Assessing cardiometabolic parameter monitoring in inpatients taking a second-generation antipsychotic: The CAMI-SGA study - a cross-sectional study

OBJECTIVES

This study aims to determine the proportion of initial cardiometabolic assessment and its predicting factors in adults with schizophrenia, bipolar disorder or other related diagnoses for whom a second-generation antipsychotic was prescribed in the hospital setting.

DESIGN

Cross-sectional study.

SETTING

The psychiatry unit of a Canadian tertiary care teaching hospital in Montreal, Canada.

PARTICIPANTS

402 patients with aforementioned disorders who initiated, restarted or switched to one of the following antipsychotics: clozapine, olanzapine, risperidone, paliperidone or quetiapine, between 2013 and 2016.

PRIMARY OUTCOME MEASURES

We assessed the proportion of cardiometabolic parameters monitored.

SECONDARY OUTCOME MEASURES

We identified predictors that influence the monitoring of cardiometabolic parameters and we assessed the proportion of adequate interventions following the screening of uncontrolled blood pressure and fasting glucose or glycated haemoglobin (HbA1c) results.

RESULTS

Only 37.3% of patients received monitoring for at least three cardiometabolic parameters. Blood pressure was assessed in 99.8% of patients; lipid profile in 24.4%; fasting glucose or HbA1c in 33.3% and weight or body mass index in 97.8% of patients while waist circumference was assessed in 4.5% of patients. For patients with abnormal blood pressure and glycaemic values, 42.3% and 41.2% subsequent interventions were done, respectively. The study highlighted the psychiatric diagnosis (substance induced disorder OR 0.06 95% CI 0.00 to 0.44), the presence of a court-ordered treatment (OR 0.79 95% CI 0.35 to 1.79) and the treating psychiatrist (up to OR 34.0 95% CI 16.2 to 140.7) as predictors of cardiometabolic monitoring.

CONCLUSIONS

This study reports suboptimal baseline cardiometabolic monitoring of patients taking an antipsychotic in a Canadian hospital. Optimising collaboration within a multidisciplinary team may increase cardiometabolic monitoring.

A Horizon Scan of research priorities to inform policies aimed at reducing the harm of plastic pollution to biota

Plastic pollution in the oceans is a priority environmental issue. The recent increase in research on the topic, coupled with growing public awareness, has catalyzed policymakers around the world to identify and implement solutions that minimize the harm caused by plastic pollution. To aid and coordinate these efforts, we surveyed experts with scientific experience identified through their peer-reviewed publications. We asked experts about the most pressing research questions relating to how biota interact with plastic pollution that in turn can inform policy decisions and research agendas to best contribute to understanding and reducing the harm of plastic pollution to biota. We used a modified Horizon Scan method that first used a subgroup of experts to generate 46 research questions on aquatic biota and plastics, and then conducted an online survey of researchers globally to prioritize questions in terms of their importance to inform policy development. One hundred and fifteen experts from 29 countries ranked research questions in six themes. The questions were ranked by urgency, indicating which research should be addressed immediately, which can be addressed later, and which are of limited relevance to inform action on plastics as an environmental pollutant. We found that questions relating to the following four themes were the most commonly top-ranked research priorities: (i) sources, circulation and distribution of plastics, (ii) type of harm from plastics, (iii) detection of ingested plastics and the associated problems, and (iv) related economies and policy to ingested plastics. While there are many research questions on the topic of impacts of plastic pollution on biota that could be funded and investigated, our results focus collective priorities in terms of research that experts believe will inform effective policy and on-the-ground conservation.

Renal trace elements in barren-ground caribou subpopulations: Temporal trends and differing effects of sex, age and season

Caribou (Rangifer tarandus) are a culturally significant food resource for communities in northern Canada and Greenland. Many barren-ground caribou subpopulations are currently in decline, some dramatically; understanding the influence of stressors, such as toxic trace metals, is important. These contaminants enter Arctic terrestrial environments via atmospheric transport from industrialized areas and from local sources, accumulating there in the environment. Understanding how trace element concentrations interact and are influenced by caribou sex, age and season of collection is essential to evaluating trends in these elements over time and differences among subpopulations. We used path analysis to model the direct and indirect relationships between these variables in the Porcupine subpopulation and in barren-ground caribou from the Canadian Arctic and Greenland. Renal cadmium (Cd), copper (Cu) and mercury (Hg) varied significantly among subpopulations. Hg was positively correlated with Cd, Cu and selenium (Se) in female Porcupine caribou whereas Cd and Cu were negatively correlated in male Porcupine caribou. Age, season and sex influenced all three element concentrations and should be considered when comparing elements among caribou subpopulations or years. Renal Cd decreased slightly from the Canadian Western Arctic to Greenland and increased slightly over time, possibly reflecting patterns of atmospheric deposition. Renal Hg did not change significantly over time, and differences among subpopulations did not follow specific geographical patterns. Renal Cu declined over time, the changes being markedly different among subpopulations, sexes and seasons. This temporal decline is likely due to changes in diet, which could be driven by various environmental factors. Declining Cu concentrations in caribou is of concern as low levels could negatively affect reproductive success and therefore caribou at a population level. Continuing to monitor element concentrations in caribou is essential to better comprehend potential threats facing the species, and to promote food security in communities harvesting this important resource.

Are phthalate ester contaminants in northern fulmar preen oil higher in birds that have ingested more plastic?

Understanding the impacts of plastic pollution is a global research priority. Previous research has shown that plasticizers such as phthalate esters detected in seabird tissues can be useful non-lethal biochemical markers of plastic ingestion as compared with more standard necropsy techniques. We examined the concentrations of six phthalate esters in the preen oil of Northern Fulmars (Fulmarus glacialis) in relation to their retained plastics. Contrary to a previous study, we found that the phthalates examined were not analytically detectable in fulmar preen oil. Given that the birds we examined had up to 100 pieces of plastics in their stomachs, and all uropygial glands were completely emptied during the necropsies, it does not appear that measuring phthalates in preen oil of Northern Fulmars is a useful, non-lethal technique to determine if individuals ingest plastics, at least not currently given the available commercial analytical detection limits.

Anti-parasite treatment results in decreased estimated survival with increasing lead (Pb) levels in the common eider Somateria mollissima

Field experiments where parasites are removed through treatment and contaminant levels in host tissues are recorded can provide insight into the combined effects of parasitism and contaminants in wild populations. In 2013 and 2014, we treated northern common eider ducks (Somateria mollissima) arriving at a breeding colony with either a broad-spectrum antihelminthic (PANACUR^®) or distilled water, and measured their blood lead (Pb) levels. Breeding propensity and clutch sizes were inversely related to Pb in both treatment groups. In comparison, a negative effect of Pb on resight probability the following year was observed only in the anti-parasitic treatment (APT) group. These contrasting patterns suggest a long-term benefit to survival of intestinal parasitism in eiders experiencing Pb exposure. The arrival date of hens explained some, but not all, of the effects of Pb. We weigh the merits of different hypotheses in explaining our results, including protective bioaccumulation of Pb by parasites, condition-linked thresholds to costly reproduction and the direct effects of APT on eider health. We conclude that variation in helminth parasitism influences survival in this migratory bird in counterintuitive ways.

Garbage in guano? Microplastic debris found in faecal precursors of seabirds known to ingest plastics

Plastic pollution is global environmental contaminant. Plastic particulates break down into smaller fragments in the environment, and these small pieces are now commonly found to be ingested by animals. To date, most plastic ingestion studies have focused on assessing retained plastics or regurgitated plastics, but it is likely that animals also excrete plastic and other debris items. We examined the terminal portion of the gastrointestinal tract of a seabird known to commonly ingest plastics, the Northern Fulmar (Fulmarus glacialis), to determine if seabirds excrete microplastics and other debris via their guano. We also examine how guano collections may be used as an indicator of retained plastics. The frequency of occurrence of microplastics did not correlate between the gut and faecal precursor samples, but there was a positive relationship between the number of pieces of plastics in the gut and the number of microplastics in the guano. Our findings suggest that seabirds are acting as vectors of microplastics and debris in the marine environment where their guano accumulates around their colonies. This transport of microplastics and debris by colonial seabirds needs to be further examined, and considered when designing environmental monitoring for microplastics in regions where seabird colonies are found.

Are ingested plastics a vector of PCB contamination in northern fulmars from coastal Newfoundland and Labrador?

While marine animals are exposed to environmental contaminants via their prey, because plastic pollution in the aquatic environment can concentrate some chemicals, ingested plastics are thought to increase the exposure of biota to contaminants. Currently, in the literature there are contradictory results relating to how higher levels of ingested plastics by birds may lead to higher levels of polychlorinated biphenyl (PCBs). To date none of these have incorporated known Toxic Equivalency Factors (TEFs) for non-ortho and mono-ortho congeners of PCB which is critical to assessing the potential effects from PCBs. We examined northern fulmars (Fulmarus glacialis) from the Labrador Sea region Canada, and the ingested plastics from these same birds for comparative PCB concentrations. We found no significant correlations between the PCB concentrations in the birds and the mass or number of retained ingested plastic pieces in the stomach, this held true when PCBs were considered by a number of different ways, including ∑₄PCB, ∑PCB, lower-chlorinated, high-chlorinated, non-ortho PCB, and mono-ortho congeners. PCB concentrations were lower in plastics as compared with livers. We found significant differences in congener profiles between the ingested plastics and seabird livers suggesting that while plastics do not contribute to the PCB concentrations, there may be some interactions between plastics and the chemicals that the birds are exposed to via ingested plastics.

Plastic and Non-plastic Debris Ingestion in Three Gull Species Feeding in an Urban Landfill Environment

Plastic debris is recognized as a widespread, common and problematic environmental pollutant. An important consequence of this pollution is the ingestion of plastic debris by wildlife. Assessing the degree to which different species ingest plastics, and the potential effects of these plastics on their health are important research needs for understanding the impacts of plastic pollution. We examined debris (plastic and other types) ingestion in three sympatric overwintering gull species (Herring gulls Larus smithsonianus, Great Black-backed Gulls Larus marinus, and Iceland Gulls Larus glaucoides) to understand how debris ingestion differs among species, age classes and sexes in gulls. We also assessed how plastic burdens were associated with body condition to investigate how gulls may be affected by debris ingestion. There were no differences among the species, age classes or sexes in the incidence of debris ingestion (plastic or otherwise), the mass or number of debris pieces ingested. We found no correlation between ingested plastics burdens and individual condition. Gulls ingested plastic debris, but also showed high levels of other debris types as well, including metal, glass and building materials, including a metal piece of debris found within an abscess in the stomach. Thus, when the health effects of debris ingestion on gulls, and other species that ingest debris, is of interest, either from a physical or chemical perspective, it may be necessary to consider all debris types and not just plastic burdens as is often currently done for seabirds.

Anti-parasite treatment, but not mercury burdens, influence nesting propensity dependent on arrival time or body condition in a marine bird

Arctic wildlife can be exposed to high mercury (Hg) levels, and are also naturally exposed to gastrointestinal parasites that can reduce condition and negatively affect reproductive output and/or survival in similar ways. Importantly, both Hg and parasites are increasing in wildlife in some Arctic regions. We studied the northern common eider duck (Somateria mollissima) to explore how Hg in association with both natural levels and experimentally reduced parasitic infections, affect reproduction and survival. Female eiders were measured, banded, and blood sampled to determine blood Hg burdens, prior to breeding. Propensity to nest, clutch size, nest survival, nest attendance, and return rates were assessed in relation to both Hg burden and parasite treatment. Neither reproduction nor return rates of females varied with Hg concentrations, but females arriving late to the colony, or in low body condition, showed increased nesting propensity when given the anti-parasite treatment as compared to placebo treatment. Our results suggest that parasites can play a critical role in decisions to invest in avian breeding annually, particularly among individuals with a late onset to breeding, and in poor condition.

Implications of mercury and lead concentrations on breeding physiology and phenology in an Arctic bird

Although physiological traits and phenology are thought to be evolved traits, they often show marked variation within populations, which may be related to extrinsic factors. For example, trace elements such as mercury (Hg) and lead (Pb) alter biochemical processes within wildlife that may affect migration and breeding. While there is a growing understanding of how contaminants may influence wildlife physiology, studies addressing these interactions in free-living species are still limited. We examined how four non-essential trace elements (cadmium, Hg, Pb and selenium) interacted with physiological and breeding measures known to influence breeding in a free-living population of common eider ducks (Somateria mollissima). We collected blood from female eiders as they arrived at a breeding colony in northern Canada. Blood was subsequently assessed for baseline corticosterone (CORT), immunoglobulin Y (IgY), and the four trace elements. We used model selection to identify which elements varied most with CORT, IgY, arrival condition, and arrival timing. We then used path analysis to assess how the top two elements from the model selection process (Hg and Pb) varied with metrics known to influence reproduction. We found that arrival date, blood Hg, CORT, and IgY showed significant inter-annual variation. While blood Pb concentrations were low, blood Pb levels significantly increased with later arrival date of the birds, and varied negatively with eider body condition, suggesting that even at low blood concentrations, Pb may be related to lower investment in reproduction in eiders. In contrast, blood Hg concentrations were positively correlated with eider body condition, indicating that fatter birds also had higher Hg burdens. Overall, our results suggest that although blood Hg and Pb concentrations were below no-effect levels, these low level concentrations of known toxic metals show significant relationships with breeding onset and condition in female eider ducks, factors that could influence reproductive success in this species.

Direct and indirect causes of sex differences in mercury concentrations and parasitic infections in a marine bird

In many animal species, males and females differ in their levels of contaminants and/or parasitic infections. Most contaminants and gastro-intestinal parasites are obtained through prey ingestion, and thus the causes of sex differences in the distribution of these factors might follow similar pathways. We studied the northern common eider duck (Somateria molissima borealis) as an avian model, and used directed separation path analysis to explore the causes of sex differences in mercury (Hg) and gastro-intestinal helminths. Two trophically transmitted helminths were examined: a cestode (Lateriporus sp.) and an acanthocephalan (Polymorphus sp). We found that the number of Lateriporus sp. varied positively with stable isotope signature (as indicated by δ(15)N in eider breast muscle tissue), and negatively with crustaceans being present in the short term diet. We also found that Polymorphus sp. varied positively with eider tissue stable isotope signature. However, Polymorphus sp. varied negatively with sex indirectly through condition and liver mass. Similarly, Hg concentrations also varied negatively with sex indirectly through condition and liver mass, with both Polymorphus sp. intensity and Hg concentrations significantly higher in males. We found that model fit increased when a negative relationship between the two helminth species was included, suggesting a yet unknown causal mechanism linking these parasites. Our findings suggest that although Hg and gastro-intestinal parasites are both trophically transmitted through the eider's prey items, the factors that contribute towards bioaccumulation of these two burdens differ in source, likely caused by several different factors and may potentially influence each other.

Plastic debris in great skua (Stercorarius skua) pellets corresponds to seabird prey species

Plastic is a common item in marine environments. Studies assessing seabird ingestion of plastics have focused on species that ingest plastics mistaken for prey items. Few studies have examined a scavenger and predatory species that are likely to ingest plastics indirectly through their prey items, such as the great skua (Stercorarius skua). We examined 1034 regurgitated pellets from a great skua colony in the Faroe Islands for plastics and found approximately 6% contained plastics. Pellets containing remains of Northern fulmars (Fulmarus glacialis) had the highest prevalence of plastic. Our findings support previous work showing that Northern fulmars have higher loads of plastics than other sympatric species. This study demonstrates that marine plastic debris is transferred from surface feeding seabird species to predatory great skuas. Examination of plastic ingestion in species that do not ingest plastics directly can provide insights into how plastic particles transfer vertically within the food web.

Trace element concentrations and gastrointestinal parasites of Arctic terns breeding in the Canadian High Arctic

Baseline data on trace element concentrations are lacking for many species of Arctic marine birds. We measured essential and non-essential element concentrations in Arctic tern (Sterna paradisaea) liver tissue and brain tissue (mercury only) from Canada's High Arctic, and recorded the presence/absence of gastrointestinal parasites during four different phases of the breeding season. Arctic terns from northern Canada had similar trace element concentrations to other seabird species feeding at the same trophic level in the same region. Concentrations of bismuth, selenium, lead and mercury in Arctic terns were high compared to published threshold values for birds. Selenium and mercury concentrations were also higher in Arctic terns from northern Canada than bird species sampled in other Arctic areas. Selenium, mercury and arsenic concentrations varied across the time periods examined, suggesting potential regional differences in the exposure of biota to these elements. For unknown reasons, selenium concentrations were significantly higher in birds with gastrointestinal parasites as compared to those without parasites, while bismuth concentrations were higher in Arctic terns not infected with gastrointestinal parasites.

Plastic ingestion in marine-associated bird species from the eastern North Pacific

In addition to monitoring trends in plastic pollution, multi-species surveys are needed to fully understand the pervasiveness of plastic ingestion. We examined the stomach contents of 20 bird species collected from the coastal waters of the eastern North Pacific, a region known to have high levels of plastic pollution. We observed no evidence of plastic ingestion in Rhinoceros Auklet, Marbled Murrelet, Ancient Murrelet or Pigeon Guillemot, and low levels in Common Murre (2.7% incidence rate). Small sample sizes limit our ability to draw conclusions about population level trends for the remaining fifteen species, though evidence of plastic ingestion was found in Glaucous-Winged Gull and Sooty Shearwater. Documenting levels of plastic ingestion in a wide array of species is necessary to gain a comprehensive understanding about the impacts of plastic pollution. We propose that those working with bird carcasses follow standard protocols to assess the levels of plastic ingestion whenever possible.