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Shan J, Yin R, Panuthai S. Body mass index and multimorbidity risk: A systematic review and dose-response meta-analysis. Arch Gerontol Geriatr 2024; 123:105418. [PMID: 38604087 DOI: 10.1016/j.archger.2024.105418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 03/11/2024] [Accepted: 03/13/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To verify the dose-response relationship between body mass index (BMI) and multimorbidity risk. METHODS PubMed, CINAHL, and Embase were systematically studied until January 25, 2023. Original articles on BMI and multimorbidity risk were included. Random effects model and dose-response meta-analysis were used to estimate the pooled odds ratio (OR) with 95 % confidence interval (CI). Subgroup analysis was performed to explore potential heterogeneity. RESULTS A total of 43 studies involving 969,130 patients (94,978 with multimorbidity) were involved in the meta-analysis. In the longitudinal studies, the pooled results showed that, compared to being a normal BMI, being overweight was much similar with 1.32 times possibility of getting multimorbidity; in persons with obesity the risk was 1.93 times higher; and the risk decreased 0.80 times among underweight persons. Additionally, obesity was 1.75 times as likely to be multimorbidity than those non-obese persons. In the cross-sectional studies, the pooled results demonstrated that persons with overweight and obesity had a 1.38-fold and 2.38-fold risk for multimorbidity, respectively; and the risk decreased 0.90 times among underweight persons compared to those with normal BMI. Besides, obese people are 1.89 times more likely to have multimorbidity than non-obese people. Dose response analysis found the linear connection between BMI and multimorbidity risk (Pnon-linearity=0.762), that for each 1 kg/m2 and 5 kg/m2 increase in BMI, the multimorbidity risk increased by 6 % and 35 %, respectively. CONCLUSIONS Multimorbidity increased linearly with an increase in BMI. Clinicians should pay attention to persons with abnormal weight, to help them achieve normal BMI.
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Affiliation(s)
- Jun Shan
- School of Nursing and Rehabilitation, Nantong University, China; Faculty of Nursing, Chiang Mai University, under the CMU presidential Scholarship, Thailand
| | - Rulan Yin
- Department of Nursing, The First Affiliated Hospital of Soochow University, China; Faculty of Nursing, Chiang Mai University, 110/406 Inthavaroros Road, Suthep, Muang district, Chiangmai 50200, Thailand
| | - Sirirat Panuthai
- Faculty of Nursing, Chiang Mai University, 110/406 Inthavaroros Road, Suthep, Muang district, Chiangmai 50200, Thailand.
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Feng X, Sarma H, Seubsman SA, Sleigh A, Kelly M. Impact of age and gender differences in the prevalence and patterns of multimorbidity in the Thai Cohort Study. Int Health 2024; 16:454-462. [PMID: 38520373 DOI: 10.1093/inthealth/ihae018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/30/2023] [Accepted: 03/19/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The study aims to identify the common patterns of multimorbidity and their distribution by age and gender. METHOD This cross-sectional study collected self-reported data from 42 785 Thai Cohort Study members through mailed questionnaires. Employing prevalence-based analysis, it identified common multimorbidity (coexistence of two or more chronic conditions) patterns, analysing the three most common patterns stratified by age and sex. P for trend (p-trend) was used to test the linear trend for associations between age and prevalence of these chronic conditions in the multimorbidity patterns. RESULTS Chronic conditions with the highest prevalence were related to metabolic syndromes: obesity (28.5%), hyperlipidaemia (13.2%) and hypertension (7.2%). A positive linear age-multimorbidity association was observed (p-trend = 0.0111). The 60+ participants averaged 1.20 diseases, with 33.7% multimorbidity prevalence. Hyperlipidaemia + obesity was most prevalent in the under-40 multimorbid group (38.7%). Men exhibited a higher prevalence of multimorbidity and associated patterns involving hypertension, hyperlipidaemia and obesity than women. CONCLUSION Metabolic syndrome components were the prominent factors driving multimorbidity. Significant age and gender differences were also revealed in multimorbidity prevalence. People aged 60+ faced high risk of multimorbidity, while younger individuals tended towards the multimorbidity pattern of obesity and hyperlipidaemia. Men were more susceptible to multimorbidity patterns associated with metabolic syndromes. Future studies for metabolic-related multimorbidity should consider these differences, addressing age and gender issues.
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Affiliation(s)
- Xiyu Feng
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
| | - Haribondhu Sarma
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
| | - Sam-Ang Seubsman
- School of Human Ecology, Sukhothai Thammathirat Open University, Nonthaburi, 11120, Thailand
| | - Adrian Sleigh
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
| | - Matthew Kelly
- Department of Applied Epidemiology, National Centre of Epidemiology and Population Health, the Australian National University, Canberra 2601, Australia
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Biosca O, Bellazzecca E, Donaldson C, Bala A, Mojarrieta M, White G, McHugh N, Baker R, Morduch J. Living on low-incomes with multiple long-term health conditions: A new method to explore the complex interaction between finance and health. PLoS One 2024; 19:e0305827. [PMID: 38923966 PMCID: PMC11207141 DOI: 10.1371/journal.pone.0305827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 06/03/2024] [Indexed: 06/28/2024] Open
Abstract
People on low-incomes in the UK develop multiple long-term health conditions over 10 years earlier than affluent individuals. Financial diaries -new to public health- are used to explore the lived experiences of financially-vulnerable individuals, diagnosed with at least one long-term condition, living in two inner-city London Boroughs. Findings show that the health status of these individuals is a key barrier to work opportunities, undermining their income. Their precarious and uncertain financial situation, sometimes combined with housing issues, increased stress and anxiety which, in turn, contributed to further deteriorate participants' health. Long-term health conditions limited the strategies to overcome moments of financial crisis and diarists frequently used credit to cope. Restrictions to access reliable services and timely support were connected to the progression of multiple long-term conditions. Models that integrate healthcare, public health, welfare and financial support are needed to slow down the progression from one to many long-term health conditions.
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Affiliation(s)
- Olga Biosca
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Enrico Bellazzecca
- Department of Management, Economics and Industrial Engineering, Politecnico di Milano, Milan, Italy
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom
- National Centre for Epidemiology & Public Health, Australian National University, Canberra, Australia
| | - Ahalya Bala
- School of Law and Social Sciences, Oxford Brookes University, Oxford, United Kingdom
| | - Marta Mojarrieta
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Gregory White
- National Centre for Social Research, London, United Kingdom
| | - Neil McHugh
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Jonathan Morduch
- Wagner Graduate School of Public Service, New York University, New York, NY, United States of America
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Xi J, Li PWC, Yu DSF. Multimorbidity: The need for a consensus on its operational definition. J Adv Nurs 2024. [PMID: 38887124 DOI: 10.1111/jan.16292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/20/2024]
Affiliation(s)
- Jing Xi
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Polly Wai-Chi Li
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Doris Sau-Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Bugge SJ, Henriksen DP, Damkier P, Rahbek MT, Schousboe K, Rothmann MJ, Poulsen MK, Hansen C, Nagarajah S, Jensen PB, Johansson SL, Panou V, Schneider IR, Pedersen CG, Andersen JD, Hangaard J, Zwisler ADO. Network of doctors for multimorbidity and diabetes - the NOMAD intervention: protocol for feasibility trial of multidisciplinary team conferences for people with diabetes and multimorbidity. Pilot Feasibility Stud 2024; 10:91. [PMID: 38879561 PMCID: PMC11179232 DOI: 10.1186/s40814-024-01517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 06/06/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND The prevalence of diabetes and coexisting multimorbidity rises worldwide. Treatment of this patient group can be complex. Providing an evidence-based, coherent, and patient-centred treatment of patients with multimorbidity poses a challenge in healthcare systems, which are typically designed to deliver disease-specific care. We propose an intervention comprising multidisciplinary team conferences (MDTs) to address this issue. The MDT consists of medical specialists in five different specialities meeting to discuss multimorbid diabetes patients. This protocol describes a feasibility test of MDTs designed to coordinate care and improve quality of life for people with diabetes and multimorbidity. METHODS A mixed-methods one-arm feasibility test of the MDT. Feasibility will be assessed through prospectively collected data. We will explore patient perspectives through patient-reported outcomes (PROs) and assess the feasibility of electronic questionnaires. Feasibility outcomes are recruitment, PRO completion, technical difficulties, impact of MDT, and doctor preparation time. During 17 months, up to 112 participants will be recruited. We will report results narratively and by the use of descriptive statistics. The collected data will form the basis for a future large-scale randomised trial. DISCUSSION A multidisciplinary approach focusing on better management of diabetic patients suffering from multimorbidity may improve functional status, quality of life, and health outcomes. Multimorbidity and diabetes are highly prevalent in our healthcare system, but we lack a solid evidence-based approach to patient-centred care for these patients. This study represents the initial steps towards building such evidence. The concept can be efficiency tested in a randomised setting, if found feasible to intervention providers and receivers. If not, we will have gained experience on how to manage diabetes and multimorbidity as well as organisational aspects, which together may generate hypotheses for research on how to handle multimorbidity in the future. ADMINISTRATIVE INFORMATION Protocol version: 01 TRIAL REGISTRATION: NCT05913726 - registration date: 21 June 2023.
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Affiliation(s)
- Stine Jorstad Bugge
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark.
- Department of Pharmacology, Odense University Hospital, Odense, Denmark.
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Daniel Pilsgaard Henriksen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Per Damkier
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Martin Torp Rahbek
- Department of Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karoline Schousboe
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Mette Juel Rothmann
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Marianne Kjær Poulsen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Camilla Hansen
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
| | - Subagini Nagarajah
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Per Bruno Jensen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Nephrology, Odense University Hospital, Odense, Denmark
| | - Sofie Lock Johansson
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Vasiliki Panou
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Ida Ransby Schneider
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Charlotte Gjørup Pedersen
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jonas Dahl Andersen
- Steno Diabetes Centre Northern Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Jørgen Hangaard
- Steno Diabetes Centre Odense, Odense University Hospital, 5000, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ann-Dorthe Olsen Zwisler
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
- REHPA, The Danish Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, Nyborg, Denmark
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Zhao Z, Li H, Xing X, Sun W, Ma X, Zhu H. Temporal trends and correlates in multiple hospitalizations among older adults: findings from a nationally representative sample in China. Geriatr Nurs 2024; 58:336-343. [PMID: 38875760 DOI: 10.1016/j.gerinurse.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 05/23/2024] [Accepted: 05/23/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVE This study aims to examine the trends and correlates in multiple hospitalizations among older adults in China. METHODS The data were from the China Health and Retirement Longitudinal Study (CHARLS), and generalized ordered logit model (GOLM) was used to identify the correlates of multiple hospitalizations among older adults aged≥60 years old. RESULTS Between 2011 and 2018, the proportion of older adults having multiple hospitalizations in the past year showed an increasing trend in the total sample (p value for trend = 0.014). Being older, male, illiterate, living in the middle/western region, having higher annual per capita household expenditure, health insurance, multimorbidity, and being depressed were associated with increased odds of multiple hospitalizations. CONCLUSIONS Our findings indicated that older adults with multiple hospitalizations may expect an increasing burden on healthcare system. More efforts are needed to improve health insurance and primary healthcare to reduce avoidable hospitalizations.
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Affiliation(s)
- Ziyin Zhao
- School of Public Health, Peking University, Beijing 100191, China
| | - Huining Li
- School of Public Health, Peking University, Beijing 100191, China
| | - Xing Xing
- School of Public Health, Peking University, Beijing 100191, China
| | - Wenjun Sun
- School of Public Health, Peking University, Beijing 100191, China
| | - Xiaochen Ma
- China Center for Health Development Studies, Peking University, Beijing 100191, China
| | - He Zhu
- China Center for Health Development Studies, Peking University, Beijing 100191, China.
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Joseph L, Krishnan A, Lekha TR, Sasidharan N, Thulaseedharan JV, Valamparampil MJ, Harikrishnan S, Greenfield S, Gill P, Davies J, Manaseki-Holland S, Jeemon P. Experiences and challenges of people living with multiple long-term conditions in managing their care in primary care settings in Kerala, India: A qualitative study. PLoS One 2024; 19:e0305430. [PMID: 38870110 PMCID: PMC11175503 DOI: 10.1371/journal.pone.0305430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Multimorbidity or multiple long-term conditions (MLTCs), the coexistence of two or more chronic conditions within an individual, presents a growing concern for healthcare systems and individuals' well-being. However, we know little about the experiences of those living with MLTCs in low- and middle-income countries (LMICs) such as India. We explore how people living with MLTCs describe their illness, their engagements with healthcare services, and challenges they face within primary care settings in Kerala, India. METHODS We designed a qualitative descriptive study and conducted in-depth, semi-structured interviews with 31 people (16 males and 15 females) from family health centres (FHCs) in Kerala. Interview data were recorded, transcribed, and thematic analysis using the Framework Method was undertaken. FINDINGS Two main themes and three sub-themes each were identified; (1) Illness impacts on life (a)physical issues (b) psychological difficulties (c) challenges of self-management and (2) Care-coordination maze (a)fragmentation and poor continuity of care (b) medication management; an uphill battle and (c) primary care falling short. All participants reported physical and psychological challenges associated with their MLTCs. Younger participants reported difficulties in their professional lives, while older participants found household activities challenging. Emotional struggles encompassed feelings of hopelessness and fear rooted in concerns about chronic illness and physical limitations. Older participants, adhering to Kerala's familial support norms, often found themselves emotionally distressed by the notion of burdening their children. Challenges in self-management, such as dietary restrictions, medication adherence, and physical activity engagement, were common. The study highlighted difficulties in coordinating care, primarily related to traveling to multiple healthcare facilities, and patients' perceptions of FHCs as fit for diabetes and hypertension management rather than their multiple conditions. Additionally, participants struggled to manage the task of remembering and consistently taking multiple medications, which was compounded by confusion and memory-related issues. CONCLUSION This study offers an in-depth view of the experiences of individuals living with MLTCs from Kerala, India. It emphasizes the need for tailored and patient-centred approaches that enhance continuity and coordination of care to manage complex MLTCs in India and similar LMICs.
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Affiliation(s)
- Linju Joseph
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Athira Krishnan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | - Neethu Sasidharan
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
| | | | | | | | - Sheila Greenfield
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Paramjit Gill
- Academic Unit of Primary Care (AUPC) Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Justine Davies
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Semira Manaseki-Holland
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Panniyammakal Jeemon
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, India
- Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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Oliveira FEG, Griep RH, Chor D, Barreto SM, Molina MDCB, Machado LAC, Fonseca MDJMD, Bastos LS. Racial inequalities in the development of multimorbidity of chronic conditions: results from a Brazilian prospective cohort. Int J Equity Health 2024; 23:120. [PMID: 38867238 PMCID: PMC11170781 DOI: 10.1186/s12939-024-02201-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 05/21/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND The occurrence of multimorbidity and its impacts have differentially affected population subgroups. Evidence on its incidence has mainly come from high-income regions, with limited exploration of racial disparities. This study investigated the association between racial groups and the development of multimorbidity and chronic conditions in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Data from self-reported white, brown (pardos or mixed-race), and black participants at baseline of ELSA-Brasil (2008-2010) who were at risk for multimorbidity were analysed. The development of chronic conditions was assessed through in-person visits and self-reported diagnosis via telephone until the third follow-up visit (2017-2019). Multimorbidity was defined when, at the follow-up visit, the participant had two or more morbidities. Cumulative incidences, incidence rates, and adjusted incidence rate ratios (IRRs) were estimated using Poisson models. RESULTS Over an 8.3-year follow-up, compared to white participants: browns had a 27% greater incidence of hypertension and obesity; and blacks had a 62% and 45% greater incidence, respectively. Blacks also had 58% more diabetes. The cancer incidence was greater among whites. Multimorbidity affected 41% of the participants, with a crude incidence rate of 57.5 cases per 1000 person-years (ranging from 56.3 for whites to 63.9 for blacks). Adjusted estimates showed a 20% higher incidence of multimorbidity in black participants compared to white participants (IRR: 1.20; 95% CI: 1.05-1.38). CONCLUSIONS Significant racial disparities in the risk of chronic conditions and multimorbidity were observed. Many associations revealed a gradient increase in illness risk according to darker skin tones. Addressing fundamental causes such as racism and racial discrimination, alongside considering social determinants of health, is vital for comprehensive multimorbidity care. Intersectoral, equitable policies are essential for ensuring health rights for historically marginalized groups.
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Affiliation(s)
| | - Rosane Härter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Rio de Janeiro, Brazil
| | - Dora Chor
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, 4365 Brazil Avenue, Manguinhos, Rio de Janeiro, 21040900, Brazil
| | - Sandhi Maria Barreto
- Department of Preventive and Social Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Luciana A C Machado
- Clinical Hospital/EBSERH, Federal University of Minas Gerais, Belo Horizonte, Brazil
- Executive Office, Science Integrity Alliance, Sunrise, Florida, US
| | - Maria de Jesus Mendes da Fonseca
- Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, 4365 Brazil Avenue, Manguinhos, Rio de Janeiro, 21040900, Brazil
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Hong HC, Kim YM. Multimorbidity and its Associated Factors in Korean Shift Workers: Population-Based Cross-Sectional Study. JMIR Public Health Surveill 2024; 10:e55014. [PMID: 38857074 PMCID: PMC11196912 DOI: 10.2196/55014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/11/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Multimorbidity is a crucial factor that influences premature death rates, poor health, depression, quality of life, and use of health care. Approximately one-fifth of the global workforce is involved in shift work, which is associated with increased risk for several chronic diseases and multimorbidity. About 12% to 14% of wage workers in Korea are shift workers. However, the prevalence of multimorbidity and its associated factors in Korean shift workers are rarely reported. OBJECTIVE This study aimed to assess multimorbidity prevalence, examine the factors associated with multimorbidity, and identify multimorbidity patterns among shift workers in Korea. METHODS This study is a population-based cross-sectional study using Korea National Health and Nutrition Examination Survey data from 2016 to 2020. The study included 1704 (weighted n=2,697,228) Korean shift workers aged 19 years and older. Multimorbidity was defined as participants having 2 or more chronic diseases. Demographic and job-related variables, including regular work status, average working hours per week, and shift work type, as well as health behaviors, including BMI, smoking status, alcohol use, physical activity, and sleep duration, were included in the analysis. A survey-corrected logistic regression analysis was performed to identify factors influencing multimorbidity among the workers, and multimorbidity patterns were identified with a network analysis. RESULTS The overall prevalence of multimorbidity was 13.7% (302/1704). Logistic regression indicated that age, income, regular work, and obesity were significant factors influencing multimorbidity. Network analysis results revealed that chronic diseases clustered into three groups: (1) cardiometabolic multimorbidity (hypertension, dyslipidemia, diabetes, coronary heart disease, and stroke), (2) musculoskeletal multimorbidity (arthritis and osteoporosis), and (3) unclassified diseases (depression, chronic liver disease, thyroid disease, asthma, cancer, and chronic kidney disease). CONCLUSIONS The findings revealed that several socioeconomic and behavioral factors were associated with multimorbidity among shift workers, indicating the need for policy development related to work schedule modification. Further organization-level screening and intervention programs are needed to prevent and manage multimorbidity among shift workers. We also recommend longitudinal studies to confirm the effects of job-related factors and health behaviors on multimorbidity among shift workers in the future.
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Affiliation(s)
- Hye Chong Hong
- Department of Nursing, Chung-Ang University, Seoul, Republic of Korea
| | - Young Man Kim
- College of Nursing, Jeonbuk National University, Jeonju, Republic of Korea
- Research Institute of Nursing Science, Jeonbuk National University, Jeonju, Republic of Korea
- Biomedical Research Institute, Jeonbuk National University Hospital, Jeonju, Republic of Korea
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Yan Z, Chen J, Guo L, Zhang H, Ding Y, Ren G, Mao Y, Bai R, Ma X. Genetic analyses of the bidirectional associations between common mental disorders and asthma. Front Psychiatry 2024; 15:1372842. [PMID: 38903633 PMCID: PMC11187307 DOI: 10.3389/fpsyt.2024.1372842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 05/17/2024] [Indexed: 06/22/2024] Open
Abstract
Objective Although extensive research has explored the link between mental disorders and asthma, the characteristics and patterns of this association are still unclear. Our study aims to examine the genetic causal links between common mental disorders (specifically, anxiety and depression) and asthma. Methods We conducted genetic analyses including linkage disequilibrium score regression (LDSC) and bidirectional two-sample Mendelian randomization (MR) analyses, and utilized summary statistics from recent large-scale Genome-Wide Association Studies (GWASs) in European populations, covering sensation of anxiety or depression, anxiety sensation, depression sensation, anxiety disorders, major depression disorder (MDD), and asthma. Results LDSC revealed significant genetic correlations among sensation of anxiety or depression, MDD and asthma (P < 0.017), highlighting potential genetic correlation between anxiety disorders and asthma (P < 0.05 yet > 0.017). In bidirectional two-sample MR, inverse-variance weighted (IVW) analyses suggested that genetic liability to asthma was significantly associated with an increased risk of sensation of anxiety or depression (OR = 4.760, 95%CI: 1.645-13.777), and MDD (OR = 1.658, 95%CI: 1.477-1.860). Conversely, IVW analyses indicated that genetic liability to anxiety disorders was not associated with an increased risk of asthma (P > 0.01), nor was genetic liability to asthma associated with an increased risk of anxiety disorders (P > 0.01). Furthermore, no significant genetic causal relationships were observed for other studied traits. Multivariate MR, after adjusting for body mass index and alcohol consumption, further corroborated the independent causal effect of genetic predisposition to MDD on the risk of asthma (OR = 1.460, 95% CI: 1.285-1.660). Conclusion Our study establishes MDD as a predisposing factor for asthma. Meanwhile, anxiety disorders are not causal risk factors for asthma, nor is the reverse true. It is recommended to closely monitor asthma symptoms in patients with MDD.
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Affiliation(s)
- Zian Yan
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jingjing Chen
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Lijun Guo
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Hongwei Zhang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yanqiu Ding
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Gaocan Ren
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yiyi Mao
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Ruina Bai
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaochang Ma
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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11
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Wang Z, Burgers JS, Shao R, Bian Z, Wang C, Chen Y, Estill J. Strengthening transparency in randomised trials related to multimorbidity: key points and recommendations to guide reporting. BMJ Evid Based Med 2024:bmjebm-2024-112907. [PMID: 38839262 DOI: 10.1136/bmjebm-2024-112907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2024] [Indexed: 06/07/2024]
Affiliation(s)
- Zijun Wang
- Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Global Health, University of Geneva, Geneve, GE, Switzerland
| | - Jako S Burgers
- Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Limburg, Netherlands
| | - Ruitai Shao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, Beijing, China
| | - Zhaoxiang Bian
- China EQUATOR Centre, School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong
| | - Chen Wang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, Beijing, China
| | - Yaolong Chen
- Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Janne Estill
- Research Unit of Evidence-Based Evaluation and Guidelines (2021RU017), Chinese Academy of Medical Sciences, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Global Health, University of Geneva, Geneve, GE, Switzerland
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12
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Beltrán V, Muñoz-Sepúlveda F, Acevedo C, Navarro P, Venegas B, Salgado C, Uribe P, Engelke W. A rural teledentistry care experience: a geriatric approach to assessing oral health status and treatment needs in older adults from a Mapuche community in Chile. Front Public Health 2024; 12:1356622. [PMID: 38903581 PMCID: PMC11188396 DOI: 10.3389/fpubh.2024.1356622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/08/2024] [Indexed: 06/22/2024] Open
Abstract
Background Limited attention has been given to oral health challenges faced by older Indigenous populations, especially in rural settings, where disparities exist. This study aims to assess oral health in a rural Mapuche community in southern Chile, utilizing geriatric technology support, and exploring the connection between geriatric health and oral well-being to fill a gap in this context. Methods A cross-sectional study was conducted involving 76 independent older adults from a rural Mapuche community who required dental care. Assessments were in a remote care setting gathering extensive data including comprehensive geriatric assessments, medical and dental conditions using a geriatric teledentistry platform (TEGO®). Statistical analysis involved descriptive analysis, logistic regression, and both multiple correspondence analysis and k-means cluster analysis. Results The sample comprised individuals with limited formal education and a high degree of vulnerability. Geriatric assessments unveiled cognitive deterioration, frailty, depression risk, and multimorbidity. A distribution of the DMFT index, number of remaining teeth, number of occluding pairs, number of teeth with restorative needs and other relevant clinical findings was conducted based on sociodemographic, and medical-geriatric-dental characteristics, and additionally, a Multinomial Logistic Regression Analysis of Dentition Variables in Relation to Geriatric Assessments was performed. The dental burden was substantial, with an average DMFT index of 25.96 (SD 4.38), high prevalence of non-functional dentition (89.3%), periodontal disease (83%), xerostomia (63.2%) and oral mucosal lesions (31.5%). Age, lower education, depression, daily medication number and sugary consumption frequency were associated with a decreased average number of teeth (p < 0.05). Multiple correspondence analysis and k-means cluster analysis identified 4 clusters, with the edentulous and functional dentition groups being the most distinct. Conclusion This study uncovers a substantial dental burden and intricate medical-geriatric conditions interlinked among Indigenous older adults in a rural Chilean Mapuche community. The implementation of a geriatric technological ecosystem in the community enabled the resolution of less complex oral health issues and facilitated remote consultations with specialists, reducing the necessity for travel to health centers. This underscores the need for innovative dental public health initiatives to address health disparities and improve the overall well-being of older Indigenous adults.
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Affiliation(s)
- Víctor Beltrán
- Clinical Investigation and Dental Innovation Center (CIDIC), Dental School and Center for Translational Medicine (CEMT-BIOREN), Universidad de La Frontera, Temuco, Chile
- Interuniversity Center for Healthy Aging (CIES), Santiago, Chile
| | - Fernanda Muñoz-Sepúlveda
- Clinical Investigation and Dental Innovation Center (CIDIC), Dental School and Center for Translational Medicine (CEMT-BIOREN), Universidad de La Frontera, Temuco, Chile
- Interuniversity Center for Healthy Aging (CIES), Santiago, Chile
- Program of Master in Dental Science, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Claudia Acevedo
- Clinical Investigation and Dental Innovation Center (CIDIC), Dental School and Center for Translational Medicine (CEMT-BIOREN), Universidad de La Frontera, Temuco, Chile
| | - Pablo Navarro
- Research Center for Dental Sciences (CICO), Dental School, Universidad de La Frontera, Temuco, Chile
- Faculty of Health Sciences, Universidad Autónoma de Chile, Temuco, Chile
| | - Bernardo Venegas
- Stomatology Department, Faculty of Dentistry, Universidad de Talca, Talca, Chile
| | | | - Pablo Uribe
- Dental School, Universidad de La Frontera, Temuco, Chile
| | - Wilfried Engelke
- Faculty of Medicine, Georg-August University of Göttingen, Göttingen, Germany
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13
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Mahapatra P, Sahoo KC, Pati S. A longitudinal qualitative study on physician experience in managing multimorbidity across the COVID-19 pandemic in Odisha, India. Sci Rep 2024; 14:12866. [PMID: 38834635 DOI: 10.1038/s41598-024-60473-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 04/23/2024] [Indexed: 06/06/2024] Open
Abstract
While many studies have documented adverse impact of multiple chronic conditions or multimorbidity on COVID-19 outcomes in patients, there is scarcity of report on how physicians managed these patients. We investigated the experiences and challenges of clinicians in managing patients with multimorbidity throughout the COVID-19 pandemic in Odisha state, India. To understand the factors influencing illness management and the adaptive responses of physicians alongside the evolving pandemic, we followed a longitudinal qualitative study design. Twenty-three physicians comprising general practitioners, specialists, and intensivists, were telephonically interviewed in-depth. Saldana's longitudinal qualitative data analysis method was employed for data analysis. COVID-19 pandemic initially diverted the attention of health systems, resulting in reduced care. With time, the physicians overcame fear, anxiety, and feelings of vulnerability to COVID-19 and started prioritising patients with multimorbidity for treatment and vaccination. All physicians recommended teleconsultation and digital health records to benefit chronic illness care during future public health crises. The findings underscore the transformative potential of physician resilience and adaptation during the COVID-19 pandemic, emphasizing the importance of prioritizing patients with multimorbidity, incorporating teleconsultation, and implementing digital health records in healthcare systems to enhance chronic illness care and preparedness for future public health crises.
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Affiliation(s)
- Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, Odisha, India
| | - Krushna Chandra Sahoo
- Department of Health Research, Health Technology Assessment in India (HTAIn), Ministry of Health and Family Welfare, New Delhi, 110001, India
| | - Sanghamitra Pati
- ICMR-Regional Medical Research Centre Bhubaneswar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India.
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14
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Parchmann N, Hansen D, Orzechowski M, Steger F. An ethical assessment of professional opinions on concerns, chances, and limitations of the implementation of an artificial intelligence-based technology into the geriatric patient treatment and continuity of care. GeroScience 2024:10.1007/s11357-024-01229-6. [PMID: 38834930 DOI: 10.1007/s11357-024-01229-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024] Open
Abstract
With the introduction of an artificial intelligence-based dashboard into the clinic, the project SURGE-Ahead responds to the importance of improving perioperative geriatric patient treatment and continuity of care. The use of artificial intelligence to process and analyze data automatically, aims at an evidence-based evaluation of the patient's health condition and recommending treatment options. However, its development and introduction raise ethical questions. To ascertain professional perspectives on the clinical use of the dashboard, we have conducted 19 semi-structured qualitative interviews with head physicians, computer scientists, jurists, and ethicists. The application of a qualitative content analysis and thematic analysis enabled the detection of main ethical concerns, chances, and limitations. These ethical considerations were categorized: changes of the patient-physician relationship and the current social reality are expected, causing de-skilling and an active participation of the artificial intelligence. The interviewees anticipated a redistribution of human resources, time, knowledge, and experiences as well as expenses and financing. Concerns of privacy, accuracy, transparency, and explainability were stated, and an insufficient data basis, an intensifying of existing inequalities and systematic discrimination considering a fair access emphasized. Concluding, the patient-physician relationship, social reality, redistribution of resources, fair access, as well as data-related aspects of the artificial intelligence-based system could conflict with the ethical principles of autonomy, non-maleficence, beneficence, and social justice. To respond to these ethical concerns, a responsible use of the dashboard and a critical verification of therapy suggestions is mandatory, and the application limited by questions at the end of life and taking life-changing decisions.
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Affiliation(s)
- Nina Parchmann
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Oberberghof 7, 89081, Ulm, Baden-Wuerttemberg, Germany.
| | - David Hansen
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Oberberghof 7, 89081, Ulm, Baden-Wuerttemberg, Germany
| | - Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Oberberghof 7, 89081, Ulm, Baden-Wuerttemberg, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Oberberghof 7, 89081, Ulm, Baden-Wuerttemberg, Germany
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15
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Yu H, Zhang Y, Hu M, Xiang B, Wang S, Wang Q. Inter- and intrapopulation differences in the association between physical multimorbidity and depressive symptoms. J Affect Disord 2024; 354:434-442. [PMID: 38508455 DOI: 10.1016/j.jad.2024.03.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND The association between physical multimorbidity and depression differs by populations. However, no direct inter- or intrapopulation comparison of the association has been conducted. Thus, this study aims to estimate the association in China and the United States and reveal inter- and intrapopulation differences in the association. METHODS Middle-aged and older adults from the China Health and Retirement Longitudinal Study and the Health and Retirement Study were included. Physical multimorbidity was defined as the simultaneous presence of two or more chronic physical conditions and depressive symptoms was measured by the Center for Epidemiologic Studies Depression Scale. Generalized estimating equation model and stratification multilevel method were the main statistical models. RESULTS The presence of physical multimorbidity was associated with a higher risk of depression in both China (RR = 1.360 [95 % CI: 1.325-1.395]) and the US (RR = 1.613 [95 % CI: 1.529-1.701]). For individuals at a low risk of multimorbidity, multimorbidity was associated with 47.4 % (95 % CI: 1.377-1.579) and 71.1 % (95 % CI: 1.412-2.074) increases in the likelihood of depression in China and the US. The effect size was smaller for individuals at a moderate or high risk. However, the cross-national differences were greater for those with a high risk of multimorbidity. LIMITATIONS The self-report measures, attribution bias. CONCLUSIONS Compared to Chinese adults, the presence of physical multimorbidity led to an additional increase in depressive symptoms for American counterparts. The association was stronger for individuals at a low risk of multimorbidity, but cross-national differences were observed mostly among individuals at a high risk.
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Affiliation(s)
- Haiyang Yu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Yike Zhang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Mengxiao Hu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Bowen Xiang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China
| | - Sijia Wang
- National Institute of Health Data Science of China, Shandong University, Jinan, China; Institute for Global Health, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Qing Wang
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China; National Institute of Health Data Science of China, Shandong University, Jinan, China; Yellow River National Strategic Research Institute, Shandong University, Jinan, Shandong, China.
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16
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Ugarteche Pérez A, Berger E, Kelly-Irving M, Delpierre C, Capuron L, Castagné R. Early life stress in relation with risk of overweight, depression, and their comorbidity across adulthood: findings from a British birth cohort. Psychol Med 2024; 54:1853-1866. [PMID: 38197250 DOI: 10.1017/s0033291723003823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
BACKGROUND Multimorbidity, known as the co-occurrence of at least two chronic conditions, has become of increasing concern in the current context of ageing populations, though it affects all ages. Early life risk factors of multimorbidity include adverse childhood experiences (ACEs), particularly associated with psychological conditions and weight problems. Few studies have considered related mechanisms and focus on old age participants. We are interested in estimating, from young adulthood, the risk of overweight-depression comorbidity related to ACEs while adjusting for early life confounders and intermediate variables. METHODS We used data from the 1958 National Child Development Study, a prospective birth cohort study (N = 18 558). A four-category outcome (no condition, overweight only, depression only and, overweight-depression comorbidity) was constructed at 23, 33, and 42 years. Multinomial logistic regression models adjusting for intermediate variables co-occurring with this outcome were created. ACEs and sex interaction on comorbidity risk was tested. RESULTS In our study sample (N = 7762), we found that ACEs were associated with overweight-depression comorbidity risk throughout adulthood (RRR [95% CI] at 23y = 3.80 [2.10-6.88]) though less overtime. Comorbidity risk was larger than risk of separate conditions. Intermediate variables explained part of the association. After full-adjustment, an association remained (RRR [95% CI] at 23y = 2.00 [1.08-3.72]). Comorbidity risk related to ACEs differed by sex at 42. CONCLUSION Our study provides evidence on the link and potential mechanisms between ACEs and the co-occurrence of mental and physical diseases throughout the life-course. We suggest addressing ACEs in intervention strategies and public policies to go beyond single disease prevention.
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Affiliation(s)
| | - Eloïse Berger
- CERPOP, University of Toulouse, Inserm, UPS, Toulouse, France
| | | | | | - Lucile Capuron
- University of Bordeaux, INRAE, Bordeaux INP, NutriNeuro, UMR 1286, Bordeaux, France
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17
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Zhong J, Chen L, Li C, Li J, Niu Y, Bai X, Wen H, Diao Z, Yan H, Xu M, Huang W, Xu Z, Liang X, Liu D. Association of lifestyles and multimorbidity with mortality among individuals aged 60 years or older: Two prospective cohort studies. SSM Popul Health 2024; 26:101673. [PMID: 38779456 PMCID: PMC11109000 DOI: 10.1016/j.ssmph.2024.101673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/28/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
Lifestyles are associated with all-cause mortality, yet limited research has explored the association in the elderly population with multimorbidity. We aim to investigate the impact of adopting a healthy lifestyle on reducing the risk of all-cause mortality in older individuals with or without multimorbidity in both China and UK. This prospective study included 29,451 and 173,503 older adults aged 60 and over from Chinese Longitudinal Healthy Longevity Survey (CLHLS) and UK Biobank. Lifestyles and multimorbidity were categorized into three groups, respectively. Cox proportional hazards regression was used to estimate the Hazard Ratios (HRs), 95% confidence intervals (95% CIs), and dose-response for all-cause mortality in relation to lifestyles and multimorbidity, as well as the combination of both factors. During a mean follow-up period of 4.7 years in CLHLS and 12.14 years in UK Biobank, we observed 21,540 and 20,720 deaths, respectively. For participants with two or more conditions, compared to those with an unhealthy lifestyle, adopting a healthy lifestyle was associated with a 27%-41% and 22%-42% reduction in mortality risk in the CLHLS and UK Biobank, respectively; Similarly, for individuals without multimorbidity, this reduction ranged from 18% to 41%. Among participants with multimorbidity, individuals with an unhealthy lifestyle had a higher mortality risk compared to those maintaining a healthy lifestyle, with HRs of 1.15 (95% CI: 1.00, 1.32) and 1.27 (95% CI: 1.16, 1.39) for two conditions, and 1.24 (95% CI: 1.06, 1.45) and 1.73 (95% CI: 1.56, 1.91) for three or more conditions in CLHLS and UK Biobank, respectively. Adherence to a healthy lifestyle can yield comparable mortality benefits for older individuals, regardless of their multimorbidity status. Furthermore, maintaining a healthy lifestyle can alleviate the mortality risks linked to a higher number of diseases.
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Affiliation(s)
- Jianfeng Zhong
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Lianhong Chen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Chengping Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Jing Li
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Yingying Niu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xuerui Bai
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Huiyan Wen
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhiquan Diao
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Haoyu Yan
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Miao Xu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Wenqi Huang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Zhitong Xu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - Xiaofeng Liang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
- Disease Control and Prevention Institute of Jinan University, Jinan University, Guangzhou, China
| | - Dan Liu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
- Laboratory of Viral Pathogenesis & Infection Prevention and Control (Jinan University), Ministry of Education, Guangzhou, China
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18
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Sussex J, Smith J, Wu FM. Service innovations for people with multiple long-term conditions: reflections of a rapid evaluation team. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2024; 12:1-76. [PMID: 38940736 DOI: 10.3310/ptru7108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Background People living with multiple long-term conditions represent a significant concern for National Health Service policy and practice, and their care is a major theme in the 2019 National Health Service Long Term Plan. The Birmingham RAND and Cambridge Rapid Evaluation Centre team has undertaken a thematic synthesis of the 10 evaluations it has conducted from 2018 to 2023, exploring the needs, priorities and implications for people with multiple long-term conditions. Objectives The aims for this overarching study were to: (1) build a body of learning about service innovations in primary and community settings for people of all ages with multiple long-term conditions, focused on questions that matter most to people with multimorbidity; and (2) develop methodological insights about how rapid evaluation can be used to inform the scoping, testing and implementation of service innovations for people with multiple long-term conditions. Design The focus on multiple long-term conditions came from a Birmingham RAND and Cambridge Rapid Evaluation Centre prioritisation process undertaken in 2018 using James Lind Alliance methods. Cross-analysis of the findings from the 10 individual rapid evaluations was supplemented by (1) building aspects of multimorbidity into the design of later evaluations; (2) interviewing national and regional stakeholders (n=19) working in or alongside integrated care systems; (3) undertaking a rapid review of evidence on remote monitoring for people with multiple long-term conditions (19 papers included); and (4) testing overall insights with organisations representing patients and carers through a patient, public and professional engagement workshop with 10 participants plus members of the research team. Results While living with multiple long-term conditions is common and is the norm for people over the age of 50 using health and care services, it is not often a focus of health service provision or innovation, nor of research and evaluation activity. We discuss six themes emerging from the totality of the study: (1) our health system is mainly organised around single conditions and not multiple long-term conditions; (2) research calls and studies usually focus on single conditions and associated services; (3) building opportunities for engaged, informed individuals and carers and improved self-management; (4) the importance of measures that matter for patients and carers; (5) barriers to developing and implementing service innovations for people with multiple long-term conditions; and (6) what is needed to make patients with multiple long-term conditions a priority in healthcare planning and delivery. Limitations Care of people with multiple long-term conditions was not the principal focus of several of the rapid evaluations. While this was a finding in itself, it limited our learning about designing and implementing, as well as methodological approaches to evaluating, service innovations for people with multiple long-term conditions. Conclusions Through a thematic analysis of the portfolio of evaluations, we have deduced a set of suggested implications for how the needs of people with multiple long-term conditions can be better embedded in policy, research and practice. Future work Areas of uncertainty related to the care of people with multiple long-term conditions should be further explored, including developing and testing measures of patient experience of (un)co-ordinated care across settings, and interrogating the experience of health and care staff when working with people with multiple long-term conditions, to understand what works. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR134284) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 15. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Jon Sussex
- RAND Europe, Eastbrook House, Cambridge, UK
| | - Judith Smith
- University of Birmingham, Health Services Management Centre, Edgbaston, Birmingham, UK
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19
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Plana-Ripoll O, Chen D, Laustsen LM, Momen NC. The challenges at the core of multimorbidity research. Lancet Psychiatry 2024; 11:399-400. [PMID: 38642561 DOI: 10.1016/s2215-0366(24)00129-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/22/2024]
Affiliation(s)
- Oleguer Plana-Ripoll
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark; National Centre for Register-based Research, Aarhus University, 8200 Aarhus, Denmark
| | - Danni Chen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark
| | - Lisbeth Mølgaard Laustsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark
| | - Natalie C Momen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus University, 8200 Aarhus, Denmark.
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20
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Abufaraj M, Alhalaseh L, Al-Sabbagh MQ, Eyadat Z, Khatib WA, Samara OA, Moonesar IA, Smith L, Al Qutob R. The current status of health care indices and functional independence among older adults: data from HelpAge international-jordan study. Aging Clin Exp Res 2024; 36:124. [PMID: 38811496 PMCID: PMC11136843 DOI: 10.1007/s40520-024-02738-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 03/17/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND Health services should anticipate the changing pattern of illnesses associated with population aging to promote healthy aging. AIM We aimed to evaluate health indices and chronic illnesses and their relationship with functional independence in community Syrian refugees & Jordanian elderly. METHODS A stratified sample of 1,718 community older adults aged ≥ 60-year-old from four major Jordanian governorates was interviewed in this cross-sectional study. Katz Index of Independence in Activities of Daily Living was utilized to assess functional status. Data were analyzed using STATA 15. RESULTS Despite the similarities in baseline function, Syrian refugees had more multimorbidities but less active health insurance, accessibility to healthcare services and availability of medications and medical devices than Jordanians. Two-thirds had multimorbidities; with heart diseases, musculoskeletal conditions, hypertension, and diabetes being the most commonly reported chronic illnesses. Females had significantly more multimorbidities, and functional dependence, yet less education, income and accessibility to healthcare services. The mean Katz Index score was 4.99 ± 1.61. Significant predictors of functional dependence included increasing age, lower level of education, and some chronic illnesses. CONCLUSION National inclusive plans to support vulnerable older adults especially refugees and older women, provide health insurance, enhance access to health care facilities, and manage chronic medical illnesses comprehensively are urgently needed to improve independence of community-living older adults and to promote healthy aging.
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Affiliation(s)
- Mohammad Abufaraj
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, 11942, Jordan.
- Center of strategic studies, The University of Jordan, Amman, Jordan.
| | - Lana Alhalaseh
- Division of Geriatrics, Department of Family and Community Medicine, School of Medicine, The University of Jordan, Amman, Jordan
| | | | - Zaid Eyadat
- Center of strategic studies, The University of Jordan, Amman, Jordan
| | - Walid Al Khatib
- Center of strategic studies, The University of Jordan, Amman, Jordan
| | - Osama A Samara
- Department of Radiology and nuclear medicine, University Hospital, The University of Jordan, Amman, Jordan
| | - Immanuel Azaad Moonesar
- Health Administration & Policy, Mohammed Bin Rashid School of Government, Dubai, United Arab Emirates
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Raeda Al Qutob
- Department of Family and Community Medicine, School of medicine, The University of Jordan, Amman, Jordan
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21
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Triolo F, Vetrano DL, Trevisan C, Sjöberg L, Calderón-Larrañaga A, Belvederi Murri M, Fratiglioni L, Dekhtyar S. Mapping 15-year depressive symptom transitions in late life: population-based cohort study. Br J Psychiatry 2024:1-7. [PMID: 38812455 DOI: 10.1192/bjp.2024.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND The longitudinal course of late-life depression remains under-studied. AIMS To describe transitions along the depression continuum in old age and to identify factors associated with specific transition patterns. METHOD We analysed 15-year longitudinal data on 2745 dementia-free persons aged 60+ from the population-based Swedish National Study on Aging and Care in Kungsholmen. Depression (minor and major) was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision; subsyndromal depression (SSD) was operationalised as the presence of ≥2 symptoms without depression. Multistate survival models were used to map depression transitions, including death, and to examine the association of psychosocial (social network, connection and support), lifestyle (smoking, alcohol consumption and physical activity) and clinical (somatic disease count) factors with transition patterns. RESULTS Over the follow-up, 19.1% had ≥1 transitions across depressive states, while 6.5% had ≥2. Each additional somatic disease was associated with a higher hazard of progression from no depression (No Dep) to SSD (hazard ratio 1.09; 1.07-1.10) and depression (Dep) (hazard ratio 1.06; 1.04-1.08), but also with a lower recovery (HRSSD-No Dep 0.95; 0.93-0.97 [where 'HR' refers to 'hazard ratio']; HRDep-No Dep 0.96; 0.93-0.99). Physical activity was associated with an increased hazard of recovery to no depression from SSD (hazard ratio 1.49; 1.28-1.73) and depression (hazard ratio 1.20; 1.00-1.44), while a richer social network was associated with both higher recovery from (HRSSD-No Dep 1.44; 1.26-1.66; HRDep-No Dep 1.51; 1.34-1.71) and lower progression hazards to a worse depressive state (HRNo Dep-SSD 0.81; 0.70-0.94; HRNo Dep-Dep 0.58; 0.46-0.73; HRSSD-Dep 0.66; 0.44-0.98). CONCLUSIONS Older people may present with heterogeneous depressive trajectories. Targeting the accumulation of somatic diseases and enhancing social interactions may be appropriate for both depression prevention and burden reduction, while promoting physical activity may primarily benefit recovery from depressive disorders.
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Affiliation(s)
- Federico Triolo
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Caterina Trevisan
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Department of Medical Sciences, University of Ferrara, Italy
| | - Linnea Sjöberg
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Martino Belvederi Murri
- Institute of Psychiatry, Department of Neuroscience and Rehabilitation, University of Ferrara, Italy
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden; and Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Serhiy Dekhtyar
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden
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Chen X, Geng S, Zhu Y, Li Q, Li Y, Yuan H, Jiang H. Impact of infection on healthcare costs and clinical outcomes in elderly hospitalized patients with multimorbidity. Heliyon 2024; 10:e31560. [PMID: 38826722 PMCID: PMC11141361 DOI: 10.1016/j.heliyon.2024.e31560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 09/10/2023] [Accepted: 05/17/2024] [Indexed: 06/04/2024] Open
Abstract
Background Elderly patients with multimorbidity are at higher risk of greater healthcare costs and poor outcomes due to decreased physical function. The aim of this study was to investigate the impact of infection on healthcare costs and poor outcomes in elderly hospitalized patients with multimorbidity. Methods We retrospectively enrolled 264 patients who met the inclusion criteria from the department of geriatrics of a large public hospital in Shanghai, China between January 2020 and December 2020. Patients were divided into two groups based on whether they had infection [infection present on admission (IPOA) or healthcare-associated infection(HAI)]. We recorded the basic information and follow-up information of all patients. The follow-up information included 30-day and 1-year all-cause readmission and mortality. Then we analyzed the association between infection and healthcare costs and clinical outcomes. Results Among 264 subjects, 47.73 % of them achieved IPOA or HAI. The 30-day poor outcomes rate was 45.45 %, and the 1-year poor outcomes rate was 78.41 %. Compared with subjects without infection, the number of drugs and the disease burden were greater in subjects with infection(P < 0.001). Subjects with infection had longer length of hospital stay(P < 0.001) and had greater healthcare cost(P < 0.001). Moreover, subjects with infection had higher poor outcomes rates of 30-day and 1-year(P < 0.001). Infection could predict greater total cost [odds ratio (OR): 1.32, 95 % CI: 1.18,1.49,P < 0.001], nursing cost(OR: 11.45, 95 % CI: 3.49,37.63,P < 0.001), and medicine cost (OR: 2.37, 95 % CI: 1.70,3.31,P < 0.001). In addition, infection was also independently associated with the 30-day poor outcomes rate(OR:3.07, 95%CI: 1.80,5.24,P < 0.001), but we found no association between infection and 1-year poor outcomes rate(OR:1.43, 95 % CI:0.73,2.79,P = 0.300) after adjustment. Conclusions Infection was a risk factor for higher healthcare cost and 30-day poor outcome rate in elderly hospitalized patients with multimorbidity.
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Affiliation(s)
- Xin Chen
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shasha Geng
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yingqian Zhu
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qingqing Li
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Li
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huixiao Yuan
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hua Jiang
- Department of Geriatrics, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
- Department of General Practice, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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23
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Chen C, Zheng X, Liao S, Chen S, Liang M, Tang K, Yin M, Liu H, Ni J. The diabetes mellitus multimorbidity network in hospitalized patients over 50 years of age in China: data mining of medical records. BMC Public Health 2024; 24:1433. [PMID: 38811975 PMCID: PMC11134652 DOI: 10.1186/s12889-024-18887-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 05/20/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE Many diabetes mellitus (DM) patients suffer from multimorbidity. Understanding the DM multimorbidity network should be given priority. The purpose of this study is characterize the DM multimorbidity network in people over 50 years. METHODS Data on 75 non-communicable diseases (NCDs) were extracted from electronic medical records of 309,843 hospitalized patients older than 50 years who had at least one NCD. The association rules analysis was used as a novel classification method and combined with the Chi-square tests to identify associations between NCDs and DM. RESULT A total of 12 NCDs were closely related to DM, {cholelithiasis, DM} was an unexpected combination. {dyslipidemia, DM} and {gout, DM} had the largest lift in the male and female groups, respectively. The negative related group included 7 NCDs. There were 9 NCDs included in the strong association rules. Most combinations were different by age and sex. In males, the strongest rule was {peripheral vascular disease (PVD), dyslipidemia, DM}, while {hypertension, dyslipidemia, chronic liver disease (CLD), DM} was the strongest in females. In patients younger than 70 years, hypertension, CLD, and dyslipidemia were the most dominant NCDs in the DM multimorbidity network. In patients 70 years or older, chronic kidney disease (CKD), CVD, CHD, and heart disease (HD) frequently co-occurred with DM. CONCLUSION Future primary healthcare policies for DM should be formulated based on age and sex. In patients younger than 70 years, more attention to hypertension, CLD, and dyslipidemia is required, while attention to CKD, CVD, CHD and HD is needed in patients older than 70 years.
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Affiliation(s)
- Chao Chen
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Xueting Zheng
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Shaobing Liao
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
- Department of Epidemiology and Health Statistics, School of Public Health, Guangdong Medical University, Dongguan, Guangdong, China
| | - Shimin Chen
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
| | - Minyi Liang
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
| | - Kang Tang
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
| | - Mingjuan Yin
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
| | - Huansheng Liu
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China
| | - Jindong Ni
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, No.1 Xincheng Road, Songshan Lake, Dongguan, 523808, Guangdong, China.
- Maternal and Child Research Institute, Shunde Women and Children's Hospital, Guangdong Medical University, Foshan, China.
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24
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Lammila-Escalera E, Greenfield G, Aldakhil R, Zaman H, Neves AL, Majeed A, Wj Hayhoe B. Structured medication reviews for adults with multimorbidity and polypharmacy in primary care: a systematic review protocol. BMJ Open 2024; 14:e082825. [PMID: 38806416 PMCID: PMC11138296 DOI: 10.1136/bmjopen-2023-082825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 05/10/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Polypharmacy is common among individuals with multimorbidity, often leading to inappropriate medication use and is associated with an increased risk of frailty, hospitalisation and mortality. Structured medication reviews (SMRs) have emerged as a promising method for optimising medication use. However, research examining their efficacy is limited. This review aims to evaluate the impact of SMRs on improving outcomes for adults with multimorbidity and polypharmacy in primary care settings. Additionally, this review seeks to identify prevailing patterns and trends in the mode of delivery of SMRs. METHODS AND ANALYSIS A systematic review will be conducted using Ovid MEDLINE, Ovid EMBASE, Web of Science and CINAHL (1997-present). Primary outcomes will include medication-related measures such as dose, frequency and dosage form. Secondary outcomes under investigation will include physical, mental, functional and health service outcomes, as reported. Two independent reviewers will conduct the screening and data extraction, resolving disagreements through discussion. Once eligible studies are identified, the extracted data will be summarised in tabular format. The risk of bias in the articles will be assessed using either the Cochrane Risk of Bias 2 tool or the Newcastle-Ottawa scale, depending on the design of the studies retrieved. Subgroup analysis will be performed using demographic variables and modes of delivery where the data supports. If appropriate, a meta-analysis of the data extracted will be conducted to determine the impact of the SMRs on reported outcomes. If a meta-analysis is not possible due to heterogeneity, a narrative synthesis approach will be adopted. ETHICS AND DISSEMINATION This proposed review is exempt from ethical approval as it aims to collate and summarise peer-reviewed, published evidence. This protocol and the subsequent review will be disseminated in peer-reviewed journals, conferences and patient-led lay summaries. PROSPERO REGISTRATION NUMBER CRD42023454965.
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Affiliation(s)
| | - Geva Greenfield
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Reham Aldakhil
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Hadar Zaman
- School of Pharmacy and Medical Sciences, University of Bradford, Bradford, UK
| | - Ana Luisa Neves
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Benedict Wj Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London, UK
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25
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Guerrero-Menéndez R, Fontán-Vinagre G, Cobos-Serrano JL, Ayuso-Murillo D. The advancement of critical care nursing as a response to the current demands. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00017-X. [PMID: 38806311 DOI: 10.1016/j.enfie.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/22/2024] [Indexed: 05/30/2024]
Abstract
The current demand on health services requires that nurses play a key role, by adapting their competencies to different fields and complexity levels. The approach of situations presented by critically ill patients underpins the need for development of specialised competencies in specific areas such as patient safety, prevention and control of healthcare-associated infections, performance of specific techniques and interventions, autonomous medication management or the use of technology, among others. Spain relies on a specialist training programme that is unique worldwide. Training admission is managed through a contract as a "Resident Nurse Intern" (EIR, Enfermera Interna Residente), provided by regional healthcare services. Only 6 specialities have been established and developed, in an uneven manner and with a short provision of places, annually. Given that the specialization in critical care nursing does not exist, nurses usually self-fund their postgraduate training to enhance their opportunities career development. The development of a speciality for critical care nursing is a priority. The models proposed advocate for creating nursing roles that could cover the systemic gaps through the expansion of their competencies and the introduction of procedures that fit nursing into advanced practice, which could be achieved through Advanced Accreditation Diplomas. Simultaneously, it would be convenient to analyse how and why such a dynamic discipline in some countries became stuck in anachronistic models of the Spanish healthcare system. This analysis might contribute to move forward on the development of areas of improvement in terms of service access and quality of care.
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Affiliation(s)
- R Guerrero-Menéndez
- Instituto Español de Investigación Enfermera, Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain.
| | - G Fontán-Vinagre
- Instituto Español de Investigación Enfermera, Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain
| | - J L Cobos-Serrano
- Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain
| | - D Ayuso-Murillo
- Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain
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26
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Strayer N, Vessels T, Choi K, Zhang S, Li Y, Han L, Sharber B, Hsi RS, Bejan CA, Bick AG, Balko JM, Johnson DB, Wheless LE, Wells QS, Philips EJ, Pulley JM, Self WH, Chen Q, Hartert T, Wilkins CH, Savona MR, Shyr Y, Roden DM, Smoller JW, Ruderfer DM, Xu Y. Interoperability of phenome-wide multimorbidity patterns: a comparative study of two large-scale EHR systems. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.03.28.24305045. [PMID: 38585743 PMCID: PMC10996752 DOI: 10.1101/2024.03.28.24305045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Background Electronic health records (EHR) are increasingly used for studying multimorbidities. However, concerns about accuracy, completeness, and EHRs being primarily designed for billing and administrative purposes raise questions about the consistency and reproducibility of EHR-based multimorbidity research. Methods Utilizing phecodes to represent the disease phenome, we analyzed pairwise comorbidity strengths using a dual logistic regression approach and constructed multimorbidity as an undirected weighted graph. We assessed the consistency of the multimorbidity networks within and between two major EHR systems at local (nodes and edges), meso (neighboring patterns), and global (network statistics) scales. We present case studies to identify disease clusters and uncover clinically interpretable disease relationships. We provide an interactive web tool and a knowledge base combining data from multiple sources for online multimorbidity analysis. Findings Analyzing data from 500,000 patients across Vanderbilt University Medical Center and Mass General Brigham health systems, we observed a strong correlation in disease frequencies (Kendall's τ = 0.643) and comorbidity strengths (Pearson ρ = 0.79). Consistent network statistics across EHRs suggest similar structures of multimorbidity networks at various scales. Comorbidity strengths and similarities of multimorbidity connection patterns align with the disease genetic correlations. Graph-theoretic analyses revealed a consistent core-periphery structure, implying efficient network clustering through threshold graph construction. Using hydronephrosis as a case study, we demonstrated the network's ability to uncover clinically relevant disease relationships and provide novel insights. Interpretation Our findings demonstrate the robustness of large-scale EHR data for studying phenome-wide multimorbidities. The alignment of multimorbidity patterns with genetic data suggests the potential utility for uncovering shared biology of diseases. The consistent core-periphery structure offers analytical insights to discover complex disease interactions. This work also sets the stage for advanced disease modeling, with implications for precision medicine. Funding VUMC Biostatistics Development Award, the National Institutes of Health, and the VA CSRD.
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Affiliation(s)
- Nick Strayer
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tess Vessels
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Digital Genomic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karmel Choi
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
| | - Siwei Zhang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yajing Li
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lide Han
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Digital Genomic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Brian Sharber
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Ryan S Hsi
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cosmin A Bejan
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexander G. Bick
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin M Balko
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Douglas B Johnson
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lee E Wheless
- Tennessee Valley Health System VA Hospital, Nashville, TN, USA
- Department of Dermatology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn S Wells
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Elizabeth J Philips
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Institute for Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia
| | - Jill M Pulley
- Department of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Wesley H Self
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Qingxia Chen
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tina Hartert
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Consuelo H Wilkins
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael R Savona
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yu Shyr
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Dan M Roden
- Department of Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jordan W Smoller
- Psychiatric & Neurodevelopmental Genetics Unit, Center for Genomic Medicine, Massachusetts General Hospital, Boston MA
- Center for Precision Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston MA
- Stanley Center for Psychiatric Research, Broad Institute, Cambridge, MA
| | - Douglas M Ruderfer
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA
- Center for Digital Genomic Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Yaomin Xu
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
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Ho VWT, Ling NMW, Anbarasan D, Chan YH, Merchant RA. Proof-of-concept for an automatable mortality prediction scoring in hospitalised older adults. Front Med (Lausanne) 2024; 11:1329107. [PMID: 38846139 PMCID: PMC11153690 DOI: 10.3389/fmed.2024.1329107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 04/24/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction It is challenging to prognosticate hospitalised older adults. Delayed recognition of end-of-life leads to failure in delivering appropriate palliative care and increases healthcare utilisation. Most mortality prediction tools specific for older adults require additional manual input, resulting in poor uptake. By leveraging on electronic health records, we aim to create an automatable mortality prediction tool for hospitalised older adults. Methods We retrospectively reviewed electronic records of general medicine patients ≥75 years at a tertiary hospital between April-September 2021. Demographics, comorbidities, ICD-codes, age-adjusted Charlson Comorbidity Index (CCI), Hospital Frailty Risk Score, mortality and resource utilization were collected. We defined early deaths, late deaths and survivors as patients who died within 30 days, 1 year, and lived beyond 1 year of admission, respectively. Multivariate logistic regression analyses were adjusted for age, gender, race, frailty, and CCI. The final prediction model was created using a stepwise logistic regression. Results Of 1,224 patients, 168 (13.7%) died early and 370 (30.2%) died late. From adjusted multivariate regression, risk of early death was significantly associated with ≥85 years, intermediate or high frail risk, CCI > 6, cardiovascular risk factors, AMI and pneumonia. For late death, risk factors included ≥85 years, intermediate frail risk, CCI >6, delirium, diabetes, AMI and pneumonia. Our mortality prediction tool which scores 1 point each for age, pneumonia and AMI had an AUC of 0.752 for early death and 0.691 for late death. Conclusion Our mortality prediction model is a proof-of-concept demonstrating the potential for automated medical alerts to guide physicians towards personalised care for hospitalised older adults.
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Affiliation(s)
- Vanda W. T. Ho
- Division of Geriatric Medicine, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Natalie M. W. Ling
- Division of Geriatric Medicine, Department of Medicine, National University Health System, Singapore, Singapore
| | - Denishkrshna Anbarasan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yiong Huak Chan
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Reshma Aziz Merchant
- Division of Geriatric Medicine, Department of Medicine, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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李 雨, 王 瑗, 袁 泉. [Latest Findings on the Role of α-Ketoglutarate in Metabolic Syndrome]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2024; 55:783-792. [PMID: 38948289 PMCID: PMC11211801 DOI: 10.12182/20240560302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Indexed: 07/02/2024]
Abstract
Alpha-ketoglutarate (α-KG), an endogenous intermediate of the tricarboxylic acid cycle, is involved in a variety of cellular metabolic pathways. It serves as an energy donor, a precursor of amino acid biosynthesis, and an epigenetic regulator. α-KG plays physiological functions in immune regulation, oxidative stress, and anti-aging as well. In recent years, it has been reported that the level of α-KG in the body is closely associated with metabolic syndrome, including obesity, hyperglycemia, and other pathological factors. Exogenous supplementation of α-KG improves obesity, blood glucose levels, and cardiovascular disease risks associated with metabolic syndrome. Furthermore, α-KG regulates the common pathological mechanisms of metabolic syndrome, suggesting the potential application prospect of α-KG in metabolic syndrome. In order to provide a theoretical basis for further exploration of the application of α-KG in metabolic syndrome, we focused on α-KG and metabolic syndrome in this article and summarized the latest research progress in the role of α-KG in improving the pathological condition and disease progression of metabolic syndrome. For the next step, researchers may focus on the co-pathogenesis of metabolic syndrome and investigate whether α-KG can be used to achieve the therapeutic goal of "homotherapy for heteropathy" in the treatment of metabolic syndrome.
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Affiliation(s)
- 雨含 李
- 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心 四川大学华西口腔医院 种植科 (成都 610041)State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Dental Implant, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - 瑗 王
- 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心 四川大学华西口腔医院 种植科 (成都 610041)State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Dental Implant, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
| | - 泉 袁
- 口腔疾病防治全国重点实验室 国家口腔医学中心 国家口腔疾病临床医学研究中心 四川大学华西口腔医院 种植科 (成都 610041)State Key Laboratory of Oral Diseases, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Department of Dental Implant, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, China
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Anthonimuthu DJ, Hejlesen O, Zwisler ADO, Udsen FW. Application of Machine Learning in Multimorbidity Research: Protocol for a Scoping Review. JMIR Res Protoc 2024; 13:e53761. [PMID: 38767948 PMCID: PMC11148516 DOI: 10.2196/53761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/15/2024] [Accepted: 04/02/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Multimorbidity, defined as the coexistence of multiple chronic conditions, poses significant challenges to health care systems on a global scale. It is associated with increased mortality, reduced quality of life, and increased health care costs. The burden of multimorbidity is expected to worsen if no effective intervention is taken. Machine learning has the potential to assist in addressing these challenges since it offers advanced analysis and decision-making capabilities, such as disease prediction, treatment development, and clinical strategies. OBJECTIVE This paper represents the protocol of a scoping review that aims to identify and explore the current literature concerning the use of machine learning for patients with multimorbidity. More precisely, the objective is to recognize various machine learning models, the patient groups involved, features considered, types of input data, the maturity of the machine learning algorithms, and the outcomes from these machine learning models. METHODS The scoping review will be based on the guidelines of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). Five databases (PubMed, Embase, IEEE, Web of Science, and Scopus) are chosen to conduct a literature search. Two reviewers will independently screen the titles, abstracts, and full texts of identified studies based on predefined eligibility criteria. Covidence (Veritas Health Innovation Ltd) will be used as a tool for managing and screening papers. Only studies that examine more than 1 chronic disease or individuals with a single chronic condition at risk of developing another will be included in the scoping review. Data from the included studies will be collected using Microsoft Excel (Microsoft Corp). The focus of the data extraction will be on bibliographical information, objectives, study populations, types of input data, types of algorithm, performance, maturity of the algorithms, and outcome. RESULTS The screening process will be presented in a PRISMA-ScR flow diagram. The findings of the scoping review will be conveyed through a narrative synthesis. Additionally, data extracted from the studies will be presented in more comprehensive formats, such as charts or tables. The results will be presented in a forthcoming scoping review, which will be published in a peer-reviewed journal. CONCLUSIONS To our knowledge, this may be the first scoping review to investigate the use of machine learning in multimorbidity research. The goal of the scoping review is to summarize the field of literature on machine learning in patients with multiple chronic conditions, highlight different approaches, and potentially discover research gaps. The results will offer insights for future research within this field, contributing to developments that can enhance patient outcomes. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/53761.
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Affiliation(s)
| | - Ole Hejlesen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gistrup, Denmark
| | - Ann-Dorthe Olsen Zwisler
- Clinic for Rehabilitation and Palliative Medicine, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Witt Udsen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Gistrup, Denmark
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Wang X, Zhang T, Gu X, Xu L, Li F, Zhai Y, Wu M, Lin J. Depressive symptoms and associated factors among older patients with arthritis: evidence from a community-based study in eastern China. Front Public Health 2024; 12:1375106. [PMID: 38827624 PMCID: PMC11140034 DOI: 10.3389/fpubh.2024.1375106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/24/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction Depressive symptoms are often experienced by patients with arthritis and are correlated with poor health outcomes. However, the association between depressive symptoms and multidimensional factors (sociodemographic characteristics, health conditions, health behaviors, and social support) among older patients with arthritis in China remains poorly understood. This study aimed to explore the prevalence of depressive symptoms in older patients with arthritis in eastern China and identify the associated factors. Methods We analyzed data of 1,081 older patients with arthritis using secondary data from 2014 to 2020 from a community-based ongoing study initiated in 2014 in eastern China. The prevalence of depressive symptoms was calculated, and univariate and multilevel logistic regression analyses were used to identify the associated factors. Results The mean age of older patients with arthritis was 69.16 ± 7.13 years; 42.92% were men and 57.08% were women. The prevalence of depressive symptoms in older patients with arthritis was 14.99% (95% confidence interval: 12.91-17.26%), about 1.8 times higher than that in older adults without arthritis (8.49%, p < 0.001). Multilevel logistic regression identified perception of poor economic status (odds ratio [OR] = 5.52, p < 0.001), multimorbidity (OR = 1.96, p = 0.001), limitations in activities of daily living (OR = 2.36, p = 0.004), and living alone (OR = 3.13, p = 0.026) as factors positively associated with depressive symptoms. Patients diagnosed with arthritis at an older age had lower odds of experiencing depressive symptoms (OR = 0.67, p = 0.046). Conclusion Screening for depressive symptoms is essential among older patients with arthritis, especially those who perceive themselves as having a poor economic status, are diagnosed at an earlier age, have multimorbidity, have limitations in activities of daily living, and live alone. The associations of age at arthritis diagnosis and dietary behaviors with depressive symptoms require further research.
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Affiliation(s)
| | | | | | | | | | | | | | - Junfen Lin
- Department of Public Health Surveillance and Advisory, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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Ioakeim-Skoufa I, González-Rubio F, Aza-Pascual-Salcedo M, Laguna-Berna C, Poblador-Plou B, Vicente-Romero J, Coelho H, Santos-Mejías A, Prados-Torres A, Moreno-Juste A, Gimeno-Miguel A. Multimorbidity patterns and trajectories in young and middle-aged adults: a large-scale population-based cohort study. Front Public Health 2024; 12:1349723. [PMID: 38818448 PMCID: PMC11137269 DOI: 10.3389/fpubh.2024.1349723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 05/06/2024] [Indexed: 06/01/2024] Open
Abstract
Introduction The presence of multiple chronic conditions, also referred to as multimorbidity, is a common finding in adults. Epidemiologic research can help identify groups of individuals with similar clinical profiles who could benefit from similar interventions. Many cross-sectional studies have revealed the existence of different multimorbidity patterns. Most of these studies were focused on the older population. However, multimorbidity patterns begin to form at a young age and can evolve over time following distinct multimorbidity trajectories with different impact on health. In this study, we aimed to identify multimorbidity patterns and trajectories in adults 18-65 years old. Methods We conducted a retrospective longitudinal epidemiologic study in the EpiChron Cohort, which includes all inhabitants of Aragón (Spain) registered as users of the Spanish National Health System, linking, at the patient level, information from electronic health records from both primary and specialised care. We included all 293,923 patients 18-65 years old with multimorbidity in 2011. We used cluster analysis at baseline (2011) and in 2015 and 2019 to identify multimorbidity patterns at four and eight years of follow-up, and we then created alluvial plots to visualise multimorbidity trajectories. We performed age- and sex-adjusted logistic regression analysis to study the association of each pattern with four- and eight-year mortality. Results We identified three multimorbidity patterns at baseline, named dyslipidaemia & endocrine-metabolic, hypertension & obesity, and unspecific. The hypertension & obesity pattern, found in one out of every four patients was associated with a higher likelihood of four- and eight-year mortality (age- and sex-adjusted odds ratio 1.11 and 1.16, respectively) compared to the unspecific pattern. Baseline patterns evolved into different patterns during the follow-up. Discussion Well-known preventable cardiovascular risk factors were key elements in most patterns, highlighting the role of hypertension and obesity as risk factors for higher mortality. Two out of every three patients had a cardiovascular profile with chronic conditions like diabetes and obesity that are linked to low-grade systemic chronic inflammation. More studies are encouraged to better characterise the relatively large portion of the population with an unspecific disease pattern and to help design and implement effective and comprehensive strategies towards healthier ageing.
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Affiliation(s)
- Ignatios Ioakeim-Skoufa
- Department of Drug Statistics, Division of Health Data and Digitalisation, Norwegian Institute of Public Health, Oslo, Norway
- Emerging Technologies Advisory Group, ISACA, Chicago, IL, United States
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Drug Utilisation Work Group, Spanish Society of Family and Community Medicine (semFYC), Barcelona, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Department of Pharmacology, Physiology, and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Francisca González-Rubio
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Drug Utilisation Work Group, Spanish Society of Family and Community Medicine (semFYC), Barcelona, Spain
| | - Mercedes Aza-Pascual-Salcedo
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Primary Care Pharmacy Service Zaragoza III, Aragon Health Service (SALUD), Zaragoza, Spain
| | - Clara Laguna-Berna
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
| | - Beatriz Poblador-Plou
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Jorge Vicente-Romero
- Department of Pharmacology, Physiology, and Legal and Forensic Medicine, Faculty of Medicine, University of Zaragoza, Zaragoza, Spain
| | - Helena Coelho
- Tondela-Viseu Hospital Centre, Viseu, Portugal
- Specialised Section for Regulatory Affairs & Quality, Portuguese Society of Health Care Pharmacists (SPFCS), Coimbra, Portugal
| | - Alejandro Santos-Mejías
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
| | - Alexandra Prados-Torres
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
| | - Aida Moreno-Juste
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
- Aragon Health Service (SALUD), Zaragoza, Spain
| | - Antonio Gimeno-Miguel
- EpiChron Research Group on Chronic Diseases, Aragon Health Sciences Institute (IACS), Aragon Health Research Institute (IIS Aragón), Miguel Servet University Hospital, Zaragoza, Spain
- Research Network on Chronicity, Primary Care, and Health Promotion (RICAPPS), Institute of Health Carlos III (ISCIII), Madrid, Spain
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Soares ACDO, Petarli GB, Cattafesta M, dos Santos Neto ET, Salaroli LB. Complex multimorbidity in hemodialysis patients: Study in a metropolitan region in Brazil. PLoS One 2024; 19:e0303068. [PMID: 38753673 PMCID: PMC11098310 DOI: 10.1371/journal.pone.0303068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
The objective of this article was to analyze the factors associated with complex multimorbidity (CMM) among hemodialysis patients in a metropolitan region in southeastern Brazil. To this end, a cross-sectional epidemiological survey was carried out with 1,024 individuals in the year 2019. CMM data were collected through the application of a questionnaire to hemodialysis patients. The binary logistic regression model was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) between independent variables and CMM. The prevalence of CMM was 81% and the results indicated that: living in cities with a low rate of general mortality (OR = 0.395, 95%CI = 0.179-0.870), being aged between 18 and 29 (OR = 0.402, 95%CI = 0.196-0.825), having an elementary education (OR = 0.536, 95%CI = 0.290-0.966) and assessing health as good/very good (OR = 0.446, 95%CI = 0.301-0.661) are factors that reduced the chances of having CMM, whereas a longer period of hemodialysis (OR = 1.779 and 95%CI = 1.057-2.997) increased the chances of CMM. The findings show that characteristics of the social and individual context are associated with CMM in hemodialysis patients, signaling the need for public health policies that include monitoring the complex multimorbidity condition among individuals undergoing hemodialysis treatment.
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Affiliation(s)
| | - Glenda Blaser Petarli
- Graduate Program in Collective Health, Federal University of Espírito Santo, Vitória, ES, Brazil
| | - Monica Cattafesta
- Graduate Program in Collective Health, Federal University of Espírito Santo, Vitória, ES, Brazil
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Fu T, Yang YQ, Tang CH, He P, Lei SF. Genetic effects and causal association analyses of 14 common conditions/diseases in multimorbidity patterns. PLoS One 2024; 19:e0300740. [PMID: 38753827 PMCID: PMC11098521 DOI: 10.1371/journal.pone.0300740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/04/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Multimorbidity has become an important health challenge in the aging population. Accumulated evidence has shown that multimorbidity has complex association patterns, but the further mechanisms underlying the association patterns are largely unknown. METHODS Summary statistics of 14 conditions/diseases were available from the genome-wide association study (GWAS). Linkage disequilibrium score regression analysis (LDSC) was applied to estimate the genetic correlations. Pleiotropic SNPs between two genetically correlated traits were detected using pleiotropic analysis under the composite null hypothesis (PLACO). PLACO-identified SNPs were mapped to genes by Functional Mapping and Annotation of Genome-Wide Association Studies (FUMA), and gene set enrichment analysis and tissue differential expression were performed for the pleiotropic genes. Two-sample Mendelian randomization analyses assessed the bidirectional causality between conditions/diseases. RESULTS LDSC analyses revealed the genetic correlations for 20 pairs based on different two-disease combinations of 14 conditions/diseases, and genetic correlations for 10 pairs were significant after Bonferroni adjustment (P<0.05/91 = 5.49E-04). Significant pleiotropic SNPs were detected for 11 pairs of correlated conditions/diseases. The corresponding pleiotropic genes were differentially expressed in the brain, nerves, heart, and blood vessels and enriched in gluconeogenesis and drug metabolism, biotransformation, and neurons. Comprehensive causal analyses showed strong causality between hypertension, stroke, and high cholesterol, which drive the development of multiple diseases. CONCLUSIONS This study highlighted the complex mechanisms underlying the association patterns that include the shared genetic components and causal effects among the 14 conditions/diseases. These findings have important implications for guiding the early diagnosis, management, and treatment of comorbidities.
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Affiliation(s)
- Ting Fu
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
| | - Yi-Qun Yang
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
| | - Chang-Hua Tang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Soochow University, Suzhou, Jiangsu, P. R. China
| | - Pei He
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
| | - Shu-Feng Lei
- Collaborative Innovation Center for Bone and Immunology between Sihong Hospital and Soochow University, Center for Genetic Epidemiology and Genomics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, Jiangsu P. R. China
- Department of Orthopedics, Sihong Hospital, Suzhou, Jiangsu, P. R. China
- Changzhou Geriatric Hospital Affiliated to Soochow University, Changzhou, China
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Batista SRR, Sousa ALL, Nunes BP, Rodrigues RRD, Jardim PCBV. Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity. BMC Geriatr 2024; 24:430. [PMID: 38750413 PMCID: PMC11094868 DOI: 10.1186/s12877-024-05048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In ageing populations, multimorbidity is a complex challenge to health systems, especially when the individuals have both mental and physical morbidities. Although a regular source of primary care (RSPC) is associated with better health outcomes, its relation with health service utilisation in elderly patients with mental-physical multimorbidity (MP-MM) is scarce. OBJECTIVE This study explored the relations among health service utilisation, presence of RSPC and MP-MM among elderly Brazilians. METHODS A national cross-sectional study performed with data from national representative samples from the Brazilian National Health Research (PNS, in Portuguese; Pesquisa Nacional de Saúde) carried out in 2013 with 11,177 elderly Brazilian people. MP-MM was defined as the presence of two or more morbidities, including at least one mental morbidity, and was evaluated using a list of 16 physical and mental morbidities. The RSPC was analysed by the presence of regular font of care in primary care and health service utilisation according to the demand for health services ≤ 15 days, medical consultation ≤ 12 months, and hospitalisation ≤ 1 year. Frequency description of variables and bivariate association were performed using Stata v.15.2 software. RESULTS The majority of individuals was female (56.4%), and their mean age was 69.8 years. The observed prevalence of MP-MM was 12.2%. Individuals with MP-MM had higher utilisation of health services when compared to those without MP-MM. RSPC was present at 36.5% and was higher in women (37.8% vs. 34.9%). There was a lower occurrence of hospitalisation ≤ 1 year among MP-MM individuals with RSPC and without a private plan of health. CONCLUSION Our findings demonstrate that RSPC can be an important component of care in elderly individuals with MP-MM because it was associated with lower occurrence of hospitalisation, mainly in those that have not a private plan of health. Longitudinal studies are necessary to confirm these findings.
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Affiliation(s)
- Sandro Rogério Rodrigues Batista
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil.
- Postgraduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil.
- Postgraduate Program in Public Health, Faculty of Health Sciences, University of Brasília, Brasília, Brazil.
| | - Ana Luiza Lima Sousa
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
| | | | - Rodolfo Rêgo Deusdará Rodrigues
- Postgraduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
- Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - Paulo Cesar Brandão Veiga Jardim
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
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Zhou X, Qin JJ, Li H, Chen J, Zhang Q, Ye X. The effect of multimorbidity patterns on physical and cognitive function in diabetes patients: a longitudinal cohort of middle-aged and older adults in China. Front Aging Neurosci 2024; 16:1388656. [PMID: 38808035 PMCID: PMC11130586 DOI: 10.3389/fnagi.2024.1388656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 04/22/2024] [Indexed: 05/30/2024] Open
Abstract
Background The prevalence of diabetes has increased rapidly, and comorbid chronic conditions are common among diabetes patients. However, little is known about the pattern of multimorbidity in diabetes patients and the effect on physical and cognitive function. This study aimed to assess the disease clusters and patterns of multimorbidity in diabetes patients using a novel latent class analysis (LCA) approach in middle-aged and older adults and explore the association between different clusters of multimorbidity in diabetes and the effect on physical and cognitive function. Methods This national observational study included 1,985 diabetes patients from the four waves of the China Health and Retirement Longitudinal Study (CHARLS) in 2011 to 2018. Thirteen chronic diseases were used in latent class analysis to identify the patterns of multimorbidity in diabetes, which span the cardiovascular, physical, psychological, and metabolic systems. Cognitive function is assessed via a structured questionnaire in three domains: memory, executive function, and orientation. We combined activities of daily living (ADL) with instrumental activities of daily living (IADL) to measure physical function. Linear mixed models and negative binomial regression models were used to analyze the association between patterns of multimorbidity in diabetes and the effect on cognitive function and disability, respectively. Results A sample of 1,985 diabetic patients was identified, of which 1,889 (95.2%) had multimorbidity; their average age was 60.6 years (standard deviation (SD) = 9.5), and 53.1% were women. Three clusters were identified: "cardio-metabolic" (n = 972, 51.5%), "mental-dyslipidemia-arthritis" (n = 584, 30.9%), and "multisystem morbidity" (n = 333, 17.6%). Compared with diabetes alone, the "multisystem morbidity" class had an increased association with global cognitive decline. All patterns of multimorbidity were associated with an increased risk of memory decline and disability; however, the "multisystem morbidity" group also had the strongest association and presented a higher ADL-IADL disability (ratio = 4.22, 95% CI = 2.52, 7.08) and decline in memory Z scores (β = -0.322, 95% CI = -0.550, -0.095, p = 0.0058). Conclusion Significant longitudinal associations between different patterns of multimorbidity in diabetes patients and memory decline and disability were observed in this study. Future studies are needed to understand the underlying mechanisms and common risk factors for multimorbidity in diabetes patients and to propose treatments that are more effective.
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Affiliation(s)
| | | | | | | | - Qing Zhang
- School of Nursing, Department of Geriatric, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xujun Ye
- School of Nursing, Department of Geriatric, Zhongnan Hospital of Wuhan University, Wuhan, China
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Vega-Cabello V, Al Hinai M, Yévenes-Briones H, Caballero FF, Lopez-García E, Baylin A. Plant-Based Diets and Risk of Multimorbidity: The Health and Retirement Study. J Nutr 2024:S0022-3166(24)00240-2. [PMID: 38705471 DOI: 10.1016/j.tjnut.2024.04.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 04/18/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Plant-based diets have gained attention due to their beneficial effects against major chronic diseases, although their association with multimorbidity is mostly unknown. OBJECTIVES We examined the association between the healthful (hPDI) and unhealthful plant-based diet indices (uPDI) with multimorbidity among middle-aged and older adults from the United States. METHODS Data on 4262 adults aged >50 y was obtained from the 2012-2020 Health and Retirement Study (HRS) and 2013 Health Care and Nutrition Study (HCNS). Food consumption was collected at baseline with a food frequency questionnaire and 2 PDIs were derived: the hPDI, with positive scores for healthy plant foods and reverse scores for less healthy plant foods and animal foods; and the uPDI, with only positive scoring for less healthy plant foods. Complex multimorbidity, defined as ≥3 coexistent conditions, was ascertained from 8 self-reported conditions: hypertension, diabetes, cancer, chronic lung disease, heart disease, stroke, arthritis, and depression. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS After a median follow-up of 7.8 y, we documented 1202 incident cases of multimorbidity. Compared with the lowest quartile, higher adherence to the hPDI was inversely associated with multimorbidity (HR for quartile 3: 0.77; 95% CI: 0.62, 0.96 and HR for quartile 4: 0.79; 95% CI, 0.63, 0.98; P-trend = 0.02). In addition, a 10-point increment in the hPDI was associated with a 11% lower incidence of multimorbidity (95% CI: 1, 20%). No significant associations were found for the uPDI after adjusting for sociodemographic and lifestyle factors. CONCLUSIONS Higher adherence to the hPDI was inversely associated with multimorbidity among middle-aged and older adults. Plant-based diets that emphasize consumption of high-quality plant foods may help prevent the development of complex multimorbidity.
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Affiliation(s)
- Veronica Vega-Cabello
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain
| | - Maymona Al Hinai
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States; Department of Food Science and Human Nutrition, Sultan Qaboos University College of Agriculture and Marine Science, Muscat, Oman
| | - Humberto Yévenes-Briones
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain
| | - Francisco Felix Caballero
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain
| | - Esther Lopez-García
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autonoma de Madrid, Madrid, Spain; CIBERESP (CIBER of Epidemiology and Public Health), Instituto de Salud Carlos III, Madrid, Spain; IMDEA-Food Institute, CEI UAM+CSIC, Madrid, Spain
| | - Ana Baylin
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
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Kay RS, Ho L, Clement ND, Duckworth AD, Hall AJ. The incidence of subsequent contralateral hip fracture and factors associated with increased risk: the IMPACT Contralateral Fracture Study. Osteoporos Int 2024; 35:903-909. [PMID: 38448782 DOI: 10.1007/s00198-024-07039-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 02/09/2024] [Indexed: 03/08/2024]
Abstract
Patients who sustain a contralateral hip fracture experience significantly inferior outcomes; however, the incidence and predictors of contralateral hip fracture remain poorly understood. In the present study, 2.5% of patients sustained a contralateral hip fracture within 12 months, and socioeconomic deprivation was associated with reduced risk of contralateral hip fracture. INTRODUCTION Hip fractures are associated with high morbidity and mortality, and patients that sustain a subsequent contralateral fracture experience inferior outcomes. The risk of contralateral fracture is highest within the first year; however, the incidence and associated factors remain poorly understood. The aims were to investigate (i) the incidence of a subsequent contralateral hip fracture within the first year, (ii) identify factors associated with an increased risk of contralateral fracture and (iii) compare early mortality risk after index versus contralateral hip fracture. METHODS This study included all patients aged over 50 years admitted to NHS hospitals in Scotland between 1st March 2020 and 31st December 2020 (n = 5566) as routine activity of the Scottish Hip Fracture Audit (SHFA). Multivariate logistic regression was used to examine factors associated with 30-day mortality, and cox regression was used to identify factors associated with a contralateral fracture. RESULTS During the study period 2.5% (138/5566) of patients sustained a contralateral hip fracture within 12 months of the index hip fracture. Socioeconomic deprivation was inversely associated with increased risk of contralateral fracture (odds ratio 2.64, p < 0.001), whilst advancing age (p = 0.427) and sex (p = 0.265) were not. After adjusting for significant cofounders, there was no significant difference in 30-day mortality following contralateral fracture compared to index fracture (OR 1.22, p = 0.433). CONCLUSION One in 40 (2.5%) hip fracture patients sustained a contralateral fracture within 12 months of their index fracture, and deprivation was associated with a reduced risk of contralateral fracture. No difference in 30-day mortality was found.
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Affiliation(s)
- Robert S Kay
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
| | - Lucas Ho
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Scottish Hip Fracture Audit, Edinburgh, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Andrew J Hall
- Scottish Hip Fracture Audit, Edinburgh, UK
- School of Medicine, University of St Andrews, St Andrews, UK
- Scottish Centres for Orthopaedic Treatment & Innovation in Surgery & Healthcare (SCOTTISH) Network, St Andrews, UK
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Lu H, Dong XX, Li DL, Nie XY, Wang P, Pan CW. Multimorbidity patterns and health-related quality of life among community-dwelling older adults: evidence from a rural town in Suzhou, China. Qual Life Res 2024; 33:1335-1346. [PMID: 38353890 DOI: 10.1007/s11136-024-03608-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The high prevalence of multimorbidity in aging societies has posed tremendous challenges to the healthcare system. The aim of our study was to comprehensively assess the association of multimorbidity patterns and health-related quality of life (HRQOL) among rural Chinese older adults. METHODS This was a cross-sectional study. Data from 4,579 community-dwelling older adults aged 60 years and above was collected by the clinical examination and questionnaire survey. Information on 10 chronic conditions was collected and the 3-Level EQ-5D (EQ-5D-3L) was adopted to measure the HRQOL of older adults. An exploratory factor analysis was performed to determine multimorbidity patterns. Regression models were fitted to explore the associations of multimorbidity patterns with specific health dimensions and overall HRQOL. RESULTS A total of 2,503 (54.7%) participants suffered from multimorbidity, and they reported lower HRQOL compared to those without multimorbidity. Three kinds of multimorbidity patterns were identified including cardiovascular-metabolic diseases, psycho-cognitive diseases and organic diseases. The associations between psycho-cognitive diseases/organic diseases and overall HRQOL assessed by EQ-5D-3L index score were found to be significant (β = - 0.097, 95% CI - 0.110, - 0.084; β = - 0.030, 95% CI - 0.038, - 0.021, respectively), and psycho-cognitive diseases affected more health dimensions. The impact of cardiovascular-metabolic diseases on HRQOL was largely non-significant. CONCLUSION Multimorbidity was negatively associated with HRQOL among older adults from rural China. The presence of the psycho-cognitive diseases pattern or the organic diseases pattern contributed to worse HRQOL. The remarkable negative impact of psycho-cognitive diseases on HRQOL necessiates more attention and relevant medical assistance to older rural adults.
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Affiliation(s)
- Heng Lu
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xing-Xuan Dong
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Dan-Lin Li
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xin-Yi Nie
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China.
- Key Lab of Health Technology Assessment, National Health Commission of the People's Republic of China (Fudan University), Shanghai, China.
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
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Defina S, Woofenden T, Baltramonaityte V, Tiemeier H, Fairchild G, Felix JF, Cecil CAM, Walton E. The role of lifestyle factors in the association between early-life stress and adolescent psycho-physical health: Moderation analysis in two European birth cohorts. Prev Med 2024; 182:107926. [PMID: 38447658 DOI: 10.1016/j.ypmed.2024.107926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/01/2024] [Accepted: 03/02/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Early-life stress (ELS) is an established risk factor for a host of adult mental and physical health problems, including both depression and obesity. Recent studies additionally showed that ELS was associated with an increased risk of comorbidity between mental and physical health problems, already in adolescence. Healthy lifestyle factors, including physical activity, sleep and diet have also been robustly linked to both emotional and physical wellbeing. However, it is yet unclear whether these lifestyle factors may moderate the association between ELS and psycho-physical comorbidity. METHODS We investigated whether (a) participation in physical activity, (b) sleep duration, and (c) adherence to a Mediterranean diet, moderated the relationship between cumulative ELS exposure over the first 10 years of life and psycho-physical comorbidity at the age of 13.5 years. Analyses were conducted in 2022-2023, using data from two large adolescent samples based in the UK (ALSPAC; n = 8428) and The Netherlands (Generation R; n = 4268). RESULTS Exposure to ELS was significantly associated with a higher risk of developing comorbidity, however this association was not modified by any of the three lifestyle factors investigated. Only physical activity was significantly associated with a reduced risk of comorbidity in one cohort (ORALSPAC [95%CI] = 0.73 [0.59;0.89]). CONCLUSIONS In conclusion, while we found some evidence that more frequent physical activity may be associated with a reduction in psycho-physical comorbidity, we did not find evidence in support of the hypothesised moderation effects. However, more research is warranted to examine how these associations may evolve over time.
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Affiliation(s)
- Serena Defina
- Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Tom Woofenden
- Department of Psychology, University of Bath, Bath, United Kingdom
| | | | - Henning Tiemeier
- Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Graeme Fairchild
- Department of Psychology, University of Bath, Bath, United Kingdom
| | - Janine F Felix
- Generation R Study Group, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Paediatrics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Charlotte A M Cecil
- Department of Child and Adolescent Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Molecular Epidemiology, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
| | - Esther Walton
- Department of Psychology, University of Bath, Bath, United Kingdom.
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Siafarikas N. Personalized medicine in old age psychiatry and Alzheimer's disease. Front Psychiatry 2024; 15:1297798. [PMID: 38751423 PMCID: PMC11094449 DOI: 10.3389/fpsyt.2024.1297798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/15/2024] [Indexed: 05/18/2024] Open
Abstract
Elderly patients show us unfolded lives with unique individual characteristics. An increasing life span is associated with increasing physical and mental disease burden. Alzheimer's disease (AD) is an increasing challenge in old age. AD cannot be cured but it can be treated. The complexity of old age and AD offer targets for personalized medicine (PM). Targets for stratification of patients, detection of patients at risk for AD or for future targeted therapy are plentiful and can be found in several omic-levels.
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Affiliation(s)
- Nikias Siafarikas
- Department of Geriatric Psychiatry, Akershus University Hospital, Lørenskog, Norway
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Krishnan JK, Murphy ML, Edgar AS, Aronson KI, Guri A, Gross L, Younger T, Martinez FJ, Safford MM. Perspectives of Black Adults Living with Chronic Obstructive Pulmonary Disease on Barriers to Cardiovascular Disease Prevention. Ann Am Thorac Soc 2024; 21:706-715. [PMID: 38079490 PMCID: PMC11109915 DOI: 10.1513/annalsats.202304-342oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/08/2023] [Indexed: 05/02/2024] Open
Abstract
Rationale: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with chronic obstructive pulmonary disease (COPD). Black women with COPD are at elevated risk of CVD-related mortality compared with White women. CVD risk factors are undertreated in Black men and women. However, barriers to CVD prevention from the perspective of Black individuals living with COPD have not been previously identified. Objectives: To identify barriers and facilitators for CVD prevention among Black individuals living with COPD. Methods: We conducted semistructured interviews with Black participants living with COPD and attending clinics at two urban hospitals. Participants were included if they had physician-confirmed COPD diagnoses and presence of CVD or CVD risk factors. Interviews were conducted until thematic saturation was reached, with additional interviews conducted to confirm saturation. Data were analyzed using thematic analysis, iteratively revising and updating the codebook by consensus of the study team. Codes were grouped into categories, subthemes, and themes. Themes were organized using the social ecological framework into individual, interpersonal, health system, and societal levels. Results: We interviewed 30 participants of mean age 67.8 ± 8.3 years; 17 (57%) were Black women and 13 (43%) were Black men. Individual-level themes were that living with COPD and resultant multimorbidity affects CVD prevention (theme 1) and that self-efficacy and advocacy affect care received (theme 2). At the interpersonal level, supportive relationships facilitate improved access to CVD prevention (theme 3). System-level themes were that health systems are not designed to support patients with COPD and CVD (theme 4) and that health systems do not deliver effective patient education (theme 5). At the societal level, structural barriers and racism prevent access to care and adoption of a healthy lifestyle (theme 6). Conclusions: We identified barriers to CVD prevention at all levels of the socioecological framework for Black individuals living with COPD. To maximize their impact, future interventions to prevent CVD among individuals with COPD can use these findings to target barriers at multiple levels.
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Affiliation(s)
| | - Michaela L. Murphy
- Internal Medicine and
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Miami Health System, Miami, Florida
| | | | | | - Albina Guri
- Pulmonary and Critical Care, Brooklyn Methodist Hospital, Brooklyn, New York
| | - Liam Gross
- Pulmonary and Critical Care, Brooklyn Methodist Hospital, Brooklyn, New York
- Montefiore Nyack Hospital, Nyack, New York; and
| | - Tiffany Younger
- Graduate Center for Social Welfare, City University of New York, New York, New York
| | | | - Monika M. Safford
- Division of General Internal Medicine, Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, New York
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Hounkpatin H, Simpson G, Santer M, Farmer A, Dambha-Miller H. Multiple long-term conditions, loneliness and social isolation: A scoping review of recent quantitative studies. Arch Gerontol Geriatr 2024; 120:105347. [PMID: 38309103 DOI: 10.1016/j.archger.2024.105347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND Multiple long-term conditions (MLTC), loneliness and social isolation are common in older adults. Recent studies have explored the association of MLTC with loneliness and social isolation. This scoping review aimed to map this current evidence and identify gaps in the literature. METHODS A scoping review was conducted following the PRISMA guidelines for scoping reviews. Ovid Medline, Embase, CINAHL, The Cochrane Library, PsycInfo, and Bielefeld Academic Search Engine were searched for studies published between January 2020-April 2023. Quantitative studies, published in any language, that assessed the association of MLTC with loneliness and/or social isolation were included. RESULTS 1827 records were identified and screened. Of these, 17 met inclusion criteria. Most studies were cross-sectional and based on older adults. Studies were conducted in Europe, the US, Canada, and low- and middle-income countries. Ten studies focused on the association between MLTC and loneliness, six assessed the association between MLTC and social isolation and one examined associations with both loneliness and social isolation. Most studies reported a significant cross-sectional association of MLTC with loneliness, but there was weaker evidence for a longitudinal association between MLTC and loneliness and an association between MLTC and social isolation. Studies were heterogenous in terms of measures and definitions of loneliness/social isolation and MLTC, confounders adjusted for, and analytical models used, making comparisons difficult. CONCLUSIONS Further population-based longitudinal studies using consistent measures and methodological approaches are needed to improve understanding of the association of MLTC with both loneliness and social isolation.
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Affiliation(s)
- Hilda Hounkpatin
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK.
| | - Glenn Simpson
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Hajira Dambha-Miller
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education, University of Southampton, UK
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Shao L, Zhu X, Li DL, Wu L, Lu X, Fan Y, Qiao Z, Hou L, Pan CW, Ke C. Quantifying depressive symptoms on incidence of common chronic diseases and multimorbidity patterns in middle-aged and elderly Chinese adults. J Psychiatr Res 2024; 173:340-346. [PMID: 38579479 DOI: 10.1016/j.jpsychires.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Depressive symptoms are highly prevalent and increase risks of various morbidities. However, the extent to which depressive symptoms could account for incidence of these chronic conditions, in particular multimorbidity patterns, remains to be examined and quantified. METHODS For this cohort analysis, we included 9024-14,093 participants aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS). Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the longitudinal associations between depressive symptoms and 13 common chronic diseases and 4 multimorbidity patterns. Population attributable fractions (PAFs) combining the information on both exposure prevalence and risk association were estimated to quantify the magnitude of the burden of these conditions attributable to depressive symptoms. RESULTS Depressive symptoms were associated with increased risks of liver disease, stroke, heart problem, asthma, diabetes, arthritis, kidney disease, chronic lung disease, digestive disease, dyslipidemia, and memory-related disease, and the adjusted HRs (95% CIs) and PAFs (95% CIs) ranged from 1.15 (1.05-1.26) to 1.64 (1.38-1.96) and 5% (0-10%) to 17% (6-28%), respectively. In addition, individuals with depressive symptoms had elevated risks of the cardiometabolic-cancer pattern, the cerebrovascular-memory pattern, the articular-visceral organ pattern, and the respiratory pattern, with respective HRs (95% CIs) of 1.26 (1.11-1.42), 1.34 (1.07-1.69), 1.45 (1.29-1.63), and 2.01 (1.36-2.96), and respective PAFs (95% CIs) of 5% (0-10%), 8% (-4-21%), 12% (7-17%), and 20% (5-35%). CONCLUSION Depressive symptoms contribute substantially to the burden across a broad range of chronic diseases as well as different multimorbidity patterns in middle-aged and older Chinese.
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Affiliation(s)
- Liping Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xiaohong Zhu
- Suzhou Centers for Disease Control and Prevention, Suzhou, China
| | - Dan-Lin Li
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Luying Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Xujia Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Yulong Fan
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Zhengpeng Qiao
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China
| | - Liying Hou
- School of Public Health, North China University of Science and Technology, Tangshan, China.
| | - Chen-Wei Pan
- School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
| | - Chaofu Ke
- Department of Epidemiology and Biostatistics, School of Public Health, Suzhou Medical College of Soochow University, Suzhou, China.
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Gellert P, Brandenburg H, Franke A, Kessler EM, Krupp S, Pantel J, Schramek R, Simm A, Swoboda W, Wurm S, Fuellen G. [Strengthening prevention and health promotion in and for old age]. Z Gerontol Geriatr 2024; 57:199-206. [PMID: 38092985 PMCID: PMC11078798 DOI: 10.1007/s00391-023-02262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/03/2023] [Indexed: 05/09/2024]
Abstract
BACKGROUND Disease prevention and health promotion in and for old age have become increasingly more important. Nevertheless, more (national) research and implementation in practice is needed, as the international comparison shows. OBJECTIVE To develop guiding principles for research and practice on prevention and health promotion in and for old age. MATERIAL AND METHODS As part of an iterative process, members of the German Society of Gerontology and Geriatrics came together in workshops and symposia to formulate key guiding principles and fields of action for prevention and health promotion. RESULTS The following were worked out: 1) prevention and health promotion are useful and possible up to oldest age, 2) prevention and health promotion for advanced age should start early, 3) prevention and health promotion must take into account the diversity and heterogeneity of the life situations of old people, 4) prevention and health promotion promote and demand self-determination and participation, 5) prevention of multiple illnesses must be given greater attention, 6) prevention of the need for long-term care and prevention in long-term care must be treated equally, 7) prevention and health promotion must be thought of in terms of life worlds and across sectors, paying particular attention to aspects of social inequality and a focus on resources, 8) prevention and health promotion and the related research must be interdisciplinary and transdisciplinary and be applied at different levels, from molecular to societal. DISCUSSION The guiding principles outline the focal points of future-oriented ageing, health and healthcare research and open up fields of action but also show the limits of this approach for political decision-makers, researchers and practitioners.
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Affiliation(s)
- Paul Gellert
- Institut für Medizinische Soziologie und Rehabilitationswissenschaft, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Friede Springer - Cardiovascular Prevention Center, Berlin, Deutschland.
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Standort Berlin/Potsdam, Deutschland.
- Einstein Center for Population Diversity, Berlin, Deutschland.
| | - Hermann Brandenburg
- Dekan, Pflegewissenschaftliche Fakultät, Vinzenz Pallotti University Vallendar, Vallendar, Deutschland
| | - Annette Franke
- Gesundheitswissenschaften, Soziale Gerontologie und Methoden und Konzepte der Sozialen Arbeit, Evangelische Hochschule Ludwigsburg, Ludwigsburg, Deutschland
| | - Eva-Marie Kessler
- Department Psychologie, MSB Medical School Berlin, Berlin, Deutschland
| | - Sonja Krupp
- Forschungsgruppe Geriatrie Lübeck, Krankenhaus Rotes Kreuz Lübeck Geriatriezentrum, Lübeck, Deutschland
| | - Johannes Pantel
- Arbeitsbereich Altersmedizin mit Schwerpunkt Psychogeriatrie und klinische Gerontologie, Institut für Allgemeinmedizin, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Deutschland
- Frankfurter Forum für interdisziplinäre Alternsforschung (FFIA), Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Renate Schramek
- Gesundheitsdidaktik, Department of Community Health, Hochschule für Gesundheit Bochum, Bochum, Deutschland
| | - Andreas Simm
- Universitätsklinik und Poliklinik für Herzchirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle, Deutschland
- Klinik und Poliklinik für Herzchirurgie, Martin Luther Universität Halle-Wittenberg, Ernst-Grube Straße 40, 06120, Halle (Saale), Deutschland
| | - Walter Swoboda
- Praxis für Geriatrie und Innere Medizin, Würzburg, Deutschland
- Institut für Biomedizin des Alterns, Nürnberg, Deutschland
| | - Susanne Wurm
- Abteilung für Präventionsforschung und Sozialmedizin, Institut für Community Medicine, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - Georg Fuellen
- Institut für Biostatistik und Informatik in Medizin und Alternsforschung (IBIMA), Universitätsmedizin Rostock, Rostock, Deutschland
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Lim A, Benjasirisan C, Liu X, Ogungbe O, Himmelfarb CD, Davidson P, Koirala B. Social determinants of health and emergency department visits among older adults with multimorbidity: insight from 2010 to 2018 National Health Interview Survey. BMC Public Health 2024; 24:1153. [PMID: 38658873 PMCID: PMC11044401 DOI: 10.1186/s12889-024-18613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Multimorbidity is prevalent among older adults and is associated with adverse health outcomes, including high emergency department (ED) utilization. Social determinants of health (SDoH) are associated with many health outcomes, but the association between SDoH and ED visits among older adults with multimorbidity has received limited attention. This study aimed to examine the association between SDoH and ED visits among older adults with multimorbidity. METHODS A cross-sectional analysis was conducted among 28,917 adults aged 50 years and older from the 2010 to 2018 National Health Interview Survey. Multimorbidity was defined as the presence of two or more self-reported diseases among 10 common chronic conditions, including diabetes, hypertension, asthma, stroke, cancer, arthritis, chronic obstructive pulmonary disease, and heart, kidney, and liver diseases. The SDoH assessed included race/ethnicity, education level, poverty income ratio, marital status, employment status, insurance status, region of residence, and having a usual place for medical care. Logistic regression models were used to examine the association between SDoH and one or more ED visits. RESULTS Participants' mean (± SD) age was 68.04 (± 10.66) years, and 56.82% were female. After adjusting for age, sex, and the number of chronic conditions in the logistic regression model, high school or less education (adjusted odds ratio [AOR]: 1.10, 95% confidence interval [CI]: 1.02-1.19), poverty income ratio below the federal poverty level (AOR: 1.44, 95% CI: 1.31-1.59), unmarried (AOR: 1.19, 95% CI: 1.11-1.28), unemployed status (AOR: 1.33, 95% CI: 1.23-1.44), and having a usual place for medical care (AOR: 1.46, 95% CI 1.18-1.80) was significantly associated with having one or more ED visits. Non-Hispanic Black individuals had higher odds (AOR: 1.28, 95% CI: 1.19-1.38), while non-Hispanic Asian individuals had lower odds (AOR: 0.71, 95% CI: 0.59-0.86) of one or more ED visits than non-Hispanic White individuals. CONCLUSION SDoH factors are associated with ED visits among older adults with multimorbidity. Systematic multidisciplinary team approaches are needed to address social disparities affecting not only multimorbidity prevalence but also health-seeking behaviors and emergent healthcare access.
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Affiliation(s)
- Arum Lim
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA.
| | | | - Xiaoyue Liu
- University of New York Rory Meyers College of Nursing, 433 1st Ave, NY, USA
| | - Oluwabunmi Ogungbe
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA
| | | | - Patricia Davidson
- University of Wollongong, Northfields Ave, Wollongong, NSW, Australia
| | - Binu Koirala
- Johns Hopkins University School of Nursing, 525 N. Wolfe St, Baltimore, MD, USA
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Blasi AM, Derman SHM, Kunnel A, Pape P, Röhrig G, Barbe AG. Oral Health and the Association with Blood Parameters in Neurogeriatric Inpatients without Relevant Systemic Inflammation: An Observational Study. Geriatrics (Basel) 2024; 9:55. [PMID: 38804312 PMCID: PMC11130911 DOI: 10.3390/geriatrics9030055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/29/2024] Open
Abstract
As little evidence is available, we report the oral health of neurogeriatric inpatients and the association with hematological parameters representing systemic health. We performed a cross-sectional investigation of 30 patients undergoing neurogeriatric early rehabilitation and excluded systemic inflammation as a trigger for oral infection (C-reactive protein >5 mg/dL). Outcomes included oral health and hygiene status and routine laboratory parameters. Patients (mean age 79 ± 6 years, mean comorbidities 7 ± 3, and mean Barthel Index at hospital admission 31 ± 18) had impaired oral health (mean 18 ± 7 of their own teeth, elevated plaque indices (2.5 ± 0.4), and bleeding on probing (26 ± 17)), representing short- and long-term reduced oral hygiene. Twenty-four (80%) patients had periodontitis. Laboratory parameters for inflammation, nutrition, and anemia did not correlate with oral health parameters (p > 0.05). The number of teeth correlated moderately with total protein (Spearman's rank correlation coefficient (rs) = 0.524; p = 0.003). Plaque indices correlated weakly with number of teeth (rs = -0.460; p = 0.010) and periodontitis diagnosis (rs = 0.488; p = 0.006). Thus, highly vulnerable neurogeriatric inpatients had reduced oral health and hygiene independent of laboratory parameters, representing a high-risk population for oral health problems even without clinically proven systemic infection. This should be considered in future interprofessional therapy planning.
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Affiliation(s)
- Alicia Maria Blasi
- Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, University of Cologne, D-50923 Cologne, Germany; (A.M.B.); (S.H.M.D.)
| | - Sonja Henny Maria Derman
- Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, University of Cologne, D-50923 Cologne, Germany; (A.M.B.); (S.H.M.D.)
| | - Asha Kunnel
- Clinic for Early Neurological and Interdisciplinary Rehabilitation, St. Marien-Hospital, D-50668 Cologne, Germany; (A.K.); (P.P.)
| | - Pantea Pape
- Clinic for Early Neurological and Interdisciplinary Rehabilitation, St. Marien-Hospital, D-50668 Cologne, Germany; (A.K.); (P.P.)
| | - Gabriele Röhrig
- Department of Health, EUFH-European University of Applied Sciences, D-50996 Cologne, Germany;
| | - Anna Greta Barbe
- Faculty of Medicine and University Hospital Cologne, Polyclinic for Operative Dentistry and Periodontology, University of Cologne, D-50923 Cologne, Germany; (A.M.B.); (S.H.M.D.)
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47
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Xie Z, Liu X, Hu Z, Dong C. Longitudinal association between the dynamic nature of depression with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). BMC Public Health 2024; 24:1121. [PMID: 38654263 DOI: 10.1186/s12889-024-18618-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Depression is associated with an increased risk of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH). Whether the dynamic nature of depression affects the incidence of LUTS/BPH remains unknown. A four-year cohort study based on the China Health and Retirement Longitudinal Study (CHARLS) was conducted to assess their association. METHODS This study included 3433 Chinese men from the CHARLS 2011, representative of > 95 million individuals. All eligible individuals underwent three assessments of LUTS/BPH and depression in 2011, 2013 and 2015. The dynamic nature of depression was classified as acute depression with remission, acute depression with recurrence, or chronic major depression. Weighted, generalized additive analyses with three binomial models were used to investigate the relationship between LUTS/BPH and the dynamic nature of depression. RESULTS During the four-year follow-up, 11.5% (95% confidence interval [95% CI] = 9.5-13.3%) of Chinese men were diagnosed with newly incident LUTS/BPH. Meanwhile, there were 60.6% (95% CI = 58.5-62.7%) of the individuals without depression and 8.9% (95% CI = 7.9-10%) of the individuals with chronic major depression. A total of 25.1% (95% CI = 23.4-26.9%) and 5.4% (95% CI = 4.6-6.3%) of the individuals were categorized as acute depression with remission and recurrence. After weighted, adjusted all included confounding risk factors, chronic major depression (RR = 1.63, 95% CI = 1.14-2.33, P < 0.01) but not acute depression with remission (RR = 1.2, 95% CI = 0.92-1.56, P = 0.18) and recurrence (RR = 1.32, 95% CI = 0.82-2.10, P = 0.26) significantly increased the incidence of LUTS/BPH compared with no depression. The subgroup analysis showed that the above relationships appeared to be evident among Chinese men < 60 years. CONCLUSIONS Our results suggest that the dynamic nature of depression has a different effect on the incidence of LUTS/BPH. The monitoring and treatment of depression are important in preventing LUTS/BPH.
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Affiliation(s)
- Zonglan Xie
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China
| | - Xuebin Liu
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China
| | - Zhigang Hu
- Department of Evidence Based Medicine Center, The First College of Clinical Medicine Science, China Three Gorges University, 443003, Yichang, China
| | - Chuanjiang Dong
- Department of Urology, The First Dongguan Affiliated Hospital, Guangdong Medical University, Jiaoping Road No. 42, 523710, Dongguan, People's Republic of China.
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48
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Ogaz-González R, Corpeleijn E, García-Chanes RE, Gutierréz-Robledo LM, Escamilla-Santiago RA, López-Cervantes M. Assessing the relationship between multimorbidity, NCD configurations, frailty phenotypes, and mortality risk in older adults. BMC Geriatr 2024; 24:355. [PMID: 38649809 PMCID: PMC11034053 DOI: 10.1186/s12877-024-04948-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Older adults are increasingly susceptible to prolonged illness, multiple chronic diseases, and disabilities, which can lead to the coexistence of multimorbidity and frailty. Multimorbidity may result in various noncommunicable disease (NCD) patterns or configurations that could be associated with frailty and death. Mortality risk may vary depending on the presence of specific chronic diseases configurations or frailty. METHODS The aim was to examine the impact of NCD configurations on mortality risk among older adults with distinct frailty phenotypes. The population was analyzed from the Costa Rican Longevity and Healthy Aging Study Cohort (CRELES). A total of 2,662 adults aged 60 or older were included and followed for 5 years. Exploratory factor analysis and various clustering techniques were utilized to identify NCD configurations. The frequency of NCD accumulation was also assessed for a multimorbidity definition. Frailty phenotypes were set according to Fried et al. criteria. Kaplan‒Meier survival analyses, mortality rates, and Cox proportional hazards models were estimated. RESULTS Four different types of patterns were identified: 'Neuro-psychiatric', 'Metabolic', 'Cardiovascular', and 'Mixt' configurations. These configurations showed a higher mortality risk than the mere accumulation of NCDs [Cardiovascular HR:1.65 (1.07-2.57); 'Mixt' HR:1.49 (1.00-2.22); ≥3 NCDs HR:1.31 (1.09-1.58)]. Frailty exhibited a high and constant mortality risk, irrespective of the presence of any NCD configuration or multimorbidity definition. However, HRs decreased and lost statistical significance when phenotypes were considered in the Cox models [frailty + 'Cardiovascular' HR:1.56 (1.00-2.42); frailty + 'Mixt':1.42 (0.95-2.11); and frailty + ≥ 3 NCDs HR:1.23 (1.02-1.49)]. CONCLUSIONS Frailty accompanying multimorbidity emerges as a more crucial indicator of mortality risk than multimorbidity alone. Therefore, studying NCD configurations is worthwhile as they may offer improved risk profiles for mortality as alternatives to straightforward counts.
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Affiliation(s)
- Rafael Ogaz-González
- Department of Public Health, Faculty of Medicine, National Autonomous University of México, Sixth Floor, Building B, 411A Circuito Escolar, Copilco Universidad, Mexico City, Coyoacán, 04360, Mexico
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | - Ricardo Antonio Escamilla-Santiago
- Department of Public Health, Faculty of Medicine, National Autonomous University of México, Sixth Floor, Building B, 411A Circuito Escolar, Copilco Universidad, Mexico City, Coyoacán, 04360, Mexico
| | - Malaquías López-Cervantes
- Department of Public Health, Faculty of Medicine, National Autonomous University of México, Sixth Floor, Building B, 411A Circuito Escolar, Copilco Universidad, Mexico City, Coyoacán, 04360, Mexico.
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Xia W, Luo K, Gu Z, Hu J, Liu X, Xiao Q. Correlational analysis of sarcopenia and multimorbidity among older inpatients. BMC Musculoskelet Disord 2024; 25:309. [PMID: 38649917 PMCID: PMC11034126 DOI: 10.1186/s12891-024-07412-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 04/03/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Sarcopenia and multimorbidity are common in older adults, and most of the available clinical studies have focused on the relationship between specialist disorders and sarcopenia, whereas fewer studies have been conducted on the relationship between sarcopenia and multimorbidity. We therefore wished to explore the relationship between the two. METHODS The study subjects were older patients (aged ≥ 65 years) who were hospitalized at the Department of Geriatrics of the First Affiliated Hospital of Chongqing Medical University between March 2016 and September 2021. Their medical records were collected. Based on the diagnostic criteria of the Asian Sarcopenia Working Group in 2019, the relationship between sarcopenia and multimorbidity was elucidated. RESULTS 1.A total of 651 older patients aged 65 years and above with 2 or more chronic diseases were investigated in this study, 46.4% were suffering from sarcopenia. 2. Analysis of the relationship between the number of chronic diseases and sarcopenia yielded that the risk of sarcopenia with 4-5 chronic diseases was 1.80 times higher than the risk of 2-3 chronic diseases (OR 1.80, 95%CI 0.29-2.50), and the risk of sarcopenia with ≥ 6 chronic diseases was 5.11 times higher than the risk of 2-3 chronic diseases (OR 5.11, 95% CI 2.97-9.08), which remained statistically significant, after adjusting for relevant factors. 3. The Charlson comorbidity index was associated with skeletal muscle mass index, handgrip strength, and 6-meter walking speed, with scores reaching 5 and above suggesting the possibility of sarcopenia. 4. After adjusting for some covariates among 14 common chronic diseases in older adults, diabetes (OR 3.20, 95% CI 2.01-5.09), cerebrovascular diseases (OR 2.07, 95% CI 1.33-3.22), bone and joint diseases (OR 2.04, 95% CI 1.32-3.14), and malignant tumors (OR 2.65, 95% CI 1.17-6.55) were among those that still a risk factor for the development of sarcopenia. CONCLUSION In the hospitalized older adults, the more chronic diseases they have, the higher the prevalence of sarcopenia. When the CCI is 5, attention needs to be paid to the occurrence of sarcopenia in hospitalized older adults.
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Affiliation(s)
- Wenjing Xia
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Kang Luo
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ziwei Gu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jianping Hu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Xintong Liu
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Qian Xiao
- Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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50
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Bastholm-Rahmner P, Bergqvist M, Modig K, Gustafsson LL, Schmidt-Mende K. Homecare workers - an untapped resource in preventing emergency department visits among older individuals? A qualitative interview study from Sweden. BMC Geriatr 2024; 24:350. [PMID: 38637752 PMCID: PMC11027288 DOI: 10.1186/s12877-024-04906-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Older individuals with functional decline and homecare are frequent visitors to emergency departments (ED). Homecare workers (HCWs) interact regularly with their clients and may play a crucial role in their well-being. Therefore, this study explores if and how HCWs perceive they may contribute to the prevention of ED visits among their clients. METHODS In this qualitative study, 12 semi-structured interviews were conducted with HCWs from Sweden between July and November 2022. Inductive thematic analysis was used to identify barriers and facilitators to prevent ED visits in older home-dwelling individuals. RESULTS HCWs want to actively contribute to the prevention of ED visits among clients but observe many barriers that hinder them from doing so. Barriers refer to care organisation such as availability to primary care staff and information transfer; perceived attitudes towards HCWs as co-workers; and client-related factors. Participants suggest that improved communication and collaboration with primary care and discharge information from the ED to homecare services could overcome barriers. Furthermore, they ask for support and geriatric education from primary care nurses which may result in increased respect towards them as competent staff members. CONCLUSIONS HCWs feel that they have an important role in the health management of older individuals living at home. Still, they feel as an untapped resource in the prevention of ED visits. They deem that improved coordination and communication between primary care, ED, and homecare organisations as well as proactive care would enable them to add significantly to the prevention of ED visits.
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Affiliation(s)
- Pia Bastholm-Rahmner
- Academic Primary Healthcare Center, Region Stockholm, Sweden.
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden.
| | - Monica Bergqvist
- Academic Primary Healthcare Center, Region Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Lars L Gustafsson
- Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Schmidt-Mende
- Academic Primary Healthcare Center, Region Stockholm, Sweden
- Department of Neurobiology and Care Sciences and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
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