Methodological strengths and weakness of cohorts and administrative data for developing population estimates of dementia

Background: There are three main methods of obtaining population data on the incidence and/or prevalence of dementia: cross-sectional surveys (which may be repeated over time); cohort studies that follow people initially without dementia and count newly diagnosed cases over time; and administrative health records (including linkage of records from multiple sources). The major challenges for all these methods are: how well the study sample represents the target population, the accuracy of diagnoses, and the costs of maintaining the data collection over time. Method: In a project to improve Australia’s dementia statistics, we conducted a series of studies to compare population estimates of dementia obtained using different methods. Firstly, we used existing general health studies of community-based cohorts, supplemented by linkage to administrative records of hospital and emergency department admissions, assessments for aged care support, medication prescriptions, and death certificates to estimate the cumulative incidence of dementia. Secondly, we created cohorts based on administrative records for entire populations. Thirdly, we assessed the validity of the identification of people with dementia in the record linkage cohorts in various ways, including linkage with studies that had obtained clinical diagnosis through the standardised assessment of participants. Result: We will present empirical results illustrating the strengths and limitations of these different approaches. In summary, community-based cohort studies lack representativeness of national or regional populations due to recruitment biases and differential loss to follow-up. Cohort studies are also costly to maintain over the long time needed for participants to develop dementia. In contrast, the use of administrative records is relatively inexpensive, but is subject to policy changes that impact on the continuity of data coverage and quality. Population coverage may also be problematic for administrative data if important sources of care for people with dementia are not included; for example, in Australia linkable primary care data are not available. The validation studies showed that accuracy was highly dependent on data sources, and identification of dementia type was unreliable. Conclusion: Prevalence and trends data of dementia obtained from multiple sources are needed to provide accurate population estimates, together with detailed contextual knowledge and careful analysis

Differing Methodologies Are Required to Estimate Prevalence of Dementia: Single Study Types Are No Longer Reliable

Abstract: Population-based surveys were used to estimate community prevalence of dementia, but have low response fractions due, among other things, to difficulties in obtaining informed consent from people with diminished capacity. Cohort studies of younger people are subject to recruitment bias and non-random drop-outs. Dementia registries can delineate sub-types of dementia but have limited population coverage and are costly to maintain. Administrative datasets have low costs but may be subject to selection bias and uncertain sensitivity. We propose that astute combination of methodologies, including assessment of coverage and validity of administrative datasets, is the most cost-effective process to estimate and monitor community prevalence

What kind of heat loss requirements NZEB and deep renovation sets for building envelope?

In most of countries the energy performance of buildings is defined as (primary) energy use of whole buildingâ s (heating, cooling, ventilation, DHW, lighting, HVAC auxiliary, appliances), not as specific requirements for building envelope. For construction companies of production of modular renovation panels it in necessary to know heat loss properties of building envelope (U, W/(m2â K); ï , W/(mâ K); ï £, W/K; q50, m3/(hâ m2)). In this study it is analyzed what kind of heat loss requirements exists for building envelope to meet on annual basis to following targets: nZEB i.e. national nearly zero energy definition; deep energy renovation with 80 % reduction of primary energy; ZEB i.e. net Zero Energy Building = the annual primary energy use = 0 kWh/(m² a). Indoor climate and energy calculations were made based on national energy calculation methodologies in six countries: Denmark, Estonia, Latvia, Czech Republic, Portugal, and Netherlands. Requirements for heat loss of building envelope vary depending on requirements on indoor climate and energy performance in specific country, outdoor climate, availability of renewable energy, and building typology. The thermal transmittance of the modular wall panels for nZEB was â 5% from pre renovation thermal transmittance in Latvia, â 10% in Estonia and up to 50% in Portugal. For roof the decrease of thermal transmittance was smaller mainly due to smaller thermal transmittance before renovation. Results show the difficulties to reach ZEB with multi-story apartment buildings in cold climate. There are not enough places to install renewables for energy production on site.The study has been conducted in the projects H2020 MoreConnect, TK146 the Estonian Centre of Excellence in Zero Energy and Resource Efficient Smart Buildings and Districts, ZEBE, IUT1−15 Nearly-zero energy solutions and their implementation on deep renovation of buildings

Homocysteine, Grey Matter and Cognitive Function in Adults with Cardiovascular Disease

Background: Elevated total plasma homocysteine (tHcy) has been associated with cognitive impairment, vascular disease and brain atrophy. Methods: We investigated 150 volunteers to determine if the association between high tHcy and cerebral grey matter volume and cognitive function is independent of cardiovascular disease. Results: Participants with high tHcy ($15 mmol/L) showed a widespread relative loss of grey matter compared with people with normal tHcy, although differences between the groups were minimal once the analyses were adjusted for age, gender, diabetes, hypertension, smoking and prevalent cardiovascular disease. Individuals with high tHcy had worse cognitive scores across a range of domains and less total grey matter volume, although these differences were not significant in the adjusted models. Conclusions: Our results suggest that the association between high tHcy and loss of cerebral grey matter volume and decline in cognitive function is largely explained by increasing age and cardiovascular diseases and indicate that th

Geographical distribution of American cutaneous leishmaniasis and its phlebotomine vectors (Diptera: Psychodidae) in the state of São Paulo, Brazil

<p>Abstract</p> <p>Background</p> <p>American cutaneous leishmaniasis (ACL) is a re-emerging disease in the state of São Paulo, Brazil. It is important to understand both the vector and disease distribution to help design control strategies. As an initial step in applying geographic information systems (GIS) and remote sensing (RS) tools to map disease-risk, the objectives of the present work were to: (i) produce a single database of species distributions of the sand fly vectors in the state of São Paulo, (ii) create combined distributional maps of both the incidence of ACL and its sand fly vectors, and (iii) thereby provide individual municipalities with a source of reference material for work carried out in their area.</p> <p>Results</p> <p>A database containing 910 individual records of sand fly occurrence in the state of São Paulo, from 37 different sources, was compiled. These records date from between 1943 to 2009, and describe the presence of at least one of the six incriminated or suspected sand fly vector species in 183/645 (28.4%) municipalities. For the remaining 462 (71.6%) municipalities, we were unable to locate records of any of the six incriminated or suspected sand fly vector species (<it>Nyssomyia intermedia</it>, <it>N. neivai</it>, <it>N. whitmani</it>, <it>Pintomyia fischeri</it>, <it>P. pessoai </it>and <it>Migonemyia migonei</it>). The distribution of each of the six incriminated or suspected vector species of ACL in the state of São Paulo were individually mapped and overlaid on the incidence of ACL for the period 1993 to 1995 and 1998 to 2007. Overall, the maps reveal that the six sand fly vector species analyzed have unique and heterogeneous, although often overlapping, distributions. Several sand fly species - <it>Nyssomyia intermedia </it>and <it>N. neivai </it>- are highly localized, while the other sand fly species - <it>N. whitmani, M. migonei, P. fischeri </it>and <it>P. pessoai </it>- are much more broadly distributed. ACL has been reported in 160/183 (87.4%) of the municipalities with records for at least one of the six incriminated or suspected sand fly vector species, while there are no records of any of these sand fly species in 318/478 (66.5%) municipalities with ACL.</p> <p>Conclusions</p> <p>The maps produced in this work provide basic data on the distribution of the six incriminated or suspected sand fly vectors of ACL in the state of São Paulo, and highlight the complex and geographically heterogeneous pattern of ACL transmission in the region. Further studies are required to clarify the role of each of the six suspected sand fly vector species in different regions of the state of São Paulo, especially in the majority of municipalities where ACL is present but sand fly vectors have not yet been identified.</p

Proinflammatory genotype is associated with the frailty phenotype in the English Longitudinal Study of Ageing

Background: Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event, which increases the risk of adverse outcomes including falls, disability and death. The underlying pathophysiological pathways of frailty are not known but the hypothalamic–pituitary–adrenal axis and heightened chronic systemic inflammation appear to be major contributors. Methods: We used the English Longitudinal Study of Ageing dataset of 3160 individuals over the age of 50 and assessed their frailty status according to the Fried-criteria. We selected single nucleotide polymorphisms in genes involved in the steroid hormone or inflammatory pathways and performed linear association analysis using age and sex as covariates. To support the biological plausibility of any genetic associations, we selected biomarker levels for further analyses to act as potential endophenotypes of our chosen genetic loci. Results: The strongest association with frailty was observed in the Tumor Necrosis Factor (TNF) (rs1800629, P = 0.001198, β = 0.0894) and the Protein Tyrosine Phosphatase, Receptor type, J (PTPRJ) (rs1566729, P = 0.001372, β = 0.09397) genes. Rs1800629 was significantly associated with decreased levels of high-density lipoprotein (HDL) (P = 0.00949) and cholesterol levels (P = 0.00315), whereas rs1566729 was associated with increased levels of HDL (P = 0.01943). After correcting for multiple testing none of the associations remained significant. Conclusions: We provide potential evidence for the involvement of a multifunctional proinflammatory cytokine gene (TNF) in the frailty phenotype. The implication of this gene is further supported by association with the endophenotype biomarker results

The Dynamics of Transmission and Spatial Distribution of Malaria in Riverside Areas of Porto Velho, Rondônia, in the Amazon Region of Brazil

The study area in Rondônia was the site of extensive malaria epidemic outbreaks in the 19th and 20th centuries related to environmental impacts, with large immigration flows. The present work analyzes the transmission dynamics of malaria in these areas to propose measures for avoiding epidemic outbreaks due to the construction of two Hydroelectric Power Plants. A population based baseline demographic census and a malaria prevalence follow up were performed in two river side localities in the suburbs of Porto Velho city and in its rural vicinity. The quantification and nature of malaria parasites in clinical patients and asymptomatic parasite carriers were performed using microscopic and Real Time PCR methodologies. Anopheles densities and their seasonal variation were done by monthly captures for defining HBR (hourly biting rate) values. Main results: (i) malaria among residents show the riverside profile, with population at risk represented by children and young adults; (ii) asymptomatic vivax and falciparum malaria parasite carriers correspond to around 15% of adults living in the area; (iii) vivax malaria relapses were responsible for 30% of clinical cases; (iv) malaria risk for the residents was evaluated as 20–25% for vivax and 5–7% for falciparum malaria; (v) anopheline densities shown outdoors HBR values 5 to 10 fold higher than indoors and reach 10.000 bites/person/year; (vi) very high incidence observed in one of the surveyed localities was explained by a micro epidemic outbreak affecting visitors and temporary residents. Temporary residents living in tents or shacks are accessible to outdoors transmission. Seasonal fishermen were the main group at risk in the study and were responsible for a 2.6 fold increase in the malaria incidence in the locality. This situation illustrates the danger of extensive epidemic outbreaks when thousands of workers and secondary immigrant population will arrive attracted by opportunities opened by the Hydroelectric Power Plants constructions