Morbidity In People Research Articles

A Review on Schizophrenia: Outline and Treatment

Schizophrenia is a debilitating, genetic brain condition caused by anomalies that appear early in infancy and interrupt normal brain development. It has a lifetime risk of 1% and affects people of all ages, with around 10% dying by suicide. COVID-19 may raise the risk of mortality and morbidity in people with schizophrenia. Although antipsychotic medications of the first, second, and third generations are the most commonly prescribed treatments for schizophrenia, they are linked to major side effects such as tardive dyskinesia, oxidative stress, and EPS. Ayurvedic herbal medications and some dietary supplements score well in this category since they can be taken for a long time without causing major adverse effects and have antioxidant properties. Low potency first generation antipsychotics, sedating antihistamines, and benzodiazepines, as well as inhalable antipsychotics, oral and short acting injectable olanzapine, and ziprasidone, as well as low potency first generation antipsychotics, sedating antihistamines, and benzodiazepines, should be avoided or closely monitored for patients with COVID-19. Mentally ill patients with COVID -19 should be segregated if at all possible, and employees should be adequately protected.

Prevalence and characteristics of psychiatric morbidity treated in specialized health care in a nationwide cohort of people with newly diagnosed Alzheimer's disease.

ObjectivePsychiatric disorders have been implied as both risk factors and prodromal symptoms of Alzheimer's disease (AD). A better understanding of the history of psychiatric morbidity in people with AD may aid with understanding this relationship and highlight challenges in diagnosing AD in people with concomitant psychiatric disorders.MethodsMedication use and Alzheimer's disease (MEDALZ) study is a nationwide register‐based cohort of people (n = 70,718) who received a clinically verified AD diagnosis in Finland in 2005–2011 and were community‐dwelling at the time of diagnosis. The study population was divided into four groups based on psychiatric morbidity treated in specialized health care. We characterized the groups using data of psychiatric and somatic illnesses, psychotropic drug use, and socioeconomic factors and investigated factors associated with prodromal AD.ResultsAltogether, 4.3% of cohort members had a psychiatric diagnosis at least five years before AD diagnosis, 3.1% had a psychiatric diagnosis only up to five years before AD diagnosis, and 1.1% had a psychiatric diagnosis both less and more than 5 years before AD. Belonging to the Prodromal group (psychiatric diagnosis within 5 years before AD diagnosis) was most strongly associated with substance abuse (RR 65.06, 95%CI 55.54–76.22). Other associated factors with the Prodromal group were female gender, use of psychotropics, stroke, and asthma/COPD.ConclusionSubstance abuse and psychotropic drug use are common five years before AD diagnosis. These can be potential markers of possible prodromal symptoms of AD and should be acknowledged in clinical work.

Assessment of the Impact of the Covid-19 Pandemic on the Incomes and Adaptation of the Population of the Region To It: Statistical Approach

The aim of the study is to determine the impact of the COVID-19 pandemic and the self-isolation regime announced in Russia on the incomes of the population. The relevance of the study is connected with the problems of reflecting the pandemic, searching for patterns and its interrelations with incomes, health, living conditions of the population. The emergence of coronavirus disease (March 2020), quickly spread to all regions of the country, in 2021 the fourth record wave of morbidity and mortality of the population was recorded.The research methods are the theory and methodology of income of the population used by the Federal State Statistics Service, corresponding to international norms and standards, including the system of national accounts. To determine the directions of the impact of the COVID-19 pandemic on the incomes of the population of the region, the method of analytical groupings (stochastically deterministic relationships), as well as the method of comparing parallel series, the index method and interregional data evaluation analysis were used.The results of the study: the use of a statistical approach to assess and determine the impact of the COVID-19 pandemic on the real incomes of the population allowed us to determine the features of the spread of the disease in the regions of the Ural Federal District. The conclusion is made: the spread of COVID-19 in 2020-2021 did not have a significant impact on the real monetary incomes of the population in the regions of the Ural Federal District, despite the increase in the morbidity of people. The population quickly adapted to the pandemic, many enterprises were operating normally, and the state took prompt measures to reduce tensions and support the population and the health system in the country. The oppositely directed factors of the impact of the pandemic, leading to negative and positive consequences of real incomes of the population, have been identified. The level and degree of influence of the morbidity of the population on the income of the population are determined.Conclusion: the use of a statistical approach makes it possible to improve the quality of information, to determine the positive and negative factors of the COVID-19 pandemic’s impact on incomes and the level of adaptation of the region’s population to it. The adaptation of the population to the coronavirus will continue for several more years and longer, and the waves of the disease will decrease as medicines are created. The study makes it possible to assess not only the main directions of influence on the real monetary incomes of the population, but also the quality of decisions made by management structures.

OUTCOME OF TUBERCULOSIS IN HIV INFECTED PATIENTS WITH SPECIAL REFERENCE TO CD4 COUNT IN AN ART CENTRE, WEST BENGAL

Background: Opportunistic Infections in HIV are major determinants of mortality in HIV patients. Tuberculosis is a leading cause of mortality. Tuberculosis is a public health challenge specially in developing countries like India. The incidence of TB HIVco-infection is gradually increasing. Methods: This was institution based, retrospective study. Study was conducted at ART Centre, North Bengal Medical College & Hospital, Sushruta Nagar, Darjeeling, West Bengal from January 2015 to January 2020 including 105 HIV-TB co-infected patients. Data was collected and template was generated in MS excel sheet and analysis was done on SPSS software. Results: 105, HIV-TB co-infected patients were registered with majority being male (n=79), mean age for male and female patients were 36.78 years and 35.73 years respectively.. The number of patients diagnosed with Extra-pulmonary tuberculosis (EPTB) and Pulmonary tuberculosis (PTB) were almost equal. Majority of patients (34.3%) had CD4 counts <200 whereas (33.3%) had CD4 counts between 200-349. Favourable outcome in terms of cured patients were 82.85% with a statistically signicant pre-treatment and post-treatment improvement in body weight (p value<0.0001) and CD4 count (p value<0.002. Conclusions: There is a strong association between incidence of TB and HIV infection. Early diagnosis and treatment are essential to reduce mortality and morbidity in people living with HIV. Strict adherence to treatment and dedicated counseling for drug compliance is the need of the hour.

Epigenetic biomarkers of ageing, physiological frailty, and mortality in people with HIV: a longitudinal cohort study

BackgroundApproaches that provide insight into ageing mechanisms for people with HIV are needed. Epigenetic modifications such as DNA methylation have been operationalised as epigenetic clocks, providing an estimate of age acceleration in years (DNA methylation age acceleration; DNAmAA). Our objective was to determine if measures of DNAmAA predict physiological frailty, as measured by the Veterans Aging Cohort Study (VACS) Index and all-cause mortality, in people with HIV. MethodsAs part of the observational VACS, we profiled epigenome-wide DNA methylation on peripheral blood samples collected from people with HIV as part of a biomarker cohort. We generated six established measures of DNAmAA in samples from 531 participants with VACS Index data at the time of sample collection. All-cause mortality was assessed over 10 years. For each DNAmAA measure, the hazard ratio (HR) per increased unit (1 year) was determined using Cox regression. To test the association of DNAmAA measures with the VACS Index 2.0, linear regression was performed. All regression models were performed with and without adjustment for chronological age. FindingsParticipants were mostly men (98·5% [n=523]; 1·5% [n=8] women); 83·4% (n=448) were Black, 10·5% (n=56) were White, and 5·1% (n=27) were Hispanic; and their mean age was 52·4 years (SD 7·8). There were 136 deaths during a median follow-up of 8·7 years (IQR 7·7–9·4). Hannum's DNAm age acceleration (Hannum AA), extrinsic epigenetic age acceleration (EEAA), Grim age acceleration (Grim AA), and Pheno age acceleration (Pheno AA) were significantly associated with all-cause mortality, but Horvath's DNAm age acceleration (Horvath AA) and intrinsic epigenetic age acceleration (IEAA) were not in unadjusted and age-adjusted models. GrimAA was the strongest predictor (adjusted HR 1·10, 95% CI 1·06–1·14; p<0·0001). Similarly, four of the six DNAmAA measures were significantly associated with the VACS Index in unadjusted and age-adjusted models. Each year increase in GrimAA was associated with a point increase in VACS Index (adjusted β 1·16, 95% CI 0·905–1·42; p<0·0001). InterpretationAmong people with HIV, several DNAmAA measures predicted all-cause mortality and physiological frailty. Each 1-year increase in GrimAA was associated with a 10% increased risk of death. A 5-year increase in GrimAA was associated with a clinically meaningful 5·8-point increase in VACS Index. GrimAA might provide key insights into the molecular mechanisms mediating biological ageing and physiological frailty, while informing the design of novel strategies to reduce mortality and morbidity for people with HIV. FundingKKO received funding from the US Department of Veterans Affairs (grant number I01 RX002790). VCM received funding from Emory (grant number CFAR P30 AI050409). ZW received funding from NIDDK (grant number R01DK125187). KX received funding from NIDA (grant number R01DA042691). MM received funding from NIA (grant numbers P30 AG031679 and P30AI060354). ACJ received funding from NIAAA (grant numbers U24-AA020794, U01-AA020790, U24-AA022001, U10 AA013566 [completed], in kind by US Department of Veterans Affairs). YVS received funding from NIDDK (grant number R01-DK125187) and Emory (grant number CFAR P30 AI050409).

"Vaccination in Chronic Kidney Disease: An Overview "

Infection are second leading reason of mortality in individuals with end stages renal diseases, behind cardiovascular disease, and they can cause substantial morbidity in people with chronic kidney disease at an earlier stage. Vaccines are a method of attempting to decrease infection-related morbidity. Although individuals with the CKD or ESRD might not react to immunization and those without renal failures, sufficient seroresponse has been reported with conventional or enhanced influenza, pneumococcus, hepatitis B, or varicella vaccinations. With normal dosage regimens, influenza seems to offer sufficient protection. Despite the fact that some vaccinations are less efficacious in individuals with CKD, there is growing evidence that immunization is beneficial in these groups. Vaccination rates, on the other hand, are low. Given the growing body of data, quality improvement initiatives aimed at improving immunization rate in the patient with all stages of the CKD are required.

Perceptions of buprenorphine barriers and efficacy among nurse practitioners and physician assistants

BackgroundMedications for opioid use disorder (MOUDs), including methadone, buprenorphine, and naltrexone, decrease mortality and morbidity for people with opioid use disorder (OUD). Buprenorphine and methadone have the strongest evidence base among MOUDs. Unlike methadone, buprenorphine may be prescribed in office-based settings in the U.S., including by nurse practitioners (NPs) and physician assistants (PAs) who have a federal waiver and adhere to federal patient limits. Buprenorphine is underutilized nationally, particularly in rural areas, and NPs/PAs could help address this gap. Therefore, we sought to identify perceptions of buprenorphine efficacy and perceptions of prescribing barriers among NPs/PAs. We also sought to compare perceived buprenorphine efficacy and perceived prescribing barriers between waivered and non-waivered NPs/PAs, as well as to compare perceived buprenorphine efficacy to perceived naltrexone and methadone efficacy.MethodsWe disseminated an online survey to a random national sample of NPs/PAs. We used Mann–Whitney U tests to compare between waivered and non-waivered respondents. We used non-parametric Friedman tests and post-hoc Wilcoxon signed-rank tests to compare perceptions of medication types.Results240 respondents participated (6.5% response rate). Most respondents agreed buprenorphine is efficacious and believed counseling and peer support should complement buprenorphine. Buprenorphine was generally perceived as more efficacious than both naltrexone and methadone. Perceived buprenorphine efficacy and prescribing barriers differed by waiver status. Non-waivered practitioners were more likely than waivered practitioners to have concerns about buprenorphine affecting patient mix. Among waivered NPs/PAs, key buprenorphine prescribing barriers were insurance prior authorization and detoxification access.ConclusionsOur results suggest that different policies should target perceived barriers affecting waivered versus non-waivered NPs/PAs. Concerns about patient mix suggest stigmatization of patients with OUD. NP/PA education is needed about comparative medication efficaciousness, particularly regarding methadone. Even though many buprenorphine treatment patients benefits from counseling and/or peer support groups, NPs/PAs should be informed that such psychosocial treatment methods are not necessary for all buprenorphine patients.

Maternity morbidity outcomes among planned versus unplanned peripartum hysterectomies

When compared to unplanned peripartum hysterectomy in the setting of placenta accreta spectrum (PAS), planned PAS cases have fewer complications and lower rates of blood loss and transfusion. Unplanned peripartum hysterectomy is indicated in the setting of refractory uterine bleeding. We compare maternal morbidity in people undergoing planned versus unplanned peripartum hysterectomy for all indications.

Short Communication: Predictive Value of HIV-Related Versus Traditional Risk Factors for Coronary Atherosclerosis in People Aging with HIV.

Cardiovascular disease (CVD) is an important cause of morbidity in people living with HIV (PLWH). We compared the predictive value of HIV-related and traditional CVD risk factors to assess which factors best predict the presence of subclinical coronary atherosclerosis in PLWH. This is a cross-sectional study in PLWH over 50 years of age who performed computed tomography coronary artery calcium (CAC) scoring between 2009 and 2019 at Chelsea and Westminster Hospital. The following outcomes were analyzed: CAC = 0 (no calcification), CAC >0 (any calcification), CAC >100 (moderate calcification), and CAC >400 (severe calcification). Univariate and multivariate logistic regression analyses were performed to assess predictors of coronary calcification. A total of 744 patients were included (mean age 56 ± 5.7 years, 94.8% male, 84% white). A CAC >0 was found in 392 (52.7%), CAC >100 in 90 (12.1%), and CAC >400 in 42 (5.6%) subjects. CAC >100 was strongly associated with hypertension [odds ratio, OR: 2.91, (95% confidence interval: 1.93-4.36), p < .001], dyslipidemia [2.71 (1.81-4.06), p < .001], and diabetes [2.53 (1.29-4.96), p = .01]. Regarding HIV-specific factors, a significant association was found with exposure (>6 years) to protease inhibitors [1.67 (1.06-2.61), p = .05], whereas exposure to tenofovir (>8 years) was negatively associated with CAC >100 [0.54 (0.30-0.98), p = .05]. Despite the high prevalence of hypertension (45.4%) only 21.5% were on antihypertensives, whereas only 29.2% of eligible candidates were receiving lipid-lowering drugs for primary prevention of CVD. Traditional cardiometabolic risk factors remain the strongest predictors of coronary atherosclerosis in PLWH as in the general population. These results underscore the importance of optimizing treatment of hypertension and promoting primary prevention strategies that may be underused in PLWH.

SP3.2.2 Closed Incision Negative Pressure Wound Therapy reduces Surgical Site Infection following Emergency Laparotomy: A Propensity Matched, NELA Registry Study

Abstract Aims Surgical site infection (SSI) contributes to a significant proportion of post-operative morbidity in people undergoing emergency surgery. Prophylactic closed incision negative pressure therapy (CINPT) has been shown to reduce SSI rates in patients undergoing elective laparotomy however there is limited evidence for their use in the emergency setting. This study aimed to determine whether prophylactic CINPT provides comparable SSI rate to SSD for midline incision following emergency laparotomy. Methods A registry-based, prospective cohort study was undertaken using data from National Emergency Laparotomy Audit (NELA) database at our centre. The primary outcome measure was SSI as defined by the Centers for Disease Control (CDC) criteria. Secondary outcomes included 30 day post-operative morbidity and grade using Clavien-Dindo (CD) classification and the Comprehensive Complication Index, length of stay, 30 day mortality and readmission rates. CINPT and standard surgical dressing group were compared with respect to peri-operative characteristics and post-operative outcomes. A propensity- score matching (PSM) was performed to mitigate for selection bias. Results A total of 1484 patients were identified. Following PSM, a matched cohort of 474 patients were identified with 237 patients in each arm. SSI rate in CINPT cohort was found to be significantly lower compared to the SSD cohort (16.9% vs. 33.8%, p &amp;lt; 0.001). The rate of superficial and deep infections were higher in the standard dressing arm compared to the CINPWT, p &amp;lt; 0.001. There were no overall differences in 30-day morbidity and grade of post-operative complications. Conclusion Prophylactic CINPT in the emergency laparotomy is associated with reduced SSI rates.

1466 Closed Incision Negative Pressure Wound Therapy reduces Surgical Site Infection following Emergency Laparotomy: A Propensity Matched NELA Registry Study

Abstract Background Surgical site infection (SSI) contributes to a significant proportion of post-operative morbidity in people undergoing emergency surgery. Prophylactic closed incision negative pressure therapy (CINPT) has been shown to reduce SSI rates in patients undergoing elective laparotomy however there is limited evidence for their use in the emergency setting. This study aimed to determine whether prophylactic CINPT provides comparable SSI rate to SSD for midline incision following emergency laparotomy. Method A registry-based, prospective cohort study was undertaken using data from National Emergency Laparotomy Audit (NELA) database at our centre. The primary outcome measure was SSI as defined by the Centers for Disease Control (CDC) criteria. Secondary outcomes included 30-day post-operative morbidity and grade using Clavien-Dindo (CD) classification and the Comprehensive Complication Index, length of stay, 30-day mortality and readmission rates. CINPT and standard surgical dressing group were compared with respect to peri-operative characteristics and post-operative outcomes. A propensity- score matching (PSM) was performed to mitigate for selection bias. Results A total of 1484 patients were identified. Following PSM, a matched cohort of 474 patients were identified with 237 patients in each arm. SSI rate in CINPT cohort was found to be significantly lower compared to the SSD cohort (16.9% vs. 33.8%, p &amp;lt; 0.001). The rate of superficial and deep infections was higher in the standard dressing arm compared to the CINPWT, p &amp;lt; 0.001. There were no overall differences in 30-day morbidity and grade of post-operative complications. Conclusions Prophylactic CINPT in the emergency laparotomy is associated with reduced SSI rates.

Knowledge about juvenile idiopathic arthritis-associated uveitis: more frequent reminders are associated with higher patient and family uveitis knowledge

BackgroundChronic anterior uveitis is a sight-threatening complication of juvenile idiopathic arthritis (JIA) and a primary contributor to long-term morbidity in people with JIA. Levels of knowledge about uveitis among JIA patients and their parents are unknown. A survey of JIA patients and parents was conducted to assess knowledge about uveitis complications and recommended screening.MethodsA survey was developed consisting of six demographic questions, six arthritis/uveitis history questions, and nine uveitis knowledge questions. The survey was administered to JIA patients age 14 and older and parents of patients with JIA at three pediatric rheumatology practices and online through the Patients, Advocates, and Rheumatology Teams Network for Research and Service (PARTNERS) network. ANOVA, chi-square and Fisher’s exact tests were used to look for relationships between survey questions and demographic variables.ResultsThirty-three patients and 111 parents completed the survey. Overall, 17.4% reported a history of uveitis, and 89.6% had heard of uveitis. The mean composite knowledge score was 6.46 ± 2.6 out of 9. Patients and parents with a history of uveitis had higher composite knowledge scores than their counterparts without a uveitis history (p = 0.01 and p < 0.01, respectively). Parents whose rheumatologist reminded them about eye exams at every visit had higher knowledge of the risk of blindness (p = 0.04), the risk for uveitis when arthritis is controlled (p = 0.02), the need for ongoing eye exams when off of medications (p = 0.01), and had a higher overall score (p = 0.02) than those who were reminded at some visits or not at all.ConclusionsJIA patients and parents report variable levels of knowledge regarding uveitis complications and recommended screening. Frequent discussion between the rheumatology provider and family about uveitis screening is associated with higher uveitis knowledge. Incorporating detailed and frequent education about uveitis into rheumatology clinic appointments may improve early uveitis detection and visual outcomes.

Effect of testing for cancer on cancer- or venous thromboembolism (VTE)-related mortality and morbidity in people with unprovoked VTE.

Effect of testing for cancer on cancer- or venous thromboembolism (VTE)-related mortality and morbidity in people with unprovoked VTE.

Анализ уровня и структуры заболеваемости населения ХМАО-Югры

Purpose of the study: assessment of the level and structure of the incidence of the population to determine the main categories of diseases most common in the Khanty-Mansi Autonomous Okrug-Yugra, as well as making a territorial comparison of the incidence of the population. Materials and research methods: statistical materials from the annual collection “Health of the population of the Khanty-Mansi Autonomous Okrug-Yugra and the activities of medical organizations” and data of statistical reporting on the incidence of the population from the Medstat program were used, in particular, the primary morbidity of the population of the Khanty-Mansi Autonomous Okrug-Yugra in different age groups, the general incidence the population of different age groups of the Khanty-Mansi Autonomous Okrug-Yugra. The analysis used indicators such as primary morbidity, general morbidity, one-year mortality (died within the first year from the date of diagnosis) in malignant neoplasms. Results. The primary morbidity of the population in the Khanty-Mansi Autonomous Okrug-Yugra tends to grow in all age groups. The indicators of primary morbidity of the population of the Khanty-Mansi Autonomous Okrug-Yugra in 2018 are 17.1% higher than in the Russian Federation and 12.2% higher than in the Ural Federal District. In the structure of primary morbidity, the first place is taken by diseases of the respiratory system, the second place in the structure of the primary morbidity of people over working age is taken by diseases of the circulatory system, and the third place is by diseases of the genitourinary system. The overall incidence rate of the entire population is 1896 per 1000 population. In 2018, 41.2 cases of tuberculosis per 100 thousand of the population were detected for the first time in the Khanty-Mansi Autonomous Okrug-Yugra (in the Ural Federal District – 61.6, in the Russian Federation – 44.4 per 100 thousand of the population). This pathology tends to decrease and compared with 2017 decreased by 10.2% (the Russian Federation decreased by 8.1%, the Ural Federal District – 2.1%). The number of patients with newly diagnosed HIV infection in 2018 decreased by 1.5% compared to 2017 and amounted to 82.3 per 100 thousand population, which is higher than in the Russian Federation (58.5), but lower. than in the Ural Federal District (108.2) per 100 thousand population. Since 2012, there has been a tendency towards an increase in the incidence of malignant neoplasms, but the detection rate of malignant neoplasms at stages III-IV has not changed since 2015 and is 39.5%, which is higher than in the Russian Federation (38.5%). Conclusion: the primary morbidity in the Khanty-Mansi Autonomous Okrug-Yugra in 2018 is 17.1% higher than in the Russian Federation. In the first place are diseases of the respiratory system (48.4%, of which in children – 66.4, and in persons of older working age – 22.2%). In second place in children is infectious pathology, and in people of working age – diseases of the genitourinary system. The second place in morbidity in older people of working age is diseases of the circulatory system. The district has a high level of infectious and parasitic diseases. The number of patients with newly diagnosed tuberculosis is lower than in the Ural Federal District and the Russian Federation. The number of patients with HIV infection is higher than in the Russian Federation, but lower than in the Ural Federal District. There is a tendency towards an increase in the number of malignant neoplasms. The number of neoplasms is lower than in the Ural Federal District and the Russian Federation. In the Khanty-Mansi Autonomous Okrug-Yugra, there is a positive trend in the reduction of socially significant diseases, such as tuberculosis, HIV infection, STIs, alcoholism, drug addiction, injuries and an increase in overall morbidity, including malignant neoplasms, which indicates the availability of medical care, health literacy of the population and carrying out appropriate preventive work.

Joint effects of educational attainment, type 2 diabetes and coexisting morbidity on disability pension: results from a longitudinal, nationwide, register-based study.

High prevalence of coexisting morbidity in people with type 2 diabetes highlights the need to include interactions with education and comorbidity in the assessments of societal consequences of type 2 diabetes. The purpose of this study was to estimate the joint effects of education, type 2 diabetes and six frequent comorbidities. Nationwide administrative register data on type 2 diabetes diagnosis, hospital admissions, education and disability pension were grouped at the individual level by means of a unique personal identification number. Included were all people (N = 2,281,599) in the age span of 40-59years living in Denmark in the period 2005 to 2017, covering a total of 17,754,788 person-years. We used both Cox proportional hazards and Aalen additive hazards models to estimate relative and absolute joint effects of type 2 diabetes, educational attainment and six common comorbidities (CVD, cancer and cerebrovascular, respiratory, musculoskeletal and psychiatric diseases). We decomposed the joint effects of educational level, type 2 diabetes and comorbidities into main effects and the interaction effect, measured as extra cases of disability pension. Lower level of educational attainment, type 2 diabetes and comorbidities independently contributed to additional granted disability pensions. The joint number of cases of disability pension exceeded the sum of the three exposures, which is explained by a synergistic effect of lower educational level, type 2 diabetes and comorbidity. In this population study, the joint effects of type 2 diabetes, lower education and comorbidity were associated with larger than additive rates of disability pension. An integrated approach that takes into account socioeconomic barriers to type 2 diabetes rehabilitation may slow down disease progression and increase the working ability of socially disadvantaged people.

A model of weight-based stigma in health care and utilization outcomes: Evidence from the learning health systems network.

ObjectiveObesity is stigmatized and people with obesity report experiencing stigmatizing situations when seeking health care. The implications of these experiences are not well understood. This study tests an indirect effects model of negative care experiences as an intermediate variable between obesity and care avoidance/utilization and switching primary care doctors.MethodsA survey was completed by 2380 primary care patients in the Learning Health Systems Network (LHSNet) Clinical Data Research Network with a BMI >25 kg/m2. Measures included scales assessing stigmatizing situations, perceived patient‐centered communication, perceived respect, having delayed needed care, and having looked for a new primary doctor in the past 12 months. Sequential and serial indirect effects of care experiences and respect in the association between BMI and care utilization outcomes was modeled.ResultsThe hypothesized model was supported by findings. The associations between BMI and delaying needed care (OR = 1.06, p < 0.001) and attempting to switch primary doctors (OR = 1.02, p = 0.04) was mediated by both stigmatizing situations experienced in a health care context and lower patient‐centered communication. Lower perceived respect mediated the association between care experiences and utilization outcomes.ConclusionsPeople with higher BMIs may avoid care or switch doctors as a result of stigmatizing experiences and poor communication with doctors. These outcomes may contribute to morbidity in people with obesity if they delay or avoid care for health concerns when symptoms first present.

U.S. Survey Investigating Gaps between Patients and Specialists in the Treatment of Severe Hypoglycemia and Impressions of the Ease-of-Use of Liquid-Stable Glucagon for Subcutaneous Injection

Severe hypoglycemia is an emergency condition where very low blood sugar may lead to confusion, seizure, unconsciousness, and if left untreated, death. It has been identified as a cause for recurrent morbidity in people with either Type 1 Diabetes (T1D) or Type 2 Diabetes (T2D); however, the understanding of signs and symptoms of Severe Hypoglycemia (SH), as well as when to use glucagon, tend to vary between patients, caregivers, and adult and pediatric endocrinologists (specialists).

The role of cardiopulmonary exercise testing in predicting mortality and morbidity in people with congenital heart disease: a systematic review and meta-analysis.

The role of cardiopulmonary exercise testing (CPET) in predicting major adverse cardiovascular events (MACE) in people with congenital heart disease (ConHD) is unknown. A systematic review with meta-analysis was conducted to report the associations between CPET parameters and MACE in people with ConHD. Electronic databases were systematically searched on 30 April 2020 for eligible publications. Two authors independently screened publications for inclusion, extracted study data, and performed risk of bias assessment. Primary meta-analysis pooled univariate hazard ratios across studies. A total of 34 studies (18 335 participants; 26.2 ± 10.1 years; 54% ± 16% male) were pooled into a meta-analysis. More than 20 different CPET prognostic factors were reported across 6 ConHD types. Of the 34 studies included in the meta-analysis, 10 (29%), 23 (68%), and 1 (3%) were judged as a low, medium, and high risk of bias, respectively. Primary univariate meta-analysis showed consistent evidence that improved peak and submaximal CPET measures are associated with a reduce risk of MACE. This association was supported by a secondary meta-analysis of multivariate estimates and individual studies that could not be numerically pooled. Various maximal and submaximal CPET measures are prognostic of MACE across a variety of ConHD diagnoses. Further well-conducted prospective multicentre cohort studies are needed to confirm these findings.

Traditional and new in the content and technique of ukrainian regional nosogeographic mapping

The aim of the article is to outline the traditional classification of nosogeographic maps and suggest additions to it. These additions are formulated, taking into account the changes that have occurred in the classification of nosologies, the source base and technical capabilities of mapping, as well as in the organization of the system of medical care for the population. Main material. The authors have analysed peculiarities of the content and specifics of making nosogeographic maps. They have established the fact that computerization of the health care facilities, including primary medicine ones, makes it possible to carry out very detailed types of nosogeographic mapping, taking into account more advanced methods of medical and statistical data processing, which are a source of information in compiling such maps. It becomes possible to draw new nosogeographic maps by using individual address accounting data with flexible selection of territorial units over which averaging is carried out. Thus, we can obtain characteristics not only for administrative units, but also for individual houses, their groups, micro-districts (communities), etc. Conclusions and further research. The cartographic method has extremely wide possibilities in the implementation of nosogeographic analysis, since each group of diseases has its own chorological and chronological specificity. Its use allows us to predict the existence of specific factors (indicators of the environmental situation, level of medical care, sociodemographic indicators, etc.) that determine the morbidity rate. Cartographic models can be used in strategies for socioeconomic development of regions, special events, aimed at reducing the level of certain types of diseases, rational territorial organization of medical care system for the population. The authors believe that the classification of nosogeographic maps, and, accordingly, the structure of nosogeographic mapping, as well as the topic of cartographic plots, should be supplemented by the following three varieties. Firstly, these are demographic and nosogeographic maps. They convey differences in the morbidity of people according to demographic and sociodemographic indicators of the population. These maps analyze gender, age, nationality, other factors of population susceptibility to certain types of diseases. Secondly, there are physiological-nosogeographic maps, which, in addition to the morbidity of the inhabitants of a country or region, transmit certain indicators of physical development and health of certain population groups. Thirdly, nosogeographic maps should also include maps of road traffic accidents.

Tissue-specific transcriptional profiling of plasmacytoid dendritic cells reveals a hyperactivated state in chronic SIV infection.

HIV associated immune activation (IA) is associated with increased morbidity in people living with HIV (PLWH) on antiretroviral therapy, and remains a barrier for strategies aimed at reducing the HIV reservoir. The underlying mechanisms of IA have not been definitively elucidated, however, persistent production of Type I IFNs and expression of ISGs is considered to be one of the primary factors. Plasmacytoid DCs (pDCs) are a major producer of Type I IFN during viral infections, and are highly immunomodulatory in acute HIV and SIV infection, however their role in chronic HIV/SIV infection has not been firmly established. Here, we performed a detailed transcriptomic characterization of pDCs in chronic SIV infection in rhesus macaques, and in sooty mangabeys, a natural host non-human primate (NHP) species that undergoes non-pathogenic SIV infection. We also investigated the immunostimulatory capacity of lymph node homing pDCs in chronic SIV infection by contrasting gene expression of pDCs isolated from lymph nodes with those from blood. We observed that pDCs in LNs, but not blood, produced high levels of IFNα transcripts, and upregulated gene expression programs consistent with T cell activation and exhaustion. We apply a novel strategy to catalogue uncharacterized surface molecules on pDCs, and identified the lymphoid exhaustion markers TIGIT and LAIR1 as highly expressed in SIV infection. pDCs from SIV-infected sooty mangabeys lacked the activation profile of ISG signatures observed in infected macaques. These data demonstrate that pDCs are a primary producer of Type I IFN in chronic SIV infection. Further, this study demonstrated that pDCs trafficking to LNs persist in a highly activated state well into chronic infection. Collectively, these data identify pDCs as a highly immunomodulatory cell population in chronic SIV infection, and a putative therapeutic target to reduce immune activation.