Search

Objective: To examine glucocorticoid‐sparing immunomodulatory medication use in youth with systemic lupus erythematosus (SLE) during their first year of care. Methods: We conducted a retrospective cohort study using administrative claims for 2000 to 2013 from Clinformatics DataMart for youth ages 10–24 years with an incident diagnosis of SLE (≥3 International Classification of Diseases, Ninth Revision codes for SLE [710.0], each >30 days apart). We determined the proportion of subjects filling a prescription for immunomodulatory medications within 12 months of the first SLE code (index date). We used multivariable regression to examine associations between demographic/disease factors and time to prescription fill in the first year, and also between prescription fill at any time after the index date. Results: We identified 532 youth with an incident SLE diagnosis, of which 413 (78%) had a glucocorticoid‐sparing immunomodulatory prescription fill in the first year. Prescriptions for hydroxychloroquine and immunosuppressants were filled in the first year by 366 youth (69%) and by 182 (34%), respectively. Those with adult‐onset (versus childhood‐onset) disease were less likely to fill an immunomodulatory medication by 12 months. No other statistically significant associations were found, although there was increasing likelihood of immunomodulatory medication fills with each subsequent calendar year. Conclusion: Among youth with newly diagnosed SLE, hydroxychloroquine use is prevalent although not universal, and prescription immunosuppressant use is notably low during the first year of care. Further research is needed to identify factors contributing to suboptimal immunomodulatory medication use during the first year of care. [ABSTRACT FROM AUTHOR]

Glucose metabolism disorders in adolescent patients have a diverse background. The most common cause is type 1 diabetes. Persistently elevated blood glucose initiates many processes that lead to blood vessel and nerve damage. Early detection and treatment of these abnormalities can help prevent the development of many complications. [ABSTRACT FROM AUTHOR]

Background: Although schools have been identified as significant settings in the response to the HIV/AIDS pandemic, limited research is available on how they can accommodate Youth Living with HIV/AIDS (YLWHA), especially in resource limited countries. In this study, we explored strategies by school stakeholders (school staff, parents/caretakers, and students) in western Uganda to care for and support YLWHA in their schools.Methods: The article utilizes data collected between May and October, 2019 from a qualitative inquiry based on focus group discussions and interviews with 88 school stakeholders purposively selected from 3 secondary schools in western Uganda. Textual data was analyzed thematically involving both inductive and deductive coding.Results: We identified 7 overarching interrelated themes in which participants reported strategies to care for and support YLWHA: counselling and guidance; social support networks and linkages; knowledge and skills; anti-stigma and anti-discrimination measures; disclosure of HIV status; treatment and management of HIV/AIDS; and affirmative actions for YLWHA. Stakeholders' strategies often differed regarding what was considered appropriate, the approach and who to take lead in supporting YLWHA.Conclusions: Despite the limited care and support strategies specific for YLWHA currently available in schools, our study points to optimism and high potential given stakeholders' identified avenues for improvement. We posit that promoting HIV/AIDS-care and support in schools is a gradual process requiring each school to develop a strong knowledge base about HIV/AIDS and support needs of YLWHA, develop a coherent and school-wide approach, and collaborate extensively with external stakeholders who are significant in supporting YLWHA. [ABSTRACT FROM AUTHOR]

Introduction: In pediatric patients with asthma, measurements of forced expiratory volume in 1 s (FEV1) may be normal or may not correlate with symptom severity. Forced expiratory flow at 25–75% of the vital capacity (FEF25–75%) is a potentially more sensitive parameter for assessing peripheral airway function. This post hoc analysis compared FEF25–75% with FEV1 as an endpoint to assess bronchodilator responsiveness in children with asthma. Methods: Change from baseline in trough FEF25–75% and trough FEV1 following treatment with either tiotropium (5 µg or 2.5 µg) or placebo Respimat® was analyzed in four phase III trials in children (aged 6–11 years) and adolescents (aged 12–17 years) with symptomatic moderate (VivaTinA-asthma® and PensieTinA-asthma®) and mild (CanoTinA-asthma® and RubaTinA-asthma®) asthma. Data from all treatment arms were pooled and correlations between FEF25–75% and FEV1 were calculated and analyzed. Results: A total of 1590 patients were included in the analysis. Tiotropium Respimat® consistently improved FEF25–75% and FEV1 versus placebo, although in adolescents with severe asthma, the observed improvements were not statistically significant. Improvements in FEF25–75% response with tiotropium versus placebo were largely more pronounced than improvements in FEV1. Statistical assessment of the correlation of FEV1 and FEF25–75% showed moderate-to-high correlations (Pearson's correlation coefficients 0.73–0.80). Conclusions: In pediatric patients, FEF25–75% may be a more sensitive measure to detect treatment response, certainly to tiotropium, than FEV1 and should be evaluated as an additional lung function measurement. [ABSTRACT FROM AUTHOR]

Background: Allergic diseases often occur in combination (multimorbidity). Human blood transcriptome studies have not addressed multimorbidity. Large‐scale gene expression data were combined to retrieve biomarkers and signaling pathways to disentangle allergic multimorbidity phenotypes. Methods: Integrated transcriptomic analysis was conducted in 1233 participants with a discovery phase using gene expression data (Human Transcriptome Array 2.0) from whole blood of 786 children from three European birth cohorts (MeDALL), and a replication phase using RNA Sequencing data from an independent cohort (EVA‐PR, n = 447). Allergic diseases (asthma, atopic dermatitis, rhinitis) were considered as single disease or multimorbidity (at least two diseases), and compared with no disease. Results: Fifty genes were differentially expressed in allergic diseases. Thirty‐two were not previously described in allergy. Eight genes were consistently overexpressed in all types of multimorbidity for asthma, dermatitis, and rhinitis (CLC, EMR4P, IL5RA, FRRS1, HRH4, SLC29A1, SIGLEC8, IL1RL1). All genes were replicated the in EVA‐PR cohort. RT‐qPCR validated the overexpression of selected genes. In MeDALL, 27 genes were differentially expressed in rhinitis alone, but none was significant for asthma or dermatitis alone. The multimorbidity signature was enriched in eosinophil‐associated immune response and signal transduction. Protein‐protein interaction network analysis identified IL5/JAK/STAT and IL33/ST2/IRAK/TRAF as key signaling pathways in multimorbid diseases. Synergistic effect of multimorbidity on gene expression levels was found. Conclusion: A signature of eight genes identifies multimorbidity for asthma, rhinitis, and dermatitis. Our results have clinical and mechanistic implications, and suggest that multimorbidity should be considered differently than allergic diseases occurring alone. [ABSTRACT FROM AUTHOR]

• The social patterning of the 5 inflammatory markers was heterogeneous. • Educational attainment was most strongly related to CRP and fibrinogen. • The social gradient for IL-6 was weaker compared to CRP and fibrinogen. • TNF-α and IL-1β were not socially patterned by educational attainment. • The social patterning of inflammatory biomarkers was variable by country. Evidence suggests that the inflammatory reaction, an adaptive response triggered by a variety of harmful stimuli and conditions involved in the risk and development of many chronic diseases, is a potential pathway through which the socioeconomic environment is biologically embedded. Difficulty in interpreting the role of the inflammatory system in the embodiment dynamic arises because of heterogeneity across studies that use a limited but varied number of inflammatory markers. There is no consensus in the literature as to which inflammatory markers beyond the C-reactive protein and to a lesser extent interleukin 6 are related to the social environment. Accordingly, we aimed to investigate the association between educational attainment, and several markers of inflammation – C-reactive protein, fibrinogen, interleukin 6, interleukin 1β and tumor necrosis factor α– in 6 European cohort studies. Up to 17,470 participants from six European cohort studies with data on educational attainment, health behaviors and lifestyle factors, and at least two different inflammatory markers. Four sub-datasets were drawn with varying numbers of participants to allow pairwise comparison of the social patterning of C-reactive protein and any other inflammatory markers. To evaluate within each sub-dataset the importance of the context and cohort specificities, linear regression-based analyses were performed separately for each cohort and combined in a random effect meta-analysis to determine the relationship between educational attainment and inflammation. We found that the magnitude of the relationship between educational attainment and five inflammatory biomarkers (C-reactive protein, fibrinogen, interleukin 6 and 1β and tumor necrosis factor α) was variable. By far the most socially patterned biomarker was C-reactive protein, followed by fibrinogen and to lesser extent interleukin 6, where a low educational attainment was associated with higher inflammation even after adjusting for health behaviours and body mass index. No association was found with interleukin 1β and tumor necrosis factor α. Our study suggests different educational patterning of inflammatory biomarkers. Further large-scale research is needed to explore social differences in the inflammatory cascade in greater detail and the extent to which these differences contribute to social inequalities in health. [ABSTRACT FROM AUTHOR]

Background: Depression in childhood frequently involves significant impairment, comorbidity, stress, and mental health problems within the family. Family-Focused Treatment for Childhood Depression (FFT-CD) is a 15-session developmentally-informed, evidence-based intervention targeting family interactions to enhance resiliency within the family system to improve and manage childhood depression.Methods: We present the conceptual framework underlying FFT-CD, the treatment development process, the intervention strategies, a case illustration, and efficacy data from a recent 2-site randomized clinical trial (N = 134) of 7-14 year old children randomly assigned to FFT-CD or individual supportive psychotherapy (IP) conditions.Results: Compared to children randomized to IP, those randomized to FFT-CD showed higher rates of depression response (≥50% Children's Depression Rating Scale-Revised reduction) across the course of acute treatment (77.7% vs. 59.9%, t = 1.97, p = .0498). The rate of improvement overall leveled off following treatment with a high rate of recovery from index depressive episodes in both groups (estimated 76% FFT-CD, 77% IP), and there was an attenuation of observed group differences. By final follow-up (9 months post-treatment), one FFT-CD child and six IP children had suffered depressive recurrences, and four IP children attempted suicide.Limitations: Without a no treatment control group it is not possible to disentangle the impact of the interventions from time alone.Conclusions: While seldom evaluated, family interventions may be particularly appropriate for childhood depression. FFT-CD has demonstrated efficacy compared to individual supportive therapy. However, findings underscore the need for an extended/chronic disease model to enhance outcomes and reduce risk over time. [ABSTRACT FROM AUTHOR]

Background: Dietary patterns were associated with the risk of chronic disease development and outcome-related diseases. In this study, we aimed to compare the correlation between dietary patterns and metabolic syndrome (MetS) using two methods for identifying dietary patterns.Methods: The participants (n = 25,569) aged ≥40 years with impaired kidney function were retrieved from Mei Jau (MJ) Health Screening database from 2008 to 2010. Dietary patterns were identified by principal component analysis (PCA) and reduced rank regression (RRR) from twenty-two food groups using PROC FACTOR and PROC PLS functions.Results: We identified two similar dietary pattern characteristics (high intakes of deep fried foods, preserved or processed foods, dipping sauce, meat, sugary drinks, organ meats, jam/honey, fried rice/flour products, instant noodles and eggs) derived by PCA and RRR. Logistic regression analysis revealed that RRR-derived dietary pattern scores were positively associated with an odds ratio (OR = 1.70, 95% CI: 1.56, 1.86) of having MetS than PCA-derived dietary pattern scores (OR = 1.38, 95% CI: 1.27, 1.51). The correlations between RRR-derived dietary pattern scores and elevated systolic and diastolic blood pressure (OR = 1.30 for both) or low high density lipoprotein cholesterol in women (OR = 1.32) were statistically significant but not significant in PCA-derived dietary pattern scores.Conclusions: Our findings suggest that RRR gives better results when studying behavior related dietary patterns in association with MetS. RRR may be more preferable to provide dietary information for developing dietary guidelines among people with MetS. Further studies with prospective measurements are needed to verify whether RRR is a useful analytic tool for the association between dietary patterns and other chronic diseases. [ABSTRACT FROM AUTHOR]

Background: Stroke rates and risk factors may change as percutaneous coronary intervention practice evolves and no data are available comparing stroke incidence after percutaneous coronary intervention to the general population. Aims: This study aimed to identify the incidence and risk factors for inpatient and subsequent stroke following percutaneous coronary intervention with comparison to age-matched controls. Methods: Data were prospectively collected from 22,618 patients undergoing percutaneous coronary intervention in the Melbourne Interventional Group registry (2005–2015). The cohort was compared to the North-East Melbourne Stroke Incidence Study population-based cohort (1997–1999) and predefined variables assessed for association with inpatient or outpatient stroke. Results: Inpatient stroke occurred in 0.33% (65.3% ischemic, 28.0% haemorrhagic, and 6.7% cause unknown), while outpatient stroke occurred in 0.55%. Inpatient and outpatient stroke were associated with higher rates of in-hospital major adverse cardiovascular outcomes (p < 0.0001) and mortality (p < 0.0001), as well as 12-month mortality (p < 0.0001). Factors independently associated with inpatient stroke were renal impairment, ST-elevation myocardial infarction, previous stroke, left ventricular ejection fraction 30–45%, and female sex, while those associated with outpatient stroke were previous stroke, chronic lung disease, previous myocardial infarction, rheumatoid arthritis, female sex, and older age. Compared to the age-standardized population-based cohort, stroke rates in the 12 months following discharge were higher for percutaneous coronary intervention patients <65 years old, but lower for percutaneous coronary intervention patients ≥65 years old. Conclusions: Risk of inpatient stroke following percutaneous coronary intervention appears to be largely associated with clinical status at presentation, while outpatient stroke relates more to age and chronic disease. Compared to the general population, outpatient stroke rates following percutaneous coronary intervention are higher for younger, but not older, patients. [ABSTRACT FROM AUTHOR]

Background: Patients with severe, uncontrolled asthma have a significant unmet need for new treatments that have broader effects on airway inflammation, and that provide greater improvements in asthma outcomes than currently approved biologics and standard-of-care therapies. Tezepelumab is a human monoclonal antibody that blocks the activity of the epithelial cytokine thymic stromal lymphopoietin. In the PATHWAY phase 2b study (NCT02054130), tezepelumab significantly reduced exacerbations by up to 71% in adults with severe, uncontrolled asthma, irrespective of baseline disease phenotype. This article reports the design and objectives of the pivotal phase 3 NAVIGATOR study.Methods: NAVIGATOR (NCT03347279) is an ongoing randomized, double-blind, placebo-controlled trial in adults (18-80 years old) and adolescents (12-17 years old) with severe, uncontrolled asthma, who are receiving treatment with medium- or high-dose inhaled corticosteroids plus at least one additional controller medication with or without oral corticosteroids (N = 1061). The study population includes approximately equal proportions of patients with high (≥ 300 cells/μL) and low (< 300 cells/μL) blood eosinophil counts. The study comprises a 5-6-week screening period, a 52-week treatment period and a 12-week post-treatment follow-up period. All patients will receive their prescribed controller medications without change throughout the study. The primary efficacy endpoint is the annualized asthma exacerbation rate during the 52-week treatment period. Key secondary endpoints include the effect of tezepelumab on lung function, asthma control and health-related quality of life.Discussion: NAVIGATOR is evaluating the effect of tezepelumab in patients with a broad range of severe asthma phenotypes at baseline, including those with low blood eosinophil counts. The target sample size for NAVIGATOR (N = 1060) was achieved, and it is the largest clinical study of tezepelumab in severe, uncontrolled asthma to date. NAVIGATOR aims to further investigate the effect of tezepelumab on exacerbations and build on observations from the phase 2b PATHWAY study, and to demonstrate further the potential of tezepelumab to provide patients with severe, uncontrolled asthma with improvements in lung function, asthma control and health-related quality of life.Trial Registration: NCT03347279 (ClinicalTrials.gov). Registered 20 November 2017. [ABSTRACT FROM AUTHOR]

Summary: Lifestyle is fundamental in chronic disease prevention and management, and it has been recommended as a first‐line treatment in the Australian polycystic ovary syndrome (PCOS) guideline 2011. The first international evidence‐based guideline on PCOS was developed in 2018, which expanded the scope and evidence in the Australian guideline. This paper summarizes the lifestyle recommendations and evidence summaries from the guideline. International multidisciplinary guideline development groups delivered the International Evidence‐based Guideline for the Assessment and Management of Polycystic Ovary Syndrome 2018. The process followed the Appraisal of Guidelines for Research and Evaluation II and The Grading of Recommendations, Assessment, Development and Evaluation framework. Extensive communication and meetings addressed six prioritized clinical questions through five reviews. Evidence‐based recommendations were formulated before consensus voting within the panel. Evidence shows the benefits of multicomponent lifestyle intervention, efficacy of exercise and weight gain prevention with no specific diet recommended. Lifestyle management is the first‐line management in the intervention hierarchy in PCOS. Multicomponent lifestyle intervention including diet, exercise and behavioural strategies is central to PCOS management with a focus on weight and healthy lifestyle behaviours. The translation programme optimizes reach and dissemination for health professionals and consumers. [ABSTRACT FROM AUTHOR]

Congenital heart defects (CHD) represent a growing burden of illness among adults. We estimated the lifetime health, education, labor, and social outcomes of adults with CHD in the USA using the Future Adult Model, a dynamic microsimulation model that has been used to study the lifetime impacts of a variety of chronic diseases. We simulated a cohort of adult heads of households > 25 years old derived from the Panel Survey of Income Dynamics who reported a childhood heart problem as a proxy for CHD and calculated life expectancy, disability-free and quality-adjusted life years, lifetime earnings, education attainment, employment, development of chronic disease, medical spending, and disability insurance claiming status. Total burden of disease was estimated by comparing to a healthy cohort with no childhood heart problem. Eighty-seven individuals reporting a childhood heart problem were identified from the PSID and were used to generate the synthetic cohort simulated in the model. Life expectancy, disability-free, quality-adjusted, and discounted quality-adjusted life years were an average 4.6, 6.7, 5.3, and 1.4 years lower than in healthy adults. Lung disease, cancer, and severe mental distress were more common compared to healthy individuals. The CHD cohort earned $237,800 less in lifetime earnings and incurred higher average total medical spend by $66,600 compared to healthy individuals. Compared to healthy adults, the total burden of CHD is over $500K per adult. Despite being among the healthiest adults with CHD, there are significant decrements in life expectancy, employment, and lifetime earnings, with concomitant increases in medical spend. [ABSTRACT FROM AUTHOR]

Summary: This study aims to examine the trend in the diagnosis of obesity and the use of surgical treatment in in‐patient settings as well as per person and national costs associated with the surgical treatment of obesity. We conducted cross‐sectional and trend analyses of in‐patient obesity diagnosis and surgical treatment for obesity using data from the National Inpatient Sample (2011‐2014) of adult patients in the United States aged 18 years and older. We studied the rate of in‐patient obesity diagnosis among hospitalized patients, the rate of bariatric surgery among patients diagnosed with obesity in the hospital, and the costs associated with surgical treatment. Trend analyses showed a statistically significant increase in the proportion of (a) hospitalized patients diagnosed with obesity, and (b) bariatric surgery among those diagnosed with obesity and among different socio‐demographic and insurance groups. Despite the increase in the national in‐patient cost, the average in‐patient cost per hospitalization associated with bariatric surgery decreased from 2012 to 2014. With the increase in the rate of diagnosed obesity and bariatric surgery among hospitalized patients and the decrease in the average in‐patient cost, future research should address the short‐ and long‐term cost‐effectiveness of bariatric surgery on chronic diseases. [ABSTRACT FROM AUTHOR]

Objective: This study aims to investigate the psychiatric disorders in children with parental multiple sclerosis (MS) and to research the differences between without parental chronic disease. Methods: The children of the parents with MS diagnosis in the neurology department and the children of parents without chronic medical and psychiatric diseases were included in the study. Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children Present and Lifetime Version (K-SADS-PL) was applied to the children. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinical Version (SCID-I-CV) was applied to parents with MS. Psychiatric characteristics of the parents and children were determined. The accompanying psychiatric disorders in children and adolescents with paternal MS and the clinical features affecting these disorders were analyzed. Results: Fifty children and adolescents with parental MS were included in the study group and 75 children and adolescents without a chronic disease in the parents were included in the control group. The mean age of children in the study group was 12.7±2.9 years and 58% were girls. 52% of the parents with MS were diagnosed with a psychiatric disorder. As a result of the evaluation, 54% of the children with parental MS were diagnosed with psychiatric disorder. The most common psychiatric diagnoses were anxiety disorders (30%), attention deficit and hyperactivity disorder (ADHD) (22%), and tic disorders (16%), respectively. The Expanded Disability Status Scale scores of the parents of children with psychiatric diagnoses were significantly higher than those of the children with no diagnosis. Conclusion: Children of MS patients have a high rate of psychiatric disorder. As the severity of MS increases, it is more common for children to be affected psychosocially. Children with parental MS should be follow-up for psychiatric disorders, especially for anxiety disorders and ADHD. [ABSTRACT FROM AUTHOR]

Background: The prevalence and incidence of youth‐onset nonalcoholic fatty liver disease (NAFLD) far exceeds other paediatric chronic liver diseases and represents a considerable public health issue globally. Methods: Here, we performed a narrative review of current knowledge regarding the epidemiology of paediatric NAFLD, selected concepts in pathogenesis, comorbidities, diagnosis, and management, and issues related to the transition to adulthood. Results: Paediatric NAFLD has become increasingly more prevalent, especially in certain subgroups, such as children with obesity and certain races/ethnicities. The pathophysiology of paediatric NAFLD is complex and multifactorial, driven by an interaction of environmental and genetic factors. Once developed, NAFLD in childhood is associated with type 2 diabetes, hypertension, increased cardiovascular disease risk, and end‐stage liver disease. This predicts an increased burden of morbidity and mortality in adolescents and young adults. Early screening and diagnosis are therefore crucial, and the development of noninvasive biomarkers remains an active area of investigation. Currently, treatment strategies are focused on lifestyle changes, but there is also research interest in pharmacological and surgical options. In the transition from paediatric to adult care, there are several potential challenges/barriers to treatment and research is needed to understand how best to support patients during this time. Conclusions: Our understanding of the epidemiology and pathophysiology of paediatric NAFLD has increased considerably over recent decades, but several critical knowledge gaps remain and must be addressed in order to better mitigate the short‐term and long‐term risks of youth‐onset NAFLD. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether activity-monitors and machine learning models could provide accurate information about physical activity performed by children and adolescents with cerebral palsy (CP) who use mobility aids for ambulation.Method: Eleven participants (mean age 11y [SD 3y]; six females, five males) classified in Gross Motor Function Classification System (GMFCS) levels III and IV, completed six physical activity trials wearing a tri-axial accelerometer on the wrist, hip, and thigh. Trials included supine rest, upper-limb task, walking, wheelchair propulsion, and cycling. Three supervised learning algorithms (decision tree, support vector machine [SVM], random forest) were trained on features in the raw-acceleration signal. Model-performance was evaluated using leave-one-subject-out cross-validation accuracy.Results: Cross-validation accuracy for the single-placement models ranged from 59% to 79%, with the best performance achieved by the random forest wrist model (79%). Combining features from two or more accelerometer placements significantly improved classification accuracy. The random forest wrist and hip model achieved an overall accuracy of 92%, while the SVM wrist, hip, and thigh model achieved an overall accuracy of 90%.Interpretation: Models trained on features in the raw-acceleration signal may provide accurate recognition of clinically relevant physical activity behaviours in children and adolescents with CP who use mobility aids for ambulation in a controlled setting.What This Paper Adds: Machine learning may assist clinicians in evaluating the efficacy of surgical and therapy-based interventions. Machine learning may help researchers better understand the short- and long-term benefits of physical activity for children with more severe motor impairments. [ABSTRACT FROM AUTHOR]

Background: Previous studies have showed the independent associations between screen time, physical activity (PA), sleep duration, and depressive symptoms, but little is known about the influence of lifestyles on depressive symptoms. This study aimed to identify clustering patterns of health-related behavior in Chinese adolescents and their association with depressive symptoms.Methods: The sample consisted of 4178 adolescent students. Screen time, physical activity, and sleep time were self-reported. The level of depressive symptoms was measured using the Center for Epidemiologic Studies Depression Scale. A two-step cluster analysis was conducted to identify lifestyle patterns. Univariate and multivariate logistic regression were used to examine the associations between clusters and depressive symptoms.Results: About 28.1% of participants reported depressive symptoms. Four lifestyle clusters were identified: (1) active pattern (n = 865 [20.7%]); (2) high sleep duration pattern (n = 1263 [30.2%]); (3) high screen time pattern (n = 665 [15.9%]); and (4) low physical activity-low sleep duration pattern (n = 1385[33.1%]). Cluster 1 and 2 were relatively healthy groups. Cluster 3 and 4 were at a higher risk of developing depressive symptoms than cluster 1.Limitations: This was a cross-sectional study, and causal relations could not be identified. Self-reported questionnaire instruments were used to collect data, which might have led to some recall bias.Conclusions: Clusters of lifestyle behaviors were identified, and differences in depressive symptoms were found among clusters. Public mental illness prevention strategies should expand their capacity to focus on lifestyle patterns. [ABSTRACT FROM AUTHOR]

• ICHRON predicted a 3-year chronic disease among an Australian validation cohort. • ICHRON is valuable for primary care patients in distinct locales. • ICHRON was found to be more predictive among Aboriginal and Torres Islanders. • ICHRON can be calculated within the EHR using standardized laboratory parameters. The Intermountain Chronic Disease Risk Score (ICHRON) is a primary prevention risk prediction tool that uses commonly ordered blood tests and is designed to be calculated by the electronic health record. ICHRON was highly predictive of 3-year chronic disease (ChrD) diagnosis in an internal validation; however, external validation is needed. ICHRON was calculated among patients from a region of Australia using sex-specific weightings of age and components of the comprehensive metabolic panel and the complete blood count. Original ICHRON weightings and risk stratification thresholds from the US-based derivation at Intermountain Healthcare were used. ICHRON was evaluated as a predictor of an incident 3-year ChrD diagnosis (coronary artery disease, myocardial infarction, heart failure, atrial fibrillation, stroke, dementia, diabetes, renal failure, chronic obstructive pulmonary disease, and peripheral vascular disease). A total 5,512 females (49.6 ± 19.2) and 3,461 males (53.0 ± 18.6) were studied. Among females, 50.3%, 33.7% and 16.0% were low, moderate, and high-risk, respectively; and for males, 39.6%, 35.0%, and 25.4%. Frequency of a 3-year ChrD diagnosis among females was 2.2%, 8.5%, and 15.9% for low, moderate, and high-risk groups, respectively, and 4.7%, 9.7%, and 20.0% among males. C-statistics were 0.726 (0.700, 0.752) for females and 0.694 (0.665, 0.724) for males. ICHRON predicted ChrD diagnosis at 3-years among an external, geographically distant validation cohort. These findings show the value of ICHRON for primary care patients in distinct locales. Additionally, electronic calculation of ICHRON empowers the clinical use of this tool to identify and differentially manage and treat high-risk patients. [ABSTRACT FROM AUTHOR]

Cardiorespiratory fitness (CRF) is now established as a vital sign. Cardiopulmonary exercise testing (CPX) is the gold-standard approach to assessing CRF. A body of literature spanning several decades clearly supports the clinical utility of CPX in those who are apparently health and at risk for chronic disease as well as numerous patient populations. While CPX, in and of itself, is a valid and reliable clinical assessment, combining findings with other available assessments may provide a more comprehensive perspective that enhances clinical decision making and outcomes. The current review will accomplish the following: (1) define key CPX measures based upon current evidence; and (2) describe the current evidence addressing the relationships between CPX and echocardiography, serum biomarkers, and cardiovascular magnetic resonance. Cardiopulmonary exercise testing provides prognostic and diagnostic information in apparently healthy individuals, those at risk for one or more chronic conditions, as well as numerous patient populations. Moreover, if the goal of an intervention is to improve one or more systems integral to the physiologic response to exercise, CPX should be considered as a central assessment to gauge therapeutic efficacy. To further refine the information obtained from CPX, combining other assessments has demonstrated promise. [ABSTRACT FROM AUTHOR]

The article offers information on the tobacco use which is the leading cause of preventable death in the United States. Topics include tobacco use via electronic cigarettes (e-cigarettes) is quickly rising; e-cigarette use by youth has been tracked in the National Youth Tobacco Survey; and e-Cigarette products usually contain nicotine, which is addictive, raising concerns about e-cigarette use and nicotine addiction in children.

Background: Studies have indicated variability around prevalence estimates of multimorbidity due to poor consensus regarding its definition and measurement. Medication-based measures of morbidity may be valuable resources in the primary-care setting where access to medical data can be limited. We compare the agreement between patient self-reported and medication-based morbidity; and examine potential patient-level predictors of discordance between these two measures of morbidity in an older (≥ 50 years) community-based population.Methods: A retrospective cohort study was performed using national pharmacy claims data linked to The Irish LongituDinal study on Ageing (TILDA). Morbidity was measured by patient self-report (TILDA) and two medication-based measures, the Rx-Risk (< 65 years) and Rx-Risk-V (≥65 years), which classify drug claims into chronic disease classes. The kappa statistic measured agreement between self-reported and medication-based morbidity at the individual patient-level. Multivariate logistic regression was used to examine patient-level characteristics associated with discordance between measures of morbidity.Results: Two thousand nine hundred twenty-five patients were included (< 65 years: N = 1095, 37.44%; and ≥ 65 years: N = 1830 62.56%). Hypertension and high cholesterol were the most prevalent self-reported morbidities in both age cohorts. Agreement was good or very good (κ = 0.61-0.81) for diabetes, osteoporosis and glaucoma; and moderate for high cholesterol, asthma, Parkinson's and angina (κ = 0.44-0.56). All other conditions had fair or poor agreement. Age, gender, marital status, education, poor-delayed recall, depression and polypharmacy were significantly associated with discordance between morbidity measures.Conclusions: Most conditions achieved only moderate or fair agreement between self-reported and medication-based morbidity. In order to improve the accuracy in prevalence estimates of multimorbidity, multiple measures of multimorbidity may be necessary. Future research should update the current Rx-Risk algorithms in-line with current treatment guidelines, and re-assess the feasibility of using these indices alone, or in combination with other methods, to yield more accurate estimates of multimorbidity. [ABSTRACT FROM AUTHOR]

Background: The emergence of COVID‐19 global pandemic coupled with high transmission rate and mortality has created an unprecedented state of emergency worldwide. This global situation may have a negative impact on the psychological well‐being of individuals which in turn impacts individuals' performance. This study aims to explore the prevalence of depression and anxiety among the GP, HCPs, and USs during COVID‐19 outbreak, and to identify key population(s) who might need psychological intervention. Methods: A cross‐sectional study using an online survey was conducted in Jordan between 22 and 28 March 2020 to explore the mental health status (depression and anxiety) of the general population, healthcare professionals, and university students during the COVID‐19 outbreak. The Patient Health Questionnaire (PHQ‐9) and Generalized Anxiety Disorder‐7 (GAD‐7) were used to assess depression and anxiety among the study participants. Logistic regression analysis was used to identify predictors of depression and anxiety. Results: The prevalence of depression and anxiety among the entire study participants was 23.8% and 13.1%, respectively. Anxiety was most prevalent across university students 21.5%, followed by healthcare professionals 11.3%, and general population 8.8%. Females among healthcare professionals and university students, divorced healthcare professionals, pulmonologists, and university students with history of chronic disease were at higher risk of developing depression. Females, divorced participants among the general population, and university students with history of chronic disease and those with high income (≥1,500 JD) were at higher risk of developing anxiety. Conclusions: During outbreaks, individuals are put under extreme stressful condition resulting in higher risk of developing anxiety and depression particularly for students and healthcare professionals. Policymakers and mental healthcare providers are advised to provide further mental support to these vulnerable groups during this pandemic. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has shattered the meticulously developed processes by which we delivered quality care for patients with cirrhosis. Care has been transformed by the crisis, but enduring lessons have been learned. In this article, we review how COVID-19 will impact cirrhosis care. We describe how this impact unfolds over 3 waves; i) an intense period with prioritized high-acuity care with delayed elective procedures and routine care during physical distancing, ii) a challenging 'return to normal' following the end of physical distancing, with increased emergent decompensations, morbidity, and systems of care overwhelmed by the backlog of deferred care, and iii) a protracted period of suboptimal outcomes characterized by missed diagnoses, progressive disease and loss to follow-up. We outline the concrete steps required to preserve the quality of care provided to patients with cirrhosis. This includes an intensification of the preventative care provided to patients with compensated cirrhosis, proactive chronic disease management, robust telehealth programs, and a reorganization of care delivery to provide a full service of care with flexible clinical staffing. Managing the pandemic of a serious chronic disease in the midst of a global infectious pandemic is challenging. It is incumbent upon the entire healthcare establishment to be strong enough to weather the storm. Change is needed. [ABSTRACT FROM AUTHOR]

Objectives: Acute respiratory failure is a common reason for admission to PICUs. Short- and long-term effects on pulmonary health in previously healthy children after acute respiratory failure requiring mechanical ventilation are unknown. The aim was to determine if clinical course or characteristics of mechanical ventilation predict persistent respiratory morbidity at follow-up.Design: Prospective cohort study with follow-up questionnaires at 6 and 12 months.Setting: Ten U.S. PICUs.Patients: Two-hundred fifty-five children were included in analysis after exclusion for underlying chronic disease or incomplete data. One-hundred fifty-eight and 130 children had follow-up data at 6 and 12 months, respectively.Interventions: None.Measurements and Main Results: Pulmonary dysfunction at discharge a priori defined as one of: mechanical ventilation, supplemental oxygen, bronchodilators or steroids at 28 days or discharge. Persistent respiratory morbidity a priori defined as a respiratory PedsQL, a pediatric quality of life measure, greater than or equal to 5 or asthma diagnosis, bronchodilator or inhaled steroids, or unscheduled clinical evaluation for respiratory symptoms. Multivariate backward stepwise regression using Akaike information criterion minimization determined independent predictors of these outcomes. Pulmonary dysfunction at discharge was present in 34% of patients. Positive bacterial respiratory culture predicted pulmonary dysfunction at discharge (odds ratio, 4.38; 95% CI, 1.66-11.56). At 6- and 12-month follow-up 42% and 44% of responders, respectively, had persistent respiratory morbidity. Pulmonary dysfunction at discharge was associated with persistent respiratory morbidity at 6 months, and persistent respiratory morbidity at 6 months was strongly predictive of 12-month persistent respiratory morbidity (odds ratio, 18.58; 95% CI, 6.68-52.67). Positive bacterial respiratory culture remained predictive of persistent respiratory morbidity in patients at both follow-up points.Conclusions: Persistent respiratory morbidity develops in up to potentially 44% of previously healthy children less than or equal to 24 months old at follow-up after acute respiratory failure requiring mechanical ventilation. This is the first study, to our knowledge, to suggest a prevalence of persistent respiratory morbidity and the association between positive bacterial respiratory culture and pulmonary morbidity in a population of only previously healthy children with acute respiratory failure. [ABSTRACT FROM AUTHOR]

Background/Aim. Asthma is the most common chronic disease in children and adolescents and has shown an apparent increase in incidence in recent years. The first purpose of the study was to evaluate the influence of education about proper use of inhalers on quality of life in children with asthma. Secondly, we aimed to understand which aspects of quality of life in children with asthma can be significantly improved after education and to identify factors that may affect the level of that improvement. Methods. In this prospective, before-and-after interventional study, a total of 147 children with asthma were enrolled. The Pediatric Asthma Quality of Life Questionnaire (PAQLQ) was used to measure the functional problems that are most troublesome to children with asthma. We used the Asthma Control Test (ACT), based on a series of question about symptoms and daily functioning, to identify patients with poorly controlled asthma. Forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were also determined. Trained educators estimated patients' inhaler technique and collected questionnaire information. Results. Multivariate analysis of covariance indicated significant differences between PAQLQ and ACT scores which all were significantly higher after education about proper use of inhalers (p < 0.001). A number of children demonstrating a correct inhalation technique improved from 28 (19%) to 127 (86.4%) (p < 0.001). Asthma severity accounted for the largest proportion of variability PAQLQ and ACT scores (38.4%). Conclusion. Inhaler technique improvement contributes to better asthma control in children with asthma rather than to their quality of life. Asthma severity proved to be a major contributor to variations in PAQLQ and ACT scores and significant obstacle for quality of life improvement in children with asthma. [ABSTRACT FROM AUTHOR]

Purpose: The COVID-19 epidemic has caused difficulties in continuous treatment for patients with chronic diseases and resulted in nonadherence to treatment and adverse health outcomes. This study aimed to investigate the associations of nonadherence to treatment with patient-reported outcomes of psoriasis during the COVID-2019 epidemic. Methods: A cross-sectional study among Chinese patients with psoriasis was conducted through a web-based questionnaire survey during 25 Feb 2020 and 6 Mar 2020. Demographic and clinical data, nonadherence to treatment, and patient-reported outcomes were collected. The outcomes included deterioration of the disease condition, perceived stress, and symptoms of anxiety and depression. Logistic regression was used to investigate the associations. Results: A total of 926 questionnaires were collected. A total of 634 (68.5%) reported nonadherence to treatment, and worse adherence was found among patients receiving systemic treatment (adjusted odds ratio [AOR]: 2.67; 95% CI: 1.40– 5.10) and topical treatment (AOR: 4.51; 95% CI: 2.66– 7.65) compared to biological treatment. Nonadherence to treatment (less than two weeks and more than two weeks) was significantly associated with deterioration of psoriasis (aOR: 2.83 to 5.25), perceived stress (AOR: 1.86 to 1.57), and symptoms of anxiety (AOR: 1.42 to 1.57) and depression (AORs: 1.78). Subgroup analysis by treatment showed consistent results in general. Conclusion: Nonadherence to treatment was associated with the aggravation of psoriasis conditions, perceived stress, and symptoms of anxiety and depression. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the attitude of adolescents with chronic diseases toward social media exposure, focusing in particular on Facebook.Design: Cross-sectional study.Setting: An anonymous semistructured survey was distributed to an Italian hospital-based cohort of adolescents with chronic disease to explore the role of Facebook in their daily life.Patients: We recruited 212 adolescents (aged between 13 and 24 years) with a diagnosis of inflammatory bowel disease, coeliac disease, diabetes mellitus type 1 and cystic fibrosis.Results: Two hundred and seven of the 212 (97.6%) expressed the need of sharing their illness experience with friends, 201 out of 212 (94.8%) usually searched information on the internet to find new therapies and to discover their prognosis. One hundred and forty-nine out of 212 adolescents (70.3%) perceived dependence on their parents as the most negative aspect of having a chronic disease, and 200 out of 212 (94.3%) were looking for friends with the same disease on Facebook. Two hundred and ten out of 212 (99.1%) did not want their doctors or nurse on their social media platforms. During the active disease periods, the time spent with social media increased from an average of 5 to 11 hours.Conclusions: This descriptive analysis focused on the Facebook impact on chronic disease perception among affected adolescents. It showed that they used to spend an increased amount of time on this platform during disease flare-up and highlighted their wish of keeping doctors and nurses away from their social dimension. [ABSTRACT FROM AUTHOR]

As the COVID‐19 pandemic continues to claim lives across the globe, insufficient data exists regarding the optimal treatment. It is well known that patients 55 years of age or older and patients with certain chronic diseases are at higher risk of severe illness, including acute respiratory distress syndrome and death. A potentially fatal pulmonary complication of sickle cell disease, acute chest syndrome, can be precipitated by acute infections, including respiratory viruses. We report the case of a patient with sickle cell disease (HbSC) who developed COVID‐19 pneumonia and acute chest syndrome who was treated with emergent red blood cell exchange in order to avoid endotracheal intubation. [ABSTRACT FROM AUTHOR]

Background: To establish a system for assessing pre-chronic disease status (PCDS) whereby changes in biomolecule levels occur before the appearance of physical damage to body organs. We based our study on the common biomarkers of aging, disease and end-of-life processes.Methods: The red blood cell count as well as levels of albumin, creatinine and aspartate aminotransferase were used as indicators for measurement. The basic premise for determining PCDS was that the measured value was outside the reference range for a healthy individual. A binary outcome was determined according to reference range given by the laboratory undertaking the measurements. The Biological Age Index (BAI) was used to ascertain PCDS.Results: The four indictors that we chose were sensitive for end-of-life and aging. The BAI score for each age group increased significantly with increasing age. The BAI score of patients with cardiac disease, cerebrovascular disease, cancer or chronic obstructive pulmonary disease were mostly higher than those in healthy age-matched people.Conclusion: A system for assessing PCDS centered on biomolecular detection and independent of the pathologic diagnosis could be effective. [ABSTRACT FROM AUTHOR]

Optimal health benefits from exercise are achieved by meeting both aerobic and muscle strengthening guidelines, however, most older adults (OAs) do not exercise and the majority of those who do only perform one type of exercise. A pragmatic solution to this problem may be emphasizing a single exercise strategy that maximizes health benefits. The loss of muscle mass and strength at an accelerated rate are hallmarks of aging that, without intervention, eventually lead to physical disability and loss of independence. Additionally, OAs are at risk of developing several chronic diseases. As such, participating in activities that can maintain or increase muscle mass and strength, as well as decrease chronic disease risk, is essential for healthy aging. Unfortunately, there is a widely held belief that adaptations to aerobic and resistance exercise are independent of each other, requiring the participation of both types of exercise to achieve optimal health. However, we argue that this assertion is incorrect, and we discuss crossover adaptations of both aerobic and resistance exercise. Aerobic exercise can increase muscle mass and strength, though not consistently and may be limited to exercise that overloads a particular muscle group, such as stationary bicycling. In contrast, resistance exercise is effective at maintaining muscle health with increasing age, and also has significant effects on cardiovascular disease (CVD) risk factors, type 2 diabetes (T2D), cancer, and mortality. We posit that resistance exercise is the most effective standalone exercise strategy for improving overall health in OAs and should be emphasized in future guidelines. [ABSTRACT FROM AUTHOR]

While the world is facing an unprecedented pandemic with COVID‐19, patients with chronic diseases need special attention and if warranted adaptation of their regular treatment plan. In children, allergy and asthma are among the most prevalent non‐communicable chronic diseases, and healthcare providers taking care of these patients need guidance. At the current stage of knowledge, children have less severe symptoms of COVID‐19, and severe asthma and immunodeficiency are classified as risk factors. In addition, there is no evidence that currently available asthma and allergy treatments, including antihistamines, corticosteroids, and bronchodilators, increase the risk of severe disease from COVID‐19. Most countries affected by COVID‐19 have opted for nationwide confinement, which means that communication with the primary clinician is often performed by telemedicine. Optimal disease control of allergic, asthmatic, and immunodeficient children should be sought according to usual treatment guidelines. This statement of the EAACI Section on Pediatrics puts forward six recommendations for the management of childhood allergies and immunodeficiencies based on six underlying facts and existing evidence. [ABSTRACT FROM AUTHOR]

The situation and challenges of young people with depression in the urban African context of Soweto, Johannesburg, South Africa, are investigated from a pastoral care perspective. Depression is one of the more prevalent mental disorders. In African contexts it is often equated with demon possession. The aim of this article is to investigate the interplay between Western understandings of depression and African perspectives, and to come to a deeper understanding of the way in which support and healing are approached in this context. The article investigates the ways in which young South Africans in Soweto, their families and faith communities cope with and understand 'depression' on the one hand, and the culturally related phenomenon of 'demon possession' on the other. The article proposes a collaborative method of providing support which requires the cooperation of psychologists, psychiatrists, social workers, African spiritual healers and pastoral caregivers. Contribution: The article contributes to an understanding of the experience of depression among young people in a context where both Western psychological ideas and African cultural and religious beliefs with regard to demon possession, play a role. Professionals from the various relevant fields should collaborate in order to provide effective support. [ABSTRACT FROM AUTHOR]

With the growing amount of chronic and rare diseases in childhood that often require lifelong treatment, improvement of health-related quality of life is a major goal in therapy. Therefore, the assessment of health-related quality of life from the patient's perspective as a relevant outcome parameter in clinical practice gained increased recognition. Health-related quality of life measures are still rarely applied in the pediatric practice context, although progress has been made in the development of instruments that are now ready for implementation. Inclusion of measures in research and practice is needed to accumulate and critically appraise knowledge about health-related quality of life to broaden the understanding of the child's health status, impacting on the whole family. From the perspective of a pediatric surgeon, knowledge about health-related quality of life of the children and their parents is important since it might influence treatment decisions and facilitates patient-physician communication. This article will review the concept of health-related quality of life, its methodological challenges and the application, and the challenges of health-related quality of life instruments in pediatric practice and health services research. [ABSTRACT FROM AUTHOR]

Objective measurements of ADHD symptom levels can be a highly valuable complement to ratings. However, sometimes it is not feasible to bring patients into the clinic/lab for assessment. The aim of the present study was therefore to evaluate the psychometric properties of the QbCheck, an online computerized test that measures errors and reaction time as well as activity during testing using the computer's built‐in web camera. Study I (n = 27 adolescents/adults) investigated test–retest reliability and concurrent validity of the QbCheck. Study II included 142 adolescents/adults (69 with ADHD/73 controls) and investigated convergent and diagnostic validity, as well as usability, of the QbCheck. In Study I, the QbCheck showed high test–retest reliability and high concurrent validity. In Study II, high convergent validity was observed when studying associations between the QbCheck performed in the home and the QbTest performed at the clinic. In addition, the QbCheck discriminated well between patients with ADHD and controls, with a sensitivity of 82.6 and a specificity of 79.5. The QbCheck appears to be a valuable test with good psychometric properties and will thereby enable assessment of ADHD symptom levels in adolescents and adults outside the clinic in the home setting. [ABSTRACT FROM AUTHOR]

Depression not only creates enormous costs for treatment and lost work time, but also increases the risk for other costly chronic diseases such as cardiovascular disease and diabetes. The magnitude of these risks remains unclear, with existing prospective studies using small sample sizes with limited diversity and reliant on surveys. We use 2 billion prescription fill records to quantify depression by antidepressant fill records. We track each patient's prescriptions longitudinally and use Cox's time varying proportional hazard model to quantify the effect of taking antidepressants on the hazard rate of taking drugs associated with other chronic diseases quantified similarly by disease-relevant fill records. Controlling for socioeconomic variables, antidepressant use increased the hazard rate for drugs used for cardiovascular disease (1.59 fold), diabetes (1.30) and cancer (1.50). Antidepressant use also predicted substantially higher use of sedatives (3.06) and amphetamines (4.11). Antidepressant use, as a proxy for depression, is a significant risk factor for the most prevalent and costly chronic diseases, and should be treated as a disease with quantifiable and significant implications for individual health. • Antidepressant use, as proxy for depression, is a significant risk factor for the most prevalent and costly chronic diseases. • Depression should be treated as a disease with quantifiable physical and economic implications for individual health. • We use 2.4 billion longitudinal prescription fill records as a proxy to quantify depression by antidepressant fill records. • We track patients and quantify the effect of antidepressants on the hazard rate of taking drugs for other chronic diseases. • Antidepressants predict higher drug usage for cardiovascular disease (1.59 fold), diabetes (1.30), cancer (1.50). • Antidepressant use also predicted substantially higher use of sedatives (3.06) and amphetamines (4.11). [ABSTRACT FROM AUTHOR]

Background: According to the World Health Organization in 2009, hypertension is responsible for 13% of all deaths. Hypertension can increase the risk of stroke, coronary artery disease, dementia, heart disorder, kidney, and other chronic diseases. In this study, the prevalence and incidence of hypertension and knowledge and awareness of it among adults in Ahvaz are investigated. Methods: This cohort study was carried out on 688 participants in a study on the prevalence of metabolic syndrome investigated in adults in the city of Ahvaz in 2009. In 2014, participants were again recruited. Based on the standard method and disease history, blood pressure, height, and weight were measured, and a demographic information questionnaire was completed through interviews. Results: In this study, 688 individuals over 20 years of age participated with an average age of 42.7 ± 13.3 years, 300 men (43.6%), and 388 women (56.4%). Hypertension incidence was 65/1000 person-years which included 67.7 and 57.8/1000 person-years in men and women, respectively. The awareness of patients about hypertension was 51.2% in phase 2 (hypertension new cases). Conclusions: In this study conducted in Ahvaz, the incidence rate of hypertension was 65/1000 person-years, higher in men than women. Hypertension awareness was 50.5%, 45.1% in men, and 55.1% in women. [ABSTRACT FROM AUTHOR]

Background: This paper re-evaluates the impacts of China's New Cooperative Medicine Scheme (NCMS), a social health insurance program targeting China's rural population, on the incidences of chronic diseases among its enrollees. Although coverage under the NCMS expanded rapidly following its implementation in 2003, previous studies have failed to reach a consensus on its health impacts. Existing conflicting results may be due to methodological problems such as implausible identification assumptions and the failure to focus on the most relevant beneficiaries. Methods: Drawing on data from a longitudinal sample from the China Health and Nutrition Survey (CHNS), we focus on a subgroup of patients over the age of 55 years to re-estimate the NCMS's impact on incidences of chronic disease among enrollees. We adopt a triple-difference (difference-in-difference-in-differences) method, relaxing the parallel-trend assumption commonly invoked in the previous double-difference (difference-in-differences) studies. Results: Our triple-difference estimates suggest that the NCMS has significantly reduced the incidences of apoplexy and diabetes among rural residents aged 55 years or older. The impacts of the NCMS on chronic disease are underestimated by the commonly adopted double-difference method. The triple-difference method allows evaluations to focus on the most relevant subgroups for detecting program impacts. Conclusion: Our findings that the NCMS has significantly positive impacts on elderly enrollees' incidences of chronic diseases also suggest the need for examining its impacts on other vulnerable groups, such as low-income individuals, young children, and individuals with poor health conditions. [ABSTRACT FROM AUTHOR]

Aim: To analyze the relationship between polypharmacy and variables as frailty and other chronic comorbidities in Chilean older adults. Design: Cross-sectional study. Participants: One thousand two hundred and five older adults aged 65 and older. Methods: The presence or absence of frailty syndrome was determined according to Fried criteria. Data collection was made through questionnaires conducted by an interview. Results: The prevalence of polypharmacy was 37.59%. The prevalence of hyperpolypharmacy was 2%. Increased prevalence of frailty was demonstrated regarding the progression of the state of polypharmacy. When analyzing the contribution of frailty respect polypharmacy condition, frail state, nutritional risk and obesity are founded as a factor associated with polypharmacy. Regarding chronic disease, hypertension (OR: 8.039, p< 0.0001), type 2 diabetes (OR: 4.001, p< 0.0001) and respiratory diseases (OR: 2.930, p< 0.0001) were associated to polypharmacy. It was found a strong and significant positive correlation between polypharmacy prevalence and frailty score (polypharmacy condition, Spearman R: 0.89, p=0.033; hyperpolypharmacy condition, Spearman R: 0.94, p=0.016). When analyzing the contribution of the polypharmacy to the presence of frailty, polypharmacy condition (OR: 1.510, p< 0.05), cognitive impairment (OR: 3.887, p< 0.001), obesity (OR: 1.560, p< 0.01) and nutritional risk (OR: 2.590, p< 0.001) are associated to frailty. Conclusion: Frailty and chronic conditions as nutritional risk, obesity, hypertension, type 2 diabetes and respiratory disease are an important risk factor for the development of polypharmacy in Chilean older adults. Likewise, polypharmacy condition was observed to be a risk factor for frailty, demonstrating the bidirectional relationship between both conditions. Frailty syndrome evaluation in Chilean older adults could be an important alternative for polypharmacy prevention. [ABSTRACT FROM AUTHOR]

Background: To date multimorbidity has not received much attention in health policies, even though multiple chronic diseases put high demands on the health care system in industrial nations. Enormous costs of care and a physically, mentally, and socially reduced quality of life are common consequences of multimorbidity. Physical activity (PA) has a positive preventive and therapeutic effect on common non-communicable diseases. The objective of this study will be to evaluate the health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. Methods: This is the study protocol for a systematic review. We will search PubMed, MEDLINE (Ovid), Web of Science, CINHAL, and the Cochrane Library (from inception onwards). In addition, clinical trial registers and reference lists of included studies will be searched. We will include randomized controlled trials, quasi-experimental, and non-randomized trials examining the health benefits and harms of PA interventions with or without additional lifestyle interventions for sedentary adult patients with multimorbidity (e.g., two or more chronic non-communicable diseases) in primary care. Eligible control groups will be standard care, placebo, or medications. Two reviewers will independently screen all citations, abstracts data, and full-text articles. The primary outcomes will be health-related quality of life and mortality. Secondary outcomes will include cardiovascular fitness, muscular strength and disease-specific outcomes (e.g., depression score), biomarkers as well as control of metabolic risk factors (e.g., blood pressure, HBA1c, body weight) and any adverse event. The methodological quality of the studies will be appraised using appropriate tools. If feasible, we will conduct random effects meta-analysis. Additional analyses will be conducted to explore the potential sources of heterogeneity (e.g., study design, geographical location, or type of intervention). Strength of the body of evidence will be assessed according to the Grading of Recommendations Assessment (GRADE). Discussion: This review will evaluate the evidence on health benefits and harms of PA interventions for sedentary adults with multimorbidity in primary care settings. We anticipate our findings to be of interest to patients, their families, caregivers, and healthcare professionals in selecting and conducting optimal health promotion programs. Possible implications for further research will be discussed. Systematic review registration: Open Science Framework (registration identifier: osf.io/ka8yu) [ABSTRACT FROM AUTHOR]

The prevalence and incidence of allergic diseases is rising and these diseases have become the most common chronic diseases during childhood in Westernized countries. Early life forms a critical window predisposing for health or disease. Therefore, this can also be a window of opportunity for allergy prevention. Postnatally the gut needs to mature, and the microbiome is built which further drives the training of infant's immune system. Immunomodulatory components in breastmilk protect the infant in this crucial period by; providing nutrients that contain substrates for the microbiome, supporting intestinal barrier function, protecting against pathogenic infections, enhancing immune development and facilitating immune tolerance. The presence of a diverse human milk oligosaccharide (HMOS) mixture, containing several types of functional groups, points to engagement in several mechanisms related to immune and microbiome maturation in the infant's gastrointestinal tract. In recent years, several pathways impacted by HMOS have been elucidated, including their capacity to; fortify the microbiome composition, enhance production of short chain fatty acids, bind directly to pathogens and interact directly with the intestinal epithelium and immune cells. The exact mechanisms underlying the immune protective effects have not been fully elucidated yet. We hypothesize that HMOS may be involved in and can be utilized to provide protection from developing allergic diseases at a young age. In this review, we highlight several pathways involved in the immunomodulatory effects of HMOS and the potential role in prevention of allergic diseases. Recent studies have proposed possible mechanisms through which HMOS may contribute, either directly or indirectly, via microbiome modification, to induce oral tolerance. Future research should focus on the identification of specific pathways by which individual HMOS structures exert protective actions and thereby contribute to the capacity of the authentic HMOS mixture in early life allergy prevention. [ABSTRACT FROM AUTHOR]

Objective: To examine the effectiveness of a nurse-led multidisciplinary self-management program (NMSP) on self-management behaviors, self-efficacy, health-related quality of life (HRQoL) and unplanned health service utilization (HSU) among Chinese patients with coronary heart disease (CHD) in communities.Methods: A randomized controlled trial with repeated measurements was used. A convenience sample of 144 participants was recruited from a community health center in China. All participants were randomly assigned to an intervention group (n = 72) in the newly developed NMSP or a control group (n = 72) in routine care. Outcome measurement was performed at baseline, 3 months and 6 months using Coronary Artery Disease Self-Management Scale (CADSs), Self-efficacy for Chronic Disease 6-item Scale (SECD6), and Short Form-12 health survey questionnaire (SF-12).Results: Over the six months, the two groups reported significant differences in disease medical and emotional management of CADSs, confidence in symptom and disease management of SECD6, physical and mental component summary of SF-12, as well as emergency and outpatient visits of unplanned HSU.Conclusions: The NMSP improves self-management behaviors, self-efficacy, HRQoL and reduces unplanned HSU among CHD patients in communities.Practice Implications: This study provides an effective approach to empower CHD patients with emphasizing on collaboration support of health professionals in communities. [ABSTRACT FROM AUTHOR]

Background: Many chronic diseases increase the risk of depressive symptoms, but few studies have examined whether these diseases also affect the composition of symptoms a person is likely to experience. As the risk and progression of depression may vary between chronic diseases, we used network analysis to examine how depression symptoms are connected before and after the diagnosis of diabetes, heart disease, stroke, and cancer.Methods: Participants (N = 7779) were from the longitudinal survey of the Health and Retirement Study. Participants were eligible if they had information on depression symptoms two and/or four years before and after the diagnosis of either diabetes, heart disease, cancer or stroke. We formed a control group with no chronic disease that was matched on age, sex and ethnic background to those with a disease. We constructed depression symptom networks and compared the overall connectivity of those networks, and depression symptom sum scores, for before and after the diagnosis of each disease.Results: Depression symptom sum scores increased with the diagnosis of each disease. The connectivity of depression symptoms remained unchanged for all the diseases, except for stroke, for which the connectivity decreased with the diagnosis.Limitations: Comorbidity with other chronic diseases was not controlled for as we focused on the onset of specific diseases.Conclusions: Our results suggest that although the mean level of depression symptoms increases after the diagnosis of chronic disease, with most chronic diseases, these changes are not reflected in the network structure of depression symptoms. [ABSTRACT FROM AUTHOR]

Introduction. Early childhood caries (ECC) is a common chronic disease in preschool children. The objectives of the present study were to: (1) compare pre- and post-treatment Early Childhood Oral Health Impact Scale (ECOHIS) scores, (2) evaluate the socio-demographic factors affecting them, and (3) investigate the relationship between early ECC and the socio-demographic characteristics. Materials and methods. The study included 252 children with ages between 27 and 72 months who received dental treatment under general anesthesia at the Department of Pediatric Dentistry in the Western Mediterranean region of Turkey. In order to evaluate the effects of treatments on the quality of the life of children, ECOHIS was used. The ECOHIS was filled in by the parents along pre- and post-treatment in two follow-ups. Results and discussion. The mean of the baseline ECOHIS scores obtained was 12.54 (SD 5.46). ECOHIS scores ranged from 0 to 23 in the child section [mean=7.25 (SD 4.67)], and 0 to 11 in the family section [mean=5.30 (SD 2.14)]. The mean ECOHIS scores were associated with mother's age and occupation, while the mean child impact section (CIS) scores were associated with only father's age (p<0.05). Pain was the most frequently reported complication in CIS, and the feeling of upset in the family impact section (FIS). After general anesthesia, the mean ECOHIS scores of two follow-ups decreased significantly according to the baseline mean scores in all domains. Conclusions. Dental rehabilitation under general anesthesia has some positive physical and psychological effects on both patients and their families. [ABSTRACT FROM AUTHOR]

Objectives: Timely empiric antimicrobial therapy is associated with improved outcomes in pediatric sepsis, but minimal data exist to guide empiric therapy. We sought to describe the prevalence of four pathogens that are not part of routine empiric coverage (e.g., Staphylococcus aureus, Pseudomonas aeruginosa, Clostridium difficile, and fungal infections) in pediatric sepsis patients in a contemporary nationally representative sample.Design: This was a retrospective cohort study using administrative data.Setting: We used the Nationwide Readmissions Database from 2014, which is a nationally representative dataset that contains data from nearly half of all discharges from nonfederal hospitals in the United States.Patients: Discharges of patients who were less than 19 years old at discharge and were not neonatal with a discharge diagnosis of sepsis.Interventions: None.Measurements and Main Results: Of the 19,113 pediatric admissions with sepsis (6,300 [33%] previously healthy and 12,813 [67%] with a chronic disease), 31% received mechanical ventilation, 19% had shock, and 588 (3.1%) died during their hospitalization. Among all admissions, 8,204 (42.9%) had a bacterial or fungal pathogen identified. S. aureus was the most common pathogen identified in previously healthy patients (n = 593, 9.4%) and those with any chronic disease (n = 1,430, 11.1%). Methicillin-resistant S. aureus, P. aeruginosa, C. difficile, and fungal infections all had high prevalence in specific chronic diseases associated with frequent contact with the healthcare system, early surgery, indwelling devices, or immunosuppression.Conclusions: In this nationally representative administrative database, the most common identified pathogen was S. aureus in previously healthy and chronically ill children. In addition, a high proportion of children with sepsis and select chronic diseases had infections with methicillin-resistant S. aureus, fungal infections, Pseudomonas infections, and C. difficile. Clinicians caring for pediatric patients should consider coverage of these organisms when administering empiric antimicrobials for sepsis. [ABSTRACT FROM AUTHOR]

Background and Aims: Chronic diseases are the leading cause of death as well as disability worldwide. There is a little information about the prevalence of these diseases among Saudi elderly population. The aim of the study was to assess the role of gender as risk factor for chronic diseases among elderly patients seen at primary health care centers and identify the most common chronic comorbidities among the elderly. Methods: A cross-sectional study was conducted by reviewing charts of elderly patients having chronic illnesses seeking consultation between January to December 2016. Based on WHO classification data for 19 chronic diseases were extracted using electronic charts of the patients. Chi-square test and logistic regression was used to access the gender as predictor for chronic illnesses with statistical significance was set at P < 0.05. Results: The total number 319 elderly patients were included in the study after random sampling with a mean age of 75 ± 7 years. Around 83 (26%) of patients were severely obese (BMI >35) with a mean BMI of 30 ± 6.7. The most common chronic illnesses were cardiovascular diseases 229 (71.8%), dyslipidemia 183 (57.4%) and diabetes 179 (56.1%). The chronic respiratory and endocrine diseases were common among the elderly females (P value 0.004, P value < 0.001). The most significant problem among males was disease of genitourinary system. There was significant positive correlation of multimorbidity with number of times of consultation in a year (r = 0.442, P value < 0.001). Conclusion: The study concludes that females are more likely to have chronic diseases at elder age than males. However, disease of the genitourinary system was significantly higher among male elderly. Multimorbidity significantly increased the need for frequent visits to the hospital. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Among all the respiratory diseases that occurs in childhood, Asthma is possibly the most common disease, where every pediatrician has to play a role because of Its chronic nature. Even though there are guidelines to assist asthma severity and treatment effectiveness it is under practiced. In our study we emphasize the role of spirometry and age specific Asthma control tests to access the effectiveness of treatment as well as understand the factors of treatment failure. OBJECTIVES: To identify the factors affecting the outcome of STEP2 therapy in moderately persistent asthma as well as to access the response to treatment by spirometric evaluation. METHODOLOGY: A prospective cross-sectional study was conducted in 50 children diagnosed as moderate persistent asthma. They were prescribed Inhaled corticosteroids and after four weeks, effectiveness to treatment was assessed by spirometry and age specific Asthma control test. Those who showed poor control by these two tests that is both by objective and subjective evaluation the reasons for poor control were looked for. These children were given correction techniques wherever needed and council about the dangers of poor control resulting in exacerbation leading to ICU admissions resulting burden of health care costs. RESULTS : Asthma is a chronic disease, poor control of it can significantly affects the lifestyle of children and daily routines like going to school, playing games etc. Treatment effectiveness can be assessed by both Spirometry and age specific Asthma control test. In our study both test were equally effective in assessing asthma treatment. By using spirometry along with age specific asthma control test we got a better understanding of asthma control. Statistically significant correlation was obtained between asthma control test and spirometry Among the reasons for poor control, non adherence was seen in highest percentage followed by incorrect dosage. In these cases, parents and care givers were given guidance to proper dosage and council about importance of adherence to the treatment. CONCLUSION: Even though Age specific asthma control test is an easy and simple method of asthma control assessment, including spirometry as a routine practice gives better idea. It is an objective test where value canbe compared with the pre-treatment value for a better idea about Asthma control. Among the reasons for poor control, non adherence was seen in highest percentage followed by incorrect dosage. In these cases, parents and care givers were given guidance to proper dosage and council about importance of adherence to the treatment. Parents and care givers active participation is very important in achieving proper control of asthma in children. [ABSTRACT FROM AUTHOR]

Background: Osteoporosis incidence in children is increasing due to the increased survival rate of patients suffering from chronic diseases and the increased use of drugs that can damage bones. Recent changes made to the definition of childhood osteoporosis, along with the lack of guidelines or national consensuses regarding its diagnosis and treatment, have resulted in a wide variability in the approaches used to treat this disease. For these reasons, the Osteogenesis Imperfecta and Childhood Osteoporosis Working Group of the Spanish Society of Pediatric Rheumatology has sounded the need for developing guidelines to standardize clinical practice with regard to this pathology. Methods: An expert panel comprised of 6 pediatricians and 5 rheumatologists carried out a qualitative literature review and provided recommendations based on evidence, when that was available, or on their own experience. The level of evidence was determined for each section using the Oxford Centre for Evidence-based Medicine (CEBM) system. A Delphi survey was conducted for those recommendations with an evidence level of IV or V. This survey was sent to all members of the SERPE. All recommendations that had a level of agreement higher or equal to 70% were included. Results: Fifty-one recommendations, categorized into eight sections, were obtained. Twenty-four of them presented an evidence level 4 or 5, and therefore a Delphi survey was conducted. This was submitted electronically and received a response rate of 40%. All recommendations submitted to the Delphi round obtained a level of agreement of 70% or higher and were therefore accepted. Conclusion: In summary, we present herein guidelines for the prevention, diagnosis and treatment of secondary childhood osteoporosis based on the available evidence and expert clinical experience. We believe it can serve as a useful tool that will contribute to the standardization of clinical practice for this pathology. Prophylactic measures, early diagnosis and a proper therapeutic approach are essential to improving bone health, not only in children and adolescents, but also in the adults they will become in the future. [ABSTRACT FROM AUTHOR]

Introduction: This study examines the prospective association between a range of psychosocial factors and common noncommunicable diseases.Methods: In October 2018, nationally representative data were analyzed from 11,637 adults followed annually between 2003 and 2013. Participants reported on psychosocial factors they experienced in the 12 months preceding each wave. The onset of noncommunicable diseases was defined based on self-reported physician's diagnosis. Generalized estimating equations estimated the ORs and 95% CIs of psychosocial factors on noncommunicable diseases, controlling for other confounders.Results: Social support index was inversely associated with the onset of anxiety or depression in men (OR=0.95, 95% CI=0.93, 0.98) and women (OR=0.96, 95% CI=0.95, 0.98) and with emphysema in women (OR=0.96, 95% CI=0.93, 0.99). Psychological distress was positively associated with the onset of heart diseases (OR=2.38, 95% CI=1.16, 4.89 for men; OR=2.30, 95% CI=1.10, 4.78 for women), emphysema (OR=1.11, 95% CI=1.03, 1.20 for men; OR=1.08, 95% CI=1.04, 1.12 for women), and circulatory diseases (OR=1.04, 95% CI=1.02, 1.08 for women). Financial stress increased the onset of anxiety or depression (OR=1.36, 95% CI=1.26, 1.63 for men; OR=1.30, 95% CI=1.10, 1.52 for women) and type 2 diabetes in women (OR=1.60, 95% CI=1.18, 2.18). Significant associations of parenting stress and the likelihood of the onset of anxiety or depression were only evident in women.Conclusions: These findings suggest that several adverse psychosocial risk factors are independently associated with the onset of noncommunicable diseases. [ABSTRACT FROM AUTHOR]

This paper is a case study that is the result of a research project that involved using psychoanalytic observation to reflect on a series of counselling sessions. It provides a description of the work and shares some of the psychoanalytically-informed themes that emerged from the experience. The subject of the case is David, a boy who had lost one brother to cystic fibrosis and who had another brother with the disease. David was free from the condition but in crisis. The themes that emerge from reflecting on the sessions helped to illuminate the use of defences to manage the anxiety inherent in the situation for David and the experience of living with the constant, unrelenting theme of death in a young life. [ABSTRACT FROM AUTHOR]