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BACKGROUND/OBJECTIVES: The Kimel Family Centre for Brain Health and Wellness is a research-driven community centre testing the efficacy of personalized dementia risk reduction programming on dementia risk and cognition. The objective of this protocol is to validate this approach by following people for two years. DESIGN/SETTING: Participants will receive a comprehensive dementia risk assessment, including nonmodifiable and modifiable risk factors, from which they will receive a Personalized Dementia Risk Report and Program Strategy, indicating their health conditions increasing and their risk level in five modifiable risk domains: physical activity, brain-healthy eating, cognitive engagement, social connections, and mental wellbeing. Equipped with this information, participants will enroll in programs within the Centre to address their risk factors. Changes to their dementia risk, cognition, and Personalized Program Strategy will be communicated through re-assessments of risk factors every six months (risk and cognition) and every year (comprehensive assessment). PARTICIPANTS: Participants (n = 450) will be 50 years of age or older, without a diagnosis of dementia, and sufficiently fluent in English to complete the assessments and understand program instructors. One goal is that our participant sample will include people of low income (with fundraising providing free community centre membership), and from various ethno-racial backgrounds. INTERVENTION: Participants will select programs to meet their Personalized Program Strategy. For physical activity, they will gradually work toward the Canadian Society for Exercise Physiology guidelines. For brain-healthy eating, they will learn about the Brain Health Food Guide and food label reading, and then take additional programs. For cognitive engagement and mental wellbeing, they will take at least one hour of relevant programming per week. Social connections will be reinforced throughout all programs. All participants will also have access to the Canadian Consortium on Neurodegeneration's CAN-THUMBS Up online, educational program on modifiable dementia risk factors, called Brain Health PRO. MEASUREMENTS: The comprehensive assessment includes numerous dementia risk factors, but the primary measures are risk in the five domains, health conditions proximal to those five risk domains, and cognition, and how these are affected by adherence and quality of goal-directed future simulation. We hypothesize a reduced risk in the five domains within six months, improvements in health biomarkers within a year, and maintenance of cognition within two years, with these benefits accruing with greater adherence, but only up to a point, at which benefits will plateau, and greater benefits among participants whose goal-directed simulations are more vivid, personally-relevant, achievable, and positive. CONCLUSIONS: This innovative approach overcomes a number of limitations present in prior multidomain dementia prevention trials. Adapting a preference clinical trial that is embedded in a community centre, where participants have autonomy to choose programs to address their modifiable dementia risk factors, has real-world applicability in the global effort to reduce dementia risk.
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Demência , Comportamento de Redução do Risco , Humanos , Demência/prevenção & controle , Pessoa de Meia-Idade , Medição de Risco , Exercício Físico , Fatores de Risco , Idoso , Masculino , Feminino , Cognição/fisiologiaRESUMO
BACKGROUND: Little is known about the impact of short, low-intensity multidomain dementia risk reduction interventions in older adults. OBJECTIVES: To examine the effectiveness and feasibility of a low-intensity multidomain lifestyle intervention on dementia risk and dementia literacy in Australian older adults. DESIGN: Single-group pre-post design. SETTING: Community-dwelling. PARTICIPANTS: A total of 853 older Australians (Mean age=73.3 years, SD=6.1) recruited from the community. INTERVENTION: A 3-month dementia risk reduction program, BRAIN BOOTCAMP, including education, personalised risk information, physical cues for healthier choices and goal setting and planning to target four modifiable risk factors of diet, exercise, cognitive activity and social interaction in older adults. MEASUREMENTS: The 'LIfestyle for BRAin health' (LIBRA) index was used to assess participants' modifiable dementia risk based on 12 factors, with higher scores indicating greater risk. Dementia literacy was measured using a modified questionnaire derived from Dutch and British surveys, encompassing knowledge, risk reduction, and awareness aspects. Paired t-tests were used to compare dementia risk scores and dementia literacy before and after the program. Multivariate regressions were performed to identify sociodemographic and psychological factors associated with change in the LIBRA index. RESULTS: Program attrition was high (58.3%). Participants who completed the program had decreased dementia risk scores (Cohen's d=0.59, p<0.001), increased dementia literacy and awareness (Cohen's d=0.64, p<0.001) and increased motivation to change lifestyle behaviors (Cohen's d=0.25-0.52, p<0.016). Participants with higher motivational beliefs had greater dementia risk reduction. CONCLUSIONS: Improving older adults' motivation and knowledge may help modify lifestyle behaviors to reduce dementia risk. However, program attrition remains a challenge, suggesting the need for strategies to enhance participant engagement and retention in such interventions.
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Demência , Dieta , Exercício Físico , Comportamento de Redução do Risco , Interação Social , Humanos , Idoso , Projetos Piloto , Demência/prevenção & controle , Masculino , Feminino , Austrália , Cognição/fisiologia , Idoso de 80 Anos ou mais , Fatores de Risco , Letramento em Saúde , Vida Independente , Estilo de VidaRESUMO
Most participants reported a positive perception of bone active medication despite sustaining a fracture while taking the medication, reporting medication side effects, or having a healthcare provider stop the prescription. Participants did not appear to connect the medication to fracture risk, suggesting this connection should be emphasized by healthcare providers. OBJECTIVE: Our purpose was to examine perceptions about bone active medication from individuals with a fragility fracture and a prescription for bone active medication. METHODS: In this qualitative description study, eligible participants were those who attended an Osteoporosis Canada education session, and reported sustaining a previous fragility fracture and receiving a prescription for bone active medication. We conducted one-on-one interviews and analyzed the data using the analytic hierarchy approach. RESULTS: We interviewed 32 female participants (age range 58-89 years). Based on our analysis, two themes were developed: (1) most participants spoke positively about bone active medication, indicating they were willing to start, or continue to take, their medication. Positive perceptions were held by participants who sustained a fracture while taking bone active medication, participants whose healthcare provider had stopped the prescription, and participants who reported side effects from the medication; (2) most participants did not discuss bone active medication in relation to their fracture and did not appear to connect the medication to the concept of fracture risk. Instead, participants talked about the medication in relation to bone health in general, or to bone density. CONCLUSION: Participants appeared to have positive perceptions of bone active medication, despite sustaining a fracture while taking the medication, reporting medication side effects, or having a healthcare provider stop the prescription. Participants did not connect bone active medication to the concept of fracture risk, illustrating the need for healthcare providers to emphasize the connection between fracture risk and bone active medication.
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Conservadores da Densidade Óssea , Fraturas por Osteoporose , Humanos , Feminino , Idoso , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fraturas por Osteoporose/prevenção & controle , Conservadores da Densidade Óssea/uso terapêutico , Conservadores da Densidade Óssea/efeitos adversos , Osteoporose/tratamento farmacológico , Pesquisa Qualitativa , Comportamento de Redução do Risco , Conhecimentos, Atitudes e Prática em Saúde , CanadáRESUMO
BACKGROUND: Substantial variability in response to lifestyle interventions has been recognized for many years, and researchers have begun to disentangle sources of error from inherent differences in individual responsiveness. The objective of this secondary analysis of an intensive lifestyle intervention (diet and exercise) for metabolic syndrome (MetS) was to identify potentially important differences among study completers grouped by treatment response as measured by change in a continuous metabolic syndrome score (Gurka/MetS). METHODS: All study completers from a 12-month primary care study were categorized into one of five groups according to change in the Gurka/MetS score. A change of 0.4 in z-score defined clinically relevant change in line with results of previous studies. Repeated measures analysis of variance was used to examine cardiovascular disease risk and individual clinical indicators of MetS over 12 months, looking for differences in response over time by the five groups. RESULTS: Of 176 participants, 50% (n = 88) had stable scores, 10% (n = 18) had relevant change scores in the first 3 months only and reverted toward baseline, 20% (n = 35) achieved meaningful change over the whole study, 11% (n = 20) had a delayed response at 3-12 months, and 9% (n = 15) demonstrated worsening scores. Significant differential patterns were noted for groups over the duration of the intervention (p < .001). Improvement in diet quality and fitness scores were similar across all groups. Other available variables were tested and did not account for the differences. CONCLUSION: Work is needed to identify key factors that account for differences in responses to lifestyle interventions that can be used to guide treatment decisions for intensive lifestyle interventions for this common condition. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01616563; first registered June 12, 2012.
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Síndrome Metabólica , Humanos , Síndrome Metabólica/terapia , Síndrome Metabólica/dietoterapia , Masculino , Feminino , Pessoa de Meia-Idade , Estilo de Vida , Exercício Físico , Adulto , Idoso , Dieta , Comportamento de Redução do RiscoRESUMO
BACKGROUND: In developing nations, myocardial infarction (MI) remains a significant contributor to deaths from sudden cardiac arrest, with diet playing a key role in its incidence through oxidative stress mechanisms. Although the connection between the Dietary Antioxidant Index (DAI) and cardiovascular diseases has been demonstrated in some studies, the relationship between DAI and MI has not been extensively explored. Therefore, this research aims to investigate this association. METHODS: We conducted a nested case-control study involving 156 MI cases and 312 healthy controls, utilizing data from the Fasa Adults Cohort Study (FACS), a population-based study of individuals aged 35-70 residing in Fasa, Iran, with 11,097 participants included at baseline. The DAI was determined by normalizing the intake values of six dietary vitamins and minerals, adjusting by subtracting the global mean, and then dividing by the global standard deviation. MI diagnosis was established by an experienced cardiologist using electronic medical records. Conditional logistic regression was employed to examine the association between DAI and MI. RESULTS: There were no significant differences between the case and control groups in terms of age (P = 0.96), gender distribution (P = 0.98), and education level (P = 0.38). In a multiple conditional logistic regression analysis, after adjusting for key variables-including body mass index (BMI), smoking status, education level, and serum levels of triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol (TC), fasting blood sugar (FBS), saturated fatty acids (SFA), and polyunsaturated fatty acids (PUFA)-an inverse association was found between DAI and the risk of myocardial infarction (MI) [adjusted Odds Ratio (Adj OR) = 0.88, 95% Confidence Interval (CI): 0.85-0.92; P < 0.001]. CONCLUSIONS: This study highlights the crucial role of the DAI in reducing the risk of myocardial infarction. Promoting diets rich in antioxidants presents a straightforward and effective strategy for MI prevention and the promotion of cardiovascular health, underscoring the novelty and significance of this research in dietary approaches to disease prevention.
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Antioxidantes , Infarto do Miocárdio , Fatores de Proteção , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/epidemiologia , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/prevenção & controle , Infarto do Miocárdio/sangue , Irã (Geográfico)/epidemiologia , Estudos de Casos e Controles , Idoso , Adulto , Antioxidantes/administração & dosagem , Medição de Risco , Dieta Saudável , Fatores de Risco , Valor Nutritivo , Comportamento de Redução do Risco , Recomendações NutricionaisRESUMO
BACKGROUND: Intensive lifestyle interventions were effective to reduce the risk of type 2 diabetes mellitus (T2DM) for women with gestational diabetes mellitus (GDM) history. However, reaching these mothers and maintaining participation in lifestyle interventions is suboptimal in real-world settings. Effective, feasible and sustainable new lifestyle interventions are needed. The objectives of this three-arm trial are to (1) compare diabetes risk outcomes of an evidence-based intensive lifestyle modification (ILSM) intervention, a camp-style lifestyle modification program (CAMP) intervention, and usual care among women with GDM history; and (2) evaluate the comparative efficacy of the CAMP versus ILSM intervention on implementation outcomes. METHODS: A three-arm cluster randomized clinical trial (RCT) using a hybrid type 2 implementation design will be conducted in two counties in Hunan province in China. Six towns from each county will be randomly selected and assigned to CAMP, ILSM, and the usual care group (25 women from each of 12 towns, 100 women in each arm). The ILSM includes six biweekly in-person sessions and 3-month telephone health consultations, while the CAMP consists of a 2-day camp-based session and 3-month health consultations via a popular social media platform. Both interventions share the same session content, including six lifestyle skills. Efficacy (T2DM risk score and behavioral, anthropometric, psychosocial, and glycemic variables) and implementation outcomes (recruitment, acceptability, feasibility, fidelity, and cost-effectiveness) will be collected at baseline, 6-month, and 12-month. Pre-planned ANOVA F-test and generalized estimating equations will be included to test time-by-arm interactions. DISCUSSION: The CAMP intervention is expected to have better reach, better attendance, and comparable effectiveness in reducing the risk of T2DM, thus improving postpartum care for GDM in China. The delivery of a concentrated format supplemented with technology-based support may provide an efficient and effective delivery model for implementing maternal health promotion programs in primary care settings. TRIAL REGISTRATION: Registered in the Chinese Clinical Trial Registry (ChiCTR2200058150) on 31st March 2022.
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Diabetes Mellitus Tipo 2 , Diabetes Gestacional , População Rural , Adulto , Feminino , Humanos , Gravidez , China , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/prevenção & controle , Estilo de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento de Redução do RiscoRESUMO
INTRODUCTION: The Diabetes Prevention Program (DPP) is effective; enrollment is low. Little research has examined factors driving individuals' enrollment decisions. METHODS: In our final survey of a randomized trial comparing methods to increase enrollment in the DPP, we asked participants about factors impacting enrollment. We conducted interviews with a subgroup. RESULTS: Participants who completed the survey (n = 299) were primarily female (96 male); middle-aged (mean 52.9, SD = 14.7); white (86%); non-Hispanic (85%). Only 19% reported awareness of the DPP prior to the study. Cost, online availability, and behavior-change motivation were the most highly rated factors influencing enrollment. The median amount participants were willing to pay for the program was $66.50. Phone interviews included 17 individuals who were/were not interested in receiving a referral to the DPP. Those interested described risk awareness, family history, social support, and healthcare-provider influence as facilitating enrollment. Cost, time, travel, unsupportive family, incomplete knowledge about the program's impact and low self-efficacy were barriers. Among those uninterested, some were already engaging in lifestyle change, and some didn't see a benefit. CONCLUSIONS: Results suggest that, even among high-risk individuals, efforts to increase awareness and benefits of the DPP are needed, as are efforts to address cost of enrollment and low motivation. TRIAL REGISTRATION: ClinicalTrials.gov protocol ID: 00132307. The Effect of 360 Video and MAPS on Enrollment in the DPP. URL: https://www.clinicaltrials.gov/study/NCT04746781?id=00132307&rank=1.
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Estado Pré-Diabético , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Motivação , Diabetes Mellitus Tipo 2/prevenção & controle , Idoso , Estilo de Vida , Comportamento de Redução do Risco , Promoção da Saúde/métodos , Conhecimentos, Atitudes e Prática em SaúdeAssuntos
Analgésicos Opioides , Transtornos Relacionados ao Uso de Opioides , Dor Pós-Operatória , Humanos , Analgésicos Opioides/efeitos adversos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/etiologia , Medição de Risco , Fatores de Risco , Comportamento de Redução do RiscoRESUMO
Whilst dementia is a global health concern, recent research indicates that behaviour changes can reduce its risk. This study aimed to explore the impact of an interactive visual art exhibition on adults' motivation for dementia risk reduction. Participants (N = 165) completed the Motivation to Change Behaviour for Dementia Risk Reduction 10-item scale before and after the exhibition. Paired-sample t-tests compared changes in total motivation levels, and positive and negative cues to action scores. Multilinear regression was employed to identify predictors of increased motivation post exhibit. Participants showed a significant overall increase in motivation for brain-healthy lifestyles immediately post-exhibit (t(62) = - 2.70, p = 0.009), particularly with positive cues to action. Longer time spent engaging in the exhibit was associated with increased motivational change (R2 = 0.177, F(6,156) = 5.605, p < 0.001). Findings indicate that interactive visual art exhibitions hold significant potential as a means of enhancing adults' motivation for dementia risk reduction. By offering positive cues to action, these exhibitions could serve as an innovative component of public health strategies focused on promoting brain-healthy lifestyles. Our results contribute to the relatively limited body of research on the development of arts-based interventions that are both engaging and scalable, with the capacity to reach diverse populations. Further investigation into the long-term effects and underlying mechanisms is warranted to inform the design of more efficacious public health programs to support global efforts on mitigating the burden of dementia.
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Demência , Promoção da Saúde , Motivação , Comportamento de Redução do Risco , Humanos , Demência/prevenção & controle , Feminino , Masculino , Idoso , Pessoa de Meia-Idade , Promoção da Saúde/métodos , Adulto , Encéfalo/fisiologia , Idoso de 80 Anos ou maisRESUMO
Background Primary care practitioners worldwide are urged to promote dementia risk reduction as part of preventive care. To facilitate this in Australian primary care, we developed the Umbrella intervention, comprising a waiting room survey and patient information cards for use in consultations. Educational and relational strategies were employed to mitigate implementation barriers. Methods In this cross-sectional, non-randomised implementation study within the South East Melbourne Primary Health Network, we employed mixed-methods outcome evaluation. Antecedent outcomes (acceptability, appropriateness, and feasibility) and actual outcomes (adoption, penetration, and fidelity) were assessed from the perspective of primary care practitioners and patients. Results Five practices piloted the intervention and implementation strategies, including 16 primary care practitioners engaging with 159 patients. The Umbrella intervention was deemed acceptable, appropriate, and feasible, but penetration was limited. Approximately half of eligible primary care practitioners used the intervention, with moderate fidelity. Engagement with implementation strategies was similarly limited. While most strategies were well-received, improvements in online peer discussions and staff readiness were desired. Conclusions The Umbrella intervention is a viable approach to promoting dementia risk reduction in Australian general practice, supported by educational and relational strategies. Stakeholder-informed refinements to enhance uptake are recommended before advancing to a definitive trial.
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Demência , Medicina Geral , Atenção Primária à Saúde , Comportamento de Redução do Risco , Humanos , Estudos Transversais , Projetos Piloto , Masculino , Feminino , Austrália , Medicina Geral/métodos , Idoso , Pessoa de Meia-Idade , Promoção da Saúde/métodos , AdultoRESUMO
Patients with diabetes mellitus (DM) are at a higher risk of infectious diseases, and exercise is an important treatment modality for DM. Despite their susceptibility to infection in diabetic patients, the association between the amount of physical activity and the incidence of infective endocarditis (IE) is unclear. We attempted to demonstrate risk reduction by physical activity in diabetic patients with IE. From the National Health Insurance database, patients with DM were verified, and the incidence of IE was investigated. The level of physical activity was categorized into < 500, 500-999, 1,000-1,499, and ≥ 1,500 metabolic equivalent task (METs) minutes/week. Cox proportional hazard models were used to analyze the relationship between incident IE and physical activity. A total of 2,603,012 patients were included in this study. The incidence rate of IE was 10.06, 9.45, 7.78, and 8.84 in < 500, 500-999, 1,000-1,499, and ≥ 1,500 METs-minutes/week groups, respectively (100,000 person/year). A significant risk reduction of incident IE was observed in the 1,000-1499 and ≥ 1,500 METs-min/week groups compared to the < 500 METs-min/week group (Hazard ratio = 0.82, 95% confidence interval [0.690-0.976], HR = 0.831, 95% CI [0.704-0.981]). An analysis of a large national cohort database demonstrated that physical exercise reduced the risk of IE in patients with DM.
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Endocardite , Exercício Físico , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Incidência , Endocardite/epidemiologia , Endocardite/prevenção & controle , Comportamento de Redução do Risco , Estudos de Coortes , Adulto , Diabetes Mellitus/epidemiologia , Modelos de Riscos Proporcionais , Fatores de RiscoRESUMO
For patients considering surgery, the preoperative evaluation allows physicians to identify and treat acute cardiac conditions before less-urgent surgery, predict the benefits and harms of a proposed surgery, and make temporary management changes to reduce operative risk. Multiple risk prediction tools are reasonable for use in estimating perioperative cardiac risk, but management changes to reduce risk have proven elusive. For all but the most urgent surgical procedures, patients with active coronary syndromes or decompensated heart failure should have surgery postponed.
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Complicações Pós-Operatórias , Humanos , Medição de Risco/métodos , Complicações Pós-Operatórias/prevenção & controle , Complicações Pós-Operatórias/diagnóstico , Fatores de Risco , Doença das Coronárias/prevenção & controle , Comportamento de Redução do RiscoRESUMO
Tobacco use affects about 25% of the population and is the most important modifiable risk factor for many diseases, namely cancers, cardiovascular and pulmonary diseases. The role of the primary care physician is essential in providing screening and brief intervention to all patients, particularly to those at higher risk. This will help them to quit smoking, or adopt risk reduction strategies, according to their own wish. The main interventions include motivational support, nicotine replacement therapy and other medications. Vaping has been proved to be efficient for tobacco withdrawal and is still studied as a risk reduction tool. At the moment, it is considered by some as twenty times less harmful than smoked tobacco.
La consommation de tabac concerne environ 25 % de la population et est le facteur de risque modifiable le plus important pour de nombreuses pathologies, dont les cancers et les atteintes cardiovasculaires et pulmonaires. Le rôle du médecin de premier recours est primordial dans le dépistage et l'intervention brève chez tous les patients, notamment ceux à plus haut risque, afin d'aider à l'arrêt de la consommation ou à la mise en place de mesures de réduction des risques, selon leur souhait. Les principales stratégies comprennent, en plus de l'accompagnement, les substituts nicotiniques et les approches médicamenteuses. Le vapotage a aujourd'hui démontré son efficacité pour l'arrêt du tabac et, tout en étant encore à l'étude comme moyen de réduction des risques du tabac, il est estimé comme étant jusqu'à vingt fois moins nocif que ce dernier.
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Médicos de Atenção Primária , Abandono do Hábito de Fumar , Uso de Tabaco , Humanos , Abandono do Hábito de Fumar/métodos , Médicos de Atenção Primária/normas , Uso de Tabaco/prevenção & controle , Atenção Primária à Saúde/normas , Guias de Prática Clínica como Assunto , Papel do Médico , Fatores de Risco , Dispositivos para o Abandono do Uso de Tabaco , Vaping , Motivação , Comportamento de Redução do RiscoRESUMO
OBJECTIVE: To understand the perspectives of key informant experts regarding the relationship between food insecurity and gestational diabetes mellitus risk reduction behaviors among young American Indian and Alaska Native females. METHODS: Participants were adult key informants with expertise in food/nutrition and health within Tribal communities (N = 58) across the US. Data were collected through 1:1 interviews using a semistructured moderator guide and analyzed using thematic content analysis methods. RESULTS: Three themes included (1) diet and nutrition habits are formed through intergenerational food preferences and are driven by lasting implications of colonization; (2) young people are influenced by what their peers eat and the food environment, including outside of the home; and (3) the methods used to understand household food insecurity and nutrition habits in the parent study were likely limited. CONCLUSIONS AND IMPLICATIONS: Findings provide guidance as to where nutrition education and interventions may best support young Native females.
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Indígena Americano ou Nativo do Alasca , Diabetes Gestacional , Insegurança Alimentar , Adolescente , Adulto , Feminino , Humanos , Gravidez , Adulto Jovem , Diabetes Gestacional/prevenção & controle , Diabetes Gestacional/etnologia , Dieta Saudável/psicologia , Comportamento Alimentar/etnologia , Pesquisa Qualitativa , Comportamento de Redução do Risco , Estados UnidosRESUMO
OBJECTIVE: To determine the level of readiness on disaster risk-reduction management among employees of an educational institution. METHODS: The descriptive, evaluative study was conducted from March to April 2022 at 6 branches of Systems Plus College Foundation, Philippines, in Balibago, Rizal, Miranda, San Fernando, Caloocan and Cubao after approval from the ethics review committee of the Our Lady of Fatima University, Philippines, and comprised employees who were associated with the college for at least 6 months. Data was collected using Google Forms, and a validated tool was used to assess the disaster risk-reduction management readiness. The responses were categorised into 5 groups, ranging from 'very much ready' to 'not ready'. Gathered data was analysed by using SPSS version 20. Mean results were derived and presented with standard deviation. RESULTS: The responses suggested moderate readiness regarding structural safety codes 3.02±0.98, non-structural safety codes 3.02±1.04, availability of emergency supplies and equipment 2.84±1.09, and servicing and maintenance 2.85±1.03. CONCLUSIONS: Increasing the level of readiness related to disaster risk-reduction management must be given priority to ensure the safety of the employees in a higher education institution.
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Planejamento em Desastres , Humanos , Filipinas , Feminino , Gestão de Riscos/métodos , Adulto , Universidades , Comportamento de Redução do Risco , MasculinoRESUMO
BACKGROUND AND AIMS: Risk factor modification may decrease the risk of cardiovascular disease (CVD). Whether risk factor modification can mitigate the effect of hyperuricemia on CVD is unclear. This study aimed to investigate the risk of CVD among individuals with hyperuricemia, according to risk factors on target, compared with controls without hyperuricemia. METHODS AND RESULTS: This prospective study included 91,722 participants free of CVD at baseline (2006-2007) of the Kailuan study. Individuals with hyperuricemia were categorized according to the number of seven selected risk factors within the guideline-recommended target range (nonsmoking, physical activity, healthy diet, guideline-recommended levels of body mass index, blood pressure, fasting blood glucose, and total cholesterol). During a median follow-up of 13.00 years, 671 out of 6740 individuals (9.96%) with hyperuricemia and 6301 out of 84,982 control subjects (7.41%) had incident CVD. Compared with control subjects without hyperuricemia, individuals with hyperuricemia who had 4 or 5 to 7 risk factors on target had no significant excess CVD risk, the hazard ratio (HR) (95% confidence internal [CI]) was 0.93 (0.79-1.10) and 0.88 (0.71-1.10), respectively. Among individuals with hyperuricemia, excess CVD risk decreased stepwise for a higher number of risk factors on target, the HR of CVD associated with per additional risk factor within target range was 0.82 (95% CI, 0.77-0.87). Similar results were yielded for CVD subtypes. CONCLUSIONS: Among individuals with hyperuricemia, excess CVD risk decreased stepwise for a higher number of risk factors within target.
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Biomarcadores , Doenças Cardiovasculares , Fatores de Risco de Doenças Cardíacas , Hiperuricemia , Ácido Úrico , Humanos , Hiperuricemia/epidemiologia , Hiperuricemia/sangue , Hiperuricemia/diagnóstico , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/prevenção & controle , Estudos Prospectivos , Medição de Risco , Adulto , China/epidemiologia , Incidência , Biomarcadores/sangue , Fatores de Tempo , Ácido Úrico/sangue , Comportamento de Redução do Risco , Dieta Saudável , Prognóstico , Fatores de Proteção , Idoso , Fumar/epidemiologia , Fumar/efeitos adversos , Exercício Físico , Glicemia/metabolismo , Fatores de RiscoRESUMO
BACKGROUND: Metabolic dysfunction-associated fatty liver disease is a significant risk factor for cardiovascular disease (CVD). This study assesses the association between leisure-time physical activity, sedentary behavior, and CVD risk among patients with metabolic dysfunction-associated fatty liver disease, considering genetic predisposition to CVD. METHODS: This cohort study included 157â 794 participants with metabolic dysfunction-associated fatty liver disease from the UK Biobank who were free of CVD at baseline. The study measured leisure-time sedentary behaviors (watching TV, using a computer, and driving) and physical activities (walking for pleasure, light and heavy do-it-yourself activities, strenuous sports, and other exercises) in terms of frequency and duration over the 4 weeks before assessment. Both a Cox proportional hazard model and an isotemporal substitution model were utilized in the study to assess the association between leisure sedentary behavior, physical activities, and CVD risk. RESULTS: During a median 12.5 years of follow-up, 26â 355 CVD cases were reported, including 19â 746 coronary heart disease, 4836 stroke, and 7398 heart failure cases. High physical activity levels were linked to a significantly lower risk of CVD (21%), coronary heart disease (20%), stroke (15%), and heart failure (31%). In contrast, individuals with >6.5 h/d of sedentary behavior faced a 16% to 21% higher risk of these conditions compared with those with ≤3.5 h/d. Notably, replacing 30 minutes of inactivity with physical activity reduced CVD risks by 3% to 16%, particularly with strenuous sports. A significant interaction was observed between physical activity, sedentary behavior, and genetic predisposition in relation to stroke risk. CONCLUSIONS: Among patients with metabolic dysfunction-associated fatty liver disease, higher leisure-time physical activity levels correlate with reduced CVD risks, while increased sedentary behavior is linked to higher CVD risks. Replacing sedentary time with physical activity consistently shows benefits in reducing CVD outcomes, irrespective of genetic predisposition.
Assuntos
Doenças Cardiovasculares , Exercício Físico , Atividades de Lazer , Hepatopatia Gordurosa não Alcoólica , Comportamento Sedentário , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Doenças Cardiovasculares/epidemiologia , Medição de Risco , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Adulto , Idoso , Reino Unido/epidemiologia , Fatores de Risco , Fatores de Tempo , Comportamento de Redução do Risco , Fatores de Risco de Doenças Cardíacas , Fatores de Proteção , Estudos ProspectivosRESUMO
PURPOSE: Endoscopic sleeve gastroplasty (ESG) is a minimally invasive day procedure that the MERIT randomized controlled trial (RCT) has demonstrated to be an effective and safe method of weight loss versus lifestyle modification alone. We sought to evaluate the cost-effectiveness of ESG from the perspective of a US commercial payer in a cohort of adults with class II and class I obesity with diabetes based on this RCT. MATERIALS: We used a Markov modelling approach with BMI group health states and an absorbing death state. Baseline characteristics, utilities, BMI group transition probabilities, and adverse events (AEs) were informed by patient-level data from the MERIT RCT. Mortality was estimated by applying BMI-specific hazard ratios to US general population mortality rates. We used BMI-based health state utilities to reflect the impact of obesity comorbidities and applied disutilities due to ESG AEs. Costs included intervention costs, AE costs, and BMI-based annual direct healthcare costs to account for costs associated with obesity comorbidities. A willingness-to-pay threshold of $100,000 per quality-adjusted life year (QALY) was assumed. RESULTS: In our base-case analysis over a 5-year time horizon, ESG was cost-effective versus lifestyle modification alone with an incremental cost-effectiveness ratio of $23,432/QALY. ESG remained cost-effective in all sensitivity analyses we conducted and was dominant in analyses with longer time horizons. CONCLUSION: ESG is a cost-effective treatment option for people living with obesity and should be considered in commercial health plans as an additional treatment option for clinically eligible patients.