Future Medical Treatment Research Articles

Triglycerides/HDL cholesterol ratio and type 2 diabetes incidence: Panasonic Cohort Study 10

BackgroundPrevious studies have investigated the association between the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) and the incidence of diabetes in adults and discovered that a high TG/HDL-C ratio was linked to an elevated risk of new-onset diabetes. However, the comparison of predicting diabetes development among lipid profiles including the TG/HDL-C ratio, and the ratio of TG/HDL-C cut-off value has received limited attention. We examined the relationship between diabetes onset and the TG/HDL-C ratio in addition to the applicable cut-off value for predicting diabetes onset.MethodsThis study included 120,613 participants from the health examination database at Panasonic Corporation from 2008 to 2017. Cox regression analysis employing multivariable models was used to investigate the association between lipid profiles, particularly the ratio of TG/HDL-C and the development of type 2 diabetes (T2D). The multivariable model was adjusted for age, sex, BMI, systolic blood pressure, plasma glucose levels after fasting, smoking status, and exercise habits. Areas under time-dependent receiver operating characteristic (ROC) curves (AUCs) were employed to assess the prediction performance and cut-off values of each indicator. A fasting plasma glucose level of 126 mg/dL, a self-reported history of diabetes, or usage of antidiabetic medicines were used to identify T2D.ResultsDuring the course of the study, 6,080 people developed T2D. The median follow-up duration was 6.0 (3–10) years. Multivariable analysis revealed that the ratio of TG/HDL-C (per unit, HR; 1.03 [95% CI 1.02–1.03]) was substantially linked to the risk of incident T2D. AUC and cut-off points for the ratio of TG/HDL-C for T2D development after 10 years were 0.679 and 2.1, respectively. Furthermore, the AUC of the ratio of TG/HDL-C was considerably larger compared to that of LDL-C, HDL-C, and TG alone (all P < 0.001). We discovered an interaction effect between sex, BMI, and lipid profiles in subgroup analysis. Females and participants having a BMI of < 25 kg/m2 showed a higher correlation between lipid profile levels and T2D onset.ConclusionsThe ratio of TG/HDL-C was found to be a stronger predictor of T2D development within 10 years than LDL-C, HDL-C, or TG, indicating that it may be useful in future medical treatment support.

Is there interest of Mexican adults in being prepared should they develop Alzheimer’s or other dementia?

Introduction. Alzheimer's disease, as well as other dementias, cause a progressive deterioration of cognitive functions, preventing patients from making decisions and having control over themselves in an advanced stage of the disease. Objective. To explore some expectations, wishes and preferences in a sample of mature adults should they develop Alzheimer or other dementia. Method. We surveyed 368 mature Mexican adults without dementia using a large survey created by the authors and used in a previous study; data were collected in some public places where mature people were invited to participate. The survey was completed from July 2019 to August 2020. Results. Although most participants had considered they might suffer from dementia in the future, less than half had communicated their wishes to their relatives about future medical treatments in case they could no longer decide for themselves; very few had prepared a written advance directive. Most participants agreed that patients should know their initial diagnosis, mainly to be able to prepare themselves. The main reason given by those who would prefer to hide the diagnosis was to avoid suffering. Discussion and conclusion. Our results highlight the need for health professionals to promote discussion with people about the possibility of suffering from dementia, as well as the importance of making decisions in advance, and letting their relatives know about them.

Deployment of a Digital Advance Care Planning Platform at an Accountable Care Organization.

Advance care planning (ACP), a process of sharing one's values and preferences for future medical treatments, can improve quality of life, reduce loved ones' anxiety, and decrease unwanted medical utilization and costs. Despite benefits to patients and health care systems, ACP uptake often remains low, due partially to lack of knowledge and difficulty initiating discussions. Digital tools may help reduce these barriers to entry. We retrospectively examined data from pilot deployment of Koda Health patient-facing ACP among Houston Methodist Coordinated Care patients, for quality improvement (QI) purposes. Patients referred by nurse navigators could access Koda's digital platform, complete ACP, and share the legal documentation generated. Analyzed measures include usage rates and ACP-related decisions within the platform. Of eligible patients (n = 203), 52.7% voluntarily completed their plan. Engagement and completion rates were similar across demographics. Patients indicated majority preference (66.4%) toward spending the last days of life at home. Most patients indicated wanting no life-support intervention if quality of life became unacceptable (51 to 71% across 4 treatments). Life-support decisions were similar between demographic categories, excepting CPR and dialysis, wherein a greater portion of Black patients than White patients preferred at least trial intervention, rather than none. As an observational QI analysis, limitations include bounded geographical reach and lack of data on ACP impacts to subsequent health care utilization, which future studies will address. Findings suggest that digital health tools like Koda can effectively facilitate equitable ACP access and may help support health systems and providers in offering comprehensive ACP.

The management of pediatric Graves' disease.

Graves' disease (GD) constitutes a significant proportion of thyroid disorders seen during childhood. Several specialties may be closely involved in the management of pediatric patients with GD and emerging research in each field contributes to variations in the approach over time. Here we review the recent literature on the management of the disease, with the hope that this can be a valuable resource for treating specialists who need to be continuously updated on new data obtained in relevant fields. Genetic, postinfectious and environmental factors may play a role in the immunological pathophysiology of GD. Research performed during the COVID-19 pandemic supports that viral-induced immune dysregulation may be a possible trigger for the disease. The various current treatment options all have positive and negative factors to consider. Antithyroidal drug therapy (ATD) is generally recommended as the initial treatment, although remission rates are only 20-30% at 2 years and 75% at 9 years. Unfortunately, about half of patients will relapse within 1 year of discontinuing therapy. Radioactive iodine therapy (RAI) is an effective treatment option and can be considered in certain pediatric patients. There continues to be no definitive evidence that the doses used for GD lead to a higher risk of cancer. Surgical treatment via thyroidectomy is effective and safe when performed by a high-volume surgeon. Recent studies show improvement in quality-of-life after surgery in adolescents and young adults. Future medical treatment options for GD currently being studied include antigen-specific immunotherapy and monoclonal antibodies. Although the future holds promising new therapeutic options for autoimmune diseases including GD, the current choices continue to be ATD, usually first-line, and definitive treatments including RAI and surgery. While all three offer the possibility of remission or cure, drug therapy and RAI have a possibility of relapse. Risks of each approach should be broached in detail with patients and their families, and the nuances of treating this disease specifically in children should be familiar to all treating providers.

Palliative Care in Amyotrophic Lateral Sclerosis.

Amyotrophic lateral sclerosis (ALS) is an incurable neurodegenerative disease of the motor neurons. Given the evolutive characteristics of this disease, palliative care principles should be a foundation of ALS care. A multidisciplinary medical intervention is of paramount importance in the different phases of disease. The involvement of the palliative care team improves quality of life and symptoms, and prognosis. Early initiation is of paramount importance to ensuring patient-centered care, when the patient has still the capability to communicate effectively and participate in his medical care. Advance care planning supports patients and family members in understanding and sharing their preferences according to their personal values and life goals regarding future medical treatment. The principal problems which require intensive supportive care include cognitive disturbances, psychological distress, pain, sialorrhrea, nutrition, and ventilatory support. Communication skills of health-care professionals are mandatory to manage the inevitability of death. Palliative sedation has peculiar aspects in this population, particularly with the decision of withdrawing ventilatory support.

Precautionary planning at the end of life from a palliative care point of view

What happens when you are no longer able to make medical decisions yourself? The constant increase in the number of people in need of care has led to the concept of advance care planning (ACP). This is a forward-looking, ongoing, and constantly reflective process of discussion regarding preferences and values for future medical and nursing treatments. ACP can sustainably improve the medical and nursing landscape as well as psychosocial care, so that people are treated according to their wishes, even if they can no longer be asked about their treatment wishes. The implementation strategy is dependent on this, as presented in studies. This also includes the financial support of such implementation projects, because only the talks alone, which are exclusively refinanced by §132g SGB V, do not lead to a cultural change regarding the importance of self-determination and dealing with living wills, as well as an improvement in treatment, care, and support for people in the health system.

Advance Care Planning in Huntington Disease: The Elderly Care Physician's Perspective

ObjectiveHuntington disease (HD) has a poor prognosis. Decision-making capacity and communication ability may become impaired as the disease progresses. Therefore, HD patients are encouraged to engage in advance care planning (ACP). Elderly care physicians (ECPs) can play an important role in ACP in HD patients. However, little is known about their experiences in this role. The aim of this study is to gain insight into how ECPs practice ACP with HD patients. DesignA qualitative interview study. Setting and ParticipantsNine ECPs working in HD-specialized nursing homes in the Netherlands. MethodsWe conducted semistructured interviews with ECPs between June 2018 and July 2020. ResultsTwo phases could be identified in the process of ACP. In the first phase, when the feared future seems to be far away, the ECP asks about the patient's wishes for the future in an accommodating manner. In the second phase, when the feared future is closer, future medical treatment and care becomes less hypothetical. Agreement has to be reached on upcoming treatment decisions. In this phase, the ECP takes a more guiding role, and consequently encounters more difficulties, such as maintaining a positive patient/family-physician relationship while dealing with disagreements with patient or family. Most participants shared their experiences with euthanasia when asked about ACP. When making a comparison of ACP between HD patients and patients with other neurodegenerative disorders in nursing homes, the ECPs emphasized the similarities. Conclusions and ImplicationsACP in HD can be classified into 2 phases, which differ in ECPs’ approach and the complexity experienced by the ECP. Awareness of this finding may help to further develop training and education in ACP, including dealing with euthanasia, to make ECPs feel better equipped in practicing ACP in HD.

Experiences of dialogue in advance care planning educational programs.

Advance care planning (ACP) is a process in which adults engage in an ongoing dialogue about future medical treatment and care. Though ACP is recommended to improve the quality of end-of-life care, the details of the dialogue experience in ACP are unknown. To explore participants' experiences of dialogue in an ACP educational program that encouraged them to discuss the value of a way of life. This qualitative descriptive study used the focus group interview method. Data were analyzed using qualitative content analysis. A dialogue-based ACP educational program was conducted in four regions in Japan for local citizens to discuss the value of their way of life. A total of 66 individuals (mean age = 55.5 ± 17.2years; 50 women and 16 men) participated in focus group interviews. This study was approved by the Ethical Review Committee of Tokyo Women's Medical University (no. 4723) and Kyoto University (no. R2099). Five main themes were extracted: discussing one's thoughts with others in a considerate manner, reflecting on one's way of life through others, feeling a sense of connection with others through storytelling, realizing the difficulties of talking about "what if" topics, and turning one's eyes toward the future through the dialogue. These themes were interrelated and illustrated the complexity of the experience of discussing values. The results suggest that dialogue in ACP is useful in clarifying values. They also indicated the need for dealing with the ethical challenges of discussing value and the importance of caring for the interlocutor to have a safe dialogue. In the ACP process, safety in dialogue may improve readiness in ACP, and health practitioners who support ACP need to address the ethical challenges entailing dialogue about values.

Familiarity with and Dissemination of Advance Directives in Germany: Results of a Representative Survey of the General Population

With an advance directive, people can make provisions for the case of incapacity to give consent with regard to future medical and nursing treatment decisions. Currently, there are no data available on how well known and widespread advance directives are in the population in Germany. The aim of the study was, in addition to record awareness and dissemination, to find out more about the reasons for (not) writing an advance directive and about information and support used by people. An online survey of a representative sample of the general population (n=1000) was conducted. The data were analysed descriptively and by means of regression analysis. The survey showed that 92% of the sample knew about advance directives, and 37% had already created one. The probability of having already written an advance directive increases with increasing age. The reported reasons for (not) writing were heterogeneous. Almost 2/3 of all respondents had already accessed information on this topic, mainly via the Internet. The majority of those surveyed was not aware of any support available in drafting the advance directive. These findings provide suggestions for tailoring information and support services.

Predictive value of clinician impression for readmission and postdischarge mortality among neonates and young children in Dar es Salaam, Tanzania and Monrovia, Liberia

BackgroundThere are no validated clinical decision aids to identify neonates and young children at risk of hospital readmission or postdischarge mortality in sub-Saharan Africa, leaving the decision to discharge a...

Defining advance care planning from the perspective of people with dementia: Focus groups with the European Working Group of People with dementia

AbstractBackgroundThe European Association for Palliative Care (EAPC) defines advance care planning (ACP) as a process enabling individuals with decisional capacity to define goals and preferences for future medical treatment and care, discuss these with family and health‐care providers, and record and review them if appropriate. There are concerns that this and other definitions may not apply to ACP in the context of dementia. ACP needs for people with dementia differ from those of people with other diseases. Furthermore, current definitions are not informed by input from people with dementia, but rely on professional expert recommendations. We gathered the perspectives of the European Working Group of People with Dementia (EWGPWD) regarding the EAPC ACP definition to explore its applicability in the context of dementia.MethodsWe conducted 3 online focus groups with members of the EWGPWD (n = 12) and their supporters (n = 9). We deconstructed ACP in four topics revolving around the what, why, who, and when of ACP to guide discussions. To analyze the data, we used inductive thematic analysis.ResultsThree key issues were highlighted as important to consider in an ACP definition which would be inclusive for people with dementia. First, participants disagreed with the focus on people with decisional capacity, as they saw loss of capacity as a gradual process that depends on context and should be supported throughout the dementia trajectory. Second, although some noted that family dynamics vary, the essential role of families or trust‐based relationships was found to be under‐addressed, as families were generally considered to have personal knowledge of the person with dementia. Third, participants suggested that ACP is too centered on medical care. It should include broader conversations on what matters to people in the future, social care, and future daily life activities.ConclusionWe identified three points of contention with the EAPC ACP definition corresponding to dementia‐specific issues. The perspectives of the EWGPWD emerging from our focus groups contribute to the understanding of ACP in the context of dementia and highlight the need for a dementia‐inclusive ACP definition focusing on the issues of decisional capacity, family involvement and social aspects of care.

Heterogeneity of vascular cells in different breast cancer subtypes revealed by single-cell RNA-seq analysis

Breast cancer is a common type of malignant tumor developing from breast tissue that happens in women, which can be triggered by both genetic and environmental factors. Nowadays, it is increasing recognized as a global public health problem. Despite some treatments have been used, there are still many challenges in treating breast cancer due to the recurrence and metastasis. The development of single-cell RNA sequencing (scRNA-seq) technology has shown great potential in deeply discovering the molecular mechanism of breast cancer. In this study, we processed scRNA-seq data of patients from different types of breast cancer subtypes, extracted and integrated the vascular cells, and found a distinct tumor-specific endothelial cell. The results not only showed the power of meta-analysis of existing single-cell data, but also revealed the detailed characteristics of vascular cells in different conditions, yielding light to future medical treatments in breast cancer.

Barriers and facilitators for healthcare professionals to the implementation of Multidisciplinary Timely Undertaken Advance Care Planning conversations at the outpatient clinic (the MUTUAL intervention): a sequential exploratory mixed-methods study

BackgroundAdvance Care Planning (ACP) enables patients to define and discuss their goals and preferences for future medical treatment and care. However, the structural implementation of ACP interventions remains challenging. The Multidisciplinary Timely Undertaken Advance Care Planning (MUTUAL) intervention has recently been developed which takes into account existing barriers and facilitators. We aimed to evaluate the MUTUAL intervention and identify the barriers and facilitators healthcare professionals experience in the implementation of the MUTUAL intervention and also to identify suggestions for improvement.MethodsWe performed a sequential exploratory mixed-methods study at five outpatient clinics of one, 300-bed, non-academic hospital. Firstly, semi-structured interviews were performed with a purposive sample of healthcare professionals. The content of these interviews was used to specify the Measurement Instrument for Determinants of Innovations (MIDI). The MIDI was sent to all healthcare professionals. The interviews and questionnaires were used to clarify the results.ResultsEleven healthcare professionals participated in the interviews and 37 responded to the questionnaire. Eight barriers and 20 facilitators were identified. Healthcare professionals agreed that the elements of the MUTUAL intervention are clear, correct, complete, and simple - and the intervention is relevant for patients and their proxies. The main barriers are found within the user and the organisational domain. Barriers related to the organisation include: inadequate replacement of staff, insufficient staff, and insufficient time to introduce and invite patients. Several suggestions for improvement were made.ConclusionOur results show that healthcare professionals positively evaluate the MUTUAL intervention and are very receptive to implementing the MUTUAL intervention. Taking into account the suggestions for improvement may enhance further implementation.

Multi-Wavelength Light-Responsive Metal-Phenolic Network-Based Microrobots for Reactive Species Scavenging.

Light-driven microrobots with different propulsion mechanisms have attracted great attention in microrobot synthesis and applications. However, current systems rely heavily on precious metals, using a complex synthesis process and limited working wavelength. It is therefore of great interest to fabricate microrobots that can be driven by multi-wavelength irradiation and with simple components. Here, metal-phenolic network (MPN)-based microrobots are synthesized using a sacrificial polystyrene bead template and an extra capping is added to regulate their symmetry. The hollow MPN microrobots with different layers of capping are capable of moving under both near-infrared (NIR) irradiation and ultraviolet (UV) irradiation, without fuel. The velocity of the microrobots under irradiation is altered by the thickness of the asymmetric capping and their motion could be manipulated remotely by switching the NIR or UV irradiation on and off. With light-driven mobility, the reactive oxygen and nitrogen species (RONS) scavenging activity of the microrobots is significantly increased. Therefore, this proposed microrobot system provides a synthesis strategy to develop asymmetric light-navigated microrobots for future medical treatment with tunable structure, multi-wavelength light-responsive mobility, and great RONS scavenging capacity.

Advance Care Planning With Black Women with Breast Cancer: A Community Health Worker Model.

Despite the importance of advance care planning (ACP), a process that optimizes future medical treatment and end-of-life care, for at-risk populations, rates of patient-provider ACP conversations are extremely low among Black women with breast cancer. Community health workers (CHWs) are well-positioned to support patients in engaging in ACP conversations with their providers; yet research on integrating CHWs to promote ACP is scant. The current study examined multilevel facilitators and barriers to successful ACP conversations among Black women from the perspective of providers and CHWs who serve this community. Providers and CHWs were recruited from an academic medical center in a large urban city. Retrospective qualitative data on barriers and facilitators to ACP conversations, as well as CHWs' training needs, were collected from two focus groups (N = 5 providers, N = 5 CHWs) and one individual interview (N = 1 provider), and transcribed and coded for themes. All providers reported working primarily with Black patients, and identified stigma and time constraints as major barriers to ACP discussions; they also identified the structural barriers and injustices that their patients face during medical care. CHWs reported having a trusted relationship with their patients and flexibility in their care that would allow for ongoing ACP conversations, discussing their ability to serve as a bridge between the patient and provider. However, CHWs discussed that they lacked the tools and skills to have ACP conversations, largely because existing formal trainings in ACP are cost prohibitive. Competing priorities of the provider to discuss/treat the patient's disease and medical mistrust were major barriers to successful ACP conversations among Black women with breast cancer, leading to ACP completion occurring late in treatment. CHWs are uniquely qualified to overcome multilevel barriers to ACP and establish trusting relationships with patients in order to facilitate earlier and ongoing communication between patients and providers.

THE RELATIONSHIP BETWEEN HEALTHCARE STEREOTYPE THREAT AND ADVANCE CARE PLANNING AMONG HISPANIC PATIENTS

Abstract Experiencing ethnic/racial stereotype threat, the psychological experience of confronting stereotypes in the healthcare system, has been found to negatively impact healthcare outcomes (e.g. dissatisfaction with healthcare, poorer mental and physical health, higher physician distrust). Few studies have examined healthcare stereotype threat among Hispanics, and no study has tested how it might impact advance care planning outcomes among Hispanic hospitalized patients. This study aims to examine the relationship between healthcare stereotype threat and advance care planning activities among Hispanic hospitalized patients. We analyzed secondary data collected from a feasibility study of a palliative care educational intervention among 50 Spanish-speaking, Hispanic patients, over the age of 40, who were hospitalized in a large public hospital. Fifty percent had discussed future care if they were to become seriously ill, 18% had written instructions about their care (living will or advance directive), and 32% had a durable power of attorney (proxy) for healthcare. Results of logistic regressions revealed that greater healthcare stereotype threat scores were associated with lower odds of having discussed future care or medical treatment with others (OR=0.49, p=.03). However, healthcare stereotype threat scores were not associated with having provided written instructions about future medical care (OR=0.44; p=0.07), or with having a durable power of attorney for healthcare (OR=0.89; p=0.76). Future research should investigate ways to improve the cultural sensitivity in broaching discussions of future medical treatment among seriously ill patients. Additionally, more research and attention to policy implication are needed to reduce racial stereotype threat experienced in the healthcare system.

Association of Chlamydia trachomatis infection with pregnancy outcomes among Japanese pregnant women: The Japan environment and children's study.

This study aimed to investigate the impact of Chlamydia trachomatis (CT) infection on pregnancy outcome in pregnant Japanese women. We utilized the data from a nationwide birth cohort study, the Japan Environment and Children's Study (JECS), for this study. We enrolled 26,385 individuals who could refer to data on pregnancy outcomes and confounding factors, with data on CT. Binominal logistic regression models were used to determine whether pregnant women with CT positivity were at more risk of experiencing adverse pregnancy outcomes, preterm birth (PTB), preterm prelabor rupture of membrane (pPROM), low birth weight (LBW) infants, small for gestational age (SGA) births, or hypertensive disorders of pregnancy (HDP). After adjusting for maternal age, parity, marital status, smoking status, and education status, there were no significantly increased risks of PTB, pPROM, LBW infants, SGA, and HDP in the odds ratios. No significant increase in the risk of adverse pregnancy outcomes was observed in any of the subgroup analyses, which were limited to the pregnancy women in Fukushima prefecture, where CT screening could be confirmed at 28-30 weeks of gestation. We believe that the results of this study will make a significant contribution to the future of medical care for pregnant women in Japan. Our findings are important for medical practitioners to contribute to the future medical treatment of Japanese pregnant women, and also to contribute to pre-conception care for Japanese society as a whole, including pregnant women.

Uncovering the promiscuous activity of IL-6 proteins: A multi-dimensional analysis of phylogeny, classification and residue conservation.

The IL‐6 family of cytokines, known for their pleiotropic behavior, share binding to the gp130 receptor for signal transduction with the necessity to bind other receptors. Leukemia inhibitory factor receptor is triggered by the IL‐6 family proteins: leukemia inhibitory factor (LIF), oncostatin‐M (OSM), cardiotrophin‐1 (CT‐1), ciliary neurotrophic factor (CNTF), and cardiotrophin‐like cytokine factor 1 (CLCF1). Besides the conserved binding sites to the receptor, not much is known in terms of the diversity and characteristics of these proteins in different organisms. Herein, we describe the sequence analysis of LIF, OSM, and CT‐1 from several organisms, and m17, a LIF ortholog found in fishes, regarding its phylogenetics, intrinsic properties, and the impact of conserved residues on structural features. Sequences were identified in seven classes of vertebrates, showing high conservation values in binding site III, but protein‐dependent results on binding site II. GRAVY, isoelectric point, and molecular weight parameters were relevant to differentiate classes in each protein and to enable, for the first time and with high fidelity, the prediction of both organism class and protein type just using machine learning approaches. OSM sequences from primates showed an increased BC loop when compared to the remaining mammals, which could influence binding to OSM receptor and tune signaling pathways. Overall, this study highlights the potential of sequence diversity analysis to understand IL‐6 cytokine family evolution, showing the conservation of function‐related motifs and evolution of class and protein‐dependent characteristics. Our results could impact future medical treatment of disorders associated with imbalances in these cytokines.

Catalogue of multimorbidity mean based severity and associational prevalence rates between 199+ chronic conditions-A nationwide register-based population study.

BackgroundReal-world data on multimorbidity represents an important but underutilised source of evidence for the planning of healthcare services, including prevention, treatments, and health economic modelling.AimsThis study aimed to estimate means of multimorbidity and provide associated prevalence rates and frequencies between 199 x 199 chronic conditions and disease groups based on the total adult Danish population and sex, age, and educational attainment. Thus, this study provides an off-the-shelf catalogue for use in treatments and planning by clinicians, decision-makers and researchers.MethodsThe study population contained all Danish residents above 16 years on 1 January 2013 (n = 4,555,439). The data was based on the linkage of six national registers covering hospital contacts, services in general practice, filled-in out-of-hospital prescriptions, and educational attainments. The health registers were used to identify the 199 chronic conditions based on the ICD-10 classification system.ResultsThe mean number of chronic conditions (NCC) was 2.2. The mean increased with age, women had a higher mean than men, and there was a social gradient with the mean increasing with lower educational attainment. The mean NCC varied from 3.3–9.8 among all conditions. Across disease groups, the highest mean NCC were found within disease group N (chronic renal failure, mean = 8.8), D (in situ and benign neoplasms; mean = 6.5), K (diseases of the digestive system; mean = 5.7), and H (diseases of the eye and the ear; mean = 5.6). The highest mean NCC among the 29 common diseases was heart failure, ischemic heart diseases, angina pectoris, stroke, and dementia, with a mean above 6.5. Several prevalent conditions like hypertension, arthritis, chronic lower respiratory diseases, depression, type 2 diabetes, and overweight transcended other conditions regarding the associated prevalence rates. As one of the most frequent, hypertensive diseases were highly associated with arthritis (50.4%), depression (37.4%), type 2 diabetes (75.4%), cancers (49.7%), and being overweight (39.7%)–meaning that 50.4% of people with arthritis, 37.4% of people with depression and so on also had hypertensive diseases. The largest differences in means between individuals with no educational attainment and individuals with high educational attainment were found within disease groups J (diseases of the respiratory system, ratio = 1.8), Q (congenital malformations, deformations, and chromosomal abnormalities, ratio = 1.7), and B (viral hepatitis and human immunodeficiency virus disease, ratio = 1.7).ConclusionsThe current study provides a nationwide off-the-shelf catalogue of multimorbidity means and real-world associations estimates of 199+ chronic conditions for future clinical treatments and health care systems planning. The findings described are just one example of numerous results and underline that multimorbidity is highly prevalent in the adult Danish population and that it is a vital condition transcending all future medical treatment. The data offer essential information on the multimorbidity burden of disease in future differentiated treatments, healthcare planning, and economic, aetiological, and other research.

Evolution of dynamics of physico-chemical and mechanical properties of hydroxyapatite with fluorine addition and degradation stability of new matrices

This multidisciplinary study examined sensitively the change in the dynamics of main mechanical performance, stability of crystal structure, crystallinity quality, strength, corrosion resistance, biocompatibility, resistance to structural degradation/separations and mechanical durability features of hydroxyapatite (HAp) biomedical materials based on the fluorine addition and degradation process to guide future medical and dental treatment studies. In the study, the fluorine ions were used to be the dental coating, filling and supporting material for biologically or synthetically produced bone minerals. The general characteristic properties were investigated by means of standard spectroscopic, structural and mechanical analysis methods including RAMAN, SEM-EDS, TEM, Vickers micro-indentation hardness and density measurements. A time dependent release test was performed to evaluate possible fluorine ion release after the degradation process. It was found that the fundamental characteristic properties of HAp biomedical materials are noted to improve with the increase in the fluoride level up to 2% due much more stabilization of HAp crystal system. The combination of RAMAN spectra and powder XRD analyzes indicates that 2% addition level affects positively the formation velocity of characteristic HAP phase. Besides, fluorine doped HAp materials all exhibited the main characteristic peaks after degradation process. This is attributed to the fact that the fluorine ions enabled the hydroxyapatite to enhance the structural quality and stability towards the corrosion environment. However, in case of excess dopant level of 3% the degradation rates were obtained to increase due to higher contribution rate and especially electrostatic interactions. As for the surface morphology examinations, 2% fluorine added HAp with the highest density of 3.0879 g/cm3 was determined to present the superior crystallinity quality (smallest grain size, best smooth surface, honeycomb pattern, regular shaped particles and densest particle distributions through the specimen surface). Conversely, the excess fluorine triggered to increase seriously degree of micro/macro porosity in the surface morphology and microscopic structural problems in the crystal system. Thus, the HAp doped with 3% was the most affected material from the degradation process. Additionally, the fluorine ion values read after the release process were quite far from the value that could cause toxic effects. Lastly, the optimum fluorine addition provides the positive effects on the highest durability, stiffness and mechanical fracture strength properties as a consequence of differentiation in the surface residual compressive stress regions (lattice strain fields), amplification sites and active operable slip systems in the matrix. Hence, the crack propagations prefer to proceed in the transcrystalline regions rather than the intergranular parts. Similarly, it was found that Vickers micro-indentation hardness tests showed that the microhardness parameters increased after the degradation process. All in all, the fluorine addition level of 2% was noted to be good choice to improve the fundamental characteristic properties of hydroxyapatite biomedical materials for heavy-duty musculoskeletal, orthopedic implant, biological and therapeutic applications in medicine and dentistry application fields.