Self-reported Risk Factors Research Articles

Stroke and cardiovascular risk factors among working-aged Finnish migraineurs

BackgroundThe aim of our study was to evaluate the risk for comorbid cardio- and cerebrovascular diseases in the working-aged migraine population of Finland.MethodsA total of 1505 cases who reported diagnosed migraine and 3010 controls from a cohort of 11,596 cases in the Finnish Health and Social Support Study were included. The study material was linked with two registers. ICD diagnoses I63 for ischemic stroke (IS), I21 − I22 for acute myocardial infarction (AMI), and G43 for transient ischemic attack (TIA) among study participants were drawn from the national Finnish Care Register for Health Care at the follow-up in 2012. Reimbursed triptan prescriptions were drawn from the national Social Security Institution (SII) data. The self-reported vascular risk factors were hypertension, high cholesterol values, any diabetes, myocardial infarction, stroke, and TIA. Odds Ratios (OR) with 95% confidence (95% CI) intervals were assessed for diagnosed stroke, myocardial infarction, and TIA.ResultsMigraineurs were mostly female (82%) and ≥ 54 years old (62%). Triptans were reimbursed among 34.7% of migraineurs. A self-reported hypertension (21%), high serum cholesterol (38%), and any diabetes (7%) were more common among migraineurs vs controls (p < 0.05). There was no risk for AMI. The risk for TIA (OR 3.20, 95% CI 1.45–7.05) and IS (2.57, 95% CI 1.28–5.17) among migraineurs vs controls remained high after adjustment for self-reported hypertension, obesity, and smoking. The risk was higher among women in two groups ≥54 years (3.25, 95% CI 1.35–7.84 and 5.0, 95% CI 1.94–12.89, respectively). The average age for IS in migraine was 57.5 years and for TIA 58.2 years among women, and 52.8 years and 50.3 years among men, respectively.ConclusionCardiovascular risk should be screened in the aging migraine population, and hormonal and other migraine-related risk factors should be considered, especially among women. Efficacious attack treatment with triptans should be offered to migraine patients who do not show contraindications.

Self-Reported Modifiable Risk Factors of Cardiovascular Disease among Seafarers: A Cross-Sectional Study of Prevalence and Clustering

Background: Cardiovascular diseases (CVD) are the major cause of work-related mortality from diseases onboard ships in seafarers. CVD burden derives mainly from modifiable risk factors. To reduce the risk factors and the burden of CVD onboard ships in seafarers, it is important to understand the up-to-date prevalence of modifiable risk factors. The primary purpose of this study was to assess the prevalence and clustering of self-reported modifiable CVD risk factors among seafarers. We have also explored the association between socio-demographic and occupational characteristics and reported modifiable CVD risk factor clustering. Materials and methods: A cross-sectional study was conducted among seafarers from November to December 2020 on board ships. In total, 8125 seafarers aged 18 to 70 were selected from 400 ships. Data were collected using a standardized and anonymous self-reported questionnaire. The prevalence value for categorical variables and mean differences for continuous variables were compared using chi-square and independent sample t-tests. Multinomial logistic regression models were performed to identify independent predictors for modifiable CVD risk factor clustering. Results: Out of a total of 8125 seafarers aged ≥18 years on selected vessels, 4648 seafarers volunteered to participate in the survey, with a response rate of 57.2%. Out of 4318 participants included in analysis, 44.7% and 55.3% were officers and non-officers, respectively. The prevalence of reported hypertension, diabetes, current smoking and overweight or obesity were 20.8%, 8.5%, 32.5%, and 44.7%, respectively. Overall, 40%, 20.9%, 6% and 1.3% of the study participants respectively had one, two, three and four modifiable CVD risk factors. Older age (51+ years) (odds ratio (OR): 3.92, 95% confidence interval (CI): 2.44–6.29), being non-officers (OR: 1.36, 95% CI: 1.09–1.70), job duration (10–20 years) (OR: 2.73, 95% CI: 2.09–3.57), job duration (21+ years) (OR: 2.60, 95% CI: 1.79–3.78), working 57–70 h per week (OR: 2.03, 95% CI: 1.65–2.49) and working 71+ h per week (OR: 3.08, 95% CI: 2.42–3.92) were independent predictors for at least two self-reported modifiable CVD risk factor clustering. Conclusion: The results of our study demonstrate that more than four in six (68.5%) seafarers aged between 19 and 70 years have at least one of the modifiable CVD risk factors. Therefore, CVD prevention and modifiable risk factors reduction strategies targeting high-risk groups should be designed and implemented on board ships.

Physical Activity and Self-Reported Metabolic Syndrome Risk Factors in the Aboriginal Population in Perth, Australia, Measured Using an Adaptation of the Global Physical Activity Questionnaire (GPAQ).

Background: Complex, ongoing social factors have led to a context where metabolic syndrome (MetS) is disproportionately high in Aboriginal Australians. MetS is characterised by insulin resistance, abdominal obesity, hypertension, hypertriglyceridemia, high blood-sugar and low HDL-C. This descriptive study aimed to document physical activity levels, including domains and intensity and sedentary behaviour, and MetS risk factors in the Perth Aboriginal (predominately Noongar) community. Methods: The Global Physical Activity Questionnaire (GPAQ), together with a questionnaire on self-reported MetS risk factors, was circulated to community members for completion during 2014 (n = 129). Results: Data were analysed using chi-squared tests. The average (SD) age was 37.8 years (14) and BMI of 31.4 (8.2) kg/m2. Occupational, transport-related and leisure-time physical activity (PA) and sedentary intensities were reported across age categories. The median (interquartile range) daily sedentary time was 200 (78, 435), 240 (120, 420) and 180 (60, 300) minutes for the 18–25, 26–44 and 45+ year-olds, respectively (p = 0.973). Conclusions: An in-depth understanding of the types, frequencies and intensities of PA reported for the Perth Aboriginal community is important to implementing targeted strategies to reduce the prevalence of chronic disease in this context. Future efforts collaborating with community should aim to reduce the risk factors associated with MetS and improve quality of life.

Sex Differences in the Mediating Effects of Modifiable Risk Factors in Associations Between Socioeconomic Position and Cardiovascular Disease Morbidity and Mortality

Abstract Objectives Socioeconomic inequities in cardiovascular diseases (CVDs) are greater in females than males. However, the mechanisms underpinning the excess CVD risk conferred by low socioeconomic position (SEP) in females remain unclear. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and CVD morbidity and mortality. Methods We combined eight cycles of the nationally-representative cross-sectional Canadian Community Health Survey (2000–2011) to identify a cohort of adults (≥35 years) without CVD at the time of survey administration (n = 289,800). Survey data were linked to administrative health (Hospital Discharge Abstract Database) and mortality (Canadian Mortality Database) records for 2000–2012. SEP was captured by a latent variable consisting of self-reported educational level and household income. Self-reported modifiable risk factors, including smoking, physical inactivity, obesity, diabetes, and hypertension were considered as potential mediators. The outcome was CVD morbidity and mortality as reported in administrative health and mortality databases. Generalized structural equation modeling was used to estimate the mediating effects of modifiable risk factors in associations between SEP and CVD morbidity and mortality in males and females. Results The total effects of SEP on CVD morbidity and mortality were higher in females than in males. The modifiable risk factors mediated the higher proportion of the total effects in females than in males (87.80% vs 687.8%). Smoking was the most important mediator of associations between SEP and CVD morbidity and mortality for both males and females. The pathways linking SEP with obesity, diabetes and hypertension and subsequent CVD morbidity and mortality were significant in females but not among males. Conclusions These findings revealed evidence of some sex-specific patterns in the mediating effects of modifiable risk factors on associations between SEP and CVD morbidity and mortality. The findings suggest that different strategies may be required to reduce inequities in CVD in males and females. Funding Sources This study was funded by a Libin Cardiovascular Research Institute of Alberta Innovation Seed Grant and the Petro-Canada Young Innovator Award in Community Health.

Burnout amongst neurosurgical trainees in the UK and Ireland

IntroductionBurnout is becoming an increasingly recognised phenomenon within the medical profession. This study aims to investigate the presence of burnout amongst neurosurgical trainees in the UK and Ireland as well as investigating potential exacerbating and protective factors.MethodAn online survey was sent to all neurosurgical trainees in the UK and Ireland via the British Neurosurgical Trainees’ Association (BNTA) mailing list. Responding participants anonymously completed the Copenhagen Burnout Inventory (CBI) and answered questions about known risk factors for burnout including workplace environment, workplace bullying, time spent on leisure activities and sleep and reported likelihood of leaving neurosurgery. We also collated data on responders’ demographics. We compared CBI scores for participants with and without risk factors to determine correlation with CBI.ResultsThere were 75 respondents (response rate 42%) from a range of ages and all training grades, 72% of whom were male. The median CBI score was 38.85 (IQR 17.76). Participants showed a higher degree of personal and workplace burnout (median CBIs of 47.02, IQR 25.00; and 49.14, IQR 19.64, respectively) compared with patient-related burnout (median CBI 18.67, IQR 25.00). Participants with the following self-reported risk factors were significantly more likely to have higher CBIs: workplace bullying (p = 0.01), getting on less well with colleagues (p < 0.05), working longer hours (p < 0.05) and insufficient sleep, exercise and leisure time (all p < 0.01). Those with higher CBI scores were more likely to consider leaving neurosurgical training (p = 0.01).ConclusionWe identified a high burnout incidence in a cohort representative of UK neurosurgical trainees, although our results may have been skewed somewhat by selection bias. We determined potential risk factors for burnout related to specific workplace stressors and time for non-work activities. In the future, changes to training curricula should address these issues, aiming to improve training, enhance patient care and reduce attrition rates.

Seroprevalence of SARS-CoV-2 infection in health care workers of a teaching hospital in Belgium: self-reported occupational and household risk factors for seropositivity

This study aims to evaluate SARS-CoV-2 seroprevalence among health care workers (HCWs) and to assess self-reported risk factors for seropositivity. A total of 3255 HCWs were included and the overall seroprevalence was 7.8%. The likelihood of seropositivity was higher in participants reporting any COVID-19 symptoms within the last 4 months (OR 8.32, 95% CI 5.83-11.88, P < 0.001). Being a female HCW (OR 1.32, 95% CI 1.11–2.32, P < 0.01), having a cohabitant who was infected with SARS-CoV-2 (OR 2.55, 95% CI 1.78–3.66 P < 0.001) or a cohabitant who was a nursing home caregiver (OR 3.71, 95% CI 1.59–8.65, P = 0.002) were independently associated with an increased risk of seropositivity. Working in a COVID-19 unit (OR 1.64, 95% CI 1.21–2.23, P < 0.001) and being exposed to a SARS-CoV-2 infected co-worker (OR 1.30,95% CI 0.97–1.74, P = 0.016) resulted in higher seropositivity rate. Even if in-hospital exposure may play a significant role, increased infection risk is most likely attributable to household contact.

A comparison of self-reported risk and protective factors and the death implicit association test in the prediction of future suicide attempts in adolescent emergency department patients.

Concerns have been raised about the utility of self-report assessments in predicting future suicide attempts. Clinicians in pediatric emergency departments (EDs) often are required to assess suicidal risk. The Death Implicit Association Test (IAT) is an alternative to self-report assessment of suicidal risk that may have utility in ED settings. A total of 1679 adolescents recruited from 13 pediatric emergency rooms in the Pediatric Emergency Care Applied Research Network were assessed using a self-report survey of risk and protective factors for a suicide attempt, and the IAT, and then followed up 3 months later to determine if an attempt had occurred. The accuracy of prediction was compared between self-reports and the IAT using the area under the curve (AUC) with respect to receiver operator characteristics. A few self-report variables, namely, current and past suicide ideation, past suicidal behavior, total negative life events, and school or social connectedness, predicted an attempt at 3 months with an AUC of 0.87 [95% confidence interval (CI), 0.84-0.90] in the entire sample, and AUC = 0.91, (95% CI 0.85-0.95) for those who presented without reported suicidal ideation. The IAT did not add significantly to the predictive power of selected self-report variables. The IAT alone was modestly predictive of 3-month attempts in the overall sample ((AUC = 0.59, 95% CI 0.52-0.65) and was a better predictor in patients who were non-suicidal at baseline (AUC = 0.67, 95% CI 0.55-0.79). In pediatric EDs, a small set of self-reported items predicted suicide attempts within 3 months more accurately than did the IAT.

Self-reported Metabolic Risk Factor Associations with Adenomatous, Sessile Serrated, and Synchronous Adenomatous and Sessile Serrated Polyps.

Studies have found a positive association between metabolic risk factors, such as obesity and diabetes, and adenomatous polyps (AP). However, fewer studies have assessed the association between sessile serrated polyps (SSP) or synchronous diagnosis of APs and SSPs (synch polyps). Study participants (N = 1,370; ages 40-85) undergoing screening colonoscopy were enrolled between August 2016 and February 2020. Self-reported metabolic risk factors, including diabetes, hypertension, hyperlipidemia, and overweight/obesity, were evaluated for associations with new diagnoses of APs, SSPs, and synch polyps at the present colonoscopy. Average participant age was 60.73 ± 8.63 (SD) years; 56.7% were female and 90.9% white. In an assessment of individual metabolic risk factors, adjusted for age, sex, race, and smoking status, increased body mass index (BMI; overweight or obese vs. normal BMI of <25 kg/m2) was associated with an increased odds for new onset of colon APs (P trend < 0.001) as was a diagnosis of diabetes [adjusted conditional OR (aCOR) = 1.59 (1.10-2.29)]. No associations were seen between the metabolic risk factors and onset of SSPs. Being obese or hypertensive each increased the odds of new onset of synch polyps with aCOR values of 2.09 (1.01-4.32) and 1.79 (1.06-3.02), respectively. Self-reported risk factors may help assess polyp type risk. Because SSPs and synch polyps are rare, larger studies are needed to improve our understanding of the contribution of these factors to polyp risk. These data lead us to hypothesize that differences in observed metabolic risk factors between polyp types reflect select metabolic impact on pathways to colorectal cancer. PREVENTION RELEVANCE: Self-reported medical history provides valuable insight into polyp risk, potentially enabling the use of larger retrospective studies of colonoscopy populations to assess knowledge gaps. More aggressive colonoscopy screening, critical to colorectal cancer prevention, may be considered in populations of individuals with metabolic risk factors and modifiable lifestyle risk factors.

Quantifying the contribution of modifiable risk factors to socio-economic inequities in cancer morbidity and mortality: a nationally representative population-based cohort study.

Compared with those with a higher socio-economic position (SEP), individuals with a lower SEP have higher cancer morbidity and mortality. However, the contribution of modifiable risk factors to these inequities is not known. This study aimed to quantify the mediating effects of modifiable risk factors to associations between SEP and cancer morbidity and mortality. This study used a prospective observational cohort design. We combined eight cycles of the Canadian Community Health Survey (2000/2001-2011) as baseline data to identify a cohort of adults (≥35 years) without cancer at the time of survey administration (n = 309800). The cohort was linked to the Discharge Abstract Database and the Canadian Mortality Database for cancer morbidity and mortality ascertainment. Individuals were followed from the date they completed the Canadian Community Health Survey until 31 March 2013. Dates of individual first hospitalizations for cancer and deaths due to cancer were captured during this time period. SEP was operationalized using a latent variable combining measures of education and household income. Self-reported modifiable risk factors, including smoking, excess alcohol consumption, low fruit-and-vegetable intake, physical inactivity and obesity, were considered as potential mediators. Generalized structural equation modelling was used to estimate the mediating effects of modifiable risk factors in associations between low SEP and cancer morbidity and mortality in the total population and stratified by sex. Modifiable risk factors together explained 45.6% of associations between low SEP and overall cancer morbidity and mortality. Smoking was the most important mediator in the total population and for males, accounting for 15.5% and 40.2% of the total effect, respectively. For females, obesity was the most important mediator. Modifiable risk factors are important mediators of socio-economic inequities in cancer morbidity and mortality. Nevertheless, more than half of the variance in these associations remained unexplained. Midstream interventions that target modifiable risk factors may help to alleviate inequities in cancer risk in the short term. However, ultimately, upstream interventions that target structural determinants of health are needed to reduce overall socio-economic inequities in cancer morbidity and mortality.

THE ASSOCIATIONS BETWEEN HYPERTENSION AND STROKE FROM MAY MEASUREMENT MONTH AND BETWEEN NATIONAL HYPERTENSION PARAMETERS WITH STROKE MORTALITY FROM THE GLOBAL BURDEN OF DISEASE

Objective: To characterise the association between stroke history and hypertension from the 2017 and 2018 May Measurement Month (MMM) blood pressure (BP) screening campaigns. To identify whether national-level MMM hypertension parameters are associated with national stroke mortality statistics. Design and method: Three BP readings and self-reported demographic, lifestyle and cardiovascular risk factors were collected from 2,515,578 participants in 95 countries. National stroke mortality statistics and Socio-Demographic Index (SDI) were extracted from the Global Burden of Disease (GBD) study 2017. Hypertension was defined as a raised BP (systolic BP &gt; = 140 mmHg or diastolic BP &gt; = 90 mmHg based on the mean of the second and third readings), or on antihypertensive medication. Multiple imputation using chained equations was performed to estimate mean BP readings where missing. Logistic and linear regression were applied, respectively, to the association between hypertension and stroke and between national-level GBD stroke mortality with MMM proportions with raised, treated and uncontrolled BP. Results: Low-middle-SDI countries in MMM had the highest age-sex standardised proportion of participants with a previous stroke (4.9%), compared with high-middle-SDI countries (1.4%). Globally, individuals with a history of stroke had a significantly higher mean BP than those without (6.6/1.7 mmHg higher, p &lt; 0.001). Amongst post-stroke participants, antihypertensive medication appeared to mitigate the impact of lifestyle factors on the odds of hypertension. Stroke mortality increased, on average, by 34 per 100,000 per 1% increase in the proportion of untreated individuals with raised BP (p = 0.006) and by 22 per 100,000 per 1% increase in proportion with treated but uncontrolled BP (p = 0.003). Stroke mortality decreased, on average, by 14 per 100,000 per 1% increase in the proportion of hypertensives treated (p = 0.01). Conclusions: Our study found suboptimal BP control among participants with a previous stroke globally, especially in low SDI countries. There was a significant association between national stroke mortality from GBD and the proportions of participants with raised or uncontrolled BP and of hypertensives treated in MMM. This suggests that despite lacking a population-based design, estimates from MMM broadly reflect rates of downstream mortality and that opportunistic screening can be an effective means of screening for hypertension.

Self-reported health and smoking status, and body mass index: a case-control comparison based on GEN SCRIP (GENetics of SChizophRenia In Pakistan) data

IntroductionIndividuals with schizophrenia are at a high risk of physical health comorbidities and premature mortality. Cardiovascular and metabolic causes are an important contributor. There are gaps in monitoring, documenting and...

English

Lassa fever (LF) is an acute, viral hemorrhagic illness which is common in West Africa. Students of tertiary institutions are also exposed to risk factors. Hence, the study aimed to assess the knowledge and risk factors for Lassa fever amongst students of the Federal Polytechnic Auchi, Edo State, Nigeria. This descriptive cross-sectional study was conducted among 240 undergraduate students of the Federal Polytechnic, Auchi, Edo State, Nigeria, between August and October, 2019. The participants included 240 respondents with mean age of 22.77&plusmn;5.30 years, 147 (61.37%) females and 149 (62.1%) between 20-25 years. Most of the respondents 103(42.9%) were in their second year. Also, majority, 194 (80.8%) of them were aware of Lassa fever, but only 58 (29.6%) of them had knowledge of the disease. One hundred and thirty (67%) of them had high self-reported risk factors for LF. The most common risk factors for LF included: Poor hand-washing culture 176 (90.8%), inadequately covered food 175 (90.4%), lack of mouse proofs in places of residence 158 (81.3%) and bush burning 65 (33.8%). There was a statistically significant relationship between the age of respondents (p&lt;0.001) and the knowledge of Lassa fever. From the study, more than four-fifth of the respondents were aware of LF, but only a third of them had knowledge of the disease. Thus, it can be seen that the common risk factors mentioned by the respondents cannot simply be glossed over. The State government and school authority should provide more risk communication messages through health workers and indigenous media. Key words: Lassa fever, risk factors, knowledge, polytechnic, Auchi.

Self-Reported Risk Factors for Financial Distress and Attitudes Regarding Cost Discussions in Cancer Care: A Single-Institution Cross-Sectional Pilot Study of Breast Reconstruction Recipients.

High treatment costs associated with breast cancer are a substantial burden to patients and society. Despite mounting awareness, patient perspectives about the value of cost discussions in breast reconstruction and risk factors for financial distress are unknown. The authors performed a single-institution, cross-sectional survey of all women who underwent breast reconstruction following mastectomy or lumpectomy for breast cancer or risk reduction. Questions were derived from previously published survey items, and the authors leveraged regression analysis to identify patient-level risk factors for major financial distress. A total of 647 of 2293 patients returned the survey questionnaires (28.2 percent response rate). From the 647 respondents, 399 (62 percent) underwent breast reconstruction, and of these, 140 (35 percent) reported that total treatment expenses were higher than expected. One hundred twenty-nine breast reconstruction patients (32 percent) paid over $5000 in out-of-pocket costs. Two hundred eighty-four (71 percent) felt that surgeons should explain the estimated out-of-pocket costs when choosing a type of breast reconstruction and 205 (51 percent) believed that a financial consultation should be scheduled with every new cancer diagnosis. However, only 52 patients (13 percent) reported having had cost discussions with the treatment team. The incidence of major financial distress was n = 70 (18 percent), and following regression analysis, higher credit score and annual income were associated with a 66 percent and 69 percent risk reduction, respectively. Recipients of breast reconstruction demonstrate unanticipated and unplanned financial strain related to out-of-pocket expenses and believe that cost-consciousness should impact treatment decisions. Lower income and credit score are associated with financial distress. Cost discussions may optimize decision-making in preference sensitive conditions.

Discussion: Self-Reported Risk Factors for Financial Distress and Attitudes Regarding Cost Discussions in Cancer Care: A Single-Institution Cross-Sectional Pilot Study of Breast Reconstruction Recipients.

Discussion: Self-Reported Risk Factors for Financial Distress and Attitudes Regarding Cost Discussions in Cancer Care: A Single-Institution Cross-Sectional Pilot Study of Breast Reconstruction Recipients.

Discussion: Self-Reported Risk Factors for Financial Distress and Attitudes Regarding Cost Discussions in Cancer Care: A Single-Institution Cross-Sectional Pilot Study of Breast Reconstruction Recipients.

Discussion: Self-Reported Risk Factors for Financial Distress and Attitudes Regarding Cost Discussions in Cancer Care: A Single-Institution Cross-Sectional Pilot Study of Breast Reconstruction Recipients.

Association between physical activity level and cardiovascular risk factors in adolescents living with type 1 diabetes\xa0mellitus: a cross-sectional study

BackgroundType 1 diabetes mellitus (T1DM) is associated with an increased risk for cardiovascular disease (CVD) related morbidity and premature mortality. Regular physical activity plays an important role in the primary and secondary prevention of CVD, improving overall health and wellbeing. Previous observational studies have examined the associations between self-reported physical activity and CVD risk factors in largely adult Caucasian populations. However, limited work has evaluated the relationship between objectively measured physical activity and CVD risk factors in other ethnicities, particularly Chinese youth living with T1DM.MethodsThis cross-sectional study assessed CVD risk factors, physical activity, and aerobic fitness (and their associations) in Chinese youth living with T1DM (n = 48) and peers (n = 19) without T1DM. Primary outcomes included blood pressure, lipid profiles, and physical activity (accelerometry). Statistical differences between groups were determined with chi-square, independent-samples t-tests, or analysis of covariance. The associations between aerobic fitness, daily physical activity variables, and CVD risk factors were assessed with univariate and multivariate linear regression analyses.ResultsResults were summarized using means and standard deviation (SD) for normally distributed variables and medians and 25–75th quartile for non-normally distributed variables. In comparison to peers without diabetes, youth living with T1DM showed higher levels of total cholesterol (3.14 ± 0.67 vs. 4.03 ± 0.81 mmol·L-1, p = 0.001), low-density lipoprotein cholesterol (1.74 ± 0.38 vs. 2.31 ± 0.72 mmol·L-1, p = 0.005), and triglycerides (0.60 ± 0.40 vs. 0.89 ± 0.31 mmol·L-1p = 0.012), and lower maximal oxygen power (44.43 ± 8.29 vs. 35.48 ± 8.72 mL·kg-1·min-1, p = 0.003), total physical activity counts (451.01 ± 133.52 vs. 346.87 ± 101.97 counts·min-1, p = 0.004), metabolic equivalents (METs) (2.41 ± 0.60 vs. 2.09 ± 0.41 METs, p = 0.033), moderate-to-vigorous intensity physical activity [MVPA: 89.57 (61.00–124.14) vs (53.19 (35.68–63.16) min, p = 0.001], and the percentage of time spent in MVPA [11.91 (7.74–16.22) vs 8.56 (6.18–10.12) %, p = 0.038]. The level of high-density lipoprotein cholesterol was positively associated with METs (β = 0.29, p = 0.030, model R2 = 0.168), and the level of triglycerides was negatively associated with physical activity counts (β = − 0.001, p = 0.018, model R2 = 0.205) and METs (β = − 0.359, p = 0.015, model R2 = 0.208), and positively associated with time spent in sedentary behaviour (β = 0.002, p = 0.041, model R2 = 0.156) in persons living with T1DM.ConclusionsChinese youth with T1DM, despite their young age and short duration of diabetes, present early signs of CVD risk, as well as low physical activity levels and cardiorespiratory fitness compared to apparently healthy peers without diabetes. Regular physical activity is associated with a beneficial cardiovascular profile in T1DM, including improvements in lipid profile. Thus, physical activity participation should be widely promoted in youth living with T1DM.

Development of a multivariable model to predict medication non-adherence risk factor for patients with acute coronary syndrome

Abstract Objective The aim of this study was to develop a risk prediction model for non-adherence to prescribed medication based on self-reported risk factors in patients with the acute coronary syndrome (ACS). Methods This is a prospective follow-up cohort study of 210 patients with ACS at a tertiary hospital in Al Ain city in the United Arab Emirates. Patients with ACS in the electronic registry who were discharged from the hospital but continued to attend outpatient clinics and were prescribed evidence-based medications were identified and interviewed. Univariate and multivariate logistic regression models were constructed and used as appropriate. SPSS V24 was used for data analysis. Key findings A final predictive model of eight variables was developed for ACS medication non-adherence. The significant predicted risk factors identified in the final model with their odds ratios (ORs) and confidence intervals (CIs) were as follows: poor knowledge of prescribed medications (OR = 1.81; CI = 1.032–3.34; P = 0.010), five or more prescribed medicines (OR = 4.97; CI = 1.98–2.49; P = 0.007), more than twice daily dosing regimen (OR = 2.21; CI = 1.04–4.67; P = 0.039), unpleasant side-effects (OR = 2.97; CI = 1.98–2.49; P = 0.007), patients believed that side-effects were the cause of health problems (OR = 4.28; CI = 1.78–10.39; P = 0.001), patients undertaking regular exercise (OR = 2.14; CI = 1.06–4.32; P = 0.035), and comorbid diabetes (OR = 1.97; CI = 1.00–3.87; P = 0.049). Conclusion This study indicates poor knowledge, polypharmacy and comorbidity as risk factors associated with medication non-adherence among patients with ACS. Identification of predictors of non-adherence and strategies has the potential to reduce non-adherence dramatically.

Validation of multivariable lung cancer risk prediction models for the personalized assignment of optimal screening frequency: a retrospective analysis of data from the German Lung Cancer Screening Intervention Trial (LUSI).

BackgroundCurrent guidelines for lung cancer screening via low-dose computed tomography recommend annual screening for all candidates meeting basic eligibility criteria. However, lung cancer risk of eligible screening participants can vary widely, and further risk stratification could be used to individually optimize screening intervals in view of expected benefits, possible harms and financial costs. To this effect, models have been developed in the US National Lung Screening Trial based on self-reported lung cancer risk factors and imaging data. We evaluated these models using data from an independent screening trial in Germany.MethodsWe examined the Polynomial model by Schreuder et al., the Lung Cancer Risk Assessment Tool extended by CT characteristics (LCRAT + CT) by Robbins et al., and a criterion of presence vs. absence of pulmonary nodules ≥4 mm (Patz et al.), applied to sub-sets of screening participants according to eligibility criteria. Discrimination was evaluated via the receiver operating characteristic curve. Delayed diagnoses and false positive results were calculated at various thresholds of predicted risk. Model calibration was assessed by comparing mean predicted risk versus observed incidence.ResultsOne thousand five hundred and six participants were eligible for the validation of the LCRAT + CT model, and 1,889 for the validation of the Polynomial model and Patz criterion, yielding areas under the receiver operating characteristic curve of 0.73 (95% CI: 0.63, 0.82), 0.75 (0.67, 0.83), and 0.56 (0.53, 0.72) respectively. Skipping 50% annual screenings (participants within the 5 lowest risk deciles by LCRAT + CT in any round or by the Polynomial model; baseline screening round), would have avoided 75% (21.9%, 98.7%) and 40% (21.8%, 61.1%) false positive screen tests and delayed 10% (1.8%, 33.1%) or no (0%, 32.1%) diagnoses, respectively. Using the Patz criterion, referring 63.2% (61.0% to 65.4%) of participants to biennial screening would have avoided 4% (0.2% to 22.3%) of false positive screen tests but delayed 55% (24.6% to 81.9%) diagnoses.ConclusionsIn this German trial, the LCRAT + CT and Polynomial models showed useful discrimination of screening participants for one-year lung cancer risk following CT examination. Our results illustrate the remaining heterogeneity in risk within screening-eligible subjects and the trade-off between a low-frequency screening approach and delayed detection.

Abstract P680: Stroke, Stroke Risk Factors and Physical Activity Among Overweight and Obese Women of Reproductive Age

Background: Stroke is a concern for women of reproductive age, as pregnant women have an increased risk of stroke. Primary prevention is critical to reducing this burden among this group. High physical activity levels (compared to low physical activity levels) can decrease stroke risks in adults, though this is not well-researched among women of reproductive age. Methods: Using NHANES 2013-2017 data, we examined the impact of physical activity on self-reported stroke and risk factors for stroke among overweight and obese women of reproductive age (20-44) using logistic regression models. Covariates include age, race, and smoking status. Risk factors examined were stroke history, hypertension, elevated total cholesterol, LDL cholesterol, triglycerides, and blood glucose levels. Results: Logistic regression models showed that getting at least 150 minutes of exercise per week reduced the odds of having elevated glucose levels by 58% (aOR=0.425, 95% CI=0.19-0.95). While physical activity did not show any significant differences in the other stroke risk factors, there was a trend toward a lower percentage of women having hypertension and elevated triglycerides if they were physically active. Further, compared to white women, Black women had nearly two times higher odds of having hypertension (aOR=1.97, 95%CI 1.41-2.76). Conclusions: Previous studies show that increasing physical activity can lower stroke risk, including lowering blood pressure and insulin levels. While our results show lower blood glucose among physically active overweight or obese women of reproductive age, a similar effect was not seen for hypertension. In this population, hypertension may result in adverse maternal outcomes such as pre-eclampsia, eclampsia or stroke during pregnancy, should a woman become pregnant. This demonstrates the importance of managing stroke-related risk factors during a woman’s reproductive years.

Pandemic blood donor demographics – Do changes impact blood safety?

BackgroundCOVID‐19 safety measures and possibly SARS‐CoV‐2 antibody testing may alter blood donor demography, which has the potential to alter blood safety. We characterized pre‐pandemic and pandemic rates of donor infectious disease marker (IDM) reactivity which reflect the residual risk of transfusion‐transmitted infections (TTIs) undetectable by current testing.MethodsThis cross‐sectional analysis of allogeneic blood donor presentations and successful donations in a large national US blood collector identifies changes in self‐reported behavioral risk factors and IDM reactivity. Data on allogeneic blood donor presentations and successful donations from March 1 through August 31, 2020 and the same period in 2019 were retrieved from the blood center's computer system. Donor demographics and deferrals for reported behavioral risk factors and confirmed‐positive IDMs were compared in pre‐pandemic and pandemic periods.ResultsWith increasing mobile blood drive cancellations, pandemic donors were more likely than 2019 donors to be female, over age 30, non‐Hispanic Whites, and have a post‐secondary degree. First‐time donations (at highest risk for confirmed‐positive IDMs) did not substantially increase. Pandemic donors reported fewer behavioral risks and IDMs declined among these donors. Mid‐pandemic introduction of screening for SARS‐CoV‐2 antibodies did not affect IDM rates.ConclusionsUnlike disasters, which tend to bring out more first‐time donors with increased IDM reactivity and TTI residual risk, COVID‐19 donors had lower IDM rates which were not affected by SARS‐CoV‐2 antibody testing. Already‐low TTI residual risk is likely to have declined as a result.