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Challenges of developing a cervical screening information system: the Ontario pilot project.

OBJECTIVE: To create a cervical screening information and reporting system in 2 geographic areas of Ontario. DESIGN: A pilot project involving access to, and linkage of, cervical screening-related cytology, colposcopy and histopathology records for women in the study areas, followed by development and production of woman-specific and aggregate reports. SETTING: Hospital cytology and pathology departments, colposcopy clinics, private cytology laboratories, and the provincial cancer agency (Cancer Care Ontario, formerly the Ontario Cancer Treatment and Research Foundation). MAIN OUTCOME MEASURES: Access to required records; data quality (i.e., standardization, completeness, accuracy); quality of record linkage; utility of reports to evaluators, data sources and physicians. RESULTS: The pilot project was not completed because of a number of major challenges, including multiple data sources requiring separate investigation and negotiations for access; variations in reporting terminology and coding; incompatibility or lack of computer systems; incompleteness of identifiers for record linkage; variation in legislation permitting data access and sharing and in its interpretation; and major financial, resource and time requirements. CONCLUSIONS: Although sufficient will and resources can overcome technical obstacles, changes in legislation will be required to overcome other challenges. Strong links with all sectors involved in cervical screening and attention to changes in the health care system are essential.

Colposcopy↗

Incidence of IDDM in German children aged 0-14 years. A 6-year population-based study (1987-1993)

OBJECTIVE: Generally accepted data on the incidence of childhood diabetes in Germany have not been available up to now. To register the total number of newly diagnosed cases in Baden-Wuerttemberg (a federal state in southwest Germany), data on 1,160 children were retrospectively collected for the years 1987-1993. RESEARCH DESIGN AND METHODS: Hospital records were the primary data source. There were 32 hospital units in Baden-Wuerttemberg included in this study. A secondary independent data source was a questionnaire circulated among the patients' association, Deutscher Diabetiker Bund. Case definition was done according to criteria EURODIAB ACE, a collaborative European study set up to assess the incidence of childhood diabetes. The degree of ascertainment was 96.2%, using the capture-mark-recapture method. The study includes a population at risk, entailing 1.5 million children, corresponding to 12.3% of all German children. RESULTS: The incidence was found to be 11.6/100,000 (95% CI 10.9-12.2) for children aged 0-14 years. There was no significant difference between the incidence rates of boys and girls. Seasonal variation was observed, with cases increasing between November and February and incidence increasing with age. Peaks were found in early childhood (3-4 years of age) and prepuberty (10-12 years of age). There was marked geographical variation that did not correlate significantly with population density. CONCLUSIONS: For the first time, internationally comparable data on the incidence of diabetes in children up to 15 years of age are available for Germany. The yearly incidence of 11.6/100,000 proved to be much higher than assumed so far.

Age Factors↗

Using data for couples to project the distributional effects of changes in Social Security policy.

Under Social Security program rules, the aged receive Social Security benefits either as retired workers, spouses, divorced spouses, or widow(er)s. Retired-worker benefits are paid to workers who have 40 quarters of coverage over their lives. Auxiliary benefits are paid to spouses, divorced spouses, and widow(er)s of retired workers. Spouse benefits are computed using the earnings history of the current spouse for individuals who are married when they apply for benefits. Divorced spouse and widow(er) benefits are computed using the earnings history of the ex-spouse or deceased spouse with the highest PIA. A large number of retired women are entitled to auxiliary benefits. Some women receive only auxiliary benefits, while the majority of women have their retired-worker benefit supplemented by auxiliary benefits. Because the level of Social Security benefits can reflect the relative lifetime earnings of both spouses, as a couple, using individual data to estimate Social Security benefits will tend to underestimate actual benefits, particularly for women. However, detailed data for couples are often difficult to obtain. There is currently no known single data source that includes both marital and earnings history information. As a result, many researchers resort to estimating Social Security benefits using individual data or aggregate data, such as the average earnings of men and women. The Social Security Administration's Office of Research, Evaluation, and Statistics, with substantial assistance from the Brookings Institution, the Urban Institute, and the RAND Corporation, is developing a model that overcomes this problem by using the marital and earnings histories of both marital partners to estimate Social Security benefits. The Modeling Income in the Near Term (MINT) model projects retirement income (Social Security benefits, pension income, asset income, and earnings of working beneficiaries) from 1997 through 2031 for current and future Social Security beneficiaries using a unique data source--the Survey of Income and Program Participation (SIPP)--matched to Social Security Administration records. Using MINT data, this article establishes the importance of using data for couples rather than individuals by examining the impact of changing Social Security benefits to reflect 40 years of lifetime earnings rather than the 35 years required under current law. We compare the effect of this policy change on married women by estimating their benefits with data for couples and with individual data. Results indicate that: Using individual data overestimates the projected reduction in retirement benefits brought about by the policy change and makes the effects on women look more severe than they actually are. Because older birth cohorts are more likely than younger cohorts to receive auxiliary benefits based on their husbands' average lifetime earnings, the bias created by using individual data is projected to be much larger for older cohorts than for younger cohorts. This article emphasizes the importance of using data for couples to estimate Social Security benefits, particularly for women. Although our focus is on married women, using data for couples is just as important for calculating the retirement benefits of divorced and widowed individuals. For individuals who are divorced or widowed at retirement, their Social Security benefits are based on their own earnings history, as well as the earnings histories of each of their previous spouses.

Age Factors↗

Statistical evaluation of bacterial source tracking data obtained by rep-PCR DNA fingerprinting of Escherichia coli.

Pattern recognition has been applied to environmental systems for identification of numerous pollution sources including aerosolized lead and petroleum hydrocarbons. In recent years, DNA fingerprinting has gained widespread application as a means to characterize genetic variations for such purposes as microbial source tracking. This approach, however, is strongly dependent on the statistical and image analyses applied. Several statistical analyses of rep-PCR DNA fingerprints were assessed as a means to differentiate between potential sources of fecal contamination. GelCompar II and methods based on penalized discriminant analysis (PDA) and k-nearest neighbors (KNN) classification procedures were used to differentiate between 10 source groups within a library containing DNA fingerprints of 548 Escherichia coli isolates from known human and nonhuman sources. KNN performed significantly better than PDA in a jackknife analysis, though the library was not large enough to detect significant differences between GelCompar II and the other two methods. GelCompar II and KNN both attained > or = 90% correct classification in a holdout procedure. In addition, interpoint distance analyses indicate coherency within source groups, while library randomization demonstrated that KNN does not create artificial groupings. This investigation stresses the need to understand limitations of statistical analyses used in pattern recognition of DNA fingerprints.

DNA Fingerprinting↗

An update of cancer mortality among the French cohort of uranium miners: extended follow-up and new source of data for causes of death.

The follow-up of the French cohort of uranium miners has been extended to 1994, and a new source of information for causes of death has been used. The paper presents the new results regarding the risk of death among the cohort, and analyses the impact of the methodological changes on these results. The extension of the follow-up results in a substantial increase in statistical power compared with previous analysis (+25% for person-years and +74% for the number of deaths). The use of the National Mortality Database as the principal source for causes of death allows to reduce the potential bias in the calculation of standardized mortality ratios (SMR). As a consequence, an excess risk of deaths from laryngeal cancer, suggested in the first analysis, is not confirmed. The analysis shows the existence of an excess risk of deaths from lung cancer among French uranium miners (85 observed deaths, SMR = 1.9, 95% confidence interval CI: 1.5-2.3), and an increase of this risk with cumulative exposure to radon (excess relative risk per 100 working level month = 0.6, 95% CI: 0.1-1.2). These results confirm the existence of a risk of death from lung cancer in a population chronically exposed to relatively low levels of radon.

Adult↗

Contextualizing heterogeneous data for integration and inference.

Systems that attempt to integrate and analyze data from multiple data sources are greatly aided by the addition of specific semantic and metadata "context" that explicitly describes what a data value means. In this paper, we describe a systematic approach to constructing models of data and their context. Our approach provides a generic "template" for constructing such models. For each data source, a developer creates a customized model by filling in the tem-plate with predefined attributes and value. This approach facilitates model construction and provides consistent syntax and semantics among models created with the template. Systems that can process the template structure and attribute values can reason about any model so described. We used the template to create a detailed knowledge base for syndromic surveillance data integration and analysis. The knowledge base provided support for data integration, translation, and analysis methods.

Database Management Systems↗

Fulvestrant: pharmacologic profile versus existing endocrine agents for the treatment of breast cancer.

OBJECTIVE: To compare the pharmacologic profile of fulvestrant with that of tamoxifen and the aromatase inhibitors with respect to the choice of treatment for advanced breast cancer (ABC). DATA SOURCES: Principal literature and review articles were obtained from MEDLINE (1991-March 2006). Key search terms included fulvestrant, tamoxifen, aromatase inhibitors, pharmacology, and breast cancer. Further data sources were identified from the bibliographies of selected articles. STUDY SELECTION AND DATA EXTRACTION: English-language preclinical and clinical research and review articles reporting pharmacologic and safety data for fulvestrant, tamoxifen, and the aromatase inhibitors were evaluated to identify relevant information. Randomized clinical trial data were preferred over preclinical or Phase I and II trial data. DATA SYNTHESIS: A total of 52 clinical papers (including 10 reviews) and 17 clinical abstracts were evaluated reporting results from controlled Phase I-III studies and pilot studies. Eleven preclinical papers (including 2 reviews) and 6 preclinical abstracts were also included. Fulvestrant has little effect on sex hormone endocrinology, bone metabolism, and lipid biochemistry and appears unlikely to be the subject or cause of CYP3A4-mediated drug interactions. Tamoxifen has a protective effect on bone (due to its partial estrogen agonist activity) and reduces plasma low-density lipoprotein cholesterol but increases triglyceride levels. The aromatase inhibitors have variable effects on lipid profiles and sex hormone endocrinology but have detrimental effects on bone due to inhibition of estrogen synthesis. Drug interactions have been noted between tamoxifen and anticoagulants and tamoxifen and aromatase inhibitors, which may be due to CYP-mediated mechanisms. CONCLUSIONS: Fulvestrant appears to have little effect on sex hormone endocrinology, bone metabolism, and lipid biochemistry and is unlikely to be subject to or the cause of CYP3A4-mediated drug-drug interactions. As such, fulvestrant represents a valuable new endocrine therapy for the treatment of ABC and broadens the options available to clinicians in the treatment of this disease.

Antineoplastic Agents, Hormonal↗

The role of public clinics in preventable hospitalizations among vulnerable populations.

OBJECTIVE: To determine if the availability of public ambulatory clinics affects preventable hospitalization (PH) rates of low-income and elderly populations. DATA SOURCES: PH rates were calculated using elderly and low-income discharges from 1995-97 Virginia hospital discharge data. Other data sources include the 1990 Census, the 1998 Area Resource File, the 1996 American Hospital Association Survey, the Virginia Department of Health, the Virginia Primary Care Association, and the Bureau of Primary Health Care. STUDY DESIGN: Multiple linear regression was used to evaluate the relationship between ambulatory clinic availability and PH rates, controlling for population and other provider characteristics in a cross-section of zip code clusters. DATA EXTRACTION METHODS: Clusters with populations of at least 2,000 were assembled from zip codes in each county in the state of Virginia. Overlapping medical market service areas were constructed around the population centroid of each cluster. PRINCIPAL FINDINGS: Populations in medically underserved areas (MUAs) served by a Federally Qualified Health Center had significantly lower PH rates than did other MUA populations. The presence of a free clinic had a marginally significant association with lower PH rates. CONCLUSIONS: The availability of public ambulatory clinics is associated with better access to primary care among low-income and elderly populations.

Adolescent↗

Gene prioritization through genomic data fusion.

The identification of genes involved in health and disease remains a challenge. We describe a bioinformatics approach, together with a freely accessible, interactive and flexible software termed Endeavour, to prioritize candidate genes underlying biological processes or diseases, based on their similarity to known genes involved in these phenomena. Unlike previous approaches, ours generates distinct prioritizations for multiple heterogeneous data sources, which are then integrated, or fused, into a global ranking using order statistics. In addition, it offers the flexibility of including additional data sources. Validation of our approach revealed it was able to efficiently prioritize 627 genes in disease data sets and 76 genes in biological pathway sets, identify candidates of 16 mono- or polygenic diseases, and discover regulatory genes of myeloid differentiation. Furthermore, the approach identified a novel gene involved in craniofacial development from a 2-Mb chromosomal region, deleted in some patients with DiGeorge-like birth defects. The approach described here offers an alternative integrative method for gene discovery.

Algorithms↗

International variation in hip replacement rates.

OBJECTIVES: To summarise epidemiological data on the frequency of hip replacements in the countries of the developed world, especially in countries of the Organisation for Economic Cooperation and Development (OECD), and to investigate whether missing consensus criteria for the indication for total hip replacement (THR) result in different replacement rates. METHODS: Country-specific hip replacement rates were collected using the available literature, different data sources of national authorities, and estimates of leading hip replacement manufacturers. RESULTS: According to administrative and literature data sources the reported crude primary THR rate varied between 50 and 130 procedures/100000 inhabitants in OECD countries in the 1990s. The crude overall hip implantation rate, summarising THR, partial hip replacement, and hip revision procedures, was reported to range from 60 to 200 procedures/100000 inhabitants in the late 1990s. Moreover, large national differences were seen in the relationship between total and partial hip replacement procedures. CONCLUSION: The reported differences in hip replacement rates in OECD countries are substantial. They may be due to various causes, including different coding systems, country-specific differences in the healthcare system, in total expenditure on health per capita, in the population age structure, and in different indication criteria for THR.

Age Factors↗

Obstacles encountered in the use of the medical record and cancer registry abstract in breast cancer research.

A historical-prospective study is being conducted to determine whether there is a relationship between obesity and breast cancer recurrence and survival in African-American women. The primary data sources for the study are the medical record and cancer registry abstract. It has been found that data items such as occupation, menopausal status, height, weight, estrogen receptor and progesterone receptor values, stage, tumor size, number of positive nodes, family history of cancer, and tumor status are not always documented. Suggestions for improving documentation of the primary data sources are provided.

Abstracting and Indexing↗

Discharge planning in nursing homes.

OBJECTIVE: The purpose of this study is to identify nursing home residents who vary in their discharge planning needs. DATA SOURCES AND STUDY SETTING: Administrative records from a database maintained by the National Health Corporation were the primary data source. The 3,883 persons studied were admitted in 1982 to one of 48 nursing homes located in Tennessee, other southern states, and Missouri. STUDY DESIGN: Residents were followed until discharge or for one year, whichever occurred first. A multinomial logistic regression model was used to identify the characteristics at the time of admission of persons likely to go home and the characteristics of those who may be able to be discharged to other residential care facilities. DATA EXTRACTION METHODS: A data tape with resident information was supplied by the National Health Corporation, which also provided data on the 48 nursing homes. Market data were obtained from the Area Resource File. PRINCIPAL FINDINGS: Health status measures are important predictors of discharge status. Financial status (i.e., primary payer) also had a large effect on discharge status; a measure of potential informal care in the community did not. CONCLUSIONS: It is possible to identify at admission nursing home residents likely to have very different discharge planning needs. Nursing home staff can use the results to focus their discharge planning efforts. Regulators can use them to assess how well nursing homes are meeting the discharge planning needs of their residents.

Aged↗

Does noninvasive positive pressure ventilation improve outcome in acute hypoxemic respiratory failure? A systematic review.

CONTEXT: The results of studies on noninvasive positive pressure ventilation (NPPV) for acute hypoxemic respiratory failure unrelated to cardiogenic pulmonary edema have been inconsistent. OBJECTIVE: To assess the effect of NPPV on the rate of endotracheal intubation, intensive care unit and hospital length of stay, and mortality for patients with acute hypoxemic respiratory failure not due to cardiogenic pulmonary edema. DATA SOURCE: We searched the databases of MEDLINE (1980 to October 2003) and EMBASE (1990 to October 2003). Additional data sources included the Cochrane Library, personal files, abstract proceedings, reference lists of selected articles, and expert contact. STUDY SELECTION: We included studies if a) the design was a randomized controlled trial; b) patients had acute hypoxemic respiratory failure not due to cardiogenic pulmonary edema; c) the interventions compared noninvasive ventilation and standard therapy with standard therapy alone; and d) outcomes included need for endotracheal intubation, length of intensive care unit or hospital stay, or intensive care unit or hospital survival. DATA EXTRACTION: In duplicate and independently, we abstracted data to evaluate methodological quality and results. DATA SYNTHESIS: The addition of NPPV to standard care in the setting of acute hypoxemic respiratory failure reduced the rate of endotracheal intubation (absolute risk reduction 23%, 95% confidence interval 10-35%), ICU length of stay (absolute reduction 2 days, 95% confidence interval 1-3 days), and ICU mortality (absolute risk reduction 17%, 95% confidence interval 8-26%). However, trial results were significantly heterogeneous. CONCLUSION: Randomized trials suggest that patients with acute hypoxemic respiratory failure are less likely to require endotracheal intubation when NPPV is added to standard therapy. However, the effect on mortality is less clear, and the heterogeneity found among studies suggests that effectiveness varies among different populations. As a result, the literature does not support the routine use of NPPV in all patients with acute hypoxemic respiratory failure.

Adult↗

Recreational use of sildenafil by HIV-positive and -negative homosexual/bisexual males.

OBJECTIVE: To conduct an epidemiologic review of sildenafil in homosexual and bisexual males focusing on concurrent use with club drugs and/or antiretroviral medications. DATA SOURCES: A search of MEDLINE was conducted (1966-September 2003), and an extensive manual review of journals was performed using the key search terms club drugs, sildenafil, antiretrovirals, and HIV. STUDY SELECTION AND DATA EXTRACTION: All articles identified from the data sources were evaluated and information deemed relevant was included. DATA SYNTHESIS: Several epidemiologic studies have reported that sildenafil is abused in a recreational fashion, typically with agents commonly known to be "club drugs." In this setting, sildenafil may reverse the impotence-inducing effects of the club drugs and restore sexual capabilities. Many implications of both recreational and nonrecreational use of sildenafil exist in relation to HIV disease. Concern has been raised regarding the potential effects on high-risk sexual practices. Also, several researchers have documented interactions between sildenafil and various club drugs, as well as with antiretrovirals intended for HIV disease. CONCLUSIONS: Serious concerns exist regarding the concurrent use of sildenafil with antiretrovirals and/or club drugs. Clinicians prescribing sildenafil to patients receiving protease inhibitor-containing antiretroviral regimens should be aware of the potential for reduced sildenafil metabolism with resultant adverse effects. Additionally, untoward effects may also occur when sildenafil is used concurrently with various club drugs including amyl and butyl nitrites ("poppers").

Anti-HIV Agents↗

Comparison of urea reduction ratio and hematocrit data reported in different data systems: results from the Centers for Medicare & Medicaid Services and the Renal Network Inc.

BACKGROUND: Urea reduction ratio (URR) and hematocrit values reported on the Centers for Medicare & Medicaid Services (CMS) claims were compared with data from two different databases. METHODS: URRs and hematocrits from two different CMS databases (National Claims History and End-Stage Renal Disease Clinical Performance Measures [CPM] Project) and one Network database (The Renal Network Data System [TRNDS]) were compared for October through December 1998 and December 1998, respectively. A sample of records from the regional database was validated by independent chart review. RESULTS: Nationally, the percentage of agreement for patients with URRs of 65% or greater and less than 65% was 94% (kappa, 0.81; 95% confidence interval [CI], 0.80 to 0.83); regionally, the percentage of agreement was 95% (kappa, 0.85; 95% CI, 0.84 to 0.86). Nationally, linear regression of hematocrit values from both data sources yielded r(2) congruent with 0.61 each month and r(2) = 0.70 for average values during the 3-month study period. Nationally, the percentage of agreement for patients with hematocrits of 33% or greater and less than 33% was 84% (kappa approximately 0.66) each month. Regionally, linear regression of monthly hematocrit values from both data sources yielded r(2) = 0.66, and percentage of agreement for patients with hematocrits of 33% or greater and less than 33% was 87% (kappa, 0.71; 95% CI, 0.70 to 0.73). Validation of a sample of records in the TRNDS database resulted in 98% agreement for patients with URRs of 65% or greater and less than 65% and 96% agreement for patients with hematocrits of 33% or greater and less than 33%. CONCLUSION: Although there is general agreement between clinical variables submitted on the claims and in the CPM Project, some variation exists. Data from either source yield the same information when classifying patients as above or below threshold values.

Anemia↗

Child and adolescent psychiatric emergencies in nonsuicide-specific samples: the state of the research literature.

OBJECTIVE: Since the 1980s, there has been an increase in the frequency with which children and adolescents with psychiatric symptoms present to emergency departments (ED). Recent trend data from the National Hospital Ambulatory Medical Care Survey database suggest that the increase in ED use for mental health concerns is not driven by a rise in the frequency of medically serious suicide attempts but, rather, nonurgent diagnoses. The current paper is a systematic review of the existing research literature on child and adolescent psychiatric emergencies among nonsuicidal samples to assess the type and quality of the data reported. This is a first step in developing a profile of which children, in the absence of medically serious suicide attempt, seek psychiatric care in EDs. METHODS: Literature searches were conducted through PsycINFO, MEDLINE, and PubMed databases for the years 1990 through 2004. Twelve studies were identified as meeting inclusion criteria and were reviewed for general study information (ie, bibliography); quality indicators; study characteristics (ie, data source, location of study, method of subject recruitment, and study inclusion/exclusion criteria); subject characteristics, and outcome measures and results (specific outcome assessed, types of data analyses). RESULTS: Most of the studies were cross-sectional, retrospective chart reviews, with one data source. Only one study reported on all variables of interest, and there was no consistency in data collection or reporting across studies. CONCLUSIONS: Although there has been a documented increase in children and adolescents seeking care for psychiatric emergencies in EDs, a clear and basic understanding of who these patients are cannot be determined from existing published research reports. Significant inconsistencies in data collection and reporting make recommendations for treatment planning and service delivery challenging. A research agenda in the field of child and adolescent psychiatric emergencies is proposed.

Adolescent↗

Glycoprotein IIb/IIIa receptor inhibitors in percutaneous coronary intervention and acute coronary syndrome.

OBJECTIVE: To review the contemporary role of the glycoprotein (GYP) IIb/IIIa receptor inhibitors abciximab, eptifibatide, and tirofiban in patients undergoing percutaneous coronary intervention (PCI) and those with an acute coronary syndrome (ACS), and to provide an algorithm based on currently available evidence for specific agents. DATA SOURCES: Primary articles were identified by a MEDLINE search (1966-January 2003); references cited in these articles provided additional resources. STUDY SELECTION AND DATA EXTRACTION: All of the articles identified from data sources were considered for relevant information; this article primarily addresses large, controlled or comparative studies, and meta-analyses. DATA SYNTHESIS: The role of GYP IIb/IIIa inhibitors in patients undergoing PCI and those with ACS has progressed markedly. To date, abciximab has the most robust data in patients undergoing PCI, particularly high-risk individuals. In PCI patients with lower risk (e.g., elective stenting), eptifibatide is a reasonable first-line option. Data do not support tirofiban for routine use in patients undergoing PCI. For individuals with signs and symptoms of ACS, specifically unstable angina or non-ST-segment elevation myocardial infarction (MI), eptifibatide or tirofiban is recommended in high-risk patients when a conservative approach is used (PCI is not planned). Abciximab is not recommended in this situation. In patients with ST-segment elevation MI (STEMI), abciximab is the only GYP IIb/IIIa inhibitor evaluated in large, well-designed investigations. For medical management in combination with a fibrinolytic agent, the role of abciximab remains unclear. For patients undergoing primary PCI for the management of STEMI, the available evidence supports the use of abciximab, albeit further investigation is warranted. CONCLUSIONS: The role of GYP IIb/IIIa inhibitors in clinical cardiology continues to evolve. Choice of the agent depends on situation of use, patient-specific characteristics and risk stratification, and, in the case of ACS, chosen management strategy (medical management or intervention).

Animals↗

The role of cholesterol and statins in Alzheimer's disease.

OBJECTIVE: To briefly discuss the impact of elevated total and low-density-lipoprotein cholesterol levels, as well as the potential relationship of hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) use, on the development of Alzheimer's disease (AD). DATA SOURCES: Biomedical literature was accessed through MEDLINE and International Pharmaceutical Abstracts (1966-June 2003). The authors independently reviewed literature for possible inclusion in this article. STUDY SELECTION AND DATA EXTRACTION: Clinical studies were selected and reviewed from the data sources, with special emphasis on those dealing with statin use and AD. DATA SYNTHESIS: The impact of AD is significant, as it is rapidly becoming one of our country's most debilitating and costly diseases. Data from epidemiologic trials indicate that statins may have some protective effect against the development of AD. These trials also allude to theories regarding possible mechanisms of action for this use, data implicating possible superiority of one statin over another, and their lack in certain populations, specifically the very old elderly population. CONCLUSIONS: Preliminary evidence suggests that statins may offer a protective effect against the development of AD. However, review of the literature does not lend credence to the use of statins in the general nondemented population without hyperlipidemia. Potential confounding variables have not been considered in the majority of trials. Placebo-controlled clinical trials are ongoing and should yield more definitive results.

Alzheimer Disease↗