Browsing by Subject "Comorbidity"
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Item Clinical overlap between Posttraumatic Stress Disorder and Borderline Personality Disorder in male veterans(Texas A&M University, 2006-10-30) Boggs, Christina DanielleThe associated features, high rates of comorbidity and chronicity of Posttraumatic Stress Disorder (PTSD) and Borderline Personality Disorder (BPD) raise questions regarding the distinctiveness of the two disorders. The present study expands upon previous literature by providing an investigation of clinical features across two groups: PTSD only and comorbid PTSD and BPD in a sample of male veterans (n=178). Results suggest that the two groups were distinct, with the comorbid group displaying higher levels of depression, hostility, alcohol use and general psychopathology. Groups did not differ on rates of personal trauma, adult sexual abuse, childhood sexual abuse, attack, accident or disaster. The two groups did differ significantly on rates of childhood violence.Item Comorbidity measures to predict clinical and economic outcomes among elderly gynecologic cancer survivors(2016-05) Park, Chanhyun; Lawson, Kenneth Allen, 1952-; Barner, Jamie C.; Powers, Daniel A.; Rascati, Karen L.; Wilson, James P.The incidence of gynecologic cancers increases with age, and elderly cancer survivors are more likely to have additional comorbid conditions. However, little is known about the relationships between comorbidity and health outcomes among elderly gynecologic cancer survivors. The primary purpose of this study is to examine the relationships between comorbidity and health outcomes, and the secondary purpose is to compare the performance of commonly used comorbidity indices to predict health outcomes among elderly gynecologic cancer survivors. This retrospective data analysis study used the 2007-2010 SEER-Medicare data. The study population was elderly gynecologic cancer survivors in the US. The primary independent variable was each comorbidity index: diagnosis-based indices (Charlson Comorbidity Index (CCI), Elixhauser Index (EI), National Cancer Institute comorbidity (NCI) index) and medication-based indices (the Chronic Disease Score (CDS) and RxRisk). The dependent variables were: survival (overall survival time and one-year mortality), the numbers of healthcare utilization events (emergency room (ER)/inpatient visits, outpatient visits, and office-based practitioner visits), and healthcare costs (ER/inpatient visit, outpatient visit, office-based practitioner visit, pharmacy, and total healthcare). Cox models with time-dependent covariates, Poisson regressions, negative binomial regressions, and gamma regressions with a log link were used. A total of 4,063 survivors were included. Among them, 27.59% died within one year after diagnosis, and the mean (SD) of total healthcare costs was $40,605 ($34,014). The diagnosis-based indices were associated with a shorter overall survival time and an increased mortality and outperformed the medication-based indices in predicting them. Regarding healthcare utilization and costs, the CCI and CDS-1 scores were better predictors for ER/inpatient visit-related outcomes and total healthcare cost, while the CDS-2 and RxRisk scores were better predictors for office-based practitioner visit-related outcomes. None of the comorbidity indices were significant predictors for outpatient visit-related outcomes and prescription costs. Since the ability of the comorbidity indices varied depending on the outcome of interest, the outcome along with the purpose of the study should be considered in selecting an appropriate comorbidity index. This study provides evidence that clinicians can use in developing better treatment plans for specific conditions, that researchers can use in choosing the best comorbidity index, and that payers can use in their budgeting by identifying comorbid conditions with higher costs.Item The effect of internalizing symptomatology on executive functioning performance and processing speed in children with ADHD(2010-08) Christopher, Gina B.; Nussbaum, Nancy; Carlson, Cindy I., 1949-; Keith, Timothy Z.; Sander, Janay B.; Bunner, MelissaAttention Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood psychological disorders with prevalence estimates ranging from 3%-7% (APA, 2000) and one of the most thoroughly studied child neurocognitive disorders. Children with ADHD have consistently shown executive functioning and processing speed deficits on a variety of measures (Berlin, Bohlin, Nyberg, & Janols, 2004; Geurts, Verté, Oosterlaan, Roeyers & Sergeant, 2004; Nigg, 1999; Nigg, Blaskey, Huang-Pollock & Rappley, 2002). The research on executive functioning deficits in other childhood disorders has been comparatively lacking. There is some research that suggests that internalizing disorders, such as anxiety and depression, can also have a detrimental effect on certain executive functioning domains (Airaksinen, Larsson, & Forsell, 2005; Christopher, & MacDonald, 2005; Emerson, Mollet, & Harrison, 2005). It is unclear how these internalizing symptoms will impact executive functioning, processing speed and fine motor control in children with ADHD. The purpose of this study is to determine whether the presence of internalizing symptoms impacts the ability of children with ADHD to perform executive functioning, processing speed, and fine motor control tasks. In order to assess this, the predictive ability of gender, ADHD subtype, parent ratings of anxiety, and parent ratings of depression were examined for processing speed, working memory, response inhibition, vigilance and fine motor control tasks. Gender was found to predict differences in working memory, response inhibition and fine motor control. ADHD subtype was found to predict differences in response inhibition. Parent ratings of anxiety were found to interact with ADHD subtype to predict some aspects of vigilance. Parent ratings of anxiety and of depression were found to predict differences in other aspects of vigilance looking across gender and subtype. Finally, teacher ratings of anxiety were found to predict differences in working memory.Item Intraindividual dimensional structure and prediction of symptoms from cognitions in adults being treated for comorbid mood and anxiety disorders(Texas Tech University, 2000-12) Green, Katherine MichelleCognitive models of depression and anxiety posit that maladaptive beliefs and schemas about the self, world and future play an important causal role in a patient's distress and dysfunction (Clark & A. Beck, 1999). Cognitive therapy manuals (e.g., A. Beck et al., 1979; J. Beck, 1995; Persons, 1989) stress the importance of assessing idiosyncratic beliefs/schema and using this formulation to guide treatment decisions. However, most research testing the cognitive model has used cross sectional aggregate designs instead of the idiographic methodology necessary to determine the role of idiosyncratic beliefs in symptom maintenance. The present study investigated the intraindividual dimensional structure of symptoms and cognitions, and their relationship in adults with comorbid depression and anxiety disorders. The study used a multivariate, replicated, single-subject, repeated-measures design (Jones & Nesselroade, 1990) and an idiographic assessment methodology. Four adults completed a l2-week cognitive-interpersonal formulation-based treatment. Concurrently, each completed daily measures of idiographic items developed from a semi-structured assessment interview as well as items based on standardized outcome measures. Results indicated that one patient demonstrated significant improvement m most standardized measures while the remaining three showed decreases in severity of depression or anxiety. Notably, some individualized measures demonstrated greater sensitivity to change than standardized measures. Interview-based idiographic cognition items contributed strongly to intraindividual cognition factors assessing idiosyncratic beliefs. Time-series regression analyses indicated that these idiosyncratic maladaptive beliefs were important in the maintenance and topography of patient distress. The strength of prediction ranged from R^2 = .05 to .90, with the majority being R^2 > .45. Furthermore, many symptoms were predicted by cognitions on previous days, with lagged relationships present for 11 of the 14 symptom factors (across the four patients). Finally, cognitive-behavioral interpersonal scenarios, developed from the clinical interview, predicted symptom factors incrementally above that of the cognition factors. Results have significant implications for clinical cognitive theory and for assessing and treating patients with comorbid disorders.Item A marketing analysis of how baby boomers can manage their chronic health conditions through digital health information technologies(2011-05) Nettleton, Laura Jeanne; Mackert, Michael; Love, BradThis paper explores chronic health issues as it relates to baby boomers and their use of digital technology. After considering how baby boomers use mobile devices and Internet technologies and what types of information they seek out within these platforms, further examination is done on health related topics such as healthcare, health literacy, and chronic health conditions. In recognition of baby boomers' likely development of one chronic condition or multiple occurring ones (known as comorbidity), three new health technologies are analyzed based on their ability to help individuals manage their chronic conditions. From these three technologies, smart pills, the Health Journal for Pain, and lx Conversations, individual marketing plans are recommended according to how they will benefit baby boomers in regards to better self health management in later adulthood years.Item Performance of comorbidity adjustment measures to predict healthcare utilization and expenditures for patients with diabetes using a large administrative database(2010-12) Cheng, Lung-I; Rascati, Karen L.; Barner, Jamie C.; Lawson, Kenneth A.Objective: The objective of this study was to compare the use of different comorbidity measures to predict future healthcare utilization and expenditures for diabetic patients. Methods: This was a retrospective study that included 8,704 diabetic patients enrolled continuously for three years in the Department of Defense TRICARE program. Administrative claims data were used to calculate six comorbidity measures: number of distinct medications, index-year healthcare expenditures, two versions of the Charlson Comorbidity Index (CCI), and two versions of the Chronic Disease Score (CDS). Linear regression models were used to estimate three health outcomes for one- and two-year post-index periods: healthcare expenditures (COST), number of hospitalizations (HOS), and number of emergency department visits (ED). Logistic regression models were used to estimate binary outcomes (above or below the 90th percentile of COST; [greater than or equal to] 1 HOS or none; [greater than or equal to] 1 ED or none). Comparisons were based on adjusted R², areas under the receiver-operator-curve (c statistics), and the Hosmer-Lemeshow goodness-of-fit tests. Results: The study population had a mean age of 51.0 years (SD = 10.5), and 46.3 percent were male. After adjusting for age and sex, the updated CCI was the best predictor of one-year and two-year HOS (adjusted R² = 8.1%, 9.3%), the number of distinct medications was superior in predicting one-year and two-year ED (adjusted R² = 9.9%, 12.4%), and the index-year healthcare expenditures explained the most variance in one-year and two-year COST (adjusted R² = 35.6%, 31.6%). In logistic regressions, the number of distinct medications was the best predictor of one-year and two-year risks of emergency department use (c = 0.653, 0.654), but the index-year healthcare expenditures performed the best in predicting one-year and two-year risks of hospitalizations (c = 0.684, 0.676) and high-expenditure cases (c = 0.810, 0.823). The updated CCI consistently outperformed the original CCI in predicting the outcomes of interest. Conclusions: In a diabetic population under age 65, the number of distinct medications and baseline healthcare expenditures appeared to have superior or similar powers compared to the CCI or CDS for the prediction of future healthcare utilization and expenditures. The updated CCI was a better predictor than the original CCI in this population.