Gender Difference in Circulatory Associated Multi-Morbidity among the Elderly in Rural Southwest China

Aim: This study examined the prevalence of four chronic circulatory system diseases (hypertension, CHD, hyperlipemia, Stroke) and associated multi-morbidity in order to identify the risk factors among the elderly in Yunnan province. Methods: A cross-sectional survey including 2299 consenting adults aged ≥ 60 years from rural places was conducted in 2018. Data of demographic parameters and clinical characteristics were acquired from questionnaire and health examination. Categorical variables were presented as counts and percentages. Multivariable logistic regression analysis was used to analyze the association between individual SES and lifestyle variables and multimorbidity of the four chronic cardiovascular and cerebrovascular diseases. All analyses were conducted with SPSS 17.0 software. Results: Our study suggested that the prevalence of hypertension, CHD, hyperlipemia, Stroke was 57.1%, 4.2%, 5.9% and 5.3%, respectively and the prevalence of multimorbidity was 10.3%. Females had a higher prevalence of family history of chronic cardiovascular and cerebrovascular diseases, obesity, central obesity and illiteracy than males (P < 0.01), whereas males had a markedly higher prevalence of drinking, smoking and good sleeping quality than females (P < 0.01). The family genetic history, obesity, smoking, education, and diabetes were positively and drinking was negatively correlated with the prevalence of circulatory associated multimorbidity in elderly. Interestingly, some of the above associations were only observed in male/female but not the other sex. Conclusions: The prevalence of circulatory disease associated multimorbidity is relatively high among elderly population in rural places of Yunan province and the risk factors are different between females and males.

Transitions of care across hospital settings in patients with inflammatory bowel disease

BACKGROUND Inflammatory bowel disease(IBD) is a chronic, inflammatory disorder characterised by both intestinal and extra-intestinal pathology. Patients may receive both emergency and elective care from several providers, often in different hospital settings. Poorly managed transitions of care between providers can lead to inefficiencies in care and patient safety issues. To ensure that the sharing of patient information between providers is appropriate, timely, accurate and secure, effective data-sharing infrastructure needs to be developed. To optimise inter-hospital data-sharing for IBD patients, we need to better understand patterns of hospital encounters in this group.AIM To determine the type and location of hospital services accessed by IBD patients in England.METHODSThis was a retrospective observational study using Hospital Episode Statistics, a large administrative patient data set from the National Health Service in England.Adult patients with a diagnosis of IBD following admission to hospital were followed over a 2-year period to determine the proportion of care accessed at the same hospital providing their outpatient IBD care, defined as their ‘home provider'. Secondary outcome measures included the geographic distribution of patient-sharing, regional and age-related differences in accessing services, and type and frequency of outpatient encounters.RESULTS95055 patients accessed hospital services on 1760156 occasions over a 2-year follow-up period. The proportion of these encounters with their identified IBD‘home provider' was 73.3%, 87.8% and 83.1% for accident and emergency,inpatient and outpatient encounters respectively. Patients living in metropolitan centres and younger patients were less likely to attend their ‘home provider' for hospital services. The most commonly attended specialty services were gastroenterology, general surgery and ophthalmology.CONCLUSION Transitions of care between secondary care settings are common for patients with IBD. Effective systems of data-sharing and care integration are essential to providing safe and effective care for patients. Geographic and age-related patterns of care transitions identified in this study may be used to guide interventions aimed at improving continuity of care.

Care of older adults

In the United States, approximately 40 million adults over the age 65 are affected by one or more forms of cardiovascular disease and it remains the leading cause of morbidity and mortality in this population. Among older adults, therapeutic goals for cardiovascular diseases （CVD） are often confounded by comorbid diseases and/or conditions that dominate their overall sense of health and well-being. Thus, even while CVD is usually considered a principal concern,