Academic literature on the topic 'Comorbidity – Scotland'

Aims:To analyse the nature and extent of data extracted from case files of deceased individuals in contact with health, social care and criminal justice services six months prior to their drug deaths in Scotland during 2003.Methods:A cross-sectional descriptive analysis of 317 case notes of 237 individuals who had drug related deaths, using a data linkage process, was undertaken. All contacts made with services in the six months prior to death were identified. Information on clinical and social circumstances obtained from case records of social care services, specialist drug treatment, mental health and non-statutory services and the Scottish Prison Service and Criminal Records Office were collated using the Centre for Addiction Research and Education Scotland (CARES) Clinical and Social Circumstances Data Collection Form.Findings:More than 50% (n=237) were seen six months prior to their drug death. Sociodemographic details were reported much more frequently than medical problems. While there was information available on ethnicity (49%), living accommodation (66%), education and income (52%), and dependent children (73%), medical and psychiatric history was recorded in only 12%, blood-borne viral status in 17%, and life events in 26%. This paucity of information was also a feature of the treatment plans and progress recorded for these individuals.Conclusions:The 237 drug deaths were not a population unknown to services. Highly relevant data about the six-month period prior to death were missing. Improved training to promote in-depth recording, and effective monitoring may result in better understanding and reduction of drug deaths.

The article provides a reflection on the social inclusion of children and young people with IDD and associated psychiatric comorbidity through the eyes of practitioners and academics from Norway, Scotland, Sweden, and Romania. Using an autoethnographic approach to share the first-hand experiences of supporting children and young adults with IDD from the perspective of experienced practitioners, telling their stories (individual case studies) and mapping the challenges and successes (best practice) through these professional narratives. The article also acknowledges psychiatric comorbidity in young people with IDD and how psychiatric disorders can impact social inclusion. The results of the self-reflection of active practitioners involved with complex disabilities may serve as a guide for others in sharing best practices and facing difficulties. It also shows the policy developments on a timeline of their practice. Practice-informed issues clinicians and support staff face may aid the training and share the knowledge with other experts. The value added is the interprofessional exchange created by the international contributors.

707 Background: Although inextricably linked, both comorbidity and systemic inflammatory responses have been shown to determine survival in patients undergoing surgery for colorectal cancer (CRC). The present study examines the interrelationships between comorbidity (ASA grade) and systemic inflammation (modified Glasgow Prognostic Score (mGPS)) in patients from the ScotScan dataset. Methods: Clinicopathological characteristics and outcome of consecutive patients undergoing potentially curative resection of TNM I-III CRC in Glasgow Royal Infirmary (Scotland) and Sørlandet Hospital (Norway) were prospectively collected. ASA grade and mGPS (0-CRP ≤ 10mg/L, 1-CRP > 10mg/L, 2-CRP > 10mg/L and albumin < 35g/L) prior to surgery was recorded and relationship with overall survival (OS) examined. Results: 2,295 patients (Scotland: n = 1,234 , Norway: n = 1,061) were included. Patients from Norway were more likely to be older, female and have higher ASA grade (all P < 0.001), and more likely to have colon cancer (76% vs. 67%, P < 0.001). Patients from Norway were less likely to be systemically inflamed (mGPS = 0: 72% vs. 65%, P < 0.001), even after propensity score matching ( n = 736, OR 0.36 95%CI0.25-0.51, P < 0.001). ASA grade and mGPS were significantly associated; 21% of ASA 1 patients had mGPS ≥ 1 compared to 41% of ASA four patients ( P < 0.001). In the propensity-matched cohort, both increasing ASA (HR 1.98 95% CI1.57-2.49, P < 0.001) and mGPS (HR 1.20 95% CI1.02-1.41, P = 0.027) were associated with OS independent of age, N stage and adjuvant therapy use; results in the whole cohort were similar. The combination of ASA grade and mGPS was examined with respect to OS in patients with stage II-III CRC (Table 1). In patients with stage II disease, 3-year OS was stratified from 96% (ASA 1, mGPS0) to 67% (ASA 3, mGPS2) ( P < 0.001); in patients with stage II disease, 3-year OS was stratified from 84% to 44% ( P < 0.001). Conclusions: Using a large, prospectively collected dataset of patients undergoing resection of CRC in two countries, the results of the present study confirm the independent prognostic value of measures of comorbidity and systemic inflammation prior to surgery.

Background: Chronic migraine is common but there is limited knowledge on associated comorbidities. Objectives: To examine mental and physical comorbidities in chronic migraine and the influence of socioeconomic status in a large, nationally representative dataset. Design: Analysis of cross-sectional primary healthcare data from 1,468,404 adults in Scotland. Chronic migraine, 31 other physical conditions, and seven mental health conditions we examined. Prevalence rates were standardized by age groups, sex, and socioeconomic deprivation, and adjusted odds ratio (aOR) and 95% confidence intervals (CI) calculated for those with chronic migraine compared with those without. Results: Chronic migraine patients had more conditions, with the biggest difference found for five or more conditions (chronic migraine 11.7% vs. controls 4.9%; aOR 3.00; 95% CI 2.78–3.22). Twenty-five of the 31 physical conditions were significantly more prevalent in the chronic migraine group. The biggest difference was for chronic pain (aOR 4.33; 95% CI 4.12–4.55). For mental health conditions, the biggest differences were for anxiety (aOR 2.95; 95% CI 2.76–31.5) and depression (aOR 2.94; 95% CI 2.81–3.08). Increasing deprivation was associated with more severe and complex comorbidity (five or more conditions), and with more combined mental and physical comorbidity in the chronic migraine group. Conclusions In a large nationally representative sample in primary care, comorbidity was most common in those with chronic migraine compared with standardized controls, and this was exacerbated by living in areas of higher deprivation.

IntroductionSevere acute pancreatitis (AP) requiring critical care admission (ccAP) impacts negatively on long-term survival.ObjectiveTo document organ-specific new morbidity and identify risk factors associated with premature mortality after an episode of ccAP.DesignCohort study.SettingElectronic healthcare registries in Scotland.ParticipantsThe ccAP cohort included 1471 patients admitted to critical care with AP between 1 January 2008 and 31 December 2010 followed up until 31 December 2014. The population cohort included 3450 individuals from the general population of Scotland frequency-matched for age, sex and social deprivation.MethodsRecord linkage of routinely collected electronic health data with population matching.Primary and secondary outcome measuresPatient demographics, comorbidity (Charlson Comorbidity Index), acute physiology, organ support and other critical care data were linked to records of mortality (death certificate data) and new-onset morbidity. Kaplan-Meier and Cox regression analyses were used to identify risk factors associated with mortality.Results310 patients with AP died during the index admission. Outcomes were not ascertained for five patients, and the deprivation quintile was not known for six patients. 340 of 1150 patients in the resulting postdischarge ccAP cohort died during the follow-up period. Greater comorbidity measured by the Charlson score, prior to ccAP, negatively influenced survival in the hospital and after discharge. The odds of developing new-onset diabetes mellitus after ccAP compared with the general population were 10.70 (95% CI 5.74 to 19.94). A new diagnosis of myocardial infarction, stroke, heart failure, liver disease, peptic ulcer, renal failure, cancer, peripheral vascular disease and lung disease was more frequent in the ccAP cohort than in the general population.ConclusionsThe persistent deleterious impact of severe AP on long-term outcome and survival is multifactorial in origin, influenced by pre-existing patient characteristics and acute episode features. Further mechanistic and epidemiological investigation is warranted.

Before 1980 few patients over the age of 65 started chronic dialysis, despite the fact that the incidence of advanced chronic renal failure was approximately ten times greater in this group compared to young and middle aged adults.1 Since that time the number of elderly patients starting renal replacement has increased markedly and accounted for 38% of new dialysis patients in Scotland in 1995. (Data supplied by the Scottish Renal Registry). In order to meet the needs of older patients with chronic renal failure there has been considerable expansion in renal services and it has been predicted that this will continue to increase in Scotland until 2010.2 The number of older patients receiving dialysis and transplantation is rising steadily and will continue to rise in the future. There is nowadays no justification for a rigid upper age limit in the selection of patients for dialysis although inevitably more elderly patients will be unsuitable on medical grounds than in the younger age groups in particular due to cardiovascular disease. The majority of elderly patients are best managed by haemodialysis but a considerable number can achieve a reasonable quality of health on peritoneal dialysis. Renal transplantation should be seriously considered in the older patient provided that comorbidity is not present, usually in the form of cardiovascular disease, to a degree which would seriously limit life expectation.

Abstract Background Motoric cognitive risk syndrome (MCR) - objective slow gait and subjective cognitive complaints - is quick and easy to measure, making it a potentially useful clinical tool for identifying those at high risk of developing dementia. This is the first exploration of MCR syndrome’s predictive ability for incident dementia in a Scottish cohort (Lothian Birth Cohort 1936) and the first examination of the various trajectories of MCR. Method: We classified a total of 680 community-dwelling participants (mean [SD] age 76.3 [0.8] years) free from dementia into non-MCR or MCR groups. We used cox proportional hazard methods to evaluate the risk of developing all-cause dementia in the years following MCR diagnosis, adjusting for age, sex, comorbidity index, apolipoprotein E status, physical activity level, and years of education. We analysed the trajectories for everyone with MCR by tracking their outcomes over 9 years. Result: The prevalence of MCR at baseline was 5.6% (n=38/680). After 9 years of follow-up, 11.6% (n=79/680) of the total cohort developed dementia. The presence of MCR increased the risk of dementia (adjusted hazard ratio 2.37 [95%CI 1.06-5.32; p=0.0359]). The trajectories of those with MCR at baseline were: i) reverted to healthy (n=6/38), ii) ongoing MCR (n=13/38), iii) progressed to dementia (n=9/38), or iv) died (n=10/38). Conclusion MCR could identify a target group for early interventions of modifiable risk factors to prevent incident dementia. Individuals with MCR follow similar trajectories to the related predementia syndrome, Mild Cognitive Impairment.

Background:Comorbidities are prevalent in patients with rheumatoid arthritis (RA) and associated with worse outcomes as well as higher economic burden. Little is known about the impact of multimorbidity on the direct and indirect costs of RA. Evidence of the incremental scale of these multimorbidity costs will usefully inform RA interventions and policies.Objectives:The aim of this study was to describe how multimorbidity impacts on the cost-of-illness, including direct and indirect costs, in patients with RA.Methods:The Scottish Early Rheumatoid Arthritis (SERA) is a registry of patients newly presenting with RA since 2011. It contains data on patient characteristics, clinical outcomes, health-related quality of life, and employment status data. These data were linked to routinely recorded hospital admissions and primary care prescribing data. Direct costs were estimated by applying relevant unit costs to healthcare resource use quantities. Indirect cost estimates were obtained from information on employment status and hospital admissions, valued by age and sex specific wages. Two-part models (probit followed by generalized linear model) were used to estimate direct and indirect costs, adjusting for age, gender, and functional disability. The Charlson Comorbidity Index (CCI) score was calculated using patient ICD-10 diagnoses from hospital records. The number of comorbidities was categorized into “RA alone”, “single comorbidity” and “multimorbidity (>1 comorbidity)”.Results:Data were available for 1,150 patients, 65.7% were female and a mean age of 57.5±14 years. The majority of patients only had RA (54.1%), followed by a single comorbidity (23.4%) and multimorbidity (22.5%). Annual total costs were significantly higher for patients with multimorbidity (£6,669 95% CI £4,871-£8,466; OR 11.3 95% CI 8.14-15.87) and for patients with a single comorbidity (£2,075 95% CI £1,559-£2,591; OR 3.52 95% CI 2.61-4.79), when compared with RA alone (£590). The excess costs were mainly driven by direct costs (£6,281 versus £1,875 versus £556). Although the difference in indirect costs between patients with multimorbidity and a single comorbidity were not statistically significant (£1,218 versus £914, p=0.11), patients with multimorbidity were associated with significantly higher costs than those with RA only (£594, p<0.01).Conclusion:The presence of comorbidity contributes significant excess to both direct and indirect costs among RA patients. In particular, patients with multimorbidity incurred substantially higher direct costs than those with a single comorbidity or RA only.Acknowledgements:The study analysed the data from the Scottish Early Rheumatoid Arthritis (SERA) study with a linkage to routinely recorded health data from Information Service Division, National Service Scotland. We would like to thank all the patients, clinical and nursing colleagues who have contributed their time and support to the study, the SERA steering committee for the approval, and Allen Tervit from the Robertson Centre for Biostatistics, University of Glasgow for the timely technical supports.Disclosure of Interests:Ping-Hsuan Hsieh: None declared, Claudia Geue: None declared, Olivia Wu Consultant of: OW has received consultancy fees from Bayer, Lupin and Takeda outside the submitted work., Emma McIntosh: None declared

As the chronic disease model is now accepted as the model to treat individuals in the community in the UK, it has become important to recognise that individuals tend to present with more than one concomittant problem (comorbidity). A increasing patient centred approach to treatment and recovery has helped to recognise the dual concept of pain and dependence within the clinical environment. There is an ever increasing prevalence of this dual presentation and this has helped to effectively manage individuals with a substance misuse history and associated chronic pain and others treated for their chronic pain with strong analgesic and subsequently experiencing substance misuse and dependence problems.This presenation aims to provide the literature overview of these populations, clinical characteristics and problems presenting in a pain and dependence clinic in Scotland. Several models of practice will also be presented.

Background Multimorbidity, the co-existence of multiple health conditions in an individual, is a significant Public Health challenge. However, it has no consensus definition or measure, and its determinants and outcomes are not fully understood. Resilience may be a mechanism by which the experience of multimorbidity can be improved but there has been little study of this. Aim To define and measure the prevalence of multimorbidity and resilience to multimorbidity, to assess the role of mental health and childhood socio-economic status (SES) and to investigate the long-term outcomes. Objectives 1. To determine how multimorbidity and resilience to multimorbidity should be defined and measured in Public Health research 2. To assess the prevalence of multimorbidity and resilience to multimorbidity using the measures identified in objective one 3. To assess the role of mental health conditions and childhood SES in the occurrence of multimorbidity and resilience to multimorbidity 4. To assess the impact of multimorbidity and resilience to multimorbidity on long-term outcomes Method Systematic reviews of the literature were conducted to address objective one. The analysis of two contrasting study populations was used to address objectives two to four. These were the Australian cross-sectional Diamond study and the Aberdeen Children of the 1950s cohort study. Results Multimorbidity was defined as the presence of two or more conditions and was measured by patient self-report and healthcare administrative data. Resilience was the presence of good self-reported outcomes despite multimorbidity. Multimorbidity prevalence ranged from 3% to 38%. Mental health conditions led to an increased burden of multimorbidity and a reduced prevalence of resilience. Childhood SES and other SES factors were associated with multimorbidity. Childhood SES and other SES factors were associated with multimorbidity. Multimorbidity was associated with poorer outcomes. Conclusion The findings in this thesis can be used to improve consensus approaches to studying multimorbidity and resilience, and to develop interventions to tackle these.