scholarly journals The Influence of Patient Characteristics on Anticholinergic Events in Older People

2016 ◽  
Vol 5 (3) ◽  
pp. 530-541 ◽  
Author(s):  
Mohammed Saji Salahudeen ◽  
Prasad S. Nishtala ◽  
Stephen B. Duffull
Keyword(s):  
Older People ◽  
Population Level ◽  
Information Criterion ◽  
Patient Characteristics ◽  
Model Framework ◽  
Significant Independent Predictor ◽  
Logistic Regression Models ◽  
Level Data ◽  
Hospitalised Patients ◽  
Comorbidity Index

Aims: To examine patient characteristics that predict adverse anticholinergic-type events in older people. Methods: This retrospective population-level study included 2,248 hospitalised patients. Individual data on medicines that are commonly associated with anticholinergic events (delirium, constipation and urinary retention) were identified. Patient characteristics examined were medicines with anticholinergic effects (ACh burden), age, sex, non-anticholinergic medicines (non-ACM), Charlson comorbidity index scores and ethnicity. The Akaike information criterion was used for model selection. The data were analysed using logistic regression models for anticholinergic events using the software NONMEM. Results: ACh burden was found to be a significant independent predictor for developing an anticholinergic event [adjusted odds ratio (aOR): 3.21, 95% CI: 1.23-5.81] for those taking an average of 5 anticholinergic medicines compared to those taking 1. Both non-ACM and age were also independent risk factors (aOR: 1.41, 95% CI: 1.31-1.51 and aOR: 1.08, 95% CI: 1.05-1.10, respectively). Conclusion: To our knowledge, this is the first study that has examined population-level data in a nonlinear model framework to predict anticholinergic-type adverse events. This study evaluated the relationship between important patient characteristics and the occurrence of anticholinergic-type events. These findings reinforce the clinical significance of reviewing anticholinergic medicines in older people.

Impact of Air Pollution on Cognitive Impairment in Older People: A Cohort Study in Rural and Suburban China

2020 ◽  
Vol 77 (4) ◽  
pp. 1671-1679
Author(s):  
Fan He ◽  
James J. Tang ◽  
Tao Zhang ◽  
Junfen Lin ◽  
Fudong Li ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cognitive Impairment ◽  
Older People ◽  
Air Pollutants ◽  
Disease Risk ◽  
Logistic Regression Models ◽  
Level Data ◽  
Older Chinese ◽  
High Level ◽  
The Impact

Background: The impact of air pollution on cognitive impairment in older people has not been fully understood. It is unclear which air pollutants are the culprit. Objective: We assessed the associations of six air pollutants and air quality index (AQI) with cognitive impairment. Methods: We examined 7,311 participants aged ≥60 years from the ZJMPHS cohort in China. They were interviewed for baseline socio-demographic and disease risk factors in 2014, and re-interviewed in 2015 and 2016, respectively. The presence of cognitive impairment was determined by the Chinese version of the Mini-Mental State Examination. Daily area-level data monitored for air pollution during 2013-2015 was then examined for associations with cognitive impairment in logistic regression models. Results: Over the two years follow-up, 1,652 participants developed cognitive impairment, of which 917 were severe cases. Continuous air pollution data showed the risk of cognitive impairment increased with exposure to PM2.5 (fully adjusted odds ratio [aOR] 1.04, 95% CI 1.01–1.08), PM10 (1.03, 1.001–1.06), and SO2 (1.04, 1.01–1.08), but not with NO2, CO, O3, and AQI. Categorized data analysis for low, middle, and high level exposure demonstrated that the aOR increased with PM2.5 and AQI, somehow with PM10 and CO, but not significantly with SO2 and NO2, and decreased with O3. The patterns for these associations with severe cognitive impairment were stronger. Conclusion: Lowering PM2.5, PM10, SO2, and CO level could reduce the risk of cognitive impairment in older Chinese. Strategies to target most important air pollutants should be an integral component of cognitive interventions.

scholarly journals LO10: Associations between ED crowding metrics and 72h-hour ED re-visits: Which crowding metrics are most highly associated with patient-oriented adverse outcomes?

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S10
Author(s):  
A. McRae ◽  
G. Innes ◽  
M. Schull ◽  
E. Lang ◽  
E. Grafstein ◽  
...  
Keyword(s):  
Patient Outcomes ◽  
Regression Models ◽  
Information Criterion ◽  
Patient Characteristics ◽  
Adverse Outcomes ◽  
Logistic Regression Models ◽  
Return Visits ◽  
Offload Delay ◽  
Ed Crowding ◽  
Meaningful Measure

Introduction: Emergency Department (ED) crowding is a pervasive problem and is associated with adverse patient outcomes. Yet, there are no widely accepted, universal ED crowding metrics. The objective of this study is to identify ED crowding metrics with the strongest association to the risk of ED revisits within 72 hours, which is a patient-oriented adverse outcome. Methods: Crowding metrics, patient characteristics and outcomes were obtained from administrative data for all ED encounters from 2011-2014 for three adult EDs in Calgary, AB. The data were randomly divided into three partitions for cross-validation, and further divided by CTAS category 1, 2/3 and 4/5. Twenty unique ED crowding metrics were calculated and assigned to each patient seen on each calendar day or shift, to standardize the exposure. Logistic regression models were fitted with 72h ED revisit as the dependent variable, and an individual crowding metric along with a common list of confounders as independent variables. Adjusted odds ratios (OR) for the 72h return visits were obtained for each crowding metric. The strength of associations between 72h revisits and crowding metrics were compared using Akaike's Information Criterion and Akaike weights. Results: This analysis is based on 1,149,939 ED encounters. Across all CTAS groups, INPUT metrics (ED census, ED occupancy, waiting time, EMS offload delay, LWBS%) were only weakly associated with the risk of 72h re-visit. Among THROUGHPUT metrics, ED Length of Stay and MD Care Time had similar adjusted ORs for 72h ED re-visit (range 0.99-1.15). Akaike weights ranging from 0.3/1.00 to 0.4/1.00 indicate that both THROUGHPUT metrics are reasonable predictors of 72h ED re-visits. All OUTPUT metrics (boarding time, # of boarded patients, % of beds occupied by boarded patients, hospital occupancy) had statistically significant ORs for 72h ED re-visits. The median boarding time had the highest adjusted OR for 72h ED re-visit (adjusted OR 1.40, 95% CI 1.33-1.47) and highest Akaike weight (0.97/1.00) compared to all other OUTPUT metrics, indicating that median boarding time had the strongest association with 72h re-visits. Conclusion: ED THROUGHPUT and OUTPUT metrics had consistent associations with 72h ED re-visits, while INPUT metrics had little to no association with 72h re-visits. Median boarding time is the strongest predictor of 72h re-visits, indicating that this may be the most meaningful measure of ED crowding.

Impact of Air Pollution on Cognitive Impairment in Older People: A Cohort Study in Rural and Suburban China

2021 ◽  
Author(s):  
Fan He ◽  
James J. Tang ◽  
Tao Zhang ◽  
Junfen Lin ◽  
Fudong Li ◽  
...  
Keyword(s):  
Air Pollution ◽  
Cognitive Impairment ◽  
Older People ◽  
Air Pollutants ◽  
Disease Risk ◽  
Logistic Regression Models ◽  
Level Data ◽  
Older Chinese ◽  
High Level ◽  
The Impact

Background: The impact of air pollution on cognitive impairment in older people has not been fully understood. It is unclear which air pollutants are the culprit. Objective: We assessed the associations of six air pollutants and air quality index (AQI) with cognitive impairment. Methods: We examined 7,311 participants aged ≥60 years from the ZJMPHS cohort in China. They were interviewed for baseline socio-demographic and disease risk factors in 2014, and re-interviewed in 2015 and 2016, respectively. The presence of cognitive impairment was determined by the Chinese version of the Mini-Mental State Examination. Daily area-level data monitored for air pollution during 2013–2015 was then examined for associations with cognitive impairment in logistic regression models. Results: Over the two years follow-up, 1,652 participants developed cognitive impairment, of which 917 were severe cases. Continuous air pollution data showed the risk of cognitive impairment increased with exposure to PM2.5 (fully adjusted odds ratio [aOR] 1.04, 95%CI 1.01–1.08), PM10 (1.03, 1.001–1.06), and SO2 (1.04, 1.01–1.08), but not with NO2, CO, O3, and AQI. Categorized data analysis for low, middle, and high level exposure demonstrated that the aOR increased with PM2.5 and AQI, somehow with PM10 and CO, but not significantly with SO2 and NO2, and decreased with O3. The patterns for these associations with severe cognitive impairment were stronger. Conclusion: Lowering PM2.5, PM10, SO2, and CO level could reduce the risk of cognitive impairment in older Chinese. Strategies to target most important air pollutants should be an integral component of cognitive interventions.

scholarly journals Pancreaticobiliary endoscopic ultrasound in England 2007 to 2016: Changing practice and outcomes

2021 ◽  
Vol 09 (11) ◽  
pp. E1731-E1739
Author(s):  
Nigel Trudgill ◽  
Kofi W. Oppong ◽  
Umair Kamran ◽  
Dominic King ◽  
Amandeep Dosanjh ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Adverse Events ◽  
Endoscopic Ultrasound ◽  
Emergency Admission ◽  
Population Level ◽  
Needle Aspiration ◽  
Logistic Regression Models ◽  
Factors Associated ◽  
Changing Practice ◽  
Level Data

Abstract Background and study aims Population-level data on the outcomes of pancreaticobiliary endoscopic ultrasound (PB-EUS) are limited. We examined national PB-EUS and fine-needle aspiration (FNA) activity, its relation to pancreatic cancer therapy, associated mortality and adverse events. Patients and methods Adults undergoing PB-EUS in England from 2007–2016 were identified in Hospital Episode Statistics. A pancreatic cancer cohort diagnosed within 6 months of PB-EUS were studied separately. Multivariable logistic regression models examined associations with 30-day mortality and therapies for pancreatic cancer. Results 79,269 PB-EUS in 68,908 subjects were identified. Annual numbers increased from 2,874 (28 % FNA) to 12,752 (35 % FNA) from 2007 to 2016. 8,840 subjects (13 %) were diagnosed with pancreatic cancer. Sedation related adverse events were coded in 0.5 % and emergency admission with acute pancreatitis in 0.2 % within 48 hours of PB-EUS. 1.5 % of subjects died within 30 days of PB-EUS. Factors associated with 30-day mortality included increasing age (odds ratio 1.03 [95 % CI 1.03–1.04]); male sex (1.38 [1.24–1.56]); increasing comorbidity (1.49 [1.27–1.74]); EUS-FNA (2.26 [1.98–2.57]); pancreatic cancer (1.39 [1.19–1.62]); increasing deprivation (least deprived quintile 0.76 [0.62–0.93]) and lower provider PB-EUS volume (2.83 [2.15–3.73]). Factors associated with surgical resection in the pancreatic cancer cohort included lower provider PB-EUS volume (0.44 [0.26–0.74]) and the least deprived subjects (1.33 [1.12–1.57]). 33 % of pancreatic cancer subjects who underwent EUS, did not subsequently receive active cancer treatment. Conclusions Lower provider PB-EUS volume was associated with higher 30-day mortality and reduced rates of both pancreatic cancer surgery and chemotherapy. These results suggest potential issues with case selection in lower-volume EUS providers.

scholarly journals Association between multimorbidity patterns and disability among older people covered by long-term care insurance in Shanghai, China

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zijing Wang ◽  
Wenjia Peng ◽  
Mengying Li ◽  
Xinghui Li ◽  
Tingting Yang ◽  
...  
Keyword(s):  
Older People ◽  
Functional Disability ◽  
Long Term Care ◽  
Strong Association ◽  
Binary Logistic Regression ◽  
Term Care ◽  
Logistic Regression Models ◽  
Disease Pattern ◽  
Long Term Care Insurance

Abstract Background Functional disability and multimorbidity are common among older people. However, little is known about the relationship between functional disability and different multimorbidity combinations. We aimed to identify multimorbidity patterns and explore the associations between these patterns and functional disability. Methods We investigated a multi-stage random sample of 1871 participants aged ≥60 years and covered by long-term care insurance in Shanghai, China. Multimorbidity was defined as the simultaneous presence of two or more chronic diseases in an individual. Participants completed scales to assess basic and instrumental activities of daily living (BADL and IADL, respectively). Multimorbidity patterns were identified via exploratory factor analysis. Binary logistic regression models were used to determine adjusted associations between functional disability and number and patterns of multimorbidity. Results Multimorbidity was present in 74.3% of participants. The prevalence of BADL disability was 50.7% and that of IADL disability was 90.7%. There was a strong association between multimorbidity and disability. We identified three multimorbidity patterns: musculoskeletal, cardio-metabolic, and mental-degenerative diseases. The cardio-metabolic disease pattern was associated with both BADL (OR 1.28, 95%CI 1.16–1.41) and IADL (OR 1.41, 95%CI 1.19–1.68) disability. The mental-degenerative disease pattern was associated with BADL disability (OR 1.55, 95%CI 1.40–1.72). Conclusions Multimorbidity and functional disability are highly prevalent among older people covered by long-term care insurance in Shanghai, and distinct multimorbidity patterns are differentially associated with functional disability. Appropriate long-term healthcare and prevention strategies for older people may help reduce multimorbidity, maintain functional ability, and improve health-related quality of life.

scholarly journals Population-Level Prevalence, Bother, and Treatment Behavior for Urinary Incontinence in an Eastern European Country: Findings from the LUTS POLAND Study

2021 ◽  
Vol 10 (11) ◽  
pp. 2314
Author(s):  
Mikolaj Przydacz ◽  
Marcin Chlosta ◽  
Piotr Chlosta
Keyword(s):  
Quality Of Life ◽  
Urinary Incontinence ◽  
Rural Areas ◽  
Eastern European Country ◽  
Population Level ◽  
Eastern European ◽  
Level Data ◽  
Urban And Rural Areas ◽  
Eastern European Countries

Objectives: Population-level data are lacking for urinary incontinence (UI) in Central and Eastern European countries. Therefore, the objective of this study was to estimate the prevalence, bother, and behavior regarding treatment for UI in a population-representative group of Polish adults aged ≥ 40 years. Methods: Data for this epidemiological study were derived from the larger LUTS POLAND project, in which a group of adults that typified the Polish population were surveyed, by telephone, about lower urinary tract symptoms. Respondents were classified by age, sex, and place of residence. UI was assessed with a standard protocol and established International Continence Society definitions. Results: The LUTS POLAND survey included 6005 completed interviews. The prevalence of UI was 14.6–25.4%; women reported a greater occurrence compared with men (p < 0.001). For both sexes, UI prevalence increased with age. Stress UI was the most common type of UI in women, and urgency UI was the most prevalent in men. We did not find a difference in prevalence between urban and rural areas. Individuals were greatly bothered by UI. For women, mixed UI was the most bothersome, whereas for men, leak for no reason was most annoying. More than half of respondents (51.4–62.3%) who reported UI expressed anxiety about the effect of UI on their quality of life. Nevertheless, only around one third (29.2–38.1%) of respondents with UI sought treatment, most of whom received treatment. Persons from urban and rural areas did not differ in the degrees of treatment seeking and treatment receiving. Conclusion: Urinary incontinence was prevalent and greatly bothersome among Polish adults aged ≥ 40 years. Consequently, UI had detrimental effects on quality of life. Nonetheless, most affected persons did not seek treatment. Therefore, we need to increase population awareness in Poland about UI and available treatment methods, and we need to ensure adequate allocation of government and healthcare system resources.

scholarly journals The domestication of Cucurbita argyrosperma as revealed by the genome of its wild relative

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Josué Barrera-Redondo ◽  
Guillermo Sánchez-de la Vega ◽  
Jonás A. Aguirre-Liguori ◽  
Gabriela Castellanos-Morales ◽  
Yocelyn T. Gutiérrez-Guerrero ◽  
...  
Keyword(s):  
Defense Mechanisms ◽  
Population Level ◽  
Growth Hormones ◽  
Comparative Genomic ◽  
Structural Variants ◽  
Closely Related Species ◽  
Level Data ◽  
Genomic Analyses ◽  
Genotype By Sequencing ◽  
Regulation Of Growth

AbstractDespite their economic importance and well-characterized domestication syndrome, the genomic impact of domestication and the identification of variants underlying the domestication traits in Cucurbita species (pumpkins and squashes) is currently lacking. Cucurbita argyrosperma, also known as cushaw pumpkin or silver-seed gourd, is a Mexican crop consumed primarily for its seeds rather than fruit flesh. This makes it a good model to study Cucurbita domestication, as seeds were an essential component of early Mesoamerican diet and likely the first targets of human-guided selection in pumpkins and squashes. We obtained population-level data using tunable Genotype by Sequencing libraries for 192 individuals of the wild and domesticated subspecies of C. argyrosperma across Mexico. We also assembled the first high-quality wild Cucurbita genome. Comparative genomic analyses revealed several structural variants and presence/absence of genes related to domestication. Our results indicate a monophyletic origin of this domesticated crop in the lowlands of Jalisco. We found evidence of gene flow between the domesticated and wild subspecies, which likely alleviated the effects of the domestication bottleneck. We uncovered candidate domestication genes that are involved in the regulation of growth hormones, plant defense mechanisms, seed development, and germination. The presence of shared selected alleles with the closely related species Cucurbita moschata suggests domestication-related introgression between both taxa.

scholarly journals A Hybrid Modeling Technique of Epidemic Outbreaks with Application to COVID-19 Dynamics in West Africa

Biology ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 365
Author(s):  
Chénangnon Frédéric Tovissodé ◽  
Jonas Têlé Doumatè ◽  
Romain Glèlè Kakaï
Keyword(s):  
West Africa ◽  
Growth Curve ◽  
Exponential Growth ◽  
Latency Period ◽  
Growth Curves ◽  
Exponential Growth Phase ◽  
Model Framework ◽  
Logistic Regression Models ◽  
Containment Measures ◽  
Reporting Data

The widely used logistic model for epidemic case reporting data may be either restrictive or unrealistic in presence of containment measures when implemented after an epidemic outbreak. For flexibility in epidemic case reporting data modeling, we combined an exponential growth curve for the early epidemic phase with a flexible growth curve to account for the potential change in growth pattern after implementation of containment measures. We also fitted logistic regression models to recoveries and deaths from the confirmed positive cases. In addition, the growth curves were integrated into a SIQR (Susceptible, Infective, Quarantined, Recovered) model framework to provide an overview on the modeled epidemic wave. We focused on the estimation of: (1) the delay between the appearance of the first infectious case in the population and the outbreak (“epidemic latency period”); (2) the duration of the exponential growth phase; (3) the basic and the time-varying reproduction numbers; and (4) the peaks (time and size) in confirmed positive cases, active cases and new infections. The application of this approach to COVID-19 data from West Africa allowed discussion on the effectiveness of some containment measures implemented across the region.

scholarly journals Are there sex differences among colorectal cancer patients in treatment and survival? A Swiss cohort study

2021 ◽  
Vol 147 (5) ◽  
pp. 1407-1419
Author(s):  
Manuela Limam ◽  
Katarina Luise Matthes ◽  
Giulia Pestoni ◽  
Eleftheria Michalopoulou ◽  
Leonhard Held ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Regression Models ◽  
Proportional Hazards ◽  
Treatment Decision ◽  
Tumor Stage ◽  
Primary Treatment ◽  
Cox Proportional Hazards ◽  
Men And Women ◽  
Logistic Regression Models ◽  
Comorbidity Index

Abstract Background Colorectal cancer (CRC) is among the three most common incident cancers and causes of cancer death in Switzerland for both men and women. To promote aspects of gender medicine, we examined differences in treatment decision and survival by sex in CRC patients diagnosed 2000 and 2001 in the canton of Zurich, Switzerland. Methods Characteristics assessed of 1076 CRC patients were sex, tumor subsite, age at diagnosis, tumor stage, primary treatment option and comorbidity rated by the Charlson Comorbidity Index (CCI). Missing data for stage and comorbidities were completed using multivariate imputation by chained equations. We estimated the probability of receiving surgery versus another primary treatment using multivariable binomial logistic regression models. Univariable and multivariable Cox proportional hazards regression models were used for survival analysis. Results Females were older at diagnosis and had less comorbidities than men. There was no difference with respect to treatment decisions between men and women. The probability of receiving a primary treatment other than surgery was nearly twice as high in patients with the highest comorbidity index, CCI 2+, compared with patients without comorbidities. This effect was significantly stronger in women than in men (p-interaction = 0.010). Survival decreased with higher CCI, tumor stage and age in all CRC patients. Sex had no impact on survival. Conclusion The probability of receiving any primary treatment and survival were independent of sex. However, female CRC patients with the highest CCI appeared more likely to receive other therapy than surgery compared to their male counterparts.

Sign in / Sign up

Export Citation Format

Share Document