Comorbid Medical Illness Research Articles

Indian Hedgehog (IHh) Protein and COX-2 as Biomarkers to Define the Mechanism of Epilepsy and Gastrointestinal Problems as Comorbid Medical Illnesses in Autism Spectrum Disorder: Combining ROC Curves to Improve Diagnostic Values

Background/Objectives: Autism spectrum disorder (ASD) is a neurodevelopmental disorder that is increasing throughout the world. Nevertheless, no specific diagnostic or even risk assessment marker is available. Combining more than one marker can improve the diagnostic value of each marker alone and maximize the AUC for ROC curve. Hedgehog (Hh) signaling modulates both intestinal inflammation and immunity. Cyclooxygenase-2 (COX-2) is required for inflammation, and it has been related to epileptic seizures. COX-2 generates prostaglandins-EP2 (PGE2) in the brain, which plays a major role in neuropathology and epilepsy. This study aims to understand the pathophysiology of ASD by investigating the diagnostic value of COX-2 and IHh using independent and combined ROC curves. Methods: COX-2 and IHh were measured in 40 children with ASD and 41 age and sex-matched controls using ELISA. Statistical analyses were performed using ROC curves, odds ratios, and multiple logistic regression models. Results: Higher levels of COX-2 and IHh were observed in the plasma of patients with autism than in controls. The ROC curve of HIh and COX-2 independently showed poor and fair AUCs of 0.662 and 0.776, respectively, while the combined ROC for both variables in relation to the control group increased the AUC = 0.831 significantly (p < 0.001). Conclusions: Thus, combining these variables could be a useful diagnostic marker for ASD.

Long-term benzodiazepine prescriptions in community psychiatry clinics.

Anecdotal evidence indicates that the prevalence of long-term benzodiazepine prescription is high and not in accordance with accepted prescribing guidelines. To determine the prevalence of long-term prescriptions of benzodiazepines and associations thereof in community psychiatry clinics. Of the 27 community psychiatry clinics, 5 were randomly selected. A descriptive, retrospective, and cross-sectional record review of files of 126 adult patients was conducted, to obtain sociodemographic and clinical characteristics. Descriptive statistics were presented as proportions and percentages. Fisher's exact test was used to determine any associations between long-term benzodiazepines use and demographic and clinical variables. Regression analyses were performed to determine the significance of any such associations. Approximately one out of every four patients were prescribed benzodiazepines. Most of the patients were males aged between 18 and 50 years, single and unemployed. The most common psychiatric diagnoses were bipolar disorders and psychotic disorders, and the majority had no comorbid medical illnesses or substance use. Ninety-three per cent of the patients were prescribed long-term (more than 180 days) benzodiazepines. There were no statistically significant associations between prescribing patterns and any sociodemographic and clinical characteristics (p > 0.05). This study found that nearly all the benzodiazepine prescriptions were long-term (over 180 days) and no statistically significant associations between this practice and any sociodemographic and clinical characteristics could be established. There is high prevalence rate of long-term benzodiazepine prescription in community psychiatry clinics, and as such clinical monitoring systems need to be established and enforced.

Review finds antidepressants effective for depression comorbid with medical illness

A systematic review of 52 meta‐analyses has concluded that antidepressants improve symptoms of depression relative to placebo in patients with comorbid depression and medical illness. Antidepressants were shown to be safe overall but were associated with a higher risk of adverse events compared with placebo.

What is the prevalence of orthostatic hypotension in an Australasian emergency department population?

Orthostatic hypotension (OH) is associated with increased morbidity and there is limited research on the prevalence in the Australian ED population. The aim was to determine the prevalence of OH in an Australian ED population. Secondary outcomes included any associations of OH with symptoms, presenting complaints, patient demographics, or hospital admission, and the timing of OH findings. Patients presenting to a regional Australasian ED underwent orthostatic measurements at 1, 3 and 5 min of standing following 5 min of supine bed rest. OH was defined as a drop in systolic and/or diastolic blood pressure by ≥20 and ≥10 mmHg, respectively. Of the 312 patients who were enrolled in the study, 69 (22.1%, 95% confidence interval 17.7-27.2%) had OH and 76.8% of cases were detected after 3 min of standing. There was evidence of difference in the prevalence of OH with age (P < 0.001). Similarly, there was evidence of a difference in supine systolic and diastolic blood pressure measurements (P = 0.012 and P < 0.001, respectively) between orthostatic and normotensive subjects. No association was found with OH and hospital admission, presenting complaints or comorbid medical illnesses. In this single Australian ED population, there was a high prevalence of OH (22.1%) with most cases detected within 3 min of standing. A higher-powered study across multiple sites would better substantiate these findings.

Positive Religious Coping and Associated Factors Among Participants with Severe Mental Illness Attending Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia, 2021.

Religion has been reported to be the most widely used coping resource in stressful conditions including physical and mental illnesses. Different studies consistently find that positive religious coping is associated with a reduced level of severe mental illness such as depression. Despite its high prevalence and being a significant coping mechanism for persons with severe mental illness, there are no published studies on positive religious coping in Ethiopia. To assess the prevalence of positive religious coping and associated factors among people with severe mental illness attending outpatient service at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, northwest Ethiopia, 2021. A cross-sectional institution-based study was conducted and systematic random sampling was applied to select participants. Data were collected through a face-to-face interview. The collected data were entered into EpiData version 3.1 and exported to SPSS version 20 for processing and analysis. Multivariable logistic regression was used to identify independent factors associated with religious coping. P-value <0.05 was declared a statistically significant association with a 95% confidence interval. The prevalence of positive religious coping among severe mental illness was 72.4% (95% CI= 68.2, 76.4). Having no comorbid medical illness, good quality of life, good medication adherence, and mild subjective severity scale were associated with positive religious coping. The magnitude of positive religious coping among severe mental illness was relatively high. Not having a comorbid medical illness, good medication adherence, good quality of life, and mild subjective severity scale were factors associated with it. Patients report different factors that affect practicing positive religious coping factors. In the other direction, positive religious coping was reported to contribute to symptom alleviating and increasing a sense of well-being.

Psychological distress and associated factors among asthmatic patients in Southern, Ethiopia, 2021

BackgroundThere is an increased prevalence of psychological distress in adults with asthma. Psychological distress describes unpleasant feelings or emotions that impact the level of functioning. It is a significant exacerbating factor in asthma control. Addressing factors that contribute to psychological distress in those asthma patients improves asthma outcomes. So, this study aimed to assess the prevalence of psychological distress and associated factors among asthmatic patients at Hawassa public hospitals, Ethiopia, 2021.MethodsInstitution-based cross-sectional study design was used to select 394 asthma patients. Proportional allocation and systematic sampling techniques were used to select study participants. A logistic regression model was used to assess the predictors and psychological distress of the asthmatic patient. The association was interpreted using the odds ratio and 95% confidence interval.ResultA total of 394 asthma patients participated in the study, giving a response rate of 93.4%. The prevalence of psychological distress among asthmatic patients was 51% [95%CI: 46%-56%]. Participants who had comorbid medical illness [AOR: 6.049, 95% CI (3.131–11.684)], experienced stigma [AOR: 3.587, 95%CI (1.914–6.723)], chewed khat [AOR: 7.268, 95%CI (3.468–15.231)], had poor social support and had uncontrolled asthma were significantly associated with psychological distress in asthmatic patients.ConclusionThis study demonstrated that the prevalence of psychological distress was found to be high among asthmatic patients. Social support, stigma, chewing khat, comorbid medical illness, and poor asthmatic control had significantly associated with psychological distress in asthmatic patients.

Correlates for the severity of suicidal risk in participants with common mental disorders with comorbid chronic medical conditions in rural primary healthcare settings in India.

Suicide is on the rise in low- and middle-income countries (LMICs), including India. There are limited studies assessing factors linked to the severity of suicidal risk in patients with depression and comorbid chronic medical disorders in primary healthcare (PHC) settings. This study examines factors linked to suicidal risk among participants in a cluster randomized controlled trial of collaborative care intervention (Healthier Options through Empowerment (HOPE Study)). The setting was at 49 PHC in the rural Ramanagara District of Karnataka State in southern India. Study eligibility criteria included being ≥30 years with at least mild depression or generalized anxiety disorder and at least one medical condition (cardiovascular disorder or type 2 diabetes mellitus). The severity of suicidal risk at baseline was assessed using the Mini International Neuropsychiatric Interview (MINI), and other measures included the severity of depression (Patient Health Questionnaire-9-items (PHQ-9)), the severity of anxiety (Generalized Anxiety Disorder Scale-7-items (GAD-7)), disability, social support, quality of life, number of comorbid chronic medical illnesses, and body mass index (BMI). Chi-square tests and independent-samples t-tests were used to compare the demographic and clinical characteristics of the no-low and mod-high suicidal risk groups. Logistic regression analysis was used to identify correlates associated with the mod-high suicidal risk group. Mod-high suicidal risk was significantly positively associated with the severity of depression and disability and significantly negatively associated with social support. The severity of depression, higher disability scores, and lower social support were found to be independent correlates of mod-high suicidal risk. Screening, managing depression, and facilitating social support for patients with chronic medical illness in PHC settings may reduce suicidal risk.

Hypoalbuminemia as a risk factor for complications in revisional/conversional bariatric surgery: an MBSAQIP analysis.

Hypoalbuminemia (HA) is a risk factor for serious complications after elective bariatric surgery. Patients undergoing revisional/conversional bariatric surgery may represent a higher-risk group who often have underlying co-morbid medical illnesses and more complex surgery. This study investigated the postoperative complications in patients with HA undergoing revisional/conversional bariatric surgery. Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), years 2015-2019. The MBSAQIP database was used to evaluate patients undergoing non-banding revisional/conversional bariatric surgery between 2015 and 2019. Patients were categorized by serum albumin (≤3.5 g/dL). Variables were assessed via bivariate analysis and multivariable regression. Propensity score matching was conducted to compare gastric bypass (RYGB) to sleeve gastrectomy (VSG). One hundred forty-seven thousand four hundred thirty patients underwent revisional/conversional procedures. After applied exclusions, 58,777 patients were available for analysis. The HA group had a significantly (P < .05) higher prevalence of being black (22.95% versus 17.76%), renal insufficiency (1.08% versus .36%), smoking history (9.47% versus 6.91%), chronic obstructive pulmonary disease (COPD) (2.54% versus 1.33%), and history of deep vein thrombosis (DVT) (4.03% versus 2.3%). Postoperative complications associated with HA included perioperative blood transfusion (3.1% versus 1.27%; P < .001), 30day readmission (10.87 versus 6.77%; P < .001), 30day reoperation (4.9% versus 3.18%; P < .001), and 30day mortality (.40% versus .14%; P < .0001). HA was a significant predictor of 30day readmission in the RYGB versus VSG matched cohort (odds ratio [OR], 1.30; 95% confidence interval [CI], [1.14, 1.48]; P < .001). HA is a risk factor requiring attention for patients undergoing revisional/conversional bariatric surgery and optimization of nutritional status or medical comorbidities associated with HA prior to bariatric surgery may help avoid postoperative complications.

Foreign Nationality, Family Psychiatry History and Pregestational Neoplastic Disease as Predictors of Perinatal Depression in a Cohort of Healthy Pregnant and Puerperal Women during the COVID-19 Pandemic.

Background: Perinatal depression (PND) represents one of the most common mental disorders in the pregnancy and/or postpartum period, with a 5-25% prevalence rate. Our aim was to investigate predictors associated with PND in a cohort of pregnant and puerperal women based in an Italian setting during the COVID-19 pandemic. Methods: We retrospectively recruited 199 (55 pregnant and 144 puerperal) women, afferent to our Perinatal Mental Outpatient Service of Ancona (Italy). Participants were administered an ad hoc case-report form, Whooley Questions (WQ), the General Health Questionnaire-12 (GHQ-12), the Stress Holmes-Rahe scale (HR) and the Edinburgh Postnatal Depression Scale (EPDS). Results: Around 10% of the sample had a confirmed PND. Being a foreigner woman (RR = 3.8), having a positive psychiatric family history (RR = 5.3), a pre-pregnancy medical comorbidity (RR = 1.85) and a comorbid medical illness occurring during the pregnancy (RR = 2) were much likely associated with PND. Multiple linear regression analysis demonstrated that GHQ, medium- and high-risk at the HR, foreign nationality, positive family psychiatric history, and neoplastic disease before conception significantly predicted EPDS [F(1, 197) = 10.086, R2 = 0.324, p < 0.001]. Limitations: The sample size, poor heterogeneity in terms of socio-demographic, clinical and gynecological-obstetric characteristics, the cross-sectional design of the study. Conclusions: Our study showed a set of predictors associated with a higher risk for the PND onset, including gestational and pregestational medical disease. Our findings outline the need to screen all fertile women, particularly in gynecological and medical settings, in order to identify at-risk women for PND and promptly suggest a psychiatric consultation.

Prescribing pattern of anti-psychotic medications in patients with dementia in Oman: a retrospective observational study

BackgroundAggression, agitation, psychosis, and sleep disturbances are common behavioral symptoms of people with dementia and they can be distressing for both individuals and their carers. Due to their potential side effects, antipsychotic medications are recommended only for severe behavioral and psychological symptoms of dementia (BPSD). This study explores the prevalence, patterns, and associated factors with antipsychotic drug use among patients with dementia attending geriatric psychiatry services at Sultan Qaboos University Hospital (SQUH). Using a retrospective cross-sectional design, this study examines antipsychotic use among elderly patients aged 60 years or older with dementia who attended geriatric psychiatry services from January 2020 to December 2021. The following information was solicited: socio-demographic factors, type and severity of dementia, presence of co-morbid medical or mental illness, the psychotropic medications prescribed, the anti-psychotic medication use, duration of use, and the indication of use were solicited as well. A multivariate logistic regression analysis was conducted.ResultsThe total prevalence of anti-psychotic use among elderly patients with dementia was 56.6%, and among them, 59% were prescribed anti-psychotics for more than 2 years. Being female, having non-Alzheimer’s dementia, experiencing severe stages of dementia, and having other medical or mental co-morbid conditions were independent predictors of antipsychotic drug use (odds ratio [OR] =1.85, confidence interval [CI] =1.04–3.30; OR=2.77, C.I. 1.52–5.04; OR=4.47, C.I. 2.18–9.18; and OR=2.54, C.I. 1.11–5.78, respectively).ConclusionsAntipsychotic medication use is prevalent among elderly patients with dementia in Oman. The results from this study will help the policymakers and psychiatrists in Oman to plan for the use of non-pharmacological strategies as the first line of management for BPSD.

Anaemia in Post-Menopausal Women-A Hidden Hunger

Objective: To determine the factors of iron deficiency anaemia among the post-menopausal women in our population.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Aug 2019 to Jan 2020.&#x0D; Methodology: A total of 300 post-menopausal women were included in this study. Menopausal status was taken as one year after the last menstrual period. Iron deficiency anaemia was diagnosed, based on haemoglobin and ferritin levels. In addition,the relationship of age, age at menopause, comorbid medical illnesses and duration of menopause was assessed with the presence of iron deficiency anaemia among the post-menopausal women participating in this study.&#x0D; Results: Out of 300 post-menopausal women studied in the given period, 124(41.3%) had no anaemia, while 176(58.7%) had the iron deficiency anaemia. Furthermore, 225(75.0%) had menopause after the age of forty, while 75(25.0%) had menopause after the age of forty. After applying the binary logistic regression analysis, we found that advancing age, longer duration since menopause and presence of medical comorbidities had a statistically significant association with anaemia in the target population.&#x0D; Conclusion: This study showed a high frequency of iron deficiency anaemia among post-menopausal women. In addition, women with longer duration since menopause, advanced age and other medical illnesses were more at risk of having iron deficiency anaemia s compared to other women.

Physical Health and Activity of Inpatients under Forensic Mental Health Care: A Cross-Sectional Survey and Audit of Patients in a High Secure Setting in Queensland, Australia

Obesity and metabolic syndrome are disproportionately prevalent among people with mental disorders, particularly those subject to long periods of inpatient care where sedentary lifestyle and medication side effects can be compounding problems. This study reports on a cross-sectional survey of 28 patients under forensic mental health care in a high secure inpatient service in Queensland, Australia. The study comprises a file review, structured questionnaire and an interview, to evaluate the physical health and activity, as well as possible causes of low physical activity of these patients. Rates of overweight (50.0%), obesity (46.6%), and metabolic syndrome (39.3%) were very high within the study population. Mean waist circumference measurements were also high for both females (110.8 cm) and males (109.0 cm). Around one half of the study population (46.4%) did not meet the World Health Organization’s recommended levels of physical activity. Self-reported low levels of physical activity were significantly associated with the presence of comorbid medical illness (p = 0.007). Further research investigating the factors contributing to poor physical health and low activity levels within this population will support attempts to understand and address the physical health needs of this population.

Depressive symptoms in diabetic patients; prevalence, correlates, and moderating effect in Taif, Saudi Arabia.

Diabetes is associated with a range of psychosocial stressors that could lead to considerable distress and increased risk of depressive symptoms. There is a pressing need to understand the underpinnings of diabetes-related distress and how it evolves in connection with depressive moods, and fears related to hypoglycaemia. Our current study attempts to fill this knowledge gap and further explore the interconnections between distress, fear, and depression among Saudi diabetic patients. Descriptive questionnaire-based cross-sectional study of type II diabetes patients in a specialist diabetes clinic in Taif, Saudi Arabia. We carried out Poisson regression modelling to evaluate the correlates of depressive and distress symptoms. The study included (n = 365) patients living with type II diabetes. Cronbach's alpha for the DDS-17 was 0.93, and for HABS was 0.84, indicative of excellent internal consistency. Diabetes-related distress affected (n = 114, 22.8%) patients, whereas depressive symptoms affected (n = 190, 52.1%) patients. The mean HABS score was 32.7 points (out of 70 points) (SD = 9.8 points). High physical activity levels were found only in (n = 23, 6.3%) patients and moderate physical activity in (n = 65, 17.8%), whereas patients with low physical activity were (n = 277, 75.9%). Diabetes-related distress was associated with increased HbA1c, presence of eye disease, comorbid mental illness, heart disease, stroke, and low physical activity levels. Depressive symptoms were associated with increased HbA1c, longer diabetes duration, presence of eye disease, comorbid mental illness, comorbid neuropathy, heart disease, and low physical activity levels. Distress and depression levels are worryingly higher than previous estimates from Saudi Arabia among patients with type II diabetes, indicative of an upward trend and/or a pandemic-related jump. One significant finding from our results is the substantial effect of glycaemic control on increased distress, and depression among our type II diabetes patients. This interaction is likely due to effects on self-care and medication adherence. We also confirmed the association between depressive symptoms and the duration of diabetes. Our results indicated a connection between comorbid medical illness with depressive and distress symptoms.

Effects of Tele-Counseling on Reducing Anxiety Levels of COVID-19 Patients in Isolation Wards: An Observational Study.

COVID-19 causes psychological distress and anxiety due to fear of infection and the possibility of worsening symptoms leading to mortality. Public health measures like contact tracing and lockdowns further increase the panic among infected patients and the public. We intended to assess the effect of telecounseling in reducing anxiety in patients admitted to isolation wards. In this multi-center observational study, we administered a Generalized Anxiety Disorder-7 (GAD-7) scale before and after telecounseling. The study group consisted of participants who gave consent for telecounseling, and those who did not give consent constituted the control group. The telecounseling was based on the Psychological First Aid model, due to its simplicity. There was a statistically significant decrease in anxiety after telecounseling in the study group (P value ≤ 0.001, effect size = 0.484). There was a statistically significant decrease in anxiety in the study group compared to the control group (P value ≤ 0.001). Telecounseling contributed to the reduction in anxiety in COVID-19 patients in isolation wards. Several other factors like severity of the infection, comorbid medical illness, pre-existing mental health issues, individual's level of coping with stress, and duration and place of admission may have affected the anxiety levels in the patients.

Contrast induced nephropathy in patients of acute coronary syndrome with normal renal functions undergoing percutaneous coronary intervention

Background: Contrast induced nephropathy is a well-known entity but it is less known that whether cardiac disease is a risk factor for this complication. Contrast induced nephropathy (CIN) is related with increase mortality and morbidity and the chances of this complication rises in patients who have coronary artery disease (CAD).&#x0D; Objective: The objective of the study is to identify the frequency of contrast induced nephropathy in patients undergoing percutaneous coronary intervention who have normal baseline renal functions.&#x0D; Material and methods: This cross sectional study conducted at angiography department of Punjab Institute of Cardiology, Lahore over a period of 2 years from January 2015 to January 2017. Patients regardless of gender with age of 30 - 65 years, diabetic or non-diabetics were included. Patients with renal disease or serum creatinine &gt; 2 mg/dl at presentation or any other co-morbid medical illness, LV ejection fraction &lt;30% were excluded from study. All the patients underwent coronary angioplasty. Renal function tests were checked 48 hours after procedure. The patients who had their creatinine level raised by 0.5mg/dl after 48hrs were labeled as sufferers of contrast induced nephropathy (CIN).&#x0D; RESULTS&#x0D; Results were compiled after studying the specific variables. Out of 5400 patients who underwent coronary angioplasty, 2988 (55.4%) patients were males &amp; 2412 (44.6%) were females. Out of 5400 patients, 936 (17.33 %) suffered from CIN after PCI.&#x0D; Patients suffered from CIN when following volume of contrast was used: &lt;100ml, 36 (3.84%) patients, 100-200 ml, 288 (30.7%) patients and &gt;200ml, 612 (65.3%) patients. According to the age group following patients suffered from CIN: 30-40 years, 72 (8.6%) patients, 41-55 years, 288 (11.2 %) patients and 56-65 years 576 (28.5%) patients. Out of 2988 male patients, 324 (10.8 %) patients suffered from CIN (p=0.06). Similarly, out of 2412 females 612 (25.3 %) patients had CIN (p=0.05). In 936 patients suffering from CIN, 684(73.1%) patients were diabetic and 252 (26.9%) were non-diabetic.&#x0D; �&#x0D; Conclusion: There is a high frequency of contrast induced nephropathy in elderly and diabetic patients who undergo PCI even if they have normal preexisting renal functions, so this complication can be avoided by the minimum use of contrast during the procedure

Culture-based determinants and outcome of Staphylococcus aureus bloodstream infections

The objective of this study was to examine the occurrence, determinants, and outcome of S. aureus bloodstream infections (BSI) diagnosed based on single versus multiple positive initial cultures. All adults with first episodes of mono-microbial S. aureus BSI in Queensland during 2000-2019 were included. 10,855 (67%) and 5,421 (33%) were diagnosed based on one and multiple positive initial cultures, respectively. Patients with multiple positive initial cultures were significantly younger, more likely to have community-associated disease, have a shorter time to culture positivity, less likely to have methicillin-resistant S. aureus BSI, and have a different distribution of comorbid medical illnesses and clinical foci. The 30-day all-cause case-fatality rate was 18% and single positive initial culture was an independent risk factor for death. Among patients with S. aureus BSI, those diagnosed by single positive initial blood cultures have different clinical features and a higher risk for death.

HIV and AIDS in Older Adults: Neuropsychiatric Changes.

Patients diagnosed with HIV can now survive well into their old age. Aging with HIV is not only associated with comorbid medical illnesses but also with neuropsychiatric conditions that can range from cognitive changes to severe behavioral manifestations. This paper reviews mood, anxiety, and cognitive changes in older patients with HIV, as well as some of the treatment challenges in this population. Most recent findings show that untreated HIV illness over a long period of time may further worsen both preexisting neuropsychiatric illness and may cause new onset behavioral and cognitive symptoms. HIV induces immune phenotypic changes that have been compared to accelerated aging Low CD 4 counts and high viral counts are indicative of poor prognosis. Evaluation for potential HIV infections may be overlooked in older adults and require screening. Older adults experience accelerated CD4 cell loss. Older adults endorsing new onset mood or cognitive changes must be screened for HIV infection. New onset neurobehavioral symptoms should be carefully screened for and treated simultaneously in patients with HIV infection.

Predictors of the Third (Booster) Dose of COVID-19 Vaccine Intention among the Healthcare Workers in Saudi Arabia: An Online Cross-Sectional Survey.

Objective: The COVID-19 pandemic is still continuing throughout the world, with newer genetic variants regularly appearing from different parts of the world. Considering the waning of immunity against COVID-19 infection even with two doses of the COVID-19 vaccine, regulatory authorities have authorised booster COVID-19 vaccination in many countries, especially for vulnerable populations, including healthcare workers. The current study analysed factors predicting the third (booster) dose of COVID-19 vaccine intention, including the health belief model (HBM), among the healthcare workers in Saudi Arabia. Methods: The current study was a cross-sectional online survey performed from 1st October 2021 to 30th November 2021, using a questionnaire prepared in GoogleTM form among healthcare workers in Saudi Arabia. The questionnaire asked demographic factors, COVID-19 experience of participants, subjective assessment of health, intention of COVID-19 booster dose vaccination, preferences for local/foreign-made vaccines, and health belief of the study population related to COVID-19 infection and COVID-19 booster dose. Results: This study received 2059 complete responses. The study population reported mixed health belief with respect to the susceptibility of COVID-19 infection, and higher health belief perception regarding the severity. The perceptions of the study participants regarding the benefits of COVID-19 booster dose were positive. There were few barriers to COVID-19 booster dose expressed by study participants. A total of 1464 (71.1%) study participants reported positive intent for receiving a COVID-19 booster dose. The study showed significant association between definite intention to receive a booster dose and nationality (p = 0.001), marital status (p = 0.017), gender (p < 0.001), education level (p = 0.001), monthly income (p < 0.001), and co-morbid medical illness (p = 0.045). The perception of the COVID-19 booster vaccine as a good idea to minimise worries about getting COVID-19 (OR = 2.28, CI 1.89–2.76), and perceptions that receiving the third (booster) dose reduces the risk of COVID-19 infection and associated complications (OR= 2.69, CI = 2.17–3.34), of the perceived benefit construct of HBM, predicted significantly higher definite intention to receive a booster dose. The concern with the safety of the vaccine (OR= 0.40, CI 0.34–0.47) under the perceived barriers construct of HBM predicted as significantly higher no definite intention to receive a booster dose. Conclusions: The results of the present study can guide policy makers in their efforts to promote booster doses of COVID-19 vaccination among the healthcare workers in Saudi Arabia.

Prognostic Impact of Cardiovascular Versus Noncardiovascular Hospitalizations in Heart Failure With Preserved Ejection Fraction: Insights From TOPCAT

BackgroundPatients with heart failure (HF) with preserved ejection fraction are commonly admitted to the hospital for both cardiovascular (CV) and noncardiovascular (non-CV) reasons. The prognostic implications of non-CV hospitalizations in this population are not well understood. In this study, we aimed to examine the prognostic implications of hospitalizations owing to CV and non-CV reasons in a HF with preserved ejection fraction population. Methods and ResultsThe Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist trial (TOPCAT) randomized 3445 stable outpatients with chronic HF with a left ventricular ejection fraction of 45% or greater and either prior hospitalization for HF or elevated natriuretic peptides to treatment with spironolactone or placebo. Hospitalizations for any cause were reported by investigators during study follow-up and characterized according to prespecified category causes. This analysis focused on the subset of TOPCAT participants enrolled in the Americas (n = 1767), in which 2973 hospitalizations were observed in 1062 subjects (60%) over a mean follow-up of 3.3 years of study follow-up, of which 1474 (49%) were ascribed to CV causes. Among 1056 first hospitalizations, 478 (45%) were for CV reasons and 578 (55%) for non-CV reasons. Mortality rates were lowest for participants not hospitalized during the trial (3.2 per 100 patient-years [PY]), but similarly elevated after first hospitalization for CV and non-CV reasons (11.0 per 100 PY vs 12.6 per 100 PY, respectively; P = .24). Among those hospitalized for CV reasons, mortality rates were similar after hospitalization for HF and non-CV related reasons (15.2 per 100 PY vs 12.6 per 100 PY; P = .23). Recurrent hospitalization, whether owing to CV or non-CV causes, was associated with a heightened risk for subsequent mortality, with similar death rates after hospitalization twice for CV reasons (18.5 per 100 PY), twice for non-CV reasons (21.6 per 100 PY), or once each for CV and non-CV reasons (18.4 per 100 PY). ConclusionsAmong patients with HF with preserved ejection fraction, hospitalization for any cause is associated with a heightened risk for postdischarge mortality, with an even higher risk associated with recurrent hospitalization. Given the high burden of non-CV hospitalizations in this population, the targeted management of comorbid medical illness may be critical to decreasing morbidity and mortality.

Functional Rehabilitation: An Integrated Treatment Model for Patients With Complex Physical and Psychiatric Conditions.

The health care delivery system in the United States, structured to provide single-disease care, presents unique challenges for patients with complex physical and psychiatric comorbidities. Patients in these populations are often referred to multiple specialty clinics, encounter little continuity of care or collaboration among their providers, incur high health care costs, and experience poor treatment outcomes. Given these barriers, questions remain about the extent to which siloed and fragmented care, as opposed to the complex nature of the illnesses themselves, contribute to poor outcomes. If given the opportunity to receive well-integrated, consistent, and personalized care, can patients with historically difficult-to-treat comorbid medical and mental illnesses make progress? This article describes an innovative model of care called functional rehabilitation that is designed to address existing barriers in treatment. The functional rehabilitation program seeks to disrupt the escalating effects of interacting comorbidities by offering highly collaborative treatment from a small team of clinicians, personalized interventions using a shared decision-making framework, multipronged treatment options, colocation in a large hospital system, and significant 1:1 time with patients. The article includes a case example with longitudinal outcome data that illustrates how progress can be made with appropriate programmatic supports. Future research should examine the cost-effectiveness of this model of care.