Acute Physical Illness Research Articles

Health service utilization, substance use treatment response, and death in patients with opioid use disorder and comorbid hepatitis C findings from prospective cohort study with administrative database linkage

BackgroundAmong patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment. AimTo establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT). MethodsThis multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes. ResultsAmong recruited participants (n = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (n = 365). Methadone was used most often (83.9 %, n = 2876), followed by sublingual buprenorphine (16.2 %, n = 554). Over the three-year follow-up, 5.3 % of patients died (n = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes. ConclusionA high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs.

Colonialism as a Social Determinant of Health in Puerto Rico: Using the Socioecological Model to Examine How the Jones Act Impacted Health After Hurricane María.

Puerto Rico is a territory of the United States, making Puerto Ricans vulnerable to damaging colonial policy. The purpose of this article is to utilize the socioecological model (SEM) to evaluate how the Jones Act impacted Puerto Rico after Hurricane María, examining colonialist policy as a social determinant of health (SDOH) in Puerto Rico. Levels of the SEM used in this examination included: individual, institutional, community, policy, and context. Evaluation of the Jones Act using the model demonstrated relationships between all socioecological levels. The Jones Act caused delays and increased prices for goods needed to rebuild community utility infrastructure, which led to extended closures of institutions like workplaces, schools, and hospitals, and ultimately contributed to increased acute and chronic physical and mental illness among Puerto Ricans. This evaluation establishes that colonialist policy negatively impacts the health of Puerto Ricans, positioning colonialism as an SDOH.

Mental illness comorbidity significantly impacts surgical outcomes for emergency surgical patients.

Whilst both mental illness comorbidity and the delivery of emergency surgery are commonplace in Australia, there is little evidence investigating any link between them. As such, this study examines the emergency surgical outcomes for patients with mental illness compared to other surgical patients within the Australian public surgical system. Retrospective cohort study involving adult emergency and elective surgical patients treated at three public hospitals in Sydney, Australia between 2018 and 2019. Patients were identified using ICD-10 diagnosis codes, and grouped by those with decompensated mental illness, chronic depression, or those without mental illness. Outcome measures included those within the emergency department (ED), along with in-hospital mortality and surgical outcomes. Of 48 338 total patients, 31 890 (66.0%) had elective and 16 448 (34.0%) had emergency surgery. For patients with decompensated mental illness, only 228 (0.7%) had elective whilst 425 (2.6%) had emergency surgery. Their outcomes for this surgery type included being triaged significantly higher (Cat 1 or 2, 34% vs. 15%) and longer ED stays (8.3 vs. 6.6 h). They also had significantly more post-operative complications (26% vs. 8%) and total days in hospital (33.8 vs. 8.5 days). There was no significant difference for in-hospital mortality. Patients with mental illness are significantly more likely to have emergency surgery including presenting to the ED with more acute physical illness and to experience worse surgical outcomes compared to other surgical patients for every measure analyzed except mortality. There is considerable opportunity to further investigate how these differences might be improved.

The Influence of Infection Control Knowledge, Emergency Nursing Competency, and Infection Prevention Environment on Burnout among Psychiatric Nurses Caring for Patients with COVID-19

Purpose: Psychiatric nurses lack experience caring for patients with acute physical illnesses. Notably, they are expected to have experienced burnout when they were taking care of mentally ill patients infected with COVID-19. This study aimed to determine the impact of infection control knowledge, emergency nursing competency, and infection prevention environment on burnout.Methods: This survey was conducted on 127 psychiatric nurses from February to March 2023 using a structured self-report questionnaire. The collected data were analyzed through multiple regression analysis using the SPSS 28.0 program.Results: The subject's burnout score was 2.83 out of 5, infection control knowledge was 0.69 out of 1, emergency nursing competency was 2.80 out of 4, and infection prevention environment was 3.83 out of 5. Regression analysis showed infection control knowledge (β=-.17, <i>p</i>=.048) and nurses’ self-perceived efficacy in responding to an emergency (β=.26, <i>p</i>=.002) were factors affecting burnout, and the explanatory power for burnout was 9% (F=7.22, <i>p</i><.001).Conclusion: Based on these results, we believe that infection control is needed. In addition, rather than simply providing education to increase nurses' emergency nursing competence, educational measures are needed to increase nurses' sense of efficacy in responding to emergencies.

Extraction of effective cycles on reducing patients’ depression in the design of treatment spaces

PurposeThe most common reaction to an acute physical illness is anxiety, which may be followed by depression. In patients with chronic diseases, the prevalence of anxiety disorders and depression is almost twice as high as in other diseases. This study aims to extract prominent components in the design of treatment spaces on reducing hospitalized patients’ depression from both experts and patients/users’ point of views. A final model is also presented based on the findings.Design/methodology/approachThis research used an exploratory mixed method. The effective components were extracted through the administration of two Likert-scale researcher-made questionnaires in two phases. Q factor analysis was conducted to reach the components. A total of 205 patients were admitted to Namazi Hospital in Shiraz, and 20 architecture and psychology experts participated in the survey. Final modeling of the data was done through path analysis.FindingsSix factors were found to be effective by experts in reducing depression in therapeutic spaces: nature-oriented space, targeted social space, diverse space, visual comfort, logical process and safe space. On the part of patients, seven components were deemed to be effective: visual perception, naturalism, functionalism, physical security, logical process, psychological safety and diversity. Also, four main cycles were extracted from the final model with the direct effect of diversity and the other five cycles were mediated by naturalism.Research limitations/implicationsA total of 15 interviews with architects and psychologists, who were available at the time of the study, were conducted in January 2018. The only general question during interviews was “In your opinion, what factors are effective in reducing the level of depression of patients in the design of treatment spaces?” This may have limited the range of factors that could be surveyed in the study. After collecting the effective factors from the aforementioned expert’s points of view, the questionnaire of experts was designed (Appendix). The expert questionnaires were distributed and edited in two stages in January 2019 among 20 architect experts who were available at the time of the study. The one-year interval between designing and administering the questionnaires occurred because of the limitations posed by the COVID-19 pandemic situation. However, the interval did not pose methodological obstacles for the study.Originality/valueEvidence-based investigation of the effectiveness of proper design components of therapeutic spaces in reducing the symptoms of patients with chronic secondary depression has received little attention in the literature. Using a “conceptual model,” the present study brought the issue into its focus so as to find effective components in the design of treatment spaces that can alleviate depression symptoms in chronically hospitalized patients.

Mesenchymal stem cell-derived exosomal miR-548x-3p inhibits pyroptosis of vascular endothelial cells through HMGB1 in heat stroke

Heat stroke (HS) is an acute physical illness associated with a higher risk of organ dysfunction. This study is the first to explore exosomal miR-548x-3p derived from human bone marrow mesenchymal stem cells (BMSCs) in the pyroptosis of vascular endothelial cells (VECs) associated with HS. Human BMSCs-derived exosome alleviated the injury of the heart, liver, kidney and ileum tissues, the increase of IL-1β, IL-18 and TNF-α levels, pyroptosis of endothelial cells and the increase of HGMB1, NLRP3, ASC, caspase1 and GSDMD-N protein expression in HS mice and HS-induced human umbilical vein endothelial cells (HUVECs). miR-548x-3p was down-expressed in HS patients, while up-expressed in BMSCs-derived exosome. BMSCs-ExomiR-548x-3p mimics to inhibit pyroptosis, inflammation and HGMB1/NLRP3 activation in HS-induced HUVECs and HS mice, which were blocked by overexpression of HMGB1. In conclusion, human BMSCs-derived exosomes carried miR-548x-3p mimics to inhibit pyroptosis of VECs through HMGB1 in HS mice.

Acute illness symptoms among investment professionals and stock market dynamics: Evidence from New York City

In the U.S., stock market professionals (e.g., traders, portfolio managers, and analysts) are clustered in New York City (NYC). In view of this, I exploit daily changes in the incidence of acute illness symptoms among 18–64 year old New Yorkers to identify exogenous variation in the rate of acute illness among market professionals and estimate its causal impact on key stock market outcomes. A detailed analysis of taxi trips from a sample of financial institutions to local hospitals provides support for my identification assumption. Other things equal, increased rates of acute physical illness (i.e., reduced productivity) among market professionals hamper price discovery and lower trading activity, volatility, and returns. A one-standard-deviation increase in my illness incidence proxy reduces by 18% (6.7%) the immediate response of stock prices to earnings surprises (changes in analysts’ consensus recommendations) and increases by 29% (42%) their delayed response.

Do as I Say, Not as I Do: Resident Physicians’ Approach to Seeking Care During Times of Acute Physical Illness

INTRODUCTION: Surgeons must be healthy to perform surgery safely. Surgical residents may not seek appropriate care when acutely physically ill due to demands and workplace culture. This study aimed to understand delays in seeking care and use of informal care among surgical residents. METHODS: Cross-sectional multi-institutional survey of residents from nine geographically diverse US general surgery residencies that explored the topics of healthcare for physical illness, delay in care, and informal care (self-diagnosing or diagnosed/treated by colleagues) (Figure). Quantitative data were evaluated with summary statistics.FigureRESULTS: The response rate was 50% (232/460). Sixty-three percent (147/232) reported having delayed care for a physical condition since starting residency. The most common reason for delaying care was not wanting to create more work for colleagues, which was reported by 72% (106/147). The most common consequence of delaying care was declining work quality in 27% (39/147), while 18% (26/147) reported having an emergency procedure that could have been avoided. Overall, 62% (144/232) reported having self-diagnosed/self-treated a physical illness while 60% (140/232) reported asking for informal care from a colleague. Of the informal care accessed, 44% (63/144) reported self-prescribing prescription medications while 44% (61/144) asked for a colleague to do so. CONCLUSION: Most surgical residents have delayed seeking care for an acute physical illness during residency. This negatively impacts residents’ health and work quality and is attributed to workload and workplace culture. Not surprisingly, residents access informal care frequently. Structural and cultural change are needed to ensure the physical well-being of surgical residents.

The psychometric properties of the of the Persian version of the Screen for adult anxiety related disorders (SCAARED) in patients with anxiety disorders

BackgroundThe aim of this study was to investigate the psychometric properties of the Persian version of the Screen for adult anxiety related disorders (SCAARED) in Tehran.MethodThe present study was a descriptive‐survey method and a cross‐sectional method. The present research population consists of patients referring to hospitals and psychiatric clinics in Tehran, as well as male and female students in Tehran. The sample of the present study included 300 participants (150 patients with a diagnosis of anxiety disorders and 150 non‐clinical samples), who were selected by random sampling method. Inclusion criteria included age 18 to 50, minimum diploma, lack of mental retardation, and lack of acute physical illnesses such as cancer or severe pain. The participants, after completing the demographic questionnaire and conducting a Structured Clinical Interview for DSM‐5 Disorders–Clinical Version (SCID‐5‐CV), completed the SCAARED and the Personal Wellbeing Index—Adults (PWI‐A). Finally, face and content validity and construct validity, test–retest reliability, Cronbach's alpha, and factor analysis were used.ResultsThe results of the present study confirmed the face validity and content of the present scale. A review of Cronbach's standardized alpha showed that SCAARED has a reliability of 0.966, and therefore, the Persian version of these questionnaires is a reliable tool. Also, the results showed a correlation between the two implementations of the questionnaire; in addition to the strong correlation at the level (p < .01) between the factors of the questionnaire and the factors with the total score, there was a strong correlation between the first and second implementation in four factors and the overall score. Therefore, it can be concluded that the SCAARED has good test–retest reliability. Also, there is a positive correlation between the factors and the overall score of the SCAARED with anxiety disorders based on Structured Clinical Interview for DSM‐5 Disorders (p < .01), which indicates the favorable convergent validity of the SCAARED questionnaire. There is a negative correlation between the factors and the overall score of the SCAARED with the PWI‐A at the level (p < .01), which indicates the favorable divergent validity of the SCAARED, and the results of exploratory factor analysis of the questionnaire were confirmed.ConclusionThe Persian version of the SCAARED is a tool with appropriate validity and reliability.

The association of physical illness and low-grade inflammatory markers with depressive symptoms in a large NHANES community sample: Dissecting mediating and moderating effects

BackgroundBoth low-grade elevation in peripheral inflammatory markers (e.g., white blood count (WBC) and C-reactive protein (CRP)) and physical illness (both chronic and acute) have been associated with depressive symptomology. However, it is unclear if low-grade elevation in inflammatory markers mediates relationships between physical illness and depression or if physical illness positively moderates relationships between inflammatory markers and depression. MethodsIn a well-powered, racially diverse cohort (n = 21,525) from NHANES datasets, we examined if inflammatory markers (CRP and WBC) and physical illnesses (acute and chronic) were independently associated with depression severity. We also examined if associations between physical illness and depression severity were mediated by inflammatory markers and if physical illness moderated associations between inflammatory markers and depression. ResultsWe found that both inflammatory markers and physical illness were associated with depression severity, even after considering a wide range of potential confounders (e.g., age, gender, body mass index). Inflammatory markers mediated a marginal portion (<5%; p < 0.001) of potential effects of physical illness on depression severity. In moderation analyses, associations between inflammatory markers and depression severity were significantly stronger in participants with chronic physical illness than those without. This moderating effect was not present for acute physical illness. ConclusionsInflammatory markers and physical illness appear independently linked to depression severity and, in individuals with chronic physical illness, inflammatory markers are more tightly connected to depressive symptomology. Such findings could help guide future individualized treatment research for depression based on both inflammatory marker level and physical illness burden.

Education based on the health belief model to improve the level of physical activity.

[Purpose] This study aimed to investigate the effect of education based on the health belief model on the physical activity of the staff of the University of Medical Sciences.[Methods] This semi-experimental study was conducted on 130 university staff aged 25-50 years from the Hamadan University of Medical Sciences. Inclusion criteria were having at least 1 year of work experience, lack of acute and chronic physical and mental illnesses, and not using drugs that affect physical activity. The samples were randomly divided into two groups. The experimental group received three training sessions based on the health belief model. Before and 2 months after training, the control and experimental groups were evaluated via the following questionnaires: (1) demographic information questionnaire, (2) Health Belief Model Questionnaire, and (3) International Physical Activity Questionnaire. Finally, data were analyzed statistically.[Results] The training process resulted in a significant increase in the mean scores of the health belief model constructs in the experimental group, but changes in the control group were not significant. Self-efficacy was the strongest predictor of physical activity.[Conclusion] The health belief model is a useful model for improving individuals' understanding of the benefits of physical activity.

Type of Stressor and Medium-Term Outcomes After Takotsubo Syndrome: What Becomes of the Broken Hearted? (ANZACS-QI 59)

Takotsubo syndrome (TS) is often triggered by an acute physical or emotional stressor. We hypothesised that medium-term prognosis may be better for TS patients with an associated emotional stressor than for those with an acute physical illness. We identified consecutive TS patients presenting in New Zealand (2006-2018). The clinical presentation and outcomes of TS patients according to types of stressor (physical, emotional or no stressor) were assessed. Post-discharge survival after TS was compared with age- and gender-matched patients after myocardial infarction (MI) and people in the community without known cardiovascular disease (CVD). Of 632 TS patients (95.9% women, mean age 65.0±11.1 years), 27.4% had an associated acute physical stressor, 46.4% an emotional stressor and 26.2% no evident stressor. In-hospital mortality was similar for each group (1.7%, 1.2%, 0.3% respectively, p=0.29). In a median 4.4 years post-discharge there were 54 deaths (53 non-cardiac). Compared with patients without known CVD, TS patients with physical stress and those with MI were less likely to survive (HR 4.46, 95%CI 3.10-6.42; HR 4.23, 95%CI 3.81-4.70 respectively) but survival for TS patients associated with emotional stress or no stressor was similar (HR 1.11, 95%CI 0.66-1.85; HR 1.08, 95%CI 0.54-2.18, respectively). Recurrence was similar among the three groups (p=0.14). Takotsubo syndrome associated with physical stressor has a post-discharge mortality risk as high as after MI. In contrast, prognosis for TS triggered by an emotional stressor is excellent, and similar to that of those without known CVD.

Associations between breastfeeding and cognitive function in children from early childhood to school age: a prospective birth cohort study

BackgroundDespite evidences of breastfeeding for preventing acute physical illnesses in infants, the evidence for the association between breastfeeding and long-term cognitive development is not yet convincing.MethodsThe data of nationwide representative sample of 1752 children born between 2008 and 2009 in Korea were prospectively assessed from the fetal period to examine the benefits of breastfeeding and cognitive development. Breastfeeding duration was prospectively assessed by parents. The Korean Ages and Stages Questionnaire and the Korean version of Denver II were used to assess early development annually from 5.5 to 26.2 months of age. Language development at 3 years of age was assessed with Receptive and Expressive Vocabulary Tests. Cognitive function at 8 years of age was assessed using multifactorial intelligence test.ResultsIn the analysis of categorical variables, children who were breastfed for > 1 and ≤ 3 months displayed significantly higher odds ratios for delayed development assessed with Korean Ages and Stages Questionnaire at 14.1 months than those breastfed for > 3 and ≤ 6 months (OR = 2.21; 95% CI: 1.08, 4.50), but no significant differences in other rounds of assessments. In the analysis with continuous variables, there were significant differences among six groups of breastfeeding duration in communication (F = 3.72; p < 0.002) and problem solving (F = 3.09; p < 0.009) at 14.1 months, expressive language (F = 3.74; p = 0.002) at 3 years, and calculation (F = 2.43; p < 0.033) at 8 years. When analyzed by two groups, children breastfed for > 3 months scored significantly higher on the communication (F = 17.71; p < 0.001) and problem-solving (F = 11.26; p < 0.001) subscales at 14.1 months, and expressive language (F = 12.85; p < 0.001) at 3 years, and vocabulary (F = 6.78; p = 0.009) and language inference (F = 5.62; p = 0.018) at 8 years, compared to children breastfed for 3 months or less.ConclusionWe found that cognitive development was improved in children that were breastfed for > 3 months. Although these results are supported by previous studies, it is important to note that other factors were reported as larger determinants of cognitive development than breastfeeding. Future studies that examine the underlying mechanism for the association between breastfeeding and cognitive development are warranted.

Excess mortality and risk factors for mortality among patients with severe mental disorders receiving home care case management

Aim Home care case management (CM) is the main intervention for patients with severe mental disorders (SMDs) requiring outreach care. This study investigated the long-term mortality outcome and associated risk factors in patients who received home care CM. Methods This nationwide study enrolled patients who received home care CM (n = 10,255) between 1 January 1999 and 31 December 2010. Each patient was followed up from the baseline (when patients underwent home case CM for the first time during the study period) to the censor (i.e. mortality or the end of the study). We calculated the standardized mortality ratio (SMR) and presented by age and diagnosis. Multivariate regression was performed to assess independent risk factors for mortality. Results Among 10,255 patients who received home care CM, 1409 died during the study period; the overall SMR was 3.13. Specifically, patients with organic mental disorder had the highest SMR (4.98), followed by those with schizophrenia (3.89), major depression (2.98), and bipolar disorder (1.97). In the multivariate analysis, patients with organic mental disorder or dementia had the highest risk, whereas the mortality risk in patients with schizophrenia was comparable to that in patients with bipolar disorder or major depression. Deceased patients had a significantly higher proportion of acute or chronic physical illnesses, including cancer, chronic hepatic disease, pneumonia, diabetes mellitus, cardiovascular disease, and asthma. Conclusion This study presented the gap of mortality in patients with SMDs receiving home care CM in Taiwan. We highlight the need for effective strategies to improve medical care for this specified population.

Effects of conflict, displacement, and migration on the health of refugee and conflict-stricken populations in the Middle East

&lt;p dir="ltr"&gt;The global refugee crisis has reached an all-time high, with over 68 million innocent people forced to flee their homes due to violence, famine, governmental instability, or genocide. As a result of the struggles and traumas encountered by war and migration, millions of refugees suffer from acute and life-threatening physical and mental health illnesses. However, these diseases and internal-battles are often overlooked, leaving most conflict-stricken countries and refugee camps ill-equipped and unable to cope. Rather than settling into more humane and healthy living conditions, upon migration, most refugees are faced with realities that deny them &lt;br /&gt; a dignified and fulfilling life. More often than not, refugee camps and host countries accommodate a deplorable lifestyle that provides minimal and inadequate health-care, extreme and life-threatening poverty, and inhumane and unsanitary living conditions-exasperating the rate and risk of morbidity and mortality amongst refugee populations. This research paper aims to analyze the harsh conditions that refugees and conflict-stricken populations are currently forced to endure, as well as the effects of those conditions on the spread of communicable and non-communicable diseases, &lt;br /&gt; the development and growth of neonatal disorders, and the overall rise in mental illness. The paper also aims to suggest specific measures that can be taken in order to prevent the increase in morbidity and mortality rates amongst vulnerable refugee populations and recommend steps that international bodies and non-governmental organizations can take in order to solve the refugee health crisis.&lt;/p&gt;

Human trafficking education for nurse practitioners: Integration into standard curriculum

BackgroundHuman trafficking is a crime resulting in serious negative health outcomes for the victims. To provide optimal care, thus improving health outcomes, healthcare providers must be able to identify victims as they seek care for acute and chronic physical illness, communicable diseases, sexually transmitted infections, and mental health disorders (Lederer and Wetzel, 2014; Oram et al., 2012). Unfortunately, healthcare providers lack appropriate knowledge of clues that would lead to victim identification. This may result in a failure to identify victims (Beck et al., 2015; Ross et al., 2015; Konstantopoulos et al., 2013; Chisolm-Straker et al., 2012). Increasing the number of healthcare providers able to identify, treat, and refer victims of trafficking for further care is imperative. ObjectivesThe study evaluated the knowledge level of student nurse practitioners enrolled in an adult, family, or pediatric clinical course. Knowledge domains included the definitions, laws, prevalence, identification, treatment, and community and social service resources. Design/Setting/ParticipantsThe study was designed as a non-probability sampling of adult, family, and pediatric nurse practitioner students (n=73). Participants included students enrolled in the Adult & Older Adult I or the Primary Care of the Child & Adolescent I course at a large public university. MethodsThe study was designed as a one hour educational intervention intended for presentation in a lecture-style format. The educational intervention included a PowerPoint lecture and embedded videos. The pre-survey, designed as a paper survey, contained a demographic section followed by six survey questions covering the six domains of interest. Following the intervention, participants completed the post-survey prior to leaving the classroom. ResultsPre-survey results pinpointed knowledge gaps across all six domains under investigation. Post-survey results revealed an increase in knowledge across all six domains of interest. ConclusionsThe educational intervention increased knowledge of human trafficking among students enrolled in a nurse practitioner program. Informed nurse practitioners have the ability to identify, treat, and refer victims of trafficking. As an integral part of the health care team, nurse practitioners should receive trafficking education as part of the standard course curricula.

Cognitive screening and behavioural observation of functional ability in patients with multiple episode schizophrenia: an exploratory study

ObjectivesTo evaluate the usability of a neuropsychological screening instrument and two observation scales of everyday behaviour to describe cognitive and functional capacity of patients with multiepisode schizophrenia and considerable care...

AIDE–Acute Illness and Depression in Elderly Patients. Cognitive Behavioral Group Psychotherapy in Geriatric Patients With Comorbid Depression: A Randomized, Controlled Trial

BackgroundComorbid depression is highly prevalent in geriatric patients and associated with functional loss, frequent hospital re-admissions, and a higher mortality rate. Cognitive behavioral psychotherapy (CBT) has shown to be effective in older depressive patients living in the community. To date, CBT has not been applied to older patients with acute physical illness and comorbid depression. ObjectivesTo evaluate the effectiveness of CBT in depressed geriatric patients, hospitalized for acute somatic illness. DesignRandomized controlled trial with waiting list control group. SettingPostdischarge intervention in a geriatric day clinic; follow-up evaluations at the patients’ homes. ParticipantsA total of 155 randomized patients, hospitalized for acute somatic illness, aged 82 ± 6 years and suffering from depression [Hospital Anxiety and Depression Scale (HADS) scores >7]. Exclusion criteria were dementia, delirium, and terminal state of medical illness. InterventionFifteen, weekly group sessions based on a CBT manual. Commencement of psychotherapy immediately after discharge in the intervention group and a 4-month waiting list interval with usual care in the control group. MeasurementsHADS depression total score after 4 months. Secondary endpoints were functional, cognitive, psychosocial and physical status, resource utilization, caregiver burden, and amount of contact with physician. ResultsThe intervention group improved significantly in depression scores (HADS baseline 18.8; after 4 months 11.4), whereas the control group deteriorated (HADS baseline 18.1; after 4 months 21.6). Significant improvement in the intervention group, but not in the control group, was observed for most secondary outcome parameters such as the Barthel and Karnofsky indexes. Intervention effects were less pronounced in patients with cognitive impairment or acute fractures. ConclusionsCBT is feasible and highly effective in geriatric patients. The benefits extend beyond effective recovery and include improvement in physical and functional parameters. Early diagnosis, good access to psychotherapy, and early intervention could improve care for depressive older patients. Clinical Trial Registrationwww.germanctr.de German Trial Register DRKS 00004728

Diagnoses Treated in Ambulatory Care Among Homeless-Experienced Veterans: Does Supported Housing Matter?

Little is known about how permanent supported housing influences ambulatory care received by homeless persons. To fill this gap, we compared diagnoses treated in VA Greater Los Angeles (VAGLA) ambulatory care between Veterans who are formerly homeless-now housed/case managed through VA Supported Housing ("VASH Veterans")-and currently homeless. We performed secondary database analyses of homeless-experienced Veterans (n = 3631) with VAGLA ambulatory care use from October 1, 2010 to September 30, 2011. We compared diagnoses treated-adjusting for demographics and need characteristics in regression analyses-between VASH Veterans (n = 1904) and currently homeless Veterans (n = 1727). On average, considering 26 studied diagnoses, VASH (vs currently homeless) Veterans received care for more (P < .05) diagnoses (mean = 2.9/1.7). Adjusting for demographics and need characteristics, VASH Veterans were more likely (P < .05) than currently homeless Veterans to receive treatment for diagnoses across categories: chronic physical illness, acute physical illness, mental illness, and substance use disorders. Specifically, VASH Veterans had 2.5, 1.7, 2.1, and 1.8 times greater odds of receiving treatment for at least 2 condition in these categories, respectively. Among participants treated for chronic illnesses, adjusting for predisposing and need characteristics, VASH (vs currently homeless) Veterans were 9%, 8%, and 11% more likely to have 2 or more visits for chronic physical illnesses, mental illnesses, and substance use disorder, respectively. Among homeless-experienced Veterans, permanent supported housing may reduce disparities in the treatment of diagnoses commonly seen in ambulatory care.

Study of Delerium and Its Subtypes in Medically Ill Hospitalised Patients

Introduction A multitude of terms are used to describe delirium, including encephalopathy, acute brain failure, acute confusional state and post-operative or intensive care unit psychosis, essentially it is defined as a relatively acute decline in cognitions that fluctuates over hours or days. There are two broad clinical categories have been described -hyperactive and hypoactive subtypes;that are based on differential psycho-motor features. A possible neuro-inflammatory basis for delirium is emerging and low levels of IGF-1 have recently been found as a risk factor for delirium. Acute phase reactant C-RP has been used as a marker of inflammation may also be implicated in the cause and outcome of delirium. Aims and Objectives 1) To study the prevalence of various subtypes of delirium in medically ill hospitalised patients. 2) To test C-RP as predictor of delirium and recovery from delirium as part of preliminary observational study. Methodology This is a cross-sectional study of descriptive and explorative design conducted at JSS Hospital, Mysore. A total of 113 patients were taken for the study and Patients who were admitted to ICU were assessed within 3 days of admission with 1) A standard bedside test of cognitive function, the MMSE(Mini Mental State Examination) 2) The Confusion Assessment Method(CAM) to determine the presence or absence of delirium. 3) The acute physiological score of APACHE-2,to measure the severity of acute physical illness. 4) Delirium Rating Scale. 5) C-RP was measured routinely along with other routine ICU investigations in all acute admissions. Results of the study The study is still being done in the hospital. Hence, the results will be presented during oral presentation in the conference.