Academic literature on the topic 'Polymorbidita'

Based on the analysis of Russian and foreign literary sources, the definition of the concept of polymorbidity is given, its classification, information on prevalence, measurement methods and practical significance are given. It is emphasized that at present in the literature the concepts of polymorbidity, comorbidity, multimorbidity coexist, while there is no universally accepted definition of them. This uncertainty is historically conditioned and is associated with the use of these concepts by various scientific schools. In most modern literary sources, polymorbidity (multimorbidity) refers to a combination of two or more chronic diseases in one patient. At present, a considerable number of different methods of measuring polymorbidity are used, which have their own advantages and disadvantages, and a universal method has not been developed. The most convenient for assessing polymorbidity is currently recognized polymorbidity index Charlson. Due to the lack of unified approaches to the measurement of polymorbidity, as well as taking into account the fact that studies are conducted in different population samples, the published figures for the prevalence of polymorbidity vary considerably. Emphasis is placed on the fact that polymorbidity is a multifaceted problem that has not only clinical but also economic and social importance, which requires a further in-depth study.

Background. Hypertension (HTN) is often combined with other diseases, that significantly complicate its course, worsen the prognosis, interfere with the therapeutic and preventive measures. Therefore, assessing the development and structure of polymorbidity (PM) in hypertension is a relevant issue. Objective. To study the structure and degree of PM in hypertensive patients depending on age and gender. Design and methods. We conducted an analysis of 20 560 case histories of patients with HTN and without HTN (men and women), inhabitants of West Siberia-Novosibirsk region, who underwent examination and treatment at the clinic of the Federal Research Center of Fundamental and Translational Medicine in Novosibirsk. All identified diagnoses (nosological forms and classes according to the International Classification of Diseases of the 10th revision, ICD‑10) were considered. Transnosological PM was assessed by the average number of nosologies corresponding to the three-digit ICD‑10 rubric. Results. An increase in the PM index by 16,8 % was found in HTN patients compared to patients without HTN. Among HTN patients, there was an increase in the incidence of comorbid diseases of the circulatory system (in the 16–39 age group in men — by 46 %, in women — by 42,8 %), the endocrine system, eating disorders and metabolism (in the age group 16–39 years for men — by 19,3 %, for women — by 45,2 %), the musculoskeletal system, urinary system (for men) and neoplasms (for women) compared with patients without HTN. Conclusions. We found a high rate of transnosological PM in HTN patients was found and defined its structure.

The prevalence of polymorbidity and its features in military personnel of various age groups was studied. It has been established that polymorbidity during medical examinations of military personnel occurs in all age groups, increasing with age. For each age group of military personnel, its characteristic polymorbidity models are formed. So, in the age group up to 35 years, polymorbidity occurs in one third of the examined and is characterized by both functional disorders of the circulatory system and digestive organs, and the presence of organic pathology of the circulatory system (congenital malformations (developmental defects), mitral and other valve prolapse), digestive organs (chronic gastritis, gastroesophageal reflux disease) and the musculoskeletal system (flat feet, dorsopathies). At the age of 35 to 45 years, polymorbidity occurs in93,5% of those examined and is characterized by the presence of a cardiac and gastroenteric component in all polymorbidity models, in 80% of the models - the musculoskeletal component, in 60% - the metabolic component, in 40% - the endocrine component. Polymorbidity occurs in 97,5% of those examined over the age of 46 years and is characterized by the presence in all models of polymorbidity of the cardiac, cerebrovascular and musculoskeletal component, in 75% of the models - the metabolic component, in 50% - the endocrine component.

Abstract. The risk factors for the formation of polymorbidity in military personnel of different age groups were studied during a medical examination to determine the category of fitness for military service. It was established that the most effective indicators in the form of linear dependences were: the level of trans-systemic polymorbidity and body mass index, waist-to-hip ratio, the cardio-anklevascular index, the thickness of the intima-media complex of the common carotid artery, the level of total cholesterol, and alcohol consumption.In the group of military personnel under the age of 35, positive correlation was found between trans-systemic polymorbidity and body fat, body fat percentage, body mass index, total cholesterol and low density lipoproteins.In the group of military personnel aged 36 to 45 years, positive correlation was found between trans-systemic polymorbidity and body mass index, percentage of body fat, and fat tissue in the body. Given the positive correlation between trans-systemic polymorbidity and indicators characterizing overweight, obesity is one of the leading factors in the formation of polymorbidity under the age of 45 years. It is shown that measures aimed at the prevention of polymorbidityshould basicallyinclude generally accepted measures for cardiovascular prophylaxis and obesity.

Purpose. To study the dependence of the frequency of occurrence and the values of indicators of basic risk factors for chronic non-communicable diseases on the degree of transnosological polymorbidity in patients of a clinic of general therapeutic profile for the period from 2003 to 2013. Material and methods. The analysis of 5019 medical records (2501 men, 2518 women) treated in the clinic of RIECM, Novosibirsk, was carried out. Transnosological polymorbidity was evaluated from the average number of nosologies in accordance with the International Classification of Diseases, 10th revision (ICD-10). The following risk factors were assessed based on clinical and laboratory tests: high blood pressure, increased concentration of total cholesterol, low density lipoprotein cholesterol, triglycerides, glucose, uric acid, decreased concentration of high density lipoprotein cholesterol, obesity. Results. The dependence of the values of indicators and frequency of occurrence of chronic non-communicable diseases risk factors on the degree of polymorbidity, taking into account gender differences, was studied. In both men and women, increased transnosological polymorbidity index was associated with the growth of indicators of main non-communicable risk factors: systolic blood pressure, diastolic blood pressure, glucose, low density lipoprotein cholesterol, uric acid in the blood. In men, a more pronounced increase with growing polymorbidity index was especially noticeable in the body mass index and blood glucose; in women in blood glucose and triglyceride levels. Conclusion. The study demonstrated the important role of risk factors of chronic non-communicable diseases that collectively represent clinical manifestations of metabolic syndrome in the development of polymorbidity in patients of therapeutic profile. These findings indicate the need of differential prevention and treatment of patients with polymorbidity together with mandatory identification and correction of modifiable risk factors of chronic non-communicable diseases.

SUBCLINICAL CARDIAC DAMAGE IN CARDIOPULMONARY POLYMORBIDITY. (review). Part 1. Ashcheulova T., Ambrosova T., Kochubiei O., Honchar O., Sytina I. Hypertension and chronic obstructive pulmonary disease are one of the frequent comorbid conditions in internal medicine and are subject to meaningful cooperation among physicians, cardiologists, and pulmonologists. A combination of chronic obstructive pulmonary disease and hypertension presents certain diagnostic and therapeutic challenges. These conditions share common risk factors, similar clinical presentations and some common parts of pathogenesis. The problem of association between chronic obstructive pulmonary disease and hypertension may be currently discusses both as a simple combination of various clinical entities, and as chronic obstructive pulmonary disease resulting in development of factors contributing to hypertension. One way or another, either a simple combination, or a mutually aggravating syndrome, but we state there is a cardiorespiratory continuum where chronic obstructive pulmonary disease acts as a valid component of hypertension development, and vice versa. Thus, it seems to be relevant to study peculiarities of the structural and functional status of the cardiovascular system and microcirculation, systemic remodeling mechanisms, endothelial dysfunction and inflammation in presence of chronic obstructive pulmonary disease -associated hypertension. Problems of additional cardiovascular risk marker development, treatment efficiency assessment remain topical. Use of electrocardiography and echocardiography with dopplerometry has been an important diagnostic principle of subclinical cardiovascular damage in presence of hypertension and chronic obstructive pulmonary disease comorbidity. Non-invasive imaging methods play a central part in diagnostics of subclinical target organ damage. Wide implementation thereof is based on high diagnostic accuracy, common availability, safety and relatively low price. Key words: hypertension, chronic obstructive pulmonary disease, comorbidity, electrocardiography, echocardiography with dopplerometry Резюме. СУБКЛІНІЧНЕ УРАЖЕННЯ СЕРЦЯ ПРИ КАРДІОПУЛЬМОНАЛЬНІЙ ПОЛІМОРБІДНОСТІ (огляд). Частина 1. Ащеулова Т.В., Амбросова Т.М., Кочубєй О.А., Гончарь О.В., Ситіна І.В. Артеріальна гіпертензія і хронічне обструктивне захворювання легень - одне з частих коморбідних станів в клініці внутрішніх хвороб і є предметом конструктивної взаємодії терапевтів, кардіологів, пульмонологів. Поєднання хронічного обструктивного захворювання легень і артеріальної гіпертензії являє певні труднощі для діагностики і лікування. Ці захворювання мають загальні фактори ризику, схожі клінічні прояви і спільність деяких ланок патогенезу. Таким чином, представляється актуальним дослідження особливостей структурно-функціонального стану серцево-судинної системи і мікроциркуляції, вивчення системних механізмів ремоделювання, ендотеліальної дисфункції та запалення при артеріальній гіпертензії в поєднанні з хронічним обструктивним захворюванням легень. Залишаються актуальними питання розробки додаткових маркерів серцево-судинного ризику, оцінки ефективності проведеного лікування. В останні роки важливими принципами діагностики субклінічного ураження серця і судин при коморбідності хронічного обструктивного захворювання легень і артеріальної гіпертензії є використання електрокардіографії та ехокардіографії з доплерометрією. Неінвазивні методи візуалізації відіграють центральну роль в діагностиці субклінічного ураження органів-мішеней. Їх широке застосування обумовлено високою діагностичної точністю, повсюдною поширеністю, безпекою і відносно низькою вартістю. Ключові слова. Артеріальна гіпертензія, хронічне обструктивне захворювання легень, коморбідность, електрокардіографія, ехокардіографія з доплерометрією. Резюме. СУБКЛИНИЧЕСКОЕ ПОРАЖЕНИЕ СЕРДЦА ПРИ КАРДИОПУЛЬМОНАЛЬНОЙ ПОЛИМОРБИДНОСТИ (обзор). Часть 1. Ащеулова Т.В., Амбросова Т.Н., Кочубей О.А., Гончарь А.В., Сытина И.В. Артериальная гипертензия и хроническое обструктивное заболевание легких - одно из частых коморбидных состояний в клинике внутренних болезней и являются предметом конструктивного взаимодействия терапевтов, кардиологов, пульмонологов. Сочетание хронического обструктивного заболевания легких и артериальной гипертензии представляет определенные трудности для диагностики и лечения. Эти заболевания имеют общие факторы риска, схожие клинические проявления и общность некоторых звеньев патогенеза. Таким образом, представляется актуальным исследование особенностей структурно-функционального состояния сердечно-сосудистой системы и микроциркуляции, изучение системных механизмов ремоделирования, эндотелиальной дисфункции и воспаления при артериальной гипертензии в сочетании с хроническим обструктивным заболеванием легких. Остаются актуальными вопросы разработки дополнительных маркеров сердечно-сосудистого риска, оценки эффективности проводимого лечения. В последние годы важными принципами диагностики субклинического поражения сердца и сосудов при коморбидности хронического обструктивного заболевания легких и артериальной гипертензии является использование электрокардиографии и эхокардиографии с допплерометрией. Неинвазивные методы визуализации играют центральную роль в диагностике субклинического поражения органов-мишеней. Их широкое применение обусловлено высокой диагностической точностью, повсеместной распространенностью, безопасностью и относительно низкой стоимостью. Ключевые слова. Артериальная гипертензия, хроническое обструктивное заболевание легких, коморбидность, электрокардиография, эхокардиография с допплерометрией.

Annotation: The purpose of this Master's thesis is to describe objectively topic of medical social workers' communication in centers of post-acute care, to highlight importance and difficulty of social work with senior citizens and to propose eventual changes leading to eventual communication improvement. Social work here is complicated because senior citizens are often lonely or may have problematic family relationships or may suffer from dementia and quite often are polymorbid patients. For the thesis were used statistics from The Centre of Postacute Care - Motol University Hospital, then method of questionnaire realized with medical social workers from centers of post-acute care in Czech Republic, and method of structured interview with patients in Center of Postacute Care - Motol University Hospital.

This chapter addresses strategies for closing the ‘quality gap’ between the needs of complex older patients presenting to an emergency department (ED) and what current EDs mostly provide. It reviews historical reasons that the current system often fails to address the multiple and multifactorial needs of an older person in the ED. It explores domains of care—complex and atypical presentations, an awareness of polymorbidity, polypharmacy, falls, cognitive impairment, and end-of-life issues—that are specific to the older ED patient. It suggests opportunities for quality improvement in the essential components of a senior-friendly ED, summarizing some of the changes to staffing, education, policies, procedures, and physical design that prioritize the needs of older patients. It identifies the importance of the ED’s role in the continuum of care and opportunities for improving transitions of care involving the ED.