A 10-Year Trend in Statin Use Among Older Adults in Australia: an Analysis Using National Pharmacy Claims Data

Background

Statins have become standard of care in the prevention and treatment of atherosclerotic cardiovascular disease. The objective of this study was to examine the trends in statin use among Australians aged ≥?65 years for the period 2007–2016.

Methods

Data from the Pharmaceutical Benefits Scheme covering a 10% random sample of the Australian population were analysed. The 1-year prevalence and incidence of statin use were determined for each year, as were the percentage of statin dispensations according to statin type or intensity and the percentage of new users prescribed each statin type or intensity. To describe relative changes, age-sex adjusted rate ratios (RRs) and 95% confidence intervals (CIs) were determined via Poisson regression modelling using 2007 as the reference year.

Results

The 1-year prevalence of statin use increased consistently each year from 34.2% in 2007 to 44.1% in 2016 (RR 1.29, 95% CI 1.28–1.31). The 1-year incidence was 68.5 per 1000 in 2007 and 59.0 per 1000 in 2016 (RR 0.87, 95% CI 0.84–0.90). Women were 18% (age-adjusted rate ratio [aRR] 0.82, 95% CI 0.79–0.83) less likely than men to initiate statins across all years. The incidence of statin use was also highest among individuals aged 65–74 years, who were about 15% (sex-adjusted rate ratio [sRR] 1.15, 95% CI 1.13–1.16) and 45% (sRR 1.45, 95% CI 1.44–1.47) more likely to initiate statins than those aged 75–84 and ≥ 85 years, respectively. Atorvastatin was the most commonly dispensed statin across all years. The proportion of new users dispensed high-intensity statins increased year-on-year from 23.6% in 2007 to 30.5% in 2016 (RR 1.26, 95% CI 1.21–1.31).

Conclusion

The proportion of older adults in Australia using statins has increased over the last decade, although the incidence has declined. Atorvastatin is the most commonly dispensed statin and the use of high intensity statin has increased.

     

Alterations during medical interpretation of ICU family conferences that interfere with or enhance communication

RATIONALE: Many conferences in the ICU occur with the families of patients with limited English proficiency, requiring a medical interpreter. Despite the importance of medical interpretation, little is known about the alterations that occur and their effect on communication. OBJECTIVES: This study characterizes the types, prevalence, and potential effects of alterations in interpretation during ICU family conferences involving end-of-life discussions. METHODS: We identified ICU family conferences in two hospitals in which a medical interpreter was used. Ten conferences were audiotaped; 9 physicians led these conferences, and 70 family members participated. Research interpreters different from those attending the conference translated the non-English language portions of the audiotaped conferences. We identified interpretation alterations, grouped them into four types, and categorized their potential effects on communication. RESULTS: For each interpreted exchange between clinicians and family, there was a 55% chance that an alteration would occur. These alterations included additions, omissions, substitutions, and editorializations. Over three quarters of alterations were judged to have potentially clinically significant consequences on the goals of the conference. Of the potentially significant alterations, 93% were likely to have a negative effect on communication; the remainder, a positive effect. The alterations with potentially negative effects included interference with the transfer of information, reduced emotional support, and reduced rapport. Those with potential positive effects included improvements in conveying information and emotional support. CONCLUSIONS: Alterations in medical interpretation seem to occur frequently and often have the potential for negative consequences on the common goals of the family conference. Further studies examining and addressing these alterations may help clinicians and interpreters to improve communication with family members during ICU family conferences.     

General 2.5 power law of metallic glasses

Metallic glass (MG) is an important new category of materials, but very few rigorous laws are currently known for defining its “disordered” structure. Recently we found that under compression, the volume (V) of an MG changes precisely to the 2.5 power of its principal diffraction peak position (1/q₁). In the present study, we find that this 2.5 power law holds even through the first-order polyamorphic transition of a Ce₆₈Al₁₀Cu₂₀Co₂ MG. This transition is, in effect, the equivalent of a continuous “composition” change of 4f-localized “big Ce” to 4f-itinerant “small Ce,” indicating the 2.5 power law is general for tuning with composition. The exactness and universality imply that the 2.5 power law may be a general rule defining the structure of MGs.Metallic glasses (MGs) possess many unique and superior properties, such as extremely high strength, hardness, and corrosion resistance, etc., making them promising metallic materials with widespread applications (1, 2). Thousands of MGs with a wide range of compositions and properties have been synthesized over the past decades. However, so far the development of MGs is mainly based on tedious composition mapping in multicomponent space to pinpoint the combination of elements with optimized glass-forming ability (GFA). This method for development of MGs is a time- and resource-intensive strategy of trial and error which highlights the need for the guidance of a general theory (2, 3). Intensive research effort has been devoted to finding general rules in various MGs to understand the fundamentals and to guide the development of new MGs (4, 5). Quantitative correlations between their properties have been observed. For instance, compressive yield strength and elastic moduli of MGs are found to be intimately connected with their glass transition temperature T_g (6–10), and the ductility, fragility (11, 12), and Poisson’s ratio of MGs are closely related (13–16). The extensive correlations in properties suggest that the disordered MGs may share general rules in their structure. To clarify this scenario, detailed and accurate structural information spanning short range to long range is required. However, the current experimental probes and theories are limited to local structure in MGs (17). Therefore, understanding how the atoms efficiently fill up the 3D space and how this controls the bulk properties of MGs remains a long-standing theoretical challenge (18–23). To date, few general and exact rules regarding structure–property relationships have been established in MGs (23).Encouraging progress on understanding structure–property relationships in MGs has recently been made through the discoveries of the noncubic (2.3 or 2.5) power laws that correlate the principal diffraction peak (PDP) position q₁ with the bulk density ρ or average atomic volume, V_a, i.e., ρ∝(q₁)^D or V_a∝(1/q₁)^D, where D equals ∼2.3 with varying the composition of MGs at ambient pressure (19) or ∼2.5 for tuning the density of MGs with pressure (22, 24). Whereas composition and pressure show similar exponents in the power laws in MGs, composition and pressure are two independent variables for controlling the density (volume) of materials; they usually have dramatically different effects on MGs. For example, pressure is thought to cause only elastic densification in MGs without obvious structural change because of their already densely packed structure; the structure and properties of MGs are very sensitive to even minor compositional variations (25, 26). In addition, to achieve composition change, different samples usually have to be synthesized. And, many other variables are thought to be inevitably involved, making the compositional change complex (23). Therefore, some basic questions have been perplexing to the glass community: Why do “complex” compositional and “simple” pressure power laws show similar exponents? Is there any connection between them? These questions remain unanswered and have been the major obstacle in understanding the nature of these noncubic power laws.To address these questions, a systematic study in the 2D pressure-composition space seems to be required. However, the consistency of the data in this kind of study will be questionable. Alternatively, in the present study, we choose the polyamorphous Ce₆₈Al₁₀Cu₂₀Co₂ MG as a model system. It is well known that Ce-based MG systems show a polyamorphic transition between ∼2 GPa and ∼5 GPa caused by the pressure-induced 4f electron localized-to-itinerant transition (27, 28). During this polyamorphic transition, both the atomic size and the electronegativity of Ce are significantly changed (29). Composition tuning in MGs mainly means the variation of atomic size and electronegativity of components, which controls the formation of MGs (30). Therefore, although nothing changes in the nucleus, for MGs this pressure-induced polyamorphic transition is equivalent to a continuous “composition” change with the 4f-localized “big Ce” gradually substituted by 4f-itinerant “small Ce.” As a result, we are able to vary both pressure and composition of a MG in a well-controlled way for the first time, to our knowledge.     

Characteristic variation in evoked potential amplitude with changes in pacing stimulus strength

The evoked potential, the intracardiac signal generated by a pacing stimulus, shows promise as a sensor for rate-responsive pacing and automatic threshold determinations. Thus, it is important to understand factors that may alter the morphology of evoked potentials and affect accurate signal analysis. Using a computer-based pacing system emulator, stimuli at 2.5, 5.0 and 6.9 V were delivered to 12 patients through permanent bipolar pacing leads. At 2.5 V, the evoked potential amplitude measured -12.63 +/- 7.79 mV. When the pacing amplitude was increased to 5.0 and 6.9 V, the signal diminished in size or reversed in polarity, or both, averaging -0.83 +/- 7.82 mV and 0.64 +/- 7.0 mV, respectively (p less than 0.01 vs 2.5 V). Pacing at 2.5 V was performed in an additional 8 patients with temporary quadripolar electrode catheters. With the distal pole of the catheter as the cathode and the proximal 3 poles as a common anode, the evoked potential averaged -9.01 +/- 5.44 mV. With the proximal 2 poles of the catheter disconnected to make the anode equal in size and current density to the cathode, the evoked potential diminished to -0.94 +/- 11.27 mV (p less than 0.05). There is thus a decrease in the evoked potential at high stimulus amplitudes compared to that obtained at the cathodic threshold. This finding can be reproduced by manipulation of the size and current density of the anode, suggesting that anodal stimulation at the ring of permanent pacing leads may be responsible.     

Examination of the Safety of Pediatric Vaccine Schedules in a Non-Human Primate Model: Assessments of Neurodevelopment,Learning, and Social Behavior

Background

In the 1990s, the mercury-based preservative thimerosal was used in most pediatric vaccines. Although there are currently only two thimerosal-containing vaccines (TCVs) recommended for pediatric use, parental perceptions that vaccines pose safety concerns are affecting vaccination rates, particularly in light of the much expanded and more complex schedule in place today.

Objectives

The objective of this study was to examine the safety of pediatric vaccine schedules in a non-human primate model.

Methods

We administered vaccines to six groups of infant male rhesus macaques (n = 12–16/group) using a standardized thimerosal dose where appropriate. Study groups included the recommended 1990s Pediatric vaccine schedule, an accelerated 1990s Primate schedule with or without the measles–mumps–rubella (MMR) vaccine, the MMR vaccine only, and the expanded 2008 schedule. We administered saline injections to age-matched control animals (n = 16). Infant development was assessed from birth to 12 months of age by examining the acquisition of neonatal reflexes, the development of object concept permanence (OCP), computerized tests of discrimination learning, and infant social behavior. Data were analyzed using analysis of variance, multilevel modeling, and survival analyses, where appropriate.

Results

We observed no group differences in the acquisition of OCP. During discrimination learning, animals receiving TCVs had improved performance on reversal testing, although some of these same animals showed poorer performance in subsequent learning-set testing. Analysis of social and nonsocial behaviors identified few instances of negative behaviors across the entire infancy period. Although some group differences in specific behaviors were reported at 2 months of age, by 12 months all infants, irrespective of vaccination status, had developed the typical repertoire of macaque behaviors.

Conclusions

This comprehensive 5-year case–control study, which closely examined the effects of pediatric vaccines on early primate development, provided no consistent evidence of neurodevelopmental deficits or aberrant behavior in vaccinated animals.

Citation

Curtis B, Liberato N, Rulien M, Morrisroe K, Kenney C, Yutuc V, Ferrier C, Marti CN, Mandell D, Burbacher TM, Sackett GP, Hewitson L. 2015. Examination of the safety of pediatric vaccine schedules in a non-human primate model: assessments of neurodevelopment, learning, and social behavior. Environ Health Perspect 123:579–589; http://dx.doi.org/10.1289/ehp.1408257     

Temporal Trends Between 2010 and 2015 in Intensity of Care at End-of-Life for Patients With Chronic Illness: Influence of Age Under vs. Over 65 Years

Context

Recent analyses of Medicare data show decreases over time in intensity of end-of-life care. Few studies exist regarding trends in intensity of end-of-life care for those under 65 years of age.