1383Interaction of cognitive decline and walking ability to influence wandering behavior: a cohort study

Background Wandering behavior is one of the most troublesome behavioral disturbances in dementia. Though cognitive decline leads to wandering behavior, its effects may vary across walking ability. The purpose of this study was to investigate the joint effect of cognitive decline and walking ability on wandering behavior. Methods This retrospective cohort study in community analyzed 3920 elderly adults with dementia. The association of cognitive function and walking ability with an incidence of wandering behavior during a 5-year follow-up period were examined using a generalized linear model, and relative excess risk due to interaction was calculated. Results Compared to ‘walk independently’, adjusted risk ratios (95% confidence intervals) for ‘walk with help’ and ‘unable to walk’ were 0.51 (0.42, 0.63) and 0.21 (0.16, 0.28), respectively (P for trend < 0.001). Compared to mild cognitive decline, adjusted risk ratios (95% confidence intervals) for moderate and severe cognitive decline were 1.44 (1.17, 1.77) and 1.73 (1.36, 2.18), respectively (P for trend < 0.001). Additionally, some joint effects of cognitive decline and walking ability decline were lower than the sum of its individual effects (relative excess risk due to interaction (95% confidence interval), moderate cognitive decline × ‘walk with help’: -0.45 (-0.98, -0.01); severe cognitive decline × ‘unable to walk’: -0.95 (-1.71, -0.37)). Conclusions Effects of cognitive decline and walking ability on incidence of wandering behavior were observed, and the effects varied depending on their combination. Key messages Our results help clinicians to predict and manage wandering behavior.

Association of Splanchnic Vein Thrombosis on Survival: 15‐Year Institutional Experience With 1561 Cases

Background Previous studies regarding survival in patients with splanchnic vein thrombosis (SVT) are limited. This study measured overall survival in a large cohort of SVTs through linkage to population‐based data. Methods and Results Using a previously derived text‐search algorithm, we screened the reports of all abdominal ultrasound and contrast‐enhanced computed tomography studies at The Ottawa Hospital over 14 years. Screen‐positive reports were manually reviewed by at least 2 authors to identify definite SVT cases by consensus. Images of uncertain studies were independently reviewed by 2 radiologists. One thousand five hundred sixty‐one adults with SVT (annual incidence ranging from 2.8 to 5.9 cases/10 000 patients) were linked with population‐based data sets to measure the presence of concomitant cancer and survival status. Thrombosis involved multiple veins in 314 patients (20.1%), most commonly the portal vein (n=1410, 90.3%). Compared with an age‐sex‐year matched population, patients with SVT had significantly reduced survival in particular with local cancer (adjusted relative excess risk for recent cases 12.0 [95% CI, 9.8–14.6] and for remote cases 9.7 [7.7–12.2]), distant cancer (relative excess risk for recent cases 5.7 [4.5–7.3] and for remote cases 5.4 [4.4–6.6]), cirrhosis (relative excess risk 8.2 [5.3–12.7]), and previous venous thromboembolism (relative excess risk 3.8 [2.4–6.0]). One hundred fifty (23.9%) of patients >65 years of age were anticoagulated within 1 month of diagnosis. Conclusions SVT is more common than expected. Most patients have cancer and the portal vein is by far the most common vein involved. Compared with the general population, patients with SVT had significantly reduced survival, particularly in patients with concomitant cancer, cirrhosis, and previous venous thromboembolic disease. Most elderly patients did not receive anticoagulant therapy.

Diabetes, Hypertension, and Incidence of Chronic Kidney Disease: Is There any Multiplicative or Additive Interaction?

Background: The burden of chronic kidney disease (CKD) is on the rise worldwide; diabetes and hypertension are mentioned as the main contributors. Objectives: The current study aimed to investigate the multiplicative and additive interaction of diabetes and hypertension in the incidence of CKD. Methods: In this population-based cohort study, 7342 subjects aged 20 years or above (46.8% male) were divided into four groups: no diabetes and hypertension; diabetes and no hypertension; no diabetes but suffer from hypertension; and both diabetes and hypertension. The multivariable Cox regression was used to determine the effect of diabetes, hypertension, and their multiplicative interaction on CKD. The following indices were used to determine the additive interaction of diabetes and hypertension: the relative excess risk of interaction, the attributable proportion due to interaction, and the synergism index. Results: Diabetes and hypertension had no significant multiplicative interaction in men (hazard ratio of 0.93, P value: 0.764) and women (hazard ratio of 0.79, P value: 0.198); furthermore, no additive interaction was found in men (Relative Excess Risk due to Interaction of 0.79, P value: 0.199; Attributable Proportion due to Interaction of 0.22, P value: 0.130; Synergy index of 1.44, P value: 0.183) and women (Relative Excess Risk due to Interaction of -0.26, P value: 0.233, Attributable Proportion due to Interaction of -0.21, P value: 0.266; Synergy index of 0.48, P value: 0.254). Conclusions: This study demonstrated no synergic effect between diabetes and hypertension on the incidence of CKD.

Examining the independent and joint effects of genomic and exposomic liabilities for schizophrenia across the psychosis spectrum

Aims Psychosis spectrum disorder has a complex pathoetiology characterised by interacting environmental and genetic vulnerabilities. The present study aims to investigate the role of gene–environment interaction using aggregate scores of genetic (polygenic risk score for schizophrenia (PRS-SCZ)) and environment liability for schizophrenia (exposome score for schizophrenia (ES-SCZ)) across the psychosis continuum. Methods The sample consisted of 1699 patients, 1753 unaffected siblings, and 1542 healthy comparison participants. The Structured Interview for Schizotypy-Revised (SIS-R) was administered to analyse scores of total, positive, and negative schizotypy in siblings and healthy comparison participants. The PRS-SCZ was trained using the Psychiatric Genomics Consortiums results and the ES-SCZ was calculated guided by the approach validated in a previous report in the current data set. Regression models were applied to test the independent and joint effects of PRS-SCZ and ES-SCZ (adjusted for age, sex, and ancestry using 10 principal components). Results Both genetic and environmental vulnerability were associated with case-control status. Furthermore, there was evidence for additive interaction between binary modes of PRS-SCZ and ES-SCZ (above 75% of the control distribution) increasing the odds for schizophrenia spectrum diagnosis (relative excess risk due to interaction = 6.79, [95% confidential interval (CI) 3.32, 10.26], p < 0.001). Sensitivity analyses using continuous PRS-SCZ and ES-SCZ confirmed gene–environment interaction (relative excess risk due to interaction = 1.80 [95% CI 1.01, 3.32], p = 0.004). In siblings and healthy comparison participants, PRS-SCZ and ES-SCZ were associated with all SIS-R dimensions and evidence was found for an interaction between PRS-SCZ and ES-SCZ on the total (B = 0.006 [95% CI 0.003, 0.009], p < 0.001), positive (B = 0.006 [95% CI, 0.002, 0.009], p = 0.002), and negative (B = 0.006, [95% CI 0.004, 0.009], p < 0.001) schizotypy dimensions. Conclusions The interplay between exposome load and schizophrenia genetic liability contributing to psychosis across the spectrum of expression provide further empirical support to the notion of aetiological continuity underlying an extended psychosis phenotype.

Private Dental Care Benefits Non-Indigenous Children More Than Indigenous Children

Introduction: Various arrangements for funding health care facilities can have different levels of performance of care provision on different groups of people. Such differential performance of oral care is not previously known concerning Indigenous communities. Objective: This study aimed to assess the effect of visiting a public or private dental care facility on the performance of oral care experienced by Indigenous versus non-Indigenous children in Australia. Methods: Data from the National Child Oral Health Survey were used with a representative sample of children from all the states and territories of Australia. The performance of oral care was measured with the Child Oral Care Performance Assessment Scale (COPAS), which contains 37 items from 9 domains (Effective, Appropriate, Efficient, Responsive, Accessible, Safe, Continuous, Capable, and Sustainable) with a score ranging from 0 to 148. Mixed effects models that accounted for stratum and sampling weights were used for the stratified analyses (Indigenous vs. non-Indigenous) that assessed the effect of public versus private care on the COPAS. Relative excess risk due to interaction was calculated to assess effect modification. Results: Among the Indigenous children, private care was similar to public care (regression coefficient [RC] = −1.27, 95% CI = −9.5 to 6.97), whereas private care was higher than public care among non-Indigenous children (RC = 4.60, 95% CI = 3.67 to 6.18). This trend was similar among the 9 domains of the COPAS as well, except for Effectiveness, which was similar for private and public facilities among non-Indigenous children (RC = −0.03, 95% CI = −0.29 to 0.23). Based on the continuous COPAS score, effect modification was 4.46 (95% CI = 0.11 to 8.82) on the additive scale and 1.06 (1.01, 1.13) on the multiplicative scale. The relative excess risk due to interaction reported an excess chance of 1.17 (95% CI = 0.01 to 0.33), which was consistent with the stratified analyses and effect modification measured with the continuous score. Conclusion: Thus, this study found a higher performance of oral care in private care locations among non-Indigenous children versus Indigenous children. Knowledge Transfer Statement: The findings caution policy makers and other stakeholders that moving oral care from public to private care facilities can increase the inequity faced by Indigenous children in Australia.