The Experts below are selected from a list of 8853 Experts worldwide ranked by ideXlab platform

Noreen M Clark - One of the best experts on this subject based on the ideXlab platform.

  • an examination of adverse asthma outcomes in u s adults with Multiple Morbidities
    Annals of the American Thoracic Society, 2013
    Co-Authors: Minal R Patel, Mary R Janevic, Steven G Heeringa, Alan P Baptist, Noreen M Clark
    Abstract:

    Rationale: More Americans are managing Multiple chronic conditions. Little is known regarding combinations of Multiple chronic conditions with asthma.Objectives: To examine the prevalence and demographic distribution of five common chronic conditions (arthritis, heart disease, cancer, diabetes, and hypertension) in adults with and without asthma and the adverse asthma outcomes associated with Multiple chronic conditions.Methods: Cross-sectional interview data from the National Health and Nutrition Examination Survey were analyzed (n = 22,172) between 2003 and 2010. Bivariate analysis methods and multivariate generalized linear regression were used to examine associations.Measurements and Main Results: Of the 10% of subjects with asthma, 54% had one or more coexisting health condition(s). The prevalence of two or three or more other chronic conditions was greater among those with asthma compared with those without (P < 0.001). Common coMorbidities with asthma were hypertension (34%) and arthritis (31%). Fo...

  • the Multiple challenges of Multiple Morbidities
    Health Education & Behavior, 2011
    Co-Authors: Noreen M Clark
    Abstract:

    More than half the American population lives with a chronic disease. These ailments include arthritis, asthma and other respiratory conditions, diabetes, heart disease, HIV, hypertension, and some forms of cancer. More than two thirds of older adults are so afflicted and the aging of the population does not portend good news. Neither is the problem particular to the United States. Last year, the World Health Organization acknowledged that, regardless of where one lives in the world, premature death is most likely to be caused by a chronic condition (leaving aside war, other forms of violence, and vehicular injuries). However, recognition of the prevalence and importance of managing Multiple Morbidities has been slow in coming. Current data are alarming. For example, one in four Americans has two or more concurrent chronic conditions (Anderson, 2010). A study by the Center for Healthcare Research and Transformation in the State of Michigan showed that those older than 65 years had an average of eight chronic physical and/or psychological conditions with a range from 1 to 18 (Udow-Phillips, 2009). Other states are generating similar profiles of those with chronic disease. Even the young are not spared. When obesity, recently determined to be a chronic condition by the Centers for Disease Control and Prevention, is counted, children and adolescents have an increasing number of Multiple chronic health problems with asthma and diabetes being frontrunners. Of course, the weaknesses in our health care system are magnified when a person seeks care for more than one chronic condition as the chances of negative outcomes increase. These include death, poor functional status, unnecessary hospitalizations, adverse drug events, duplicative tests, and conflicting medical advice, to name just a few (Institute of Medicine, Committee on Quality of Health Care in America, 2001; Vogeli et al., 2007). The impact of Multiple chronic diseases on people and the health care system, in large part, depends on the extent to which clinicians understand how to treat people with several ailments, make the appropriate clinical recommendations, write and implement therapeutic regimens, communicate with other clinicians an individual may see, and counsel patients. At the moment, the evidence base for best practices in clinical management of Multiple conditions is very thin and to a great extent comprises expert opinion rather than results of empirical study. A second influence on outcomes is how well services are organized and paid for. Care delivery and payment patterns either facilitate or hinder effective practice. Policies are needed that ensure the patient gets the assistance he or she requires. They must ensure that health care providers practice in a system that rewards them for effective management across chronic conditions. Equally as crucial an influence on health outcomes is the extent to which we understand challenges patients face when trying to manage co Morbidities and how they can be helped through education, social support, and resources. Management of a chronic condition (not to mention several at once) occurs outside the health system at home, work, and school. Clinicians are actually just guides or coaches for management. The people with the condition are the managers. What we know about patient management of a single condition has not been adequately translated into day-to-day practice in the health system and many individuals get little or no education for the task. That being said, some progress regarding management of individual illnesses has been made. Several models have been developed, rigorously evaluated, replicated, and are frequently used (see, e.g., Clark, Gong, & Kaciroti, 2001; Glasgow et al., 2005; Lorig et al., 1999). Other proven models have focused on how the clinician and patient educators can become better communicators and counselors of patients with a chronic disease (see, e.g., Clark et al., 2008; Heisler, Bouknight, Hayward, Smith, & Kerr, 2002). The picture is quite different for Multiple chronic conditions. One or two intervention models have tried to lump together people with different chronic illnesses to help them improve their skills. This has been done to make self-management education more efficient and assumes disease management is much the same across conditions. These approaches also have been thought to have spillover effect to improve management of other illnesses a person might have. However, such efforts have not proven robust in producing outcomes related to control of symptoms or reduction in the need for health services. Neither have their intended outcomes been reproduced in replication studies nor has the idea of “spillover” to other conditions been proven (Foster, Taylor, Eldridge, Ramsay, & Griffiths, 2007).

Miriam C Morey - One of the best experts on this subject based on the ideXlab platform.

  • impact of supervised exercise on one year medication use in older veterans with Multiple Morbidities
    Gerontology and Geriatric Medicine, 2020
    Co-Authors: Marc J Pepin, Willy Marcos Valencia, Janet Prvu Bettger, Megan Pearson, Kenneth Manning, Richard Sloane, Kenneth E Schmader, Miriam C Morey
    Abstract:

    Exercise is touted as the ideal prescription to treat and prevent many chronic diseases. We examined changes in utilization and cost of medication classes commonly prescribed in the management of c...

  • long term changes in physical activity following a one year home based physical activity counseling program in older adults with Multiple Morbidities
    Journal of Aging Research, 2011
    Co-Authors: Katherine S Hall, Richard Sloane, Carl F Pieper, Matthew J Peterson, Gail M Crowley, Patricia A Cowper, Eleanor S Mcconnell, Hayden B Bosworth, Carola C Ekelund, Miriam C Morey
    Abstract:

    This study assessed the sustained effect of a physical activity (PA) counseling intervention on PA one year after intervention, predictors of sustained PA participation, and three classes of post-intervention PA trajectories (improvers, maintainers, and decliners) in 238 older Veterans. Declines in minutes of PA from 12 to 24 months were observed for both the treatment and control arms of the study. PA at 12 months was the strongest predictor of post-intervention changes in PA. To our surprise, those who took up the intervention and increased PA levels the most, had significant declines in post-intervention PA. Analysis of the three post-intervention PA trajectories demonstrated that the maintenance group actually reflected a group of nonresponders to the intervention who had more coMorbidities, lower self-efficacy, and worse physical function than the improvers or decliners. Results suggest that behavioral counseling/support must be ongoing to promote maintenance. Strategies to promote PA appropriately to subgroups of individuals are needed.

Eiji Shimizu - One of the best experts on this subject based on the ideXlab platform.

  • frailty and loss of rectus femoris muscle thickness in elderly patients hospitalized with community acquired pneumonia a case control study
    European Respiratory Journal, 2016
    Co-Authors: Hirokazu Touge, Katsuyuki Tomita, Yasuto Ueda, Keiji Matsunami, Tsuyoshi Kitaura, Shizuka Nishii, Hiromitsu Sakai, Akira Yamasaki, Yuji Kawasaki, Eiji Shimizu
    Abstract:

    Aim: Frailty is at the core of geriatric syndromes that are characterized by Multiple Morbidities and mobility disability. The purpose of this prospective study was to assess the frailty scale and muscle mass on the acute phase in hospitalized elderly patients with community-acquired pneumonia (CAP). Methods: Thirty-two elderly patients, aged 75 years or older, hospitalized with CAP and 32 gender- and age-matched controls hospitalized without CAP were recruited. All of them had been able to walk without mobility limitation prior to admission. Frailty scale and muscle mass was assessed as the Reported Edmonton Frail Scale (REFS) and rectus femoris (RF) thickness using ultrasound, respectively. Activity status of life was estimated using the Eastern Cooperative Oncology Group (ECOG) performance status. Relationships between REFS and muscle mass were evaluated using Spearman9s correlation coefficient and piece-wise linear regression analysis. Results: There was a significant increase in the frequency of frailty, which was defined as 8 or more scores of REFS, in CAP patients (50%), compared to controls (22%). Frailty scale was negatively correlated with RF thickness and activity status of life. Based upon the piece-wise linear regression analysis between REFS and RF thickness decreased rapidly with the pre-frailty status in CAP patients. Conclusion: The results of our study suggest that elderly patients with CAP might have had a significant impairment of physical performance due to decreased thickness of RF prior to admission.

Tolu Oni - One of the best experts on this subject based on the ideXlab platform.

  • provider workload and Multiple Morbidities in the caribbean and south africa
    2018
    Co-Authors: Bilikisu Elewonibi, Shalini Pooransingh, Natalie Greaves, Linda Skaal, Tolu Oni, Madhuvanti M Murphy, Alafia T Samuels, Rhonda Belue
    Abstract:

    This chapter discusses the current state of healthcare, challenges and potential local and cross-national solutions related to Multiple morbidity in low and middle income countries and vulnerable populations in high income countries, based on interdisciplinary research of provider workload in South Africa and the Caribbean. With a high chronic and noncommunicable disease (NCD) and HIV burden in both settings, it is not uncommon to find patients having this double burden of disease. Additionally, patient resiliency is exacerbated by the multiplication of both demands made by the interactions from treatment modalities and Multiple service providers. The Cumulative Complexity Model (CCM) posits that as the burden of disease and resulting workload increase, the patient capacity to respond to it diminishes. In middle and high-income countries, a dedicated system of care for people living with HIV/AIDS was developed in parallel to existing systems of care for NCDs, which has been successful in increasing advocacy, political will, and healthcare worker empowerment. We explore the application of this model across settings, along with other potential solutions.

  • patterns of hiv tb and non communicable disease multi morbidity in peri urban south africa a cross sectional study
    BMC Infectious Diseases, 2015
    Co-Authors: Tolu Oni, Elizabeth Youngblood, Andrew Boulle, Nuala Mcgrath, Robert J Wilkinson, Naomi S Levitt
    Abstract:

    Many low and middle-income countries are experiencing colliding epidemics of chronic infectious (ID) and non-communicable diseases (NCD). As a result, the prevalence of Multiple Morbidities (MM) is rising. We conducted a study to describe the epidemiology of MM in a primary care clinic in Khayelitsha. Adults with at least one of HIV, tuberculosis (TB), diabetes (DM), and hypertension (HPT) were identified between Sept 2012-May 2013 on electronic databases. Using unique patient identifiers, drugs prescribed across all facilities in the province were linked to each patient and each drug class assigned a condition. These 4 diseases accounted for 45% of all prescription visits. Among 14364 chronic disease patients, HPT was the most common morbidity (65%). 22.6% of patients had MM, with an increasing prevalence with age; and a high prevalence among younger antiretroviral therapy (ART) patients (26% and 30% in 18-35 yr and 36–45 year age groups respectively). Among these younger ART patients with MM, HPT and DM prevalence was higher than in those not on ART. We highlight the co-existence of Multiple ID and NCD. This presents both challenges (increasing complexity and the impact on health services, providers and patients), and opportunities for chronic diseases screening in a population linked to care. It also necessitates re-thinking of models of health care delivery and requires policy interventions to integrate and coordinate management of co-morbid chronic diseases.

Josef S Smolen - One of the best experts on this subject based on the ideXlab platform.

  • different rating of global rheumatoid arthritis disease activity in rheumatoid arthritis patients with Multiple Morbidities
    Arthritis & Rheumatism, 2017
    Co-Authors: Helga Radner, Kazuki Yoshida, Sara K Tedeschi, Paul Studenic, Michelle L Frits, Christine Iannaccone, Nancy A Shadick, Michael E Weinblatt, Daniel Aletaha, Josef S Smolen
    Abstract:

    Objective To quantify differences and determine the factors contributing to the difference in patient global assessment of rheumatoid arthritis (RA) disease activity (PtGA) between RA patients with Multiple Morbidities (RA-MM) and those with RA only. Methods We compared the PtGA between RA-MM patients and those with RA only, followed up in a longitudinal cohort (n = 1,040). In analyses performed on RA-MM patients (n = 575) and those with RA only (matched for swollen joint count, tender joint count, evaluator global assessment, and disease duration), the mean difference in PtGA (ΔPtGA) between the 2 groups was assessed. The contribution of patient characteristics to the explained variation of ΔPtGA in the matched cohort was calculated as semipartial R2 and summarized as the percentage of the total R2 in linear regression models. Results RA-MM patients reported higher (or worse) PtGA, with an increased PtGA associated with more Morbidities (P for linear trend < 0.01); this relationship remained significant after adjustment for disease activity, age, and disease duration. After matching 294 RA-MM patients to those with RA only, the pairwise comparison of mean PtGA (on a scale of 0–100 mm) was significantly higher (worse) for RA-MM patients (mean ± SD 30.5 ± 24.3) versus those with RA only (25.6 ± 22.9) (mean ΔPtGA 4.9 ± 26.7; P < 0.01 by paired t-test). Variables uniquely contributing to ΔPtGA were fatigue (18%), pain (17%), and modified Health Assessment Questionnaire scores (9%). Conclusion In RA patients with Multiple Morbidities, the perception of RA disease activity as measured by the PtGA might be impacted by the burden of Multiple diseases in one individual. RA-MM patients have higher (worse) levels of PtGA scores compared to patients with RA only. The difference in PtGA is mainly explained by differences in fatigue and pain.