Non-modifiable Factors Research Articles

Prediction of post-traumatic stress disorder in family members of ICU patients: a machine learning approach.

Post-traumatic stress disorder (PTSD) can affect family members of patients admitted to the intensive care unit (ICU). Easily accessible patient's and relative's information may help develop accurate risk stratification tools to direct relatives at higher risk of PTSD toward appropriate management. PTSD was measured 90days after ICU discharge using validated instruments (Impact of Event Scale and Impact of Event Scale-Revised) in 2374 family members. Various supervised machine learning approaches were used to predict PTSD in family members and evaluated on an independent held-out test dataset. To better understand variables' contributions to PTSD predicted probability, we used machine learning interpretability methods on the best predictive algorithm. Non-linear ensemble learning tree-based methods showed better predictive performances (Random Forest-area under curve, AUC = 0.73 [0.68-0.77] and XGBoost-AUC = 0.73 [0.69-0.78]) than regularized linear models, kernel-based models, or deep learning models. In the best performing algorithm, most important features that positively contributed to PTSD's predicted probability were all non-modifiable factors, namely, lower patient's age, longer duration of ICU stay, relative's female sex, lower relative's age, relative being a spouse/child, and patient's death in ICU. A sensitivity analysis in bereaved relatives did not alter the algorithm's predictive performance. We propose a machine learning-based approach to predict PTSD in relatives of ICU patients at an individual level. In this model, PTSD is mostly influenced by non-modifiable factors.

Age, sex, antihypertensive drugs and the Mediterranean diet on hypertension-related biomarkers: Impact on carotid structure and blood lipids in an Argentinian cross-sectional study

BackgroundCardiovascular risk is modifiable by changes in lifestyle and pharmacological management, with hypertension being a common pathology worldwide. Its treatment must address multiple metabolic targets. Based on the hypothesis that certain antihypertensive medications, such as the commonly used enalapril and losartan, and dietary habits improve hypertension-related changes in carotid structure and cardiometabolic variables, this work aimed to associate these drugs, as well as the Mediterranean diet adherence and non-modifiable biological factors, with changes in carotid intima-media thickness [cIMT] and blood lipids. MethodsSociodemographic, clinical, biochemical and lifestyle data were collected in a cross-sectional study of 313 subjects under survey due to cardiovascular risk factors, aged 34–83 years (Cordoba, Argentina). Generalised structural equation models were used for analysis. ResultsA higher cIMT with age and male sex was confirmed. Women had lower triacylglycerols and saturated fatty acids in serum but higher circulating levels of LDL-C, HDL-C and total cholesterol than men. Also, a higher adherence to the Mediterranean diet was associated with lower triacylglycerols, but higher levels of HDL-C cholesterol and ω-3 polyunsaturated fatty acids (ω-3 PUFAs) in serum. A greater adherence to the Mediterranean diet did not affect cIMT. Enalapril was associated with increased serum ω-3 PUFAs levels, but it did not affect other lipid fractions. Moreover, enalapril may control cIMT, whereas losartan may not. ConclusionsOur data demonstrate that the Mediterranean diet and enalapril are associated with a cardioprotective circulating lipid profile in hypertension. Concerning this, enalapril potentially promotes serum ω-3 PUFAs levels beyond its classical antihypertensive effect, which encourages future clinical studies to confirm it.

Addressing urinary incontinence by gender: a nationwide population-based study in Turkiye

BackgroundUrinary incontinence (UI), which usually occurs in women but affects both sexes, is a significant public health challenge. This study aims to comprehensively investigate the prevalence and determinants of UI in men and women, considering gender-specific factors.MethodsThe study performed a secondary analysis on data obtained from 13,383 individuals surveyed in the 2019 Turkish Health Survey, providing a representation of the Turkish population. The dataset included sociodemographic and health-related variables like UI, body mass index (BMI), physical activity, smoking, and chronic diseases—statistical analysis employed chi-square tests and gender-stratified logistic regression models to identify UI-associated factors.ResultsOur results showed that UI affected 8.8% of the population, with a striking gender disparity. Women had a notably higher prevalence at 11.2%, while men had a lower rate of 5.5%. Importantly, this gender gap narrowed with age. For example, in the 34–44 age group, the female/male ratio was 6.9, but it decreased to 1.4 in the 65–74 age group. Marital status and employment status played significant roles. Separated, divorced, or widowed individuals, particularly women, had the highest prevalence at 19.3%. Employment status influenced UI prevalence, with employed men having the lowest rate (2.1%), while retired women faced the highest rate (15.0%). Higher BMI, especially in obese individuals, significantly raised UI prevalence, reaching 7.9% for men and 15.8% for women. Physical inactivity, notably in women (17.0%), and prolonged sedentary hours (13.9%) were associated with higher UI rates. Former smokers, especially women (15.9%), had a notable impact on UI. Poor perceived health and chronic conditions like Chronic Obstructive Pulmonary Disease (COPD), hypertension, and diabetes were significantly associated with higher UI prevalence. Logistic regression analysis revealed that age, education, perceived health status, COPD, and diabetes were significant factors associated with UI in both sexes, while in women, BMI, physical activity, and smoking also played notable roles.ConclusionsThis extensive UI study has unveiled notable gender disparities and determinants. Notably, these disparities decrease with age, underlining UI’s changing nature over time. Modifiable factors impact women more, while non-modifiable factors are linked to men. The study underscores the importance of tailoring healthcare strategies to address UI based on gender.

Placebo and nocebo in the treatment of migraine: How much does real world effectiveness depend on contextual effects?

Treatments in medicine impact individuals beyond their intended effects, due to phenomena such as the placebo and nocebo effects. The placebo effect arises from the positive expectation of a treatment being beneficial, while the nocebo effect stems from the negative expectation of a treatment causing harm. Both in real-world practice and clinical trials, treatments can lead to outcomes unrelated to their intended mechanism of action, which we categorize as placebo and nocebo responses. These responses, combined with the inherent fluctuation in a condition's natural progression, regression to the mean, and random comorbidities, make up a significant part of the therapeutic experience. Particularly in pain management, placebo and nocebo effects play a substantial role. By addressing modifiable contextual factors such as patient expectations, lifestyle choices, and the therapeutic relationship, healthcare providers can enhance the effectiveness of migraine treatments, paving the way for a more comprehensive, individualized approach to patient care. We must also consider non-modifiable factors like personal experiences, beliefs, and information from social media and the internet. This review offers a summary of our current understanding of the placebo and nocebo effects in migraine management.

A comprehensive analysis on contributing factors for varus or valgus malposition of femoral stems in uncemented total hip arthroplasty via DAA

BackgroundVarus or valgus malposition of uncemented femoral stems have been described to have detrimental effects for long term implant survival. Various pre- and intra-OP factors have been suggested to be relevant, one of them being the approach to the hip. The aim was to investigate several pre- and intra-OP factors associated with femoral stem malpositioning in a large series of DAA hips. MethodsA series of 400 consecutive patients (416 hips) who underwent navigated (Brainlab) cementless Total Hip Arthroplasty (THA) in 2022 (Corail or Actis stem DePuy Synthes) via a direct anterior approach (DAA) was analyzed. Preoperative data were collected based on patients’ demographics, radiographic information [critical trochanteric angle (CTA), centrum collum diaphyseal (CCD) angle, greater trochanter overhang, femoral neck resection angle, femoral neck resection height and Door classification], and these were correlated with the postoperative stem position. Univariable and multivariable linear regression were carried out to determine significant factors that contribute to varus and valgus stem malalignment. ResultsWith the DAA approach, 56.5 % of stems were placed in an optimal neutral position, 38.4 % were in acceptable position of 0.1°–2° varus/valgus and only 5 % had a deviation larger than 2° varus/valgus. The critical trochanteric angle (CTA) was statistically significant in determining varus stem placement whereas centrum collum diaphyseal angle (CCD) was found to affect valgus stem malpositioning. All other factors have shown no relevant effect on stem placement using stepwise regression method. ConclusionIn DAA, 95 % of stems were found in a varus/valgus position of 2° or less. In pre-operative measurement, only femoral morphology (e.g. CTA & CCD) were found to be relevant, affecting varus/valgus stem malposition. All other tested modifiable and non-modifiable factors had no significant effect. Therefore, pre-OP templating including measurement of CTA and CCD, intra-operative assessment as well as proper operative techniques are paramount to prevent excessive varus/valgus mal-position of femoral stem in DAA.

Do Surgery Residents Prepare Enough for Surgical Cases?

This study aimed to identify both modifiable and nonmodifiable factors that affect intraoperative-specific surgical education and performance, with an overall goal of increasing cognizance of such factors to improve surgical training. To determine whether surgery residents prepare adequately for participation in surgical cases and to examine specific variables that affect resident preparation. This study is a retrospective survey-based study that included data from 1945 postoperative case evaluations completed by 59 different general surgery residents over a period of 8 years (2014-2022). A Midwestern medical school's general surgery residency program. Fifty-nine general surgery residents at Western Michigan University's medical school; 50 attending surgeons and faculty with whom residents regularly operate. The sample was comprised of residents and attendings who voluntarily filled out postoperative performance surveys after elective cases. This retrospective survey-based study included postoperative evaluation data from 1945 procedures performed by 59 different residents and 50 attendings. Participants included 36 male residents, 23 female residents, 39 male attendings, and 11 female attendings. All included data were for elective cases. Self-reported preoperative communication was worst at the PGY1 level with positive correlation of improvement yearly (r = 0.30, p < 0.001). Positive correlation was seen between overall preparedness and case complexity (r = 0.25, p < 0.001). Positive correlation was seen between case complexity and resident perception of intraoperative teaching quality (r = 0.53, p < 0.001). Preoperative communication initiated by residents was significantly worse when the attending surgeon was female, regardless of resident gender (p < 0.001); this effect was particularly profound with male residents. Male residents overall rated themselves as more prepared compared to their female counterparts (11.13 ± 1.96 vs. 10.84 ± 2.03, p = 0.003). There is a need to identify and address quantifiable gaps in communication between residents and faculty to optimize surgical education; one of the first steps is characterizing nonmodifiable factors that correlate with differences in pre-operative communication and case preparation.

A Retrospective Study of the Epidemiology, Histomorphological Features, Hormonal Status, and Radiological Features of Breast Cancer Diagnosed on Biopsies in Women in Bahrain Up to the Age of 40: A Single-Center Study.

Breast cancer is the most commonly diagnosed cancer in women worldwide. There are many risk factors that contribute to breast cancer which involvemodifiable and non-modifiable factors. Most of the patients diagnosed with breast cancer are over 50 years of age, with breast cancer in women less than 40 years of age being relatively rare and typically more aggressive variants. Moreover, radiological examination is essential for diagnosis and triaging patients for further diagnostic procedures including tissue biopsy sampling. Despite the rarity of malignancy amongthe younger age group, all of their breast lesions are usually biopsied. Hence, this paper outlines the percentage of benign and malignant breast lesions detected on biopsies obtained from female patients who presented to our hospital before or at the age of 40. We conducted a single institution retrospective study on 267 breast biopsies done for female patientsbefore or at the age of 40 in the period from January 2020 to January 2023. The data was obtained from the National Health Information System at Salmaniya Medical Complex. The data collected included clinical history, histological, and radiological findings. Data on prognostic markers (estrogen receptor (ER)/progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) status) were also included. The distribution of samples was established according to age ranges, pathological diagnostic categories (B1-5), and prognostic marker interpretation. Further subdivision was performed on cases with malignancy according to tumor grade. The frequency distribution was obtained for ER, PR, and HER status jointly. The association between age and grade, as well as age and categories, was also determined. All the analyses were performed using SPSS Statistics version 26.0 (IBM Corp. Released 2019. IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp), and the statistical significance was tested at a 5% level. Out of 267 samples, the majority (62.9%) were in patients with a range of age between 30 and 40. There were 68.5% of samples with the B2 (benign) category, followed by 20.2% with the B5b (malignant-invasive carcinoma) category. Out of 61 malignant samples, there were 17 (6.4%) samples positive on ER and PR but negative on HER2, 16 (6.0%) samples negative on ER, PR, and HER2, eight (3.0%) samples negative on ER and PR negative but positive on HER2, and five (8.2%) samples positive on ER, PR, and HER2. The majority of malignant cases were of grade II which accounted for 29 (10.9%) samples, followed by 23 (8.6%) with grade III. The association between age and grade was statistically not significant (p=0.113). However, the association between age and B categories was statistically significant with a p-value of 0.0002. A significantly higher proportion of cases with B5a (malignant-in situ carcinoma) or B5b (malignant-invasive carcinoma) categories were in the age range of 31-35 years and 36-40 years. Breast cancer is rare amongyounger women. It mostly occurs in women over the age of 40 years. In women under the age of 40, it usually presents as a self-detected palpable mass and can show various radiological findings in accordance with the histological grade. Ultrasonography is the main method for the diagnosis of breast cancer especially in younger women, whereas mammography and MRI can contribute to both diagnosis and assessment of the extent of the disease.

Physiological confounders of renal blood flow measurement.

Renal blood flow (RBF) is controlled by a number of physiological factors that can contribute to the variability of its measurement. The purpose of this review is to assess the changes in RBF in response to a wide range of physiological confounders and derive practical recommendations on patient preparation and interpretation of RBF measurements with MRI. A comprehensive search was conducted to include articles reporting on physiological variations of renal perfusion, blood and/or plasma flow in healthy humans. A total of 24 potential confounders were identified from the literature search and categorized into non-modifiable and modifiable factors. The non-modifiable factors include variables related to the demographics of a population (e.g. age, sex, and race) which cannot be manipulated but should be considered when interpreting RBF values between subjects. The modifiable factors include different activities (e.g. food/fluid intake, exercise training and medication use) that can be standardized in the study design. For each of the modifiable factors, evidence-based recommendations are provided to control for them in an RBF-measurement. Future studies aiming to measure RBF are encouraged to follow a rigorous study design, that takes into account these recommendations for controlling the factors that can influence RBF results.

Investigation of the Relationship Between Serum Low-Density Lipoprotein Cholesterol Levels with Genetic Polymorphisms, Gut Microbiota, and Nutrition.

Background: To prevent cardiovascular disease (CVD), it is important to determine the factors that are associated with its development. High serum low-density lipoprotein (LDL) cholesterol (LDL-C) levels are a modifiable prevention and treatment target known to contribute to the development of CVD, but the factors affecting blood cholesterol levels, including LDL-C, remain controversial. Objective: In this study, the factors (genetic, nutritional, and gut microbiota) thought to be effective on serum LDL-C levels were discussed from a holistic perspective, and the effects of the relationship between these factors on LDL-C levels were examined. Methods: The study was carried out with 609 adults (48% male) who applied to a private health institution between 2016 and 2022. Results: It was observed that serum LDL-C levels were positively correlated with body mass index (BMI) (P = 0.000) and different ApoE alleles had significant effects on LDL-C levels. It was observed that the highest LDL-C levels were in the ɛ4+ group, followed by ɛ3+ and ɛ2+ groups, respectively (P = 0.000). Results showed that dietary cholesterol and fiber consumption did not significantly affect serum LDL-C levels (P = 0.705 and P = 0.722, respectively). It was also observed that enterotypes and the butyrate synthesis potential of intestinal microbiota did not cause significant changes in serum LDL-C levels (P = 0.369 and P = 975, respectively). Conclusion: Serum LDL-C levels are affected by modifiable factors such as BMI and nonmodifiable factors such as APOE genotype. By identifying these factors and conducting further studies on them, new ways to improve serum LDL-C levels, which is an important factor in the development of CVD, can be identified. In addition, no significant effect of gene-nutrient or microbiota-nutrient interactions on serum LDL-C levels was detected. Further research is needed, especially on the relationship between intestinal microbiota and serum LDL levels.

Abstract 18795: Low Density Lipoprotein Cholesterol Levels at Baseline and the Need for Additional Non Statin Lipid Lowering Therapy for Attaining Lipid Targets in Patients Presenting With Acute Coronary Syndromes- A Retrospective Study

Introduction: CAD is the leading cause of death globally, with more than 17.3 million deaths per year. Multiple modifiable and non-modifiable factors may contribute to cardiovascular risk; among them, LDL-C levels play a crucial role in the pathophysiology of ACS. Objectives: To study the baseline LDL in ACS patients and Predict the need for additional lipid lowering therapies other than high-dose statins for attaining LDL-C goals. Methods: This is a single-centre retrospective study analysing LDL-C levels at the time of admission for ACS. Results: A total of 1880 ACS patients were enrolled (75.3% STEMI &amp; 19.7% NSTEMI) with a mean age of 56±11.79 years (82% males).The mean LDL-C was 74.73mg/dL, with 79 % of patients having LDL less than 100 mg/dL and 89% of patients having LDL-C levels less than 130 mg/dL. Patients less than 40 years of age had a mean LDL of 88.01 mg/dL, while individuals over 60 years had 69.03 mg/dL (p- &lt;0.001). No significant correlation was observed between angiographic severity and LDL-C levels in 1259 patients who underwent coronary angiography. Most patients (96%) received high-dose statin (Atorvastatin 80 mg and Rosuvastatin 40 mg) on discharge. Considering the expected LDL-C reduction by 50 % with high intensity statins alone, the target LDL-C goals as prescribed by ESC guidelines (&lt; 55 mg/dl) and ACC/AHA guidelines (&lt; 70 mg/dl) would be attained by 79% &amp; 89% of patients respectively on follow up. With high intensity statin plus ezetimibe combination (with an expected 65% LDL-C reduction), 89% patients could achieve LDL-C goal by ESC guidelines criteria and &gt; 99% would attain LDL targets set by ACC/AHA guidelines. Conclusions: In this south Asian cohort of ACS patients, the LDL-C levels at presentation were lower compared to western studies and more than three quarters could potentially achieve their LDL-C targets by high intensity statin alone. The results could have potential implications for non-statin therapy utilization.

Abstract 14425: Independent Predictors of ECG Interpretation Proficiency in Healthcare Professionals

Background: Accurate ECG interpretation is vital, but variations in skills exist among healthcare professionals. This study aims to identify factors contributing to ECG interpretation proficiency. Methods: Survey data and ECG test scores from participants in the EDUCATE Trial were analyzed. The dependent variable was the test score for interpreting 30 12-lead ECGs. Independent variables included non-modifiable factors (physician status, clinical experience, patient care impact) and modifiable factors (weekly interpretations, training hours, expert supervision frequency). Bivariate and multivariate analyses generated the Comprehensive Model (all factors) and Actionable Model (modifiable factors only). Results: Among 1206 participants, there were 72 (6.0%) primary care physicians, 146 (12.1%) cardiology fellows-in-training, 353 (29.3%) resident physicians, 182 (15.1%) medical students, 84 (7.0%) advanced practice providers, 120 (9.9%) nurses, and 249 (20.7%) allied health professionals. Physicians accounted for 571 (47.3%) of participants, while 453 (37.6%) were non-physicians. Bivariate analysis showed associations between test scores and multiple variables (Table 1) . In the Comprehensive Model, scores were independently associated with weekly interpretations (9.9 score increase; 95% CI 7.9-11.8; P&lt;0.001), physician status (9.0 score increase; 95% CI 7.2-10.8; P&lt;0.001), and training hours (5.7 score increase; 95% CI 3.7-7.6; P&lt;0.001). In the Actionable Model, scores were independently associated with weekly interpretations (12.0 score increase; 95% CI, 10.0-14.0; P&lt;0.001) and training hours (4.7 score increase; 95% CI 2.6-6.7; P&lt;0.001). The Comprehensive and Actionable Models accounted for 18.7% and 12.3% of the variance in test scores, respectively. Conclusions: Being a physician is a non-modifiable predictor, while training and regular practice are modifiable predictors of ECG interpretation performance.

Disparities in the non-laboratory INTERHEART risk score and its components in selected countries of Europe and sub-Saharan Africa: analysis from the SPICES multi-country project.

Accurate prediction of a person's risk of cardiovascular disease (CVD) is vital to initiate appropriate intervention. The non-laboratory INTERHEART risk score (NL-IHRS) is among the tools to estimate future risk of CVD. However, measurement disparities of the tool across contexts are not well documented. Thus, we investigated variation in NL-IHRS and components in selected sub-Saharan African and European countries. We used data from a multi-country study involving 9309 participants, i.e. 4941 in Europe, 3371 in South Africa, and 997 in Uganda. Disparities in total NL-IHRS score, specific subcomponents, subcategories, and their contribution to the total score were investigated. The variation in the adjusted total and component scores was compared across contexts using analysis of variance. The adjusted mean NL-IHRS was higher in South Africa (10.2) and Europe (10.0) compared to Uganda (8.2), and the difference was statistically significant (P < 0.001). The prevalence and per cent contribution of diabetes mellitus and high blood pressure were lowest in Uganda. Score contribution of non-modifiable factors was lower in Uganda and South Africa, entailing 11.5% and 8.0% of the total score, respectively. Contribution of behavioural factors to the total score was highest in both sub-Saharan African countries. In particular, adjusted scores related to unhealthy dietary patterns were highest in South Africa (3.21) compared to Uganda (1.66) and Europe (1.09). Whereas, contribution of metabolic factors was highest in Europe (30.6%) compared with Uganda (20.8%) and South Africa (22.6%). The total risk score, subcomponents, categories, and their contribution to total score greatly vary across contexts, which could be due to disparities in risk burden and/or self-reporting bias in resource-limited settings. Therefore, primary preventive initiatives should identify risk factor burden across contexts and intervention activities need to be customized accordingly. Furthermore, contextualizing the risk assessment tool and evaluating its usefulness in different settings are recommended.

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies. To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors. This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio. Preoperative S aureus colonization. The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models. In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs. In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk.

Liver Transplant and Incisional Hernia: What Do We Know and What Can We Improve

During follow-up, incisional hernias can reduce the quality of life of transplant recipients. The objective was to analyze the incidence of incisional hernia and risk factors to detect improvements. Retrospective study of transplant recipients between 2002 and 2021. The diagnosis of incisional hernia was clinical and/or radiological. Demographic variables, risk factors, and incisional hernias were studied. Absolute and relative frequency measures have been calculated for qualitative variables and central tendency and dispersion in cases of numerical ones. A multivariate study was performed to identify incisional hernia predictors. We selected 400 patients, 101 (25.3%) who developed hernia. Fifty-one (72.9%) were not clinically diagnosed. Multivariate analysis revealed that overweight (hazard ratio [HR] 1.36; 95% CI 0.72-2.56), obesity (HR 2.36; 95% CI 1.26-4.42), transfusion platelet (3% increase per concentrate), smoking history (HR 1.71; 95% CI 0.99-2.964), immunosuppression induction with everolimus (HR 4.43; 95% CI 1.61-12.16), and maintenance with sirolimus (HR 2.34; 95% CI 1.21-4.52) were risk factors for developing incisional hernia. The wide interval of incidence of incisional hernia reflects diagnostic inconsistencies. Incisional hernias should be known by clinicians and patients due to their possible complications. There are significant risk factors related to unhealthy lifestyle habits that are modifiable. Carrying out "small bites" as a closure technique could improve the results. Patients with other no-modifiable factors should be closely followed up. Incisional hernia is frequent and underdiagnosed. Healthy lifestyle habits should be promoted and corrected. Patients with non-modifiable factors should be closely monitored.

Cluster analysis of maternal socioeconomic and non-modifiable factors with birth &amp; placental outcomes

Abstract Background Maternal social disadvantage adversely affects both maternal and offspring health outcomes. This study aimed to explore clustering of socioeconomic and non-modifiable factors in mothers and their association with birth and placental outcomes, which are under-researched in this context. Methods This analysis of the Lifeways Cross-Generational Cohort includes 250 mother-child pairs. Self-completed general health and food frequency questionnaires in early pregnancy provided information on diet, lifestyle, socioeconomic status (SES) and non-modifiable factors. Parity, untrimmed placental weight (PW) and birthweight (BW) were abstracted from hospital records, and the BW:PW ratio was generated. TwoStep cluster analysis clustered mothers based on age, parity, marital status, net household income, private healthcare insurance, homeowner status, and tertiary education. Differences between clusters were assessed using one-way ANOVA and chi-square tests. Results A three-cluster solution was found to be optimal with a modest average silhouette coefficient of 0.3. Clusters were classified as “Married Homeowners” (n = 140, 37.1%), “Highest Income” (n = 58, 23.2%) and “Renters” (n = 52, 20.8%) based on predictor importance. Renters were younger, more likely to smoke, have a medical card (an indicator of social disadvantage) and have poorer dietary quality and dietary inflammatory status (as indicated by lower Healthy Eating Index (HEI-2015) and higher energy-adjusted Dietary Inflammatory Index (E-DII) scores) compared to other clusters (all p &amp;lt; 0.01). Offspring of Renters were more likely to have lower BW (-259.26g, p &amp;lt; 0.01) and shorter birth length (-1.31cm, p &amp;lt; 0.01) and head circumference (-0.59cm, p = 0.02) compared to offspring of Married Homeowners. Conclusions Results suggest associations of SES (particularly housing status) with birth, but not placental, outcomes and less favourable lifestyle factors, which may have multi-behavioural and multi-sectoral policy implications. Key messages • Associations between low SES, adverse lifestyle behaviours and birth outcomes highlight the importance of a multi-sectoral public health strategy. • Placental outcomes should be examined in further studies.

Machine learning-based identification of determinants for rehabilitation success and future healthcare use prevention in patients with high-grade, chronic, nonspecific low back pain: an individual data 7-year follow-up analysis on 154,167 individuals.

To individually prescribe rehabilitation contents, it is of importance to know and quantify factors for rehabilitation success and the risk for a future healthcare use. The objective of our multivariable prediction model was to determine factors of rehabilitation success and the risk for a future healthcare use in patients with high-grade, chronic low back pain. We included members of the German pension fund who participated from 2012 to 2019 in multimodal medical rehabilitation with physical and psychological treatment strategies because of low back pain (ICD10:M54.5). Candidate prognostic factors for rehabilitation success and for a future healthcare use were identified using Gradient Boosting Machines and Random Forest algorithms in the R-package caret on a 70% training and a 30% test set. We analysed data from 154,167 patients; 8015 with a second medical rehabilitation measure and 5161 who retired because of low back pain within the study period. The root-mean-square errors ranged between 494 (recurrent rehabilitation) and 523 (retirement) days ( R2 = 0.183-0.229), whereas the prediction accuracy ranged between 81.9% for the prediction of the rehabilitation outcome, and 94.8% for the future healthcare use prediction model. Many modifiable prognostic factors (such as duration of the rehabilitation [inverted u-shaped], type of the rehabilitation, and aftercare measure), nonmodifiable prognostic factors (such as sex and age), and disease-specific factors (such as sick leave days before the rehabilitation [linear positive] together with the pain grades) for rehabilitation success were identified. Inpatient medical rehabilitation programmes (3 weeks) may be more effective in preventing a second rehabilitation measure and/or early retirement because of low back pain compared with outpatient rehabilitation programs. Subsequent implementation of additional exercise programmes, cognitive behavioural aftercare treatment, and following scheduled aftercare are likely to be beneficial.

Perioperative Factors Affecting the Healing of Rectovaginal Fistula.

Rectovaginal fistula is rare, but a severe complication in gynecology, which despite the effort of clinicians is still not treated successfully in many cases. According to statistics, the healing rates of surgery in patients with RVF range from 20 to 100%. The treatment effectiveness depends on the etiology of fistula, the age of the patients, the presence of comorbidities, the type of surgery and many other factors. Considering the low efficiency of treatment and the high risk of recurrence, the question of possible methods to improve the results occurs. In our review, we analyzed both modifiable and non-modifiable factors which may influence the treatment, healing rate and future fate of the patients. Taking into account all analyzed risk factors, including age, comorbidities, smoking status, microbiology, medications, stoma and stool features, we are aware that rectovaginal fistula's treatment must be individualized and holistic. In cases of poorly healing RVF, the drainage of feces, the use of antibiotic prophylaxis or the implementation of estrogen therapy may be useful. Moreover, microbiome research in women with RVF and towards estrogen therapy should be performed in order to create treatment algorithms in women with fistulae. Those interventions, in our opinion, may significantly improve the outcome of the patients.

Failure-to-Salvage After Femoropopliteal Bypass Surgery is Associated With Nonmodifiable Risk Factors

IntroductionBypass graft failure and major amputation are among the worst complications after femoropopliteal bypass surgery. In this large multicenter analysis, we examined our incidence and risk factors for failure-to-salvage (FTS) following either bypass surgery or bypass graft failure. MethodsA regional multicenter database was retrospectively queried for all femoropopliteal bypass procedures performed between 2002 and 2021. Re-do bypasses were excluded. The primary outcome was FTS, defined as major ipsilateral limb amputation within 90 d following index bypass surgery or bypass graft failure. Bypass graft failure was defined as critical stenosis or occlusion of the bypass graft requiring reintervention. Graft rescue was defined as bypass graft failure without subsequent major ipsilateral limb amputation within 90 d. Multivariable logistic regression analysis was utilized to identify factors associated with bypass graft failure and FTS. ResultsOver the study period, 1315 femoropopliteal bypass procedures were performed across five hospitals. There were 25 major amputations within 90 d of initial bypass. Bypass graft failure was diagnosed in an additional 503 (38.3%) patients. Mean time to graft failure was 619 d. On multivariable analysis, bypass for tissue loss (adjusted odds ratio [aOR] 1.38 [95% confidence interval (CI) 1.03-1.83], P = 0.03) was associated with graft failure. Of patients with graft failure, 33 had major amputation, leading to an overall FTS incidence of 4.4% (n = 58) over a mean follow-up period of 3.4 y. Patient demographics, medical comorbidities, and bypass conduits were similar between the FTS and graft rescue groups (n = NS each). The FTS group more frequently underwent bypass for tissue loss (51.7% versus 29.8%, P = 0.002), and an infrageniculate bypass target was more frequently utilized in FTS compared to graft rescue patients (81.0% versus 60.4%, P = 0.002). Anticoagulation (34.5% in FTS versus 37.7% in rescue) and dual antiplatelet therapy (15.5% versus 22.1%, respectively) were similar between groups (P = NS each). On multivariable analysis, factors associated with FTS included infrageniculate target (aOR 2.42 [95% CI 1.22-4.08], P = 0.01), black race (aOR 2.47 [95% CI 1.04-5.84], P = 0.04), and bypass for tissue loss (aOR 4.75 [95% CI 1.41-16.0], P = 0.01). Anticoagulation and dual antiplatelet therapy were not associated with loss of graft patency or FTS. ConclusionsFailure-to-salvage after femoropopliteal bypass surgery is associated with nonmodifiable factors, and may represent progression of underlying disease. These data may help inform vascular surgeons in counseling patients with failing bypass grafts. Further investigation of care delivery factors improving likelihood of graft salvage may be warranted.

Relationships between common pre-season screening measures and dance-related injuries in pre-professional ballet dancers.

OBJECTIVE: To examine modifiable and non-modifiable factors for associations with dance-related injury among pre-professional ballet dancers over five academic years. DESIGN: Prospective cohort study METHODS: Full-time pre-professional ballet dancers [n=452; 399 female, median (range) age: 15 years (11-21)] participated across five academic years at a vocational school. Participants completed baseline screening and online weekly injury questionnaires including dance exposure (hours/week). Zero-inflated Poisson regression models were used to examine associations between potential risk factors measured at baseline and self-reported dance-related injury. RESULTS: In count model coefficients, left one leg standing score [log coefficient estimate: -0.249 (95%CI: -0.478, -0.02); p=0.033] and right unipedal dynamic balance time [log coefficient estimate: -0.0294 (95%CI: -0.048, -0.01); p>0.001] carried a protective effect with increased years of training when adjusted for Athletic Coping Skills Inventory (ACSI) score. A significant association was found for left unipedal dynamic balance time and dance-related injury [log coefficient estimate: 0.013 (95%CI: 0.000, 0.026); p=0.045] when adjusted for years training and ACSI score. There were no significant associations between dance-related injury and ankle and hip range of motion, active straight leg raise or Y-balance test measures. CONCLUSION: When adjusted for years of previous dance training and psychological coping skills, there was a significant association between limb-specific lumbopelvic control and dynamic balance tasks, and self-reported dance-related injury in pre-professional ballet.

Socioeconomic, health-care access and clinical determinants of disease severity in Multiple Sclerosis in Chile.

MS severity may be affected by genetic, patient-related, disease-related and environmental factors. Socioeconomic status, including income and healthcare access, amongst others, may also have a role in affecting diagnostic delay or therapy prescription. In Chile, two main healthcare systems exist, public-healthcare and private-healthcare, nonetheless universal care laws (e.g., access to High Efficacy Therapy-HET), including both systems, have been recently enacted for people with MS. To assess the role of Socioeconomic Conditions (SEC), clinical variables and public health policies on the impact of disease severity of MS patients in Chile. Multicentric, observational, cross-sectional study including patients from two reference centres (1 national reference centre from the private-health system and 1 regional reference centre from the public-health system). SEC and clinical variables included healthcare insurance (private or public), subclassification of health insurance according to monthly income, sex, age at onset, diagnostic delay, disease duration, diagnosis before HET law (as a proxy of HET delay), and current HET treatment. Progression Index (PI), EDSS ≥6.0 and Progressive MS diagnosis were used as outcome measures. Multivariable binary logistic regression was performed. We included 604 patients (460 private-health, 144 public-health), 67% women, 100% white/mestizo, 88% RRMS, mean age 42±12 years, mean age at onset 32±11 years, mean disease duration 10±6 years, median diagnostic delay 0 (0-34) years, 86% currently receiving any DMT, 55% currently receiving HET, median EDSS at last visit of 2.0 (0-10), and median PI 0.17 (0-4.5). Lower monthly income was associated with higher EDSS and higher PI. In the multivariable analysis, public-healthcare (OR 10.2), being diagnosed before HET-law (OR 4.89), longer diagnostic delay (OR 1.26), and older age at onset (OR 1.05) were associated with a higher risk of PI>0.2, while current HET (OR 0.39) was a protective factor. Diagnosis before HET-law (OR 7.59), public-healthcare (OR 6.49), male sex (OR 2.56), longer disease duration (OR 1.2) and older age at onset (OR 1.1) were associated with a higher risk of Progressive MS. Public-healthcare (OR 5.54), longer disease duration (OR 1.14) and older age at onset (OR 1.08) were associated with a higher risk of EDSS ≥6.0 while current treatment with HET had a trend as being a protective factor (OR 0.44, p=0.05). MS severity is impacted by non-modifiable factors such as sex and age at onset. Interventions focused on shortening diagnostic delay and encouraging early access to high-efficacy therapies, as well as initiatives that may reduce the disparities inherent to lower socioeconomic status, may improve outcomes in people with MS.