Self-reported medication side effects in an older cohort living independently in the community - the Melbourne Longitudinal Study on Health Ageing (MELSHA) : cross-sectional analysis of prevalence and risk factors

Background Medication side effects are an important cause of morbidity, mortality and costs in older people. The aim of our study was to examine prevalence and risk factors for self-reported medication side effects in an older cohort living independently in the community.

Methods The Melbourne Longitudinal Study on Healthy Ageing (MELSHA), collected information on those aged 65 years or older living independently in the community and commenced in 1994. Data on medication side effects was collected from the baseline cohort (n = 1000) in face-to-face baseline interviews in 1994 and analysed as cross-sectional data. Risk factors examined were: socio-demographics, health status and medical conditions; medication use and health service factors. Analysis included univariate logistic regression to estimate unadjusted risk and multivariate logistic regression analysis to assess confounding and estimate adjusted risk.

Results Self-reported medication side effects were reported by approximately 6.7% (67/1000) of the entire baseline MELSHA cohort, and by 8.5% (65/761) of those on medication. Identified risk factors were increased education level, co-morbidities and health service factors including recency of visiting the pharmacist, attending younger doctors, and their doctor's awareness of their medications. The greatest increase in risk for medication side effects was associated with liver problems and their doctor's awareness of their medications. Aging and gender were not risk factors.

Conclusion Prevalence of self-reported medication side effects was comparable with that reported in adults attending General Practices in a primary care setting in Australia. The prevalence and identified risk factors provide further insight and opportunity to develop strategies to address the problem of medication side effects in older people living independently in the community setting.

Does aid improve democracy and governance? A meta-regression analysis

The paper provides a systematic and quantitative review of the empirical evidence on the effects of development aid on democracy and governance. We find that aid has had, on average, a zero or negative effect on democracy, except that it has had a positive effect on democratization in European transitional economies. Aid had a positive effect on governance during the Cold War period but has had no effect on governance in the post-Cold War period.

Does the UK minimum wage reduce employment? A meta-regression analysis

The employment effect from raising the minimum wage has long been studied but remains in dispute. Our meta-analysis of 236 estimated minimum wage elasticities and 710 partial correlation coefficients from 16 UK studies finds no overall practically significant adverse employment effect. Unlike US studies, there seems to be little, if any, overall reporting bias. Multivariate meta-regression analysis identifies several research dimensions that are associated with differential employment effects. In particular, the residential home care industry may exhibit a genuinely adverse employment effect.

Does education reduce income inequality? A meta-regression analysis

This paper reexamines the effects of education on inequality through a comprehensive meta-regression analysis of the extant empirical literature. We find that education affects the two tails of the distribution of income: Education reduces the income share of top earners and increases the share of the bottom earners. Education has been particularly effective in reducing inequality in Africa. Some of the results suggest that secondary schooling appears to have a stronger effect than primary schooling, though this finding is not always robust. The heterogeneity in reported estimates can be largely explained by differences in the specification of the econometric model and measure of inequality and education. © 2013 John Wiley & Sons Ltd.

Risk factors for violence in psychosis: systematic review and meta-regression analysis of 110 studies

Background

Previous reviews on risk and protective factors for violence in psychosis have produced contrasting findings. There is therefore a need to clarify the direction and strength of association of risk and protective factors for violent outcomes in individuals with psychosis.

Method

We conducted a systematic review and meta-analysis using 6 electronic databases (CINAHL, EBSCO, EMBASE, Global Health, PsycINFO, PUBMED) and Google Scholar. Studies were identified that reported factors associated with violence in adults diagnosed, using DSM or ICD criteria, with schizophrenia and other psychoses. We considered non-English language studies and dissertations. Risk and protective factors were meta-analysed if reported in three or more primary studies. Meta-regression examined sources of heterogeneity. A novel meta-epidemiological approach was used to group similar risk factors into one of 10 domains. Sub-group analyses were then used to investigate whether risk domains differed for studies reporting severe violence (rather than aggression or hostility) and studies based in inpatient (rather than outpatient) settings.

Findings

There were 110 eligible studies reporting on 45,533 individuals, 8,439 (18.5%) of whom were violent. A total of 39,995 (87.8%) were diagnosed with schizophrenia, 209 (0.4%) were diagnosed with bipolar disorder, and 5,329 (11.8%) were diagnosed with other psychoses. Dynamic (or modifiable) risk factors included hostile behaviour, recent drug misuse, non-adherence with psychological therapies (p values<0.001), higher poor impulse control scores, recent substance misuse, recent alcohol misuse (p values<0.01), and non-adherence with medication (p value <0.05). We also examined a number of static factors, the strongest of which were criminal history factors. When restricting outcomes to severe violence, these associations did not change materially. In studies investigating inpatient violence, associations differed in strength but not direction.

Conclusion

Certain dynamic risk factors are strongly associated with increased violence risk in individuals with psychosis and their role in risk assessment and management warrants further examination.

Role of dietary pattern analysis in determining cognitive status in elderly Australian adults

Principal Component Analysis (PCA) was used to determine the association between dietary patterns and cognitive function and to examine how classification systems based on food groups and food items affect levels of association between diet and cognitive function. The present study focuses on the older segment of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) sample (age 60+) that completed the food frequency questionnaire at Wave 1 (1999/2000) and the mini-mental state examination and tests of memory, verbal ability and processing speed at Wave 3 (2012). Three methods were used in order to classify these foods before applying PCA. In the first instance, the 101 individual food items asked about in the questionnaire were used (no categorisation). In the second and third instances, foods were combined and reduced to 32 and 20 food groups, respectively, based on nutrient content and culinary usage—a method employed in several other published studies for PCA. Logistic regression analysis and generalized linear modelling was used to analyse the relationship between PCA-derived dietary patterns and cognitive outcome. Broader food group classifications resulted in a greater proportion of food use variance in the sample being explained (use of 101 individual foods explained 23.22% of total food use, while use of 32 and 20 food groups explained 29.74% and 30.74% of total variance in food use in the sample, respectively). Three dietary patterns were found to be associated with decreased odds of cognitive impairment (CI). Dietary patterns derived from 101 individual food items showed that for every one unit increase in ((Fruit and Vegetable Pattern: p = 0.030, OR 1.061, confidence interval: 1.006–1.118); (Fish, Legumes and Vegetable Pattern: p = 0.040, OR 1.032, confidence interval: 1.001–1.064); (Dairy, Cereal and Eggs Pattern: p = 0.003, OR 1.020, confidence interval: 1.007–1.033)), the odds of cognitive impairment decreased. Different results were observed when the effect of dietary patterns on memory, processing speed and vocabulary were examined. Complex patterns of associations between dietary factors and cognition were evident, with the most consistent finding being the protective effects of high vegetable and plant-based food item consumption and negative effects of ‘Western’ patterns on cognition. Further long-term studies and investigation of the best methods for dietary measurement are needed to better understand diet-disease relationships in this age group.

The economic value of wetlands in developing countries: a meta-regression analysis

This paper presents the first comprehensive synthesis of economic valuations of wetlands in developing countries. Meta-regression analysis (MRA) is applied to 1432 estimates of the economic value of 379 distinct wetlands from 50 countries. We find that wetlands are a normal good, wetland size has a negative effect on wetland values, and urban wetlands and marine wetlands are more valuable than other wetlands. Wetland values estimated by stated preferences are lower than those estimated by market price methods. The MRA benefit transfer function has a median transfer error of 17%. Overall, MRA appears to be useful for deriving the economic value of wetlands at policy sites in developing nations.

Authorship, Collaboration, and Funding Trends in Implantology Literature: Analysis of Five Journals From 2005 to 2009

Purpose: To identify the trend of authorship in dental implant by exploring the prevalence of coauthored articles and to investigate the collaboration efforts, trends in funding involved in original articles, and their relationships. Materials: Articles published in the Clinical Oral Implants Research, International Journal of Oral & Maxillofacial Implants, Clinical Implant Dentistry and Related Research, Implant Dentistry, and Journal of Oral Implantology from 2005 to 2009 were reviewed. Nonoriginal articles were excluded. For each included articles, number of authors, collaboration efforts, and extramural funding were recorded. Descriptive and analytical statistics (alpha = 0.05), including logistic regression analysis and chi(2) test, were used. Results: From a total of 2085 articles, 1503 met the inclusion criteria. Publications with 5 or more authors increased over time (P = 0.813). The amount of collaboration among different disciplines, institutions, and countries all increased. The greatest increase of collaboration was seen among institutions (P = 0.09). Non-funding studies decreased over time (P = 0.031). There was a strong association between collaboration and funding for the manuscripts during the years studied (OR, 1.5). Conclusion: The number of authors per articles and collaborative studies increased over time in implant-related journals. Collaborative studies were more likely to be funded. (Implant Dent 2011;20:68-75)

Some practical advice on polynomial regression analysis from blocked response surface designs

It is often necessary to run response surface designs in blocks. In this paper the analysis of data from such experiments, using polynomial regression models, is discussed. The definition and estimation of pure error in blocked designs are considered. It is recommended that pure error is estimated by assuming additive block and treatment effects, as this is more consistent with designs without blocking. The recovery of inter-block information using REML analysis is discussed, although it is shown that it has very little impact if thc design is nearly orthogonally blocked. Finally prediction from blocked designs is considered and it is shown that prediction of many quantities of interest is much simpler than prediction of the response itself.

Analysis of criteria for metabolic syndrome in a population-based study of Japanese-Brazilians

Objective: Criteria for metabolic syndrome (MS) differ particularly regarding the definition of central obesity and consequently, there could be differences in the assessment of cardiovascular risk. We estimated the prevalence of metabolic syndrome, compared the agreement of the World Health Organization (WHO) criteria with the standard and a modified National Cholesterol Education Program (NCEP) criterion and investigated whether additional factors were associated with the diagnosis of the syndrome in a Japanese descendant population.Methods: In this cross-sectional, population-based survey, 1166 Japanese-Brazilians (533 men, 633 women) aged 57.4 +/- 12.4 years with mean body mass index (BMI) and waist of 25.2 +/- 4.0 kg/m(2) and 84.5 +/- 10.6 cm, respectively, were included. McNemar and kappa statistics were used to assess the concordance between WHO criteria with the standard and a modified NCEP criteria (waist of 90 and 80 cm, for men and women, respectively). in logistic regression analysis, a number of metabolic variables and albumin-to-creatinine ratio were included to test independent associations with metabolic syndrome defined by the modified NCEP criteria.Results: According to WHO, 55.4% (95% Cl 52.5-58.2%) of the subjects had MS and to NCEP 47.4% (95% Cl 44.6-50.0%). WHO criterion detected 48.3% of central obese subjects while NCEP only 14.0%. Kappa statistics showed a good strength of agreement (k = 0.67, p < 0.01) between WHO and NCEP standard definitions of MS. Using the modified NCEP criterion for Asians, more subjects with metabolic syndrome were identified (58%) and agreement with WHO was improved (k = 0.72, p < 0.001). However, similar Framingham risk scores were attributed to the subsets of subjects classified by any of the three criteria. Areas under the receiver operating characteristic curves, obtained for the modified waist values to diagnose metabolic syndrome according to WHO, were > 0.80 and corresponded, respectively, to sensitivity and specificity of 63 and 83% for men and 77 and 72% for women. In final logistic regression model, age, male sex, BMI and homeostasis model assessment-insulin resistance but not with albumin-to-creatinine ratio (ACR) were independently associated with the syndrome.Conclusions: High prevalence of MS, independent of the criterion considered, was found in this Japanese-Brazilian population. The replacement of waist cutoff by those proposed by WHO for Asians lead to this diagnosis in a higher number of subjects with elevated cardiovascular risk. Our data did not support that ACR should be included in the classical definition of MS in Japanese descendants as previously suggested by WHO.

Prevalence of Treponema Species Detected in Endodontic Infections: Systematic Review and Meta-regression Analysis

Introduction: This systematic review and meta-regression analysis aimed to calculate a combined prevalence estimate and evaluate the prevalence of different Treponema species in primary and secondary endodontic infections, including symptomatic and asymptomatic eases. Methods: The MEDLINE/PubMed, Embase, Scielo, Web of Knowledge, and Scopus data-bases were searched without starting date restriction up to and including March 2014. Only reports in English were included. The selected literature was reviewed by 2 authors and classified as suitable or not to be included in this review. Lists were compared, and, in case of disagreements, decisions were made after a discussion based on inclusion and exclusion criteria. A pooled prevalence of Treponema species in endodontic infections was estimated. Additionally, a meta-regression analysis was performed. Results: Among the 265 articles identified in the initial search, only 51 were included in the final analysis. The studies were classified into 2 different groups according to the type of endodontic infection and whether it was an exclusively primary/secondary study (n = 36) or a primary/secondary comparison (n = 15). The pooled prevalence of Treponema species was 41.5% (95% confidence interval, 35.9-47.0). In the multivariate model of meta-regression analysis, primary endodontic infections (P < .001), acute apical abscess, symptomatic apical periodontitis (P < .001), and concomitant presence of 2 or more species (P = .028) explained the heterogeneity regarding the prevalence rates of Treponema species. Conclusions: Our findings suggest that Treponema species are important pathogens involved in endodontic infections, particularly in cases of primary and acute infections.

Analysis of relevant factors in patients with oral and pharyngeal cancers

This study presented an epidemiological data of 177 medical records of patients affected by oral and pharyngeal cancers with prosthesis indication. The gender, age, sun exposure, disease diagnosis, cancer anatomic site, radiation treatment and type of prosthesis, death from oral and pharyngeal cancers were collected. Data were analyzed by summary measures and logistic regression analysis. The mean age of the patients was 62.7 years, and 46.8％ died between 52 and 62 years old. Most of the patients were male (74％), and 42％ died among them. Squamous cell carcinoma was the most prevalent cancer (75.1％) and 42.1％ of these patients died. The age, gender, diagnosis and the interaction of these factors exhibited strong association with the patients’ death (P<.05, Chi-square test). The multivariate odds ratios (OR) of the death were 0.40 for women and 0.39 for other pathologies versus male and squamous cell carcinoma, respectively. It was concluded that age, gender and diagnosis of cancer had significant effect on patients’ death.