Community-based Sample Of Patients Research Articles

Natural History of Asymptomatic Moderate Carotid Artery Stenosis in a Large Community-Based Cohort.

Moderate carotid artery stenosis is a poorly defined risk factor for ischemic stroke. As such, practice recommendations are lacking. In this study, we describe the long-term risk of stroke in patients with moderate asymptomatic stenosis in an integrated health care system. All adult patients with asymptomatic moderate (50%-69%) internal carotid artery stenosis between 2008 and 2012 were identified, with follow-up through 2017. The primary outcome was acute ischemic stroke attributed to the ipsilateral carotid artery. Stroke rates were calculated using competing risk analysis. Secondary outcomes included disease progression, ipsilateral intervention, and long-term survival. Overall, 11 614 arteries with moderate stenosis in 9803 patients were identified. Mean age was 74.2±9.9 years with 51.4% women. Mean follow-up was 5.1±2.9 years. There were 180 ipsilateral ischemic strokes (1.6%) identified (crude annual risk, 0.31% [95% CI, 0.21%-0.41%]), of which thirty-one (17.2%) underwent subsequent intervention. Controlling for death and intervention as competing risks, the cumulative incidence of stroke was 1.2% (95% CI, 1.0%-1.4%) at 5 years and 2.0% (95% CI, 1.7%-2.4%) at 10 years. Of identified strokes, 50 (27.8%) arteries had progressed to severe stenosis or occlusion. During follow-up, there were 17 029 carotid studies performed in 5951 patients, revealing stenosis progression in 1674 (14.4%) arteries, including 1614 (13.9%) progressing to severe stenosis and 60 (0.5%) to occlusion. The mean time to stenosis progression was 2.6±2.1 years. Carotid intervention occurred in 708 arteries (6.1%). Of these, 66.1% (468/708) had progressed to severe stenosis. The overall mortality rate was 44.5%, with 10.5% of patients lost to follow-up. In this community-based sample of patients with asymptomatic moderate internal carotid artery stenosis followed for an average of 5 years, the cumulative incidence of stroke is low out to 10 years. Future research is needed to optimize management strategies for this population.

Patient adherence to drug treatment in a community based-sample of patients with chronic heart failure

Despite high success in heart failure (HF) treatment, prognosis of patients with HF seems to be improving slowly [1–3]. In real world, there is an increasing divergence between prescriptions of HF medication and guideline recommendations [4–7]. However, few detailed data provides a granular representation of reasons for under-use of HF drugs in HF patients with reduced ejection fraction (HFrEF). Interestingly, recent observational studies pointed out that prescriptions of evidence-based treatment continue to be representative also in HF patients with preserved ejection fraction (HFpEF), in spite of a lack of clear benefits [6,8].

COPD Comorbidity Profiles and 2-Year Trajectory of Acute and Postacute Care Use

Multiple morbidity is the norm in advanced COPD and contributes to high symptom burden and worse outcomes. Can distinct comorbidity profiles be identified and validated in a community-based sample of patients with COPD from a large integrated health care system using a standard, commonly used diagnostic code-based comorbidity index and downstream 2-year health care use data? In this retrospective cohort study, we used latent class analysis (LCA) to identify comorbidity profiles in a population-based sample of 91,453 patients with a COPD diagnosis between 2011 and 2015. We included specific comorbid conditions from the Charlson Comorbidity Index (CCI) and accounted for variation in underlying prevalence of different comorbidities across the three study sites. Sociodemographic, clinical, and health-care use data were obtained from electronic health records (EHRs). Multivariate logistic regression analysis was used to compare rates of acute and postacute care use by class. The mean age was 71 ± 11 years, 55%of patients were women, 23%of patients were people of color, and 80%of patients were former or current smokers. LCA identified four distinct comorbidity profiles with progressively higher CCI scores: low morbidity (61%; 1.9 ± 1.4), metabolic renal (21%; 4.7 ± 1.8), cardiovascular (12%; 4.6 ± 1.9), and multimorbidity (7%; 7.5 ± 1.7). In multivariate models, during 2 years of follow-up, a significant, nonoverlapping increase was found in the odds of having any all-cause acute (hospitalizations, observation stays, and ED visits) and postacute care use across the comorbidity profiles. Distinct comorbidity profiles can be identified in patients with COPD using standard EHR-based diagnostic codes, and these profiles are associated with subsequent acute and postacute care use. Population-based risk stratification schemes for end-to-end, comprehensive COPD management should consider integrating comorbidity profiles such as those found in this study.

The World Health Organization Disability Assessment Schedule-2.0 (WHODAS 2.0) in a chronic pain population being considered for chronic opioid therapy.

PurposeTo examine the validity of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for the assessment of function in a community-based sample of patients with chronic pain conditions undergoing evaluation for chronic opioid therapy.Patients and methodsOne hundred nine of 124 patients were evaluated for a chronic opioid therapy program between December 1, 2014 and April 10, 2015, inclusive, at one community-based interdisciplinary pain management practice. Measures included: demographic data; the WHODAS 2.0; a modified version of the Roland Morris Disability Questionnaire (RMDQ-m); the Patient Health Questionnaire-9 item (PHQ-9); the Screener and Opioid Assessment for Patients with Pain-Revised (SOAPP-R); the Current Opioid Misuse Measure (COMM), the Opioid Risk Tool (ORT); opioid dose. These data were collected as part of routine care, and this retrospective chart review study examined the data from this convenience sample, comparing the results of each assessment tool to the results of the WHODAS 2.0.ResultsMedian score on the WHODAS 2.0 was 25.69 (IQR=16.01 to 35.28). WHODAS 2.0 score was significantly correlated with the RMDQ-m (rs=0.69, p<0.001), the PHQ-9 (rs=0.68, p<0.001), the COMM (rs=0.52, p<0.001) and the SOAPP-R (rs=0.51, p<0.001). There was no significant correlation between the WHODAS 2.0 and the ORT (rs=0.14, p=0.12) or opioid dose (rs=0.07, p=0.47).ConclusionsThe WHODAS 2.0 was significantly positively correlated with other measures, including measures of disability, risk of opioid misuse, and depression among patients being evaluated for chronic opioid therapy. The WHODAS 2.0 may be a useful measure of disability across a number of important domains when discussing expectations of both patients and providers at initiation of opioid therapy for chronic pain management. This assessment and discussion is crucial, particularly given the focus on function, rather than analgesia alone, when evaluating the effectiveness of opioid treatment.

Burden of AL Amyloidosis on Health-Related Quality of Life in Clinic-Based, Community-Based, and Trial-Based Studies

Introduction: Light chain (AL) amyloidosis is a rare disease characterized by misfolded amyloid protein deposits in tissues and vital organs which may lead to organ failure, disability, and death. Little is known about the burden of AL amyloidosis on health-related quality of life (HRQoL) - particularly whether patients in different types of studies experience the same degree and type of burden or whether there are unique differences.The objective of this study is to compare the HRQoL profile of patients with AL amyloidosis from clinic-, community-, and clinical trial-based samples to a general population (GP) sample and other benchmarks from more commonly known diseases.MethodsSampleData were drawn from three different samples of AL amyloidosis patients:1. A clinic-based sample of AL amyloidosis patients seen at the Amyloidosis Center at Boston University between 1994 and 2014 who completed the HRQoL survey within 30 days of their initial evaluation (n=1,438)2. A community-based sample of patients who completed a cross-sectional online survey in the Fall of 2015 (n=341)3. A trial-based sample of treatment naïve patients with cardiac involvement who completed the HRQoL survey during baseline data collection of the VITAL Amyloidosis Study, a Phase 3 randomized control trial (RCT) of NEOD001 (clinical trials.gov ID: NCT02312206; n=85)MeasuresAll three studies assessed HRQoL using the SF-36® Health Survey (SF-36). The SF-36v1 was administered to the clinic-based sample and the SF-36v2 was administered to the community- and trial-based samples. The SF-36 measures eight domain scales (physical functioning (PF), role limitations due to physical health problems (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role limitations due to emotional health problems (RE), and mental health (MH)) and two component summary measures: physical (PCS) and mental (MCS).AnalysisAnalysis of variance was used to compare the norm-based SF-36 scores from patients with AL amyloidosis to that from samples representing a GP norm. The GP data were adjusted to the age and gender distribution of the patient samples using separate ordinary least-squares regression models, with each SF-36 scale or summary score as a dependent variable. Using the same method, mean SF-36 scales and summary scores in the three AL amyloidosis patient samples were compared to the mean SF-36 scores in other disease populations, including congestive heart failure (CHF) and kidney disease (KD). Established minimally important differences (MIDs) were used to determine whether deficits in HRQoL were clinically meaningful, as well as statistically significant.Results: Differences between AL amyloidosis patients’ SF-36 scores and those of the GP are presented in Table 1 by sample. Relative to the GP, patients with AL amyloidosis exhibited broad deficits in HRQoL, particularly related to physical well-being. Deficits were more prominent for PCS where the differences between the GP scores and the scores observed in all three AL amyloidosis samples were both statistically significant and clinically meaningful (p < 0.001 and D ≥ 2.0 points for all).Differing patterns of relative burden emerged when AL amyloidosis samples were compared to other common disease benchmarks:· As compared to the CHF benchmarks, scores for PCS among the community-based sample were statistically and clinically better (p < 0.001 and D=4.5); whereas, PCS scores were significantly worse among the trial-based sample (p < 0.01 and D=-8.9).· Relative to KD benchmarks, the trial-based, treatment naïve sample reported significant deficits across many scores that were comparable in the community-based sample, including RP, VT, and PCS.Conclusions: Regardless of the data source, patients with AL amyloidosis exhibited significant and clinically meaningful deficits in HRQoL compared to the GP. Despite heterogeneity across the three samples in terms of duration and severity of disease, deficits related to physical well-being were consistent and clinically meaningful. Different patterns of deficits emerged when comparing the three samples to other disease benchmarks. This may be due to the heterogeneity in the community-based sample where patients varied in duration of disease and course of treatment versus the other AL amyloidosis samples which were comprised of newly diagnosed and/or treatment naïve patients. [Display omitted] DisclosuresBayliss:Prothena Biosciences Inc: Research Funding. White:Prothena Biosciences Inc: Research Funding. McCausland:Prothena Biosciences Inc: Research Funding. Guthrie:Prothena: Employment, Equity Ownership, Other: Leadership.

Psychiatric readmissions in a community-based sample of patients with mental disorders.

This study examined whether receipt of outpatient psychiatric services after hospital discharge was associated with reduced risk of readmission. Treatment records from patients admitted to San Diego County psychiatric hospitals over a one-year period were obtained from the San Diego County Behavioral Health Services electronic health record system. A discrete-time proportional hazards model was used to examine the association of receipt of outpatient psychiatric services with readmission within 30 days of discharge from the index hospitalization. Of the 4,663 patients, 16% were readmitted within 30 days. In an adjusted model, receipt of outpatient therapy after discharge was associated with a greater likelihood of being readmitted (hazard ratio=1.36, 95% confidence interval=1.14-1.67), whereas receipt of case management or medication management was not associated with readmission. The differential risk of readmission by service type suggests a need for studies that explore reasons for an increased risk of readmission with certain types of services.

FRI0159 Severe extra-articular manifestations in rheumatoid arthritis: risk factors and incidence in relation to treatment with tnf-inhibitors

BackgroundExtra-articular rheumatoid arthritis (ExRA) manifestations are associated with increased comorbidity and premature mortality. While tumour necrosis factor (TNF)-inhibitors efficiently reduce arthritis, their impact on the risk of ExRA is still...

Sleep problems in Parkinson’s disease: a community-based study in Norway

BackgroundThe purpose of this study was to examine the prevalence of sleep problems in a community-based sample of patients with Parkinson’s disease (PD) in Norway, and their associated factors.Methods176 consecutive PD outpatients (41% females) were included in a study of non-motor symptoms, including sleep problems. All participants responded to the Parkinson’s Disease Sleep Scale (PDSS), where an overall score below 82 or a score below 5 on a sub-item indicate possible sleep problem. Factors associated with sleep were also investigated, with special emphasis on severity of PD, fatigue, mental health and restless legs syndrome (RLS).ResultsThe mean age was 68.5 years (range 35–90); the mean Hoehn and Yahr stage was 2.11 (SD 0.86), and the mean UPDRS part III was 22.3 (SD 11.7). Sleep problems were common among PD patients. While only 17% of the sample had an overall score below 82 on the PDSS, 70% of the patients had a score below 5 on one item. There was no significant association between PD severity and any of the sleep items in the PDSS; whereas fatigue, mental health problems, and RLS were associated with PDSS score.ConclusionsThe current findings call for increased awareness of sleep problems in PD patients, especially focusing on the association with mental health problems, fatigue and RLS.

Abstract 253: Comparative Effectiveness of Clopidogrel in Medically Managed Patients with Unstable Angina and non-ST Segment Myocardial Infarction

Background: The CURE trial demonstrated improved outcomes with the addition of clopidogrel to aspirin in unstable angina (UA) or NSTEMI, leading to guideline adoption and widespread use. Although the role of clopidogrel after PCI is well studied, 40-50% of patients with UA/NSTEMI are medically managed, i.e., without revascularization during the index hospitalization. The effectiveness and optimal duration in real-world medically managed patients is unknown. Methods: We conducted a retrospective cohort study of all adult members of Kaiser Permanente of Northern California, a large, integrated health care delivery system, without known CAD or prior clopidogrel use who presented with UA/NSTEMI from 2003-2008 and did not receive revascularization (PCI or CABG) during the index hospitalization or within 7 days post-discharge (i.e., “medically managed”). We measured the association between use of clopidogrel within 7 days of discharge with subsequent all-cause mortality and MI at 2 years of follow up. Outcomes were examined in unmatched and propensity-matched multivariable Cox regression analyses, adjusted for demographics, comorbidities, longitudinal medication use and secular trends. Results: We identified 18,771 patients (mean age 69.3 years; 42.4% women) with incident UA (34.7%) or NSTEMI (65.3%) followed for a mean 2.5 years after the initial event. Clopidogrel prescription within 7 days of discharge was observed for 34.5% of the sample. Among these, the mean duration of continuous clopidogrel use was 255 days. An additional 1.6% filled a clopidogrel prescription between 7 and 30 days after discharge, and 5.0% filled a prescription after 30 days. During the first 2-years of follow up, patients prescribed clopidogrel within the first 7 days after discharge had lower unadjusted rates of all-cause mortality (7.5% vs 19.2%, p &lt; 0.001; HR = 0.42, 95% CI [0.38-0.45]) and subsequent MI (6.5% vs 8.2%, p = 0.002; HR = 0.85 [0.76-0.95]). In multivariable Cox regression models, clopidogrel users had lower risk of 2-year all-cause mortality (HR = 0.65, [0.60-0.71]) but similar rates of MI (HR = 1.07, [0.96-1.20]). Propensity-matched models demonstrated similar results. A sensitivity analysis in which clopidogrel use was defined by initiation within 30-days post-discharge also demonstrated similar results. Conclusions: In a large community-based sample of patients with incident medically managed UA/NSTEMI, receipt of early post-discharge clopidogrel was independently associated with lower rates of death but similar rates of MI. Future research should identify the subset of patients who experience the greatest net clinical benefit with clopidogrel after UA/NSTEMI as well as the optimal duration of treatment.

Extra-articular manifestations in a community-based sample of patients with rheumatoid arthritis: incidence and relationship to treatment with TNF inhibitors

Objectives: To determine the incidence of severe extra-articular rheumatoid arthritis (ExRA) in a community-based cohort of RA patients, and to evaluate whether treatment with tumour necrosis factor (TNF) inhibitors has any effect on the risk of ExRA.Methods: In a review of clinical records from 1 July 1997 to 31 December 2004, severe ExRA manifestations were classified according to predefined criteria. Patients were censored at the development of ExRA, death, emigration, or 31 December 2004. Exposure to anti-TNF treatment has continuously and independently been recorded as part of a regional follow-up system.Results: During treatment with TNF inhibitors, there were two patients with new onset of ExRA in 408 person-years at risk (pyr) [0.49/100 pyr, 95% confidence interval (CI) 0.06–1.77]. Among those without anti-TNF treatment there were 63 patients with ExRA in 5425 pyr (1.16/100 pyr, 95% CI 0.89–1.49). The relative risk comparing those treated to those not treated with TNF inhibitors was 0.42 (95% CI 0.10–1.73).Conclusion: Our data show a lower incidence of ExRA in patients treated with TNF inhibitors but further studies with a larger sample size are needed for a more accurate estimate of the size of the effect.

Correlation between neuropsychiatric syndromes and impaired activities of daily living in a community-based sample of patients with dementia

Correlation between neuropsychiatric syndromes and impaired activities of daily living in a community-based sample of patients with dementia

Impact of Chronic Aspirin and Statin Therapy on Presentation of Patients With Acute Myocardial Infarction and Impaired Renal Function

Chronic use of aspirin and statins has been associated with reduced risk of subsequent myocardial infarction (MI). However, in patients with chronic kidney disease (CKD), the cardioprotective role of aspirin and statins seems to be reduced. To evaluate the impact of chronic aspirin and statin use on clinical presentation of acute MI according to renal function, the authors retrospectively analyzed 595 consecutive patients admitted to our hospital for acute MI. Renal function was normal in 404 patients and impaired in 191. Patients on therapy (113 patients) were less likely to have ST-segment elevation MI (STEMI) compared with patients not treated (36% vs 53%, respectively, P=.0002). These results have been confirmed in the population of patients with CKD (48% of STEMI in patients receiving chronic therapy and 67% in patients without therapy,P=.01). Multivariate analysis in the group of patients with CKD showed that use of aspirin or statins was an independent predictor of a decreased probability of STEMI (odds ratio, 0.5; 95% confidence interval, 0.2-1.0,P=.05). The authors' results suggest that in a community-based sample of patients with acute MI, chronic aspirin and statin therapy has a cardioprotective role that is evident also in patients with CKD.

Pain and Its Relationship to Depression in Parkinson Disease

Depression and pain are common in Parkinson disease (PD). An association between pain and depression has been demonstrated in non-PD groups, but little is known about this relationship in PD. The authors examined the relationship between pain and depression in a community-based sample of patients with PD. Two hundred twenty-seven patients with PD were drawn from a community-based prevalence study. A random sample of 100 healthy elderly comparable regarding age and sex were included for comparison. Pain was assessed by employing the pain section of the Nottingham Health Profile and depression by the Montgomery-Asberg Depression Rating Scale (MADRS) and the Beck Depression Inventory (BDI). General linear models and regression analyses were used to study the relationship between pain and depression. Sixty-seven percent of PD patients suffered from pain, compared with 39% of the control group. PD subjects with pain had higher scores on MADRS and BDI, and were more likely to have major depression, than PD patients without pain. In multivariate analyses, the presence of pain was significantly associated with depression scores, even after adjusting for demographic and clinical variables. A significant relationship between pain and depression was found. Pain issues should be integrated in the evaluation and management of depression in PD, and vice versa.

Clinical characteristics of chronic kidney disease patients with and without diabetes: a subanalysis of the PAERI study

Diabetes is the leading cause of chronic kidney disease (CKD) in the United States, and cardiac disease is the primary cause of death in patients with CKD and diabetes. The Prevalence of Anemia in Early Renal Insufficiency (PAERI) study evaluated the prevalence of anemia and associated comorbidities in a community-based sample of patients with CKD. The purpose of this post hoc analysis was to identify differences, if any, in the prevalence and severity of anemia (hemoglobin < or = 12 g/dl (120 g/l)) and other clinical characteristics between CKD patients with diabetes and patients with CKD who did not have diabetes. The PAERI study was a prospective, cross-sectional, multicenter survey. Eligible patients were > or = 18 years old with CKD, defined as serum creatinine 1.5 - 6.0 mg/dl (132.6 - 530.4 micromol/l) in females and 2.0 - 6.0 mg/dl (176.8 530.4 micromol/l) in males within 12 months before enrollment. Study duration for each patient was a single site visit. Of the original 5,222 patients enrolled, 3,361 had diabetes and 1,861 did not. A family history of diabetes was present in 72.7% of diabetic patients vs. 27.2% of nondiabetic patients (p < 0.0001). Patients with diabetes had a significantly higher prevalence of anemia (52.7 vs. 39.4%, p < 0.0001) and cardiac disease (55.7 vs. 42.9%, p < 0.0001). The prevalence of hypertension was high in both groups (91.5 and 89.3%). Significantly more diabetic patients than nondiabetic patients received angiotensin-converting enzyme inhibitors (60.4 vs. 43.8%, p < 0.0001). Hyperlipidemia was more common in patients with diabetes (73.9 vs. 55.4%, p < 0.0001). Patients with diabetes were slightly younger and had a significantly higher mean body mass index and lower transferrin saturation compared with nondiabetic patients. In diabetic and nondiabetic patients, more than 97% had glomerular filtration rate < 60 ml/min/1.73 m2 and more than 70% had serum creatinine < 2.5 mg/dl (221.0 micromol/l). These findings underscore the extent and severity of concurrent illnesses in patients with both diabetes and CKD. In those patients, diabetes was associated with a greater prevalence of serious cardiac-related comorbidities than observed in nondiabetic patients.

Cognitive profiles of individual patients with Parkinson's disease and dementia: Comparison with dementia with lewy bodies and Alzheimer's disease

We describe the pattern of cognitive profiles within a community-based sample of patients with Parkinson's disease (PD) and dementia (PDD) using cluster analyses, and compare the results with data from patients with Alzheimer's disease (AD) and dementia with Lewy bodies (DLB). Fifty patients with PDD and 39 with AD from Stavanger, Norway, and 62 patients with DLB from San Diego, CA, USA were diagnosed by either standardized clinical procedures or criteria (all PDD and all AD cases) or necropsy (all DLB cases). Four subgroups were identified: two subgroups with a subcortical cognitive profile (one with mild and one with moderate dementia severity), one subgroup with global impairment and severe dementia, and one subgroup with a cortical cognitive profile and moderate dementia. Of the patients with PDD and with DLB, 56% and 55%, respectively, had a subcortical cognitive profile, compared with only 33% of the AD patients. Conversely, 30% of the patients with PDD and 26% of those with DLB had a cortical cognitive profile, compared with 67% of the patients with AD. These findings suggest that in some patients with PDD, frontosubcortical changes are the main contributing factor to dementia, whereas in other patients, cortical and hippocampal changes are more important.

Forty-eight percent of dentate patients receive dental radiographs per year

Gilbert GH, Reems RA, Shelton BJ. Incidence of dental radiographic procedures during a 48-month population-based study of dentate adults. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:243-9. 2c What is the incidence of various common dental radiographic procedures, and the interval between these procedures, in a community-based sample of patients? National Institutes of Health. Prospective descriptive study of dental radiographic use by a cohort of patients

Quality of life in patients with established inflammatory bowel disease: a UK general practice survey.

The current understanding of quality of life impairment in inflammatory bowel disease has largely been derived from selected populations and may not reflect the experience of patients in the community, where fewer than half are likely to be under specialist care. To describe the health-related quality of life in a community-based sample of patients with established inflammatory bowel disease and explore its association with the type and extent of disease, gender, age, material deprivation and other factors. Adults with established inflammatory bowel disease were identified systematically from the records of 23 family practices in north-east England. The health-related quality of life was assessed by self-completion of the UK Inflammatory Bowel Disease Questionnaire. Five hundred and fifty-six patients were sent the questionnaire and 409 (74%) gave usable replies. Lower scores (worse quality of life) were significantly associated with female gender, Crohn's disease, more extensive disease (ulcerative colitis) and being under specialist care. The mean health-related quality of life score was significantly lower in patients resident in more deprived districts, independent of the type and extent of disease. Most patients with established inflammatory bowel disease showed only minor impairment of their health-related quality of life. On average, women and those with Crohn's disease were relatively more affected. Clinicians responsible for the care of patients with inflammatory bowel disease should be aware of these more vulnerable groups.

Type D personality: A potential risk factor refined

Objective. Acute and chronic psychological distress have been associated with coronary heart disease (CHD) but little is known about the determinants of distress as a coronary risk factor. Broad and stable personality traits may have much explanatory power; this article selectively focuses on negative affectivity (NA; tendency to experience negative emotions) and social inhibition (SI; tendency to inhibit self-expression in social interaction) in the context of CHD. Methods. The first part of this article reviews research on NA and SI in patients with CHD. The second part presents new findings on NA and SI in 734 patients with hypertension. Results. Accumulating evidence suggests that the combination of high NA and high SI designates a personality subtype (“distressed” type or type D) of coronary patients who are at risk for clustering of psychosocial risk factors and incidence of long-term cardiac events. Type D and its contributing low-order traits (dysphoria/tension and reticence/withdrawal) could also be reliably assessed in a community-based sample of patients with hypertension. This finding was replicated in men and women, and in Dutch- and French-speaking subjects. Type D hypertensives reported more depressive affect than their non type D counterparts. Conclusions. There is an urgent need to adopt a personality approach in the identification of patients at risk for cardiac events. NA and SI are broad and stable personality traits that may be of special interest not only in CHD, but in other chronic medical conditions as well.

Measuring the impact of Parkinson's disease with the Parkinson's Disease Quality of Life questionnaire.

To assess the validity of the Parkinson's Disease Quality of Life (PDQL) questionnaire, a patient-specific multi-dimensional quality of life measure, in a community-based sample of patients with Parkinson's disease (PI)) using standardized measures of disease severity, depressive symptomatology and cognitive function. A group of 194 patients with probable PD were randomly selected from a community-based register and were invited to self-complete the 37-item PDQL. Disease severity was measured by the disease-specific Webster scale, cognition by the CAMCOG neuropsychological test and depressive symptomatology by the self-report 15-item GDS-15 geriatric depression scale. A total of 136 patients returned completed PDQL questionnaires. Significant differences (P < 0.05) emerged between the pooled PDQL score of patients grouped on the basis of disease severity. Depressive symptoms and cognition were also associated with poorer perceived quality of life as measured by the PDQL. The results of this study are indicative of the validity of the PDQL as an important additional measurement which reflects the impact of PD from the patient perspective. It shows poorer quality of life to be associated with increasing age, disease severity more severe depressive symptomatology and impaired cognitive functioning. However, the responsiveness of this instrument in the evaluation of care in PD remains to be determined.

Predicting the "revolving door" phenomenon among patients with schizophrenic, schizoaffective, and affective disorders

A subpopulation of chronically mentally ill patients, sometimes referred to as "revolving door" patients, are frequently readmitted to psychiatric units. This study examined the relationships among demographic features, diagnostic characteristics, and frequency of hospitalization of patients from four state hospitals. Two semistructured, standardized instruments, the Schedule for Affective Disorders and Schizophrenia and a life events history, were administered to 135 inpatients who met the Research Diagnostic Criteria for schizophrenia (N = 56), schizoaffective disorder (N = 33), unipolar major depressive disorder (N = 23), and bipolar disorder (N = 23). Criminal history was assessed by arrest records. The main outcome measure was the number of hospitalizations. Chi-square and trend test analyses indicated that substance abuse and noncompliance with medication regimens were significantly associated with higher frequencies of hospitalization. A multiple regression model, which included alcohol/drug problems, medication noncompliance, and six sociodemographic and diagnostic variables (age, gender, race, marital status, years of education, and diagnosis) accounted for a significant proportion of the ability to predict frequency of hospitalization. Half of this predictability was due to the relationship of substance abuse and medication noncompliance with number of hospitalizations. Alcohol/drug problems and noncompliance with medication were the most important factors related to frequency of hospitalization. Preventing these behaviors through patient education may reduce rehospitalization rates.