ARTICLE | doi:10.20944/preprints202109.0254.v2
Subject: Medicine & Pharmacology, Cardiology Keywords: cardiovascular; schizophrenia; prospective cohort; hospital admissions
Online: 30 December 2021 (19:42:41 CET)
(1) Background: Patients with schizophrenia have higher mortality, with cardiovascular diseases being the first cause of mortality. This study aims to estimate the excess risk of hospital admission for cardiovascular events in schizophrenic patients, adjusting for comorbidity and risk factors. (2) Methods: The APNA study is a dynamic prospective cohort of all residents in Navarra, Spain. 505889 people over 18 years were followed for five years. The endpoint was hospital admissions for a cardiovascular event. Direct Acyclic Graphs (DAG) and Cox regression were used. (3) Results: Schizophrenic patients had a Hazard Ratio (HR) of 1.414 (95% CI 1.031-1.938) of hospital admission for a cardiovascular event after adjusting for age, sex, hypertension, type 2 diabetes, dyslipidemia, smoking, low income, obesity, antecedents of cardiovascular disease, and smoking. In non-adherent to antipsychotic treatment schizophrenia patients, the HR was 2.232 (95% CI 1.267-3.933). (4) Conclusions: Patients with schizophrenia have a higher risk of hospital admission for cardiovascular events than persons with the same risk factors without schizophrenia. Primary care nursing interventions should monitor these patients and reduce cardiovascular risk factors.
ARTICLE | doi:10.20944/preprints202201.0078.v1
Subject: Medicine & Pharmacology, General Medical Research Keywords: rehospitalization; transition care; pilot study; prospective randomized trial
Online: 6 January 2022 (11:40:43 CET)
Hospital readmission within 30 days of discharge (30-day readmission) is a high-priority quality measure and cost target. The purpose of this study was to explore the feasibility and efficacy of the Diabetes Transition of Hospital Care (DiaTOHC) Program on readmission risk in high-risk adults with diabetes. This was a non-blinded pilot randomized controlled trial (RCT) that compared usual care (UC) to DiaTOHC at a safety-net hospital. The primary outcome was all-cause 30-day readmission. Between 10/16/2017 and 05/30/2019, 115 patients were randomized. In the intention-to-treat (ITT) population, 14 (31.1%) of 45 DiaTOHC subjects and 15 (32.6%) of 46 UC subjects had a 30-day readmission (p=0.88) while 35.6% DiaTOHC and 39.1% UC subjects had a 30-day readmission or ED visit (p=0.72). The Intervention:UC cost ratio was 0.33 (0.13-0.79)95%CI (p<0.01). Among the 69 subjects with baseline HbA1c >7.0% (53 mmol/mol), 30-day readmission rates were 23.5% (DiaTOHC) and 31.4% (UC, p=0.46) and composite 30-day readmission or ED visit rates were 26.5% (DiaTOHC) and 40.0% (UC, p=0.23). In this subgroup, the Intervention:UC cost ratio was 0.21 (0.08-0.58)95%CI (p=0.002). The DiaTOHC Program is feasible and may decrease combined 30-day readmission/ED visit risk as well as healthcare costs among patients with higher HbA1c levels.
Subject: Engineering, Automotive Engineering Keywords: Business incubators; Multiple Criteria Decision Making (MCDM); Prospective Scenarios; Hybrid Method.
Online: 22 February 2021 (15:22:29 CET)
This paper proposes a model to evaluate business projects to get into an incubator, allowing to rank them in order of selection priority. The model combines the Momentum method to build prospective scenarios and the Multiple Criteria Decision Making (MCDM) method TOPSIS-2N to rank the alternatives. Six business projects were evaluated to be incubated. The Momentum method made it possible for us to create an initial core of criteria for the evaluation of incubation projects. The TOPSIS-2N method supported the decision to choose the company to be incubated by ranking the alternatives in order of relevance. Our evaluation model has improved the existing models used by incubators. This model can be used and / or adapted by any incubator to evaluate the business projects to be incubated. The set of criteria for the evaluation of incubation projects is original and the use of prospective scenarios with a MCDM method to evaluate companies to be incubated does not exist in the literature.
ARTICLE | doi:10.20944/preprints202009.0339.v1
Subject: Medicine & Pharmacology, Cardiology Keywords: Great East Japan Earthquake; disaster; cardiovascular disease; psychological factors; evacuation; prospective study
Online: 16 September 2020 (03:01:44 CEST)
Evidence regarding the effect of psychological factors and evacuation on cardiovascular disease occurrence after large-scale disasters is limited. This prospective study followed up a total of 37,810 Japanese men and women aged 30–89 years from the Fukushima Prefecture with no history of stroke or heart disease at baseline (2012), until 2017. This period included 3000 cardiovascular events recorded through questionnaires and death certificates. The participants’ psychological distress, trauma reaction, and evacuation status were defined, and divided into four groups based on combinations of psychological factors and evacuation status. We calculated the hazard ratios and 95% confidence intervals for only psychological, only evacuation, or both of them compared with neither using Cox proportional hazard models. Psychological factors along with evacuation resulted in approximately 5% to 25% higher magnitude of stroke and heart disease risk than psychological factors only among men. Compared to neither, the multivariable hazard ratios of those with both psychological distress and evacuation were 1.75 for stroke and 1.49 for heart disease, and those of both trauma reaction and evacuation were 2.01 and 1.57, respectively, among men. Evacuation combined with psychological factors increased the risk of stroke and heart disease risks especially in men after the Great East Japan Earthquake.
ARTICLE | doi:10.20944/preprints202104.0730.v1
Subject: Earth Sciences, Atmospheric Science Keywords: Prospective analysis; strategic actors; scenarios; objectives; policies; phosphate extraction; mining project; rural communities
Online: 28 April 2021 (07:47:34 CEST)
Followed by the aspect of respect for rights 20, the social and environmental issue has a score of 19.9, the dialogue issue is 19. In short, the proximity plan indicates that the policies used regarding the issue of generating employment and economic growth (Empresa Mantaro Perú SAC), continue to be the strategic variables in the first instance, but they are far from the social actors (rural communities of Aco, Vico, Cruz Pampa and others) and environmental (Junín environmental dialogue table) and Ombudsman's Office (rights) that are currently closer together. The actor from the Archbishop of Huancayo referred to communication is one of the driving variables of power. The proximity plan shows us that the policies used regarding the issue of generating employment and economic growth (Empresa Mantaro Perú SAC), continue to be the strategic variables in the first instance, but that they are far from the social actors (Rural Communities of Aco , Vico, Cruz Pampa and others) and environmental (Junín Environmental Dialogue Table) and Ombudsman's Office (rights) that are currently closer together. The actor from the Archbishop of Huancayo referred to communication is one of the driving variables of power. The proximity plan shows us that the policies used regarding the issue of generating employment and economic growth (Empresa Mantaro Perú SAC), continue to be the strategic variables in the first instance, but that they are far from the social actors (Rural Communities of Aco , Vico, Cruz Pampa and others) and environmental (Junín Environmental Dialogue Table) and Ombudsman's Office (rights) that are currently closer together. The actor from the Archbishop of Huancayo referred to communication is one of the driving variables of power. but they are far from the social actors (rural communities of Aco, Vico, Cruz Pampa and others) and environmental (Junín Environmental Dialogue Table) and the Ombudsman's Office (rights) that are closer together today. The actor from the Archbishopric of Huancayo referred to communication, is within the driving variables of power. but they are far from the social actors (rural communities of Aco, Vico, Cruz Pampa and others) and environmental (Junín Environmental Dialogue Table) and the Ombudsman's Office (rights) that are currently closer together. The actor of the Archbishopric of Huancayo referred to communication, is within the driving variables of power.
REVIEW | doi:10.20944/preprints202301.0271.v1
Subject: Medicine & Pharmacology, Obstetrics & Gynaecology Keywords: evolutionary mismatch; diagnosis of labor; prospective diagnosis; cervical dilatation; uterine contractions; pain intensity; metabolomic.
Online: 16 January 2023 (07:25:19 CET)
The difficulty in the clinical diagnosis of labor is due to an evolutionary mismatch. The ability to hide the signs and symptoms of labor is an evolutionary trait that was once advantageous, but became maladaptive due to environmental changes. Prospective diagnosis of labor is not possible with certainty using only clinical criteria; however, by analyzing the urinary metabolome of women in labor, this diagnosis is likely possible in all cases. In this review, we explain why the two methods (clinical and metabolomic) differ in efficacy and sensitivity, and we try to fit this difference into an evolutionary framework that explains these discrepancies considering evolutionary mismatch. The study of metabolomics allows the truth to emerge from the past, and the diffusion of metabolomic techniques and their application to clinical reality in the form of POC (Point of Care) could change the management of labor and childbirth in the future.
ARTICLE | doi:10.20944/preprints201811.0237.v1
Subject: Medicine & Pharmacology, Nutrition Keywords: epidemiology; prospective cohort study; n-6 fatty acids; n-3 fatty acids; linoleic acid; arachidonic acid
Online: 9 November 2018 (04:07:36 CET)
Background: The prognostic value of erythrocyte levels of the n-6 fatty acids (FAs) for total mortality and cardiovascular disease (CVD) outcomes remains an open question. Methods: We examined CV outcomes and death in 2500 individuals in the Framingham Heart Study Offspring cohort without prevalent CVD (mean age 66 years, 57% women) as a function of baseline levels of different length n-6 FAs (18 carbon, 20 carbon and 22 carbon) in the erythrocyte membranes. Clinical outcomes were monitored for up to 9.5 years (median follow up, 7.26 years). Cox proportional hazards models were adjusted for a variety of demographic characteristics, clinical status and RBC n-6 and long chain n-3 FA content. Results: There were 245 CV events, 119 CHD events, 105 ischemic strokes, 58 CVD deaths, and 350 deaths from all causes. Few associations between either mortality or CVD outcomes were observed for the n-6 FAs, with those that were observed becoming non-significant after adjusting for n-3 FA levels. Conclusions: Higher circulating levels of the marine n-3 FA levels are associated with reduced risk for incident CVD and ischemic stroke and for death from CHD and all-causes, however in the same sample, little evidence exists for association with n-6 FAs. Further work is needed to identify a full profile of FAs associated with cardiovascular risk and mortality.
REVIEW | doi:10.20944/preprints202112.0278.v1
Subject: Medicine & Pharmacology, Nutrition Keywords: systematic review; meta-analysis; dietary pattern; prospective cohort; randomized controlled trial; cancer prognosis; cancer survival; dietary intervention
Online: 16 December 2021 (15:06:33 CET)
Cancer survival continues to improve in high-income countries, partly explained by advances in screening and treatment. Previous studies have mainly examined the relationship between individual dietary components and cancer prognosis in tumours with good therapeutic response (breast, colon and prostate cancers). The aim of this review was to assess qualitatively (and quantitatively where appropriate) the associations of dietary patterns and cancer prognosis from published prospective cohort studies, as well as the effect of diet interventions by means of randomized controlled trials (RCT). A systematic search was conducted in PubMed, and a total of 35 prospective cohort studies and 14 RCT published between 2011 and 2021 were selected. Better overall diet quality was associated with improved survival among breast and colorectal cancer survivors; adherence to the Mediterranean diet was associated to lower risk of mortality in colorectal and prostate cancer survivors. A meta-analysis using a random-effects model showed that higher versus lower diet quality was associated with a 23% reduction in overall mortality in breast cancer survivors. There was evidence that dietary interventions, generally combined with physical activity, improved overall quality of life, though most studies were in breast cancer survivors. Further cohort and intervention studies in other cancers are needed to make more specific recommendations.
ARTICLE | doi:10.20944/preprints202301.0131.v1
Subject: Medicine & Pharmacology, Pathology & Pathobiology Keywords: BCG; bladder cancer; non-muscle-invasive bladder cancer; prospective validation; pT1 high-grade bladder cancer; risk stratification; ROL; substaging; TURBT; urothelial carcinoma.
Online: 9 January 2023 (01:17:29 CET)
Patients with pT1 high-grade (HG) bladder cancer (BC) and a very high risk of progression might benefit from immediate radical cystectomy (RC), but this option remains controversial. Validation of a standardized method to evaluate the extent of lamina propria (LP) invasion (with recognized prognostic value) in transurethral resections (TURBT) specimens is still needed. The Rete Oncologica Lombarda (ROL) system showed a high predictive value for progression after TURBT in recent retrospective studies. Our aim was to validate ROL system on a large mono-institutional prospective series of primary urothelial carcinomas. From 2016 to 2020, we adopted ROL for all patients with pT1 HG BC on TURBT. We employed a 1.0-mm threshold to stratify tumors in ROL1 and ROL2. A total of 222 pT1HGBC were analyzed. Median age was 74 years, with male predominance (73.8%). ROL was feasible in all cases: 91 cases were ROL1 (41%) and 131 ROL2 (59%). At a median follow up of 26.9 months (IQR 13.8-40.6), we registered 80 recurrences and 40 progressions. ROL was a significant predictor of tumor progression at both univariable (HR 3.53; CI 95% 1.56 – 7.99; p<0.01) and multivariable (HR 2.90; CI 95% 1.25 – 6.75; p=0.01) Cox regression analyses. At Kaplan-Meier estimates, ROL showed correlation with both PFS (p=0.0012) and RFS (p=0.0167). Our results confirmed the strong predictive value of ROL for progression on a large prospective series. We encourage the application of ROL for reporting the extent of LP invasion, substaging T1 HG BC, and improving risk tables for urological decision making.