Social relationships and the risk of incident heart failure: results from a prospective population-based study of older men

Aims: Limited social relationships, particularly in older adults, have been implicated as a risk factor for cardiovascular disease. However, little is known about the associations between poor social relationships and heart failure incidence. Methods and results: Prospective study of socially representative men aged 60-79 years drawn from general practices in 24 British towns and followed up for a maximum of 18 years. A total of 3698 participants with no previous diagnosis of heart failure were included. Information on social relationships was based on a combination of marital status, living circumstances, and social contacts with friends and family. These provided information on contact frequency, contact satisfaction, and a social relationship score (low to high) combining frequency and satisfaction with contact. Heart failure included both incidents non-fatal heart failure and death from heart failure. Among 3698 participants, 330 developed heart failure. Men with low compared to high frequency of contact with family and friends had an increased risk of incident heart failure [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.15-2.18]; this remained statistically significant after adjustment for social class, behavioural, and biological risk factors. Low compared to high scores for satisfaction with contacts was associated with increased risk of heart failure (adjusted HR = 1.54; 95% CI 1.14-2.07). Lower social relationship scores (combining frequency and satisfaction with contact) were associated with greater risk of incident heart failure (adjusted HR = 1.38, 95% CI 1.02-1.87). Marital status and living alone were not significantly associated with heart failure. Conclusion: Weaker social relationships appear to increase the risk of developing heart failure in older age. Further research is needed to investigate pathways underlying these associations and to test whether interventions to strengthen social relationships can reduce the risk of heart failure

Social relationships and the risk of incident heart failure: results from a prospective population-based study of older men.

Aims: Limited social relationships, particularly in older adults, have been implicated as a risk factor for cardiovascular disease. However, little is known about the associations between poor social relationships and heart failure incidence. Methods and results: Prospective study of socially representative men aged 60-79 years drawn from general practices in 24 British towns and followed up for a maximum of 18 years. A total of 3698 participants with no previous diagnosis of heart failure were included. Information on social relationships was based on a combination of marital status, living circumstances, and social contacts with friends and family. These provided information on contact frequency, contact satisfaction, and a social relationship score (low to high) combining frequency and satisfaction with contact. Heart failure included both incidents non-fatal heart failure and death from heart failure. Among 3698 participants, 330 developed heart failure. Men with low compared to high frequency of contact with family and friends had an increased risk of incident heart failure [hazard ratio (HR) 1.59, 95% confidence interval (CI) 1.15-2.18]; this remained statistically significant after adjustment for social class, behavioural, and biological risk factors. Low compared to high scores for satisfaction with contacts was associated with increased risk of heart failure (adjusted HR = 1.54; 95% CI 1.14-2.07). Lower social relationship scores (combining frequency and satisfaction with contact) were associated with greater risk of incident heart failure (adjusted HR = 1.38, 95% CI 1.02-1.87). Marital status and living alone were not significantly associated with heart failure. Conclusion: Weaker social relationships appear to increase the risk of developing heart failure in older age. Further research is needed to investigate pathways underlying these associations and to test whether interventions to strengthen social relationships can reduce the risk of heart failure

Investigating the effectiveness and acceptability of oral health and related health behaviour interventions in adults with severe and multiple disadvantage: Protocol for a mixed-methods systematic review

Increasing numbers of people in England experience homelessness, substance use, and repeated offending (known as ‘severe and multiple disadvantage’; SMD). Populations experiencing SMD often have extremely poor oral health, which is closely inter-linked with high levels of substance use, smoking, and poor diet. This study aims to undertake an evidence synthesis to identify the effectiveness, resource requirements, and factors influencing the implementation and acceptability of oral health and related health behaviour interventions in adults experiencing SMD. Two systematic reviews will be conducted using mixed-methods. Review 1 will investigate the effectiveness and resource implications of oral health and related health behaviours (substance use, smoking, diet) interventions; Review 2 will investigate factors influencing the implementation of such interventions. The population includes adults (≥18 years) experiencing SMD. Standard review methods in terms of searches, screening, data extraction, and quality appraisal will be conducted. Narrative syntheses will be conducted. If feasible, a meta-analysis will be conducted for Review 1 and a thematic synthesis for Review 2. Evidence from the two reviews will then be synthesised together. Input from people with experience of SMD will be sought throughout to inform the reviews. An initial logic model will be iteratively refined during the review

When Antibiotics Fail: The Expert Panel on the Potential Socio-Economic Impacts of Antimicrobial Resistance in Canada

Antimicrobials are life savers in Canada, enabling modern healthcare and playing a central role in agriculture. They have reduced the economic, medical, and social burden of infectious diseases and are part of many routine medical interventions, such as caesarean sections, joint replacements, and tonsillectomies. As use of antimicrobials has increased, bacteria evolved to become resistant, resulting in drugs that are no longer effective at treating infections. Antimicrobial resistance (AMR) is increasing worldwide, and with widespread trade and travel, resistance can spread quickly, posing a serious threat to all countries. For Canada, the implications of AMR are stark. When Antibiotics Fail examines the current impacts of AMR on our healthcare system, projects the future impact on Canada’s GDP, and looks at how widespread resistance will influence the day-to-day lives of Canadians. The report examines these issues through a One Health lens, recognizing the interconnected nature of AMR, from healthcare settings to the environment to the agriculture sector. It is the most comprehensive report to date on the economic impact of AMR in Canada

Patients' perspectives on high-tech home care: a qualitative inquiry into the user-friendliness of four technologies

BACKGROUND: The delivery of technology-enhanced home care is growing in most industrialized countries. The objective of our study was to document, from the patient's perspective, how the level of user-friendliness of medical technology influences its integration into the private and social lives of patients. Understanding what makes a technology user-friendly should help improve the design of home care services. METHODS: Four home care interventions that are frequently used and vary in their technical and clinical features were selected: Antibiotic intravenous therapy, parenteral nutrition, peritoneal dialysis and oxygen therapy. Our qualitative study relied on the triangulation of three sources of data: 1) interviews with patients (n = 16); 2) interviews with carers (n = 6); and 3) direct observation of nursing visits of a different set of patients (n = 16). Participants of varying socioeconomic status were recruited through primary care organizations and hospitals that deliver home care within 100 km of Montreal, the largest urban area in the province of Quebec, Canada. RESULTS: The four interventions have both a negative and positive effect on patients' lives. These technologies were rarely perceived as user-friendly, and user-acceptance was closely linked to user-competence. Compared with acute I.V. patients, who tended to be passive, chronic patients seemed keener to master technical aspects. While some of the technical and human barriers were managed well in the home setting, engaging in the social world was more problematic. Most patients found it difficult to maintain a regular job because of the high frequency of treatment, while some carers found their autonomy and social lives restricted. Patients also tended to withdraw from social activities because of social stigmatization and technical barriers. CONCLUSIONS: While technology contributes to improving the patients' health, it also imposes significant constraints on their lives. Policies aimed at developing home care must clearly integrate principles and resources supporting the appropriate use of technology. Close monitoring of patients should be part of all technology-enhanced home care programs

Peak grain forecasts for the US High Plains amid withering waters

ACKNOWLEDGMENTS. This paper stems from discussions during the Ettersburg Ecohydrology Workshop in Germany (October 2018), with the corresponding manuscript preparation ensuing in subsequent months. The workshop was funded by the UNIDEL Foundation, Inc. and the University of Delaware. Accordingly, partial support for this paper derived from funding for the workshop. A.M. was supported by the US NSF (Grants NSF-AGS-1644382 and NSF-IOS-175489).Peer reviewedPublisher PD

Impact of the Health Gym Program on hospital admissions for stroke in the state of Pernambuco, Brazil

This study aimed to evaluate the impact of the Health Gym Program (HGP) on hospital admissions for stroke in the state of Pernambuco, Brazil. This policy impact evaluation used a quasi-experimental approach consisting of a difference-in-differences estimator, weighted by propensity score matching to deal with potential confounding variables. The study comprised socioeconomic, demographic, and epidemiological data from official Brazilian databases from 2010 to 2019. The treatment group was composed of the 134 municipalities that implemented the HGP since 2011. The 51 municipalities that did not were allocated to the comparison group. The nearest neighbor algorithm (N5) was used to pair treatment and comparison group municipalities and create the weights to evaluate the average treatment effect on the treated (ATT) in the difference-in-differences estimator. In 2010, 2,771 people were hospitalized for stroke (0.51% of all hospitalizations) and in 2019, 11,542 (2%). Municipalities that implemented the HGP had 18.37% fewer hospitalizations than their counterparts in the comparison group. The program’s impact in reducing hospitalization rates was incrementally greater among men (ATT: -0.1932) and those aged 71 to 80 years (ATT: -0.1911). All results were statistically significant at the 5% level. The HGP reduced hospitalization for stroke in several population groups, but primarily in those whose underlying prevalence of stroke is highest, reinforcing the importance of public investments in health promotion policies designed to encourage lifestyle changes.Resumo: O estudo teve como objetivo avaliar o impacto do Programa Academia da Saúde (PAS) nas internações hospitalares por acidente vascular cerebral (AVC) no Estado de Pernambuco, Brasil. Esta avaliação de impacto das políticas utilizou uma abordagem quase-experimental que consiste em um estimador de diferença-em-diferenças, ponderado pelo pareamento por escore de propensão para lidar com possíveis fatores de confusão. O estudo foi composto por dados socioeconômicos, demográficos e epidemiológicos de bases de dados oficiais brasileiras entre os anos de 2010 e 2019. O grupo de tratamento foi composto pelos 134 municípios que implantaram o PAS a partir de 2011, e os 51 municípios que não implantaram foram alocados no grupo de comparação. O algoritmo do vizinho mais próximo (N5) foi utilizado para emparelhar os municípios tratados e comparar aos municípios do grupo controle, criando os pesos que foram utilizados para avaliar o efeito médio do tratamento sobre o tratado (ATT) no estimador de diferença- -em-diferenças. Houve 2.771 internações por AVC em 2010 (0,51% de todas as internações) e 11.542 (2%) em 2019. Os municípios que implementaram o PAS tiveram 18,37% menos internações em comparação com seus homólogos no grupo de comparação. O impacto do programa na redução das taxas de internação foi maior entre os homens (ATT: -0,1932) e naqueles com idade entre 71 e 80 anos (ATT: -0,1911). Todos os resultados foram estatisticamente significativos em um nível de 5%. O PAS reduziu a hospitalização por AVC em vários grupos populacionais, mas principalmente naqueles em que a prevalência subjacente de AVC é mais alta, reforçando a importância dos investimentos públicos em políticas de promoção da saúde destinadas a estimular mudanças nos estilos de vida. Avaliação de Programas e Projetos de Saúde; Doença Crônica; Promoção da Saúde; Pontuação de Propensão; Acidente Vascular CerebralResumen: El objetivo de este trabajo es evaluar el impacto del Programa Academia de la Salud (PAS) en los ingresos hospitalarios por accidente cerebrovascular (ACV) en el estado de Pernambuco, Brasil. Esta evaluación del impacto de la política utilizó un enfoque cuasi-experimental que consiste en un estimador de diferencias en diferencias, ponderado por el emparejamiento de puntuación de propensión para hacer frente a posibles factores de confusión. El estudio incluyó datos socioeconómicos, demográficos y epidemiológicos de bases de datos oficiales brasileñas de 2010 a 2019. El grupo de tratamiento se compuso de los 134 municipios que implementaron el PAS a partir de 2011 y los 51 municipios que no lo hicieron se asignaron al grupo de comparación. Se utilizó el algoritmo del vecino más próximo (N5) para emparejar los municipios tratados y los del grupo de comparación y crear las ponderaciones que se emplearon para evaluar el efecto medio del tratamiento sobre los tratados (ATT) en el estimador de diferencias en diferencias. Hubo 2.771 hospitalizaciones por ACV en 2010 (0,51% de todas las hospitalizaciones) y 11.542 (2%) en 2019. Los municipios que aplicaron el PAS tuvieron un 18,37% menos de hospitalizaciones en comparación con sus homólogos del grupo de comparación. El impacto del programa en la reducción de las tasas de hospitalización fue gradualmente mayor entre los hombres (ATT: -0,1932) y entre las personas de 71 a 80 años (ATT: -0,1911). Todos los resultados fueron estadísticamente significativos al nivel del 5%. El PAS redujo la hospitalización por ACV en varios grupos de población, pero principalmente en aquellos en los que la prevalencia subyacente de ACV es mayor, lo que refuerza la importancia de las inversiones públicas en políticas de promoción de la salud diseñadas para impulsar cambios en los estilos de vida. Evaluación de Programas y Proyectos de Salud; Enfermedad Crónica; Promoción de la Salud; Puntaje de Propensión; Accidente CerebrovascularPernambuco State Foundation for the Support of Science and Technology (FACEPE), and the Brazilian National Research Council (CNPq)

Peak grain forecasts for the US High Plains amid withering waters

Irrigated agriculture contributes 40% of total global food production. In the US High Plains, which produces more than 50 million tons per year of grain, as much as 90% of irrigation originates from groundwater resources, including the Ogallala aquifer. In parts of the High Plains, groundwater resources are being depleted so rapidly that they are considered nonrenewable, compromising food security. When groundwater becomes scarce, groundwater withdrawals peak, causing a subsequent peak in crop production. Previous descriptions of finite natural resource depletion have utilized the Hubbert curve. By coupling the dynamics of groundwater pumping, recharge, and crop production, Hubbert-like curves emerge, responding to the linked variations in groundwater pumping and grain production. On a state level, this approach predicted when groundwater withdrawal and grain production peaked and the lag between them. The lags increased with the adoption of efficient irrigation practices and higher recharge rates. Results indicate that, in Texas, withdrawals peaked in 1966, followed by a peak in grain production 9 y later. After better irrigation technologies were adopted, the lag increased to 15 y from 1997 to 2012. In Kansas, where these technologies were employed concurrently with the rise of irrigated grain production, this lag was predicted to be 24 y starting in 1994. In Nebraska, grain production is projected to continue rising through 2050 because of high recharge rates. While Texas and Nebraska had equal irrigated output in 1975, by 2050, it is projected that Nebraska will have almost 10 times the groundwater-based production of Texas

Epidemiology of Knee and Hip Arthroplasty: A Systematic Review§

We present a systematic review of epidemiologic studies of Total Knee Arthroplasty (TKA) and Total Hip Arthroplasty (THA). The studies summarized in this systematic review provide us with estimates of arthroplasty utilization rates, underlying disease frequency and its trends and differences in utilization rates by age, gender and ethnicity among other factors. Among these, many studies are registry-based that assessed utilization rates using data from major orthopedic centers that may provide some understanding of underlying diagnosis and possibly time-trends. Several studies are population-based cross-sectional, which provide estimates of prevalence of TKA and THA. Population-based cohort studies included in this review provide the best estimates of incidence and utilization rates, time-trends and differences in these rates by important patient characteristics (age, gender, ethnicity and others). This article reviews the current published literature in the area and highlights the main findings