Dissertations / Theses on the topic 'Chronic disease'
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Williams, Stacey L., and E. Fekete. "Chronic Disease." Digital Commons @ East Tennessee State University, 2012. https://dc.etsu.edu/etsu-works/8145.
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Jaishankar, Gayatri. "Chronic Granulomatous Disease." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/8869.
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Ye, Ping. "Autoimmunity in chronic periodontitis." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/4256.
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Profound perturbation of epithelial structure is a characteristic feature of the immunopatholoical response to bacterial antigens considered to be central in the pathogenesis of the destructive lesion of periodontitis. The pathological basis for the disturbance of epithelial structure is not understood. It was demonstrated that the structural integrity and functional differentiation of the lining epithelium is compromised in relation to inflammatory changes associated with destructive periodontitis. In the pathological lining epithelium of the periodontal pocket there was a marked reduction of epithelial cadherin important in intercellular adhesion, of involucrin, a marker of terminal differentiation, and of the gap junction connexions that form intercellular communication channels. These changes were associated with alterations of filamentous actin expression, collectively indicating profound perturbation of epithelial structure. The data reported support the concept that the ability of the pathological lining epithelium to function as an effective barrier against the ingress of microbial products into the tissues is severely compromised (Ye et al., 2000). In addition, a recent study (Ye et al., 2003) by Western analysis of serum IgG from all 22 patients with chronic periodontitis tested indicated recognition of multiple epithelial components in individual patterns. In contrast, subjects with a healthy periodontium displayed only trace recognition of epithelial antigens. Levels of epithelial-reactive antibodies were significantly correlated with attachment loss as an indication of disease activity. To investigate a possible relationship between the bacterial flora adjacent to the diseased sites and the presence of epithelial-reactive antibodies, subgingival plague samples were taken from deep periodontal pockets and cultured anaerobically. Gram positive bacteria containing antigens potentially cross-reactive with epithelial cells were reproducibly isolated by probing membrane colony lifts with affinity-isolated (epitheial-specific) antibodies. The bacteria were identified as streptococci (S. mitis, S. constellatus and two S. intermedius strains) and Actinomyces (A. georgiae, and A. sp. oral clone) by 16S rDNA sequence homology. Recognition by affinity-isolated antibodies of antigens from the captured organisms was confirmed by Western analysis. Conversely, absorption of affinity-isolated antibodies with bacterial species specifically reduced subsequent recognition of epithelial antigens. To identify the auto-antigens, a human keratinocyte cDNA expression library in Lambda phage was probed using a pooled sera. Groups of responders were detected for CD24 (a recently described adhesion molecule also known as P-selectin ligand), antioxidant protein 2 (a newly recognised member of the thiol-dependment anti-oxidant proteins), lavtate dehydrogenase A, the transcription factor NFAT5, and for three genes encoding novel proteins. Six identified bacteria, especially S intermedius were demonstrated to absorb antibodies reaching with identified auto-antigens in patterns varying between individuals. This evidence indicated that during the course of periodontits, subjects develop increased levels of antibodies to common oral bacteria amongst which are included tissue cross-reactive antigens. Periodontitis could therefore present a risk for the subsequent initiation or exacerbation of a broad spectrum of disease processes including autoimmune, inflammatory, proliferative and degenerative disorders.
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Ye, Ping. "Autoimmunity in chronic periodontitis." University of Sydney, 2003. http://hdl.handle.net/2123/4256.
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Doctor of PhilosophyProfound perturbation of epithelial structure is a characteristic feature of the immunopatholoical response to bacterial antigens considered to be central in the pathogenesis of the destructive lesion of periodontitis. The pathological basis for the disturbance of epithelial structure is not understood. It was demonstrated that the structural integrity and functional differentiation of the lining epithelium is compromised in relation to inflammatory changes associated with destructive periodontitis. In the pathological lining epithelium of the periodontal pocket there was a marked reduction of epithelial cadherin important in intercellular adhesion, of involucrin, a marker of terminal differentiation, and of the gap junction connexions that form intercellular communication channels. These changes were associated with alterations of filamentous actin expression, collectively indicating profound perturbation of epithelial structure. The data reported support the concept that the ability of the pathological lining epithelium to function as an effective barrier against the ingress of microbial products into the tissues is severely compromised (Ye et al., 2000). In addition, a recent study (Ye et al., 2003) by Western analysis of serum IgG from all 22 patients with chronic periodontitis tested indicated recognition of multiple epithelial components in individual patterns. In contrast, subjects with a healthy periodontium displayed only trace recognition of epithelial antigens. Levels of epithelial-reactive antibodies were significantly correlated with attachment loss as an indication of disease activity. To investigate a possible relationship between the bacterial flora adjacent to the diseased sites and the presence of epithelial-reactive antibodies, subgingival plague samples were taken from deep periodontal pockets and cultured anaerobically. Gram positive bacteria containing antigens potentially cross-reactive with epithelial cells were reproducibly isolated by probing membrane colony lifts with affinity-isolated (epitheial-specific) antibodies. The bacteria were identified as streptococci (S. mitis, S. constellatus and two S. intermedius strains) and Actinomyces (A. georgiae, and A. sp. oral clone) by 16S rDNA sequence homology. Recognition by affinity-isolated antibodies of antigens from the captured organisms was confirmed by Western analysis. Conversely, absorption of affinity-isolated antibodies with bacterial species specifically reduced subsequent recognition of epithelial antigens. To identify the auto-antigens, a human keratinocyte cDNA expression library in Lambda phage was probed using a pooled sera. Groups of responders were detected for CD24 (a recently described adhesion molecule also known as P-selectin ligand), antioxidant protein 2 (a newly recognised member of the thiol-dependment anti-oxidant proteins), lavtate dehydrogenase A, the transcription factor NFAT5, and for three genes encoding novel proteins. Six identified bacteria, especially S intermedius were demonstrated to absorb antibodies reaching with identified auto-antigens in patterns varying between individuals. This evidence indicated that during the course of periodontits, subjects develop increased levels of antibodies to common oral bacteria amongst which are included tissue cross-reactive antigens. Periodontitis could therefore present a risk for the subsequent initiation or exacerbation of a broad spectrum of disease processes including autoimmune, inflammatory, proliferative and degenerative disorders.
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Philips, L. G. "Disease management in chronic kidney disease /." abstract and full text PDF (free order & download UNR users only), 2005. http://0-wwwlib.umi.com.innopac.library.unr.edu/dissertations/fullcit/1430446.
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Thesis (M.B.A.)--University of Nevada, Reno, 2005."May, 2005." Includes bibliographical references (leaves 92-97). Online version available on the World Wide Web. Library also has microfilm. Ann Arbor, Mich. : ProQuest Information and Learning Company, [2005]. 1 microfilm reel ; 35 mm.
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Ye, Ping. "Autoimmunity In Chronic Periodontitis." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/4872.
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Ormarsdóttir, Sif. "Osteoporosis in chronic liver disease." Doctoral thesis, Uppsala University, Department of Medical Sciences, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-660.
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Ormarsdóttir, S. 2001. Osteoporosis in Chronic Liver Disease. Acta Universitatis Upsaliensis. Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 1037. 60 pp. Uppsala. ISBN 91-554-5021-0.
Osteoporosis is a well-known and frequently reported complication of chronic liver disease (CLD) with a high fracture rate contributing to significant morbidity after liver transplantation. The pathogenesis is unknown and controversy exists about many risk factors for osteoporosis in CLD.
In the present thesis, bone mineral density (BMD) was found to be significantly lower at the lumbar spine (p<0.01) in a cohort of patients with CLD compared with age- and gender -matched individuals. Osteoporosis was found in 30% of the patients and 15% of the controls, respectively. Low body mass index (BMI), corticosteroid treatment, prothrombin time, age and female gender were independent risk factors for osteoporosis in the patients.
In a follow-up study, 43 of 72 patients were available for a second BMD measurement 25 months (median) after the first. Bone loss at the femoral neck was 1.5 ± 2.4% in females and 2.9 ± 2.0% in males with a significant decrease in BMD Z-score over time (p=0.005 and p=0.02 for females and males, respectively), indicating increased bone loss at this site. Hyperbilirubinaemia and low circulating levels of 25-hydroxy vitamin D3 predicted increased bone loss at the femoral neck. These findings suggest that cortical bone, in addition to trabecular bone, may be affected in CLD and bilirubin and vitamin D3 may be involved in the pathophysiology of osteoporosis in CLD.
In order to elucidate the suggested role of insulin-like growth factors (IGFs) and leptin in the pathophysiology of osteoporosis in CLD, we studied the relationship between these factors and BMD. Levels of IGFs were extremely low (p<0.0001 compared with the controls) and related to liver function but no correlation was found between the IGFs and BMD. Serum leptin adjusted for BMI correlated negatively with BMD in female patients (p=0.003 and p=0.04 at the lumbar spine and the femoral neck, respectively) and in male patients at the femoral neck (p=0.04). Thus, the IGFs appear not to be involved in the pathophysiology of osteoporosis in CLD but a role of circulating leptin is possible.
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Ormarsdóttir, Sif. "Osteoporosis in chronic liver disease /." Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2001. http://publications.uu.se/theses/91-554-5021-0/.
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Begbuna, Veronica. "Haemodynamics in chronic venous disease." Thesis, Imperial College London, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.401816.
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Leslie, Wilma S. "Weight management and chronic disease." Thesis, University of Glasgow, 2009. http://theses.gla.ac.uk/1300/.
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Abstract Background: Obesity, in addition to being a serious condition in its own right, is causally associated with many chronic non-communicable diseases, and its prevention, identification and treatment is a public health priority. Results: The main findings of the present thesis were that 1) many drugs, used in the management of chronic disease, have an adverse effect on body weight with weight change of +10kg observed as a real side effect of some. 2) Identification and management of obesity is not a formal part of current practice in many secondary care clinics. While acknowledging the adverse health effects of obesity within their specialist areas, clinicians felt under-skilled and insufficiently resourced to provide effective management. 3) Improvements in iron status in pre-menopausal women can be achieved during weight loss, using eating plans that either include or exclude red meat. The data while in-conclusive suggest that a diet including red meat may confer greater benefits on iron status. Discussion: Weight gain is an adverse effect of many drugs used to treat chronic diseases. This should be discussed with patients prior to treatment and advice provided on how to avoid or minimise weight gain. NHS secondary care consultants are concerned about obesity and its impact on their patient’s health. Most have no weight management strategy and would like one. This will require additional training and resources. Excluding red meat did not adversely affect iron status in pre-menopausal women. A larger study is required for definitive health promotion advice. Conclusion: Pharmacotherapy is a significant factor in the rising prevalence of obesity. Weight management is not an integral part of patient care in secondary care clinic settings. The exclusion of red meat during weight management does not compromise iron status in pre-menopausal women with low iron stores.
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Wong, Germaine. "Cancer and chronic kidney disease." Thesis, The University of Sydney, 2008. https://hdl.handle.net/2123/28229.
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Introduction
Chronic kidney disease (CKD) is a common and important public health problem, with significant impact on the person’s quality of life and chances of survival. Cardiovascular disease is major cause of morbidity and mortality among people with CKD. Cancer is also a well-recognised complication in people on dialysis and with kidney transplants, but has not been adequately assessed in people with mild to moderately reduced kidney function. It is uncertain whether the basis of such increased risk in the end-stage kidney and transplant populations is solely related to their immunocompromised health states, or there are plausible biological reasons to explain the association beyond current knowledge. Screening, which allows early detection and subsequent treatment, is effective in reducing cancer-related deaths for common cancer such as breast, colorectal and cervical cancers in the general population. Given the inherent differences in the overall cancer risk and life expectancy among people with CKD, it is plausible that the effects, costs, and harms of routine population cancer screening may be different to the general population. This thesis is presented as published work on the theme of cancer and chronic kidney disease. The first chapter summarises the existing epidemiological evidence of association between cancer and kidney transplantation. The second chapter, uses data from the Blue Mountain Eyes Study cohort and linkage with the New South Wales Central Cancer Registry, explores the hypothesis of increased cancer risk in people with mild to moderately reduced kidney function. The work presented in the last five chapters of this thesis have extrapolated, critically appraised, and synthesized the available evidence for cancer screening in the general, end-stage kidney disease and kidney transplant populations.
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Laba, Tracey-Lea. "Medication Adherence in Chronic Disease." Thesis, The University of Sydney, 2013. http://hdl.handle.net/2123/9546.
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Background: Chronic disease places a substantial health and economic burden on individuals and health systems globally. Effective chronic disease management relies on patient adherence to proven medications. Medication adherence rates in chronic disease are sub-optimal, yet adherence-enhancing intervention results are underwhelming. Potentially, current strategies are not matching patient adherence preferences, nor addressing heterogeneity in adherence behaviour between social groups. To inform effective intervention design, this thesis aimed to explore adherence preferences for chronic disease medications and to investigate the effectiveness of adherence-enhancing strategies in socioeconomically disadvantaged groups. Methods: Two discrete choice experiments (DCEs) and a qualitative study were conducted to explore adherence preferences within Australia. A systematic review exploring the effect of strategies aimed at improving adherence to cardiovascular disease medications in socioeconomically disadvantaged populations was conducted. Results and conclusions: Intentional medication decisions were a product of trading between treatment-related factors, particularly cost, treatment scheduling, medication harms and long-term benefits. A patient’s attitudes towards medications, expectations of prescribers and their social context shaped adherence preferences and behaviour. The findings do not support a one-size-fits-all approach to adherence-enhancing interventions. By accounting for heterogeneity in behaviour and critically addressing patient-perceived safety of medications, significant improvements in adherence within the Australian healthcare setting may be achieved.
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Joshi, S., and David L. Wood. "Telementoring for Chronic Disease Management." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/5165.
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Biati, Raquel Marie. "Chronic Disease Self-Management Program." ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2598.
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The World Health Organization noted that 2 global health problems have reached epidemic proportions: obesity and type 2 diabetes. These conditions affect nearly 170 million people worldwide. The clinical practice problem addressed by this project was the prevalence of adults ages 50 and older in an ambulatory care setting who suffer from obesity and diabetes and may benefit from a tailored weight management and nutrition education intervention. The purpose of this project was to design a program that would decrease body mass index and hemoglobin A1c in older patients through adaption of the Chronic Disease Self-Management Program. The evidence supporting this project was obtained through a systematic literature review. The self-efficacy theory guided the project, and the evidence-based practice model used to plan the translation of the evidence into practice was the plan-do-check/study-act cycle, a continuous process improvement model used in many health care settings. The product of the project was an education intervention implementation plan that will be agreed upon by the project team and tracked using a Gantt chart. The program's effectiveness will be evaluated by analyzing the themes of qualitative feedback from patients who complete the program and through comparisons using t test statistics of body mass index and A1c that will be collected at 12 weeks and 12 months after the program start. The social change expected of this program, when implemented, is an increase in patients' engagement in and self-management of their care and a more trusting relationship among patients and the health care team. The recommendations from this project also may be useful in addressing health disparities often experienced by patients suffering from obesity and diabetes.
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McAllister, David Anthony. "Chronic obstructive pulmonary disease, pulmonary function and cardiovascular disease." Thesis, University of Edinburgh, 2011. http://hdl.handle.net/1842/5615.
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Cardiovascular disease is common in Chronic Obstructive Pulmonary Disease (COPD), and forced expiratory volume in one second (FEV1) independently predicts cardiovascular morbidity and mortality. Pathological changes in the systemic vasculature have been proposed as potential mechanisms linking COPD to cardiovascular disease, and patients with COPD may be at increased risk of acute myocardial infarction during acute exacerbations. Notwithstanding causation, FEV1 may be a useful prognostic marker in patients undergoing cardiac surgery. This thesis examined these three aspects of cardiovascular co-morbidity in relation to COPD and FEV1. In 2,241 consecutive cardiac surgery patients, FEV1 was associated with length of hospital stay (p<0.001) and mortality (p<0.001) adjusting for age, sex, height, body mass index, socioeconomic status, smoking, cardiovascular risk factors, chronic pulmonary disease, and type/urgency of surgery. In a survey of Scottish Respiratory Consultants there was no consensus regarding the investigation and management of acute coronary syndrome in exacerbation of COPD. In a case-series of 242 patients with exacerbations 2.5% (95% CI 1.0 to 5.6%) had chest pain, raised serum troponin and serial electrocardiogram changes suggestive of acute coronary syndrome. However, over half reported chest pain, while raised troponin was not associated with chest pain or serial ECG changes. Carotid-radial pulse wave velocity (PWV), aortic distensibility, and aortic calcification were measured to assess the relationship of the systemic vasculature to FEV1 and emphysema severity on CT. In adjusted analyses, emphysema was associated with PWV in patients with COPD (p = 0.006) and, in population based samples, with extent of distal aortic calcification (p=0.02) but not with aortic distensibility (p=0.60). This thesis found that FEV1 was associated with mortality and length of hospital stay in patients undergoing cardiac surgery, and that chest pain and raised troponin were common but unrelated in exacerbation of COPD. In the vascular studies distal but not proximal vascular pathology was associated with FEV1, and if COPD is truly related to systemic arterial disease, the distal arterial tree is implicated.
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Murphy, Nicola. "Chronic obstructive pulmonary disease and anxiety." Thesis, Coventry University, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.368862.
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Danesh, John. "Chronic infection and coronary heart disease." Thesis, University of Oxford, 1999. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.326020.
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Tomlinson, Laurie. "Arterial Stiffness and Chronic Kidney Disease." Thesis, University of Brighton, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.518323.
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Introduction: Chronic kidney disease (CKD) common, particularly in the elderly, and is linked to an increased risk of cardiovascular disease (CVD). This is partly explained by joint risk factors such as hypertension and diabetes but novel risk factors such as arterial stiffness, arterial calcification and endothelial dysfunction may play a role. Our aims were 1) to prospectively investigate whether aortic stiffness was linked with rate of decline of renal dysfunction, 2) to investigate the associations of arterial stiffness in patients with moderate renal dysfunction, and 3) to investigate whether aortic stiffness was linked with adverse outcomes. Secondary aims were to explore the links between 24 hour ambulatory blood pressure (BP) monitoring (24h ABPM), aortic stiffness, and the novel CV risk factors asymmetric dimethylarginine (ADMA) and Fetuin-A. Methods: This is an observational study of 133 patients with CKD stages 3-4 (estimated GFR 15-60mUmin). At baseline subjects underwent full assessment of CV risk, measurement of arterial stiffness, Fetuin-A, ADMA, and 24h ABPM. Patients were then followed-up with repeat of arterial stiffness measurements 6- monthly. Change in renal function and clinical events were recorded. Major results: Renal function is a determinant of aortic stiffness independent of other well-described factors. Aortic stiffness is closely linked to deterioration in renal function and predicts cardiovascular events within this cohort. There is a high prevalence of ambulatory hypotension during 24h ABPM in older patients with CKD, and a large difference in BP between clinic and home measurements. The BP difference is associated with aortic stiffness, and is suggestive of a causal relationship. A rise in BP at night is associated with increased aortic stiffness, as is the related measure of postural hypotension. ADMA levels are related to change in renal function, while Fetuin-A is related to change in aortic stiffness. Conclusion: In this predominantly elderly cohort of patients with CKD stages 3 and 4, aortic stiffness is associated with baseline and change in renal fundion, CV risk and BP pattems. This highlights the close links between macro- and microvascular disease and suggests that knowledge of aortic stiffness may be crucial in further understanding the pathophysiology and treatment of renal disease.
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Aravinthan, Aloysious Dominic. "Hepatocyte senescence in chronic liver disease." Thesis, University of Cambridge, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.708050.
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Thomas, James A. "Cell therapy for chronic liver disease." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/19553.
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There is a growing literature of clinical studies of bone marrow (BM) cell therapy for liver cirrhosis. At present, the optimum choice of cell type(s) and the mechanism(s) of effect remain undefined. Cells of the monocyte-macrophage lineage have key roles in the development and resolution of liver fibrosis. Therefore, I tested the therapeutic effects of these cells in the context of experimental murine liver fibrosis. The effects of unmanipulated, syngeneic macrophages, their specific BM precursors and unfractionated (whole) BM cells were examined in the iterative carbon tetrachloride model of liver fibrosis. BM-derived macrophage (BMM) delivery resulted in early chemokine upregulation with the hepatic recruitment of endogenous macrophages and neutrophils. These cells delivered matrix metalloproteinases-13 and -9 respectively, into the hepatic scar. The effector cell infiltrate was accompanied by increased levels of the anti-inflammatory cytokine IL-10. A reduction in hepatic myofibroblasts was followed by reduced fibrosis detected 4 weeks after macrophage infusion. Serum albumin levels were elevated at this time. Upregulation of the liver progenitor cell mitogen TWEAK preceded expansion of the progenitor cell compartment. BMM delivery increased hepatic expression of cytokines with reparative effects (including colony stimulating factor-1, insulin-like growth factor-1 and vascular endothelial growth factor). In contrast to the effects of differentiated macrophages, liver fibrosis was not significantly improved by the application of macrophage precursors and was exacerbated by whole BM. BMMs did not affect liver fibrosis or regeneration in the 1% DDC model of biliary disease. These effects were only detected following the intraportal delivery of BM cells. The peripheral (tail) vein administration of BMMs, either singly or repeatedly did not recapitulate the therapeutic phenotype. This was investigated by in vivo tracking of BMMs constitutively expressing green fluorescent protein (GFP). The peripheral administration route resulted in the early (1 hour) accumulation of BMMs within the pulmonary system. This was followed by delayed hepatic engraftment, which was also numerically reduced (< 30%) compared with intraportal administration. Macrophage cell therapy improves clinically relevant parameters in experimental chronic liver injury. Paracrine signalling to endogenous cells amplifies the effect. The benefits from this single, defined cell type suggest clinical potential.
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Navaneethan, Sankar. "METABOLIC SYNDROME AND CHRONIC KIDNEY DISEASE." Case Western Reserve University School of Graduate Studies / OhioLINK, 2014. http://rave.ohiolink.edu/etdc/view?acc_num=case1401967446.
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Xie, Jeffrey Xinshuo. "Molecular Insights into Chronic Kidney Disease." University of Toledo Health Science Campus / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=mco1500201100900825.
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White, Joanna D. "Investigations into feline chronic kidney disease." Thesis, The University of Sydney, 2010. https://hdl.handle.net/2123/28931.
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Chronic kidney disease (CKD) is arguably the most common disease of older cats. A disproportionate number of
younger, male cats with CKD was identified among a cohort of cats with CKD and was hypothesised to be due to
membranous glomerulopathy or an FIV associated nephropathy. Examination of epidemiologic, histologic,
immunohistologic and survival data revealed an association between the presence of CKD and FIV infection among
young cats and an adverse effect of FIV infection on survival among cats with CKD, but no specific histological
changes were seen among FIV positive cats.
Glomerulopathies were identified among 16% of cats with CKD but more female than male cats were diagnosed
with glomerulopathies and proliferative rather than membranous glomerulopathies were diagnosed more commonly.
' While glomerulopathies are the cause of CKD in a proportion of cats, membranous glomerulopathy is unlikely to be
the predominant glomerulopathy and more work is required to define the both the pathophysiology and histology of
feline glomerulopathies. A novel familial glomerulopathy was identified among young Abyssinian cats which was
characterised by the presence of haematuria. Ultrastructural and immunhistochemical studies will be required to
further characterise these glomerulopathies.
Routine histologic examination of 95 cats with kidney disease confirmed the results of earlier studies regarding the
proportions of cats with CKD with glomerulopathies, chronic tubulointerstitial nephritis (TIN) and pyelonephritis. A
new observation was the significant number of cats had pathologic changes in the inner medulla and renal crest
including necrosis and epithelial dysplasia.
Bacteriuria was common among cats with CKD, in particular among older, female cats. There was no association
between a positive urine culture and disease severity, assessed by creatinine concentration, and a treated episode of
bacteriuria had no adverse influence on survival. Bacteria were infrequently identified in cats with neutrophilic TIN,
including cats with a histologic diagnosis consistent with pyelonephritis. Further work is required to distinguish cats
with asymptomatic bacteriuria from those with urinary tract infections and at risk of pyelonephritis. In addition,
causes of neutrophilic TIN other than bacterial infection should be evaluated.
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Vidot, Marie Helen. "Nutrition Interventions and Chronic Liver Disease." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21592.
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Background The liver has an integral role in all metabolic processes Hypothesis Identification of nutritional abnormalities in patients with CLD facilitates targeted nutrition intervention to improve patient outcomes Aim To investigate specific nutritional features and interventions in patients with CLD Methods The population was adults with CLD All investigations were approved by the Sydney Local Health District Research Ethics and Governance Office Studies included: Retrospective analysis of subjective global assessment (SGA), obesity, malnutrition and muscle wasting in patients with CLD Retrospective review of continuous nasogastric feeding in malnourished individuals with CLD and refractory ascites Randomised, placebo-controlled, observer-blinded study of supplementation with Synbiotics, BCAAs in hepatic encephalopathy (HE) Retrospective review of the relationship between 25-hydroxy vitamin D and HE Systematic review of treatments for muscle cramps in CLD Randomised, placebo-controlled, double-blinded, cross-over study of taurine supplementation for cramps in patients with CLD A number of novel methodologies were utilised: Computer tomography (CT) to measure psoas, anterior and lateral abdominal muscles at the 3rd lumbar vertebra The Inhibitory Control Test (ICT) and Trail Making Test (TMT) to assess HE DASS-21 (Depression, Anxiety and Stress Score, short form) to assess negative emotional states of participants with HE Synbiotics Forte™ Taurine supplements for muscle cramps in CLD Results The liver specific SGA fails to identify muscle wasting in obese patients with CLD Continuous nasogastric feeding reduces paracentesis requirements and increases muscle mass in malnourished patients with CLD There was a significant improvement in cognition in patients taking combined synbiotics and BCAAs The prevalence of HE was significantly higher in individuals with low concentrations of 25-OH vit D independent of disease severity There was lack of evidence for physician prescribed treatments for muscle cramps in CLD 2g taurine/day reduces frequency, duration and intensity of cramps in CLD Conclusion Targeted nutritional interventions improves patient symptoms and outcomes
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Lindholm, Michelle Marie. "Chronic childhood disease and child abuse." CSUSB ScholarWorks, 1998. https://scholarworks.lib.csusb.edu/etd-project/1559.
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The purpose of the present research is to investigate whether or not chronically ill children are victims of child abuse more frequently than healthy children. The gender of the child and of the parent will also be examined for differences in the treatment children receive.
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Kirsch, Florian [Verfasser]. "Economic aspects of disease management programs in chronic diseases / Florian Kirsch." München : Verlag Dr. Hut, 2018. http://d-nb.info/1164293648/34.
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Ramzan, Naveen, Shimin Zheng, Hemang Panchal, Edward Leinaar, Christian Nwabueze, and Timir K. Paul. "Investigating The Association Between Chronic Kidney Disease and Clinical Outcomes." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/21.
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Background
Chronic Kidney Disease (CKD) can be described as the loss of the kidney function over time. Symptoms usually develop slowly, and it may not appear in early stages. Lab tests can confirm a CKD diagnosis. The approximate number of incidents per year is more than 200,000 cases, and approximately 30 million people are living with CKD today in the United States. This long-standing disease ultimately leads to renal failure at the end. At this present time, there are no known cures for CKD, and the only treatment available is dialysis. Objectives
The purpose of this study is to determine the association between CKD and further with hemodialysis (HD) and medical condition such as cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications, and death. Study design
The study employed secondary data in a cross-sectional design. Methods
A sample of 106,969 was drawn from the population. The outcome variables were a diagnosis of CKD and/or CKD with HD. The predictor variables were cardiac complications, cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death. Logistic regression was conducted to analyze the relationship between outcome variable and each independent variable. Variables with a p-value Results
Analysis shows that subjects with cardiac complications were 17% less likely to have CKD as compared to those who did not have cardiac complications (OR: 0.83, 95% CI: 0.78-0.88). CKD patients who had cardiac complications were 18% more likely to have HD than the subjects who did not have cardiac complications (OR: 1.18, 95% CI: 1.01-1.39). Patients with cardiogenic shock were 86% more likely to have CKD than the subjects who did not have cardiogenic shock (OR: 1.86, 95% CI: 1.82-1.91). CKD patients who had cardiogenic shock were also 18% more likely to have HD than the subjects who did not have cardiogenic shock (OR: 1.18, 95% CI: 1.11-1.25). We have similar results if a patient had other conditions. Conclusion
Chronic kidney disease with hemodialysis is significantly associated by the other medical conditions such as cardiac complications cardiogenic shock, hemorrhage, anemia, vascular complication, postop respiratory failure, post op infarct hemorrhage, acute renal failure, new temporary pacemaker, new permanent pacemaker, pericardial complications and death in the United States. Further studies are needed to confirm the results and to understand the prognosis.
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Graves, Carolyn Mary. "Comparing parents' and nurses' identification and prioritization of parental needs in the context of caring for children with chronic conditions." Thesis, University of British Columbia, 1991. http://hdl.handle.net/2429/29728.
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Accurate assessment is the foundation on which effective nursing interventions rest. However, it is not known how accurately nurses identify and prioritize the needs of parents whose children have chronic conditions. When nurses proceed with interventions based on inaccurate assessments, the results can be unsuccessful interventions that neither meet parental needs nor provide optimal health care for this population of children.
This descriptive comparative study was conducted to 1) examine parental needs identified and prioritized by parents of children with chronic conditions and their respective nurse care-givers, and 2) identify similarities and differences between the two groups. Patterns that evolved from these similarities and differences provide us with information related to where nurses have expertise or difficulty identifying and prioritizing the needs of parents.
Kleinman's (1978) health care systems theory, which supports the premise that health care professionals and clients perceive health care episodes differently, provided the conceptual framework for this study. Study participants included 38 parents and 13 nurses who were affiliated with ten ambulatory programs in a Western Canadian pediatric hospital. Both groups completed the modified Family Needs Survey (Bailey & Simeonsson, 1988b) and socio-demographic tool developed by this investigator. Responses to the 35-item scale of the Family Needs Survey were described and ranked, in addition to being analyzed using inferential parametric statistics to determine differences between parents' and nurses' identification of parental needs. Responses to the open-ended question on the Survey were described and ranked.
Research findings revealed some similarities and a number of striking differences between the responses of parents and nurses. On the 35-item scale, parents and nurses
agreed that five parental needs were 1) information about current research, future services and treatments, 2) help locating competent regular or respite care providers, 3) reading material about other parents with a similar child, 4) opportunity to meet and talk with other parents, with a similar child, and 5) more time for self, spouse and other children. Both groups were consistent in their ranking of the first two needs as the most important needs in the information and community services subscales, respectively. However, nurses had generally higher responses on all subscales and identified eight more parental needs than did parents which were related to information, support, and family functioning. Parents and nurses repeated most of the above needs on the open-ended question, although nurses indicated that parents also had a number of needs related to psychosocial issues and family functioning. Nurses ranked counselling (child's condition, treatment, stress management) as the primary support need. Further, both groups differed in their prioritization of parental needs on the open-ended question. Where parents ranked information, community services, and support needs as the most important, nurses ranked support, information, and community services. The implications of these research findings for nursing practice and education are discussed and recommendations for future research are presented.Applied Science, Faculty of
Nursing, School of
Graduate
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Soicher, Judith Eileen. "A longitudinal study of physical activity behaviour in chronic disease: the example of chronic obstructive pulmonary disease." Thesis, McGill University, 2009. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=32532.
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In chronically ill adults, involvement in physical activity is associated with reduced mortality and better quality of life. In chronic obstructive pulmonary disease (COPD), exercise training within a pulmonary rehabilitation program leads to improvements in dyspnea, exercise capacity and quality of life measured immediately after the program. These gains diminish within 6-18 months of program completion, in part due to patients' difficulty in sustaining physical activity behaviour. The global objective of this thesis was to examine behavioural and disease-related aspects of physical activity over 1 year among individuals with COPD. A longitudinal behavioural study was embedded within a randomized multicentre trial comparing the effectiveness of home-based versus hospital-based outpatient pulmonary rehabilitation. The first study of this thesis assessed behavioural aspects of exercise before and after a 3-month rehabilitation program. Exercise habits, self-efficacy for exercise and barriers to exercise improved significantly following rehabilitation. In cross-sectional path analysis, past exercise habits and greater exercise capacity had a positive effect on self-efficacy for endurance exercise (measured pre-rehabilitation), while external barriers, depression and female sex had a negative effect. In the second study, logistic longitudinal modelling showed that adherence to exercise (at least 3 days per week for endurance exercise and at least 2 days per week for strength exercise) declined progressively between 4 and 12 months after rehabilitation start. Adherence to endurance exercise was higher during spring/summer, and if individuals had exercised prior to rehabiliL'activité physique est associée à un taux de mortalité réduit et à l'amélioration de la qualité de vie chez les adultes atteints de maladies chroniques. L'entraînement physique chez les sujets atteints de la maladie pulmonaire obstructive chronique (MPOC) dans le cadre d'un programme de réadaptation pulmonaire entraîne l'amélioration de la dyspnée, de la capacité d'exercice et de la qualité de vie. Cependant, ces améliorations diminuent dans les 6 à 18 mois suivant la fin du programme du, en partie, aux difficultés de maintenir l'activité physique. L'objectif général de cette thèse était d'examiner pendant un an les aspects comportementaux et médicaux (reliés à la maladie) de l'activité physique chez les individus atteints d'une MPOC. Une étude longitudinale fut incorporée à un essai multicentrique randomisé comparant l'efficacité de la réadaptation pulmonaire à domicile à celle en clinique externe. La première étude de cette thèse a évalué l'aspect comportemental de l'exercice avant et après le programme de réadaptation qui était d'une durée de 3 mois. Les habitudes d'exercices, l'auto-efficacité et les barrières à l'exercice se sont améliorées de façon significative suivant la réadaptation. Il a été démontré que les habitudes passées relatives à l'exercice et la capacité à l'exercice ont un effet positif sur l'auto-efficacité en exercice d'endurance (mesurée avant la réadaptation) tandis que les barrières externes, la dépression et le sexe féminin ont un effet négatif. Pour la seconde étude, le modèle logistique longitudinal a démontré que l'adhésion à l'exercice (exercices en endurance au moins 3 jours par se
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So, Beng Hock. "Chronic kidney disease : determining chronicity, prevalence, variation and survival in a community chronic kidney disease (CKD) cohort." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/30671/.
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Chronic kidney disease (CKD) is insidious and most cases are diagnosed through opportunistic serum creatinine (SCr) testing before symptoms develop. However, efforts to accurately assess prevalence have been hampered by the lack of a universally agreed definition of SCr thresholds for the diagnosis of CKD. At the turn of the millennium, two crucial developments occurred. The first was the description of the Modification of Diet in Renal Disease estimated Glomerular Filtration Rate (eGFR) which closely correlated to cumbersome measured GFR and could be used instead in daily clinical practice. The second was the publication of the Kidney Disease Outcomes Quality Initiative (KDOQI) clinical practice guideline for the evaluation, classification and stratification of CKD detailing a new definition of CKD based on GFR thresholds. Together, these two developments formed the basis of CKD as we know it today. Prevalence of CKD varies, and accurate prevalence estimates are difficult to obtain especially with respect to fulfilling the chronicity criterion (reduced eGFR ≥ 90 days). Traditional risk factors for CKD are well described and non-traditional risk factors such as socio-economic status (SES), health literacy and rurality are gaining interest. SCr sampling patterns in the community mean that most individuals with CKD are tested routinely every year. This information may not be considered in its entirety by primary care providers (PCP) which may explain inaccuracies in PCP CKD registers. Accurate identification is important to direct evidence based clinical interventions to this patient group. In chapter 2, a novel algorithm for detecting CKD and confirming chronicity from a laboratory database was developed to identify a CKD cohort of the population served by NHS Ayrshire & Arran. Data linkage of additional laboratory data, Scottish Morbidity Records for co-morbidity, statin dispensing information from Prescribing Information Scotland, area SES, rurality and deaths from Information Services Division Scotland enriched the cohort. Patients on renal replacement therapy were identified and excluded through the Scottish Renal Registry. Multiple imputations were applied where appropriate to address missing values. There were 21,037 individuals from 2010 to 2012 fulfilling the definition of CKD stage 3 – 5. Prevalence of adults with CKD was 5.6% – 5.8%. Average age (± SD) of the cohort was 75 ± 11 years. 64.6% were female and average eGFR for the cohort was 47.32 ± 11.53 mL/min/1.73m2. In chapter 3, laboratory ascertainment of CKD identified 7% more cases than PCP CKD registers. Furthermore, around 25% of patients on PCP CKD registers may be wrongly coded as having CKD. There was a 3.9-fold variation in CKD prevalence amongst PCPs, ranging from 2.8% - 11.0%. Variation fell to 3-fold with laboratory ascertainment, ranging from 3.0% - 9.1%. This fell further with age and gender stratification. Stratified laboratory CKD prevalence was positively associated with SES and rurality, a novel finding, but in multivariate linear regression, only SES, in addition to age and gender, were significant predictors for CKD prevalence. Chapter 4 explored the association between SES, eGFR and all-cause mortality. One-way ANOVA demonstrates a linear relationship between eGFR and SES (F (4,15078) = 2.52, p = 0.039) with a mean difference in eGFR of 0.83 mL/min/1.73m2 between the lowest and the highest SES quintile. However, linear regression modelling found proteinuria, hypertension, peripheral arterial disease, age, gender and serum albumin to be significant predictors for eGFR, but not SES. After adjustment for age and gender imbalance, survival demonstrated substantial influence by SES, but weakened in effect with full adjustment with only Scottish Index of Multiple Deprivation (SIMD) quintile 3 demonstrating a 13% increased risk (HR 1.13, 95% CI 1.03 to 1.24) with no progressive increase in risk associated with lower levels of SES. As a quality of care marker, the dispensing of statin was examined in chapter 5. Having another diagnosis where statins are indicated, male gender, higher serum albumin, CKD stage 3B and age between 65 – 80 were associated with higher odds ratio for statin dispensing. 64% of the cohort was dispensed a statin in 2010, but the proportion fell by 5% to 58% in 2012. This fall in dispensing disproportionately affected younger and less co-morbid CKD patients who were all eligible for a statin. SES and gender did not appear to be a factor in falling dispensing rates. Average LDL levels were lower in the statin group by (mean difference) 0.78 mmol/L (95% CI 0.74 to 0.81) in 2010 and 0.93 mmol/L (0.90 to 0.97) in 2012. 37.2% of all statin prescriptions was for Simvastatin 40 mg. Statins reduce cardiovascular events and mortality in CKD. However, in older patients typical of CKD, evidence is lacking. Chapter 6 examines survival in those dispensed a statin. Those dispensed a statin were younger, more likely to be male, had higher serum albumin and more co-morbid. After full adjustment, statin dispensing was associated with a 24% lower risk of death (HR 0.76, 95% CI 0.71 to 0.83) overall, 18% benefit for primary prevention (no prior coronary heart disease or cerebrovascular disease) (0.82, 0.74 to 0.91), 32% benefit in secondary prevention (0.68, 0.60 to 0.77), 22% benefit in younger (< 76 years) CKD patients (0.78, 0.67 to 0.92) and 22% benefit in the older (≥ 76 years) CKD patients (0.78, 0.71 to 0.85) over 4.5 years follow-up. To illustrate absolute risk reduction, the number needed to treat to avoid one death for all patients is 15.8 (95% CI 12.3 to 22.2) and 12.4 (9.3 to 18.5) for older CKD patients. This thesis demonstrates that centralised ascertainment of CKD is better at case finding, than existing PCP CKD registers. The linkage of additional, routinely collated healthcare data can develop CKD registers into a powerful tool for monitoring quality of care, efficacy of therapy and hypothesis generation which can, and should be, integrated into clinical IT systems with the appropriate information governance oversight in place.
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Harbord, Marcus William Nixon. "Investigation of acute inflammation in Crohn's disease and chronic granulomatous disease." Thesis, University College London (University of London), 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.399572.
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Roos-Engstrand, Ester. "T cells in chronic obstructive pulmonary disease." Doctoral thesis, Umeå : Umeå university, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-33677.
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Stevenson, Nicola Jane. "Lung mechanics in chronic obstructive pulmonary disease." Thesis, University of Liverpool, 2006. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.432977.
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Hermans, Marcus Matheus Hendrik. "Arterial wall abnormalities in chronic kidney disease." Maastricht : Maastricht : Universitaire Pers Maastricht ; University Library, Universiteit Maastricht [host], 2007. http://arno.unimaas.nl/show.cgi?fid=9384.
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Urb, Mirjam. "Mechanisms of «Aspergillus fumigatus» chronic airway disease." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110500.
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Colonization of airways by Aspergillus fumigatus hyphae in immunocompetent patients with chronic lung disease leads to progressive decline in pulmonary function. While a minority of these patients develop a severe allergic response to the fungus, the majority of patients show a decline in lung function and airway hyperreactivity despite the absence of elevated IgE levels, eosinophilia or other evidence of hypersensitivity. Treatment of these non-allergic patients with antifungal drugs improves the symptoms, suggesting that pulmonary complications might be directly caused by A. fumigatus. The mechanisms underlying the acquisition of A. fumigatus colonization and the pathogenesis of pulmonary inflammation have not been studied. Our central hypothesis is that A. fumigatus interacts directly with elements of the immune system to facilitate its own colonization and induces ineffective inflammatory responses that damage host airways. To begin to investigate this hypothesis we used two complementary approaches to examine the interactions of A. fumigatus with elements of the pulmonary immune system. First, we studied the in vitro interactions of A. fumigatus with mast cells, key effector cells involved in orchestrating inflammatory responses and airway reactivity. We found that A. fumigatus triggers mast cell degranulation, while suppressing cytokine expression in an IgE-independent manner. While both degranulation and cytokine transcription required direct contact with mature hyphae, cytokine suppression could also be induced in part by A. fumigatus culture supernatant. Further studies revealed that A. fumigatus hyphae modulated mast cell function by downregulating protein tyrosine phosphorylation and in part by cleavage-dependent activation of protein tyrosine phosphatase 1B (PTP1B). The cleavage of PTP1B was caused by A. fumigatus serine proteases. In parallel, we developed a murine model of A. fumigatus colonization, where airways of healthy mice were colonized with live A. fumigatus by intratracheal injection of conidia embedded within agar beads. Unlike previously described models that induce airway hyperreactivity by repeated challenge with antigen or A. fumigatus spores, infection with this approach resulted in chronic colonization with fungi for up to 28 days. Fungal lesions within the airways were surrounded by a robust neutrophilic inflammation and peribronchial infiltration of lymphocytes. During the first 2 weeks of infection, low level Th2 type responses were seen in the infection, including increased pulmonary IL-4 levels, elevated serum IgE, and a mild increase in airway responsiveness. In addition, significant levels of pro-inflammatory cytokines and chemokines including TNF-α and MIG were observed, suggesting a mixed inflammatory picture. Furthermore, elevated IL-17 levels and presence of RORγ-positive mononuclear cells during late phase of the infection indicated the development of a Th17 response in association with reduction in pulmonary fungal load. Collectively, these results provide insight into the pathogenesis of A. fumigatus-induced chronic airways disease in patients without allergic bronchopulmonary aspergillosis, and suggest a possible role for mast cells in the pathogenesis of this condition.La colonisation des voies respiratoires par les hyphes d'Aspergillus fumigatus chez des patients immunocompétents, mais avec une maladie pulmonaire chronique, entraîne le déclin progressif de la fonction des poumons. Alors qu'une minorité de ces patients développe une réponse allergique aigue au champignon, la majorité montre un déclin dans la fonction des poumons et une hyperréactivité des voies respiratoires malgré l'absence d'une augmentation du niveau des IgE, des éosinophiles ou d'autres indications d'hyper-sensibilité. Le traitement antifongique chez ces patients améliore les symptômes suggérant que le champignon peut être la cause directe des complications observées. Les mécanismes qui sous-tendent la colonisation par A. fumigatus et la pathogenèse de l'inflammation des voies respiratoires restent largement indéterminés. Notre hypothèse centrale stipule que le champignon interagit directement avec des éléments du système immunitaire pour faciliter la colonisation et induire une réponse inflammatoire inefficace qui cause des dégâts aux voies respiratoires de l'hôte. Pour vérifier cette hypothèse, nous avons développé deux approches complémentaires visant à tester l'interaction d'A. fumigatus avec des éléments du système immunitaire pulmonaire. D'abord, nous avons étudié l'interaction in vitro entre A. fumigatus avec les mastocytes, une population clé de cellules impliquées dans la réponse inflammatoire. Nous avons montré que le champignon déclenche la dégranulation des ces cellules, tout en bloquant l'expression des cytokines indépendamment des IgE. Les processus de dégranulation et de transcription des cytokines nécessitent un contact direct avec les hyphes matures, alors que la suppression des cytokines quant à elle peut être induite en partie par le surnageant de culture d'A. fumigatus. Une étude plus approfondie nous a permis de montrer que les hyphes d'A. fumigatus peuvent moduler la fonction des mastocytes via une régulation négative de la phosphorylation d'une protéine tyrosine kinase et, en partie, via l'activation clivage-dépendante de la protéine tyrosine phosphatase 1B (PTP1B). Ce clivage de PTP1B est causé par la serine protéase du champignon. Dans une seconde approche, nous avons développé un modèle murin pour la colonisation par A. fumigatus, où nous avons fait coloniser les voies respiratoires de souris saines avec le champignon par injection intra-trachéale de conidies encapsulées dans des billes en agar. Ce modèle, au contraire des précédents, qui induisent l'hyperréactivité des voies respiratoires par exposition répétée à un antigène ou des spores de A. fumigatus, permet une colonisation chronique par le champignon allant jusqu'à 28 jours. Après ce traitement, les lésions des voies respiratoires, causées par le champignon, se retrouvent entourées par une inflammation neutrophilique robuste ainsi qu'une infiltration péri-bronchiale des lymphocytes. Durant les deux premières semaines qui suivent l'infection, nous avons détecté des niveaux bas d'une réponse type Th2, y compris une augmentation des niveaux des IL-4 pulmonaires, élévation des IgE dans le sérum, et une augmentation légère de la réponse des voies respiratoires. En plus, une augmentation significative des cytokines et des chémokines pro-inflammatoires, y compris les TNF-α et MIG, a été observée suggérant une réponse inflammatoire mixte. Les niveaux élevés des IL-7 et la présence des cellules mononucléaires RORγ-positives durant la phase tardive de l'infection indiquent le développement d'une réponse de type Th-17 associée à une réduction de la charge fongique pulmonaire. Collectivement, ces résultats nous permettent de mieux comprendre le processus de pathogenèse lié aux maladies chroniques des voies respiratoires induites par A. fumigatus chez les patients sans aspergillose bronchopulmonaire allergique, et suggèrent que les mastocytes peuvent jouer un rôle dans cette pathogenèse.
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Hood, Vivienne Claire. "Neurogenic influences on chronic inflammatory joint disease." Thesis, Queen Mary, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.252151.
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Wodehouse, Theresa. "Ciliary aspects of chronic sino-pulmonary disease." Thesis, Imperial College London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271952.
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Parham, Rhian. "Caregiver burden in paediatric chronic kidney disease." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10347/.
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Section A provides an overview of the role of family caregivers of individuals with chronic illness, and describes key conceptualisations and theories posited in the caregiver literature. This is followed by an overview of research conducted with caregivers of children with chronic kidney disease (CKD), a summary of the limitations of this research, and suggestions for future research. Section B Despite a recognised need to monitor caregiver burden in caregivers of children with CKD, there is no measurement tool currently available to meet this aim. The present research documents the development of a measure of caregiver burden specific to family caregivers of children with CKD. Methods: Interviews were conducted with 16 caregivers of children with CKD and 10 healthcare professionals in order to generate measure items. A provisional version of the measure was developed and piloted with 18 caregivers of children with CKD and five healthcare professionals. Results: An initial pool of 97 items was generated from the content of interviews, which was reduced to 60 items following review for item redundancy. A piloting exercise provided preliminary evidence for the usability, readability, and relevance of measure items; adaptations further to piloting resulted in the 51-item ‘Paediatric Renal Caregiver Burden Scale’ (PR-CBS). Conclusions: It is hoped that the PR-CBS will serve to identify areas of need amongst caregivers of children with CKD, and in turn improve outcomes for this caregiver population and children with CKD. Section C is a critical appraisal of the conducted research study, and includes an overview of research abilities acquired during its completion, reflections on how the research may have been conducted differently, implications for future clinical practice, and ideas for future research.
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Cash, W. J. "Disordered Vascular Compliance in Chronic Liver Disease." Thesis, Queen's University Belfast, 2010. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.517250.
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Al-shair, Khaled. "Systemic Manifestations of Chronic Obstructive Pulmonary Disease." Thesis, University of Manchester, 2009. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.509061.
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Parkes, Dr Julie. "Non-invasive biomarkers in chronic liver disease." Thesis, University of Southampton, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.509473.
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Revill, Susan M. "Endurance exercise in chronic obstructive pulmonary disease." Thesis, Loughborough University, 1997. https://dspace.lboro.ac.uk/2134/15388.
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White, David James. "Haemophilus in acute and chronic respiratory disease." Thesis, Liverpool John Moores University, 1991. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.304425.
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Poustie, Vanessa Jane. "Dietary interventions for children with chronic disease." Thesis, University of Liverpool, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.269705.
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Polkey, Michael Iain. "Diaphragm function in chronic obstructive pulmonary disease." Thesis, King's College London (University of London), 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.286262.
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Woolf, Adrian Spencer. "Atrial natriuretic factor and chronic renal disease." Thesis, Imperial College London, 1990. http://hdl.handle.net/10044/1/46615.
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Roberts, Helen Michelle. "Neutrophil function in chronic inflammatory disease states." Thesis, University of Birmingham, 2016. http://etheses.bham.ac.uk//id/eprint/7018/.
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Inflammation is a central component of the immune response. In its acute form it aids the transition from disease to health via the activation of numerous immune cells, enabling them to reach the site of infection/injury and orchestrate themselves to combat pathogens, facilitating resolution and repair to restore the host to health. However, chronic inflammation is deleterious to the host and differs from the “classical” acute inflammatory process in that the inflammation is not necessarily so readily obvious and is not self-limiting; rather, the immune system is in a constant state of low-grade activation and when challenged by pathogenic or sterile injury the response is heightened, resulting in prolonged tissue damage and a failure of efficient resolution mechanisms. Neutrophils are important mediators of acquired innate immune responses but may also contribute to the pathogenesis of chronic inflammatory diseases. Neutrophils are heavily involved in antimicrobial defence; their primary role is the localisation and elimination of pathogenic microorganisms. This, combined with their relatively short lifespan, has resulted in a traditional view of them as limited “kamikaze” cells. However, as detailed here, neutrophils have been shown to act with complexity and sophistication, orchestrating the immune/inflammatory response but also inadvertently contributing to tissue damage in different disease states. This thesis includes the study of neutrophil function in acute inflammatory episodes such as gingivitis and more chronic long-term health conditions such as obesity, chronic periodontitis and Papillon-Lefèvre Syndrome. The findings outlined here support the role of neutrophils as important contributors to both acute and chronic disease, showing these cells to be far more sophisticated than previously regarded.
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Eckerblad, Jeanette. "Symptom burden among people with chronic disease." Doctoral thesis, Linköpings universitet, Hälsa, Aktivitet, Vård (HAV), 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-122742.
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Introduction: Chronic diseases tend to increase with old age. Older people with chronic disease are commonly suffering from conditions which produce a multiplicity of symptoms and a decreased health-related quality of life. Nurses have a responsibility to prevent, ease or delay a negative outcome through symptom management, or assist in achieving an acceptable level of symptom relief. Aim: The overall aim of the thesis was to describe different aspects of symptom burden from the perspective of community-dwelling people with chronic disease. Methods: This thesis is based upon four papers that used both quantitative and qualitative data to describe different aspects of symptom burden, experienced by people with chronic diseases. Paper (I) is a cross-sectional study with 91 participants diagnosed with chronic obstructive pulmonary disease. Papers (II and IV) are based upon secondary outcome data from a randomized controlled trial with 382 community-dwelling older people with multimorbidity. Paper (II) is a cross-sectional study and Paper (IV) has a descriptive and an explorative design reporting on the trajectory of symptom prevalence and symptom burden. Paper (III) is a qualitative study with participants from the AGe-FIT. Results: Among people diagnosed with COPD the most prevalent symptoms with the highest symptom burden scores were shortness of breath, dry mouth, cough, sleep problems, and lack of energy, with just a few differences between participants with moderate and severe airflow limitation (I). For older people with multimorbidity, pain was the symptom with the highest prevalence and burden. Other highly prevalent symptoms were lack of energy and a dry mouth. Poor vision, likelihood of depression, and diagnoses of the digestive system were independently related to the total symptom burden score (II). The symptoms experienced by the older people were persistent and the symptom burden remained high over time (IV). The experience of living with a high symptom burden was described as an endless struggle. The analysis revealed an overall theme, “To adjust and endure” and three sub-themes, “to feel inadequate and limited”, “to feel dependent”, and “to feel dejected” (III). Conclusions: The results of this thesis indicate the importance of early symptom identification. People with chronic diseases have an unmet need for optimized treatment that focuses on the total symptom burden, and not only disease specific symptoms. A large proportion of older people with multimorbidity suffer a high and persistent symptom burden, and the prevalence and trajectory of pain are high. Older people sometimes think their high age is the reason they experience a diversity of symptoms, and they do not always communicate these to their health-care provider.
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Donaldson, Anna. "Circulating microRNA in Chronic Obstructive Pulmonary Disease." Thesis, Imperial College London, 2014. http://hdl.handle.net/10044/1/24776.
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Skeletal muscle dysfunction in COPD is associated with increased morbidity. Novel agents might reverse skeletal muscle dysfunction through different mechanisms since the biopsy picture in COPD patients is heterogenous. Thus there is a need for a biomarker of skeletal muscle dysfunction which could both be measured in blood and obviate the need for a biopsy. Previous work has found that muscle-specific microRNA (miR-1, miR-499, miR-206 and miR-133) are down-regulated in the quadriceps of COPD patients. Tissue specific miRNA circulate in the blood at detectable levels and are currently under investigation as biomarkers of other diseases. I therefore hypothesised that muscle-specific microRNA might be clinically viable biomarkers of skeletal muscle dysfunction. The studies in this thesis found that: 1. Levels of circulating muscle-specific microRNA (miR-1, miR-133, miR-206 and miR-499) were increased in stable COPD patients. The increase in muscle-specific microRNA in the stable COPD patients suggests that continual muscle turnover occurs outside of times of disease exacerbation. 2. Plasma levels of muscle-specific miRNA were not different in COPD patients admitted to hospital for an exacerbation of their disease compared to stable COPD patients. 3. Most muscle-specific microRNA did not change in muscle with acute exercise. I demonstrated an increase in miR-181 (an miRNA not restricted to, but with known function in muscle) one hour after acute exercise in the quadriceps muscle of COPD patients. However when fold change was calculated for the COPD patients and controls, there was no statistical difference found. There were no detectable miR-181 changes measured in blood. 4. Finally, I used a microarray approach to investigate other circulating microRNA that might to be useful to separate patients based on their lean muscle-mass. COPD patients with a reduced skeletal muscle mass had a reduced number of microRNA associated with growth and cell pluripotency, further studies are required to validate these findings. Taken together, the results from this thesis suggest that the microRNA analysed were detectable in blood, but they could not be usefully used (based on current analysis) as biomarkers of quadriceps dysfunction.
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Dias, Daniel de Matos. "Platform for chronic respiratory disease patient management." Master's thesis, Universidade de Aveiro, 2013. http://hdl.handle.net/10773/11560.
Full textAbstract:
Mestrado em Engenharia de Computadores e TelemáticaAs doenças respiratórias são uma das razões mais frequentes para consultas médicas e uma das causas de morte mais frequentes a nível mundial, representando gastos de vários milhões de euros. A frequência e grau de severidade de ocorrência de tosse é um dos principais indicadores a analisar, por ser este o sintoma mais frequente em grande parte destas doenças respiratórias e por ser também um bom indicador da evolução do estado do paciente. Dada a importância deste sintoma, foi desenvolvido o Leicester Cough Monitor, uma aplicação que permite obter, de forma automática e não invasiva, dados quantitativos fiáveis relativos à frequência de ocorrência de tosse. Contudo, essa aplicação funciona apenas em modo local, tendo esta de estar instalada no computador onde se deseje realizar o estudo não havendo qualquer tipo de ligação e comunicação entre mais que um computador. Dado este facto, não é possível manter de forma eficiente um sincronismo de informação e de estudos realizados em mais que um computador ou em diferentes centros. O trabalho descrito nesta dissertação teve como objectivo fundamental desenvolver uma plataforma Web que, através da integração da ferramenta LCM já existente, permita a realização de estudos sobre a evolução dos sintomas de tosse de vários pacientes. Foi então desenvolvida uma plataforma que permite ter informação organizada, sincronizada e reunida num único ponto estando esta acessível de qualquer local com acesso à Internet. A disponibilização das várias funcionalidades da ferramenta LCM numa vertente Web foi o foco principal, sendo que novas funcionalidades foram criadas de modo a permitir de uma forma organizada e controlada a gestão de toda a informação com a implementação de um sistema de gestão de utilizadores.
Respiratory diseases are one of the most frequent reasons for medical appointments and one of the main causes of death worldwide, accounting costs of several millions of Euros. The frequency and severity of occurrence of cough is one of the most important indicators, being the most frequent symptom in many of these diseases and also a good indicator of the evolution of the patient’s disease state. Given the importance of this symptom, the Leicester Cough Monitor, an application that allows obtaining, in an automatic and noninvasively way, reliable quantitative data on the frequency of occurrence of cough, was developed. However, this application only works locally, requiring that it is installed on the computer where we want to perform the study with no other kind of connection and communication between more than one computer. Given this fact, it is not possible to efficiently maintain synchronism of information and studies on more than one computer or between different centers. The work described in this dissertation had as fundamental goal the development of a Web platform that, through the integration of the existing LCM tool, enables studies of the evolution of patients with various symptoms of cough. Thus, a platform was developed that allows having information organized, synchronized and collected at a single point being this accessible from any location with Internet access. The availability of the various functionalities of the LCM tool on a Web context was the main focus, and new features were created to allow an organized and controlled management of all information with the implementation of a user management system.