Low Risk Factors Research Articles

Patient-Centred Modular Secondary Prevention Improves Risk Factors (RFs), Global Risk and Knowledge Following Acute Coronary Syndrome (ACS): A Randomised Controlled Trial

Ralph Reader Prize – Clinical Science 1 Patient-CentredModular SecondaryPrevention Improves RiskFactors (RFs),GlobalRisk andKnowledgeFollowing Acute Coronary Syndrome (ACS): A Randomised Controlled Trial Julie Redfern1,∗, Tom Briffa 2, Elizabeth Ellis 1, Ben Freedman1,3 1University of Sydney, NSW, Australia; 2 University of Western Australia, WA, Australia; 3 Cardiology Department, Concord Hospital, NSW, Australia Background:Approximately 80%of eligibleACSsurvivors receive no cardiac rehabilitation (CR). We have shown their baseline risk factors (RFs) and knowledge are significantly worse than CR attendees and hypothesised they would benefit from a patient-centred modular program. Methods: ACS survivors not accessing CR were randomised to conventional care (n= 72) or a modular program (n= 72) comprising lowering cholesterol and choice of modules to lower other RFs. RFs and knowledge were blindly assessed at baseline, 3 and 12 months and compared with CR attendees (n= 64). All groups had similar demographics. Results: Modular and control groups were well matched 2 Baseline and “On-Treatment” Risk Scores for Predicting Mortality in Patients with Infective Endocarditis R. Sy1,2,∗, C. Chawantanpipat 2, D. Richmond2, L. Kritharides1 1Department of Cardiology, Concord Repatriation General Hospital, Sydney, Australia; 2 Department of Cardiology Royal Prince Alfred Hospital, Sydney, Australia Background: Incorporation of baseline and “ontreatment” parameters in the prognostic classification of adults with infective endocarditis (IE) has the potential to guide management and improve prognosis. Methods:Westudied 273 consecutive patients admitted to two independent centres with a diagnosis of IE between 1996 and 2006 (derivation cohort, centre A, n= 192; validation cohort, centre B, n= 81). Clinical and laboratory parameters were collected at baseline (Model 1) and 1 week (Model 2) after admission. Associations with mortality were tested by univariate and multivariate Cox proportional-hazards analysis in the derivation cohort. Independent predictors were combined to derive a risk score for each patient, and Models 1 and 2 were tested against the validation cohort. All-cause mortality at 6months (centreA24%, centreB 32%)wasdetermined from medical records and government registry data. for baseline cardiovascular risk, which was significantly higher thanCR.At12months, themodulargroupachieved significantly lower global risk and RF levels than controls and similar to CR. Knowledge of TC, BP and exercise improved significantly in the modular group and knowledge correlated with lower RFs.

2212: Ten Years Experience of Carbon Ion Radiotherapy for Prostate Cancer

To evaluate the usefulness of carbon ion beams in the treatment of prostate cancer by analyzing the Results: of 3 institutional clinical trials A total of 432 patients were enrolled to three consecutive trials of C-ion RT for prostate cancer between Jun.1995 and Feb.2006. Analysis was performed on 378 patients who had the histological diagnosis of central pathologist and a follow-up period of more than 6 months. The C-ion RT of 20 fractions over 5weeks was carried out for all the patients and the applied doses ranged from 54.0GyE to 72.0GyE according to the dose-escalation protocol performed in the first two studies. Three hundreds and three (80%) of the patients received 66.0GyE/20fr. mostly in the third trial. Androgen deprivation (AD) was applied to the patient with relatively high risk factors (HR), such as PSA>20ng/ml or T-stage>T2a or Gleason score >6. Neoadjuvant AD was administrated for 2 - 6 months before the C-ion RT and adjuvant AD was given for at least 12 months except for the HR patients with pathological evidence of N0 (pN0). The patient with lower risk factors (LR), such as PSA<20 and T<T2a and GS<7, received only the C-ion RT. Median follow up periods of 378 patients was 40.4 months. According to the TNM classification in 1997, T1b-T1c in 92, T2a in 57, T2b in 85, and T3 in 144 patients, respectively. Pathological diagnosis of lymph nodes was performed in 30 patients and 3 of them had a positive, solitary node in the pelvis. A hundred patients had a serum prostate specific antigen (PSA) of lower than 10ng/ml, 111 had that between 10 and 20, 167 had that >20, and the median value was 18.0. Centrally reviewed Gleason score was 7 in 98 patients, respectively. Out of the 378 patients, 62 were categorized to the LR and the remaining 316 were HR. Eight patients treated in the first dose-escalation study developed grade III late radiation morbidities in the rectum or the genitourinary system (GU). The applied dose and radiation techniques were modified according to the dose-volume histogram analysis using the Results: of this study and no grade III morbidity has observed after these modifications. With the current method of C-ion RT, grade II morbidities occurred only 2.1% patients in the rectum and 7.0% in the GU. Kaplan-Meier estimates of overall and cause-specific survival (CSS) rates at 5 and 8 years were 90.5%, 77.7% and 97.5%, 97.5%, respectively. Biochemical relapse free rates (BRF) at 5 and 8 years were 87.7% and 81.8%, respectively. The BRF of the HR and LR groups at 8 years were 80.5% and 90.9%, respectively, but the difference was not statistically significant. Concerning the influence of each risk factor on the BRF or CSS, T-stage and GS had significant influences on both endpoints but PSA did not. Through the 3 clinical trials, the sufficiently safe and effective treatment methods of C-ion RT for prostate cancer could be established. Recently, the intermediate risk group was separated from the HR group and shortening the duration of AD for this group for the sake of improvement of patient’s QOL.

What is the Relationship between Physical activity and Cardiovascular Risk Factors in Adults Women?

Physical activity is consider an important lifestyle behavior towards health promotion and cardiovascular diseases prevention risk factors. PURPOSE: This paper aimed to determine the relationship between physical activity level and chronic disease prevalence in adults living in a high-density population area from developing country. METHODS: We evaluated 590 adults (28.45±3.81 years old) with 63.82±13.19 kg (body weight); 1.63±0.07 m (body height) and BMI 23.85±4.28 kg/m2. Physical activity level (PAL) was assessed through International Physical Activity Questionnaire-IPAQ (2001). IPAQ allows the PAL classification in sedentary (S), insufficient active (IA), active (AT) and very active (VA) by association of intensity and activities duration. Lifestyle was determined by Health and Risk Prevalence Survey (2004), that characterizes daily activities at workplace, home and during leisure time, as well cardiovascular risk factors (RF) as hypertension, smoking, obesity and physical activity behavior. Blood pressure, serum cholesterol, diabetes, triglycerides were evaluated. Pearson Linear Single Factor Correlation was used (SPSS 13.0) to assess PAL and RF prevalence association as follows bellow:TableRESULTS: We found that during work the groups keep seated for 6.11±1.18 hours. Light and moderate intensities represented 22% of total time at workplace. On the other hand cardiovascular risk factors were 45.5% (sedentary); smoking (27.3%); obesity (39.9%) and 28.2% for hypertension. Also 60.79% of the sample presented 1–3 risk factors and 33.51% presented 4–8 risks. Active group performed moderate physical activity for 31.3+2.8 min; 2.8 times.w-1 and 14.7±1.7 min for vigorous 2 times.w-1. CONCLUSION: We concluded positive physical activity influence on risk factors for AT than IA group, showing lower RF prevalence, suggesting that moderate physical activity is an important behavior to decrease risk factor for cardiovascular disease and health benefits.

Biohazards of investigations on the transmissible spongiform encephalopathies.

There is considerable current interest in the agents that cause the spongiform encephalopathies: scrapie, transmissible mink encephalopathy, kuru, and Creutzfeldt-Jakob disease (CJD). The unusual properties of these agents, their elusiveness, and their pathogenicity for humans (in the cases of kuru and CJD) make these agents interesting subjects of investigation but also make imperative a consideration of their potential biohazards in the laboratory. In view of both the potential pathogenicity of these agents and the potential hazards of many laboratory procedures, a series of physical containment levels, each of which corresponds to a range of composite risk factors, are suggested. The estimated composite risk factor used is a function of the potential pathogenicity or relative risk factor of the agent and the potential hazard of a laboratory procedure. The lowest risk factors (1 to 2+) correspond to levels of containment similar to those recommended by the Center for Disease Control for class II microorganisms, while the highest risk factors (5 to 8+) correspond to levels similar to those for class III microorganisms. The use of such a biohazard ranking system aids in a rational approach to selection of equipment and procedures.