International journal of clinical practice
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Int. J. Clin. Pract. · Sep 2007
ReviewUnder-diagnosis of common chronic diseases: prevalence and impact on human health.
The disability-adjusted life years (DALY) and its components, namely the years lived with disability and the years of life lost, are measures of the impact of disease on human health. Our impression was that several common chronic diseases responsible for many DALYs are frequently under-diagnosed. ⋯ The available evidence suggests that the prevalence of under-diagnosis of common chronic diseases is considerable. Physicians should be aware of the prevalence of under-diagnosis of chronic diseases and its impact on human health.
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Obesity, with all its consequences, is audaciously confronting medical professionals and health service providers worldwide. Diet and exercise intervention is an essential part of any weight management strategy, but may not succeed in isolation. Effective approaches for routine practice are more likely to involve affordable, efficacious and well-tolerated drug therapy than the more expensive, case selective approach of bariatric surgery. ⋯ Advancement of pharmacotherapy is expanding the battery of available drugs; the clinician is faced with an increasingly complex therapeutic decision. Which drug to use, and when, is influenced by a range of factors, discussed here. There is a large body of high quality evidence in the literature to support the presently available drugs; however, many questions remain unanswered including duration of therapy and whether longer-term goals of improved morbidity and mortality are achievable. Clinician and patient awareness of these issues will provide a more informed therapeutic decision and ultimately improve the potential for reaching the weight management targets.
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Int. J. Clin. Pract. · Sep 2007
Impact of noninvasive home ventilation on long-term survival in chronic hypercapnic COPD: a prospective observational study.
The long-term benefit from noninvasive ventilation (NIV) in chronic hypercapnic chronic obstructive pulmonary disease (COPD) remains uncertain. ⋯ In patients with severe chronic hypercapnic COPD receiving NIV at high inspiratory pressure levels and showing high adherence to this therapy, long-term survival was significantly higher than in non-ventilated patients. Patients displaying more severe disease according to known risk factors seemed to benefit most from long-term NIV.