Importance:The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing primary care.Objective: The purpose of this study was to determine the prevalence of multi-morbidity and to document changes in prevalence during the last 25 years.Design/Setting: Cross-sectional study using multiple years (1988 -2014) Results: A total of 57,303 individuals were surveyed regarding the presence of multi-morbidity in separate surveys spanning 1988 -2014. The overall current prevalence in 2013-2014 of >2 morbidities was 59.6% (95% CI 58.1%-61.1%), 38.5% had 3 or more, and 22.7% had 4 or more morbidities, which was significantly higher than in 1988 (45.7%, 95% CI 43.5%-47.8%, with >2 morbidities). Among individuals with 2 or more morbidities, 54.1% have obesity compared to 41.9% in 1988. Among adults age >65, prevalence was 91.8% for 2 or more morbidities. Whites and Blacks had significantly higher prevalence (59.2% and 60.1%) than Hispanic or "other" race (45.0%, P < .0001). Women (58.4%) had more current multi-morbidities (>2) than men (55.9%, P ‫؍‬ .01). The simultaneous presence of multiple conditions in one patient (multimorbidity) is a key challenge in primary care. Multimorbidity adds to the complexity of care and threatens the quality, coordination, continuity, and safety of care in the United States health care system and elsewhere. Despite the seriousness and far-reaching impacts of this phenomenon, characterization of this population in recent studies has focused on older populations, include a limited number of chronic conditions, and often do not include obesity as a chronic condition. [1][2][3][4][5][6][7][8] The burden on patients with multimorbidity is considerable and is associated with increased mortality. Conclusions and9-12 A recent meta-analysis by Nunes and colleagues 10 included 5806 multimorbidity studies, and mortality (26 studies were included) demonstrated a hazard ratio of 1.73 (95% CI, 1.41-2.13) and 2.72 (95% CI, 1.81-4.08) for people with 2 or more and 3 or more morbidities, respectively. This article was externally peer reviewed.

Objectives Driving under the influence of prescription and over-the-counter medication is a growing public health concern. A systematic review of the literature was performed to investigate which specific medications were associated with increased risk of motor vehicle collision (MVC). Methods The a priori inclusion criteria were: 1) studies published from English-language sources on or after January 1, 1960, 2) licensed drivers 15 years of age and older, 3) peer-reviewed publications, master's theses, doctoral dissertations, and conference papers, 4) studies limited to randomized control trials, cohort studies, case-control studies, or case-control type studies 5) outcome measure reported for at least one specific medication, 6) outcome measure reported as the odds or risk of a motor vehicle collision. Fourteen databases were examined along with hand-searching. Independent, dual selection of studies and data abstraction was performed. Results Fifty-three medications were investigated by 27 studies included in the review. Fifteen (28.3%) were associated with an increased risk of MVC. These included Buprenorphine, Codeine, Dihydrocodeine, Methadone, Tramadol, Levocitirizine, Diazepam, Flunitrazepam, Flurazepam, Lorazepam, Temazepam, Triazolam, Carisoprodol, Zolpidem, and Zopiclone. Conclusions Several medications were associated with an increased risk of MVC and decreased driving ability. The associations between specific medication use and the increased risk of MVC and/or affected driving ability are complex. Future research opportunities are plentiful and worthy of such investigation.

This article describes an outbreak of COVID-19 in a long-term care facility (LTCF) in West Virginia that was the epicenter of the state’s pandemic. Beginning with the index case, we describe the sequential order of procedures undertaken by the facility including testing, infection control, treatment, and communication with facility residents, staff, and family members. We also describe the lessons learned during the process and provide recommendations for handling an outbreak at other LTCFs.

Comorbidity is a growing challenge and the older adult population is most at risk of developing comorbid conditions. Comorbidity is associated with increased risk of mortality, increased hospitalizations, increased doctor visits, increased prescription medications, nursing home placement, poorer mental health, and physical disability. American Indians experience some of the highest rates of chronic conditions, but to date there have been only two published studies on the subject of comorbidity in this population. With a community-based sample of 505 American Indians aged 55 years or older, this study identified the most prevalent chronic conditions, described comorbidity, and identified socio-demographic, functional limitations, and psychosocial correlates of comorbidity. Results indicated that older American Indians experience higher rates of hypertension, diabetes, back pain, and vision loss compared to national statistics of older adults. Two-thirds of the sample experienced some degree of comorbidity according to the scale used. Older age, poorer physical functioning, more depressive symptomatology, and lower personal mastery were all correlates of higher comorbidity scores. Despite medical advances increasing life expectancy, morbidity and mortality statistics suggest that the health of older American Indians lags behind the majority population. These findings highlight the importance of supporting chronic care and management services for the older American Indian population.

BackgroundCardiovascular disease is the leading cause of death in the United States, making improving cardiovascular health a key population health goal. As part of efforts to achieve this, the American Heart Association has developed the first comprehensive cardiovascular health index (CVHI). Our objective was to investigate the changes in CVHI in US states from 2003 to 2011.Methods and ResultsCVHI was examined using Behavioral Risk Factor Surveillance System data between 2003 and 2011 (odd-numbered years). Total CVHI decreased from 3.73±0.01 in 2003 to 3.65±0.01 in 2009. The majority of states (88%) experienced a decline in CVHI and an increase in the prevalence of “poor” CVHI between 2003 and 2009. Among CVHI components, the highest prevalence of “ideal” was observed for blood glucose followed by smoking, whereas the lowest prevalence of “ideal” was observed for physical activity and diet. Between 2003 and 2009, prevalence of “ideal” smoking and diet status increased, while “ideal” prevalence of blood pressure, cholesterol, blood glucose, body mass index, and physical activity status decreased. We observed statistically significant differences between 2009 and 2011, outside the scope of the 2003–2009 trend, which we hypothesize are partially attributable to differences in sample demographic characteristics related to changes in Behavioral Risk Factor Surveillance System methodology.ConclusionsOverall, CVHI decreased, most likely due to decreases in “ideal” blood pressure, body mass index, and cholesterol status, which may stem from low prevalence of “ideal” physical activity and diet status. These findings can be used to inform state-specific strategies and targets to improve cardiovascular health.