Search

BACKGROUND: Identifying patients at high risk of falling is crucial in implementing effective fall prevention programs. While the integration of information systems is becoming more widespread in the healthcare industry, it poses a significant challenge in analysing vast amounts of data to identify factors that could enhance patient safety. OBJECTIVE: To determine fall-associated factors and develop high-performance prediction tools for at-risk patients in acute and sub-acute care services in Australia. METHODS: A retrospective study of 672,400 patients admitted to acute and sub-acute care services within a large metropolitan tertiary health service in Victoria, Australia, between January 1, 2019, and December 31, 2021. Data were obtained from four sources: the Department of Health Victorian Admitted Episodes Dataset, RiskManTM, electronic health records, and the health workforce dataset. Machine learning techniques, including Random Forest and Deep Neural Network models, were used to analyse the data, predict patient falls, and identify the most important risk factors for falls in this population. Model performance was evaluated using accuracy, F1-score, precision, recall, specificity, Matthew's correlation coefficient, and the area under the receiver operating characteristic curve (AUC). RESULTS: The deep neural network and random forest models were highly accurate in predicting hospital patient falls. The deep neural network model achieved an accuracy of 0.988 and a specificity of 0.999, while the RF achieved an accuracy of 0.989 and a specificity of 1.000. The top 20 variables impacting falls were compared across both models, and 12 common factors were identified. These factors can be broadly classified into three categories: patient-related factors, staffing-related factors, and admission-related factors. Although not all factors are modifiable, they must be considered when planning fall prevention interventions. CONCLUSION: The study demonstrated machine learn

Overlapping clinical phenotypes and an expanding breadth and complexity of genomic associations are a growing challenge in the diagnosis and clinical management of Mendelian disorders. The functional consequences and clinical impacts of genomic variation may involve unique, disorder-specific, genomic DNA methylation episignatures. In this study, we describe 19 novel episignature disorders and compare the findings alongside 38 previously established episignatures for a total of 57 episignatures associated with 65 genetic syndromes. We demonstrate increasing resolution and specificity ranging from protein complex, gene, sub-gene, protein domain, and even single nucleotide-level Mendelian episignatures. We show the power of multiclass modeling to develop highly accurate and disease-specific diagnostic classifiers. This study significantly expands the number and spectrum of disorders with detectable DNA methylation episignatures, improves the clinical diagnostic capabilities through the resolution of unsolved cases and the reclassification of variants of unknown clinical significance, and provides further insight into the molecular etiology of Mendelian conditions.

Item does not contain fulltext

We sought to determine the effects of 12 months of power training on cognition, and whether improvements in body composition, muscle strength, and/or aerobic capacity (VO2peak) were associated with improvements in cognition in older adults with type 2 diabetes (T2D). Participants with T2D were randomized to power training or low-intensity sham exercise control condition, 3 days per week for 12 months. Cognitive outcomes included memory, attention/speed, executive function, and global cognition. Other relevant outcomes included VO2peak, strength, and whole body and regional body composition. One hundred and three adults with T2D (mean age 67.9 years; standard deviation [SD] 5.9; 50.5% women) were enrolled and analyzed. Unexpectedly, there was a nearly significant improvement in global cognition (p = .05) in the sham group relative to power training, although both groups improved over time (p < .01). There were significant interactions between group allocation and body composition or muscle strength in the models predicting cognitive changes. Therefore, after stratifying by group allocation, improvements in immediate memory were associated with increases in relative skeletal muscle mass (r = 0.38, p = .03), reductions in relative body fat (r = -0.40, p = .02), and increases in knee extension strength were directly related to changes in executive function (r = -0.41, p = .02) within the power training group. None of these relationships were present in the sham group (p > .05). Although power training did not significantly improve cognition compared to low-intensity exercise control, improvements in cognitive function in older adults were associated with hypothesized improvements in body composition and strength after power training.

Background: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. Materials and Methods: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. Results: Participants were aged 67.9 - 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0-6 (p = 0.16) or 0-6-12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were significantly greater in the power training compared to the sham exercise group across timepoints (p = 0.0001). However, there were no associations between changesin any PA measures over time and changes in metabolic profile. Conclusion: Structured high-intensity power training may be an effective strategy to enhance overall PA in this high-risk cohort.

BACKGROUND: We examined the effect of power training on habitual, intervention and total physical activity (PA) levels in older adults with type 2 diabetes and their relationship to metabolic control. MATERIALS AND METHODS: 103 adults with type 2 diabetes were randomized to receive supervised power training or sham exercise three times/week for 12 months. Habitual, intervention, and total PA, as well as insulin resistance (HOMA2-IR) and glycosylated hemoglobin (HbA1c), were measured. RESULTS: Participants were aged 67.9 ± 5.5 yrs, with well-controlled diabetes (HbA1c = 7.1%) and higher than average habitual PA levels compared to healthy peers. Habitual PA did not change significantly over 12 months (p = 0.74), and there was no effect of group assignment on change over time in habitual PA over 0-6 (p = 0.16) or 0-6-12 months (p = 0.51). By contrast, intervention PA, leg press tonnage and total PA increased over both 6- and 12-month timepoints (p = 0.0001), and these changes were significantly greater in the power training compared to the sham exercise group across timepoints (p = 0.0001). However, there were no associations between changes in any PA measures over time and changes in metabolic profile. CONCLUSION: Structured high-intensity power training may be an effective strategy to enhance overall PA in this high-risk cohort.

Prader-Willi syndrome (PWS) is a rare disorder caused by the loss of expression of genes on the paternal copy of chromosome 15q11-13. The main molecular subtypes of PWS are the deletion of 15q11-13 and non-deletion, and differences in neurobehavioral phenotype are recognized between the subtypes. This study aimed to investigate growth trajectories in PWS and associations between PWS subtype (deletion vs. non-deletion) and height, weight and body mass index (BMI). Growth data were available for 125 individuals with PWS (63 males, 62 females), of which 72 (57.6%) had the deletion subtype. There was a median of 28 observations per individual (range 2-85), producing 3565 data points distributed from birth to 18 years of age. Linear mixed models with cubic splines, subject-specific random effects and an autoregressive correlation structure were used to model the longitudinal growth data whilst accounting for the nature of repeated measures. Height was similar for males in both PWS subtypes, with non-deletion females being shorter than deletion females for older ages. Weight and BMI were estimated to be higher in the deletion subtype compared to the non-deletion subtype, with the size of difference increasing with advancing age for weight. These results suggest that individuals with deletion PWS are more prone to obesity.

RIVM rapport:In 2015 dronk rond de 80 procent van de Nederlandse jongeren van dertien tot achttien jaar nooit of minder dan een keer per week energiedranken. Bij de meeste jongeren die energiedrank drinken is er geen reden tot zorg. Dit product past echter niet in een gezond voedingspatroon, alleen al vanwege het hoge gehalte aan suiker. Daarnaast bevatten vrijwel alle merken van deze dranken cafeïne en twee andere stoffen (taurine en D-glucuronolacton). Als je te veel van deze stoffen binnenkrijgt, kan dat klachten veroorzaken als hartkloppingen en duizeligheid. Wanneer dat is, verschilt per persoon en hangt onder andere af van het gewicht. Een kleine groep jongeren (1 tot 2 procent) drinkt regelmatig drie of meer blikjes per dag, dus dagelijks minstens 750 ml. Hierdoor lopen zij het risico gezondheidsklachten te krijgen. Deze jongeren vertonen ook vaker ander risicogedrag, zoals roken en meer alcohol drinken, ten opzichte van jongeren die geen energiedrank drinken. Om de hoge consumptie bij deze groep jongeren tegen te gaan, zouden de Jeugdgezondheidszorg en (kinder)artsen het gebruik (nog) beter kunnen signaleren. Dat gebeurt bijvoorbeeld door dit onderwerp aan te kaarten bij het 'contactmoment' met middelbare scholieren van de Jeugdgezondheidszorg. Zij en (kinder)artsen kunnen voorlichting geven en alert zijn op energiedrankgebruik bij klachten. Specifieke aandacht voor de risicogroep is daarbij van belang. Het RIVM-onderzoek bevestigt het huidige advies van het Voedingscentrum over energiedrank voor dertien- tot achttienjarigen: drink het liever niet, en anders maximaal één blikje per dag. Het onderzoek is uitgevoerd in opdracht van het Ministerie van VWS in samenwerking met onder andere zes GGD's. Ruim 60.000 jongeren zijn (deels anoniem) bevraagd naar de mate waarin zij energiedrank drinken. Ook zijn risico's van de desbetreffende stoffen bekeken. Daarnaast is geïnventariseerd welke klachten kunnen optreden als jongeren veel energiedrank drinken, bijvoorbeeld meer dan een, In 2015, 80% of the Dutch adolescents aged 13-18 years did not consume energy drinks at all or less than once a week. For most of the young consumers, drinking energy drinks is no reason for concern. However, energy drinks do not fit into a healthy diet because they contain high amounts of added sugar. Energy drinks also contain caffeine and two other substances (taurine and D-glucurono-?-lactone). If you drink too many energy drinks, they may cause complaints such as palpitations or dizziness. The occurrence of these complaints depends on a person's characteristics, such as body weight. A small group of Dutch adolescents (1-2%) regularly consumes at least three cans of energy drinks a day, amounting to a daily intake of at least 750 ml. This group may be at risk of developing health complaints. Besides their high consumption of energy drinks, they also display other unhealthy behaviour, such as excessive use of alcohol and smoking. Measures can be taken to reduce a high consumption of energy drinks. Youth Health Care (YHC) and (pediatric) physicians could identify excessive intake. For example this issue could be addressed during regular controls by YHC in secondary schools. YHC and (pediatric) physicians could provide education and would also be aware of possible excessive intake in case of complaints. These measures should specifically target the high consumers of energy drinks. Our research supports the recommendations of the Netherlands Nutrition Centre for adolescents (13-18 yrs): preferably do not drink energy drinks at all, or no more than one can a day. This research was commissioned by the Dutch Ministry of Health. RIVM collaborated with six municipal public health services and other parties. More than 60,000 adolescents completed (partly anonymously) questionnaires about their consumption. Furthermore, we summarized the health risks of the specific substances. We also identified the type of health complaints resulting from the excessive consumption of ene

Item does not contain fulltext, OBJECTIVE: To investigate outcomes in patients with ST-segment elevation myocardial infarction (STEMI) after treatment with the Stentys self-apposing stent (Stentys SAS; Stentys S.A.) for bifurcation culprit lesions. BACKGROUND: The nitinol, self-expanding Stentys was initially developed as a dedicated bifurcation stent. The stent facilitates a provisional strategy by accommodating its diameter to both the proximal and distal reference diameters and offering an opportunity to "disconnect" the interconnectors, opening the stent toward the side branch. METHODS: The APPOSITION (a post-market registry to assess the Stentys self-expanding coronary stent in acute myocardial infarction) III study was a prospective, multicenter, international, observational study including STEMI patients undergoing primary percutaneous coronary intervention (PCI) with the Stentys SAS. Clinical endpoints were evaluated and stratified by bifurcation vs non-bifurcation culprit lesions. RESULTS: From 965 patients included, a total of 123 (13%) were documented as having a bifurcation lesion. Target-vessel revascularization (TVR) rates were higher in the bifurcation subgroup (16.4% vs 10.0%; P=.04). Although not statistically significant, other endpoints were numerically higher in the bifurcation subgroup: major adverse cardiac events (MACE; 12.7% vs 8.8%), myocardial infarction (MI; 3.4% vs 1.8%), and definite/probable stent thrombosis (ST; 5.8% vs 3.1%). However, when postdilation was performed, clinical endpoints were similar between bifurcation and non-bifurcation lesions: MACE (8.7% vs 8.4%), MI (1.2% vs 0.7%), and definite/probable ST (3.7% vs 2.4%). CONCLUSIONS: The use of the Stentys SAS was safe and feasible for the treatment of bifurcation lesions in the setting of primary PCI for STEMI treatment with acceptable 1-year cardiovascular event rates, which improved when postdilation was performed.