Journal of multimorbidity and comorbidity最新文献

{"title":"Management of multimorbidity.","authors":"Alessio Bricca, Susan M Smith, Søren T Skou","doi":"10.1177/26335565231156693","DOIUrl":"https://doi.org/10.1177/26335565231156693","url":null,"abstract":"Multimorbidity is a global challenge with substantial impact on individuals, health-care systems, and society. More than 3 out of 4 consultations in primary care involve multimorbidity and the relationship between the number of chronic conditions and their associated cost is almost exponential. Managing multimorbidity is complex, given the need to address management of individual conditions while incorporating patient preferences. A range of management strategies have been evaluated and the current evidence base includes more than 40 trials. Nevertheless, there is still limited high-quality evidence to guide clinical practice (Table 1).This Editorial highlights management approaches that have potential to improve outcomes for patients with multimorbidity.","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231156693"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/a8/cb/10.1177_26335565231156693.PMC9996704.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9487658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of multimorbidity among a community-based cohort in rural India.","authors":"Balaji Gummidi,&nbsp;Vaishali Gautam,&nbsp;Oommen John,&nbsp;Arpita Ghosh,&nbsp;Vivekanand Jha","doi":"10.1177/26335565221149623","DOIUrl":"https://doi.org/10.1177/26335565221149623","url":null,"abstract":"<p><strong>Background: </strong>Multimorbidity estimates are expected to increase in India primarily due to the population aging. However, there is a lack of research estimating the burden of multimorbidity in the Indian context using a validated tool. We estimated the prevalence and determinants of multimorbidity amongst the adult population of the rural Uddanam region, Andhra Pradesh.</p><p><strong>Methods: </strong>This community-based cross-sectional study was conducted as a part of an ongoing research program. Multistage cluster sampling technique was used to select 2419 adult participants from 40 clusters. Multimorbidity was assessed using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool, collecting information on 13 chronic diseases. Patient Health Questionnaire (PHQ-12) was used to screen for depression. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity.</p><p><strong>Results: </strong>Of the 2419 participants, 2289 completed the MAQ-PC tool. Mean age (standard deviation) of participants was 48.1 (13.1) years. The overall prevalence of multimorbidity was 58.5% (95% CI 56.5-60.6); with 30.7%, 15.6%, and 12.2% reporting two, three, and four chronic conditions, respectively. Acid peptic disease-musculoskeletal disease (44%) and acid peptic disease-musculoskeletal disease-hypertension (14.9%) were the most common dyad and triad. Among metabolic diseases, diabetes-hypertension (28.3%) and diabetes-hypertension-chronic kidney disease (7.6%) were the most common dyad and triad, respectively. Advancing age, female gender, and being obese were the strongest determinates of the presence of multimorbidity. Depression was highly prevalent among the study population, and participants with higher PHQ-12 score had 3.7 (2.5-5.4) greater odds of having multimorbidity.</p><p><strong>Conclusions: </strong>Our findings suggest that six of 10 adults in rural India are affected with multimorbidity. We report a higher prevalence of multimorbidity as compared with other studies conducted in India. We also identified vulnerable groups which would guide policy makers in developing holistic care packages for individuals with multimorbidity.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565221149623"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/c0/d6/10.1177_26335565221149623.PMC9832245.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10540971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity prevalence and patterns at the baseline of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil).","authors":"Larissa Pruner Marques,&nbsp;Odaleia Barbosa de Aguiar,&nbsp;Daniela Polessa Paula,&nbsp;Fernanda Esthefane Garrides Oliveira,&nbsp;Dóra Chor,&nbsp;Isabela Benseñor,&nbsp;Antonio Luiz Ribeiro,&nbsp;Andre R Brunoni,&nbsp;Luciana A C Machado,&nbsp;Maria de Jesus Mendes da Fonseca,&nbsp;Rosane Härter Griep","doi":"10.1177/26335565231173845","DOIUrl":"https://doi.org/10.1177/26335565231173845","url":null,"abstract":"<p><strong>Background: </strong>To identify multimorbidity patterns, by sex, according to sociodemographic and lifestyle in ELSA-Brasil.</p><p><strong>Methods: </strong>Cross-sectional study with 14,516 participants from ELSA-Brasil (2008-2010). Fuzzy c-means was used to identify multimorbidity patterns of 2+ chronic morbidities, where the consequent morbidity had to occur in at least 5% of all cases. Association rule (O/E≥1.5) was used to identify co-occurrence of morbidities, in each cluster, by sociodemographic and lifestyle factors.</p><p><strong>Results: </strong>The prevalence of multimorbidity was higher in women (73.7%) compared to men (65.3%). Among women, cluster 1 was characterized by hypertension/diabetes (13.2%); cluster 2 had no overrepresented morbidity; and cluster 3 all participants had kidney disease. Among men, cluster 1 was characterized by cirrhosis/hepatitis/obesity; cluster 2, most combinations included kidney disease/migraine (6.6%); cluster 3, no pattern reached association ratio; cluster 4 predominated co-occurrence of hypertension/rheumatic fever, and hypertension/dyslipidemia; cluster 5 predominated diabetes and obesity, and combinations with hypertension (8.8%); and cluster 6 presented combinations of diabetes/hypertension/heart attack/angina/heart failure. Clusters were characterized by higher prevalence of adults, married and participants with university degrees.</p><p><strong>Conclusion: </strong>Hypertension/diabetes/obesity were highly co-occurred, in both sexes. Yet, for men, morbidities like cirrhosis/hepatitis were commonly clustered with obesity and diabetes; and kidney disease was commonly clustered with migraine and common mental disorders. The study advances in understanding multimorbidity patterns, benefiting simultaneously or gradually prevention of diseases and multidisciplinary care responses.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231173845"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/40/0f/10.1177_26335565231173845.PMC10201182.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10290193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of US Medicare Coverage on Multimorbidity Accumulation Among Patients Seen in Community Health Centers","authors":"Katherine D Peak, Teresa D. Schmidt, Tahlia L. Hodes, Ana R. Quiñones, N. Huguet","doi":"10.1370/afm.21.s1.3975","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3975","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87331191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity in South Africa: Is the health system ready?","authors":"Rifqah Abeeda Roomaney,&nbsp;Brian van Wyk,&nbsp;Victoria Pillay-van Wyk","doi":"10.1177/26335565231182483","DOIUrl":"https://doi.org/10.1177/26335565231182483","url":null,"abstract":"<p><p><b>Background:</b> Multimorbidity is likely to be a significant contributor to ill health and inequality in South Africa and yet has been largely overlooked. <b>Purpose:</b> This paper focuses on the findings of a recent large study that highlighted emerging issues - namely (i) the high levels of multimorbidity among three key groups - older adults, women, and the wealthy; (ii) discordant and concordant disease clusters among the multimorbid. <b>Research Design:</b> Narrative. <b>Study Sample and Data Collection:</b> Not applicable. <b>Results:</b> We discuss the implications of each emerging issue for health systems policy and practice. <b>Conclusion:</b> Although key policies are identified, many of these policies are not implemented and are therefore not part of routine practice, leaving much space for improvement.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231182483"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/74/1c/10.1177_26335565231182483.PMC10278409.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10351479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The association between physical activity, low-grade inflammation, and labour market attachment among people with multimorbidity: A cross-sectional study from the Lolland-Falster Health Study, Denmark.","authors":"Vivian Rueskov Poulsen,&nbsp;Linda Kjær Fischer,&nbsp;Mette Aadahl,&nbsp;Ole Steen Mortensen,&nbsp;Søren T Skou,&nbsp;Lars Bo Jørgensen,&nbsp;Randi Jepsen,&nbsp;Anne Møller,&nbsp;Therese Lockenwitz Petersen,&nbsp;Jan Christian Brønd,&nbsp;Lars Tang,&nbsp;Mette Korshøj","doi":"10.1177/26335565231195510","DOIUrl":"https://doi.org/10.1177/26335565231195510","url":null,"abstract":"<p><strong>Aim: </strong>Evidence suggests low-grade inflammation (LGI) to be associated with multimorbidity. Furthermore, there are links between inflammation markers, physical activity (PA), and labour market participation. The aims of this study were to examine the association between PA and LGI in people with multimorbidity and if this association was moderated by self-reported labour market attachment.</p><p><strong>Methods: </strong>Cross-sectional data were collected in the Lolland-Falster Health Study (LOFUS) from 2016-2020. We included 1,106 participants with multimorbidity and valid accelerometer data. PA was measured as the average counts per minute (CPM) per day during wake time and split in time spent in moderate to vigorous intensity (MVPA) and light intensity (LPA). Degree of inflammation was determined by high sensitive C-reactive protein (hsCRP) level. Associations were investigated using multiple logistic regression analyses, stratified by labour market attachment.</p><p><strong>Results: </strong>The odds of having LGI was higher with lower amount of daily LPA. The highest odds of LGI was observed for CPM < 200 per day (odds ratio (OR) 2.55; 95% confidence interval (CI) 1.46-4.43), MVPA < 15 minutes per day (OR 2.97; 95 % CI 1.56-5.62), and LPA < 90 (OR 2.89; 95 % CI 1.43-5.81) with the reference groups being CPM ≥ 400 per day, MVPA ≥ 30, and LPA ≥ 180 min per day, respectively. We could not preclude an interaction between LPA and labour market attachment (<i>p</i> = 0.109).</p><p><strong>Conclusion: </strong>PA recommendations should be developed with attention to people with chronic diseases, who may experience barriers to reach PA at high intensities. People with no labour market attachment may benefit from primary and secondary prevention of multimorbidity.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231195510"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/8f/28/10.1177_26335565231195510.PMC10447179.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10356826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot, randomized, feasibility study to improve health self-management behaviors in older adults with multiple chronic conditions and functional limitations: Protocol for the Behavioral Activation and Occupational Therapy Trial (BA+OT).","authors":"Tara C Klinedinst,&nbsp;Carrie A Ciro,&nbsp;Darla E Kendzor","doi":"10.1177/26335565231163037","DOIUrl":"https://doi.org/10.1177/26335565231163037","url":null,"abstract":"<p><strong>Background: </strong>Approximately 45% of older adults in the U.S. have 2 or more chronic health conditions (e.g., arthritis, hypertension, diabetes) in addition to functional limitations that prevent performance of health self-management activities. Self-management continues to be the gold standard for managing MCC, but functional limitations create difficulty with these activities (e.g., physical activity, symptom monitoring). Restricted self-management accelerates the downward spiral of disability and accumulating chronic conditions which, in turn, increases rates of institutionalization and death by 5-fold. Currently, there are no tested interventions designed to improve independence in health self-management activities in older adults with MCC and functional limitations. Research suggests that older adults are more likely to change behavior with interventions that assist with planning health-promoting daily activities, especially when contending with complex medical regimens and functional limitations. Our team asserts that combining occupational therapy (OT) and behavioral activation (BA) shows promise to improve health self-management in populations with chronic conditions and/or functional limitations. This innovative combination uses the goal setting, scheduling/monitoring activities, and problem-solving components of the BA approach as well as the environmental modification, activity adaptation, and focus on daily routines from OT practice.</p><p><strong>Objectives: </strong>We will test the effect of this combined approach in a Stage I, randomized controlled pilot feasibility study compared to enhanced usual care. We will recruit 40 older adults with MCC and functional limitation and randomize 20 to the PI- delivered BA-OT protocol. This research will inform modification and larger-scale testing of this novel intervention.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565231163037"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/e0/8e/10.1177_26335565231163037.PMC9998403.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9157258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multimorbidity Burden for Adults Seeking Care in Community Health Centers Living in Different Areas of Social Deprivation","authors":"Katherine D Peak, M. Marino, Steele Valenzuela, Robert W. Voss, Ana R. Quiñones","doi":"10.1370/afm.21.s1.3977","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3977","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85849094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Classification of long-term condition patterns in rheumatoid arthritis and associations with adverse health events: a UK Biobank cohort study.","authors":"Philip McLoone,&nbsp;Bhautesh D Jani,&nbsp;Stefan Siebert,&nbsp;Fraser R Morton,&nbsp;Jordan Canning,&nbsp;Sara Macdonald,&nbsp;Frances S Mair,&nbsp;Barbara I Nicholl","doi":"10.1177/26335565221148616","DOIUrl":"https://doi.org/10.1177/26335565221148616","url":null,"abstract":"<p><strong>Purpose: </strong>We aimed to classify individuals with RA and ≥2 additional long-term conditions (LTCs) and describe the association between different LTC classes, number of LTCs and adverse health outcomes.</p><p><strong>Methods: </strong>We used UK Biobank participants who reported RA (n=5,625) and employed latent class analysis (LCA) to create classes of LTC combinations for those with ≥2 additional LTCs. Cox-proportional hazard and negative binomial regression were used to compare the risk of all-cause mortality, major adverse cardiac events (MACE), and number of emergency hospitalisations over an 11-year follow-up across the different LTC classes and in those with RA plus one additional LTC. Persons with RA without LTCs were the reference group. Analyses were adjusted for demographic characteristics, smoking, BMI, alcohol consumption and physical activity.</p><p><strong>Results: </strong>A total of 2,566 (46%) participants reported ≥2 LTCs in addition to RA. This involved 1,138 distinct LTC combinations of which 86% were reported by ≤2 individuals. LCA identified 5 morbidity-classes. The distinctive condition in the class with the highest mortality was cancer (class 5; HR 2.66 95%CI (1.91-3.70)). The highest MACE (HR 2.95 95%CI (2.11-4.14)) and emergency hospitalisations (rate ratio 3.01 (2.56-3.54)) were observed in class 3 which comprised asthma, COPD & CHD. There was an increase in mortality, MACE and emergency hospital admissions within each class as the number of LTCs increased.</p><p><strong>Conclusions: </strong>The risk of adverse health outcomes in RA varied with different patterns of multimorbidity. The pattern of multimorbidity should be considered in risk assessment and formulating management plans in patients with RA.</p>","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"13 ","pages":"26335565221148616"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9926377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9162051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Baseline Treatment Burden in People Experiencing Homelessness with a Recent Non-Fatal Overdose: Findings from PHOENIx Trial","authors":"Caitlin Jones, Frances S. Mair, Andrea E. Williamson, D. Eton, R. Lowrie, A. McPherson","doi":"10.1370/afm.21.s1.3910","DOIUrl":"https://doi.org/10.1370/afm.21.s1.3910","url":null,"abstract":"","PeriodicalId":73843,"journal":{"name":"Journal of multimorbidity and comorbidity","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79308884","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}