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Aims Methods Results Conclusions To determine the prognosis associated with severe hypoglycaemia (SH) and diabetic ketoacidosis (DKA) in adults presenting to a hospital emergency department (ED).Medical records of adults with type 1 (T1D) and type 2 (T2D) diabetes who attended the ED with SH and DKA between 1 January 2019 and 30 June 2023, were reviewed for comorbidities, long‐term survival, mortality and causes of death.A total of 429 episodes of DKA occurred in 293 people and 643 episodes of SH in 515 people. DKA predominated in T1D (77.6%) and SH in T2D (54.3%). In T2D, 32.3% of DKA events were associated with sodium‐glucose cotransporter‐2 inhibitor (SGLT2‐i) medication. In both SH and DKA, patients with T2D were older and had more comorbidities than T1D, particularly cardiorenal disease, heart failure, cognitive impairment and cancer (all p < 0.005). Compared with T1D, mortality was higher in T2D after SH (48.4% vs. 19.9%, p < 0.005) and after DKA (30.8% vs. 13.4%, p = 0.001) with shorter median times to fatal outcome (SH: 134 vs. 511 days; DKA: 43 vs. 266 days, both p < 0.005). Long‐term survival was lower (p < 0.005) and mortality risk was higher in T2D after index presentation with SH (HR 3.43 [95% CI: 2.43–4.84], p < 0.005) and DKA (HR 3.00 [95% CI: 1.77–5.10], p < 0.005). Irrespective of diabetes type, most causes of death in SH and DKA were non‐cardiovascular.SH and DKA events requiring hospital treatment herald a poor prognosis with greater mortality in T2D adults with multimorbidity. A significant number of DKA episodes in T2D occurred in people receiving SGLT2‐i medication. [ABSTRACT FROM AUTHOR]

Aims Design, setting and participants Measurements Findings Conclusions This study (1) estimated changes in anxiety and depression throughout 3 years in a community‐recruited cohort who use methamphetamine and (2) modelled whether these changes were associated with patterns of methamphetamine use or other time‐varying or fixed covariates.We used a longitudinal analysis using data derived from surveys conducted between August 2016 and March 2020, set in metropolitan and rural locations in Victoria, Australia. Participants comprised a total of 849 adults with regular methamphetamine use history at baseline, recruited for the prospective VMAX study via snowball and respondent‐driven sampling.Anxiety and depression symptoms were measured using the Generalized Anxiety Disorder (GAD)‐7 and the Patient Health Questionnaire (PHQ)‐9 instruments. Frequency of methamphetamine use was measured by self‐reported number of days per week participants used any form of methamphetamine in the past month.Changes in anxiety and depression symptom scores were associated with change in route of administration from non‐injecting to injecting [adjusted coefficient (adj. coeff.) = 1.44, 95% confidence intervals (CI) = 0.39, 2.48, adj. coeff. = 1.49, 95% CI = 0.39, 2.58], change in severity of dependence for methamphetamine (adj. coeff. = 0.29, 95% CI = 0.21, 0.37, adj. coeff. = 0.34, 95% CI = 0.26, 0.42), starting treatment for drugs other than methamphetamine (adj. coeff. = −2.21, 95% CI = −3.70, −0.73, adj. coeff. = −2.09, 95% CI = −3.60, −0.58) and other covariates.Among regular methamphetamine users in Australia, changes in anxiety or depression scores are associated with changes in route of administration, dependence severity and starting treatment for other drugs, but do not appear to be associated with frequency of methamphetamine use. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Method Result Conclusion This study seeks to thoroughly investigate the generation mechanism of the integrated management pathway for comorbidities, as well as its implementation and execution in practical settings. The findings aim to offer insights for the development of an integrated mechanism for comorbidity services.The collected raw data was coded and analyzed in depth by utilizing grounded theory as the research methodology, in conjunction with NVivo 14.0 software for qualitative analysis, and by adhering to domestic and international guidelines and consensus on comorbidity management.Following the three‐level coding process, a total of 49 initial categories, 14 main categories, and 4 core categories (supply‐type, demand‐type, collaboration‐type, and environment‐type) were identified. Subsequently, a four‐dimensional comprehensive comorbidities management pathway model, referred to as the “Derivative driving force—management pathway—main body network—operation mechanism,” was developed.The model integrates the four paths of supply‐type, demand‐type, collaboration‐type, and environment‐type with the derived dynamics, subject network, and operation mechanism of comorbidities management. This not only enhances the comprehensiveness and continuity of comorbidities management but also establishes clear direction and evaluation indices for future empirical research. [ABSTRACT FROM AUTHOR]

Aims Methods and results Conclusion Atrial fibrillation (AF) is associated with heart failure (HF). However, it is unclear if postoperative AF (POAF) following non‐cardiac surgery differs from non‐surgical AF in terms of the risk of HF. We compared the long‐term rate of incident HF in patients developing new‐onset POAF following non‐cardiac surgery with patients who did not develop POAF following non‐cardiac surgery and patients with non‐surgical non‐valvular AF (NVAF).Using Danish nationwide registries, all patients aged ≥30 years who developed POAF following non‐cardiac surgery (1996–2020) were identified and matched in a 1:3 ratio by age, sex, surgery type (only for the surgery group), selected comorbidities, and inclusion year with patients without POAF following non‐cardiac surgery and individuals with NVAF, respectively. A total of 2270 patients with POAF were matched with 6810 patients without POAF following non‐cardiac surgery, and 1846 patients with POAF were matched with 5538 patients with NVAF. The median follow‐up was 7.2 years. Compared with patients without POAF, those with POAF had a higher associated long‐term rate of incident HF (2.6 vs. 1.2 events per 100 person‐years; adjusted hazard ratio [HR] 2.39, 95% confidence interval [CI] 2.06–2.78). Compared with individuals with NVAF, patients with POAF did not have a significantly different rate of incident HF (2.7 vs. 3.0 events per 100 person‐years; adjusted HR 0.89, 95% CI 0.78–1.03).Patients with new‐onset POAF following non‐cardiac surgery had a higher associated long‐term rate of incident HF compared to those without POAF, with no significant difference in the rate of incident HF when compared to patients with NVAF. [ABSTRACT FROM AUTHOR]

Background and Aim Methods Results Conclusions Sarcopenia and osteoporosis adversely impact the clinical outcomes of patients with chronic liver disease (CLD). The Japan Society of Hepatology (JSH) sarcopenia criteria utilize bioelectrical impedance analysis (BIA) for assessing muscle mass rather than dual‐energy X‐ray absorptiometry (DXA), which can simultaneously diagnose these comorbidities. We investigated the correlations and interchangeability between the appendicular skeletal muscle mass index (ASMI) values determined using BIA and DXA and evaluated the diagnostic ability of DXA for sarcopenia and osteosarcopenia in patients with CLD.This cross‐sectional study included 173 patients with CLD. Sarcopenia was defined as low ASMIBIA according to the JSH and Asian Working Group for Sarcopenia (AWGS) criteria (ASMIBIA cutoff) or low ASMIDXA according to the AWGS criteria (ASMIDXA cutoff) and low handgrip strength. For women, a provisional cutoff value was set for ASMIDXA using the ASMIBIA cutoff (ASMIDXA‐altered cutoff).We found that ASMIBIA and ASMIDXA were significantly correlated (r = 0.921; P < 0.001). The Bland–Altman plots demonstrated substantial agreement between ASMIBIA and ASMIDXA, with a mean difference of 0.0116 kg/m2. The prevalence rates of sarcopenia and osteosarcopenia diagnosed using the ASMIBIA cutoff were 26.0% and 17.3%, respectively. The kappa coefficients for the prevalence of sarcopenia and osteosarcopenia were 0.759 and 0.775 between ASMIBIA cutoff and ASMIDXA cutoff and 0.780 and 0.806 between ASMIBIA cutoff and ASMIDXA‐altered cutoff, respectively.The utilization of DXA can facilitate the comprehensive assessment and management of musculoskeletal comorbidities in patients with CLD. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Conclusion This study aimed to analyze the factors affecting the occurrence of peri‐implant medication‐related osteonecrosis of the jaw (PI‐MRONJ) in patients using anti‐resorptive drugs (ARDs) on different implant position, inclinations, and types of prosthesis.The data of 75 patients with bone necrosis that progressed around the implant between 2018 and 2022 were retrospectively examined to identify the factors influencing PI‐MRONJ. Data, including patient demographics (age, sex, smoking status, concomitant disease, time of ARD therapy, dose of ARDs, and parafunctional habits) and implant‐specific information (type of prosthesis, angle of insertion), were extracted from medical and dental records.Tilted implants with an angle ≥ 5.1° relative to the occlusal plane of the prosthesis had a stronger association with PI‐MRONJ in comparison to non‐tilted implants (inclination was < 5°). Additionally, the boundary of the area of osteonecrosis around the fixture was larger for the splinted implant‐supported crowns than for the single implant supported crowns).In patients taking anti‐resorptive medications the inclination of the implant was associated with the occurrence of PI‐MRONJ. Further studies are required to confirm the clinical findings. [ABSTRACT FROM AUTHOR]

Background and Aims Methods Results Conclusion Atrial fibrillation is the most prevalent cardiac arrhythmia, and catheter ablation (CA) has emerged as a viable treatment option for selected patients. However, its safety profile in liver cirrhosis (LC) populations remains underexplored.This was an observational analysis of the National Inpatient Sample Database 2016–2020; we analyzed adult encounters undergoing CA for atrial fibrillation who had a concomitant diagnosis of LC. Using propensity scores, encounters were divided into two cohorts based on the presence or absence of LC and matched in a 1:1 fashion using LC as the dependent variable. In‐hospital mortality and postprocedure total complications were compared using regression models.93 830 procedures were identified for non‐LC patients and 960 involving LC patients; after propensity score matching, each cohort included 910 hospitalizations. The mean age in the LC‐matched cohort was 66.5 ± 9.1 years. In‐hospital mortality did not differ between the groups (aOR = 1.01; 95% CI [0.06–16.1]; p = .99). However, the LC cohort exhibited higher odds of total complications (aOR = 1.98; 95% CI [1.42–2.75]; p < .001). Length of stay (LOS) was comparable, but total costs were higher in the LC cohort: LOS was 2 days (95% CI [1–3]) in the LC group versus 3 days (95% CI [1–4]) (p < .11) and LC: $202,000 (95% CI [$142 000–$261 000]) versus non‐LC: $189 000, (95% CI [$153 000–$222 000]) (p < .0001).In this national analysis of patients undergoing CA for AF, those with LC had similar in‐hospital mortality, postprocedure complications, and LOS compared to noncirrhotic patients. Furthermore, longitudinal studies are needed to assess the safety profile of CA in this subpopulation. [ABSTRACT FROM AUTHOR]

Background: The publication of phase 2 of the CATALISE project in 2017 clarified terminology for children with developmental language disorder (DLD) or delay but unintentionally muddied the water for children with unintelligible speech. A diagnostic label of DLD (phonology) indicates poor prognosis and phonological disorder that persists into middle childhood. However, in contrast to other diagnostic labels that fall under the overarching term of speech sound disorder (SSD), DLD (phonology) does not elucidate the characteristics of the child's speech nor does it point us in the direction of appropriate intervention. Aims: The aim of this paper is to discuss terminology in SSD leading to an evidence‐based model which builds on the model of DLD developed in CATALISE, supports descriptive diagnosis and signposts intervention. Methods: Following a focused review of literature proposing or describing terminology for SSD, an expert group of researchers in developmental SSD proposed a revised model of existing terminology. Groups of UK speech and language therapists (SLTs) who provide services for children with SSD were asked to comment on its acceptability and feasibility. Discussion: A three‐level terminology model was developed. This comprised an overarching Level 1 term; Level 2 terms that differentiated SSD of unknown origin from SSD with associated or underlying conditions; and specific diagnostic terms at Level 3 to support further assessment and intervention decisions. Consulted SLTs generally expressed agreement with the proposed terminology and a willingness to adopt it in practice. Conclusions: Existing terminology for childhood SSD provides a good basis for clinical decision‐making. A modified version of Dodd's (2005) terminology was found to be acceptable to UK SLTs. There is an evident overlap of SSD with CATALISE terminology. However more detailed and specialist terminology than 'DLD (phonology)' is required to support clinical decision‐making. It is proposed that endorsement by the UK Royal College of Speech and Language Therapists would obviate the need for a Delphi process. What this paper adds: What is already known on this subject: Over nearly a hundred years, as our knowledge and understanding of speech sound disorder (SSD) has increased, so has the terminology that is used to describe those disorders. Current terminology not only describes subtypes of SSD but can also signpost us to effective interventions. With the publication, in 2017, of phase 2 of CATALISE a new term of 'developmental language disorder (DLD) (phonology)' was introduced with the unintentional consequence of challenging more specific descriptive terms for SSD. What this paper adds: In the context of CATALISE and DLD (phonology), the history and nature of SSD terminology are reappraised. Building on the model of DLD developed in CATALISE, a tiered model that supports descriptive diagnosis and signposts intervention is proposed for discussion. Clinical implications of this study: The proposed model of terminology for SSD provides descriptive and detailed labels that will support accuracy in differential diagnosis of developmental SSD by speech and language therapists. Furthermore, a decision‐making tree for SSD demonstrates the pathway from diagnostic use of the terminology to the selection of evidence‐based, effective interventions. [ABSTRACT FROM AUTHOR]

Summary: Validation of biobanks and large cancer cohorts is essential in ensuring high‐quality research results. We examined the coverage, generalisability and validity of the lymphoma collection of the Uppsala‐Umeå Comprehensive Cancer Consortium (U‐CAN) biobank in Sweden, one of the largest cancer biobanks in Europe. Up until 2022, 889 lymphoma patients in U‐CAN Uppsala had available samples, and 329 in U‐CAN Umeå. Patients diagnosed in the U‐CAN Uppsala area 2011–2021 (n = 843) were linked to the nationwide Swedish Lymphoma Register, and a subset diagnosed before 2019 (n = 727) to population‐based registers. The coverage was 39% of all lymphoma patients between 2011 and 2019 diagnosed in the U‐CAN Uppsala area, with a pandemic decline to 10% during 2020–2021. The patients included had superior overall survival (hazard ratio = 0.70 [95% confidence interval, CI: 0.60–0.82]) than all lymphoma patients in Sweden. They had better performance status, were younger (odds ratio [OR] = 0.21 [95% CI: 0.13–0.34]) and had less comorbidities (OR = 0.66 [95% CI: 0.56–0.78]). However, cause‐specific survival and stage distribution were similar. The questionnaire data captured less comorbidities compared to the national registers. Evaluations of biobanks are important, as even population‐based biobanks such as U‐CAN select younger patients with higher socioeconomical status and better performance status. However, the similar cause‐specific survival as in the registries suggests U‐CANs usefulness for prognostic biomarker studies. [ABSTRACT FROM AUTHOR]

Objective: Limited evidence exists regarding the impact of the COVID‐19 pandemic on the onset and trajectory of eating disorders (EDs) among young in Spain. This study aims to analyze the characteristics and recent trends in hospital admissions for EDs within the pediatric population. Methods: A retrospective analysis was conducted on hospital admissions for EDs among patients aged 10–19 years between 2016 and 2022. The main outcomes examined included hospital rates (overall, stratified by ED type and age group), psychiatric comorbidities, and length of stay. Results: A total of 8275 hospitalizations due to EDs were identified, constituting 1 in 6 hospital admissions for mental illness and behavioral disorders. Predominant characteristics of this population included female sex (93%), aged 15–19 years (58.3%), admission primarily for anorexia nervosa (71.6%), and psychiatric comorbidity (35.6%). Hospital admissions for EDs in the pediatric population showed an increasing trend, with an annual average increase of 11.1% (95% CI: 2.6, 22.6). This rise was led by children aged 10–14 years, with a yearly increase in EDs hospitalization rates of 28.4% (95% CI: 13.5, 56.3) since 2019. Each discharge related to EDs was associated with a median stay of 24 days (IQR: 10, 40). Discussion: Efforts in community healthcare should prioritize early detection and intervention for symptoms indicative of EDs in the pediatric population, aiming to mitigate the severity of cases requiring hospitalization. These findings underscore the necessity for targeted health planning policies to address the growing burden of EDs among Spanish youth. [ABSTRACT FROM AUTHOR]

Objective: Avoidant/restrictive food intake disorder (ARFID) is common among populations with nutrition‐related medical conditions. Less is known about the medical comorbidity/complication frequencies in youth with ARFID. We evaluated the medical comorbidities and metabolic/nutritional markers among female and male youth with full/subthreshold ARFID across the weight spectrum compared with healthy controls (HC). Method: In youth with full/subthreshold ARFID (n = 100; 49% female) and HC (n = 58; 78% female), we assessed self‐reported medical comorbidities via clinician interview and explored abnormalities in metabolic (lipid panel and high‐sensitive C‐reactive protein [hs‐CRP]) and nutritional (25[OH] vitamin D, vitamin B12, and folate) markers. Results: Youth with ARFID, compared with HC, were over 10 times as likely to have self‐reported gastrointestinal conditions (37% vs. 3%; OR = 21.2; 95% CI = 6.2–112.1) and over two times as likely to have self‐reported immune‐mediated conditions (42% vs. 24%; OR = 2.3; 95% CI = 1.1–4.9). ARFID, compared with HC, had a four to five times higher frequency of elevated triglycerides (28% vs. 12%; OR = 4.0; 95% CI = 1.7–10.5) and hs‐CRP (17% vs. 4%; OR = 5.0; 95% CI = 1.4–27.0) levels. Discussion: Self‐reported gastrointestinal and certain immune comorbidities were common in ARFID, suggestive of possible bidirectional risk/maintenance factors. Elevated cardiovascular risk markers in ARFID may be a consequence of limited dietary variety marked by high carbohydrate and sugar intake. [ABSTRACT FROM AUTHOR]

Objective: Adherence to antiretroviral treatment (ART) plays a key role in achieving viral suppression in people living with HIV. We aimed to quantify ART adherence in the entire French HIV‐infected population treated in 2019 and to determine factors of influence. Methods: People living with HIV were identified using HIV diagnosis according to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision criteria, HIV‐specific laboratory tests, and prescription of antiretrovirals in 2019. Adherence was measured using the medication possession ratio (MPR; actual divided by theoretical number of tablets). Variables of interest included sex, age, type of ART, relevant comorbidities, and receiving supplementary universal health coverage for low‐income citizens (CMUc). Results: Of the n = 211 124 people living with HIV identified between 2006 and 2019, we included n = 140 607 on ART with two or more prescription fills in 2019 in this analysis. In total, 87.5% of people living with HIV were receiving ART in 2019. Mean ± standard deviation MPR was 82.5 ± 22.7%; 57% of people living with HIV had an MPR ≥90%, and 12.7% had an MPR <50%. Those with an MPR ≥90% significantly differed between males and females (59.1% and 52.8%, respectively; p < 0.001), and between CMUc recipients and non recipients (54.1% and 57.6%, respectively; p < 0.001). MPR ≥90% rate was lower for those with chronic nephropathy (50.2%), renal failure (46.6%), and tuberculosis (50.1%), and for those using psychoactive substances (52.3%). Factors associated with MPR ≥90% in multivariable analysis were older age, male sex, not receiving CMUc, more recent HIV diagnosis, and triple (vs. dual) ART. Conclusion: In 2019, the average MPR in people living with HIV was 82.5% according to the comprehensive French health care database. Besides sociodemographic variables such as older age, male sex, and not being a CMUc recipient (i.e. of low socioeconomic status), more recent HIV diagnosis and triple therapy were independently associated with better adherence, possibly reflecting advances in ART tolerability and dosing. [ABSTRACT FROM AUTHOR]

Background: Pain in cancer patients is a complex clinical problem. Pain is systematically assessed and treated during palliative care, but little is known about how it is addressed before starting palliative care. Aim: This study primarily analyzed pain, symptoms, ongoing therapy at patients' admittance to the palliative care unit, and the relationships between pain and tumor, comorbidities, performance status and quality of life (QoL). Notably, patient satisfaction with the received antalgic therapy was assessed. Methods: A multicentric, prospective, observational study was conducted in seven Italian palliative centers. The population consisted of adult cancer patients admitted to specialist palliative care units in hospice and home care. Results: The sample consisted of 476 patients. Ninety‐three patients reported moderate pain of 4.0 and worst pain of 5.9 at the initial medical examination. The pain was high, and QoL was lower in breakthrough pain. The pain was lower in older subjects when it was discontinuous and when it was also treated with corticosteroids. A total of 61% of the patients were unsatisfied with the prescribed pain therapy. Conclusions: Before the beginning of palliative care, physicians do not manage pain adequately. We support the idea that palliative care is not only intended for the last days of life but must be started early and simultaneously with oncological treatments. All that, in our opinion, is often ignored, and we hope that our study could have a positive influence and that the study results stimulate further research in this area with in‐depth studies. [ABSTRACT FROM AUTHOR]

Background: Effective interventions for the management of alcohol‐related liver disease (ARLD) remain a gap in clinical practice, and patients' engagement with alcohol services is suboptimal. Based upon the principles of operant conditioning, contingency management (CM) is a psychosocial intervention th at involves gradual, increasing incentives upon completion of treatment‐related goals such as treatment attendance. Methods: A pilot feasibility trial was conducted with 30 adult patients recruited from an inpatient clinical setting. Consecutive sampling was used to recruit patients presenting comorbid alcohol use disorder (AUD) and ARLD. Participants were randomized to integrated liver care (ILC), receiving hepatology and AUD care, or ILC with a voucher‐based CM intervention (intervention arm). A longitudinal qualitative approach was adopted to explore anticipated (Stage 1) and experienced acceptability (Stage 2). The Theoretical Framework of Acceptability (TFA) guided semi‐structured in‐depth interviews and deductive analysis. Results: Thirty participants were enrolled in the pilot trial, and interviews were conducted with 24 participants at Stage 1 and seven at Stage 2. Over half of the cohort (54.2%, n = 13) presented decompensated liver disease, and an average of 179 units of alcohol were consumed per week. Overall positive views toward voucher‐based CM were noted, and explanatory data emerged across five TFA domains (intervention coherence, ethicality, self‐efficacy, perceived effectiveness, and affective attitude). The core aspects of the voucher‐based CM intervention matched participants' preferences and needs. Participants regarded CM as having a symbolic value and strengthening the therapeutic alliance with healthcare providers. Conclusion: The data support the scope of voucher‐based CM intervention to promote engagement with treatment services, and its potential to address the gaps in the care continuum in ARLD. The findings are of practical significance for developing person‐centered, tailored interventions for this clinical population. The outcomes of this investigation can inform decision‐making among stakeholders and healthcare providers and improve health outcomes for this clinical population. [ABSTRACT FROM AUTHOR]

The article discusses the challenges and opportunities in managing alcohol-associated liver disease (ALD) and alcohol use disorder (AUD), emphasizing the importance of effective treatment for improving patient outcomes. Topics include the role of family support in recovery, barriers such as stigma and healthcare system complexities, and the potential for integrative care models to improve treatment for patients with comorbid AUD and ALD.

Background: Alcohol use after liver transplant (LT) is associated with higher rates of graft loss and increased mortality; however, there are limited data evaluating predictors of return to alcohol use using biochemical markers like phosphatidylethanol (PEth). Methods: This multicenter retrospective cohort study evaluated psychosocial predictors of return to alcohol use using PEth testing in patients transplanted for alcohol‐associated liver disease (ALD). The study included 223 patients at three centers who had received a LT for ALD and had at least one PEth measurement post‐LT. Results: The rate of return to alcohol use was 6.9 cases per 100 person‐years (26 patients total) over a median 555 days of follow‐up after transplant. Younger age (HR 0.96; 95% CI 0.92–0.99, p = 0.02), mental health comorbidities (HR 2.83; 95% CI 1.25–6.39, p = 0.01), and non‐Hispanic White race (HR 3.79; 95% CI 1.42–10.15, p = 0.01) were associated with return to alcohol use post‐LT. There was no difference between post‐LT return to alcohol use rates or short‐term survival among patients with less than 6 months of sobriety prior to listing compared with those with more than 6 months. Patients with sustained alcohol use post‐LT had increased odds of history of illicit substance use (OR 5.20; 95% CI 1.01–26.83, p = 0.04) but no significant difference in time from the last drink to listing (OR 1.03; 95% CI 0.18–5.80, p = 0.97). Conclusions: These findings emphasize the importance of mental health comorbidities rather than period of sobriety in predicting post‐LT return to alcohol use. Furthermore, the higher risk of return to alcohol use in non‐Hispanic White patients suggests a potential disparity with referral and selection of higher risk White patients. [ABSTRACT FROM AUTHOR]

Background: Current guidelines for the diagnosis and treatment of pericarditis refer to the general adult population. Few and fragmentary data regarding recurrent pericarditis in older adults exist. Objective of the Study: Given the absence of specific data in scientific literature, we hypothesized that there might be clinical, laboratory and outcome differences between young adults and older adults affected by idiopathic recurrent pericarditis. Materials and Methods: We performed an international multicentric retrospective cohort study analyzing data from patients affected by recurrent pericarditis (idiopathic or post‐cardiac injury) and referring to tertiary referral centers. Clinical, laboratory, and outcome data were compared between patients younger than 65 years (controls) and patients aged 65 or older. Results: One hundred and thirty‐three older adults and 142 young adult controls were enrolled. Comorbidities, including chronic kidney diseases, atrial fibrillation, and diabetes, were more present in older adults. The presenting symptom was dyspnea in 54.1% of the older adults versus 10.6% in controls (p < 0.001); pain in 32.3% of the older adults versus 80.3% of the controls (p < 0.001). Fever higher than 38°C was present in 33.8% versus 53.5% (p = 0.001). Pleural effusion was more prevalent in the older adults (55.6% vs 34.5%, p < 0.001), as well as severe pericardial effusion (>20 mm) (24.1% vs 12.7%, p = 0.016) and pericardiocentesis (16.5% vs 8.5%, p = 0.042). Blood leukocyte counts were significantly lower in the older adults (mean + SE: 10,227 + 289/mm3 vs 11,208 + 285/mm3, p = 0.016). Concerning therapies, NSAIDS were used in 63.9% of the older adults versus 80.3% in the younger (p = 0.003), colchicine in 76.7% versus 87.3% (p = 0.023), corticosteroids in 49.6% versus 26.8% (p < 0.001), and anakinra in 14.3% versus 23.9% (p = 0.044). Conclusions: Older adults affected by recurrent pericarditis show a different clinical pattern, with more frequent dyspnea, pleural effusion, severe pericardial effusion, and lower fever and lower leukocyte count, making the diagnosis sometimes challenging. They received significantly less NSAIDs and colchicine, likely due to comorbidities; they were also treated less commonly with anti‐IL1 agents, and more frequently with corticosteroids. [ABSTRACT FROM AUTHOR]

Objective: Describe the epidemiology of cluster headache (CH) using Veterans Health Administration (VHA) Electronic Health Record (EHR) data. Background: Epidemiologic studies of CH at the population level are difficult because it has a prevalence of ~0.1%. Hospital system‐wide studies are an attractive alternative as they have large numbers of patients and broader populations than headache or neurology clinic‐based studies. The VHA is an ideal hospital‐based system in which to study CH because it is nationwide, predominantly male, has a strong focus on mood disorders and suicidality, and has accessible individual medical records. Here, we report the first headache study based on an ongoing longitudinal cohort of patients with CH using VHA EHR data. Methods: The VHA EHR data were accessed from Fiscal Year 2008 to 2019. Patients with CH consisted of all patients with at least one outpatient visit containing a CH diagnosis code from the International Classification of Diseases (ICD)‐9 or ‐10. We extracted data on demographic features, incidence, and prevalence, as well as pain and psychiatric comorbidities. Results: Of the 1,524,960 distinct patients who presented for headache treatment in the VHA between Fiscal Year 2008–2019, 24,131 had at least one visit with a CH diagnosis. The 1‐year period prevalence of a CH diagnosis in the VHA ranges from 0.08% to 0.10% for women and 0.10% to 0.18% for men. A larger proportion of women versus men received a diagnosis of unspecified CH (59.6% [1412/2368] vs. 53.6% [11,663/21,763], p < 0.001). Most patients with CH had both comorbid headache and non‐headache pain diagnoses. Headache not‐otherwise‐specified was the most common comorbid headache disorder at 70.0% (16,885/24,131) and was more common in women (76.1%, 1801/2368) compared to men (69.3%, 15,084/21,763). Other common comorbidities included migraine, depression, tobacco use, and obstructive sleep apnea. Rates of suicidal ideation or attempt were almost 50% higher in women (5‐year proportion 9.4%, 222/2368) with CH compared to men (6.6%, 1433/21,763). Conclusions: To our knowledge this is the largest hospital system study of CH to date and reinforces several previous studies. Pain, mental health, and sleep disorders comorbidities are particularly prevalent in this group and were often more common in women compared to men with CH. Future work should examine gender and race stratified prevalence estimates within the VHA and other healthcare systems. Plain Language Summary: This study describes the epidemiology of cluster headache among all Veterans Health Administration (VHA) enrollees using electronic medical record data from the VHA. We found that during any given 1‐year period, between 0.08–0.10% of women and 0.10–0.18% of men in the VHA were treated for cluster headache. Many of these patients also had co‐occurring disorders including other headache disorders and depression, so more research is needed to find the best ways to treat these patients. [ABSTRACT FROM AUTHOR]

Background: Limited information is available regarding the impact of sarcopenia on the prognosis of antiangiogenic therapy in individuals with advanced non‐small cell lung cancer (NSCLC). This study primarily sought to examine the prognostic significance of sarcopenia in individuals with advanced NSCLC undergoing antiangiogenic therapy. Methods: We retrospectively enrolled all patients who met the inclusion and exclusion criteria from 2019 to 2021 at Nantong University Hospital. Patients were grouped according to the presence or absence of sarcopenia. After propensity score matching (PSM), progression‐free survival (PFS), overall survival (OS), and adverse event rates were compared between the two groups. Factors associated with prognosis were screened using univariate and multivariate analyses. Results: A total of 267 patients were included, with a total of 201 matched at baseline after PSM (77 in the sarcopenia group and 124 in the non‐sarcopenia group). The sarcopenia group had lower PFS (p = 0.043) and OS (p = 0.011) than the non‐sarcopenia group and a higher incidence of adverse events (p = 0.044). Multivariate analysis suggested that sarcopenia is an independent prognostic risk factor for OS in advanced NSCLC patients receiving antiangiogenic therapies (p = 0.009). Results of subgroup analyses showed some differences in the impact of sarcopenia on survival prognosis in populations with different characteristics. Conclusion: Patients with advanced NSCLC with comorbid sarcopenia exhibit a worse prognosis when treated with antiangiogenic therapy, and preventing and ameliorating sarcopenia may lead to better survival outcomes in patients with advanced NSCLC. [ABSTRACT FROM AUTHOR]

Introduction: Supraventricular tachycardia (SVT) is a common pediatric arrhythmia. Beta blockers (BBs) and calcium channel blockers (CCBs) are used for treatment despite little data examining their use. We describe the prescriptive tendencies, efficacy, and tolerability of BBs and CCBs used in the treatment of pediatric SVT. Methods and Results: This is a multicenter retrospective cohort study from three academic children's hospitals. Individuals aged 1–21 years at time of SVT diagnosis initiated on a BB or a CCB between 01/01/2010 and 12/31/2020 were included. Exclusion criteria were pre‐excitation, ectopic atrial tachycardia, and hemodynamically significant heart disease. Demographic, comorbidity, symptomatology, and medication data were collected. Treatment success was defined using a composite data abstraction tool. Of 164 patients, 151 received a BB and 13 received a CCB. The success rate on the initial dosage was 46% for both BB and CCB; the success rate following dosage adjustments was also comparable for BBs (98/151, 65%) and CCBs (9/13, 69%). While 27 (18%) BB patients experienced intolerable side effects, no CCB patient did. Conclusion: Treatment with a BB or CCB was successful in half of patients. BBs were prescribed more frequently than CCBs but were associated with more side effects. [ABSTRACT FROM AUTHOR]

Aim: Previous studies have shown that chronic diseases are strongly linked to the development of sarcopenia. Few studies have assessed the relationship between multimorbidity patterns and sarcopenia. This study aimed to investigate the impact of multimorbidity patterns on sarcopenia transitions in Chinese older adults. Methods: A total of 3842 older adults (aged 66.7 ± 6.2 years) with complete data at baseline and at least one follow‐up record (2 years) were included from the China Health and Retirement Longitudinal Study. Multimorbidity patterns were identified using latent class analysis. Sarcopenia was determined by the Asian Working Group for Sarcopenia 2019 criteria. Multistage Markov modeling was used to explore the association of multimorbidity patterns with sarcopenia transitions after controlling for covariates in demographic features, health status and health‐related behaviours. Results: Four multimorbidity patterns were identified at baseline: respiratory (17.73%), osteoarthritis‐hypertension (22.23%), digestive‐osteoarthritis (26.78) and cardiometabolic (33.27%). Participants with non‐sarcopenia had 1‐year transition probability of developing possible sarcopenia (10.1%) or sarcopenia (5.4%). Compared with the group without chronic diseases, the presence of cardiometabolic pattern increased the risk of progression from non‐sarcopenia to possible sarcopenia (HR 1.43, 95% CI 1.05–2.95). The presence of the osteoarthritis‐hypertension pattern (HR 1.55, 95% CI 1.00–2.41) and the digestive‐osteoarthritis pattern (HR 1.78, 95% CI 1.20–2.66) were associated with the transition toward sarcopenia from non‐sarcopenia. Conclusions: Sarcopenia is a dynamic condition in older adults. To address sarcopenia in older adults, tailored interventions should be targeted at populations with different multimorbidity patterns. Geriatr Gerontol Int 2024; 24: 1137–1143. [ABSTRACT FROM AUTHOR]

Aim: To investigate if tachypneic response to hypoxia is decreased in older patients. Methods: We included all patients ≥65 years of age attending 52 Spanish emergency departments (EDs) for whom peripheral arterial oxygen saturation (SatO2) measured by pulsioxymetry and respiratory rate (RR) were registered at ED arrival. We assessed the relationship between SatO2 and RR in different models, and with the best‐fitting model, we independently analyzed this relationship in four subgroups according to patient age (65–69, 70–79, 80–89, and ≥90 years). Five sensitivity analyses using different subsets of patients were carried out to check for the consistency of the results. Results: We included 7126 patients, with medians for SatO2 and RR of 97% (interquartile range [IQR]: 94–98) and 15 bpm (IQR: 15–16), respectively. We found significant associations (P < 0.001) between SatO2 and RR in every model tested (P < 0.001 for all), with the quadratic model obtaining the best fit (R2: 0.098) over those obtained with linear (R2: 0.096) and logarithmic (R2: 0.092) models. The same was observed in sensitivity analyses, with R2 for quadratic models ranging from 0.069 in patients with low comorbidity and 0.102 in patients breathing room air. The mean RR for 100% SatO2 was 15 bpm and increased as SatO2 decreased, although with a progressive slowing of the slope, with a mean RR of 27 at 50% SatO2. We detected a decreased RR response to increasing hypoxemia according to age and, while the RR curve was higher and with a progressively steepening slope in the 972 patients aged 65–69 (mean RR of 42 bpm with 50% SatO2), a progressive slowing of slope was observed in the 2693 patients aged 70–79 (mean RR of 28 with 50% SatO2), the 2582 aged 80–89 (mean RR of 25) and the 879 aged ≥90 (mean RR of 23). Sensitivity analyses provided very similar results. Conclusion: Tachypneic response to hypoxemia in older patients decreases as age advances, regardless of the reason leading to hypoxemia. Geriatr Gerontol Int 2024; 24: 1120–1129. [ABSTRACT FROM AUTHOR]

Objectives: Treatments for borderline personality disorder (BPD) and post‐traumatic stress disorder (PTSD) are less effective for patients with co‐occurring symptoms of both disorders, who are considered to have complex PTSD (cPTSD), compared with patients with either condition alone. Evidence suggests that co‐occurrence of symptoms indicates greater impairment in mentalizing. This study examines evidence for targeting mentalizing when treating individuals with co‐occurring symptoms, irrespective of their exposure to developmental trauma and, for the first time, investigates the mediational role of mentalizing in the associations between BPD symptomatology and cPTSD. Design: We identified in a routine clinical service a group of patients with BPD, with or without co‐occurring symptoms of PTSD. We hypothesized that patients with co‐occurring symptoms and a history of childhood maltreatment will show more severe clinical profiles and greater mentalizing problems, which in turn lead to symptoms consistent with cPTSD. Method: Clinical profiles of 72 patients with BPD (43 with and 29 without co‐occurring symptoms of PTSD; mean age in both groups 28 years, 79% and 83% female, respectively) were identified using the Structured Clinical Interview for DSM‐IV Axis II Disorders. Patients completed self‐report measures of BPD and PTSD symptoms, well‐being, dissociation and reflective functioning. Childhood trauma histories were evaluated. Results: Compared with patients with BPD‐only, those with co‐occurring BPD and PTSD showed greater severity in terms of BPD and dissociative symptoms, met a broader range of BPD diagnostic criteria, had a greater sense of personal worthlessness and self‐evaluated their well‐being as considerably diminished. This group was also more inclined to recall increased instances of childhood sexual abuse. In a mediation analysis, mentalizing acted as a partial mediator for the relationship between BPD severity and cPTSD, as well as between dissociative symptoms and cPTSD. Interestingly, mentalizing did not mediate the relationship between childhood sexual abuse and cPTSD. Conclusions: Overall, the correlational findings are consistent with an intended focus on mentalizing to treat cPTSD symptoms in individuals who also meet criteria for a diagnosis of BPD. [ABSTRACT FROM AUTHOR]

Background: Ventricular tachycardia (VT) catheter ablation in the presence of intracardiac thrombi was evaluated in very few studies. Objectives: To investigate in‐hospital outcomes of VT ablation in the presence of an intracardiac thrombus, in a large inpatient US registry. Methods: Using the National Inpatient Sample (NIS) database, patients who underwent non‐elective VT catheter ablations in the United States between 2016 and 2019 were identified using ICD‐10 codes. Sociodemographic, clinical data, in‐hospital procedures, and outcomes as well as in‐hospital mortality were collected. In‐hospital outcomes were compared using propensity score (PS) matching analysis with a 1:3 ratio between patients with and without intracardiac thrombus. Results: A weighted total of 15,725 admissions for non‐elective VT ablation were included in the study, of which 190 (1.2%) had a discharge diagnosis of intracardiac thrombus. Patients with intracardiac thrombus had a higher comorbidity burden and were more likely to have ischemic cardiomyopathy and a diagnosis of cardiac aneurysm. In PS analysis, the presence of intracardiac thrombus was significantly associated with higher rates of any in‐hospital complications (42.1% vs. 19.3%, p < 0.009), driven by higher periprocedural cerebrovascular accident and vascular injury events. In‐hospital mortality rates were not significantly different between the groups. Conclusions: In patients undergoing non‐elective VT ablation, intracardiac thrombus was associated with higher rates of in‐hospital complications, but not higher in‐hospital mortality. These findings suggest that intracardiac thrombus should not contraindicate VT ablation when deemed necessary, while efforts should be made to decrease potential complications. [ABSTRACT FROM AUTHOR]

Background: Anecdotally, patients don't seem to be more unwell than they were 10 years ago, yet they still seem more 'complex'. Aims: The aim of this study was to use an objective measure to assess the trend in complexity of general medicine patients over a 9‐year period. Methods: Complexity was pragmatically defined as a composite of comorbidity plus dependence/frailty. We selected 100 consecutive patients discharged from General Medicine at Monash Medical Centre (a tertiary hospital in Melbourne, Australia) in the month of April of each year from 2011 to 2019. For each patient, we retrospectively calculated their burden of comorbidity and their degree of dependency/frailty. Comorbidity was measured using the Charlson Comorbidity Index (CCI), and dependence/frailty was assessed using the Katz Index of Independence in Activities of Daily Living (Katz ADL) and the Braden Scale (BS). The BS is a pressure injury risk assessment tool. Additional demographic data were collected, including length of stay, admission and discharge residence, 30‐day readmission rate and inpatient mortality. Results: There was no statistically significant change in the CCI or the Katz ADL. The median BS did however significantly decrease from 19 in 2011 to 16 in 2019 (P = 0.006), reflecting an increased risk of pressure injuries. Conclusions: Despite a stable level of comorbidity, our finding of a decreasing BS score may suggest that patients are becoming more dependent. This increase in dependency rather than a change in chronic disease burden may be the cause of apparent increasing patient complexity. [ABSTRACT FROM AUTHOR]

Background: Many of the familial Mediterranean fever (FMF) patients present with arthritis during attacks, which may vary in its characteristics. Aims: In this study, we aimed to describe and characterise arthritis in FMF patients. Methods: We used our hospital's record system to retrospectively identify FMF patients with arthritis who presented to our clinic between 2005 and 2020. The prevalence, laboratory results of attack, remission periods, genetic mutations, demographic data, characteristics of attacks, characteristics of arthritis, comorbidities, treatments and treatment responses were recorded. Results: Nine hundred fifty‐four patients from a cohort of 2350 FMF patients had arthritis (40%). The male/female ratio was 0.49 in patients with arthritis. The frequency of at least one exon 10 mutation was high. The age of onset of symptoms was earlier for patients with arthritis. Monoarticular pattern was more frequent compared to oligo‐ and polyarticular patterns. Colchicine resistance was higher; the required colchicine dose for disease control and the frequency of use of biological agents were higher compared to general FMF population. Conclusion: Since M694V mutation is common and the colchicine dose required for disease control is high, we can conclude that the disease activity is high in FMF patients with arthritis. The frequency of sacroiliitis and spondyloarthropathy is significantly increased, especially in individuals with M694V mutation, suggesting that there may be a common pathway in their pathogenesis. FMF should be included in the differential diagnosis in patients presenting with arthritis in FMF endemic regions. [ABSTRACT FROM AUTHOR]

Background: There is a lack of studies investigating death anxiety among the oldest old based on a large, nationally representative sample during the pandemic. Thus, our aim was to investigate the prevalence and determinants of death anxiety among the oldest old in Germany during the Covid‐19 pandemic. Methods: Cross‐sectional data were taken from the 'Old Age in Germany' (D80+) study. This is a large, nationwide representative study including individuals 80 years and over living at home and individuals in institutionalised settings (N = 9542 individuals in the analytic sample). Results: Overall, 30% of the respondents reported the absence of death anxiety, 45.5% reported a rather not strong death anxiety, 20.2% reported a rather strong death anxiety, and 4.3% reported a very strong death anxiety. Linear regressions revealed that higher death anxiety was significantly associated with being female (β = 0.21, P < 0.01), younger age (β = −0.02, P < 0.001), being married (β = 0.09, P < 0.001), high education (compared to low education, β = 0.07, P < 0.05), the presence of meaning in life (β = 0.13, P < 0.001), higher loneliness levels (β = 0.18, P < 0.001), the presence of multimorbidity (β = 0.07, P < 0.05), and poorer self‐rated health (β = −0.07, P < 0.001). A further analysis showed that probable depression (β = 0.31, P < 0.001) is also associated with higher death anxiety. Conclusion: About one in four individuals had a strong or very strong fear of death during the pandemic. Several sociodemographic, psychosocial, and health‐related factors are associated with higher death anxiety. This better understanding of the determinants of death anxiety can be relevant for, among others, the affected individuals, informal and professional carers, as well as friends and relatives. [ABSTRACT FROM AUTHOR]

We present two cases of patients with body mass index (BMI) >50 undergoing transvaginal natural orifice transluminal endoscopic surgery (vNOTES) hysterectomy for gynecological indications. Case 1 involves a 52‐year‐old woman with post‐menopausal bleeding and suspicion of ovarian torsion, while case 2 describes a patient with newly diagnosed endometrial adenocarcinoma. Both cases highlight the feasibility and challenges of vNOTES in this patient population. To date, this is the first paper to describe the use of vNOTES in patients of Asian ethnicity, with BMI >50. [ABSTRACT FROM AUTHOR]

Background: Pain is one of the common postoperative issues that impair recovery and quality of life in patients undergoing coronary artery bypass graft (CABG) surgery. It leads to prolonged recovery and sleep disturbances in patients. Aim: This study was conducted to examine the effect of eye mask use on sleep quality and pain in patients undergoing CABG surgery. Study Design: A double‐blind randomized trial design was employed. The study included 60 patients undergoing CABG surgery. They were divided into intervention and control groups through block randomization. Data were collected using a 'Demographic Characteristics Form', the 'Richards‐Campbell Sleep Questionnaire (RCSQ)' and a 'Visual Analogue Scale' (VAS) through face‐to‐face interviews. While patients in the control group received standard care throughout the night, patients in the intervention group received standard care and used eye mask. All patients were followed up for three nights. The CONSORT was used to report the study. Results: The main outcome of the study, the RCSQ score, was higher in the intervention group at baseline. The intervention group had higher RCSQ scores than the control group at time 1 and time 2. There were no differences between the groups in the secondary outcome, pain levels. The control group had higher pain scores at time 1 and time 2 than the intervention group. Conclusion: The use of an eye mask after CABG surgery is an effective, safe and simple nursing intervention to improve sleep quality and control pain. Relevance to Clinical Practice: Because the use of an eye mask is an independent and unique nursing intervention, nurses should be supported and allowed to practise it. [ABSTRACT FROM AUTHOR]

Objective: Many guidelines recommend limiting glucocorticoids in patients with rheumatoid arthritis (RA), but 40% of patients remain on glucocorticoids long term. We evaluated the cardiovascular risk of long‐term glucocorticoid prescription by studying patients on stable disease‐modifying antirheumatic drugs (DMARDs). Methods: Using two claims databases, we identified patients with RA on stable DMARD therapy for >180 days. Proportional hazards models with inverse‐probability weights and clustering to account for multiple observations were used to estimate the effect of glucocorticoid dose on composite cardiovascular outcomes (stroke or myocardial infarction [MI]). Results: There were 135,583 patients in Medicare and 39,272 in Optum's de‐identified Clinformatics Data Mart (CDM) database. Medicare and CDM patients had an incidence of 1.3 and 0.8 composite cardiovascular outcomes per 100 person‐years, respectively. In the older, comorbid Medicare cohort, glucocorticoids were associated with a dose‐dependent increase in composite cardiovascular outcomes in adjusted models with predicted one‐year incidence of 1.4% (95% confidence interval [CI] 1.2%–1.6%) for ≤5 mg, 1.6% (95% CI 1.4%–1.9%) for >5 to 10 mg, and 1.8% (95% CI 1.2%–2.5%) for >10 mg versus 1.1% (95% CI 1.1%–1.2%) among patients not receiving glucocorticoids. There was no significant association among the CDM cohort. However, in the subgroup of younger patients with RA and higher cardiovascular risk, glucocorticoids were associated with a dose‐dependent increase in composite cardiovascular outcomes. Conclusion: Among older patients with more comorbidities and younger patients with higher cardiovascular risk with RA on stable DMARD therapy, glucocorticoids were associated with a dose‐dependent increased risk of MI and stroke, even at doses ≤5 mg/day. By contrast, no association was noted among younger, healthier patients with RA. [ABSTRACT FROM AUTHOR]

The study published in the Journal of the European Academy of Dermatology & Venereology explores the association between comorbidities, itch intensity, and quality of life in patients with Chronic Nodular Prurigo (CNPG). The research involved 513 adult CNPG patients from 12 European countries and found that hypertension was significantly associated with itch intensity, while depression was significantly associated with impaired quality of life. The study suggests that conditions like diabetes, hypertension, and arthritis may impact itch perception, highlighting the need for further investigation into the pathophysiological significance of these associations. [Extracted from the article]

The article discusses a 5-year retrospective study on the long-term effectiveness and tolerability of apremilast in patients with moderate-to-severe plaque psoriasis in Italy. A total of 335 patients were treated with apremilast, with demographic characteristics and treatment outcomes recorded. Results showed significant reductions in Psoriasis Area and Severity Index (PASI) scores over the study period, with a majority of patients achieving PASI 75, PASI 90, and PASI 100. The study concluded that apremilast demonstrated effectiveness and tolerability as a treatment option for patients with contraindications to biological treatments. [Extracted from the article]

Background: Comorbidities are similarly associated with short‐term mortality for COVID‐19, acute respiratory distress syndrome (ARDS) and sepsis in intensive care unit (ICU) patients, but their adjusted frequencies at admission are unknown. Thus, we aimed to evaluate the adjusted distribution, reported as odds ratios, of known risk factors (i.e., age, sex and comorbidities) for ICU admission between COVID‐19, sepsis and ARDS patients in this nationwide registry‐based study. Methods: In this cohort study, we included adult patients admitted to Swedish ICUs with COVID‐19 (n = 7382) during the pandemic and compared them to patients admitted to ICU with sepsis (n = 22,354) or ARDS (n = 2776) during a pre‐COVID‐19 period. The main outcomes were the adjusted odds for comorbidities, sex, and age in multivariable logistic regression on diagnostic categories in patients admitted to ICU, COVID‐19 or sepsis and COVID‐19 or ARDS. Results: We found that most comorbidities, as well as age, had a stronger association with sepsis admission than COVID‐19 admission with the exception of male sex, type 2 diabetes mellitus, and asthma that were more strongly associated with COVID‐19 admission, while no difference was seen for chronic renal failure and obesity. For COVID‐19 and ARDS admission most risk factors were more strongly associated with ARDS admission except for male sex, type 2 diabetes mellitus, chronic renal failure, and obesity which were more strongly associated with COVID‐19 admission, whereas hypertension, chronic obstructive pulmonary disease and asthma were not different. Conclusions: Patients admitted to ICU with sepsis or ARDS carry a heavier burden of comorbidity and high age than patients admitted with COVID‐19. This is likely caused by a combination of: (1) respiratory failure in COVID‐19 being less dependent on comorbidities than in other forms of ARDS, and the cause of critical illness in other infections causing sepsis and (2) COVID‐19 patients being deferred admission in situations where patients with the other syndromes were admitted. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a systemic disorder associated with various metabolic and inflammatory comorbidities. Although HS shares risk factors and pathogenic pathways with various respiratory conditions, few studies have explored the relationship between HS and respiratory disease. Methods: This is a cross‐sectional, case‐control, population‐based study that examined the United States National Inpatient Sample database from January 1, 2002, to December 31, 2012. HS was identified using ICD‐9‐CM codes during hospital admissions. Multivariable logistic regression was used to evaluate for adjusted associations between HS and respiratory diagnoses as compared to matched controls. Results: Twenty‐three thousand seven hundred and sixty‐seven hospital admissions for HS were compared with 95,068 age‐ and sex‐matched controls. HS patients had significantly higher adjusted odds of asthma (OR: 1.233; 95% CI: [1.170–1.299]; P < 0.001), chronic airway obstruction (OR: 1.532; 95% CI: [1.419–1.651]; P < 0.001), sarcoidosis (OR: 1.601; 95% CI: [1.157–2.214]; P < 0.001), and sleep apnea (OR: 1.274; 95% CI: [1.182–1.374]; P < 0.001). Conclusion: HS is associated with several common forms of respiratory disease. Knowledge of these associations may allow for better recognition of respiratory disease in HS patients. [ABSTRACT FROM AUTHOR]

Aim: To investigate the associations between oral health and depression, anxiety and their comorbidity in the UK Biobank cohort. Materials and Methods: Oral health problems were self‐reported at baseline. Symptoms of depression and anxiety were assessed using the Mental Health Questionnaire (PHQ‐4) in a cross‐sectional study. In the cohort study, diagnoses of depression and anxiety disorders were based on hospital records. Logistic regression and Cox regression models were used to analyse the association between oral health and depression/anxiety. Results: A total of 305,188 participants were included in the cross‐sectional study, and multivariate analysis showed that periodontal disease was associated with depression and/or anxiety (odds ratio [OR]: 1.79, 95% confidence interval [CI]: 1.73–1.86). In the prospective cohort study involving 264,706 participants, periodontal disease was significantly associated with an increased risk of depression and/or anxiety (hazard ratio [HR]: 1.14, 95% CI: 1.10–1.19), depression (HR: 1.19, 95% CI: 1.13–1.25) and anxiety (HR: 1.13, 95% CI: 1.07–1.19). Periodontal disease was also significantly associated with comorbid depression and anxiety (HR: 1.27, 95% CI: 1.16–1.38). Multiple mediation analysis using baseline inflammatory factors showed that white blood cell count and C‐reactive protein explained 3.07% and 3.15% of the association between periodontal disease and depression and anxiety, respectively. However, the results of longitudinal multiple mediation analysis of inflammatory factors at first follow‐up (N = 10,673) were not significant. Conclusions: Periodontal disease was found to be consistently associated with an increased risk of depression, anxiety and their comorbidity. [ABSTRACT FROM AUTHOR]

Background and aims: This is the first nation‐wide register study based on a total population sample measuring the gender‐specific incidences of chronic diseases and conditions among adults diagnosed with gambling disorder (GD). Design, setting and participants: The study used aggregated data for 2011–22 retrieved from the Register of Primary Health Care visits, Care Register for Health Care and Care Register for Social Welfare, including specialized outpatient and inpatient health care, inpatient social care and institutional care and housing services with 24‐hour or part‐time assistance, set in mainland Finland. Participants comprised people aged 18–90+ years with GD diagnosis [corresponding to pathological gambling, International Classification of Diseases 10th revision (ICD‐10) code F63.0, n = 3605; men n = 2574, women n = 1031] and the general population (n = 4 374 192). Measurements: Incidences of somatic diseases and psychiatric disorders were calculated for the people with diagnosed GD and for the general population, separately for women and men. Findings After standardizing for age, the incidence of each diagnostic group was systematically higher for people with GD compared with the general population, except for cancer. The highest standardized incidence ratio (SIR) values were for psychiatric disorders [SIR = 234.2; 95% confidence interval (CI) = 226.1–242.4], memory disorders (SIR = 172.1; 95% CI = 119.1–234.8), nervous system diseases (SIR = 162.8; 95% CI = 152.8–173.1), chronic respiratory diseases (SIR = 150.6; 95% CI = 137.6–164.2), diabetes (SIR = 141.4; 95% CI = 127.9–155.5) and digestive diseases (SIR = 134.5; 95% CI = 127.1–142.2). Conclusions: In Finland, the incidence of chronic diseases and conditions among people with gambling disorder is higher compared with the general population, apart from cancer. [ABSTRACT FROM AUTHOR]

Background and Aims: Studies on adolescent alcohol use and cognition are often unable to separate the potential causal effects of alcohol use on cognition from shared etiological influences, including genetic influences or other substance use comorbidities also known to be associated with cognition, such as nicotine use. The present study aimed to fill this gap and clarify the relationship between adolescent alcohol use and young adult cognition by accounting for both measured and unmeasured confounders. Design: A random effects model accounting for nesting in families was used to control for measured confounders. Next, co‐twin comparisons were conducted within the full sample and in monozygotic twin pairs (MZ) to control for unmeasured genetic and environmental confounders shared by co‐twins. Participants/Setting: Participants were 812 individuals (58.6% female, 361 complete pairs, 146 MZ pairs) from the longitudinal FinnTwin12 study in Finland. Measurements Adolescent alcohol use was indexed with measures of frequency of use and intoxication averaged across ages 14 and 17. Cognitive outcomes were measured at average age 22 and included Trail Making Test, California Stroop test, Wechsler Adult Intelligence subtests (Vocabulary, Block Design, Digit Symbol), Digit Span subtest of Wechsler Memory Scale, Mental Rotation Test and Object Location Memory test. Covariates included sex, parental education, general cognitive ability, current alcohol use and nicotine use. Findings Greater frequency of alcohol use and frequency of intoxication across adolescence was associated with decreased vocabulary scores in the co‐twin control [freq: stnd beta = −0.12, 95% confidence interval (CI) = −0.234, −0.013] and MZ only co‐twin control models (freq: stnd beta = −0.305, 95% CI = –0.523, −0.087; intox: stnd beta = −0.301, 95% CI = ‐0.528, −0.074). Conclusions: In Finland, there appears to be little evidence that adolescent alcohol use causes cognitive deficits in young adulthood, except modest evidence for association of higher adolescent alcohol use with lower young adult vocabulary scores. [ABSTRACT FROM AUTHOR]

Aims: Our study aimed to a) describe the distribution of hospital discharges with primary and secondary alcohol‐specific diagnoses by sex and age group, and b) describe how the number of hospital discharges with primary and secondary alcohol‐specific diagnoses have changed across different diagnostic groups (categorized by primary International Classification of Diseases, 10th Revision [ICD‐10] diagnosis) over time. Design: Retrospective cross‐sectional analysis. Setting: German hospital settings between 2012 and 2021. Participants: All persons aged 15–69 admitted to hospitals as registered in a nationwide data set. Measurements We counted a) the number of all hospital discharges and b) the number of hospital discharges with at least one alcohol‐specific secondary diagnosis (secondary alcohol‐specific diagnosis) by year, sex, age group, and diagnostic group. One diagnostic group included all primary alcohol‐specific diagnoses, while 13 additional groups aligned with ICD‐10 chapters (e.g., neoplasms). Alcohol‐involvement was defined as either a primary or secondary alcohol‐specific diagnosis. Findings Of 95 417 204 recorded hospital discharges between 2012 and 2021, 3 828 917 discharges (4.0%; 2 913 903 men (6.4%); 915 014 women (1.8%)) involved either a primary or at least one secondary diagnosis related to alcohol. Of all alcohol‐involved hospital discharges, 56.8% (1 654 736 discharges) had no primary but only a secondary alcohol‐specific diagnosis. Secondary alcohol‐specific diagnoses were particularly prevalent in hospital discharges due to injuries. With rising age, alcohol‐involvement in hospital discharges due to digestive or cardiovascular diseases increased. Between 2012 and 2021, the rate of alcohol‐involved hospital discharges has decreased more in younger as compared with older adults (average change between 2012 and 2021: 15–24: −55%; 25–34: −41%; 35–44: −23%; 45–54: −31%; 55–64: −21%; 65–69: −8%). Conclusions: The number of alcohol‐involved hospital discharges in Germany from 2012 to 2021 more than doubles (from 1 654 736 to 3 828 917) when including secondary alcohol‐specific diagnoses. More pronounced declines among younger adults may be attributed to unequal changes in alcohol consumption patterns across the population and to the hazardous effects of long‐term alcohol use. [ABSTRACT FROM AUTHOR]

Background and Aims: People with opioid use disorder (OUD) commonly experience pain including chronic pain. Despite the high prevalence, few studies have systematically examined the prevalence and correlates of pain among people seeking or receiving opioid agonist treatment (OAT) for OUD. This review aimed to determine the prevalence of pain in this population globally, and estimate the association between chronic pain and other demographic and clinical characteristics. Methods: Electronic searches were conducted in three databases (Medline, Embase and PsycINFO) from the inception until October 2022. Eligible studies reported prevalence rates of current and/or chronic pain. Meta‐analyses examining the main prevalence estimates were conducted by Stata SE 18.0, and comorbid clinical conditions were analysed by Review Manager 5.4. Results: Fifty‐six studies (n participants = 35 267) from sixty‐seven publications were included. Prevalence estimates of current and chronic pain were reported in 27 (48.2%) and 40 studies (71.4%), respectively. Most studies were conducted in North America (71.4%, n = 40) and used cross‐sectional designs (64.3%, n = 36). Meta‐analyses revealed a pooled prevalence of 60.0% (95% confidence interval [CI]: 52.0–68.0) for current pain and 44.0% [95% CI: 40.0–49.0] for chronic pain. Chronic pain was positively associated with older age (mean deviation of mean age: 2.39 years, 95% CI: 1.40–3.37; I2 = 43%), unemployment (odds ratio [OR] = 0.57, 95% CI: 0.42–0.76; I2 = 78%), more severe mental health symptoms (e.g. more severe depression (standardised mean difference [SMD] of mean scores: 0.45, 95% CI: 0.20–0.70; I2 = 48%) and anxiety symptoms (SMD: 0.52, 95% CI: 0.17–0.88; I2 = 67%), and hepatitis C (OR = 1.41, 95% CI: 1.03–1.94; I2 = 0%). No association was observed between chronic pain and the onset and type of OAT, geographic location, study design, survey year, participant age or use of specific pain assessment tools. Conclusions: There appears to be a high prevalence of pain among people seeking or receiving opioid agonist treatment for opioid use disorder compared with the general population, with positive associations for older age, unemployment, hepatitis C and the severity of some mental health symptoms. [ABSTRACT FROM AUTHOR]

Background: Few neuroimaging studies have investigated structural brain differences associated with variations in pain distribution. Objective: To explore structural differences of the brain in fibromyalgia (FM), temporomandibular disorder pain (TMD) and healthy pain‐free controls (CON) using structural and diffusion MRI. Methods: A case–control exploratory study with three study groups with different pain distribution were recruited: FM (n = 16; mean age [standard deviation]: 44 [14] years), TMD (n = 17, 39 [14] years) and CON (n = 10, 37 [14] years). Participants were recruited at the University Dental Clinic in Malmö, Sweden. T1‐weighted and diffusion MRIs were acquired, clinical and psychosocial measures were obtained. Main outcome measures were subcortical volume, cortical thickness, white matter microstructure and whole brain grey matter intensity. Results: Patients with FM had smaller volume in the right thalamus than patients with TMD (p =.020) and CON (p =.030). The right thalamus volume was negatively correlated to pain intensity (r = −0.37, p =.022) and pain‐related disability (r = −0.45, p =.004). The FM group had lower cortical thickness in the right anterior prefrontal cortex than CON (p =.005). Cortical thickness in this area was negatively correlated to pain intensity (r [37] = − 0.48, p =.002). Conclusions: This study suggests that thalamus grey matter alterations are associated with FM and TMD, and that anterior prefrontal cortex grey matter alterations are associated with FM but not TMD. Studies on chronic overlapping pain conditions are needed in relation to possible nociplastic pain mechanisms in the brain and central nervous system. [ABSTRACT FROM AUTHOR]

Objectives: The feared possible self refers to an imagined version of self that one is afraid of being or becoming. Previous evidence has shown that dysfunctional reasoning (i.e., inferential confusion) is associated with obsessive‐compulsive disorder (OCD) symptoms, which is partially mediated by a feared self. However, the evidence is reliant on non‐clinical samples and a general measure of the feared self. Methods: Using a cross‐sectional design, the current study attempted to replicate and extend this literature in a sample clinically diagnosed with OCD (n = 350) to assess the pathway from inferential confusion to OCD symptoms when feared self is accounted for as a mediator, particularly the individual dimensions of feared self (i.e., corrupted, culpable, and malformed feared selves). Participants completed a structured clinical interview for DSM‐5, as well as measures of inferential confusion (Dysfunctional Reasoning Processes Task), obsessive beliefs, feared self, OCD symptoms, and psychological distress. Results: Inferential confusion directly, and indirectly through the feared corrupted self, affected OCD symptoms, even after adjusting for obsessive beliefs, psychological distress, and comorbidity. However, the feared culpable and malformed selves did not play a role in this pathway. Conclusions: The study underscores that the feared corrupted self links inferential confusion to OCD symptoms, translating to the need to consider both dysfunctional reasoning processes and this specific feared self in clinical settings when treating OCD. Furthermore, the study provides more support for the inference‐based approach (IBA) to OCD. [ABSTRACT FROM AUTHOR]

Aim: To assess the prevalence of individual obesity‐related complications (ORCs) and multimorbidity (≥ 1, ≥ 2 and ≥ 3 ORCs), and multimorbidity‐associated healthcare costs, over 10 years. Methods: This retrospective open cohort study used Discover, a UK database of linked primary and secondary electronic health records. Adults were stratified by body mass index (BMI; overweight: 25‐< 30 kg/m2; obesity class I: 30‐< 35 kg/m2; obesity class II: 35‐< 40 kg/m2; obesity class III: ≥ 40 kg/m2). Outcomes by year since baseline were assessed for serial cross sections across the study period (1 January 2004 to 31 December 2019; the index date was the date of first eligible BMI measurement). Results: Across 1 410 146 individuals (overweight: 1 008 101; obesity class I: 278 782; obesity class II: 80 621; obesity class III: 42 642), ORC prevalence was higher in successive BMI groups, and increases over time were generally greater for obesity relative to overweight. In those with ORC multimorbidity, both higher BMI and the presence of more ORCs were associated with higher annual per‐person healthcare costs. Costs increased over time in those individuals with obesity and one or more ORC, as well as in those with obesity and two or more ORCs. Conclusions: Higher BMI was associated with higher baseline ORC prevalence and a greater increase in ORC prevalence over time, and with higher healthcare costs in those with multimorbidity. To reduce the burden of overweight and obesity on patients and healthcare systems, the presence, number and type of ORCs should be considered in developing effective, targeted prevention and management care pathways. [ABSTRACT FROM AUTHOR]

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Summary: Background and Objectives: Up to 30% of psoriasis (PsO) is clinically associated with psoriatic arthritis (PsA). A large proportion of new onset of PsA is diagnosed at a later stage, despite the necessity of early effective treatment to prevent structural damage. This study aimed to identify the routine screening practices used for PsA in patients with PsO. Patients and Methods: This non‐interventional, prospective, epidemiological, cross‐sectional study conducted in Germany focuses on screening activity and treatment selection of dermatological practices in suspected PsA. Descriptive statistics and patient characteristics were analyzed for different center types. Results: One hundred ninety‐five patients from 34 office‐based physicians, five non‐university hospitals, and nine university hospitals were included. Questionnaires or imaging techniques were not routinely used (< 45%). Especially, ultrasounds (≤ 5%) and MRIs (< 6.3%) were rarely performed. Between 30% and 75% of suspected PsA could be confirmed. Referral to rheumatologists and/or appropriate therapy initiation were the most frequent consequences. Conclusions: Results of this study reflect the status of PsA screening activity by dermatologists. Imaging techniques, particularly ultrasound or MRIs to detect early forms of PsA, were inadequately used, which may have contributed to continued underdiagnoses. Collaboration between dermatologists and rheumatologists should be reviewed with a view to improving effective PsA screening. [ABSTRACT FROM AUTHOR]

Early life seizures are associated with a variety of behavioral comorbidities. Among the most prevalent of these are deficits in communication. Auditory communicative behaviors in mice, known as ultrasonic vocalizations (USVs), can be used to assess potential treatments. Agomelatine is a melatonin agonist that effectively reduces behavioral comorbidities of seizures in adults; however, its ability to attenuate seizure‐induced communicative deficits in neonates is unknown. To address this, we administered C57 mice either saline or kainic acid (KA) on postnatal day (PD) 10. The mice then received either agomelatine or saline 1‐h post‐status epilepticus. On PD 11, we assessed the quantity of USVs produced, the duration, peak frequency, fundamental frequency, and amplitude of the vocalizations, as well as the call type utilization. We found that KA increased vocal production and reduced USV variability relative to controls. KA also increased USV duration and amplitude and significantly altered the types of calls produced. Agomelatine did not attenuate any of the deficits. Our study is the first to assess agomelatine's efficacy to correct USVs and thus provides an important point of context to the literature, indicating that despite its high therapeutic efficacy to attenuate other behavioral comorbidities of seizures, agomelatine's ability to correct neonatal communicative deficits is limited. [ABSTRACT FROM AUTHOR]

Borderline personality disorder (BPD) is characterized by affective, interpersonal, and identity instability, as well as marked impulsivity. There is evidence that BPD may be best operationalized dimensionally using models such as the Alternative Model for Personality Disorders (AMPD) described in Section III of the Diagnostic and Statistical Manual for Mental Disorders (DSM). Moreover, biosocial theory is a well‐known etiological theory of BPD emphasizing emotion dysregulation, inherited impulsivity, and development within invalidating contexts as key etiological mechanisms. Given that current research and clinical efforts for BPD are informed by both nosology and etiology, this narrative review examined how well biosocial theory (a) aligns with AMPD conceptualizations, (b) accounts for psychiatric comorbidity, and (c) accounts for heterogeneity in BPD presentation. Findings suggested that tenets of biosocial theory align well with Criteria A and B of the AMPD; however, biosocial theory focuses narrowly on roles of emotion dysregulation, impulsivity, and invalidating contexts, and empirical support is lacking in some ways for several etiological explanations proposed by biosocial theory. Additionally, although biosocial theory captures empirically supported features of BPD and emphasizes high‐risk subgroups, the theory may not account for lower‐risk subgroups. Finally, the theory accounts for diagnostic co‐occurrence via the central role of emotion dysregulation, but biosocial theory may not be specific to BPD and may broadly apply to a range of psychopathology. Based on the literature reviewed, implications for future research and clinical efforts are highlighted. [ABSTRACT FROM AUTHOR]

The potential efficacy of psychosocial interventions in the treatment of borderline personality disorder (BPD) is impacted by significant treatment non‐completion (TNC), with meta‐analytic studies reporting rates of attrition of between 25% and 28%. Increasing patient retention could facilitate outcomes and improve resource utilization, given limited healthcare services. A systematic search of PsycINFO, CINAHL, EMBASE, CENTRAL, and Web of Science Core Collection identified 33 articles that met the criteria for inclusion. Although substantial heterogeneity in terms of methodology and quality of analysis limited conclusions that could be drawn in the narrative review, a few consistent patterns of findings were elucidated, such as Cluster B personality disorder comorbidities and lower therapeutic alliance were associated with TNC. Interestingly, the severity of BPD symptoms was not a predictor of TNC. These findings are discussed in terms of their potential theoretical contribution to TNC. Clinically, there may be value in applying mindfulness and motivational interviewing strategies early on in treatment for individuals who present uncertainty about engaging in treatment. Further research to develop this empirical landscape includes focusing on high‐powered replications, examining burgeoning lines of research, and investigating dynamic predictors of TNC. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion To evaluate comorbidities in Japanese testicular cancer (TC) survivors in a multi‐institutional, cross‐sectional study.This study enrolled TC survivors who visited any of the eight high‐volume institutions in Japan from 2018 to 2019. After obtaining informed consent, participants answered questionnaires about their comorbidities. We analyzed the impact of treatment on comorbidities rate in TC survivors.A total of 509 TC survivors responded to the comorbidity questionnaires. Median age at the time of response was 43 years (IQR 35–51 years) and median follow‐up period after treatment was 5.1 years (IQR 2.1–9.2 years). TC survivors were divided according to the number of cycles of chemotherapy into the following groups: None (n = 153); 1–2 cycles (n = 34); 3–4 cycles (n = 234); or ≥5 cycles (n = 88). The prevalence of kidney disease increased significantly with increasing number of cycles of chemotherapy (p < 0.05). The relative risk of cardiovascular disease in the groups with three or more cycles was 2.6 compared to the group without chemotherapy.The present study showed that the prevalence of kidney disease in TC survivors was increased with increasing number of cycles of chemotherapy. [ABSTRACT FROM AUTHOR]

Generating real‐world evidence about the effect of medication discontinuation or dose reduction on outcomes, such as reduction of adverse drug effects (ADE; intended benefit) and occurrence of adverse drug withdrawal events (ADWE; unintended harm), is crucial to informing deprescribing decisions. Determining the causal effects of deprescribing is difficult for many reasons, including lack of randomization in real‐world study designs and other design and measurement issues that pose threats to internal validity. The inherent challenge is how to identify the effects, both intended benefits and unintended harms, of a new medication stoppage or reduction when implemented in patients with many potential clinical and social risks that may influence the likelihood of deprescribing as well as outcomes. We discuss methodological issues of estimating the effect of medication discontinuation or reduction on risk of ADEs and ADWEs considering: (1) sampling study populations of sufficient size with the potential to demonstrate clinically meaningful and quantifiable outcomes, (2) accurate and appropriately timed measurement of covariates, outcomes, and discontinuation, and (3) statistical approaches to managing confounding and other biases inherent in long‐term medication use by individuals with multiple morbidities. Designing rigorous deprescribing studies that address internal validity threats will support evidence generation by improving the ability to assess benefits and harms when the exposure of interest is the absence of a medication. Iterative learnings about data quality, variable definition, variable measurement, and exposure‐outcome associations will inform strategies to improve the causal inferences possible in real‐world deprescribing studies. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusion Asciminib, a novel allosteric BCR::ABL1 inhibitor, targets the ABL1 myristoyl pocket to potentially reduce toxicity and enhance efficacy. It is approved for Philadelphia chromosome‐positive chronic‐phase chronic myeloid leukemia (CML‐CP) in patients with resistance or intolerance to two or more tyrosine kinase inhibitors (TKIs) or those with the T315I mutation.This retrospective analysis evaluated patients with CML treated with asciminib under a managed‐access program across eight Israeli centers from July 2019 to August 2022. We assessed treatment responses, toxicities, event‐free survival (EFS), and overall survival (OS) using Kaplan–Meier methods.The study included 30 patients who had received a median of three prior TKIs, with 73% starting asciminib due to intolerance. After a median follow‐up of 7.1 months, 85% of those without prior complete cytogenetic response (CCyR) achieved CCyR, and 60% previously not in major molecular response (MMR) attained MMR. Resistance was rare (10%), with no cardiovascular events reported despite high baseline comorbidity (73%). Median EFS was 47 months; median OS was not reached.Asciminib demonstrates significant efficacy and tolerability in heavily pretreated patients with CML‐CP, with no new cardiovascular events observed. Further long‐term studies are necessary to explore its full cardiovascular impact. [ABSTRACT FROM AUTHOR]