Search

Background: The most common reason for help-seeking in ultra-high risk (UHR) for psychosis patients is comorbid symptoms, mainly anxiety and depression. However, psychological interventions are mainly focused on subthreshold psychotic symptoms. There is a growing push to include transdiagnostic therapies in specialized intervention teams for psychosis in young people. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) has demonstrated efficacy in emotional disorders, and its application has recently expanded to other pathologies such as borderline personality disorder (BPD) and bipolar disorder (BD)., Methods: This pilot study was conducted with 36 patients with UHR for psychosis and symptoms of comorbid emotional disorders who were receiving treatment in an early intervention programme for psychosis. This is a randomised control trial (RCT) with two conditions: treatment as usual (TAU) with the group and online application of the UP (UP+TAU) (n = 18) and TAU (n = 18). Evaluations were conducted at baseline, after treatment, and at the three-month follow-up., Results: Comorbid anxiety and depression symptoms improved significantly in patients in the UP+TAU group compared to those in the TAU. Significant improvements in negative affect, emotional dysregulation, neuroticism, extraversion, functioning, and quality of life were also observed, and satisfaction with the intervention was high., Conclusions: UP may be an acceptable and effective intervention for the treatment of symptoms of comorbid emotional disorders in patients with UHR for psychosis., Limitations: The sample size was small, and further studies are needed to test this intervention with larger samples of patients with UHR for psychosis with emotional comorbidities., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Pediatric OCD is associated with functional impairment in multiple environments. However, relatively little is known about the impact of comorbid conditions, as well as OCD severity on psychosocial functioning in this population. Furthermore, most studies did not include a control sample, nor examined differences between children and adolescents. The goal of this investigation was to assess psychosocial functioning and its associations with age, symptom severity, and comorbid conditions in a large well characterized sample of pediatric OCD probands, and controls., Methods: Participants included 117 pediatric OCD probands and 147 controls, that underwent a careful diagnostic process, and completed several questionnaires and interviews., Results: Results revealed significant psychosocial impairments across multiple domains/settings, some of which were affected by symptom severity as well as by conduct related comorbidities and to a lesser extent affective disorders. In addition, different aspects of psychosocial impairments were found between children and adolescents., Conclusion: This study provides high resolution information regarding the types and extent of psychosocial dysfunction in youth with OCD, as well as its relationship with clinical and diagnostic correlates. It is recommended that evaluation and management of OCD in youth in research and clinical settings regularly include qualitative and semi-quantitative assessment of function across these domains., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Daniel Geller reports financial support was provided by National Institute of Mental Health. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Aims: Dilated cardiomyopathy (DCM) is characterized by unilateral or bilateral ventricular enlargement and reduced ventricular systolic function, with or without heart failure. In previous studies, we found that a history of chronic obstructive pulmonary disease (COPD) or chronic bronchitis is a high risk factor for DCM combined with pulmonary hypertension (PH). Therefore, we propose that the comorbidity of COPD or chronic bronchitis will increase the cardiogenic mortality of patients with DCM., Methods: Data were collected from patients with DCM who were admitted to The First Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2008 to April 2020. The primary endpoint was cardiac death. Multivariable Cox regression analyses were employed to assess the associations between the comorbidities COPD or chronic bronchitis with the study endpoints. Different adjusting models were used to adjust for potential confounders., Results: A total of 305 DCM patients were ultimately enrolled, among whom 46 patients had COPD or chronic bronchitis. The median follow-up was 50 months. The rate of cardiac death in the COPD or chronic bronchitis group was significantly greater than that in the non-COPD or nonchronic bronchitis group ( p  < 0.001). The associations between comorbid COPD or chronic bronchitis and cardiac death remained robust after eliminating the possible effects of confounders. After grouping by PH, the risk difference was mainly derived from the intermediate- or high-probability PH group., Conclusions: Comorbid COPD or chronic bronchitis increased the risk of cardiac death among DCM patients with an intermediate or high PH probability.

Disorders across the affective disorders-psychosis spectrum such as major depressive disorder (MDD), bipolar disorder (BD), schizoaffective disorder (SCA), and schizophrenia (SCZ), have overlapping symptomatology and high comorbidity rates with other mental disorders. So far, however, it is largely unclear why some of the patients develop comorbidities. In particular, the specific genetic architecture of comorbidity and its relationship with brain structure remain poorly understood. Therefore, we performed systematic analyses of clinical, genetics and brain structural measures to gain further insights into the neurobiological correlates of mental disorder's comorbidity. We investigated a sub-sample of the Marburg/Münster Cohort Study (MACS), comprising DSM-IV-TR diagnosed patients with a single disorder in the affective disorders-psychosis spectrum (SD, n = 470, MDD; BD; SCA; SCZ), with additional mental disorder's comorbidities (COM, n = 310), and healthy controls (HC, n = 649). We investigated group differences regarding a) the global severity index (based on SCL90-R), b) a cross-disorder polygenic risk score (PRS) calculated with PRS-continuous shrinkage (PRS-CS) using the summary statistics of a large genome-wide association study across mental disorders, and c) whole brain grey matter volume (GMV). The SCL90-R score significantly differed between groups (COM > SD > HC). While SD and COM did not differ in cross-disorder PRS and GMV, SD and COM versus HC displayed increased cross-disorder PRS and decreased GMV in the bilateral insula, the left middle temporal, the left inferior parietal, and several frontal gyri. Our results thus suggest that disorders in the affective disorders-psychosis spectrum with or without additional comorbidities differ in self-reported clinical data, but not on genetic or brain structural levels., Competing Interests: Declaration of competing interest TK received unrestricted educational grants from Servier, Janssen, Recordati, Aristo, Otsuka, neuraxpharm. MN reports receiving personal fees from Life&Brain GmbH outside the submitted work. The other authors declare no potential competing interests., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Comorbid cannabis use disorder (CUD) is disproportionately high in people with bipolar disorder (BD) and has been associated with worsening of BD symptoms. However, many people with BD report regularly using cannabis to ameliorate symptoms, including sleep disturbances. Sleep and circadian rhythm disturbances are hallmark features of BD that often precede the onset of mood symptoms. Genetic studies indicate that circadian disruption may predispose individuals towards both problematic cannabis use and BD, rather than cannabis use directly impacting BD symptoms. To further disentangle these hypotheses, we aimed to investigate the relationship between chronotype, cannabis use disorder (CUD) and BD mood symptoms. Data from 212 participants with BD I from the Pharmacogenomics of Bipolar Disorder study dataset were analyzed for this study. Participants were stratified by those diagnosed with co-morbid CUD and BD symptom variables, including the mean number of mood episodes per year and age of mood symptom onset for both depression and mania symptoms. The Basic Language Morningness scale (BALM) was used to assess chronotype. There was no interaction between morningness levels and CUD on BD symptoms, however both lower morningness and CUD were independently associated with earlier age of mood symptom onset. However, patients who reported initiating cannabis use post mood symptom onset had an earlier mood symptom age of onset compared to those who reported initiating cannabis use prior to mood symptom onset. These findings could provide further evidence that circadian rhythm disruption could be an underlying factor that predisposes individuals toward both CUD and BD., Competing Interests: Declaration of competing interest The authors report no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Although new pediatric human immunodeficiency virus (HIV) infections have declined in the Asia-Pacific region, coverage of interventions to prevent vertical HIV transmission remains inconsistent. The TREAT Asia pediatric HIV cohort includes data from ∼7700 children and adolescents with HIV (90% perinatally acquired) who have been under care at 18 centers in six Asian countries. Research on their HIV treatment outcomes has been complemented by studies on coinfections and comorbidities. These studies have shown that greater attention is needed to support and sustain clinical and social outcomes as children with perinatal HIV age into adulthood and transition to adult HIV care., Competing Interests: Disclosure A. H. Sohn receives program funding to her institution from ViiV Healthcare, United States and United Kingdom. The other authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

We aimed to evaluate the presence of sleep-disordered breathing (SDB) in generalized anxiety disorder (GAD) patients and its impacts after 12-week of escitalopram treatment. In this prospective observational study, GAD patients were followed up to determine whether comorbid SDB affects their treatment response. They underwent a home sleep apnea test (HSAT), and oxygen desaturation index ≥5 was considered indicative of SDB. All participants were treated with escitalopram 5 mg in the first 2 weeks and 10 mg in the remaining 10 weeks. They underwent assessments of heart rate variability and completed questionnaires for sleep, mood, attention, and daytime sleepiness on the day of enrollment, and 2 weeks, 4 weeks, and 12 weeks later. A total of 45 GAD participants (mean age, 56.2 years) were included in the study. Of these, 53.3% had comorbid SDB. Participants with GAD and SDB had higher baseline Beck Anxiety Inventory (BAI) and STOP-BANG scores. Both groups of participants with GAD showed overall improvement in anxiety, depression, and insomnia symptoms after 12 weeks of escitalopram treatment. Additionally, there were no statistically significant differences in the changes in BAI, Beck Depression Inventory, and Epworth Sleepiness Scale scores between the two groups at the Week 2, Week 4, and Week 12 assessments compared to baseline. However, the GAD group with comorbid SDB seemed to have a lower tendency for improvement in depressive symptoms than the group with non-comorbid SDB. Compared with the GAD group without comorbid SDB, the GAD group with comorbid SDB exhibited more severe anxiety symptoms at baseline and tended to show less improvement in depressive symptoms after 12 weeks of escitalopram treatment., Competing Interests: Declaration of competing interest The authors declare that this study was conducted in the absence of any commercial or financial relationships that could be construed as potential conflicts of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: The prevalence of combinations of comorbidities and their associations with inpatient service utilization and readmission among patients with chronic obstructive pulmonary disease (COPD) have not been extensively examined. To address this gap in knowledge, an observational prospective study was conducted using retrospective data., Aims: To identify patterns of comorbidities linked to length of hospital stay, daily expenses, and one-year readmission., Methods: The 30 most common comorbidities were identified in patients with secondary diagnoses using the association rule mining (ARM) method. Regression models were used to examine the relationships between combinations of comorbidities and service utilization, with adjustments for covariates., Results: The five most prevalent comorbidities were pulmonary heart disease (40.99%), ischemic heart disease (38.97%), heart failure (36.77%), hypertension (34.11%), and respiratory disorders (19.12%). Most combinations of comorbidities identified by ARM showed significant associations with an extended length of stay (>13 days), increased daily expenses (>930 CNY), and reduced readmission rates. Among these combinations, glycoprotein metabolism disorder had the strongest association with prolonged length of stay (adjusted odds ratio [aOR]): 1.89, 95% confidence interval [CI]: 1.82-1.95). Conversely, the combination of other brain diseases and respiratory failure was linked to higher daily expenses (aOR: 11.34, 95% CI: 10.58-12.15), and the presence of pulmonary heart disease was associated with elevated one-year readmission rates (aOR: 1.41, 95% CI: 1.37-1.46)., Conclusion: Common combinations of comorbidities among inpatients with COPD were identified from an extensive collection of discharge medical records. Furthermore, the associations between comorbidities, inpatient service usage, and readmission rates were determined.

Background: The clinical pathogenesis of COVID-19 necessitates a comprehensive and homogeneous study to understand the disease mechanisms. Identifying clinical symptoms and laboratory parameters as key predictors can guide prognosis and inform effective treatment strategies. This study analyzed comorbidities and laboratory metrics to predict COVID-19 mortality using a homogeneous model., Method: A retrospective cohort study was conducted on 7500 COVID-19 patients admitted to Rasoul Akram Hospital between 2022 and 2022. Clinical and laboratory data, along with comorbidity information, were collected and analyzed using advanced coding, data alignment, and regression analyses. Machine learning algorithms were employed to identify relevant features and calculate predictive probability scores., Results: The frequency and mortality rates of COVID-19 among males (19.3 %) were higher than those among females (17 %) (p = 0.01, OR = 0.85, 95 % CI = 0.76-0.96). Cancer (p < 0.05, OR = 1.9, 95 % CI = 1.48-2.4) and Alzheimer's (p < 0.05, OR = 2.36, 95 % CI = 1.89-2.9) were the two most common comorbidities associated with long-term hospitalization (LTH). Kidney disease (KD) was identified as the most lethal comorbidity (45 % of KD patients) (OR = 5.6, 95 % CI = 5.05-6.04, p < 0.001). Age > 55 was the most predictive parameter for mortality (p < 0.001, OR = 6.5, 95 % CI = 1.03-1.04), and the CT scan score showed no predictive value for death (p > 0.05). WBC, Cr, CRP, ALP, and VBG-HCO3 were the most significant critical data associated with death prediction across all comorbidities (p < 0.05)., Conclusion: COVID-19 is particularly lethal for elderly adults; thus, age plays a crucial role in disease prognosis. Regarding death prediction, various comorbidities rank differently, with KD having a significant impact on mortality outcomes., Competing Interests: Declaration of Competing Interest I, Nazanin Mojtabavi, on behalf of all co-authors, hereby declare that there is no conflict of interest regarding the research presented in this manuscript entitled "[Retrospective Analysis of COVID-19 Clinical and Laboratory Data: Constructing a Multivariable Model Across Different Comorbidities]". I affirm that neither myself nor any of my co-authors have any financial, personal, or professional interests that could influence the interpretation or presentation of the research findings contained within this manuscript., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: Patients with comorbidities are highly prone to mortality risk than those suffering from a single disease. Therefore, quantification and prediction of disease comorbidities is necessary to stratify the mortality risk of the patients, predict the probability of their occurrence, design treatment strategies, and to prevent the progression of diseases. Enriching comorbidity disease relationships with rich semantics established by genetic components play a vital role in effectively quantifying and predicting comorbidities. However, the existing studies have not extensively explored the semantic richness conveyed by different types of genetic links connecting the comorbidity pairs., Methods: To solve this, a novel genetic-semantic aware weighted homogeneous network-based method, GSWHomoNet is proposed which first constructs the gene enriched comorbidity heterogeneous network, CoGHetNet with encoded genetic semantic aware weighted meta-path instance disease pair embedding to obtain an enhanced disease node embedding of the network. For enhanced comorbidity prediction and scoring, both direct and indirect semantically enriched comorbidity relationships of the disease nodes is preserved while transforming heterogeneous to homogeneous comorbidity network GSWHomoNet. The proposed GSWHomoNet not only helps discover comorbidity links transductively between known-known disease pairs but also improves the inductive link prediction between known-unknown disease pairs by supplying unknown disease nodes with semantically enriched heterogeneous structural knowledge., Results: The effectiveness of the proposed components is proved by AUC scores of 0.895 and 0.860, as well as AUPR scores of 0.903 and 0.873 for transductive and inductive link prediction respectively. In comorbidity scoring, GSWHomoNet outperformed other methods with a correlation result of 0.848. The effect of the improved association prediction ability of the genetic semantic aware weighted meta-path instance embedding based node embedding is proved on disease-microbe and bibliographic heterogeneous network datasets. For biological significance of GSWHomoNet-based comorbidity scoring, we compared it with gene, pathway, and protein-protein interaction (PPI) perspectives, revealing a stronger correlation with the PPI aspect. We identified a substantial number of predicted comorbidity disease pairs, with 77,456 and 48,972 pairs supported by literature evidence for transductive and inductive predictions, respectively. Additionally, we highlighted shared pathways and PPIs for these pairs, demonstrating the robustness of comorbidity predictions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Purpose of Review: The aim of this review is to examine published reports of neurodevelopmental phenotypes in patients with inborn errors of immunity (IEI). We briefly discuss potential interactions between the immune and the central nervous system and the implications of this crosstalk for current clinical management guidelines., Recent Findings: An increasing number of reports have described neurodevelopmental disorders (NDDs) comorbid with immune-mediated signs. However, the prevalence of this association in IEIs remains unknown., Summary: IEIs comprise a group of clinically heterogeneous disorders associated with a number of nonimmune comorbidities. Although certain neurological conditions such as microcephaly are recognized as associated features of some IEIs, NDDs are less well described. We reviewed published clinical descriptions of IEIs and found a number of comorbid NDDs in these patients, including autism spectrum disorder (ASD), behavioral deficits, and intellectual disability. Given the lack of uniform assessments for NDDs, we suspect they may be underdiagnosed in IEIs. As NDDs manifest early and can result in life-long cognitive and emotional deficits, which diminish quality of life and increase healthcare utilization, we hope to elucidate relevant pathomechanisms and raise clinician awareness of these comorbidities so appropriate and timely interventions are sought., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Among patients with opioid use disorder (OUD), high rates of overdose and death have been reported in subgroups with Hepatitis C Virus (HCV). Evidence on the comorbid effect of HCV on clinical and substance use trajectories has been limited by small sample sizes, short follow-up, and heavy reliance on administrative data which lacks granularity on important prognostic factors. Additionally, few studies include populations on substance use treatment., Aim: To establish the impact of HCV exposure (antibody positivity) on health care utilization patterns, substance use treatment response, and death in a cohort of patients with OUD on opioid agonist therapy (OAT)., Methods: This multi-center prospective cohort study recruited adult patients with OUD on OAT from 57 substance use treatment centers in Ontario, Canada. The study collected substance use outcomes, and classified patients with ≥50 % positive opioid urine screens over one year of follow-up as having poor treatment response. Additional data obtained via linkage with ICES administrative databases evaluated the relationship between HCV status, healthcare service utilization, and death over 3 years of follow-up. Multiple logistic regression models established the adjusted impact of HCV on various outcomes., Results: Among recruited participants (n = 3430), 44.10 % were female with a mean age of 38.64 years (Standard deviation: 10.96). HCV was prevalent in 10.6 % of the cohort (n = 365). Methadone was used most often (83.9 %, n = 2876), followed by sublingual buprenorphine (16.2 %, n = 554). Over the three-year follow-up, 5.3 % of patients died (n = 181). Unadjusted results reveal rates of hospitalization (all-cause, mental-health related, critical care) and emergency department visits (mental health-related), were significantly higher among HCV patients. Associations diminished in adjusted models. Active injection drug use exhibited the highest predictive risk for all outcomes., Conclusion: A high degree of acute physical and mental illness and its resulting health service utilization burden is concentrated among patients with OUD and comorbid HCV. Future research should explore the role for targeted interventions and how best to implement integrated healthcare models to better address the complex health needs of HCV populations who inject drugs., Competing Interests: Declaration of competing interest None. The authors have no declarations of interest to report., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: Health-related quality of life (HRQoL) impacts of insomnia and depression (as separated entities) have been well investigated in previous studies. However, little is known about the effect of comorbid insomnia and depression on HRQoL. This study aimed to assess the impacts of insomnia and depression, in combination or alone, on HRQoL in Australian adults., Methods: Data used in this study were obtained from the large-scale longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey. Insomnia was defined using key insomnia criteria of DSM-V. Depression was based on validated cut-off points of the Mental Health Inventory-5 (MHI-5) (scores ≤ 62) in the base case analysis. HRQoL expressed as utility scores (ranging from 0 to 1) were measured using the Short-Form 6-Dimension (SF-6D) converted from the SF-36 and valued using an Australian scoring algorithm. Multi-level modelling was applied to assess the effect of insomnia and/or depression on utility scores., Results: The study analysed 30,972 observations from 10,324 individuals (age [mean ± SD]: 45.7 ± 16.5, female: 54.6%). The proportion of individuals with insomnia only, depression only, and comorbid insomnia and depression was 11.3%, 11.6%, and 8.2%, respectively. The interaction effect suggested the combined impact of insomnia and depression on health-related quality of life beyond the sum of their individual effects. Marginal mean difference in utility scores for insomnia only, depression only, and the comorbidity relative to no insomnia or depression was -0.058 (SE: 0.003, Cohen's d: 0.420, small effect), -0.210 (SE: 0.003, Cohen's d: 1.530, large effect), and -0.291 (SE: 0.004, Cohen's d: 2.120, large effect), respectively., Conclusion: Comorbid depression and insomnia appear to have very large quality-of-life impacts. Furthermore, this is the first study that has estimated the magnitude of the impact of comorbid insomnia and depression on utility scores which can be utilised in future clinical or economic studies., Competing Interests: Declarations. Ethical approval: The HILDA survey was granted ethics approval by the Human Research Ethics Committee of the University of Melbourne (ID: 1647030). Consent was implied when participants agreed to be interviewed. Using secondary de-identified data, this study received low-risk ethics approval from the Human Research Ethics Committee (Project ID: 36681, date: 27th Feb 2023). Competing interests: There is no conflict of interest to declare., (© 2024. The Author(s).)

Objectives: Adverse childhood experiences (ACE) are associated with immune-mediated inflammatory diseases (IMID). We evaluated whether: (i) ACE associate with psychiatric comorbidity among individuals with IMID, including rheumatoid arthritis (RA), multiple sclerosis (MS), and inflammatory bowel disease (IBD); (ii) whether psychiatric disorders mediate the relationship between ACE and IMID; and (iii) whether these findings differ from those in individuals with other chronic physical disorders., Methods: Using data from the Canadian Longitudinal Study on Aging (CLSA) we performed a retrospective case-control study of participants aged 45-85 years recruited between 2010 and 2015. ACE were queried using questions derived from the Childhood Experiences of Violence Questionnaire-Short Form and the National Longitudinal Study of Adolescent to Adult Health Wave III questionnaire. We used multivariable logistic regression and causal mediation analysis to address our objectives., Results: We included 13,977 CLSA participants. Among the 31 % of IMID participants who reported a comorbid psychiatric disorder, 79 % reported a history of ACE. ACE associated with increased odds (OR [95 % CI]) of a psychiatric disorder (2.55 [1.02-6.35]) among participants with IMID; this did not differ across IMID. The total effect (OR [95 % CI]) of ACE on IMID was 1.11 (1.07-1.16), of which 10.60 % (8.04-17.47) was mediated by psychiatric disorders. We found similar associations among participants with other chronic physical disorders., Conclusion: Our findings suggest that psychiatric disorders partially mediate the association between ACE and IMID. Most participants with IMID and comorbid psychiatric disorders report a history of ACE and may benefit from trauma-informed mental health care., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: The aim of our study was to estimate the frequency of autoimmune comorbidities, in NMOSD patients from the national Serbian NMOSD Registry., Methods: Our study comprises 136 patients with NMOSD, diagnosed according to the NMOSD criteria 2015. At the time of the study, in the Registry were collected demographic and clinical data, including those related to the coexisting comorbidities and pathogenic autoantibodies. Not all patients were tested for all autoimmune antibodies. None of the seronegative aquaporin4-IgG (AQP4-IgG) NMOSD patients, included in the Registry, were positive for the myelin oligodendrocyte glycoprotein IgG., Results: Among 136 NMOSD patients, 50 (36.8%) had at least one associated autoimmune disorder. AQP4-IgG was present in the sera from 106 patients (77.9%), the proportion of NMOSD patients with autoimmune comorbidities being significantly higher in the AQP4-IgG positive subgroup in comparison to the AQP4-IgG negative (p = 0.002). AQP4-IgG seropositive NMOSD patients had 5.2-fold higher risk of comorbid autoimmune diseases (OR = 5.2, 95% CI 1.4-18.5, p = 0.012). The most frequently reported diseases were autoimmune thyroid disease (15.4%), Sjogren's syndrome (11.0%), systemic lupus erythematosus (5.1%), myasthenia gravis (4.4%), and primary antiphospholipid antibody syndrome (2.9%). Antinuclear antibodies (ANAs) were frequently detected in the subgroup of NMOSD patients tested for this antibody (50/92; 54.3%). The higher frequency of ANAs and anti-extractable nuclear antigen autoantibodies, in the subgroups of AQP4-IgG-positive patients compared to the AQP4-IgG negative, tested for these antibodies, was statistically significant (p = 0.009, and p = 0.015, respectively)., Conclusion: In conclusion, based on our results, in a defined cohort with European ethnical background, a wide spectrum of autoimmune diseases is frequently associated with AQP4-IgG seropositive NMOSD patients., Competing Interests: Declarations. Conflict of interest: Tatjana Pekmezovic has been an advisor or speaker for Sanofi-Genzyme, Medis, Hemofarm, Merck, Teva, and Roche. Vanja Jovicevic declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Marko Andabaka declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Nikola Momcilovic declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Nikola Veselinovic has been a speaker for Medis, Merck, Teva, Hemofarm, Novartis and Roche. Olivera Tamas has been a speaker for Medis, Merck, Teva, Hemofarm, Novartis and Roche. Maja Budimkic has been a speaker for Medis, Merck, Teva, Hemofarm, Novartis and Roche. Stefan Todorovic declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Marta Jeremic declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. Evica Dincic has been an advisor or speaker for Medis, Merck, Teva, Hemofarm, Novartis, and Roche. Slobodan Vojinovic has been an advisor or speaker for Medis, Merck, Teva, Hemofarm, Novartis, and Roche. Sladjana Andrejevic has been speaker for Takeda Pharmaceuticals. Sarlota Mesaros has been an advisor or speaker for Medis, Merck, Teva, Hemofarm, Novartis, and Roche. Jelena Drulovic has been an advisor or speaker for Bayer HealthCare, Sanofi-Genzyme, Medis, Merck, Teva, Novartis, Biogen, Hemofarm, Pharma Swiss, Amicus, and Roche., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: Comorbidities between internalizing disorders (IDs) and functional disorders (FDs) are well-documented, indicating shared pathways. However, their symptom-level relationships have been largely unexplored. This exploratory study employs a network approach to investigate symptoms of major depressive disorder (MDD), generalized anxiety disorder (GAD), myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), fibromyalgia (FM), and irritable bowel syndrome (IBS) to identify bridge symptoms explaining comorbidity between the two domains., Methods: We used cross-sectional data on 72,919 adult subjects from the Lifelines Cohort Study, a Dutch general population sample. A total of 38 symptoms representing diagnostic criteria of IDs and FDs were assessed with validated questionnaires. Network models were estimated using eLasso, based on the Ising model, to identify bridge symptoms. The Network Comparison Test (NCT) was used to test whether there were differences in network structure and strength across sex and age., Results: Symptoms were moderately connected, with a network density of 52.7%. ID and FD symptoms clustered in their respective domains, but were connected through the bridge symptoms, fatigue, difficulty concentrating, trouble sleeping, and unrefreshing sleep. Fatigue and difficulty concentrating had the most connections, associated with 86.6% and 78.9% of the other symptoms, respectively. NCTs indicated no differences in network connectivity between females versus males or younger versus older adults (>50 years)., Conclusions: ID and FD symptoms are moderately interconnected. Bridge symptoms displaying strong connections to multiple disorders may play a central role in the mechanisms underpinning the comorbidity between IDs and FDs., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Vestibular migraine (VM) is a usual trigger of episodic vertigo. Patients with VM often experience spinning, shaking, or unsteady sensations, which are usually also accompanied by photophobia, phonophobia, motor intolerance, and more. VM is often associated with a number of comorbidities. Recurrent episodes of VM can affect the patient's emotions, sleep, and cognitive functioning to varying degrees. Patients with VM may be accompanied by adverse moods such as anxiety, fear, and depression, which can gradually develop into anxiety disorders or depressive disorders. Sleep disorders are also a common concomitant symptom of VM, which significantly lower patients' quality of life. The influence of anxiety disorders and sleep disorders may reduce cognitive functions of VM, such as visuospatial ability, attention, and memory decline. Clinically, it is also common to see VM comorbid with other vestibular disorders, making the diagnosis more difficult. VM episodes are relieved but lingering, in which case VM may coexist with persistent postural-perceptual dizziness (PPPD). Anxiety may be an important bridge between recurrent VM and PPPD. The clinical manifestations of VM and Meniere's disease (MD) overlap considerably, and those who meet the diagnostic criteria for both can be said to have VM/MD comorbidity. VM can also present with positional vertigo, and some patients with VM present with typical benign paroxysmal positional vertigo (BPPV) nystagmus on positional testing. In this paper, we synthesize and analyze the pathomechanisms of VM comorbidity by reviewing the literature. The results show that it may be related to the extensive connectivity of the vestibular system with different brain regions and the close connection of the trigeminovascular system with the periphery of the vestibule. Therefore, it is necessary to pay attention to the diagnosis of comorbidities in VM, synthesize its pathogenesis, and give comprehensive treatment to patients., Competing Interests: Declarations. Conflict of interest: The authors declare that they have no competing interests. The authors have no financial or non-financial interests to disclose. Consent to participate: This manuscript does not contain clinical studies or patient data., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)

Purpose: Both metabolic syndrome (MetS) and cognitive dysfunction impair health-related quality of life (HRQOL). This study aims to determine whether individuals experiencing both MetS and cognitive dysfunction have lower HRQOL., Methods: This cross-sectional study enrolled 567 participants who attended outpatient clinics at a medical center in northern Taiwan. MetS was diagnosed according to the modified criteria for the Asian population. Cognitive function was categorized as normal, mild cognitive dysfunction, and advanced cognitive dysfunction according to the score of the Montreal Cognitive Assessment, Taiwanese version. HRQOL was assessed using the SF-36v2® Health Survey (SF-36v2). The associations of the comorbidity status of MetS and cognitive dysfunction with HRQOL were analyzed using linear regression models, adjusting for age, sex, marital status, education level, income groups, and activities of daily living., Results: Out of 567 participants, 33 (5.8%) had MetS with mild cognitive dysfunction, and 34 (6.0%) had MetS with advanced cognitive dysfunction. Participants with both MetS and advanced cognitive dysfunction exhibited the lowest scores in the physical component summary and almost all scales of HRQOL. MetS exacerbated the inverse association between mild cognitive dysfunction and the mental component summary. For those with MetS, the scores on scales of role physical, bodily pain, vitality, and social functioning worsened as cognitive function deteriorated (all P trend <0.05)., Conclusion: As the severity of comorbidity between MetS and cognitive dysfunction varies, patients exhibited poorer performance in different aspects of HRQOL. Future research is needed to find solutions to improve HRQOL for patients with both MetS and cognitive dysfunction., Competing Interests: Declarations. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research Ethics Committee of Taipei Veterans General Hospital, Taipei, Taiwan, on May 9, 2022 (Protocol Code: 2020-06-001 A). Consent to participate: All participants in this study provided written informed consent before participating in the research. Competing interests: The authors declare that they have no conflict of interest., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008-2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: "Few Co-occurring Diagnoses" (42.3%); "Multiple Pain Conditions" (21.3%); "Pain + SUD" (18.4%) and "Pain + SUD + Mental Health" (18.0%). Patients in the "Pain + SUD" class and "Pain + SUD + Mental Health" class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the "Few Co-occurring Diagnoses" class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention., Competing Interests: Declarations. Competing Interests: Termeh Feinberg was supported as a contractor with the National Institutes of Health National Center for Complementary and Integrative Health. All other authors declare no potential conflicts of interest. Preliminary findings of this research study were presented at the American Society of Clinical Pharmacology and Therapeutics (ASCPT) Annual Meeting in Atlanta, GA in March 2023., (© 2024. The Author(s).)

Background: Widowhood, as a traumatic event in the aging process, may lead to adverse psychological consequences such as anxiety and depression. However, the heterogeneity of anxiety and depression comorbidity patterns in widowed elderly and the interrelationships between symptoms have not been adequately studied., Method: 10,239 elderly aged 65 years and older were screened from the Chinese Longitudinal Healthy Longevity Survey (CLHLS 2017-2018), to assess depression and anxiety using the Center for Epidemiologic Studies Depression Scale (CESD) and the 7-item Generalized Anxiety Disorder Questionnaire (GAD). The subgroups of widowed elderly with similar patterns of symptoms were identified by latent profile analysis (LPA). The structure of anxiety-depressive comorbidity network was characterized using "bridge expected influence" as centrality indices. Network stability was tested using a case drop bootstrap program. A network comparison test (NCT) was performed to examine the differences in network characteristics across LPA subgroups., Result: LPA identified dichotomous profiles: low comorbid (n = 4457) and high comorbid (n = 692). NCT revealed a significant difference in the global strength between networks (S = 0.631, p < 0.001). GAD1 (Nervousness or anxiety) is the common bridging symptom for both networks, while the bridging symptom for the high comorbidity network also includes GAD3 (Generalized worry)., Limitations: Cross-sectional methods are unable to verify causal relationships, and further randomized controlled trials are warranted., Conclusion: Anxiety-depressive pattern in Chinese widowed elderly can be categorized into a low comorbid or a high comorbid group. GAD3 (Generalized worry) can be used as the core intervention target during intervention., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Purpose: This study compares the objective American Society of Anesthesiologists (ASA) and Adult Comorbidity Evaluation-27 (ACE-27) scores with the subjective Eastern Cooperative Oncology Group performance status (ECOG PS) for patient outcome prediction., Methods: We retrospectively analyzed head and neck squamous cell carcinoma patients treated with adjuvant (chemo)radiotherapy at the LMU Munich from June 2008 to June 2015. The study focused on associations between patient outcomes; treatment failures; known risk factors (including human papillomavirus [HPV] status and tumor stage); and the comorbidity indices ECOG-PS, ASA score, and ACE-27. The Kaplan-Meier method and Cox proportional hazards model were used for survival analysis and identifying independent risk factors., Results: A total of 302 patients were analyzed, 175 received concurrent chemotherapy. Median follow-up was 61.8 months, and median age at diagnosis was 61 years. The 3‑ and 5‑year overall survival (OS) and disease-free survival (DFS) rates were 70.5%/60.2% and 64.7%/57.6%, respectively. Both ACE-27 and ASA showed significant correlations with OS in univariate and multivariate analyses, while ECOG-PS was significant only in univariate analysis. ASA and ACE-27 scores were also significantly correlated with local and locoregional recurrence, but only HPV status and tumor stage were significant in multivariate models., Conclusion: ACE-27 and ASA score effectively categorize patients' risks in adjuvant radiotherapy for head and neck cancer, proving more predictive of overall survival than ECOG-PS. These results underscore the importance of objective comorbidity assessment and suggest further prospective studies., Competing Interests: Declarations. Conflict of interest: S.N. Marschner, C. Maihöfer, R. Späth, E. Haehl, D. Reitz, N. Kienlechner, L. Schüttrumpf, P. Baumeister, U. Pflugradt, J. Heß, H. Zitzelsberger, K. Unger, C. Belka, and F. Walter declare that they have no competing interests. Ethical standards: All procedures performed in studies involving human participants or on human tissue were in accordance with the ethical standards of the institutional and/or national research committee and with the 1975 Helsinki declaration and its later amendments or comparable ethical standards. A positive ethics vote (no. 448-13) of the local ethics committee (LMU Munich, Germany) was available in the context of the clinical cooperation group (KKG) “Personalized radiotherapy for head and neck tumors.” Informed consent was obtained from all individual participants included in the study. All patients are part of the adjuvant cohort of the clinical cooperation group “Personalized Radiotherapy in Head and Neck Cancer,” which was separately published by Maihöfer et al. [9]., (© 2024. The Author(s).)

Background: Children with established kidney failure may have additional medical conditions influencing kidney care and outcomes. This cross-sectional study aimed to examine the prevalence of co-existing diseases captured in the electronic hospital record compared to UK Renal Registry (UKRR) data and differences in coding., Methods: The study population comprised children aged < 18 years receiving kidney replacement therapy (KRT) in England and Wales on 31/12/2016. Comorbidity data at KRT start was examined in the hospital record and compared to UKRR data. Agreement was assessed by the kappa statistic. Associations between patient and clinical factors and likelihood of coding were examined using multivariable logistic regression., Results: A total of 869 children (62.5% male) had data linkage for inclusion. UKRR records generally reported a higher prevalence of co-existing disease than electronic health records; congenital, non-kidney disease was most commonly reported across both datasets. The highest sensitivity in the hospital record was seen for congenital heart disease (odds ratio (OR) 0.65, 95% confidence interval (CI) 0.51, 0.78) and malignancy (OR 0.63, 95% CI 0.41, 0.85). At best, moderate agreement (kappa ≥ 0.41) was seen between the datasets. Factors associated with higher odds of coding in hospital records included age, while kidney disease and a higher number of comorbidities were associated with lower odds of coding., Conclusions: Health records generally under-reported co-existing disease compared to registry data with fair-moderate agreement between datasets. Electronic health records offer a non-selective overview of co-existing disease facilitating audit and research, but registry processes are still required to capture paediatric-specific variables pertinent to kidney disease., (© 2024. The Author(s).)

Background: Knowledge of clinical, treatment and life circumstances of individuals with bipolar I disorder (BP-I) in US households is informed by decades old epidemiological surveys., Methods: The Mental and Substance Use Disorders Prevalence Study was conducted October 2020-October 2022. Clinicians administered the Structured Clinical Interview for the DSM-5 diagnosing 12-month prevalence of BP-I and other mental health disorders (MHD) among 4764 adults aged 18-65 years and collected sociodemographic information. We examined clinical characteristics, differences by sex and age among adults with BP-I, and compared adults with BP-I versus no MHD regarding sociodemographic characteristics, functioning, and substance use disorders (SUDs)., Results: Prevalence of BP-I in the MDPS was 1.5 %. Among those with BP-I, 73.4 % had comorbid psychiatric disorders, and 43.4 % had comorbid SUDs. Alcohol use disorder was higher in those with BP-I versus no MHD (33.0 % vs. 6.3 %). Mean Global Assessment of Functioning scores were lower among those with BP-I versus no MHD (53.2 vs. 77.0). Of individuals with BP-I, 64.9 % had past-year outpatient, 5.4 % inpatient, and 18.7 % minimally adequate treatment (≥1 antimanic agent and ≥ 4 outpatient visits). Individuals with BP-I were less likely to be employed (37.3 % vs. 63.0 %) and have a family income ≥$20,000 (48.2 % vs. 81.9 %) versus no MDPS MHD., Limitations: The survey response rate was low., Conclusions: In this sample, many individuals with BP-I had psychiatric and SUD comorbidities, lived in poverty and had functional impairment. Few received adequate treatment; women and younger individuals were particularly disadvantaged. Early detection and treatment represent substantial opportunities to improve outcomes., Competing Interests: Declaration of competing interest Dr. Kessler: In the past 3 years, Dr. Kessler was a consultant for Cambridge Health Alliance, Canandaigua VA Medical Center, Child Mind Institute, Holmusk, Massachusetts General Hospital, Partners Healthcare, Inc., RallyPoint Networks, Inc., Sage Therapeutics and University of North Carolina. He has stock options in Cerebral Inc., Mirah, PYM (Prepare Your Mind), Roga Sciences and Verisense Health. All other authors have no declarations to report., (Copyright © 2024 Elsevier B.V. All rights reserved.)

The study aimed to describe respiratory syncytial virus infections among hospitalized adults between January 2021 and February 2023 from a single medical center in Taiwan. Clinical information from infected patients with RSV was via medical charts review. The incidence of RSV during the study period among adult inpatients showed seasonal variation and could be up to around 2 % in peak season. Among 19 patients identified, the major comorbidity was chronic heart disease (10/19; 52.6 %) followed by chronic pulmonary disease (5/19; 26.3 %) and diabetes mellitus (5/19; 26.3 %). A quarter of infected patients required intensive care with overall mortality reached 26.3 % and the readmission rates within 30 days after was 15.8 %. Our study results suggests that RSV infections among adults could cause a substantial disease burden on healthcare systems., Competing Interests: Declaration of competing interest None, (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

The quality of general obesity management before bariatric surgery (BS) is rarely investigated. Inadequate information regarding undetected and undiagnosed comorbidities (UUCs) in individuals with obesity may influence the penetration, risks, and outcomes of BS. We conducted a cohort study involving a pre-specified medical check-up in a cooperation between a BS department and an outpatient medical centre. A total of 1068 patients (74.4% women) were enrolled in the study. The mean age was 42.1 years (standard deviation [SD] 11.9) and the mean body mass index (BMI) was 46.1 (SD 6.91). The onset of obesity occurred in 11.4% of patients during childhood, 47.2% during schooltime/adolescence, 41.4% in adulthood. Gender differences were observed: men had higher BMI, systolic blood pressure, and impaired metabolic state (including diabetes, dyslipidemia, and liver disease with p-values <.001 for all). Women had lower haemoglobin levels, impaired iron status, lower albumin levels (p < .001), and increased C-reactive protein levels (p < .05). The prevalence of UUC conditions (percentage of cases) was as follows: arterial hypertension, 53%; decreased cystatin C clearance, 57%; dyslipidemia, 41%; fatty liver, 40%; iron deficiency, 37%; diabetes mellitus, 34%; vitamin D deficiency, 32%; chronic pain syndrome, 23%; liver fibrosis, 12%; obstructive sleep apnea, 10%; and vitamin deficiencies (vitamin B 12 , folic acid, vitamin K 1 ) <10%. Undiagnosed hypertension was more prevalent in younger women, and nutritional deficits were associated with high BMI in both genders. Older age and high BMI were associated with undiagnosed diabetes and decreased glomerular filtration rate in both genders, and with liver fibrosis in men. UUC are highly prevalent in individuals undergoing BS. A refined assessment is recommended to improve health conditions and outcome in these candidates., (© 2024 The Author(s). Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Objective: This study examined rates of positive screens for depression and posttraumatic stress and their comorbidity among undergraduate ( N  = 77) and graduate ( N  = 136) students who participated in on-campus Spiritual-Mind-Body (SMB) wellness interventions., Methods: Participants completed the PHQ-9 and the PCL-C before starting an 8-week in-person SMB wellness intervention. Elevated depression was indicated by a score of ≥10 on the PHQ-9; elevated posttraumatic stress (PTS) was indicated by a score of ≥30 on the PCL-C., Results: There were unexpectedly high rates of posttraumatic stress among both undergraduate (39%) and graduate (32%) students without the presence of comorbid depression. A small minority of students experienced depression apart from elevated PTS symptoms. Overall, students reported high levels of clinically relevant psychopathology., Conclusion: On-campus wellness centers may offer an appropriate setting for the screening of trauma-related distress and depression and their comorbidity to address the psychiatric concerns of SMB wellness-seeking students.

Background: Sleep apnea (SA) and insomnia (INS) are prevalent sleep disorders among referrals to sleep clinics. People with comorbid insomnia and sleep apnea (COMISA) suffer both disorders simultaneously. The epidemiology of COMISA is not well known in the Middle East including Iran. We hypothesized that COMISA is prevalent in metropolitan sleep clinic cohorts in Iran., Method: The records of patients aged < 95 years referred to sleep disorders centers in four large metropolitan areas including Kermanshah, Tabriz, Shiraz, and Ahvaz were examined. Polysomnography (PSG) was performed in all these patients in specialized centers and the results were scored by a trained technician and interpreted by a sleep specialist. SA was defined as an Apnea-Hypopnea Index (AHI ≥ 5), INS was defined by psychiatrists according to self-report and clinical interviews, and COMISA was defined if both disorders were present. Participants with neither condition were included in as comparator group. One-way ANOVAs, correlation, and linear/logistic regression analyses were used., Results: This study included 1807 patients (Mean age 49.3, SE ± 13.7; 38.8% Female). Comparator, INS, SA and COMISA made up 7.2%, 16%, 50.2% and 26.6% of the sample, respectively. Logistic regression analyses showed that male gender, older age, and increasing neck circumference, but not BMI, were associated with COMISA. Epworth Sleepiness Scale scores were lower in INS (5.39 ± 5.78) compared to the other three groups., Conclusion: COMISA is a prevalent condition in metropolitan sleep centers in Iran among participants referred to sleep centers. The data showed that male gender and age were associated significantly with COMISA., Competing Interests: Declarations Ethics approval and consent to participate The Review Board of the Kermanshah University of Medical Sciences (Ethical Approval ID: IR.KUMS.REC.1401.423) approved the study, which was performed in accordance with the ethical principles laid down in the seventh and current edition (2013) of the Declaration of Helsinki. Participant s’ signed the written informed consent sheet and gave their assent to participate in the present study. Consent for publication For all details include data and images relating to an individual person, written informed consent for the publication of these details and any potentially identifiable images were obtained from that person. Consent to participate Participants were fully informed about the aims and the procedure of the study, and the anonymous data handling. They all signed the written informed consent sheet to participate in the present study., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: There is a robust relationship between depression and substance use in youth, with higher levels of substance use associated with greater depressive symptomatology. However, previous research has examined individual substances, without consideration of psychiatric comorbidities. Here, we investigate patterns of substance use among depressed and/or suicidal youth within the context of psychiatric comorbidities., Methods: 945 youth with depression and/or suicidality from the Texas Youth Depression and Suicide Research Network (TX-YDSRN) were assessed for current use of alcohol, nicotine, cannabis, and other drugs and comorbid psychiatric diagnoses. We used latent class analysis to identify patterns of past-year substance use, then examined if demographics or psychiatric disorders predicted class membership., Results: We identified three patterns of substance use: non-use (63.4 %), moderate likelihood of using alcohol, nicotine and cannabis (23.8 %), and high likelihood of using all substances (12.7 %). Compared to non-users, individuals in the moderate and high likelihood classes were more likely to be older. Individuals in the high likelihood class were more likely to have a substance use disorder, ADHD, and higher suicidality scores., Limitations: We cannot ascertain the causal or temporal ordering of substance use and psychiatric diagnoses due to the cross-sectional nature of the study., Conclusions: Using a brief, self-report measure of substance use, we identified three classes of substance users differing in probability of past-year use, which were predicted by older age and some psychiatric comorbidities. While research on universal screening of substance use in youth remains limited, we discuss who may benefit from such screening among depressed youth., Competing Interests: Declaration of competing interest Drs. Mitchell and Wakefield serve as Executive Committee Members of the Texas Child Mental Health Care Consortium. Dr. Jha has received contract research grants from Acadia Pharmaceuticals, Neurocrine Bioscience, Navitor/Supernus and Janssen Research & Development; honorarium to serve as Section Editor of the Psychiatry & Behavioral Health Learning Network and as Guest Editor for Psychiatric Clinics of North America from Elsevier; consultant fees from Eleusis Therapeutics US, Inc., Janssen Global Services, Janssen Scientific Affairs, Boehringer Ingelheim, and Guidepoint Global; fees to serve on Data Safety and Monitoring Board for Worldwide Clinical Trials (Eliem and Inversargo), Vicore Pharma and IQVIA (Click); and honoraria for educational presentations from North American Center for Continuing Medical Education, Medscape/WebMD, Clinical Care Options, H.C. Wainwright & Co., and Global Medical Education. Dr. Soares has served as a consultant to Boehringer Ingelheim, Livanova, Sunovian, and Johnson & Johnson. He has served on the advisory board of Alkermes and received research grants from Compass Pathways, Mind Med, and Relmada Therapeutics Inc. Dr. Trivedi has provided consulting services to Acadia Pharmaceuticals, Alkermes Inc., Alto Neuroscience Inc., Axsome Therapeutics, BasePoint Health management LLC, Biogen MA Inc., Cerebral Inc., Circular Genomics Inc., Compass Pathfinder Limited, Daiichi Sankyo Inc., GH Research, GreenLight VitalSign6 Inc., Heading Health, Janssen Pharmaceutical, Legion Health, Merck Sharp & Dohme Corp., Mind Medicine Inc., Myriad Neuroscience, Naki Health Ltd., Neurocrine Biosciences Inc., Noema Pharma AG, Orexo US Inc., Otsuka America Pharmaceutical Inc., Otsuka Europe LTD, Otsuka Pharmaceutical Development & Commercialization Inc., Praxis Precision Medicines Inc., PureTech LYT Inc., Relmada Therapeutics Inc., SAGE Therapeutics, Signant Health, Sparian Biosciences, Titan Pharmaceuticals, Takeda Pharmaceuticals Inc., WebMD. He has received grant/research funding from NIMH, NIDA, NCATS, American Foundation for Suicide Prevention, Patient-Centered Outcomes Research Institute (PCORI), Blue Cross Blue Shield of Texas, SAMHSA, and the DoD. Additionally, he has received editorial compensation from Elsevier and Oxford University Press. No other authors have interests to declare., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Lay Abstract: What is already known about the topic? Autistic children frequently often have accompanying physical health problems. However, this has been much less studied in autistic men and women during adulthood. What does this article add? This is one of the first studies to investigate the associations between autistic and somatic problems in adults from the general population. Using a continuous measure of autistic symptom scores and a categorical definition of autism (referred to below as probable autism) which considered symptom severity, childhood age of onset, and functional impairment, we found that autistic problems and irritable bowel syndrome, food allergy, pain, and fatigue were associated in adults. Sex differences were present for pain and fatigue, for which the associations with autistic symptom scores were somewhat stronger in females than males. Regarding age differences, the associations with fatigue and having food allergy were more pronounced in younger adults. Conversely, older individuals had a higher risk of developing irritable bowel syndrome or experiencing pain if they met the criteria for probable autism. Implications for practice, research, or policy There is a need for providing routine programs of screening, assessment, and treatment of autism-related somatic problems and developing evidence-based interventions for autistic individuals. These could be tailored to the needs of specific autistic populations. For example, autistic females could be given extra attention about the potential presence of pain and fatigue, younger adults about the potential presence of food allergy and fatigue, and older adults concerning the potential presence of irritable bowel syndrome and pain., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Both schizophrenia and type 1 diabetes mellitus (T1D) are known as immune-related disorders. We systematically reviewed observational studies to explore the relationship between schizophrenia or schizoaffective disorder and T1D., Methods: A preliminary search of articles was completed using the following databases: Airiti Library, CINAHL Complete (via EBSCOhost), OVID MEDLINE, Embase, and PubMed. Two researchers independently assessed each study's quality based on Joanna Briggs Institute (JBI). A narrative review summarized the potential relationship between the two diseases., Results: Eleven studies were included in the final analysis. Six observational studies investigated the risk of schizophrenia and schizoaffective disorder in patients with T1D. Two studies showed negative correlations, one showed no correlation, and three showed positive correlations. On the other hand, five studies reported the prevalence of T1D in patients with schizophrenia. Two of them showed positive associations, and three others showed no association. Although the majority of the included studies suggested a positive association between the two medical conditions, these studies were still too heterogeneous to draw consistent results., Conclusion: We found conflicting results regarding the bidirectional relationship between schizophrenia or schizoaffective disorder and T1D. These may stem from differences in study design, sampling methods, or definition of diagnoses, which are essential aspects to consider in future research., Competing Interests: Conflict of interest: Y. Liu, Y. Liao, and K. Lin declared that they have no known financial, professional, or contractual competing interests that could influence the study design, writing of the paper, or presentation of our work., (© 2024. Der/die Autor(en), exklusiv lizenziert an Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

We examined the association between comorbid conditions and mild cognitive impairment (MCI) in Native Hawaiians and Pacific Islanders (NHPI) ( n  = 54). Cross-sectional, self-reported questionnaires were utilized to collect demographic, comorbid conditions, and MCI (via the AD8 index) data. Separate logistic regression models were conducted to investigate the relationship between comorbid conditions and MCI, adjusting for other covariates. We found significantly increased odds of MCI in those reporting high blood pressure (OR = 5.27; 95% CI: [1.36, 20.46]; p  = 0.016), high cholesterol (OR = 7.30; 95% CI: [1.90, 28.14], p  = 0.004), and prediabetes or borderline diabetes (OR = 4.53; 95% CI: [1.27, 16.16], p  = 0.02) compared with those not reporting these respective conditions. These data show that hypertension, hypercholesterolemia, and prediabetes are associated with MCI in the NHPI community, suggesting that preventive strategies to reduce chronic conditions may also potentially slow cognitive decline in underrepresented/understudied NHPI., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: With an increase in life expectancy of people with HIV, there is a corresponding rise in comorbidities and consequent increases in comedications. Objective: This study compared comorbidity and polypharmacy among people with HIV and people without HIV stratified by age, sex, and race. Methods: This retrospective study utilised administrative claims data to identify adult people with HIV with antiretroviral therapy (ART) claims and HIV diagnosis codes from 01 January 2018 to 31 December 2018. Index date was the earliest ART claim or HIV diagnosis in the absence of ART claims. Inclusion required continuous enrolment for ≥12-month pre-index and ≥30-day post-index, along with ≥1 HIV diagnosis during baseline or follow-up. People with HIV were matched 1:2 with people without HIV on sociodemographic. Results were compared using z-tests with robust standard errors in an ordinary least squares regression or Rao-Scott tests. Results: Study sample comprised 20,256 people with HIV and 40,512 people without HIV. Mean age was 52.3 years, 80.0% males, 45.9% Caucasian, and 28.5% African American. Comorbidities were significantly higher in younger age people with HIV than people without HIV. Female had higher comorbidity across all comorbidities especially younger age people with HIV. Polypharmacy was also significantly greater for people with HIV versus people without HIV across all age categories, and higher in females. Across races, multimorbidity and polypharmacy were significantly greater for people with HIV versus people without HIV. Conclusions: Comorbidities and polypharmacy may increase the risk for adverse drug-drug interactions and individualised HIV management for people with HIV across all demographics is warranted.

Background: Despite conflicting data, some studies have suggested a pathophysiological relationship between inflammation and attention-deficit/hyperactivity disorder (ADHD)., Methods: Using data from the nationwide and representative German Health Interview and Examination Survey for Children and Adolescents (KiGGS; n = 6922 study participants aged 11-17 years), this post hoc analysis assessed the associations between ADHD and three common inflammatory diseases., Results: Results showed univariate associations between ADHD and lifetime inflammatory diseases including atopic dermatitis (p = 0.002), otitis media (p = 0.001), and herpes simplex infection (p = 0.032). In logistic regression models adjusted for clinically relevant confounders, we found that ADHD remained a significant predictor of all three inflammatory diseases (atopic dermatitis, Exp(β) = 1.672, 95% confidence interval [CI] 1.239-2.257, p = 0.001; otitis media, Exp(β) = 1.571, 95% CI 1.209-2.040, p = 0.001; herpes simplex, Exp(β) = 1.483, 95% CI 1.137-1.933, p = 0.004)., Conclusion: Our findings demonstrate a positive link between ADHD and peripheral inflammatory diseases, including atopic dermatitis, otitis media, and herpes simplex infection. Further studies are needed to understand the exact pathophysiological mechanisms underlying these associations., Competing Interests: Conflict of interest: L. Boemanns, J. Staab and T. Meyer declare that they have no competing interests., (© 2023. The Author(s).)

Background: Numerous studies have linked the inflammatory pathway in psoriasis and metabolic disease, while no specific marker defined it. It is worth exploring the association of β2-microglobulin (β2M) in psoriasis severity and comorbidities., Objectives: To investigate the correlation between blood β2M level and psoriasis severity, to explore the inflammatory factors influencing the occurrence of psoriasis comorbidities such as arthritis, diabetes, and hypertension., Methods: Ninety-seven psoriasis patients were analyzed in the cohort retrospective study during 12 weeks., Results: Significantly higher levels of blood β2M and ESR were observed in the group that patients' PASI ≥10 than in the group that PASI <10. Blood β2M level had strong significantly positive correlations with the PASI in Pearson's correlation analysis. In the model that systemic inflammatory factors to find psoriasis comorbidity risk factors, logistic regression analysis showed that blood β2M level was the significant risk factor associated with diabetes and hypertension. High-sensitivity C-reactive protein (hsCRP) was the significant risk factor associated with arthritis., Conclusions: Patients with a severer psoriasis tended to have higher blood β2M levels and severer inflammatory state. In the systemic inflammation indexes, the level of blood β2M affected the risk of hypertension and diabetes, and hsCRP affected the risk of arthritis in patients with psoriasis.

Background: Previous studies showed that comorbidity and demographic factors added to burden on health-related quality of life (HRQoL). Only one study explored the relationship between HRQoL and comorbidity in college students with mental disorders, leaving generalizability of findings uncertain. Less is known about the association of demographics on HRQoL. This study investigated HRQoL based on demographics and comorbidity among college students with mental disorders., Methods: Participants were students (N = 5535) across 26 U.S. colleges and universities who met criteria for depression, generalized anxiety, panic, social anxiety, post-traumatic stress, or eating disorders based on self-report measures. ANOVA and linear regressions were conducted., Results: Overall, female, minoritized (gender, sexual orientation, race, or ethnicity), and lower socioeconomic status students reported lower HRQoL than male, heterosexual, White, non-Hispanic, and higher socioeconomic status peers. After accounting for comorbidity, differences in physical HRQoL based on sex assigned at birth and gender were no longer significant. For mental HRQoL, only gender and sexual orientation remained significant. A greater number of comorbidities was associated with lower HRQoL regardless of demographic group., Limitations: The non-experimental design limits causal inference. The study focused on univariable associations without examining potential interactions between demographic factors. Future research should explore structural factors like discrimination., Conclusion: Results suggested that increased comorbidities placed an additional burden on HRQoL and that certain demographic groups were more vulnerable to HRQoL impairment among students with mental disorders. Findings suggest the need for prevention of disorders and their comorbidity and implementing tailored interventions for specific student subgroups with increased vulnerability., Competing Interests: Declaration of competing interest None., (Copyright © 2024. Published by Elsevier B.V.)

Background: Limited evidence exists on the influence of hospital procedure volume, socioeconomic status, and comorbidities on surgical abortion outcomes., Objective: Our study aimed to assess the association between hospital procedure volume, individual and neighborhood deprivation, comorbidities, and abortion-related adverse events., Study Design: A nationwide population-based cohort study of all women hospitalized for surgical abortion was conducted from January 1, 2018 to December 31, 2019 in France. Annual hospital procedure volume was categorized into 4 levels based on spline function visualization: very low (<80), low ([80-300]), high ([300-650]), and very high-volume (≥650) centers. The primary outcome was the occurrence of at least one surgical-related adverse event, including hemorrhage, retained products of conception, genital tract and pelvic infection, transfusion, fistulas and neighboring lesions, local hematoma, failure of abortion, and admission to an intensive care unit or death. These events were monitored during the index stay and during a subsequent hospitalization up to 90 days. The secondary outcome encompassed general adverse events not directly linked to surgery., Results: Of the 112,842 hospital stays, 4951 (4.39%) had surgical-related adverse events and 256 (0.23%) had general adverse events. The multivariate analysis showed a volume-outcome relationship, with lower rates of surgical-related adverse events in very high-volume (2.25%, aOR=0.34, 95% CI [0.29-0.39], P<.001), high-volume (4.24%, aOR=0.61, 95% CI [0.55-0.69], P<.001), and low-volume (4.69%, aOR=0.81, 95% CI [0.75-0.88], P<.001) wh en compared to very low-volume centers (6.65%). Individual socioeconomic status (aOR=1.69, 95% CI [1.47-1.94], P<.001), neighborhood deprivation (aOR=1.31, 95% CI [1.22-1.39], P<.001), and comorbidities (aOR=1.79, 95% CI [1.35-2.38], P<.001) were associated with surgical-related adverse events. Conversely, the multivariate analysis of general adverse events did not reveal any volume-outcome relationship., Conclusion: The presence of a volume-outcome relationship underscores the need for enhanced safety standards in low-volume centers to ensure equity in women's safety during surgical abortions. However, our findings also highlight the complexity of this safety concern which involves multiple other factors including socioeconomic status and comorbidities that policymakers must consider., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Comorbidities complicate the management of tuberculosis (TB) and have become an essential part of the end TB strategy to eradicate TB. However, pulmonary TB has received the most attention, and little is known about the impact of comorbidities and other factors on outcomes in patients with extrapulmonary tuberculosis (EPTB)., Objectives: Our aim was to analyze the factors associated with hospitalization and mortality in EPTB at a hospital in Central India, using non-TB patients with similar clinical presentations as a comparison., Methods: Patients with presumptive EPTB were prospectively enrolled and followed up until the end of treatment or for at least 6 months. Detailed demographic and clinical information was collected for all participants, and patients were categorized as TB or non-TB using a composite reference standard. Multivariate logistic regression was used to analyze the impact of various clinical findings and risk factors on hospitalization and mortality., Results: A total of 276 patients were categorized as TB cases and 175 as non-TB cases. Factors associated with hospitalization in children were younger age and non-adenitis site of disease. In adults, factors associated with mortality were older age, non-adenitis site of disease and HIV infection regardless of TB diagnosis, while diabetes mellitus increased the odds of mortality in EPTB patients., Conclusion: Our results show that comorbidities increase the odds of death in both TB and non-TB patients in low-resource settings. This argues for a shift away from the traditional vertical management of diseases in these areas and supports a continued focus on building robust healthcare systems.

Objective: To investigate the associations between parity (the number of offspring a female has borne) and cognitive function, depression, and chronic comorbidity in Western China., Methods: A total of 846 women aged 50-55 years were included in the current analysis. Cognitive status was measured using a 10-item short portable mental status questionnaire (SPMSQ). Depressive symptoms were assessed using the 15-item geriatric depression scale (GDS-15). Other characteristics were self-reported. The associations between parity and cognitive decline, depression, and chronic comorbidity were analyzed using univariable and multivariable models. Multivariable models were adjusted for age, ethnic group, occupation, marital status, educational level, lifestyle factors, and sleeping time., Results: Among the enrolled women, 26.71% were either childless or had one child, 47.40% had two children, 18.32% had three children, and 7.57% had ≥4 children. Compared to women with low parity, women with two or more children exhibited a higher risk of cognitive decline. Moreover, having four or more children was significantly associated with depression and chronic comorbidity. After adjusting covariates, women with three or more children exhibited a higher risk of cognitive decline than those with low parity. However, high parity was not significantly associated with depression or chronic comorbidity after adjustment for covariates., Conclusion: Our study showed that ≥3 children was associated with cognitive decline in women. Longitudinal studies are needed to evaluate this conclusion and to investigate the mechanisms involved. More importantly, families and societies should pay more attention to women's long-term health outcomes related to fertility., (© 2024 International Federation of Gynecology and Obstetrics.)

Introduction: Asthma is a chronic inflammatory disease of the lower airways that affects more than 260 million people worldwide and has been related to more than 460,000 deaths a year. It is estimated that in 60% of asthma cases, the symptoms are not adequately controlled. The objective of this study was to determine the association between some comorbidities, habits, and health risk behaviors with uncontrolled asthma in a sample of young people with asthma., Methods: Through a cross-sectional study, data from 1,078 young people aged 17 to 19 years were analyzed. Information was collected through physical examination, direct questioning, and the application of a self-administered questionnaire., Results: In the group of young people with asthma, the prevalence of uncontrolled asthma was 20.6%, of which 53.8% were women, 76.9% suffered from rhinitis, 46.2% were overweight and 23.1% were obese. In the group of young with uncontrolled asthma, gingivitis was detected in 53.8% and alcohol consumption in 84.6%. Logistic regression analysis showed a significant association between allergic rhinitis, gingivitis, carbohydrate intake, alcohol consumption, overweight, and obesity with uncontrolled asthma., Conclusions: Parents and members of the health team need to identify on time the risk factors associated with uncontrolled asthma in young people with asthma to limit its development and the negative effects it generates. The results of this study should be used to strengthen programs that promote the comprehensive health of adolescents.

Aim: To investigate the factors affecting postoperative frailty and the relationship between frailty and postoperative recovery in patients undergoing cardiovascular surgery., Design: The study was descriptive, cross-sectional, and predictive., Methods: Data were collected by researchers in a university research and application hospital cardiovascular surgery inpatient clinic between March 2022 and March 2023. Sociodemographic-Clinical Characteristics Form, Comorbidity Index, Edmonton Frail Scale, Postoperative Recovery, and Nutritional Risk Screening were used to collect the data., Results: Of the 145 patients included in the study, 65.51% (n = 95) were male and the mean age was 62.02 ± 10.16 years. While frailty was not found to be significant by age group, it was found that women had more comorbidities and were more frail than men. It was found that 17.2% (n = 25) of patients had a history of falls before surgery, 26.2% (n = 38) had a fear of falling after surgery and 17.24% (n = 25) had rehospitalisations. While postoperative recovery index predicted fraility by 34% in patients undergoing cardiovascular surgery; general symptoms and psychological symptoms, which are the sub-dimensions of the postoperative recovery index and comorbidity and, fear of falling after surgery predicted frailty by 61%. The order of importance of variables on fraility: general symptoms (β = 0.297), fear of falling (β = 0.222), psychological symptoms (β = 0.218), Charlson Comorbidity Index (β = 0.183)., Patient or Public Contribution: This study clarifies the role of frailty as an important factor influencing the recovery process in patients undergoing cardiovascular surgery. The findings show that frailty has a determining effect on postoperative recovery in these patients. Among the factors affecting frailty status, comorbidities, fear of postoperative falls, and postoperative general and psychological symptoms were found to contribute. These findings emphasise that these factors should be taken into account when assessing and managing the postoperative recovery process. Understanding these factors that influence postoperative frailty is crucial for patient care. Recognising the multifaceted nature of frailty, personalised interventions are needed to improve patient care and postoperative outcomes. Personalised interventions are particularly important for older women with multiple comorbidities, as they are more likely to be frail., (© 2024 The Author(s). Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.)

Rheumatic diseases present unique challenges in the elderly, with changes in the immune system contributing to varied clinical presentations. More individuals are now living with chronic diseases due to greater life expectancy, but there is a lack of real-world data about rheumatic diseases and comorbidities in older people. This study aimed to investigate disease types, comorbidities, treatments, and mortality in geriatric patients in comparison to non-geriatric patients at a rheumatology clinic. This retrospective observational cohort study reviewed the medical records of 2610 patients from January 2021 to January 2024 at 2 branches of a private hospital's rheumatology clinics. Demographic information and data on rheumatic diseases, noninflammatory conditions, treatments, comorbidities, and mortality were collected, and geriatric patients were compared to non-geriatric patients. Geriatric patients (n = 515) had a significantly higher prevalence of rheumatoid arthritis (50.6% vs 28.8%, P < .001), polymyalgia rheumatica (11.1% vs 0.2%, P < .001), and crystal arthritis (19.6% vs 8.8%, P < .001), with more frequent geriatric-onset cases. Osteoarthritis was also more prevalent in geriatric patients (51.2% vs 11.3%, P < .001), while fibromyalgia was more common in the non-geriatric group (15.9% vs 4.1%, P < .001). Geriatric patients experienced higher rates of comorbidities, including hypertension (72.4% vs 17.8%, P < .001), diabetes (33.6% vs 12.1%, P < .001), and osteoporosis (64.9% vs 35.4%, P < .001). These patients used more corticosteroids (74.5% vs 44%, P < .001), and conventional synthetic disease-modifying antirheumatic drugs (62.4% vs 49.4%, P < .001) but fewer biological disease-modifying antirheumatic drugs (9.2% vs 23.1%, P < .001). Mortality rates were significantly higher in geriatric patients (6% vs 0.3%), with cancer (P = .001), ischemic heart disease (P = .04), heart failure (P = .01), chronic kidney disease (P = .02), and interstitial lung disease (P = .01) being associated with increased mortality. Geriatric rheumatology should receive greater focus in future research to help address the anticipated increases in demand and to develop tailored management strategies for elderly patients with rheumatic diseases and comorbidities., Competing Interests: The author has no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

This study aims to (1) analyze the clinical characteristics and risk factors of patients with type 2 diabetes and comorbid depression and (2) explore the association between SIRT1 gene single-nucleotide polymorphism sites and this comorbidity. A total of 450 type 2 diabetes patients hospitalized in the General Medicine Department at The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology from July 2022 to September 2023, and 300 healthy individuals from the physical examination department were selected as study subjects. Both groups were assessed using general information surveys and questionnaires. Statistical analyses were performed to compare clinical indicators across 3 groups: individuals with only type 2 diabetes, those with comorbid depression, and healthy controls. The age, gender, disease duration, marital status, income and drug expenditure, employment status, fasting blood glucose level, fasting insulin level difference, insulin resistance index difference, glycated hemoglobin, high-density lipoprotein level, and HCY difference among the 3 groups of patients were risk factors for type 2 diabetes comorbid depression patients. The SIRT1 mRNA level was significantly reduced in type 2 diabetes comorbid depression patients. The SIRT1 gene had 3 sites: rs12415800, rs3758391, and rs932658, which were related to the patient's type 2 diabetes comorbid depression. They were the additive model and dominant model of rs12415800 and rs3758391, respectively. In addition, the GTGGT haplotype composed of rs12415800-rs932658-rs7895833-rs2273773-rs1467568 and the AGACT haplotype composed of rs3758391-rs932658-rs33957861-rs3818292-rs1467568 were significantly associated with type 2 diabetes comorbid depression. Numerous factors influence the presence of depression in patients with type 2 diabetes, with the SIRT1 gene playing a significant role, serving as a potential biomarker for this comorbidity., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Mental illness remains a significant global health concern that affects diverse populations, including individuals living with hypertension and/or type 2 diabetes, predominantly in lower-income to middle-income countries. The association between non-communicable diseases (NCDs) and mental illness is firmly established globally, however, this connection has yet to be comprehensively explored in West Africa. Our systematic review and meta-analysis aim to synthesise existing evidence on the prevalence, incidence, and risk factors for comorbid mental illness with hypertension and/or type 2 diabetes in West Africa. This effort seeks to contribute to bridging the knowledge gap and facilitating the implementation of interventions tailored to this context., Methods and Analysis: A comprehensive search will be conducted across multiple databases (PubMed, Google Scholar, PsycINFO, Carin Info and CINAHL), supplemented by searches on the websites of the WHO and various countries' ministries of health, and references cited in relevant papers. Inclusion criteria specify studies conducted in countries from the Economic Community of West African States, reported from January 2000 until date of search, focusing on adults with hypertension and/or type 2 diabetes and mental illness. Exclusion criteria encompass studies outside the specified time frame, involving pregnant women, or lacking relevant outcomes. There will be no language restrictions for inclusion. Study selection, data extraction and risk of bias assessment will be carried out independently by at least two reviewers. We will employ pooled proportions of OR, risk ratio and mean differences to assess prevalence, and incidence of mental illness and heterogeneity will be assessed., Ethics and Dissemination: This protocol does not require ethical approval; however, it is a part of a larger study on NCDs, which has received ethical clearance from the Ghana Health Service (ID NO: GHS-ERC 013/02/23). The results will be presented to stakeholders (policymakers and practitioners) and disseminated through conferences and peer-reviewed publications., Prospero Registration Number: CRD42023450732., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Purpose: The aim of the study is to determine the prevalence of restless legs syndrome (RLS) in patients with relapsing-remitting multiple sclerosis (RRMS) and explore its associations with sleep quality, comorbidities and quality of life., Methods: RLS and RRMS diagnosis were made using the latest criteria the International Classification of Sleep Disorders-3 (ICSD-3) criteria and 2017 McDonald criteria. A total of 210 individuals, including 105 patients diagnosed with RRMS and 105 healthy volunteers were included into the study. Data of demographical and disease characteristics and RLS properties were collected. Several scales to assess anxiety, depression, fatigue, sleep quality and quality of life scales were used., Results: RLS prevalence was found in 21.9% of RRMS patients and 12.4%of healthy volunteers. RRMS patients with RLS exhibit significantly higher anxiety and depression scores in sleep quality, fatigue and quality of life compared to the patients without RLS., Conclusion: This study highlights a higher prevalence of RLS in patients with RRMS compared to healthy individuals. RRMS patients with RLS exhibited distinct characteristics, including lower sleep quality and higher quality of life scores while RLS was nod significantly associated with demographic or clinical variables. Recognizing RLS in patients with RRMS is important for the treatment and improving their overall well-being., Competing Interests: Declarations. Ethics approval and consent to participate: Our study was conducted in accordance with the Helsinki Declaration Rules, and it was approved by the Health Sciences University Antalya Training and Research Hospital Clinical Research Ethics Committee on 25/08/2022 with decision number 16/13. Declaration of Generative AI and AI-assisted technologies in the writing process: The authors declare no AI usage in the writing process. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Due to demographic changes, a growing number of elderly patients with comorbidities will require spine surgery in the next decades. However, age and multimorbidity have been associated with considerably worse postoperative outcomes, and is often associated with surgical invasiveness. Full-endoscopic spine-surgery (FESS), as a cornerstone of contemporary minimally invasive surgery, has the potential to mitigate some of these disparities. Thus, we conducted an analysis of all FESS cases at a national center. Utilizing the Charlson Comorbidity index (CCI) ≥ 3 as a frailty surrogate we separated patients in two groups for patients with and without comorbidities. Patients with (CCI) ≥ 3 exhibited a higher age (p < 0.001), and number of comorbidities (p < 0.001) than the control group. Thereafter, a propensity score matching was done to adjust for potential confounders. Postoperative safety measures in emergency department utilization, and clinic readmission did not significantly differ between the groups. Furthermore, patients of both groups reported similar postoperative pain improvements. However, patients with a (CCI) ≥ 3 were treated as inpatients more often (p < 0.001), had a higher length of stay (p < 0.001) and a smaller functional improvement after at a chronic postoperative timepoint (p = 0.045). The results underline safety and efficacy of FESS in patients with comorbidities. Additionally, they provide guidance for preoperative patient counselling and resource utilization when applying FESS in frail patients., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To investigate the comorbidity status of hypertension, diabetes, and dyslipidemia (the"three diseases") among residents aged≥40 in Liaoning Province, and to explore the correlation between the comorbidity and cardiovascular disease mortality. Methods: This investigation was a prospective cohort study. From February 2017 to March 2019, a multi-stage stratified cluster random sampling method was used to carry out a baseline survey of 18 758 permanent residents aged≥40 years in Liaoning Province. Demographic information and history of hypertension, diabetes, and dyslipidemia were collected and followed up every year. Death was mainly identified by linkage to the Population Death Information Registration Management System. Cox proportional hazard regression model was used to analyze the association between the comorbidity of the "three diseases" and cardiovascular disease mortality risk. Results: A total of 18 758 residents aged≥40 in Liaoning Province were included, with an age of (60.3±9.9) years and 7 325 males (39.1%). The comorbidity rate of hypertension, diabetes, and dyslipidemia was 6.7% (1 256/18 758), and the standardized prevalence rate was 5.4%. The comorbidity rate increased with age (P<0.001), which was higher in women than in men, and more significant in urban areas than in rural areas (all P <0.001). The comorbidity of "three diseases" accounted for 39.3% (1 256/3 198), 18.7% (1 256/6 710), and 11.8% (1 256/10 653) in patients with diabetes, dyslipidemia, and hypertension, respectively. With a follow-up of (4.3±0.6) years, 463 people died of cardiovascular disease. The mortality rate of cardiovascular disease in the comorbidity of hypertension, diabetes, and dyslipidemia was 8.74/1 000 person-years. After adjusting potential confounders, Cox proportional hazard regression model analysis showed that compared with normal individuals, the hazard ratio of cardiovascular disease mortality in patients with the "three diseases" was 2.55 (95% CI : 1.63-3.99). Conclusion: The prevalence of comorbidity of hypertension, diabetes, and dyslipidemia among residents aged≥40 in Liaoning Province was relatively high, and the risk of cardiovascular disease mortality in patients with the "three diseases" was increased.

The role of Interleukin-40 (IL-40) in rheumatoid arthritis (RA) is not well understood, and this study was designed to explore serum IL-40 levels in RA patients to assess its potential as a disease biomarker. In this research, serum IL-40 levels were determined using enzyme-linked immunosorbent assay in 116 patients with RA, 40 with osteoarthritis (OA), 29 with systemic lupus erythematosus (SLE), and 66 healthy controls (HCs). Paired serum samples were collected from 86 of the 116 patients treated during follow-up visits at week 12. Group comparison analysis showed that serum IL-40 levels were significantly higher in patients with RA than in HCs, and the areas under the curve for IL-40 were 0.688, 0.865, and 0.870 for distinguishing patients with RA from HCs and those with OA and SLE, respectively. Furthermore, in RA, serum IL-40 levels were lower in patients with comorbidities of cardiovascular diseases or OA. Correlation analyses revealed that serum IL-40 levels were positively associated with RA-related autoantibodies and coagulation-related indicators, whereas no correlation was observed with disease activity-associated factors. When comparing paired samples, treatment with TNF inhibitors (TNFi) significantly reduced serum IL-40 levels, emphasizing its potential as a treatment guide., Competing Interests: Declaration. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Depression is among the leading causes of the global burden of disease and is associated with substantial morbidity in old age. The importance of providing timely intervention, particularly those with subclinical symptoms, has thus increasingly been emphasised. Despite their overall effectiveness, a small but notable subgroup tends to be less responsive to interventions. Identifying predictors of non-remission and non-response is critical to inform future strategies for optimising intervention outcomes., Methods: A total of 4153 older adults aged 60 years and above with subclinical depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] = 5-19) were recruited from JC JoyAge, a large-scale collaborative stepped-care intervention service across Hong Kong. A wide range of clinical and modifiable risk and protective factors at baseline were assessed, including depressive symptoms, anxiety symptoms, loneliness, suicidal ideation, cognitive capacity, multimorbidity, chronic pain, need for informal care due to mental health reasons, history of abuse, and sociodemographic characteristics. Separate multivariable logistic regression models were applied to identify predictors of non-remission (PHQ-9 ≥ 5) and non-response (< 50% reduction in PHQ-9) following intervention., Results: The rates of non-remission and non-response were 18.9% (n = 784) and 23.0% (n = 956), respectively. Comorbid anxiety symptoms (adjusted odds ratio [aOR] = 2.08, CI = 1.72-2.51; 1.28, 1.05-1.57), loneliness (2.00, 1.66-2.42; 1.67, 1.38-2.01), need for informal care (1.86, 1.49-2.33; 1.48, 1.18-1.85), lower cognitive capacity (0.95, 0.93-0.97; 0.94, 0.92-0.96), and absence of chronic pain (0.59, 0.48-0.72; 0.76, 0.64-0.91) predicted both non-remission and non-response. Meanwhile, moderate-to-severe depressive symptoms predicted higher odds of non-remission (1.41, 1.18-1.69) and lower odds of non-response (0.28, 0.23-0.34), respectively. Subgroup analyses conducted separately in older adults with mild and moderate-to-severe depressive symptoms at baseline revealed that comorbid anxiety, loneliness, need for informal care, and absence of chronic pain were consistent predictors of non-remission. Those with non-remission and non-response showed more depression-related functional impairments and poorer health-related quality of life post-intervention., Conclusions: Older adults with subclinical depressive symptoms showing comorbid anxiety, higher loneliness, need for informal care, and chronic pain may be offered more targeted interventions in future services. A personalised risk-stratification approach may be helpful., Trial Registration: ClinicalTrials.gov identifiers: NCT03593889 (registered 29 May 2018), NCT04863300 (registered 23 April 2021)., Competing Interests: Declarations. Ethics approval and consent to participate: This study was reviewed and approved by the Human Research Ethics Committee (HREC) of The University of Hong Kong (Phase I reference number: EA1709021; Phase II reference number: EA2003001). Written informed consent was obtained from all participants. All procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2000. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose of Review: Chronic rhinosinusitis (CRS) is a heterogenous disease with a significant impact on patient quality of life and a substantial economic burden. CRS is associated with several systemic inflammatory conditions. We provide an updated review of CRS comorbidities as a springboard for future comorbidity mapping and potential therapeutics., Recent Findings: The link between environmental allergies and CRS is most evident for central compartment atopic disease (CCAD) and allergic fungal rhinosinusitis (AFRS) subtypes but remains inconclusive for CRS overall. The association between asthma and CRS, reinforced by the unified airway theory, is evidenced by their response to similar biologic therapies. Another lower respiratory tract disease, COPD, has up to a 50% co-occurrence with CRS and warrants careful screening and treatment. Eosinophilic esophagitis and CRS share eosinophilic inflammation in different sites, meriting further research. Obesity not only presents physiological challenges but also correlates with a more severe subset of CRS. Diabetes mellitus is associated with CRSwNP, possibly secondary to therapeutics with steroids. Autoimmunity may contribute to nasal polyp formation through cytokines such as B-cell activating factor (BAFF), offering potential for future therapeutics.  This review illustrates the need to employ a macroscopic approach in clinical decision making and treatment of CRS. Comorbidities may contribute to an overall proinflammatory state, magnify severity of symptoms, be a source of treatment resistance, and even an opportunity for future therapeutics., Competing Interests: Declarations Competing Interests The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Polycystic ovary syndrome (PCOS) and endometriosis are widely recognized as significant risk factors affecting the reproductive health of women. The underlying mechanisms impacting fertility may vary, potentially leading to divergent outcomes. We aimed to examine and contrast the prevalence patterns of diseases coexisting with PCOS and endometriosis, using a large-scale nationwide insurance claims data from Asian women of reproductive age., Methods: We analyzed health insurance and examination data of 157,662 Korean women aged 15-45 years, drawn from the Korea National Health Insurance Service-National Sample Cohort database. International Classification of Disease, Tenth Revision codes were mapped to phenome-wide association study codes (phecodes). Subsequently, multivariate logistic regression was performed to assess the comorbidity patterns among patients diagnosed with PCOS and endometriosis and healthy control groups., Results: Our analysis revealed that PCOS was correlated with a wider range of metabolic disorders and symptoms, such as hyperlipidemia, type 2 diabetes, various gastrointestinal (GI) issues, and an array of pregnancy-related complications. Conversely, endometriosis was more prevalent among benign neoplasms of female reproductive and digestive organs, endometrial hyperplasia, and angina pectoris. Notably, infertility and glaucoma demonstrated significant associations with both conditions. Furthermore, a comparison of symptom-related codes in women with endometriosis revealed a predominance of pain-related symptoms, whereas those with PCOS exhibited a broader spectrum, encompassing pain, pruritus, GI problems, cough, fever, menstrual cycle disorders, edema, and dizziness., Conclusion: PCOS and endometriosis, which are prevalent gynecological disorders affecting similar age groups of women, rarely co-occur and exhibit unique comorbidity profiles. Tailored healthcare strategies that take into account these distinct patterns have the potential to enhance long-term healthcare outcomes of affected patients. Further research is required to elucidate the underlying mechanisms and contrasting comorbidity profiles between PCOS and endometriosis., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2024 The Korean Academy of Medical Sciences.)