Prevalence of disability according to multimorbidity and disease clustering: a population-based study

Background: The prevalence of chronic diseases has increased with population ageing, and research has attempted to elucidate the correlation between chronic diseases and disability. However, most studies in older populations have focused on the effect of single disabling conditions, even though most older adults have more than one chronic disease (multimorbidity). Objective: The aims of this study were to evaluate the association of disability with disease, in terms of multimorbidity and specified pairs of diseases, in a population-based study of older adults. Materials and Methods: Using the Kungsholmen Project, we estimated the prevalence of disability by the number of chronic diseases, disease status by organ systems, and in specific pairs of chronic conditions, in a Swedish population (n=1,099; ≥77 years). Disability was defined as need of assistance in at least one activity of daily living (Katz index). Results: Functional disability was seen in 17.9% of participants. It increased as the number of chronic diseases increased. The prevalence of disability varied greatly amongst specific pairs of diseases: from 6.7% in persons affected by hypertension and atrial fibrillation to 82.4% in persons affected by dementia and hip fracture. In multivariate logistic regression models, the disease pairs that were significantly associated with the highest increased relative odds of disability contained dementia (dementia–hip fracture, dementia–CVD, and dementia–depression). Conclusions: Our findings suggest specific pairs of diseases are much more highly associated with disability than others, particularly diseases coupled with dementia. This knowledge may improve prevention of disablement and planning of resource distribution.Journal of Comorbidity 2011;1(1):11–1

Long-term interleukin-6 levels and subsequent risk of coronary heart disease: Two new prospective studies and a systematic review

Background The relevance to coronary heart disease (CHD) of cytokines that govern inflammatory cascades, such as interleukin-6 (IL-6), may be underestimated because such mediators are short acting and prone to fluctuations. We evaluated associations of long-term circulating IL-6 levels with CHD risk (defined as nonfatal myocardial infarction [MI] or fatal CHD) in two population-based cohorts, involving serial measurements to enable correction for within-person variability. We updated a systematic review to put the new findings in context. Methods and Findings Measurements were made in samples obtained at baseline from 2,138 patients who had a first-ever nonfatal MI or died of CHD during follow-up, and from 4,267 controls in two cohorts comprising 24,230 participants. Correction for within-person variability was made using data from repeat measurements taken several years apart in several hundred participants. The year-to-year variability of IL-6 values within individuals was relatively high (regression dilution ratios of 0.41, 95% confidence interval [CI] 0.28-0.53, over 4 y, and 0.35, 95% CI 0.23-0.48, over 12 y). Ignoring this variability, we found an odds ratio for CHD, adjusted for several established risk factors, of 1.46 (95% CI 1.29-1.65) per 2 standard deviation (SD) increase of baseline IL-6 values, similar to that for baseline C-reactive protein. After correction for within-person variability, the odds ratio for CHD was 2.14 (95% CI 1.45-3.15) with long-term average ("usual'') IL-6, similar to those for some established risk factors. Increasing IL-6 levels were associated with progressively increasing CHD risk. An updated systematic review of electronic databases and other sources identified 15 relevant previous population-based prospective studies of IL-6 and clinical coronary outcomes (i.e., MI or coronary death). Including the two current studies, the 17 available prospective studies gave a combined odds ratio of 1.61 (95% CI 1.42-1.83) per 2 SD increase in baseline IL-6 (corresponding to an odds ratio of 3.34 [95% CI 2.45-4.56] per 2 SD increase in usual [long-term average] IL-6 levels). Conclusions Long-term IL-6 levels are associated with CHD risk about as strongly as are some major established risk factors, but causality remains uncertain. These findings highlight the potential relevance of IL-6-mediated pathways to CH

Assessing and measuring chronic multimorbidity in the older population: a proposal for its operationalization

Background Although the definition of multimorbidity as “the simultaneous presence of two or more chronic diseases” is well established, its operationalization is not yet agreed. This study aims to provide a clinically driven comprehensive list of chronic conditions to be included when measuring multimorbidity. Methods Based on a consensus definition of chronic disease, all four-digit level codes from the International Classification of Diseases, 10th revision (ICD-10) were classified as chronic or not by an international and multidisciplinary team. Chronic ICD-10 codes were subsequently grouped into broader categories according to clinical criteria. Last, we showed proof of concept by applying the classification to older adults from the Swedish National study of Aging and Care in Kungsholmen (SNAC-K) using also inpatient data from the Swedish National Patient Register. Results A disease or condition was considered to be chronic if it had a prolonged duration and either (a) left residual disability or worsening quality of life or (b) required a long period of care, treatment, or rehabilitation. After applying this definition in relation to populations of older adults, 918 chronic ICD-10 codes were identified and grouped into 60 chronic disease categories. In SNAC-K, 88.6% had =2 of these 60 disease categories, 73.2% had =3, and 55.8% had =4. Conclusions This operational measure of multimorbidity, which can be implemented using either or both clinical and administrative data, may facilitate its monitoring and international comparison. Once validated, it may enable the advancement and evolution of conceptual and theoretical aspects of multimorbidity that will eventually lead to better care

Association between the metabolic syndrome and its components and gait speed among U.S. adults aged 50 years and older: a cross-sectional analysis

BACKGROUND: To examine the relationship between the metabolic syndrome and its components and gait speed among older U.S. men and women. Whether these associations are independent of physical activity was also explored. METHODS: Eight hundred and thirty-five men and 850 women aged ≥50 years from the continuous National Health and Nutrition Examination Survey 1999–2002 were examined. We used the definition of the metabolic syndrome developed by the U.S. National Cholesterol Education Program Adult Treatment Panel III. Gait speed was measured with a 6.10-meter timed walk examination. RESULTS: The prevalence of the metabolic syndrome was 40.2% in men and 45.6% in women (P = .127). The prevalence of gait speed impairment was 29.3% in men and 12.5% in women (P < .001). No association was found between the metabolic syndrome and gait speed impairment. After including the individual components of the metabolic syndrome in a logistic model adjusted for age and leisure-time physical activity, abdominal obesity, low HDL cholesterol, and high fasting glucose were significantly associated with gait speed impairment among women (adjusted odds ratio [AOR] = 0.48, 95% confidence interval [CI] = 0.26 to 0.89; AOR = 2.26, 95% CI = 1.08 to 4.75; and AOR = 2.05, 95% CI = 1.12 to 3.74, respectively). Further adjustment for race/ethnicity, education, smoking status, alcohol consumption, arthritis status, and use of an assistive device attenuated these associations; among women, abdominal obesity and low HDL cholesterol remained significantly associated with gait speed impairment (AOR = 0.37, 95% CI = 0.18 to 0.76 and AOR = 2.45, 95% CI = 1.07 to 5.63, respectively) while the association between hyperglycemia and impaired gait speed attenuated to nonsignificance. CONCLUSION: Among women, gait speed impairment is associated with low HDL cholesterol and inversely with abdominal obesity. These associations may be sex-dependent and warrant further research

Western men and Eastern arts: The significance of Eastern martial arts disciplines in British men's narratives of masculinity

Previous Western sociological research on Eastern martial arts has identified a tension between ‘traditional’ Eastern forms of practice and ‘modernized’ Western methods of training and competition. In particular, the ‘sportization’ of Eastern styles, where combat-centred arts based upon moral philosophies have transformed more or less into competitive activities following Western models of rationalized sport, has been an important theme. However, it is also suggested that Eastern martial arts hold special significance in the West for their seemingly esoteric nature. In this regard, such martial arts are considered significant because they are not ‘sports’, but rather disciplines, with fairly different connotations for practitioners. Drawing on interview data, this paper explores how Western practitioners of Eastern martial arts articulate this difference, principally by examining the place of martial artistry in British men's narratives of masculinity. Comparing themselves favourably to assumed, typical visions of Western sporting masculinity, such men draw upon the imagined uniqueness of their martial arts to construct a sense of moral superiority over other men. In so doing, they contribute to a rejection of what they believe to be ‘mainstream’ sporting Western masculinity, thus indicating the role that ‘alternative’ visions of physical culture can play in men's active constructions of gender

Incidence and predictors of multimorbidity in the elderly: a population-based longitudinal study.

Contains fulltext : 129951.pdf (publisher's version ) (Open Access

Firefighter Stress: Association between Work Stress, Posttraumatic Stress Symptoms and Cardiovascular Disease Risk

The effects of occupational stress on public servants who seek to protect and maintain security for the general public have begun to receive more attention in recent years. Most of this research has focused on police officers. Much less attention has been directed towards other first responders (i.e., firefighters, paramedics) except in comparisons with police samples or inclusion in mixed first responder groups. Investigative efforts that specifically target firefighters and their unique responses to occupational stress, the vulnerabilities of negative responses to stress, and the variables that enhance and maintain resiliency in these first responders is limited. Moreover, cardiovascular risk has been recognized in firefighters. However research has been focused on examining physical variables related to this risk with little attention to psychological contributions, particularly the role of posttraumatic stress disorder (PTSD) on cardiovascular disease (CVD). The goals of the current investigation were to (1) review research that has been conducted on stress in firefighters, (2) examine the effects of job stress, length of service, and critical incidents on developing PTSD and CVD risk (3) evaluate the relationship between PTSD and CVD risk in firefighters (4) increase our understanding of the manifestations of stress in this population, and (5) provide organizations and treatment providers potentially useful information for developing and improving assessment and intervention strategies. Firefighters from the Broward Sheriff\u27s Office special operations teams (N=87) were the participants. Self-report measures and annual physical examination data provided information regarding CVD risk (weight, height, blood pressure, cholesterol, smoking, physical exercise), job stress, trauma exposure, service length, and posttraumatic stress symptoms. Results indicated statistically significant relationships between PTSD symptomatology and current smoking status, triglycerides levels, and the number of CVD risk factors. Neither the number of experienced critical incidents, nor the number of service years was associated with PTSD symptomatology. Organizational job stress variables were associated with PTSD symptoms, but not directly with CVD risk. Collectively these findings suggest the reaction to traumatic experiences may be a better indicator of PTSD symptom development, than the actual number of traumatic events experienced. Moreover, the presence of PTSD symptoms may negatively influence overall CVD risk

Prevalence of disability according to multimorbidity and disease clustering: a population-based study

Background: The prevalence of chronic diseases has increased with population ageing, and research has attempted to elucidate the correlation between chronic diseases and disability. However, most studies in older populations have focused on the effect of single disabling conditions, even though most older adults have more than one chronic disease (multimorbidity). Objective: The aims of this study were to evaluate the association of disability with disease, in terms of multimorbidity and specified pairs of diseases, in a population-based study of older adults. Materials and Methods: Using the Kungsholmen Project, we estimated the prevalence of disability by the number of chronic diseases, disease status by organ systems, and in specific pairs of chronic conditions, in a Swedish population (n=1,099; ≥77 years). Disability was defined as need of assistance in at least one activity of daily living (Katz index). Results: Functional disability was seen in 17.9% of participants. It increased as the number of chronic diseases increased. The prevalence of disability varied greatly amongst specific pairs of diseases: from 6.7% in persons affected by hypertension and atrial fibrillation to 82.4% in persons affected by dementia and hip fracture. In multivariate logistic regression models, the disease pairs that were significantly associated with the highest increased relative odds of disability contained dementia (dementia–hip fracture, dementia–CVD, and dementia–depression). Conclusions: Our findings suggest specific pairs of diseases are much more highly associated with disability than others, particularly diseases coupled with dementia. This knowledge may improve prevention of disablement and planning of resource distribution