Chronic Physical Conditions Research Articles

The Incidence and Burden of Risk Factors for Mild Cognitive Impairment in Older Rural Chinese Persons.

Objective: The study investigated the prevalence of mild cognitive impairment (MCI), a common cognitive disorder in late life, among rural older residents in China. The associated risk factors were also analyzed. Methods: Two thousand one hundred forty-six older adults aged 60 or more in a rural town of Zhejiang Province, China, were recruited and analyzed. Demographic characteristics were collected by a self-designed questionnaire. Diagnosis of MCI was made by well-trained primary care physicians according to the Petersen criteria. Results: 23.16% of the analyzed sample were diagnosed with MCI, while the prevalence was significantly higher in women, those never married, not employed, and with older age, lower education, diabetes, coronary heart disease and stroke. Stepwise logistic regression indicated that age, education, diabetes, coronary heart disease, and stroke were significant predictive factors of MCI. Conclusion: The prevalence of MCI in rural older residents in China is high, and those with specific demographic characteristics like women, never married, not employed, and with older age, lower education and chronic physical conditions should be more concerned in primary care management. Integrated care approaches managing MCI and comorbid chronic conditions are recommended in future management practices.

How Does Pediatric Quality Measure Development Reflect the Real World Needs of Hospitalized Children?

Infants, children, and adolescents experience more than 6 million hospitalizations each year in the United States (US), with health care costs exceeding 47 billion dollars annually.1 More than half of these hospitalizations occur at the time of birth, while the remaining represent medical, surgical, and mental health hospitalizations beyond the immediate neonatal period.1 The burden of pediatric hospitalization is disproportionately borne by children with chronic physical and mental health conditions, those insured by Medicaid, and those experiencing social risk factors including poverty and housing insecurity.

Trained lay coaches and self-care cognitive-behavioral tools improve depression outcomes

ObjectivesIdentify the key effective components of a depression self-care intervention. MethodsSecondary analysis of data from 3 studies that demonstrated effectiveness of a similar depression self-care intervention (n = 275): 2 studies among patients with chronic physical conditions and 1 among cancer survivors. The studies used similar tools, and telephone-based lay coaching. Depression remission and reduction at 6 months were assessed with either PHQ-9 (chronic condition cohorts) or CES-D (cancer survivor cohort). Multiple logistic regression was used to analyze data when the interaction p-value with cohort was < 0.10. ResultsThe 3 coached cohorts achieved better depression outcomes than usual care. The combination of coaching and joint use of 2 tools based on cognitive-behavioral therapy (CBT) was associated with depression remission and reduction among chronic condition cohorts but not among cancer survivors. Neither the number nor the length of coach calls were associated with outcomes in pooled data. ConclusionsTrained lay coaching and use of CBT-based self-care tools were associated with improved depression outcomes in patients with chronic conditions but not among cancer survivors. Practice implicationsTrained lay coaching and CBT tools are key components of depression self-care interventions. Further research is needed on the effective components in cancer survivors.

More food for thought: a follow-up qualitative study on experiences of food bank access and food insecurity in Ottawa, Canada

BackgroundDespite the widespread proliferation of food banks in high-income countries over the past several decades, there is a paucity of data regarding the long-term experiences of the people who rely on food banks. We were unable to find any other studies with follow-up interviews later than 6 months after baseline.ObjectiveThis study examined the changes in the lived experiences of people who accessed food banks over a period of 18 months.MethodsSemi-structured interviews were conducted with 11 people who accessed food banks in Ottawa, Canada and who had participated in a 6-month study that ended one full year before this follow-up study was done. Transcripts of the interviews were analyzed through a general inductive approach involving repeated readings and coding of relevant segments of text with NVivo software according to themes that emerged iteratively. Code reports were then used to discuss and reach consensus on a final set of themes.ResultsThree main themes emerged: (1) chronic physical and mental health issues intersecting with food bank access; (2) psychosocial impact of relying on food banks; and (3) living on a low income and dealing with poverty. Chronic physical and mental health conditions were prevalent among the participants. As well, 10 of the 11 participants in this 18-month follow-up continued to rely on food banks as a regular resource – not as an emergency relief measure – to supplement their nutritional needs. While most of the participants reported that food banks helped them in some way, many shortcomings were also noted regarding food amounts, quality and choice. Overall, there was little change reported since the 6-month follow-up.ConclusionsThe shortcomings reported by participants can mostly be attributed to the dependence of food banks on charitable donations; thus, despite the commendable work of food bank staff and volunteers, participants described the food assistance as inadequate. Additionally, long-term food bank usage was a common denominator in the lived experiences of all our participants; therefore, our findings reinforce the need for assistance programs that target long-term food insecurity and its underlying causes, to replace or supplement charity-based food bank programs.

Physical multimorbidity and depression: A mediation analysis of influential factors among 34,129 adults aged ≥50 years from low- and middle-income countries.

There is a scarcity of literature on the association between physical multimorbidity (i.e., ≥2 chronic physical conditions) and depression among older adults, especially from low- and middle-income countries (LMICs). In addition, the mediators in this association are largely unknown. Therefore, we aimed to examine this association among adults aged ≥50 years from six LMICs (China, Ghana, India, Mexico, Russia, and South Africa), and to identify potential mediators. Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. Depression was defined as past-12 months DSM-IV depression or receiving depression treatment in the last 12 months. Information on 11 chronic physical conditions were obtained. Multivariable logistic regression and mediation analyses were conducted. Data on 34,129 individuals aged ≥50 years were analyzed [mean (SD) age 62.4 (16.0) years; maximum 114 years; 52.1% females]. Compared to no chronic conditions, 2, 3, 4, and ≥5 chronic conditions were associated with 2.55 (95% CI = 1.90-3.42), 3.12 (95% CI = 2.25-4.34), 5.68 (95% CI = 4.02-8.03), and 8.39 (95% CI = 5.87-12.00) times higher odds for depression. Pain/discomfort (% mediated 39.0%), sleep/energy (33.2%), mobility (27.5%), cognition (13.8%), perceived stress (7.3%), disability (6.7%), loneliness (5.5%), and food insecurity (1.5%) were found to be significant mediators in the association between physical multimorbidity and depression. Older adults with physical multimorbidity are at increased odds of depression in LMICs. Future studies should assess whether addressing the identified potential mediators in people with physical multimorbidity can lead to reduction in depression in this population.

Medication use to manage comorbidities in people with dementia: a systematic review

AbstractAimTo investigate physical health outcomes associated with medications prescribed to manage chronic physical conditions in people living with dementia; and determine whether a dementia diagnosis altered drug utilisation patterns for physical health conditions.Data sourcesMedline, Embase, Central and Scopus were searched 01/2011 to 12/2020.Study selectionExperimental and observational studies, where participants with dementia using medications prescribed by doctors to prevent or treat one or more chronic comorbid physical condition, were compared to no intervention, usual care, or a non‐dementia comparison group. The outcomes of interest were clinically meaningful physical outcomes, and medication utilisation patterns.ResultsTen studies met the inclusion criteria. All were of medium to high quality relative to their study design. Mixed findings were reported for ischemic stroke (n = 3), all‐cause mortality (n = 3) and bleeding‐related outcomes (n = 2). This is likely due to the heterogeneity in exposures reported. One study found that people with dementia, receiving antidiabetic management, had a higher rate of severe hypoglycaemia compared to people without dementia. Medication utilisation pattern outcomes included oral anticoagulant use before stroke‐related hospitalisation (n = 1), antithrombotic medication use before stroke‐related hospitalisation (n = 1), cardiovascular medication use for secondary prevention of ischemic heart disease (n = 1), antidepressant medication discontinuation (n = 1), osteoporosis treatment (n = 1), diabetic medication use (n = 2), and antihypertensive medication discontinuation (n = 1).ConclusionThis systematic review showed there is currently insufficient evidence to conclude that medication management in people with dementia should differ substantially to people without dementia. Comprehensive and high‐quality evidence is needed to improve confidence that medication prescribing achieves optimum clinical outcomes, quality of life, and benefit‐to‐risk determination in this vulnerable population.

Personalized treatment - which interaction ingredients should be focused to capture the unconscious.

A recent meta-analysis revealed that mental health and baseline psychological impairment affect the quality of life and outcomes in different chronic conditions. Implementing mental health care in physical care services is still insufficient. Thus, interdisciplinary communication across treatment providers is essential. The standardized language provided by the diagnostic statistical manual favors a clear conceptualization. However, this approach might not focus on the individual, as thinking in categories might impede recognizing the continuum from healthy to diseased. Psychoanalytic theory is concerned with an individual’s unconscious conflictual wishes and motivations, manifested through enactments like psychic symptoms or (maladaptive) behavior with long-term consequences if not considered. Such modifiable internal and external factors often are inadequately treated. However, together with the physical chronic condition constraints, these factors determine degrees of freedom for a self-determined existence. The effect of therapeutic interventions, and especially therapy adherence, relies on a solid therapeutic relationship. Outcome and process research still investigates the mechanism of change in psychotherapeutic treatments with psychanalysis’s focus on attachment problems. This article examines existing knowledge about the mechanism of change in psychoanalysis under the consideration of current trends emerging from psychotherapy research. A clinical example is discussed. Additionally, further directions for research are given. The theoretical frame in psychoanalytic therapies is the affect-cognitive interface. Subliminal affect-perception is enabled via awareness of subjective meanings in oneself and the other; shaping this awareness is the main intervention point. The interactional ingredients, the patient’s inherent bioenvironmental history meeting the clinician, are relevant variables. Several intrinsic, subliminal parameters relevant for changing behavior are observed. Therapeutic interventions aim at supporting the internalization of the superego’s functions and at making this ability available in moments of self-reflection. By supporting mentalization abilities, a better understanding of oneself and higher self-regulation (including emotional regulation) can lead to better judgments (application of formal logic and abstract thinking). Thus, this facilitates enduring behavior change with presumably positive effects on mental and physical health.

An epidemic and a pandemic collide: Assessing the feasibility of tobacco treatment among vulnerable groups at COVID-19 protective lodging.

Individuals experiencing homelessness have elevated smoking rates in addition to chronic and acute physical and mental health conditions, which may increase chances for complications associated with COVID-19 recovery. Unfortunately, there is underuse of tobacco cessation services in many agencies (e.g., substance use treatment centers, mental health treatment centers) providing care to these individuals. The purpose of the current study was to evaluate the feasibility of providing tobacco cessation treatment alongside local COVID-19 emergency response efforts. Taking Texas Tobacco Free (TTTF) partnered with relevant emergency response teams at 5 isolation centers (repurposed hotels) in Austin, Texas, to address tobacco use among presumed or confirmed COVID-19 positive individuals who had nowhere else to seek care and shelter. TTTF trained staff on tobacco cessation treatment; specifically, the 5A's and use of nicotine replacement therapy. Over 5 months in 2020; 170 of 379 (44.9%) isolation center residents were reached and assessed for cigarette or vape use. Smoking/vaping prevalence was 70.6%, and 41.7% of tobacco users accepted cessation treatment. Results suggest the feasibility and potential acceptability of providing tobacco treatment services in similar care settings during local emergency response efforts, including but potentially not limited to the COVID-19 pandemic. Further, this initiates a call to action for health care providers to deliver tobacco use cessation services for typically hard-to-reach groups (e.g., individuals/families experiencing homelessness) who may have increased contact with service agencies and health providers during times of crisis. Limitations and suggestions for future implementation are also provided. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Theorising painkiller (mis)use in football using Bourdieu's practice theory and physical capital

This conceptual article advances the value of Bourdieu's practice theory and physical capital as a tool to understand the various types of painkiller (mis)use in sport. Consuming painkillers to manage injury and fatigue is a common practice among male professional footballers and misuse can exacerbate existing injuries and contribute to chronic physical and mental health conditions. In order to highlight the interaction between micro and macro-level factors we conceptualise painkiller use in professional football as a relational process between habitus, capital, and field position wherein variation in use is a result of social trajectory and field experiences. The analysis elaborates upon Bourdieu's practice theory in sport. It shows that the importance of protecting physical capital stems from internalised dispositions about how the body is viewed, which legitimise the use of painkillers within the social field of football despite the damaging potential outcomes for players. The article extends Bourdieu's practice theory to managing painkiller (mis)use, provides recommendations towards a future research programme, and identifies potential interventions for improving athlete welfare.

National Research Agenda on Health Systems for Children and Youth With Special Health Care Needs.

Children and youth with special health care needs (CYSHCN) "have or are at increased risk for chronic physical, developmental, behavioral or emotional conditions and also require health and related services of a type or amount beyond that required by children generally." CYSHCN rely on health systems, which extend beyond traditional health care entities, to optimize their health and well-being. The current US health system is not fully equipped and functioning to meet the needs of CYSHCN. Recognizing this, the Maternal and Child Health Bureau and the US Health Resources and Services Administration established the Research Network on Health Systems for CYSHCN (CYSHCNet, http://www.cyshcnet.org). With input from >800 US stakeholders, CYSHCNet developed a national research agenda on health systems for CYSHCN designed to: 1) highlight important health system challenges faced by key stakeholders (ie, patients and families, health care providers, insurers, administrators, etc.); 2) organize research topics and goals to identify opportunities for improvement, to address challenges and to promote progress toward the ideal health system; and 3) provide a blueprint for health systems research ideas and studies that will guide CYSHCN investigators and other stakeholders going forward. We introduce the 6 research topics currently included in the research agenda-transition to adulthood, caregiving, family health, child health care, principles of care, and financing-to inform and guide investigators as they embark on a trajectory of health systems research on CYSHCN.

A pragmatic randomized controlled trial of a group self-management support program versus treatment-as-usual for anxiety disorders: study protocol

BackgroundThe integration of a personal recovery-oriented practice in mental health services is an emerging principle in policy planning. Self-management support (SMS) is an intervention promoting recovery that aims at educating patients on the nature of their mental disorder, improving their strategies to manage their day-to-day symptoms, fostering self-efficacy and empowerment, preventing relapse, and promoting well-being. While SMS is well established for chronic physical conditions, there is a lack of evidence to support the implementation of structured SMS programs for common mental disorders, and particularly for anxiety disorders. This study aims to examine the effectiveness of a group-based self-management support program for anxiety disorders as an add-on to treatment-as-usual in community-based care settings.Methods/designWe will conduct a multicentre pragmatic randomized controlled trial with a pre-treatment, post-treatment (4-month post-randomization), and follow-ups at 8, 12 and 24-months.Treatment and control groupsa) group self-management support (10 weekly 2.5-h group web-based sessions with 10–15 patients with two trained facilitators); b) treatment-as-usual. Participants will include adults meeting DSM-5 criteria for Panic Disorder, Agoraphobia, Social Anxiety Disorder, and/or Generalized Anxiety Disorder. The primary outcome measure will be the Beck Anxiety Inventory; secondary outcome measures will comprise self-reported instruments for anxiety and depressive symptoms, recovery, self-management, quality of life, and service utilisation.Statistical analysisData will be analysed based on intention-to-treat with a mixed effects regression model accounting for between and within-subject variations in the effects of the intervention.DiscussionThis study will contribute to the limited knowledge base regarding the effectiveness of structured group self-management support for anxiety disorders. It is expected that changes in patients’ self-management behaviour will lead to better anxiety management and, consequently, to improved patient outcomes.Trial registrationClinicalTrials.gov: NCT05124639. Prospectively registered 18 November 2021.

Chronic physical health conditions up to five years after serious orthopaedic injury

BackgroundInformation about the prevalence of chronic physical health conditions following serious orthopaedic injury is currently lacking in the general population and is essential for quantifying the burden of injury and improving outcomes. ObjectivesTo determine the prevalence of chronic physical health conditions recorded within hospitalisations and emergency department presentations and associated factors five years following serious orthopaedic injury. MethodsWe conducted a registry-based cohort study using data from the Victorian State Trauma Registry (2007–2016) linked with hospital admissions and ED presentations for 16,249 adults with serious orthopaedic injuries. We considered that people who were admitted to hospital or presented to an emergency department with a chronic physical health condition one to five years post-injury had “new-onset” conditions. We applied Kaplan-Meier failure curves and Cox proportional hazard regression models to determine factors associated with new-onset conditions. ResultsThere were 1420 people (11.0%) with at least one new-onset condition. Cancer (6.1%), cardiovascular disease (5.1%) and hypertension (6.2%) were the three most common “new-onset” chronic physical health conditions. Older adults, women, smokers, and people with mental health and alcohol and drug-related conditions had a higher risk of hospitalisation or emergency department presentation with new-onset conditions post-injury. ConclusionPeople with serious orthopaedic injuries experienced a significant additional burden of chronic physical health conditions up to five years after serious orthopaedic injury, posing a new challenge to post-trauma care. Early preventive interventions may be required in people with serious orthopaedic injuries to minimise modifiable risk factors such as smoking, excessive consumption of alcohol or drug use.

Mental health concerns and childhood chronic physical health conditions: a narrative review

Mental health concerns and childhood chronic physical health conditions: a narrative review

Experiences of adolescent and young adult cancer survivors during the COVID-19 pandemic.

PurposeThis study aimed to evaluate the impact of the COVID-19 pandemic on adolescent and young adult (AYA) cancer survivors.MethodsWe conducted a cross-sectional survey of AYAs aged 18–49 with cancer in Canada between January and February 2021. Data from survivors, defined as AYAs more than one year off cancer treatment, were analysed. Multiple logistic regression was used to identify factors associated with psychological distress, loneliness and insomnia.ResultsThe analysis included 384 survivors. Moderate-to-severe psychological distress was reported by 257 (68.9%) survivors and was associated with an income ≥ $60,000 (adjusted odds ratio [AOR] 2.15, 95% CI 1.11–4.17) and the presence of a pre-existing chronic physical health condition (AOR 2.05, 95% CI 1.18–3.56). Loneliness was reported by 204 (54.0%) survivors and was associated with being unemployed (AOR 2.26 95%CI 1.18–4.31), pandemic causing finances to be worse (AOR 1.82, 95%CI 1.08–3.06) and the presence of a pre-pandemic mental health condition (AOR 1.88, 95% CI 1.03–3.42). Clinical insomnia was reported by 74 (19.5%) survivors and was associated with employment status as a student (AOR 3.00, 95% CI 1.08–8.29) or unemployed (AOR 3.97, 95% CI 1.46–10.83), earning $60,000 or more in the year 2020 (AOR 4.36, 95% CI 1.43–13.32), having haematologic cancer (AOR 2.21, 95% CI 1.05–4.70) and being single (AOR 2.52, 95% CI 1.08–5.91). Pandemic negatively affected employment, finances, physical activity, cancer care and substance use for 73.9%, 66.5%, 32.5%, 21.8% and 19.2% of survivors, respectively. Worries about finances, contracting COVID-19, cancer treatment increasing the risk of COVID-19 infection, and having poor health outcomes from contracting COVID-19 were reported by 46.0%, 45.6%, 55.0% and 47.3% of survivors, respectively.ConclusionsThe COVID-19 pandemic has had a significant impact on AYA cancer survivors, and these individuals report high levels of psychological distress, insomnia and loneliness.Implications for Cancer Survivors.Cancer survivors are at risk for worsening mental and physical health outcomes during the COVID-19 pandemic. Targeted interventions and support programs are urgently needed to support the mental health of AYA cancer survivors and optimize their health outcomes.Supplementary InformationThe online version contains supplementary material available at 10.1007/s11764-021-01158-9.

Subjective Aging and Objectively Assessed Hearing Function: A Prospective Study of Older Adults.

Subjective aging is consistently related to a range of health-related outcomes, but little is known about its relationship with sensory functioning. The present prospective study tested whether subjective age and self-perceptions of aging (SPA) are associated with objective hearing function. Participants were 7,085 individuals aged 50-93 years (60% women, mean = 65.15, standard deviation [SD] = 8.71) from the Health and Retirement Study. Measures of subjective age, SPA, and information on demographic factors were obtained in 2008/2010. Objective hearing function was assessed 8 years later in 2016/2018. Furthermore, potential mediating variables (C-reactive protein, body mass index, physical inactivity, and chronic conditions) were assessed in 2012/2014. In regression analyses that accounted for demographic factors, older subjective age and negative SPA were associated with lower hearing acuity 8 years later. In addition, 1 SD older subjective age and negative SPA were related to a 9% and 7% higher likelihood of hearing impairment. Mediation analyses revealed that physical inactivity and chronic conditions partially mediated subjective age and SPA associations with hearing acuity. There was little evidence that the link between subjective aging and hearing was moderated by hearing aids and partial support for a moderating role of age. This study provides new evidence that subjective aging is prospectively related to hearing function. Individuals with older subjective age or negative SPA have unfavorable behavioral and clinical profiles that explain part of their lower hearing function. Individuals' experience with their aging process is a marker of risk for impaired hearing.

Protocol for READY2Exit: a patient-oriented, mixed methods study examining transition readiness in adolescents with co-occurring physical and mental health conditions

AbstractBackgroundUp to 57% of adolescents and young adults (AYA) with chronic physical health conditions experience mental health conditions, the presence of which contributes to increased morbidity and poor quality of life. AYA with co-occurring physical and mental health conditions, therefore, may experience additional challenges as they transition from pediatric to adult services. While transition readiness – the acquisition of self-management and advocacy skills – contributes to successful transitions to adult care, this concept has not been adequately explored for AYA with co-occurring physical and mental health conditions. Research is needed to identify whether the presence of a mental health comorbidity is associated with transition readiness, and what the experiences of AYA with co-occurring conditions are as they exit pediatric services. This paper outlines the protocol for theReadiness andExperiences ofADolescents andYoung Adults with Co-occurring Physical and Mental Health ConditionsExiting Pediatric Services (READY2Exit) study; the first study to address this gap using a patient-oriented, mixed methods design.MethodsA sequential explanatory mixed methods design will be used to understand the transition readiness of 16–21 year olds with physical and mental health conditions using quantitative and qualitative data. First, Transition Readiness Assessment Questionnaire (TRAQ) scores will be compared among AYA with chronic health conditions, with and without mental health comorbidity. Interviews will then be conducted with approximately 15 AYA with co-occurring health and mental health conditions and analyzed using qualitative description. The READY2Exit study will be conducted in collaboration with five Young Adult Research Partners (YARP) aged 18–30 with lived experience in the health/mental health systems across Canada. The YARP will partner in key tasks such as interview guide co-design, data interpretation, and knowledge translation tool development.DiscussionAYA with co-occurring physical and mental health conditions may have unique needs as they prepare for health care transitions. The results of this study will inform the refinement of transition readiness practices to improve care for this group. The active involvement of the YARP across study phases will bring the critical perspectives of young adults to READY2Exit, ensuring the methods, research approaches and outputs align with their needs.

Prevalence and Correlates of Physical Comorbidities in Alcohol Use Disorder (AUD): a Pilot Study in Treatment-Seeking Population

This study aimed to understand the prevalence of physical comorbidities, undiagnosed and inadequately controlled chronic physical conditions and correlates of high cholesterol, hypertension and liver enzyme abnormalities in those with alcohol use disorder (AUD). Participants (n = 101) with AUD were recruited from a tertiary care centre through convenient sampling. The prevalence of physical and psychiatric comorbidities in the sample was 83.17% and 51.49%, respectively. Around 53.47% had two or more chronic physical conditions (multimorbidity). Hypertension (44.55%), asthma (23.76%), high cholesterol (22.77%) and liver enzyme abnormalities (21.78%) were the top four physical comorbidities. The prevalence of undiagnosed and inadequately controlled chronic physical conditions was 61.4% and 32.7%, respectively. Gender, education and body mass index (BMI) were associated with hyperlipidaemia while age and education were associated with hypertension. Higher waist-hip ratio was associated with liver enzyme abnormalities. Routine clinical care must include regular screening and follow-up of the risk groups to monitor their physical and mental health.

Association between physical multimorbidity and sleep problems in 46 low- and middle-income countries

BackgroundLittle is known about the association between multimorbidity (i.e., two or more chronic conditions) and sleep problems in the general adult populations of low- and middle-income countries (LMICs). Thus, we aimed to assess this association among adults from 46 LMICs, and to quantify the extent to which anxiety, depression, stress, and pain explain this association. MethodsCross-sectional, predominantly nationally representative, community-based data from the World Health Survey were analyzed. Nine chronic physical conditions (angina, arthritis, asthma, chronic back pain, diabetes, edentulism, hearing problems, tuberculosis, visual impairment) were assessed. To be included in the analysis, sleep problems had to have been experienced in the past 30 days and to have been severe or extreme; they included difficulties falling asleep, waking up frequently during the night or waking up too early in the morning. Multivariable logistic regression and mediation analyses were conducted to explore the associations. ResultsData on 237,023 individuals aged ≥18 years [mean (SD) age 38.4 (16.0) years; 49.2% men] were analyzed. Compared with no chronic conditions, having 1, 2, 3, and ≥4 conditions was associated with 2.39 (95%CI=2.14, 2.66), 4.13 (95%CI=3.62, 4.71), 5.70 (95%CI=4.86, 6.69), and 9.99 (95%CI=8.18, 12.19) times higher odds for sleep problems. Pain (24.0%) explained the largest proportion of the association between multimorbidity and sleep problems, followed by anxiety (21.0%), depression (11.2%), and stress (10.4%). ConclusionsMultimorbidity was associated with a substantially increased odds for sleep problems in adults from 46 LMICs. Future studies should assess whether addressing factors such as pain, anxiety, depression, and stress in people with multimorbidity can lead to improvement in sleep in this population.

Chronic Physical Health Conditions After Injury: A Comparison of Prevalence and Risk in People With Orthopedic Major Trauma and Other Types of Injury

ObjectivesTo determine (1) the prevalence of chronic physical health conditions reported preinjury, at the time of injury, up to 1 year postinjury, and 1 to 5 years postinjury; and (2) the risk of chronic physical health conditions reported 1 to 5 years postinjury in people with orthopedic and other types of major trauma. DesignCohort study using linked trauma registry and health administrative datasets. SettingThis study used linked data from the Victorian State Trauma Registry (VSTR), the Victorian Registry of Births, Deaths and Marriages (BDM), the Victorian Admitted Episodes Dataset (VAED), and the Victorian Emergency Minimum Dataset (VEMD). ParticipantsMajor trauma patients (N=28,522) aged 18 years and older who were registered by the VSTR, with dates of injury from 2007 to 2016, and who survived to at least 1 year after injury, were included in this study. Major trauma cases were classified into 4 groups: (1) orthopedic injury, (2) severe traumatic brain injury (s-TBI), (3) spinal cord injury, and (4) other major trauma. InterventionNot applicable. Main Outcome MeasurePrevalence of chronic physical health conditions. ResultsThe cumulative prevalence of any chronic physical health condition for all participants was 69.3%. The s-TBI group had the highest cumulative prevalence of conditions. The most common conditions were arthritis and arthropathies, cancer, and cardiovascular diseases. Preinjury chronic conditions were most common in people with s-TBI (19.3%) and were least common in people with other types of major trauma (6.6%). The highest prevalence of new-onset conditions after injury was found in people with s-TBI (21.7%) and orthopedic major trauma (21.4%), whereas the lowest prevalence was found in people with other types of major trauma (9.2%). For the orthopedic injury group, there were no significant differences in the adjusted risk of conditions reported 1 to 5 years postinjury compared with other major trauma groups. ConclusionsChronic physical health conditions were common among all injury groups. There was no significant difference in the risk of chronic conditions among injury groups. Rehabilitation practitioners should be aware of the risk of chronic conditions in people with orthopedic and other types of major trauma. Long-term follow-up care after injury should include prevention and treatment of chronic conditions.

Mobile applications for the management of chronic physical conditions: a systematic review.

Chronic physical conditions (CPC) decrease the quality of life of millions of people. In the absence of curative treatments, maintaining healthy lifestyle habits is one of the main pillars in their clinical management. Mobile-based interventions may help patients take care of their health and follow medical recommendations. The purpose of this review is to summarise the latest evidence about mobile telephone applications (apps) for the management of CPC. We performed a systematic search of the PubMed and EMBASE databases to identify articles that explored apps for the management of CPC, testing the apps empirically and providing clear outputs on effectiveness and/or feasibility. A total of 3528 articles were identified in the initial search. Following screening and selection process, 20 articles were included in the final review. Mobile apps for CPC are very heterogeneous. The condition with the greater number of apps available was diabetes, followed by cardiovascular diseases. Results of feasibility were generally positive, with high rates of study completion and user engagement. Some studies used incentives, monetary of otherwise. Some of the apps have been tested in randomised controlled trials showing effectiveness in improving symptoms and/or controlling analytical parameters. Mobile apps are promising tools for the management of CPC. Some apps have been sufficiently tested to propose their implementation in clinical practice. However, several barriers exist that can slow down the routine use of new technologies in healthcare settings.