The purpose of this study was to discover how considering multiplicative, additive, and interactive effects modifies results of a prospective cohort study on coronary heart disease (CHD) incidence ...and its main risk factors.
The Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study provided the study material, 2682 Eastern Finnish middle-aged men, followed since the 1980s. We applied multiplicative and additive survival models together with different statistical metrics and confidence intervals for risk ratios and risk differences to estimate the nature of associations.
The mean (SD) follow-up time among men who were free of CHD at baseline (n = 1958) was 21.4 (10.4) years, and 717 (37%) of them had the disease and 301 (15%) died for CHD before the end of follow-up. All tested non-modifiable and modifiable risk factors statistically significantly predicted CHD incidence. We detected three interactions: circulating low-density lipoprotein cholesterol (LDL-C) × age, obesity × age, and obesity × smoking of which LDL-C × age was the most evident one. High LDL-C increased the risk of CHD more among men younger than 50 risk ratio (RR) 2.10 than those older than 50 (RR 1.22). LDL-C status was the only additive covariate. The additive effect of high LDL-C increased almost linearly up to 18 years and then reached a plateau. The simple multiplicative survival model stressed glycemic status as the strongest modifiable risk factor for developing CHD hazard ratio (HR) for diabetes vs. normoglycemia was 2.69, whereas the model considering interactions and time dependence emphasised the role of LDL-C status (HR for high LDL-C vs. lower than borderline was 4.43). Age was the strongest non-modifiable predictor.
Including covariate interactions and time dependence in survival models potentially refine results of epidemiological analyses and ease to define the order of importance across CHD risk factors.
KEY MESSAGES
Including covariate interactions and time dependence in survival models potentially refine results of epidemiological analyses on coronary heart disease.
Including covariate interactions and time dependence in survival models potentially ease to define the order of importance across coronary heart disease risk factors.
Purpose
Serum copper (Cu), zinc (Zn), and Cu/Zn-ratio have emerged as ageing-related biomarkers. We sought to assess the association between Cu/Zn-ratio and chronic obstructive pulmonary disease ...(COPD) risk.
Methods
Serum Cu and Zn were measured using atomic absorption spectrometry in 2,503 men aged 42–61 years.
Results
During a median follow-up of 27.1 years, 210 COPD cases occurred. Serum Cu/Zn-ratio and Cu concentrations were linearly associated with COPD risk, whereas the relationship was curvilinear for Zn and COPD risk. A unit increase in Cu/Zn-ratio was associated with an increased COPD risk in multivariable analysis (hazard ratio, HR 1.81; 95% CI 1.08–3.05). The corresponding adjusted HR (95% CI) was 3.17 (1.40–7.15) for Cu. Compared to the bottom tertile of Zn, the HRs (95% CIs) were 0.68 (0.48–0.97) and 1.01 (0.73–1.41) for the middle and top tertiles of Zn, respectively.
Conclusions
Increased serum Cu/Zn-ratio and Cu concentrations were linearly associated with an increased COPD risk in men.
Background
Future nursing shortages and advanced technological developments mean that robots and automated devices could play a valuable role in nursing, but little has been published on their use, ...and outcomes, to date.
Aim
This integrative review identified how robots are currently used in nursing and the outcomes of those initiatives.
Design
This study used integrative review using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses.
Data sources
We searched the CINAHL, PubMed, Web of Science, and Scopus databases for peer‐reviewed papers published in English from January 2010 to August 2018.
Review methods
The five‐stage review process by Whittemore and Knafl was used.
Results
The 25 included papers showed that robots and automated devices were mainly used in nursing to deliver medication, monitor patients, and provide nursing treatments. The outcomes were evaluated in relation to patient safety, working time and workload, usability, and the end users' satisfaction. In addition, the costs, care outcomes, nurses' behaviour, and changes in working procedures were considered.
Conclusions
Robots and automated devices have the potential to develop nurses' work, but more research and critical evaluations are needed to find the most suitable devices and focus on the functions that will provide the best outcomes for nurses' work.
SUMMARY STATEMENT
What is already known about this topic?
The use of robotics in care has been of increased interest to researchers in recent years.
Nurses are the largest staff group in health care; and nursing shortages, greater care needs, and technological advances are driving the need for changes to nursing practice.
A number of researchers have considered how automated devices can deliver traditional nursing functions.
What this paper adds?
This paper provides an integrated review of how robots and automated devices can be used in nursing.
To date, the most commonly studied field has been dispensing medication, and the most frequent outcomes have been medication errors.
Other research areas have been patient monitoring and nursing treatments, and studies have highlighted the outcomes of nursing workloads, working time, and user satisfaction.
The implications of this paper:
The results of this paper can be used to identify the nursing fields that can effectively use robotics and automated devices in clinical care and the expected outcomes. This knowledge can also be used by nursing managers to develop nurses' work.
Based on our analysis of the existing research studies, it is very clear that more research is needed in this area.
We aimed to determine whether handgrip strength (HGS)improves type 2 diabetes (T2D) risk prediction beyond conventional risk factors.
Handgrip strength was assessed at baseline in 776 individuals ...aged 60-72 years without a history of T2D in a prospective cohort. Handgrip strength was normalized to account for the effect of body weight. Hazard ratios (HRs) (95% confidence intervals CI) and measures of risk discrimination for T2D and reclassification net reclassification improvement (NRI), integrated discrimination index (IDI) were assessed.
During 18.1 years median follow-up, 59 T2D events were recorded. The HR (95% CI)for T2D adjusted for conventional risk factors was 0.49 (0.31-0.80) per 1 standard deviation higher normalised HGS and was 0.54 (0.31-0.95) and 0.53 (0.29-0.97) on adjustment for risk factors in the DESIR and KORA S4/F4 prediction models, respectively. Adding normalised HGS to these risk scores was associated with improved risk prediction as measured by differences in −2 log likelihood, NRI and IDI. Sex-specific HRs and risk prediction findings using sensitive measures suggested the overall results were driven by those in women.
Adding measurements of HGS to conventional risk factors might improve T2D risk assessment, especially in women. Further evaluation is needed in larger studies.
KEY MESSAGES
Handgrip strength (HGS) is independently associated with reduced risk of type 2 diabetes (T2D), but its utility in classifying or predicting T2D risk has not been explored.
In this prospective cohort study of older Caucasian men and women, adding measurements of HGS to conventional risk factors improved T2D risk assessment, especially in women.
Assessment of HGS is simple and inexpensive and could prove a valuable clinical tool in the early identification of people at high risk of future T2D.
Background: Atherosclerotic cardiovascular disease (ASCVD) shares several risk factors with venous thromboembolism (VTE). The American Heart Association's Life's Simple 7 (LS7), which included seven ...health and behavioural factors for CVD prevention, has recently been upgraded to Life's Essential 8 (LE8) score. We aimed to examine the prospective association between LE8 and the risks of ASCVD and VTE in Finland.
Methods: We utilized data based on 1899 men aged 42-61 years in the Kuopio Ischaemic Heart Disease (KIHD) prospective study. The LE8 score was generated from baselines measures of four health behaviours (physical activity, diet, nicotine exposure and sleep health) and four health factors (BMI, blood lipids, blood glucose and blood pressure). Each factor was scored from 0 to 100 and summed into a composite score. Participants were classified into quartiles (Q) based on the total LE8 score - Q1, ≤ 420; Q2, >420 to 485; Q3, >485 to 550; Q4, >550. Multivariable Cox regression models were utilized to determine the hazard ratios (HRs) along with the 95% confidence intervals (CI) for ASCVD and VTE.
Results: After median follow-up durations of 24 and 25 years, 889 ASCVD and 127 VTE events were recorded, respectively. The risk of ASCVD was found to be 58% lower in men belonging to the highest LE8 quartile compared to those in the lowest quartile (HR:0.42; 95%CI: 0.34-0.51). There was no significant evidence of an association between LE8 and VTE risk (Q4 vs Q1, HR:1.02; 95%CI: 0.60-1.74).
Conclusion: The risk of ASCVD was significantly lower in middle-aged and older Finnish men who had a high LE8 score, but there was no significant association with VTE. Further large-scale prospective studies conducted in women and other population groups are necessary to confirm these findings.
We carried out this study to demonstrate the effects of outcome sensitivity, participant exclusions, and covariate manipulations on results of the epidemiological analysis of coronary heart disease ...(CHD) and its behaviour-related risk factors.
Our study population consisted of 1592 54-year-old men, who participated in the Kuopio Ischaemic Heart Disease Risk Factor (KIHD) Study. We used the Cox proportional-hazards model to predict the hazard of CHD and applied different sets of outcomes concerning outcome sensitivity and data preprocessing procedures regarding participant exclusions and covariate manipulations.
The mean follow-up time was 23 years, and 730 men received the CHD diagnosis. Cox regressions based on data with no participant exclusions most often discovered statistically significant associations. Loose inclusion criteria for study participants with any CVD during the follow-up and strict exclusion criteria for participants with no CVD were best in discovering the associations between risk factors and CHD. Outcome sensitivity affected the associations, whereas the covariate type, continuous or categorical, did not.
This study suggests that excluding study participants who are not disease-free at baseline is probably unnecessary for epidemiological analyses. Epidemiological research reports should present results based on no data exclusions together with results based on reasoned exclusions.
The relationship between nurses' job satisfaction and their perceptions of quality of care has been examined in previous studies. There is little evidence, however, about relationships between the ...job satisfaction of nursing staff and quality of care perceived by the patients. The aim of this study was to analyze, how the job satisfaction of nursing staff, organizational characteristics (hospital and unit type), and patients' age relate to patients' perceptions of the quality of care.
The study was cross-sectional and descriptive, based on a secondary analysis of survey data acquired during the At Safe study in Finland. The study included 98 units at four acute care hospitals between autumn 2008 and spring 2009. The participants were 1909 patients and 929 nursing staff. Patients' perceptions of quality of care were measured using the 42-item RHCS questionnaire. Job satisfaction of nursing staff was measured with the 37-item KUHJSS scale. Statistical analyses included descriptive statistics, principal component analysis, t-tests, analysis of variance, linear regression, and multivariate analysis of variance.
Patients' perceptions of overall quality of care were positively related to general job satisfaction of nursing staff. Adequate numbers of staff appeared to be the clearest aspect affecting quality of care. Older patients were more satisfied with staff number than younger patients. Patients cared for in outpatient departments felt more respected than patients in wards, whereas patients in wards reported better care of basic needs (e.g., hygiene, food) than outpatients.
The evaluation of resources by nursing staff is related to patients' perceptions of the adequacy of nursing staff levels in the unit. The results emphasize the importance of considering patients' perceptions of the quality of care and assessments by nurses of their job satisfaction at the hospital unit level when evaluating quality of care.
Handgrip strength (HGS), a measure of muscular strength, might be a risk indicator for cognitive functioning, but the evidence is not consistent. Using a new prospective study and meta-analysis of ...published observational cohort studies, we aimed to evaluate the prospective associations of HGS with poor cognitive outcomes including cognitive impairment, dementia and Alzheimer’s disease (AD). Handgrip strength, measured using a Martin-Balloon-Vigorimeter, was assessed at baseline in a population-based sample of 852 men and women with good cognitive function in the Kuopio Ischemic Heart Disease cohort. Hazard ratios (HRs) with 95% confidence intervals (CIs) were estimated for cognitive outcomes. Relevant published studies were sought in MEDLINE, Embase and Web of Science from inception until October 2021 and pooled using random effects meta-analysis. During a median follow-up of 16.6 years, 229 dementia cases were recorded. Comparing extreme tertiles of HGS, the multivariable adjusted HR (95% CI) for dementia, AD and vascular dementia was 0.77 (0.55–1.07), 0.75 (0.52–1.10) and 0.49 (0.16–1.48), respectively. In a meta-analysis of 16 population-based prospective cohort studies (including the current study) comprising 180,920 participants, the pooled multivariable adjusted relative risks (95% CIs) comparing the top vs bottom thirds of HGS levels were as follows: 0.58 (0.52–0.65) for cognitive impairment; 0.37 (0.07–1.85) for cognitive decline; 0.73 (0.62–0.86) for dementia; 0.68 (0.53–0.87) for AD; and 0.48 (0.32–0.73) for vascular dementia. GRADE quality of evidence ranged from low to very low. Meta-analysis of aggregate prospective data suggests that HGS may be a risk indicator for poor cognitive outcomes such as cognitive impairment, dementia and AD. Systematic review registration: PROSPERO 2021: CRD42021237750.
A cross-sectional study was conducted with a convenience sample (N = 3,093) of Finnish and Italian registered nurses to identify differences related to generation, country, gender, and educational ...level in their perceptions and opinions about workplace-related dimensions of nursing and their managers’ leadership practices. The Multidimensional Nursing Generations Questionnaire (MNGQ) and two subscales of the Transformational Leadership Scale (TLS), “Feedback and Rewards” and “Professional Development,” were used as survey tools. Data were analyzed with descriptive and inferential statistics. Statistically significant (p < .05) generational and country differences emerged in the MNGQ components “Conflicts between generations,” “Patient safety view,” “Relationships between generations,” “Working as a multigenerational team,” “Orientation to change,” “Intention to leave,” and “Flexibility and availability.” Generational and country differences also emerged for the two TLS subscales. Generational differences existed between registered nurses of different generations and countries, and should be considered in leading multigenerational nurses’ workforces.
PurposeTo estimate the maximum mass-specific oxygen uptake (VO2max) from the ratio of the heart rate at maximal exercise (HRmax) to heart rate at rest (HRrest) in middle-aged men. VO2max is an ...essential measure of cardiorespiratory fitness, but it is difficult to utilize in clinical practice. The proportionality factor HRmax to HRrest is known to approximate 15 in young well-trained adults. Presumably, the same value is inaccurate for middle-aged men.Materials and MethodsSix-hundred thirty-four men belonging to the Kuopio Ischaemic Heart Disease Risk Factor Study. Their mean age, body mass index (BMI), the daily total physical activity (TPA), VO2max, HRmax, and HRrest were: 49.4±6.4 years, 26.3±3.2 kg/m2, 48.5±10.1 metabolic equivalent hours per day, 33.7±7.6 mL/min/kg, 170.1±15.4 beats/min, and 63.3±10.8 beats/min. They included never-smokers 38%, former smokers 29%, and current smokers 33%.ResultsThe proportionality factor HRmax to HRrest in around 50-year-old men approximated 12. One year in age, one step change in BMI (normal weight, overweight, obese), smoking status (never, former, current), and TPA (moderately active, active, highly active) reduced the proportionality factor by 0.1, 0.6, 0.4, and 0.1, respectively. The proportionality factor in obese or current smoking middle-aged men was one point lower compared to normal weight or never-smoking peers. This corresponds to approximately 10 years in chronological age.ConclusionsIn around 50-year-old men with no cardiovascular diseases, bronchial asthma, or cancer, the HRmax to HRrest ratio should be multiplied by approximately 12 to estimate VO2max. BMI and smoking status can be considered in calculations to improve accuracy.
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