Tackling Ageing Continence through Theory, Tools & Technology

Originally presented at ‘Aging and Society: An Interdisciplinary Conference’, University of California, Berkeley (2011), this article was double-blind peer reviewed, receiving scores of 96% and 73%. It outlines the interdisciplinary research of the cross-Research-Council-funded New Dynamics of Ageing Tackling Ageing Continence through Theory Tools & Technology (TACT3) project (2008–12), which brought together designers, social scientists, bio-engineers, chemists and care-management services to understand the challenges faced by an ageing population in the management of continence. Bichard’s Work Package, ‘Challenging Environmental Barriers to Continence’, explored the need for public toilet provision as essential for quality of life, health and well-being. It developed a life-course methodology that considered ageing from birth through to advanced age (0–101 years), and involved inclusive design research with members of the public and providers of facilities to assess public expectations and provider limitations in service provision. As co-investigator on TACT3, this research built on Bichard’s previous work for the VivaCity2020 consortium (Bichard REF Output 2). Whereas the VivaCity2020 work focused on architectural barriers in toilet provision, the TACT3 project examined the problem in service provision, and how, through inclusive design research, service-design solutions might be explored and implemented. Bichard’s contribution to the TACT3 project produced The Great British Public Toilet Map (http://greatbritishpublictoiletmap.rca.ac.uk/), a public participation website that provides information and locations of public toilets, encouraging members of the public to contact relevant local authorities that have not released information in the format of Open Data. Secondary analysis of TACT3 data for references to issues of personal safety and community initiative in toilet provision was used for the ESRC-funded Robust Accessible Toilets (RATs) project (2011) and produced Publicly Accessible Toilets: An Inclusive Design Guide (2011). Related published conference papers include those in ‘Cumulus 2010’ (China) and ‘Include 2011’ (UK)

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362