Risk Factors For High Levels Research Articles

Stroke Prevention: A Lifetime of Lessons.

In 44 years of practicing stroke prevention, I have learned many lessons; in this article, I hope to impart some of them. Three areas of my research are discussed. Controlling resistant hypertension is markedly improved by physiologically individualized therapy based on renin/aldosterone phenotyping; this is particularly important in black patients. Measurement of carotid plaque burden strongly predicts cardiovascular risk and is useful for genetic research and for a process called treating arteries instead of risk factors. Doing so in high-risk patients with asymptomatic carotid stenosis was associated with a >80% reduction in the 2-year risk of stroke and myocardial infarction. It also permitted the identification of extremes of atherosclerosis that are useful for studying both the genetics and the biology of atherosclerosis. Patients with very high plaque burden despite low levels of risk factors have an unexplained phenotype; those with little or no plaque despite high levels of risk factors are protected. Patients with unexplained atherosclerosis have higher plasma levels of toxic metabolites produced by the intestinal microbiome largely from egg yolk, red meat, and protein, and those metabolites are renally excreted. This has important dietary implications for stroke prevention. Lowering of plasma total homocysteine with B vitamins significantly reduces the risk of stroke. That was not apparent in early studies because harm from cyanocobalamin among participants with renal failure obscured the benefit among those with good renal function. We should be using B vitamins to prevent stroke but should use methylcobalamin or oxocobalamin instead of cyanocobalamin.

T149. CARDIOVASCULAR RISK AND VASCULAR AGE IN ADULTS WITH SCHIZOPHRENIA COMPARED TO A HEALTHY POPULATION: DATA FROM CORTEX-SP STUDY

BackgroundCardiovascular disease (CVD) is the most common cause of death in people with schizophrenia (SP). The European guidelines on CVD prevention recommend that people with high levels of individual risk factors should automatically have all their risk factors actively managed. It is suggested that CVD risk in SP should be assessed by general risk charts and to include specific relative risk chart for people with severe mental illnesses. Therefore, the purpose of the present study was to estimate CVD risk and vascular age in adults with SP and compared them with a healthy sample.MethodsA total of 85 participants with SP (16.2% women, 42.1±10.0 yr old) were compared with 30 HEALTHY participants (60.0% women, 40.0±9.0 yr old). CVD risk was calculated using Systematic Coronary Risk Estimation (SCORE), Framingham Heart Score-Cardiovascular Disease (FRS-CVD), relative risk SCORE and vascular age. Likewise, the variables assessed to calculate the risk charts were age, body mass index, smoking percentage, systolic blood pressure (SBP) through ambulatory blood pressure monitoring during 24 hours and through a fasting biochemical profile, high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC).ResultsAll HEALTHY variables were in normal values. Sample with SP showed overweight (body mass index=27.1±6.1 kg∙m-2) and higher (P<0.001) smoking percentage than HEALTHY (69.8% vs. 16.1%). Both groups presented normotensive SBP values (SP=115±15 mmHg, HEALTHY=113±10 mmHg). Concerning cholesterol profile, SP showed lower to optimal values in HDL-C (39.0±12.0 mg/dL), yet both were in optimal TC levels (SP=189.7±44 mg/dL, HEALTHY=183.6±35.1 mg/dL). Considering SCORE, both groups were in low risk values with higher (P<0.001) values in SP (0.6±1.0 vs. 0.1±0.4). However, according to relative risk SCORE and FRS-CVD, SP showed medium risk (2.0±1.0; 6.7±12.3), and HEALTHY low (1.0±0.4; 2.6±2.8) risk, respectively. Vascular age was higher (P<0.001) in SP than HEALTHY (48.0±26.0 vs. 36.0±24.0 yr).DiscussionPatients suffering from SP compared to HEALTHY showed higher CVD risk and vascular age. These results strongly suggest the promotion of a healthy lifestyle behavior in order to optimize risk factors.

Not Flourishing Mental Health Is Associated with Higher Risks of Anxiety and Depressive Symptoms in College Students

Youth mental health is a major public health concern. This study assesses whether baseline and short-term changes in mental health predict anxiety and depressive symptoms in college students. Not flourishing mental health at baseline was a risk factor for high levels of anxiety and depressive symptoms. Compared to participants with stable flourishing mental health, those who declined to not flourishing and those who were stable not flourishing had increased risks of high anxiety and depressive symptoms. Assessing mental health may be effective in predicting mental disorder symptoms and supports the need for mental health promotion interventions.

Longitudinal Association Between Risk Profiles, School Dropout Risk, and Substance Abuse in Adolescence

Youth psychosocial and school adjustment results from complex developmental transactions between their individual characteristics and diverse environmental influences, which appear as risk or protective factors throughout one’s development. From an ecosystemic and developmental perspective, this study aims to: (1) identify risk profiles among 13-year-old adolescents, and (2) associate these specific profiles with school dropout risk and substance abuse at age 15 years. Data comes from a large Canadian study, the Quebec Longitudinal Study of Development through which adolescents (n = 1312) answered questionnaires at 13 and 15 years old. First, through latent profile analyses, five profiles were identified based on individual, family, social, and school-based risk factors. Some profiles present higher levels of risk factors, while others comprise risk factors that are under the sample average level. Higher-risk profiles show stronger longitudinal associations with later adjustment difficulties. The findings help provide a deeper understanding of how the co-occurrence of various risk factors in adolescence is associated with later adjustment. The combination of the developmental psychopathology and ecosystemic frameworks, as well as the person-centered approach allowed by the latent profile analyses, helps shed new light on individual and developmental risk.

Diminished Returns of Educational Attainment on Heart Disease among Black Americans

Socioeconomic Status (SES) indicators, such as educational attainment, are social determinants of heart disease. Marginalization related Diminished Returns (MDRs) refer to smaller health benefits of high SES for racial and ethnic minorities compared to the majority group. It is still unknown, however, if MDRs also apply to the effects of education on heart disease. Using a nationally representative sample, we explored racial/ethnic variation in the link between educational attainment and heart disease among American adults. We analyzed data (n=25,659) from a nationally representative survey of American adults in 2013. The first wave of the Population Assessment of Tobacco and Health - Adult (PATH-Adult) study was used. The independent variable was education (college graduate, high school graduate, less than a high school diploma). The dependent variable was any heart disease. Age and gender were the covariates. Race, as well as ethnicity, were the moderators. Logistic regressions were used to analyze the data. Individuals with higher educational attainment had lower odds of heart disease. Race and ethnicity showed statistically significant interactions with education, suggesting that the protective effect of higher education on reducing odds of heart disease was smaller for Hispanic and Black people than for non-Hispanic and White individuals. Education reduces the risk of heart disease better among non-Hispanic Whites than for Hispanics and Blacks. Therefore, we may expect a disproportionately higher than expected risk of heart disease in Hispanics and Blacks with high educational attainment. Future research should test if the presence of high levels of environmental and behavioral risk factors contribute to the high risk of heart disease in highly educated Black and Hispanic Americans. Policymakers should not reduce health inequalities to just gaps in SES because disparities are present across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.

Multilevel factors associated with the intergenerational continuity of child sexual abuse

BackgroundDespite burgeoning interest in the phenomenon of intergenerational continuity, literature concerning risk and protective factors in the context of child sexual abuse (CSA) is still underdeveloped. ObjectiveSince the identification of such risk and protective factors is essential in order to break these negative cycles, the present study aimed to identify specific multilevel factors associated with the continuity of CSA in a large sample of mother–child dyads using secondary analysis of data. Participants and settingMother-child dyads (n = 1,250) were divided into four groups: 1) CSA Both (mother and child are victims); 2) CSA Mother (only mothers are victims); 3) CSA Neither (mother and child are not victims); and 4) CSA Child (only children are victims). MethodsMothers completed a series of self-report measures assessing maternal characteristics (e.g., history of intimate partner victimization, psychological functioning), parenting and familial characteristics (e.g., cohesion, conflicts, empowerment), and demographic variables (e.g., early maternity, income, education). ResultsThe four groups were compared using analyses of variance and chi-square analyses. Overall, mothers in the CSA Both group showed an increased number of risk factors compared to the mothers in the other three groups; however, mothers in the CSA Child group also presented with high levels of risk factors. ConclusionsFindings suggest that practitioners should be attentive to the needs of the mothers of young CSA victims they are serving, since mothers involved in the cycle of intergenerational continuity appear to be particularly vulnerable and distressed.

Findings from Community-Based Screenings for Type 2 Diabetes Mellitus in at Risk Communities in Cape Town, South Africa: A Pilot Study

Completed and ongoing implementation activities globally advocate for community-based approaches to improve strategies for type 2 diabetes prevention. However, little is known about such strategies in the African region where there are higher relative increases in diabetes prevalence. We reported findings from the first 8-month pilot phase of the South African diabetes prevention program. The study was conducted across eight townships (four black and four mixed-ancestry communities) in Cape Town, South Africa, between August 2017 and March 2018. Participants were recruited using both random and self-selected sampling techniques because the former approach proved to be ineffective; <10% of randomly selected individuals consented to participate. Non-laboratory-based diabetes risk screening, using the African diabetes risk score, and based on targeted population specific cut-offs, identified potentially high-risk adults in the community. This was followed by an oral glucose tolerance test (OGTT) to confirm prevalent pre-diabetes. Among the 853 adults without prior diabetes who were screened in the community, 354 (43.4%) were classified as high risk, and 316 presented for further screening. On OGTT, 13.1% had dysglycemia, including 10% with screen-detected diabetes and 67.9% with glycated haemoglobin (HbA1c)-defined high risk. Participants with pre-diabetes (n = 208) had high levels of common cardiovascular risk factors, i.e., obesity (73.7%), elevated total cholesterol (51.9%), and hypertension (29.4%). Self-referral is likely an efficient method for selecting participants for community-based diabetes risk screening in Africa. Post-screening management of individuals with pre-diabetes must include attention to co-morbid cardiovascular risk factors.

Prisons and custodial settings are part of a comprehensive response to COVID-19

Comment: Prisons are epicentres for infectious diseases because of the higher background prevalence of infection, the higher levels of risk factors for infection, the unavoidable close contact in often overcrowded, poorly ventilated, and unsanitary facilities, and the poor access to health-care services relative to that in community settings. Infections can be transmitted between prisoners, staff and visitors, between prisons through transfers and staff cross-deployment, and to and from the community. As such, prisons and other custodial settings are an integral part of the public health response to coronavirus disease 2019 (COVID-19).

Reduced Cognitive Assessment Scores Among Individuals With Magnetic Resonance Imaging-Detected Vascular Brain Injury.

Background and Purpose- Little is known about the association between covert vascular brain injury and cognitive impairment in middle-aged populations. We investigated if scores on a cognitive screen were lower in individuals with higher cardiovascular risk, and those with covert vascular brain injury. Methods- Seven thousand five hundred forty-seven adults, aged 35 to 69 years, free of cardiovascular disease underwent a cognitive assessment using the Digital Symbol Substitution test and Montreal Cognitive Assessment, and magnetic resonance imaging (MRI) to detect covert vascular brain injury (high white matter hyperintensities, lacunar, and nonlacunar brain infarctions). Cardiovascular risk factors were quantified using the INTERHEART (A Global Study of Risk Factors for Acute Myocardial Infarction) risk score. Multivariable mixed models tested for independent determinants of reduced cognitive scores. The population attributable risk of risk factors and MRI vascular brain injury on low cognitive scores was calculated. Results- The mean age of participants was 58 (SD, 9) years; 55% were women. Montreal Cognitive Assessment and Digital Symbol Substitution test scores decreased significantly with increasing age (P<0.0001), INTERHEART risk score (P<0.0001), and among individuals with high white matter hyperintensities, nonlacunar brain infarction, and individuals with 3+ silent brain infarctions. Adjusted for age, sex, education, ethnicity covariates, Digital Symbol Substitution test was significantly lowered by 1.0 (95% CI, -1.3 to -0.7) point per 5-point cardiovascular risk score increase, 1.9 (95% CI, -3.2 to -0.6) per high white matter hyperintensities, 3.5 (95% CI, -6.4 to -0.7) per nonlacunar stroke, and 6.8 (95% CI, -11.5 to -2.2) when 3+ silent brain infarctions were present. No postsecondary education accounted for 15% (95% CI, 12-17), moderate and high levels of cardiovascular risk factors accounted for 19% (95% CI, 8-30), and MRI vascular brain injury accounted for 10% (95% CI, -3 to 22) of low test scores. Conclusions- Among a middle-aged community-dwelling population, scores on a cognitive screen were lower in individuals with higher cardiovascular risk factors or MRI vascular brain injury. Much of the population attributable risk of low cognitive scores can be attributed to lower educational attainment, higher cardiovascular risk factors, and MRI vascular brain injury.

Race, Ethnicity, Socioeconomic Status, and Chronic Lung Disease in the U.S.

Higher socioeconomic status (SES) indicators such as educational attainment and income reduce the risk of chronic lung diseases (CLDs) such as Chronic Obstructive Pulmonary Disease (COPD), emphysema, chronic bronchitis, and asthma. Marginalization-related Diminished Returns (MDRs) refer to smaller health benefits of high SES for marginalized populations such as racial and ethnic minorities compared to the socially privileged groups such as non-Hispanic Whites. It is still unknown, however, if MDRs also apply to the effects of education and income on CLDs. Using a nationally representative sample, the current study explored racial and ethnic variation in the associations between educational attainment and income and CLDs among American adults. In this study, we analyzed data (n = 25,659) from a nationally representative survey of American adults in 2013 and 2014. Wave one of the Population Assessment of Tobacco and Health (PATH)-Adult study was used. The independent variables were educational attainment (less than high school = 1, high school graduate = 2, and college graduate =3) and income (living out of poverty =1, living in poverty = 0). The dependent variable was any CLDs (i.e., COPD, emphysema, chronic bronchitis, and asthma). Age, gender, employment, and region were the covariates. Race and ethnicity were the moderators. Logistic regressions were fitted to analyze the data. Individuals with higher educational attainment and those with higher income (who lived out of poverty) had lower odds of CLDs. Race and ethnicity showed statistically significant interactions with educational attainment and income, suggesting that the protective effects of high education and income on reducing odds of CLDs were smaller for Blacks and Hispanics than for non-Hispanic Whites. Education and income better reduce the risk of CLDs among Whites than Hispanics and Blacks. That means we should expect disproportionately higher than expected risk of CLDs in Hispanics and Blacks with high SES. Future research should test if high levels of environmental risk factors contribute to the high risk of CLDs in high income and highly educated Black and Hispanic Americans. Policy makers should not reduce health inequalities to SES gaps because disparities sustain across SES levels, with high SES Blacks and Hispanics remaining at risk of health problems.

Correlation between serological biomarkers of extracellular matrix turnover and lung fibrosis and pulmonary artery hypertension in patients with systemic sclerosis

To determine the value of serological biomarkers of collagen degradation/turnover as serum markers of organ involvement in patients with systemic sclerosis (SSc). Serum samples were obtained from 79 SSc patients and 19 healthy control subjects. Types I to VI collagen turnover, excluding type II collagen, were evaluated using nine serological biomarkers. Organ involvement, such as interstitial lung disease (ILD), pulmonary arterial hypertension (PAH), esophageal motility disorder, lower gastrointestinal lesions, joint contractures and digital ulceration, were evaluated and correlated with serum biomarkers. Among multiple serological biomarkers of collagen turnover, the mean level of C5M was higher in SSc (3.9ng/mL) than healthy subjects (2.6ng/mL). In addition, PRO-C6 (12.6ng/mL vs 5.4ng/mL) and C6M (26.0ng/mL vs 16.7ng/mL) were higher in SSc than the controls. The modified Rodnan skin score correlated with PRO-C3 and PRO-C6. Serum level of C6M was higher in patients with ILD. Furthermore, serum levels of PRO-C3, PRO-C6, and C6M were higher in patients with PAH. The use of high levels of these biomarkers as risk factors of PAH showed that all patients with PAH had high levels of risk factors. Of note, two-third of patients with serum PRO-C3, PRO-C6 and C6M values above the respective cut-off values had PAH. Our study indicated that collagen turnover abnormality, especially type VI collagen, is not only important pathologically in skin sclerosis but also in organ involvement. These biomarkers of collagen turnover are potentially clinically useful as biomarkers of organ involvement in SSc.

Associations of Psychosocial Factors with Multiple Health Behaviors: A Population-Based Study of Middle-Aged Men and Women.

Background: The health behaviors smoking, risky alcohol consumption, insufficient physical activity, and poor diet constitute the main contributors to non-communicable diseases. Clustering of risk behaviors is common and increases the risk of these diseases. Despite health benefits, it is difficult to change health behaviors. Psychosocial factors could play a role in health behavior change, with research showing relationships between unfavorable psychosocial factors and health risk behaviors. However, many studies only investigated one or two health behaviors at a time. The present study, therefore, aimed to investigate associations between a broad range of psychosocial factors and multiple health risk behaviors in a general middle-aged population in Sweden. Methods: A cross-sectional design was used to investigate a random sample from the general population in Sweden (n = 1007, 45–69 years, 50% women). Questionnaire data on health behaviors (smoking, alcohol consumption, physical activity, and fruit/vegetable intake) and psychosocial factors, with both psychological and social resources (social integration, emotional support, perceived control, self-esteem, sense of coherence and trust) and psychological risk factors (cynicism, vital exhaustion, hopelessness and depressiveness), were analyzed. Logistic and ordinal logistic regression were used to analyze associations between psychosocial factors and multiple (0–1, 2 or 3–4) health risk behaviors. Results: A total of 50% of the sample had two health risk behaviors and 18% had three health risk behaviors. After adjusting for age, sex, education, employment status, and immigrant status, eight out of 10 psychosocial factors (exceptions: social integration and self-esteem) showed significant odds ratios (ORs) in the expected directions; low levels of psychosocial resources and high levels of psychosocial risk factors were associated with multiple risk behaviors. The strongest associations with multiple risk behaviors were seen for vital exhaustion (adjusted (adj.) OR 1.28; confidence interval (CI) 1.11–1.46), depressiveness (adj. OR 1.32, CI 1.14–1.52), and trust (adj. OR 0.80, CI 0.70–0.91). When controlling for all psychosocial factors in the same model, only the association with trust remained statistically significant (adj. OR 0.89, CI 0.73–1.00, p = 0.050). Associations with individual health behaviors were fewer and scattered, with no psychosocial factor being related to all four behaviors. Conclusions: Examining associations between a broad range of psychosocial factors and multiple health risk behaviors revealed consistent and significant associations for almost all psychosocial factors. These associations were stronger compared to associations to single health risk behaviors. Our findings support the relevance of considering psychosocial aspects in interventions aimed at health behavior change, especially for people with multiple health risk behaviors.

Methamphetamine use in pregnancy, child protection, and removal of infants: Tertiary centre experience from Western Australia

AbstractThe aim of this study is to explore factors that determine infant removal by Child Protective Services and placement in out of home care, for methamphetamine-using women receiving pregnancy care with Western Australia Women and Newborn Drug and Alcohol Service. MethodA prospective cohort study of 112 methamphetamine-using women attending Women and Newborn Drug and Alcohol Service for pregnancy care from 2015 to 2018 was undertaken. Maternal methamphetamine use was assessed during each trimester of pregnancy using a standardised assessment tool. Drug use was by maternal self-report. Involvement of Western Australia's Department for Child Protection and Family Support and removal from maternal care were recorded. Infant development was formally assessed at 12 months with Griffiths Mental Development Scales. The comparison was made between three groups: those women who had no involvement with Child Protection, those for whom Child Protection was involved but the child remained in maternal care and those women who had their infants removed from their care. A comparison between Aboriginal and non-Aboriginal women was also undertaken. ResultsOf the 110 infants born to 112 women, 33 (30.3%) of infants were removed from maternal custody after delivery. Overall 60 (53.5%) of women had Child Protection involvement. Aboriginal women were overrepresented in our population 59 (52.7%) and 24 out of the 33 infants were Aboriginal were removed and placed into out of home care. Infants were removed from women with a high level of risk factors associated with MA use including those who were homeless, in prison, unemployed or continued high use of MA, mental health issues. Aboriginal infants were at increased risk of removal. Children removed from maternal care had a trend towards poorer developmental attainment at around 12 months compared to those who remained with their mother. Infants who were removed by the Child protection had lower general quotients (p = 0.132) than infants who had no involvement or some involvement. ConclusionInfants removed from maternal care were more likely to be from women with high use, adverse social factors and born to mothers who identified as being Aboriginal. Resources are required that work intensively with families to reduce the number of infants being removed from maternal care to overcome the risks and challenges of addiction. Implications for practiceResources that provide long term support and community-based models that offer a comprehensive range of maternal-child services and in-home-support would be more effective in keeping families together.

Preoperative Assessment and Management of Patients with Pain and Anxiety Disorders.

Purpose of ReviewThis review summarizes selected recent evidence on issues important for preoperative pain evaluation.Recent FindingsOpioids, though a mainstay of postoperative pain management, are associated with both short and increasingly recognized long-term risks, including persistent opioid use. Risk factors for high levels of acute postoperative pain as well as chronic postsurgical pain may overlap, including psychological factors such as depression, anxiety, and catastrophizing. Tools to predict those at risk for poor postoperative pain outcomes are being studied.SummaryPreoperative pain and psychological factors can affect postoperative pain outcomes. More work is needed in the future to develop practical interventions in the preoperative period to address these factors.

High levels of non-communicable diseases risk factors among transgenders in Puducherry, South India.

Context:Identification and documentation of risk factors for non-communicable diseases (NCDs) among an 'invisible community' like the transgenders (TGs) will throw light on the prevailing health status of one of the most marginalized populations in India, thereby paving way for initiating measures that would cater to their healthcare needs.Aims:To estimate prevalence of risk factors for NCDs among TGs registered in a community-based organization in Puducherry.Settings and Design:A cross-sectional descriptive study among adult (≥18 years) TGs in a community-based organization in Puducherry.Methods and Material:Data on sociodemographic details, selected risk factors of NCDs—alcohol use, tobacco use, physical inactivity, obesity, unhealthy diet, hypertension, and self-reported diabetes mellitus (DM) were collected using a pre-tested structured questionnaire. Dependence levels on tobacco and/or alcohol were obtained using “Fagerstrom Addiction Scale” and “Alcohol Use Disorder Identification Test” scales, respectively.Statistical Analysis Used:Data were single entered using EpiData and analyzed using EpiData Analysis.Results:Of the 200 TGs included in the study, mean (SD) age was 30 (8.8) years. Around 47% belonged to upper-lower socioeconomic class. About 90% of the participants had unhealthy dietary practice, 84% were physically inactive, 41% had high waist hip ratio, 36% were obese, 16% had high blood pressure, and 8% had self-reported DM. Prevalence of tobacco use was 43.5% with high nicotine dependence noted in 29% (23/79) of smokeless tobacco users and 12% (2/17) of smokers. Alcohol use was reported among 64.5% of which one fifth had possible dependence.Conclusion:Prevalence of selected risk factors for NCDs was high among TGs when compared to general population in Puducherry, which warrants targeted health interventions and priority in policy planning.

Association of longitudinal risk profile trajectory clusters with adipose tissue depots measured by magnetic resonance imaging

The objective of the study was to identify associations of longitudinal trajectories of traditional cardiometabolic risk factors with abdominal and ectopic adipose tissue depots measured by magnetic resonance imaging (MRI). We measured total abdominal, visceral, and subcutaneous adipose tissue in liter and intrahepatic, intrapancreatic and renal sinus fat as fat fractions by MRI in 325 individuals free of cardiovascular disease at Exam 3 of a population-based cohort. We related these MRI measurements at Exam 3 to longitudinal risk profile trajectory clusters, based on risk factor measurements from Exam 3, Exam 2 (seven years prior to MRI) and Exam 1 (14 years prior to MRI). Based on the levels and longitudinal trajectories of several risk factors (blood pressure, lipid profile, anthropometric measurements, HbA1c), we identified three different trajectory clusters. These clusters displayed a graded association with all adipose tissue traits after adjustment for potential confounders (e.g. visceral adipose tissue: βClusterII = 1.30 l, 95%-CI:[0.84 l;1.75 l], βClusterIII = 3.32 l[2.74 l;3.90 l]; intrahepatic: EstimateClusterII = 1.54[1.27,1.86], EstimateClusterIII = 2.48[1.93,3.16]. Associations remained statistically significant after additional adjustment for the risk factor levels at Exam 1 or Exam 3, respectively. Trajectory clusters provided additional information in explaining variation in the different fat compartments beyond risk factor profiles obtained at individual exams. In conclusion, sustained high risk factor levels and unfavorable trajectories are associated with high levels of adipose tissue; however, the association with cardiometabolic risk factors varies substantially between different ectopic adipose tissues. Trajectory clusters, covering longitudinal risk profiles, provide additional information beyond single-point risk profiles. This emphasizes the need to incorporate longitudinal information in cardiometabolic risk estimation.

Alexithymia and psychological distress among women undergoing in vitro fertilization.

The aim of the current study was to analyze the relationship between alexithymia, anxiety, physical problems, trauma, and psychological distress in women undergoing in vitro fertilization. The study was based on 78 women (mean age = 34.4 ys) who were referred to a fertility treatment with in vitro fertilization. The questionnaires (socio-demographic questionnaire, Toronto Alexithymia Scale, and Clinical Outcomes in Routine Evaluation - Outcome Measure) were administered by the investigators. Our results suggest that alexithymia was significantly correlated to anxiety (r=0.506, p=0.00), depression (r=0.591, p=0.00), physical problems (r=0.477, p=0.00), trauma (r=0.512, p=0.00), and psychological distress (r=0.598, p=0.00). Furthermore, high alexithymia group showed significantly higher levels of anxiety (F=4.65, p=0.00), depression (F=2.30, p=0.00), trauma (F=1.80, p=0.00) and general psychological distress (F=2.85, p=0.04) than the low alexithymia group. Results of the present study point out that alexithymia could be considered a potential risk factor for high levels of anxiety, depression and general psychological distress. It may also be used as an indicator of a need for further psychological support aimed at women undergoing in vitro fertilization.

MHealth tool to improve community health agent performance for child development: study protocol for a cluster-randomised controlled trial in Peru

IntroductionCultivating child health and development creates long-term impact on the well-being of the individual and society. The Amazon of Peru has high levels of many risk factors that are associated...

RATIONALE, DEVELOPMENT AND IMPLEMENTATION OF THE FUNCTIONAL-ORGANIZATIONAL MODEL FOR IMPROVEMENT OF SECONDARY PREVENTION OF ACTINIC KERATOSIS

It is known that effective prevention of skin cancer is to identify individuals with a high level of risk factors for skin cancer, timely diagnosis and active treatment of precancerous skin lesions. Among the diseases that pose an increased risk of squamous cell carcinoma are actinic keratosis. Thus, effective prevention of actinic keratosis is one of the crucial factors in justifying cost minimization and improving patients' quality of life.&#x0D; Aim – to substantiate the improvement of secondary prevention of actinic keratosis by developing a functional-organizational model based on a process approach.&#x0D; Material and methods.The methods of system and process approach, system and content analysis are applied in the research; medical-statistical, descriptive modeling. Statistical processing of material using EZR v. 1.35.&#x0D; Results. The proposed model envisages a number of structural elements and functions inherent in them, from the provision of health services at the level of a health care facility to communicative, informational-analytical, educational-methodological and scientific, resource and regulatory support at the territorial and national levels of government. The advantages of the proposed model include its justification based on the results of research, international developments, as well as current regulatory documents, medical standards. The implementation of the model will allow the healthcare provider to select and apply the necessary set of preventive measures in accordance with the medical-technological standards of medical care. The values ​​of the coefficients of variation for all the distinguished advantages of the model, which were evaluated during the examination, did not exceed 10.0%, which indicates a low degree of variability and unanimity of expert estimates.&#x0D; Conclusions. The proposed functional and organizational model for improving the secondary prevention of actinic keratosis is in line with the principles of comprehensiveness and continuity of medical care and provides patients with quality and affordable medical care while optimizing available resources.

Sleep quality is associated with psychosocial functioning and health-related quality of life in pediatric transplant recipients.

This study examined patient-reported sleep quality in a single-center cross-sectional sample of adolescents with solid organ transplants and evaluated associations between sleep quality, psychosocial functioning (ie, depression/anxiety symptoms), and HRQOL. Health disparities associated with minority race/ethnicity and socioeconomic variables were also examined. Sixty-nine adolescents (M=16.51years; SD=1.63) who received a solid organ transplant (kidney: n=25; liver: n=24; heart: n=20) completed self-report measures of sleep quality, psychosocial functioning, and HRQOL. Adolescent transplant recipients endorsed significantly lower levels of sleep quality (ie, falling asleep) compared with previously published norms of healthy peers (t=-3.60; P≤.001). Higher sleep quality was significantly associated with fewer anxiety and depressive symptoms (r=-.31 to -.40), and higher physical and psychosocial HRQOL (r=.33-.43). Adolescents from minority backgrounds had significantly worse sleep quality compared with non-Hispanic Whites. Adolescent transplant recipients, particularly those from minority backgrounds, may be at increased risk for experiencing poor sleep quality. Suboptimal sleep is a risk factor for higher levels of anxiety and depressive symptoms, as well as lower levels of physical and psychosocial HRQOL. Sleep is an important modifiable factor that, if improved, may contribute to lower anxiety/depressive symptoms and better HRQOL in adolescent transplant recipients.