Comorbidity - Knowledge

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Whenever a new, as well as mildly notable symptom appears, it is necessary to conduct a deep examination to uncover its causes. It is also necessary to be remembered that comorbidity leads to polypragmasy (polypharmacy), i.e. simultaneous prescription of a large number of medicines, which renders impossible the control over the effectiveness of the therapy, increases monetary expenses and therefore reduces compliance. At the same time, polypragmasy, especially in aged patients, renders possible the sudden development of local and systematic, unwanted medicinal side-effects. These side-effects are not always considered by the doctors, because they are considered as the appearance of comorbidity and as a result become the reason for the prescription of even more drugs, sealing-in the vicious circle. Simultaneous treatment of multiple disorders requires strict consideration of compatibility of drugs and detailed adherence of rules of rational drug therapy, based on E. M. Tareev's principles, which state: "Each non-indicated drug is contraindicated" and B. E. Votchal said: "If the drug does not have any side-effects, one must think if there is any effect at all".

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the patient's condition and would complicate the process of prescribing rational medicinal therapy for the identified disorders. Such problems are faced by doctors on everyday basis, despite all their knowledge about medical science. The main hurdle in the way of inducting comorbidity evaluation systems in broad based diagnostic-therapeutic process is their inconsistency and narrow focus. Despite the variety of methods of evaluation of comorbidity, the absence of a singular generally accepted method, devoid of the deficiencies of the available methods of its evaluation, causes disturbance. The absence of a unified instrument, developed on the basis of colossal international experience, as well as the methodology of its use does not allow comorbidity to become doctor "friendly". At the same time due to the inconsistency in approach to the analysis of comorbid state and absence of components of comorbidity in medical university courses, the practitioner is unclear about its prognostic effect, which makes the generally available systems of associated pathology evaluation unreasoned and therefore un-needed as well.

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of organic nitrates. This time taking three tablets of nitroglycerine did not kill the pain. It was also known from the case history that the patient had twice had myocardial infarctions during the last ten years, as well as had an Acute Cerebrovascular Event with sinistral hemiplegia more than 15 years ago. Apart from that the patient had hypertension, type 2 diabetes with diabetic nephropathy, hysteromyoma, cholelithiasis, osteoporosis and varicose pedi-vein disease. It was also learned that the patient regularly takes a number of antihypertensive drugs, urinatives and oral antihyperglycemic remedies, as well as statins, antiplatelet and nootropics. In the past the patient had undergone cholecystectomy due to cholelithiasis more than 20 years ago, as well as the extraction of a cataract of the right eye 4 years ago. The patient was admitted to cardiac intensive care unit at a general hospital diagnosed for acute transmural myocardial infarction. During the check-up moderate azotemia, mild erythronormoblastic anemia, proteinuria and lowering of left vascular ejection fraction were also identified.

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the level of their damaging effect on body organs, are classified as mild, moderate and severe. In this case the conclusion about cumulative comorbidity is drawn on the basis of the most decompensated biological system. This index gives cumulative, but less detailed as compared to CIRS, assessment of the condition of each of the biological systems: "0": Absence of disease, "1": Mild course of the disease, "2": Moderate disease, "3": Severe disease. The Kaplan–Feinstein Index evaluates comorbidity by cumulative score, which can vary from 0 to 36. Apart from that the notable deficiency of this method of evaluating comorbidity is the excessive generalization of diseases (nosologies) and the absence of a large number of illnesses in the scale, which, probably, should be noted in the "miscellaneous" column, which undermines (decreases) this method's objectivity and productivity of this method. However the indisputable advantage of the Kaplan–Feinstein Index as compared to CIRS is in the capability of independent analysis of malignant neoplasms and their severities.

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the points are accumulated, according to associated diseases, as well as the addition of a single point for each 10 years of age for patients of ages above forty years (in 50 years 1 point, 60 years 2 points etc.). The distinguishing feature and undisputed advantage of the Charlson Index is the capability of evaluating the patient's age and determination of the patient's mortality rate, which in the absence of comorbidity is 12%, at 1–2 points it is 26%; at 3–4 points it is 52% and with the accumulation of more than 5 points it is 85%. Regretfully this method has some deficiencies: Evaluating comorbidity severity of many diseases is not considered, as well as the absence of many important for prognosis disorders. Apart from that it is doubtful that possible prognosis for a patient with bronchial asthma and chronic leukemia is comparable to the prognosis for the patient ailing from myocardial infarction and cerebral infarction.

670: = 1,779,167). The Elixhauser comorbidity measure developed a list of 30 comorbidities relying on the ICD-9-CM coding manual. The comorbidities were not simplified as an index because each comorbidity affected outcomes (length of hospital stay, hospital changes, and mortality) differently among different patients groups. The comorbidities identified by the Elixhauser comorbidity measure are significantly associated with in-hospital mortality and include both acute and chronic conditions. van Walraven et al. have derived and validated an Elixhauser comorbidity index that summarizes disease burden and can discriminate for in-hospital mortality. In addition, a systematic review and comparative analysis shows that among various comorbidities indices, Elixhauser index is a better predictor of the risk especially beyond 30 days of hospitalization. 391:, as a priority project for the second decade of the 20th century, are meant to better the quality of the global population. This is the reason for an overall tendency of large-scale epidemiological researches in different medical fields, carried-out using serious statistical data. In most of the carried-out, randomized, clinical researches the authors study patients with single refined pathology, making comorbidity an exclusive criterion. This is why it is hard to relate researches, directed towards the evaluation of the combination of ones or the other separate disorders, to works regarding the sole research of comorbidity. The absence of a single scientific approach to the evaluation of comorbidity leads to omissions in clinical practice. It is hard not to notice the absence of comorbidity in the taxonomy (systematics) of disease, presented in 741:

the risks of repeated admittance of the same at a hospital after going through surgical procedures. For the evaluation of comorbidity the ICED index suggests to evaluate the patient's condition separately as per two different components: Physiological functional characteristics. The first component comprises 19 associated disorders, each of which is assessed on a 4-point scale, where "0" indicates the absence of disease and "3" indicates the disease's severe form. The second component evaluates the effect of associated diseases on the physical condition of the patient. It assesses 11 physical functions using a 3-point scale, where "0" means normal functionality and "2" means the impossibility of functionality.

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the presence of a number of diseases in a patient, not having any connection to each other through any of the proven to date pathogenetic mechanisms. Others affirm that multi-morbidity is the combination of a number of chronic or acute diseases and clinical symptoms in a person and do not stress the similarities or differences in their pathogenesis. However the principle clarification of the term was given by H. C. Kraemer and M. van den Akker, determining comorbidity as the combination in a patient of 2 or more chronic diseases (disorders), pathogenetically related to each other or coexisting in a single patient independent of each disease's activity in the patient.

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current practice urologists, gynecologists, ENT specialists, eye specialists, surgeons and other specialists all too often mention only the diseases related to "own" field of specialization, passing on the discovery of other accompanying pathologies "under the control" of other specialists. It has become an unspoken rule for any specialized department to carry out consultations of the therapist, who feels obliged to carry out symptomatic analysis of the patient, as well as to the form the diagnostic and therapeutic concept, taking in view the potential risks for the patient and his long-term prognosis.

344:, who had greatly influenced the methods of clinical diagnosis and particularly methods used in the field of clinical epidemiology, came out with the term of "comorbidity". The appearance of comorbidity was demonstrated by Feinstein using the example of patients physically affected by rheumatic fever, discovering the worst state of the patients, who simultaneously had multiple diseases. In due course of time after its discovery, comorbidity was distinguished as a separate scientific-research discipline in many branches of medicine. 705:

means separate cumulative evaluation of each of the biological systems: "0" The selected system corresponds to the absence of disorders, "1": Slight (mild) abnormalities or previously had disorders, "2": Illness requiring the prescription of medicinal therapy, "3": Disease, which caused disability and "4": Acute organ insufficiency requiring emergency therapy. The CIRS system evaluates comorbidity in cumulative score, which can be from 0 to 56. As per its developers, the maximum score is not compatible with the patient's life.

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used to determine the index disease were flawed and subjective, and moreover, trying to identify an index disease as the cause of the others can be counterproductive to understanding and treating interdependent conditions. In response, 'multimorbidity' was introduced to describe concurrent conditions without relativity to or implied dependency on another disease, so that the complex interactions to emerge naturally under analysis of the system as a whole.

215:). In psychiatric diagnoses it has been argued in part that this "'use of imprecise language may lead to correspondingly imprecise thinking', this usage of the term 'comorbidity' should probably be avoided." However, in many medical examples, such as comorbid diabetes mellitus and coronary artery disease, it makes little difference which word is used, as long as the medical complexity is duly recognized and addressed. 764:

severity of the complications, worsens the patient's life quality and limit or make difficult the remedial-diagnostic process. Comorbidity affects life prognosis and increases the chances of fatality. The presence of comorbid disorders increases bed days, disability, hinders rehabilitation, increases the number of complications after surgical procedures, and increases the chances of decline in aged people.

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reflection of the "intensity" of the associated comorbid conditions. This score has been tested and validated extensively in the trauma population, demonstrating good correlation with mortality, morbidity, triage, and hospital readmissions. Of interest, increasing levels of CPS were associated with significantly lower 90-day survival in the original study of the score in trauma population.

626:(a total of 17 conditions). Each condition is assigned a score of 1, 2, 3, or 6, depending on the risk of dying associated with each one. Scores are summed to provide a total score to predict mortality. Many variations of the Charlson comorbidity index have been presented, including the Charlson/Deyo, Charlson/Romano, Charlson/Manitoba, and Charlson/D'Hoores comorbidity indices. 248:, psychology, and mental health counseling, comorbidity refers to the presence of more than one diagnosis occurring in an individual at the same time. However, in psychiatric classification, comorbidity does not necessarily imply the presence of multiple diseases, but instead can reflect current inability to supply a single diagnosis accounting for all symptoms. On the 36: 452:

absence it is 83%, in the second stage of cancer the rate of survivability is 14% and 76%, in the third stage it is 28% and 66% and in the fourth stage of cancer it is 0% and 50% respectively. Overall the survivability rate of comorbid larynx cancer patients is 59% lower than the survivability rate of patients without comorbidity.

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question: How to wholly evaluate the state of a patient who has a number of diseases simultaneously, where to start from and which disease(s) require(s) primary and subsequent treatment? For many years this question stood out unanswered, until 1970, when a renowned American doctor epidemiologist and researcher,

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Complications: Nosologies having pathogenetic relation to the primary disease, supporting the adverse progression of the disorder, causing acute worsening of the patient's conditions (are a part of the complicated comorbidity). In a number of cases the complications of the primary disease and related

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The listed methods of obtaining medical information are mainly based on clinical experience and qualification of the physicians, carrying out clinically, instrumentally and laboratorially confirmed diagnosis. This is why despite their competence, they are highly subjective. No analysis of the results

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Comorbidity means that one 'index' condition is the focus of attention, and others are viewed in relation to this. In contrast, multimorbidity describes someone having two or more long-term (chronic) conditions without any of them holding priority over the others. This distinction is important in how

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A study of inpatient hospital data in the United States in 2011 showed that the presence of a major complication or comorbidity was associated with a great risk of intensive-care unit utilization, ranging from a negligible change for acute myocardial infarction with major complication or comorbidity

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The effect of comorbid pathologies on clinical implications, diagnosis, prognosis and therapy of many diseases is polyhedral and patient-specific. The interrelation of the disease, age and drug pathomorphism greatly affect the clinical presentation and progress of the primary nosology, character and

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Analyzing the comorbid state of patient S, 73 years of age, using the most used international comorbidity assessment scales, a doctor would come across totally different evaluation. The uncertainty of these results would somewhat complicate the doctors judgment about the factual level of severity of

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Index of Co-Existent Disease (ICED): This Index was first developed in 1993 by S. Greenfield to evaluate comorbidity in patients with malignant neoplasms, later it also became useful for other categories of patients. This method helps in calculating the duration of a patient's stay at a hospital and

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Patient S., 73 years, called an ambulance because of a sudden pressing pain in the chest. It was known from the case history that the patient had CHD for many years. Such chest pains were experienced by her earlier as well, but they always disappeared after a few minutes of sublingual administration

556:"Arbitrary" comorbidity: initial alogism of the combination of diseases is not proven, but soon can be explained with clinical and scientific point of view (for example, combination of coronary heart disease (CHD) and choledocholithiasis; combination of acquired heart valvular disease and psoriasis). 423:

The analysis of a decade long Australian research based on the study of patients having 6 widespread chronic diseases demonstrated that nearly half of the elderly patients with arthritis also had hypertension, 20% had cardiac disorders and 14% had type 2 diabetes. More than 60% of asthmatic patients

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Presently there is no agreed-upon terminology of comorbidity. Some authors bring forward different meanings of comorbidity and multi-morbidity, defining the former, as the presence of a number of diseases in a patient, connected to each other through proven pathogenetic mechanisms and the latter, as

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Aronow, Wilbert S; Ahn, Chul; Mercando, Anthony D; Epstein, Stanley (2000). "Prevalence of coronary artery disease, complex ventricular arrhythmias, and silent myocardial ischemia and incidence of new coronary events in older persons with chronic renal insufficiency and with normal renal function".

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Charlson Index: This index is meant for the long-term prognosis of comorbid patients and was developed by M. E. Charlson in 1987. This index is based on a point scoring system (from 0 to 40) for the presence of specific associated diseases and is used for prognosis of lethality. For its calculation

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In patients with chronic kidney disease (renal insufficiency) the frequency of coronary heart disease is 22% higher and new coronary events 3.4 times higher compared to patients without kidney function disorders. Progression of CKD towards end stage renal disease requiring renal replacement therapy

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The term 'comorbidity' was introduced in medicine by Feinstein (1970) to describe cases in which a 'distinct additional clinical entity' occurred before or during treatment for the 'index disease', the original or primary diagnosis. Since the terms were coined, meta studies have shown that criteria

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The Kaplan–Feinstein Index: This index was created in 1973 based on the study of the effect of the associated diseases on patients with type 2 diabetes during a period of 5 years. In this system of comorbidity evaluation all the present (in a patient) diseases and their complications, depending on

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Rival diseases: These are the concurrent nosological forms in a patient, interdependent in etiologies and pathogenesis, but equally sharing the criterion of a primary disease (for example, transmural myocardial infarction and massive thromboembolism of pulmonary artery, caused by phlebemphraxis of

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Primary disease: This is the nosological form, which itself or as a result of complications calls for the foremost necessity for treatment at the time due to threat to the patient's life and danger of disability. Primary is the disease, which becomes the cause of seeking medical help or the reason

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The number of comorbid diseases increases with age. Comorbidity increases by 10% in ages up to 19 years, up to 80% in people of ages 80 and older. According to data by M. Fortin, based on the analysis of 980 case histories, taken from daily practice of a family doctor, the spread of comorbidity is

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The division of comorbidity as per syndromal and nosological principles is mainly preliminary and inaccurate, however it allows us to understand that comorbidity can be connected to a singular cause or common mechanisms of pathogenesis of the conditions, which sometimes explains the similarity in

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Except for therapists and general physicians, the problem of comorbidity is also often faced by specialists. Regretfully they seldom pay attention to the coexistence of a whole range of disorders in a single patient and mostly conduct the treatment of specific to their specialization diseases. In

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According to Russian data, based on the study of more than three thousand postmortem reports (n=3239) of patients of physical pathologies, admitted at multidisciplinary hospitals for the treatment of chronic disorders (average age 67.8 ± 11.6 years), the frequency of comorbidity is 94.2%. Doctors

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These scientists and physicians included: M. H. Kaplan (1974), T. Pincus (1986), M. E. Charlson (1987), F. G. Schellevis (1993), H. C. Kraemer (1995), M. van den Akker (1996), A. Grimby (1997), S. Greenfield (1999), M. Fortin (2004) & A. Vanasse (2004), C. Hudon (2005), L. B. Lazebnik (2005),

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The influence of comorbidity on the clinical progression of the primary (basic) physical disorder, effectiveness of the medicinal therapy and immediate and long-term prognosis of the patients was researched by physicians and scientists of various medical fields in many countries across the globe.

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Symptom overlap is a key component against DSM classification and serves as a note towards redefining criteria in disorders that the root cause may not be understood thoroughly. Regardless of criticisms, it stands that, annually, up to 45% of mental health patients fit the criteria for a comorbid

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The presence of comorbidity must be taken into account when selecting the algorithm of diagnosis and treatment plans for any given disease. It is important to enquire comorbid patients about the level of functional disorders and anatomic status of all the identified nosological forms (diseases).

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Cumulative Illness Rating Scale (CIRS): Developed in 1968 by B. S. Linn, it became a revolutionary discovery, because it gave the practicing doctors a chance to calculate the number and severity of chronic illnesses in the structure of the comorbid state of their patients. The proper use of CIRS

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Many centuries ago the doctors propagated the viability of a complex approach in the diagnosis of disease and the treatment of the patient, however, modern medicine, which boasts a wide range of diagnostic methods and a variety of therapeutic procedures, stresses specification. This brought up a

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are often criticized because their comorbidity rates are excessively high, approaching 60% in some cases. Critics assert this indicates these categories of mental illness are too imprecisely distinguished to be usefully valid for diagnostic purposes, impacting treatment and resource allocation.

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Since patients often do not know how severe their conditions are, nurses were originally supposed to review a patient's chart and determine whether a particular condition was present in order to calculate the index. Subsequent studies have adapted the comorbidity index into a questionnaire for

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Polypathia: Diseases with different etiologies and pathogenesis, each of which separately could not cause death, but, concurring during development and reciprocally exacerbating each other, they cause the patient's death (for example, osteoporotic fracture of the surgical neck of the femur and

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Unspecified (NOS) comorbidity: This type assumes the presence of singular pathogenetic mechanisms of development of diseases, comprising this combination, but require a number of tests, proving the hypothesis of the researcher or physician (for example, erectile dysfunction as an early sign of

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In a research conducted on 196 larynx cancer patients, it was determined that the survival rate of patients at various stages of cancer differs depending upon the presence or absence of comorbidity. At the first stage of cancer the survival rate in the presence of comorbidity is 17% and in its

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for example is common for both ADHD and OCD with pediatric onset and can be effective for both in a comorbid diagnosis. OCD and eating disorders have a high rate of occurrence, it is estimated that 20-60% of patients with an eating disorder have OCD. More often, comorbidity complicates and can

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The comorbidity–polypharmacy score (CPS) is a simple measure that consists of the sum of all known comorbid conditions and all associated medications. There is no specific matching between comorbid conditions and corresponding medications. Instead, the number of medications is assumed to be a

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Many tests attempt to standardize the "weight" or value of comorbid conditions, whether they are secondary or tertiary illnesses. Each test attempts to consolidate each individual comorbid condition into a single, predictive variable that measures mortality or other outcomes. Researchers have

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Although the term 'comorbidity' has recently become very fashionable in psychiatry, its use to indicate the concomitance of two or more psychiatric diagnoses is said to be incorrect because in most cases it is unclear whether the concomitant diagnoses actually reflect the presence of distinct

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The fourteen-year research conducted on 883 patients of idiopathic thrombocytopenic purpura (Werlhof disease), conducted in Great Britain, shows that the given disease is related to a wide range of physical pathologies. In the comorbid structure of these patients, most frequently present are

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All the fundamental researches of medical documentation, directed towards the study of the spread of comorbidity and influence of its structure, were conducted until the 1990s. The sources of information, used by the researchers and scientists, working on the matter of comorbidity, were case

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Miller, Mark D.; Paradis, Cynthia F.; Houck, Patricia R.; Mazumdar, Sati; Stack, Jacqueline A.; Rifai, A. Hind; Mulsant, Benoit; Reynolds, Charles F. (1992). "Rating chronic medical illness burden in geropsychiatric practice and research: Application of the Cumulative Illness Rating Scale".

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For a physician, this score is helpful in deciding how aggressively to treat a condition. For example, a patient may have cancer with comorbid heart disease and diabetes. These comorbidities may be so severe that the costs and risks of cancer treatment would outweigh its short-term benefit.

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Based on the available clinical and scientific data it is possible to conclude that comorbidity has a range of undoubted properties, which characterize it as a heterogeneous and often encountered event, which enhances the seriousness of the condition and worsens the patient's prospects. The

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A Canadian research conducted upon 483 obesity patients, it was determined that spread of obesity related accompanying diseases was higher among females than males. The researchers discovered that nearly 75% of obesity patients had accompanying diseases, which mostly included dyslipidemia,

415:. Autopsy allows you to exactly determine the structure of comorbidity and the direct cause of death of each patient independent of his/her age, gender and gender specific characteristics. Statistical data of comorbid pathology, based on these sections, are mainly devoid of subjectivism. 565:

There are a number of rules for the formulation of clinical diagnosis for comorbid patients, which must be followed by a practitioner. The main principle is to distinguish in diagnosis the primary and background diseases, as well as their complications and accompanying pathologies.

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Etiological comorbidity: It is caused by concurrent damage to different organs and systems, which is caused by a singular pathological agent (for example due to alcoholism in patients with chronic alcohol intoxication; pathologies associated with smoking; systematic damage due to

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Comorbidity is widespread among the patients admitted at multidiscipline hospitals. During the phase of initial medical help, the patients having multiple diseases simultaneously are a norm rather than an exception. Prevention and treatment of chronic diseases declared by the

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Stier, David M; Greenfield, Sheldon; Lubeck, Deborah P; Dukes, Kimberly A; Flanders, Scott C; Henning, James M; Weir, Julie; Kaplan, Sherrie H (1999). "Quantifying comorbidity in a disease-specific cohort: Adaptation of the total illness burden index to prostate cancer".

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Using this method patient S's, age 73, comorbidity can be evaluated as of moderate severity (16 out of 36 points), however its prognostic value is unclear, because of the absence of the interpretation of the overall score, resulting from the accumulation of the patient's

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Fibromyalgia is a condition which is comorbid with several others, including but not limited to; depression, anxiety, headache, irritable bowel syndrome, chronic fatigue syndrome, systemic lupus erythematosus, rheumatoid arthritis, migraine, and panic disorder.

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clinical entities or refer to multiple manifestations of a single clinical entity. It has been argued that because "'the use of imprecise language may lead to correspondingly imprecise thinking', this usage of the term 'comorbidity' should probably be avoided".

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malignant neoplasms, locomotorium disorders, skin and genitourinary system disorders, as well as haemorrhagic complications and other autoimmune diseases, the risk of whose progression during the first five years of the primary disease exceeds the limit of 5%.

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Background disease: This helps in the occurrence of or adverse development of the primary disease increases its dangers and helps in the development of complications. This disease as well as the primary one requires immediate treatment (for example, type 2

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Muñoz, Eric; Rosner, Fred; Friedman, Richard; Sterman, Harris; Goldstein, Jonathan; Wise, Leslie (1988). "Financial risk, hospital cost, and complications and comorbidities in medical non-complications and comorbidity-stratified diagnosis-related groups".

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Due to its artifactual nature, psychiatric comorbidity has been considered as a Kuhnian anomaly leading the DSM to a scientific crisis and a comprehensive review on the matter considers comorbidity as an epistemological challenge to modern psychiatry. The

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Boyd, Jeffrey H.; Burke, Jack D.; Gruenberg, Ernest; Holzer, Charles E.; Rae, Donald S.; George, Linda K.; Karno, Marvin; Stoltzman, Roger; et al. (1984). "Exclusion Criteria of DSM-III: A Study of Co-occurrence of Hierarchy-Free Syndromes".

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have higher rates of co-occurring or being prevalent in separate diagnoses. "Comorbidity in OCD is the rule rather than the exception" with OCD diagnoses facing a lifetime rate of 90%. With overlapping symptoms comes overlap in treatment as well,

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Cumulative Illness Rating Scale for Geriatrics (CIRS-G): This system is similar to CIRS, but for aged patients, offered by M. D. Miller in 1991. This system takes into account the age of the patient and the peculiarities of the old age

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to it etiological and pathogenetic factors, are indicated as conjugated disease. In this case they must be identified as the cause of comorbidity. Complications are listed in a descending order of prognostic or disabling significance.

2396:; Cleary, Paul D. (1993). "The Importance of Co-Existent Disease in the Occurrence of Postoperative Complications and One-Year Recovery in Patients Undergoing Total Hip Replacement: Comorbidity and Outcomes after Hip Replacement". 3057:

Van Den Akker, Marjan; Buntinx, Frank; Metsemakers, Job F.M.; Roos, Sjef; Knottnerus, J. André (1998). "Multimorbidity in General Practice: Prevalence, Incidence, and Determinants of Co-Occurring Chronic and Recurrent Diseases".

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Rhee, Soo Hyun; Hewitt, John K.; Lessem, Jeffrey M.; Stallings, Michael C.; Corley, Robin P.; Neale, Michael C. (May 2004). "The Validity of the Neale and Kendler Model-Fitting Approach in Examining the Etiology of Comorbidity".

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Iatrogenic comorbidity: It appears as a result of necessitated negative effect of the doctor on the patient, under the conditions of pre determine danger of one or the other medical procedure (for example, glucocorticosteroid

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Reale, Laura; Bartoli, Beatrice; Cartabia, Massimo; Zanetti, Michele; Costantino, Maria Antonella; Canevini, Maria Paola; Termine, Cristiano; Bonati, Maurizio; Conte, Stefano; Renzetti, Valeria; Salvoni, Laura (2017-12-01).

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Cloninger, C. Robert (2002). "Implications of Comorbidity for the Classification of Mental Disorders: The Need for a Psychobiology of Coherence". In Maj, Mario; Gaebel, Wolfgang; López-Ibor, Juan José; et al. (eds.).

129:(to indicate a state or condition). Comorbidity includes all additional ailments a patient may experience alongside their primary diagnosis, which can be either physiological or psychological in nature. In the context of 440:

from 69% in young patients, up to 93% among middle aged people and up to 98% patients of older age groups. At the same time the number of chronic diseases varies from 2.8 in young patients and 6.4 among older patients.

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Van Walraven, Carl; Austin, Peter C.; Jennings, Alison; Quan, Hude; Forster, Alan J. (2009). "A Modification of the Elixhauser Comorbidity Measures into a Point System for Hospital Death Using Administrative Data".

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Elixhauser Index: The Elixhauser comorbidity measure include 30 comorbidities, which are not simplified as an index. Elixhauser shows a better predictive performance for mortality risk especially beyond 30 days of

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The factors responsible for the development of comorbidity can be chronic infections, inflammations, involutional and systematic metabolic changes, iatrogenesis, social status, ecology and genetic susceptibility.

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Patients who are more seriously ill tend to require more hospital resources than patients who are less seriously ill, even though they are admitted to the hospital for the same reason. Recognizing this, the

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that allows focusing on all of the patient's symptoms and providing a more holistic care. In other settings, for example in pharmaceutical research, comorbidity might often be the more useful term to use.

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Klein Hofmeijer-Sevink, Mieke; van Oppen, Patricia; van Megen, Harold J.; Batelaan, Neeltje M.; Cath, Danielle C.; van der Wee, Nic J. A.; van den Hout, Marcel A.; van Balkom, Anton J. (2013-09-25).

683:(DRG) manually splits certain DRGs based on the presence of secondary diagnoses for specific complications or comorbidities (CC). The same applies to Healthcare Resource Groups (HRGs) in the UK. 3636:

Justiniano, CF; Coffey, RA; Evans, DC (Jan 2015). "Comorbidity–polypharmacy score predicts in-hospital complications and the need for discharge to extended care facility in older burn patients".

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The Elixhauser comorbidity measure was developed using administrative data from a statewide California inpatient database from all non-federal inpatient community hospital stays in California (

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Weir, Peter T.; Harlan, Gregory A.; Nkoy, Flo L.; Jones, Spencer S.; Hegmann, Kurt T.; Gren, Lisa H.; Lyon, Joseph L. (2006). "The Incidence of Fibromyalgia and Its Associated Comorbidities".

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is related to comorbidity but is different in its definition and approach, focusing on the presence of multiple diseases or conditions in a patient without the need to specify one as primary.

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Wang, P. S.; Avorn, J; Brookhart, MA; Mogun, H; Schneeweiss, S; Fischer, MA; Glynn, RJ (2005). "Effects of Noncardiovascular Comorbidities on Antihypertensive Use in Elderly Hypertensives".

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Michelson, Helena; Bolund, Christina; Brandberg, Yvonne (2000). "Multiple chronic health problems are negatively associated with health related quality of life (HRQoL) irrespective of age".

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lower limbs). For practicing pathologist rival are two or more diseases, exhibited in a single patient, each of which by itself or through its complications could cause the patient's death.

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Kristiansen, K.; Nesbakken, R. (1975). "Proceedings of the 26th annual meeting of the Nordisk Neurokirurgisk Förening (Scandinavian Neurosurgical Society) Sept. 5–7, 1974, Oslo, Norway".

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Complicated comorbidity: It is the result of the primary disease and often subsequent after sometime after its destabilization appears in the shape of target lesions (for example chronic

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Charlson, Mary E.; Pompei, Peter; Ales, Kathy L.; MacKenzie, C. Ronald (1987). "A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation".

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Jakovljević M, Ostojić L (June 2013). "Comorbidity and multimorbidity in medicine today: challenges and opportunities for bringing separated branches of medicine closer to each other".

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Charlson, Mary E.; Sax, Frederic L. (1987). "The therapeutic efficacy of critical care units from two perspectives: A traditional cohort approach vs a new case-control methodology".

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the healthcare system treats people and helps making clear the specific settings in which the use of one or the other term can be preferred. Multimorbidity offers a more general and

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Cuijpers, Pim; Van Lammeren, Paula; Duzijn, Bernadette (1999). "Relation Between Quality of Life and Chronic Illnesses in Elderly Living in Residential Homes: A Prospective Study".

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The Charlson index, especially the Charlson/Deyo, followed by the Elixhauser have been most commonly referred by the comparative studies of comorbidity and multimorbidity measures.

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Harrison, Christopher; Fortin, Martin; van den Akker, Marjan; Mair, Frances; Calderon-Larranaga, Amaia; Boland, Fiona; Wallace, Emma; Jani, Bhautesh; Smith, Susan (2021-01-01).

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Gijsen, Ronald; Hoeymans, Nancy; Schellevis, François G.; Ruwaard, Dirk; Satariano, William A.; Van Den Bos, Geertrudis A.M. (2001). "Causes and consequences of comorbidity".

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Sanderson, William C.; Beck, Aaron T.; Beck, Judith (1990). "Syndrome comorbidity in patients with major depression or dysthymia: Prevalence and temporal relationships".

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histories, hospital records of patients and other medical documentation, kept by family doctors, insurance companies and even in the archives of patients in old houses.

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Hudson, James I.; Goldenberg, Don L.; Pope, Harrison G.; Keck, Paul E.; Schlesinger, Lynn (1992). "Comorbidity of fibromyalgia with medical and psychiatric disorders".

786: 54: 3864: 571:

for the patient's death. If the patient has several primary diseases it is important to first of all understand the combined primary diseases (rival or concomitant).

171:

Comorbidity can indicate either a condition existing simultaneously, but independently with another condition or a related derivative medical condition. The latter

1866:

Schellevis, F.G.; Van De Lisdonk, E.; Van Der Velden, J.; Van Eijk, J.Th.M.; Van Weel, C. (1993). "Validity of diagnoses of chronic diseases in general practice".

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mostly come across a combination of two to three disorders, but in rare cases (up to 2.7%) a single patient carried a combination of 6–8 diseases simultaneously.

1096:

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Kaplan, M. H.; Feinstein, A. R. (1973). "A critique of methods in reported studies of long-term vascular complications in patients with diabetes mellitus".

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general atherosclerosis (ASVD); occurrence of erosive-ulcerative lesions in the mucous membrane of the upper gastrointestinal tract in "vascular" patients).

195:

is not easy to measure, because both diseases are quite multivariate and there are likely aspects of both simultaneity and consequence. The same is true of

432:

hypertension and type 2 diabetes. Among the young obesity patients (from 18 to 29) more than two chronic diseases were found in 22% males and 43% females.

590:

Associating diseases: Nosological units not connected etiologically and pathogenetically with the primary disease (Listed in the order of significance).

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Kaplan, Moreson H.; Feinstein, Alvan R. (1974). "The importance of classifying initial co-morbidity in evaluating the outcome of diabetes mellitus".

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Evans, DC; Cook, CH; Christy, JM (August 2012). "Comorbidity–polypharmacy scoring facilitates outcome prediction in older trauma patients".

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Widespread study of physical and mental pathology found its place in psychiatry. I. Jensen (1975), J.H. Boyd (1984), W.C. Sanderson (1990),

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Elixhauser, Anne; Steiner, Claudia; Harris, D. Robert; Coffey, Rosanna M. (1998). "Comorbidity Measures for Use with Administrative Data".

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to indicate a medical condition in a patient that causes, is caused by, or is otherwise related to another condition in the same patient.

646: 3145:Роль хронического аллергического воспаления в патогенезе бронхиальной астмы и его рациональная фармакотерапия у пациентов с полипатией 192: 278: 3547:

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4209: 724:

In this case comorbidity of patient S, 73 years of age according to this method, is equivalent to mild state (9 out of 40 points)

4409: 4168: 2160: 4082:

Litwin, Mark S.; Greenfield, Sheldon; Elkin, Eric P.; Lubeck, Deborah P.; Broering, Jeanette M.; Kaplan, Sherrie H. (2007).

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The Charlson Comorbidity Index predicts the mortality for a patient who may have a range of comorbid conditions, such as

661: 529:

resulting from diabetic nephropathy (Kimmelstiel-Wilson disease) in patients with type 2 diabetes; development of brain

287: 3860:

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Robins, Lee N. (1994). "How Recognizing 'Comorbidities' in Psychopathology May Lead to an Improved Research Nosology".

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added chronic forms of ischemic cardiac disorder and the stages of chronic cardiac insufficiency to this index in 1992.

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Fuchs, Z.; Blumstein, T.; Novikov, I.; Walter-Ginzburg, A.; Lyanders, M.; Gindin, J.; Habot, B.; Modan, B. (1998).

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Sharabiani, M.; Aylin, P.; Bottle, A. (2012). "Systematic review of comorbidity indices for administrative data".

526: 4006:

Rozzini, R.; Frisoni, GB; Ferrucci, L; Barbisoni, P; Sabatini, T; Ranieri, P; Guralnik, JM; Trabucchi, M (2002).

388: 253: 3224:"Hospitalizations for back and neck problems: A comparison between the Province of Ontario and Washington State" 4358: 1963:

Grimby, A; Svanborg, A (1997). "Morbidity and health-related quality of life among ambulant elderly citizens".

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2543:

Gill, Thomas M.; Feinstein, AR (1994). "A Critical Appraisal of the Quality of Quality-of-Life Measurements".

2042:

Fortin, Martin; Lapointe, Lise; Hudon, Catherine; Vanasse, Alain; Ntetu, Antoine L; Maltais, Danielle (2004).

161:

to indicate a medical condition existing simultaneously but independently with another condition in a patient.

2701:"Morbidity, Comorbidity, and Their Association with Disability Among Community-Dwelling Oldest-Old in Israel" 2664:

Hoffman, Catherine; Rice, D; Sung, HY (1996). "Persons with Chronic Conditions: Their Prevalence and Costs".

680: 600:

validated such tests because of their predictive value, but no one test is as yet recognized as a standard.

188: 180: 1245:"Clinical relevance of comorbidity in obsessive compulsive disorder: The Netherlands OCD Association study" 167:

to indicate two or more medical conditions existing simultaneously regardless of their causal relationship.

4419: 4377: 3815: 3321: 265:. A comorbid diagnosis is associated with more severe symptomatic expression and greater chance of dismal 4414: 428:

is accompanied by increasing prevalence of Coronary Heart Disease and sudden death from cardiac arrest.

772:

to nearly nine times more likely for a major joint replacement with major complication or comorbidity.

3450: 1244: 2393: 2338:

Feinstein, Alvan R. (1970). "The pre-therapeutic classification of co-morbidity in chronic disease".

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Van Den Akker, Marjan; Buntinx, Frank; Knottnerus, J André (1996). "Comorbidity or multimorbidity".

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complained of concurrent arthritis, 20% complained of cardiac problems and 16% had type 2 diabetes.

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in patients treated for a long time using systematic hormonal agents (preparations); drug-induced

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94: 3971:(1992). "Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases". 307:

is a leading alternative classification system that addresses these concerns about comorbidity.

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There are currently several generally accepted methods of evaluating (measuring) comorbidity:

549:

resulting from chemotherapy against TB, prescribed due to the conversion of tubercular tests).

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Zhang, M.; Holman, C D. J; Price, S. D; Sanfilippo, F. M; Preen, D. B; Bulsara, M. K (2009).

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Trans-syndromal comorbidity: coexistence, in a single patient, of two and/or more syndromes,

4308: 4262: 4225: 4141: 4095: 4056: 4019: 3980: 3933: 3890: 3827: 3788: 3738: 3700: 3692: 3681:"Comorbidity–polypharmacy score: a novel adjunct in post-emergency department trauma triage" 3645: 3602: 3556: 3516: 3423: 3386: 3378: 3331: 3284: 3276: 3235: 3190: 3180: 3114: 3106: 3067: 3031: 2988: 2922: 2876: 2868: 2818: 2781: 2712: 2673: 2630: 2587: 2552: 2509: 2468: 2460: 2405: 2347: 2224: 2214: 2106: 2065: 2055: 2016: 1972: 1945: 1910: 1875: 1840: 1778: 1741: 1729: 1686: 1628: 1593: 1557: 1499: 1462: 1415: 1377: 1359: 1304: 1256: 1215: 1199: 1152: 1109: 1068: 1052: 1002: 945: 885: 877: 134: 102: 2770:"Prevalence, Expenditures, and Complications of Multiple Chronic Conditions in the Elderly" 4384: 3868: 2380: 816: 408:

of postmortem of deceased patients was carried out for any of the comorbidity researches.

341: 106: 1597: 1419: 3476:Формулировка и сопоставление клинического и патологоанатомического диагнозов: Справочник 3473:Формулировка и сопоставление клинического и патологоанатомического диагнозов: справочник 936:

Maj, M (2005), "'Psychiatric comorbidity': an artefact of current diagnostic systems?",

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heterogeneous character of comorbidity is due to the wide range of reasons causing it.

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Fortin, Martin; Bravo, Gina; Hudon, Catherine; Vanasse, Alain; Lapointe, Lise (2005).

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their clinical aspects, which makes it difficult to differentiate between nosologies.

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Feudjo-Tepie, M. A.; Le Roux, G.; Beach, K. J.; Bennett, D.; Robinson, N. J. (2009).

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Caughey, Gillian E; Vitry, Agnes I; Gilbert, Andrew L; Roughead, Elizabeth E (2008).

1879: 1844: 1782: 1730: 1511: 1348:"Presence of eating disorder symptoms in patients with obsessive-compulsive disorder" 615: 282: 130: 4328: 4290: 4245: 4117: 3953: 3910: 3847: 3758: 3622: 3576: 3351: 3008: 2838: 2650: 2529: 2447:

Starfield, B.; Lemke, KW; Bernhardt, T; Foldes, SS; Forrest, CB; Weiner, JP (2003).

2433: 1992: 1708:[Psychopathology of depression (the construction of a typological model)]. 1569: 1435: 1293:"Comorbidity prevalence and treatment outcome in children and adolescents with ADHD" 1172: 1129: 1022: 199:. In other examples, the true independence or relation is not ascertainable because 4060: 3665: 3483:] (in Russian) (2nd ed.). Moscow: Meditsinskoe informatsionnoe agentstvo. 2948:

Bruce, Sharon G.; Riediger, Natalie D.; Zacharias, James M.; Young, T. Kue (2010).

2449:"Comorbidity: Implications for the Importance of Primary Care in 'Case' Management" 2180: 1705: 1655: 1332: 1006: 542: 534: 498: 208: 4363: 4312: 4229: 4084:"Assessment of prognosis with the total illness burden index for prostate cancer" 3742: 3649: 3560: 3382: 2950:"Obesity and Obesity-Related Comorbidities in a Canadian First Nation Population" 2786: 2769: 1526: 866:"Defining Comorbidity: Implications for Understanding Health and Health Services" 98: 3968: 3219: 3169:"Comorbidities of Idiopathic Thrombocytopenic Purpura: A Population-Based Study" 2717: 2700: 973: 781: 730: 316: 4024: 4007: 3696: 3459:] (in Russian). Moscow: Scientific Research Institute of Human Morphology. 2822: 2705:

The Journals of Gerontology Series A: Biological Sciences and Medical Sciences

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Kraemer, Helena Chmura (1995). "Statistical issues in assessing comorbidity".

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prevent treatment efficacy on a varying scale depending on the circumstances.

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Barrett ML, Smith MW, Elizhauser A, Honigman LS, Pines JM (December 2014).

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Formulation and comparison of clinical and postmortem diagnoses: A Handbook

3435: 3400: 3343: 3298: 3204: 3128: 3000: 2965: 2934: 2890: 2830: 2795: 2642: 2521: 2497: 2482: 2359: 2317: 2238: 2120: 2079: 2060: 2028: 1914: 1745: 1632: 1476: 1427: 1391: 1324: 1276: 1229: 1164: 1121: 1082: 1014: 959: 922: 899: 4282: 4153: 3992: 3945: 3937: 3902: 3839: 3528: 3249: 3185: 3079: 3043: 2726: 2685: 2599: 2564: 2425: 1984: 1922: 1887: 1852: 1817: 1790: 1640: 1605: 1467: 1450: 950: 2095:"Multimorbidity is common to family practice: Is it commonly researched?" 2093:

Fortin, Martin; Lapointe, Lise; Hudon, Catherine; Vanasse, Alain (2005).

2044:"Multimorbidity and quality of life in primary care: A systematic review" 1658:[Depression and depersonalization: the problem of comorbidity]. 796: 505: 211:

commonalities are confirmed (and, in some examples, before they are even

200: 86: 4350: 4274: 4100: 4083: 2417: 1976: 1561: 1503: 1451:"'Psychiatric comorbidity': An artifact of current diagnostic systems?" 3280: 2881: 1156: 4197: 623: 392: 274: 3452:Никонов Е.Л. Правила формулировки диагноза. Часть 1. Общие положения 3110: 881: 3222:; Lavis, JN; Deyo, RA; Bombardier, C; Malter, A; Axcell, T (1998). 3095:"Prevalence of Multimorbidity Among Adults Seen in Family Practice" 4175:(185). Rockville, MD: Agency for Healthcare Research and Quality. 3774:"How to measure comorbiditya critical review of available methods" 2464: 1527:"Comorbidity as an epistemological challenge to modern psychiatry" 1098:"Aging with multimorbidity: A systematic review of the literature" 508:

comorbidity: coexistence, in a single patient, of two and/or more

110: 2255:Лечение внутренних болезней в условиях коморбидности: монография 619: 227:

even though the two are considered distinct clinical scenarios.

4390:

MDCalc – Medical calculators, equations, scores, and guidelines

1706:"Психопатология депрессий (к построению типологической модели)" 133:, comorbidity frequently refers to the concurrent existence of 29: 2203:"Prevalence of comorbidity of chronic diseases in Australia" 4389: 3772:

Degroot, V; Beckerman, H; Lankhorst, G; Bouter, L (2003).

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Linn, Bernard S.; Linn, Margaret W.; Gurel, Lee (1968).

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van Loo, Hanna M.; Romeijn, Jan-Willem (February 2015).

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Modified Charlson Index: R. A. Deyo, D. C. Cherkin, and

27:

Presence of more than one medical condition in a patient

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Geriatric Index of Comorbidity (GIC): Developed in 2002

472:

Singular pathogenetic mechanism of a number of diseases

50: 1656:"Депрессия и деперсонализация: проблема коморбидности" 841:"comorbidity | Etymology of comorbidity by etymonline" 747:

Functional Comorbidity Index (FCI): Developed in 2005.

975:

Multimorbidity: a priority for global health research

750:

Total Illness Burden Index (TIBI): Developed in 2007.

475:

Terminable cause-effect relation between the diseases

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Rules language diagnosis. Part 1. General provisions

2258:Лечение внутренних болезней в условиях коморбидности 4344: 2498:"Comorbidity and guidelines: Conflicting interests" 1041:"Comorbidity versus multimorbidity: Why it matters" 478:

One disease resulting from complications of another

109:) with a primary condition. It originates from the 93:refers to the simultaneous presence of two or more 45:

may be too technical for most readers to understand

1531:Dialogues in Philosophy, Mental and Neuro Sciences 3542: 3540: 3538: 1525:Jakovljević, Miro; Crnčević, Željka (June 2012). 256:is a very common comorbid disorder. The Axis II 4198:Comorbidity: Addiction and Other Mental Illness. 3679:Justiniano, CF; Evans, DC; Cook, CH (May 2013). 2768:Wolff, J. L.; Starfield, B; Anderson, G (2002). 2496:Van Weel, Chris; Schellevis, François G (2006). 787:Conditions comorbid to autism spectrum disorders 3502: 3500: 3365:Tomblin, J. Bruce; Mueller, Kathyrn L. (2012). 4169:"Utilization of Intensive Care Services, 2011" 3862:Pittsburgh, Pa: University of Pittsburgh; 1991 2861:Journal of Epidemiology & Community Health 3470:Зайратьянц, О. В.; Кактурский, Л. В. (2011). 2372:Лазебник Л. Б. Старение и полиморбидность // 512:, pathogenetically not related to each other. 8: 1188:"Psychiatric comorbidity: fact or artifact?" 157:The term "comorbid" has three definitions: 120: 114: 4341: 3820:Journal of the American Geriatrics Society 2169:] (in Russian). 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(2001). 2716: 2472: 2228: 2218: 2110: 2069: 2059: 1679:Clinical Psychology: Science and Practice 1466: 1381: 1363: 1219: 1072: 1045:Journal of Multimorbidity and Comorbidity 949: 889: 73:Learn how and when to remove this message 57:, without removing the technical details. 2392:Greenfield, Sheldon; Apolone, Giovanni; 1732:Psychiatric Diagnosis and Classification 1492:Philosophy, Psychiatry, & Psychology 305:Hierarchical Taxonomy of Psychopathology 4202:U.S. Dept. of Health and Human Services 2304:[Co-morbidity in ENT practice] 808: 191:is an independent comorbidity versus a 3588: 3586: 3218:Taylor, VM; Anderson, GM; McNeney, B; 1034: 1032: 537:crisis in patients with hypertension). 469:Anatomic proximity of diseased organs 55:make it understandable to non-experts 7: 1938:European Journal of General Practice 1710:Депрессии и коморбидные расстройства 1660:Депрессии и коморбидные расстройства 1598:10.1001/archpsyc.1984.01790210065008 978:. Academy of Medical Sciences. 2018. 641:Comorbidity–Polypharmacy Score (CPS) 533:resulting from complications due to 223:Comorbidity is often referred to as 137:, for example, the co-occurrence of 2269:(in Russian). Irkutsk: РИО ИГМАПО. 2140:[Aging and polymorbidity]. 2048:Health and Quality of Life Outcomes 119:(meaning "sickness") prefixed with 3832:10.1111/j.1532-5415.1968.tb02103.x 3336:10.1161/01.HYP.0000172753.96583.e1 2993:10.1097/01.rhu.0000221817.46231.18 2915:The American Journal of Cardiology 1691:10.1111/j.1468-2850.1994.tb00010.x 1621:The American Journal of Psychiatry 1420:10.1023/B:BEGE.0000017871.87431.2a 1192:Theoretical Medicine and Bioethics 917:. 25 Suppl 1 (25 Suppl 1): 18–28. 197:intercurrent diseases in pregnancy 25: 3816:"Cumulative illness rating scale" 3142:Вёрткин, А. Л.; Скотников, А. С. 1714:Depression and comorbid disorders 1664:Depression and comorbid disorders 1455:The British Journal of Psychiatry 207:are often identified long before 4378:Online comorbidity scoring tools 4267:10.1097/00005650-199801000-00004 4210:National Institute on Drug Abuse 4134:The American Journal of Medicine 4049:Journal of Clinical Epidemiology 3973:Journal of Clinical Epidemiology 3781:Journal of Clinical Epidemiology 3607:10.1111/j.1532-5415.2012.04075.x 3416:Journal of Clinical Epidemiology 3060:Journal of Clinical Epidemiology 3024:The American Journal of Medicine 2981:Journal of Clinical Rheumatology 2743:Enquête Sociale et de Santé 1998 2678:10.1001/jama.1996.03540180029029 2557:10.1001/jama.1994.03520080061045 2410:10.1097/00005650-199302000-00005 2263:Internal Medicine in comorbidity 1868:Journal of Clinical Epidemiology 995:Journal of Clinical Epidemiology 604:Charlson Comorbidity Index (CCI) 399:Clinico-pathological comparisons 34: 2299:"Co-morbidity in ENT practice" 374:, used for mental health issues 183:. For example, in longstanding 125:("together") and suffixed with 4061:10.1016/j.jclinepi.2004.10.018 2811:International Psychogeriatrics 1586:Archives of General Psychiatry 1249:Journal of Affective Disorders 1007:10.1016/j.jclinepi.2018.09.008 687:Clinical example of evaluation 647:Comorbidity–polypharmacy score 219:Difference from multimorbidity 1: 4206:National Institutes of Health 3793:10.1016/S0895-4356(02)00585-1 3428:10.1016/S0895-4356(00)00363-2 3072:10.1016/S0895-4356(97)00306-5 2927:10.1016/S0002-9149(00)01176-0 2774:Archives of Internal Medicine 2514:10.1016/S0140-6736(06)68198-1 2374:Консилиум Медикум, 2005, № 12 2021:10.1016/S0090-4295(99)00203-4 759:Treatment of comorbid patient 4313:10.1097/MLR.0b013e31819432e5 4230:10.1097/MLR.0b013e31825f64d0 4146:10.1016/0002-9343(88)90074-5 3985:10.1016/0895-4356(92)90133-8 3895:10.1016/0165-1781(92)90005-N 3743:10.1097/MLR.0b013e31819432e5 3650:10.1097/bcr.0000000000000094 3561:10.1097/MLR.0b013e31825f64d0 3521:10.1016/0021-9681(87)90171-8 3383:10.1097/TLD.0b013e318261c264 3371:Topics in Language Disorders 3036:10.1016/0002-9343(92)90265-D 2787:10.1001/archinte.162.20.2269 2352:10.1016/0021-9681(70)90054-8 2301:Коморбидность в ЛОР-практике 1880:10.1016/0895-4356(93)90023-T 1845:10.1016/0021-9681(87)90094-4 1783:10.1016/0021-9681(74)90017-4 662:Elixhauser Comorbidity Index 656:Elixhauser Comorbidity Index 269:. Certain diagnoses such as 3509:Journal of Chronic Diseases 2340:Journal of Chronic Diseases 2310:Вестник оториноларингологии 2142:Новости медицины и фармации 1833:Journal of Chronic Diseases 1806:The Journal of Rheumatology 1771:Journal of Chronic Diseases 4436: 2954:Preventing Chronic Disease 2137:Старение и полиморбидность 659: 644: 610:Charlson Comorbidity Index 607: 3697:10.1016/j.jss.2012.05.042 3099:Annals of Family Medicine 2823:10.1017/S1041610299006067 2718:10.1093/gerona/53A.6.M447 2453:Annals of Family Medicine 2312:(in Russian) (2): 79–82. 2099:Canadian Family Physician 1950:10.3109/13814789609162146 1365:10.1186/s12888-020-2457-0 1309:10.1007/s00787-017-1005-z 1261:10.1016/j.jad.2013.03.014 1204:10.1007/s11017-015-9321-0 1114:10.1016/j.arr.2011.03.003 870:Annals of Family Medicine 389:World Health Organization 254:major depressive disorder 3475: 3451: 3228:Health Services Research 3144: 2873:10.1136/jech.2009.088260 2623:Quality of Life Research 2592:10.2337/diacare.11.9.725 2300: 2257: 2161: 2136: 2134:Лазебник, Л. Б. (2007). 1709: 1659: 1057:10.1177/2633556521993993 175:of the term causes some 4025:10.1093/ageing/31.4.277 3156:(in Russian) (4): 6–14. 2635:10.1023/A:1016654621784 2297:Лучихин, Л. А. (2010). 2252:Белялов, Ф. И. (2012). 2220:10.1186/1471-2458-8-221 1102:Ageing Research Reviews 681:diagnosis-related group 674:Diagnosis-related group 365:Multifactorial diseases 233:person-centered concept 189:coronary artery disease 4410:Diseases and disorders 4173:HCUP Statistical Brief 3967:Deyo, R; Cherkin, DC; 3173:Advances in Hematology 2061:10.1186/1477-7525-2-51 1915:10.1002/sim.4780140803 1903:Statistics in Medicine 1746:10.1002/047084647X.ch4 1633:10.1176/ajp.147.8.1025 579:hypostatic pneumonia). 501:related to each other. 187:, the extent to which 121: 115: 3938:10.2337/diab.22.3.160 2162:Окончательный диагноз 1468:10.1192/bjp.186.3.182 951:10.1192/bjp.186.3.182 696:Methods of evaluation 348:Evolution of the term 335:Inception of the term 258:personality disorders 193:diabetic complication 1550:Acta Neurochirurgica 179:with the concept of 97:in a patient; often 3883:Psychiatry Research 3186:10.1155/2009/963506 2921:(10): 1142–43, A9. 2586:(9): 725–32. 1988. 2286:on August 19, 2019. 2167:The final diagnosis 1716:] (in Russian). 1666:] (in Russian). 1449:Maj, Mario (2005). 1051:: 263355652199399. 4383:2016-03-04 at the 4101:10.1002/cncr.22615 3867:2012-01-25 at the 3234:(4 Pt 1): 929–45. 3154:Врач скорой помощи 2394:McNeil, Barbara J. 2379:2016-03-04 at the 1977:10.1007/bf03339614 1562:10.1007/BF01406298 1504:10.1353/ppp.0.0211 845:www.etymonline.com 95:medical conditions 4405:Medical diagnosis 4373: 4372: 3490:978-5-89481-881-8 3281:10.1136/bmj.a2752 2276:978-5-89786-091-3 2207:BMC Public Health 2176:978-5-9704-0920-6 1755:978-0-471-49681-6 1408:Behavior Genetics 1303:(12): 1443–1457. 1157:10.1159/000086093 185:diabetes mellitus 145:. The concept of 143:anxiety disorders 83: 82: 75: 16:(Redirected from 4427: 4342: 4332: 4294: 4249: 4185: 4184: 4164: 4158: 4157: 4128: 4122: 4121: 4103: 4079: 4073: 4072: 4044: 4038: 4037: 4027: 4003: 3997: 3996: 3964: 3958: 3957: 3921: 3915: 3914: 3877: 3871: 3858: 3852: 3851: 3811: 3805: 3804: 3778: 3769: 3763: 3762: 3725: 3719: 3718: 3708: 3676: 3670: 3669: 3633: 3627: 3626: 3595:J Am Geriatr Soc 3590: 3581: 3580: 3544: 3533: 3532: 3504: 3495: 3494: 3467: 3461: 3460: 3446: 3440: 3439: 3411: 3405: 3404: 3394: 3362: 3356: 3355: 3329: 3309: 3303: 3302: 3292: 3260: 3254: 3253: 3243: 3215: 3209: 3208: 3198: 3188: 3164: 3158: 3157: 3151: 3139: 3133: 3132: 3122: 3090: 3084: 3083: 3054: 3048: 3047: 3019: 3013: 3012: 2976: 2970: 2969: 2945: 2939: 2938: 2909: 2903: 2902: 2884: 2858: 2849: 2843: 2842: 2806: 2800: 2799: 2789: 2765: 2759: 2758: 2756: 2755: 2737: 2731: 2730: 2720: 2696: 2690: 2689: 2661: 2655: 2654: 2629:(10): 1093–104. 2618: 2612: 2611: 2575: 2569: 2568: 2540: 2534: 2533: 2508:(9510): 550–51. 2493: 2487: 2486: 2476: 2444: 2438: 2437: 2389: 2383: 2370: 2364: 2363: 2335: 2329: 2328: 2326: 2320:. 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Archived from 2156: 2150: 2149: 2131: 2125: 2124: 2114: 2090: 2084: 2083: 2073: 2063: 2039: 2033: 2032: 2003: 1997: 1996: 1960: 1954: 1953: 1933: 1927: 1926: 1898: 1892: 1891: 1863: 1857: 1856: 1828: 1822: 1821: 1801: 1795: 1794: 1777:(7–8): 387–404. 1766: 1760: 1759: 1735: 1724: 1718: 1717: 1701: 1695: 1694: 1674: 1668: 1667: 1651: 1645: 1644: 1616: 1610: 1609: 1580: 1574: 1573: 1545: 1539: 1538: 1522: 1516: 1515: 1487: 1481: 1480: 1470: 1446: 1440: 1439: 1402: 1396: 1395: 1385: 1367: 1343: 1337: 1336: 1287: 1281: 1280: 1240: 1234: 1233: 1223: 1183: 1177: 1176: 1140: 1134: 1133: 1093: 1087: 1086: 1076: 1036: 1027: 1026: 986: 980: 979: 970: 964: 963: 953: 933: 927: 926: 910: 904: 903: 893: 861: 855: 854: 852: 851: 837: 831: 830: 829: 828: 813: 737:hospitalization. 499:pathogenetically 135:mental disorders 124: 118: 78: 71: 67: 64: 58: 38: 37: 30: 21: 4435: 4434: 4430: 4429: 4428: 4426: 4425: 4424: 4395: 4394: 4385:Wayback Machine 4374: 4369: 4368: 4353: 4339: 4297: 4252: 4224:(12): 1109–18. 4215: 4200:Rockville, MD: 4194: 4192:Further reading 4189: 4188: 4166: 4165: 4161: 4130: 4129: 4125: 4081: 4080: 4076: 4046: 4045: 4041: 4005: 4004: 4000: 3966: 3965: 3961: 3923: 3922: 3918: 3879: 3878: 3874: 3869:Wayback Machine 3859: 3855: 3813: 3812: 3808: 3776: 3771: 3770: 3766: 3727: 3726: 3722: 3678: 3677: 3673: 3638:J Burn Care Res 3635: 3634: 3630: 3592: 3591: 3584: 3555:(12): 1109–18. 3546: 3545: 3536: 3506: 3505: 3498: 3491: 3477: 3469: 3468: 3464: 3453: 3448: 3447: 3443: 3413: 3412: 3408: 3364: 3363: 3359: 3327:10.1.1.580.8951 3311: 3310: 3306: 3262: 3261: 3257: 3217: 3216: 3212: 3166: 3165: 3161: 3149: 3146: 3141: 3140: 3136: 3111:10.1370/afm.272 3092: 3091: 3087: 3056: 3055: 3051: 3021: 3020: 3016: 2978: 2977: 2973: 2947: 2946: 2942: 2911: 2910: 2906: 2867:(12): 1036–42. 2856: 2851: 2850: 2846: 2808: 2807: 2803: 2780:(20): 2269–76. 2767: 2766: 2762: 2753: 2751: 2739: 2738: 2734: 2698: 2697: 2693: 2672:(18): 1473–79. 2663: 2662: 2658: 2620: 2619: 2615: 2577: 2576: 2572: 2542: 2541: 2537: 2495: 2494: 2490: 2446: 2445: 2441: 2391: 2390: 2386: 2381:Wayback Machine 2371: 2367: 2337: 2336: 2332: 2324: 2305: 2302: 2296: 2295: 2291: 2283: 2277: 2266: 2259: 2251: 2250: 2246: 2200: 2199: 2195: 2186: 2184: 2177: 2163: 2158: 2157: 2153: 2138: 2133: 2132: 2128: 2092: 2091: 2087: 2041: 2040: 2036: 2005: 2004: 2000: 1962: 1961: 1957: 1935: 1934: 1930: 1900: 1899: 1895: 1865: 1864: 1860: 1830: 1829: 1825: 1803: 1802: 1798: 1768: 1767: 1763: 1756: 1726: 1725: 1721: 1711: 1703: 1702: 1698: 1676: 1675: 1671: 1661: 1653: 1652: 1648: 1618: 1617: 1613: 1582: 1581: 1577: 1556:(3–4): 257–74. 1547: 1546: 1542: 1524: 1523: 1519: 1489: 1488: 1484: 1448: 1447: 1443: 1404: 1403: 1399: 1345: 1344: 1340: 1289: 1288: 1284: 1242: 1241: 1237: 1185: 1184: 1180: 1145:Psychopathology 1142: 1141: 1137: 1095: 1094: 1090: 1038: 1037: 1030: 988: 987: 983: 972: 971: 967: 938:Br J Psychiatry 935: 934: 930: 915:Psychiatr Danub 912: 911: 907: 882:10.1370/afm.983 863: 862: 858: 849: 847: 839: 838: 834: 826: 824: 815: 814: 810: 805: 778: 761: 698: 689: 676: 664: 658: 649: 643: 612: 606: 597: 563: 494: 466: 421: 401: 384: 377:Pluralpathology 359: 350: 337: 313: 242: 221: 155: 79: 68: 62: 59: 51:help improve it 48: 39: 35: 28: 23: 22: 15: 12: 11: 5: 4433: 4431: 4423: 4422: 4417: 4412: 4407: 4397: 4396: 4393: 4392: 4387: 4371: 4370: 4367: 4366: 4354: 4349: 4348: 4346: 4345:Classification 4338: 4337:External links 4335: 4334: 4333: 4295: 4250: 4213: 4193: 4190: 4187: 4186: 4159: 4123: 4094:(9): 1777–83. 4074: 4055:(6): 595–602. 4039: 4012:Age and Ageing 3998: 3959: 3916: 3872: 3853: 3806: 3764: 3720: 3671: 3628: 3601:(8): 1465–70. 3582: 3534: 3496: 3489: 3462: 3441: 3406: 3377:(3): 198–206. 3357: 3304: 3255: 3210: 3159: 3134: 3085: 3049: 3014: 2971: 2940: 2904: 2844: 2801: 2760: 2732: 2711:(6): M447–55. 2691: 2656: 2613: 2570: 2535: 2488: 2439: 2384: 2365: 2330: 2327:on 2012-01-18. 2289: 2275: 2244: 2193: 2175: 2151: 2144:(in Russian). 2126: 2085: 2034: 1998: 1955: 1928: 1893: 1858: 1823: 1796: 1761: 1754: 1719: 1696: 1669: 1654:Нуллер, Ю. Л. 1646: 1627:(8): 1025–28. 1611: 1592:(10): 983–89. 1575: 1540: 1517: 1482: 1441: 1397: 1352:BMC Psychiatry 1338: 1282: 1255:(3): 847–854. 1235: 1178: 1135: 1108:(4): 430–439. 1088: 1028: 981: 965: 928: 905: 856: 832: 807: 806: 804: 801: 800: 799: 794: 792:Superinfection 789: 784: 777: 774: 760: 757: 752: 751: 748: 745: 742: 738: 734: 727: 719: 710: 706: 697: 694: 688: 685: 675: 672: 660:Main article: 657: 654: 645:Main article: 642: 639: 608:Main article: 605: 602: 596: 593: 592: 591: 588: 584: 580: 576: 572: 562: 559: 558: 557: 554: 550: 538: 523: 522:collagenoses). 514: 513: 502: 493: 490: 485: 484: 479: 476: 473: 470: 465: 462: 420: 417: 400: 397: 383: 380: 379: 378: 375: 372:Dual diagnosis 369: 366: 363: 358: 355: 349: 346: 342:A.R. Feinstein 336: 333: 321:C.R. Cloninger 312: 309: 283:mood disorders 241: 238: 225:multimorbidity 220: 217: 169: 168: 165: 162: 154: 151: 147:multimorbidity 81: 80: 42: 40: 33: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 4432: 4421: 4420:Public health 4418: 4416: 4413: 4411: 4408: 4406: 4403: 4402: 4400: 4391: 4388: 4386: 4382: 4379: 4376: 4375: 4365: 4361: 4360: 4356: 4355: 4352: 4347: 4343: 4336: 4330: 4326: 4322: 4318: 4314: 4310: 4307:(6): 626–33. 4306: 4302: 4296: 4292: 4288: 4284: 4280: 4276: 4272: 4268: 4264: 4260: 4256: 4251: 4247: 4243: 4239: 4235: 4231: 4227: 4223: 4219: 4214: 4211: 4207: 4203: 4199: 4196: 4195: 4191: 4182: 4178: 4174: 4170: 4163: 4160: 4155: 4151: 4147: 4143: 4140:(5): 933–39. 4139: 4135: 4127: 4124: 4119: 4115: 4111: 4107: 4102: 4097: 4093: 4089: 4085: 4078: 4075: 4070: 4066: 4062: 4058: 4054: 4050: 4043: 4040: 4035: 4031: 4026: 4021: 4018:(4): 277–85. 4017: 4013: 4009: 4002: 3999: 3994: 3990: 3986: 3982: 3979:(6): 613–19. 3978: 3974: 3970: 3963: 3960: 3955: 3951: 3947: 3943: 3939: 3935: 3932:(3): 160–74. 3931: 3927: 3920: 3917: 3912: 3908: 3904: 3900: 3896: 3892: 3889:(3): 237–48. 3888: 3884: 3876: 3873: 3870: 3866: 3863: 3857: 3854: 3849: 3845: 3841: 3837: 3833: 3829: 3826:(5): 622–26. 3825: 3821: 3817: 3810: 3807: 3802: 3798: 3794: 3790: 3787:(3): 221–29. 3786: 3782: 3775: 3768: 3765: 3760: 3756: 3752: 3748: 3744: 3740: 3737:(6): 626–33. 3736: 3732: 3724: 3721: 3716: 3712: 3707: 3702: 3698: 3694: 3690: 3686: 3682: 3675: 3672: 3667: 3663: 3659: 3655: 3651: 3647: 3644:(1): 193–96. 3643: 3639: 3632: 3629: 3624: 3620: 3616: 3612: 3608: 3604: 3600: 3596: 3589: 3587: 3583: 3578: 3574: 3570: 3566: 3562: 3558: 3554: 3550: 3543: 3541: 3539: 3535: 3530: 3526: 3522: 3518: 3515:(5): 373–83. 3514: 3510: 3503: 3501: 3497: 3492: 3486: 3482: 3478: 3474: 3466: 3463: 3458: 3454: 3445: 3442: 3437: 3433: 3429: 3425: 3422:(7): 661–74. 3421: 3417: 3410: 3407: 3402: 3398: 3393: 3388: 3384: 3380: 3376: 3372: 3368: 3361: 3358: 3353: 3349: 3345: 3341: 3337: 3333: 3328: 3323: 3320:(2): 273–79. 3319: 3315: 3308: 3305: 3300: 3296: 3291: 3286: 3282: 3278: 3274: 3270: 3266: 3259: 3256: 3251: 3247: 3242: 3237: 3233: 3229: 3225: 3221: 3214: 3211: 3206: 3202: 3197: 3192: 3187: 3182: 3178: 3174: 3170: 3163: 3160: 3155: 3147: 3138: 3135: 3130: 3126: 3121: 3116: 3112: 3108: 3104: 3100: 3096: 3089: 3086: 3081: 3077: 3073: 3069: 3066:(5): 367–75. 3065: 3061: 3053: 3050: 3045: 3041: 3037: 3033: 3030:(4): 363–67. 3029: 3025: 3018: 3015: 3010: 3006: 3002: 2998: 2994: 2990: 2987:(3): 124–28. 2986: 2982: 2975: 2972: 2967: 2963: 2959: 2955: 2951: 2944: 2941: 2936: 2932: 2928: 2924: 2920: 2916: 2908: 2905: 2900: 2896: 2892: 2888: 2883: 2878: 2874: 2870: 2866: 2862: 2855: 2848: 2845: 2840: 2836: 2832: 2828: 2824: 2820: 2817:(4): 445–54. 2816: 2812: 2805: 2802: 2797: 2793: 2788: 2783: 2779: 2775: 2771: 2764: 2761: 2750:on 2013-01-26 2749: 2745: 2744: 2736: 2733: 2728: 2724: 2719: 2714: 2710: 2706: 2702: 2695: 2692: 2687: 2683: 2679: 2675: 2671: 2667: 2660: 2657: 2652: 2648: 2644: 2640: 2636: 2632: 2628: 2624: 2617: 2614: 2609: 2605: 2601: 2597: 2593: 2589: 2585: 2581: 2580:Diabetes Care 2574: 2571: 2566: 2562: 2558: 2554: 2551:(8): 619–26. 2550: 2546: 2539: 2536: 2531: 2527: 2523: 2519: 2515: 2511: 2507: 2503: 2499: 2492: 2489: 2484: 2480: 2475: 2470: 2466: 2465:10.1370/afm.1 2462: 2458: 2454: 2450: 2443: 2440: 2435: 2431: 2427: 2423: 2419: 2415: 2411: 2407: 2404:(2): 141–54. 2403: 2399: 2395: 2388: 2385: 2382: 2378: 2375: 2369: 2366: 2361: 2357: 2353: 2349: 2346:(7): 455–68. 2345: 2341: 2334: 2331: 2323: 2319: 2315: 2311: 2303: 2293: 2290: 2282: 2278: 2272: 2264: 2260: 2256: 2248: 2245: 2240: 2236: 2231: 2226: 2221: 2216: 2212: 2208: 2204: 2197: 2194: 2183:on 2013-06-08 2182: 2178: 2172: 2168: 2164: 2155: 2152: 2147: 2143: 2139: 2130: 2127: 2122: 2118: 2113: 2108: 2105:(2): 244–45. 2104: 2100: 2096: 2089: 2086: 2081: 2077: 2072: 2067: 2062: 2057: 2053: 2049: 2045: 2038: 2035: 2030: 2026: 2022: 2018: 2015:(3): 424–29. 2014: 2010: 2002: 1999: 1994: 1990: 1986: 1982: 1978: 1974: 1971:(5): 356–64. 1970: 1966: 1959: 1956: 1951: 1947: 1943: 1939: 1932: 1929: 1924: 1920: 1916: 1912: 1909:(8): 721–33. 1908: 1904: 1897: 1894: 1889: 1885: 1881: 1877: 1874:(5): 461–68. 1873: 1869: 1862: 1859: 1854: 1850: 1846: 1842: 1838: 1834: 1827: 1824: 1819: 1815: 1812:(5): 841–45. 1811: 1807: 1800: 1797: 1792: 1788: 1784: 1780: 1776: 1772: 1765: 1762: 1757: 1751: 1747: 1743: 1739: 1734: 1733: 1723: 1720: 1715: 1707: 1700: 1697: 1692: 1688: 1684: 1680: 1673: 1670: 1665: 1657: 1650: 1647: 1642: 1638: 1634: 1630: 1626: 1622: 1615: 1612: 1607: 1603: 1599: 1595: 1591: 1587: 1579: 1576: 1571: 1567: 1563: 1559: 1555: 1551: 1544: 1541: 1536: 1532: 1528: 1521: 1518: 1513: 1509: 1505: 1501: 1497: 1493: 1486: 1483: 1478: 1474: 1469: 1464: 1461:(3): 182–84. 1460: 1456: 1452: 1445: 1442: 1437: 1433: 1429: 1425: 1421: 1417: 1414:(3): 251–65. 1413: 1409: 1401: 1398: 1393: 1389: 1384: 1379: 1375: 1371: 1366: 1361: 1357: 1353: 1349: 1342: 1339: 1334: 1330: 1326: 1322: 1318: 1314: 1310: 1306: 1302: 1298: 1294: 1286: 1283: 1278: 1274: 1270: 1266: 1262: 1258: 1254: 1250: 1246: 1239: 1236: 1231: 1227: 1222: 1217: 1213: 1209: 1205: 1201: 1197: 1193: 1189: 1182: 1179: 1174: 1170: 1166: 1162: 1158: 1154: 1151:(4): 206–10. 1150: 1146: 1139: 1136: 1131: 1127: 1123: 1119: 1115: 1111: 1107: 1103: 1099: 1092: 1089: 1084: 1080: 1075: 1070: 1066: 1062: 1058: 1054: 1050: 1046: 1042: 1035: 1033: 1029: 1024: 1020: 1016: 1012: 1008: 1004: 1000: 996: 992: 985: 982: 977: 976: 969: 966: 961: 957: 952: 947: 944:(3): 182–84, 943: 939: 932: 929: 924: 920: 916: 909: 906: 901: 897: 892: 887: 883: 879: 876:(4): 357–63. 875: 871: 867: 860: 857: 846: 842: 836: 833: 822: 818: 817:"comorbidity" 812: 809: 802: 798: 795: 793: 790: 788: 785: 783: 780: 779: 775: 773: 769: 765: 758: 756: 749: 746: 743: 739: 735: 732: 728: 725: 720: 717: 711: 707: 703: 702: 701: 695: 693: 686: 684: 682: 673: 671: 669: 663: 655: 653: 648: 640: 638: 635: 631: 627: 625: 621: 617: 616:heart disease 611: 603: 601: 594: 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