Higher Number Of Comorbidities Research Articles

RURAL–URBAN DIFFERENCES IN INFORMAL CAREGIVER RESOURCES, CAREGIVING INTENSITY, AND HEALTH-RELATED QUALITY OF LIFE

Abstract Rural-urban health disparities are pervasive among older adults and their caregivers. Rural areas in the US have a disproportionately high population of older adults, have reduced access to services, and are more reliant on family and friends for care. Research examining rural-urban disparities for informal caregivers is limited. There is a critical need to understand how caregiving intensity, access to resources, and caregiver health-related quality of life (HRQoL) differ by rural-urban status. Study objectives were to explore rural-urban differences in caregiving resources, intensity, and HRQoL. Data were abstracted from Waves 1 and 5 of the National Study of Caregiving. Rural-urban status was based on Rural Urban Continuum Codes. Generalized linear models, accounting for complex sampling, were used to explore associations between rural-urban status and caregiver resource utilization, caregiving intensity, and HRQoL. Compared to urban caregivers, rural caregivers were significantly more likely to be female (OR 1.19, 95%CI 1.12-1.26), older (beta=1.13 years, 95%CI 0.70-1.55), have obesity (OR 1.25, 95%CI 1.17-1.32), report poor/fair health (OR 1.08, 95%CI 1.01-1.16), and higher numbers of comorbidities (beta=0.18, 95%CI 0.13-0.22). Compared to urban caregivers, rural caregivers were significantly less likely to attend support groups (OR 0.55, 95% CI 0.46-0.65), but more likely to have caregiver training (OR 1.46, 95%CI 1.33-1.62). They assisted with fewer instrumental activities of daily living (beta=0.54, 95%CI 0.44-0.65), although there was not a significant difference for activities of daily living. Findings can facilitate the translation and adaption of policies, programs, and interventions to support and address the unique needs of rural caregivers.

The role of pharmacist education as a catalyst: Examining COVID-19 vaccine acceptance and hesitancy in senior Lebanese citizens

Objective: This study aims to underscore the potential of pharmacist education in bridging the gap between COVID-19 vaccine hesitancy and acceptance, focusing on senior Lebanese citizens. Methods: The study is an online cross-sectional observational survey using the snowball technique. It was conducted in Lebanon during the lockdown over a period of five months from December 2020 to April 2021. Two hundred Lebanese adults aged 65 years and older with internet access were enrolled. Results: In total, 229 seniors completed the questionnaire, among which 18.8% took the COVID-19 vaccine. Results showed a significant association between vaccine-intake individuals with a higher number of comorbidities (ORa=1.15, 95% CI (1.09;1.22)). Acceptance of the vaccine (ORa=1.12, 95% CI (1.04; 1.20)) had a more significant influence than vaccine hesitancy (ORa=0.81, 95% CI (0.73; 0.90)). Key factors affecting higher vaccine acceptance were a recent history of falls (Beta=2.545, CI (0.823;4.268)), and seeking advice from a pharmacist (Beta=3.992, CI (0.877;7.106)) while being a healthcare professional was associated with lower acceptance (Beta=-2.398, CI (-4.492; -0.305)). Conclusion: This study accentuates the vital role of pharmacists' educational influence in promoting vaccine acceptance among seniors, emphasising the need to empower the elderly in their health choices for effective disease prevention.

Risk of extended viral shedding of Omicron BA.2 in Shanghai: Implications for vaccination strategy optimization

BackgroundIn late March 2022, an outbreak of coronavirus disease 2019 (COVID-19) caused by the Omicron BA.2 strain occurred in Shanghai, China. This retrospective study aimed to investigate the clinical characteristics, laboratory parameters, and vaccine protectiveness related to this disease in China. MethodsWe conducted a single-center retrospective study on 735 patients with COVID-19 hospitalized from March 17 to May 14, 2022. Clinical characteristics were analyzed based on vaccination status and viral shedding time (VST). The least absolute shrinkage and selection operator (LASSO) regression and 5-fold cross-validation were applied to screen factors linked to the rate of the VST. Generalized linear models were further applied to estimate the odds ratios for factors influencing the VST. ResultsThe median VST of unvaccinated patients was 13 (11–16) days, which was longer than that of patients vaccinated with one or two doses (11 [9–13] days) and with completed booster doses (11 [8–12] days). A LASSO regression model and 5-fold cross-validation showed that age of ≥60 years (β = 0.01), pneumonia (β = 0.53), and higher number of comorbidities (β = 0.69) were positively associated with the VST, whereas the platelet count (β = −8.0×10−5) was inversely associated with the VST. Subgroup analysis revealed that the number of vaccinations was significantly associated with a decreased VST among patients with renal dysfunction (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.44–0.97; P = 0.034) and patients with two or more comorbidities (OR, 0.09; 95% CI, 0.03–0.28; P < 0.001). The lymphocyte count was significantly associated with a decreased VST among patients aged <60 years (OR, 0.51; 95% CI, 0.30–0.85; P = 0.011), patients with normal renal function (OR, 0.41; 95% CI, 0.21–0.80; P = 0.009), and patients with fewer than two comorbidities (OR, 0.49; 95% CI, 0.30–0.80; P = 0.005). ConclusionOur preliminary results suggest that the complete and booster vaccination contributes to the viral clearance of Omicron BA.2 variants, while the protectiveness of vaccination is most imperative in patients with impaired renal function and more comorbidities.

Higher GOLD spirometeric class (severity of airflow limitation) correlated with higher number of comorbidities

Background: Various systemic manifestations of chronic obstructive pulmonary disease (COPD) are well known to us. One patient of COPD may have more than one associated comorbid conditions. Severity of airflow limitation is expressed as a global initiative for chronic obstructive lung disease (GOLD) spirometeric classification in patients with COPD, which has been proposed to better identify the disease severity and survival. Aims and Objectives: In this study, we aimed to find out correlation between GOLD spirometeric classification and comorbidities in patients. Materials and Methods: An observational study conducted at the Institute of Medical Science Banaras Hindu University Varanasi India. We evaluated 50 patients of COPD, containing smokers, non-smokers, and ex-smokers. The severity of airflow limitation in COPD was classified using the GOLD. The most frequent comorbidities are assessed in COPD which were cardiovascular diseases, diabetes, hypertension, osteoporosis, muscle wasting, psychological illness, and anemia. Results: Fifty patients were analyzed: Male 90%, mean age 68.5 years and mean forced vital capacity in 1 s 34.3%. There is an association between GOLD spirometeric classification and total number of comorbidities in patients. Subjects with higher GOLD spirometeric classification have more associated comorbid conditions, which suggest that these conditions may aggravate COPD course and increase risk of mortality. Conclusion: Assessment of GOLD spirometeric classification could provide information about a total number of various comorbid conditions in a patient with COPD. Patient with higher GOLD spirometeric classification has more comorbidities.

Work Ability in the Year after Rehabilitation—Results from the RehabNytte Cohort

Background: There is limited knowledge regarding the impact of rehabilitation on work ability. The aim of this study was to explore factors associated with work ability 12 months following a multidisciplinary rehabilitation program in a cohort with different diagnoses. Methods: Of 9108 potentially eligible participants for the RehabNytte research project, 3731 were eligible for the present study, and 2649 participants (mean age 48.6 years, 71% female) consented to contribute with work-related data, and were included. Self-perceived work ability was assessed by the Work Ability Score (WAS) (0–10, 10 = best), during the follow-up period using paired t-tests and logistic regression to examine associations between demographic and disease-related factors and work ability at 12-month follow-up. Results: The mean baseline WAS for the total cohort was 3.53 (SD 2.97), and increased significantly to 4.59 (SD 3.31) at 12-month follow-up. High work ability (WAS ≥ 8) at 12 months was associated with high self-perceived health at the baseline (OR 3.83, 95% CI 2.45, 5.96), while low work ability was associated with a higher number of comorbidities (OR 0.26, 95% CI 0.11, 0.61), medium pain intensity (OR 0.56, 95% CI 0.38, 0.83) and being married or cohabiting (OR 0.61, 95% CI 0.43, 0.88). There were no significant differences in work ability between participants receiving occupational and standard rehabilitation. Conclusions: Work ability increased significantly over the follow-up period. High work ability at 12-month follow-up was associated with high self-perceived health at baseline, while being married or cohabiting, having higher number of comorbidities, and experiencing medium baseline pain intensity was associated with lower work ability. Rehabilitation interventions targeting these factors may potentially enhance work ability, leading to a positive impact on work participation among people in need of rehabilitation.

Characteristics of 'super responders' and 'super nonresponders' to first biologic monotherapy for psoriasis: a nested case-control study.

It is unknown why some patients with psoriasis experience long-term effectiveness with their first biologic monotherapy. Our aim was to compare the baseline demographic, disease, genotypic, clinical and lifestyle characteristics of patients with psoriasis registered in the British Association of Dermatologists Biologics and Immunomodulators Register and the aligned Biomarkers and Stratification to Optimise outcomes in Psoriasis study who were designated as ‘super responders’ (SRs), defined as patients on their first biologic with more than 5 years continuous biologic monotherapy, or ‘super nonresponders’ (SNRs), defined as patients on their first biologic who had discontinued at least two biologics in their first year of treatment, to biologic therapy. Female sex, shorter study follow-up, higher Dermatology Life Quality Index, high frequency of adalimumab, less frequency of ustekinumab at registration, and higher number of comorbidities were associated with SNRs compared with SRs.

Abstract 12413: Arrhythmia Burden, Associated Outcomes, and Cost Implications in Patients Hospitalized With Idiopathic Pulmonary Fibrosis

Introduction: Arrhythmias are a common cardiovascular manifestation of idiopathic pulmonary fibrosis (IPF), however, associated costs and hospital outcomes are unknown. We aim to determine the impact of cardiac arrhythmias on outcomes and costs among hospitalized IPF patients. Methods: A retrospective cohort analysis was conducted using the National Inpatient Sample from 2017-2019. IPF-associated hospitalizations with and without concurrent arrhythmia were compared and identified by appropriate ICD-10 CM codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were the duration of hospitalization and associated costs. Results: Among 92,125 IPF patients, 28.5% (n=26,235) were diagnosed with 29,885 arrhythmias. The most frequent (65%) form of arrhythmias was atrial tachyarrhythmias of which atrial fibrillation was the most predominant (88%). The frequency of bradyarrhythmias, ventricular tachyarrhythmias, and unspecified arrhythmias were 10%, 8%, and 17%, respectively. The IPF-arrhythmia group was predominantly male (64% vs 36%, P &lt; 0.001) and significantly older (76 vs 69 years, p&lt;0.001) with a higher number of comorbidities (3 or more Charlson comorbidity index score: 52% vs 40%, p&lt;0.001). All-cause mortality was significantly higher in the IPF-arrhythmia cohort (12.3% vs. 9.5%, p&lt;0.001) and the odds of in-hospital death remained significantly higher among the IPF-arrhythmia cohort after adjusting for sociodemographic and hospital-level factors (AOR 1.30, 95% CI 1.17-1.44, P &lt;0.001). The hospital length of stay was longer (8.4 vs. 6.7 days, p&lt;0.001), and costs were higher ($123,185 vs. $88,073, p&lt;0.001) among the IPF-arrhythmia cohort. Conclusions: Concurrent arrhythmias are associated with worse survival outcomes and costs for patients with IPF. Future studies are needed to confirm the benefits of treatment and elucidate the appropriateness and cost-effectiveness of screening for arrhythmias among IPF patients.

Incidence, severity and outcomes of COVID-19 in age and gender matched adults with and without epilepsy in Moscow: A historical cohort study.

We hypothesized that PWE have an increased risk to acquire COVID-19. This was a historical cohort study to determine COVID-19 incidence, severity, mortality and risk factors in adults with active epilepsy (PWE) compared to residents of Moscow without epilepsy matched by age, gender, and region of residence - Moscow Community Comparisons (MCC). Subjects were derived from a cohort of adult PWE and a cohort of age- and gender-matched population-based MCC without epilepsy identified in 2018. Incidence of COVID-19 was compared in each cohort from 01.03.2020 through 28.02.21. Influence of age, gender, comorbidities, and for the PWE cohort, epilepsy type, seizure frequency, and number/class of antiseizure medications was evaluated using Pearson's chi-squared test and logistic regression analysis. We found 887 COVID-19 positive people in the two cohorts: 156 in PWE (51.8±19.7 years) and 731 in MCC (52.0±17.3 years,). COVID-19 incidence was lower in PWE: 13.8% versus 18.7% in MCC (p=0.0002). In PWE no specific epilepsy related variables influenced incidence. Despite no difference in severity distribution in PWE versus MCC, hospitalization rate (37.6% versus 25.5%, p=0.002), disease duration (57.1% versus 47.1, p=0.023), and mortality (10.9% versus 4.2%, p=0.0009) were significantly higher in PWE. Age and number of comorbidities significantly influenced COVID-19 incidence, severity, duration, and outcomes in both cohorts. Incidence of COVID-19 in PWE in Moscow was significantly lower compared to MCC. Age and comorbidities were strongly associated with severity, duration and outcomes of COVID-19 for all infected persons. Higher mortality in PWE may be explained by a higher number of comorbidities.

Associations of comorbidities with telehealth use in cancer survivors amidst the COVID-19 pandemic: Findings from the HINTS 6 (2022).

522 Background: Cancer survivors with comorbidities often need specialized care. Telehealth, using remote technologies such as phone calls or video conferences, addresses their specific needs, particularly during the COVID-19 pandemic, offering time and cost savings. However, understanding of telehealth use among cancer survivors with comorbidities is limited. This study examines the associations between comorbidities and telehealth use in cancer survivors during the pandemic. Methods: We analyzed the Health Information National Trends Survey (HINTS) 6, a nationally representative survey conducted in 2022. This study included 4,756 adults aged ≥18 (representing 195 million), including 730 cancer survivors (representing 20 million) in the U.S. The outcome variable was telehealth use in the past 12 months, including video or phone call with healthcare providers. Comorbidities included diabetes, hypertension, heart conditions, lung diseases, and depression. Design-based F-test was used for bivariate analyses. Logistic regression was used to determine associations of comorbidities and telehealth use, controlling for sociodemographic and cancer-related clinical factors. All data analyses accounted for the complex survey design and sample weights using jackknife replication method. Results: Cancer survivors’ telehealth use was slightly higher than adults without cancer (50.37% vs. 43.62%). Among cancer survivors, bivariate analysis revealed associations between telehealth use and younger age and higher number of comorbidities (P&lt;.001). These associations remained significant in the logistic regression model (OR=0.25 and 0.12, 95% CI 0.11-0.57 and 0.05-0.29 for ages 61-75 and &gt;75, respectively; OR=1.65, 95% CI 1.32-2.07 for number of comorbidities; all P&lt;.001). When examining specific comorbidities, the logistic regression model indicated that cancer survivors with heart conditions (OR=6.03, 95% CI 2.34-15.54, P&lt;.001), lung diseases (OR=5.53, 95% CI 1.89-16.17, P=.002), and depression (OR=4.46, 95% CI 2.35-8.46, P&lt;.001) were more likely to utilize telehealth compared to those without comorbidities. Additionally, higher education levels were associated with increased telehealth use, even after adjusting for other factors (OR=2.41, 95% CI 1.04-5.59, P=.04). Conclusions: This national survey analysis detected the higher rate of telehealth use in cancer survivors with comorbidities during the pandemic. Further research is needed to explore the experiences of cancer survivors with heart conditions, lung diseases, and depression regarding telehealth. Additional support is necessary to encourage older individuals and those with lower education levels to embrace telehealth for the delivery of optimal and high-quality care.

Therapy-Related Myeloid Neoplasms: Predisposition and Clonal Evolution.

Therapy-related Myeloid Neoplasm (t-MN) represents one of the worst long-term consequences of cytotoxic therapy for primary tumors and autoimmune disease. Poor survival and refractoriness to current treatment strategies characterize affected patients from a clinical point of view. In our aging societies, where newer therapies and ameliorated cancer management protocols are improving the life expectancy of cancer patients, therapy-related Myeloid Neoplasms are an emerging problem. Although several research groups have contributed to characterizing the main risk factors in t-MN development, the multiplicity of primary tumors, in association with the different therapeutic strategies available and the new drugs in development, make interpreting the current data still complex. The main risk factors involved in t-MN pathogenesis can be subgrouped into patient-specific, inherited, and acquired predispositions. Although t-MN can occur at any age, the risk tends to increase with advancing age, and older patients, characterized by a higher number of comorbidities, are more likely to develop the disease. Thanks to the availability of deep sequencing techniques, germline variants have been reported in 15-20% of t-MN patients, highlighting their role in cancer predisposition. It is becoming increasingly evident that t-MN with driver gene mutations may arise in the background of Clonal Hematopoiesis of Indeterminate Potential (CHIP) under the positive selective pressure of chemo and/or radiation therapies. Although CHIP is generally considered benign, it has been associated with an increased risk of t-MN. In this context, the phenomenon of clonal evolution may be described as a dynamic process of expansion of preexisting clones, with or without acquisition of additional genetic alterations, that, by favoring the proliferation of more aggressive and/or resistant clones, may play a crucial role in the progression from preleukemic states to t-MN.

Neighborhood Social Vulnerability Impacts Quality of Life in Kidney Stone Patients.

This study aimed to investigate the association between social vulnerability, as measured by the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI), and the quality of life (QoL) of kidney stone patients using the validated Wisconsin Stone Quality of Life Questionnaire (WISQOL). A retrospective analysis was conducted on medical records of new urolithiasis patients who completed the WISQOL at the University of Rochester Medical Center kidney stone clinic. The primary outcome was WISQOL score, which was measured across multiple domains. SVI was used to assess social vulnerability. Neighborhoods with high SVI were defined by a threshold greater than or equal to the 75th percentile nationally. Demographic and clinical data were collected. Statistical analyses, including univariate tests and multivariate linear regression, were performed to evaluate the relationships between social vulnerability and disease-specific QoL. A total of 1718 patients were included in the study. One hundred five subjects (6.1%) were from neighborhoods of high social vulnerability. Patients residing in neighborhoods with high social vulnerability (SVI quartile) reported significantly lower QoL scores (69.1 vs 77.2; P = .001) and this persisted across all domains, including social impact (32.6 vs 35.1; P = .002), emotional impact (25.2 vs 27.5; P = .006), disease impact (28.5 vs 31.4; P = .001), and vitality (10.3 vs 11.2; P = .015). Younger age, female sex, and higher number of comorbidities were identified as independent predictors of lower QoL scores. However, non-White race and Latinx ethnicity did not exhibit a significant association with QoL scores. These findings highlight the negative impact of high social vulnerability on QoL, emphasizing the importance of considering socioeconomic factors in patient care. These results emphasize the need for targeted interventions to support vulnerable populations. While this study offers initial insights, further research is essential to corroborate these outcomes across larger and more diverse populations.

Recurrent lower urinary tract infections: more than an infection for older women.

Older adults tend to have more urinary tract infections (UTIs). The frequency of recurrent lower urinary tract infections (rLUTIs) increases with age. rLUTIs are associated with long-term chronic effects on geriatric syndromes in older adults. We aimed to investigate possible risk factors that influence rLUTIs in older adults based on comprehensive geriatric assessment (CGA). This cross-sectional study included 235 older adults admitted to Gaziantep University's Geriatric Outpatient Clinic between June 1 and November 30, 2022. All patients underwent CGA. The Geriatric Depression Scale (GDS), the European Quality of Life-Five Dimension (EQ-5D) questionnaire, the Pittsburgh Sleep Quality Index (PSQI), the Katz Index of Activities of Daily Living (ADL), the Lawton and Brody Index of Instrumental Activities of Daily Living (IADL), and the Mini Nutritional Assessment (MNA) tool were,administered. Handgrip strength (HGS) and gait speed were also measured, and the number of falls in the last year was recorded. The mean age of the participants was 72.8 ± 6.8 years and 61.3% were female. Sixty-four patients had rLUTIs. The rLUTI group had higher frequencies of sarcopenia, hypertension, and diabetes; higher numbers of comorbidities and medications; higher GDS and PSQI scores; and more reported falls. They had lower ADL, MNA, EQ-5D, and gait speed scores. HGS was found to be lower in women with rLUTIs. Higher numbers of comorbidities and GDS scores and lower HGS were independent predictors of rLUTIs in women (p = 0.011, OR: 1.75; p = 0.018, OR: 1.14; and p = 0.042, OR: 0.91, respectively). We revealed that decreased HGS, higher GDS, and the number of comorbidities in older women were independent risk factors for rLUTIs. Our findings offer a new perspective on the importance of CGA in diagnosing and preventing rLUTIs.

Comparing 90-Day Post-Operative Mortality after Neoadjuvant Proton-Based vs. Photon-Based Chemoradiotherapy for Esophageal Cancer

Standard of treatment for locally advanced esophageal cancer consists of chemoradiotherapy (CRT) followed by surgery. Evidence suggests that proton beam therapy (PBT) results in lower toxicity and fewer post-operative complications compared to photon-based radiotherapy (RT). Mortality in the first 90 days after surgery is a rare event occurring in 2-8% of patients, with higher reported rates (of up to 17%) in older patients. This 90-day mortality (90DM) rate is an important measure of post-operative (non-oncologic) mortality as a proxy of quality of care. We hypothesize that PBT could reduce the incidence of 90DM compared to photon-based RT. From a single-center retrospectively acquired database patients with esophageal cancer treated with neoadjuvant CRT and esophagectomy in 1998-2022 were selected. Univariable logistic regression analyses were used to study the associations of RT modality and other patient- and treatment-related characteristics with 90DM. Subsequently, 3 separate methods were applied to adjust for confounding bias. These included multivariable logistic regression, 1:1 nearest-neighbor propensity score matching (PSM), and inverse probability of treatment weighting (IPTW). Finally, stratified analyses for patient groups aged ≥67 vs. <67 years were performed. A total of 894 eligible patients were included (PBT, n = 202; photon-based RT, n = 692). PBT patients had a significantly higher age, better performance score, and a higher number of comorbidities. The 90DM rate was 5 (2.5%) in the PBT group and 29 (4.2%) in the photon-based RT group (p = 0.262). Significant univariable predictors of 90DM included higher age and tumor location. After multivariable adjustment, PBT vs. photon therapy was not significantly associated with 90DM (OR 0.49, 95% CI 0.18-1.31). The 90DM rates in the PSM cohort (n = 181 vs. n = 181) were 2.8% for PBT and 3.3% for photon-based RT (p = 0.379). The 90DM rates in the IPTW cohort were 2.8% for PBT and 4.1% for photon-based RT (p = 0.427). In the full cohort, stratified analysis for age groups revealed that in patients aged ≥67 years, PBT was associated with a decreased risk of 90DM compared to photon-based RT (1.3% vs. 8.8%; p = 0.046), which was not the case in patients aged <67 years. In the PSM cohort, a comparable (but non-significant) difference was observed in favor of PBT in patients aged ≥67 years (i.e., 1.5% vs. 7.5%; p = 0.099). Within-group analyses in the original cohort demonstrated that a higher age significantly increased the risk of 90DM within the photon-based RT group (8.8% vs. 2.7% for age ≥67 vs. <67 years; p = 0.001), but not within the PBT group (1.3% vs. 3.2%; p = 0.398). Post-operative 90DM after esophagectomy for cancer was not significantly different between PBT and photon-based neoadjuvant CRT. However, among older patients we observed a signal that PBT may reduce the risk of 90DM. Higher age increased the risk of 90DM in patients who underwent photon-based RT, but not in patients who underwent PBT.

Use of molnupiravir: A Danish nationwide drug utilization study.

To describe utilization patterns, characteristics of users and prescribers of the new oral antiviral medication, molnupiravir, indicated for mild-to-moderate COVID-19. Using nationwide registries, we identified all Danish adults who filled a prescription for molnupiravir from December 16th, 2021, to August 31st, 2022. We described weekly incidence rates and patient characteristics over time, prescriber characteristics as well as time between molnupiravir initiation and a positive SARs-CoV-2 test. Patient characteristics were compared to matched, untreated SARS-CoV-2 positive reference groups. By August 31st, 2022, 5847 individuals had filled a prescription for molnupiravir. The incidence rate gradually increased to 16 weekly prescriptions per 1000 RT-PCR SARS-CoV-2 positives. Users of molnupiravir were most often men (55% vs. 45% women). The majority (81%) had a positive RT-PCR SARS-CoV-2 test and few (2.9%) redeemed molnupiravir outside the recommended window of 5 days from the positive test result. Compared to matched, untreated SARS-CoV-2 positive reference groups, users of molnupiravir had a median age of 74 years versus 49 years, a higher proportion resided in a nursing home (12% vs. 1.5%) and had a higher number of comorbidities (median of 3 vs. 0); most commonly hypertension (38%), chronic lung disease (35%), diabetes (20%) and mood disorders (20%). General practitioners were the primary prescribers of molnupiravir (91%). Molnupiravir was mainly prescribed by general practitioners to RT-PCR SARS-CoV-2 positive individuals who had a potentially increased risk of severe COVID-19. Though some off-label prescribing occurred, our study indicates a high level of adherence to contemporary guidelines.

Drugs with a negative impact on cognitive function (Part 1): chronic kidney disease as a risk factor.

People living with chronic kidney disease (CKD) frequently suffer from mild cognitive impairment and/or other neurocognitive disorders. This review in two parts will focus on adverse drug reactions resulting in cognitive impairment as a potentially modifiable risk factor in CKD patients. Many patients with CKD have a substantial burden of comorbidities leading to polypharmacy. A recent study found that patients seen by nephrologists were the most complex to treat because of their high number of comorbidities and medications. Due to polypharmacy, these patients may experience a wide range of adverse drug reactions. Along with CKD progression, the accumulation of uremic toxins may lead to blood-brain barrier (BBB) disruption and pharmacokinetic alterations, increasing the risk of adverse reactions affecting the central nervous system (CNS). In patients on dialysis, the excretion of drugs that depend on kidney function is severely reduced such that adverse and toxic levels of a drug or its metabolites may be reached at relatively low doses, unless dosing is adjusted. This first review will discuss how CKD represents a risk factor for adverse drug reactions affecting the CNS via (i) BBB disruption associated with CKD and (ii) the impact of reduced kidney function and dialysis itself on drug pharmacokinetics.

Poor sleep quality is an overlooked risk for geriatric syndromes in older adults with type 2 diabetes mellitus

ABSTRACT Background Aging and type 2 diabetes mellitus (DM) are two different conditions that impair sleep quality. The primary objective of this study was to investigate the impact of sleep quality on geriatric syndromes in older diabetic adults. Methods Comprehensive geriatric assessment was performed on 236 patients. The assessment included the Geriatric Depression Scale (GDS), Beck Anxiety Inventory (BAI), European Quality of Life Questionnaire (EQ-5D), Mini Mental Statement Examination (MMSE), Pittsburgh Sleep Quality Index (PSQI), Mini Nutritional Assessment, and measurement of handgrip strength (HGS). Results Of the participants, 55% had DM, and 61.4% had poor sleep quality. Poor sleep prevalence was higher in diabetic patients (68.5%) than in non-diabetics (52.8%). Diabetic patients with poor sleep quality had higher frequencies of chronic pain, recurrent urinary tract infections, confirmed sarcopenia, and frailty (p = 0.015, p < 0.001, p = 0.027, and p < 0.001, respectively), a higher number of comorbidities and higher GDS and BAI scores (p = 0.046, p < 0.001 and p < 0.001, respectively), and lower scores of activities of daily living, HGS, and EQ-5D index (p = 0.023, p = 0.004, and p < 0.001, respectively) compared to diabetic patients with good sleep quality. According to the correlation analysis results, PSQI score had a positive correlation with GDS score (r = 0.461, p < 0.001) and a negative correlation with Mini Nutritional Assessment score (r = –0.317, p < 0.001), skeletal muscle mass index (r = –0.283, p = 0.002) and HGS (r = –0.307, p < 0.001) scores in diabetic older adults. Conclusion Poor sleep quality in older diabetic patients has a negative impact on several geriatric syndromes. Our findings suggest that poor sleep quality is an independent risk factor for depression, malnutrition, and lower muscle mass in older diabetic adults. Improving sleep quality may play a crucial role in preventing and managing geriatric syndromes in this population.

Patients Hospitalized for COVID-19 in the Periods of Delta and Omicron Variant Dominance in Greece: Determinants of Severity and Mortality.

Coronavirus disease 2019 (COVID-19) has been a pandemic since 2020, and depending on the SARS-CoV-2 mutation, different pandemic waves have been observed. The aim of this study was to compare the baseline characteristics of patients in two phases of the pandemic and evaluate possible predictors of mortality. This is a retrospective multicenter observational study that included patients with COVID-19 in 4 different centers in Greece. Patients were divided into two groups depending on the period during which they were infected during the Delta and Omicron variant predominance. A total of 979 patients (433 Delta, 546 Omicron) were included in the study (median age 67 years (54, 81); 452 [46.2%] female). Compared to the Omicron period, the patients during the Delta period were younger (median age [IQR] 65 [51, 77] vs. 70 [55, 83] years, p < 0.001) and required a longer duration of hospitalization (8 [6, 13] vs. 7 [5, 12] days, p = 0.001), had higher procalcitonin levels (ng/mL): 0.08 [0.05, 0.17] vs. 0.06 [0.02, 0.16], p = 0.005, ferritin levels (ng/mL): 301 [159, 644] vs. 239 [128, 473], p = 0.002, C- reactive protein levels (mg/L): 40.4 [16.7, 98.5] vs. 31.8 [11.9, 81.7], p = 0.003, and lactate dehydrogenase levels (U/L): 277 [221, 375] vs. 255 [205, 329], p < 0.001. The Charlson Comorbidity Index was lower (3 [0, 5] vs. 4 [1, 6], p < 0.001), and the extent of disease on computed tomography (CT) was greater during the Delta wave (p < 0.001). No evidence of a difference in risk of death or admission to the intensive care unit was found between the two groups. Age, cardiovascular events, acute kidney injury during hospitalization, extent of disease on chest CT, D-dimer, and neutrophil/lymphocyte ratio values were identified as independent predictors of mortality for patients in the Delta period. Cardiovascular events and acute liver injury during hospitalization and the PaO2/FiO2 ratio on admission were identified as independent predictors of mortality for patients in the Omicron period. In the Omicron wave, patients were older with a higher number of comorbidities, but patients with the Delta variant had more severe disease and a longer duration of hospitalization.

Revisional Roux-en-Y Gastric Bypass After Sleeve Gastrectomy for Gastro-esophageal Reflux Disease and or Insufficient Weight-Loss: a Comparative Study.

Sleeve gastrectomy (SG) is a popular surgical weight-loss procedure, but there are increasing reports of revisional Roux-Y-gastric-bypass (R-RYGB) to manage weight-loss failure (WLF) or proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) after SG, with little data available in these settings. This retrospective study included all consecutive patients undergoing R-RYGB for WLF or RGERD after SG in two bariatric care centers from 2012 to 2018. Of 720 patients, 46 (3.6%) underwent R-RYGB (RGERD, n = 25; 54.4%; WLF, n = 21; 45.6%) within 44.8 ± 27.5months post-SG. SG had enabled 27% ± 11.6 total weight loss (TWL) in the RGERD group vs. 7.2% ± 12.5% TWL in the WLF group (p < 0.001). At R-RYGB, WLF-group patients had a higher BMI (47.8 ± 8.4 vs. 34.7 ± 6.1kg/m2; p < 0.001) and a higher number of comorbidities (2.4 ± 1.5 vs 1.5 ± 1.2; p < 0.02) compared to RGERD-group patients, while severe morbidity (Clavien-Dindo ≥ IIIb) was not significantly different between groups (6.5% vs 2.1%, p = 0.6). %TWL was still higher in the RGERD group at 12months post-R-RYGB (35.6% ± 10.4 vs. 23.8% ± 9.2; p < 0.01) but not after 24months post-R-RYGB. R-RYGB corrected reflux symptoms in 32 (94%) patients and reduced PPI use in 29 (97%) patients (p < 0.001), with no significant between-group difference. A history of adjustable gastric banding (AGB) (N = 8;17.4%) prior to SG was associated with a similar prevalence of GERD at R-RYGB and a lower %TWL (AGB:13.1 ± 10.2 vs. No AGB:31.6 ± 8.5; p < 0.05) at 3years post-R-RYGB. R-RYGB following SG provides remission of reflux symptoms in 94% of patients and extra weight loss in patients with WLF, except in patients with a history of AGB prior to SG.

Correlation of health-related quality of life for older adults with diabetes mellitus in South Korea: theoretical approach

BackgroundWhile some studies have explored the health-related quality of life (HRQOL) of older adults with diabetes mellitus (DM) in South Korea using a theoretical framework, these studies suffer sample-related limitations, as they focus only on a specific subgroup of older adults. To address this gap, this study aimed to investigate the predictors of HRQOL of older adults with DM in South Korea, using extensive national data and based on the theory of Health-Related Quality of Life in South Korean Older Adults with Type 2 Diabetes (The HIKOD theory).MethodsA secondary data analysis was conducted using data from 1,593 participants aged 65 years and older with DM sourced from the 2015–2019 Korea National Health and Nutrition Examination Survey (KNHANES). The variables included in this study are as follows: demographic factors (gender, age, household income, and education level), disease-specific factors (duration of DM, treatment of DM, and control of HbA1c), barriers (number of comorbidities), resources (living alone status), psychosocial factors (perceived stress), and health-promoting behaviors (physical activity and fundus examination). Considering the complex sampling design employed in this study, statistical analyses including Rao-Scott chi-square tests, correlation analysis, and hierarchical multiple regression analysis were conducted.ResultsMobility (45.0%) was the HRQOL dimension with which participants experienced the highest number of problems. Number of comorbidities (r = -0.36, p < 0.001), living alone status (rpb = 0.16, p < 0.001), perceived stress (rpb = 0.14, p < 0.001), and physical activity (rpb = 0.12, p < 0.001) were correlated with HRQOL. While adjusting for background factors, HRQOL was negatively predicted by higher number of comorbidities (estimate B = -0.03, p < 0.001), living alone (estimate B = -0.03, p = 0.043), higher perceived stress (estimate B = -0.09, p < 0.001), and lower physical activity (estimate B = -0.03, p < 0.001).ConclusionComplex and diverse factors influence HRQOL among older adults with DM in South Korea. To improve their HRQOL, intervention programs that integrally regard HRQOL, along with various predictors, are necessary.

An eight-year analysis of participant characteristics at admission to inpatient prosthetic rehabilitation following a lower limb amputation: a Canadian perspective

Purpose To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. Methods A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. Results A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. Conclusion People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population.