Abstract Background Allostatic load (AL) reflects the cumulative burden of chronic stress throughout life, potentially influencing the onset and prognosis of cancer. However, the associations between AL, colorectal cancer (CRC) risk and all-cause mortality in patients with CRC remain unclear. Methods We analyzed the association between AL and CRC risk in 304,959 adults and all-cause mortality in 1,794 patients with CRC from the UK Biobank, using Cox proportional hazards regression models. Results Compared to the AL level in the first quartile, individuals in the second to fourth quartiles had a respective 20%, 29%, and 43% increased risk of CRC; 15%, 24%, and 42% increased risk for colon cancer; and 30%, 38%, and 45% increased risk for rectal cancer. We identified a positive dose-gradient association of AL score with CRC risk, including colon and rectal cancer. Additionally, the association between AL and increased risk of CRC was observed across different strata of genetic susceptibility for CRC. Eliminating AL exposures could prevent nearly 39.24% (95% CI: 36.16-42.32) of CRC incident cases. Meanwhile, a significant association between the AL and all-cause mortality in patients with CRC was found, with a HR of 1.71 (95% CI: 1.16-2.50) for the fourth quartile compared to the AL score in the first quartile, demonstrating a positive dose-response relationship. Conclusion High AL was associated with increased CRC risk and all-cause mortality in CRC patients. Future research should prioritize the development of cognitive or behavioral intervention strategies to mitigate the adverse effects of AL on CRC incidence and prognosis.
Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)-based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China.
Purpose: To summarize adverse healthcare outcomes experienced by older adults with multimorbidity and barriers perceived by stakeholders regarding the healthcare systems primarily designed to address individual health conditions. Healthcare elements that aim to provide coordinated, continuous, and comprehensive services for this population were also identified. Patients and Methods: We applied the methodology framework developed by Arksey and O'Malley to guide the review. The three-step search strategy was used to identify relevant English reviews that focused on adverse healthcare outcomes and barriers encountered by older adults with multimorbidity and other stakeholders regarding the single-disease-focused healthcare systems, as well as those concentrated on healthcare elements that aim to provide coordinated, continuous, and comprehensive services for older adults with multimorbidity. Five electronic databases, including PubMed/Medline, CINAHL, Web of Science Core Collection, Cochrane Library, and Embase, were systematically searched from database inception to February 2022. A standardized table was used to extract data. Thematic analysis was then conducted under the guidance of the Rainbow Model of Integrated Care and the Chronic Care Model. Results: Twenty reviews were included in this study. Therapeutic competitions, high healthcare service utilization, and high healthcare costs were three adverse healthcare outcomes experienced by patients. Both patients and healthcare professionals faced various barriers. Other stakeholders, including informal caregivers, healthcare managers, and policymakers, also perceived several barriers. Numerous healthcare elements were identified that may contribute to optimized services. The elements most frequently mentioned included the implementation of shared decision-making, comprehensive geriatric assessments, and individual care plans. Conclusion: This study conducted a comprehensive overview of the current knowledge related to healthcare for older adults with multimorbidity. In the future, it is necessary to develop more coordinated, continuous, and comprehensive healthcare service delivery models based on the healthcare needs of older adults with multimorbidity and the specific characteristics of different countries. Keywords: multiple chronic conditions, aging, healthcare service delivery, long-term care, review
ABSTRACT Aims To classify the unmet integrated care needs of older adults with multimorbidity and to explore the factors associated with different categories of unmet integrated care needs among the target population. Design A cross‐sectional survey using the statistical method of latent profile analysis. Methods From July 2022 to March 2023, 397 older adults with multimorbidity, aged 60 years or older, were recruited from one primary healthcare setting and from four secondary and tertiary hospitals to participate in face‐to‐face questionnaire surveys. The questionnaire used in this study to assess unmet integrated care needs among older adults with multimorbidity was self‐designed through a series of steps, including a scoping review, expert consultation and cognitive interviews. Latent profile analysis was applied to uncover distinct profiles of unmet integrated care needs, and multinomial logistic regression was employed to explore whether the profiles were further distinguished by participants' sociodemographic and health‐related covariates. The data were analysed using IBM SPSS v.29.0 and Mplus v.8.0. Results The optimal solution was a four‐profile model, characterised by high unmet integration needs, high unmet system integration needs, low unmet system integration needs and low unmet integration needs, respectively. Multinomial logistic regression results indicated that profile differences were associated with place of residence, number of coresidents and the presence or absence of complex multimorbidity. Conclusion The integrated care needs of older adults with multimorbidity have not yet been fully met. Classifying and characterising unmet integrated care needs profiles is a crucial step in the rational allocation of integrated care resources. Reporting Method This study was reported based on the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for cross‐sectional studies. Patient or Public Contribution All participants were older adults with multimorbidity, and they were informed that they could withdraw from the study at any time.
Introduction Multimorbidity is increasing globally, emphasizing the need for effective self-management strategies. The Cumulative Complexity Model (CuCoM) offers a unique perspective on understanding self-management based on workload and capacity. This study aims to validate the CuCoM in multimorbid patients and identify tailored predictors of self-management.
Summary The dose–response association between sedentary time and the risk of metabolic syndrome is unclear, which indicates an important knowledge gap in public health. The objective of this study was to determine the categorical and continuous dose–response associations between sedentary time and the risk of metabolic syndrome. A systematic literature search of English articles published in PubMed, CINHAL, Embase, and Web of Science Core Collection prior to June 2022 was conducted. All cohort and cross‐sectional studies that examined the association between sedentary time and the risk of metabolic syndrome were considered, and duplicate and non‐related studies were excluded. Data extraction using a standardized chart and quality assessment using two appraisal tools were also performed. Two independent reviewers were involved in these processes. In categorical meta‐analyses, the pooled effect sizes for metabolic syndrome associated with different categories of sedentary time were calculated by comparing the highest and intermediate with the lowest categories. In continuous meta‐analyses, the linear and nonlinear dose–response associations were estimated using generalized least squares and restricted cubic spline models, respectively. Data were collected and analyzed from March to June 2022. Four prospective cohort studies and 22 cross‐sectional studies with 105,239 participants and 16,185 MetS cases were included in this study. In categorical analyses, both intermediate (median duration: 4.11 h/day; pooled OR: 1.17, 95% CI: 1.08–1.26, P < 0.001) and high levels (median duration: 7.26 h/day; pooled OR: 1.71, 95% CI: 1.43–2.04, P < 0.001) of total sedentary time were significantly associated with an increased risk of metabolic syndrome. Similarly, a significant association between screen time and the risk of metabolic syndrome was also found in intermediate (median duration: 2.22 h/day; pooled OR: 1.20, 95% CI: 1.10–1.32, P < 0.001) and high levels (median duration: 3.40 h/day; pooled OR: 1.63, 95% CI: 1.44–1.86, P < 0.001) of exposure. Of note, these associations were significantly stronger in women. Different patterns of the behavior‐disease association were not observed in children, adolescents, and adults. The findings of continuous meta‐analyses could not provide solid evidence for the linearity and nonlinearity of the behavior‐disease association. This study demonstrated that long‐time sedentary behavior was associated with a higher risk of MetS independent of physical activity and the patterns of association varied by gender instead of age. These findings have implications for future guideline recommendations on physical activity, sedentary behavior, and prevention of metabolic syndrome.
IntroductionIntrinsic capacity (IC), a composite of physical and mental capacities, is a marker of healthy aging. Social determinants of health (SDOH), namely the economic and social environments across a lifespan, are the most fundamental factors influencing health outcomes and health disparities. However, there is limited evidence on the influence of the individual and combined burden of the SDOH on IC.MethodsData were obtained from the China Health and Retirement Longitudinal Study (2011-2015), and data analysis was conducted in 2023. Linear mixed-effect regression was employed to investigate the association between SDOH and IC in a longitudinal analysis.ResultsThis study comprised 7669 participants (mean [SD] age, 68.5 [7.1] years; 49.8% female; mean [SD] IC, 7.2 [1.6]). In the longitudinal analysis, all five SDOH domains were independently and significantly associated with IC. The absence of social association within the social and community context domain exhibited the weakest association with IC (β: -0.11 [95% confidence interval (CI) -0.20, -0.02]), while illiteracy within the education access and quality domain demonstrated the strongest association with IC (β: -0.51 [95% CI -0.60, -0.42]). Furthermore, the adverse effects of SDOH on IC became more distinguishable with the cumulative number of SDOH variables (coefficient for 2 SDOH, -0.41 [-0.64, -0.19]; 3 SDOH, -0.70 [-0.93, -0.48]; ≥4 SDOH, -1.10 [-1.33, -0.88]) compared with those without any SDOH.ConclusionsCertain SDOH levels were significantly and negatively associated with IC. Targeted interventions may be needed to improve SDOH in individuals at high risk of poor IC.
Purpose: A lack of coordinated care leads to multiple adverse effects for older adults with multimorbidity, including high treatment burdens, adverse health outcomes, reduplicated healthcare service utilization, and catastrophic healthcare expenditure. To foster healthy aging, person-centered integrated care that is responsive to older adults has been proposed by the World Health Organization. The objective of this study was to identify factors that impact the successful implementation of integrated care for older adults with multimorbidity in China. Patients and Methods: From July 2022 to May 2023, 33 healthcare providers and managers involved in the delivery and management of healthcare services for older adults with multimorbidity were recruited from Zhejiang Province, China using purposeful and maximum variation sampling methods. Semi-structured, face-to-face in-depth interviews were conducted by the same interviewer in the participants' native Chinese language until data saturation was reached. Inductive thematic analysis was used to analyze the data, and then, themes were mapped onto six dimensions using the Rainbow Model of Integrated Care to allow for a comprehensive view of the study's findings. Results: Eleven themes were generated as facilitators and barriers to integrated care for older adults with multimorbidity in China. These themes include (1) clinical integration: patient-centered care, (2) professional integration: interdisciplinary teams and training, (3) organizational integration: resources and accessibility, (4) system integration: community and funds, incentives, and health insurance, (5) functional integration: electronic health record systems, workforce, and guidelines, and (6) normative integration: shared mission. Conclusion: Guided by the Rainbow Model of Integrated Care, various factors at both micro, meso, and macro levels that impact the implementation of integrated care for older adults with multimorbidity in the Chinese context have been identified in this study. The strategies for future interventions and policies should focus on promoting facilitators and addressing barriers. Keywords: delivery of health care, integrated, aged, older adult, multiple chronic conditions, facilitator, barrier
BACKGROUND Metabolic syndrome (MetS) is a common public health challenge. Health-promoting behaviors such as diet and physical activity are central to preventing and controlling MetS. However, the adoption of diet and physical activity behaviors has always been challenging. An individualized mobile health (mHealth)–based intervention using the Behavior Change Wheel is promising in promoting health behavior change and reducing atherosclerotic cardiovascular disease (ASCVD) risk. However, the effects of this intervention are not well understood among people with MetS in mainland China. OBJECTIVE We aimed to evaluate the effects of the individualized mHealth-based intervention using the Behavior Change Wheel on behavior change and ASCVD risk in people with MetS. METHODS We conducted a quasi-experimental, nonrandomized study. Individuals with MetS were recruited from the health promotion center of a tertiary hospital in Zhejiang province, China. The study involved 138 adults with MetS, comprising a control group of 69 participants and an intervention group of 69 participants. All participants received health education regarding diet and physical activity. The intervention group additionally received a 12-week individualized intervention through a WeChat mini program and a telephone follow-up in the sixth week of the intervention. Primary outcomes included diet, physical activity behaviors, and ASCVD risk. Secondary outcomes included diet self-efficacy, physical activity self-efficacy, knowledge of MetS, quality of life, and the quality and efficiency of health management services. The Mann-Whitney <i>U</i> test and Wilcoxon signed rank test were primarily used for data analysis. Data analysis was conducted based on the intention-to-treat principle using SPSS (version 25.0; IBM Corp). RESULTS Baseline characteristics did not differ between the 2 groups. Compared with the control group, participants in the intervention group showed statistically significant improvements in diet behavior, physical activity behavior, diet self-efficacy, physical activity self-efficacy, knowledge of MetS, physical health, and mental health after a 12-week intervention (<i>P</i>=.04, <i>P</i>=.001, <i>P</i>=.04, <i>P</i>=.04, <i>P</i>=.001, <i>P</i>=.04, <i>P</i>=.04, and <i>P</i><.05). The intervention group demonstrated a statistically significant improvement in outcomes from pre- to postintervention evaluations (<i>P</i><.001, <i>P</i>=.03, <i>P</i><.001, <i>P</i>=.04, <i>P</i><.001, <i>P</i><.001, and <i>P</i><.001). The intervention also led to enhanced health management services and quality. CONCLUSIONS The individualized mHealth-based intervention using the Behavior Change Wheel was effective in promoting diet and physical activity behaviors in patients with MetS. Nurses and other health care professionals may incorporate the intervention into their health promotion programs.
This study aims to identify self-management behavior profiles in multimorbid patients, and explore how workload, capacity, and their interactions influence these profiles. A sequential explanatory mixed-methods design was employed. In the quantitative phase (August 2022 to May 2023), data were collected from 1,920 multimorbid patients across nine healthcare facilities in Zhejiang Province. Latent Profile Analysis (LPA) was used to identify distinct self-management behavior profiles. Multinomial logistic regression was then used to assess the influence of workload and capacity dimensions (independent variables in Model 1), as well as their interaction (independent variables in Model 2), on these profiles (dependent variables in two models). The qualitative phase (May to August 2023) included semi-structured interviews with 16 participants, and the Giorgi analysis method was used for data categorization and coding. Quantitative analysis revealed three self-management behavior profiles: Symptom-driven Profile (8.0%), Passive-engagement Profile (29.5%), and Active-cooperation Profile (62.5%). Compared to the Active-cooperation Profile, both the Symptom-driven and Passive-engagement Profiles were associated with a higher workload (OR > 1, P < 0.05) and lower capacity (OR < 1, P < 0.05). An interaction of the overall workload and capacity showed a synergistic effect in the Passive-engagement Profile (OR = 1.08, 95% CI = 1.03-1.13, P < 0.05). Qualitative analysis identified six workload themes, and related coping strategies of three self-management behavior profiles. The integrated results highlighted distinct characteristics: Symptom-driven Profile patients exhibited reactive behaviors with limited health awareness, Passive-engagement Profile patients reduced engagement once symptoms stabilized, while Active-cooperation Profile patients proactively managed their conditions. Identifying three distinct self-management behavior profiles and their relationship with workload and capacity provides valuable insights into multimorbid patients' experiences, emphasizing the need for tailored interventions targeting workload and capacity to improve health outcomes.
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