cause of death over the next decade (Stewart, et al., 2004). Cancer was the leading cause of death among non-Hispanic blacks and Hispanics aged 45 to 64 years (Centers for Disease Control and Prevention, 2001).
The increase in the incidence of the metabolic syndrome is likely to cause future increases in the incidence of diabetes and cardiovascular disease. In the United States, arthritis, other rheumatic conditions, and musculoskeletal disorders are the leading cause of disability and impaired quality of life. Some research suggests that psychosocial stress is implicated in the etiology of the disease and exacerbates the pain symptoms (Dedert, et al., 2004).
Despite improved patient care, greater public awareness, and extensive use of medical innovations, cardiovascular disease remains the leading cause of death in the United States (MMWR, 2001).
Health Care Costs
Technological innovations in diagnostic, therapeutic, and health care information technologies such as electronic medical records and telemedicine offer the potential to reduce health care costs (Hersh, et al., 2001). More than 1.5 million osteoporosis-related fractures occur annually (Orsini, et al., 2005) and the aging population will increase the social and economic costs of osteoporosis on the United States health care system (Burge, et al. ., 2003). In California, it was estimated that osteoporosis accounted for more than $2.4 billion in direct health care costs in 1998 and more than $4 million in lost productivity related to premature death (Max, et al., 2002).
The cost of fibromyalgia increases overall health care costs due to the extensive use of health care services by fibromyalgia patients. 2004) found that in Canada the mean 6-month direct costs among women with primary fibromyalgia. Low back pain represents a major cost to society due to the cost of medical treatment, lost productivity, and non-monetary costs such as the reduced ability to perform usual activities (Ozguler, et al., 2004; U.S. Agency for Health Care Policy and Research, 1994). Resource utilization and costs associated with the clinical care of stroke patients have a significant impact on healthcare costs (Doedel, et al., 2004).
Several factors can increase health care costs for patients with cardiovascular disease or those at risk for the disease.
Living with a Chronic Disease
The literature on suicide suggests that patients with chronic pain are at greater risk for depression than the general population. These studies showed that suicidal ideation, suicide attempts, and suicide completion are commonly found in individuals with chronic pain. Penttinen (1995) found a relationship between back pain and suicide among Finnish farmers, while Fishbain, et al. 1991) studied patients in a pain center and found that the overall suicide rate for patients with chronic pain was significantly higher than that of the general population. 2004) studied the role of sleep onset insomnia and pain intensity in individuals with chronic musculoskeletal pain and evidence of suicidal ideation in these individuals.
In another study, Hadjistavropoulos, et al. 2002) evaluated 65 patients with chronic pain and the role of anxiety in pain. Tricyclic antidepressants are commonly prescribed for the treatment of many chronic pain syndromes, especially neuropathic pain. The role of the family in the development and persistence of chronic pain conditions has attracted considerable empirical attention (Kerns and Otis, 2003).
In counseling, Rita complained of weight gain (a common side effect of steroid treatment), feeling useless, and chronic pain.
Diabetes Mellitus
Research has shown that a history of parental diabetes is directly related to an increased chance of developing type 2 diabetes (Wei, et al., 1999). Although familial clustering of type 2 diabetes has been established, Shaw, et al. 1999) note that little is known about the prevalence of diabetes in relatives of people with diabetes compared to the general population. Age disparities among persons with type 2 diabetes, hypertension, and hyperlipidemia have been identified (Pontiroli and Galli, 1998; Wei, et al., 1999).
However, another study found that male gender was associated with diabetes risk factors (Devroey, et al., 2004). Researchers have focused on the role of diet and nutrition in the development of type 2 diabetes (Harding, et al., 2004; van Dam, 2003). Another study showed that high triglyceride levels and other factors were associated with the risk of type 2 diabetes (Wei, et al., 1999).
However, moderate and heavy alcohol consumption may be associated with an increased risk of type 2 diabetes (Waki et al., 2005). In a study of 437 patients with type 2 diabetes, one report found that older age (over 75 years) predicted lower quality of life (Senez, et al., 2004). For example, Liu, et al. 2005) reports a new series of dual PPAR alpha/gamma agonists for the treatment of type 2 diabetes and dyslipidemia.
Rheumatoid Arthritis,
Osteoarthritis, Osteoporosis, Fibromyalgia, and Low
Back Pain
One study by Krishnan et al. 2003) evaluated the possible association between gender, smoking and the risk of developing rheumatoid arthritis. The role of menopause as a risk factor for rheumatoid arthritis needs further investigation (Krishnan et al., 2003). In addition to causing early retirement, rheumatoid arthritis can cause significant absenteeism from work (Kapidzic-Basic, et al., 2004).
One report showed that the number of vertebral deformities was significantly increased in patients with rheumatoid arthritis compared to a control population (Orstavik et al., 2004). In a literature review, Wilson et al. 2004) found that improvement in indicators of rheumatoid arthritis (swollen, painful and tender joints, pain, low muscle strength, and low energy levels) was associated with resolution of anemia. Varying levels of pain, stress, and other factors may determine disease activity and other outcomes in patients with rheumatoid arthritis (Barlow et al., 2003).
Another study by Griffin, et al. 2001) assessed the impact of negative responses from significant others on patients with rheumatoid arthritis. Certain occupations and working conditions have been associated with an increased risk of osteoarthritis (Croft, et al., 1992; One study of back pain among farmers found that psychological depression was significantly associated with back pain (Xiang, et al., 1999).
A multi-dose randomized controlled trial by Dreiser et al. 2003) tested the effectiveness and safety of Diclofenac-K in the treatment of acute low back pain. Other research has evaluated the efficacy of Rofecoxib in the treatment of chronic low back pain (Katz, et al., 2004; based on a randomized clinical trial, Katz, et al. 2004) showed that approximately 2/3 of patients with chronic low back pain achieved pain relief with Rofecoxib.
Spinal cord stimulation is used to treat low back pain and other types of chronic pain (Mailis-Gagnon et al., 2004). Many studies have evaluated the effects of physical exercise on patients with acute, subacute and chronic low back pain (Ozguler et al., 2004; Faas, 1996). Returning schools vary in terms of target population and duration (from 45-minute sessions to multi-week programs) (Ozguler et al., 2004).
Work hardening interventions are multidisciplinary programs that attempt to address the physical and functional needs of patients with low back pain (Ozguler, et al., 2004).
Cardiovascular Disease
Diabetes
Persons with type 2 diabetes have an increased risk of cardiovascular disease, coronary heart disease and vascular disease (Lu, et al., 2004). Researchers emphasize the need to control metabolic syndrome to prevent cardiovascular disease (Park, et al., 2004; Scuteri, et al., 2004). Researchers have found that diet plays an important role in reducing high blood pressure and cardiovascular risk factors (Krousel-Wood, et al., 2004; Azizi, et al., 2004).
Increased calcium intake is associated with decreased systolic and diastolic blood pressure and serum triglycerides in adolescent females (Azizi, et al., 2004). Cholesterol is a major risk factor for cardiovascular disease and associated morbidity and mortality (De Luca and Boccini, 2003; Ketola, et al., 2000). Based on a sample of Greek adults in the Athens area, Panagiotakos, et al. 2005) found that alcohol consumption was one of the.
There is emerging evidence that exposure to environmental tobacco smoke may be associated with increased cardiovascular risks (Zhang, et al., 2005). Epidemiological studies have documented increased incidence of cardiovascular disease and myocardial infarction associated with short-term and daily fine particulate air pollution (Sullivan, et al., 2005). In an investigation of patients with peripheral arterial disease and claudication, age was also found to be one of the strongest predictors of lower extremity disability (Oka, et al., 2004).
Women with heart disease have a poorer prognosis and higher rates of disability compared to men with heart disease (Davidson et al., 2003). In a 4-month follow-up study of 288 hospitalized patients with myocardial infarction, Lane et al. 2000) reported that both depression and anxiety were associated with reduced quality of life. Another study by Karoff et al. 2000) reported that they were elderly patients after myocardial infarction and/or bypass surgery.
In their study, Lane, et al. 2000) found that 4 months after hospitalization for acute myocardial infarction, patients suffered from both depression and anxiety, which were associated with lower quality of life. Psychosocial problems often occur after acute myocardial infarction and are associated with other forms of cardiovascular morbidity (Lacey, et al., 2004).
Cancer
There are several risk factors for breast cancer and premalignant breast cancer (Tyrer, et al., 2004). BRCA1 and BRCA2 mutations are not responsible for the entire familial aggregation of breast cancer (Tyrer, et al., 2004). A number of reproductive and hormonal factors have been linked to an increased risk of breast cancer.
Women's first pregnancy has been found to have a negative effect on breast cancer risk (Colditz, et al., 2004). Menopausal status has been associated with breast cancer risk and other breast cancer risk factors. The association between circulating IGF-I and breast cancer risk may vary by menopausal status (Schernhammer, et al., 2005).
Some studies suggest that an increased intake of (n-3) fatty acids and/or an increased ratio of (n-3)/(n-6) polyunsaturated fatty acids (PUFA) are associated with a lower risk of breast cancer. There are inconclusive findings on the effect of fruits, vegetables and antioxidant micronutrients on breast cancer risk (Gaudet, et al., 2004; Nkondjock and Ghadirian, 2004). Epidemiological reports link alcohol consumption to an increased risk of breast cancer (Laufer, et al., 2004; Mattisson, et al., 2004).
Physical activity has been identified as a possible protective factor in reducing the risk of breast cancer (Varo Cenarruzabeitia, et al., 2003; Walker, et al., 2004; Kaaks and Lukanova, 2002). Similarly, other research has shown that low levels of physical activity have been associated with an increased risk of breast cancer (Varo Cenarruzabeitia, et al., 2003). Women's menopausal status may mediate the association between physical activity and breast cancer risk.
However, in postmenopausal women, lifetime physical activity was associated with a reduced risk of breast cancer. They found that frequent use of aspirin and other NSAIDs (more than or equal to 7 tablets per week) was associated with a reduced risk of breast cancer.
