Background Exposure to ultraviolet radiation (from solar and nonsolar sources) is a risk factor for skin cancer. Objective We sought to summarize recent estimates on sunburns, sun-protection ...behaviors, and indoor tanning available from national and selected statewide behavioral surveys. Methods Estimates of the prevalence of sunburn, sun-protection behaviors, and indoor tanning by US adults, adolescents, and children collected in national surveys in 1992, 2004 to 2005, and 2007 to 2009 were identified and extracted from searches of computerized databases (ie, MEDLINE and PsychINFO), reference lists, and survey World Wide Web sites. Sunburn estimates from 3 state Behavioral Risk Factors Surveillance Systems were also analyzed. Results Latest published estimates (2005) showed that 34.4% of US adults were sunburned in the past year. Incidence of sunburns was highest among men, non-Hispanic whites, young adults, and high-income groups in national surveys. About 3 in 10 adults routinely practiced sun-protection behaviors, and women and older adults took the most precautions. Among adolescents, 69% were sunburned in the previous summer and less than 40% practiced sun protection. Approximately 60% of parents applied sunscreen and a quarter used shade to protect children. Indoor tanning was prevalent among younger adults and females. Limitations Limitations include potential recall errors and social desirability in self-report measures, and lack of current data on children. Conclusion Many Americans experienced sunburns and a minority engaged in protective behaviors. Females and older adults were most vigilant about sun protection. Substantial proportions of young women and adolescents recently used indoor tanning. Future efforts should promote protective hats, clothing, and shade; motivate males and younger populations to take precautions; and convince women and adolescents to reduce indoor tanning.
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in cancer survivors, particularly after chest radiation therapy (RT). However, the extent to which CVD events are ...consistently reported in contemporary prospective trials is unknown.
From 10 high-impact RT, oncology, and medicine journals, we identified all latter phase trials from 2000 to 2019 enrolling patients with breast, lung, lymphoma, mesothelioma, or esophageal cancer wherein chest-RT was delivered. The primary outcome was the report of major adverse cardiac events (MACEs), defined as incident myocardial infarction, heart failure, coronary revascularization, arrhythmia, stroke, or CVD death across treatment arms. The secondary outcome was the report of any CVD event. Multivariable regression was used to identify factors associated with CVD reporting. Pooled annualized incidence rates of MACEs across RT trials were compared with contemporary population rates using relative risks (RRs).
The 108 trials that met criteria enrolled 59,070 patients (mean age, 58.0 ± 10.2 years; 46.0% female), with 273,587 person-years of available follow-up. During a median follow-up of 48 months, 468 MACEs were reported (including 96 heart failures, 75 acute coronary syndrome, 1 revascularization, 94 arrhythmias, 28 strokes, and 20 CVD deaths; 307 occurred in the intervention arms vs 144 in the control arms; RR, 1.96; P < .001). Altogether, 50.0% of trials did not report MACEs, and 37.0% did not report any CVD. The overall weighted-trial incidence was 376 events per 100,000 person-years compared with 1408 events per 100,000 person-years in similar nontrial patients (RR, 0.27; P < .001). There were no RT factors associated with CVD reporting.
In contemporary chest RT–based clinical trials, reported CVD rates were lower than expected population rates.
Purpose To investigate risk factors that may be linked to pancreatic cancer. Methods We designed a multicenter population-based case–control (823 cases, 1679 control patients) study with data ...collection by using a common protocol and questionnaire. Participating centers were located in Australia, Canada, the Netherlands, and Poland. Results After adjustment for confounding factors, a positive history of pancreatitis was associated with pancreatic cancer (odds ratio OR, 4.68; 95% confidence interval 95% CI, 2.23 − 9.84). The risk was especially high in heavy smokers (OR, 15.4; 95% CI, 3.18 − 74.9). Patients with diabetes had an increased risk of developing pancreatic cancer (OR, 2.16; 95% CI, 1.60 − 2.91). The risk was highest in the first year after the development of diabetes (OR, 6.68; 95% CI, 3.56 − 12.6) and decreased over time. A history of allergy was associated with a reduced risk of pancreas cancer (OR, 0.64; 95% CI, 0.50 − 0.82). Conclusions Patients with newly diagnosed diabetes and patients with pancreatitis, particularly in heavy smokers, have an increased risk for developing pancreatic cancer. In addition to being risk factors, these conditions could be early manifestations of underlying pancreatic cancer. A history of allergy decreases the risk of pancreatic cancer.
Sickle cell disease (SCD) is associated with serious comorbidities resulting in a shortened lifespan, and many clients suffer from frequent pain episodes. However, others successfully manage their ...disease in the outpatient setting without the need for frequent health care utilization. The purpose of this project was to describe specific strategies used by adult clients with sickle cell disease to achieve optimal physical health.
A Best Self-management Practices workshop was held in conjunction with the Sickle Cell Disease Association of America meeting. A panel discussion was organized; adult clients were recruited for participation. The workshop was divided into 3 topics: complementary and alternative medicine, psychosocial issues, and work/education/training. Panel discussions were audiotaped, transcribed, and analyzed using the constant comparative method.
Seven adult patients with sickle cell disease and 1 social worker participated. The following themes emerged: self-awareness, emotional support, career selection and success factors, nutrition, advocacy, knowledge, physical, and complementary and alternative medicine. Self-awareness was the most reported strategy with emphasis on journaling and body awareness. Emotional support included spiritual support, friends, family, professional counseling, and spiritual support. A variety of suggestions were discussed related to the other themes. All participants used many strategies daily to maintain optimal health.
Background
Dissemination research is the study of distributing information and intervention materials to a specific clinical practice or public health audience. Acupuncture, a healthcare practice ...involving the stimulation of certain body points, often with thin needles, is considered an evidence-based treatment for low back pain (LBP), but is underutilized in the United States.
Body: We will use the example of acupuncture for LBP to identify opportunities to leverage dissemination research to increase utilization of acupuncture. Deficits in the awareness or knowledge of acupuncture may limit its adoption by patients and other stakeholders. Thus, we summarize methods to gather data on stakeholder awareness and knowledge of acupuncture for LBP, i.e., audience research. Engaging multiple stakeholder audiences (e.g., health system leaders, primary care providers, patients), is needed to generate knowledge on promising dissemination strategies for each audience. Audience segmentation is important for identifying population subgroups for whom adoption of acupuncture may require a more intensive or tailored dissemination strategy. To illustrate potential audience ‘segments’, our research discussion focused on developing dissemination strategies by age (i.e., older adults – those age 65 years or older, and younger adults – those under age 65 ). This decision was prompted by Medicare’s recent policy covering acupuncture for chronic LBP. We leverage current knowledge of barriers and facilitators of acupuncture use to discuss how further tailoring of dissemination strategies might optimize adoption of acupuncture in both groups of adults. Experimental study designs could then be used to compare the effectiveness of such strategies to increase awareness, knowledge, or adoption of acupuncture.
Conclusions: Conducting dissemination research may improve awareness and knowledge of acupuncture, and ultimately the adoption of acupuncture in biomedical settings. We anticipate that the concepts highlighted in this manuscript will also be helpful for those disseminating information about other complementary and integrative health approaches.
Objectives The purpose of this study was to characterize operative outcomes for ascending aorta and arch replacement on a national scale and to develop risk models for mortality and major morbidity. ...Background Contemporary outcomes for ascending aorta and arch replacement in North America are unknown. Methods We queried the Society of Thoracic Surgeons Database for patients undergoing ascending aorta (with or without root) with or without arch replacement from 2004 to 2009. The database captured 45,894 cases, including 12,702 root, 22,048 supracoronary ascending alone, 6,786 ascending plus arch, and 4,358 root plus arch. Baseline characteristics and clinical outcomes were analyzed. A parsimonious multivariable logistic regression model was constructed to predict risks of mortality and major morbidity. Results Operative mortality was 3.4% for elective cases and 15.4% for nonelective cases. A risk model for operative mortality (c-index 0.81) revealed a risk-adjusted odds ratio for death after emergent versus elective operation of 5.9 (95% confidence interval: 5.3 to 6.6). Among elective patients, end-stage renal disease and reoperative status were the strongest predictors of mortality (adjusted odds ratios: 4.0 95% confidence interval: 2.6 to 6.4 and 2.3 (95% confidence interval: 1.9 to 2.7, respectively; p < 0.0001). Conclusions Current outcomes for ascending aorta and arch replacement in North America are excellent for elective repair; however, results deteriorate for nonelective status, suggesting that increased screening and/or lowering thresholds for elective intervention could potentially improve outcomes. The predictive models presented may serve clinicians in counseling patients.
Objectives This study determined whether greater volumes of exercise were associated with greater reductions in clinical events. Background The HF-ACTION (Heart Failure: A Controlled Trial ...Investigating Outcomes of Exercise Training) trial showed that among patients with heart failure (HF), regular exercise confers a modest reduction in the adjusted risk for all-cause mortality or hospitalization. Methods Patients randomized to the exercise training arm of HF-ACTION who were event-free at 3 months after randomization were included (n = 959). Median follow-up was 28.2 months. Clinical endpoints were all-cause mortality or hospitalization and cardiovascular mortality or HF hospitalization. Results A reverse J-shaped association was observed between exercise volume and adjusted clinical risk. On the basis of Cox regression, exercise volume was not a significant linear predictor but was a logarithmic predictor (p = 0.03) for all-cause mortality or hospitalization. For cardiovascular mortality or HF hospitalization, exercise volume was a significant (p = 0.001) linear and logarithmic predictor. Moderate exercise volumes of 3 to <5 metabolic equivalent (MET)-h and 5 to <7 MET-h per week were associated with reductions in subsequent risk that exceeded 30%. Exercise volume was positively associated with the change in peak oxygen uptake at 3 months (r = 0.10; p = 0.005). Conclusions In patients with chronic systolic HF, volume of exercise is associated with the risk for clinical events, with only moderate levels (3 to 7 MET-h per week) of exercise needed to observe a clinical benefit. Although further study is warranted to confirm the relationship between volume of exercise completed and clinical events, our findings support the use of regular exercise in the management of these patients. (Heart Failure: A Controlled Trial Investigating Outcomes of Exercise Training HF-ACTION; NCT00047437 )
Impact of obesity on cardiovascular disease Zalesin, Kerstyn C; Franklin, Barry A; Miller, Wendy M ...
The Medical clinics of North America,
09/2011, Letnik:
95, Številka:
5
Journal Article
Recenzirano
Obesity promotes a cascade of secondary pathologies including diabetes, insulin resistance, dyslipidemia, inflammation, thrombosis, hypertension, the metabolic syndrome, and OSA, which collectively ...heighten the risk for cardiovascular disease. Obesity may also be an independent moderator of cardiac risk apart from these comorbid conditions. Rates of obesity and cardiac disease continue to rise in a parallel and exponential manner. Because obesity is potentially one of the most modifiable mediators of cardiovascular morbidity and mortality, effective treatment and prevention interventions should have a profound and favorable impact on public health.
Objective Analysis of congenital heart surgery results requires a reliable method of estimating the risk of adverse outcomes. Two major systems in current use are based on projections of risk or ...complexity that were predominantly subjectively derived. Our goal was to create an objective, empirically based index that can be used to identify the statistically estimated risk of in-hospital mortality by procedure and to group procedures into risk categories. Methods Mortality risk was estimated for 148 types of operative procedures using data from 77,294 operations entered into the European Association for Cardiothoracic Surgery (EACTS) Congenital Heart Surgery Database (33,360 operations) and the Society of Thoracic Surgeons (STS) Congenital Heart Surgery Database (43,934 patients) between 2002 and 2007. Procedure-specific mortality rate estimates were calculated using a Bayesian model that adjusted for small denominators. Each procedure was assigned a numeric score (the STS–EACTS Congenital Heart Surgery Mortality Score 2009) ranging from 0.1 to 5.0 based on the estimated mortality rate. Procedures were also sorted by increasing risk and grouped into 5 categories (the STS–EACTS Congenital Heart Surgery Mortality Categories 2009) that were chosen to be optimal with respect to minimizing within-category variation and maximizing between-category variation. Model performance was subsequently assessed in an independent validation sample (n = 27,700) and compared with 2 existing methods: Risk Adjustment for Congenital Heart Surgery (RACHS-1) categories and Aristotle Basis Complexity scores. Results Estimated mortality rates ranged across procedure types from 0.3% (atrial septal defect repair with patch) to 29.8% (truncus plus interrupted aortic arch repair). The proposed STS–EACTS score and STS–EACTS categories demonstrated good discrimination for predicting mortality in the validation sample (C-index = 0.784 and 0.773, respectively). For procedures with more than 40 occurrences, the Pearson correlation coefficient between a procedure's STS–EACTS score and its actual mortality rate in the validation sample was 0.80. In the subset of procedures for which RACHS-1 and Aristotle Basic Complexity scores are defined, discrimination was highest for the STS–EACTS score (C-index = 0.787), followed by STS–EACTS categories (C-index = 0.778), RACHS-1 categories (C-index = 0.745), and Aristotle Basic Complexity scores (C-index = 0.687). When patient covariates were added to each model, the C-index improved: STS–EACTS score (C-index = 0.816), STS–EACTS categories (C-index = 0.812), RACHS-1 categories (C-index = 0.802), and Aristotle Basic Complexity scores (C-index = 0.795). Conclusion The proposed risk scores and categories have a high degree of discrimination for predicting mortality and represent an improvement over existing consensus-based methods. Risk models incorporating these measures may be used to compare mortality outcomes across institutions with differing case mixes.
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