Search Results (849)

Background: Although survival in coronary artery disease (CAD) has improved with modern therapies, quality of life (QoL) remains an important clinical concern. Our study aimed to evaluate QoL, life satisfaction, and disease acceptance in CAD patients and to identify their clinical and lifestyle determinants. Methods: This single-center, prospective study included patients undergoing percutaneous coronary intervention for myocardial infarction (MI) or chronic coronary syndrome (CCS). QoL was assessed using validated questionnaires (WHOQOL-BREF, SWLS, AIS). Comparative analyses between the MI and CCS groups were performed, and the determinants of the outcomes were evaluated using regression models. Results: The study included 220 patients (110 MI and 110 CCS) with a median age of 64 years (IQR 54–70); 30% were women. The WHOQOL-BREF-assessed QoL was comparable between MI and CCS patients, whereas MI patients reported higher life satisfaction (SWLS 24 vs. 20, p = 0.003). Smoking was the strongest determinant of poorer QoL, associated with lower SWLS (β = −2.75; p < 0.001) and WHOQOL-BREF (β = −4.46; p = 0.014). Alcohol consumption (β = −6.22; p = 0.008), hypertension (β = −7.10; p < 0.001), and chronic obstructive pulmonary disease (β = −9.84; p < 0.001) were also independently associated with lower WHOQOL-BREF scores. Subgroup analyses showed heterogeneity between MI and CCS patients. Conclusions: QoL in CAD patients might be influenced more by lifestyle factors and multimorbidity than by CAD phenotype. Smoking, alcohol, and cardiopulmonary comorbidities might have the most consistent adverse associations with QoL. These findings highlight the potential importance of integrating lifestyle and comorbidity management to improve QoL and patient-reported outcomes in CAD care. Full article

Background: Population aging among people living with HIV (PLWH) has led to a growing burden of multimorbidity and complex medication regimens. However, the relationships between medication-related challenges and antiretroviral therapy (ART) adherence in older PLWH remain insufficiently understood. Methods: A multicenter cross-sectional study was conducted among PLWH aged ≥50 years receiving routine HIV care in Hunan Province, China. Multimorbidity, polypharmacy, potential drug–drug interactions (PDDIs), medication-related burden, and ART adherence were assessed using validated instruments and clinical records. Path analysis was applied to examine hypothesized relationships based on the transactional model of stress and coping. Results: Among 301 participants, 54.2% experienced multimorbidity and 29.2% met criteria for polypharmacy. Medication-related burden was moderate to high. The proposed path model demonstrated good fit. Multimorbidity was positively associated with polypharmacy and PDDIs, both of which contributed to higher medication-related burden. Medication-related burden was the only factor directly associated with lower ART adherence, whereas polypharmacy and PDDIs showed no significant direct effects. Conclusions: Medication-related burden was significantly associated with both clinical complexity indicators and ART adherence among older PLWH. Interventions addressing patients’ subjective treatment burden may be critical for sustaining long-term adherence in aging HIV populations. Full article

Background/Objectives: Cardiometabolic multimorbidity (CMM) significantly reduces healthy life expectancy in older adults. The specific role of adiposity indices derived from the triglyceride-glucose (TyG) index, body mass index (BMI), and waist-to-height ratio (WHtR) in predicting incident CMM has not been fully elucidated in longitudinal settings. We investigated these associations and the mediating role of the atherogenic index of plasma (AIP). Methods: We analyzed 304,586 community-dwelling adults aged ≥65 years from the prospective Guangzhou Older Longitudinal Dynamic Health (GOLD-Health) cohort (2018–2019), who were free of CMM at baseline. Multivariable Cox proportional hazards models evaluated the risk of incident CMM (coexistence of ≥2 cardiometabolic diseases) across quartiles of six TyG-derived indices. Mediation analysis quantified the contribution of atherogenic dyslipidemia via AIP. Results: Following a median observation time of 4.3 years, the study recorded 7816 participants who developed CMM. All six indices showed significant positive associations with CMM risk. TyG-WHtR demonstrated the strongest association (Hazard Ratio [HR] comparing highest vs. lowest quartile = 2.150; 95% Confidence Interval [CI] 1.998–2.314), closely followed by TyG-BMI (HR = 2.146). AIP significantly mediated the associations, explaining 7.5–33.0% of the effect, with the highest proportion observed for TyG using the Chinese visceral adiposity index (CVAI). Conclusions: TyG-derived adiposity indices, particularly TyG-WHtR and TyG-BMI, are robust independent risk markers for incident CMM in older adults. The substantial mediating role of AIP suggests that targeting atherogenic dyslipidemia may be a key strategy to interrupt the progression from insulin resistance to multimorbidity. These accessible metrics hold promise for large-scale risk stratification and early intervention in primary care settings. Full article

Background/Objectives: The Lancet Diabetes & Endocrinology Commission recently proposed distinguishing preclinical obesity from clinical obesity, in which excess adiposity is accompanied by obesity-related disease. Using data from the China Nutrition and Health Surveillance 2015, we estimated the prevalence and comorbidity burden of clinical obesity among Chinese adults and further explored the association between physical activity and clinical obesity. Methods: This cross-sectional study included adults aged 18–79 years from the China Nutrition and Health Surveillance 2015 (N = 180,480). Excess adiposity was identified using body mass index, waist circumference, and waist-to-height ratio. Participants were classified as having no obesity, preclinical obesity, or clinical obesity, defined as excess adiposity plus at least one obesity-related comorbidity. We estimated the prevalence of clinical obesity overall and across sociodemographic subgroups. In secondary analyses, we examined the association of physical activity (MET-min/week) with clinical obesity prevalence and ordered obesity status using fully adjusted proportional-odds models. Results: Overall, 33.9% of adults had excess adiposity, and 26.9% met the criteria for clinical obesity. The prevalence of clinical obesity increased from 15.3% among adults aged 18–39 years to 33.3% among those aged ≥60 years and varied across sociodemographic subgroups. Among individuals with clinical obesity, dyslipidemia, hypertension, and diabetes were the most common comorbidities, indicating a substantial cardiometabolic burden. Higher physical activity was associated with a lower prevalence of clinical obesity and lower odds of more severe ordered obesity status. Conclusions: Clinical obesity affects more than one quarter of Chinese adults and is associated with a substantial cardiometabolic burden. Higher physical activity was associated with a lower prevalence of clinical obesity and less severe obesity status. These findings provide nationally relevant evidence to inform prevention and clinical management in China. Full article

Background and Objectives: Patients admitted to plastic surgery units increasingly present with multimorbidity, advanced age, diabetes, cardiovascular disease, chronic wounds, and complex metabolic requirements. In several surgical specialties, internal medicine specialist (IMS) co-management has been associated with improved clinical outcomes, yet its potential role in plastic surgery remains unexplored. Materials and Methods: A narrative scoping review conducted using systematic search principles was conducted using MEDLINE, Web of Science, Scopus, and Google Scholar from inception to 1 December 2025. Search terms combined “internal medicine,” “co-management,” and “surgery.” Studies assessing outcomes of IMS involvement in surgical inpatient care were included. Data on population, intervention characteristics, and outcomes were extracted and summarized. PRISMA recommendations were used to report the study selection process. The review focuses on adult and elderly surgical inpatients, as the available evidence is not applicable for pediatric populations. Results: Twenty-two articles met the inclusion criteria. IMS co-management demonstrated consistent benefits across multiple surgical specialties, including reduced length of stay, lower complication rates, improved metabolic and cardiovascular stabilization, enhanced perioperative optimization, and decreased costs. Despite the growing complexity of plastic surgery inpatients, no studies specifically evaluated IMS co-management in this field. Conclusions: Evidence from other surgical specialties suggests that structured IMS co-management may offer substantial benefits for plastic surgery patients, particularly those with multimorbidity, diabetes, severe burns, chronic wounds, or undergoing microsurgical reconstruction. Prospective studies are needed to determine its impact on patient outcomes, resource utilization, and clinical workflows within plastic surgery. Full article

Background/Objectives: Administrative and clinical databases are increasingly used for research, but their value depends on coding accuracy. The Spanish National Hospital Discharge Database (CMBD) is a standardised registry widely applied in epidemiology. Type 1 diabetes mellitus (T1DM) is an autoimmune disease with early onset and long-term complications. This study aimed to validate the accuracy of T1DM diagnoses recorded in the CMBD. Methods: A cross-sectional validation study was conducted at Hospital Clínico San Carlos (Madrid, Spain) including discharges from 2016–2023. Two age- and sex-matched samples of 384 admissions each (with and without T1DM coding, ICD-10 E10) were randomly selected. The gold standard was the confirmation of T1DM based on the diagnostic criteria established by the 2016 American Diabetes Association (ADA) consensus, which remained valid through 2025, verified by a detailed review of electronic health records (EHRs). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated with 95% confidence intervals (CIs), and interobserver concordance was assessed with Cohen’s kappa. Results: Of the 245,206 discharges, 1324 (0.54%) included a T1DM diagnosis. Validation showed a sensitivity of 100% (95% CI: 98.7–100), specificity of 80.2% (95% CI: 76.4–83.5), PPV of 75.3% (95% CI: 70.7–79.3), and NPV of 100% (95% CI: 99.0–100). Interobserver agreement was excellent (κ = 0.869). Specificity declined with age, from 100% in patients < 30 years to 60% in those ≥ 80 years, mainly due to misclassification with insulin-treated type 2 diabetes. Conclusions: T1DM diagnoses in the CMBD show very high validity and reliability in younger patients, supporting their use in epidemiological and clinical research, while complementary verification is advisable in older adults. Full article

Background: Vitamin deficiencies remain prevalent worldwide and contribute to chronic disease burden. This study evaluated serum concentrations of vitamins D, A, and E in Italian general practice populations and examined their associations with prevalent chronic diseases. Methods: This multicenter cross-sectional study enrolled 500 adult patients (median age: 60.7 years; 40.4% male) attending 21 general practice offices across Italy between January 2021 and December 2024. Serum concentrations of 25-hydroxyvitamin D [25(OH)D], vitamin A, and vitamin E were measured alongside demographic, clinical, and biochemical parameters. Statistical analyses included chi-square tests, correlation analyses, and stepwise logistic regression. Results: The median 25(OH)D concentration was 20.4 ng/mL, below optimal levels. Vitamin D deficiency was significantly associated with osteoporosis (p = 0.015), arterial hypertension (p = 0.047), and coronary artery disease (p = 0.002). The median vitamin A (654 μg/L) and vitamin E (11.3 mg/L) concentrations were within normal ranges. Notably, elevated vitamin A levels were significantly associated with arterial hypertension (p = 0.005), diabetes mellitus (p = 0.036), and cancer (p = 0.010). In the multivariate analysis, elevated vitamin A levels emerged as an independent predictor of multiple comorbidities (p < 0.001) and cancer presence (p = 0.014), alongside age, male gender, and body mass index. Conclusions: Vitamin D insufficiency is highly prevalent in Italian primary care populations. Vitamin A concentrations show independent associations with multimorbidity and cancer, suggesting a potential negative influence of an animal-based diet, warranting prospective investigation. These findings highlight the importance of comprehensive vitamin assessment in general practice settings. Full article

Background/Objectives: People experiencing homelessness (PEH) face greater morbidity, multimorbidity, and premature mortality than the general population. Medical data on this population in Gdańsk remain scarce. The aim of this study was to assess the prevalence, age distribution, comorbidity burden, and healthcare utilization of selected neurological and vascular diseases among homeless men in Gdańsk, Poland. Methods: A retrospective secondary analysis was performed using data from 551 men residing in shelters operated by the largest PEH support organization in Gdańsk. A random sample of 226 individuals (95% confidence level) was analyzed, selected by randomization in Microsoft Excel. Data were extracted from interviews, verified medical documentation, and staff records. Results: Mean age was 57.0 (SD 12.9) years (median 60). Among the studied sample, essential (primary) hypertension (20.4%), heart failure (10.2%), atrial fibrillation (8.9%), and chronic obstructive pulmonary disease (8.4%) were the most common conditions. Sequelae of cerebrovascular disease (ICD-10: I69) affected 8.9% of participants; this subgroup was older and had higher rates of disability certification and hospitalization than the overall sample. Epilepsy (12.0%) and polyneuropathy (4.0%) differed in age distribution, disability rates, and comorbidity burden, with the epilepsy subgroup displaying high substance-use prevalence. Overall, 44.0% of the sample had been hospitalized since 2019. Conclusions: Homeless men in Gdańsk present a high burden of neurological and vascular disease at comparatively young ages, along with substantial multimorbidity. These findings highlight structural inequalities in healthcare access and the need for integrated, equity-oriented health and social care interventions. Full article

Background/Objectives: Chronic obstructive pulmonary disease (COPD) is a leading cause of mortality worldwide and a systemic condition in which outcomes are influenced by respiratory impairment, multimorbidity, exacerbation burden, and functional status. This study aimed to identify multidimensional determinants of all-cause mortality in a population-based cohort of primary care patients with spirometry-confirmed COPD. Methods: We conducted a retrospective population-based cohort study using electronic health records from primary care in the Lleida health region (Catalonia, Spain). Adult patients with spirometry-confirmed COPD (FEV1/FVC < 0.70) between 2019 and 2023 were included. Baseline demographic, clinical, spirometric, functional, and social variables were extracted. Exacerbations in the year prior to baseline were classified as 0, 1, or ≥2 events (and, where available, as moderate vs. severe) using a prespecified operational definition. The primary outcome was all-cause mortality during follow-up (censoring date: 31 December 2023). Time-to-event analyses were performed using Cox proportional hazards models. Results: A total of 2056 patients were included (median age 71 years; 78.4% male). During follow-up, 558 patients died (27.1%). Independent predictors of mortality included male sex, increasing age, current smoking, and prior exacerbations, whereas sufficient physical activity and better lung function (FEV1 % predicted) were protective. Conclusions: Mortality in spirometry-confirmed COPD managed in primary care is driven by a multidimensional vulnerability profile beyond lung function alone. Integrating respiratory, clinical, and functional determinants may improve risk stratification and management in chronic lung disease. Full article

Background: Non-cardiac comorbidities (NCCs) are highly prevalent among patients hospitalized for acute heart failure (HF). However, data from sub-Saharan Africa (SSA) on their distribution across HF phenotypes and association with in-hospital outcomes remain limited. Methods: We prospectively enrolled adults hospitalized with acute HF at a tertiary centre in South Africa between February and November 2023. Ten NCCs were assessed and patients were categorized according to comorbidity burden. The primary outcomes were all-cause in-hospital mortality and length of stay. Multivariable regression and sensitivity analyses were performed to identify predictors of outcomes. Results: Of the 406 patients (mean age 54.9 ± 15.8 years; 51% women), HF with reduced ejection fraction (HFrEF) accounted for 63%, HF with mildly reduced ejection fraction (HFmrEF) for 15%, and HF with preserved ejection fraction (HFpEF) for 21%. The most common NCCs were diabetes (47%), chronic kidney disease (CKD) (46%), obesity (45%), and anaemia (33%). Two-thirds had ≥2 NCCs. The median hospital stay was 8 days (IQR: 5–12) and in-hospital mortality was 3.4% (p > 0.05 across NCC groups). Higher heart rate predicted longer hospitalization, while renin angiotensin system inhibitor (RASi) therapy was associated with shorter stay. Lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score (adjusted odds ratio [aOR] 1.009; 95% confidence interval [CI]: 1.003–1.015) and higher log-transformed NT-proBNP were independently associated with increased in-hospital mortality (aOR 1.85; 95% CI: 1.07–3.50; p = 0.026). Total comorbidity burden was not independently associated with length of stay or in-hospital mortality. Conclusions: Non-cardiac comorbidities are common in acute HF in SSA, and functional status and clinical markers were the strongest predictors of length of stay and in-hospital mortality. Full article

Background: Non-invasive brain stimulation (NIBS) is increasingly used as an adjunctive option in late-life depression (≥60 years), a condition frequently complicated by multimorbidity and incomplete response to standard treatments. Comparative real-world evidence between repetitive Transcranial Magnetic Stimulation (rTMS) and transcranial Direct Current Stimulation (tDCS), particularly including functional outcomes, remains limited. Methods: We conducted a retrospective, naturalistic comparative study of 104 depressed inpatients (≥60 years), either unipolar or bipolar, treated with rTMS (n = 48) or tDCS (n = 56) as part of routine care. Depression severity was assessed with the 21-item Hamilton Depression Rating Scale (HDRS21) at baseline, 2 weeks, and 1 month; response was defined as ≥50% HDRS21 score reduction and remission as HDRS21 < 7 at 1 month. Global Assessment of Functioning (GAF) was assessed at admission and discharge (baseline and 1 month). Longitudinal changes were examined using covariate-adjusted mixed-effects models; categorical outcomes were compared using χ² tests. Propensity score matching was applied as an additional approach to reduce confounding due to the observational design. Results: At 1 month, response and remission rates were significantly higher in the rTMS group than in the tDCS group (87.5% vs. 55.4%, p < 0.001; 62.5% vs. 41.1%, p = 0.047, respectively). rTMS showed greater HDRS21 score reductions at 2 weeks and 1 month (Time × Treatment, p < 0.001). GAF scores significantly improved over time in both groups (Time effect, p < 0.001) without between-technique differences (Time × Treatment, p = 0.56), and GAF scores did not differ by response/remission status. Conclusions: In this cohort of inpatients aged ≥ 60 years with depressive episodes, rTMS was associated with greater short-term reductions in HDRS21 scores compared with tDCS, whereas both modalities showed comparable improvements in GAF from admission to discharge. Full article

Background: Chronic non-cancer pain (CNCP) is an increasing global health concern and a multidimensional condition shaped by biological, psychological, social, and cultural factors, with impacts on functioning, quality of life, and healthcare. However, evidence remains fragmented, limiting integrated understanding and care. Objective: This study aimed to synthesize and critically analyze existing evidence on the biological, psychological, social, and cultural dimensions characterizing individuals with CNCP, and their impact on functionality, quality of life, and healthcare. Methodology: An integrative review was conducted following the Whittemore and Knafl framework. Searches were performed in Medline, Cumulative Index of Nursing and Allied Literature Complete (CINAHL), PsycINFO, Scopus, Web of Science, and grey literature in English and Spanish, without time restrictions. Studies were screened using predefined eligibility criteria and appraised with Joanna Briggs Institute tools. Data were systematically extracted and synthesized using thematic analysis to identify key attributes of people living with CNCP. Quantitative findings were summarized descriptively and mapped to thematic domains, while qualitative data were analyzed interpretively. Both evidence streams were integrated through convergent thematic synthesis. Results: Forty-four studies were included, predominantly cross-sectional and observational. Five themes emerged: biological aspects; functioning and quality of life; psychological and mental factors; social support and peer relationships; and social and gender determinants. CNCP was consistently associated with multimorbidity, sleep disturbance, psychological distress, and maladaptive coping, contributing to reduced functional capacity, greater disability, poorer quality of life, and increased healthcare utilization. Socioeconomic disadvantages and environmental constraints were linked to higher pain burden, whereas resilience and social support emerged as protective factors mitigating functional and psychosocial impact. Conclusions: Evidence largely concentrates on biomedical, functional, and psychological dimensions, whereas social determinants and healthcare quality remain comparatively underexplored. Broadening these perspectives is essential to inform public health strategies and support multidisciplinary, equitable care for individuals living with CNCP. Full article

The lack of reliable diagnostic tools and relapse monitoring for latent tuberculosis infection (LTBI) constitutes a major obstacle to global tuberculosis (TB) control. This highlights an urgent need for robust animal models and predictive biomarkers. To address this, we report the successful establishment of a rapid murine model of recapitulating the active, latent, and relapse phases of TB within a compressed ten-week timeframe—hence termed the rapid multi-stage TB murine model. In this model, mice were first intravenously infected with Mycobacterium tuberculosis, followed by a four-week isoniazid (INH) regimen starting at two weeks post-infection. By week six, pulmonary bacterial loads in most mice dropped below the detection limit, signifying the establishment of latency. Reactivation was subsequently triggered by a four-week administration of anti-TNF-α (Tumor Necrosis Factor-α) monoclonal antibody. Leveraging this reproducible and time-efficient model, we performed transcriptomic profiling of peripheral blood and identified a distinct sixteen-gene signature (including Ets2, Fam111a, Fosl2, Gadd45b, Nfkbid, Rgs1, Bhlhe40, Il1r2, Clec2d, Kmo, Lynx1, Papd4, Trim34a, Wrb, Nlrp12, Spns1) that dynamically tracks disease progression. Collectively, these findings not only provide a valuable and efficient preclinical tool but also deliver transformable candidate biomarkers with immediate potential to guide the development of novel diagnostic strategies for LTBI surveillance and management. Full article

(1) Background: Proactive health behaviors are key to reducing their burden and supporting healthy aging. (2) Methods: We analyzed five waves (2011–2020) of CHARLS data from 1343 middle-aged and older adults (≥45 years) with multimorbidity. An entropy weight method was used to create a composite score for proactive health behaviors, and group-based trajectory modeling identified behavioral trajectories. Multivariate logistic regression and Shapley value decomposition assessed determinants and their relative contributions. Generalized structural equation modeling and latent class analysis were applied to estimate direct and indirect effects across the full sample and key multimorbidity subgroups. (3) Results: Two trajectories emerged: a “declining group” (91.44%) and an “improving group” (8.56%). The improving group was more likely to include younger, urban individuals with higher education, retired status, smaller family size, and lower depression levels. Education (40.67%) and depressive symptoms (31.22%) were the strongest determinants of trajectory. Path analysis showed that higher education and retirement indirectly supported sustained proactive health behaviors by reducing depression. The direct and indirect effects varied across subgroups. (4) Conclusion: The proactive health behaviors of middle-aged and elderly patients with multimorbidity exhibit a declining trend. Future health policies and interventions should prioritize mental health. Full article

Multimorbidity is a key global trend across healthcare fields, including gynecology. It is strongly associated with an overall poorer health status. Statistics indicate that in the 21st century most women experience at least one gynecological disease. Meanwhile, there is a consistent increase in the prevalence of obesity associated with chronic inflammation and hyperestrogenism. Alongside other factors, it leads to a growing prevalence of hyperproliferative diseases of the female reproductive system (FRS), encompassing both benign and malignant conditions. While advanced-stage malignant tumors can be linked to missed detection and wrong checkup strategies, benign neoplasms can compromise the ovarian reserve and thus cause major concerns. The prevailing benign FRS tumors are uterine fibroids (UFs) and benign ovarian tumors (BOTs), including serous and mucinous cystadenomas. It appears that an increase in certain benign FRS tumors is occurring in parallel with a rise in infertility (especially “unexplained infertility”) and reproduction failures, potentially associated with endometrial dysfunction. Thus, the endometrium is currently considered a critical area of research due to its vital role as the site of blastocyst adhesion and implantation, especially in patients with comorbidities. In this context, this article highlights the significance and pathophysiological characteristics of UFs and BOTs and their impact on defective endometrial receptivity. Full article