Impact Of Modifiable Risk Factors Research Articles

Prevalence and Impact of Modifiable Risk Factors on Acute Coronary Syndrome: A Case Control Study

Highlights: 1. Smoking duration, dyslipidemia, hypertension, diabetes mellitus, obesity, and hyperuricemia, are significantly associated with ACS. 2. Obesity and hypertension are identified as risk factors for inpatient ACS. - Background: Acute coronary syndrome (ACS) is defined by the abrupt reduction or total obstruction of blood flow to the myocardium. Recognized risk factors for ACS include conditions such as hypertension, dyslipidemia, smoking, obesity, diabetes mellitus, hyperuricemia, as well as variables like age, gender, and family history of the ailment. The objective of this research was to examine the prevalence and importance of modifiable risk factors associated with ACS. Material and Methods: The study is structured as a prospective case-control study. The research sample comprises 100 ACS patients, categorized into three groups: STEMI, NSTEMI, and UAP. The Chi-Square test and logistic regression were used to examine the samples. The threshold for statistical significance was set at p<0.05. Results: ACS occurred more frequently in male patients (54%) and those aged ≥ 40 years (85%). Several factors demonstrated significant associations with ACS, including smoking habits, dyslipidemia, hypertension, diabetes mellitus, obesity, and hyperuricemia. Among these, inpatient ACS was notably linked with obesity (OR: 7.42; 95% CI: 1.48-37.11; p=0.015) and hypertension (OR: 0.13; 95% CI: 0.03-0.53; p=0.005). The presence of ACS was also correlated with a notable increase in inpatient care, with obesity and hypertension emerging as risk factors for inpatient ACS. Conclusion: ACS was more common in males and individuals aged 40 or older, with significant associations identified between ACS and various factors, including smoking, dyslipidemia, diabetes, obesity, hyperuricemia, and hypertension, with obesity and hypertension specifically linked to inpatient ACS.

Sex‐specific effects of genetically predicted BMI and education on risk of AD

AbstractBackgroundExamining sex differences on the impact of modifiable risk factors in Alzheimer’s disease (AD) risk can help us better understand the mechanisms underlying sex differences in the prevalence and incidence of AD. Here, we used polygenic risk scores (PRS) and Mendelian randomization (MR) to investigate sex‐specific effects of sleep duration, insomnia, blood pressure, diabetes, alcohol intake, smoking, body mass index, high cholesterol, and education on AD risk.MethodWe obtained combined and sex‐stratified genome‐wide association study (GWAS) summary statistics for each risk factor from the UK Biobank and used them as the base dataset for constructing PRS and exposure datasets in the MR analysis. Linkage disequilibrium clumping was performed to identify independent genome‐wide significant single nucleotide polymorphisms (SNPs) across the sex‐combined, male‐specific, and female‐specific GWAS. The combined lead SNPs were then weighted by their strata‐specific effect sizes in the stratified PRS and MR analyses. PRS were constructed for each risk factor in participants from the Alzheimer’s Disease Genetics Consortium. Linear regression was used to investigate the association of each PRS with AD risk, adjusting for age, principal components, and cohort. MR was used to estimate sex‐stratified causal effects of each risk factor on AD. Sex differences in PRS associations and MR causal estimates were determined using Fisher’s Z score method.ResultsAssociation testing of the PRS with AD risk in sex stratified cohorts revealed that the BMI PRS was associated with differential effects in men and women (OR [95%CI]: males: 1.05 [1.00, 1.10] vs females: 0.96 [0.93, 0.99], p = 0.003). Furthermore, the university completion PRS was non‐significant in men but was associated with reduced risk in women (OR [95%CI]: males: 0.96 [0.92, 1.01] vs females: 0.92 [0.89, 0.96], p = 0.12). In the follow‐up MR analysis, university completion was also causally associated with reduced risk in women only (OR [95%CI]: males: 1.09 [0.77, 1.53] vs females: 0.55 [0.42, 0.72], p = 0.002) (Figure 1). No other risk factors showed evidence of sex‐differences.ConclusionOur study found sex‐specific effects of genetically predicted BMI and educational attainment on AD risk. These findings suggest the need for sex‐specific approaches to AD prevention and management.

What are the most prevalent combinations of modifiable dementia risk factors that can be targeted in multidomain lifestyle intervention in Canada?

AbstractBackgroundNot all risk factors have the same weight in dementia development, and the combinations of common risk factors differs across individuals and populations. The goal of this study is to estimate the potential population impact of modifiable risk factors for dementia in Canada, and to identify the combinations of the modifiable risk factors that could prevent many dementia cases in Canadian adults.MethodThis is a secondary analysis of data from the Canadian Longitudinal Study on Aging Comprehensive Cohort (n = 30,009). The prevalence and population attributable fraction (PAF) of 12 modifiable lifestyle risk factors established in the Lancet Commission Report 2020 were calculated using baseline data. The prevalence of every possible dyad, triad, and tetrad combination of the risk factors was estimated. All analyses were stratified by 2 sex strata (male, female) and 4 age strata (45‐54, 55‐64, 65‐74, 75+).ResultThe combined PAF of the 12 lifestyle risk factors was 49% in the Canadian population. The single risk factors that contributed the most were physical inactivity (11.3%), hearing loss (6.9%), and obesity (6.9%) in Canada, whereas social isolation (0.4%), alcohol (1.1%), and smoking (1.4%) had substantially smaller effects (Table 1). The most prevalent risk factor dyad was physical inactivity and sleep disturbance (34%). Obesity, physical inactivity, and sleep disturbance was the most prevalent risk factor triad (14%). The tetrad of hearing loss, obesity, physical inactivity, and sleep disturbance had the highest prevalence (4.9%). The prevalent risk factor combinations were similar in the two younger age groups and both sexes, but not in the two older age groups (Table 2).ConclusionNearly 50% of dementia cases in Canada can be prevented by modifying 12 lifestyle risk factors. The most prevalent combinations of risk factors differ before and after the age of 65, but not by sex. The most prevalent risk factor combinations consist of physical inactivity, sleep disturbance and obesity in the two younger age groups, and hearing loss, sleep disturbance and obesity in the two older age groups. These findings may help strategically target tailoring multidomain dementia intervention programs to have the greatest impact in the Canadian population.

Spatial and Temporal Trends in Pancreatic Cancer Burden Attributable to High Body Mass Index at the Global and National Levels

ObjectivesTo examine the spatiotemporal trends in pancreatic cancer (PC) disability-adjusted life years (DALYs) and mortality attributable to high body-mass index (BMI) by age, gender, and countries from 1990 to 2019.MethodsData were extracted from the Global Burden of Disease Study 2019 results. We presented the annual number of PC DALYs and mortality, and corresponding age-standardized rates (ASDR and ASMR), which were further stratified by age, gender, and countries. The estimated annual percentage change (EAPC) was computed to assess the longitudinal trends in ASRs.ResultsIn 2019, 0.7 million DALYs and 31.9 thousand deaths worldwide were caused by PC attributable to high BMI, with the largest amount reported in high-income North America, Western Europe, and East Asia. The corresponding ASDR and ASMR were highest in females and in high SDI regions, while quite varied across countries. The global EAPC in ASDR and ASMR was 1.45 (95% uncertainty interval [UI]: 1.40, 1.50) and 1.44 (95% UI: 1.39, 1.49), respectively. Almost all involved countries demonstrated significant uptrends in ASRs from 1990 to 2019.ConclusionsMore productive efforts to reduce the impact of modifiable risk factors, such as overweight, should be undertaken, and thus effectively curb the rise of PC burden.

Impact of modifiable risk factors on prediction of 10-year cardiovascular disease utilizing framingham risk score in Southwest Iran

BackgroundThis cohort study was conducted to examine the association between modifiable risk factors, including hypertension, smoking, physical activity, diabetes, cholesterol, and high-density lipoprotein with Framingham risk score in the prediction of 10-year-risk of cardiovascular diseases (CVD) between men and women in an Arab community of Southwest Iran, Hoveyzeh.Materials and methodsA total of 8,526 people aged 35–70 participated in this cohort study. Framingham was used to estimate the 10-year risk of CVD. Also, the linear regression models were used to assess the relationship between modifiable risk factors and the 10-year risk of CVD. Finally, the area under the receiver operating characteristic curve (AUC) was used to measure the ability of modifiable risk factors to predict the 10-year risk of CVD.ResultsOur results of linear regression models showed that hypertension, smoking, PA, diabetes, cholesterol, and HDL were independently associated with the CVD risk in men and women. Also, AUC analysis showed that hypertension and diabetes have the largest AUC in men 0.841; 0.778 and in women 0.776; 0.715, respectively. However, physical activity had the highest AUC just in women 0.717.ConclusionHypertension and diabetes in both gender and physical activity in women are the most important determinant for the prediction of CVD risk in Hoveyzeh. Our cohort study may be useful for adopting strategies to reduce CVD progression through lifestyle changes.

Analysis of pathological complete response (PCR) and impact of modifiable risk factors on the premature discontinuation of pertuzumab use in early stage HER-2 breast cancer: A retrospective single-institutional study.

e12627 Background: In patients with HER-2 positive breast cancer, Pertuzumab in combination with Trastuzumab forms a potent Anti HER-2 regimen. Randomized clinical trials have concluded that addition of Pertuzumab to Trastuzumab and Chemotherapy leads to improved rates of Pathological Complete Response and also improved Invasive-disease-free survival rates in early stage HER-2 positive breast cancer. Pertuzumab is frequently associated with treatment limiting diarrhea and other adverse effects. In this study, we report our experience with the use of Pertuzumab in early stage HER-2 breast cancer. We analyzed the adverse events, PCR rates for those patients who had premature discontinuation of treatment versus those who had successful treatment completion, and modifiable risk factors that may have affected completion of treatment. Methods: We conducted an IRB approved, retrospective study, analyzing the use of Pertuzumab at our institution for early stage (Stage I-III), HER-2 positive female and male breast cancer patients seen from June 2018 to June 2022. Data were obtained from our Institutional Cancer Registry. Results: One hundred and eighteen (118) patient charts were reviewed. Sixty Five (55.08%) patients received Pertuzumab. Of the patients who received Pertuzumab, 61 (93.85%) received it in the Neoadjuvant setting. Thirty Eight (58.46%) patients completed the treatment and 27 (41.5%) patients had premature treatment discontinuation due to adverse effects. The rate of PCR in patient who completed the prescribed treatment course was 55.56%, and 51.85% for those who did not (p value 0.77). Among the patients in whom treatment was discontinued, diarrhea (51%), followed by rash (11.11%) were the main adverse effects. Almost 66% of non-smokers completed treatment as compared to 48% of smokers (p value 0.15). Patients with a normal BMI had a treatment completion rate of 76% compared to obese or overweight patients who had a rate of 52% (p value 0.08). Conclusions: Our retrospective study showed that there was a high premature discontinuation rate of the use of Pertuzumab. This is due to adverse effects, diarrhea being the most notable. However, the PCR rate difference was not statistically significant (55.56 vs 51.85, P value 0.77) in patients who completed treatment versus those who did not. There was a positive trend observed that non-smokers and non-obese patients were more likely to complete treatment with Pertuzumab. Although it was observed that premature discontinuation of Pertuzumab did not significantly impact PCR, further studies are required to validate this observation.

Ischemic Heart Disease and Vascular Risk Factors Are Associated With Accelerated Brain Aging

BackgroundIschemic heart disease (IHD) has been linked with poor brain outcomes. The brain magnetic resonance imaging–derived difference between predicted brain age and actual chronological age (brain-age delta in years, positive for accelerated brain aging) may serve as an effective means of communicating brain health to patients to promote healthier lifestyles. ObjectivesThe authors investigated the impact of prevalent IHD on brain aging, potential underlying mechanisms, and its relationship with dementia risk, vascular risk factors, cardiovascular structure, and function. MethodsBrain age was estimated in subjects with prevalent IHD (n = 1,341) using a Bayesian ridge regression model with 25 structural (volumetric) brain magnetic resonance imaging features and built using UK Biobank participants with no prevalent IHD (n = 35,237). ResultsPrevalent IHD was linked to significantly accelerated brain aging (P < 0.001) that was not fully mediated by microvascular injury. Brain aging (positive brain-age delta) was associated with increased risk of dementia (OR: 1.13 [95% CI: 1.04-1.22]; P = 0.002), vascular risk factors (such as diabetes), and high adiposity. In the absence of IHD, brain aging was also associated with cardiovascular structural and functional changes typically observed in aging hearts. However, such alterations were not linked with risk of dementia. ConclusionsPrevalent IHD and coexisting vascular risk factors are associated with accelerated brain aging and risk of dementia. Positive brain-age delta representing accelerated brain aging may serve as an effective communication tool to show the impact of modifiable risk factors and disease supporting preventative strategies.

The impact of modifiable risk factors in the association between socioeconomic status and sudden cardiac death in a prospective cohort study: equal access to healthcare, unequal outcome.

Low socioeconomic status is associated with all-cause mortality and cardiac risk factors. Furthermore, sudden cardiac death (SCD) is among the leading causes of death in the general population, and identification of high-risk subgroups is needed. The aim of this study was to investigate the association between income and education level and incidence of SCD, and to calculate the impact of modifiable mediating risk factors. Participants in the Copenhagen City Heart Study were followed from 1993-2016. SCD was identified using high quality death certificates, autopsy reports, discharge summaries, and national registry data. Hazard ratios were calculated using Cox proportional hazards regression and adjusted cumulative incidences were predicted using cause-specific Cox models. Mediation analyses were performed using a marginal structural model approach. During 24 years of follow-up, 10,006 participated, whereof 5,514 died during the study period with 822 SCDs. Compared to long education, persons with elementary school level education had an SCD incidence rate ratio (IRR) of 2.48 (CI-95% 1.86-3.31), and low income was likewise associated with an SCD IRR of 2.34 (CI-95% 1.85-2.96) compared to high income. In the association between education and SCD, the combined mediating effect of smoking, physical activity, and BMI accounted for about 20% of the risk differences. We observed an inverse association between both income and education and the risk of SCD, which was only in part explained by common cardiac risk factors, implying that further research into competing causes of SCD is needed and stresses the importance of targeted preventive measures.

Externally validated models for first diagnosis and risk of progression of knee osteoarthritis.

ObjectiveWe develop and externally validate two models for use with radiological knee osteoarthritis. They consist of a diagnostic model for KOA and a prognostic model of time to onset of KOA. Model development and optimisation used data from the Osteoarthritis initiative (OAI) and external validation for both models was by application to data from the Multicenter Osteoarthritis Study (MOST).Materials and methodsThe diagnostic model at first presentation comprises subjects in the OAI with and without KOA (n = 2006), modelling with multivariate logistic regression. The prognostic sample involves 5-year follow-up of subjects presenting without clinical KOA (n = 1155), with modelling with Cox regression. In both instances the models used training data sets of n = 1353 and 1002 subjects and optimisation used test data sets of n = 1354 and 1003. The external validation data sets for the diagnostic and prognostic models comprised n = 2006 and n = 1155 subjects respectively.ResultsThe classification performance of the diagnostic model on the test data has an AUC of 0.748 (0.721–0.774) and 0.670 (0.631–0.708) in external validation. The survival model has concordance scores for the OAI test set of 0.74 (0.7325–0.7439) and in external validation 0.72 (0.7190–0.7373). The survival approach stratified the population into two risk cohorts. The separation between the cohorts remains when the model is applied to the validation data.DiscussionThe models produced are interpretable with app interfaces that implement nomograms. The apps may be used for stratification and for patient education over the impact of modifiable risk factors. The externally validated results, by application to data from a substantial prospective observational study, show the robustness of models for likelihood of presenting with KOA at an initial assessment based on risk factors identified by the OAI protocol and stratification of risk for developing KOA in the next five years.ConclusionModelling clinical KOA from OAI data validates well for the MOST data set. Both risk models identified key factors for differentiation of the target population from commonly available variables. With this analysis there is potential to improve clinical management of patients.

Analysing the impact of modifiable risk factors on cardiovascular disease mortality in Brazil.

We have examined the impact of changes in modifiable risk factors on CVD mortality in 26 Brazilian states from 2005 to 2017. Data were acquired from the Global Burden of Diseases study (GBD) and official sources of the Brazilian government, totalling 312 state-year observations. Population attributable fractions (PAFs) were calculated to determine the number of deaths attributed to changes in each risk factor. Fixed-effects multivariable linear regression models were performed, adjusting for income, income inequality, poverty and access to healthcare. Between 2005 and 2017, CVD deaths reduced by 21.42%, accompanied by a decrease in smoking (-33%) and increases in hyperglycaemia (+9.5%), obesity (+31%) and dyslipidaemia (+5.2%). Reduction in smoking prevented or postponed almost 20,000 CVD deaths in this period, while increased hyperglycaemia exposure resulted in more than 6,000 CVD deaths. The association between hyperglycaemia and CVD mortality was 5 to 10 times higher than those found for other risk factors, especially in women (11; 95%CI 7 to 14, deaths per 1-point increase in hyperglycaemia exposure). Importantly, the association between hyperglycaemia and CVD mortality was independent of socioeconomic status and access to healthcare, while associations for other risk factors after the same adjustments. Reduction in smoking was the risk factor that led to the highest number of CVD deaths prevented or postponed, while hyperglycaemia showed the most deleterious association with CVD mortality. Health policies should aim to directly reduce the prevalence of hyperglycaemia to mitigate the population burden of CVD in Brazil in the future.

Large Contribution of Oral Status for Death Among Modifiable Risk Factors in Older Adults: The Japan Gerontological Evaluation Study (JAGES) Prospective Cohort Study.

Oral diseases are preventable and modifiable, but highly prevalent, and cause worse oral status. Particularly, tooth loss has increased in aging societies. However, studies on population-attributable risks of modifiable risk factors for mortality have neglected oral status. This study aimed to investigate the impact of modifiable risk factors on mortality, including oral status. This cohort study used the Japan Gerontological Evaluation Study data, including participants aged ≥65 years. The outcome was death between August 2010 and March 2017. We calculated the hazard ratios (HRs) and population attributable fraction (PAF) of modifiable risk factors (oral status, hypertension, depression, heart disease, diabetes, physical activity, smoking status, and alcohol drinking history) for mortality. Analyses included 24 175 men and 27 888 women (mean age: 73.8 [6.0] and 74.2 [6.1], respectively). In men, after adjusting for covariates, having no teeth showed the highest hazard ratio (HR = 1.67, 95% confidence interval [CI] = 1.51-1.86) among the modifiable risk factors, and the PAF for the number of teeth (18.2%) was the second largest following age. In women, having no teeth had the third largest HR (HR = 1.37, 95% CI = 1.19-1.56) following current and former smoking. The PAF for the number of teeth (8.5%) was the sixth largest, which was larger than that of smoking status (4.8%). In the older population, the HR and PAF of the number of teeth on mortality were sufficiently large compared with other modifiable risk factors, especially in men. Therefore, maintaining good oral status should be included more in global health policies.

Do modifiable risk factors for cardiovascular disease post-pregnancy influence the association between hypertensive disorders of pregnancy and cardiovascular health outcomes? A systematic review of observational studies

Hypertensive disorders of pregnancy (HDP) are associated with increased risk of developing cardiovascular disease (CVD) in later life. This systematic review aimed to evaluate the impact of modifiable risk factors for CVD following pregnancy on the relationship between HDP and cardiovascular health outcomes. Seven databases (Medline, CENTRAL, CINAHL, Cochrane Reviews, Embase, PsycINFO and Scopus) were searched from date of inception to July 24, 2019. Observational studies that included female adults with a history of HDP and analysed whether modifiable risk factors for CVD following pregnancy (dietary intake, physical activity, smoking status, alcohol intake, body weight and mental health status) influenced associations between HDP and cardiovascular health outcomes (morbidity, mortality or related risk markers) were eligible for inclusion. In total, 4704 articles were identified, with 11 studies included. The modifiable risk factors measured included body weight (11 studies), physical activity and dietary intake (one study) and smoking (one study). Overall, five of seven studies provided convincing evidence that the relationship between HDP and blood pressure was adversely impacted by excess body weight post-pregnancy. The current systematic review provides evidence that excess body weight post-pregnancy impacts associations between HDP and hypertension in later life. However, there is a lack of evidence exploring the impact of a variety of modifiable risk factors for CVD on associations between HDP and cardiovascular health outcomes. This evidence is imperative to inform development of effective CVD prevention interventions for women with a history of HDP.

Corelația dintre stilul de viață nesănătos, reinternarea în perioada vulnerabilă și mortalitatea intraspitalicească și la un 1 an la pacienții cu insuficiență cardiacă

Purpose. The present study aim to identify whether an unhealthy lifestyle, defined as active smoking and hyper sodium diet, leads to a higher likelihood of readmission of patients with heart failure (HF) during the vulnerable period or to an increased risk of in-hospital mortality and one year mortality. The vulnerable period for patients with heart failure refers to the first 90 days after discharge. Material and methods. This was a retrospective study conducted in the Cardiology Clinic of the Emergency Clinical Hospital “Bagdasar Arseni” in Bucharest, between October 2018 and October 2019 and enrolled 500 patients with heart failure. After applying the inclusion and exclusion criteria, 198 patients remained eligible for inclusion in this study. Demographic data as well as those related to the presence of complications during hospitalization and in-hospital mortality were collected from the observation sheet and from the database of the “Bagdasar Arseni” hospital. Data on readmission in the first 90 days after the reference discharge and one year mortality were assessed by telephone and using the Hipocrate software. All data obtained were entered into the Microsoft Excel database and were statistically processed using the Python program. Results. An unhealthy lifestyle increase the probability of readmission by 12% and the risk of in-hospital mortality by 17%. Younger patients tends to have an unhealthy lifestyle compared to the elderly (p-value = 0.000). Men have an unhealthy lifestyle (p- value = 0.000). Professionally active people tend to have an unhealthy lifestyle (p-value = 0.02). No statistically significant differences were observed in terms of the unhealthy lifestyle of people from urban or rural areas. Conclusions. The present study highlights the fact that an unhealthy lifestyle increase the mortality rate and readmissions in patients with heart failure. From the analyzed data, our study is the first study that measured the cumulative impact of modifiable risk factors related to lifestyle on readmission in the vulnerable period. We believe that these results could be the basis of a future study that would include a larger number of a patients and more modifiable factors.

Modifiable factors of 20-year blood pressure trajectories among normotensives and their associations with hypertension : a prospective study.

Little is known about the impact of modifiable risk factors on blood pressure (BP) trajectories and their associations with hypertension (HTN). We aimed to identify BP trajectories in normotensive Chinese adults and explore their influencing factors and associations with HTN. We used data from 3436 adults with at least four BP measurements between 1989 and 2018 in the China Health and Nutrition Survey, an ongoing cohort study. We measured BP using mercury sphygmomanometers with appropriate cuff sizes in all surveys. We used group-based trajectory modelling to identify BP trajectories between 1989 and 2009 and multiple logistic and Cox regression models to analyse their influencing factors and associations with HTN in 2011-2018. We identified five systolic blood pressure (SBP) trajectories, 'Low-increasing (LI)', 'Low-stable (LS)', 'Moderate-increasing (MI)', 'High-stable (HS)' and 'Moderate-decreasing (MD)', and four diastolic blood pressure (DBP) trajectories classified as 'Low-increasing (LI)', 'Moderate-stable (MS)', 'Low-stable (LS)' and 'High-increasing (HI)'. People with higher physical activity (PA) levels and lower waist circumferences (WC) were less likely to be in the SBP LI, MI, HS and MD groups (P < 0·05). People with higher fruit and vegetable intakes, lower WCs and salt intakes and higher PA levels were less likely to be in the DBP LI, MS and HI groups (P < 0·05). Participants in the SBP HS group (hazard ratio (HR) 2·01) or the DBP LI, MS and HI groups (HR 1·38, 1·40, 1·71, respectively) had higher risks of HTN (P < 0·05). This study suggests that BP monitoring is necessary to prevent HTN in the Chinese population.

Authors’ Response to Peer Reviews of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

Authors’ Response to Peer Reviews of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study.

In 2018, an outbreak of cutaneous leishmaniasis (CL) occurred in Diyala Province in Iraq. Several risk factors of CL were identified in a prior study; however, the impact of removing modifiable risk factors on the occurrence of the disease was not measured. The aim of this study is to measure the impact of removing modifiable risk factors of CL on the occurrence of the disease. We conducted a population-based unmatched case-control study in two conveniently selected districts in Diyala Province. All cases of CL were included. Controls were chosen preferentially according to the site where the cases occurred. A structured questionnaire was used to collect data. The unadjusted odds ratios (ORs) and 95% confidence intervals for each risk factor were calculated using binary logistic regression. We also calculated the attributable fractions and 95% confidence intervals of the modifiable risk factors. A P value <.05 was considered statistically significant. Data from 844 persons (432 cases, 51.2%) were analyzed. Cases were more likely than controls to report a history of previous displacement (OR 5.18, 95% CI 3.84-6.98), electricity supply for less than 12 hours per day (OR 1.94, 95% CI 1.47-2.55), living in a rural area (OR 1.91, 95% CI 1.45-2.51), living in a clay house (OR 2.41, 95% CI 1.59-3.66), having an unpainted indoor living space (OR 2.14, 95% CI 1.51-3.02), having rodents inside the house (OR 5.15, 95% CI 3.56-7.47), having chickens, sheep, or both (OR 3.44, 95% CI 2.48-4.75), having a mixture of dogs and sheep or of dogs and chickens within a distance of less than 100 meters (OR 3.92, 95% CI 2.59-5.94), fogging (OR 2.11, 95% CI 1.40-3.19), bed net use (OR 1.72, 95% CI 1.08-2.72), and sleeping outside or a mixture of inside and outside (OR 4.01, 95% CI 1.32-12.19). The data show that the exposure of approximately 70% to 80% of cases was associated with displacement, the presence of rodents inside the house, the presence of animals within 100 meters of the house, the presence of animals (chickens/sheep/both or a mixture of dogs and sheep or of dogs and chickens), and sleeping outside. Approximately 40%-50% of the cases reported living in a clay house, living in a rural area, having an unpainted indoor space, having an electricity supply for less than 12 hours, and using a bed net. Prevention and control of CL requires a multifaceted approach that relies on changing environmental conditions, housing conditions, and human behavior. Fogging and bed net use were not effective because the underlying housing characteristics and human behavior provided a good culture for the disease. We recommend conducting a study to identify the species, reservoirs, and vectors of CL in Iraq; studying vector behaviors before applying environmental control measures; and educating the public on how and when to use bed nets as well as how to accompany their use with behavioral changes.

Peer Review of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

Peer Review of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

Peer Review of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

Peer Review of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

Peer Review of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

Peer Review of “Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study”

The Effect of Modifiable Risk Factors on Postoperative Complications in Lumbar Spine Fusions.

Retrospective cohort study. The impact of modifiable risk factors (MRFs) on complications, costs, and readmission rates at 30, 90, and 180-days following lumbar spine fusion. Patients with lumbar spine fusions within the 2016-2017 Nationwide Readmissions Database (NRD). Patients were stratified by the following MRFs: Alcohol use, tobacco/nicotine use, nutritional malnourishment, dyslipidemia, and primary hypertension. Differences in complications, non-elective readmission rates, costs, and length of stay were compared between MRFs and the non-MRF group. Statistical analysis was conducted using Tukey multiple comparisons of means, 1-way ANOVA, Wald testing, unpaired Welch 2-sample t-tests, multivariate analysis, and predictive modeling. The final analysis included 297,579 lumbar fusion patients. At 30 and 90 days, patients with nutritional malnutrition, dyslipidemia, and primary hypertension had significantly greater readmission rates than patients without MRFs (all P<0.01). At 180-days, all MRFs had significantly greater readmission rates than the non-MRF group (all P<0.001). Dyslipidemia demonstrated significantly greater rates of myocardial infarction at 90 days compared to all groups (all P<0.02). Nutritional malnutrition was associated with a significantly greater mortality rate than primary hypertension, non-MRF, and tobacco/nicotine use at 90 days (P<0.001) and only tobacco/nicotine use at 180 days (P=0.007). Predictive modeling showed increases of 0.77%, 1.70%, and 2.44% risk of readmission at 30, 90, and 180-days respectively per additional MRF (all P<0.001). These findings highlight the negative impact each MRF has on patients following lumbar spinal fusion. Further longitudinal research is necessary to comprehensively characterize the effects of various MRFs on spine surgery outcomes.