Browsing by Subject "multimorbidity"
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Item Open Access A Systematic Review of Conceptual Frameworks of Medical Complexity and New Model Development.(J Gen Intern Med, 2016-03) Zullig, Leah L; Whitson, Heather E; Hastings, Susan N; Beadles, Chris; Kravchenko, Julia; Akushevich, Igor; Maciejewski, Matthew LBACKGROUND: Patient complexity is often operationalized by counting multiple chronic conditions (MCC) without considering contextual factors that can affect patient risk for adverse outcomes. OBJECTIVE: Our objective was to develop a conceptual model of complexity addressing gaps identified in a review of published conceptual models. DATA SOURCES: We searched for English-language MEDLINE papers published between 1 January 2004 and 16 January 2014. Two reviewers independently evaluated abstracts and all authors contributed to the development of the conceptual model in an iterative process. RESULTS: From 1606 identified abstracts, six conceptual models were selected. One additional model was identified through reference review. Each model had strengths, but several constructs were not fully considered: 1) contextual factors; 2) dynamics of complexity; 3) patients' preferences; 4) acute health shocks; and 5) resilience. Our Cycle of Complexity model illustrates relationships between acute shocks and medical events, healthcare access and utilization, workload and capacity, and patient preferences in the context of interpersonal, organizational, and community factors. CONCLUSIONS/IMPLICATIONS: This model may inform studies on the etiology of and changes in complexity, the relationship between complexity and patient outcomes, and intervention development to improve modifiable elements of complex patients.Item Open Access Association between Road Traffic Injury and Multimorbidity in Brazil-Results from Pesquisa Nacional de Saude(2019) Pokam Tchuisseu, Yolande BertilleBackground: Globally, road traffic injury (RTI) is predicted to become the fifth leading cause of mortality by 2030. In addition to the burden of RTI, multimorbidity (MM) is increasingly becoming a health concern across all age groups. If MM is left unaddressed, individuals suffering from RTI will most likely experience delayed recovery and poorer health outcomes. Thus, there is a need to examines the association between RTI and MM in order to inform post-injury care practices.
Methods: This study is a cross-sectional analysis of the 2013 Brazilian National Health Survey. 60,202 individuals, aged 18 and above, were included in this study. Univariate and bivariate analyses were used to explore the relationship between demographic variables, chronic diseases, MM and RTI. Network analysis was used to identify multimorbidity patterns.
Results: Out of those who had experienced RTI (n=1910), 16.50% have reported having a multimorbid condition. Age, gender, risky alcohol use and regions were key predictors of RTI. Risky alcohol use was one of the direct nodes that connected RTI to other morbidities. Within the road traffic injured population, seven multimorbid communities were identified, with two communities being the most central: the cardio-metabolic morbidities and physical-mental morbidities.
Conclusions: Risky use of alcohol was a key predictor of RTI and a potential mediator in the association between RTI and other morbidities. Given that the temporal association between RTI and MM could not be established in this study, additional studies are needed to further assess the direction of the association between RTI and MM.
Item Open Access Cumulative Human Immunodeficiency Virus (HIV)-1 Viremia Is Associated With Increased Risk of Multimorbidity Among US Women With HIV, 1997-2019.(Open forum infectious diseases, 2023-02) Morton, Zoey P; Christina Mehta, C; Wang, Tingyu; Palella, Frank J; Naggie, Susanna; Golub, Elizabeth T; Anastos, Kathryn; French, Audrey L; Kassaye, Seble; Taylor, Tonya N; Fischl, Margaret A; Adimora, Adaora A; Kempf, Mirjam-Colette; Tien, Phyllis C; Ofotokun, Ighovwerha; Sheth, Anandi N; Collins, Lauren FBackground
To evaluate the effect of cumulative human immunodeficiency virus (HIV)-1 viremia on aging-related multimorbidity among women with HIV (WWH), we analyzed data collected prospectively among women who achieved viral suppression after antiretroviral therapy (ART) initiation (1997-2019).Methods
We included WWH with ≥2 plasma HIV-1 viral loads (VL) <200 copies/mL within a 2-year period (baseline) following self-reported ART use. Primary outcome was multimorbidity (≥2 nonacquired immune deficiency syndrome comorbidities [NACM] of 5 total assessed). The trapezoidal rule calculated viremia copy-years (VCY) as area-under-the-VL-curve. Cox proportional hazard models estimated the association of time-updated cumulative VCY with incident multimorbidity and with incidence of each NACM, adjusting for important covariates (eg, age, CD4 count, etc).Results
Eight hundred six WWH contributed 6368 women-years, with median 12 (Q1-Q3, 7-23) VL per participant. At baseline, median age was 39 years, 56% were Black, and median CD4 was 534 cells/mm3. Median time-updated cumulative VCY was 5.4 (Q1-Q3, 4.7-6.9) log10 copy-years/mL. Of 211 (26%) WWH who developed multimorbidity, 162 (77%) had incident hypertension, 133 (63%) had dyslipidemia, 60 (28%) had diabetes, 52 (25%) had cardiovascular disease, and 32 (15%) had kidney disease. Compared with WWH who had time-updated cumulative VCY <5 log10, the adjusted hazard ratio of multimorbidity was 1.99 (95% confidence interval [CI], 1.29-3.08) and 3.78 (95% CI, 2.17-6.58) for those with VCY 5-6.9 and ≥7 log10 copy-years/mL, respectively (P < .0001). Higher time-updated cumulative VCY increased the risk of each NACM.Conclusions
Among ART-treated WWH, greater cumulative viremia increased the risk of multimorbidity and of developing each NACM, and hence this may be a prognostically useful biomarker for NACM risk assessment in this population.