Cancer types with high numbers of driver events are largely preventable

There is a long-standing debate on whether cancer is predominantly driven by extrinsic risk factors such as smoking, or by intrinsic processes such as errors in DNA replication. We have previously shown that the number of rate-limiting driver events per tumor can be estimated from the age distribution of cancer incidence using the gamma/Erlang probability distribution. Here, we show that this number strongly correlates with the proportion of cancer cases attributable to modifiable risk factors for all cancer types except the ones inducible by infection or ultraviolet radiation. The correlation was confirmed for three countries, three corresponding incidence databases and risk estimation studies, as well as for both sexes: USA, males (r = 0.80, P = 0.002), females (r = 0.81, P = 0.0003); England, males (r = 0.90, P < 0.0001), females (r = 0.67, P = 0.002); Australia, males (r = 0.90, P = 0.0004), females (r = 0.68, P = 0.01). Hence, this study suggests that the more driver events a cancer type requires, the more of its cases are due to preventable anthropogenic risk factors.

Risk factors associated with pressure ulcers in a public hospital [Factores de riesgos asociados a úlceras por presión en un hospital público]

The general objective was to determine risk factors associated with pressure ulcers. Hypothesis: Intrinsic and extrinsic risk factors are significantly associated in the development of pressure ulcers. The research was applied, correlational, retrospective, quantitative. The population was 180 Clinical Histories, of which 60 belonged to patients who presented pressure ulcers (Cases) and 120 to patients who did not present pressure ulcers (Controls). The instrument was a data collection sheet; the information being processed through the SSPS Vs 22 program. The Chi square statistical test, the P - Value was less than 5%. The results were; age, sex, mobility, incontinence, nutrition, state of consciousness, degree of dependence and main diagnosis are intrinsic risk factors for the appearance of pressure ulcers, also extrinsic factors; Hospital stay, availability of equipment and materials, postural changes, body hygiene, massages, location of pressure ulcers and stages are risk factors for the formation of pressure ulcers. Conclusion: intrinsic and extrinsic factors are significantly associated with the development of pressure ulcers in adulthood and older adults.

Predictive Model of Preventive Behaviors against COVID-19 in the Older Adult: The PREASOC-COVID-19 Study

Background: The purpose of this study was to analyze the relationship between COVID-19 preventive behaviors, as the dependent variable, with risk perception, coping style and sense of coherence, as independent variables, in older people living in the community. Methods: An observational design for predictive model development. This study was reported following the STROBE statement. The subjects were people over 65 years of age living in the community. Data collection included sociodemographic variables related to COVID-19, risk perception and types, coping styles in the face of contagion, sense of coherence, and preventive behaviors in the face of COVID-19. The data collection period was from November 2020 to January 2021. Results: A total of 305 people participated in this study (71.5% women, mean age 71.34 years; 6.9% suffered from COVID-19 and 44.3% knew someone close to them who suffered from the virus). The coping style variables problem-focused, emotion-focused, and sense of coherence subscales Significance and manageability explained 17% of the variable preventive behaviors against COVID-19. There were statistically significant differences by gender in all subscales, with women scoring higher in all of them; Conclusions: Men with low risk perception, extrinsic risk perception, and low sense of coherence presented worse COVID-19 preventive behaviors. It would be interesting to develop specific prevention and health education campaigns for this population.

Urinary Tract Infections in Elderly Patients: A 10-Year Study on Their Epidemiology and Antibiotic Resistance Based on the WHO Access, Watch, Reserve (AWaRe) Classification

The ageing of the population—especially in developed countries—has brought on many societal challenges and has significantly contributed to the burden on healthcare infrastructures worldwide. Elderly persons (aged ≥ 65 years) are at higher risk for developing UTIs, due to a range of intrinsic and extrinsic risk factors, and they often delay seeking treatment. A retrospective observational study was performed regarding the epidemiology and resistance of UTIs in elderly patients. Identification of the isolates was carried out using VITEK 2 ID/AST and MALDI-TOF mass spectrometry. Antibiotic resistance in these isolates was assessed based on EUCAST guidelines, and were grouped into the WHO AWaRe (Access, Watch, Reserve) classification of antimicrobials. During the 10-year study period, n = 4214 (421.4 ± 118.7/year) and n = 4952 (495.2 ± 274.6) laboratory-confirmed UTIs were recorded in inpatients and outpatients, respectively. The causative agents showed differentiation among outpatients and inpatients: Escherichia coli (48.14% vs. 25.65%; p = 0.001), Enterococcus spp. (20.15% vs. 21.52%; p > 0.05), Klebsiella spp. (16.28% vs. 16.26%; p > 0.05), Pseudomonas spp. (4.40%vs. 13.36%; p = 0.001); Proteus-Providencia-Morganella group (4.56% vs. 10.96%; p = 0.001); Candida spp. (0.53% vs. 5.98%; p = 0.001); Citrobacter-Enterobacter-Serratia group (1.90% vs. 2.71%; p < 0.05). Significantly higher resistance rates were observed in inpatient isolates for many Access and Watch antibiotics compared to isolates of outpatient origin; in addition, resistance rates were higher in these uropathogens compared to the previously recorded rates in the region. More care should be taken for the diagnosis and treatment of UTIs affecting elderly patients, as they represent a particularly vulnerable patient population.

STUDY OF VARIOUS BASELINE FACTORS AND PRE-OPERATIVE FACTORS AFFECTING SURGICAL SITE INFECTION IN CAESAREAN SECTION

Introduction: Caesarean section is one of the most commonly performed surgical procedure in hospitals. But it carries 5-20 fold increase risk of infection compared to vaginal delivery. Analysis of various baseline, intrinsic and extrinsic risk factors predisposing to surgical site infection is necessary to detect common links. obtained information is important to plan a strategy to reduce post caesarean wound infections and its complications. Material and Method: This is a prospective observational study enrolling 1500 sequentiall consenting subjects who had undergone caesarean section, on surgical site infection following caesarean section. Results: The cesarean section rate was found to be 41.2%.Subjects over 35 years of age had highest SSI rates of 16.7% and difference in SSI in subjects more than 35years was statistically significant (p value = 0.04) (88.6%) of the total enrolled subjects undergoing LSCS were antenatally registered amongst which 3.3% developed SSI compared to 11.4% of the total subjects were antenatally unregistered amongst which 5.8% developed SSI (p value=0.04) 1% of the total enrolled subjects undergoing LSCS had a history of gestational diabetes mellitus amongst which 33.3% had SSI , while 99% of the subjects did not have history of gestational diabetes amongst whom SSI incidence was 3.3% (p value <0.01) which is significant. 7.6% of the total enrolled subjects undergoing LSCS had a history of hypertension amongst which 8.8% developed SSI compared to 92.4% of the subjects without hypertension had 3.2% SSI. (p value <0.01) there is a significant association of body mass index with SSI. (p value <0.01). There is significant association found between preterm rupture of membrane and SSI (p value <0.01). Conclusion: Strategies for the prevention of post operative BMI must aim to control mother’s pre-conceptual weight, their antenatal registration, follow standard intranatal mangement guidelines, timely administration of prophylactic antibiotic if decision to perform LSCS is to be taken. Keywords: Surgical site infection, caesarean section.

Avaliação dos fatores de risco ambientais para quedas em idosos da comunidade: revisão narrativa de literatura /Assessment of environmental risk factors for falls in the elderly community: narrative literature review

Introdução: A identificação dos fatores de risco ambientais de quedas é determinante para a prevenção deste evento em idosos da comunidade. Objetivo: Apresentar as principais diretrizes para a avaliação dos riscos ambientais de quedas em idosos da comunidade. Método: Revisão narrativa de literatura com pesquisa bibliográfica realizada por meio de busca nas bases de dados LILACS, MEDLINE, SciELO e PubMed no período de agosto a novembro de 2018. Resultados: As diretrizes sobre riscos de quedas em idosos da comunidade recomendam a realização de avaliação multifatorial, incluindo fatores de risco intrínsecos e extrínsecos, com destaque para os fatores domiciliares. Diversas abordagens e ferramentas têm sido utilizadas para a avaliação do risco de quedas em idosos da comunidade. Entre os instrumentos validados para a avaliação de riscos ambientais residenciais, a maioria requer visita domiciliar pelo profissional de saúde para ser aplicado. Conclusão: Avaliação multifatorial é fundamental para identificar os principais fatores de risco para quedas em idosos da comunidade. A identificação de perigos no domicílio é um dos requisitos fundamentais para uma avaliação eficiente.Palavras-chave: Acidentes por Quedas. Idosos. Avaliação de Risco. Riscos Ambientais. AbstractIntroduction: The identification of environmental risk factors for falls is crucial for the prevention of this event in the elderly in the community. Objective: To present the main guidelines for the assessment of the environmental risks of falls among elderly people in the community. Method: Narrative review of literature with bibliographic research carried out by searching the LILACS, MEDLINE, SciELO and PubMed databases from August to November 2018. Results: The guidelines on the risks of falls in the elderly in the community recommend carrying out multifactorial assessment, including intrinsic and extrinsic risk factors, with emphasis on household factors. Several approaches and tools have been used to assess the risk of falls in the elderly in the community. Among the validated instruments for assessing residential environmental risks, most require home visits by health professionals to be applied. Conclusion: Multifactorial assessment is essential to identify the main risk factors for falls in the elderly in the community. The identification of hazards at home is one of the fundamental requirements for an efficient assessment.Keywords: Accidental Falls. Aged, Risk Assessment. Environmental Risks. ResumenIntroducción: La identificación de los factores de riesgo ambientales para las caídas es crucial para la prevención de este evento en los ancianos de la comunidad. Objetivo: Presentar las principales pautas para la evaluación de los riesgos ambientales de caídas entre las personas mayores en la comunidad. Método: revisión narrativa de la literatura con investigación bibliográfica realizada mediante la búsqueda en las bases de datos LILACS, MEDLINE, SciELO y PubMed de agosto a noviembre de 2018. Resultados: las pautas sobre los riesgos de caídas en los ancianos en la comunidad recomiendan llevar a cabo evaluación multifactorial, incluidos los factores de riesgo intrínsecos y extrínsecos, con énfasis en los factores del hogar. Se han utilizado varios enfoques y herramientas para evaluar el riesgo de caídas en los ancianos de la comunidad. Entre los instrumentos validados para evaluar los riesgos ambientales residenciales, la mayoría requiere que se apliquen visitas domiciliarias de profesionales de la salud. Conclusión: la evaluación multifactorial es esencial para identificar los principales factores de riesgo de caídas en los ancianos de la comunidad. La identificación de los peligros en el hogar es uno de los requisitos fundamentales para una evaluación eficiente.Palabras clave: Accidentes por Caídas. Personas Mayores. Evaluación de Riesgos. Riesgos Ambientales.

Mechanisms by Which Probiotic Bacteria Attenuate the Risk of Hepatocellular Carcinoma

Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the second leading cause of cancer-related deaths worldwide. Chronic infections with hepatitis B virus (HBV) and hepatitis C virus (HCV), alcoholic liver disease (ALD), and non-alcoholic fatty liver disease (NAFLD)/non-alcoholic steatohepatitis (NASH) are the major extrinsic risk factors of HCC development. Genetic background is pivotal in HCC pathogenesis, and both germline mutations and single nucleotide polymorphism (SNP) are intrinsic risk factors of HCC. These HCC risk factors predispose to hepatic injury and subsequent activation of fibrogenesis that progresses into cirrhosis and HCC. Probiotic bacteria can mitigate HCC risk by modulating host gut microbiota (GM) to promote growth of beneficial microbes and inhibit HCC-associated dysbiosis, thus preventing pathogen-associated molecular patterns (PAMPs)-mediated hepatic inflammation. Probiotics have antiviral activities against HBV and HCV infections, ameliorate obesity and risk of NAFLD/NASH, and their antioxidant, anti-proliferative, anti-angiogenic, and anti-metastatic effects can prevent the HCC pathogenesis. Probiotics also upregulate the expression of tumor suppressor genes and downregulate oncogene expression. Moreover, metabolites generated by probiotics through degradation of dietary phytochemicals may mitigate the risk of HCC development. These multiple anticancer mechanisms illustrate the potential of probiotics as an adjuvant strategy for HCC risk management and treatment.

Idiopathic spontaneous compartment syndrome of the right lower limb: a case report

Background Acutely painful lower limb is a common presentation to the emergency department, and acute compartment syndrome is an important differential diagnosis to consider given the correct predisposing history and clinical presentation. However, idiopathic spontaneous compartment syndrome is an uncommon occurrence. Case presentation A 54-year-old Caucasian man with no previous comorbidities presented with acute right-sided lower limb pain with classical symptoms showing gradual evolution. He had no other history of medical relevance and no preceding injury. Examination showed a marginally enlarged right lower limb with stretched skin and tenderness. Routine blood tests were normal including D-dimer levels. However, in the absence of any underlying risk factors, acute compartment syndrome was suspected on clinical merit and confirmed with magnetic resonance imaging. He underwent successful surgical intervention with fasciotomy and achieved good recovery. Discussion Acute compartment syndrome, though commonly attributed to trauma, can occur due to varied causes. Spontaneous acute compartment syndrome is attributed to diabetes mellitus. Idiopathic acute spontaneous compartment syndrome occurs in the absence of either intrinsic or extrinsic risk factors and is rarely documented in the literature. This case highlights the importance of appreciating classical clinical signs and having the clinical acumen to consider an obvious diagnosis even in its rarer form of presentation.

“You come up with different theories every year”: Practitioner perceptions of injury risk factors and player monitoring practices in elite men’s domestic cricket

The aim of the current study was to capture and better understand the current perceptions of injury risk factors and player monitoring practices in elite men’s domestic senior cricket, to help guide practice in this setting. A cross-sectional mixed-methods design was used, consisting of a quantitative survey sent to science and medicine practitioners at all English County clubs ( n = 23, with representation from each club) and a set of qualitative interviews ( n = 10 from six County clubs). Previous injury and physical fitness were the intrinsic injury risk factors most frequently endorsed as being important, with reduced recovery time and congested match schedules the most frequently endorsed extrinsic risk factors. Monitoring bowling overs was the most common tool for continually assessing injury risk. Player adherence was perceived to be the main factor impacting effective monitoring, along with human resource and practical application of monitoring knowledge. The interviews revealed that communicating value, fostering effective working relationships, and a strong club culture were important for successfully implementing monitoring and prevention initiatives. Cricket presents distinct challenges for its practitioners, and more education and guidance on appropriate monitoring methods and analysis is needed.