Evidence from cohort studies suggests that patients with periodontal disease are at increased risk of developing lung cancer.

BackgroundPatients with dementia have increased healthcare utilization and often have comorbid chronic conditions. It is not clear if the increase in utilization is driven by dementia, the comorbidities or both. The objective of this study was to describe the number and types of comorbid conditions in a population-based cohort of older adults with dementia and how the level of comorbidity impacts dementia-related and non-dementia-related health service utilization.MethodsThis study is a retrospective cohort study using multiple linked administrative databases to examine health service utilization and costs of 100,630 community-living older adults living with pre-existing dementia in Ontario, Canada. Comorbid conditions and health service utilization were measured using administrative data (physician visits, emergency department visits, hospitalizations, and homecare contacts).ResultsNearly all, 96.3 %, had at least one comorbid condition, while 18.4 % had five or more comorbid conditions. The most common comorbid conditions were hypertension (77.8 %), and arthritis (66.2 %). All types of utilization increased consistently with the number of comorbid conditions. The average number of dementia-related services tended to be similar across all levels of comorbidity while the average number of non-dementia related visits tended to increase with the level of comorbidity.ConclusionsComorbidities in community-living older adults with dementia are common and account for a substantial proportion of health service use and costs in this population. Our results suggest that comprehensive programs that take a holistic view to identify the needs of patients in the context of other comorbidities are required for persons with dementia living in the community.Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0351-x) contains supplementary material, which is available to authorized users.

Objective: To characterize comorbid chronic conditions, describe health services use, and estimate health care costs among community-dwelling older adults with prior stroke.Methods: This is a retrospective cohort study using administrative data from Ontario, Canada. We identified all community-dwelling individuals aged 66 and over on April 1, 2008 (baseline), who had experienced a stroke at least 6 months prior. We estimated the prevalence of 14 comorbid conditions at baseline; we captured all physician visits, emergency department visits, hospital admissions, home care contacts, and associated costs over 5 years stratifying by number of comorbid conditions. Where possible, we distinguished between health services use for stroke-and non-stroke-related reasons.Results: A total of 29,673 individuals met our criteria. Only 1% had no comorbid conditions, while 74.9% had 3 or more. The most common conditions were hypertension (89.8%) and arthritis (65.8%); 5 other conditions had a prevalence of 20% or more (ischemic heart disease, diabetes, chronic obstructive pulmonary disease, inflammatory bowel disease, and dementia). Use of all health services doubled with increasing comorbidity and was largely attributed to non-strokerelated reasons. Total and per-patient costs increased with comorbidity. Main cost drivers shifted from physician and home care visits to hospital admissions with greater comorbidity.Conclusions: Our findings demonstrate the importance of community-based patient-centered care strategies for stroke survivors that address their range of health needs and prevent more costly acute care use.

Polycyclic aromatic hydrocarbons (PAHs) as constituents of urban grime and indoor surfaces can impact the photochemical conversion of nitrogen dioxide (NO 2 ) to nitrous acid (HONO) thereby impacting the oxidation capacity of the atmosphere. In this study we investigate the effect of relative humidity (RH%), light intensity, and NO 2 concentrations on uptake coefficients (γ) of NO 2 on solid film consisting of fluorene (FL) and a mixture of FL and Na 2 SO 4 as a proxy for urban and indoor grime at ambient pressure and temperature. γ(NO 2 ) on solid FL increased markedly from (5.7 ± 1.7) × 10 −7 at 0% RH to (4.6 ± 1.0) × 10 −6 at 90% RH. The NO 2 to HONO conversion yield, (ΔHONO/ ΔNO 2 )%, increases with RH from 40% at 0% RH up to 80% at 60−90% RH, indicating that the water molecules favor the formation of HONO up to 60% RH. These results suggest that the heterogeneous photochemical reaction of NO 2 on FL and FL/Na 2 SO 4 can be an important source of HONO in the urban environment and indoor atmosphere and should be considered in photochemical models.

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