Risk Reduction Research Articles

Dietary patterns and the risk of hematological malignancy in the California Teachers study cohort.

10545 Background: Many studies show a correlation between diet and the risk of developing cancer, but most of these studies pertain to solid tumors and data linking certain diets to hematologic malignancies is scarce. This study aims to elucidate the effect of dietary patterns on the risk of developing hematologic malignancy. This study aims to elucidate dietary patterns and correlation with the risk of developing a hematologic malignancy. Methods: Data from 106,029 women in the California Teachers Study (CTS) cohort was analyzed, 476 participants were diagnosed with lymphocytic, monocytic, or other leukemia, 895 with Hodgkin’s or non-Hodgkin’s lymphoma, and 227 with multiple myeloma between 1995-2020. Results: Five major dietary patterns were identified as: 1) plant-based diet, characterized by a high consumption of fruit and vegetables, 2) high-protein, high-fat diet characterized by a high consumption of animal proteins animal protein (e.g., meat and eggs) and added fats (e.g., butter and mayonnaise), 3) high-carbohydrate diet characterized by a high consumption of convenience foods, pasta, and bread, 4) ethnic diet characterized by a high consumption of legumes, soy-based foods, rick and dark-green leafy vegetables and 5) the salad and wine diet characterized by high consumption of salad and low-fat dressing, fish, wine, coffee and tea, using principal factors analysis (PCFA). Relative risk and confidence intervals were analyzed for each dietary pattern and their correlation to a diagnosis of a hematologic malignancy. Models were adjusted for race-ethnicity/birthplace, living/working half a mile from a chemical plan, living/working half a mile from a powerplant, cigarette use, family history of leukemia and/or lymphoma, BMI (kg/m2), daily caloric intake (kcal/day), socioeconomic status, and moderate physical activity (h/wk). Overall, the high-carbohydrate diet was shown to be protective against hematologic malignancy risk with the lowest RR in all quintiles, but lowest in the 5th quintile (RR: 0.73; 95% CI: 0.59, 0.99, p=0.004). A high-carbohydrate diet was also shown to be associated with a reduction in multiple myeloma risk specifically with the lowest RR in all quintiles, but lowest in the 5th quintile (RR: 0.79; 95% CI: 0.63, 0.98, p=0.03). The ethnic diet was associated with a higher risk of multiple myeloma with the highest RR in all quintiles but highest in the 2nd quintile (RR:1.21; 95% CI 1.06, 1.39, p=0.006). Conclusions: The finding that the high-carbohydrate diet is associated with a reduced risk of a hematologic malignancy warrants further research to characterize the degree of risk reduction, what specific foods, if any, in the category offer protective effects, and if it is a potential approach for prevention.

Scenarios of Delayed First Births and Associated Cohort Fertility Levels.

Fertility rates among individuals in their 20s have fallen sharply across Europe over the past 50 years. The implications of delayed first births for fertility levels in modern family regimes remain little understood. Using microsimulation models of childbearing and partnership for the 1970-1979 birth cohorts in Italy, Great Britain, Sweden, and Norway, we implement fictive scenarios that reduce the risk of having a first child before age 30 and examine fertility recovery mechanisms for aggregate fertility indicators (the proportion of women with at least one, two, three, or four children; cohort completed fertility rate). Exposure to a first birth increases systematically in the ages following the simulated reduction in first-birth risks, leading to a structural recovery in childbearing that varies across countries according to their fertility and partnership regimes. Full recovery requires an increase in late first-birth risks, with greater increases in countries where late family formation is uncommon and average family sizes are larger: in scenarios where early fertility declines substantially (a linear decline from 50% at age 15 to 0% at age 30), first-birth risks above age 30 would have to increase by 54% in Great Britain, 40% in Norway and Sweden, and 20% in Italy to keep completed fertility constant.

Controversy on the CONVINCE study findings: the PRO take.

The CONVINCE study, recently published in the New England Journal of Medicine, reveals a groundbreaking 23% reduction in the relative risk of all-cause mortality among end-stage kidney patients undergoing high convective volume hemodiafiltration. This significant finding challenges the conventional use of high-flux hemodialysis and offers hope for improving outcomes in chronic kidney disease patients. While some controversies surround the study's findings, including concerns about generalizability and the causes of death, it is essential to acknowledge the study's design and its main outcomes. The CONVINCE study, part of the HORIZON 2020 project, enrolled 1360 patients and demonstrated the superiority of hemodiafiltration in reducing all-cause mortality overall, as well as in specific patient subgroups (elderly, short vintage, non-diabetic, and those without cardiac issues). Interestingly, it was shown that hemodiafiltration had a protective effect against infection, including COVID-19. Future research will address sustainability, dose scaling effects, identification of subgroups especially likely to benefit and cost-effectiveness. However, for now, the findings strongly support a broader adoption of hemodiafiltration in renal replacement therapy, marking a significant advancement in the field.

A Methodology for Vulnerability Assessment of Cultural Heritage in Extreme Climate Changes

Vulnerability evaluation plays a key role in risk assessment and reduction and is essential for defining strategies for climate change adaptation and mitigation. In dealing with the safeguarding of cultural heritage at risk, we are still far from adopting and applying an agreed methodology for vulnerability assessment. With the aim to support practitioners, heritage managers, and policy and decision makers to undertake actions that address the protection of cultural heritage at risk, the methodology set up in the framework of the Interreg Central Europe STRENCH is illustrated and discussed here. Based on three major requirements (susceptibility, exposure, and resilience) and a continuous consultation with local stakeholders, the proposed methodology is applicable for evaluating the vulnerability of built heritage and cultural landscape exposed to hydrometeorological hazards, such as heavy rains, floods, and droughts. The results obtained through its validation on 15 case studies from seven Central European regions are shown to underline the strengths and limitations of the methodological approach. Iterative consultation with local stakeholders was fundamental for the definition of the criteria/subcriteria and related values for the assessment of the requirements. Application to further sites in other contexts would surely contribute to strengthening the reliability of the methodological approach.

Lessons learned from a genetic counseling randomized clinical trial: Implications for recruiting individuals identifying as Asians in research.

1576 Background: Despite the clinical importance of genetic testing and counseling for cancer risk reduction and treatment, minority populations are less likely to receive genetic testing and counseling or participate in genetics research, contributing to health disparities. In a randomized study of three modes of genetic counseling (GC3) conducted in three safety net hospitals, we noted a lower accrual of participants identifying as Chinese despite the availability of language-concordant study documents and bilingual staff. To understand barriers to recruitment, we conducted a mixed methods study using responses to the San Francisco Mammography Registry (SFMR) Breast Health History questionnaire (used for recruitment for GC3) and qualitative interviews with seven participants of the genetic counseling study. Methods: We extracted data from the SFMR from 2014-2018 for patients self-identifying as Asian and a control group of patients self-identifying as White. The primary outcome was the proportion of patients who agreed to be contacted for future breast health research. Survey data included information for personal history of breast cancer, history of biopsy, first-degree relative with cancer, age, and level of education. Z-tests were conducted for comparisons between groups. For qualitative analysis, seven Chinese-identifying participants were interviewed to understand why they chose to participate in the genetic counseling study and identify potential barriers and facilitators. Results: We included 121,415 patients (n=38,483 Asian). Asian patients had significantly lower rates of accepting future contact for breast health research studies (25.4% for Asians vs. 48.3% for White, p<0.0001). Lower rates were observed across Chinese (23.3%), Filipina (30.2%), Japanese (27.8%), and Vietnamese (23.3%) subgroups (p<0.0001 for all). A history of breast cancer (personal or family) or biopsy was associated with higher rates of acceptance within both Asian and White groups (p<0.001 for all comparisons). Education did not change participation rates as much in Asian patients as in White patients. The qualitative study found barriers across three domains: awareness, opportunity, and acceptance, with a referral from the participant’s medical team identified as a facilitator. Conclusions: Individuals identifying as Asian in the SFMR were less likely to agree to be contacted for future breast health research. We identified multilevel barriers through qualitative interviews. This has important implications for designing recruitment strategies for Asian populations.

Randomized phase III trial of neo-adjuvant and adjuvant chemotherapy vs adjuvant chemotherapy alone for localized soft tissue sarcoma (NACLESS, JCOG2102).

TPS11589 Background: Soft-tissue sarcomas (STS) are a rare malignant tumor. Adjuvant perioperative chemotherapy has been investigated for high-risk patients due to the poor overall survival (OS) for surgery. A meta-analysis revealed that adjuvant chemotherapy (AC) with doxorubicin plus ifosfamide (AI) significantly prolonged OS with an absolute risk reduction of 11%. However, the optimal timing for surgery and number of courses of chemotherapy are still controversial. In Europe, Italian sarcoma group and the Spanish sarcoma group reported on the non-inferiority of three courses of neoadjuvant chemotherapy (NAC) + surgery without AC, compared to three courses of NAC + surgery + two courses of AC. On the other hand, even in the same Europe, the latest report on perioperative chemotherapy with AI from Germany was a trial of surgery + AC. Furthermore, adjuvant chemotherapy itself remains skeptical in other countries such as the US, UK, and Canada. No investigation has been made into whether chemotherapy/surgery are better to initiate treatment with. In Japan, the standard treatment is three courses of NAC with AI, surgery, and two of AC with AI. However, in JCOG1306, NAC was discontinued in 12 of 70 (17.1%) patients due to high toxicity. Only one patient (1.4%) became partial response after NAC, whereas six patients (8.6%) had disease progression during NAC. Of the 65 patients eligible for limb-sparing surgery at enrollment, three (4.6%) underwent limb amputation. Upfront surgery followed by three courses of AC was considered the most promising treatment, it avoided extended surgery and reduced toxicity while maintaining an OS equivalent to the standard treatment. The aim of this trial is to optimize the balance between the survival benefit of perioperative chemotherapy, reduce toxicities, and risks of extended surgery. Methods: This is a multicenter two-arm open-label randomized phase III trial. Patients are randomly assigned to standard (three courses of NAC, surgery, and two of AC) or experimental (surgery and three courses of AC) arms with AI comprising doxorubicin (30 mg/m2, days 1, 2) and ifosfamide (2 g/m2, days 1–5). Major inclusion criteria were (1) spindle cell STS; (2) T2-4N0M0 (UICC/AJCC 8th edition) and deeply located; (3) resectable tumors in the extremities or trunk; (4) age, 16–70 years; (5) ECOG performance status of 0–1; (6) no history of chemotherapy/radiotherapy; and (7) sufficient bone marrow function. To evaluates the non-inferiority in OS (margin: hazard ratio of 1.61) with power of 70% and one-sided alpha of 10%, 224 patients will be enrolled from 39 institutions in Japan. We began this study on November 16, 2022, and 27 of 224 patients have been enrolled as of January 7, 2024. Clinical trial information: jRCTs031220446 .

EOC 68 - Cluster Investigation of Environmental Fungal Pathogens & Implementation of Risk Reduction Strategies in an Intensive Care Burn Unit

EOC 68 - Cluster Investigation of Environmental Fungal Pathogens & Implementation of Risk Reduction Strategies in an Intensive Care Burn Unit

T cell-mediated rejection and cancer risk in 579,905 organ transplant recipients.

10552 Background: Prolonged immunosuppression following organ transplant raises post-transplant malignancy (PTM) risk without affecting chronic rejection graft failure (CRGF) rates. Our study investigated if T cell responses during rejection could protect against cancer, whereas T cell suppression in PTM might prevent rejection. Methods: Data from 1987 to 2023 on adult first-time single-organ transplant recipients were collected from the UNOS-OPTN database, excluding those with a history of malignancy. Time-dependent Cox regression and landmark analyses (at 1, 2, 3, 5, 10, 15, and 20 years) were used to explore the link between rejection-induced graft failure (RGF) and PTM. Results: The study included 579,905 recipients (kidney 386,878, liver 108,390, heart 45,046, lung 37,643, pancreas 1,948), with a mean follow-up of 7.3 years. RGF occurred in 9.5% of recipients (kidney 12.1%, liver 1.8%, heart 3.9%, lung 12.0%, pancreas 10.2%; p<0.001), with 2.1% experiencing acute rejection graft failure (ARGF) and 7.4%, CRGF. PTM occurred in 12.0% of recipients (kidney 9.9%, liver 12.4%. heart 20.9%, lung 22.6%, pancreas 11.3%; p<0.001), including breast (0.5%), digestive (1.2%), genitourinary (1.7%), gynecologic (0.1%), head and neck (0.3%), hematologic (1.4%), musculoskeletal (0.1%), neurologic (0.0%), respiratory (1.1%), and skin/Kaposi sarcoma (6.4%). In recipients with RGF, PTM risk significantly decreased (HR 0.21 [0.19-0.24]; p<0.001), with consistent trends observed across seven time landmarks (HR 0.20-0.07; p<0.001). Both ARGF and CRGF were associated with lower PTM risk (HR 0.23 [0.18-0.29], 0.21 [0.19-0.24]; p<0.001). In organ-specific analyses, kidney transplants showed similar outcomes for RGF, ARGF, and CRGF (HR 0.21-0.22; p<0.001). Lung transplants exhibited significant risk reductions with RGF (HR 0.44 [0.22-0.89]; p=0.02) and CRGF (HR 0.47 [0.24-0.94]; p=0.03), with no significant results in other organs. All findings remained consistent even after excluding re-transplantations and deaths due to rejection. Excluding PTM-related deaths from PTM cases significantly lowered RGF risk (HR 0.69 [0.65-0.73]; p<0.001), a trend that was consistent across all time landmarks (HR 0.51-0.80; p<0.001). This inverse pattern was seen in kidney, liver, heart, and lung transplants (HR 0.90 [0.84-0.95], 0.21 [0.11-0.38], 0.21 [0.14-0.31], 0.18 [0.14-0.23]; p<0.001) but not in pancreas transplants (HR 1.62 [0.69-3.77]; p=0.27). Conclusions: This study shows that rejection lowers cancer risk in kidney and lung transplants and that PTM reduces rejection risk in kidney, liver, heart, and lung transplants. Implementing enhanced cancer screening for those who have not experienced rejection may be considered. Further research is needed to elucidate the underlying T cell biology specific to each type of transplant.

Identification of Coastal Typology and Utilization of Geospatial Technology for Tsunami Hazard Modeling in Kulon Progo Coastal Area, Special Region of Yogyakarta, Indonesia

Abstract Tsunamis are natural disasters that cause material losses and cause loss of life. Tsunamis are generated by underwater earthquakes. The coastal region of Kulon Progo is prone to the risk of a tsunami disaster due to its proximity to the megathrust zone and direct exposure to the Indian Ocean. This research aims to (1) determining the typological characteristics in the Kulon Progo Coastal Area, Special Region of Yogyakarta; (2) determining the spatial distribution of tsunami hazards in the Kulon Progo Coastal Area, Special Region of Yogyakarta; (3) developing recommendations for tsunami disaster mitigation models in the coastal area of Kulon Progo, special region of Yogyakarta. The method used in this research is the Hloss calculation developed by Berryman-2006. Furthermore, the identification of coastal typology was carried out according to Shepard with field observations, which were taken based on the Identification of Coastal Geomorphology according to Khakhim-2008. The research results show that tsunami inundation modeling with scenarios of 5, 10, 15, 20, 25, and 30 meters inundated the entire area with 14,462.22 hectares. It is known that the identification of the Kulon Progo coastal typology is marine deposition coast and coast built by organisms. Suitable recommendations for tsunami disaster mitigation on the Kulon Progo coast are the application of green belts around the coastline and the constructing of breakwaters. The results of this research can be used as a basis for determining tsunami disaster risk reduction policies in the coastal area of Kulon Progo, Special Region of Yogyakarta.

Mental Health Symptoms of Amateur Association Football Referees: A Cross-Sectional Study

Although referees who officiate in the amateur football leagues are exposed to various stressors that can negatively affect their mental health (MH), little is known about their MH symptoms. The purpose of the study was to evaluate MH symptoms of referees who officiate in the Turkish amateur football leagues. An online survey was sent to all referees in the Turkish amateur football leagues (n = 4,900) incorporating standardized scales assessing depression, anxiety, and stress. A total of 1,279 referees participated in the study. Female referees reported higher depression (p < .01) and anxiety (p = .02) scores than males. Younger referees (23–27 years) reported higher depression (p = .01) and anxiety (p < .01) scores than older (>38 years) referees. Results showed that symptoms of depression, anxiety, and stress scores were associated with marital status (being single), lower incomes, severe sports injury history, and inadequate social support. In light of these results, MH assessments should be undertaken to detect which referees are at greater risk of MH problems and facilitate appropriate and timely MH interventions. Further study is needed to inform MH risk reduction strategies and/or programming.

Understanding the Contribution of Conventional Media in Earthquake Risk Communication

To mitigate the damage from and prepare for disasters, individuals and communities should be involved in the disaster risk reduction efforts. Communicating the risk effectively is the essential step of this involvement. Risk communication is a multidisciplinary field. Disaster managers have to work closely with the media, among other partners, but there is a gap in their understanding of each other’s roles. This study aims to explore the process of publishing and broadcasting earthquake information through the experiences of media professionals, to understand how journalists and news organizations function before and after disasters, and to provide evidence to help bridge the gap between disaster managers and/or public health authorities and disaster journalists and/or news organizations., especially in earthquake preparedness. Thirteen in-depth interviews were conducted with editors/journalists from national newspapers and TV channels. A good context for investigating these issues is afforded by the megacity Istanbul and the Turkish media. Turkey is a land of earthquakes. A further strong earthquake is expected to hit in the near future. The findings, which gave valuable hints for better collaboration, are presented according to the focus of the question guide: time of and norms for publishing or broadcasting news or information about earthquakes; content of the news or information; disaster journalism and guidelines.

Barriers in cancer risk reduction in community in Indonesia: a qualitative study

Integrated development post of non-communicable diseases (Posbindu penyakit tidak menular/PTM) is one of the strategies implemented by the MOH of Indonesia for prevention, screening, and early detection through community empowerment and community involvement in reducing the number of non-communicable diseases (NCDs), including cancer. This study aimed to explore the barriers to reducing the risk of cancer. Twelve participants were involved in this study using in-depth interviews and participant observations. All the interviews and discussions were recorded using an audio tape recorder and also using field notes, and then a transcript was transcribed verbatim. Five themes emerged namely providing funding for the program, obtaining appropriate support from the government based on the community’s needs and a health workforce shortage, sharing and discussing the health information, and cultural practices of the community as barriers to reducing the risk of cancer in the community. The study results can be used as evidence to develop and sustain effective strategies to address the barriers to reducing the risk of cancer in communities in Indonesia.

Transdisciplinary Approach: Toward Innovative Recovery and Disaster Risk Reduction

Transdisciplinary Approach: Toward Innovative Recovery and Disaster Risk Reduction

Persistence and Adherence to PCSK9 Inhibitor Monoclonal Antibodies Versus Ezetimibe in Real-World Settings.

The cardiovascular disease risk reduction benefits of proprotein convertase subtilisin/kexin type 9 inhibitor monoclonal antibodies (PCSK9i mAb) and ezetimibe are dependent on remaining on treatment and being persistent and adherent. We estimated the percentage of patients on therapy, persistent and adherent at 182 and 365days among US adults with health insurance who initiated a PCSK9i mAb (n = 16,588) or ezetimibe (n = 83,086) between July 2015 and December 2019. Using pharmacy fill claims, being on therapy was defined as having a day of medication supply in the last 60 of 182 and 365days following treatment initiation, being persistent was defined as not having a gap of 60days or more between the last day of supply from one prescription fill and the next fill, and being adherent was defined by having medication available to take on ≥ 80% of the 182 and 365days following treatment initiation. We estimated multivariable-adjusted risk ratios for being persistent and adherent comparing patients initiating PCSK9i mAb versus ezetimibe using Poisson regression. At 182days following initiation, 80% and 68% were on therapy and 76% and 64% were persistent among patients who initiated a PCSK9i mAb and ezetimibe, respectively. Among patients who were on therapy and persistent at 182days following initiation, 88% and 81% of those who initiated a PCSK9i mAb and ezetimibe, respectively, were on therapy at 365days. Among those on therapy and persistent at 182days following initiation, being persistent and being adherent at 365days were each more common among PCSK9i mAb versus ezetimibe initiators (persistent: 82% versus 76%, multivariable-adjusted risk ratio 1.07; 95% confidence interval [CI] 1.06-1.08; adherent: 74% versus 71%, multivariable-adjusted risk ratio 1.02; 95% CI 1.01-1.03). These data suggest approaches to increase persistence and adherence to PCSK9i mAb and ezetimibe should be implemented prior to or within 182days following treatment initiation.

Long-term follow up for adjuvant dabrafenib plus trametinib in stage III BRAF-mutated melanoma: Final results of the COMBI-AD study.

9500 Background: Dabrafenib plus trametinib, a standard-of care adjuvant treatment for patients with BRAF-mutated AJCC-stage III melanoma, has significantly improved the primary endpoint, relapse-free survival (RFS). Further to published interim assessments, we present updated and final results for RFS, distant-metastasis-free survival (DMFS) and overall survival (OS). Methods: In the COMBI-AD phase 3 study, patients received dabrafenib (150 mg BD) plus trametinib (2 mg OD; n=438) or matching placebos (n=432). Treatment continued for up to 12 months or until disease relapse, unacceptable toxicity, withdrawal of consent, or death. OS, RFS, and DMFS were summarized using Kaplan–Meier estimates. OS was compared between study arms using stratified log-rank test. Hazard ratio (HR) was calculated using Pike estimator. Safety data were summarized descriptively. Results: At final analysis, median duration of follow up was 100.0 months in the treatment arm and 82.5 months in the placebo arm. Median OS was not attained in the two arms (HR: 0.80; 95% CI: 0.62, 1.01; P=0.063). Consistent OS benefits were seen across most prespecified subgroups including patients with BRAFV600E mutation (n=397; HR: 0.75; 95% CI: 0.58, 0.96). Estimated RFS (HR: 0.52; 95% CI: 0.43, 0.63) and DMFS (HR: 0.56; 95% CI: 0.44, 0.71) favored the dabrafenib plus trametinib arm. In both arms, patients received salvage immunotherapies (29% each) and targeted therapy (21% vs. 37% for treatment and placebo arms, respectively). Safety profile was consistent with previous reports. Conclusions: COMBI-AD presents the longest follow-up data (over 10 years) in adjuvant treatment of stage III melanoma in the modern era. OS was improved with dabrafenib plus trametinib over placebo for adjuvant treatment of stage III melanoma with a 20% risk reduction for death. However, this difference was not statistically significant. Consistent with published results at 3 and 5 years, RFS and DMFS were more favorable in the treatment vs. placebo arm. Clinical trial information: NCT01682083 . [Table: see text]

A Quantitative Analysis of Default Risk Using Machine Learning and SHAP Value Interpretation

Abstract In finance, creating a model that balances risk reduction with opportunity is essential. This investigation addresses the necessity for risk evaluation frameworks that combine efficiency with adaptability, thus preserving opportunities for transactions critical to some organizations. The present study identifies, within a factoring process involving two key players: the invoice seller and the debtor, the essential variables that determine the likelihood of the debtor defaulting on the invoice payment. The event of non-payment is most often associated with the debtor's inability to pay due to insolvency, making it crucial in this type of activity to emphasize an efficient credit scoring system capable of proactively highlighting a debtor company with a high risk of default. Nonetheless, some companies pass this filter and enter the factoring process, but end up being unable to pay. The study identifies them based on a set of real data and uses supervised machine learning techniques to select the optimal classification model, also highlighting the variables with a major impact on the target. The specialized literature is focused on identifying the models that perform best in the credit scoring activity or studies that identify the non-payment behavior of clients. What this work adds is the combination of these two dimensions, for example, it provides an additional filter to credit scoring, using parameters identified as essential in determining defaulters and using them as inputs for an unsupervised learning model, thus classifying the entire population of companies in Romania to identify clusters containing the highest proportion of non-payment companies.

CSP2023: 122 - Improving exercise prescription for falls risk reduction on an older adults’ ward

CSP2023: 122 - Improving exercise prescription for falls risk reduction on an older adults’ ward

The Effect of Implantable Loop Recorder based Continuous Rhythm Monitoring on Incident Atrial Fibrillation and Stroke: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

BackgroundIn patients with a history of stroke or those at high risk of developing stroke, a continuous rhythm monitoring strategy using implantable loop recorders (ILR) is often performed to screen for atrial fibrillation (AF). ObjectivesWe performed a systematic review (MEDLINE and EMBASE) including randomized controlled trials comparing ILR-based continuous rhythm monitoring versus usual care in patients with a history of stroke or patients at high risk of developing stroke. MethodsA meta-analysis was performed and aggregate risk ratios (RR) and risk difference (RD) with their 95% confidence intervals were calculated. ResultsFour randomized controlled trials with 7,237 patients (ILR=2,114 and non-ILR=5,123) were included. ILR vs. non-ILR was associated with increased detection of incident AF (RR 3.88; 95% CI [2.23 - 6.75]; p<0.00001; NNT=7.7, I2=61%), increased appropriate initiation of anticoagulation (RR 2.29; 95% CI [2.07 - 2.55]; p<0.00001; NNT=6.7, I2=0), and a 25% lower risk of developing stroke (RR 0.75; 95% CI [0.59 – 0.95]; p=0.02; NNT=100, I2=0%). In patients with history of stroke there was no difference in the risk of developing incident stroke (RR 0.83; 95% CI [0.61 – 1.14]; p=0.25; I2=0%). ConclusionOur meta-analysis shows that screening for AF with ILR is associated with increased detection of AF, and increased initiation of appropriate anticoagulation in patients with a history of stroke or those with risk factors for stroke. The benefit of stroke risk reduction with ILR remains unclear, and future studies focused on the inclusion of patients without a history of stroke are needed to elucidate this uncertainty.

Inclusive Disaster Risk Reduction Toward a Society Wherein All People Can Choose How They Live: A Report from a Panel of World BOSAI Forum 2023

Inclusive Disaster Risk Reduction Toward a Society Wherein All People Can Choose How They Live: A Report from a Panel of World BOSAI Forum 2023

Determinants of 1-year mortality after acute myocardial infarction in patients with and without diabetes

The gap in excess mortality between patients with and without diabetes has not decreased over time. The aim of this study was to investigate the determinants of mortality after acute myocardial infarction (AMI) in patients with diabetes and without diabetes in a contemporary population. A retrospective analysis of a cohort of 266 patients with a diagnosis of AMI during 2022 was carried out. Patients living with diabetes had higher 1-year mortality, even after adjustment for covariates. Estimated glomerular filtration (eGFR) rate was independently associated with increased mortality in patients with diabetes. Plasma glucose was independently associated with peak troponin in patients both with and without diabetes. These data suggest that patients living with diabetes and with a low eGFR warrant more aggressive risk reduction and use of nephroprotective medications. Further studies are needed to assess whether early blood glucose control improves cardiovascular outcomes in all patients with AMI.