Multimorbidity : definition, assessment, measurement and impact

Research and clinical practice mostly focus on single-disease approaches whereas in reality many patients suffer from more than one chronic condition. The co-occurrence of conditions has increasingly been defined as multimorbidity. Multimorbidity challenges patients, providers and health systems. This has increased the interest of researchers, clinicians and policy makers. However, multimorbidity poses important challenges to those who want to study it. This chapter provides an overview on the definition and measurement of multimorbidity from an epidemiological approach and elicits possible effective approaches to overcome the important clinical challenges of care for this growing group of patients. The aging of the population, due to two demographic effects, namely increasing longevity and declining fertility, is a widespread phenomenon across the world. At the same time, it is an enormous challenge as aging populations obviously results in more people with chronic diseases. Research and clinical practice have mainly focused on building evidence for single diseases while in reality 50% of patients with a chronic disease have more than one medical condition. Besides, the complexity of health problems increases dramatically: 20%–40% of patients aged 65 or older suffer from more than 5 chronic diseases. The complexity of multimorbidity challenges research processes on care for multimorbidity)

How to Interpret Nutrition Drink Test

Nutrient drink test is one of the drink test techniques to assess gastric accommodation and to quantify meal-induced symptoms. It uses nutrient-containing solution instead of water and has been proposed as a surrogate method for estimating gastric volumes and validated for assessing satiation, sensation of bothersome symptoms after meal ingestion. Various nutrient-containing solution and drinking rates have been used and there were no widely accepted reference values for nutrient drink test until now. However, tests results are usually reported as the maximum tolerated volume, individual and cumulative symptom scores. The accommodation response, gastric sensation and gastric emptying may influence the maximum tolerated volume of nutrient drink. Although drink test is a useful tool for assessing gastric accommodation and sensation, it remains unclear exactly what physiologic processes are assessed by nutrient drink tests

Achalasia.

SummaryAchalasia is a rare motility disorder of the oesophagus characterised by loss of enteric neurons leading to absence of peristalsis and impaired relaxation of the lower oesophageal sphincter. Although its cause remains largely unknown, ganglionitis resulting from an aberrant immune response triggered by a viral infection has been proposed to underlie the loss of oesophageal neurons, particularly in genetically susceptible individuals. The subsequent stasis of ingested food not only leads to symptoms of dysphagia, regurgitation, chest pain, and weight loss, but also results in an increased risk of oesophageal carcinoma. At present, pneumatic dilatation and Heller myotomy combined with an anti-reflux procedure are the treatments of choice and have comparable success rates. Per-oral endoscopic myotomy has recently been introduced as a new minimally invasive treatment for achalasia, but there have not yet been any randomised clinical trials comparing this option with pneumatic dilatation and Heller myotomy

The link between income inequality and health in Europe, adding strength dimensions of primary care to the equation

Income inequality has been dearly associated with reduced population health. A body of evidence suggests that a strong primary care system may mitigate this negative association. The aim of this study is to assess the strength of the primary care system's effect on the inverse association between income inequality and health in Europe. Health is operationalised using four cross-sectional outcomes: self-rated health, life expectancy, mental well-being, and infant mortality. Strength of the primary care system is measured using the framework of the Primary Health Care Activity Monitor Europe, and income inequality by the Gini coefficient. Multiple regression models with interaction terms were used. The results confirm that especially the structure and continuity dimension of primary care strength can buffer the inverse association between income inequality and health. European policymakers should therefore focus on strengthening primary care systems in order to reduce inequity in health

Prevalence of multimorbidity with frailty and associations with socioeconomic position in an adult population : findings from the cross-sectional HUNT Study in Norway

ObjectivesTo explore prevalences and occupational group inequalities of two measures of multimorbidity with frailty.DesignCross-sectional study.SettingThe Nord-TrOndelag Health Study (HUNT), Norway, a total county population health survey, 2006-2008.ParticipantsParticipants older than 25 years, with complete questionnaires, measurements and occupation data were included.Outcomes >= 2 of 51 multimorbid conditions with >= 1 of 4 frailty measures (poor health, mental illness, physical impairment or social impairment) and >= 3 of 51 multimorbid conditions with >= 2 of 4 frailty measures.AnalysisLogistic regression models with age and occupational group were specified for each sex separately.ResultsOf 41 193 adults, 38 027 (55% female; 25-100 years old) were included. Of them, 39% had >= 2 multimorbid conditions with >= 1 frailty measure, and 17% had >= 3 multimorbid conditions with >= 2 frailty measures. Prevalence differences in percentage points (pp) with 95% confidence intervals of those in high versus low occupational group with >= 2 multimorbid conditions and >= 1 frailty measure were largest in women age 30 years, 17 (14 to 20) pp and 55 years, 15 (13 to 17) pp and in men age 55 years, 15 (13 to 17) pp and 80 years, 14 (9 to 18) pp. In those with >= 3 multimorbid conditions and >= 2 frailty measures, prevalence differences were largest in women age 30 years, 8 (6 to 10) pp and 55 years, 10 (8 to 11) ppand in men age 55 years, 9 (8 to 11) pp and 80 years, 6 (95% CI 1 to 10) pp.ConclusionMultimorbidity with frailty is common, and social inequalities persist until age 80 years in women and throughout the lifespan in men. To manage complex multimorbidity, strategies for proportionate universalism in medical education, healthcare, public health prevention and promotion seem necessary