Age Bands Research Articles

Life expectancy of people with HIV on long-term antiretroviral therapy in Europe and North America: a cohort study

BackgroundThe life expectancy of people with HIV starting combination antiretroviral therapy (ART) has increased substantially over the past 25 years. However, individuals treated before 1996 or with less effective and more toxic regimens than those currently available might have a worse prognosis. We estimated life expectancy from 2015 onwards, comparing people with HIV who started ART in different time periods since 1996. MethodsData were derived from 20 European and North American cohorts (Antiretroviral Therapy Cohort Collaboration and UK Collaborative HIV Cohort Study), for people with HIV who started potent ART after 1996 and were still on ART in 2015, or who started ART after 2015 and survived for at least 1 year. Follow-up started on or after Jan 1, 2015. Associations between mortality and demographic characteristics and biomarkers (CD4 and CD8 count in cells per μL and HIV-1 RNA viral load) at follow-up start were estimated using multivariable Poisson models. Estimated mortality rates in 5-year age bands were entered into life tables that contain follow-up information to estimate expected remaining life expectancy, stratified by sex and variables associated with mortality, and standardised to the proportion of people with HIV in each stratum. Life expectancy was compared with the French general population, as more data were available for France than for other countries included in the analyses. FindingsOf the 206 891 people with HIV eligible for inclusion from the cohort data, 5780 died during 619 356 person-years of follow-up after 2015. For women, the standardised remaining years of life expectancy at age 40 years for individuals starting ART between 1996 and 2014 was 36·0 years (95% CI 35·4–36·6), whereas it was 39·4 years (39·0–39·8) for individuals starting after 2015 (general population comparator 46·0 years). Corresponding figures for men were 34·7 years (34·1–35·3) and 37·2 years (36·6–38·8), respectively (general population comparator 40·3 years). For women starting ART between 1996 and 2014, with a CD4 count of 0–49 cells per μL at the commencement of follow-up, remaining life expectancy at age 40 years was 19·4 years (95% CI 18·2–20·6), rising to 40·4 years (40·0–40·8) for people with a CD4 count of 500 cells per μL or greater at commencement of follow-up. Corresponding figures for women starting ART after 2015 were 24·9 years (23·9–25·9) and 42·6 years (422–43·0), respectively. For men starting ART between 1996 and 2014 with a CD4 count of 0–49 cells per μL at commencement of follow-up, remaining life expectancy at age 40 years was 18·2 years (17·0–19·4), rising to 38·2 years (37·6–38·8) for men with a CD4 count of 500 cells per μL or more at commencement of follow-up. Corresponding remaining life expectancy for men starting ART after 2015 was 23·7 years (22·7–24·7) and 39·5 years (38·9–40·1), respectively. InterpretationFor people with HIV on long-term ART with high CD4 cell counts, life expectancies are estimated to be close to those of the general population, regardless of when they started ART. However, for people with HIV with low CD4 cell counts, estimates of remaining life expectancy are up to 30 years lower than in the general population, indicating the importance of early diagnosis and sustained treatment. FundingUS National Institute on Alcohol Abuse and Alcoholism, UK Medical Research Council.

Mortality Rate Associated with Diabetes: Outcomes From a General Practice Level Analysis in England Using the Royal College of General Practitioners (RCGP) Database Indicate Stability Over a 15 Year Period.

IntroductionTotal population mortality rates have been falling and life expectancy increasing for more than 30 years. Diabetes remains a significant risk factor for premature death. Here we used the Oxford Royal College of General Practitioners Research and Surveillance Centre (RCGP RSC) practices to determine diabetes-related vs non-diabetes-related mortality rates.MethodsRCGP RSC data were provided on annual patient numbers and deaths, at practice level, for those with and without diabetes across four age groups (< 50, 50–64, 65–79, ≥ 80 years) over 15 years. Investment in diabetes control, as measured by the cost of primary care medication, was also taken from GP prescribing data.ResultsWe included 527 general practices. Over the period 2004–2019, there was no significant change in life years lost, which varied between 4.6 and 5.1 years over this period. The proportion of all diabetes deaths by age band was significantly higher in the 65–79 years age group for men and women with diabetes than for their non-diabetic counterparts. For the year 2019, 26.6% of deaths were of people with diabetes. Of this 26.6%, 18.5% would be expected from age group and non-diabetes status, while the other 8.1% would not have been expected—pro rata to nation, this approximates to approximately 40,000 excess deaths in people with diabetes vs the general population.ConclusionThere remains a wide variation in mortality rate of people with diabetes between general practices in UK. The mortality rate and life years lost for people with diabetes vs non-diabetes individuals have remained stable in recent years, while mortality rates for the general population have fallen. Investment in diabetes management at a local and national level is enabling us to hold the ground regarding the life-shortening consequences of having diabetes as increasing numbers of people develop T2DM at a younger age.

Urgent dental care use in the North East and Cumbria: predicting repeat attendance

Introduction Around one-third of the UK population are 'problem-orientated dental attenders', only seeking care when suffering with dental pain and often on a repeated basis to secondary care. Little is known about attendance in primary care. The aim here was to examine the period prevalence of repeat urgent care attenders and establish predictors of repeat attendance in primary care.Methods Data on urgent and emergency dental care attendances in primary dental care in the North East and Cumbria were analysed from 2013-2019. Variables included: patient sex; ten-year age band; lower super output area; and Index of Multiple Deprivation. Period prevalence was calculated and data were considered year by year to identify trends in attendances. Analysis was with descriptive statistics and predictors of repeat attendance were identified using logistic regression modelling.Results Over the six-year period, there were 601,432 attendances for urgent primary dental care, equating to a period prevalence of 2.76% for the geographic population studied. In total, 16.15% of attendances were repeat attendances (period prevalence 0.45%) and predictors included being a woman and residence in deprived and rural areas. All urgent care attendances decreased over the six-year period, with one-off attendances beginning to increase again in 2019, while repeat attendances stabilised.Conclusion Interventions to encourage regular dental attendances should be targeted at patients from the most deprived and rural areas of the North East and Cumbria; however, a decrease in repeat attendance was noted in these areas.

Early Motor Milestones in Infancy and Later Motor Impairments: A Population-Based Data Linkage Study.

BackgroundDevelopmental Coordination Disorder (DCD) is a neurodevelopmental condition with high prevalence. Early motor milestones are important markers to identify DCD. The current study aims to evaluate the association between the onset of crawling and independent walking and their transition pattern during infancy and later motor impairments.MethodsA total of 8,395 children aged 3–6 years old in China were included in the final analysis. A parent questionnaire was used to collect early milestone onset data. Children's motor performance was measured using the Movement Assessment Battery for Children-2nd edition (MABC-2). The association between motor milestones and motor impairment was analyzed using a multilevel regression model.ResultsThe result showed that a 1-month delay in crawling onset increased the risk of significant overall motor impairment by 5.3, and 14.0% when adjusting for child and family characteristics. A 1-month delay in walking onset increased the risk of significant overall motor, fine, gross, and balance impairment by 21.7, 8.3, 13.3, and 17.8%. A 1 month increase in the transition time from crawling to independent walking increased the risk of significant overall motor and gross motor impairment by 7.7 and 6.6%. These results were inconsistent across different age bands (each p < 0.05).ConclusionsOur study indicates that even a mild delay in crawling and walking onsets in infancy increase the risk for subsequent motor impairments in childhood, and children with motor impairments revealed a different transition pattern from crawling to walking. The motor abilities of children with motor impairments can be observed to diverge from typically developing children as early as 6–8 months old. The findings can facilitate the early identification of motor impairments in children, and provide early signs to initiate intervention.

Acquired mild cognitive impairment in adults with Down syndrome: Age-related prevalence derived from single point assessment data normed by degree of intellectual disability.

BackgroundIndividuals with Down syndrome (DS) are at significant risk for early onset Alzheimer's disease (AD), likely due to the triplication of genes on chromosome 21 that facilitate AD neuropathology. To aid the effective early diagnosis of dementia in DS, we demonstrate the strategy of using single point assessment of cognitive performance with scoring normed for degree of intellectual disability to generate age related prevalence data for acquired mild cognitive impairment (AMCI).MethodsFour hundred and twelve adults with DS were assessed using the Neuropsychological Assessment of dementia in adults with Intellectual Disability. Normative data, banded by degree of intellectual disability, allowed identification of AMCI by atypical deviation from expected performance.ResultsAMCI was evident in approximately 20% of adults with DS aged 40 and under, 40% aged 41–50 and 45% aged 51 and over. Relative risk increased significantly in those aged 46 and over. Analysis of prevalence by 5‐year age bands revealed two peaks for higher prevalence of AMCI.ConclusionsPsychometric data indicate single point assessment of AMCI is possible for the majority of adults with DS. Two peaks for age‐related prevalence of AMCI suggest the risk for onset of AD conferred by trisomy of chromosome 21 is moderated by another factor, possibly ApoE status.

Mission statements in universities: Readability and performance

The mission statement(s) (MS) is one of the most-used tools for planning and management. Universities worldwide have implemented MS in their knowledge planning and management processes since the 1980s. Research studies have extensively explored the content and readability of MS and its effect on performance in firms, but their effect on public or nonprofit institutions such as universities has not been scrutinized with the same intensity. This study used Gunning's Fog Index score to determine the readability of a sample of worldwide universities’ MS and two rankings, i.e., Quacquarelli Symonds World University Ranking and SCImago Institutions Rankings, to determine their effect on performance. No significant readability differences were identified in regions, size, focus, research type, age band, or status. Logistic regression (cumulative link model) results showed that variables, such as universities’ age, focus, and size, have more-significant explanatory power on performance than MS readability.

Phonological acquisition of Brazilian Portuguese: Ages of customary production, acquisition and mastery.

AIMS: To describe typical phonological development of Brazilian Portuguese (BP)-speaking children, considering the following parameters: age of customary production, acquisition and mastery. Data were collected from 857 children aged between 3 years and 8 years 11 months with typical language and speech development. The sample was grouped into 6-month age bands. The data were analysed using one-way analysis of variance (ANOVA) followed by Games-Howell post-hoc tests. Stops (/p, b, t, d, k, g/), nasals (/m, n, ɲ/) and some fricatives (/f, v, s, z/) were mastered before the age of 3 years (age of mastery). The age of acquisition for phonemes /ʃ, ʒ/ was 3;6, though both were only mastered at 4;0 years. The liquid /l/ was acquired at 3;0 and mastered at age 3;6, while /x/ was acquired and mastered at age 3;6. The phoneme /ʎ/ was acquired at 7;0 and mastered at age 8;6. The tap /ɾ/ was acquired between the ages of 4;0 and 4;6, and mastered at 4;6. In coda position, /n, l/ were acquired at 3;0, while /s/ was mastered at 4;6 and /ɾ/ between 4;6 and 5;0 years. Clusters involving /ɾ/ were acquired at 6;0, while those with /l/ were acquired between the ages of 6;6 and 7;0. This study presented acquisition for consonants in BP and can be used as a reference for the assessment of developmental speech disorders. In this study, stops and nasals were acquired first, followed by fricatives and, lastly, liquids. This finding is corroborated by previous studies in BP and other languages. What is already known on the subject What this paper adds to existing knowledge What are the potential or actual clinical implications of this work?

GeriPOP: Older Adults Population Health Serious Game

Health professionals have limited opportunities to learn about population health in their curriculum. With a shortage of geriatricians nationwide, health care systems need different ways to provide evidence-based geriatric care. To address both these shortcomings, a serious game, called GeriPOP has been developed to allow trainees to explore the impact of assessment and management of principles of geriatric care (the 4Ms+) on quality of life, health, longevity, and health care costs by applying them to a virtual older adult population. Trainees assume the role of a system manager who is asked to explore ways to optimize health outcomes and lower costs. They develop their population health plan around a framework of Geriatric 4Ms+ and apply it in a virtual panel of older adult patients that move longitudinally into different age bands (65-74; 75-84; 85+). As the game progresses, a dashboard helps trainees track the impact of their treatment decisions across the population. Several levels of play allow trainees to explore various issues intersecting with aging such as gender, diversity, social determinants, and multiple chronic conditions. Periodic debriefings and explanatory pop ups during the game allow trainees to further explore evidence–based Geriatrics. The game engages health care trainees to strengthen their knowledge of Geriatrics through exploration of systems change. Future study is needed on whether Geri POP changes learner attitudes, future clinical practice or healthcare outcomes.

Characterizing and mapping the spatial variability of HIV risk among adolescent girls and young women: A cross-county analysis of population-based surveys in Eswatini, Haiti, and Mozambique.

BackgroundTo stem the HIV epidemic among adolescent girls and young women (AGYW), prevention programs must target services towards those most at risk for HIV. This paper investigates approaches to estimate HIV risk and map the spatial heterogeneity of at-risk populations in three countries: Eswatini, Haiti and Mozambique.MethodsWe analyzed HIV biomarker and risk factor data from recent population-based household surveys. We characterized risk using three approaches: complementary log-log regression, latent class analysis (LCA), and presence of at least one risk factor. We calculated the proportion and 95 percent confidence intervals of HIV-negative AGYW at risk across the three methods and employed Chi-square tests to investigate associations between risk classification and HIV status. Using geolocated survey data at enumeration clusters and high-resolution satellite imagery, we applied algorithms to predict the number and proportion of at-risk AGYW at hyperlocal levels.ResultsThe any-risk approach yielded the highest proportion of at-risk and HIV-negative AGYW across five-year age bands: 26%-49% in Eswatini, 52%-67% in Haiti, and 32%-84% in Mozambique. Using LCA, between 8%-16% of AGYW in Eswatini, 37%-62% in Haiti, and 56%-80% in Mozambique belonged to a high vulnerability profile. In Haiti and Mozambique, the regression-based profile yielded the lowest estimate of at-risk AGYW. In general, AGYW characterized as “at risk” across the three methods had significantly higher odds of HIV infection. Hyperlocal maps indicated high levels of spatial heterogeneity in HIV risk prevalence and population density of at-risk AGYW within countries.ConclusionCharacterizing risk among AGYW can help HIV prevention programs better understand the differential effect of multiple risk factors, facilitate early identification of high-risk AGYW, and design tailored interventions. Hyperlocal mapping of these at-risk populations can help program planners target prevention interventions to geographic areas with populations at greatest risk for HIV to achieve maximal impact on HIV incidence reduction.

A mixed method inquiry of early complementary feeding of infants in the Dominican Republic

Exclusive breastfeeding (EBF) is infrequent and decreasing over time in the Dominican Republic. This study aimed to identify patterns of, and women's rationale for, early complementary feeding. Mothers of children under 12 months of age living in a low-resource peri-urban community had three opportunities to contribute: (i) responding to feeding questions embedded in a standardized questionnaire used at a well-baby clinic (n = 101), (ii) participating in focus groups (n = 31), and (iii) engaging in home-based, semi-structured individual interviews (n = 25). Quantitative questionnaire data were analyzed to identify feeding practices as a function of child age. Textual data from the individual interviews and focus groups were systematically reviewed and coded to identify key constructs through a qualitative descriptive approach. The majority (>86%) of mothers reported breastfeeding at all monthly age bands up to six months. However, EBF was rare, with more than half reporting use of other milks and other foods by the infants' second and fifth month, respectively. Overarching themes to explain early complementary feeding from the qualitative data can be broadly captured by the complementary perceptions that there are problems with relying on breastfeeding alone and that there are benefits to early complementary feeding in the early months of an infant's life. EBF was experienced as (A) insufficient, (B) not always available, (C) sometimes not safe, (D) having potentially negative effects on the mother, and (E) bringing challenges. Complementary feeding was identified as helpful in addressing each of these concerns. Although mothers typically endorsed breastmilk as the preferable and best option for infant feeding, this did not translate into EBF and was not presented as contradictory to the use and perceived benefits of early complementary feeds.

Dynamic Norming for Systematic Analysis of Language Transcripts.

This exploratory study sought to establish the psychometric stability of a dynamic norming system using the Systematic Analysis of Language Transcripts (SALT) databases. Dynamic norming is the process by which clinicians select a subset of the normative database sample matched to their individual client's demographic characteristics. The English Conversation and Student-Selected Story (SSS) Narrative databases from SALT were used to conduct the analyses in two phases. Phase 1 was an exploratory examination of the standard error of measure (SEM) of six clinically relevant transcript metrics at predetermined sampling intervals to determine (a) whether the dynamic norming process resulted in samples with adequate stability and (b) the minimum sample size required for stable results. Phase 2 was confirmatory, as random samples were taken from the SALT databases to simulate clinical comparison samples. These samples were examined (a) for stability of SEM estimations and (b) to confirm the sample size findings from Phase 1. Results of Phase 1 indicated that the SEMs for the six transcript metrics across both databases were low relative to each metric's scale. Samples as small as 40-50 children in the Conversation database and 20-30 children in the SSS Narrative database resulted in stable SEM estimations. Phase 2 confirmed these findings, indicating that age bands as small as ±4 months from a given center-point resulted in stable estimations provided there were approximately 35 children or more in the comparison sample. Psychometrically stable comparison samples can be achieved using SALT's dynamic norming system that are much smaller than the standard sample size recommended in most tests of children's language.

Development and validation of an algorithm to estimate the risk of severe complications of COVID-19: a retrospective cohort study in primary care in the Netherlands

ObjectiveTo develop an algorithm (sCOVID) to predict the risk of severe complications of COVID-19 in a community-dwelling population to optimise vaccination scenarios.DesignPopulation-based cohort study.Setting264 Dutch general practices contributing to the...

Acquisition of cognitive and communication milestones in infants with Down syndrome.

Understanding the timing of developmental milestones in typical and clinical populations facilitates intervention planning and the early detection of risk for co-occurring conditions. Normative timing of developmental milestone achievement has been established for typically developing children. However, there is little information regarding the timing of cognitive and communication skill acquisition in young children with Down syndrome (DS). The objectives of this study are to (1) provide foundational information regarding the timing of cognitive and communication skill acquisition in infants with DS and (2) facilitate the early identification of infants with risk for co-occurring conditions. Seventy-four infants with DS (age range: 4-18months) completed the Bayley Scales of Infant Development-III (Bayley 2006). Individual items from the cognitive and communication scales were selected for analysis. Parents provided information regarding their infant's developmental and family history. The percentage of infants who attained each skill was calculated within 2-month age bands. For infants who did not show skill acquisition within each age band, the rates of prematurity, heart defects, corrective heart surgery and significant illness were calculated as well. This study provides foundational information that can contribute to the formulation of a developmental schedule for cognitive and language milestone acquisition in infants with DS.

Understanding the differential impacts of COVID-19 among hospitalised patients in South Africa for equitable response.

There are limited in-depth analyses of COVID-19 differential impacts, especially in resource-limited settings such as South Africa (SA). To explore context-specific sociodemographic heterogeneities in order to understand the differential impacts of COVID-19. Descriptive epidemiological COVID-19 hospitalisation and mortality data were drawn from daily hospital surveillance data, National Institute for Communicable Diseases (NICD) update reports (6 March 2020 - 24 January 2021) and the Eastern Cape Daily Epidemiological Report (as of 24 March 2021). We examined hospitalisations and mortality by sociodemographics (age using 10-year age bands, sex and race) using absolute numbers, proportions and ratios. The data are presented using tables received from the NICD, and charts were created to show trends and patterns. Mortality rates (per 100 000 population) were calculated using population estimates as a denominator for standardisation. Associations were determined through relative risks (RRs), 95% confidence intervals (CIs) and p-values &lt;0.001. Black African females had a significantly higher rate of hospitalisation (8.7% (95% CI 8.5 - 8.9)) compared with coloureds, Indians and whites (6.7% (95% CI 6.0 - 7.4), 6.3% (95% CI 5.5 - 7.2) and 4% (95% CI 3.5 - 4.5), respectively). Similarly, black African females had the highest hospitalisation rates at a younger age category of 30 - 39 years (16.1%) compared with other race groups. Whites were hospitalised at older ages than other races, with a median age of 63 years. Black Africans were hospitalised at younger ages than other race groups, with a median age of 52 years. Whites were significantly more likely to die at older ages compared with black Africans (RR 1.07; 95% CI 1.06 - 1.08) or coloureds (RR 1.44; 95% CI 1.33 - 1.54); a similar pattern was found between Indians and whites (RR 1.59; 95% CI 1.47 - 1.73). Women died at older ages than men, although they were admitted to hospital at younger ages. Among black Africans and coloureds, females (50.9 deaths per 100 000 and 37 per 100000, respectively) had a higher COVID-19 death rate than males (41.2 per 100 000 and 41.5 per 100000, respectively). However, among Indians and whites, males had higher rates of deaths than females. The ratio of deaths to hospitalisations by race and gender increased with increasing age. In each age group, this ratio was highest among black Africans and lowest among whites. The study revealed the heterogeneous nature of COVID-19 impacts in SA. Existing socioeconomic inequalities appear to shape COVID-19 impacts, with a disproportionate effect on black Africans and marginalised and low socioeconomic groups. These differential impacts call for considered attention to mitigating the health disparities among black Africans.

Failure Rate Estimation for Transformer Population based on Health Index through Markov Model Approach

This work examines the failure rate of the transformer population through the application of the Markov Model (MM) and Health Index (HI). Overall, the condition parameters data extracted from 3,192 oil samples were analysed in this study. The samples were from 370 transformers with the age range between 1 and 25 years. First, both HIs and failure rates of transformers were determined based on the condition parameters data of the oil samples known as Oil Quality Analysis (OQA), Dissolved Gas Analysis (DGA), Furanic Compounds Analysis (FCA) and age. A two-parameter exponential function model was applied to represent the relationship between the HI and failure rate. Once the failure rate state was obtained, the non-linear optimisation was used to determine the transition probability for each age band. Next, the future failure rate of the transformer population was computed through the MM prediction model. The goodness-of-fit test and Mean Absolute Percentage Error (MAPE) were utilised to determine the performance of the predicted failure rate. The current study reveals that the future state of the transformer population and failure rate could be predicted through MM based on updated transition probabilities. It is observed that the MAPE between predicted and computed failure rates is 7.3%.

Tweens are not teens: the problem of amalgamating broad age groups when making pandemic recommendations.

Demarcating childhood into two distinct and broad 10-year age bands of over and under age 10 is a disservice to our tween population (9–12 years), and may be overlooking our role in understanding the negative impacts of SARS-CoV-2 (COVID-19) during a formative period of development. In this commentary, we discuss the importance of considering tweens as a unique population of youth who are differentially impacted by the COVID-19 pandemic. We first describe the distinctive progress of tweens across various facets of developmental health, followed by recommendations to improve understanding and address impact of the pandemic and its restrictions on tweens. The COVID-19 pandemic has had a large impact on the day-to-day lives of tweens and what we do now will have long-lasting effects on their lifelong trajectories.

Musculoskeletal Features in Adults With X-linked Hypophosphatemia: An Analysis of Clinical Trial and Survey Data.

ContextPatients with X-linked hypophosphatemia (XLH) experience multiple musculoskeletal manifestations throughout adulthood.ObjectiveTo describe the burden of musculoskeletal features and associated surgeries across the lifespan of adults with XLH.MethodsThree groups of adults were analyzed: subjects of a clinical trial, participants in an online survey, and a subgroup of the online survey participants considered comparable to the clinical trial subjects (according to Brief Pain Inventory worst pain scores of ≥ 4). In each group, the adults were categorized by age: 18-29, 30-39, 40-49, 50-59, and ≥ 60 years. Rates of 5 prespecified musculoskeletal features and associated surgeries were investigated across these age bands for the 3 groups.ResultsData from 336 adults were analyzed. In all 3 groups, 43% to 47% had a history of fracture, with the proportions increasing with age. The overall prevalence of osteoarthritis was > 50% in all 3 groups, with a rate of 23% to 37% in the 18- to 29-year-old group, and increasing with age. Similar patterns were observed for osteophytes and enthesopathy. Hip and knee arthroplasty was reported even in adults in their 30s. Spinal stenosis was present at a low prevalence, increasing with age. The proportion of adults with ≥ 2 musculoskeletal features was 59.1%, 55.0%, and 61.3% in the clinical trial group, survey group, and survey pain subgroup, respectively.ConclusionThis analysis confirmed high rates of multiple musculoskeletal features beginning as early as age 20 years among adults with XLH and gradually accumulating with age.

Flash monitor initiation is associated with improvements in HbA1c levels and DKA rates among people with type 1 diabetes in Scotland: a retrospective nationwide observational study

Aims/hypothesisWe assessed the real-world effect of flash monitor (FM) usage on HbA1c levels and diabetic ketoacidosis (DKA) and severe hospitalised hypoglycaemia (SHH) rates among people with type 1 diabetes in Scotland and across sociodemographic strata within this population.MethodsThis study was retrospective, observational and registry based. Using the national diabetes registry, 14,682 individuals using an FM at any point between 2014 and mid-2020 were identified. Within-person change from baseline in HbA1c following FM initiation was modelled using linear mixed models accounting for within-person pre-exposure trajectory. DKA and SHH events were captured through linkage to hospital admission and mortality data. The difference in DKA and SHH rates between FM-exposed and -unexposed person-time was assessed among users, using generalised linear mixed models with a Poisson likelihood. In a sensitivity analysis, we tested whether changes in these outcomes were seen in an age-, sex- and baseline HbA1c-matched sample of non-users over the same time period.ResultsPrevalence of ever-FM use was 45.9% by mid-2020, with large variations by age and socioeconomic status: 64.3% among children aged <13 years vs 32.7% among those aged ≥65 years; and 54.4% vs 36.2% in the least-deprived vs most-deprived quintile. Overall, the median (IQR) within-person change in HbA1c in the year following FM initiation was −2.5 (−9.0, 2.5) mmol/mol (−0.2 [−0.8, 0.2]%). The change varied widely by pre-usage HbA1c: −15.5 (−31.0, −4.0) mmol/mol (−1.4 [−2.8, −0.4]%) in those with HbA1c > 84 mmol/mol [9.8%] and 1.0 (−2.0, 5.5) mmol/mol (0.1 [−0.2, 0.5]%) in those with HbA1c < 54 mmol/mol (7.1%); the corresponding estimated fold change (95% CI) was 0.77 (0.76, 0.78) and 1.08 (1.07, 1.09). Significant reductions in HbA1c were found in all age bands, sexes and socioeconomic strata, and regardless of prior/current pump use, completion of a diabetes education programme or early FM adoption. Variation between the strata of these factors beyond that driven by differing HbA1c at baseline was slight. No change in HbA1c in matched non-users was observed in the same time period (median [IQR] within-person change = 0.5 [−5.0, 5.5] mmol/mol [0.0 (−0.5, 0.5)%]). DKA rates decreased after FM initiation overall and in all strata apart from the adolescents. Estimated overall reduction in DKA event rates (rate ratio) was 0.59 [95% credible interval (CrI) 0.53, 0.64]) after FM vs before FM initiation, accounting for pre-exposure trend. Finally, among those at higher risk for SHH, estimated reduction in event rates was rate ratio 0.25 (95%CrI 0.20, 0.32) after FM vs before FM initiation.Conclusions/interpretationFM initiation is associated with clinically important reductions in HbA1c and striking reduction in DKA rate. Increasing uptake among the socioeconomically disadvantaged offers considerable potential for tightening the current socioeconomic disparities in glycaemia-related outcomes.Graphical abstract

Smartphone-Based Human Sitting Behaviors Recognition Using Inertial Sensor.

At present, people spend most of their time in passive rather than active mode. Sitting with computers for a long time may lead to unhealthy conditions like shoulder pain, numbness, headache, etc. To overcome this problem, human posture should be changed for particular intervals of time. This paper deals with using an inertial sensor built in the smartphone and can be used to overcome the unhealthy human sitting behaviors (HSBs) of the office worker. To monitor, six volunteers are considered within the age band of 26 ± 3 years, out of which four were male and two were female. Here, the inertial sensor is attached to the rear upper trunk of the body, and a dataset is generated for five different activities performed by the subjects while sitting in the chair in the office. Correlation-based feature selection (CFS) technique and particle swarm optimization (PSO) methods are jointly used to select feature vectors. The optimized features are fed to machine learning supervised classifiers such as naive Bayes, SVM, and KNN for recognition. Finally, the SVM classifier achieved 99.90% overall accuracy for different human sitting behaviors using an accelerometer, gyroscope, and magnetometer sensors.

S3346 TNF-alpha Inhibitor Adherence Review: Healthcare Practitioner Administration Compared to Self-Administration

Introduction: Adherence is the extent to which a person’s behavior coincides with health related advice. Poor medication adherence leads to poorer clinical outcomes. TNF-alpha inhibitors (TNF inhibitors) have a significant relationship between clinical outcome and rate of medication adherence. TNF inhibitors are either self-administered (SA) or administered by a healthcare practitioner (HC P-administered), such as a Registered Nurse (RN). To better understand medication adherence in SA and HCP-administered TNF inhibitor populations, an analysis was conducted to measure medication adherence to the HCP-administered product, infliximab, through an alternate site infusion pharmacy. These results were then compared to SA medication adherence rates according to previously published analyses. The comparative results show that administration of infliximab by an RN results in higher medication adherence rates than those reported for SA TNF inhibitor patients. Methods: The analysis was conducted using data extracted from a CPR+ dispensing system, targeting infliximab dispenses with a start of service date (SVC START DT) between 1/1/20 and 8/31/20. Unique patients with at least two SVC START DT values were included. The eligibility of each patient was considered to end as of their final SVC START DT. Adherence was calculated using the industry-standard metric “Proportion of Days Covered” (PDC) methodology. Medication coverage of each treatment was calculated as: Medication Coverage = SVC START DT + Days Supply -1 Adherence was reported as a percentage of analyzed patients with a PDC value of 80% and as the average PDC value of the analyzed population. Results: A 92% average PDC was observed in the overall infliximab RN administered population, with 89% of patients at or above the 80% PDC threshold required to be considered “adherent”. No statistically significant difference in average PDC across age band, sex, or disease state was observed. Conclusion: In this study, patients receiving infliximab administered by an RN (HCP-administered) have a very high adherence rate, as measured by PDC. As it has been reported that patients utilizing SA TNF inhibitors have an average adherence rate of only 37%, these data represent a substantial improvement over SA treatment as it relates to adherence. Additional patient factors not related to the method of administration that could affect adherence including treatment outcomes were not evaluated.Table 1.: Overall Patient Adherence.