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Khattak M, Rehman AU, Muqaddas T, Hussain R, Rasool MF, Saleem Z, Almalki MS, Alturkistani SA, Firash SZ, Alzahrani OM, Bahauddin AA, Abuhussain SA, Najjar MF, Elsabaa HMA, Haseeb A. Tuberculosis (TB) treatment challenges in TB-diabetes comorbid patients: a systematic review and meta-analysis. Ann Med 2024; 56:2313683. [PMID: 38346381 PMCID: PMC10863515 DOI: 10.1080/07853890.2024.2313683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/29/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The Directly Observed Treatment-Short Course (DOTS) Programme was implemented by WHO and includes a combination of four anti-tuberculosis (TB) drugs (isoniazid, pyrazinamide, ethambutol and rifampicin) for a period of six months to eradicate the TB infection completely. Diabetes mellitus (DM) is recognized as one of a strong contributor of TB according to World Health Organization (WHO). The presence of diabetes mellitus type 2 (DM type 2) makes TB treatment complicated. Thus, the objective of the current meta-analysis was to identify and quantify the impact of type 2 DM on treatment outcomes of TB patients treated under the DOTS Programme. METHODS This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Through a systematic review of relevant literature, we focused on studies investigating treatment outcomes including extended treatment duration and recurrence for individuals with both TB and DM undergoing DOTS therapy. The extracted information included study designs, sample sizes, patient characteristics and reported treatment results. RESULTS In 44 studies from different parts of the world, the pooled HR for the impact of DM on extended treatment duration and reoccurrence were HR 0.72, 95% CI 0.56-0.83, p < .01 and HR 0.93, 95% CI 0.70-1.04, p = .08, respectively. The pooled HR for impact of DM on composite TB treatment outcomes was calculated as 0.76 (95% CI 0.60-0.87), p < .01 with an effect size of 41.18. The heterogeneity observed among the included studies was moderate (I2 = 55.79%). CONCLUSIONS A negative impact of DM was found on recurrence and extended treatment duration in TB patients treated with DOTS therapy. DM type 2 is responsible for the TB treatment prolongation and TB recurrence rates. By implementing effective management strategies and advancing research, the challenges can be mitigated, arising due to the complex interaction between DM and TB.
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Affiliation(s)
- Mahnoor Khattak
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Anees ur Rehman
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Tuba Muqaddas
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Rabia Hussain
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, University Sains Malaysia, Penang, Malaysia
| | - Muhammad Fawad Rasool
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | | | | | - Shuruq Zuhair Firash
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | | | | | - Muath Fahmi Najjar
- Department of Clinical Pharmacy, Al Rayan Private College of Health Sciences and Nursing, Madinah, Saudi Arabia
| | | | - Abdul Haseeb
- Department of Clinical Pharmacy, Al Rayan Private College of Health Sciences and Nursing, Madinah, Saudi Arabia
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Schaarschmidt ML, Kromer D, Wellmann P, Peitsch WK, Kromer C. Patients' preferences for systemic treatment of atopic dermatitis: safety and efficacy count the most. J DERMATOL TREAT 2024; 35:2308682. [PMID: 38297480 DOI: 10.1080/09546634.2024.2308682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 01/17/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The advent of biologics and janus kinase inhibitors has revolutionized treatment of atopic dermatitis (AD). OBJECTIVE To investigate preferences of patients with AD for attributes of currently approved systemic treatments and assess influencing factors. METHODS An online discrete choice experiment was conducted in patients with AD throughout Germany to analyze preferences for outcome (probability of (almost) clear skin at week 16, probability of significant itch improvement, time to onset of itch relief and type of side effects) and process attributes (application method and frequency of laboratory tests). RESULTS Participants (n = 182, 75.3% female) considered side effects (Relative Importance Score (RIS): 31.2), (almost) clear skin (RIS: 24.2) and probability of itch improvement (RIS: 16.0) most important. Application method (RIS: 14.4), time to onset of itch relief (RIS: 7.4) and frequency of laboratory tests (RIS: 6.8) were less relevant. Preferences were significantly influenced by sex, age, psychiatric comorbidity, current therapy and health-related quality of life according to multivariate regression analysis. CONCLUSIONS Participants attached great importance to safety and symptom control. However, preferences were also dependent on individual characteristics, underscoring the importance of personal counseling. Conjoined with medical considerations, patients' preferences have fundamental impact on shared decisions for treatment of AD.
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Affiliation(s)
- Marthe-Lisa Schaarschmidt
- Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Kromer
- Real-World and Advanced Analytics, Ingress-Health HWM GmbH - A Cytel Company, Berlin, Germany
| | - Phoebe Wellmann
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
| | - Wiebke K Peitsch
- Department of Dermatology and Phlebology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center Göttingen, Göttingen, Germany
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Eilat-Tsanani S, Ernst P, Suissa S. Real-World Effectiveness of Single-Inhaler Triple Therapy for COPD: Impact of Diabetes Comorbidity. COPD 2024; 21:2327345. [PMID: 38509685 DOI: 10.1080/15412555.2024.2327345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/01/2024] [Indexed: 03/22/2024]
Abstract
Type 2 diabetes is a frequent comorbidity in chronic obstructive pulmonary disease (COPD) patients, with the GOLD treatment recommendations asserting that the presence of diabetes be disregarded in the choice of treatment. In a cohort of COPD patients with frequent exacerbations, initiators of single-inhaler triple therapy or dual bronchodilators were compared on the incidence of COPD exacerbation and pneumonia over one year, adjusted by propensity score weighting and stratified by type 2 diabetes. The COPD cohort included 1,114 initiators of triple inhalers and 4,233 of dual bronchodilators (28% with type 2 diabetes). The adjusted hazard ratio (HR) of exacerbation with triple therapy was 1.04 (95% CI: 0.86-1.25) among COPD patients with type 2 diabetes and 0.74 (0.65-0.85) in those without. The incidence of severe pneumonia was elevated with triple therapy among patients with type 2 diabetes (HR 1.77; 1.14-2.75). Triple therapy in COPD is effective among those without, but not those with, type 2 diabetes. Future therapeutic trials in COPD should consider diabetes comorbidity.
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Affiliation(s)
- Sophia Eilat-Tsanani
- Department of Family Medicine, Clalit Health Services, North District, Israel
- Department of Family Medicine, Azrieli Faculty of Medicine, Bar-Ilan University, Ramat Gan, Israel
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Montreal, Canada
| | - Pierre Ernst
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, and of Medicine, McGill University, Montreal, Canada
| | - Samy Suissa
- Centre for Clinical Epidemiology, Lady Davis Institute-Jewish General Hospital, Montreal, Canada
- Department of Epidemiology and Biostatistics, and of Medicine, McGill University, Montreal, Canada
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Gehlenborg J, Miegel F, Moritz S, Scheunemann J, Yassari AH, Jelinek L. Implicit aggressive self-concept in patients with obsessive-compulsive disorder: Results from an approach-avoidance task. J Behav Ther Exp Psychiatry 2024; 83:101927. [PMID: 38064875 DOI: 10.1016/j.jbtep.2023.101927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/13/2023] [Accepted: 11/21/2023] [Indexed: 02/25/2024]
Abstract
BACKGROUND AND OBJECTIVES Patients with obsessive-compulsive disorder (OCD) have reported higher anger and aggression than healthy individuals in previous studies using explicit measures. However, studies using implicit measures have demonstrated mixed results. The aim of the present study was to investigate implicit aggressiveness in OCD using an approach-avoidance task (AAT). METHODS Seventy-eight patients with OCD and 37 healthy controls underwent structured clinical interviews and measures of anger, OCD, and depressive symptoms as well as a computerized AAT that included aggressive, peaceful, negative, and positive stimuli. RESULTS In line with previous studies, patients with OCD reported higher scores on explicit anger. With respect to the implicit measure, repeated measures ANOVAs did not show any differences in mean reaction times for pushing compared to pulling aggressive versus peaceful and negative versus positive words. However, analyses of specific OCD symptom dimensions demonstrated significantly faster reaction times for pulling compared to pushing aggressive words for patients with high scores in the OCD symptom dimensions obsessing and hoarding. LIMITATIONS Eighty percent of patients with OCD showed psychiatric comorbidities and all were seeking treatment. CONCLUSION The present study supports previous studies reporting the absence of higher aggressiveness in patients with OCD compared to healthy controls using implicit measures. However, in contrast to previous studies, we found an implicit approach bias towards aggressive self-statements for OCD patients scoring high in the symptom dimensions obsessing and hoarding compared to healthy controls. Future studies should further elucidate putative functional relationships between different OCD symptom dimensions and implicit aggressiveness.
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Affiliation(s)
- Josefine Gehlenborg
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Franziska Miegel
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, D-20246, Hamburg, Germany
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, D-20246, Hamburg, Germany
| | - Jakob Scheunemann
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, D-20246, Hamburg, Germany
| | - Amir-Hosseyn Yassari
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, D-20246, Hamburg, Germany
| | - Lena Jelinek
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistraße 52, D-20246, Hamburg, Germany
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Pinciotti CM, Van Kirk N, Horvath G, Storch EA, Mancebo MC, Abramowitz JS, Fontenelle LF, Goodman WK, Riemann BC, Cervin M. Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response. J Affect Disord 2024; 353:109-116. [PMID: 38452939 DOI: 10.1016/j.jad.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. METHODS The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3083, 94.2 %) and OCD + PTSD (n = 191, 5.2 %) who received CBT with ERP in two major intensive OCD treatment programs. RESULTS Although patients with OCD + PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD + PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD. LIMITATIONS Findings are limited by a naturalistic treatment sample with variation in treatment provision. CONCLUSIONS Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD + PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.
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Affiliation(s)
- Caitlin M Pinciotti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Nathaniel Van Kirk
- OCD Institute, Office of Clinical Assessment and Research (OCAR), McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Gregor Horvath
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Maria C Mancebo
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leonardo F Fontenelle
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Matti Cervin
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
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Sim DKL, Mittal S, Zhang J, Hung CL, Azman WAW, Choi JO, Yingchoncharoen T, De Lara ACF, Ito H, Ashraf T, Yiu KH, Krittayaphong R. Expert recommendations for the management of iron deficiency in patients with heart failure in Asia. Int J Cardiol 2024; 403:131890. [PMID: 38382854 DOI: 10.1016/j.ijcard.2024.131890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Iron deficiency is a common comorbidity in heart failure (HF) and is independently associated with a worse quality-of-life and exercise capacity, as well as increased risk of hospitalization, regardless of anemia status. Although international guidelines have provided recommendations for the management of iron deficiency in patients with HF, guidelines in Asia are less established, and practical use of guidelines for management of iron deficiency is limited in the region. METHODS A panel comprising cardiologists from China, Hong Kong, India, Japan, Malaysia, Pakistan, Philippines, Singapore, South Korea, Taiwan, and Thailand convened to share insights and provide guidance for the optimal management of iron deficiency in patients with HF, tailored for the Asian community. RESULTS Expert opinions were provided for the screening, diagnosis, treatment and monitoring of iron deficiency in patients with HF. It was recommended that all patients with HF with reduced ejection fraction should be screened for iron deficiency, and iron-deficient patients should be treated with intravenous iron. Monitoring of iron levels in patients with HF should be carried out once or twice yearly. Barriers to the management of iron deficiency in patients with HF in the region include low awareness of iron deficiency amongst general physicians, lack of reimbursement for screening and treatment, and lack of proper facilities for administration of intravenous iron. CONCLUSIONS These recommendations provide a structured approach to the management of iron deficiency in patients with HF in Asia.
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Affiliation(s)
| | - Sanjay Mittal
- Department of Clinical and Preventive Cardiology, Heart Institute, Mendanta - The Medicity, India
| | - Jian Zhang
- Heart Failure Centre, Fuwai Hospital, China
| | - Chung-Lieh Hung
- Institute of Biomedical Sciences, MacKay Medical College, New Taipei, Taiwan; Division of Cardiology, Department of Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | | | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Republic of Korea
| | | | - Aileen Cynthia F De Lara
- Department of Medical Education and Research, Faculty of Medicine and Surgery, University of Santo Tomas, Philippines
| | - Hiroshi Ito
- Department of General Internal Medicine, Kawasaki Medical School, Japan
| | - Tariq Ashraf
- National Institute of Cardiovascular Disease, Pakistan
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, China
| | - Rungroj Krittayaphong
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Thailand
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Orsolini L, Bellagamba S, Volpe U. Lurasidone as add-on to fluoxetine in obsessive-compulsive disorder with comorbid restrictive anorexia: a case report. Int Clin Psychopharmacol 2024; 39:211-214. [PMID: 37556307 DOI: 10.1097/yic.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a pervasive disabling disorder that may overlap with other psychiatric conditions, including anorexia nervosa. Recent guidelines recommend low doses of second-generation antipsychotics as add-on therapy to selective serotonin reuptake inhibitors (SSRIs) for those patients presenting OCD who display residual symptomatology. Here we report a clinical case of a 45-years-old woman affected by severe OCD in comorbidity with anorexia nervosa, restrictive type (AN-r), treated with fluoxetine (titrated up to 40 mg/day) in augmentation with low doses of lurasidone (37 mg/day). At baseline and during a 6 months-follow-up we administered Clinical Global Impression-Severity, Symptom Checklist-90 items, Y-BOCS-II (Yale-Brown Obsessive Compulsive Scale) and EDI-3 (Eating Disorder Inventory). After 1 month of augmentation treatment, a clinically significant response was observed on obsessive symptoms at Y-BOCS-II (≥35% Y-BOCS reduction) and eating symptomatology at EDI-3. Full remission was reported after 3 months (Y-BOCS scoring ≤14) ( P < 0.01). Further longitudinal and real-world effectiveness studies should be implemented to confirm these novel results, to investigate the potential of lurasidone as add-on strategy to SSRI in poor responder OCD patients, including treatment-resistant-OCD (tr-OCD), as well as in improving eating disorder symptomatology, whereas there is comorbidity with AN-r.
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Affiliation(s)
- Laura Orsolini
- Unit of Clinical Psychiatry, Department of Clinical Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
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Kato TA, Sartorius N, Shinfuku N. Shifting the paradigm of social withdrawal: a new era of coexisting pathological and non-pathological hikikomori. Curr Opin Psychiatry 2024; 37:177-184. [PMID: 38415743 DOI: 10.1097/yco.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
PURPOSE OF REVIEW Social withdrawal syndrome, known as "hikikomori," has been highlighted since the late 1990 s in Japan. Hikikomori is more common in urban areas, and often comorbid with mental disorders, and now spreading throughout the world. In the post-COVID-19 era, not outing is no longer considered pathological in itself as the "new normal," and a novel concept of hikikomori is needed. This review summarizes the concept of hikikomori, and presents the latest methods for identification of hikikomori. RECENT FINDINGS The novel definition can distinguish between pathological and non-pathological hikikomori using the scale of "Hikikomori Diagnostic Evaluation (HiDE)," which has been developed in the hikikomori research lab at Kyushu University. An online survey among non-working adults has revealed that persons who have become pathological hikikomori for less than three months showed a particularly strong tendency toward gaming disorder and depression. SUMMARY Now, physical isolation itself is not pathological, but when dysfunction and distress are present, rapid mental health support should be provided. In the novel urban society, the establishment of a checkup system to assess whether persons who stay home are happy or suffering is important for prevention against mental disorders triggered by social isolation.
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Affiliation(s)
- Takahiro A Kato
- Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University
- Mood Disorder & Hikikomori Clinic, Kyushu University Hospital
- Hikikomori Research Lab, Kyushu University, Fukuoka, Japan
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programs, Geneva, Switzerland
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Misitano A, Moro AS, Ferro M, Forresi B. The Dissociative Subtype of Post-Traumatic Stress Disorder: A Systematic Review of the Literature using the Latent Profile Analysis. J Trauma Dissociation 2024; 25:349-365. [PMID: 36062756 DOI: 10.1080/15299732.2022.2120155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
A PTSD subtype with dissociative symptoms (D-PTSD) was included in the DSM-5 recognizing the existence of a more severe form of PTSD, associated to past trauma, high comorbidity, and complex clinical management. As research is rapidly growing and results are inconsistent, a better investigation of this subtype is of primary importance. We conducted a systematic review of studies using Latent Profile Analysis to investigate the existence of a D-PTSD subtype. Covariates of D-PTSD were included, to understand additional symptoms, risk factors and comorbidities. The search was performed on PubMed, EBSCOHost, and PTSDPubs according to 2020 PRISMA guidelines. Eligible articles assessed trauma exposure, PTSD symptoms and diagnosis, and dissociation, in adult samples. 13 of 165 articles met the inclusion criteria. All identified a dissociative subtype of PTSD, mainly characterized by higher levels of depersonalization and derealization. D-PTSD profile sometimes presented other dissociative symptoms, such as gaps in awareness and memory, other comorbid disorders, and a history of abuse. Despite some limitations, this review supports the existence of a dissociative subgroup of individuals among those with PTSD. More rigorous studies are needed to clarify these findings and their clinical implications.
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Affiliation(s)
- Alberto Misitano
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Andrea Stefano Moro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Mattia Ferro
- Department of Psychology, Sigmund Freud University, Milan, Italy
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Forresi
- Department of Psychology, Sigmund Freud University, Milan, Italy
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Sæle RH, Ndetei DM, Mutiso VN, Mamah D. Epidemiology of DSM-5 psychiatric disorders in Kenyan Youth with Low and High Psychosis Risk. Compr Psychiatry 2024; 131:152473. [PMID: 38503003 DOI: 10.1016/j.comppsych.2024.152473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 01/30/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION There are few psychiatric epidemiology studies among Kenyan youth and fewer among those at high psychosis risk (HR). METHODS This study assessed the epidemiology of DSM-5 psychiatric disorders in HR and low-risk (LR) individuals to inform research and mental health services. 567 participants (aged 15-25) in HR (n = 246) and LR (n = 260) groups based on Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen scores. Diagnostic Interview Schedule, version 5 (DIS-5) assessed DSM-5 psychiatric disorder prevalence. Diagnostic comorbidity and demographic relationships were investigated. RESULTS A higher prevalence was observed for all DSM-5 disorders in the HR group, significantly for gambling disorder (13% vs. 5.8%), major depressive disorder (9.8% vs. 3.8%), antisocial personality disorder (5.7% vs. 2.3%), general anxiety disorder (4.9% vs. 0.4%), oppositional defiant disorder (3.3% vs. 0.4%), panic disorder (2.8% vs. 0.8%), and anorexia nervosa (2.8% vs. 0%). Gambling disorder was the most prevalent and showed significant gender effects (males>females). DISCUSSION Psychiatric disorders occur at increased rates among HR compared to LR. Prevalence rates found are lower than in US studies, except for gambling disorder which was highly prevalent. Large-population-based epidemiology studies in Africa are needed to estimate rates, particularly of disorders such as schizophrenia, accurately.
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Affiliation(s)
- Rebekka H Sæle
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America.
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Daniel Mamah
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America
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Johnson K, Stanfield AC, Scerif G, McKechanie A, Clarke A, Herring J, Smith K, Crawford H. A holistic approach to fragile X syndrome integrated guidance for person-centred care. J Appl Res Intellect Disabil 2024; 37:e13214. [PMID: 38383947 DOI: 10.1111/jar.13214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND The Fragile X community has expressed a desire for centralised, national guidelines in the form of integrated guidance for Fragile X Syndrome (FXS). METHODS This article draws on existing literature reviews, primary research and clinical trials on FXS, a Fragile X Society conference workshop and first-hand experience of clinicians who have worked with those living with FXS over many years. RESULTS The article scopes proposed integrated guidance over the life course, including appendices of symptoms, comorbidities and referral options for FXS and Fragile X Premutation Associated Conditions. CONCLUSION Integrated guidance would provide an authoritative source for doctors, health professionals, therapists, care workers, social workers, educators, employers, families and those living with FXS, so that a holistic, person-centred approach can be taken across the United Kingdom to garner the best outcomes for those with FXS.
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Affiliation(s)
- Kirsten Johnson
- The Fragile X Society, Great Dunmow, Essex, UK
- Fragile X International, Brussels, Belgium
| | - Andrew C Stanfield
- The Fragile X Society, Great Dunmow, Essex, UK
- The Patrick Wild Centre, The University of Edinburgh, Edinburgh, UK
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | | | - Angus Clarke
- The Fragile X Society, Great Dunmow, Essex, UK
- Institute of Cancer & Genetics, Cardiff University, Cardiff, UK
| | - Jonathan Herring
- The Fragile X Society, Great Dunmow, Essex, UK
- Law Faculty, University of Oxford, Oxford, UK
| | - Kayla Smith
- Mental Health and Wellbeing Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Hayley Crawford
- The Fragile X Society, Great Dunmow, Essex, UK
- Mental Health and Wellbeing Unit, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Wong CPS, Yeung JTK, Fong DYT, Smith RD, Ngan AHY, Lam YYL, Chan KSS, Leung HHY, Wang MP, Wong JYH. Effectiveness of group cognitive behavioral therapy for depression in adults: a systematic review and meta-analysis of delivery by different healthcare professionals. Cogn Behav Ther 2024; 53:302-323. [PMID: 38372166 DOI: 10.1080/16506073.2024.2313741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/14/2024] [Indexed: 02/20/2024]
Abstract
This study addresses the gap in understanding the varied effectiveness of group cognitive behavioral therapy (gCBT) delivered by different professionals. This study aims to address this gap by conducting a systematic review of randomized controlled trials (RCTs) that evaluate gCBT and compare it to inactive controls in adults with a clinical diagnosis of depression. A total of 33 RCTs were included for analysis. In the overall analysis, 'profession of gCBT deliverer' was not a significant moderator in the meta-regression model (p = 0.57). For people without comorbidity, the overall effect size estimate was -0.69 (95% CI, -1.01. to -0.37, p = 0.03). Among gCBT deliverers, psychologists and nurses/psychiatric nurses demonstrated significant effectiveness, with psychologists showing a large effect size of -0.78 (95% CI, -1.25 to -0.30, p < 0.01) and nurses/psychiatric nurses showing a medium effect size of -0.45 (95% CI, -0.85 to -0.05, p = 0.03). The certainty of evidence for both professionals was moderate. These results have significant implications for the delivery of mental healthcare, as nurses/psychiatric nurses may be more accessible and cost-effective than psychologists in some settings. However, further research is necessary to determine the effectiveness of gCBT delivered by a broader range of healthcare professionals for patients with depression and other comorbidities.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Man Ping Wang
- School of Nursing, the University of Hong Kong, Hong Kong, SAR, China
| | - Janet Yuen Ha Wong
- School of Nursing and Health Studies, Hong Kong Metropolitan University, Hong Kong, China
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13
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Nyasulu PS, Doumbia CO, Ngah V, Togo ACG, Diarra B, Chongwe G. Multidrug-resistant tuberculosis: latest opinions on epidemiology, rapid diagnosis and management. Curr Opin Pulm Med 2024; 30:217-228. [PMID: 38488133 DOI: 10.1097/mcp.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
PURPOSE OF REVIEW This review addresses the escalating global challenge of multidrug-resistant tuberculosis (MDR-TB) in Sub-Saharan Africa, with a focus on its complex comorbidity with HIV/AIDS. Emphasizing the urgency of the issue, the review aims to shed light on the unique healthcare landscape shaped by the convergence of high prevalence rates and intersecting complexities with HIV/AIDS in the region. RECENT FINDINGS A notable increase in MDR-TB cases across Sub-Saharan Africa is attributed to challenges in timely diagnoses, treatment initiation, and patient treatment defaulting. The literature underscores the critical need for proactive measures to address diagnostic and treatment gaps associated with MDR-TB, particularly concerning its comorbidity with HIV/AIDS. SUMMARY To effectively manage MDR-TB and its co-morbidity with HIV/AIDS, proactive screening programs are imperative. The review highlights the necessity of active follow-up strategies to ensure treatment adherence and reduce default rates, offering evidence-based insights for improved disease management in the region.
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Affiliation(s)
- Peter S Nyasulu
- Department of Global Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Stellenbosch
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cheick Oumar Doumbia
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Veranyuy Ngah
- Department of Global Health, Faculty of Medicine & Health Sciences, Stellenbosch University, Stellenbosch
| | - Antieme Combo Georges Togo
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Bassirou Diarra
- University Clinical Research Center, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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Bommaraju S, Dhokne MD, Arun EV, Srinivasan K, Sharma SS, Datusalia AK. An insight into crosstalk among multiple signalling pathways contributing to the pathophysiology of PTSD and depressive disorders. Prog Neuropsychopharmacol Biol Psychiatry 2024; 131:110943. [PMID: 38228244 DOI: 10.1016/j.pnpbp.2024.110943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 01/08/2024] [Accepted: 01/10/2024] [Indexed: 01/18/2024]
Abstract
Post-traumatic stress disorder (PTSD) and depressive disorders represent two significant mental health challenges with substantial global prevalence. These are debilitating conditions characterized by persistent, often comorbid, symptoms that severely impact an individual's quality of life. Both PTSD and depressive disorders are often precipitated by exposure to traumatic events or chronic stress. The profound impact of PTSD and depressive disorders on individuals and society necessitates a comprehensive exploration of their shared and distinct pathophysiological features. Although the activation of the stress system is essential for maintaining homeostasis, the ability to recover from it after diminishing the threat stimulus is also equally important. However, little is known about the main reasons for individuals' differential susceptibility to external stressful stimuli. The solution to this question can be found by delving into the interplay of stress with the cognitive and emotional processing of traumatic incidents at the molecular level. Evidence suggests that dysregulation in these signalling cascades may contribute to the persistence and severity of PTSD and depressive symptoms. The treatment strategies available for this disorder are antidepressants, which have shown good efficiency in normalizing symptom severity; however, their efficacy is limited in most individuals. This calls for the exploration and development of innovative medications to address the treatment of PTSD. This review delves into the intricate crosstalk among multiple signalling pathways implicated in the development and manifestation of these mental health conditions. By unravelling the complexities of crosstalk among multiple signalling pathways, this review aims to contribute to the broader knowledge base, providing insights that could inform the development of targeted interventions for individuals grappling with the challenges of PTSD and depressive disorders.
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Affiliation(s)
- Sumadhura Bommaraju
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, Uttar Pradesh (UP) 226002, India
| | - Mrunali D Dhokne
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, Uttar Pradesh (UP) 226002, India
| | - E V Arun
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, Uttar Pradesh (UP) 226002, India
| | - Krishnamoorthy Srinivasan
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), SAS Nagar, Punjab 160062, India
| | - Shyam Sunder Sharma
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), SAS Nagar, Punjab 160062, India
| | - Ashok Kumar Datusalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Raebareli, Uttar Pradesh (UP) 226002, India; Department of Regulatory Toxicology, National Institute of Pharmaceutical Education and Research (NIPER) Raebareli, Uttar Pradesh (UP) 226002, India.
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Redding A, Kalesnikava VA, Bergmans R, Redding S, Dent K, Mezuk B. Medically unexplained pain and suicidal ideation among US adults. J Affect Disord 2024; 351:425-429. [PMID: 38272364 DOI: 10.1016/j.jad.2024.01.192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 01/27/2024]
Abstract
BACKGROUND Chronic pain is an established risk factor for suicide. Pain syndromes are complex to diagnose, particularly in cases with limited evidence of injury or pathology. The goal of this study is to assess whether pain of unknown origin (i.e., medically-unexplained pain, MUEP) is more strongly associated with suicide behaviors than pain with a diagnostic explanation. METHODS Data comes from the National Comorbidity Survey-Replication, a nationally-representative sample of US adults. Analysis was limited to participants with a lifetime history of any type of chronic pain (n = 3421), which were categorized as having medically-explained pain (MEP, e.g., pain due to a specific health condition or resulting from an injury identified in an x-ray) or MUEP. Logistic regression, using survey procedures, was used to assess the relationship between lifetime MUEP and lifetime history of suicidal ideation and attempts. RESULTS Approximately 1 in 10 (11.6 %) adults with chronic pain had MUEP. Those with MUEP reported earlier age of pain onset and more impairment due to health problems. Suicidal ideation was reported by 18.7 % of those with MEP and 28.4 % of those with MUEP. In fully-adjusted models, MUEP was associated with 1.60 times (95 % CI: 1.17-2.18) higher odds of suicidal ideation, and 1.89 (1.25-2.83) higher odds of suicide attempt, compared to MEP. LIMITATIONS Cross-sectional analysis; MUEP assessed by self-report. CONCLUSIONS Among adults with chronic pain, those with MUEP are more likely to report suicide behaviors. Findings illustrate a role for diagnostic and treatment processes in the relationship between pain and suicide.
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Affiliation(s)
- Ashley Redding
- Public Health Sciences, Henry Ford Health, Detroit, MI 48202, United States of America
| | - Viktoryia A Kalesnikava
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States of America
| | - Rachel Bergmans
- Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Stephen Redding
- Wayne State University School of Medicine, Detroit, MI 48201, United States of America
| | - Kallisse Dent
- Department of Psychology, University of Michigan, Ann Arbor, MI 48109, United States of America
| | - Briana Mezuk
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health, Ann Arbor, MI 48109, United States of America; Eisenberg Family Depression Center, University of Michigan, Ann Arbor, MI 48109, United States of America.
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Coello K, Kuchinke OV, Kjærstad HL, Miskowiak KW, Faurholt-Jepsen M, Vinberg M, Kessing LV. Differences in clinical presentation between newly diagnosed bipolar I and II disorders: A naturalistic study. J Affect Disord 2024; 351:95-102. [PMID: 38244799 DOI: 10.1016/j.jad.2024.01.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 01/10/2024] [Accepted: 01/14/2024] [Indexed: 01/22/2024]
Abstract
AIM This naturalistic clinical study aims to investigate differences between newly diagnosed patients with bipolar type I (BDI) and bipolar type II (BDII) disorders in socio-demographic and clinical characteristics, affective symptoms, cognition, functioning and comorbidity with personality disorders. METHODS The BD diagnosis and type were confirmed using the Schedules for Clinical Assessment in Neuropsychiatry. Affective symptoms were assessed with the Young Mania Rating Scale, the Hamilton Depression Rating Scale, the Major Depressive Index, and the Altman Self-Rating Mania Scale. Functional impairment was assessed with the Functional Assessment Short Test. Cognitive impairment was evaluated by the Screen for Cognitive Impairment in Psychiatry and the Cognitive Complaints in Bipolar Disorder Rating Assessment. Finally, comorbid personality disorders were assessed with the Standardized Assessment of Personality-Abbreviated Scale and structured interview Structured Clinical Interview for DSM-disorders. RESULTS 383 newly diagnosed patients were included (BDI: n = 125; BDII: n = 258). Against expectations, we found no more depressive symptoms in BDII compared with BDI nor any differences in cognitive, childhood trauma or overall functional impairment. The only difference was lower occupational impairment in the BDII group. LIMITATIONS The self-reported measures of cognitive difficulties and childhood trauma involved potential bias (recall or other). Despite BD being newly diagnosed a diagnostic delay was observed. CONCLUSION Patients newly diagnosed with BDII and BDI had similar burdens of depressive symptoms and cognitive and overall functional impairment, however patients with BDI had lower occupational functioning. No statistically significant difference was found in prevalence of comorbid personality disorders between patients with BDI and BDII.
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Affiliation(s)
- Klara Coello
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark.
| | - Oscar Vittorio Kuchinke
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Hanne Lie Kjærstad
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Kamilla Woznica Miskowiak
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maria Faurholt-Jepsen
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Maj Vinberg
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Lars Vedel Kessing
- Copenhagen Affective Disorders Research Centre (CADIC), Psychiatric Center Copenhagen, Hovedvejen 13, 1. sal, bygning 18, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Su Y, Li M, Meng X. Symptom patterns in the co-occurrence of depressive and generalized anxiety symptoms: A network analysis of a Canadian nationally representative sample. J Affect Disord 2024; 351:888-894. [PMID: 38320661 DOI: 10.1016/j.jad.2024.01.266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/26/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND This study aimed to investigate the symptom patterns of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in a matched nationally representative sample of the Canadian population. We also tested whether childhood maltreatment (CM) exposures and sex would be linked with different symptom patterns. METHODS A total of 3296 participants from the Canadian Community Health Survey-Mental Health with complete information on MDD and GAD symptoms and being matched on the studied sociodemographic characteristics were included in the current study. Network analysis was performed to examine the MDD-GAD symptom network, network stability and centrality indices were also estimated. Finally, network comparison in connectivity patterns was conducted to explore the impact of maltreatment experience and sex differences in the MDD-GAD symptom networks. RESULTS The CM group had stronger network connections and showed differences in the network structures from the non-CM group. In the CM group, depressed mood and diminished interest were central symptoms and strongly connected with other symptoms. Additionally, females had stronger connections in the MDD-GAD symptom network than males, and sleep disturbance was a central symptom for females, alongside depressed mood and diminished interest. LIMITATIONS The cross-sectional design restricts our capacity to establish longitudinal or causal connections between symptoms. CONCLUSIONS Depressed mood was the most central node that was strongly connected with other symptoms in the network. Distinct MDD-GAD symptom networks were discovered in the CM and the female group when compared to their counterparts. Noteworthy, individuals with CM had a stronger correlation between worry and suicidal ideation. Clinical management and intervention efforts should pay close attention to these core symptoms to yield optimal treatment effects, particularly for females and individuals with CM.
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Affiliation(s)
- Yingying Su
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Research Centre, Montreal, QC, Canada
| | - Muzi Li
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Research Centre, Montreal, QC, Canada
| | - Xiangfei Meng
- Department of Psychiatry, McGill University, Montreal, QC, Canada; Douglas Research Centre, Montreal, QC, Canada.
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Ríos A, Quirante-Botía AM, López-Navas AI, Iniesta-Sepúlveda M. Risk factors for posttraumatic stress disorder in trauma patients from bullfighting-related events in Spain. J Affect Disord 2024; 351:90-94. [PMID: 38296056 DOI: 10.1016/j.jad.2024.01.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Unintentional Trauma injuries are one of the leading causes of posttraumatic stress disorder development. However, screening for this condition is not typically included in routine medical care. Research on posttraumatic stress disorder after unintentional injuries sustained during entertainment activities involving risk, has been scarce. This study aimed to analyze the proportion of posttraumatic stress disorder and its risk factors in patients with trauma injuries sustained during bullfighting-related events in Spain. METHODS Two hundred and seventy-four patients were evaluated to determine the presence of posttraumatic stress disorder at least one month after the injury. Data about sociodemographic variables, injury circumstances, characteristics of the injury, and treatments were collected by the surgery team on-site or collected during the follow-up assessment. Diagnosis of posttraumatic stress disorder was made by a trained clinician using a structured clinical interview based on DSM criteria. RESULTS The estimated proportion of was 25.18 % (95 % CI: 20.18 %, 30.18 %). Residing in areas with a bullfighting tradition, female gender, referral to a medical center, hospitalization, events involving fighting bulls, and having been injured by the crowd were significant predictors. LIMITATIONS The short-term follow-up and the inability to evaluate some predictors of interest, including the body site of the injury, the presence of disfigurement, and comorbid anxiety and depression, were noted. CONCLUSION Posttraumatic stress disorder could have a high prevalence in individuals injured in these types of events, especially in women, those who are not familiar with the situation, and those who require medical attention. These results highlight the need for routine screening for posttraumatic stress disorder in individuals with trauma injuries for early symptom management.
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Affiliation(s)
- Antonio Ríos
- Department of Surgery, Pediatrics, Obstetrics y Gynecology, University of Murcia, Spain; Surgery Service, IMIB - Clinical University Hospital Virgen de la Arrixaca, Murcia, Spain.
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Wallensten J, Ljunggren G, Nager A, Wachtler C, Petrovic P, Carlsson AC. Differences in psychiatric comorbidity patterns in patients diagnosed with chronic stress-induced exhaustion disorder and depression - A cohort study in the total population of Region Stockholm. J Affect Disord 2024; 351:765-773. [PMID: 38331048 DOI: 10.1016/j.jad.2024.01.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/16/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024]
Abstract
The high prevalence of stress-related disorders and depression underscores the urgent need to unravel their impact on individual well-being. This study aim to investigate common psychiatric and stress-related diagnoses, along with postviral fatigue, in individuals with prior stress-induced exhaustion disorder (SED) and prior depression compared to those without prior SED or depression, and to study whether the psychiatric comorbidity patterns differ. The study includes individuals in Region Stockholm who, in 2011, did not have a diagnosis of SED or depression. ICD-10 diagnosis of SED, depression, or both, recorded in 2012-2013, were compared to individuals without prior SED or depression in a cohort (n = 1,362,886), aged 18 to 65. Odds ratios (OR) with 99 % confidence intervals, adjusted for age and neighborhood socioeconomic status, were calculated for psychiatric disorders and post-viral fatigue in 2014-2022. Patients with prior SED showed associations primarily with stress related diagnoses, including acute stress reaction, reaction to severe stress, as well as post-COVID-19 and post-viral fatigue syndrome. These ORs were all larger for SED than depression. Depression was primarily associated with post-traumatic stress disorder (PTSD), alcohol related and substance use disorders, schizophrenia, schizotypal disorders, delusional disorders, manic episode, bipolar affective disorder, persistent mood disorder, neurotic disorder, borderline personality disorder, autistic disorder, Asperger's syndrome, attention -deficit hyperactivity disorder, attention-deficit disorders ADHD/ADD), and suicide attempt. These ORs were all higher for depression, although autistic disorders, ADHD/ADD and PTSD were also highly associated with prior SED (OR > 3.5). The divergent psychiatric comorbidity patterns suggest different underlying mechanisms and clinical prognosis.
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Affiliation(s)
- Johanna Wallensten
- Department of clinical sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Sweden.
| | - Gunnar Ljunggren
- Academic Primary Health Care Centre, Region Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Anna Nager
- Department of clinical sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Caroline Wachtler
- Academic Primary Health Care Centre, Region Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
| | - Predrag Petrovic
- Center for Psychiatry Research (CPF), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Center for Cognitive and Computational Neurosceince (CCNP), Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Axel C Carlsson
- Academic Primary Health Care Centre, Region Stockholm, Sweden; Division of Family Medicine and Primary Health Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
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Duan Y, Fu H, Jiang S, Yin Z, Wang S, Gao J, Yang M, Wang S, Mu Z, Chen C, Zhao Y, Wang C. Association between PM 10 pollution and the hospitalization of chronic obstructive pulmonary disease with comorbidity: evidence in 17 cities of Henan, Central China. Int J Biometeorol 2024; 68:625-635. [PMID: 38147118 DOI: 10.1007/s00484-023-02610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 12/27/2023]
Abstract
Particulate matter (PM10) changes have been confirmed as one of the contributory factors affecting human health, the association between PM10 pollution and the hospitalization of chronic obstructive pulmonary disease (COPD) with comorbidity diseases was rarely reported. The same inpatient more than twice times admissions with COPD illness from January 1, 2016 to December 31, 2021 were identified from hospitals in the 17 cities of Henan, Central China. City-specific associations were firstly estimated using the case time series (CTS) model and then combined to obtain the regional average association. The multivariate meta-analytic model produces pooled estimates of the set of coefficients representing the PM10-COPD hospitalizations association across the 17 cities. Cause-specific hospitalization analyses were performed by COPD patients with different comorbidity combinations. A total of 34,348 elderly (age ≥ 65) subjects were analyzed and with a total of 35,122.35 person-years. These coefficients can be used to compute the linear exposure-response curve expressed as relative risk (RR) in per 10 µg/m3 increase in PM10 at lag03, which was 1.0091 (95% CI 1.0070-1.0112) for COPD with comorbidity, 1.0089 (95% CI 1.0067-1.0110) for COPD with circulatory system diseases, 1.0079 (95% CI 1.0052-1.0105) for COPD with respiratory system diseases, 1.0076 (95% CI 1.0032-1.0121) for COPD with endocrine system diseases, and 1.0087 (95% CI 1.0013-1.0162) for COPD with genitourinary system diseases, respectively. Some heterogeneity was found across cities, with estimates ranging from 1.0227 in the Puyang and Jiaozuo to 1.0053 in Henan Provance, China. The effect of higher PM10, on average, was higher in studies for northern cities, with a steeper raise in risk: per 10 µg/m3 increase in PM10, the RR from 1.0062 (95% CI 1.0030-1.0093) for the 10th percentile of latitude to 1.0124 (95% CI 1.0089-1.0160) for the 90th percentile. Our findings indicated that PM10 exposure may increase the risk of hospitalizations for COPD with comorbidity. Moreover, there might be a higher morbidity risk associated with PM10 in northern latitudes, indicating that stricter air quality standards could potentially reduce PM10-related morbidity among individuals with COPD. These findings have implications for the implementation of effective clean air interventions aligned with national climate policies.
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Affiliation(s)
- Yanran Duan
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Hang Fu
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Shuai Jiang
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Zhao Yin
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Sufan Wang
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Jinghong Gao
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Mengyu Yang
- Zhengzhou University School of Public Health, Zhengzhou, China
| | - Suxian Wang
- Zhengzhou University School of Public Health, Zhengzhou, China
| | - Zihan Mu
- Operation Management Department, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 450001, China
| | - Changying Chen
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China
- Institute for Hospital Management of Henan Province, Zhengzhou, China
| | - Yaojun Zhao
- Operation Management Department, Central China Fuwai Hospital of Zhengzhou University, Zhengzhou, 450001, China.
| | - Chengzeng Wang
- The First Affiliated Hospital of Zhengzhou University, 1 Jianshe Road, Zhengzhou, 450000, Henan Province, China.
- Institute for Hospital Management of Henan Province, Zhengzhou, China.
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Abbad-Gomez D, Domingo L, Comas M, Santiá P, Jansana A, Poblador B, Sanz T, Del Cura I, Ibañez B, Padilla M, Redondo M, Castells X, Sala M. Effect of comorbidity and multimorbidity on adherence to follow-up recommendations among long-term breast cancer survivors. Maturitas 2024; 182:107918. [PMID: 38280353 DOI: 10.1016/j.maturitas.2024.107918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/22/2023] [Accepted: 01/14/2024] [Indexed: 01/29/2024]
Abstract
OBJECTIVES To study the impact of comorbidities, multimorbidity, and multimorbidity clusters on adherence to recommended follow-up guidelines among long-term breast cancer survivors. STUDY DESIGN Retrospective cohort study based on 2078 women diagnosed with breast cancer from 2000 to 2006 and followed up from 2012 to 2016. MAIN OUTCOME MEASURES Adherence to breast cancer follow-up recommendations (annual medical visit and imaging) was determined. Comorbidities were classified as acute/chronic. Multimorbidity was defined as the presence of two or more chronic comorbidities aside from breast cancer. Five multimorbidity clusters were considered. Multivariate logistic regression models were fitted to determine the relationship between adherence to recommendations and the presence of comorbidities and multimorbidity, considering both sociodemographic and clinical characteristics. RESULTS Overall adherence to recommendations was 79.5 %. Adherence was lower among long-term breast cancer survivors with no comorbidities (75.8 %). Among multimorbidity clusters, adherence was highest in the anxiety and fractures cluster (84.3 %) and was lowest in the musculoskeletal and cardiovascular cluster (76.4 %). In adjusted multivariate models, multimorbidity was associated with higher levels of adherence (OR = 1.52 95 %CI 1.16-1.99), and adherence was highest in the metabolic and degenerative cluster (OR = 2.2 95 %CI 1.4-3.5). CONCLUSION Adherence to follow-up recommendations was higher among long-term breast cancer survivors with multimorbidity than among those without. Adherence also differed by multimorbidity cluster. These results suggest suboptimal adherence to the current follow-up recommendations in certain groups, suggesting the need to adapt clinical practice guidelines to reflect patients' comorbidities and different characteristics.
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Affiliation(s)
- David Abbad-Gomez
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; PhD Program in Biomedicine, Universitat Pompeu Fabra, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain.
| | - Mercè Comas
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
| | - Paula Santiá
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain
| | - Anna Jansana
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Nutrition and Metabolism Branch, International Agency for Research On Cancer (IARC-WHO), 25 Avenue Tony Garnier, Lyon, France
| | - Beatriz Poblador
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; EpiChron Research Group, Aragon Health Sciences Institute (IACS), IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
| | - Teresa Sanz
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Madrid Health Service, Primary Care Research Unit, Madrid, Spain
| | - Isabel Del Cura
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Madrid Health Service, Primary Care Research Unit, Madrid, Spain
| | - Berta Ibañez
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Navarrabiomed, HUN, UPNA, IdISNA. Pamplona, Spain
| | - Maria Padilla
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Maximino Redondo
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Research Unit, Costa del Sol Hospital, University of Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain; Autonomous University of Barcelona (UAB), Barcelona, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Hospital del Mar Research Institute, Barcelona, Spain; Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), ISCIII, 28029 Madrid, Spain
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De Jongh A, Hafkemeijer LCS. Trauma-focused treatment of a client with Complex PTSD and comorbid pathology using EMDR therapy. J Clin Psychol 2024; 80:824-835. [PMID: 37058521 DOI: 10.1002/jclp.23521] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 03/20/2023] [Accepted: 03/25/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE Complex post-traumatic stress disorder (CPTSD) is a classification within the International Classification of Diseases, 11th Revision (ICD-11) that, besides the DSM-5 symptom clusters of post-post-traumatic stress disorder (PTSD), includes the presence of negative self-concept, difficulties in regulating emotions and relationship skills. The purpose of the present study was to provide guidance on how to deliver Eye Movement Desensitization and Reprocessing (EMDR) therapy in the context of CPTSD, based on current clinical knowledge and the latest scientific research findings. METHOD This paper describes the treatment of a 52-year-old woman with CPTSD and borderline personality disorder for which immediate trauma-focused EMDR therapy was used. RESULTS First, a description of what EMDR therapy entails and some important treatment strategies that the therapist may employ to assist in trauma-focused treatment of clients with CPTSD using EMDR therapy are outlined. CONCLUSION The treatment results are in line with mounting evidence supporting the notion that EMDR therapy is a safe and potentially effective treatment alternative for individuals with CPTSD or personality problems.
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Affiliation(s)
- A De Jongh
- Psychotrauma Expertise Centre (PSYTREC), Bilthoven, The Netherlands
- Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and VU University Amsterdam, Amsterdam, The Netherlands
- Research Department PSYTREC, Bilthoven, The Netherlands
- School of Health Sciences, Salford University, Manchester, UK
- Institute of Health and Society, University of Worcester, Worcester, UK
- School of Psychology, Queen's University, Belfast, Northern Ireland
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23
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Fedorchenko Y, Mahmudov K, Abenov Z, Zimba O, Yessirkepov M. Rehabilitation of patients with inflammatory rheumatic diseases and comorbidities: unmet needs. Rheumatol Int 2024; 44:583-591. [PMID: 38296848 DOI: 10.1007/s00296-023-05529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/25/2023] [Indexed: 02/02/2024]
Abstract
Comorbidities may contribute to inadequate response to therapy and accelerate disability in various rheumatic diseases such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and psoriatic arthritis (PsA). Cardiovascular, oncological, and infectious comorbidities are common in rheumatic patients. The rehabilitation of patients with inflammatory rheumatic diseases (IRDs) with comorbidities requires a multidisciplinary approach to improving patients' functional mobility, slowing down the disease progression and minimizing the risks of complications. The evidence suggests that cardiac rehabilitation can be implemented in daily practice in patients with IRDs to reduce mortality for those with established risk factors. Physical exercises reduce the severity, improve the clinical course, and reduce hospitalization rates in patients with rheumatic diseases. A rehabilitation program with focused physical therapy can lead to functional improvements and reduction of disease activity in patients with lowered quality of life (QoL). Health professionals should provide evidence-based recommendations for patients with rheumatic diseases and comorbidities to initiate the self-management of their diseases and prevent complications.
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Affiliation(s)
- Yuliya Fedorchenko
- Department of Pathophysiology, Ivano-Frankivsk National Medical University, Halytska Str. 2, Ivano-Frankivsk, 76018, Ukraine.
| | - Khaiyom Mahmudov
- Department of Propaedeutics of Internal Diseases, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - Zhumabek Abenov
- Student Polyclinic, Shymkent, Kazakhstan
- South Kazakhstan Medical Academy, Shymkent, Kazakhstan
| | - Olena Zimba
- Department of Clinical Rheumatology and Immunology, University Hospital in Krakow, Krakow, Poland
- National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
- Department of Internal Medicine N2, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Marlen Yessirkepov
- Department of Biology and Biochemistry, South Kazakhstan Medical Academy, Shymkent, Kazakhstan
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Kimbrough BA, Crowson CS, Lennon RJ, Davis JM, Strangfeld A, Myasoedova E. Multiple morbidities are associated with serious infections in patients with rheumatoid arthritis. Semin Arthritis Rheum 2024; 65:152386. [PMID: 38244447 PMCID: PMC10954402 DOI: 10.1016/j.semarthrit.2024.152386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVE To assess the association between a comprehensive list of morbidities and serious infection (SI) in patients with rheumatoid arthritis (RA). METHODS This study evaluated SI risk associated with 55 comorbidities using a population-based inception cohort including all adult patients with incident RA from 1999 through 2014 with follow up through 2021. Morbidities and SI were ascertained using previously validated international classification of disease (ICD)-9 and ICD-10 codes. Conditional frailty models were utilized to analyze the association between each morbidity and SI: Model 1 adjusted for age, sex, and calendar year; Model 2 adjusted for factors in Model 1 and the Rheumatoid Arthritis Observation of Biologic Therapy (RABBIT) Risk Score of Infections; and Model 3 adjusted for factors in Model 1 and the Mayo SI Risk Score. RESULTS 911 patients (70 % female, mean age 56 years, 66 % seropositive) were included. There were 293 SI among 155 patients (17 %), corresponding to an incidence of 3.9 SI per 100 person-years. Eighteen SI were fatal. Risk of SI was significantly increased in 27 of 55 morbidities in Model 1, 11 morbidities in Model 2, and 23 morbidities in Model 3. Additionally, several morbidities included in the RABBIT and Mayo risk scores continued to have large effect sizes despite adjustment. Serious infection risk increased by 11-16 % per morbidity in the three models. CONCLUSIONS Several morbidities are associated with an increased risk for SI. Future risk scores may include morbidities identified in this study for improved SI risk assessment.
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Affiliation(s)
- Bradly A Kimbrough
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA; Department of Quantitative Health Sciences Division of Clinical Trials and Biostatistics, Mayo Clinic, 200 1st ST SW, Rochester, MN 55905, USA
| | - Ryan J Lennon
- Department of Quantitative Health Sciences Division of Clinical Trials and Biostatistics, Mayo Clinic, 200 1st ST SW, Rochester, MN 55905, USA
| | - John M Davis
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Anja Strangfeld
- Epidemiology and Health Services Research, German Rheumatism Research Centre (DRFZ) Berlin and Charite University Medicine, Charitéplatz 1, Berlin 10117, Federal Republic of Germany
| | - Elena Myasoedova
- Division of Rheumatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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25
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Pradhan P, Wen W, Shrubsole M, Steinwandel M, Han X, Powers AC, Lipworth L, Zheng W. Association of cardiometabolic comorbidities with mortality among low-income Black and White Americans. J Natl Med Assoc 2024; 116:189-201. [PMID: 38296693 DOI: 10.1016/j.jnma.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/20/2023] [Accepted: 01/09/2024] [Indexed: 02/02/2024]
Abstract
METHODS Investigated the association of multiple cardiometabolic comorbidities with total/major cause-specific mortality and evaluate if this association might be modified by race among predominantly low-income Black and White participants. METHODS The Southern Community Cohort Study, prospective cohort study. Participants (40-79 years) recruited predominantly from community health centers across 12 states in southeastern United States. Enrollment began in 2002 and concluded in 2009, follow-up until 2020. Cardiometabolic comorbidities (diabetes, hypertension, myocardial infarction, stroke) ascertained at the baseline survey. Cox proportional hazard models used. RESULTS Study included 76,721 participants; 16,197, 41,944, 5,247, and 4,919 participants with prior diagnosis of diabetes, hypertension, myocardial infarction, and stroke, respectively at baseline. Compared to individuals with no comorbidity, individuals with any single comorbidity experienced a significantly 30 to 90% increased rate of death due to any causes. The increase in mortality was elevated with an increasing number of comorbidities, with HR of 3.81 (95% CI: 3.26-4.46) and a cumulative risk of 62.5% at age 75 years for total mortality for those with four comorbidities. The risk was high for death due to cardiovascular diseases (HR: 6.18, 95% CI: 5.12-7.47). These associations were stronger among Blacks than Whites. Individuals with four comorbidities at age 40 years were estimated to have a 16-year loss in life expectancy compared with those without any comorbidity. CONCLUSION Cardiometabolic comorbidities were associated with increases in all-cause and major cause-specific mortality, particularly Black Americans. This study calls for effective measures to prevent cardiometabolic comorbidities to reduce premature deaths in underserved Americans.
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Affiliation(s)
- Pranoti Pradhan
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Wanqing Wen
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Martha Shrubsole
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Mark Steinwandel
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Xijing Han
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Alvin C Powers
- Division of Diabetes and Endocrinology, Department of Medicine, Vanderbilt University Medical Center, 1301 Medical Center Drive, Nashville, TN, 37232 USA
| | - Loren Lipworth
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA
| | - Wei Zheng
- Division of Epidemiology, Department of Medicine, Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, 1161 21(st) Avenue South, Nashville, TN, 37232 USA.
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Green RL, Gao TP, Kuo LE. Perioperative Outcomes After Adrenalectomy for Secondary Adrenal Malignancy. J Surg Res 2024; 296:556-562. [PMID: 38340489 DOI: 10.1016/j.jss.2024.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 01/06/2024] [Accepted: 01/17/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION The risk of adverse outcomes after adrenal metastasectomy is not well defined. Knowledge of these risks is essential to guide patient counseling. METHODS The 2015-2020 National Surgical Quality Improvement Program datasets were combined. Patients who underwent adrenalectomy for secondary adrenal malignancy (SM) and benign nonfunctional (BNF) adrenal neoplasms were identified; BNF neoplasms were chosen as a comparison as functional neoplasms can contribute to comorbidity. Patients who had additional surgery at the time of adrenalectomy were excluded. Patient demographics, comorbidities, perioperative factors, and outcomes were compared between groups. Multivariable logistic regression analysis was performed. RESULTS Of 3496 adrenalectomy patients, 332 had SM and 3164 had BNF neoplasms. Patients with SM were older (65 versus 54 y) and more often had chronic obstructive pulmonary disease (7.5% versus 4.4%), chronic steroid use (10.5% versus 3.8%), and bleeding disorders (4.5% versus 2.2%) than patients with BNF, respectively (P < 0.01 for all). Laparoscopic adrenalectomy was the most common operative approach for both groups (74.7% versus 88.3%). Rates of mortality, morbidity, reoperation, readmission, and nonhome discharge did not differ significantly between groups. Patients with SM had higher rates of postoperative bleeding than patients with BNF (6.3% versus 2.6%, P < 0.001). This persisted on multivariable regression analysis that adjusted for demographics, comorbidities, and operative approach (odds ratio 2.34, 95% confidence interval 1.19-4.64). CONCLUSIONS Adrenalectomy for SM is associated with an increased risk of postoperative bleeding compared to adrenalectomy for BNF adrenal neoplasms. Patients with SM that meet criteria for adrenal metastasectomy should be counseled appropriately.
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Affiliation(s)
- Rebecca L Green
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania.
| | - Terry P Gao
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Lindsay E Kuo
- Department of General Surgery, Temple University Lewis Katz School of Medicine, Philadelphia, Pennsylvania
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Shahrestani S, Reardon T, Brown NJ, Kuo CC, Gendreau J, Singh R, Patel NA, Chou D, Chan AK. Developing Mixed-Effects Models to Compare the Predictive Ability of Various Comorbidity Indices in a Contemporary Cohort of Patients Undergoing Lumbar Fusion. Neurosurgery 2024; 94:711-720. [PMID: 37855622 DOI: 10.1227/neu.0000000000002733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/01/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND AND OBJECTIVE As incidence of operative spinal pathology continues to grow, so do the rates of lumbar spinal fusion procedures. Comorbidity indices can be used preoperatively to predict potential complications. However, there is a paucity of research defining the optimal comorbidity indices in patients undergoing spinal fusion surgery. We aimed to use modeling strategies to evaluate the predictive validity of various comorbidity indices and combinations thereof. METHODS Patients who underwent spinal fusion were queried using data from the Nationwide Readmissions Database for the years 2016 through 2019. Using comorbidity indices as predictor variables, receiver operating characteristic curves were developed for pertinent complications such as mortality, nonroutine discharge, top-quartile cost, top-quartile length of stay, and 30-day readmission. RESULTS A total of 750 183 patients were included. Nonroutine discharges occurred in 161 077 (21.5%) patients. The adjusted all-payer cost for the procedure was $37 616.97 ± $27 408.86 (top quartile: $45 409.20), and the length of stay was 4.1 ± 4.4 days (top quartile: 8.1 days). By comparing receiver operating characteristics of various models, it was found that models using Frailty + Elixhauser Comorbidity Index (ECI) as the primary predictor performed better than other models with statistically significant P -values on post hoc testing. However, for prediction of mortality, the model using Frailty + ECI was not better than the model using ECI alone ( P = .23), and for prediction of all-payer cost, the ECI model outperformed the models using frailty alone ( P < .0001) and the model using Frailty + ECI ( P < .0001). CONCLUSION This investigation is the first to use big data and modeling strategies to delineate the relative predictive utility of the ECI and Johns Hopkins Adjusted Clinical Groups comorbidity indices for the prognostication of patients undergoing lumbar fusion surgery. With the knowledge gained from our models, spine surgeons, payers, and hospitals may be able to identify vulnerable patients more effectively within their practice who may require a higher degree of resource utilization.
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Affiliation(s)
- Shane Shahrestani
- Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles , California , USA
- Department of Medical Engineering, California Institute of Technology, Pasadena , California , USA
| | - Taylor Reardon
- Kentucky College of Osteopathic Medicine, University of Pikeville, Pikeville , Kentucky , USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, Orange , California , USA
| | - Cathleen C Kuo
- Department of Neurological Surgery, University at Buffalo, Buffalo , New York , USA
| | - Julian Gendreau
- Department of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore , Maryland , USA
| | - Rohin Singh
- Mayo Clinic Alix School of Medicine, Arizona Campus, Scottsdale , Arizona , USA
| | - Neal A Patel
- School of Medicine, Mercer University, Savannah , Georgia , USA
| | - Dean Chou
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York , New York , USA
| | - Andrew K Chan
- Department of Neurological Surgery, Columbia University Vagelos College of Physicians and Surgeons, The Och Spine Hospital at NewYork-Presbyterian, New York , New York , USA
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Lisoni J, Nibbio G, Baldacci G, Cicale A, Zucchetti A, Bertoni L, Calzavara Pinton I, Necchini N, Deste G, Barlati S, Vita A. What impact can brain stimulation interventions have on borderline personality disorder? Expert Rev Neurother 2024; 24:343-360. [PMID: 38349069 DOI: 10.1080/14737175.2024.2316133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 02/05/2024] [Indexed: 03/12/2024]
Abstract
INTRODUCTION Borderline personality disorder (BPD) is a severe mental disorder characterized by emotion dysregulation, impulsivity, neuropsychological impairment, and interpersonal instability, presenting with multiple psychiatric comorbidities, functional disability and reduced life expectancy due suicidal behaviors. AREAS COVERED In this perspective, the authors explore the application of noninvasive brain stimulation (NIBS) (rTMS, tDCS, and MST) in BPD individuals by considering a symptom-based approach, focusing on general BPD psychopathology, impulsivity and neuropsychological impairments, suicidality and depressive/anxious symptoms, and emotion dysregulation. EXPERT OPINION According to a symptoms-based approach, NIBS interventions (particularly rTMS and tDCS) are promising treatment options for BPD individuals improving core symptoms such as emotional and behavioral dysregulation, neuropsychological impairments and depressive symptoms. However, the heterogeneity of stimulation protocols and of assessment tools used to detect these changes limits the possibility to provide definitive recommendations according to a symptom-based approach. To implement such armamentarium in clinical practice, future NIIBS studies should further consider a lifespan perspective due to clinical variability over time, the role of psychiatric comorbidities affecting BPD individuals and the need to combine NIBS with specialized psychotherapeutic approaches for BPD patients and with functional neuroimaging studies.
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Affiliation(s)
- Jacopo Lisoni
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Gabriele Nibbio
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Baldacci
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Cicale
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Andrea Zucchetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Lorenzo Bertoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | | | - Nicola Necchini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giacomo Deste
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Barlati
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Antonio Vita
- Department of Mental Health and Addiction Services, ASST Spedali Civili of Brescia, Brescia, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
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Qu HQ, Glessner JT, Qu J, Liu Y, Watson D, Chang X, Saeidian AH, Qiu H, Mentch FD, Connolly JJ, Hakonarson H. High Comorbidity of Pediatric Cancers in Patients with Birth Defects: Insights from Whole Genome Sequencing Analysis of Copy Number Variations. Transl Res 2024; 266:49-56. [PMID: 37989391 DOI: 10.1016/j.trsl.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/01/2023] [Accepted: 11/17/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Patients with birth defects (BD) exhibit an elevated risk of cancer. We aimed to investigate the potential link between pediatric cancers and BDs, exploring the hypothesis of shared genetic defects contributing to the coexistence of these conditions. METHODS This study included 1454 probands with BDs (704 females and 750 males), including 619 (42.3%) with and 845 (57.7%) without co-occurrence of pediatric onset cancers. Whole genome sequencing (WGS) was done at 30X coverage through the Kids First/Gabriella Miller X01 Program. RESULTS 8211 CNV loci were called from the 1454 unrelated individuals. 191 CNV loci classified as pathogenic/likely pathogenic (P/LP) were identified in 309 (21.3%) patients, with 124 (40.1%) of these patients having pediatric onset cancers. The most common group of CNVs are pathogenic deletions covering the region ChrX:52,863,011-55,652,521, seen in 162 patients including 17 males. Large recurrent P/LP duplications >5MB were detected in 33 patients. CONCLUSIONS This study revealed that P/LP CNVs were common in a large cohort of BD patients with high rate of pediatric cancers. We present a comprehensive spectrum of P/LP CNVs in patients with BDs and various cancers. Notably, deletions involving E2F target genes and genes implicated in mitotic spindle assembly and G2/M checkpoint were identified, potentially disrupting cell-cycle progression and providing mechanistic insights into the concurrent occurrence of BDs and cancers.
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Affiliation(s)
- Hui-Qi Qu
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Joseph T Glessner
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA; Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Jingchun Qu
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Yichuan Liu
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Deborah Watson
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Xiao Chang
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Amir Hossein Saeidian
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Haijun Qiu
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Frank D Mentch
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - John J Connolly
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA
| | - Hakon Hakonarson
- Center for Applied Genomics (CAG), Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA; Department of Pediatrics, The Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, 19104, USA; Division of Human Genetics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA; Division of Pulmonary Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, 19104, USA; Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
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Patel J, Zia H, Lo DF. Analyzing key genetic and comorbid factors on the efficacy of digital therapeutics for treating high blood pressure. Blood Press Monit 2024; 29:107-108. [PMID: 38419593 DOI: 10.1097/mbp.0000000000000687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- Jigar Patel
- Department of Medicine, Rowan University School of Osteopathic Medicine
- American Preventive Screening & Education Association (APSEA), Stratford
| | - Hasan Zia
- American Preventive Screening & Education Association (APSEA), Stratford
- Department of Biology, Rutgers, the State University of New Jersey, New Brunswick
| | - David F Lo
- Department of Medicine, Rowan University School of Osteopathic Medicine
- American Preventive Screening & Education Association (APSEA), Stratford
- Department of Biology, Rutgers, the State University of New Jersey, New Brunswick
- Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
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O'Brien C, Murad V, Renton M. Up-to-date review into the evolving world of bariatric interventions: a guide for radiologists. Abdom Radiol (NY) 2024; 49:1007-1019. [PMID: 38329482 DOI: 10.1007/s00261-023-04137-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 11/08/2023] [Accepted: 11/23/2023] [Indexed: 02/09/2024]
Abstract
Obesity is a worldwide health concern leading to several chronic health problems and comorbidities. Its treatment requires a multidisciplinary approach where lifestyle changes are fundamental. Additionally, in the past decade, the use of different surgical procedures of various levels of complexity has grown, with the objective of reducing the gastric capacity, creating diversions, or a combination of both. The aim of this article is to review and illustrate the major types of bariatric surgical techniques, their normal post-surgical anatomy, and the possible associated complications, to aid the radiologist in their assessment and timely diagnosis.
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Affiliation(s)
- Ciara O'Brien
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada. ciara.o'
| | - Vanessa Murad
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
| | - Mary Renton
- Department of Medical Imaging, JDMI University Health Network, University of Toronto, 610 University Avenue, Toronto, ON, M5G 2M9, Canada
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Medrano Nava E, Flores-Lázaro JC, Nicolini Sánchez H, Juárez García F. Effects of comorbidity on executive functions among children with ADHD, finding trends. Appl Neuropsychol Child 2024; 13:100-112. [PMID: 36395527 DOI: 10.1080/21622965.2022.2135440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
There is still no basic overview about the effect of various types of comorbidity in executive functions due to two main reasons: (1) the type and number of comorbidities in ADHD is significantly varied, (2) EFs are very diverse and have different neuropsychological properties. Our objective was to determine the effect of comorbid disorders (number and type) on the performance in a wide range (seven) of executive functions in a sample of children with ADHD. Fifty-five male children aged seven to nine years with ADHD were divided into six groups: G1 = ADHD only (ADHD-O), G1 = Oppositional defiant disorder (ODD), G3 = (anxiety/depressive disorder (ADD), G4 = ODD + ADD, G5 = ODD + learning disorder (LD), G6 = ODD + LD + conduct disorder (CD). The six groups exhibited different number of deficits in EFs; G1 showed only 1 deficit in contrast, G6 presented 11. Statistical analysis (ANOVA and logistic regression) identified three most affected EFs: Working memory, generation/classification of semantic categories, and inhibitory control. Alterations in EFs increased mainly in relation to the increase of the specific number and type of comorbidity. To date, no studies have addressed comorbidity from this perspective. A wide range approach of EF confirms the need to further study comorbidity in ADHD from a wide range/variety perspective and determine all possible combinations (number/type) to clarify its contribution to the complex neuropsychology functioning in ADHD.
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Affiliation(s)
- Eliana Medrano Nava
- Child Psychiatry Hospital, SAP-DJNN, Ministry of Health, Mexico City, Mexico
- Postgraduate program in Health Sciences, Faculty of Medicine, UNAM, Mexico City, Mexico
| | - Julio C Flores-Lázaro
- Child Psychiatry Hospital, SAP-DJNN, Ministry of Health, Mexico City, Mexico
- Psychology Faculty, UNAM, Mexico City, Mexico
| | - Humberto Nicolini Sánchez
- Genomics of Psychiatric and Neurodegenerative Diseases Laboratory, National Institute of Genomic Medicine (INMEGEN), Mexico City, Mexico
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Lee C, Park YH, Cho B, Lee HA. A network-based approach to explore comorbidity patterns among community-dwelling older adults living alone. GeroScience 2024; 46:2253-2264. [PMID: 37924440 PMCID: PMC10828172 DOI: 10.1007/s11357-023-00987-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/14/2023] [Indexed: 11/06/2023] Open
Abstract
The detailed comorbidity patterns of community-dwelling older adults have not yet been explored. This study employed a network-based approach to investigate the comorbidity patterns of community-dwelling older adults living alone. The sample comprised a cross-sectional cohort of adults 65 or older living alone in a Korean city (n = 1041; mean age = 77.7 years, 77.6% women). A comorbidity network analysis that estimates networks aggregated from measures of significant co-occurrence between pairs of diseases was employed to investigate comorbid associations between 31 chronic conditions. A cluster detection algorithm was employed to identify specific clusters of comorbidities. The association strength was expressed as the observed-to-expected ratio (OER). As a result, fifteen diseases were interconnected within the network (OER > 1, p-value < .05). While hypertension had a high prevalence, osteoporosis was the most central disease, co-occurring with numerous other diseases. The strongest associations among comorbidities were found between thyroid disease and urinary incontinence, chronic otitis media and osteoporosis, gastric duodenal ulcer/gastritis and anemia, and depression and gastric duodenal ulcer/gastritis (OER > 1.85). Three distinct clusters were identified as follows: (a) cataracts, osteoporosis, chronic otitis media, osteoarthritis/rheumatism, low back pain/sciatica, urinary incontinence, post-accident sequelae, and thyroid diseases; (b) hyperlipidemia, diabetes mellitus, and hypertension; and (c) depression, skin disease, gastric duodenal ulcer/gastritis, and anemia. The results may prove valuable in guiding the early diagnosis, management, and treatment of comorbidities in older adults living alone.
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Affiliation(s)
- Chiyoung Lee
- School of Nursing & Health Studies, University of Washington Bothell, 18115 Campus Way NE, Bothell, WA, 98011, USA
| | - Yeon-Hwan Park
- College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
| | - Belong Cho
- Department of Family Medicine, College of Medicine, Seoul National University, 103 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Health Promotion Center, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Hye Ah Lee
- Clinical Trial Center, Ewha Womans University Mokdong Hospital, 1071 Anyangcheon-Ro, Yangcheon-Gu, Seoul, 07985, Republic of Korea
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Karsten RT, Rijken JA, Toprak I, Kant E, de Bree R, Smeele LE, van den Brekel MWM, de Vries N, Ravesloot MJL. Prevalence of obstructive sleep apnea after treatment for advanced T-stage head and neck cancer. Eur Arch Otorhinolaryngol 2024; 281:1941-1952. [PMID: 38326581 PMCID: PMC10943135 DOI: 10.1007/s00405-024-08467-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/09/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE Treatment of head and neck cancer (HNC) may lead to obstructive sleep apnea (OSA), but conclusive results on the prevalence of OSA are lacking. The objective of this study is to investigate the prevalence of OSA in a cohort of patients treated for advanced T-stage HNC. METHODS A cross-sectional study was conducted in two tertiary cancer care centers including patients at least 1 year after treatment with curative intent with surgery and/or (chemo)radiotherapy ((C)RT) for advanced T-staged (T3-4) cancer of the oral cavity, oropharynx, hypopharynx, or larynx. A polysomnography (PSG) was performed in all participants. OSA was defined as an apnea-hypopnea index (AHI) of 15 events/h or higher or an AHI of 5 events/h and higher with OSA related symptoms, such as sleeping problems, daytime dysfunction and/or cardiac/metabolic comorbidities collected through file review and questionnaires. RESULTS Of the 67 participants, 48 (72%, 95% CI 59-82%) were diagnosed with OSA. Possible risk factors are male gender, higher BMI, greater neck circumference, more nicotine pack years, cardiometabolic comorbidities, use of medication with sleepiness as side effect, present tonsils, lower T-stage (T3 vs. T4 stage), higher AJCC stage and a HPV-negative tumor. CONCLUSION In this population of advanced T-stage HNC patients, the prevalence of OSA was 72%, which is considerably higher than in the general population (2-50%). Given the high prevalence, screening of this entire subgroup for OSA may be indicated. Future studies to identify high risk factors and develop an OSA screening protocol are needed.
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Affiliation(s)
- R T Karsten
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J A Rijken
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Toprak
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - E Kant
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R de Bree
- Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L E Smeele
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - M W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
- Amsterdam Center for Language and Communication/ACLC-Institute of Phonetic Sciences, University of Amsterdam, Amsterdam, The Netherlands.
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands.
- , Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
| | - N de Vries
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
| | - M J L Ravesloot
- Department of Otorhinolaryngology and Head and Neck Surgery, OLVG, Amsterdam, The Netherlands
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Zhu KY, Bobak L, Dorney I, Breslin MA, Hendrickson SB, Vallier HA. Risk of Fracture and Complications After Fixation in Patients With Pre-injury Psychiatric Illness: A Propensity-Matched Cohort Study. J Orthop Trauma 2024; 38:e142-e148. [PMID: 38381117 DOI: 10.1097/bot.0000000000002755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/27/2023] [Indexed: 02/22/2024]
Abstract
OBJECTIVES The purpose was to describe the frequency of orthopaedic trauma and postsurgical complications associated with psychiatric diagnoses. METHODS DESIGN Query of TriNetx Analytics Network. SETTING Participating hospitals. PATIENT SELECTION CRITERIA Those ≥18 years old with psychiatric illness and orthopaedic trauma. OUTCOME MEASURES AND COMPARISONS Fractures and postoperative complications were described. A 1:1 propensity score matching function was used. Odds ratios compared intercohort complications. RESULTS A total of 11,266,415 patients were identified with a psychiatric diagnosis, including bipolar disorder (8.9%), schizophrenia (3.3%), major depression (12.4%), stress-related disorder (9.6%), anxiety disorder (64.5%), borderline personality disorder (1.1%), or antisocial personality (0.2%). Prevalence of 30.2% was found for a fracture and at least 1 psychiatric diagnosis. Antisocial personality disorder had the highest risk ratio relative to people without that mental disorder (relative risk [RR] = 5.09) of having 1 or more associated fracture, followed by depression (RR = 3.03), stress-related disorders (RR = 3.00), anxiety disorders (RR = 2.97), borderline personality disorder (RR = 2.92), bipolar disorder (RR = 2.80), and schizophrenia (RR = 2.69). Patients with at least 1 psychiatric comorbidity had greater risk of pulmonary embolism, superficial and deep surgical site infections, pneumonia, urinary tract infection, deep venous thrombosis, osteonecrosis, and complex regional pain syndrome by 1 month after fixation, when compared with patients without psychiatric disorder. By 1 year, they were also at an increased risk for stroke and myocardial infarction. CONCLUSIONS All psychiatric comorbidities were associated with increased RR of fracture and higher odds of complications compared with patients without psychiatric comorbidities. Providers should be aware of preexisting psychiatric diagnoses during treatment of acute injuries because of these risks. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Kevin Y Zhu
- Case Western Reserve University School of Medicine, Cleveland, OH
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Venchiarutti RL, Clark JR, Palme CE, Dwyer P, Tahir ARM, Hill J, Ch'ng S, Elliott MS, Young JM. Associations between patient-level health literacy and diagnostic time intervals for head and neck cancer: A prospective cohort study. Head Neck 2024; 46:857-870. [PMID: 38213101 DOI: 10.1002/hed.27633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 12/20/2023] [Accepted: 12/31/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Health literacy (HL) comprises skills and knowledge required to understand, access, and make decisions about healthcare. Our aim was to examine associations between patient HL and time intervals (defined in the Aarhus statement) along the pathway to treatment of head and neck cancer (HNC). METHODS A prospective cohort study was conducted from October 2018 to March 2020. Participants completed the Health Literacy Questionnaire (HLQ®) and described key events and dates along the pathway to treatment using validated questionnaires. Correlations between six diagnostic time intervals and domains of HL were explored, and factors predicting exceeding maximum acceptable timeframes were assessed using logistic regression. RESULTS One hundred patients with a diagnosis of HNC within the preceding 6 months were recruited. HLQ® Domain 2 (sufficient information to manage health) was significantly negatively associated with four intervals: the patient interval (first symptom to first presentation), primary care interval (first presentation to referral to secondary care), diagnostic interval (first presentation to diagnosis), and total interval (first symptom to treatment onset); correlation coefficients -0.25 to -0.27 (P < 0.05). Domain 8 (ability to find good information) was significantly negatively associated with three intervals (primary care interval, diagnostic interval, and total interval; correlation coefficients -0.23 to -0.34; P < 0.05). Higher education, age, and comorbidity levels were associated with shorter patient and diagnostic intervals. CONCLUSIONS HL may be a potential target to improve timeliness of HNC diagnosis and reduce disparities in outcomes.
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Affiliation(s)
- Rebecca L Venchiarutti
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
| | - Jonathan R Clark
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Carsten E Palme
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Patrick Dwyer
- Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia
| | - Abdul Rahim Mohd Tahir
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia
| | - Jacques Hill
- Department of Radiation Oncology, Mid North Coast Cancer Institute, Port Macquarie, New South Wales, Australia
| | - Sydney Ch'ng
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- RPA Institute of Academic Surgery, Sydney Local Health District, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Michael S Elliott
- Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Camperdown, New South Wales, Australia
- The University of Sydney, Faculty of Medicine and Health, Central Clinical School, Camperdown, New South Wales, Australia
| | - Jane M Young
- The University of Sydney, Faculty of Medicine and Health, Sydney School of Public Health, Camperdown, New South Wales, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Camperdown, New South Wales, Australia
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Zarnowski J, Treudler R. [Which augmentation and trigger factors are relevant in urticaria?]. Dermatologie (Heidelb) 2024; 75:295-302. [PMID: 38347239 DOI: 10.1007/s00105-024-05306-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 03/27/2024]
Abstract
The aim of this review is to present relevant trigger as well as augmentation factors that can induce or exacerbate urticaria on the basis of a current, PubMed-based literature search. In addition to a brief description of relevant influencing factors in acute and chronic inducible urticaria, the focus will be on chronic spontaneous urticaria. In particular, the aggravating role of medication, stress, food, psychological and metabolic comorbidities, infections and inflammation as well as hormonal processes will be discussed.
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Affiliation(s)
- Julia Zarnowski
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig A.ö.R., Philipp-Rosenthal-Str. 69, 04103, Leipzig, Deutschland.
| | - Regina Treudler
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig A.ö.R., Philipp-Rosenthal-Str. 69, 04103, Leipzig, Deutschland
- Institut für Allergieforschung, Charité Universitätsklinikum Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Deutschland
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von Deimling M, Rink M, Klemm J, Koelker M, Schuettfort V, König F, Gild P, Ludwig TA, Marks P, Dahlem R, Fisch M, Shariat SF, Vetterlein MW. Comprehensive Evaluation of the Ability of Comorbidity and Health Status Indices to Improve the Prediction of Perioperative Morbidity and Long-Term Survival Outcomes After Radical Cystectomy. Clin Genitourin Cancer 2024; 22:336-346.e9. [PMID: 38199879 DOI: 10.1016/j.clgc.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND In the era of standardized outcome reporting, it remains unclear if widely used comorbidity and health status indices can enhance predictive accuracy for morbidity and long-term survival outcomes after radical cystectomy (RC). PATIENTS AND METHODS In this monocentric study, we included 468 patients undergoing open RC with pelvic lymph node dissection for bladder cancer between January 2009 and December 2017. Postoperative complications were meticulously assessed according to the EAU guideline criteria for standardized outcome reporting. Multivariable regression models were fitted to evaluate the ability of ASA physical status (ASA PS), Charlson comorbidity index (± age-adjustment) and the combination of both to improve prediction of (A) 30-day morbidity key estimates (major complications, readmission, and cumulative morbidity as measured by the Comprehensive Complication index [CCI]) and (B) secondary mortality endpoints (overall [OM], cancer-specific [CSM], and other-cause mortality [OCM]). RESULTS Overall, 465 (99%) and 52 (11%) patients experienced 30-day complications and major complications (Clavien-Dindo grade ≥IIIb), respectively. Thirty-seven (7.9%) were readmitted within 30 days after discharge. Comorbidity and health status indices did not improve the predictive accuracy for 30-day major complications and 30-day readmission of a reference model but were associated with 30-day CCI (all P < .05). When ASA PS and age-adjusted Charlson index were combined, ASA PS was no longer associated with 30-day CCI (P = .1). At a median follow-up of 56 months (IQR 37-86), OM, CSM, and 90-day mortality were 37%, 24%, and 2.9%, respectively. Both Charlson and age-adjusted Charlson index accurately predicted OCM (all P < .001) and OM (all P ≤ .002) but not CSM (all P ≥ .4) and 90-day mortality (all P > .05). ASA PS was not associated with oncologic outcomes (all P ≥ .05). CONCLUSION While comorbidity and health status indices have a role in predicting OCM and OM after RC, their importance in predicting postoperative morbidity is limited. Especially ASA PS performed poorly. This highlights the need for procedure-specific comorbidity assessment rather than generic indices.
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Affiliation(s)
- Markus von Deimling
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jakob Klemm
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mara Koelker
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Victor Schuettfort
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Frederik König
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Philipp Gild
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tim A Ludwig
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Phillip Marks
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Roland Dahlem
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Margit Fisch
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Hourani Center for Applied Scientific Research, Al-Ahliyya Amman University, Amman, Jordan; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX; Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic; Department of Urology, Weill Cornell Medical College, New York, NY; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria
| | - Malte W Vetterlein
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Samuelsson J, Bertilsson R, Bülow E, Carlsson S, Åkesson S, Eliasson B, Hanas R, Åkesson K. Autoimmune comorbidity in type 1 diabetes and its association with metabolic control and mortality risk in young people: a population-based study. Diabetologia 2024; 67:679-689. [PMID: 38252314 PMCID: PMC10904419 DOI: 10.1007/s00125-024-06086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/27/2023] [Indexed: 01/23/2024]
Abstract
AIMS/HYPOTHESIS This register-based study aimed to describe autoimmune comorbidity in children and young adults from type 1 diabetes onset, and to investigate whether such comorbidity was associated with a difference in HbA1c or mortality risk compared with children/young adults with type 1 diabetes without autoimmune comorbidity. METHODS A total of 15,188 individuals from the Swedish National Diabetes Register, registered with type 1 diabetes before 18 years of age between 2000 and 2019, were included. Five randomly selected control individuals from the Swedish population (Statistics Sweden) were matched to each individual with type 1 diabetes (n=74,210 [346 individuals with type 1 diabetes were not found in the Statistics Sweden register at the date of type 1 diabetes diagnosis, so could not be matched to control individuals]). The National Patient Register was used to attain ICD-10 codes on autoimmune diseases and the Cause of Death Register was used to identify deceased individuals. RESULTS In the total type 1 diabetes cohort, mean±SD age at onset of type 1 diabetes was 9.5±4.4 years and mean disease duration at end of follow-up was 8.8±5.7 years. Of the individuals with type 1 diabetes, 19.2% were diagnosed with at least one autoimmune disease vs 4.0% of the control group. The HRs for comorbidities within 19 years from onset of type 1 diabetes were 11.6 (95% CI 10.6, 12.6) for coeliac disease, 10.6 (95% CI 9.6, 11.8) for thyroid disease, 1.3 (95% CI 1.1, 1.6) for psoriasis, 4.1 (95% CI 3.2, 5.3) for vitiligo, 1.7 (95% CI 1.4, 2.2) for rheumatic joint disease, 1.0 (95% CI 0.8, 1.3) for inflammatory bowel disease, 1.0 (95% CI 0.7, 1.2) for systemic connective tissue disorder, 1.4 (95% CI 1.1, 1.9) for uveitis, 18.3 (95% CI 8.4, 40.0) for Addison's disease, 1.8 (95% CI 0.9, 3.6) for multiple sclerosis, 3.7 (95% CI 1.6, 8.7) for inflammatory liver disease and 19.6 (95% CI 4.2, 92.3) for atrophic gastritis. Autoimmune disease in addition to type 1 diabetes had no statistically significant effect on HbA1c or mortality risk. CONCLUSIONS/INTERPRETATION To our knowledge, this is the first comprehensive study where young individuals with type 1 diabetes were followed regarding development of a wide spectrum of autoimmune diseases, from onset of type 1 diabetes. In this nationwide and population-based study, there was already a high prevalence of autoimmune diseases in childhood, especially coeliac and thyroid disease. The presence of autoimmune comorbidity did not have a statistically significant effect on metabolic control or mortality risk.
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Affiliation(s)
- John Samuelsson
- Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
| | | | - Erik Bülow
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Department of Orthopaedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sanna Carlsson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Sanna Åkesson
- The Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Centre of Registers in Region Västra Götaland, Gothenburg, Sweden
- Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ragnar Hanas
- The Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics, NU Hospital Group, Uddevalla, Sweden
| | - Karin Åkesson
- Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
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Šonka K, Feketeová E, Nevšímalová S, Horvat EM, Příhodová I, Dostálová S, Galušková K, Milata M, Bušková J, Susta M. Idiopathic hypersomnia years after the diagnosis. J Sleep Res 2024; 33:e14011. [PMID: 37572055 DOI: 10.1111/jsr.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/18/2023] [Accepted: 07/25/2023] [Indexed: 08/14/2023]
Abstract
Little attention has been paid to the long-term development of idiopathic hypersomnia symptoms and idiopathic hypersomnia comorbidities. The aim of this study was to describe the general health of patients with idiopathic hypersomnia years after the initial diagnosis, focusing on current subjective hypersomnolence and the presence of its other possible causes. Adult patients diagnosed with idiopathic hypersomnia ≥ 3 years ago at sleep centres in Prague and Kosice were invited to participate in this study. A total of 60 patients were examined (age 47.3 ± SD = 13.2 years, 66.7% women). In all participants, their hypersomnolence could not be explained by any other cause but idiopathic hypersomnia at the time of diagnosis. The mean duration of follow-up was 9.8 + 8.0 years. Fifty patients (83%) reported persisting hypersomnolence, but only 33 (55%) had no other disease that could also explain the patient's excessive daytime sleepiness and/or prolonged sleep. In two patients (3%), the diagnosis in the meantime had changed to narcolepsy type 2, and 15 patients (25%) had developed a disease or diseases potentially causing hypersomnolence since the initial diagnosis. Complete hypersomnolence resolution without stimulant treatment lasting longer than 6 months was reported by 10 patients (17%). To conclude, in a longer interval from the diagnosis of idiopathic hypersomnia, hypersomnolence may disappear or may theoretically be explained by another newly developed disease, or the diagnosis may be changed to narcolepsy type 2. Thus, after 9.8 years, only 55% of the examined patients with idiopathic hypersomnia had a typical clinical picture of idiopathic hypersomnia without doubts about the cause of the current hypersomnolence.
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Affiliation(s)
- Karel Šonka
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Feketeová
- Department of Neurology, Faculty of Medicine, University of P.J. Šafárik and University Hospital of L. Pasteur, Košice, Slovak Republic
| | - Soňa Nevšímalová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eszter Maurovich Horvat
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Iva Příhodová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Simona Dostálová
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolína Galušková
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Martin Milata
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jitka Bušková
- National Institute of Mental Health, Klecany and Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Marek Susta
- St. Elisabeth University, Bratislava, Slovak Republic
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Wu Q, Hatse S, Kenis C, Fernández-García J, Altea-Manzano P, Billen J, Planque M, Vandekeere A, Lambrechts Y, Richard F, Punie K, Neven P, Smeets A, Nevelsteen I, Floris G, Desmedt C, Gomes AP, Fendt SM, Wildiers H. Serum methylmalonic acid concentrations at breast cancer diagnosis significantly correlate with clinical frailty. GeroScience 2024; 46:1489-1498. [PMID: 37632634 PMCID: PMC10828366 DOI: 10.1007/s11357-023-00908-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/04/2023] [Indexed: 08/28/2023] Open
Abstract
Methylmalonic acid (MMA), a by-product of propionate metabolism, is known to increase with age. This study investigates the potential of serum MMA concentrations as a biomarker for age-related clinical frailty in older patients with breast cancer. One hundred nineteen patients ≥ 70 years old with early-stage breast cancer were included (median age 76 years). G8 screening, full geriatric assessment, clinical parameters (i.e., estimated glomerular filtration rate (eGFR) and body mass index (BMI)), and serum sample collection were collected at breast cancer diagnosis before any therapy was administered. MMA concentrations were measured via liquid chromatography with tandem mass spectrometry. MMA concentrations significantly increased with age and eGFR (all P < 0.001) in this older population. The group with an abnormal G8 (≤ 14, 51% of patients) had significantly higher MMA levels than the group with normal G8 (> 14, 49%): 260 nmol/L vs. 188 nmol/L, respectively (P = 0.0004), even after correcting for age and eGFR (P = 0.001). Furthermore, in the detailed assessment, MMA concentrations correlated most with mobility (Eastern Cooperative Oncology Group (ECOG) Performance Status and Activities of Daily Living (ADL) tools, all P ≤ 0.02), comorbidity (Charlson Comorbidity Index (CCI) tool, P = 0.005), and polypharmacy (P < 0.001), whereas no significant associations were noted for instrumental ADL (IADL), Mini-Mental State Examination (MMSE), Geriatric Depression Scale-15 (GDS15), Mini Nutritional Assessment-Short Form (MNA-SF), and pain (all P > 0.1). In addition, our results showed that higher MMA levels correlate with poor overall survival in breast cancer patients (P = 0.003). Elevated serum MMA concentrations at initial diagnosis are significantly associated, not only with age but also independently with clinical frailty, suggesting a possible influence of MMA on clinical frailty in older patients with early-stage breast cancer.
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Affiliation(s)
- Qi Wu
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Louvain, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Herestraat 49, 3000, Louvain, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Herestraat 49, 3000, Louvain, Belgium
| | - Sigrid Hatse
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Louvain, Belgium
| | - Cindy Kenis
- Department of General Medical Oncology, University Hospitals Leuven, Louvain, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Louvain, Belgium
| | - Juan Fernández-García
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Herestraat 49, 3000, Louvain, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Herestraat 49, 3000, Louvain, Belgium
| | - Patricia Altea-Manzano
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Herestraat 49, 3000, Louvain, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Herestraat 49, 3000, Louvain, Belgium
| | - Jaak Billen
- Laboratory of Clinical and Experimental Endocrinology, Department of Chronic Disease and Metabolism, KU Leuven, Louvain, Belgium
| | - Mélanie Planque
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Herestraat 49, 3000, Louvain, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Herestraat 49, 3000, Louvain, Belgium
| | - Anke Vandekeere
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Herestraat 49, 3000, Louvain, Belgium
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Herestraat 49, 3000, Louvain, Belgium
| | - Yentl Lambrechts
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Louvain, Belgium
| | - François Richard
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Louvain, Belgium
| | - Kevin Punie
- Department of General Medical Oncology, University Hospitals Leuven, Louvain, Belgium
- Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium
- Multidisciplinary Breast Center, University Hospitals Leuven, Louvain, Belgium
| | - Patrick Neven
- Multidisciplinary Breast Center, University Hospitals Leuven, Louvain, Belgium
| | - Ann Smeets
- Multidisciplinary Breast Center, University Hospitals Leuven, Louvain, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, KU Leuven, Louvain, Belgium
| | - Ines Nevelsteen
- Multidisciplinary Breast Center, University Hospitals Leuven, Louvain, Belgium
| | - Giuseppe Floris
- Laboratory for Cell and Tissue Translational Research, Department of Imaging and Radiology, KU Leuven, Louvain, Belgium
- Department of Pathology, University Hospitals Leuven, Louvain, Belgium
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Louvain, Belgium
| | - Ana P Gomes
- Department of Molecular Oncology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL, USA
| | - Sarah-Maria Fendt
- Laboratory of Cellular Metabolism and Metabolic Regulation, VIB-KU Leuven Center for Cancer Biology, VIB, Herestraat 49, 3000, Louvain, Belgium.
- Laboratory of Cellular Metabolism and Metabolic Regulation, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Herestraat 49, 3000, Louvain, Belgium.
| | - Hans Wildiers
- Laboratory of Experimental Oncology (LEO), Department of Oncology, KU Leuven, Louvain, Belgium.
- Department of General Medical Oncology, University Hospitals Leuven, Louvain, Belgium.
- Department of Geriatric Medicine, University Hospitals Leuven, Louvain, Belgium.
- Multidisciplinary Breast Center, University Hospitals Leuven, Louvain, Belgium.
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Vijay M, Reuber M. An update on psychogenic nonepileptic seizures. Curr Opin Neurol 2024; 37:121-126. [PMID: 38235768 DOI: 10.1097/wco.0000000000001245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW The understanding of psychogenic nonepileptic seizures (PNES) has advanced steadily over recent decades. This update summarizes new insights from the last three years. RECENT FINDINGS The process of diagnosing PNES has shifted from the exclusion of epilepsy to one based on the recognition of typical clinical features. While the diagnosis cannot rely on any single feature in isolation, a range of semiological features characterising PNES are now recognised and a number of studies hint at the potential for machine learning and AI to improve the diagnostic process. Advances in data processing and analysis may also help to make sense of the heterogeneity of PNES populations demonstrated by recent studies focussing on aetiology and patient subgroups. It is now clear that PNES are associated with high rates of mental and physical comorbidities and premature death, highlighting that they are only one manifestation of a complex disorder extending beyond the nervous system and the seizures themselves. SUMMARY PNES are now understood as a manifestation of dysfunction in interacting brain networks. This understanding provides an explanation for the psychopathological and semiological heterogeneity of PNES patient populations. New insights into medical comorbidities and increased rates of premature death call for more research into associated pathological processes outside the nervous system.
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Affiliation(s)
| | - Markus Reuber
- Department of Neurology
- Academic Neurology Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
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Ali S, Shebl FM, Aboian E, Strosberg D, Fischer U, Cardella J, Guzman RJ, Ochoa Chaar CI. The Utilization of Protamine during Peripheral Vascular Interventions in the VQI. Ann Vasc Surg 2024; 101:72-79. [PMID: 38110083 DOI: 10.1016/j.avsg.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 09/24/2023] [Accepted: 10/22/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND Protamine administration was shown to reduce bleeding after carotid surgery but the role of protamine during peripheral vascular interventions (PVIs) remains unknown. This study evaluates the trend and outcomes of protamine use in the Vascular Quality Initiative (VQI). Our hypothesis is that the use of protamine is associated with decreased bleeding after PVI. METHODS Patients undergoing elective PVI in the VQI (2016-2020) for peripheral arterial disease were reviewed and the utilization trend for protamine was described. The characteristics of patients undergoing PVI with and without protamine use were compared. After propensity score matching based on the patient's comorbidities, access site, and procedural characteristics, the perioperative outcomes of both groups were compared using multivariable Poisson regression to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (95% CIs). RESULTS The total number of patients was 131,618 and patients who received protamine constituted 29.8% of the sample (N = 38,191). After propensity matching, the total number of patients was 94,582, and patients who received protamine constituted 28.8% of the sample (N = 27,275). Protamine use significantly increased during the study period from 5.2 to 22.9%. Before propensity score matching, patients who received protamine were more likely to be white (79% vs. 76.8, P ≤ 0.001), smokers (80.5% vs. 78.5%, P ≤ 0.001), with medical comorbidities including hypertension (88.9% vs. 88.5%, P = 0.074), congestive heart failure (20.5% vs. 19.8%, P = 0.006), and chronic obstructive pulmonary disease (28.2% vs. 26.5%). They were also more likely to be on perioperative medications such as P2Y12 inhibitors (44.3% vs. 45, P = 0.013%) and statin (77.4% vs. 76.5%, P = 0.001) compared to patients who did not receive protamine. After propensity matching, there were no significant differences between the 2 groups. There was a significant decrease in bleeding during procedures where protamine was administered compared to no protamine (2.0% vs. 2.2%) (aRR, 0.89 [95% CI 0.80, 0.98]). Protamine was more likely to be given in procedures complicated by perforation (0.8% vs. 0.5%) (aRR, 1.48 [95% CI 1.24, 1.76]) and less likely to be given during procedures with distal embolization (0.4% vs. 0.7%) (aRR, 0.59 [95% CI 0.49, 0.73]). However, patients receiving protamine had significantly higher cardiac complications (1.4% vs. 1.1%) (aRR, 1.27 [95% CI 1.12, 1.43]). There was no significant difference in mortality between the 2 groups. CONCLUSIONS Protamine use is associated with decreased perioperative bleeding but increased cardiac complications. Protamine should be selectively administered to patients at high risk of bleeding during PVI.
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Affiliation(s)
- Sahar Ali
- Vascular Surgery Department, Assiut University Hospital, Faculty of Medicine, Assiut, Egypt.
| | - Fatma M Shebl
- Medical Practice Evaluation Center, Massachusetts General Hospital, Boston, MA
| | - Edouard Aboian
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - David Strosberg
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Uwe Fischer
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Jonathan Cardella
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
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Xu H, Wang W, Yuan J, Guo C, Hu F, Yang W, Luo X, Cui J, Qiao S, Wang J. Implication of sleep apnea for cardiac remodeling in patients with hypertrophic cardiomyopathy. Sleep Med 2024; 116:115-122. [PMID: 38447294 DOI: 10.1016/j.sleep.2024.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 02/21/2024] [Accepted: 02/26/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVES Cardiac remodeling is a life-long process in hypertrophic cardiomyopathy (HCM), and if uncontrolled, would cause substantial morbidity and mortality. Sleep apnea (SA) is a common comorbidity in HCM. This study aimed to investigate the relationship between SA and cardiac remodeling in a large series of patients with HCM. METHODS A total of 606 patients with HCM who underwent sleep evaluations at Fuwai Hospital were included. Parameters of cardiac remodeling were evaluated by echocardiographic studies. RESULTS SA was present in 363 (59.9%) patients. Left ventricular (LV) end-diastolic diameter (P < 0.001), left atrial (LA) diameter (P = 0.024), ascending aortic diameter (P < 0.001) all increased and maximal end-diastolic wall thickness (P < 0.001) decreased with the severity of SA. After adjustment for sex, age, body mass index, hypertension, hyperlipidemia, diabetes, coronary artery disease and cigarette use, log (apnea-hypopnea index+1) was independently correlated with increasing LV end-diastolic diameter (β = 0.729, P = 0.003) and deceasing maximal end-diastolic wall thickness (β = -0.503, P = 0.009). Log (percentage of total sleep time spent with oxygen saturation<90% + 1) was independently correlated with increasing LV end-diastolic diameter (β = 0.609, P = 0.004) and LA diameter (β = 0.695, P = 0.006). Severity of SA (severe SA with odds ratio, 2.38; 95% CI, 1.20-4.70; P = 0.013), log (apnea-hypopnea index+1) (OR, 1.28; 95% CI, 1.01-1.63; P = 0.045) and log (percentage of total sleep time spent with oxygen saturation<90% + 1) (OR, 1.31; 95% CI, 1.08-1.59; P = 0.006) were also independently associated with LV enlargement. CONCLUSIONS Severity of SA is independently associated with cardiac remodeling indicating a trend toward enlarged chamber size and thinned wall. Clinical trials are required to determine whether treatment of SA improves cardiac remodeling and long-term outcomes in patients with HCM.
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Affiliation(s)
- Haobo Xu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiansong Yuan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Chao Guo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Fenghuan Hu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Weixian Yang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoliang Luo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Jingang Cui
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
| | - Shubin Qiao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China
| | - Juan Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Beijing, China.
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Shah JK, Amakiri UO, Cevallos P, Yesantharao P, Ayyala H, Sheckter CC, Nazerali R. Updated Trends and Outcomes in Autologous Breast Reconstruction in the United States, 2016-2019. Ann Plast Surg 2024; 92:e1-e13. [PMID: 38320006 DOI: 10.1097/sap.0000000000003764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
INTRODUCTION Autologous breast reconstruction (ABR) has increased in recent decades, although concerns for access remain. As such, our goal is to trend national demographics and operative characteristics of ABR in the United States. METHODS Using the National Inpatient Sample, 2016-2019, the International Classification of Disease , Tenth Edition codes identified adult female encounters undergoing ABR. Demographics and procedure-related characteristics were recorded. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate regression modeling. RESULTS A total of 52,910 weighted encounters met the criteria (mean age, 51.5 ± 10.0 years). Autologous breast reconstruction utilization increased (Δ = +5%), 2016-2019, primarily driven by a rise in deep inferior epigastric perforator (DIEP) reconstructions (Δ = +28%; incidence rate ratio [IRR], 1.070; P < 0.001), which were predominant throughout the study period (69%). More recent surgery year, bilateral reconstruction, higher income levels, commercial insurance, and care in the South US region increased the odds of DIEP-based ABR ( P ≤ 0.036). Transverse rectus abdominis myocutaneous flaps, bilateral reconstructions, higher comorbidity levels, and experiencing complications increased the length of stay ( P ≤ 0.038). Most ABRs (75%) were privately insured. The rates of immediate reconstructions increased over the study period (from 26% to 46%; IRR, 1.223; P < 0.001), as did the rates of bilateral reconstructions (from 54% to 57%; IRR, 1.026; P = 0.030). The rates of ABRs performed at teaching hospitals remained high (90% to 93%; P = 0.242). CONCLUSIONS As of 2019, ABR has become more prevalent, with the DIEP flap constituting the most common modality. With the increasing ABR popularity, efforts should be made to ensure geographic and financial accessibility.
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Affiliation(s)
- Jennifer K Shah
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | | | | | - Pooja Yesantharao
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Haripriya Ayyala
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT
| | - Clifford C Sheckter
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
| | - Rahim Nazerali
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA
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Kral P, Allen FL, Larsen S, Holst-Hansen T, Olivieri AV, Manton A. Treatment effect of semaglutide 2.4 mg on health-related quality of life from STEP 1 SF-6D derived from SF-36 with Australian weights. Diabetes Obes Metab 2024; 26:1171-1179. [PMID: 38195847 DOI: 10.1111/dom.15426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/04/2023] [Accepted: 12/07/2023] [Indexed: 01/11/2024]
Abstract
AIM This study aimed to determine the comparative treatment effects of semaglutide 2.4 mg and placebo on health utility index scores [6-dimension short-form survey (SF-6D)] with Australian weights in full analysis set (FAS) and in post-hoc subgroups of the STEP 1 trial, defined according to different body mass index (BMI) cut-off points and presence of comorbidities at baseline. The study also explored the correlation between baseline BMI and SF-6D in the STEP 1 trial population. METHODS The 36-item SF survey (SF-36) scores from STEP 1 were mapped to SF-6D health states and converted to utility index scores using an Australian valuation algorithm. The change from baseline in SF-6D utility score (95% confidence intervals) was compared between semaglutide 2.4 mg and placebo at week 68 using the mixed model for repeated measurements approach. The relationship between utility scores and BMI at baseline was assessed by multiple linear regression analyses, controlling for demographic and clinical parameters. RESULTS The estimated mean treatment difference in SF-6D utility score favoured semaglutide 2.4 mg, and, at week 68, it was 0.057 (0.038-0.076) for the FAS. A greater treatment effect was noted in subgroups with presence of symptomatic comorbidities, i.e. 0.077 (0.027-0.128) to 0.105 (0.030-0.179) at week 68. A 1-unit increase in BMI was associated with a utility loss of 0.0075 (-0.0089 to -0.0062) for the FAS population, while controlling for demographic and clinical parameters. CONCLUSION To our knowledge, this is the first study showing statistically significant and clinically meaningful improvements in SF-6D utility scores with weight-loss pharmacotherapy in Australia.
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Affiliation(s)
- Pavol Kral
- IQVIA, Bratislava, Slovakia, IQVIA, Bratislava, Slovakia
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Terrell J, Campbell JA, Thorgerson A, Bhandari S, Egede LE. Understanding the relationship between social risk factors and functional limitation among stroke survivors in the US. J Stroke Cerebrovasc Dis 2024; 33:107583. [PMID: 38242184 PMCID: PMC10939811 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 01/08/2024] [Accepted: 01/15/2024] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Stroke is the fifth leading cause of death and disability in the United States. Social risk factors contribute to recovery from stroke, however the relationship between social risk factors and functional limitation among stroke survivors remains unknown. METHODS Data on 2,888 adults with stroke from the National Health Interview Survey from 2016-2018 was analyzed. The primary independent variables included six social risk factors: economic instability, lack of community, educational deficit, food insecurity, social isolation, and inadequate access to care. The outcome measure was functional limitation count. Negative binomial regression models were run to test the relationship between the independent and dependent variables adjusting for covariates. RESULTS Overall, 56% of the study participants were aged 65+, 70% were Non-Hispanic White, and 95% had at least one comorbidity. The mean functional limitation count was 1.8. In the unadjusted model, each social risk factor was significantly associated with functional limitation. In the fully adjusted model, significant association with functional limitation was found in individuals reporting economic instability (Incidence rate ratio [IRR] 1.65, 95% CI 1.33, 2.06), food insecurity (IRR 1.28, 95% CI 1.15, 1.42), and social isolation (IRR 1.64, 95% CI 1.48, 1.82). CONCLUSIONS Social risk factors such as economic instability, food insecurity and social isolation are significantly associated with functional limitation in adults with stroke. Interventions designed to address both social and medical needs have the potential to improve physical functioning and other clinical outcomes in stroke survivors.
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Affiliation(s)
- Jennifer Terrell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Jennifer A Campbell
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Abigail Thorgerson
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Sanjay Bhandari
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Leonard E Egede
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, USA; Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
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48
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Wagner N, Berking C. [Recognition and management of relevant comorbidities in chronic spontaneous urticaria]. Dermatologie (Heidelb) 2024; 75:289-294. [PMID: 38411698 DOI: 10.1007/s00105-024-05311-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/26/2024] [Indexed: 02/28/2024]
Abstract
Various mechanisms contributing to the activity of chronic spontaneous urticaria (CU) have been postulated. Associated comorbidities are increasingly leading to the discovery of further signaling pathways which may support the activity of chronic urticaria or contribute to low-grade systemic inflammation. Moreover psychoimmunological factors may also be involved. The aim of this work is to improve the clinical care of patients with CU by increasing knowledge regarding optional influencing factors due to comorbidities and to possibly influence disease activity. Chronic urticaria due to autoimmune mechanisms may dispose to other autoimmune diseases, especially autoimmune thyroiditis, which can trigger chronic disease. Association of CU with metabolic syndrome has received little attention to date. Obesity may contribute to low-grade systemic inflammation by cytokine-secreting adipose tissue and hence to mediator-release of mast cells. Furthermore, neuroimmunological pathways, especially increased release of substance P, an activating ligand of Mas-related G protein-coupled receptor X2 (MRGPX2) on mast cells, should be addressed when optimizing therapy.
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Affiliation(s)
- Nicola Wagner
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Deutschland.
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), 91054, Erlangen, Deutschland
- Hautklinik, Uniklinikum Erlangen, 91054, Erlangen, Germany
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49
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Ng MK, Pasternack JB, Mastrokostas PG, Voyvodic L, Kang KK. The real time to surgery: Limited delay after medical optimization does not impact hip fracture surgery outcomes. Injury 2024; 55:111421. [PMID: 38359712 DOI: 10.1016/j.injury.2024.111421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/17/2024]
Abstract
INTRODUCTION Current U.S./Canadian guidelines recommend hip fracture surgery within 48 h of injury to decrease morbidity/mortality. Multiple studies have identified medical optimization as the key component of time to surgery, but have inherent bias as patients with multiple co-morbidities often take longer to optimize. This study aimed to evaluate time from medical optimization to surgery (TMOS) to determine if "real surgical delay" is associated with: 1) mortality and 2) complications for geriatric hip fracture patients. METHODS A retrospective chart review of geriatric hip fractures treated from 2015-2018 at a single, level-1 trauma center was conducted. Univariate logistic regression was performed to identify association between TMOS and post-operative complication rates. For mortality, the Wilcoxon test was used to compare TMOS for patients discharged following surgery to those who were not. RESULTS A total of 884 hip fractures were treated operatively, with median TMOS 16.2 h (5.0-22.5, 1st-3rd quartiles). Univariate logistic regression models did not identify an association between TMOS and complication rates. For patients successfully discharged, median TMOS was 16.2 h (5.0-22.3, 1st-3rd quartiles). For the cohort of patients not successfully discharged, median TMOS was 19.1 h (10.1-25.9, 1st-3rd quartiles, p = 0.16). CONCLUSION "Real surgical delay", or TMOS is not associated with increased complications or with inpatient mortality for geriatric hip fracture patients. With few exceptions, our institution adhered to the 48-hour time window from injury to hip surgery. We maintain the belief timely surgery following optimization plays a crucial role in the geriatric hip fracture patient outcomes.
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Affiliation(s)
- Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States.
| | - Jordan B Pasternack
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
| | - Paul G Mastrokostas
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
| | - Lucas Voyvodic
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
| | - Kevin K Kang
- Department of Orthopaedic Surgery, Maimonides Medical Center, 4802 10th Avenue, Brooklyn, NY 11219, United States
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50
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Bu Y, Yang S, Wang D, Hu S, Zhang Q, Wu Z, Yang C. Role of soluble epoxide hydrolase in pain and depression comorbidity. Neurobiol Dis 2024; 193:106443. [PMID: 38395315 DOI: 10.1016/j.nbd.2024.106443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/15/2024] [Accepted: 02/19/2024] [Indexed: 02/25/2024] Open
Abstract
The coexistence of chronic pain and depression in clinical practice places a substantial social burden and profoundly impacts in patients. Although a clear correlation exists, the underlying mechanism of comorbidity between chronic pain and depression remains elusive. Research conducted in recent decades has uncovered that soluble epoxide hydrolase, a pivotal enzyme in the metabolism of polyunsaturated fatty acids, plays a crucial role in inflammation. Interestingly, this enzyme is intricately linked to the development of both pain and depression. With this understanding, this review aims to summarize the roles of soluble epoxide hydrolase in pain, depression, and their comorbidity. Simultaneously, we will also explore the underlying mechanisms, providing guidance for future research and drug development.
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Affiliation(s)
- Yuchen Bu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Siqi Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Di Wang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Suwan Hu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Qi Zhang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
| | - Zifeng Wu
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Chun Yang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
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