Adjusted Population Attributable Risk Research Articles

The reduction in macrosomia prevalence over a decade following the intensive intervention programs

ObjectiveTo assess changes in macrosomia prevalence following a two-stage lifestyle intervention program. MethodsThe study collected annual delivery data from singleton pregnant women at the Beijing Obstetrics and Gynecology Hospital in Beijing, China (2014–2023). The first intervention stage involved nutritional assessment and lifestyle management in pregnancy, and maternal weight and fetal growth monitoring were added in the second stage, with intensive management as necessary. Pre-intervention births (2014–2016) served as controls. The change in macrosomia and low birth weight prevalence following the intervention was assessed by an interrupted time series analysis. ResultsAmong 126,824 pregnant women, macrosomia prevalence decreased from 7.11 % to 4.15 % over ten years, with an accelerated decrease post-intervention (p for slope = 0.050 and 0.004 for the first and second stages), primarily contributed by the reduction in excessive gestational weight gain (adjusted population attributable risk = 28.6 %, p for Granger cause = 0.0001). The change in the increasing rate of low-birth-weight prevalence was non-significant. ConclusionsMacrosomia prevalence significantly decreased over a decade following the intensive intervention programs.

Psychiatric disorders and reoffending risk in individuals with community sentences in Sweden: a national cohort study

Community sentences are widely used in many countries, often comprising the majority of criminal justice sanctions. Psychiatric disorders are highly prevalent in community-sentenced populations and are thus potential targets for treatment interventions designed to reduce reoffending. We examined the association between psychiatric disorders and reoffending in a national cohort of individuals given community sentences in Sweden, with use of a sibling control design to account for unmeasured familial confounding. We did a longitudinal cohort study of 82 415 individuals given community sentences between Nov 1, 1991, and Dec 31, 2013, in Sweden using data from population-based registers. We calculated hazard ratios (HRs) for any reoffending and violent reoffending with Cox regression models. We compared community-sentenced siblings with and without psychiatric disorders to control for potential familial confounding. Additionally, we calculated population attributable fractions to assess the contribution of psychiatric disorders to reoffending behaviours. The primary outcomes of the study were any (general) reoffending and violent reoffending. Between Nov 1, 1991, and Dec 31, 2013, those given community sentences who were diagnosed with any psychiatric disorder had an increased reoffending risk in men (adjusted HR 1·59, 95% CI 1·56-1·63 for any reoffending; 1·60, 1·54-1·66 for violent reoffending) and women (1·71, 1·61-1·82 for any reoffending; 2·19, 1·88-2·54 for violent reoffending). Risk estimates remained elevated after adjustment for familial confounding. Schizophrenia spectrum disorders, personality disorders, and substance use disorders had stronger associations with violent reoffending than did other psychiatric disorders. Assuming causality, the adjusted population attributable risk of psychiatric disorders on violent reoffending was 8·3% (95% CI 6·6-10·0) in the first 2 years of community follow-up in men and 30·9% (22·7-39·0) in women. Psychiatric disorders were associated with an increased risk of any reoffending and violent reoffending in the community-sentenced population. The magnitude of the association between psychiatric disorders and reoffending varied by individual diagnosis. Substance use disorders had the highest absolute and relative risks. Most of the increased risk for any reoffending in individuals with psychiatric disorders could be attributed to comorbid substance misuse. Given their high prevalence, substance use disorders should be the focus of treatment programmes in community-sentenced populations. Wellcome Trust.

The Effect of Body Weight and Alcohol Consumption on Hyperuricemia and Their Population Attributable Fractions: A National Health Survey in China

Introduction: The prevalence of hyperuricemia (HUA) is increasing worldwide; understanding of population attributable fraction of modifiable risk factors (MRFs) is important for disease prevention. Given the sparse evidence on how MRFs influence HUA in mainland China, we aimed to explore the effect of excess body weight and alcohol consumption and their population attributable fractions of HUA based on a national survey in mainland China. Methods: Using data from the China National Health Survey which included 31,746 Han Chinese of 20–80 years of age from 10 provinces, we estimated the prevalence and MRFs (overweight/obesity and alcohol consumption) of HUA. HUA was defined as serum uric acid >417 μmol/L in men and >340 μmol/L in women. Restricted cubic-spline models were used to demonstrate the linear and nonlinear associations between exposures and HUA. The adjusted population attributable risk (PAR) was calculated to understand the relative importance of each MRF. Results: The prevalence of HUA was 25.1% in men and 15.9% in women. The population fraction of HUA cases that could be avoided by weight loss was 20.6% (19.3%–22.0%) in men and 18.1% (17.1%–19.0%) in women. The PAR of alcohol consumption was 12.8% (8.5%–17.1%) in men. Participants from Southwest China (Yunnan) had the highest HUA prevalence (47.9% in men and 29.9% in women) but with lower PAR of MRFs, especially in men (16.7%). Subjects in North China had lower HUA prevalence but higher PAR of MRFs. Around 44.8% male HUA cases in Inner Mongolia (26.9% of HUA prevalence) and 37.7% cases in Heilongjiang (34.4% of HUA prevalence) were attributable to overweight/obesity and alcohol consumption. Conclusion: There are significant sex and geographic difference on PAR of HUA due to MRFs. More tailored prevention strategies are needed to prevent HUA through weight loss and reduction of alcohol consumption.

Sex-Specific Differences in Related Indicators of Blood Pressure in School-Age Children With Overweight and Obesity: A Cross-Sectional Study.

Objective: The objective of this study is to further explore the difference between elevated blood pressure (EBP), elevated pulse pressure (EPP), and elevated mean arterial pressure (EMAP) and obesity in Chinese school-age children by sex.Methods: We performed a cross-sectional study of 935 children between 7 and 12 years old. Overweight and obesity were defined by body mass index and body composition. The multivariate logistic regression and the adjusted population attributable risk were used to assess the effects of obesity on pre-EBP/EBP, EPP, and EMAP. The interactions were used to identify the modification of obese on the relationship between related indicators of blood pressure and height or age.Results: The average age of the children included in the study was 10. Boys with overweight and obesity had higher pre-EBP/EBP, EPP, and EMAP (p < 0.05). The multivariate logistic regression analysis showed that overweight and obesity had a greater impact on BP and MAP than PP, especially in boys [odds ratio (OR) > 1]. Pre-EBP/EBP in 79% of boys and 76% of girls could be attributable to the visceral fat level. The interaction between BP, PP, MAP, and height or age was modestly increased in children with overweight and obesity, especially in boys.Conclusions: Independent of age and height, obesity not only increases blood pressure, it also increases mean arterial pressure and pulse pressure, and this effect is more pronounced in boys.

Population Attributable Risks of Subtypes of Esophageal and Gastric Cancers in the United States.

To help target preventive strategies, we estimated US population attributable risks (PARs) of demographic and potentially modifiable risk factors for esophageal squamous cell carcinoma (ESCC), esophageal adenocarcinoma (EAC), gastric cardia adenocarcinoma (GCA), and gastric noncardia adenocarcinoma (GNCA). We prospectively examined the associations for risk factors and these cancers in 490,605 people in the National Institutes of Health-the American Association of Retired Persons Diet and Health cohort Diet and Health Study cohort from 1995 to 2011. Exposures were obtained from the baseline questionnaire. Diagnoses of gastroesophageal reflux disease were extracted for a subset of eligible National Institutes of Health-the American Association of Retired Persons Diet and Health cohort subjects through linkage to Medicare and then multiply imputed for non-Medicare-eligible subjects. Hazard ratios were calculated using multivariable-adjusted Cox proportional hazards regression. Adjusted population attributable risks were calculated for the US population aged 50-71 years by combining the hazard ratios with the estimated joint distribution of risk factor prevalence from the 2015 National Health Interview Survey. Smoking remained the most important risk factor for ESCC and was estimated to cause more than 1/3 of EAC and GCA and 1/10 of GNCA. Obesity and gastroesophageal reflux disease were associated with more than 1/2 of EAC and 1/3 of GCA. Compared with each lowest-risk level category, common risk factors were estimated to be associated with 73.7% of ESCC (95% confidence interval [CI]: 62.1%-85.4%), 70.3% of EAC (95% CI: 64.4%-76.2%), 69.3% of GCA (95% CI: 61.0%-77.7%), and 33.6% of GNCA (95% CI: 21.7%-45.5%). These factors accounted for a large proportion of esophageal and gastric cancers in the United States, highlighting opportunities for education and intervention to reduce the burden of these highly fatal cancers.

How Much Hypertension is Attributed to Overweight, Obesity, and Hyperglycemia Using Adjusted Population Attributable Risk in Adults?

Background High blood pressure (HBP) is a proven risk factor for cardiovascular diseases. So, determining the extent of the contribution of the factors associated with HBP seems to be necessary. Accordingly, this study aimed to investigate how much the prevalence of HBP attributed to obesity and high blood glucose (HBG). Methods Data were collected from 7612 participants extracted from a screening program in 2018, in Iran, which was conducted on the subjects with the age of 30 years old and older to investigate the prevalence of HBP and their associated risk factors. To collect data, we used a standard checklist in terms of the WHO STEPS manual, and a stratified multistage sampling method was also applied. The adjusted population attributable risk of overweight, obesity, and HBG for HBP was calculated by the logistic regression model using the aflogit module. Results Among the studied people, 7.4% of male and 10.8% of female subjects were hypertensive. The adjusted analysis showed that, in men, 27% and 41% and, among women, 19% and 37% of HBP prevalence rates were attributable to obesity (BMI ≥ 30) and fast blood sugar (FBS) (≥126), respectively. In people with both obesity and HBG, 59% of the prevalence rate of HBP in men and 46% of the prevalence in women were due to the abovementioned risk factors altogether. The results show that, if obesity and HBG were eliminated, the prevalence of HBP could be theoretically decreased from 7.4% to 5.4% and 4.3% in male subjects and from 10.8% to 8.7% and 6.8% in female subjects, respectively. Conclusions Our findings indicate that how much the prevalence of HBP attributes to obesity and HBG in middle-age and older population. It seems that the prevention programs should be administered in the general population, and excess body weight prevention programs should also be implemented in childhood.

Renal function and attributable risk of death and cardiovascular hospitalization in participants with diabetes from a registry-based cohort

AimsTo estimate the attributable risk of renal function on all-cause mortality and cardiovascular hospitalization in patients with diabetes. MethodsA prospective cohort study in 19,469 adults with diabetes, free of cardiovascular disease, attending primary care in Spain (2008–2011). The estimated glomerular filtration rate (eGFR) and other variables were collected and patients were followed to the first hospitalization for coronary or stroke event, or death, until the end of 2012. The cumulative incidence of the study endpoints by eGFR categories was graphically displayed and adjusted population attributable risks (PARs) for low eGFR was calculated. ResultsMean follow-up was 3.2 years and 506 deaths and 1720 hospitalizations were recorded. The cumulative risk for the individual events increased as eGFR levels decreased. The PAR associated with having an eGFR of 60mL/min/1.73m2 or less was 11.4% (95% CI 4.8–18.3) for all-cause mortality, 9.2% (95% CI 5.3–13.4) for coronary heart disease, and 2.6% (95% CI −1.8 to 7.4) for stroke. ConclusionsReduced eGFR levels were associated with a larger proportion of avoidable deaths and cardiovascular hospitalizations in people with diabetes compared to previously reported results in people with other cardiovascular risk factors.

Efforts to alter the trajectory of neonatal mortality in Malawi: evaluating relative effects of access to maternal care services and birth history risk factors.

BackgroundThe neonatal mortality rate (NMR) in Malawi has remained stagnant at around 27 per 1000 live births over the last 15 years, despite an increase in the uptake of targeted health care interventions. We used the nationally representative 2015/16 Demographic Health Survey data set to evaluate the effect of two types of maternal exposures, namely, lack of access to maternal or intra-partum care services and birth history factors, on the risk of neonatal mortality.MethodsA causal inference approach was used to estimate a population attributable risk parameter for each exposure, adjusting for co-exposures and household, maternal and child-specific covariates. The maternal exposures evaluated were unmet family planning needs, less than 4+ antenatal care visits, lack of institutional delivery or skilled birth attendance, having prior neonatal mortality, short (8-24 months) birth interval preceding the index birth, first pregnancy, and two or more pregnancy outcomes within the preceding five years of the survey interview.ResultsWe included 9553 women and their most recent live birth within 3 years of the survey. The sample’s overall neonatal mortality rate was 18.5 per 1000 live births. The adjusted population attributable risk for first pregnancies was 3.9/1000 (P < 0.001), while non-institutional deliveries and the shortest preceding birth interval (8-24 months) each had an attributable risk of 1.3/1000 (Ps = 0.01). Having 2 or more pregnancy outcomes within the last 5 years had an attributable risk of 3/1000 (P = 0.006). Attending less than 4 ANC visits had, a relatively large attributable risk (2.1/1,000), and it was not statistically significant at alpha level 0.05.ConclusionsOur analysis addresses the gap in the literature on evaluating the effect of these exposures on neonatal mortality in Malawi. It also helps inform programs and current efforts such as the Every Newborn Action 2020 Plan. Increasing access to maternal care interventions has an important role to play in changing the trajectory of neonatal mortality, and women who are at an increased risk may not be receiving adequate care. Recent studies indicate an urgent need to assess gaps in service readiness and quality of care at the antenatal and obstetric care facilities.

Low diet quality and the risk of stroke mortality: the multiethnic cohort study.

Several diets, e.g., those low in fruits/vegetables, high in sodium, and red/processed meat, have been related to a higher stroke risk. We investigated stroke mortality associated with a priori diet-quality indices in the Multiethnic Cohort study. Based on 172,043 observations including 3548 stroke deaths, we investigated the Healthy Eating Index-2010 (HEI-2010), the Alternative HEI-2010, the alternate Mediterranean diet score, and the Dietary Approaches to Stop Hypertension index in relation to stroke mortality. Using Cox regression, we estimated adjusted population attributable risks (PAR) and hazard ratios (HR) for tertiles of the indices while adjusting for relevant confounders. The associations between all diet-quality indices and stroke mortality were consistent in direction; a low-quality diet was associated with a greater risk of stroke death, but the HEI-2010 was the strongest predictor. The PAR for stroke death based on HEI-2010 was 7.9% (95%-CI: 3.7-12.2%), indicating the preventable percentage of deaths if the total population had the same diet quality as those in the highest tertile for this diet-quality index. The lowest as compared to the highest tertile of the HEI-2010 was associated with a 1.23-fold (95%-CI: 1.13-1.34) risk. The PARs for low and medium adherence to the indices were similar by sex and follow-up time, but varied by ethnicity, with the highest PAR in Whites (15.4%) and no association in Latinos. Findings for four diet-quality indices, in particular the HEI-2010, indicated that diet quality acts as an independent risk factor for stroke mortality. Promotion of a high diet quality could have a substantial impact on the prevention of stroke deaths.

Workplace justice and intention to leave the nursing profession.

Poor psychosocial work environments are considered critical factors of nurses' intention to leave their profession. Workplace injustice has been proven to increase the incidence of psychiatric morbidity among workers. However, few studies have directly investigated the effect of workplace justice on nurses' intention to leave their profession and the population attributable risk among nurses. This study identified factors associated with workplace justice and nurses' intention to leave the profession. A cross-sectional survey was conducted using a self-administered structured questionnaire. Approximately 10% of all secondary referral centers in Taiwan were stratified and randomly sampled. Multiple logistic regression and population attributable risks were preformed to assess the effect of workplace justice on nurses' intention to leave the nursing profession. This study was approved by the Research and Ethical Committee of National Taiwan University Hospital. Only nurses who consented to the study participated in the survey. A total of 2268 nurses were recruited, of whom 1417 (62.5%) satisfactorily completed the questionnaire. The participants were classified and 342 (24.1%) of them were placed into the low workplace justice group. Nurses with low workplace justice had a higher intention of leaving the profession (adjusted odds ratio = 1.34, 95% confidence interval = 1.02-1.77). "Employees' opinions are influential in hospital's decision making" and "employees' performance is evaluated fairly" were the most influential factors of the participants' intention to quit. The adjusted population attributable risk was 3.7% for low workplace justice. This study has identified that workplace justice is a protective factor of nurses' leaving their current profession. A fair performance appraisal system and increased autonomy at work are warranted to dissuade nurses from leaving the nursing profession.

Population Attributable Risk of Unintentional Poisoning in Iranian Children

Background: It is introduced that unintentional childhood poisoning can be as result of child home environment and characteristics of parents. This study aimed at quantifying the adjusted population attributable risk percentage of risk factor of unintentional childhood poisoning. Materials and Methods: The hospital based case- control included 140 consecutive poisoned children who admitted to the Loghman Hospital between March 2013 and July 2014 in Tehran- Iran. The cases were matched with 280 control based on age (within a calliper of six month), gender, and date of hospital attendance. A standardized questionnaire including characterises of unintentional poisoning and its risk factors was completed in a structured interview for cases and controls. We estimated the adjusted odds ratios (OR) and population attributable risks (PAR) of unintentional childhood poisoning, PAR is proportion of poisoning that could have been avoided by the intervention on the modifiable risk factors. Results: Narcotic poisoning was most common type of poisoning among cases (58.6%) and among them accidental methanol ingestion was most (74.7%). The adjusted PARs for lack of attention to labels of poisoning products and availability to them were 54% and 41% respectively, also these figures for children with addicted parents and paternal smoking were 57% and 54% for, respectively. Conclusion: Children with addicted parents were more vulnerable for unintentional poisoning. For substantial reduction of unintentional poisoning, the preventive interventions should focus on modification of child's home environment, improvement of safety behaviours and health literacy of parents, especially in addicted parents.

Short term effects of periodontal therapy on inflammatory markers in patients with type-2 diabetes.

Objectives:To evaluate the influence of periodontal therapy on glycosylated hemoglobin and fasting blood glucose and serum levels of interleukin (IL)-4, IL-6, IL-8, IL-10, and tumor necrosis factor-alpha (TNF-α) in chronic periodontitis (CP) patients with type-2 diabetes mellitus (T2DM) and in controls.Methods:A total of 30 periodontal patients, 15 of which were systemically healthy (control group), and 15 were T2DM patients (test group) were included in this study. This prospective study was carried out at Istanbul University, Istanbul, Turkey between February 2011 and December 2013. Plaque index, gingival index, bleeding on probing, periodontal probing depth, and clinical attachment level were assessed and recorded at baseline, one, and 3 months after therapy. Serum samples were collected at the same time-points and analyzed using Luminex assay for the levels of IL-4, IL-6, IL-8, IL-10, and TNF-α. The change in the metabolic control was also monitored.Results:All clinical parameters were significantly improved after the periodontal therapy in both groups (p<0.001). Glycosylated hemoglobin levels were decreased; however, the difference was not significant (p>0.05). Fasting blood glucose levels were decreased one month after therapy, and increased at 3 months. Patients with T2DM had significantly higher levels of circulating IL-8 at each time point, and TNF-α (p<0.05) at baseline. The IL-4 and IL-10 levels were decreased at one month after therapy (p>0.05).Conclusion:Periodontal therapy has limited impact on the serum levels of IL-4, IL-6, IL-8, IL-10, and TNF-α. Metabolic control levels were not influenced by periodontal therapy.

Breastfeeding Concerns at 3 and 7 Days Postpartum and Feeding Status at 2 Months

We characterized breastfeeding concerns from open-text maternal responses and determined their association with stopping breastfeeding by 60 days (stopping breastfeeding) and feeding any formula between 30 and 60 days (formula use). We assessed breastfeeding support, intentions, and concerns in 532 expectant primiparas and conducted follow-up interviews at 0, 3, 7, 14, 30, and 60 days postpartum. We calculated adjusted relative risk (ARR) and adjusted population attributable risk (PAR) for feeding outcomes by concern category and day, adjusted for feeding intentions and education. In 2946 interviews, 4179 breastfeeding concerns were reported, comprising 49 subcategories and 9 main categories. Ninety-two percent of participants reported ≥ 1 concern at day 3, with the most predominant being difficulty with infant feeding at breast (52%), breastfeeding pain (44%), and milk quantity (40%). Concerns at any postpartum interview were significantly associated with increased risk of stopping breastfeeding and formula use, with peak ARR at day 3 (eg, stopping breastfeeding ARR [95% confidence interval] = 9.2 [3.0-infinity]). The concerns yielding the largest adjusted PAR for stopping breastfeeding were day 7 "infant feeding difficulty" (adjusted PAR = 32%) and day 14 "milk quantity" (adjusted PAR = 23%). Breastfeeding concerns are highly prevalent and associated with stopping breastfeeding. Priority should be given to developing strategies for lowering the overall occurrence of breastfeeding concerns and resolving, in particular, infant feeding and milk quantity concerns occurring within the first 14 days postpartum.

Modifiable exposures to air pollutants related to asthma phenotypes in the first year of life in children of the EDEN mother-child cohort study

BackgroundStudies have shown diverse strength of evidence for the associations between air pollutants and childhood asthma, but these associations have scarcely been documented in the early life. The purpose of this study was to evaluate the impacts of various air pollutants on the development of asthma phenotypes in the first year of life.MethodsAdjusted odds ratios were estimated to assess the relationships between exposures to air pollutants and single and multi-dimensional asthma phenotypes in the first year of life in children of the EDEN mother-child cohort study (n = 1,765 mother-child pairs). The Generalized Estimating Equation (GEE) model was used to determine the associations between prenatal maternal smoking and in utero exposure to traffic-related air pollution and asthma phenotypes (data were collected when children were at birth, and at 4, 8 and 12 months of age). Adjusted Population Attributable Risk (aPAR) was estimated to measure the impacts of air pollutants on health outcomes.ResultsIn the first year of life, both single and multi-dimensional asthma phenotypes were positively related to heavy parental smoking, traffic-related air pollution and dampness, but negatively associated with contact with cats and domestic wood heating. Adjusted odds ratios (aORs) for traffic-related air pollution were the highest [1.71 (95% Confidence Interval (CI): 1.08-2.72) for ever doctor-diagnosed asthma, 1.44 (95% CI: 1.05-1.99) for bronchiolitis with wheezing, 2.01 (95% CI: 1.23-3.30) for doctor-diagnosed asthma with a history of bronchiolitis]. The aPARs based on these aORs were 13.52%, 9.39%, and 17.78%, respectively. Results persisted for prenatal maternal smoking and in utero exposure to traffic-related air pollution, although statistically significant associations were observed only with the asthma phenotype of ever bronchiolitis.ConclusionsAfter adjusting for potential confounders, traffic-related air pollution in utero life and in the first year of life, had a greater impact on the development of asthma phenotypes compared to other factors.

Association Between Bleeding Events and In-hospital Mortality After Percutaneous Coronary Intervention

Bleeding is the most common complication after percutaneous coronary intervention (PCI) and is associated with increased morbidity and health care costs. The incidence of bleeding-related mortality after PCI has not been described in a nationally representative population. Furthermore, the relationships among bleeding risk, bleeding site, and mortality are unclear. To describe the association between bleeding events and in-hospital mortality after PCI and to estimate the adjusted population attributable risk (estimated as the proportion of mortality risk associated with bleeding events), risk difference, and number needed to harm (NNH) for bleeding-related in-hospital mortality after PCI. Data from 3,386,688 procedures in the CathPCI Registry performed in the United States between 2004 and 2011 were analyzed. The population attributable risk was calculated after adjustment for baseline demographic, clinical, and procedural variables. To calculate the NNH for bleeding-related mortality, a propensity-matched analysis was performed. In-hospital mortality. There were 57,246 bleeding events (1.7%) and 22,165 in-hospital deaths (0.65%) in 3,386,688 PCI procedures. The adjusted population attributable risk for mortality related to major bleeding was 12.1% (95% CI, 11.4%-12.7%) in the entire CathPCI cohort. The propensity-matched population consisted of 56,078 procedures with a major bleeding event and 224 312 controls. In this matched cohort, major bleeding was associated with increased in-hospital mortality (5.26% vs 1.87%; risk difference, 3.39% [95% CI, 3.20%-3.59%]; NNH = 29 [95% CI, 28-31]; P < .001). The association between major bleeding and in-hospital mortality was observed in all strata of preprocedural bleeding risk (low: 1.62% vs 0.17%; risk difference, 1.45% [95% CI, 1.13%-1.77%], NNH = 69 [95% CI, 57-88], P < .001; intermediate: 3.27% vs 0.71%; risk difference, 2.56% [95% CI, 2.33%-2.79%], NNH = 39 [95% CI, 36-43], P < .001; and high: 8.16% vs 3.45%; risk difference, 4.71% [95% CI, 4.35%-5.07%], NNH = 21 [95% CI, 20-23], P < .001). Although both access-site and non-access-site bleeding were associated with increased in-hospital mortality (2.73% vs 1.87%; risk difference, 0.86% [95% CI, 0.66%-1.05%], NNH = 117 [95% CI, 95-151], P < .001; and 8.25% vs 1.87%; risk difference, 6.39% [95% CI, 6.04%-6.73%], NNH = 16 [95% CI, 15-17], P < .001, respectively), the NNH was lower for nonaccess bleeding. In a large registry of patients undergoing PCI, postprocedural bleeding events were associated with increased risk of in-hospital mortality, with an estimated 12.1% of deaths related to bleeding complications.

ANXIETY SYMPTOMS AS PRECURSORS OF MAJOR DEPRESSION AND SUICIDAL IDEATION

Relative to depression symptoms, the role of anxiety symptoms in the development of depression and suicidal ideation has not been well established. This study aimed to identify the anxiety and depression symptoms that confer the greatest amount of risk for depression and suicidal ideation at the population level. The PATH through Life study is an Australian community-based longitudinal cohort study of 7,485 younger, middle-aged, and older adults. Adjusted population attributable risk (PAR) for incident depression and suicidal ideation after 4 years was assessed for 18 symptoms of anxiety and depression. Anxiety symptoms contributed greater risk overall to both depression (45%) and suicidal ideation (23%) incidence than depression symptoms (35% and 16%, respectively). Anxiety symptoms had largest PARs among younger age groups. Prevention programs for depression and suicide should aim to reduce anxiety symptoms in addition to depression symptoms, and target individuals reporting symptoms such as worrying or irritability.

Perinatal and Early Childhood Factors for Overweight and Obesity in Young Canadian Children

This study assessed potential early-life factors and their interrelationships with obesity among young Canadian children. Data from a nationally representative sample of children aged 6 to 11 years in the Canadian Health Measures Survey were analyzed. The associations of perinatal and early childhood behaviours and socio-economic factors with overweight or obesity were evaluated using multivariate logistic regression models. Adjusted population attributable risk fractions (PARFs) were calculated using multivariate logistic regression models. Of 968 term-born children, 21% were overweight and another 13% were obese. Maternal smoking during pregnancy (adjusted odds ratio, 2.26; 95% confidence interval, 1.23-4.15) was positively associated with obesity. This association was mediated by birth weight (suppression effect); once controlled, the strength of the association between smoking and child obesity increased by 12%. Birth weight per 100 g (1.05; 1.005-1.09) was significantly associated with obesity. Exclusive breastfeeding for 6 months (0.44; 0.31-0.61), adequate sleep hours (0.39; 0.16-0.94) and being physically active (0.50; 0.26-0.93) were found to be protective. Breastfeeding, whether exclusive or not, significantly reduced obesity risk among children whose mothers never smoked in pregnancy. PARFs indicated that 24.4%, 11.5%, 11.3% and 6.0% prevalent cases of child obesity might be prevented by exclusive breastfeeding, smoking cessation during pregnancy, adequate sleep during childhood, and avoiding high birth weight, respectively. This study identified multiple perinatal and childhood factors associated with obesity in young Canadian children. Effective prevention strategies targeting four modifiable maternal and child risk factors may reduce childhood obesity by up to 54% in Canada.

Predictors for suicidal ideation after occupational injury

Risk of suicide has been associated with trauma and negative life events in several studies. Our aim was to investigate the prevalence and risk factors of suicidal ideation, and the population attributable risk among workers after occupational injuries. We investigated workers who had been hospitalized for ≧3days after occupational injuries between February 1 and August 31, 2009. A self-reported questionnaire including demographic data, injury condition, and the question of suicidal ideation was sent to 4498 workers at 3months after their occupational injury. A total of 2001 workers (45.5%) completed the questionnaires and were included in final analysis. The prevalence of reporting suicidal ideation was 8.3%. After mutual adjustment, significant risk factors for suicidal ideation higher than “serious” in a self-rated severity scale (adjusted odds ratio, aOR=2.31; adjusted population attributable risk, aPAR=34.7%), total hospital stay for 8days or longer (OR=1.98; aPAR=20.5%), intracranial injury (OR=2.30; aPAR=10.2%), and marriage status of being divorced/separated/widowed (OR=2.70; aPAR=10.0%). Three months after occupational injury, a significant proportion of workers suffered from suicidal ideation. Significant predictors of suicidal ideation after occupational injury included broken marriage, intracranial injury, injury severity, and total hospital stay. Identification of high risk subjects for early intervention is warranted.

O6-2.1 Use of smokeless tobacco and the risk of oesophageal squamous-cell carcinoma: a multicenter case-control study

IntroductionOesophageal cancer remains an important public health problem worldwide. This multicenter matched case-control study examined chewing of betel quid, areca nut, snuff dipping and cigarette smoking as the risk factors...

Specific medical conditions associated with clinically significant depressive symptoms in men

To define specific medical conditions associated with clinically significant depressive symptoms in men. A cross-sectional study was conducted in a community-based sample of Australian men (N = 1,195, aged 35-80 years; for 2002-2005). Depression was defined by: (1) symptomatic depression (current symptoms) or (2) current prescription for antidepressant(s) or (3) previously diagnosed depression. Logistic regression was used to determine prevalence odds ratios (OR) for depression independently associated with an extensive range of demographic, lifestyle, and clinical factors. Adjusted population attributable risk (PAR%) estimates were also computed. Depression was significantly (ORs at P < 0.05) associated with previously diagnosed anxiety (12.0) and insomnia (4.4), not married (1.7), current smoker (1.7), low muscle strength tertile (1.7, P = 0.059), high triglycerides (1.6), high storage lower urinary tract symptoms (LUTS) tertile (1.8), past year general practitioner visits 5-9 (1.9), middle energy density tertile (0.4), and high systolic blood pressure (0.5). Significant PAR% estimates (at P < 0.05) were for previous anxiety (27.0%) and insomnia (16.1%), middle energy density tertile (-17.2%), high SBP (-23.5%), high triglycerides (15.2%), and high storage LUTS tertile (12.6%). Results strengthened when depression-related factors (previous anxiety and insomnia, psycholeptics, and cognition) were omitted, and became significant for CVD (OR 1.6; PAR 13.9%). Medical conditions associated with depression in men include high triglycerides, low muscle strength, CVD, and LUTS. Depressed men are likely to use health services frequently, be current smokers, not be married, eat unhealthily, and report previous diagnosis of anxiety and insomnia; which has important implications for clinicians managing male patients.