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1.
Med Teach ; : 1-15, 2021 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-33826870

RESUMO

Scholarship is an integral aspect of academia. It shapes the practice of individuals and the field and is often used to inform career progression decisions and policies. This makes it high stakes. Yet it is complex, and ambiguous. Definitions vary and the term does not necessarily translate well across contexts. In this AMEE guide, our aim is to establish a contemporary definition of scholarship which is appropriate to health professions education (HPE). Our specific objectives are to provide guidance to support colleagues in their career development as professional educators and to challenge biases and assumptions about scholarship which may still exist in educational systems and structures. Ultimately, we hope that this work will advance the stature/standing of scholarship in the field. We provide a general definition of scholarship and how this relates to the scholarship of teaching (and learning) (SoT[L]) and scholarly teaching. Drawing on Boyer's seminal work, we describe different types of scholarship and reflect on how these apply to HPE, before moving on to describe different types of engagement with scholarship in HPE, including scope of contribution and influence. Using cases and examples, we illustrate differences in scholarly engagement across stages of a career, contexts, and ways of engaging. We provide guidance on how to assess 'quality' of scholarship. We offer practical advice for health professions' educators seeking academic advancement. We advocate that institutional leaders consider their systems and structures, so that these align with faculty work patterns, and judge teaching and professional practice appropriately. We conclude by offering a new definition of scholarship in HPE.

2.
Med Educ ; 2021 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-33792952

RESUMO

INTRODUCTION: Assessment of healthcare professionals should be authentic to clinical practice. As clinicians regularly use resources in practice, similar resources should be available to those sitting assessment. There is limited information on the impacts of open-book (resource) assessments on standard setting for use in high-stakes assessments. This research aims to explore the effects on standard setting and student perceptions when open vs closed resources are available in high-stakes assessment of medical students. METHODS: Students sat multiple-choice question (MCQ) examinations under both closed- and open-resource conditions in a randomised crossover design. A standard setting panel set pass-marks for both closed- and open-resource conditions of delivery, and we compared these pass-marks with each other and with actual performance. Students responded to a survey on perceptions of open-resource assessments. RESULTS: The pass-mark was set higher when panellists considered open-resource conditions compared to closed conditions (59% vs 47%), but actual student performance showed no difference in scores between the two conditions. The net effect was that the pass rate was higher for closed than open-resource conditions (71% vs 34%). Open-resource conditions increased the time to complete the questions. The students perceived that open resource was more authentic but was more time-consuming and would require different preparation. Regarding the acceptability of including open resources in high-stakes assessment, the responses of students were mixed. DISCUSSION: Pass standards based solely on judgements by panellists experienced in closed-resource conditions might not be applicable under open conditions. Questions vary in how much time accessing resources may take and the degree of assistance in selecting the correct answer. A programme of assessment could be constructed to include both closed- and open-resource condition assessments depending on the questions' content and format. Open-resource conditions may promote assessment preparation that focuses more on seeking and evaluating resources rather than learning facts.

3.
Anat Sci Educ ; 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33752261

RESUMO

University assessment is in the midst of transformation. Assessments are no longer designed solely to determine that students can remember and regurgitate lecture content, nor in order to rank students to aid with some future selection process. Instead assessments are expected to drive, support and enhance learning and to contribute to student self-assessment and development of skills and attributes for a lifetime of learning. While traditional purposes of certifying achievement and determining readiness to progress remain important, these new expectations for assessment can create tensions in assessment design, selection and deployment. With recognition of these tensions, three contemporary approaches to assessment in medical education are described. These approaches include: careful consideration of the educational impact of assessment - before, during (test or recall enhanced learning) and after assessments; development of student (and staff) assessment literacy; and planning of cohesive systems of assessment (with a range of assessment tools) designed to assess the various competencies demanded of future graduates. These approaches purposefully straddle the cross purposes of assessment in modern health professions education. The implications of these models are explored within the context of medical education and then linked with contemporary work in the anatomical sciences in order to highlight current synergies and potential future innovations when using evidence informed strategies to boost the educational impact of assessments.

4.
Eur J Neurol ; 2021 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-33657269

RESUMO

BACKGROUND AND PURPOSE: Several epidemiological studies from Taiwan, all using the same data resource, found significant associations between herpes virus infection, antiherpetic medication, and subsequent dementia. We conducted a multicenter observational cohort study using health registry data from Wales, Germany, Scotland, and Denmark to investigate potential associations between antiherpetic medication and incident dementia, and also to comprehensively investigate such associations broken down according to medication type and dose, type of herpes virus, and dementia subtype. METHODS: A total of 2.5 million individuals aged 65 years or more were followed up using linked electronic health records in four national observational cohort studies. Exposure and outcome were classified using coded data from primary and secondary care. Data were analyzed using survival analysis with time-dependent covariates. RESULTS: Results were heterogeneous, with a tendency toward decreased dementia risk in individuals exposed to antiherpetic medication. Associations were not affected by treatment number, herpes subtype, dementia subtype, or specific medication. In one cohort, individuals diagnosed with herpes but not exposed to antiherpetic medication were at higher dementia risk. CONCLUSIONS: Short-term antiherpetic medication is not markedly associated with incident dementia. Because neither dementia subtype nor herpes subtype modified the association, the small but significant decrease in dementia incidence with antiherpetic administration may reflect confounding and misclassification.

5.
Med Educ ; 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-33247954

RESUMO

INTRODUCTION: Learner neglect is a relatively new concept in education and no suitable framework for its exploration has been devised. The aim of this study was to determine whether an existing framework, Glaser's framework of child neglect, could be applied to learner neglect in clinical learning environments. This was a retrospective analysis of data obtained as part of a related study. METHOD: Six focus groups were conducted with medical students in their early clinical years to explore their views of what experiences in medical education were challenging and why they presented a challenge. The transcript data were analysed using inductive content analysis, within an interpretivist approach in the development of categories. The identified categories were cross referenced with Glaser's framework categories replacing the carer with the teacher and the child with the learner. RESULTS: Glaser's classifications of teacher (parent) behaviours were all identified in the negative aspects of medical learner clinical education including: emotional unavailability/unresponsiveness, acting in a hostile manner, inappropriate inconsistent developmental interaction, failure to recognise individuality and failure to promote social adaption. Physical unavailability was identified as an additional category and is included in our proposed framework of learner neglect. DISCUSSION: Adapting Glaser's framework was useful in considering learner neglect. Medical schools have a role in ensuring learning experiences are positive across contexts and to make explicit to teachers any behaviours that may appear as learner neglect. Applying this framework has the potential to make more explicit any subtle undermining teacher behaviours. Once explicit, there is a greater likelihood that behaviours may be reappraised both by the teacher and learner and modified to promote a more effective clinical learning experience.

6.
Nutrients ; 12(10)2020 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-33007886

RESUMO

The low fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAP)diet has been extensively researched, but not in the management of older adults with functional gastrointestinal symptoms. This study determines the positive and negative impacts of this dietary treatment in older adults with chronic diarrhea. A non-blinded intervention study was conducted with adults over 65 years with chronic diarrhea referred for colonoscopy where no cause was found. Participants followed a dietitian-led low FODMAP diet for six weeks and completed a structured assessment of gastrointestinal symptoms, the Hospital Anxiety and Depression scale, and a four-day food diary before and after the intervention. Twenty participants, mean age 76 years, were recruited. Adherence to the low FODMAP diet was acceptable; mean daily FODMAP intake reduced from 20.82 g to 3.75 g (p < 0.001) during the intervention and no clinically significant changes in macro- or micronutrient intakes were observed. There were clinically significant improvements in total gastrointestinal symptoms (pre diet 21.15/88 (standard deviation SD = 10.99), post diet 9.8/88 (SD = 9.58), p < 0.001) including diarrhea (pre diet 9.85 (SD = 3.84), post diet 4.05 (SD = 3.86), p < 0.001) and significant reductions in anxiety (pre diet 6.11/21 (SD = 4.31), post diet 4.26/21 (SD = 3.38), p < 0.05). In older adults the low FODMAP diet is clinically effective and does not jeopardise nutritional intake when supervised by an experienced dietitian.

7.
Artigo em Inglês | MEDLINE | ID: mdl-33045103

RESUMO

OBJECTIVES: Limited research has shown that people with dementia (PwD) from lower socio-economic backgrounds can face difficulties in accessing the right care at the right time. This study examined whether socio-economic status (SES) and rural versus urban living location are associated with the time between diagnosis and care home admission in PwD living in Wales, UK. METHODS/DESIGN: This study linked routine health data and an e-cohort of PwD who have been admitted into a care home between 2000 and 2018 living in Wales. Survival analysis explored the effects of SES, living location, living situation, and frailty on the time between diagnosis and care home admission. RESULTS: In 34,514 PwD, the average time between diagnosis and care home admission was 1.5 (±1.4) years. Cox regression analysis showed that increased age, living alone, frailty, and living in less disadvantaged neighbourhoods were associated with faster rate to care home admission. Living in rural regions predicted a slower rate until care home admission. CONCLUSIONS: This is one of the first studies to show a link between socio-economic factors on time to care home admission in dementia. Future research needs to address variations in care needs between PwD from different socio-economic and geographical backgrounds.

8.
BMC Med Educ ; 20(1): 344, 2020 Oct 06.
Artigo em Inglês | MEDLINE | ID: mdl-33023565

RESUMO

BACKGROUND: Self-monitoring is an important component of clinical practice. It is underpinned by the framework of self-efficacy which is concerned with judgments of how well one believes one can achieve or perform a task. This research aimed to develop criteria for adequate self-monitoring, then to measure patterns of self-monitoring, and to explore how these patterns relate to a student's year in a medical course and to patterns of knowledge. METHODS: Analysis of individuals' levels of correctness in answering assessment items and their certainty in correctness may be used to inform assessments of ability to self-monitor. Two criteria were proposed and applied to define adequate self-monitoring. Firstly, increasing proportions correct with increasing levels of certainty. Secondly, having a proportion correct for high certainty responses that was not lower than cohort levels. Student responses in progress tests comprising multiple-choice questions (MCQs) and associated certainty were analysed. Criteria for the presence of adequate self-monitoring and for adequate knowledge were applied to the results of each of four tests conducted over 2 years, and used to categorise patterns of self-monitoring and knowledge. RESULTS: Data from 3 year group cohorts totalling 737 students were analysed. The majority (58%) of students demonstrated adequate knowledge and met both criteria for adequate self-monitoring across all four tests. The most advanced year group cohort had the highest rates of adequate knowledge and the highest rates of meeting both self-monitoring criteria. The patterns of self-monitoring were the same as the patterns of knowledge across the four tests for 454 students, but for the remaining 283 the patterns of self-monitoring and knowledge differed. CONCLUSION: Analysis of responses to item level certainty has informed development of a definition of adequate self-monitoring that may be applied to individual student's responses from a single test, and to track the adequacy of a student's self-monitoring over time. Patterns of self-monitoring tend to match patterns of knowledge, but not in all cases, suggesting the self-monitoring measure could provide additional information about student ability.

10.
Med Teach ; : 1-10, 2020 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-33054524

RESUMO

INTRODUCTION: In 2011 the Consensus Statement on Performance Assessment was published in Medical Teacher. That paper was commissioned by AMEE (Association for Medical Education in Europe) as part of the series of Consensus Statements following the 2010 Ottawa Conference. In 2019, it was recommended that a working group be reconvened to review and consider developments in performance assessment since the 2011 publication. METHODS: Following review of the original recommendations in the 2011 paper and shifts in the field across the past 10 years, the group identified areas of consensus and yet to be resolved issues for performance assessment. RESULTS AND DISCUSSION: This paper addresses developments in performance assessment since 2011, reiterates relevant aspects of the 2011 paper, and summarises contemporary best practice recommendations for OSCEs and WBAs, fit-for-purpose methods for performance assessment in the health professions.

11.
Rev. peru. biol. (Impr.) ; 27(4): 451-482, Oct-Dec 2020. tab, graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1150086

RESUMO

Resumen Las regiones desérticas costeras del Pacífico de Perú y Chile albergan especies de Prosopis (Leguminosae: Mimosoideae), árboles bien adaptados a las condiciones del desierto y con funciones clave en los ecosistemas de bosques secos. Entre el 2001 y 2017, Prosopis en Perú ha sufrido una extensiva defoliación y muerte regresiva, con la consecuente deforestación y disminución de la producción de vainas de algarrobo. Aquí, se reporta una nueva especie de insecto plaga del bosque de Prosopis en Perú: Enallodiplosis discordis Gagné 1994 (Diptera: Cecidomyiidae), una feroz especie defoliadora que contribuye a la mortalidad generalizada de Prosopis. Se proporciona un análisis de la taxonomía larvaria de E. discordis, ciclo de vida y la infestación ocurrida después de El Niño Oscilación del Sur (ENSO) 1998/99. Su dispersión, distribución y ecología es examinada utilizando distintas líneas de evidencia. Durante casi dos décadas de trabajo de campo, se observó la muerte regresiva del bosque de Prosopis devastando los medios de vida rurales y los servicios de los ecosistemas en las regiones de las tierras bajas del sur (Ica), el centro y el norte de la costa peruana (Lambayeque, La Libertad, Piura). El colapso en la producción de vainas de Prosopis (algarroba, huaranga) y miel también fue registrada. Las notas complementarias proporcionan observaciones sobre: (i) el desarrollo de la plaga y el cambio de uso de la tierra y el clima, (ii) el control biológico y físico de E. discordis, (iii) la polilla Melipotis aff. indomita (Lepidoptera: Noctuidae) como defoliador concurrente de Prosopis.


Abstract The coastal desert of Peru and Chile is home to Prosopis (Leguminosae: Mimosoideae) tree species that are exceptionally well-adapted to the hyperarid conditions and keystone in dry-forest ecosystems. From 2001 to 2018, Prosopis in Peru have suffered widespread defoliation and die-back, with consequent deforestation and collapse in pod production. This paper reports a new insect plague species of Prosopis forest in Peru: Enallodiplosis discordis Gagné 1994 (Diptera: Cecidomyiidae) as a fiercely defoliating agent contributing to widespread Prosopis mortality. An analysis of E. discordis larval taxonomy, life cycle and plague infestation, following El Niño Southern Oscillation (ENSO) 1998/99 is provided. Using distinct lines of evidence, its spread, distribution, and ecology are examined. Over two decades of fieldwork, Prosopis forest die-back and loss was observed devastating rural livelihoods and ecosystem services across lowland regions of southern (Ica), central and northern coastal Peru (Lambayeque, La Libertad, Piura). The collapse in production of Prosopis pods (algarroba, huaranga) and honey was recorded. Supplementary notes provide observations of: (i) plague development, changing land-use and climate, (ii) biological and physical control of E. discordis, (iii) the moth Melipotis aff. indomita (Lepidoptera: Noctuidae) as a concurrent defoliator of Prosopis.

12.
Perspect Med Educ ; 9(6): 359-366, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32930985

RESUMO

INTRODUCTION: There has been a marked increase in institutional structures developed to support health professions education scholarship recently. These health professions education scholarship units (HPESUs) engage in a diverse range of activities. Previous work provided insight into factors that influence the functioning of such units, but data from European, Asian, Latin American, and African contexts was absent, potentially leading to a single world-view informing international standards for HPESUs. This aim of this study was to explore perspectives from sub-Saharan Africa (SSA) in response to this omission. METHODS: Situated within an interpretivist paradigm, the research team conducted semi-structured interviews with nine HPESU leaders in SSA, exploring how participants experienced and understood the functioning of their units. Despite efforts to have representation from across the region, most participants were from South Africa. The researchers analysed data thematically using the theory of institutional logics as an analytical frame. RESULTS: Several aspects of the HPESUs aligned with the previously identified logics of academic research, service and teaching; and of a cohesive education continuum. By contrast, leaders described financial sustainability as a more prominent logic than financial accountability. DISCUSSION: The similarities identified in this study may reflect isomorphism-a process which sees institutions within a similar field becoming more alike, particularly as newer institutions seek to acquire legitimacy within that field. An important caveat, however, is that isomorphism tends to occur across similar institutional contexts, which was not the case in this study. Understanding these differences is key as these HPESUs move to foster scholarship that can respond to the region's unique context.

13.
Mar Pollut Bull ; 160: 111572, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32920260

RESUMO

Data on the occurrence and abundance of meso and microplastics for the South Pacific are limited and there is urgent need to fill this knowledge gap. The main aim of the study was to apply a rapid screening method, based on the fluorescence tagging of polymers using Nile red, to determine the concentration of meso and microplastics in biota, sediment and surface waters near the capital cities of Vanuatu and Solomon Islands. A spatial investigation was carried out for sediment, biota and water as well as a temporal assessment for sediment for two consecutive years (2017 and 2018). Accumulation zones for microplastics were identified supported by previous hydrodynamic models. Microplastics were detected for all environmental compartments investigated indicating their widespread presence for Vanuatu and Solomons Islands. This method was in alignment with previous recommendations that the Nile red method is a promising approach for the largescale mapping of microplastics in a monitoring context.


Assuntos
Plásticos , Poluentes Químicos da Água , Biota , Cidades , Monitoramento Ambiental , Melanesia , Microplásticos , Poluentes Químicos da Água/análise
14.
Stroke ; 51(10): 3007-3017, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32842921

RESUMO

BACKGROUND AND PURPOSE: An important minority of cerebral small vessel disease (cSVD) is monogenic. Many monogenic cSVD genes are recognized to be associated with extracerebral phenotypes. We assessed the frequency of these phenotypes in existing literature. METHODS: We performed a systematic review following the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), searching Medline/Embase for publications describing individuals with pathogenic variants in COL4A1/2, TREX1, HTRA1, ADA2, and CTSA genes (PROSPERO 74804). We included any publication reporting on ≥1 individual with a pathogenic variant and their clinically relevant phenotype. We extracted individuals' characteristics and information about associated extracerebral phenotypes and stroke/transient ischemic attack. We noted any novel extracerebral phenotypes and looked for shared phenotypes between monogenic cSVDs. RESULTS: After screening 6048 publications, we included 96 COL4A1 (350 individuals), 32 TREX1 (115 individuals), 43 HTRA1 (38 homozygous/61 heterozygous individuals), 16 COL4A2 (37 individuals), 119 ADA2 (209 individuals), and 3 CTSA (14 individuals) publications. The majority of individuals originated from Europe/North America, except for HTRA1, where most were from Asia. Age varied widely, ADA2 individuals being youngest and heterozygous HTRA1/CTSA individuals oldest. Sex distribution appeared equal. Extracerebral phenotypes were common: 14% to 100% of individuals with a pathogenic variant manifested at least one extracerebral phenotype (14% COL4A2, 43% HTRA1 heterozygotes, 47% COL4A1, 57% TREX1, 91% ADA2, 94% HTRA1 homozygotes, and 100% CTSA individuals). Indeed, for 4 of 7 genes, an extracerebral phenotype was observed more frequently than stroke/transient ischemic attack. Ocular, renal, hepatic, muscle, and hematologic systems were each involved in more than one monogenic cSVD. CONCLUSIONS: Extracerebral phenotypes are common in monogenic cSVD with extracerebral system involvement shared between genes. However, inherent biases in the existing literature mean that further data from large-scale population-based longitudinal studies collecting health outcomes in a systematic unbiased way is warranted. The emerging knowledge will help to select patients for testing, inform clinical management, and provide further insights into the underlying mechanisms of cSVD.


Assuntos
Doenças de Pequenos Vasos Cerebrais/genética , Genótipo , Heterozigoto , Humanos , Mutação , Fenótipo
15.
Disabil Rehabil ; : 1-5, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631089

RESUMO

Introduction: Low impact flooring (LIF) has shown potential for reducing fall-related injuries for older people in residential care or hospital environments. However, the increased rolling resistance when moving equipment on these floors has raised concerns that staff injuries may increase.Methods: LIF was trialled on one Older Persons Health ward for 2.5 years. Reported staff injuries were monitored during and following the trial. Numbers of staff injured on the LIF ward were compared with three other similar and adjacent OPH wards without LIF for the duration of the trial ('concurrent control' evaluation). At the trial conclusion the LIF ward moved to a different hospital that had standard flooring. This enabled a further 'during and after' evaluation where numbers of staff injured from the LIF ward during the trial were compared with those reported afterwards by the same ward staff without LIF.Results: There was no difference in the numbers of staff injured in the LIF ward compared with the concurrent control wards (28 LIF vs 30 control; p = 0.44). The number of staff with injuries in the LIF ward also did not significantly alter when those staff moved to a new ward without LIF (45 after vs 28 before; p = 0.11).Conclusion: There was no change in the numbers of staff with injuries during the LIF trial in an Older Persons Health ward. This small study suggests LIF appears safe for both patients and staff.Implications for rehabilitationFalls in hospital are common with patient injuries occurring in approximately 20-30% of falls.Low impact (compliant) flooring may reduce fall-related injuries in hospitals and residential care.Low impact flooring has an increased rolling resistance, which has the potential to increase staff injuries when moving equipment.This study found no change in the number of staff injured during a low impact flooring trial providing some reassurance that these floors are safe for staff.

16.
Med Teach ; 42(9): 1043-1050, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32603620

RESUMO

Background: Widespread concerns about new medical graduates' 'work readiness' may reflect, in part, differences in mandatory learning outcomes for medical students and new medical graduates.Purpose: To examine differences between required medical student and PGY1 (first year resident) training program outcomes, and the nature and magnitude of these differences.Method: Comparison, systematic identification and thematic analysis of differences between the graduate outcomes in the Australian Medical Council Standards for the Assessment and Accreditation of Primary Medical Programs and those in the New Zealand Curriculum Framework for Prevocational Training.Results: The relationship between these outcome statements were categorized as: essentially similar; continuity; partial discontinuity; and complete discontinuity of learning trajectory. Areas requiring substantial new learning may reflect medical schools' focus on individual student performance, and on learning and assessments based on single episodes of often uncomplicated illness. This contrasted with a post-graduate focus on integrated health care delivery by teams and management of complex illnesses over the whole patient care journey.Conclusions: Characterizing these marked differences between pre-graduate and postgraduate standards, within a trajectory of learning, explains some of the difficulties in students' preparation for work readiness. These could inform learning interventions to support new graduates' professional development to ensure patient safety. Development and revision of accreditation standards should include formal review against the expectations of the preceding and succeeding phases of learning.

17.
Neurology ; 95(6): e697-e707, 2020 08 11.
Artigo em Inglês | MEDLINE | ID: mdl-32616677

RESUMO

OBJECTIVE: In UK Biobank (UKB), a large population-based prospective study, cases of many diseases are ascertained through linkage to routinely collected, coded national health datasets. We assessed the accuracy of these for identifying incident strokes. METHODS: In a regional UKB subpopulation (n = 17,249), we identified all participants with ≥1 code signifying a first stroke after recruitment (incident stroke-coded cases) in linked hospital admission, primary care, or death record data. Stroke physicians reviewed their full electronic patient records (EPRs) and generated reference standard diagnoses. We evaluated the number and proportion of cases that were true-positives (i.e., positive predictive value [PPV]) for all codes combined and by code source and type. RESULTS: Of 232 incident stroke-coded cases, 97% had EPR information available. Data sources were 30% hospital admission only, 39% primary care only, 28% hospital and primary care, and 3% death records only. While 42% of cases were coded as unspecified stroke type, review of EPRs enabled a pathologic type to be assigned in >99%. PPVs (95% confidence intervals) were 79% (73%-84%) for any stroke (89% for hospital admission codes, 80% for primary care codes) and 83% (74%-90%) for ischemic stroke. PPVs for small numbers of death record and hemorrhagic stroke codes were low but imprecise. CONCLUSIONS: Stroke and ischemic stroke cases in UKB can be ascertained through linked health datasets with sufficient accuracy for many research studies. Further work is needed to understand the accuracy of death record and hemorrhagic stroke codes and to develop scalable approaches for better identifying stroke types.


Assuntos
Acidente Vascular Cerebral/epidemiologia , Adulto , Idoso , Isquemia Encefálica/epidemiologia , Coleta de Dados/métodos , Conjuntos de Dados como Assunto , Atestado de Óbito , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Reino Unido/epidemiologia
18.
Neurology ; 95(12): e1686-e1693, 2020 09 22.
Artigo em Inglês | MEDLINE | ID: mdl-32680951

RESUMO

OBJECTIVE: To determine the association of epilepsy with incident dementia by conducting a nationwide, retrospective data-linkage, cohort study to examine whether the association varies according to dementia subtypes and to investigate whether risk factors modify the association. METHODS: We used linked health data from hospitalization, mortality records, and primary care consultations to follow up 563,151 Welsh residents from their 60th birthday to estimate dementia rate and associated risk factors. Dementia, epilepsy, and covariates (medication, smoking, comorbid conditions) were classified with the use of previously validated code lists. We studied rate of dementia and dementia subtypes in people with epilepsy (PWE) and without epilepsy using (stratified) Kaplan-Meier plots and flexible parametric survival models. RESULTS: PWE had a 2.5 (95% confidence interval [CI] 2.3-2.6) times higher hazard of incident dementia, a 1.6 (95% CI 1.4-1.8) times higher hazard of incident Alzheimer disease (AD), and a 3.1 (95% CI 2.8-3.4) times higher hazard of incident Vascular dementia (VaD). A history of stroke modified the increased incidence in PWE. PWE who were first diagnosed at ≤25 years of age had a dementia rate similar to that of those diagnosed later in life. PWE who had ever been prescribed sodium valproate compared to those who had not were at higher risk of dementia (hazard ratio [HR] 1.6, 99% CI 1.4-1.9) and VaD (HR 1.7, 99% CI 1.4-2.1) but not AD (HR 1.2, 99% CI 0.9-1.5). CONCLUSION: PWE compared to those without epilepsy have an increased dementia risk.


Assuntos
Demência/epidemiologia , Epilepsia/complicações , Distribuição por Idade , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Estudos Retrospectivos , Fatores de Risco , País de Gales/epidemiologia
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