Burden of multimorbidity, socioeconomic status and use of health services across stages of life in urban areas: a cross-sectional study

This is a freely-available open access publication. Please cite the published version which is available via the DOI link in this record.Background The burden of chronic conditions and multimorbidity is a growing health problem in developed countries. The study aimed to determine the estimated prevalence and patterns of multimorbidity in urban areas of Catalonia, stratified by sex and adult age groups, and to assess whether socioeconomic status and use of primary health care services were associated with multimorbidity. Methods A cross-sectional study was conducted in Catalonia. Participants were adults (19+ years) living in urban areas, assigned to 251 primary care teams. Main outcome: multimorbidity (≥2 chronic conditions). Other variables: sex (male/female), age (19–24; 25–44; 45–64; 65–79; 80+ years), socioeconomic status (quintiles), number of health care visits during the study. Results We included 1,356,761 patients; mean age, 47.4 years (SD: 17.8), 51.0% women. Multimorbidity was present in 47.6% (95% CI 47.5-47.7) of the sample, increasing with age in both sexes but significantly higher in women (53.3%) than in men (41.7%). Prevalence of multimorbidity in each quintile of the deprivation index was higher in women than in men (except oldest group). In women, multimorbidity prevalence increased with quintile of the deprivation index. Overall, the median (interquartile range) number of primary care visits was 8 (4–14) in multimorbidity vs 1 (0–4) in non-multimorbidity patients. The most prevalent multimorbidity pattern beyond 45 years of age was uncomplicated hypertension and lipid disorder. Compared with the least deprived group, women in other quintiles of the deprivation index were more likely to have multimorbidity than men until 65 years of age. The odds of multimorbidity increased with number of visits in all strata. Conclusions When all chronic conditions were included in the analysis, almost 50% of the adult urban population had multimorbidity. The prevalence of multimorbidity differed by sex, age group and socioeconomic status. Multimorbidity patterns varied by life-stage and sex; however, circulatory-endocrine-metabolic patterns were the most prevalent multimorbidity pattern after 45 years of age. Women younger than 80 years had greater prevalence of multimorbidity than men, and women’s multimorbidity prevalence increased as socioeconomic status declined in all age groups. Identifying multimorbidity patterns associated with specific age-related life-stages allows health systems to prioritize and to adapt clinical management efforts by age group.Ministry of Science and Innovation through the Instituto Carlos III (ISCiii)ISCiii-RETICSISCiiiInstitut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol

Abastecimiento y saneamiento en zoras rurales de paises en desarrollo. Situacion actual y desafios para el futuro

El presente articulo detalla la problematica asociada a la provision de los servicios de abastecimiento y saneamiento en las zonas rurales de los paises en desarrollo. Se caracteriza la evolucion historia y la situacion actual en cada uno de estos servicios. Se explican y se analizan criticamente los criterios de medicion de acceso y las metodologias de intervencion principales. Las conclusiones ofrecen lineas de avance a incorporar en los modelos de provision de dichos servicios, teniendo en cuenta la consideracion del aqua y saneamiento como un derecho humano. EL concreto se revisa el denominado modelo de gestion comunitaria para el caso del abastecimiento de agua y se determinan sus debilidades en lo que atane a la universalifaf y equidad de las intervencioens, su sostenibilidad y la falta de participacion activa de las administracioness publicas de ambito local o regional. Por lo que se refiere a las intervenciones destinadas a la promocion del saneamiento, se pasa revista a las que actualmente estan vigentes, y concretamente las relacionadas con la concienciacion sobre la salud e higiene, el denominado marketing social, y, por ultimo, los destinados a incentivar la inversion en saneamiento. This paper analyses the management performance of rural communities for water supply and sanitation systems in developing countries, describing the historical trends and its current situation. Special attention is paid to the criteria considered to determine the effective access to both services, as well as to the principal implementation models actually used. Different solutions are proposed in order to incorporate in the the provision of both facilities the consideration of the human right to water and sanitation. Specifically, the community water management model is considered, identifying its weaknesses in relation to different human rights considerations such as universality, equity, sustainability, as well as the necessary participation of the public administrations, and specially from the intermediate level. With respect to the implementing models that aim the promotion of sanitation services, three alternatives are considered: linking health and hygiene, social marketing, and promotion of the financing of the sanitation services

Laser beam coating of materials

Translated from Russian (Report of the A.A. Baikov Inst. of Metallurgy, Moscow, 1999)Available from British Library Document Supply Centre-DSC:9023.190(9859)T / BLDSC - British Library Document Supply CentreSIGLEGBUnited Kingdo

Cardiovascular risk assessment in patients with a severe mental illness: a systematic review and meta-analysis.

BACKGROUND: Cardiovascular risk (CVR) has been observed to be higher in patients with severe mental illness (SMI) than in the general population. However, some studies suggest that CVR is not equally increased in different subgroups of SMI. The purposes of this review are to summarise CVR scores of SMI patients and to determine the differences in CVR between patients with different SMIs and between SMI patients and the control-population. METHODS: MEDLINE (via PubMed) was searched for literature published through August 28, 2014, followed by a snowball search in the Web of Science. Observational and experimental studies that reported CVR assessments in SMI patients using validated tools were included. The risk of bias was reported using STROBE and CONSORT criteria. Pooled continuous data were expressed as standardized mean differences (SMD) with 95 % confidence intervals (CI). Two reviewers independently selected studies, extracted data and assessed methodological quality. RESULTS: A total of 3,608 articles were identified, of which 67 full text papers were assessed for eligibility and 35 were finally included in our review, in which 12,179 psychiatric patients and 225,951 comparative patients had been assessed. The most frequent diagnoses were schizophrenia and related diagnoses (45.7 %), depressive disorders (14.7 %), SMI (11.4 %) and bipolar disorders (8.6 %). The most frequent CVR assessment tool used was the Framingham risk score. Subgroups analysis showed a higher CVR in schizophrenia than in depressive disorder or in studies that included patients with multiple psychiatric diagnoses (SMD: 0.63, 0.03, and 0.02, respectively). Six studies were included in the meta-analysis. Total overall CVR did not differ between SMI patients and controls (SMD: 0.35 [95 % CI:-0.02 to 0.71], p = 0.06); high heterogeneity was observed (I (2) = 93 %; p < 0.001). CONCLUSIONS: The summary of results from studies that assessed CVR using validated tools in SMI patients did not find sufficient data (except for limited evidence associated with schizophrenia) to permit any clear conclusions about increased CVR in this group of patients compared to the general population. The systematic review is registered inThis research has been funded by the Ministry of Science and Innovation through the Instituto Carlos III (PI12/00427). This study received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. LA is funded by the National Institute of Health Research (NIHR) U

Heterozygous pathogenic variants in GLI1 are a common finding in isolated postaxial polydactyly A/B

Postaxial polydactyly (PAP) is a frequent limb malformation consisting in the duplication of the fifth digit of the hand or foot. Morphologically, this condition is divided into type A and B, with PAP-B corresponding to a more rudimentary extra-digit. Recently, biallelic truncating variants in the transcription factor GLI1 were reported to be associated with a recessive disorder, which in addition to PAP-A, may include syndromic features. Moreover, two heterozygous subjects carrying only one inactive copy of GLI1 were also identified with PAP. Herein, we aimed to determine the level of involvement of GLI1 in isolated PAP, a condition previously established to be autosomal dominantly inherited with incomplete penetrance. We analyzed the coding region of GLI1 in 95 independent probands with nonsyndromic PAP and found 11.57% of these subjects with single heterozygous pathogenic variants in this gene. The detected variants lead to premature termination codons or result in amino acid changes in the DNA-binding domain of GLI1 that diminish its transactivation activity. Family segregation analysis of these variants was consistent with dominant inheritance with incomplete penetrance. We conclude that heterozygous changes in GLI1 underlie a significant proportion of sporadic or familial cases of isolated PAP-A/B