OBJECTIVE: To describe the prevalence of multimorbidity among individuals with premature ovarian insufficiency (POI) and early menopause, in comparison to average age of menopause.
METHODS: Prospective cohort SUBJECTS: This prospective cohort encompassed female postmenopausal individuals from the Canadian Longitudinal Study on Aging (CLSA). The CLSA collected cross-sectional data from 50,000 community-dwelling Canadians aged 45 to 85 between 2010 and 2015.
METHODS: The primary exposure was primary ovarian insufficiency (defined by onset of menopause younger than 40 years). Comparators included average age of menopause (age 46 to 55 years), early menopause (40-45 years), late onset menopause (56-65 years), and those who underwent a hysterectomy.
METHODS: The primary outcome was multimorbidity, which was defined as two or more chronic conditions. The secondary outcome was severe multimorbidity (defined as three or more chronic conditions) as well as frequencies of specific chronic conditions among a comprehensive list of 15 individual conditions. We assessed the association between multimorbidity and age at menopause using logistic regression and odds ratios, with confidence intervals set at 95%. Odds ratios were adjusted for known predictors of multimorbidity, including age, menopause hormone therapy (MHT), education, ethnicity, self-reported loneliness, living alone, BMI, smoking habits, nutritional risk, social participation, and physical activity.
RESULTS: A total of 12,339 postmenopausal participants were included, of which 374 (3.0%) experienced POI and 1396 (11.3%) experienced early menopause. The prevalence of multimorbidity was 64.8% and 51.1% among those with POI and early menopause respectively. In contrast, only 43.9% of individuals with average age of menopause (age 46 to 55 years) had multimorbidity. The OR for multimorbidity in the POI population was 2.5 (95% CI 2.0-3.1) in comparison to those who underwent the average age of menopause. This relationship was maintained after adjustment for confounders (aOR 2.0, 95% CI: 1.5-2.5). The prevalence of severe multimorbidity was also double in the POI group in comparison in the average age group (39.2% versus 21.1%). There was significantly increased risk of ischemic heart disease (aOR 2.8, 95% CI: 1.7-4.7), gastric ulcers (aOR 1.6, 95% CI: 1.1-2.3) and osteoporosis (aOR 1.6, 95% CI: 1.2-2.1) in the POI group.
CONCLUSIONS: Individuals with POI and early menopause experience increased multimorbidity in comparison to those undergoing menopause at an average age. This trend persists even after adjusting for significant multimorbidity risk factors.

OBJECTIVE: This study aimed to investigate the impact of nutritional support on the clinical efficacy in hospitalised tuberculosis patients with nutritional risk.
METHODS: We selected a total of 266 eligible patients with tuberculosis for the experimental and 190 patients for control groups. The patients in intervention group received adjusted dietary structure, enteral nutrition via oral intake or gastric tube, total parenteral nutrition and combined enteral and parenteral nutrition. We recorded various factors, including age, sex, underlying disease, tuberculosis type, nutritional risk at admission, serum albumin (ALB), body mass index, complications during hospitalisation, nutritional support status, serum ALB before discharge and length of hospital stay.
RESULTS: The incidences of nutritional risk in the control and experimental groups were 64.41% and 64.72%, respectively, with no statistically significant differences in baseline characteristics. The occurrence rates of complications and secondary infections in the experimental group were 57.89% and 51.5%, respectively, which were significantly lower than the control group\'s rates of 70.00% and 56.31%. These differences were statistically significant. The experimental group had a significantly shorter hospital stay (16.5±7.54 days) compared with the control group (19.55±7.33 days). Furthermore, the serum ALB levels of patients in the experimental group were higher on discharge than at admission.
CONCLUSIONS: Hospitalised patients with tuberculosis often face a high incidence of nutritional risk. However, the implementation of standardised nutritional support treatment has shown promising results in improving the nutritional status of tuberculosis patients with nutritional risk. This approach not only helps reduce the occurrence of complications but also enhances short-term prognosis and improves overall clinical efficacy.

In Canada, unhealthy dietary patterns comprise diets with poor nutrient density and are associated with chronic conditions. Plant-based diets have gained popularity due to their ability to provide a nutritionally adequate healthy diet. This study aims to compare sociodemographic, socioeconomic, and health characteristics, and diet quality between Canadian adults following plant-based and omnivore diets as well as assess the extent to which key nutrient intakes are of public health concern among Canadians following plant-based diets. The study used nationally representative nutritional data from the 2015 Canadian Community Health Survey and descriptive statistics were computed. The analysis determined that Canadians following strict plant-based diets (1% of total population) were significantly more likely to be an immigrant to Canada, less likely to meet national physical activity guidelines, and less likely to be overweight, compared to Canadians following omnivore diets. Compared to omnivore diets, plant-based diets were nutritionally superior according to the Nutrient-Rich Food index. Continued knowledge translation on what comprises healthy plant-based diets, public guidance on the intersection between diet and health, and the completion of prospective cohort studies are needed. To conclude, the research suggests well-planned plant-based diets, in comparison to omnivore diets, offer a nutrient-dense diet.

The role of psychotherapy in the management of chronic conditions has been widely explored and supported. The current approach to the utilization of family-oriented psychotherapy in treatment plans is individualized to the patient and focused on the development of personal coping skills alongside identifying and changing negative thoughts, emotions, and behaviors. Alleviation of symptom burden, improvement in psychiatric co-morbidities like anxiety and depression, and enhancement of quality of life have all been found to be associated with incorporating family-oriented psychotherapy in the management of chronic conditions. In contrast, heritable conditions, such as hereditary angioedema (HAE), have not been the center of extensive research. Heritable conditions introduce a new category of stressors that require management like the anxiety of a parent, a sibling, a child, or another family member decompensating at the same time as oneself. Family-centered psychotherapy focuses on discussing the stressors of the family unit and the development of coping strategies to prevent the time course of one family member\'s condition from exacerbating another family member\'s condition. This model has been utilized for families with separate chronic conditions, but its role and effectiveness in managing inherited conditions have room for investigation. This paper presents a case series on a family engaging in family-centered psychotherapy for HAE.

Migraine is a chronic headache disorder. A prototype mobile app-based system was implemented to test data collection and improve data coverage for the Empatica E4 biometric sensor device. Results from the prototype testing are reported. Future iteration of the app will be tested with patients with migraine to predict events and potentially reduce event duration and therefore disease burden.

BACKGROUND: Continuity and coordination-of-care for childhood cancer survivors with multiple chronic conditions are understudied but critical for appropriate follow-up care.
METHODS: From April through June 2022, 800 Childhood Cancer Survivor Study participants with two or more chronic conditions (one or more severe/life-threatening/disabling) were emailed the \"Patient Perceived Continuity-of-Care from Multiple Clinicians\" survey. The survey asked about survivors\' main (takes care of most health care) and coordinating (ensures follow-up) provider, produced three care-coordination summary scores (main provider, across multiple providers, patient-provider partnership), and included six discontinuity indicators (e.g., having to organize own care). Discontinuity (yes/no) was defined as poor care on one or more discontinuity item. Chi-square tests assessed associations between discontinuity and sociodemographics. Modified Poisson regression models estimated prevalence ratios (PRs) for discontinuity risk associated with the specialty and number of years seeing the main and coordinating provider, and PRs associated with better scores on the three care-coordination summary measures. Inverse probability weights adjusted for survey non-participation.
RESULTS: A total of 377 (47%) survivors responded (mean age 48 years, 68% female, 89% non-Hispanic White, 78% privately insured, 74% ≥college graduate); 147/373 (39%) reported discontinuity. Younger survivors were more likely to report discontinuity (chi-square p = .02). Seeing the main provider ≤3 years was associated with more prevalent discontinuity (PR; 95%CI) (1.17; 1.02-1.34 vs ≥ 10 years). Cancer specialist main providers were associated with less prevalent discontinuity (0.81; 0.66-0.99 vs. primary care). Better scores on all three care-coordination summary measures were associated with less prevalent discontinuity: main provider (0.73; 0.64-0.83), across multiple providers (0.81; 0.78-0.83), patient-provider partnership (0.85; 0.80-0.89).
CONCLUSIONS: Care discontinuity among childhood cancer survivors is prevalent and requires intervention.

There is a growing need to implement high quality chronic care to address the global burden of chronic conditions. However, to our knowledge, there have been no systematic attempts to define and specify aims for chronic care quality. To address this gap, we conducted a scoping review and Delphi survey to establish and validate comprehensive specifications. The Institute of Medicine\'s (IOM) quality of care definition and aims were used as the foundation. We purposively selected articles from the scientific (n=48) and grey literature (n=26). We sought papers that acknowledged and unpacked the plurality of quality in chronic care and proposed or utilised frameworks, studied their implementation, or investigated at least two IOM quality care aims and implementation. Articles were analysed both deductively and inductively. The findings were validated through a Delphi survey involving 49 international chronic care experts with varied knowledge of, and experience in, low-and-middle-income countries. Considering the natural history of chronic conditions and the journey of a person with a chronic condition, we defined and identified the aims of chronic care quality. The six IOM aims apply with specific meanings. We identified a seventh aim, continuity, which relates to the issue of chronicity. The group endorsed our specifications and several participants gave contextualised interpretations and concrete examples. Chronic conditions pose specific challenges underscoring the relevance of tailoring quality of care aims. The next steps require a tailored definition and specific aims to improve, measure and assure the quality of chronic care.
Main findings: While previously defined aims of good-quality care may also apply to chronic care quality, the nature of chronic conditions and ensuing healthcare needs warrant specifications for good-quality chronic care.Added knowledge: Our proposed definition and specific aims are tailored to the natural history of chronic conditions, and can serve as a guide on determining what can be deemed as good-quality chronic care.Global health impact for policy and action: This work, developed to guide further work on designing purchasing instruments to improve quality of chronic care, particularly in low- and middle-income countries, may also be a source of inspiration for other interventions aiming at improving quality of chronic care.

OBJECTIVE: People with multiple system atrophy (MSA) and their carers may have many concerns about their disease and the future. This survey of people with MSA and their carers aimed to increase understanding of end-of-life care and palliative care for this group.
METHODS: A survey was undertaken by the MSA Trust of people living with MSA and carers of those with the condition between August and October 2022.
RESULTS: 520 people responded: 215 people with MSA, 214 carers and 91 former carers. The modal class for age in people with MSA was 65-74 years, with 52% male. 76% of people living with MSA had thought to some extent about what they wanted to happen towards the end of their lives. 38% of respondents had discussed end-of-life care options with a healthcare professional and of those who had, over 81% found the conversation helpful. Nevertheless, for 37% of former carers, the death had been unexpected. Only a minority of people living with MSA had been referred for specialist palliative care. 65% of the former carers reported that they were satisfied with the quality of end-of-life care.
CONCLUSIONS: People with MSA and their carers continue to face many complex physical and emotional issues that would benefit from palliative care. Discussions about care at the end of life were generally perceived as helpful, but although the deterioration was often discussed, many families seemed unprepared for the death. Palliative care services were involved but this appeared limited.

BACKGROUND: Children with chronic conditions have greater health care needs than the general paediatric population but may not receive care that centres their needs and preferences as identified by their families. Clinicians and researchers are interested in developing interventions to improve family-centred care need information about the characteristics of existing interventions, their development and the domains of family-centred care that they address. We conducted a scoping review that aimed to identify and characterize recent family-centred interventions designed to improve experiences with care for children with chronic conditions.
METHODS: We searched Medline, Embase, PsycInfo and Cochrane databases, and grey literature sources for relevant articles or documents published between 1 January 2019 and 11 August 2020 (databases) or 7-20 October 2020 (grey literature). Primary studies with ≥10 participants, clinical practice guidelines and theoretical articles describing family-centred interventions that aimed to improve experiences with care for children with chronic conditions were eligible. Following citation and full-text screening by two reviewers working independently, we charted data covering study characteristics and interventions from eligible reports and synthesized interventions by domains of family-centred care.
RESULTS: Our search identified 2882 citations, from which 63 articles describing 61 unique interventions met the eligibility criteria and were included in this review. The most common study designs were quasiexperimental studies (n = 18), randomized controlled trials (n = 11) and qualitative and mixed-methods studies (n = 9 each). The most frequently addressed domains of family-centred care were communication and information provision (n = 45), family involvement in care (n = 37) and access to care (n = 30).
CONCLUSIONS: This review, which identified 61 unique interventions aimed at improving family-centred care for children with chronic conditions across a range of settings, is a concrete resource for researchers, health care providers and administrators interested in improving care for this high-needs population.
UNASSIGNED: This study was co-developed with three patient partner co-investigators, all of whom are individuals with lived experiences of rare chronic diseases as parents and/or patients and have prior experience in patient engagement in research (I. J., N. P., M. S.). These patient partner co-investigators contributed to this study at all stages, from conceptualization to dissemination.

BACKGROUND: The adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine (RSVPreF3 OA) is approved in adults aged ≥60 years. We evaluated RSVPreF3 OA immunogenicity and safety in adults aged 50-59 years without or with increased risk for RSV disease due to specific chronic medical conditions.
METHODS: This observer-blind, phase 3, noninferiority trial included adults aged 50-59 years, stratified into 2 subcohorts: those with and those without predefined, stable, chronic medical conditions leading to an increased risk for RSV disease. Participants in both subcohorts were randomized 2:1 to receive RSVPreF3 OA or placebo. A control group of adults aged ≥60 years received RSVPreF3 OA. Primary outcomes were RSV-A and RSV-B neutralization titers (geometric mean titer ratios and sero-response rate differences) 1 month post-vaccination in 50-59-year-olds versus ≥60-year-olds. Cell-mediated immunity and safety were also assessed.
RESULTS: The exposed population included 1152 participants aged 50-59 years and 381 participants aged ≥60 years. RSVPreF3 OA was immunologically noninferior in 50-59-year-olds versus ≥60-year-olds; noninferiority criteria were met for RSV-A and RSV-B neutralization titers in those with and those without increased risk for RSV disease. Frequencies of RSVPreF3-specific polyfunctional CD4+ T cells increased substantially from pre- to 1 month post-vaccination. Most solicited adverse events had mild-to-moderate intensity and were transient. Unsolicited and serious adverse event rates were similar in all groups.
CONCLUSIONS: RSVPreF3 OA was immunologically noninferior in 50-59-year-olds compared to ≥60-year-olds, in whom efficacy was previously demonstrated. The safety profile in 50-59-year-olds was consistent with that in ≥60-year-olds.
BACKGROUND: ClinicalTrials.gov: NCT05590403.