Tree-Based Machine Learning to Identify Predictors of Psoriasis Incidence at the Neighborhood Level: A Populational Study from Quebec, Canada

BACKGROUND

Psoriasis is a major global health burden affecting ~ 60 million people worldwide. Existing studies on psoriasis focused on individual-level health behaviors (e.g. diet, alcohol consumption, smoking, exercise) and characteristics as drivers of psoriasis risk. However, it is increasingly recognized that health behavior arises in the context of larger social, cultural, economic and environmental determinants of health. We aimed to identify the top risk factors that significantly impact the incidence of psoriasis at the neighborhood level using populational data from the province of Quebec (Canada) and advanced tree-based machine learning (ML) techniques.

METHODS

Adult psoriasis patients were identified using International Classification of Disease (ICD)-9/10 codes from Quebec (Canada) populational databases for years 1997-2015. Data on environmental and socioeconomic factors 1 year prior to psoriasis onset were obtained from the Canadian Urban Environment Health Consortium (CANUE) and Statistics Canada (StatCan) and were input as predictors into the gradient boosting ML. Model performance was evaluated using the area under the curve (AUC). Parsimonious models and partial dependence plots were determined to assess directionality of the relationship.

RESULTS

The incidence of psoriasis varied geographically from 1.6 to 325.6/100,000 person-years in Quebec. The parsimonious model (top 9 predictors) had an AUC of 0.77 to predict high psoriasis incidence. Amongst top predictors, ultraviolet (UV) radiation, maximum daily temperature, proportion of females, soil moisture, urbanization, and distance to expressways had a negative association with psoriasis incidence. Nighttime light brightness had a positive association, whereas social and material deprivation indices suggested a higher psoriasis incidence in the middle socioeconomic class neighborhoods.

CONCLUSION

This is the first study to highlight highly variable psoriasis incidence rates on a jurisdictional level and suggests that living environment, notably climate, vegetation, urbanization and neighborhood socioeconomic characteristics may have an association with psoriasis incidence.

Exposure to silica and systemic sclerosis: A retrospective cohort study based on the Canadian Scleroderma Research Group

Introduction

Systemic sclerosis (SSc) is thought to be induced by an environmental trigger in genetically predisposed individuals. This study assessed the demographic and clinical characteristics and disease severity of silica exposed SSc patients.

Methods

Data was obtained from the Canadian Scleroderma Research Group (CSRG) cohort, containing 1,439 patients (2004–2019). Univariate and multivariate logistic regression analyses were performed, to determine the phenotype and severity of silica-exposed SSc patients. Mortality was assessed using Cox Survival Regression and Kaplan-Meier analyses.

Results

Among 1,439 patients (86.7% females), 95 patients reported exposure to silica. Those exposed were younger, of male sex and with more severe disease. Sex differences were observed where male patients exposed to silica were more likely to be Caucasian and smokers whereas female patients were younger at SSc diagnosis compared to unexposed. Multivariate regression, controlled for multiple confounders, showed that silica exposure was associated with a younger age at diagnosis and worse disease severity and mortality.

Conclusion

Exposure to silica was reported in ∼7% of CSRG cohort and ∼20% of male patients and was associated with a worse prognosis in terms of age of diagnosis, organ involvement and mortality. Hence, screening for silica exposure among higher risk individuals may be beneficial and these patients may require closer monitoring for systemic disease.

The effect of antidepressant treatment on white matter integrity in Major Depression

Introduction

White matter abnormalities have been identified in major depressive disorder (MDD). Although several diffusion tensor imaging studies found decreased fractional anisotropy (FA) in MDD, the effect of antidepressants (AD) treatment on white matter integrity has been insufficiently studied.

Objectives

We sought to examine the effect of AD treatment of MDD on white matter, using DTI, in responders compared to nonresponders.

Methods

We included 25 individuals with MDD (HAMD >/=20) without inflammatory, unstable medical/neurological conditions or prolonged duration (> 1 year),or AD or anti-inflammatory treatment >/=1 week preceding first evaluation. Evaluation before treatment and at 16 weeks included depression rating scales, a cognitive battery, inflammatory markers and MRI. Desvenlafaxine was initiated at 50mg with a possible increase to 100mg at 8 weeks.

Results

Changes included: increased volume in responders in the right Inferior Fronto-Occipital fasciculus (p=0.0315) and Superior Longitudinal Fasciculus part 3 (p=0.0050); in remitters in the right Inferior Fronto-Occipital fasciculus (p=0.0359) and Superior Longitudinal Fasciculus part 2 (p<0.05) and 3 (p=0.0481); decreased volume in responders in the left Superior Longitudinal Fasciculus part 1 (p=0.0147) and left Corona Radiata(p<0.05); and in remitters in the left Superior Longitudinal Fasciculus part 1 (p=0.0109) and the Corpus Callosum part 5 (p<0.05); decreased FA in the right Cortico Spinal Tract in remitters (p=0.0175) and responders (p=0.0272), and an increase in FA in the left Uncinate Fasciculus in nonremitters (p=0.0493). These results lose significance following Bonferroni correction.

Conclusions

Overall, AD treatment of MDD was not associated with significant changes in FA, whole brain, or specific tract volume in this study.

Disclosure

This research was funded by Pfizer Canada.

Sex Differences in the Patterns of Systemic Agent use Among Patients With Psoriasis: A Retrospective Cohort Study in Quebec, Canada

Background: Sex differences exist in psoriasis manifestation and expectations from treatment with systemic agents, including, conventional systemic agents (CSA) and tumor necrosis factor inhibitors or ustekinumab (TNFi/UST). However, sex differences in patterns of systemic agent use, such as CSA discontinuation and switch from CSA to TNFi/UST have not been examined.

Objectives: To assess sex differences in patterns of CSA use and identify factors associated with switch to (or add) a TNFi/UST and those associated with CSA discontinuation.

Methods: We conducted a retrospective cohort study using the Quebec health administrative databases. We included patients with psoriasis initiating a CSA in 2002–2015. We excluded patients with a psoriasis diagnosis in the 3 years prior to the first diagnosis date between 2002 and 2015, and those with a systemic agent dispensation in the year prior to that date. We used Cox regression models with the Least Absolute Shrinkage and Selection Operator method to identify factors associated with Switch/add TNFi/UST, and those associated with CSA discontinuation. Separate analyses were performed for male and female patients.

Results: We included 1,644 patients (55.7% females, mean age 60.3 years), among whom 60.4% discontinued their CSA and 7.4%, switched/added TNFi/UST (3.4% switched and 4.0% added) within a median of 0.78 years of follow-up. Among male and female patients, rates of Switch/add TNFi/UST per 1,000 person-year were 49.1 and 41.0 and rates of CSA discontinuation were 381.2 and 352.8. Clinical obesity in male patients (HR 3.53, 95% CI 1.20–10.35), and adjustment/somatoform/dissociative disorders (HR 3.17, 95% CI 1.28–7.85) and use of nonsteroidal anti-inflammatory drugs (HR 2.70, 95% CI 1.56–4.70) in female patients were associated with Switch/add TNFi/UST. Male patients followed by a rheumatologist (HR 0.66, 95% CI 0.46–0.94) and those with a prior hospitalization (HR 0.70, 95% CI 0.57–0.87) were at lower risk of CSA discontinuation, while those initiated on acitretin (vs methotrexate) were at higher risk to discontinue their CSA (HR 1.61, 95% CI 1.30–2.01). Female patients with rheumatoid arthritis comorbidity (HR 0.69, 95% CI 0.51–0.93), those with a dispensed lipid-lowering agent (HR 0.72, 95% CI 0.59–0.88) and hypoglycemic agent (HR 0.75, 95% CI 0.57–0.98) and those initiated on methotrexate (vs all other CSAs) were less likely to discontinue their CSA. Male and female patients entering the cohort between 2011 and 2015 were at reduced risk of CSA discontinuation compared to those entering the cohort before 2011.

Conclusion: Most male and female patients discontinued their CSA within 1 year of follow-up. Our study highlighted sex differences in patients’ characteristics associated with switch/add a TNFi/UST and CSA discontinuation; treatment switch and discontinuation may be indications of treatment failure in most patients.

The association between side effects and adherence to antidepressants among primary care community-dwelling older adults

Aims: To evaluate the association between adherence to antidepressants and self-reported side effects while considering their tolerability among primary care community-dwelling older adults.Methods: This is a secondary analysis of data available for 137 individuals participating in the third wave of the Étude sur la Santé des Aînés - Services study (2015-2017) conducted among older adults aged 65 years and older. Adherence to antidepressants was assessed with the 4-item Medication Assessment Questionnaire. Side effects were also self-reported from a list of 20 potential side effects related to antidepressant use, while considering their tolerability (tolerable and non-tolerable) and were then grouped into seven categories specific to organ or function systems. Multilevel logistic regression analyses were carried out to assess the association between adherence and the presence of side effects accounting for participants nested within primary health clinics.Results: In this study, 69.3% of participants were adherent to their antidepressants and 30.7% were non-adherent. Participants reporting sleep disturbance (OR = 0.58, 95% CI = 0.47-0.72), gastrointestinal system (OR = 0.64, 95% CI = 0.45-0.92), and nervous system (OR = 0.60, 95% CI = 0.48-0.78) related side effects were less likely to be adherent to their antidepressants. Participants reporting palpitations were more likely to adhere to antidepressants (OR = 2.20, 95% CI = 1.03-4.67). With regards to severity, participants reporting non-tolerable nervous system related side effects were less likely to be adherent (OR = 0.37, 95% CI = 0.26-0.53) and those reporting non-tolerable gastrointestinal system related side effects reported higher adherence to antidepressants (OR = 1.82, 95% CI = 1.08-3.08).Conclusion: Adherence to antidepressants was associated with side effects, and more precisely with sleep disturbance, gastrointestinal and nervous systems side effects.

Patient and health system factors associated with hospital readmission in older adults without cognitive impairment

OBJECTIVE

To study the factors associated with hospital readmission.

METHODS

Data used in this study came from a population-based survey of older adults without cognitive impairment. Cox regression was used to assess the factors associated with readmission within a 2-year follow-up period. According to Andersen's model of healthcare seeking behavior, study variables considered included predisposing, enabling and need factors at the individual and health system levels.

RESULTS

Of the 433 participants with an index hospitalization, 97% were discharged with a physical and 3% with a psychiatric disorder. During follow-up, 29% (128/433) were readmitted with a median time to readmission reaching 83 days. The risk of readmission was associated with the following: age, marital status, attraction index of the region of residence for psychiatric services, the presence of an anxio-depressive and other mental disorder, as well as a disorder of the musculoskeletal system. The presence of a physical and psychiatric comorbidity was also associated with readmission.

CONCLUSIONS

Post-discharge follow-up of vulnerable populations with a history of mental disorders and improved availability of psychiatric services in the community are associated with a reduced risk of readmission.

Out-of-pocket costs and adherence to antihypertensive agents among older adults covered by the public drug insurance plan in Quebec

OBJECTIVE

To evaluate the effect of patient out-of-pocket costs on adherence to antihypertensive agents (AHA) in community-dwelling older adults covered by the public drug insurance plan in Quebec.

METHODS

This is a secondary analysis of data from the "Étude sur la santé des aînés" study (2005-2008) on community-dwelling older adults in Quebec aged 65 years and older (N=2,811). The final sample included 881 participants diagnosed with arterial hypertension and treated with AHA. Medication adherence was measured with the proportion of days covered over a 2-year follow-up period (<80% and ≥80%). Out-of-pocket costs for AHA, in Canadian dollars (CAD), at cohort entry were categorized as follows: $0, $0.01-$5.00, $5.01-$10.00, $10.01-$15.00 and $15.01-$36.00. Multivariable logistic regression models were constructed to study adherence to AHA as a function of out-of-pocket costs while controlling for several confounders. Models were also stratified by annual household income (<$15,000 CAD and ≥$15,000 CAD).

RESULTS

In this study, 80.8% of participants were adherent to their AHA. Among participants reporting an annual household income <$15,000 CAD, those with an out-of-pocket cost of $10.01-$15.00 CAD were significantly less adherent to their AHA than those with no contribution (OR =0.175, 95% CI: 0.042-0.740). Among participants reporting an income of ≥$15,000 CAD, those with out-of-pocket costs of $0.01-$5.00 CAD (OR =0.194; 95% CI: 0.048-0.787), $5.01-$10.00 CAD (OR =0.146; 95% CI: 0.036-0.589), $10.01-$15.00 CAD (OR =0.192; 95% CI: 0.047-0.777) and $15.01-$36.00 CAD (OR =0.160, 95% CI: 0.039-0.655) were significantly less adherent to their AHA than participants with no contribution.

CONCLUSION

Increased out-of-pocket costs are associated with non-adherence to AHA in older adults covered by a public drug insurance plan, more importantly in those reporting an annual household income ≥$15,000 CAD. A reduction in the amount of out-of-pocket costs and yearly maximum contribution for drugs may improve adherence to treatment.

ZnO@SnO2 engineered composite photoanodes for dye sensitized solar cells

Layered multi-oxide concept was applied for fabrication of photoanodes for dye-sensitized solar cells based on ZnO and SnO₂, capitalizing on the beneficial properties of each oxide. The effect of different combinations of ZnO@SnO₂ layers was investigated, aimed at exploiting the high carrier mobility provided by the ZnO and the higher stability under UV irradiation pledged by SnO₂. Bi-oxide photoanodes performed much better in terms of photoconversion efficiency (PCE) (4.96%) compared to bare SnO₂ (1.20%) and ZnO (1.03%). Synergistic cooperation is effective for both open circuit voltage and photocurrent density: enhanced values were indeed recorded for the layered photoanode as compared with bare oxides (V_oc enhanced from 0.39 V in case of bare SnO₂ to 0.60 V and J_sc improved from 2.58 mA/cm² pertaining to single ZnO to 14.8 mA/cm²). Improved functional performances of the layered network were ascribable to the optimization of both high chemical capacitance (provided by the SnO₂) and low recombination resistance (guaranteed by ZnO) and inhibition of back electron transfer from the SnO₂ conduction band to the oxidized species of the electrolyte. Compared with previously reported results, this study testifies how a simple electrode design is powerful in enhancing the functional performances of the final device.

Pylorogastric intussusception in a Chihuahua puppy. A case report

A three-month-old Chihuahua dog was presented with acute abdominal pain, vomiting and cardiovascular shock. Abdominal ultrasound (US) and iodated contrast gastrogram revealed suspected pylorogastric intussusception. Because of the poor prognosis the dog was euthanatized. Diagnosis of pylorogastric intussusception was confirmed at necropsy. Parasitological, virological, serological and histological examinations were also performed. This report documents the sixth case of pylorogastric (i.e. duodenogastric, gastrogastric) intussusception in the veterinary medical literature and it is the first report on a puppy dog in which US and radiographic diagnosis were confirmed post mortem.

Observation of multiple volume reflection of ultrarelativistic protons by a sequence of several bent silicon crystals

The interactions of 400 GeV protons with different sequences of bent silicon crystals have been investigated at the H8 beam line of the CERN Super Proton Synchrotron. The multiple volume reflection of the proton beam has been studied in detail on a five-crystal reflector measuring an angular beam deflection theta = 52.96 +/- 0.14 microrad. The efficiency was found larger than 80% for an angular acceptance at the reflector entrance of 70 microrad, with a maximal efficiency value of epsilon = 0.90 +/- 0.01 +/- 0.03.

Volume reflection dependence of 400 GeV/c protons on the bent crystal curvature

The trend of volume reflection parameters (deflection angle and efficiency) in a bent (110) silicon crystal has been investigated as a function of the crystal curvature with 400 GeV/c protons on the H8 beam line at the CERN Super Proton Synchrotron. This Letter describes the analysis performed at six different curvatures showing that the optimal radius for volume reflection is approximately 10 times greater than the critical radius for channeling. A strong scattering of the beam by the planar potential is also observed for a bend radius close to the critical one.

Prevalence of intestinal metaplasia in the distal oesophagus, oesophagogastric junction and gastric cardia in symptomatic patients in north-east Italy: a prospective, descriptive survey. The Italian Ulcer Study Group "GISU"

BACKGROUND

Incidence of adenocarcinoma of distal oesophagus and gastric cardia, probably arising from areas of intestinal metaplasia, has been increasing rapidly.

AIMS

To define prevalence of intestinal metaplasia of distal oesophagus, oesophagogastric junction and gastric cardia and to evaluate potential associated factors, by means of a prospective multicentre study including University and teaching hospitals, and primary and tertiary care centres.

PATIENTS

Each of 24 institutions involved in study enrolled 10 consecutive patients undergoing first-time routine endoscopy for dyspeptic symptoms.

METHODS

Patients answered symptom questionnaires and underwent gastroscopy Three biopsies were taken from distal oesophagus, oesophago-gastric junction and gastric cardia, and were stained with haematoxylin and eosin. Specimens were also evaluated for Helicobacter pylori infection.

RESULTS

A total of 240 patients (124 male, 116 female; median age 56 years, range 20-90) were enrolled in study. Intestinal metaplasia affected distal oesophagus in 5, oesophago-gastric junction in 19 and gastric cardia in 10 patients. Low-grade dysplasia was found at distal oesophagus and/or oesophago-gastric junction of 3/24 patients with intestinal metaplasia vs 2/216 without intestinal metaplasia (p<0.05). A significant association was found between symptoms and presence of intestinal metaplasia, regardless of location, and between Helicobacter pylori infection and intestinal metaplasia at oesophago-gastric junction.

CONCLUSIONS

Intestinal metaplasia of distal oesophagus, oesophagogastric-junction and gastric cardia is found in a significant proportion of symptomatic patients undergoing gastroscopy and is associated with dysplasia in many cases. Although prevalence of dysplasia seems to decrease when specialized columnar epithelium is found in short segment, or even focally in oesophago-gastric junction, these small foci of intestinal metaplastic cells may represent source of most adenocarcinomas of cardia.

Effect of glipizide on dopamine synthesis, release and metabolism in PC12 cells

Sulfonylureas block ATP-dependent K(+) channels (K/ATP channels) in pancreatic beta cells and brain gamma-aminobutyric acid (GABA) containing neurons causing depolarization-evoked insulin or GABA release. In high concentrations, sulfonylureas also inhibit catecholamine release from bovine adrenal chromaffin cells and isolated guinea pig aorta. In this study, we examined the effect of glipizide, a sulfonylurea, on dopamine release from PC12 cells and found that neither basal nor K(+)-stimulated dopamine release was affected. Although PC12 cells expressed mRNA for the K/ATP channel, functional K/ATP channels could not be demonstrated electrophysiologically, consistent with the lack of effect of glipizide on dopamine release. Glipizide did, however, increase cytoplasmic retention of the acidic dopamine metabolites, 3, 4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA), indicating blockade of their outward transport. The cellular accumulation of DOPAC was accompanied by reduced tyrosine hydroxylase activity and reduced formation of dopamine and its metabolites presumably by a negative feedback effect of the increased cytoplasmic concentrations of DOPAC.

[Transfer to nursing care of patients with problems occurred during hospital care]

The innovative experience of the participation of a Registered Nurse in the Hospital Therapeutic Committee is described. The occasion for the participation was the drawing up of the Hospital Therapeutic Reference Book. The nurse had an active role in the identification of problems related to the practical use of drugs. Problems emerged, concerning the choices of the Committee and the implications for nursing care are discussed. The nurse can have a positive impact and her/his presence in the Therapeutic Committees should be mandatory.

[To live death in the hospital. The Lendinara School of Nursing]

Issues related to death and dying are important subjects in the educational curriculum of nursing students; in the nursing school of Lendinara this subjects were discussed analysing practical and emotional experience of nursing students. An anonymous questionnaire was distributed to the 74 second and third year students (67 returned) to explore emotional experience and 52 terminal patients were observed during a 3 month period, to obtain data on the care of these patients in the hospital. Data were analysed by nursing students as part of their practical training. Some of the results are presented; results were discussed in the classroom and presented and commented in an open meeting with caring personnel (nurses, doctors, volunteers) involved in the care of dying patients.

[Non-epithelial benign gastric neoplasms]

The Authors report five cases of benign neoplasm of the stomach: 2 leiomyoblastomas, 2 leiomyomas and 1 ganglioneuroblastoma, underlining its rarity. After a review of the literature, the anatomo-pathological, clinical and therapeutical findings are described. The difficulty of early diagnosis is underline and the need for surgical therapy states.