Variety Of Risk Factors Research Articles

Improving quality, affordability, and equity of multiple sclerosis care.

ObjectiveThe prevailing approaches to selecting multiple sclerosis (MS) disease modifying therapies (DMTs) have contributed to exponential increases in societal expenditures and out‐of‐pocket expenses, without compelling evidence of improved outcomes. Guidance is lacking regarding when and in whom the benefits of preventing MS‐related disability likely outweighs the risks of highly effective DMTs (HET) and when it is appropriate to consider DMT costs. Our objective was to develop a standardized approach to improve the quality, affordability and equity of MS care.MethodsMS experts partnered with health plan pharmacists to develop an ethical, risk‐stratified, cost‐sensitive treatment algorithm. We developed a risk‐stratification schema to classify patients with relapsing forms of MS as high, intermediate or low risk of disability based on the best available evidence and, when the evidence was poor or lacking, by consensus. DMTs are grouped as highly, modestly or low/uncertain effectiveness and preferentially ranked within groups by safety based on pre‐specified criteria. We reviewed FDA documents and the published literature. When efficacy and safety are equivalent, the lower cost DMT is preferred.ResultsAssignment to the high‐risk group prompts treatment with preferred HETs early in the disease course. For persons in the intermediate‐ or low‐risk groups with cost or health care access barriers, we incorporated induction therapy with an affordable B‐cell depleting agent. Based on more favorable safety profiles, our preferred approach prioritizes use of rituximab and natalizumab among HETs and interferon‐betas or glatiramer acetate among modestly effective agents.InterpretationThe risk‐stratified treatment approach we recommend provides clear, measurable guidance in whom and when to prescribe HETs, when to prioritize lower cost DMTs and how to accommodate persons with MS with cost or other barriers to DMT use. It can be adapted to other cost structures and updated quickly as new information emerges. We recommend that physician groups partner with health insurance plans to adapt our approach to their settings, particularly in the United States. Future studies are needed to resolve the considerable uncertainty about how much variability in prognosis specific risk factors explain.

New Insights into the Role of Visit-to-Visit Glycemic Variability and Blood Pressure Variability in Cardiovascular Disease Risk.

There is evidence from epidemiologic studies that variability in cardiovascular risk factors influences risk of cardiovascular disease. We review new studies and novel findings in the relationship between visit-to-visit glycemic variability and blood pressure variability and risk of adverse outcomes. Visit-to-visit glycemic variability is consistently linked to macrovascular disease. This relationship has been observed in both clinical trials and retrospective studies of electronic health records. Long-term blood pressure variability also predicts cardiovascular outcomes, and the association appears stronger in those with lower levels of systolic and diastolic function. As epidemiologic evidence increases in support of a role for metabolic risk factor variability in cardiovascular risk, there is a corresponding rise in interest in applying this information toward improving risk factor prediction and treatment. Future investigation of underlying mechanisms for these associations as well as implications for therapy is also warranted. The potential additive contribution of variability of multiple parameters also merits additional scrutiny. As our technology for capturing risk factor variability continues to improve, this will only enhance our understanding of its links with vascular disease and how to best utilize this information to reduce cardiovascular outcomes.

17890 Cardiovascular risk factors in victims of child sexual abuse

ABSTRACT IMPACT: The impact of this study is to encourage health professionals to screen for violent experiences as potential risk factors for CVD and adapt interventions from the non-abused in children as in adults. OBJECTIVES/GOALS: This study aims to assess the relationship between child sexual abuse and cardiovascular risk factors (CVDRF) that present in children. The objectives will provide the prevalence of CVDRF, their association with types of sexual victimization, and a score to assess the impact. METHODS/STUDY POPULATION: This study is a chart review, cross-sectional study. The Puerto Rico Health Justice Center (PRHJC) is a forensic, transdisciplinary, victim-centered, trauma-informed, and evidence-based service. The demographic variables collected are age, sex; the cardiovascular risk factors variables include a level of physical activity, tobacco exposure/alcohol, vital signs (blood pressure, BMI), lipid profile, and C-reactive protein. Sexual violence variables are the type of victimization (sexual assault, sexual molestation), the number of victimizations, and the relationship with the offender. RESULTS/ANTICIPATED RESULTS: A previous study, which examined types of evidence related to the prosecution of sexual violence cases, found that among female victims, 54% was a victim of sexual assault, and 59% had at least one health concern. The study’s hypothesis includes that older and female victims have a higher prevalence of cardiovascular disease risk factors. Also, children victims of sexual assault will have more cardiovascular risk factors than victims of sexual molestation. The age group, sex, number of victimizations, and relationship with the offender will also impact the relationship between the type of victimization and cardiovascular risk factors. DISCUSSION/SIGNIFICANCE OF FINDINGS: Early identification of child sexual abuse is needed to prevent long-term health impacts. The study’s results will be significant in developing clinical guidelines for health care providers to identify child sexual abuse as a predictor of cardiovascular risk factors and encourage victim advocates to identify cardiovascular risk factors.

Vascular thromboembolic events following COVID‐19 hospital discharge: Incidence and risk factors

BackgroundCoronavirus disease 2019 (COVID‐19) is associated with high rates of thromboembolic events in hospitalized patients. It remains to be determined if this risk persists following hospital discharge. MethodsWe conducted a retrospective cohort study of outpatients recently hospitalized for COVID‐19 to determine the incidence of vascular thromboembolic events within 30 days of discharge. We investigated the risk factors associated with these events, including intensive care admission, age, and anticoagulation. ResultsAmong 447 patients hospitalized for COVID‐19, 2.0% experienced a vascular thromboembolic event within 30 days of discharge. No risk factor variable was significantly associated with an increased risk for these events. ConclusionsThe incidence of vascular thromboembolic events following hospital discharge for COVID‐19 is low. These findings suggest against the routine use of postdischarge thromboprophylaxis in patients with COVID‐19.

Assessment of the prevalence of intestinal parasitic infections and associated habit and culture-related risk factors among primary schoolchildren in Debre Berhan town, Northeast Ethiopia

BackgroundIntestinal parasitic infections (IPIs) are still among the major public health issues in developing countries. Assessing the prevalence of IPIs and potential risk factors in different localities is essential to enhance control strategies. To date, no prevalence assessment study was conducted in Debre Berhan town. Therefore, the aim of this study was to assess the prevalence of IPIs and associated habit and culture-related risk factors among primary schoolchildren in Debre Berhan town, Northeast Ethiopia.MethodSchool based cross-sectional study was conducted from April to June 2017. A total of 645 children aged 6–15 years were selected from six primary schools in Debre Berhan town via a multistage random sampling technique. A structured questionnaire was used to collect data about sociodemographic and potential risk factor variables. Fresh stool samples were collected from each child and examined using direct smear and formal-ether concentration technique.ResultAmong the 645 children participated in the study, 341 (52.9%) were infected by one or more intestinal parasites. Helminths (33.8%) were more prevalent than protozoa (20%). Double parasitic infection rate was 0.9%. The predominant parasites were Ascaris lumbricoides (22.6%), Entamoeba histolytica/dispar/moshkovskii (18.1%) and Hymenolepis nana (5.7%). Multivariable logistic regression analysis showed that age of child (6–9 years), family size (above 5), mother’s illiteracy and primary education, father’s illiteracy, urban-farmer father, manual-worker father, not washing hands before eating, unclean fingers, open defecation site (ODS) near residence, latrine type, cultural response to dropped food (cleaning and eating; ‘kiss and replace’), habit of playing with waste water, habit of playing with soil, habit of sucking fingers and habit of eating when playing were significantly associated with IPIs (p< 0.05). Likewise, age (6–9 years), mother’s illiteracy, urban-farmer father, not washing hands before eating, ODS near residence, tradition of cleaning and eating dropped food, habit of playing with soil, sucking fingers and eating when playing were identified as significant risk factors of A. lumbricoides infection.ConclusionHigh prevalence of IPIs among the study participants demands improvement of environmental sanitation, personal hygiene, and health education regarding the potential habit and culture-related risk factors.

Skin Cancer: Back to Basics

ABSTRACT There are more than a million cases of cutaneous squamous cell carcinoma that occur annually, with incidences increasing over the past 30 years. This common skin cancer has a variety of risk factors, with ultraviolet radiation and increasing age being two of the greatest known associated risks. This article is a review of the epidemiology and other risk factors of this common skin cancer and is also an update on its pathophysiology and treatment.

Aerococcus urinae : A Rare Cause of Endocarditis Presenting With Acute Stroke

Aerococcus urinae is a rare organism infrequently isolated from cultures. Mostly known to cause urinary tract infection, it can cause bacteremia leading to severe urosepsis and infective endocarditis. Embolization is frequently reported with Aerococcus urinae endocarditis (AUE); hence, the presentation is highly variable. Sequelae such as various central nervous system manifestations, sepsis, valvular regurgitation with heart failure and even coronary artery involvement have been reported. We report a case of a 58-year-old man with AUE of the aortic valve, severe aortic regurgitation and embolic stroke as a result of embolization from AUE and ultimately required aortic valve replacement. Our case highlights this rare cause of endocarditis and offers insight into the variability of patient presentation and risk factors to consider. J Med Cases. 2021;12(2):65-70 doi: https://doi.org/10.14740/jmc3612

Factors of Incidence of Hypertension in Southwest Sumba

Hypertension in conditions when blood pressure is at a value of 130/80 mmHg or more with the number of cases experiencing an increase from 2016-2018, Tana Mete Village, Kodi Balaghar District. in 2016 there were 880 (8.8%), cases in 2017 were 2,580 (25.8%) cases and in 2018 there were 3. 410 (34.1%) cases. Hypertension in influenced by factors of age, smoking habits, stress, and alcohol consumption. This study aims to analyze the relationship between age, smoking habits, stress, and alcohol comsuption. This research is an analytic observational research with a case control research design. The number of cases in Tana Mete Village, Kodi Balaghar District, Southwest Sumba Regency was 220 (22%) and the sample was 80 respondents and divided into two groups, namely the case and control group, the case group was 40 respondents and the control group was 40 respondents. These variables have been analyzed univariately and bivariately, the results of this study incidate that there are three risk factor variables for the incidence of hypertentsion. Namely age with a value p= 0.003, OR=4.059 (95% CI: 1.568-10.510), smoking habits with a value p=0.001, OR: 6.378 (95%CI:2.280-17.842), stress with a value of p=0.014, OR: 3.095 (95%CI: 3.095-7.706) while the variable alcohol comsumption has no relationship with the value of p=0.133. To prevent the occurrence of hypertension, the activities undertaken include avoiding smoking, stress and taking time for recreation.

Assessing the generalizability of findings from the Alzheimer’s Disease Neuroimaging Initiative to the Atherosclerosis Risk in Communities study cohort

AbstractBackgroundThe Alzheimer’s Disease Neuroimaging Initiative (ADNI) collects and shares high quality imaging, biomarker, genetic, and clinical data. Whether findings from ADNI generalize broadly is unclear, given its highly‐selected, predominantly white and well‐educated participants. We compared associations estimated in ADNI to those estimated in the Atherosclerosis Risk in Communities (ARIC) study, which initially recruited participants randomly from four US communities, to examine the potential generalizability of ADNI findings.MethodWe identified common risk factor, cognitive, and imaging variables at the ADNI screening/baseline visits and ARIC Visit 5. Data were pooled to estimate associations between risk factors and cognitive or imaging data, and between cognitive and imaging data, using adjusted linear and logistic regression models. Models included a term for cohort and its interaction with the variable of interest, allowing for cohort‐specific estimates and statistical evaluation of cohort differences. We repeated analyses on data subsets defined by race and cognition. Sensitivity analyses accounted for cohort differences in the impact of confounders by including cohort by covariate interactions.ResultThe proportion of estimated associations that differed significantly by cohort (interaction p‐value&lt;.05) in primary analyses was 42% (range 25‐42% across subset and sensitivity analyses). Many differences were substantively meaningful (e.g. OR for APOE‐4 on amyloid positivity in ARIC: OR=2.75; in ADNI: OR=8.44; OR for any functional limitations on MMSE score &lt; 25: OR = 5.05 (2.87 ‐ 8.90) in ADNI, OR = 1.34 (0.99 ‐ 1.81) in ARIC).ConclusionThe proportion of associations that differed significantly between ADNI and ARIC was substantially higher than would be expected by chance. Differences may stem from inherent differences in the populations from which participants were recruited. This has implications for the generalizability of highly selected samples, including deeply phenotyped samples typically used for biomarker research.

Abstract PO-258: Cancer risk factors and screening across various U.S. rural classification codes: Cancer disparities in the context of rurality

Abstract Incidence and mortality of many preventable cancers are higher in rural compared to urban U.S. regions. However, prior research is limited by methodological inconsistencies in defining rurality, and has largely focused on a rural-urban dichotomy which ignores potential variability of cancer risk factors and outcomes within rural and urban settings. These limitations hamper data interpretation and may lead to inequitable distribution of resources to address disparities. In this study, we describe cancer risk factors and screening across various U.S. rural-urban classification codes to inform our understanding of cancer disparities across the rural to urban continuum. We examined the prevalence and trends in cancer risk factors and screening across the following rural-urban classification codes for counties and county-equivalents in 2013; U.S. Office of Management and Budget (OMB), National Center for Health Statistics (NCHS), U.S. Department of Agriculture, Economic Research Service’s rural-urban continuum codes (RUCC), and Urban Influence Codes (UIC). County-level data on demographics (age, race, education, income, poverty level, insurance status), and cancer risk factors (obesity, physical inactivity, alcohol consumption), including cancer screening (colorectal, cervical and breast) were obtained from the U.S. Census Bureau, Behavioral Risk Factor Surveillance System, and National Health Interview Survey from 2008-2013. Overall, rural counties’ populations were more likely to be older, white, and uninsured with lower educational attainment and household income than urban counties (all ptrend&amp;lt;0.001). Across all classification codes, the prevalence of smoking, obesity, physical inactivity, and binge alcohol use increased (all ptrend&amp;lt;0.03), while colorectal, cervical and breast cancer screening decreased (all ptrend&amp;lt;0.001) with increasing rurality. Variation in the prevalence of cancer risk factors and screening was also evident within rural regions. For example, cervical cancer screening ranged from 67.6% to 74.7%, breast cancer screening from 65.4% to 68.2%, and colorectal cancer screening from 52.8% to 57.2% across rural counties. Our findings suggest that rural cancer disparities persist across multiple rural-urban classification codes, with marked variation in cancer risk factors and screening apparent within rural regions. Thus, focusing on a rural-urban dichotomy may fail to identify subpopulations of rural residents at greater risk for cancer and cancer-related mortality. As such, the variation in cancer disparities within rural regions, including persistent racial/ethnic and socioeconomic differences, should be considered in future cancer control research to inform the development of targeted policies and strategies to address rural cancer disparities. Citation Format: Kelly A. Hirko, Huiwen Xu, Laura Q. Rogers, Michelle Y. Martin, Siddhartha Roy, Kimberly M. Kelly, Shannon M. Christy, Kimlin T. Ashing, Jean C. Yi, Marquita W. Lewis-Thames, Cathy D. Meade, Qian Lu, Clement K. Gwede, Julianna Nemeth, Rachel M. Ceballos, Usha Menon, Katie Cueva, Karen Yeary, Lisa Klesges, Monica L. Baskin, Kassandra I. Alcaraz, Sabrina Ford. Cancer risk factors and screening across various U.S. rural classification codes: Cancer disparities in the context of rurality [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-258.

Cardiovascular risk factors and lifestyle behaviours in relation to longevity: a Mendelian randomization study.

BackgroundThe American Heart Association introduced the Life's Simple 7 initiative to improve cardiovascular health by modifying cardiovascular risk factors and lifestyle behaviours. It is unclear whether these risk factors are causally associated with longevity.ObjectivesThis study aimed to investigate causal associations of Life's Simple 7 modifiable risk factors, as well as sleep and education, with longevity using the two‐sample Mendelian randomization design.MethodsInstrumental variables for the modifiable risk factors were obtained from large‐scale genome‐wide association studies. Data on longevity beyond the 90th survival percentile were extracted from a genome‐wide association meta‐analysis with 11,262 cases and 25,483 controls whose age at death or last contact was ≤ the 60th survival percentile.ResultsRisk factors associated with a lower odds of longevity included the following: genetic liability to type 2 diabetes (OR 0.88; 95% CI: 0.84;0.92), genetically predicted systolic and diastolic blood pressure (per 1‐mmHg increase: 0.96; 0.94;0.97 and 0.95; 0.93;0.97), body mass index (per 1‐SD increase: 0.80; 0.74;0.86), low‐density lipoprotein cholesterol (per 1‐SD increase: 0.75; 0.65;0.86) and smoking initiation (0.75; 0.66;0.85). Genetically increased high‐density lipoprotein cholesterol (per 1‐SD increase: 1.23; 1.08;1.41) and educational level (per 1‐SD increase: 1.64; 1.45;1.86) were associated with a higher odds of longevity. Fasting glucose and other lifestyle factors were not significantly associated with longevity.ConclusionMost of the Life's Simple 7 modifiable risk factors are causally related to longevity. Prevention strategies should focus on modifying these risk factors and reducing education inequalities to improve cardiovascular health and longevity.

A narrative review of intraoperative floppy iris syndrome: an update 2020.

Intraoperative floppy iris syndrome (IFIS) is characterized by intraoperative floppiness or billowing of the iris, progressive miosis, and iris prolapse through the surgical wounds. It was originally reported about fifteen years ago, which was later identified to be closely associated with tamsulosin, the most commonly used α1 adrenoceptor antagonist for benign prostatic hyperplasia (BPH). A variety of risk factors, including age, gender, hypertension, axial length of the eye, 5α-reductase inhibitors, other α adrenoceptor antagonist and neuromodulators, have been connected with IFIS. If IFIS occurs during phacoemulsification surgery, complications such as corneal endothelial loss, iris trauma, posterior capsule rupture (PCR), high intraocular pressure and vitreous loss are significantly increased. Therefore, preoperative evaluation of high-risk patients and appropriate intraoperative intervention is crucial to avoid severe complications. This review summarizes the pathogenesis and clinical features of classic IFIS, and provides some clinical pearls to ophthalmologists that may help identify, prevent or reduce IFIS associated complications. Additionally, from the perspective of clinical occurrence of IFIS, there are some recommendations for urologists as well. In conclusion, both ophthalmologists and urologists should be aware of this special clinical situation and communicate with each other about their own fields. A multidisciplinary interaction is of importance to simplify potentially complicated clinical issues.

Male survival advantage on the Baja California peninsula.

A consistent finding from contemporary Western societies is that women outlive men. However, what is unclear is whether sex differences in survival are constant across varying socio-ecological conditions. We test the universality of the female survival advantage with mortality data from a nineteenth century population in the Baja California peninsula of Mexico. When examined simply, we find evidence for a male-biased survival advantage. However, results from Cox regression clearly show the importance of age intervals for variable survival patterns by sex. Our key findings are that males: (i) experience significantly lower mortality risk than females during the ages 15-30 (RR = 0.69), (ii) are at a significantly increased risk of dying in the 61+ category (RR = 1.30) and (iii) do not experience significantly different mortality risk at any other age interval (0-14, 31-45, 46-60). We interpret our results to stem from differing intrinsic and extrinsic risk factors for sex-biased mortality across age intervals, highlighting the relevance of a lifecourse approach to the study of survival advantage. Ultimately, our results make clear the need to more broadly consider variability in mortality risk factors across time and place to allow for a clearer understanding of human survival differences.

Racial differences in the association of accelerated aging with future cardiovascular events and all-cause mortality: the coronary artery risk development in young adults study, 2007–2018

ABSTRACT Objective Variability of Cardiovascular disease (CVD) risk, including racial difference, is not fully accounted for by the variability of traditional CVD risk factors. We used a multiple biomarker model as a framework to explore known racial differences in CVD burden. Design We measured associations between accelerated aging (AccA) measured by a combination of biomarkers, and cardiovascular morbidity and all-cause mortality using data from the Coronary Artery Risk Development in Young Adults study (CARDIA). AccA was defined as the difference between biological age, calculated using biomarkers with the Klemera and Doubal method, and chronological age. Using logistic regression, we assessed overall and race-specific associations between AccA, CVD, and all-cause mortality. Results Among our cohort of 2959 Black or White middle-aged adults, after adjustment, a one-year increase in AccA was associated with increased odds of CVD (Odds Ratio (OR) = 1.04; 95% CI: 1.02, 1.06), stroke (OR = 1.12; 95% CI: 1.07, 1.17), and all-cause mortality (OR = 1.05; 95% CI: 1.02, 1.08). We did not find significant overall racial differences, but we did find race by sex differences where Black men differed markedly from White men in the strength of association with CVD (OR = 1.06, 95% CI: 1.01, 1.12). Conclusions We provide evidence that AccA is associated with future CVD.

Shoulder Osteonecrosis: Pathogenesis, Causes, Clinical Evaluation, Imaging, and Classification

The humeral head is the second most common site for nontraumatic osteonecrosis after the femoral head, yet it has attracted relatively little attention. Osteonecrosis is associated with many conditions, such as traumatism, corticosteroid use, sickle cell disease, alcoholism, dysbarism (or caisson disease), and Gaucher's disease. The diagnosis is clinical and radiographic with MRI, with radiographs being the basis for staging. Many theories have been proposed to decipher the mechanism behind the development of osteonecrosis, but none have been proven. Because osteonecrosis may affect patients with a variety of risk factors, it is important that caregivers have a heightened index of suspicion. Early detection may affect prognosis because prognosis is dependent on the stage and location of the disease. In particular, the disease should be suspected in patients with a history of fractures, steroid usage, or sickle cell disease, and in divers. This report reviews osteonecrosis of the humeral head, with an emphasis on causes, clinical evaluation, imaging, and classification.

Seasonal trends and maternal characteristics as predictors of maternal undernutrition and low birthweight in Eastern Maharashtra, India.

Few studies have assessed whether women and infants in rural and peri‐urban communities in South Asia experience seasonal fluctuations in nutritional status; however, a handful of studies have documented seasonal variability in risk factors for undernutrition including food availability, physical activity and infections. We used data from the Maternal and Newborn Health (MNH) registry, a population‐based pregnancy and birth registry in Eastern Maharashtra, India, to analyse seasonal trends in birthweight and maternal nutritional status—body mass index (BMI) and haemoglobin—in the first trimester of pregnancy. We plotted monthly and seasonal trends in birthweight, and maternal BMI and haemoglobin, and used multivariable regression models to identify seasonal and maternal characteristics that predicted each outcome. Between October 2014 and January 2018, MNH included 29,253 livebirths with recorded birthweight. BMI was assessed in 15,252 women less than 12 weeks of gestation and haemoglobin in 18,278 women less than 13 weeks of gestation. Maternal characteristics (age, education, parity and height) were significantly associated with nutritional status; however, there were minimal seasonal fluctuations in birthweight or maternal nutrition. There were significant secular trends in maternal haemoglobin; between 2014 and 2018, the prevalence of maternal anaemia decreased from 91% to 79% and moderate or severe anaemia from 53% to 37%. The prevalence of maternal underweight (45.3%) and overweight (9.8%) and low birthweight (19.1%) remained relatively constant over the study period. Our findings highlight that in some rural and peri‐urban areas in South Asia, tackling systemic drivers of malnutrition may be more effective than targeted interventions based on season.

Risk and Protective Factors to LGBTQ+ Youth Suicide: A Review of the Literature

LGBTQ+ youth experience higher rates of suicidal ideation and behavior than their cisgender, heterosexual peers, and these disparities have created a need for academic exploration of the risk factors and protective factors surrounding LGBTQ+ youth suicide (Taliaferro and Muehlenkamp in Acad Pediatr 17:715–722; Toomey et al. in J Youth Adolesc 48:788–801; Ybarra et al. in: Espelage et al. (eds) Youth suicide and bullying: challenges and strategies for prevention and intervention, Oxford University Press, Oxford, 2014). This paper reviews the research that has been completed on these topics in the last 10 years. A variety of risk factors have contributed to higher rates of suicidal ideation, attempts, and completion: minority stress, interpersonal constructs, race, transgender identity, partner violence, homelessness, school victimization, and a lack of school support (Joiner in Why people die by suicide, Harvard University Press, Cambridge, 2005; Meyer in Psychol Bull 129:674–697; Mustanski and Liu in Arch Sex Behav 42:437–448; Van Orden et al. in Psychol Rev 117:575–600). Furthermore, a range of protective factors have been connected with lower rates of suicidal ideation and behavior: gender and sexuality alliances, LGBTQ+ inclusive curriculum, LGBTQ+ affirming school policies, familial support, peer support, and mental health interventions (Poteat and Rivers in Youth suicide and bullying: challenges and strategies for prevention and intervention, Oxford University Press, Oxford, 2014; Stone et al. in Suicide Life Threat Behav 45:415–430; Whitaker et al. in J Adolesc Health 58:63–68). Areas for future research are recommended, including examining diverse LGBTQ+ subpopulations and developing standard measurements for LGBTQ+ identities. The paper concludes with highlights from the past 10 years of research.

Faktor Risiko yang Mempengaruhi Terjadinya Stroke Non Hemoragik pada Pasien di RS RK Charitas dan RS Myria Palembang

Non-hemorrhagic stroke is a frequent case of stroke caused by blockage of blood vessels and the accumulation of changeable and unchangeable risk factors. The impact of stroke is a long-term physical and functional disorder that affects the life quality of the patient and the family. The aim of this study was to analyze the factors that influence the occurrence of non-hemorrhagic stroke. This study is an observational analytic epidemiological study with case control research design conducted in 2 private hospitals. The samples were selected sequentially with a ratio of 1: 2 (case: control) consisting of 50 patients with non-hemorrhagic stroke and 100 patients without non-hemorrhagic stroke. The data was analyzed by univariate, bivariate, and multivariate analysis method by using binary logistic regression. The results of risk factor analysis which were independently associated were Total Blood Cholesterol, History of Hypertension, Systolic Blood Pressure, Diastolic Blood Pressure, and Cardiac Examination. The multivariate analysis showed that the risk factors affecting non hemorrhagic stroke were History of Hypertension (OR: 6,476, p = 0.000, 95% CI: 2,338-17,935), Total Blood Cholesterol Level ≥200 mg/dl (OR: 6,139, p = 0.000, 95% CI: 2,334-16,148), Education Level (OR: 0,311, p = 0.009, 95% CI: 0,129-0,747), Gender (OR: 0.379, p = 0.022, 95% CI: 0.165-0.871 ), and Obesity (OR: 2,217, p = 0.080, 95% CI: 0.910-5.401). As a conclusion, there were 5 variables of risk factors that influence to Non Hemorrhagic Stroke. If those variables of risk factors were exist in the respondent, the risk of a non hemorrhagic Stroke reached 81.6%. It was suggested that the patients made an effort on preventions by maintaining a healthy lifestyle and controlling risk factors affecting the occurrence of non-hemorrhagic stroke.

Utility of data-driven clusters for the prevention of type 2 diabetes

Abstract Background Type 2 diabetes (T2D) is an important cause of mortality, disability and health care expenditures. Prevention is crucial to counter global trends, but individual variability of different risk factors leading to T2D has made prevention difficult to achieve. We aimed to identify clusters of individuals based on individual level characteristics of different risk factors using a data driven approach. Methods We used data from the Stockholm Diabetes Prevention Program. A population-based, prospective study. Healthy participants who were born in Sweden and aged 35 to 55 years old were recruited between 1992 and 1998 and followed up after 10 and 20 years. At each visit, participants answered extensive questionnaires, anthropometric measures, laboratory examinations and an oral glucose tolerance test. We used age, sex, family history of diabetes, fasting and two hours glucose and insulin, body mass index (BMI), systolic and diastolic blood pressure, and level of education were at baseline to group participants using the k-prototype algorithm. We then examined the risk of diabetes between clusters using survival analysis. Results A total of 7,173 participants representing 138,942 person years of follow-up were included in this study. Among them, 998 (14%) developed T2D. We identified six stable clusters: the group with the lowest cumulative incidence of T2D (2.3%) was used as reference (n = 1,265). In the group with the highest risk, 47% developed T2D (n = 772, HR 26.3, 95%CI 17.9-38.5) followed by 17.1% (n = 1,146, HR 7.6, 95%CI 5.1-11.22), 15.2% (n = 1,453, HR 6.7, 95%CI 4.5-9.8), 9.5% (n = 1,384, HR 4.1, 95%CI 2.8-6.2) and 5.2% (n = 1,157, HR 2.0, 95%CI 1.3-3.1) in the remaining groups. Conclusions There is important variability between individuals regarding the effect of different risk factors on the incidence of T2D. Data driven categorization strategies can be useful epidemiological tools to pave the way for more precise T2D intervention programs. Key messages Prevention strategies for T2D usually follow a one-size fits all approach, ignoring the important variability of risk factors and their consequences among individuals. It is possible to identify subgroups of people with different risk of T2D based on simple clinical and phenotypical characteristics, and could help to improve prevention and treatment of T2D.

The French national Global Burden of Disease (GBD) evaluation project

Abstract As in many countries, there is an urgent need to prioritize the issues in public health care and prevention in France. The French GBD project aims to offer a unique set of combined morbidity and mortality estimates to inform health policy makers in France, at the national level. However, because of the variability in health status and risk factors across geographical areas, policy makers need comparable estimates at the regional and local levels to target specific populations and to implement actions to improve health. Besides, although the accuracy of the indicators provided by the GBD has not been evaluated in the French context, it would be likely improved by enhancing and enriching the French data used as input. The French national health data system is one of the largest healthcare claims database in Europe. Based on these data, the French National Health Insurance (Cnam) and Santé publique France (SpFrance), in collaboration with clinicians and researchers, have developed a set of algorithms to identify diseases based on health care reimbursements, which could improve GBD estimates. Cnam and SpFrance both contribute to the definition, prioritization and evaluation of health policies in France and have therefore decided to pool their strengths and mutualize their resources to build a common rationale and provide consistent French Burden of Diseases estimates. A collaboration with the Institute of Health Metrics and Evaluation (IHME) has also been initiated, to allow Cnam and SpFrance benefiting from IHME's infrastructure and expertise and together seek to improve the estimates of the indicators using comparable methods at local and national levels, and consistent with the overall Global Burden of Disease project. Finally, beyond the ongoing production of the GBD metrics, another objective is the knowledge transfer to Cnam and SpFrance as learning organizations. The project has started with a framework between the three parties and the expression of interest.