Adults with CP should be monitored for conditions occurring at higher prevalence in CP, as well as common conditions occurring with advancing age. Age-related functional decline should be anticipated, especially with coexisting seizure disorders and urinary incontinence.

Patients identified with internalizing mental health concerns utilize the ED at elevated rates while also reporting the greatest difficulties accessing care. These findings highlight the need for ED interventions aimed at identifying patient mental health concerns, as well as perceived barriers to care, to design interventions to effectively improve continuity of care.

Background The prevalence of depression among patients in the emergency department (ED) is significantly higher than in the general population, making the ED a potentially important forum for the identification of depression and intervention. Concomitant to the identification of depression is the issue of patient access to appropriate care. Objectives This study sought to establish prevalence estimates of potential barriers to care among ED patients and relate these barriers with symptoms of depression. Methods Two medical students conducted brief surveys on all ED patients ≥ 18 years on demographics, perceived access to care, and depression. Results A total of 636 participants were enrolled. The percentage of participants with mild or greater depression was 42%. The majority of patients reported experiencing some barriers to care, with the most prominent being difficulty finding transportation, work responsibilities, and the feeling that the doctor is not responsive to their concerns. Higher depression scores were bivariately associated with higher overall barriers to care mean scores (r=0.44, p<0.001), suggesting that greater symptoms of depression are associated with greater difficulties accessing care. Particularly strong associations were observed between symptoms of depression and difficulty finding transportation, the feeling that the doctor is not responsive to patients’ concerns, embarrassment about a potential illness and confusion trying to schedule an appointment. Conclusion Across all barriers analyzed, there was a greater incidence of depression associated with a greater perception of barriers. These barriers may be used as potential targets for intervention to increase access to health care resources.

Background/Synopsis Low-dose aspirin is an effective drug for the prevention of cardiovascular disease (CVD) events but individuals with diabetes mellitus can be subject to ‘aspirin resistance’. Thus, aspirin’s effect in these individuals is controversial. Higher blood levels of seafood-derived omega-3 polyunsaturated fatty acids (ω3) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) also have beneficial effects in reducing risk of CVD events but few studies have examined the interaction of plasma EPA and DHA with aspirin ingestion. Objective/Purpose Our study examined the combinatory effects of EPA, DHA, and aspirin ingestion on HDL-cholesterol (HDL-C) and apoA-I exchange (shown to be associated with CVD event risk). Methods 30 adults with Type 2 diabetes mellitus ingested aspirin (81 mg/day) for 7 consecutive days, EPA+DHA (2.6g/day) for 28 days, then both for 7 days. Plasma was collected at baseline and at 5 subsequent visits including 4 hours after each aspirin ingestion. Mixed model methods were used to determine HDL-C-concentrations and apoA-I exchange compared to the baseline visit values. LOWESS curves were used for non-linear analyses of outcomes to help discern change patterns, which was followed by piecewise linear functions for formal testing of curvilinear relationships. Results Significant changes (p<0.05) compared to baseline in both HDL-C-concentrations and apoA-I exchange were present at different times. After 7 days of aspirin-only ingestion, apoA-I exchange was significantly modified by increasing levels of DHA concentration, with increased apoA-I exchange observed up until log(DHA) of 4.6 and decreased exchange thereafter (p=0.03). These LOWESS curve effects were not observed for EPA or HDL-C (p>0.05). Aspirin’s effects on apoA-I exchange were the greatest when EPA or DHA concentrations were moderate compared to high or low. Comparison of EPA, DHA, and EPA+DHA LOWESS curves, demonstrated that the majority of the effect is due to DHA. Conclusion Our results strongly suggest that plasma concentrations of EPA and DHA influence aspirin effects on lipid mediators of CVD event risk where their concentrations are most beneficial when moderate, not high or low. These effects on HDL-C cholesterol and apoA-I exchange are novel. Personalized dosing of DHA in those who take aspirin may be a beneficial option for patients with type 2 diabetes mellitus.

A large number of individuals with developmental disabilities (DDs) go undiagnosed with mental health disorders as a result of being predominantly identified by their DDs. This biased treatment is referred to as diagnostic overshadowing and can stem from stigma and lack of education. It is often exacerbated by the inability to directly apply diagnostic criteria to this population. Despite the prevalence of these issues, these concerns are amenable to appropriate intervention, thus improving quality of care. Since social workers typically have a higher rate of contact with clients compared to other health care professionals, they may play a vital role in identifying the possible presence of mental health issues that otherwise have been overshadowed. The current practice note seeks to identify issues concerning the underdiagnoses of mental health issues in individuals with DDs, highlight their impact, and provide modifiable solutions.

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Introduction Emergency department (ED) patients experience a variety of barriers to care that can lead to unnecessary or repeated visits. By identifying the patterns of barriers experienced by subsets of the ED patient population, future researchers might effectively design interventions to circumvent these barriers and improve care. This study sought to identify classes of individuals with regard to perceived barriers to care. Methods Over a 10-week period, two medical students distributed surveys to eligible patients ≥18 years who presented to the ED. After consent, patients provided demographics data and rated their perceived access to care on nine specific items (scored 1–5). We used latent class analysis (LCA), a parametric clustering method, to determine patient groups. Demographic characteristics were then compared across classes. Results We enrolled a total of 637 patients. Results of the LCA indicated that a six-class solution fit best: 1) low barriers (60%); 2) “work responsibility” barriers (13%); 3) economic-related barriers (10%); 4) “appointment difficulty” barriers (8%); 5) “illness and care responsibilities” barriers (6%); and 6) diverse barriers (2%). Patients in the low-barriers class were the oldest across classes (p<.001). Individuals in the low-barriers class were also more likely to be White (p=.015) and have private insurance (p<.001) than those in the “appointment difficulty,” “illness and care responsibilities,” and diverse barriers classes. Conclusion LCA suggests there are six distinct classes of patients with regard to perceived access to care. These classes may be used as a potential starting point in designing targeted interventions for ED patients to improve continuity of care.