1
|
Mazzeffi M, Beller J, Strobel R, Norman A, Wisniewski A, Smith J, Fonner CE, McNeil J, Speir A, Singh R, Tang D, Quader M, Yarboro L, Teman N. Trends in the Use of Recombinant Activated Factor VII and Prothrombin Complex Concentrate in Heart Transplant Patients in Virginia. J Cardiothorac Vasc Anesth 2024; 38:660-666. [PMID: 38220518 DOI: 10.1053/j.jvca.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/28/2023] [Accepted: 10/02/2023] [Indexed: 01/16/2024]
Abstract
OBJECTIVES To explore trends in intraoperative procoagulant factor concentrate use in patients undergoing heart transplantation (HTx) in Virginia. Secondarily, to evaluate their association with postoperative thrombosis. DESIGN Patients who underwent HTx were identified using a statewide database. Trends in off-label recombinant activated factor VII (rFVIIa) use and on-label and off-label prothrombin complex concentrate (PCC) use were tested using the Mantel-Haenszel test. Multivariate logistic regression was used to test for an association between procoagulant factor concentrate administration and thrombosis. SETTING Virginia hospitals performing HTx. PARTICIPANTS Adults undergoing HTx between 2012 and 2022. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among 899 patients who required HTx, 100 (11.1%) received off-label rFVIIa, 69 (7.7%) received on-label PCC, and 80 (8.9%) received off-label PCC. There was a downward trend in the use of rFVIIa over the 10-year period (p = 0.04). There was no trend in on-label PCC use (p = 0.12); however, there was an increase in off-label PCC use (p < 0.001). Patients who received rFVIIa were transfused more and had longer cardiopulmonary bypass time (p < 0.001). Receipt of rFVIIa was associated with increased thrombotic risk (odds ratio [OR] 1.92; 95% CI 1.12-3.29; p = 0.02), whereas on-label and off-label PCC use had no association with thrombosis (OR 0.98, 95% CI 0.49-1.96, p = 0.96 for on-label use; and OR 0.61, 95% CI 0.29-1.30, p = 0.20 for off-label use). CONCLUSIONS Use of rFVIIa in HTx decreased over the past decade, whereas off-label PCC use increased. Receipt of rFVIIa was associated with thrombosis; however, patients who received rFVIIa were more severely ill, and risk adjustment may have been incomplete.
Collapse
Affiliation(s)
- Michael Mazzeffi
- University of Virginia, Department of Anesthesiology, Charlottesville, VA.
| | - Jared Beller
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Raymond Strobel
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Anthony Norman
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Alexander Wisniewski
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Judy Smith
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | | | - John McNeil
- University of Virginia, Department of Anesthesiology, Charlottesville, VA
| | - Alan Speir
- INOVA Heart and Vascular Institute, Department of Cardiothoracic Surgery, Fairfax, VA
| | - Ramesh Singh
- INOVA Heart and Vascular Institute, Department of Cardiothoracic Surgery, Fairfax, VA
| | - Daniel Tang
- INOVA Heart and Vascular Institute, Department of Cardiothoracic Surgery, Fairfax, VA
| | - Mohammed Quader
- Virginia Commonwealth University, Department of Surgery, Division of Cardiothoracic Surgery, Richmond, VA
| | - Leora Yarboro
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| | - Nicholas Teman
- University of Virginia, Department of Surgery, Division of Cardiothoracic Surgery, Charlottesville, VA
| |
Collapse
|
2
|
Vishwanath S, Hopper I, Chowdhury E, Wolfe R, Freak-Poli R, Reid CM, Tonkin AM, Murray AM, Shah RC, Chong TTJ, Woods RL, McNeil J, Orchard SG, Nelson MR, Steves CJ, Ryan J. Cardiovascular Disease Risk Scores and Incident Dementia and Cognitive Decline in Older Men and Women. Gerontology 2023; 70:143-154. [PMID: 37984339 PMCID: PMC10866179 DOI: 10.1159/000535284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023] Open
Abstract
INTRODUCTION Risk factors for cardiovascular disease (CVD) also increase the risk of dementia. However, whether commonly used CVD risk scores are associated with dementia risk in older adults who do not have a history of CVD, and potential gender differences in this association, remains unclear. The aim of this study was to determine whether CVD risk scores are prospectively associated with cognitive decline and dementia in initially healthy older men and women. METHODS A total of19,114 participants from a prospective cohort of individuals aged 65+ years without known CVD or dementia were recruited. The atherosclerotic cardiovascular disease risk score (ASCVDRS), Systematic Coronary Risk Evaluation 2-Older Persons (SCORE2-OP), and the Framingham risk score (FRS) were calculated at baseline. Risk of dementia (according to DSM-IV criteria) and cognitive decline (defined as a >1.5 standard deviation decline in global cognition, episodic memory, psychomotor speed, or verbal fluency from the previous year) were assessed using hazard ratio. RESULTS Over a median follow-up of 6.4 years, 850 individuals developed dementia and 4,352 cognitive decline. Men and women in the highest ASCVDRS tertile had a 41% (95% CI 1.08, 1.85) and 45% (1.11, 1.89) increased risk of dementia compared to the lowest tertile, respectively. Likewise, men and women in the highest SCORE2-OP tertile had a 64% (1.24, 2.16) and 60% (1.22, 2.11) increased risk of dementia compared to the lowest tertile, respectively. Findings were similar, but the risk was slightly lesser when examining risk of cognitive decline for both ASCVDRS and SCORE2-OP. However, FRS was only associated with the risk of cognitive decline among women (highest vs. lowest tertiles: 1.13 [1.01-1.26]). CONCLUSION These findings suggest the utility of the ASCVDRS and SCORE2-OP in clinical practice, to not only assess future risk of CVD, but also as potential early indicators of cognitive impairment, even in relatively healthy older men and women.
Collapse
Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia,
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Cardiology and General Medicine Unit, Alfred Health, Melbourne, Victoria, Australia
| | - Enayet Chowdhury
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- GenesisCare, Leabrook, South Australia, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Public Health, Curtin University, Bentley, Washington, Australia
| | - Andrew M Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne M Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
- Department of Medicine, Division of Geriatrics Hennepin Healthcare, University of Minnesota, Minneapolis, Minnesota, USA
| | - Raj C Shah
- Department of Family and Preventive Medicine and the Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Trevor T-J Chong
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
- Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
- Department of Clinical Neurosciences, St. Vincent's Hospital, Melbourne, Victoria, Australia
| | - Robyn L Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Suzanne G Orchard
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Claire J Steves
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
- Department of Ageing and Health, Guy's and St Thomas's NHS Foundation Trust, London, UK
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Nilaweera D, Gurvich C, Freak-Poli R, Woods RL, Owen A, McNeil J, Nelson M, Stocks N, Ryan J. The association between adverse events in later life and mortality in older individuals. Compr Psychoneuroendocrinol 2023; 16:100210. [PMID: 37753199 PMCID: PMC10518669 DOI: 10.1016/j.cpnec.2023.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
Background Stress can have adverse impacts on health, particularly when it is chronic or resulting from major adverse events. Our study investigated whether relatively common adverse events in older individuals were associated with an increased risk of death, as well as cause-specific death and potential gender differences. Methods Participants were 12896 community-dwelling Australians aged ≥70 years at enrolment into the ASPREE (ASPirin in Reducing Events in the Elderly) study and without known life-limiting disease. A questionnaire administered in the year after enrolment, collected information on ten adverse events experienced in the past year. Mortality status was verified by multiple sources including health records and the National Death Index across a maximum of 10 years. Underlying causes of death were determined using clinical information by two adjudicators. Cox-proportional hazards regression models were used to estimate mortality risk. Results Two of the ten adverse events were associated with an increased risk of mortality in fully adjusted models. A 69% increased risk of mortality was observed in participants who reported their spouse/partner had recently died (95% CI: 1.19-2.39, P < 0.01). Cancer-related but not cardiovascular deaths also increased. Participants with a seriously ill spouse/partner also had a 23% increased risk of mortality (HR: 1.23, 95% CI: 1.02-1.48, P = 0.03). There was a tendency for these associations to be stronger among men than women. Limitations Perceived stress and cortisol were not measured, thus limiting our understanding of the psychological and physiological impacts of adverse events. Conclusions Experiencing adverse events in later-life, especially the death of a spouse/partner, may be a risk factor for earlier mortality. These findings may increase public health awareness and better inform initiatives for particular groups, including bereaved men.
Collapse
Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Caroline Gurvich
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, South Australia, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
4
|
Manning A, Sevilla-González M, Smith K, Wang N, Jensen A, Litkowski E, Kim H, DiCorpo D, Westerman K, Cui J, Liu CT, Yu C, McNeil J, Lacaze P, Chang KM, Tsao P, Phillips L, Goodarzi M, Sladek R, Rotter J, Dupuis J, Florez J, Merino J, Meigs J, Zhou J, Raghavan S, Udler M. Heterogeneous effects on type 2 diabetes and cardiovascular outcomes of genetic variants and traits associated with fasting insulin. Res Sq 2023:rs.3.rs-3317661. [PMID: 37790568 PMCID: PMC10543499 DOI: 10.21203/rs.3.rs-3317661/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Hyperinsulinemia is a complex and heterogeneous phenotype that characterizes molecular alterations that precede the development of type 2 diabetes (T2D). It results from a complex combination of molecular processes, including insulin secretion and insulin sensitivity, that differ between individuals. To better understand the physiology of hyperinsulinemia and ultimately T2D, we implemented a genetic approach grouping fasting insulin (FI)-associated genetic variants based on their molecular and phenotypic similarities. We identified seven distinctive genetic clusters representing different physiologic mechanisms leading to rising FI levels, ranging from clusters of variants with effects on increased FI, but without increased risk of T2D (non-diabetogenic hyperinsulinemia), to clusters of variants that increase FI and T2D risk with demonstrated strong effects on body fat distribution, liver, lipid, and inflammatory processes (diabetogenic hyperinsulinemia). We generated cluster-specific polygenic scores in 1,104,258 individuals from five multi-ancestry cohorts to show that the clusters differed in associations with cardiometabolic traits. Among clusters characterized by non-diabetogenic hyperinsulinemia, there was both increased and decreased risk of coronary artery disease despite the non-increased risk of T2D. Similarly, the clusters characterized by diabetogenic hyperinsulinemia were associated with an increased risk of T2D, yet had differing risks of cardiovascular conditions, including coronary artery disease, myocardial infarction, and stroke. The strongest cluster-T2D associations were observed with the same direction of effect in non-Hispanic Black, Hispanic, non-Hispanic White, and non-Hispanic East Asian populations. These genetic clusters provide important insights into granular metabolic processes underlying the physiology of hyperinsulinemia, notably highlighting specific processes that decouple increasing FI levels from T2D and cardiovascular risk. Our findings suggest that increasing FI levels are not invariably associated with adverse cardiometabolic outcomes.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kyong-Mi Chang
- The Corporal Michael J. Crescenz Veterans Affairs Medical Center and University of Pennsylvania Perelman School of Medicine
| | - Phil Tsao
- Stanford University School of Medicine
| | | | | | | | - Jerome Rotter
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center
| | | | | | | | - James Meigs
- Department of Medicine, Harvard Medical School
| | | | | | | |
Collapse
|
5
|
Vishwanath S, Hopper I, Wolfe R, Polekhina G, Reid CM, Tonkin AM, Murray AM, Shah RC, Storey E, Woods RL, McNeil J, Orchard SG, Nelson MR, Steves CJ, Ryan J. Cognitive trajectories and incident dementia after a cardiovascular event in older adults. Alzheimers Dement 2023; 19:3670-3678. [PMID: 36856152 PMCID: PMC10440246 DOI: 10.1002/alz.13006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/17/2023] [Accepted: 01/19/2023] [Indexed: 03/02/2023]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is a recognized risk factor for dementia. Here we determined the extent to which an incident CVD event modifies the trajectory of cognitive function and risk of dementia. METHODS 19,114 adults (65+) without CVD or dementia were followed prospectively over 9 years. Incident CVD (fatal coronary heart disease, nonfatal myocardial infarction [MI], stroke, hospitalization for heart failure) and dementia (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria) were adjudicated by experts. RESULTS Nine hundred twenty-two participants had incident CVD, and 44 developed dementia after CVD (4.9% vs. 4.4% for participants without CVD). Following a CVD event there was a short-term drop in processing speed (-1.97, 95% confidence interval [CI]: -2.57 to -1.41), but there was no significant association with longer-term processing speed. In contrast, faster declines in trajectories of global function (-0.56, 95% CI: -0.76 to -0.36), episodic memory (-0.10, 95% CI: -0.16 to -0.04), and verbal fluency (-0.19, 95% CI: -0.30 to -0.01) were observed. DISCUSSION Findings highlight the importance of monitoring cognition after a CVD event.
Collapse
Affiliation(s)
- Swarna Vishwanath
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Ingrid Hopper
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- School of Public Health, Curtin University, Western Australia, Australia
| | - Andrew M. Tonkin
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Anne M. Murray
- Berman Center for Outcomes & Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, MN, USA
- Department of Medicine, Division of Geriatrics Hennepin Healthcare, University of Minnesota, Minneapolis, MN, USA
| | - Raj C. Shah
- Department of Family Medicine and the Rush Alzheimer’s Disease Centre, Rush University Medical Centre, Chicago, IL, USA
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Mark R. Nelson
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Claire J. Steves
- Department of Twin Research & Genetic Epidemiology, King’s College London, United Kingdom
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| |
Collapse
|
6
|
Nilaweera D, Gurvich C, Freak-Poli R, Woods R, Owen A, Murray A, Orchard SG, Britt C, Wu Z, McNeil J, Ryan J. Adverse events in older adults and the risk of dementia and cognitive decline. J Affect Disord Rep 2023; 13:100592. [PMID: 37475782 PMCID: PMC10357969 DOI: 10.1016/j.jadr.2023.100592] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Background Increasing evidence suggests that stress could be a risk factor for dementia but this might vary by gender. This study investigated whether adverse life events were associated with cognitive decline and dementia in later-life, separately in men and women. Methods Participants were 12,789 community-dwelling Australians aged ≥ 70 years. Ten common adverse events in later-life were self-reported. Cognitive decline was defined as a 1.5 SD decline from participants' baseline score in tests of global cognition, psychomotor speed, episodic memory, and executive functioning, which were assessed regularly over a maximum of 10.3 years. Dementia was diagnosed according to DSM-IV criteria. Results An increased risk of dementia was observed in participants who experienced the death of a spouse/partner (HR: 1.72, 95% CI: 1.17 - 2.52) and for individuals who experienced major financial problems (HR: 1.53, 95% CI: 1.05 - 2.23). The latter also increased the risk of cognitive decline in men specifically (HR: 1.43, 95% CI: 1.10 - 1.86). In contrast, some events for women were associated with a reduced risk of dementia (e.g. close family or friends lost their job/retired (HR: 0.62, 95% CI: 0.40-0.95)). Limitations Events including major money problems may result from prodromal dementia symptoms, thus reverse causation needs to be considered. Conclusions Adverse life events may influence dementia risk in older adults, but associations vary depending on the nature of the event, and across genders. These findings support the need for early interventions in older people who have experienced adversities, particularly for the death of a loved one.
Collapse
Affiliation(s)
- Dinuli Nilaweera
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Caroline Gurvich
- Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Anne Murray
- Berman Centre for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, USA
| | - Suzanne G. Orchard
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Zimu Wu
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Level 4, 553St Kilda Road, Melbourne, Victoria 3004, Australia
| |
Collapse
|
7
|
Thompson A, Fitzsimons J, Killackey E, Ahern S, Amminger P, Alvarez-Jimenez M, Berk M, Cotton S, McNeil J, McGorry P, Nelson B, O'Donoghue B, Ratheesh A, Rickwood D, Yung A, Wood S. The Australian Early Psychosis Collaborative Consortium (AEPCC): Improving Clinical Care in Early Psychosis. Australas Psychiatry 2023:10398562231174691. [PMID: 37171091 DOI: 10.1177/10398562231174691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The field of early psychosis has undergone considerable expansion over the last few decades and has a strong evidence base of effectiveness. Like all areas of healthcare, however, early psychosis services need to more consistently deliver higher quality care to achieve better outcomes for patients and families. A national clinical research infrastructure is urgently required to enable the sector to deliver the highest quality care and expand and translate evidence more quickly and efficiently. This paper describes the establishment of the Australian Early Psychosis Collaborative Consortium (AEPCC) that aims to achieve this. CONCLUSION AEPCC is the first of its kind in Australia (and internationally). It will deliver the required clinical research infrastructure through the implementation of a clinical quality registry, clinical trials and translation network, and lived experience network. AEPCC will provide a critical resource to better understand the state of early psychosis care, and trial new interventions on a scale that has not previously been possible in Australia.
Collapse
Affiliation(s)
- Andrew Thompson
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Joanna Fitzsimons
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eoin Killackey
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Paul Amminger
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Michael Berk
- Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Sue Cotton
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Clayton, VIC, Australia
| | - Patrick McGorry
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Barnaby Nelson
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | | | - Aswin Ratheesh
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Debra Rickwood
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Alison Yung
- Faculty of Health, Deakin University, Burwood, VIC, Australia
| | - Stephen Wood
- Orygen, Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
8
|
Ramarapu S, McNeil J, Tanaka KA, Vandyck K. Diagnosis of Microvascular Bleeding After Cardiopulmonary Bypass-A Game of Hide and Seek. J Cardiothorac Vasc Anesth 2023:S1053-0770(23)00233-1. [PMID: 37100638 DOI: 10.1053/j.jvca.2023.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 03/25/2023] [Accepted: 03/29/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Srikiran Ramarapu
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - John McNeil
- Department of Anesthesiology, University of Virginia, Charlottesville, Virginia
| | - Kenichi A Tanaka
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kofi Vandyck
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| |
Collapse
|
9
|
Lin X, Ward SA, Pritchard E, Ahern S, Gardam M, Brodaty H, Ryan J, McNeil J, Tsindos T, Wallis K, Jeon Y, Robinson S, Krysinska K, Ayton D. Carer-reported measures for a dementia registry: A systematic scoping review and a qualitative study. Australas J Ageing 2023; 42:34-52. [PMID: 36383194 PMCID: PMC10947070 DOI: 10.1111/ajag.13148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/30/2022] [Accepted: 10/08/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Informal carers play a critical role in supporting people with dementia. We conducted a scoping review and a qualitative study to inform the identification and development of carer-reported measures for a dementia clinical quality registry. METHODS Phase 1-Scoping review: Searches to identify carer-reported health and well-being measures were conducted in three databases (MEDLINE, PsycINFO and Embase). Data were extracted to record how the measures were administered, the domains of quality-of-life addressed and whether they had been used in a registry context. Phase 2-Qualitative study: Four focus groups were conducted with carers to examine the acceptability of selected measures and to identify outcomes that were important but missing from these measures. RESULTS Phase 1: Ninety-nine carer measures were identified with the top four being the Zarit Burden Interview (n = 39), the Short-Form12/36 (n = 14), the Brief Coping Orientation to Problems Experienced scale and the Sense of Coherence scale (both n = 9). Modes of administration included face-to-face (n = 50), postal (n = 11), telephone (n = 8) and online (n = 5). No measure had been used in a registry context. Phase 2: Carers preferred brief measures that included both outcome and experience questions, reflected changes in carers' circumstances and included open-ended questions. CONCLUSIONS Carer-reported measures for a dementia clinical quality registry need to include both outcome and experience questions to capture carers' perceptions of the process and outcomes of care and services. Existing carer-reported measures have not been used in a dementia registry context and adaption and further research are required.
Collapse
Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Stephanie A. Ward
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Centre for Healthy Brain Ageing (CHeBA), School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
- Department of Geriatric MedicineThe Prince of Wales HospitalRandwickNew South WalesAustralia
| | - Elizabeth Pritchard
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Susannah Ahern
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Madeleine Gardam
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
- Dementia Centre for Research Collaboration, School of PsychiatryUniversity of New South WalesSydneyNew South WalesAustralia
| | - Joanne Ryan
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - John McNeil
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Tess Tsindos
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Kasey Wallis
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Yun‐Hee Jeon
- Susan Wakil School of Nursing and MidwiferyUniversity of SydneySydneyNew South WalesAustralia
| | - Sandra Robinson
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Karolina Krysinska
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Centre for Mental Health, School of Population and Global HealthThe University of MelbourneMelbourneVictoriaAustralia
| | - Darshini Ayton
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| |
Collapse
|
10
|
Welberry HJ, Chau T, Heffernan M, San Jose JC, Jorm LR, Singh MF, Sachdev PS, Anstey KJ, Lautenschlager NT, Valenzuela M, McNeil J, Brodaty H. Factors Associated with Participation in a Multidomain Web-Based Dementia Prevention Trial: Evidence from Maintain Your Brain (MYB). J Alzheimers Dis 2023; 92:959-974. [PMID: 36806506 DOI: 10.3233/jad-220990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The Maintain Your Brain (MYB) trial aims to prevent cognitive decline and dementia through multidomain, web-based risk-reduction. To facilitate translation, it is important to understand drivers of participation. OBJECTIVE To describe characteristics associated with participation in MYB. METHODS This was an observational ancillary study of MYB, a randomized controlled trial nested within the 45 and Up Study in New South Wales, Australia. We linked 45 and Up Study survey and MYB participation data. The study cohort comprised 45 and Up Study participants, aged 55-77 years at 1 January 2018, who were invited to participate in MYB. 45 and Up Study participant characteristics and subsequent MYB consent and participation were examined. RESULTS Of 98,836 invited, 13,882 (14%) consented to participate and 6,190 participated (6%). Adjusting for age and sex, a wide range of factors were related to participation. Higher educational attainment had the strongest relationship with increased MYB participation (university versus school non-completion; AdjOR = 5.15; 95% CI:4.70-5.64) and lower self-rated quality of life with reduced participation (Poor versus Excellent: AdjOR = 0.19; 95% CI:0.11-0.32). A family history of Alzheimer's disease was related to increased participation but most other dementia risk factors such as diabetes, obesity, stroke, high blood pressure, and current smoking were associated with reduced participation. CONCLUSION Higher socio-economic status, particularly educational attainment, is strongly associated with engagement in online dementia prevention research. Increasing population awareness of dementia risk factors, and better understanding the participation barriers in at-risk groups, is necessary to ensure online interventions are optimally designed to promote maximum participation.
Collapse
Affiliation(s)
- Heidi J Welberry
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia.,Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Tiffany Chau
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Megan Heffernan
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Juan Carlo San Jose
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Louisa R Jorm
- Centre for Big Data Research in Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maria Fiaratone Singh
- School of Health Sciences and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Kaarin J Anstey
- UNSW Ageing Futures Institute, University of New South Wales, Sydney, New South Wales, Australia.,School of Psychology, University of New South Wales, Sydney, Australia.,Neuroscience Research Australia
| | - Nicola T Lautenschlager
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne, Parkville, Australia.,North Western Mental Health, Royal Melbourne Hospital, Parkville, Australia
| | - Michael Valenzuela
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| | | | - Henry Brodaty
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, University of New South Wales, Sydney, New South Wales, Australia
| |
Collapse
|
11
|
Craig H, Gasevic D, Ryan J, Owen A, McNeil J, Woods R, Britt C, Ward S, Freak-Poli R. Socioeconomic, Behavioural, and Social Health Correlates of Optimism and Pessimism in Older Men and Women: A Cross-Sectional Study. Int J Environ Res Public Health 2023; 20:3259. [PMID: 36833951 PMCID: PMC9961087 DOI: 10.3390/ijerph20043259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Optimism is a disposition characterised by positive future expectancies, while pessimism is characterised by expecting the worst. High optimism and low pessimism promote the health of older adults and may potentiate full engagement in life. We identified socioeconomic, behavioural, and social factors associated with optimism and pessimism in older adults. METHODS Participants included 10,146 community-dwelling, apparently healthy Australian adults aged 70 years and over from the ASPREE Longitudinal Study of Older Persons (ALSOP). Optimism and pessimism were measured using the revised Life Orientation Test. Cross-sectional ordinal logistic regression was used to determine the socioeconomic, behavioural, and social health factors associated with optimism and pessimism. RESULTS Higher education, greater physical activity, lower loneliness, and volunteering were associated with higher optimism and lower pessimism. Low social support was associated with higher pessimism. Higher socioeconomic advantage, greater income, and living alone were associated with lower pessimism. Women were more optimistic and less pessimistic than men. The association of age, smoking status, and alcohol consumption with optimism and pessimism differed for men and women. CONCLUSIONS Factors associated with higher optimism and lower pessimism were also those demonstrated to support healthy ageing. Health-promotion action at the individual level (e.g., smoking cessation or regular physical activity), health professional level (e.g., social prescribing or improving access and quality of care for all older adults), and community level (e.g., opportunities for volunteer work or low-cost social activities for older adults) may improve optimism and reduce pessimism, possibly also promoting healthy ageing.
Collapse
Affiliation(s)
- Heather Craig
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Centre for Global Health, Usher Institute, University of Edinburgh, Teviot Place, Edinburgh EH8 9AG, UK
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, NSW 2031, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC 3004, Australia
| |
Collapse
|
12
|
Roebuck G, Lotfaliany M, Agustini B, Forbes M, Mohebbi M, McNeil J, Woods RL, Reid CM, Nelson MR, Shah RC, Ryan J, Newman AB, Owen A, Freak-Poli R, Stocks N, Berk M. The effect of depressive symptoms on disability-free survival in healthy older adults: A prospective cohort study. Acta Psychiatr Scand 2023; 147:92-104. [PMID: 36281968 PMCID: PMC10026010 DOI: 10.1111/acps.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 10/11/2022] [Accepted: 10/20/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Gerontology and ageing research are increasingly focussing on healthy life span (healthspan), the period of life lived free of serious disease and disability. Late-life depression (LLD) is believed to impact adversely on physical health. However, no studies have examined its effect on healthspan. This study investigated the effect of LLD and subthreshold depression on disability-free survival, a widely accepted measure of healthspan. METHODS This prospective cohort study used data from the ASPirin in Reducing Events in the Elderly study. Participants were aged ≥70 years (or ≥65 years for African-American and Hispanic participants) and free of dementia, physical disability and cardiovascular disease. Depressive symptoms were measured using the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10). LLD and subthreshold depression were defined as CES-D-10 scores ≥8 and 3-7, respectively. Disability-free survival was defined as survival free of dementia and persistent physical disability. RESULTS A total of 19,110 participants were followed up for a maximum of 7.3 years. In female participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors, medical comorbidities, polypharmacy, physical function and antidepressant use (HR, 1.50; 95% CI, 1.23-1.82). In male participants, LLD was associated with lower disability-free survival adjusting for sociodemographic and lifestyle factors (HR, 1.30; 95% CI, 1.03-1.64). Subthreshold depression was also associated with lower disability-free survival in both sexes. CONCLUSIONS LLD may be a common and important risk factor for shortened healthspan.
Collapse
Affiliation(s)
- Greg Roebuck
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
- Phoenix Australia – Centre for Posttraumatic Mental Health, Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | - Mojtaba Lotfaliany
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
| | - Bruno Agustini
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
| | - Malcolm Forbes
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
- Department of Psychiatry, University of Melbourne, Parkville, Victoria, Australia
| | | | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anne B. Newman
- School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Nigel Stocks
- Discipline of General Practice, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Michael Berk
- The Institute for Mental and Physical Health and Clinical Translation (IMPACT), School of Medicine, Deakin University, and Barwon Health, Geelong, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Orygen, the National Centre of Excellence in Youth Health, and the Florey Institute for Neuroscience and Mental Health, Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia
| | | |
Collapse
|
13
|
Chan PY, Tay A, Chen D, De Freitas M, Millet C, Nguyen-Duc T, Duke G, Lyall J, Nguyen JT, McNeil J, Hopper I. Ambient intelligence-based monitoring of staff and patient activity in the intensive care unit. Aust Crit Care 2023; 36:92-98. [PMID: 36244918 DOI: 10.1016/j.aucc.2022.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 08/19/2022] [Accepted: 08/20/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Caregiver workload in the ICU setting is difficult to numerically quantify. Ambient Intelligence utilises computer vision-guided neural networks to continuously monitor multiple datapoints in video feeds, has become increasingly efficient at automatically tracking various aspects of human movement. OBJECTIVES To assess the feasibility of using Ambient Intelligence to track and quantify allpatient and caregiver activity within a bedspace over the course of an ICU admission and also to establish patient specific factors, and environmental factors such as time ofday, that might contribute to an increased workload in ICU workers. METHODS 5000 images were manually annotated and then used to train You Only LookOnce (YOLOv4), an open-source computer vision algorithm. Comparison of patientmotion and caregiver activity was then performed between these patients. RESULTS The algorithm was deployed on 14 patients comprising 1762800 framesof new, untrained data. There was a strong correlation between the number ofcaregivers in the room and the standardized movement of the patient (p < 0.0001) withmore caregivers associated with more movement. There was a significant difference incaregiver activity throughout the day (p < 0.05), HDU vs. ICU status (p < 0.05), delirious vs. non delirious patients (p < 0.05), and intubated vs. not intubated patients(p < 0.05). Caregiver activity was lowest between 0400 and 0800 (average .71 ± .026caregivers per hour) with statistically significant differences in activity compared to 0800-2400 (p < 0.05). Caregiver activity was highest between 1200 and 1600 (1.02 ± .031 caregivers per hour) with a statistically significant difference in activity comparedto activity from 1600 to 0800 (p < 0.05). The three most dominant predictors of workeractivity were patient motion (Standardized Dominance 78.6%), Mechanical Ventilation(Standardized Dominance 7.9%) and Delirium (Standardized Dominance 6.2%). CONCLUSION Ambient Intelligence could potentially be used to derive a single standardized metricthat could be applied to patients to illustrate their overall workload. This could be usedto predict workflow demands for better staff deployment, monitoring of caregiver workload, and potentially as a tool to predict burnout.
Collapse
Affiliation(s)
- Peter Y Chan
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Victoria, Australia; School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Andrew Tay
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - David Chen
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Maria De Freitas
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Coralie Millet
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Thanh Nguyen-Duc
- School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia
| | - Graeme Duke
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Jessica Lyall
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - John T Nguyen
- School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ingrid Hopper
- School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
14
|
Alharbi TA, Ryan J, Freak-Poli R, Gasevic D, McNeil J, Woods RL, Britt C, Nelson MR, Owen AJ. Self-Reported Early and Later Life Weight and the Risk of All-Cause Mortality in Older Adults. J Nutr Health Aging 2023; 27:301-308. [PMID: 37170438 PMCID: PMC10353754 DOI: 10.1007/s12603-023-1907-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/25/2023] [Indexed: 05/13/2023]
Abstract
OBJECTIVES The extent to which body weight in early adulthood is associated with late-life mortality risk is unclear. This study aimed to determine the association between body mass index (BMI) in early adulthood (at 18 years of age) and older age (70 years and over), and the risk of mortality in later life. DESIGN Secondary analysis of the ASPREE Longitudinal Study of Older Persons (ALSOP). SETTING, PARTICIPANTS Data were from 14,853 relatively healthy community-dwelling Australians aged ≥ 70 years when enrolled in the study. MEASUREMENTS Self-reported weight at age ≥ 70 years and recalled weight at age 18 years were collected at ALSOP study baseline. Height was measured with a stadiometer and was used for calculation of BMI at both timepoints. BMI at each timepoint was defined as: underweight, normal weight, overweight and obese. Individuals were categorised into one of five 'lifetime' BMI groups: normal weight (BMI between 18.5 and 24.9 at both times), overweight (25.0-29.9 at either or both times), obesity to non-obese (≥30.0 at age 18 and <30.0 ≥ 70 years), non-obese to obesity (<30.0 at age 18 and ≥30.0 at age ≥ 70 years), and early and later life obesity (≥30.0 at both times). RESULTS During a median 4.7 years follow-up, 715 deaths occurred. Obesity at 18 years, but not in older age (p=0.44), was significantly associated with the risk of mortality in later life, even after accounting for current health status (HR: 2.35, 95% CI: 1.53-3.58, p<0.001). Compared with participants with normal BMI at both time points, being obese at both time points was associated with increased mortality risk (HR=1.99, 95% CI: 1.04-3.81, p=0.03), and the risk was even greater for individuals who were obese at 18 years but were no longer obese in older age (HR=2.92, 95% CI: 1.65-5.16, p<0.001), in fully adjusted models. Participants who were normal weight at 18 years and were obese in later life, did not have an increased mortality risk (p=0.78). CONCLUSIONS Obesity in early adulthood, and obesity in both early and later life, were associated with increased mortality risk in later life. This highlights the importance of preventing obesity in early adulthood and maintaining a normal weight over an adult lifespan.
Collapse
Affiliation(s)
- T A Alharbi
- Dr Alice J. Owen, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St. Kilda Rd., Level 4, Melbourne VIC 3004, Australia, Tel: +61 3 9903 0416,
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Wild H, Gasevic D, Woods RL, Ryan J, Berk M, Wolfe R, McNeil J, Owen AJ. Correlates of Meal Skipping in Community Dwelling Older Adults: A Cross-Sectional Study. J Nutr Health Aging 2023; 27:159-165. [PMID: 36806870 PMCID: PMC10035663 DOI: 10.1007/s12603-023-1884-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/24/2022] [Indexed: 02/05/2023]
Abstract
In this cross-sectional analysis of 10,071 community dwelling adults aged ≥70 years, we examined factors associated with meal skipping (self-reported) using multivariable logistic regression. Prevalence of meal skipping in this study was 19.5%. The adjusted odds (aOR [95%CI]) of meal skipping were lower in those 85+ years (vs. 70-74.9 years, 0.56 [0.45-0.70]), and in those in regional areas (vs. urban area, 0.81 [0.72-0.92]). Higher odds of meal skipping were observed for those living alone (vs. living with someone, 1.84 [1.64-2.05]), current smokers (vs. non-smokers, 2.07 [1.54-2.80]), consumers of high amounts of alcohol (vs. abstainers 1.93 [1.35-2.75]), those with poor oral health (vs. excellent oral health, 1.71 [1.07 -2.73]) diabetes (vs. not 1.26 [1.06-1.50]), or frailty (vs. not, 1.63 [1.09-2.43]). This study identified socio-demographic, social, behavioural and biomedical correlates of meal skipping in later life, which may assist in targeting interventions to address meal skipping.
Collapse
Affiliation(s)
- H Wild
- Dr Alice J Owen, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Melbourne 3004, VIC, Australia, T: +61 3 9903 0416
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Ekram ARMS, Espinoza S, Ryan J, Ernst M, Tonkin A, Reid C, McNeil J, Woods R. FRAILTY AND CARDIOVASCULAR DISEASE EVENTS IN COMMUNITY-DWELLING HEALTHY OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9766191 DOI: 10.1093/geroni/igac059.1301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Frailty is associated with adverse outcomes, but whether it independently increases cardiovascular disease (CVD) risk requires clarification. METHODS This study examined the association between frailty in a cohort with no previous CVD events and subsequent CVD outcomes in 19,114 community-dwelling older people from the ASPREE trial. Frailty was assessed using the modified Fried phenotype, comprising weakness, exhaustion, low body mass index (BMI), slowness and low physical activity, and a deficit accumulation frailty index (FI) of 66 items. CVD event was defined as a composite of CVD death, non-fatal myocardial infarction, non-fatal stroke and hospitalization for heart failure. Results Over a median 4.7-years of follow-up (interquartile range: 3.6 to 5.7 years), pre-frail/frail participants were more likely to develop CVD events (Hazard ratio (HR): 1.33; 95% Confidence Interval (CI): 1.16, 1.53 for pre-frail and HR: 1.68; 95% CI: 1.19, 2.38 for frail participants) according to Fried phenotype. Subtypes of CVD (fatal/non-fatal myocardial infarction and heart failure hospitalization) similarly increased HRs except fatal or non-fatal stroke. These effect sizes were more prominent when frailty was assessed using the FI than that assessed by Fried phenotype. CONCLUSION Pre-frail and frail participants were at significantly increased risk of developing CVD and its sub-types (particularly fatal/non-fatal myocardial infarction and hospitalization for heart failure). Addressing pre-frailty and frailty in older people could contribute to CVD prevention strategies.
Collapse
Affiliation(s)
| | - Sara Espinoza
- Sam and Ann Barshop Institute, UT Health San Antonio, San Antonio, Texas, United States
| | - Joanne Ryan
- Monash University, Melbourne, Victoria, Australia
| | - Michael Ernst
- The University of Iowa, Iowa City, Iowa, United States
| | | | | | - John McNeil
- Monash University, Melbourne, Victoria, Australia
| | - Robyn Woods
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
17
|
Hussain SM, Newman A, Beilin L, Tonkin A, Woods R, Neumann J, Nelson M, McNeil J. EFFECT OF CHANGE IN BODY SIZE ON MORTALITY IN THE INITIALLY HEALTHY COMMUNITY-DWELLING OLDER ADULTS. Innov Aging 2022. [DOI: 10.1093/geroni/igac059.2716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Utilising data from the ASPirin in Reducing Events in the Elderly trial participants [aged >70-years (Australians), >65-years (US)], we estimated percent change in body size (BMI: body mass index, WC: waist circumference) from baseline and the second annual visits. Both BMI and WC changes were categorised as 1) change within 5% (stable), 2) decrease by 5–10%, 3) decrease by >10%, 4) increase by 5–10%, and 5) increase by >10%. Mortality events were classified according to the underlying cause by adjudicators. Hazard ratios were calculated to compare mortality between body size change categories. Amongst 16,773 participants, 1,269 mortality were observed over an average 4.4±1.7 years. In men compared to stable BMI, a 5–10% decrease in BMI had a 35% higher (HR 1.35, 95% CI 1.08–1.67), and a >10% decrease in BMI had a 3.84-fold higher (HR 2.99, 95% CI 2.44–3.68) risk in all-cause mortality. A decrease in BMI was associated with a higher cause-specific (cancer, cardiovascular disease [CVD], and non-cancer non-CVD) mortality. A decrease in BMI was associated with higher mortality risk in women, however, the magnitude of association was weaker than men. A decrease in WC was predictive of mortality but with a much weaker relationship than a decrease in BMI. Weight gain was not predictive of mortality except for non-cancer non-CVD mortality in women. Physicians should be aware of the ominous consequence of weight loss, especially amongst older men. The risk extends beyond an increased risk of cancer, extending to CVD and a range of other life-limiting conditions.
Collapse
Affiliation(s)
| | - Anne Newman
- University of Pittsburgh , Pittsburgh, Pennsylvania , United States
| | - Lawrence Beilin
- The University of Western Australia , Perth, Western Australia , Australia
| | | | - Robyn Woods
- Monash University , Melbourne, Victoria , Australia
| | - Johannes Neumann
- University Heart & Vascular Center Hamburg , Hamburg, Hamburg , Germany
| | - Mark Nelson
- Menzies Research Institute, University of Tasmania , Hobart, Tasmania , Australia
| | - John McNeil
- Monash University , Melbourne, Victoria , Australia
| |
Collapse
|
18
|
Hussain SM, Ebeling P, Barker A, Beilin L, Tonkin A, McNeil J. PLASMA HIGH DENSITY LIPOPROTEIN CHOLESTEROL AND RISK OF FRACTURES IN OLDER ADULTS. Innov Aging 2022. [PMCID: PMC9766916 DOI: 10.1093/geroni/igac059.2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The ASPirin in Reducing Events in the Elderly trial participants (ASPREE, aged >70-years Australians), for whom high-density lipoprotein cholesterol (HDL-C) levels were measured were included. Fractures included were confirmed by medical imaging and included both traumatic and pathological fractures. Fractures were confirmed by an expert review panel. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for associations with fractures. Of the 16262 participants who had a plasma HDL-C measurement at baseline 1,659 experienced at least one episode of fracture over a median of 3.98 years (interquartile range, 0.02, 7.0 years). In the fully adjusted model, each mmol/L increment in HDL-C was associated with a 34% (HR 1.34, 95% CI 1.20–1.50) higher risk of fractures. The results remained similar when these analyses were stratified by sex. Sensitivity analyses demonstrated that these associations persisted when the analyses were repeated including only: 1) nontraumatic fractures, 2) participants not on osteoporotic medications, 3) participants who were never-smokers and reported that they did not drink alcohol, and 4) participants who walked outside less than 30 minutes and reported no participation in moderate/vigorous physical activity. No association was observed between non-HDL-C and fractures. This prospective observational study suggests that higher levels of HDL-C are associated with higher fracture risk. This association was independent of the common risk factors of fractures.
Collapse
Affiliation(s)
| | | | - Anna Barker
- Monash University, Melbourne, Victoria, Australia
| | - Lawrence Beilin
- The University of Western Australia, Perth, Western Australia, Australia
| | | | - John McNeil
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Brodaty H, Heffernan M, Singh MAF, Valenzuela M, Lautenschlager NT, Anstey KJ, Sachdev PS, Jorm L, McNeil J, Maeder A, Ginige JA, Chau T, Jose JCS, Millard M, Welberry H. Maintain Your Brain: a 3‐year online randomized controlled trial to reduce cognitive decline in 55‐77 year olds. Alzheimers Dement 2022. [DOI: 10.1002/alz.061548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Sydney Sydney NSW Australia
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
- UNSW Sydney Sydney NSW Australia
| | | | | | | | | | - Kaarin J. Anstey
- University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, UNSW Sydney Sydney NSW Australia
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
- Neuropsychiatric Institute (NPI), Euroa Centre, Prince of Wales Hospital Sydney NSW Australia
| | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales Sydney NSW Australia
| | | | | | | | - Tiffany Chau
- Centre for Healthy Brain Ageing, University of New South Wales Sydney NSW Australia
| | | | | | | | | |
Collapse
|
20
|
Craig H, Ryan J, Freak-Poli R, Owen A, McNeil J, Woods RL, Britt C, Tonkin A, Gasevic D. The Association of Dispositional Optimism and Pessimism With Cardiovascular Disease Events in Older Adults: A Prospective Cohort Study. J Aging Health 2022; 34:961-972. [PMID: 35410519 PMCID: PMC10026003 DOI: 10.1177/08982643221083118] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Positive psychosocial factors may protect against cardiovascular disease (CVD). We aimed to determine the association of optimism and pessimism with CVD events in community-dwelling older adults. Methods: 11,651 adults aged 70 years and over, participants of the ASPREE Longitudinal Study of Older Persons (ALSOP), were followed-up for 4.7 years (median). The association of optimism and pessimism (assessed as separate constructs by revised Life Orientation Test) and incident CVD events (composite and components) was assessed by Cox regression adjusted for demographic, socioeconomic and health factors. Results: No association was observed between optimism and pessimism with composite CVD events. Being more pessimistic was associated with a greater risk of fatal coronary heart disease, while being more optimistic was associated with a lower risk of non-fatal myocardial infarction. Conclusions: Optimism and pessimism may shape cardiovascular health of older adults; and we argue these psychosocial factors should be researched as separate constructs.
Collapse
Affiliation(s)
| | - Joanne Ryan
- Monash University, Melbourne, VIC, Australia
- INSERM, Montpellier, France
| | | | - Alice Owen
- Monash University, Melbourne, VIC, Australia
| | - John McNeil
- Monash University, Melbourne, VIC, Australia
| | | | | | | | - Danijela Gasevic
- Monash University, Melbourne, VIC, Australia
- University of Edinburgh, Edinburgh, UK
| |
Collapse
|
21
|
Chan PY, Ryan NP, Chen D, McNeil J, Hopper I. Novel wearable and contactless heart rate, respiratory rate, and oxygen saturation monitoring devices: a systematic review and meta-analysis. Anaesthesia 2022; 77:1268-1280. [PMID: 35947876 DOI: 10.1111/anae.15834] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2022] [Indexed: 11/28/2022]
Abstract
We performed a systematic review and meta-analysis to identify, classify and evaluate the body of evidence on novel wearable and contactless devices that measure heart rate, respiratory rate and oxygen saturations in the clinical setting. We included any studies of hospital inpatients, including sleep study clinics. Eighty-four studies were included in the final review. There were 56 studies of wearable devices and 29 of contactless devices. One study assessed both types of device. A high risk of patient selection and rater bias was present in proportionally more studies assessing contactless devices compared with studies assessing wearable devices (p = 0.023 and p < 0.0001, respectively). There was high but equivalent likelihood of blinding bias between the two types of studies (p = 0.076). Wearable device studies were commercially available devices validated in acute clinical settings by clinical staff and had more real-time data analysis (p = 0.04). Contactless devices were more experimental, and data were analysed post-hoc. Pooled estimates of mean (95%CI) heart rate and respiratory rate bias in wearable devices were 1.25 (-0.31-2.82) beats.min-1 (pooled 95% limits of agreement -9.36-10.08) and 0.68 (0.05-1.32) breaths.min-1 (pooled 95% limits of agreement -5.65-6.85). The pooled estimate for mean (95%CI) heart rate and respiratory rate bias in contactless devices was 2.18 (3.31-7.66) beats.min-1 (pooled limits of agreement -6.71-10.88) and 0.30 (-0.26-0.87) breaths.min-1 (pooled 95% limits of agreement -3.94-4.29). Only two studies of wearable devices measured Sp O2 ; these reported mean measurement biases of 3.54% (limits of agreement -5.65-11.45%) and 2.9% (-7.4-1.7%). Heterogeneity was observed across studies, but absent when devices were grouped by measurement modality and reference standard. We conclude that, while studies of wearable devices were of slightly better quality than contactless devices, in general all studies of novel devices were of low quality, with small (< 100) patient datasets, typically not blinded and often using inappropriate statistical techniques. Both types of devices were statistically equivalent in accuracy and precision, but wearable devices demonstrated less measurement bias and more precision at extreme vital signs. The statistical variability in precision and accuracy between studies is partially explained by differences in reference standards.
Collapse
Affiliation(s)
- P Y Chan
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - N P Ryan
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - D Chen
- Department of Intensive Care Medicine, Eastern Health, Melbourne, Vic., Australia
| | - J McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| | - I Hopper
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic., Australia
| |
Collapse
|
22
|
Tse A, Ward S, McNeil J, Barker A, Cicuttini F, Fitzgibbon B, Hussain SM, Owen A, Wang YY, Wolfe R, Gilmartin-Thomas JFM. Severe low back or lower limb pain is associated with recurrent falls amongst older Australians. Eur J Pain 2022; 26:1923-1937. [PMID: 35862463 PMCID: PMC9546413 DOI: 10.1002/ejp.2013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 06/25/2022] [Accepted: 07/16/2022] [Indexed: 11/14/2022]
Abstract
Background Few studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults. Objectives Investigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls‐related injuries. Methods Community‐dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged ≥70 years. Self‐reported, cross‐sectional questionnaire data regarding number of falls and falls‐related injuries in the last 12 months; and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately. Results Of 14,892 ALSOP participants, 13% (n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001; lower limb: males RR = 2.0, p < 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls‐related injury in the last 12 months compared to females with mild pain. Conclusion Severe low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls‐related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls‐risk evaluation. Significance Severe low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls‐related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls‐risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms.
Collapse
Affiliation(s)
- Amy Tse
- Aged Care Department, Bankstown-Lidcombe Hospital, New South Wales, Australia.,School of Health, University of New South Wales, New South Wales, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Centre for Healthy Brain Ageing, University of New South Wales, New South Wales, Australia.,Dept of Geriatric Medicine, Prince of Wales Hospital, New South Wales, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Anna Barker
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Silver Chain, Victoria, Australia
| | - Flavia Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Bernadette Fitzgibbon
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Department of Medical Education, Melbourne Medical School, The University of Melbourne, Victoria, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Yuan Yuan Wang
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Julia Fiona-Maree Gilmartin-Thomas
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia.,Institute for Health & Sport, Victoria University, Victoria, Australia.,Australian Institute for Musculoskeletal Science, Victoria, Australia
| |
Collapse
|
23
|
Bakshi A, Cao Y, Orchard SG, Carr PR, Joshi AD, Manning AK, Buchanan DD, Umar A, Winship IM, Gibbs P, Zalcberg JR, Macrae F, McNeil J, Lacaze P, Chan AT. Aspirin and the Risk of Colorectal Cancer According to Genetic Susceptibility among Older Individuals. Cancer Prev Res (Phila) 2022; 15:447-454. [PMID: 35348611 PMCID: PMC9256779 DOI: 10.1158/1940-6207.capr-22-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/22/2022] [Accepted: 03/25/2022] [Indexed: 01/07/2023]
Abstract
Although aspirin has been considered a promising agent for prevention of colorectal cancer, recent data suggest a lack of benefit among older individuals. Whether some individuals with higher risk of colorectal cancer may benefit from aspirin remains unknown. We used a 95-variant colorectal cancer polygenic risk score (PRS) to explore the association between genetic susceptibility to colorectal cancer and aspirin use in a prospective study of 12,609 individuals of European descent ages ≥70 years, enrolled in the ASPirin in Reducing Events in the Elderly (ASPREE) double-blinded, placebo-controlled randomized trial (randomized controlled trial; RCT). Cox proportional hazards models were used to assess the association of aspirin use on colorectal cancer, as well as the interaction between the PRS and aspirin treatment on colorectal cancer. Over a median of 4.7 years follow-up, 143 participants were diagnosed with incident colorectal cancer. Aspirin assignment was not associated with incidence of colorectal cancer overall [HR = 0.94; 95% confidence interval (CI), 0.68-1.30] or within strata of PRS (P for interaction = 0.97). However, the PRS was associated with an increased risk of colorectal cancer (HR = 1.28 per SD; 95% CI, 1.09-1.51). Individuals in the top quintile of the PRS distribution had an 85% higher risk compared with individuals in the bottom quintile (HR = 1.85; 95% CI, 1.08-3.15). In a prospective RCT of older individuals, a PRS is associated with incident colorectal cancer risk, but aspirin use was not associated with a reduction of incident colorectal cancer, regardless of baseline genetic risk. PREVENTION RELEVANCE There is strong evidence to support prophylactic aspirin use for the prevention of colorectal cancer. However recent recommendations suggest the risk of bleeding in older individuals outweighs the benefit. We sought to determine whether some older individuals might still benefit from aspirin based on their genetic susceptibility.
Collapse
Affiliation(s)
- Andrew Bakshi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC 3004 Melbourne, Australia
| | - Yin Cao
- Alvin J. Siteman Cancer Center, Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St Louis, MO 63110, USA
| | - Suzanne G. Orchard
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC 3004 Melbourne, Australia
| | - Prudence R. Carr
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC 3004 Melbourne, Australia
| | - Amit D. Joshi
- Clinical and Translational Epidemiology Unit, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02108, USA
| | - Alisa K Manning
- Clinical and Translational Epidemiology Unit, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02108, USA
| | - Daniel D. Buchanan
- Colorectal Oncogenomics Group, Department of Clinical Pathology, Melbourne Medical School, The University of Melbourne, Parkville, Australia,University of Melbourne Centre for Cancer Research, The University of Melbourne, Parkville, Australia,Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia
| | - Asad Umar
- Division of Cancer Prevention, National Cancer Institute, Rockville, MD 20892, USA
| | - Ingrid M Winship
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia,Department of Medicine (RMH),The University of Melbourne, Parkville, Australia
| | - Peter Gibbs
- Personalised Oncology Division, Walter and Eliza Hall Institute Medical Research, Faculty of Medicine, University of Melbourne, Melbourne, VIC 3052, Australia
| | - John R. Zalcberg
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC 3004 Melbourne, Australia
| | - Finlay Macrae
- Genomic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Parkville, Australia,Department of Medicine (RMH),The University of Melbourne, Parkville, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC 3004 Melbourne, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, VIC 3004 Melbourne, Australia
| | - Andrew T Chan
- Clinical and Translational Epidemiology Unit, MGH Cancer Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02108, USA
| |
Collapse
|
24
|
Zhou Z, Nelson M, Ernst ME, Reid C, McNeil J, Tonkin A. Does Aspirin Prevent Incident Heart Failure in Healthy Older Adults? Examining the Evidence From the ASPREE Trial. Circ Heart Fail 2022; 15:e009511. [PMID: 35727884 PMCID: PMC9228581 DOI: 10.1161/circheartfailure.122.009511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Zhen Zhou
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mark Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IA, USA,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IA, USA
| | - Christopher Reid
- School of Public Health, Curtin University, Perth, WA, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | |
Collapse
|
25
|
Lacaze P, Wang Y, Polekhina G, Bakshi A, Riaz M, Owen A, Franks A, Abidi J, Tiller J, McNeil J, Cicuttini F. Genomic risk score for advanced osteoarthritis in older adults. Arthritis Rheumatol 2022; 74:1480-1487. [PMID: 35506208 PMCID: PMC9427681 DOI: 10.1002/art.42156] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 01/20/2022] [Accepted: 04/28/2022] [Indexed: 11/29/2022]
Abstract
Objective Prevention of osteoarthritis (OA) remains important, as there are no disease‐modifying treatments. A personalized approach has the potential to better target prevention strategies. In the present study, we used recently identified genetic risk variants from genome‐wide association analysis for advanced OA to calculate polygenic risk scores (PRS) for knee and hip OA and assessed PRS performance in an independent population of older community‐dwelling adults. Methods PRS were calculated in 12,093 individuals of European genetic descent ages ≥70 years who were enrolled in the Aspirin in Reducing Events in the Elderly trial. The outcome measure was knee and hip replacement (hospitalizations during the trial and self‐reported joint replacements before enrollment). PRS were considered as continuous (per SD) and categorical (low risk [0–20%], medium risk [21–80%], high risk [81–100%]) variables. Logistic regression was used to examine associations between PRS and risk of joint replacement, adjusted for age, sex, body mass index, and socioeconomic status. Results Among the participants, 1,422 (11.8%) had knee replacements and 1,297 (10.7%) had hip replacements. PRS (per SD) were associated with a risk of knee replacement (odds ratio [OR] 1.13 [95% confidence interval (95% CI) 1.07–1.20]) and hip replacement (OR 1.23 [95% CI 1.16–1.30]). Participants with high PRS had an increased risk of knee replacement (OR 1.44 [95% CI 1.20–1.73]) and hip replacement (OR 1.88 [95% CI 1.56–2.26]), compared to those with low PRS. Associations were stronger for PRS and hip replacement risk in women than in men. Associations were similar in sensitivity analyses that examined joint replacements before and during the trial separately. Conclusion PRS have the potential to improve prevention of severe knee and hip OA by providing a personalized approach and identifying individuals who may benefit from early intervention.
Collapse
Affiliation(s)
- Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Galina Polekhina
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Bakshi
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Moeen Riaz
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angus Franks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jawad Abidi
- Department of Medicine, Alfred Hospital, Melbourne, Australia
| | - Jane Tiller
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Flavia Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
26
|
Lacaze PA, Tiller J, Winship I, Lacaze P, Tiller J, Winship I, Brotchie A, McNeil J, Zalcberg J, Thomas D, Milne R, James P, Delatycki M, Young M, Nowak K, Nguyen‐Dumont T, Southey M, Ademi Z, Bruinsma F, Riaz M, Terrill B, Kirk J, Tucker K, Andrews L, Pachter N, Susman R, Poplawski N, Wallis M, Watts G, Nicholls S, Macrae F, Sturm A, Green R, Ahern S, Revote J, Von Saldern S, Powell S, Rice T. Population DNA screening for medically actionable disease risk in adults. Med J Aust 2022; 216:278-280. [PMID: 35267197 PMCID: PMC9314023 DOI: 10.5694/mja2.51454] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/10/2022] [Accepted: 01/18/2022] [Indexed: 12/31/2022]
Affiliation(s)
| | | | - Ingrid Winship
- Royal Melbourne Hospital Melbourne VIC
- University of Melbourne Melbourne VIC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Mazzeffi M, McNeil J, Singh K, Tanaka K. Retrograde Autologous Priming in Minimally Invasive Mitral Valve Surgery: Simple, Safe, and Effective. J Cardiothorac Vasc Anesth 2022; 36:3036-3037. [DOI: 10.1053/j.jvca.2022.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 04/20/2022] [Indexed: 11/11/2022]
|
28
|
Neumann JT, Riaz M, Bakshi A, Polekhina G, Thao LTP, Nelson MR, Woods RL, Abraham G, Inouye M, Reid CM, Tonkin AM, McNeil J, Lacaze P. Prognostic Value of a Polygenic Risk Score for Coronary Heart Disease in Individuals Aged 70 Years and Older. Circ Genom Precis Med 2022; 15:e003429. [PMID: 34949098 PMCID: PMC8847323 DOI: 10.1161/circgen.121.003429] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The use of a polygenic risk score (PRS) to improve risk prediction of coronary heart disease (CHD) events has been demonstrated to have clinical utility in the general adult population. However, the prognostic value of a PRS for CHD has not been examined specifically in older populations of individuals aged ≥70 years, who comprise a distinct high-risk subgroup. The objective of this study was to evaluate the predictive value of a PRS for incident CHD events in a prospective cohort of older individuals without a history of cardiovascular events. METHODS We used data from 12 792 genotyped, healthy older individuals enrolled into the ASPREE trial (Aspirin in Reducing Events in the Elderly), a randomized double-blind placebo-controlled clinical trial investigating the effect of daily 100 mg aspirin on disability-free survival. Participants had no previous history of diagnosed atherothrombotic cardiovascular events, dementia, or persistent physical disability at enrollment. We calculated a PRS (meta-genomic risk score) consisting of 1.7 million genetic variants. The primary outcome was a composite of incident myocardial infarction or CHD death over 5 years. RESULTS At baseline, the median population age was 73.9 years, and 54.9% were female. In total, 254 incident CHD events occurred. When the PRS was added to conventional risk factors, it was independently associated with CHD (hazard ratio, 1.24 [95% CI, 1.08-1.42], P=0.002). The area under the curve of the conventional model was 70.53 (95% CI, 67.00-74.06), and after inclusion of the PRS increased to 71.78 (95% CI, 68.32-75.24, P=0.019), demonstrating improved prediction. Reclassification was also improved, as the continuous net reclassification index after adding PRS to the conventional model was 0.25 (95% CI, 0.15-0.28). CONCLUSION A PRS for CHD performs well in older people and improves prediction over conventional cardiovascular risk factors. Our study provides evidence that genomic risk prediction for CHD has clinical utility in individuals aged 70 years and older. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT01038583.
Collapse
Affiliation(s)
- Johannes T. Neumann
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;,Department of Cardiology, University Heart & Vascular Centre, Hamburg, Hamburg, Germany;,German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Bakshi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Galina Polekhina
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Le T. P. Thao
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark R. Nelson
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;,Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Robyn L. Woods
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gad Abraham
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Michael Inouye
- Cambridge Baker Systems Genomics Initiative, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia;,Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christopher M. Reid
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia;,School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew M. Tonkin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
29
|
Lacaze P, Marquina C, Tiller J, Riaz M, Sturm A, Nelson M, Ference B, Pang J, Watts G, Nicholls S, Zoungas S, Liew D, McNeil J, Ademi Z. Population Genomic Screening of Young Adults for Familial Hypercholesterolaemia: A Cost-Effectiveness Analysis. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
30
|
Ng S, Parker E, Pusic A, Farrell G, Moore C, Elder E, Cooter RD, McNeil J, Hopper I. Lessons Learned in Implementing Patient-Reported Outcome Measures (PROMs) in the Australian Breast Device Registry (ABDR). Aesthet Surg J 2022; 42:31-37. [PMID: 33331907 DOI: 10.1093/asj/sjaa376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Australian Breast Device Registry (ABDR) is a clinical quality registry which utilizes both surgical data and patient-reported outcome measures (PROMs) to understand device performance. The ABDR is the first national breast device registry utilizing the BREAST-Q Implant Surveillance module to conduct PROMs via text messaging as the primary method of contact for most patients. ABDR PROMs are structured upon a successful acceptability and feasibility study and a pilot study. OBJECTIVES This aim of this paper was to examine the challenges we faced and consider how lessons learned in implementing PROMs might inform future registry studies and interventions. METHODS We tracked the number of completed follow-ups and documented feedback between October 2017 and December 2018 from various stakeholders, including sites, surgeons, and patients. RESULTS In total, 10,617 patients were contacted: 59% of breast augmentation and 77% breast reconstruction patients responded to our PROMs survey. We encountered challenges and developed solutions to overcome several key issues, including database setup; follow-up contact methods; ethics; education of surgeons and patients; associated costs; and ongoing evaluation and modification. The strategies we devised to address these challenges included drawing on experiences from previous studies, greater communication with sites and surgeons, and having the flexibility to improve and modify our PROMs. CONCLUSIONS The ABDR PROMs experience and lessons learned can inform a growing number of registries seeking to conduct PROMs. We describe our approach, obstacles encountered, and strategies to increase patient participation. As more breast device registries worldwide adopt PROMs, data harmonization is crucial to better understand patient outcomes and device performance.
Collapse
Affiliation(s)
- Sze Ng
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Emily Parker
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | - Colin Moore
- Australasian College of Cosmetic Surgery, Parramatta, Australia
| | - Elisabeth Elder
- Breast Surgeons of Australia and New Zealand, Randwick, Australia
| | | | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ingrid Hopper
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
31
|
Hussain SM, Ernst M, Reid C, Tonkin AM, Neumann J, Le Thao TP, Barker A, McNeil J. Mean Arterial Pressure and Risk of Falls Resulting in Hospital Presentation in Older Adults. Innov Aging 2021. [PMCID: PMC8969989 DOI: 10.1093/geroni/igab046.1727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Utilising data from the ASPirin in Reducing Events in the Elderly trial participants aged 70-years, we estimated MAP and variation in MAP defined as within-individual SD of MAP from baseline and first 2 annual visits. Falls were confined to those involving presentation to a hospital. Cox proportional hazards regression was used to calculate hazard ratio (HR) and 95% confidence interval (CI) for associations with falls. Amongst 16,703 participants (1,540 falls), MAP was not associated with falls irrespective of antihypertensive medication status (all: HR 1.00, 95% CI 0.99-1.01, not on antihypertensive: HR 1.01, 95% CI 0.99, 1.02, on antihypertensive: HR 1.01, 95% CI 0.99-1.02). Amongst 14,818 participants who remained in the study up to year 2 without falls, 1 unit escalation in MAP variability increased the risk (HR 1.01, 95% CI 1.00-1.03). Compared with those in the lowest tercile of variability, those in the middle or highest tercile of variability experienced an increased risk of falling (middle: HR 1.32, 95% CI 1.06-1.65; highest: HR 1.25, 95% CI 1.01-1.55). When stratified for antihypertensive medication status, those receiving diuretics (HR 1.18, 95% CI 1.00-1.39) or beta-blockers (HR 1.37, 95% CI 1.08-1.73) were at increased risk compared to those receiving renin-angiotensin-system acting agents. All results persisted after adjustment for multiple covariates. The association of diuretics and beta-blockers with falls remained significant even after excluding those with history of heart failure. Older community-dwelling adults with high variability in MAP are at increases risk of falls, particularly amongst those receiving beta-blockers or diuretics.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Anna Barker
- Silver Chain, Melbourne, Victoria, Australia
| | - John McNeil
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
32
|
Espinoza S, Ekram ARMS, Woods R, Ernst M, Polekhina G, McNeil J, Murray A, Ryan J. The Effect of Low-Dose Aspirin on Frailty in Older Adults in the Aspirin in Reducing Events in the Elderly Study. Innov Aging 2021. [PMCID: PMC8969428 DOI: 10.1093/geroni/igab046.3009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are no widely accepted pharmacologic treatments for frailty prevention. Since frailty is associated with inflammation, aspirin has the potential to reduce frailty. We investigated whether low-dose aspirin reduces incident frailty in participants of the ASPirin in Reducing Events in the Elderly (ASPREE) trial. In the U.S and Australia, 19,114 healthy community-dwelling individuals aged ≥70 years (U.S. minorities ≥65 years) were enrolled in ASPREE, a double-blind, placebo-controlled trial of 100mg daily low-dose aspirin vs. placebo. Frailty was defined according to a modified Fried frailty definition, and a frailty index which used a deficit accumulation model. Competing risk Cox proportional hazards models were used to compare time to incident frailty for aspirin vs. placebo. At baseline, 2.2% and 8.1% met criteria for frailty by Fried and frailty index criteria, respectively. Over a median of 4.7 years of follow-up, 2252 participants developed incident frailty according to Fried classification, and 4376 according to the frailty deficit accumulation index. There was no difference in the risk of incident frailty between individuals randomized to aspirin versus placebo according to either criteria (Fried frailty HR: 1.03, 95% CI 0.97-1.09, p=0.41; frailty index HR: 1.03, 95% CI 0.97-1.10, p=0.29). Change in frailty over time was not different between the aspirin and placebo treatment arms. The results were consistent across a series of sub-groups, including baseline frailty status. Based on these results, aspirin use in healthy older adults does not reduce incident frailty.
Collapse
Affiliation(s)
- Sara Espinoza
- University of Texas Health Science Center San Antonio, San Antonio, Texas, United States
| | | | - Robyn Woods
- Monash University, Melbourne, Victoria, Australia
| | | | | | - John McNeil
- Monash University, Melbourne, Victoria, Australia
| | - Anne Murray
- Hennepin HealthCare Research Institute, Hennepin HealthCare, Minneapolis, Minnesota, United States
| | - Joanne Ryan
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
33
|
Riaz M, Mattisson J, Polekhina G, Bakshi A, Halvardson J, Danielsson M, Ameur A, McNeil J, Forsberg LA, Lacaze P. A polygenic risk score predicts mosaic loss of chromosome Y in circulating blood cells. Cell Biosci 2021; 11:205. [PMID: 34895331 PMCID: PMC8667399 DOI: 10.1186/s13578-021-00716-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 11/23/2022] Open
Abstract
Background Mosaic loss of Y chromosome (LOY) is the most common somatic change that occurs in circulating white blood cells of older men. LOY in leukocytes is associated with increased risk for all-cause mortality and a range of common disease such as hematological and non-hematological cancer, Alzheimer’s disease, and cardiovascular events. Recent genome-wide association studies identified up to 156 germline variants associated with risk of LOY. The objective of this study was to use these variants to calculate a novel polygenic risk score (PRS) for LOY, and to assess the predictive performance of this score in a large independent population of older men. Results We calculated a PRS for LOY in 5131 men aged 70 years and older. Levels of LOY were estimated using microarrays and validated by whole genome sequencing. After adjusting for covariates, the PRS was a significant predictor of LOY (odds ratio [OR] = 1.74 per standard deviation of the PRS, 95% confidence intervals [CI] 1.62–1.86, p < 0.001). Men in the highest quintile of the PRS distribution had > fivefold higher risk of LOY than the lowest (OR = 5.05, 95% CI 4.05–6.32, p < 0.001). Adding the PRS to a LOY prediction model comprised of age, smoking and alcohol consumption significantly improved prediction (AUC = 0.628 [CI 0.61–0.64] to 0.695 [CI 0.67–0.71], p < 0.001). Conclusions Our results suggest that a PRS for LOY could become a useful tool for risk prediction and targeted intervention for common disease in men. Supplementary Information The online version contains supplementary material available at 10.1186/s13578-021-00716-z.
Collapse
Affiliation(s)
- Moeen Riaz
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonas Mattisson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Galina Polekhina
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Andrew Bakshi
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonatan Halvardson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Marcus Danielsson
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Adam Ameur
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Lars A Forsberg
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden. .,The Beijer Laboratory, Uppsala University, Uppsala, Sweden.
| | - Paul Lacaze
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| |
Collapse
|
34
|
Brodaty H, Heffernan M, Anstey KJ, Fiatarone Singh MA, Jorm L, Lautenschlager NT, Maeder A, McNeil J, Sachdev PS, Valenzuela M, Chau T. Maintain Your Brain trial: Early findings and lessons learned from adherence and compliance data. Alzheimers Dement 2021. [DOI: 10.1002/alz.053596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
- University of New South Wales Sydney NSW Australia
| | | | - Kaarin J Anstey
- University of New South Wales Sydney NSW Australia
- 4. ARC Centre for Excellence in Population Ageing Research Sydney NSW Australia
- School of Psychology, University of New South Wales Sydney NSW Australia
- Neuroscience Research Australia Sydney NSW Australia
- UNSW Ageing Futures Institute Sydney NSW Australia
| | | | - Louisa Jorm
- Centre for Big Data Research in Health, University of New South Wales Sydney NSW Australia
| | - Nicola T Lautenschlager
- North Western Mental Health, Melbourne Health Parkville VIC Australia
- The University of Melbourne Parkville VIC Australia
- Melbourne Health Melbourne VIC Australia
- University of Western Australia Perth Australia
| | | | | | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Sydney NSW Australia
- Prince of Wales Hospital Sydney Australia
- Neuropsychiatric Institute (NPI), Euroa Centre, Prince of Wales Hospital Sydney NSW Australia
| | | | - Tiffany Chau
- Centre for Healthy Brain Ageing, University of New South Wales Sydney NSW Australia
| | | |
Collapse
|
35
|
Marquina C, Lacaze P, Tiller J, Riaz M, Sturm AC, Nelson MR, Ference BA, Pang J, Watts GF, Nicholls SJ, Zoungas S, Liew D, McNeil J, Ademi Z. Population genomic screening of young adults for familial hypercholesterolaemia: a cost-effectiveness analysis. Eur Heart J 2021; 43:3243-3254. [PMID: 34788414 DOI: 10.1093/eurheartj/ehab770] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/29/2021] [Accepted: 10/22/2021] [Indexed: 12/18/2022] Open
Abstract
AIMS The aim of this study was to assess the impact and cost-effectiveness of offering population genomic screening to all young adults in Australia to detect heterozygous familial hypercholesterolaemia (FH). METHODS AND RESULTS We designed a decision analytic Markov model to compare the current standard of care for heterozygous FH diagnosis in Australia (opportunistic cholesterol screening and genetic cascade testing) with the alternate strategy of population genomic screening of adults aged 18-40 years to detect pathogenic variants in the LDLR/APOB/PCSK9 genes. We used a validated cost-adaptation method to adapt findings to eight high-income countries. The model captured coronary heart disease (CHD) morbidity/mortality over a lifetime horizon, from healthcare and societal perspectives. Risk of CHD, treatment effects, prevalence, and healthcare costs were estimated from published studies. Outcomes included quality-adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER), discounted 5% annually. Sensitivity analyses were undertaken to explore the impact of key input parameters on the robustness of the model. Over the lifetime of the population (4 167 768 men; 4 129 961 women), the model estimated a gain of 33 488years of life lived and 51 790 QALYs due to CHD prevention. Population genomic screening for FH would be cost-effective from a healthcare perspective if the per-test cost was ≤AU$250, yielding an ICER of <AU$28 000 per QALY gained. From a societal perspective, population genomic screening would be cost-saving. ICERs from societal perspective remained cost-saving after adaptation to other countries. CONCLUSION Based on our model, offering population genomic screening to all young adults for FH could be cost-effective, at testing costs that are feasible.
Collapse
Affiliation(s)
- Clara Marquina
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Paul Lacaze
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Jane Tiller
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Moeen Riaz
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Amy C Sturm
- Genomic Medicine Institute, 100 North Academy Avenue, Geisinger, PA 17822, USA
| | - Mark R Nelson
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia.,Menzies Institute for Medical Research, 17 Liverpool St, Hobart, TAS 7000, Australia
| | - Brian A Ference
- University of Cambridge, Centre for Naturally Randomised Trials, The Old Schools, Trinity Ln, Cambridge CB2 1TN, UK
| | - Jing Pang
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Hwy, Perth, WA 6009, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, 35 Stirling Hwy, Perth, WA 6009, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia.,Lipid Disorders Clinic, Cardiometabolic Service, Department of Internal Medicine, Royal Perth Hospital, Victoria Square, Perth, WA 6000, Australia
| | - Stephen J Nicholls
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, VIC 3004, Australia
| |
Collapse
|
36
|
Ademi Z, Marquina C, Lacaze P, Tiller J, Riaz M, Sturm AC, Nelson M, Ference BA, Pang J, Watts GF, Nicholls SJ, Zoungas S, Liew D, McNeil J. Population genomic screening of all young adults in Australia to detect familial hypercholesterolemia: a cost-effectiveness analysis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Heterozygous familial hypercholesterolemia (FH) is a highly-penetrant, autosomal dominant monogenic disorder that causes elevated plasma low-density cholesterol (LDL-C) levels and risk of premature coronary heart disease (CHD). To date, the cost-effectiveness of the emerging strategy of genomic screening of adult populations for FH has not been investigated.
Purpose
To assess the impact and cost-effectiveness of offering population genomic screening to all young adults in Australia to detect heterozygous familial hypercholesterolemia (FH).
Methods
We designed a decision analysis model to compare the current standard of care for heterozygous FH diagnosis in Australia (opportunistic cholesterol screening and genetic cascade testing) with population genomic screening of adults aged 18–40 years to detect pathogenic variants in the LDLR/APOB/PCSK9 genes. The model captured morbidity/mortality due to coronary heart disease (CHD) over a lifetime horizon, from a healthcare perspective. Risk of CHD, treatment effects, prevalence, and healthcare costs were estimated from published studies. Outcomes included quality adjusted life years (QALYs), costs and incremental cost-effectiveness ratio (ICER), discounted 5% annually. Sensitivity analyses were undertaken to explore the impact of key input parameters on the robustness of the model. The model structure was designed to be transferable to countries with different healthcare systems.
Results
Over the lifetime of the population (4,167,768 men; 4,129,961 women), the model estimated a gain of 62,722 years of life lived and 73,959 QALYs due to CHD prevention. Population genomic screening for FH would be cost-effective from a healthcare perspective if the cost per test was ≤AU$300 (∼US$233) which would yield an ICER AU$28,000 cost-saving.
Conclusion
Based on our model, offering population genomic screening to all young adults to detect FH could be cost-effective in the Australian healthcare system, at testing costs that are currently feasible.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): This work was supported by the Australian National Heart Foundation and Monash University Faculty of Medicine, Nursing and Health Sciences Results from scenario analysesResults from Monte Carlo simulations
Collapse
Affiliation(s)
- Z Ademi
- Monash University, Melbourne, Australia
| | | | - P Lacaze
- Monash University, Melbourne, Australia
| | - J Tiller
- Monash University, Melbourne, Australia
| | - M Riaz
- Monash University, Melbourne, Australia
| | - A C Sturm
- Genomic Medicine Institute, Geisinger, United States of America
| | - M Nelson
- Monash University, Melbourne, Australia
| | - B A Ference
- University of Cambridge, Cambridge, United Kingdom
| | - J Pang
- The University of Western Australia, Perth, Australia
| | - G F Watts
- The University of Western Australia, Perth, Australia
| | | | - S Zoungas
- Monash University, Melbourne, Australia
| | - D Liew
- Monash University, Melbourne, Australia
| | - J McNeil
- Monash University, Melbourne, Australia
| |
Collapse
|
37
|
Craig H, Ryan J, Freak-Poli R, Owen A, McNeil J, Woods R, Ward S, Britt C, Gasevic D. Dispositional Optimism and All-Cause Mortality in Older Adults: A Cohort Study. Psychosom Med 2021; 83:938-945. [PMID: 34334727 PMCID: PMC8490272 DOI: 10.1097/psy.0000000000000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Optimism is modifiable and may be associated with healthy aging. We aim to investigate whether dispositional optimism is associated with all-cause mortality in adults 70 years and older. METHODS Between 2010 and 2014, older adults free of serious cardiovascular disease and dementia were recruited through primary care physicians and enrolled in the Aspirin Reducing Events in the Elderly (ASPREE) clinical trial. Australian ASPREE participants were invited to participate in the ASPREE Longitudinal Study of Older Persons (ALSOP) that was running in parallel to ASPREE. Optimism was assessed at baseline using the Life Orientation Test-Revised. The association between optimism, divided into quartiles, and all-cause mortality was assessed using Cox proportional hazards models. RESULTS A total of 11,701 participants (mean [standard deviation] age = 75.1 [4.24] years; 46.6% men) returned the ALSOP Social questionnaire and completed the Life Orientation Test-Revised. During a median follow-up of 4.7 years, 469 deaths occurred. The fully adjusted model was not significant (hazard ratio = 0.78, 95% confidence interval = 0.58-1.06). There was evidence that age was an effect modifier of the association between optimism and longevity. Higher optimism was associated with lower mortality risk in the oldest individuals only (77+ years; hazard ratio = 0.61, 95% confidence interval = 0.39-0.96). CONCLUSIONS We observed no independent relationship between optimism and all-cause mortality in the total sample, although optimism seemed to be associated with lower risk among the oldest old (adults 77 years and older).
Collapse
Affiliation(s)
- Heather Craig
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- PSNREC, Univ Montpellier, INSERM, Montpellier, 34000, France
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Alice Owen
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Carlene Britt
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, UK
| |
Collapse
|
38
|
Orchard S, Lockery J, Gibbs P, Polehkina G, Wolfe R, Zalcberg J, Haydon A, McNeil J, Nelson M, Reid C, Kirpach B, Murray A, Woods R. 602Prevalence of cancer history and association with risk factors in a healthy older population. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The ASPirin in Reducing Events in the Elderly (ASPREE) study randomised healthy older individuals to 100mg aspirin or placebo, with clinical outcomes and disability-free survival endpoints. Detailed baseline data provides a rare opportunity to explore cancer burden and association with known cancer risk factors in this population.
Methods
At enrolment (2010-2014), self-reported personal cancer history, cancer type and cancer risk factor data were sought from 19,114 participants (Australia, n = 16,703; U.S., n = 2,411). Participants were healthy and expected to survive 5 years.
Results
Of those reporting a prior cancer diagnosis (18% women, 22% men), women were diagnosed younger (16% vs 6% of diagnoses <50 years). Cancer prevalence increased with age. Prostate and breast cancer history were higher in U.S. participants; melanoma and colorectal cancer were higher in Australian participants. Cancer history prevalence was not associated with any common risk factors, but was associated with poor health ratings in men. Blood and breast cancer history was more common with past aspirin use.
Conclusions
Personal cancer history in healthy older ASPREE participants was as expected for the most common cancer types in the respective populations. The lack of alignment with known risk factors is attributable to survivor bias, driven by entry criteria, and to possible molecular differences in cancer between elderly and younger people.
Key messages
As the prevalence of cancer increases with age, the lack of alignment with known risk factors implies other factors play a significant role.
Collapse
Affiliation(s)
| | | | - Peter Gibbs
- Peter Macallum Cancer Foundation, Melbourne, Australia
| | | | | | | | | | | | - Mark Nelson
- Menzies Institute For Medical Research, University of Tasmania, Hobart, Australia
| | | | | | | | | |
Collapse
|
39
|
Wrigglesworth J, Yaacob N, Ward P, Woods R, McNeil J, Storey E, Egan G, Murray A, Shah R, Jamadar S, Trevaks R, Ward S, Harding I, Ryan J. 1195Brain-predicted age difference is associated with cognitive processing and delayed recall in later life. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Brain age is a novel neuroimaging-based marker of ageing that uses machine learning to predict a person’s biological brain age. A higher brain age relative to chronological age (i.e., brain-predicted age difference [brain-PAD]) is considered a sign of accelerated ageing. We examined whether brain-PAD is associated with cognition and the change in cognitive function over time.
Methods
This study involved 531 cognitively healthy community-dwelling older adults (70+ years). Using a previously trained algorithm, brain age was estimated using T1-weighted structural magnetic resonance images acquired at baseline. Psychomotor speed, delayed recall, verbal fluency and global cognition were assessed at baseline, years 1 and 3.
Results
At baseline, a significant negative association was observed between brain-PAD and psychomotor speed (r=-0.14, p = 0.001), delayed recall (r=-0.09, p = 0.04), and the three-year change in delayed recall (r=-0.15, p = 0.02), which persisted after adjusting for covariates.
Conclusions
These findings indicate that accelerated brain ageing in cognitively unimpaired older people is associated with worse psychomotor speed, and delayed recall. This study also provides new evidence that accelerated brain ageing is a risk factor for progressive memory decline. Future research would benefit from further prospective analyses of associations between brain-PAD and cognitive function in community dwelling older adults.
Key messages
Brain age is a neuroimaging-based marker of biological ageing. A higher estimate of brain age relative to chronological age (i.e., accelerated ageing) is associated with worse psychomotor speed and memory, and memory decline.
Collapse
Affiliation(s)
- Jo Wrigglesworth
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nurathifah Yaacob
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Phillip Ward
- Monash Biomedial Imaging, Monash University, Clayton, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Australian Research Council Center of Excellence for Integrative Brain Function, Clayton, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Elsdon Storey
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Gary Egan
- Monash Biomedial Imaging, Monash University, Clayton, Australia
- Australian Research Council Center of Excellence for Integrative Brain Function, Clayton, Australia
| | - Anne Murray
- Berman Center for Outcomes & Clinical Research, Hennepin Healthcare Research Institute, Minneapolis, USA
- Department of Medicine, Division of Geriatrics, Hennepin Healthcare, University of Minnesota, Minneapolis, USA
| | - Raj Shah
- Department of Family Medicine and the Rush Alzheimer’s Disease Center, Rush University Medical Center, South Paulina, Illinois
| | - Sharna Jamadar
- Monash Biomedial Imaging, Monash University, Clayton, Australia
- Turner Institute for Brain and Mental Health, Monash University, Clayton, Australia
- Australian Research Council Center of Excellence for Integrative Brain Function, Clayton, Australia
| | - Ruth Trevaks
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephanie Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Center for Healthy Brain Ageing (CHeBA), University of New South Wales, Sydney, Australia
- Department of Geriatric Medicine, Prince of Wales Hospital, Randwick, Australia
| | - Ian Harding
- Monash Biomedial Imaging, Monash University, Clayton, Australia
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
40
|
Phyo AZZ, Ryan J, Gonzalez-Chica D, McNeil J, Woods R, Nelson M, Murray A, Lockery J, Gasevic D, Stocks N, Freak-Poli R. 226Health-related quality of life and all-cause mortality among older people: a prospective cohort study. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Health-related quality of life (HRQoL) is a measure of an individual’s self-perceived health status. Few studies have examined HRQoL as a risk factor for mortality. This study examined whether HRQoL predicts all-cause mortality in older community-dwelling individuals from Australia and the United States enrolled in the Aspirin in Reducing Events in the Elderly (ASPREE) trial, and if this association varies across gender.
Methods
The 19,106 persons aged 65–98 years and free of known major life-limiting disease, who completed the 12-item short form (SF-12) HRQoL at ASPREE-baseline (2010–2014) were followed prospectively until 2017 for all-cause mortality. Cox proportional-hazard models were used to determine the association between the physical (PCS) and mental component scores (MCS) of HRQoL and all-cause mortality, adjusting for sociodemographic factors, health-related behaviours, and clinical measures.
Results
There were 1,052 deaths over a median 4.7-year of follow-up, with 11.9 events per 1,000 person-years. A 10-unit increase in PCS was associated with a 17% decrease in all-cause mortality (95%CI: 0.77, 0.89). MCS was not associated with all-cause mortality. There was no evidence these associations were different between males and females (P-values for interaction: PCS 0.13 and MCS 0.44).
Conclusions
PCS, but not MCS, was inversely associated with all-cause mortality in this large cohort of healthy older individuals.
Key messages
Our findings support the decision of the Australian Commission on Safety and Quality in Health Care to incorporate the SF-12 into the routine collection of Patient Reported Outcome Measures as a policy goal for the Australian health system.
Collapse
Affiliation(s)
- Aung Zaw Zaw Phyo
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Joanne Ryan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- PSNREC, Univ Montpellier, INSERM, Montpellier, France
| | - David Gonzalez-Chica
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Adelaide Rural Clinical School, University of Adelaide, Adelaide, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Robyn Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Nelson
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Anne Murray
- Berman Center for Outcomes and Clinical Research, Minneapolis Medical Research Foundation, Hennepin County Medical Center, Minneapolis, United States
- Division of Geriatrics, Department of Medicine, Hennepin County Medical Center and University of Minnesota, Minneapolis, United States
| | - Jessica Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danijela Gasevic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Usher Institute, University of Edinburgh, Teviot Place, Edinburgh, United Kingdom
| | - Nigel Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Rosanne Freak-Poli
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Epidemiology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | |
Collapse
|
41
|
Chan PY, Tay A, Chen D, Timms P, McNeil J, Hopper I. Infrared thermography as a modality for tracking cutaneous temperature change and post-mortem interval in the critical care setting. Forensic Sci Int 2021; 327:110960. [PMID: 34455397 DOI: 10.1016/j.forsciint.2021.110960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/02/2021] [Accepted: 08/17/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the potential use of cutaneous facial temperature change as measured by an infrared camera as a marker of postmortem interval (PMI) in the minutes immediately following death. METHODS This was a prospective, observational pilot study using a convenience sample of all deaths which occurred in a room in an Intensive Care Unit equipped with a ceiling mounted thermal camera. Cutaneous temperature measurements were taken from 60 min antemortem to as long as possible postmortem. RESULTS A total of 134 separate measurements was taken from 5 patients, with 65 occurring antemortem, and 69 occurring post-mortem. The longest recorded post-mortem time was 130 min. A Kruskal-Wallis ANOVA testing the hypothesis that there was a difference in facial temperature at each of the different timepoints showed significance (p = 0.029). Post-Hoc comparisons were then performed to compare median temperature values at each timeframe to the baseline value. Compared to baseline, there was a significant difference in facial temperature at 30, 60, and 90 min (p = 0.007, p = 0.01, p = 0.016) (Table 2). CONCLUSION There is a statistically significant cutaneous facial temperature change in patients immediately following death as measured by a thermal camera. There is potential for infrared thermography to identify changes immediately before and after death in environments where traditional temperature measurement cannot be accomplished. More work needs to be done to confirm whether a precise postmortem interval (PMI) could be derived from these values.
Collapse
Affiliation(s)
- Peter Y Chan
- Intensive Care Services, Eastern Health, Melbourne, Victoria, Australia; School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Andrew Tay
- Intensive Care Services, Eastern Health, Melbourne, Victoria, Australia
| | - David Chen
- Intensive Care Services, Eastern Health, Melbourne, Victoria, Australia
| | - Paddy Timms
- Intensive Care Services, Eastern Health, Melbourne, Victoria, Australia
| | - John McNeil
- School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia
| | - Ingrid Hopper
- School of Public Health and Prevention Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
42
|
Lin X, Wallis K, Ahern S, Brodaty H, Rowe C, Kain B, Lambourne S, McNeil J, Ward SA. Optimising participation of persons with cognitive impairment in a national dementia registry: challenges and solutions. Intern Med J 2021; 51:988-992. [PMID: 34155757 DOI: 10.1111/imj.15357] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 02/10/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Clinical quality registries are increasingly utilised to monitor and improve healthcare quality. Opt-out consent is recommended to maximise participation and ensure validity of data, however, presents specific considerations when including persons with impaired decision-making abilities. This paper describes the innovative Australian Dementia Network Registry recruitment framework designed to optimise inclusion of people with dementia and mild cognitive impairment.
Collapse
Affiliation(s)
- Xiaoping Lin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Kasey Wallis
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Susannah Ahern
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Dementia Centre for Research Collaboration, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Christopher Rowe
- Department of Molecular Imaging and Therapy, Austin Health, Melbourne, Victoria, Australia.,Florey Department of Neuroscience and Mental Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Barbara Kain
- Carer representative, Melbourne, Victoria, Australia
| | - Sally Lambourne
- Consumer Engagement, Dementia Australia, Sydney, New South Wales, Australia
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Stephanie A Ward
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Department of Geriatric Medicine, The Prince of Wales Hospital, Sydney, New South Wales, Australia
| |
Collapse
|
43
|
Huq AJ, Fulton‐Howard B, Riaz M, Laws S, Sebra R, Ryan J, Renton AE, Goate AM, Masters CL, Storey E, Shah RC, Murray A, McNeil J, Winship I, James PA, Lacaze P. Polygenic score modifies risk for Alzheimer's disease in APOE ε4 homozygotes at phenotypic extremes. Alzheimers Dement (Amst) 2021; 13:e12226. [PMID: 34386572 PMCID: PMC8339682 DOI: 10.1002/dad2.12226] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/28/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Diversity in cognition among apolipoprotein E (APOE) ε4 homozygotes can range from early-onset Alzheimer's disease (AD) to a lifetime with no symptoms. METHODS We evaluated a phenotypic extreme polygenic risk score (PRS) for AD between cognitively healthy APOE ε4 homozygotes aged ≥75 years (n = 213) and early-onset APOE ε4 homozygote AD cases aged ≤65 years (n = 223) as an explanation for this diversity. RESULTS The PRS for AD was significantly higher in APOE ε4 homozygote AD cases compared to older cognitively healthy APOE ε4/ε4 controls (odds ratio [OR] 8.39; confidence interval [CI] 2.0-35.2; P = .003). The difference in the same PRS between APOE ε3/ε3 extremes was not as significant (OR 3.13; CI 0.98-9.92; P = .053) despite similar numbers and power. There was no statistical difference in an educational attainment PRS between these age extreme case-controls. DISCUSSION A PRS for AD contributes to modified cognitive expression of the APOE ε4/ε4 genotype at phenotypic extremes of risk.
Collapse
Affiliation(s)
- Aamira J. Huq
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
- Department of Genomic MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
- Department of MedicineRoyal Melbourne HospitalUniversity of MelbourneMelbourneVictoriaAustralia
| | - Brian Fulton‐Howard
- Nash Family Department of Neuroscience and Ronald Loeb Center for Alzheimer's DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Departments of Neurology and Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Moeen Riaz
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Simon Laws
- Collaborative Genomics GroupCentre of Excellence for Alzheimer's Disease Research and CareSchool of Medical and Health SciencesEdith Cowan UniversityJoondalupWestern AustraliaAustralia
- School of Pharmacy and Biomedical SciencesFaculty of Health SciencesCurtin Health InnovationPerthWestern AustraliaAustralia
| | - Robert Sebra
- Departments of Neurology and Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Joanne Ryan
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | | | - Alan E. Renton
- Nash Family Department of Neuroscience and Ronald Loeb Center for Alzheimer's DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Departments of Neurology and Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alison M. Goate
- Nash Family Department of Neuroscience and Ronald Loeb Center for Alzheimer's DiseaseIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Departments of Neurology and Genetics and Genomic SciencesIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Colin L. Masters
- The Florey InstituteUniversity of MelbourneParkvilleVictoriaAustralia
| | - Elsdon Storey
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer's Disease CenterRush University Medical CenterChicagoIllinoisUSA
| | - Anne Murray
- Berman Center for Outcomes and Clinical ResearchHennepin Healthcare Research InstituteHennepin Healthcareand University of MinnesotaMinneapolisMinnesotaUSA
| | - John McNeil
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| | - Ingrid Winship
- Department of Genomic MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Paul A. James
- Department of Genomic MedicineRoyal Melbourne HospitalMelbourneVictoriaAustralia
| | - Paul Lacaze
- Department of Epidemiology and Preventive MedicineSchool of Public Health and Preventive MedicineMonash UniversityMelbourneAustralia
| |
Collapse
|
44
|
Bhatt DL, Kaski JC, Delaney S, Alasnag M, Andreotti F, Angiolillo DJ, Ferro A, Gorog DA, Lorenzatti AJ, Mamas M, McNeil J, Nicolau JC, Steg PG, Tamargo J, Tan D, Valgimigli M. Results of an international crowdsourcing survey on the treatment of non-ST segment elevation ACS patients at high-bleeding risk undergoing percutaneous intervention. Int J Cardiol 2021; 337:1-8. [PMID: 34000356 DOI: 10.1016/j.ijcard.2021.05.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022]
Abstract
AIMS Choosing an antiplatelet strategy in patients with non-ST segment elevation acute coronary syndrome (NSTE-ACS) at high bleeding risk (HBR), undergoing post-percutaneous coronary intervention (PCI), is complex. We used a unique open-source approach (crowdsourcing) to document if practices varied across a small, global cross-section of antiplatelet prescribers in the post-PCI setting. METHODS AND RESULTS Five-hundred and fifty-nine professionals from 70 countries (the 'crowd') completed questionnaires containing single- or multi-option and free form questions regarding antiplatelet clinical practice in post-PCI NSTE-ACS patients at HBR. A threshold of 75% defined 'agreement'. There was strong agreement favouring monotherapy with either aspirin or a P2Y12 inhibitor following initial DAPT, within the first year (94%). No agreement was reached on the optimal duration of DAPT or choice of monotherapy: responses were in equipoise for shorter (≤3 months, 51%) or longer (≥6 months, 46%) duration, and monotherapy choice (45% aspirin; 53% P2Y12 inhibitor). Most respondents stated use of guideline-directed tools to assess risk, although clinical judgement was preferred by 32% for assessing bleeding risk and by 46% for thrombotic risk. CONCLUSION The crowdsourcing methodology showed potential as a tool to assess current practice and variation on a global scale and to achieve a broad demographic representation. These preliminary results indicate a high degree of variation with respect to duration of DAPT, monotherapy drug of choice following DAPT and how thrombotic and bleeding risk are assessed. Further investigations should concentrate on interrogating practice variation between key demographic groups.
Collapse
Affiliation(s)
- Deepak L Bhatt
- Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK.
| | - Sean Delaney
- Radcliffe Cardiology Bourne End Business Park, Cores End Rd, Wooburn Green, Bourne End SL8 5AS, UK.
| | - Mirvat Alasnag
- King Fahd Armed Forces Hospital, Jeddah-KSA, Al Kurnaysh Rd, Al Andalus, Jeddah 23311, Saudi Arabia.
| | - Felicita Andreotti
- Scientific Directorate, FPUG IRCCS, Rome, Italy; Cardiovascular Dept, Catholic University, Rome, Italy.
| | - Dominick J Angiolillo
- University of Florida College of Medicine-Jacksonville, Division of Cardiology, ACC Building 5th floor 655 West 8th Street, Jacksonville, FL 32209, USA.
| | - Albert Ferro
- King's College London, School of Cardiovascular Medicine and Sciences, British Heart Foundation Centre of Research Excellence, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
| | - Diana A Gorog
- Faculty of Medicine, National Heart & Lung Institute, Imperial College, Dovehouse Street, London SW3 6LY, UK; School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK.
| | - Alberto J Lorenzatti
- Instituto Medico DAMIC, Av. Colon 2057, Cordoba, Argentina; Departamento de Cardiologia, Hospital Córdoba, Av. Patria 656, Córdoba, Argentina
| | - Mamas Mamas
- University Hospitals of North Midlands NHS Trust, Keel University, Staffordshire ST5 5BG, UK
| | - John McNeil
- School of Public Health and Preventive Medicine, Monash University, Wellington Rd, Clayton VIC, Melbourne 3800, Australia.
| | - José C Nicolau
- Instituto do Coracao (InCor), Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César, São Paulo, Brazil.
| | - Philippe Gabriel Steg
- Université de Paris, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, FACT (French Alliance for Cardiovascular Trials), INSERM U1148, Paris, France.
| | - Juan Tamargo
- Faculty of Medicine of the Complutense University of Madrid, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Doreen Tan
- Dept of Pharmacy, National University of Singapore, 8 Science Drive 4, 117543, Singapore.
| | | |
Collapse
|
45
|
Ayton D, Gardam M, Ward S, Brodaty H, Pritchard E, Earnest A, Krysinska K, Banaszak-Holl J, McNeil J, Ahern S. How Can Quality of Dementia Care Be Measured? The Development of Clinical Quality Indicators for an Australian Pilot Dementia Registry. J Alzheimers Dis 2021; 75:923-936. [PMID: 32390616 DOI: 10.3233/jad-191044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND A clinical quality registry (CQR) for dementia provides benefits to those living with dementia and their carers by improving the quality and experience of care through benchmarking and monitoring patient outcomes. CQRs use data collected to form clinical quality indicators (CQIs) through which variations in clinical processes and outcomes between different services and jurisdictions can be highlighted. OBJECTIVE This modified Delphi study aimed to develop CQIs for a pilot Australian CQR for dementia and mild cognitive impairment. These CQIs are based on evidence, patient and caregiver experience, and clinician perspectives across the trajectory of care from diagnosis to end-of-life. METHODS An initial list of indicators from existing dementia registries, academic literature, and clinical practice guidelines was synthesized. A working group of clinicians and registry experts further refined these indicators. A panel of experts comprised of a consumer, a carer, clinicians, consumer organization representatives, and academics. The experts participated in three phases of the modified Delphi study: 1) online survey for scoring importance and validity, 2) a one-day face-to-face discussion, and 3) final survey round to assess importance, validity, and feasibility. RESULTS The panel assessed 33 CQIs and confirmed a final set of 18 indicators. The CQIs mapped to the domains of quality of diagnosis, quality of management, access to services and supports, and potentially preventable complications. These CQIs will be tested initially in memory clinics and inform the data collection processes for the Australia Dementia Network Registry (ADNet). CONCLUSION A dementia CQR is fundamental to ongoing monitoring and development of good quality and consistent care across Australia.
Collapse
Affiliation(s)
- Darshini Ayton
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Madeleine Gardam
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephanie Ward
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales (UNSW), Sydney, NSW, Australia
| | - Elizabeth Pritchard
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Arul Earnest
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Karolina Krysinska
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jane Banaszak-Holl
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - John McNeil
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Susannah Ahern
- Department of Epidemiology and Preventive Medicine, Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|
46
|
Neumann J, Riaz M, Bakshi A, Polekhina G, Thao L, Nelson M, Woods R, Abraham G, Inouye M, Reid C, Tonkin A, Williamson J, Donnan G, Brodtmann A, Cloud G, McNeil J, Lacaze P. PREDICTIVE PERFORMANCE OF A POLYGENIC RISK SCORE FOR INCIDENT ISCHEMIC STROKE IN A HEALTHY OLDER POPULATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02829-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
47
|
Neumann J, Riaz M, Bakshi A, Polekhina G, Thao L, Nelson M, Woods R, Abraham G, Inouye M, Reid C, Tonkin A, McNeil J, Lacaze P. PREDICTIVE PERFORMANCE OF A POLYGENIC RISK SCORE FOR CORONARY HEART DISEASE IN A HEALTHY ELDERLY POPULATION. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01395-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
48
|
Nguyen-Dumont T, Dowty J, Tucker K, Kirk J, James P, Trainer A, Winship I, Pachter N, Poplawski N, Grist S, Park DJ, Renault AL, Hammet F, Mahmoodi M, Tsimiklis H, Steen JA, Theys D, Rewse A, Willis A, Morrow A, Speechly C, Harris R, Riaz M, Sebra R, Schadt E, Lacaze P, McNeil J, Hopper JL, Southey MC. Abstract PS7-04: Population-based estimates of breast cancer risk for germline pathogenic variants identified by gene-panel testing: An Australian perspective. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BRA-STRAP is an Australia-wide study of breast cancer predisposition that brings together gene-panel data from 30,000 adult Australian women of all ages, across the breast cancer risk spectrum, with and without a diagnosis of breast cancer. The “BRA-STRAP panel” includes 24 genes* that are involved in, or putatively associated with, predisposition to breast and/or ovarian cancer. Despite insufficient evidence for clinical translation for some of these genes, all 24 are commonly included on panel tests for breast cancer predisposition.
We present findings from the population-based case-control sub-study of BRA-STRAP, which involved 1451 women diagnosed with breast cancer and 857 age-matched controls participating in the Australian Breast Cancer Family Registry (ABCFR), and 6101 healthy, elderly Australian women enrolled in the ASPREE study. These analyses focus on rare genetic variants predicted to lead to loss of function and/or classified as pathogenic/likely pathogenic (P/LP) in ClinVar. Odds ratios (ORs) for their associations with breast cancer were estimated by aggregating genetic variants for each gene.
For the women diagnosed with breast cancer, the median age at diagnosis (inter-quartile range, IQR) was 40.0 (14.0) years and the overall frequency of P/LP variant carriers across all genes was 156/1451 (10.8%). The median age (IQR) of the ABCFR and ASPREE controls were 39.4 (14.9) and 73.9 (5.8) years, respectively. The frequencies of P/LP variant carriers were 33/857 (3.9%) and 268/6101 (4.4%) in the ABCFR and ASPREE controls, respectively. We combined both control datasets and, after adjusting for age and other potential confounders, the ORs associated with P/LP variants in BRCA1 and BRCA2 were 4.1 [95% confidence interval (CI): 1.8-10.2] and 2.9 [95% CI: 1.5-6], respectively. We also found that the OR for P/LP variants in ATM was 4.0 [95% CI: 1.5-10.4] and the OR for P/LP variants in PALB2 was 2.2 [95% CI: 0.75-5.7] although this did not reach statistical significance.
These results contribute to international efforts to refine the breast cancer risk estimates for genetic variants identified from population-based screening of unselected women using genes that are included on panel tests and thought to be potentially breast cancer predisposition genes.The case-control-family design of the ABCFR will also allow us to estimate the age specific cumulative risk (penetrance) of these genetic variants, which is important for genetic counselling and the clinical management of carrier families.
*ATM, BARD1, BRCA1, BRCA2, BRIP1, CDH1, CHEK2, FANCM, MLH1, MRE11A, MSH2, MSH6, MUTYH, NBN, NF1, PALB2, PMS2, PTEN, RAD50, RAD51C, RAD51D, RECQL, STK11 and TP53
Citation Format: Tu Nguyen-Dumont, James Dowty, Katherine Tucker, Judy Kirk, Paul James, Alison Trainer, Ingrid Winship, Nicholas Pachter, Nicola Poplawski, Scott Grist, Daniel J Park, Anne-Laure Renault, Fleur Hammet, Maryam Mahmoodi, Helen Tsimiklis, Jason A Steen, Derrick Theys, Amanda Rewse, Amanda Willis, April Morrow, Catherine Speechly, Rebecca Harris, Moeen Riaz, Robert Sebra, Eric Schadt, Paul Lacaze, John McNeil, John L Hopper, Melissa C Southey. Population-based estimates of breast cancer risk for germline pathogenic variants identified by gene-panel testing: An Australian perspective [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-04.
Collapse
Affiliation(s)
| | - James Dowty
- 2The University of Melbourne, Parkville, Australia
| | | | - Judy Kirk
- 4Westmead Institute for Cancer Research, Sydney, Australia
| | - Paul James
- 5Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Nicola Poplawski
- 8South Australian Clinical Genetics Service, Adelaide, Australia
| | - Scott Grist
- 9SA Pathology, Flinders Medical Centre, Adelaide, Australia
| | | | | | | | | | | | | | | | | | | | | | | | - Rebecca Harris
- 4Westmead Institute for Cancer Research, Sydney, Australia
| | | | - Robert Sebra
- 11Icahn School of Medicine at Mount Sinai, New York, NY
| | - Eric Schadt
- 11Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | | | | |
Collapse
|
49
|
Banaszak-Holl J, Lin X, Xie J, Ward S, Brodaty H, Shah R, Murray A, McNeil J. Dementia Adjudication Triggers Associated With Increased Mortality for Older Australians: Evidence From ASPREE. Innov Aging 2020. [PMCID: PMC7740293 DOI: 10.1093/geroni/igaa057.523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Research Aims: This study seeks to understand whether those with dementia experience higher risk of death, using data from the ASPREE (ASPirin in Reducing Events in the Elderly) clinical trial study. Methods: ASPREE was a primary intervention trial of low-dose aspirin among healthy older people. The Australian cohort included 16,703 dementia-free participants aged 70 years and over at enrolment. Participants were triggered for dementia adjudication if cognitive test results were poorer than expected, self-reporting dementia diagnosis or memory problems, or dementia medications were detected. Incidental dementia was adjudicated by an international adjudication committee using the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) criteria and results of a neuropsychological battery and functional measures with medical record substantiation. Statistical analyses used a cox proportional hazards model. Results: As previously reported, 1052 participants (5.5%) died during a median of 4.7 years of follow-up and 964 participants had a dementia trigger, of whom, 575 (60%) were adjucated as having dementia. Preliminary analyses has shown that the mortality rate was higher among participants with a dementia trigger, regardless of dementia adjudication outcome, than those without (15% vs 5%, Χ2 = 205, p <.001). Conclusion: This study will provide important analyses of differences in the hazard ratio for mortality and causes of death among people with and without cognitive impairment and has important implications on service planning.
Collapse
Affiliation(s)
| | - Xiaoping Lin
- Monash University, Melbourne, Victoria, Australia
| | - Jing Xie
- Peter Mac Cancer Centre, Melbourne, Victoria, Australia
| | | | | | - Raj Shah
- Rush University, Chicago, Illinois, United States
| | - Anne Murray
- University of Minnesota, Minneapolis, Minnesota, United States
| | - John McNeil
- Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
50
|
Brodaty H, Heffernan M, Andrews G, Anstey KJ, Singh MAF, Jorm L, Lautenschlager NT, Maeder A, McNeil J, Sachdev PS, Valenzuela M. Internet based multicomponent interventions to prevent cognitive decline: The Maintain Your Brain trial. Alzheimers Dement 2020. [DOI: 10.1002/alz.044180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney Australia
- UNSW Sydney Sydney Australia
- Dementia Centre for Research Collaboration (DCRC) UNSW Sydney Sydney Australia
| | - Megan Heffernan
- Centre for Healthy Brain Ageing University of New South Wales Sydney Australia
| | | | | | | | - Louisa Jorm
- Centre for Big Data Research in Health University of New South Wales Sydney Australia
| | | | | | | | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA) University of New South Wales (UNSW) Sydney Sydney Australia
| | - Michael Valenzuela
- The Regenerative Neuroscience Group Brain and Mind Centre Sydney Australia
| |
Collapse
|