Multifactorial Risk Assessment Research Articles

Shrinking Habitats and Native Species Loss Under Climate Change: A Multifactorial Risk Assessment of China's Inland Wetlands

AbstractWetlands are highly productive ecosystems that host unique biota and provide vital ecosystem services. Despite their critical importance, we still lack a fundamental understanding of factors controlling species suitability and climate change impacts in wetlands essential to conserving these imperiled ecosystems in the face of anthropogenic threats. Here, we applied ecological niche models (ENMs) inferred from a massive nationwide data set including field surveys and herbarium specimens representing 101 dominant plant species of China's inland wetlands, to explore the potential climate‐driven shifts in these ecosystems. Our optimal models applying machine learning and integrating key aspects of climate, soil, topographic hydrology, and anthropogenic disturbance, identified that (a) species of different types (e.g., woody/nonwoody) showed significant differences in their sensitivity to extracted key environmental factors (e.g., isothermality, water table depth) in wetlands; (b) native wetland species likely face habitat shrinkage under climate change, especially in Northeast China, as well as potential encroachment of xeric and nonnative species; (c) only less than 20% of projected conservation hotspots are currently protected. We propose four protection gaps that need to be addressed urgently in China's current wetland protection framework. This study clarifies the conservation priorities of China's inland wetlands and provides practical guidelines for the improvement of wetland conservation efforts.

Physical activity and fall prevention - solving clinical problems

Introduction. A multidisciplinary and therapeutic approach is used for patients with osteoporotic bone fractures. Falls, leading to injuries, including bone fractures, are a common occurrence in the elderly suffering from osteoporosis. Multifactorial risk assessment is of great importance in identifying risk factors for the occurrence of falls, their removal and implementing preventive measures. The issue of risk assessment is very current and treated by related professional recommendations and national and international guidelines. The latter point out the following fall risks: previous falls, use of psychotropic substances, vision impairment, mobility, gait, muscle strength and balance and impairment of cognitive functions. Fear of falling, psychological passivity, urinary incontinence, inadequate footwear and certain neurologic and cardiovascular conditions are also considered additional risks. Fall risks may also be environmental (within the dwelling and outside), such as low lighting, inadequate furniture and its disposition, difficulty in accessing the bed, chair, toilet, bathroom, stairs and other. For a realistic fall risk estimate, besides using adequate questionnaires, several static and dynamic tests may be used to assess balance and mobility. Depending on the type of risk factors present, actions for their removal through information, education and participation of the elderly in preventive measures are also recommended. Conclusion. Multifactorial risk assessment of fall occurrence and bone fracture, as of recovery, are of great importance within certain population groups, especially the elderly.

How to identify balance disorders and reduce fall risk.

A multifactorial risk assessment, correction of hearing impairment, exercise, and an optimized home environment can help prevent imbalance-related falls.

Determination of Caries Risk by Your Fingertips – A Mobile Application Based Study

Background: Technology has become a fundamental part of our daily life. It has been delivered to our fingertips since the first smartphone arrived in market. In this regard, Cariogram has been developed to bring caries prevention to the fingertips. This particular caries assessment method was selected for the study as it is considered one of the most reliable models as per reports. Methods: A questionnaire-based survey was carried out among 90 school going children in the age group of 7-10-years in North Bengaluru, Karnataka. A cariogram model was used to create caries risk profiles of 45-males and 45-females. The caries risk profiles generated by the cariogram software were observed amongst different genders and age groups. Results: The results obtained showed that children aged 10-years had comparatively less chance to avoid new caries as compared to age groups 7, 8, and 9 years. On comparison between male and female subjects, females had more chances of avoiding new caries as compared to males, even though they did not have a significant difference in their oral hygiene practices, dietary practices, and socioeconomic background. Conclusion: The Cariogram program is functional and has certain benefits such as providing recommendations for preventive care and motivating the patient with its presentation in the form of pie-chart, viewing the multifactorial caries risk assessment instead of single variables.

Development of the Prevent for Work Questionnaire (P4Wq) for the assessment of musculoskeletal risk factors in the workplace: part 2—pilot study for questionnaire development and validation

ObjectiveThe aim of this study was to develop a multifactorial, self-report questionnaire: Prevent for Work Questionnaire (P4Wq). The questionnaire is intended for screening for risk factors in work-related musculoskeletal disorders...

Qualitative research to inform economic modelling: a case study in older people\u2019s views on implementing the NICE falls prevention guideline

BackgroundHigh prevalence of falls among older persons makes falls prevention a public health priority. Yet community-based falls prevention face complexity in implementation and any commissioning strategy should be subject to economic evaluation to ensure cost-effective use of healthcare resources. The study aims to capture the views of older people on implementing the National Institute for Health and Care Excellence (NICE) guideline on community-based falls prevention and explore how the qualitative data can be used to inform commissioning strategies and conceptual modelling of falls prevention economic evaluation in the local area of Sheffield.MethodsFocus group and interview participants (n = 27) were recruited from Sheffield, England, and comprised falls prevention service users and eligible non-users of varying falls risks. Topics concerned key components of the NICE-recommended falls prevention pathway, including falls risk screening, multifactorial risk assessment and treatment uptake and adherence. Views on other topics concerning falls prevention were also invited. Framework analysis was applied for data analysis, involving data familiarisation, identifying themes, indexing, charting and mapping and interpretation. The qualitative data were mapped to three frameworks: (1) facilitators and barriers to implementing the NICE-recommended pathway and contextual factors; (2) intervention-related causal mechanisms for formulating commissioning strategies spanning context, priority setting, need, supply and demand; and (3) methodological and evaluative challenges for public health economic modelling.ResultsTwo cross-component factors were identified: health motives of older persons; and professional competence. Participants highlighted the need for intersectoral approaches and prioritising the vulnerable groups. The local commissioning strategy should consider the socioeconomic, linguistic, geographical, legal and cultural contexts, priority setting challenges, supply-side mechanisms spanning provider, organisation, funding and policy (including intersectoral) and health and non-health demand motives. Methodological and evaluative challenges identified included: incorporating non-health outcomes and societal intervention costs; considering dynamic complexity; considering social determinants of health; and conducting equity analyses.ConclusionsHolistic qualitative research can inform how commissioned falls prevention pathways can be feasible and effective. Qualitative data can inform commissioning strategies and conceptual modelling for economic evaluations of falls prevention and other geriatric interventions. This would improve the structural validity of quantitative models used to inform geriatric public health policies.

Unexplained falls in the elderly.

Falls are a geriatric syndrome affecting mortality, morbidity, and institutionalization. Falls are also the leading cause of unintentional injury and a common emergency department presentation. Physical and psychological issues may develop after falling, leading to increase in dependency and disability and their relative costs. The pathogenesis of falls is multi-factorial, being indeed the result of the interaction between increased individual susceptibility, high risk activities and environmental hazards. The patient should be evaluated for gait, standing balance, mobility, muscle weakness, cognitive status, osteoporosis risk, sensorial impairment, urinary incontinence, functional status, and for possible residential environmental hazards. It is also mandatory to obtain a full report of the circumstances and a careful therapeutic recognition. However not all falls are explainable. Indeed, retrograde amnesia and the frequent absence of a witness complicate history collection of falls in older adults. In this case, "the management of unexplained falls should be the same as that for unexplained syncope" as stated by the latest version of the European Society of Cardiology guidelines on syncope. In this context, the investigation of the cardiovascular autonomic nervous system and the use of implantable loop recorder have an increasing role. The present paper addresses the diagnostic approach to falls in older adults through a comprehensive multifactorial risk assessment and examines evidence and gaps on fall prevention strategies.

Metabolomics as a Tool for Biomarker Discovery in Gastric Cancer.

Globally, early detection and interception of gastric cancer remains limited by the lack of a broad screening paradigm for individuals with the exception of those at established hereditary risk (e.g., hereditary diffuse gastric cancer or CDH1 germline mutation status). The path forward will likely rely on establishment of biomarkers using multiple -omic approaches to detect molecular profiles associated with gastric cancer risk that can in turn be leveraged to identify individuals who may benefit from more intensive evaluation, such as screening endoscopy. In this issue, Shu and colleagues describe the results of a case-control cohort study of Asian individuals that demonstrates baseline metabolite levels are predictive of future gastric cancer risk above and beyond lifestyle and demographic risk factors. We discuss the promise and limitations of these exemplar circulating biomarkers and emphasize the need for a multifactorial risk assessment to advance precision prevention and early detection of gastric cancer.See related article by Shu et al., p. 1634.

Women's Views on Multifactorial Breast Cancer Risk Assessment and Risk-Stratified Screening: A Population-Based Survey from Four Provinces in Canada.

Risk-stratified screening for breast cancer (BC) is increasingly considered as a promising approach. However, its implementation is challenging and needs to be acceptable to women. We examined Canadian women’s attitudes towards, comfort level about, and willingness to take part in BC risk-stratified screening. We conducted an online survey in women aged 30 to 69 years in four Canadian provinces. In total, 4293 women completed the questionnaire (response rate of 63%). The majority of women (63.5% to 72.8%) expressed favorable attitudes towards BC risk-stratified screening. Most women reported that they would be comfortable providing personal and genetic information for BC risk assessment (61.5% to 67.4%) and showed a willingness to have their BC risk assessed if offered (74.8%). Most women (85.9%) would also accept an increase in screening frequency if they were at higher risk, but fewer (49.3%) would accept a reduction in screening frequency if they were at lower risk. There were few differences by province; however, outcomes varied by age, education level, marital status, income, perceived risk, history of BC, prior mammography, and history of genetic test for BC (all p ≤ 0.01). Risk-based BC screening using multifactorial risk assessment appears to be acceptable to most women. This suggests that the implementation of this approach is likely to be well-supported by Canadian women.

Assessing Vision in Elderly Patients Admitted to Hospital Following a Fall

Introduction: Falls are a major cause of morbidity and mortality in older people, and those with reduced visual acuity are twice as likely to fall as those with normal eyesight. Accordingly, NICE guidelines recommend assessment of vision as part of a multi-factorial risk assessment in older people, who present for medical attention, because of a fall. Methods: We included all patients admitted to a senior health ward at St George’s hospital because of a fall. A baseline audit was conducted in May 2020. Our primary intervention was a departmental teaching session with subsequent first cycle data. We trialled the ‘Lookout! Bedside vision check for falls prevention’ recommended by the Royal College of Physicians. Our secondary intervention was designing an ‘initial assessment’ proforma to include a section for sensory impairment followed by a second cycle data collection. Results: Our initial results showed that none of the 24 patients admitted with a fall had any form of documented visual assessment. Using a simple bedside vision check tool, we found 22% (n=2) of screened patients had significantly impaired vision. Following our teaching session, 50% (n=7) of patients had some form of visual assessment on admission and after introduction of the proforma, this increased to 56% (n=5). Visual risk factors were identified in multiple patients, including outdated prescriptions for corrective glasses. Discussion: Identifying reversible visual risk factors may reduce recurrent falls and subsequent complications as well as hospital admissions in older patients. A teaching session was found to be effective, however a ‘proforma’ may encourage more sustainable improvements. The reduction in ophthalmology and optometry services during the Covid-19 pandemic will inevitably increase the prevalence of visual risk factors. Effects including delayed eyesight tests and cataract operations. It is therefore more important now than ever, to ensure bedside assessment of vision in older adults presenting to hospital, with a fall and proactively in falls prevention strategies.

Data set for reporting of carcinoma of the adrenal cortex: explanations and recommendations of the guidelines from the International Collaboration on Cancer Reporting

Complete resection of adrenal cortical carcinoma (ACC) with or without adjuvant therapy offers the best outcome. Recurrence is common, and in individual cases, the long-term outcome is difficult to predict, making it challenging to personalize treatment options. Current risk stratification approaches are based on clinical and conventional surgical pathology assessment. Rigorous and uniform pathological assessment may improve care for individual patients and facilitate multi-institutional collaborative studies. The International Collaboration on Cancer Reporting (ICCR) convened an expert panel to review ACC pathology reporting. Consensus recommendations were made based on the most recent literature and expert opinion. The data set comprises 23 core (required) items. The core pathological features include the following: diagnosis as per the current World Health Organization classification, specimen integrity, greatest dimension, weight, extent of invasion, architecture, percentage of lipid-rich cells, capsular invasion, lymphatic invasion, vascular invasion, atypical mitotic figures, coagulative necrosis, nuclear grade, mitotic count, Ki-67 proliferative index, margin status, lymph node status, and pathological stage. Tumors were dichotomized into low-grade (<20 mitoses per 10mm2) and high-grade (>20 mitoses per 10mm2) ones. Additional noncore elements that may be useful in individual cases included several multifactorial risk assessment systems (Weiss, modified Weiss, Lin-Weiss-Bisceglia, reticulin, Helsinki, and Armed Forces Institute of Pathology scores/algorithms). This data set is now available through the ICCR website with the hope of better standardizing pathological assessment of these relatively rare but important malignancies.

The introduction of risk stratified screening into the NHS breast screening Programme: views from British-Pakistani women

BackgroundUK national guidelines suggest women at high-risk of breast cancer should be offered more frequent screening or preventative medications. Currently, only 1 in 6 high-risk women are identified. One route to identify more high-risk women is via multifactorial risk assessment as part of the UK’s NHS Breast Screening Programme (NHSBSP). As lower socioeconomic and minority ethnic populations continue to experience barriers to screening, it is important that any new service does not exacerbate issues further. To inform service development, this study explored views of women from underserved backgrounds regarding the introduction of risk stratification into the NHSBSP.MethodsNineteen semi-structured interviews were conducted with British-Pakistani women from low socioeconomic backgrounds from East Lancashire, UK. Fourteen interviews were conducted via an interpreter.ResultsThematic analysis produced three themes. Attitudes toward risk awareness concerns the positive views women have toward the idea of receiving personalised breast cancer risk information. Anticipated barriers to accessibility emphasises the difficulties associated with women’s limited English skills for accessing information, and their I.T proficiency for completing an online risk assessment questionnaire. Acceptability of risk communication strategy highlights the diversity of opinion regarding the suitability of receiving risk results via letter, with the option for support from a healthcare professional deemed essential.ConclusionsThe idea of risk stratification was favourable amongst this underserved community. To avoid exacerbating inequities, this new service should provide information in multiple languages and modalities and offer women the opportunity to speak to a healthcare professional about risk. This service should also enable completion of personal risk information via paper questionnaires, as well as online.

‘I’ve always done what I was told by the medical people’: a qualitative study of the reasons why older adults attend multifactorial falls risk assessments mapped to the Theoretical Domains Framework

ObjectivesMultifactorial falls risk assessments reduce the rate of falls in older people and are recommended by international guidelines. Despite their effectiveness, their potential impact is often constrained by barriers to...

Attitudes towards risk-stratified breast cancer screening among women in England: A cross-sectional survey.

Risk stratification may improve the benefit/harm ratio of breast screening. Research on acceptability among potential invitees is necessary to guide implementation. We assessed women's attitudes towards and willingness to undergo risk assessment and stratified screening. Women in England aged 40-70 received summary information about the topic, and completed face-to-face computer-assisted interviews. Questions assessed willingness to undergo multifactorial breast cancer risk assessment, more frequent breast screening (if at very high risk), or less frequent or no screening (if at very low risk), and preferences for delivery of assessment results. Among 933 women, 85% considered breast cancer risk assessment a good idea, and 74% were willing to have it. Among 125 women unwilling to have risk assessment, reasons commonly related to 'worry' (14%) and 'preferring not to know' (14%). Among those willing to have risk assessment (n = 689), letters/emails were generally preferred (42%) for results about very low-risk status. Face-to-face communication was most commonly preferred for results of very high-risk status (78%). General practitioners were most commonly preferred sources of assessment results (≈40%). Breast cancer specialists were often preferred for results of very high-risk status (38%). Risk-stratified breast screening was considered a good idea by 70% and 89% were willing to have more frequent screening. Fewer would accept less (51%) or no screening (37%) if at very low risk. Women were generally in favour of multifactorial breast cancer risk assessment and risk-stratified screening. Some were unwilling to accept less or no screening if at very low risk.

217 Investigating the Delivery of Falls Prevention Interventions to Older People Following Multi-Factorial Risk Assessment: A Cross-sectional Study

Abstract Background Falls are one of the most common threats to older peoples’ independence. In Ireland, approximately one in three adults aged ≥65 years fall each year. Multifactorial interventions, which include an assessment of an individual's risk of falling followed by customised interventions or referral have been shown to reduce the rate of falls among community-dwelling older people. As part of an Integrated Falls Prevention Pathway initiated in 2016, six multidisciplinary risk assessment clinics were established in Cork city and county. The aim of this study is to examine whether recommended follow-on interventions were received following a falls risk assessment in the community. Methods Routinely collected administrative data for clients who attended a falls risk assessment clinic are being collated. Data include client demographics, onward referrals, waiting times and receipt of intervention. A process map of the patient pathway following a falls risk assessment is under development and will be refined based on the study findings. Results Preliminary analysis of a two-year implementation period (April 2016-2018) indicates that following assessment, clients received an average of 2.4 onward referrals. Most referrals were made to general practice (29%, n=315), community physiotherapy (25%, n=272), and community occupational therapy (15%, n=165). Other referrals were to public health nurses (n=104, 10%) and falls prevention classes (n=60, 6%). Further analysis will identify the percentage of individuals who receive interventions, the type of interventions received, the percentage of patients who do not attend and the waiting lists. Conclusion The Integrated Falls Prevention Service is the sole example of an operational integrated falls pathway in Ireland. This research will identify potential roadblocks for providers and clients along the pathway and will identify opportunities to. The results will also be used to inform service planning and resource allocation to ensure that this model of care is sustainable.

220 Is Multifactorial Risk Assessment a Team Sport? Disciplinary Differences in Perceived Acceptability and Feasibility of a Community-based Fall Prevention Service

Abstract Background Multifactorial falls risk assessment is an evidence-based practice recommended to prevent falls among older people. Previous research has identified cultural, practical and professional challenges to implementing complex fall prevention interventions. Fall prevention interventions are frequently delivered by multidisciplinary teams (MDTs). This requires multiple health professionals, who practice under different professional norms and governance structures, to accommodate new ways of working. Our aim is to explore disciplinary differences in the perceived acceptability, appropriateness and feasibility of community-based multifactorial falls risk assessment clinics during initial implementation. Methods A mixed methods study is being conducted with analysis of administrative data on delivery of risk assessments (2016-2018), and semi-structured interviews staff involved in multidisciplinary teams (physiotherapists (PT, n=5), occupational therapists (OT, n=6), and public health nurses (n=4)]. Interviews were conducted prior to implementation and at 6 months (n=30 interviews total). Framework-driven thematic analysis was used to identify factors influencing implementation and explore perceptions of acceptability, appropriateness and feasibility. Results Implementation varied across disciplines; 28% of assessments were conducted by nurses (n=83), 36% (n=111) by physiotherapists, and 36% (n=108) by OTs. Preliminary qualitative analysis suggests that OTs welcomed the opportunity to expand their scope of practice. Conducting assessments at set times in static clinics was incompatible with public health nurses’ workflow. Their limited availability and time-sensitive competing priorities were barriers to the feasibility of an MDT-approach. Physiotherapists questioned the relative advantage of a broad assessment, and whether it was an appropriate use of resources given waiting lists for physiotherapy intervention. Data analysis is ongoing. Conclusion The study results have already been used to inform service adaptations including the introduction of dedicated intervention sessions. Training and implementation support for multidisciplinary teams may need to be tailored to the needs of different professional groups to enhance adoption and fidelity.

Gender-stratified analyses reveal longitudinal associations between social support and cognitive decline in older men

Objectives: Research has extensively examined the relationship between social support and health outcomes in older adults. Little is known, however, about the longitudinal associations between distinct dimensions of perceived social support and incident cognitive decline. The current longitudinal study examined whether dimensions of perceived social support were associated with increased risk of cognitive decline, and if the relationship differed by gender.Methods: 493 community-residing non-demented older adults were assessed for baseline social support via the Medical Outcomes Study-Social Support Survey (MOS-SSS). Incident cognitive impairment was determined using a 1 standard deviation below age and education adjusted total score on the Repeatable Battery for the Assessment of Neuropsychological Status Cox proportional-hazard models were used to analyze incident risk of cognitive impairment.Results: Higher perceived support, overall and in specific domains, at baseline was associated with increased risk of incident cognitive impairment. Further gender-stratified analyses revealed that higher perceived support at baseline was associated with increased risk of incident cognitive impairment only among males.Conclusion: Contrary to previous research, results from this longitudinal study suggest that perceived support might be an important risk factor for cognitive decline, notably in males, and should be integrated into multifactorial risk assessment and intervention procedures.

Clinical Utility of Complement Dependent Assays in Kidney Transplantation.

Formation of antibodies against polymorphic HLA molecules on donor endothelium is central to the pathogenesis of antibody-mediated rejection, the dominant cause of long-term kidney allograft loss. Although introduction of the single-antigen bead assay has greatly facilitated the immune risk assessment of transplant recipients, it is recognized that not all IgG HLA antibodies detected using this method are equally relevant. In recent years, novel assays (C4d, C1q, C3d) have been developed to interrogate the complement-activating potential of anti-HLA antibodies in vitro, with the hypothesis that complement-fixing antibodies are more immediately injurious to the graft compared with noncomplement-binding antibodies. Although initial studies demonstrated the potential of these assays to risk-stratify antibodies beyond the conventional limited metric of mean fluorescence intensity values, new data from recent analyses challenge some of these early findings. In this review, we examine the technical aspects of these assays and key studies that evaluated the discriminant capacity of these tests to predict numerous outcomes in kidney transplantation. We discuss conflicting data and emerging controversies in the context of recent experimental evidence which offer new insights into the major factors that influence complement activation. Finally, we provide our perspective on the current role and utility of complement diagnostic assays as 1 variable in the multifactorial risk assessment and management of kidney transplant recipients.

Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE): A Cluster-Randomized Pragmatic Trial of a Multifactorial Fall Injury Prevention Strategy: Design and Methods.

Fall injuries are a major cause of morbidity and mortality among older adults. We describe the design of a pragmatic trial to compare the effectiveness of an evidence-based, patient-centered multifactorial fall injury prevention strategy to an enhanced usual care. Strategies to Reduce Injuries and Develop Confidence in Elders (STRIDE) is a 40-month cluster-randomized, parallel-group, superiority, pragmatic trial being conducted at 86 primary care practices in 10 health care systems across United States. The 86 practices were randomized to intervention or control group using covariate-based constrained randomization, stratified by health care system. Participants are community-living persons, ≥70 years, at increased risk for serious fall injuries. The intervention is a comanagement model in which a nurse Falls Care Manager performs multifactorial risk assessments, develops individualized care plans, which include surveillance, follow-up evaluation, and intervention strategies. Control group receives enhanced usual care, with clinicians and patients receiving evidence-based information on falls prevention. Primary outcome is serious fall injuries, operationalized as those leading to medical attention (nonvertebral fractures, joint dislocation, head injury, lacerations, and other major sequelae). Secondary outcomes include all fall injuries, all falls, and well-being (concern for falling; anxiety and depressive symptoms; physical function and disability). Target sample size was 5,322 participants to provide 90% power to detect 20% reduction in primary outcome rate relative to control. Trial enrolled 5,451 subjects in 20 months. Intervention and follow-up are ongoing. The findings of the STRIDE study will have important clinical and policy implications for the prevention of fall injuries in older adults.

Practice-Based Longitudinal Study of Multifactorial Risk Assessment for Periodontal Condition and Survival of Remaining Teeth in Patients with Removable Partial Dentures.

This retrospective cohort study examined factors affecting the periodontal condition and survival of remaining teeth 5 years after removable partial denture (RPD) placement using multivariate analyses. Of 231 patients who received RPDs at Tohoku University Hospital, 108 patients who had agreed to undergo a 5-year follow-up were examined. The outcomes of RPD treatment were assigned to one of three categories: successful (n = 58), remake (n = 36), and failure (n = 14). A total of 80 patients in the successful and remake groups were included in this study. The parameters analyzed to evaluate the periodontal condition were probing depth, Miller index of tooth mobility, and bone resorption level. Criterion variables were the outcome of each periodontal condition, deterioration, and tooth loss. Independent variables were sex, age, smoking habit, number of periodic maintenance appointments, location of RPD, number of abutment teeth, denture base material, design, and existence of a denture in the opposite jaw. Bivariate analyses were performed using chi-square test, and multivariate regression analysis was used to assess significance. Sex and frequency of maintenance care were independently associated with deterioration of the periodontal condition. Sex and existence of a denture in the opposite jaw were independently associated with tooth loss. The findings suggest that periodic maintenance care and condition of the opposite jaw are essential for maintaining the condition of the remaining teeth.