High Levels Of Comorbidity Research Articles

Ожирение и депрессия у детей и подростков: проблема коморбидности и профилактики

<p><strong>The relevance:</strong> currently, scientists talk about the epidemic of obesity among children and adolescents, which is associated with significant risks and deterioration of mental and physical health of the young generation. <strong>Objective:</strong> to study association between depression and obesity in children and adolescents. The paper presents a literature review of the widely discussed problem of the relationship between depression and obesity, as well as the results of our own empirical study obtained on a sample of patients from the Center for Treatment and Prevention of Metabolic Diseases and Obesity, FGBU «National Medical Research Center for Endocrinology» of the Ministry of Health of Russia. <strong>Sample.</strong> The study involved respondents aged 7 to 17 years (M=12,5, SD=2,5), a total of 153 people with SDS BMI from 1,2 to 4,2 (M=2,8, SD=0,5), of which 52% were female and 48% were male. The study included a diagnostic interview with the child and parents, each child was asked to fill out the Children's Depression Inventory (Maria Kovacs 1992). The <strong>results</strong> suggest a high level of comorbidity of obesity and depressive symptoms among children and adolescents ¾ 52% of girls and 27% of boys who participated in the study have symptoms of depression of varying degrees of severity. Also, more severe forms of obesity were recorded in boys compared to girls at the initial application for specialized care, which indirectly indicates a greater concern for health and appearance on the part of girls and their families. The overwhelming majority of parents of children note unhealthy eating habits, low physical activity and sleep disorders in their children. It is <strong>concluded</strong> that it is necessary to raise awareness of children, parents, teachers and child specialists of different profiles about the relationship between depressive symptoms and obesity, as well as the importance of appropriate diagnosis and the development of comprehensive treatment and prevention programs for both obesity and depression.</p>

Do mindfulness interventions cause harm? Findings from the Learning to Apply Mindfulness to Pain (LAMP) Pragmatic Clinical Trial

Abstract Background Although mindfulness-based interventions (MBIs) are widely used in clinical and nonclinical settings, there has been little systematic study of their potential risks. To address this gap, we examined differences in psychological and physical worsening among participants in the usual care and intervention conditions of a 3-group, randomized pragmatic trial (Learning to Apply Mindfulness to Pain [LAMP]) that tested the effectiveness of 2 approaches to delivering MBIs to patients with chronic pain. Methods The sample consisted of 374 male and 334 female patients with chronic pain enrolled in the LAMP trial who completed a 10-week follow-up survey, 61% of whom had a mental health diagnosis. Psychological and physical worsening was assessed by a checklist asking whether participants experienced specific symptoms since beginning the study. We used multivariable logistic regression models with imputed data to determine whether predicted probabilities of increased symptoms differed between usual care and the 2 MBIs. Results Participants in usual care were more likely to report experiencing increased psychological and physical worsening than were those in the MBIs, including an increase in disturbing memories; sadness, anxiousness, and fatigue; isolation and loneliness; and feeling more upset than usual when something reminded them of the past. Conclusions MBIs do not appear to cause harm, in terms of increased symptoms, for this population of patients with chronic pain and high levels of mental health comorbidities. Clinical trial registration Preregistration with an analysis plan at www.ClinicalTrials.gov: NCT04526158. Patient enrollment began December 4, 2020.

CHANGES IN LIPID AND CARBOHYDRATE METABOLISM IN PATIENTS WITH OSTEOARTHRITIS WITH ACCOMPANYING ARTERIAL HYPERTENSION AND TYPE 2 DIABETES, DEPENDING ON BSMI VDR GENE POLYMORPHISM

It is known that Osteoarthritis (OA) is a common chronic disease of the musculoskeletal system, which leads to a significant loss of working capacity and disability of people of working age, which worsens the quality of life of the population and causes economic burden and losses to all countries of the world. In addition, OA is known as a disease with an inherent high level of comorbidity. Scientists single out diseases of cardiovascular diseases, digestive systems and metabolic disorders as those that are most often combined with OA and complicate the course of each other in manifestations, diagnostic and treatment processes. Today, modern science needs to understand the presence of a common genetic origin. It is known that the polymorphic variant of the VDR vitamin D receptor gene has a predisposition to common osteochondral diseases. However, the issue of participation in pathogenetic mechanisms of development and progression remains controversial. A polymorphic variant of the VDR gene has a predisposition to osteochondral diseases. However, its involvement in the pathogenetic mechanisms of the development and progression of osteoarthritis remains controversial, therefore The aim of the study is to investigate the specifics of the impact of comorbid pathology on carbohydrate and lipid metabolism and the state of the vascular wall in patients with osteoarthritis, taking into account the polymorphic variant of the VDR gene (Bsml, rs1544410). Object and research methods. 100 patients were examined and also divided into groups: 1st group – patients with OA; II – OA with arterial hypertension; ІІІ – OA, arterial hypertension (AG) and type 2 diabetes mellitus, a blood sample was taken and, depending on age, comorbidity, the presence of the polymorphic variant BsmI (rs1544410) of the VDR gene, indicators of carbohydrate and lipid metabolism, the level of end metabolites of nitric oxide and endothelin-1 were studied and the impact on radiological changes and the functional state of the knee joints was evaluated. Control – 30 people. Results of the study and their discussion. It has been established that osteoarthritis is characteristic of persons of working age. With increasing age, it is characteristic to be burdened by comorbid pathologies with worsening of the course of the main disease. Expected violation of carbohydrate metabolism was observed in the III group of patients, although dynamic probable changes were also in the II group (p<0.05). Lipid metabolism in the I group was probably higher than the group of control, but was within the physiological norm, while groups II and III had significant pathological changes compared to the indicators of the I group and practically healthy persons. Hypercholesterolemia became a trigger for a decrease in the total level of stable total nitrogen monoxide metabolites and an increase in endothelin-1, which forms endothelial dysfunction and leads to the progression of AG and worsening of the course of OA. After the genotyping and division into genotypes of the polymorphic variant BsmI of the VDR gene, conclusions were obtained about the unfavorable allele A in the exchange processes of the above indicators. Conclusions. Features of violations of carbohydrate and lipid metabolism, the condition of the endothelium, against the background of comorbidity and the presence of an unfavorable allele A of the BsmI polymorphic variant of the VDR gene should be taken into account in the complex diagnostic and treatment process of patients with OA.

Substance use and psychiatric phenotypes of youth experiencing homelessness: A cluster analysis.

Due to the complex interactions of psychopathology, psychosocial stressors, and risk behaviors, characterizing high-risk phenotypic groups of transitional-age youth experiencing homelessness (TAY-EH) for targeted interventions remains difficult. We aimed to uncover specific phenotypes of TAY-EH based upon psychiatric and substance use disorder (SUD) diagnoses, and to assess relationships between these phenotypes and negative outcomes including suicidality and high-risk behaviors. Participants (N = 140; 57% male, 54% Black) were individuals aged 16-25 years accessing support at a psychosocial agency in the U.S. Northeast. Data were gathered via structured assessment. Cluster analysis identified sub-groups of TAY-EH with differing diagnostic patterns. Bivariate analyses examined associations between cluster membership and target outcomes. A four-cluster solution was identified. Cluster 1 (Co-occurring; N = 33) was characterized by high levels of comorbidity (i.e., major depressive disorder (MDD), SUD, and notable levels of other diagnoses). Clusters 2 (MDD alone; N = 47) and 3 (SUD alone; N = 18) were characterized by single diagnoses. Cluster 4 (None; N = 42) was characterized by low levels of psychopathology. Clusters differed significantly on several variables including suicidality, adverse childhood experiences, and social connectedness. Comorbid MDD and SUD were most strongly associated with high-risk behaviors and suicidality. These results highlight the importance of diagnosis and targeted interventions for co-occurring MDD and SUD to address the crisis of early mortality and other negative outcomes among TAY-EH. This study is the first to identify specific high-risk psychiatric and psychosocial phenotypes among the highly complex group of TAY-EH based upon structured diagnostic assessments.

Tapestry of postnatal emotional disorders: exploring the interplay of anxiety and depressive disorders and their associated risk factors in Sudanese women.

This research aims to unravel the prevalence of postnatal emotional disorders with a focus on how postnatal anxiety remained under-estimated and often embroiled in postnatal depression. Out of 600 postnatal women invited to take part in this study from two prominent primary care clinics in Khartoum, 468 women agreed to participate in this study. Three questionnaires were utilized in this study, a Personal Information Questionnaire (PIQ), Hospital Anxiety and Depression Scale (HADS), and Beck depression Inventory (BDI). Multiple linear regression analysis applied to gauge risk factors with postnatal anxiety and depression. More than half (52.50%) of women showed evidence of both anxiety and depression using HADS, while only (20.9%) of cases were detected by BDI, showing evidence of moderate depressive disorder. A substantial proportion (28.4%) showed high levels of comorbidity of anxiety and depression in the category of moderate to severe symptoms. Main risks factors for postnatal disorders were past psychiatric illness (β = 0.25, p = 0.001), a family history of psychiatric illness (β = 0.15, p = 0.002), and stress due to the number of children (β = 0.32, p = 0.001). This study advances our understanding of postnatal emotional disorders, particularly highlighting the prevalence as well as correlates of postpartum anxiety. More importantly, this study highlights the importance of routine screen for emotional distress in postnatal women.

Non-HACEK gram-negative bacilli infective endocarditis: data from a retrospective German cohort study

Abstract Purpose Infective endocarditis caused by non-HACEK gram-negative bacilli (GNB-IE) is rare but associated with significant morbidity and case fatality. Evidence on optimal treatment and management is limited. We aimed to describe the characteristics and management of GNB-IE patients, investigating factors associated with disease acquisition and unfavorable outcomes. Methods We conducted a retrospective descriptive single-center study (tertiary care and referral hospital) between 2015 and 2021, including adult patients with definite GNB-IE. We reviewed demographic, clinical and microbiological data, focusing on predisposing factors, clinical outcomes and 1-year mortality. Results Of 1093 patients with probable or definite IE, 19 patients (median age 69 years) had definite GNB-IE, with an increasing incidence throughout the study period. Median age-adjusted Charlson Comorbidity Index score was 4 points. Prosthetic valve IE (PVIE) was present in 7/19 (37%) patients. Nosocomial acquisition occurred in 8/19 (42%) patients. Escherichia coli and Klebsiella pneumoniae were the most common pathogens. Beta-lactam (BL) based combination therapy was applied in 12/19 (63%) patients (58% BL + fluoroquinolone, 42% BL + aminoglycoside). Cardiac surgery was required in 8/19 (42%) patients (PVIE 71%, native valve IE 25%), primarily for embolism prevention and heart failure. Complications occurred in 14/19 (74%) patients. The in-hospital mortality rate was 21% (4/19); the one-year mortality rate was 44% (7/16). One-year mortality did not significantly differ between patients who underwent cardiac surgery and patients managed with anti-infective treatment alone (p = 0.633). Conclusions GNB-IE affects elderly patients with high comorbidity levels and recent health-care exposure. GNB-IE was associated with high complication rates and high mortality.

Aggressive Hyperkalemia Treatment in the Prehospital Setting

This is a case of profound unstable hyperkalemia encountered in the American pre-hospital 911 setting, with subsequent aggressive treatment and stabilization. Although hyperkalemia may be present in the prehospital setting, it is difficult to diagnose without laboratory testing or a reliable history of illness. It is frequently encountered in the pre-hospital setting, especially in communities with high levels of comorbidities and multiple dialysis centers. However, in the spectrum of hyperkalemia presentations, many of these patients are either early in their disease presentation or found when already in cardiac arrest. Early identification and rapid, aggressive treatment are paramount to decreasing morbidity and mortality in these patient populations. This case shows how aggressive prehospital critical care can have a significant impact on patient outcomes.

Low-Grade Inflammation Associated with Major Depression Subtypes: A Cross-Sectional Study.

Major depressive disorder (MDD) is associated with inflammation and a high level of comorbidities. Atypical depression (AD) is a MDD subtype based on DSM criteria, that could have specific underlying biological mechanisms. AD is associated with elevated cardiovascular (CVD) comorbidities, higher risk of suicide attempts, hypersomnia, and anxiety disorder. In this study, we aim to investigate if AD and polysomnographic parameters could be associated with low-grade inflammation (LGI). LGI is defined by a range from 3 to 10 mg/L of C-reactive protein levels. We carried out a retrospective cohort study in which 765 individuals with MDD were split into two groups: with and without LGI. Our results exhibit differences between the groups for the polysomnographic parameters, with the LGI group showing parameters already associated with inflammation such as reduced rapid eye movement sleep and elevated hypoxemia markers (identified as CVD risk factor). We found that AD is associated with LGI (OR 1.48; p = 0.047) after adjustment. Likewise, we found an LGI prevalence in AD higher (34.8%) than in MDD without atypical features (26.8%). Overall, these results confirm the low-grade inflammation feature of AD and highlight polysomnographic parameters associated with LGI that could also act as risk factors in this context.

А COMPREHENSIVE STUDY OF PATIENTS WITH ISCHEMIC HEART DISEASE: AGE, GENDER, AND COMORBIDITY ASPECTS

The purpose of the study was to analyze the clinical characteristics, comorbid status, individual biochemical indicators, and systemic inflammation activity in patients with ischemic heart disease (IHD) depending on age, gender distribution, and diagnosis influence.Materials and methods. The study included 144 patients with IHD, who were divided into two groups – the main and the control. The main group comprised 120 patients with stable angina pectoris (SAP) II-III functional class (FC). The control group consisted of 24 patients with STEMI. All patients underwent a comprehensive examination: general clinical, anthropometric, laboratory (complete blood count, biochemical analysis), and instrumental (office blood pressure measurement, heart rate, and echocardiography). The comorbid profile of patients with IHD was assessed using the Charlson comorbidity index. The severity of systemic inflammation syndrome in the selected patient groups was assessed by the cellular composition of peripheral blood upon admission to the hospital, and based on the obtained data, the values of leukocyte inflammatory markers were calculated.Results. Patients in the main group were younger than those in the control group (54.78 ± 1.11 vs. 63.50 ± 1.82) (p<0.001). A statistically significant predominance of men over women was found among the cohort of IHD patients (63.33% and 36.67%, respectively) (p<0.001), with a tendency towards male predominance among patients with SAP II-III FC compared to those with STEMI (p = 0.074). Patients in the main group compared to those in the control group had significantly higher left ventricular ejection fraction (p<0.001), systolic blood pressure (p<0.001), and diastolic blood pressure (p=0.001). In the control group compared to the main group, more cases of patients with high levels of comorbidity were found (p<0.001). Lower levels of creatinine, fibrinogen, prothrombin time, and glucose were observed in patients in the main group. Patients with SAP II-III FC compared to those with STEMI had lower levels of leukocyte inflammatory markers, such as neutrophil-to-lymphocyte ratio (NLR) (p<0.001), systemic immune inflammation index (SII) (p=0.002), systemic inflammation response index (SIRI) (p=0.007), and aggregate index of systemic inflammation (AISI) (p=0.011).Conclusions. The study underscores the need for an individualized approach to each patient with ischemic heart disease, considering their age, gender, and comorbid characteristics, as well as laboratory peculiarities, to improve therapy outcomes and prevent complications.

A New Start with HAART: Evaluating Breast Reconstruction in the Era of Highly Active Antiretroviral Therapy.

As HIV-positive individuals utilizing highly active antiretroviral therapy live longer, the burden of breast cancer increases in the population. Breast reconstruction is an integral aspect of surgical treatment for many patients after a breast cancer diagnosis, prompting this examination of the characteristics and outcomes of breast reconstruction in this growing patient population. Using Merative MarketScan Research Databases, a large multipayer database, HIV-positive adult patients who underwent autologous or implant-based breast reconstruction between 2007 and 2021 were identified using International Classification of Disease codes and Common Procedural Terminology codes. In both HIV-positive and -negative cohorts, patient demographics, procedure-related complications, and postoperative revisions were recorded. Shapiro-Wilk, chi-square, Wilcoxon-Mann-Whitney, and multivariable logistic regression tests were used for statistical analysis. Of 173,421 patients who underwent breast reconstruction, 1816 had an HIV diagnosis. HIV-positive patients were younger (P < 0.001), underwent surgery more recently (P < 0.001), more often underwent immediate breast reconstruction (P < 0.001), and had higher comorbidity levels (P < 0.001). There was a regional variation in which the patient cohorts underwent breast reconstruction. There was no significant difference in overall complication rates between patient groups, but HIV-negative patients more often underwent revision procedures (P = 0.009). When compared to their HIV-negative counterparts, breast reconstruction can be considered safe and efficacious in patients living with HIV. HIV-positive patients are a growing demographic who seek breast reconstruction, and surgeons must continue to further understand the unique implications of breast reconstruction in this population.

(115) SEXUAL SELF-ESTEEM IN TWO SAMPLES OF ADOLESCENT AND YOUNG ADULT CANCER SURVIVORS: A QUALITATIVE INVESTIGATION

Abstract Introduction As rates of survival from cancer continue to increase in adolescents and young adults, long term physical and psychological impacts are likely to rise. For those diagnosed with cancer during childhood or adolescence, one such late effect may be delayed sexual development. Delayed sexual development may manifest as issues of sexual functioning (i.e., the ability to successfully complete the sexual response cycle) as well as issues of sexual self-concept (i.e., how one navigates the world as a sexual being). These issues may, in turn, impact survivors’ self-esteem. These concerns are likely to be exponentially exacerbated when survivors identify as a member of a sexual and/or gender minority (SGM) group. Objective Based on empirical research and two studies from our team, we examine variables that impact the sexual self-esteem of AYA cancer survivors, particularly those that identify as members of an SGM group. Methods In our small pilot project, we conducted cognitive interviews to assess whether a novel model, adapted from sexual health frameworks established by Woods (1995) and Evan et al. (2006), applied to AYA cancer survivors. Following analysis of these interviews, we refined our model, and received funding for a larger qualitative study (n = 30) tailored to AYA cancer survivors who identify as members of an SGM group. Results Four cisgender female cancer survivors participated in this small qualitative study, which provided preliminary validation that variables such as body image, amount of sexual education, quality of interpersonal relationships, and sexual functioning, were all tied into one’s perception of their sexual self-esteem. Several additional potential variables were identified from these interviews, including amount of sexual equity (how much participants felt that their sexual activity was balanced between them and a partner), religiosity, negative self-evaluative emotions (e.g., guilt and shame), and SGM identity, that could influence sexual self-esteem. Preliminary analyses of our SGM-focused qualitative study have revealed high levels of asexuality and mental health comorbidities that may be affecting sexual self-esteem. Recruitment and analysis for this study is ongoing. Conclusions Results from these two studies will provide some of the first empirical research on sexual self-esteem in a population for which sexual health is vastly under researched. We anticipate that this work will lay the foundation for novel measurements and interventions for these individuals. By providing a voice to those who are underrepresented in research, we hope that this research may have high-impact in informing future interventions to become more holistic and culturally-informed to allow for studies to ensure they are reflecting all identities of cancer survivors. Finally, we anticipate that this research may be of significant benefit to oncology providers and clinicians to overhaul and adapt sexual education for patients in treatment, as well as inform areas of concern and assessment for these providers and clinicians, particularly among their SGM patients and survivors. Disclosure No.

Suicidal Ideation Status and Its Related Factors Among Older Adults in Yazd, Iran

Objectives: To assess the prevalence of suicidal ideation and identify the factors associated with it among the elderly population in Yazd during the year 2021. Design: A cross-sectional study. Setting(s): Tabriz, the capital city of the East Azerbaijan province in northwestern Iran. Participants: A total of 386 seniors aged 60 years and above, residing in Yazd, participated in this study. The sample consisted of 212 women and 174 men selected using the cluster random sampling method. Outcome measures: Data were collected via the Beck Scale for Suicide Ideation (BSSI). Results: Five percent of the participants have a high level of suicidal risk and readiness for suicide. Additionally, the mean score of suicidal ideation varied significantly based on demographic variables such as gender, occupation, education level, and income type (P &lt; 0.05). Moreover, the risk of suicidal ideation was higher among women compared to men, particularly among housekeepers compared to other occupational groups (P &lt; 0.05). Furthermore, elderly individuals who relied on support from their children and other supportive institutions as their source of income were more susceptible to suicidal ideation compared to others (P &lt; 0.05). In terms of education, elderly individuals with no education or only primary education had a higher risk of suicidal ideation compared to those with a high school diploma or higher education (P&lt;0.05). In addition, individuals with a history of psychiatric disorders, musculoskeletal diseases, high blood pressure, comorbidity, and high cholesterol levels obtained significantly higher scores for suicidal ideation compared to elderly individuals without these conditions (P&lt;0.05). Conclusions: The elderly individuals in Yazd exhibited a desirable level of suicidal ideation, with a low risk of suicide. However, the risk factors for suicidal ideation examined in this study highlight the need for increased attention by healthcare managers to the mental health of the elderly population.

КАРДИОВАСКУЛЯРНАЯ КОМОРБИДНОСТЬ У ПАЦИЕНТОВ С ПСОРИАЗОМ

Abstract. Introduction. Psoriatic disease is a genetically determined disease of a multifactorial nature that affects about 2% of the population. According to modern concepts of this pathology, there is a high level of comorbidities, especially those associated with damage to the cardiovascular system. The aim of the study is a comprehensive analysis of the features of epidemiological and clinical data linking psoriasis with cardiovascular risk factors and cardiovascular diseases. Material and Methods. A review and analysis of modern scientific data in the databases, such as eLibrary, PubMed/Medline, Web of Science, Google Scholar, and Cyberleninka for the period from 2000 to the present. Results and Discussion. Up-to-date information has been collected regarding comorbid cardiovascular pathology in psoriasis. We systematized the data related to the analysis of possible pathophysiological mechanisms that justify this relationship and analyzed the methods of cardiovascular risk stratification in patients with psoriasis. Conclusions. Various studies have shown that psoriasis is associated with a higher prevalence of cardiovascular diseases, including hypertension, diabetes mellitus, dyslipidemia, obesity, and metabolic syndrome. The relationship is discussed between psoriasis severity and the risk of developing cardiovascular diseases, as well as prognostic risks with mortality rates. The common pathogenetic mechanisms proposed include genetic factors, inflammatory pathways, adipokine secretion, insulin resistance, lipoprotein composition and function, angiogenesis, oxidative stress, and hypercoagulability.

Exploring latent clusters in pediatric OCD based on symptoms, severity, age, gender, and comorbidity.

Given diverse symptom expression and high rates of comorbid conditions, the present study explored underlying commonalities among OCD-affected children and adolescents to better conceptualize disorder presentation and associated features. Data from 830 OCD-affected participants presenting to OCD specialty centers was aggregated. Dependent mixture modeling was used to examine latent clusters based on their age- and gender adjusted symptom severity (as measured by the Children's Yale-Brown Obsessive-Compulsive Scale; CY-BOCS), symptom type (as measured by factor scores calculated from the CY-BOCS symptom checklist), and comorbid diagnoses (as assessed via diagnostic interviews). Fit statistics favored a four-cluster model with groups distinguished primarily by symptom expression and comorbidity type. Fit indices for 3-7 cluster models were only marginally different and characteristics of the clusters remained largely stable between solutions with small clusters of distinct presentations added in more complex models. Rather than identifying a single classification system, the findings support the utility of integrating dimensional, developmental, and transdiagnostic information in the conceptualization of OCD-affected children and adolescents. Identified clusters point to the centrality of contamination concerns to OCD, relationships between broader symptom expression and higher levels of comorbidity, and the potential for complex/neurodevelopmental presentations.

The 30,000 Foot View: Using Big Data to Address Complex Clinical Questions in the Most Vulnerable Older Adults

Older people of color, those who are socially isolated, veterans, and incarcerated older adults experience disparities in mental healthcare and high levels of psychiatric and physical comorbidity, including increased risk of suicide. The identification of risk factors and understanding the culture and context that impact risk are major public health challenges. Effective approaches to address these challenges are likely to involve using national databases and applying advanced methodologies to address complex clinical questions in older adults. By leveraging extensive epidemiological datasets, we can effectively pinpoint risk factors and consequences associated with mental health disorders in later stages of life. Moreover, these datasets allow us to disaggregate heterogeneous groups which are often treated as homogeneous (e.g. people of color, veterans, etc.). This disaggregation may reveal significant within group differences and provide important contextual information regarding these groups which can be used to deliver precision mental healthcare in an efficient manner and reduce the burden of mental illness in late life. In this session, we will explore innovative methodologies of utilizing national datasets to discern the cultural and contextual elements that impact the mental health and well-being of four high-risk, older adult populations. Emphasis will be placed on identifying patterns in mental healthcare disparities and comprehending how factors such as race, ethnicity, sex, gender, and incarceration contribute to feelings of loneliness, suicide rates, and dementia. Furthermore, we will also discuss the potential application of this data in developing precise risk assessment tools and targeted prevention and treatment strategies. interventions for late-life mental health issues.

The genetic epidemiology of schizotypal personality disorder.

The concept of schizotypal personality disorder (SPD) emerged from observations of personality characteristics common in relatives of schizophrenic patients. While often studied in family designs, few studies and none with genetic measures, have examined SPD in epidemiological samples. We studied individuals born in Sweden 1940-2000 with an ICD-10 diagnosis of SPD with no prior schizophrenia (SZ) diagnosis (n = 2292). Demographic features, patterns of comorbidity, and Family Genetic Risk Scores (FGRS) were assessed from multiple Swedish registries. Prediction of progression to SZ was assessed by Cox models. SPD was rare, with a prevalence of 0.044%, and had high levels of comorbidity with autism spectrum disorder (ASD), OCD, ADHD, and major depression (MD), and increased rates of being single, unemployed and in receipt of welfare. Affected individuals had elevated levels of FGRS for SZ (+0.42), ASD (+0.30), MD (+0.29), and ADHD (+0.20). Compared to cases of schizophrenia, they had significantly lower rates of FGRSSZ, but significantly elevated rates of genetic risk for ASD, MD, and ADHD. Over a mean follow-up of 8.7 years, 14.6% of SPD cases received a first diagnosis of SZ, the risk for which was significantly increased by levels of FGRSSZ, male sex, young age at SPD diagnosis and an in-patient SPD diagnosis and significantly decreased by comorbidity with MD, ASD, and ADHD. Our results not only support the designation of SPD as a schizophrenia spectrum disorder but also suggest potentially important etiologic links between SPD and ASD and, to a lesser extent, ADHD, OCD, and MD.

Medication-based Comorbidity Measures and Prostate Cancer Treatment Selection

IntroductionWe aimed to assess the association between comorbidities and prostate cancer management. Patients and methodsWe studied 12,603 South Australian men diagnosed with prostate cancer between 2003 and 2019. Comorbidity was measured one year prior to prostate cancer diagnosis using a medication-based comorbidity index (Rx-Risk). Binomial logistic regression analyses were used to assess the association between comorbidities and primary treatment selection (active surveillance, radical prostatectomy (RP), external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT), brachytherapy, ADT alone, and watchful waiting (WW)). Certain common comorbidities within Rx-Risk (cardiac disorders, diabetes, chronic airway diseases, depression and anxiety, thrombosis, and chronic pain) were also assessed. All models were adjusted for sociodemographic and tumor characteristics. ResultsLikelihood of receiving RP was lower among men with Rx-Risk score ≥3 (odds ratio (OR) 0.62, 95%CI:0.56-0.69) and Rx-Risk 2 (OR 0.80, 95%CI:0.70-0.92) compared with no comorbidity (Rx-Risk ≤0). Men with high comorbidity (Rx-Risk ≥3) were more likely to have received ADT alone (OR 1.76, 95%CI:1.40-2.21), EBRT (OR 1.30, 95%CI:1.17-1.45) or WW (OR 1.49, 95%CI:1.19-1.88) compared with Rx-Risk ≤0. Pre-existing cardiac and respiratory disorders, thrombosis, diabetes, depression and anxiety, and chronic pain were associated with lower likelihood of selecting RP and higher likelihood of EBRT (except chronic airway disease) or WW (except diabetes and depression and anxiety). Cardiac disorders and thrombosis were associated with higher likelihood of selecting ADT alone. Furthermore, age had greater effect on treatment choice than the level of comorbidity. ConclusionHigh comorbidity burden was associated with primary treatment choice, with significantly less RP and more EBRT, WW and ADT alone among men with higher levels of comorbidity. Each of the individual comorbid conditions also influenced treatment selection.

1720 Frailty and the impact of Electronic Advance Care Planning records on readmission rates and location of end of life care

Abstract Introduction Older people with severe frailty are 5 times more likely to die in the next 12 months than older non-frail people however prognosis and disease trajectory in frailty remains difficult to predict. Advance care planning (ACP) is often not fully discussed or documented due to these prognostic uncertainties, plus time/workload constraints. This can result in multiple admissions for people with frailty in the last 12 months of life and can lead to care and death in a non-preferred place. Electronic Advance Care Plans (eACP) can be useful in reducing unwanted admissions and promoting care and death in preferred location. This project aimed to improve proportion of patients receiving care in their preferred location and reduce readmission rates. Method Identified patients who wished to avoid hospital readmission with clinical frailty score of 6 or more and at least 2 unplanned admissions in the preceding 12 months over a 4-month period at a district general hospital in south London. ACP was discussed with patients and families and an eACP was generated. Patients were then followed up at 3 and 6 months to assess readmission rate and rate of end-of-life care in preferred location. 24 patients consented - 17 women, 7 men. Mean age of 88.3 Mean pre-admission frailty score of 6.1. High level of pre-admission co-morbidity with 80% having 3 or more major comorbidities. Results Readmission rate was 8%. One third of patients alive at 3 months all without readmission. 23 patients had died at 6 months. 13% died in hospital versus a national average of around 50%. 70% died in preferred place of death versus national average of around 49%. Solution Use of electronic Advance Care plans resulted in a low readmission rate and a higher proportion of people receiving end of life care in their preferred place of death.

Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016-2019.

Autologous breast reconstruction (ABR) has increased in recent decades, although concerns for access remain. As such, our goal is to trend national demographics and operative characteristics of ABR in the United States. Using the National Inpatient Sample, 2016-2019, the International Classification of Disease , Tenth Edition codes identified adult female encounters undergoing ABR. Demographics and procedure-related characteristics were recorded. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate regression modeling. A total of 52,910 weighted encounters met the criteria (mean age, 51.5 ± 10.0 years). Autologous breast reconstruction utilization increased (Δ = +5%), 2016-2019, primarily driven by a rise in deep inferior epigastric perforator (DIEP) reconstructions (Δ = +28%; incidence rate ratio [IRR], 1.070; P < 0.001), which were predominant throughout the study period (69%). More recent surgery year, bilateral reconstruction, higher income levels, commercial insurance, and care in the South US region increased the odds of DIEP-based ABR ( P ≤ 0.036). Transverse rectus abdominis myocutaneous flaps, bilateral reconstructions, higher comorbidity levels, and experiencing complications increased the length of stay ( P ≤ 0.038). Most ABRs (75%) were privately insured. The rates of immediate reconstructions increased over the study period (from 26% to 46%; IRR, 1.223; P < 0.001), as did the rates of bilateral reconstructions (from 54% to 57%; IRR, 1.026; P = 0.030). The rates of ABRs performed at teaching hospitals remained high (90% to 93%; P = 0.242). As of 2019, ABR has become more prevalent, with the DIEP flap constituting the most common modality. With the increasing ABR popularity, efforts should be made to ensure geographic and financial accessibility.

Influence of Alcohol Dependence on the Clinical and Dynamic Characteristics of Bipolar Disorder with Their Comorbidity in Psychiatric Hospital Patients

Background: numerous studies indicate a high level of comorbidity of bipolar disorder with other psychiatric disorders. Alcohol dependence is one of the most common comorbid pathologies, along with anxiety disorders and personality disorders. Objective: determination of the frequency of comorbidity of BAR with alcohol dependence in patients of a specialized psychiatric hospital and identiашcation of clinical and dynamic features of BAR with this comorbidity. Patients and methods: in the psychiatric unit, 188 patients with bipolar disorder diagnosed according to ICD-10 (136 women and 52 men) were examined. The age of female patients was 41.6 ± 14.4 years, male — 39.4 ± 14.0 years. Depending on the current affective disorder, patients were distributed as follows: a depressive episode — 62.2 % (n = 117), a hypomanic episode — 2.7 % (n = 5), a manic episode (ME) — 1.6 % (n = 3), mixed episode — 33.5 % (n = 63). A comparative assessment of the clinical and dynamic characteristics of bipolar disorder was carried out in 2 groups of patients: with bipolar disorder and comorbid alcohol dependence — 30 individuals (14 women and 16 men), aged 43 years [29; 55] and without comorbidity with alcohol dependence — 59 individuals (39 women and 20 men), age 36 years [29; 50]. During the study, clinical-psychopathological, clinical-catamnestic, psychometric, statistical methods were used. Results and discussion: the level of comorbidity of bipolar disorder with alcohol dependence was determined — 15.9 %. It was found that in BD with comorbid alcohol dependence, compared with BD without alcohol dependence, patients have an early onset age of BD, more often have mixed episodes during an affective disorder. In addition, such patients have a higher risk of suicidal behavior, bipolar-I, and exacerbation of affective symptoms. It has also been shown that alcohol dependence makes it difficult to recognize bipolar disorder during the primary visit to specialized psychiatric care. Conclusion: addition of alcohol dependence to bipolar disorder affects negatively its main clinical and dynamic parameters and delays the terms of its diagnostics.