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Concept: Comorbidity

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The objective was to estimate temporal associations between mental disorders and physical diseases in adolescents with mental-physical comorbidities.

Concepts: Mental disorder, Comorbidity, Mental illness diagnosis by DSM and ICD

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 To determine whether late mortality after sepsis is driven predominantly by pre-existing comorbid disease or is the result of sepsis itself.

Concepts: Cohort study, Cohort, Epidemiology, Demography, Actuarial science, Comorbidity

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IMPORTANCE Nonmelanoma skin cancer (NMSC) is the most common cancer and predominantly affects older patients. Because NMSCs do not typically affect survival or short-term quality of life, the decision about whether and how to treat patients with limited life expectancy (LLE) is challenging, especially for asymptomatic tumors. OBJECTIVE To compare treatment patterns and clinical outcomes of patients with NMSC with and without LLE. DESIGN, SETTING, AND PARTICIPANTS A prospective cohort study of 1536 consecutive patients diagnosed with NMSC at 2 dermatology clinics: a university-based private practice and a Veterans Affairs Medical Center in San Francisco, California. Patients were recruited in 1999 through 2000 and followed up for a median of 9 years. A total of 1360 patients with 1739 tumors (90%) were included in the final analysis. Limited life expectancy was defined as patients either 85 years or older at the time of diagnosis or patients with multiple comorbidities (Charlson Comorbidity Index of ≥ 3). Treatment options included no treatment, destruction, or 2 types of surgery-elliptical excision or Mohs surgery. MAIN OUTCOMES AND MEASURES Treatment type. RESULTS Most NMSCs (69%) were treated surgically, regardless of patient life expectancy. The choice of surgery was not influenced by patient prognosis in univariate or multivariable models adjusted for tumor and patient characteristics. Many patients with LLE (43%) died within 5 years, none of NMSC. Tumor recurrence was rare (3.7% at 5 years [95% CI, 2.6%-4.7%]) in all patients. Although serious complications were unusual, approximately 20% of patients with LLE reported complications of therapy, compared with 15% of other patients. CONCLUSIONS AND RELEVANCE Most NMSCs are treated surgically, regardless of the patient’s life expectancy. Given the very low tumor recurrence rates and high mortality from causes unrelated to NMSC in patients with LLE, clinicians should consider whether these patients would prefer less invasive treatment strategies.

Concepts: Oncology, Patient, Hospital, Surgery, Physician, Comorbidity, Skin cancer, Mohs surgery

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Arthritis affects an estimated 54 million U.S. adults and, as a common comorbidity, can contribute arthritis-specific limitations or barriers to physical activity or exercise for persons with diabetes, heart disease, and obesity (1). The American College of Rheumatology’s osteoarthritis management guidelines recommend exercise as a first-line, nonpharmacologic strategy to manage arthritis symptoms (2), and a Healthy People 2020 objective is to increase health care provider counseling for physical activity or exercise among adults with arthritis.* To determine the prevalence and percentage change from 2002 to 2014 in receipt of health care provider counseling for physical activity or exercise (counseling for exercise) among adults with arthritis, CDC analyzed 2002 and 2014 National Health Interview Survey (NHIS) data. From 2002 to 2014, the age-adjusted prevalence of reporting health care provider counseling for exercise among adults with arthritis increased 17.6%, from 51.9% (95% confidence interval [CI] = 49.9%-53.8%) to 61.0% (CI = 58.6%-63.4%) (p<0.001). The age-adjusted prevalence of reporting health care provider counseling for exercise among persons with arthritis who described themselves as inactive increased 20.1%, from 47.2% (CI = 44.0%-50.4%) in 2002 to 56.7% (CI = 52.3%-61.0%) in 2014 (p = 0.001). Prevalence of counseling for exercise has increased significantly since 2002; however, approximately 40% of adults with arthritis are still not receiving counseling for exercise. Improving health care provider training and expertise in exercise counseling and incorporating prompts into electronic medical records are potential strategies to facilitate counseling for exercise that can help adults manage their arthritis and comorbid conditions.

Concepts: Health care, Health care provider, Medicine, Healthcare, Health, Obesity, Weight loss, Comorbidity

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INTRODUCTION: Erectile dysfunction (ED) is a common complaint in men over 40 years of age, and prevalence rates increase throughout the aging period. Prevalence and risk factors of ED among young men have been scantly analyzed. AIM: Assessing sociodemographic and clinical characteristics of young men (defined as ≤40 years) seeking first medical help for new onset ED as their primary sexual disorder. METHODS: Complete sociodemographic and clinical data from 439 consecutive patients were analyzed. Health-significant comorbidities were scored with the Charlson Comorbidity Index (CCI). Patients completed the International Index of Erectile Function (IIEF). MAIN OUTCOME MEASURE: Descriptive statistics tested sociodemographic and clinical differences between ED patients ≤40 years and >40 years. RESULTS: New onset ED as the primary disorder was found in 114 (26%) men ≤40 years (mean [standard deviation [SD]] age: 32.4 [6.0]; range: 17-40 years). Patients ≤40 years had a lower rate of comorbid conditions (CCI = 0 in 90.4% vs. 58.3%; χ(2) , 39.12; P < 0.001), a lower mean body mass index value (P = 0.005), and a higher mean circulating total testosterone level (P = 0.005) as compared with those >40 years. Younger ED patients more frequently showed habit of cigarette smoking and use of illicit drug, as compared with older men (all P ≤ 0.02). Premature ejaculation was more comorbid in younger men, whereas Peyronie’s disease was prevalent in the older group (all P = 0.03). At IIEF, severe ED rates were found in 48.8% younger men and 40% older men, respectively (P > 0.05). Similarly, rates of mild, mild-to-moderate, and moderate ED were not significantly different between the two groups. CONCLUSIONS: This exploratory analysis showed that one in four patients seeking first medical help for new onset ED was younger than 40 years. Almost half of the young men suffered from severe ED, with comparable rates in older patients. Overall, younger men differed from older individuals in terms of both clinical and sociodemographic parameters. Capogrosso P, Colicchia M, Ventimiglia E, Castagna G, Clementi MC, Suardi N, Castiglione F, Briganti A, Cantiello F, Damiano R, Montorsi F, and Salonia A. One patient out of four with newly diagnosed erectile dysfunction is a young man-worrisome picture from the everyday clinical practice. J Sex Med **;**:**-**.

Concepts: Testosterone, Mental disorder, Prevalence, Erectile dysfunction, Comorbidity, Penis, Premature ejaculation, Sexual dysfunction

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OBJECTIVE:: In a large nationwide administrative database of hospitalized patients, we investigated postoperative outcomes after laparoscopic or open distal gastrectomy in Japan. BACKGROUND:: The benefits of laparoscopic gastrectomy, such as decreased length of stay and morbidity, have typically been evaluated only with limited data on the basis of small samples. METHODS:: Using the Japanese Diagnosis Procedure Combination Database, we identified 9388 patients who were preoperatively diagnosed with stage I and II gastric cancer and underwent laparoscopic (n = 3937) or open (n = 5451) distal gastrectomy between July and December 2010. One-to-one propensity score matching was performed to compare in-hospital mortality, postoperative complication rates, length of stay, total costs, and 30-day readmission rates between the 2 groups. RESULTS:: Patients with younger age, lower comorbidity index, or stage I cancer were more likely to receive laparoscopic gastrectomy. In the propensity-matched analysis with 2473 pairs, the laparoscopic gastrectomy group in comparison with the open gastrectomy group showed a slight reduction in median postoperative length of stay (13 days vs 15 days, P < 0.001) but a slight increase in median total costs (US $21,510 vs $21,024, P = 0.002). There were no significant differences in in-hospital mortality (0.36% vs 0.28%, P = 0.80), overall postoperative complications (12.9% vs 12.6%, P = 0.73), or 30-day readmission rates (3.2% vs 3.2%, P = 0.94). CONCLUSIONS:: In this large nationwide cohort of patients with early-stage gastric cancer, laparoscopic gastrectomy was associated with a statistically significant but slight reduction in postoperative length of stay, but no differences between laparoscopic gastrectomy and open gastrectomy were detected in terms of early mortality and morbidity.

Concepts: Cancer, Cancer staging, Statistical significance, Actuarial science, Stomach, Propensity score, Comorbidity, Propensity score matching

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Dissociative disorders are frequent comorbid conditions of other mental disorders. Yet, there is controversy about their clinical relevance, and little systematic research has been done on how they influence global functioning. Outpatients and day care patients (N=160) of several psychiatric units in Switzerland were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV Axis I Disorders, Structured Clinical Interview for DSM-IV Dissociative Disorders, Global Assessment of Functioning Scale, and World Health Organization Disability Assessment Schedule-II. The association between subjects with a dissociative disorder (N=30) and functional impairment after accounting for non-dissociative axis I disorders was evaluated by linear regression models. We found a proportion of 18.8% dissociative disorders (dissociative amnesia=0%, dissociative fugue=0.6%, depersonalization disorder=4.4%, dissociative identity disorder=7.5%, dissociative disorder-not-otherwise-specified=6.3%) across treatment settings. Adjusted for other axis I disorders, subjects with a comorbid dissociative identity disorder or dissociative disorder-not-otherwise-specified had a median global assessment of functioning score that was 0.86 and 0.88 times, respectively, the score of subjects without a comorbid dissociative disorder. These findings support the hypothesis that complex dissociative disorders, i.e., dissociative identity disorder and dissociative disorder-not-otherwise-specified, contribute to functional impairment above and beyond the impact of co-existing non-dissociative axis I disorders, and that they qualify as “serious mental illness”.

Concepts: Linear regression, Mental disorder, Schizophrenia, Psychiatry, Mental illness, Comorbidity, Dissociative identity disorder, Dissociative disorders

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Children with sickle cell disease (SCD) are at greater risk for developing pica compared to other children. This comorbidity can result in harmful medical and nutritional, and neurodevelopmental consequences. This article will describe the medical, nutritional, and psychosocial functioning in two children with SCD and pica in order to illustrate the potential complications and correlates of this co-morbidity. In addition, the clinical implications of pica in children with SCD will be discussed.

Concepts: Medicine, Sickle-cell disease, Comorbidity, Sickle, Latin

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BACKGROUND: Treatment of Clostridium difficile infection (CDI) is often limited by recurrence in 25% of cases. The objective of this study was to determine risk factors of CDI recurrence during a provincial endemic. METHODS: Data was prospectively collected for 1 year in a Montréal hospital. Inclusion criteria were: age ≥ 18 years; admission for ≥ 72 hours; CDI diagnosis during current admission; no CDI diagnosis in the previous 3 months. RESULTS: A total of 121 patients were included, of which 42% were female. Mean age was 77 years old, with a median Charlson comorbidity index of 5. Forty patients (33%) had recurrent disease within 2 months of initial CDI treatment. There were 20 deaths (17%) within the 2-month follow-up period. Higher risk of CDI recurrence was independently associated with older age (HR=2.26 for each decade), female gender (HR=1.56), and lymphopenia at completion of CDI treatment (HR=2.18), while a positive C. difficile antitoxin serology was protective (HR=0.17). CDI recurrence was not associated with lymphopenia at time of diagnosis, underlying comorbidities, severity or treatment of the initial CDI episode, or re-exposure to antibiotics during the follow-up period. CONCLUSION: Lymphopenia at the end of CDI treatment appears to be a strong marker for CDI recurrence. This available and inexpensive test may identify patients who are at higher risk of CDI recurrence.

Concepts: Gut flora, Infection, Antibiotic resistance, Antibiotic, Comorbidity, Clostridium difficile, Clostridium, Clostridia