Implementation Of Prevention Strategies Research Articles

Comparison of Cognitive Impairment Diagnosis Criteria in Clinical Settings: Conventional vs. Neuropsychological.

Theories on Alzheimer disease pathogenesis propose a gap between pathological changes and the onset of clinical symptoms. The early detection of cognitive decline is crucial for the implementation of preventive strategies. Mild cognitive impairment is a transitional stage and an accurate diagnosis is vital. However, the diagnosis of mild cognitive impairment varies due to inconsistent diagnostic criteria. This study aims to explore the effectiveness of comprehensive neuropsychological criteria, including all cognitive domains, for diagnosing cognitive impairment in clinical settings. The study included 509 subjects with subjective cognitive complaints between 2017 and 2021. They were diagnosed using the conventional and neuropsychological criteria, and the results were named the complex criteria (conventional criteria-neuropsychological criteria). Concordance between the conventional and neuropsychological diagnostic criteria diagnoses was 87.82%. Some participants diagnosed with mild cognitive impairment or dementia using the conventional criteria were classified as normal according to the neuropsychological criteria. Notably, the mild cognitive impairment - normal cognition (MCI-NC) and dementia (DEM)-NC (normal cognition) groups exhibited distinct characteristics. The MCI-NC group had higher depression scores (P = .008) and better memory performance (P = .026) and executive function (P = .020) than the MCI-MCI group. The DEM-NC group had better instrumental activities of daily living (P < .001) than the DEM-DEM group. This study highlights the complexity of diagnosing cognitive impairment and the importance of comprehensive criteria. Relying solely on conventional criteria may lead to overdiagnosis. The neuropsychological criteria consider various cognitive domains and better discriminate between individuals with MCIs or other factors that contribute to cognitive difficulties.

Emerging Strategies and Effective Prevention Measures for Investigating the Association Between Stroke and Sudden Cardiac Fatality.

Stroke-related cardiac death is a significant concern for patients with stroke and their healthcare providers. It is a complex and multifaceted condition that requires careful management of both modifiable and non-modifiable risk factors. This review provides an overview of the pathophysiology, risk factors, and prevention strategies for stroke-related cardiac death. The review highlights the importance of identifying and managing modifiable risk factors such as hypertension, diabetes, and lifestyle factors, as well as non-modifiable risk factors such as age and genetics. Additionally, the review explores emerging strategies for prevention, including the use of wearable devices and genetic testing to identify patients at risk, stem cell therapy and gene therapy for cardiac dysfunction, and precision medicine for personalized treatment plans. Despite some limitations to this review, it provides valuable insights into the current understanding of stroke-related cardiac death and identifies important areas for future research. Ultimately, the implementation of evidence-based prevention strategies and personalized treatment plans has the potential to improve outcomes for patients with stroke and reduce the burden of stroke-related cardiac death in the population.

Investigating the Effect of Substance Desire and Child Abuse in Adolescent Suicide Attempt.

This study aimed to investigate the impact of child abuse and substance desire on adolescent suicide. This cross-sectional analytical study was conducted on all adolescents aged 12 to 19 who attempted suicide in 2018 at Khorshid Hospital, Isfahan, Iran. A checklist of the patients' demographic information, toxicological data, and 2 standard questionnaires, including substance desire (family, personal, social) and child abuse questionnaire (emotional abuse, physical abuse, and neglect abuse), were collected. The data were analyzed using SPSS version 15. Comparisons between the 2 groups were performed using t tests, chi-square tests, regression analysis, and crude model analysis. Odds ratio (OR) and 95% confidence interval were calculated based on logistic regression. A total of 196 teenagers were included in the study, with a mean age of 16.48±1.6 years. Out of these, 155 individuals (79.1%) were female, resulting in a female-to-male ratio of 3.78. There was a significant relationship between gender and alcohol consumption in the personal aspect, as well as between the history of psychiatric diseases and alcohol consumption in the physical aspect (P<0.005). The previous history of suicide was the only variable that showed significance in all aspects of both the substance desire and child abuse questionnaires. History of neglect abuse (OR: 1.2, 95% CI [1.07-1.41]; P=0.009) was a predictive factor for suicide attempt. However, being male (OR: 0.12, 95% CI [0.039-0.37], P=0.000), having no psychiatric history (OR: 0.23, 95% CI [0.10-0.52], P<0.001) and not consuming alcohol (OR 0.33, 95% CI 0.15-0.71, P=0.005) were identified as protective factors for attempted suicide. A public health strategy for suicide prevention includes implementing prevention strategies aimed at reducing risk factors, such as alcohol consumption and the risk of neglect abuse.

Defining the concept of reserve in the motor domain: a systematic review.

A reserve in the motor domain may underlie the capacity exhibited by some patients to maintain motor functionality in the face of a certain level of disease. This form of "motor reserve" (MR) could include cortical, cerebellar, and muscular processes. However, a systematic definition has not been provided yet. Clarifying this concept in healthy individuals and patients would be crucial for implementing prevention strategies and rehabilitation protocols. Due to its wide application in the assessment of motor system functioning, non-invasive brain stimulation (NIBS) may support such definition. Here, studies focusing on reserve in the motor domain and studies using NIBS were revised. Current literature highlights the ability of the motor system to create a reserve and a possible role for NIBS. MR could include several mechanisms occurring in the brain, cerebellum, and muscles, and NIBS may support the understanding of such mechanisms.

Injury Risk and Prevention Strategies Among Saudi and Irish Amateur Women Soccer Players – A qualitative study

Abstract This qualitative study aimed to explore how Saudi and Irish women amateur soccer players perceive soccer-related injury risk and prevention, including barriers and facilitators to the implementation of prevention strategies. Online interviews were conducted with 36 amateur women soccer players (20 Saudi and 16 Irish) of 18 years and older. Findings were analysed using Reflexive Thematic Analysis. Three main themes were identified; (1) “we don’t have enough knowledge about injury prevention” (2) implementing injury prevention measures varies across players and teams, and (3) “we love the game…but we are undervalued”. The biopsychosocial characteristics of the players influenced their experiences on injury prevention in all three themes. Tailored educational programmes for women, their coaches, and parents of younger players, as well as provision of the required support for amateur teams are recommended to encourage participation and implementation of evidence-based injury prevention strategies, taking player’s biopsychosocial characteristics into account.

The Biodiversity of Blackflies (Diptera: Simuliidae) in Brazil: New Distribution Records and Updated Checklist.

Currently, according to the most recent Simuliidae World Inventory, there are 97 valid species of blackflies recorded in Brazil, some of which act as vectors for zoonoses such as human onchocerciasis and mansonellosis in the northern and central-western regions of the country. Meanwhile, other species can cause serious socioeconomic problems due to the nuisance of female bites. Therefore, accurate knowledge of their distribution is crucial for the development and implementation of successful preventive strategies. With this aim, this study reviewed and updated the geographical distribution of the blackfly fauna throughout the Brazilian states. The data were compiled from three main sources: geographic information of material deposited at the Simuliidae Collection of the Instituto Oswaldo Cruz (CSIOC-IOC), a comprehensive review of scientific literature, and online biodiversity databases. We present a total of 71 new distribution records of 38 different Simuliidae species for 24 Brazilian states. Neither of these sets of records has been included in the Simuliidae World Inventory. Consequently, an updated Brazilian Simuliidae checklist, comprising a total of 98 valid species, is presented, highlighting these new distribution records. We also discuss six dubious records for the country and the implications of this updated data for the Simuliidae species richness of Brazil, its states, and biomes. This information is essential for future studies in the taxonomy, systematics, and biogeography of this family in Brazil.

Male perspectives on intimate partner violence: A qualitative analysis from South Africa.

Intimate partner violence (IPV) affects one in four women globally and is more commonly enacted by men than women. Rates of IPV in South Africa exceed the global average. Exploring the background and context regarding why men use violence can help future efforts to prevent IPV. We explored adult men's perspectives of IPV, livelihoods, alcohol use, gender beliefs, and childhood exposure to abuse through a secondary analysis of qualitative interviews that were conducted in South Africa. The setting was a peri-urban township characterized by high unemployment, immigration from rural areas, and low service provision. We utilized thematic qualitative analysis that was guided by the social ecological framework. Of 30 participants, 20 were residents in the neighborhood, 7 were trained community members, and 3 were program staff. Men reported consumption of alcohol and lack of employment as being triggers for IPV and community violence in general. Multiple participants recounted childhood exposure to abuse. These themes, in addition to culturally prescribed gender norms and constructs of manhood, seemed to influence the use of violence. Interventions aimed at reducing IPV should consider the cultural and social impact on men's use of IPV in low-resource, high-IPV prevalence settings, such as peri-urban South Africa. This work highlights the persistent need for the implementation of effective primary prevention strategies that address contextual and economic factors in an effort to reduce IPV that is primarily utilized by men directed at women.

The global burden and risk factors of cardiovascular diseases in adolescent and young adults, 1990–2019

BackgroundTo provide details of the burden and the trend of the cardiovascular disease (CVD) and its risk factors in adolescent and young adults.MethodsAge-standardized rates (ASRs) of incidence, mortality and Disability-Adjusted Life Years (DALYs) were used to describe the burden of CVD in adolescents and young adults. Estimated Annual Percentage Changes (EAPCs) of ASRs were used to describe the trend from 1990 to 2019. Risk factors were calculated by Population Attributable Fractions (PAFs).ResultsIn 2019, the age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR) and age-standardized DALYs rate (ASDR) of CVD were 129.85 per 100 000 (95% Confidence interval (CI): 102.60, 160.31), 15.12 per 100 000 (95% CI: 13.89, 16.48) and 990.64 per 100 000 (95% CI: 911.06, 1076.46). The highest ASRs were seen in low sociodemographic index (SDI) and low-middle SDI regions. The burden was heavier in male and individuals aged 35–39. From 1990 to 2019, 72 (35.29%) countries showed an increasing trend of ASIR and more than 80% countries showed a downward trend in ASMR and ASDR. Rheumatic heart disease had the highest ASIR and Ischemic Heart Disease was the highest in both ASMR and ASDR. The main attributable risk factor for death and DALYs were high systolic blood pressure, high body-mass index and high LDL cholesterol.ConclusionsThe burden of CVD in adolescent and young adults is a significant global health challenge. It is crucial to take into account the disparities in SDI levels among countries, gender and age characteristics of the population, primary types of CVD, and the attributable risk factors when formulating and implementing prevention strategies.

Level of implementation of multimodal strategies for infection prevention and control interventions and prevalence of healthcare-associated infections in Northern Italy

BackgroundIn November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions.MethodsA PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0–1 or 0–2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient.ResultsIn total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25–12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman’s Rho -0.340, p 0.034). No other significant correlation was found.ConclusionsThis study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission.

Profiles of suicide attempted in children and adolescents

ObjectiveSuicide attempt (SA) is the strongest predictive variable for completed suicide. The Department of Cauca in Colombia has an SA rate higher than the national average, but the factors are unknown. The objective was to identify the profiles of SA in children and adolescents of Cauca. MethodsCross-sectional study, which included all SA (Event-356) records from the SIVIGILA platform in children under 18 years of age between 2016 and 2019. The authors described the variables and multiple correspondence analysis (MCA) with the Burt method, according to the completeness of the data to establish the possible SA profiles using STATA 15.1, and R. The Ethics Committee at Universidad del Cauca approved it. ResultsThe study found 977 SA during this period, 72.4% female, 97.1% adolescent, 74.4% mestizo, 19.3% indigenous, 45.3% resided in municipalities exposed to the armed conflict, 32.3% expressed ideation and previous attempts, and 15.5% prior attempts. The MCA included 810 SA and identified three profiles: “Classic”, which had mestizo adolescents with a history of prior SA, mental illness, or psychoactive substance use problems; “Related to the armed conflict”, which included female adolescents with a first SA and residents in municipalities exposed to the armed conflict; “Ethnic” represented by male indigenous, with housing in a rural area. ConclusionThe SA profiles found in Cauca were “Classic”, “Related to the armed conflict”, and “Ethnic”; these can be considered to implement prevention strategies from a cross-cultural, mental health, and gender perspective, with the presence of the state in the territories.

Spatial-temporal distribution characteristics of etiologically positive pulmonary tuberculosis in Jiangsu Province from 2011 to 2021

Objective: To analyze the spatial-temporal distribution of etiologically positive pulmonary tuberculosis (PTB) at the county (city, district) unit in Jiangsu Province from 2011 to 2021 to provide evidence for the implementation and adjustment of prevention and control strategies of PTB in Jiangsu Province. Methods: The registration data of etiologically positive PTB patients in Jiangsu Province from 2011 to 2021 were collected from the Tuberculosis Management Information System in the China Information System of Disease Control and Prevention. Data on the permanent population were from the statistical yearbook of each county (city, district) in Jiangsu Province. Geoda 1.18.0 software was used to analyze the global and local spatial autocorrelation and explore the spatial clustering. SaTScan 10.1 software was used to analyze the spatial-temporal clusters, and ArcGIS 10.7 software was used to visualize the spatial-temporal clusters. Results: A total of 128 240 etiological positive PTB cases were registered in Jiangsu Province from 2011 to 2021, with an average annual registration rate of 13.99/100 000. The registration rate showed an overall upward trend (trend χ2=63.49, P<0.001) after 2017, and the etiologically positive rate showed an overall upward trend (trend χ2=3 710.86, P<0.001). The annual Moran's I values ranged from 0.107 to 0.343, which showed a spatial clustering distribution. The results of local spatial autocorrelation analysis showed that there were "high-high" clustering areas in Jiangsu Province each year, showing a dynamic distribution, and most of the areas were distributed in the central and southern regions of Jiangsu Province, with the largest number (7) in 2015 and the smallest number (1) in 2011. A total of 4 spatial-temporal clustering areas were explored by spatial-temporal scanning analysis (all P<0.001), among which the first-level clustering area covered 3 counties (cities, districts), namely Changshu, Taicang, and Xiangcheng District of Suzhou, and the clustering time was from 2011 to 2015. The secondary clustering areas covered 24 counties (cities, districts), mainly covering Jiangsu's central and northern regions, such as Huai'an, Suqian, and Yancheng. The third-level clustering areas covered 26 counties (cities, districts); the fourth-level clustering area was the Gaochun District of Nanjing, with the clustering period from 2017 to 2021. Conclusions: From 2011 to 2021, the etiologically positive PTB registration rate at the county (city, district) level in Jiangsu Province had obvious spatial-temporal clustering characteristics. The clustering areas included the northern areas with relatively backward economies and the southern areas with better economic development. Multiple measures should be taken to prevent and control PTB according to the specific situation in different regions.

Management of traumatic brain injury in Africa: Challenges and opportunities.

Traumatic brain injury (TBI) is a major public health concern globally, with significant implications for morbidity, mortality, and long-term disability. While extensive research has been conducted on TBI management in high-income countries, limited attention has been given to the specific challenges and opportunities faced by healthcare systems in Sub-Saharan Africa (SSA). This perspective study aims to provide a comprehensive overview of the current status of TBI management in SSA, focusing on the unique challenges and potential opportunities for improvement. The findings highlight several key challenges faced by SSA healthcare systems in managing TBIs, including limited resources, inadequate infrastructure, and a shortage of trained healthcare professionals. Furthermore, social and cultural factors, such as ignorance of driving laws, financial constraints, and limited access to modern technology services. However, the study also identifies potential opportunities for improving TBI management in SSA. These include strengthening healthcare infrastructure, enhancing pre-hospital care and transportation systems, and increasing public awareness and education about TBI. This perspective study emphasizes the urgent need for tailored interventions and strategies to address the unique challenges faced by SSA in managing TBIs. Addressing the challenges and opportunities in brain injury management in sub-Saharan Africa requires a comprehensive approach which can be through investing in health infrastructure, addressing socioeconomic inequalities, implementing prevention strategies, and fostering evidence-based research collaboration. Through this, the region can significantly improve TBI care and outcomes, thereby improving the well-being of people affected by TBI in sub-Saharan Africa.

Lifelong psychological and lifestyle features in relation to cardiovascular disease development: A narrative review

Despite the extensive literature on individual risk factors, such as diet, physical activity, body weight, smoking habits, and mental health characteristics, the literature on different lifestyle and mental health patterns, their evolution over time, and how these factors interact and synergistically affect cardiovascular health is sparse. The need for longitudinally studying these characteristics is currently being highlighted by the limited studies with repeated measurements. This review summarizes the literature concerning lifestyle and psychological characteristics, both well-studied (e.g., diet, physical activity, smoking habits, chronic stress and depression), as well as newly proposed characteristics (e.g., sleep habits, positive psychology characteristics) and their longitudinal association with cardiovascular disease. Studies with data on lifelong characteristics are not always comparable and have found mixed results, especially concerning changes in characteristics such as quitting smoking or starting to be physically active later in life. Therefore, further research is warranted for the implementation of future preventive strategies for cardiovascular disease.

Breast cancer mortality in Chinese women and men from 1990 to 2019: Analysis of trends in risk factors.

This study aimed to examine the relative risk of risk factor in male and female breast cancer (BC) deaths in China and analyzed the changing trends in BC mortality rates from 1990 to 2019. Open data from the Global Burden of Disease database from 1990 to 2019 were analyzed to assess the number of BC deaths and age-standardized mortality rates (ASMR) in China. The age-period-cohort model was employed to study age effects, period effects, cohort effects, as well as local drift and net drift of the data, determining the impact of changing risk factors on crude mortality rates and ASMR of BC. In 2019, the number of BC deaths across all age groups in China increased by 130.38% compared to 1990, with an increase of 125.68% in females and 648.80% in males. The ASMR for BC and male BC increased in 2019, while female BC ASMR declined. Overall, alcohol consumption and smoking as risk factors contributed to increased mortality rates of BC with advancing age. Over the entire study period, the net drift of alcohol consumption in females for BC was 0.06% (95% confidence interval [CI]: -0.24% to 0.36%), while for smoking it was -0.64% (95% CI: -0.83% to -0.45%). For males, the net drift of alcohol consumption for BC was 6.75% (95% CI: 5.55% to 7.96%), and for smoking, it was 6.09% (95% CI: 2.66% to 9.64%). Hence, improving awareness of BC-related risk factors and implementing prevention strategies are necessary to alleviate future BC burdens.

Thromboprophylaxis in hospitalized trauma patients: a systematic review and meta-analysis of implementation strategies

IntroductionVenous thromboembolism (VTE) prophylaxis implementation strategies are well-studied in some hospitalized medical and surgical patients. Although VTE is associated with substantial mortality and morbidity in trauma patients, implementation strategies for...

PRESERVING THE HEALTH OF THE ORGAN OF VISION IN CHILDREN: ORGANIZATIONAL PRINCIPLES

Background. The relevance of the study is due to the growing prevalence of ophthalmic pathology among children, in particular, the growing prevalence of refractive errors in early and older adolescence. The results of scientific research prove the presence of a direct correlation between the growth of the prevalence of ophthalmic pathology and the growth of the child's age and the amount of visual stress, which is primarily related to the educational process during school education. The effective organization of medical care should take into account modern medical and preventive technologies of early preventive intervention, as well as be comprehensive with the involvement of medical specialists (pediatric ophthalmologists, family doctors) and educators, family members, parents of the child for effective support and leveling of managed risk factors for the development of ophthalmic pathology.&#x0D; Aim: to study the modern organizational principles of preserving the health of eye care of children, to clarify the medical and social aspects of the formation of the burden of ophthalmic pathology from childhood in different countries of the world.&#x0D; Materials and methods. The materials for the research were publications of the results of modern scientific research on the study of medical and social aspects of preserving the ophthalmic health of children, the peculiarities of the organization of providing medical and preventive care to children with visual impairments. The methods for carrying out scientific research were: system approach and system analysis, as well as content analysis.&#x0D; Results of the study prove the prospects for the implementation of medical and preventive strategies in the provision of primary and specialized ophthalmic medical care, in view of the significant medical and social burden of ophthalmopathology, the distribution of nosologies by class of diseases of the eye and its accessory apparatus, which are most often found in certain age groups of the children's population, is presented. It has been proven that compliance with the optimal periodicity of medical and preventive examinations is necessary for the majority of ophthalmological nosologies diagnosed since childhood and involves long-term supervision. In children of preschool, preschool and early school age, efforts at early prevention and diagnosis of such ophthalmological nosologies as: refraction anomalies (astigmatism, hypermetropia, myopia) are justified. strabismus and amblyopia; accommodation disorders; lack of convergence. Untreated or untimely detected refraction anomaly, strabismus, amblyopia can lead to the development of irreversible loss of visual functions, blindness and even inhibition of the formation of the visual system with distorted perception of visual information, which without timely correction lead to the appearance of complications, progression of strabismus, decrease in visual acuity, amblyopia , asthenopia, headache and deterioration of general well-being.&#x0D; Conclusion. The important medico-social importance of disorders of visual functions in childhood is a serious problem for the health care system, public health and ophthalmology service, in particular. Reasoned expediency of applying measures to level the managed risk factors against the background of intersectoral interaction of doctors, educators, the child himself and his family. This approach allows you to prevent the negative impact of ophthalmic pathology on academic performance, activate physical development, and promote harmonious personality development.

Overview of Ventilator-Associated Pneumonia in Traumatic Cervical Spinal Injury in Trauma Center of Nepal

Background Cervical spine, crucial for nerve innervation and head and neck motion, is vulnerable to injury due to its over-reliance on ligaments. This study examines the increasing incidence of traumatic spinal cord injuries, particularly in fall and traffic accidents, with respiratory complications being the leading cause of morbidity and mortality, with VAP being a significant complication. MethodsA retrospective cross-section study involving 52 patient data, using self-prepared proforma. The patient’s age, sex, injury severity, and CPIS score were used to determine VAP.ResultsThe study involved 52 patients with a mean age of 50.96. Of these, 67.3% were male and 11.5% female, with 45-60 years being the most common age group. The most severe spinal injury patients, i.e., ASIA A Neurology, developed VAP. Patients with prolonged ICU stay and intubation days also developed VAP, but no statistical significance was seen (P-value: 0.3941 and 0.4751). Mortality had a significant association with VAP (P-value: 0.023). Acinetobacter Baumann was the most common microorganism causing VAP, while Staphylococcus aureus was the least common. The most sensitive antibiotics for isolated organisms were Polymyxin B, Amikacin, Colistin, and Levofloxacin.Conclusions The study found a high prevalence of ventilator association pneumonia (VAP) in cervical spine fracture patients, with mortality associated with the most common organism being Acinetobacter, sensitivity to Polymyxin b. Further monitoring and implementation of VAP prevention strategies are recommended.

Impact of Prosthesis-Patient Mismatch After Surgical Aortic Valve Replacement: Systematic Review and Meta-Analysis of Reconstructed Time-to-Event Data of 122 989 Patients With 592 952 Patient-Years.

It remains controversial whether prosthesis-patient mismatch (PPM) impacts long-term outcomes after surgical aortic valve replacement. We aimed to evaluate the association of PPM with mortality, rehospitalizations, and aortic valve reinterventions. We performed a systematic review with meta-analysis of reconstructed time-to-event data of studies published by March 2023 (according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Sixty-five studies met our eligibility criteria and included 122 989 patients (any PPM: 68 332 patients, 55.6%). At 25 years of follow-up, the survival rates were 11.8% and 20.6% in patients with and without any PPM, respectively (hazard ratio [HR], 1.16 [95% CI, 1.13-1.18], P<0.001). At 20 years of follow-up, the survival rates were 19.5%, 12.1%, and 8.8% in patients with no, moderate, and severe PPM, respectively (moderate versus no PPM: HR, 1.09 [95% CI, 1.06-1.11], P<0.001; severe versus no PPM: HR, 1.29 [95% CI, 1.24-1.35], P<0.001). PPM was associated with higher risk of cardiac death, heart failure-related hospitalizations, and aortic valve reinterventions over time (P<0.001). Statistically significant associations between PPM and worse survival were observed regardless of valve type (bioprosthetic versus mechanical valves), contemporary PPM definitions unadjusted and adjusted for body mass index, and PPM quantification method (in vitro, invivo, Doppler echocardiography). Our meta-regression analysis revealed that populations with more women tend to have higher HRs for all-cause death associated with PPM. The results of the present study suggest that any degree of PPM is associated with poorer long-term outcomes following surgical aortic valve replacement and provide support for implementation of preventive strategies to avoid PPM after surgical aortic valve replacement.

The ENJOY Seniors Exercise Park IMP-ACT project: IMProving older people’s health through physical ACTivity: a hybrid II implementation design study protocol

IntroductionThe health benefits of physical activity are well established; however, most older people are not sufficiently physically active. Despite the availability of various physical activity interventions and programs, implementation of effective prevention strategies to reduce older people’s physical inactivity are lacking. The ENJOY IMP-ACT project is an implementation research project, based on a previous evidence-based physical and social activity program utilising specialised outdoor exercise equipment (the Seniors Exercise Park) for older people. The ENJOY IMP-ACT aims to increase participation in physical activity to improve health outcomes for older people in Victoria, Australia.MethodThe ENJOY IMP-ACT is a hybrid II implementation-effectiveness pre-post mixed method study design. Five local governments (6 public sites/parks) will undergo a 3-month control period followed by 9-months implementation intervention (TERM framework intervention: Training, Engagement, Resources development, Marketing and promotion), and a maintenance phase (3 months). Various methodologies will be employed throughout the project at each site and will include direct observations of park users, intercept surveys with park users, online access monitor platform (using an online app), interviews with stakeholders and exercise program leaders, a process evaluation of physical activity programs, a social return-on-investment analysis, and other related activities.DiscussionThrough the implementation framework design, the ENJOY IMP-ACT is uniquely placed to translate an evidenced-based physical and social activity program into real world settings and increase physical activity among older people. If successful, this program will inform scale up across Australia with the goal of improving the health and wellbeing of older people.Trial registrationThis registration trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial number ACTRN12622001256763. Date registered 20/09/2022.

Association between Migraine and Cardiovascular Diseases among Women of a Tertiary Care Hospital, Hyderabad – A Case–Control Study

Objectives: Women tend to have a higher risk of migraine compared to men. Apart from the conventional risk factors, this study aims to provide insight into the association between migraine and cardiovascular diseases (CVDs). The aim of this study was to assess the association between CVDs and migraine along with other conventional factors among migraineurs with and without aura. Materials and Methods: A case–control study was done among the women attending outpatient of a tertiary care hospital those having hypertension, coronary artery disease, and stroke at the age of &gt;30–60 years, and those who do not have any of the CVDs. Conventional risk factors such as age, body mass index (BMI), physical activity, frequent junk food intake, BMI, and presence of diabetes were assessed along with migraine status adhering to the International Classification of Headache Disorders-3. Comparison of risk factors among cases and controls was done using the Chi-square test and independent t-test whichever was appropriate. Results: Our study included 191 cases and 191 controls; among the cases, hypertensives were predominant. There was a statistically significant association between migraine and any CVD with an increased risk of 12.35 times (confidence interval 7.12–21.4). The only statistically significant risk factor among the cases was the frequent intake of junk food and uncontrolled status was more among those migraineurs having an aura. Conclusion: The importance of migraine as one of the risk factors should be kept in mind among CVDs to implement prevention strategies at the earliest.