Presence Of Comorbid Medical Conditions Research Articles

Comparison of Presentation Types and Clinical Findings of Rural and Urban Patients with Mastalgia: A Retrospective Analysis of 730 Patients from Turkey.

BACKGROUND Breast pain, prevalent among women of reproductive age, varies during menstrual cycles and is influenced by sociodemographic and clinical factors. This study aimed to assess these demographic and clinical variables in women with breast pain, considering the spatial distinctions between urban and rural locations. MATERIAL AND METHODS This retrospective study included 730 women presenting with mastalgia between 2010 and 2023. The study evaluated patient demographics, pain characteristics (eg, breast pain duration, site, quadrant-based localization, and radiation of breast pain), radiologic findings, and the presence of comorbid medical conditions. RESULTS There were 498 patients in the urban group and 232 patients in the rural group. Among the radiologic findings, the rate of mastitis was higher in the rural group (P.

Predictors of non-adherence to antihypertensive medications: A cross-sectional study from a regional hospital in Afghanistan.

Non-adherence to antihypertensive medications (AHMs) is a widespread problem. Cardiovascular morbidity and mortality reduction is possible via better adherence rates among hypertensive patients. This study aimed to assess the prevalence of non-adherence to AHMs and its predictors among hypertensive patients who attended Mirwais Regional Hospital in Kandahar, Afghanistan. A cross-sectional study using random sampling method was conducted among hypertensive patients, aged ≥18 years in Mirwais Regional Hospital at a 6-month follow-up between October and December 2022. To assess non-adherence to AHMs, we employed the Hill-Bone Medication Adherence scale. A value below or equal to 80% of the total score was used to signify non-adherence. A multivariable binary logistic regression model was used to identify predictors of non-adherence to AHMs. We used data from 669 patients and found that 47.9% (95%CI: 44.1-51.8%) of them were non-adherent to AHMs. The majority (71.2%) of patients had poorly controlled blood pressure (BP). The likelihood of non-adherence to AHMs was significantly higher among patients from low monthly-income households [Adjusted odds ratio (AOR) 1.70 (95%CI: 1.13-2.55)], those with daily intake of multiple AHMs [AOR 2.02 (1.29-3.16)], presence of comorbid medical conditions [AOR 1.68 (1.05-2.67), lack of awareness of hypertension-related complications [AOR 2.40 (1.59-3.63)], and presence of depressive symptoms [AOR 1.65 (1.14-2.38)]. Non-adherence to AHMs was high. Non-adherence to AHMs is a potential risk factor for uncontrolled hypertension and subsequent cardiovascular complications. Policymakers and clinicians should implement evidence-based interventions to address factors undermining AHMs adherence in Afghanistan.

The association of the comorbidity polypharmacy score (CPS) with functional limitations, frailty, and mortality in older adults with gastrointestinal malignancies.

12036 Background: Older adults share a growing burden of cancer morbidity and mortality. The presence of comorbid medical conditions and polypharmacy may present significant challenges to cancer management for older adults. Although geriatric assessment (GA) is recommended to personalize treatment for older adults with cancer, it remains underutilized in routine oncology practice, and how best to measure comorbidity and polypharmacy remain unknown. The Comorbidity Polypharmacy Score (CPS), which is the sum of the number of comorbid medical conditions and medications for a patient, has been validated in other medical fields. Here we review the association of CPS with key outcomes among older adults with gastrointestinal (GI) malignancy. Methods: The Cancer and Aging Resilience Evaluation (CARE) tool is a brief, patient-completed GA developed for older adults with cancer at the University of Alabama at Birmingham (UAB). For patients enrolled in the CARE registry, diagnosed with a new GI malignancy between September 2017 and April 2021, we calculated a CPS based upon the number of patient-reported medical comorbid conditions and daily medications. Patients were separated into two groups, those with CPS ≥ 15, or high-risk, and those with CPS < 15. Multivariable analyses were adjusted for age, sex, race, cancer type, and cancer stage, and were performed to examine the potential association between high-risk CPS and falls, functional limitations, frailty, and mortality. Results: 548 patients were included in this study with a mean age of 69.7 years; 44.9% female and 23.9% Black. Common GI malignancies included colorectal (30.8%), pancreatic (25.5%), hepatobiliary (17.7%), and gastroesophageal (10.8%). Patients with CPS ≥ 15 were more likely to report falls (adjusted odds ratio [aOR] 3.39, 95% CI 1.91-6.02), dependence in activities of daily living (ADL) (aOR 3.07, 95% CI 1.67-5.66) and instrumental ADL (aOR 3.81, 95% CI 2.02-7.20), and have frailty (aOR 5.17, 95% CI 2.84-9.39). There was not a statistically significant association with either six-month or twelve-month survival. Conclusions: CPS was associated with falls, functional limitations, and frailty, but not survival, among older adults with GI malignancies. This association highlights the potential role of CPS as an efficient screening tool for older adults with cancer who would benefit from more comprehensive comorbidity and medication review.

Human herpes virus 8-negative effusion-based lymphoma in a patient with persistent serous effusions.

Diffuse large B-cell lymphoma is the most common histologic diagnosis among the aggressive lymphomas, accounting for 30% of all lymphomas. Human herpes virus 8-negative effusion-based lymphoma (HHV8-negative EBL) is a rare form of lymphoma, under recognized and still not well characterized in the literature. In contrast to primary effusion lymphoma (PEL), HHV8-negative EBL is characterized by malignant effusion in essentially serous body cavity with no detectable contiguous tumor masses and is no associated with human immunodeficiency virus and HHV8 infections. The presence of comorbid medical conditions can hide this type of lymphoma and made diagnosis more challenging. Here, we describe a rare case of an 82-year-old male suffering from peritoneal and pleural effusion and Hepatitis B virus related cirrhosis diagnosed with HHV8-negative EBL.

Novel neurostimulation approaches: Focus on neuropsychiatric symptoms

Neuropsychiatric symptoms (NPS) such as depression, apathy and agitation are common in neurocognitive disorders such as Alzheimer's disease (AD) and its prodrome, Mild Cognitive Impairment (MCI). Importantly, the presence of NPS is a prognostic indicator of future decline in MCI and AD and reduces quality of life in both patients and caregivers. Pharmacological interventions for NPS in neurocognitive disorders have not been shown to be effective and moreover, often have unfavourable side effect profiles for older adults due to age-related changes in pharmacokinetics and pharmacodynamics and the presence of comorbid medical conditions. Non-pharmacological approaches such as neurostimulation are increasingly being applied to treat primary psychiatric and neuropsychiatric conditions and hold promise for treatment of NPS in neurocognitive conditions, both from a symptom management point of view, and as a potential disease-modifying intervention for neurocognitive disorders. In this session, we will review novel neurostimulation modalities including transcranial direct current stimulation (tDCS), deep transcranial magnetic stimulation (dTMS), and photobiomodulation and their application to treatment of NPS in MCI and AD. Preliminary findings will be reviewed from ongoing clinical trials of neurostimulation for NPS in neurocognitive disorders: 1) Transcranial direct current stimulation (tDCS) combined with exercise for treatment of apathy in AD (Dr. Krista Lanctôt); 2) TDCS for treatment of agitation in AD (Dr. Sanjeev Kumar); 3) Deep transcranial magnetic stimulation (dTMS) for depression in MCI or AD [ClinicalTrials.gov Identifier: NCT03665831] (Dr. Linda Mah); 4) Photobiomodulation therapy for AD and as a potential treatment for NPS in neurocognitive disorders (Dr. Corinne Fischer).

Distribution of molecular strains of Mycobacterium tuberculosis in an intermediate burden Asia Pacific city.

Hong Kong is an intermediate tuberculosis (TB) burden city in Asia Pacific with slow decline of case notification in the last decade. By 24-loci mycobacterial interspersed repetitive units - variable number of tandem repeats genotyping, we examined 534 Mycobacterium tuberculosis isolates collected from culture-positive hospitalised TB patients in a 1.7 million population geographic region in the city. Overall, 286 (75%) were classified as Beijing genotype, of which 216 (76%) and 59 (21%) belonged to modern and ancient sub-lineage, respectively. Only two cases were genetically clustered while spatial clustering was absent. Male gender, permanent residency in Hong Kong and born in Hong Kong or Mainland China were associated with Beijing genotype. The high prevalence of Beijing modern lineage was similar to that in East Asia, which reflected the pattern resulting from population migration. The paucity of clustering suggested that reactivation accounted for most of the TB disease cases, which was and echoed by observation that half were 60 years old or above, and the presence of co-morbid medical conditions. The predominance of reactivation TB cases in intermediate burden localities implies that the detection and control of latent TB infection would be the major challenge in achieving TB elimination.

GLYCATED HAEMOGLOBIN (HBA1C) AND ITS ASSOCIATION WITH ISCHAEMIC STROKE IN DIABETICS AND NON- DIABETICS.

Stroke is a condition that results in high mortality rates and severe disabilities. Stroke is expected to be the second most important cause of mortality worldwide by 2020. Most stroke survivors can and do experience improvements in their functional abilities, but the amount, rate, timing, pattern, type, and ultimate outcome of the improvements differ across patients and situations.1 Stroke severity and patient age are the main predictors of stroke outcome in the acute phase 2. Additional important predictors include functional status prior to stroke, presence of comorbid medical conditions, etiologies and the vascular territories affected.3

NOVEL NEUROSTIMULATION APPROACHES: FOCUS ON NEUROPSYCHIATRIC SYMPTOMS

Neuropsychiatric symptoms (NPS) such as depression, apathy and agitation are common in neurocognitive disorders such as Alzheimer's disease (AD) and its prodrome, Mild Cognitive Impairment (MCI). Importantly, the presence of NPS is a prognostic indicator of future decline in MCI and AD and reduces quality of life in both patients and caregivers. Pharmacological interventions for NPS in neurocognitive disorders have not been shown to be effective and moreover, often have unfavourable side effect profiles for older adults due to age-related changes in pharmacokinetics and pharmacodynamics and the presence of comorbid medical conditions. Non-pharmacological approaches such as neurostimulation are increasingly being applied to treat primary psychiatric and neuropsychiatric conditions and hold promise for treatment of NPS in neurocognitive conditions, both from a symptom management point of view, and as a potential disease-modifying intervention for neurocognitive disorders. In this session, we will review novel neurostimulation modalities including transcranial direct current stimulation (tDCS), deep transcranial magnetic stimulation (dTMS), and photobiomodulation and their application to treatment of NPS in MCI and AD. Preliminary findings will be reviewed from ongoing clinical trials of neurostimulation for NPS in neurocognitive disorders: 1) Transcranial direct current stimulation (tDCS) combined with exercise for treatment of apathy in AD (Dr. Krista Lanctôt); 2) TDCS for treatment of agitation in AD (Dr. Sanjeev Kumar); 3) Deep transcranial magnetic stimulation (dTMS) for depression in MCI or AD [ClinicalTrials.gov Identifier: NCT03665831] (Dr. Linda Mah); 4) Photobiomodulation therapy for AD and as a potential treatment for NPS in neurocognitive disorders (Dr. Corinne Fischer).

The X-Y factor: Females and males with urological chronic pelvic pain syndrome present distinct clinical phenotypes.

Urological chronic pelvic pain syndrome (UCPPS) in females is often attributed to the bladder (interstitial cystitis/ bladder pain syndrome), while UCPPS in males is often attributed to the prostate (chronic prostatitis/chronic pelvic pain syndrome). However, there is increasing awareness that bladder pain plays a role in both males and females and the degree of overlap of clinical characteristics in males and females with UCPPS is not well known. Our objective was to compare clinical phenotypes of females and males with UCPPS. We conducted a retrospective analysis of prospectively collected data from a single-centre patient population presenting between 1998 and 2016 to our UCPPS clinic. Demographics, symptom scores, pain scales, retrospectively described clinical UPOINT (urinary, psychosocial, organ-specific, infection, neurogenic, and tenderness) scoring, and presence of comorbid medical conditions were compared between females and males using comparative analyses. We identified 2007 subjects (1523 males, 484 females) with UCPPS. Females had increased prevalence of irritable bowel syndrome (25% vs. 11.2%), chronic fatigue syndrome (13.6% vs. 1.6%), fibromyalgia (16.9% vs. 1.6%), drug allergies (56.6% vs. 13.5%), diabetes (20.2% vs. 3.9%), depression (31% vs. 18.4%), and alcohol use (44.2% vs. 10.8%) compared to males with UCPPS (all p<0.001). In respect to UPOINT domains, females had a higher "total" (3.2 vs. 2.4), "urinary" (92.8% vs. 67.6%), "organ-specific" (90.1% vs. 51.4%), and "neurogenic" (44.7% vs. 30%) prevalence compared to males (all p<0.001). Females with UCPPS have greater prevalence of systemic disorders/symptoms and worse urinary symptoms than males with UCPPS. These findings demonstrate that females and males with UCPPS have distinct and different clinical phenotypes.

Comorbidity index in central cancer registries: the value of hospital discharge data.

BackgroundThe presence of comorbid medical conditions can significantly affect a cancer patient’s treatment options, quality of life, and survival. However, these important data are often lacking from population-based cancer registries. Leveraging routine linkage to hospital discharge data, a comorbidity score was calculated for patients in the California Cancer Registry (CCR) database.MethodsCalifornia cancer cases diagnosed between 1991 and 2013 were linked to statewide hospital discharge data. A Deyo and Romano adapted Charlson Comorbidity Index was calculated for each case, and the association of comorbidity score with overall survival was assessed with Kaplan–Meier curves and Cox proportional hazards models. Using a subset of Medicare-enrolled CCR cases, the index was validated against a comorbidity score derived using Surveillance, Epidemiology, and End Results (SEER)-Medicare linked data.ResultsA comorbidity score was calculated for 71% of CCR cases. The majority (60.2%) had no relevant comorbidities. Increasing comorbidity score was associated with poorer overall survival. In a multivariable model, high comorbidity conferred twice the risk of death compared to no comorbidity (hazard ratio 2.33, 95% CI: 2.32–2.34). In the subset of patients with a SEER-Medicare-derived score, the sensitivity of the hospital discharge-based index for detecting any comorbidity was 76.5. The association between overall mortality and comorbidity score was stronger for the hospital discharge-based score than for the SEER-Medicare-derived index, and the predictive ability of the hospital discharge-based score, as measured by Harrell’s C index, was also slightly better for the hospital discharge-based score (C index 0.62 versus 0.59, P<0.001).ConclusionsDespite some limitations, using hospital discharge data to construct a comorbidity index for cancer registries is a feasible and valid method to enhance registry data, which can provide important clinically relevant information for population-based cancer outcomes research.

Risk Factors for Increased Hospital Resource Utilization and In-Hospital Mortality in Adults With Single Ventricle Congenital Heart Disease

Most patients with single ventricle congenital heart disease are now expected to survive to adulthood. Co-morbid medical conditions (CMCs) are common. We sought to identify risk factors for increased hospital resource utilization and in-hospital mortality in adults with single ventricle. We analyzed data from the 2001 to 2011 Nationwide Inpatient Sample database in patients aged ≥18years admitted to nonteaching general hospitals (NTGHs), TGHs, and pediatric hospitals (PHs) with either hypoplastic left heart syndrome, tricuspid atresia or common ventricle. National estimates of hospitalizations were calculated. Elixhauser CMCs were identified. Length of stay (LOS), total hospital costs, and effect of CMCs were determined. Age was greater in NTGH (41.5 ± 1.3years) than in TGH (32.8 ± 0.5) and PH (25.0 ± 0.6; p <0.0001). Adjusted LOS was shorter in NTGH (5.6days) than in PH (9.7days; p <0.0001). Adjusted costs were higher in PH ($56,671) than in TGH ($31,934) and NTGH ($18,255; p <0.0001). CMCs are associated with increased LOS (p <0.0001) and costs (p <0.0001). Risk factors for in-hospital mortality included increasing age (odds ratio [OR] 5.250, CI 2.825 to 9.758 for 45- to 64-year old vs 18- to 30-year old), male gender (OR 2.72, CI 1.804 to 4.103]), and the presence of CMC (OR 4.55, CI 2.193 to 9.436) for 2 vs none). No differences in mortality were found among NTGH, TGH, and PH. Cardiovascular procedures were more common in PH hospitalizations and were associated with higher costs and LOS. CMCs increase costs and mortality. In-hospital mortality is increased with age, male gender, and the presence of hypoplastic left heart syndrome.

Hyponatremia and psychotropics

Psychotropic-induced hyponatremia is one of the most common electrolyte abnormalities seen in routine psychiatric practice and is especially common in elderly subjects. Recent evidence suggests that even mild hyponatremia is associated with several detrimental effects in elderly. However, practicing clinicians often overlook hyponatremia due to lack of awareness about the incidence, presentation, and risk factors of psychotropic-induced hyponatremia. Available evidence suggests that all classes of psychotropics, i.e., antidepressants, antipsychotics, mood stabilizers, and sedative/hypnotics can lead to hyponatremia. Maximum evidence is available for antidepressant-associated hyponatremia. Various risk factors for hyponatremia include increasing age, female gender, low body weight, history of hyponatremia, low baseline sodium levels, summer season, initial phase of antidepressant use, early-onset psychiatric illnesses, longer duration of psychiatric disorder, prolonged admission, presence of comorbid medical conditions, concomitant use of diuretics, antihypertensives, and cytochrome P450 inhibitors. Awareness about this potentially life-threatening side effect and taking appropriate, timely steps can help in prevention of psychotropic-associated hyponatremia.

Lower Frequency of co-Morbid Medical Disorders Related to Poor Impulse Control in Parkinson's than Alzheimer's Disease.

Parkinson's disease is associated with progressive degeneration of mesolimbic dopaminergic neurons that are involved in reward-based behavior learning, including rewarding effects of food consumption and drugs of abuse. The importance of this pathway in development of addictive behaviors led us to hypothesize that medical disorders related to poor impulse control may occur less frequently among patients with Parkinson's disease than those with other progressive neurodegenerative disorders such as Alzheimer's disease. Retrospective cross-sectional study of all patients treated for Parkinson's disease and Alzheimer's disease in a community based clinic during a two-year period. Associations were summarized using odds ratios (OR) and 95% confidence intervals (95% CI) estimated from logistic regression models, adjusted for differences in gender distribution between the groups. A total of 106 patients with Parkinson's disease and 72 patients with Alzheimer's disease were included. Patients with Parkinson's disease were less likely to have either past substance use (adjusted OR = 0.035, 95% CI = 0.009 - 0.130) or presence of co-morbid medical conditions related to poor dietary choices (adjusted OR = 0.157, 95% CI = 0.062 - 0.397). Co-morbid medical conditions related to poor impulse control occur less frequently among those with Parkinson's disease than those with Alzheimer's disease. These findings are consistent with dysfunction of dopamine dependent pathways involved in addiction during the presymptomatic phase of Parkinson's disease and support a biological basis for addiction.

Comorbid Medical Conditions in Vascular Dementia: A Matched Case-Control Study.

The objective of the study was to compare the presence of comorbid medical conditions between patients with a vascular dementia (VaD) and a control group, from the Integrated Healthcare Information Services (IHCIS) database. VaD was defined by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes 290.40, 290.4, 290.41, 290.42, and, 290.43. An individual matching method was used to select the controls, which were matched to cases on a 15:1 ratio by age, gender, type of health plan, and pharmacy benefits. Alzheimer's disease, any other dementia or cognitive deficits associated were considered exclusion criteria. Among the IHCIS patients 60 years of age or older and full year of eligibility during 2010, there were 898 VaD patients, from which 63.6% were women. Concurrent presence of cerebrovascular disease, atherosclerosis, heart failure, and atrial fibrillation were found at 12.6, 4.6, 2.8, and 1.7 times higher in VaD patients, respectively. Compared to controls, VaD patients had more septicemia, injuries, lung diseases including chronic obstructive pulmonary disease, and urinary diseases (all with df = 897,1; p < 0.0001). The present study confirms that these four medical comorbidities are frequent complications of VaD and physicians should be alert to the presence of them in patients with VaD.

Risk factors for severe anaphylaxis in patients receiving anaphylaxis treatment in US emergency departments and hospitals

Although reported risk factors for severe anaphylaxis include older age, presence of comorbid medical conditions, and concomitant medications, previous studies have used varying definitions for anaphylaxis and heterogeneous methodology. To describe risk factors for severe anaphylaxis among US patients treated in emergency departments (EDs) or hospitals for anaphylaxis. Individuals with an ED visit/hospitalization for anaphylaxis were identified from 2 MarketScan Research Databases using an expanded International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code algorithm. Eligibility for the current study required continuous medical and prescription coverage for at least 1 year before and after the index date. Severe anaphylaxis was defined as a reaction requiring hospital admission. Among 11,972 individuals, 2,622 (22%) had severe anaphylaxis. Unadjusted analysis showed that severe anaphylaxis was associated with older age and higher comorbidity burden. These patients were also less likely to have filled an epinephrine autoinjector (EAI) prescription or visited an allergist/immunologist, but more likely to have had an ED visit/hospitalization (any cause). On multivariable analysis, filling an EAI prescription (odds ratio [OR], 0.64; 95% CI, 0.53-0.78) or visiting an allergist/immunologist (OR, 0.78; 95% CI, 0.63-0.95) before the index event was associated with a lower risk of severe anaphylaxis, while any previous ED visit (OR, 1.18; 95% CI, 1.07-1.30) or hospitalization (OR, 1.55; 95% CI, 1.36-1.75) was associated with a higher risk of severe anaphylaxis. In this large cohort with an ED visit or hospitalization for anaphylaxis, 22% had severe anaphylaxis. Pre-index preventive anaphylaxis care (ie, EAI prescription fill and allergist/immunologist visit) was associated with a significantly lower risk, supporting the benefits of preventive anaphylaxis care in real-world practice.

Severity of sleep apnea syndrome is associated with arterial stiffness in elderly population

Obstructive sleep apnea (OSA) increases cardiovascular morbidity and mortality, and higher arterial stiffness is one of the biological markers for increased cardiovascular risk in OSA. However, with aging, several cardiovascular comorbidities and treatments may confound the relationship between OSA and arterial stiffness. Therefore, we sought to investigate the association between OSA and arterial stiffness in otherwise healthy elderly population. We performed a cross-sectional study of 476 elderly patients ( ⩾ 60 yr) recruited from community and the sleep clinic in a university hospital between November 2010 and January 2013. Clinical data were collected using a standardized protocol, including questions about current medical condition and its medication. OSA was diagnosed using laboratory polysomnography. Subjects were stratified into two groups according to the presence of comorbid medical conditions or its treatment, such as, hypertension, diabetes, and dyslipidemia. Each group was subdivided into three groups based on apnea-hypopnea index (AHI), consisting of normal (AHI < 15), mild-to-moderate OSA (15 ⩽ AHI ⩽ 30), and severe OSA (AHI > 30). Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV) and cardio-ankle vascular index (CAVI). Among 476 participants, 101 subjects were without any comorbid medical condition or medication use. The baPWV, CAVI, CRP were significantly higher in patients with severe OSA group after adjustment for gender, body mass index and smoking status ( P = 0.003, 0.001, and 0.025 by ANCOVA, respectively) in healthy elderly group, but not in comorbid group. Multiple regression analysis showed baPWV, CAVI, and C-reactive protein had linear association with AHI ( β = 0.326, P = 0.002; β =0.326, P = 0.002; β = 3.253, P = 0.002, respectively) in healthy group. The severity of OSA is associated with arterial stiffness in otherwise healthy elderly individuals with OSA, but not in comorbid OSA individuals. In exploring the association between OSA and cardiovascular complications in the elderly, comorbidities need to be controlled, and we have found that OSA still increases cardiovascular risk in the elderly. This study was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (Grant No. 2010–0008886).

A high physical symptom count reduces the effectiveness of treatment for depression, independently of chronic medical conditions

AimTo assess to what extent a high physical symptom count influences the effect of treatment for major depressive disorder (MDD), and whether or not actual comorbid medical conditions explain this relationship. MethodSecondary data-analysis on a cluster-randomized trial in primary care, comparing the effectiveness of collaborative care with care as usual (CAU). MDD was measured using the PHQ-9. The Physical Symptoms Questionnaire (PSQ) was filled out at baseline by 115 patients (77.2% of those who entered the trial). Multilevel logistic regression models were used to test whether a high physical symptom count predicted lack of response to treatment, adding interaction terms to test differential effects on collaborative care versus CAU. ResultsA high physical symptom count negatively influenced the effect of both collaborative care and care as usual (no interaction). Specifically, a high physical symptom count predicted lack of response in both conditions at 3 (odds ratio=6.8), 6 (OR=4.1), and 9months follow-up (OR=6.4). This was not explained by chronic physical illness. ConclusionIn this RCT, patients with MDD accompanied by a high physical symptom count benefited less from treatment for MDD in primary care, regardless of the type of treatment (either collaborative care or CAU). This was not explained by the presence of comorbid medical conditions. Further research is needed to improve treatment for MDD accompanied by a high physical symptom count, although collaborative care for depression is still more effective than CAU for this group of patients. Trial registration: Dutch trial register ISRCTN15266438.

Menopausal Hormone Therapy for the Primary Prevention of Chronic Conditions: U.S. Preventive Services Task Force Recommendation Statement

Update of the 2005 U.S. Preventive Services Task Force (USPSTF) recommendation statement on hormone therapy for the prevention of chronic conditions in postmenopausal women. The USPSTF commissioned a review of the literature to update evidence about the benefits and harms of using menopausal hormone therapy to prevent chronic conditions, as well as whether the benefits and harms of hormone therapy differ by population subgroups defined by age; the presence of comorbid medical conditions; and the type, dose, and method of hormonal delivery. This recommendation applies to postmenopausal women who are considering hormone therapy for the primary prevention of chronic medical conditions. It does not apply to women who are considering hormone therapy for the management of menopausal symptoms, such as hot flashes or vaginal dryness. It also does not apply to women younger than 50 years who have had surgical menopause. The USPSTF recommends against the use of combined estrogen and progestin for the prevention of chronic conditions in postmenopausal women. (Grade D recommendation).The USPSTF recommends against the use of estrogen for the prevention of chronic conditions in postmenopausal women who have had a hysterectomy. (Grade D recommendation).

Gynecologic Concerns in Pubertal Females with Blood Disorders

Purpose of ReviewThe incidence and prevalence of blood disorders varies depending on the underlying etiology, age, ethnicity, family history, and presence of comorbid medical conditions. Gynecologic problems occurring around puberty may cause stress to families and patients, as well as management challenges to providers. Recent FindingsManagement strategies in the setting of bleeding disorders include hormonal and non-hormonal options to address problems occurring around puberty. Management strategies in the setting of clotting disorders allow providers to address common problems occurring in adolescence, while minimizing risk of venous thromboembolism. SummaryPreparedness is important at this time of life, not only to prevent unwanted gynecologic complications or hospitalizations related to specific blood conditions, but also to identify problems related to reproductive care that may be exacerbated or complicated by an underlying blood disorder.

Excess Mortality and Causes of Death in Autism Spectrum Disorders: A Follow up of the 1980s Utah/UCLA Autism Epidemiologic Study

This study's purpose was to investigate mortality among individuals with autism spectrum disorders (ASD) ascertained during a 1980s statewide autism prevalence study (n=305) in relation to controls. Twenty-nine of these individuals (9.5%) died by the time of follow up, representing a hazard rate ratio of 9.9 (95% CI 5.7-17.2) in relation to population controls. Death certificates identified respiratory, cardiac, and epileptic events as the most common causes of death. The elevated mortality risk associated with ASD in the study cohort appeared related to the presence of comorbid medical conditions and intellectual disability rather than ASD itself suggesting the importance of coordinated medical care for this high risk sub-population of individuals with ASD.