Potentially inappropriate medication use: the Beers' Criteria used among older adults with depressive symptoms

INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3) years and 59% were women. The median number of medications used was 6 (range 1-21 medications). The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49%) of the participants were prescribed at least one potentially inappropriate medication; 29% were considered to suffer significant depressive symptoms (Geriatric Depression Scale ≥5) and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54). DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed

N,N′-Bis[(E)-quinoxalin-2-ylmethyl­idene]­ethane-1,2-diamine

In the mol­ecule of the title compound, C20H16N6, the central C—C bond lies on a crystallographic inversion centre. The quinoxalidine ring is nearly planar, with a maximum deviation of 0.021 (2) Å from the mean plane. The crystal structure is stabilized by inter­molecular C—H⋯N inter­actions, leading to the formation of a layer-like structure, which extends along the a axis

An Expanded Chronic Care Management approach to Multiple Chronic Conditions in Hispanics Using Community Health Workers as Community Extenders in the Rio Grande Valley of Texas

INTRODUCTION: The synergistic negative effects of type 2 diabetes (T2DM) and hypertension increases all-cause mortality and the medical complexity of management, which disproportionately impact Hispanics who face barriers to healthcare access. The Salud y Vida intervention was delivered to Hispanic adults living along the Texas-Mexico Border with comorbid poorly controlled T2DM and hypertension. The Salud y Vida multicomponent intervention incorporated community health workers (CHWs) into an expanded chronic care management model to deliver home-based follow-up visits and provided community-based diabetes self-management education. METHODS: We conducted multivariable longitudinal analysis to examine the longitudinal intervention effect on reducing systolic and diastolic blood pressure among 3806 participants enrolled between 2013 and 2019. Participants were compared according to their program participation as either higher (≥ 10 combined educational classes and CHW visits) or lower engagement (\u3c10 \u3eencounters). Data was collected between 2013 and 2020. RESULTS: Baseline mean systolic and diastolic blood pressure were 138 and 81 mmHg respectively. There were overall improvements in systolic (-6.49; 95% CI = [-7.13, -5.85]; p \u3c 0.001) and diastolic blood pressure (-3.97; 95% CI = [-4.37, -3.56]; p \u3c 0.001). The higher engagement group had greater systolic blood pressure reduction at 3 months (adjusted mean difference = -1.8 mmHg; 95% CI = [-3.2, -0.3]; p = 0.016) and at 15 month follow-up (adjusted mean difference = -2.3 mmHg; 95% CI = [-4.2, -0.39]; p = 0.0225) compared to the lower engagement group. CONCLUSION: This intervention, tested and delivered in a real-world setting, provides an example of how CHW integration into an expanded chronic care model can improve blood pressure outcomes for individuals with co-morbidities

SMART Research: Toward Interdisciplinary River Science in Europe

Interdisciplinary science is rapidly advancing to address complex human-environment interactions. River science aims to provide the methods and knowledge required to sustainably manage some of the planet’s most important and vulnerable ecosystems; and there is a clear need for river managers and scientists to be trained within an interdisciplinary approach. However, despite the science community’s recognition of the importance of interdisciplinary training, there are few studies examining interdisciplinary graduate programs, especially in science and engineering. Here we assess and reflect on the contribution of a 9-year European doctoral program in river science: ‘Science for MAnagement of Rivers and their Tidal Systems’ Erasmus Mundus Joint Doctorate (SMART EMJD). The program trained a new generation of 36 early career scientists under the supervision of 34 international experts from different disciplinary and interdisciplinary research fields focusing on river systems, aiming to transcend the boundaries between disciplines and between science and management. We analyzed the three core facets of the SMART program, namely: (1) interdisciplinarity, (2) internationalism, and (3) management-oriented science. We reviewed the contents of doctoral theses and publications and synthesized the outcomes of two questionnaire surveys conducted with doctoral candidates and supervisors. A high percentage of the scientific outputs (80%) were interdisciplinary. There was evidence of active collaboration between different teams of doctoral candidates and supervisors, in terms of joint publications (5 papers out of the 69 analyzed) but this was understandably quite limited given the other demands of the program. We found evidence to contradict the perception that interdisciplinarity is a barrier to career success as employment rates were high (97%) and achieved very soon after the defense, both in academia (50%) and the private/public sector (50%) with a strong international dimension. Despite management-oriented research being a limited (9%) portion of the ensemble of theses, employment in management was higher (22%). The SMART program also increased the network of international collaborations for doctoral candidates and supervisors. Reflections on doctoral training programs like SMART contribute to debates around research training and the career opportunities of interdisciplinary scientists

A review of assessment methods for river hydromorphology

The work leading to this paper has received funding for the EU’s FP7 under Grant Agreement No. 282656 (REFORM

Ancestral Components of Admixed Genomes in a Mexican Cohort

For most of the world, human genome structure at a population level is shaped by interplay between ancient geographic isolation and more recent demographic shifts, factors that are captured by the concepts of biogeographic ancestry and admixture, respectively. The ancestry of non-admixed individuals can often be traced to a specific population in a precise region, but current approaches for studying admixed individuals generally yield coarse information in which genome ancestry proportions are identified according to continent of origin. Here we introduce a new analytic strategy for this problem that allows fine-grained characterization of admixed individuals with respect to both geographic and genomic coordinates. Ancestry segments from different continents, identified with a probabilistic model, are used to construct and study “virtual genomes” of admixed individuals. We apply this approach to a cohort of 492 parent–offspring trios from Mexico City. The relative contributions from the three continental-level ancestral populations—Africa, Europe, and America—vary substantially between individuals, and the distribution of haplotype block length suggests an admixing time of 10–15 generations. The European and Indigenous American virtual genomes of each Mexican individual can be traced to precise regions within each continent, and they reveal a gradient of Amerindian ancestry between indigenous people of southwestern Mexico and Mayans of the Yucatan Peninsula. This contrasts sharply with the African roots of African Americans, which have been characterized by a uniform mixing of multiple West African populations. We also use the virtual European and Indigenous American genomes to search for the signatures of selection in the ancestral populations, and we identify previously known targets of selection in other populations, as well as new candidate loci. The ability to infer precise ancestral components of admixed genomes will facilitate studies of disease-related phenotypes and will allow new insight into the adaptive and demographic history of indigenous people

History Shaped the Geographic Distribution of Genomic Admixture on the Island of Puerto Rico

Contemporary genetic variation among Latin Americans human groups reflects population migrations shaped by complex historical, social and economic factors. Consequently, admixture patterns may vary by geographic regions ranging from countries to neighborhoods. We examined the geographic variation of admixture across the island of Puerto Rico and the degree to which it could be explained by historic and social events. We analyzed a census-based sample of 642 Puerto Rican individuals that were genotyped for 93 ancestry informative markers (AIMs) to estimate African, European and Native American ancestry. Socioeconomic status (SES) data and geographic location were obtained for each individual. There was significant geographic variation of ancestry across the island. In particular, African ancestry demonstrated a decreasing East to West gradient that was partially explained by historical factors linked to the colonial sugar plantation system. SES also demonstrated a parallel decreasing cline from East to West. However, at a local level, SES and African ancestry were negatively correlated. European ancestry was strongly negatively correlated with African ancestry and therefore showed patterns complementary to African ancestry. By contrast, Native American ancestry showed little variation across the island and across individuals and appears to have played little social role historically. The observed geographic distributions of SES and genetic variation relate to historical social events and mating patterns, and have substantial implications for the design of studies in the recently admixed Puerto Rican population. More generally, our results demonstrate the importance of incorporating social and geographic data with genetics when studying contemporary admixed populations