Interaction of obesity polygenic score with lifestyle risk factors in an electronic health record biobank

Background Genetic and lifestyle factors have considerable effects on obesity and related diseases, yet their effects in a clinical cohort are unknown. This study in a patient biobank examined associations of a BMI polygenic risk score (PRS), and its interactions with lifestyle risk factors, with clinically measured BMI and clinical phenotypes. Methods The Mass General Brigham (MGB) Biobank is a hospital-based cohort with electronic health record, genetic, and lifestyle data. A PRS for obesity was generated using 97 genetic variants for BMI. An obesity lifestyle risk index using survey responses to obesogenic lifestyle risk factors (alcohol, education, exercise, sleep, smoking, and shift work) was used to dichotomize the cohort into high and low obesogenic index based on the population median. Height and weight were measured at a clinical visit. Multivariable linear cross-sectional associations of the PRS with BMI and interactions with the obesity lifestyle risk index were conducted. In phenome-wide association analyses (PheWAS), similar logistic models were conducted for 675 disease outcomes derived from billing codes. Results Thirty-three thousand five hundred eleven patients were analyzed (53.1% female; age 60.0 years; BMI 28.3 kg/m2), of which 17,040 completed the lifestyle survey (57.5% female; age: 60.2; BMI: 28.1 (6.2) kg/m2). Each standard deviation increment in the PRS was associated with 0.83 kg/m2 unit increase in BMI (95% confidence interval (CI) =0.76, 0.90). There was an interaction between the obesity PRS and obesity lifestyle risk index on BMI. The difference in BMI between those with a high and low obesogenic index was 3.18 kg/m2 in patients in the highest decile of PRS, whereas that difference was only 1.55 kg/m2 in patients in the lowest decile of PRS. In PheWAS, the obesity PRS was associated with 40 diseases spanning endocrine/metabolic, circulatory, and 8 other disease groups. No interactions were evident between the PRS and the index on disease outcomes. Conclusions In this hospital-based clinical biobank, obesity risk conferred by common genetic variants was associated with elevated BMI and this risk was attenuated by a healthier patient lifestyle. Continued consideration of the role of lifestyle in the context of genetic predisposition in healthcare settings is necessary to quantify the extent to which modifiable lifestyle risk factors may moderate genetic predisposition and inform clinical action to achieve personalized medicine.

New Discovery of Left Atrial Macroreentry Tachycardia: Originating from the Spontaneous Scarring of Left Atrial Anterior Wall

Aims. This study sought to describe left atrial macroreentry tachycardia (LAMRT) originating from the spontaneous scarring of left atrial anterior wall (LAAW) and its clinical and electrophysiological characteristics, mechanisms, and the formation of substrates. Methods and Results. 9 of 123 patients (89% female, age 79.78 ± 5.59 years) had LAMRT originating from the LAAW with no cardiac surgery or prior left atrial (LA) ablation. The mean tachycardia cycle length (TCL) was 241.67 ± 38.00 milliseconds. Spontaneous scars areas and low voltage areas (LVAs) in the LAAW were found in all patients. Successful ablation of the critical isthmus caused termination of the LAMRT and was not inducible in all patients. Arrhythmogenic substrates of LAMRT were the spontaneous scars of LAAW, which matched with the aorta or/and pulmonary artery contact area. The area under the curve (AUC) of age and combination of gender and age for predicting the LAMRT originating from the LAAW were 0.918 and 0.951, respectively, with a cutoff value of ≥73.5 years of age and gender (female) predicting LAMRT with 88.9% sensitivity and 89% specificity. Conclusion. Combination of gender and age provides a simple and useful criterion to distinguish LAMRT from cavotricuspid isthmus- (CTI-) dependent atrial tachycardia in macroreentry atrial tachycardia (MRAT) in patients without a history of surgery or ablation. Aorta or/and pulmonary artery contacting LA may be related to spontaneous scars. Ablation the isthmus eliminated LAMRT in all patients.

PENGELOMPOKAN KABUPATEN/KOTA DI PROVINSI JAWA TENGAH BERDASARKAN JUMLAH PEREMPUAN (USIA 18+) KORBAN KEKERASAN DENGAN MENGGUNAKAN K-MEANS CLUSTERING

Violence against women is one of the cases that often gets attention and news in various mass media and electronic media today. In Komnas Perempuan's Annual Records, there were 406,178 cases of violence against women reported and handled throughout 2018. This number increased compared to the previous year's 348,466 cases. This study was conducted to try to group 35 districts/cities in Central Java into 3 clusters based on the number of women (age 18+) victims of violence. Grouping is done using the k-means cluster method. The regencies/cities in Central Java are grouped into 3 clusters, namely: cluster 1 there is 1 Regency/City with a high number of women (age 18+) victims of violence, cluster 2 there are 4 Regency/City with a high number of victims of violence. female (age 18+) victims of violence. moderate, and cluster 3 there are 30 districts/cities with a low number of women (age 18+) victims of violence.

Perspectives on How Fall Prevention Technologies Can Support Older Adults’ Self-Monitoring Processes

Fall risk increases as older adults lose the functional resources necessary to maintain balance while completing everyday activities. As functional resources often decline gradually with age, momentary deficits may not be apparent until after a fall occurs. Mobile fall prevention technologies could support older adults in self-monitoring their ability to safely navigate their environments. In this paper we present perspectives on self-monitoring and feedback in a sample of older adults (n = 20, 50% female, age 65+) who had self-assessed their balance via a smartphone for 30 consecutive days. Thematic analysis of semi-structured interviews showed that fall history differentiated a) participants’ awareness of day-to-day variation in functional ability; b) trust in the accuracy of self-monitoring; and c) imaginations of what types of feedback a mobile fall prevention technology should provide. Insight on older adults’ internal self-monitoring processes and guidelines for feedback design are discussed.

Recreational Screen Time Use among a Small Sample of Canadians during the First Six Months of the COVID-19 Pandemic

(1) Background: The coronavirus (COVID-19) pandemic has caused disruptions in the daily lives of individuals in Canada. Purpose: Examine how total and specific (i.e., watching television, using social media, going on the Internet, playing video games, and engaging in virtual social connection) recreational screen time behaviours changed throughout the first six months of the COVID-19 pandemic, in comparison to pre-pandemic levels; (2) Methods: Sixty four Canadians (mostly Caucasian, female, age range = 21–77 years) completed monthly surveys from April to September of 2020; (3) Results: A one-way repeated measures analysis of variance (RM-ANOVA) and subsequent post hoc analysis revealed that total recreational screen time was statistically higher in late March/April (292.5 min/day ± 143.0) and into May, compared to pre-COVID-19 (187.8 min/day ± 118.3), before declining in subsequent months; (4) Conclusions: Generally, specific recreational screen time behaviours, such as time spent watching television, followed the same trend. Future studies with larger sample sizes and from other countries examining recreational screen time behaviours longitudinally over the pandemic are still needed to allow for greater generalizability.

Descriptive Epidemiology of Fall-Related Injuries Among Older Adults in Ontario, Canada

The number of older adults is growing rapidly in the province of Ontario meaning there will be more fall-related injuries (FRIs) in coming decades. Falls are the leading cause of injury-related hospitalizations in Canada. The purpose of this study was to describe the prevalence, circumstances, types, and locations of FRIs among older adults in Ontario. Using a population-based retrospective design, we analyzed secondary data from three health administrative databases (NACRS, DAD, RPDB) for 2010-2014. Older adults (≥ 65 years) admitted to an emergency department (ED) with a combined diagnosis of ICD-10-CA codes for a fall (W00-W19) and injury (S00-S99 or T00-T14) were selected. Descriptive statistics were performed in R and rates were reported per 100,000 population. There were 304,610 FRI ED admissions (3,089/100,000) and 143,210 patients (47.0%) were subsequently hospitalized (1,452/100,000). Females accounted for 63.0% ED and 61.2% hospital admissions. Age-specific rates increased with age at both ED (2,208/100,000 in 65-69 group, 6,552/100,000 in 90+ years old) and hospital (698/100,000 in 65-69 group, 4,364/100,000 in 90+ years old). Females had higher rates of ED (3,503 vs. 2,572/100,000) and hospital (1,598 vs. 1,270/100,000) admissions than males. The most common injury types at the ED were fractures (1,234/100,000), superficial injuries (719/100,000), other or unspecified injuries (572/100,000), open wounds (498/100,000), and sprains, strains, and tears (162/100,000). FRIs are a considerable problem for older adults and better injury prevention strategies are needed for all female age groups, the 90+ year age group of both genders, and fractures.

Near-Fatal Self-Harm Among Canadian Adolescents

Objective To evaluate the clinical features of Canadian adolescents admitted to the intensive care unit (ICU) for medically serious self-harm. Methods 2700 Canadian paediatricians were surveyed monthly over two years (January 2017 to December 2018) through the Canadian Paediatric Surveillance Program to ascertain data from eligible cases. Results Ninety-three cases (73 female; age 15.2 ± 1.5) met the case definition. Four provinces reported the majority of cases: Quebec (n = 27), Ontario (n = 26), Alberta (n = 21), and British Columbia (n = 8). There were 10 deaths, 9 by hanging. Overdose and hanging were the most frequently reported methods of self-harm (74.2% and 19.4%, respectively). Overdose was more common in females (80.8% females vs. 50% males; χ2 = 7.8 (1), p = .005), whereas hanging was more common in males (35% males vs. 15.1% females, χ2 = 3.9 (1), p = .04). More females than males had a past psychiatric diagnosis (79% vs. 58%; χ2 = 4.1 (1), p = .06), a previous suicide attempt (55.9% vs. 29.4%, χ2 = 3.8 (1), p = .05), and prior use of mental health service (69.7% vs. 27.8%, χ2 = 10.4 (1), p = .001). Family conflict was the most commonly identified precipitating factor (43%) of self-harm. Conclusions Among Canadian adolescents admitted to the ICU with medically serious self-harm, females demonstrate a higher rate of suicide attempts and prior mental health care engagement, whereas males are more likely to die by suicide. These findings are consistent with data from other adolescent samples, as well as data from working-age and older adults. Therefore, a sex-specific approach to suicide prevention is warranted as part of a national suicide prevention strategy; family conflict may be a specific target for suicide prevention interventions among adolescents.