Comorbid Risk Factors Research Articles

Abstract 10346: Peripheral Vascular Disease Hospitalizations with Cardiovascular Disease Risk and Major Adverse Cardiac and Cerebrovascular Events Occur at Increasingly Younger Age Across Two Nationwide Cohorts Selected 10-Years Apart

Introduction: There have been increasing hospitalizations among young adults for peripheral vascular disease (PVD) in the last decade. We compared the mean age of young PVD admissions with cardiovascular comorbidities and major adverse cardiac and cerebrovascular events (MACCE) across two national cohorts 10-years apart. Methods: Two nationwide cohorts from 2007 and 2017 were analyzed for mean age at presentation with CVD risk factors and MACCE in young (18-44 years) PVD hospitalizations. Age at admission was reported as Mean± SD and compared between two groups using student’s t-test. Results: A total of 37,099 admissions in 2007 and 46,760 admissions in 2017 were identified for PVD among young adults. Total admissions increased from 0.4% to 0.5%.The 2017 cohort showed that non-elective PVD admissions occurred at significantly younger age (mean 35 vs 38 years) compared to 2007 cohort. Patients with PVD had comorbid risk factors including hypertension, diabetes mellitus, smoking, obesity, and congestive heart failure (CHF) with a mean age of 39±5 years at presentation in 2007 which decreased to 38±6 years for hypertension and diabetes, 36±6 years for smoking and 37±6 years for CHF and obesity (p<0.001) in 2017. Mean age for MACCE in PVD was 39±5 years in 2007 cohort which significantly reduced to 36±7 years in 2017 (p<0.001) (Table 1). Acute myocardial infarction, cardiogenic shock and PCI procedures were recorded at a younger age in 2017 PVD cohort vs. 2007 PVD cohort. Similarly, the 2017 PVD cohort included relatively younger patients experiencing ventricular tachyarrhythmias and stroke. Conclusions: This study from two young cohorts selected 10-years apart shows increasing trends in PVD hospitalizations occurring at a significantly younger age with associated cardiovascular comorbidities and MACCE in recent years. The link between young age and complicated/severe PVD admissions with frequent comorbidities should be further investigated.

A Multi-Center Retrospective Review of COVID-19 Outcomes in Patients with Lymphoid Malignancy

A Multi-Center Retrospective Review of COVID-19 Outcomes in Patients with Lymphoid Malignancy

Increased Perceived Age as a Risk Factor for All-cause Mortality and Comorbidities: A Systematic Review

INTRODUCTION: Chronological age has been identified as a major risk factor for a wide variety of pathologies, also serving as a mortality predictor. However, same-aged patients’ diverse health outcomes put its predictor role for reconsideration. Biological age is a measure based on physical, physiological, cellular, and biochemical parameters and might reflect a person’s aging process more accurately. A higher biological age or its isolated components have been associated with a higher risk of developing several chronic diseases and increased mortality risk. Perceived age, defined as how old a person looks to external evaluators, reflects the underlying biological age. Therefore, this review aimed to find whether perceived age is associated with mortality risk or comorbidity outcomes. METHODS: PubMed, EMBASE, and CINAHL were inquired on July 27, 2020. Mesh terms related to perceived age, mortality, and the most prevalent chronic diseases in the United States (including heart disease, cancer, and diabetes) were used. Studies were included if they (1) measured perceived age or isolated facial characteristics of old age, (2) measured mortality risk, mortality rate, or comorbidity outcomes, and (3) were in English. RESULTS: Of the 977 studies, 15 fulfilled the inclusion criteria. Follow-up periods ranged from 2 to 15 years. Same age younger-looking people were used as control groups in all studies. Four studies correlated perceived age with all-cause mortality risk. These studies found that mortality risk increased by 6%–51% in older-looking people (HR 1.06–1.51, P < 0.05) compared with controls. This association was found in women in only one study (HR 1.51, P < 0.05). One study correlated isolated facial characteristics with mortality risk, finding a decreased mortality risk in men with no gray hair (RR 0.81, P < 0.05) and increased mortality risk in women with arcus senilis (RR 1.13, P < 0.05 for half arcus; RR 1.25, P < 0.05 for complete arcus). Two studies measuring mortality rate found deceased patients to look between 1.04 and 1.15 years older than same-aged survivors (P < 0.05). Nine studies correlated perceived age or isolated facial characteristics with different comorbidity parameters. Older-looking people were found to have a higher carotid intima-media thickness (P < 0.01). Breaking down perceived age by facial characteristics, pigmentation showed a significant positive correlation with carotid intima-media thickness (P < 0.05). Younger-looking patients were found to have lower cardiovascular risk (P < 0.01). Additionally, gray hair increased the risk of myocardial infarction in men (RR 1.91, P < 0.01). Older-looking people were also found to have decreased cognitive function and lower bone mineral density (P < 0.01). Lastly, high wrinkle scores were associated with low forced expiratory volume in one second (P < 0.05), the extent of emphysema on computed tomography (P < 0.05), and increased the risk of chronic obstructive pulmonary disease (P < 0.05). CONCLUSIONS: Measurement outcomes differed among included studies and, although perceived age promises to be a useful predictor of mortality and comorbidities, further characterization of its role as a risk factor and its application in general practice is warranted.

Comorbid mental health issues in patients with pemphigus vulgaris and pemphigus foliaceus.

The term 'pemphigus' refers to chronic autoimmune skin disorders that cause blistering erosions on the skin and oral mucosa. The two major clinical forms are pemphigus vulgaris and pemphigus foliaceus. Although rare, they confer a stark symptomatic burden upon patients that significantly impacts daily life. Comorbid mental health issues are not routinely screened for in patients with pemphigus, and current UK guidance provides no formal provision for the identification and treatment of psychological issues. This review is the first of its kind, to our knowledge, to systematically examine the available evidence on mental health issues in pemphigus. Published work suggests that the incidence of anxiety and depression is much higher in patients with pemphigus compared with both the general population and with patients having other chronic skin disorders. Disease severity appears to be closely linked to mental health, with worsening of pemphigus associated with deteriorations in psychological wellbeing. Corticosteroids, which are associated with depression in chronic use, are the current first-line therapy for pemphigus and have been identified as a potential confounder and independent risk factor for mental health comorbidity in pemphigus. Current evidence is unclear whether a bidirectional relationship exists between mental health and pemphigus severity, and more thorough research is required to develop understanding of this issue. In conclusion, we have identified a high incidence of mental health comorbidity in pemphigus, and recommend routine screening of patients with pemphigus for mental health issues and signposting toward mental health services as an initial measure to address this.

Workflow Automation for a Virtual Hypertension Management Program.

Objectives Hypertension is a modifiable risk factor for numerous comorbidities and treating hypertension can greatly improve health outcomes. We sought to increase the efficiency of a virtual hypertension management program through workflow automation processes. Methods We developed a customer relationship management (CRM) solution at our institution for the purpose of improving processes and workflow for a virtual hypertension management program and describe here the development, implementation, and initial experience of this CRM system. Results Notable system features include task automation, patient data capture, multi-channel communication, integration with our electronic health record (EHR), and device integration (for blood pressure cuffs). In the five stages of our program (intake and eligibility screening, enrollment, device configuration/setup, medication titration, and maintenance), we describe some of the key process improvements and workflow automations that are enabled using our CRM platform, like automatic reminders to capture blood pressure data and present these data to our clinical team when ready for clinical decision making. We also describe key limitations of CRM, like balancing out-of-the-box functionality with development flexibility. Among our first group of referred patients, 76% (39/51) preferred email as their communication method, 26/51 (51%) were able to enroll electronically, and 63% of those enrolled (32/51) were able to transmit blood pressure data without phone support. Conclusion A CRM platform could improve clinical processes through multiple pathways, including workflow automation, multi-channel communication, and device integration. Future work will examine the operational improvements of this health information technology solution as well as assess clinical outcomes.

Demographic, lifestyle and comorbid risk factors for all-cause mortality in a Danish cohort of middle-aged adults with incident asthma

ObjectiveWe aimed to identify factors associated with all-cause mortality in adults with incident asthma.Design and settingCross-sectional cohort study, in the metropolitan areas of Copenhagen and Aarhus, Denmark.ParticipantsAdults aged 50–64 years...

Combined Effects of Insulin Resistance and Inflammation on Comorbidities of Type 2 Diabetes

Background: Insulin resistance (IR) and inflammation are closely related to each other and share common pathophysiological and metabolic mechanisms. We aimed to investigate the combined effect of IR and inflammation on comorbidities of type 2 diabetes mellitus (T2DM). Methods: A total 3,758 patients with T2DM were recruited through Huh’s Diabetes Center from January 2003 to June 2009. Insulin sensitivity was measured by a rate constant for plasma glucose disappearance (&lt;i&gt;Kitt&lt;/i&gt; , %/min) using short insulin tolerance test. High sensitivity C-reactive protein (hs-CRP) was used as a surrogate for inflammation.Results: Patients with the lowest tertile of &lt;i&gt;Kitt&lt;/i&gt; (IR group) showed worse cardio-metabolic parameters while those with the highest tertile of hs-CRP levels had worse cardio-metabolic parameters. The prevalence of metabolic syndrome, fatty liver, albuminuria, and carotid atherosclerosis decreased with &lt;i&gt;Kitt&lt;/i&gt; tertile, but increased with hs-CRP tertile. In multiple regression analysis, both &lt;i&gt;Kitt&lt;/i&gt; and hs-CRP were independent risk factors for comorbidities of T2DM. In addition, they showed synergistic effects on these comorbidities. Conclusion: Both IR and inflammation were significantly associated with comorbidities of T2DM in a dose dependent manner. In addition, the coexistence of IR and inflammation may synergistically contribute to increased comorbidities of T2DM.

A Population-Based Cohort Study on Chronic Comorbidity Risk Factors for Adverse Dengue Outcomes.

ABSTRACT.The global burden of dengue is increasing against a background of rising global prevalence of chronic noncommunicable diseases (NCDs) and an epidemiological shift of dengue toward older age groups. The contribution of NCDs toward risk for adverse clinical and healthcare utilization outcomes was assessed in a national linked-database study. About 51,433 adult dengue cases between 2014 and 2015 were assessed for outpatient and inpatient claims data in Taiwan’s National Health Insurance Research Database for the 30 days after their dengue diagnosis. A multivariable logistic regression with generalized estimating equations was used to estimate the probability of adverse dengue outcomes in patients with NCDs compared with dengue patients without underlying diseases. Rheumatoid arthritis and related disease were associated with the highest risk of hospitalization after dengue diagnosis (odds ratio: 1.78; 95% CI: 1.37–2.30), followed by stroke, chronic kidney disease (CKD), liver cirrhosis, asthma, coronary artery disease, chronic obstructive pulmonary disease, diabetes, congestive heart failure, hypertension, and malignancy. Chronic kidney disease and diabetes were associated with higher risks of hospitalization, intensive care unit (ICU) use, and all-cause mortality. After adjusting for socioeconomic status and other variables, the number of coexisting chronic diseases was associated with increasing risk of adverse dengue outcomes. Specific NCDs were associated with longer hospitalizations, ICU admission, and higher healthcare costs. Quantifying the risks of adverse dengue outcomes and health expenditures among dengue patients with preexisting NCDs provides insights for improved clinical management and essential inputs for health economic analyses on the cost-benefit of risk-based routine or catch-up immunization programs.

The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population

BackgroundAdhesive capsulitis (AC) of the shoulder, also known as frozen shoulder, causes substantial pain and disability. In cases of secondary AC, the inflammation and fibrosis of the synovial joint can be triggered by trauma or surgery to the joint followed by extended immobility. However, for primary AC the inciting trigger is unknown. The burden of the disorder among the elderly is also unknown leading to this age group being left out of therapeutic research studies, potentially receiving delayed diagnoses, and unknown financial costs to the Medicare system. The purpose of this analysis was to describe the epidemiology of AC in individuals over the age of 65, an age group little studied for this disorder. The second purpose was to investigate whether specific medications, co-morbidities, infections, and traumas are risk factors or triggers for primary AC in this population.MethodsWe used Medicare claims data from 2010–2012 to investigate the prevalence of AC and assess comorbid risk factors and seasonality. Selected medications, distal trauma, and classes of infections as potential inflammatory triggers for primary AC were investigated using a case–control study design with patients with rotator cuff tears as the comparison group. Medications were identified from National Drug codes and translated to World Health Organization ATC codes for analysis. Health conditions were identified using ICD9-CM codes.ResultsWe found a one-year prevalence rate of AC of approximately 0.35% among adults aged 65 years and older which translates to approximately 142,000 older adults in the United States having frozen shoulder syndrome. Diabetes and Parkinson’s disease were significantly associated with the diagnosis of AC in the elderly. Cases were somewhat more common from August through December, although a clear seasonal trend was not observed. Medications, traumas, and infections were similar for cases and controls.ConclusionsThis investigation identified the burden of AC in the US elderly population and applied case–control methodology to identify triggers for its onset in this population. Efforts to reduce chronic health conditions such as diabetes may reduce seemingly unrelated conditions such as AC. The inciting trigger for this idiopathic condition remains elusive.

Fifteen-Years Follow-Up in a Cohort of Children with Functional Gastrointestinal Disorders: Prevalence and Risk Factors to Develop Neuropsychiatric Disorders and Other Comorbidities.

Background: Functional gastrointestinal disorders (FGIDs) are chronic and recurrent disorders, which affect up to 23% of children and adolescents and represent 50% of gastroenterological accesses. The association between FGIDs diagnosed at paediatric age and the onset of migraine or headache and neuropsychiatric diseases in adolescence and adulthood is widely reported in the literature. However, there is still limited knowledge about the long-term prognosis and risk factors for neuropsychiatric pathologies and other comorbidities. Aim: The aim is to assess the prevalence and persistence of FGIDs as well as the occurrence of migraine or headache and neuropsychiatric disorders in a cohort of patients diagnosed with FGIDs 15 years ago compared with a control group of peers. Materials and methods: We enrolled a group of patients diagnosed with FGIDs at paediatric age, at least 10 years ago (FGIDs group, n = 79; median age 23), and control subjects (control group, n = 201; median age 23). In both groups, an online questionnaire created explicitly for the study was submitted in order to investigate the presence of chronic intestinal diseases, migraine, headache or neuropsychiatric disorders. Results: 45.6% (36 out of 79) of patients previously diagnosed with FGIDs still suffer from FGIDs versus 12% (24 out of 201) of healthy controls (p < 0.0001). The prevalence of chronic organic gastrointestinal disorders was comparable in the two groups (2.5% in FGIDs group versus 1% in healthy group, p = 0.3). Thirty-three percent (26 out of 79) of FGIDs patients reported headache or migraine versus 13% (26 out of 201) of healthy peers (p < 0.001). No differences were found regarding the prevalence of anxiety and depression. Conclusion: The outcome at 15 years of FGIDs was characterized by a high prevalence of persisting functional symptoms along with a significant incidence of headaches and migraines. Abbreviation: FGIDs: Functional gastrointestinal disorders; IBS: Inflammatory Bowel Syndrome.

Insights Into Co-Morbidity and Other Risk Factors Related to COVID-19 Within Ontario, Canada.

The worldwide rapid spread of the severe acute respiratory syndrome coronavirus 2 has affected millions of individuals and caused unprecedented medical challenges by putting healthcare services under high pressure. Given the global increase in number of cases and mortalities due to the current COVID-19 pandemic, it is critical to identify predictive features that assist identification of individuals most at-risk of COVID-19 mortality and thus, enable planning for effective usage of medical resources. The impact of individual variables in an XGBoost artificial intelligence model, applied to a dataset containing 57,390 individual COVID-19 cases and 2,822 patient deaths in Ontario, is explored with the use of SHapley Additive exPlanations values. The most important variables were found to be: age, date of the positive test, sex, income, dementia plus many more that were considered. The utility of SHapley Additive exPlanations dependency graphs is used to provide greater interpretation of the black-box XGBoost mortality prediction model, allowing focus on the non-linear relationships to improve insights. A “Test-date Dependency” plot indicates mortality risk dropped substantially over time, as likely a result of the improved treatment being developed within the medical system. As well, the findings indicate that people of lower income and people from more ethnically diverse communities, face an increased mortality risk due to COVID-19 within Ontario. These findings will help guide clinical decision-making for patients with COVID-19.

Association between obesity and iron deficiency (Review).

Obesity is a risk factor for several comorbidities and complications, including iron deficiency anemia. Iron deficiency anemia is a serious global public health problem, with a worldwide prevalence. The high prevalence of obesity in combination with iron deficiency incidence observed in different age and sex categories suggests an association between obesity and iron status. Obesity may disrupt iron homeostasis, resulting in iron deficiency anemia. The association between obesity and iron deficiency may be due to increased hepcidin levels mediated by chronic inflammation. Hepcidin is a small peptide hormone that functions as a negative regulator of intestinal iron absorption. Significant body weight loss in overweight and obese individuals decreases chronic inflammation and serum hepcidin levels, resulting in improved iron status due to increased iron absorption. However, further randomized controlled trials are required to confirm this effect.

Suicidality in individuals with Prader-Willi syndrome: a review of registry survey data

IntroductionPrader–Willi syndrome (PWS) is a rare, genetic, neurodevelopmental syndrome associated with hyperphagia and early onset obesity, growth and sex hormone insufficiencies, mild-to-moderate intellectual disability, and behavioral challenges such as compulsivity, anxiety, skin picking, social skills deficits and temper outbursts. Given high rates of psychiatric comorbidity and potential risk factors for suicide in PWS, this study sought a first estimate of the prevalence of suicidal ideation (SI) and attempts (SA) in the PWS population and any characteristics associated with suicidality in this population.MethodsUsing the Global Prader-Willi Syndrome Registry, we included all participants who had answered a question about SI. We examined the most recent data from the surveys about social, economic, and demographic factors, genetic subtype, and psychiatric symptoms and treatments. A chi-square analysis was used to compare registry participants who reported SI to those without reported SI.ResultsFrom 750 included survey respondents, 94 (12.5%) endorsed some history of SI. Of these, 25 (26.6%) also reported a history of SA, with an average age of 16.25 years at their first attempt. Those with a history of SI were predominantly male and adult age, and had higher rates of aggression and psychiatric comorbidities, therapies, and medications.ConclusionsThis study indicates that the rate of SI and SA in PWS is comparable to the general population, and that suicide attempts in PWS typically begin in middle-teenage years. Despite unique challenges, individuals with PWS and their caregivers should be included in screens and psychoeducation for suicide and mental health concerns.

RNA sequencing of blood in coronary artery disease: involvement of regulatory T cell imbalance

BackgroundCardiovascular disease had a global prevalence of 523 million cases and 18.6 million deaths in 2019. The current standard for diagnosing coronary artery disease (CAD) is coronary angiography. Surprisingly, despite well-established clinical indications, up to 40% of the one million invasive cardiac catheterizations return a result of ‘no blockage’. The present studies employed RNA sequencing of whole blood to identify an RNA signature in patients with angiographically confirmed CAD.MethodsWhole blood RNA was depleted of ribosomal RNA (rRNA) and analyzed by single-molecule sequencing of RNA (RNAseq) to identify transcripts associated with CAD (TRACs) in a discovery group of 96 patients presenting for elective coronary catheterization. The resulting transcript counts were compared between groups to identify differentially expressed genes (DEGs).ResultsSurprisingly, 98% of DEGs/TRACs were down-regulated ~ 1.7-fold in patients with mild to severe CAD (> 20% stenosis). The TRACs were independent of comorbid risk factors for CAD, such as sex, hypertension, and smoking. Bioinformatic analysis identified an enrichment in transcripts such as FoxP1, ICOSLG, IKZF4/Eos, SMYD3, TRIM28, and TCF3/E2A that are likely markers of regulatory T cells (Treg), consistent with known reductions in Tregs in CAD. A validation cohort of 80 patients confirmed the overall pattern (92% down-regulation) and supported many of the Treg-related changes. TRACs were enriched for transcripts associated with stress granules, which sequester RNAs, and ciliary and synaptic transcripts, possibly consistent with changes in the immune synapse of developing T cells.ConclusionsThese studies identify a novel mRNA signature of a Treg-like defect in CAD patients and provides a blueprint for a diagnostic test for CAD. The pattern of changes is consistent with stress-related changes in the maturation of T and Treg cells, possibly due to changes in the immune synapse.

Association of Systemic Inflammation with Depressive Symptoms in Individuals with COPD.

RationaleDepression is a prevalent comorbidity of chronic obstructive pulmonary disease (COPD) that, along with COPD, has been associated with inflammation. An association between inflammation and depression in COPD has not been validated in a large COPD cohort.MethodsIndividuals from the University of Pittsburgh SCCOR cohort and the COPDGene cohort with tobacco use history and airway obstruction (FEV1/FVC <0.7) were evaluated using the Beck Depression Inventory II (BDI-II) and the Hospital Anxiety and Depression Scale (HADS), respectively. Participants completed symptom-related questionnaires and plasma IL-6 measurements. T-test, Fisher’s Exact tests and logistic regression were used for statistical analysis.ResultsThe SCCOR cohort included 220 obstructed participants: 44% female and 21.4% with elevated depressive symptoms. GOLD staging distribution was predominantly stage I and II. The COPDGene cohort included 745 obstructed participants: 44% female and 13.0% with elevated depressive symptoms. GOLD distribution was predominantly stage II and III. In the SCCOR cohort, correlation between IL-6 and depressive symptoms trended toward significance (p= 0.08). Multivariable modeling adjusted for FEV1, age, gender and medical comorbidities showed a significant association (OR = 1.70, 95% CI = 1.08–2.69). IL-6 was significantly associated with elevated depressive symptoms in COPDGene in both univariate (p=0.001) and multivariable modeling (OR = 1.52, 95% CI =1.13–2.04).ConclusionElevated plasma IL-6 levels are associated with depressive symptoms in individuals with COPD independent of airflow limitation and comorbid risk factors for depression. Our results suggest that systemic inflammation may play a significant and possibly bidirectional role in depression associated with COPD.

Contributions of specific causes of death by age to the shorter life expectancy in depression: a register-based observational study from Denmark, Finland, Sweden and Italy

BackgroundThe reasons for the shorter life expectancy of people with depression may vary by age. We quantified the contributions of specific causes of death by age to the life-expectancy gap in four European countries. MethodsUsing register-based cohort data, we calculated annual mortality rates in between 1993 and 2007 for psychiatric inpatients with depression identified from hospital-care registers in Denmark, Finland and Sweden, and between 2000 and 2007 for antidepressant-treated outpatients identified from medication registers in Finland and Turin, Italy. We decomposed the life-expectancy gap at age 15 years by age and cause of death. ResultsThe life-expectancy gap was especially large for psychiatric inpatients (12.1 to 21.0 years) but substantial also for antidepressant-treated outpatients (6.3 to 14.2 years). Among psychiatric inpatients, the gap was largely attributable to unnatural deaths below age 55 years. The overall contribution was largest for suicide in Sweden (43 to 45%) and Finland (37 to 40%). In Denmark, ‘other diseases’ (25 to 34%) and alcohol-attributable causes (10 to 18%) had especially large contributions. Among antidepressant-treated outpatients, largest contributions were observed for suicide (18% for men) and circulatory deaths (23% for women) in Finland, and cancer deaths in Turin (29 to 36%). Natural deaths were concentrated at ages above 65 years. LimitationsThe indication of antidepressant prescription could not be ascertained from the medication registers. ConclusionsInterventions should be directed to self-harm and substance use problems among younger psychiatric inpatients and antidepressant-treated young men. Rigorous monitoring and treatment of comorbid somatic conditions and disease risk factors may increase life expectancy for antidepressant-treated outpatients, especially women.

Medical therapies for prevention of cardiovascular and renal events in patients with atrial fibrillation and diabetes mellitus.

Atrial fibrillation (AF), type 2 diabetes mellitus (DM), and chronic kidney disease (CKD) are three global epidemics with significant effects on morbidity and mortality. Diabetes is a risk factor for AF, and a risk factor for thromboembolism, comorbidity, and mortality when AF is present. The pathophysiology of diabetes-related AF and interrelationships with cardiovascular events and renal events is not fully understood but is in part related to structural, electrical, electromechanical, and autonomic remodelling. The current practice guidelines offer limited recommendations on the management of patients with AF (or risk of AF) and diabetes with its own heterogeneity for the prevention of cardiovascular and renal events. This document discusses possible clinical approaches for these patients. In the last decade, there have been major improvements for the prevention of stroke in AF patients with direct oral anticoagulants, which are preferable to vitamin K antagonists for stroke prevention in DM. Because of the increased risk rate for several cardiovascular adverse events in diabetic patients, a similar relative risk reduction generally translates into greater absolute risk reduction in the diabetic population. Recent trials with non-insulin diabetes drugs using glucagon-like peptide-1 agonists and sodium-glucose cotransporter-2 inhibitors showed a significant reduction for the risk of major adverse cardiovascular events in patients with type 2 DM. Sodium-glucose cotransporter-2 inhibitors also showed a large reduction in hospitalization for heart failure and renal events, which need to be more completely evaluated in patients with AF. Mechanisms, risks, and optimal management of AF patients with DM who have or are under risk of developing heart failure or CKD are also discussed in this document. The benefits of medical therapies for these patients still need to be put into perspective, and gaps in evidence on some of these issues are likely to be addressed in future years.

Sex-specific risk profiles for suicide mortality in bipolar disorder: incidence, healthcare utilization and comorbidity.

Evidence on sex-specific incidence and comorbidity risk factors of suicide among patients with bipolar disorder is scarce. This study investigated the sex-specific risk profiles for suicide among the bipolar disorder population in terms of incidence, healthcare utilization and comorbidity. Using data from the Taiwan National Health Insurance Research Database between 1 January 2000 and 31 December 2016, this nationwide cohort study included patients with bipolar disorder (N = 46 490) and individuals representative of the general population (N = 185 960) matched by age and sex at a 1:4 ratio. Mortality rate ratios (MRRs) of suicide were calculated between suicide rates of bipolar disorder cohort and general population. In addition, a nested case-control study (1428 cases died by suicide and 5710 living controls) was conducted in the bipolar disorder cohort to examine the sex-specific risk of healthcare utilization and comorbidities. Suicide risk was considerably higher in the cohort (MRR = 21.9) than in the general population, especially among women (MRR = 35.6). Sex-stratified analyses revealed distinct healthcare utilization patterns and physical comorbidity risk profiles between the sexes. Although female patients who died by suicide had higher risks of nonhypertensive cardiovascular disease, pneumonia, chronic kidney disease, peptic ulcer, irritable bowel syndrome, and sepsis compared to their living counterparts, male patients who died by suicide had higher risks of chronic kidney disease and sepsis compared to the living controls. Patients with bipolar disorder who died by suicide had sex-specific risk profiles in incidence and physical comorbidities. Identifying these modifiable risk factors may guide interventions for suicide risk reduction.

Prevalence of obesity and associated sociodemographic factors among adolescents in Udham Singh Nagar, Uttarakhand, India

Obesity is global health concern due to its steadily rising prevalence and major risk factors for several obesity related comorbidities. This study aimed to determine the prevalence and sociodemographic factors of obesity among adolescents. A school-based cross-sectional study was conducted on 1101 school-going adolescents of 12 – 17 years studying in class 6 to 9. Anthropometric measurements were taken. The overall prevalence of overweight and obesity was estimated to be 10.4% and 4.1%, considering IAP reference standards as cut – offs. Altogether, overweight and obesity involve 14.4% of the sample. Obesity was higher in early adolescents, private school, joint family, lower socio- economic status, higher parental educational level, in high income families and in first birth order adolescents. Overweight/obesity prevalence should be taken into consideration as adolescent obesity is marker of adulthood obesity and is associated with increased rate obesity related comorbidities in adult population. A preventive programmed action considering these factors must be planned for reducing obesity among adolescents in the society.

Emergent Crisis of COVID-19 Pandemic: Mental Health Challenges and Opportunities.

Mental health is a fundamental human right and is part of the well-being of society. The public health burden of mental health disorders affects people's social and economic status around the world. Coronavirus's (COVID-19) negative impact on the economy and mental health worldwide is concerning. This is a worldwide emergency, and there is an urgent need for research about this topic to prevent long-lasting adverse effects on the population. Unpreparedness and inconsistencies in guidelines, lockdowns, containment strategies, unemployment, financial losses, physical distancing, isolation, chaos, and uncertainty are among factors that lead to a rise in emotional distress, anxiety, and depression. Governments' decisions affect the socioeconomic status of a country and the psychological well-being of the people. COVID-19 pandemic exposed disparities in multiple mental health care systems by having adverse mental health effects in people with pre-existing mental health disorders and previously healthy individuals. Aggregation of concurrent or cumulative comorbid risk factors for COVID-19 disease and its psychosocial sequelae could provide invaluable information for the public health stakeholders. This review aims to address the burden and the psychosocial impact of the COVID-19 pandemic, the challenges and opportunities facing mental health systems, and proposes new strategies to improve the mental health outcomes in the post-COVID era.