Screening For Risk Factors Research Articles

Chinese version of exercise dependence scale-revised: psychometric analysis and exploration of risk factors.

Exercise addiction (EA) is a dysfunctional behavior characterized by exaggerated training which has adverse effects on physiology and psychology. To examine the reliability and validity of the Chinese version of the Exercise Dependence Scale-Revised (EDS-R) and the social and psychological aspects related to EA, a large sample behavioral study was conducted. College students were selected as the target group. All of them were asked to finish the scales about exercise, including the Chinese version of EDS-R and the Motives for Physical Activity Measure-Revised scales. A confirmatory factor analysis, Mann-Whitney U test, and hierarchical regression test were performed to test the reliability and validity of the Chinese version of EDS-R and find the explanatory variables of EA. A total of 837 (556 female) students with a mean age of 20.38 years were recruited in the present study. The Chinese version of EDS-R showed good reliability and validity (McDonald's ω = 0.973, CR = 0.99, AVE = 0.80) in Chinese college students. EA was positively correlated with exercise frequency and ability motivation across the study sample. Besides, the Mann-Whitney U test revealed that the exercise motivation difference is the primary cause of the gender gap in EA. The Chinese version of EDS-R is a relatively robust and accurate instrument to assess the risk of EA. Additionally, exercise frequency and motivation may be the potential risk factors for EA. The screening of risk factors is of great significance for the early detection and prevention of EA.

Men with erectile dysfunction (ED) should be screened for cardiovascular risk factors - Cost-benefit considerations in Swiss men.

Background: Current evidence indicates that erectile dysfunction (ED) is an independent risk factor for future cardiovascular events. This study aimed to estimate the cost-effectiveness of screening and subsequent preventive treatment for cardiovascular risk factors among men newly diagnosed with ED from the Swiss healthcare system perspective. Methods: Based on known data on ED and cardiovascular disease (CVD) prevalence and incidence costs and effects of a screening intervention for cardiovascular risk including corresponding cardiovascular prevention in men with ED were calculated for the Swiss population over a period of 10 years. Results: Screening and cardiovascular prevention over a period of 10 years in Swiss men with ED of all seriousness degrees, moderate and severe ED only, or severe ED only can probably avoid 41,564, 35,627, or 21,206 acute CVD events, respectively. Number needed to screen (NNS) to prevent one acute CVD event is 30, 23, and 10, respectively. Costs for the screening intervention are expected to be covered at the seventh, the fifth, and the first year, respectively. Conclusion: Screening and intervention for cardiovascular risk factors in men suffering from ED is a cost-effective tool not only to strengthen prevention and early detection of cardiovascular diseases but also to avoid future cardiovascular events.

Exploring factors related to clinically advanced fibrosis in patients with nonalcoholic fatty liver disease or nonalcoholic steatohepatitis

ABSTRACT Objectives To describe the clinical profile of nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH) patients in a Texas integrated delivery network (IDN) and elucidate the local relationship between patient factors and the risk of advanced fibrosis. Methods This observational, retrospective, cross-sectional study utilized existing data from the electronic health record at a large Texas IDN. Data was collected during the study period from 1 January 2019, to 1 March 2023. Patient characteristics, comorbidities, labs, and medication orders were collected from the most recent encounter in which a Fibrosis-4 (FIB-4) score could be calculated. Chi square tests and analysis of variance (ANOVA) tests were conducted to evaluate differences among the three fibrosis risk categories. Ordinal logistic regression was utilized to assess associations between select variables and a higher risk of advanced fibrosis. Results A total of 56,253 patients were included in the study. 34,839 (61.9%) were Low-Risk 15,578 (27.7%) were Intermediate-Risk, and 5,836 (10.4%) were High-Risk of advanced fibrosis. Results showed that up to 70.4% of patients within a risk group were obese. Only 49.5% of patients in the High-Risk group had at least one gastroenterologist or hepatologist visit. Males, Medicare patients, former smokers, and those with hypertension, type 2 diabetes, and chronic kidney disease were associated with a higher risk of advanced fibrosis. Conclusion This study highlights the need for early screening and proactive management of metabolic risk factors for patients with NAFLD/NASH. The findings indicate a notable prevalence of obesity in the study population, a need for specialist referral for those at High-Risk of advanced fibrosis, and the importance of routine labs to evaluate metabolic factors. Primary care providers may be ideal providers to target these interventions and address this care need.

Evaluating the Predictive Value of a Short Preoperative Holistic Risk Factor Screening Questionnaire in Preventing Persistent Pain in Elective Adult Surgery: Study Protocol for a Prospective Observational Pragmatic Trial [PERISCOPE

Evaluating the Predictive Value of a Short Preoperative Holistic Risk Factor Screening Questionnaire in Preventing Persistent Pain in Elective Adult Surgery: Study Protocol for a Prospective Observational Pragmatic Trial [PERISCOPE

1873. The role of electronic health record note templates to improve screening for tuberculosis risk factors in children

Abstract Background Children should be evaluated annually for tuberculosis (TB) risk factors to detect and treat latent TB infection (LTBI), but there are gaps in screening and documentation. Embedding TB questions in an electronic health record (EHR) note template may increase screening. Methods TB risk assessment questions were added to the well-child and -adolescent note templates at a Federally Qualified Health Center in Oakland, California in 2014. We extracted EHR data from all well patient visits from individuals 1-19 years old without a past medical history of latent or active TB over a 7-year period. We compared the proportion of visits that documented TB risk factor screening, before and after introduction of the note template and annually. Results We examined 18,681 visits from 2014-2020, of which 7,071 (38%) were for children 1-4 years old, and 3,556 (19%) preferred a language other than English. One year after embedding TB risk factor questions in the note template, TB risk assessment increased from 76% to 92% (p = 0.02). In the subsequent six years, TB risk factor screening remained high ( >90%) and sustained (Figure 1). This trend was also seen among visits for those whose primary language spoken was not English. Screening for adolescents ≥12 years old improved over time (63% to 86%) but had lower overall screening than children 1-4 years old (≥90%) (Figure 1, p < 0.01). The lines represent the proportion of well-child or -adolescent visits that have documentation of a TB risk assessment, overall and for children who prefer a language other than English, as well as for children aged 1-4 years old and those older than 12. The red horizontal line indicates that assessments for TB risk factors were completed in 90% of visits during the given year. Conclusion A simple EHR-based intervention can significantly improve screening and documentation for TB risk factors in the primary care setting and suggests that additional EHR solutions may address other gaps in the LTBI care cascade. Disclosures All Authors: No reported disclosures

Pembentukan Desa Mitra Santun Lansia di Desa Tunas Mudo Sekernan Ilir Muaro Jambi

Advances in the health sector affected to the quality of all aspects of life including health services for the elderly. The ageing process in the elderly reduced their independence in maintaining health and independence in carrying out daily activities. The elderly were also very vulnerable to non-communicable diseases such as heart failure, hypertension, stroke and diabetes. Elderly people in the community can be empowered in terms of health education, screening for health risk factors and maintaining physical exercise. One of the strategies to increase the participation of the elderly’s provided elderly-friendly areas in a sustainable manner. This activity is the development of a partner village with the concept of an elderly-friendly village in Tunas Mudo Village, the Working Area of the Sekernan Ilir Muaro Jambi Health Center, which was carried out from July to September 2022. In the early stages of the activity, coordination was established with the Head of the Public Health Center and the local Village Head, then socialization was carried out with cadres, villagers and the elderly. At the implementation stage, there are 3 activities of screening and exercise for the elderly. This community service activity results investigated the health volunteer knowledge that was slightly increased for identifying changes in the elderly and maintaining the health of the elderly, the participation of the elderly in screening activities and physical exercise was improved. Supervision should be carried out routinely so that the elderly and villagers are able to implement friendly health behavior for the elderly and reduce risk factors for non-communicable diseases in the elderly

The application of CRISPR genome editing technologies in the pathogenesis studies, diagnosis, prevention and treatment of infectious diseases.

The CRISPR genome editing technology shows great application prospects in gene manipulation and infectious disease research, and is of great value for effective control and cure of infectious diseases. It has been utilized to generate specific disease models in cells, organoids and animals, which provide great convenience for research into the molecular mechanisms associated with infectious diseases. CRISPR screening technology enables high-throughput identification of risk factors. New molecular diagnostic tools based on CRISPR offer a more sensitive and faster method for detecting pathogens. The use of CRISPR tools to introduce resistance genes or to specifically destroy risk genes and virus genomes is intended to help prevent or treat infectious diseases. This review discusses the application of CRISPR genome editing technologies in the construction of disease models, screening of risk factors, pathogen diagnosis, and prevention and treatment of infectious diseases, thereby providing a reference for follow-up research in pathogenesis, diagnosis, prevention and treatment of infectious diseases.

Atherosclerosis in Patients with Congenital Hemophilia: A Focus on Peripheral Artery Disease.

Advances in the treatment of hemophilia have increased the life expectancy of this population and we are currently facing diseases associated with aging, including cardiovascular ones. Coronary atherosclerosis, with acute myocardial infarction as the most severe form of manifestation, has been recognized as part of the comorbidities of hemophiliacs. However, little is known about peripheral artery disease. Available data show that hemophiliacs have cardiovascular risk factors and atherosclerosis similar to the general population. Impaired thrombus formation and phenotype of atheroma plaque rather than the burden of atherosclerosis explains their lower cardiovascular mortality. Since the effect of traditional cardiovascular risk factors overpowers that of decreased coagulability and promotes the onset and progression of atherosclerotic lesions, screening for traditional cardiovascular risk factors and peripheral artery disease should be integrated into standard hemophilia care. There is evidence that invasive treatments and long-term antithrombotic therapy are generally safe, provided that coagulation factor levels are taken into account and replacement therapy is given when necessary.

Opportunistic health screening for cardiovascular and diabetes risk factors in primary care dental practices: experiences from a service evaluation and a call to action

Introduction Substantial evidence has established associations between oral health and chronic diseases, mediated by common risk factors and inflammatory processes. Dental professionals are aptly positioned to screen for cardiovascular disease and diabetes high-risk indicators. This article presents a service evaluation of two dental practices delivering health screening in dental practice, and a call to action for the wider profession.Methods Following training, two general dental practices implemented a suite of health screens, including blood pressure, blood glucose, cholesterol, body mass index (BMI) and waist-to-height ratio. A service evaluation was undertaken to review and improve service provision.Results Most patients (78.4%) had blood pressure values above normal range. More than half (55.8%) were outside of the healthy range for BMI. Out-of-range results for cholesterol were observed in less than one-fifth (16.7%). High blood glucose values were observed for few patients (3.3%).Conclusion Dental professionals can be successfully trained to deliver health screening interventions. Out-of-range health screening results offer an opportunity to provide targeted health advice for both the oral and general health. Clear protocols and careful interpretation of screening tests are required to minimise patients' confusion. More robust alliances between dental and general medical care are recommended.

Long-term and real-life incidence of cancer therapy-related cardiovascular toxicity in patients with breast cancer: a swedish cohort study

Abstract Background Cancer treatment and cancer itself increase the risk for cardiovascular disease (CVD) which in its turn contributes to cancer therapy-related cardiovascular toxicity (CTR-CVT). The aim of this study was to evaluate the long-term risk and predictors of CTR-CVT as well as all-cause mortality in women diagnosed with early breast cancer (BC) who were candidates for adjuvant chemotherapy. Methods Data from 433 women aged 18-60 years who were diagnosed with lymph node-positive BC between 1998-2002 and were eligible for adjuvant chemotherapy, were collected from Swedish health registers and medical records. For this study CTR-CVT was defined as hypertension (HT), coronary artery disease (CAD), heart failure (HF) or atrial fibrillation (AF) after the diagnosis of BC. Follow-up was from the date of BC diagnosis until November 30, 2021, or death. The incidence of CTR-CVT and all-cause mortality were calculated and hazard ratios (HR) for various factors associated with CTR-CVT were determined. Results The median age of the study population was 50 years (interquartile range (IQR) 32 years). A total of 910 CTR-CVT events were diagnosed in 311 women with a median of 19.3 years of follow-up (IQR 15.3 years). The proportions of CTR-CVT events were as follows: HT 281 (64%); CAD 198 (46%); HF 206 (47%); and AF 225 (51%). The cumulative incidence of CTR-CVT was 71.8% and 50% of all 433 patients developed CTR-CVT within 11.7 years of BC diagnosis (standard deviation (SD) 0.57, 95% confidence interval (CI) 10.6-12.9). Age was a risk factor for CTR-CVT. Treatment with anthracyclines increased the risk for HF (p=0.001; HR 2.0; 95%CI 1.4-2.8), CAD (p= 0.002; HR 1.7; 95% CI 1.2-2.4), and AF (p=0.013; HR 1.5; 95%CI 1.0-2.0). At the end of the 24-year study period, 227 of the 433 women were alive and the total cumulative mortality was 47.6%. Chemotherapy (anthracyclines or other agent) and older age at the time of BC diagnosis were associated with higher mortality rate. Conclusions In this cohort study the incidence of CTR-CVT and all-cause mortality after BC diagnosis and treatment was high, particularly in older patients and those receiving anthracyclines. This finding together with the time to onset of CTR-CVT, supports the current cardio-oncology guidelines recommending initial risk stratification, cardiovascular monitoring during treatment, followed by long-term annual screening for cardiovascular risk factors and CTR-CVT among BC survivors.Incidence CTR-CVTSurvival rate

Abstract 12487: Healthcare Access and Cardiovascular Risk Factor Management in Low-Income Working-Age Adults After the COVID-19 Pandemic

Background: Low-income working age adults disproportionately experienced disruptions in care and deepening financial hardship at the onset of the COVID-19 pandemic. Little is known about how health care access and cardiovascular (CV) risk factor management changed as the pandemic went on, and if these patterns differed by state Medicaid expansion status. Methods: We identified adults aged 18-64 using the CDC’s Behavioral Risk Factor Surveillance System. Low-income adults were defined as those with incomes <138% of the federal poverty level (FPL), and high-income adults >400% FPL. We fit logistic regression models to compare changes in measures of health care access and CV risk factor management in 2021 to a pre-pandemic baseline (2019), adjusted for age and sex. We included an interaction term for income level and year, to evaluate whether there was a differential change between low- and high-income adults. We also evaluated changes among low-income adults in Medicaid expansion vs. non-expansion states. Results: As shown in the Table , health insurance coverage, access to personal health care provider, and ability to afford care all improved in 2021 compared to pre-pandemic baseline (2019), although gains were more pronounced for high-income vs low-income groups. In contrast, the proportion of adults with a check-up in the past 12 months, or who received recommended cardiovascular risk factor screening, worsened in both low- and high-income groups. Among the low-income group, those in Medicaid expansion states experienced greater increases in insurance coverage than those in non-expansion states (OR 1.53 [1.40,1.68] vs 1.27 [1.11,1.46], p = 0.0283). Conclusion: In this national study, low- and high-income working-age adults experienced decreases in outpatient check-ups and CV risk factor screening in 2021 compared with pre-pandemic baseline. Public health initiatives are needed to improve screening for CV risk factor as the US emerges from the pandemic.

Abstract 14144: Higher Burden of Cardiovascular Risk Factors in Schizophrenia Patients: Results From All of Us Study

Background: Patients with schizophrenia experience a higher risk of mortality and morbidity from physical health issues, including cardiovascular disease, diabetes, and metabolic syndrome. The literature suggests that patients with schizophrenia have a higher prevalence of metabolic syndrome than the general population. However, there is limited research examining the prevalence of hypertension (HTN), hyperlipidemia (HLD), and types 2 diabetes mellitus (T2DM) among patients with schizophrenia in large biobank data. Therefore, this study aims to investigate the prevalence of three disorders among patients with schizophrenia enrolled in All of Us database. Methods: In this cross-sectional study, we included participants from All of Us dataset version 6. Schizophrenia cohort was defined as having at least one ICD diagnosis code for schizophrenia and one or more antipsychotic exposure for schizophrenia. Patients with HTN, HLD, T2DM were identified using diagnosis codes, blood pressure measurements, medication history, and laboratory results (HbA1C, fasting, and random blood glucose). The prevalence of each disease was identified in schizophrenia cohort as well as all participants enrolled in the database, and odds ratios were calculated. Results: Of 258,188 individuals with available electronic health records data, 3,246 had schizophrenia. The median age was 51.8 (SD 13.1). 1,687 (52.0%) were males, 1,407 (43.3%) were African American, and 1015 (31.3%) were White. The prevalence of HTN, HLD, T2DM in participants with schizophrenia was 38.9%, 34.6%, 16.5%, respectively, compared to 21.6%, 22%, and 7.9% in all participants. The unadjusted odds ratios of HTN, HLD, T2DM in participants with schizophrenia compared to all participants were 2.344 (95% CI 2.182-2.561), 1.889 (95% CI 1.756-2.032), 2.336 (95% CI 2.125-2.563), respectively. Conclusion: Our analysis shows that the prevalence of HTN, HLD, T2DM is higher in individuals with schizophrenia compared to all participants in All of Us database. This highlights the importance of regular screening and prevention of cardiovascular disease risk factors in patients with schizophrenia. Future studies regarding the impact of these disorders on schizophrenia patients need to be undertaken.

Abstract 14112: Reproductive Risk Factors and Pulmonary Arterial Hypertension in Women

Introduction: Pulmonary arterial hypertension (PAH) is a devastating disease that affects women more often than men. The female predominance has increased over time; recent U.S. cohorts demonstrate a female:male ratio of nearly 4:1. The role of women-specific risk, such as reproductive exposures, is poorly understood in the pathophysiology of PAH. Hypothesis/Goals: We hypothesize that reproductive exposures influence the development and/or severity of PAH in women. We sought to investigate the role of reproductive factors and contribution of exogenous estrogen exposures to PAH onset and severity. Methods: Using reproductive history/exposure questionnaires from 390 women with PAH, enrolled in both the PAH Biobank and United States Pulmonary Hypertension Scientific Registry, we conducted linear regression analyses to assess the association between individual disease severity variables, as well as REVEAL Lite 2.0 scores, and patient reported reproductive variables as the predictors (Table 1). We adjusted for potential confounders including age, race, BMI, and PAH sub-group (idiopathic, heritable, or associated). Results: We found that younger menopause age, less than or equal to 40 years old, associates with a lower cardiac index (CI) at diagnosis [β -0.57, p 0.02]. The association persisted when controlling for use of hormone replacement therapy (HRT). There was a trend toward lower CI in those with menopause age of 41 to 50 years old, but not statistically significant [p 0.10]. Ever use of HRT was associated with a higher pulmonary vascular resistance [β 1.6, p 0.05] and lower CI [β -0.28, p 0.01] at diagnosis. Conclusion: Premature menopause (age less than 40 years) and ever use of HRT associate with worse hemodynamics at diagnosis in women with PAH, including lower cardiac index. Further investigations into reproductive exposures may offer an opportunity for more comprehensive risk factor screening and modification by physicians treating PAH patients.

Abstract 13829: Assessing the Recovery From COVID-19-Related Disruptions to Cardiovascular-Related Screening Services by Race and Ethnicity

Introduction: The COVID-19 pandemic significantly disrupted routine clinical care in 2020. We aimed to assess recovery from COVID-19’s impacts on health care utilization, affordability, and cardiovascular risk factor screening in 2021, both overall and by race and ethnicity. Methods: We used 2019 and 2021 National Health Interview Survey data-a nationally-representative, cross-sectional household interview survey of US adults ( > 18 years old). Outcomes included measures of health care access, affordability, and cardiovascular risk factor screening. Logistic regression models compared outcomes in 2021 (second year of pandemic) to 2019 (pre-pandemic baseline), adjusting for age and sex. An interaction term for race/ethnicity and year assessed for differential change across racial/ethnic groups. Results: The weighted population size was 250.9 and 253.1 million adults in 2019 and 2021. In 2021, wellness visits significantly decreased for all racial/ethnic groups compared with 2019, a decline most pronounced for Asian adults. Medical financial concerns decreased for White, Black, and Hispanic adults. Blood pressure, cholesterol, and diabetes screening significantly decreased for all groups in 2021 vs. 2019, with the largest declines among Asian adults (see Table 1 and Figure 1 for all results). Conclusions: In this national study of US adults, there were significantly fewer wellness visits and lower rates of cardiovascular risk factor screening in 2021 compared to pre-pandemic levels, overall and across all racial and ethnic groups. These results suggest that policy efforts are needed to improve access and cardiovascular screening as the US emerges from the pandemic.

Health Care Access and Cardiovascular Risk Factor Management Among Working-Age US Adults During the Pandemic.

Low-income working-age US adults disproportionately experienced health care disruptions at the onset of the coronavirus disease 2019 pandemic. Little is known about how health care access and cardiovascular risk factor management changed as the pandemic went on or if patterns differed by state Medicaid expansion status. Cross-sectional data from the behavioral risk factor surveillance system were used to compare self-reported measures of health care access and cardiovascular risk factor management among US adults aged 18 to 64 years in 2021 (pandemic) to 2019 (prepandemic) using multivariable Poisson regression models. We assessed differential changes between low-income (<138% federal poverty level) and high-income (>400% federal poverty level) working-age adults by including an interaction term for income group and year. We then evaluated changes among low-income adults in Medicaid expansion versus nonexpansion states using a similar approach. The unweighted study population included 80 767 low-income and 184 136 high-income adults. Low-income adults experienced improvements in insurance coverage (relative risk [RR], 1.10 [95% CI, 1.08-1.12]), access to a provider (RR, 1.12 [95% CI, 1.09-1.14]), and ability to afford care (RR, 1.07 [95% CI, 1.05-1.09]) in 2021 compared with 2019. While these measures also improved for high-income adults, gains in coverage and ability to afford care were more pronounced among low-income adults. However, routine visits (RR, 0.96 [95% CI, 0.94-0.98]) and cholesterol testing (RR, 0.93 [95% CI, 0.91-0.96]) decreased for low-income adults, while diabetes screening (RR, 1.01 [95% CI, 0.95-1.08]) remained stable. Treatment for hypertension (RR, 1.05 [95% CI, 1.02-1.08]) increased, and diabetes-focused visits and insulin use remained stable. These patterns were similar for high-income adults. Across most outcomes, there were no differential changes between low-income adults residing in Medicaid expansion versus nonexpansion states. In this national study of working-age adults in the United States, measures of health care access improved for low- and high-income adults in 2021. However, routine outpatient visits and cardiovascular risk factor screening did not return to prepandemic levels, while risk factor treatment remained stable. As many coronavirus disease-era safety net policies come to an end, targeted strategies are needed to protect health care access and improve cardiovascular risk factor screening for working-age adults.

Utilisation of cardiovascular preventive services in a rheumatoid arthritis population-based cohort

ObjectivesThe objective is to examine utilisation of cardiovascular preventive services in patients with rheumatoid arthritis (RA), compared with a non-RA population, and to examine cardiovascular disease (CVD) screening rates among...

Factors Associated with Chronic Kidney Disease in Jigawa State, Nigeria: A Mixed Methods Study

Abstract Background: Chronic kidney disease (CKD) is becoming an increasing public health problem. A study that reviewed patients receiving treatment in hemodialysis centers reported 79.2% of patients from Jigawa State to be managed for CKD. This study aimed to find the factors associated with CKD among adults from high-burden kidney disease areas of Jigawa State. Materials and Methods: A cross-sectional descriptive study design that utilized mixed methods (quantitative and qualitative) of data collection (sequential explanatory) was used to study eligible respondents from the four local government areas (LGAs) reported to have a high burden of kidney disease. The modified WHO STEPS questionnaire, key informant interview, and in-depth interview guides were employed to collect information from the eligible selected community members. Multistage and purposive sampling techniques were used, and data were analyzed using IBM SPSS version 22.0 with a statistical significance set at P ≤ 0.05. Thematic analysis was used to analyze the qualitative interviews. Results: The age of the respondents ranged from 18 to 102 years, with a median of 45 (interquartile range = 30–80) years. The period prevalence over the past five years (2018–2023) of having kidney disease in the family was 67 (18.6%), while the point prevalence (currently having a patient with kidney disease) was 51 (14.1%). In terms of the distribution of cases by LGAs, Jahun reported more cases, 33.3% in the family within the last five years, followed by Hadejia 18.7%. In the same vein, respondents from Jahun 28.9% and Hadejia 16.5% reported more current cases of kidney disease in the family. The prevalence of ever had patient with chronic kidney disease in the family was significantly higher among those with systolic hypertension (BP) ≥140 mmHg (29.3%, P &lt; 0.001). Elevated systolic BP was significantly associated with currently having a kidney disease patient (23.3%, P = 0.001). The interviews revealed late presentation and noncompliance to medications among those with risk factors as the perceived facilitators of kidney disease. Conclusions: The prevalence of kidney disease was alarming in the high-burden kidney disease areas. The government should develop a sustainable model for mass community screening of risk factors and community-based health insurance to effectively manage all identified cases.

A scoping review of cardiovascular risk factor screening rates in general or family practice attendees living with severe mental ill-health.

Primary care is essential to address the unmet physical health needs of people with severe mental ill-health. Continued poor cardiovascular health demands improved screening and preventive care. No previous reviews have examined primary care cardiovascular screening rates for people living with severe mental ill-health; termed in the literature "severe mental illness". A scoping review following Joanna Briggs Institute methodology was conducted. Cardiovascular risk factor screening rates in adults with severe mental ill-health were examined in general or family practices (as the main delivery sites of primary care). Literature published between 2001 and 2023 was searched using electronic databases including Medline, Embase, Web of Science, PsychINFO and CINAHL. Two reviewers independently screened titles and abstracts and conducted a full-text review. The term "severe mental illness" was applied as the term applied in the literature over the past decades. Study information, participant details and cardiovascular risk factor screening rates for people with 'severe mental illness' were extracted and synthesised. Thirteen studies were included. Nine studies were from the United Kingdom and one each from Canada, Spain, New Zealand and the Netherlands. The general and/or family practice cardiovascular disease screening rates varied considerably across studies, ranging from 0% to 75% for people grouped within the term "severe mental illness". Lipids and blood pressure were the most screened risk factors. Cardiovascular disease screening rates in primary care settings for adults living with severe mental ill-health varied considerably. Tailored and targeted cardiovascular risk screening will enable more comprehensive preventive care to improve heart health outcomes and address this urgent health inequity.

Clinical characteristics, treatment, and management of pembrolizumab induced hemophagocytic lymphohistiocytosis.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and fatal adverse reaction to pembrolizumab. The clinical characteristics of pembrolizumab induced HLH are unknown. Exploring the clinical features of pembrolizumab induced HLH is crucial for the treatment and prevention of immune checkpoint inhibitor-induced HLH. The literature related to pembrolizumab induced HLH was collected for retrospective analysis by searching the Chinese and English databases from inception until August 31, 2023. A total of 24 patients were included, including 17 men (70.8%) with a median age of 61 years (41,80). The time between the last infusion and the start of HLH ranged from 2 to 46 days, with a median time of 14 days. Fever (100%) was the most common symptom, accompanied by splenomegaly (14 cases, 58.3%) and hepatomegaly (6 cases, 25.0%). Laboratory examination revealed revealed anemia (18 cases, 75.0%), leukopenia (12 cases, 50.0%), thrombocytopenia (20 cases, 83.3%), hypertriglyceridemia (11 cases, 45.8%), hypofibrinogenemia (11 cases, 45.8%). decreased natural killer cell function (7 cases, 29.2%), and elevated soluble CD25(15 cases, 62.5%). All patients developed hyperferriinemia, with a median of 30,808 ng/mL (range 1303 ~ 100,000). Bone marrow biopsy showed hemophagocytosis (15 cases, 62.5%). After discontinuation of pembrolizumab and treatment with steroids, etoposide, intravenous immunoglobulin, cytokine blocking, and immunosuppression, 17 patients recovered or improved, and 5 patients eventually died. HLH should be suspected when unexplained fever, cytopenia, splenomegaly, and elevated aminotransferase occur in patients using pembrolizumab. Screening for risk factors before treatment with pembrolizumab may be necessary to prevent HLH.

Androgen deprivation therapy and cardiovascular morbidity in prostate cancer: a narrative review

Prostate cancer is the most common malignancy in men, mostly affecting older men who harbor an increased prevalence of cardiovascular disease and metabolic syndrome. Androgen deprivation therapy (ADT), the standard therapy for various stages of prostate cancer, further increases the risk for cardiovascular disease and for metabolic syndrome. Therefore, screening for cardiovascular risk factors should be performed prior to the initiation of ADT, and, if necessary, cardiological evaluation and interdisciplinary management should be provided during and after completion of ADT. Moreover, the use of agonadotropin-releasing hormone (GnRH) antagonist may help reduce cardiovascular risk in patients with cardiovascular disease.