Potential Modifiable Risk Factors Research Articles

Association between sleep behaviors and stroke in Southwest China: a prospective cohort study

BackgroundSleep can function as a potential modifiable risk factor in the control and prevention of stroke. Geography significantly influences sleep patterns. The association of sleep with stroke in population of Southwest China has not so far been investigated.MethodsA total of 55,001 residents aged from 30 to 79 years in Southwest China were included in this study, obtaining their complete information of baseline survey and follow-up in China Kadoorie Biobank (CKB). Sleep-evaluating score was constructed on the basis of short/long sleep duration, insomnia, and snoring. The multivariate Cox proportional hazards regression was used to analyze the association between sleep behaviors and stroke.ResultsDuring 11.15 years of follow-up, 3410 stroke cases (572.78 cases/100,000 person-years) were documented. There exists no association of sleep-evaluating score with the risk of stroke in the total population. Male-predisposing association between sleep-evaluating score and risk of stroke was observed (for total stroke, HR = 1.52, 95% CI: 1.03–2.23; for hemorrhagic stroke, HR = 2.31, 95% CI: 1.22–4.34), with anisotropism in male residents with overweight and obesity (HR = 1.93, 95% CI: 1.03–3.63), and those without hypertension (HR = 1.76, 95% CI: 1.01–3.07) in the baseline survey.ConclusionsThere exists the male-predisposing association between sleep-evaluating score and the risk of stroke in Southwest China. Improving sleep is required for reducing the risk of stroke.

Relationship between socioeconomic status and stroke: An observational and network Mendelian randomization study

BackgroundThe relationship between socioeconomic status (SES) and stroke remains controversial, and the underlying mediator is unclear. This study aimed to assess the causal relationship of SES with stroke and its subtypes and to identify potential modifiable risk factors responsible for this relationship. MethodsThe study included 372,437 participants from the UK Biobank. Over an average period of 12.13 years, 6,457 individuals (2.7 %) were recorded as having experienced a stroke. Cox proportional hazards model was used to determine the relationship between SES (average annual household income before tax and age at the end of full-time education) and stroke, ischemic stroke, and hemorrhagic stroke. Two-sample Mendelian randomization (MR) was employed to assess the causal relationship between SES and stroke and its subtypes. Furthermore, network MR was utilized to evaluate the potential mediating role of modifiable risk factors for stroke in this causal relationship. ResultsAfter adjusting for factors such as sociodemographic characteristics, health behaviors, health status, and past medical history, participants in the second highest income group showed the lowest risk of stroke, with a hazard ratio (HR) of 0.780 (95 % confidence interval [CI]: 0.702–0.866), and for ischemic stroke, the HR was 0.701 (95 % CI: 0.618–0.795). Those who completed full-time education at the latest age group(>18 years) had the lowest risk of stroke (HR: 0.906, 95 % CI: 0.830–0.988) and ischemic stroke (HR: 0.897, 95% CI: 0.811–0.992). MR analysis showed that higher income and education were both associated with a lower risk of stroke (income: inverse-variance-weighted odds ratio [ORIVW] =0.796, 95 % CI: 0.675–0.940, education: ORIVW = 0.631, 95 % CI: 0.557–0.716) and ischemic stroke (income: ORIVW = 0.813, 95 % CI: 0.684–0.966, education: ORIVW = 0.641, 95 % CI: 0.559–0.735). Additionally, hypertension had the highest mediating effect on this relationship. It accounted for 57.12 % of the effect of income on stroke, 51.24 % on ischemic stroke, and 27 % and 24 % for education. ConclusionHigher SES was associated with a lower risk of stroke and ischemic stroke, and hypertension had the highest mediating effect on this causal relationship. The results have significant public health implications, emphasizing the importance of early intervention to reduce the risk of stroke in low SES populations.

Analysis of adolescent idiopathic scoliosis population for Surgical Site Infection Risk Factors

ObjectiveThe incidence of surgical site infection (SSI) in adolescent idiopathic scoliosis (AIS) patients undergoing surgical correction varies but is commonly reported between 0.5 and 6.7 %. The identification of modifiable risk factors is crucial to preventing these infections in the AIS population. Some potential modifiable risk factors include the use of stainless-steel implants, a larger volume of instrumentation and an increased volume of blood products transfused. However, evidence in support of these factors and others representing true risk for the development of SSI is limited and often varies. We aimed to determine the incidence of SSI in AIS undergoing primary scoliosis fusion at our hospital, and explore demographic and clinical variables in the development of SSI in AIS. MethodsThis was a case control retrospective study. Patients aged 10-19 year-old that underwent posterior spinal fusion for initial correction of AIS at our hospital between the years 2012–2020 were eligible. Patients with any previous spine surgery or spine fracture were excluded. A descriptive analysis was then performed on the data. ResultsOf the 334 patients on which data was collected, one SSI was identified resulting in an incidence of infection of 0.3 %. The largest ethnicity represented was Caucasian with 254 patients. The average age was 14.3 years with averaged follow-up of 6.6 years. The majority of patients (252) received implants composed of titanium and cobalt chrome. The average operation duration was 5 h and 7.7 min, and the average hospital stay was 4.2 days. The average amount of blood loss was 553 ml. Chlorhexidine wipes or some other antimicrobial preparation was used on 197 patients and betadine solution was used on 321.185 patients were recorded to have received either antibiotic-loaded allograft or antibiotic powder and 326 patients were recorded to have received intraoperative antibiotics. ConclusionsThe long term clinical follow up of our study and low incidence of infection provide additional evidence for the benefit of antimicrobial techniques and risk factor mitigation previously suggested in the literature for the prevention of SSI in AIS. Level of evidenceLevel III.

Self-reported hearing loss is associated with faster cognitive and functional decline but not diagnostic conversion in the ADNI cohort.

Hearing loss is identified as one of the largest modifiable risk factors for cognitive impairment and dementia. Studies evaluating this relationship have yielded mixed results. We investigated the longitudinal relationship between self-reported hearing loss and cognitive/functional performance in 695 cognitively normal (CN) and 941 participants with mild cognitive impairment (MCI) enrolled in the Alzheimer's Disease Neuroimaging Initiative. Within CN participants with hearing loss, there was a significantly greater rate of cognitive decline per modified preclinical Alzheimer's cognitive composite. Within both CN and MCI participants with hearing loss, there was a significantly greater rate of functional decline per the functional activities questionnaire (FAQ). In CN and MCI participants, hearing loss did not significantly contribute to the risk of progression to a more impaired diagnosis. These results confirm previous studies demonstrating a significant longitudinal association between self-reported hearing loss and cognition/function but do not demonstrate an increased risk of conversion to a more impaired diagnosis. NCT00106899 (ADNI: Alzheimer's Disease Neuroimaging Initiative, clinicaltrials.gov), NCT01078636 (ADNI-GO: Alzheimer's Disease Neuroimaging Initiative Grand Opportunity, clinicaltrials.gov), NCT01231971 (ADNI2: Alzheimer's Disease Neuroimaging Initiative 2, clinicaltrials.gov), NCT02854033 (ADNI3: Alzheimer's Disease Neuroimaging Initiative 3, clinicaltrials.gov). Hearing loss is a potential modifiable risk factor for dementia. We assessed the effect of self-reported hearing loss on cognition and function in the ADNI cohort. Hearing loss contributes to significantly faster cognitive and functional decline. Hearing loss was not associated with conversion to a more impaired diagnosis.

Modifiable risk factors for developing otitis media with effusion in children under 12 years in high-income countries: a systematic review

ObjectiveTo systematically assess the modifiable risk factors for developing otitis media with effusion (OME) in children under 12 years.MethodsWe searched Embase, MEDLINE, INAHTA database, CENTRAL, CDSR and Epistemonikos for cohort...

Daily steps are a predictor of, but perhaps not a modifiable risk factor for Parkinson's Disease: findings from the UK Biobank.

Higher physical activity levels have been suggested as a potential modifiable risk factor for lowering the risk of incident Parkinson's disease (PD). This study uses objective measures of physical activity to investigate the role of reverse causation in the observed association. To investigate the association between accelerometer-derived daily step count and incident PD, and to assess the impact of reverse causation on this association. This prospective cohort study involved a follow-up period with a median duration of 7.9 years, with participants who wore wrist-worn accelerometers for up to 7 days. The study was conducted within the UK Biobank, a large, population-based cohort. The analysis included 94,696 participants aged 43-78 years (56% female) from the UK Biobank who provided valid accelerometer data and did not have prevalent PD. Daily step counts were derived using machine learning models to determine the median daily step count over the monitoring period. The primary outcome was incident PD, identified through hospital admission and death records. Cox proportional hazards regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between daily step count and incident PD, with adjustments for various covariates and evaluation of reverse causation by splitting follow-up periods. During a median follow-up of 7.9 years (IQR: 7.4-8.4), 407 incident PD cases were identified. An inverse linear association was observed between daily step count and incident PD. Participants in the highest quintile of daily steps (>12,369 steps) had an HR of 0.41 (95% CI 0.31-0.54) compared to the lowest quintile (<6,276 steps; HR 1.00; 95% CI 0.84-1.19). A per 1,000 step increase was associated with an HR of 0.92 (95% CI 0.89-0.94). However, after excluding the first six years of follow-up, the association was not significant (HR 0.96, 95% CI 0.92-1.01). The observed association between higher daily step count and lower incident PD is likely influenced by reverse causation, suggesting changes in physical activity levels occur years before PD diagnosis. While step counts may serve as a predictor for PD, they may not represent a modifiable risk factor. Further research with extended follow-up periods is warranted to better understand this relationship and account for reverse causation.

Extensive social media use and frequency of current e-cigarette use among US youth

IntroductionBoth electronic cigarette (e-cigarette) and social media use among youth are public health concerns. While the health impacts of extensive social media use and frequent use of e-cigarettes have been discussed independently in the literature, little is known about the relationship between the two. This study aims to examine the potential association between extensive social media use and the frequency of current, e-cigarette use among United States (US) youth. MethodsData from the 2022 National Youth Tobacco Survey (NYTS) were analyzed. The sample included 23,655 middle and high school students aged 9–18 years. Frequency of current e-cigarette use was categorized based on past-30 day use (i.e., never/former, 1–9 days, 10–29 days, or 30 days). Social media use was dichotomized into less than 4 hours daily and 4+ hours daily (i.e., extensive use). Multivariable multinomial logistic regression estimated the relationship between social media use and e-cigarette use frequency. ResultsOver one-third (35.8 %) of youth used social media extensively and 8.6 % reported current use of e-cigarettes. Extensive social media use was associated with daily e-cigarette use (OR: 1.94, 95 % CI: 1.48–2.56) but not with other use categories. Older age, female sex, lower grades, current other tobacco use, and family tobacco use were also associated with daily e-cigarette use. ConclusionsExtensive social media use is associated with daily e-cigarette use among US youth. Public health interventions should consider the influence of social media on tobacco use behaviors and tailor prevention strategies to address this potential modifiable risk factor.

Post-Traumatic Stress Disorder 4 Years after the COVID-19 Pandemic in Adolescents with Different Levels of Physical Activity Engagement: A Repeated Cross-Sectional Study.

The aim of this study was to assess whether the psychological impact of the COVID-19 pandemic on children and adolescents had decreased four years after the initial assessment. This study aimed to determine if children with an active lifestyle and participation in sports activities were protected against this traumatic stress. This study included a total of 284 Italian participants assessed at two different time points: the first assessment was conducted in 2020 when the children were aged 9-12 years, and a second assessment was carried out four years later when the participants were aged 13-16. Participants completed the Impact of Event Scale-Revised questionnaire (IES-R), with the IES-8 and IES-15 versions used accordingly based on age group. In the 2020 assessment, 146 (51.4%) reported a score higher than the cut-off for significant traumatic stress, while in 2024, only 49 participants (17.2%). The chi-square analysis indicated that this decrement was statistically significant (p < 0.001). RM-ANOVA showed a significant reduction for both Intrusion Score and Avoidance Score (p < 0.001). A statistical interaction between gender and time was observed. There were weak correlations between the level of children's sport practice, and no differences between those who engage in individual or team sports. Despite this study showing that young people are overcoming the pandemic crisis and its consequences, identifying potential modifiable risk factors and empowering protective factors remains crucial, especially for those who continue to experience psychological issues. The restrictions particularly impacted active children by disrupting their routine, which may have compromised the universally recognized protective value of sports.

Comparison of the latest cancer statistics, cancer epidemic trends and determinants between China and the United States

Objective: To provide supports for the cancer prevention and control strategies in China by comparing the disease burden, epidemic trends, 5-year relative survival rate and major determinants of common cancers between China and the United States. Methods: A descriptive secondary analysis was conducted using data extracted from the GLOBOCAN database, the Surveillance, Epidemiology, and End Results database, Global Burden of disease 2019 database, and previous studies. The main indicators included the cases of malignant tumors in different sites, the cases of deaths, the age-standardized incidence (world standard incidence) and mortality (world standard mortality), the 5-year relative survival rate, and population attributable fraction (PAF). Results: In 2022, an estimated 4.825 million new cases and 2.574 million deaths of malignant neoplasms in China. The world standard incidence rate (201.6/100 000) in China was lower than that in the United States (367.0/100 000), and the world standard mortality rate (96.5/100 000) was higher than that in the United States (82.3/100 000). Lung cancer ranked first in the disease burden of malignant tumors in China, the new cases and deaths accounted for 22.0% and 28.5% of all malignant tumors, respectively. The top three malignant tumors in China were breast cancer (11.5%), prostate cancer (9.7%) and lung cancer (9.5%), which were also among the top five causes of death. However, the second to fifth leading causes of death from malignant tumors in China were digestive system tumors (liver cancer 12.3%, stomach cancer 10.1%, colorectal cancer 9.3%, and esophageal cancer 7.3%). From 2000 to 2018, the world standard incidence of malignant tumors showed an increasing trend and the world standard mortality of malignant tumors showed a decreasing trend in China, while the world standard incidence and mortality of malignant tumors in the United States showed a significant decreasing trend after 2000. The incidence of breast cancer, colorectal cancer and thyroid cancer increased rapidly in China, while the incidence and mortality of stomach cancer, liver cancer and esophageal cancer decreased, but they still had a heavy disease burden. From 2003 to 2015, the overall 5-year relative survival rate of malignant tumors increased from 30.9% to 40.5% in China. However, with the exception of esophageal cancer, the 5-year relative survival rates of other major malignant tumors were lower than those in the United States. In 2019, the PAF of malignant tumors death attributable to potential modifiable risk factors was 48.3% in China, which was similar to the United States (49.8%). Of these, smoking was the most important attributable risk factor, and the PAF was more than 30% both in China and the United States. In addition, about 18.8% of malignant tumors were caused by preventable chronic infections, such as hepatitis B virus and Helicobacter pylori, while less than 4% of malignant tumors in the United States were caused by infection. Conclusions: China has made great progress in the prevention and treatment of malignant tumors, but it still faces a serious disease burden. The cancer spectrum is changing from developing countries to developed countries. We should pay attention to modifiable factors, take comprehensive measures, and prevent cancer scientifically.

The impact of nutritional status on revision total shoulder arthroplasty: perioperative outcomes and complications

BackgroundAs the prevalence of primary total shoulder arthoplasty (TSA) increases in the United States so does the number of revision TSA. Those undergoing primary TSA with lower nutritional status have been shown to have worse outcomes; however, little knowledge exists regarding the effects of malnutrition on outcomes following revision TSA. The purpose of this study is to determine the clinical outcomes and complication rates following revision TSA, as well as the prevalence of diabetes mellitus (DM) in malnourished patients undergoing revision TSA. MethodsThe American College of Surgeons National Surgical Quality Improvement Program Database was queried from 2013 to 2020 and found 783 cases of revision TSA. Albumin was used as a surrogate marker for nutritional status. Patients were stratified into unmatched cohorts of normal (albumin ≥ 3.5 g/dL, n = 700) and low (albumin < 3.5 g/dL, n = 83) nutritional status, as well as by diagnosis of DM. Comparative differences in demographics, comorbidities, length of stay (LOS), readmission, reoperation, and 30-day postoperative complications related to their nutritional status and presence of DM were analyzed using chi-squared tests, independent sample t tests, and multivariate analysis on SPSS. ResultsPatients within the low albumin cohort were more likely to be female (P = .008), increased mean age (P = .018), on dialysis (P = .002), had undergone an emergency procedure (P < .001), classified with a dependent functional status (P < .001), and had a higher American Society of Anesthesiologists classification (P < .001). There was a higher percentage of patients with a DM diagnosis and hypoalbuminemia compared to nondiabetic patients (36.2% vs. 19.4%, P < .001). Compared to the normal albumin cohort, the low albumin cohort was found to have significantly longer LOS (P = .025), increased bleeding/transfusion complications (8.4% vs. 3.3%, P = .021), and increased reoperation rate (8.4% vs. 0.71%, P = .034). No significant difference in readmission was found (P = .226). ConclusionEleven percentage of patients undergoing revision TSA were malnourished and had higher LOS and reoperation rates. Patients with DM had a significantly higher incidence of being malnourished than those without DM. Malnourishment represents a potential modifiable risk factor for patients undergoing revision TSA, and surgeons should screen patients preoperatively, especially those patients with DM.

Interpregnancy Interval After Healthy Live Birth and Subsequent Spontaneous Abortion

Many studies have reported that the interpregnancy interval (IPI) is a potential modifiable risk factor for adverse perinatal outcomes. However, the association between IPI after live birth and subsequent spontaneous abortion (SA) is unclear. To investigate the association of IPI after a healthy live birth and subsequent SA. This prospective cohort study used data from 180 921 women aged 20 to 49 years who had a single healthy live birth and planned for another pregnancy and who participated in the Chinese National Free Prepregnancy Checkups Project from January 1, 2010, to December 31, 2020. Statistical analysis was conducted from June 20 to October 5, 2023. Interpregnancy interval, defined as the interval between the delivery date and conception of the subsequent pregnancy, was categorized as follows: less than 18 months, 18 to 23 months, 24 to 35 months, 36 to 59 months, and 60 months or longer. The main outcome was SA. Multivariable-adjusted odds ratios (ORs) were calculated by logistic regression models to examine the association between IPI and the risk of SA. Dose-response associations were evaluated by restricted cubic splines. The analyses included 180 921 multiparous women (mean [SD] age at current pregnancy, 26.3 [2.8] years); 4380 SA events (2.4% of all participants) were recorded. A J-shaped association between IPI levels and SA was identified. In the fully adjusted model, compared with IPIs of 18 to 23 months, both short (<18 months) and long (≥36 months) IPIs showed an increased risk of SA (IPIs of <18 months: OR, 1.15 [95% CI, 1.04-1.27]; IPIs of 36-59 months: OR, 1.28 [95% CI, 1.15-1.43]; IPIs of ≥60 months: OR, 2.13 [95% CI, 1.78-2.56]). Results of the subgroup analysis by mode of previous delivery were consistent with the main analysis. This cohort study of multiparous women suggests that an IPI of shorter than 18 months or an IPI of 36 months or longer after a healthy live birth was associated with an increased risk of subsequent SA. The findings are valuable to make a rational prepregnancy plan and may facilitate the prevention of SA and improvement in neonatal outcomes.

The Effect of Sleep Duration on Hypertension Risk in an Adult Asian Population: A Systematic Review and Meta-Analysis.

Sleep duration has been proposed as a potential and important modifiable risk factor, yet its precise relationship with hypertension among Asian adults remains unclear. This meta-analysis aims to elucidate the impact of short sleep duration on hypertension risk within the adult Asian population. A systematic search of databases, including PubMed, Scopus, and ScienceDirect, was conducted to identify relevant studies published up to January 4, 2024. Eligible studies comprised observational cohort studies and cross-sectional studies that compared short sleep duration to normal sleep duration in relation to hypertension risk among Asian adults. The definitions for short and normal sleep durations were derived from the respective studies. The random effects model was utilized to pool effect estimates, and all statistical analyses were conducted usingReview Manager 5.4 software (RevMan) (Cochrane Collaboration, Oxford, UK). Results from a systematic search obtained seven studies assessing sleep duration and hypertension risk in Asian populations. Based on a meta-analysis of six studies, short sleep duration is associated with a higher hypertension risk when compared to normal sleep duration (OR: 1.36; 95% CI: 1.13-1.64; p: 0.0010; I2: 75%). Subgroup analysis based on sex showed that the association is evident across males (OR: 1.12; 95% CI: 1.01-1.25; p: 0.03; I2: 64%) and females (OR: 1.22; 95% CI: 1.10-1.35; p: 0.0003; I2: 82%). In conclusion, based on the analyzed studies, short sleep duration is associated with a higher mild risk of hypertension, irrespective of sex. Thus, short sleep duration can be a modifiable risk factor that can be prevented to reduce the risk of hypertension. By incorporating sleep hygiene practices and promoting healthy sleep habits,significantimprovement in cardiovascular health can be made, especially in hypertension riskat a population level. Further studies on the effect of sleep duration in different age populations should be conducted to confirm the impact of short sleep duration.

Osteoporosis as a Potential Modifiable Risk Factor for Dementia in Thailand: A Cross-Sectional Analysis.

This study aims to explore the potential of osteoporosis as a modifiable risk factor for dementia and investigatewhether treatments like estrogen supplementation and bisphosphonates can reduce the risk of dementia in the Thai population. This study aimed to evaluate the risk of dementia in patients with osteoporosis. A cross-sectional analysis was conducted. Participants aged <50 years and those with a history of dementia at baseline were excluded. Clinical variables were analyzed using the chi-squared test. Logistic regression analysis was conducted to determine independent factors of dementia after adjusting for potential confounders. The cohort was conducted on 54,399 participants, of whom 9763 (17.9%) had osteoporosis. The results indicated that individuals with osteoporosis had an odds ratio (OR) of 1.62-fold higher risk of developing dementia compared to those without osteoporosis (95% confidence interval (CI) 1.37-1.92, p-value < 0.001). Furthermore, compared to patients with osteoporosis not undergoing any treatment, those receiving estrogen supplementation and bisphosphonate treatment showed reduced associations with dementia, with an OR of 0.84 (95% CI 0.73-0.98, p-value = 0.023) and 0.66 (95% CI 0.60-0.73, p-value < 0.001), respectively. The study findings suggest an elevated risk of dementia in patients with osteoporosis and contribute substantially to our understanding of the link between osteoporosis and dementia in the Thai population.

The brain structure, inflammatory, and genetic mechanisms mediate the association between physical frailty and depression

Cross-sectional studies have demonstrated strong associations between physical frailty and depression. However, the evidence from prospective studies is limited. Here, we analyze data of 352,277 participants from UK Biobank with 12.25-year follow-up. Compared with non-frail individuals, pre-frail and frail individuals have increased risk for incident depression independent of many putative confounds. Altogether, pre-frail and frail individuals account for 20.58% and 13.16% of depression cases by population attributable fraction analyses. Higher risks are observed in males and individuals younger than 65 years than their counterparts. Mendelian randomization analyses support a potential causal effect of frailty on depression. Associations are also observed between inflammatory markers, brain volumes, and incident depression. Moreover, these regional brain volumes and three inflammatory markers—C-reactive protein, neutrophils, and leukocytes—significantly mediate associations between frailty and depression. Given the scarcity of curative treatment for depression and the high disease burden, identifying potential modifiable risk factors of depression, such as frailty, is needed.

Prevalence of Autism Spectrum Disorder Among Children and Adolescents in the United States from 2021 to 2022.

The prevalence of autism spectrum disorder (ASD) among children and adolescents seem to be high in countries around the world, and it's worth understanding the latest prevalence and trends of ASD in children and adolescents. The purpose of this study was to examine the latest prevalence and decade trend of ASD among individuals aged 3-17years in the United States. A total of 13,198 individuals aged 3-17years were included. Annual data were examined from the National Health Interview Survey (2021-2022). Weighted prevalence for each of the selected developmental disabilities were calculated. This cross-sectional study estimated the weighted prevalence of autism spectrum disorder were 3.05, 3.79, and 3.42% among individuals aged 3-17years in the US in 2021, 2022, and the 2-year overall, respectively. We also observed a decade-long upward trend even after adjusting for demographic characteristics (P for trend < .05). The results of this study showed that the prevalence of ASD among children and adolescents aged 3-17years in the United States remained high and has increased over the past decade. The further investigation is necessary to evaluate potential modifiable risk factors and causes of ASD.

Association between household size and risk of incident dementia in the UK Biobank study

Currently, the relationship between household size and incident dementia, along with the underlying neurobiological mechanisms, remains unclear. This prospective cohort study was based on UK Biobank participants aged ≥ 50 years without a history of dementia. The linear and non-linear longitudinal association was assessed using Cox proportional hazards regression and restricted cubic spline models. Additionally, the potential mechanisms driven by brain structures were investigated by linear regression models. We included 275,629 participants (mean age at baseline 60.45 years [SD 5.39]). Over a mean follow-up of 9.5 years, 6031 individuals developed all-cause dementia. Multivariable analyses revealed that smaller household size was associated with an increased risk of all-cause dementia (HR, 1.06; 95% CI 1.02–1.09), vascular dementia (HR, 1.08; 95% CI 1.01–1.15), and non-Alzheimer’s disease non-vascular dementia (HR, 1.09; 95% CI 1.03–1.14). No significant association was observed for Alzheimer’s disease. Restricted cubic splines demonstrated a reversed J-shaped relationship between household size and all-cause and cause-specific dementia. Additionally, substantial associations existed between household size and brain structures. Our findings suggest that small household size is a risk factor for dementia. Additionally, brain structural differences related to household size support these associations. Household size may thus be a potential modifiable risk factor for dementia.

Is content of delusions in psychotic depression related to the risk of dementia?

Introduction Some studies have shown that late-life depression is related to faster cognitive decline and may increase the risk of dementia.Identifying risk and protective factors for dementia is essential to develop preventive interventions. Some literature has suggested that mood disorders (namely depression) are potential modifiable risk factors for dementia.Thus, it is important to know clinical presentation of depression that is associated to dementia, as a manifestation of subclinical dementia or as a risk factor for neurocognitive disorders.ObjectivesWe aim to identify clinical characteristics related to dementia of inpatients admitted for first time due to depressive episode after 55 years old.MethodsRetrospective cohort study of inpatients admitted between January 1st 2010 and March 31st 2022 in a psychiatry inpatient unit of a tertiary hospital. Descriptive analysis of the results was performed using the SPSS software, version 26.0.ResultsOur sample included 57 inpatients, 15,8% (n=9) with the diagnosis of dementia 5,2 (SD 5,6) years after admission. All of these patients presented a depressive episode with psychotic symptoms, namely delusion activity. In those with hallucinatory activity, no one developed dementia.Interestingly, 33,3% of patients with dementia (n=3) presented with delusion of ruin, 55,6% (n=5) with delusion of prejudice/persecutory delusion and 66,7% (n=6) manifested delusion of ruin and/or prejudice.We also found that 42,9% (n=3) of patients with dementia manifested Cotard delusion while this type of delusion was observed in 13,6% of patients without dementia (p=0,095).ConclusionsOur study has several limitations because is based on results of only one hospital, with a small sample size.However, since depressive symptoms are potentially modifiable risk factors for dementia, future studies are essential to understand the mechanisms that link depression to cognitive decline as well as clinical characteristics that may constitute predictors of dementia.Disclosure of InterestNone Declared

Lifestyle Factors Associated With Frequent Recurrent Headaches in Children and Adolescents: A Canadian Population-Based Study.

Lifestyle behaviors have been postulated to affect headache frequency in youth and are often the primary target of self-management recommendations. Our study aimed to assess the association between various lifestyle factors and frequent recurrent headaches in children and youth. Children and adolescents aged 5-17 years were enrolled in a large cross-sectional Canadian population-based health survey, completed on January 31, 2019. Headache frequency was dichotomized into "approximately once/week or less" or ">once/week" (defined as frequent recurrent headaches). The association between frequent headaches and meal schedules, screen exposure, physical activity, chronotype, and frequent substance use/exposure (alcohol, cigarettes, electronic cigarettes, and cannabis) was assessed using both unadjusted logistic regression models and models adjusted for age/sex. Fully adjusted models examined the odds of frequent headaches according to all exposures. Survey design effects were accounted for using bootstrap replicate weighting. There were an estimated nweighted = 4,978,370 eligible participants in the population. The mean age was 10.9 years (95% CI 10.9-11.0); 48.8% were female; 6.1% had frequent headaches. Frequent headaches were associated with older age (odds ratio [OR] = 1.31, 95% CI 1.28-1.34, p < 0.001) and female sex (OR = 2.39, 95% CI 2.08-2.75, p < 0.001). In models adjusted for age/sex, the odds of frequent headaches decreased with meal regularity (adjusted OR [aOR] = 0.90, 95% CI 0.89-0.92, p < 0.001) and increased with later chronotype (aOR = 1.10, 95% CI 1.05-1.15, p < 0.001) and excess screen exposure (≥21 hours vs none in past week: aOR = 2.97, 95% CI 1.53-5.77, p = 0.001); there was no significant association with reported physical activity (aOR = 0.95, 95% CI 0.67-1.34, p = 0.77). In 12- to 17-year-olds, frequent headaches were associated with frequent alcohol use (≥1/wk vs never: aOR = 3.50, 95% CI 2.18-5.62, p < 0.001), binge drinking (≥5 times in past month vs never: aOR = 5.52, 95% CI 2.95-10.32, p < 0.001), smoking cigarettes (daily vs never: aOR = 3.81, 95% CI 1.91-7.62, p < 0.001), using e-cigarettes (daily vs never: aOR = 3.10, 95% CI 2.29-4.20, p < 0.001), and cannabis use (daily vs never: aOR = 3.59, 95% CI 2.0-6.45, p < 0.001). In the entire sample, daily exposure to smoking inside the house was associated with frequent headaches (aOR = 2.00, 95% CI 1.23-3.27, p = 0.005). Several lifestyle behaviors were associated with frequent headaches in children and youth, such as meal irregularity, late chronotype, prolonged screen exposure, and frequent substance use/exposure, suggesting that these are potential modifiable risk factors to target in this population.

Association between joint physical activity and healthy dietary patterns and hypertension in US adults: cross-sectional NHANES study

BackgroundLack of physical activity (PA), poor dietary habits, or other unhealthy lifestyle behaviors are potential modifiable risk factors for hypertension. It has been sufficiently demonstrated in previous studies that physical activity or healthy dietary patterns can reduce the risk of hypertension. However, no research focused on the joint effects of PA and healthy dietary patterns on hypertension in a representative sample of adults.MethodsWe used data collected from the 2007–2018 National Health and Nutrition Examination Survey. Healthy dietary patterns were assessed with the Healthy Eating Index 2015 (HEI-2015), and PA was measured using the metabolic equivalent minutes per week reported in questionnaires. We created four lifestyle categories based on the HEI-2015 and PA: (1) unhealthy diet and physically inactive (less than recommended PA), (2) healthy diet but physically inactive, (3) unhealthy diet but physically active (recommended PA), (4) healthy diet and physically active. Logistic regression was used to evaluate the association between joint PA and HEI-2015 and hypertension.ResultsA total of 24,453 participants were enrolled in the study. Compared with unhealthy diet and physically inactive individuals, only healthy diet and physically active participants (adjusted odds ratio [AOR]: 0.77, 95% CI 0.65–0.9) were negatively associated with hypertension, while healthy diet but physically inactive participants (AOR: 0.89, 95% CI 0.76–1.03) and unhealthy diet but physically active participants (AOR: 0.9, 95% CI 0.76–1.06) were not associated with hypertension.ConclusionIn a representative sample of US adults, our findings suggest that individuals with recommended PA and healthy dietary patterns have a lower risk of hypertension than those with an unhealthy diet or less than recommended PA. Healthy eating habits and regular PA are potential preventive precautions against hypertension.

Risk Factors for Postoperative Delirium in Patients Undergoing Major Head and Neck Cancer Surgery: A Meta-analysis.

Postoperative delirium (POD) is a common and serious complication after extensive surgery. Understanding the independent and potential modifiable risk factors leading to POD in patients with head and neck cancer (HNC) can provide information for future intervention trials aimed at reducing this risk. To systematically analyze influencing factors of POD in patients with HNC and identify high-risk individuals for delirium. PubMed, EMBASE, Scopus, OVID, and Cochrane Library were searched for publications prior to June 2023. Comparative studies in which POD risk factors were investigated were identified following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The Newcastle-Ottawa Scale was used to evaluate the study quality. Pooled odds ratios or mean differences for individual risk factors were estimated using the Mantel-Haenszel and inverse-variance methods. This review included 17 studies with a total of 4188 patients undergoing HNC surgery. The pooled prevalence of POD was 15.44%. Based on pooled analysis, 8 significant risk factors were identified including age older than 70 years, male sex, history of smoking, history of psychiatric disorder, American Society of Anesthesiologists score, albumin level, postoperative insomnia, and fluid intake. In the present study, 8 factors that correlated with POD were identified: 6 preoperative, 1 intraoperative, and 1 postoperative. The influencing factors for POD in patients with HNC were identified that can provide a reference for improving the psychological state of the patient population and further development of effective treatment interventions.