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Key points: There is a lack of data on the self‐perceived burden (SPB) of terminal cancer patients at their very end of life.In this multicenter Korean study, terminal cancer patients perceived their burdensomeness from their family caregiver perspective.To relieve patients' SPB, physicians should pay attention to dyads with the features identified in this study. [ABSTRACT FROM AUTHOR]

Aim: The presence of periodontal disease (PD) at a single time point has been suggested as a predictor of diabetes risk, but whether changes in PD status are associated with altered risk of diabetes is yet to be reported on a population scale. This study investigated whether recovery from or development of PD in a population is associated with an altered risk of diabetes occurrence. Materials and Methods: Data of subjects who received health screening from 2002 to 2007 were obtained from the National Health Insurance Service–National Health Screening cohort database of Korea. Patients with a history of diabetes were excluded. Changes in PD status were determined from the first two health screenings. Study subjects were divided into four groups according to the changes in PD status: PD‐free, PD‐recovered, PD‐developed, and PD‐chronic. The outcome was the occurrence of diabetes. Results: Overall, 111,611 subjects were included for analysis. During a median follow‐up of 9.10 years, diabetes developed in 6102 subjects. The adjusted hazard ratios (HRs) for incident diabetes across various PD change groups (in reference to the PD‐free group) were as follows: PD‐chronic group = 1.096 (95% confidence interval [CI] 1.026–1.170, p =.006); PD‐developed group = 1.073 (95% CI 0.993–1.159, p =.075); and PD‐recovered group = 1.019 (95% CI 0.945–1.100, p =.622). The subjects who recovered from PD had a lower diabetes risk than those who had consistent PD (adjusted HR 0.930, 95% CI 0.865–1.000, p =.050), whereas those who developed PD had a higher risk of diabetes than those who remained PD‐free. Conclusion: The longitudinal change in PD status is associated with incident diabetes risk. Future intervention studies are necessary to determine whether PD treatment can prevent incident diabetes. [ABSTRACT FROM AUTHOR]

Background: Artificial hydration (AH) is a challenging issue in terminally ill patients with cancer, because it influences patients' symptoms control, quality of life, and quality of dying (QOD). To date, it is not clear how much AH supply is proper for imminently dying patients. This study aimed to investigate the association between the amount of AH and QOD. Methods: This study is part of the East Asian Collaborative Cross‐Cultural Study to Elucidate the Dying Process (EASED) conducted in Japan, Korea, and Taiwan from January 2017 to September 2018. Patients' demographics, symptoms, and managements on admission to palliative care units (PCUs) and before death were recorded. The AH amount was classified into different groups by 250‐mL intervals to compare their difference. The Good Death Scale (GDS) was used to measure QOD, with patients classified into higher or lower QOD groups using GDS = 12 as the cutoff point. We used logistic regression analysis to assess the association between AH amount and QOD. Results: In total, 1530 patients were included in the analysis. Country, religion, spiritual well‐being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with QOD. After conducting regression analysis, patients administered with 250 to 499 mL AH had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072‐4.730; P =.032) than those without AH. Conclusions: AH use impacts the QOD of terminally ill patients with cancer admitted to PCUs. Communication with patients and their families on appropriate AH use has a positive effect on QOD. Lay Summary: Our prospective cross‐cultural multicenter study aims to investigate the relationship between artificial hydration (AH) amount and quality of dying among terminally ill patients with cancer.The findings reveal that country, religion, spiritual well‐being, fatigue, delirium, dyspnea, AH, and antibiotics use before death were significantly associated with quality of death (QOD).After multivariable logistic regression, patients administered with AH amount 250 to 499 mL had significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072‐4.730; P =.032) than those without AH.Communication with patients and their families regarding AH is recommended as it may help them be better prepared for the end‐of‐life stage and achieve a good death. Artificial hydration (AH) use affects the quality of death (QOD) of terminally ill patients with cancer cared for in palliative care units. Patients administered 250 to 499 mL of AH have significantly better QOD (odds ratio, 2.251; 95% confidence interval, 1.072‐4.730; P =.032) than those without AH. [ABSTRACT FROM AUTHOR]

Background: The aim of this study is to examine whether oral hygiene and self-care, particularly in periodontal health, are associated with chronic obstructive pulmonary disease (COPD) in the Korean population.Methods: Data from the Korean National Health and Nutrition Examination Survey from 2010 to 2012 were used to assess the community periodontal index (CPI) of 5,878 participants (normal lung function: n = 5,181; obstructive spirometric pattern: n = 697) aged ≥40 years, who underwent spirometry.Results: Participants with COPD brushed their teeth less frequently and used the following less frequently: 1) dental floss and/or interdental brush; 2) mouthwash; and 3) electric toothbrush (P <0.001). Prevalence of periodontitis in patients with COPD (58.1%) was significantly higher than in those without COPD (34.0%, P <0.001). Number of teeth was significantly lower in patients with COPD compared with controls. Decayed-missing-filled tooth index was significantly lower in patients with COPD. This study shows risk of COPD by periodontal severity. Periodontitis (CPI 3 and 4) was associated in males with COPD after adjustment for: 1) age; 2) income; 3) education; 4) smoking; 5) alcohol consumption; 6) exercise; 7) body mass index; 8) toothbrushing frequency; 9) diabetes mellitus; and 10) number of teeth (CPI 3: relative risk [RR] = 1.38, 95% confidence interval [CI] = 1.12 to 2.05; CPI 4: RR = 1.23, 95% CI = 1.06 to 1.56).Conclusion: Findings of this cross-sectional study suggest that COPD in males may be associated with severe periodontitis and indicates the importance of promoting dental care in patients with COPD. [ABSTRACT FROM AUTHOR]

Background: Limited data are available on how the timing and setting of palliative care (PC) referral can affect end-of-life care. In this retrospective cohort study, the authors examined how the timing and setting of PC referral were associated with the quality of end-of-life care.Methods: All adult patients residing in the Houston area who died of advanced cancer between September 1, 2009 and February 28, 2010 and had a PC consultation were included. Data were retrieved on PC referral and quality of end-of-life care indicators.Results: Among 366 decedents, 120 (33%) had an early PC referral (>3 months before death), and 169 (46%) were first seen as outpatients. Earlier PC referral was associated with fewer emergency room visits (39% vs 68%; P<.001), fewer hospitalizations (48% vs 81%; P<.003), and fewer hospital deaths (17% vs 31%; P5.004) in the last 30 days of life. Similarly, outpatient PC referral was associated with fewer emergency room visits (48% vs 68%; P<.001), fewer hospital admissions (52% vs 86%; P<.001), fewer hospital deaths (18% vs 34%; P5.001), and fewer intensive care unit admissions (4% vs 14%; P5.001). In multivariate analysis, outpatient PC referral (odds ratio [OR], 0.42; 95% confidence interval [CI], 0.28-0.66; P<.001) was independently associated with less aggressive end-of-life care. Men (OR, 1.63; 95% CI, 1.06-2.50; P5.03) and hematologic malignancies (OR, 2.57; 95% CI, 1.18-5.59; P5.02) were associated with more aggressive end-of-life care.Conclusions: Patients who were referred to outpatient PC had improved end-of-life care compared with those who received inpatient PC. The current findings support the need to increase the availability of PC clinics and to streamline the process of early referral. [ABSTRACT FROM AUTHOR]