Chronic Medical Diseases Research Articles

Study of Life Events and Quality of Life in Patients of Major Depressive Disorder

Abstract Background: Depression is one of the most common mental illnesses found across all ages, genders and socioeconomic status. It has significant health, psychosocial, and economic impact. It is worse than many chronic medical diseases and has a negative effect on quality of life which persists even after remission. Objectives: The aim of this research was to study the relationship of major depressive disorder with quality of life and stressful life events in adults. Materials and Methods: This was a cross-sectional study wherein purposive sampling method was employed. Patients from psychiatry outpatient department who fulfilled the criteria for major depressive disorder and belonging to the age range of 18–75 years were shortlisted and requested to participate in the study. After taking informed consent, data on quality of life, enjoyment and satisfaction, stressful life events and severity of depression were gathered using questionnaires and a semi structured interview. Results: Severity of depression was found to be negatively correlated with quality of life, enjoyment and satisfaction P = 0.001 level of significance. There were no significant correlations between severity of depression and stressful life events. Pearson’s Chi-square indicated that the severity of depression has a significant association with highest educational qualification, occupation, marital status, and socioeconomic status. Conclusion: Measuring and keeping track of quality of life through self-report levels is important in improving depressive disorders and should be integral part of management. Other steps comprise of starting early treatment, ensuring treatment adherence, reducing severity, and reducing relapse. Psychosocial interventions should also be taken into consideration.

Prevelance and risk factors of female sexual dysfunction in females attending infertility clinic at Kasr Alainy hospital: a cross-sectional descriptive study

Background: Female sexual dysfunction (FSD) is a common health problem that is inadequately investigated in Egypt. Sexual problems are reported by approximately 40 percent of females worldwide. There is a strong relationship between FSD, quality of life and infertility. Objective: The aim of this study is to assess the prevalence of female sexual dysfunction and also to investigate possible risk factors that may cause sexual dysfunction in the Egyptian infertile women seeking fertility Patients and Methods: This cross-sectional clinic-based survey was conducted at the infertility clinic, in Kasr Al-Ainy Hospital, Cairo, Egypt from October 2023 to February 2024. During this study, 186 women were enrolled and asked to answer the validated Arabic version of the Female Sexual Function Index and World Health Organization Quality of Life Questionnaire- Brief that were provided by female investigators. Results: 186 females were included in our study. The prevalence of FSD was 56 females (30.1%) while 130 females (69.9%) had good sexual function with FSFI >28.1. Also, patients with sexual dysfunction had mean value of QoL that was (38.5±8.7) while females with good sexual function had mean value of QoL that (64.2±11.2) respectively. We found that the most frequent risk factors of female sexual dysfunction were advanced maternal and paternal age, no maternal occupation, duration of marriage <5 years, nulliparous women ,maternal obesity, timed intercourse and number of IVF trials. On the other hand, no relations were reported between female sexual dysfunction and family income, residence, menstrual Rhythm, associated chronic medical diseases, drug intake, contraception, vaginitis, mode of delivery, circumcision and previous episiotomy. Conclusion: FSD is a major health problem that affect 30.1% of women attending infertility outpatient clinic in Kasr Alainy Hospital and greatly affected their quality of life.

Testosterone replacement therapy in patients with cachexia: a contemporary review of the literature.

Patients with long-term chronic illnesses frequently present with hypogonadism, which is primarily managed through exogenous testosterone. These same patients also experience a high degree of cachexia, a loss of skeletal muscle and adipose tissue. To perform a contemporary review of the literature to assess the effectiveness of testosterone replacement therapy (TRT) for managing chronic disease-associated cachexia. We performed a PubMed literature search using MeSH terms to identify studies from 2000 to 2022 on TRT and the following cachexia-related chronic medical diseases: cancer, COPD, HIV/AIDS, and liver cirrhosis. From the literature, 11 primary studies and 1 meta-analysis were selected. Among these studies, 3 evaluated TRT on cancer-associated cachexia, 3 on chronic obstructive pulmonary disease, 4 on HIV and AIDS, and 2 on liver cirrhosis. TRT showed mixed results favoring clinical improvement on each disease. Cachexia is commonly observed in chronic disease states. Its occurrence with hypogonadism, alongside the shared symptoms of these 2 conditions, points toward the management of cachexia through the administration of exogenous testosterone. Robust data in the literature support the use of testosterone in increasing lean body mass, improving energy levels, and enhancing the quality of life for patients with chronic disease. However, the data are variable, and further studies are warranted on the long-term efficacy of TRT in patients with cachexia.

Depression and its associated factors among adult hypertensive patients attending follow-up in South Gondar zone public hospitals, Ethiopia, 2023

IntroductionDepression is the most common public health issue affecting the world's population. Like patients with other chronic medical diseases, hypertensive patients experience many intense emotions which increase their risk for the development of depression. This study aimed to assess the magnitude of depression and its associated factors among hypertensive patients in South Gondar zone governmental hospitals, Northwest Ethiopia, 2023.MethodsAn institutional-based cross-sectional study was used in government hospitals of South Gondar Zone. A total of 311 patients were sampled randomly and included in the study. Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Data were analyzed mainly by using descriptive statistics and binary logistics regression.ResultsA total of 311 patients participated with a 100% response rate. Almost half of the participants were female. The mean age of the respondents was 58.85 years. More than 60% of the respondents had a co-morbid illness. Among participants, 83 (26.7%) of hypertensive patients had depression. Being female, age, uneducated, having poor social support, the presence of co-morbid illness and complications, uncontrolled hypertension, having less than or equal to two dietary regimen and duration of hypertension greater than ten years were significantly associated with depression.ConclusionThe magnitude of depression was found to be high. This indicated that depression is a common co-morbid illness among hypertensive patients. Healthcare professionals and other stakeholders should consider and diagnose co-morbid diseases like depression among hypertensive patients. It is also better to give particular emphasis to highly vulnerable groups like females, elders, uneducated and those who have poor social support.

Prevalence, Risk Factors, and Impact on Quality of Life Due to Urinary Incontinence Among Palestinian Women: A Cross-Sectional Study.

Urinary incontinence (UI) is a common condition that affects females with variable incidence. Factors like age, obesity, weak pelvic floor, and pregnancy contribute to UI pathogenesis. Our study aimed to determine the prevalence of UI and identify associated risk factors. A cross-sectional study recruited females aged 18-65 attending primary health care (PHC) centers. The collected data included demographic information and questionnaire scores for urinary incontinence diagnosis (QUID), International Consultation on Incontinence Questionnaire-Urinary Incontinence (ICIQ-UI), and Incontinence Impact Questionnaire-Short Form (IIQ-7) scores. Three hundred and eleven females met our inclusion criteria, with 162 (52.1%) participants aged ≥ 42 years. Approximately 41.5% were college/university graduates, and 23.2% had an education level less than high school. Moreover, 108 (34.7%) participants were smokers, 223 (71.7%) drank coffee, and approximately 212 (68.2%) drank tea. Only 125 (40.2%) participants engaged in exercise at variable frequencies, and most of them exercised once per week. Approximately 27.3% of the participants had chronic medical illness with hypertension or diabetes mellitus (40 (12.9%) or 25 (8%), respectively). Stress urinary incontinence (SUI) was found among 152 (48.9%) participants, while urgency urinary incontinence (UUI) was found among 114 (36.7%) participants. Age ≥ 42, marital status, low educational level, unemployment, lack of physical activity, and chronic medical illnesses were significantly correlated with both SUI and UUI. There was a strong correlation between UI and the severity of symptoms and between UI and quality of life (QoL). The prevalence of UI is relatively high among Palestinian women. Many factors contributing to UI included age, marital status, the presence of other chronic medical diseases, and a lack of physical activity. Early detection and diagnosis are necessary to provide effective treatment and improve UI symptoms and QoL.

Subclinical Hypothyroidism as a Possible Cause of Herpes Zoster Reactivation

Background: Hypothyroidism was considered as a predisposing factor for herpes zoster (HZ) infection. Thus, Thyroxine deficiency may be a risk factor for varicella zoster virus reactivation. The aim of this study was to test if thyroid hormone supplementation will ameliorate the clinical course of HZ infection.
 Methodology: This was a prospective cohort conducted on 60 herpes zoster infected patients, who had a subclinical hypothyroidism. Serum TSH and FT4 measurements were made by using electrochemiluminescence immunoassay. All patients were divided into two groups. Group A included 30 patients who were treated with Eltroxin 25 µg daily for 3 months. Group B included 30 patients who took placebo. All were submitted to cutaneous examination (e.g., rash and new lesions). Any complications were documented. Pain was assessed before and after treatment, and any pain-controlling medications were registered. The primary endpoints were time to achieve complete pain cessation, time to cessation of the formation of the new lesions, and time to > 50% crusting/healed lesions. Secondary outcome included time to 100% crusting/healed lesions, time to complete absence of moderate to excruciating pain, time to first pain-free period, and time to absence of abnormal sensations.
 Results: Both groups were comparable regarding patient age, gender, chronic medical diseases, and characteristics of herpes zoster rash. Ophthalmic zoster was reported in 6.7% and 10% of groups A and B respectively. However, group A (Eltroxin supported) had much better and rapid and rash healing of pain than group B. Finally, zoster-related complications were significantly lower in group A than group B.
 Conclusions: Subclinical hypothyroidism is associated with HZ reactivation process, so hypothyroid medical treatments are effective in this case.

Nudging towards COVID-19 and influenza vaccination uptake in medically at-risk children: EPIC study protocol of randomised controlled trials in Australian paediatric outpatient clinics

IntroductionChildren with chronic medical diseases are at an unacceptable risk of hospitalisation and death from influenza and SARS-CoV-2 infections. Over the past two decades, behavioural scientists have learnt how to...

Health-care Utilisation among Elderly People with Chronic Medical Conditions in a Secondary Health-care Center, Southwestern Nigeria

Abstract Background: The elderly population of the world is projected to continue to increase. There is an anticipated increase in the utilisation of health-care services due to chronic diseases and other impairments with resulting pressure on health systems. Aims: This study aimed to determine the health-care utilisation of elderly patients with chronic medical diseases attending a secondary health facility in southwestern Nigeria. Materials and Methods A structured questionnaire was administered to gather the data from 300 older people by random sampling during follow-up care for those receiving care for more than 6 months following a diagnosis of a chronic disease. SPSS software version 26 was used for the data analysis, and the results are presented in the tables. The Chi-square test was applied to test for associations between the categorical variables, and a logistic regression model was used to rule out confounders, while P < 0.05 was considered to indicate statistical significance. Results: The mean age (standard deviation) in the study was 68.26 (7.01) years and 58.3% were females. The average number of routine clinic visits was 4.12, whereas 20.7% had emergency room visits, 6.6% were referred to specialists, and 33.3% had laboratory investigations. After logistic regression was applied, living conditions, average monthly income, and treatment for diabetes were found to be significant factors for the utilisation of care. Conclusion: The provision of rich social support, improving economic empowerment, and performing screening and timely management for diabetes will improve preventive care while reducing the use of expensive and specialised care for older people.

Immediate Loading of Implants with Fixed Rehabilitations in Geriatric Edentulous Patients; Biological Complications.

This study aimed to report the outcomes of the immediate loading of implants with fixed rehabilitations in edentulous geriatric patients. Edentulous geriatric patients were diagnosed with an oral examination, radiographic evaluation, and intermaxillary relations and treated with fixed rehabilitation over several implants. After immediate surgery, the implants were immediately loaded with a fully fixed prosthesis. Twenty-four patients (20 females and 4 males) were treated using a total 210 implants. All patients (100%) had a previous history of periodontitis. Eleven patients (45.8%) were smokers. Eleven patients (45.8%) suffered from chronic medical diseases (i.e., diabetes, cardiovascular diseases). The study's clinical follow-up period extended for three years, during which thirty-three fixed prostheses were installed over the implants in 24 patients. The average marginal bone loss measured was 1.33 ± 0.17 mm. The success rate of the implants and prosthodontics being placed in this study yielded 98.5% and 97%, respectively. One patient (4.2%) showed some kind of technical complications. Eleven patients (45.8%) showed mucositis, and 25 implants (11.9%) in 10 patients (41.7%) were associated with peri-implantitis. This study shows that the treatment of edentulous geriatric patients by immediate loading of implants with fixed rehabilitations is a clinically successful protocol but with a high prevalence of peri-implant diseases.

Use of Remote Physiologic and Therapeutic Monitoring Following Total Knee Arthroplasty.

Remote physiologic monitoring (RPM), or remote therapeutic monitoring (RTM), has grown exponentially for the management of chronic medical diseases in Medicare patients. More recently, the application of this technology has ventured into the orthopaedic arena, and more specifically, for total joint arthroplasty. Platforms to expedite this monitoring can provide continuous biodata feedback on digital biomarkers to patients and surgeons, which can potentially help improve and create novel patient-specific recovery pathways. Furthermore, various devices developed for this monitoring might help obviate the need for frequent emergency room visits, readmissions, and prolonged outpatient physical therapy sessions, as well as reduce complications and increase patient satisfaction scores after total joint arthroplasty surgery. However, while there are a number of potential benefits to technology for this type of care, its application following total knee arthroplasty has not been well-studied. Therefore, after an overview of the usage of RPM and RTM, the purpose of this study was to review the current literature regarding three common remote monitoring technologies: 1) smartphone apps; 2) wearables; and 3) combined smartphone apps and wearables. We also considered the potential financial implications of remote physiologic monitoring. A comprehensive search of the PubMed, Cochrane Library, MedLine, and Web of Science databases was performed. Three main subgroups of monitoring devices were included for analysis: smartphone apps, wearable devices, and combined wearable plus smartphone app platforms. Searches focused on remote physiologic monitoring, patient-specific advantages, financial advantages, billing and coding options, as well as overall efficacy of platforms. The current review found smartphone apps, wearables, and combined smartphone app and wearable platform technologies to be advantageous in the postoperative period following total knee arthroplasty. The wearable components can provide highly accurate and reproducible data, which the user-friendly smartphone app can relay to the patient so they can easily understand their progress. Additionally, through the apps, patients can directly access their surgical team. By constantly collecting and evaluating range of motion and functional data, the surgical team can identify if the patient is appropriately progressing through treatment or if further intervention is warranted. The incorporation of the remote physiologic monitoring devices during the post-total knee arthroplasty period shows strong promise as a progress-tracking modality. Published benefits include reduced physical therapy visits, decreased pain scores and reliance on opioids, increased activity levels as assessed by step counts, increased ability to follow less well-performing patients, reduced readmissions, reduced in-person clinic visits, and decreased postoperative costs.

Risk of Mortality Associated with Preexisting Chronic Diseases and Prior Year Diagnosis of a Mental Disorder in Survivors of a First Myocardial Infarction or Stroke

Background: Chronic medical diseases and recurrent mental disorders are common and may lead to a negative prognosis in adults with cardiovascular diseases (CVDs). The impact of these overlapping morbidities is likely to be further increased in the critical years following a first acute CVD event such as a stroke or myocardial infarction (MI). Objectives: The objective of this study was to examine associations of preexisting chronic diseases and recent mental disorders with mortality in survivors of a first MI or stroke. Methods: Data from the 48,526 patients (59% men) aged ≥40 years with a first MI or stroke were extracted from the Quebec Integrated Chronic Disease Surveillance System. Cox regression models were used to assess the effect of preexisting cancer, renal disease, diabetes, chronic obstructive pulmonary disease (COPD), and recent mental disorders on the risk of recurrent fatal CVD events and all-cause mortality following the index MI or stroke. Results: An increased risk of CVD mortality was observed at 1, 3, and 4.5 years in women and men with coexisting mental disorders and at 4.5 years in those with chronic, preexisting renal disease. Inversely, cancer and COPD were associated with a lowered risk of CVD mortality during the study period. An increased risk of all-cause mortality at all time points was observed in adults with any of the assessed conditions. Conclusions: Adults with coexisting mental disorders are at increased risk of CVD mortality and all-cause mortality in the years following a first MI or stroke. This increased vulnerability is separate from the extra mortality attributable to preexisting chronic diseases.

Increasing access to specialist care with group medical visits: summary of a pilot in a post-crisis psychiatric clinic.

Group medical visits (GMVs) have strong evidence of acceptability and effectiveness in the management of chronic medical diseases. Adaptation of GMVs for psychiatric care has potential to increase access, decrease stigma and save costs. Despite promise, this model has not been widely adopted. A novel GMV pilot was implemented for psychiatric care post-crisis among patients with primary mood or anxiety disorders who required medication management. Participants filled out PHQ-9 and GAD-7 scales at each visit in order to track their progress. After discharge, charts were reviewed for demographics, medication changes and symptom changes. Patient characteristics were compared between those who attended and those who didn't. Changes in total PHQ-9 and GAD-7 scores among attendees were assessed with paired t-tests. Forty-eight patients were enrolled between October 2017 and the end of December 2018, 41 of whom consented to participate. Of those, 10 did not attend, 8 attended but did not complete, and 23 completed. Baseline PHQ-9 and GAD-7 scores did not differ significantly between groups. Significant and meaningful reductions in PHQ-9 and GAD-7 scores from baseline to last visit attended occurred among those who attended at least 1 visit (decrease of 5.13 and 5.26 points, respectively). This GMV pilot demonstrated feasibility of the model as well as positive outcomes for patients recruited in a post-crisis setting. This model has the potential to increase access to psychiatric care in the face of limited resources, however the failure of the pilot to sustain highlights challenges to be addressed in future pivots.

Omega-3 polyunsaturated fatty acids (n-3 PUFAs), somatic and fatigue symptoms in cardiovascular diseases comorbid major depressive disorder (MDD): A randomized controlled trial

IntroductionCardiovascular diseases (CVDs) and major depressive disorder (MDD) are the two most disabling diseases. Patients with CVDs comorbid depression had somatic and fatigue symptoms and were associated with chronic inflammation and omega-3 polyunsaturated fatty acid (n-3 PUFA) deficits. However, there have been limited studies on the effects of n-3 PUFAs on somatic and fatigue symptoms in patients with CVDs comorbid MDD. MethodForty patients with CVDs comorbid MDD (58% males, mean age of 60 ± 9 years) were enrolled and randomised to receive either n-3 PUFAs (2 g of eicosapentaenoic acid [EPA] and 1 g of docosahexaenoic acid[DHA] per day) or placebo in a 12-week double-blind clinical trial. We assessed the somatic symptoms with Neurotoxicity Rating Scale (NRS) and fatigue symptoms with Fatigue Scale at baseline, weeks 1, 2, 4, 8 and 12, as well as blood levels of Brain-Derived Neurotrophic Factor (BDNF), inflammatory biomarkers and PUFAs, at the baseline and week 12. ResultsThe n-3 PUFAs group had a greater reduction in Fatigue scores than the placebo group at Week 4 (p =.042), while there were no differences in the changes of NRS scores. N-3 PUFAs group also had a greater increase in EPA (p =.001) and a greater decrease in total n-6 PUFAs (p =.030). Moreover, in the subgroup analyses in the younger age group (age < 55), the n-3 PUFAs group had a greater reduction on NRS total scores at Week 12 (p =.012) and NRS Somatic scores at Week 2 (p =.010), Week 8 (p =.027), Week 12 (p =.012) than the placebo group. In addition, the pre- and post-treatment changes of EPA and total n-3 PUFAs levels were negatively associated with the changes of NRS scores at Weeks 2, 4, and 8 (all p <.05), and the changes of BDNF levels were negatively associated with NRS scores at Weeks 8 and 12 (both p <.05) in the younger age group. In the older age group (age ≥ 55), there were a lesser reduction on NRS scores at Weeks 1, 2 and 4 (all p <.05), but a greater reduction on Fatigue score at Week 4 (p =.026), compared to the placebo group. There was no significant correlation between the changes of blood BDNF, inflammation, PUFAs and NRS and Fatigue scores in general and in the older age group. ConclusionOverall, n-3 PUFAs improved the fatigue symptoms in patients with CVDs comorbid MDD and the general somatic symptoms in specific subpopulation of younger age patients, and perhaps via the interplay between BDNF and EPA. Our findings provide promising rationales for future studies to investigate the treatment effects of omega-3 fatty acids on fatigue and somatic symptoms of chronic mental and medical diseases.

Association of Sleep-Disordered Breathing and Medial Temporal Lobe Atrophy in Cognitively Unimpaired Amyloid-Positive Older Adults.

Sleep disordered breathing (SDB) has been related to amyloid deposition and an increased dementia risk. However, how SDB relates to medial temporal lobe neurodegeneration and subsequent episodic memory impairment is unclear. Our objective was to investigate the impact of amyloid positivity on the associations between SDB severity, medial temporal lobe subregions, and episodic memory performance in cognitively unimpaired older adults. Data were acquired between 2016 and 2020 in the context of the Age-Well randomized controlled trial of the Medit-Aging European project. Participants older than 65 years who were free of neurologic, psychiatric, or chronic medical diseases were recruited from the community. They completed a neuropsychological evaluation, in-home polysomnography, a Florbetapir PET, and an MRI, including a specific high-resolution assessment of the medial temporal lobe and hippocampal subfields. Multiple linear regressions were conducted to test interactions between amyloid status and SDB severity on the volume of MTL subregions, controlling for age, sex, education, and the ApoE4 status. Secondary analyses aimed at investigating the links between SDB, MTL subregional atrophy, and episodic memory performance at baseline and at a mean follow-up of 20.66 months in the whole cohort and in subgroups stratified according to amyloid status. We included 122 cognitively intact community-dwelling older adults (mean age ± SD: 69.40 ± 3.85 years, 77 women, 26 Aβ+ individuals) in baseline analyses and 111 at follow-up. The apnea-hypopnea index interacted with entorhinal (β = -0.81, p < 0.001, pη2 = 0.19), whole hippocampal (β = -0.61, p < 0.001, pη2 = 0.10), subiculum (β = -0.56, p = 0.002, pη2 = 0.08), CA1 (β = -0.55, p = 0.002, pη2 = 0.08), and DG (β = -0.53, p = 0.003, pη2 = 0.08) volumes such that a higher sleep apnea severity was related to lower MTL subregion volumes in amyloid-positive individuals, but not in those who were amyloid negative. In the whole cohort, lower whole hippocampal (r = 0.27, p = 0.005) and CA1 (r = 0.28, p = 0.003) volumes at baseline were associated with worse episodic memory performance at follow-up. Overall, we showed that SDB was associated with MTL atrophy in cognitively asymptomatic older adults engaged in the Alzheimer continuum, which may increase the risk of developing memory impairment over time. ClinicalTrials.gov Identifier: NCT02977819.

(362) Testosterone Replacement Therapy for Management of Cachexia: A Review of Current Literature

Abstract Introduction Cachexia is a progressively debilitating loss of skeletal muscle often seen in late-stage chronic medical diseases, such as cancer, HIV/AIDS, chronic obstructive pulmonary disease (COPD), and liver cirrhosis. Cachexia contributes to mortality and morbidity with reduced quality-of-life (QoL) and disease treatment options, and can be associated with adult-onset hypogonadism (AOH), which is commonly treated with testosterone replacement therapy (TRT) in men. Objective This comprehensive review highlights the current literature on TRT for management of patients with chronic disease-associated cachexia, with an emphasis on clinical outcomes and side effects. Specifically, we identify and highlight relevant primary literature and reviews published since 2000 on TRT for management of patients with cancer, COPD, HIV/AIDS, and liver cirrhosis. Methods A comprehensive PubMed literature review was performed to identify articles published between 2000-2021 on TRT and cachexia-related chronic medical diseases (cancer, COPD, HIV/AIDS, and liver cirrhosis) to highlight the use of TRT for management of AOH in male patients with cachexia. The list of studies generated by the initial search was screened to identify eligible studies. Inclusion criteria included primary literature with clinical outcome measures related to changes in lean body mass, muscle mass, body composition, QoL, fatigue scores, and/or exercise scores, in addition to relevant meta-analyses. Results 12 studies were included in our review out of 653 initial search results (Table 1). In three studies of TRT in cancer patients, there were mixed results on the effects of TRT on QoL assessment. Across three studies of TRT in COPD patients, there was consistent improvement in exercise capacity and disease condition with TRT. Across four studies of TRT in HIV-infected men, TRT resulted in notable improvement in body weight, muscle mass, function, and QoL. Lastly, in two studies of TRT in patients with cirrhosis, testosterone therapy improved muscle strength and body composition across both cohorts. Conclusions Based on recent studies, there is robust data for the clinical benefits of TRT for the management of certain subgroups of cachexic patients, specifically those with COPD, HIV, and liver cirrhosis. Because of mixed results in cancer cachexia patients, further investigation of its long-term efficacy is warranted, in addition to hormonal therapy for female cachexic patients. Disclosure No

Co-occurring Medical Multimorbidity, Mental Illness, and Substance Use Disorders Among Older Criminal Legal System-Involved Veterans.

Older veterans involved in the criminal legal system (CLS) may have patterns of multimorbidity that place them at risk for poor health outcomes. To estimate the prevalence of medical multimorbidity (≥2 chronic medical diseases), substance use disorders (SUDs), and mental illness among CLS-involved veterans aged 50 and older. Using Veterans Health Administration health records, we estimated the prevalence of mental illness, SUD, medical multimorbidity, and the co-occurrence of these conditions among veterans by CLS involvement as indicated by Veterans Justice Programs encounters. Multivariable logistic regression models assessed the association between CLS involvement, the odds for each condition, and the co-occurrence of conditions. Veterans aged 50 and older who received services at Veterans Health Administration facilities in 2019 (n=4,669,447). Mental illness, SUD, medical multimorbidity. An estimated 0.5% (n=24,973) of veterans aged 50 and older had CLS involvement. For individual conditions, veterans with CLS involvement had a lower prevalence of medical multimorbidity compared with veterans without but had a higher prevalence of all mental illnesses and SUDs. After adjusting for demographic factors, CLS involvement remained associated with concurrent mental illness and SUD (adjusted odds ratio [aOR] 5.52, 95% CI=5.35-5.69), SUD and medical multimorbidity (aOR=2.09, 95% CI=2.04-2.15), mental illness and medical multimorbidity (aOR=1.04, 95% CI=1.01-1.06), and having all 3 simultaneously (aOR=2.42, 95% CI=2.35-2.49). Older veterans involved in the CLS are at high risk for co-occurring mental illness, SUDs, and medical multimorbidity, all of which require appropriate care and treatment. Integrated care rather than disease-specific care is imperative for this population.

Paracetamol use prior to and in early pregnancy: Prevalence and patterns among women with and without chronic medical diseases.

Paracetamol is commonly consumed by pregnant women, even though recent data have questioned its safety. Having chronic medical diseases (CMDs) may influence the prevalence of use during pregnancy. We aimed to assess the prevalence and patterns of use 3 months prior to pregnancy and in the first trimester among women with and without CMDs and the potential influence of CMDs on frequent use in the first trimester. We used patient-reported data from the Copenhagen Pregnancy Cohort from 1 October 2013 to 23 May 2019 with information on CMDs and paracetamol use. Prevalence and patterns of use were assessed descriptively and by multivariable logistic regression models. We included 24 019 pregnancies. Use of paracetamol prior to and in early pregnancy was significantly higher among women with CMDs compared to women without (40.7% vs. 35.8% and 9.1% vs. 5.1%, respectively). Women with CMDs were 2.7 times more likely to have a frequent intake compared to women without [aOR 2.69 (95% CI 2.05-3.32)]. Migraine, rheumatoid arthritis and mental disease were associated with a higher use of paracetamol [aOR 4.39 (3.20-6.02), aOR 4.32 (2.41-7.72) and aOR 2.74 (1.67-4.49), respectively]. Women with CMDs had a higher paracetamol use before and during pregnancy than women without CMDs. Women with migraine, rheumatoid arthritis and mental disease showed the highest risk of frequent use. This study highlights the importance of discussing pain relief in pregnancy and evaluating the influence of maternal CMDs when assessing adverse effects of paracetamol use during pregnancy.

Knowledge of COVID-19 Vaccine and Factors that Influence Its Acceptance among Patients Living with Chronic Medical Conditions in Nigeria

Aims: Vaccines against COVID-19 have been developed but there are not enough vaccines for everyone. Special groups of people, such as those with chronic health conditions, must be prioritized. This study investigates the factors that influence the acceptance of the COVID-19 vaccine among patients living with chronic medical diseases in Nigeria.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: University College Hospital between October 2021 – December 2021.&#x0D; Methodology: 387 adults with chronic medical conditions were sampled via an offline questionnaire using a cross-sectional design. Convenience sampling was used to recruit participants. The information was collected using a validated structured questionnaire adapted from the study carried out in Bangladesh by Saifu et al and entered into the Stata MP 14.0. To summarize the data, descriptive statistics such as mean, frequency, and percentages were used, and Chi-square analysis was used to test hypotheses with an Alpha level of 0.05.&#x0D; Results: The majority of responders (69.5 %) correctly identify the modes of transmission. . . While the knowledge of COVID-19 infection was found to be statistically correlated with age, gender, education, income and ethnicity, the knowledge of the COVID-19 vaccine is significantly correlated with education and occupation. The respondents' income, occupation, and education were significantly correlated with their desire to receive the vaccine at a p-value&lt;0.01.&#x0D; Conclusion: The results highlight the need to step up efforts to inform Nigerian adults about the COVID-19 infection and the available vaccines, especially those who have chronic medical conditions.

Delayed Medical Care of Underserved Middle-Aged and Older African Americans with Chronic Disease during COVID-19 Pandemic.

Background: While African American middle-aged and older adults with chronic disease are particularly vulnerable during the COVID-19 pandemic, it is unknown which subgroups of this population may delay seeking care. The aim of this study was to examine demographic, socioeconomic, COVID-19-related, and health-related factors that correlate with delayed care in African American middle-aged and older adults with chronic disease. Methods: In this cross-sectional study, 150 African American middle-aged and older adults who had at least one chronic disease were recruited from faith-based organizations. We measured the following exploratory variables: demographic factors (age and gender), socioeconomic status (education), marital status, number of chronic diseases, depressive symptoms, financial strain, health literacy, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 knowledge, and COVID-19 perceived threat. The outcome was delay in chronic disease care. Results: According to the Poisson log-linear regression, higher level of education, higher number of chronic diseases, and depressive symptoms were associated with a higher level of delayed care. Age, gender, COVID-19 vaccination history, COVID-19 diagnosis history, COVID-19 perceived threat, COVID-19 knowledge, financial strain, marital status, and health literacy were not correlated with delayed care. Discussion: Given that higher healthcare needs in terms of multiple chronic medical diseases and depressive symptomatology but not COVID-19-related constructs (i.e., vaccination history, diagnosis history, and perceived threat) were associated with delayed care, there is a need for programs and interventions that assist African American middle-aged and older adults with chronic disease to seek the care that they need. More research is needed to understand why educational attainment is associated with more delayed care of chronic disease in African American middle-aged and older adults with chronic illness.

Determinants of Maternal Near Miss among Women in Northeast Iran: A Facility-Based Case-Control Study.

The investigation of Maternal Near-Miss (MNM) risk factors is important for the global reduction of maternal mortality. This study aimed to identify the determinants of MNM among pregnant women in northeastern Iran. A prospective case-control study was conducted on 250 women referred to the maternity ward of Nohom-e-Dey hospital in Torbat-e Heydarieh, Iran, from June 2018 to May 2020. Applying the criteria of the World Health Organization tool, near-miss mothers were taken as cases, and mothers with normal obstetric outcomes were selected as controls with convenience sampling. Logistic regression models using Stata version 14.0 and odds ratios (95% confidence intervals) were reported. A total of 123 MNM cases and 127 controls were included in the study. The multiple logistic regression represented that having had previous abortion, living in rural or urban areas, whether the mother went through C/S or vaginal delivery and level of prenatal education were associated with MNM. Besides, having experienced chronic medical diseases during pregnancy had the strongest association with MNM, and next were complications during childbirth and neonatal outcomes which were associated with MNM, although in terms of statistical association, only the first two mentioned factors were statistically significant. Determinants of MNM could be experiencing chronic medical disorders during maternal complications. Health providers need to carefully manage past medical history and adverse perinatal outcomes, especially in pregnant women who live in rural areas. Encouraging mothers to attend pregnancy training classes is effective in reducing MNM.