Tabernacles of the Spirit

In the classic tradition of the exploratory essay, George Gammack examines the theme of community in this paper. He details varied aspects of the creation of community among those who are retired, taking as its focus the Men’s Sheds movement. The paper explores the relationship between persons and community in later years, looking in particular at how those with a lifetime’s worth of skills and knowledge can continue to contribute to the life of a community. Along the way we are introduced to the work of authors such as Charles Taylor, Richard Niebuhr, Primo Levi, Seamus Heaney and Richard Sennett on the subject of work and what comes after it.Publisher PD

Depression in Parkinson's disease: A case-control study

<div><p>Background</p><p>To evaluate the association between Parkinson’s disease (PD) prognosis and the patient’s onset of depression.</p><p>Methods</p><p>A total of 353 patients with newly-diagnosed PD and a history of depression were enrolled. On the basis of the onset of depression before or after PD diagnosis, we divided participants into PD patients with pre- or post-diagnostic depression. Cox’s regression analysis was used to detect risks between the onset of depression and outcomes (including death, accidental injury, dementia, and aspiration pneumonia). The association between the onset of depression and levodopa equivalent dosage (LED) and cumulative equivalent dosage of antidepressants were assessed.</p><p>Results</p><p>PD patients with post-diagnostic depression were associated with significantly higher risks of dementia (adjusted HR = 2·01, <i>p</i> = 0·015), and were older (58·5 ± 17·7 vs. 53·7 ± 18·6, <i>p</i> = 0·020) at the time of PD diagnosis than PD patients with pre-diagnostic depression. The higher incident rate of accidental injury was also noted in PD patients with post-diagnostic depression (48·1 vs. 31·3/1000 person-years, HR = 1·60, <i>p</i> = 0·041), but no statistical significance was observed in the adjusted hazard ratio (HR) (HR = 1·52, <i>p</i> = 0·069). Otherwise, mortality, motor condition and severity of depression revealed no significant difference between PD patients with pre-diagnostic and post-diagnostic depression.</p><p>Conclusion</p><p>PD patients with post-diagnostic depression had higher incidence of dementia, implying different onset time of depression could be associated with different subtypes and spreading routes which should be examined in follow-up studies.</p></div

Initial Medication in Patients of Newly Diagnosed Parkinson’s Disease in Taiwan

<div><p>Introduction</p><p>Several treatment guidelines for Parkinson’s disease (PD) had been proposed in recent decades. The aim of current study was to investigate the initial medication utilized in newly diagnosed PD subjects in Taiwan during an eleven-year period.</p><p>Methods</p><p>A total of 7,550 patients with newly diagnosed Parkinsonism were retrospectively enrolled from the National Health Insurance Research Database of Taiwan from 2000 to 2010. After excluding patients at risk of secondary or atypical Parkinsonism, those never receiving medication or having incomplete data, 1,645 subjects were included. The participants were then divided into four treating regimen groups, namely levodopa (LD) only group, dopamine agonist (DA) only group, LD+DA group, and No-LD, No-DA group. The demographic data and medication retention rate were compared across the four treatment groups.</p><p>Results</p><p>LD only and No-LD, No-DA regimens were the main initial choice of PD treatment in Taiwan. LD containing drugs were more often prescribed to the elderly population than the other two treatment regimens, while No-LD, No-DA medication was the major initial choice for younger patients. DA only regimen occupied only 3–4% of the initial PD prescriptions and was given predominantly by neurologists. Over the eleven-year period, there is a trend for the middle-aged population to receive medication containing LD as initial treatment. The one year retention rate of anti-Parkinsonism medication was around 30–50% in our population. Age, polypharmacy, change of one-year daily levodopa equivalent dosage and newly onset of dementia, stroke and psychiatric diseases all affect drug compliance in PD patients.</p><p>Conclusions</p><p>This is the first long-term study to explore initial pharmacotherapies in an Asian PD population. We hope to provide evidence for adjusting government policies and public education of physicians and PD patients in the future.</p></div

Risk of Atrial Fibrillation or Flutter Associated with Periodontitis: A Nationwide, Population-Based, Cohort Study

<div><p>Objective</p><p>To investigate the risk of atrial fibrillation or atrial flutter in patients with periodontitis (PD) in comparison with individuals without PD.</p><p>Methods</p><p>We used the 1999–2010 Taiwanese National Health Insurance Research Database to identify cases of PD in the year 2000 matching (1:1) with persons without PD during 1999–2000 according to sex and individual age as the control group. Using Cox proportional regression analysis adjusting for potential confounders, including age, sex, and comorbidities at baseline, and average annual number of ambulatory visits and dental scaling frequency during the follow-up period, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) to examine the risk of atrial fibrillation or flutter in PD patients in comparison with the control group. Subgroup analyses according to age, gender, or comorbidities were conducted to study the robustness of the association and investigate possible interaction effects.</p><p>Results</p><p>We enrolled 393,745 patients with PD and 393,745 non-PD individuals. The incidence rates of atrial fibrillation or flutter were 200 per 10⁵ years among the PD group and 181 per 10⁵ years in the non-PD group (incidence rate ratio, 1.10; 95% CI, 1.06–1.14). After adjusting for potential confounders, we found an increased risk of atrial fibrillation or flutter in the PD group compared with the non-PD group (HR, 1.31; 95% CI, 1.25–1.36). The greater risk of atrial fibrillation or flutter in the PD group remained significant across all disease subgroups except hyperthyroidism and sleep apnea.</p><p>Conclusion</p><p>The present study results indicate an increased risk of atrial fibrillation or flutter in patients with PD. Lack of individual information about alcohol consumption, obesity, and tobacco use was a major limitation.</p></div

Incidence rates of atrial fibrillation and flutter according to periodontitis status.

<p>Incidence rates of atrial fibrillation and flutter according to periodontitis status.</p

Incidence and hazard ratio of outcome variables associated with pre-diagnostic and post-diagnostic depression in Cox's regression analysis.

<p>Incidence and hazard ratio of outcome variables associated with pre-diagnostic and post-diagnostic depression in Cox's regression analysis.</p

Clinical characteristics of retention and non-retention groups of patients with newly diagnosed Parkinson’s disease.

<p>N: case number, %: percentage, MPR: medical possession rate, No medication: receive no anti-PD medication during the 7^th to 12^th month after starting medication, CNS: central nervous system.</p>a<p>ANOVA test; chi-squared test for all other p-values.</p><p>Post hoc test (Scheffe’s test) with statistical significance (p<0.05):</p>b<p>Retention (MPR≥80%) group differs from Retention (MPR<80%) group;</p>c<p>Retention (MPR≥80%) group differs from Non-retention (Keep medication) group;</p>d<p>Retention (MPR<80%) group differs from Non-retention (No-medication) group;</p>e<p>Non-retention (Keep medication) group differs from Non-retention (No-medication) group.</p><p>*p<0.05 compared to MPR≥80% group;</p>#<p>p<0.05 compared to medical center group;</p><p><a href="mailto:@p" target="_blank">@p</a><0.05 compared to regional hospital group;</p>$<p>p<0.05 compared to clinics group.</p>f<p>The medical institution from where patients received ≥50% medication during the first year. Subjects would be classified into multiple hospitals group if they received medication <50% from each level of medical institution.</p>g<p>Only patients with medication from outpatient services were analyzed.</p>h<p>The last prescription of patients with medication from outpatient services during one-year follow-up were analyzed.</p>i<p>Definition of comorbidities: patients with diseases of the following ICD codes for more than three times during the outpatient services or once during hospitalization within one year after the diagnosis of Parkinson’s disease. Stroke: 430–438/A290-A294, A299; Dementia: 290, 331.0, 331.2/A210; CNS trauma: 344, 800, 801, 803, 804, 805, 806, 850, 851, 852, 853, 854, 959.01/A470, A490, A491, 952; Sepsis: 038, 020.0, 790.7, 117.9, 112.5, 112.81; Congestive heart failure: 398.91, 402.01, 402.11, 402.91, 404.01, 404.03, 404.11, 404.13, 404.91, 404.93, 425.4–425.9, 428; Liver decompensation: 570, 571.2, 571.5, 571.6, 572.2, 572.4, 567.0, 567.2, 567.8, 567.9, 789.5, 456.0, 456.1, 456.2; Renal decompensation (renal failure): 584, 585, 586, V451, V56; Respiratory failure: 5188; Neoplasm: 140–208 (excluding 195–199); Psychiatric disorders: 290–313.</p><p>Clinical characteristics of retention and non-retention groups of patients with newly diagnosed Parkinson’s disease.</p

Levodopa equivalent dosage in PD patients with and without premotor symptoms.

<p>Levodopa equivalent dosage in PD patients with and without premotor symptoms.</p

Demographic characteristics of newly diagnosed PD patients, 2000–2010.

a<p>ANOVA test; chi-squared test for all other p-values.</p>b<p>Only patients with medication from outpatient services were analyzed.</p><p>Post hoc test (Scheffe’s test) with statistical significance (p<0.05):</p>c<p>LD only group differs from DA only group;</p>d<p>LD+DA group differs from DA only group;</p>e<p>LD+DA group differs from No-LD, No-DA group;</p>f<p>LD only group differs from No-LD, No-DA group;</p>g<p>DA only group differs from No-LD, No-DA group;</p>h<p>LD+DA group differs from LD only group.</p><p>*p<0.05 compared to LD only group;</p>#<p>p<0.05 compared to medical center group;</p><p><a href="mailto:@p" target="_blank">@p</a><0.05 compared to day 0 group.</p><p>PD: Parkinson’s disease, N: case number, %: percentage, SD: standard deviation, NTD: New Taiwan Dollar.</p><p>Demographic characteristics of newly diagnosed PD patients, 2000–2010.</p

Univariate and multivariate analyses of the risk of atrial fibrillation or flutter associated with each variable shown as hazard ratio with 95% confidence intervals.

<p>Univariate and multivariate analyses of the risk of atrial fibrillation or flutter associated with each variable shown as hazard ratio with 95% confidence intervals.</p