The changing prevalence and incidence of dementia over time — current evidence

Abstract Background A recent systematic review highlighted significant gaps in the evidence on atrial fibrillation (AF) patients' adherence to oral anticoagulants (OAC). Current evidence suffers from short follow-up times, focuses on the first OAC and does not take switching into account. There is also lack of observational data on adherence to warfarin due to its varying dose that complicates the calculations. As such there is lack of evidence on comparative adherence between VKAs and DOACs and whether the convenience of DOACs translates into better adherence in AF patients. Purpose Our objective was to measure AF patients' long-term OAC adherence and compare the impact of taking direct oral anticoagulants (DOAC) versus vitamin K antagonists (VKA) on adherence, while accounting for switching. Methods Using linked, population-based administrative data containing physician billings, hospitalization and prescription records of 4.8 million British Columbians (1996–2019), incident adult cases of AF were identified. The primary measure of adherence was proportion of days covered (PDC). Consecutive rolling 90-day windows were created for each patient starting from their first OAC prescription fill date until the end of their follow-up. The PDC for each 90-day rolling window was calculated and averaged to yield mean adherence over the follow-up period for each patient. Permanent medication discontinuation resulted in a PDC of 0 for all subsequent rolling windows after their supply ran out. As such, both poor execution and non-persistence were measured simultaneously. The association between drug class and adherence was assessed using generalized mixed effect linear regression models with drug class treated as time-varying covariate to account for switching. Results The study cohort was 30,264 AF patients [mean age 72.2 years (SD11.0), 44.6% female, mean CHA2DS2-VASc 2.94 (SD1.4)] with mean follow-up of 7.7 (SD 4.8) years. The mean PDC was 0.71 (SD 0.27) with 51% of the cohort having mean PDC values below the conventional threshold of adherence (PDC<0.8). Adherence dropped over time with the greatest decline in the first two years after therapy initiation. After controlling for all other confounders and accounting for switching, taking VKA compared to DOAC was, on average, associated with a 1-day decrease in number of days of medication-taking per year. Conclusion AF patients' OAC adherence was below the conventional threshold of 0.8, and dropped over time, particularly in the first two years. Drug class had no clinically meaningful impact on medication adherence. Our study highlights the need for effective adherence interventions particularly early in OAC therapy. Our findings also emphasizes that prescribers should not assume inherently better adherence for DOACs and should instead choose OAC in conversation with the patient and in accordance with their values and preferences. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Canadian Institutes of Health Research grant

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Total extraperitoneal endoscopic hernioplasty (TEP) versus Lichtenstein hernioplasty: a systematic review by updated traditional and cumulative meta-analysis of randomised-controlled trials

Hernia ◽

10.1007/s10029-019-02049-w ◽

2019 ◽

Vol 23 (6) ◽

pp. 1093-1103 ◽

Cited By ~ 7

Author(s):

P. Gavriilidis ◽

R. J. Davies ◽

J. Wheeler ◽

N. de’Angelis ◽

S. Di Saverio

Keyword(s):

Randomised Controlled Trials ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Controlled Trials ◽

Vascular Injuries ◽

Lichtenstein Hernioplasty ◽

Randomised Controlled ◽

Haematoma Formation ◽

Over Time

Abstract Background–purpose Totally extraperitoneal (TEP) endoscopic hernioplasty and Lichtenstein hernioplasty are the most commonly used approaches for inguinal hernia repair. However, current evidence on which is the preferred approach is inconclusive. This updated meta-analysis was conducted to track the accumulation of evidence over time. Methods Studies were identified by a systematic literature search of the EMBASE, PubMed, Cochrane Library, and Google Scholar databases. Fixed- and random-effects models were used to cumulatively assess the accumulation of evidence over time. Results The TEP cohort showed significantly higher rates of recurrences and vascular injuries compared to the Lichtenstein cohort; [Peto Odds ratio (OR) = 1.58 (1.22, 2.04), p = 0.005], [Peto OR = 2.49 (1.05, 5.88), p = 0.04], respectively. In contrast, haematoma formation rate, time to return to usual activities, and local paraesthesia were significantly lower in the TEP cohort compared to the Lichtenstein cohort; [Peto OR = 0.26 (0.16, 0.41), p ≤ 0.001], [mean difference = − 6.32 (− 8.17, − 4.48), p ≤ 0.001], [Peto OR = 0.26 (0.17, 0.40), p ≤ 0.001], respectively. Conclusions This study, which is based on randomised-controlled trials (RCTs) of high quality, showed significantly higher rates of recurrences and vascular injuries in the TEP cohort than in the Lichtenstein cohort. In contrast, rate of postoperative haematoma formation, local paraesthesia, and time to return to usual activities were significantly lower in the TEP cohort than in the Lichtenstein cohort. Future multicentre RCTs with strict adherence to the standards recommended in the Consolidated Standards of Reporting Trials guidelines will shed further light on the topic.

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Assessing Nutritional Changes in a Vegetable Over Time: Issues and Considerations

HortScience ◽

10.21273/hortsci.49.2.128 ◽

2014 ◽

Vol 49 (2) ◽

pp. 128-132 ◽

Cited By ~ 2

Author(s):

Mark W. Farnham ◽

Michael A. Grusak

Keyword(s):

Field Tests ◽

Field Studies ◽

Current Evidence ◽

Nutrient Concentrations ◽

Vegetable Crops ◽

Mineral Concentrations ◽

New Crop ◽

Over Time ◽

New Cultivars ◽

Vegetable Quality

For many decades plant breeders have worked to improve vegetable crops for numerous economically important traits, like host plant resistance to disease, yield, and vegetable quality. Most improvements have been made with little knowledge as to how, or if, nutritional or phytonutrient concentrations might also be indirectly altered in the process. There have been some reports suggesting that concentrations of nutrients in vegetables have been reduced over time, possibly related to introductions of new cultivars. However, for most vegetables, current evidence indicating changes in nutrient concentrations, and specifically mineral concentrations, is circumstantial at best. To effectively test whether changes may have occurred over time as new cultivars replace older ones, appropriate field studies must be conducted wherein harvested produce from “old” vs. “new” crop cultivars is analyzed by appropriate methods and compared directly. Numerous considerations and issues such as 1) the set of cultivars to be used in field tests; 2) how nutritional concentration will be expressed; and 3) the evolution, history, and consumption changes of the crop under study must be addressed in making such direct comparisons and interpreting results.

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Eye Gaze And Perceptual Adaptation To Audiovisual Degraded Speech

10.31234/osf.io/65849 ◽

2020 ◽

Author(s):

Briony Banks ◽

Emma Gowen ◽

Kevin Munro ◽

patti adank

Keyword(s):

Visual Cues ◽

Eye Gaze ◽

Real Life ◽

Audio Signal ◽

Current Evidence ◽

Control Group ◽

Speech Comprehension ◽

Perceptual Adaptation ◽

Degraded Speech ◽

Over Time

Visual cues from a speaker’s face may improve perceptual adaptation to degraded speech over time, but current evidence is limited. We aimed to replicate results from previous studies and extend them to more demanding speech stimuli (sentences), to better represent real-life, challenging speech comprehension. In addition, we investigated whether particular eye gaze patterns towards the speaker’s mouth were related to adaptation, hypothesising that listeners who looked more at the speaker’s mouth would show greater adaptation. A group of listeners were presented with noise-vocoded sentences in audiovisual format while a control group were presented with the audio signal only, presented congruently with a still image of the speaker’s face. Results of previous adaptation studies were partially replicated: the audiovisual group had better recognition throughout and adapted slightly more rapidly, but both groups showed an equal amount of improvement overall (after exposure to 90 sentences). Longer fixations on the speaker’s mouth in the audiovisual group were related to better overall accuracy, although evidence for this relationship was relatively weak. An exploratory analysis further showed that the duration of fixations to the speaker’s mouth decreased over time. The results suggest that the benefits from visual cues to adaptation to unfamiliar speech vary more than previously thought. Longer fixations on a speaker’s mouth may play a role in successfully decoding these cues, but more evidence is needed to fully establish how patterns of eye gaze are related to audiovisual speech recognition.

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The Epidemiology of Multiple Sclerosis: An Historical Perspective

10.1093/med/9780199937837.003.0080 ◽

2017 ◽

Author(s):

Kassandra L. Munger

Keyword(s):

Multiple Sclerosis ◽

Vitamin D ◽

Environmental Factors ◽

Sex Ratio ◽

Cigarette Smoking ◽

Historical Perspective ◽

Current Evidence ◽

Descriptive Epidemiology ◽

Ebv Infection ◽

Over Time

The descriptive epidemiology has proved to be dynamic with attenuation of the latitude gradient, increase in incidence among women, and changes in the sex ratio over time, indicating that recent changes in environmental factors are responsible. Although we still do not know the causes of MS, or how to prevent it, the current evidence supports causal roles for EBV infection, vitamin D, and cigarette smoking.

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The Evolution of Mutualistic Dependence

Annual Review of Ecology Evolution and Systematics ◽

10.1146/annurev-ecolsys-110218-024629 ◽

2020 ◽

Vol 51 (1) ◽

pp. 409-432 ◽

Cited By ~ 5

Author(s):

Guillaume Chomicki ◽

E. Toby Kiers ◽

Susanne S. Renner

Keyword(s):

Tree Of Life ◽

Context Dependence ◽

Current Evidence ◽

Time And Space ◽

Context Dependent ◽

The Stability ◽

Different Levels ◽

Over Time

While the importance of mutualisms across the tree of life is recognized, it is not understood why some organisms evolve high levels of dependence on mutualistic partnerships, while other species remain autonomous or retain or regain minimal dependence on partners. We identify four main pathways leading to the evolution of mutualistic dependence. Then, we evaluate current evidence for three predictions: ( a) Mutualisms with different levels of dependence have distinct stabilizing mechanisms against exploitation and cheating, ( b) less dependent mutualists will return to autonomy more often than those that are highly dependent, and ( c) obligate mutualisms should be less context dependent than facultative ones. Although we find evidence supporting all three predictions, we stress that mutualistic partners follow diverse paths toward—and away from—dependence. We also highlight the need to better examine asymmetry in partner dependence. Recognizing how variation in dependence influences the stability, breakdown, and context dependence of mutualisms generates new hypotheses regarding how and why the benefits of mutualistic partnerships differ over time and space.

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Does self-paced exercise depend on executive processing? A narrative review of the current evidence

10.31236/osf.io/3np6b ◽

2019 ◽

Author(s):

Darias Holgado ◽

Daniel Sanabria

Keyword(s):

Physical Activity ◽

Executive Functions ◽

Cognitive Processes ◽

Current Evidence ◽

Top Down ◽

Executive Processing ◽

Complex Process ◽

Potential Link ◽

Over Time

Self-paced exercise is any physical activity in which the effort has to be distributed over time in order to achieve the objective of the event. Hence, self-paced aerobic exercise is a goal-directed behaviour towards an objective that involves several cognitive processes. The aim of the present review is to ask the extent to which self-paced exercise might rely on executive functions and the empirical evidence of top-down processing on self-paced exercise. We discuss the evidence from different experimental manipulations showing a potential link between self-paced exercise and executive processing. We finally highlight some gaps in the literature and possible factors that might mediate the role of executive processing and self-paced exercise. Self-paced exercise is likely to be a highly complex process, in which a multitude of factors non-related to executive functions can also contribute to the ultimate decision to upregulate or downregulate exercise intensity.

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Generalized Anxiety Disorder 7-Item (GAD-7) Scores in Medically Authorized Cannabis Patients—Ontario and Alberta, Canada

The Canadian Journal of Psychiatry ◽

10.1177/07067437211043393 ◽

2021 ◽

pp. 070674372110433

Author(s):

Cerina Lee ◽

Jessica M. Round ◽

John G. Hanlon ◽

Elaine Hyshka ◽

Jason R.B. Dyck ◽

...

Keyword(s):

Anxiety Disorder ◽

Generalized Anxiety Disorder ◽

Current Evidence ◽

P Value ◽

Generalized Anxiety ◽

Medical Cannabis ◽

Time Period ◽

Clinically Significant ◽

Over Time

Objectives Despite increasing rates of legalization of medical cannabis worldwide, the current evidence available on its effect on mental health outcomes including anxiety is of mixed results. This study assesses the effect of medical cannabis on generalized anxiety disorder 7-item (GAD-7) scores in adult patients between 2014 and 2019 in Ontario and Alberta, Canada. Methods An observational cohort study of adults authorized to use medical cannabis. The GAD-7 was administered at the time of the first visit to the clinic and subsequently over the follow-up time period of up to 3.2 years. Overall changes in GAD-7 scores were computed (mean change) and categorized as: no change (<1 point); improvement; or worsening—over time. Results A total of 37,303 patients had initial GAD-7 scores recorded and 5,075 (13.6%) patients had subsequent GAD-7 follow-up scores. The average age was 54.2 years (SD 15.7 years), 46.0% were male, and 45.6% noted anxiety symptoms at the baseline. Average GAD-7 scores were 9.11 (SD 6.6) at the baseline and after an average of 282 days of follow-up (SD 264) the average final GAD-7 score recorded was 9.04 (SD 6.6): mean change −0.23 (95% CI, −0.28 to −0.17, t[5,074]: −8.19, p-value <0.001). A total of 4,607 patients (90.8%) had no change in GAD-7 score from their initial to final follow-up, 188 (3.7%) had a clinically significant decrease, and 64 (1.3%) noted a clinically significant increase in their GAD-7 scores. Conclusions Overall, there was a statistically significant decrease in GAD-7 scores over time (in particular, in the 6–12-month period). However, this change did not meet the threshold to be considered clinically significant. Thus, we did not detect clinical improvements or detriment in GAD-7 scores in medically authorized cannabis patients. However, future well-controlled clinical trials are needed to fully examine risks or benefits associated with using medical cannabis to treat anxiety conditions.

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Current evidence from a worldwide, multicentre, follow-up study of the recalled Articular Surface Replacement Hip System

Hip International ◽

10.1177/1120700019887726 ◽

2019 ◽

pp. 112070001988772 ◽

Cited By ~ 1

Author(s):

Vincent P Galea ◽

Pakdee Rojanasopondist ◽

Sean J Matuszak ◽

James W Connelly ◽

Gabrielle S Ray ◽

...

Keyword(s):

Metal Ion ◽

Clinical Performance ◽

Articular Surface ◽

Health Indicators ◽

Hip Resurfacing ◽

Current Evidence ◽

System A ◽

Articular Surface Replacement ◽

Over Time

Introduction: Our first aim was to report the longitudinal clinical performance of patients treated with the ASR Hip System, a metal-on-metal (MoM) device, in their mid- to late-term follow-up. Secondly, we sought to report on the reasons and risk factors for mid- to late-term implant failure. Methods: A total of 1721 ASR patients (1933 hips) from 16 centres in 6 countries were enrolled to a prospective, post-recall study. The average time to enrollment was 7.4 years from index surgery. Data from 3 follow-up visits over 2 years were analysed. Implant performance, based on ion levels and PROMs, was determined at each clinical visit. Results: The proportion of those exhibiting good performance decreased over time for hip resurfacing (ASR HRA) and total hip arthroplasty (ASR XL) patients. ASR XL patients were likely to exhibit longitudinal blood metal ion increases regardless of symptom state. ASR HRA patients were more likely to present with and maintain good performance over time, especially males with high general health indicators. 6% of ASR HRA and 14% of ASR XL patients were revised throughout the study period. Discussion: ASR XL THA patients are likely to exhibit blood metal ion increases without accompanying changes in symptom state, and therefore should be followed with annual blood tests at minimum. While appropriately selected ASR HRA patients were the most likely to exhibit low blood metal ion levels and report no symptoms, we recommend vigilant follow-up of all ASR patients to ensure that worsening clinical outcomes and asymptomatic soft tissue damage are not missed.

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A structured pathway for developing your complex abdominal hernia service: our York pathway

Hernia ◽

10.1007/s10029-020-02354-9 ◽

2021 ◽

Vol 25 (2) ◽

pp. 267-275

Author(s):

O. Smith ◽

T. MacLeod ◽

P. Lim ◽

P. Chitsabesan ◽

S. Chintapatla

Keyword(s):

Abdominal Wall ◽

Clinical Pathways ◽

Abdominal Wall Reconstruction ◽

Abdominal Wall Hernia ◽

Healthcare Services ◽

Abdominal Hernia ◽

Current Evidence ◽

Wall Unit ◽

Improve Patient ◽

Over Time

Abstract Purpose Clinical pathways are widely prevalent in health care and may be associated with increased clinical efficacy, improved patient care, streamlining of services, while providing clarity on patient management. Such pathways are well established in several branches of healthcare services but, to the authors’ knowledge, not in complex abdominal wall reconstruction (CAWR). A stepwise, structured and comprehensive approach to managing complex abdominal wall hernia (CAWH) patients, which has been successfully implemented in our practice, is presented. Methods A literature search of common databases including Embase® and MEDLINE® for CAWH pathways identified no comprehensive pathway. We therefore undertook a reiterative process to develop the York Abdominal Wall Unit (YAWU) through examination of current evidence and logic to produce a pragmatic redesign of our own pathway. Having introduced our pathway, we then performed a retrospective analysis of the complexity and number of abdominal wall cases performed in our trust over time. Results We describe our pathway and demonstrate that the percentage of cases and their complexity, as defined by the VHWG classification, have increased over time in York Abdominal Wall Unit. Conclusion A structured pathway for complex abdominal wall hernia service is one way to improve patient experience and streamline services. The relevance of pathways for the hernia surgeon is discussed alongside this pathway. This may provide a useful guide to those wishing to establish similar personalised pathways within their own units and allow them to expand their service.

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