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1.
Age Ageing ; 51(5)2022 05 01.
Article in English | MEDLINE | ID: covidwho-2151828

ABSTRACT

Randomised controlled trials (RCTs) usually provide the best evidence for treatments and management. Historically, older people have often been excluded from clinical medication trials due to age, multimorbidity and disabilities. The situation is improving, but still the external validity of many trials may be questioned. Individuals participating in trials are generally less complex than many patients seen in geriatric clinics. Recruitment and retention of older participants are particular challenges in clinical trials. Multiple channels are needed for successful recruitment, and especially individuals experiencing frailty, multimorbidity and disabilities require support to participate. Cognitive decline is common, and often proxies are needed to sign informed consent forms. Older people may fall ill or become tired during the trial, and therefore, special support and empathic study personnel are necessary for the successful retention of participants. Besides the risk of participants dropping out, several other pitfalls may result in underestimating or overestimating the intervention effects. In nonpharmacological trials, imperfect blinding is often unavoidable. Interventions must be designed intensively and be long enough to reveal differences between the intervention and control groups, as control participants must still receive the best normal care available. Outcome measures should be relevant to older people, sensitive to change and targeted to the specific population in the trial. Missing values in measurements are common and should be accounted for when designing the trial. Despite the obstacles, RCTs in geriatrics must be promoted. Reliable evidence is needed for the successful treatment, management and care of older people.


Subject(s)
Clinical Trials as Topic , Multimorbidity , Aged , Humans
2.
BMJ Open ; 12(11): e063573, 2022 11 22.
Article in English | MEDLINE | ID: covidwho-2137753

ABSTRACT

INTRODUCTION: There is growing evidence that the impact of COVID-19 crisis may be stronger for individuals with multimorbidity, frailty and lower socioeconomic status. Existing reviews focus on few, mainly short-term effects of COVID-19 illness and patients with single chronic disease. Information is also largely missing for population representative samples.Applying population-based approach, the systematic reviews will have two objectives: (1) to evaluate the aetiological roles of frailty, multimorbidity and socioeconomic status on SARS-CoV-2 infection probability, hospitalisation, intensive care unit (ICU) admission, mechanical ventilation and COVID-19 related mortality among general population and (2) to investigate the prognostic roles of frailty, multimorbidity and socioeconomic characteristics on the risk of hospitalisation, ICU admission, mechanical ventilation, COVID-19 mortality, functioning, quality of life, disability, mental health and work absence. METHODS AND ANALYSIS: For this ongoing work, four databases were searched: PubMed, Embase, WHO COVID-19 Global literature on coronavirus disease and PsycINFO, for the period between January 2020 and April 7 2021. Peer-reviewed published literature in English and all types of population-based studies will be considered. Studies using standard tools to assess multimorbidity such as disease count, comorbidity indices or disease combinations will be retained, as well as studies with standard scales and scores for frailty or measurement of a socioeconomic gradient. Initial search included 10 139 articles, 411 for full-text reading. Results will be summarised by risk factor, objective and outcome. The feasibility of meta-analysis will be determined by the findings and will aim to better understand uncertainties of the results. Quality of studies will be assessed using standardised scales. ETHICS AND DISSEMINATION: The study will be based on published evidence, and it is exempt from the ethical approval. This work is part of the Population Health Information Research Infrastructure (PHIRI) project. Dissemination of the results will imply conference presentation, submission for scientific publication and PHIRI project report. PROSPERO REGISTRATION NUMBER: CRD42021249444.


Subject(s)
COVID-19 , Frailty , Humans , Frailty/epidemiology , Multimorbidity , SARS-CoV-2 , Prognosis , COVID-19/epidemiology , Quality of Life , Systematic Reviews as Topic , Socioeconomic Factors , Meta-Analysis as Topic
3.
Sci Rep ; 12(1): 17313, 2022 Oct 15.
Article in English | MEDLINE | ID: covidwho-2077092

ABSTRACT

We investigated the association between a wide range of comorbidities and COVID-19 in-hospital mortality and assessed the influence of multi morbidity on the risk of COVID-19-related death using a large, regional cohort of 6036 hospitalized patients. This retrospective cohort study was conducted using Patient Administration System Admissions and Discharges data. The International Classification of Diseases 10th edition (ICD-10) diagnosis codes were used to identify common comorbidities and the outcome measure. Individuals with lymphoma (odds ratio [OR], 2.78;95% CI,1.64-4.74), metastatic cancer (OR, 2.17; 95% CI,1.25-3.77), solid tumour without metastasis (OR, 1.67; 95% CI,1.16-2.41), liver disease (OR: 2.50, 95% CI,1.53-4.07), congestive heart failure (OR, 1.69; 95% CI,1.32-2.15), chronic obstructive pulmonary disease (OR, 1.43; 95% CI,1.18-1.72), obesity (OR, 5.28; 95% CI,2.92-9.52), renal disease (OR, 1.81; 95% CI,1.51-2.19), and dementia (OR, 1.44; 95% CI,1.17-1.76) were at increased risk of COVID-19 mortality. Asthma was associated with a lower risk of death compared to non-asthma controls (OR, 0.60; 95% CI,0.42-0.86). Individuals with two (OR, 1.79; 95% CI, 1.47-2.20; P < 0.001), and three or more comorbidities (OR, 1.80; 95% CI, 1.43-2.27; P < 0.001) were at increasingly higher risk of death when compared to those with no underlying conditions. Furthermore, multi morbidity patterns were analysed by identifying clusters of conditions in hospitalised COVID-19 patients using k-mode clustering, an unsupervised machine learning technique. Six patient clusters were identified, with recognisable co-occurrences of COVID-19 with different combinations of diseases, namely, cardiovascular (100%) and renal (15.6%) diseases in patient Cluster 1; mental and neurological disorders (100%) with metabolic and endocrine diseases (19.3%) in patient Cluster 2; respiratory (100%) and cardiovascular (15.0%) diseases in patient Cluster 3, cancer (5.9%) with genitourinary (9.0%) as well as metabolic and endocrine diseases (9.6%) in patient Cluster 4; metabolic and endocrine diseases (100%) and cardiovascular diseases (69.1%) in patient Cluster 5; mental and neurological disorders (100%) with cardiovascular diseases (100%) in patient Cluster 6. The highest mortality of 29.4% was reported in Cluster 6.


Subject(s)
Asthma , COVID-19 , Cardiovascular Diseases , Neoplasms , Asthma/epidemiology , COVID-19/epidemiology , Comorbidity , Hospital Mortality , Humans , Multimorbidity , Neoplasms/epidemiology , Preexisting Condition Coverage , Retrospective Studies
4.
Int J Environ Res Public Health ; 19(20)2022 Oct 13.
Article in English | MEDLINE | ID: covidwho-2071433

ABSTRACT

Economic burden issues in SARS-CoV-2 patients with underlying co-morbidities are enormous resources for patient treatment and management. The uncertainty costs for clinical management render the healthcare system catatonic and incurs deficits in national annual budgets. This article focuses on systematic steps towards selecting and evaluating literature to uncover gaps and ways to help healthcare stakeholders optimize resources in treating and managing COVID-19 patients with multi-morbidity. A systematic review of all COVID-19 treatment procedures with co-morbidities or multi-morbidity for the period from 2019 to 2022 was conducted. The search includes studies describing treatment costs associated with multi- or co-morbidity cases for infected patients and, if concurrently reported, determining recurring expenses. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Galbraith plots and I2 statistics will be deployed to assess heterogeneity and to identify potential sources. A backward elimination process will be applied in the regression modelling procedure. Based on the number of studies retrieved and their sample size, the subgroup analysis will be stratified on participant disease category, associated total costs, and degree of freedom in cost estimation. These studies were registered in the PROSPERO registry (ID: CRD42022323071).


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , COVID-19/epidemiology , Financial Stress , Multimorbidity , Morbidity , Systematic Reviews as Topic
5.
BMC Public Health ; 22(1): 1597, 2022 08 22.
Article in English | MEDLINE | ID: covidwho-2002157

ABSTRACT

BACKGROUND: Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases and multi-morbidity, yet face significant barriers in accessing healthcare services. These health inequalities were further aggravated during the COVID-19 pandemic. While there is a lack of comprehensive health data on PEH, even less is known about populations experiencing housing exclusion, a hidden form of homelessness. This study examines and compares chronic diseases and multi-morbidity in PEH, persons experiencing housing exclusion, and persons with secure housing who lacked access to regular healthcare services in the wake of the COVID-19 pandemic in Germany. METHODS: Study participants were adults who sought medical care at clinics of the humanitarian organisation "Ärzte der Welt" in Munich, Hamburg and Berlin in 2020. The patients were categorised into three housing groups according to the ETHOS classification of homelessness and housing exclusion. Socio-demographic characteristics, self-rated health, chronic diseases and multi-morbidity were described in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity in each housing group. RESULTS: Of the 695 study participants, 333 experienced homelessness, 292 experienced housing exclusion and 70 had secure housing. 92.3% of all patients had either no or limited health coverage, and 96.7% were below the poverty line. Males and EU/EEA citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and a higher prevalence of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, belonging to the age group 35-49 and ≥ 50 years were associated with greater odds of chronic disease (AOR = 2.33, 95% CI = 1.68-3.24; AOR = 3.57, 95% CI = 2.55-5.01, respectively) while being ≥ 50 years old was associated with multi-morbidity (AOR = 2.01, 95% CI = 1.21, 3.33). Of the 18 participants tested for SARS-COV-2, 15 were PEH, 1 of whom tested positive. CONCLUSIONS: Housing status was not an independent risk factor for chronic disease and multi-morbidity in our study population. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to healthcare services amongst persons experiencing homelessness and housing exclusion are needed in Germany.


Subject(s)
COVID-19 , Homeless Persons , Adult , COVID-19/epidemiology , Chronic Disease , Cross-Sectional Studies , Homeless Persons/psychology , Housing , Humans , Male , Middle Aged , Multimorbidity , Pandemics , SARS-CoV-2
6.
Nat Rev Dis Primers ; 8(1): 48, 2022 07 14.
Article in English | MEDLINE | ID: covidwho-1947361

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.


Subject(s)
Multimorbidity , Quality of Life , Humans
7.
Med J Aust ; 216 Suppl 10: S19-S21, 2022 06 06.
Article in English | MEDLINE | ID: covidwho-1918034

ABSTRACT

Australia's primary health care system works well for most Australians, but 20% of people live with multimorbidity, often receiving fragmented care in a complex system. Australia's 10-year plan for primary health care recognises that person-centred care is essential to securing universal health coverage, improving health outcomes and achieving an integrated sustainable health system. The Health Care Homes trial tested a new model of person-centred care for people with chronic and complex health conditions. This model demonstrated that change can be achieved with dedicated transformational support and highlighted the importance of enablers and reform streams that are now established in the 10-year plan.


Subject(s)
Delivery of Health Care , Multimorbidity , Australia , Health Facilities , Humans
8.
J Affect Disord ; 314: 86-93, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-1914536

ABSTRACT

Multimorbidity is a global health issue impacting the quality of life of all ages. Multimorbidity with a mental disorder is little studied and is likely to have been affected by the COVID-19 pandemic. We used a survey of 14,007 respondents living in Brazil to investigate whether people who already had at least one chronic medical condition had more depression and anxiety symptoms during social distancing in 2020. Generalized linear models and structural equation modelling were used to estimate the effects. A 19 % and 15 % increase in depressive symptoms were found in females and males, respectively, for each unit of increase in the observed value of reported chronic disease. Older subjects presented fewer symptoms of depression and anxiety. There was a 16 % increase in anxiety symptoms in females for each unit increase in the reported chronic disease variable and a 14 % increase in males. Younger subjects were more affected by anxiety symptoms in a dose-response fashion. High income was significantly related to fewer depressive and anxiety symptoms in both males and females. Physical activity was significantly associated with fewer anxiety and depression symptoms. Structural equation modelling confirmed these results and provided further insight into the hypothesised paths.


Subject(s)
COVID-19 , Anxiety/diagnosis , Anxiety/epidemiology , Brazil/epidemiology , COVID-19/epidemiology , Chronic Disease , Depression/diagnosis , Depression/epidemiology , Female , Humans , Male , Multimorbidity , Pandemics , Quality of Life
9.
PLoS One ; 17(5): e0268068, 2022.
Article in English | MEDLINE | ID: covidwho-1910630

ABSTRACT

BACKGROUND: The COVID-19 pandemic has increased mental stress among the population and, at the same time, has lowered consumer income. Alcohol, non-alcoholic beverages, and tobacco consumption are associated with multiple health conditions but the information on how the consumption pattern of these goods shifted during the pandemic remains limited. OBJECTIVE: To examine the consumer spending on alcohol, non-alcoholic beverages, and tobacco products during the COVID-19 pandemic compared to the pre-pandemic period. DESIGN: An observational study utilizing the expenditures data on alcohol, non-alcoholic beverages, and tobacco between 2017 and 2020 obtained from the US Consumer Expenditure Diary Survey. PARTICIPANTS: 18,808 respondents aged ≥ 21 years who answered the Consumer Expenditure Diary Survey. Main Outcome Measure(s): Bi-weekly expenditure on alcohol, non-alcoholic beverages, and tobacco products. ANALYSIS: Multivariable linear regression models. RESULTS: A total of 18,808 respondents (mean [SD] age = 52.5[16.9] years; 53.8% females) were included. Compared to the pre-pandemic levels, household expenditures on alcohol, non-alcoholic beverages, and tobacco products significantly decreased during the pandemic period by 28.6%, 7.9%, and 15.5%, respectively, after controlling for the state-, individual-, and household-level characteristics. Individual age, race/ethnicity, income, and education were significant predictors of spending. Heterogeneities in expenditures were evident across subgroups, with less educated and low-income households cutting their alcohol expenses while the wealthy and more educated consumers spent more during the pandemic. CONCLUSIONS AND IMPLICATIONS: Household expenditures on alcohol, non-alcoholic beverages, and tobacco products significantly decreased. The results might be beneficial in understanding consumer spending habits concerning risky health behaviors during the period of economic disruption.


Subject(s)
COVID-19 , Tobacco Products , Alcohol Drinking/epidemiology , Alcoholic Beverages , COVID-19/epidemiology , Cross-Sectional Studies , Female , Health Expenditures , Health Risk Behaviors , Humans , Male , Multimorbidity , Pandemics
10.
Soc Psychiatry Psychiatr Epidemiol ; 57(12): 2511-2521, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-1899116

ABSTRACT

PURPOSE: The COVID-19 pandemic may have exacerbated ethnic health inequalities, particularly in people with multiple long-term health conditions, the interplay with mental health is unclear. This study investigates the impact of the pandemic on the association of ethnicity and multimorbidity with mortality/service use among adults, in people living with severe mental illnesses (SMI). METHODS: This study will utilise secondary mental healthcare records via the Clinical Record Interactive Search (CRIS) and nationally representative primary care records through the Clinical Practice Interactive Research Database (CPRD). Quasi-experimental designs will be employed to quantify the impact of COVID-19 on mental health service use and excess mortality by ethnicity, in people living with severe mental health conditions. Up to 50 qualitative interviews will also be conducted, co-produced with peer researchers; findings will be synthesised with quantitative insights to provide in-depth understanding of observed associations. RESULTS: 81,483 people in CRIS with schizophrenia spectrum, bipolar or affective disorder diagnoses, were alive from 1st January 2019. Psychiatric multimorbidities in the CRIS sample were comorbid somatoform disorders (30%), substance use disorders (14%) and personality disorders (12%). In CPRD, of 678,842 individuals with a prior probable diagnosis of COVID-19, 1.1% (N = 7493) had an SMI diagnosis. People in the SMI group were more likely to die (9% versus 2% in the non-SMI sample) and were more likely to have mental and physical multimorbidities. CONCLUSION: The effect of COVID-19 on people from minority ethnic backgrounds with SMI and multimorbidities remains under-studied. The present mixed methods study aims to address this gap.


Subject(s)
COVID-19 , Mental Disorders , Adult , Humans , Mental Health , Ethnicity , Multimorbidity , Pandemics , Mental Disorders/psychology
11.
Expert Rev Cardiovasc Ther ; 20(1): 13-34, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1852794

ABSTRACT

INTRODUCTION: Growth of the older adult demographic has resulted in an increased number of older patients with cardiovascular disease (CVD) in combination with comorbid diseases and geriatric syndromes. Cardiac rehabilitation (CR) is utilized to promote recovery and improve outcomes, but remains underutilized, particularly by older adults. CR provides an opportunity to address the distinctive needs of older adults, with focus on CVD as well as geriatric domains that often dominate management and outcomes. AREAS COVERED: Utility of CR for CVD in older adults as well as pertinent geriatric syndromes (e.g. multimorbidity, frailty, polypharmacy, cognitive decline, psychosocial stress, and diminished function) that affect CVD management. EXPERT OPINION: Mounting data substantiate the importance of CR as part of recovery for older adults with CVD. The application of CR as a standard therapy is especially important as the combination of CVD and geriatric syndromes catalyzes functional decline and can trigger progressive clinical deterioration and dependency. While benefits of CR for older adults with CVD are already evident, further reengineering of CR is necessary to better address the needs of older candidates who may be frail, especially as remote and hybrid formats of CR are becoming more widespread.


Subject(s)
Cardiac Rehabilitation , Cardiovascular Diseases , Frailty , Aged , Cardiovascular Diseases/epidemiology , Frail Elderly , Humans , Multimorbidity
12.
Sao Paulo Med J ; 140(3): 447-453, 2022.
Article in English | MEDLINE | ID: covidwho-1833819

ABSTRACT

BACKGROUND: Due to the coronavirus disease 2019 (COVID-19) pandemic, access to healthcare services may have become difficult, which may have led to an increase in chronic diseases and multimorbidity. OBJECTIVES: To assess the incidence of multimorbidity and its associated factors among adults living in the state of Rio Grande do Sul, Brazil. DESIGN AND SETTING: Cohort study conducted in Rio Grande do Sul, Brazil. METHODS: We included data from the two waves of the Prospective Study About Mental and Physical Health (PAMPA). Data were collected via online questionnaires between June and July 2020 (wave 1) and between December 2020 and January 2021 (wave 2). Multimorbidity was defined as the presence of two or more diagnosed medical conditions. RESULTS: In total, 516 individuals were included, among whom 27.1% (95% confidence interval, CI: 23.5-31.1) developed multimorbidity from wave 1 to 2. In adjusted regression models, female sex (hazard ratio, HR: 1.97; 95% CI: 1.19-3.24), middle-aged adults (31-59 years) (HR: 1.78; 95% CI: 1.18-2.70) and older adults (60 or over) (HR: 2.41; 95% CI: 1.25-4.61) showed higher risk of multimorbidity. Back pain (19.4%), high cholesterol (13.3%) and depression (12.2%) were the medical conditions with the highest proportions reported by the participants during wave 2. CONCLUSION: The incidence of multimorbidity during a six-month period during the COVID-19 pandemic was 27.1% in the state of Rio Grande do Sul, Brazil.


Subject(s)
COVID-19 , Pandemics , Aged , Brazil/epidemiology , COVID-19/epidemiology , Cohort Studies , Female , Humans , Incidence , Middle Aged , Multimorbidity , Prospective Studies
13.
PLoS One ; 17(3): e0265737, 2022.
Article in English | MEDLINE | ID: covidwho-1775447

ABSTRACT

BACKGROUND: Participation in American-style football (ASF), one of the most popular sports worldwide, has been associated with adverse health outcomes. However, prior clinical studies of former ASF players have been limited by reliance on subjective self-reported data, inadequate sample size, or focus on a single disease process in isolation. OBJECTIVE: To determine the burden of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players. METHODS: The In-Person Assessment is a case-control, multi-day, deep human phenotyping protocol designed to characterize and quantify pathology among former professional ASF players. Participants, recruited from an on-going large-scale longitudinal cohort study, will include 120 men who report either no health conditions, a single health condition, or multiple health conditions across the key domains of cardiometabolic disease, disordered sleep, chronic pain, and cognitive impairment. Data will be collected from validated questionnaires, structured interviews, physical examinations, multi-modality imaging, and functional assessments over a 3-day study period. A pilot study was conducted to assess feasibility and to obtain participant feedback which was used to shape the final protocol. RESULTS: This study provides a comprehensive assessment of objective multi-system pathology and its relationship with subjective health complaints among former professional ASF players. CONCLUSION: The study will determine whether subjective health complaints among former professional ASF players are explained by objective explanatory pathology and will provide novel opportunities to examine the interrelatedness of co-morbidities. It is anticipated that this protocol will be applicable to other clinical and occupational populations.


Subject(s)
Football , Athletes , Cross-Sectional Studies , Humans , Longitudinal Studies , Male , Multimorbidity , Pilot Projects , United States
14.
PLoS One ; 17(3): e0265091, 2022.
Article in English | MEDLINE | ID: covidwho-1753194

ABSTRACT

The COVID-19 pandemic has abruptly changed care priority and delivery, delaying others like the multimorbidity approach. The Centro de Innovación en Salud ANCORA UC, the Health National Fund, and the Servicio de Salud Metropolitano Sur Oriente implemented a Multimorbidity Patient-Centered Care Model as a pilot study in the public health network from 2017 to 2020. Its objective was to reorganize the single diagnosis standard care into a new one based on multimorbidity integrated care. It included incorporating new roles, services, and activities according to each patient's risk stratification. This study aims to describe the perception of the health care teams regarding the impact of the COVID-19 pandemic on four main topics: how the COVID-19 pandemic affected the MCPM implementation, how participants adapted it, lessons learned, and recommendations for sustainability. We conducted a qualitative study with 35 semi-structured interviews between October and December 2020. Data analysis was codified, triangulated, and consolidated using MAXQDA 2020. Results showed that the pandemic paused the total of the implementation practically. Positive effects were the improvement of remote health care services, the activation of self-management, and the cohesion of the teamwork. In contrast, frequent abrupt changes and reorganization forced by pandemic evolution were negative effects. This study revealed the magnitude of the pandemic in the cancelation of health services and identified the urgent need to restart chronic services incorporating patient-centered care in our system.


Subject(s)
COVID-19/epidemiology , Patient-Centered Care/methods , Female , Health Personnel , Humans , Male , Multimorbidity , Pilot Projects , Qualitative Research , Self Care
15.
Cien Saude Colet ; 25(suppl 1): 2457-2460, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-1725049

ABSTRACT

Mental disorders (MD) are commonly comorbid with cardiovascular, metabolic, and some infectious diseases. Since the current SARS-CoV-2 epidemic is affecting the most multimorbid individuals, we might expect that the epidemic will be particularly problematic for people with MD. Understanding the burden of an outbreak on mental health is fundamental to effective action towards containing the spread of the disease, as psychopathology might reduce endurance during the lockdown. This can potentially reduce adhesion to ongoing treatment resulting in avoidable recurrence of a disorder. Additionally, there is the stress caused by the eminent risk of infection or economic uncertainty, especially in low-middle income settings. This is an overview on the expected influence of the COVID-19 on mental health from a research group that has not long ago been involved in the Zika epidemic. It aims to discuss the effects of the pandemic on a Low and Middle-Income country (LMIC), Brazil.


Subject(s)
Betacoronavirus , Coronavirus Infections/epidemiology , Coronavirus Infections/psychology , Developing Countries , Mental Health , Pandemics , Pneumonia, Viral/epidemiology , Pneumonia, Viral/psychology , Bipolar Disorder/psychology , Bipolar Disorder/therapy , Brazil , COVID-19 , Caregivers , Dementia/nursing , Family , Health Services Accessibility , Humans , Mental Disorders/drug therapy , Mental Disorders/epidemiology , Mental Disorders/psychology , Multimorbidity , SARS-CoV-2 , Sensation , Social Isolation
16.
Sci Rep ; 12(1): 2831, 2022 02 18.
Article in English | MEDLINE | ID: covidwho-1708164

ABSTRACT

A major risk factor of COVID-19 severity is the patient's health status at the time of the infection. Numerous studies focused on specific chronic diseases and identified conditions, mainly cardiovascular ones, associated with poor prognosis. However, chronic diseases tend to cluster into patterns, each with its particular repercussions on the clinical outcome of infected patients. Network analysis in our population revealed that not all cardiovascular patterns have the same risk of COVID-19 hospitalization or mortality and that this risk depends on the pattern of multimorbidity, besides age and sex. We evidenced that negative outcomes were strongly related to patterns in which diabetes and obesity stood out in older women and men, respectively. In younger adults, anxiety was another disease that increased the risk of severity, most notably when combined with menstrual disorders in women or atopic dermatitis in men. These results have relevant implications for organizational, preventive, and clinical actions to help meet the needs of COVID-19 patients.


Subject(s)
COVID-19/epidemiology , Multimorbidity , Adolescent , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Spain/epidemiology , Young Adult
17.
BMJ Open ; 12(2): e055264, 2022 02 23.
Article in English | MEDLINE | ID: covidwho-1704088

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.


Subject(s)
Multimorbidity , Research Design , Humans , Socioeconomic Factors
18.
BMC Geriatr ; 22(1): 92, 2022 02 02.
Article in English | MEDLINE | ID: covidwho-1690967

ABSTRACT

BACKGROUND: The Coronavirus Disease-2019 (COVID-19) pandemic has created a spectrum of adversities that have affected older adults disproportionately. This paper examines older adults with multimorbidity using longitudinal data to ascertain why some of these vulnerable individuals coped with pandemic-induced risk and stressors better than others - termed multimorbidity resilience. We investigate pre-pandemic levels of functional, social and psychological forms of resilience among this sub-population of at-risk individuals on two outcomes - self-reported comprehensive pandemic impact and personal worry. METHODS: This study was conducted using Follow-up 1 data from the Canadian Longitudinal Study on Aging (CLSA), and the Baseline and Exit COVID-19 study, conducted between April and December in 2020. A final sub-group of 9211 older adults with two or more chronic health conditions were selected for analyses. Logistic regression and Generalized Linear Mixed Models were employed to test hypotheses between a multimorbidity resilience index and its three sub-indices measured using pre-pandemic Follow-up 1 data and the outcomes, including covariates. RESULTS: The multimorbidity resilience index was inversely associated with pandemic comprehensive impact at both COVID-19 Baseline wave (OR = 0.83, p < 0.001, 95% CI: [0.80,0.86]), and Exit wave (OR = 0.84, p < 0.001, 95% CI: [0.81,0.87]); and for personal worry at Exit (OR = 0.89, p < 0.001, 95% CI: [0.86,0.93]), in the final models with all covariates. The full index was also associated with comprehensive impact between the COVID waves (estimate = - 0.19, p < 0.001, 95% CI: [- 0.22, - 0.16]). Only the psychological resilience sub-index was inversely associated with comprehensive impact at both Baseline (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]) and Exit waves (OR = 0.89, p < 0.001, 95% CI: [0.87,0.91]), in the final model; and between these COVID waves (estimate = - 0.11, p < 0.001, 95% CI: [- 0.13, - 0.10]). The social resilience sub-index exhibited a weak positive association (OR = 1.04, p < 0.05, 95% CI: [1.01,1.07]) with personal worry, and the functional resilience measure was not associated with either outcome. CONCLUSIONS: The findings show that psychological resilience is most pronounced in protecting against pandemic comprehensive impact and personal worry. In addition, several covariates were also associated with the outcomes. The findings are discussed in terms of developing or retrofitting innovative approaches to proactive coping among multimorbid older adults during both pre-pandemic and peri-pandemic periods.


Subject(s)
COVID-19 , Pandemics , Aged , Aging , Canada/epidemiology , Humans , Longitudinal Studies , Multimorbidity , SARS-CoV-2 , Self Report
19.
Eur J Clin Invest ; 52(5): e13760, 2022 May.
Article in English | MEDLINE | ID: covidwho-1685286

ABSTRACT

BACKGROUND: With the spread of COVID-19 pandemic, there have been reports on its impact on incident myocardial infarction (MI) emanating from studies with small to modest sample sizes. We therefore examined the incidence of MI in a very large population health cohort with COVID-19 using a methodology which integrates the dynamicity of prior comorbid history. We used two approaches, i.e. main effect modelling and a machine learning (ML) methodology, accounting for the complex dynamic relationships among comorbidity and other variables. METHODS: We studied a very large prospective 18-90-year US population, including 4,289,481 patients from medical databases in a 12-month investigation of those with/without newly incident COVID-19 cases together with a 2-year comorbid profile in the baseline period. Incident MI outcomes were examined in relationship to diverse multimorbid conditions, COVID-19 status and demographic variables-with ML accounting for the dynamic nature of changing multimorbidity risk factors. RESULTS: Multimorbidity, defined as a composite of cardiometabolic/noncardiometabolic comorbid profile, significantly contributed to the onset of confirmed COVID-19 cases. Furthermore, a main effect model (C-index value 0.932; 95%CI 0.930-0.934) had medium to large effect sizes with incident MI outcomes in a COVID-19 cohort for the classic multimorbid conditions in medical history profile which includes prior coronary artery disease (OR 4.61 95%CI 4.49-4.73); hypertension (OR 3.55 95%CI 3.55-3.83); congestive heart failure (2.31 95%CI 2.24-2.37); valvular disease (1.43 95%CI 1.39-1.47); stroke (1.30 95%CI 1.26-1.34); and diabetes (1.26 95%CI 1.23-1.34). COVID-19 status (1.86 95%CI 1.79-1.93) contributed an independent large size risk effect for incident MI. The ML algorithm demonstrated better discriminatory validity than the main effect model (training: C-index 0.949, 95%CI 0.948-0.95; validation: C-index 0.949, 95%CI 0.948-0.95). Calibration of the ML-based formulation was satisfactory and better than the main effect model. Decision curve analysis demonstrated that the ML clinical utility was better than the 'treat all' strategy and the main effect model. The ML logistic regression model was better than the neural network algorithm. CONCLUSION: The very large investigation conducted herein confirmed the importance of cardiometabolic and noncardiometabolic multimorbidity in increasing vulnerabilities to a higher risk of COVID-19 infections. Furthermore, the presence of COVID-19 infections increased incident MI complications both in terms of independent effects and interactions with the multimorbid profile and age.


Subject(s)
COVID-19 , Myocardial Infarction , COVID-19/epidemiology , Humans , Incidence , Multimorbidity , Myocardial Infarction/epidemiology , Pandemics , Prospective Studies , Risk Factors
20.
Psychiatry Res ; 309: 114427, 2022 03.
Article in English | MEDLINE | ID: covidwho-1655051

ABSTRACT

The COVID-19 pandemic hit individuals with chronic conditions the hardest. It is known that anxiety symptoms are frequent in post-COVID conditions. We want to examine whether multimorbidity is associated with anxiety in post-COVID patients. We reported descriptive statistics from 389 post-COVID patients and perform a linear regression with anxiety symptoms measured using the Hospital Anxiety and Depression (HAD) scale. For each extra chronic condition, there was a mean increase of 0.11 in the HAD-anxiety score. However, there was a reduction for age and being male. These findings can potentially help policy-makers better organize post-COVID health services and improve patients care.


Subject(s)
COVID-19 , Pandemics , Anxiety/diagnosis , Anxiety/epidemiology , Depression/diagnosis , Humans , Male , Multimorbidity , SARS-CoV-2
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