Lifetime prevalence, comorbidities, and Sociodemographic predictors of post-traumatic stress disorder (PTSD): the National Epidemiology of Iranian Children and adolescents Psychiatric disorders (IRCAP).

OBJECTIVE: The aims of this study were to (a) evaluate the lifetime prevalence of post-traumatic stress disorder (PTSD) according to sociodemographic characteristics, (b) determine sociodemographic factors associated with PTSD, (c) estimate the lifetime prevalence rates of comorbidities by age and gender, and (d) assess the proportion of traumatic events in the non-PTSD sample and the PTSD sample, according to gender. METHODS: The data used for the present study were obtained from the IRCAP study which was a cross-sectional, community-based study on 29,250 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Trained psychologists conducted diagnostic interviews with parents, children, and adolescents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: In this study, the prevalence of PTSD across the sample population was 0.6% (95% CI, 0.5-0.7%). Higher rates of PTSD were observed among girls (0.7%, CI 0.5-0.8%), adolescents aged 15-18 years (0.8%, CI 0.6-1.0%), and participants who had unemployed (1.5%, CI 0.8-2.8%), or farmer fathers (1.1%, CI 0.5-2.5%). Of the participants with PTSD, 65.1% met the criteria for at least one other psychiatric disorder. PTSD had a high rate of comorbidity with oppositional defiant disorder (22.9%, CI 17.5-29.4%), generalized anxiety disorder (20.8%, CI 15.7-27.1%), separation anxiety disorder (20.3%, CI 15.2-26.6%), and major depressive disorder (19.8%, CI 14.8-26.0%). We found 9.5% of non-PTSD sample experienced at least one traumatic event. Witness to domestic violence was the most common traumatic event experienced by 32.8% of PTSD sample. CONCLUSION: Our results in the prevalence, comorbidities, and sociodemographic factors associated with PTSD supported findings of previous studies that used a structured diagnostic interview. It is recommended to use purposive sampling and to investigate comorbidities of PTSD and type of traumatic events in a large clinical population.

Categorization of Patients with Pulmonary Embolism by Charlson Comorbidity Index.

BACKGROUND: Short-term outcomes of pulmonary embolism are closely related to right ventricular dysfunction and patient's hemodynamic status, but also to individual comorbidity profile. However, the impact of patients' comorbidities on survival during pulmonary embolism might be underrated. Although the Charlson Comorbidity Index (CCI) is the most extensively studied comorbidity index for detecting comorbidity burden, studies analysing the impact of CCI on pulmonary embolism patients' survival are limited. METHODS: We used the German nationwide inpatient sample to analyse all hospitalised patients with pulmonary embolism in Germany 2005-2020 and calculated CCI for each patient, compared the CCI classes (very-low: CCI=0points, mild: CCI=1-2 points, moderate: CCI=3-4, high severity: CCI>4 points) and impact of CCI class on outcomes. RESULTS: Overall, 1,373,145 hospitalizations of patients with acute pulmonary embolism (53.0% females, 55.9% aged ≥70years) were recorded in Germany between 2005 and 2020; the CCI class stratified them. Among these, 100,156 (7.3%) were categorized as very-low, 221,545; (16.1%) as mild, 394,965 (28.8%) as moderate, and 656,479 (47.8%) as patients with a high comorbidity burden according to CCI class. In-hospital case-fatality increased depending on the CCI class: 3.6% in very-low, 6.5% in mild, 12.1% in moderate and 22.1% in high CCI class (P<0.001). CCI class was associated with increased in-hospital case-fatality (OR 2.014 [95%CI 2.000-2.027], P<0.001). CONCLUSION: Our study results may help to better understand and measure the association between an aggravated comorbidity profile and increased in-hospital case-fatality in patients with pulmonary embolism.

Undiagnosed Autism Spectrum Disorder in a Child With Chronic Pain: A Case Report.

The literature acknowledges the presence of psychiatric comorbidities in pediatric chronic pain populations. Few studies have focused on comorbidity with autism spectrum disorders. We describe the case of a 10-year-old patient at the onset of his care by the chronic pain team. This boy had been experiencing refractory multifocal chronic pain for three years and had undergone multiple medical examinations that had not identified the cause of the pain or provided sufficient pain relief. During our consultations, the behavioral peculiarities (averted gaze, inhibition), the atypical description of this boy's pain (pain in the hair), and sensory peculiarities (intolerance to noise) led us to suspect an autism spectrum disorder. A multidisciplinary approach, including a thorough developmental history and evaluation by an autism resource center, confirmed this suspicion. The diagnosis of an underlying autism spectrum disorder allowed us to guide our management by integrating the specific sensory aspects of this boy. Concurrently, we facilitated the family's better understanding of the young boy's issues and addressed his social and communication difficulties. Through multidisciplinary care and the integration of these various aspects, our patient's clinical situation improved. Multidisciplinary management is essential in chronic pain teams.

The comorbid network characteristics of anxiety and depressive symptoms among Chinese college freshmen.

BACKGROUND: This study aimed to investigate the interplay between anxiety and depressive symptoms in Chinese college freshmen using the causal system perspective (CSP), which differs from the traditional common cause perspective (CCP) by providing an alternative explanation by attributing comorbidity to direct interactions among symptoms. METHODS: A convenience sample of 2,082 Chinese college freshmen (39.51% male, Mage = 18.61) from a normal university completed the Generalized Anxiety Disorder 7-Item Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9). Network analysis was conducted and evaluated as to centrality, stability, node predictability, and bridging features. Moreover, the moderated network model (MNM) was utilized to detect the moderation effects of gender in the comorbidity network. RESULTS: The network of anxiety and depressive symptoms exhibited stability, characterized by the core symptoms of "restlessness", "lack of energy", and "excessive worry about control", as well as the bridging symptoms of "fearfulness", "sad mood", and "irritability". Notably, the nodes representing "uncontrollable worry" and "difficulty in relaxation" demonstrated the highest predictive power. Gender did not exert any moderating effects on the anxiety and depressive symptom network. CONCLUSION: These results reinforce that certain anxiety or depressive symptoms are more central than others, and thus play a more vital role in the comorbid network. These findings highlight underlying potential targeting symptoms to consider in future interventions.

The impact of comorbidity on the quality of life of people who recovered from COVID-19 in Bangladesh.

Objectives: COVID-19 affects the quality of life (QoL) in a reverse way after recovery, which might be multiplied by the comorbid non-communicable diseases. This study explored the relationship between comorbidities and the QoL of people who recovered from COVID-19 in Bangladesh. Methods: The cross-sectional study was conducted among 3244 participants between June 2020 and November 2020 using a pre-tested questionnaire through over-the-phone interviews. The WHOQOL-BREF was used to explore the QoL among the study participants. A multivariable linear regression model was conducted to identify the effects of the number of comorbidities on QoL scores of all four domains. Results: Of 3244 patients who recovered from COVID-19, over one-third (39.4%) had one or more chronic diseases, such as hypertension, diabetes mellitus, ischemic heart disease, bronchial asthma/chronic obstructive pulmonary disease, chronic kidney disease, and cancer. Around 46.85% of the participants aged above 40 years presented with one to two chronic diseases, and 16.33% had three or more chronic diseases. Among all comorbidities, the participants with cancer and chronic kidney disease were found to have relatively lower scores in all four domains than other comorbidities. The lowest QoL scores were observed in the psychological domain. Those with three or more simultaneous chronic comorbidities had the lowest QoL score in all four domains: physical, psychological, social relationship, and environmental. Conclusions: Persons who recovered from COVID-19 with comorbidities undergo a lower QoL. Therefore, special attention is required to these vulnerable groups to ensure their smooth recuperation.

The regional disparities in liver disease comorbidity among elderly Chinese based on a health ecological model: the China Health and Retirement Longitudinal Study.

PURPOSE: This study aimed to investigate the risk factors for liver disease comorbidity among older adults in eastern, central, and western China, and explored binary, ternary and quaternary co-morbid co-causal patterns of liver disease within a health ecological model. METHOD: Basic information from 9,763 older adults was analyzed using data from the China Health and Retirement Longitudinal Study (CHARLS). LASSO regression was employed to identify significant predictors in eastern, central, and western China. Patterns of liver disease comorbidity were studied using association rules, and spatial distribution was analyzed using a geographic information system. Furthermore, binary, ternary, and quaternary network diagrams were constructed to illustrate the relationships between liver disease comorbidity and co-causes. RESULTS: Among the 9,763 elderly adults studied, 536 were found to have liver disease comorbidity, with binary or ternary comorbidity being the most prevalent. Provinces with a high prevalence of liver disease comorbidity were primarily concentrated in Inner Mongolia, Sichuan, and Henan. The most common comorbidity patterns identified were "liver-heart-metabolic", "liver-kidney", "liver-lung", and "liver-stomach-arthritic". In the eastern region, important combination patterns included "liver disease-metabolic disease", "liver disease-stomach disease", and "liver disease-arthritis", with the main influencing factors being sleep duration of less than 6 h, frequent drinking, female, and daily activity capability. In the central region, common combination patterns included "liver disease-heart disease", "liver disease-metabolic disease", and "liver disease-kidney disease", with the main influencing factors being an education level of primary school or below, marriage, having medical insurance, exercise, and no disabilities. In the western region, the main comorbidity patterns were "liver disease-chronic lung disease", "liver disease-stomach disease", "liver disease-heart disease", and "liver disease-arthritis", with the main influencing factors being general or poor health satisfaction, general or poor health condition, severe pain, and no disabilities. CONCLUSION: The comorbidities associated with liver disease exhibit specific clustering patterns at both the overall and local levels. By analyzing the comorbidity patterns of liver diseases in different regions and establishing co-morbid co-causal patterns, this study offers a new perspective and scientific basis for the prevention and treatment of liver diseases.

Risk factors for anxiety and its impacts on acute exacerbation in older patients with chronic obstructive pulmonary disease.

Background: Anxiety is common in patients with chronic obstructive pulmonary disease (COPD), especially in older patients with the definition of age over 60 years old. Few studies have focused on anxiety in older COPD patients. This study aimed to analyze the risk factors of anxiety in older COPD patients and the impacts of anxiety on future acute exacerbation. Methods: The general information, questionnaire data, previous acute exacerbation and pulmonary function were collected. Hamilton Anxiety Rating Scale (HAMA) was used to evaluate the anxiety of older COPD patients. The patients were followed up for one year, the number and the degrees of acute exacerbations of COPD were recorded. Results: A total of 424 older COPD patients were included in the analysis. 19.81% (N = 84) had anxiety symptoms, and 80.19% (N = 340) had no anxiety symptoms. There were increased pack-years, more comorbidities, and more previous acute exacerbations in older COPD patients with anxiety compared to those without anxiety (P < 0.05). Meanwhile, a higher modified Medical Research Council (mMRC), a higher COPD assessment test (CAT) score and a shorter six-minute walking distance (6MWD) were found in older COPD patients with anxiety (P < 0.05). The BODE index, mMRC, CAT score, comorbidities and acute exacerbations were associated with anxiety. Eventually, anxiety will increase the risk of future acute exacerbation in older COPD patients (OR = 4.250, 95% CI: 2.369-7.626). Conclusion: Older COPD patients with anxiety had worsening symptoms, more comorbidities and frequent acute exacerbation. Meanwhile, anxiety may increase the risk of acute exacerbation in the future. Therefore, interventions should be provided to reduce the risk of anxiety in older COPD patients at an early stage.

Correlational analysis of sarcopenia and multimorbidity among older inpatients.

BACKGROUND: Sarcopenia and multimorbidity are common in older adults, and most of the available clinical studies have focused on the relationship between specialist disorders and sarcopenia, whereas fewer studies have been conducted on the relationship between sarcopenia and multimorbidity. We therefore wished to explore the relationship between the two. METHODS: The study subjects were older patients (aged ≥ 65 years) who were hospitalized at the Department of Geriatrics of the First Affiliated Hospital of Chongqing Medical University between March 2016 and September 2021. Their medical records were collected. Based on the diagnostic criteria of the Asian Sarcopenia Working Group in 2019, the relationship between sarcopenia and multimorbidity was elucidated. RESULTS: 1.A total of 651 older patients aged 65 years and above with 2 or more chronic diseases were investigated in this study, 46.4% were suffering from sarcopenia. 2. Analysis of the relationship between the number of chronic diseases and sarcopenia yielded that the risk of sarcopenia with 4-5 chronic diseases was 1.80 times higher than the risk of 2-3 chronic diseases (OR 1.80, 95%CI 0.29-2.50), and the risk of sarcopenia with ≥ 6 chronic diseases was 5.11 times higher than the risk of 2-3 chronic diseases (OR 5.11, 95% CI 2.97-9.08), which remained statistically significant, after adjusting for relevant factors. 3. The Charlson comorbidity index was associated with skeletal muscle mass index, handgrip strength, and 6-meter walking speed, with scores reaching 5 and above suggesting the possibility of sarcopenia. 4. After adjusting for some covariates among 14 common chronic diseases in older adults, diabetes (OR 3.20, 95% CI 2.01-5.09), cerebrovascular diseases (OR 2.07, 95% CI 1.33-3.22), bone and joint diseases (OR 2.04, 95% CI 1.32-3.14), and malignant tumors (OR 2.65, 95% CI 1.17-6.55) were among those that still a risk factor for the development of sarcopenia. CONCLUSION: In the hospitalized older adults, the more chronic diseases they have, the higher the prevalence of sarcopenia. When the CCI is 5, attention needs to be paid to the occurrence of sarcopenia in hospitalized older adults.

Prospective Cohort Study Identifies Medical Predictors of Treatment-Related Oral Toxicities in Oral and Oropharyngeal Cancer Patients.

The dental treatment of patients with oral cavity and oropharyngeal squamous cell carcinoma (OOPSCC) may be challenging for dentists. This study aimed to characterize systemic changes in patients with OOPSCC undergoing dental treatment prior to cancer therapy, with a specific focus on laboratory assessments. The primary objectives included identifying potential adverse events, such as infections or bleeding, resulting from dental procedures. Additionally, the study aimed to correlate baseline patient characteristics with treatment-related toxicities. This was a prospective cohort study that included 110 OOPSCC patients referred to the Dental Oncology Service at São Paulo State Cancer Institute, Brazil, between November/2019 and December/2020. Comorbidities, sociodemographic data, medication in use, cancer treatment-related toxicities, and altered laboratory tests results were correlated. The most common comorbidities and altered laboratory results were hypertension, dyslipidemia, diabetes, as well as elevated levels of C-reactive protein, hemoglobin, and hematocrit. Toxicities exhibited a progressive pattern over time, encompassing oral mucositis (OM), xerostomia, dysphagia, dysgeusia, trismus, and radiodermatitis. No correlation between comorbidities and cancer treatment-related toxicities, a positive correlation between medications in use and OM, and a negative correlation between medications and dysgeusia were found. OM was associated with altered thyroxine (T4) and free thyroxine (FT4), calcium, urea, creatinine, alkaline phosphatase, and syphilis. Family income and housing were OM predictors. Altered T4/FT4/urea/calcium/alkaline phosphatase/creatinine/syphilis may be useful clinical predictors of OM. Despite the elevated prevalence of comorbidities and abnormal laboratory findings, dental treatment prior to cancer treatment yielded no adverse events.

The clinical outcomes and healthcare resource utilization in IgG4-related disease: a claims-based analysis of commercially insured adults in the United States.

OBJECTIVES: IgG4-related disease (IgG4-RD) can affect nearly any organ and is often treated with glucocorticoids, which contribute to organ damage and toxicity. Comorbidities and healthcare utilization in IgG4-RD are poorly understood. METHODS: We conducted a cohort study using claims data from a United States managed care organization. Incident IgG4-RD cases were identified using a validated algorithm; general population comparators were matched by age, sex, race/ethnicity, and index date. The frequency of 21 expert-defined clinical outcomes associated with IgG4-RD or its treatment and healthcare-associated visits and costs were assessed 12 months before and 36 months after the index date (date of earliest IgG4-RD-related claim). RESULTS: There were 524 cases and 5,240 comparators. Most cases received glucocorticoids prior to (64.0%) and after (85.1%) the index date. Nearly all outcomes, many being common glucocorticoid toxicities, occurred more frequently in cases vs comparators. During follow-up, the largest differences between cases and comparators were seen for gastroesophageal reflux disease (prevalence difference: +31.2%, p< 0.001); infections (+17.3%, p< 0.001); hypertension (+15.5%, p< 0.01); and diabetes mellitus (+15.0%, p< 0.001). The difference in malignancy increased during follow-up from +8.8% to + 12.5% (p< 0.001). 17.4% of cases used pancreatic enzyme replacement therapy during follow-up. Over follow-up, cases were more often hospitalized (57.3% vs 17.2%, p< 0.01) and/or had an ER visit (72.0% vs 36.7%, p< 0.01); all costs were greater in cases than comparators. CONCLUSIONS: Patients with IgG4-RD are disproportionately affected by adverse outcomes, some of which may be preventable or modifiable with vigilant clinician monitoring. Glucocorticoid-sparing treatments may improve these outcomes.

Social support and the burden of physical and psychiatric comorbidities in the patients with late-onset epilepsy in China: A cross-sectional study.

INTRODUCTION: Epilepsy is the third most common neurological disorder in elderly people. Patients with epilepsy (PWEs) are more likely to have comorbidities. Social support is very important for PWEs. However, there are many gaps in the research on social support in older PWEs, especially the correlation between social support and comorbidities. METHODS: A cross-sectional study was conducted in three hospitals in China. Social support was assessed using the Social Support Rate Scale. The burden of physical comorbidities was assessed using the CCI, and global disability was assessed using the mRS. The NDDIE was used to assess depression, the GAD7 was used for anxiety, the CDR was used for cognitive status, and the NPI was used for psychotic symptoms. RESULTS: A total of 154 older PWEs participated in the study. There were 97 patients with at least one physical comorbidities. The burden of physical comorbidities was negatively correlated with overall social support (Adj. r = -0.35, P < 0.001) and global disability (Adj. r = -0.45, P < 0.001). In terms of psychiatric comorbidities, anxiety, depression, and cognitive status were not correlated with overall social support (Adj. r = -0.03, -0.02, and -0.11, P > 0.05). Psychotic symptoms were correlated with overall social support (Adj. r = -0.20, P < 0.05). The overall burden of psychiatric comorbidities was associated with overall social support (r = 0.30, P < 0.01). DISCUSSION: Neurologists and social workers should consider more personalized biopsychosocial care to improve the quality of life of older PWEs.

Charlson comorbidity index and the severity of community-acquired pneumonia caused by SARS-CoV-2: A retrospective analysis.

BACKGROUND: The Charlson comorbidity index (CCI) has been considered as a valid and reliable tool for predicting poor clinical outcomes and mortality in patients with coronavirus disease 2019 (COVID-19). However, its relationship with the severity of pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has not been thoroughly explored. OBJECTIVES: The aim of the present study was to identify the impact of the comorbidity burden, quantitatively assessed by applying CCI, on the severity of inpatient community-acquired pneumonia (CAP) caused by SARS-CoV-2. MATERIAL AND METHODS: The study was conducted using the medical records of 208 patients with CAP who had an epidemiological history of a plausible SARS-CoV-2 infection, with positive polymerase chain reaction (PCR) confirmation no later than 1 month before being admitted for inpatient treatment. The CCI was calculated using a custom computer program. The statistical analysis of data was carried out using Statistica, v. 7.0. RESULTS: Our study found a significant correlation between the comorbidity burden and the severity of CAP caused by SARS-CoV-2. Specifically, we observed a low CCI score in the majority of patients in the pneumonia risk class II and III groups, and a high CCI score ≥3 in the majority of patients in the pneumonia risk class IV group. Moreover, a direct correlation between CCI and age was established. The comorbidities most commonly associated with CAP caused by SARS-CoV-2 were congestive heart failure, moderate to severe liver diseases and diabetes mellitus (DM) with chronic complications. CONCLUSIONS: The use of CCI to evaluate comorbid pathology in hospitalized patients with CAP caused by SARS-CoV-2 can assist the medical staff in developing timely preventive and therapeutic strategies, leading to improved patient prognosis.

Age-varying associations between attempts to change weight and suicidal ideation among adolescents in the United States.

PURPOSE: The goal of this study was to inform theory and suicide prevention efforts by examining how the link between attempts to change weight and suicidal ideation varies across adolescence, when it is strongest, and whether there are sex differences. METHODS: Data were from 13,518 youth ages 14-18 years who participated in the 2019 Youth Risk Behavior Survey, a nationally representative study of U.S. high school students. Time-varying effect modeling was used to estimate associations between attempts to change weight and suicidal ideation as continuous functions of age and to test sex differences in these links. RESULTS: The link between attempts to lose weight and suicidal ideation was positive and significant between ages 14.0-17.3 years, with the strongest association at age 15.0 (OR = 2.07). There were no sex differences in this age-varying association. The association between attempts to gain weight and suicidal ideation was positive and age-varying for girls, with the strongest association at age 17.2 years (OR = 2.79). This association was not significant for boys at any age. CONCLUSIONS: Girls and boys who are trying to lose weight and girls who are trying to gain weight may be at elevated risk for suicidal ideation between ages 14 and 18 years. Findings illuminate patterns of association during adolescence and have implications for suicide prevention.

Psychiatric diagnoses, somatic disorders, and emergency dispatches among individuals who used a national suicide crisis line.

Crisis line responders initiate emergency dispatches by activating 911 or other local emergency services when individuals are determined to be at imminent risk for undesired outcomes. This study examined the association of characteristics, psychiatric diagnoses, and somatic symptoms with emergency dispatches in a national sample. Veterans Crisis Line data were used to identify contacts (i.e., calls, texts, chats, emails) that were linked with medical records and had a medical encounter in the year prior to contact. Hierarchical logistic regression clustered by responders was used to identify the association among demographics, psychiatric diagnoses, and somatic disorders, and emergency dispatches. Analyses examined 247,340 contacts from 2017 to 2020, with 27,005 (10.9%) emergency dispatches. Odds of an emergency dispatch increased with each diagnosis (three diagnoses Adjusted Odds Ratio [AOR] (95% CI) = 1.88 [1.81,1.95]). Odds were highest among individuals with substance use disorders (SUD) (alcohol AOR (95% CI) = 1.85 [1.80,1.91]; drugs AOR (95% CI) = 1.63 [1.58, 1.68]), which may be a result of intoxication or overdose during contact, requiring further research. Having more psychiatric and somatic conditions was associated with greater odds of an emergency dispatch, indicating that comorbidity contributed to the need for acute care.

Incidence, prevalence, and medical costs of pressure injuries in Taiwan from 2001 to 2015: Results of a retrospective cohort study.

AIMS AND OBJECTIVES: This study aims to analyse the trends in the incidence, prevalence and medical costs of pressure injuries (PIs) among genders in Taiwan. BACKGROUND: The treatment of PIs is complex and costly, often leading to complications and increased mortality. This issue significantly impacts healthcare quality and incurs substantial medical and social costs, warranting attention. METHODS: A retrospective cohort study was conducted using data from Taiwan's National Health Insurance Database to obtain and calculate the incidence, prevalence, and medical costs of PIs in the country between 2001 and 2015 as well as to analyse high-risk groups and the medical care utilisation of patients following the STROBE reporting guidelines. RESULTS: Between 2001 and 2015, 15,327 incident case of PIs were diagnosed. During the study period, the prevalence rate of PIs per 100,000 population rose from 26.3 to 189.6, with approximately 11.5%-16.3% of patients undergoing surgical debridement. The PIs prevalence rate increased by 7.2-fold, and hospitalisation costs accounted for 91.7%-96.0% of the total medical costs. Patients with older age, comorbidities, poorer financial status and lower education levels were found to be likely to develop PIs. These predisposing factors differed between males and females. The prevalence of PIs was higher in patients ≥75 years old than in patients from other age groups. Moreover, PI-related medical expenses have been increasing annually. CONCLUSIONS: In Taiwan, the rising incidence of PIs is driving up medical costs. Effective care and prevention of PIs necessitate a comprehensive plan from the entire healthcare system. RELEVANCE TO CLINICAL PRACTICE: This research fills a gap in the available data on the incidence, prevalence, and medical costs of PIs in Taiwan and Asia. PATIENT OR PUBLIC CONTRIBUTION: The findings can be used to help develop clinical guidelines for preventive education and treatment of PIs.

Lifetime and current mental health based on avoidant/restrictive food intake disorder history versus other eating disorder history in the Healthy Minds Study.

OBJECTIVE: Research on psychiatric comorbidities associated with avoidant/restrictive food intake disorder (ARFID) primarily compares ARFID versus anorexia nervosa (AN). Little is known about comorbidities associated with mixed ARFID/other eating disorder (ED) history or ARFID comorbidities relative to EDs beyond AN. This study assessed lifetime and current psychiatric factors in a large college sample with varying ED histories. METHOD: Participants were United States students from the 2021/2022 Healthy Minds Study who endorsed lifetime professionally diagnosed EDs (N = 4657). Chi-square tests compared lifetime ED groups (ARFID, ARFID + Non-ARFID ED, Non-ARFID ED) on lifetime neurodevelopmental, anxiety, obsessive-compulsive, trauma/stressor-related, and depressive disorder prevalence, and suicidality and counseling/therapy receipt. Multivariate analysis of variance evaluated current depressive, anxiety, and ED symptom differences. RESULTS: Lifetime neurodevelopmental and anxiety disorders were less prevalent in "Lifetime Non-ARFID ED" than ARFID groups. Lifetime depressive, trauma/stressor-related, and obsessive-compulsive disorders were relatively more prevalent in "Lifetime ARFID + Non-ARFID ED." This group demonstrated relatively greater current depressive symptoms and past-year suicide attempts. Lifetime ARFID groups demonstrated relatively greater current anxiety. All groups differed on current ED symptoms. Effects were small. DISCUSSION: Historical ARFID is associated with neurodevelopmental disorders and historical/current anxiety. Mixed ARFID/non-ARFID ED history may indicate increased propensity toward varied psychopathology. PUBLIC SIGNIFICANCE STATEMENT: This study replicated findings that ARFID is associated with neurodevelopmental and anxiety disorders in the lifespan through young adulthood. Extending prior work, results suggest a history of ARFID is associated with increased anxiety in young adulthood. Finally, a history of both ARFID and other eating pathology is associated with increased risk for a wide range of psychiatric difficulties (e.g., obsessive-compulsive symptoms, suicide attempts) in the lifespan through young adulthood.

Patterns of comorbid PTSD, depression, alcohol use disorder, and insomnia symptoms in firefighters: A latent profile analysis.

BACKGROUND: Firefighters are an at-risk population for multiple psychiatric conditions, including posttraumatic stress disorder (PTSD), depression, alcohol use disorders (AUDs), and insomnia. These disorders are likely to co-occur; however, patterns of comorbidity have scarcely been investigated in firefighters. We aimed to identify subgroups of comorbidity of PTSD, depression, AUDs, and insomnia in a nationwide population of firefighters in South Korea. METHODS: A total of 54,054 firefighters responded to an online survey. Latent classes of comorbidity were categorized using latent profile analysis (LPA) based on the symptom scores of PTSD, depression, AUDs, and insomnia. Analysis of variance was performed to compare the characteristics of the identified classes, and multinomial logistic regression was conducted to examine whether anger reactions, resilience, and number of traumatic events predicted class membership. RESULTS: The LPA identified four subgroups: minimal symptoms (n = 42,948, 79.5 %), predominant PTSD (n = 2858, 5.3 %), subthreshold symptoms and comorbidity (n = 7003, 13.0 %), and high symptoms and comorbidity (n = 1245, 2.3 %). Three comorbidity classes were defined based on severity and one class showed predominant PTSD symptoms. Number of traumatic exposures predicted predominant PTSD, while resilience and anger reactions predicted severity of comorbidities. LIMITATIONS: The cross-sectional design and usage of self-reported questionnaires are limitations of this study. CONCLUSIONS: The severity of PTSD, depression, AUDs and insomnia tend to correlate and co-occur in firefighters. Our findings highlight the need to assess comorbid symptoms in firefighters and need to reduce anger reactions and enhance resilience in those with multiple comorbidities.

SAGL: A self-attention-based graph learning framework for predicting survival of colorectal cancer patients.

BACKGROUND AND OBJECTIVE: Colorectal cancer (CRC) is one of the most commonly diagnosed cancers worldwide. The accurate survival prediction for CRC patients plays a significant role in the formulation of treatment strategies. Recently, machine learning and deep learning approaches have been increasingly applied in cancer survival prediction. However, most existing methods inadequately represent and leverage the dependencies among features and fail to sufficiently mine and utilize the comorbidity patterns of CRC. To address these issues, we propose a self-attention-based graph learning (SAGL) framework to improve the postoperative cancer-specific survival prediction for CRC patients. METHODS: We present a novel method for constructing dependency graph (DG) to reflect two types of dependencies including comorbidity-comorbidity dependencies and the dependencies between features related to patient characteristics and cancer treatments. This graph is subsequently refined by a disease comorbidity network, which offers a holistic view of comorbidity patterns of CRC. A DG-guided self-attention mechanism is proposed to unearth novel dependencies beyond what DG offers, thus augmenting CRC survival prediction. Finally, each patient will be represented, and these representations will be used for survival prediction. RESULTS: The experimental results show that SAGL outperforms state-of-the-art methods on a real-world dataset, with the receiver operating characteristic curve for 3- and 5-year survival prediction achieving 0.849±0.002 and 0.895±0.005, respectively. In addition, the comparison results with different graph neural network-based variants demonstrate the advantages of our DG-guided self-attention graph learning framework. CONCLUSIONS: Our study reveals that the potential of the DG-guided self-attention in optimizing feature graph learning which can improve the performance of CRC survival prediction.

Improving care for patients with multiple long-term conditions admitted to hospital: challenges and potential solutions.

Increasing numbers of people live with multiple long-term conditions. These people are more likely to be admitted to hospital, experience adverse outcomes and receive poorer quality care than those with a single condition. Hospitals remain organised around a model of single-organ, disease-specific care which is not equipped to meet the needs of people living with multiple long-term conditions. This article considers these challenges and explores potential solutions. These include different service models to provide holistic, multidisciplinary inpatient and outpatient care across specialty boundaries, training a workforce to deliver high-quality hospital care for people living with multiple long-term conditions, and developing technological, financial and cultural enablers of change. Considerably more research is required to fully appreciate the shared risk factors, underlying mechanisms, patterns and consequences of multiple long-term conditions. This is essential to design and deliver better structures and processes of hospital care for people living with multiple long-term conditions.

Enuresis in young offenders - a study on prevalence and mental health comorbidity.

Background: Enuresis is a common disorder in the school-age period, and is often associated with a variety of behavioral, psychological, and social problems. While early studies suggested an association between enuresis and delinquent behavior, there has been no recent research assessing the prevalence of enuresis and its comorbid psychopathology in young offenders. The aim of this study was to therefore assess the prevalence of enuresis and its associated psychiatric comorbidity in incarcerated young offenders. Methods: The prevalence of past and current enuresis and comorbid psychopathology was assessed using a semi-structured psychiatric interview and self-reports from 366 incarcerated male young offenders [age 14 to 19 years (mean age = 16.4)] from Northern Russia. Results: Seventy-three (20.0%) adolescents reported a previous history of enuresis, and in addition almost 10% of the youth reported current enuresis symptoms. Delinquent youth with enuresis did not significantly differ from other youth in the prevalence of comorbid psychiatric diagnoses when assessed by a clinical diagnostic interview, but had significantly higher levels of self-reported mental health problems, and suicidal ideation and attempts. Conclusion: Problems with enuresis are common among delinquent youth and may be associated with increased mental health problems. Given the potentially increased risk for suicidal thoughts and behavior in young offenders with enuresis, comprehensive mental health screening of those who are detected with this condition should be considered in the juvenile justice system.