Recommendations For Risk Reduction Research Articles

Evidence-based recommendations regarding risk reduction practices for people at risk of or with breast cancer-related lymphedema: consensus from an expert panel.

Several recent studies have investigated the validity of precautionary practices for lymphedema risk reduction after breast cancer treatment, such as avoidance of blood pressure measurements, skin puncture, blood draws, and use of prophylactic compression during air travel. Other studies have elucidated risk factors for breast cancer-related lymphedema, such as axillary lymph node dissection and skin infection (cellulitis). Combining the current evidence base with the consensus opinion of lymphatic experts assembled at the American Cancer Society/Lymphology Association of North America Summit in October 2023, updated evidence-based risk reduction recommendations are presented for those with or at risk of breast cancer-related lymphedema. Recommendation topics include prospective surveillance, patient education, individual risk factors, exercise, blood pressure, skin care and hygiene, skin puncture and blood draws, surgical procedures, prophylactic compression, air travel, and hot climate and sauna. These recommendations will help inform education and medical choices for individuals treated for breast cancer who are at risk of or diagnosed with breast cancer-related lymphedema. More high-quality evidence is required to allow the development of risk reduction recommendations for other cancer types such as gynecological, melanoma, and head and neck. It is recommended that clinicians and organizations serving people at risk of or with lymphedema align risk reduction guidelines with the evidence-based recommendations provided within this consensus document and companion manuscripts from the American Cancer Society/Lymphology Association of North America Lymphedema Summit: Forward Momentum: Future Steps in Lymphedema Management.

Understanding Pregnancy-Related Cardiovascular Disease Risk Communication and Management Among Women Veterans.

Background: Women veterans who experience certain conditions during pregnancy, such as gestational hypertension, pre-eclampsia, and gestational diabetes, are at increased risk of developing cardiovascular disease (CVD) later in life. Many women are unaware of this risk. Furthermore, women often face financial, socioeconomic, or physical challenges when trying to make healthy behavior modifications to reduce CVD risk. Objective: To examine Veterans' pregnancy-related cardiovascular (CV) risk conditions, risk identification, and risk communication with primary care providers. Research Design: Telephone/video interviews were conducted with female Veterans who had experienced at least one sex-specific CV risk condition during pregnancy. Interviews were recorded, transcribed, and analyzed using content analysis techniques. Major themes and representative quotes were derived. Results: Twenty-eight women Veterans participated in the study, conducted between October and December 2023. A majority of participants were racial/ethnic minorities, and the average age was 38. Four themes arose: (1) Veterans Affairs (VA) medical records may contain limited information regarding CV risk factors experienced during pregnancy; (2) strong relationships between Veterans and their VA primary care providers can facilitate management of CV risk factors following pregnancy; (3) some Veterans receive vague and/or conflicting recommendations for CV risk reduction following pregnancy; and (4) social determinants of health may play a key role in Veterans' ability to follow recommended CV risk reduction behaviors. Conclusions: Women Veterans with pregnancy-related CV risk conditions may not know that they are at increased risk of developing future CVD conditions, often because VA providers receive limited records from outside providers. Those who are aware often receive conflicting or vague recommendations to address these risk factors. When trying to follow CV health recommendations, many women have difficulty due to lack of finances, childcare, or safe areas. Future interventions should be aimed at improving access to medical records between outside and VA providers, patient education, and access to heart-healthy resources.

What do women want to see in a personalized breast cancer risk report? A qualitative study of Asian women of two countries.

A breast cancer risk assessment tool for Asian populations, incorporating Polygenic Risk Score and Gail Model algorithm, has been established and validated. However, effective methods for delivering personalized risk information remain underexplored. This study aims to identify and develop effective methods for conveying breast cancer risk information to Asian women. Through ten focus group discussions with 32 women in Indonesia and Singapore, we explored preferences for the presentation of risk information. Participants favored comprehensive reports featuring actionable steps, simplified language, non-intimidating visuals, and personalized risk reduction recommendations. Singaporean participants, more aware of breast cancer prevention, showed a lower likelihood of seeking follow-ups upon receiving low-risk results compared to Indonesians. Overall, participants found the reports useful and advocated for similar approaches in other disease assessments. Balancing content and complexity in reports is crucial, highlighting the need for improved patient understanding and engagement with healthcare providers. Future studies could explore physicians' roles in delivering personalized risk assessments for breast cancer prevention.

Dysgeusia and paresthesia following suspension microlaryngoscopy: review and recommendations for risk reduction

BackgroundDysgeusia or altered taste is a rare complication following suspension microlaryngoscopy with the incidence ranging from 2.9 to 12.1%. We report this with recommendations to avoid similar complications following suspension laryngoscopy, tonsillectomy, and tongue base surgery which require pressure to be placed on the tongue for better surgical field visualization.Case presentationA 53-year-old man with underlying diabetes mellitus presented with long standing history of irritative cough, globus sensation, and evidence of laryngopharyngeal reflux. A left ventricle swelling was noted on flexible laryngoscopy and neck. He underwent direct laryngoscopy and biopsy of the left ventricle lesion which revealed to be acute on chronic inflammation. Day 1 postoperatively, patient complained of reduced sensation over left hemi-tongue. A referral to a neurologist was made for further examination and he was found to have loss of taste over anterior two-third of tongue and treated with vitamin B complex. To date, dysgeusia remains persistent. Patient relayed his grievances to the hospital following these complications. Review of literature on relevant topic was made through PubMed, Web of Science, and Cochrane Library Database by two reviewers, working independently. Twenty-three papers, available in full, written in English language, containing number of cases, type of surgery, and complications were extracted and studied.ConclusionsRisk of dysgeusia and paresthesia postoperatively should be informed during consent taking for all patients undergoing tonsillectomy, laryngeal microsurgery, and tongue base surgery. Zinc deficiency should be investigated in patients with persistent taste disturbance post-tonsillectomy. Intermittent release during suspension laryngoscopy beyond 30 min to reduce post-surgical complications. Greater care should be taken to reduce the amount of force during the suspension laryngoscopy due to smaller oral and oropharyngeal structure in female. Keeping close to the tonsillar capsule particularly in mid and lower pole areas should be done in tonsillectomy using diathermy dissection.

Cross‐sectional evaluation of a clinical decision support tool to identify medication‐related problems at discharge from the acute care setting

AbstractBackgroundThere are many reported pharmacist‐led transitions of care (TOC) programs to address medication‐related problems (MRP) at discharge from the acute care setting. Most have identified time and labor resources as significant limitations. This study aims to assess the effectiveness of a medication risk score (MRS)‐driven clinical decision support system (CDSS) in identifying actionable MRPs and improving medication safety in the acute care discharge TOC setting.MethodsA cross‐sectional analysis was conducted in a cohort of 481 subjects discharged from the acute care setting. The MRS‐CDSS was utilized to identify MRPs and provide recommendations for risk reduction. The distribution of MRPs, recommendations, and their associations with MRS severity were analyzed. Additionally, the potential reduction in MRS per subject and its correlation with MRS severity were examined.ResultsThe median MRS reduction per subject was 2 points, while high/severe‐risk patients showed a median potential reduction of 7 points. Among the identified MRPs (n = 691), drug interaction, drug use without indication, and adverse drug reaction accounted for 89.7% of all MRPs. The top three recommendations, discontinue medication, change the time of administration, and start alternative therapy, represented 94.1% of all recommendations. Stratified analysis by MRS category revealed a significant increase in adverse drug reaction MRPs and recommendations to discontinue medications with higher MRS severity. The results were consistent with previous outpatient studies, supporting the MRS‐CDSS's ability to enhance medication safety.ConclusionThis study demonstrates that the MRS‐CDSS effectively identifies actionable MRPs and has the potential to substantially reduce overall pharmacotherapy regimen risk when applied during acute care discharge TOC. The findings support implementable recommendations directed at patient safety and the allocation of health care resources to high‐risk patients for maximum benefit.

The Effects of Almond Consumption on Cardiovascular Health and Gut Microbiome: A Comprehensive Review.

The consumption of almonds has been associated with several health benefits, particularly concerning cardiovascular and intestinal health. In this comprehensive review, we compile and deliberate studies investigating the effects of almond consumption on cardiovascular disease (CVD) risk factors and gut health. Almonds are rich in monounsaturated fats, fiber, vitamins, minerals, and polyphenols, which contribute to their health-promoting properties. Regular intake of almonds has been shown to improve lipid profiles by reducing LDL cholesterol and enhancing HDL functionality. Additionally, almonds aid in glycemic control, blood pressure reduction, and chronic inflammation amelioration, which are critical for cardiovascular health. The antioxidant properties of almonds, primarily due to their high vitamin E content, help in reducing oxidative stress markers. Furthermore, almonds positively influence body composition by reducing body fat percentage and central adiposity and enhancing satiety, thus aiding in weight management. Herein, we also contemplate the emerging concept of the gut-heart axis, where almond consumption appears to modulate the gut microbiome, promoting the growth of beneficial bacteria and increasing short-chain fatty acid production, particularly butyrate. These effects collectively contribute to the anti-inflammatory and cardioprotective benefits of almonds. By encompassing these diverse aspects, we eventually provide a systematic and updated perspective on the multifaceted benefits of almond consumption for cardiovascular health and gut microbiome, corroborating their broader consideration in dietary guidelines and public health recommendations for CVD risk reduction.

Study on the Driving Risk Reduction in the Mountain Highway Tunnel Group under the Perspective of Visual Load

More highway built in the mountains in recent years, the driving risk in the tunnel group is becoming a new issue. This paper analyzed the driving risk in the mountain highway tunnel group from the perspective of visual load. Based on vehicle test in the Pengshui‐Xiantang tunnel group in China, the evolution characteristics of MTPA were quantitatively analyzed, and the random forest model was constructed to discuss the effect factors of the maximum transient velocity value of the pupil area (MTPA) in different sections. The results are as follows: (1) The MTPA frequently presents a tendency of steep rise and fall in the tunnel group. MTPA in the second tunnel is significantly higher than the first tunnel. (2) The mountain tunnel group can be divided into nine sections; the velocity, design luminance, measured luminance, and location have different effects on MTPA in each section. Due to the complex terrain conditions, the location has a more significant impact on MTPA in the second tunnel. (3) The first tunnel entrance, the first tunnel exit to the second tunnel entrance, and the second tunnel exit are the areas with more significant pressure on drivers in the tunnel group. The visual load of drivers in the exit section of the last tunnel is the greatest. The driving risk reduction recommendations include improving the transition lighting design of the second tunnel, clarifying the tunnel group identification, and adding safety features at the tunnel connection section, in order to clarify the driver’s expectations and reduce the fear of the unknown mountain environment.

Assessment of human safety risks from the use of plant protection products

Agriculture is a very serious sector in the life of mankind, with a history that goes back thousands of years, and we know from history that many wars have been fought to gain land in order to obtain better farmland. To meet the needs of growing societies and the increasing pressures that came with it, various technologies were adopted to increase both the quality and quantity of crops. Increasing attention has been paid to the control of crop pests, leading to the emergence of plant protection, which aims not only to kill crop pests but also to produce healthier products for human consumption and to prevent the spread of weeds and their destruction. In the course of our work, we have grouped pesticides by active substance. Knowledge of these groups is essential to assess the risks associated with each of these products and, after a detailed risk assessment of the spraying process, to make recommendations for risk reduction to address high unacceptable risks in order to make agricultural work safer for the use of pesticides.

Problems experienced by nurses working in the region affected by Kahramanmaraş earthquakes in Turkey and their recommendations for risk reduction: A descriptive and cross-sectional study

Nurses have crucial roles and responsibilities for ensuring the sustainability of health services during disaster periods. One of these roles and responsibilities is to guide future planning efforts in light of their experiences and problems. This study was conducted with 130 nurses as a descriptive and cross-sectional study to identify the experiences and recommendations of nurses working in the region affected by earthquakes centered around the Kahramanmaraş province of Turkey. The snowball sampling method, which is a purposive sampling method, was used in the study, and the data were collected using an online survey form. In this study, it was found that nurses worked as emergency nurses or first aid and triage nurses voluntarily or on temporary assignment in hospitals across the region affected by earthquakes and would like to continue to work in the region. It was discerned that the participants experienced primarily psychological problems at the individual level, and in the context of nursing services, they mostly had managerial and organizational problems during the period when they worked in the region. In light of these problems, the participants recommended that the competencies of nurses be enhanced through training programs and by organizing events to have a more effective disaster preparation, and the managerial skills and psychological coping skills of nurses be improved. In the direction of these results, the experiences and recommendations of nurses should be used for enhancing their disaster preparedness and designing more effective plans for the future, and in particular, their psychological coping skills should be improved, and the management and organization skills of those taking roles in disaster management should be enhanced.

Comparison of 5- and 10-year breast cancer risk predictions.

10529 Background: Breast cancer risk assessment is valuable in personalizing risk-reduction and screening approaches for the general population. Maximizing the benefits while reducing the harms associated with current breast cancer screening and risk-reduction recommendations should increase the efficacy of these paradigms. Because healthcare providers have limited time with their patients, we developed a risk prediction model, BRISK, which uses the most important clinical risk factors for breast cancer (in an easily collected format), polygenic risk and mammographic density. We previously validated BRISK 5-year risk predictions and found that it performed better than IBISv7 and BCRAT. Methods: The dataset comprised 241,633 women (mean age at baseline assessment = 56.6 years). We included all races/ethnicities available in the UK Biobank. There were 3726 women affected during the first five years of follow-up and 7482 women affected during the full 10 years of follow-up. We compared the performance of the 5-year and 10-year risk predictions by assessing the association with breast cancer using Cox regression to estimate the hazard ratio (HR) per SD of risk, discrimination using calculating Harrell’s C-index and calibration using logistic regression to estimate the slope and the intercept of the logit of the risk predictions. Nelson–Aalen estimates of the hazard function by quintiles of risk and standardized incidence ratios (SIRs) of the number of breast cancer cases expected were used to illustrate performance. Results: The predictive performance of BRISK was consistent for 5-year and 10-year risk predictions. Discrimination was similar, with a Harrell’s C-index of 0.645 (95% CI = 0.636, 0.654) for the 5-year risk and of 0.638 (95% CI = 0.632, 0.645) for the 10-year risk. We used Nelson_Aalen cumulative hazard estimates to compare breast cancer incidence by risk quintile for both 5 and 10-year risk. Both risk scores overestimated risk in the top two deciles with the 5-year expected risks of 2.8% and 5.0% corresponding to observed risks of 2.3% and 3.3%. The 10-year expected risks for the top two deciles were 5.6% and 9.8% while the corresponding observed risks were 4.6% and 6.4%. Finally, we used clinically actionable thresholds to show the standard incidence ratios (SIR) of 1.77 (95% CI = 1.69, 1.85) for women ≥3% 5-year risk and 2.05 (95% CI = 1.93, 2.18) ≥8% 10-year risk. Conclusions: The BRISK 5-year and 10-year risk prediction perform equally well. There is an overestimation of risk for the top decile in both models. This is important to consider in risk-management conversations between clinician and patient. While the observed risk of the top decile remained above the 3% 5-year risk threshold used in the United States, the top decile observed risk dropped below the 8% 10-year risk threshold used in the United Kingdom. Risk scores are not used in isolation, but it may be preferable to err on the side of overestimation rather than underestimation.

Summary: Management of Hyperglycemia in Type 2 Diabetes according to the 2022 ADA-EASD Consensus Report and 2023 ADA Standards of Care in Diabetes

In October 2022, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) updated the previous consensus report for management of hyperglycemia in type 2 diabetes (T2DM). In January 2023, ADA Standards of Care in Diabetes with pharmacologic approaches to achieve a glycemic target were published to align with the consensus report by ADA and EASD. This recent consensus report and ADA Standards of Care in Diabetes emphasized weight management as an important aspect of the holistic approach to management of T2DM. In addition, it included numerous results of cardiorenal trials involving glucagon-like peptide 1 (GLP-1) receptor agonist and sodium glucose cotransporter 2 (SGLT2) inhibitor in type 2 diabetes. This information was added to address broader recommendations for cardiorenal risk reduction, in particular for organ (heart and kidney)-specific protection. This review summarizes the 2022 ADA-EASD consensus report and 2023 ADA standards of care for diabetes regarding management of hyperglycemia in T2DM.

S3-Leitlinie Prävention von Hautkrebs: Evaluation und Aktualisierungsprozess

Originally published in 2014, the S3 guideline "Prevention of skin cancer" is the first evidence-based guideline available exclusively for primary and secondary prevention, which summarizes interprofessional consented recommendations for skin cancer risk reduction and early detection. Due to the large number of new publications and expanding focus, an update was deemed necessary. After a structured needs assessment, key questions were prioritized. The resulting systematic literature search resulted in a three-stage screening process. Recommendations formulated in working groups were approved in a formal consensus process, taking into account conflicts of interest, and finalized after a 6‑week public consultation process. The needs assessment identified "skin cancer screening" (60.1%), "individual risk avoidance behaviors" (44.20%), and "risk factors" (43.48%) as topics of greatest interest. The prioritization phase resulted in 41 new key questions. A total of 22 key issues were re-evaluated in an evidence-based manner using 93 publications. As part of comprehensive guideline restructuring, 61 recommendations were newly developed and 43 were modified. The consultation phase resulted in no changes to recommendations and 33 changes to background material. The identified need for change resulted in extensive modification and redrafting of recommendations. As the target group "nononcology patients" cannot be identified via cancer registries or certification systems, no quality indicators can be derived from the guideline. To transfer the guideline to health care, innovative, addressee-specific concepts are required, which will be discussed and implemented during the preparation of the patient guideline.

Updates in gynecologic care for individuals with lynch syndrome.

Lynch syndrome is an autosomal dominant hereditary cancer syndrome caused by germline pathogenic variants (PVs) in DNA mismatch repair genes (MLH1, MSH2, PMS2, MSH6) or the EPCAM gene. It is estimated to affect 1 in 300 individuals and confers a lifetime risk of cancer of 10-90%, depending on the specific variant and type of cancer. Lynch syndrome is the most common cause of inherited colorectal cancer, but for women, endometrial cancer is more likely to be the sentinel cancer. There is also evidence that certain PVs causing Lynch syndrome confer an increased risk of ovarian cancer, while the risk of ovarian cancer in others is not well defined. Given this, it is essential for the practicing gynecologist and gynecologic oncologist to remain up to date on the latest techniques in identification and diagnosis of individuals with Lynch syndrome as well as evidence-based screening and risk reduction recommendations for those impacted. Furthermore, as the landscape of gynecologic cancer treatment shifts towards treatment based on molecular classification of tumors, knowledge of targeted therapies well-suited for mismatch repair deficient Lynch tumors will be crucial. The objective of this review is to highlight recent updates in the literature regarding identification and management of individuals with Lynch syndrome as it pertains to endometrial and ovarian cancers to allow gynecologic providers the opportunity to both prevent and identify Lynch-associated cancers earlier, thereby reducing the morbidity and mortality of the syndrome.

Factors that influence the management recommendations breast surgeons provide to women with pathogenic variants in moderate penetrance breast cancer susceptibility genes.

Pathogenic variants in moderate penetrance breast cancer susceptibility genes, such as ATM and CHEK2, confer a two- to five-fold increased lifetime risk for breast cancer. The National Comprehensive Cancer Network has guidelines for breast surgeons to utilize when counseling women with pathogenic variants in these genes; however, previous studies indicate that other factors impact breast surgeons' recommendations to patients. This study investigated factors influencing management recommendations presented by breast surgeons to women with pathogenic variants in moderate penetrance breast cancer susceptibility genes. Focus groups and interviews were conducted with breast surgeons practicing in Ohio, Kentucky, and Indiana. A total of 15 breast surgeons from eight different hospitals participated in five focus groups and three individual interviews. Participants discussed factors they consider when making management recommendations for risk reduction in women with pathogenic variants in moderate penetrance breast cancer susceptibility genes. Participants provided risk management recommendations for given scenarios. Patient motivation/opinion, family history, patient current health status, patient personal preference, and patient anxiety level were among the most common factors mentioned. It appeared that how these factors are valued and applied in practice varies. There was no consensus among breast surgeons on which risk-reducing management options they would recommend in each scenario. There are many factors breast surgeons take into consideration when making recommendations for this patient population. This information could inform future research on decision making around treatment for individuals with pathogenic variants in moderate penetrance breast cancer susceptibility genes.

Escalating costs of billion-dollar disasters in the US: Climate change necessitates disaster risk reduction

IntroductionThe United States (US) spends a staggering amount on costs secondary to natural disasters, over $2 trillion between 1980 and 2021, during which time 15,347 disaster related deaths also occurred [1]. We assess the relationship between CO2, temperature, and the number and economic costs of billion-dollar disaster events in the US during this period. Materials & MethodsData on the annual number of inflation-adjusted billion-dollar disasters in the US, global CO2 levels, average temperature, and fatalities were obtained from the National Oceanic and Atmospheric Administration (NOAA) for the period 1980–2021. Spearman's correlation (rs) was calculated to analyze the relationship between these variables. ResultsOver this 41-year period, CO2 levels, temperature, and the number of billion-dollar disasters in the US all increased and are strongly correlated. The rate of events over this period increased along with increases in CO2 (Spearman's correlation (rs)=0.841) and temperature (rs =0.748). ConclusionsCO2 levels and temperature have increased over the past 4 decades and are strongly positively correlated with the number of and total cost due to billion-dollar disasters. This strong correlation suggests that the annual number of events in the US will continue to increase along with their economic burden, so measures are needed to mitigate those costs. We recommend a focus on Disaster Risk Reduction (DRR) as an immediate cost savings measure, in keeping with United Nations Disaster Risk Reduction and UN Sustainable Development Goals recommendations. Additional research on the healthcare costs associated with natural disasters is needed.

OPERASI UDARA KHUSUS TNI ANGKATAN UDARA MENGHADAPI ANCAMAN SESAR LEMBANG

The theory in this research is the theory of special air operations, disaster theory, vulnerability, regional capacity, risk, and resilience. The research method uses qualitative methods with source triangulation techniques using GIS and Powersim software. The results of this study are, first, the implementation of OPDPB through Preliminary Operations (Territorial Task Force, Information Task Force, Air Base Elements, Pasgat Task Force, and Aviation Support Task Force), Basic Operations (Information Task Force, Joint Task Force, C-130 Transport Element, Helicopter Element), Termination Operations (Legal Task Force, Info Task Force). Second, the geospatial map of the distribution of multi-hazard risk levels with a Low-Risk level of 0.32 (Kabupaten Purwakarta and Subang), and a High-Risk level of 0.68% (Bandung Regency, West Bandung Regency, Cimahi City, Bandung City, and Sumedang Regency). Third, recommendations for disaster risk reduction by reducing the value of social vulnerability, physical vulnerability, economic vulnerability, and environmental vulnerability through strengthening resilience (PSBB, local wisdom, volunteers) to face the threat of the Lembang Fault.

Assessment of Climate Change Mainstreaming in Spatial Planning at the Central Level in Kosovo

Abstract Spatial developments contribute to climate change through greenhouse gas emissions and disordered land use. At the same time, climate change impacts have spatial implications, influencing the land uses and settlements development, and damaging habitats, ecosystems, infrastructure and other assets. Considering its regulatory character and multi-sectorial approach, spatial planning is gaining an increasingly important role in climate change management. As such, it could be better utilized in increasing climate resiliency and achieving decarbonization targets in Kosovo as well. While Kosovo is prone to natural hazards such as floods, landslides, droughts, and wildfires, the future climate change could further impact the economy, infrastructure, buildings, energy, health and wellbeing of its communities. Assuming that climate change considerations are not sufficiently integrated in spatial planning policies at the national level in Kosovo, this research assesses the extent that the Law on Spatial Planning and the Spatial Plan of Kosovo (also referred as the Spatial Planning Strategy) address those considerations. Upon the identified gaps, this research provides recommendations for better climate change management, risk reduction and resiliency building. Considering that the Spatial Plan of Kosovo has expired, and the Kosovo’s institutions are currently reviewing and considering the updating of the Law on Spatial Planning, the findings of this research could better inform and orient climate change mainstreaming in spatial planning at the central level.

Neuropsychological effects of a six‐month online cognitive health program with a weekly telehealth lifestyle support group and personalized precision medicine recommendations for health optimization in older adults with subjective cognitive impairment

AbstractBackgroundMaintaining healthy lifestyle behaviors and optimizing health may slow cognitive decline through risk reduction in older adults with cognitive impairments. Curriculum‐based health coaching, weekly psychosocial support, and use of biomarkers to guide health optimization may aid in establishing effective behavior change centered around multiple reversible dementia risk factors.MethodWe piloted combined use of a six‐month online Cognitive Health Program (www.amosinstitute.com) with a telehealth lifestyle support group in six patients with subjective cognitive complaints receiving ongoing outpatient memory care. These patients were given lab‐guided personalized health recommendations for dementia risk reduction throughout the pilot intervention during monthly individual appointments with the study physician overseeing the group. A registered dietician was invited to lead the weekly telehealth lifestyle support group, which was delivered in partnership with the Center’s memory clinicians and health coaches. Highlights of the online Cognitive Health Program were reviewed by the dietician each week followed by group discussion on topics including diet, exercise, sleep, stress, and cognitive training. Cognition was assessed at baseline and post‐intervention using a computerized battery (www.cambridgebrainsciences.com). The significance of cognitive changes was estimated with nonparametric tests and effect sizes (Cohen’s d). The participants were also queried qualitatively on adherence and satisfaction.ResultCompared to baseline, the participants improved significantly in the global cognition score (p<.02, d = 1.6), and had significant improvements in spatial planning (p<.01, d = 2.3) and visuospatial processing (p<.05, d = 1.1). There was a borderline improvement in verbal reasoning (p<.06, d = 1.0). Subjective reports indicated that participants were able to successfully adhere to multiple lifestyle habits in the areas of sleep, nutrition, and exercise. Participants reported high levels of satisfaction with the virtual group format, the online curriculum, and access to the additional online resources.ConclusionA virtually administered, six‐month, weekly health coaching group that addresses multiple lifestyle factors associated with brain health, supplemented by self‐paced online health education and lab‐based health optimization by a physician, is feasible and potentially efficacious for improving cognition in participants with subjective cognitive impairment. This format may facilitate behavior change to slow cognitive decline. Future studies will include neuroimaging, formal neuropsychological testing, controls, and larger sample sizes.

Risk factors and socio-demographic determinants of tuberculosis relapse in the pediatric population

Risk factors and socio-demographic determinants of tuberculosis relapse in the pediatric population. The aim of the study was to evaluate the risk factors of tuberculosis (TB) relapse in the pediatric population and to identify sociodemographic determinants for establishing the risk reduction recommendations in tuberculosis relapse development. Material and methodology: a retrospective, case-control study was conducted, which included the study group – 27 relapses of TB and the control group with 109 new cases of TB diagnosed in children (age 0-18 years) hospitalized in the IMSP Municipal Hospital of Phthisiopneumology during 2006-2021. Results: socio-demographic determinants of new cases and TB relapse are the same, and the major risk factor for relapse is the comorbid state. Maintaining the dispensarisation of previously treated patients is one of the key principles of the clinical management.

Attitudes among Parents towards Return of Disease-Related Polygenic Risk Scores (PRS) for Their Children.

The electronic MEdical Records and GEnomics (eMERGE) consortium will return risk reports pertaining to specific diseases, a key component of which will be polygenic risk scores (PRS), to 25,000 participants, including 5000 children. Understanding comprehension and the perceived value of these PRS-based reports among parents will be critical for effective return of results in children. To address this issue, we conducted semi-structured interviews with 40 African American and Hispanic parents at The Children's Hospital of Philadelphia and Boston Children's Hospital. Each participant received a hypothetical risk report identifying their child as high risk for either type 2 diabetes or asthma. Participants were assessed on their comprehension of absolute versus relative risk framing, likelihood of following risk-reduction recommendations, perceived value of the information, psychosocial impact, education/support needed, and suggestions to improve the PRS-based report to make it more accessible. Results demonstrated high perceived value in receiving PRS-based reports but also draws attention to important shortfalls in comprehension due to factors including the health of the child, family history, and how the risk was framed. This study provides an insight into implementing the return of genomic risk scores in a pediatric setting.