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Geriatr Gerontol Int ; 19(8): 699-704, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31397060


The number of older adults is increasing worldwide, including in Asian countries. Various problems associated with medical care for older adults are being highlighted in aging societies. As the number of chronic diseases increases with age, older adults are more likely to have multiple chronic diseases simultaneously (multimorbidity). Multimorbidity results in poor health-related outcomes, leading to increased use and cost of healthcare. Above all, it leads to deterioration in older adults' quality of life. However, it is unclear whether any medical interventions are effective for multimorbidity, which means medical practitioners currently offer medical care "in the dark." It is therefore necessary for researchers and medical professionals involved in geriatric medicine to establish ways to manage multimorbidity among older adults. This means that the development of research in this field is essential. Geriatr Gerontol Int 2019; 19: 699-704.

Geriatria , Multimorbidade/tendências , Múltiplas Afecções Crônicas , Qualidade de Vida , Idoso , Geriatria/métodos , Geriatria/tendências , Saúde Global , Serviços de Saúde para Idosos , Transição Epidemiológica , Humanos , Múltiplas Afecções Crônicas/economia , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Pesquisa
Med. clín (Ed. impr.) ; 153(3): 93-99, ago. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183430


Background and objective: The objective of the study was to evaluate the effects of a multidisciplinary intervention on the outcomes of polypathological patients (PP). Methods: A multicenter quasi-experimental pre-post study with a 12-month follow up was performed. In-hospital, at discharge and outpatient clinics patients who met criteria of PP between March 2012 and October 2013 were included. The multidisciplinary approach was defined by 11 interventions performed by general practitioners, internal medicine physicians, team care nurses and hospital pharmacists. The primary outcome was reduction in the number of hospital admissions and days of hospitalization. Secondary outcomes included mortality and the effects of 11 interventions on mortality. Results: 420 patients were included. Mean patient age was 77.3 (SD: 8.90) and average number of PP defining categories was 2.99 (SD: 1.00). Number of hospital admissions and days of hospitalization decreased significantly after intervention: 1.52 (SD: 1.35) versus 0.82 (SD: 1.29), p<0.001, and 13.77 (SD: 15.20) versus 7.21 (SD: 12.90), p<0.001 respectively. 12-month mortality was 37.7%. PP who failed to receive a structured medical visit from the internal medicine physician and educational workshops from the team care nurses had a higher risk of exitus in the next 12 months, HR: 1.68; 95% CI: 1.15-2.46, p=0.007 and HR: 2.86; 95% CI: 1.92-4.27, p<0.001, respectively. Conclusions: This multidisciplinary intervention reduced the risk of PP hospital admission and days of hospitalization. Educational workshop programs for PP and their caregivers and structured IM medical visits were associated with improvements of survival

Introducción y objetivo: El objetivo del estudio fue evaluar los resultados en salud tras la implantación de una intervención multidisciplinar a pacientes pluripatológicos (PP). Metodología: Se realizó un estudio multicéntrico antes-después cuasi-experimental, con seguimiento a 12 meses. Se incluyeron pacientes que cumplían los criterios de PP entre marzo de 2012 y octubre de 2013, tanto en el ámbito hospitalario como en atención primaria. El enfoque multidisciplinar fue definido por 11 intervenciones realizadas por médicos de familia, médicos internistas, enfermeras y farmacéuticos hospitalarios. El resultado fundamental fue la reducción en el número de ingresos hospitalarios y días de hospitalización al año de seguimiento. Los resultados secundarios incluyeron la mortalidad y los efectos de las intervenciones sobre la misma. Resultados: Se incluyeron 420 pacientes. La edad media de los pacientes fue de 77,3 (DE: 8,90) y la media de categorías definitorias de PP fue de 2,99 (DE: 1,00). El número de ingresos hospitalarios y los días de hospitalización disminuyeron significativamente después de la intervención: 1,52 (DE: 1,35) versus 0,82 (DE: 1,29), p<0,001 y 13,77 (DE: 15,20) versus 7,21 (DE: 12,90), p<0,001, respectivamente. La mortalidad a los 12 meses fue del 37,7%. Los PP que no recibieron la visita médica estructurada del médico internista tras la inclusión y los talleres educativos de las enfermeras tuvieron un mayor riesgo de exitus en los 12 meses de seguimiento, HR: 1,68; IC del 95%: 1,15-2,46, p=0,007 y HR: 2,86; IC del 95%: 1,92-4,27, p<0,001, respectivamente. Conclusiones: Esta intervención multidisciplinaria reduce el riesgo de ingreso y los días de ingreso hospitalario en PP. Los programas de talleres educativos para PP y sus cuidadores, y las visitas médicas estructuradas por parte de medicina interna se asociaron con una mayor supervivencia

Humanos , Masculino , Idoso , Pesquisa Interdisciplinar , Múltiplas Afecções Crônicas/epidemiologia , Hospitalização , Doença Crônica/terapia , Equipe de Assistência ao Paciente , Serviços de Saúde , Planejamento de Assistência ao Paciente/organização & administração , Comunicação Interdisciplinar
Geriatr Gerontol Int ; 19(8): 705-710, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237101


AIM: The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany. METHODS: The multicenter prospective cohort Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85+) (AgeQualiDe) was carried out. Individuals were recruited through GP offices at six study centers in Germany (follow-up wave 7). Primary care patients were aged ≥85 years (n = 861, mean age 89.0 years; range 85-100 years). The self-reported number of outpatient visits to the GP was used as the outcome measure. To explore religious and spiritual beliefs, the short form of the Transpersonal Trust scale was used. The presence or absence of 36 chronic conditions was recorded by the GP. RESULTS: Multiple Poisson regressions showed that GP visits were positively associated with the number of chronic conditions (incidence rate ratio 1.03, P < 0.05). TPT moderated the relationship between chronic conditions and GP visits (incidence rate ratio 1.01, P < 0.05). The association between chronic conditions and GP visits was significantly more pronounced when TPT was high. CONCLUSION: Our findings highlight the importance of TPT in the relationship between chronic conditions and GP visits. Future longitudinal studies are required to clarify this subject further. Geriatr Gerontol Int 2019; 19: 705-710.

Clínicos Gerais , Múltiplas Afecções Crônicas , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Qualidade de Vida , Espiritualidade , Confiança , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Alemanha , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Masculino , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
Int J Circumpolar Health ; 78(1): 1607703, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31043136


Rapid social, economic, and environmental changes in the northern territories of Canada have raised concerns about potentially increasing levels of chronic disease. This concern prompted us to compare multimorbidity prevalence in Canada between the territories and provinces. We analyzed Canadian Community Health Survey data for 2013/14. We defined multimorbidity, the outcome, as having 3 or more chronic conditions and used survey-weighted multivariable logistic regression for comparisons between territories and provinces. We found a prevalence of multimorbidity in Canada of 14.0% (95% CI: 13.6, 14.3). We could not find significant difference in multimorbidity prevalence between the territories and provinces of Canada overall; however, the territories tended to have lower prevalence estimates than provinces for multimorbidity (adj-OR = 0.88; 95% CI: 0.74-1.04). Sensitivity analyses from propensity score analyses had similar conclusions. Effect modification analyses identified lower multimorbidity in territories versus provinces among households without a post-secondary graduate (adj-OR = 0.46; 95% CI: 0.34-0.61 for northern residence), males (adj-OR = 0.71; 95% CI: 0.54-0.93), and ages 12-29 years (adj-OR = 0.63; 95% CI: 0.39-0.99). Caution is needed in interpreting the results in light of representativeness of CCHS in northern populations of Canada.

Múltiplas Afecções Crônicas/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Consumo de Bebidas Alcoólicas/etnologia , Regiões Árticas/epidemiologia , Canadá/epidemiologia , Estudos Transversais , Comportamentos Relacionados com a Saúde/etnologia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/etnologia , Prevalência , Pontuação de Propensão , Fatores de Risco , Fatores Sexuais , Fumar/etnologia , Fatores Socioeconômicos , Adulto Jovem
Int Urol Nephrol ; 51(7): 1231-1238, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31134506


PURPOSE: The number of elderly patients with end-stage renal disease on maintenance dialysis therapy is gradually increasing. The elderly population has difficulties in making decisions regarding initiation of dialysis treatment because of their high morbidity and frailty. The purpose of this study was to determine the best prognostic tool in predicting short-term mortality in elderly patients undergoing dialysis. METHODS: This study is a multicenter retrospective study. We enrolled patients, aged ≥ 75 years, who began hemodialysis at three university hospitals in Korea from January 2010 to December 2016. We applied two comorbidity-based score tools (Thamer and Wick, each consisting of seven variables) and the Clinical Frailty Scale (CFS, seven scales), which were validated for mortality prediction in elderly incident patients. Patient's information was obtained from electronic medical records in the participating center, and mortality data (up to December 2016) were obtained from the Korean National Statistical Office. Models were compared using the area under the receiver operating characteristic curve. RESULTS: Among the 219 patients enrolled in this study, the 3- and 6-month mortality rates were 31 (14.4%) and 48 (22.4%), respectively. Receiver operating characteristic curve analysis revealed that both score systems and the CFS showed similar performance while predicting 3- and 6-month mortality. The scores from these indices correlated with survival time. CONCLUSION: Predicting short-term mortality and long-term survival time for elderly patients is possible using the Thamer and Wick scores and the CFS.

Fragilidade , Avaliação Geriátrica/métodos , Falência Renal Crônica , Múltiplas Afecções Crônicas/epidemiologia , Diálise Renal , Medição de Risco/métodos , Idoso , Feminino , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Humanos , Falência Renal Crônica/diagnóstico , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Mortalidade , Prognóstico , Diálise Renal/efeitos adversos , Diálise Renal/métodos , Diálise Renal/mortalidade , Reprodutibilidade dos Testes , República da Coreia/epidemiologia , Projetos de Pesquisa/normas , Projetos de Pesquisa/estatística & dados numéricos , Fatores de Risco , Sobreviventes/estatística & dados numéricos
BMC Med ; 17(1): 75, 2019 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-30961604


BACKGROUND: Comorbidity patterns of childhood infections, atopic diseases, and adverse childhood experiences (ACE) are related to immune system programming conditions. The aim of this study was to make a step beyond the hygiene hypothesis and to comprehensively classify these patterns with latent class analysis (LCA). A second aim was to characterize the classes by associations with immunological, clinical, and sociodemographic variables. METHODS: LCA was applied to data from the CoLaus|PsyCoLaus study (N = 4874, age range 35-82 years) separately for men and women. It was based on survey information on chickenpox, measles, mumps, rubella, herpes simplex, pertussis, scarlet fever, hay fever, asthma, eczema, urticaria, drug allergy, interparental violence, parental maltreatment, and trauma in early childhood. Subsequently, we examined how immune-mediated classes were reflected in leukocyte counts, inflammatory markers (IL-1ß, IL-6, TNF-α, hsCRP), chronic inflammatory diseases, and mental disorders, and how they differed across social classes and birth cohorts. RESULTS: LCA results with five classes were selected for further analysis. Latent classes were similar in both sexes and were labeled according to their associations as neutral, resilient, atopic, mixed (comprising infectious and atopic diseases), and ACE class. They came across with specific differences in biomarker levels. Mental disorders typically displayed increased lifetime prevalence rates in the atopic, the mixed, and the ACE classes, and decreased rates in the resilient class. The same patterns were apparent in chronic inflammatory diseases, except that the ACE class was relevant specifically in women but not in men. CONCLUSIONS: This is the first study to systematically determine immune-mediated classes that evolve early in life. They display characteristic associations with biomarker levels and somatic and psychiatric diseases occurring later in life. Moreover, they show different distributions across social classes and allow to better understand the mechanisms beyond the changes in the prevalence of chronic somatic and psychiatric diseases.

Doenças Transmissíveis/epidemiologia , Doenças Transmissíveis/imunologia , Hipótese da Higiene , Fenômenos do Sistema Imunológico/fisiologia , Análise de Classes Latentes , Adulto , Idoso , Idoso de 80 Anos ou mais , Asma/epidemiologia , Asma/imunologia , Criança , Comorbidade , Feminino , Humanos , Inflamação/complicações , Inflamação/epidemiologia , Inflamação/imunologia , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/epidemiologia , Prevalência , Inquéritos e Questionários
Aten. prim. (Barc., Ed. impr.) ; 51(4): 218-229, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-180862


Objetivo: Analizar en el contexto de una Zona Básica de Salud (ZBS) la prevalencia de los factores de riesgo cardiovascular (FRCV) y el impacto que generan en la morbilidad y el consumo de recursos sanitarios en la población estratificada según el sistema Clinical Risk Groups (CRG) en Atención Primaria (AP), con la finalidad de identificar la población con multimorbilidad para aplicar medidas preventivas, así como aquella que genera más carga asistencial y necesidades sociales. Diseño: Estudio observacional, de corte transversal y ámbito poblacional para una ZBS durante el año 2013. Emplazamiento: Departamento de salud de Castellón, Comunidad Valenciana (CV). Incluye asistencia ambulatoria en AP y especializada. Participantes: Todos los ciudadanos dados de alta en el Sistema de Información Poblacional (SIP), N = 32.667. Mediciones: Del sistema informatizado Abucasis obtuvimos las variables demográficas, clínicas y de consumo de recursos sanitarios. Consideramos la prevalencia de los FRCV a partir de la presencia o ausencia de los códigos diagnósticos CIE.9.MC. Se analizó la relación de los FRCV con los 9 estados de salud CRG, y se realizó un análisis predictivo con el modelo de regresión logística para evaluar la capacidad explicativa de cada variable. Además, se obtuvo mediante regresión multivariante un modelo explicativo del gasto farmaceútico ambulatorio. Resultados: La población del estado de salud CRG 4 en adelante tenía multimorbilidad. Los estados de salud CRG 7 y CRG 6 tienen mayor prevalencia de FRCV. Fue predictivo que a mayor morbilidad, mayor consumo de recursos, mediante OR superiores a la media, p < 0,05 e intervalos de confianza del 95%. Se observó que un 59,8% del gasto farmacéutico ambulatorio quedaba explicado por el sistema CRG y todos los FRCV (p < 0,05 y R2 corregido = 0,598). En cuanto al efecto de los FRCV sobre los estados de salud CRG, hubo asociación significativa (p < 0,05) para la alteración de la glucemia, dislipidemia e HTA en todos los estados CRG. Conclusiones: El estudio de los FRCV en una población estratificada mediante el sistema CRG identifica y predice dónde se genera mayor impacto en la morbilidad y consumo de recursos sanitarios. Nos permite conocer los grupos de pacientes en quienes desarrollar estrategias de prevención y cronicidad. A nivel de la práctica clínica se aporta un nuevo concepto de multimorbilidad, definido a partir del estado de salud CRG 4 en adelante

Objective: To analyze the prevalence of Cardiovascular Risk Factors (CVRF) in the context of a Basic Health Area and the impact they generate on morbidity and consumption of healthcare resources in the stratified population according to the Clinical System Risk Groups (CRG) in Primary Care, with the purpose of identifying the population with multimorbidity to apply preventive measures, as well as the one that generates the highest care burden and social needs. Design: Observational, cross-sectional and population-based study for a basic health area during 2013. Location: Department of Health 2 (Castellón), Comunidad Valenciana (CV). Includes outpatient care in Primary Care and specialized. Participants: All citizens registered in the Population Information System, N = 32,667. Measurements: From the computerized system Abucasis we obtained the demographic, clinical and consumption variables of health resources. We consider the prevalence of CVRF based on the presence or absence of the ICD.9.MC diagnostic codes. The relationship of the CVRF with the 9 CRG health states was analyzed and a predictive analysis was performed with the logistic regression model to evaluate the explanatory capacity of each variable. In addition, an explanatory model of ambulatory pharmaceutical expenditure was obtained through multivariate regression. Results: The population of health status CRG4 and above had multimorbidity. The CRG7 and 6 health states have a higher prevalence of CVRF; it was predictive that the higher the morbidity, the greater the consumption of resources through OR above the mean, p < 0.05 and the 95% confidence intervals. It was observed that 59.8% of ambulatory pharmaceutical expenditure was explained by the CRG system and all the CVRF (p < 0.05 and R2 corrected = 0.598). Regarding the effect of the CVRF on the CRG health states, there was a significant association (p < 0.05) for the alteration of blood glucose, dyslipidemia and HBP in all the CRG states. Conclusions: The study of CVRF in a stratified population using the CRG system identifies and predicts where the greatest impact on morbidity and consumption of healthcare resources is generated. It allows us to know the groups of patients where to develop prevention and chronicity strategies. At the level of clinical practice, a new concept of multimorbidity is provided, defined from the state of health CRG 4 and above

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares/prevenção & controle , Atenção Primária à Saúde/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Custos de Medicamentos/estatística & dados numéricos , Fatores de Risco , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Estudos Transversais , Grupos de Risco , Risco Ajustado/organização & administração , Nível de Saúde , Múltiplas Afecções Crônicas/epidemiologia
Enferm. glob ; 18(54): 410-417, abr. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-183489


Introducción: La calidad de vida relacionada con la salud se entiende como el efecto funcional y anímico que una enfermedad produce en una persona, incluyendo el tratamiento y cómo este proceso es percibido por la persona, el cual puede estar influido por el género.Objetivo: Determinar la percepción de la calidad de vida relacionada con la salud entre hombre y mujeres adultos mayores en la Comarca Lagunera de Coahuila.Método: Estudio cuantitativo y descriptivo de corte transversal. La muestra estuvo conformada por 100 adultos mayores seleccionados a conveniencia en la escuela de Lic. en Enfermería, U.T. de la Universidad Autónoma de Coahuila y un hospital público de la localidad. Los datos se analizaron en el programa SPSS v22 para Mac, se utilizó estadística descriptiva y la prueba U de Mann-Withney.Resultados: El análisis entre el género y la percepción de calidad de vida relacionada con la salud no observó diferencia significativa (U= 922.00, p=.178); sin embargo, al analizar la calidad de vida por dimensiones, existe diferencia significativa en tres componentes que son movilidad física (U= 812.00, p>.05), dolor (U= 816.00, p>.05) y energía (U= 807.50, p>.05).Conclusiones: En la presente investigación, se puede observar que los hombres y mujeres adultos mayores perciben la calidad de vida relacionada a la salud de una forma muy parecida, sin embargo, se encontró diferencia en algunos componentes que desde el punto de vista de los autores están muy ligados al rol social que cumple una mujer o un hombre adulto mayor

Introduction: The quality of life related to health is understood as the functional and emotional effect that a disease produces in a person, including treatment and how this process is perceived by the person, which may be influenced by gender.Objective: To determine the perception of quality of life related to health among men and older women in the Comarca Lagunera of Coahuila.Method: Quantitative and descriptive cross-sectional study. The sample was 100 old adults selected at convenience in the Nursing School, U.T. from the Autonomous University of Coahuila and a public hospital in the town. Data were analyzed in the SPSS v22 program for Mac, descriptive statistics and the Mann-Whitney U test were used.Results: The analysis between gender and health-related quality of life perception did not observe a significant difference (U=922.00, p=.178); However, when analyzing the quality of life by dimensions, there is a significant difference in three components that are physical mobility (U= 812.00, p< .05), pain (U= 816.00, p< .05) and energy (U= 807.50, p< .05).Conclusions: In the present investigation, it can be observed that older men and women perceive the quality of life related to health in a very similar way, however, a difference was found in some components that from the point of view of the authors, they are closely linked to the social role played by a woman or an older adult man

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Saúde do Idoso , Qualidade de Vida/psicologia , Idoso/psicologia , Envelhecimento/psicologia , Percepção Social , Habilidades Sociais , Fatores de Proteção , Fatores de Risco , Distribuição por Sexo , Múltiplas Afecções Crônicas/epidemiologia , Polimedicação
Rev. esp. quimioter ; 32(2): 178-182, abr. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-182819


Objetivos: Describir las características clínico-epidemiológicas en una serie de casos de sospecha de reacciones adversas sistémicas registradas tras la administración de la vacuna frente a neumococo polisacárida de 23 serotipos (PNEUMOVAX23(R)). Calcular la incidencia acumulada de dicha reacción y conocer si se han descrito casos similares y/o compatibles en la literatura científica o en Farmacovigilancia. Métodos: Estudio observacional retrospectivo realizado entre 01/12/2015 y 30/09/2017 en la Unidad de Vacunas de un hospital autonómico de referencia. Se calculó la incidencia acumulada de la reacción adversa sistémica para esa vacuna. Se consultó la base de datos del Sistema Español de Farmacovigilancia (FEDRA). Resultados: Se registraron 9 sospechas de reacciones adversas sistémicas inmediatas (flushing + broncoespasmo + SatO2<95%). La incidencia acumulada fue 1,036%. El desenlace fue recuperado/resuelto para todos. No se encontraron casos similares y/o compatibles. Conclusiones: Las reacciones descritas no constan en la ficha técnica de PNEUMOVAX23(R). Epidemiológicamente no se puede establecer ninguna relación causal entre la aparición de los síntomas y las variables estudiadas. Esta información podría ser la base de investigaciones más amplias que supusieran la posible modificación de la ficha técnica

Objectives: To describe the clinical-epidemiological characteristics of a series of suspected systemic adverse reactions registered with the 23 serotype pneumococcal polysaccharide vaccine (PNEUMOVAX23(R)). Calculate the cumulative incidence of the reaction and know if similar and/or compatible cases have been described in the scientific literature or in pharmacovigilance. Methods: Observational and retrospective study realized between 01/12/2015 and 30/09/2017 in the Vaccines Unit of an autonomic reference hospital. We calculated the cumulative incidence of the adverse reaction for that vaccine. The common pharmacovigilance database (FEDRA) was consulted. Results: Nine systemic adverse reactions were recorded (flushing + bronchospasm + SatO2<95%). The cumulative incidence was 1.036%. The outcome was recovered/resolved for everyone. No similar and/or compatible cases were found. Conclusions: The reactions described do not appear in the PNEUMOVAX23(R) data sheet. Epidemiologically, no causal relationship can be established between the symptoms and the variables studied. This study could be the basis for more detailed research that could modify the vaccine data sheet

Humanos , Masculino , Feminino , Criança , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Múltiplas Afecções Crônicas/epidemiologia , Vacinas Pneumocócicas/efeitos adversos , Espasmo Brônquico/epidemiologia , Estudos Retrospectivos , Infecções Estreptocócicas/prevenção & controle , Farmacovigilância , Rubor/epidemiologia
Eur J Orthop Surg Traumatol ; 29(5): 1055-1060, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30864015


INTRODUCTION: A hip fracture carries significant morbidity and mortality-a second fracture of the contralateral hip carries even higher complications. Most second hip fractures occur within 48 months of the first. The aim of this study was to comprehensively analyse all identifiable variables that may increase the risk of a contralateral hip fracture within this time period. METHODS: We retrospectively analysed 1242 consecutive patients with hip fractures presenting to our institution. All patient-related, surgery-related and inpatient variables were collected from the index admission. We then identified patients with a subsequent contralateral hip fracture in the following 2 years. Univariate and multivariate analyses were performed to identify risk factors associated with a second fracture. RESULTS: A total of 66 patients (5.3%) had a contralateral hip fracture in the 2 years following initial hip fracture. Mean age at first presentation was 81 years, and mean time to second fracture was 305 days. Following multivariate analysis, the patients at highest risk of a second fracture were those with dementia, acute inpatient chest infection, urinary tract infection and multiple comorbidities as measured by the Charlson score. Discharge destination after initial fracture was not associated with the risk of a second fracture. CONCLUSIONS: We have identified a number of discrete risk factors that are associated with a short- to medium-term risk of contralateral hip fracture that may be useful in screening for patients at risk and provide them with focused medical rehabilitation.

Demência/epidemiologia , Fixação de Fratura , Fraturas do Quadril , Fraturas por Osteoporose , Readmissão do Paciente/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Idoso Fragilizado/estatística & dados numéricos , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Masculino , Múltiplas Afecções Crônicas/epidemiologia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/cirurgia , Período Pós-Operatório , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Reino Unido/epidemiologia
Enferm. nefrol ; 22(1): 19-25, ene.-mar. 2019.
Artigo em Espanhol | IBECS | ID: ibc-183590


El riñón del anciano experimenta cambios estructurales y funcionales, que lo convierte en más vulnerable para la enfermedad renal. La mayoría de ancianos con enfermedad renal crónica fallece antes de desarrollar progresión renal. Sin embargo, el principal grupo de pacientes incidentes de nefropatía terminal es el de personas mayores de 65 años, representando la diabetes mellitus y las causas vasculares sus principales etiologías. En esta revisión se analizan elementos renales (filtrado glomerular, proteinuria/albuminuria, potasio, fracaso renal agudo y diuréticos) y factores geriátricos (estado funcional, cognitivo y fragilidad) como predictores de progresión de enfermedad renal. La identificación de estos factores contribuirá a establecer estrategias de prevención renal y al pronóstico de la enfermedad en la toma decisiones

The kidney in elderly people suffers structural and functional changes, which makes it more vulnerable to kidney disease. The majority of the elderly with chronic kidney disease die before developing renal progression. However, the main group of patients that develop terminal nephropathy is that of people older than 65 years, representing diabetes mellitus and vascular causes the main etiologies. In this review, renal elements (glomerular filtration, proteinuria/albuminuria, potassium, acute renal failure and diuretics) and geriatric factors (functional, cognitive and frail state) are analyzed as predictors of renal disease progression. The identification of these factors will help to establish strategies for renal prevention and the prognosis of the disease in decision making

Humanos , Idoso , Insuficiência Renal Crônica/epidemiologia , Falência Renal Crônica/epidemiologia , Fragilidade/epidemiologia , Progressão da Doença , Envelhecimento/fisiologia , Insuficiência Renal Crônica/complicações , Idoso Fragilizado/estatística & dados numéricos , Análise de Classes Latentes , Previsões/métodos , Múltiplas Afecções Crônicas/epidemiologia , Doente Terminal/estatística & dados numéricos , Transplante de Rim/estatística & dados numéricos
Brain Behav ; 9(3): e01233, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30724486


OBJECTIVE: We investigated white matter differences associated with distinct neurocognitive profiles derived from a large cohort of marginally housed persons with comorbid physical and mental illnesses. Our prior work identified three profile cluster groups: a high functioning group (Cluster 1), a low functioning group with relative strength in decision-making (Cluster 3), and an intermediary group with a relative decision-making weakness (Cluster 2). This study extends previous findings of cortical gray matter differences between these groups with evidence for putative neurodevelopmental abnormalities in the low cognitive functioning group (i.e., Cluster 3). We hypothesized that altered white matter diffusion would be associated with the lowest functioning neurocognitive profile and would be associated with previously observed gray matter differences. METHOD: Participants from a socially impoverished neighborhood in Vancouver, Canada underwent neurocognitive evaluation and neuroimaging. We performed Tract-Based Spatial Statistics using diffusion tensor imaging data from 184 participants to examine whole-brain differences in white matter microstructure between cluster analytically derived neurocognitive profiles, as well as unitary neurocognitive measures. Correlations between frontal gray and white matter were also examined. RESULTS: Cluster 3 showed increased diffusion in predominately bilateral frontal and interhemisphere tracts (vs. Clusters 1 and 2), with relatively greater diffusion in the left hemisphere (vs. Cluster 1). Differences in radial diffusivity were more prominent compared with axial diffusivity. A weak association between regional frontal fractional anisotropy and previously defined abnormalities in gyrification was observed. CONCLUSIONS: In a socially marginalized sample, we established several patterns in the covariation of white matter diffusion and neurocognitive functioning. These patterns elucidate the neurobiological substrates and vulnerabilities that are apt to underlie functional impairments inherent to this complex and heterogeneous population.

Imagem de Tensor de Difusão/métodos , Substância Cinzenta , Transtornos Neurocognitivos , Substância Branca , Adulto , Asilos , Canadá/epidemiologia , Cognição/fisiologia , Estudos de Coortes , Feminino , Substância Cinzenta/diagnóstico por imagem , Substância Cinzenta/fisiopatologia , Humanos , Masculino , Testes de Estado Mental e Demência , Múltiplas Afecções Crônicas/epidemiologia , Transtornos Neurocognitivos/diagnóstico , Transtornos Neurocognitivos/epidemiologia , Transtornos Neurocognitivos/fisiopatologia , Populações Vulneráveis , Substância Branca/diagnóstico por imagem , Substância Branca/fisiopatologia
PLoS One ; 14(2): e0211965, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30730970


INTRODUCTION: To design effective policy and interventions, public health officials must have an accurate and granular picture of the state of multiple chronic conditions (MCC) in their region. The objective of this research is to describe the prevalence and distribution of MCC in New York State. METHODS: We performed a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) from 2011 through 2016 for New York adults (n = 76,186). We analyzed the self-reported prevalence of individuals having 0, 1, 2, or ≥ 3 chronic conditions by sex, race/ethnicity, age, health insurance type, annual household income, and whether respondents lived in New York City. We also examined the most common condition dyads and triads. Finally, we assessed the prevalence of MCC (2 or more chronic conditions) by county across New York State, and neighborhood within New York City. RESULTS: During 2011-2016, 25.2% of adults in New York State had zero chronic conditions, 24.1% had 1 condition, 18.4% had 2 conditions, and 32.4% had 3 or more. The most prevalent dyad was hypertension and high cholesterol in 17.0% of individuals. The most prevalent triad was hypertension, high cholesterol, and arthritis in 4.5% of individuals. County prevalence of MCC ranged from 42.6% in Westchester County to 66.1% in Oneida County. The prevalence of MCC in New York City neighborhoods ranged from 33.5% in Gramercy Park-Murray Hill to 60.6% in High Bridge-Morrisania. CONCLUSION: This research contributes to the field's understanding of multiple chronic conditions and allows policy and public health leaders in New York to better understand the prevalence and distribution of MCC.

Múltiplas Afecções Crônicas/epidemiologia , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prevalência , Autorrelato , Adulto Jovem
Acta Med Port ; 32(1): 30-37, 2019 Feb 01.
Artigo em Português | MEDLINE | ID: mdl-30753801


INTRODUCTION: The simultaneous presence of multiple chronic diseases in the same individual is recognized as an important public health problem. Patients with multimorbidity have greater healthcare needs, which represents a higher burden on health services. Although there is no consensual definition of this concept, multimorbidity is usually defined as the presence of two or more chronic diseases in the same patient. The existence of evidence regarding multimorbidity will lead to more efficient management and treatment of these patients. MATERIAL AND METHODS: In order to estimate the prevalence of multimorbidity and to identify the associated factors, a cross-sectional epidemiological study was developed based on data from the INSEF, a population-based survey conducted on a representative probability sample of the Portuguese population (n = 4911). The prevalence of multimorbidity was estimated for the total population and separately for men and women, stratified by age group, region, education and income. The magnitudes of the associations were measured by the adjusted prevalence ratios calculated by the Poisson regression model. RESULTS: Prevalence of multimorbidity was 38.3% (95% CI: 35.4% to 41.3%), with higher frequency in women, older people, Lisbon and Tagus Valley; Northern Portugal; Algarve and Alentejo regions and in those with lower academic qualifications. No association was found between multimorbidity and income. DISCUSSION: Multimorbidity affects more than one third of the Portuguese population. Epidemiological data about multimorbidity in Portugal allows the identification of population groups with higher multimorbidity prevalence. CONCLUSION: Our results, which highlight the greater risk of multimorbidity among older and less instructed people, are in line with the literature. These results show the relevance of multimorbidity patients and are especially important in the way how healthcare is organized and provided.

Inquéritos Epidemiológicos/estatística & dados numéricos , Multimorbidade , Múltiplas Afecções Crônicas/epidemiologia , Adulto , Distribuição por Idade , Idoso , Estudos Transversais , Escolaridade , Feminino , Inquéritos Epidemiológicos/ética , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Portugal/epidemiologia , Prevalência , Distribuição por Sexo
Acta Med Port ; 32(1): 38-46, 2019 Feb 01.
Artigo em Português | MEDLINE | ID: mdl-30753802


INTRODUCTION: The association between multimorbidity and disease severity is not well established. The objectives were to characterise multimorbidity and determine disease severity (trough Charlson), as well as to verify if there is an association between the number and type of disease and the Charlson index. MATERIAL AND METHODS: A cross-sectional study based on exported data from the Portuguese National Health Service hospitalisations database, during the year 2015. The study included 22 chronic health conditions: 15 predicted in the Charlson index and seven frequent conditions (hypertension, obesity, dyslipidaemia, osteoarthritis, osteoporosis, anxiety and depression). The analysis was performed through the generalised linear model, considering binary logistic regression. In the analysis, the IBM SPSS version 24.0 tool was used. RESULTS: The study analysed 800 376 hospitalisations, from which 42% correspond to males. The average age of the sample was 59.8 years, being higher in men (62.3 years). The mean number of problems per person was 1.6, greater in men (1.8). Disease severity was also higher in males. The worst prognosis was associated with six or more conditions per person. The largest predictor of disease severity was the number of problems, followed by dementia and diabetes. DISCUSSION: The results seem to confirm the gender difference regarding morbidity pattern. The number of conditions per person was the greatest predictor of disease severity, particularly the presence of six or more conditions per person. CONCLUSION: The major limitation was the use of the same medical conditions to measure multimorbidity and disease severity. Other studies and analysis models should explore the complexity of the multimorbidity phenomenon.

Pacientes Internados/estatística & dados numéricos , Multimorbidade , Múltiplas Afecções Crônicas/epidemiologia , Índice de Gravidade de Doença , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Codificação Clínica , Estudos Transversais , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/classificação , Portugal/epidemiologia , Distribuição por Sexo , Adulto Jovem
Health Serv Res ; 54(2): 484-491, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30790281


OBJECTIVE: The study's purpose was to describe the cumulative duration of 19 chronic conditions among Medicare fee-for-service (FFS) beneficiaries and examine variation in total expenditures explained by cumulative duration and condition counts. DESIGN, SETTING, STUDY DESIGN, AND DATA EXTRACTION: In a retrospective cohort of FFS beneficiaries age ≥68, 2015 Medicare enrollment and claims data (N = 20 124 230) were used to identify the presence or absence of 19 diagnosed chronic conditions, and to construct MCC categories (0-1, 2-3, 4-5, 6+) and cumulative duration of each of 19 conditions from the date of first possible occurrence in claims (1/1/1999) to the end of follow-up (date of death or 12/31/2015). Total Medicare expenditures were estimated using linear models adjusted for demographic characteristics. PRINCIPAL FINDINGS: Multimorbidity was common (71.7 percent with 2+ conditions). The mean cumulative duration of all 19 conditions was 23.6 person-years, which varied greatly by age and number of conditions. Condition counts were more predictive of Medicare expenditures than cumulative duration (R-squared for continuous measures = 0.461 vs 0.272; R-squared for quartiles = 0.408 vs 0.266). CONCLUSIONS: The cumulative duration of chronic conditions varied widely for Medicare beneficiaries, especially for those with 6+ conditions, but was less predictive of total expenditures than condition counts.

Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Medicare/estatística & dados numéricos , Múltiplas Afecções Crônicas/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Planos de Pagamento por Serviço Prestado/economia , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Medicare/economia , Modelos Econômicos , Múltiplas Afecções Crônicas/economia , Estudos Retrospectivos , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos
Anthropol Med ; 26(1): 33-47, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30714817


An in-depth case study of integrated health and social care provides the empirical basis for this exploration of tensions between ethnography and evaluation. The case study, developed from a two year period of fieldwork, is based on ethnographic data of individuals' experiences of living with multiple long-term conditions, their experiences of integrated care, and integrated care commissioning practices. Narrative and phenomenological analysis show how temporal aspects of ethnographic fieldwork contribute to producing knowledge of patients' experiences. However, tensions emerge when attempting to bring learning from these experiences into discussions about evaluations of services. Data generated from fieldwork are seen as both too 'big', in terms of quantity of details, and too 'small', in terms of generalisability. Scale is also of concern, as tensions between ethnography and evaluation play out in questions of relevance. Ethnography foregrounds embodied, day-to-day lived experience, bringing the minutiae of daily life into sharp focus whereas evaluators need a wider angle to foreground larger objects of interest; organisations, budgets, services. A further source of tension between ethnography and evaluation emerges in defining interventions as distinct from context, when the conceptual boundary required to distinguish the shape of the intervention within a social world blurs and dissolves under the close gaze of an immersed ethnographer, problematizing attempts to inform causation. Concerns are raised that without greater dialogue about the nature of knowledge produced by patients' experiences, these experiences are at risk of being marginalised and de-centred.

Antropologia Cultural , Antropologia Médica , Prestação Integrada de Cuidados de Saúde/métodos , Inglaterra , Acesso aos Serviços de Saúde , Humanos , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Participação do Paciente , Pesquisa Qualitativa
Rev. esp. geriatr. gerontol. (Ed. impr.) ; 54(1): 27-33, ene.-feb. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-182219


El aumento creciente de la población mundial y el envejecimiento generalizado se han acompañado de un incremento en la prevalencia de cáncer en el anciano. El envejecimiento se asocia a determinados cambios fisiológicos, algunos de los cuales se potencian por la propia neoplasia. Junto a esto, el anciano oncológico suele tener más problemas que el resto de los individuos de edad avanzada, y es habitual que presente multitud de déficits. Estas características hacen necesario un manejo especial del mismo, utilizando, para ello, la principal herramienta empleada en Geriatría, la valoración geriátrica integral. Con este manuscrito se pretende analizar cuál es la trascendencia de la valoración geriátrica integral en dicho grupo poblacional, prestando especial atención a su capacidad para predecir la toxicidad a la quimioterapia y la supervivencia del anciano oncológico, y su capacidad para clasificar a estos pacientes en grupos que faciliten la toma de decisiones posterior

The growing increase in world population and generalised aging have been accompanied by an increase in the prevalence of cancer in the elderly. Aging is associated with certain physiological changes, some of which are enhanced by the neoplasm itself. Along with this, the elderly oncology patient usually has more problems than the rest of the elderly, and has a multitude of deficits. These characteristics require a special handling of the older patient with cancer, by using the main tool used in Geriatrics, the comprehensive geriatric assessment. This article analyses the importance of the comprehensive geriatric assessment in this population group, paying special attention to its ability to predict the toxicity of chemotherapy and the survival of the elderly oncology, as well as its ability to classify these patients into groups that help in the decision making process

Humanos , Idoso , Avaliação Geriátrica/métodos , Neoplasias/epidemiologia , Assistência Integral à Saúde/organização & administração , Fragilidade/epidemiologia , Múltiplas Afecções Crônicas/epidemiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle