Objective To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA),... more Objective To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population. Methods We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected. Results Overall, 23 545 RA and 47 090 general populat...
Background Hepatitis C virus (HCV) education may be changing following the simplification of HCV ... more Background Hepatitis C virus (HCV) education may be changing following the simplification of HCV treatment and emergence of direct acting antiviral (DAA). We aimed to characterize HCV knowledge among people who recently completed DAA therapy. Methods The Per-SVR (Preservation of Sustained Virologic Response) is a prospective cohort of patients who achieved a sustained virologic response upon successful completion of DAA therapy. The per-SVR study provided the sampling frame of participants who completed a psychometrically validated 19-item HCV knowledge scale at cohort entry (n = 227). To score the questionnaire, for each correct response one point was awarded, with no point for incorrect response. We assessed mean HCV knowledge score in the overall sample and mutually exclusive populations: people who inject drug (PWID) (n = 71); people with co-occurring HIV (n = 23); PWID and co-occurring HIV (n = 29), and others (n = 104) Using a latent class analysis based on distal outcome, we ...
OBJECTIVE To evaluate secular trend in ten-year risk of incident acute myocardial infarction (AMI... more OBJECTIVE To evaluate secular trend in ten-year risk of incident acute myocardial infarction (AMI) in incident rheumatoid arthritis (RA) relative to the general population. METHODS We conducted a retrospective study of population-based incident RA cohorts with RA incidence from 1997 to 2004 in British Columbia, Canada, with matched general population comparators, using administrative health data. RA and their matched cohorts were divided according to the year of RA incidence, defined according to the first RA visit of the case definition. Incident AMI was defined as the first event occurring within 10 years from RA incidence. Secular trend was assessed using delayed-entry Cox models with an interaction term between the year of RA onset and indicator of RA vs. general population. Linear, quadratic and spline functions of year of RA onset were compared to assess possibility of nonlinear trends. The model with the lowest AIC was selected to interpret the results. Sensitivity analyses were conducted to account for potential effect of unmeasured (e.g. smoking) or partially measured (e.g. obesity) confounders in administrative data, on the interaction term. RESULTS Overall, 23,237 RA and 46,474 general population controls experienced 1,133 and 1,606 incident AMIs, respectively. A linear Cox model was selected as the model best fitting the AMI events. Overall, RA patients were found to have a 21% higher risk of AMI than the matched general population controls [1.21 (1.10, 1.32); p < 0.001]. A significant linear decline in risk of AMI was observed in RA patients [0.94 (95% CI 0.91, 0.97) p = <0.0001], and in the general population [0.93 (0.91, 0.95); p = <0.0001]. The change in AMI risk over time did not differ in RA compared to the general population [p-value of interaction term=0.49]. Our results remained similar after adjusting for the potential effect of confounders on the interaction term, and no difference in the change in risk of AMI over time was observed between RA and the general population. CONCLUSION Our findings suggest a decline in 10-year risk of AMI in RA, and in the general population. The decline in the risk of AMI over time did not differ between RA and the general population, such that the excess risk of AMI in RA relative to the general population, has remained the same.
ObjectiveThere is a dearth of high-quality systematic evidence on the impact of opioid substituti... more ObjectiveThere is a dearth of high-quality systematic evidence on the impact of opioid substitution medications on mental health. We compared mental health outcomes between opioid medications and placebo/waitlist, and between different opioids.MethodsThis systematic review and meta-analysis of randomized clinical trials (RCTs) was pre-registered at PROSPERO (CRD42018109375). Embase, MEDLINE, PsychInfo, CINAHL Complete, and Web of Science Core Collection were searched from inception to May 2020. RCTs were included if they compared opioid agonists with each other or with a placebo/waitlist in substitution treatment of patients with opioid use disorder, and reported at least one mental health outcome on a span of more than 1-month post baseline. Studies with psychiatric care, adjunct psychotropic medications, or unbalanced psychosocial services were excluded. Primary outcomes were comparison of depressive symptoms and overall mental health between opioids and placebo/waitlist. Random e...
Social Psychiatry and Psychiatric Epidemiology, 2020
Objective To assess impact of employment on recovery in a sample of adults from Vancouver At Home... more Objective To assess impact of employment on recovery in a sample of adults from Vancouver At Home (VAH) study, who were homeless and were diagnosed with severe mental disorders. Methods The VAH included two randomized controlled trials investigating the effect of housing first with support intervention in vulnerable population. Employment was assessed at baseline and during the follow-up using Demographics, Housing, Vocational, and Service Use History (DSHH), and Vocational Timeline Follow-Back (VTLFB) self-report questionnaires, respectively. Recovery was examined using Recovery Assessment Scale (RAS) at baseline and at 24-month follow-up visit. Multivariable regression models were built to examine: (1) the effect of current employment at baseline on RAS score at baseline, and RAS score at 24-month follow-up visit; and (2) and to examine the cumulative effect of recent employment over 8 follow-up visits on RAS score at 24-month visit. Cumulative effect of employment over the follow-up visits was weighted by recency using a pre-specified weighting function. Results Employment at baseline was associated with an increase in recovery score at baseline [8.06 (95% CI 1.21, 14.91); p = 0.02], but not with recovery score at 24-month follow-up visit [3.78 (−4.67, 12.24); p = 0.37]. Weighted cumulative effect of employment over 8 follow-up visits was associated with increase in RAS score at 24-month follow-up visit [8.33 (1.68, 14.99) p = 0.01]. Conclusion Employment is associated with an increase in recovery. Our result suggests a dual effect of employment on recovery, an immediate effect through current employment, and a long-term effect of cumulative employment.
THU0110-Table 2. Results: After PSM, baseline characteristics in 283 pairs of pts with and withou... more THU0110-Table 2. Results: After PSM, baseline characteristics in 283 pairs of pts with and without SS were well balanced (Table 1). Mean change in CDAI score was numerically lower in SS than non-SS pts (8.8 vs 9.3; Table 2), but this did not reach statistical significance. Improvements in pain, fatigue and stiffness were 2-2.5-fold greater for non-SS than SS pts (Table 2). Conclusion: Among those initiating b/tsDMARD treatment, improvements in RA-related PROs were lower in pts with RA with SS than non-SS pts. Physicians may want to consider SS status secondary to RA when managing pts with RA and specifically explore whether additional intervention is needed to improve the pt experience for pts with RA.
large scale of study 2). In daily practice or observation, "patient's VAS" is usually used withou... more large scale of study 2). In daily practice or observation, "patient's VAS" is usually used without specifying whether it refers to PtGA or PtGH. The factors which influence the change in PtGA or PtGH have not been demonstrated concomitantly in daily practice. Objectives: We investigated the difference between PtGA and PtGH, especially each change obtained after intensification of treatment in 12 weeks and identified the factors that influence on each measurement in RA patients. Methods: Consecutive patients were enrolled to this retrospective study at our hospital from October 2017 to September 2018. Demographic and clinical data at enrollment as well as treatment regimens were collected by review of medical charts. At first, we examined the baseline data and the changes in 12 weeks of PtGA and PtGH in their relations. The second, we divided those patients into two subsets according to medications intensified by methotrexate (MTX) subset and biological disease-modifying antirheumatic drugs (DMARDs) or janus kinase (JAK) inhibitor (B/J) subset. We compared the difference of the changes in PtGA from the baseline to 12 weeks (DPtGA) and those in PtGH (DPtGH) between MTX subset and B/J subset. Finally, the logistic regression analysis was performed to identify factors that differently influence for each scale in 12 weeks. Results: Consecutive 38 RA patients were enrolled. Women were 76%. The median age [IQR] was 66.5 [55-75] years old. Disease duration was 2.5 [1-15] years. DAS28 was 2.61 [2.02-3.17]. SDAI was 16.8 [11.1-24.6] and CDAI was 15.3 [9.38-23.9]. MTX was initiated or increased in 24 patients (63%). The baseline median dose of MTX was 6 [3.5-8] mg/ week. Biologics or JAK inhibitor were initiated in 8 patients (21%); tocilizumab (n=5), golimumab (n=1), abatacept (n=1) and tofacitinib (n=1). Other DMARDs were used in 6 patients (16%). DPtGH in 12 weeks was-1.68 (p<0.01), and DPtGA in 12 weeks was-2.22 (p<0.01). DPtGH and DPtGA correlated significantly (r=0.785, p<0.01). DPtGA in MTX subsets was not different from that in B/J subsets in (p=0.50) and DPtGH was not either (p=0.57). No significant improving factor in DPtGA was identified, whereas, woman (p<0.05) and usage of steroid (p<0.01) were improving factors in DPtGH. Conclusion: Intensification of treatment significantly improved in both DPtGA and DPtGH but we need to pay attentions that there were different improving factors between these two patient's measuremet.
Objective To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA),... more Objective To evaluate secular trends in 10-year risk of incident cerebrovascular accidents (CVA), in incident RA relative to the general population. Methods We conducted a retrospective study of a population-based incident cohort with RA onset from 1997 to 2004 in British Columbia, Canada, with matched general population controls (2:1), using administrative health data. RA and general population cohorts were divided according to year of RA onset, defined according to the first RA visit of the case definition. Incident CVA was defined as the first CVA occurring within 10 years from the first RA visit. Secular trend was assessed using delayed-entry Cox models with a two-way interaction term between the year of RA onset and indicator of RA vs general population. Linear, quadratic and spline functions of year of RA onset were compared with assess non-linear effects. The model with the lowest Akaike Information Criterion was selected. Results Overall, 23 545 RA and 47 090 general populat...
Background Hepatitis C virus (HCV) education may be changing following the simplification of HCV ... more Background Hepatitis C virus (HCV) education may be changing following the simplification of HCV treatment and emergence of direct acting antiviral (DAA). We aimed to characterize HCV knowledge among people who recently completed DAA therapy. Methods The Per-SVR (Preservation of Sustained Virologic Response) is a prospective cohort of patients who achieved a sustained virologic response upon successful completion of DAA therapy. The per-SVR study provided the sampling frame of participants who completed a psychometrically validated 19-item HCV knowledge scale at cohort entry (n = 227). To score the questionnaire, for each correct response one point was awarded, with no point for incorrect response. We assessed mean HCV knowledge score in the overall sample and mutually exclusive populations: people who inject drug (PWID) (n = 71); people with co-occurring HIV (n = 23); PWID and co-occurring HIV (n = 29), and others (n = 104) Using a latent class analysis based on distal outcome, we ...
OBJECTIVE To evaluate secular trend in ten-year risk of incident acute myocardial infarction (AMI... more OBJECTIVE To evaluate secular trend in ten-year risk of incident acute myocardial infarction (AMI) in incident rheumatoid arthritis (RA) relative to the general population. METHODS We conducted a retrospective study of population-based incident RA cohorts with RA incidence from 1997 to 2004 in British Columbia, Canada, with matched general population comparators, using administrative health data. RA and their matched cohorts were divided according to the year of RA incidence, defined according to the first RA visit of the case definition. Incident AMI was defined as the first event occurring within 10 years from RA incidence. Secular trend was assessed using delayed-entry Cox models with an interaction term between the year of RA onset and indicator of RA vs. general population. Linear, quadratic and spline functions of year of RA onset were compared to assess possibility of nonlinear trends. The model with the lowest AIC was selected to interpret the results. Sensitivity analyses were conducted to account for potential effect of unmeasured (e.g. smoking) or partially measured (e.g. obesity) confounders in administrative data, on the interaction term. RESULTS Overall, 23,237 RA and 46,474 general population controls experienced 1,133 and 1,606 incident AMIs, respectively. A linear Cox model was selected as the model best fitting the AMI events. Overall, RA patients were found to have a 21% higher risk of AMI than the matched general population controls [1.21 (1.10, 1.32); p < 0.001]. A significant linear decline in risk of AMI was observed in RA patients [0.94 (95% CI 0.91, 0.97) p = <0.0001], and in the general population [0.93 (0.91, 0.95); p = <0.0001]. The change in AMI risk over time did not differ in RA compared to the general population [p-value of interaction term=0.49]. Our results remained similar after adjusting for the potential effect of confounders on the interaction term, and no difference in the change in risk of AMI over time was observed between RA and the general population. CONCLUSION Our findings suggest a decline in 10-year risk of AMI in RA, and in the general population. The decline in the risk of AMI over time did not differ between RA and the general population, such that the excess risk of AMI in RA relative to the general population, has remained the same.
ObjectiveThere is a dearth of high-quality systematic evidence on the impact of opioid substituti... more ObjectiveThere is a dearth of high-quality systematic evidence on the impact of opioid substitution medications on mental health. We compared mental health outcomes between opioid medications and placebo/waitlist, and between different opioids.MethodsThis systematic review and meta-analysis of randomized clinical trials (RCTs) was pre-registered at PROSPERO (CRD42018109375). Embase, MEDLINE, PsychInfo, CINAHL Complete, and Web of Science Core Collection were searched from inception to May 2020. RCTs were included if they compared opioid agonists with each other or with a placebo/waitlist in substitution treatment of patients with opioid use disorder, and reported at least one mental health outcome on a span of more than 1-month post baseline. Studies with psychiatric care, adjunct psychotropic medications, or unbalanced psychosocial services were excluded. Primary outcomes were comparison of depressive symptoms and overall mental health between opioids and placebo/waitlist. Random e...
Social Psychiatry and Psychiatric Epidemiology, 2020
Objective To assess impact of employment on recovery in a sample of adults from Vancouver At Home... more Objective To assess impact of employment on recovery in a sample of adults from Vancouver At Home (VAH) study, who were homeless and were diagnosed with severe mental disorders. Methods The VAH included two randomized controlled trials investigating the effect of housing first with support intervention in vulnerable population. Employment was assessed at baseline and during the follow-up using Demographics, Housing, Vocational, and Service Use History (DSHH), and Vocational Timeline Follow-Back (VTLFB) self-report questionnaires, respectively. Recovery was examined using Recovery Assessment Scale (RAS) at baseline and at 24-month follow-up visit. Multivariable regression models were built to examine: (1) the effect of current employment at baseline on RAS score at baseline, and RAS score at 24-month follow-up visit; and (2) and to examine the cumulative effect of recent employment over 8 follow-up visits on RAS score at 24-month visit. Cumulative effect of employment over the follow-up visits was weighted by recency using a pre-specified weighting function. Results Employment at baseline was associated with an increase in recovery score at baseline [8.06 (95% CI 1.21, 14.91); p = 0.02], but not with recovery score at 24-month follow-up visit [3.78 (−4.67, 12.24); p = 0.37]. Weighted cumulative effect of employment over 8 follow-up visits was associated with increase in RAS score at 24-month follow-up visit [8.33 (1.68, 14.99) p = 0.01]. Conclusion Employment is associated with an increase in recovery. Our result suggests a dual effect of employment on recovery, an immediate effect through current employment, and a long-term effect of cumulative employment.
THU0110-Table 2. Results: After PSM, baseline characteristics in 283 pairs of pts with and withou... more THU0110-Table 2. Results: After PSM, baseline characteristics in 283 pairs of pts with and without SS were well balanced (Table 1). Mean change in CDAI score was numerically lower in SS than non-SS pts (8.8 vs 9.3; Table 2), but this did not reach statistical significance. Improvements in pain, fatigue and stiffness were 2-2.5-fold greater for non-SS than SS pts (Table 2). Conclusion: Among those initiating b/tsDMARD treatment, improvements in RA-related PROs were lower in pts with RA with SS than non-SS pts. Physicians may want to consider SS status secondary to RA when managing pts with RA and specifically explore whether additional intervention is needed to improve the pt experience for pts with RA.
large scale of study 2). In daily practice or observation, "patient's VAS" is usually used withou... more large scale of study 2). In daily practice or observation, "patient's VAS" is usually used without specifying whether it refers to PtGA or PtGH. The factors which influence the change in PtGA or PtGH have not been demonstrated concomitantly in daily practice. Objectives: We investigated the difference between PtGA and PtGH, especially each change obtained after intensification of treatment in 12 weeks and identified the factors that influence on each measurement in RA patients. Methods: Consecutive patients were enrolled to this retrospective study at our hospital from October 2017 to September 2018. Demographic and clinical data at enrollment as well as treatment regimens were collected by review of medical charts. At first, we examined the baseline data and the changes in 12 weeks of PtGA and PtGH in their relations. The second, we divided those patients into two subsets according to medications intensified by methotrexate (MTX) subset and biological disease-modifying antirheumatic drugs (DMARDs) or janus kinase (JAK) inhibitor (B/J) subset. We compared the difference of the changes in PtGA from the baseline to 12 weeks (DPtGA) and those in PtGH (DPtGH) between MTX subset and B/J subset. Finally, the logistic regression analysis was performed to identify factors that differently influence for each scale in 12 weeks. Results: Consecutive 38 RA patients were enrolled. Women were 76%. The median age [IQR] was 66.5 [55-75] years old. Disease duration was 2.5 [1-15] years. DAS28 was 2.61 [2.02-3.17]. SDAI was 16.8 [11.1-24.6] and CDAI was 15.3 [9.38-23.9]. MTX was initiated or increased in 24 patients (63%). The baseline median dose of MTX was 6 [3.5-8] mg/ week. Biologics or JAK inhibitor were initiated in 8 patients (21%); tocilizumab (n=5), golimumab (n=1), abatacept (n=1) and tofacitinib (n=1). Other DMARDs were used in 6 patients (16%). DPtGH in 12 weeks was-1.68 (p<0.01), and DPtGA in 12 weeks was-2.22 (p<0.01). DPtGH and DPtGA correlated significantly (r=0.785, p<0.01). DPtGA in MTX subsets was not different from that in B/J subsets in (p=0.50) and DPtGH was not either (p=0.57). No significant improving factor in DPtGA was identified, whereas, woman (p<0.05) and usage of steroid (p<0.01) were improving factors in DPtGH. Conclusion: Intensification of treatment significantly improved in both DPtGA and DPtGH but we need to pay attentions that there were different improving factors between these two patient's measuremet.
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