Chronic Disease Comorbidities Research Articles

P-965. Using Simulated Corrective Mentoring to Improve Clinical Decision-Making for Patients with HIV and Identify Drivers for Treatment Choices

Abstract Background Due to the vast number of treatment options for the management of patients with HIV, providers are challenged to optimally individualize treatment based on comorbidities, viral resistance, and patient preferences. The use of corrective mentoring in continuing education (CE), is a proven method to improve clinical decision-making while identifying persisting practice challenges. Methods Vindico Medical Education and Syandus developed four virtual clinical scenarios designed to encourage optimal decision-making for patients with HIV by providing immediate feedback via simulated corrective mentoring. Results As of April 2024, 220 physicians or advanced practice providers involved in the management of patients with HIV had participated in the simulations. Across simulations, only 27% of initial decisions were optimal. At baseline, the most challenging topics regarding medication management were related to management during pregnancy (33% optimal), initial ART selection (49% optimal), and identifying candidates for injectable therapy (44% optimal). However, after corrective mentoring, there was over a 300% increase in optimal decisions made. Of optimal decisions, 48% of clinicians preferred BIC/FTC/TAF as initial treatment selection for a young male with no comorbidities and 47% preferred this regimen for an older patient with early-stage chronic kidney disease (CKD) and various other cardiovascular comorbidities. However, for a patient who is pregnant, BIC/FTC/TAF was also the preferred regimen, even though at the time of the simulation development there was insufficient data to recommend its use. These findings suggest that comfortability with certain regimens may be a driving force for clinical decision-making, even when those decisions may not be ideal. Drivers of choosing alternatives such as CAB/RPV or DTC/3TC include avoidance of weight gain, reduced pill burden, and later stage CKD. Conclusion The use of corrective mentoring in simulation-based CE is an impactful way to encourage clinical decision-making aligned with the latest evidence. Moreover, these data highlight the need to educate clinicians who manage patients with HIV on the importance of individualizing treatment based on patient characteristics. Disclosures All Authors: No reported disclosures

Disparities in anxiety and related factors among Chinese older adults across different aged-care models: a comparison of two cross-sectional studies

BackgroundAnxiety disorders in older adults have become a prominent public health problem due to their concomitant chronic conditions, reduced quality of life and even death. However, fewer studies have been conducted on differences in anxiety among older individuals in different aged-care models, and the interactive relationship between the influencing factors on anxiety remains unclear. The study aimed to examine the disparities in the prevalence of anxiety between community-dwelling and institutionalized older adults and related influencing factors.MethodsData were collected from the Anhui Healthy Longevity Survey (AHLS) and the Anhui Elderly Caring Social Organizations Survey (AECSOS). Data on demographic variables, lifestyle factors and health-related variables in 6968 older adults were used for analysis. Anxiety symptoms were evaluated using the Generalized Anxiety Disorder Assessment Scale (GAD-7). Binary logistic regression models and a Classification and Regression Tree model (CART) were utilized to examine the relationship between variables.ResultsThe prevalence of anxiety were 24.3% and 16.7% among community-dwelling older adults and institutionalized older adults, respectively. Several factors including age, gender, residence, education, income level, live alone, and number of chronic diseases showed a linkage with anxiety among community-dwelling older adults. For the institutionalized older adults, gender, residence, source of income, and number of chronic diseases exhibited a significant association with anxiety. We noted the interactive effect, suggesting that community-dwelling female older adults with an income level of less than 6500 RMB per year and reported chronic disease comorbidities had the highest likelihood of anxiety, and institutionalized female older adults with income sources such as pension, subsidy, family providing, and resident in rural areas have the greatest risk of experiencing anxiety.ConclusionsThis study has brought to light the higher risk of anxiety among community-dwelling older adults compared to institutionalized older adults. Targeted interventions are, therefore emphasized to address the negative impact of anxiety for populations at higher risk.

Trends in Co-morbid Dementia and Chronic Kidney Disease.

Little is known about the population of Medicare beneficiaries with both chronic kidney disease (CKD) and Alzheimer's disease and related dementias (ADRD). Using data from Medicare fee-for-service (FFS) beneficiaries aged 65 and over identified through 2011-2019 Master Beneficiary Summary File (MBSF), we estimated the size, growth, and racial-ethnic characteristics of the ADRD and CKD populations. Individuals were classified as having ADRD and CKD based on CMS Chronic Conditions Data Warehouse (CCW) indicators in the MBSF Chronic Conditions file. Among FFS beneficiaries, the prevalence of CKD has increased from 17.5% in 2011 to 27.9% in 2019, and the prevalence of ADRD has decreased over that time from 13.3 to 12.5%. The prevalence of individuals with co-morbid ADRD and CKD has risen from 4.4 to 6.3% which represents 1.72 million older adults. Black and Hispanic individuals have the highest prevalence of co-morbid CKD and ADRD, averaging 10.0% and 9.0% in 2019, respectively, compared to other racial-ethnic groups (≤ 7.2% all others). In addition, among those previously diagnosed with ADRD, the proportion with co-morbid CKD has been steadily increasing from 25.5% in 2011 to 44.4% in 2019. While the proportion of individuals with ADRD who have co-morbid CKD has increased across all race-ethnicities, it is highest in Black and Hispanic individuals (56.7 and 51%, respectively in 2019). The prevalence of Medicare FFS enrollees with both ADRD and CKD is increasing. Although the ADRD prevalence has declined, there is a rising number of individuals with CKD who are diagnosed with ADRD and a rising proportion of those with ADRD who also have CKD. Due to shared clinical and demographic risk factors, interventions to reduce CKD progression could also delay ADRD onset. In patients with both advanced ADRD and advanced CKD, clinicians and policymakers should focus on treatment options that consider both co-morbidities.

Common comorbidities among tuberculosis patients in Western Sudan during the Sudan armed conflict

Background: Tuberculosis continues to be the primary cause of death from infectious diseases globally. In low- and middle-income countries, TB significantly contributes to morbidity and mortality, particularly among patients with comorbidities such as HIV infection, diabetes mellitus, smoking, depression, chronic obstructive pulmonary disease, and pulmonary TB. HIV co-infection elevates the risk of progression to developed tuberculosis (TB) disease. This study evaluated comorbidity in tuberculosis among patients attending El-Obeid Teaching Hospital during the armed conflict from 2023 to 2024. Methodology: This descriptive retrospective study took place in the respiratory department of El-Obeid Teaching Hospital in North Kordofan State, Sudan. The study examined 751 patients diagnosed with tuberculosis, alongside detailed coverage files from the early years of the Sudan war. We collected the data in August 2024. We developed a thorough data collection sheet and methodically organized all pertinent data. Results: Of the 751 patients, 692 received a tuberculosis (TB) diagnosis without any comorbidities, making up 92% of the cohort. The remaining 59 patients, accounting for 8%, had TB with comorbidities: 40% with diabetes mellitus (DM), 29% with HIV, 15% with hypertension (HIN), and 7%, 6%, and 3% with chronic kidney disease (CKD), bronchial asthma, and cardiac disease, respectively. The majority of patients were over 60 years old, comprising 37% of the cohort. The majority of the patients were unemployed, and their tuberculosis treatment outcomes were complete. Conclusion: Tuberculosis (TB) with comorbidity is more prevalent in diabetic patients than in those with HIV. We recommend regular screening for chronic comorbid diseases to improve treatment outcomes and minimize complications. Additionally, promoting outpatient care is essential for improving TB management, and further surveillance is necessary to fully understand the extent of the issue.

Investigation of sexual life and perceived spousal support in female recipients after kidney transplantation.

End-stage renal failure has negative effects on sexual life, and solid kidney transplantation helps to recovery in sexuality. However, recovery in sexual life progresses slowly, and female recipients may need spousal support during this process. To examine the perceived spousal support and sexual lives of female kidney recipients in the aim of this study. The study was conducted as a descriptive and cross-sectional research. 158 female kidney recipients were included in the study. In data collection, Personal Information Form, Spousal Support Scale, and Arizona Sexual Experience Scale were used. The study data were analyzed through descriptive statistics, Mann-Whitney U test, Kruskal-Wallis test, Dunn-Bonferroni post-hoc test, and Spearman correlation analysis. In this study 47.5% of the female recipients were within the age range of 28-40 years. 43.7% had university education and above. 60.1% had their income equal to their expenses. 38% of the female kidney recipients suffered from diabetes mellitus and endocrine problems. In this study, sexual dysfunction of female kidney recipients was found to be slightly above average. The spouse support perceived by the female recipients was well above average. As a result of this study was determined that as the economic status of the female recipients improved, perceived spousal support increased (p<0.05). It was also determined that the female kidney recipients who were 40 years old and above, had poor economic status, used Tacrolimus and Cyclosporine, and had a comorbid chronic disease were under more risk in terms of poor sexual life, and their perceived spousal support was above moderate level. The sexual life of female kidney recipients is affected by their clinical situation (concomitant diseases, advanced age, medication use). On the other hand, strong spouse support can make significant contributions to improving sexual life. A correlation was found in the study between sexual life and perceived spousal support in the female kidney recipients. The findings of the study point to the importance of spousal support in terms of improving sexual lives in female kidney recipients. Studies should be conducted on these two important concepts in planning care interventions and training programs.

Combined Romosozumab and Raloxifene treatment targets impaired bone quality in a male murine model of diabetic kidney disease.

Comorbid diabetes and chronic kidney disease create a complex disease state with multi-faceted impacts on bone health, primarily reduced bone mass and tissue quality. To reduce fracture risk in this growing population, interventions are needed that target both bone mass and quality. Romosozumab (Romo) is an FDA-approved sclerostin inhibitor that has been shown to increase bone mass and strength in a murine model of combined diabetes and CKD (DKD), while Raloxifene (RAL) is a mild anti-resorptive used to treat osteoporosis that has also been shown to increase bone mechanical properties by increasing bone bound water content. We aimed to test whether combined RAL and Romo treatment could improve bone quality in our murine model of DKD more than either treatment alone. Using a previously established streptozotocin- and adenine-diet-induced model, male, C57BL/6J mice were randomly divided into four treatment groups and given daily subcutaneous injections of 100 μL vehicle (phosphorus buffered saline, PBS) or 0.5 mg/kg RAL. In addition, two groups were also given a weekly dose of Romo (10 mg/kg). Overall, Romo increased whole-bone strength and RAL improved tissue-level mechanical properties. Combined RAL-Romo treatment led to significantly higher cortical and trabecular bone mass compared to untreated controls. These morphological improvements created corresponding improvements in cortical bending strength and vertebral trabecular compression strength. These results suggest that combined RAL-Romo treatment provides both mass and quality improvements to DKD bone.

Sociodemographic Factors Associated with Chronic Obstructive Pulmonary Disease Comorbidities: Based on Indonesia Family Life Survey-5

COPD is still one of the major health problems in Indonesia. The aim of this study was to look at the relationship between sociodemographics and the incidence of comorbidities in COPD patients. Cross-sectional study design, using IFLS-5 data. Inclusion criteria were patients with a diagnosis of COPD by self-report, and at least 15 years old. Results: Of 34,252 people filling out household health questionnaires in IFLS 5, 618 subjects had COPD. Based on multivariate test, gender (aOR: 1.792 (1.282-2.506); p-value: 0.001), age 36-45 years (aOR: 1.259 (0.764-2.074); p-value: 0.028), age 46-55 years (aOR: 2.418 (1.365-4.282); p-value: 0.002), age 56-65 years (aOR: 2.418 (1.365-4.282); p-value: 0.002), and age &gt;65 years (aOR: 3.502 (1.884-6.510); p-value: 0.000). 002), age 56-65 years (aOR: 3.502 (1.884-6.510); p-value: 0.000), and age &gt;65 years (aOR: 6.508 (3.338-12.690); p-value: 0.000) had a significant association with the incidence of comorbidities in COPD patients in Indonesia.

RENAL HEMODYNAMICS IN PATIENTS WITH HYPERTENSION AND STAGE II–III CHRONIC OBSTRUCTIVE PULMONARY DISEASE

The purpose of the study is to assess the changes in renal blood flow during the combined course of essential hypertension and stage II-III chronic obstructive pulmonary disease. Participants and methods. The study included 60 patients, divided into three clinical groups: Group 1 involved 15 patients with stage II essential hypertension (mean age 52.87 ± 1.36 years; male-to-female ratio 73.33%/26.67%); Group 2 included 15 patients with stage II–III chronic obstructive pulmonary disease (COPD) (mean age 48.01 ± 2.75 years; male-to-female ratio 86.67%/13.33%); Group 3 included 30 patients with stage II–III COPD combined with stage II essential hypertension and stage I–III arterial hypertension (23 men and 7 women; mean age 57.49 ± 2.39 years). These patients had no other clinically significant concomitant pathologies and had not received systematic antihypertensive therapy. A control group of 20 healthy donors was also examined. Results. The study of renal blood flow dynamics at the levels of the common trunk, segmental, and interlobar branches of the renal artery revealed statistically significant changes, particularly in the presence of comorbidity. A notable increase in the parameters Vmax, Vmin, and Vaverage, as well as the resistive index (RI) and pulsatility index (PI), was observed in patients with chronic obstructive pulmonary disease (COPD) combined with essential hypertension. These changes indicate impaired renal hemodynamics, characterized by increased microvascular resistance in the interlobar branches. The severity of disturbances in key Doppler parameters of renal blood flow at the levels of the common trunk, segmental, and interlobar branches was associated with elevated RI and PI values in patients with the comorbidity of essential hypertension and COPD (p&lt;0.05), as well as in those with essential hypertension alone (p&lt;0.05). In contrast, patients with COPD alone exhibited higher values of Vmax, Vmin, and Vaverage at these levels of the renal artery. Conclusions. The evolution of linear velocity and vascular resistance indices in the renal vessels across the studied patient groups showed a consistent, proportional pattern, with more pronounced renal blood flow impairment observed in patients with the comorbidity of essential hypertension and chronic obstructive pulmonary disease, based on key Doppler criteria.

Impact of Persistent Combat-Related PTSD on Heart Disease and Chronic Disease Comorbidity in Aging Vietnam Veterans.

To assess combat and combat-related posttraumatic stress disorder (PTSD) as risk factors for heart disease and non-cardiac chronic disease comorbidity in deployed Vietnam veterans 50 years post-War. A random sample of 735 Vietnam-deployed American Legionnaires was surveyed in 1984, 1998, and 2000 for combat exposure, probable PTSD, and history of diagnosed chronic illnesses. Twenty-eight percent reported a diagnosed heart condition; combat exposure in Vietnam was a significant predictor (OR = 1.92, 95% confidence interval 1.13-3.31). Veterans with heart disease reported significantly more comorbid chronic illnesses, including arthritis and respiratory conditions: sleep apnea, emphysema, and asthma. Chronic illnesses were reported more often by men with PTSD. Emerging evidence suggests that 50 years after Vietnam combat and associated PTSD may contribute to heart disease and comorbid conditions.

Sexual dissatisfaction and its association with health status among older adults in China: a nationwide study.

Background Most population-based sexual health research in China excludes older adults. To fill the gap, this study aims to characterise sexual dissatisfaction among people aged 50years or older from a nationwide, population-representative sample and to explore its association with physical, mental, and self-reported overall health indicators. Methods Data were collected as part of the China Family Panel Studies in 2020, led by the Institute of Social Science Survey of Peking University. Multivariable logistic regressions with robust estimators were used to investigate the association between sexual dissatisfaction and health indicators and potential demographic confounders. Results Among the 8222 partnered Chinese adults aged 50years or older (median age: 59, IQR: 54-66, 47% identified as women), 78% (6380/8222) reported being satisfied or very satisfied in their sex life. After adjusting for demographic variables, poor self-rated health status (aOR: 1.59, 95% CI: 1.42-1.77), experiencing depression symptoms (aOR: 2.02, 95% CI: 1.80-2.26), and having chronic diseases (aOR: 1.20, 95% CI: 1.07-1.36) were positively associated with sexual dissatisfaction in multivariable analyses. Among sociodemographic factors, younger age, female gender, and education level at senior high school or above were more likely to experience sexual dissatisfaction (all P Conclusion Based on our sample, more than one in five Chinese adults aged 50years or older might face sexual dissatisfaction. Comorbidities common in older age likely exacerbate sexual dissatisfaction. Greater attention to sexual satisfaction research and sexual health programs among older adults is needed with respect to gender differences and chronic disease comorbidities.

The Problem of Assessing the Extent of Somatic Comorbidity in Patients with Major Depressive Disorder and Bipolar Disorder: Metabolic Syndrome, Cardiovascular Diseases, and Type II Diabetes Mellitus

The deleterious impact of depression on the course and outcome of somatic illness is well understood, but the subject of how somatic diseases affect the clinical picture, course, and prognosis of depression has received little attention. There is a lack of awareness on the actual level of comorbidity of somatic diseases in patients with depression, as well as the relationship of comorbidity with clinical features of the disease, patient age, sex, and diagnostic variants of depression. Metabolic syndrome (MS), cardiovascular diseases (CVDs), and type II diabetes (T2D) are the most common comorbidities, causing significant impairment and contributing to mortality rates. All these diseases are closely related to depression through shared pathophysiologic mechanisms of neuro-immuno-metabolic and cardio-metabolic nature. Inflammatory processes and genetic risk factors play a crucial role in realization of these mechanisms. Objective: The aim of this study is to analyze the existent knowledge on prevalence of MS, CVDs, and T2D in patients with major depressive disorder (MDD) and bipolar disorder (BD) in comparative aspect, taking into account possible effects of sex and age. Additionally, we strive to highlight the specific clinical features of comorbid patients. Methods: We conducted a literature review on the topic of comorbidity of MDD and BD with MS, CVDs, and T2D. We mostly selected meta-analyses and prospective studies with large samples. Results: According to current research, MS affects an average of 30-35% of individuals with both BD and MDD, with a minor predominance of male patients. CVDs are detected in an average of 18-20% of patients with BD and 25-45% of patients with MDD, also with a slight predominance of male patients. T2D affects an average of 8-10% of people with both BD and MDD, with no gender differences. There are no consistent and identifiable clinical signs that distinguish comorbid patients from non-comorbid patients for either BD or MDD. Conclusion: More research into the comorbidity of depression and chronic somatic diseases is required, particularly given the scarcity of scientific data for the Russian population.

Biochemical profiles of patients with COVID-19 during the first and second waves in Ethiopia.

Coronavirus disease 2019 (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2. Nasopharyngeal swabs (NP swabs) were used for patients with COVID-19 who demonstrated serious clinical symptoms and disturbances in biochemical parameters. The biochemical profiles of these patients remain ambiguous and differ from wave to wave of COVID-19 infections. Herein, we conducted a multicenter retrospective cohort study with 538 patients with COVID-19 at six COVID-19 treatment centers in Ethiopia. Professional data collectors collected the data. Descriptive statistics were used to summarize the data, and independent t-tests and chi-square tests were used to assess the relationships between the continuous and categorical variables across waves, respectively. In total, 240 and 298 patients were included from the first and second waves, respectively. Men and individuals aged 53-69 years were more likely to be infected in each wave. The mean alkaline phosphatase (p < 0.001) and sodium levels (p = 0.035) significantly differed between patients across the two waves of COVID-19; the significant difference in the alkaline phosphatase levels of patients between the two waves was -45.425. All the symptoms of COVID-19 were significantly (p < 0.05) associated with the waves of the pandemic. Patients in both waves had no chronic disease comorbidities. This study showed that the mean alkaline phosphatase and sodium levels differed significantly across the first two waves of the pandemic at six COVID-19 treatment centers in Ethiopia while all clinical symptoms of COVID-19 were associated with the first two waves of the pandemic.

Family function and depression in older adults with chronic comorbidities: the chain-mediated role of cognitive fusion and coping styles.

This study explores the influence of family function on depression in older adults with chronic comorbidities and the mediating roles of cognitive fusion and coping styles. The Family Adaptation Partnership Growth Affection and Resolve Index, Patient Health Questionnaire-9, Cognitive Fusion Questionnaire-Fusion, and Trait Coping Style Questionnaire were used to survey 448 community-dwelling older adults with chronic comorbidities. A mediation test was conducted using the Process 4.0 macro program. Family function was found to be significantly and negatively correlated with cognitive fusion, maladaptive coping style, and depression. Cognitive fusion and maladaptive coping style were positively correlated with depression. Cognitive fusion was positively correlated with maladaptive coping styles. Family function affected depression directly; it also affected older adults' depression through two indirect paths: through the mediating role of cognitive fusion and the chain-mediating role of both cognitive fusion and maladaptive coping style. Family function in older adults can influence their levels of depression, which is mediated by cognitive fusion and maladaptive coping styles. Based on these findings, interventions to prevent and alleviate depression in older adults with chronic disease comorbidities can be offered to improve their well-being.

IMPACT OF INFLAMMATORY RHEUMATIC DISEASES ON THE COURSE AND OUTCOME OF COVID-19

. Literature data on the risk of SARS-CoV-2 coronavirus infection in people with inflammatory rheumatic diseases (RD) are contradictory. According to most studies, the risk of infection and development of severe forms of COVID-19 is higher in patients with RD compared to the general population, but largely depends on the type and activity of RD. Patients with severe RD most often required mechanical ventilation and died more often. This is due to immune dysfunction caused by both the disease itself and antirheumatic therapy using immunomodulatory drugs. The state of immunosuppression, additional comorbid chronic diseases and incomplete vaccination are factors in the need for hospitalization, intensive care, the risk of severe COVID-19 outcomes and reinfection with coronavirus in patients with RD. They retained their significance during the spread of the SARS-CoV-2 Omicron variant. Although there is no complete consensus in the literature regarding the association between the presence of rheumatic diseases and the severity of COVID-19, in general, rheumatic diseases are not considered to be a factor that increases the severity and mortality of COVID-19. Vaccination against SARS-CoV-2 stimulates the antibody response and reduces the incidence and severity of COVID-19. However, people with rheumatic diseases have reduced or absent antibody production in response to even full vaccination and higher rates of breakthrough infection after vaccination. Further research on specific rheumatic diseases and the use of antirheumatic drugs in the context of COVID-19 is needed to reduce the severity of COVID-19 in this population.

Clinical Predictors of Medication Compliance in Patients With Acute Herpetic Neuralgia

PurposePain is one of the most common and harmful symptoms experienced by individuals with acute herpetic neuralgia (AHN). In this population, studies to determine the causes that affect patients taking medications compliance are rare. This study aimed to construct a predictive model for medication compliance of patients with AHN and to verify its performance. Design and MethodsIn this prospective study of 398 patients with AHN who were discharged from a tertiary hospital with medications from July 2020 to October 2022, we used logistic regression analysis to explore the predictive factors of medication compliance of patients with AHN and to construct a nomogram. The area under the curve was used to evaluate the predictive effect of the model. ResultsA predictive model of drug compliance of patients with AHN was constructed based on the following four factors: disease duration, pain severity before treatment, medication beliefs, and comorbidity of chronic diseases. The area under the curve of the model was 0.766 (95% confidence interval [0.713, 0.819]), with a maximum Youden's index of 0.431, sensitivity of 0.776, and specificity of 0.655. A linear calibration curve was found with a slope close to 1. ConclusionsThe prediction model constructed in this study had good predictive performance and provided a reference for early clinical screening of independent factors that affected the medication compliance of patients with AHN.

Structural and functional brain correlates of the neutrophil- and monocyte-to-lymphocyte ratio in neuropsychiatric disorders.

Skews in the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) increasingly demonstrate prognostic capability in a range of acute and chronic mental health conditions. There has been a recent uptick in structural and functional magnetic responance imaging data corroborating the role of NLR and MLR in a cluster of neuropsychiatric disorders that are characterized by cognitive, affective, and psychomotor dysfunction. Moreover, these deficits are mostly evident in setting of acute and chronic disease comorbidity implicating aging and immunosenescent processes in the manifestation of these geriatric syndromes. The studies reviewed in this special edition implicate neutrophil and monocyte expansion relative to lymphocytopenia in the sequelae of depression, cognitive and functional decline, as well as provide support from a range of neuroimaging techniques that identify brain alteartions concommitant with expansion of the NLR or MLR and the sequelae of depression, dementia, and functional decline.

Association of grip strength, sleep duration, and comorbidities with depressive symptoms in middle-aged and older patients with chronic lung diseases: a cross-sectional network analysis based on CHARLS data.

Depressive symptoms are prevalent among patients with chronic lung diseases (CLDs) and adversely impact their quality of life. This study aims to explore the association of grip strength (GS), sleep duration, and comorbidities with depressive symptoms in patients with CLDs, with an in-depth analysis of the underlying mechanisms. Based on data from the China Health and Retirement Longitudinal Study (CHARLS), this study included participants aged 45 and above with diagnosed CLDs. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression Scale (CESD-10). Binary logistic regression, subgroup analysis, and network analysis were conducted to examine the intricate relationships between GS, sleep duration, comorbidities, and specific depressive symptoms. Among the 1,427 participants, 39.8% exhibited depressive symptoms. Adjusted analyses revealed that GS (OR = 0.964, p < 0.001) and sleep duration (OR = 0.808, p < 0.001) were negatively associated with depressive symptoms, whereas the number of comorbid chronic diseases (OR = 1.189, p < 0.001) showed a significant positive correlation with depressive symptoms. Subgroup analyses demonstrated variations in these relationships across different demographic characteristics and lifestyle factors. Network analysis pinpointed "depressed" as the core symptom, with "annoyed," "exhausted," and "lonely" as secondary core symptoms. The robust associations between specific factors and depressive symptoms (GS with "annoyed," sleep and comorbid chronic diseases with "depressed") suggested potential targets for interventions. This study underscores the complex interplay of GS, sleep duration, and comorbidities with depressive symptoms in patients with CLDs. These findings offer new perspectives for improving the mental health of this vulnerable population.

Nutritional Inequality and Co-Morbid Chronic Disease Among Breast Cancer Survivors in China.

Breast cancer survivors often face an elevated risk of developing co-morbid chronic diseases, which may be exacerbated by nutritional inequalities. This study aimed to comprehensively assess the associations between nutrition literacy, dietary quality, and the risk of co-morbidity in breast cancer survivors in China. A cross-sectional study was conducted among cancer survivors enrolled in the Shanghai Cancer Rehabilitation Club from March to July 2023. The multivariable models of logistic regression, Poisson regression, and mediation analysis were used to explore the relationship between nutrition literacy, dietary quality, and co-morbid chronic diseases among breast cancer survivors in China. The mean age of the 1552 female breast cancer survivors was 64.5 ± 7.02 years. Nutrition literacy was found to be low, with 49.81% of participants scoring above the threshold for adequate nutrition literacy. The median (IQR) diet quality distance, low bound score, and high bound score were 67.0 (55.0, 81.0), -39.0 (-51.0, -28.0), and 25.0 (16.0, 36.0), respectively. Of the total female breast cancer survivors, 67.27% were reported to have at least one comorbid chronic disease. Hypertension (37.32%) was the most common co-morbid chronic disease. Each score increase of 10 in nutrition literacy (AOR 0.88, 95%CI 0.808-0.962) was associated with a significant reduction in co-morbid chronic disease risk among breast cancer survivors. Poisson regression analysis of the number of chronic diseases was conducted, and consistently, an association between higher nutrition literacy levels and fewer chronic diseases was observed (AOR 0.94, 95%CI 0.911-0.971). The indirect effect of nutrition literacy on comorbidity risk through dietary quality was not significant (indirect effect = 0.994, 95%CI = 0.980-1.008). Nutrition literacy is paramount in breast cancer survivors' dietary quality and prognosis. Enhancing nutrition literacy may be a crucial strategy for improving dietary quality and mitigating the risk of comorbid chronic diseases in this vulnerable population.

P007 A Comparison of Sleep Study Parameters between COPD+OSA (Overlap Syndrome) and Obstructive Sleep Apnoea

Abstract Background Comorbid Chronic Obstructive Pulmonary Disease (COPD) and Obstructive Sleep Apnoea (OSA)—Overlap Syndrome (OVS) is associated with worse sleep study parameters than OSA alone. The patient demographics and severity of OSA often confound these sleep study parameters. Aim: In this study, we aim to compare OVS to OSA PSG parameters in a case-control study. Methods We matched OVS and OSA patients for age, sex, BMI, and AHI, then compared the PSG data. We also compared additional measures of hypoxic burden, including desaturation severity, desaturation slope, and desaturation recovery. Results We suitably matched a total of 83 patients in each group. There were no differences in sleepiness (Epworth Sleepiness Scale; OVS 10±5 vs. OSA 10±5, P = 0.978), PVT lapses (OVS 30±30 vs. OSA 25±30, P = 0.260), or comorbidity. The OVS group has poorer quality of life (SF36 Physical Component Score (OVS 37±11 vs. OSA 41±11, P = 0.001). There were no differences in sleep duration (OVS 274±82 min vs. OSA 284±78 min, P = 0.383) or sleep efficiency (OVS 63% vs. OSA 66%, P = 0.204). There were no differences in the number of ≥3% desaturations scored (OVS 149±117 vs. OSA 125±126, P = 0.072). The OVS had greater desaturation severity (0.40% vs. 0.25%; P&amp;lt;0.035) and greater sleep time below SpO2 90% (11% vs. 1%; P&amp;lt;0.001). There were no differences in desaturation duration, desaturation slope, or recovery slope. Discussion/Conclusion When controlling for demographics and AHI, OVS shows no differences in sleep study parameters except for oxygen saturation.

Artificial intelligence-based personalized survival prediction using clinical and radiomics features in patients with advanced non-small cell lung cancer

BackgroundMultiple first-line treatment options have been developed for advanced non-small cell lung cancer (NSCLC) in each subgroup determined by predictive biomarkers, specifically driver oncogene and programmed cell death ligand-1 (PD-L1) status. However, the methodology for optimal treatment selection in individual patients is not established. This study aimed to develop artificial intelligence (AI)-based personalized survival prediction model according to treatment selection.MethodsThe prediction model was built based on random survival forest (RSF) algorithm using patient characteristics, anticancer treatment histories, and radiomics features of the primary tumor. The predictive accuracy was validated with external test data and compared with that of cox proportional hazard (CPH) model.ResultsA total of 459 patients (training, n = 299; test, n = 160) with advanced NSCLC were enrolled. The algorithm identified following features as significant factors associated with survival: age, sex, performance status, Brinkman index, comorbidity of chronic obstructive pulmonary disease, histology, stage, driver oncogene status, tumor PD-L1 expression, administered anticancer agent, six markers of blood test (sodium, lactate dehydrogenase, etc.), and three radiomics features associated with tumor texture, volume, and shape. The C-index of RSF model for test data was 0.841, which was higher than that of CPH model (0.775, P < 0.001). Furthermore, the RSF model enabled to identify poor survivor treated with pembrolizumab because of tumor PD-L1 high expression and those treated with driver oncogene targeted therapy according to driver oncogene status.ConclusionsThe proposed AI-based algorithm accurately predicted the survival of each patient with advanced NSCLC. The AI-based methodology will contribute to personalized medicine.Trial registrationThe trial design was retrospectively registered study performed in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of Nagoya University Graduate School of Medicine (approval: 2020 − 0287).