Number Of Comorbid Conditions Research Articles

Differences Between Dialysis Modality Selection and Initiation

Although dialysis modality education is associated with higher rates of peritoneal dialysis (PD) use, some patients start hemodialysis (HD) therapy despite initially selecting PD as their modality of choice. This study seeks to identify predictors of this discrepancy. Retrospective cohort study. 217 patients who received dialysis modality education at the University of Rochester between January 2004 and September 2009 and subsequently started dialysis therapy. Demographic (age, race, sex, and timing of education), social (education, income, insurance, marital, employment, and smoking status), and clinical data (estimated glomerular filtration rate, cause of end-stage renal disease [ESRD], number of comorbid conditions, and number of nephrology visits). HD use at initiation and day 91 of dialysis therapy in patients initially selecting PD. Of 217 patients receiving education and starting dialysis therapy, at the time of education, 124 chose PD, 52 were undecided, and 41 chose HD. Modality distribution at the time of dialysis therapy initiation was 150 with HD and 67 with PD. Of 124 patients who chose PD at the time of education, 59 started dialysis therapy with PD and 65 started with HD. On day 91, a total of 60 patients were on PD therapy and 55 were on HD therapy. Nine patients had either died, undergone transplant, or not yet reached 91 days of dialysis therapy. On multivariable analysis, nonglomerular cause of ESRD, age older than 75 years, and not being employed predicted starting with HD therapy, whereas age older than 75 years, nonwhite race, and nonglomerular cause of ESRD predicted HD use at day 91. Single-center observational study. This study shows that patients choosing PD after dialysis education may not start with this modality and identifies several predictors of this mismatch. Further investigation into predictors of this discrepancy and strategies promoting a PD start in patients selecting this modality are warranted.

Polypharmacy as a risk for fall occurrence in geriatric outpatients

To investigate the predictors of falls, such as comorbidity and medication, in geriatric outpatients in a longitudinal observational study. A total of 172 outpatients (45 men and 126 women, mean age 76.9 ± 7.0 years) were evaluated. Physical examination, clinical history and medication profile were obtained from each patient at baseline. These patients were followed for up to 2 years and falls were self-reported to their physicians. The factors associated with falls were analyzed statistically. A total of 32 patients experienced falls within 2 years. On univariate analysis, older age, osteoporosis, number of comorbid conditions and number of drugs were significantly associated with falls within 2 years. On multiple logistic regression analysis, the number of drugs was associated with falls, independent of age, sex, number of comorbid conditions and other factors that were significantly associated in univariate analysis. A receiver-operator curve evaluating the optimal cut-off value for the number of drugs showed that taking five or more drugs was a significant risk. In geriatric outpatients, polypharmacy is associated with falls. Intervention studies are needed to clarify the causal relationship between polypharmacy, comorbidity and falls.

Sense of control and sociodemographic differences in self-reported health in older adults

Stronger sense of control has been associated with improved health outcomes. This study tested whether the association between sense of control and self-reported health varied among demographic groups and whether sense of control attenuated sociodemographic differences in self-reported health. Data from 6,815 participants in the Health and Retirement Study were used to examine moderation between demographic characteristics and sense of control (measured by the personal mastery and perceived constraints scales of the midlife developmental inventory) in their associations with three self-reported health measures (global rating of fair/poor health, functional limitations, and number of comorbid conditions). Higher personal mastery and lower perceived constraints were associated with better self-reported health. There were no significant interactions between the sense of control measures and age, gender, education level, income, or marital status in their associations with either global self-rated health or functional limitations. Higher levels of mastery were associated with lower likelihood of functional limitations among blacks and whites, but not among those of other races. Perceived constraints were slightly more strongly associated with number of comorbid conditions among older than younger individuals. Sense of control measures were generally similarly associated with self-reported health across demographic groups and did not attenuate demographic differences in health.

Incidence and predictive factors of depressive symptoms in Alzheimer's disease: the REAL.FR study.

Many patients develop psychiatric and behavioral disturbances in the course of Alzheimer's disease (AD). Among these disturbances, depressive symptoms are frequent and affect nearly 40% of patients. The natural history and course of such symptoms in AD, and in particular the predictive factors, are little known. We studied the incidence and risk factors for the development of the first depressive symptoms in AD. Multicenter prospective study. Three hundred twelve AD patients from the French Network on AD (REAL.FR) without depression and without antidepressant treatment at baseline were followed up and assessed every 6 months for 4 years. During follow-up, all events occurring between two visits were carefully recorded. We used the Neuropsychiatric Inventory (NPI) for comprehensive evaluation of behavioral and psychological symptoms and depressive symptoms in particular. A multivariate analysis was performed using a backward stepwise Cox proportional hazards model. The incidence of depressive symptoms was 17.45% person/years, 95%CI (13.88-21.02). Among non-time dependent variables, duration of disease (RR=0.51; 95%CI: 0.30-0.85, p=0.0102) and the number of comorbid conditions (RR=0.45; 95%CI: 0.24-0.83, p=0.0115) were protective factors against the development of depressive symptoms. Agitation/aggression (RR=1.96; 95%CI: 1.19-3.23, p=0.0078) and sleep disturbances (RR=2.65; 95%CI: 1.40-5.00, p=0.0026) were time-dependent variables predictive of depressive symptoms. Better knowledge of predictive factors of mood disturbances in AD will enable clinicians to set up appropriate management of their patients. As published longitudinal studies are few, further works should be carried out to improve knowledge of the pattern and course of depression and depressive symptoms in AD.

Abstract ED02-04: Intersection of cancer, aging, and survivorship

Abstract Cancer is a disease associated with aging, with approximately 60% of cancer diagnoses occurring in patients age 65 and older. Of 10.8 million cancer survivors in the US, approximately 6.8 million are age 65 or older. With the aging of the baby boomer population and rises in life expectancy, the number of cancer cases and the number of cancer survivors is anticipated to grow over the coming decades.1 Optimal care of this growing population of older adult cancer survivors will require an understanding of the interaction between cancer, cancer therapy, and the aging process. In particular there is a gap in knowledge regarding whether cancer and/or cancer treatment accelerates the aging process, and if so whether the accelerated aging is transient or permanent. This lecture will provide an overview of the available data regarding the intersection between aging and survivorship, as well as specific considerations in the assessment and treatment of older adult survivors. Cancer and cancer treatment has a potential long term impact on the health status and physical function of older adults.2–3 The Health and Retirement study evaluated the health and functional status of older cancer survivors in comparison to controls. Older cancer survivors were less likely to report excellent or good health (P<0.001), reported more mobility limitations (P<0.001), and reported more limitations with activities of daily living (P=0.01). Among older cancer survivors, obesity, lack of exercise, and poor diet are associated with a poorer quality of life.4 A randomized study tested the benefits of an exercise and diet intervention in older cancer survivors and demonstrated that the intervention was associated with a decrease in self-reported functional decline.5 Older cancer survivors have an increased number of comorbid conditions in comparison to individuals without a history of cancer.2 The NIA/NCI Collaborative Study on Cancer and Comorbidity in the Elderly provided summary data on the comorbidity of 7,600 patients age 55 and older with a history of cancer. The most common comorbid conditions included hypertension (43%), heart conditions (39%) and arthritis (35%).6 Patients may be at increased risk for specific comorbid conditions based on their preexisting comorbid conditions and the therapeutic exposures received. For example, therapy with doxorubicin is associated with an increased risk of congestive heart failure and cardiomyopathy.7–8 Risk factors include a history of diabetes mellitus, coronary artery disease, and hypertension. Therapy with an aromatase inhibitor is associated with a loss in bone mineral density and this risk is most pronounced in patients with pre-existing bone loss.9 These examples highlight the need to better understand the association between a history of cancer, patient characteristics (including pre-existing comorbid conditions), specific therapeutic exposure, and the subsequent development or acceleration of comorbid conditions. Although our knowledge of the potential survivorship issues facing older adults is growing, several gaps in knowledge remain.10 As the number of cancer survivors is on the rise, it is critical to improve our evidence-based knowledge to identify and reduce the risk of late side effects from treatment. Prospective longitudinal studies of the long term impact of cancer therapies and interventions to decrease the risk are needed.

The Impact of Frailty on Health Related Quality of Life in Heart Failure

Most heart failure (HF) hospital discharges involve people >65years, many frail. The purpose of this study was to determine if frailty explains variability in health related quality of life (HRQOL) in older adults with HF over and above known correlates. A frailty index score was developed by weighting age, number of comorbid conditions, and symptom severity. A multivariate hierarchical regression analysis of known predictors of HRQOLgender, income, ethnicity, health perception, NYHA class - were entered first and then the frailty index was entered and regressed on HRQOL in 2 unique samples. When known predictors were tested on a sample they explained 11% (p 0.14) of the variance in HRQOL; when the frailty index score was added 24% (p 0.001) was explained. When the index was validated in a second sample, known predictors explained 15% (p 0.04) of the variance; with the frailty index score 40% (p 0.000) was explained. Frailty explains significant amounts of variance in HRQOL in HF. Treating comorbid conditions and controlling symptoms may improve HRQOL in HF patients. These findings support the need for further research into the impact of frailty on HRQOL in HF patients.

Symptom burden in cancer survivors 1 year after diagnosis

AbstractBACKGROUND:Few studies have examined risk for severe symptoms during early cancer survivorship. By using baseline data from the American Cancer Society's Study of Cancer Survivors‐I, the authors examined cancer survivors with high symptom burden, identified risk factors associated with high symptom burden, and evaluated the impact of high symptom burden on health‐related quality of life (HRQoL) 1 year postdiagnosis.METHODS:Participants were enrolled from 11 state cancer registries approximately 1 year after diagnosis and were surveyed by telephone or mail. The outcomes measures used were the Modified Rotterdam Symptom Checklist and the Profile of Mood States‐37 (to assess symptom burden) and the Satisfaction with Life Domains Scale‐Cancer (to assess HRQoL).RESULTS:Of 4903 survivors, 4512 (92%) reported symptoms related to their cancer and/or its treatment. Two‐step clustering yielded 2 subgroups, 1 with low symptom burden (n = 3113) and 1 with high symptom burden (n = 1399). Variables that were associated with high symptom burden included lung cancer (odds ratio [OR], 2.27), metastatic cancer (OR, 2.05), the number of comorbid conditions (OR, 1.76), remaining on active chemotherapy (OR, 1.93), younger age (OR, 2.31), lacking insurance/being underinsured (OR, 1.57), having lower income (OR, 1.61), being unemployed (OR, 1.27), and being less educated (OR, 1.29). Depression, fatigue, and pain had the greatest impact on HRQoL in survivors with high symptom burden, who also had lower HRQoL (P < .0001).CONCLUSIONS:More than 1 in 4 cancer survivors had high symptom burden 1 year postdiagnosis, even after treatment termination. These results indicate a need for continued symptom monitoring and management in early post‐treatment survivorship, especially for the underserved. Cancer 2011;. © 2011 American Cancer Society.

Evaluation of Outcome Change Scores for Patients With Pneumonia or Heart Failure

This study was conducted to describe the variance in selected Nursing Outcomes Classification (NOC) outcome change scores of hospitalized older patients with pneumonia (n = 216) or heart failure (HF; n = 67) that could be explained by age, length of stay (LOS), number of comorbid conditions, number of nursing diagnoses, and number of nursing interventions. Investigators used a descriptive correlational design to analyze data sets from three U.S. community hospitals. Study participants had at least two ratings on one of nine outcomes selected for their frequency and use across the three hospitals. A significant portion of the variance in the outcomes Knowledge: Illness Care and Fall Prevention Behavior was explained for pneumonia patients. None of the regression models for HF patients showed significance. Individual independent variables were significant in some of the models (i.e., LOS [pneumonia], number of nursing diagnoses [pneumonia and HF]). Implications for research and clinical practice are discussed.

Respiratory Dysfunction in Patients With Sepsis: Protective Effect of Diabetes Mellitus

Sepsis is a common complication in patients with diabetes mellitus. In a Western population, risk of respiratory dysfunction was lower in diabetic patients with sepsis. To compare organ dysfunction, particularly respiratory dysfunction, between sepsis patients with and without diabetes mellitus in an Asian population. Hospital discharge data were collected for the period 2004 through 2008. Patients with sepsis, diabetes mellitus, and organ dysfunction were identified by using the International Statistical Classification of Diseases and Related Health Problems, 9th Revision, Australian Modification codes. Of the 383 238 patients hospitalized during the 5 years, 2943 of the 9221 who had sepsis also had diabetes (31.9%).The most common organ dysfunctions in patients with sepsis were renal (31.5%), cardiovascular (19.2%), and respiratory (10.9%). Among patients with sepsis, respiratory dysfunction was less likely in patients with diabetes (9.4%) than in those without (11.6%; P = .002), but renal dysfunction was more likely in patients with diabetes (46.5%) than in those without (24.4%; P < .001). However, only 27.6% of patients with diabetes had a respiratory source of sepsis compared with 33.4% in patients without diabetes (P < .001). Among patients with sepsis, diabetes mellitus was a significant and independent predictor of respiratory dysfunction (odds ratio, 0.80; 95% confidence interval, 0.66-0.98) after adjustments for age, sex, ethnicity, admission to intensive care, number of comorbid conditions, and other infection sources. Among an Asian population, respiratory dysfunction in patients with sepsis is less likely to develop in those with diabetes than in those without diabetes.

Treatment and nontreatment predictors of health assessment questionnaire disability progression in rheumatoid arthritis: A longitudinal study of 18,485 patients

To examine predictors of progression of disability in rheumatoid arthritis (RA), as measured by the Health Assessment Questionnaire disability index (HAQ), and to determine rates of progression during biologic treatment. We followed 18,485 RA patients for up to 11 years (mean 3.7 years) in a longitudinal study of RA outcomes. Patients were characterized as having moderate or severe RA versus less severe RA at study entry. Annualized progression rates were determined in multivariable analyses using generalized estimating equations. Although all of the demographic and severity characteristics were associated with baseline differences in HAQ score, progression was only associated with age, comorbidity, initial severity, and treatment. HAQ score increased fastest in patients ages >65 years (0.031; 95% confidence interval [95% CI] 0.028, 0.034). HAQ progression was independently associated with the presence of baseline cardiovascular disease, hypertension, diabetes mellitus, and the number of comorbid conditions. Annualized progression rates were greater in patients with mild to inactive RA (0.021; 95% CI 0.019, 0.023) than in moderate to severe RA (0.003; 95% CI 0.001, 0.006). The overall progression rate during biologic treatment was 0.008 (95% CI 0.005, 0.011); for patients with moderate to severe RA, the rate was 0.001 (95% CI -0.005, 0.003). Age and comorbidity are important predictors of the rate of loss of functional status, and have a stronger effect on HAQ progression than does biologic treatment. There is little difference in progression rates among biologics. Patients with more severe RA progress less than those with less severe RA, a possible function of regression to the mean.

Treatment patterns among physician specialties in the management of fibromyalgia: results of a cross-sectional study in the United States

Background:Fibromyalgia (FM) is characterized by persistent and widespread pain and often associated with other symptoms and comorbidities. Thus, FM patients seek care from multiple physician specialties. This study compared prescribing patterns, patient-reported outcomes (PROs), healthcare resource use (HRU), and direct costs related to FM in routine clinical practice across physician specialties.Methods:This cross-sectional, observational study recruited 203 FM subjects from 20 community-based physician offices (eight primary care, six rheumatology, three neurology, three psychiatry). Subjects completed questions about pain, other symptoms, quality of life, productivity, treatment effectiveness and satisfaction, and out-of-pocket expenses related to FM; site staff recorded subjects’ treatment and HRU based on medical chart review. Results were compared across specialties. Statistical significance was evaluated at the 0.05 level. Annual direct costs associated with FM were calculated in 2009 US dollars.Results:Subject demographic and clinical characteristics were not significantly different across physician specialties, except psychiatry subjects had the highest mean number of co-morbid conditions; p < 0.001. PROs were similar across physician specialties except fatigue; neurology subjects reported the highest levels. There were no significant differences in subject-reported outcomes of medication effectiveness (p = 0.782) and medication satisfaction (p = 0.338) for FM. Psychiatry subjects had more FM-related physician visits compared to other specialties (p = 0.013) and a higher proportion received diagnostic tests related to FM (p = 0.013). The mean (SD) number of FM prescription medications prescribed per subject was highest in the primary care and lowest in the neurology group; p = 0.024. The proportion of hypnotic (p = 0.001), muscle relaxant (p = 0.005), anxiolytic (p = 0.005), anti-epileptic (p = 0.007), and other medications (p = 0.044) prescribed for FM were significantly different across specialties. Overall direct medical costs did not differ significantly (p = 0.284) across specialties.Conclusions:Patient characteristics were similar across specialties, except with regards to comorbidity burden. This study noted significant differences among physician specialties in HRU and treatment patterns among medications, diagnostics, and outpatient visits. Consistent with other studies, this study did not identify a dominant strategy for FM management across physician specialties as overall per patient medical costs and subject-reported treatment satisfaction were similar. Future research to better characterize differences among physician specialties in FM management, as well as the reasons for these differences, would be useful.

The serotonin axis: Shared mechanisms in seizures, depression, and SUDEP

There is a growing appreciation that patients with seizures are also affected by a number of comorbid conditions, including an increase in prevalence of depression (Kanner, 2009), sleep apnea (Chihorek et al., 2007), and sudden death (Ryvlin et al., 2006; Tomson et al., 2008). The mechanisms responsible for these associations are unclear. Herein we discuss the possibility that underlying pathology in the serotonin (5-HT) system of patients with epilepsy lowers the threshold for seizures, while also increasing the risk of depression and sudden death. We propose that postictal dysfunction of 5-HT neurons causes depression of breathing and arousal in some epilepsy patients, and this can lead to sudden unexpected death in epilepsy (SUDEP). We further draw parallels between SUDEP and sudden infant death syndrome (SIDS), which may share pathophysiologic mechanisms, and which have both been linked to defects in the 5-HT system.

Self-Reported Comorbidity Affects Health-Related Quality of Life and Perception of Shoulder Function in Patients with Rotator Cuff Disease

Background The present study aimed to describe the comorbidity burden of a rotator cuff disease cohort and to examine the effects of patient comorbidities on general health and shoulder-specific outcome measures. Methods A retrospective cohort of patients with rotator cuff disease was identified using the coding of the International Classification of Diseases, Ninth Revision, Clinical Modification. Demographic variables and numbers of systemic and musculoskeletal comorbid conditions were collected. General health and shoulder-specific tools were used to assess disability. Analyses using regression, correlation and analysis of variance were performed to assess the impact of comorbidity upon outcome measures. Results Three hundred and seventy-three patients with rotator cuff disease were identified. Two-thirds of the group reported at least one systemic comorbidity. Non-shoulder musculoskeletal comorbidities were reported by 80% of the cohort. Women reported a significantly greater number of comorbid conditions than men ( p &lt; 0.02). Baseline health-related quality of life and self-reported shoulder function were impacted significantly by comorbidity when controlling for patient demographic characteristics. Discussion Comorbidities are common in this population and significantly affect health-related quality of life and self-reported shoulder pain and disability in patients presenting with rotator cuff-related symptoms. Comorbidities should be considered when shoulder disability measures are utilized in clinical practice and when studying outcomes.

Abstract A111: Race is a predictor for endometrioid endometrial cancer cause-specific survival, but not all-cause survival

Abstract Endometrial cancer is the most common gynecologic cancer, with an estimated 42,000 new cases in 2010. The reported difference in overall five year survival between white women and African American (AA) women represents significant survival disparity in cancer. Histologic types of endometrial cancer and stage at diagnosis differ substantially between AAs and whites, but AA women experience poorer survival even after adjusting for these factors. After IRB approval, we performed a case-only retrospective analysis of 362 patients with surgically treated endometrioid endometrial cancer. Data from 120 AA and 242 white women, diagnosed from 1990-2005 at a single institution were analyzed to examine risk factors associated with survival. Age at diagnosis, co-morbid conditions in the 5 years prior to diagnosis, BMI, and smoking history were obtained from medical record review. Tumor histologic type, 1988 FIGO stage, grade, vital status and number of months surviving were obtained from the Metropolitan Detroit Cancer Surveillance System, part of the SEER program. Differences in stage, co-morbid conditions (using a modified Charlson Comorbidity Index, CCI), and BMI were examined by race. Chisquare tests were used to assess differences in distribution of clinical and demographic variables. Log-rank tests and Cox proportional hazards models were used to assess the risk of all-cause and endometrial cancer-related deaths. AA women were more likely than white women to have high grade tumors (p=0.009), hypertension (p=0.0005) and higher mean BMI (p=0.009). No differences by race were identified among the total group for age (p=0.98), stage at diagnosis (p=0.78), categorical modified CCI (p=0.51) or smoking history (p=0.96). When data were stratified by grade, hypertension (p=0.0009) and high BMI (p=0.002) were more frequent among AAs compared to whites with low grade tumors, but not high grade tumors. Among women with high grade tumors, AAs had a greater number of co-morbid conditions (p=0.005) and were more likely to be current or former smokers compared to whites (p=0.003). In univariate survival analysis, age at diagnosis, CCI, stage, and grade were all significantly associated with any cause survival, whereas race was not. When examining deaths due to endometrial cancer, only stage (HR=3.37,95% CI: 2.52-4.51), grade (HR=4.32,95% CI: 2.89-6.47) and race (HR=2.12,95% CI: 1.13-3.97) were predictors of survival. Analysis of endometrial cancer-related deaths by grade suggest this difference in survival by race is seen for high grade (p=0.03) but not low grade (p=0.87) tumors. In this single institution study, race was not a predictor of overall survival, but was associated with endometrial cancer-related survival. Excess of co-morbid conditions was associated with AA race, and overall survival, but not endometrial cancer-related survival in this population. A larger, more comprehensive study, including information regarding socio-economic factors, molecular tumor markers, and treatment modality is necessary to elucidate the causes underlying the large disparity in endometrial cancer survival between AA and white women. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A111.

Co-morbidities of COPD in primary care: frequency, relation to COPD, and treatment consequences

In the Western world, chronic obstructive pulmonary disease (COPD) is predominantly caused by long-term smoking, which results in pulmonary inflammation that is often associated with systemic inflammation. A number of co-morbid conditions, such as cardiovascular disease, muscle wasting, type 2 diabetes and asthma, may coexist with COPD; these and other co-morbidities not directly related to COPD are major causes of excess morbidity and mortality. This review sets out to explore the most frequent co-morbidities in COPD and their implications for treatment. Review of the literature on co-morbidities of COPD. Co-morbidities are frequent, but often remain undiagnosed in the COPD patient. In order to provide the best possible care for people with COPD, the physician should be aware of all potential co-morbidities that may arise, and the critical role that effective management of these co-morbidities can play in improving patient outcomes. Increased awareness of the potential co-morbidities of COPD, although potentially adding to the general practitioner's work burden, may provide insights into this difficult disease state and possibly improve each individual's prospects for effective management.

Rural/urban differences in health care utilization and place of death for persons with respiratory illness in the last year of life

Respiratory illness is a leading cause of death worldwide, with rates that will continue to escalate into the foreseeable future. Rural residents have an increased risk of dying from some forms of respiratory disease, although little is known about the healthcare utilization or location of death for persons with advanced respiratory illness in rural settings. The purpose of this study was to examine rural-urban differences in healthcare utilization and location of death for residents of Saskatchewan, Canada, with chronic obstructive pulmonary disease (COPD) or lung cancer in the last 12 months of life. A retrospective cohort study was undertaken of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer in administrative health data from Saskatchewan Health. Decedents were classified as residents of rural/remote (< or =9,999 population size), small urban (10 000-99 999) or urban (> or =100 000) locations and analysis conducted using this primary variable of interest. Comparisons were made between the three groups in terms of demographic characteristics, healthcare utilization (physician visits, length of stay, hospitalizations, institutional care, home care, transitions between care settings) and location of death (hospital, long-term care [LTC] or home). The study population was 57% male with a mean age of 77 years (SD=11). Demographic characteristics, underlying cause of death and number of comorbid conditions were similar between urban, small urban and rural/remote groups. After adjustment for area of residence, underlying cause of death (UCOD), age group, sex, marital status, and comorbidity, urban, small urban and rural/remote residents were comparable in terms of the likelihood of: any hospitalizations, having had 5 or more transfers between settings, and dying in hospital. The proportion of home deaths in rural settings was 15.4%, and was comparable to the rate in urban settings (16.3%). Urban residents were more likely to have had 24 or more physician visits in the last year of life compared with small urban (OR=0.52, 95% CI=.37-.74) or rural/remote residents (OR=0.52, 95% CI=.40-.69), while rural/remote residents were more likely to have received any institutional LTC (OR=1.40, 95% CI=1.03-1.90) than the other groups. Hospital as a location of death was more likely for those with a UCOD of cardiovascular disease (OR=1.84, 95% CI=1.24-2.71), but was less likely for those aged 80-85 years (OR=0.46, 95% CI=.31-.69), those aged more than 85 years (OR=0.28, 95% CI=.19-.42) and those who had never married (OR=0.48, 95% CI=.29-.78). Residents of rural/remote areas were significantly less likely than those in urban or small urban settings to receive any home care (OR=0.74, 95% CI=.56-.97), any home palliative care (OR=0.29, 95% CI=.19-.45) or home physiotherapy services (OR=0.09, 95% CI=.03-.25). Rural/remote residents were, however, much more likely to receive home supportive care (OR=1.60, 95% CI=1.17-2.19) and home meal preparation (OR=2.51, 95% CI=1.44-4.39). While the healthcare needs of persons with respiratory illness in the last year of life were likely to be similar between locations, rural-urban differences were apparent in the number of primary care physician visits and in access to and the nature of home care services provided. Significantly fewer physician visits were made by residents of small urban or rural remote locations compared with those in urban settings, although additional research is needed to determine the reasons for this discrepancy. The likelihood of receiving home care services and professional home care services such as palliative care and physiotherapy was significantly lower for persons in rural/remote locations. The challenges experienced by rural remote regions with supporting patients in the community may have led to the increased likelihood of admission to institutional LTC noted for this group compared with residents of urban and small urban settings. The low home death rates is both urban and rural settings may pose particular hardship for rural families who may need to travel extensively or temporarily relocate to be closer to the hospital where their loved one is dying. Further investigation of issues related to differences in quality of care and unmet health care needs between rural and non-rural settings will strengthen the evidence base to allow equitable care at the end of life.

Nutritional Intervention in Young Women with Eating Disorders: A Brief Report

Eating disorders in young women are often associated with a number of comorbid conditions, including mood disorders and cognitive problems. Although group therapy is often used as part of overall treatment for eating disorders in many types of settings, specific nutritional interventions used in such settings have rarely been evaluated. In this study, I evaluated the effects of a nutritional intervention used by 78 girls, aged 12–18 years, at a private school. My results showed that nutritional knowledge increased following intervention, but attitudes toward eating healthy did not change.

Symptoms of Depression in Kidney Transplant Recipients: A Cross-sectional Study

Depression is associated with impaired quality of life and increased morbidity and mortality in patients with end-stage renal disease. Little is known about the prevalence and correlates of depression in kidney transplant recipients. In this study, we aimed to compare depressive symptoms between kidney transplant recipients and wait-listed dialysis patients and identify the correlates of depressive symptoms in the transplant recipient population. Observational cross-sectional study using the Center for Epidemiologic Studies Depression Scale (CES-D) to assess the severity of depressive symptoms. A cutoff score of 18 was used to identify the presence of depression. 1,067 kidney transplant recipients and 214 wait-listed dialysis patients were asked to participate; the final analysis included 854 kidney transplant and 176 wait-listed dialysis patients, respectively. Sociodemographic and clinical variables. Severity of depressive symptoms and presence of depression (CES-D score > or = 18). The prevalence of depression was 33% versus 22% in wait-listed versus transplant patients, respectively (P = 0.002). In multivariate regression, number of comorbid conditions, estimated glomerular filtration rate, perceived financial situation, and marital status were significant and independent predictors of depression in the transplant recipient group. Treatment modality was associated significantly with the presence of depression, even after adjustment for clinical and sociodemographic variables (OR, 2.01; 95% CI, 1.25-3.23; P = 0.004). Self-reported measurement of depressive symptoms. The prevalence of depression is lower in transplant recipients than in wait-listed patients. However, one-fifth of transplant patients are still at high risk of clinically significant depression. Comorbid conditions, socioeconomic status, and treatment modality predicted depressive symptoms in patients with end-stage renal disease.

A Catalogue of EQ-5D Utility Weights for Chronic Diseases among Noninstitutionalized Community Residents in Korea

The main purpose of this study is to provide a national catalog of preference-based utility weights associated with major chronic diseases in Korea. The 2005 Korea National Health and Nutrition Examination Survey was used to get EQ-5D scores for 27 major chronic diseases. The independent detrimental effect of each chronic disease was estimated using a censored least absolute deviations regression. The respondents (60.5%) rated their health as perfect or 11111 on the EQ-5D scale showing ceiling effect. Stroke (0.5067 approximately 0.5756) was the condition of the lowest EQ-5D utility weight and was followed by renal failure (0.6637 approximately 0.7739), angina pectoris (0.7325 approximately 0.8364), and arthritis (0.7621 approximately 0.8644). The marginal impact of each chronic disease after adjusting for age, sex, education, income, marital status, and the number of comorbid conditions was largest in stroke, arthritis, cancer, renal failure, and herniated disc. This study provided a nationally representative catalog of utility weights for major chronic diseases in Korea. The three most burdensome chronic diseases among Korean adults based on the regression analysis were stroke, arthritis, and cancer.

Alcohol and the Older Adult: A Comprehensive Review

Alcohol consumption in the older adult is of major concern with the advent of baby boomers coming into the over 65-age bracket. Alcohol consumption has been touted as beneficial for health, and while that may be accurate for moderate consumption in younger persons, there is considerable risk associated with increased alcohol intake in older adults. This increase is partially due to age-related physiological changes, existing diagnoses, number of comorbid conditions, and increased use of prescribed and/or over-the-counter medications, coupled with other concerns. This review addresses the current research regarding ethanol consumption in older adults and all-cause mortality as well as several conditions more frequently seen in the geriatric population. These conditions include vascular diseases, hypertension, type 2 diabetes, gastrointestinal disorders, hepatic disorders, dental and oro-facial problems, bone density decline, and falls and fractures. In addition, drug interactions and recent research into select vitamin and mineral considerations with increased alcohol intake in older persons are addressed. While recommendations for alcohol intake have not been specifically established for age ranges within the 65-year-and-older bracket, and practitioners do not routinely assess alcohol intake or ethanol related adverse events in this population, common sense approaches to monitoring will become increasingly important as the generation of “boomers” who believe that alcohol intake improves health comes of age.