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https://www.readbyqxmd.com/read/28443096/the-microbiota-and-epigenetic-regulation-of-t-helper-17-regulatory-t-cells-in-search-of-a-balanced-immune-system
#1
REVIEW
Annie Luo, Steven T Leach, Romain Barres, Luke B Hesson, Michael C Grimm, David Simar
Immune cells not only affect tissue homeostasis at the site of inflammation but also exert systemic effects contributing to multiple chronic conditions. Recent evidence clearly supports an altered T helper 17/regulatory T cell (Th17/Treg) balance leading to the development and progression of inflammatory diseases that not only affect the gastrointestinal tract but also have whole-body manifestations, including insulin resistance. Epigenetic mechanisms are amenable to both environmental and circulating factors and contribute to determining the T cell landscape...
2017: Frontiers in Immunology
https://www.readbyqxmd.com/read/28399316/predicting-health-promotion-and-quality-of-life-with-symptom-clusters-and-social-supports-among-older-adults-with-multiple-sclerosis
#2
Wenhui Zhang, Heather Becker, Alexa K Stuifbergen, Adama Brown
Symptoms common among individuals with multiple sclerosis (MS) may influence health promotion and quality of life, especially among older adults, who often experience multiple chronic conditions. To identify and examine symptom clusters' effect on health promotion and quality of life, data from 215 adults with MS older than 60 (average years with diagnosis = 29) were analyzed. Correlations among symptoms ranged from 0.33 to 0.81. Factor analysis identified two symptom clusters: (a) physical/psychological/cognitive symptoms and (b) pain symptoms...
April 11, 2017: Journal of Gerontological Nursing
https://www.readbyqxmd.com/read/28388911/the-impact-of-multi-morbidity-on-disability-among-older-adults-in-south-africa-do-hypertension-and-socio-demographic-characteristics-matter
#3
Philippa Waterhouse, Nele van der Wielen, Pamela Chirwa Banda, Andrew Amos Channon
BACKGROUND: Alongside the global population ageing phenomenon, there has been a rise in the number of individuals who suffer from multiple chronic conditions. Taking the case of South Africa, this study aims, first, to investigate the association between multi-morbidity and disability among older adults; and second, to examine whether hypertension (both diagnosed and undiagnosed) mediates this relationship. Lastly, we consider whether the impact of the multi-morbidity on disability varies by socio-demographic characteristics...
April 8, 2017: International Journal for Equity in Health
https://www.readbyqxmd.com/read/28381395/a-mobile-app-for-chronic-disease-self-management-protocol-for-a-randomized-controlled-trial
#4
Raymond L Ownby, Amarilis Acevedo, Drenna Waldrop-Valverde, Joshua Caballero, Michael Simonson, Rosemary Davenport, Kofi Kondwani, Robin J Jacobs
BACKGROUND: Health literacy is a critically important skill that helps people become active participants in their health care. Multiple studies in the United States and across the world have documented the association of health literacy with multiple health outcomes. In particular, the elderly and many members of minority groups have been shown to have low levels of health literacy; the same groups are disproportionately affected by chronic illnesses. These twin burdens affect the people most in need of the skills and knowledge required for coping with chronic illnesses...
April 5, 2017: JMIR Research Protocols
https://www.readbyqxmd.com/read/28371441/comorbidity-physical-and-mental-health-among-cancer-patients-and-survivors-an-australian-population-based-study
#5
Huah Shin Ng, David Roder, Bogda Koczwara, Agnes Vitry
AIM: To assess the prevalence of comorbidities and measures of physical and mental health among the cancer patients and survivors compared with the general population. METHODS: Data collected by the Australian Bureau of Statistics from 2011-2012 National Health Survey were utilized for this cross-sectional study. Comparisons were made between adults aged 25 years and over with history of cancer (n = 2170) and those respondents who did not report having had a cancer (n = 11 592) using logistic regression models...
March 29, 2017: Asia-Pacific Journal of Clinical Oncology
https://www.readbyqxmd.com/read/28365140/deregulation-of-crtcs-in-aging-and-age-related-disease-risk
#6
REVIEW
Caroline C Escoubas, Carlos G Silva-García, William B Mair
Advances in public health in the past century have seen a sharp increase in human life expectancy. With these changes have come an increased prevalence of age-related pathologies and health burdens in the elderly. Patient age is the biggest risk factor for multiple chronic conditions that often occur simultaneously within a single individual. An alternative to disease-centric therapeutic approaches is that of 'geroscience', which aims to define molecular mechanisms that link age to overall disease risk. One such mechanism is deregulation of CREB-regulated transcriptional coactivators (CRTCs)...
March 29, 2017: Trends in Genetics: TIG
https://www.readbyqxmd.com/read/28349856/older-adult-spouses-with-multiple-chronic-conditions-challenges-rewards-and-coping-strategies
#7
Shelley Peacock, Bharati Sethi, Allison Williams, Wendy Duggleby, Melanie Bayly, Jenny Swindle, Jenny Ploeg, Maureen Markle-Reid
There is a paucity of research exploring how spouses to older adults with multiple chronic conditions make meaning of their caregiving experience. For this study, we asked: What is the experience of spousal caregivers to persons with multiple chronic conditions? We applied Thorne's interpretive description approach, interviewing 18 spouses who provided a rich description of their caregiving experience; interviews were transcribed verbatim and thematically analysed. Themes were categorized according to challenges encountered, rewards gleaned, and sustaining strategies employed by participants in caregiving to their spouse with multiple chronic conditions...
March 28, 2017: Canadian Journal on Aging, la Revue Canadienne du Vieillissement
https://www.readbyqxmd.com/read/28349409/engaging-stakeholders-to-inform-clinical-practice-guidelines-that-address-multiple-chronic-conditions
#8
Wendy L Bennett, Craig W Robbins, Elizabeth A Bayliss, Renee Wilson, Heather Tabano, Richard A Mularski, Wiley V Chan, Milo Puhan, Tsung Yu, Bruce Leff, Tianjing Li, Kay Dickersin, Carol Glover, Katie Maslow, Karen Armacost, Suzanne Mintz, Cynthia M Boyd
BACKGROUND: Having more than one chronic condition is common and is associated with greater health care utilization, higher medication burden and complexity of treatment. However, clinical practice guidelines (CPGs) do not routinely address the balance between harms and benefits of treatments for people with multiple chronic conditions (MCCs). OBJECTIVE: To partner with the Kaiser Permanente Integrated Cardiovascular Health (ICVH) program to engage multiple stakeholders in a mixed-methods approach in order to: 1) identify two high-priority clinical questions related to MCCs, and 2) understand patients' and family caregivers' perceptions of meaningful outcomes to inform benefit/harm assessments for these two high-priority questions...
March 27, 2017: Journal of General Internal Medicine
https://www.readbyqxmd.com/read/28342694/nursing-led-home-visits-post-hospitalization-for-children-with-medical-complexity
#9
Sarah Wells, Margaret O'Neill, Jayne Rogers, Kevin Blaine, Amy Hoffman, Sarah McBride, Meghan M Tschudy, Igor Shumskiy, Sangeeta Mauskar, Jay G Berry
PURPOSE: Hospital discharge for children with medical complexity (CMC) can be challenging for families. Home visits could potentially benefit CMC and their families after leaving the hospital. We assessed the utility of post-discharge home visits to identify and address health problems for recently hospitalized CMC. DESIGN AND METHODS: A prospective study of 36 CMC admitted to a children's hospital from 4/15/2015 to 4/14/2016 identified with a possible high risk of hospital readmission and offered a post-discharge home visit within 72h of discharge...
March 23, 2017: Journal of Pediatric Nursing
https://www.readbyqxmd.com/read/28302750/the-clinical-frailty-scale-upgrade-your-eyeball-test
#10
Jonathan Afilalo
With the emergence of transcatheter aortic valve replacement (TAVR) as a therapeutic option to treat high-risk older adults suffering from aortic stenosis, the geriatric concept of frailty has assumed mainstream relevance for cardiovascular practitioners. We have eagerly adopted tools to objectify the definition of frailty and accordingly discern good and bad candidates among a pool of complex octogenarians with multiple chronic conditions - a daunting yet mission-critical task. Initial studies published during the first half of this decade revealed that frailty status was one of the top predictors of mid-term mortality and incident disability after TAVR1, leading to its integration in clinical care pathways and predictive risk models...
March 16, 2017: Circulation
https://www.readbyqxmd.com/read/28285088/impact-of-multiple-chronic-conditions-in-patients-hospitalized-with-stroke-and-transient-ischemic-attack
#11
Mohammed Yousufuddin, Adam C Bartley, Mouaz Alsawas, Heather L Sheely, Jessica Shultz, Paul Y Takahashi, Nathan P Young, M Hassan Murad
BACKGROUND: The prevalence and clinical impact of chronic conditions (CCs) have increasingly been recognized as an important public health concern. We evaluated the prevalence of coexisting CCs and their association with 30-day mortality and readmission in hospitalized patients with stroke and transient ischemic attack (TIA). METHODS: In a retrospective study of patients aged ≥18 years hospitalized for first-ever stroke and TIA, we assessed the prevalence of coexisting CCs and their predictive value for subsequent 30-day mortality and readmission...
March 8, 2017: Journal of Stroke and Cerebrovascular Diseases: the Official Journal of National Stroke Association
https://www.readbyqxmd.com/read/28284416/using-the-beers-criteria-to-identify-potentially-inappropriate-medication-use-by-older-adult-dental-patients
#12
Daniel D Skaar, Heidi O'Connor
BACKGROUND: An aging population indicates that increasing numbers of older adults will seek oral health care and have multiple chronic conditions treated with a number of medications. The authors examined the Medicare Current Beneficiary Survey administrative data set to characterize potentially inappropriate medication (PIM) use by older adults visiting the dentist and related adverse experiences that may affect oral health care. METHODS: The authors used the 2015 Beers criteria to identify PIMs for older adults...
March 8, 2017: Journal of the American Dental Association
https://www.readbyqxmd.com/read/28283685/expansion-or-compression-of-multimorbidity-10-year-development-of-life-years-spent-in-multimorbidity-based-on-health-insurance-claims-data-of-lower-saxony-germany
#13
Juliane Tetzlaff, Denise Muschik, Jelena Epping, Sveja Eberhard, Siegfried Geyer
OBJECTIVES: Our study examined how life years spent in multimorbidity changed over a period of 10 years (2005-2014) and whether morbidity expansion or compression has taken place. There is a little evidence on whether life years gained due to increasing life expectancy are spent in good health, or if they are accompanied by morbidity expansion. METHODS: The analyses are based on German administrative claims data. Multimorbidity was defined as a combination of at least six chronic conditions and polypharmacy...
March 10, 2017: International Journal of Public Health
https://www.readbyqxmd.com/read/28282022/barriers-to-health-care-for-adults-with-multiple-chronic-conditions-united-states-2012-2015
#14
Brian W Ward
Data from the National Health Interview Survey •In 2015, the percentage of adults aged 18-64 who delayed or did not obtain needed medical care due to cost in the past 12 months was highest among those diagnosed with 2 or more of 10 selected chronic conditions (16.9%), and it was lowest among those with none of the selected conditions (8.5%). •The percentage of adults who delayed needed medical care for a non-cost reason in the past 12 months increased as the number of conditions increased. •The percentage of adults who had seen or talked to a health professional in the past 12 months increased as the number of conditions increased...
March 2017: NCHS Data Brief
https://www.readbyqxmd.com/read/28264943/innovative-home-visit-models-associated-with-reductions-in-costs-hospitalizations-and-emergency-department-use
#15
Sarah Ruiz, Lynne Page Snyder, Christina Rotondo, Caitlin Cross-Barnet, Erin Murphy Colligan, Katherine Giuriceo
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits...
March 1, 2017: Health Affairs
https://www.readbyqxmd.com/read/28205206/apples-and-oranges-four-definitions-of-multiple-chronic-conditions-and-their-relationship-to-30-day-hospital-readmission
#16
Melissa Dattalo, Eva DuGoff, Katie Ronk, Korey Kennelty, Andrea Gilmore-Bykovskyi, Amy J Kind
OBJECTIVES: To determine the extent of agreement between four commonly used definitions of multiple chronic conditions (MCCs) and compare each definition's ability to predict 30-day hospital readmissions. DESIGN: Retrospective cohort study. SETTING: National Medicare claims data. PARTICIPANTS: Random sample of Medicare beneficiaries discharged from the hospital from 2005 to 2009 (n = 710,609). MEASUREMENTS: Baseline chronic conditions were determined for each participant using four definitions of MCC...
April 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28196486/integrated-care-at-home-reduces-unnecessary-hospitalizations-of-community-dwelling-frail-older-adults-a-prospective-controlled-trial
#17
Laura Di Pollina, Idris Guessous, Véronique Petoud, Christophe Combescure, Bertrand Buchs, Philippe Schaller, Michel Kossovsky, Jean-Michel Gaspoz
BACKGROUND: Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems. The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room visits, institutionalization, and mortality in community dwelling frail and dependent older adults. METHODS: A prospective controlled trial was conducted, in real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service centers...
February 14, 2017: BMC Geriatrics
https://www.readbyqxmd.com/read/28181895/-inter-practice-variation-in-polypharmacy-prevalence-amongst-older-patients-in-primary-care
#18
J Sinnige, J C Braspenning, F G Schellevis, K Hek, I Stirbu, G P Westert, J C Korevaar
PURPOSE: Complex medication management in older people with multiple chronic conditions can introduce practice variation in polypharmacy prevalence. This study aimed to determine the inter-practice variation in polypharmacy prevalence and examine how this variation was influenced by patient and practice characteristics. METHODS: This cohort study included 45,731 patients aged 55 years and older with at least one prescribed medication from 126 general practices that participated in NIVEL Primary Care Database in the Netherlands...
2017: Nederlands Tijdschrift Voor Geneeskunde
https://www.readbyqxmd.com/read/28179450/prevalence-incidence-and-associated-comorbidities-of-treated-hypothyroidism-an-update-from-a-european-population
#19
Carlo B Giorda, Paolo Carnà, Francesco Romeo, Giuseppe Costa, Barbara Tartaglino, Roberto Gnavi
OBJECTIVE: Estimates of the prevalence of hypothyroidism in unselected populations date from the late 1990s. We present an update on the prevalence and incidence of overt hypothyroidism in Piedmont, northwest Italy and examine the association between hypothyroidism and multiple chronic comorbidities. DESIGN AND METHODS: Data were obtained from drug prescription and hospital discharge databases. Individuals who had received at least two levothyroxine prescriptions in 2012 were defined as having hypothyroidism; those who had undergone thyroidectomy or I(131) irradiation in the previous 5 years were defined as having iatrogenic hypothyroidism and those who had either obtained exemption from treatment co-payment or had been discharged from hospital with a chronic comorbidity (diabetes and connective tissue diseases) were identified as having one of these conditions...
May 2017: European Journal of Endocrinology
https://www.readbyqxmd.com/read/28166816/the-achru-cpp-versus-usual-care-for-older-adults-with-type-2-diabetes-and-multiple-chronic-conditions-and-their-family-caregivers-study-protocol-for-a-randomized-controlled-trial
#20
Maureen Markle-Reid, Jenny Ploeg, Kimberly D Fraser, Kathryn Ann Fisher, Noori Akhtar-Danesh, Amy Bartholomew, Amiram Gafni, Andrea Gruneir, Sandra P Hirst, Sharon Kaasalainen, Caralyn Kelly Stradiotto, John Miklavcic, Carlos Rojas-Fernandez, Cheryl A Sadowski, Lehana Thabane, Jean A C Triscott, Ross Upshur
BACKGROUND: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges...
February 6, 2017: Trials
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