Comments of The language of polypathology

 Comorbidity

In 1990, the US National Library of Medicine introduced the MeSH term comorbidity defining it as the presence of coexistent diseases, or diseases which have a compounding effect, dating from an initial diagnosis or referring to a primary condition which is the subject of study. This approach, which emphasizes the existence of a primary or core disease and a constellation of associated conditions (only sometimes secondary to the primary disease) makes comorbidity a vertical concept. Because of its verticality, patients can be labeled differently depending on the clinician's point of view. For instance, a patient with advanced diabetes who presents congestive heart failure, peripheral neuropathy and incipient nephropathy could be assigned different primary diseases depending on whether she is being managed by an endocrinologist, a cardiologist, a neurologist or a nephrologist.

Seasoned clinicians who devote most of their time to the management of patients with multiple diseases suggest that comordibity be classified in three groups depending on the relationship between the index disease and the accompanying conditions (Bob Bernstein, personal communication):

- Random: These are the diseases that occur together with a frequency no different from that of the individual conditions separately in the population. An example is the co-existence of hand warts and osteoarthritis.

- Consequential: This is the usual type of co-morbidity included in most classification systems, and refers to conditions that are patho-physiologically part of the same process, such as diabetes and hypertension, occurring together with a frequency that is much greater than what could be explained by chance. These co-morbidities, though interesting, are predictable.

- Cluster co-morbidity: This is what happens when there is non-random clustering of health conditions without an evident underlying patho-physiological cause, as occurs with obesity and cancer, for instance. This provides an opportunity for new discoveries-either new understandings of patho-physiology, or a new appreciation of the nature of complexity. This term could be considered equivalent to polypathology, as described below.

Terms that would translate as multimorbidity, polypathology or pluripathology are often used interchangeably with comorbidity in German, French and Spanish (3-12). Polypathology, however, may offer some advantages in its own right, as a distinct term.

 

Existing comments

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La verdad es que más que verticalidad, yo optaría por un concepto de horizontalidad. las diferentes patologías acaban rodeando a la persona, y a través del desarrollo del proceso, no es dificil que se mezclen las diferentes entidades de las patologías, (Pluri, muchas veces)

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El problema que tiene el termino comorbilidad dado el fino límite dentro de la clasificación que se muestra es en la aplicación el establecerlo en una y otra categoria.

El problema esta en como cladificarlo según quién es el profesional que trata al paciente, ya que cada especilista lo llevará a su terreno. Dificil utilizar la clasificación en el día a día.

19/03/2012 Conchi Candela
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Supongo que la aparición de este término, tiene que ver con la coexistencia de enfermedades, que sin tener un vínculo causa efecto, iban apareciendo, pero no era algo generalizado. Hoy, debido al incremento de longevidad, la existencia de varias enfermedades, en la misma persona es algo habitual, y la asistencia a estas personas debe  interrelacionar esas enfermedades

07/02/2012 Lola Nieto
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Pienso que el concepto de comorbilidad es muy amplio y aunque define realmente una situación es poco práctico a la hora de tomar decisiones y mucho menos a la hora de valorar pronóstico o evolución natural de las enfermedades crónicas. 

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Aún distinguiendo varios grupos dentro de la comorbilidad, en determinados pacientes dichos grupos se superponen. En definitiva, sea aleatoria, consecuencial o por agrupación, el hecho es que se presentan varias patologías crónicas ya establecidas (sean de una etiología común o no, relacionada o no), con sus tratamientos correspondientes, y los problemas derivados de ello.

08/06/2010 allan kofoed-enevoldsen
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The argument that comorbidity is essentially a vertical concept needs support by reference. Alternatively, and perhaps preferably, one should rather argue in favour of conferring the verical essence to the comorbidity term thereby acknowledging the likely lack consensus in this area.

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