Abstract T MP99: What Are the Blood Pressure Levels Associated With the Lowest Stroke Rates in the Elderly? Findings From the Reasons for Geographic and Racial Differences in Stroke (regards) Cohort Study

OBJECTIVES: To identify the blood pressure (BP) level associated with the lowest stroke incidence in elderly persons taking antihypertensive medication in the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. METHODS: We categorized 13,948 REGARDS participants with hypertension into 3 age groups: 55-64, 65-74 and ≥75 years old and 5 levels of treated systolic BP (SBP): <120 (reference group), 120-129, 130-139, 140-149, and ≥150 mmHg, and 4 levels of diastolic BP (DBP) levels: <70 (reference group), 70-79, 80-89, and ≥90 mmHg. Participants without a history of stroke were followed for a median of 5.7 years (maximum 8.5 years) for incident stroke (n=425). RESULTS: For participants at age 55-64 SBP level <120 mmHg and DBP <70 mmHg were associated with the lowest risk of stroke (incidence per 1,000 person-years: 2.4, 95%Cl: 1.4-4.0 and 2.5, 95%Cl: 1.3-4.7, respectively). Higher stroke risk was observed at SBP ≥140 mmHg. For those aged 65-74, stroke incidence was increased at SBP ≥130 mmHg and at lower DBP levels (with the lowest stroke risk for DBP ≥90 mmHg). For participants ≥75 years SBP ≥150 mmHg was associated with the highest risk of stroke (incidence rate: 15.0, 95%Cl: 10.5-21.3) but no increased risk was observed for SBP between 120-149 mmHg. For DBP, stroke incidence was highest for DBP <70 mmHg (adjusted incidence rate: 9.8; 95%Cl: 6.8-14.1), and lowest for DBP ≥90 mmHg (adjusted incidence rate: 6.5; 95%Cl: 2.9-14.5) (see table). CONCLUSIONS: These results suggest that the lowest risk for stroke for the participants between 55-64 years old are at BP levels <140/70 mmHg, for persons 65-74 we should aim at SBP levels <130 mmHg, and for the oldest patients at SBP <150 with DBP ≥90 mmHg for both groups. For participants aged ≥65 a caution should be kept with the reduction of DBP <90 mmHg, what requires further investigations. Key words: blood pressure, elderly, hypertension, treatment, mortality, stroke.

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Emotional states and future risk of venous thromboembolism

Thrombosis and Haemostasis ◽

10.1160/th11-09-0667 ◽

2012 ◽

Vol 107 (03) ◽

pp. 485-493 ◽

Cited By ~ 13

Author(s):

Sigrid K. Brækkan ◽

Ida J. Hansen-Krone ◽

John-Bjarne Hansen ◽

Kristin F. Enga

Keyword(s):

Venous Thromboembolism ◽

Incidence Rate ◽

Population Based ◽

Emotional States ◽

Depressive Feelings ◽

Increased Risk ◽

Adjusted Incidence Rate ◽

Adjusted Incidence ◽

Reduced Risk

SummaryEmotional states of depression and loneliness are reported to be associated with higher risk and optimism with lower risk of arterial cardiovascular disease (CVD) and death. The relation between emotional states and risk of venous thromboembolism (VTE) has not been explored previously. We aimed to investigate the associations between self-reported emotional states and risk of incident VTE in a population-based, prospective study. The frequency of feeling depressed, lonely and happy/optimistic were registered by self-administered questionnaires, along with major co-morbidities and lifestyle habits, in 25,964 subjects aged 25–96 years, enrolled in the Tromsø Study in 1994–1995. Incident VTE-events were registered from the date of inclusion until September 1, 2007. There were 440 incident VTE-events during a median of 12.4 years of follow-up. Subjects who often felt depressed had 1.6-fold (95% CI:1.02–2.50) higher risk of VTE compared to those not depressed in analyses adjusted for other risk factors (age, sex , body mass index, oes-trogens), lifestyle (smoking, alcohol consumption, educational level) and co-morbidities (diabetes, CVD, and cancer). Often feeling lonely was not associated with VTE. However, the incidence rate of VTE in subjects who concurrently felt often lonely and depressed was higher than for depression alone (age-and sex-adjusted incidence rate: 3.27 vs. 2.21). Oppositely, subjects who often felt happy/optimistic had 40% reduced risk of VTE (HR 0.60, 95% CI: 0.41–0.87). Our findings suggest that self-reported emotional states are associated with risk of VTE. Depressive feelings were associated with increased risk, while happiness/ optimism was associated with reduced risk of VTE.

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Effects of Dose Adjustment Rules on Safety during Erythropoietic Therapy: A Retrospective Analysis of Darbepoetin alfa Administered Either Every 3 Weeks or Weekly.

Blood ◽

10.1182/blood.v106.11.3376.3376 ◽

2005 ◽

Vol 106 (11) ◽

pp. 3376-3376 ◽

Cited By ~ 4

Author(s):

Michael Hedenus ◽

Jean-Luc Canon ◽

Dusan Kotasek ◽

Tom Lillie ◽

Lisa Hendricks ◽

...

Keyword(s):

Dose Reduction ◽

Incidence Rate ◽

Darbepoetin Alfa ◽

Dose Adjustment ◽

Safety Concern ◽

Performance Status ◽

Thrombotic Event ◽

Increased Risk ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Abstract Background: Rapid increases in hemoglobin (Hb) concentrations or achievement of high Hb levels during erythropoiesis-stimulating protein (ESP) therapy may put anemic patients undergoing chemotherapy at increased risk for cardiovascular/thromboembolic adverse events (AEs). A potential safety concern of less frequent ESP administration (eg, every 3 weeks [Q3W] vs weekly [QW]) is that higher single doses may cause rapid increases in Hb levels. Dose adjustment rules may provide physicians with guidance on how to minimize these risks; however, defining appropriate rules can be challenging. Methods: To evaluate the ability of dose reduction rules to discriminate between natural Hb variability and inappropriate Hb increases, we performed a pooled analysis of 5 randomized, double-blind studies involving Q3W and QW darbepoetin alfa (Aranesp®; DA) vs placebo. In these studies, 2335 eligible patients (pts) had cancer and anemia, were undergoing chemotherapy, and had received ≥1 dose of study drug. AE categories of interest in this analysis were hypertension, seizure, ischemic myocardial infarction, and embolism/thrombosis (arterial and venous). Three definitions for excessive rate-of-rise in Hb were compared as triggers for dose reduction: ≥1-g/dL increase in 14 days; ≥1.5-g/dL in 21 days; or ≥2-g/dL in 28 days. Results: Of the 3 definitions evaluated for excess rate-of-rise in Hb concentration, the 2-g/dL increase in 28 days best discriminated pts receiving DA treatment from placebo pts (see Table). The 1-g/dL increase in 14 days rule did not discriminate well between inappropriate Hb increases related to ESP therapy and natural Hb variability (ie, placebo). These results suggest that a 2-g/dL increase in 28 days may be associated with an increased risk of thrombotic events in pts receiving DA therapy compared with pts receiving placebo, after adjusting for thrombotic event history and ECOG performance status; the 1-g/dL increase in 14 days rule was not associated with an increased risk of thrombotic events in a similar analysis. No significant differences in the exposure-adjusted incidence rate of embolism/thrombosis events were observed between the DA extended-dose and 2.25-μg/kg QW groups, regardless of the definitions used. Conclusions: The 2-g/dL increase in 28 days definition discriminates natural Hb variability and excess rate-of-rise that may be associated with cardiovascular/thromboembolic AEs. The 1-g/dL increase in 14 days rule resulted in an excessive rate of “false positives,” even in the absence of ESP therapy. Placebo DA QW 2.25 μg/kg All DA Q3W extended dosing All DA N = No. of pts evaluable for safety; E = Total 16 person-week exposure period; n = Pts who experienced event; R = Exposure-adjusted incidence rate based on the no. of pts with event in a 16-week time period (R=n/E). No. of pts (N) 379 1049 907 1956 Exposure adjusted time (E) 321.1 979.1 928.8 1908 Hb threshold, n (R) ≥ 13 g/dL at any time 23 (0.07) 344 (0.35) 233 (0.25) 577 (0.30) Excess rise in Hb, n (R) ≥ 1 g/dL in 14 days 212 (0.66) 796 (0.81) 690 (0.74) 1486 (0.78) ≥ 1.5 g/dL in 21 days 138 (0.43) 654 (0.67) 560 (0.60) 1214 (0.64) ≥ 2 g/dL in 28 days 83 (0.26) 487 (0.50) 390 (0.42) 877 (0.46)

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Patients With MEN1 Are at an Increased Risk for Venous Thromboembolism

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/clinem/dgaa501 ◽

2020 ◽

Author(s):

Maya E Lee ◽

Yashira M Ortega-Sustache ◽

Sunita K Agarwal ◽

Aisha Tepede ◽

James Welch ◽

...

Keyword(s):

Venous Thromboembolism ◽

Incidence Rate ◽

Incidence Rates ◽

Natural History Study ◽

Search Terms ◽

Increased Risk ◽

Mechanistic Investigation ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Abstract Background Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited disorder predisposing the development of multiple functional and nonfunctional neuroendocrine tumors (NETs). Only uncommon MEN1-associated functional NETs such as glucagonomas (<1%) and adenocorticotropic hormone-producing tumors (<5%) are known to be associated with hypercoagulability. It is unknown if patients with MEN1 generally have an increased risk of venous thromboembolism (VTE). Methods We queried a prospective natural history study of germline mutation-positive MEN1 patients (n = 286) between 1991 and 2019 for all lifetime events of VTE. The search terms were: DVT, thromb, embol, PE, pulmonary embolism, clot, hematology consult, anticoagulant, coumadin, lovenox, xarelto, warfarin, aspirin, rivaroxaban, and apixaban. Incidence rates were calculated, accounting for age and sex. Comparisons were made to published incidence rates in healthy populations, different types of cancer, and Cushing’s syndrome. Results Thirty-six subjects (median age 45 years, range 16–75) experienced a VTE event, yielding a prevalence rate of 12.9%. The age–sex adjusted incidence rate of VTE is 9.11 per 1000 patient-years, with a sex-adjusted lifetime incidence rate of 2.81 per 1000 patient-years. MEN1-associated lifetime incidence rates are ~2-fold higher than the estimated annual incidence rate in the general population and are comparable to the known risk in the setting of various types of cancer. Approximately 80% of patients who had a VTE were diagnosed with pancreatic NETs, of which 24% were insulinomas. Fourteen patients (42%) experienced perioperative VTE events. Conclusions MEN1 patients have an increased risk of VTE. Further mechanistic investigation and validation from other MEN1 cohorts are needed to confirm the increased prevalence of VTE in MEN1.

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Effects of Intensive Blood Pressure Control in Patients with Evident Cardiovascular Disease: An Investigation Using the SPRINT Study Data

Current Vascular Pharmacology ◽

10.2174/1570161116666180305160116 ◽

2019 ◽

Vol 17 (3) ◽

pp. 298-306 ◽

Cited By ~ 1

Author(s):

Charalambos Vlachopoulos ◽

Dimitrios Terentes-Printzios ◽

Konstantinos Aznaouridis ◽

Nikolaos Ioakeimidis ◽

Panagiotis Xaplanteris ◽

...

Keyword(s):

Blood Pressure ◽

Cardiovascular Disease ◽

Beneficial Effect ◽

Harmful Effect ◽

Adverse Outcomes ◽

Intensive Treatment ◽

Serious Adverse Events ◽

Stroke Incidence ◽

Increased Risk ◽

All Cause Mortality

Background: Recent data advocate adoption of a more intensive treatment strategy for management of blood pressure (BP). Objective: We investigated whether the overall effects of the Systolic Blood Pressure Intervention Trial (SPRINT) are applicable to cardiovascular disease (CVD) patients. Methods: In a post hoc analysis we analyzed data from SPRINT that randomly assigned 9361 individuals to a systolic BP (SBP) target of <120 mmHg (intensive treatment) or <140 mmHg (standard treatment). 1562 patients had clinically evident CVD (age=70.3±9.3 years, 24% females) at study entry and were followed for 3.1 years. Further, we assessed the effect of low (<150 mmHg) baseline SBP on outcome. Results: In CVD patients, there was no benefit from the intensive treatment regarding all endpoints, except for a marginally significant benefit on all-cause mortality (hazard ratio [HR]: 0.67; 95% confidence interval [CI], 0.45 to 1.00; p=0.0509). Further, while there was no increase in serious adverse events (SAE) in the intensive group, there was increased risk for study-related SAE, acute renal failure and electrolyte abnormalities. In patients with low baseline SBP there was a beneficial effect on allcause mortality (HR: 0.56; 95% CI: 0.33 to 0.96; p=0.033), but with greater stroke incidence (HR: 2.94; 95% CI: 1.04 to 8.29; p=0.042). Conclusion: We confirm the beneficial effect of the intensive strategy in SPRINT study on all-cause mortality and the harmful effect on specific adverse outcomes in patients with CVD. However, in patients with low baseline SBP stroke may increase.

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Inflammatory Bowel Disease and Risk of Major Bleeding During Anticoagulation for Venous Thromboembolism

Inflammatory Bowel Diseases ◽

10.1093/ibd/izaa337 ◽

2021 ◽

Author(s):

Susanna Scharrer ◽

Christian Primas ◽

Sabine Eichinger ◽

Sebastian Tonko ◽

Maximilian Kutschera ◽

...

Keyword(s):

Ulcerative Colitis ◽

Inflammatory Bowel Disease ◽

Venous Thromboembolism ◽

Incidence Rate ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Fatal Bleeding ◽

Adjusted Incidence Rate ◽

Inflammatory Bowel ◽

Adjusted Incidence

Abstract Background Little is known about the bleeding risk in patients with inflammatory bowel disease (IBD) and venous thromboembolism (VTE) treated with anticoagulation. Our aim was to elucidate the rate of major bleeding (MB) events in a well-defined cohort of patients with IBD during anticoagulation after VTE. Methods This study is a retrospective follow-up analysis of a multicenter cohort study investigating the incidence and recurrence rate of VTE in IBD. Data on MB and IBD- and VTE-related parameters were collected via telephone interview and chart review. The objective of the study was to evaluate the impact of anticoagulation for VTE on the risk of MB by comparing time periods with anticoagulation vs those without anticoagulation. A random-effects Poisson regression model was used. Results We included 107 patients (52 women, 40 with ulcerative colitis, 64 with Crohn disease, and 3 with unclassified IBD) in the study. The overall observation time was 388 patient-years with and 1445 patient-years without anticoagulation. In total, 23 MB events were registered in 21 patients, among whom 13 MB events occurred without anticoagulation and 10 occurred with anticoagulation. No fatal bleeding during anticoagulation was registered. The incidence rate for MB events was 2.6/100 patient-years during periods exposed to anticoagulation and 0.9/100 patient-years during the unexposed time. Exposure to anticoagulation (adjusted incidence rate ratio, 3.7; 95% confidence interval, 1.5-9.0; P = 0.003) and ulcerative colitis (adjusted incidence rate ratio, 3.5; 95% confidence interval, 1.5-8.1; P = 0.003) were independent risk factors for MB events. Conclusion The risk of major but not fatal bleeding is increased in patients with IBD during anticoagulation. Our findings indicate that this risk may be outweighed by the high VTE recurrence rate in patients with IBD.

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Abstract W P386: Matrix Metalloproteinase Levels May Mediate Ischemic Stroke Incidence and Recovery in Stroke Patients with Metabolic Syndrome

Stroke ◽

10.1161/str.46.suppl_1.wp386 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Ashley B Petrone ◽

Taura L Barr ◽

Kelly Devlin ◽

Sara B Fournier ◽

Evan D Devallance ◽

...

Keyword(s):

Metabolic Syndrome ◽

Stroke Risk ◽

Plasma Concentrations ◽

Stroke Recovery ◽

Ultrasound Images ◽

Stroke Patients ◽

Stroke Incidence ◽

The Metabolic Syndrome ◽

Diabetes Status ◽

Increased Risk

Intro: The metabolic syndrome (MetS) is highly prevalent in the US characterized by a combination of risk factors that can lead to cardiovascular disease (CVD). While the association between CVD, inflammation, and stroke risk has been characterized, the immune mechanisms underlying increased risk of stroke in MetS is unclear. While stroke risk is higher among MetS, MetS individuals tend to have better stroke recovery than controls. The immune response may mediate these paradoxical observations in stroke. In particular, matrix metalloproteinases (MMP) enzymes play a role in stroke incidence and recovery. Similar to MetS, MMPs have a dual role in stroke, as they are harmful immediately after stroke, but play a vital role in brain repair and recovery following stroke. We hypothesize that elevated levels of MMPs in MetS may account for the paradoxical increased stroke risk, yet better recovery seen in stroke patients with MetS. Methods: MMP protein concentrations were obtained from fasting venous samples and quantified using a Multi-Analyte Profiling Kit (Millipore) on the Luminex®. Each subject was assigned a metabolic risk score (MRS) based on sex, age, SBP, treatment for hypertension, smoking and diabetes status, HDL, and total cholesterol. B-mode ultrasound images of the right common carotid artery were obtained to measure intima-medial thickness (cIMT). Spearman correlations were used to measure the relationship between MRS, cIMT, and MMP levels. Results: In n=68 subjects (60% female) with a mean age of 48+14 yrs, MRS of 25+12, and cIMT of 0.57+0.12 mm. MRS was significantly correlated with cIMT (r=0.39, p< .001). Further, cIMT was positively correlated with MMP1 (r=0.025, p=0.04), MMP7 (r=0.5, p=0.01), and MMP9 (r=0.31, p=0.01). Conclusion: Plasma concentrations of MMP1, 7, and 9 were significantly correlated with cIMT, indicating that increased severity of MetS is associated with increased inflammation. Elevated MMP protein levels may account for the increased stroke risk, yet better recovery seen in stroke patients with MetS.

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Premature Ventricular Complexes on Screening Electrocardiogram and Risk of Ischemic Stroke

Stroke ◽

10.1161/strokeaha.114.008447 ◽

2015 ◽

Vol 46 (5) ◽

pp. 1365-1367 ◽

Cited By ~ 7

Author(s):

Sunil K. Agarwal ◽

Jennifer Chao ◽

Frederick Peace ◽

Suzanne E. Judd ◽

Brett Kissela ◽

...

Keyword(s):

Blood Pressure ◽

Ischemic Stroke ◽

Racial Differences ◽

Proportional Hazards Model ◽

Geographic Region ◽

Left Ventricular ◽

Cox Proportional Hazards ◽

Cox Proportional Hazards Model ◽

Premature Ventricular Complexes ◽

Increased Risk

Background and Purpose— Premature ventricular complexes (PVCs) detected from long-term ECG recordings have been associated with an increased risk of ischemic stroke. Whether PVCs seen on routine ECG, commonly used in clinical practice, are associated with an increased risk of ischemic stroke remains unstudied. Methods— This analysis included 24 460 participants (aged, 64.5+9.3 years; 55.1% women; 40.0% blacks) from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study who were free of stroke at the time of enrollment. PVCs were ascertained from baseline ECG (2003–2007), and incident stroke cases through 2011 were confirmed by an adjudication committee. Results— A total of 1415 (5.8%) participants had at least 1 PVC at baseline, and 591 developed incident ischemic stroke during an average (SD) follow-up of 6.0 (2.0) years. In a cox proportional hazards model adjusted for age, sex, race, geographic region, education, previous heart disease, systolic blood pressure, blood pressure–lowering medications, current smoking, diabetes mellitus, left ventricular hypertrophy by ECG, and aspirin use and warfarin use, the presence of PVCs was associated with 38% increased risk of ischemic stroke (hazard ratio [95% confidence interval], 1.38 [1.05–1.81]). Conclusions— PVCs are common on routine screening ECGs and are associated with an increased risk of ischemic stroke.

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Spatial and temporal analysis of myocardial infarction incidence in Zanjan province, Iran

BMC Public Health ◽

10.1186/s12889-021-11695-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Mohsen Soleimani ◽

Nasser Bagheri

Keyword(s):

Myocardial Infarction ◽

Spatial Analysis ◽

High Risk ◽

Incidence Rate ◽

Temporal Analysis ◽

Analysis Methods ◽

Spatial And Temporal Analysis ◽

Risk Areas ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Abstract Background Myocardial Infarction (MI) is a major important public health concern and has huge burden on health system across the world. This study aimed to explore the spatial and temporal analysis of the incidence of MI to identify potential clusters of the incidence of MI patterns across rural areas in Zanjan province, Iran. Materials & methods This was a retrospective and geospatial analysis study of the incidence of MI data from nine hospitals during 2014–2018. Three different spatial analysis methods (Spatial autocorrelation, hot spot analysis and cluster and outlier analysis) were used to identify potential clusters and high-risk areas of the incidence of MI at the study area. Results Three thousand eight hundred twenty patients were registered at Zanjan hospitals due to MI during 2014–2018. The overall age-adjusted incidence rate of MI was 343 cases per 100,000 person which was raised from 88 cases in 2014 to 114 cases in 2018 per 100,000 person-year (a 30% increase, P < 0.001). Golabar region had the highest age-adjusted incidence rate of MI (515 cases per 100,000 person). Five hot spots and one high-high cluster were detected using spatial analysis methods. Conclusion This study showed that there is a great deal of spatial variations in the pattern of the incidence of MI in Zanjan province. The high incidence rate of MI in the study area compared to the national average, is a warning to local health authorities to determine the possible causes of disease incidence and potential drivers of high-risk areas. The spatial cluster analysis provides new evidence for policy-makers to design tailored interventions to reduce the incidence of MI and allocate health resource to unmet need areas.

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Dengue Fever in Italy: The “Eternal Return” of an Emerging Arboviral Disease

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed7010010 ◽

2022 ◽

Vol 7 (1) ◽

pp. 10

Author(s):

Matteo Riccò ◽

Simona Peruzzi ◽

Federica Balzarini ◽

Alessandro Zaniboni ◽

Silvia Ranzieri

Keyword(s):

Incidence Rate ◽

Central Italy ◽

Denv Infection ◽

Incidence Rates ◽

Annual Incidence ◽

Annual Reports ◽

Foreign Born ◽

Time Period ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Enhanced surveillance for dengue virus (DENV) infections in Italy has been implemented since 2012, with annual reports from the National Health Institute. In this study, we summarize available evidence on the epidemiology of officially notified DENV infections from 2010–2021. In total, 1043 DENV infection cases were diagnosed, and most of them occurred in travelers, with only 11 autochthonous cases. The annual incidence rates of DENV infections peaked during 2019 with 0.277 cases per 100,000 (95% confidence interval [95% CI] 0.187–0.267), (age-adjusted incidence rate: 0.328, 95% CI 0.314–0.314). Cases of DENV were clustered during the summer months of July (11.4%), August (19.3%), and September (12.7%). The areas characterized by higher notification rates were north-western (29.0%), and mostly north-eastern Italy (41.3%). The risk for DENV infection in travelers increased in the time period 2015–2019 (risk ratio [RR] 1.808, 95% CI 1.594–2.051) and even during 2020–2021 (RR 1.771, 95% CI 1.238–2.543). Higher risk for DENV was additionally reported in male subjects compared with females subjects, and aged 25 to 44 years, and in individuals from northern and central Italy compared to southern regions and islands. In a multivariable Poisson regression model, the increased number of travelers per 100 inhabitants (incidence rate ratio [IRR] 1.065, 95% CI 1.036–1.096), the incidence in other countries (IRR 1.323, 95% CI 1.165–1.481), the share of individuals aged 25 to 44 years (IRR 1.622, 95% CI 1.338–1.968), and foreign-born residents (IRR 2.717, 95% CI 1.555–3.881), were identified as effectors of annual incidence. In summary, although the circulation of DENV remains clustered among travelers, enhanced surveillance is vital for the early detection of human cases and the prompt implementation of response measures.

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Accelerometer-Measured Daily Steps, Physical Function, and Subsequent Fall Risk in Older Women: The Objective Physical Activity and Cardiovascular Disease in Older Women Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2021-0159 ◽

2021 ◽

pp. 1-11

Author(s):

Benjamin T. Schumacher ◽

John Bellettiere ◽

Michael J. LaMonte ◽

Kelly R. Evenson ◽

Chongzhi Di ◽

...

Keyword(s):

Physical Function ◽

Older Women ◽

Incidence Rate ◽

Fall Risk ◽

Rate Ratio ◽

Incidence Rate Ratio ◽

Steps Per Day ◽

Falls In Older Adults ◽

Adjusted Incidence Rate ◽

Adjusted Incidence

Steps per day were measured by accelerometer for 7 days among 5,545 women aged 63–97 years between 2012 and 2014. Incident falls were ascertained from daily fall calendars for 13 months. Median steps per day were 3,216. There were 5,473 falls recorded over 61,564 fall calendar-months. The adjusted incidence rate ratio comparing women in the highest versus lowest step quartiles was 0.71 (95% confidence interval [0.54, 0.95]; ptrend across quartiles = .01). After further adjustment for physical function using the Short Physical Performance Battery, the incidence rate ratio was 0.86 ([0.64, 1.16]; ptrend = .27). Mediation analysis estimated that 63.7% of the association may be mediated by physical function (p = .03). In conclusion, higher steps per day were related to lower incident falls primarily through their beneficial association with physical functioning. Interventions that improve physical function, including those that involve stepping, could reduce falls in older adults.

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