Dementia and Depression with Ischemic Heart Disease: A Population-Based Longitudinal Study Comparing Interventional Approaches to Medical Management

BACKGROUND: We compared the proportion of ischemic heart disease (IHD) patients newly diagnosed with dementia and depression across three treatment groups: percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and medical management alone (IHD-medical). METHODS AND FINDINGS: De-identified, individual-level administrative records of health service use for the population of Manitoba, Canada (approximately 1.1 million) were examined. From April 1, 1993 to March 31, 1998, patients were identified with a diagnosis of IHD (ICD-9-CM codes). Index events of CABG or PCI were identified from April 1, 1998 to March 31, 2003. Outcomes were depression or dementia after the index event. Patients were followed forward to March 31, 2006 or until censored. Proportional hazards regression analysis was undertaken. Independent variables examined were age, sex, diabetes, hypertension and income quintile, medical management alone for IHD, or intervention by PCI or CABG. Age, sex, diabetes, and presence of hypertension were all strongly associated with the diagnosis of depression and dementia. There was no association with income quintile. Dementia was less frequent with PCI compared to medical management; (HR = 0.65; p = 0.017). CABG did not provide the same protective effect compared to medical management (HR = 0.90; p = 0.372). New diagnosis depression was more frequent with interventional approaches: PCI (n = 626; hazard ratio = 1.25; p = 0.028) and CABG (n = 1124, HR = 1.32; p = 0.0001) than non-interventional patients (n = 34,508). Subsequent CABG was nearly 16-fold higher (p<0.0001) and subsequent PCI was 22-fold higher (p<0.0001) for PCI-managed than CABG-managed patients. CONCLUSIONS: Patients managed with PCI had the lowest likelihood of dementia-only 65% of the risk for medical management alone. Both interventional approaches were associated with a higher risk of new diagnosed depression compared to medical management. Long-term myocardial revascularization was superior with CABG. These findings suggest that PCI may confer a long-term protective effect from dementia. The mechanism(s) of dementia protection requires elucidation

A Hierarchical HMM Implementation for Vertebrate Gene Splice Site Prediction

With the current volume of genomic information available, and the rate at which new data is being accumulated, there is a tremendous need for tools to effectively manage the information. It is here that bioinformatics attempts to begin solving problems.\ud A common scenario occurs when a newly sequenced piece of genomic data is produced. There are several questions that are often asked about this piece of data. Is it similar to an existing piece of data? What are the coding regions of the sequence? The first question can be answered using a tool called BLAST (Basic Local Alignment Search Tool) which is capable of finding homologies to existing sequences. It is the latter question that we attempt to solve in this endeavor.\ud In a sequence of genomic data, a gene occurs as a band of alternating introns (noncoding) and exons (coding). At first the entire sequence is transcribed, but the non-coding regions are subsequently spliced out. The start of an intron is marked with a sequence of nucleotides called a donor site, and the end is marked with an acceptor site. The donor and acceptor sites are used mechanistically in the removal of the intron. What is left after the splicing is the raw coding sequences that will be used to build up the proteins.\ud By first identifying the donor and acceptor regions of a sequence, it is then known which regions will be spliced out of the transcribed sequence. We attempt to solve the problem by creating a tool that will predict the locations of these donors, acceptors and subsequent exon regions in a raw genomic sequence.\ud Due to the transcriptional machinery, the donor and acceptor sites in a genomic sequence has stochastic signals or patterns which can be utilized for recognition. Similarly, exons or gene encoding areas also exhibit faint patterns which can be exploited for recognition

Summary of Patient Characteristics.

<p>Summary of Patient Characteristics.</p

Proportional Hazards Regression for Covariates of Depression.

<p>Proportional Hazards Regression for Covariates of Depression.</p

Proportional Hazards Regression for Covariates of Dementia.

<p>Proportional Hazards Regression for Covariates of Dementia.</p

Patient Outcome Hazard Ratios.

<p>Patient Outcome Hazard Ratios.</p

Comparison of socio-economic determinants of COVID-19 testing and positivity in Canada: A multi-provincial analysis.

BackgroundThe effects of the COVID-19 pandemic have been more pronounced for socially disadvantaged populations. We sought to determine how access to SARS-CoV-2 testing and the likelihood of testing positive for COVID-19 were associated with demographic factors, socioeconomic status (SES) and social determinants of health (SDH) in three Canadian provinces.MethodsAn observational population-based cross-sectional study was conducted for the provinces of Ontario, Manitoba and New Brunswick between March 1, 2020 and April 27, 2021, using provincial health administrative data. After excluding residents of long-term care homes, those without current provincial health insurance and those who were tested for COVID-19 out of province, records from provincial healthcare administrative databases were reviewed for 16,900,661 healthcare users. Data was modelled separately for each province in accordance to a prespecified protocol and follow-up consultations among provincial statisticians and collaborators. We employed univariate and multivariate regression models to examine determinants of testing and test results.ResultsAfter adjustment for other variables, female sex and urban residency were positively associated with testing, while female sex was negatively associated with test positivity. In New Brunswick and Ontario, individuals living in higher income areas were more likely to be tested, whereas in Manitoba higher income was negatively associated with both testing and positivity. High ethnocultural composition was associated with lower testing rates. Both high ethnocultural composition and high situational vulnerability increased the odds of testing positive for SARS-CoV-2.DiscussionWe observed that multiple demographic, income and SDH factors were associated with SARS-CoV-2 testing and test positivity. Barriers to healthcare access identified in this study specifically relate to COVID-19 testing but may reflect broader inequities for certain at-risk groups