Artery-to-Fistula Diameter Ratio as a Predictor of Early Re-Occlusion of Immature Right Radio-Cephalic Arteriovenous Fistula after Primary PTA.

Percutaneous transluminal angioplasty (PTA) is widely performed for arteriovenous fistula (AVF) that fails to mature after initial formation. We observed that some immature AVFs re-occlude earlier than others. We sought to investigate the predictors for early post-intervention failure of immature fistulas after primary PTA. We retrospectively reviewed the records and angiographic images of patients who had immature fistulas and thereby received PTA between 2013 and 2019 at our center. We investigated the short-term post-intervention outcomes of the patients within 90 days post-PTA. Patients who had re-occlusion within the period were defined as the early failure group and the rest as the patent group. We investigated factors associated with early failure. There were 80 eligible patients with 22 brachio-cephalic (BC) and 58 radio-cephalic (RC) AVFs. The median age of the patients was 64 years [range, 38-87]. There were 51 (63%) males and 29 (36%) females. Among the 58 RC AVFs, 10 (17%) patients had early failure. Logistic regression analysis showed that a larger artery to fistula (A/F) diameter ratio was the sole independent predictor of early failure after primary PTA (odd ratio 2.29 [1.023-5.147], p value = 0.044). Although further studies on a larger scale are required to confirm the clinical significance, a larger A/F diameter ratio was a potential predictor of early re-occlusion in immature fistulas after primary PTA.

The impact of court-ordered psychiatric treatment on hospital length of stay: balancing legal and clinical concerns.

Purpose: Psychiatric hospital length of stay (LOS) is not affected solely by socio-clinical factors but also by legal procedures. This study examined the associations between legal procedures and LOS. Methods: Data from 521 patients with psychiatric illnesses hospitalized over 2013-2015 were analyzed. Logistic regression was used to evaluate the predictors of longer (> 14 days) or prolonged (> 30) LOS with socio-clinical factors and legal procedures including court-ordered interventions (assisted outpatient treatment, medication over objection, and retention). Results: Longer LOS occurred in 246 patients and 99 had prolonged LOS. Legal procedures affected 57 patients, with 11 assisted outpatient treatments, 39 cases of medication over objection, and 16 retentions. Longer LOS was significantly associated with six factors including older age, unmarried status, non-Hispanic race, risk of violence, schizophrenia, and legal procedures. Legal procedures had the strongest association. Longer/prolonged LOS yielded qualitatively similar associations. Conclusion: Among 521 psychiatric inpatients, approximately 11% were mandated to receive interventions/procedures by the courts. Court-ordered legal procedures were strongly associated with longer LOS. Mental health providers may consider legal procedures for patients at high treatment/medication noncompliance risk as early as patient admission to inpatient units to prevent, intervene or prepare for a longer or prolonged LOS.

Serum Growth Differentiation Factor-15/Albumin Ratio as a 2-Year Survival Marker of End-Stage Renal Disease Patients Initiating Maintenance Hemodialysis.

It is important to identify risk factors related to mortality in end-stage renal disease (ESRD) patients starting renal replacement therapy. Recently, several studies proposed that growth-differentiation factor-15 (GDF-15) is a possible biomarker for the prognosis of patients on maintenance hemodialysis. Here, we investigated the predictive value of serum GDF-15/Albumin ratio on two-year mortality in ESRD patients initiating maintenance hemodialysis. The study was a single center, retrospective study on ESRD patients starting maintenance hemodialysis with a follow-up of two years. All patients completed laboratory test and bioimpedance spectroscopy prior to the initiation of the first dialysis. The patients were stratified into quartiles according to the quartiles of serum GDF-15/Albumin ratio. Among the 159 patients, the mean age was 61.78 ± 12.52 years and median survival was 20.03 ± 7.73 months. The highest GDF-15/Albumin quartile was significantly more associated with the increased risk of all-cause mortality than other quartiles (unadjusted hazard ratio (HR): 8.468, 95% CI 2.981-24.054, p < 0.001). Older age and a higher overhydration state were associated with GDF-15/Albumin ratio. The ROC analysis confirmed that the ability of the GDF-15/Albumin ratio to predict mortality was superior to GDF-15 or albumin alone. In conclusion, the GDF-15/Albumin ratio measured at the initial maintenance hemodialysis is an independent prognostic marker of two-year mortality in ESRD patients.

Body Fat Plays an Important Role in of Bioimpedance Spectroscopy-Based Dry Weight Measurement Error for Patients with Hemodialysis.

Accurate dry weight (DW) estimation is important for hemodialysis patients. Although bioimpedance spectroscopy (BIS) is commonly used to measure DW, the BIS-based DW frequently differs from the clinical DW. We analyzed the characteristics of patients whose BIS-based DWs were over- and underestimated. In this retrospective cohort study, we evaluated 1555 patients undergoing maintenance hemodialysis in Chungnam National University Hospital. The gap (DWCP-BIS) was calculated by comparing the BIS and clinical DWs. We analyzed the clinical characteristics of patients with positive (n = 835) and negative (n = 720) gaps. Compared with other patients, the DWCP-BIS-positive group had higher extracellular water (ECW) level and extracellular/intracellular water index (E/I) and had lower weight, body mass index (BMI), lean tissue index (LTI), fat tissue index (FTI), fat mass (FAT), and adipose tissue mass (ATM). The DWCP-BIS-negative group exhibited elevated BMI, FTI, FAT, and ATM; however, it had lower height, ECW, and E/I. Linear regression analysis revealed that FAT significantly predicted DWCP accuracy. The clinical DW of patients with a low fat mass tended to be underestimated, while the clinical DW of patients with comparatively large fat reserves tended to be overestimated. These characteristics will aid in the reduction of BIS-based DW errors.

Help-seeking behaviors for serious psychological distress among individuals with diabetes mellitus: The California Health Interview Survey, 2011-2012.

AIM: To investigate patterns of and factors associated with help-seeking behaviors among individuals with diabetes mellitus (DM) and/or serious psychological distress (SPD). METHODS: The analysis was conducted with the California Health Interview Survey (CHIS) 2011-2012 of 40,803 adults. Logistic regression was used to examine the associations between the multiple facilitating/preventing factors and outcome, guided by the Andersen's Health Care Utilization Model. RESULTS: The prevalence of DM and SPD were 10.9% and 3.4%, respectively, among participants in the survey. The participants with DM were more likely to experience SPD than those without DM (OR 1.46, 95% CI=1.11-1.91, p=0.006). Participants with combined DM and SPD, the most underserved, were less likely to perceive the need for mental health services and less likely to seek help, compared to those with only SPD. Need factors (SPD status and perceived need) were significantly associated with help-seeking behaviors for mental health, along with predisposing factors (age, gender, obesity, race, and employment), and enabling factors (insurance, English proficiency). CONCLUSIONS: Perceptions about need for seeking help seem to play an important role in receiving mental health services in addition to other predisposing or enabling factors. Identification of these factors may improve clinical outcomes related to DM and SPD.

Screening for type 2 diabetes mellitus in patients with mental illness: application of a self-assessment score for diabetes mellitus risk.

Various methods for diabetes risk assessment have been developed over a decade, but they were not evaluated in patients with mental illness. This study examined the feasibility and utility of a self-assessment score for type 2 diabetes mellitus (DM2) risk among patients with mental illness. DM2 risk was assessed by patients with mental illness as well as clinicians via a self-assessment questionnaire, and the resulting scores were compared to each other as well as with actual diagnosis. Of 100 patients, nine patients were newly revealed to have DM2 and 34 patients have pre-DM2. Patients tended to underreport risk factors - obesity and physical activity - so perceived to have lower risk. Sensitivity of the self-assessment score was different when used by patients and by clinicians despite correlation coefficient of 0.82. Based on positive predictive values, we may expect one out of two patients who have high scores actually have DM2 or pre-DM2. Also, the discrimination capability was reasonably high (AUC=0.79), comparable to its performance observed in general populations. The self-assessment score has potential as a simple and adjunct tool to identify a high risk group of DM2/pre-DM2 among persons with mental illness, especially, when used together with health care providers.

Factors associated with mental health service utilization among Korean American immigrants.

This study adapted Andersen's Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services.

Weight changes and characteristics of patients associated with weight gain during inpatient psychiatric treatment.

This study investigated weight changes and patient characteristics associated with weight gain in a public psychiatric hospital. A retrospective chart review was conducted on a multi-racial population admitted for psychiatric inpatient treatment. Patients gained an average of 5.41 pounds during psychiatric hospitalization. Patients with normal weight at admission were significantly more likely to gain weight compared to overweight or obese patients. Black patients showed the greatest weight gain, while Asian patients showed the smallest weight gain. This study suggests that it may be possible to identify specific demographic characteristics that warrant more intensive clinical evaluation, although additional research is necessary.

Serious psychological distress, health risk behaviors, and diabetes care among adults with type 2 diabetes: the California Health Interview Survey 2007.

AIMS: To examine the association between type 2 diabetes and serious psychological distress (SPD) and to assess if SPD was an independent risk factor for health risk behaviors and diabetes care among adults with diabetes. METHODS: Cross-sectional analysis was performed using the 2007 California Health Interview Survey with adults in California. Multiple logistic models were used to examine the associations between the multiple risk and outcome factors. RESULTS: Of the participants, 6.9% of adults had diagnoses of type 2 diabetes. SPD was present in 7.0% of adults with diabetes but only in 3.5% of adults without diabetes. Multiple logistic regression analysis revealed that participants with diabetes were significantly more likely than those without diabetes to experience SPD (OR=1.81; 95% CI=[1.3-2.5], p=0.0002), adjusting for other factors. In addition, participants with diabetes and SPD were more likely to report insufficient physical activity and more current cigarette smoking than participants without SPD. SPD among participants with diabetes, however, did not significantly affect good diabetes care. CONCLUSIONS: The findings suggest that adults with diabetes are more likely to experience SPD than adults without diabetes. Further research is needed to explore the underlying mechanisms for this association among adults with both diabetes and SPD.

The interactive role of chronic medical conditions and sleep disturbance in predicting depressive symptoms among Korean American older adults.

OBJECTIVES: This study examined the independent and interactive effects of chronic medical conditions and sleep disturbance on depressive symptomatology. The sample (N = 675) consisted of community-dwelling Korean American older adults, a group that has been found to be particularly high in depressive symptomatology. METHODS: A hierarchical regression model of depressive symptoms was estimated with an array of predictors: (a) demographic variables, including immigration history, (b) chronic medical conditions, (c) sleep disturbance, and (d) an interaction between chronic medical conditions and sleep disturbance. RESULTS: After controlling for the effects of demographic variables, both chronic medical conditions and sleep disturbance were identified as independent risk factors for depressive symptoms. Moreover, their interaction was significant, indicating that the coexistence of chronic medical conditions and sleep disturbance was significantly associated with higher levels of depressive symptoms (ß = 0.15, p < 0.01). CONCLUSION: Our findings call attention to sleep hygiene among older individuals with chronic medical conditions and recommend that sleep quality should be closely monitored and assessed by healthcare professionals.

Acculturation, discrimination and depressive symptoms among Korean immigrants in New York City.

Immigrant mental health issues, especially depression in relation to discrimination and acculturation, are reported to be serious problems in the United States. The current study examines the prevalence of depressive symptoms among Korean immigrants in New York City (NYC) and its relation to self-reported discrimination and acculturation. A sample of 304 Korean immigrants residing in NYC completed a survey utilizing the Center for Epidemiologic Studies Depression Scale-Korean version, Discrimination Scale, and Acculturation Stress Scale. Results indicated that 13.2% of the sample population demonstrated some symptoms of depression and that variable such as living alone, marital status, education, years in US and income impact high depression scores. Results also indicate that higher self-reported exposure to discrimination and lower self-reported language proficiency were related to higher depressive symptoms. In a regression analysis, discrimination and English language proficiency were significant predictors of depression, but acculturation stress was not significantly related to depression.

Understanding the experience and manifestation of depression among Korean immigrants in New York City.

Depression among immigrant groups, especially Korean immigrants, has often lacked a comprehensive understanding by the providers of Western health care. This study aims to explore the subjective experience of Korean immigrants suffering from depression during resettlement in the United States. A series of focus groups and in-depth interviews were conducted with Korean immigrants in New York City who identified themselves as depressed. Participants described their depression as manifested through the feeling of an "unbalanced self " and tended to express dysphoric symptoms in somatic terms. These differences need to be reflected in the assessment and treatment of depression in Korean immigrants.

Inpatient stays of Asian patients with psychiatric diagnoses in New York City.

This study examines whether race, specifically Asian, contributes to longer inpatient stays for patients with psychiatric diagnoses in a large American city. Secondary data analyses were conducted using Statewide Planning and Research Cooperative System data sets for 983,584 inpatient discharges with psychiatric diagnoses in New York City between 1995 and 1999. Asians were admitted more often through the emergency room and showed a higher incidence of emergency admission than non-Asians. Greater percentages of Asians were diagnosed with schizophrenic disorders and affective psychoses compared to non-Asians. Furthermore, Asians were about 70% less likely to utilize inpatient services but stayed considerably longer than non-Asians when hospitalized. Study findings will assist in development of policy to improve service utilization for this vulnerable population.

Help-seeking behaviors by Korean immigrants for depression.

Underutilization of mental health services by Asian immigrants has been an ongoing concern for those attempting to provide accessible care for people suffering from mental illness. The author investigated Korean immigrants' help-seeking behaviors for depression to understand their underutilization of mental health services. The study involved 6 focus group discussions and 24 in-depth interviews with 70 Korean immigrants in New York City. Prolonged care within family and traditional Asian practices led to a delay in seeking mental health services, keeping many Korean immigrants with depression out of the delivery system. The lack of interface between formal service providers and psychiatric service providers also caused delayed treatment. This study suggests the need for a comprehensive care model based on community education, linking mental health care with other services, and cultural brokering, as ways to connect population needs with mental health service delivery.

Quality of care measurement in nursing home AIDS care: a pilot study.

A pilot study was conducted to identify which, if any, demographic or quality indicators differentiate HIV-positive patients from other long-term care patients. This study used the Minimum Data Set files for all New York state nursing homes submitted in 1997. Chi-square tests were used to assess difference in proportions of demographics and quality indicators between HIV-positive and HIV-negative patients. The HIV-positive patients tended to be between 40 and 59 years of age and male and were more likely to be Black or Hispanic. HIV-positive patients had a significantly higher prevalence of diagnosis or symptoms of depression without any treatment compared to HIV-negative patients. HIV-positive patients had significantly higher prevalence of weight loss, antipsychotic use, antianxiety/hypnotic use, and incontinence of bladder and bowel compared to HIV-negative patients. This study paves the way for the development of a more appropriate quality indicator system tailored to the AIDS population and allows facilities to make necessary improvements in the quality of care offered to this vulnerable population.

Genetic polymorphism of the serum proteins of horses in Jeju.

The study was carried out to investigate the genetic polymorphism of the serum proteins of horses in Cheju. They were assigned to three groups; 45 Cheju native horses(CNH), 60 Cheju racing horses(CRH) and 60 Thoroughbreds(TB). We analyzed the phenotypes and gene frequencies of serum proteins which were albumin (Alb), vitamin-D binding protein(GC), esterase (ES), A1B glycoprotein(A1B) and transferrin(TF) loci using horizontal polyacrylamide gel electrophoresis (HPAGE). All of the loci, except A1B in TB, showed polymorphisms and different allelic and phenotypic frequencies in all three groups. ESS and TFF1 were not observed in CNH. Allelic frequencies of AlbB, ESI, TFD and TFF1 were high in TB. All of the loci, except ES locus in CRH, appeared to be in a state of Hardy-Weinberg equilibrium from goodness-of-fit test in all three groups. Heterozygosity estimates at Alb, ES and TF loci were high, but GC and A1B loci were low in all three groups. Average heterozygosities in CNH, CRH and TB were 0.3535, 0.3555 and 0.2726, respectively. Results showed differences in the frequencies of alleles and phenotypes of several serum protein loci between CNH and CRH, suggested that CRH might be crossed with other breeds of horses in some degree.