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Yin C, Mpofu E, Brock K, Ingman S. COVID-19 hospitalization place of live discharge outcomes for long-term care facility residents with dementia: Mediation by comorbidities index scores and moderation by health insurance status. Geriatr Nurs 2025:103356. [PMID: 40360324 DOI: 10.1016/j.gerinurse.2025.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 03/20/2025] [Accepted: 04/28/2025] [Indexed: 05/15/2025]
Abstract
BACKGROUND AND AIM COVID-19 hospitalization place of discharge outcomes for Long Term Care Facility (LTCF) residents with dementia are less well known for preventing excess mortality in this vulnerable population. METHOD This cross-sectional study utilized the Texas Inpatient Public Use Data File (PUDF) data on LTCF residents with dementia (n = 1,413) and without dementia (n = 1,674) to examine variations in their hospitalization outcomes of live place of discharge, comorbidity scores, and health insurance status. RESULTS Dementia diagnosis increased risks of hospice care (OR = 1.44, 95 %CI = 1.16-1.80), while decreasing the likelihood of discharge to recovery hospitals by almost 30 % (OR = 0.70, 95 %CI = 0.52-0.94). Higher Elixhauser Comorbidity Index Score (ECIS) significantly mediated the relationship between dementia and hospice care discharge (indirect effect = 0.07, p < 0.01, R2 = 0.09). Health insurance significantly moderated the relationship between dementia and hospice discharge, with for a lower probability of discharge to hospice care with health maintenance organization insurance (β = -0.51, p < 0.05, R2 = 0.09). CONCLUSION AND IMPLICATION Covid-19 discharge plans for patients with dementia should prioritize recovery hospitals rather than hospice care for minimizing health care disparities compared to other residents. Given the increased risk of hospice discharge among dementia patients, healthcare providers should integrate comorbidity burden assessments into discharge planning. Conceivably, dementia patients with higher ECIS may face systemic barriers to recovery-focused care if carers paid less regard to the role of comorbidities in hospitalization outcomes.
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Affiliation(s)
- Cheng Yin
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, 76201, USA.
| | - Elias Mpofu
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, 76201, USA; Discipline of Behavioural and Social Sciences in Health, School of Health Sciences, University of Sydney, Australia; Department of Educational Psychology, University of Johannesburg, South Africa.
| | - Kaye Brock
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, 76201, USA; School of Medical Sciences, University of Sydney, NSW, Australia.
| | - Stan Ingman
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, 76201, USA.
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Overbeek BUH, van Erp WS, Eilander HJ, Koopmans RTCM, Lavrijsen JCM. Medical complications and advance medical decision-making in the minimally conscious state. Brain Inj 2025; 39:249-256. [PMID: 39530489 DOI: 10.1080/02699052.2024.2425737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 10/30/2024] [Indexed: 11/16/2024]
Abstract
OBJECTIVES Medical complications occur frequently in MCS and influence advance medical decision-making. This study aimed to report on medical complications and advance medical decision-making in a nationwide group of MCS patients. METHODS In this descriptive cross-sectional study, clinical and advance medical decision-making characteristics were collected in a survey, completed by the treating physician. RESULTS The MCS population consisted of 32 patients: 65.6% traumatic etiology, 68.8% male. Patients had a median of five complications: hypertonia/spasticity (81.3%) and pneumonia (50.0%) occurred most frequently. Most patients had curative goals: three patients had a fully curative treatment scenarios, 29 a curative scenario with ≥ 1 treatment restrictions, two a palliative and two a symptomatic scenario. Conversations about advance medical decision-making were complicated by disputes with next of kin, inability to evaluate medical treatment because of medical instability, next of kin not being ready to discuss medical treatment, or a treatment scenario explicitly based on requests of next of kin. CONCLUSION Medical complications are common in MCS patients and advance medical decision making was complicated. This legitimates realization of specialized care across acute, post-acute and long-term care. Further longitudinal research into advance medical decision-making is recommended.
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Affiliation(s)
- Berno U H Overbeek
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, The Netherlands
- Kalorama, Beek Ubbergen, The Netherlands
- Azora, Terborg, The Netherlands
| | - Willemijn S van Erp
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, The Netherlands
- Accolade Zorg, Bosch en Duin, The Netherlands
- Libra Rehabilitation & Audiology, Tilburg, The Netherlands
| | - Henk J Eilander
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, The Netherlands
| | - Raymond T C M Koopmans
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, The Netherlands
- Joachim en Anna, Center for Specialized Geriatric Care, Nijmegen, The Netherlands
| | - Jan C M Lavrijsen
- Department of Primary and Community Care, Radboud University Medical Center, Research Institute for Medical Innovation, Nijmegen, The Netherlands
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Song W, Birk N, Matsuzaki M, Lieber J, Yamanashi H, Rogers E, Aramrat C, Wiwatkunupakarn N, Angkurawaranon C, Lewin A, Kinra S, Mallinson PAC. Analytical approaches to evaluate risk factors of multimorbidity: a systematic scoping review protocol. BMJ Open 2025; 15:e083278. [PMID: 39880433 PMCID: PMC11781107 DOI: 10.1136/bmjopen-2023-083278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 11/11/2024] [Indexed: 01/31/2025] Open
Abstract
INTRODUCTION Understanding causal risk factors that contribute to the development of multimorbidity is essential for designing and targeting effective preventive strategies. Despite a large body of research in this field, there has been little critical discussion about the appropriateness of the various analytical approaches used. This proposed scoping review aims to summarise and appraise the analytical approaches used in the published literature that evaluated risk factors of multimorbidity and to provide guidance for researchers conducting analyses in this field. METHODS AND ANALYSIS We will systematically search three electronic databases-Embase, Global Health and MEDLINE, as well as the reference lists of identified relevant review articles, from inception to September 2024. We will screen titles and abstracts using the artificial intelligence-aided software ASReview, followed by screening for eligible articles in full text and extracting data. We will then categorise the analytical approaches used across studies, provide a comprehensive overview of the methodology and discuss the potential strengths and limitations of each analytical approach. ETHICS AND DISSEMINATION We will undertake a secondary analysis of published literature; therefore, ethical approval is not required. The results will be disseminated through an open-access, peer-reviewed publication. This systematic scoping review will serve as a guide for researchers in selecting analytical approaches for aetiological multimorbidity research, thereby improving the quality and comparability of research in this field.
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Affiliation(s)
- Wenbo Song
- London School of Hygiene & Tropical Medicine, London, UK
- Nagasaki University, Nagasaki, Japan
| | - Nick Birk
- Harvard University, Cambridge, Massachusetts, USA
| | | | - Judith Lieber
- London School of Hygiene & Tropical Medicine, London, UK
| | | | | | - Chanchanok Aramrat
- London School of Hygiene & Tropical Medicine, London, UK
- Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- London School of Hygiene & Tropical Medicine, London, UK
- Chiang Mai University, Chiang Mai, Thailand
| | | | - Alex Lewin
- London School of Hygiene & Tropical Medicine, London, UK
| | - Sanjay Kinra
- London School of Hygiene & Tropical Medicine, London, UK
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Mukhtar I. Unravelling the critical role of neuroinflammation in epilepsy-associated neuropsychiatric comorbidities: A review. Prog Neuropsychopharmacol Biol Psychiatry 2025; 136:111135. [PMID: 39237022 DOI: 10.1016/j.pnpbp.2024.111135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Revised: 09/01/2024] [Accepted: 09/01/2024] [Indexed: 09/07/2024]
Abstract
Epilepsy is a complex neurological disorder characterized not only by seizures but also by significant neuropsychiatric comorbidities, affecting approximately one-third of those diagnosed. This review explores the intricate relationship between epilepsy and its associated psychiatric and cognitive disturbances, with a focus on the role of inflammation. Recent definitions of epilepsy emphasize its multifaceted nature, linking it to neurobiological, psychiatric, cognitive, and social deficits. Inflammation has emerged as a critical factor influencing both seizure activity and neuropsychiatric outcomes in epilepsy patients. This paper critically examines how dysregulated inflammatory pathways disrupt neurotransmitter transmission and contribute to depression, mood disorders, and anxiety prevalent among individuals with epilepsy. It also evaluates current therapeutic approaches and underscores the potential of anti-inflammatory therapies in managing epilepsy and related neuropsychiatric conditions. Additionally, the review highlights the importance of the anti-inflammatory effects of anti-seizure medications, antidepressants, and antipsychotics and their therapeutic implications for mood disorders. Also, the role of ketogenic diet in managing epilepsy and its psychiatric comorbidities is briefly presented. Furthermore, it briefly discusses the role of the gut-brain axis in maintaining neurological health and how its dysregulation is associated with epilepsy. The review concludes that inflammation plays a pivotal role in linking epilepsy with its neuropsychiatric comorbidities, suggesting that targeted anti-inflammatory interventions may offer promising therapeutic strategies. Future research should focus on longitudinal studies comparing outcomes between epileptic patients with and without neuropsychiatric comorbidities, the development of diagnostic tools, and the exploration of novel anti-inflammatory treatments to better manage these complex interactions.
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Affiliation(s)
- Iqra Mukhtar
- Faculty of Pharmacy, Iqra University, Karachi, Pakistan.
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Piera-Jiménez J, Dedeu T, Pagliari C, Trupec T. Strengthening primary health care in Europe with digital solutions. Aten Primaria 2024; 56:102904. [PMID: 38692228 PMCID: PMC11070233 DOI: 10.1016/j.aprim.2024.102904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/06/2024] [Accepted: 02/07/2024] [Indexed: 05/03/2024] Open
Abstract
This article provides an in-depth analysis of digital transformation in European primary healthcare (PHC). It assesses the impact of digital technology on healthcare delivery and management, highlighting variations in digital maturity across Europe. It emphasizes the significance of digital tools, especially during the COVID-19 pandemic, in enhancing accessibility and efficiency in healthcare. It discusses the integration of telehealth, remote monitoring, and e-health solutions, showcasing their role in patient empowerment and proactive care. Examples are included from various countries, such as Greece's ePrescription system, Lithuania's adoption of remote consultations, Spain's use of risk stratification solutions, and the Netherlands' advanced use of telemonitoring solutions, to illustrate the diverse implementation of digital solutions in PHC. The article offers insights into the challenges and opportunities of embedding digital technologies into a multidisciplinary healthcare framework, pointing towards future directions for PHC in Europe.
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Affiliation(s)
- Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain; Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain; Faculty of Informatics, Multimedia and Telecommunications, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Toni Dedeu
- WHO European Centre for Primary Health Centre, Almaty, Kazakhstan
| | - Claudia Pagliari
- Usher Institute and Edinburgh Global Health Academy, The University of Edinburgh, Edinburgh, United Kingdom
| | - Tatjana Trupec
- Care and Public Health Research Institute, Maastricht University, The Netherlands; School of Medicine, University of Zagreb, Croatia
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Kenfaoui I, Bouchefra S, Daouchi S, Benzakour A, Ouhssine M. The comorbidity burden of type 2 diabetes mellitus (T2DM): sex differences and associated factors among 830 cases in North-Eastern Morocco. Diabetol Int 2024; 15:814-827. [PMID: 39469545 PMCID: PMC11513066 DOI: 10.1007/s13340-024-00750-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 07/17/2024] [Indexed: 10/30/2024]
Abstract
Background and aim Type 2 diabetes is prone to numerous comorbidities resulting from complex mechanisms involving hyperglycemia, insulin resistance, low-grade inflammation and accelerated atherogenesis. The purpose of the present study was to investigate these disorders and their associated risk factors according to patient sex in a population of type 2 diabetics in North-Eastern Morocco. Methods This study was conducted in a medical analysis laboratory over a 1-year period from 01/10/2018 to 01/10/2019. This epidemiological study was carried out on 830 subjects aged 18 and over. Quantitative variables were expressed as means ± standard deviation, and qualitative variables as frequencies and percentages. Hypothesis tests used to compare means and proportions were Student's t-test and Chi-square test of independence, respectively. Logistic regression was used to predict risk factors for each diabetes. Results 830 patients were surveyed. 95.66% had diabetes-related comorbidities. Hypertension (23.7%), nephropathy (18.19%), dyslipidemia (14.82%), thyroid dysfunction (10.72%), cataract (10.12%), diabetic foot (7.23%), ketoacidosis (6.27%), retinopathy (3.49%), and skin disorders (2.77%) were observed. Sex was associated with dyslipidemia (p = 0.025), hypertension (p = 0.032) and retinopathy (p = 0.029). Uncontrolled blood sugar, unbalanced lipid profile, age, physical activity, obesity, smoking, and alcohol consumption were risk factors with differential involvement in the occurrence of the mentioned pathologies. Conclusions The results of our study showed that a significant proportion of the population suffers from diabetic comorbidities. To meet this challenge, further research is needed to identify the mechanisms of action of these factors, to control them and combat diabetogenic environments by setting up adapted educational programs.
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Affiliation(s)
- Ikram Kenfaoui
- Laboratory of Natural Resources and Sustainable Development, Faculty of Sciences, Ibn Tofail University, Ville Haute, 14020 Kenitra, Morocco
| | - Said Bouchefra
- Laboratory of Biology and Health, Team of Nutritional Sciences, Food and Health, Faculty of Sciences, University Ibn Tofail, Hassan 2 Street N 54, Taza, 35000 FSK-Kenitra, VN Morocco
- Higher Institute of Nursing and Health Techniques, Taza, Morocco
| | - Siham Daouchi
- Laboratory of Natural Resources and Sustainable Development, Faculty of Sciences, Ibn Tofail University, Ville Haute, 14020 Kenitra, Morocco
| | - Abderrahim Benzakour
- Laboratory of Natural Resources and Sustainable Development, Faculty of Sciences, Ibn Tofail University, Ville Haute, 14020 Kenitra, Morocco
| | - Mohammed Ouhssine
- Laboratory of Natural Resources and Sustainable Development, Faculty of Sciences, Ibn Tofail University, Ville Haute, 14020 Kenitra, Morocco
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Alnajashi H, Wali A, Aqeeli A, Magboul A, Alfulayt M, Baasher A, Alzahrani S. The Prevalence of Comorbidities Associated with Multiple Sclerosis in Saudi Arabia. Ann Afr Med 2024; 23:600-605. [PMID: 39138964 PMCID: PMC11556490 DOI: 10.4103/aam.aam_49_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic, immune mediated demyelinating illness of the central nervous system. This study looks at various comorbidities associated with MS, focusing on their impact on disease progression. Understanding comorbidities in MS is important as it can impact treatment selection and overall disease management and prognosis. AIMS AND OBJECTIVES Our aim is to show the prevalence of comorbidities along with MS. This research focuses on the comorbidities associated with MS and their impact on disease progression in the Arab Gulf region, with a special emphasis on Jeddah, Saudi Arabia. MATERIAL AND METHODS A retrospective record review was conducted from July 2022 to July 2023. The study included 286 patients, selected based on a definitive MS diagnosis in accordance with McDonald's 2017 criteria. Data collected included demographic information, MS type, duration of diagnosis, type of disease modifying therapy (DMT) used, Expanded Disability Status Scale (EDSS) score, and type of comorbidities. RESULTS The majority of the patients were female (70%) with an average age of 36 years. Most patients had relapsing remitting MS, and the majority were on DMTs, with fingolimod being the most common. Nearly half of the patients had comorbidities, with mood disorders, diabetes mellitus (DM), migraine, and hypertension (HTN) being prevalent. A significant positive association was found between the EDSS scores and both DM and HTN, but there was no significant link with migraine. CONCLUSION The findings indicate that individuals with MS have an increased risk of developing comorbidities such as migraine, DM, and HTN. Emphasizing a healthy lifestyle could potentially reduce the incidence of DM and HTN and their related vascular complications. The research also notes the prevalence of mood disorders among the MS population, although it remains inconclusive whether these are separate comorbid conditions or inherent symptoms of MS.
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Affiliation(s)
- Hind Alnajashi
- Department of Neurology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Wali
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ali Aqeeli
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Mohammed Alfulayt
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Baasher
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Samer Alzahrani
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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Faitna P, Bottle A, Klaber B, Aylin PP. Has multimorbidity and frailty in adult hospital admissions changed over the last 15 years? A retrospective study of 107 million admissions in England. BMC Med 2024; 22:369. [PMID: 39256751 PMCID: PMC11389502 DOI: 10.1186/s12916-024-03572-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 08/20/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Few studies have quantified multimorbidity and frailty trends within hospital settings, with even fewer reporting how much is attributable to the ageing population and individual patient factors. Studies to date have tended to focus on people over 65, rarely capturing older people or stratifying findings by planned and unplanned activity. As the UK's national health service (NHS) backlog worsens, and debates about productivity dominate, it is essential to understand these hospital trends so health services can meet them. METHODS Hospital Episode Statistics inpatient admission records were extracted for adults between 2006 and 2021. Multimorbidity and frailty was measured using Elixhauser Comorbidity Index and Soong Frailty Scores. Yearly proportions of people with Elixhauser conditions (0, 1, 2, 3 +) or frailty syndromes (0, 1, 2 +) were reported, and the prevalence between 2006 and 2021 compared. Logistic regression models measured how much patient factors impacted the likelihood of having three or more Elixhauser conditions or two or more frailty syndromes. Results were stratified by age groups (18-44, 45-64 and 65 +) and admission type (emergency or elective). RESULTS The study included 107 million adult inpatient hospital episodes. Overall, the proportion of admissions with one or more Elixhauser conditions rose for acute and elective admissions, with the trend becoming more prominent as age increased. This was most striking among acute admissions for people aged 65 and over, who saw a 35.2% absolute increase in the proportion of admissions who had three or more Elixhauser conditions. This means there were 915,221 extra hospital episodes in the last 12 months of the study, by people who had at least three Elixhauser conditions compared with 15 years ago. The findings were similar for people who had one or more frailty syndromes. Overall, year, age and socioeconomic deprivation were found to be strongly and positively associated with having three or more Elixhauser conditions or two or more frailty syndromes, with socioeconomic deprivation showing a strong dose-response relationship. CONCLUSIONS Overall, the proportion of hospital admissions with multiple conditions or frailty syndromes has risen over the last 15 years. This matches smaller-scale and anecdotal reports from hospitals and can inform how hospitals are reimbursed.
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Affiliation(s)
- Puji Faitna
- School of Public Health, Imperial College London, 80-92 Wood Lane, London, W12 7TA, UK.
| | - Alex Bottle
- School of Public Health, Imperial College London, 80-92 Wood Lane, London, W12 7TA, UK
| | - Bob Klaber
- School of Public Health, Imperial College London, 80-92 Wood Lane, London, W12 7TA, UK
- Imperial College London Healthcare NHS Trust, St Mary's Hospital, South Wharf Road, London, W2 1NY, UK
| | - Paul P Aylin
- School of Public Health, Imperial College London, 80-92 Wood Lane, London, W12 7TA, UK
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O'Malley DM, Alavi S, Tsui J, Abraham CM, Ohman-Strickland P. Racial and Ethnic Differences in Diabetes Care Quality in A National Sample of Cancer Survivors Relative to Non-Cancer Controls. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02156-0. [PMID: 39230653 DOI: 10.1007/s40615-024-02156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 07/31/2024] [Accepted: 08/25/2024] [Indexed: 09/05/2024]
Abstract
BACKGROUND Among cancer survivors, diabetes is associated with greater morbidity and mortality. The objective of this study is to describe racial/ethnic disparities in diabetes care quality (DCQ) among cancer survivors compared to non-cancer controls. METHODS We used Medical Expenditure Panel Survey Household Component data (2010-2018). Black, non-Hispanic White (NHW), and Hispanic respondents diagnosed with diabetes and cancer were frequency matched 1:5 to non-cancer controls. Multivariable logistic regression estimated associations for specific indices and overall DCQ by race/ethnicity stratified by cancer site/status in partially adjusted (not controlling for socioeconomic indicators) and fully adjusted models. RESULTS The final sample of 4775 included cancer survivors (n = 907 all cancers; n = 401 breast; n = 167 colon; n = 339 prostate) and non-cancer controls (n = 3868) matched by age, race/ethnicity, and year. In partially adjusted models, Black (adjusted odds ratio, AOR) 0.67 [95% CI 0.54-0.83]) and Hispanic (AOR 0.68 [95% CI 0.54-0.87]) non-cancer controls had significant disparities for overall DCQ compared to NHWs. Among cancer survivors, DCQ disparities for Black (AOR 0.62, [95% CI 0.4-0.96]) and Hispanics (AOR 0.60, [95% CI 0.38-0.97]) were identified. Among prostate cancer survivors, DCQ disparities were identified for Blacks (AOR 0.38; [95% CI 0.20-0.72]) and Hispanics (AOR 0.39; [95% CI 0.17-0.89]) compared to NHWs. Racial disparities among Black controls and Black prostate cancer survivors remained significant in fully adjusted models. CONCLUSION Diabetes care disparities are evident among cancer survivors and salient among non-cancer controls. Strategies to promote health equity should target specific care indices among survivors and emphasize equitable DCQ strategies among Black and Hispanic communities.
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Affiliation(s)
- Denalee M O'Malley
- Department of Family Medicine and Community Health, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Sarah Alavi
- Rutgers School of Public Health, Department of Epidemiology and Biostatistics, Piscataway, NJ, USA
| | - Jennifer Tsui
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Cilgy M Abraham
- Georgetown University Law Center, Georgetown University, Washington, DC, USA
| | - Pamela Ohman-Strickland
- Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
- Rutgers School of Public Health, Department of Epidemiology and Biostatistics, Piscataway, NJ, USA
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Oliveira Ramos F, Zinterl C, Fonseca JE. A lifelong journey: Long-term perspectives on Juvenile Idiopathic Arthritis. Best Pract Res Clin Rheumatol 2024; 38:101984. [PMID: 39068102 DOI: 10.1016/j.berh.2024.101984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 07/30/2024]
Abstract
Juvenile Idiopathic Arthritis (JIA) represents a diverse group of chronic inflammatory conditions that begin in childhood or adolescence and continue into adulthood, with varying severity and outcomes. This review discusses the complexities of transitioning JIA patients emphasizing that inadequate transition from pediatric to adult care leads to loss of follow-up, treatment discontinuation, and increased disease activity. Furthermore, challenges in disease classification hinder continuity of care across lifespan. It is also pointed out that predicting long-term outcomes in JIA remains complex due to heterogeneity and evolving phenotypes. Factors such as disease category, joint involvement, and treatment influence disease activity, functional disability, and quality of life. Despite advancements in treatment strategies, a substantial proportion of patients experience long-term disability and joint damage. Finally, it is underscored that optimising long-term outcomes in adults with JIA requires a multifaceted approach encompassing structured transition processes, personalised treatment strategies, and comprehensive management of comorbidities. Further research is needed to refine predictive models, enhance disease monitoring tools, and understand the complex interplay between disease activity, treatment response, and long-term outcomes.
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Affiliation(s)
- Filipa Oliveira Ramos
- Unidade de Reumatologia Pediátrica, Hospital Universitário Santa Maria, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal; Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal.
| | - Carolina Zinterl
- Unidade de Reumatologia Pediátrica, Hospital Universitário Santa Maria, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal
| | - João Eurico Fonseca
- Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Portugal; Serviço de Reumatologia, ULS Santa Maria, Centro Académico de Medicina de Lisboa, Portugal
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Mao X, Wu S, Huang D, Li C. Complications and comorbidities associated with antineoplastic chemotherapy: Rethinking drug design and delivery for anticancer therapy. Acta Pharm Sin B 2024; 14:2901-2926. [PMID: 39027258 PMCID: PMC11252465 DOI: 10.1016/j.apsb.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 01/29/2024] [Accepted: 02/10/2024] [Indexed: 07/20/2024] Open
Abstract
Despite the considerable advancements in chemotherapy as a cornerstone modality in cancer treatment, the prevalence of complications and pre-existing diseases is on the rise among cancer patients along with prolonged survival and aging population. The relationships between these disorders and cancer are intricate, bearing significant influence on the survival and quality of life of individuals with cancer and presenting challenges for the prognosis and outcomes of malignancies. Herein, we review the prevailing complications and comorbidities that often accompany chemotherapy and summarize the lessons to learn from inadequate research and management of this scenario, with an emphasis on possible strategies for reducing potential complications and alleviating comorbidities, as well as an overview of current preclinical cancer models and practical advice for establishing bio-faithful preclinical models in such complex context.
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Affiliation(s)
- Xiaoman Mao
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Shuang Wu
- Medical Research Institute, Southwest University, Chongqing 400715, China
| | - Dandan Huang
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
| | - Chong Li
- College of Pharmaceutical Sciences, Southwest University, Chongqing 400715, China
- Medical Research Institute, Southwest University, Chongqing 400715, China
- School of Pharmaceutical Sciences, Southern Medical University, Guangzhou 510515, China
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Tharwat S, Nassar MK, Salem KM, Nassar MK. Extraarticular manifestations of juvenile idiopathic arthritis and their impact on health-related quality of life. Clin Rheumatol 2024; 43:2295-2305. [PMID: 38797812 DOI: 10.1007/s10067-024-07008-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES The objective of this study is to investigate extraarticular manifestations (EAMs) in patients with juvenile idiopathic arthritis (JIA) and assess their impact on health-related quality of life (HRQoL) among these patients. METHODS This cross-sectional analytic study was carried out on 117 patients with JIA. EAMs were identified clinically by history and examination. Sicca symptoms, peripheral neuropathy, enthesitis, and skin lesions were picked up during clinical examination. Pulmonary involvement was evaluated by high-resolution CT chest. Patients were assessed by abdominal ultrasonography to assess the size of liver and spleen. Atlantoaxial subluxation was evaluated by cervical spine x-rays. Patients were evaluated by Pediatric Quality of Life Inventory-4 (PedsQL-4) and PedsQL-3 arthritis module. RESULTS The median age of patients was 14 years with a median disease duration 4 years, 82.9% were females. Of the studied 117 JIA patients, 85 patients (72.6%) had at least one EAM. Persistent fatigue (51.3%) was the most prevalent EAM, followed by recurrent skin rash (16.2%), enthesitis (15.4%), recurrent fever (13.7%), and uveitis (12%). Patients with EAMs scored significantly lower in physical functioning (p = 0.001), emotional functioning (p < 0.001), social functioning (p = 0.005), and school functioning (p = 0.001). Regarding PedsQL arthritis module, patients with EAM had also significantly lower scores than did patients without EAM on the domains of pain and hurt (p < 0.001), daily activities (p = 0.008), and worry (p = 0.001). RESULTS EAMs are prevalent among JIA patients and have a negative impact on their HRQoL. So, early identification and treatment are highly recommended. Key Points • A large percentage of JIA patients experienced at least one extraarticular manifestation (EAM). • Persistent fatigue and recurrent skin rash are the most prevalent EAMs in JIA patients. • JIA patients with EAMs have worse scores in almost all domains of HRQoL.
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Affiliation(s)
- Samar Tharwat
- Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Dakahlia Governorate, Mansoura University Hospital, El Gomhouria St, Mansoura, 35511, Egypt.
- Department of Internal Medicine, Faculty of Medicine, Horus University, New Damietta, Egypt.
| | - Mona Kamal Nassar
- Department of Radiology, Student Hospital, Mansoura University, Mansoura, Egypt
| | - Karem Mohamed Salem
- Department of Internal Medicine, Faculty of Medicine, Nephrology Unit, Fayoum University, Fayoum, Egypt
| | - Mohammed Kamal Nassar
- Mansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Cyntia Lima Fonseca Rodrigues A, Jung KH. Advancing Post-Stroke Cognitive Assessments: The Potential and Challenges of Integrating Eye Tracking Technology in Clinical Practice. Cerebrovasc Dis 2024; 54:194-195. [PMID: 38815554 DOI: 10.1159/000539594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 05/23/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Thomsen MK, Løppenthin KB, Bidstrup PE, Andersen EW, Dalton S, Petersen LN, Pappot H, Mortensen CE, Christensen MB, Frølich A, Lassen U, Johansen C. Impact of multimorbidity and polypharmacy on mortality after cancer: a nationwide registry-based cohort study in Denmark 2005-2017. Acta Oncol 2023; 62:1653-1660. [PMID: 37874076 DOI: 10.1080/0284186x.2023.2270145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Concurrent chronic diseases and treatment hereof in patients with cancer may increase mortality. In this population-based study we examined the individual and combined impact of multimorbidity and polypharmacy on mortality, across 20 cancers and with 13-years follow-up in Denmark. MATERIALS AND METHODS This nationwide study included all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015, and followed until the end of 2017. We defined multimorbidity as having one or more of 20 chronic conditions in addition to cancer, registered in the five years preceding diagnosis, and polypharmacy as five or more redeemed medications 2-12 months prior to cancer diagnosis. Cox regression analyses were used to estimate the effects of multimorbidity and polypharmacy, as well as the combined effect on mortality. RESULTS A total of 261,745 cancer patients were included. We found that patients diagnosed with breast, prostate, colon, rectal, oropharynx, bladder, uterine and cervical cancer, malignant melanoma, Non-Hodgkin lymphoma, and leukemia had higher mortality when the cancer diagnosis was accompanied by multimorbidity and polypharmacy, while in patients with cancer of the lung, esophagus, stomach, liver, pancreas, kidney, ovarian and brain & central nervous system, these factors had less impact on mortality. CONCLUSION We found that multimorbidity and polypharmacy was associated with higher mortality in patients diagnosed with cancer types that typically have a favorable prognosis compared with patients without multimorbidity and polypharmacy. Multimorbidity and polypharmacy had less impact on mortality in cancers that typically have a poor prognosis.
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Affiliation(s)
- Mette K Thomsen
- Department of Oncology, Cancer Survivorship and Treatment Late effects CASTLE group, Copenhagen, Denmark
| | | | | | | | - Susanne Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | | | - Mikkel B Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Innovation and Research Center for Multimorbidity and Chronic Conditions, Slagelse, Denmark
- Section of General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Department of Oncology, Cancer Survivorship and Treatment Late effects CASTLE group, Copenhagen, Denmark
- Department of Oncology, Copenhagen, Denmark
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Batista R, Reaume M, Roberts R, Seale E, Rhodes E, Sucha E, Pugliese M, Kendall CE, Bjerre LM, Bouchard L, Prud'homme D, Manuel DG, Tanuseputro P. Prevalence and patterns of multimorbidity among linguistic groups of patients receiving home care in Ontario: a retrospective cohort study. BMC Geriatr 2023; 23:725. [PMID: 37946126 PMCID: PMC10634019 DOI: 10.1186/s12877-023-04267-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Prior studies have demonstrated the negative impact of language barriers on access, quality, and safety of healthcare, which can lead to health disparities in linguistic minorities. As the population ages, those with multiple chronic diseases will require increasing levels of home care and long-term services. This study described the levels of multimorbidity among recipients of home care in Ontario, Canada by linguistic group. METHODS Population-based retrospective cohort of 510,685 adults receiving home care between April 1, 2010, to March 31, 2018, in Ontario, Canada. We estimated and compared prevalence and characteristics of multimorbidity (2 or more chronic diseases) across linguistic groups (Francophones, Anglophones, Allophones). The most common combinations and clustering of chronic diseases were examined. Logistic regression models were used to explore the main predictors of 'severe' multimorbidity (defined as the presence of five or more chronic diseases). RESULTS The proportion of home care recipients with multimorbidity and severe multimorbidity was 92% and 44%, respectively. The prevalence of multimorbidity was slightly higher among Allophones (93.6%) than among Anglophones (91.8%) and Francophones (92.4%). However, Francophones had higher rates of cardiovascular and respiratory disease (64.9%) when compared to Anglophones (60.2%) and Allophones (61.5%), while Anglophones had higher rates of cancer (34.2%) when compared to Francophones (25.2%) and Allophones (24.3%). Relative to Anglophones, Allophones were more likely to have severe multimorbidity (adjusted OR = 1.04, [95% CI: 1.02-1.06]). CONCLUSIONS The prevalence of multimorbidity among Ontarians receiving home care services is high; especially for whose primary language is a language other than English or French (i.e., Allophones). Understanding differences in the prevalence and characteristics of multimorbidity across linguistic groups will help tailor healthcare services to the unique needs of patients living in minority linguistic situations.
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Affiliation(s)
- Ricardo Batista
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Michael Reaume
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | | | - Emily Seale
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Emily Rhodes
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Claire E Kendall
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Lise M Bjerre
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Louise Bouchard
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- School of Social and Anthropological Studies, University of Ottawa, Ottawa, ON, Canada
| | - Denis Prud'homme
- Institut du Savoir Montfort, Hôpital Montfort, 202-745A Ch. Montréal Road, Ottawa, ON, K1K 0T1, Canada
- Université de Moncton, Nouveau-Brunswick, Canada
| | - Douglas G Manuel
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Peter Tanuseputro
- Ottawa Hospital Research Institute, Ottawa, ON, Canada.
- ICES uOttawa, Ottawa, ON, Canada.
- Bruyère Research Institute, Ottawa, ON, Canada.
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada.
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Skajaa N, Laugesen K, Horváth-Puhó E, Sørensen HT. Comorbidities and mortality among patients with chronic obstructive pulmonary disease. BMJ Open Respir Res 2023; 10:e001798. [PMID: 37797964 PMCID: PMC10551998 DOI: 10.1136/bmjresp-2023-001798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
INTRODUCTION Comorbidities are common in patients with chronic obstructive pulmonary disease (COPD). Estimates of prevalence, incidence and prognostic impact of comorbidities provide foundational knowledge of COPD epidemiology. We examined the prevalence, incidence and prognostic impact of 21 comorbidities among patients with COPD compared with the Danish general population. METHODS We conducted a nationwide, population-based cohort study based on longitudinal Danish registry data, covering all Danish hospitals (2010-2021). The cohorts comprised 142 973 patients with a first-time hospital-based diagnosis of COPD and 428 917 age-matched and sex-matched comparators from the general population. During follow-up, we estimated the 5-year risk and risk difference, using competing risk methods when applicable. RESULTS At time of diagnosis, the comorbidities with the highest prevalence were mood, stress-related or anxiety disorders (25.2% for patients with COPD vs 13.1% for comparators), osteoporosis/hip fractures (17.4% vs 9.9%), diabetes (15.6% vs 10.5%), peripheral arterial disease (13.5% vs 4.9%) and heart failure (13.3% vs 4.0%). During follow-up, the risk of most incident comorbidities was markedly elevated among patients with COPD. The five comorbidities associated with the highest 5-year absolute risk difference with respect to the risk in the general population were mood, stress-related or anxiety disorders (5.7%), osteoporosis/hip fractures (5.6%), heart failure (4.2%), smoking-related cancers (2.8%) and peripheral arterial disease (2.7%). The 5-year mortality risk was 43% vs 17.7%. Among patients with COPD, the 5-year mortality risk markedly increased with the number of comorbidities present. CONCLUSIONS Our population-based findings underscore the importance of considering comorbidities in the management of COPD.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Kristina Laugesen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Shuvo SD, Hossen MT, Riazuddin M, Hossain MS, Mazumdar S, Parvin R, Elahi MT. Prevalence of comorbidities and its associated factors among type-2 diabetes patients: a hospital-based study in Jashore District, Bangladesh. BMJ Open 2023; 13:e076261. [PMID: 37696641 PMCID: PMC10496697 DOI: 10.1136/bmjopen-2023-076261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/24/2023] [Indexed: 09/13/2023] Open
Abstract
OBJECTIVE This study aimed to estimate the prevalence of comorbidity and its associated factors among Bangladeshi type-2 diabetes (T2D) patients. DESIGN A hospital-based cross-sectional study. SETTING This study was conducted in two specialised diabetic centres residing in the Jashore District of Bangladesh. A systematic random sampling procedure was applied to identify the T2D patients through a face-to-face interview. PARTICIPANTS A total of 1036 patients with T2D were included in this study. A structured questionnaire was administered to collect data on demographic, lifestyle, medical and healthcare access-related data through face-to-face and medical record reviews. OUTCOME MEASURES AND ANALYSES The main outcome variable for this study was comorbidities. The prevalence of comorbidity was measured using descriptive statistics. A logistic regression model was performed to explore the factors associated with comorbidity among Bangladeshi T2D patients. RESULTS The overall prevalence of comorbidity was 41.4% and the most prevalent conditions were hypertension (50.4%), retinopathy (49.6%), obesity (28.7%) and oral problem (26.2). In the regression model, the odds of comorbidities increased with gender (male: OR: 1.27, 95% CI 0.62 to 1.87), age (50-64 years: OR: 2.14, 95% CI 1.32 to 2.93; and above 65 years: OR: 2.96, 95% CI 1.83 to 4.16), occupation (unemployment: OR: 3.32, 95% CI 0.92 to 6.02 and non-manual worker: OR: 2.31, 95% CI 0.91 to 5.82), duration of diabetes (above 15 years: OR: 3.28, 95% CI 1.44 to 5.37), body mass index (obese: OR: 2.62, 95% CI 1.24 to 4.26) of patients. We also found that individuals with recommended moderate to vigorous physical activity levels (OR: 0.41, 95% CI 1.44 to 5.37) had the lowest odds of having comorbidity. Meanwhile, respondents with limited self-care practice, unaffordable medicine and financial problems had 1.82 times, 1.94 times and 1.86 times higher odds of developing comorbidities. CONCLUSION The findings could be useful in designing and implementing effective intervention strategies and programmes for people with T2D to reduce the burden of comorbidity.
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Affiliation(s)
- Suvasish Das Shuvo
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Md Toufik Hossen
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Md Riazuddin
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Md Sakhawot Hossain
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Sanaullah Mazumdar
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Rashida Parvin
- Department of Nutrition and Food Technology, Jashore University of Science and Technology, Jashore, Bangladesh
| | - Md Toufiq Elahi
- Applied Nutrition and Food Technology, Islamic University, Kushtia, Bangladesh
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Valero-Bover D, Monterde D, Carot-Sans G, Cainzos-Achirica M, Comin-Colet J, Vela E, Clèries M, Folguera J, Abilleira S, Arrufat M, Lejardi Y, Solans Ò, Dedeu T, Coca M, Pérez-Sust P, Pontes C, Piera-Jiménez J. Is Age the Most Important Risk Factor in COVID-19 Patients? The Relevance of Comorbidity Burden: A Retrospective Analysis of 10,551 Hospitalizations. Clin Epidemiol 2023; 15:811-825. [PMID: 37408865 PMCID: PMC10319286 DOI: 10.2147/clep.s408510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/26/2023] [Indexed: 07/07/2023] Open
Abstract
Purpose To assess the contribution of age and comorbidity to the risk of critical illness in hospitalized COVID-19 patients using increasingly exhaustive tools for measuring comorbidity burden. Patients and Methods We assessed the effect of age and comorbidity burden in a retrospective, multicenter cohort of patients hospitalized due to COVID-19 in Catalonia (North-East Spain) between March 1, 2020, and January 31, 2022. Vaccinated individuals and those admitted within the first of the six COVID-19 epidemic waves were excluded from the primary analysis but were included in secondary analyses. The primary outcome was critical illness, defined as the need for invasive mechanical ventilation, transfer to the intensive care unit (ICU), or in-hospital death. Explanatory variables included age, sex, and four summary measures of comorbidity burden on admission extracted from three indices: the Charlson index (17 diagnostic group codes), the Elixhauser index and count (31 diagnostic group codes), and the Queralt DxS index (3145 diagnostic group codes). All models were adjusted by wave and center. The proportion of the effect of age attributable to comorbidity burden was assessed using a causal mediation analysis. Results The primary analysis included 10,551 hospitalizations due to COVID-19; of them, 3632 (34.4%) experienced critical illness. The frequency of critical illness increased with age and comorbidity burden on admission, irrespective of the measure used. In multivariate analyses, the effect size of age decreased with the number of diagnoses considered to estimate comorbidity burden. When adjusting for the Queralt DxS index, age showed a minimal contribution to critical illness; according to the causal mediation analysis, comorbidity burden on admission explained the 98.2% (95% CI 84.1-117.1%) of the observed effect of age on critical illness. Conclusion Comorbidity burden (when measured exhaustively) explains better than chronological age the increased risk of critical illness observed in patients hospitalized with COVID-19.
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Affiliation(s)
- Damià Valero-Bover
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - David Monterde
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Catalan Institute of Health, Barcelona, Spain
| | - Gerard Carot-Sans
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Josep Comin-Colet
- Cardiology Department, Bellvitge University Hospital (IDIBELL), Barcelona, Spain
- Department of Medicine, University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
- CIBER Cardiovascular (CIBERCV), L’Hospitalet de Llobregat, Barcelona, Spain
| | - Emili Vela
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Montse Clèries
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Júlia Folguera
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | - Sònia Abilleira
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | - Òscar Solans
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Health Department, eHealth Unit, Barcelona, Spain
| | - Toni Dedeu
- WHO European Centre for Primary Health Care, Almaty, Kazakhstan
| | - Marc Coca
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
| | | | - Caridad Pontes
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Pharmacology, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Piera-Jiménez
- Catalan Health Service, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3) – Institut d’Investigacions Biomèdiques de Bellvitge (IDIBELL), Barcelona, Spain
- Faculty of Informatics, Telecommunications and Multimedia, Universitat Oberta de Catalunya, Barcelona, Spain
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Gupta A, Marzook H, Ahmad F. Comorbidities and clinical complications associated with SARS-CoV-2 infection: an overview. Clin Exp Med 2023; 23:313-331. [PMID: 35362771 PMCID: PMC8972750 DOI: 10.1007/s10238-022-00821-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/12/2022] [Indexed: 01/08/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) causes major challenges to the healthcare system. SARS-CoV-2 infection leads to millions of deaths worldwide and the mortality rate is found to be greatly associated with pre-existing clinical conditions. The existing dataset strongly suggests that cardiometabolic diseases including hypertension, coronary artery disease, diabetes and obesity serve as strong comorbidities in coronavirus disease (COVID-19). Studies have also shown the poor outcome of COVID-19 in patients associated with angiotensin-converting enzyme-2 polymorphism, cancer chemotherapy, chronic kidney disease, thyroid disorder, or coagulation dysfunction. A severe complication of COVID-19 is mostly seen in people with compromised medical history. SARS-CoV-2 appears to attack the respiratory system causing pneumonia, acute respiratory distress syndrome, which lead to induction of severe systemic inflammation, multi-organ dysfunction, and death mostly in the patients who are associated with pre-existing comorbidity factors. In this article, we highlighted the key comorbidities and a variety of clinical complications associated with COVID-19 for a better understanding of the etiopathogenesis of COVID-19.
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Affiliation(s)
- Anamika Gupta
- Cardiovascular Research Group, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 27272, UAE
| | - Hezlin Marzook
- Cardiovascular Research Group, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 27272, UAE
| | - Firdos Ahmad
- Cardiovascular Research Group, Sharjah Institute for Medical Research, University of Sharjah, Sharjah, 27272, UAE.
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, 27272, UAE.
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Haşlak F, Guliyeva V, Hotaman B, Duman Ç, Yıldız M, Günalp A, Aslan E, Könte EK, Aliyeva A, Adrovic A, Şahin S, Barut K, Kasapçopur Ö. Non-Rheumatic Chronic Comorbidities in Children with Juvenile Idiopathic Arthritis. Turk Arch Pediatr 2023; 58:212-219. [PMID: 36856360 PMCID: PMC10081080 DOI: 10.5152/turkarchpediatr.2023.22303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/05/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Juvenile idiopathic arthritis is a heterogeneous group of disorders and is the most common rheumatic condition in childhood. There are scarce data regarding all comorbidities in juvenile idiopathic arthritis patients. MATERIALS AND METHODS We aimed to identify the non-rheumatic comorbidities in our juvenile idiopathic arthritis patients. Data were obtained cross-sectionally from the medical records and the face-to-face interviews for 6 consecutive months. Those with more than 1 rheumatic disease were excluded, and conditions that were highly related to the disease, such as uveitis, were not taken into account. RESULTS The study included 459 patients with female dominance (62.1%, n = 285). The median age of the patients was 12.87 (1.53-20.95) years. One hundred fifty patients (32.7%) had at least 1 comorbidity (5 patients had 3 comorbidities, and 24 patients had 2 comorbidities). The most common 3 non-rheumatic accompanying medical conditions in our patients were allergic rhinitis (n = 37, 8.1%), attention-deficit hyperactivity disorder (n = 35, 7.6%), and atopic dermatitis (n = 28, 6.1%). None of our patients with systemic JIA had any autoimmune disease. All the patients with primary immune deficiencies had anti-nuclear antibody positivity. CONCLUSION Almost one-third of our patients had at least one comorbidity. This finding might be very helpful to us in planning our multi-disciplinary approach to our patients.
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Affiliation(s)
- Fatih Haşlak
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Vafa Guliyeva
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Büşra Hotaman
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Çisem Duman
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Mehmet Yıldız
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Aybüke Günalp
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Esma Aslan
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Elif Kılıç Könte
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Ayten Aliyeva
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Amra Adrovic
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Sezgin Şahin
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Kenan Barut
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
| | - Özgür Kasapçopur
- Department of Pediatric Rheumatology, İstanbul University-Cerrahpaşa, Cerrahpaşa Faculty of Medicine, İstanbul, Turkey
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21
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Tsigebrhan R, Derese A, Kariuki SM, Fekadu A, Medhin G, Newton CR, Prince MJ, Hanlon C. Co-morbid mental health conditions in people with epilepsy and association with quality of life in low- and middle-income countries: a systematic review and meta-analysis. Health Qual Life Outcomes 2023; 21:5. [PMID: 36670421 PMCID: PMC9854052 DOI: 10.1186/s12955-022-02086-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 12/29/2022] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Comorbid mental health conditions are common in people with epilepsy and have a significant negative impact on important epilepsy outcomes, although the evidence is mostly from high-income countries. This systematic review aimed to synthesise evidence on the association between comorbid mental health conditions and quality of life and functioning among people with epilepsy living in low- and middle income countries (LMICs). METHODS We searched PubMed, EMBASE, CINAHL, Global Index medicus (GID) and PsycINFO databases from their dates of inception to January 2022. Only quantiative observational studies were included. Meta-analysis was conducted for studies that reported the same kind of quality of life and functioning outcome. Cohen's d was calculated from the mean difference in quality-of-life score between people with epilepsy who did and did not have a comorbid depression or anxiety condition. The protocol was registered with PROSPERO: CRD42020161487. RESULTS The search strategy identified a total of 2,101 articles, from which 33 full text articles were included. Depression was the most common comorbid mental health condition (33 studies), followed by anxiety (16 studies). Meta-analysis was conducted on 19 studies reporting quality of life measured with the same instrument. A large standardized mean effect size (ES) in quality of life score was found (pooled ES = -1.16, 95% confidence interval (CI) - 1.70, - 0.63) between those participants with comorbid depression compared to non-depressed participants. There was significant heterogeneity between studies (I2 = 97.6%, p < 0.001). The median ES (IQR) was - 1.20 (- 1.40, (- 0.64)). An intermediate standard effect size for anxiety on quality of life was also observed (pooled ES = -0.64, 95% CI - 1.14, - 0.13). There was only one study reporting on functioning in relation to comorbid mental health conditions. CONCLUSION Comorbid depression in people with epilepsy in LMICs is associated with poor quality of life although this evidence is based on highly heterogeneous studies. These findings support calls to integrate mental health care into services for people with epilepsy in LMICs. Future studies should use prospective designs in which the change in quality of life in relation to mental health or public health interventions across time can be measured.
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Affiliation(s)
- Ruth Tsigebrhan
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Andualem Derese
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Symon M Kariuki
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Public Health, Pwani University, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, UK
| | - Abebaw Fekadu
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Global Health and Infection Department, Brighton and Sussex Medical School, Brighton, UK
| | - Girmay Medhin
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Aklilu-Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charles R Newton
- Neuroscience Unit, KEMRI-Wellcome Trust Research Programme, Kilifi, Kenya
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, UK
| | - Martin J Prince
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Hanlon
- Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Psychiatry, WHO Collaborating Centre in Mental Health Research and Capacity-Building, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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22
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Non-comorbid Respiratory Factor and Work of Breathing in Pediatric COVID-19 Patient: How is Their Synergistic Correlation with the Level of Care? NURSE MEDIA JOURNAL OF NURSING 2022. [DOI: 10.14710/nmjn.v12i3.45340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Work of breathing (WOB) and non-comorbidities factors in the respiratory system are the two probable findings in pediatric COVID-19 patients. However, the association of those factors with level of care was not well reported.Purpose: This study aimed to identify the relation between potential predictors including comorbidity, low nutritional fulfillment, infectious disease, shock, cough, O2 saturation reduction, abnormal blood gas analysis and sore throat with the level of care among pediatric COVID-19 patients. We also analyzed the synergistic correlation of non-comorbidities factors in the respiratory system and work of breathing to predict level of care in pediatric COVID-19 patients.Methods: A cross-sectional study was conducted in the six referral hospitals from July to September 2020 in four provinces in Indonesia. An observation checklist was used to collect data from the medical records of pediatric patients with COVID-19, including medical diagnosis, demographic, and clinical manifestation. This study included 423 participants aged from 0 to 18. The multivariate logistic regression was performed to test the adjusted odds ratios (AORs) with the 95% confidence intervals (CIs) of the association between WOB, non-comorbid respiratory, and level of care. Moreover, dummy variables (2x2) were made to analyze synergistic correlation of non-comorbid respiratory disease and WOB. The AOR with the 95% CIs was applied in the association between the complication of non-comorbid respiratory diseases and high work of breathing with level of care among pediatric patients with COVID-19.Results: Results showed that age, presence of comorbidity, nutritional fulfillment, infectious disease, shock, work of breathing, O2 saturation reduction, abnormal blood gas analysis, sore throat, and convulsive meningeal consciousness were significantly associated with the level of care (p<0.05). Pediatric patients with non-comorbid respiratory and increased work of breathing had a 15.59 times higher risk of requiring PICU care level (p<0.01). Meanwhile, pediatric patients who experienced both non-comorbid respiratory and increased work of breathing had a 5.76 times risk of requiring an intermediate level of care (p<0.05), and 9.32 times higher risk of requiring a PICU level of care (p<.05).Conclusion: It was found that both non-comorbid respiratory and increased WOB had a significant relationship with the level of care for pediatric patients with COVID-19. Nurse should take into account those clinical findings to increase the awareness in monitoring clinical deterioration in pediatric COVID-19 patients.
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23
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Juvenile Idiopathic Arthritis, Uveitis and Multiple Sclerosis: Description of Two Patients and Literature Review. Biomedicines 2022; 10:biomedicines10082041. [PMID: 36009588 PMCID: PMC9405697 DOI: 10.3390/biomedicines10082041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/04/2022] Open
Abstract
Juvenile idiopathic arthritis (JIA) is the most common rheumatic disease in childhood, while multiple sclerosis (MS) is a demyelinating disease of the central nervous system, characterized by remission and exacerbation phases. An association between MS and rheumatologic diseases, in particular rheumatoid arthritis, has been described and numerous studies acknowledge anti-TNF-α drugs as MS triggers. Conversely, the association between MS and JIA has been reported merely in five cases in the literature. We describe two cases of adult patients with longstanding JIA and JIA-associated uveitis, who developed MS. The first patient was on methotrexate and adalimumab when she developed dizziness and nausea. Characteristic MRI lesions and oligoclonal bands in cerebrospinal fluid led to MS diagnosis. Adalimumab was discontinued, and she was treated with three pulses of intravenous methylprednisolone. After a few months, rituximab was started. The second patient had been treated with anti-TNF-α and then switched to abatacept. She complained of unilateral arm and facial paraesthesias; brain MRI showed characteristic lesions, and MS was diagnosed. Three pulses of intravenous methylprednisolone were administered; neurological disease remained stable, and abatacept was reintroduced. Further studies are warranted to define if there is an association between JIA and MS, if MS represents JIA comorbidity or if anti-TNF-α underpins MS development.
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24
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Kearsley-Fleet L, Klotsche J, van Straalen JW, Costello W, D’Angelo G, Giancane G, Horneff G, Klein A, Láday M, Lunt M, de Roock S, Ruperto N, Schoemaker C, Vijatov-Djuric G, Vojinovic J, Vougiouka O, Wulffraat NM, Hyrich KL, Minden K, Swart JF. Burden of comorbid conditions in children and young people with juvenile idiopathic arthritis: a collaborative analysis of 3 JIA registries. Rheumatology (Oxford) 2022; 61:2524-2534. [PMID: 34613385 PMCID: PMC9157174 DOI: 10.1093/rheumatology/keab641] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/04/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Burden of comorbidities are largely unknown in JIA. From 2000, national and international patient registries were established to monitor biologic treatment, disease activity and adverse events in patients with JIA. The aim of this analysis was to investigate in parallel, for the first time, three of the largest JIA registries in Europe/internationally-UK JIA Biologic Registers (BCRD/BSPAR-ETN), German biologic registers (BiKeR/JuMBO), multinational Pharmachild-to quantify the occurrence of selected comorbidities in patients with JIA. METHODS Information on which data the registers collect were compared. Patient characteristics and levels of comorbidity were presented, focussing on four key conditions: uveitis, MAS, varicella, and history of tuberculosis. Incidence rates of these on MTX/biologic therapy were determined. RESULTS 8066 patients were registered into the three JIA registers with similar history of the four comorbidities across the studies; however, varicella vaccination coverage was higher in Germany (56%) vs UK/Pharmachild (16%/13%). At final follow-up, prevalence of varicella infection was lower in Germany (15%) vs UK/Pharmachild (37%/50%). Prevalence of TB (0.1-1.8%) and uveitis (15-19%) was similar across all registers. The proportion of systemic-JIA patients who ever had MAS was lower in Germany (6%) vs UK (15%) and Pharmachild (17%). CONCLUSION This analysis is the first and largest to investigate the occurrence of four important comorbidities in three JIA registries in Europe and the role of anti-rheumatic drugs. Combined, these three registries represent one of the biggest collection of cases of JIA worldwide and offer a unique setting for future JIA outcome studies.
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Affiliation(s)
- Lianne Kearsley-Fleet
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Jens Klotsche
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Joeri W van Straalen
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Wendy Costello
- iIrish Children’s Arthritis Network (iCAN), Bansha, Co Tipperary, Ireland
| | | | - Gabriella Giancane
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Gerd Horneff
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Ariane Klein
- Department of Pediatrics, Asklepios Kinderklinik Sankt Augustin, Sankt Augustin
- Department of Pediatric and Adolescent Medicine, Medical Faculty, University Hospital of Cologne, Cologne, Germany
| | - Matilda Láday
- Pediatric Clinical Department 1, Spitalul Clinic Judetean De Urgenta, Tîrgu-Mureș, Romania
| | - Mark Lunt
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sytze de Roock
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | - Nicolino Ruperto
- Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Casper Schoemaker
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
- Dutch JIA Patient and Parent Organisation (Member of ENCA), Rijen, The Netherlands
| | - Gordana Vijatov-Djuric
- Faculty of Medicine, University of Novi Sad
- Department of Immunology, Allergology and Rheumatology, Institute for Child and Youth Health Care of Vojvodina, Novi Sad
| | - Jelena Vojinovic
- Faculty of Medicine, Department of Pediatric Immunology and Rheumatology, University of Nis, University Clinic Center
- Department of Pediatric Rheumatology, Clinical Center Nis, Clinic of Pediatrics, Nis, Serbia
| | - Olga Vougiouka
- ‘P a A Kyriakou’ Children’s Hospital, 2nd Paediatric Department, Athens University School of Medicine, Athens, Greece
| | - Nico M Wulffraat
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
| | | | - Kimme L Hyrich
- Centre for Epidemiology Versus Arthritis, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester BRC, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Kirsten Minden
- Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
- Department of Pediatric Pulmonology, Immunology and Critical Care Medicine, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Joost F Swart
- Department of Paediatric Immunology and Rheumatology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands
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Vela E, Carot-Sans G, Clèries M, Monterde D, Acebes X, Comella A, García Eroles L, Coca M, Valero-Bover D, Pérez Sust P, Piera-Jiménez J. Development and validation of a population-based risk stratification model for severe COVID-19 in the general population. Sci Rep 2022; 12:3277. [PMID: 35228558 PMCID: PMC8885698 DOI: 10.1038/s41598-022-07138-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 02/14/2022] [Indexed: 11/09/2022] Open
Abstract
The shortage of recently approved vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has highlighted the need for evidence-based tools to prioritize healthcare resources for people at higher risk of severe coronavirus disease (COVID-19). Although age has been identified as the most important risk factor (particularly for mortality), the contribution of underlying comorbidities is often assessed using a pre-defined list of chronic conditions. Furthermore, the count of individual risk factors has limited applicability to population-based "stratify-and-shield" strategies. We aimed to develop and validate a COVID-19 risk stratification system that allows allocating individuals of the general population into four mutually-exclusive risk categories based on multivariate models for severe COVID-19, a composite of hospital admission, transfer to intensive care unit (ICU), and mortality among the general population. The model was developed using clinical, hospital, and epidemiological data from all individuals among the entire population of Catalonia (North-East Spain; 7.5 million people) who experienced a COVID-19 event (i.e., hospitalization, ICU admission, or death due to COVID-19) between March 1 and September 15, 2020, and validated using an independent dataset of 218,329 individuals with COVID-19 confirmed by reverse transcription-polymerase chain reaction (RT-PCR), who were infected after developing the model. No exclusion criteria were defined. The final model included age, sex, a summary measure of the comorbidity burden, the socioeconomic status, and the presence of specific diagnoses potentially associated with severe COVID-19. The validation showed high discrimination capacity, with an area under the curve of the receiving operating characteristics of 0.85 (95% CI 0.85-0.85) for hospital admissions, 0.86 (0.86-0.97) for ICU transfers, and 0.96 (0.96-0.96) for deaths. Our results provide clinicians and policymakers with an evidence-based tool for prioritizing COVID-19 healthcare resources in other population groups aside from those with higher exposure to SARS-CoV-2 and frontline workers.
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Affiliation(s)
- Emili Vela
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Gerard Carot-Sans
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Montse Clèries
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - David Monterde
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
- Sistemes d'Informació, Institut Català de La Salut, Barcelona, Catalonia, Spain
| | - Xènia Acebes
- Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Adrià Comella
- Servei Català de la Salut (CatSalut), Barcelona, Spain
| | - Luís García Eroles
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Marc Coca
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | - Damià Valero-Bover
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain
| | | | - Jordi Piera-Jiménez
- Servei Català de la Salut (CatSalut), Barcelona, Spain.
- Digitalization for the Sustainability of the Healthcare System (DS3), IDIBELL, Barcelona, Spain.
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.
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de Figueiredo IR, Branco Ferrão J, Dias S, Vieira Alves R, Taulaigo A, Ferraz M, Guerreiro Castro S, Antunes AM, Mihon C, Llado A, Gruner H, Panarra A. Trends in Infectious Diseases: A Retrospective 5-Year Study. EMJ MICROBIOLOGY & INFECTIOUS DISEASES 2022. [DOI: 10.33590/emjmicrobiolinfectdis/21-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Although hospital admission is frequently due to the exacerbation of chronic diseases, most often it is caused by an underlying infectious process. Patients often have several admissions per year, making them at risk for recurrent infections, increased morbidity, and the emergence of resistant strains of microorganisms.
Methods: This is a retrospective, descriptive study of all patients with an infectious disease diagnosis, who were admitted to the medical ward of a tertiary hospital during a 5-year period. Information was collected from electronic medical files regarding gender, age, autonomy, comorbidities, primary diagnosis, in-hospital length of stay, and mortality as well as microbiological data surveillance.
Results: A total of 355 patients fulfilled the inclusion criteria. Amongst the sample analysed, the average age was 78.10+12.47 years years. Of the patients, 57.2% (203) were female, with most patients considered as dependent according to Katz score. The average Charlson Comorbidity Index (CCI) score was 6.28+2.74, increasing with age. The main diagnostic categories were respiratory (191 patients: 137 with pneumonia and 49 with acute bronchitis) and urinary tract (138 patients: 69 with pyelonephritis and 66 with cystitis). Urinary tract infections were more frequent in females and in dependent patients. Only 37.8% of infections had a microbiologic isolate: Escherichia coli (28.4%), Pseudomonas aeruginosa (12.7%), and Klebsiella pneumoniae (8.2%). The overall mortality was 6.77%.
Conclusions: The frequent in-hospital admission due to infectious diseases makes it imperative to characterise and follow-up on evolution of the disease itself in order to better know the characteristics of community-acquired diseases, establish routes of transmission and outbreak identification, microbiology patterns, and resistance towards further improving empiric therapy.
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Affiliation(s)
- Inês Rego de Figueiredo
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Joana Branco Ferrão
- Medicina 2.3, Hospital de Santo António dos Capuchos, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Sara Dias
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Rita Vieira Alves
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Anna Taulaigo
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Mário Ferraz
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Sara Guerreiro Castro
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Ana Margarida Antunes
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Claudia Mihon
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Ana Llado
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - Heidi Gruner
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
| | - António Panarra
- Medicina 7.2, Hospital Curry Cabral, Centro Hospitalar Universitário Lisboa Central (CHULC), Portugal
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Koul A, Shetty AS. Frequency of psychiatric comorbid symptoms in bipolar disorder patients in remission. Ind Psychiatry J 2022; 31:126-134. [PMID: 35800862 PMCID: PMC9255627 DOI: 10.4103/ipj.ipj_233_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 03/16/2021] [Accepted: 07/05/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Psychiatric comorbidity has been detected in one-third of bipolar patients. The illness itself may be a precipitating factor for developing substance use and anxiety disorders. Comorbid anxiety disorders with bipolar disorder (BD) are associated with decreased chances of recovery, poorer role functioning, and quality of life, and greater likelihood of suicide attempts. Hence, identifying comorbid symptoms in remitting patients has important preventive and therapeutic implications. AIMS The aim of the study was to estimate the frequency of psychiatric comorbid symptoms in patients of bipolar affective disorder in remission and to identify its relationship with sociodemographic variables. METHODOLOGY This is a cross-sectional study conducted in Father Muller Medical College and Hospital, Mangalore (April 2019-July 2019), which included 90 patients aged 18-50 years with BD, manic, or depressive episodes in remission for 8 weeks who were evaluated using mini international neuropsychiatric interview plus, Hamilton rating scale for depression, and young mania rating scale. Sociodemographic details were assessed by a semi-structured pro forma. The data were analyzed using frequency, Chi-square test, and t-test. RESULTS Most common psychiatry comorbid symptoms seen in BD were found to be drug dependence/abuse (n = 31), second most common being alcohol dependence/abuse (n = 21), followed by suicidality (n = 8), antisocial personality, social phobia, panic disorder, and agoraphobia. Significance was found for suicidality, agoraphobia, and social phobia if the last episode was depressive and for suicidality if index episode was depressive and if age of onset was >40 years. CONCLUSION Psychiatric comorbidities in BD may worsen the course and prognosis of the disorder and hence, clinicians must maintain a high index of suspicion for them. Furthermore, comorbidities may need to be identified and appropriate interventions employed to prevent iatrogenic complications.
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Affiliation(s)
- Aarshie Koul
- Department of Psychiatry, Father Muller Medical College Hospital, Mangalore, Karnataka, India
| | - A Siddharth Shetty
- Department of Psychiatry, Father Muller Medical College Hospital, Mangalore, Karnataka, India
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28
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Monterde D, Carot-Sans G, Cainzos-Achirica M, Abilleira S, Coca M, Vela E, Clèries M, Valero-Bover D, Comin-Colet J, García-Eroles L, Pérez-Sust P, Arrufat M, Lejardi Y, Piera-Jiménez J. Performance of Three Measures of Comorbidity in Predicting Critical COVID-19: A Retrospective Analysis of 4607 Hospitalized Patients. Risk Manag Healthc Policy 2021; 14:4729-4737. [PMID: 34849041 PMCID: PMC8627311 DOI: 10.2147/rmhp.s326132] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Comorbidity burden has been identified as a relevant predictor of critical illness in patients hospitalized with coronavirus disease 2019 (COVID-19). However, comorbidity burden is often represented by a simple count of few conditions that may not fully capture patients' complexity. PURPOSE To evaluate the performance of a comprehensive index of the comorbidity burden (Queralt DxS), which includes all chronic conditions present on admission, as an adjustment variable in models for predicting critical illness in hospitalized COVID-19 patients and compare it with two broadly used measures of comorbidity. MATERIALS AND METHODS We analyzed data from all COVID-19 hospitalizations reported in eight public hospitals in Catalonia (North-East Spain) between June 15 and December 8 2020. The primary outcome was a composite of critical illness that included the need for invasive mechanical ventilation, transfer to ICU, or in-hospital death. Predictors including age, sex, and comorbidities present on admission measured using three indices: the Charlson index, the Elixhauser index, and the Queralt DxS index for comorbidities on admission. The performance of different fitted models was compared using various indicators, including the area under the receiver operating characteristics curve (AUROCC). RESULTS Our analysis included 4607 hospitalized COVID-19 patients. Of them, 1315 experienced critical illness. Comorbidities significantly contributed to predicting the outcome in all summary indices used. AUC (95% CI) for prediction of critical illness was 0.641 (0.624-0.660) for the Charlson index, 0.665 (0.645-0.681) for the Elixhauser index, and 0.787 (0.773-0.801) for the Queralt DxS index. Other metrics of model performance also showed Queralt DxS being consistently superior to the other indices. CONCLUSION In our analysis, the ability of comorbidity indices to predict critical illness in hospitalized COVID-19 patients increased with their exhaustivity. The comprehensive Queralt DxS index may improve the accuracy of predictive models for resource allocation and clinical decision-making in the hospital setting.
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Affiliation(s)
- David Monterde
- Catalan Institute of Health, Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
| | - Gerard Carot-Sans
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
- Servei Català de la Salut, Barcelona, Spain
| | - Miguel Cainzos-Achirica
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Sònia Abilleira
- Catalan Institute of Health, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Marc Coca
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
- Servei Català de la Salut, Barcelona, Spain
| | - Emili Vela
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
- Servei Català de la Salut, Barcelona, Spain
| | - Montse Clèries
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
- Servei Català de la Salut, Barcelona, Spain
| | - Damià Valero-Bover
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
- Servei Català de la Salut, Barcelona, Spain
| | - Josep Comin-Colet
- Department of Cardiology, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
- Bioheart-Cardiovascular Diseases Research Group (Idibell), L’Hospitalet de Llobregat, Barcelona, Spain
- Department of Clinical Sciences, School of Medicine, Universität de Barcelona - UB, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Luis García-Eroles
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
- Servei Català de la Salut, Barcelona, Spain
| | | | | | | | - Jordi Piera-Jiménez
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Barcelona, Spain
- Servei Català de la Salut, Barcelona, Spain
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain
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Vela E, Clèries M, Monterde D, Carot-Sans G, Coca M, Valero-Bover D, Piera-Jiménez J, García Eroles L, Pérez Sust P. Performance of quantitative measures of multimorbidity: a population-based retrospective analysis. BMC Public Health 2021; 21:1881. [PMID: 34663289 PMCID: PMC8524794 DOI: 10.1186/s12889-021-11922-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 10/05/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Multimorbidity measures are useful for resource planning, patient selection and prioritization, and factor adjustment in clinical practice, research, and benchmarking. We aimed to compare the explanatory performance of the adjusted morbidity group (GMA) index in predicting relevant healthcare outcomes with that of other quantitative measures of multimorbidity. METHODS The performance of multimorbidity measures was retrospectively assessed on anonymized records of the entire adult population of Catalonia (North-East Spain). Five quantitative measures of multimorbidity were added to a baseline model based on age, gender, and socioeconomic status: the Charlson index score, the count of chronic diseases according to three different proposals (i.e., the QOF, HCUP, and Karolinska institute), and the multimorbidity index score of the GMA tool. Outcomes included all-cause death, total and non-scheduled hospitalization, primary care and ER visits, medication use, admission to a skilled nursing facility for intermediate care, and high expenditure (time frame 2017). The analysis was performed on 10 subpopulations: all adults (i.e., aged > 17 years), people aged > 64 years, people aged > 64 years and institutionalized in a nursing home for long-term care, and people with specific diagnoses (e.g., ischemic heart disease, cirrhosis, dementia, diabetes mellitus, heart failure, chronic kidney disease, and chronic obstructive pulmonary disease). The explanatory performance was assessed using the area under the receiving operating curves (AUC-ROC) (main analysis) and three additional statistics (secondary analysis). RESULTS The adult population included 6,224,316 individuals. The addition of any of the multimorbidity measures to the baseline model increased the explanatory performance for all outcomes and subpopulations. All measurements performed better in the general adult population. The GMA index had higher performance and consistency across subpopulations than the rest of multimorbidity measures. The Charlson index stood out on explaining mortality, whereas measures based on exhaustive definitions of chronic diagnostic (e.g., HCUP and GMA) performed better than those using predefined lists of diagnostics (e.g., QOF or the Karolinska proposal). CONCLUSIONS The addition of multimorbidity measures to models for explaining healthcare outcomes increase the performance. The GMA index has high performance in explaining relevant healthcare outcomes and may be useful for clinical practice, resource planning, and public health research.
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Affiliation(s)
- Emili Vela
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain
| | - Montse Clèries
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain
| | - David Monterde
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain
- Sistemes d'Informació, Institut Català de la Salut, Barcelona, Catalonia, Spain
| | - Gerard Carot-Sans
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain
| | - Marc Coca
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain
| | - Damià Valero-Bover
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain
| | - Jordi Piera-Jiménez
- Servei Català de la Salut (CatSalut), Barcelona, Spain.
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain.
- Sistemes d'Informació, Institut Català de la Salut, Barcelona, Catalonia, Spain.
- Open Evidence Research Group, Universitat Oberta de Catalunya, Barcelona, Spain.
| | - Luís García Eroles
- Servei Català de la Salut (CatSalut), Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Barcelona, Spain
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Thygesen LC, Christensen K, Rørth M, Sørensen HT, Vandenbroucke JP, Westendorp RGJ. Tipping Points - Do the Prognostic Values of Multimorbidity and Functional Status Vary with Age? Clin Epidemiol 2021; 13:853-857. [PMID: 34588816 PMCID: PMC8473562 DOI: 10.2147/clep.s325348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/23/2021] [Indexed: 12/24/2022] Open
Abstract
Aging of the population is a pressing challenge for healthcare systems and knowledge of a patient’s prognosis is a key to shaping effective interventions. As the prevalence of multimorbidity strongly increases with age, the prognostic value of multiple disease diagnoses for survival among older people may diminish, whereas other measures of health, such as functional status (defined as a measure of an individual’s ability to perform activities of daily living), may become more important. In this commentary, the impact of age on the prognostic value of multimorbidity is discussed, with the aim of identifying relevant alternative risk indicators for different age groups. The key question is to determine at what age the prognostic value of multimorbidity for meaningful clinical outcomes decreases and is overridden by the prognostic value of functional status. This tipping point likely depends on age, calendar time, and birth cohort. The public health and clinical implications of these tipping points are important. Among younger and middle-aged persons, interventions could be directed towards prevention and treatment of specific diseases, while among older persons efforts should focus more on improving functional levels that include physical, emotional, and social dimensions.
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Affiliation(s)
- Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kaare Christensen
- The Danish Aging Research Center, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Mikael Rørth
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Aarhus University Hospital, Aarhus, Denmark
| | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Aarhus University Hospital, Aarhus, Denmark
| | - Jan P Vandenbroucke
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.,Department of Medical Statistics and Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rudi G J Westendorp
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
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Grzegorzewska AM, Wiglusz MS, Landowski J, Jakuszkowiak-Wojten K, Cubała WJ, Włodarczyk A, Szarmach J. Multiple Comorbidity Profile of Psychiatric Disorders in Epilepsy. J Clin Med 2021; 10:jcm10184104. [PMID: 34575214 PMCID: PMC8465099 DOI: 10.3390/jcm10184104] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/07/2021] [Indexed: 11/16/2022] Open
Abstract
The co-occurrence of psychiatric disorders in people with epilepsy (PWE) is not well documented or studied. Anxiety and depressive disorders are the most frequent comorbid disorders in PWE. In this paper, we characterized the rates of multiple psychiatric disorder comorbidity by reanalyzing data from a study sample of PWE. A total of 96 outpatient PWE completed the self-report symptom scale, and were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) Axis I disorders (SCID-I). For analyses, patients were assigned to a comprehensive diagnostic group of anxiety and depressive disorders. In order to determine comorbidity across psychiatric diagnoses for the DSM-IV categories, Pearson's chi-squared test (χ2) was used. In the study sample, eight patients (8.3% of the study sample, n = 96) had comorbid major depressive disorder and anxiety disorder. When looking at comorbidity of each diagnosis separately, it was determined that 50% of individuals with an anxiety disorder had comorbid Major Depressive Disorder (MDD) and 38% patients with MDD had comorbid anxiety disorder. This finding encourages a more systematic reporting of psychiatric prevalence data in epilepsy, especially taking into account the high ratio of multiple comorbid anxiety and depressive disorders in PWE.
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32
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Rasmussen B, Wynter K, Rawson HA, Skouteris H, Ivory N, Brumby SA. Self-management of diabetes and associated comorbidities in rural and remote communities: a scoping review. Aust J Prim Health 2021; 27:243-254. [PMID: 34229829 DOI: 10.1071/py20110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Chronic health conditions are more prevalent in rural and remote areas than in metropolitan areas; living in rural and remote areas may present particular barriers to the self-management of chronic conditions like diabetes and comorbidities. The aims of this review were to: (1) synthesise evidence examining the self-management of diabetes and comorbidities among adults living in rural and remote communities; and (2) describe barriers and enablers underpinning self-management reported in studies that met our inclusion criteria. A systematic search of English language papers was undertaken in PsycINFO, Medline Complete, Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, EMBASE and the Cochrane Database of Systematic Reviews, searching for literature indexed from the beginning of the database until 6 March 2020. Essential key concepts were diabetes, comorbidities, self-management and rural or remote. Twelve studies met the inclusion criteria. Six of these reported interventions to promote self-management for adults with diabetes in rural and remote communities and described comorbidities. These interventions had mixed results; only three demonstrated improvements in clinical outcomes or health behaviours. All three of these interventions specifically targeted adults living with diabetes and comorbidities in rural and remote areas; two used the same telehealth approach. Barriers to self-management included costs, transport problems and limited health service access. Interventions should take account of the specific challenges of managing both diabetes and comorbidities; telehealth may address some of the barriers associated with living in rural and remote areas.
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Affiliation(s)
- Bodil Rasmussen
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia; and Department of Public Health, University of Copenhagen, Denmark; and Faculty of Health Sciences, University of Southern Denmark, Denmark; and Corresponding author.
| | - Karen Wynter
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Centre for Quality and Patient Safety Research - Western Health Partnership, Sunshine Hospital, 176 Furlong Road, St Albans, Vic. 3021, Australia
| | - Helen A Rawson
- Deakin University School of Nursing and Midwifery, 1 Gheringhap Street, Geelong, Vic. 3220, Australia; and Nursing and Midwifery, Monash University, 35 Rainforest Walk, Clayton, Vic. 3800, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia
| | - Nicola Ivory
- Deakin University School of Psychology, 1 Gheringhap Street, Geelong, Vic. 3220, Australia
| | - Susan A Brumby
- School of Medicine, Deakin University, 75 Pigdons Road, Waurn Ponds, Vic. 3216, Australia; and National Centre for Farmer Health, Western District Health Service, 20 Foster Street, Hamilton, Vic. 3300, Australia
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Rodrigues LP, Rezende ATDO, Moura LDANE, Nunes BP, Noll M, de Oliveira C, Silveira EA. What is the impact of multimorbidity on the risk of hospitalisation in older adults? A systematic review study protocol. BMJ Open 2021; 11:e049974. [PMID: 34162654 PMCID: PMC8230920 DOI: 10.1136/bmjopen-2021-049974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The development of multiple coexisting chronic diseases (multimorbidity) is increasing globally, along with the percentage of older adults affected by it. Multimorbidity is associated with the concomitant use of multiple medications, a greater possibility of adverse effects, and increased risk of hospitalisation. Therefore, this systematic review study protocol aims to analyse the impact of multimorbidity on the occurrence of hospitalisation in older adults and assess whether this impact changes according to factors such as sex, age, institutionalisation and socioeconomic status. This study will also review the average length of hospital stay and the occurrence of hospital readmission. METHODS AND ANALYSIS A systematic review of the literature will be carried out using the PubMed, Embase and Scopus databases. The inclusion criteria will incorporate cross-sectional, cohort and case-control studies that analysed the association between multimorbidity (defined as the presence of ≥2 and/or ≥3 chronic conditions and complex multimorbidity) and hospitalisation (yes/no, days of hospitalisation and number of readmissions) in older adults (aged ≥60 years or >65 years). Effect measures will be quantified, including ORs, prevalence ratios, HRs and relative risk, along with their associated 95% CI. The overall aim of this study is to widen knowledge and to raise reflections about the association between multimorbidity and hospitalisation in older adults. Ultimately, its findings may contribute to improvements in public health policies resulting in cost reductions across healthcare systems. ETHICS AND DISSEMINATION Ethical approval is not required. The results will be disseminated via submission for publication to a peer-reviewed journal when complete. PROSPERO REGISTRATION NUMBER CRD42021229328.
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Affiliation(s)
| | | | | | - Bruno Pereira Nunes
- Department of Nursing in Collective Health and the Postgraduate Program in Nursing, Federal University of Pelotas, Pelotas, Brazil
| | - Matias Noll
- Instituto Federal Goiano, Ceres, Goiás, Brazil
| | - Cesar de Oliveira
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Erika Aparecida Silveira
- Postgraduate Program in Health Sciences, Universidade Federal de Goiás, Goiânia, Goiás, Brazil
- Affiliate Academic, Department of Epidemiology and Public Health, University College London, London, UK
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Schmaderer M, Struwe L, Linton N, Zimmerman L. Self-management strategies differ by level of cognition in multimorbid patients. Appl Nurs Res 2021; 58:151407. [PMID: 33745560 DOI: 10.1016/j.apnr.2021.151407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/17/2020] [Accepted: 02/08/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Myra Schmaderer
- University of Nebraska Medical Center, College of Nursing, 550 N 19th St, P.O. Box 880220, Lincoln, NE 68588-0220, United States.
| | - Leeza Struwe
- University of Nebraska Medical Center, College of Nursing, 550 N 19th St, P.O. Box 880220, Lincoln, NE 68588-0220, United States.
| | - Nicole Linton
- University of Nebraska Medical Center, College of Nursing, 550 N 19th St, P.O. Box 880220, Lincoln, NE 68588-0220, United States.
| | - Lani Zimmerman
- University of Nebraska Medical Center, College of Nursing, 550 N 19th St, P.O. Box 880220, Lincoln, NE 68588-0220, United States.
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35
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Carrato A, Melisi D, Prager G, Westphalen CB, Ferreras A, D'Esquermes N, Taieb J, Mercadé TM. Chart review of diagnostic methods, baseline characteristics and symptoms for European patients with pancreatic cancer. Future Oncol 2021; 17:1843-1854. [PMID: 33663227 DOI: 10.2217/fon-2020-0749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aim: To survey European physicians managing patients with metastatic pancreatic ductal adenocarcinoma (PDAC) and understand differences in baseline characteristics, diagnostic methods, symptoms and co-morbidities. Materials & methods: Patient record inclusion criteria were: ≥18 years old, metastatic PDAC diagnosis and completion of first-line treatment between July 2014 and January 2016. Records were grouped by patient age, gender and primary tumor location. Results: Records (n = 2565) were collected from nine countries. Baseline characteristics varied between subgroups. Computed tomography was the most frequently used diagnostic technique. Symptoms at diagnosis included abdominal and/or mid-back pain (72% of patients) and weight loss (61.5%). Co-morbidities varied with patient age. Conclusion: Greater awareness of symptoms, diagnostic methods and co-morbidities present at PDAC diagnosis may support better patient management decisions.
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Affiliation(s)
- Alfredo Carrato
- Ramón y Cajal University Hospital, Medical Oncology Department, IRYCIS, CIBERONIC, Alcala University, Madrid, Spain
| | - Davide Melisi
- Digestive Molecular Clinical Oncology Unit, University of Verona, Verona, Italy
| | - Gerald Prager
- Comprehensive Cancer Center Vienna, Medical University of Vienna, Austria
| | - Christoph B Westphalen
- Department of Medicine III & Comprehensive Cancer Center Munich, University Hospital, LMU Munich, Munich, Germany
| | | | | | - Julien Taieb
- Sorbonne Paris Cité Hôpital Européen Georges Pompidou, Paris, France
| | - Teresa M Mercadé
- Vall d'Hebron University Hospital (HUVH) & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Clofent D, Álvarez A, Traversi L, Culebras M, Loor K, Polverino E. Comorbidities and mortality risk factors for patients with bronchiectasis. Expert Rev Respir Med 2021; 15:623-634. [PMID: 33583300 DOI: 10.1080/17476348.2021.1886084] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Introduction: Comorbidities in patients with bronchiectasis are common and have a significant impact on clinical outcomes, contributing to lower quality of life, lung function, and exacerbation frequency. At least 13 comorbidities have been associated with a higher risk of mortality in bronchiectasis patients. Nonetheless, the kind of relationship between bronchiectasis and comorbidities is heterogeneous and poorly understood.Areas covered: different biological mechanisms leading to bronchiectasis could have a role in the development of the associated comorbidities. Some comorbidities could have a causal relationship with bronchiectasis, possibly through a variable degree of systemic inflammation, such as in rheumatic disorders and bowel inflammatory diseases. Other comorbidities, such as COPD or asthma, could be associated through airway inflammation and there is an uncertain cause-effect relationship. Finally, shared risk factors could link different comorbidities to bronchiectasis such as in the case of cardiovascular diseases, where the known link between chronic systemic inflammation and pulmonary infection could play a significant role.Expert opinion: Although different tools have been developed to assess the role of comorbidities in bronchiectasis , we believe that the implementation of current strategies to manage them is absolutely necessary and could significantly improve long-term prognosis in patients with bronchiectasis.
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Affiliation(s)
- David Clofent
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Antonio Álvarez
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Letizia Traversi
- Department of Medicine and Surgery, Respiratory Diseases, Università dell'Insubria, Varese, Italy
| | - Mario Culebras
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Karina Loor
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
| | - Eva Polverino
- Vall d'Hebron Institute of Research (VHIR) - Respiratory Disease Department, Hospital Universitari Vall d'Hebron (HUVH) Passeig Vall d'Hebron, 119-129, Barcelona, Spain.,Respiratory Diseases, Vall d'Hebron University Hospital, Barcelona, Catalunya, Spain
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Li X, Chattopadhyay K, Xu S, Chen Y, Xu M, Li L, Li J. Prevalence of comorbidities and their associated factors in patients with type 2 diabetes at a tertiary care department in Ningbo, China: a cross-sectional study. BMJ Open 2021; 11:e040532. [PMID: 33414143 PMCID: PMC7797259 DOI: 10.1136/bmjopen-2020-040532] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To determine the prevalence of comorbidities in patients with type 2 diabetes mellitus (T2DM) and identify the factors independently associated with comorbidities in a tertiary care department in Ningbo, China. DESIGN A computerised medical records database was used to conduct a cross-sectional study. SETTING The study was conducted in a tertiary care department in Ningbo, China. PARTICIPANTS The study was conducted on adult patients with T2DM, and it included 8 years of data, from 1 January 2012 to 31 December 2019. THE PRIMARY OUTCOME MEASURE Comorbidity was defined as the coexistence of at least one other chronic condition, that is, either a physical non-communicable disease (duration ≥3 months), a mental health condition (duration ≥3 months) or an infectious disease (duration ≥3 months). RESULTS In total, 4777 patients with T2DM satisfied the eligibility criteria. Over 8 years, the prevalence of comorbidities was 93.7%. The odds of comorbidities increased with the age of patients (18 to 39 years: 1; 40 to 59 years: OR 2.80, 95% CI 1.98 to 3.96; 60 to 69 years: OR 4.43, 95% CI 3.04 to 6.44; and ≥70 years: OR 10.97, 95% CI 7.17 to 16.77). The odds were lower in female patients (OR 0.66, 95% CI 0.51 to 0.84), patients residing in rural areas (OR 0.75, 95% CI 0.59 to 0.95) and patients without health insurance (OR 0.62, 95% CI 0.46 to 0.83). The odds were higher in single/divorced/widowed patients compared with those in married patients (OR 1.95, 95% CI 1.21 to 3.12). CONCLUSIONS A large percentage of patients with T2DM in the tertiary care department in Ningbo, China, had comorbidities, and the factors associated with comorbidities were identified. The findings could be used in developing, evaluating and implementing interventions aimed at improving outcomes in patients with T2DM with comorbidities.
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Affiliation(s)
- Xueyu Li
- School of Medicine, Ningbo University, Ningbo, China
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Shengnan Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Yanshu Chen
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Miao Xu
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
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Timmis JK, Waal RXVD, Herz J, Waal MBVD, Claassen E, Burgwal LHMVD. Market Knowledge and Stakeholder Considerations for the Biopharmaceutics Sector—Incorporating User Value and Societal Needs in Therapeutic Interventions. Health (London) 2021. [DOI: 10.4236/health.2021.1311099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Kataoka H, Ohara M, Mochizuki T, Iwadoh K, Ushio Y, Kawachi K, Watanabe K, Watanabe S, Akihisa T, Makabe S, Manabe S, Sato M, Iwasa N, Yoshida R, Sawara Y, Hanafusa N, Tsuchiya K, Nitta K. Sex Differences in Time-Series Changes in Pseudo- R2 Values Regarding Hyperuricemia in Relation to the Kidney Prognosis. J Pers Med 2020; 10:jpm10040248. [PMID: 33256045 PMCID: PMC7711484 DOI: 10.3390/jpm10040248] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/03/2020] [Accepted: 11/24/2020] [Indexed: 12/03/2022] Open
Abstract
Studies on sex differences in time-series changes in pseudo-R2 values regarding hyperuricemia (HU) in relation to the kidney prognosis among patients with chronic kidney disease (CKD) are scant. The kidney prognosis was evaluated in 200 patients with CKD (median follow-up, 12.3 years). Survival analyses and logistic regression analyses were conducted, generating time-series pseudo-R2 values. We used four definitions of HU according to serum uric acid (SUA) levels (HU6, SUA ≥ 6.0 mg/dL; HU7, SUA ≥ 7.0 mg/dL; HU8, SUA ≥ 8.0 mg/dL) and antihyperuricemic agent use to calculate the mean and percentage of the change in pseudo-R2 values from the 6th year until the end of the study (6Y–End Mean and 6Y–End Change, respectively). The multivariable Cox regression analysis showed that HU7 was significantly associated with kidney outcomes. When stratified by sex, the 6Y–End Mean was clearly higher in women than in men for all HU definitions, with the highest value (0.1755) obtained for HU7 in women. The pseudo-R2 values for HU6 in women showed an increasing pattern, with a 6Y–End Change of 11.4%/year. Thus, it may be clinically meaningful to consider sex differences in the time-series pseudo-R2 values regarding HU and kidney outcomes.
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Affiliation(s)
- Hiroshi Kataoka
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
- Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Mamiko Ohara
- Department of Nephrology, Kameda Medical Center, Chiba 296-8602, Japan
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
- Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
- Correspondence: ; Tel.: +81-3-3353-8111; Fax: +81-3-3356-0293
| | - Kazuhiro Iwadoh
- Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Yusuke Ushio
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Keiko Kawachi
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Kentaro Watanabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Saki Watanabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Shun Manabe
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Masayo Sato
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Naomi Iwasa
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Rie Yoshida
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Yukako Sawara
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women’s Medical University, Tokyo 162-8666, Japan
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women’s Medical University, Tokyo 162-8666, Japan; (H.K.)
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Skajaa N, Ording AG, Darvalics B, Horvath-Puho E, Sørensen HT. Long-term mortality in young and middle-aged adults hospitalised with chronic disease: a Danish cohort study. BMJ Open 2020; 10:e038131. [PMID: 33046469 PMCID: PMC7552875 DOI: 10.1136/bmjopen-2020-038131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To examine the long-term outcomes for patients hospitalised with chronic diseases at age 30, 40 or 50 years. DESIGN Nationwide, population-based cohort study. SETTING All Danish hospitals, 1979-1989, with follow-up through 2014. PARTICIPANTS Patients hospitalised during the study period with one, two or three or more chronic diseases and age-matched and sex-matched persons from the general population without chronic disease leading to hospitalisation: age-30 group: 13 857 patients and 69 285 comparators; age-40 group: 24 129 patients and 120 645 comparators; and age-50 group, 37 807 patients and 189 035 comparators. MAIN OUTCOME MEASURES Twenty-five-year mortality risks based on Kaplan-Meier estimates, years-of-life-lost (YLLs) and mortality rate ratios based on Cox regression analysis. YLLs were computed for each morbidity level, as well as in strata of income, employment, education and psychiatric conditions. RESULTS Twenty-five-year mortality risks and YLLs increased steadily with increasing number of morbidities leading to hospitalisation and age, but the risk difference with general population comparators remained approximately constant across age cohorts. In the age-30 cohort, the risk differences for patients compared with comparators were 35.0% (95% CI 32.5 to 37.5) with two diseases and 62.5% (54.3% to 70.3%) with three or more diseases. In the age-50 cohort, these differences were, respectively, 48.4% (47.4 to 49.3) and 61.7% (60.1% to 63.0%). Increasing morbidity burden augmented YLLs resulting from low income, unemployment, low education level and psychiatric conditions. In the age-30 cohort, YYLs attributable to low income were 2.4 for patients with one disease, 6.2 for patients with two diseases and 11.5 for patients with three or more diseases. CONCLUSIONS Among patients with multiple chronic diseases, the risk of death increases steadily with the number of chronic diseases and with age. Multimorbidity augments the already increased mortality among patients with low socioeconomic status.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Gulbech Ording
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bianka Darvalics
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Toft Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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41
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Kang KA, Kwon HJ, Ham SY, Park HJ, Shin JH, Lee SR, Kim MS. Impacts on outcomes and management of preoperative magnetic resonance cholangiopancreatography in patients scheduled for laparoscopic cholecystectomy: for whom it should be considered? Ann Surg Treat Res 2020; 99:221-229. [PMID: 33029481 PMCID: PMC7520229 DOI: 10.4174/astr.2020.99.4.221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/05/2020] [Accepted: 07/16/2020] [Indexed: 01/04/2023] Open
Abstract
Purpose We evaluated the impact of preoperative magnetic resonance cholangiopancreatography (MRCP) on patient outcomes, and found which patients should be considered for MRCP before cholecystectomy. Methods We performed retrospective analysis of 2,072 patients that underwent cholecystectomy for benign gallbladder disease from January 2014 to June 2017. Patients were grouped as CT only group (n = 737) and MRCP group (n = 1,335), including both CT and MRCP (n = 1,292) or MRCP only (n = 43). The main outcome measure was associated with complications after cholecystectomy, and the secondary outcomes were hospital stay, readmission, and events that could impact patient management due to addition of MRCP. Results There were no statistical differences in occurrence of intraoperative or postoperative complications or readmission rate between the 2 groups. Hospital stay was about 0.6 days longer in the MRCP group. However, MRCP group was more susceptible to complications due to underlying patient demographics (older age, higher frequency of diabetes, and higher level of the inflammatory markers). MRCP diagnosed common bile duct (CBD) stones in 6.5% of patients (84/1,292) without CBD stones in CT, and bile duct anomalies were identified in 41 patients (3.2%). Elevated γ-GT was the only independent factor for additional detection of CBD stones (adjusted odds ratio [OR], 2.89; P = 0.029) and subsequent biliary procedures (adjusted OR, 3.34; P = 0.018) when additional MRCP was performed. Conclusion MRCP is valuable for identification of bile duct variation and CBD stones. Preoperative MRCP can be considered, particularly in patients with elevated γ-GT, for proper preoperative management and avoidance of complications.
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Affiliation(s)
- Kyung A Kang
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heon-Ju Kwon
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Soo-Youn Ham
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Jin Park
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jun Ho Shin
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Sung Kim
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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42
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Janssen LMM, Hiligsmann M, Elissen AMJ, Joore MA, Schaper NC, Bosma JHA, Stehouwer CDA, Sep SJS, Koster A, Schram MT, Evers SMAA. Burden of disease of type 2 diabetes mellitus: cost of illness and quality of life estimated using the Maastricht Study. Diabet Med 2020; 37:1759-1765. [PMID: 32112462 PMCID: PMC7539911 DOI: 10.1111/dme.14285] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2020] [Indexed: 11/29/2022]
Abstract
AIMS To estimate the societal costs and quality of life of people with type 2 diabetes and to compare these results with those of people with normal glucose tolerance or prediabetes. METHODS Data from 2915 individuals from the population-based Maastricht Study were included. Costs were assessed through a resource-use questionnaire completed by the participants; cost prices were based on Dutch costing guidelines. Quality of life was expressed in utilities using the Dutch EuroQol 5D-3L questionnaire and the SF-36 health survey. Based on normal fasting glucose and 2-h plasma glucose values, participants were classified into three groups: normal glucose tolerance (n = 1701); prediabetes (n = 446); or type 2 diabetes (n = 768). RESULTS Participants with type 2 diabetes had on average 2.2 times higher societal costs than those with normal glucose tolerance (€3,006 and €1,377 per 6 months, respectively) and had lower utilities (0.77 and 0.81, respectively). No significant differences were found between participants with normal glucose tolerance and those with prediabetes. Subgroup analyses showed that higher age, being female and having two or more diabetes-related complications resulted in higher costs (P < 0.05) and lower utilities. CONCLUSIONS This study showed that people with type 2 diabetes have substantially higher societal costs and lower quality of life than people with normal glucose tolerance. The results provide important input for future model-based economic evaluations and for policy decision-making.
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Grants
- NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, The Netherlands)
- Sanofi-Aventis Netherlands B.V. (Gouda, The Netherlands)
- Stichting Annadal (Maastricht, The Netherlands)
- (grant 31O.041) European Regional Development Fund via OP-Zuid, the Province of Limburg, the Dutch Ministry of Economic Affairs
- CAPHRI Care and Public Health Research Institute (Maastricht, The Netherlands)
- the Pearl String Initiative Diabetes (Amsterdam, The Netherlands)
- Novo Nordisk Farma B.V. (Alphen aan den Rijn, The Netherlands)
- CARIM School for Cardiovascular Diseases (Maastricht, The Netherlands)
- Health Foundation Limburg (Maastricht, The Netherlands)
- Stichting De Weijerhorst (Maastricht, The Netherlands)
- the Cardiovascular Center (CVC, Maastricht, the Netherlands)
- Janssen-Cilag B.V. (Tilburg, The Netherlands)
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Affiliation(s)
- L. M. M. Janssen
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. Hiligsmann
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - A. M. J. Elissen
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA)Maastricht University Medical CentreMaastrichtThe Netherlands
| | - N. C. Schaper
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - J. H. A. Bosma
- Department of Social MedicineMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - C. D. A. Stehouwer
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
| | - S. J. S. Sep
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
- Adelante Centre of Expertise in Rehabilitation and AudiologyHoensbroekThe Netherlands
| | - A. Koster
- Department of Social MedicineMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
| | - M. T. Schram
- Department of Internal MedicineMaastricht University Medical CentreMaastrichtThe Netherlands
- Cardiovascular Research Institute Maastricht (CARIM)Maastricht UniversityMaastrichtThe Netherlands
- Heart and Vascular CentreMaastricht University Medical CentreMaastrichtThe Netherlands
| | - S. M. A. A. Evers
- Department of Health Services ResearchMaastricht UniversityMaastrichtThe Netherlands
- CAPHRI Care and Public Health Research InstituteMaastricht UniversityMaastrichtThe Netherlands
- Trimbos Institute Centre for Mental Health and Economic EvaluationUtrechtThe Netherlands
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Melo LAD, Lima KCD. Prevalence and factors associated with multimorbidities in Brazilian older adults. CIENCIA & SAUDE COLETIVA 2020; 25:3869-3877. [PMID: 32997019 DOI: 10.1590/1413-812320202510.34492018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/17/2018] [Indexed: 11/22/2022] Open
Abstract
This study aimed to identify the prevalence of multimorbidity in Brazilian older adults and factors associated with socioeconomic and lifestyle variables. This is a cross-sectional, population-based study carried out with data from the National Health Survey database. Seniors with multimorbidity where the ones with a diagnosis of two or more chronic diseases. The chi-square test was used in data analysis, and then prevalence ratios were estimated through Poisson multiple regression, both with 95% confidence level. In total, 11,697 older adults were evaluated and the multimorbidity prevalence was 53.1%. As a result of the multivariate analysis, female seniors (p < 0.001), the oldest elderly (p = 0.002), those who were not single, more strongly associated with widowers (p = 0.001) and those with a health plan at the interview (p < 0.001) were associated with multimorbidity. Also, in comparison with older adults with two chronic diseases, women are associated with three (p = 0.003) and four or more chronic diseases (p < 0.001). We can conclude that multimorbidity in Brazilian older adults is a widespread condition and that it has been influenced by socioeconomic factors and is poorly related to lifestyle.
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Affiliation(s)
- Laércio Almeida de Melo
- Departamento de Odontologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Av. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
| | - Kenio Costa de Lima
- Departamento de Odontologia, Centro de Ciências da Saúde, Universidade Federal do Rio Grande do Norte. Av. Salgado Filho 1787, Lagoa Nova. 59056-000 Natal RN Brasil.
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44
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Emerging role of microRNAs in ischemic stroke with comorbidities. Exp Neurol 2020; 331:113382. [DOI: 10.1016/j.expneurol.2020.113382] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/07/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023]
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Shang X, Peng W, Hill E, Szoeke C, He M, Zhang L. Incidence, Progression, and Patterns of Multimorbidity in Community-Dwelling Middle-Aged Men and Women. Front Public Health 2020; 8:404. [PMID: 33014956 PMCID: PMC7461897 DOI: 10.3389/fpubh.2020.00404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 07/09/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Determining the incidence, progression, and patterns of multimorbidity are important for the prevention, management, and treatment of concurrence of multiple conditions. This study aimed to analyze major multimorbidity patterns and the association of the onset of a primary condition or combinations of a primary and a secondary condition with the progression to subsequent conditions. Methods: We included 53,867 participants aged 45-64 years from the 45 and Up Study who were free of 10 predefined chronic conditions at baseline (2006-2009). The incidence of multimorbidity (coexistence of ≥2, ≥3, and ≥4 conditions) was identified using the claims database until December 31, 2016. The primary, secondary, tertiary, and quaternary condition for each participant was defined according to its temporal order of onset. Results: During a mean 9-years follow-up, the cumulative incidence of primary, secondary, tertiary, and quaternary conditions was 49.6, 23.7, 9.0, and 2.9%, respectively. The time to develop a subsequent condition decreased with the accumulation of conditions (P < 0.0001). Two concurrent cardiometabolic disorders (CMDs, 30.4%) and CMDs clustered with musculoskeletal disorders (15.2%), mental disorders (13.5%), asthma (12.0%), or cancer (8.7%) were the five most common multimorbidity patterns. CMDs tended to occur prior to mental or musculoskeletal disorders but after the onset of cancers or asthma. Compared with all participants who developed cancer as a primary condition, individuals who experienced mental disorders/neurodegenerative disorders and a comorbidity as cardiovascular disease, hypertension, dyslipidemia, diabetes, asthma, or osteoarthritis were 3.36-10.87 times more likely to develop cancer as a tertiary condition. Individuals with neurodegenerative disorders and a comorbidity as hypertension, dyslipidemia, osteoarthritis, or asthma were 5.14-14.15 times more likely to develop mental disorders as a tertiary condition. Conclusions: A high incidence of multimorbidity in middle-aged adults was observed and CMDs were most commonly seen in multimorbidity patterns. There may be accelerated aging after a primary condition occurs. Our findings also reveal a potential preventative window to obviate the development of secondary or tertiary conditions.
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Affiliation(s)
- Xianwen Shang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia.,Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, VIC, Australia
| | - Wei Peng
- Research Centre for Data Analytics and Cognition, La Trobe University, Melbourne, VIC, Australia
| | - Edward Hill
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, VIC, Australia.,Wicking Dementia Research and Education Centre, University of Tasmania, Hobart, TAS, Australia
| | - Cassandra Szoeke
- Department of Medicine (Royal Melbourne Hospital), University of Melbourne, Melbourne, VIC, Australia
| | - Mingguang He
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, VIC, Australia.,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Lei Zhang
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, VIC, Australia.,China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China.,Melbourne Sexual Health Centre, Alfred Health, Melbourne, VIC, Australia.,Central Clinical School, Faculty of Medicine, Monash University, Melbourne, VIC, Australia
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Manabe S, Kataoka H, Mochizuki T, Iwadoh K, Ushio Y, Kawachi K, Watanabe K, Watanabe S, Akihisa T, Makabe S, Sato M, Iwasa N, Yoshida R, Sawara Y, Hanafusa N, Tsuchiya K, Nitta K. Maximum Carotid Intima-Media Thickness in Association with Renal Outcomes. J Atheroscler Thromb 2020; 28:491-505. [PMID: 32759541 PMCID: PMC8193787 DOI: 10.5551/jat.57752] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Aim:
We aimed to examine the association between the maximum intima-media thickness of the carotid artery (Max IMT) and renal prognosis, considering their potential interaction with age.
Methods:
Survival analyses were performed in 112 patients with chronic kidney disease (CKD), to assess renal prognosis, with the endpoint defined as a ≥ 30% decline in estimated glomerular filtration rate (eGFR) or end-stage renal disease.
Results:
During a median follow-up of 12.5 years, 44 participants reached the study endpoint. The major determinant of Max IMT was the maximum IMT of the internal carotid artery (Max ICA-IMT), which was the distribution ratio of 50.0% of Max IMT. Kaplan–Meier analyses showed that Max IMT ≥ 1.5 mm was significantly associated with renal prognosis when age and eGFR were matched. On multivariate Cox regression analysis, Max IMT was significantly associated with the renal outcomes and had a significant interaction with the age categories (≥ 65 years or ＜65 years) (
P
=0.0153 for interaction). A 1-mm increase in Max IMT was significantly associated with disease progression in the sub-cohort ＜65 years age-category, but not in the ≥ 65 years age-category; similarly the hazard ratio (HR) in the ＜65 years age-category was higher than in the ≥ 65 years age-category (HR: 2.52 vs. 0.95). Comparable results were obtained for Max ICA-IMT, Max bulb-IMT, but not for Max common carotid artery-IMT.
Conclusions:
A higher Max IMT was a significant renal prognosis factor in patients with CKD aged ＜65 years. Our results may provide new insights into treating CKD.
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Affiliation(s)
- Shun Manabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Hiroshi Kataoka
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Toshio Mochizuki
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Kazuhiro Iwadoh
- Department of Blood Purification, Tokyo Women's Medical University
| | - Yusuke Ushio
- Department of Nephrology, Tokyo Women's Medical University
| | - Keiko Kawachi
- Department of Nephrology, Tokyo Women's Medical University
| | | | - Saki Watanabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Taro Akihisa
- Department of Nephrology, Tokyo Women's Medical University
| | - Shiho Makabe
- Department of Nephrology, Tokyo Women's Medical University
| | - Masayo Sato
- Department of Nephrology, Tokyo Women's Medical University
| | - Naomi Iwasa
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Rie Yoshida
- Department of Nephrology, Tokyo Women's Medical University.,Department of Nephrology, Clinical Research Division for Polycystic Kidney Disease, Tokyo Women's Medical University
| | - Yukako Sawara
- Department of Nephrology, Tokyo Women's Medical University
| | - Norio Hanafusa
- Department of Blood Purification, Tokyo Women's Medical University
| | - Ken Tsuchiya
- Department of Blood Purification, Tokyo Women's Medical University
| | - Kosaku Nitta
- Department of Nephrology, Tokyo Women's Medical University
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Loeppenthin K, Dalton SO, Johansen C, Andersen E, Christensen MB, Pappot H, Petersen LN, Thisted LB, Frølich A, Mortensen CE, Lassen U, Ørsted J, Bidstrup PE. Total burden of disease in cancer patients at diagnosis-a Danish nationwide study of multimorbidity and redeemed medication. Br J Cancer 2020; 123:1033-1040. [PMID: 32632149 PMCID: PMC7493878 DOI: 10.1038/s41416-020-0950-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 01/09/2023] Open
Abstract
Background Multimorbidity is a growing challenge worldwide. In this nationwide study, we investigated the prevalence of multimorbidity and polypharmacy at the time of diagnosis across 20 cancers. Methods We conducted a nationwide register-based cohort study of all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015. Multimorbidity was defined as one or more of 20 conditions (131 specific diagnoses) registered in the Danish National Patient Registry < 5 years before the cancer diagnosis. Polypharmacy was defined as five or more medications registered in the Danish National Prescription Registry and redeemed twice 2–12 months before the cancer diagnosis. Results We included 261,745 patients with a first primary cancer, of whom 55% had at least one comorbid condition at diagnosis and 27% had two or more. The most prevalent conditions at the time of cancer diagnosis were cardiovascular disease, chronic obstructive pulmonary disease, diabetes, stroke and depression/anxiety disorder. Polypharmacy was present in one-third of the cancer patients with antihypertensives, anti-thrombotic agents, anti-hyperlipidaemic agents, analgesics and diuretics as the most prevalent redeemed medications. Conclusion Among patients with a newly established cancer diagnosis, 55% had at least one comorbid condition and 32% were exposed to polypharmacy.
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Affiliation(s)
- Katrine Loeppenthin
- Late Effect Research Unit CASTLE, Department of Oncology, Rigshospitalet, Blegdamsvej 58, 9601, 2100, Copenhagen, Denmark. .,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Late Effect Research Unit CASTLE, Department of Oncology, Rigshospitalet, Blegdamsvej 58, 9601, 2100, Copenhagen, Denmark.,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Elisabeth Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 24, 2400, Copenhagen, Denmark
| | - Helle Pappot
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Lise Bjerrum Thisted
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anne Frølich
- Research Center for Multimorbidity and Chronic Conditions, Region Zealand, University of Copenhagen, Copenhagen, Denmark
| | | | - Ulrik Lassen
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jytte Ørsted
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
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The ENGAGE-2 study: Engaging self-regulation targets to understand the mechanisms of behavior change and improve mood and weight outcomes in a randomized controlled trial (Phase 2). Contemp Clin Trials 2020; 95:106072. [PMID: 32621905 DOI: 10.1016/j.cct.2020.106072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/02/2020] [Accepted: 06/12/2020] [Indexed: 01/07/2023]
Abstract
Despite evidence for effective integrated behavior therapy for treating comorbid obesity and depression, treatment response is highly variable and the underlying neurobiological mechanisms remain unknown. This hampers efforts to identify mechanistic targets in order to optimize treatment precision and potency. Funded within the NIH Science of Behavior Change (SOBC) Research Network, the 2-phased ENGAGE research project applies an experimental precision medicine approach to address this gap. The Phase 1 study focused on demonstrating technical feasibility, target engagement and potential neural mechanisms of responses to an integrated behavior therapy. This therapy combines a video-based behavioral weight loss program and problem-solving therapy for depression, with as-needed intensification of antidepressant medications, and its clinical effectiveness was demonstrated within a parent randomized clinical trial. Here, we describe the ENGAGE Phase 2 (ENGAGE-2) study protocol which builds on Phase 1 in 2 ways: (1) pilot testing of an motivational interviewing-enhanced, integrated behavior therapy in an independent, primarily minority patient sample, and (2) evaluation of a priori defined neural targets, specifically the negative affect (threat and sadness) circuits which demonstrated engagement and malleability in Phase 1, as mediators of therapeutic outcomes. Additionally, the Phase 2 study includes a conceptual and methodological extension to explore the role of microbiome-gut-brain and systemic immunological pathways in integrated behavioral treatment of obesity and depression. This protocol paper documents the conceptualization, design and the transdisciplinary methodologies in ENGAGE-2, which can inform future clinical and translational research in experimental precision medicine for behavior change and chronic disease management. Trial registration: ClinicalTrials.gov #NCT 03,841,682.
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Lentz TA, Marlow NM, Beneciuk JM, Fillingim RB, George SZ. Comorbidity Subgroups Among Medicare Beneficiaries Seeking Health Care for Musculoskeletal Pain. J Gerontol A Biol Sci Med Sci 2020; 74:1310-1315. [PMID: 30165549 DOI: 10.1093/gerona/gly202] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Treatment of musculoskeletal pain in older adults may be more effective if it incorporates integrated management of comorbid health conditions. The purpose of this study was to define empirically derived comorbidity subgroups among Medicare beneficiaries with an index condition of osteoarthritis (OA) or low back pain (LBP) as a precursor to the development of comorbidity-specific pain treatment pathways. METHODS This study included Medicare beneficiaries participating in the Medicare Current Beneficiary Survey (MCBS) and seeking care for OA (n = 723) or LBP (n = 617) with data available for 3 years after entry into the survey. We identified 30 comorbidity diagnoses using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes in claims data during beneficiaries' first year in the survey. Latent class analysis defined comorbidity subgroups, and posterior probabilities were used to assign subgroup classification. Self-reported disability was compared over three consecutive years for each subgroup. RESULTS We identified similar comorbidity subgroups for OA and LBP. The subgroups included (range of percent prevalence) low comorbidity (47.6%-54.4%), nonvascular (21.8%-28.6%), diabetes (12.2%-15.0%), renal disease with complicated hypertension (5.5%-5.8%), and complex cardiac disease/high comorbidity (3.3%-5.8%). OA and LBP subgroups with more complex comorbidity burden generally demonstrated higher disability over 3 years. CONCLUSIONS Five comorbidity subgroups were identified, with a large proportion of older adults classified into the subgroup defined by a low probability of most comorbidities. These findings provide direction for the development of pain treatment pathways that are tailored to address common comorbidity profiles among older adults.
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Affiliation(s)
- Trevor A Lentz
- Duke Clinical Research Institute, Durham, North Carolina
| | - Nicole M Marlow
- Department of Health Services Research, Management, and Policy, University of Florida, Gainesville
| | - Jason M Beneciuk
- Department of Physical Therapy, Brooks Rehabilitation-College of Public Health and Health Professions Research Collaboration, University of Florida, Gainesville
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, Clinical and Translational Science Institute, Gainesville, Florida.,College of Dentistry, University of Florida, Gainesville
| | - Steven Z George
- Duke Clinical Research Institute, Durham, North Carolina.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
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Tan XW, Chong SA, Abdin E, Vaingankar J, Shafie S, Zhang Y, Chang S, Shahwan S, Heng D, Subramanian M. Comorbidities within mental illnesses in a multiethnic urban population. Asian J Psychiatr 2020; 51:102018. [PMID: 32247879 DOI: 10.1016/j.ajp.2020.102018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/16/2020] [Accepted: 03/19/2020] [Indexed: 01/08/2023]
Abstract
The prevalence and patterns of comorbidities among mental illnesses including substance misuse have been rarely documented in urban communities. In this study, we aimed to examine the prevalence, diagnostic patterns, common risk factors and functioning associated with comorbid mental illness among community residents in an urban population. Using data from Singapore Mental Health Study (SMHS) 2010 (n = 6616) and SMHS 2016 (n = 6126), we investigated the changes in the overall prevalence of comorbid mental illness and the diagnostic patterns of multiple affective disorders, affective disorder comorbid with substance misuse and multiple substance misuse. The most common diagnostic pair of comorbid affective disorder was major depressive disorder (MDD) and obsessive-compulsive disorder (OCD) (0.4 % at 2010 and 0.7 % at 2016). Among comorbid substance misuse, comorbidity of MDD and alcohol related disorder (ARD) was most frequent (0.5 % and 0.7 % respectively), while comorbidity of nicotine dependence (ND) with ARD decreased from 0.5 % to 0.1 %. Logistic regression was utilized to identify the associations of socio-demographics/clinical characteristics with patterns of comorbid mental illness and the associations of number of comorbid mental illness with impaired functioning. The risk profileassociated with comorbid mental illnesses differed among various comorbidity groups. Moreover, in SMHS 2016, higher number of comorbidities within mental illness was associated with higher odds of functioning impairment. The increase in the prevalence of comorbid mental illnesses indicates the need for early diagnosis and integrated disease management. Moreover, certain subgroups in the general population are more at risk of comorbid mental illnesses.
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Affiliation(s)
- Xiao Wei Tan
- Research Division, Institute of Mental Health, 539747, Singapore; Department of Mood and Anxiety Disorder, Institute of Mental Health, 539747, Singapore.
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, 539747, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, 308232, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 539747, Singapore
| | | | - Saleha Shafie
- Research Division, Institute of Mental Health, 539747, Singapore
| | - Yunjue Zhang
- Research Division, Institute of Mental Health, 539747, Singapore
| | - Sherilyn Chang
- Research Division, Institute of Mental Health, 539747, Singapore
| | - Shazana Shahwan
- Research Division, Institute of Mental Health, 539747, Singapore
| | - Derrick Heng
- Ministry of Health of Singapore, 169854, Singapore
| | - Mythily Subramanian
- Research Division, Institute of Mental Health, 539747, Singapore; Lee Kong Chian School of Medicine, Nanyang Technology University of Singapore, 308232, Singapore
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