Steep Decline Research Articles

Clinical outcomes in patients switching from agalsidase beta to migalastat: A Fabry Registry analysis.

Fabry Registry data were analyzed among 83 agalsidase beta-treated patients with Fabry disease who switched to migalastat. Outcomes (estimated glomerular filtration rate [eGFR], urine protein-creatinine ratio [UPCR], plasma globotriaosylceramide [GL-3], plasma globotriaosylsphingosine [lyso-GL-3], interventricular septal wall thickness [IVST], left posterior wall thickness [LPWT], left ventricular mass index [LVMI]) were assessed using linear mixed models to estimate annual change over time in the pre- and postswitch periods. eGFR decreased throughout both periods (preswitch: -0.85 mL/min/1.73 m2/year; postswitch: -1.96 mL/min/1.73 m2/year; both p < 0.0001), with steeper decline postswitch (ppre/post = 0.01) in both classic and late-onset patients. UPCR increased significantly postswitch (ppre/post = 0.003) among classic patients and was stable in both periods among late-onset patients. GL-3 trajectories worsened postswitch across phenotypes (ppre/post = 0.0005 classic, 0.02 late-onset). LPWT was stable preswitch (0.07 mm/year, p = 0.25) and decreased postswitch (-0.51 mm/year, p = 0.0005; ppre/post = 0.0009), primarily among late-onset patients. IVST and LVMI slopes varied significantly by phenotype. Among classic patients, IVST and LVMI were stable and decreasing, respectively preswitch and increasing postswitch (ppre/post = 0.02 IVST, 0.01 LVMI). Among late-onset patients, IVST significantly decreased postswitch (ppre/post = 0.0003); LVMI was stable over time (ppre/post = 0.89). Ultimately, eGFR and GL-3 trajectories worsened postswitch across phenotypes, while UPCR and cardiac measures worsened among classic and stabilized/improved among late-onset patients. These findings indicate variability in long-term outcomes after switching from ERT to migalastat, underscoring the importance of careful monitoring.

HEMATOLOGY AND BIOCHEMISTRY REFERENCE INTERVALS FOR FREE-LIVING ADULT LESSER KESTRELS (FALCO NAUMANNI) IN SOUTHERN ITALY.

The lesser kestrel (Falco naumanni) is a small falcon with a Euro-Central and Asian-Mediterranean range wintering in sub-Saharan Africa. In the second half of the 20th century, the European population experienced a steep decline and was classified as at risk; thus, its biological and ecological aspects have been widely investigated. Nonetheless, data on hematology and plasma chemistry are not yet available. Therefore, hematology and biochemistry parameters were investigated in a sampling population of clinically healthy lesser kestrels (21 female and 10 male adults) from an Italian rescue center during breeding season, estimating the 95% (2.5 - 97.5th percentile) reference intervals (RI) for standard tests based on either parametric or robust statistical methods. The effect of sex on the referenced parameters was also tested and showed no statically significant differences. The established 95% RI highlighted values comparable with those of other similar raptors such as American kestrel (Falco sparverius) and peregrine falcon (Falco peregrinus). As the first recorded hematology and serum chemistry RI, these clinical data could support conservation efforts and clarify the effects of various environmental and ecological factors on the clinical and health status of lesser kestrels, although they should be reinforced with further data from healthy wild animals.

Changes in skin barrier over the first four days of life: a cross-sectional study.

We aimed to evaluate the trajectory of skin barrier properties in full-term newborns during the first four days after birth. Based on the MKNFOAD cohort (NCT02889081), transepidermal water loss (TEWL), stratum corneum hydration (SCH), skin pH, and sebum content at five anatomical sites (cheek, forehead, volar forearm, abdomen, and dorsal lower leg) were examined once within 96 h after birth in 384 full-term infants. Multivariable linear regression analysis was performed to assess variations in these skin barrier parameters with age adjusted for gestational age, neonate's sex, parents' allergy history, delivery mode, amniotic fluid characteristics, and birth weight. The regression coefficient (ß) and 95% confidence interval were reported. We analyzed a total of 384 neonates including 198 (51.6%) boys. TEWL values remained stable and showed no significant association with age (days). pH values exhibited a declining trend with age (p for trend <0.001). Both SCH values and sebum content grew with age (p for trend <0.001). During the first four days after birth, the skin TEWL remained stable, pH decreased, and the SCH and sebum content increased over time. These findings provide insights into the neonatal skin physiological development at the beginning of life. From birth to 96 h, TEWL was stable, pH showed a steep decline, SCH and sebum content increased. This study provides the first evidence of skin adaptation in the newborn due to changes in utero to after birth in the first 4 days of life in an Asian population. These findings will provide a new theoretical basis for neonatal skin physiology and clinical strategies for guiding newborn skin care.

Influence of stage and age on survival of patients with vulvar cancer in Germany: a retrospective study

ObjectivesTo evaluate the 5-year survival rate of patients with vulvar cancer, taking into account prognostic factors (International Federation of Gynecology and Obstetrics (FIGO) stage and age) and the influence of...

Study on mechanical properties and corrosion damage mechanism of mixed sand concrete

In order to address the excessive utilization of river sand resources in Inner Mongolia, an investigation is being conducted on the utilization of wind-blown sand and machine-made sand for the production of mixed sand concrete. A study is conducted to examine the influence of including mixed sand in concrete on its mechanical qualities, working performance, and erosion resistant durability. The findings suggest that when the proportion of wind-blown sand in the mixed sand mixture increases, the compressive strength of the mixed sand concrete exhibits a general pattern of initially increasing and subsequently dropping. At a ratio of 1:1 between wind-blown sand and machine-made sand, there is a maximum point. Nevertheless, the capacity for stretching under tension, resilience, and the strength of the connection all demonstrate a consistent decline. The wind-blown sand content of 50 % in the mixed sand is the critical value. When the wind-blown sand content exceeds 50 %, the tensile deformation capacity, toughness, and bond strength experience a steep decline. Utilizing a combination of different types of sand diminishes the efficiency of concrete. Nevertheless, the efficacy of concrete can be enhanced by modifying the water-cement ratio and the quantity of water-reducing admixtures. It is worth mentioning that although the work performance can be improved, there might be a little reduction in the mechanical qualities of the concrete. The erosion depth in mixed sand concrete has a growth rate that is 0.027 mm/d lower compared to ordinary river sand concrete under erosion conditions. The compressive erosion resistance coefficient and saturated surface dry water absorption rate show significantly reduced damage in mixed sand concrete compared to standard river sand concrete. Moreover, when erosion-freeze-thaw coupling circumstances are present, the structural deterioration of mixed sand concrete is less significant in comparison to ordinary river sand concrete. By using a mixture of sand, the concrete's ability to withstand erosion is improved, resulting in a longer lifespan. This discovery establishes a theoretical foundation for the secure utilization of concrete in aquatic environments in Inner Mongolia.

Trends in alcohol-attributable morbidity and mortality in Germany from 2000 to 2021: A modelling study.

We aimed to assess: (i) trends in alcohol-specific - that is, fully attributable - morbidity and mortality in the German adult population aged 15-69 between 2000 and 2021; and (ii) changes in alcohol-attributable disease burden - that is, fully and partially alcohol-attributable categories - for 2006, 2012, 2018 and 2021. Morbidity data was pulled from hospitalisation and rehabilitation statistics and mortality data was pulled from the causes of death registry. Alcohol use, adjusted for unrecorded consumption, was estimated using the Epidemiological Survey of Substance Abuse and triangulated with per capita consumption from annual sales data. For major disease categories, alcohol-attributable fractions were estimated for males and females by age groups (15-29, 30-49, 50-69 years) using the comparative risk assessment methodology. For males and females, the age-standardised rate of alcohol-specific morbidity peaked in 2012 and decreased thereafter showing a steep decline from 2019 to 2021. The rates of alcohol-specific mortality decreased constantly from 2000 to 2019 but increased from 2019 to 2021. Compared to 2006 the age-standardised alcohol-attributable morbidity and mortality rates in males and females were lower in 2021. For both sexes, the age-standardised alcohol-attributable morbidity and mortality rates and the proportions of morbidity/mortality rates relative to all-cause morbidity/mortality decreased between 2006 and 2021. The declines in alcohol-attributable morbidity and mortality are in line with decreases in consumption and signal that the importance of alcohol in health service utilisation and mortality has weakened. Sex ratios in morbidity and mortality do not indicate a strong converging trend.

European Society of Cardiology: the 2023 Atlas of Cardiovascular Disease Statistics.

This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the 2021 report in presenting cardiovascular disease (CVD) statistics for the ESC member countries. This paper examines inequalities in cardiovascular healthcare and outcomes in ESC member countries utilizing mortality and risk factor data from the World Health Organization and the Global Burden of Disease study with additional economic data from the World Bank. Cardiovascular healthcare data were collected by questionnaire circulated to the national cardiac societies of ESC member countries. Statistics pertaining to 2022, or latest available year, are presented. New material in this report includes contemporary estimates of the economic burden of CVD and mortality statistics for a range of CVD phenotypes. CVD accounts for 11% of the EU's total healthcare expenditure. It remains the most common cause of death in ESC member countries with over 3 million deaths per year. Proportionately more deaths from CVD occur in middle-income compared with high-income countries in both females (53% vs. 34%) and males (46% vs. 30%). Between 1990 and 2021, median age-standardized mortality rates (ASMRs) for CVD decreased by median >50% in high-income ESC member countries but in middle-income countries the median decrease was <12%. These inequalities between middle- and high-income ESC member countries likely reflect heterogeneous exposures to a range of environmental, socioeconomic, and clinical risk factors. The 2023 survey suggests that treatment factors may also contribute with middle-income countries reporting lower rates per million of percutaneous coronary intervention (1355 vs. 2330), transcatheter aortic valve implantation (4.0 vs. 153.4) and pacemaker implantation (147.0 vs. 831.9) compared with high-income countries. The ESC Atlas 2023 report shows continuing inequalities in the epidemiology and management of CVD between middle-income and high-income ESC member countries. These inequalities are exemplified by the changes in CVD ASMRs during the last 30 years. In the high-income ESC member countries, ASMRs have been in steep decline during this period but in the middle-income countries declines have been very small. There is now an important need for targeted action to reduce the burden of CVD, particularly in those countries where the burden is greatest.

Impact of the South African Child Support Grant on memory decline and dementia probability in rural and low-income mothers, 2014–2021

IntroductionAging populations across sub-Saharan Africa are rapidly expanding, leading to an increase in the burden of Alzheimer's disease and related dementias (ADRD). Cash transfer interventions are one plausible mechanism to combat ADRD at a population-level in low-income settings. We exploited exogenous variation in eligibility for South Africa's Child Support Grant (CSG) to estimate the longitudinal association between potential CSG benefit and cognitive trajectories in rural mothers with <10 children (n = 1090). MethodsSouth Africa's CSG delivers monthly cash payments to primary caregivers, predominantly mothers, to offset the costs associated with child rearing. This study implemented a quasi-experimental design using data (2014–2022) from a rural, low-income cohort in the Agincourt research area, South Africa. We fit linear mixed effects models and generalized linear models to estimate the association of potential CSG benefit per eligible child with memory decline and dementia probability, respectively. We stratified all models by the mother's total number of children (1–4 and 5–9) and examined effect modification by household wealth and the mother's education level. ResultsHaving above median CSG per eligible child was associated with higher baseline memory scores (β = 0.12 SD units, 95% CI = 0.02, 0.22) but steeper memory decline (β = −0.02 SD units, 95% CI = −0.04, -0.00) compared to below median CSG. Within stratified analyses, this effect was primarily observed among mothers with 5–9 children. No associations were observed between potential CSG per eligible child and dementia probability. ConclusionsOur findings support the use of large-scale cash transfers as a promising intervention to promote healthy cognitive aging in mid-life women within rural, low-income settings. However, we found evidence that the CSG in its current structure may not be sufficient support for women to sustain measurable cognitive benefits over the long-term.

Identification of regional and sex differences in asthma mortality trends in Spanish Autonomous Communities (1980–2022)

Objective Despite global declines in asthma mortality, regional variations and sex disparities persist. This study investigates asthma mortality trends in Spanish Autonomous Communities (ACs) from 1980 to 2022, analyzing data by sex. Methods Data on asthma deaths and population were obtained from the National Institute of Statistics for the study period. Age-standardized mortality rates (ASMRs) were calculated, and joinpoint regression models were applied to identify trends. Results Overall, 44,728 asthma deaths occurred, with a steeper decline observed in men (−3.5% per year) compared to women (−0.7% per year). The female-to-male mortality ratio climbed from 0.7 in 1980 to 5.4 in 2016. Both sexes exhibited a significant decrease in ASMRs, with a more substantial decline in males (−6.3%). While all ACs showed a significant decrease in male ASMRs, female trends varied, with significant decreases in 13 ACs and stable trends elsewhere. Joinpoint analysis revealed diverse regional patterns for both sexes, with some ACs experiencing steady declines and others exhibiting periods of slower decline or even stabilization. Conclusion This study identified concerning regional and sex disparities in Spanish ACs’ asthma mortality (1980–2022). While male rates declined significantly across all regions, female rates showed variation, with even increases in some ACs. Targeted interventions addressing these disparities and their underlying causes (healthcare access, management practices, etc.) are crucial.

Endothelium-related biomarkers and cognitive decline in prevalent hemodialysis patients: A prospective cohort study.

Cognitive decline is prevalent in maintenance hemodialysis patients. The blood-brain barrier has been implicated in cognitive decline. In this prospective cohort study, we investigated the associations between endothelium-related biomarkers and steeper cognitive decline in this population. Cognitive function was assessed using the Portuguese-adapted Cambridge Cognitive Examination (CAMCOG) with items of the Mini-Mental State Examination (MMSE). Endothelium-related biomarkers included syndecan-1, ICAM-1, VCAM-1 and angiopoietin-2 (AGPT2). Patients were followed up for 4 years, and cognitive assessments were repeated. Multinomial regression analyses were performed to evaluate associations between biomarkers and cognitive decline. A total of 216 patients completed the test battery at baseline. After 4 years, 102 patients had follow-up data. There was a significant decrease in cognitive function according to the CAMCOG and MMSE scores: a change of -0.39 (95% CI -0.27 to -0.51) and -0.51 (95% CI -0.27 to -0.76) standard deviation (SD) of the baseline scores. Additionally, executive function but not memory significantly decreased. Syndecan-1 level was independently associated with steeper cognitive decline; each increase in the SD of the syndecan-1 level was associated with a decrease in the CAMCOG of 0.20 (95% CI 0.07-0.33) SD from baseline. Syndecan-1 was associated with a steeper decline in MMSE score (β 0.54, 95% CI 0.28-0.81) and executive function (β 0.17, 95% CI 0.02-0.32). Syndecan-1 predicted severe cognitive impairment with an area under the curve for receiver operating characteristic curves of 0.75 (95% CI 0.64-0.83). Our findings highlight the potential of syndecan-1, a biomarker of endothelium glycocalyx derangement, as a predictor of steeper cognitive decline in prevalent hemodialysis patients.

Implementing Tri-Brid Energy Systems for Renewable Integration in Southern Alberta, Canada

The steep decline in the price of wind and solar photovoltaics provides a possibility to decarbonize electricity deeply and affordably. This study uses the HOMER Pro energy modeling tool to model an optimized grid-connected renewable energy system for a community in southern Alberta, Canada. The study’s goal is to identify the best renewable energy technology combinations that can provide electricity at the lowest levelized cost of energy (LCOE) and has lower greenhouse gas emissions as compared to the electricity produced by traditional fossil fuel. Gleichen is a small town in southern Alberta that is close to numerous commercial wind and solar projects given the region’s high quality renewable resources. “Tri-brid” systems consisting of wind turbines, solar photovoltaics, and battery energy storage systems (BESS) are considered and compared based on electricity prices, net present cost, and greenhouse gas emissions savings. This tri-brid system is connected to the grid to sell excess generated electricity or buy electricity when there is less or no availability of solar and wind energy. The tri-brid energy system has an estimated LCOE of 0.0705 CAD/kWh, which is competitive with the price of electricity generated by natural gas and coal, which is 0.127 CAD/kWh.

Broken expectations: Population decline of a key grouper species within a 30-year-old no-take MPA in the Southwestern Atlantic

Understanding the impacts of human actions on marine species and developing mitigation strategies are crucial conservation challenges. Many fish species, especially marine top predators, are already highly depleted and rely on population monitoring and conservation strategies for their maintenance. In this context, Marine Protected Areas can help recover target species and provide crucial information about population trends when human activities are restricted or managed. Here, we used the longest and most complete temporal series of reef fish data in the Southwestern Atlantic, comprising 16 years of underwater visual census sampling. We evaluated temporal trends in the density and biomass of the dusky grouper (Epinephelus marginatus), both inside and outside a no-take and no-entry Marine Reserve. Our findings reveal a consistent decline in density and biomass inside and outside the MPA over time, reaching alarmingly low densities and experiencing a steeper biomass decline in the last five years. Our results contradict global expectations of positive population recovery trends within MPAs. We highlight the adverse impacts of human activities on the dusky grouper population, including illegal fishing and habitat degradation. Additionally, we address the limited understanding of species' life stages, underscoring that their occurrence outside protected boundaries may render the entire population vulnerable to human pressures. Thus, to guarantee population recovery, stakeholders and researchers must take immediate action to increase knowledge of all life stages and improve ongoing strategies.

Trends and Racial/Ethnic Disparities in Prenatal Care (PNC) Use from 2016 to 2021 in the United States.

To investigate the trends and racial/ethnic disparities in adequate prenatal care (PNC) use in the USA. A repeated cross-sectional study was conducted using May 2016-May 2021 data from the Pregnancy Risk Assessment Monitoring System (PRAMS). A primary outcome was the Kotelchuck index, a measure of the adequacy of PNC use, and the year was a key independent variable. Multinomial and binary logistic regression analyses were performed to examine PNC utilization using multiple imputations with chained equations. Among the 190,262 pregnant individuals, adequate PNC use was largely consistent from 2016 to 2019. However, there was an immediate drop from 77.4-78.3% between 2016 and 2019 to 75.2% in 2020 and 75.8% in 2021. Conversely, both intermediate and inadequate PNC use tended to increase in 2020 and 2021. Adequate PNC use, when compared to inadequate use, showed significantly lower odds in 2020 (adjusted Odds Ratio [aOR] 0.87, 95% CI 0.78-0.96; p = 0.009) and 2021 (aOR 0.87, 95% CI 0.77-0.99; p = 0.033) than in 2016. Notably, Hispanic participants experienced substantial impacts (aOR 0.75, 95% CI 0.64-0.88; p = 0.001 in 2020 and aOR 0.72, 95% CI 0.59-0.89; p = 0.002 in 2021). While adequate PNC use was a steady, slightly upward trend before 2020, it had a steep decline afterward. It is worth noting that Hispanic individuals were severely affected. Targeted interventions or policies to address barriers to PNC and foster equitable and sustainable care models are required.

Course and Prediction of Dissociation in Patients with Borderline Personality Disorder and Personality-Disordered Comparison Subjects: A 24-Year Follow-Up Study

ABSTRACT The first purpose of this study was to determine the course of dissociation among patients with borderline personality disorder (BPD) and personality-disordered comparison subjects (OPD) over 24 years of prospective follow-up. The second purpose was to determine clinically meaningful predictors of dissociation among patients with BPD. The Dissociative Experiences Scale (DES) was administered to 290 patients with BPD and 72 personality-disordered comparison subjects at baseline, and then once every two years over 24 years of prospective follow-up. Baseline predictors were assessed with the Revised Childhood Experiences Questionnaire (CEQ-R), the SCID-I, and the Shipley Institute of Living Scale. Time-varying predictors were assessed at baseline and every subsequent two years by means of the Abuse History Interview (AHI). Patients with BPD had higher baseline dissociation scores than personality-disordered comparison subjects. Whilst dissociation decreased significantly over time for both patient groups, the BPD group showed a steeper decline. Severity of childhood sexual abuse, adult history of rape, adult history of partner violence, and IQ were multivariate predictors of dissociation among patients with BPD. Taken together, the present findings suggest that a combination of interpersonal trauma exposure and cognitive abilities may contribute to the severity of dissociation in adult patients with BPD.

Allelochemicals determine competition and grazing control in Alexandrium catenella

The production of allelochemicals by the toxigenic dinoflagellate Alexandrium catenella is one of the suggested mechanisms to facilitate its bloom formation and persistence by outcompeting other phototrophic protists and reducing grazing pressure. In Southern California, toxic events caused by A. catenella and paralytic shellfish toxins (PSTs) regularly impact coastal ecosystems; however, the trophic interactions and mechanisms promoting this species in a food web context are still not fully understood. In the present study, we combined a dynamical mathematical model with laboratory experiments to investigate potential toxic and allelochemical effects of an A. catenella strain isolated off the coast of Los Angeles, Southern California, on competitors and a common zooplankton consumer. Experiments were conducted using three toxigenic strains of A. catenella, comparing the new Californian isolate (Alex Cal) to two strains previously described from the North Sea, a lytic (Alex2) and non-lytic (Alex5) strain, testing for donor density-dependent effects on two phytoplankton species (Rhodomonas salina, Tetraselmis sp.) and on the rotifer Brachionus plicatilis. Bioassays revealed a steep decline in competitor and consumer populations with increasing Alex Cal concentrations, indicating an intermediate lytic activity compared to the North Sea strains (lytic Alex2 and non-lytic Alex5). The rotifer fed and grew well on the PST- toxic, but non-lytic Alex5 strain, while its survival significantly decreased with increasing concentrations of the two lytic strains Alex Cal and Alex 2, indicating that negative effects on the rotifer were mediated by allelochemicals rather than PST-toxins. Mixed culture experiments including both competitors and consumers demonstrated that the intensity of allelochemical effects not only depended on the A. catenella density but also on the target density. Negative effects on grazers were alleviated by co-occurring competitors with a lower sensitivity to allelochemicals, thus reducing harmful compounds and allowing grazing control on the dinoflagellate to come into effect again. Results from mixed culture experiments were supported by the mathematical approach used in this study which was calibrated with data from simple monoculture growth, pairwise competition and predator-prey experiments, demonstrating the applicability of this model approach to predict the outcome of more complex food web dynamics at the community level.

Steep Decline in the Rare Flat Abalone, Haliotis walallensis, Following Fishing Exploitation and a Marine Heat Wave: The Next Neoextinction?

Ocean warming is impacting marine systems directly and indirectly via intensifying multiple stressors such as hypoxia, acidification and kelp forest collapse potentially exacerbating neoextinctions. Abalones are extremely vulnerable to both ocean warming and fishing stressors making them marine "canaries in the coal mine". The rare flat abalone, Haliotis walallensis, has been subject to a targeted commercial fishery and then exposed to an extreme marine heat wave. We examine the current status of flat abalone before and after a marine heat wave of 2014-2016 and the concomitant collapse of the bull kelp (Nereocystis leutkeana) forest in 2015. We find that flat abalone density (as assessed in surveys) and abundances (inside deployed "abalone modules") in the core of the range dropped to near zero after the marine heat wave and have not recovered. Further, we examine the status of flat abalone in southern Oregon after both overfishing and the kelp forest collapse and find dramatic declines, especially in former fishery hot spots. Our results show that flat abalone have experienced a major decline and may be an example of a neoextinction in the making. A standardized and well funded status review and proactive restoration plan, if not too late, are both critically needed for flat abalone throughout its range.

Amyloid and SCD jointly predict cognitive decline across Chinese and German cohorts.

Subjective cognitive decline (SCD) in amyloid-positive (Aβ+) individuals was proposed as a clinical indicator of Stage 2 in the Alzheimer's disease (AD) continuum, but this requires further validation across cultures, measures, and recruitment strategies. Eight hundred twenty-one participants from SILCODE and DELCODE cohorts, including normal controls (NC) and individuals with SCD recruited from the community or from memory clinics, underwent neuropsychological assessments over up to 6 years. Amyloid positivity was derived from positron emission tomography or plasma biomarkers. Global cognitive change was analyzed using linear mixed-effects models. In the combined and stratified cohorts, Aβ+ participants with SCD showed steeper cognitive decline or diminished practice effects compared with NC or Aβ- participants with SCD. These findings were confirmed using different operationalizations of SCD and amyloid positivity, and across different SCD recruitment settings. Aβ+ individuals with SCD in German and Chinese populations showed greater global cognitive decline and could be targeted for interventional trials. SCD in amyloid-positive (Aβ+) participants predicts a steeper cognitive decline. This finding does not rely on specific SCD or amyloid operationalization. This finding is not specific to SCD patients recruited from memory clinics. This finding is valid in both German and Chinese populations. Aβ+ older adults with SCD could be a target population for interventional trials.

The Steep Decline in Reporting to the National Practioner Data Bank, and a Look at Reporting Levels from “Plaintiff-Favorable” and “Defendant-Favorable” States

The establishment of the National Practitioner Data Bank (NPDB) was authorized in the Health Care Quality Improvement Act of 1986, and it mandated a federal database to collect information related to adverse actions initially against just physicians and dentists throughout the United States, including payments from malpractice lawsuits, restrictions on clinical privileges by hospitals, and medical licensure limitations and revocations by state licensing boards. The aggregate data reports made by this federal data bank began in 1991. The reporting level for the first ten years remained relatively stable in the nationwide range of 16,000 to 18,000 reports per year, but then a steady decline occurred over the second and third decades to under 8,000 reports per year by the year 2021. The researchers in this study explored a theory that might explain at least part of the drop in the states’ reporting levels. That is, states that could be called “Plaintiff-Favorable” (Arizona, Kentucky, New York, Pennsylvania, and Washington) would demonstrate a lesser rate of decline or even an increase in the reporting levels, and states that could be characterized as “Defendant-Favorable” (California, Michigan, Nevada, North Carolina, and Texas) would demonstrate a comparatively greater rate of decline in the reporting levels. The decline in reporting to the NPDB proved fairly consistent for both Plaintiff-Favorable and Defendant-Favorable states. The larger question as to why there occurred an overall negative trend in reporting to the NPDB across the United States during the second and third decades remains an intriguing area for future exploration.

Impact of cumulative exposure to anticholinergic and sedative drugs on cognition in older adults: a memory clinic cohort study

BackgroundLong-term exposure to anticholinergic and sedative drugs could be a modifiable risk factor for cognitive decline. The objective of this study was to measure the association between previous cumulative anticholinergic and sedative drug exposure (Drug Burden Index) and cognitive decline.MethodsA cohort study (MEMORA cohort) was conducted in a French memory clinic for patients attending a consultation between November 2014 and December 2020, with at least 2 Mini-Mental State Examination (MMSE) measurements (≥ 6 months apart) and available medication data from the local Primary Health Insurance Fund database (n = 1,970). Drug Burden Index was linearly cumulated until each MMSE measurement and was used to categorise patients according to their level of exposure (no exposure, moderate, or high). The longitudinal association between Drug Burden Index and MMSE was assessed using a multivariate linear mixed model, adjusted for age, education level, anxiety disorders, depressive disorders, functional autonomy, and behavioural disorders.ResultsOverall, 1,970 patients were included with a mean follow-up duration of 2.78 years (± 1.54) and 2.99 visits per patients (5,900 MMSE + Drug Burden Index measurements collected). At baseline, 68.0% of patients had moderate cumulative anticholinergic and sedative drug exposure and a mean MMSE of 21.1. MMSE decrease was steeper in patients with moderate and high Drug Burden Index ( -1.74 and -1.70/year, respectively) than in patients with no exposure (-1.26/year) after adjusting for age, education, anxiety and depressive disorders, functional autonomy, and behavioural disorders (p < 0.01).ConclusionsLong-term exposure to anticholinergic and sedative drugs is associated with steeper cognitive decline. Medication review focusing on de-prescribing these drugs could be implemented early to reduce cognitive impairment.

Inbreeding and cognition in wild populations: a relationship that remains unnoticed

Anthropogenic activities are causing a steep decline of wildlife populations. Increased inbreeding in shrinking populations can substantially curb individual fitness and population viability. One potentially important but largely ignored component of inbreeding depression may be cognitive decline. Cognition affects an animal's capacity to respond to environmental disturbance, which, in the face of global change, may make the difference between persistence and extinction. While the effects of inbreeding on cognitive performance have been relatively well documented in humans, they remain largely unexplored in natural populations. Here we review the current (limited) knowledge on whether and how inbreeding impinges on animals' cognitive abilities. Insights into the relationship between inbreeding and cognition could prove valuable not only for comprehending the development and evolution of cognition but also for conservation.