Medication Gaps and Antipsychotic Polypharmacy in Previously Hospitalized Schizophrenia Patients: An Electronic Cohort Study in Three Canadian Provinces.

Background: Real world evidence about antipsychotics focuses on rehospitalization. Modeling the time course of pharmacotherapy would show patients' adherence to medications and physicians' adherence to medication guidelines. We aimed to calculate the cumulative time spent in second generation antipsychotics (SGAs), gaps, antipsychotic polypharmacy, and clozapine in discharged schizophrenia patients. Methods: Hospitalization and pharmacy dispensing data from 2008-2018 in Manitoba, Saskatchewan, and British Columbia were linked and an electronic cohort (N = 2,997) was created (mean follow-up: 49 months, SD = 38). Cohort members were required to have a minimum of 6 weeks medicated with aripiprazole, olanzapine, paliperidone, quetiapine, risperidone, or ziprasidone. Results: The multistate model predicted that schizophrenia patients accumulated 44 months in SGA monotherapy, 4 months in polypharmacy, 11 months in medication gaps and 17 days in clozapine over a 5-year period. The majority of transitions were between SGA and medication gap. Accumulated time in medication gaps was seven times as much as in clozapine. Each 10% delay in SGA initiation post-discharge was associated with a 2, 1, and 6% higher risk for polypharmacy (95% CI: 1.01-1.02), gap (95% CI: 1.01-1.01), and clozapine (95% CI: 1.04-1.08), respectively. Interpretation: Schizophrenia patients accumulated more time unmedicated and in polypharmacy compared to clozapine. Either treatment guidelines for schizophrenia are not followed, or real-world challenges hamper their implementation.

Identifying long-term and imminent suicide predictors in a general population and a clinical sample with machine learning.

BACKGROUND: Machine learning (ML) is increasingly used to predict suicide deaths but their value for suicide prevention has not been established. Our first objective was to identify risk and protective factors in a general population. Our second objective was to identify factors indicating imminent suicide risk. METHODS: We used survival and ML models to identify lifetime predictors using the Cohort of Norway (n=173,275) and hospital diagnoses in a Saskatoon clinical sample (n=12,614). The mean follow-up times were 17 years and 3 years for the Cohort of Norway and Saskatoon respectively. People in the clinical sample had a longitudinal record of hospital visits grouped in six-month intervals. We developed models in a training set and these models predicted survival probabilities in held-out test data. RESULTS: In the general population, we found that a higher proportion of low-income residents in a county, mood symptoms, and daily smoking increased the risk of dying from suicide in both genders. In the clinical sample, the only predictors identified were male gender and older age. CONCLUSION: Suicide prevention probably requires individual actions with governmental incentives. The prediction of imminent suicide remains highly challenging, but machine learning can identify early prevention targets.

Association between the 10-year predicted risk of atherosclerotic cardiovascular disease and dietary patterns among Canadian adults 40-79 years.

BACKGROUND/OBJECTIVES: Identifying groups at risk for atherosclerotic cardiovascular disease (ASCVD) and improving prevention strategies are important due to the high rates of these diseases in the world. We aimed to determine the 10-year ASCVD risk and cardiovascular age gap (CAG) of Canadians 40-79 and the association between prevalent dietary patterns and ASCVD risk, and CAG. SUBJECTS/METHODS: Health measures and dietary intake information were obtained from 2088 respondents representative of 13,655,671 Canadians 40-79 years in the cross-sectional Canadian Health Measures Survey Cycles 1 and 2 (2007-11). The estimated 10-year ASCVD risk and CAG were determined for 40-79 years adults across different levels of sociodemographic/lifestyle factors. Dietary patterns emerged using the principal component analysis from 32 food groups collected using food frequency questionnaire. The association between 10-year ASCVD risk, and CAG, with dietary patterns was investigated controlling for potential covariates. Survey data were weighted and bootstrapped to be nationally representative. RESULTS: The mean 10-year ASCVD risk of 40-79 years was 6.9%. The mean CAG for men was -4.1 years (older) and for females was +0.4 years (younger). Four dietary patterns emerged. Of note, the "High carbohydrate and protein" dietary pattern, which included potatoes, red meat, sausage, egg and ice-cream/frozen yoghurt was positively associated with 10-year ASCVD (Ptrend = 0.013). The "Healthy like" and "Fast food" dietary patterns had an inverse (p < 0.0001) and positive (p = 0.005) association, respectively, with CAG. CONCLUSIONS: Dietary patterns prevalent among this population were associated with CAG and ASCVD risk. Interventions for promoting healthy dietary patterns may be beneficial to reduce ASCVD in Canada.

Consumption of Ready-to-Eat Cereal in Canada and Its Contribution to Nutrient Intake and Nutrient Density among Canadians.

In recent years, ready-to-eat cereal (RTEC) has become a common breakfast option in Canada and worldwide. This study used the nationally representative cross-sectional data from the Canadian Community Health Survey (CCHS) 2015-Nutrition to determine patterns of RTEC consumption in Canada and the contribution to nutrient intake among Canadians who were ≥2 years, of whom 22 ± 0.6% consumed RTEC on any given day. The prevalence of RTEC consumption was highest in children aged two to 12 years (37.6 ± 1.2%), followed by adolescents aged 13 to 18 years (28.8 ± 1.4%), and then by adults ≥19 years (18.9 ± 0.6%). RTEC consumers had higher intakes of "nutrients to encourage" compared to the RTEC non-consumers. More than 15% of the daily intake of some nutrients, such as folic acid, iron, thiamin, and vitamin B6, were contributed by RTEC. It was noted that nearly 66% of milk consumption was co-consumed with RTEC among RTEC consumers. The nutrient density of the diet, as defined by Nutrient-Rich Food Index (NRF 9.3), was significantly higher among RTEC consumers compared to non-consumers. RTEC consumption was not associated with overweight/obesity. RTEC consumption considerably contributed to the intake of some key nutrients among all age groups in Canada.

Consumption of Yogurt in Canada and Its Contribution to Nutrient Intake and Diet Quality Among Canadians.

The current study utilizes a nationally representative nutrition survey data (Canadian Community Health Survey 2015, nutrition component, n = 20,487) in order to evaluate patterns of yogurt consumption among Canadians. Overall, 20% of Canadians have reportedly consumed yogurt on a given day in 2015. Higher prevalence of yogurt consumption was noted among children aged 2-5 years old (47%) when compared to adults aged 19-54 years (18%). When the prevalence of yogurt consumption at the regional level in Canada was assessed, Quebec had the most consumers of yogurt (25%) compared to other regions, namely the Atlantic (19%), Ontario (18%), Prairies (19%) and British Columbia (20%). Yogurt consumers reported consuming higher daily intakes of several key nutrients including carbohydrates, fibre, riboflavin, vitamin C, folate, vitamin D, potassium, iron, magnesium, and calcium when compared to yogurt non-consumers. Additionally, the diet quality, measured using NRF 9.3 scoring method, was higher among yogurt consumers compared to non-consumers. Nearly 36% of Canadians who meet the dietary guidelines for milk and alternative servings from the Food Guide Canada (2007) reported consuming yogurt. Lastly, no significant difference in BMI was noted among yogurt consumers and non-consumers. Overall, yogurt consumers had a higher intake of key nutrients and had a better diet quality.

Consumption Patterns of Grain-Based Foods among Adults in Canada: Evidence from Canadian Community Health Survey-Nutrition 2015.

In this study, we used the Canadian Community Health Survey-Nutrition (CCHS) 2015 data to examine the consumption patterns of grain-based foods (GBFs) for Canadian adults. We used a k-mean cluster analysis based on the contribution of 21 grain-based foods to total energy intake of adults in Canada to find the dietary patterns of GBFs. Cluster analyses rendered seven dietary patterns including: 'other bread', 'cake and cookies', 'pasta', 'rice', 'mixed', 'white bread', and finally 'whole wheat and whole-grain bread'. 'No grain' and 'rice' consumers had lower intakes of dietary fibre, folate, iron and calcium, which are the nutrients of public health concern in Canada. Adults consuming a 'mixed grain' dietary pattern had a greater daily intake of calcium, potassium, magnesium, riboflavin, and vitamin B6 than those in the 'no grain' dietary pattern. We also observed that a considerable proportion of individuals clustered in the 'rice' group are immigrants and belong to households with lower income levels.

Consumption Patterns of Grain-Based Foods among Children and Adolescents in Canada: Evidence from Canadian Community Health Survey-Nutrition 2015.

The current analyses used data from the Canadian Community Health Survey-Nutrition 2015 to investigate grain-based food (GBF) dietary patterns of consumptions among 6,400,000 Canadian children and adolescents 2 to 18 years old. Nutrient intakes, socioeconomic differences, body mass index (BMI) z-scores, and intakes of several food groups were examined across the identified grain patterns of consumption. We employed k-mean cluster analysis to identify the consumption patterns of grain products. Based on the contributions of 21 grain food groups to the total energy intake of each individual, seven GBF consumption patterns were identified including other bread; salty snacks; pasta; rice; cakes and cookies; white bread; and mixed grains. Individuals having less than one serving of grain products were also separately categorized as no-grain consumers. Mean energy intake (kcal/day) was lowest for the "no-grain" consumers and greatest in children/adolescents consuming a "salty snacks" pattern when all GBF patterns were compared. Children and adolescents with "no-grain" and "rice" GBF consumption patterns had significantly lower intakes of several nutrients including dietary fiber, folate, magnesium, calcium, iron, zinc, thiamin, niacin, and riboflavin. No associations were observed with any of the identified GBF patterns and BMI z-scores. In addition, the socioeconomic status (SES) indicators such as household incomes and immigration status of participants were shown to be significantly different across the identified clusters.