Association between diseases of despair and atherosclerotic cardiovascular disease among insured adults in the USA: a retrospective cohort study from 2017 to 2021

Objectives To assess associations between diseases of despair (DoD) and incident atherosclerotic cardiovascular disease (ASCVD) among insured adults in the USA.Design Retrospective cohort study.Setting Highmark insurance claims data in the USA from 2017 to 2021.Participants Adults with at least 10 months of continuous insurance enrolment, no record of ASCVD in the 2016 baseline year and no missing data on study variables.Primary and secondary outcome measures Cox proportional hazard regression was used to calculate crude and adjusted hazard ratios (HR) and 95% confidence intervals (CI) to assess risk of ASCVD (composite of ischaemic cardiomyopathy, non-fatal ischaemic stroke, peripheral arterial disease or non-fatal acute myocardial infarction) by baseline DoD overall, and by the component conditions comprising DoD (alcohol-related disorders, substance-related disorders, suicidality) individually and in combination.Results The DoD-exposed group had an age-adjusted rate of 20.5 ASCVD events per 1000 person-years, compared with 11.7 among the unexposed. In adjusted models, overall DoD was associated with increased risk of incident ASCVD (HR 1.42, 95% CI 1.36 to 1.47). Individually and in combination, component conditions of DoD were associated with higher risk for ASCVD relative to no DoD. Substance-related disorders were associated with 50% higher risk of incident ASCVD (HR 1.5, 95% CI 1.41 to 1.59), alcohol-related disorders and suicidality/intentional self-harm were associated with 33% and 30% higher risk, respectively (HR 1.33, 95% CI 1.26 to 1.41; HR 1.30, 95% CI 1.11 to 1.52). Co-occurring DoD components conferred higher risk still. The highest risk combination was substance-related disorders+suicidality (HR 2.01, 95% CI 1.44 to 2.82).Conclusions Among this cohort of insured adults, documented DoD was associated with increased ASCVD risk. Further research to understand and address cardiovascular disease prevention in those with DoD could reduce costs, morbidity and mortality. Further examination of overlapping structural factors that may be contributing to concurrent rises in ASCVD and DoD in the USA is needed

The Effects of the Safe-sun Program on Patrons' and Lifeguards' Skin Cancer Risk-reduction Behaviors at Swimming Pools

The 'Safe Sun' program had the goal of increasing patrons' and lifeguards' skin-protective behaviors and involved informational, prompting, feedback and goal-setting and incentive components coupled with pool lifeguards modeling protective behaviors such as wearing shirts, hats and sunglasses or staying in shaded areas. During two phases of a project involving 27 pools, it was found that while the program increased patrons' and lifeguards' protective behaviors, the largest changes were found at one pool where lifeguards were required to participate in the program. Patrons' protective behaviors at this pool increased from 30.7 percent to 52 percent, and lifeguards' protective behaviors increased from 40.8 percent to 95.7 percent. Social marketing, environmental change and institutionalization processes are needed to make skin-cancer prevention programs more effective

The Effects of the Safe-sun Program on Patrons\u27 and Lifeguards\u27 Skin Cancer Risk-reduction Behaviors at Swimming Pools

The \u27Safe Sun\u27 program had the goal of increasing patrons\u27 and lifeguards\u27 skin-protective behaviors and involved informational, prompting, feedback and goal-setting and incentive components coupled with pool lifeguards modeling protective behaviors such as wearing shirts, hats and sunglasses or staying in shaded areas. During two phases of a project involving 27 pools, it was found that while the program increased patrons\u27 and lifeguards\u27 protective behaviors, the largest changes were found at one pool where lifeguards were required to participate in the program. Patrons\u27 protective behaviors at this pool increased from 30.7 percent to 52 percent, and lifeguards\u27 protective behaviors increased from 40.8 percent to 95.7 percent. Social marketing, environmental change and institutionalization processes are needed to make skin-cancer prevention programs more effective

Exercise as an Augmentation Treatment for Nonremitted Major Depressive Disorder: A Randomized, Parallel Dose Comparison

OBJECTIVE: Most patients with major depressive disorder (MDD) require second-step treatments to achieve remission. The TReatment with Exercise Augmentation for Depression (TREAD) study was designed to test the efficacy of aerobic exercise as an augmentation treatment for MDD patients who had not remitted with antidepressant treatment. METHOD: Eligible participants in this randomized controlled trial were sedentary individuals (men and women aged 18–70 years) diagnosed with DSM-IV nonpsychotic MDD who had not remitted with selective serotonin reuptake inhibitor (SSRI) treatment. Participants were recruited through physician referrals and advertisements. A total of 126 participants were randomized to augmentation treatment with either 16 kcal per kg per week (KKW) or 4 KKW of exercise expenditure for 12 weeks while SSRI treatment was held constant. Supervised ses sions were conducted at The Cooper Institute, Dallas, Texas, with additional home-based sessions as needed to fulfill the weekly exercise prescription. The primary outcome was remission (as determined by a score ≤ 12 on the Inventory of Depressive Symptomatology, Clinician-Rated). The study took place between August 2003 and August 2007. RESULTS: There were significant improvements over time for both groups combined (F(1,121) = 39.9, P < .0001), without differential group effect (group effect: F(1,134) = 3.2, P = .07; group-by-time effect: F(1,119) = 3.8, P = .06). Adjusted remission rates at week 12 were 28.3% versus 15.5% for the 16-KKW and 4-KKW groups, respectively, leading to a number needed to treat (NNT) of 7.8 for 16 KKW versus 4 KKW. Men, regardless of family history of mental illness, and women without a family history of mental illness had higher remission rates by week 12 with higher-dose (women, 39.0%; men, 85.4%) than with lower-dose exercise (women, 5.6%; men, 0.1%) (women: t(95) = 2.1, P = .04; men: t(88) = 5.4, P < .0001) (NNT: women, 3.0; men, 1.2). CONCLUSIONS: There was a trend for higher remission rates in the higher-dose exercise group (P < .06), with a clinically meaningful NNT of 7.8 in favor of the high exercise dose. Significant differences between groups were found when the moderating effects of gender and family history of mental illness were taken into account and suggest that higher-dose exercise may be better for all men and for women without a family history of mental illness