Key Modifiable Factors Research Articles

Patient, health service factors and variation in mortality following resuscitated out-of-hospital cardiac arrest in acute coronary syndrome: Analysis of the Myocardial Ischaemia National Audit Project

AimsTo determine patient and health service factors associated with variation in hospital mortality among resuscitated cases of out-of-hospital cardiac arrest (OHCA) with acute coronary syndrome (ACS). MethodsIn this cohort study, we used the Myocardial Ischaemia National Audit Project database to study outcomes in patients hospitalised with resuscitated OHCA due to ACS between 2003 and 2015 in the United Kingdom. We analysed variation in inter-hospital mortality and used hierarchical multivariable regression models to examine the association between patient and health service factors with hospital mortality. ResultsWe included 17604 patients across 239 hospitals. Overall hospital mortality was 28.7%. In 94 hospitals that contributed at least 60 cases, mortality by hospital ranged from 10.7% to 66.3% (median 28.6%, IQR 23.2% to 39.1%)). Patient and health service factors explained 36.1% of this variation.After adjustment for covariates, factors associated with higher hospital mortality included increasing serum glucose, ST-Elevation myocardial infarction (STEMI) diagnosis, and initial admission to a primary percutaneous coronary intervention (pPCI) capable hospital. Hospital OHCA volume was not associated with mortality. The key modifiable factor associated with lower mortality was early reperfusion therapy in STEMI patients. ConclusionThere was wide variation in inter-hospital mortality following resuscitated OHCA due to ACS that was only partially explained by patient and health service factors. Hospital OHCA volume and pPCI capability were not associated with lower mortality. Early reperfusion therapy was associated with lower mortality in STEMI patients.

Dietary Patterns and Cardiovascular Disease Risk in People with Type 2 Diabetes.

The primary objective of this review is to identify dietary patterns with beneficial effects on cardiovascular health of adults with type 2 diabetes. The prevalence of diabetes is increasing globally. People with diabetes have a greater risk for cardiovascular disease. Mediterranean diet, dietary approaches to stop hypertension diet, vegetarian diet, traditional Korean diet, Japanese diet, and low-glycemic-index diet can reduce cardiovascular disease risk in people with diabetes. Dietary intake is a key modifiable factor in the management of diabetes and plays a significant role in limiting the incidence of cardiovascular diseases.

Long-term associations between inflammatory dietary scores in relation to long-term C-reactive protein status measured 12 years later: findings from the Supplémentation en Vitamines et Minéraux Antioxydants (SU.VI.MAX) cohort.

Chronic low-grade inflammation has been recognised as a key underlying mechanism for several chronic diseases, including cancer and CVD. Nutrition represents a host of key modifiable factors that influence chronic inflammation. Dietary inflammatory scores were developed to assess the inflammatory potential of the diet and have been associated with inflammatory biomarkers in cross-sectional and short-term longitudinal studies. The objective of this study was to investigate the relationship between the dietary inflammatory index (DII), the alternate dietary inflammatory index (ADII) and long-term C-reactive protein (CRP). We also tested age as an effect modifier of this relationship. Participants were selected in the Supplémentation en Vitamines et Minéraux Antioxydants study, which included subjects aged 45-60 years old for men and 35-60 years old for women in 1994. Participants with ≥3 24-h dietary records at baseline and a CRP measurement at the 12-year follow-up evaluation were included in the present study (n 1980). The relationships between the DII and ADII and elevated CRP (>3 mg/l) were investigated using logistic multivariable regression. All analyses were stratified by age (cut-off at median age=50 years old). The overall associations between DII and ADII and long-term CRP were not statistically significant (P trend across tertiles=0·16 for DII and 0·10 for ADII). A quantitative interaction was found between ADII score and age (P=0·16 for ADII, 0·36 for DII). In stratified analyses the ADII was significantly prospectively associated with CRP only in younger participants: OR tertile 3 v. tertile 1: 1·79 (95 % CI 1·04, 3·07). Pro-inflammatory diets may have long-term effect on CRP only in younger subjects.

Feasibility of Use of a Mobile Application for Nutrition Assessment Pertinent to Age-Related Macular Degeneration (MANAGER2).

PurposeThis is a feasibility study assessing use of a mobile phone application (app.) to measure nutrient intake relevant to age-related macular degeneration (AMD).MethodsInclusion criteria were age over 40 and ownership of a smartphone. Participants included healthy volunteers and those with ophthalmic conditions. They were asked to record daily food intake for a minimum of 3 days in a paper food diary and the app. A dietician analyzed the food diaries, and an independent researcher analyzed data from the app. Average daily intake of nutrients relevant to AMD (docosahexaenoic acid [DHA], eicosapentaenoic acid [EPA], vitamins E and C, copper, zinc, and lutein + zeaxanthin) were calculated for both and then compared.ResultsA total of 54 participants completed the app. and food diary. Male-to-female ratio was 7:20. Median (interquartile range [IQR]) age was 57 years (45.3–68.7 years). More than 90% of all values were within the limits of agreement for all micronutrients. Bland Altman agreement plots demonstrated clinically acceptable agreement between the two systems of analysis.ConclusionsThis study has demonstrated that the app. is a feasible alternative to the food diary for assessing nutrient intake relevant to AMD. Further studies are suggested to assess long-term adherence and effect of the app. on nutrient intake in AMD patients.Translational RelevanceAfter smoking, nutritional modification is the key modifiable factor to reduce incidence of AMD. Use of the app. could be an efficient, easy way to monitor and improve dietary intake of required nutrients pertinent to AMD.

Applied investigation of person-specific and context-specific factors on postoperative recovery and clinical outcomes of patients undergoing gastrointestinal cancer surgery: multicentre European study

IntroductionCancer treatments have greatly advanced over the past two decades causing survival improvements and reduced complications from cancer surgery. However, the cancer diagnosis and the effects of treatment modalities pose...

Evaluation and classification of different types of anthropogenic resources: the cases of old landfills, obsolete computers and in-use wind turbines

Various recent policy initiatives indicate an increasing need for a comprehensive overview of potentially extractable anthropogenic resources, in order to compare them with geogenic resources. Therefore, a method has been developed to evaluate and classify anthropogenic resource deposits and to prioritize potential extraction projects in a transparent manner. In this study we present how anthropogenic resources can be systematically integrated into the United Nations Framework Classification for Fossil Energy and Mineral Reserves and Resources 2009 (UNFC-2009). The main goal is to illustrate different settings of anthropogenic resource classification, and to provide specific criteria to map different types of anthropogenic resources within the three dimensions of UNFC-2009, i.e. “knowledge on composition and extractable material content”, “technical and project feasibility” and “socioeconomic viability”. Projects for recovering materials from an old landfill, from obsolete PCs (personal computers), and from in-use wind turbines are exemplarily evaluated and classified under UNFC-2009. The economic results depend on the respective scenarios, where the timing of mining is varied, different organizational and societal settings are compared and different choices for technological options are made. While landfill mining under current conditions is not economically viable, the final result might look different in the future with changing key modifying factors, such as increasing secondary raw material prices. Mining materials from obsolete PCs and from permanent magnets in in-use wind turbines would both yield positive economic results for all investigated scenarios.

Healthy Lifestyle and Risk of Cancer in the European Prospective Investigation Into Cancer and Nutrition Cohort Study.

It has been estimated that at least a third of the most common cancers are related to lifestyle and as such are preventable. Key modifiable lifestyle factors have been individually associated with cancer risk; however, less is known about the combined effects of these factors.This study generated a healthy lifestyle index score (HLIS) to investigate the joint effect of modifiable factors on the risk of overall cancers, alcohol-related cancers, tobacco-related cancers, obesity-related cancers, and reproductive-related cancers. The study included 391,608 men and women from the multinational European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The HLIS was constructed from 5 factors assessed at baseline (diet, physical activity, smoking, alcohol consumption, and anthropometry) by assigning scores of 0 to 4 to categories of each factor, for which higher values indicate healthier behaviors. Hazard ratios (HR) were estimated by Cox proportional regression and population attributable fractions (PAFs) estimated from the adjusted models.There was a 5% lower risk (adjusted HR 0.952, 95% confidence interval (CI): 0.946, 0.958) of all cancers per point score of the index for men and 4% (adjusted HR 0.961, 95% CI: 0.956, 0.966) for women. The fourth versus the second category of the HLIS was associated with a 28% and 24% lower risk for men and women respectively across all cancers, 41% and 33% for alcohol-related, 49% and 46% for tobacco-related, 41% and 26% for obesity-related, and 21% for female reproductive cancers.Findings suggest simple behavior modifications could have a sizeable impact on cancer prevention, especially for men.

Reducing low birth weight: prioritizing action to address modifiable risk factors.

BackgroundLow birth weight (LBW) affects 6.9% of all UK births and has remained largely unchanged for many years. The United Nations and the World Health Assembly have set targets to substantially reduce global incidence. Understanding the contribution of modifiable risk factors to the burden of LBW is required to ensure appropriate interventions are in place to achieve this reduction.MethodsData from published studies on the risks from key modifiable factors were used alongside prevalence data from the Welsh population to calculate the population attributable risk for each factor individually and in combination.ResultsFourteen risk factors accounted for nearly half of LBW births, and 60% of those to younger mothers (<25 years). Tobacco smoke exposure was the largest contributor. We estimated that smoking in pregnancy was a factor in one in eight LBW births, increasing to one in five for women aged under 25.ConclusionsRisk factors are interrelated and inequitably distributed within the population. Exposure to one factor increases the likelihood of exposure to a constellation of factors further increasing risk. Action to address LBW must consider groups where the risk factors are most prevalent and address these risk factors together using multi-component interventions.

Alcohol Use and Firearm Violence.

Although the misuse of firearms is necessary to the occurrence of firearm violence, there are other contributing factors beyond simply firearms themselves that might also be modified to prevent firearm violence. Alcohol is one such key modifiable factor. To explore this, we undertook a 40-year (1975-2014) systematic literature review with meta-analysis. One large group of studies showed that over one third of firearm violence decedents had acutely consumed alcohol and over one fourth had heavily consumed alcohol prior to their deaths.Another large group of studies showed that alcohol was significantly associated with firearm use as a suicide means. Two controlled studies showed that gun injury after drinking, especially heavy drinking, was statistically significant among self-inflicted firearm injury victims. A small group of studies investigated the intersection of alcohol and firearms laws and alcohol outlets and firearm violence. One of these controlled studies found that off-premise outlets selling takeout alcohol were significantly associated with firearm assault. Additional controlled, population-level risk factor and intervention studies, including randomized trials of which only 1 was identified, are needed. Policies that rezone off-premise alcohol outlets, proscribe blood alcohol levels and enhance penalties for carrying or using firearms while intoxicated, and consider prior drunk driving convictions as a more precise criterion for disqualifying persons from the purchase or possession of firearms deserve further study.

Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death.

PurposeCritically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided.MethodsA year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors.ResultsThe study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children.ConclusionsThe study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.

Investigation of body image as a mediator of the effects of bowel and GI symptoms on psychological distress in female survivors of rectal and anal cancer.

Treatment for rectal and anal cancer (RACa) can result in persistent bowel and gastrointestinal (GI) dysfunction. Body image problems may develop over time and exacerbate symptom-related distress. RACa survivors are an understudied group, however, and factors contributing to post-treatment well-being are not well understood. This study examined whether poorer body image explained the relation between symptom severity and psychological distress. Participants (N = 70) completed the baseline assessment of a sexual health intervention study. Bootstrap methods tested body image as a mediator between bowel and GI symptom severity and two indicators of psychological distress (depressive and anxiety symptoms), controlling for relevant covariates. Measures included the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-CR38) Diarrhea, GI Symptoms, and Body Image subscales and Brief Symptom Index Depression and Anxiety subscales. Women averaged 55 years old (SD = 11.6), White (79 %), and were 4 years post-treatment. Greater Depression was related to poorer Body Image (r = -.61) and worse Diarrhea (r = .35) and GI Symptoms (r = .48). Greater Anxiety was related to poorer Body Image (r = -.42) and worse GI Symptoms (r = .45), but not Diarrhea (r = .20). Body Image mediated the effects of bowel and GI symptoms on Depression, but not on Anxiety. Long-term bowel and GI dysfunction are distressing and affect how women perceive and relate to their bodies, exacerbating survivorship difficulties. Interventions to improve adjustment post-treatment should address treatment side effects, but also target body image problems to alleviate depressive symptoms. Reducing anxiety may require other strategies. Body image may be a key modifiable factor to improve well-being in this understudied population. Longitudinal research is needed to confirm findings.

Analysis of interrelationships among excavator productivity modifying factors

Purpose – Excavator productivity calculations embrace myriad variables, which in turn, can be modelled in several ways. A key productivity variable is operator competence (O c ) because this can impact on so many of the other variables. Earlier research has studied excavator productivity, but little has attempted to simultaneously model productivity variables in relation to O c . The purpose of this paper is to address the void in extant literature. Design/methodology/approach – A numeric, theoretical analysis is undertaken using the Caterpillar® hydraulic excavator productivity model to estimate excavator production, given: first, variance in modifying factors based on derived maximum and minimum values; and second, variance resulting from linear calculations based on excavator operator competence. Findings – Excavator productivity resulting from incremental variance of modifying factors in isolation is shown to be linear except, in the case of bucket payload. Simultaneous application of modifying variables results in a greater, curvilinear productivity trend; while it is demonstrated that quantification of key modifying factors can to a significant extent be related to operator competence. Research limitations/implications – Findings add to productivity literature generally and to that of plant and equipment more specifically. Results will help productivity estimation of excavation in a practical sense while informing subsequent design of an empirical academic research of this problem. Originality/value – Originality relates principally to determining modifying factor ranges and their analysis of simultaneous effect on each other, especially, as influenced on assumptions of operator competence.

Digestion and Postprandial Metabolism in the Elderly.

The elderly are an increasing segment of the population. Despite the rapid gains in medical knowledge and treatments, older adults are more likely to experience chronic illnesses that decrease quality of life and accelerate mortality. Nutrition is a key modifiable lifestyle factor which greatly impacts chronic disease risk. Yet despite the importance of nutrition, relatively little is known of the impact of advancing age on the gastrointestinal function, the digestive responses, and the post-meal metabolic adaptations that occur in response to ingested food. Knowledge of the age-related differences in digestion and metabolism in the elderly is essential to the development of appropriate nutritional recommendations for the maintenance of optimal health and prevention of disease.

Electrochromic performance of WO3films: optimization by crystal network topology modification

In this study, we demonstrate the enhancement of the electrochromic performance of tungsten oxide (WO3) by crystal network topology modification. This is achieved by constructing various crystalline morphologies and patterns of the films. Different mesoscopic crystalline networks of WO3 were acquired on transparent conducting fluorine-doped tin oxide (FTO) by a crystal-seed-assisted hydrothermal process. The modification of the crystal network topology and crystal growth habit of WO3 films was achieved by adding different concentrations of oxalic acid and HCl, and controlling the growth time. The influence of the topological patterns on the corresponding electrochromic performance of WO3 films was examined by scanning electron microscopy (SEM), transmission electron microscopy (TEM), X-ray photoelectron spectroscopy (XPS), X-ray diffraction (XRD) and in situ reflectance spectroscopy. It follows that four different topological patterns of WO3 microstructures, namely random “rocks” of the seed layers, micro-urchin, small peony, and blooming peony were obtained by adding different concentrations of oxalic acid and hydrochloric acid. It is found that pH and oxalic acid are both the key modifying factors of the habit and topology of the crystal networks. Consequently, the urchin-like pattern gives rise to a high efficiency in optical modulation and coloration due to its similarity to micro-sized antennas, which may facilitate the emission and absorption of charged particles and electrochemical reactions at the WO3 surfaces.

Manifestation of anxiety and depression and their association with cardiovascular diseases in the Lithuanian population

Background. Cardiovascular diseases (CVD) continue to be the leading cause of morbidity and mortality in Lithuania. The key modifiable factors identified for CVD prevention include lifestyle and behavior factors (e. g. diet, body weight, physical activity, cigarette smoking), and health risk factors (e. g. hypertension, hypercholesterolemia, etc.), also anxiety and depression are considered as potentially modifiable CVD risk factors as well. The aim of this study was to evaluate the association between psychosocial stress, manifested as anxiety and depression, and CVD. Material and methods. 317 individuals (155 men and 162 women) aged 40–85 years were randomly selected from primary care centers in 20 cities of Lithuania. Individuals were interviewed using the validated questionnaire comprising nutritional habits, family history and lifestyle factors. Psychosocial stress was evaluated using the HAD scale. Serum concentrations of cholesterol, HDL-Ch, LDL-Ch, triglycerides were measured. Results. In 103 individuals (32.5%) the symptoms of clinical anxiety were found (HAD score was 8 points and above according to the anxiety scale). 43 individuals (13.6%) had symptoms of clinical depression (HAD score reached 8 points and above according to the depression scale). The median of depression symptoms was significantly different between men and women (p

Acute kidney injury urinary biomarker time-courses.

Factors which modify the excretion profiles of acute kidney injury biomarkers are difficult to measure. To facilitate biomarker choice and interpretation we modelled key modifying factors: extent of hyperfiltration or reduced glomerular filtration rate, structural damage, and reduced nephron number. The time-courses of pre-formed, induced (upregulated), and filtered biomarker concentrations were modelled in single nephrons, then combined to construct three multiple-nephron models: a healthy kidney with normal nephron number, a non-diabetic hyperfiltering kidney with reduced nephron number but maintained total glomerular filtration rate, and a chronic kidney disease kidney with reduced nephron number and reduced glomerular filtration rate. Time-courses for each model were derived for acute kidney injury scenarios of structural damage and/or reduced nephron number. The model predicted that pre-formed biomarkers would respond quickest to injury with a brief period of elevation, which would be easily missed in clinical scenarios. Induced biomarker time-courses would be influenced by biomarker-specific physiology and the balance between insult severity (which increased single nephron excretion), the number of remaining nephrons (reduced total excretion), and the extent of glomerular filtration rate reduction (increased concentration). Filtered biomarkers have the longest time-course because plasma levels increased following glomerular filtration rate decrease. Peak concentration and profile depended on the extent of damage to the reabsorption mechanism and recovery rate. Rapid recovery may be detected through a rapid reduction in urinary concentration. For all biomarkers, impaired hyperfiltration substantially increased concentration, especially with chronic kidney disease. For clinical validation of these model-derived predictions the clinical biomarker of choice will depend on timing in relation to renal insult and interpretation will require the pre-insult nephron number (renal mass) and detection of hyperfiltration.

Why women choose to give birth at home: a situational analysis from urban slums of Delhi

ObjectivesIncreasing institutional births is an important strategy for attaining Millennium Development Goal -5. However, rapid growth of low income and migrant populations in urban settings in low-income and middle-income countries,...

The Association Between Adiposity and Breast Cancer Recurrence and Survival: A Review of the Recent Literature

Breast Cancer (BC) is the most common and second deadliest malignancy among American women. Many factors contribute to BC prognosis but a key modifiable lifestyle factor is body weight. In this review, we update the reader on the association between adiposity and poor BC outcomes. We summarize the findings from studies that show obesity to be a risk factor for BC recurrence and reduced survival, including research that shows that treatment with aromatase inhibitors in hormone-receptor positive BC survivors who are obese may not be as effective as in normal weight women. In addition, we summarize the findings from studies that show that obesity-induced changes in glucose metabolism, type-2 diabetes and metabolic syndrome contribute to negative outcomes in BC survivors. Given the evidence, there is a critical need to determine whether weight loss can improve outcomes in BC survivors.

An Anxious Heart: Anxiety and the Onset of Cardiovascular Diseases

The public health burden of cardiovascular disease (CVD) is high both in terms of economic and social costs. Key modifiable factors identified for CVD prevention include health behaviors and health risk factors (e.g., cholesterol, blood pressure). However, a substantial body of research has also identified stress, anxiety, and depression as potentially modifiable CVD risk factors. Here we focus on the role of anxiety in the development of CVD and consider its potential as a key target for primordial prevention strategies. First, we highlight important findings and summarize the latest research on anxiety and incident CVD. We also review and summarize the findings to date on subclinical CVD outcomes and briefly consider mechanisms by which anxiety may influence CVD. We identify key issues and consider how these issues may inform our understanding of the anxiety-CVD relationship. Finally, we briefly discuss the clinical implications of this work, with specific recommendations for providers.

Predicting influenza vaccination uptake among health care workers: What are the key motivators?

Health care worker (HCW) vaccination was critical to protecting HCW during the H1N1 pandemic. However, vaccine uptake rates fell below recommended targets. This study examined motivators and barriers influencing HCW pH1N1 vaccination to identify modifiable factors that can improve influenza vaccine uptake. A cross-sectional survey was conducted at a large Canadian tertiary care hospital. HCW (N=3,275) completed measures of demographics, vaccination history, influenza risk factors, and attitudes toward pH1N1 vaccination. Self-reported vaccination was verified with staff vaccination records. Of the total sample, 2,862 (87.4%) HCW received the pH1N1 vaccine. Multiple logistic regression analyses were used to predict HCW vaccination. HCW attitudes toward vaccination significantly predicted vaccination, even after adjusting for demographics, vaccine history, and influenza risk factors. This model correctly predicted 95% (confidence interval [CI]: 0.93-0.96) of HCW vaccination. Key modifiable factors driving HCW vaccination include (1) desire to protect family members and patients, (2) belief that vaccination is important even if one is healthy, (3) confidence in vaccine safety, and (4) supervisor and physician encouragement. This research identified fundamental reasons why HCW get vaccinated and provides direction for future influenza vaccination programs. To enhance vaccine uptake, it is important to target HCW attitudes in influenza vaccine campaigns and create a culture of vaccine promotion in the workplace, including strong messaging from supervisors and physicians.