How does Multimorbidity affect Middle-Aged Adults? A Cross-Sectional Survey in the Singapore Primary Healthcare Setting.

Abstract Background Multimorbidity is of increasing prevalence and importance. It has been associated with poorer health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity at midlife, defined as those between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore. Methods A cross-sectional study involving 40-64 year old participants was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol 5 dimensions 3-levels questionnaire (EQ5D-3L). The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses. Results The study included 297 participants, aged 40-64 years, of which 124 (42.7%) had multimorbidity. Participants with multimorbidity had lower mean EQ5D Utilities Index (UI) and mean Visual Analogue Scale (VAS) scores (UI = 0.804 ±0.251, VAS = 64.9 ±16.8) compared to those without multimorbidity (UI = 0.871 ±0.198, VAS = 68.5 ±16.0). After adjusting for sociodemographic factors, those with multimorbidity had significantly lower EQ5D UI, (β-coefficient = -0.064 (C.I -0.125, -0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient = -0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort. Conclusion Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population.

Download Full-text

How does Multimorbidity affect Middle-Aged Adults? A Cross-Sectional Survey in the Singapore Primary Healthcare Setting.

10.21203/rs.2.24538/v3 ◽

2020 ◽

Author(s):

Sai Zhen - Sim ◽

Hui Li Koh ◽

Sabrina Poay Sian Lee ◽

Doris Yee Ling Young ◽

Eng Sing Lee

Keyword(s):

Primary Care ◽

Chronic Conditions ◽

Healthcare Setting ◽

The Elderly ◽

Sociodemographic Factors ◽

Health State ◽

Middle Aged ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Impact

Abstract Background: Multimorbidity is of increasing prevalence and importance. It has been negatively associated with health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity for the middle-aged population, defined as those between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore.Methods: A cross-sectional study was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol five dimensions 3-levels questionnaire (EQ5D). We defined multimorbidity as the presence of three or more conditions, out of a list of 14 chronic conditions. The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses.Results: The study included 297 participants, aged 40-64 years, of which 124 (41.7%) had multimorbidity. After adjusting for sociodemographic factors, participants with multimorbidity had significantly lower EQ5D UI, (β-coefficient -0.064 (C.I -0.125, -0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient -0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort.Conclusion: Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a statistically significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population.

Download Full-text

How does Multimorbidity affect Middle-Aged Adults? A Cross-Sectional Survey in the Singapore Primary Healthcare Setting.

10.21203/rs.2.24538/v2 ◽

2020 ◽

Author(s):

Sai Zhen - Sim ◽

Hui Li Koh ◽

Sabrina Poay Sian Lee ◽

Doris Yee Ling Young ◽

Eng Sing Lee

Keyword(s):

Primary Care ◽

Chronic Conditions ◽

Healthcare Setting ◽

The Elderly ◽

Sociodemographic Factors ◽

Health State ◽

Middle Aged ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Impact

Abstract Background Multimorbidity is of increasing prevalence and importance. It has been negatively associated with health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity for the middle-aged population, defined as those between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore. Methods A cross-sectional study was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol five dimensions 3-levels questionnaire (EQ5D). We defined multimorbidity as the presence of three or more conditions, out of a list of 14 chronic conditions. The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses. Results The study included 297 participants, aged 40-64 years, of which 124 (41.7%) had multimorbidity. After adjusting for sociodemographic factors, participants with multimorbidity had significantly lower EQ5D UI, (β-coefficient -0.064 (C.I -0.125, -0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient -0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort. Conclusion Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a statistically significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population

Download Full-text

How does multimorbidity affect middle-aged adults? A cross-sectional survey in the Singapore primary healthcare setting

BMC Family Practice ◽

10.1186/s12875-020-01262-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Sai Zhen Sim ◽

Hui Li Koh ◽

Sabrina Poay Sian Lee ◽

Doris Yee Ling Young ◽

Eng Sing Lee

Keyword(s):

Primary Care ◽

Chronic Conditions ◽

Healthcare Setting ◽

The Elderly ◽

Sociodemographic Factors ◽

Health State ◽

Middle Aged ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The Impact

Abstract Background Multimorbidity is of increasing prevalence and importance. It has been associated with poorer health-related quality of life (HrQoL) especially in the elderly population. Despite substantial multimorbidity in the middle-aged population, defined as those aged between 40-64 years old, there is a paucity of research investigating the impact of multimorbidity in this population. This study aimed to investigate the association between multimorbidity and HrQoL in the middle-aged primary care population in Singapore. Methods A cross-sectional study was conducted at a primary care centre in Singapore. Interviewer-administered questionnaires were used to collect data regarding the participants’ sociodemographic characteristics, chronic conditions, and HrQoL, as measured by the EuroQol five dimensions 3-levels questionnaire (EQ5D). We defined multimorbidity as the presence of three or more conditions, out of a list of 14 chronic conditions. The associations between multimorbidity and the components of the EQ5D were assessed using multivariable regression analyses. Results The study included 297 participants, aged 40–64 years, of which 124 (41.7%) had multimorbidity. After adjusting for sociodemographic factors, participants with multimorbidity had significantly lower EQ5D UI, (β-coefficient − 0.064 (C.I -0.125, − 0.003), p = 0.04), but not significantly lower EQ5D VAS, (β-coefficient − 0.045 (C.I 0.102, 0.012), p = 0.12). Additionally, participants with multimorbidity had higher odds (OR = 2.41, p = 0.01) of reporting problems due to pain/discomfort. Conclusion Multimorbidity was not significantly associated with the overall health state, as measured by the EQ5D VAS, in middle-aged primary care patients. However, it was associated with the EQ5D UI which is a composite measure of five specific domains of HrQoL. Specifically, there was a statistically significant association between multimorbidity and the pain domain. Further studies are required to understand the relationship between multimorbidity and pain to enable physicians to better manage pain and HrQoL in this population.

Download Full-text

The Association Between Mental Health, Chronic Disease, and Retired Status Among Korean Elderly: A Cross-Sectional Study

10.21203/rs.3.rs-26125/v1 ◽

2020 ◽

Author(s):

Tae Yoon Kim ◽

Sook-Hyun Lee ◽

Eun-Jung Kim ◽

Jae-Hong Kim ◽

Sun Yong Chung ◽

...

Keyword(s):

Mental Health ◽

Chronic Disease ◽

Health Behavior ◽

Large Scale ◽

The Elderly ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

The Impact

Abstract Background Retired status has strong associations with mental health factors and involves gender disparities. However, while retirement is known to affect the mental health of the elderly, large-scale studies examining the impact on mental health by gender are scarce.Methods This cross-sectional study examined the data of 1,664 participants aged over 65 years old who completed the economic status and mental health sections of the 6-7th Korean National Health and Nutrition Examination Surveys (2013–2017). We adjusted for covariates (health behavior, sociodemographic factors) in regression analysis for complex sampling design to calculate regression coefficients and 95% confidence intervals of the link between retired status and mental health. We also assessed which covariates of chronic disease, health behavior, and sociodemographic factors weakened the correlation between retired status and mental health.Results Retired status in Korean populations has persisted to negatively impact the incidence of depressive symptoms and thoughts of suicide, even after adjusting for confounding variables. Regarding mental health, women were affected by retired status to a greater extent than men. Among covariates, health behaviors and sociodemographic factors were most affected by retired status. Women were more affected by household income, and men were more affected by drinking behaviors.Conclusions These results imply that chronic diseases and psychological factors should be managed delicately among the retired elderly, and that there may be gender differences in retirement adaptation.

Download Full-text

Factors Associated with the Caregivers’ Desire to Institutionalize Persons with Dementia: A Cross-Sectional Study

Dementia and Geriatric Cognitive Disorders ◽

10.1159/000494023 ◽

2018 ◽

Vol 46 (5-6) ◽

pp. 298-309 ◽

Cited By ~ 6

Author(s):

Sophie Vandepitte ◽

Koen Putman ◽

Nele Van Den Noortgate ◽

Sofie Verhaeghe ◽

Eric Mormont ◽

...

Keyword(s):

Behavioral Problems ◽

The Elderly ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Respite Care ◽

Community Dwelling ◽

Cross Sectional ◽

Factors Associated ◽

Care Services ◽

Modifiable Factors

Background/Aims: Dementia is one of the main reasons for institutionalization among the elderly. Few studies have explored factors associated with the caregivers’ (CG) desire to institutionalize (DTI) a person with dementia (PWD). The objective of this study is to identify modifiable and non-modifiable psychosocial and sociodemographic factors associated with a caregiver’s DTI. Methods: Cross-sectional data of 355 informal CG of community-dwelling PWD were analyzed. Several characteristics were identified in CG and PWD to be included in a multivariable regression model based on the purposeful selection method. Results: Positively modifiable associated factors were: higher CG burden, being affected by behavioral problems, and respite care use. Positively associated non-modifiable factors were: CG older age, being professionally active, and CG higher educational level. Cohabitation and change of professional situation were negatively associated. Conclusion: Although no causality can be assumed, several practical recommendations can be suggested. First of all, these results reconfirm the importance of multicomponent strategies, especially support aimed at decreasing burden and in learning coping strategies. Also, CG might benefit from information about support options, such as respite care services. Finally, special attention should be given to older and working CG. In the latter, flexible and adaptive working conditions might alleviate burden and therefore reduce the DTI of the PWD.

Download Full-text

THE IMPACT OF MEDICATION ADHERENCE ON HEALTH-RELATED QUALITY OF LIFE OF DIABETIC PATIENTS IN THE KINGDOM OF SAUDI ARABIA: FINDINGS FROM A CROSS-SECTIONAL STUDY

Periódico Tchê Química ◽

10.52571/ptq.v17.n34.2020.891_p34_pgs_867_873.pdf ◽

2020 ◽

Vol 17 (34) ◽

pp. 867-873

Author(s):

Dhfer ALSHAYBAN ◽

Royes JOSEPH

Keyword(s):

Quality Of Life ◽

Medication Adherence ◽

Cross Sectional Study ◽

P Value ◽

Diabetic Patients ◽

Health State ◽

Cross Sectional ◽

Related Quality ◽

The Impact

Diabetes is a common chronic disease that is considered as one of the fastest-growing health problems in the world. Adherence to medications could be an important factor in reducing these complications and improving the quality of life. The purpose of this research was to assess the impact of treatment adherence on health-related quality of life in patients with type 2 diabetes. A multicenter cross-sectional study was carried out among 368 diabetes patients. General Medication Adherence Scale was used to assess the adherence level and EuroQol-5D to assess the quality of life. The results show that 19%, 21%, and 23% of patients had maintained low medication adherence due to patient’s intentional or unintentional behavior due to additional diseases or pills burden and due to financial constraints, respectively. Overall, 43% (n=162) participants had maintained high medication adherence, and 37% (n=138) had maintained low medication adherence to antidiabetic drugs. Nearly one-third (31%) of patients with high overall adherence had perfect health state in comparison with 4% among patients with low adherence. Further, the lower proportion (21%) of patients with high overall adherence had perfect health state in comparison with that among patients with low adherence (34%). In addition to the overall adherence, the association was statistically significant for the domains related to non-adherence due to the patient’s intentional or unintentional behavior (p-value 0.001) and non-adherence due to additional diseases or pills burden (p-value 0.001) after taking into account of socio-demographic and clinical characteristics. In conclusion, the findings suggest that the policymakers should establish an intervention to improve adherence to diabetic treatment, and thus improve the quality of life for the type 2 diabetic patients.

Download Full-text

The impact of general practitioners’ gender on process indicators in Hungarian primary healthcare: a nation-wide cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2018-027296 ◽

2019 ◽

Vol 9 (9) ◽

pp. e027296 ◽

Cited By ~ 1

Author(s):

Nóra Kovács ◽

Orsolya Varga ◽

Attila Nagy ◽

Anita Pálinkás ◽

Valéria Sipos ◽

...

Keyword(s):

Primary Care ◽

Primary Healthcare ◽

Cross Sectional Study ◽

Gender Effect ◽

Sectional Study ◽

Cross Sectional ◽

Process Indicators ◽

Wide Cross ◽

The Impact

ObjectivesThe objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process indicators for GP performance and (2) to assess the size of the gender impact.Study designA nation-wide cross-sectional study was performed in 2016.Setting and participantsThe study covered all general medical practices in Hungary (n=4575) responsible for the provision of primary healthcare (PHC) for adults. All GPs in their private practices are solo practitioners.Main outcome measuresMultilevel logistic regression models were used to analyse the association between GP gender and process indicators of PHC, and attributable proportion (AP) was calculated.Results48% of the GPs (n=2213) were women in the study. The crude rates of care provided by female GPs were significantly higher for seven out of eight evaluated indicators than those provided by male GPs. Adjusted for practice, physician and patient factors, GP gender was associated with the haemoglobin A1c (HbA1c) measurement: OR=1.18, 95% CI (1.14 to 1.23); serum creatinine measurement: OR=1.14, 95% CI (1.12 to 1.17); lipid measurement: OR=1.14, 95% CI (1.11 to 1.16); eye examination: OR=1.06, 95% CI (1.03 to 1.08); mammography screening: OR=1.05, 95% CI (1.03 to 1.08); management of patients with chronic obstructive pulmonary disease: OR=1.05, 95% CI (1.01 to 1.09) and the composite indicator: OR=1.08, 95% CI (1.07 to 1.1), which summarises the number of care events and size of target populations of each indicator. The AP at the specific indicators varied from 0.97% (95% CI 0.49% to 1.44%) of influenza immunisation to 8.04% (95% CI 7.4% to 8.67%) of eye examinations.ConclusionFemale GP gender was an independent predictor of receiving higher quality of care. The actual size of the gender effect on the quality of services seemed to be notable. Factors behind the gender effect should receive more attention in quality improvement particularly in countries where the primary care is organised around solo practices.

Download Full-text

Cross-sectional study on the awareness, susceptibility and use of heated tobacco products among adolescents in Guatemala City, Guatemala

BMJ Open ◽

10.1136/bmjopen-2020-039792 ◽

2020 ◽

Vol 10 (12) ◽

pp. e039792

Author(s):

Anna Gottschlich ◽

Sophia Mus ◽

Jose Carlos Monzon ◽

James F Thrasher ◽

Joaquin Barnoya

Keyword(s):

Sociodemographic Factors ◽

Cross Sectional Study ◽

Secondary Outcome ◽

Tobacco Prevention ◽

Guatemala City ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Tobacco Products ◽

Middle Income ◽

The Past

ObjectivesHeated tobacco products (HTPs) are increasingly marketed worldwide, yet limited research on HTPs has been conducted in low and middle-income countries (LMICs) or among adolescents. Guatemala is one of the few LMICs where HTPs are available. This study examined prevalence and correlates of HTP awareness, susceptibility and use among adolescents in Guatemala.Design, setting and participantsA cross-sectional survey on HTP awareness, susceptibility and use was conducted among 2870 students between the ages of 13 and 17 in private schools in Guatemala City, Guatemala.Primary and secondary outcome measuresThe primary outcome was susceptibility to future use of HTP among school-aged current and never smokers in Guatemala. We also explored awareness and use of HTPs. Multivariate binomial regression models were used to explore associations between these outcomes and both sociodemographic factors and established smoking correlates.ResultsOf all students (n=2870), about half were aware of HTPs (52.4%) and susceptible to future or continued use (52.4%). Whereas 8.4% of students had tried HTPs in the lifetime (but not in the last month), only 2.9% used HTPs in the past month. Independent correlates of HTP susceptibility and ever-use included: use of other tobacco products (current smoking: adjusted OR (AOR)=10.53 and 6.63, respectively; current e-cigarette use: AOR=21.87 and 10.40, respectively), moderate alcohol consumption (AOR=1.49 and 1.19, respectively), marijuana use in the past 30 days (AOR=3.49 and 2.29, respectively) and having friends who use HTPs (AOR=1.83 and 7.28, respectively).ConclusionsAmong this sample of adolescents in Guatemala City, where tobacco control is weak, the prevalence of HTP use was low but susceptibility to future use was high. Tobacco prevention and intervention strategies for cigarettes and e-cigarettes should now also include HTPs, which tend to be used by similar adolescent populations (ie, those who use other substances or are exposed to tobacco through family and friends).

Download Full-text

Arterial hypertension in the elderly accompanied in primary care: profile and associated factors

Escola Anna Nery ◽

10.1590/2177-9465-ean-2018-0322 ◽

2019 ◽

Vol 23 (2) ◽

Author(s):

Breno de Sousa Santana ◽

Bárbara Soares Rodrigues ◽

Marina Morato Stival ◽

Cris Renata Grou Volpe

Keyword(s):

Risk Factors ◽

Blood Pressure ◽

Strong Association ◽

Federal District ◽

The Elderly ◽

Pressure Control ◽

Sociodemographic Factors ◽

Cross Sectional Study ◽

Cross Sectional ◽

Elderly Hypertensive

Abstract Objective: to analyze blood pressure control in elderly hypertensives accompanied by a Basic Health Unit of the Federal District, determining the sociodemographic profile and the associated risk factors. Method: this is a cross-sectional study with 133 elderly hypertensive patients. Variables related to sociodemographic factors, life habits, clinical factors and adherence to drug therapy were evaluated through the application of semistructured instruments and validated scales. Results with p <0.05 were considered significant. Results: the elderly presented controlled blood pressure (56.4%) predominantly. The majority of the participants were female and women also had a higher rate of uncontrolled blood pressure (86.2%). Older age was associated with higher blood pressure values (p = 0.031). Alcoholism (p = 0.020) and mean body mass index of 33.0 (p <0.000) were factors associated with hypertension adherence to therapy had more controlled values of systolic and diastolic blood pressure. Conclusion and implications for the practice: it was verified that there is a strong association between the risk factors discussed and the lack of control of the blood pressure of elderly hypertensive, especially with regard to advanced age, alcoholism, obesity and overweight, and it is necessary to reorient the planning and strategies of promotion of health and prevention of diseases directed at the elderly hypertensive in the scope of primary health care.

Download Full-text

Impact of postgraduate study on healthcare professionals' academic and clinical practice

British Journal of Healthcare Management ◽

10.12968/bjhc.2019.0058 ◽

2020 ◽

Vol 26 (7) ◽

pp. 171-178

Author(s):

Samantha Holloway ◽

Ann Taylor ◽

Michal Tombs

Keyword(s):

Clinical Practice ◽

Personal Growth ◽

Healthcare Professionals ◽

Healthcare Setting ◽

Subject Area ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Postgraduate Study ◽

The Impact

Aims/Background Existing literature in the healthcare setting indicates that individuals enter higher education, particularly postgraduate programmes, to gain in-depth knowledge of a subject area, with a view to improving their career opportunities. Evidence also suggests that, in addition to perceived career enhancement, individuals also report benefits such as personal growth and broadening of perspectives, which have helped their clinical practice. The aim of this study was to examine the impact of postgraduate study on healthcare professionals' academic practice and discuss the potential links to improvements in clinical practice. Method This was a descriptive cross-sectional survey of a convenience sample of graduates from a range of postgraduate healthcare programmes at one UK university. A survey comprising 18 questions was designed to explore perceptions of impact and was distributed to 962 graduates with a response rate of 9.81% (n=98). Results The majority of respondents were doctors (n=54, 55.1%), women (n=59, 60.2%), based within the UK (n=36, 36.7%) and had completed their programme between 2014 and 2016 (n=72, 73.4%). With regards to achievements in professional practice, participants felt more confident in relation to research and evaluating evidence. In relation to impact on clinical practice, improvements in multidisciplinary team working as well as increased confidence emerged as main themes. Conclusions Findings support existing evidence in relation to the importance of postgraduate study, which is able to instil an increased sense of confidence in graduates' ability. This was particularly related to having a better understanding of speciality-related evidence and its application in clinical practice. This is something that previous studies do not seem to have reported and may reflect the multiprofessional nature of many of the postgraduate programmes provided.

Download Full-text