Screening For Comorbidities Research Articles

ODP422 PCOS is Associated with Increased Incidence of Co-morbidities

Abstract Background PCOS is the most common metabolic-endocrine disorder impacting women over their lifespan. It is important to understand the scope of health outcomes that impact the health and quality of life of those with PCOS in order to improve clinical and patient-centered health care in this population. Aim The aim of this study was to determine the incidence of co-morbidities in PCOS compared to age matched controls. We hypothesised that women with PCOS would have increased incidence of co-morbidities. Methods A retrospective observational case-control study in those diagnosed with PCOS and age-matched controls (>12 yrs of age in a ratio of 1: 3) was undertaken using the Alberta Health Services Health Analytics database from 2002-2019 in Alberta, Canada. International classification codes (ICD9 and ICD10) were used to determine PCOS diagnosis including visits to a health care provider, Alberta ambulatory care reporting system and Discharge Abstract Data databases. Results The incidence of several co-morbidities were 20-40% higher in PCOS (n=16531) including hypertension, dyslipidemia, cardiovascular, cerebrovascular, gastrointestinal and renal disease, metabolic syndrome, eating disorders, mental illness, depression-anxiety, rheumatoid arthritis, respiratory infections and all cancers compared to controls (n=49335) (p<0. 0001). Overweight-obesity, non-alcoholic liver disease, Type 1 diabetes and Type 2 Diabetes had a 3-fold greater incidence in PCOS compared to controls (p<0. 0001). Conclusion These findings demonstrate PCOS is a major public health concern due to increased risk of co-morbidities and associated health-care costs. These findings provide evidence-based research to support the development of strategies to improve health care; screening, management and prevention of co-morbidities in high-risk PCOS populations. Presentation: No date and time listed

Pathogenesis of psoriasis: past, present, future

Psoriasis is a common, chronic, systemic immune-mediated inflammatory disease that affects the skin, joints, and other organs and systems. Despite the fact that psoriasis is one of the most studied dermatoses, its pathogenesis has not yet been fully clarified. In recent years, the pathogenetic model leading to the formation of psoriatic papules and plaques has undergone significant changes.
 This article presents a retrospective analysis of the study of the disease over the past 60 years from the generally accepted concept of epidermal dermatosis to understanding the complex interactions between keratinocytes, dendritic cells, T-lymphocytes, neutrophils and mast cells, with a significant role of interleukins (IL) 23, 17, 22,10, T-helper cells (Th) 17, 22, T-regulatory cells, transformative growth factor b1 (TGF-b1), in the pathogenesis of the disease. Targeted therapy using new biologics and small molecules, patient education, screening for comorbidities, and regular patient follow-up allow to apply a personalized approach to the patient and achieve impressive results.
 Achievements in psoriasis research have led to the fact that today we are witnessing the so-called translational revolution in psoriasis therapy, consisting in the fastest possible transfer of fundamental discoveries of the field of theoretical research to the field of practical application.

Suicide and women living with and beyond a breast cancer diagnosis.

Early diagnosis and intervention, and the use of targeted cancer treatments, have significantly reduced mortality from breast cancer. Emotional distress following a diagnosis of cancer is a normal and anticipated, but it may manifest in some individuals at some point as a level of anxiety or depression that significantly affects quality of life and coping. In extreme cases, these feelings can move from physical symptoms of low energy and an inability to complete basic tasks to despair and hopelessness. Confronting a cancer diagnosis is a life-changing experience, bringing a sense of vulnerability. This may create or precipitate a crisis that threatens to overwhelm a person, resulting in a negative impact on established coping mechanisms. There appears to be a paucity of literature on suicide or suicide attempts by people living with and beyond a cancer diagnosis. A literature search identified 19 papers on suicide and or suicide ideation in patients who had had a cancer diagnosis, which were included in the review. Two clear themes emerged from the literature: that a cancer diagnosis with or without pre-existing mental health comorbidities is a risk factor for suicide; and that there is a significant incidence and prevalence of anxiety and depression in cancer patient populations. The literature identifies multiple variables that impact on prevalence of mental health disorders after a breast cancer diagnosis. Despite this, there appears to be a lack of guidance at national level for screening for mental health comorbidities in patients with a cancer diagnosis.

Frequency and Predictors of Falls Among Adults With Heart Failure: A Prospective Study

Adults with heart failure (HF) may be at high risk for falling due to age, comorbidities and frailty; however, few studies have examined falls in HF. The purpose of this study was to quantify the frequency and predictors of falls over 1 year among adults with HF. We conducted a prospective study of adults with New York Heart Association (NYHA) functional class I-IV HF. After baseline assessment of physical frailty and clinical characteristics, participants self-reported falls every 3 months during 1 year. Comparative statistics were used to identify baseline differences between those who fell vs those who did not. A stepwise negative binomial regression model was used to identify predictors of fall rate over 1 year. The sample (n = 111) was 63.4 ± 15.7 years old, 48% were women, 28% had HF with preserved ejection fraction, and 41% were frail. Over 1 year, 43 (39%) of participants reported at least 1 fall and 28 (25%) of participants reported 2+ falls. Among those who fell, 29 (67%) reported injurious falls. Those who fell had significantly higher body mass indexes and were more likely to have NYHA class III/IV, type 2 diabetes and HF with preserved ejection fraction and to meet slowness and physical exhaustion criteria than those who did not fall. The fall rate was elevated among those with type 2 diabetes and those meeting the slowness and physical exhaustion criteria for physical frailty. Nearly 40% of adults with HF experienced a fall within 1 year. Screening for comorbidities, slowness and exhaustion may help to identify those at risk for a fall.

Cross-Sectional Analysis of Mental Health among University Students: Do Sex and Academic Level Matter?

University students’ mental health and well-being is a growing public health concern. There is a lack of studies assessing a broad range of mental health domains by sex and academic level of study. This cross-sectional online survey of BSc, MSc, and PhD students (n = 3353, 67% female) enrolled at one university in Germany assessed a wide scope of mental health domains, covering positive (i.e., self-rated health, self-esteem, student engagement) and negative aspects (i.e., perceived stress, irritation, and screening positive for depression, anxiety, comorbidity, and psychological distress). We evaluated differences in mental health by sex and academic level. Overall, although self-rated health did not differ by sex and academic level, females and lower academic level were associated with less favorable mental health. Males reported higher prevalence of high self-esteem, and higher engagement (all p ≤ 0.04). Conversely, mean perceived stress and cognitive/emotional irritation were higher among females, as were rates for positive screenings for anxiety, anxiety and depression comorbidity, and psychological distress (p < 0.001 for all). Likewise, lower academic level (BSc) was associated with lower rates of high self-esteem (p ≤ 0.001), increased perceived stress (p < 0.001), and higher prevalence of positive screening for depression, anxiety, comorbidity, and psychological distress (p ≤ 0.002 for all), while higher academic level (PhD) was linked to increased student engagement (p < 0.001 for all). Although the effect sizes of sex and academic level on student mental health were modest, these findings support a need for action to establish and expand early detection and prevention programs, on-campus advisory services, and peer counseling that focus on the sex-specific and academic-study-level-specific factors, as well as mental health and career development resources for students. Academics and policy makers need to consider multipronged intervention strategies to boost confidence of students and their academic career.

Impacts of tuberculosis services strengthening and the COVID-19 pandemic on case detection and treatment outcomes in Mimika District, Papua, Indonesia: 2014-2021.

Indonesia is a high-burden tuberculosis (TB) country with a wide case detection gap, exacerbated by the COVID-19 pandemic. We aimed to review the epidemiology of TB in a high-endemic setting of Indonesia before and during the implementation of health system strengthening activities for TB, including during the first two years of the COVID-19 pandemic. We analysed TB program data from Mimika District, Papua, Indonesia from 2014 to 2021. Health system strengthening activities to improve the programmatic management of TB were implemented from 2017 onwards. Activities included decentralization of TB services, training and mentoring of healthcare workers, improved screening for co-morbidities, and introduction and optimisation of Xpert testing in 2018. A total of 11,803 TB cases were notified to the Mimika District Health Office over eight years (2014-21). Between 2015 and 2019, there was a 67% increase in annual case notifications, an 89% increase in bacteriologically confirmed cases and the proportion of TB cases detected in primary care increased from 26% to 46%. In 2020, coinciding with the COVID-19 pandemic, investigation of people with presumptive TB fell by 38%, but the proportion of those tested with Xpert increased. TB case notifications decreased by 19% from 1,796 in 2019 to 1,461 in 2020, but then increased by 17% to 1,716 in 2021. Routine screening for co-morbidities (HIV, diabetes) among TB patients improved over time and was not affected by the pandemic. Treatment success overall was 71% and remained relatively unchanged. Loss to follow-up and death were 18% and 3.7% respectively. Improvements in TB case finding were observed over a period in which a range of health system strengthening activities were implemented. While COVID-19 had a negative impact on the TB program in Mimika District, there are encouraging signs of recovery. Further work is needed to improve TB treatment outcomes.

Do Non Alcoholic Fatty Liver Disease Patients Have more Severe Metabolic Syndrome

Background and goal: Alcohol-unrelated fatty liver disease (NAFLD) is a frequent type of chronic liver disease (CLD) that is rapidly spreading around the world. The study's primary goal is to evaluate the severity of metabolic syndrome in people with nonalcoholic fatty liver disease. Materials and methods: From January to July 2019, Shalimar Medical and Dental College in Lahore, Pakistan, conducted this cross-sectional study. Through the use of non-probability sampling, the data was gathered. 100 patients with hepatic cirrhosis provided the data. The participants in this study ranged in age from 20 to 60. For the serum examination of liver enzymes, blood was drawn. Results: A correlation between the severity of the metabolic syndrome and NAFLD was found in this study, which included data from 100 individuals with biopsy-proven NAFLD. The patients were 45.67 3.56 years old on average. Compared to the normal control (11,3.42), the ALT levels in the patients were 258.291.73, 79.6628.63, and 50.73 8.4 correspondingly. Patients with cirrhosis, alcoholic liver disease, and viral hepatitis all had considerably higher aspartate aminotransferase levels. The significant frequency elevated aminotransferases and of NAFLD in IR-obese adolescents, as well as the potential consequences for their health, are concluded. The strong connections between NAFLD and MetS encourage the screening for additional MetS co-morbidities.

Comorbidities of Child Malnutrition in Low- and Medium-Income Countries: A Systematic Review.

The study intended to review the best evidence on prevalence, diagnosis, and treatment outcomes of comorbidities associated with child malnutrition. The study design was a systematic review of quantitative studies. Critical appraisal tools were used to assess the methodological quality of the studies. Data were extracted according to the predetermined data extraction table. Data were further analyzed narratively according to the set study objectives and main concepts. Fifteen studies were eligible to include in the review. All 15 studies reported on the prevalence of 4 child malnutrition-associated comorbidities. Five (n = 5/15) studies reported on length of hospitalization/stay, 10 (n = 10) studies on recovery rate, and 9 (n = 9/15) studies on mortality rate as treatment outcomes of child malnutrition associated comorbidities. The most prevalent child malnutrition associated comorbidities were tuberculosis, pneumonia, gastroenteritis, and anemia. The treatment outcomes identified included the length of hospitalization/stay, recovery rate, and mortality rate. Screening of prevalent comorbidities in children admitted with malnutrition should be standard procedure in practice. More research needs to be done on the diagnosis of under-5 child malnutrition associated comorbidities.

The role of a multidisciplinary heart failure clinic in optimization of guideline-directed medical therapy: HF-optimize

BackgroundGuideline-directed medical therapy (GDMT) reduces mortality and hospitalizations in adults with heart failure with reduced ejection fraction (HFrEF); however, few are receiving GDMT. National registries show as few as 1% of patients are receiving appropriate GDMT. Development of heart failure clinics achieving optimal GDMT are crucial to improve outcomes for HFrEF patients. ObjectiveWe developed a multidisciplinary HF-Optimize clinic aimed at improving GDMT use along with providing education, resources, and comorbidity screening for adults with HFrEF. MethodsWe targeted patients with newly diagnosed HFrEF and/or recent or multiple admissions for 6 visits over 12 weeks. We measured medication use, ejection fraction, 6-minute walk test distance, and health-related quality of life (EuroQol Visual Analog Scale) at visits 1 and 6. ResultsOne-hundred ten patients completed all visits. Patients were a mean age of 58 (±14) years, 37% were female, and 42% were of non-White race. From visit 1 to visit 6, utilization of GDMT increased from 35.5% to 85.5% (p < 0.001) and significant improvements in ejection fraction (25.9% to 35.5%, p < 0.001), 6-minute walk distance (1032 feet to 1121.7 feet, p = 0.001), and quality of life (63.8/100 vs 70.8/100, p = 0.002). Only 2 patients (1.8%) that completed HF-Optimize had a 30-day heart failure readmission. ConclusionOur multidisciplinary HF-Optimize clinic improved medication usage and clinical outcomes. Further studies are needed to validate outcomes of multidisciplinary GDMT clinics.

P81. Effect of psychiatric comorbidities on outcomes following anterior cervical discectomy and fusion

<h3>BACKGROUND CONTEXT</h3> The incidence and prevalence of psychiatric disorders is increasing both domestically and internationally. Numerous studies have linked psychiatric comorbidities to increased health risks, poor treatment outcomes and higher use of health care resources. <h3>PURPOSE</h3> To assess the relationship between psychiatric comorbidities and medication use with outcomes following anterior cervical discectomy and fusion. <h3>STUDY DESIGN/SETTING</h3> Retrospective chart review of all patients undergoing anterior cervical discectomy and fusion over the course of 8 months at a local community hospital. <h3>PATIENT SAMPLE</h3> A total of 79 patients underwent anterior cervical discectomy and fusion. The mean age was 55.7 years. <h3>OUTCOME MEASURES</h3> Length of stay, disposition. <h3>METHODS</h3> Seventy-nine patient charts were reviewed retrospectively over the course of 8 months at Monmouth Medical Center. The procedure as well as age were recorded. DSM-V psychiatric diagnoses were noted in the patients' problem list or admission diagnoses. Psychiatric medications from the admission medical reconciliation were recorded. Lastly, disposition was noted (rehabilitation facility versus home) for each patient. <h3>RESULTS</h3> Of the 79 patients included in this study, 31 had a diagnosed DSM-V psychiatric disorder. Of the patients with psychiatric diagnoses, 15 had anxiety, 11 had depression, 1 had bipolar disorder, 1 had obsessive compulsive disorder, 4 with both anxiety and depression and 1 had diagnosed with anxiety and bipolar disorder. The average length of stay for all patients was 1.4 +/- 1.0 days. For those with depression, the average length of stay was 1.5 +/- 0.9 days. In patients with anxiety, the average length of stay was 1.6 +/- 1.5 days. Lastly in patients with bipolar disorder, the average length of stay was 3 +/- 0 days. When compared to patients without psychiatric diagnoses, the difference in length of stay was statisically significant only for patients with bipolar disorder (p = .000408). In addition, patients with psychiatric diagnoses had a higher rate of nonroutine disposition compared to those without psychiatric diagnoses (OR 15.9, p 0.0471). Lastly, the difference in length of stay in patients taking psychoactive medications (1.7 +/-1.4 days) versus those that did not (1.23 +/- 0.6 days) was statistically significant (p 0.021523). <h3>CONCLUSIONS</h3> Patients with bipolar disorder and those that take psychiatric medications may be at risk for increased length of stay following anterior cervical discectomy and fusion. Additionally, patients with psychiatric diagnoses are at a higher risk for discharge to a rehabilitation facility compared to home. Patients undergoing anterior cervical discectomy and fusion may benefit from presurgical screening for psychiatric comorbidities. This may lead to improved patient expectations regarding discharge and a better understanding of outcomes in this population. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.

Prevalence of chronic comorbidities in people with multiple sclerosis: descriptive study based on administrative data in Tuscany (Central Italy)

ObjectiveChronic comorbidities are common in people with multiple sclerosis (PwMS), thus worsening their prognosis and quality of life, and increasing disease burden. The aim of the present study was to evaluate the prevalence of common comorbidities in PwMS in Tuscany (Central Italy) and to compare it with the general population.MethodsThe prevalence of comorbidities, including diabetes, chronic obstructive pulmonary disease (COPD), hypertension, stroke, heart failure (HF), cardiac infarction and ischemic heart disease (IHD), was assessed in PwMS and in general population resident in Tuscany, aged > 20 years, using administrative data.ResultsIn total, we identified 8,274 PwMS. Among them, 34% had at least one comorbidity, with hypertension being the most common (28.5%). Comparing PwMS with the general population, PwMS had a higher frequency of hypertension and stroke when considering the whole group, and of diabetes, COPD, and IHD when considering sex and age subgroups. This increased risk was especially evident in the young and intermediate age groups, where multiple sclerosis may play an important role as risk factor for some comorbidities.In PwMS, as well as in the general population, prevalence of chronic diseases was higher in males and increased with age.ConclusionsComorbidities frequently coexist with multiple sclerosis and they may have an impact on this complex disease, from the health, clinical, and socioeconomic points of view. Therefore, a routine screening of chronic comorbidities should be a crucial step in clinical practice, as well as the promotion of healthy lifestyles to prevent the onset and to reduce their burden.

Describing the natural history of clinical, biochemical and radiological outcomes of children with familial partial lipodystrophy type 2 (FPLD2) from the United Kingdom: A retrospective case series.

Familial partial lipodystrophy type 2 (FPLD2) results from autosomal dominant mutations in the LMNA gene, causing lack of subcutaneous fat deposition and excess ectopic fat accumulation, leading to metabolic complications and reduced life expectancy. The rarity of the condition means that the natural history of FPLD2 throughout childhood is not well understood. We report outcomes in a cohort of 12 (5M)children with a genetic diagnosis of FPLD2, under the care of the UK National Severe Insulin Resistance Service (NSIRS)which offers multidisciplinary input including dietetic, in addition to screening for comorbidities. To describe the natural history of clinical, biochemicaland radiological outcomes of children with FPLD2. A retrospective case note review of children with a genetic diagnosis of FPLD2 who had been seen in the paediatric NSIRS was performed. Twelve (5M)individuals diagnosed with FPLD2 via genetic testing before age 18 and who attended the NSIRS clinic were included. Relationships between metabolic variables (HbA1c, triglycerides, fasting insulin, fasting glucose and alanine transaminase[ALT]) across time, from first visit to most recent, were explored using a multivariate model, adjusted for age and gender. The age of development of comorbidities was recorded. Three patients (all female) developed diabetes between 12 and 19 years and were treated with Metformin. Onefemale has hypertrophic cardiomyopathy and four(1M)patients developed mild hepatic steatosis at a median [range]age of 14(12-15)years. Three (1M)patients reported mental health problems related to lipodystrophy. There was no relationship between biochemical results and age. Patients with diabetes had higher concentrations of ALT than patients who did not have diabetes, adjusted for age, gender and body mass indexstandard deviation scores. Despite dietetic input, some patients, more commonly females, developed comorbidities after the age of 10. The absence of relationships between biochemical results and age likely reflects a small cohort size. We propose that, whileclinical review and dietetic support are beneficial for children with FPLD2, formal screening for comorbidities before age 10 may not be of benefit. Clinical input from an multidisciplinary team including dietician, psychologistand clinician should be offered after diagnosis.

Neglected Comorbidity of Chronic Heart Failure: Iron Deficiency.

Iron deficiency is a significant comorbidity of heart failure (HF), defined as the inability of the myocardium to provide sufficient blood flow. However, iron deficiency remains insufficiently detected. Iron-deficiency anemia, defined as a decrease in hemoglobin caused by iron deficiency, is a late consequence of iron deficiency, and the symptoms of iron deficiency, which are not specific, are often confused with those of HF or comorbidities. HF patients with iron deficiency are often rehospitalized and present reduced survival. The correction of iron deficiency in HF patients is associated with improved functional capacity, quality of life, and rehospitalization rates. Because of the inflammation associated with chronic HF, which complicates the picture of nutritional deficiency, only the parenteral route can bypass the tissue sequestration of iron and the inhibition of intestinal iron absorption. Given the negative impact of iron deficiency on HF progression, the frequency and financial implications of rehospitalizations due to decompensation episodes, and the efficacy of this supplementation, screening for this frequent comorbidity should be part of routine testing in all HF patients. Indeed, recent European guidelines recommend screening for iron deficiency (serum ferritin and transferrin saturation coefficient) in all patients with suspected HF, regular iron parameters assessment in all patients with HF, and intravenous iron supplementation in symptomatic patients with proven deficiency. We thus aim to summarize all currently available data regarding this common and easily improvable comorbidity.

Care Pattern for Fontan-Associated Liver Disease by Academic Pediatric Hepatologists in Canada.

The current study aims to determine academic pediatric hepatologists' practices and identify variability in management provided to children with FALD in Canada. Using the infrastructure of the Canadian Pediatric Hepatology Research Group, a nationwide survey was distributed electronically to all pediatric hepatologists practicing in university-affiliated hospitals. Twelve pediatric hepatologists from 12 of 13 academic centers (92%) responded to the survey. The institutions of only 2 (17%) physicians offer post-Fontan care with a multidisciplinary team, both from different provinces. The screening for other comorbidities, use of noninvasive modality, and timing of liver biopsy for estimation of liver fibrosis and screening for esophageal varices differ from program to program. The frequency of outpatient clinic follow-up varies significantly. Education and counseling concerning liver health are generally used as treatment; only 58% of academic centers have a formal adult care transition plan. Significant discrepancies exist in the care provided to children with FALD by hepatologists practicing in academic centers across Canada. Future study is needed to develop a standardized protocol for managing and following children and youth with FALD.

Update on the Management of Pediatric Psoriasis: An Italian Consensus.

IntroductionPsoriasis affects children with a considerable burden in early life. Treating pediatric psoriasis is challenging also because of the lack of updated specific guidelines. With the recent approval of several biologics for pediatric psoriasis and the ongoing COVID-19 pandemic, the management of young psoriatic patients is facing major changes. A revision of treatment recommendations is therefore needed.MethodsIn September 2021, a board of six Italian dermatologists convened to update treatment recommendations. The board issued evidence- and consensus-based statements covering relevant areas of pediatric psoriasis, namely: assessment of psoriasis severity, management of children with psoriasis, and treatment of pediatric psoriasis. To reach consensus, the statements were submitted to a panel of 24 experts in a Delphi process performed entirely via videoconference. A treatment algorithm was produced.ResultsThere was full consensus that psoriasis severity is determined by the extension/severity of skin lesions, site of lesions, and impact on patient quality of life. Agreement was reached on the need for a multidisciplinary approach to pediatric psoriasis and the importance of patient/parents education. The relevance of vaccinations, including COVID-19 vaccination, for psoriatic children was acknowledged by all participants. Management issues that initially failed to reach consensus included the screening for psoriasis comorbidities and early treatment with biologics to prevent them and the use of telemedicine to facilitate patient follow-up. There was full consensus that topical corticosteroids are the first choice for the treatment of mild pediatric psoriasis, while phototherapy and systemic therapy are used in children with moderate-severe psoriasis. According to the proposed treatment algorithm, biologics are the first line of systemic therapy.ConclusionsTargeted systemic therapies are changing the treatment of moderate-severe pediatric psoriasis, while topical corticosteroids continue to be the first choice for mild disease. Children-centered research is needed to further improve the treatment of pediatric psoriasis.

Socioeconomic and Clinical Determinants of Coronary Artery Disease in Symptom-Free Type 2 Diabetes Mellitus Patients

Background: There are global reports of rising cardiovascular burden in persons living with type 2 diabetes mellitus (T2DM) patients. The presence of coronary artery disease (CAD) increases mortality risk in T2DM patients. There are currently no data on the determinants of CAD in Nigerian T2DM patients. Objective: The objective was to determine the determinants of CAD in persons with T2DM. Methods: This was a cross-sectional study involving T2DM patients with and without CAD attending the diabetes clinic of Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. The diagnosis of CAD was made based on personal information obtained using the Rose angina questionnaire and resting electrocardiogram findings. Medical history and other clinical evaluations were done to identify the socioeconomic and clinical variables in the study participants. Data obtained were analyzed using appropriate statistical software. Results: The study involved 400 asymptomatic T2DM patients with a median age of 60 years and a female-to-male ratio of 1.3:1. Sixty-four (16%) participants had CAD. The male: female ratio in CAD and non-CAD groups was 1.8:1 and 0.7:1 (χ2 = 1.7, P = 0.22). Formal education (χ2 = 4.1, P = 0.02), upper socioeconomic class (χ2 = 5.1, P = 0.02), hypertension (χ2 = 2.2, P = 0.03), dyslipidemia (χ2 = 4.7, P = 0.02), cerebrovascular disease (χ2 = 5.2, P = 0.01), smoking (χ2 = 9.1, P = 0.01), waist circumference (Mann–Whitney U = 358, P = 0.02), carotid intima-media thickness (Mann–Whitney U = 300, P = 0.01), and ankle brachial pressure index (Mann–Whitney U = 315, P = 0.01) were significantly associated with CAD in the study participants. Multivariate logistic regression analysis showed that formal education had the least odds of predicting CAD (odd ratio [OR] =2.1, 95% confidence interval [CI] =1.6–6.2; P = 0.02), while low-density lipoprotein cholesterol had the highest odds of predicting CAD (OR = 5.2, 95% CI = 2.1–9.5, P = 0.01) among the study participants. Conclusions: Early screening for comorbidities and lipid abnormalities in T2DM patients is required, especially in those with formal education and within the high socioeconomic class.

Comorbid Psoriasis and Metabolic Syndrome: Clinical Implications and Optimal Management.

PurposeTo review the literature on guidance on the follow-up of psoriasis and its comorbidities and to provide practical recommendations.Patients and MethodsA PubMed search was conducted using MeSH terms and free text keywords related to “psoriasis”, “obesity”, “hypertension”, “diabetes”, “dyslipidemia”, “metabolic syndrome” and “Psoriatic arthritis”. The search was conducted between September 2021 and January 2022. References of selected articles were scanned to identify additional articles.ResultsRecommendations on the follow-up of hypertension, obesity, dyslipidemia, type 2 diabetes, metabolic syndrome, psoriatic arthritis, non-alcoholic fatty liver disease and inflammatory bowel disease in psoriasis patients were extracted from the included articles. These data are presented in summary tables for both adults and children. A practical and feasible approach for each comorbidity is discussed.ConclusionAwareness among dermatologists for relevant psoriasis-associated comorbidities is crucial. The dermatologist should function as gatekeeper and screen for comorbidities, in order to make timely referrals when indicated.

Psychological distress among healthcare workers accessing occupational health services during the COVID-19 pandemic in Zimbabwe

BackgroundHealthcare workers (HCWs) have experienced anxiety and psychological distress during the COVID-19 pandemic. We established and report findings from an occupational health programme for HCWs in Zimbabwe that offered screening for SARS-CoV-2 with integrated screening for comorbidities including common mental disorder (CMD) and referral for counselling. MethodsQuantitative outcomes were fearfulness about COVID-19, the Shona Symptom Questionnaire (SSQ-14) score (cutpoint 8/14) and the number and proportion of HCWs offered referral for counselling, accepting referral and counselled. We used chi square tests to identify factors associated with fearfulness, and logistic regression was used to model the association of fearfulness with wave, adjusting for variables identified using a DAG. Qualitative data included 18 in-depth interviews, two workshops conducted with HCWs and written feedback from counsellors, analysed concurrently with data collection using thematic analysis. ResultsBetween 27 July 2020–31 July 2021, spanning three SARS-CoV-2 waves, the occupational health programme was accessed by 3577 HCWs from 22 facilities. The median age was 37 (IQR 30–43) years, 81.9% were women, 41.7% said they felt fearful about COVID-19 and 12.1% had an SSQ-14 score ≥ 8. A total of 501 HCWs were offered referral for counselling, 78.4% accepted and 68.9% had ≥1 counselling session. Adjusting for setting and role, wave 2 was associated with increased fearfulness over wave 1 (OR = 1.26, 95% CI 1.00–1.60). Qualitative data showed high levels of anxiety, psychosomatic symptoms and burnout related to the pandemic. Mental wellbeing was affected by financial insecurity, unmet physical health needs and inability to provide quality care within a fragile health system. ConclusionsHCWs in Zimbabwe experience a high burden of mental health symptoms, intensified by the COVID-19 pandemic. Sustainable mental health interventions must be multisectoral addressing mental, physical and financial wellbeing.

Exploring subtypes and correlates of internet gaming disorder severity among adolescents during COVID-19 in China: A latent class analysis.

The WHO recently included Gaming Disorder as a psychiatric diagnosis. Whether there are distinct groups of adolescents who differ based on severity of gaming disorder and their relationships with other mental health and addictive behavior outcomes, including problematic smartphone use (PSU), remains unclear. The current study explored and identified subtypes of Internet Gaming Disorder (IGD) severity and estimated the association between these subtypes and other disorders. Participants completed online questionnaires assessing the severity of IGD, PSU, depression, and anxiety during COVID-19. We conducted a latent class analysis of IGD symptoms among 1,305 Chinese adolescents (mean age = 15.2; male = 58.5%) from 11 secondary schools in Macao (SAR), China. Multinomial logistic regression estimated correlates of latent class membership and PSU. A 4-class model adequately described the sample subgroups. Classes were labeled as normative gamers (30.9%), occasional gamers (42.4%), problematic gamers (22.7%), and addictive gamers (4.1%). Relative to normative gamers, PSU severity, depression, and being male were significantly higher among problematic gamers, addictive gamers, and occasional gamers. Only problematic gamers showed significant positive associations with anxiety severity compared to the other groups. The study revealed the differences in severity of gaming disorder and its association with psychopathology outcomes. Application in screening for IGD and comorbidity is discussed.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12144-022-03133-8.

An international survey on patterns of practice in NAFLD and expectations for therapies-The POP-NEXT project.

Differences between countries in NAFLD patient care pathways and management need to be understood prior to defining supranational guidelines. We conducted an anonymous survey in France, Germany, Hong Kong, Italy, Romania, Spain, the United Kingdom, and the United States among physicians providing specialist care for patients with NAFLD. Modalities of patient referral, patterns of practice (diagnosis, staging, monitoring, and indications for liver biopsy), therapeutic management, and expectations for future NASH pharmacotherapies were assessed, with 664 physicians completing the survey. Referral to surveyed physicians (SPs) mostly came from primary care. Prior to referral, NAFLD was rarely diagnosed, and noninvasive tests were not performed. Screening for comorbidities by SPs was incomplete and cardiovascular risk not calculated. Elastometry in combination with a serum biomarker was the most common first-line method for fibrosis staging. Liver biopsy, when performed, was often delayed by at least 1 year after diagnosis. It was, however, recommended even if noninvasive methods indicated advanced fibrosis. Frequent, biannual monitoring was conducted, including HCC surveillance in Stage 3 fibrosis. SPs rarely implemented and followed dietary and lifestyle changes themselves, and local availability of such programs was highly heterogenous. SPs favored pharmacotherapy based on mechanism of action adapted to the stage of the disease, including for early stages such as steatohepatitis with mild fibrosis. This international survey revealed major deficiencies and delays in referral pathways, suboptimal screening for comorbidities or managing of lifestyle modifications by SPs, and limited local availability for nonpharmacological interventions. Monitoring practices are not aligned with current guidelines.