Comorbid Conditions In People Research Articles

Impact of multiple sclerosis comorbidities on quality of life and job activity

Background: Multiple sclerosis (MS) is frequently accompanied by comorbid conditions. Objectives: This study aimed to determine the prevalence of key comorbid conditions in people with multiple sclerosis (pwMS) and assess their impact on quality of life and work-related activities. Methods: A cross-sectional study involving 755 pwMS from two third-level Italian MS centers was conducted. Comorbidities were identified from medical records, and quality of life was assessed using the EQ-5D-3L questionnaire. Work-related challenges were evaluated using the Multiple Sclerosis Questionnaire for Job Difficulties (MSQ-Job). Results: 53.8% of pwMS had at least one comorbidity. Hypertension, depression, and anxiety were the most prevalent. Comorbidity presence was associated with reduced quality of life scores in almost all EQ-5D-3L domains and greater job difficulties in all but one MSQ-Job domain. Conclusion: Comorbidities in pwMS are prevalent and have a profound influence on quality of life and work-related activities. This comprehensive study offers new insights into the role of comorbidities in MS within the Italian context, emphasizing the need for a multidisciplinary approach in MS management. Further research is crucial to deepen our understanding of these findings in the broader Italian MS community.

Twelve-year neurocognitive decline in HIV is associated with comorbidities, not age: a CHARTER study.

Modern antiretroviral therapy (ART) has increased longevity of people with HIV and shifted the age distribution of the HIV pandemic upward toward that of the general population. This positive development has also led to concerns about premature and/or accelerated neurocognitive and physical ageing due to the combined effects of chronic HIV, accumulating comorbidities, adverse effects or possible toxicities of ART and biological ageing. Here we present results of comprehensive assessments over 12 years of 402 people with HIV in the CNS HIV ART Effects Research (CHARTER) programme, who at follow-up were composed of younger (<60 years) and older (≥60 years) subgroups. Over the 12 years, ART use and viral suppression increased in both subgroups as did systemic and psychiatric comorbidities; participants in both subgroups also evidenced neurocognitive decline beyond what is expected in typical ageing. Contrary to expectations, all these adverse effects were comparable in the younger and older CHARTER subgroups, and unrelated to chronological age. Neurocognitive decline was unrelated to HIV disease or treatment characteristics but was significantly predicted by the presence of comorbid conditions, specifically diabetes, hypertension, chronic pulmonary disease, frailty, neuropathic pain, depression and lifetime history of cannabis use disorder. These results are not consistent with premature or accelerated neurocognitive ageing due to HIV itself but suggest important indirect effects of multiple, potentially treatable comorbidities that are more common among people with HIV than in the general population. Good medical management of HIV disease did not prevent these adverse outcomes, and increased attention to a range of comorbid conditions in people with HIV may be warranted in their care.

Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia

Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.

Chronic kidney disease among children living with the human immunodeficiency virus in sub-Saharan Africa

BackgroundChronic kidney disease (CKD) remains an important comorbid condition in people living with HIV. However, data in children living with HIV/AIDS (CLWHA) in sub-Saharan Africa is limited. We sought to establish the prevalence and identify risk factors of CKD among CLWHA in SSA. MethodsThis was a retrospective chart review across five SSA countries HIV/AIDS care sites, March 2000 and June 2016. Results4,859 children with at least two clinic visits were enrolled in the study. The median age at the first clinic visit was 5.7 (IQR; 2.5, 9.5) years, and median follow-up time was 22.6 (IQR 9.8, 46.1) months. 11.2% CLWHA had an eGFR of <60 mL/min/1.73m2 on at least one clinic visit. The prevalence of CKD was 1.6%. In a multivariable Poisson regression analysis, CKD was associated with severe immunosuppression, incident rate ratio (IRR) 2.69 (95% CI, 1.11, 6.51). Risk of CKD decreased with increasing age (IRR 0.51 (95% CI, 0.39, 0.67). There was no association between CKD and ART regimen. ConclusionCKD was not as prevalent as previously reported in children in other studies. Kidney function monitoring should be incorporated into the pediatric HIV care monitoring guidelines to allow for better evaluation of kidney disease in CLWHA.

Associations of Dietary Macroelements with Knee Joint Structures, Symptoms, Quality of Life, and Comorbid Conditions in People with Symptomatic Knee Osteoarthritis.

Background: Osteoarthritis (OA), the most common joint disease in the elderly, has no cure. Macroelements are vital in human health and their relationships with OA are not clear. Clarifying the relationships between macroelements and OA may assist knee OA management. Methods: This study was a post-hoc analysis using data from a two-year randomized controlled trial among 392 participants with knee OA. Dietary macroelements, including calcium, magnesium, potassium, and phosphorus were computed-based on a semi-quantitative food frequency questionnaire at baseline. Knee joint structures (including cartilage volume, cartilage defect, bone marrow lesions, and effusion-synovitis volume), OA symptoms, quality of life, and OA comorbid conditions (including lower limb muscle strength and depressive symptoms) were assessed at baseline and month 24. Western Ontario and McMaster Universities (WOMAC) Index and depressive symptoms were assessed at baseline and months 3, 6, 12, and 24. Quality of life and lower limb muscle strength were assessed at baseline and months 6, 12, and 24. All analyses were conducted using mixed-effects models. Results: Higher dietary magnesium and potassium were associated with fewer OA symptoms, higher quality of life, greater lower limb muscle strength, and fewer depressive symptoms, but not with knee joint structures. Higher dietary calcium and phosphorus was not associated with any of the OA-related outcomes, except that dietary phosphorus was associated with greater lower limb muscle strength. Conclusions: In the longitudinal analyses, higher dietary magnesium and potassium intake are associated with fewer OA symptoms, higher quality of life, and milder comorbid conditions in patients with knee OA, suggesting dietary magnesium and potassium may have beneficial effects on OA and could be used for knee OA management.

Smoking and Human Immunodeficiency Virus 1 Infection Promote Retention of CD8+ T Cells in the Airway Mucosa.

Smoking and human immunodeficiency virus 1 (HIV-1) infection are risk factors for chronic obstructive pulmonary disease (COPD), which is among the most common comorbid conditions in people living with HIV-1. HIV-1 infection leads to persistent expansion of CD8+ T cells, and CD8+ T cell-mediated inflammation has been implicated in COPD pathogenesis. In this study, we investigated the effects of HIV-1 infection and smoking on T-cell dynamics in patients at risk of COPD. BAL fluid, endobronchial brushings, and blood from HIV-1 infected and uninfected nonsmokers and smokers were analyzed by flow cytometry, and lungs were imaged by computed tomography. Chemokines were measured in BAL fluid, and CD8+ T-cell chemotaxis in the presence of cigarette smoke extract was assessed invitro. HIV-1 infection increased CD8+ T cells in the BAL fluid, but this increase was abrogated by smoking. Smokers had reduced BAL fluid concentrations of the T cell-recruiting chemokines CXCL10 and CCL5, and cigarette smoke extract inhibited CXCL10 and CCL5 production by macrophages and CD8+ T-cell transmigration invitro. In contrast to the T cells in BAL fluid, CD8+ T cells in endobronchial brushings were increased in HIV-1-infected smokers, which was driven by an accumulation of effector memory T cells in the airway mucosa and an increase in tissue-resident memory T cells. Mucosal CD8+ T-cell numbers inversely correlated with lung aeration, suggesting an association with inflammation and remodeling. HIV-1 infection and smoking lead to retention of CD8+ T cells within the airway mucosa.

Barriers to timely tympanostomy tube placement in trisomy 21

ObjectivesTrisomy 21 is the most common chromosomal abnormality in the United States with an incidence of 1 in 700 in live-born children. Children with trisomy 21 are at increased risk for chronic ear disease, as well as other medical issues that may complicate healthcare access. In this study, we investigate whether children with trisomy 21 experience delays in tympanostomy tube insertion, and if there are any factors that contribute to a delay in care. MethodsWe performed a retrospective analysis on patients with trisomy 21 undergoing tympanostomy tube insertion at Boston Medical Center between 2005 and 2019 by analyzing the electronic medical record. This cohort was matched to patients without trisomy 21 by age, gender, surgery date and surgeon. The primary outcome was time elapsed between surgery decision date and date of tympanostomy tube insertion. ResultsA total of 20 patients with trisomy 21 underwent tympanostomy tube insertion at Boston Medical Center between 2005 and 2019. The trisomy 21 cohort was matched to 39 patients in the general population. The average time elapsed from decision to undergo surgery to tympanostomy tube insertion was 43.1 days in the general population and 119.0 days in the trisomy 21 cohort (p < .01). ConclusionPatients with trisomy 21 experience greater delays in tympanostomy tube insertion than the general population, which may be due to the increased burden of comorbid conditions in people with trisomy 21.

A Preliminary Investigation of Depression in People with Pathological Dissociation

ABSTRACT Depression is a common and challenging comorbid condition in people with pathological dissociation. To our knowledge, this preliminary study is the first study that has looked at the clinical correlates of depression in a sample of people with pathological dissociation (N = 72). We found that severe depression is common in this sample and that depression is associated with dissociative symptoms, post-traumatic stress disorder (PTSD) symptoms, borderline personality disorder symptoms and clinical recovery; the level of depression is also associated with both childhood and adulthood betrayal trauma but not with childhood and adulthood trauma with less betrayal. PTSD symptoms are the most significant correlates of the level of depression in this sample. Some clinical implications are discussed. Our initial findings imply that it may be important to manage depression by preventing adulthood betrayal trauma and stabilizing PTSD and dissociative symptoms when working with service users with pathological dissociation. Further studies are needed.

M64 - POLYGENIC RISK FOR ANXIETY SHAPES PATTERNS OF COMORBIDITY IN BIPOLAR DISORDER

Background Anxiety disorders are one of the most common comorbid conditions in people with bipolar disorder and are associated with unfavorable outcomes, including increased recurrence, higher rates of alcohol and substance abuse, and more frequent suicide attempts. However, the causal direction has remained unclear: Does poorer outcome lead to anxiety, or does comorbid anxiety result in poorer outcomes? Methods Here we used a Polygenic Risk Score (PGS) for anxiety to approach this question in a sample of 1754 adults with bipolar I or schizoaffective bipolar disorder previously characterized by the Diagnostic Interview for Genetic Studies (DIGS) and genotyped on Affymetrix 6.0 arrays. Anxiety PGS was calculated on the basis of results from the largest published GWAS meta-analysis of anxiety disorders (Otowa et al., 2016). Markers were LD clumped and the p-value threshold was set at 1. First we examined anxiety disorder comorbidity by creating a categorical ‘anxiety disorders’ variable comprising any DSM anxiety disorder diagnosis. Results Anxiety PGS was significantly associated with anxiety comorbidity (X2=7.756, df=1, p Discussion Taken together, these findings indicate that genetic risk for anxiety contributes to patterns of comorbidity in bipolar disorder, increasing risk for some anxiety disorders and for anorexia. Other common comorbidities and clinical features appear unrelated to genetic risk for anxiety, suggesting distinct etiologies.

Ongoing Medical Management to Maximize Health and Well-being for Persons Living With Dementia.

Persons living with dementia have complex care needs including memory loss that should be taken into account by providers and family caregivers involved with their care. The prevalence of comorbid conditions in people with dementia is high and, thus, how primary care, community providers and family caregivers provide best practice care, person-centered care is important. Care providers should understand the ongoing medical management needs of persons living with dementia in order to maximize their quality of life, proactively plan for their anticipated needs, and be as well prepared as possible for health crises that may occur. This article provides eight practice recommendations intended to promote understanding and support of the role of nonphysician care providers in educating family caregivers about ongoing medical management to improve the wellbeing of persons living with dementia. Key among these are recommendations to use nonpharmacological interventions to manage behavioral and psychological symptoms of dementia as the first line of treatment and recommendations on how to best support the use and discontinuation of pharmacological interventions as necessary.

Co-occurring Depression, Chronic Pain and Substance Use Disorders in People with Hepatitis C

Chronic infection with Hepatitis C virus (HCV) is common and can result in serious and sometimes fatal liver complications. The impact of HCV on the liver can be further complicated by medical and psychological comorbidities. Depression, substance use, and pain syndromes are frequent co-morbid conditions in people with HCV and diminish functioning, quality of life, and treatment compliance. Understanding the underlying biological mechanisms of these comorbid conditions within the context of HCV may help elucidate factors contributing to their co-occurrence, perhaps mediatedviapro-inflammatory cytokines. The current review provides a synthesis of the literature on depression, substance use disorders and chronic pain in the presence of HCV. The review includes studies conducted with both veteran and civilian populations. The implications for assessment and antiviral treatment of HCV will be considered.

Recognizing the Extent of Overlap Between Bipolar Disorder and Anxiety Disorders

The meta-analysis of prevalence of anxiety disorders among patients with bipolar disorder in this issue of E-Biomedicine (Nabavi et al., 2015) provides a timely summary of knowledge to date regarding this important co-occurrence of psychiatric conditions. The authors report that 43% of people with bipolar disorder have had at least one lifetime anxiety disorder. This figure is very similar to the 45% rate of people with bipolar disorder having had at least one lifetime anxiety disorder recently reported in a recent different meta-analysis, based on an only partially (less than half) overlapping set of studies (Pavlova et al., 2015). Individuals with bipolar disorder commonly have had more than one lifetime anxiety disorder. Indeed, the sum of the lifetime prevalences reported by Nabavi and associates for the individual anxiety disorders (panic disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, specific phobia, obsessive compulsive disorder, and agoraphobia) was approximately twice as high (nearly 85%) as that for any anxiety disorder. Nabavi and associates' 43% meta-analytic lifetime prevalence rate of any anxiety disorder is slightly below the 48% mid-point between the lowest (17%) (Angst et al., 2013) and highest (79%) (Pini et al., 1997) lifetime prevalence rates reported in the individual studies reviewed, highlighting the substantial heterogeneity of anxiety disorder lifetime prevalence across samples. This important heterogeneity was evident despite only including studies that used the rigorous approach of using interview-based diagnosis for comorbid anxiety disorders. As such heterogeneity likely has meaningful relationships with not only neurobiology but also clinical outcomes, researchers and clinicians alike need to account for anxiety disorder comorbidity in their efforts to understand, diagnose, and treat patients with complicated bipolar disorders. The very substantial percentage of bipolar disorder patients with a lifetime anxiety disorder has particularly profound clinical implications. Anxiety disorders and alcohol/substance use disorders commonly co-occur with one another and with mood disorders. Indeed, anxiety disorders and alcohol/substance use disorders constitute the two most commonly encountered comorbid conditions in people with bipolar disorder (Merikangas et al., 2007). As the authors point out, management of comorbid anxiety disorders in bipolar disorder patients with antidepressants and benzodiazepines may be limited by the risks of mood destabilization and exacerbation of substance use problems, respectively. Moreover, the utility of other medications, such as second-generation antipsychotics may be limited by inefficacy and/or adverse effects, whereas the utility of adjunctive psychotherapy may be limited by inefficacy, particularly in individuals challenged by more than one anxiety disorder in addition to bipolar disorder (Deckersbach et al., 2014). Like many good studies, Nabavi and associates' article raises more questions than it answers. Prior studies have consistently reported associations in bipolar disorder patients between comorbid anxiety disorders and multiple unfavorable illness characteristics, including earlier bipolar disorder onset age, and increased suicidality, rate of substance use disorders, and mood episode severity and frequency, as well as treatment resistance. Teasing out how this multivariate “web of causality” of factors (that include comorbid anxiety disorders) mediates poorer outcomes could help inform prioritization of efforts to enhance prognosis in patients with bipolar disorder and comorbid anxiety disorders. In addition, Nabavi and associates' study (which focused on individuals with bipolar I disorder) did not address the important question of putative differential lifetime anxiety disorder comorbidity rates in people with bipolar I disorder compared to those with bipolar II disorder. Finally, Nabavi and associates' study did not address important questions regarding the degree to which co-occurring anxiety and bipolar disorders may be independent or inter-related problems. Although meta-analysis of the clinical correlates of anxiety disorder comorbidity in bipolar disorder patients was beyond the scope of this paper, and as pointed out by the authors, may have substantial feasibility limitations; such information could importantly inform clinical efforts to mitigate the adverse effects of concurrent anxiety disorders in patients with bipolar disorder. Information regarding the impact of interventions focusing on relieving comorbid anxiety upon overall mood and anxiety disorder illness burden in individuals remains an important research priority. Nevertheless, Nabavi and associates' study leaves both researchers and clinicians with a very clear take-home message – that the very common occurrence of anxiety disorders in people with bipolar disorder contributes in an important fashion to challenges faced by those striving to accurately assess neurobiology and diagnosis and to provide effective treatment for individuals struggling with both conditions.

Comorbidity and dementia: a scoping review of the literature.

BackgroundEvidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient’s ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity.MethodsWe undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014).ResultsWe included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia.ConclusionsThe prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0192-4) contains supplementary material, which is available to authorized users.

Physical activity and cancer survivorship.

There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management. This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors. The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort. Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.

The fragile X syndrome-autism comorbidity: what do we really know?

Autism spectrum disorder (ASD) is a common comorbid condition in people with fragile X syndrome (FXS). It has been assumed that ASD symptoms reflect the same underlying psychological and neurobiological impairments in both FXS and non-syndromic ASD, which has led to the claim that targeted pharmaceutical treatments that are efficacious for core symptoms of FXS are likely to be beneficial for non-syndromic ASD as well. In contrast, we present evidence from a variety of sources suggesting that there are important differences in ASD symptoms, behavioral and psychiatric correlates, and developmental trajectories between individuals with comorbid FXS and ASD and those with non-syndromic ASD. We also present evidence suggesting that social impairments may not distinguish individuals with FXS with and without ASD. Finally, we present data that demonstrate that the neurobiological substrates of the behavioral impairments, including those reflecting core ASD symptoms, are different in FXS and non-syndromic ASD. Together, these data suggest that there are clinically important differences between FXS and non-syndromic ASD that are masked by reliance on the categorical diagnosis of ASD. We argue for use of a symptom-based approach in future research, including studies designed to evaluate treatment efficacy.

Cognitive and physical function in chronic kidney disease

Both cognitive and physical function are commonly impaired in individuals with chronic kidney disease (CKD), resulting in important impacts on their quality of life and overall health. This review summarizes the burden of cognitive and physical impairment in CKD, focusing on recent research that highlights a possible unifying microvascular cause among these shared comorbid conditions. Multiple small studies have been published recently evaluating cognitive and physical functioning in people with CKD. These studies overall demonstrate a high burden of comorbid conditions in people with CKD, including microvascular disease, that may result in cognitive impairment. Additionally, studies demonstrate that physical function is substantially worse than expected in individuals with CKD, that decreased physical activity is associated with worse outcomes, that frailty is very common and associated with an increased risk of death, and that structured exercise programs have small but tangible short-term effects on markers of physical performance. Impaired cognitive function and physical performance are important factors impacting the lives of people with CKD. Further research is necessary to better treat these important comorbid conditions in people with CKD.

The association between co-morbidities and physical performance in people with chronic obstructive pulmonary disease

A systematic review was conducted to examine the association between co-morbidity and physical performance in people with chronic obstructive pulmonary disease (COPD). MEDLINE, EMBASE, CINAHL, SCOPUS and Cochrane Central Register of Controlled Trials were searched from inception to end-February 2013, using keywords 'COPD', 'exercise', 'physical activity', 'rehabilitation', 'co-morbidity' and individual co-morbid conditions. Studies reporting associations of co-morbidities in COPD with at least one objective measure of physical performance were included. Study quality was appraised using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. Nine studies met inclusion criteria. Mean (standard deviation (SD)) STROBE score was 16 (3) (maximum score = 21). Four studies examined anxiety as a co-morbid condition; three examined depression; two examined obesity and two examined a range of conditions. Reduced physical performance was associated with higher Charlson score (odds ratio (OR) = 0.72, 95% confidence interval (CI) = 0.54-0.98), metabolic disease (OR = 0.58, 95% CI = 0.49-0.67), anxiety (OR = 0.37, 95% CI = 0.23-0.59) and osteoporosis (OR = 0.28, 95% CI = 0.11-0.70). Depression had minimal association with physical performance but was associated with higher dropout rates from pulmonary rehabilitation programmes. Obesity was negatively associated with baseline physical performance but not with change from an exercise intervention. The presence of co-morbid conditions in people with COPD may negatively affect physical performance and should be identified and accounted for analysis of interventions.

Comorbidity and dementia: a scoping review of the literature

Evidence suggests that amongst people with dementia there is a high prevalence of comorbid medical conditions and related complaints. The presence of dementia may complicate clinical care for other conditions and undermine a patient’s ability to manage a chronic condition. The aim of this study was to scope the extent, range and nature of research activity around dementia and comorbidity. We undertook a scoping review including all types of research relating to the prevalence of comorbidities in people with dementia; current systems, structures and other issues relating to service organisation and delivery; patient and carer experiences; and the experiences and attitudes of service providers. We searched AMED, Cochrane Library, CINAHL, PubMed, NHS Evidence, Scopus, Google Scholar (searched 2012, Pubmed updated 2013), checked reference lists and performed citation searches on PubMed and Google Scholar (ongoing to February 2014). We included 54 primary studies, eight reviews and three guidelines. Much of the available literature relates to the prevalence of comorbidities in people with dementia or issues around quality of care. Less is known about service organisation and delivery or the views and experiences of people with dementia and their family carers. There is some evidence that people with dementia did not have the same access to treatment and monitoring for conditions such as visual impairment and diabetes as those with similar comorbidities but without dementia. The prevalence of comorbid conditions in people with dementia is high. Whilst current evidence suggests that people with dementia may have poorer access to services the reasons for this are not clear. There is a need for more research looking at the ways in which having dementia impacts on clinical care for other conditions and how the process of care and different services are adapting to the needs of people with dementia and comorbidity. People with dementia should be included in the debate about the management of comorbidities in older populations and there needs to be greater consideration given to including them in studies that focus on age-related healthcare issues.

Importance of allergic rhinitis management in achieving asthma control: ARIA update

Asthma continues to be a major burden for the health and healthcare of people worldwide. The recent updates of the Global Initiative for Asthma and the National Heart, Lung and Blood Institute asthma guidelines stress the need for achieving and monitoring asthma ‘control’, emphasizing the importance of identifying, assessing and treating comorbid conditions. Allergic rhinitis (AR) is a major comorbid condition in people with asthma and is related to inflammation of the upper portions of the airway. Recognizing and treating AR has been shown to improve asthma control, specifically by decreasing rates of asthma attacks or asthma exacerbations. In 2008, updated Allergic Rhinitis in Asthma (ARIA) guidelines were published. The updated version of the guidelines has a familiar look, with classification systems and care algorithms that are similar to those presented in other asthma guidelines. The new ARIA guidelines make one major change that should affect the care of adults and children with asthma: everyone with asthma should be assessed for AR. In addition, AR should be considered a risk factor for asthma, and all children and adults with AR, especially persistent AR, should be assessed for asthma, including testing lung function for reversible obstruction whenever feasible. Treatment for AR follows a similar format to that for asthma, including symptom management, treatment of chronic inflammation, identification and management of triggers, including allergens, and ongoing education for self-management. Pharmacotherapies that address both asthma and AR include corticosteroids (intranasal and inhaled), leukotriene receptor antagonists, immunomodulation or immunotherapy. Too often, pharmacotherapy is not supplemented by the necessary education and evaluation related to allergen, trigger identification and management.

Diabetes and Depression – A Burdensome Co-morbidity

1. Head of Research, Research Institute of the Diabetes Academy, Mergentheim; 2. Head of Psychosocial Care, Diabetes Centre, Mergentheim Diabetes and Depression Depression is a frequent co-morbid condition in people with diabetes. A meta-analysis of 42 studies demonstrated that 31% of patients with diabetes described themselves as having elevated depressive symptoms compared with 14% of those without diabetes. A clinical depression diagnosis based on standardised criteria defined by the International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) or the Diagnostic and Statistical Manual of Mental Disorders (DSM IV) occurred in 11.4% of patients with diabetes, whereas the prevalence in people without diabetes was 5%.1 In clinical care settings this means that out of 100 patients with diabetes, approximately 11‐12 meet the diagnostic criteria for clinical depression and another 20 have mild or subthreshold depression. Thus, approximately every third patient with diabetes is affected by depression or elevated depressive symptoms. The reasons for this close association between diabetes and depression are not yet fully understood. Below we will discuss three possible explanations.