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Zhao M, Wu Z, Huang Y, Jiang Z, Mo X, Lowis H, Zhao Y, Zhang M. Role of the physical fitness test in risk prediction of diabetes among municipal in-service personnel in Guangxi. Medicine (Baltimore) 2019; 98:e15842. [PMID: 31145330 PMCID: PMC6709133 DOI: 10.1097/md.0000000000015842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 12/02/2022] Open
Abstract
To explore the relationship between risk prediction of diabetes mellitus (DM) and different physical fitness parameters in municipal in-service personnel in Guangxi.This was a cross-sectional study conducted in China from July 2015 to December 2016. We enrolled in-service adults (20-65 year of age) from public institutions. All subjects underwent National Physical Fitness Test (NPFT) and EZSCAN screening.The 5668 subjects were 42.9±12.3 years; 2984 (52.6%) were male; 3998 (70.5%), 1579 (27.9%) and 85 (1.6%) were Han, Zhuang, and other ethnicities, respectively. The multivariable analysis showed that systolic blood pressure (odds ratio [OR] = 1.013, 95% confidence interval [CI]: 1.003-1.022, P = .01), Harvard step test index (OR = 0.958, 95% CI: 0.941-0.976, P <.001), bend-ahead in sitting (OR = 0.945, 95% CI: 0.926-0.963, P <.001), hand grip strength (OR = 0.981, 95% CI: 0.966-0.997, P = .02), vertical jump height (OR = 0.969, 95% CI: 0.944-0.996, P = .02), time of single-leg standing with eyes closed (OR = 0.981, 95% CI: 0.968-0.995, P = .007), choice reaction time (OR = 2.103, 95% CI: 1.261-3.507, P = .004), and body composition minerals (OR = 1.649, 95% CI: 1.261-1.813, P < .001) were independently associated with DM. The resulting equation for the prediction of DM had an area under the receiver operating characteristic curve of 0.808, indicating good predictive ability.NPFT and EZSCAN could help predict the risk of diabetes and give early warnings to undertake preventive actions such as changing diet and performing physical activity.
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Affiliation(s)
- Mingming Zhao
- Southern Medical University, Guangzhou
- Department of Rehabilitation Medicine, Guangdong Geriatric Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou
- Department of Cardiopulmonary Rehabilitation Center, Jiangbin Hospital, Guangxi
- Physical Fitness Surveillance and Health Management Association, Guangxi Zhuang Autonomous Region, Nanning
| | - Zhixin Wu
- Department of Intensive medicine, Foshan Hospital of Traditional Chinese Medicine, Foshan
| | - Yanqun Huang
- Department of Cardiopulmonary Rehabilitation Center, Jiangbin Hospital, Guangxi
| | - Zhirong Jiang
- Department of Cardiopulmonary Rehabilitation Center, Jiangbin Hospital, Guangxi
| | - Xiaoying Mo
- Department of Cardiopulmonary Rehabilitation Center, Jiangbin Hospital, Guangxi
| | - Heinz Lowis
- Department of Physical Therapy and Therapy Scheduling, Drei-Burgen-Klinik, Bad Kreuznach
| | - Yangyang Zhao
- Physical Fitness Surveillance and Health Management Association, Guangxi Zhuang Autonomous Region, Nanning
| | - Mingsheng Zhang
- Southern Medical University, Guangzhou
- Department of Rehabilitation Medicine, Guangdong Geriatric Institute, Guangdong Academy of Medical Sciences, Guangdong General Hospital, Guangzhou
- Department of Cardiopulmonary Rehabilitation Center, Jiangbin Hospital, Guangxi
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Hypertension and Diabetes Mellitus among Patients at Hawassa University Comprehensive Specialized Hospital, Hawassa, Southern Ethiopia. Int J Chronic Dis 2019; 2019:2509242. [PMID: 31080806 PMCID: PMC6476026 DOI: 10.1155/2019/2509242] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/03/2019] [Accepted: 03/26/2019] [Indexed: 01/03/2023] Open
Abstract
Background The burden of noncommunicable disease (NCD) in Africa is on a remarkable rise exacerbating the poor public health status affected by the existing but yet unsolved communicable disease. In Ethiopia, there is a paucity of evidence regarding prevalence and risk factors to NCD. Objective This study sought to determine the prevalence of risk factors of NCDs, prevalence of DM and HTN, and risk factors associated with diabetes mellitus (DM) and hypertension (HTN). Method This is an institution based cross-sectional study conducted on a sample of 411 clients attending a university-based comprehensive specialized hospital in Southern Ethiopia. The data was collected by using a pretested interviewer-administered questionnaire and observational checklist. Frequency, proportions, bivariate and multivariate logistic regression analysis was conducted using SPSS software version 20. Result We identified 64.2% of the clients had at least one of the risk factors to the NCDs. One-third (33.3%) had physical inactivity, whereas 20.2% had a BMI of ≥ 25%. The prevalence of DM and HTN was 12.2% and 10.5%, respectively. The multivariate analysis demonstrated that age ≥ 60 years, physical inactivity, higher BMI, and cigarette smoking were risk factors for at least one of the NCDs. Conclusion The prevalence of DM and prevalence of HTN were high. The magnitudes of risk factors to NCDs among the study population were substantial. Higher BMI, physical inactivity, low fruit and vegetable consumption, alcohol use, khat chewing, and cigarette smoking were among the prevailing risk factors identified.
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Kastner M, Hayden L, Wong G, Lai Y, Makarski J, Treister V, Chan J, Lee JH, Ivers NM, Holroyd-Leduc J, Straus SE. Underlying mechanisms of complex interventions addressing the care of older adults with multimorbidity: a realist review. BMJ Open 2019; 9:e025009. [PMID: 30948577 PMCID: PMC6500199 DOI: 10.1136/bmjopen-2018-025009] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To understand how and why effective multi-chronic disease management interventions influence health outcomes in older adults 65 years of age or older. DESIGN A realist review. DATA SOURCES Electronic databases including Medline and Embase (inception to December 2017); and the grey literature. ELIGIBILITY CRITERIA FOR SELECTING STUDIES We considered any studies (ie, experimental quasi-experimental, observational, qualitative and mixed-methods studies) as long as they provided data to explain our programme theories and effectiveness review (published elsewhere) findings. The population of interest was older adults (age ≥65 years) with two or more chronic conditions. ANALYSIS We used the Realist And MEta-narrative Evidence Syntheses: Evolving Standards (RAMESES) quality and publication criteria for our synthesis aimed at refining our programme theories such that they contained multiple context-mechanism-outcome configurations describing the ways different mechanisms fire to generate outcomes. We created a 3-step synthesis process grounded in meta-ethnography to separate units of data from articles, and to derive explanatory statements across them. RESULTS 106 articles contributed to the analysis. We refined our programme theories to explain multimorbidity management in older adults: (1) care coordination interventions with the best potential for impact are team-based strategies, disease management programmes and case management; (2) optimised disease prioritisation involves ensuring that clinician work with patients to identify what symptoms are problematic and why, and to explore options that are acceptable to both clinicians and patients and (3) optimised patient self-management is dependent on patients' capacity for selfcare and to what extent, and establishing what patients need to enable selfcare. CONCLUSIONS To optimise care, both clinical management and patient self-management need to be considered from multiple perspectives (patient, provider and system). To mitigate the complexities of multimorbidity management, patients focus on reducing symptoms and preserving quality of life while providers focus on the condition that most threaten morbidity and mortality. PROSPERO REGISTRATION NUMBER CRD42014014489.
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Affiliation(s)
- Monika Kastner
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Leigh Hayden
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Yonda Lai
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Julie Makarski
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Victoria Treister
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Joyce Chan
- Knowledge Translation and Implementation, Research and Innovation, North York General Hospital, Toronto, Ontario, Canada
| | - Julianne H Lee
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Noah M Ivers
- Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Family Medicine, Women’s College Hospital, Toronto, Ontario, Canada
| | - Jayna Holroyd-Leduc
- Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Medicine, University of Toronto, Toronto, Ontario, Canada
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Corazza GR, Formagnana P, Lenti MV. Bringing complexity into clinical practice: An internistic approach. Eur J Intern Med 2019; 61:9-14. [PMID: 30528261 DOI: 10.1016/j.ejim.2018.11.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 11/22/2018] [Accepted: 11/24/2018] [Indexed: 12/13/2022]
Abstract
Modern medicine, still largely focused on single diseases, is unprepared for managing clinical complexity (CC), which is an emerging issue. Ageing of the general population has favoured the occurrence of chronic diseases, which generate multimorbidity that has been considered for many years the main feature of CC. However, more recent studies have shown that CC is something more and different and originates from the dynamic interaction among the patient's intrinsic factors (age, gender, multimorbidity, frailty) as well as contextual factors (socioeconomic, behavioural, cultural, and environmental). The result of these interactions is non-linear and unpredictable behaviour, which is difficult to manage both in clinical practice and in the organisation of care. Up to now, the prevalent approach has consisted of breaking down and separately analysing each CC component. Consequently, only incomplete strategies to improve health outcomes have been developed, such as limited patient-centred algorithms, deprescription of therapies, and local clinical governance interventions. Medical education has a pivotal role in transmitting the knowledge of complexity, making it realistically understandable and manageable. Future research should aim at implementing our knowledge of CC, developing new tools for its quantitation, and finding new solutions to improve important health outcomes at a sustainable cost.
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Affiliation(s)
- Gino Roberto Corazza
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy.
| | - Pietro Formagnana
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Marco Vincenzo Lenti
- First Department of Internal Medicine, San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
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Sakib MN, Shooshtari S, St. John P, Menec V. The prevalence of multimorbidity and associations with lifestyle factors among middle-aged Canadians: an analysis of Canadian Longitudinal Study on Aging data. BMC Public Health 2019; 19:243. [PMID: 30819126 PMCID: PMC6394050 DOI: 10.1186/s12889-019-6567-x] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 02/20/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Multimorbidity can be defined as the presence of more than one chronic condition in an individual. Research on multimorbidity has predominantly focused on older adults and few studies have examined multimorbidity in middle-aged people. The objectives of this study were to: 1) examine the prevalence of multimorbidity among middle-aged Canadians; and 2) examine the association between lifestyle factors (smoking, alcohol intake, physical activity) and multimorbidity in this age group. METHODS In this analysis of the Canadian Longitudinal Study on Aging (CLSA) baseline data, we extracted data from 29,841 participants aged 45-64 years from a database of 51,338 people aged 45-85 years. Self-reported data on 27 chronic physical health conditions were used to derive different multimorbidity definitions. We estimated the prevalence of 3+ to 5+ chronic physical health conditions in different subgroups for descriptive purposes. Multivariable logistic regression analyses were performed to determine the association between socio-demographic and lifestyle factors, and multimorbidity using a 3+ multimorbidity case definition. RESULT We found that 39.6% (99% CI 38.4-40.7) of participants had three or more chronic conditions with a mean number of chronic condition of 2.41 (99% CI 2.37-2.46). The prevalence of multimorbidity increased with age from 29.7% in the 45-49-year-old age group to 52% in individuals aged 60-64 years. The prevalence of 4+ and 5+ chronic conditions was 24.5 and 14.2% respectively. Analyses indicated that female sex and low income were associated with higher odds of multimorbidity, whereas daily or weekly alcohol intake were associated with lower odds of multimorbidity. Exercise was not associated with multimorbidity. Results were similar when analyses were conducted separately for women and men. CONCLUSIONS Multimorbidity is not limited to older adults, but is a common phenomenon among middle-aged people. Longitudinal research is needed to better understand the temporal relationship between lifestyle factors and multimorbidity.
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Affiliation(s)
- Mohammad Nazmus Sakib
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba Canada
| | - Shahin Shooshtari
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba Canada
| | - Philip St. John
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba Canada
| | - Verena Menec
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba Canada
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Andriolo V, Dietrich S, Knüppel S, Bernigau W, Boeing H. Traditional risk factors for essential hypertension: analysis of their specific combinations in the EPIC-Potsdam cohort. Sci Rep 2019; 9:1501. [PMID: 30728434 PMCID: PMC6365562 DOI: 10.1038/s41598-019-38783-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 01/03/2019] [Indexed: 11/30/2022] Open
Abstract
Appropriate interventions might improve the prevention of essential hypertension. This requires a comprehensive view of modifiable lifestyle factors (MLFs) distribution and effect. To determine how six MLFs (general adiposity, abdominal adiposity, alcohol consumption, smoking, diet, physical inactivity) for risk of hypertension are distributed and how their combinations affect the risk, a prospective study cohort of 11,923 healthy participants from the population-based European Prospective Investigation into Cancer and Nutrition (EPIC)-Potsdam Study was used. Of these, 1,635 developed hypertension during a mean follow-up of 10.3 years. Mutually exclusive combinations, clustering and interactions of MLFs were then investigated stratifying by sex, Hazard Ratios (HRs) and Population Attributable Risks (PARs%) were calculated. General adiposity alone was sufficient to increase the risk of hypertension (HR = 1.86, PAR% 3.36), and in this cohort it played a major role in enhancing the risk of hypertension, together with smoking and physical inactivity. MLFs had a different impact and a different modulation of risk in women and men, and they showed a remarkable tendency to occur in specific patterns with higher prevalence than expected. This indication can help to promote a holistic approach through multifactorial preventive strategies addressing more than a factor at a time. For prevention of hypertension addressing adiposity together with smoking, promoting at the same time physical activity should be the first choice.
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Affiliation(s)
- Violetta Andriolo
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany.
| | - Stefan Dietrich
- Department of Molecular Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
| | - Sven Knüppel
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
| | - Wolfgang Bernigau
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition, Potsdam-Rehbrücke (DIfE), Germany
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Incidence and predictors of multimorbidity among a multiethnic population in Malaysia: a community-based longitudinal study. Aging Clin Exp Res 2019; 31:215-224. [PMID: 30062670 DOI: 10.1007/s40520-018-1007-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Multimorbidity in older adults needs to be assessed as it is a risk factor for disability, cognitive decline, and mortality. AIMS A community-based longitudinal study was performed to determine the incidence and to identify possible predictors of multimorbidity among multiethnic older adults population in Malaysia. METHODS Comprehensive interview-based questionnaires were administered among 729 participants aged 60 years and above. Data were analyzed from the baseline data of older adults participating in the Towards Useful Aging (TUA) study (2014-2016) who were not affected by multimorbidity (349 without any chronic diseases and 380 with one disease). Multimorbidity was considered present in an individual reporting two or more chronic diseases. RESULTS After 1½ years of follow-up, 18.8% of participants who were initially free of any diseases and 40.9% of those with one disease at baseline, developed multimorbidity. The incidence rates were 13.7 per 100 person-years and 34.2 per 100 person-years, respectively. Female gender, smoking, and irregular preparing of food (lifestyle) were predictors for incidence of multimorbidity, especially in those without any disease, while Body Mass Index (BMI) 22-27 kg/m2 and inadequate daily intake of iron were identified as predictors of multimorbidity among participants who already have one disease. CONCLUSIONS The incidence rates of multimorbidity among Malaysian older adults were between the ranges of 14-34 per 100 person-years at a 1½-year follow-up. Gender, smoking, BMI 22-27 kg/m2, inadequate daily intake of iron and lack of engagement in leisure or lifestyle physical activities were possible predictors in the development of multimorbidity. There is a need to formulate effective preventive management strategies to decelerate multimorbidity among older adults.
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Lee WC, Lee YT, Li LC, Ng HY, Kuo WH, Lin PT, Liao YC, Chiou TTY, Lee CT. The Number of Comorbidities Predicts Renal Outcomes in Patients with Stage 3⁻5 Chronic Kidney Disease. J Clin Med 2018; 7:E493. [PMID: 30486496 PMCID: PMC6306906 DOI: 10.3390/jcm7120493] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 11/23/2018] [Accepted: 11/26/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global health threat affecting approximately 10% of the adult population worldwide. Multimorbidity is common in CKD, but its impacts on disease outcomes are seldom investigated. METHODS This prospective cohort analysis followed patients, who were part of a multidisciplinary CKD care program, for 10 years. We aimed to determine the impact of multimorbidity on renal outcomes. RESULTS Overall, 1463 patients with stage 3⁻5 CKD were enrolled and stratified by the number of comorbidities. Mean follow-up time was 6.39 ± 1.19 years. We found that stage 3⁻5 CKD patients with at least three comorbidities at enrollment initiated dialysis earlier (hazard ratio (HR): 2.971) than patients without comorbidities. Risk factors for multimorbidity included old age, smoking, and proteinuria. CONCLUSIONS By analyzing the number of comorbidities, a simple and readily applicable method, we demonstrated an association between multimorbidity and poor renal outcomes in stage 3⁻5 CKD patients. In addition to current guideline-based approaches, our results suggest an urgent need for tailored CKD care strategies for high-risk groups.
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Affiliation(s)
- Wen-Chin Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Yueh-Ting Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Lung-Chih Li
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Hwee-Yeong Ng
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Wei-Hung Kuo
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Pei-Ting Lin
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Ying-Chun Liao
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Terry Ting-Yu Chiou
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
| | - Chien-Te Lee
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan.
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Amell A, Roso-Llorach A, Palomero L, Cuadras D, Galván-Femenía I, Serra-Musach J, Comellas F, de Cid R, Pujana MA, Violán C. Disease networks identify specific conditions and pleiotropy influencing multimorbidity in the general population. Sci Rep 2018; 8:15970. [PMID: 30374096 PMCID: PMC6206057 DOI: 10.1038/s41598-018-34361-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/15/2018] [Indexed: 01/16/2023] Open
Abstract
Multimorbidity is an emerging topic in public health policy because of its increasing prevalence and socio-economic impact. However, the age- and gender-dependent trends of disease associations at fine resolution, and the underlying genetic factors, remain incompletely understood. Here, by analyzing disease networks from electronic medical records of primary health care, we identify key conditions and shared genetic factors influencing multimorbidity. Three types of diseases are outlined: "central", which include chronic and non-chronic conditions, have higher cumulative risks of disease associations; "community roots" have lower cumulative risks, but inform on continuing clustered disease associations with age; and "seeds of bursts", which most are chronic, reveal outbreaks of disease associations leading to multimorbidity. The diseases with a major impact on multimorbidity are caused by genes that occupy central positions in the network of human disease genes. Alteration of lipid metabolism connects breast cancer, diabetic neuropathy and nutritional anemia. Evaluation of key disease associations by a genome-wide association study identifies shared genetic factors and further supports causal commonalities between nervous system diseases and nutritional anemias. This study also reveals many shared genetic signals with other diseases. Collectively, our results depict novel population-based multimorbidity patterns, identify key diseases within them, and highlight pleiotropy influencing multimorbidity.
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Affiliation(s)
- A Amell
- Department of Mathematics, Technical University of Catalonia, Castelldefels, Barcelona, 08860, Catalonia, Spain
| | - A Roso-Llorach
- Jordi Gol University Institute for Research Primary Healthcare (IDIAP Jordi Gol), Barcelona, 08007, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra, 08193, Catalonia, Spain
| | - L Palomero
- ProCURE, Catalan Institute of Oncology (ICO), Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, 08908, Catalonia, Spain
| | - D Cuadras
- Statistics Department, Foundation Sant Joan de Déu, Esplugues, 08950, Catalonia, Spain
| | - I Galván-Femenía
- GCAT-Genomes for Life, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Program for Predictive and Personalized Medicine of Cancer (IMPPC), Badalona, 08916, Catalonia, Spain
| | - J Serra-Musach
- ProCURE, Catalan Institute of Oncology (ICO), Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, 08908, Catalonia, Spain
| | - F Comellas
- Department of Mathematics, Technical University of Catalonia, Castelldefels, Barcelona, 08860, Catalonia, Spain
| | - R de Cid
- GCAT-Genomes for Life, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Program for Predictive and Personalized Medicine of Cancer (IMPPC), Badalona, 08916, Catalonia, Spain.
| | - M A Pujana
- ProCURE, Catalan Institute of Oncology (ICO), Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, 08908, Catalonia, Spain.
| | - C Violán
- Jordi Gol University Institute for Research Primary Healthcare (IDIAP Jordi Gol), Barcelona, 08007, Catalonia, Spain.
- Autonomous University of Barcelona, Bellaterra, 08193, Catalonia, Spain.
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Marques A, Peralta M, Martins J, Loureiro V, Almanzar PC, de Matos MG. Few European Adults are Living a Healthy Lifestyle. Am J Health Promot 2018; 33:391-398. [PMID: 30012013 DOI: 10.1177/0890117118787078] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aimed to measure healthy lifestyle for European adults. DESIGN Cross-sectional study. SETTINGS In 20 European countries. PARTICIPANTS A total of 34 993 (16 749 men, 18 244 women) European adults. MEASURES Data were from the 2014 European Social Survey (n = 34 993) on 4 modifiable behaviors (physical activity, fruit and vegetable consumption, not drinking alcohol to excess, and not smoking) as well as sleep quality. ANALYSIS Behaviors were combined and formed a healthy lifestyle measure. Binary logistic regression was done to determine associations of healthy lifestyle and sociodemographic characteristics. RESULTS Only 5.8% of the adults reported a healthy lifestyle. The prevalence of having a healthy lifestyle varied among European countries. The lowest rates were in Hungary (1.3%) and Czech Republic (1.9%). The highest rates were in United Kingdom (8.6%) and Finland (9.2%). Those who presented a higher likelihood of having a healthy lifestyle were middle age (odds ratio [OR] = 1.20), older people (OR = 1.34), having higher household income (OR = 1.33), being a student (OR = 1.38), and retired (OR = 1.31). Those less likely to have a healthy lifestyle were lived without a partner (OR = 0.82), unemployed (OR = 0.73), and lived in rural areas (OR = 0.86). CONCLUSIONS Few European adults were practicing 5 healthy behaviors. This should be a message for governments and be considered in the establishment of preventive public policies in the areas of health and health education.
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Affiliation(s)
- Adilson Marques
- 1 Centro Interdisciplinar do Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
- 2 Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal
- 3 Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Peralta
- 1 Centro Interdisciplinar do Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - João Martins
- 4 Laboratório de Pedagogia, Faculdade de Motricidade Humana e UIDEF, Instituto de Educação, Universidade de Lisboa, Lisboa, Portugal
| | - Vânia Loureiro
- 5 Escola Superior de Educação, Instituto Politécnico de Beja, Beja, Portugal
| | - Paola Cortés Almanzar
- 6 Centro Universitario de la Costa, Universidad de Guadalajara, Puerto Vallarta, México
| | - Margarida Gaspar de Matos
- 3 Instituto de Saúde Ambiental, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
- 7 Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
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Kanesarajah J, Waller M, Whitty JA, Mishra GD. Physical activity and body mass shape quality of life trajectories in mid-age women. Aust N Z J Public Health 2018; 42:403-409. [PMID: 29972259 DOI: 10.1111/1753-6405.12802] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 03/01/2018] [Accepted: 04/01/2018] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To determine the combined longitudinal effect of body mass index (BMI) and physical activity (PA) on health-related quality of life (HrQoL), using the SF-6D (SF-36) utility measure. METHODS Five waves of self-reported data from the 1946-51 cohort (n=5,200; data collection, 2001-2013) of the Australian Longitudinal Study on Women's Health were used. Mixed effect models were employed to address the objective. RESULTS Women with high PA experienced higher HrQoL regardless of BMI group, however, for those healthy or overweight, there was a very small decline in HrQoL over time. Women reporting no PA levels experienced the lowest baseline mean SF-6D score within each BMI group, with decreasing trajectories over the follow-up period. The rate of decline was greatest in women with obesity. Within each BMI group, there was a large, increasing gap in HrQoL between those who reported no and low PA over time. Women with obesity and high PA experienced similar HrQoL trajectories to women with normal weight or overweight with low PA levels. Overweight women with moderate PA experienced similar HrQoL to those with low PA but normal weight. CONCLUSIONS PA may mitigate the adverse effect of overweight and obesity on HrQoL at mid-life, at higher activity levels. Implications for public health: PA benefits HrQoL regardless of body mass, with larger gains for those currently not physically active. Moderate to high PA may mitigate the effect of overweight and obesity.
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Affiliation(s)
| | | | - Jennifer A Whitty
- School of Pharmacy, The University of Queensland.,Norwich Medical School, University of East Anglia, United Kingdom
| | - Gita D Mishra
- School of Public Health, The University of Queensland
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112
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Mondor L, Cohen D, Khan AI, Wodchis WP. Income inequalities in multimorbidity prevalence in Ontario, Canada: a decomposition analysis of linked survey and health administrative data. Int J Equity Health 2018. [PMID: 29941034 DOI: 10.1186/s12939‐018‐0800‐6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The burden of multimorbidity is a growing clinical and health system problem that is known to be associated with socioeconomic status, yet our understanding of the underlying determinants of inequalities in multimorbidity and longitudinal trends in measured disparities remains limited. METHODS We included all adult respondents from four cycles of the Canadian Community Health Survey (CCHS) (between 2005 to 2011/12), linked at the individual-level to health administrative data in Ontario, Canada (pooled n = 113,627). Multimorbidity was defined at each survey response as having ≥2 (of 17) high impact chronic conditions, based on claims data. Using a decomposition method of the Erreygers-corrected concentration index (CErreygers), we measured household income inequality and the contribution of the key determinants of multimorbidity (including socio-demographic, socio-economic, lifestyle and health system factors) to these disparities. Differences over time are described. We tested for statistically significant changes to measured inequality using the slope index (SII) and relative index of inequality (RII) with a 2-way interaction on pooled data. RESULTS Multimorbidity prevalence in 2011/12 was 33.5% and the CErreygers was - 0.085 (CI: -0.108 to - 0.062), indicating a greater prevalence among lower income groups. In decomposition analyses, income itself accounted more than two-thirds (69%) of this inequality. Age (21.7%), marital status (15.2%) and physical inactivity (10.9%) followed, and the contribution of these factors increased from baseline (2005 CCHS survey) with the exception of age. Other lifestyle factors, including heavy smoking and obesity, had minimal contribution to measured inequality (1.8 and 0.4% respectively). Tests for trends (SII/RII) across pooled survey data were not statistically significant (p = 0.443 and 0.405, respectively), indicating no change in inequalities in multimorbidity prevalence over the study period. CONCLUSIONS A pro-rich income gap in multimorbidity has persisted in Ontario from 2005 to 2011/12. These empirical findings suggest that to advance equality in multimorbidity prevalence, policymakers should target chronic disease prevention and control strategies focused on older adults, non-married persons and those that are physically inactive, in addition to addressing income disparities directly.
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Affiliation(s)
- Luke Mondor
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Deborah Cohen
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON, K1G Z53, Canada
| | - Anum Irfan Khan
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada.,Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada
| | - Walter P Wodchis
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. .,Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada. .,Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada. .,Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON, L5B 1B8, Canada.
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113
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Mondor L, Cohen D, Khan AI, Wodchis WP. Income inequalities in multimorbidity prevalence in Ontario, Canada: a decomposition analysis of linked survey and health administrative data. Int J Equity Health 2018; 17:90. [PMID: 29941034 PMCID: PMC6019796 DOI: 10.1186/s12939-018-0800-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 06/11/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The burden of multimorbidity is a growing clinical and health system problem that is known to be associated with socioeconomic status, yet our understanding of the underlying determinants of inequalities in multimorbidity and longitudinal trends in measured disparities remains limited. METHODS We included all adult respondents from four cycles of the Canadian Community Health Survey (CCHS) (between 2005 to 2011/12), linked at the individual-level to health administrative data in Ontario, Canada (pooled n = 113,627). Multimorbidity was defined at each survey response as having ≥2 (of 17) high impact chronic conditions, based on claims data. Using a decomposition method of the Erreygers-corrected concentration index (CErreygers), we measured household income inequality and the contribution of the key determinants of multimorbidity (including socio-demographic, socio-economic, lifestyle and health system factors) to these disparities. Differences over time are described. We tested for statistically significant changes to measured inequality using the slope index (SII) and relative index of inequality (RII) with a 2-way interaction on pooled data. RESULTS Multimorbidity prevalence in 2011/12 was 33.5% and the CErreygers was - 0.085 (CI: -0.108 to - 0.062), indicating a greater prevalence among lower income groups. In decomposition analyses, income itself accounted more than two-thirds (69%) of this inequality. Age (21.7%), marital status (15.2%) and physical inactivity (10.9%) followed, and the contribution of these factors increased from baseline (2005 CCHS survey) with the exception of age. Other lifestyle factors, including heavy smoking and obesity, had minimal contribution to measured inequality (1.8 and 0.4% respectively). Tests for trends (SII/RII) across pooled survey data were not statistically significant (p = 0.443 and 0.405, respectively), indicating no change in inequalities in multimorbidity prevalence over the study period. CONCLUSIONS A pro-rich income gap in multimorbidity has persisted in Ontario from 2005 to 2011/12. These empirical findings suggest that to advance equality in multimorbidity prevalence, policymakers should target chronic disease prevention and control strategies focused on older adults, non-married persons and those that are physically inactive, in addition to addressing income disparities directly.
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Affiliation(s)
- Luke Mondor
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Deborah Cohen
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON K1G Z53 Canada
| | - Anum Irfan Khan
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
| | - Walter P. Wodchis
- Institute for Clinical Evaluative Sciences (ICES), G1 06 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
- Health System Performance Research Network (HSPRN), 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- Institute of Health Policy, Management, and Evaluation (IHPME), University of Toronto, 155 College St 4th Floor, Toronto, ON M5T 3M6 Canada
- Institute for Better Health, Trillium Health Partners, 100 Queensway West, Mississauga, ON L5B 1B8 Canada
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114
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Singh-Manoux A, Fayosse A, Sabia S, Tabak A, Shipley M, Dugravot A, Kivimäki M. Clinical, socioeconomic, and behavioural factors at age 50 years and risk of cardiometabolic multimorbidity and mortality: A cohort study. PLoS Med 2018; 15:e1002571. [PMID: 29782486 PMCID: PMC5962054 DOI: 10.1371/journal.pmed.1002571] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 04/24/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Multimorbidity is increasingly common and is associated with adverse health outcomes, highlighting the need to broaden the single-disease framework that dominates medical research. We examined the role of midlife clinical characteristics, socioeconomic position, and behavioural factors in the development of cardiometabolic multimorbidity (at least 2 of diabetes, coronary heart disease, and stroke), along with how these factors modify risk of mortality. METHODS AND FINDINGS Data on 8,270 men and women were drawn from the Whitehall II cohort study, with mean follow-up of 23.7 years (1985 to 2017). Three sets of risk factors were assessed at age 50 years, each on a 5-point scale: clinical profile (hypertension, hypercholesterolemia, overweight/obesity, family history of cardiometabolic disease), occupational position, and behavioural factors (smoking, alcohol consumption, diet, physical activity). The outcomes examined were cardiometabolic disease (diabetes, coronary heart disease, stroke), cardiometabolic multimorbidity, and mortality. We used multi-state models to examine the role of risk factors in 5 components of the cardiometabolic disease trajectory: from healthy state to first cardiometabolic disease, from first cardiometabolic disease to cardiometabolic multimorbidity, from healthy state to death, from first cardiometabolic disease to death, and from cardiometabolic multimorbidity to death. A total of 2,501 participants developed 1 of the 3 cardiometabolic diseases, 511 developed cardiometabolic multimorbidity, and 1,406 died. When behavioural and clinical risk factors were considered individually, only smoking was associated with all five transitions. In a model containing all 3 risk factor scales, midlife clinical profile was the strongest predictor of first cardiometabolic disease (hazard ratio for the least versus most favourable profile: 3.74; 95% CI: 3.14-4.45) among disease-free participants. Among participants with 1 cardiometabolic disease, adverse midlife socioeconomic (1.54; 95% CI: 1.10-2.15) and behavioural factors (2.00; 95% CI: 1.40-2.85), but not clinical characteristics, were associated with progression to cardiometabolic multimorbidity. Only midlife behavioural factors predicted mortality among participants with cardiometabolic disease (2.12; 95% CI: 1.41-3.18) or cardiometabolic multimorbidity (3.47; 95% CI: 1.81-6.66). A limitation is that the study was not large enough to estimate transitions between each disease and subsequent outcomes and between all possible pairs of diseases. CONCLUSIONS The importance of specific midlife factors in disease progression, from disease-free state to single disease, multimorbidity, and death, varies depending on the disease stage. While clinical risk factors at age 50 determine the risk of incident cardiometabolic disease in a disease-free population, midlife socioeconomic and behavioural factors are stronger predictors of progression to multimorbidity and mortality in people with cardiometabolic disease.
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Affiliation(s)
- Archana Singh-Manoux
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
- * E-mail:
| | - Aurore Fayosse
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | - Séverine Sabia
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Adam Tabak
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Martin Shipley
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Aline Dugravot
- INSERM, U1018, Centre for Research in Epidemiology and Population Health, Hôpital Paul Brousse, Villejuif, France
| | - Mika Kivimäki
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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115
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Jacob L, Haro JM, Koyanagi A. Post-traumatic stress symptoms are associated with physical multimorbidity: Findings from the Adult Psychiatric Morbidity Survey 2007. J Affect Disord 2018. [PMID: 29522958 DOI: 10.1016/j.jad.2018.02.063] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Studies on the association between symptoms of post-traumatic stress disorder (PTSD) and physical multimorbidity (i.e., ≥2 chronic conditions) are lacking. Thus, we assessed the association between PTSD symptoms and physical multimorbidity using nationally representative, community-based data of the UK adult population. METHODS Data from the 2007 Adult Psychiatric Morbidity Survey were analyzed. PTSD symptoms were assessed using the 10-item Trauma Screening Questionnaire (TSQ). A total score of ≥6 points indicated a probable PTSD. Information was collected on 20 doctor/other health professional diagnosed physical health conditions that were present in the past 12 months. Multimorbidity was defined as ≥2 physical diseases. Multivariable logistic regression and mediation analyses were conducted to analyze the association between PTSD and physical multimorbidity, and the influence of behavioral and psychological factors in this association. RESULTS Among 7403 individuals aged ≥16 years [mean age (SD) = 46.3 (18.6) years; 51.5% females], the prevalence of PTSD increased from 2.1% in individuals with no physical conditions to 5.4% in those with ≥4 physical conditions. After adjustment for sociodemographic factors and lifetime occurrence of a traumatic event, PTSD was associated with higher odds for physical multimorbidity (Odds Ratio [OR] = 2.47; 95% Confidence Interval [CI]: 1.71-3.56). Anxiety, depression, and disordered eating explained 35%, 21%, and 8% of the PTSD-multimorbidity association, respectively. LIMITATIONS Causality or temporal associations cannot be established due to the cross-sectional nature of the study. In addition, PTSD and physical conditions were assessed using self-reports. CONCLUSIONS PTSD symptoms may be risk factors for physical multimorbidity. Anxiety and depressive symptoms might play an important role in this association. Screening for chronic physical conditions among individuals with PTSD and treating them simultaneously may lead to better clinical outcomes.
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Affiliation(s)
- Louis Jacob
- Faculty of Medicine, University of Paris 5, 15 rue de l'École de Médecine, Paris 75006, France.
| | - Josep Maria Haro
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain
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116
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Macdonald L, Olsen JR, Shortt NK, Ellaway A. Do 'environmental bads' such as alcohol, fast food, tobacco, and gambling outlets cluster and co-locate in more deprived areas in Glasgow City, Scotland? Health Place 2018; 51:224-231. [PMID: 29747132 PMCID: PMC5989655 DOI: 10.1016/j.healthplace.2018.04.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 03/12/2018] [Accepted: 04/23/2018] [Indexed: 11/30/2022]
Abstract
This study utilised an innovative application of spatial cluster analysis to examine the socio-spatial patterning of outlets selling potentially health-damaging goods/services, such as alcohol, fast food, tobacco and gambling, within Glasgow City, Scotland. For all categories of outlets combined, numbers of clusters increased linearly from the least to the most income deprived areas (i.e. one cluster within the least deprived quintile to ten within the most deprived quintile). Co-location of individual types of outlets (alcohol, fast food, tobacco and gambling) within similar geographical areas was also evident. This type of research could influence interventions to tackle the co-occurrence of unhealthy behaviours and contribute to policies tackling higher numbers of 'environmental bads' within deprived areas.
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Affiliation(s)
- Laura Macdonald
- MRC/CSO Social and Public Health Sciences, University of Glasgow, Top floor, 200 Renfield Street, Glasgow G2 3QB, United Kingdom.
| | - Jonathan R Olsen
- MRC/CSO Social and Public Health Sciences, University of Glasgow, Top floor, 200 Renfield Street, Glasgow G2 3QB, United Kingdom
| | - Niamh K Shortt
- Centre for Research on Environment, Society and Health, School of Geosciences, University of Edinburgh, Drummond Street, Edinburgh EH8 9XP, United Kingdom
| | - Anne Ellaway
- MRC/CSO Social and Public Health Sciences, University of Glasgow, Top floor, 200 Renfield Street, Glasgow G2 3QB, United Kingdom
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117
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Sibbald SL, Brown R, Schmidt L. Creating an Interprofessional Network in Lifestyle Medicine: The Journey of the Canadian Academy of Lifestyle Medicine. Am J Lifestyle Med 2018; 15:68-74. [PMID: 33447171 DOI: 10.1177/1559827618767633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Canada's population is increasing, and aging. These demographic patterns are accompanied by a growing awareness and evidence base of the benefits to society of leading a healthy and active life. The Canadian Academy of Lifestyle Medicine (CALM) was created to fill a knowledge gap in the Canadian public: how to lead a healthier and more active life. CALM aimed to address these challenges by confronting the lack of assistance modern medicine provides. As a diverse collaborative network using a lifestyle medicine philosophy, CALM's objective was to generate discussions and examine lifestyle medicine approaches to improving overall health and well-being for Canadians. CALM aimed to engage patients whose access to health care is through a physician and provide an innovative platform to support care and healthy decision making. Despite perceived widespread support, intense planning, and extensive development, CALM was slow to gain traction and realize its full potential. This article describes the experiences and lessons learned in creating CALM from the perspective of the leadership team. Although most CALM activities have ceased, virtual space and social media remain active so too does the work of the leadership team, striving to enable Canadians to develop behaviors that will improve their lifestyle, and their overall well-being.
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Affiliation(s)
- Shannon L Sibbald
- School of Health Studies, Faculty of Health Sciences (SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Family Medicine (RB, LS, SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Schulich Interfacutly Program in Public Health (SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Rebecca Brown
- School of Health Studies, Faculty of Health Sciences (SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Family Medicine (RB, LS, SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Schulich Interfacutly Program in Public Health (SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Larry Schmidt
- School of Health Studies, Faculty of Health Sciences (SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Family Medicine (RB, LS, SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Schulich Interfacutly Program in Public Health (SLS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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118
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Repo T, Tykkyläinen M, Mustonen J, Rissanen TT, Ketonen M, Toivakka M, Laatikainen T. Outcomes of Secondary Prevention among Coronary Heart Disease Patients in a High-Risk Region in Finland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040724. [PMID: 29641497 PMCID: PMC5923766 DOI: 10.3390/ijerph15040724] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/05/2018] [Accepted: 04/09/2018] [Indexed: 12/14/2022]
Abstract
Despite comprehensive national treatment guidelines, goals for secondary prevention of coronary heart disease (CHD) have not been sufficiently met everywhere in Finland. We investigated the recorded risk factor rates of CHD and their spatial differences in North Karelia Hospital District, which has a very high cardiovascular burden, in order to form a general view of the state of secondary prevention in a high-risk region. Appropriate disease codes of CHD-diagnoses and coding for percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) were used to identify from the electronic patient records the patient group eligible for secondary prevention. The cumulative incidence rate of new patients (n = 2556) during 2011–2014 varied from 1.9% to 3.5% between municipalities. The success in secondary prevention of CHD was assessed using achievement of treatment targets as defined in national guidelines. Health centres are administrated by municipalities whereupon the main reporting units were municipalities, together with composed classification of patients by age, gender and dwelling location. Health disparities between municipalities, settlement types and patient groups were found and are interpreted. Moreover, spatial high-risk and low-risk clusters of acute CHD were detected. The proportion of patients achieving the treatment targets of low-density lipoprotein cholesterol (LDL-C) varied from 21% to 38% between municipalities. Variation was also observed in the follow-up of patients; e.g., the rate of follow-up measurements of LDL-C in municipalities varied from 72% to 86%. Spatial variation in patients’ sociodemographic and neighbourhood characteristics and morbidity burden partly explain the differences in outcomes, but there are also very likely differences in the care process between municipalities which requires a study in its own right.
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Affiliation(s)
- Teppo Repo
- Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland.
| | - Markku Tykkyläinen
- Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland.
| | - Juha Mustonen
- North Karelia Hospital District, 80210 Joensuu, Finland.
| | | | - Matti Ketonen
- North Karelia Hospital District, 80210 Joensuu, Finland.
| | - Maija Toivakka
- Department of Geographical and Historical Studies, University of Eastern Finland, 80101 Joensuu, Finland.
| | - Tiina Laatikainen
- North Karelia Hospital District, 80210 Joensuu, Finland.
- National Institute for Health and Welfare (THL), 00271 Helsinki, Finland.
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, 70211 Kuopio, Finland.
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119
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Marques A, Santos DA, Peralta M, Sardinha LB, González Valeiro M. Regular physical activity eliminates the harmful association of television watching with multimorbidity. A cross-sectional study from the European Social Survey. Prev Med 2018; 109:28-33. [PMID: 29360480 DOI: 10.1016/j.ypmed.2018.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/09/2018] [Accepted: 01/16/2018] [Indexed: 01/24/2023]
Abstract
The aims of the study were to analyse the association of television viewing, physical activity (PA), and multimorbidity; and to understand if PA attenuates or eliminates the detrimental associations between television viewing and multimorbidity. This is a cross-sectional study based on data from the European Social Survey round 7, 2014. Participants were 32,931 adults (15,784 men), aged 18-114 years old, from 18 European countries. Self-reported information regarding chronic diseases (CD), PA and time watching television were collected through interview. Logistic regression analysis was conducted to analyse the association between watching television and PA with the presence of multimorbidity (≥1 CD). Men and women who watched television had increased odds of having multimorbidity. When considering PA it was observed that, independently of television viewing, compared to engaging in PA for ≤1 day/week, engaging in 2-4 days/week and in ≥5 days/week was inversely associated with multimorbidity. Increased odds of multimorbidity were observed for men spending >3 h/day watching television in the 2-3 days/week and ≤1 day/week categories of PA. For women engaged in 30 min of physical activity 2-3 days/week, spending >3 h/day watching television was associated with higher odds for multimorbidity. For adults who practiced physical activity on ≥ 5 days/week watching television was not associated with multimorbidity. Time spent watching television is associated with multimorbidity. However, physical activity participation can attenuate or even eliminate this association.
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Affiliation(s)
- Adilson Marques
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal; Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisboa, Portugal; Facultad de Ciencias del Deporte y la Educación Física, Universidad de A Coruña, A Coruña, Spain.
| | - Diana A Santos
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel Peralta
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Luís B Sardinha
- Centro Interdisciplinar de Estudo da Performance Humana, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Miguel González Valeiro
- Facultad de Ciencias del Deporte y la Educación Física, Universidad de A Coruña, A Coruña, Spain
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120
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Woldesemayat EM, Kassa A, Gari T, Dangisso MH. Chronic diseases multi-morbidity among adult patients at Hawassa University Comprehensive Specialized Hospital. BMC Public Health 2018; 18:352. [PMID: 29540155 PMCID: PMC5853145 DOI: 10.1186/s12889-018-5264-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/06/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Non-communicable chronic diseases (NCCDs) multi-morbidity is becoming one of the public health problems in Ethiopia. The objective of this study was to describe the prevalence of NCCDs and multi-morbidity among adult patients at Hawassa University Comprehensive Specialized Hospital (HUCSH). METHODS Between January and February 2016, a cross-sectional study was carried out among patients aged ⩾ 18 years attending the outpatient department of the hospital. Trained nurses interviewed patients and reviewed medical records. Multi-morbidity was defined as the coexistence of two or more NCCDs in an individual. RESULTS Two hundred twenty seven (55.2%) of the respondents had at least one of the NCCDs and 73 (17.8%) of them had multi-morbidity. The commonest diseases that affected the patients were diseases of the musculoskeletal system. The risk of having NCCDs was highest among patients aged above 44 years (Adjusted odds ratio (AOR) = 2.7, 95% CI 1.5-4.8). Non educated patients (AOR = 1.7, 95% CI 1.0-2.7) and patients with high household income (AOR = 1.6, 95% CI 1.0-2.5) and patients with a body mass index (BMI) of at least 25 (AOR = 2.0, 95% CI 1.1-3.7) had higher odds of having NCCDs. Highest odds of multi-morbidity was observed among patients aged above 44 years (AOR = 4.4, 95% CI 2.2-8.8). CONCLUSION The prevalence of NCCDs and multi-morbidity among the study population was high. Identifying and addressing modifiable risk factors; screening, treatment and follow-up of patients with NCCDs could help in reducing the burden of NCCDs multi-morbidity and its effect.
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Affiliation(s)
- Endrias Markos Woldesemayat
- Faculty of Medicine, Centre for International Health, University of Bergen, Bergen, Norway
- Hawassa University, School of Public Health, P.O.Box 1352, Hawassa, Ethiopia
| | | | - Taye Gari
- Faculty of Medicine, Centre for International Health, University of Bergen, Bergen, Norway
- Hawassa University, School of Public Health, P.O.Box 1352, Hawassa, Ethiopia
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Patterns and temporal trends of comorbidity among adult patients with incident cardiovascular disease in the UK between 2000 and 2014: A population-based cohort study. PLoS Med 2018; 15:e1002513. [PMID: 29509757 PMCID: PMC5839540 DOI: 10.1371/journal.pmed.1002513] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 01/23/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Multimorbidity in people with cardiovascular disease (CVD) is common, but large-scale contemporary reports of patterns and trends in patients with incident CVD are limited. We investigated the burden of comorbidities in patients with incident CVD, how it changed between 2000 and 2014, and how it varied by age, sex, and socioeconomic status (SES). METHODS AND FINDINGS We used the UK Clinical Practice Research Datalink with linkage to Hospital Episode Statistics, a population-based dataset from 674 UK general practices covering approximately 7% of the current UK population. We estimated crude and age/sex-standardised (to the 2013 European Standard Population) prevalence and 95% confidence intervals for 56 major comorbidities in individuals with incident non-fatal CVD. We further assessed temporal trends and patterns by age, sex, and SES groups, between 2000 and 2014. Among a total of 4,198,039 people aged 16 to 113 years, 229,205 incident cases of non-fatal CVD, defined as first diagnosis of ischaemic heart disease, stroke, or transient ischaemic attack, were identified. Although the age/sex-standardised incidence of CVD decreased by 34% between 2000 to 2014, the proportion of CVD patients with higher numbers of comorbidities increased. The prevalence of having 5 or more comorbidities increased 4-fold, rising from 6.3% (95% CI 5.6%-17.0%) in 2000 to 24.3% (22.1%-34.8%) in 2014 in age/sex-standardised models. The most common comorbidities in age/sex-standardised models were hypertension (28.9% [95% CI 27.7%-31.4%]), depression (23.0% [21.3%-26.0%]), arthritis (20.9% [19.5%-23.5%]), asthma (17.7% [15.8%-20.8%]), and anxiety (15.0% [13.7%-17.6%]). Cardiometabolic conditions and arthritis were highly prevalent among patients aged over 40 years, and mental illnesses were highly prevalent in patients aged 30-59 years. The age-standardised prevalence of having 5 or more comorbidities was 19.1% (95% CI 17.2%-22.7%) in women and 12.5% (12.0%-13.9%) in men, and women had twice the age-standardised prevalence of depression (31.1% [28.3%-35.5%] versus 15.0% [14.3%-16.5%]) and anxiety (19.6% [17.6%-23.3%] versus 10.4% [9.8%-11.8%]). The prevalence of depression was 46% higher in the most deprived fifth of SES compared with the least deprived fifth (age/sex-standardised prevalence of 38.4% [31.2%-62.0%] versus 26.3% [23.1%-34.5%], respectively). This is a descriptive study of routine electronic health records in the UK, which might underestimate the true prevalence of diseases. CONCLUSIONS The burden of multimorbidity and comorbidity in patients with incident non-fatal CVD increased between 2000 and 2014. On average, older patients, women, and socioeconomically deprived groups had higher numbers of comorbidities, but the type of comorbidities varied by age and sex. Cardiometabolic conditions contributed substantially to the burden, but 4 out of the 10 top comorbidities were non-cardiometabolic. The current single-disease paradigm in CVD management needs to broaden and incorporate the large and increasing burden of comorbidities.
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Jantsch AG, Alves RFS, Faerstein E. Educational inequality in Rio de Janeiro and its impact on multimorbidity: evidence from the Pró-Saúde study. A cross-sectional analysis. SAO PAULO MED J 2018; 136:51-58. [PMID: 29513787 PMCID: PMC9924166 DOI: 10.1590/1516-3180.2017.0209100917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/10/2017] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Information about multimorbidity is scarce in developing countries. This study aimed to estimate the association of educational attainment with occurrences of multimorbidity in a population of public employees on university campuses in Rio de Janeiro. DESIGN AND SETTING We conducted cross-sectional analyses on baseline data (1999-2001) from 3,253 participants in the Pró-Saúde study, conducted in Brazil. METHODS The prevalence of multimorbidity, defined as a self-reported history of medical diagnoses of two or more chronic conditions, was estimated according to sex, age, smoking, obesity and educational level. The association between education and multimorbidity was estimated using odds ratios (OR) and the relative and slope indices of inequality, in order to quantify the degree of educational inequality among individuals with multimorbidity in this population. RESULTS Greater age, female sex, smoking and obesity had direct associations with multimorbidity; and tobacco exposure and obesity also showed direct relationships with poorer educational level. There was a monotonic inverse linear trend between educational level and the presence of multimorbidity among women, with twice the odds (OR 2.47; 95% confidence interval, CI: 1.42-4.40) between extremities of schooling categories. There was excess multimorbidity of 22% at the lowest extremity of schooling, thus showing that women with worse educational status were more affected by the outcome. No trend and no excess multimorbidity was seen among men. CONCLUSIONS Educational inequality is an important determinant for development of multimorbidity. Men and women experience its effect differently. Researchers need to consider that sex may be an effect modifier in multimorbidity studies.
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Affiliation(s)
- Adelson Guaraci Jantsch
- MD, MSc. Doctoral Student, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), and Coordinator, Residency Program in Family and Community Medicine, Secretaria Municipal de Saúde do Rio de Janeiro, Rio de Janeiro (RJ), Brazil.
| | - Ronaldo Fernandes Santos Alves
- MSc. Doctoral Student, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro (RJ), Brazil.
| | - Eduardo Faerstein
- MSc, PhD. Associate Professor, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro (RJ), Brazil.
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Gass JC, Morris DH, Winters J, VanderVeen JW, Chermack S. Characteristics and clinical treatment of tobacco smokers enrolled in a VA substance use disorders clinic. J Subst Abuse Treat 2018; 84:1-8. [PMID: 29195588 DOI: 10.1016/j.jsat.2017.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 10/12/2017] [Accepted: 10/13/2017] [Indexed: 11/29/2022]
Abstract
Individuals with a substance use disorder (SUD) diagnosis are more than twice as likely to smoke cigarettes as the general population. Emerging research has suggested that treating a substance use disorder simultaneously with tobacco use leads to a higher rate of treatment success for both substances. Despite this, substance use treatment protocols tend not to focus on tobacco use; in fact, traditional substance use treatments often discourage patients from attempting to quit smoking. One rationale is that patients may not be motivated to quit smoking. In the current study, data from veterans enrolled in outpatient treatment for a SUD were examined to assess for general characteristics of smokers as compared to non-smokers as well as to examine motivation to quit smoking. Baseline (i.e., pre-treatment) data from 277 Veterans were used. Charts of smokers in the SUD clinic (SUDC) were reviewed to assess how smoking is handled by SUDC providers, and if smokers attempt cessation. Of 277, 163 (59%) SUDC patients reported that they currently smoke cigarettes (M=16.3 cigarettes per day, SD=11.1). Smokers in the clinic reported greater general impairment than nonsmokers on the Short Index of Problems, F(1248)=8.9, p=0.003, as well as greater specific impairment: Physical Problems, F(1258)=13.5, p=0.000; Interpersonal Problems, F(1262)=5.6, p=0.019; Intrapersonal Problems, F(1260)=6.5, p=0.011, and Social Responsibility, F(1262)=14.7, p=0.000. Smokers in the sample were marginally more anxious than their non-smoking counterparts as measured by the GAD-7, F(1254)=4.6, p=0.053, though they were not significantly more depressed (p=0.19). On a 1-10 scale, smokers reported moderate levels of importance (M=5.4, SD=3.1), readiness (M=5.6, SD=3.2), and confidence (M=5.0, SD=3.0) regarding quitting smoking. Review of smokers' medical records reveal that while SUDC providers assess tobacco use at intake (90%) and offer treatment (86.5%), a substantially small portion of smokers attempt cessation (41.1%) while enrolled in SUDC. Moreover, no patients were enrolled in smoking-specific behavioral interventions while in SUDC, though 78 patients did obtain nicotine replacement or another smoking cessation medication (41% were prescribed by a SUDC provider). Contrary to the belief that treatment-seeking substance users are not motivated to quit smoking, these preliminary analyses demonstrate that Veterans were at least contemplating quitting smoking while they were enrolled in substance use treatment. Further, there is evidence that cigarette smokers have greater impairment caused by substance use, suggesting that this subgroup is of particular high need. Specific treatment recommendations are discussed, including how behavioral health providers in SUD clinics may be better able to capitalize on patients' moderate motivation to quit at intake.
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Affiliation(s)
- Julie C Gass
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States.
| | - David H Morris
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Jamie Winters
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Joseph W VanderVeen
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
| | - Stephen Chermack
- VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105, United States; Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, United States
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Keats MR, Cui Y, DeClercq V, Dummer TJB, Forbes C, Grandy SA, Hicks J, Sweeney E, Yu ZM, Parker L. Multimorbidity in Atlantic Canada and association with low levels of physical activity. Prev Med 2017; 105:326-331. [PMID: 28987335 DOI: 10.1016/j.ypmed.2017.10.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/12/2017] [Accepted: 10/04/2017] [Indexed: 11/27/2022]
Abstract
Owing to an aging population and medical advances, the anticipated growth and prevalence of multimorbidity has been recognized as a significant challenge and priority in health care settings. Although physical activity has been shown to play a vital role in the primary and secondary prevention of chronic disease, much less is known about the relationship between physical activity and multimorbidity. The objective of the present study was to examine the relationship between physical activity levels and multimorbidity in male and female adults after adjusting for key demographic, geographical, and lifestyle factors. The study drew data from a prospective cohort in Atlantic Canada (2009-2015). The sample included 18,709 participants between the ages of 35-69. Eighteen chronic diseases were identified. Physical activity levels were estimated based on the long form of the International Physical Activity Questionnaire. Using logistic regression analysis, we found that multimorbid individuals were significantly more likely to be physically inactive (OR=1.26; 95% CI 1.10, 1.44) after adjusting for key sociodemographic and lifestyle characteristics. Additional stratified analyses suggest that the magnitude of the effect between multimorbidity and physical activity was stronger for men (OR=1.41; 95% CI 1.12, 1.79) than women (OR=1.18; CI 1.00, 1.39) and those living in rural (OR=1.43; CI 1.10, 1.85) versus urban (OR=1.20; CI 1.02, 141) areas. Given the generally low levels of physical activity across populations and a growing prevalence of multimorbidity, there is a need for a prospective study to explore causal associations between physical activity, multimorbidity, and health outcomes.
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Affiliation(s)
- Melanie R Keats
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada.
| | - Yunsong Cui
- Atlantic PATH, Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Vanessa DeClercq
- Atlantic PATH, Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Trevor J B Dummer
- Centre of Excellence in Cancer Prevention, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Cynthia Forbes
- Atlantic PATH, Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Scott A Grandy
- School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada
| | - Jason Hicks
- Atlantic PATH, Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Ellen Sweeney
- Atlantic PATH, Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Zhijie Michael Yu
- Atlantic PATH, Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
| | - Louise Parker
- Atlantic PATH, Population Cancer Research Program, Dalhousie University, Halifax, NS, Canada
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Fortin M, Almirall J, Nicholson K. Development of a research tool to document self-reported chronic conditions in primary care. JOURNAL OF COMORBIDITY 2017; 7:117-123. [PMID: 29354597 PMCID: PMC5772378 DOI: 10.15256/joc.2017.7.122] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/31/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Researchers interested in multimorbidity often find themselves in the dilemma of identifying or creating an operational definition in order to generate data. Our team was invited to propose a tool for documenting the presence of chronic conditions in participants recruited for different research studies. OBJECTIVE To describe the development of such a tool. DESIGN A scoping review in which we identified relevant studies, selected studies, charted the data, and collated and summarized the results. The criteria considered for selecting chronic conditions were: (1) their relevance to primary care services; (2) the impact on affected patients; (3) their prevalence among the primary care users; and (4) how often the conditions were present among the lists retrieved from the scoping review. RESULTS Taking into account the predefined criteria, we developed a list of 20 chronic conditions/categories of conditions that could be self-reported. A questionnaire was built using simple instructions and a table including the list of chronic conditions/categories of conditions. CONCLUSIONS We developed a questionnaire to document 20 self-reported chronic conditions/categories of conditions intended to be used for research purposes in primary care. Guided by previous literature, the purpose of this questionnaire is to evaluate the self-reported burden of multimorbidity by participants and to encourage comparability among research studies using the same measurement.
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Affiliation(s)
- Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, and Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - José Almirall
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, and Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-St-Jean, Quebec, Canada
| | - Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, Ontario, Canada
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The contribution of musculoskeletal disorders in multimorbidity: Implications for practice and policy. Best Pract Res Clin Rheumatol 2017; 31:129-144. [PMID: 29224692 DOI: 10.1016/j.berh.2017.09.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/07/2017] [Indexed: 12/11/2022]
Abstract
People frequently live for many years with multiple chronic conditions (multimorbidity) that impair health outcomes and are expensive to manage. Multimorbidity has been shown to reduce quality of life and increase mortality. People with multimorbidity also rely more heavily on health and care services and have poorer work outcomes. Musculoskeletal disorders (MSDs) are ubiquitous in multimorbidity because of their high prevalence, shared risk factors, and shared pathogenic processes amongst other long-term conditions. Additionally, these conditions significantly contribute to the total impact of multimorbidity, having been shown to reduce quality of life, increase work disability, and increase treatment burden and healthcare costs. For people living with multimorbidity, MSDs could impair the ability to cope and maintain health and independence, leading to precipitous physical and social decline. Recognition, by health professionals, policymakers, non-profit organisations, and research funders, of the impact of musculoskeletal health in multimorbidity is essential when planning support for people living with multimorbidity.
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Dhalwani NN, Zaccardi F, O'Donovan G, Carter P, Hamer M, Yates T, Davies M, Khunti K. Association Between Lifestyle Factors and the Incidence of Multimorbidity in an Older English Population. J Gerontol A Biol Sci Med Sci 2017; 72:528-534. [PMID: 27470302 DOI: 10.1093/gerona/glw146] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 07/09/2016] [Indexed: 02/05/2023] Open
Abstract
Background Evidence on the role of lifestyle factors in relation to multimorbidity, especially in elderly populations, is scarce. We assessed the association between five lifestyle factors and incident multimorbidity (presence of ≥2 chronic conditions) in an English cohort aged ≥50 years. Methods We used data from waves 4, 5, and 6 of the English Longitudinal Study of Ageing. Data on smoking, alcohol consumption, physical activity, fruit and vegetable consumption, and body mass index were extracted and combined to generate a sum of unhealthy lifestyle factors for each individual. We examined whether these lifestyle factors individually or in combination predicted multimorbidity during the subsequent wave. We used marginal structural Cox proportional hazard models, adjusted for both time-constant and time-varying factors. Results A total of 5,476 participants contributed 232,749 person-months of follow-up during which 1,156 cases of incident multimorbidity were recorded. Physical inactivity increased the risk of multimorbidity by 33% (adjusted hazard ratio [aHR]: 1.33, 95% confidence interval [CI]: 1.03-1.73). The risk was about two to three times higher when inactivity was combined with obesity (aHR: 2.87, 95% CI: 1.55-5.31) or smoking (aHR: 2.35, 95% CI: 1.36-4.08) and about four times when combined with both (aHR: 3.98, 95% CI: 1.02-17.00). Any combination of 2, 3, and 4 or more unhealthy lifestyle factors significantly increased the multimorbidity hazard, compared with none, from 42% to 116%. Conclusion This study provides evidence of a temporal association between combinations of different unhealthy lifestyle factors with multimorbidity. Population level interventions should include reinforcing positive lifestyle changes in the population to reduce the risk of developing multimorbidity.
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Affiliation(s)
| | | | | | - Patrice Carter
- Department of Public Health and Primary Care, University of Cambridge, UK
| | - Mark Hamer
- National Centre for Sport and Exercise Medicine, Loughborough University, UK
| | - Thomas Yates
- Diabetes Research Centre, University of Leicester, UK
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Lund Jensen N, Pedersen HS, Vestergaard M, Mercer SW, Glümer C, Prior A. The impact of socioeconomic status and multimorbidity on mortality: a population-based cohort study. Clin Epidemiol 2017; 9:279-289. [PMID: 28546772 PMCID: PMC5436773 DOI: 10.2147/clep.s129415] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Multimorbidity (MM) is more prevalent among people of lower socioeconomic status (SES), and both MM and SES are associated with higher mortality rates. However, little is known about the relationship between SES, MM, and mortality. This study investigates the association between educational level and mortality, and to what extent MM modifies this association. METHODS We followed 239,547 individuals invited to participate in the Danish National Health Survey 2010 (mean follow-up time: 3.8 years). MM was assessed by using information on drug prescriptions and diagnoses for 39 long-term conditions. Data on educational level were provided by Statistics Denmark. Date of death was obtained from the Civil Registration System. Information on lifestyle factors and quality of life was collected from the survey. The main outcomes were overall and premature mortality (death before the age of 75). RESULTS Of a total of 12,480 deaths, 6,607 (9.5%) were of people with low educational level (LEL) and 1,272 (2.3%) were of people with high educational level (HEL). The mortality rate was higher among people with LEL compared with HEL in groups of people with 0-1 disease (hazard ratio: 2.26, 95% confidence interval: 2.00-2.55) and ≥4 diseases (hazard ratio: 1.14, 95% confidence interval: 1.04-1.24), respectively (adjusted model). The absolute number of deaths was six times higher among people with LEL than those with HEL in those with ≥4 diseases. The 1-year cumulative mortality proportions for overall death in those with ≥4 diseases was 5.59% for people with HEL versus 7.27% for people with LEL, and 1-year cumulative mortality proportions for premature death was 2.93% for people with HEL versus 4.04% for people with LEL. Adjusting for potential mediating factors such as lifestyle and quality of life eliminated the statistical association between educational level and mortality in people with MM. CONCLUSION Our study suggests that LEL is associated with higher overall and premature mortality and that the association is affected by MM, lifestyle factors, and quality of life.
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Affiliation(s)
- Nikoline Lund Jensen
- Research Unit for General Practice.,Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Mogens Vestergaard
- Research Unit for General Practice.,Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Stewart W Mercer
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
| | - Charlotte Glümer
- Research Centre for Prevention and Health, The Capital Region of Denmark, Glostrup, Denmark
| | - Anders Prior
- Research Unit for General Practice.,Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Wang S, Ungvari GS, Forester BP, Chiu HFK, Wu Y, Kou C, Fu Y, Qi Y, Liu Y, Tao Y, Yu Y, Li B, Xiang YT. Gender differences in general mental health, smoking, drinking and chronic diseases in older adults in Jilin province, China. Psychiatry Res 2017; 251:58-62. [PMID: 28189080 DOI: 10.1016/j.psychres.2017.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 11/28/2016] [Accepted: 02/03/2017] [Indexed: 11/17/2022]
Abstract
There is little information on gender differences in general mental health, smoking, drinking and chronic diseases in Chinese elderly. We examined the gender differences in general mental health, smoking, drinking and a number of chronic diseases in a large Chinese old population. Multistage stratified cluster sampling was used in this cross-sectional study. A total of 4115 people (2198 women; 1917 men) aged between 60 and 79 years were included and their general mental health, smoking, drinking and chronic diseases were recorded with standardized assessment tools. Multivariate analyses revealed that women were less likely to be current smokers and frequent drinkers, but had higher prevalence of poor mental health compared with their male counterparts. In addition, the prevalence rate of chronic diseases and multi-morbidities were higher in women than that in men (both p values <0.05). Health professionals and policy makers need to pay special attention to the common chronic diseases and poor mental health in older women and higher prevalence of smoking and drinking in men.
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Affiliation(s)
- Shibin Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China; Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Gabor S Ungvari
- University of Notre Dame Australia / Marian Centre, Perth, Australia; School of Psychiatry & Clinical Neurosciences, University of Western Australia, Perth, Australia
| | - Brent P Forester
- Division of Geriatric Psychiatry, McLean Hospital, Belmont, MA & Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yanhua Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yingli Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yue Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yuchun Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Yaqin Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China.
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Staimez LR, Wei MY, Kim M, Narayan KMV, Saydah SH. Multimorbidity of four cardiometabolic and chronic pulmonary disease groups: prevalence and attributable fraction in US adults, 2007-2012. JOURNAL OF COMORBIDITY 2017; 7:22-32. [PMID: 29090186 PMCID: PMC5556435 DOI: 10.15256/joc.2017.7.89] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 02/01/2017] [Indexed: 01/02/2023]
Abstract
BACKGROUND Cardiometabolic and chronic pulmonary diseases may be associated with modifiable risk factors that can be targeted to prevent multimorbidity. OBJECTIVES (i) Estimate the prevalence of multimorbidity across four cardiometabolic and chronic pulmonary disease groups; (ii) compare the prevalence of multimorbidity to that of one disease and no disease; and (iii) quantify population attributable fractions (PAFs) for modifiable risk factors of multimorbidity. DESIGN Data from adults aged 18-79 years who participated in the US National Health and Nutrition Examination Survey 2007-2012 were examined. Multimorbidity was defined as ≥2 co-occurring diseases across four common cardiometabolic and chronic pulmonary disease groups. Multivariate-adjusted PAFs for poverty, obesity, smoking, hypertension, and low high-density lipoprotein (HDL) cholesterol were estimated. RESULTS Among 16,676 adults, the age-standardized prevalence of multimorbidity was 9.3%. The occurrence of multimorbidity was greater with age, from 1.5% to 5.9%, 15.0% and 34.8% for adults aged 18-39, 40-54, 55-64 and 65-79 years, respectively. Multimorbidity was greatest among the poorest versus non-poorest adults and among blacks versus other races/ethnicities. Multimorbidity was also greater in adults with obesity, hypertension, and low HDL cholesterol. Risk factors with greatest PAFs were hypertension (38.8%; 95% confidence interval [CI] 29.4-47.4) and obesity (19.3%; 95% CI 10.2-28.2). CONCLUSIONS In the USA, 9.3% of adults have multimorbidity across four chronic disease groups, with a disproportionate burden among older, black, and poor adults. Our results suggest that targeting two intermediate modifiable risk factors, hypertension and obesity, might help to reduce the prevalence of multimorbidity in US adults.
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Affiliation(s)
- Lisa R. Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Equal contribution
| | - Melissa Y. Wei
- Division of General Medicine and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
- Equal contribution
| | - Min Kim
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Sharon H. Saydah
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Hyattsville, MD, USA
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131
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Kirkpatrick SI, Vanderlee L, Raffoul A, Stapleton J, Csizmadi I, Boucher BA, Massarelli I, Rondeau I, Robson PJ. Self-Report Dietary Assessment Tools Used in Canadian Research: A Scoping Review. Adv Nutr 2017; 8:276-289. [PMID: 28298272 PMCID: PMC5347105 DOI: 10.3945/an.116.014027] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Choosing the most appropriate dietary assessment tool for a study can be a challenge. Through a scoping review, we characterized self-report tools used to assess diet in Canada to identify patterns in tool use and to inform strategies to strengthen nutrition research. The research databases Medline, PubMed, PsycINFO, and CINAHL were used to identify Canadian studies published from 2009 to 2014 that included a self-report assessment of dietary intake. The search elicited 2358 records that were screened to identify those that reported on self-report dietary intake among nonclinical, non-Aboriginal adult populations. A pool of 189 articles (reflecting 92 studies) was examined in-depth to assess the dietary assessment tools used. Food-frequency questionnaires (FFQs) and screeners were used in 64% of studies, whereas food records and 24-h recalls were used in 18% and 14% of studies, respectively. Three studies (3%) used a single question to assess diet, and for 3 studies the tool used was not clear. A variety of distinct FFQs and screeners, including those developed and/or adapted for use in Canada and those developed elsewhere, were used. Some tools were reported to have been evaluated previously in terms of validity or reliability, but details of psychometric testing were often lacking. Energy and fat were the most commonly studied, reported by 42% and 39% of studies, respectively. For ∼20% of studies, dietary data were used to assess dietary quality or patterns, whereas close to half assessed ≤5 dietary components. A variety of dietary assessment tools are used in Canadian research. Strategies to improve the application of current evidence on best practices in dietary assessment have the potential to support a stronger and more cohesive literature on diet and health. Such strategies could benefit from national and global collaboration.
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Affiliation(s)
- Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada;
| | - Lana Vanderlee
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;
| | - Amanda Raffoul
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Ilona Csizmadi
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Beatrice A Boucher
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada;,Prevention and Cancer Control, Cancer Care Ontario, Toronto, Ontario, Canada
| | | | | | - Paula J Robson
- Cancer Measurement, Outcomes, Research, and Evaluation (C-MORE), Alberta Health Services Cancer Control, Edmonton, Alberta, Canada
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Olivares DEV, Chambi FRV, Chañi EMM, Craig WJ, Pacheco SOS, Pacheco FJ. Risk Factors for Chronic Diseases and Multimorbidity in a Primary Care Context of Central Argentina: A Web-Based Interactive and Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030251. [PMID: 28257087 PMCID: PMC5369087 DOI: 10.3390/ijerph14030251] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 02/22/2017] [Accepted: 02/23/2017] [Indexed: 02/08/2023]
Abstract
Global health agencies estimate an increase of chronic diseases in South America. Nevertheless, few studies have investigated chronic diseases and their risk factors in the perspective of multimorbidity. This research aimed to identify these aspects in a primary health care setting of central Argentina. The Pan America version of the STEP wise approach surveillance (STEPS) instrument of the World Health Organization was applied to 1044 participants, 365 men and 679 women, with a mean age of 43 years. High prevalence of overweight (33.5%), obesity (35.2%), central obesity (54%), dyslipidemia (43.5%), metabolic syndrome (21.1%), low intake of fruit and vegetables (91.8%), low levels of physical activity (71.5%), risky alcohol consumption (28%), and smoking (22.5%) were detected. Hypertension and diabetes were the most prevalent chronic conditions and the total prevalence of multimorbidity was 33.1%, with 2, 3, 4, 5 and 6 chronic conditions found in 19.9%, 9.1%, 2.6%, 1.1% and 0.4% of the population, respectively. Multimorbidity affected 6.4% of the young, 31.7% of the adults, and 60.6% of the elderly, and was more prevalent among women, and in participants with lower levels of education. Having multimorbidity was significantly associated with obesity, central obesity, and higher concentrations of total blood cholesterol, low-density lipoprotein cholesterol, triglycerides, and glucose. A website was made available to the participants in order to share the experimental results and health-promoting information.
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Affiliation(s)
- David E V Olivares
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Frank R V Chambi
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Evelyn M M Chañi
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Winston J Craig
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Department of Public Health, Nutrition and Wellness, School of Health Professions, Andrews University, Berrien Springs, MI 49104, USA.
| | - Sandaly O S Pacheco
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
| | - Fabio J Pacheco
- Center for Health Sciences Research, School of Medicine & Health Sciences, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
- Institute for Food Science and Nutrition, Universidad Adventista del Plata, Libertador San Martín, 25 de Mayo 99, Entre Ríos 3103, Argentina.
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Canizares M, Hogg-Johnson S, Gignac MAM, Glazier RH, Badley EM. Increasing Trajectories of Multimorbidity Over Time: Birth Cohort Differences and the Role of Changes in Obesity and Income. J Gerontol B Psychol Sci Soc Sci 2017; 73:1303-1314. [DOI: 10.1093/geronb/gbx004] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/05/2017] [Indexed: 12/21/2022] Open
Affiliation(s)
- Mayilee Canizares
- Institute of Medical Science Faculty of Medicine, University of Toronto Medical Sciences Building, Canada
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto, Canada
| | - Sheilah Hogg-Johnson
- Dalla Lana School of Public Health, University of Toronto, Canada
- Institute for Work and Health, Toronto, Canada
| | - Monique A M Gignac
- Dalla Lana School of Public Health, University of Toronto, Canada
- Institute for Work and Health, Toronto, Canada
| | - Richard H Glazier
- Primary Care & Population Health Research Program, Institute for Clinical Evaluative Science, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Canada
| | - Elizabeth M Badley
- Arthritis Community Research and Evaluation Unit, Krembil Research Institute, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Canada
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Rzewuska M, de Azevedo-Marques JM, Coxon D, Zanetti ML, Zanetti ACG, Franco LJ, Santos JLF. Epidemiology of multimorbidity within the Brazilian adult general population: Evidence from the 2013 National Health Survey (PNS 2013). PLoS One 2017; 12:e0171813. [PMID: 28182778 PMCID: PMC5300133 DOI: 10.1371/journal.pone.0171813] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/26/2017] [Indexed: 01/06/2023] Open
Abstract
Middle-income countries are facing a growing challenge of adequate health care provision for people with multimorbidity. The objectives of this study were to explore the distribution of multimorbidity and to identify patterns of multimorbidity in the Brazilian general adult population. Data from 60202 adults, aged ≥18 years that completed the individual questionnaire of the National Health Survey 2013 (Portuguese: "Pesquisa Nacional de Saúde"-"PNS") was used. We defined multimorbidity as the presence of two or more chronic conditions, including self-reported diagnoses and responses to the 9-item Patient Health Questionnaire for depression. Multivariate Poisson regression analyses were used to explore relationship between multimorbidity and demographic factors. Exploratory tetrachoric factor analysis was performed to identify multimorbidity patterns. 24.2% (95% CI 23.5-24.9) of the study population were multimorbid, with prevalence rate ratios being significantly higher in women, older people and those with lowest educational level. Multimorbidity occurred earlier in women than in men, with half of the women and men aged 55-59 years and 65-69 years, respectively, were multimorbid. The absolute number of people with multimorbidity was approximately 2.5-fold higher in people younger than 65 years than older counterparts (9920 vs 3945). Prevalence rate ratios of any mental health disorder significantly increased with the number of physical conditions. 46.7% of the persons were assigned to at least one of three identified patterns of multimorbidity, including: "cardio-metabolic", "musculoskeletal-mental" and "respiratory" disorders. Multimorbidity in Brazil is as common as in more affluent countries. Women in Brazil develop diseases at younger ages than men. Our findings can inform a national action plan to prevent multimorbidity, reduce its burden and align health-care services more closely with patients' needs.
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Affiliation(s)
- Magdalena Rzewuska
- Community Health Postgraduate Program, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | | | - Domenica Coxon
- Centre for Population Health Sciences, University of Edinburgh, Lothian, Scotland
| | - Maria Lúcia Zanetti
- WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ana Carolina Guidorizzi Zanetti
- WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto College of Nursing, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Laercio Joel Franco
- Department of Social Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Jair Lício Ferreira Santos
- Department of Social Medicine, Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
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135
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Slattery BW, O'Connor L, Haugh S, Dwyer CP, O'Higgins S, Caes L, Egan J, McGuire BE. Prevalence, impact and cost of multimorbidity in a cohort of people with chronic pain in Ireland: a study protocol. BMJ Open 2017; 7:e012131. [PMID: 28100560 PMCID: PMC5253562 DOI: 10.1136/bmjopen-2016-012131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Multimorbidity (MM) refers to the coexistence of two or more chronic conditions within one person, where no one condition is considered primary. As populations age and healthcare provision improves, MM is becoming increasingly common and poses a challenge to the single morbidity approach to illness management, usually adopted by healthcare systems. Indeed, recent research has shown that 66.2% of the people in primary care in Ireland are living with MM. Healthcare usage and cost is significantly associated with MM, and additional chronic conditions lead to exponential increases in service usage and financial costs, and decreases in physical and mental well-being. Certain conditions, for example, chronic pain, are highly correlated with MM. This study aims to assess the extent, profile, impact and cost of MM among Irish adults with chronic pain. METHODS AND ANALYSIS Using cluster sampling, participants aged 18 years and over will be recruited from Irish pain clinics and provided an information package and questionnaire asking them to participate in our study at three time points, 1 year apart. The questionnaire will include our specially developed checklist to assess the prevalence and impact of MM, along with validated measures of quality of life, pain, depression and anxiety, and illness perception. Economic data will also be collected, including direct and indirect costs. ETHICS AND DISSEMINATION Ethical approval has been granted by the Research Ethics Committee of the National University of Ireland, Galway. Dissemination of results will be via journal articles and conference presentations.
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Affiliation(s)
- Brian W Slattery
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
| | - Laura O'Connor
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
| | - Stephanie Haugh
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
| | - Christopher P Dwyer
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
| | - Siobhan O'Higgins
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
| | - Line Caes
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
| | - Jonathan Egan
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
| | - Brian E McGuire
- School of Psychology and Centre for Pain Research, National University Ireland Galway, University Road, Galway, Ireland
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136
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Meeting the needs of a complex population: a functional health- and patient-centered approach to managing multimorbidity. JOURNAL OF COMORBIDITY 2016; 6:76-84. [PMID: 29090178 PMCID: PMC5556449 DOI: 10.15256/joc.2016.6.83] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 07/12/2016] [Indexed: 11/16/2022]
Abstract
Individuals with multimorbidity have complex care needs along with significant impacts to their functional health and quality of life. Recent evidence-based and experience-based explorations have revealed the importance of patient perspectives and functional health management in improving care delivery and health outcomes for individuals with multimorbidity. The impact of managing multimorbidity is evident at multiple levels of healthcare – the individual, the provider, and the system. Our local experience dealing with these challenges has led to the development of a functional health model that includes patient perspectives in care delivery within the Integrated Chronic Care Service (ICCS) of the health authority in Nova Scotia. In this paper, we present a discussion of the challenges, guiding models, and service-level transformations that have been integrated into care delivery at the ICCS to meet the healthcare needs of people with multiple health conditions. We describe our redesign strategies for care team planning, treatment approach, and patient inclusion.
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137
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Jovic D, Marinkovic J, Vukovic D. Association between body mass index and prevalence of multimorbidity: a cross-sectional study. Public Health 2016; 139:103-111. [PMID: 27340043 DOI: 10.1016/j.puhe.2016.05.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 03/11/2016] [Accepted: 05/24/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To explore the prevalence of multimorbidity in Serbia according to sex and body mass index (BMI) categories, and to examine the association between BMI and multimorbidity. In addition, this study examined the relationships between the main demographic and socio-economic characteristics of the population (age, settlement, education) and multimorbidity. STUDY DESIGN Secondary analysis of data from the 2013 Serbian National Health Survey. METHODS This study analyzed data from 13,103 participants aged ≥20 years with BMI data. The associations between BMI, age, education and multimorbidity were analyzed by multivariate logistic regression. RESULTS The overall prevalence of multimorbidity was higher than the overall prevalence of a single disease (26.9% vs 20.7%). The proportion of participants who reported two or more chronic diseases increased with each BMI category in both sexes, reaching the highest values in obese category III. Odds ratios (ORs) for the prevalence in all morbidity groups increased gradually with BMI category, and the highest OR values were found in obese category III. Males of obese category III were seven times more likely to have multimorbidity [OR 7.2, 95% confidence interval (CI) 4.2-12.6] than males of normal weight, whereas females of obese category III were nine and a half times more likely to have multimorbidity (OR 9.5, 95% CI 4.0-22.4) than females of normal weight. In the multivariable analysis, age (both sexes), low and middle level of education (males), and rural settlement and low level of education (females) were found to be predictors of multimorbidity. CONCLUSIONS This study found positive associations between obesity and multimorbidity and between overweight and multimorbidity. Recognizing these associations is of great importance from both clinical and public health perspectives because this could lead to an integrated approach for patients.
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Affiliation(s)
- D Jovic
- Institute of Public Health of Serbia, Centre for Hygiene and Human Ecology, Belgrade, Serbia.
| | - J Marinkovic
- Faculty of Medicine, Institute of Medical Statistics and Informatics, University of Belgrade, Belgrade, Serbia
| | - D Vukovic
- Faculty of Medicine, Institute of Social Medicine, University of Belgrade, Belgrade, Serbia
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138
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Mokraoui NM, Haggerty J, Almirall J, Fortin M. Prevalence of self-reported multimorbidity in the general population and in primary care practices: a cross-sectional study. BMC Res Notes 2016; 9:314. [PMID: 27315815 PMCID: PMC4912724 DOI: 10.1186/s13104-016-2121-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Settings affect estimation of multimorbidity prevalence. Multimorbidity prevalence was reported to be substantially higher among family practice-based patients than in the general population, but prevalence estimates were obtained with different methods and at different time periods. The aim of the present study was to compare estimates of the prevalence of multimorbidity in the general population and in primary care clinical practices, both measured simultaneously and with the same methods. Methods Cross-sectional analysis of results from the Program of Research on the Evolution of a Cohort Investigating Health System Effects (PRECISE) in Quebec, Canada. Subjects aged between 25 and 75 years. A randomly-selected cohort in the general population recruited by telephone, and patients recruited in the waiting room of 12 primary care clinics. Prevalence of multimorbidity was estimated using three operational definitions of multimorbidity: (a) two or more chronic conditions (MM 2+); (b) three or more chronic conditions (MM 3+); and (c) disease burden morbidity assessment score of 10 or higher (DBMA 10+). Results Prevalence in the general population ranged from 59.4 % (with MM2+) to 16.9 %, (with DBMA10+). In primary care practices, prevalence estimates ranged from 69.5 to 29.5 %. Prevalence estimates of multimorbidity were about 10 % higher in primary care clinical practices than in the sample from the general population. The difference was not importantly affected by the use of different operational definitions of multimorbidity. Also, there was a higher burden of disease among patients attending primary care clinics. Conclusions The study suggests that the problem of multimorbidity in the two settings is different both quantitatively (a higher proportion of patients with multimorbidity in primary care clinical practices), and qualitatively (a higher disease burden of patients attending primary care clinics). For decision-makers interested in resource allocation, prevalence estimates in samples from primary care practices are more informative than estimates in the general population, but burden of disease should also be considered as it results in more complexity in primary care clinical practices.
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Affiliation(s)
| | | | - José Almirall
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, QC, J1K 2R1, Canada
| | - Martin Fortin
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, 2500 boul. de l'Université, Sherbrooke, QC, J1K 2R1, Canada. .,Unité de médecine de famille, 305 St-Vallier, Chicoutimi, PQ, G7H 5H6, Canada.
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Volaklis KA, Halle M, Thorand B, Peters A, Ladwig KH, Schulz H, Koenig W, Meisinger C. Handgrip strength is inversely and independently associated with multimorbidity among older women: Results from the KORA-Age study. Eur J Intern Med 2016; 31:35-40. [PMID: 27108239 DOI: 10.1016/j.ejim.2016.04.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Revised: 03/26/2016] [Accepted: 04/04/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Data on the association between handgrip strength and multimorbidity (MMB) are missing. AIM The purpose of this study was to examine if handgrip strength is related to MMB in a large population-based sample of older persons. METHODS The cross-sectional analysis was based on 1079 older people (aged 65-94years), who participated in the KORA-Age study in the Augsburg region, southern Germany. Participants underwent an interview and extensive examinations, including anthropometric measurements, registration of chronic diseases, determination of health-related behaviors (smoking, alcohol intake and physical activity), collection of blood samples, and muscle strength measurement using hand-grip dynamometry. RESULTS In men, handgrip strength correlated strongly with the number of co-existing diseases (r=-0.176, p<0.001), and the same pattern was observed for women (r=-0.287, p<0.001). Among women, handgrip strength in the lower tertile compared to the upper tertile was significantly associated with an increased odds of having MMB (OR: 2.57, 95% CI: 1.30-5.07, p=0.007) after controlling for age, BMI, education, alcohol intake, smoking habits, medications number, inflammatory markers, telomere length and levels of physical activity. Contrary, no significant association between handgrip strength and MMB was found among men (OR: 1.32, 95% CI: 0.73-2.40, p=0.362) after multivariable adjustment. CONCLUSION Lower levels of handgrip strength are associated with a higher odd of MMB among older women even after adjusting for traditional and novel confounders. Increasing the levels of muscular strength in older women seems to be important in order to reduce the risk for the co-occurrence of multiple chronic diseases.
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Affiliation(s)
- K A Volaklis
- Department of Prevention and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany; 7FIT Cardiac Rehabilitation Center, Augsburg, Germany.
| | - M Halle
- Department of Prevention and Sports Medicine, Technische Universitaet Muenchen, Munich, Germany; DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany; Else-Kröner-Fresenius-Zentrum, Munich, Germany
| | - B Thorand
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - A Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - K H Ladwig
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - H Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Pneumology Center Munich (CPC-M), German Center for Lung Research,Germany
| | - W Koenig
- DZHK (German Center for Cardiovascular Research), Munich Heart Alliance, Munich, Germany; Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Ulm, Germany; Deutsches Herzzentrum München, Technische Universität München, Munich,Germany
| | - C Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
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Agrawal G, Patel SK, Agarwal AK. Lifestyle health risk factors and multiple non-communicable diseases among the adult population in India: a cross-sectional study. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0727-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Mackey LM, Doody C, Werner EL, Fullen B. Self-Management Skills in Chronic Disease Management: What Role Does Health Literacy Have? Med Decis Making 2016; 36:741-59. [PMID: 27053527 DOI: 10.1177/0272989x16638330] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 02/01/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Self-management-based interventions can lead to improved health outcomes in people with chronic diseases, and multiple patient characteristics are associated with the development of self-management behaviors. Low health literacy (HL) has been implicated in poorer self-management behaviors and increased costs to health services. However, the mechanisms behind this relationship remain unclear. Therefore, the aim of the current review is to assess the association between HL and patient characteristics related to self-management behaviors (i.e., disease-related knowledge, beliefs, and self-efficacy). METHODS The review comprised 3 phases: 1) database searches, 2) eligibility screening, and 3) study quality assessment and strength of evidence. Inclusion criteria specified that a valid HL screening tool was used, that at least one self-management behavior was assessed, and that patients had a chronic condition. RESULTS An initial search generated a total of 712 articles, of which 31 studies fulfilled the eligibility criteria. A consistent association was found between low HL and poorer disease-related knowledge in respiratory diseases, diabetes, and multiple disease categories. A significant association between low HL and poorer self-efficacy was reported in cardiovascular diseases, diabetes, human immunodeficiency virus, and multiple disease categories. HL was significantly associated with poorer beliefs in respiratory, musculoskeletal, and cardiovascular diseases. DISCUSSION The findings from the current review suggest that low HL may affect behaviors necessary for the development of self-management skills. Given that self-management strategies are core components for effective treatment of a range of chronic diseases, low HL poses a considerable health concern. Further research is needed to understand the mediating influence of HL on disease-related knowledge, self-efficacy, and beliefs. From this, HL-sensitive, self-management interventions ought to be devised and implemented.
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Affiliation(s)
- Laura M Mackey
- University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF)
| | - Catherine Doody
- University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF)
| | - Erik L Werner
- Department of General Practice, Institute of Health and Society, University of Oslo, Norway (ELW),Research Unit for General Practice, Uni Health, Bergen, Norway (ELW)
| | - Brona Fullen
- University College Dublin, Belfield, Dublin, Ireland (LMM, CD, BMF),UCD Centre for Translational Pain Research, Dublin, Ireland (BMF)
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Agrawal S, Agrawal PK. Association Between Body Mass index and Prevalence of Multimorbidity in Low-and Middle-income Countries: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF MEDICINE AND PUBLIC HEALTH 2016; 6:73-83. [PMID: 28894693 PMCID: PMC5591643 DOI: 10.5530/ijmedph.2016.2.5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Chronic diseases are increasingly becoming a health burden in terms of both morbidity and mortality in low and middle-income countries (LMICs). The role of body mass index (BMI) especially overweight and obesity in the prevalence of multimorbidity, the occurrence of two or more chronic conditions, is understudied in LMICs where two thirds of the world's obese individuals reside. We estimated the association between BMI and prevalence of chronic non communicable disease multimorbidity in six LMICs. METHODS Cross-sectional data of total of 40,166 participants from China (n=13,970), India (10,915), Mexico (2,4 26), Russia (3,892), South Africa (4,000) and Ghana (4,971), aged 18 years and above included in the WHO Study on Global Ageing and adult health (SAGE), 2007-2010 were analyzed. Multimorbidity was measured as the simultaneous presence of two or more of the nine chronic conditions including angina pectoris, arthritis, asthma, chronic lung disease, diabetes mellitus, hypertension, stroke, depression, and vision impairment. Multivariable logistic regression models were fitted to test for associations between overweight/obesity and prevalence of non communicable multimorbidity after adjusting for age, sex, rural/urban residence, education, marital status, occupation, household wealth, tobacco smoking, alcohol drinking, fruits and vegetable intake and health insurance status. Data were analyzed country wise as well as pooled together to give overall LMIC estimates. RESULTS The mean BMI was 24.4 [±7.3SD] in the pooled countries, being as low as 20.8 [±8.0 SD] in India to 23.4 [±6.3 SD] in Ghana, 23.9 [±4.9 SD] in China, 28.4 [±5.4 SD] in Mexico, 28.6 [±6.3 SD] in Russia, to as high as 30.5 [±12.0 SD] in South Africa. The prevalence of overweight was 13% and obesity was 24% in the pooled sample. The prevalence of non communicable disease multimorbidity was 23% in the pooled sample of six countries-the highest being in Russia (50%), followed by Mexico (27%), India (24%), Ghana (23%), South Africa (32%) and China (22%). The prevalence of multimorbidity was 37% among obese population and 27% among overweight population in the pooled sample-highest prevalence was in Russia (59% among obese; 45% among overweight) and lowest in Ghana (28% among obese; 23% among overweight). Being obese (OR:5.78;95%CI:3.55-9.40;p<0.0001) was associated with significantly higher likelihood of having multimorbidity as compared to normal weight category in the pooled sample. The likelihood of multimorbidity among obese were almost ten times higher in Russia (OR:9.90;95%CI:3.90-25.17;p=<0.0001), seven times higher in China (OR:7.06;95%CI:2.47-20.21;p=0.003), six times higher in Ghana (OR:5.61;95%CI:1.21-26.02;p= 0.007) and five times higher in South Africa (OR:4.66;95%CI:2.16-10.08;p=0.005). Non-significant but positive association were also observed in case of India and Mexico. The likelihood of multimorbidity was more than two times higher among overweight population in India (OR:2.33;95%CI:1.35-4.02;p=0.003) and pooled countries (OR:1.47;95%CI:1.05-2.07;p=0.004) while non-significant but positive association were also observed in case of China, Russia, and Ghana. CONCLUSIONS The prevalence of non communicable disease multimorbidity in the LMICs is high, one and half times higher in obese than in normal weight individual. Obesity was independently associated with the occurrence of multimorbidity in the six LMICs. These findings may be vital for public health surveillance, prevention and management strategies for non communicable disease multimorbidity in the LMICs.
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143
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Different Multimorbidity Measures Result in Varying Estimated Levels of Physical Quality of Life in Individuals with Multimorbidity: A Cross-Sectional Study in the General Population. BIOMED RESEARCH INTERNATIONAL 2016; 2016:7845438. [PMID: 27069925 PMCID: PMC4812198 DOI: 10.1155/2016/7845438] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/08/2016] [Accepted: 02/21/2016] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Multimorbidity adversely affects health-related quality of life. Methodological factors may impact the magnitude of this relationship. OBJECTIVE To evaluate how physical health-related quality of life varies in individuals with multimorbidity depending on the length of the list of candidate conditions considered. METHODS Secondary analysis from PRECISE, a cohort study of the general adult population of Quebec, Canada. Multimorbidity was measured using the 21-chronic condition list from the Disease Burden Morbidity Assessment, and physical health-related quality of life was measured using the physical component summary (PCS) of SF-12v2. The PCS was calculated, (a) using 2 or more conditions from the 21-condition list (MM2+, 21) and then from a reduced 6-condition list (MM2+, 6) and (b) using three or more conditions from each list (MM3+, 21, and MM3+, 6). RESULTS The analysis included 1,710 individuals (mean age 51.3, 40.5% men). Multimorbidity prevalence ranged from 63.8% (MM2+, 21 conditions) to 3.8% (MM3+, 6 conditions). The mean [95% CI] PCS dropped from 45.7 [CI: 45.0-46.3] (MM2+, 21) to 40.2 [CI: 38.7-41.8] (MM2+, 6) and from 44.2 [CI: 43.4-44.9] (MM3+, 21) to 34.8 [CI: 31.9-37.6] (MM3+, 6). CONCLUSION The length of the list of candidate conditions considered has a great impact on the estimations of physical health-related quality of life.
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Dhalwani NN, O'Donovan G, Zaccardi F, Hamer M, Yates T, Davies M, Khunti K. Long terms trends of multimorbidity and association with physical activity in older English population. Int J Behav Nutr Phys Act 2016; 13:8. [PMID: 26785753 PMCID: PMC4717631 DOI: 10.1186/s12966-016-0330-9] [Citation(s) in RCA: 109] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2015] [Accepted: 01/12/2016] [Indexed: 01/03/2023] Open
Abstract
Background Multimorbidity has become one of the main challenges in the recent years for patients, health care providers and the health care systems globally. However, literature describing the burden of multimorbidity in the elderly population, especially longitudinal trends is very limited. Physical activity is recommended as one of the main lifestyle changes in the prevention and management of multiple chronic diseases worldwide; however, the evidence on its association with multimorbidity remains inconclusive. Therefore, we aimed to assess the longitudinal trends of multimorbidity and the association between multimorbidity and physical activity in a nationally representative cohort of the English population aged ≥50 years between 2002 and 2013. Methods We used data on 15,688 core participants from six waves of the English Longitudinal Study of Ageing, with complete information on physical activity. Self-reported physical activity was categorised as inactive, mild, moderate and vigorous levels of physical activity. We calculated the number of morbidities and the prevalence of multimorbidity (more than 2 chronic conditions) between 2002 and 2013 overall and by levels of self-reported physical activity. We estimated the odds ratio (OR) and 95 % confidence intervals (CI) for multimorbidity by each category of physical activity, adjusting for potential confounders. Results There was a progressive decrease over time in the proportion of participants without any chronic conditions (33.9 % in 2002/2003 vs. 26.8 % in 2012/2013). In contrast, the prevalence of multimorbidity steadily increased over time (31.7 % in 2002/2003 vs. 43.1 % in 2012/2013). Compared to the physically inactive group, the OR for multimorbidity was 0.84 (95 % CI 0.78 to 0.91) in mild, 0.61 (95 % CI 0.56 to 0.66) in moderate and 0.45 (95 % CI 0.41 to 0.49) in the vigorous physical activity group. Conclusion This study demonstrated an inverse dose-response association between levels of physical activity and multimorbidity, however, given the increasing prevalence of multimorbidity over time, there is a need to explore causal associations between physical activity and multimorbidity and its impact as a primary prevention strategy to prevent the occurrence of chronic conditions later in life and reduce the burden of multimorbidity. Electronic supplementary material The online version of this article (doi:10.1186/s12966-016-0330-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nafeesa N Dhalwani
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
| | - Gary O'Donovan
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
| | - Francesco Zaccardi
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
| | - Mark Hamer
- National Centre Sport and Exercise Medicine, Loughborough University, Loughborough, LE11 3TU, UK.
| | - Thomas Yates
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
| | - Melanie Davies
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
| | - Kamlesh Khunti
- Diabetes Research Centre, Leicester Diabetes Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4PW, UK.
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145
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McKenzie KJ, Pierce D, Gunn JM. A systematic review of motivational interviewing in healthcare: the potential of motivational interviewing to address the lifestyle factors relevant to multimorbidity. JOURNAL OF COMORBIDITY 2015; 5:162-174. [PMID: 29090164 PMCID: PMC5636036 DOI: 10.15256/joc.2015.5.55] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023]
Abstract
Internationally, health systems face an increasing demand for services from people living with multimorbidity. Multimorbidity is often associated with high levels of treatment burden. Targeting lifestyle factors that impact across multiple conditions may promote quality of life and better health outcomes for people with multimorbidity. Motivational interviewing (MI) has been studied as one approach to supporting lifestyle behaviour change. A systematic review was conducted to assess the effectiveness of MI in healthcare settings and to consider its relevance for multimorbidity. Twelve meta-analyses pertinent to multimorbidity lifestyle factors were identified. As an intervention, MI has been found to have a small-to-medium statistically significant effect across a wide variety of single diseases and for a range of behavioural outcomes. This review highlights the need for specific research into the application of MI to determine if the benefits of MI seen with single diseases are also present in the context of multimorbidity.
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Affiliation(s)
- Kylie J. McKenzie
- Psychology Department, Ballarat Health Services and Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - David Pierce
- Rural Health Academic Centre, University of Melbourne, Ballarat, Victoria, Australia
| | - Jane M. Gunn
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
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Examining the prevalence and patterns of multimorbidity in Canadian primary healthcare: a methodologic protocol using a national electronic medical record database. JOURNAL OF COMORBIDITY 2015; 5:150-161. [PMID: 29090163 PMCID: PMC5636032 DOI: 10.15256/joc.2015.5.61] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/27/2015] [Indexed: 11/21/2022]
Abstract
In many developed countries, the burden of disease has shifted from acute to long-term or chronic diseases – producing new and broader challenges for patients, healthcare providers, and healthcare systems. Multimorbidity, the coexistence of two or more chronic diseases within an individual, is recognized as a significant public health and research priority. This protocol aims to examine the prevalence, characteristics, and changing burden of multimorbidity among adult primary healthcare (PHC) patients using electronic medical record (EMR) data. The objectives are two-fold: (1) to measure the point prevalence and clusters of multimorbidity among adult PHC patients; and (2) to examine the natural history and changing burden of multimorbidity over time among adult PHC patients. Data will be derived from the Canadian Primary Care Sentinel Surveillance Network (CPCSSN). The CPCSSN database contains longitudinal, point-of-care data from EMRs across Canada. To identify adult patients with multimorbidity, a list of 20 chronic disease categories (and corresponding ICD-9 codes) will be used. A computational cluster analysis will be conducted using a customized computer program written in JAVA. A Cox proportional hazards analysis will be used to model time-to-event data, while simultaneously adjusting for provider- and patient-level predictors. All analyses will be conducted using STATA SE 13.1. This research is the first of its kind using a pan-Canadian EMR database, which will provide an opportunity to contribute to the international evidence base. Future work should systematically compare international research using similar robust methodologies to determine international and geographical variations in the epidemiology of multimorbidity.
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147
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Hussain MA, Huxley RR, Al Mamun A. Multimorbidity prevalence and pattern in Indonesian adults: an exploratory study using national survey data. BMJ Open 2015; 5:e009810. [PMID: 26656028 PMCID: PMC4679940 DOI: 10.1136/bmjopen-2015-009810] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To estimate the prevalence and pattern of multimorbidity in the Indonesian adult population. DESIGN Cross-sectional study. SETTING Community-based survey. The sampling frame was based on households in 13 of the 27 Indonesian provinces, representing about 83% of the Indonesian population. PARTICIPANTS 9438 Indonesian adults aged 40 years and above. MAIN OUTCOME MEASURES Prevalence and pattern of multimorbidity by age, gender and socioeconomic status. RESULTS The mean number of morbidities in the sample was 1.27 (SE ± 0.01). The overall age and sex standardised prevalence of multimorbidity was 35.7% (34.8% to 36.7%), with women having significantly higher prevalence of multimorbidity than men (41.5% vs 29.5%; p<0.001). Of those with multimorbidity, 64.6% (62.8% to 66.3%) were aged less than 60 years. Prevalence of multimorbidity was positively associated with age (p for trend <0.001) and affluence (p for trend <0.001) and significantly greater in women at all ages compared with men. For each 5-year increment in age there was an approximate 20% greater risk of multimorbidity in both sexes (18% in women 95% CI 1.14 to 1.22 and 22% in men 95% CI 1.18 to 1.26). Increasing age, female gender, non-Javanese ethnicity, and high per-capital expenditure were all significantly associated with higher odds of multimorbidity. The combination of hypertension with cardiac diseases, hypercholesterolemia, arthritis, and uric acid/gout were the most commonly occurring disease pairs in both sexes. CONCLUSIONS More than one-third of the Indonesian adult population are living with multimorbidity with women and the more wealthy being particularly affected. Of especial concern was the high prevalence of multimorbidity among younger individuals. Hypertension was the most frequently occurring condition common to most individuals with multimorbidity.
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Affiliation(s)
- Mohammad Akhtar Hussain
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Rachel R Huxley
- School of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Abdullah Al Mamun
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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148
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Loprinzi PD. Sedentary behavior and medical multimorbidity. Physiol Behav 2015; 151:395-7. [PMID: 26277592 DOI: 10.1016/j.physbeh.2015.08.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/08/2015] [Accepted: 08/10/2015] [Indexed: 12/21/2022]
Abstract
Emerging research demonstrates that sedentary behavior is associated with various individual chronic conditions, independent of physical activity. Despite multimorbidity (having at least 2 chronic diseases) being highly prevalent (≥ 23% of adults) and associating with premature mortality, limited research has examined the association between sedentary behavior and multimorbidity, which was the purpose of this research letter. Data from the 2005-2006 NHANES were used (analyzed in 2015). A multimorbidity index variable was created indicating the number of 14 morbidities each patient had; sedentary behavior and physical activity were assessed via accelerometry. For every 60 min/day increase in sedentary behavior, participants had a higher multimorbidity index (β(adjusted) = 0.08; 95% CI: 0.04-0.11, p<0.001) and had an 11% (OR(adjusted) = 1.11; 95% CI: 1.01-1.21; p = 0.03) increased odds of being multimorbid (i.e., having ≥ 2 morbidities). Sedentary behavior is associated with multimorbidity (independent of light-intensity physical activity and adherence to moderate-to-vigorous physical activity guidelines), which underscores the importance of minimizing prolonged sedentary behavior (in addition to promoting physical activity) among adults.
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Affiliation(s)
- Paul D Loprinzi
- Center for Health Behavior Research, Department of Health, Exercise Science and Recreation Management, The University of Mississippi, MS, United States.
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149
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Leung Yinko SSL, Maheswaran J, Pelletier R, Bacon SL, Daskalopoulou SS, Khan NA, Eisenberg MJ, Karp I, Lavoie KL, Behlouli H, Pilote L. Sex differences in health behavior change after premature acute coronary syndrome. Am Heart J 2015; 170:242-8. [PMID: 26299220 DOI: 10.1016/j.ahj.2015.04.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 04/12/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited information is available on the health behavior profile of patients with premature acute coronary syndrome (ACS). The purpose of this study is to desribe the health bahvior of young patients with ACS at the baseline and 1 year post-ACS and examine sex differences. METHODS GENESIS-PRAXY is a prospective cohort study of adults (18-55 years old) hospitalized with ACS from 26 centers located in Canada, United States, and Switzerland. Data on diet, physical activity, smoking, alcohol consumption, and recreational drug use were collected through self-administered questionnaires at baseline and 1 year post-ACS. RESULTS Our analysis included 740 patients with complete data. At baseline, the health behavior profile of young patients with ACS was worse than that of the general population. Men had a lower fruit and vegetable intake, consumed alcohol more, and used recreational drugs more than women. Conversely, fewer men than women were smokers (34% vs 42%). At 1 year post-ACS, the proportion of those consuming ≥5 daily servings of fruits and vegetables increased modestly (+5% vs +1%, for men vs women) but remained lower than the general population. Among women, the prevalence of smoking remained about twice as high as the general population. Recreational drug use also remained higher than in the general population. CONCLUSIONS Despite small improvements at 1 year post-ACS, the health behavior profile of young patients remained worse than that of the general population. Greater efforts to improve health behaviors post-ACS among young patients are needed, and a sex-based approach may be required to ensure successful behavioral changes.
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Affiliation(s)
- Sylvie S L Leung Yinko
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Roxanne Pelletier
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Simon L Bacon
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Department of Exercise Science, Concordia University, Montreal, Quebec, Canada
| | - Stella S Daskalopoulou
- Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital and McGill University, Montreal, Quebec, Canada
| | - Igor Karp
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Kim L Lavoie
- Montreal Behavioural Medicine Centre, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada; Department of Psychology, University of Quebec at Montreal, Montreal, Quebec, Canada; Research Centre, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Hassan Behlouli
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada
| | - Louise Pilote
- Division of Clinical Epidemiology, Research Institute of McGill University Health Centre, Montreal, Quebec, Canada; Division of General Internal Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
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150
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Wang SB, D'Arcy C, Yu YQ, Li B, Liu YW, Tao YC, Wu YH, Zhang QQ, Xu ZQ, Fu YL, Kou CG. Prevalence and patterns of multimorbidity in northeastern China: a cross-sectional study. Public Health 2015. [PMID: 26210070 DOI: 10.1016/j.puhe.2015.06.013] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Information on multimorbidity in the general populations of developing countries is lacking. We examine the prevalence and patterns of multimorbidity in northeastern China. STUDY DESIGN A cross-sectional study was conducted on adult residents in Jilin Province, northeastern China from June 2012 to August 2012. METHODS Data were collected from a large cross-sectional study (n = 21,435) of adult community residents in Jilin Province in northeastern China. Multimorbidity, or co-morbidity, was defined as having two or more of 18 specified prevalent chronic diseases. A range of demographics, socio-economic factors, other risk factors and general mental health were used in describing the distribution of multimorbidity and in exploring the associations between them. RESULTS Almost a quarter (24.7%) of the adults were found to be multimorbid for chronic diseases. Multimorbidity was more common among older adults, women, rural residents and those with low income. Smoking, increasing BMI and psychological distress were independently associated with multimorbidity. Multimorbid patients were frequent users of primary care. Most dyads of chronic diseases co-occurred more frequently than would be expected on the basis of chance. CONCLUSIONS Researchers, clinicians and policy makers need to pay special attention to the health care challenges of multimorbidity and develop effective intervention strategies and programs to reduce the burden of multimorbidity.
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Affiliation(s)
- S B Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - C D'Arcy
- Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Y Q Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - B Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - Y W Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - Y C Tao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - Y H Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - Q Q Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - Z Q Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - Y L Fu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
| | - C G Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, China.
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