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1
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.
3
Ye, Ping. "Autoimmunity In Chronic Periodontitis." Thesis, The University of Sydney, 2003. http://hdl.handle.net/2123/4872.
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4
Palma, Durán Susana Alejandra. "Protein glycation & chronic diseases." Thesis, University of Glasgow, 2017. http://theses.gla.ac.uk/8640/.
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5
Cexus, Olivier. "Immunological mechanisms controlling chronic inflammatory diseases." Thesis, University of Southampton, 2009. https://eprints.soton.ac.uk/67634/.
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Autoimmune diseases (AID) are chronic inflammatory diseases (CID) mediated by selfreactive T and B cells and are generally the results of the breakdown of T cell tolerance to self-antigen and failure of peripheral regulatory mechanisms. In this thesis I studied different mechanisms controlling the development of CIDs. I investigated the initial events involved in the activation of self-reactive CD4+ T cells which mediate the destruction of the thyroid in a mouse model of spontaneous thyroiditis. TAZ10 transgenic mice express a human T cell receptor (TCR) specific for a cryptic epitope of thyroid peroxidise (TPO) generated upon endogenous processing by thyroid epithelial cells (TEC), and a naturally occurring antagonistic epitope presented by dendritic cells (DC) upon exogenous processing of TPO. I have characterized the function of myeloid derived suppressor cells (MDSCs) in TAZ10 mice. MDSCs accumulate in lymphoid and non-lymphoid organs of TAZ10 mice during acute phases of inflammation and their number decrease as inflammation is fading. Despite their strong inhibitory function on T cell function and proliferation, MDSCs fail to prevent the activation of self-reactive T cells. I showed that the manipulation of MDSCs generated DCs that efficiently promoted the activation of T cells from TAZ10 mice. By contrast, peripheral T cells from patients with rheumatoid arthritis (RA) and lupus had a high proliferative activity compared to controls. Further analysis revealed that RA patients had reduced amounts of inhibitory MDSCs in peripheral blood. I showed that in TAZ10 mice TEC upregulate MHC class II molecules and present the cryptic epitope to TAZ10 T cells inducing their activation. I have demonstrated that DCs are responsible for the spreading of the TPO cryptic epitope from the thyroid to draining lymphnodes (DLN) resulting in the strong activation of transgenic T cells from TAZ10 mice. By adoptive transfer experiments, I showed that the activation of naive TAZ10 T cells occurs within days both in the thyroid and draining lymph-nodes (DLN) and resulted in the destruction of the thyroid. Altogether, this work shows for the first time that in a model devoid of any environmental insults, the normal turnover of TEC is sufficient to induce the activation of self-reactive T cells and the development of AID. In this thesis, I have highlighted the potential role of tissue transglutaminse 2 (TG2) in the treatment of CIDs. TG2 contributes to the pathogenesis of celiac disease and I have showed that TG2 activity promotes inflammation in patients with cystic fibrosis (CF). Mutation of the cystic fibrosis transmembrane regulator gene (CFTR) in CF patients is associated with increased TG2 expression and activity. In CF, TG2 promoted the crosslinking of the antiinflammatory peroxisome proliferator-activated receptor (PPAR) into perinuclear agresomes. The functional sequestration of PPAR was leading to increased inflammation. The finding of this function of TG2 in CF was relevant in TAZ10 mice as in-vivo inhibition of TG2 downregulated common markers of inflammation.
6
Amoo, A., and Igor Antonovuch Plesh. "Anthroposophic art therapy in chronic diseases." Thesis, МАТЕРІАЛИ міжнародної науково-практичної інтернет-конференції CHERNIVTSI INTERNATIONAL MEDICAL CONFERENCE (СІМЕС). - м. Чернівці 02-03 червня 2017 р, 2017. http://dspace.bsmu.edu.ua:8080/xmlui/handle/123456789/12882.
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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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Verma, Anju. "Ontology based personalized modeling for chronic disease risk evaluation and knowledge discovery an integrated approach : a thesis submitted to Auckland University of Technology in fulfilment of the requirements for [the] degree of Doctor of Philosophy (PhD), 2009 /." Click here to access this resource online, 2009. http://hdl.handle.net/10292/784.
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Populations are aging and the prevalence of chronic disease, persisting for many years, is increasing. The most common, non-communicable chronic diseases in developed countries are; cardiovascular disease (CVD), type 2 diabetes, obesity, arthritis and specific cancers. Chronic diseases such as cardiovascular disease, type 2 diabetes and obesity have high prevalence and develop over the course of life due to a number of interrelated factors including genetic predisposition, nutrition and lifestyle. With the development and completion of human genome sequencing, we are able to trace genes responsible for proteins and metabolites that are linked with these diseases. A computerized model focused on organizing knowledge related to genes, nutrition and the three chronic diseases, namely, cardiovascular disease, type 2 diabetes and obesity has been developed for the Ontology-Based Personalized Risk Evaluation for Chronic Disease Project. This model is a Protégé-based ontological representation which has been developed for entering and linking concepts and data for these three chronic diseases. This model facilitates to identify interrelationships between concepts. The ontological representation provides the framework into which information on individual patients, disease symptoms, gene maps, diet and life history can be input, and risks, profiles, and recommendations derived. Personal genome and health data could provide a guide for designing and building a medical health administration system for taking relevant annual medical tests, e.g. gene expression level changes for health surveillance. One method, called transductive neuro-fuzzy inference system with weighted data normalization is used to evaluate personalized risk of chronic disease. This personalized approach has been used for two different chronic diseases, predicting the risk of cardiovascular disease and predicting the risk of type 2 diabetes. For predicting the risk of cardiovascular disease, the National Nutrition Health Survey 97 data from New Zealand population has been used. This data contains clinical, anthropometric and nutritional variables. For predicting risk of type 2 diabetes, data from the Italian population with clinical and genetic variables has been used. It has been discovered that genes responsible for causing type 2 diabetes are different in male and female samples. A framework to integrate the personalized model and the chronic disease ontology is also developed with the aim of providing support for further discovery through the integration of the ontological representation in order to build an expert system in genes of interest and relevant dietary components.
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Pereira, Filipa Alexandra Antunes Vences de Matos. "Patient associations: raising awareness on chronic diseases." Master's thesis, Universidade de Aveiro, 2015. http://hdl.handle.net/10773/16582.
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Mestrado em Biomedicina FarmacêuticaThe patient associations assume a significant role in representing the patients’ rights, sharing information on the diseases, accessing the available resources, maintaining important interactions with other relevant stakeholders and facing challenges. These organizations provide an important support not only to the patients, but also to their families and friends, who are most of the times their direct caregivers. Currently, the patient empowerment has been highly discussed. This project aims to demonstrate in five different clinical disorders what are the motivations, the objectives, the activities, the involvement with other stakeholders and the challenges assumed by the correspondent patient associations. The result of this project allowed to conclude that the significant prevalence of chronic diseases has been introducing changes into the healthcare systems and national disease programmes. Simultaneously, the patients’ ownership has been increasing, contributing to a more participated role near the healthcare professionals and to a more conscious decision regarding the available therapeutics. Patient associations represent these patients and act in critical areas, such as, social, clinical, research, training, education and advocacy.
As associações de doentes assumem um papel fundamental na representação dos direitos dos pacientes, na divulgação de informação acerca das doenças, no acesso aos recursos disponíveis, no relacionamento com os vários intermediários e nos desafios a enfrentar. Estas associações prestam não só um grande apoio aos doentes, como também aos seus familiares e amigos, que são na maior parte das vezes os seus cuidadores diretos. Atualmente, a capacitação de doentes tem vindo a ser bastante discutida. Este projeto pretende demonstrar em cinco quadros clínicos distintos, quais as motivações presentes, os objetivos, as atividades realizadas, o envolvimento com outros stakeholders e os desafios enfrentados pelas respetivas associações de doentes. O resultado deste trabalho permitiu concluir que a prevalência significativa de doenças crónicas tem introduzido alterações nos sistemas de saúde e nos planos nacionais de doenças. Em simultâneo, a responsabilidade dos pacientes tem vindo a aumentar, contribuindo para um posicionamento cada vez mais participativo junto dos profissionais de saúde e para uma tomada de decisão mais consciente em relação às terapêuticas disponíveis. As associações de doentes dão voz a estes pacientes e atuam em áreas críticas, tais como, a área social, emocional, clínica, de investigação, de formação, de educação e de defesa e representatividade de direitos e benefícios.
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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.
11
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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Alaei, Shahmiri Fariba. "The potential association between thiamin, hyperglycemia and chronic diseases." Thesis, Curtin University, 2012. http://hdl.handle.net/20.500.11937/1209.
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Chronic diseases, such as cardiovascular disease and diabetes, are the leading causes of morbidity and mortality worldwide. Recent studies have shown that in addition to diabetes mellitus, non-diabetic degrees of fasting and postprandial hyperglycemia are also directly linked to accelerated risks of cardiovascular diseases. Thiamin is a water soluble vitamin playing a key regulatory role as a co-enzyme in metabolic pathways implicated in the glucose metabolism. There is some evidence that diabetic patients are prone to thiamin deficiency possibly because of an increased excretion of thiamin in the urine. However, there has been no published study to investigate thiamin status in individuals with pre-diabetic range of hyperglycemia. Given this gap, we undertook a cross-sectional study, evaluating blood thiamin concentration of subjects with impaired glucose regulation compared with healthy people.To examine the main objective of this study, data of 64 subjects (29 men and 35 women) were analysed. These subjects consisted of 39 normal healthy volunteers and 25 hyperglycemics with plasma glucose levels at pre-diabetic ranges (16 IGT, 9 IFG). The mean intake of thiamin in both groups as assessed by a validated semiquantitative food frequency questionnaire was 1.37±0.72 mg/day for normal subjects and 1.46±0.51 mg/day for those with hyperglycemia. These values exceeded the Australian RDI for thiamin. There was no significant difference in the levels of RBC thiamin in hyperglycemic subjects relative to those in the normoglycemic group (0.95±0.17 vs. 0.88±0.24 nmol/g Hb, p=0.22).The two groups were also evaluated for a range of risk factors for CVD, including arterial stiffness. Hyperglycemic subjects had higher levels of fasting DVP parameters (SI & RI), accompanied with tendencies toward blunted response to ingested glucose load relative to normoglycemic group. These results suggest that screening of individuals with hyperglycemia by using a Pulse Trace machine may be a means of recognising cardiovascular complications at early stages. Further research with a larger sample size is recommended to extend these interesting results.Hyperglycemia is known to induce a variety of biochemical alterations at the cellular level, resulting in a range of vascular and tissue damages. The mechanism of action of supplemental thiamin seems to involve the diversion of "excess" metabolic load (glycolytic intermediates) away from glycolysis and toward the reductive pentose pathway, a secondary pathway for glucose catabolism. Thiamin supplementation was also shown to improve cardiovascular risk factors in diabetic rats, suggesting the potential effects of thiamin in prevention of diabetic complications.To date there has been no published study to investigate these effects in individuals with pre-diabetic range of hyperglycemia (IGT). Therefore, our objective in the second study was to assess the chronic effect of high dose thiamin supplement (300 mg/d) on glucose tolerance and some cardiovascular risk factors in individuals with hyperglycemia at an early stage. In this intervention study with a double blind cross - over design, the hyperglycemic subjects (n=12) were randomly allocated into two groups to receive either placebo for 6 weeks followed by a 14-week washout period and then thiamin for 6 weeks; or thiamin for 6 weeks, a 14-week washout period and placebo for 6 weeks.The results of our intervention study showed that after 6 weeks of supplementation, RBC thiamin increased from 0.93 (±0.17) nmol/g Hb to 1.56 (±0.31) nmol/g Hb. In subjects receiving placebo, fasting plasma glucose increased significantly from baseline after six weeks (6.11±0.70 vs. 5.87±0.63 mmol/L, p=0.003). This significant change was accompanied with concomitant increases in fasting plasma insulin (7.67± 4.39 vs. 6.64± 3.45 μIU/mL, p=0.04), and HOMA score (2.10±1.32 vs. 1.75±1.01, p= 0.02). However in the supplement arm, there was no significant change in fasting plasma glucose (6.01±0.79 vs. 6.02±0.68 mmol/L, p=0.83), fasting insulin (7.46 ±4.67 vs. 7.36± 4.40 μIU/mL, p> 0.05) or HOMA score (2.05±1.51 vs. 2.00±1.32, p=0.75) determined at week 6 compared to baseline (week 0), indicating that supplementation with high dose thiamin may have prevented the natural progression of hyperglycemia toward diabetes mellitus in individuals with impaired glucose metabolism at early stages. We also found that high dose thiamin therapy can improve glucose tolerance (week 0: 9.89±2.50 vs. week 6: 8.78±2.20 mmol/L, p=0.004), and attenuate diastolic blood pressure (week 0: 71.42 ±7.41 vs. week 6: 79.2± 5.84 mm Hg, p=0.005) in patients with impaired glucose metabolism. The findings of the present study suggest that thiamin therapy may be effective in patients with hyperglycemia at early stages.Previous studies examining the potential effects of thiamin under hyperglycemic condition have mainly been limited to animals. The current clinical study suggests that thiamin supplementation may be beneficial in humans with pre-diabetic ranges of hyperglycemia. Further studies are required to confirm these results and investigate the impact of thiamin supplementation on insulin secretion.The findings of this research have the potential to inform food formulations and dietary recommendations for people who are at risk of developing diabetes mellitus, and may have a role in the prevention of hyperglycemic complications. The findings of this study serve as a base for further research investigating the effectiveness of different doses of thiamin on cardiovascular risk factors.
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Maimela, Eric. "Development of an integrated, evidence-based management model for chronic non-communicable diseases and their risk factors, in a rural area of Limpopo Province, South Africa." Thesis, University of Limpopo, 2016. http://hdl.handle.net/10386/1732.
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Thesis(Ph.D.(Medical Science)) -- University of Limpopo, 2016Background: Chronic disease management (CDM) is an approach to health care that keeps people as healthy as possible through the prevention, early detection and management of chronic diseases. This approach offers holistic and comprehensive care, with a focus on rehabilitation, to achieve the highest level of independence possible for individuals.The aim of this study was to develop an integrated, evidence-based model for the management of chronic non-communicable diseases in a rural community of the Limpopo Province, South Africa. Methods: The study was conducted at Dikgale Health and Demographic Surveillance System (HDSS) site is situated in Capricorn District of Limpopo Province in South Africa. This study followed mixed methods methodology with an aim on integrating quantitative and qualitative data collection and analysis in a single study to develop an intervention program in a form of model to improve management of chronic diseases in a rural area. Therefore, this included literature review and WHO STEPwise approach to surveillance of NCD risk factors for quantitative techniques and focus group discussions, semi-structures interviews and quality circles for qualitative techniques. In the surveillance of NCD risk factors standardised international protocols were used to assess behavioural risk factors (smoking, alcohol consumption, fruit and vegetable consumption, physical activity) and physical characteristics (weight, height, waist and hip circumferences, and blood pressure). A purposive sampling method was used for qualitative research to determine knowledge, experience and barriers to chronic disease management in respect of patients, nurses, community health workers (CHWs), traditional health practitioners (THPs) and managers of chronic disease programmes. Data were analysed using STATA 12 for Windows, INVIVO and Excel Spreadsheets. Results: The study revealed that epidemiological transition is occurring in Dikgale HDSS. This rural area already demonstrates a high burden of risk factors for non-communicable diseases, especially smoking, alcohol consumption, low fruit and vegetable intake, physical inactivity, overweight and obesity, hypertension and dyslipidaemia, which can lead to cardiovascular diseases. The barriers mostly mentioned by the nurses, patients with chronic disease, CHWs and THPs include lack of knowledge of NCDs, shortages of medication and shortages of nurses in the clinics which cause patients to stay for long periods of time in a clinic. Lack of training on the management of chronic diseases, supervision by the district and provincial health managers, together with poor dissemination of guidelines, were contributing factors to lack of knowledge of NCDs management among nurses and CHWs. THPs revealed that cultural insensitivity on the part of nurses (disrespect) makes them unwilling to collaborate with the nurses in health service delivery. x The model developed in this study which was the main aim of the study describes four interacting system components which are health care providers, health care system, community partners and patients with their families. The main feature of this model is the integration of services from nurses, CHWs and THPs including a well-established clinical information system for health care providers to have better informed patient care. The developed model also has an intervention such as establishment of community ambassadors. Conclusion: Substantially high levels of the various risk factors for NCDs among adults in the Dikgale HDSS suggest an urgent need for adopting healthy life style modifications and the development of an integrated chronic care model. This highlights the need for health interventions that are aimed at controling risk factors at the population level in order to slow the progress of the coming non-communicable disease epidemic. Our study highlights the need for health interventions that aim to control risk factors at the population level, the need for availability of NCD-trained nurses, functional equipment and medication and a need to improve the link with traditional healers and integrate their services in order to facilitate early detection and management of chronic diseases in the community. The developed model will serve as a contribution to the improvement of NCD management in rural areas. Lastly, concerted action is needed to strengthen the delivery of essential health services in a health care system based on this model which will be tasked to organize health care in the rural area to improve management and prevention of chronic illnesses. Support systems in a form of supervisory visits to clinics, provision of medical equipments and training of health care providers should be provided. Contribution from community partners in a form of better leadership to mobilise and coordinate resources for chronic care is emphasized in the model. This productive interaction will be supported by the district and provincial Health Departments through re-organization of health services to give traditional leaders a role to take part in leadership to improve community participation.
Medical Science Department, University of Limpopo in South Africa,International Health Unit, and Antwerp University
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LORE', BRUNO. "Chronic oral diseases: clinical and therapeutic approach." Doctoral thesis, Università degli Studi di Roma "Tor Vergata", 2016. http://hdl.handle.net/2108/201776.
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Chronic oral conditions including oral lichen planus, burning mouth syndrome and
recurrent aphthous stomatitis are commonly observed in Maxillo-facial, Dentistry, ENT
and Dermatologic clinics. These diseases significantly impact patients’ quality of life.
Moreover management and treatment represent a clinical challenge since the
aforementioned specialists have heterogeneous scientific backgrounds as well as
different clinical and surgical skills. For this reason the aim of my triennial project was
the realization of a multidisciplinary clinic dedicated to the evaluation and treatment of
patients affected by 3 common oral conditions in order to optimise their management in
terms of treatment, baseline evaluation and follow-up.
Oral lichen planus, burning mouth syndrome and recurrent aphthous stomatitis are the
three inflammatory conditions of the oral mucosa studied in my project. Their
pathogenesis is not competely understood and available treatments are partially
effective. The three different clinical studies following presented evaluated possible new
therpaeutic strategies in this field.
15
潘建基 and Kin-kee Pun. "Carbohydrate metabolism in chronic renal and liver disease." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1986. http://hub.hku.hk/bib/B31981276.
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Baril, Jacinthe. "Interaction between circulatory and respiratory exercise adaptation in chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF)." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97901.
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Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) patients show a marked reduction in exercise capacity compared to that of healthy age-matched individuals. While inadequate gas exchange and resulting hypoxemia appears as the primary factor in COPD, an impaired cardiac output is the predominant explanation for the reduced oxygen delivery in CHF. However, the extent of the contributions of other systemic factors remains unclear. In light of the potential interactions between cardiac output (Qc) and pulmonary hyperinflation, there is surprisingly little data thus far on ventilatory constraints in CHF and on the role of blood flow delivery in COPD which may further limit the exercise capacity. Thus, the purpose of this study was to compare the slope of the Qc versus oxygen uptake (VO2) response through several submaximal cycling loads in patients with moderately severe COPD and with that of moderate to severe CHF patients as well as age-matched healthy control subjects (CTRL). Also examined was the possibility that ventilatory constraints such as dynamic hyperinflation contribute to an abnormal stroke volume response in both diseases. Cardiac output was measured using the CO 2-rebreathing equilibrium technique during baseline conditions and cycling at 20, 40 and 65% of peak power in 17 COPD (Age: 64 +/- 8 yrs; FEV 1/FVC: 37 +/- 11%; FEV1: 41 +/- 15 % predicted), 10 CHF (Age: 57+/- 10 yrs; FEV1/FVC: 73.8 +/- 5.6%; FEV 1: 93 +/- 13% predicted) and 10 age-matched CTRL subjects. Inspiratory capacity (IC) was also measured for the determination of dynamic hyperinflation during the steady state exercise bouts. The results indicate that while the absolute Qc values are lower in COPD and in CHF than in CTRL during 65% peak power cycling (11.30 +/- 2.38 vs 12.40 +/- 2.08 vs 15.63 +/- 2.15 L•min-1 respectively, p < 0.01), likely due to their lower exercise metabolic demand. The Qc/VO2 response to increasing levels of exercise intensity was lower or normal in CHF patients compared to CTRL, while normal or hyperdynamic in most COPD patients. Indeed, the majority of patients with COPD exhibited Qc/VO2 slopes greater than 7.0, which may be indicative of a peripheral muscle bioenergetic disturbance that may drive the need for greater oxygen delivery, and thus result in an exaggerated central circulatory response.
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Zeddies, Andréa McBride. "Chronic illness in context examining sociocultural factors in women's experience of lupus /." Access restricted to users with UT Austin EID, 2001. http://wwwlib.umi.com/cr/utexas/fullcit?p3037033.
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Roberts, Della Kim. "The family experience with chronic obstructive pulmonary disease." Thesis, University of British Columbia, 1985. http://hdl.handle.net/2429/24422.
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This study was designed to gain an understanding of the family experience when an adult member has chronic obstructive pulmonary disease (COPD). It is recognized that illness within the family affects the well-being of the family unit and the health of all members. To understand the impact of COPD upon the family, however, the literature provides only knowledge of the experience of the individual who has COPD and the spouse, not that of the family unit. Thus, the purpose of this study was to describe and explain the COPD experience from the perspective of the family unit.
A qualitative method, phenomenology, was chosen for this investigation. Data were collected through semi-structured interviews with eight families who shared their experiences. From the content analysis of these data, three themes that were common throughout the families' accounts were identified and developed to describe and explain family life with COPD.
The first theme, disease-dictated family life, describes four aspects of a common lifestyle that is imposed on the family by the characteristics of COPD. The second theme, isolation, describes the isolation that accompanies the illness experience, for the family group and the individual members within the group. The final theme, family work, describes the four primary challenges the families face and the coping strategies they use to deal with them. These findings revealed that COPD acts as an intense stressor within the family, requiring extensive family work to cope with COPD in a way that maintains the well-being of the family unit. Furthermore, it was found that living with COPD in many ways inhibits the resources within the family and those external sources of support that foster the family's ability to manage the stress associated with living with COPD. The implications for nursing practice and nursing research were delineated in light of the research findings.Applied Science, Faculty of
Nursing, School of
Graduate
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Håkansson, Niclas. "Occupational exposure to electromagnetic fields and chronic diseases /." Stockholm, 2003. http://diss.kib.ki.se/2003/91-7349-719-3/.
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Currie, D. F. "Assessment of genetic susceptibility ot chronic renal diseases." Thesis, Queen's University Belfast, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.546036.
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Chooi, Yu Chung. "Acculturation, Dietary Intake and Chronic Diseases Among Latinos." Thesis, Howard University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10190826.
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The purpose of this study was to examine the relationships of acculturation [language(s) usually spoken at home, and length of residence in the United States (US)] of Mexican-American and other Hispanics to dietary intakes, as well as to chronic diseases such as overweight/obesity, diabetes, hypertension and coronary heart disease (CHD) risk.
The study was based on data extracted from the 2011-2012 National Health and Nutrition Examination Survey (NHANES). A total of 860 Hispanic subjects aged 40 years or more were utilized in the study. Data were analyzed using SUDAAN statistical software. Statistical procedures used to address the study objectives were t-tests and chi-square tests.
The findings demonstrated that language usually spoken at home (English more than Spanish or only English) was associated with higher intakes of total fat, total saturated fat, total monounsaturated fat, total polyunsaturated fat and sodium compared with the other groups. However, greater length of residence in the US was associated with lower intakes of energy, total fat, saturated fat, and sodium; and higher fiber intakes. Overweight and obesity were associated with greater length of residence in the US and language spoken at home (English and Spanish equally). Diabetes and hypertension had no significant relationships with length of residence in the US or language usually spoken at home. Greater length of residence in the US was associated with greater risk of CHD.
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Boonarpha, N. "Choroidal structure and function in chronic retinal diseases." Thesis, University of Liverpool, 2016. http://livrepository.liverpool.ac.uk/3001786/.
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Introduction: The choroid plays an important role in maintaining retinal homeostasis. Changes in choroidal structure and a failure of choroidal autoregulation (the ability of a vascular bed to maintain blood flow despite changes in perfusion pressure) may have a great consequence in the pathogenesis of several chronic chorioretinal diseases including diabetic retinopathy (DR) and central serous chorioretinopathy (CSCR). Aim: The main aim of this thesis is to study the structure and function of the choroid and determine its role in the pathogenesis of DR and CSCR using enhanced depth imaging optical coherence tomography (EDI OCT) and laser Doppler flowmetry (LDF). Methods: A protocol for standardising the choroidal thickness (ChT) measurement using topographical appearances of the choroidal posterior boundary was developed and validated on EDI OCT images from healthy volunteers and patients with DR. Extensive experiments were performed in order to validate the hardware and software of the LDF device. Two controlled prospective studies were designed and performed; 1) Diabetic Retinopathy: Functional and Structural Study (DREFUS Study), and 2) Liverpool Central Serous Chorioretinopathy study (Liverpool CSCR Study). The DREFUS study involved diabetic patients with/without DR and healthy volunteers. DR patients were grouped using the presence or absence of clinically significant macular oedema (CSMO). The Liverpool CSCR study included patients presented with CSCR and healthy volunteers. For both of the studies the ChT was measured using a single horizontal EDI OCT scan while the choroidal blood flow (ChBFlow) parameters (choroidal blood volume [ChBVolume] and velocity [ChBVelocity]) were measured by using LDF. Isometric exercise was used to test choroidal autoregulation function. Mean arterial BP (MAP), ocular perfusion pressure (OPP) and change in choroidal vascular resistance were calculated to evaluate the choroidal autoregulation. In addition, best corrected visual acuity (BCVA), blood pressure (BP), colour fundus photography, fluorescein angiography (FA), and OCT were performed. Other tests including indocyanine green angiography (ICG), volumetric EDI OCT scans, microperimetry, intraocular pressure, and axial length were only performed by the CSCR study. Statistical analyses (correlation, t-test, ANOVA, ANCOVA, intraclass correlation coefficient [ICC], Fisher exact test, Mann-Whitney test) were performed as appropriate. Results: The standardised protocol for ChT measurement was produced. ICC for interobserver and intraobserver agreements on ChT measurements using of the protocol were 0.96 and 0.99 respectively for healthy eyes (n = 12) and 0.97 and 0.99 respectively for eyes with DR (n = 46). The mean subfoveal ChT (SfChT) was 304 µm (95% confidence interval (CI): 282 – 326) for patients with DR (N = 61). There were no significant differences in ChT between healthy eyes (N = 41; 351 µm (95% CI: 321 – 381)), diabetic eyes (N = 12; 299.9 µm (95% CI: 248.7 - 351.2) and eyes with DR (P >0.05). A statistically significant increase in ChBVelocity by 8% was observed following an increase of MAP by 18% in DR with CSMO. The mean SfChT of CSCR patients (N = 45) was 468.5 µm (95% CI: 437.1 – 499.9), approximately 30% thicker than in healthy eyes (N = 25; 361.4 µm (95% CI: 319.8 – 402.2) (P < 0.05). Hypertension was identified as the main risk factor affecting ChT in CSCR, particularly during the active stage of CSCR (normotensive CSCR: SfChT = 431 µm (95% CI: 378 – 485) vs hypertensive CSCR: SfChT = 521 µm (95% CI: 468 – 574): P < 0.05). An increase in OPP by 40% caused the ChT to increase significantly in CSCR patient (435.3 µm (95% CI: 378.2 - 492.4) at baseline vs 446.3 µm (95% CI: 393.4 - 499.2) at the end of exercise; P < 0.05). An increase of OPP by 31% caused significant change in ChBVolume in CSCR patients compared to healthy eyes (P = 0.03). Changes in ChBVolume in CSCR patients were negatively correlated with changes in choroidal vascular resistance (r = -0.83, P < 0.05). Conclusions: In patients with diabetes, no significant changes in the ChT were observed in any group of DR patients. ChBVelocity regulation was impaired in patients with severe DR. These findings suggest that functional changes of the choroid may occur well before the structural changes in patients with DR. In CSCR patients, increases in ChT and choroidal volume were observed in all CSCR phenotypes and also related with hypertension and the area of choroidal vascular hyperpermeability seen on ICG. The disruption of the regulation of choroidal structure and function was observed during isometric exercise in CSCR patients. These findings highlight the significance of choroidal regulation in the pathogenesis of DR and CSCR.
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Vickers, Margaret H. (Margaret Heather) 1962, of Western Sydney Nepean University, and Faculty of Commerce. "Life and work with 'invisible' chronic illness (ICI) :authentic stories of a passage through trauma - a Heideggerian, Hermeneutical, phenomenological, multiple-case, exploratory analysis." THESIS_FC_XXX_Vickers_M.xml, 1997. http://handle.uws.edu.au:8081/1959.7/826.
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This study is research into Invisible Chronic Illness (ICI): illness that cannot be seen by another, but that can have a major, sometimes catastrophic, effect on the lives of people concerned, especially their working lives. Each chapter deals, in some detail,with certain aspects of chronic illnesses that cannot be readily seen. The research is argued to be a vital excavation - a recognition of authentic and previously unheard voices and a methodology of primary value in researching the incommensurable, the difficult, the nasty in organisational lifeDoctor of Philosophy (PhD)
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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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Wong, Siu-lan. "Statistical methods in studying the aetiology of Chronic diseases /." [Hong Kong] : University of Hong Kong, 1987. http://sunzi.lib.hku.hk/hkuto/record.jsp?B12354430.
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Cruz, Lebron Angelica Iris. "THE GUT MICROBIOME IN HUMAN GASTROINTESTINAL DISEASES: CHRONIC OPIOID USE & INFLAMMATORY BOWEL DISEASE." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1607681399971656.
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Yarkiner, Zalihe. "Developing longitudinal models for monitoring chronic diseases in computerised general practice (GP) records : a case study in chronic kidney disease (CKD)." Thesis, Kingston University, 2015. http://eprints.kingston.ac.uk/34536/.
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Analysis of longitudinal data is a rapidly growing field of statistical analysis, in response to the increasing availability of longitudinal datasets in many disciplines. Longitudinal studies are becoming more popular as they allow investigation of the same individuals over time, and where both within-individual and between-individual differences can be examined. Since the study of change over time is necessary in many areas, longitudinal studies and meaningful analysis of longitudinal data is essential. The health sector is one such area where longitudinal research is playing an increasingly important role. The aim of this research is to examine statistical methodologies for the analysis of longitudinal medical data, specifically General Practice (GP) records. All General Practices (GPs) in England and Wales are now computerized and routinely record detailed patient information, hence providing a rich longitudinal dataset. This research investigates new techniques and adaptations of existing methodologies to understand and explain patterns of change and the natural development and treatment of chronic diseases within routinely collected GP data. The data used here, although taken from a raw sample of 129 General Practice records, have been subjected to some cleaning and recoding in places, hence it should be considered as a secondary data source. Through out the data driven applications presented, different sub¬samples of the original dataset have been used. For the main part the full cleaned sample of 876951 patients is used where possible. Smaller samples ranging between 472 and 58675 patients are used depending on the outcome of interest and the availability of valid observations for the various applications employed. Mainly regression-based techniques, in two broad categories, were used to analyse the repeated measurements from each patient in our dataset. Firstly, linear and generalized mixed modelling approaches were used, whereas in the second phase of the project, the applications of semi-parametric and non-parametric approaches were investigated. The case study of particular interest in this research project is the incidence and progression of chronic kidney disease (CKD). There is a lack of knowledge and understanding of the natural history ofCKD and its progression over time. This project aims to address these issues. The advanced statistical models used in this research quantify how kidney function, assessed using estimated Glomerular Filtration Rate (eGFR), changes with respect to time and how other factors, including other related medical conditions (known as co-morbidities of CKD), affect kidney function and its change over time. The techniques and approaches used in this study are motivated by mixed model designs. The decline of kidney function as time progresses for typical CKD patients is observed to be non-linear. The type of nonlinear mixed models developed in this project do not assume that the decline of eGFR over time is linear, and hence are better able to model the progression of CKD than more traditional linear models. As a consequence, the proportion of the total variation in the outcome that can be explained by considering the patient level factors is tripled through the use of these non-linear models, showing they have much greater explanatory power than previous, simpler statistical models. The disease under study is Chronic Kidney Disease (CKD) but the methodologies should also be applicable other chronic, progressive diseases.
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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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Acharyya, Swarnali. "Elucidating molecular mechanisms of muscle wasting in chronic diseases." Columbus, Ohio : Ohio State University, 2007. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1180096565.
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Simadibrata, Marcellus. "Small bowel diseases causing chronic diarrhea in Indonesian people." Jakarta : Amsterdam : Publishing Unit of Internal Medicine, Faculty of Medicine, University of Indonesia ; Universiteit van Amsterdam [Host], 2002. http://dare.uva.nl/document/86145.
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Arsenescu, Violeta. "ROLE OF ARYL HYDROCARBON RECEPTOR IN CHRONIC INFLAMMATORY DISEASES." UKnowledge, 2009. http://uknowledge.uky.edu/gradschool_diss/772.
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Aryl Hydrocarbon Receptor (AhR) is a ligand-actviated receptor known as the dioxin receptor. Environmental pollutants called dioxin-like toxicants are found in food, cigarette smoke, automobile exhaust and air. Therefore, they could chronically amplify the pathology of numerous chronic inflammatory diseases. AhR is a well known target of these environmental chemicals that disrupt endocrine signaling. By the year 2020, the number of people older than 60 years is expected to top 1 billion. The burden of treating chronic disease is significant both in dollars spent and in lost productivity. The need to identify risk factors for chronic diseases must be evaluated along with diet and lifestyle factors that will promote healthy aging.
The studies presented in this dissertation tested the hypothesis that habitual exposure to dioxin-like contaminants contributes to chronic inflammatory disease states through activation of AhR pathway. Due to their lipophilicity, dioxin like toxicants (like PCB 77) accumulated in mice' visceral adipose tissue and induced adipocytes maturation and ectopic fat deposition. Exposure to persistent organic pollutants, such as polychlorinated biphenyls (PCB 77) can cause endothelial cells activation and inflammation by inducing pro-inflammatory signaling pathways. In our studies, PCB 77 had cumulative effects in Angiotensin II - induced Abdominal Aortic Aneurysm (AAA) by exacerbating inflammation in and around the aortic wall. More, PCB 77 increased mortality in mice that developed AAA.
In order to appreciate the AhR involvement in inflammation we used a mouse model of Inflammatory Bowel Disease(IBD). Mice that had a reduced Ahr Receptor expression developed a less severe colitis and had a decreased general inflammatory status.
These data provide evidence that exposure to environmental toxicants could augment inflammation and contribute to the social burden of obesity and obesity related chronic inflammatory diseases.
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Lai, Ching-lung, and 黎靑龍. "Chronic hepatitis B-related liver diseases in the Chinese." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1993. http://hub.hku.hk/bib/B31981501.
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Wong, Siu-lan, and 黃小蘭. "Statistical methods in studying the aetiology of Chronic diseases." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1987. http://hub.hku.hk/bib/B31207984.
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Lai, Ching-lung. "Chronic hepatitis B-related liver diseases in the Chinese." Hong Kong : University of Hong Kong, 1993. http://sunzi.lib.hku.hk/hkuto/record.jsp?B13814060.
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Bethune, Jörn [Verfasser]. "Network-Assisted Analysis of Chronic Inflammatory Diseases / Jörn Bethune." Kiel : Universitätsbibliothek Kiel, 2016. http://d-nb.info/1118499875/34.
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Chakrabarti, Shubro. "Mechanisms of fibrosis in feline chronic kidney disease." Thesis, Royal Veterinary College (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.572451.
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Hampton, Jenaneta Sue. "Women, spirituality, and chronic illness." Thesis, Montana State University, 2004. http://etd.lib.montana.edu/etd/2004/hampton/HamptonJ1204.pdf.
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Suemanotham, Namphung. "The role of cyclooxygenase enzymes in feline chronic kidney disease." Thesis, Royal Veterinary College (University of London), 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.559010.
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Clark, Laura Elizabeth. "The epidemiology of chronic kidney disease in Grampian." Thesis, Available from the University of Aberdeen Library and Historic Collections Digital Resources, 2009. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?application=DIGITOOL-3&owner=resourcediscovery&custom_att_2=simple_viewer&pid=33407.
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Choate, Radmila. "ESTIMATING DISEASE SEVERITY, SYMPTOM BURDEN AND HEALTH-RELATED BEHAVIORS IN PATIENTS WITH CHRONIC PULMONARY DISEASES." UKnowledge, 2019. https://uknowledge.uky.edu/epb_etds/22.
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Chronic pulmonary diseases include a wide range of illnesses that differ in etiology, prevalence, symptomatology and available therapy. A common link among these illnesses is their impact on patients’ vital function of breathing, high symptom burden and significantly impaired quality of life.
This dissertation research evaluates disease severity, symptom burden and health behaviors of patients with three different chronic pulmonary conditions. First, alpha-1 antitrypsin deficiency (AATD) is an inherited condition that typically is associated with an increased risk of early onset pulmonary emphysema. This study examines differences in demographic, health, and behavioral characteristics and compares clinical outcomes and health related behaviors and attitudes between two severe genotypes of AATD - ZZ and SZ. The findings of the study suggest that patients with SZ genotype and less severe form of deficiency report higher number of exacerbations, comorbidities, as well as unhealthy behaviors such as lack of exercise and current smoking. In addition, individuals with the more severely deficient ZZ genotype are more adherent to disease management and prevention program recommendations and maintain a healthier lifestyle than individuals with SZ genotype.
Second chronic lung disease examined in this research was chronic obstructive pulmonary disease (COPD), the fourth leading cause of death and second leading cause of disability in the United States. Prevalence and burden of cough and phlegm, two of the most common symptoms of the COPD, were assessed among participants of the COPD Foundation’s Patient-Powered Research Network (COPD PPRN). In addition, association between patient-reported levels of phlegm and cough, clinical outcomes and patients’ quality of life were evaluated. Participants’ quality of life was assessed using Patient Reported Outcome Measurement Information System instrument PROMIS-29. Association between changes in symptom severity over time and patient-reported quality of life were examined. Findings of this study indicated that severity of cough and phlegm were associated with higher number of exacerbations, greater dyspnea, and worsened patient-reported quality of life including physical and social functioning. Improvement in cough and phlegm severity over time was associated with better patient-reported quality of life.
Third pulmonary illness described in this dissertation is non-cystic fibrosis bronchiectasis (NCFB), a rare and etiologically diverse condition characterized by dilated bronchi, poor mucus clearance and susceptibility to bacterial infection. Association between presence of Pseudomonas aeruginosa (PA), one of the most frequently isolated pathogens in patients with NCFFB, and disease severity was assessed utilizing enrollment data from the Bronchiectasis and NTM Research Registry (BRR). NCFB disease severity was evaluated using modified versions of validated in large international cohorts instruments, the Bronchiectasis Severity Index (BSI) and FACED. The findings of this study indicate that PA infection is common in NCFB patients, and presence of PA in patients’ sputum is associated with having moderate and high severity of bronchiectasis. In addition, the results of this study suggest that the two severity assessment instruments classify patients with NCFB differently which may be attributed to a greater number of severity markers utilized in the calculation of the BSI compared to FACED.
In conclusion, the proposed dissertation aims to enhance understanding of differences in health outcomes between genotypes of AATD within AlphaNet registry, and to guide future health-promoting behaviors. It highlights the burden of common symptoms such as cough and phlegm in patients with COPD within COPD PPRN and their association with patients’ quality of life. In addition, it introduces modified indices of NCFB severity and emphasizes high burden of the disease in patients with presence of PA within the US BRR.
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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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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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L'Italien, Matthew R. "Longitudinal Nutrition Risk Assessment of the Elderly." Fogler Library, University of Maine, 2004. http://www.library.umaine.edu/theses/pdf/LItalienMR2004.pdf.
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Elwell-Sutton, Timothy Mark. "Inequality, inequity and the rise of non-communicable disease inChina." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2013. http://hub.hku.hk/bib/B5016272X.
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Background: Rapid economic growth in mainland China has been accompanied in recent years by rising levels of inequality and a growing burden of non-communicable disease (NCD), though little is known at present about the relations between these forces. This thesis makes use of data from a large sample of older men and women in Guangzhou, one of China’s most developed cities, to examine the relations between inequality, inequity and non-communicable disease.
Objectives: This thesis addresses two research questions: what is the relationship between inequality/inequity and non-communicable disease in China; and what are the implications of this relationship for health policy in China. These two questions lead to two working hypotheses: first, that inequalities may be both a cause and consequence of NCDs in China, potentially creating a vicious cycle which reinforces inequality and inequity; and second, that reducing dependence on out of pocket payments as a source of healthcare finance may help to prevent the continuation of the inequality-NCD cycle.
Methods: I used data from the Guangzhou Biobank Cohort Study (GBCS), including 30,499 men and women aged 50 or over from Guangzhou and multi-variable regression methods to examine associations of socioeconomic position at four life stages (childhood, early adulthood, late adulthood and current) with several health outcomes: self-rated health, chronic obstructive pulmonary disease, metabolic syndrome and markers of immunological inflammation (white blood cells, granulocytes and lymphocytes). These analyses related to the hypothesis that inequalities may be a cause of non-communicable disease in China.
I also examined whether inequity may be a consequence of non-communicable disease by measuring whether horizontal inequity (deviation from the principle of equal access to healthcare for equal need) was greater for treatment of NCDs than for general healthcare. I tested this using both concentration index methods and multi-variable regression models. For comparative purposes, I conducted these analyses in data from three settings: Guangzhou, Hong Kong and Scotland (UK).
Results: I found that socioeconomic deprivation across the life course was associated with poorer self-rated health, higher risk of COPD, higher white cell and granulocyte cell counts and (in women only) higher risk metabolic syndrome and higher lymphocyte cell counts. I also found evidence of pro-rich inequity in utilisation of treatment for three major non-communicable conditions (hypertension, hyperglycaemia and dyslipidaemia) in Guangzhou, whilst there was no evidence of inequity in general healthcare utilisation (doctor consultations and hospital admissions) or treatment of gastric ulcer.
Conclusion: My findings gave qualified support for the idea that socioeconomic inequalities may contribute to some, though not all, non-communicable diseases in China. Moreover, the mechanisms which link socioeconomic inequality to NCDs in China remain unclear. My results also supported the suggestion that a rising burden of non-communicable disease may contribute to greater pro-rich inequity in healthcare utilisation, especially for conditions which are chronic and asymptomatic. As rates of NCDs continue to rise in China and other developing countries, policies to prevent and treat common NCDs may be improved by a clearer understanding of how inequality is related to non-communicable disease.published_or_final_version
Community Medicine
Doctoral
Doctor of Philosophy
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Murphy, Georgina Anne Veronica. "Chronic non-communicable diseases and risk factors in rural Uganda." Thesis, University of Cambridge, 2014. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.707995.
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Cantero, Recasens Gerard 1984. "Cellular Ca2+ homeostasis in the pathophysiology of chronic respiratory diseases." Doctoral thesis, Universitat Pompeu Fabra, 2013. http://hdl.handle.net/10803/104537.
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Calcium works as a second intracellular messenger in all cell types and its downstream signalling
is a key pathway for many systemic functions. In the lungs, the majority of activating stimuli
trigger intracellular calcium increase, which is indispensable for the normal functioning of the
airways; thus, deregulation of this pathway leads to pathological conditions. This Thesis aims to
understand the relationship of intracellular calcium homeostasis and chronic respiratory
pathologies such as asthma. I have studied three different processes involved in calcium
homeostasis and their role in asthma pathophysiology: 1) I have shown the genetic association of a
defect in calcium entry via TRPV1 with wheezing and cough, which is one feature of asthma
pathophysiology; 2) I have also demonstrated the product of the asthma associated ORMDL3 gene
is a Ca++ homeostasis and UPR modulator; and 3) I have provided a new Ca++ dependent sorting
mechanism for secretory cargoes that bind calcium.El Calci és un segon missatger intracel·lular en tots els tipus cel·lulars i la cascada de senyalització generada pel calci és una via de senyalització cel·lular clau per moltes funcions sistèmiques. En els pulmons, la majoria d’estímuls activadors produeixen un increment del calci intracel·lular, el qual és indispensable pel funcionament correcte de les vies respiratòries; i, per tant, una desregulació d’aquesta via de senyalització porta a diferents situacions patològiques. Aquesta Tesi té com a objectiu entendre la relació entre l’homeòstasi del calci intracel·lular i les malalties respiratòries cròniques, com per exemple, l’asma. Hem estudiat tres processos diferents implicats en l’homeòstasi del calci i el seu rol en la fisiopatologia de l’asma: 1) Hem demostrat que hi ha una associació genètica entre un defecte en l’entrada de calci via TRPV1 i un dels trets característics de l’asma, la tos; 2) també hem trobat que l’ORMDL3, que havia estat associat amb l’asma, és un modulador de l’homeòstasi del calci i de la UPR; i 3) hem aportat un nou mecanisme de classificació en el Golgi depenent de Ca++ per a proteïnes que uneixen calci i que seran secretades.
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Damera, Gautam V. "Molecular mechanisms of mucus hypersecretion in chronic airway obstructive diseases." Oklahoma City : [s.n.], 2006.
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Henriksson, Freddie. "Economic aspects of chronic diseases : multiple sclerosis and diabetes mellitus /." Stockholm, 2001. http://diss.kib.ki.se/2001/91-628-5023-7/.
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Adeogun, Oluseun. "Informatics for devices within telehealth systems for monitoring chronic diseases." Thesis, Cranfield University, 2011. http://dspace.lib.cranfield.ac.uk/handle/1826/6493.
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Preliminary investigation at the beginning of this research showed that informatics on point-of-care (POC) devices was limited to basic data generation and processing. This thesis is based on publications of several studies during the course of the research. The aim of the research is to model and analyse information generation and exchange in telehealth systems and to identify and analyse the capabilities of these systems in managing chronic diseases which utilise point-of-care devices. The objectives to meet the aim are as follows: (i) to review the state-of-the-art in informatics and decision support on point-of-care devices. (ii) to assess the current level of servitization of POC devices used within the home environment. (iii) to identify current models of information generation and exchange for POC devices using a telehealth perspective. (iv) to identify the capabilities of telehealth systems. (v) to evaluate key components of telehealth systems (i.e. POC devices and intermediate devices). (vi) to analyse the capabilities of telehealth systems as enablers to a healthcare policy. The literature review showed that data transfer from devices is an important part of generating information. The implication of this is that future designs of devices should have efficient ways of transferring data to minimise the errors that may be introduced through manual data entry/transfer. The full impact of a servitized model for point-of-care devices is possible within a telehealth system, since capabilities of interpreting data for the patient will be offered as a service (c.f. NHS Direct). This research helped to deduce components of telehealth systems which are important in supporting informatics and decision making for actors of the system. These included actors and devices. Telehealth systems also help facilitate the exchange of data to help decision making to be faster for all actors concerned. This research has shown that a large number of capability categories existed for the patients and health professionals. There were no capabilities related to the caregiver that had a direct impact on the patient and health professional. This was not surprising since the numbers of caregivers in current telehealth systems was low. Two types of intermediate devices were identified in telehealth systems: generic and proprietary. Patients and caregivers used both types, while health professionals only used generic devices. However, there was a higher incidence of proprietary devices used by patients. Proprietary devices possess features to support patients better thus promoting their independence in managing their chronic condition. This research developed a six-step methodology for working from government objectives to appropriate telehealth capability categories. This helped to determine objectives for which a telehealth system is suitable.
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Tarlow, Joanna Karen. "Interleukin-1 receptor antagonist gene polymorphism in chronic inflammatory diseases." Thesis, University of Sheffield, 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.296761.
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