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Thus, whilst primary care physicians are skilled in managing multiple morbidities in their patients, they face a dilemma when it comes to managing chronic non-cancer pain [ 33].
Furthermore, the premature ageing effect of HIV will likely further contribute to multiple morbidities in the population [ 12], at younger ages than described in low HIV-burden settings.
Key points This research is the first to analyse associations between socioeconomic deprivation and multiple morbidities in the Middle East and among a refugee population.
The narratives of participants in our research mirrored those reported by Townsend et al [ 16] on individuals with chronic multiple morbidities in that they "self regulated their drug use in an attempt to gain equilibrium, relief from symptoms or sense of a normal life", and showed a "reluctance to take drugs yet an inability to be free of them".
Similar(56)
Participants were allowed to progress to multiple disease states, representing all potential combinations of the selected conditions, consistent with the frequent development of multiple morbidity in primary care [ 21].
It seems plausible that the gradient in amenable mortality reflects the earlier onset and treatability of multiple morbidity in a less responsive health care environment rather than a rise in the incidence of a single specific cause.
Studies of multiple morbidity in primary care, based on a limited number of empirically selected chronic conditions, have shown that it is negatively associated with overall health [ 33] and that it is associated with increased referral to secondary care and increased health care costs [ 1, 34].
The results showed that elderly with multiple morbidities have difficulties in participating in medical decision-making when in hospital.
To this end, the 1.3-3 fold increased risk for multiple morbidities including cancer in diabetes is now well recognized [ 36, 37] and support the frequent co-occurrence of hypoglycaemia, CKD and non-CVD deaths in our analysis.
IIT (blood glucose range of 80 to 110 mg/dL) was associated with a reduction in mortality from 8.0%to4.6%6% compared with conventionally treated patients (blood glucose range of 180 to 200 mg/dL) in addition to reductions in multiple morbidities [ 23].
The issues raised may have been particularly salient to people living in west central Scotland and to those experiencing multiple morbidity early in midlife.
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Justyna Jupowicz-Kozak
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