Multimorbidity in primary care : protocol of a national cross-sectional study in Switzerland.

INTRODUCTION: With the ageing of the population and the general improvement of care, an increasing number of people are living with multiple chronic health conditions or 'multimorbidity'. Multimorbidity often implies multiple medical treatments. As a consequence, the risk of adverse events and the time spent by patients for their treatments increase exponentially. In many cases, treatment guidelines traditionally defined for single conditions are not easily applicable. Primary care for individuals with multimorbidity requires complex patient-centred care and good communication between the patient and the general practitioner (GP). This often includes prioritising among the different chronic conditions. METHODS AND ANALYSIS: The main objectives of this study are to describe the burden related to multimorbidity (disease-related burden and burden of treatment) in primary care and to identify the factors influencing it. Other objectives include evaluating patients' perception of treatment burden and quality of life, assessing factors influencing that perception, and investigating prioritisation in the management of multimorbidity from the perspectives of GPs and patients. For this cross-sectional study, patient enrolment will take place in GP's private practices across Switzerland. A convenient sample of 100 GPs will participate; overall, 1000 patients with at least three chronic health conditions will be enrolled. Data will be collected as paper-based questionnaires for GPs and delayed telephone interview questionnaires for patients. GPs will provide demographic and practice-related data. In addition, each GP will complete a paper-based questionnaire for each patient that they enrol. Each patient will complete a telephone interview questionnaire. ETHICS AND DISSEMINATION: This study has been approved by the research ethics committee of Canton Vaud, Switzerland (Protocol 315/14). The results of the study will be reported in international peer-reviewed journals.

Visual impairment and multimorbidity in a representative sample of the Spanish population

BACKGROUND: In the context of population aging, visual impairment has emerged as a growing concern in public health. However, there is a need for further research into the relationship between visual impairment and chronic medical conditions in the elderly. The aim of our study was to examine the relationship between visual impairment and three main types of co-morbidity: chronic physical conditions (both at an independent and additive level), mental health and cognitive functioning. METHODS: Data were collected from the COURAGE in Europe project, a cross-sectional study. A total of 4,583 participants from Spain were included. Diagnosis of chronic medical conditions included self-reported medical diagnosis and symptomatic algorithms. Depression and anxiety were assessed using CIDI algorithms. Visual assessment included objective distance/near visual acuity and subjective visual performance. Descriptive analyses included the whole sample (n = 4,583). Statistical analyses included participants aged over 50 years (n = 3,625; mean age = 66.45 years) since they have a significant prevalence of chronic conditions and visual impairment. Crude and adjusted binary logistic regressions were performed to identify independent associations between visual impairment and chronic medical conditions, physical multimorbidity and mental conditions. Covariates included age, gender, marital status, education level, employment status and urbanicity. RESULTS: The number of chronic physical conditions was found to be associated with poorer results in both distance and near visual acuity [OR 1.75 (CI 1.38-2.23); OR 1.69 (CI 1.27-2.24)]. At an independent level, arthritis, stroke and diabetes were associated with poorer distance visual acuity results after adjusting for covariates [OR 1.79 (CI 1.46-2.21); OR 1.59 (CI 1.05-2.42); OR 1.27 (1.01-1.60)]. Only stroke was associated with near visual impairment [OR 3.01 (CI 1.86-4.87)]. With regard to mental health, poor subjective visual acuity was associated with depression [OR 1.61 (CI 1.14-2.27); OR 1.48 (CI 1.03-2.13)]. Both objective and subjective poor distance and near visual acuity were associated with worse cognitive functioning. CONCLUSIONS: Arthritis, stroke and the co-occurrence of various chronic physical diseases are associated with higher prevalence of visual impairment. Visual impairment is associated with higher prevalence of depression and poorer cognitive function results. There is a need to implement patient-centered care involving special visual assessment in these cases.

Multimorbidity patterns in a national representative sample of the Spanish adult population.

BACKGROUND: In the context of population aging, multimorbidity has emerged as a growing concern in public health. However, little is known about multimorbidity patterns and other issues surrounding chronic diseases. The aim of our study was to examine multimorbidity patterns, the relationship between physical and mental conditions and the distribution of multimorbidity in the Spanish adult population. METHODS: Data from this cross-sectional study was collected from the COURAGE study. A total of 4,583 participants from Spain were included, 3,625 aged over 50. An exploratory factor analysis was conducted to detect multimorbidity patterns in the population over 50 years of age. Crude and adjusted binary logistic regressions were performed to identify individual associations between physical and mental conditions. RESULTS: THREE MULTIMORBIDITY PATTERNS ROSE: 'cardio-respiratory' (angina, asthma, chronic lung disease), 'mental-arthritis' (arthritis, depression, anxiety) and the 'aggregated pattern' (angina, hypertension, stroke, diabetes, cataracts, edentulism, arthritis). After adjusting for covariates, asthma, chronic lung disease, arthritis and the number of physical conditions were associated with depression. Angina and the number of physical conditions were associated with a higher risk of anxiety. With regard to multimorbidity distribution, women over 65 years suffered from the highest rate of multimorbidity (67.3%). CONCLUSION: Multimorbidity prevalence occurs in a high percentage of the Spanish population, especially in the elderly. There are specific multimorbidity patterns and individual associations between physical and mental conditions, which bring new insights into the complexity of chronic patients. There is need to implement patient-centered care which involves these interactions rather than merely paying attention to individual diseases.

Impact of multimorbidity on disability and quality of life in the spanish older population

BACKGROUND: Population aging is closely related to high prevalence of chronic conditions in developed countries. In this context, health care policies aim to increase life span cost-effectively while maintaining quality of life and functional ability. There is still, however, a need for further understanding of how chronic conditions affect these health aspects. The aim of this paper is to assess the individual and combined impact of chronic physical and mental conditions on quality of life and disability in Spain, and secondly to show gender trends. METHODS: Cross-sectional data were collected from the COURAGE study. A total of 3,625 participants over 50 years old from Spain were included. Crude and adjusted multiple linear regressions were conducted to detect associations between individual chronic conditions and disability, and between chronic conditions and quality of life. Separate models were used to assess the influence of the number of diseases on the same variables. Additional analogous regressions were performed for males and females. RESULTS: All chronic conditions except hypertension were statistically associated with poor results in quality of life and disability. Depression, anxiety and stroke were found to have the greatest impact on outcomes. The number of chronic conditions was associated with substantially lower quality of life [β for 4+ diseases: -18.10 (-20.95,-15.25)] and greater disability [β for 4+ diseases: 27.64 (24.99,30.29]. In general, women suffered from higher rates of multimorbidity and poorer results in quality of life and disability. CONCLUSIONS: Chronic conditions impact greatly on quality of life and disability in the older Spanish population, especially when co-occurring diseases are added. Multimorbidity considerations should be a priority in the development of future health policies focused on quality of life and disability. Further studies would benefit from an expanded selection of diseases. Policies should also deal with gender idiosyncrasy in certain cases.

Modeling and simulation of forced-air cooling of strawberries using variable convective coefficient

In the forced-air cooling process of fruits occurs, besides the convective heat transfer, the mass transfer by evaporation. The energy need in the evaporation is taken from fruit that has its temperature lowered. In this study it has been proposed the use of empirical correlations for calculating the convective heat transfer coefficient as a function of surface temperature of the strawberry during the cooling process. The aim of this variation of the convective coefficient is to compensate the effect of evaporation in the heat transfer process. Linear and exponential correlations are tested, both with two adjustable parameters. The simulations are performed using experimental conditions reported in the literature for the cooling of strawberries. The results confirm the suitability of the proposed methodology.

Effective diffusivity and convective mass transfer coefficient during the drying of bananas

In this article, a methodology is used for the simultaneous determination of the effective diffusivity and the convective mass transfer coefficient in porous solids, which can be considered as an infinite cylinder during drying. Two models are used for optimization and drying simulation: model 1 (constant volume and diffusivity, with equilibrium boundary condition), and model 2 (constant volume and diffusivity with convective boundary condition). Optimization algorithms based on the inverse method were coupled to the analytical solutions, and these solutions can be adjusted to experimental data of the drying kinetics. An application of optimization methodology was made to describe the drying kinetics of whole bananas, using experimental data available in the literature. The statistical indicators enable to affirm that the solution of diffusion equation with convective boundary condition generates results superior than those with the equilibrium boundary condition.

Evapotranspiration and crop coefficient of drip irrigated watermelon in Piaui coastline, Brazil

The knowledge of the evapotranspiration (ETc) and crop coefficient (Kc) is fundamental to plan and to manage the irrigation of any crop. The aim of this study was to determine the daily and hourly evapotranspiration of drip irrigated watermelon (Citrullus Lanatus, var. Crimson Sweet) and crop coefficient (Kc) in each crop development phase. The experiment was carried out in an experimental area of 1.27 ha of Embrapa Mid-North, localized in Parnaíba (02°54'S, 41°47'W and 46 m above of sea), State of Piauí, Brazil, from September to November, 2006. Electronic weighing lysimeters of 1.5 m x 1.5 m wide and long and 1.0 m deep were used to obtain the evapotranspiration. The plants were drip irrigated with a lateral row per plant row and drippers spaced 0.5 m from each other. The reference evapotranspiration (ETo) was estimated using the Penman-Monteith equation from the climatic data obtained by electronic sensors. The total evapotranspiration during the watermelon crop cycle cultivated in the state of Piauí was 233.87 mm, with mean values of 3.7 mm day-1, minimum of 1.18 and maximum of 8.14 mm day-1. The Kc of the drip irrigated watermelon was 0.18 in the initial stage of crop growth; 0.18 to 1.3, in crop development stage; 1.3 in the intermediate stage and 0.43 in the final stage.

Crop coefficient and water consumption of eggplant in no-tillage system and conventional soil preparation

Under organic management in Seropédica-RJ, Brazil, using a weighing lysimeter, the crop coefficients (kc), the maximum evapotranspiration and the productivity of eggplant cultivation under two cropping systems (no tillage with straw plus soil with conventional preparation) were determined. A whole randomized layout with two treatments (no tillage and conventional) and five replicates during 134 days of cultivation were adopted. There were no significant differences in the eggplant cultivation in the two cropping systems, with a maximum commercial productivity obtained from 47.42 Mg ha-1 for the no-tillage system, and 47.91 Mg ha-1 for the conventional tillage. The accumulated ETc was 285.15 and 323.44 mm for the no-tillage and conventional, respectively. The crop coefficients value for the phases: 1 - transplanting, flowering, 2 - flowering-fruiting, 3 - fruit- first harvesting, 4- first harvesting of the final crop cycle was 0.83, 0.77, 0.90 and 0.97 in no-tillage system for the respective phases and for the conventional one 0.81, 1.14, 1.17 and 1.05 for the same steps described above.

Evapotranspiration and crop coefficient for potato in organic farming

The aim of this study was to quantify the water consumption and the crop coefficients (Kc) for the potato (Solanum tuberosum L.), in Seropédica, Rio de Janeiro (RJ), Brazil, under organic management, and to simulate the crop evapotranspiration (ETc) using the Kc obtained in the field and the ones recommended by the Food and Agriculture Organization (FAO). The water consumption was obtained through soil water balance, using TDR probes installed at 0.15m and 0.30m deep. At the different stages of development, the Kc was determined by the ratio of ETc and reference evapotranspiration, obtained by Penman-Monteith FAO 56. The crop coefficients obtained were 0.35, 0.45, 1.29 and 0.63. The accumulated ETc obtained in the field was 109.6 mm, while the ETc accumulated from FAO's Kc were 142.2 and 138mm, respectively, considering the classical values and the values adjusted to the local climatic conditions. The simulation of water consumption based on meteorological data of historical series from 1961 to 2007 provided higher value of ETc when compared with the one obtained in the field. From the meteorological data of historical series, it was observed that the use of Kc recommended by FAO may overestimate the amount of irrigation water by 9%, over the same growing season.

Morbidity, comorbidity et multimorbidity : polysémie et pléthore terminologique

Département de linguistique et de traduction

Salting coefficient of hydroxybenzoic acids

The Setschenow parameter and thermodynamic parameters of transfer of 2- and 4- hydroxybenzoic acids from water to salt solutions have been reported. The data have been rationalised by considering the structure breaking effects of the ions of the salts, the localized hydrolysis model, the internal pressure theory and the theory of water structure due to Symons.

Malayalam Isolated Digit Recognition using HMM and PLP cepstral coefficient

Development of Malayalam speech recognition system is in its infancy stage; although many works have been done in other Indian languages. In this paper we present the first work on speaker independent Malayalam isolated speech recognizer based on PLP (Perceptual Linear Predictive) Cepstral Coefficient and Hidden Markov Model (HMM). The performance of the developed system has been evaluated with different number of states of HMM (Hidden Markov Model). The system is trained with 21 male and female speakers in the age group ranging from 19 to 41 years. The system obtained an accuracy of 99.5% with the unseen data

Estimating the reliability coefficient of tests in presence of missing values

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