Many interesting and unusual terms are known in different areas of human life. Many of them are heard, but about some most people have not even heard. For example, comorbidity. This is a medical term for a very interesting area of professional diagnosis and therapy.
Term history
If we go along the path of a clear professional vocabulary, then in medicine there is a term denoting a combination of diseases according to certain signs - comorbidity. This definition, traditional for medicine, has its roots in the Latin language. It is from it that two components are taken - coniunctim and morbus - “together” and “disease”, which became the basis of an unusual term for a simple layman, meaning a complex of chronic diseases in one patient, somehow connected in a certain way.
This definition of the patient’s condition has been considered since the earliest times, at the dawn of the birth of the healing of diseases. Both the ancient Greeks and the healers of the Ancient East did not treat the disease itself as something isolated, but the whole organism, suffering from the manifestation of a specific ailment. Doctors of different generations spoke about the interconnection of several problems in the state of human health, manifested by certain symptoms, and, therefore, about the treatment of a whole complex of diseases. And to date, comorbidity is a clinically proven technique for making an adequate diagnosis and proper treatment, which helps to maintain good health.
The term "comorbidity" was proposed in 1970 by an American epidemiologist and researcher Alvan R. Feinstein (A. R. Feinstein). At first, this concept was used mainly in clinical epidemiology, but over time it became the main research methodology of various branches of medicine.
Combination of diseases
Turning to a doctor about a specific health problem, a person most often does not suspect that his condition is caused not by one, but by a whole complex of problems. And for many specialists, when making an adequate diagnosis, it becomes clear that in a particular case we can talk about comorbidity. But at the same time, for other physicians, multimorbidity, that is, not a combination of diseases at the pathogenetic level, but their presence separately, will be the right direction for diagnosing the disease and prescribing treatment, which gives an overall picture of the patient's condition at a given time.
But meanwhile, for the vast majority of medical practitioners around the world, it is precisely the combined diseases that become the most qualitative definition of the diagnosis and treatment. For example, comorbidity in cardiology takes into account, in addition to two main problems of the cardiovascular system — arterial hypertension and coronary heart disease — also the problems of the respiratory and urinary systems.
What are the reasons?
For medical practice, comorbidity is a combination of several interrelated diseases that a particular person suffers from. Practical medicine is faced with the peculiarity that when a patient first contacts a specialized medical institution, in the vast majority of cases recorded, it is about one specific disease for which treatment is prescribed. But in multidisciplinary hospitals, the picture changes dramatically, the same patients receive a diagnosis of comorbidity, which allows to prescribe a better treatment in accordance with a comprehensive vision of the revealed pathologies. This is due to the fact that a more thorough observation and examination of the patient in different profiles takes into account all parties on the basis of which we are talking about combined diseases:
- anatomical feature - diseased organs close to each other;
- a single pathogenetic mechanism for the development of diseases;
- diseases have one causal relationship and are united by a single time threshold;
- one disease "flows" from another, as a complication.
Assuming that the patient has comorbidity, the specialist bases his opinion on identified or potential factors:
- inflammatory process;
- genetic predisposition;
- infection;
- metabolic changes of an involutive or systemic nature;
- social status;
- ecology of the region of permanent residence;
- iatrogenia - the deterioration of the patient's condition (physical and / or emotional through the fault of a medical professional)
How is the problem studied?
At the present stage of development of medicine, as a science in different spheres of the human body, the concept of “comorbidity” is a combination of diseases that are linked by a pathogenetic mechanism of occurrence, development, manifestation. Observation of the patient’s condition since ancient times allowed doctors to conclude that it is impossible to treat only the manifestation of the disease qualitatively without eliminating the cause of its occurrence, moreover, the disease often does not arise as a separate lesion of an organ or system. In fact, there are several diseases, and they are interconnected. The most accurate and ancient method of studying such a combination is autopsy. It was the posthumous study of the diseases that a person suffered that allowed us to conclude that many of them occur together, and thus reveal the presence of comorbidity.
How are concomitant diseases divided?
Combined diseases are present in various fields of medicine. And conditionally they can be divided into comorbidity in psychiatry and a combination of clinical internal diseases. Medical scientists study interconnected diseases in two directions:
- transindromal - syndromes are interconnected by pathogenetic causes;
- transzologic - diseases that a patient has do not have common pathogenetic causes.
It is this division that makes it possible to differentiate the combination of diseases for common causes or similar clinical manifestations.
Comorbidity is also divided into the following types:
- causal;
- complicated;
- iatrogenic;
- unspecified;
- "Random" comorbidity.
Diagnosis and treatment of a complex of diseases
The problems of comorbidity have been studied by medicine from various points of view for many decades. Recently, this issue has again been sharply raised at the highest levels; potential work is underway to improve diagnostics, treatment methods, and prognosis. World medicine has already developed several methods for measuring comorbidity, each of which works in a specific direction. And the main problem is that each such technique can have different results for the same patient. In determining the presence of comorbidity, which means predicting the lethality or quality of life of a patient, practitioners do not have a single tool that operates with specific arguments that allow you to get the most accurate result. That is why all these techniques are little used in practical therapy of various directions.
At the present stage of the development of medicine, comorbidity is a sphere of studying existing diseases in one patient, interrelated causes or symptoms, potentially significant, but little used in practice due to the lack of specific work algorithms.