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Patterns of Multimorbidity in the Aged Population. Results from the KORA-Age Study  [PDF]
Inge Kirchberger, Christa Meisinger, Margit Heier, Anja-Kerstin Zimmermann, Barbara Thorand, Christine S. Autenrieth, Annette Peters, Karl-Heinz Ladwig, Angela D?ring
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0030556
Abstract: Multimorbidity is a common problem in aged populations with a wide range of individual and societal consequences. The objective of the study was to explore patterns of comorbidity and multimorbidity in an elderly population using different analytical approaches. Data were gathered from the population-based KORA-Age project, which included 4,127 persons aged 65–94 years living in the city of Augsburg and its two surrounding counties in Southern Germany. Information on the presence of 13 chronic conditions was collected in a standardized telephone interview and a self-administered questionnaire. Patterns of comorbidity and multimorbidity were analyzed using prevalence figures, logistic regression models and exploratory tetrachoric factor analysis. The prevalence of multimorbidity (≥2 diseases) was 58.6% in the total sample. Hypertension and diabetes (Odds Ratio [OR] 2.95, 99.58% confidence interval [CI] [2.19–3.96]), as well as hypertension and stroke (OR 2.00, 99.58% CI [1.26–3.16]) most often occurred in combination. This association was independent of age, sex and the presence of other conditions. Using factor analysis, we identified four patterns of multimorbidity: the first pattern includes cardiovascular and metabolic diseases, the second includes joint, liver, lung and eye diseases, the third covers mental and neurologic diseases and the fourth pattern includes gastrointestinal diseases and cancer. 44% of the persons were assigned to at least one of the four multimorbidity patterns; 14% could be assigned to both the cardiovascular/metabolic and the joint/liver/lung/eye pattern. Further common pairs were the mental/neurologic pattern combined with the cardiovascular/metabolic pattern (7.2%) or the joint/liver/lung/eye pattern (5.3%), respectively. Our results confirmed the existence of co-occurrence of certain diseases in elderly persons, which is not caused by chance. Some of the identified patterns of multimorbidity and their overlap may indicate common underlying pathological mechanisms.
Population-genetic comparison of the Sorbian isolate population in Germany with the German KORA population using genome-wide SNP arrays
Arnd Gross, Anke T?njes, Peter Kovacs, Krishna R Veeramah, Peter Ahnert, Nab R Roshyara, Christian Gieger, Ina-Maria Rueckert, Markus Loeffler, Mark Stoneking, Heinz-Erich Wichmann, John Novembre, Michael Stumvoll, Markus Scholz
BMC Genetics , 2011, DOI: 10.1186/1471-2156-12-67
Abstract: The degree of relatedness was significantly higher in the Sorbs. Principal components analysis revealed a west to east clustering of KORA individuals born in Germany, KORA individuals born in Poland or Czech Republic, Half-Sorbs (less than four Sorbian grandparents) and Full-Sorbs. The Sorbs cluster is nearest to the cluster of KORA individuals born in Poland. The number of rare SNPs is significantly higher in the Sorbs sample. FST between KORA and Sorbs is an order of magnitude higher than between different regions in Germany. Compared to the other populations, Sorbs show a higher proportion of individuals with runs of homozygosity between 2.5 Mb and 5 Mb. Linkage disequilibrium (LD) at longer range is also slightly increased but this has no effect on the power of association studies.Oversampling of families in the Sorbs sample causes detectable bias regarding higher FST values and higher LD but the effect is an order of magnitude smaller than the observed differences between KORA and Sorbs. Relatedness in the Sorbs also influenced the power of uncorrected association analyses.Sorbs show signs of genetic isolation which cannot be explained by over-sampling of relatives, but the effects are moderate in size. The Slavonic origin of the Sorbs is still genetically detectable.Regarding LD structure, a clear advantage for genome-wide association studies cannot be deduced. The significant amount of cryptic relatedness in the Sorbs sample results in inflated variances of Beta-estimators which should be considered in genetic association analyses.The Sorbs living in the Upper Lusatia region of Eastern Saxony are one of the few historic ethnic minorities in Germany. They are of Slavonic origin speaking a west Slavic language (Sorbian), and it is assumed that they have lived in ethnic isolation among the German majority during the past 1100 years [1]. Therefore, this population may be of special interest for genetic studies of complex traits.The value of isolated populations f
New international classification of functioning, disability and health  [PDF]
Stucki Gerold,Maksimovi? Milo?,Davidovi? Dragana,Jorga Jagoda
Srpski Arhiv za Celokupno Lekarstvo , 2007, DOI: 10.2298/sarh0706371s
Abstract: The WHO International Classification of Functioning, Disability and Health (ICF) provides a coherent view of health from a biological, individual and social perspective. This view may be defined both as multi- and interdisciplinary management of one’s functioning and health. This new classification is currently being assessed in multiple centers in 32 countries, on 12 health conditions. The Institute of Hygiene and Medical Ecology, School of Medicine, University of Belgrade, is one of them, serving as the centre where the classification is being tested in obese population. The objective of this paper is to provide information needed for further development and practical application of this classification in various health conditions. The new language of ICF is an exciting landmark event for preventive medicine and rehabilitation. It may lead to a stronger position of rehabilitation within the medical community, change multiprofessional communication and improve communication between patients and health professionals. .
Multimorbidity and health-related quality of life in the older population: results from the German KORA-Age study
Matthias Hunger, Barbara Thorand, Michaela Schunk, Angela D?ring, Petra Menn, Annette Peters, Rolf Holle
Health and Quality of Life Outcomes , 2011, DOI: 10.1186/1477-7525-9-53
Abstract: The EQ-5D was administered in the population-based KORA-Age study of 4,565 Germans aged 65 years or older. A generalised additive regression model was used to assess the effects of chronic conditions on HRQL and to account for the nonlinear associations with age and body mass index (BMI). Disease interactions were identified by a forward variable selection method.The conditions with the greatest negative impact on the EQ-5D index were the history of a stroke (regression coefficient -11.3, p < 0.0001) and chronic bronchitis (regression coefficient -8.1, p < 0.0001). Patients with both diabetes and coronary disorders showed more impaired HRQL than could be expected from their separate effects (coefficient of interaction term -8.1, p < 0.0001). A synergistic effect on HRQL was also found for the combination of coronary disorders and stroke. The effect of BMI on the mean EQ-5D index was inverse U-shaped with a maximum at around 24.8 kg/m2.There are important interactions between coronary problems, diabetes mellitus, and the history of a stroke that negatively affect HRQL in the older German population. Not only high but also low BMI is associated with impairments in health status.Multimorbidity, defined as the coexistence of two or more chronic conditions, is a common phenomenon among the older population worldwide: two recent population-based studies indicated that the prevalence of multimorbidity ranges between 40% and 56% in the general population aged 65 years and older [1,2]. Multimorbidity is known to negatively affect health outcomes including mortality, hospitalisation, and readmission [3].Health-related quality of life (HRQL) is a health outcome measure which is increasingly used to assess the medical effectiveness of interventions and to support allocation decisions in the health care sector. Generic HRQL instruments like the EQ-5D are appropriate for non-disease-specific analyses and allow comparisons between patient groups with different medical conditions [
Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health
Martin Mueller, Edith Schuster, Ralf Strobl, Eva Grill
Health and Quality of Life Outcomes , 2012, DOI: 10.1186/1477-7525-10-75
Abstract: We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF).From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect “dizziness” most participants reported problems within “Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported “Immediate family (e310)” as a relevant modifying environmental factor.From the patients’ perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals’ daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo.
Physical Functioning, Perceived Disability, and Depressive Symptoms in Adults with Arthritis  [PDF]
Katie Becofsky,Meghan Baruth,Sara Wilcox
Arthritis , 2013, DOI: 10.1155/2013/525761
Abstract: This study investigated how physical functioning and perceived disability are related to depressive symptoms in adults with arthritis ( ). Participants self-reported depressive symptoms and disability. Objective measures of physical functioning included the 30-second chair stand test, 6-minute walk test, gait speed, balance, grip strength, and the seated reach test. Separate quantile regression models tested associations between each functional measure and depressive symptoms, controlling for age, gender, race, BMI, self-reported health status, and arthritis medication use. The association between perceived disability and depressive symptoms was also tested. Participants averaged years; 85.8% were women; 64.3% were white. Lower distance in the 6-minute walk test, fewer chair stands, slower gait speed, and greater perceived disability were associated with greater depressive symptoms in unadjusted models ( ). Fewer chair stands and greater perceived disability were associated with more depressive symptoms in adjusted models ( ). Balance, grip strength, and seated reach were not related to depressive symptoms. The perception of being disabled was more strongly associated with depressive symptoms than reduced physical functioning. To reduce the risk of depression in arthritic populations, it may be critical to not only address physical symptoms but also to emphasize coping skills and arthritis self-efficacy. 1. Introduction For public health purposes, the term arthritis refers to over 100 musculoskeletal conditions of varying etiologies that cause pain, aching, or stiffness in or around a joint [1]. During 2007–2009, an estimated 50 million adults in the United States reported doctor-diagnosed arthritis [2]. As the US population grows in number and the baby boomers continue to enter older adulthood, arthritis is projected to affect 67 million Americans by 2030 [3]. When rising obesity rates are also considered, an even larger public health burden can be expected, as obesity has been associated with both the development and progression of arthritis [4]. A recent study estimates that 18% of adults with arthritis also have comorbid depression [5], compared with 7% of the general US population [6]. This high prevalence may be due, in part, to the functional limitations associated with arthritis symptoms. Depression may also be linked to perceived disability, a construct closely related to functional limitation, but with an important distinction: functional limitations alone, defined as alterations in the performance of a functional task, are not the equivalent
Use of functioning-disability and dependency for case-mix and subtyping of schizophrenia
Ochoa,Susana; Salvador-Carulla,Luis; Villalta-Gil,Victoria; Gibert,Karina; Haro,Josep Maria; ,;
The European Journal of Psychiatry , 2012, DOI: 10.4321/S0213-61632012000100001
Abstract: background and objectives: to evaluate the utility of the constructs functioning and disability (f & d) and dependency for case-mix and subtyping of patients with schizophrenia by psychosocial, clinical, use of services and attention received from informal carers. methods: a randomly selected total of 205 people with schizophrenia, and their careers were evaluated through panss, das-sv, objective and subjective burden scale (ecfos-ii) and use of services. results: two groups and four profiles were identified according to levels of dependency: the non-dependent group was made of two profiles: independent (i), and persons with disability in the community (dic). the dependent group included persons with dependency in the community (dec) and persons with dependency in hospital care (deh). there are clinical and psychosocial differences between these profiles being the dependent the most severe. regarding use of services, dec use the most resources, with the exception deh (more hospitalization resources). the dec profile generate greater family burden in the following areas; taking medication, being accompanied to appointments, and management than the dic, despite both groups showing a high need for support. conclusions: dependency is a relevant construct for case-mix and subtyping in schizophrenia, and it is related to severity both at the social and clinical level. dec generate more family burden than the other profiles, followed by dic (patients with schizophrenia with disability but non-dependent).
Use of functioning-disability and dependency for case-mix and subtyping of schizophrenia  [cached]
Susana Ochoa,Luis Salvador-Carulla,Victoria Villalta-Gil,Karina Gibert
The European Journal of Psychiatry , 2012,
Abstract: Background and Objectives: To evaluate the utility of the constructs functioning and disability (F & D) and dependency for case-mix and subtyping of patients with schizophrenia by psychosocial, clinical, use of services and attention received from informal carers. Methods: A randomly selected total of 205 people with schizophrenia, and their careers were evaluated through PANSS, DAS-sv, Objective and Subjective Burden Scale (ECFOS-II) and use of services. Results: Two groups and Four profiles were identified according to levels of Dependency: The non-dependent group was made of two profiles: independent (I), and persons with disability in the community (DiC). The dependent group included persons with dependency in the community (DeC) and persons with dependency in hospital care (DeH). There are clinical and psychosocial differences between these profiles being the dependent the most severe. Regarding use of services, DeC use the most resources, with the exception DeH (more hospitalization resources). The DeC profile generate greater family burden in the following areas; taking medication, being accompanied to appointments, and management than the DiC, despite both groups showing a high need for support. Conclusions: Dependency is a relevant construct for case-mix and subtyping in schizophrenia, and it is related to severity both at the social and clinical level. DeC generate more family burden than the other profiles, followed by DiC (patients with schizophrenia with disability but non-dependent).
Using the International Classification of Functioning, Disability and Health (ICF) to Describe Children Referred to Special Care or Paediatric Dental Services  [PDF]
Denise Faulks, Johanna Norderyd, Gustavo Molina, Caoimhin Macgiolla Phadraig, Gabriela Scagnet, Caroline Eschevins, Martine Hennequin
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0061993
Abstract: Children in dentistry are traditionally described in terms of medical diagnosis and prevalence of oral disease. This approach gives little information regarding a child’s capacity to maintain oral health or regarding the social determinants of oral health. The biopsychosocial approach, embodied in the International Classification of Functioning, Disability and Health - Child and Youth version (ICF-CY) (WHO), provides a wider picture of a child’s real-life experience, but practical tools for the application of this model are lacking. This article describes the preliminary empirical study necessary for development of such a tool - an ICF-CY Core Set for Oral Health. An ICF-CY questionnaire was used to identify the medical, functional, social and environmental context of 218 children and adolescents referred to special care or paediatric dental services in France, Sweden, Argentina and Ireland (mean age 8 years ±3.6yrs). International Classification of Disease (ICD-10) diagnoses included disorders of the nervous system (26.1%), Down syndrome (22.0%), mental retardation (17.0%), autistic disorders (16.1%), and dental anxiety alone (11.0%). The most frequently impaired items in the ICF Body functions domain were ‘Intellectual functions’, ‘High-level cognitive functions’, and ‘Attention functions’. In the Activities and Participation domain, participation restriction was frequently reported for 25 items including ‘Handling stress’, ‘Caring for body parts’, ‘Looking after one’s health’ and ‘Speaking’. In the Environment domain, facilitating items included ‘Support of friends’, ‘Attitude of friends’ and ‘Support of immediate family’. One item was reported as an environmental barrier – ‘Societal attitudes’. The ICF-CY can be used to highlight common profiles of functioning, activities, participation and environment shared by children in relation to oral health, despite widely differing medical, social and geographical contexts. The results of this empirical study might be used to develop an ICF-CY Core Set for Oral Health - a holistic but practical tool for clinical and epidemiological use.
Graduate Courses in Occupational Therapy and International Classification of Functioning, Disability and Health  [PDF]
Ana Rita Costa de Souza Lobo Braga, Leonardo Petrus da Silva Paz, Vera Regina Fernandes da Silva Mar?es
Creative Education (CE) , 2015, DOI: 10.4236/ce.2015.617197
Abstract: The formation of Occupational Therapists has become the subject of analysis and debate in recent decades after several changes in health policies in Brazil, among them the implementation of the National Curriculum Guidelines (NCGs) directing teaching practices in line with the Health Unic System and International Classification of Functioning, Disability and Health (ICF). Given these paradigms, the Occupational Therapy courses passed with several adjustments in their course of pedagogical political projects (PPPs) and their teaching practices. The study’s goal was to characterize the Occupational Therapy courses and analyze their PPPs focusing on changes in the health care model and the inclusion of ICF. The research was exploratory and was conducted through documentary analysis. By 2013 there were 63 occupational therapy courses working in the country, 44 in private institutions and 19 in public, demonstrating a lack of supply in public. The Occupational Therapy courses are still guided by the biomedical model, and the applicability of the ICF as well as the insertion of the biopsychosocial model are incipient in teaching practice.
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