Depressive Syndromes and Medical Comorbidities

The prevalence of depression is substantial among individuals with medical conditions and is associated with poorer treatment outcome for both the mood disorder and medical condition. This chapter examines the prevalence, risk factors, causal associations, and treatment for depression in four medical conditions: cancer, cardiovascular disease, multiple sclerosis, and HIV/AIDS. Several conclusions are evident: First, depression is unrecognized in about 30% of medical patients, and twice as many medical patients experience depression relative to the general population. Second, regardless of the medical illness, there are common risk factors for depression. Third, individuals with medical illness are most vulnerable to developing depression in the year following medical diagnosis. Fourth, the relationship between depression and medical comorbidities is bidirectional. Fifth, although there are promising psychological and pharmacological interventions for individuals with comorbid depression and medical problems, significant methodological problems limit this research. These limitations must be addressed to provide optimal care for those with depression and a chronic medical condition.

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Depression among Older Adult Prisoners at the Jos Central Prison- North Central Nigeria

Journal of BioMedical Research and Clinical Practice ◽

10.46912/jbrcp.119 ◽

2019 ◽

Vol 2 (3) ◽

pp. 167-171

Author(s):

CG Piwuna ◽

TO Piwuna ◽

N Dami ◽

MA Bankat ◽

TM Agbir ◽

...

Keyword(s):

Older Adult ◽

Medical Condition ◽

Occupational Status ◽

Chronic Medical Condition ◽

P Value ◽

Medical Conditions ◽

Violent Crimes ◽

North Central ◽

Older Prisoners ◽

Prevalence Of Depression

This study was carried out to determine the prevalence of depression and its correlates among Older Adult Prisoners at the Jos Central Prison, North Central Nigeria. The study was a cross-sectional descriptive chart, conducted at the Jos Central prisons on eighty-six (86) older prisoners between June 2012 to December 2012. Bio-demographic data and history of any chronic medical condition as well as that of psychiatric condition were also obtained from their clinical records in the clinic located within the prison. Depression was assessed using the Geriatric Depression Scale (GDS) on all the volunteers 50 years and above. The GDS measures cognitive, affective, functional state and a factor that reflects helplessness and fear for the future. The study was largely composed of male making up to 99%. The age range was between 50 to 75 years with a mean 54.36 (SD 3.24) with most of them between 50 to 60 years (90%). A quarter (25%) had not received any form of education while 7 out of 10 had received some form of education. Majority of them were employed (skilled or un-skilled employment) before incarceration. Only 2% were unemployed before their incarceration. Those incarcerated for violent crimes (65%) nearly doubled those in prison for non-violent crimes 35%. Occupational status, pre-existing medical conditions and the perception of their health status before incarceration were found to be statistically significant. Type of crimes committed was not statistically significant. Known chronic medical condition(s) was a risk factor in the inmates developing depression (P-value =0.009). In comparing the specific medical conditions with depression, significant findings were found (P-value= 0.003). The study revealed a prevalence of depression at 59% in older prisoners of 50 years and above. The significant predictors of depression include occupational status, pre-exisitng medical conditions, and the perception of their health status before incarceration were found to be statistically significant.

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Reduced health-care utilization among people with chronic medical conditions during coronavirus disease 2019

Proceedings of Singapore Healthcare ◽

10.1177/2010105820964533 ◽

2020 ◽

pp. 201010582096453

Author(s):

Chetna Malhotra ◽

Isha Chaudhry ◽

Semra Ozdemir ◽

Eric Andrew Finkelstein

Keyword(s):

Health Care ◽

Health Care Utilization ◽

Perceived Risk ◽

Risk Perceptions ◽

Medical Condition ◽

Chronic Medical Condition ◽

Care Utilization ◽

Chronic Medical Conditions ◽

Medical Conditions ◽

Care Appointment

The coronavirus disease 2019 (COVID-19) outbreak may impact the health-care-seeking behaviour of people with pre-existing chronic medical conditions. We aimed to assess the extent, reasons and correlates of reduced health-care utilization among people with chronic medical conditions in Singapore during the COVID-19 pandemic. We administered a web-survey to a panel of residents between 31 March and 14 April 2020. We assessed the proportion of participants with self-reported chronic conditions that missed their health-care appointment during the outbreak either voluntarily (demand driven) or because it was cancelled by their provider (supply driven). We performed a logistic regression to examine the association of voluntarily missing the health-care appointment with participants’ age and risk perceptions. Of the 1017 surveyed participants, 349 reported at least one chronic medical condition. Of these, 40% reported missing their health-care appointment during the COVID-19 outbreak. Of these, 72% did so voluntarily, and 39% reported that it was cancelled by their provider. Younger participants, those with a greater worry of contracting COVID-19 and those with a higher perceived risk of dying due to COVID-19 were more likely to miss their health-care appointments voluntarily. These results highlight the need to ensure continuity of care for people with chronic medical conditions in order to avoid the long-term impact on their health and mortality.

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Is the link between socioeconomic status and resilience mediated by reserve-building activities: mediation analysis of web-based cross-sectional data from chronic medical illness patient panels

BMJ Open ◽

10.1136/bmjopen-2018-025602 ◽

2019 ◽

Vol 9 (5) ◽

pp. e025602 ◽

Cited By ~ 5

Author(s):

Carolyn Emily Schwartz ◽

Jie Zhang ◽

Brian Dale Stucky ◽

Wesley Michael ◽

Bruce David Rapkin

Keyword(s):

Socioeconomic Status ◽

Medical Condition ◽

Personal Finance ◽

Chronic Medical Condition ◽

Secondary Outcome ◽

Medical Illness ◽

Cross Sectional ◽

Web Based ◽

Building Activities ◽

Mediation Models

ObjectivesThe purpose of this study is to test the hypothesis that the link between socioeconomic status (SES) and resilience is mediated by reserve-building activities.DesignCross-sectional observational study. Structural equation modelling (SEM) was used to test the mediation hypothesis.SettingWeb-based survey.ParticipantsParticipants with a chronic medical condition were recruited from Rare Patient Voice.Primary and secondary outcome measuresDeltaQuest Reserve-Building Measure; demographic variables to capture SES; Centers for Disease Control Healthy Days Core Module; Self-Administered Comorbidity Questionnaire. Resilience was operationalised using residual modelling.ResultsThe study sample included 442 patients (mean age 49, 85% female). SES was modelled as a bifactor model composed of general SES and specific factors for personal finance and parent’s education. A series of simple mediation models predicting resilience led to the selection of three reserve-building activities for subsequent SEM-based mediation models: Active in the World, Outdoor and Exercise. The full SEM model supported the hypothesis that the relationships from both general SES and personal finance to resilience were mediated by engaging in the three reserve-building activities. In addition, the number of comorbidities partially mediated the relationship between personal finance and reserve-building. Those with more comorbidities generally had lower levels of resilience.ConclusionsThis study provides suggestive evidence that reserve-building activities may be one pathway by which SES is associated with resilience: people of higher SES are more likely to engage in reserve-building activities that are intellectually stimulating, involve Outdoor pursuits and include physical Exercise. These reserve-building activities are not costly to pursue. These findings may empower patients to introduce more such reserve-building activities into their lives.

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Risk factors for problem behavior in adolescents of parents with a chronic medical condition

European Child & Adolescent Psychiatry ◽

10.1007/s00787-012-0279-4 ◽

2012 ◽

Vol 21 (8) ◽

pp. 459-471 ◽

Cited By ~ 24

Author(s):

Dominik Sebastian Sieh ◽

Johanna Maria Augusta Visser-Meily ◽

Frans Jeroen Oort ◽

Anne Marie Meijer

Keyword(s):

Risk Factors ◽

Problem Behavior ◽

Medical Condition ◽

Chronic Medical Condition

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The International Medical Prevention Registry on Venous Thromboembolism (IMPROVE): Venous Thromboembolism Prophylaxis Practices in Acutely Ill Medical Patients.

Blood ◽

10.1182/blood.v104.11.1762.1762 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1762-1762 ◽

Cited By ~ 3

Author(s):

Victor F. Tapson ◽

Herve Decousus ◽

Jean-Fran[ccedi]ois Bergmann ◽

Beng H. Chong ◽

James B. Froehlich ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Major Surgery ◽

Medical Illness ◽

Medical Patients ◽

Median Length ◽

Thromboembolism Prophylaxis ◽

Vte Prophylaxis ◽

Elastic Stockings

Abstract Background Despite consensus group recommendations indicating that medical patients should receive appropriate venous thromboembolism (VTE) prophylaxis, prophylaxis practices remain poorly characterized. This analysis of IMPROVE, a prospective study of acutely ill medical patients, describes in-hospital prophylaxis practices prior to the publication of updated VTE prevention guidelines by the American College of Chest Physicians. Methods Patient recruitment began in July 2002. Patients ≥18 years old, and hospitalized for ≥3 days with an acute medical illness are enrolled consecutively. Exclusion criteria are: therapeutic antithrombotics/thrombolytics at admission; major surgery or trauma during 3 months prior to admission; and VTE treatment begun within 24 hours of admission. Results Data were from 4315 patients (32% from USA) enrolled up to 30 June 2004 in 37 hospitals in 11 countries (76% with 3-month follow-up data). Patients are 50% female, median (IQR) age 69 (50–80) years, median length of hospital stay 8 (5–14) days, median weight 68 (58–80) kg, and 40% were immobile for ≥3 days (median length of immobility 7 [4–14] days, including immobility immediately prior to admission). In-hospital VTE prophylaxis was received by 41% of patients (Table 1). Of patients with no risk factors (44%), one risk factor (40%), or ≥2 risk factors (16%), 25%, 49%, and 67% received prophylaxis, respectively. 12% of IMPROVE patients would have been eligible for inclusion in the MEDENOX study. Of these, only 52% received prophylaxis in hospital. Prophylaxis was provided to 6% of patients during the 3-month follow-up period, and continued in 11% of patients after discharge. Conclusions Only 41% of IMPROVE patients received VTE prophylaxis, with considerable variation in types and regimens of prophylaxis used. While MEDENOX showed the benefits of VTE prophylaxis (enoxaparin 40 mg) in acutely ill medical patients, only half of MEDENOX-eligible patients received prophylaxis. Table 1. Use of in-hospital VTE prophylaxis (N=4315) VTE prophylaxis Patients receiving VTE prophylaxis, % ROW, rest of world; *Excluding elastic stockings and aspirin ≥1 type of VTE prophylaxis* 41 LMWH - USA (Q12h, Qd) 7 (5, 1) LMWH- ROW (Q12h, Qd) 31 (29, 2) UFH - USA (Q12h, Q8h) 28 (15, 11) UFH - ROW (Q12h, Q8h) 6 (5, 0) Intermittent pneumatic compression (USA, ROW) 6 (19, 0) Aspirin (USA, ROW) 4 (7, 3) Elastic stockings (USA, ROW) 6 (3, 8)

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Risk Factors Associated with Adverse Events of Acupuncture: A Prospective Study

Acupuncture in Medicine ◽

10.1136/acupmed-2014-010635 ◽

2014 ◽

Vol 32 (6) ◽

pp. 455-462 ◽

Cited By ~ 10

Author(s):

Ka-Fai Chung ◽

Wing-Fai Yeung ◽

Chi-Wa Kwok ◽

Yee-Man Yu

Keyword(s):

Risk Factors ◽

Adverse Events ◽

Prospective Study ◽

Medical Condition ◽

Past History ◽

Sham Acupuncture ◽

Chronic Medical Condition ◽

Perceived Credibility ◽

Non Invasive ◽

A Prospective Study

Objective Mild adverse events (AEs) are common with acupuncture, but the risk factors remain unclear. A prospective study using a standardised AE assessment and acupuncture protocol was undertaken to address the question. Methods A 20-item AE report form investigated local and systemic AEs in 150 adults with insomnia randomised to receive traditional, minimal and non-invasive sham acupuncture. Sociodemographic, clinical and psychological variables at baseline and past history and perceived credibility of acupuncture were assessed. Results The incidence of any AEs per patient was 42.4% with traditional acupuncture, 40.7% with minimal acupuncture and 16.7% with non-invasive sham acupuncture. Traditional and minimal acupuncture were associated with a greater number of local AEs, while the presence of a chronic medical condition was predictive of fewer local and systemic AEs. Greater severity of insomnia, anxiety, depression, somatic symptoms and pain catastrophising thoughts were associated with lower risk, but most of the significant correlations disappeared after logistic regression. Divorce and widowhood were the only significant sociodemographic variables, while previous acupuncture treatment and perceived credibility of acupuncture were found to be unrelated. The risk of any AEs was higher in participants receiving traditional acupuncture (OR 4.26) and minimal acupuncture (OR 4.27) and in those without medical comorbidity (OR 3.39). Conclusions The prevalence of AEs was higher than usual, probably due to the low threshold in our definition of AEs and the systematic collection from the patients’ perspective. Baseline variables were largely unable to predict AEs associated with acupuncture. Further studies should explore the roles of practitioners, patients’ anxiety during treatment and patient–practitioner interactions. Trial Registration Number NCT01707706.

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Clinical presentation of paediatric patients with COVID-19 admitted to a single paediatric intensive care unit (PICU) in Iran

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000715 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000715

Author(s):

Amir Saeed ◽

Eslam Shorafa ◽

Anahita Sanaeidashti ◽

Mohammad Rahim Kadivar

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Paediatric Intensive Care Unit ◽

Clinical Presentation ◽

Medical Condition ◽

Paediatric Intensive Care ◽

Chronic Medical Condition ◽

Chronic Medical Conditions ◽

Medical Conditions ◽

Paediatric Patients

ObjectivesTo describe the clinical characteristics of paediatric patients admitted to a single paediatric intensive care unit (PICU) in Iran with COVID-19.MethodsA cross-sectional study of paediatric patients who were admitted to a COVID-19-dedicated PICU from 16 March 2020 to 21 April 2020 with COVID-19.ResultsSix children had confirmed COVID-19 and four had suspected COVID-19. Six had pre-existing chronic medical conditions. Nine had respiratory failure and needed ventilation. Five children, of whom four had chronic medical conditions, died. Four had cardiac arrhythmias. Clinical presentation included fever and cough.ConclusionCOVID-19 can be fatal in paediatric patients, especially in those with a chronic medical condition.

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Prevalence and risk factors of autism spectrum disorders in preschool children in Sharkia, Egypt: a community-based study

Middle East Current Psychiatry ◽

10.1186/s43045-021-00114-8 ◽

2021 ◽

Vol 28 (1) ◽

Author(s):

Amira Mohamed Yousef ◽

Eman H. Roshdy ◽

Nelly R. Abdel Fattah ◽

Randa M. Said ◽

Maha M. Atia ◽

...

Keyword(s):

Risk Factors ◽

Autism Spectrum Disorders ◽

Preschool Children ◽

High Risk ◽

Rating Scale ◽

Medical Condition ◽

Autism Spectrum ◽

Chronic Medical Condition ◽

Community Based ◽

Spectrum Disorders

Abstract Background Lateness in the diagnosis of autism spectrum disorders (ASD) results in significant disability and pressure on affected children and their families. We aimed to detect the preschool children who have high-risk criteria for ASD in Sharkia Governorate in Egypt and assess the prevalence and risk factors of ASD. A cross-sectional community-based study was done in 39 kindergartens throughout Sharkia Governorate, Egypt, using a multi-stage random sampling technique. The study included two phases, the screening phase, where 3722 preschool children were screened by Modified Check List for Toddlers/Revised (M-CHAT-R), and the diagnostic phase where the diagnosis of ASD among the high-risk children was made according to the research diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) of ASD administrated by experienced psychiatrists and the Childhood Autism Rating Scale (CARS). Results This study showed that 2.8% of children were at high risk for ASD. The prevalence of ASD in Sharkia Governorate was 5.4/1000. The significant risk factors for the disorder were the presence of factories near the house, first and middle child order, congenital anomalies, child medication during the first year of life, child chronic medical condition, child attachment to TV, a medical condition affecting mother during pregnancy, and psychiatric disorders history in the family. Conclusion Autism spectrum disorder is prevalent in preschool children in Sharkia, Egypt, and multiple risk factors contribute to this prevalence.

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From Prehab to Rehab: The Functional Restoration of a Bariatric Individual

10.5772/intechopen.94418 ◽

2020 ◽

Author(s):

Anwar Suhaimi ◽

Brenda Saria Yuliawiratman

Keyword(s):

Functional Impairment ◽

Surgical Outcomes ◽

Medical Condition ◽

Functional Decline ◽

Functional Restoration ◽

Chronic Medical Condition ◽

Medical Comorbidities ◽

Time Points ◽

Operative Complications ◽

The Face

The bariatric population presents at a greater risk for functional decline with increasing weight and advancing age. This can be prevented at various time points through multidisciplinary rehabilitation interventions in a multitude of different settings to accommodate the severity of an individuals’ disability and to target different functional goals. Bariatric rehabilitation is a multipronged approach that addresses the ongoing functional impairment, medical comorbidities, hospital-related deconditioning and prevents future cardiovascular and musculoskeletal complications from progressing. The emerging concept of utilising rehabilitation interventions and goal-centric approach as means to reduce post-operative complications and enhance surgical outcomes is also discussed. Pragmatic approaches to post-surgical bariatric rehabilitation are discussed highlighting the multi-faceted rehabilitation concerns to achieve optimal functionality in the face of a chronic medical condition.

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