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Obesity is known to increase overall disease burden but does obesity management actually help reduce disease burden? To investigate the effects of weight loss on disease burden in people with obesity using the National Health Insurance Service-Health Screening Cohort (NHIS-HEALS) in Korea. Pure longitudinal observational study using Nationwide cohort database. Out of 514,866 NHIS-HEALS cohort, participants with class II obesity in Asia-Pacific region (30 ≤ body mass index [BMI] < 35) who underwent health check-up provided by NHIS during 2003–2004 (index date) were included. All final participants continued to receive a total of 5 biennial health check-ups over the next 10 years without missing. A group-based trajectory model (GBTM) was used to categorize subjects based on 10-year BMI change patterns. The changes of co-morbidities, healthcare resource utilization, and medical cost were analyzed. The final study subjects (9857) were categorized into 3 trajectory clusters based on the pattern of BMI (kg/m2) change: maintenance (57.35%) with an average change of −.02 ±.06, loss (38.65%) with −.04 ±.08, and substantial loss (4.0%) with −.10 ±.18. The annual increases in the number of co-morbidities per subject in each cluster were.18,.18, and.16 (all P <.001), respectively. The increase of healthcare resource utilization over time was lowest for the substantial loss compared to maintenance and loss. With each passing year, the average annual total healthcare cost increased by ₩21,200 ($16.48, P =.034) and ₩10,500 ($8.16, P =.498) in the maintenance and loss, respectively, but decreased by ₩62,500 ($48.59, P =.032) in the substantial loss. Weight loss in people with obesity was associated with a reduced burden of disease, as evidenced by lower co-morbidity, healthcare resource utilization rate, and decreased medical costs. This study highlights the potential positive long-term impact on Korean society when actively managing weight in individuals with obesity. • People with obesity was categorized according to 10-year body mass index (BMI) change patterns. • Increase of co-morbidities was the slowest in substantial weight loss group. • Use of healthcare resource was the lowest in substantial weight loss group. • Overall healthcare cost was decreased in substantial weight loss group. [ABSTRACT FROM AUTHOR]

Class I obesity carries significant morbidity and mortality risk similar to higher grades of obesity, and persons with class I obesity have a high risk of progression to class II and III obesity. While bariatric surgery has made strides in safety and efficacy, it remains inaccessible for persons with class I obesity (body mass index [BMI] of 30–35 kg/m2). To assess safety, weight loss durability, co-morbidity resolution, and quality of life after laparoscopic sleeve gastrectomy (LSG) in persons with class I obesity. Multidisciplinary medical center that specializes in obesity management. A longitudinal prospective single-surgeon registry was queried for data pertaining to persons with class I obesity who underwent primary LSG. Primary endpoint was weight loss. Secondary endpoints included change in obesity-related co-morbidities, adverse events, and post hoc analysis of symptoms of gastroesophageal reflux disease (GERD) and Bariatric Analysis and Reporting Outcome System results. Follow-up was divided into short- (1–3 yr), intermediate- (4–7 yr), and long-term (8–12 yr). We evaluated percent excess weight loss (%EWL) using linear mixed models adjusting for age, sex, years since operation, and baseline BMI. Least-squares means estimates and 95% confidence intervals (CI) were generated. Of 13,863 bariatric procedures, a total of 1851 patients were included. Mean baseline BMI, age, and male:female ratio were 32.6 ± 2.1 kg/m2, 33.7 ± 9.2 years, and 1:5, respectively. Adjusted mean %EWL (95% CI) at short-, intermediate-, and long-term follow-up were 111% (95% CI, 91%–131%), 110% (95% CI, 89%–131%), and 141% (95% CI, 57%–225%), respectively. Of 195 patients with type 2 diabetes, 59% experienced complete remission, and of 168 patients with hypertension, 43% experienced complete remission. Being on oral antidiabetes medication was a significant predictor of sustained remission compared with being on insulin or combination therapy (P <.001). Sixty-nine patients had symptoms of GERD before surgery, which improved in 55 (79.7%). Thirty-three patients developed de novo symptoms of GERD. The average Bariatric Analysis and Reporting Outcome System score was 4.5 ± 1.7, with 83% of participants rating their quality of life after surgery as good, very good, or excellent. Those with class I obesity who undergo LSG experience normalization of weight, sustained remission of co-morbidity, and good quality of life without significant risk of morbidity or mortality. • In persons with Class I Obesity, LSG resulted in significant, sustained weight loss • Being treated with oral therapy was a significant predictor of cure of type 2 diabetes after LSG • Pre-existing symptoms of gastroesophageal reflux disease resolved in 80% of patients • Quality of life after surgery was good with no major morbidity or surgery-related mortality. [ABSTRACT FROM AUTHOR]

Growing evidence suggests there is a bidirectional relationship between depression and obesity, which are associated with structural and functional brain abnormalities. However, the underlying neurobiological mechanisms subserving the foregoing associations have yet to be characterized. It is necessary to summarize the neuroplastic brain changes in relation to depression and obesity. We systematically searched articles from 1990 to November 2022 on databases including MEDLINE/PubMed, Web of Science, PsycINFO. Only neuroimaging studies within the scope of potential differences in brain function and structure in individuals with depression and obesity/ BMI changes were included. Twenty-four eligible studies were included in the review herein, consisting of 17 studies reporting changes in brain structure, 4 studies reporting abnormal brain function, and 3 studies reporting both changes in brain structure and function. Results indicated an interaction between depression and obesity on brain functions, and their influence on brain structure is both extensive and specific. Overall, reduced whole brain, intracranial, and gray matter volume (e.g. frontal, temporal gyri, thalamic, and hippocampal) and impaired white matter integrity was observed in persons with depression and obesity comorbidity. Additional evidence on resting state fMRI reveals select brain regions associated with cognitive control, emotion regulation, and reward functions. Due to the diversity of tasks in task fMRI, the distinct neural activation patterns are revealed separately. The bidirectional relationship between depression and obesity reflects different characteristics in brain structure and function. Longitudinal designs should be reinforced in follow-up studies. • This review summarized the neuroplastic brain changes in relation to depression and obesity. • The bidirectional relationship between depression and obesity reflects different brain characteristics. • Reduced whole brain, intracranial, gray matter volume, and impaired white matter integrity were associated with comorbidity. • Depression and obesity altered brain regions associated with cognitive control, emotion regulation, and reward functions. [ABSTRACT FROM AUTHOR]

Endoscopic sleeve gastroplasty (ESG) is one of the new minimally invasive endoscopic treatments aimed at inducing weight loss. Its effectiveness in terms of weight loss is proven. Gastric volume reduction and delayed gastric emptying are the mechanisms that drive weight loss. However, potential benefits for co-morbidities in relation to weight loss after ESG are still being investigated. This study aims to evaluate the effect of ESG procedures on major obesity-associated co-morbidities, and on some biological parameters. This is a series of consecutive cases from a prospective observational study carried out in a specialized center that follows a standardized care pathway for the multimodal management of obesity. Patients who have undergone ESG with endoscopic and laboratory follow-up at six and twelve months after this intervention were included in the study. Prospectively recorded data on weight loss, co-morbidities and laboratory parameters at six and twelve months after surgery was analyzed retrospectively. Changes in body mass index (BMI), absolute weight loss (AWL), percent of excess weight loss (%EWL) and percent total weight loss (%TWL) were assessed at six and twelve months. Reduction in various obesity-related co-morbidities (arterial hypertension [AHT], type 2 diabetes mellitus [T2DM], gastroesophageal reflux disease [GERD], obstructive sleep apnea syndrome [OSAS] and dyslipidemia was also evaluated at six and twelve months. Changes in blood glucose, liver function tests and lipid blood tests were also analyzed at six and twelve months. From October 2016 to July 2021, 99 of the 227 patients who underwent ESG in our unit (43.6%) subsequently underwent a complete endoscopic and laboratory follow-up at six and twelve months. The initial BMI was 42.7 ± 7.8 kg/m2 and age was 45 ± 12.7 years. Seventy-four patients (74.8%) were female. Total weight loss (%TWL) and excess weight loss (%EWL) were 16.6 ± 7.4% and 43.3 ± 21.2%, respectively, at six months, 16.6 ± 9.6% and 42.9 ± 25.6%, respectively, at one year. At six and twelve month follow-up, a statistically significant reduction was observed for the rates of T2DM (30.8 and 32.7%), hypertension (18.4 and 22.1%), GERD (28 and 25.7%), OSAS (15.8 and 25.5%) and dyslipidemia (69.2 and 77.2%) (P < 0.001). A statistically significant difference was found in the reduction in blood glucose between the pre-operative period and six months post-operatively (P < 0.01) and between the pre-operative period and twelve months post-operatively (P < 0.01). The reduction in triglycerides and total cholesterol between the pre-operative values and at six months was statistically significant (P < 0.01) as was the reduction at twelve months (P < 0.01) (P = 0.017). For liver function tests, the reduction in AST was statistically significant at six and twelve months after ESG (P = 0.048) (P = 0.048) as was ALT (P < 0.01) (P < 0.01) respectively. From October 2016 to July 2021, of the 227 patients who underwent ESG, 99 (43.6%) had follow-up gastro-duodenoscopy at 6 and 12 months. %TWL and %EWL were respectively 16.6 ± 7.4% and 43.3% ± 21.2 at 6 months, 16.6 ± 9.6% and 42.9 ± 25.6% at one year. Statistically significant reduction rates at 6 and 12 months were observed in T2DM (30.8 and 32.7%), AHT (18.4 and 22.1%), GERD (28 and 25.7%), OSAS (15.8 and 25.5%) and dyslipidemia (69.2 and 77.2%) (P < 0.001). Moreover, glycemic levels were statistically significantly reduced between the pre-operative period and 6 months post-operative (1.11 ± 0.22 mg/L vs. 1.01 ± 0.17 mg/L, P < 0.01), and between the pre-operative period and 12 months post-operative (1.11 ± 0.22 mg/L vs. 1.06 ± 0.32 mg/L, P < 0.01). A statistically significant reduction was also observed in triglycerides and total cholesterol levels at 6 months (1.52 ± 0.74 mmol/L vs. 1.14 ± 0.52 mmol/L, P < 0.01) (1.94 ± 0.4 mmol/L vs. 1.85 ± 0.36 mmol/L, P < 0.01) and at 12 months (1.52 ± 0.74 mmol/L vs. 1.18 ± 0.67 mmol/L, P < 0.01) (1.94 ± 0.4 mmol/L vs. 1.82 ± 0.39 mmol/L, P = 0.017) and in AST (27.2 ± 11.7 IU/L vs. 23.7 IU/L; P = 0.048) (27.2 ± 11.7 IU/L vs. 24.7 ± 14.65 IU/L, P = 0.048) and ALAT levels (34 ± 21.32 IU/L vs. 22.3 ± 10.4 IU/L, P < 0.01 and 34 ± 21.32 IU/L vs. 27.07 ± 25 IU/L, P < 0.01) at 6 and 12 months after ESG, respectively. ESG is a well-tolerated and safe surgical procedure that is effective in terms of weight loss and reduction of obesity-related co-morbidities at six months and one year. This procedure could thus be adopted on a broader clinical scale and be more widely promoted as an effective treatment for morbid obesity. [ABSTRACT FROM AUTHOR]

To identify the most relevant factors with respect to the management of fracture-related infection (FRI) and to develop a comprehensive FRI classification that guides decision-making and allows scientific comparison. An international group of FRI experts determined the preconditions, purpose, primary factors for inclusion, format and detailed description of the elements of an FRI classification through a consensus driven process. Three major elements were identified and grouped together in the FRI Classification: Fracture (F), Related patient factors (R) and Impairment of soft tissues (I). Each element was divided into five levels of complexity. Fractures can be healed (F1) or unhealed (F2–5). Patients may be fully healthy (R1) or have 4 levels of compromise, with and without end-organ damage (R2–5). Soft tissue condition ranges from well vascularized and easily closed (I1) to major skin defects requiring free flaps (I4). In all three elements, the fifth level (F5, R5 or I5) describes a patient who has an unreconstructible bone, soft tissue envelope or is not fit for surgery. The FRI classification, which is based on the three major elements Fracture (F), Related patient factors (R) and Impairment of soft tissues (I) is intended to guide decision-making and improve the quality of scientific reporting for FRIs in the future. The proposed classification is based on expert opinion and therefore an essential next step is clinical validation, in order to realize the ultimate goal of improving outcomes in the management of FRI. [ABSTRACT FROM AUTHOR]

In New Zealand, approximately half reported pertussis cases are adult. Studies indicate underestimated pertussis burden in this population and probable reservoir for childhood pertussis. Pertussis is linked to chronic obstructive pulmonary disease (COPD) development and increased risk with pre-existing COPD. While acellular pertussis vaccines are available for adults, data on pertussis disease burden in adults and association with COPD remain limited. To estimate pertussis incidence in New Zealand adult health service user (HSU) population aged ≥ 18 between 2008–2019 and inform adult pertussis vaccination strategies by assessing disease burden and risk factors in different adult populations. Retrospective observational cohort study using an HSU cohort, formed by linking administrative health data using unique National Health Index identifier. For primary analysis, annual incidence rates were calculated using pertussis hospitalisations and notifications. In secondary analysis, Cox proportional hazards survival analyses explored association between pertussis in adults and chronic comorbidities. The cohort had 2,907,258 participants in 2008 and grew to 3,513,327 by 2019, with 11,139 pertussis cases reported. Highest annual incidence rate of 84.77 per 100,000 PYRS in 2012, notably affecting females, those aged 30–49 years, and European or Māori ethnicity. Adjusting for sociodemographic variables found no significant risk of prior pertussis notification leading to comorbidity diagnosis (Adjusted-HR: 0.972). However, individuals with prior comorbidity diagnosis had 16 % greater risk of receiving pertussis notification or diagnosis (Adjusted-HR: 1.162). Study found significant pertussis burden among the HSU adult cohort and highlighted higher risk of pertussis for those with recent comorbidity diagnoses. Vaccination for pertussis should be recommended for individuals with comorbidities to reduce infection risk and disease severity. GPs must have capability to test for pertussis, given it is notifiable disease with implications for individuals, their families, and broader population. High-quality disease surveillance is crucial for informing policy decisions. [ABSTRACT FROM AUTHOR]

• Challenges associated with TB-DM management highlight the urgency of addressing it. • TB screening for diabetes patients is essential for management of diabetes. • Advocating for TB prevention among diabetes patients with metformin. • Need for new strategies that leverage on integrated management of TB and DM. The double burden of tuberculosis (TB) and diabetes mellitus (DM) represents a major public health challenge that demands urgent and integrated approaches. The interplay between these two chronic conditions presents unique clinical and public health management challenges, as well as social and economic implications. We explored the bidirectional relationship between TB and DM, emphasizing how DM increases susceptibility to TB and complicates its management, while TB may exacerbate glycemic control in diabetic patients. This review underscores the challenges associated with the management of both diseases, obstacles in screening TB patients for DM and TB preventive therapy for DM since inadequate glycemic control can impact treatment outcomes. Several studies have investigated the disease interplay; however, the results have been equivocal, and this may be exerting negative impacts on the disease prevention and treatment. TB-diabetes comorbidity has been linked to poor treatment outcomes whereas TB prevention in people with DM at present is a dilemma. In addition to highlighting how urgent it is to address this comorbidity, this review offers a road map for better prevention, treatment, and control of several factors underlying the TB-diabetes syndemic interaction. [ABSTRACT FROM AUTHOR]

Purpose: People with intellectual disabilities (ID) suffer multimorbidity, polypharmacy and excess mortality at a younger age than general population. Those with ID and epilepsy are at higher risk of worse clinical outcomes than their peers without epilepsy. In the ID population the health profile of those aged ≥40 years can be compared to those aged over 65 in the general population. To date there is limited data available to identify clinical characteristics and risk factors in older adults (≥40 years) with ID and epilepsy.Methods: The Epilepsy in ID National Audit (Epi-IDNA) identified 904 patients with ID and epilepsy from 10 sites in England and Wales. This subsequent analysis of the Epi-IDNA cohort compared the 405 adults over 40 years with 499 adults ≥18 years aged under 40 years. Comparison was made between clinical characteristics and established risk factors using the Sudden Unexpected Death in Epilepsy (SUDEP) and Seizure Safety Checklist.Results: The older adults' cohort had significantly higher levels of co-morbid physical health conditions, mental health conditions, anti-seizure medications (median 5), and antipsychotics compared to the younger cohort. The older group were significantly less likely to be diagnosed with a co-morbid neurodevelopmental disorder, and to have an epilepsy care plan.Conclusion: This is the largest study to date focused on adults with ID and epilepsy over 40 years. The ≥40 years cohort compared to the younger group has higher levels of clinical risk factors associated with multi-morbidity, potential iatrogenic harm and premature mortality with worse clinical oversight mechanisms. [ABSTRACT FROM AUTHOR]

Aim: The aim was to describe the demographics, comorbidities and outcomes of care for patients with diabetes at primary care facilities in the Western Cape, South Africa, between 2015 and 2020.Methods: This was a secondary analysis of the diabetes cascade database.Results: The database included 116726 patients with mean age of 61.4 years and 63.8 % were female. The mean age at death was 66.0 years. Co-morbidities included hypertension (69.5 %), mental health disorders (16.2 %), HIV (6.4 %) and previous TB (8.2 %). Sixty-three percent had at least one previous hospital admission and 20.2 % of all admissions were attributed to cardiovascular diseases. Coronavirus was the third highest reason for admission over a 10-year period. Up to 70% were not receiving an annual HbA1c test. The mean value for the last HBA1c taken was 9.0%. Three-quarters (75.5 %) of patients had poor glycaemic control (HbA1c >7 %) and a third (33.7 %) were very poorly controlled (HbA1c>10 %). Glycaemic control was significantly different between urban sub-districts and rural areas. Renal disease was prevalent in 25.5 %.Conclusion: Diabetes was poorly controlled with high morbidity and mortality. There was poor compliance with guidelines for HbA1c and eGFR measurement. At least 7% of diabetic patients were being admitted for complications annually. [ABSTRACT FROM AUTHOR]

Background: This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis.Methods: 867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28.Results: Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG.Limitations: The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes.Conclusions: Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients. [ABSTRACT FROM AUTHOR]

These diverse outcomes of Covid-19 are influenced by various factors including age, gender, underlying health conditions, immune responses, viral variants, external factors, and overall quality of life. Demographic analysis of patients aged 0-18 years experienced mild to moderate cases, above 55 years with co-morbidities, were more severely affected.COVID-19 incidence was higher in males (58 %) & (42 %) in females. The reduced expression of Toll-like receptors (TLR) in severe and critical patients is a crucial determinant. This reduced TLR expression is primarily attributed to the dominance of the PLpro viral protein of COVID-19. Disease enrichment analysis highlights the long-term impact of COVID-19, which can lead to post-recovery complications such as hypertension, diabetes, cardiac diseases, and brain ischemia in Covid-19 patients. In conclusion, a comprehensive strategy targeting key factors like PLpro, TLR, and inflammatory cytokines such as IL-1 and IL-6 could offer an effective approach to mitigate the devastating effects of COVID-19. [Display omitted] [ABSTRACT FROM AUTHOR]

Aims: Diabetes can significantly impact quality of life and mental health. However, inconsistencies have been reported in the prevalence of depression in those with Type 1 and Type 2 diabetes, and those without. Systematic reviews also included studies without adequate control subjects. We update existing literature, by comparing depression prevalence between individuals with and without Type 1 and Type 2 diabetes.Methods: A systematic review and meta-analysis. We searched MEDLINE, EMBASE and PSYCHINFO, from January 1985 to August 2021. Studies were excluded if they failed to have an adequate control group, specified type of diabetes, or reported depression prevalence by type of diabetes.Results: 44 studies were selected for inclusion. The prevalence of depression was significantly higher in people with Type 1 (22% vs 13%, OR = 2.10 (95% CI: 1.23, 3.52)), or Type 2 diabetes (19% vs 11%, OR = 1.76 (1.55, 2.01)) compared to those without diabetes. There was no association between study effect size and mean age or gender. Findings did not significantly differ between methods of depression assessment. Prevalence of depression in people with diabetes was higher in studies carried out in specialist care (36%, OR = 3.14 (2.12, 4.63)) compared to those in community or primary care (12%, OR = 1.51 (1.35, 1.70) and in low- and middle-income countries (OR = 2.58 (1.91, 3.50) compared to countries with high income economies (OR = 1.59 (1.39, 1.82)).Conclusions: Depression prevalence remains significant in those with type 1 and type 2 diabetes. Effective chronic disease management in people with diabetes is important, particularly screening and managing depression and diabetes distress in specialist care settings. [ABSTRACT FROM AUTHOR]

• Adjuvant radiotherapy (RT) improved locoregional control and recurrence free survival without impact on MCC-specific survival and overall survival. • Adjuvant RT may be avoided in stage I patients with a clear margin of 1–2 cm after surgery and negative Sentinal Lymph Node Biopsy (SLNB), without high-risk factors. • Co-morbidity was independently associated with overall survival. Prospective data evaluating the role of adjuvant radiotherapy (RT) for Merkel Cell Carcinoma(MCC) is lacking. To better understand the efficacy of adjuvant RT, a population-based patterns of failure study was conducted. We identified MCC patients treated from 1988 to 2018. Primary outcome measures were recurrence-free survival (RFS), overall survival (OS) and MCC-specific survival (MCC-SS). Charlson Co-morbidity Index (CCI) was also calculated. 217 patients with mean age 79 (range: 33–96) were analyzed. The median follow-up was 40 months. Treatments were: surgery(S) alone (n = 101, 45%) or S + RT (n = 116, 55%). Local recurrence (LR) was low in stage I (n = 6, 6.5%) with clear margin of ≥1 cm, negative sentinel lymph node biopsy (SLNB) without high-risk factors, irrespective of adjuvant RT. Tumor size ≥ 2 cm (HR:2.95; p = 0.024) and immunosuppression (HR:3.98; p = 0.001) were associated with high risk of nodal failure. Adjuvant RT was associated with significant reduction in regional failure (HR:0.36; p = 0.002). Distant metastases (DM) were infrequent in stage I (4/90) and stage II (4/34), compared to stage III (32/93). Adjuvant RT improved RFS but did not influence MCC-SS and OS. CCI was a significant predictor of OS. Adjuvant RT improved RFS, without impact on MCC-SS and OS. Co-morbidity rather than RT influenced OS. Adjuvant RT may be avoided in stage I patients with negative SLNB and no associated high-risk factors. Prophylactic RNI could be considered in stage II with high risk features, inspite of negative SLNB. Stage III patients benefited from adjuvant RNI, but no impact on prevention of DM. [ABSTRACT FROM AUTHOR]

Background: Posttraumatic stress disorder (PTSD) and depression are highly co-morbid among individuals with childhood abuse history, while the mechanism of the co-morbidity is highly debated. This study sought to extent the work among college students with network analysis, which is a novel method that sees the co-morbidity from a symptom interacting perspective.Methods: Data was collected from 476 college students who were assessed to have childhood abuse history, PTSD and depression at the same time, using Childhood Trauma Questionnaire- Short Form, PTSD Checklist for DSM-5 and The Center for Epidemiological Studies Depression. We created a Graphical Gaussian Model (GGM) network to show associations between symptom pairs and a Directed Acyclic Graph (DAG) to estimate potential casual relationships among symptoms.Results: The GGM network was reliably stable, feeling sad (Depression) and trouble experiencing positive feelings (PTSD) were the most central nodes. Trouble experiencing positive feelings and several negative affect symptoms, sleep problems and difficulty in concentrating were acting as important bridging nodes. The DAG network suggested the key triggering roles of exaggerated startle (PTSD) and several re-experiencing symptoms.Limitations: The study used cross-sectional data and self-reported measures. Results from network analysis could be affected by scale factors and contain spurious correlations.Conclusions: In the childhood-abuse-related co-morbid structure, several negative affect symptoms both in PTSD and depression have pivotal roles, hyper-arousal symptoms and re-experiencing symptoms could trigger the co-morbid structure. Illustrating the strength and limitations of network analysis, this study help target the potentially influential symptoms for better clinical intervention. [ABSTRACT FROM AUTHOR]

Introduction: Insomnia and obstructive sleep apnoea (OSA) are the two most prevalent sleep disorders, and frequently co-occur (COMISA) in sleep clinic samples. However, few studies have investigated the prevalence or associations of COMISA in the general population.Methods: We used population-based online survey data from 2044 Australian adults. The prevalence and associations of insomnia, OSA and COMISA were investigated according to symptom-level, and disorder-level definitions. Insomnia was defined according to chronic difficulties initiating and/or maintaining sleep (DIMS; symptom-level), and ICSD-3 chronic insomnia disorder (disorder-level). OSA was defined according to self-reported frequent obstructive events, snoring or doctor-diagnosed OSA (symptom-level), and doctor-diagnosed OSA (disorder-level). COMISA was defined if both conditions were met (for symptom-level, and disorder-level threshold). Associations with other conditions, and general health were investigated with Poisson regression analyses.Results: Chronic insomnia occurred more frequently among participants with doctor-diagnosed OSA (22.3%), compared to those without (14.3%, p = 0.010). Doctor-diagnosed OSA was more common among participants with chronic insomnia (10.2%) compared to those without (6.2%; p = 0.010). DIMS also occurred more frequently among participants with OSA symptoms (66.6%), compared to those without (47.2%; p < 0.001). Participants with symptom-level COMISA reported increased co-morbid conditions, and worse general health compared to participants with symptoms of insomnia-alone, OSA-alone, or neither insomnia/OSA.Conclusions: COMISA at symptom and disorder level were common and associated with increased medical and psychiatric co-morbidity, as well as poor general health. More investigation is required to understand bi-directional associations underpinning the high co-morbidity, and improve diagnostic and treatment approaches for COMISA to reduce associated morbidity. [ABSTRACT FROM AUTHOR]

Objective: To estimate the potential influence of pre-operative patient condition on the benefit of earlier hip fracture surgery for elderly patients.Background: Many studies emphasize the benefit of earlier hip fracture surgery for patient survival. However less is known regarding how this relationship is influenced by clinical factors which could serve as potential contra-indicators for earlier surgery. Rushed surgery of patients with contra-indications may even compromise their survival.Methods: A retrospective study of patients aged 65 and above with an isolated hip fracture following trauma, based on data from 19 hospitals of the national trauma registry available for the years 2015-2016. Registry data was crossed with data on co-morbidities and medication intake from the biggest health insurance agency in the country, serving more than 50% of the country's population. Mediation analysis was performed on a wide list of co-morbidities, medications and clinical test results in order to establish the mediation of their relationship with inhospital mortality by earlier hip fracture surgery. Factors found significant in the mediation analysis were utilized to adjust a logistic regression for predicting inhospital mortality by function of waiting time to surgery and patient's sex and age.Results: Anti-coagulant and anti-platelet intake; test results pointing to decreased kidney function and being diagnosed with diabetes or Ischemic Heart Disease were found to be significantly mediated in their influence on inhospital mortality by hip fracture surgery. Despite anti-platelet intake and kidney function having a significant impact on mortality in the multi-variate analysis, the positive effect of earlier hip surgery on survival remained unchanged after adjustment.Conclusions: Earlier hip fracture surgery was found to be beneficial for elderly patients even when their co-morbidities and medication intake are taken into account. [ABSTRACT FROM AUTHOR]

Objective: To investigate if comorbidities are associated with change in health outcomes following an 8-week exercise and education program in knee and hip osteoarthritis (OA).Methods: We included 24,513 individuals with knee or hip OA from the Good Life with osteoArthritis in Denmark (GLA:D®). GLA:D® consists of two patient education sessions and 12 supervised exercise sessions. Before the program, individuals self-reported having one or more of 11 common comorbidities. Physical function was assessed using the 40-m Fast-Paced Walk Test (FPWT, m/sec) before and immediately after the program. Pain intensity and health-related quality of life was self-reported before, immediately after, and at 12 months post-intervention using a visual analogue scale (VAS, 0-100) and the EQ-5D-5L index (-0.624 to 1.000), respectively. Associations of comorbidity combinations with change in outcomes immediately and at 12 months was estimated using mixed linear regression.Results: Individuals with OA improved on average 0.12 m/s (95%CI 0.12 to 0.13) in 40-m FPWT, -12.7 mm (95%CI -13.2 to -12.2) in VAS, and 0.039 (95%CI 0.036 to 0.041) in EQ-5D-5L from before to immediately after the intervention with minor additional improvements at 12 months. Despite that individuals with comorbidities had worse baseline scores in all outcomes than individuals without comorbidities, they had similar levels of improvement immediately and 12 months after the intervention.Conclusion: Comorbidities are not associated with worse nor better health outcomes following an 8-week exercise and education program in individuals with OA, suggesting exercise as a viable treatment option for individuals with OA, irrespective of comorbidities. [ABSTRACT FROM AUTHOR]

Despite the publication of the American Society for Metabolic and Bariatric Surgery (ASMBS) Outcome Reporting Standards in 2015, there is still a great variety in definitions used for reporting remission of co-morbidities after bariatric surgery. This hampers meaningful comparison of results. To assess compliance with the ASMBS standards in current literature, and to evaluate use of the standards by applying them in a report on the outcomes of 5 co-morbidities after bariatric surgery. Two clinics of the Dutch Obesity Clinic, location Den Haag and Velp, and three affiliated hospitals: Haaglanden Medical Center in Den Haag, Groene Hart Hospital in Gouda, and Vitalys Clinic in Velp. A systematic search in PubMed was conducted to identify studies using the ASMBS standards. Besides, the standards were applied to a cohort of patients who underwent a primary bariatric procedure between November 2016 and June 2017. Outcomes of co-morbidities were determined at 6 and 12 months after surgery. Ten previous studies applying ASMBS definitions were identified by the search, including 6 studies using portions of the definitions, and 4 using complete definitions for 3 co-morbidities or in a small population. In this study, the standards were applied to 1064 patients, of whom 796 patients (75%) underwent Roux-en-Y gastric bypass and 268 patients (25%) underwent sleeve gastrectomy. At 12 months, complete remission of diabetes (glycosylated hemoglobin <6%, off medication) was reached in 63%, partial remission (glycosylated hemoglobin 6%–6.4%, off medication) in 7%, and improvement in 28% of patients (n = 232/248, 94%). Complete remission of hypertension (normotensive, off medication) was noted in 8%, partial remission (prehypertensive, off medication) in 23% and improvement in 63% (n = 397/412, 96%). Remission rate for dyslipidemia (normal nonhigh-density lipoprotein, off medication) was 57% and improvement rate was 19% (n = 129/133, 97%). Resolution of gastroesophageal reflux disease (no symptoms, off medication) was observed in 54% (n = 265/265). Obstructive sleep apnea syndrome improved in 90% (n = 157/169, 93%). Compliance with the ASMBS standards is low, despite ease of use. Standardized definitions provided by the ASMBS guideline could be used in future research to enable comparison of outcomes of different studies and surgical procedures. [ABSTRACT FROM AUTHOR]

Aims: The prevalence of diabetes mellitus is gradually increasing in Turkey and it is becoming a serious public health problem. Other diseases which accompany diabetes becloud its treatment and bring additional problems. Until now, there have been no studies investigating the prevalence of co-morbidities in Turkish diabetic patients. With this study, we aimed to resolve the deficiency on this subject.Methods: This cross-sectional descriptive epidemiological study was conducted between 2018 and 2019. Patients who had been regularly admitted to our diabetes center in the past 3 years were included in this study. Co-morbidities including hypertension, hyperlipidemia, obesity, coronary heart disease, cerebrovascular disease, diabetic retinopathy, and diabetic nephropathy were investigated. Factors relating to these co-morbidities were assessed.Results: After exclusion from analysis, 1024 patients were included in the study. The female/male ratio was found to be 1.7. The mean age of these patients was 69.3 ± 9.8. The mean diabetes duration was 22.2 ± 7.0. The most common co-morbidities were hypertension and hyperlipidemia by the rate of 84.9% and 65.6%. Obesity prevalence was 54.4%, nephropathy was 36.6%, coronary heart disease 22.8%, retinopathy 18.5% and stroke prevalence was found to be 4.8%. Age, diabetes duration and insulin usage were found to be significantly related to all co-morbidities.Conclusions: This study is significant in that it is the widest Turkish diabetic co-morbidity analysis study to date. When compared to other worldwide studies, co-morbidities were seen to be a little bit higher in Turkish diabetic patients. Clinicians need to not only focus on anti-diabetic treatment but also on other co-morbidities in terms of decreasing mortality and morbidity. [ABSTRACT FROM AUTHOR]

Background: Smoking and obesity are major public health concerns, though little is known about the mental and physical health burden of co-occurring obesity and smoking.Methods: Using a nationally representative sample of U.S. military veterans, we examined the prevalence of mental and physical co-morbidities, physical and mental functioning, and quality of life between obese only; smoking only; and obese smokers.Results: Among current smokers, 31.7% were obese; among obese veterans, 16.4% were current smokers; and in the total sample, 5.4% were obese and current smokers. Relative to the obese-only group, obese smokers were more likely to be younger, male, non-white, non-married, unemployed and VA-served, and have lower household incomes. These also reported higher levels of perceived stress and trauma and were more likely to endorsed current suicidal ideation and lifetime suicide attempts (odds ratio [OR]=2.0), medical (2.3<=OR<=3.9) and psychiatric (1.5<=OR<=2.9) comorbidities, and lower overall health status and quality of life. Compared to the smoking-only group, obese smokers were more likely to endorse current suicidal ideation (OR=2.0) and nicotine dependence (OR=1.5), and reported poorer physical health and overall quality of life. Analyses were adjusted for sociodemographic and military characteristics.Limitations: The cross-sectional study design precludes causal inference.Conclusions: These findings suggest that co-occurring obesity and smoking is associated with substantial mental and physical health burden in U.S. veterans. Collectively, they underscore the importance of multicomponent interventions targeting, obesity, smoking, and co-occurring issues, such as trauma and internalizing disorders, in this population. [ABSTRACT FROM AUTHOR]

Since December 2019, the novel coronavirus disease 2019 (COVID-19) that emerged in Wuhan city has spread rapidly around the world. The risk for poor outcome dramatically increases once a patient progresses to the severe or critical stage. The present study aims to investigate the risk factors for disease progression in individuals with mild to moderate COVID-19. We conducted a cohort study that included 1007 individuals with mild to moderate COVID-19 from three hospitals in Wuhan. Clinical characteristics and baseline laboratory findings were collected. Patients were followed up for 28 days for observation of disease progression. The end point was the progression to a more severe disease stage. During a follow up of 28 days, 720 patients (71.50%) had recovered or were symptomatically stable, 222 patients (22.05%) had progressed to severe disease, 22 patients (2.18%) had progressed to the critically ill stage and 43 patients (4.27%) had died. Multivariate Cox proportional hazards models identified that increased age (hazard ratio (HR) 2.56, 95% CI 1.97–3.33), male sex (HR 1.79, 95% CI 1.41–2.28), presence of hypertension (HR 1.44, 95% CI 1.11–1.88), diabetes (HR 1.82, 95% CI 1.35–2.44), chronic obstructive pulmonary disease (HR 2.01, 95% CI 1.38–2.93) and coronary artery disease (HR 1.83, 95% CI 1.26–2.66) were risk factors for disease progression. History of smoking was protective against disease progression (HR 0.56, 95% CI 0.34–0.91). Elevated procalcitonin (HR 1.72, 95% CI 1.02–2.90), urea nitrogen (HR 1.72, 95% CI 1.21–2.43), α-hydroxybutyrate dehydrogenase (HR 3.02, 95% CI 1.26–7.21) and D-dimer (HR 2.01, 95% CI 1.12–3.58) at baseline were also associated with risk for disease progression. This study identified a panel of risk factors for disease progression in individuals with mild to moderate COVID-19. [ABSTRACT FROM AUTHOR]

• According to WHO, COVID-19 pandemic belongs to very high-risk category. • Potentially lethal manifestations of COVID-19 are due to cytokine storm syndrome. • Cytokine storm in COVID-19 patients with co-morbidities is associated with elevated cytokine synergism. • Exacerbation of 'cytokine storm' in high risk patients could be responsible for the high mortality. • Antiviral state against SARS-CoV2 imparted by BCG vaccine involves IL-1β, TNF-α and IL-6 release from trained monocytes. The seventh human coronavirus SARS-CoV2 belongs to the cluster of extremely pathogenic coronaviruses including SARS-CoV and MERS-CoV, which can cause fatal lower respiratory tract infection. Likewise, SARS-CoV2 infection can be fatal as the disease advances to pneumonia, followed by acute respiratory distress syndrome (ARDS). The development of lethal clinical symptons is associated with an exaggerated production of inflammatory cytokines, referred to as the cytokine storm, is a consequence of a hyperactivated immune response aginst the infection. In this article, we discuss the pathogenic consequences of the cytokine storm and its relationship with COVID-19 associated risk factors. The increased pro-inflammatory immune status in patients with risk factors (diabetes, hypertension, cardiovascular disease, COPD) exacerbates the Cytokine-storm of COVID-19 into a 'Cytokine Super Cyclone'. We also evaluate the antiviral immune responses provided by BCG vaccination and the potential role of 'trained immunity' in early protection against SARS-CoV2. [ABSTRACT FROM AUTHOR]

The population in developed countries is getting older and with advancing age comes increasing co-morbidity and demand on health care services. The use of home parenteral nutrition (HPN) is also increasing in the UK and elsewhere. Age and co-morbidity need to be taken into consideration when HPN is contemplated because of the significant associated economic burden and clinical risk. However, there are minimal data on HPN outcomes specific to the elderly. We performed an observational study of a prospectively maintained database of patients dependent on HPN managed at a national U.K. referral centre. Data were collected on the 31st March 2018. Charlson index was used to assess co-morbidity. Data included demographics, HPN requirements, underlying disease aetiology, mechanism of intestinal failure, and whether the patient, carer or home care nurses administered the PN. The main outcome was the occurrence of at least one catheter-related blood stream infection (CRBSI) during HPN, with putative predictors of CRBSI assessed by uni- and multi-variable logistic regression. Two hundred and seventy-seven patients were included in this study, 62% were female and the overall mean age of the entire cohort was 58 years (range 20–93). The mean duration of HPN was 1778 days (range 45–12,832). One hundred patients were aged 65 years or older. Patients aged 65 years or older had a higher Charlson index (1.8 vs 1.1, p = <0.0001), were more likely to require a home care nurse to administer PN (p = 0.01), and had the lowest risk of CRBSI (25% vs 39%; p = 0.01). Home care nurse administration was associated with the lowest risk of CRBSI, followed by carer and self-administration (P = 0.001). In multivariable analysis, duration of HPN and CVC care provider were the only independent predictors of CRBSI occurrence. There was no significant difference in unplanned intestinal failure-related hospital admissions between those under or above 65 years of age (p = 0.08). HPN can be safely used in patients over the age of 65, even with increased co-morbidity. In this large cohort study, increasing age was found to be protective against CRBSI. CVC care provider was an independent predictor of CRBSI, while age and co-morbidity were not, suggesting that the use of home care nurses for PN administration is the principal reason for the low CRBSI rate in the elderly. Hence, older age should not be seen as a contra-indication for HPN, but increased healthcare resource may be required as those aged over 65 are more likely to require nursing assistance for CVC care. [ABSTRACT FROM AUTHOR]

Background: Comorbidity between Substance Use Disorders (SUDs) and major depression is highly prevalent. This systematic review and meta-analysis aimed to estimate the prevalence of SUDs in subjects diagnosed with a major depressive disorder (MDD) in community, inpatient and outpatient settings.Methods: A comprehensive literature search of Medline, EMBASE, PsycINFO and CINAHL databases was conducted from 1990 to 2019. Prevalence of co-morbid SUDs and MDD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis.Results: There were 48 articles identified by electronic searches with a total sample size of 348,550 subjects that yielded 14 unique epidemiological studies, 2 national case registry studies, 7 large cohort studies and 20 clinical studies using in- or out-patients. The prevalence of any SUD in individuals with MDD was 0.250. Maximum prevalence was found with alcohol use disorder (0.208), followed by illicit drug use disorder (0.118) and cannabis use disorder (0.117). Meta-analysis showed the pooled variance of any AUD in men with MDD was 36%, which was significantly higher than that for females with MDD (19%, OR 2.628 95% CI 2.502, 2.760).Conclusions: Few studies were published over the last decade so current prevalence rates of SUD in MDD are needed. Meta-analysis revealed that SUDs in MDD are highly prevalent and rates have not changed over time. The persistently high prevalence suggests there is an urgent need for more informative studies to help develop better prevention and treatment options for reducing prevalence of SUDs in persons with major depression and co-morbid disorders. [ABSTRACT FROM AUTHOR]

Hip fractures are the most common cause for admission to an acute orthopaedic ward in the UK, and typically affect elderly, frail individuals with extensive co-morbidity. As such, they are associated with a high burden of morbidity and mortality as well as significant financial cost. Standards have therefore been developed to improve care and outcomes for hip fracture patients, including through the introduction of the 'best practice tariff' payment system in English hospitals. These emphasize a multidisciplinary team approach with early involvement of appropriately trained healthcare professionals including anaesthetists, orthopaedic surgeons and orthogeriatricians. Key elements of the perioperative optimization of patients following admission with a hip fracture include prompt and effective analgesia, including the use of regional nerve blockade, the rapid identification and correction of acute medical problems, particularly cardiac arrhythmias, electrolyte abnormalities and anaemia, and careful management of fluid balance. In addition, medication review is of critical importance, particularly with respect to antiplatelet agents and anticoagulants. In all cases, early surgery, ideally within 36 hours of admission, should be considered a key aim given evidence supporting a reduction in complication and mortality rates when this is achieved. Similarly, patients should be mobilized as soon as possible in the postoperative period in order to maximize their rehabilitation potential. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) patients are at increased risk of depression, and low levels of physical activity (PA) are a potential warning sign of depression. PA can be estimated by patient reported outcomes (PROs) or measured with accelerometers (ACCs). We explored which of these two best captures depression in patients with, or at risk of, OA. 48-months data from the Osteoarthritis Initiative were cross-sectionally analysed. The dichotomized Centre for Epidemiological Studies Depression Scale score was used as outcome (depression y/n). The Physical Activity Scale for the Elderly (PASE) was selected as PRO. ACC-data comprised average minutes of daily moderate to vigorous activity. Two multivariable models (PRO-model/ACC-model) were compared directly and indirectly using areas under the curve (AUC) for the predicted probability of depression, penalized model selection criteria (PMSC) and log-likelihood ratio tests. AUCs from the ACC (0.71 [95% CI 0.67; 0.75]) and PRO model (0.72 [95% CI 0.68; 0.76]) were not significantly different (p = 0.28). Differences in PMSC were small (<10). The log-likelihood ratio test for the comparison of the ACC (ll −505.22) with the base model (ll −505.98) was not significant (LR chi2 = 1.52; p = 0.22), but the PRO model (ll −501.55) had a better fit than the base model (LR chi2 = 8.87; p < 0.01). PRO and ACC data perform similarly in capturing depression. Indirect comparison even pleads for PROs. Costs of accelerometers and the additional burden for patients are in support of the PASE as an appropriate alternative to screen for depression in OA patients. [ABSTRACT FROM AUTHOR]

Polymorphisms at −176 in IL-6, and −238 and −308 in TNF-α have been described as risk factors for developing tuberculosis (TB) and type 2 diabetes mellitus (T2DM). However, it is not known how these changes influence the development of TB-T2DM comorbidity. The objective of this work was therefore to analyze the impact of these polymorphisms in the Mexican population. This is a cross-sectional study of cases and controls in which polymorphisms at −174 in IL-6 , −238 and −308 in TNF-α were identified in healthy subjects, those with TB, T2DM and carriers of the comorbidity, each group consisted of 30 individuals. Descriptions of the population, frequency of genotypes and risk association were calculated, and a reduction of multifactorial dimensionality between groups (MDR) was determined. Genotype 174 G/G-of IL-6 was observed in 78% of individuals, while −308 G/G and −238 G/G of TNF-α occurred in 90% and 91% of individuals, respectively. The −174 G/G IL-6 in individuals with T2DM increased five-fold (p =.02) the risk of developing the comorbidity. The MDR analysis showed that the association of −174 G/G IL-6 and −308 G/G TNF-α in healthy individuals increased the risk of developing the comorbidity up to six-fold (p =.019), while in individuals with T2DM, this risk augmented 14-fold (p =.0002). The −174 G/G IL-6 genotype increases the risk of developing comorbidity in the T2DM population and this risk is raised when associated with −308 G/G TNF-α. These findings have implications for understanding the epidemiological dynamics of the TB-T2DM comorbidity, promoting prevention strategies and inhibiting the development of this co-morbidity. • Genotype 174 G/G-of IL-6 was observed in 78% of individuals. • Genotype −308 G/G and −238 G/G of TNF-α occurred in 90% and 91% of individuals. • Association of −174 G/G IL-6 + −308 G/G TNF-α, increase 14-fold comorbidity risk [ABSTRACT FROM AUTHOR]

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Abstract Purpose Hypertrophic osteoarthropathy (HOA) is a condition that can be inherited or acquired. It causes diffuse periosteal new bone formation on the long bones, with a predilection for the appendicular skeleton. When acquired, it is a nonspecific indicator of systemic disease that arises following a primary condition. This paper reviews the palaeopathological literature associated with this rare condition. It also describes the first possible case of co-morbidity associated with hypertrophic osteoarthropathy in an adult skeleton (cal. BC 170 – 1 cal. AD) from the mobile pastoralist Sarmatian culture of the Volga steppes of Russia. Methods Macroscopic and radiological examination provide differential diagnoses of the lesions, while clinical and bioarchaeological analyses offer insights into the possible experience of disease and social implications of care among the nomadic populations of Iron Age Russia. Results The analysis of Sk. 6524.102 displays lesions that may be due to both hypertrophic osteoarthropathy and osteomalacia. The man was physically impaired and his participation in physically challenging activities would have been limited. Conclusions The study stresses that co-morbidity is a key parameter when interpreting disease in past populations, particularly when the diagnosis involves hypertrophic osteoarthropathy. Significance This is the first case of hypertrophic osteoarthropathy identified in Eurasian prehistoric populations. The research emphasises the significance of co-morbidity in the past. Limitations The diagnosis of co-morbid diseases in human remains is extremely complex and the conditions were identified as most probable by a process of elimination. Suggestions for further research Further studies should be dedicated to understanding co-morbidity in the past. [ABSTRACT FROM AUTHOR]

Background: With increasing age of the world population, the number of parkinsonian patients with disease onset in very old age is expected to increase. Information about the clinical and morphological phenotype of very old age onset parkinsonism is poor, and only three autopsy-confirmed studies of parkinsonian patients of 80 years and older onset are available.Methods: A retrospective autopsy study of 345 patients clinically diagnosed as Parkinson disease (PD) included 90 cases with disease onset ≥80 years).Results: Clinically, the majority (60%) presented with a rigid-akinetic phenotype, 13.3% with mixed tremor, akinesia and rigidity, 8.9% tremor-dominant type, 7.8% with tremor + rigidity, 5.6% with tremor-akinesia, and 4.4% with pure akinesia or gait disorder. Additional 8.9% developed hemiparesis, and 80% were demented. In only about 49% of the patients, positive reaction to l-dopa therapy was reported. The progress of disease was accelerated, and survival time (4.34 ± 2.95 SD) was significantly shorter than in younger onset groups. At post mortem examination, only 21 cases (23.3%) revealed Lewy body disease of brainstem type (PD) alone, 44 cases (48.9%) had PD plus Alzheimer disease (AD) (including 6 cases of Lewy body variant of AD). 11% had PD plus cerebrovascular lesions, 6 cases (6.7%) were cerebrovascular disorders and 8 cases (8.9%) were other neurodegenerative diseases (AD, single cases of multiple system atrophy, progressive supranuclear palsy).Conclusion: The present and other data confirm the clinical and morphological heterogeneity of parkinsonism with shorter survival in the octogenarian population. [ABSTRACT FROM AUTHOR]

Graphical abstract Highlights • Reduced ATP or oxygen availability is common in depression models, human depression, and depression risk factors. • Capillary dysfunction can cause tissue hypoxia, even when blood supply is inconspicuous. • Tissue hypoxia triggers inflammation, affecting capillary function in other organs. • Inflammatory cytokines and tissue hypoxia interfere with neurotransmitter synthesis. • Early life stress may predispose to depression and other diseases in later life by damaging the splanchnic microcirculation. • Capillary function and neurogenic blood flow affect brain oxygenation, and whether functional neuroimaging truly detects changes in neuronal activity. Abstract Are energy demands too high, or our energy resources either too low or inappropriately prioritized, as we develop stress and/or depression? We review evidence of dysregulated cellular energy homeostasis and energy depletion in stress and depression, identifying factors that might limit energy substrate availability. Resetting of cellular energy-sensors, splanchnic hypoxia, and catecholamine effects on blood viscosity emerge as mechanisms that might disrupt normal energy homeostasis, accelerate cell injury, and cause depression-like symptoms in severe or prolonged stress. In particular, a vicious cycle of capillary dysfunction, cellular hypoxia, and inflammation emerges as a mechanism, by which prolonged stress might accelerate the development of diseases, including depression, in later life. Oxygen is a substrate for both serotonin- and ATP-synthesis, and the review therefore analyzes evidence of reduced oxygen availability in neurological diseases with high incidence of depression. Blood supply and oxygen availability are also keys to the inference of neuronal activity by functional neuroimaging. We review how neurotransmitters interfere with blood flow regulation, affecting interpretations of neuroimaging studies in stress and depression. [ABSTRACT FROM AUTHOR]

Highlights • Psychiatric co-morbidity is a common condition, partly due to the overlap of symptoms in the categorical diagnosis of mental disorders. • The co-occurrence of schizophrenia (SZ) and obsessive compulsive disorder (OCD) is a common and challenging comorbid condition, the relationship between SZ and OCD remains unclear. • Consanguinity has been clearly associated with an increased risk of genetically complex disorders. • This study describes the prevalence of comorbidity between obsessive-compulsive disorder (OCD) and schizophrenia (SZ) among patients from a highly endogamous population. Abstract Background Psychiatric co-morbidity is a common condition, partly due to the overlap of symptoms in the categorical diagnosis of mental disorders. The co-occurrence of schizophrenia (SZ) and obsessive compulsive disorder (OCD) is a common and challenging co-morbid condition. Also, the relationship between SZ and OCD remains unclear. Aim The aim of this study was to describe the co-morbidity of obsessive-compulsive disorder (OCD) among schizophrenia (SZ) patients and compare clinical characteristics of schizophrenia patients with versus without comorbid OCD. Subjects and Methods A cohort-study was carried out on 396 patients enrolled between November 2011 to June 2014 at the Department of Psychiatry, Rumeilah Hospital in Qatar. We employed the WHO Composite International Diagnostic Interview (WHO-CIDI), and Structured clinical interview for DSM-5 (SCID-5) for diagnoses, the Yale-Brown Obsessive Compulsive Scale Symptom Checklist for scoring OCD. Patients were grouped in SZ patients with and without comorbid OCD (SZ-OCD vs SZ). Results 396 subjects were interviewed. Age of SZ-OCD patients was 42.69 ± 14.33 (years old) whereas SZ patients without OCD ranged 41.59 ± 13.59 years old. There were statistically significant differences in clinical characteristics between SZ with and without OCD : age (p = 0.010), BMI (body mass index; p = 0.011), education (p = 0.033), employment (p = 0.019), cigarette smoking (p = 0.039), sheesha smoking (p = 0.008), and prevalence of consanguinity (p = 0.043). In particular, the rate of consanguinity in the current generation was 31.8% [95% CI = 29.1–34.7]. Also, there were statistically significant differences at Hamilton Depression score, General Health Score, Clinical Global Impression- Score, duration of illnesses, and Global Assessment of Functioning (p < 0.001). The results show that anxious, mood and psychotic dimensions rated higher among SZ - OCD ones than SZ only patients. Conclusion This study confirms that SZ-OCD is a common co-morbidity and prevalence of SZ OCD is higher among patients reporting a degree of consanguinity. Even if this condition is under-recognized in clinical practice, it may significantly change SZ presentation and outcome since psychopathological dimensions report higher scores in the co-morbidity sample. [ABSTRACT FROM AUTHOR]

Abstract The developmental origins of health and disease and the comparative international approach are two important strands of research exploring population health. Despite the potential insights to be gained from integrating the two approaches, their nexus remains an underexplored frontier. The current study investigates international variation in the early life origins of health among aging cohorts in 13 countries. We examine cross-national differences in exposure to poor childhood health and socioeconomic disadvantage, whether the long-term health associations with those exposures vary across contexts, and whether they persist in the face of subsequent accumulation of socioeconomic and behavioral risk. Finally, we investigate whether childhood health and socioeconomic circumstances help explain between-country differences in later life health. The findings suggest substantial international variation in the exposure to early life health and socioeconomic insults. We also find variation in their association with later life health. However, early life factors appear to play a modest role in explaining international differences in later life health in the contexts examined here. Highlights • We study international variation in life course influences on health. • Early life health & socioeconomic exposures vary across countries. • The long-term impacts of early life exposures also vary across countries. • Life course processes explain a modest portion of variation in adult health in Europe. [ABSTRACT FROM AUTHOR]

Purpose Rett syndrome (RTT) is a neurodevelopmental disorder that almost exclusively affects females. Epilepsy is a major clinical feature, but its long-term course in RTT has not been sufficiently explored. This study addresses the development of the epilepsy in adults with RTT. Methods Available females diagnosed with RTT in Norway were asked to participate. Parents/caregivers were interviewed, the girls/women were examined and their medical records reviewed. Participants were categorized according to age, epilepsy, seizure patterns and mutation severity groups. RTT severity was assessed (epilepsy score excluded). Results 70 females with classic RTT were included. A presumed pathogenic mutation in MECP2 was found in 96%. The presence of active epilepsy (seizures last five years) was similar in all age groups above the age of ten: 11 (65%) in adolescents (11–20 years), 9 (60%) in young adults (21–30 years) and 14 (67%) in participants above 30 years of age. Tonic-clonic seizures within the last year were present in 55, 67 and 64%, and ≥ weekly seizures occurred in 27, 45 and 50% in the respective age groups. Among participants with active epilepsy, 69% had unremitting seizures, whereas 31% had experienced remissions for more than six months during the last five years. In the oldest group (>30 years), only 19% had obtained seizure control for >5 years, and 14% had never experienced seizures. Seizure activity correlated with RTT severity score, whereas the relationship to mutation type remained ambiguous. Conclusion Epilepsy continues to be a major concern in adults with RTT. Two thirds of women above 30 years of age remained with active epilepsy and 50% of them had seizures at least weekly. [ABSTRACT FROM AUTHOR]

Elderly residents of long-term care commonly exhibit a number of age-related health deficits, including impaired physical and cognitive function, chronic illnesses, and chronic inflammation. Given our previous data relating the phenotype and function of innate and adaptive leukocytes from the nursing home elderly to chronic conditions and inflammatory biomarkers, we hypothesized that these factors would influence the regulatory programming of immune cells, thereby contributing to immune dysfunction. Since DNA methylation represents both an important regulatory mechanism of cells as well as a biomarker of health and disease, we sought to characterize the methylome of peripheral blood mononuclear cells (PBMCs) from the nursing home elderly ( n = 23; 82–98 years old, 70% female), and compare these patterns to pathological factors such as dementia, co-morbidity score and frailty, and immune-related factors such as serum C-reactive protein (CRP) and cytokine levels and varicella-zoster virus (VZV) vaccine responsiveness. We show that the most significant changes in DNA methylation levels occurred in relation to co-morbidity score, including one site, cg07725579 (FDR-adjusted p < 0.05; closest gene, SIRBP2), and nine DNA methylation regions (Stouffer's p < 0.05). DNA methylation age, although not strongly correlated with chronological age, was positively correlated with serum CRP levels ( p = 0.007), and negatively correlated with vaccine responsiveness ( p = 0.035). To our knowledge, this study is one of the first to describe associations of DNA methylation patterns with pathological and immune-related factors in residents of long-term care, and may provide important clues pertaining to immune cell dysfunction near the end of life. [ABSTRACT FROM AUTHOR]

Background: Tobacco and cannabis are highly co-morbid in the general population and in patients with schizophrenia. Given the putative causal mechanisms facilitating co-use, it is important to determine how cannabis cessation may influence concurrent tobacco use. Using a 28-day cannabis abstinence paradigm, we prospectively examined changes in tobacco consumption in patients with schizophrenia and controls with cannabis dependence and daily cigarette use.Methods: Cannabis dependent patients with schizophrenia (n = 19) and controls (n = 20) completed the study with abstinence rates of 42% and 55%, respectively. Participants completed measures of substance use, withdrawal, and clinical symptoms weekly. Urine samples were collected twice weekly to biochemically verify abstinence.Results: Patients reported a greater increase in cigarettes smoked per day (CPD) on Day 7 relative to baseline (2.97 cigarette increase for abstinent subgroup, p < .01) compared to controls (.06 cigarette increase for abstinent subgroup, p = .95). Initially, greater reductions in cannabis use related to greater increases in CPD relative to baseline in the patient subsample (simple slope = -2.31, p = .05), but by Day 28, CPD returned to baseline levels independent of cannabis use. CPD changes were unrelated to cannabis withdrawal. Results were similar for changes in caffeine consumption, but not for alcohol.Conclusions: Findings suggest transient tobacco substitution for cannabis in patients with schizophrenia. This provides further support for a strong association between cannabis and tobacco in schizophrenia. Future studies should focus on targeting underlying mechanisms that promote co-use to better address potential changes in concurrent substance use during treatment interventions. [ABSTRACT FROM AUTHOR]

The genetic association between autism spectrum disorder (ASD) and psychotic disorders such as schizophrenia is complicated and mirrors the clinical overlap between these conditions to some degree. However, no studies to date have examined the genetics of individuals dually diagnosed with both ASD and psychosis. In this study, we present findings of copy number variants (CNVs) from a study of 116 well-characterised individuals with this dual diagnosis. DNA was extracted and arrayed using the Affymetrix CytoScan HD 2.8M array or the Affymetrix Cytogenetics arrays and compared with existing samples from the Database of Genomic Variants and the Simons Simplex Collection of CNVs from individuals with ASD and their families. Twenty-seven novel CNVs ≥20k base pairs were identified in the sample, most occurring in only a single individual, although two were found in two female participants. Forty-nine rare CNVs (<1.5% rate in general population) were also found at significantly higher frequencies than expected. The findings may provide evidence for areas of further study in the understanding of the development of both ASD and psychosis due to the number of affected genetic regions that have not previously been linked to these conditions. [ABSTRACT FROM AUTHOR]

To examine whether the association of co-morbidity with mortality after acute stroke is influenced by stroke type, age, sex, or time since stroke. We conducted a province-wide population-based study using linked administrative databases to identify all admissions for acute stroke between 2007-2018 in Alberta, Canada. We used Cox proportional hazard models to determine the association of severe co-morbidity based on the Charlson Co-morbidity Index with 1-year mortality after stroke, assessing for effect modification by stroke type, age, and sex, and with adjustment for estimated stroke severity, comprehensive stroke centre care, hypertension, atrial fibrillation, and year of study. We used a piecewise model to analyze the impact of co-morbidity across four time periods. We had 28,672 patients in our final cohort (87.8% ischemic stroke). The hazard of mortality with severe co-morbidity was higher for individuals with ischemic stroke (adjusted hazard ratio [aHR] 2.20, 95% CI 2.07-2.32) compared to those with intracerebral hemorrhage (aHR 1.70, 95% CI 1.51-1.92; p int <0.001), and higher in individuals under age 75 (aHR 3.20, 95% CI 2.90-3.53) compared to age ≥75 (aHR 1.93, 95% CI 1.82-2.05, p int <0.001). There was no interaction by sex. The hazard ratio increased in a graded fashion at younger ages and was higher after the first 30 days of acute stroke. There was a stronger association between co-morbidity and mortality at younger age and in the subacute phase of stroke. Further research is needed to determine the reason for these findings and identify ways to improve outcomes among those with stroke and co-morbid conditions at young age. [ABSTRACT FROM AUTHOR]

The term food addiction (FA) denotes a concept among researchers and lay consumers as a behavioural phenotype related to excessive food consumption. In this study we examined the prevalence of FA using the validated Yale Food Addiction Scale (YFAS) as well as the dimensional symptom count. In addition, we explored associations between participant characteristics and FA diagnosis. Outpatients attending a clozapine clinic and possessing a diagnosis of schizophrenia were invited to complete an anonymous survey using the YFAS. Ninety three surveys were used to calculate the diagnostic YFAS criteria for FA. The prevalence of FA found in this sample was 26.9%. Among individuals who did not meet “diagnostic” criteria FA, 77.4% endorsed 3 or more symptoms but did not report distress or impairment. The most common food addiction symptom was a persistent desire or repeated unsuccessful attempts to cut down consumption (97.9%). The significant finding in association between individual’s characteristics and diagnosis of FA was employment. Several factors related to reported results are postulated and discussed. The current study has found the prevalence of FA amongst people living with schizophrenia to be higher than the general populations but not as high as populations with disordered eating. [ABSTRACT FROM AUTHOR]

Background: Collaborative Care is an evidence-based approach to the management of depression within primary care services recommended within NICE Guidance. However, uptake within the UK has been limited. This review aims to investigate the barriers and facilitators to implementing Collaborative Care.Methods: A systematic review of the literature was undertaken to uncover what barriers and facilitators have been reported by previous research into Collaborative Care for depression in primary care.Results: The review identified barriers and facilitators to successful implementation of Collaborative Care for depression in 18 studies across a range of settings. A framework analysis was applied using the Collaborative Care definition. The most commonly reported barriers related to the multi-professional approach, such as staff and organisational attitudes to integration, and poor inter-professional communication. Facilitators to successful implementation particularly focussed on improving inter-professional communication through standardised care pathways and case managers with clear role boundaries and key underpinning personal qualities.Limitations: Not all papers were independent title and abstract screened by multiple reviewers thus limiting the reliability of the selected studies. There are many different frameworks for assessing the quality of qualitative research and little consensus as to which is most appropriate in what circumstances. The use of a quality threshold led to the exclusion of six papers that could have included further information on barriers and facilitators.Conclusions: Although the evidence base for Collaborative Care is strong, and the population within primary care with depression is large, the preferred way to implement the approach has not been identified. [ABSTRACT FROM AUTHOR]

Background Morbidly obese patients with excessive concomitant disease carry a significantly increased perioperative risk. Although they may benefit most from a bariatric intervention, they are often denied surgery. Laparoscopic sleeve gastrectomy (LSG), as it is less complication-prone than other bariatric procedures, suits the needs of those patients. Objective To review the short-term outcome of LSG for high-risk patients Setting University hospital, Switzerland. Methods A total of 110 patients with high perioperative risk undergoing LSG between January 2008 and December 2014 were prospectively recorded. Patients were defined as “high-risk” if they met 2 of the following criteria: American Society of Anesthesiologists physical status score (ASA)>III, Obesity Surgery Mortality Risk Score (OS-MRS)≥4, Revised Cardiac Risk Index (RCRI) class IV, Obstructive Sleep Apnea-Severity Index (OSA-SI)≥5, renal insufficiency chronic kidney disease ≥3, liver cirrhosis, or history of life-threatening perioperative events. Results Of the patients, 59 (54%) were male. Median age was 49 years (range: 18–69), and median BMI was 51.7 kg/m 2 (38.7–89.2). Median operating time was 65 minutes (27–260). Eighty-six patients (78%) were classified as ASA IV, 65 (59%) as RCRI class IV, 51 (46%) as OS-MRS≥4 and 63 (57%) as OSA-SI≥5. Eighty-nine (81%) had type 2 diabetes, 70 (64%) were under antiplatelet and or anticoagulant therapy. Four patients (4%) were converted to open. Length of stay was 5 days (1–70). Major complications occurred in 12 patients (11%), including 1 mortality (1%). Conclusion “High-risk”-patients identified using a combination of established obesity- and co-morbidity-related risk scores profit from LSG as part of a uniform treatment pathway. Given the severity of co-morbidities, LSG can be performed safely. (Surg Obes Relat Dis 2016;X:XXX–XXX.) © 2016 American Society for Metabolic and Bariatric Surgery. All rights reserved. [ABSTRACT FROM AUTHOR]

• Individuals with trichotillomania, excoriation disorder, and both conditions share many characteristics with high rates of co-occurring disorders. • Among individuals with both trichotillomania and excoriation disorder, there is significant positive correlation between hair-pulling and skin-picking severity as well as hair-pulling and skin-picking subtypes. • This cross-sectional data suggest that hair-pulling and skin-picking severity peaks at the transition to adulthood and hair-pulling/skin-picking styes shift across the lifespan. Trichotillomania (hair-pulling disorder) and excoriation (skin-picking) disorder are body-focused repetitive behaviors, which often first present in adolescence and cause distress and impairment into adulthood. Few studies have examined the clinical characteristics of the co-occurrence of these conditions across the lifespan. We examined cross-sectional survey responses collected from April 2018-February 2020 to evaluate the relationship between trichotillomania, excoriation disorder, and their co-occurrence. Responses from individuals with trichotillomania (n = 50), excoriation disorder (n = 52), and both conditions (n = 50) ages 4–67 years old were compared for co-occurring conditions and current symptoms. Self-report measures of hair-pulling and skin-picking severity and subtypes were assessed. Gender, race, and co-occurring conditions were generally similarly distributed across the three groups with high rates of self-reported anxiety (63–82%), depression (34–50%), obsessive-compulsive disorder (16–29%), and attention-deficit/hyperactivity disorder (12–32%). Among individuals with both trichotillomania and excoriation disorder, significant positive correlations were observed between hair-pulling and skin-picking severity scores as well as hair-pulling and skin-picking subtypes. Hair-pulling and skin-picking severity peaked at the transition from adolescence to adulthood and hair-pulling/skin-picking styles appeared to shift across the lifespan. Our results support several similarities between trichotillomania and excoriation disorder, providing new insight into the clinical characteristics of these conditions. [ABSTRACT FROM AUTHOR]

Background: Comorbidity between substance use disorders (SUDs) and bipolar disorder (BD) is highly prevalent to the extent it may almost be regarded the norm. This systematic review and meta-analysis aimed to estimate the prevalence rates of SUDs in treatment seeking patients diagnosed with BD in both inpatient and outpatient settings.Methods: A comprehensive literature search of Medline, EMBASE, psychINFO and CINAHL databases was conducted from 1990 to 2015. Prevalence of co-morbid SUDs and BD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis.Results: There were 151 articles identified by electronic searches that yielded 22 large, multi-site studies and 56 individual studies describing comorbid rates of SUDs amongst community dwelling, BD inpatients or outpatients. The SUDs with the highest prevalence in BD were alcohol use (42%) followed by cannabis use (20%) and other illicit drug use (17%). Meta-analysis showed males had higher lifetime risks of SUDs compared to females. BD and comorbid SUDS were associated with earlier age of onset and slightly more hospitalisations than non-users.Limitations: The results do not take into account the possibility that individuals may have more than one comorbid disorder, such as having more than one SUD, anxiety disorder, or other combination. Some of the meta-analyses were based on relatively few studies with high rates of heterogeneity. Most included studies were cross-sectional and therefore causality cannot be inferred.Conclusions: This systematic review shows comorbidity between SUDs and bipolar illness is highly prevalent in hospital and community-based samples. The prevalence of SUDs was similar in patients with bipolar I and bipolar II disorders. This study adds to the literature demonstrating that SUDs are common in BD and reinforces the need to provide better interventions and properly conducted treatment trials to reduce the burden conferred by comorbid SUD and BD. [ABSTRACT FROM AUTHOR]

Awareness of autism spectrum disorder (ASD) within public and medical domains has increased. Demand on services is high as children and young people are being presented for earlier advice, assessment and diagnosis. To maximise detection and minimise harm it is essential for all clinicians working with children including primary care teams, allied healthcare professionals, educational and social care staff to have a sound knowledge of the presentation and assessment of autism spectrum disorders (ASD) and an understanding of the co-morbidities. Whilst routes of entry for referrals can vary due to a diversity of presentation and local service provision, there are standards in the recognition, referral and diagnosis of autism. Early identification is advantageous in order to maximize the child's potential, provide appropriate support and targeted intervention for ASD and co-occurring conditions with the aim of improving outcomes. This review addresses the diagnosis of ASD and provides an assessment framework for professionals who encounter a child with a suspected autism spectrum disorder. [ABSTRACT FROM AUTHOR]

Objective To study the risk of myocardial infarction (MI) in patients with atrial fibrillation (AF) treated in primary health care with warfarin or acetylsalicylic acid (ASA, aspirin). Methods The study population included subjects (n = 12,283) 45 years or older diagnosed with AF who were treated in 75 primary care centres in Sweden between 2001 and 2007. MI was defined as a hospital stay for MI during 2001 through 2010 registered in the Swedish Patient Register. Associations between warfarin or ASA treatment and incident MI were explored using Cox regression analysis, by estimating hazard ratios (HRs) and 95% confidence intervals (95% CIs). Adjustment was made for age, socio-economic factors and cardio-vascular co-morbidity. Results Persistent treatment (“per protocol” treatment) with warfarin alone was present among 32.4% of women and 37.4% of men, and with ASA alone among 30.0% of women and 28.1% of men. The fully adjusted HRs for MI, compared to those with no antithrombotic treatment, with warfarin treatment for women were 0.26 (95% CI 0.16–0.41) and for men 0.28 (95% CI 0.20–0.39); and the corresponding HRs for those treated with ASA were for women 0.57 (95% CI 0.37–0.87), and for men 0.44 95% CI (0.31–0.63). The fully adjusted HR for MI when comparing patients with warfarin treatment to those with ASA treatment was for women 0.46 (95% CI 0.27–0.80), and for men 0.58 (95% CI 0.38–0.89). Conclusions Warfarin seems to prevent MI among AF patients in a primary healthcare setting, which emphasizes the importance of persistent anticoagulant treatment in those patients. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the 90 days and 1 year mortality predictive ability of the RxRisk-V, Charlson, and Elixhauser co-morbidity measures in total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients.Method: A retrospective study of 11,848 THAs and 18,972 TKAs (2001-2002) was conducted. Death within 90 days and 1 year of the surgery were the main endpoints. Co-morbidity measures were calculated using either medication or hospitalisation history. Logistic regression models were employed and discrimination and calibration were assessed. Specifically, models with unweighted and weighted measure scores, models with the specific conditions, and a model combining conditions identified by all measures were assessed.Results: In THAs, the best performing prediction models included co-morbidities from all three measures (90 days: c = 0.84, P = 0.284, 1 year: c = 0.79, P = 0.158). Individually, the model with Charlson conditions performed best at 90 days mortality (c = 0.80, P = 0.777) and the Charlson and Elixhauser performed similarly at 1 year (both c = 0.77, P > 0.05). In TKAs, the best performing prediction model included co-morbidities from all measures (90 days: c = 0.82, P = 0.349, 1 year: c = 0.78, P = 0.873). Individually, the model with Elixhauser conditions performed best with 90 days mortality (c = 0.79, P = 0.435) and all performed similarly at 1 year (c = 0.74-0.75, all P > 0.05).Conclusions: A combined model with co-morbidities identified by the Elixhauser, Charlson, and RxRisk-V was the best mortality prediction model. The RxRisk-V did not perform as well as the others. Because of the Elixhauser and Charlson's similar performance we suggest basing the choice of measurement use on factors such as the need of specific conditions and modelling limitations. [ABSTRACT FROM AUTHOR]

Previous studies on effects of postpartum depression (PPD) on infant-mother attachment have been divergent. This may be due to not taking into account the effects of stable difficulties not specific for depression, such as maternal personality disorder (PD). Mothers (N=80) were recruited for a longitudinal study either during pregnancy (comparison group) or eight weeks postpartum (clinical group). Infants of mothers with depressive symptoms only or in combination with a PD diagnosis were compared with infants of mothers with no psychopathology. Depression and PD were assessed using self-report and clinical interviews. Infant-mother attachment was assessed when infants were 13 months using Strange Situation Procedure (SSP). Attachment (in)security was calculated as a continuous score based on the four interactive behavioral scales of the SSP, and the conventional scale for attachment disorganization was used. PPD was associated with attachment insecurity only if the mother also had a PD diagnosis. Infants of PPD mothers without co-morbid PD did not differ from infants of mothers with no psychopathology. These results suggest that co-existing PD may be crucial in understanding how PPD impacts on parenting and infant social-emotional development. Stable underlying factors may magnify or buffer effects of PPD on parenting and child outcomes. [ABSTRACT FROM AUTHOR]

Background Bioelectrical impedance analysis (BIA) is well tolerated, inexpensive, and readily available, but can it be used to detect with clinical precision aberrant changes in the proportion of fat mass to fat-free mass during weight loss? Objectives To assess the variance in percentage body fat mass explained by the readily available inputs and assess residual variance provided by leg-to-leg BIA scales. Methods Using cross-sectional data from a cohort of 665 patients of Indian ethnicity presenting for bariatric surgery, we examine the determinants of percentage body fat as provided by leg-to-leg output from Tanita SC-330 BIA scales. Results Four input factors—sex, weight, height, and age—contributed to provide 92% and 95% explanation in output variance for percentage fat mass (%FM) and actual fat mass, respectively, in 665 patients. Body mass index alone explained 89% and 81% of variance in %FM output for women and men, respectively. Neither weight distribution, as indicated by waist and hip circumference or waist to hip ratio, nor plasma lipids or markers of glucose metabolism contributed additional variance in %FM when controlled for the 4 key inputs. Conclusions Simple, known input variables dominate the leg-to-leg BIA output of %FM, and this may compromise the detection of aberrant changes in %FM and fat-free mass with substantial weight loss. For clinical research, validated methods not largely dependent on known inputs should be used for evaluating changes in body composition after substantial weight loss. [ABSTRACT FROM AUTHOR]

Background: Many aspects of co-morbidity burden in Parkinson's disease (PD) are unclear, but it may be an important predictor of prognosis or confounder of associations in epidemiological studies.Objectives: To determine how best to assess co-morbidity burden in PD, to compare with matched controls, and investigate its association with prognostic outcomes.Methods: Data from an incident, community-based cohort with prospective follow-up (the PINE study) were used (198 patients with PD and 151 controls). The reliability of three co-morbidity scales (the Charlson co-morbidity index (CCI), the Cumulative Illness Rating scale and a simple disease count) were evaluated. The association with mortality and development of dependency was assessed with Cox regression. The co-morbidity burden in PD and controls was compared at baseline and over 5 years of follow-up using linear mixed modelling.Results: The CCI was more reliable and was an independent predictor of mortality with a time-dependent effect (hazard ratio = 1.27 [1.08-1.49] in first four years of follow-up; no significant association after four years). Associations between the other scales and mortality and between each scale and development of dependency were non-significant once adjusted for confounders. Co-morbidity burden was similar between cases and controls at baseline and there was no evidence of differential accrual of co-morbidity between patients and controls (p = 0.94).Conclusions: The CCI is probably the better scale for measuring co-morbidity burden in PD. There were no differences between PD and controls. Co-morbidity burden at diagnosis was associated with mortality in the early part of the disease course, but not later. [ABSTRACT FROM AUTHOR]