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Gibson KA, Kaplan RM, Pincus T, Li T, Luta G. PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria. Semin Arthritis Rheum 2024; 66:152361. [PMID: 38360468 DOI: 10.1016/j.semarthrit.2024.152361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND PROMIS-29 T-scores query health-related quality of life (HRQL) in 7 domains, physical function, pain, fatigue, anxiety, depression, sleep quality, and social participation, to establish population norms. An MDHAQ (multidimensional health assessment questionnaire) scores these 7 domains and includes medical information such as a FAST4 (fibromyalgia assessment screening tool) index. We analyzed PROMIS-29 T-scores in rheumatoid arthritis (RA) patients vs population norms and for positive vs negative fibromyalgia (FM) screens and compared PROMIS-29 T-scores to MDHAQ scores to assess HRQL. METHODS A cross-sectional study was performed at one routine visit of 213 RA patients, who completed MDHAQ, PROMIS-29, and reference 2011 FM Criteria. PROMIS-29 T-scores were compared in RA vs population norms and in FM+ vs FM- RA patients, based on MDHAQ/FAST4 and reference criteria. Possible associations between PROMIS-29 T-scores and corresponding MDHAQ scores were analyzed using Spearman correlations and multiple regressions. RESULTS Median PROMIS-29 T-scores indicated clinically and statistically significantly poorer status in 26-29% FM+ vs FM- RA patients, with larger differences than in RA patients vs population norms for 6/7 domains. MDHAQ scores were correlated significantly with each of 7 corresponding PROMIS-29 domains (|rho|≥0.62, p<0.001). Linear regressions explained 55-73% of PROMIS-29 T-score variation by MDHAQ scores and 56%-70% of MDHAQ score variation by PROMIS-29 T-scores. CONCLUSIONS Scores for 7 PROMIS-29 domains and MDHAQ were highly correlated. The MDHAQ is effective to assess HRQL and offers incremental medical information, including FAST4 screening. The results indicate the importance of assessing comorbidities such as fibromyalgia screening in interpreting PROMIS-29 T-scores.
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Affiliation(s)
- Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University School of Medicine, Chicago, Ill, 60612, USA.
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA; Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg, DK-2000, Denmark
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Roversi C, Tavazzi E, Vettoretti M, Di Camillo B. A dynamic probabilistic model of the onset and interaction of cardio-metabolic comorbidities on an ageing adult population. Sci Rep 2024; 14:11514. [PMID: 38769364 PMCID: PMC11106085 DOI: 10.1038/s41598-024-61135-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024] Open
Abstract
Comorbidity is widespread in the ageing population, implying multiple and complex medical needs for individuals and a public health burden. Determining risk factors and predicting comorbidity development can help identify at-risk subjects and design prevention strategies. Using socio-demographic and clinical data from approximately 11,000 subjects monitored over 11 years in the English Longitudinal Study of Ageing, we develop a dynamic Bayesian network (DBN) to model the onset and interaction of three cardio-metabolic comorbidities, namely type 2 diabetes (T2D), hypertension, and heart problems. The DBN allows us to identify risk factors for developing each morbidity, simulate ageing progression over time, and stratify the population based on the risk of outcome occurrence. By applying hierarchical agglomerative clustering to the simulated, dynamic risk of experiencing morbidities, we identified patients with similar risk patterns and the variables contributing to their discrimination. The network reveals a direct joint effect of biomarkers and lifestyle on outcomes over time, such as the impact of fasting glucose, HbA1c, and BMI on T2D development. Mediated cross-relationships between comorbidities also emerge, showcasing the interconnected nature of these health issues. The model presents good calibration and discrimination ability, particularly in predicting the onset of T2D (iAUC-ROC = 0.828, iAUC-PR = 0.294) and survival (iAUC-ROC = 0.827, iAUC-PR = 0.311). Stratification analysis unveils two distinct clusters for all comorbidities, effectively discriminated by variables like HbA1c for T2D and age at baseline for heart problems. The developed DBN constitutes an effective, highly-explainable predictive risk tool for simulating and stratifying the dynamic risk of developing cardio-metabolic comorbidities. Its use could help identify the effects of risk factors and develop health policies that prevent the occurrence of comorbidities.
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Affiliation(s)
- Chiara Roversi
- Department of Information Engineering, University of Padua, Via Giovanni Gradenigo, 6/b, 35131, Padua, Italy
| | - Erica Tavazzi
- Department of Information Engineering, University of Padua, Via Giovanni Gradenigo, 6/b, 35131, Padua, Italy
| | - Martina Vettoretti
- Department of Information Engineering, University of Padua, Via Giovanni Gradenigo, 6/b, 35131, Padua, Italy
| | - Barbara Di Camillo
- Department of Information Engineering, University of Padua, Via Giovanni Gradenigo, 6/b, 35131, Padua, Italy.
- Department of Comparative Biomedicine and Food Science, University of Padua, Agripolis, Viale dell'Università, 16, 35020, Legnaro (PD), Italy.
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3
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Tian Y, Zhou X, Jiang Y, Pan Y, Liu X, Gu X. Bidirectional association between falls and multimorbidity in middle-aged and elderly Chinese adults: a national longitudinal study. Sci Rep 2024; 14:9109. [PMID: 38643241 PMCID: PMC11032330 DOI: 10.1038/s41598-024-59865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 04/16/2024] [Indexed: 04/22/2024] Open
Abstract
This study explores the bidirectional association between multimorbidity and falls in Chinese middle-aged and elderly adults. Participants aged 45 and above from the China Health and Retirement Longitudinal Study were included. Binary logistic regression assessed the impact of chronic conditions on fall incidence (stage I), while multinomial logistic regression examined the relationship between baseline falls and multimorbidity (stage II). The fully adjusted odds ratios (ORs) for one, two, or three or more chronic conditions were 1.34, 1.65, and 2.02, respectively. Among participants without baseline falls, 28.61% developed two or more chronic conditions during follow-up, compared to 37.4% of those with a history of falls. Fully adjusted ORs for one, two, or three or more chronic conditions in those with a history of falls were 1.21, 1.38 and 1.70, respectively. The bidirectional relationship held in sensitivity and subgroup analyses. A bidirectional relationship exists between multimorbidity and falls in Chinese middle-aged and elderly adults. Strengthening chronic condition screening and treatment in primary healthcare may reduce falls risk, and prioritizing fall prevention and intervention in daily life is recommended.
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Affiliation(s)
- Ye Tian
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Xingzhao Zhou
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Yan Jiang
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Yidan Pan
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Xuefeidan Liu
- Department of Marine Pharmacy, School of Pharmacy, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China
| | - Xingbo Gu
- Department of Health Statistics, School of Public Health, Hainan Medical University, No. 3, Xue Yuan Road, Longhua District, Haikou, 571199, People's Republic of China.
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Barrio-Cortes J, Castaño-Reguillo A, Benito-Sánchez B, Beca-Martínez MT, Ruiz-Zaldibar C. Utilization of Primary Healthcare Services in Patients with Multimorbidity According to Their Risk Level by Adjusted Morbidity Groups: A Cross-Sectional Study in Chamartín District (Madrid). Healthcare (Basel) 2024; 12:270. [PMID: 38275550 PMCID: PMC10815081 DOI: 10.3390/healthcare12020270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024] Open
Abstract
Patients with multimorbidity have increased and more complex healthcare needs, posing their management a challenge for healthcare systems. This study aimed to describe their primary healthcare utilization and associated factors. A population-based cross-sectional study was conducted in a Spanish basic healthcare area including all patients with chronic conditions, differentiating between having multimorbidity or not. Sociodemographic, functional, clinical and service utilization variables were analyzed, stratifying the multimorbid population by the Adjusted Morbidity Groups (AMG) risk level, sex and age. A total of 6036 patients had multimorbidity, 64.2% being low risk, 28.5% medium risk and 7.3% high risk. Their mean age was 64.1 years and 63.5% were women, having on average 3.5 chronic diseases, and 25.3% were polymedicated. Their mean primary care contacts/year was 14.9 (7.8 with family doctors and 4.4 with nurses). Factors associated with primary care utilization were age (B-coefficient [BC] = 1.15;95% Confidence Interval [CI] = 0.30-2.01), female sex (BC = 1.04; CI = 0.30-1.78), having a caregiver (BC = 8.70; CI = 6.72-10.69), complexity (B-coefficient = 0.46; CI = 0.38-0.55), high-risk (B-coefficient = 2.29; CI = 1.26-3.32), numerous chronic diseases (B-coefficient = 1.20; CI = 0.37-2.04) and polypharmacy (B-coefficient = 5.05; CI = 4.00-6.10). This study provides valuable data on the application of AMG in multimorbid patients, revealing their healthcare utilization and the need for a patient-centered approach by primary care professionals. These results could guide in improving coordination among professionals, optimizing multimorbidity management and reducing costs derived from their extensive healthcare utilization.
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Affiliation(s)
- Jaime Barrio-Cortes
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
- Faculty of Health, Camilo José Cela University, 28692 Madrid, Spain
| | | | - Beatriz Benito-Sánchez
- Foundation for Biosanitary Research and Innovation in Primary Care (FIIBAP), 28003 Madrid, Spain
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Amirzada M, Buczak-Stec E, König HH, Hajek A. Multimorbidity patterns in the German general population aged 40 years and over. Arch Gerontol Geriatr 2023; 114:105067. [PMID: 37257215 DOI: 10.1016/j.archger.2023.105067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/08/2023] [Accepted: 05/17/2023] [Indexed: 06/02/2023]
Abstract
AIM The aim of this study was to identify and describe multimorbidity patterns among middle-aged and older community-dwelling individuals in Germany. Moreover, we aimed to determine potential gender differences in multimorbidity patterns. METHODS We analysed data from the most recent (sixth) wave (2017) of the large nationally representative German Ageing Survey (DEAS). Altogether n = 6,554 individuals participated, mean age was 62.0 (ranging from 43 to 92 years). Latent Class Analysis was performed to identify multimorbidity patterns, based on 13 chronic conditions and diseases. Multimorbidity was defined as the presence of at least two chronic conditions. RESULTS Altogether, 53.3% of individuals were multimorbid. We identified and clinically described five multimorbidity patterns: the relatively healthy class (45.1%), the high morbidity class (10.8%), the arthrosis/inflammatory/mental illnesses class (20.6%), the hypertension-metabolic illness class (21.7%), and the cardiovascular/cancer class (1.7%). Our analysis revealed that women compared to men have higher relative risk (IRR = 1.61, 95% CI 1.25-2.06) of being in the arthrosis/inflammatory/mental illnesses class, compared to the relatively healthy class. Furthermore, we found that, depending on which multimorbidity pattern individuals belong to, they differ greatly in terms of socio-demographic factors, health behaviour, and lifestyle factors. CONCLUSIONS We showed that the many chronic diseases cluster in a non-random way. Five clinically meaningful multimorbidity patterns were identified. Gender differences were apparent only in one class, namely in the arthrosis/inflammatory/mental illnesses class.
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Affiliation(s)
- Massuma Amirzada
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany.
| | - Elżbieta Buczak-Stec
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany.
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
| | - André Hajek
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg Center for Health Economics, Martinistr. 52, 20246, Hamburg, Germany
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Carolyna Vieira Cavalcante A, Catarina de Souza Oliveira A, Gabriele Araújo de Oliveira Torres A, Cristina dos Santos Félix E, Araújo da Silva Dantas B, Arnoldo Nunes de Miranda F, Laurência Gemito M, Rosa Parreira Mendes F, de Vasconcelos Torres G, Maria Chaves Maia E. Quality of Life in the Face of Depression Among Older People: A Cross-Sectional Study in Brazil and Portugal. PSYCHIAT CLIN PSYCH 2023; 33:20-27. [PMID: 38764529 PMCID: PMC11082575 DOI: 10.5152/pcp.2023.22377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 05/21/2024] Open
Abstract
Background This study aimed to analyze and compare the association of depression levels with quality of life among older people in primary health care in Brazil and Portugal. Methods This was a cross-sectional study conducted with older people in primary health care. The Medical Outcomes Short-Form Health Quality of Life (SF-36) instrument was used to measure the quality of life, and the Beck Depression Inventory was used to evaluate depression. We grouped the depression level variables into "absent/mild" and "moderate/severe" and tested their association with the categorical variables of quality of life ("better quality of life" and "worse quality of life"). Results The total sample was 150 participants (Brazil n = 100 and Portugal n = 50). Each group results in the subcategory of absent/mild depression (n = 129) indicated better quality of life in Portugal in physical role functioning (P = .027/odds ratio = 2.768), physical functioning (P < .001/odds ratio = 5.864), and the physical health dimension (P = .002/odds ratio = 3.752). The binary logistic regression analysis highlighted the domains physical role functioning (odds ratio = 1.01/CI for 95% = 1.00-1.03), physical functioning (odds ratio = 1.02/CI for 95% = 1.01-1.03), and the physical health dimension (odds ratio = 1.09/CI for 95% = 1.04-1.13). Conclusion There was an association between better assessments of the physical and functional aspects of quality of life and lower levels of depression, in which we could highlight those aspects related to physical health and functionality. Among the groups studied, Portugal had better quality of life evaluations than Brazil. However, none of the groups overlapped the other in levels of depression.
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Affiliation(s)
| | | | | | | | | | | | - Maria Laurência Gemito
- Department of Nursing, University of Évora, Portugal The Comprehensive Health Research Centre (CHRC), Portugal
| | | | | | - Eulália Maria Chaves Maia
- Department of Psychology, Federal University of Rio Grande do Norte, Health Sciences Center, Natal-RN, Brazil.
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Giovannelli I, Pagliaro S, Spaccatini F, Pacilli MG. Self-reported psychological symptoms and severe stress events, but not patients' gender, affect illness representation and medical advice by lay-referral network advisors. Soc Sci Med 2023; 320:115666. [PMID: 36645945 DOI: 10.1016/j.socscimed.2023.115666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/08/2023]
Abstract
People who experience symptoms tend to discuss their ailments with other individuals who create their own illness representations, acting as intuitive physicians. We conducted two experimental studies to examine lay-referral network advisors' (i.e., acquaintances) representation of illness etiology and their recommendation to undergo health screenings for a man or woman with physical (vs. both physical and psychological) symptoms and a severe stressful (vs. no stressful) period in life. The presence of psychological and physical symptoms (Studies 1 and 2) and severe stressful life events (Study 2) affects lay-referral network advisors' disease representation. These factors cause participants to attribute symptoms etiology to psychological rather than organic factors and recommend more psychological screenings rather than physical ones. The simultaneous presence of psychological and physical symptoms and severe stressful events increases the likelihood of attributing the illness etiology to psychological factors, which increases participants' willingness to recommend psychological screenings. Study variables were unaffected by patient gender. The main findings, limitations, and future directions are discussed.
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Affiliation(s)
- Ilaria Giovannelli
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Italy.
| | - Stefano Pagliaro
- Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Italy
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Páscoa R, Teixeira A, Monteiro H, Prazeres F, Martins C. Association of lifestyle and sociodemographic factors on multimorbidity: a cross-sectional study in Portugal. BMC Public Health 2022; 22:2341. [DOI: 10.1186/s12889-022-14640-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 11/15/2022] [Indexed: 12/15/2022] Open
Abstract
Abstract
Background
Lifestyle factors are widely recognized as modifiers and major risk factors for non-communicable diseases. Previous studies on the prevalence of multimorbidity in Portugal predict an unfavourable reality. The aim of the present study was to analyse 1) the prevalence of multimorbidity in Portugal and 2) the association of individuals’ lifestyles and sociodemographic factors with multimorbidity.
Methods
A cross-sectional, population-wide study was conducted on a representative sample of the general population of Portuguese adults aged ≥ 20 years. Categorical variables were described by their respective absolute and relative frequencies (n (%)). All variables with a p-value < 20% were included in the multiple logistic regression model. The variables were removed one by one in descending order of p-value (p) until the model contained only significant variables. The results are presented using the odds ratio and 95% confidence intervals. P-values < 5% were considered significant.
Results
The prevalence of multimorbidity was 48.9% (n = 436), and the odds of multimorbidity increased 4% (p < 0.001) for each year of increase in age. Participants with reasonable general health status had higher odds of multimorbidity (Odds ratio (OR) = 3.04; p < 0.001), and those with poor or very poor general health status had even higher odds (OR = 9.14; p < 0.001). Compared to those who never smoked, participants who quit smoking ≥ 1 year presented an increase of 91% (p = 0.005) in the odds of multimorbidity. Individuals with no good-quality sleep, non-moderate screen time, or non-moderate stress level had higher odds of multimorbidity (OR = 1.98; OR = 1.88; OR = 2.22, respectively. p < 0.001).
Conclusions
This study presented a new approach to multimorbidity in Portugal. Population-based, multidimensional lifestyle interventions are needed. It seems necessary to optimize and adjust measures to prevent non-communicable diseases to improve health in Portugal. In the future, longitudinal studies will be an asset to reinforce and clarify these conclusions.
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Moftakhar L, Rezaeianzadeh R, Ghoddusi Johari M, Hosseini SV, Rezaianzadeh A. Epidemiology and predictors of multimorbidity in Kharameh cohort study: A population-based cross-sectional study in southern Iran. Health Sci Rep 2022; 6:e988. [PMID: 36514331 PMCID: PMC9731168 DOI: 10.1002/hsr2.988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 11/28/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Aim Multimorbidity is one of the problems and concerns of public health. The aim of this study was to estimate the prevalence and identify the risk factors associated with multimorbidity based on the data of the Kherameh cohort study. Methods This cross-sectional study was performed on 10,663 individuals aged 40-70 years in the south of Iran in 2015 to 2017. Demographic and behavioral characteristics were investigated. Multimorbidity was defined as the coexistence of two or more of two chronic diseases in a person. In this study, the prevalence of multimorbidity was calculated. Logistic regression was used to identify the predictors of multimorbidity. Results The prevalence of multimorbidity was 24.4%. The age-standardized prevalence rate was 18.01% in males and 29.6% in females. The most common underlying diseases were gastroesophageal reflux disease with hypertension (33.5%). Multiple logistic regression results showed that the age of 45-55 years (adjusted odds ratio [ORadj]] = 1.22, 95% confidence interval [CI], 1.07-1.38), age of over 55 years (ORadj = 1.21, 95% CI, 1.06-1.37), obesity (ORadj = 3.65, 95% CI, 2.55-5.24), and overweight (ORadj = 2.92, 95% CI, 2.05-4.14) were the risk factors of multimorbidity. Also, subjects with high socioeconomic status (ORadj = 1.27, 95% CI, 1.1-1.45) and very high level of socioeconomic status (ORadj = 1.53, 95% CI, 1.31-1.79) had a higher chance of having multimorbidity. The high level of education, alcohol consumption, having job, and high physical activity had a protective role against it. Conclusion The prevalence of multimorbidity was relatively high in the study area. According to the results of our study, age, obesity, and overweight had an important effect on multimorbidity. Therefore, determining interventional strategies for weight loss and control and treatment of chronic diseases, especially in the elderly, is very useful.
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Affiliation(s)
- Leila Moftakhar
- Student Research CommitteeShiraz University of Medical SciencesShirazIran
| | - Ramin Rezaeianzadeh
- Experimental Medicine Program, Department of Medicine, Faculty of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | | | - Abbas Rezaianzadeh
- Colorectal Research CenterShiraz University of Medical ScienceShirazIran
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Quality of Life in Community-Dwelling Older People with Functional and Nutritional Impairment and Depressive Symptoms: A Comparative Cross-Sectional Study in Brazil and Portugal. Geriatrics (Basel) 2022; 7:geriatrics7050096. [PMID: 36136805 PMCID: PMC9498901 DOI: 10.3390/geriatrics7050096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background: The interaction of quality of life (QoL) with functionality, nutrition and depression has been studied, but few studies have compared different realities. Our objective was to compare the associations of QoL with impaired functionality, nutritional status and depressive symptoms among older people patients treated in primary health care (PHC) in Brazil and Portugal. Methods: Cross-sectional, comparative study was conducted with primary data from PHC services in Brazil and Portugal with users over 65 years old. Participants’ scores were classified as “impaired” and “preserved” for QoL, functional decline, nutrition and depression. We used Pearson’s chi-square test, Fisher’s exact test and the Mann–Whitney U test. Results: Our sample had a total of 150 PHC users. We found lower QoL scores in Brazil, which were associated with the risk of functional decline for the domains Physical Functioning, General Health Perceptions, Mental Health dimensions and Physical Health. Nutritional impairment in the group from Portugal included the domains of Vitality and Social Role Functioning. For depressive impairment, Portugal showed an association with the domains Mental Health, Vitality and Social Role Functioning. Conclusions: QoL was associated with functional and nutritional impairment and depressive symptoms, highlighting physical, mental and social characteristics related to the perception of well-being.
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Sturmer J, Franken DL, Ternus DL, Henn RL, Soares Dias-da-Costa J, Anselmo Olinto MT, Vieira Paniz VM. Dietary patterns and prevalence of multimorbidity in women in southern Brazil. Menopause 2022; 29:1047-1054. [PMID: 35969884 DOI: 10.1097/gme.0000000000002023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to investigate the association between dietary patterns and prevalence of multimorbidity in women. METHODS This population-based cross-sectional study was conducted in 2015 and included 1,128 women aged 20 to 69 years living in the urban area of São Leopoldo municipality, southern Brazil. Multimorbidity was defined as the presence of two or more chronic conditions, among the 26 identified. Poisson regression with robust variance was used to investigate the association between the three dietary patterns (healthy, risk, and Brazilian), using different models adjusted for sociodemographic, behavioral, and nutritional status variables. RESULTS The results showed differences in the prevalence of adherence to different dietary patterns and multimorbidity across age groups, with a prevalence of multimorbidity and a healthy dietary pattern showing a direct linear trend with age, whereas the risk dietary pattern showed an inverse linear trend with age. The prevalence of the Brazilian dietary pattern remained constant despite differences in age. After adjustment, we found that women with greater adherence to the Brazilian dietary pattern showed a 40% reduction in the prevalence of multimorbidity compared with those with less adherence (prevalence ratio, 0.60; 95% confidence interval, 0.40-0.86). CONCLUSION The results revealed that the prevalence of multimorbidity was significantly lower in women with greater adherence to the Brazilian dietary pattern and highlight the importance of dietary interventions in early adulthood as a way to prevent multimorbidity in women.
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Affiliation(s)
- Jaqueline Sturmer
- From the Post-graduate Programme in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Débora Luiza Franken
- From the Post-graduate Programme in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Daiane Luisa Ternus
- From the Post-graduate Programme in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | - Ruth Liane Henn
- From the Post-graduate Programme in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
| | | | | | - Vera Maria Vieira Paniz
- From the Post-graduate Programme in Collective Health, University of Vale do Rio dos Sinos, São Leopoldo, RS, Brazil
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Skou ST, Mair FS, Fortin M, Guthrie B, Nunes BP, Miranda JJ, Boyd CM, Pati S, Mtenga S, Smith SM. Multimorbidity. Nat Rev Dis Primers 2022; 8:48. [PMID: 35835758 PMCID: PMC7613517 DOI: 10.1038/s41572-022-00376-4] [Citation(s) in RCA: 181] [Impact Index Per Article: 90.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 02/06/2023]
Abstract
Multimorbidity (two or more coexisting conditions in an individual) is a growing global challenge with substantial effects on individuals, carers and society. Multimorbidity occurs a decade earlier in socioeconomically deprived communities and is associated with premature death, poorer function and quality of life and increased health-care utilization. Mechanisms underlying the development of multimorbidity are complex, interrelated and multilevel, but are related to ageing and underlying biological mechanisms and broader determinants of health such as socioeconomic deprivation. Little is known about prevention of multimorbidity, but focusing on psychosocial and behavioural factors, particularly population level interventions and structural changes, is likely to be beneficial. Most clinical practice guidelines and health-care training and delivery focus on single diseases, leading to care that is sometimes inadequate and potentially harmful. Multimorbidity requires person-centred care, prioritizing what matters most to the individual and the individual's carers, ensuring care that is effectively coordinated and minimally disruptive, and aligns with the patient's values. Interventions are likely to be complex and multifaceted. Although an increasing number of studies have examined multimorbidity interventions, there is still limited evidence to support any approach. Greater investment in multimorbidity research and training along with reconfiguration of health care supporting the management of multimorbidity is urgently needed.
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Affiliation(s)
- Søren T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark.
| | - Frances S Mair
- Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| | - Bruce Guthrie
- Advanced Care Research Centre, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Bruno P Nunes
- Postgraduate Program in Nursing, Faculty of Nursing, Universidade Federal de Pelotas, Pelotas, Brazil
| | - J Jaime Miranda
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Medicine, School of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
- The George Institute for Global Health, UNSW, Sydney, New South Wales, Australia
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia M Boyd
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Epidemiology and Health Policy & Management, Johns Hopkins University, Baltimore, MD, USA
| | - Sanghamitra Pati
- ICMR Regional Medical Research Centre, Bhubaneswar, Odisha, India
| | - Sally Mtenga
- Department of Health System Impact Evaluation and Policy, Ifakara Health Institute (IHI), Dar Es Salaam, Tanzania
| | - Susan M Smith
- Discipline of Public Health and Primary Care, Institute of Population Health, Trinity College Dublin, Russell Building, Tallaght Cross, Dublin, Ireland
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Inappropriate Prescriptions in Older People-Translation and Adaptation to Portuguese of the STOPP/START Screening Tool. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116896. [PMID: 35682479 PMCID: PMC9180165 DOI: 10.3390/ijerph19116896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 02/04/2023]
Abstract
Inappropriate prescribing, which encompasses the prescription of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs), is a common problem for older people. The STOPP/START tool enables general practitioners, who are the main prescribers, to identify and reduce the incidence of PIMs and PPOs and appraise an older patient’s prescribed drugs during the diagnosis process to improve the clinical care quality. This study aimed to translate and validate the STOPP/START screening tool to enable its use by Portuguese physicians. A translation-back translation method including the validation of the obtained Portuguese version was used. Intra- and inter-rater reliability and agreement analyses were used in the validation process. A dataset containing the information of 334 patients was analyzed by one GP twice within a 2-week interval, while a dataset containing the information of 205 patients was independently analyzed by three GPs. Intra-rater reliability assessment led to a Kappa coefficient (κ) of 0.70 (0.65−0.74) for the STOPP criteria and 0.60 (0.52−0.68) for the START criteria, considered to be substantial and moderate values, respectively. The results of the inter-rater reliability rating were almost perfect for all combinations of raters (κ > 0.93). The version of the STOPP/START criteria translated into Portuguese represents an improvement in managing the medications prescribed to the elderly. It provides clinicians with a screening tool for detecting potentially inappropriate prescribing in patients older than 65 years old that is reliable and easy to use.
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Magalhães IA, Dantas TS, de Paulo JPM, Marçal FF, Viana TSA, Sousa FB, Barros Silva PGD. Sociodemographic factors affect the quality of life and burden of caregivers in special care in dentistry. SPECIAL CARE IN DENTISTRY 2022; 42:464-475. [PMID: 35325480 DOI: 10.1111/scd.12710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/08/2021] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
AIMS To analyze the epidemiological profile and quality of life (QoL) of patients with special needs and overload their caregivers. METHODS AND RESULTS Health-related QoL was assessed in a quantitative, observational, cross-sectional study of prospective characteristics using the WHOQOL-BREF and ZARIT-22 questionnaires. This study included 122 patients were included; they were divided into patients without caregiver assistance (n = 63) who answered WHOQOL-BREF, 49 caregivers (n = 49) who responded to ZARIT-22, and 10 patients were secondarily caregivers of their parents and answered the ZARIT-22 + WHOQOL-BREF questionnaires. The WHOQOL-BREF general score was 71.94 ± 10.58, and patients born in urban areas and married had positive correlations (p < .05) with the QoL scores in the physical and social domains. ZARIT-22 scores showed an average of 58.63 ± 14.07. Data cross-checking revealed that patients of white races (p = .030) and who lived in urban regions (p = .003) generated less overload to caregivers. CONCLUSION In the WHOQOL-BREF analysis, family income was a factor with direct impact, and all caregivers referred to moderate-to-high overload, with an increase in prevalence as far away from the service the patient resides.
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Affiliation(s)
| | - Thinali Sousa Dantas
- Department of Stomatology and Oral Pathology, Christus University Center, Fortaleza, Brazil
| | | | | | | | - Fabrício Bitu Sousa
- Department of Stomatology and Oral Pathology, Christus University Center, Fortaleza, Brazil.,Department of Stomatology and Oral Pathology, Federal University of Ceara, Fortaleza, Brazil
| | - Paulo Goberlânio de Barros Silva
- Department of Stomatology and Oral Pathology, Christus University Center, Fortaleza, Brazil.,Department of Stomatology and Oral Pathology, Federal University of Ceara, Fortaleza, Brazil
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15
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Santos S, Veiga PM, Paúl C. The Perceived Risk of Hospitalization in Primary Health Care – The Importance of Multidimensional Assessment. Gerontol Geriatr Med 2022; 7:23337214211063030. [PMID: 35321531 PMCID: PMC8935591 DOI: 10.1177/23337214211063030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Revised: 10/22/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Ageing has increased the use of health services, with a corresponding rise in avoidable hospitalizations. We aimed to assess and characterize the perceived risk of hospitalization in primary health care (PHC). 118 individuals aged ≥65 years, PHC patients, were assessed using the Community Risk Assessment Instrument by their General Practitioner, who identified their perceived risk of hospitalization, at one year. The instrument is composed of three domains (mental state, daily living activities (ADLs) state and medical state). Multivariate logistic regression was used to identify the best model to predict the risk of hospitalization. Four models were estimated, one for each domain and one with all the variables of the instrument. 58.5% were identified as being at risk of hospitalization. The best predictive models are those that include functionality assessment variables (ADL model and Community Assessment of Risk Instrument model). The model that includes all the variables of three domains presents the best predictive value. Mobility problems (Odds Ratio (OR) 16.18 [CI: 1.63–160.53]), meal preparation (OR 10.93 [CI: 1.59–75.13]), communication (OR 6.91 [CI: 1.37–34.80]) and palliative care (OR 4.84 [CI: 1.14–20.58]) are the best predictors of hospitalization risk. The use of multidimensional assessment tools can allow the timely identification of people at risk, contributing to a reduction in hospitalizations.
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Affiliation(s)
- Sara Santos
- Abel Salazar Institute of Biomedical Sciences—University of Porto, Portugal
- CINTESIS, Faculty of Medicine—University of Porto, Portugal
| | - Pedro Mota Veiga
- NECE Research Unit in Business Sciences, University of Beira Interior, Covilhã, Portugal
- Higher School of Education, Polytechnic Institute of Viseu, Portugal
| | - Constança Paúl
- Abel Salazar Institute of Biomedical Sciences—University of Porto, Portugal
- CINTESIS, Faculty of Medicine—University of Porto, Portugal
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16
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Fleitas Alfonzo L, King T, You E, Contreras-Suarez D, Zulkelfi S, Singh A. Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review. BMJ Open 2022; 12:e055264. [PMID: 35197348 PMCID: PMC8882654 DOI: 10.1136/bmjopen-2021-055264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity. DESIGN Scoping review. METHODS A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results. RESULTS A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity. CONCLUSION Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.
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Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Diana Contreras-Suarez
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Syafiqah Zulkelfi
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ankur Singh
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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17
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Tenreiro P, Ramalho A, Santos P. COVID-19 patients followed in Portuguese Primary Care: a retrospective cohort study based on the national case series. Fam Pract 2022; 39:52-58. [PMID: 34448861 DOI: 10.1093/fampra/cmab098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The pandemic state caused by SARS CoV-2 came to overburden all levels of healthcare, including Primary Care. In Portugal, most patients were followed in ambulatory, monitored by phone calls or face-to-face visits by their General Practitioner. OBJECTIVE The aim was to characterize the pathway of COVID-19 outpatients in Primary Care and establish the risk factors that mostly influences the need for hospitalization or death during the follow-up. METHODS A retrospective cohort study was established, based on the official Portuguese dataset of the first wave between March 2nd and June 30th 2020. The predictive effects of variables, including age, gender, residency and clinical features, were analysed using Cox regression analysis. RESULTS A total of 38,545 patients infected with SARS-CoV-2 was included for analysis (56.3% female), with a median age of 47 years old. There were 4,327 hospitalized patients, 253 in intensive care units and 1,153 deaths. Females present lower risk of hospitalization (HR = 0.78; 95% CI: 0.73-0.82; P < 0.001) and age is associated with higher risk (HR = 7.08; 95% CI: 6.68-7.50; P < 0.001), as well as the presence of at least one comorbidity (HR = 7.03; 95% CI: 6.43-7.69; P < 0.001). Multivariate analysis showed that cardiovascular disease, diabetes, smoking, obesity, chronic kidney disease, cancer, chronic obstructive pulmonary disease, HIV and other immunodeficiencies, transplant or immunosuppression, haematological disorders, neurological disorders and liver disease increased the risk of hospitalization. CONCLUSION Male gender, age and the presence of comorbidities are the main determinants for hospitalization and death. These COVID-19 patients should receive a higher attention when they come to primary care for assistance.
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Affiliation(s)
- Patrícia Tenreiro
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - André Ramalho
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,and Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Paulo Santos
- Department of Medicine of Community, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,and Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal
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18
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Christofoletti M, Del Duca GF, Benedetti TRB, Malta DC. Sociodemographic determinants of multimorbidity in Brazilian adults and older adults: a cross-sectional study. SAO PAULO MED J 2022; 140:115-122. [PMID: 35043867 PMCID: PMC9623826 DOI: 10.1590/1516-3180.2021.0105.r1.31052021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/31/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Multimorbidity due to non-communicable chronic diseases (NCDs) constitutes a significant challenge for healthcare systems. To attenuate its impacts, it is essential to identify the sociodemographic determinants of this condition, which can discriminate against population segments that are more exposed. OBJECTIVE To identify associations between multimorbidity conditions and sociodemographic indicators among Brazilian adults and older adults. DESIGN AND SETTING Cross-sectional telephone-based survey in 26 Brazilian state capitals and the federal district. METHODS The Vigitel 2013 survey was used, with data collected via a questionnaire. The outcome was multimorbidity (2, 3 or 4 NCDs), and the exposures were sociodemographic indicators (age, sex, skin color, marital status and education). The analysis consisted of multinomial logistic regression (odds ratio), stratified by age. RESULTS Among adults, multimorbidity comprising two, three or four diseases was associated with advancing age (P < 0.001); two and three diseases, with having a partner (P = 0.004 and P < 0.001, respectively); and two, three or four diseases, with lower education (P < 0.001). Among older adults, two, three or four diseases were associated with female sex (P < 0.001); three diseases, with living with a partner (P = 0.018); two diseases, with black skin color (P = 0.016); and two or three diseases, with lower education (P < 0.001). CONCLUSIONS To control and prevent multimorbidity, strategies for individuals with existing chronic diseases, with partners and with lower education levels are needed. Particularly for adults, advancing age should be considered; and for older adults, being a woman and having black skin color.
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Affiliation(s)
- Marina Christofoletti
- MSc. Doctoral Student, Department of Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil.
| | - Giovani Firpo Del Duca
- PhD. Full Professor, Department of Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil.
| | - Tânia Rosane Bertoldo Benedetti
- PhD. Full Professor, Department of Physical Education, Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil.
| | - Deborah Carvalho Malta
- PhD. Full Professor, Department of Maternal and Child Nursing and Public Health, Universidade Federal de Minas Gerais, Minas Gerais (MG), Brazil.
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19
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Prazeres F, Santiago LM, Simões JA. The impact on health-related quality of life of mixed mental and physical multimorbidity in adults aged 60 years and older: secondary analysis of primary care data. Arch Med Sci 2022; 18:1498-1504. [PMID: 36457974 PMCID: PMC9710290 DOI: 10.5114/aoms.2020.92914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/29/2019] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Given the number of patients with mental conditions who receive treatment within the primary care (PC) context, and the high prevalence of multimorbidity (especially in older people), there is a need to study mental-physical multimorbidity (MPM) in this population and context. This study sought to identify the impact on health-related quality of life (QoL) of MPM in adults aged 60 years and older. MATERIAL AND METHODS Secondary analysis of data derived from 251 primary health individuals. Data were collected via a sociodemographic and clinical questionnaire. Health-related QoL was assessed using the SF-12 instrument. Multiple linear regressions were performed for physical and mental health in MPM patients and in patients with physical-only multimorbidity. RESULTS Mean age of participants was 70.6 years; 57.8% were female. Quality of life was lower in MPM patients than in those with physical-only multimorbidity. Regarding MPM patients, female sex, 75 years and over, and low income were associated with worse physical health. Female sex was also associated with worse mental health. CONCLUSIONS This study contributes to the global knowledge of MPM in older people, illuminates health-related QoL differences among MPM and physical-only multimorbidity patients, and highlights the importance of non-modifiable characteristics associated with deterioration of health-related QoL. Team collaboration between primary care physicians, psychiatrists (and other mental health providers), and social workers may be necessary to assess psychiatric and physical symptoms and provide for the care needs of older people with MPM.
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Affiliation(s)
- Filipe Prazeres
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
- USF Beira Ria, Gafanha da Nazaré, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
| | - Luiz M. Santiago
- Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- General Practice Family Medicine Clinic, Faculty of Medicine, University of Coimbra, Portugal
| | - José A. Simões
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal
- Centre for Health Technology and Services Research (CINTESIS), Porto, Portugal
- USF Caminhos do Cértoma, ACeS Baixo Mondego, Portugal
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20
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Costa D, Cruz EB, Silva C, Canhão H, Branco J, Nunes C, Rodrigues AM. Factors Associated With Clinical and Radiographic Severity in People With Osteoarthritis: A Cross-Sectional Population-Based Study. Front Med (Lausanne) 2021; 8:773417. [PMID: 34869491 PMCID: PMC8634437 DOI: 10.3389/fmed.2021.773417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/11/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Hip/knee osteoarthritis (HKOA) is a leading cause of disability and imposes a major socioeconomic burden. The aim of this study is to estimate the prevalence of HKOA in Portugal, characterised the clinical severity of HKOA in the population, and identified sociodemographic, lifestyle, and clinical factors associated with higher clinical and radiographic severity. Methods: Participants with a diagnosis of HKOA from the EpiReumaPt study (2011–2013) were included (n = 1,087). Hip/knee osteoarthritis diagnosis was made through a structured evaluation by rheumatologists according to American College of Rheumatology criteria. Clinical severity was classified based on Hip Disability and Osteoarthritis Outcome Scale (HOOS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) score tertiles. Radiographic severity was classified based on the Kellgren-Lawrence grades as mild, moderate, or severe. Sociodemographic lifestyle and clinical variables, including the presence of anxiety and depression symptoms, were analysed. Factors associated with higher clinical and radiographic severity were identified using ordinal logistic regression models. Results: Hip/knee osteoarthritis diagnosis was present in 14.1% of the Portuguese population [12.4% with knee osteoarthritis (OA) and 2.9% with hip OA]. Clinical severity was similar between people with hip (HOOS = 55.79 ± 20.88) and knee (KOOS = 55.33 ± 20.641) OA. People in the high HOOS/KOOS tertile tended to be older (64.39 ± 0.70 years), female (75.2%), overweight (39.0%) or obese (45.9%), and had multimorbidity (86.1%). Factors significantly associated with higher clinical severity tertile were age [55–64 years: odds ratio (OR) = 3.18; 65–74 years: OR = 3.25; ≥75 years: OR = 4.24], female sex (OR = 1.60), multimorbidity (OR = 1.75), being overweight (OR = 2.01) or obese (OR = 2.82), and having anxiety symptoms (OR = 1.83). Years of education was inversely associated with higher clinical severity. Factors significantly associated with higher radiographic severity were age (65–74 years: OR = 3.59; ≥75 years: OR = 3.05) and being in the high HOOS/KOOS tertile (OR = 4.91). Being a female and live in Lisbon or in the Centre region were inversely associated with the higher radiographic severity. Conclusion: Hip/knee osteoarthritis is present in ~1.1 million of Portuguese people. Age, educational level, and obesity are independently associated with HKOA clinical severity, whereas age, sex, geographic location, and clinical severity are independently associated with radiographic severity.
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Affiliation(s)
- Daniela Costa
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Eduardo B Cruz
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal.,Physiotherapy Department, School of Health, Polytechnic Institute of Setúbal, Setúbal, Portugal
| | - Catarina Silva
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Helena Canhão
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Jaime Branco
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Rheumatology Unit, Centro Hospitalar Lisboa Ocidental (CHLO-E.P.E.), Hospital Egas Moniz, Lisbon, Portugal
| | - Carla Nunes
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisbon, Portugal.,Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Ana M Rodrigues
- Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisbon, Portugal.,EpiDoC Unit, Chronic Diseases Research Centre (CEDOC), NOVA Medical School, Universidade NOVA de Lisboa, Lisbon, Portugal.,Rheumatology Unit, Hospital dos Lusíadas, Lisbon, Portugal
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21
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Barcelos A, Lopes DG, Canhão H, da Cunha Branco J, Rodrigues AM. Multimorbidity is associated with fragility fractures in women 50 years and older: A nationwide cross-sectional study. Bone Rep 2021; 15:101139. [PMID: 34754887 PMCID: PMC8564033 DOI: 10.1016/j.bonr.2021.101139] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/19/2021] [Accepted: 10/01/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION Multimorbidity is a worldwide health problem, especially in elderly patients who have a higher risk of fragility fracture. Currently, there is insufficient knowledge about the burden of multimorbidity in patients with previous fragility fracture. The aim of this study was to evaluate the association between multimorbidity and previous fragility fracture, and to assess the effect of fragility fracture and/or multimorbidity in the perception of quality-of-life and physical function, in women 50 years of age and older. METHODS Women aged ≥50 years from the EpiReumaPt study (2011-2013), a nationwide population-based study, were evaluated. Self-reported data regarding sociodemographics, health-related quality of life, physical functioning, fragility fracture, and multimorbidity were collected using a semi-structured questionnaire. Multimorbidity was defined as 2 or more chronic non-communicable diseases. Descriptive exploratory analysis of the data was performed using hypothesis testing. Multiple logistic regression modelling was used to assess the association between multimorbidity and fragility fractures, and linear regression was used for the quality-of-life and physical function outcomes. RESULTS The estimated prevalence of fragility fracture in women older than 50 years was 17.5%. A higher prevalence of multimorbidity (74.6%) was found in the group of women with previous fragility fracture than in those without previous fragility fracture. Multivariate logistic regression analysis revealed that women with multimorbidity had a higher odds of fragility fracture (adjusted odds ratio, 1.38; 95% confidence interval, 1.12-1.69), compared with women with 1 or no self-reported non-communicable chronic diseases. In women with previous fragility fracture, rheumatic diseases (62.7%) and hypertension (58.6%) were the most frequently self-reported non-communicable chronic diseases. The combination of fragility fracture and multimorbidity was associated with a lower quality of life and higher degree of disability. CONCLUSIONS Women 50 years and older with multimorbidity had a significantly increased odds of fragility fracture. Fragility fracture combined with multimorbidity was negatively associated with quality of life and positively associated with disability. This study emphasizes the need to redesign health services to care for patients to prevent non-communicable chronic diseases and fragility fracture, particularly in women 50 years and older, in whom these diseases are likely to potentiate the risk of fragility fracture.
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Affiliation(s)
- Anabela Barcelos
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHBV, Aveiro, Portugal
| | - David G. Lopes
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Helena Canhão
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHULC, Lisboa, Portugal
| | - Jaime da Cunha Branco
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, CHLO, Lisboa, Portugal
| | - Ana Maria Rodrigues
- Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
- EpiDoC Unit, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
- Rheumatology Department, Hospital dos Lusíadas, Lisboa, Portugal
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22
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da Silva Dantas BA, Cavalcante ACV, de Miranda JMA, da Silva Toscano GA, Nobre TTX, Mendes FRP, de Miranda FAN, Maia EMC, Torres GDV. Depression and quality of life in Brazilian and Portuguese older people communities: Analysis of association. Medicine (Baltimore) 2021; 100:e27830. [PMID: 34797312 PMCID: PMC8601332 DOI: 10.1097/md.0000000000027830] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/29/2021] [Indexed: 01/05/2023] Open
Abstract
We aimed to compare the association of depression with aspects of quality of life (QoL) among older people users of primary health care (PHC) living in Brazil and Portugal.We carried out an observational, cross-sectional and comparative study with a quantitative approach in the PHC scope in Brazil and Portugal, where we obtained a nonrandom sample of 150 participants aged 65 years or older (100 Brazilians and 50 Portuguese). We used the socioeconomic and health data questionnaire, the Medical Outcomes Short-Form Health Survey QoL (SF-36) questionnaire and the Beck Inventory.Among the socioeconomic profiles, most were females aged between 65 and 80 years in both countries. There was a significant difference between groups in the income variable, with 100.0% of Portuguese people earning up to 1 minimum wage (P value <.001), and the presence of chronic diseases in 92.0% of respondents in Portugal (P value = .033). In the association analysis, most aspects of QoL had a higher median score (>50.0) within the categorical variables of "absent" and "mild" depression. The Emotional role functioning, Physical role functioning, Physical functioning, Mental health, Total score domains and the Mental health and Physical health summary measures stood out with this behavior in Brazil and in Portugal, where these latter 2 presented moderate to strong correlation values (ρ > 0.400) in Portugal. Greater associations of depression on QoL were revealed in Portugal than in Brazil. Among their most expressive associations, the Physical role functioning (odds ratio [OR] = 4.776; 95.0% confidence interval [CI]: 2.41-9.43), Physical functioning (OR = 3.037; 95.0% CI: 3.037), Vitality (OR = 6.000; 95.0% CI: 1.56-23.07) and Total score (OR = 3.727; 95.0% CI: 2.24-6.17) domains and the Mental health summary measure (OR = 3.870; 95.0% CI: 2.13-7.02) stood out.Aspects related to the emotional, physical, functional and mental health components stood out. The association and correlation with depression were more expressive in Portugal compared to Brazil. However, similar results were obtained in Brazil but with less relevance.
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Affiliation(s)
| | | | | | | | | | | | | | - Eulália Maria Chaves Maia
- Department of Psychology, Health Sciences Center, Federal University of Rio Grande do Norte, Natal, RN, Brazil
| | - Gilson de Vasconcelos Torres
- Postgraduate Program in Health Sciences, Federal University of Rio Grande do Norte, Natal-RN, Brazil
- Department of Nursing, Federal University of Rio Grande do Norte, Natal, RN, Brazil
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Hossain B, Govil D, Sk MIK. Persistence of Multimorbidity Among Women Aged 15-49 Years in India: An Analysis of Prevalence, Patterns and Correlation. Int J Public Health 2021; 66:601591. [PMID: 34744567 PMCID: PMC8565281 DOI: 10.3389/ijph.2021.601591] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/02/2021] [Indexed: 02/01/2023] Open
Abstract
Objectives: The present study has examined the patterns and possible correlates of coexisting morbidities among women aged 15–49 years based on biomarker measurement data at the national level in India. Methods: National Family Health Survey conducted during 2015–16 used in the present study. Simple disease count approach was used to calculate the multimorbidity among women. Multinomial logistic regression was applied to analyze the predictors of multimorbidity among women. Results: Almost 30% of the women had any of the selected morbidity and 9% of them had two or more morbidities. Hypertension and overweight combination (3%) was the most prevalent among women. The risk of having two or more morbidities was predominantly high among women aged above 30 years, low educated women, women from the wealthier group, ever-married women and women who were consuming tobacco as compared to their counterparts. Conclusions: From the policy perspective, the identification of groups of women vulnerable to multimorbidity will help in the selection of programmatic focus and preventive public health intervention in adult phase to reduce the multimorbidity burden among women in old ages.
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Affiliation(s)
- Babul Hossain
- International Institute for Population Sciences, Mumbai, India
| | - Dipti Govil
- International Institute for Population Sciences, Mumbai, India
| | - Md Illias K Sk
- International Institute for Population Sciences, Mumbai, India
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Driving factors for the utilisation of healthcare services by people with osteoarthritis in Portugal: results from a nationwide population-based study. BMC Health Serv Res 2021; 21:1022. [PMID: 34583701 PMCID: PMC8479902 DOI: 10.1186/s12913-021-07045-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 09/17/2021] [Indexed: 11/10/2022] Open
Abstract
Background Worldwide, the current management of knee osteoarthritis appears heterogeneous, high-cost and often not based on current best evidence. The absence of epidemiological data regarding the utilisation of healthcare services may conceal the need for improvements in the management of osteoarthritis. The aim of this study is to explore the profiles of healthcare services utilisation by people with knee osteoarthritis, and to analyse their determinants, according to Andersen’s behavioural model. Methods We analysed a sample of 978 participants diagnosed with knee osteoarthritis from the population-based study EpiReumaPt, in Portugal. Data was collected with a structured interview, and the diagnosis of knee osteoarthritis was validated by a rheumatologist team. With the Two-step Cluster procedure, we primarily identified different profiles of healthcare utilisation according to the services most used by patients with knee osteoarthritis. Secondly, we analysed the determinants of each profile, using multinomial logistic regression, according to the predisposing characteristics, enabling factors and need variables. Results In our sample, a high proportion of participants are overweight or obese (82,6%, n = 748) and physically inactive (20,6%, n = 201) and a small proportion had physiotherapy management (14,4%, n = 141). We identified three profiles of healthcare utilisation: “HighUsers”; “GPUsers”; “LowUsers”. “HighUsers” represents more than 35% of the sample, and are also the participants with higher utilisation of medical appointments. “GPUsers” represent the participants with higher utilisation of general practitioner appointments. Within these profiles, age and geographic location – indicated as predisposing characteristics; employment status and healthcare insurance - as enabling factors; number of comorbidities, physical function, health-related quality of life, anxiety and physical exercise - as need variables, showed associations (p < 0,05) with the higher utilisation of healthcare services profiles. Conclusions Healthcare utilisation by people with knee osteoarthritis is not driven only by clinical needs. The predisposing characteristics and enabling factors associated with healthcare utilisation reveal inequities in the access to healthcare and variability in the management of people with knee osteoarthritis. Research and implementation of whole-system strategies to improve equity in the access and quality of care are paramount in order to diminish the impact of osteoarthritis at individual-, societal- and economic-level. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07045-4.
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25
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Ahn YE, Koh CK. Effects of Living Alone and Sedentary Behavior on Quality of Life in Patients With Multimorbidities: A Secondary Analysis of Cross-Sectional Survey Data Obtained From the National Community Database. J Nurs Res 2021; 29:e173. [PMID: 34313607 DOI: 10.1097/jnr.0000000000000448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Having multimorbidities may increase health problems. Moreover, health-related quality of life correlates negatively with the number of chronic conditions a patient has. Living alone has been identified as a predictor of poorer quality of life, and a sedentary lifestyle is widely known to increase health problems and mortality. PURPOSE This study was designed to identify the effects of living alone and of sedentary behavior on health-related quality of life in patients with multimorbidities using nationally representative community data. METHODS A secondary data analysis of the Korea National Health and Nutrition Examination Survey was conducted. In this study, 1,725 adult patients aged 19 years and above with two or more chronic diseases were selected for the analysis. Health-related quality of life was measured using the European Quality of Life-5 Dimensions. Multiple logistic regression was performed to identify the effects of living alone and of sedentary behavior on health-related quality of life. The statistical analyses took into account the components of the complex sampling design such as the strata, clusters, weights, and adjustment procedures, and missing data were treated in a valid manner. RESULTS After adjusting for gender, age, employment status, and number of chronic diseases, it was found that the odds of having a high health-related quality of life were lower in single households than in multiperson households (odds ratio = 0.62, 95% confidence interval [0.46, 0.84]). In addition, after adjusting for gender, age, employment status, number of chronic diseases, and living arrangement, the odds of having a high health-related quality of life decreased as sedentary time increased (odds ratio = 0.93, 95% confidence interval [0.89, 0.96]). CONCLUSIONS/IMPLICATIONS FOR PRACTICE To improve quality of life in patients with multimorbidities, nursing interventions that support patients who live alone and have complicated disease-related issues and that reduce sedentary behavior should be developed.
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Affiliation(s)
- Young Eun Ahn
- MSN, RN, Doctoral Student, College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Chin Kang Koh
- PhD, RN, Associate Professor, College of Nursing, The Research Institute of Nursing Research, Seoul National University, Seoul, Republic of Korea
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26
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Lee ES, Lee PSS, Xie Y, Ryan BL, Fortin M, Stewart M. The prevalence of multimorbidity in primary care: a comparison of two definitions of multimorbidity with two different lists of chronic conditions in Singapore. BMC Public Health 2021; 21:1409. [PMID: 34271890 PMCID: PMC8283957 DOI: 10.1186/s12889-021-11464-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 07/07/2021] [Indexed: 12/26/2023] Open
Abstract
Background The prevalence of multimorbidity varies widely due to the lack of consensus in defining multimorbidity. This study aimed to measure the prevalence of multimorbidity in a primary care setting using two definitions of multimorbidity with two different lists of chronic conditions. Methods We conducted a cross-sectional study of 787,446 patients, aged 0 to 99 years, who consulted a family physician between July 2015 to June 2016. Multimorbidity was defined as ‘two or more’ (MM2+) or ‘three or more’ (MM3+) chronic conditions using the Fortin list and Chronic Disease Management Program (CDMP) list of chronic conditions. Crude and standardised prevalence rates were reported, and the corresponding age, sex or ethnic-stratified standardised prevalence rates were adjusted to the local population census. Results The number of patients with multimorbidity increased with age. Age-sex-ethnicity standardised prevalence rates of multimorbidity using MM2+ and MM3+ for Fortin list (25.9, 17.2%) were higher than those for CDMP list (22.0%; 12.4%). Sex-stratified, age-ethnicity standardised prevalence rates for MM2+ and MM3+ were consistently higher in males compared to females for both lists. Chinese and Indians have the highest standardised prevalence rates among the four ethnicities using MM2+ and MM3+ respectively. Conclusions MM3+ was better at identifying a smaller number of patients with multimorbidity requiring higher needs compared to MM2+. Using the Fortin list seemed more appropriate than the CDMP list because the chronic conditions in Fortin’s list were more commonly seen in primary care. A consistent definition of multimorbidity will help researchers and clinicians to understand the epidemiology of multimorbidity better. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11464-7.
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Affiliation(s)
- Eng Sing Lee
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore.
| | | | - Ying Xie
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada
| | - Martin Fortin
- Department of Family Medicine, Centre de Santé et de Services Sociaux de Chicoutimi, Unité de médecine de famille, University of Sherbrooke, 305, rue St-Vallier, Chicoutimi, QC, G7H 5H6, Canada
| | - Moira Stewart
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada.,Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, 1151 Richmond St, London, ON, N6A 5C1, Canada
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Lopes MJ, de Pinho LG, Fonseca C, Goes M, Oliveira H, Garcia-Alonso J, Afonso A. Functioning and Cognition of Portuguese Older Adults Attending in Residential Homes and Day Centers: A Comparative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18137030. [PMID: 34209339 PMCID: PMC8297339 DOI: 10.3390/ijerph18137030] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/22/2021] [Accepted: 06/28/2021] [Indexed: 12/14/2022]
Abstract
The functioning and cognition of older adults can be influenced by different care contexts. We aimed to compare the functioning profiles and cognition of institutionalized and noninstitutionalized older adults and to evaluate the effect of sociodemographic factors on the functioning and cognition. This is a cross-sectional study that included 593 older adults. The data were collected using the Elderly Nursing Core Set and Mini Mental State Examination. Women, older adults who did not attend school and those live in Residential Homes are more likely to have a higher degree of cognitive impairment than men, those who attended school and those frequent Day Centre. The chances of an older adult with moderate or severe cognitive impairment increases with age. Older women, older adults who did not attend school, and older adults who live in Residential Homes had a higher degree of functional problem than men, those who attended school and those who frequent a Day Centre, independently to age. It is necessary to promote the health literacy of older adults throughout life. The implementation of social and health responses should allow older adults to remain in their homes, given the influence of functioning and cognition on self-care and quality of life.
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Affiliation(s)
- Manuel José Lopes
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Correspondence: (M.J.L.); (L.G.d.P.); Tel.: +351-266-730-300
| | - Lara Guedes de Pinho
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Correspondence: (M.J.L.); (L.G.d.P.); Tel.: +351-266-730-300
| | - César Fonseca
- Escola Superior de Enfermagem de São João de Deus, Universidade de Évora, 7000-801 Évora, Portugal;
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
| | - Margarida Goes
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Escola Superior de Saúde, Instituto Politécnico de Beja, 7800-111 Beja, Portugal
| | - Henrique Oliveira
- Comprehensive Health Research Centre (CHRC), Universidade de Évora, 7000-801 Évora, Portugal; (M.G.); (H.O.)
- Escola Superior de Saúde, Instituto Politécnico de Beja, 7800-111 Beja, Portugal
- Instituto de Telecomunicações, 1049-001 Lisboa, Portugal
| | - José Garcia-Alonso
- Department of Computer Systems and Telematics Engineering, University of Extremadura, 10003 Cáceres, Spain;
| | - Anabela Afonso
- Departamento de Matemática, Escola de Ciências e Tecnologia, Universidade de Évora, 7000-671 Évora, Portugal;
- Centro de Investigação em Matemática e Aplicações, Universidade de Évora, 7000-671 Évora, Portugal
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Monteiro L, Monteiro-Soares M, Mendonça LV, Ribeiro-Vaz I, Martins C, Teixeira A. Translation and adaptation of the STOPP-START screening tool to Portuguese for detecting inappropriate prescriptions in older people: a protocol. BMJ Open 2021; 11:e043746. [PMID: 34183337 PMCID: PMC8240571 DOI: 10.1136/bmjopen-2020-043746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Rational prescribing for older adults is a challenge because they usually exhibit multimorbidity and multimedication. One available and reliable tool to tackle this issue consists of the Screening Tool of Older People's Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START), which has been associated with improvements in clinical outcomes. Our goal here is to translate and validate the STOPP-START screening tool for use with Portuguese general practitioners/family physicians. METHODS AND ANALYSIS The study will be conducted in four phases: phase I-translation of the STOPP-START screening tool to Portuguese; phase II-data collection of patient data; phase III-intrarater reliability and agreement study; and phase IV-inter-rater reliability and agreement study. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the Central Health Region of Portugal (where the study will take place). Every participant will sign a written consent form. We intend to publish the full article in a related peer-reviewed journal, conference presentations, reports and in a PhD thesis.
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Affiliation(s)
- Luís Monteiro
- Center for Health Technology and Services Research; Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
- Unidade de Saúde Familiar, USF Esgueira +, Aveiro, Portugal
| | - Matilde Monteiro-Soares
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, FMUP, Porto, Portugal
- Center for Health Technology and Services Research, Oporto University Faculty of Medicine, CINTESIS, Porto, Portugal
| | - Liliane Vélia Mendonça
- Center for Health Technology and Services Research, Oporto University Faculty of Medicine, CINTESIS, Porto, Portugal
| | - Inês Ribeiro-Vaz
- Center for Health Technology and Services Research, Oporto University Faculty of Medicine, CINTESIS, Porto, Portugal
- Porto Pharmacovigilance Centre, FMUP, Porto, Portugal
| | - Carlos Martins
- MEDCIDS-Department of Community Medicine, Information and Health Decision Sciences, FMUP, Porto, Portugal
- Center for Health Technology and Services Research, Oporto University Faculty of Medicine, CINTESIS, Porto, Portugal
| | - Andreia Teixeira
- Center for Health Technology and Services Research; Faculty of Medicine, University of Porto, CINTESIS, Porto, Portugal
- MEDCIDS-Department of Community Medicine, Information and Decision in Health; Faculty of Medicine, University of Porto, FMUP, Porto, Portugal
- IPVC - Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
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Fonseca C, de Pinho LG, Lopes MJ, Marques MDC, Garcia-Alonso J. The Elderly Nursing Core Set and the cognition of Portuguese older adults: a cross-sectional study. BMC Nurs 2021; 20:108. [PMID: 34162387 PMCID: PMC8220736 DOI: 10.1186/s12912-021-00623-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/26/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The aging population and its associated health needs require specific nursing care. The aim of this study was to draw an epidemiological profile of Portuguese elderly adults attending in residential homes and day centers and to evaluate the association between the functioning and cognition of these older adults and their sociodemographic characteristics and presence of multimorbidity. METHODS This was a cross-sectional study of 613 older adults. Functioning was assessed using the Elderly Nursing Core Set, and cognition was assessed using the Mini Mental State Examination. Descriptive and inferential analyses were performed. RESULTS The mean age was 85.73 years; the majority of the participants were female (69.3 %), widowed (67.0 %) and over 85 years old (60.4 %). A total of 68.2 % of the sample presented multimorbidity. A total of 54.5 % had cognitive impairment, and the average functional profile was classified as "moderate difficulty". Institutionalized older adults had more diseases than those who attended the day center. Women, those who were illiterate, those who were institutionalized and older adults who had diseases of the nervous system had a worse functional profile and greater cognitive impairment. Those with multimorbidity had a worse functional profile, and those without a spouse had greater cognitive impairment. CONCLUSIONS Given the functional and cognitive profile of older adults, it is necessary to adopt care practices focused on the rehabilitation/maintenance of self-care and affective relationships. This care must be provided by highly qualified professionals. Therefore, it is necessary to increase the ratio of nurses per older adult in these institutions.
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Affiliation(s)
- César Fonseca
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Largo do Sr. da Pobreza, 2B, 7000 - 811, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Évora, Portugal
| | - Lara Guedes de Pinho
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Largo do Sr. da Pobreza, 2B, 7000 - 811, Évora, Portugal. .,Comprehensive Health Research Centre (CHRC), Évora, Portugal.
| | - Manuel José Lopes
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Largo do Sr. da Pobreza, 2B, 7000 - 811, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Évora, Portugal
| | - Maria do Céu Marques
- Escola Superior de Enfermagem São João de Deus, Universidade de Évora, Largo do Sr. da Pobreza, 2B, 7000 - 811, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Évora, Portugal
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30
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Lu J, Wang Y, Hou L, Zuo Z, Zhang N, Wei A. Multimorbidity patterns in old adults and their associated multi-layered factors: a cross-sectional study. BMC Geriatr 2021; 21:372. [PMID: 34147073 PMCID: PMC8214251 DOI: 10.1186/s12877-021-02292-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 05/20/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Influenced by various factors such as socio-demographic characteristics, behavioral lifestyles and socio-cultural environment, the multimorbidity patterns in old adults remain complex. This study aims to identify their characteristics and associated multi-layered factors based on health ecological model. METHODS In 2019, we surveyed a total of 7480 participants aged 60+ by using a multi-stage random cluster sampling method in Shanxi province, China. Latent class analysis was used to discriminate the multimorbidity patterns in old adults, and hierarchical regression was performed to determine the multi-layered factors associated with their various multimorbidity patterns. RESULTS The prevalence of multimorbidity was 34.70% among the old patients with chronic disease. Over half (60.59%) of the patients with multimorbidity had two co-existing chronic diseases. "Degenerative/digestive diseases", "metabolic diseases" and "cardiovascular diseases" were three specific multimorbidity patterns. Behavioral lifestyles-layered factors had the most explanatory power for the three patterns, whose proportions of explanatory power were 54.00, 43.90 and 48.15% individually. But the contributions of other multi-layered factors were different in different patterns; balanced diet, medication adherence, the size of family and friendship network, and different types of basic medical insurance might have the opposite effect on the three multimorbidity patterns (p < 0.05). CONCLUSIONS In management of old patients with multimorbidity, we should prioritize both the "lifestyle change"-centered systematic management strategy and group-customized intervention programs.
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Affiliation(s)
- Jiao Lu
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China.
| | - Yuan Wang
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
| | - Lihong Hou
- The Second Affiliated Hospital, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi Province, China
| | - Zhenxing Zuo
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Na Zhang
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
| | - Anle Wei
- School of Management, Shanxi Medical University, 56 Xinjian South Road, Taiyuan, 030001, Shanxi Province, China
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Rijken M, Stüssgen R, Leemrijse C, Bogerd MJL, Korevaar JC. Priorities and preferences for care of people with multiple chronic conditions. Health Expect 2021; 24:1300-1311. [PMID: 33938597 PMCID: PMC8369115 DOI: 10.1111/hex.13262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey.
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Affiliation(s)
- Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - René Stüssgen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Zorginstituut Nederland, (National Health Care Institute), Diemen, The Netherlands
| | - Chantal Leemrijse
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mieke J L Bogerd
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Joke C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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St John PD, Menec V, Tyas SL, Tate R, Griffith L. Multimorbidity in Canadians living in the community: Results from the Canadian Longitudinal Study of Aging. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2021; 67:187-197. [PMID: 33727380 DOI: 10.46747/cfp.6703187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the mean number of chronic diseases in Canadians aged 45 to 85 years who are living in the community, and to characterize the association of multimorbidity with age, sex, and social position. DESIGN An analysis of data from the Canadian Longitudinal Study on Aging. The number of self-reported chronic diseases was summed, and then the mean number of chronic health problems was standardized to the 2011 Canadian population. Analyses were conducted stratified on sex, age, individual income, household income, and education level. SETTING Canada. PARTICIPANTS A total of 21 241 community-living Canadians aged 45 to 85 years. MAIN OUTCOME MEASURES Overall, 31 chronic diseases (self-reported from a list) were considered, as were risk factors that were not mental health conditions or acute in nature. Age, sex, education, and household and individual incomes were also self-reported. RESULTS Multimorbidity was common, and the mean number of chronic illnesses was 3.1. Women had a higher number of chronic illnesses than men. Those with lower income and less education had more chronic conditions. The number of chronic conditions was strongly associated with age. The mean number of conditions was 2.1 in those aged 45 to 54; 2.9 in those 55 to 64; 3.8 in those aged 65 to 74, and 4.8 in those aged 75 and older (P < .05, ANOVA [analysis of variance]). CONCLUSION Multimorbidity is common in the Canadian population and is strongly related to age.
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Affiliation(s)
| | - Verena Menec
- Social psychologist at the University of Manitoba in Winnipeg
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Ingram E, Ledden S, Beardon S, Gomes M, Hogarth S, McDonald H, Osborn DP, Sheringham J. Household and area-level social determinants of multimorbidity: a systematic review. J Epidemiol Community Health 2021; 75:232-241. [PMID: 33158940 PMCID: PMC7892392 DOI: 10.1136/jech-2020-214691] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND No clear synthesis of evidence examining household and area-level social determinants of multimorbidity exists. This study aimed to systematically review the existing literature on associations between household and area-level social determinants of health (SDoH) and multimorbidity prevalence or incidence in the general population. METHODS Six databases (MedLine, EMBASE, PsychINFO, Web of Science, CINAHL Plus and Scopus) were searched. The search was limited to peer-reviewed studies conducted in high-income countries and published in English between 2010 and 2019. A second reviewer screened all titles with abstracts and a subset of full texts. Study quality was assessed and protocol pre-registered (CRD42019135281). RESULTS 41 studies spanning North America, Europe and Australasia were included. Household income and area-level deprivation were the most explored with fairly consistent findings. The odds of multimorbidity were up to 4.4 times higher for participants with the lowest level of income compared with the highest level. Those living in the most deprived areas had the highest prevalence or incidence of multimorbidity (pooled OR 1.42, 95% CI 1.41 to 1.42). Associations between deprivation and multimorbidity differed by age and multimorbidity type. Findings from the few studies investigating household tenure, household composition and area-level rurality were mixed and contradictory; homeownership and rurality were associated with increased and decreased multimorbidity, while living alone was found to be associated with a higher risk of multimorbidity and not associated. CONCLUSION Improving our understanding of broader social determinants of multimorbidity-particularly at the household level-could help inform strategies to tackle multimorbidity.
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Affiliation(s)
- Elizabeth Ingram
- Department of Applied Health Research, University College London, London, UK
| | - Sarah Ledden
- Division of Psychiatry, University College London, London, UK
| | - Sarah Beardon
- Department of Applied Health Research, University College London, London, UK
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, UK
| | - Sue Hogarth
- London Boroughs of Camden and Islington, London, UK
| | - Helen McDonald
- London School of Hygiene and Tropical Medicine, London, UK
| | - David P Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, UK
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de Souza ACD, Barbosa IR, de Souza DLB. Prevalence of multimorbidity and associated factors in the Brazilian working population. Rev Bras Med Trab 2021; 18:302-311. [PMID: 33597980 PMCID: PMC7879477 DOI: 10.47626/1679-4435-2020-568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/24/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION According to the World Health Organization (2018), recent changes in the epidemiological profile of working populations point to an increase in non-communicable chronic illnesses and a decrease in communicable chronic illnesses. OBJECTIVES To estimate the prevalence of multimorbidity in the Brazilian working population (≥18 years) and identify associated factors based on data from the 2013 national health survey (Pesquisa Nacional de Saúde). METHODS This was a cross sectional study based on data from the 2013 national health survey, which included n = 47,629 people aged 18 years or older. As part of the survey, participants were asked whether they had ever been diagnosed with any of several chronic diseases. The prevalence of multimorbidity in this population and its association with socioeconomic, lifestyle and occupational characteristics were examined. Bivariate analyses were used to calculate prevalence ratios and 95% confidence intervals. Multivariate analyses were conducted using Poisson regression and Wald's tests to estimate the coefficients of significant variables. RESULTS The prevalence of multimorbidity was 19.98% (95% confidence interval: 19.29%-20.70%). Higher rates of multimorbidity were associated with female gender, age 60 years or older, living with a spouse, past history of smoking, low education levels (illiterate/primary), living in urban areas, having medical or dental insurance and a history of work accidents. CONCLUSIONS The prevalence of multimorbidity in the Brazilian population is low. When present, multimorbidity is associated with specific occupational, socioeconomic and lifestyle characteristics.
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Affiliation(s)
- Ana Clara Dantas de Souza
- Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Saúde Coletiva - Natal (RN), Brazil
| | - Isabelle Ribeiro Barbosa
- Universidade Federal do Rio Grande do Norte, Programa de Pós-Graduação em Saúde Coletiva - Natal (RN), Brazil
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Costa ÂK, Bertoldi AD, Fontanella AT, Ramos LR, Arrais PSD, Luiza VL, Mengue SS, Nunes BP. Does socioeconomic inequality occur in the multimorbidity among Brazilian adults? Rev Saude Publica 2021; 54:138. [PMID: 33331530 PMCID: PMC7703529 DOI: 10.11606/s1518-8787.2020054002569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 06/19/2020] [Indexed: 01/26/2023] Open
Abstract
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.
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Affiliation(s)
- Ândria Krolow Costa
- Universidade Federal de Pelotas. Faculdade de Enfermagem. Programa de Pós-Graduação em Enfermagem. Pelotas, RS, Brasil
| | - Andréa Dâmaso Bertoldi
- Universidade Federal de Pelotas. Faculdade de Medicina. Departamento de Medicina Social. Programa de Pós-Graduação em Epidemiologia. Pelotas, RS, Brasil
| | - Andréia Turmina Fontanella
- Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Porto Alegre, RS, Brasil
| | - Luiz Roberto Ramos
- Universidade Federal de São Paulo. Escola Paulista de Medicina. Departamento de Medicina Preventiva. São Paulo, SP, Brasil
| | | | - Vera Lucia Luiza
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Rio de Janeiro, RJ, Brasil
| | - Sotero Serrate Mengue
- Universidade Federal do Rio Grande do Sul. Faculdade de Medicina. Programa de Pós-Graduação em Epidemiologia. Porto Alegre, RS, Brasil
| | - Bruno Pereira Nunes
- Universidade Federal de Pelotas. Faculdade de Enfermagem. Departamento de Enfermagem em Saúde Coletiva. Pelotas, RS, Brasil
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Ferry FR, Rosato MG, Curran EJ, O'Reilly D, Leavey G. Multimorbidity among persons aged 25-64 years: a population-based study of social determinants and all-cause mortality. J Public Health (Oxf) 2020; 44:e59-e67. [PMID: 33348365 DOI: 10.1093/pubmed/fdaa209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 10/13/2020] [Accepted: 10/26/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Despite increasing multimorbidity across the lifespan, little is known about the co-occurrence of conditions and risk factors among younger adults. This population-based study examines multimorbidity, social determinants and associated mortality among younger and middle-age adults. METHOD Analysis was based on the Northern Ireland population aged 25-64 years enumerated in the 2011 Census (n = 878 345), with all-cause mortality follow-up to 2014 (8659 deaths). Logistic regression was used to examine social determinants and Cox proportional hazards models in the analysis of associated mortality. RESULTS Prevalence of multimorbidity was 13.7% in females and 12.7% in males. There was a strong association between multimorbidity that included mental/cognitive illness and deprivation. Among those never married, multimorbid physical conditions were less likely [relative risk ratios (RRR) = 0.92: 95% confidence interval (CI) = 0.88, 0.95 for males; and RRR = 0.90: 0.87, 0.94 for females]. Rurality was associated with lower physical multimorbidity (RRR = 0.92: 0.89, 0.95) but higher mental/cognitive multimorbidity (RRR = 1.35: 1.12, 1.64) among females. All multimorbid categories were associated with elevated risk of mortality. CONCLUSION The health and economic challenges created by multimorbidity should be addressed further 'upstream'. Future multimorbidity research should include younger adults to inform the development of preventative interventions and align health and social care services more closely with patients' needs.
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Affiliation(s)
- F R Ferry
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - M G Rosato
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - E J Curran
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
| | - D O'Reilly
- Centre for Public Health, Block A Royal Victoria Hospital, Queen's University Belfast, Belfast BT12 6BA, Northern Ireland
| | - G Leavey
- Bamford Centre for Mental Health and Wellbeing, Room H253, School of Psychology, Ulster University, Coleraine BT52 1SA, Northern Ireland
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Yu X, Zhang W. Neighborhood's locality, road types, and residents' multimorbidity: evidence from China's middle-aged and older adults. BMC Public Health 2020; 20:1728. [PMID: 33198728 PMCID: PMC7670703 DOI: 10.1186/s12889-020-09876-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 11/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background Neighborhood factors have gained increasing attention, while the association between the neighborhood’s characteristics and multimorbidity has not been clarified. In this study, we aim to depict variations in the number of non-communicable chronic diseases (NCDs) as a function of urban vs. rural settings and road types. Methods The present cross-sectional study derived data from the China Health and Retirement Longitudinal Study 2011 National Baseline Survey. Negative binomial regression with clustered robust standard errors was performed to analyze variations in the number of NCDs among 13,414 Chinese middle-aged and older adults. Logistic regression models were employed to investigate the association between neighborhood-level characteristics and each NCD, respectively. Results First, over 65% of subjects had at least one NCDs, and over 35% had multimorbidity. Arthritis (33.08%), hypertension (24.54%), and digestive disease (21.98%) were the most prevalent NCDs. Urban vs. rural differences in multimorbidity were fully explained by neighborhood clustering variations (IRR = 1.02, 95% CI, 0.95–1.10). Living with paved roads was associated with a smaller number of NCDs relative to living with unpaved roads (IRR = 0.86, 95% CI, 0.78–0.95). Results from subgroup analyses suggested that in comparison with those living with unpaved roads, individuals living with paved roads respectively had lower odds of chronic lung disease (OR = 0.76, 95% CI, 0.63–0.93), chronic liver disease (OR = 0.74, 95% CI, 0.55–0.99), chronic kidney disease (OR = 0.68, 95% CI, 0.51–0.89), digestive disease (OR = 0.82, 95% CI, 0.69–0.97), arthritis or rheumatism (OR = 0.69, 95% CI, 0.55–0.87), and asthma (OR = 0.67, 95% CI, 0.51–0.88). Conclusions Urban vs. rural disparities in multimorbidity appeared to result from within-neighborhoods characteristics. The improvement in neighborhood-level characteristics, such as road pavement, holds promise to alleviate the increasing disease burden of chronic diseases.
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Affiliation(s)
- Xuexin Yu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610040, Sichuan, China
| | - Wei Zhang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610040, Sichuan, China.
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Kshatri JS, Palo SK, Bhoi T, Barik SR, Pati S. Prevalence and Patterns of Multimorbidity Among Rural Elderly: Findings of the AHSETS Study. Front Public Health 2020; 8:582663. [PMID: 33251177 PMCID: PMC7676903 DOI: 10.3389/fpubh.2020.582663] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/30/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: In India, the proportion of older population is projected to increase from 8% in 2015 to 19% in 2050 and a third of the country's population will be older adults by end of the century. Multimorbidity is common among the elderly and the prevalence increases with age. Chronic conditions are most often present as clusters and it's critical to explore the prevalent pattern of clustering for better public health strategies. Method: A cross-sectional study was conducted among 725 rural older adults (>60 years) in Tigiria block of Odisha, India. Multimorbidity status was assessed using the prior validated MAQ-PC tool. Survey was conducted using android tablets installed with open data kit software. While Euclidean distances using K-means clustering algorithm were used to estimate the similarity or dissimilarity of observations. The optimum numbers of clusters were determined using silhouette method. Data were analyzed using multiple open source packages of R statistical programming software ver-3.6.3. Result: The overall prevalence of multimorbidity was 48.8% of which dyads (25%) were the most common form, followed by triads (15.2%). The prevalence of multimorbidity was higher in females (50.4%) than males (47.4%). The optimal number of clusters was found to be 3. While arthritis alone was a separate cluster, hypertension and acid peptic disease were in another cluster and all the rest conditions were included in the third cluster. Conclusion: The cluster analysis to measure of proximity suggested arthritis, hypertension, and acid peptic disease are the diseases that occur mostly in isolation with the other chronic conditions in the rural elderly.
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Affiliation(s)
- Jaya Singh Kshatri
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Subrata Kumar Palo
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Trilochan Bhoi
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Shakti Ranjan Barik
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
| | - Sanghamitra Pati
- Indian Council of Medical Research-Regional Medical Research Centre, Bhubaneswar, India
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Santiago LM, Silva I, Simões JA. Patients' and tutors' evaluations of medicine students' consultations in general practice/family medicine in Coimbra. BMC MEDICAL EDUCATION 2020; 20:137. [PMID: 32375791 PMCID: PMC7201647 DOI: 10.1186/s12909-020-02042-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 04/13/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Undergraduate teaching of General Practice/Family Medicine (GP/FM) must ensure students acquire the necessary competencies and skills to perform an adequate GP/FM consultation with adequate annotations (the SOAP model) and classifications. So aimed to study and to correlate students' evaluation by tutors and patients in specific consultations in the formal practical evaluation of GP/FM Curricular Unit of the Integrated Masters on Medicine at the Faculty of Medicine of the University of Coimbra (IMM-FMUC) in the academic years of 2017-2018 and 2018-2019. METHODS Observational study of the 2017-2018 and 2018-2019 academic years of the assessment grids for tutor's evaluation of SOAP performance and fluency in consultation and for patient's evaluation of the student 'performance, in the convenience sample of those who chose to be so evaluated. RESULTS We studied a population of 435 (67,7%) out of a universe of 646 students, 125 (28,7%) males, ns by sex and academic year who performed this evaluation. In a mark up to 20 from tutors, difference was found for Plan (P) mark, higher in 2018-2019 (18,38 ± 2,18vs18,54 ± 2,11, p = 0,005) of the SOAP methodology evaluation. Patients' evaluation was not different 19,34 ± 1,70vs19,35 ± 1,40, p = 0,091. A positive significant correlation was found between tutors and patients marks (ρ = 0,278; p < 0,001), as well as between tutor mark and final mark (ρ = 0,958; p < 0,001) and patient and final marks (ρ = 0,465; p < 0,001). Final marks were not different in both years, 18,61 ± 1,38vs18,78 ± 1,15, p = 0,158. CONCLUSIONS This innovative model of evaluation of student's performance in medical appointment, showed a significant positive moderate correlation between patients' and tutors' marks in the setting of GP/FM at the IMM-FMUC, and was not different between years. Yearly evaluation must be continued.
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Affiliation(s)
- Luiz Miguel Santiago
- Faculty of Medicine of the University of Coimbra, General Practice and Family Medicine University Clinic of the University of Coimbra, Coimbra, Portugal.
| | - Inês Silva
- Faculty of Medicine of the University of Coimbra, General Practice and Family Medicine University Clinic of the University of Coimbra, Coimbra, Portugal
| | - José Augusto Simões
- Faculty of Medicine of the University of Coimbra, General Practice and Family Medicine University Clinic of the University of Coimbra, Coimbra, Portugal
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Koh LJ, Teo SH, Jiang Y, Hwang EHJ, Lee ES. Difficulties that patients with chronic diseases face in the primary care setting in Singapore: a cross-sectional study. Singapore Med J 2020; 62:466-471. [PMID: 32299185 DOI: 10.11622/smedj.2020062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with chronic diseases face difficulties when navigating the healthcare system. Using the Healthcare System Hassles Questionnaire (HSHQ) developed by Parchman et al, this study aimed to explore the degree of hassles faced by primary care patients in Singapore and identify the characteristics associated with higher hassles. METHODS A cross-sectional study was conducted among patients with chronic disease at Hougang Polyclinic, Singapore, using interviewer-administered HSHQ. Mean HSHQ score was compared with Parchman et al's study. The associations between number of chronic diseases, demographic variables and healthcare hassles were assessed using multivariate linear logistic regression analysis. RESULTS 217 outpatients aged 21 years and above were enrolled. Our overall mean HSHQ score (4.77 ± 6.18) was significantly lower than that in Parchman et al's study (15.94 ± 14.23, p < 0.001). Participants with five or more chronic diseases scored 3.38 (95% confidence interval [CI] 0.11-6.65, p = 0.043) points higher than those with one chronic disease. With each increasing year of age, mean HSHQ score decreased by 0.17 (95% CI -0.26 to -0.08, p = 0.001) points. Those with polytechnic/diploma/university education and higher scored 2.65 (95% CI 0.19-5.11, p = 0.035) points higher than those with primary education and lower. CONCLUSION Patients in our population reported lower hassles than those in Parchman et al's study. Increasing age and lower education level were associated with lower hassles. Further analysis of the types of chronic diseases may yield new information about the association of healthcare hassles with the number and types of chronic diseases.
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Affiliation(s)
- Li Jia Koh
- Hougang Polyclinic, National Healthcare Group Polyclinics, Singapore
| | - Sok Huang Teo
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | - Yilin Jiang
- Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
| | | | - Eng Sing Lee
- Hougang Polyclinic, National Healthcare Group Polyclinics, Singapore.,Clinical Research Unit, National Healthcare Group Polyclinics, Singapore
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Furtado KAX, Infante P, Sobral A, Gaspar P, Eliseu G, Lopes M. Prevalence of acute and chronic wounds - with emphasis on pressure ulcers - in integrated continuing care units in Alentejo, Portugal. Int Wound J 2020; 17:1002-1010. [PMID: 32285622 DOI: 10.1111/iwj.13364] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 03/17/2020] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Abstract
The aim of the study was to describe the prevalence and general characteristics of acute and chronic wounds in 2018 in Alentejo (Portugal) continuing care units. In order to look at associations, wound characteristics studied were location, type, place of acquisition, number, and duration, and patient characteristics were sex, age, and presence of risk factors. During the first 2 weeks of February 2018, a total of 770 patients were assessed at continuing care units of Alentejo. Of these, 135 exhibited wounds, a prevalence of 17.5%. Almost two out of three patients (63%) had arterial hypertension, slightly more than one in three (37%) had a stroke and/or immobility and 30% had diabetes. Of the total wounds identified, 18% were acute wounds and 82% were chronic wounds. Of the 24 acute wounds, traumatic wounds (76%), and surgical wounds (22%) were the most prevalent. The four types of pressure ulcers represented 80% of the chronic wounds. The median duration of the pressure ulcers was 5.5 months and 25% had duration over 10 months.
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Affiliation(s)
- Kátia A X Furtado
- Outpatient Department, Unidade Local de Saúde do Norte Alentejano, Portalegre, Portugal
| | - Paulo Infante
- DMAT and CIMA, Universidade de Évora, Évora, Portugal
| | - Ana Sobral
- MAEG, Universidade de Évora, Évora, Portugal
| | - Pedro Gaspar
- Nursing School, Instituto Politécnico de Leiria, Leiria, Portugal
| | - Graça Eliseu
- ECR, Administração Regional de Saúde do Alentejo, Alentejo, Portugal
| | - Manuel Lopes
- Nursing School, Universidade de Évora, Évora, Portugal
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Lee Y, Kim H, Jeong H, Noh Y. Patterns of Multimorbidity in Adults: An Association Rules Analysis Using the Korea Health Panel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082618. [PMID: 32290367 PMCID: PMC7215522 DOI: 10.3390/ijerph17082618] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 12/24/2022]
Abstract
This study aimed to identify the prevalence and patterns of multimorbidity among Korean adults. A descriptive study design was used. Of 11,232 adults aged 18 and older extracted from the 2014 Korean Health Panel Survey, 7118 had one or more chronic conditions. The chronic conditions code uses the Korean Standard Classification of Diseases. Association rule analysis and network analysis were conducted to identify patterns of multimorbidity among 4922 participants with multimorbidity. The prevalence of multimorbidity in the overall population was 34.8%, with a higher prevalence among women (40.8%) than men (28.6%). Hypertension had the highest prevalence in both men and women. In men, diabetes mellitus and hypertension yielded the highest probability of comorbidity (10.04%). In women, polyarthrosis and hypertension yielded the highest probability of comorbidity (12.51%). The results of the network analysis in four groups divided according to gender and age showed different characteristics for each group. Public health practitioners should adopt an integrated approach to manage multimorbidity rather than an individual disease-specific approach, along with different strategies according to age and gender groups.
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Affiliation(s)
- Yoonju Lee
- College of Nursing, Pusan National University, Yangsan 50612, Korea;
| | - Heejin Kim
- Department of Nursing, The Graduate School, Pusan National University, Yangsan 50612, Korea;
- Correspondence: ; Tel.: +82-51-510-8367
| | - Hyesun Jeong
- Department of Nursing, The Graduate School, Pusan National University, Yangsan 50612, Korea;
| | - Yunhwan Noh
- Department of Statistics, The Graduate School, Pusan National University, Busan 46241, Korea;
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Quinaz Romana G, Kislaya I, Cunha Gonçalves S, Salvador MR, Nunes B, Matias Dias C. Healthcare use in patients with multimorbidity. Eur J Public Health 2020; 30:16-22. [PMID: 31978229 DOI: 10.1093/eurpub/ckz118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The existence of multiple chronic conditions in the same patient is a public health problem increasingly recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which imply a heavy burden in healthcare use. It is estimated that between 70% and 80% of the total health expenditure is used with chronic conditions. Patients with multimorbidity are responsible for up to 75% of primary care appointments. These patients are also high hospital users, with up to 14.6 times more risk of hospitalization. METHODS This study analyses the association between healthcare use and multimorbidity in the Portuguese population aged 25-74 years old. The association between socioeconomic variables and healthcare use was studied, based on data from the first Portuguese Health Examination Survey using a logistic regression model, stratified by sex and adjusted for socioeconomic confounding variables. RESULTS In patients with multimorbidity, there was a greater use of primary healthcare consultations, medical or surgical specialist consultations and hospitalizations. An association was established between female, older age groups and lower educational levels, and increased healthcare use. When adjusted to socioeconomic variables, the likelihood of using healthcare services can be as high as 3.5 times, when compared to patients without chronic conditions. CONCLUSION Our results show a greater healthcare use in multimorbidity patients, both in primary and hospital care. The availability of scientific evidence regarding the use of healthcare services by multimorbidity patients may support health policy changes, which could allow a more efficient management of these patients.
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Affiliation(s)
- Guilherme Quinaz Romana
- ACES Lisboa Norte Public Health Unit, Lisbon, Portugal.,Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Susana Cunha Gonçalves
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,ACES Médio Tejo Public Health Unit, Alcanena, Portugal
| | - Mário Rui Salvador
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,ACES Dão Lafões Public Health Unit, Viseu, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
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Robertson L, Ayansina D, Johnston M, Marks A, Black C. Urban-rural and socioeconomic status: Impact on multimorbidity prevalence in hospitalized patients. JOURNAL OF COMORBIDITY 2020; 10:2235042X19893470. [PMID: 32341912 PMCID: PMC7171988 DOI: 10.1177/2235042x19893470] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 11/06/2019] [Indexed: 12/02/2022]
Abstract
OBJECTIVE The aim of this study was to describe multimorbidity prevalence in hospitalized adults, by urban-rural area of residence and socioeconomic status (SES). METHODS Linked hospital episode data were used. Adults (≥18 years) admitted to hospital as an inpatient during 2014 in Grampian, Scotland, were included. Conditions were identified from admissions during the 5 years prior to the first admission in 2014. Multimorbidity was defined as ≥2 conditions and measured using Tonelli et al. based on International Classification of Diseases-10 coding (preselected list of 30 conditions). We used proportions and 95% confidence intervals (CIs) to summarize the prevalence of multimorbidity by age group, sex, urban-rural category and deprivation. The association between multimorbidity and patient characteristics was assessed using the χ 2 test. RESULTS Forty one thousand five hundred and forty-five patients were included (median age 62, 52.6% female). Overall, 27.4% (95% CI 27.0, 27.8) of patients were multimorbid. Multimorbidity prevalence was 28.8% (95% CI 28.1, 29.5) in large urban versus 22.0% (95% CI 20.9, 23.3) in remote rural areas and 28.7% (95% CI 27.2, 30.3) in the most deprived versus 26.0% (95% CI 25.2, 26.9) in the least deprived areas. This effect was consistent in all age groups, but not statistically significant in the age group 18-29 years. Multimorbidity increased with age but was similar for males and females. CONCLUSION Given the scarcity of research into the effect of urban-rural area and SES on multimorbidity prevalence among hospitalized patients, these findings should inform future research into new models of care, including the consideration of urban-rural area and SES.
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Affiliation(s)
- Lynn Robertson
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Dolapo Ayansina
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Marjorie Johnston
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
| | - Angharad Marks
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
- Renal Department, NHS Grampian, Aberdeen, Scotland
| | - Corri Black
- Aberdeen Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
- Health Data Research UK, University of Aberdeen, Aberdeen, Scotland
- Public Health Directorate, NHS Grampian, Aberdeen, Scotland
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Abstract
OBJECTIVE This study aimed to report prevalence and evaluate the association between multimorbidity and associated risk factors in the adult population of Bangladesh. DESIGN A cross-sectional study was conducted using a multistage clustered random sampling strategy. SETTING The study was conducted among the general population of 58 districts in Bangladesh. PARTICIPANTS A total of 12 338 male and female individuals aged ≥35 were included for analysis in this study. Identified through a household listing conducted prior to the study, from 15 297 individuals meeting the inclusion criteria, 12 338 participants were included based on availability during data collection, consent and health condition. OUTCOME MEASURES Multimorbidity in terms of hypertension, diabetes, cancer, cardiovascular diseases, stroke and chronic obstructive pulmonary disease. RESULTS Approximately 8.4% (95% CI 7.0 to 9.7) of individuals suffer from multimorbidity, of which hypertension accounted for (30.1%) followed by diabetes (10.6%). The mean age of the population was 58.6 (SD ±9.2) years. The prevalence of multimorbidity was lower among men (7.7%) compared with women (8.9%). The likelihood of having multimorbidity among obese individuals were more than double than people with normal body mass index (BMI). Physical activity protected individuals from developing multimorbidity: however, the physical activity adjusted OR was 0.5 (95% CI 0.2 to 1.2). After adjusting for all covariates, higher age, higher educational status, economic status, and higher BMI were found to be significantly associated with the odds of developing multimorbidity, with an overall adjusted OR of 0.02 (95% CI 0.01 to 0.02). CONCLUSION This study reported a high prevalence of multimorbidity in Bangladesh, although it explored the burden and identified risk factors considering only six chronic diseases. Further detailed exploration through longitudinal studies considering a wider range of diseases is needed to document the actual burden, develop effective preventive measures and clinical guidelines to improve the quality of life of the population.
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Affiliation(s)
- Nusrat Khan
- Research and Evaluation Division, BRAC, Dhaka, Bangladesh
| | | | - Dipak Mitra
- School of Public Health, North South University, Dhaka, Dhaka District, Bangladesh
| | - Kaosar Afsana
- Health, Nutrition and Population Program, BRAC, Dhaka, Dhaka, Bangladesh
- James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
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Petarli GB, Cattafesta M, Sant’Anna MM, Bezerra OMDPA, Zandonade E, Salaroli LB. Multimorbidity and complex multimorbidity in Brazilian rural workers. PLoS One 2019; 14:e0225416. [PMID: 31743369 PMCID: PMC6863555 DOI: 10.1371/journal.pone.0225416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of multimorbidity and complex multimorbidity in rural workers and their association with sociodemographic characteristics, occupational contact with pesticides, lifestyle and clinical condition. METHODS This is a cross-sectional epidemiological study with 806 farmers from the main agricultural municipality of the state of Espírito Santo/Brazil, conducted from December 2016 to April 2017. Multimorbidity was defined as the presence of two or more chronic diseases in the same individual, while complex multimorbidity was classified as the occurrence of three or more chronic conditions affecting three or more body systems. Socio-demographic data, occupational contact with pesticides, lifestyle data and clinical condition data were collected through a structured questionnaire. Binary logistic regression was conducted to identify risk factors for multimorbidity. RESULTS The prevalence of multimorbidity among farmers was 41.5% (n = 328), and complex multimorbidity was 16.7% (n = 132). More than 77% of farmers had at least one chronic illness. Hypertension, dyslipidemia and depression were the most prevalent morbidities. Being 40 years or older (OR 3.33, 95% CI 2.06-5.39), previous medical diagnosis of pesticide poisoning (OR 1.89, 95% CI 1.03-3.44), high waist circumference (OR 2.82, CI 95% 1.98-4.02) and worse health self-assessment (OR 2.10, 95% CI 1.52-2.91) significantly increased the chances of multimorbidity. The same associations were found for the diagnosis of complex multimorbidity. CONCLUSION We identified a high prevalence of multimorbidity and complex multimorbidity among the evaluated farmers. These results were associated with increased age, abdominal fat, pesticide poisoning, and poor or fair health self-assessment. Public policies are necessary to prevent, control and treat this condition in this population.
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Affiliation(s)
- Glenda Blaser Petarli
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Monica Cattafesta
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Olívia Maria de Paula Alves Bezerra
- Department of Family Medicine, Mental and Collective Health, Medical school, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Eliana Zandonade
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Luciane Bresciani Salaroli
- Postgraduate program in Nutrition and Health, and Graduate Program in Collective Health, Center for Health Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
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Monteiro L, Maricoto T, Solha I, Ribeiro-Vaz I, Martins C, Monteiro-Soares M. Reducing Potentially Inappropriate Prescriptions for Older Patients Using Computerized Decision Support Tools: Systematic Review. J Med Internet Res 2019; 21:e15385. [PMID: 31724956 PMCID: PMC6883366 DOI: 10.2196/15385] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 11/28/2022] Open
Abstract
Background Older adults are more vulnerable to polypharmacy and prescriptions of potentially inappropriate medications. There are several ways to address polypharmacy to prevent its occurrence. We focused on computerized decision support tools. Objective The available literature was reviewed to understand whether computerized decision support tools reduce potentially inappropriate prescriptions or potentially inappropriate medications in older adult patients and affect health outcomes. Methods Our systematic review was conducted by searching the literature in the MEDLINE, CENTRAL, EMBASE, and Web of Science databases for interventional studies published through February 2018 to assess the impact of computerized decision support tools on potentially inappropriate medications and potentially inappropriate prescriptions in people aged 65 years and older. Results A total of 3756 articles were identified, and 16 were included. More than half (n=10) of the studies were randomized controlled trials, one was a crossover study, and five were pre-post intervention studies. A total of 266,562 participants were included; of those, 233,144 participants were included and assessed in randomized controlled trials. Intervention designs had several different features. Computerized decision support tools consistently reduced the number of potentially inappropriate prescriptions started and mean number of potentially inappropriate prescriptions per patient. Computerized decision support tools also increased potentially inappropriate prescriptions discontinuation and drug appropriateness. However, in several studies, statistical significance was not achieved. A meta-analysis was not possible due to the significant heterogeneity among the systems used and the definitions of outcomes. Conclusions Computerized decision support tools may reduce potentially inappropriate prescriptions and potentially inappropriate medications. More randomized controlled trials assessing the impact of computerized decision support tools that could be used both in primary and secondary health care are needed to evaluate the use of medication targets defined by the Beers or STOPP (Screening Tool of Older People’s Prescriptions) criteria, adverse drug reactions, quality of life measurements, patient satisfaction, and professional satisfaction with a reasonable follow-up, which could clarify the clinical usefulness of these tools. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42017067021; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42017067021
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Affiliation(s)
- Luís Monteiro
- Esgueira+ Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal.,Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Tiago Maricoto
- Aveiro-Aradas Family Health Unit, Aveiro Healthcare Centre, Aveiro, Portugal.,Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal
| | - Isabel Solha
- Terras de Souza Family Health Unit, Paredes, Portugal
| | - Inês Ribeiro-Vaz
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Porto Pharmacovigilance Centre, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Carlos Martins
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Matilde Monteiro-Soares
- Center for Health Technology and Services Research, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Porto, Portugal
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Busija L, Lim K, Szoeke C, Sanders KM, McCabe MP. Do replicable profiles of multimorbidity exist? Systematic review and synthesis. Eur J Epidemiol 2019; 34:1025-1053. [PMID: 31624969 DOI: 10.1007/s10654-019-00568-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/09/2019] [Indexed: 12/20/2022]
Abstract
This systematic review aimed to synthesise multimorbidity profiling literature to identify replicable and clinically meaningful groupings of multimorbidity. We searched six electronic databases (Medline, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science) for articles reporting multimorbidity profiles. The identified profiles were synthesised with multidimensional scaling, stratified by type of statistical analysis used in the derivation of profiles. The 51 studies that met inclusion criteria reported results of 98 separate analyses of multimorbidity profiling, with a total of 407 multimorbidity profiles identified. The statistical techniques used to identify multimorbidity profiles were exploratory factor analysis, cluster analysis of diseases, cluster analysis of people, and latent class analysis. Reporting of methodological details of statistical methods was often incomplete. The discernible groupings of multimorbidity took the form of both discrete categories and continuous dimensions. Mental health conditions and cardio-metabolic conditions grouped along identifiable continua in the synthesised results of all four methods. Discrete groupings of chronic obstructive pulmonary disease with asthma, falls and fractures with sensory deficits and of Parkinson's disease and cognitive decline where partially replicable (identifiable in the results of more than one method), while clustering of musculoskeletal conditions and clustering of reproductive systems were each observed only in one statistical approach. The two most replicable multimorbidity profiles were mental health conditions and cardio-metabolic conditions. Further studies are needed to understand aetiology and evolution of these multimorbidity groupings. Guidelines for strengthening the reporting of multimorbidity profiling studies are proposed.
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Affiliation(s)
- Ljoudmila Busija
- Biostatistics Consulting Platform, Research Methodology Division, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Karen Lim
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Cassandra Szoeke
- School of Behavioural and Health Sciences, Faculty of Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Kerrie M Sanders
- Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Marita P McCabe
- Health and Ageing Research Group, Swinburne University of Technology, Hawthorn, Australia
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Pinto DM, Santiago LM, Maurício K, Silva IR. Health profile and medication adherence of diabetic patients in the Portuguese population. Prim Care Diabetes 2019; 13:446-451. [PMID: 30799197 DOI: 10.1016/j.pcd.2019.02.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 12/17/2018] [Accepted: 02/01/2019] [Indexed: 11/20/2022]
Abstract
AIMS To understand the psychological and behavioural impact of type 2 diabetes in the Portuguese Primary Care setting. METHODS Observational, cross-sectional study of a convenience sample of portuguese people diagnosed with type 2 diabetes mellitus. The Diabetes Health Profile (DHP-18) and the Four Item Morisky Medication Adherence Scale (MMAS-4) were applied, as well as socio-demographic and disease-related questions. RESULTS In a n=110 patient sample, lower education level showed a negative impact on the Psychological Distress dimension (p=0,013). In the Barriers to activity dimension, significant differences were found between different age groups (p=0,033) - a better health profile was observed in the 40-59 years group and also between gender (p=0,039) - greater impact in female subjects. Disinhibited Eating dimension wasn't associated with any of the studied variables. However, all the groups showed worse results in this domain. No associations were found between DHP and medication adherence. Worse medication adherence is more common when there is a prevailing notion of lack of control of diabetes. DISCUSSION AND CONCLUSION Using DHP, a larger negative impact related to type 2 diabetes mellitus is found in those with lower educational level, female and younger (20-39 years) or older (60-79 years) subjects. Broader information strategies aimed at improving the quality of life of diabetic patients is necessary, particularly those related to nutrition.
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Affiliation(s)
| | - Luiz Miguel Santiago
- Faculty of Medicine - University of Coimbra, Portugal; General Practice and Family Medicine Clinic of the Faculty of Medicine of the University of Coimbra, Portugal.
| | | | - Inês Rosendo Silva
- Faculty of Medicine - University of Coimbra, Portugal; USF Coimbra Centro, ACES Baixo Mondego, Portugal
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Heleno B, Silvério-Rodrigues D. Multimorbidity and the Challenge to Deliver Personalised and Meaningful Health Care. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2019. [DOI: 10.1159/000502270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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