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Álvarez-Gálvez J, Ortega-Martín E, Carretero-Bravo J, Pérez-Muñoz C, Suárez-Lledó V, Ramos-Fiol B. Social determinants of multimorbidity patterns: A systematic review. Front Public Health 2023; 11:1081518. [PMID: 37050950 PMCID: PMC10084932 DOI: 10.3389/fpubh.2023.1081518] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 03/02/2023] [Indexed: 03/28/2023] Open
Abstract
Social determinants of multimorbidity are poorly understood in clinical practice. This review aims to characterize the different multimorbidity patterns described in the literature while identifying the social and behavioral determinants that may affect their emergence and subsequent evolution. We searched PubMed, Embase, Scopus, Web of Science, Ovid MEDLINE, CINAHL Complete, PsycINFO and Google Scholar. In total, 97 studies were chosen from the 48,044 identified. Cardiometabolic, musculoskeletal, mental, and respiratory patterns were the most prevalent. Cardiometabolic multimorbidity profiles were common among men with low socioeconomic status, while musculoskeletal, mental and complex patterns were found to be more prevalent among women. Alcohol consumption and smoking increased the risk of multimorbidity, especially in men. While the association of multimorbidity with lower socioeconomic status is evident, patterns of mild multimorbidity, mental and respiratory related to middle and high socioeconomic status are also observed. The findings of the present review point to the need for further studies addressing the impact of multimorbidity and its social determinants in population groups where this problem remains invisible (e.g., women, children, adolescents and young adults, ethnic groups, disabled population, older people living alone and/or with few social relations), as well as further work with more heterogeneous samples (i.e., not only focusing on older people) and using more robust methodologies for better classification and subsequent understanding of multimorbidity patterns. Besides, more studies focusing on the social determinants of multimorbidity and its inequalities are urgently needed in low- and middle-income countries, where this problem is currently understudied.
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Affiliation(s)
- Javier Álvarez-Gálvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
- The University Research Institute for Sustainable Social Development (Instituto Universitario de Investigación para el Desarrollo Social Sostenible), University of Cadiz, Jerez de la Frontera, Spain
| | - Esther Ortega-Martín
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
- *Correspondence: Esther Ortega-Martín
| | - Jesús Carretero-Bravo
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | - Celia Pérez-Muñoz
- Department of Nursing and Physiotherapy, University of Cadiz, Cádiz, Spain
| | - Víctor Suárez-Lledó
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | - Begoña Ramos-Fiol
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
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Li W, Zhou Q, Liu W, Xu C, Tang ZR, Dong S, Wang H, Li W, Zhang K, Li R, Zhang W, Hu Z, Shibin S, Liu Q, Kuang S, Yin C. A Machine Learning-Based Predictive Model for Predicting Lymph Node Metastasis in Patients With Ewing's Sarcoma. Front Med (Lausanne) 2022; 9:832108. [PMID: 35463005 PMCID: PMC9020377 DOI: 10.3389/fmed.2022.832108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/24/2022] [Indexed: 11/13/2022] Open
Abstract
Objective In order to provide reference for clinicians and bring convenience to clinical work, we seeked to develop and validate a risk prediction model for lymph node metastasis (LNM) of Ewing’s sarcoma (ES) based on machine learning (ML) algorithms. Methods Clinicopathological data of 923 ES patients from the Surveillance, Epidemiology, and End Results (SEER) database and 51 ES patients from multi-center external validation set were retrospectively collected. We applied ML algorithms to establish a risk prediction model. Model performance was checked using 10-fold cross-validation in the training set and receiver operating characteristic (ROC) curve analysis in external validation set. After determining the best model, a web-based calculator was made to promote the clinical application. Results LNM was confirmed or unable to evaluate in 13.86% (135 out of 974) ES patients. In multivariate logistic regression, race, T stage, M stage and lung metastases were independent predictors for LNM in ES. Six prediction models were established using random forest (RF), naive Bayes classifier (NBC), decision tree (DT), xgboost (XGB), gradient boosting machine (GBM), logistic regression (LR). In 10-fold cross-validation, the average area under curve (AUC) ranked from 0.705 to 0.764. In ROC curve analysis, AUC ranged from 0.612 to 0.727. The performance of the RF model ranked best. Accordingly, a web-based calculator was developed (https://share.streamlit.io/liuwencai2/es_lnm/main/es_lnm.py). Conclusion With the help of clinicopathological data, clinicians can better identify LNM in ES patients. Risk prediction models established in this study performed well, especially the RF model.
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Affiliation(s)
- Wenle Li
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Qian Zhou
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China
| | - Wencai Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Chan Xu
- Department of Respiratory and Critical Care Medicine, The First People's Hospital of Chongqing Liang Jiang New Area, Chongqing, China.,Department of Dermatology, Xianyang Central Hospital, Xianyang, China
| | - Zhi-Ri Tang
- School of Physics and Technology, Wuhan University, Wuhan, China
| | - Shengtao Dong
- Department of Spine Surgery, Second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Haosheng Wang
- Department of Orthopaedics, The Second Hospital of Jilin University, Changchun, China
| | - Wanying Li
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Kai Zhang
- Department of Orthopedics, Xianyang Central Hospital, Xianyang, China.,Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Rong Li
- The First Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Wenshi Zhang
- The First Clinical Medical College, Shaanxi University of Traditional Chinese Medicine, Xianyang, China
| | - Zhaohui Hu
- Department of Spinal Surgery, Liuzhou People's Hospital, Liuzhou, China
| | - Su Shibin
- Department of Business Management, Xiamen Bank, Xiamen, China
| | - Qiang Liu
- Clinical Medical Research Center, Xianyang Central Hospital, Xianyang, China
| | - Sirui Kuang
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
| | - Chengliang Yin
- Faculty of Medicine, Macau University of Science and Technology, Macau, China
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Tyagi M, Das AV, Kaza H, Basu S, Pappuru RR, Pathengay A, Murthy S, Agrawal H. LV Prasad Eye Institute EyeSmart electronic medical record-based analytics of big data: LEAD-Uveitis Report 1: Demographics and clinical features of uveitis in a multi-tier hospital based network in Southern India. Indian J Ophthalmol 2022; 70:1260-1267. [PMID: 35326028 PMCID: PMC9240530 DOI: 10.4103/ijo.ijo_1122_21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose To describe the demographics and epidemiology of uveitis presenting to a multi-tier ophthalmology hospital network in Southern India. Methods Cross-sectional hospital-based study of 19,352 patients with uveitis presenting between March 2012 and August 2018. Results In total, 1,734,272 new patients were seen across the secondary and tertiary centers of our multi-tier ophthalmology hospital network during the study period. Among them, 25,353 eyes of 19,352 patients were diagnosed with uveitis and were included in the study. Uveitis constituted 1.11% of all cases. The majority of patients were male (60.33%) and had unilateral (68.09%) affliction. The most common age group was 21-50 years with 12,204 (63.06%) patients. The most common type of uveitis was anterior uveitis, which was seen in 7380 (38.14%) patients, followed by posterior uveitis in 5397 (23.89%) patients. Among the infectious causes, tuberculosis was the most common etiology (2551 patients, 13%) followed by toxoplasmosis (1147 patients, 6%). Conclusion Uveitis constituted 1.11% of all cases presenting to our clinics. It was more common in the age group of 21-50 and was predominantly unilateral. Anterior uveitis was the most common subtype seen in 38%.
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Affiliation(s)
- Mudit Tyagi
- Uveitis and Ocular Immunology Services; Srimati Kanuri Santhamma Center for Retina & Vitreous Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, India
| | - Hrishikesh Kaza
- Uveitis and Ocular Immunology Services, L V Prasad Eye Institute, Hyderabad, India
| | - Soumyava Basu
- Uveitis and Ocular Immunology Services, L V Prasad Eye Institute, Hyderabad; Retina and uveitis service, L V Prasad Eye Institute, Bhubaneswar, India
| | - Rajeev R Pappuru
- Uveitis and Ocular Immunology Services; Srimati Kanuri Santhamma Center for Retina & Vitreous Diseases, L V Prasad Eye Institute, Hyderabad, India
| | - Avinash Pathengay
- Retina and Uveitis Department, GMR Varalakshmi Campus, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Somasheila Murthy
- Uveitis and Ocular Immunology Services; The Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Hitesh Agrawal
- Uveitis and Ocular Immunology Services; Srimati Kanuri Santhamma Center for Retina & Vitreous Diseases, L V Prasad Eye Institute, Hyderabad, India
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Das AV, Kammari P, Vadapalli R, Basu S. Big data and the eyeSmart electronic medical record system - An 8-year experience from a three-tier eye care network in India. Indian J Ophthalmol 2021; 68:427-432. [PMID: 32056994 PMCID: PMC7043185 DOI: 10.4103/ijo.ijo_710_19] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose To assess the demographic details and distribution of ocular disorders in patients presenting to a three-tier eye care network in India using electronic medical record (EMR) systems across an 8-year period using big data analytics. Methods An 8-year retrospective review of all the patients who presented across the three-tier eye care network of L.V. Prasad Eye Institute was performed from August 2010 to August 2018. Data were retrieved using an in-house eyeSmart EMR system. The demographic details and clinical presentation and ocular disease profile of all the patients were analyzed in detail. Results In an 8-year period, a total of 2,270,584 patients were captured on the EMR system with 4,730,221 consultations. More than half of the patients presented at tertiary centers (n = 1,174,643, 51.73%), a quarter at the secondary centers (n = 564,251, 24.85%) followed by the vision centers (n = 531,690, 23.42%). The ratio of males and females was 1.18:1. Most common states of presentation were Andhra Pradesh (n = 1,103,733, 48.61%) and Telangana (n = 661,969, 29.15%). In total, 3,721,051 ocular diagnosis instances were documented in the patients. Most common ocular disorders were related to cornea and anterior segment (n = 1,347,754, 36.22%) followed by refractive error (n = 1,133,078, 30.45%). Conclusion This study depicts the demographic details and distribution of various ocular disorders in a very large cohort of patients. There is a need to adopt digitization in geographies that cater to large populations to enable insightful research. The implementation of EMR systems enables structured data for research purposes and the development of real-time analytics for the same.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR and AEye, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Priyanka Kammari
- Department of eyeSmart EMR and AEye, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ranganath Vadapalli
- Department of eyeSmart EMR and AEye, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Sayan Basu
- Department of eyeSmart EMR and AEye, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
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Prescribing Behavior of General Practitioners for Generic Drugs. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17165919. [PMID: 32824051 PMCID: PMC7460010 DOI: 10.3390/ijerph17165919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/02/2022]
Abstract
The factors influencing General Practitioners’ (GPs) prescribing behavior are diverse in terms of health care policies and regulations, GPs’ education and experience, demographic trends and disease profiles. Thus, it can be useful to analyze the specific local patterns, as they affect the quality of healthcare and the stability of the healthcare market. The aim of the present longitudinal retrospective study is to investigate the prescription of generic drugs in a database of about 4.6 million prescriptions from a sample of 38 GPs practicing in Salerno, Italy, within a timeframe of 15 years, from 2001 to 2015. The GPs in our study show a general tendency to increase prescriptions of generic drugs during the studied time span, to fulfill regulatory obligations and with some differences in prescription behavior according to age, gender and experience. The generics prescription depends also on the different diagnoses, with some diagnostic areas showing a greater generic drug prescription rate. Expanding this research to larger datasets would allow deepening the knowledge of the patterns of GPs’ prescribing decisions, to provide evidence to be used in comparison between different national settings.
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