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1.
Medicine (Baltimore) ; 100(1): e23994, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429760

RESUMO

ABSTRACT: To date research investigating the associations between handgrip strength and multimorbidity when stratifying by age and sex is limited. Furthermore, this is the first study in a Korean population, and the first to include adults ≥ 19 years of age. Here we investigated the associations between handgrip strength and multimorbidity in Korean adults aged ≥ 19 years.In this cross-sectional study data from the Korean National Health and Nutrition Examination Survey were used. Multimorbidity was defined as having 2 or more chronic diseases. A total of 19,779 participants were eligible for the study (8730 male and 11,049 female). We grouped and analysed participants based on age and sex (men and women aged 19-49 years, men and women aged 50-80 years) and examined the associations between handgrip strength and multimorbidity using multivariate logistic regressions using stratification by age, sex and body mass index (BMI).Multivariate logistic regressions revealed a significant inverse association irrespective of sex, between relative handgrip strength and multimorbidity. Participants with the lowest handgrip strength had a significantly higher odds ratio (OR) of multimorbidity (men aged 19-49 years: 3.76 and aged 50 years to 80 years: 2.11; women aged 19 years to 49 years: 1.52 and aged 50-80 years: 2.15) when compared to those with highest handgrip strength after adjusting for confounding variables. The highest OR was observed in men aged 19 years to 49 years with a BMI ≥ 25 kg/m2.In the current study we observed a significant inverse relationship between handgrip strength and multimorbidity in males and females with 2 or more chronic diseases. Male participants with a low handgrip strength aged between 19 years to 49 years with a BMI ≥25 kg/m2 may be at greater risk of multimorbidity. This study highlights the need for further longitudinal studies to investigate the effects of increasing handgrip strength combined with weight loss, as an effective strategy to reduce the incidence of multimorbidity.


Assuntos
Força da Mão/fisiologia , Multimorbidade , Adulto , Índice de Massa Corporal , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/tendências , Inquéritos Nutricionais/métodos , República da Coreia
2.
Eur J Endocrinol ; 184(1): 107-122, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33112262

RESUMO

Objective: Hypogonadism is common in HIV-infected men. The relationship between health status, sex steroids and body composition is poorly known in HIV. The aim was to investigate the association between health status (comorbidities/frailty), body composition, and gonadal function in young-to-middle-aged HIV-infected men. Design: Prospective, cross-sectional, observational study. Methods: HIV-infected men aged <50 years and ongoing Highly Active Antiretroviral Therapy were enrolled. Serum total testosterone (TT), estradiol (E2), estrone (E1) were measured by liquid chromatography-tandem mass spectrometry, LH and FSH by immunoassay. Free testosterone (cFT) was calculated by Vermeulen equation. Body composition was assessed by dual-energy X-ray absorptiometry and abdominal CT scan. Multimorbidity (MM) and frailty were defined as ≥3 comorbidities and by a 37-item index, respectively. Results: A total of 316 HIV-infected men aged 45.3 ± 5.3 years were enrolled. Body fat parameters were inversely related to cFT and TT, and directly related to E1 and E2/testosterone (TS) ratio. Patients with MM had lower cFT (P < 0.0001) and TT (P = 0.036), and higher E1 (P < 0.0001) and E2/TS ratio (P = 0.002). Frailty was inversely related to cFT (R2 = 0.057, P < 0.0001) and TT (R2 = 0.013, P = 0.043), and directly related to E1 (R2 = 0.171, P < 0.0001), E2 (R2 = 0.041, P = 0.004) and E2/TS ratio (R2 = 0.104, P < 0.0001). Conclusions: Lower TT and cFT, higher E1, E2/TS ratio and visceral fat were independently associated to poor health status and frailty, being possible hallmarks of unhealthy conditions in adult HIV-infected men. Overall, MM, frailty and body fat mass are strictly associated to each other and to sex steroids, concurring together to functional male hypogonadism in HIV.


Assuntos
Tecido Adiposo , Estrona/sangue , Infecções por HIV/fisiopatologia , Hipogonadismo/fisiopatologia , Testosterona/sangue , Absorciometria de Fóton , Adulto , Terapia Antirretroviral de Alta Atividade , Composição Corporal , Estudos Transversais , Fragilidade/fisiopatologia , Fragilidade/virologia , HIV , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Hipogonadismo/virologia , Masculino , Pessoa de Meia-Idade , Multimorbidade , Estudos Prospectivos
4.
Rev Saude Publica ; 54: 125, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331522

RESUMO

OBJECTIVE: To estimate the relation between catastrophic health expenditure (CHE) and multimorbidity in a national representative sample of the Brazilian population aged 50 year or older. METHODS: This study used data from 8,347 participants of the Estudo Longitudinal de Saúde dos Idosos Brasileiros (ELSI - Brazilian Longitudinal Study of Aging) conducted in 2015-2016. The dependent variable was CHE, defined by the ratio between the health expenses of the adult aged 50 years or older and the household income. The variable of interest was multimorbidity (two or more chronic diseases) and the variable used for stratification was the wealth score. The main analyses were based on multivariate logistic regression. RESULTS: The prevalence of CHE was 17.9% and 7.5%, for expenditures corresponding to 10 and 25% of the household income, respectively. The prevalence of multimorbidity was 63.2%. Multimorbidity showed positive and independent associations with CHE (OR = 1.95, 95%CI 1.67-2.28, and OR = 1.40, 95%CI 1.11-1.76 for expenditures corresponding to 10% and 25%, respectively). Expenditures associated with multimorbidity were higher among those with lower wealth scores. CONCLUSIONS: The results draw attention to the need for an integrated approach of multimorbidity in health services, in order to avoid CHE, particularly among older adults with worse socioeconomic conditions.


Assuntos
Doença Catastrófica/economia , Doença Crônica/economia , Gastos em Saúde/estatística & dados numéricos , Multimorbidade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Doença Catastrófica/epidemiologia , Doença Crônica/epidemiologia , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
5.
Rev Saude Publica ; 54: 138, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33331530

RESUMO

OBJECTIVE: To assess the prevalence of multimorbidity among Brazilian adults and its association with socioeconomic indicators. METHODS: Cross-sectional study that used data from the Pesquisa Nacional Sobre Acesso, Utilização e Promoção do Uso Racional de Medicamentos no Brasil (PNAUM - Brazilian National Survey on Access, Use and Promotion of Rational Use of Medicines), carried out between 2013 and 2014. The definition of multimorbidity was the coexistence, in a single individual, of two or more chronic diseases, measured through a list of 14 morbidities (self-reported medical diagnosis throughout life). Economic status and educational level were the socioeconomic indicators used, being the inequalities assessed through the Slope Index of Inequality (SII) and the Concentration Index, stratified by gender. RESULTS: The study comprehended 23,329 adults (52.8% of which were women), with an average age of 37.9 years. Hypertension and high cholesterol levels were the most prevalent conditions. The prevalence of multimorbidity was of 10.9% (95%CI 10.1-11.7) representing nearly 11 million individuals in Brazil, of which 14.5% (95%CI 13.5-15.4) were women and 6.8% (95%CI 5.9-7.8) were men. The occurrence of multimorbidity was similar according to the socioeconomic indicators. In the inequality analysis, we observed absolute and relative differences in men with a higher purchasing power (SII = 3.7; 95%CI 0.3-7.0) and higher educational level (CIX = 7.1; 95%CI 0.9-14.7), respectively. CONCLUSIONS: The frequency of comorbidities in Brazilian adults is high, especially in absolute terms. We only observed socioeconomic inequalities in multimorbidities among men.


Assuntos
Escolaridade , Hipercolesterolemia/epidemiologia , Hipertensão/epidemiologia , Multimorbidade , Classe Social , Adulto , Distribuição por Idade , Brasil/epidemiologia , Colesterol/sangue , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Distribuição por Sexo
6.
Artigo em Inglês | PAHO-IRIS | ID: phr-53159

RESUMO

[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.


[RESUMEN]. Objetivos. Describir los patrones de multimorbilidad entre los casos fatales de COVID-19, y proponer una clasificación de los pacientes basada en la edad y los patrones de multimorbilidad para iniciar la construcción de modelos etiológicos. Métodos. Se incluyeron los datos de las muertes confirmadas por COVID-19 en Colombia hasta el 11 de junio de 2020 (n=1 488 muertes). Se exploraron las relaciones entre la COVID-19, las combinaciones de enfermedades y la edad utilizando regresiones polinómicas con ponderación local. Resultados. Las enfermedades más frecuentes fueron la hipertensión arterial, las enfermedades respiratorias, la diabetes, las enfermedades cardiovasculares y las enfermedades renales. Las díadas más frecuentes fueron la hipertensión arterial combinada con diabetes, enfermedades cardiovasculares o enfermedades respiratorias. Algunos patrones de multimorbilidad aumentan la probabilidad de morir en las personas mayores, mientras que otros no están relacionados con la edad o disminuyen la probabilidad de morir en las personas mayores. A diferencia de lo que con frecuencia se considera, no toda la multimorbilidad aumenta con la edad. La obesidad, aislada o combinada con otras enfermedades, se asocia con un mayor riesgo de enfermedad grave en los jóvenes, mientras que el riesgo de la díada hipertensión arterial/diabetes tiende a tener una distribución en U invertida en relación con la edad. Conclusiones. La clasificación de los individuos según la multimorbilidad en el manejo médico de los pacientes con COVID-19 es importante para determinar los posibles modelos etiológicos y definir el triaje de los pacientes para su hospitalización. Además, la identificación de los individuos no infectados con edades y patrones de multimorbilidad de alto riesgo sirve para definir posibles intervenciones de confinamiento selectivo o manejo especial.


Assuntos
Infecções por Coronavirus , Betacoronavirus , Multimorbidade , Cuidados Médicos , Mortalidade , Colômbia , Coronavirus , Infecções por Coronavirus , Multimorbidade , Cuidados Médicos , Mortalidade , Infecções por Coronavirus
7.
Rehabilitation (Stuttg) ; 59(6): 376-389, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33285614

RESUMO

Geriatric rehabilitation care serves to maintain the self-determined participation of elderly people. It contributes to reduce dependency on care, which is one of society's major challenges. The focus of its work lies on elderly patients, mostly with multiple impairments and limited reserves. These people consequently face a high risk of developing further activity limitations and participation restrictions in the context of any acute illness. This justifies the large proportion of early rehabilitation already in hospital, which forms an essential part of geriatric rehabilitation care in Germany. Its goal is to reduce or prevent any associated setbacks regarding independent living as soon and as far as possible. However, early rehabilitation cannot replace a potentially necessary further medical rehabilitation - particularly under the conditions of lump-sum compensation in the context of the DRG system. But institutions for further medical rehabilitation exist only in some of the federal states in Germany.In addition, geriatric rehabilitation services are largely provided in inpatient settings in Germany. This system to date only rarely takes advantage of the benefits of other forms of rehabilitation. For instance, outpatient geriatric rehabilitation could already be used more frequently to prevent dependency on care in cases of slowly increasing deterioration of functional health. Mobile rehabilitation, where rehabilitation patients are visited in their residential environment, could be more efficient and more sustainable for patients whose rehabilitation and participation goals can be achieved less by means of restitution of lost functions rather than by the adaptation of contextual factors and the improvement of support arrangements.


Assuntos
Serviços de Saúde para Idosos , Centros de Reabilitação , Idoso , Avaliação da Deficiência , Avaliação Geriátrica , Alemanha , Humanos , Multimorbidade , Reabilitação
8.
BMJ Open ; 10(11): e043828, 2020 11 17.
Artigo em Inglês | MEDLINE | ID: mdl-33203640

RESUMO

OBJECTIVES: To estimate the impact of the COVID-19 pandemic on cancer care services and overall (direct and indirect) excess deaths in people with cancer. METHODS: We employed near real-time weekly data on cancer care to determine the adverse effect of the pandemic on cancer services. We also used these data, together with national death registrations until June 2020 to model deaths, in excess of background (pre-COVID-19) mortality, in people with cancer. Background mortality risks for 24 cancers with and without COVID-19-relevant comorbidities were obtained from population-based primary care cohort (Clinical Practice Research Datalink) on 3 862 012 adults in England. RESULTS: Declines in urgent referrals (median=-70.4%) and chemotherapy attendances (median=-41.5%) to a nadir (lowest point) in the pandemic were observed. By 31 May, these declines have only partially recovered; urgent referrals (median=-44.5%) and chemotherapy attendances (median=-31.2%). There were short-term excess death registrations for cancer (without COVID-19), with peak relative risk (RR) of 1.17 at week ending on 3 April. The peak RR for all-cause deaths was 2.1 from week ending on 17 April. Based on these findings and recent literature, we modelled 40% and 80% of cancer patients being affected by the pandemic in the long-term. At 40% affected, we estimated 1-year total (direct and indirect) excess deaths in people with cancer as between 7165 and 17 910, using RRs of 1.2 and 1.5, respectively, where 78% of excess deaths occured in patients with ≥1 comorbidity. CONCLUSIONS: Dramatic reductions were detected in the demand for, and supply of, cancer services which have not fully recovered with lockdown easing. These may contribute, over a 1-year time horizon, to substantial excess mortality among people with cancer and multimorbidity. It is urgent to understand how the recovery of general practitioner, oncology and other hospital services might best mitigate these long-term excess mortality risks.


Assuntos
/epidemiologia , Modelos Estatísticos , Neoplasias/epidemiologia , Pandemias , Vigilância da População , Adulto , Causas de Morte/tendências , Inglaterra/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade/tendências , Taxa de Sobrevida/tendências , Fatores de Tempo
9.
Ageing Res Rev ; 64: 101204, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33152453

RESUMO

Integrating the multifactorial processes co-occurring in both physiological and pathological human conditions still remains one of the main challenges in translational investigation. Moreover, the impact of age-associated disorders has increased, which underlines the urgent need to find a feasible model that could help in the development of successful therapies. In this sense, the Octodon degus has been indicated as a 'natural' model in many biomedical areas, especially in ageing. This rodent shows complex social interactions and high sensitiveness to early-stressful events, which have been used to investigate neurodevelopmental processes. Interestingly, a high genetic similarity with some key proteins implicated in human diseases, such as apolipoprotein-E, ß-amyloid or insulin, has been demonstrated. On the other hand, the fact that this animal is diurnal has provided important contribution in the field of circadian biology. Concerning age-related diseases, this rodent could be a good model of multimorbidity since it naturally develops cognitive decline, neurodegenerative histopathological hallmarks, visual degeneration, type II diabetes, endocrinological and metabolic dysfunctions, neoplasias and kidneys alterations. In this review we have collected and summarized the studies performed on the Octodon degus through the years that support its use as a model for biomedical research, with a special focus on ageing.


Assuntos
Doença de Alzheimer , Diabetes Mellitus Tipo 2 , Octodon , Envelhecimento , Animais , Modelos Animais de Doenças , Multimorbidade
10.
BMC Geriatr ; 20(1): 435, 2020 10 31.
Artigo em Inglês | MEDLINE | ID: mdl-33129274

RESUMO

BACKGROUND: Multimorbidity and polypharmacy are very common in older adults in primary care. Ideally, general practitioners (GPs), should regularly review medication lists to identify inappropriate medication(s) and, where appropriate, deprescribe. However, it remains challenging to deprescribe given time constraints and few recommendations from guidelines. Further, patient related barriers and enablers to deprescribing have to be accounted for. The aim of this study was to identify barriers and enablers to deprescribing as reported by older adults with polypharmacy and multimorbidity. METHODS: We conducted a survey among participants aged ≥70 years, with multimorbidity (≥3 chronic conditions) and polypharmacy (≥5 chronic medications). We invited Swiss GPs, to recruit eligible patients who then completed a paper-based survey on demographics, medications and chronic conditions. We used the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire and added twelve additional Likert scale questions and two open-ended questions to assess barriers and enablers towards deprescribing, which we coded and categorized into meaningful themes. RESULT: Sixty four Swiss GPs consented to recruit 5-6 patients each and returned 300 participant responses. Participants were 79.1 years (SD 5.7), 47% female, 34% lived alone, and 86% managed their medications themselves. Sixty-seven percent of participants took 5-9 regular medicines and 24% took ≥10 medicines. The majority of participants (77%) were willing to deprescribe one or more of their medicines if their doctor said it was possible. There was no association with sex, age or the number of medicines and willingness to deprescribe. After adjustment for baseline characteristics, there was a strong positive association between willingness to deprescribe and saying that because they have a good relationship with their GP, they would feel that deprescribing was safe OR 11.3 (95% CI: 4.64-27.3) and agreeing that they would be willing to deprescribe if new studies showed an avoidable risk OR 8.0 (95% CI 3.79-16.9). From the open questions, the most mentioned barriers towards deprescribing were patients feeling well on their current medicines and being convinced that they need all their medicines. CONCLUSIONS: Most older adults with polypharmacy are willing to deprescribe. GPs may be able to increase deprescribing by building trust with their patients and communicating evidence about the risks of medication use.


Assuntos
Desprescrições , Idoso , Feminino , Humanos , Masculino , Multimorbidade , Polimedicação , Atenção Primária à Saúde , Inquéritos e Questionários
11.
Cad Saude Publica ; 36(12): e00129620, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33237250

RESUMO

This study aimed to measure the occurrence of multimorbidity and to estimate the number of individuals in the Brazilian population 50 years or older at risk for severe COVID-19. This was a cross-sectional nationwide study based on data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), conducted in 2015-2016, with 9,412 individuals 50 years or older. Multimorbidity was defined as ≥ 2 chronic conditions based on a list of 15 diseases considered risk conditions for severe COVID-19. The analyses included calculation of prevalence and estimation of the absolute number of persons in the population at risk. Self-rated health status, frailty, and basic activities of daily living were used as markers of health status. Sex, age, region of the country, and schooling were used as covariables. Some 80% of the sample had at least one of the target conditions, which represents some 34 million individuals. Multimorbidity was reported by 52% of the study population, with higher proportions in the Central, Southeast, and South of Brazil. Cardiovascular diseases and obesity were the most frequent chronic conditions. An estimated 2.4 million Brazilians are at serious health risk. The results revealed inequalities according to schooling. The number of persons 50 years or older who presented risk conditions for severe COVID-19 is high both in absolute and relative terms. The estimate is important for planning strategies to monitor persons with chronic conditions and for preventive strategies to deal with the novel coronavirus.


Assuntos
Multimorbidade , Atividades Cotidianas , Envelhecimento , Brasil/epidemiologia , Doença Crônica , Estudos Transversais , Humanos , Estudos Longitudinais , Pandemias , Prevalência , Fatores de Risco
12.
Artigo em Inglês | MEDLINE | ID: mdl-33238506

RESUMO

No systematic review has appeared so far synthesizing the evidence regarding multimorbidity and loneliness, social isolation, or social frailty. Consequently, our aim was to fill this gap. Three electronic databases (PubMed, PsycINFO, and CINAHL) were searched in our study. Observational studies examining the link between multimorbidity and loneliness, social isolation, and social frailty were included, whereas disease-specific samples were excluded. Data extraction included methods, characteristics of the sample, and the main results. A quality assessment was conducted. Two reviewers performed the study selection, data extraction, and quality assessment. In sum, eight studies were included in the final synthesis. Some cross-sectional and longitudinal studies point to an association between multimorbidity and increased levels of loneliness. However, the associations between multimorbidity and social isolation as well as social frailty remain largely underexplored. The quality of the studies included was rather high. In conclusion, most of the included studies showed a link between multimorbidity and increased loneliness. However, there is a lack of studies examining the association between multimorbidity and social isolation as well as social frailty. Future studies are required to shed light on these important associations. This is particularly important in times of the COVID-19 pandemic.


Assuntos
Solidão , Multimorbidade , Isolamento Social , Austrália , Canadá , Humanos , Pandemias , Qualidade de Vida
13.
Cad Saude Publica ; 36Suppl 3(Suppl 3): e00196120, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33206836

RESUMO

To measure the occurrence of protective behaviors for COVID-19 and sociodemographic factors according to the occurrence of multimorbidity in the Brazilian population aged 50 or over was the objective of this study. We used data from telephone surveys among participants of ELSI-Brazil (Brazilian Longitudinal Study of Aging), conducted between May and June 2020. The use of non-pharmacological prevention measures for COVID-19, reasons for leaving home according to the presence of multimorbidity and sociodemographic variables were evaluated. among 6,149 individuals. Multimorbidity was more frequent in females, married, aged 50-59 years and residents of the urban area. Most of the population left home between once and twice in the last week, increasing according to the number of morbidities (22.3% no morbidities and 38% with multimorbidity). Leaving home every day was less common among individuals with multimorbidity (10.3%) and 9.3% left home in the last week to access health care. Hand hygiene (> 98%) and always wearing a mask when leaving home (> 96%) were almost universal habits. Greater adherence to social isolation was observed among women with multimorbidity when compared to men (PR = 1.49, 95%CI: 1.23-1.79). This adherence increased proportionally with age and inversely with the level of education. The protective behavior in people with multimorbidity seems to be greater in relation to the others, although issues related to social isolation and health care deserve to be highlighted. These findings can be useful in customizing strategies for coping with the current pandemic.


Assuntos
Infecções por Coronavirus , Multimorbidade , Pandemias , Pneumonia Viral , Adulto , Idoso , Betacoronavirus , Brasil/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade
14.
Health Qual Life Outcomes ; 18(1): 321, 2020 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-33004068

RESUMO

BACKGROUND: In a time of ageing populations, examination of the ability of multimorbid patients to achieve well-being has become increasingly important. Social production function theory is used to characterise people's ability to achieve well-being. Whereas much research has examined the fulfilment of substantive needs, far less research has investigated the quality of production functions (being in control, avoiding a loss frame, and efficiency) to achieve well-being. Therefore, this study involved the development and validation of the Social Production Function-Quality of production functions (SPF-Q) instrument to assess the quality of production functions via the fulfilment of production needs to achieve well-being. METHODS: The 12-item SPF-Q was used to assess the quality of production functions via the fulfilment of production needs to achieve well-being among patients with multimorbidity from seven health care practices in the region of Tilburg, the Netherlands. A total of 216 patients filled in the questionnaire (55% response rate). To test the validity of the SPF-Q, we used structural equation modelling to specify a measurement model by loading each item on its respective latent factor, and we examined associations between production needs and other measures. RESULTS: Psychometric results clearly showed that the SPF-Q is a valid and reliable instrument for the assessment of the quality of production functions among multimorbid patients. Confirmatory factor analyses revealed good indices of fit for the instrument. As indicated by the high reliability coefficient, the scale also showed good internal consistency. We found support for construct validity through significant positive correlations between substantive and production well-being needs, as well as with overall well-being and life satisfaction. Moreover, production needs added to multimorbid patients' overall level of well-being in addition to the substantive needs. CONCLUSION: This study clearly showed that the SPF-Q is a valid and reliable instrument for the assessment of production needs among multimorbid patients. Given that multimorbidity is becoming the leading threat to population health, such an instrument can help to improve the ability to achieve well-being in this vulnerable population.


Assuntos
Multimorbidade , Qualidade de Vida , Inquéritos e Questionários/normas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Psicometria/instrumentação , Reprodutibilidade dos Testes
15.
PLoS One ; 15(10): e0240516, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064764

RESUMO

BACKGROUND: Older people are more likely to be living with cancer and multiple long-term conditions, but their needs, preferences for treatments, health priorities and lifestyle are often not identified or well-understood. There is a need to move towards a more comprehensive person-centred approach to care that focuses on the cumulative impact of a number of conditions on daily activities and quality of life. This paper describes the intervention planning process for CHAT& PLANTM, a structured conversation intervention to promote personalised care and support self-management in older adults with complex conditions. METHODS: A theory-, evidence- and person-based approach to intervention development was undertaken. The intervention planning and development process included reviewing relevant literature and existing guidelines, developing guiding principles, conducting a behavioural analysis and constructing a logic model. Optimisation of the intervention and its implementation involved qualitative interviews with older adults with multimorbidity (n = 8), family caregivers (n = 2) and healthcare professionals (HCPs) (n = 20). Data were analysed thematically and informed changes to the intervention prototype. RESULTS: Review findings reflected the importance of HCPs taking a person-centred (rather than disease-centred) approach to their work with older people living with multimorbidity. This approach involves HCPs giving health service users the opportunity to voice their priorities, then using these to underpin the treatment and care plan that follow. Findings from the planning stage indicated that taking a structured approach to interactions between HCPs and health service users would enable elicitation of individual concerns, development of a plan tailored to that individual, negotiation of roles and review of goals as individual priorities change. In the optimisation stage, older adults and HCPs commented on the idea of a structured conversation to promote person-centred care and on its feasibility in practice. The idea of a shared, person-centred approach to care was viewed positively. Concerns were raised about possible extra work for those receiving or delivering care, time and staffing, and risk of creating another "tick-box" exercise for staff. Participants concluded that anyone with the appropriate skills could potentially deliver the intervention, but training was likely to be required to ensure correct utilisation and self-efficacy to deliver to the intervention. CONCLUSIONS: CHAT&PLAN, a structured person-centred conversation guide appears acceptable and appealing to HCPs and older adults with multimorbidity. Further development of the CHAT&PLAN intervention should focus on ensuring that staff are adequately trained and supported to implement the intervention.


Assuntos
Assistência Centrada no Paciente/métodos , Qualidade de Vida/psicologia , Autogestão/métodos , Idoso , Idoso de 80 Anos ou mais , Cuidadores , Estudos de Avaliação como Assunto , Prática Clínica Baseada em Evidências , Feminino , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Masculino , Multimorbidade , Relações Médico-Paciente , Autogestão/psicologia
16.
PLoS One ; 15(10): e0239835, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33104700

RESUMO

BACKGROUND: Multimorbidity is defined as the co-existence of two or more chronic conditions. As life expectancy is increasing so does the prevalence of multimorbidity. Our aim was to estimate the prevalence of multimorbidity in Cyprus and identify the most prevalent diseases. METHODS: A representative sample of n = 1140 individuals over 18 years old was surveyed during 2018-2019. Demographic characteristics as well as the presence of chronic conditions, including mental disorders, were collected through a standardized questionnaire. Diseases were classified according to the International Classification of Diseases, 10th Revision (ICD-10). RESULTS: The age and gender standardized prevalence of multimorbidity was 28.6%. Multimorbidity was associated with age (p<0.001), with the highest rate observed among people aged 65+ years old (68.9%). Multimorbidity was higher in women than men (28.2% vs. 22.5%, p < .001) but similar in urban and rural regions (26.4% vs. 23.8%, p = 0.395). The most prevalent chronic diseases among people with multimorbidity were hyperlipidemia (44.7%), followed by hypertension (37.5%), gastric reflux (23.9%), and thyroid diseases (22.2%), while the most common combinations of diseases were in the circulatory and endocrine systems. The profile of the multimorbid individual indicated this to be a person at an older age with a higher BMI, a current smoker with a higher salary. CONCLUSIONS: More than one quarter of the general population of Cyprus has multimorbidity, and this rate is almost 70% among the elderly. Multimorbidity is relatively common even in younger ages too. This underlines the need for prevention strategies and health awareness programs for the entire population.


Assuntos
Hiperlipidemias/epidemiologia , Hipertensão/epidemiologia , Multimorbidade , Gastropatias/epidemiologia , Doenças da Glândula Tireoide/epidemiologia , Adolescente , Adulto , Idoso , Chipre , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Prevalência
17.
Sci Rep ; 10(1): 16409, 2020 10 02.
Artigo em Inglês | MEDLINE | ID: mdl-33009485

RESUMO

This study aimed to examine the health effect of secondhand smoke (SHS) exposure at home, school, and/or public places on allergic multimorbidity using nationwide data among school-attending adolescents in Korea. Allergic multimorbidity was defined as two or more coexisting allergic diagnoses of asthma, allergic rhinitis, and/or atopic dermatitis during the past 12 months. A multinomial logistic regression analysis was performed to evaluate the association of SHS exposure and allergic multimorbidity. Of the study participants, 24.3% were diagnosed as having any allergic disease currently and 66.3% reported SHS exposure. Any SHS exposure that includes public places conferred increased odds of atopic dermatitis in non-current smokers (adjusted odds ratio 1.21-1.46; 95% confidence interval [CI] 1.10-1.66). Moreover, when controlling for current smoking additionally, SHS exposure at the three sites was 1.37 and 1.96 times more likely to be associated with allergic single and multiple morbidities, respectively (95% CI 1.26-1.49 and 1.65-2.31, respectively). In conclusion, this study found positive associations of SHS exposure with single or multiple allergic morbidity compared to no exposure at all. Further studies with longitudinal designs and objective measurement of SHS exposure and allergic diagnosis are warranted.


Assuntos
Rinite Alérgica/mortalidade , Fumar/efeitos adversos , Poluição por Fumaça de Tabaco/efeitos adversos , Adolescente , Asma/mortalidade , Estudos Transversais , Dermatite Atópica , Eczema/mortalidade , Feminino , Humanos , Masculino , Multimorbidade , Razão de Chances , República da Coreia , Inquéritos e Questionários
18.
PLoS One ; 15(10): e0240024, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33079931

RESUMO

OBJECTIVE: An increasing number of diseases is linked to deterioration of quality of life (QoL). Part of this association can be explained by socio-economic factors, which are most commonly accounted for. Our aim was to explore the potential contribution of other factors related to clinical burden, social interaction and functioning. METHODS: A cross-sectional analysis was conducted on wave 6 of the population-based Survey of Health, Ageing and Retirement in Europe (SHARE), among participants aged 50+ (n = 67 179). The Control, Autonomy, Self-Realization and Pleasure (CASP-12v1) questionnaire measured QoL. The association between number of diseases and QoL was tested in a mixed-effects linear regression model. The base model controlled for socio-economic characteristics. Factors of interest (symptoms, polypharmacy, unmet care needs, utilisation of care, social network, personal and financial help, loneliness and activities of daily living (ADL) with instrumental activities (IADL)) were added to the base model one at a time and tested for relevance (i.e. change in the ß-coefficient of the number of conditions of 15% or more). RESULTS: Symptoms, polypharmacy, loneliness and ADL/IADL appeared relevant and were retained in the final model. The association between number of conditions and QoL in the base model was -2.44 [95% CI: -2.72; -2.16], while this association was -0.76 [95%CI: -0.97; -0.54] after all relevant factors were included. CONCLUSION: Factors beyond the socio-economic circumstances play an important role in explaining the association between number of conditions and QoL. These factors should be considered to better estimate the impact of chronic diseases on QoL, and for improving patient care.


Assuntos
Multimorbidade , Qualidade de Vida , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Europa (Continente) , Feminino , Nível de Saúde , Humanos , Solidão , Masculino , Pessoa de Meia-Idade , Polimedicação , Rede Social , Apoio Social , Fatores Socioeconômicos , Inquéritos e Questionários
19.
Wei Sheng Yan Jiu ; 49(5): 844-849, 2020 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-33070834

RESUMO

OBJECTIVE: To study the status of chronic disease multimorbidity of middle-aged and elderly people over 45 years old in China, and to analyze the influencing factors. METHODS: Using the data of the"China Health and Nutrition Survey(CHNS)", this survey has been carried out in 10 rounds nationwide since 1989. Multi-stage cluster random sampling was used to investigate rural and urban areas in 9 provinces and cities in China. In this study, the general socio-demographic characteristics, disease history, living habits and other information in the 2009 database were used to analyze the subjects who were collected blood samples. The prevalence of 8 common chronic diseases and multimorbidity such as hypertension, mixed-hyperlipidemia and hyperuricemia were described respectively. The Venn diagram in the R software package was used to calculate the multimorbidity of the disease. The χ~2 test and multiple correspondence analysis were used to explore the influencing factors of chronic disease multimorbidity in the middle-aged and elderly people in China. RESULTS: Among the 5316 subjects, the highest prevalence among 8 chronic diseases was hypertension(2143, 40. 3%). The lowest prevalence was myocardial infarction(87, 1. 4%). There were all together 1498 patients who had two kinds or more than two kinds of chronic diseases with a detection rate of 28. 18%. The most common multimorbidity were hypertension+hyperuricemia(199, 13. 30%), followed by hypertension + mixed-hyperlipidemia(191, 12. 77%). Hypertension+hyperuricemia+mixed-hyperlipidemia was the most common combination of the three chronic diseases(103, 6. 89%). Age(Kendull=0. 158, P<0. 001), region(χ~2=30. 129, P<0. 001), BMI(Kendull=0. 344, P<0. 001) and marital status(χ~2=21. 923, P<0. 001) were associated with the number of multimorbidities. Correspondence analysis showed that subjects aged 65 to 74, living in cities and sleeping less than 7 hours were more likely to have multimorbidity. CONCLUSION: The prevalence of chronic disease multimorbidity among middle-aged and elderly residents in China is high. Older age, unmarried, overweight and obesity, too little or too much sleep may increase the risk of multimorbidity.


Assuntos
Hipertensão , Multimorbidade , Idoso , China/epidemiologia , Doença Crônica , Humanos , Hipertensão/epidemiologia , Pessoa de Meia-Idade , Prevalência
20.
PLoS Med ; 17(10): e1003290, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33048945

RESUMO

BACKGROUND: Neurodevelopmental conditions commonly coexist in children, but compared to adults, childhood multimorbidity attracts less attention in research and clinical practice. We previously reported that children treated for attention deficit hyperactivity disorder (ADHD) and depression have more school absences and exclusions, additional support needs, poorer attainment, and increased unemployment. They are also more likely to have coexisting conditions, including autism and intellectual disability. We investigated prevalence of neurodevelopmental multimorbidity (≥2 conditions) among Scottish schoolchildren and their educational outcomes compared to peers. METHODS AND FINDINGS: We retrospectively linked 6 Scotland-wide databases to analyse 766,244 children (390,290 [50.9%] boys; 375,954 [49.1%] girls) aged 4 to 19 years (mean = 10.9) attending Scottish schools between 2009 and 2013. Children were distributed across all deprivation quintiles (most to least deprived: 22.7%, 20.1%, 19.3%, 19.5%, 18.4%). The majority (96.2%) were white ethnicity. We ascertained autism spectrum disorder (ASD) and intellectual disabilities from records of additional support needs and ADHD and depression through relevant encashed prescriptions. We identified neurodevelopmental multimorbidity (≥2 of these conditions) in 4,789 (0.6%) children, with ASD and intellectual disability the most common combination. On adjusting for sociodemographic (sex, age, ethnicity, deprivation) and maternity (maternal age, maternal smoking, sex-gestation-specific birth weight centile, gestational age, 5-minute Apgar score, mode of delivery, parity) factors, multimorbidity was associated with increased school absenteeism and exclusion, unemployment, and poorer exam attainment. Significant dose relationships were evident between number of conditions (0, 1, ≥2) and the last 3 outcomes. Compared to children with no conditions, children with 1 condition, and children with 2 or more conditions, had more absenteeism (1 condition adjusted incidence rate ratio [IRR] 1.28, 95% CI 1.27-1.30, p < 0.001 and 2 or more conditions adjusted IRR 1.23, 95% CI 1.20-1.28, p < 0.001), greater exclusion (adjusted IRR 2.37, 95% CI 2.25-2.48, p < 0.001 and adjusted IRR 3.04, 95% CI 2.74-3.38, p < 0.001), poorer attainment (adjusted odds ratio [OR] 3.92, 95% CI 3.63-4.23, p < 0.001 and adjusted OR 12.07, 95% CI 9.15-15.94, p < 0.001), and increased unemployment (adjusted OR 1.57, 95% CI 1.49-1.66, p < 0.001 and adjusted OR 2.11, 95% CI 1.83-2.45, p < 0.001). Associations remained after further adjustment for comorbid physical conditions and additional support needs. Coexisting depression was the strongest driver of absenteeism and coexisting ADHD the strongest driver of exclusion. Absence of formal primary care diagnoses was a limitation since ascertaining depression and ADHD from prescriptions omitted affected children receiving alternative or no treatment and some antidepressants can be prescribed for other indications. CONCLUSIONS: Structuring clinical practice and training around single conditions may disadvantage children with neurodevelopmental multimorbidity, who we observed had significantly poorer educational outcomes compared to children with 1 condition and no conditions.


Assuntos
Escolaridade , Multimorbidade/tendências , Transtornos do Neurodesenvolvimento/epidemiologia , Absenteísmo , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Espectro Autista/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Bases de Dados Factuais , Depressão/epidemiologia , Feminino , Idade Gestacional , Hospitalização , Humanos , Incidência , Masculino , Razão de Chances , Prevalência , Estudos Retrospectivos , Instituições Acadêmicas , Escócia/epidemiologia , Adulto Jovem
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