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Puig-García M, López-Herraiz C, Caicedo-Montaño C, Rivadeneira MF, Vásconez-Donoso J, Montalvo-Villacis G, Benazizi-Dahbi I, Parker LA. Prevalence and factors associated with the use of traditional medicine in individuals with hypercholesterolemia, hyperglycaemia, and arterial hypertension in Ecuador: results from a population-based study in two health districts. BMC Complement Med Ther 2024; 24:363. [PMID: 39375676 PMCID: PMC11460002 DOI: 10.1186/s12906-024-04666-0] [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] [Received: 03/22/2024] [Accepted: 09/27/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND While traditional medicine (TM) is employed by a significant portion of the global population for managing health issues, clinical guidelines and state recommendations often overlook this practice. The aim of this study was to describe the frequency of use of TM to control 3 metabolic risk factors (MRF): hypertension, hypercholesterolemia, and hyperglycaemia; and the sociodemographic, economic, and clinical characteristics associated with the use of TM. METHODS Cross-sectional descriptive study that analyses data obtained from a representative population survey in 2 health districts, one urban in the south of Quito and another in a forested rural area with diverse ethnic groups in Esmeraldas, Ecuador. We include 602 individuals with at least one MRF. We calculated the proportion of people reporting the regular use of TM (herbal or traditional remedy) to control their MRF and we assessed potential associations with sociodemographic, economic, and clinical characteristics with a multivariable logistic regression model. RESULTS In two very different sociocultural contexts in Ecuador we found that use of TM to control MRF was frequent (39.4% in Esmeraldas, 31.1% in Quito), frequently in combination with CM. There is a notable percentage of people, 33.9% in Esmeraldas and 39.0% in Quito, who did not take any treatment for their MRF, and the remainder used CM alone. In both settings, an individual's education lever was significantly associated with TM use. Whereas in Quito individuals with higher education more frequently treated their MRF with TM (aOR 2.04, 95% CI 1.03-3.90), in the rural, hard-to-reach context of Esmeraldas, it was more frequent among people with no formal schooling (aOR: 3.76; 95%CI 1.59-8.88), as well as those of younger age (aOR by year: 0.97; 95% CI 0.95-0.99) and afro ethnicity (aOR: 2.13; 95%CI 1.02-4.45). CONCLUSION Traditional medicine is used by a significant proportion of the population in Ecuador, highlighting the need for a more accessible and intercultural healthcare approach. The health system should ensure access to the necessary information and resources for the management of their metabolic risk factors.
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Affiliation(s)
- Marta Puig-García
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain.
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Carmen López-Herraiz
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain
| | | | - María Fernanda Rivadeneira
- Institute of Public Health, Faculty of Medicine, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | | | - Gregorio Montalvo-Villacis
- School of Medical Specialities, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
| | - Ikram Benazizi-Dahbi
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain
| | - Lucy Anne Parker
- Department of Public Health, Universidad Miguel Hernández de Elche, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Bhuiyan MA, Galdes N, Cuschieri S, Hu P. A comparative systematic review of risk factors, prevalence, and challenges contributing to non-communicable diseases in South Asia, Africa, and Caribbeans. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2024; 43:140. [PMID: 39252085 PMCID: PMC11386079 DOI: 10.1186/s41043-024-00607-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 07/26/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND Non-communicable diseases (NCDs) are a global epidemic challenging global public health authorities while imposing a heavy burden on healthcare systems and economies. AIM To explore and compare the prevalence of NCDs in South Asia, the Caribbean, and non-sub-Saharan Africa, aiming to identify both commonalities and differences contributing to the NCD epidemic in these areas while investigating potential recommendations addressing the NCD epidemic. METHOD A comprehensive search of relevant literature was carried out to identify and appraise published articles systematically using the Cochrane Library, Ovid, Google Scholar, PubMed, Science Direct, and Web of Science search engines between 2010 and 2023. A total of 50 articles fell within the inclusion criteria. RESULTS Numerous geographical variables, such as lifestyle factors, socio-economic issues, social awareness, and the calibre of the local healthcare system, influence both the prevalence and treatment of NCDs. The NCDs contributors in the Caribbean include physical inactivity, poor fruit and vegetable intake, a sedentary lifestyle, and smoking, among others. While for South Asia, these were: insufficient societal awareness of NCDs, poverty, urbanization, industrialization, and inadequate regulation implementation in South Asia. Malnutrition, inactivity, alcohol misuse, lack of medical care, and low budgets are responsible for increasing NCD cases in Africa. CONCLUSION Premature mortality from NCDs can be avoided using efficient treatments that reduce risk factor exposure for individuals and populations. Proper planning, implementation, monitoring, training, and research on risk factors and challenges of NCDs would significantly combat the situation in these regions.
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Affiliation(s)
- Miraj Ahmed Bhuiyan
- School of Economics, Guangdong University of Finance and Economics, Guangzhou, 510320, China.
| | | | - Sarah Cuschieri
- Faculty of Medicine and Surgery, University of Malta, Msida, MSD2080, Malta
- Department of Epidemiology and Biostatistics, Western University, London, Canada
| | - Ping Hu
- School of Economics, Guangdong University of Foreign Studies South China Business College, Research Center of International Economic and Trade Rules, Guangzhou, China
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Agudelo-Botero M, Dávila-Cervantes CA, Giraldo-Rodríguez L. Cardiometabolic multimorbidity in Mexican adults: a cross-sectional analysis of a national survey. Front Med (Lausanne) 2024; 11:1380715. [PMID: 39290394 PMCID: PMC11405330 DOI: 10.3389/fmed.2024.1380715] [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: 02/16/2024] [Accepted: 08/15/2024] [Indexed: 09/19/2024] Open
Abstract
Background Cardiometabolic multimorbidity is a rising phenomenon that has been barely explored in middle-income countries such as Mexico. Objective This study aimed to estimate the prevalence, associated factors, and patterns of cardiometabolic multimorbidity (2 and 3+ diseases) in Mexican adults (≥20 years old) by age group. Methods A cross-sectional and secondary analysis of Mexico's National Health and Nutrition Survey 2018-2019 was conducted. Information on eight diseases and other sociodemographic and health/lifestyle characteristics was obtained through self-reporting. Descriptive analyses were performed, and multinomial logistic regression models were calculated to identify the variables associated with cardiometabolic multimorbidity. Factor analysis and latent classes were estimated to determine disease patterns. Results The prevalence of cardiometabolic multimorbidity for the total population study was 27.6% (13.7% for people with 2 diseases and 13.9% for people with 3+ diseases). By age group, the prevalence of 2+ diseases was 12.5% in the age group of 20-39 years, 35.2% in the age group of 40-59 years, and 44.5% in the age group of 60 years and older. The variables of depressive symptomatology and having functional limitations (1+) were statistically associated with cardiometabolic multimorbidity in almost all age groups. Patterns of cardiometabolic multimorbidity varied among adults in different age groups. Understanding the behavior of cardiometabolic multimorbidity at various stages of adulthood is a resource that could be used to design and implement intervention strategies. Such strategies should correspond to the population's sociodemographic, health, and lifestyle characteristics and the specific disease patterns of each age group.
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Affiliation(s)
- Marcela Agudelo-Botero
- Centro de Investigación en Políticas, Población y Salud, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Lam A, Keenan K, Cézard G, Kulu H, Myrskylä M. Inequalities in Disability-Free and Disabling Multimorbid Life Expectancy in Costa Rica, Mexico, and the United States. J Gerontol B Psychol Sci Soc Sci 2024; 79:gbae093. [PMID: 38785331 PMCID: PMC11227002 DOI: 10.1093/geronb/gbae093] [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: 10/04/2023] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVES To better understand variations in multimorbidity severity over time, we estimate disability-free and disabling multimorbid life expectancy (MMLE), comparing Costa Rica, Mexico, and the United States (US). We also assess MMLE inequalities by sex and education. METHODS Data come from the Costa Rican Study on Longevity and Healthy Aging (2005-2009), the Mexican Health and Aging Study (2012-2018), and the Health and Retirement Study (2004-2018). We apply an incidence-based multistate Markov approach to estimate disability-free and disabling MMLE and stratify models by sex and education to study within-country heterogeneity. Multimorbidity is defined as a count of 2 or more chronic diseases. Disability is defined using limitations in activities of daily living. RESULTS Costa Ricans have the lowest MMLE, followed by Mexicans, then individuals from the US. Individuals from the US spend about twice as long with disability-free multimorbidity compared with individuals from Costa Rica or Mexico. Females generally have longer MMLE than males, with particularly stark differences in disabling MMLE. In the US, higher education was associated with longer disability-free MMLE and shorter disabling MMLE. We identified evidence for cumulative disadvantage in Mexico and the US, where sex differences in MMLE were larger among the lower educated. DISCUSSION Substantial sex and educational inequalities in MMLE exist within and between these countries. Estimating disability-free and disabling MMLE reveals another layer of health inequality not captured when examining disability and multimorbidity separately. MMLE is a flexible population health measure that can be used to better understand the aging process across contexts.
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Affiliation(s)
- Anastasia Lam
- Max Planck Institute for Demographic Research, Rostock, Germany
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Katherine Keenan
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Geneviève Cézard
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Hill Kulu
- School of Geography and Sustainable Development, University of St Andrews, St Andrews, UK
| | - Mikko Myrskylä
- Max Planck Institute for Demographic Research, Rostock, Germany
- Center for Social Data Science and Population Research Unit, University of Helsinki, Helsinki, Finland
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Sammut-Powell C, Sisk R, Silva-Tinoco R, de la Pena G, Almeda-Valdes P, Juarez Comboni SC, Goncalves S, Cameron R. External validation of a minimal-resource model to predict reduced estimated glomerular filtration rate in people with type 2 diabetes without diagnosis of chronic kidney disease in Mexico: a comparison between country-level and regional performance. Front Endocrinol (Lausanne) 2024; 15:1253492. [PMID: 38586458 PMCID: PMC10998449 DOI: 10.3389/fendo.2024.1253492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 02/19/2024] [Indexed: 04/09/2024] Open
Abstract
Background Patients with type 2 diabetes are at an increased risk of chronic kidney disease (CKD) hence it is recommended that they receive annual CKD screening. The huge burden of diabetes in Mexico and limited screening resource mean that CKD screening is underperformed. Consequently, patients often have a late diagnosis of CKD. A regional minimal-resource model to support risk-tailored CKD screening in patients with type 2 diabetes has been developed and globally validated. However, population heath and care services between countries within a region are expected to differ. The aim of this study was to evaluate the performance of the model within Mexico and compare this with the performance demonstrated within the Americas in the global validation. Methods We performed a retrospective observational study with data from primary care (Clinic Specialized in Diabetes Management in Mexico City), tertiary care (Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán) and the Mexican national survey of health and nutrition (ENSANUT-MC 2016). We applied the minimal-resource model across the datasets and evaluated model performance metrics, with the primary interest in the sensitivity and increase in the positive predictive value (PPV) compared to a screen-everyone approach. Results The model was evaluated on 2510 patients from Mexico (primary care: 1358, tertiary care: 735, ENSANUT-MC: 417). Across the Mexico data, the sensitivity was 0.730 (95% CI: 0.689 - 0.779) and the relative increase in PPV was 61.0% (95% CI: 52.1% - 70.8%). These were not statistically different to the regional performance metrics for the Americas (sensitivity: p=0.964; relative improvement: p=0.132), however considerable variability was observed across the data sources. Conclusion The minimal-resource model performs consistently in a representative Mexican population sample compared with the Americas regional performance. In primary care settings where screening is underperformed and access to laboratory testing is limited, the model can act as a risk-tailored CKD screening solution, directing screening resources to patients who are at highest risk.
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Affiliation(s)
| | - Rose Sisk
- Gendius Ltd, Alderley Edge, United Kingdom
| | - Ruben Silva-Tinoco
- Clinic Specialized in the Diabetes Management of the Mexico City Government, Public Health Services of the Mexico City Government, Mexico, City, Mexico
| | - Gustavo de la Pena
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City, Mexico
- Metabolic Diseases Research, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Ferreira BH, de Aguiar RG, Santos EFDS, Cesar CLG, Goldbaum M, Monteiro CN. Physical activity among older adults with multimorbidity: Evidence from a population-based health survey. PLoS One 2024; 19:e0296460. [PMID: 38166094 PMCID: PMC10760873 DOI: 10.1371/journal.pone.0296460] [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: 07/13/2023] [Accepted: 12/13/2023] [Indexed: 01/04/2024] Open
Abstract
INTRODUCTION The promotion of physical activity has been recognized as an important component in the management and prevention of multimorbidity, a condition that is increasing prevalent worldwide, including in Brazil. However, there is a scarcity of studies exploring the disparity in physical activity levels between individuals with and without multimorbidity. Therefore, the study aimed to estimate the prevalence of multimorbidity and physical activity among older adults, as well as analyze the relationship of a sufficient level of physical activity and multimorbidity, while considering sociodemographic characteristics of residents in São Paulo, Brazil. MATERIALS AND METHODS Data from 1.019 participants aged 60 years or older (59.7% female; mean age 69.7±7.7) were collected from the Health Survey (ISA-Capital, 2015) conducted in the city of São Paulo, Brazil. We defined multimorbidity as the presence of two or more chronic conditions, and for physical activity, classified a sufficient level (≥150 min/week). Prevalence Ratios (PR) with 95% Confidence Intervals (95%CI) were estimated using univariate and multivariate Poisson regression to examine the relationship between multimorbidity and sufficient level of physical activity. RESULTS 67.7% of the participants lived with multimorbidity, while 30.1% had achieved a sufficient level of physical activity. There was a higher prevalence of sufficient level of physical activity among older adults with two (PR = 1.38; 95%CI 1.02-1.88) and four (PR = 1.37; 95%CI 1.00-1.87) chronic conditions. Older adults with multimorbidity who were 70 years or older (PR = 1.77; 95%IC 1.13-2.77), female (PR = 1.65; 95%CI 1.16-2.36), without a partner (PR = 1.43; 95%IC 1.03-1.99), and had a per capita income of 1 to 2.5 (PR = 1.83; 95%IC 1.00-3.33) were more likely to achieve a sufficient level of physical activity compared to their peers without multimorbidity. CONCLUSIONS The study highlights sociodemographic disparities in the sufficient level of physical activity among multimorbidity, suggesting the importance of considering these factors when planning public policies aimed at promoting physical activity.
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Affiliation(s)
- Bruno Holanda Ferreira
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil
| | - Ricardo Goes de Aguiar
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo (SP), Brazil
| | | | - Chester Luiz Galvão Cesar
- Departamento de Epidemiologia, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo (SP), Brazil
| | - Moisés Goldbaum
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil
| | - Camila Nascimento Monteiro
- Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, São Paulo (SP), Brazil
- Hospital Sírio-Libanês, São Paulo (SP), Brazil
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Alonso-Castro AJ. Special Issue "Ethnopharmacology in Latin America". Pharmaceuticals (Basel) 2023; 16:1189. [PMID: 37764997 PMCID: PMC10538167 DOI: 10.3390/ph16091189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 08/18/2023] [Indexed: 09/29/2023] Open
Abstract
Latin America is a multicultural region encompassing 43 countries, with 665 million inhabitants with a mean age of 31 years old, 84% of whom live in urban areas [...].
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Affiliation(s)
- Angel Josabad Alonso-Castro
- Departamento de Farmacia, Universidad de Guanajuato, Noria Alta, Colonia Noria Alta Guanajuato, Guanajuato 36250, Mexico
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Rodrigues LP, França DG, Vissoci JRN, Caruzzo NM, Batista SR, de Oliveira C, Nunes BP, Silveira EA. Associations of hospitalisation - admission, readmission and length to stay - with multimorbidity patterns by age and sex in adults and older adults: the ELSI-Brazil study. BMC Geriatr 2023; 23:504. [PMID: 37605111 PMCID: PMC10441711 DOI: 10.1186/s12877-023-04167-8] [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: 01/13/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Although the association between multimorbidity (MM) and hospitalisation is known, the different effects of MM patterns by age and sex in this outcome needs to be elucidated. Our study aimed to analyse the association of hospitalisations' variables (occurrence, readmission, length of stay) and patterns of multimorbidity (MM) according to sex and age. METHODS Data from 8.807 participants aged ≥ 50 years sourced from the baseline of the Brazilian Longitudinal Study of Ageing (ELSI-Brazil) were analysed. Multimorbidity was defined as ≥ 2 (MM2) and ≥ 3 (MM3) chronic conditions. Poisson regression was used to verify the association between the independent variables and hospitalisation according to sex and age group. Multiple linear regression models were constructed for the outcomes of readmission and length of stay. Ising models were used to estimate the networks of diseases and MM patterns. RESULTS Regarding the risk of hospitalisation among those with MM2, we observed a positive association with male sex, age ≥ 75 years and women aged ≥ 75 years. For MM3, there was a positive association with hospitalisation among males. For the outcomes hospital readmission and length of stay, we observed a positive association with male sex and women aged ≥ 75 years. Network analysis identified two groups that are more strongly associated with occurrence of hospitalisation: the cardiovascular-cancer-glaucoma-cataract group stratified by sex and the neurodegenerative diseases-renal failure-haemorrhagic stroke group stratified by age group. CONCLUSION We conclude that the association between hospitalisation, readmission, length of stay, and MM changes when sex and age group are considered. Differences were identified in the MM patterns associated with hospitalisation according to sex and age group.
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Affiliation(s)
- Luciana Pereira Rodrigues
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
| | | | | | | | - Sandro Rodrigues Batista
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Department of Health, Federal District Government, Brasília, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | | | - Erika Aparecida Silveira
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil.
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
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Méndez-Flores JJ, Marroquín-Cosar RE, Bernabé-Ortiz A. Multimorbidity and Sleep Patterns among Adults in a Peruvian Semi-Urban Area. Sleep Sci 2023; 16:51-58. [PMID: 37151763 PMCID: PMC10157817 DOI: 10.1055/s-0043-1767755] [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: 02/08/2022] [Accepted: 07/12/2022] [Indexed: 05/09/2023] Open
Abstract
Objective To assess if the duration and quality of sleep vary due to the presence of multimorbidity. Materials and Methods We performed a secondary analysis using data from a population-based study involving adult subjects aged between 30 and 69 years residing in a semi-urban area of Tumbes, Peru. The duration (normal, short or prolonged) and quality (good or poor) of sleep were our outcome variables, whereas the exposure was multimorbidity (two or more chronic conditions). Crude and adjusted Poisson regression models were built to assess the association of interest, and prevalence ratios (PRs) and 95% confidence intervals (95%CIs) were reported. Results We analyzed data from 1,607 subjects with a mean age of 48.2 (standard deviation [SD]: ± 10.6) years, 809 (50.3%) of whom were women. Multimorbidity was present in 634 (39.5%; 95%CI: 37.1-41.9%) subjects, and 193 (12.1%; 95%CI: 10.5-13.7%) were short sleepers, 131 (8.2%; 95%CI: 6.9-9.6%) were long sleepers, and 312 (19.5%; 95%CI: 17.5-21.5%) had poor sleep quality. In the multivariable model, multimorbidity was associated with prolonged sleep duration (PR = 1.45; 95%CI: 1.03-2.04) and poor sleep quality (PR = 2.04; 95%CI: 1.65-2.52). Conclusions Multimorbidity was associated with prolonged, but not short, sleep duration, as well as with poor sleep quality. Our results suggest the need of assessing sleep patterns among adults with multimorbidity.
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Affiliation(s)
| | | | - Antonio Bernabé-Ortiz
- Universidad Científica del Sur, Facultad de Ciencias de la Salud, Lima, Lima, Peru
- Address for correspondence Antonio Bernabé-Ortiz
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de Lucena LA, Dantas GBDS, Carneiro TV, Lacerda HG. Factors Associated with the Abandonment of Tuberculosis Treatment in Brazil: A Systematic Review. Rev Soc Bras Med Trop 2023; 56:S0037-86822023000100301. [PMID: 36700598 PMCID: PMC9870282 DOI: 10.1590/0037-8682-0155-2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 10/19/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis. In Brazil, TB is a public health problem, and the treatment dropout rate contributes to it. METHODS This systematic review investigated the factors associated with TB treatment dropout in Brazil using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The databases used were Bireme, Scopus, PubMed, Medline, Pan-American Health Organization (PAHO), and Latin-American and Caribbean Literature on Health Sciences (LILACS). The search was conducted on May 16, 2021. Nine articles were reviewed, and all were published within the last 5 years in English, Spanish, or Portuguese. RESULTS The sample sizes in the studies ranged from 148 to 77,212 individuals, and the studies enrolled only adult patients (aged 18-59 years) in Brazil. Evidence suggests that the significant risk factors associated with TB treatment dropout are male sex, black race/ethnicity, age between 19 and 49 years, human immunodeficiency virus (HIV) co-infection, low education (<8 years), use of alcohol and illicit drugs, and unsupervised treatment. This study's limitations were the small number of articles published on this topic with stronger study designs, use of secondary data sources in most articles, and a moderate to high risk of bias in most papers. CONCLUSIONS There was a significant association between abandonment of TB treatment and HIV/acquired immunodeficiency syndrome co-infection; socioeconomic factors (low education and homelessness); use of alcohol, tobacco, and illicit drugs; and failure to use directly observed treatment. These results can guide more efficient measures to prevent dropout.
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Affiliation(s)
| | | | | | - Hênio Godeiro Lacerda
- Universidade Federal do Rio Grande do Norte, Departamento de Infectologia, Natal, RN, Brasil
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Polessa Paula D, Barbosa Aguiar O, Pruner Marques L, Bensenor I, Suemoto CK, Mendes da Fonseca MDJ, Griep RH. Comparing machine learning algorithms for multimorbidity prediction: An example from the Elsa-Brasil study. PLoS One 2022; 17:e0275619. [PMID: 36206287 PMCID: PMC9543987 DOI: 10.1371/journal.pone.0275619] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Multimorbidity is a worldwide concern related to greater disability, worse quality of life, and mortality. The early prediction is crucial for preventive strategies design and integrative medical practice. However, knowledge about how to predict multimorbidity is limited, possibly due to the complexity involved in predicting multiple chronic diseases. METHODS In this study, we present the use of a machine learning approach to build cost-effective multimorbidity prediction models. Based on predictors easily obtainable in clinical practice (sociodemographic, clinical, family disease history and lifestyle), we build and compared the performance of seven multilabel classifiers (multivariate random forest, and classifier chain, binary relevance and binary dependence, with random forest and support vector machine as base classifiers), using a sample of 15105 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). We developed a web application for the building and use of prediction models. RESULTS Classifier chain with random forest as base classifier performed better (accuracy = 0.34, subset accuracy = 0.15, and Hamming Loss = 0.16). For different feature sets, random forest based classifiers outperformed those based on support vector machine. BMI, blood pressure, sex, and age were the features most relevant to multimorbidity prediction. CONCLUSIONS Our results support the choice of random forest based classifiers for multimorbidity prediction.
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Affiliation(s)
- Daniela Polessa Paula
- National School of Statistical Sciences, Brazilian Institute of Geography and Statistics, Rio de Janeiro, Brazil
- * E-mail: ,
| | | | - Larissa Pruner Marques
- National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Isabela Bensenor
- Department of Internal Medicine, Faculdade de Medicina da Universidade de São Paulo & Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
| | - Claudia Kimie Suemoto
- Division of Geriatrics, Department of Clinical Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Rosane Härter Griep
- Health and Environmental Education Laboratory, Oswaldo Cruz Institute (IOC), Rio de Janeiro, Brazil
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 277] [Impact Index Per Article: 138.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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13
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Carreño-Almánzar FR, Vega-Vera A, Cala-Gómez SA, Coronado-Galán A, Rodríguez RM. Prevalence of communicable and non-communicable diseases among adult immigrants from Venezuela at a university hospital in Colombia from 2017 to 2018. Trop Doct 2022; 52:538-542. [PMID: 35791628 DOI: 10.1177/00494755221092892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Since 2015 immigration has increased significantly into Colombia. As immigrants who are not insured to the national health system present to public hospitals for medical care. However, there is little knowledge about the prevalence of communicable and non-communicable diseases amongst them. Ours was a cross-sectional study at a university hospital reviewing 154 medical records of Venezuelan immigrants treated by the Internal Medicine Specialty between 2017 & 2018. Non-communicable diseases representing 66.3% are the main cause of hospitalization, possibly owing to poor primary care.
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Affiliation(s)
- Fabián R Carreño-Almánzar
- MD Internist at Hospital Universitario de Santander. Professor of Internal Medicine at Internal Medicine Department and Research group GERMINA, 469622Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Agustín Vega-Vera
- MD Internist - Infectious Diseases Specialist at Hospital Universitario de Santander. Professor of Internal Medicine and Infectious Diseases at Internal Medicine Department and Research group GERMINA, 469622Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Sonia A Cala-Gómez
- Research group GERMINA 469622Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Adán Coronado-Galán
- Research group GERMINA 469622Universidad Industrial de Santander, Bucaramanga, Colombia
| | - Reynaldo M Rodríguez
- Research group GERMINA 469622Universidad Industrial de Santander, Bucaramanga, Colombia
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14
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Basto-Abreu A, Barrientos-Gutierrez T, Wade AN, Oliveira de Melo D, Semeão de Souza AS, Nunes BP, Perianayagam A, Tian M, Yan LL, Ghosh A, Miranda JJ. Multimorbidity matters in low and middle-income countries. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221106074. [PMID: 35734547 PMCID: PMC9208045 DOI: 10.1177/26335565221106074] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Accepted: 05/23/2022] [Indexed: 12/30/2022]
Abstract
Multimorbidity is a complex challenge affecting individuals, families, caregivers, and health systems worldwide. The burden of multimorbidity is remarkable in low- and middle-income countries (LMICs) given the many existing challenges in these settings. Investigating multimorbidity in LMICs poses many challenges including the different conditions studied, and the restriction of data sources to relatively few countries, limiting comparability and representativeness. This has led to a paucity of evidence on multimorbidity prevalence and trends, disease clusters, and health outcomes, particularly longitudinal outcomes. In this paper, based on our experience of investigating multimorbidity in LMICs contexts, we discuss how the structure of the health system does not favor addressing multimorbidity, and how this is amplified by social and economic disparities and, more recently, by the COVID-19 pandemic. We argue that generating epidemiologic data around multimorbidity with similar methods and definition is essential to improve comparability, guide clinical decision-making and inform policies, research priorities, and local responses. We call for action on policy to refinance and prioritize primary care and integrated care as the center of multimorbidity.
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Affiliation(s)
- Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Alisha N Wade
- MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Ana S Semeão de Souza
- Institute of Social Medicine, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno P Nunes
- Department of Nursing in Public Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Maoyi Tian
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Public Health, Harbin Medical University, Harbin, China
| | - Lijing L Yan
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Arpita Ghosh
- The George Institute for Global Health, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
- University of New South Wales, Sydney, NSW, Australia
| | - J Jaime Miranda
- The George Institute for Global Health, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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15
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Ballesteros SM, Moreno-Montoya J, Grooten WJA, Barrera-López P, De la Hoz-Valle JA. Socioeconomic variation of multimorbidity in Colombian older adults. Sci Rep 2021; 11:22738. [PMID: 34815507 PMCID: PMC8611071 DOI: 10.1038/s41598-021-02219-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 11/08/2021] [Indexed: 11/09/2022] Open
Abstract
Multimorbidity (MM) prevalence among older adults is increasing worldwide. Variations regarding the socioeconomic characteristics of the individuals and their context have been described, mostly in high-income settings. However, further research is needed to understand the effect of the coexistence of infectious diseases along with socioeconomic factors regarding MM. This study aims to examine the variation of MM regarding infectious diseases mortality after adjusting for socioeconomic factors. A cross-sectional multilevel study with a nationally representative sample of 17,571 Colombian adults of 60 years of age or older was conducted. Individual socioeconomic, demographic, childhood and health related characteristics, as well as group level variables (multidimensional poverty index and infectious diseases mortality rate) were analyzed. A two-level stepwise structural equation model was used to simultaneously adjust for the individual and contextual effects. Multimorbidity prevalence was 62.3% (95% CI 61.7–62.9). In the multilevel adjusted models, age, female sex, having functional limitations, non-white ethnicity, high body mass index, higher income, physical inactivity and living in urban areas were associated with multimorbidity among the sample for this study. The median odds ratio for multidimensional poverty was 1.18 (1.16–1.19; p = 0.008) and for infectious diseases was 1.25 (1.22–1.28; p = 0.014). This paper demonstrates that MM varies regarding the mortality of infectious diseases and shows a strong association between MM and poverty in a low-middle income country. Differences in the factors involved in the etiology of multimorbidity are expected among wealthy and poor countries regarding availability and prioritization of health services.
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Affiliation(s)
- Silvia Marcela Ballesteros
- Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Calle 119 A 7-49, Bogotá, Colombia.
| | - José Moreno-Montoya
- Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Calle 119 A 7-49, Bogotá, Colombia
| | - Wilhelmus Johannes Andreas Grooten
- Department of Neurobiology, Care Sciences and Society, Division of Physical Therapy, Karolinska Institutet, 141 83, Huddinge, Sweden.,Women's Health and Allied Health Professionals Theme, Medical unit Occupational Therapy and Physiotherapy, Karolinska University Hospital, 171 77, Stockholm, Sweden
| | - Pedro Barrera-López
- Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Calle 119 A 7-49, Bogotá, Colombia
| | - José A De la Hoz-Valle
- Clinical Studies and Clinical Epidemiology Division, Fundación Santa Fe de Bogotá, Calle 119 A 7-49, Bogotá, Colombia
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16
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Bernardes GM, Saulo H, Santos JLF, da Cruz Teixeira DS, de Oliveira Duarte YA, Andrade FBD. Effect of education and multimorbidity on mortality among older adults: findings from the health, well-being and ageing cohort study (SABE). Public Health 2021; 201:69-74. [PMID: 34794094 DOI: 10.1016/j.puhe.2021.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 09/23/2021] [Accepted: 10/08/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study assessed the moderating role of education on the relationship between multimorbidity and mortality among older adults in Brazil. STUDY DESIGN This was a cohort study. METHODS This study used data from 1768 participants of the Health, Well-Being and Ageing Cohort Study (SABE) who were assessed between 2006 and 2015. The Cox Proportional Risks Model was used to evaluate the association between multimorbidity (two or more chronic diseases) and mortality. An interaction term between education and multimorbidity was included to test the moderating role of education in this association. RESULTS The average follow-up time was 4.5 years, with a total of 589 deaths in the period. Multimorbidity increased the risk of mortality (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.27-1.91), and this association was not moderated by education (HR 1.06, 95% CI 1.00-1.13; P value = 0.07). CONCLUSIONS The impact of education and multimorbidity on mortality emphasises the need for an integrated approach directed towards the social determinants of health to prevent multimorbidity and its burden among older adults.
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Affiliation(s)
- G M Bernardes
- Postgraduate Program in Collective Health, René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Brazil
| | - H Saulo
- Department of Statistics, University of Brasília, Brasília, Brazil
| | - J L F Santos
- Ribeirão Preto School of Medicine, University of São Paulo, Ribeirão Preto, Brazil
| | | | | | - F Bof de Andrade
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Brazil.
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17
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Rodriguez-Morales AJ, Mamani-García CS, Nuñez-Lupaca JN, León-Figueroa DA, Olarte-Durand M, Yrene-Cubas RA, Ticona DM, Abanto-Urbano S. COVID-19 and mucormycosis in Latin America - An emerging concern. Travel Med Infect Dis 2021; 44:102156. [PMID: 34454089 PMCID: PMC8386102 DOI: 10.1016/j.tmaid.2021.102156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Alfonso J Rodriguez-Morales
- Grupo de Investigacion Biomedicina, Faculty of Medicine, Fundacion Universitaria Autonoma de las Americas, Pereira, Risaralda, Colombia; Master of Clinical Epidemiology and Biostatistics, Universidad Cientifica del Sur, Lima, Peru; School of Medicine, Universidad Privada Franz Tamayo (UNIFRANZ), Cochabamba, Bolivia.
| | - Carlos S Mamani-García
- Facultad de Medicina Humana, Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru; Sociedad Científica de Estudiantes de Medicina Agustinos (SOCIEMA), Arequipa, Peru
| | - Janeth N Nuñez-Lupaca
- Facultad de Medicina Humana, Universidad Nacional Jorge Basadre Grohomann, Tacna, Peru; Sociedad Científica Basadrina de Estudiantes de Medicina Humana (SOCIBEMH), Tacna, Peru
| | - Darwin A León-Figueroa
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo, Peru; Sociedad Científica Médico Estudiantil Peruana, Lima, Peru; Sociedad Científica de Estudiantes de Medicina Veritas (SCIEMVE), Chiclayo, Peru
| | - Mely Olarte-Durand
- Sociedad Científica Médico Estudiantil Peruana, Lima, Peru; Facultad de Medicina Humana, Universidad Peruana Unión, Lima, Peru; Sociedad Científica de Estudiantes de Medicina (SOCEM UPEU), Lima, Peru
| | - Robinson A Yrene-Cubas
- Facultad de Medicina Humana, Universidad Científica del Sur, Lima, Peru; Sociedad Científica de Estudiantes de Medicina de la Universidad Científica del Sur (SCIEM UCSUR), Lima, Peru
| | - Diana M Ticona
- Centro de Investigación de Estudiantes de Medicina, Universidad Privada de Tacna, Tacna, Peru
| | - Sebastian Abanto-Urbano
- Facultad de Medicina, Universidad Nacional Federico Villarreal, Lima, Peru; Sociedad Científica de Estudiantes de Medicina Villarrealinos (SOCEMVI), Lima, Peru
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18
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Huaquía-Díaz AM, Chalán-Dávila TS, Carrillo-Larco RM, Bernabe-Ortiz A. Multimorbidity in Latin America and the Caribbean: a systematic review and meta-analysis. BMJ Open 2021; 11:e050409. [PMID: 34301665 PMCID: PMC8311299 DOI: 10.1136/bmjopen-2021-050409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To estimate the pooled prevalence of multimorbidity (≥2 non-communicable diseases in the same individual) among adults of the general population of Latin American and the Caribbean (LAC). DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, Embase, Global Health, Scopus and LILACS up to 1 July 2020. ELIGIBILITY CRITERIA FOR SELECTING STUDIES The outcome was the prevalence of multimorbidity. Reports were selected whether they enrolled adult individuals (age ≥18 years) from the general population. DATA EXTRACTION AND SYNTHESIS Reviewers extracted relevant data and assessed risk of bias independently. A random-effects meta-analysis was conducted to report pooled prevalence estimates of multimorbidity; pooled estimates by pre-specified subgroups (eg, national studies) were also pursued. RESULTS From 5830 results, we selected 28 reports, mostly from Brazil and 16 were based on a nationally representative sample. From the 28 selected reports, 26 were further included in the meta-analysis revealing a pooled multimorbidity prevalence of 43% (95% CI: 35% to 51%; I2: 99.9%). When only reports with a nationally representative sample were combined, the pooled prevalence was 37% (95% CI: 27% to 47%; I2: 99.9%). When the ascertainment of multimorbidity was based on self-reports alone, the pooled prevalence was 40% (95% CI: 31% to 48%; I2: 99.9%); this raised to 52% (95% CI: 33% to 70%; I2: 99.9%) for reports including self-reported and objective diagnosis. CONCLUSIONS Our results complement and advance those from global efforts by incorporating much more reports from LAC. We revealed a larger presence of multimorbidity in LAC than previously reported. PROSPERO REGISTRATION NUMBER CRD42020196177.
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Affiliation(s)
| | | | - Rodrigo M Carrillo-Larco
- Department of Epidemiology and Bisotatistics, School of Public Health, Imperial College London, London, UK
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- Universidad Científica del Sur, Lima, Peru
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- School of Public Health and Administration, Universidad Peruana Cayetano Heredia, Lima, Peru
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19
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Silva AB, Sindico SRF, Carneiro AC, Henrique SM, Fernandes AG, Gomes JP, Marinho TP, Fernandes VR. COVID-19 Remote Consultation Services and Population in Health Inequity-Concentrating Territories: A Scoping Review. Telemed J E Health 2021; 27:881-897. [PMID: 34232749 PMCID: PMC8380793 DOI: 10.1089/tmj.2021.0145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: This review aimed to map initiatives for measuring the satisfaction of vulnerable populations with teleconsultation services offered by public and private health care providers in their territories, during the coronavirus disease (COVID-19) pandemic. Systematic studies on the opinions of people most affected by health inequities are limited. Therefore, we included evaluations of teleconsultation-based services offered to socioeconomically disadvantaged and clinically vulnerable populations globally, with a focus on surveillance, treatment, and prevention of COVID-19. Materials and Methods: This review includes analytical and descriptive observational studies primarily from MEDLINE, EMBASE, SCOPUS, and Web of Science databases, published after the World Health Organization received the first warnings about COVID-19 from Chinese authorities in December, 2019, until December 2020. The search strategy combined aspects of COVID-19, telemedicine, patient satisfaction, and key concepts of vulnerable populations. Results: We selected 33 studies for full-text reading and 10 for critical appraisal. Two categories emerged from the qualitative analysis: telehealth evaluation and services during COVID-19, and opinions of vulnerable populations. Television and social networks play a crucial role in providing information. Although teleconsultations are practical and cost effective for patients, the majority preferred receiving in-person treatment in primary care clinics. Conclusions: Listening to the opinions of vulnerable groups and their caregivers is critical both before and during adoption of COVID-19 control measures. Health managers need to monitor the health of and delivery of services to socioeconomically and clinically vulnerable people closely, to improve services, and provide care from a human rights perspective.
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Affiliation(s)
- Angélica Baptista Silva
- National School of Public Health Sergio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio Ricardo Ferreira Sindico
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | | | - Joyker Peçanha Gomes
- Institute of Scientific and Technological Communication and Information in Health, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Thaysa Pereira Marinho
- Health Surveillance Department, Niterói Municipal Health Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
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20
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Jin H, Wang Z, Shi L, Chen C, Huo Y, Huang W, Zhang Y, Lu Y, Ge X, Shi J, Yu D. Multimorbid Patient Experiences With Primary Care at Community Health Centers in Shanghai, China. Front Public Health 2021; 9:606188. [PMID: 34169053 PMCID: PMC8218628 DOI: 10.3389/fpubh.2021.606188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 03/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences. Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics. Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = −0.623, P < 0.001; >70 years: ß = −0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = −1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = −1.883, P < 0.001) reported lower total PCAT scores. Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.
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Affiliation(s)
- Hua Jin
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Zhaoxin Wang
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China.,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Leiyu Shi
- Department of Health Policy and Management, Primary Care Policy Center, Johns Hopkins University, Baltimore, MD, United States
| | - Chen Chen
- Shanghai Jing'an District Jiangning Road Community Health Service Center, Shanghai, China
| | - Yongyan Huo
- Shanghai Jiading District Anting Town Huangdu Community Health Service Center, Shanghai, China
| | - Wuquan Huang
- Shanghai Jiading District Jiading Town Community Health Service Center, Shanghai, China
| | - Yi Zhang
- Shanghai Xuhui District Fenglin Community Health Service Center, Shanghai, China
| | - Yuan Lu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Xuhua Ge
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Jianwei Shi
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China.,School of Public Health, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dehua Yu
- Department of General Practice, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China.,Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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21
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Araya R, Menezes PR, Claro HG, Brandt LR, Daley KL, Quayle J, Diez-Canseco F, Peters TJ, Vera Cruz D, Toyama M, Aschar S, Hidalgo-Padilla L, Martins H, Cavero V, Rocha T, Scotton G, de Almeida Lopes IF, Begale M, Mohr DC, Miranda JJ. Effect of a Digital Intervention on Depressive Symptoms in Patients With Comorbid Hypertension or Diabetes in Brazil and Peru: Two Randomized Clinical Trials. JAMA 2021; 325:1852-1862. [PMID: 33974019 PMCID: PMC8114139 DOI: 10.1001/jama.2021.4348] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Importance Depression is a leading contributor to disease burden globally. Digital mental health interventions can address the treatment gap in low- and middle-income countries, but the effectiveness in these countries is unknown. Objective To investigate the effectiveness of a digital intervention in reducing depressive symptoms among people with diabetes and/or hypertension. Design, Setting, and Participants Participants with clinically significant depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] score ≥10) who were being treated for hypertension and/or diabetes were enrolled in a cluster randomized clinical trial (RCT) at 20 sites in São Paulo, Brazil (N=880; from September 2016 to September 2017; final follow-up, April 2018), and in an individual-level RCT at 7 sites in Lima, Peru (N=432; from January 2017 to September 2017; final follow-up, March 2018). Interventions An 18-session, low-intensity, digital intervention was delivered over 6 weeks via a provided smartphone, based on behavioral activation principles, and supported by nurse assistants (n = 440 participants in 10 clusters in São Paulo; n = 217 participants in Lima) vs enhanced usual care (n = 440 participants in 10 clusters in São Paulo; n = 215 participants in Lima). Main Outcomes and Measures The primary outcome was a reduction of at least 50% from baseline in PHQ-9 scores (range, 0-27; higher score indicates more severe depression) at 3 months. Secondary outcomes included a reduction of at least 50% from baseline PHQ-9 scores at 6 months. Results Among 880 patients cluster randomized in Brazil (mean age, 56.0 years; 761 [86.5%] women) and 432 patients individually randomized in Peru (mean age, 59.7 years; 352 [81.5%] women), 807 (91.7%) in Brazil and 426 (98.6%) in Peru completed at least 1 follow-up assessment. The proportion of participants in São Paulo with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 40.7% (159/391 participants) in the digital intervention group vs 28.6% (114/399 participants) in the enhanced usual care group (difference, 12.1 percentage points [95% CI, 5.5 to 18.7]; adjusted odds ratio [OR], 1.6 [95% CI, 1.2 to 2.2]; P = .001). In Lima, the proportion of participants with a reduction in PHQ-9 score of at least 50% at 3-month follow-up was 52.7% (108/205 participants) in the digital intervention group vs 34.1% (70/205 participants) in the enhanced usual care group (difference, 18.6 percentage points [95% CI, 9.1 to 28.0]; adjusted OR, 2.1 [95% CI, 1.4 to 3.2]; P < .001). At 6-month follow-up, differences across groups were no longer statistically significant. Conclusions and Relevance In 2 RCTs of patients with hypertension or diabetes and depressive symptoms in Brazil and Peru, a digital intervention delivered over a 6-week period significantly improved depressive symptoms at 3 months when compared with enhanced usual care. However, the magnitude of the effect was small in the trial from Brazil and the effects were not sustained at 6 months. Trial Registration ClinicalTrials.gov: NCT02846662 (São Paulo) and NCT03026426 (Lima).
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Affiliation(s)
- Ricardo Araya
- Centre for Global Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| | - Paulo Rossi Menezes
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- Department of Preventive Medicine, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Heloísa Garcia Claro
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
- School of Nursing, Universidade Estadual de Campinas, Campinas, Brazil
| | - Lena R. Brandt
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Kate L. Daley
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Julieta Quayle
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Francisco Diez-Canseco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Tim J. Peters
- Bristol Medical School, Faculty of Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Daniela Vera Cruz
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Mauricio Toyama
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Suzana Aschar
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Liliana Hidalgo-Padilla
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Hellen Martins
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Victoria Cavero
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Thais Rocha
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - George Scotton
- Population Mental Health Research Centre, Universidade de São Paulo, São Paulo, Brazil
| | - Ivan F. de Almeida Lopes
- Federal University of ABC, Engineering, Modeling and Applied Social Sciences Center (CECS), Santo André, Brazil
| | - Mark Begale
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - David C. Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - J. Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
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22
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Lee ES, Koh HL, Ho EQY, Teo SH, Wong FY, Ryan BL, Fortin M, Stewart M. Systematic review on the instruments used for measuring the association of the level of multimorbidity and clinically important outcomes. BMJ Open 2021; 11:e041219. [PMID: 33952533 PMCID: PMC8103380 DOI: 10.1136/bmjopen-2020-041219] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES There are multiple instruments for measuring multimorbidity. The main objective of this systematic review was to provide a list of instruments that are suitable for use in studies aiming to measure the association of a specific outcome with different levels of multimorbidity as the main independent variable in community-dwelling individuals. The secondary objective was to provide details of the requirements, strengths and limitations of these instruments, and the chosen outcomes. METHODS We conducted the review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO registration number: CRD42018105297). We searched MEDLINE, Embase and CINAHL electronic databases published in English and manually searched the Journal of Comorbidity between 1 January 2010 and 23 October 2020 inclusive. Studies also had to select adult patients from primary care or general population and had at least one specified outcome variable. Two authors screened the titles, abstracts and full texts independently. Disagreements were resolved with a third author. The modified Newcastle-Ottawa Scale was used for quality assessment. RESULTS Ninety-six studies were identified, with 69 of them rated to have a low risk of bias. In total, 33 unique instruments were described. Disease Count and weighted indices like Charlson Comorbidity Index were commonly used. Other approaches included pharmaceutical-based instruments. Disease Count was the common instrument used for measuring all three essential core outcomes of multimorbidity research: mortality, mental health and quality of life. There was a rise in the development of novel weighted indices by using prognostic models. The data obtained for measuring multimorbidity were from sources including medical records, patient self-reports and large administrative databases. CONCLUSIONS We listed the details of 33 instruments for measuring the level of multimorbidity as a resource for investigators interested in the measurement of multimorbidity for its association with or prediction of a specific outcome.
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Affiliation(s)
- Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Hui Li Koh
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Elaine Qiao-Ying Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Sok Huang Teo
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Fang Yan Wong
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Western University Schulich School of Medicine and Dentistry, London, Ontario, Canada
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23
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Pati S, Mahapatra P, Dwivedi R, Athe R, Sahoo KC, Samal M, Das RC, Hussain MA. Multimorbidity and Its Outcomes Among Patients Attending Psychiatric Care Settings: An Observational Study From Odisha, India. Front Public Health 2021; 8:616480. [PMID: 33968863 PMCID: PMC8096979 DOI: 10.3389/fpubh.2020.616480] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/30/2020] [Indexed: 12/17/2022] Open
Abstract
Background: Multimorbidity, the presence of two or more chronic health conditions is linked to premature mortality among psychiatric patients since the presence of one can further complicate the management of either. Little research has focused on the magnitude and effect of multimorbidity among psychiatric patients in low-and middle-income settings. Our study, provides the first ever data on multimorbidity and its outcomes among patients attending psychiatric clinics in Odisha, India. It further explored whether multimorbidity was associated with higher medical expenditure and the interaction effect of psychiatric illness on this association. Methods: This cross-sectional study included 500 adult patients presenting to the psychiatric clinic of a medical college hospital in Odisha over a period of 6 months (February 2019–July 2019). A validated structured questionnaire, “multimorbidity assessment questionnaire for psychiatric care” (MAQ-PsyC) was used for data collection. We used multinomial logistic model for the effect estimation. Odds ratios (OR) and 95% confidence intervals (CI) for high healthcare utilization and expenditure were calculated by number and pattern of multimorbidity. Data was analyzed by STATA 14. Results: Half (50%) of the psychiatric outpatients had multimorbidity. The relative probabilities of having one additional condition were 5.3 times (RRR = 5.3; 95% CI: 2.3, 11.9) and multiple morbidities were 6.6 times (RRR = 6.6; 95%CI: 3.3, 13.1) higher for patients in 60+ age group. Healthcare utilization i.e., medication use and physician consultation was significantly higher for psychiatric conditions such as mood disorders, schizophrenia, schizotypal and delusional disorders, and for hypertension, cancer, diabetes, among somatic conditions. Out of pocket expenditure (OOPE) was found to be highest for laboratory investigations, followed by medicines and transport expenditure. Within psychiatric conditions, mood disorders incurred highest OOPE ($93.43) while hypertension was the most leading for OOPE in physical morbidities ($93.43). Psychiatric illnesses had a significant interaction effect on the association between multimorbidity and high medical expenditure (P = 0.001). Conclusion: Multimorbidity is highly prevalent in psychiatric patients associated with significantly high healthcare utilization and medical expenditure. Such disproportionate effect of psychiatric multimorbidity on healthcare cost and use insinuates the need for stronger financial protection and tailor-made clinical decision making for these vulnerable patient subgroups.
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Affiliation(s)
- Sanghamitra Pati
- Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, India
| | - Pranab Mahapatra
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT) University, Bhubaneswar, India
| | - Rinshu Dwivedi
- Department of Humanities and Science (Economics), Indian Institute of Information Technology, Tiruchirappalli, India
| | - Ramesh Athe
- Department of Humanities and Science (Mathematics), Indian Institute of Information Technology, Dharwad, India
| | - Krushna Chandra Sahoo
- Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, India
| | - Mousumi Samal
- Indian Council of Medical Research (ICMR)-Regional Medical Research Centre, Bhubaneswar, India
| | - Ram Chandra Das
- Department of Psychiatry, Kalinga Institute of Medical Sciences, Kalinga Institute of Industrial Technology (KIIT) University, Bhubaneswar, India
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24
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Fernández-Niño JA, Guerra-Gómez JA, Idrovo AJ. Multimorbidity patterns among COVID-19 deaths: proposal for the construction of etiological models. Rev Panam Salud Publica 2020; 44:e166. [PMID: 33417654 PMCID: PMC7778468 DOI: 10.26633/rpsp.2020.166] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/15/2020] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVES To describe patterns of multimorbidity among fatal cases of COVID-19, and to propose a classification of patients based on age and multimorbidity patterns to begin the construction of etiological models. METHODS Data of Colombian confirmed deaths of COVID-19 until June 11, 2020, were included in this analysis (n=1488 deaths). Relationships between COVID-19, combinations of health conditions and age were explored using locally weighted polynomial regressions. RESULTS The most frequent health conditions were high blood pressure, respiratory disease, diabetes, cardiovascular disease, and kidney disease. Dyads more frequents were high blood pressure with diabetes, cardiovascular disease or respiratory disease. Some multimorbidity patterns increase probability of death among older individuals, whereas other patterns are not age-related, or decrease the probability of death among older people. Not all multimorbidity increases with age, as is commonly thought. Obesity, alone or with other diseases, was associated with a higher risk of severity among young people, while the risk of the high blood pressure/diabetes dyad tends to have an inverted U distribution in relation with age. CONCLUSIONS Classification of individuals according to multimorbidity in the medical management of COVID-19 patients is important to determine the possible etiological models and to define patient triage for hospitalization. Moreover, identification of non-infected individuals with high-risk ages and multimorbidity patterns serves to define possible interventions of selective confinement or special management.
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Affiliation(s)
| | - John A. Guerra-Gómez
- Northeastern UniversitySilicon ValleyUnited States of AmericaNortheastern University, Silicon Valley, United States of America
| | - Alvaro J. Idrovo
- Universidad Industrial de SantanderBucaramangaColombiaUniversidad Industrial de Santander, Bucaramanga, Colombia
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25
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Özçelik EA, Massuda A, McConnell M, Castro MC. Impact of Brazil's More Doctors Program on hospitalizations for primary care sensitive cardiovascular conditions. SSM Popul Health 2020; 12:100695. [PMID: 33319027 PMCID: PMC7725939 DOI: 10.1016/j.ssmph.2020.100695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 11/11/2020] [Accepted: 11/12/2020] [Indexed: 11/18/2022] Open
Abstract
Globally, cardiovascular diseases are the leading cause of disease burden and death. Timely and appropriate provision of primary care may lead to sizeable reductions in hospitalizations for a range of chronic and acute health conditions. In this paper, we study the impact of Brazil's More Doctors Program (MDP) on hospitalizations due to cerebrovascular disease and hypertension. We exploit the geographic variation in the uptake of the MPD and combine coarsened exact matching and difference-in-difference methods to construct valid counterfactual estimates. We use data from the Hospital Information System in Unified Health System, the MDP administrative records, the Brazilian Regulatory Agency, the Ministry of Health, and the Brazilian Institute of Geography and Statistics, covering the years from 2009 to 2017. Our analysis resulted in estimated coefficients of -1.47 (95%CI: -4.04,1.10) for hospitalizations for cerebrovascular disease and -1.20 (95%CI: -5.50,3.11) for hypertension, suggesting an inverse relationship between the MDP and hospitalizations. For cerebrovascular disease, the estimated MDP coefficient was -0.50 (95%CI: -2.94,1.95) in the year of program introduction, -5.21 (95%CI: -9.43,-0.99) and -8.21 (95%CI: -13.68,-2.75) in its third and fourth year of implementation, respectively. Our results further suggest that the beneficial impact of MDP on hospitalizations due to cerebrovascular disease became discernable in urban municipalities starting from the fourth year of implementation. We found no evidence that the MDP led to reductions in hospitalizations due to hypertension. Our results highlight that increased investment in resources devoted to primary care led to improvements in hospitalizations for selected cardiovascular conditions. However, it took time for the beneficial effects of the MDP to become discernable and the Program did not guarantee declines in hospitalizations for all cardiovascular conditions, suggesting that further improvements may be needed to enhance the beneficial impact of the MDP on the level and distribution of population health in Brazil.
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Affiliation(s)
- Ece A. Özçelik
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Adriano Massuda
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
| | - Margaret McConnell
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Marcia C. Castro
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
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26
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Avilés-Santa ML, Monroig-Rivera A, Soto-Soto A, Lindberg NM. Current State of Diabetes Mellitus Prevalence, Awareness, Treatment, and Control in Latin America: Challenges and Innovative Solutions to Improve Health Outcomes Across the Continent. Curr Diab Rep 2020; 20:62. [PMID: 33037442 PMCID: PMC7546937 DOI: 10.1007/s11892-020-01341-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Latin America is the scenario of great inequalities where about 32 million human beings live with diabetes. Through this review, we aimed at describing the current state of the prevalence, awareness, treatment, and control of diabetes mellitus and completion of selected guidelines of care across Latin America and identify opportunities to advance research that promotes better health outcomes. RECENT FINDINGS The prevalence of diabetes mellitus has been consistently increasing across the region, with some variation: higher prevalence in Mexico, Haiti, and Puerto Rico and lower in Colombia, Ecuador, Dominican Republic, Peru, and Uruguay. Prevalence assessment methods vary, and potentially underestimating the real number of persons with diabetes. Diabetes unawareness varies widely, with up to 50% of persons with diabetes who do not know they may have the disease. Glycemic, blood pressure, and LDL-C control and completion of guidelines to prevent microvascular complications are not consistently assessed across studies, and the achievement of control goals is suboptimal. On the other hand, multiple interventions, point-of-care/rapid assessment tools, and alternative models of health care delivery have been proposed and tested throughout Latin America. The prevalence of diabetes mellitus continues to rise across Latin America, and the number of those with the disease may be underestimated. However, some local governments are embedding more comprehensive diabetes assessments in their local national surveys. Clinicians and public health advocates in the region have proposed and initiated various multi-level interventions to address this enormous challenge in the region.
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Affiliation(s)
- M Larissa Avilés-Santa
- Division of Extramural Scientific Programs, Clinical and Health Services Research at the National Institute on Minority Health and Health Disparities, Bethesda, MD, USA.
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27
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Abebe F, Schneider M, Asrat B, Ambaw F. Multimorbidity of chronic non-communicable diseases in low- and middle-income countries: A scoping review. JOURNAL OF COMORBIDITY 2020; 10:2235042X20961919. [PMID: 33117722 PMCID: PMC7573723 DOI: 10.1177/2235042x20961919] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 09/07/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Multimorbidity is rising in low- and middle-income countries (LMICs). However, the evidence on its epidemiology from LMICs settings is limited and the available literature has not been synthesized as yet. OBJECTIVES To review the available evidence on the epidemiology of multimorbidity in LMICs. METHODS PubMed, Scopus, PsycINFO and Grey literature databases were searched. We followed the PRISMA-ScR reporting guideline. RESULTS Of 33, 110 articles retrieved, 76 studies were eligible for the epidemiology of multimorbidity. Of these 76 studies, 66 (86.8%) were individual country studies. Fifty-two (78.8%) of which were confined to only six middle-income countries: Brazil, China, South Africa, India, Mexico and Iran. The majority (n = 68, 89.5%) of the studies were crosssectional in nature. The sample size varied from 103 to 242, 952. The largest proportion (n = 33, 43.4%) of the studies enrolled adults. Marked variations existed in defining and measuring multimorbidity. The prevalence of multimorbidity in LMICs ranged from 3.2% to 90.5%. CONCLUSION AND RECOMMENDATIONS Studies on the epidemiology of multimorbidity in LMICs are limited and the available ones are concentrated in few countries. Despite variations in measurement and definition, studies consistently reported high prevalence of multimorbidity. Further research is urgently required to better understand the epidemiology of multimorbidity and define the best possible interventions to improve outcomes of patients with multimorbidity in LMICs.
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Affiliation(s)
- Fantu Abebe
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Jhpiego Corporation, Ethiopia Country Office, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Biksegn Asrat
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Fentie Ambaw
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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28
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Petarli GB, Cattafesta M, Sant’Anna MM, Bezerra OMDPA, Zandonade E, Salaroli LB. Multimorbidity and complex multimorbidity in Brazilian rural workers. PLoS One 2019; 14:e0225416. [PMID: 31743369 PMCID: PMC6863555 DOI: 10.1371/journal.pone.0225416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of multimorbidity and complex multimorbidity in rural workers and their association with sociodemographic characteristics, occupational contact with pesticides, lifestyle and clinical condition. METHODS This is a cross-sectional epidemiological study with 806 farmers from the main agricultural municipality of the state of Espírito Santo/Brazil, conducted from December 2016 to April 2017. Multimorbidity was defined as the presence of two or more chronic diseases in the same individual, while complex multimorbidity was classified as the occurrence of three or more chronic conditions affecting three or more body systems. Socio-demographic data, occupational contact with pesticides, lifestyle data and clinical condition data were collected through a structured questionnaire. Binary logistic regression was conducted to identify risk factors for multimorbidity. RESULTS The prevalence of multimorbidity among farmers was 41.5% (n = 328), and complex multimorbidity was 16.7% (n = 132). More than 77% of farmers had at least one chronic illness. Hypertension, dyslipidemia and depression were the most prevalent morbidities. Being 40 years or older (OR 3.33, 95% CI 2.06-5.39), previous medical diagnosis of pesticide poisoning (OR 1.89, 95% CI 1.03-3.44), high waist circumference (OR 2.82, CI 95% 1.98-4.02) and worse health self-assessment (OR 2.10, 95% CI 1.52-2.91) significantly increased the chances of multimorbidity. The same associations were found for the diagnosis of complex multimorbidity. CONCLUSION We identified a high prevalence of multimorbidity and complex multimorbidity among the evaluated farmers. These results were associated with increased age, abdominal fat, pesticide poisoning, and poor or fair health self-assessment. Public policies are necessary to prevent, control and treat this condition in this population.
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Affiliation(s)
- Glenda Blaser Petarli
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Monica Cattafesta
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Olívia Maria de Paula Alves Bezerra
- Department of Family Medicine, Mental and Collective Health, Medical school, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Eliana Zandonade
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Luciane Bresciani Salaroli
- Postgraduate program in Nutrition and Health, and Graduate Program in Collective Health, Center for Health Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
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29
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Miranda JJ, Bernabe-Ortiz A, Gilman RH, Smeeth L, Malaga G, Wise RA, Checkley W. Multimorbidity at sea level and high-altitude urban and rural settings: The CRONICAS Cohort Study. JOURNAL OF COMORBIDITY 2019; 9:2235042X19875297. [PMID: 34249770 PMCID: PMC8240099 DOI: 10.1177/2235042x19875297] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/19/2019] [Indexed: 12/19/2022]
Abstract
Objective: To characterize the prevalence and clustering of multimorbidity in four
diverse geographical settings in Peru. Methods: Multimorbidity, defined as having ≥2 chronic conditions, was studied in
adults aged ≥35 years in four diverse settings in Peru: Lima, Tumbes, and
urban and rural Puno. Six of these conditions (alcohol disorder, asthma,
chronic obstructive pulmonary disease, depression, diabetes, and
hypertension) were cataloged as objectively ascertained chronic conditions
and paired in dyads to explore clusters of multimorbidity. Results: We analyzed data from 2890 adults, mean age 55.2 years, 49% males. Overall,
19.1% of participants had multimorbidity, ranging from 14.7% in semi-urban
Tumbes to 22.8% in Lima. The dyads with the highest coexistence
(approximately 20%) were observed in hypertension and diabetes in Tumbes,
whereas the dyads with lowest coexistence (approximately 1%) were those
involving asthma in all study sites. In terms of clusters, Tumbes showed a
predominance of hypertension and diabetes, urban and rural Puno a
predominance of depression and alcohol disorders, and Lima a higher degree
of coexistence of all of the six conditions than in the other clusters. Conclusion: Multimorbidity is common and the pattern of clusters is highly heterogeneous.
The conditions to prioritize will vary in each setting.
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Affiliation(s)
- J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Antonio Bernabe-Ortiz
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert H Gilman
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru
| | - Liam Smeeth
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - German Malaga
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Robert A Wise
- Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - William Checkley
- Program in Global Disease Epidemiology and Control, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.,Biomedical Research Unit, Asociación Benéfica PRISMA, Lima, Peru.,Division of Pulmonary and Critical Care, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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