Understanding social care need through primary care big data: a rapid scoping review.

BACKGROUND: A more comprehensive understanding and measurement of adult social care need could contribute to efforts to develop more effective, holistic personalised care, particularly for those with multiple long-term conditions (MLTC). Progress in this area faces the challenge of a lack of clarity in the literature relating to how social care need is assessed and coded within variables included in primary care databases. AIM: To explore how social care need is assessed and coded within variables included in primary care databases. DESIGN & SETTING: An exploratory rapid scoping review of peer-reviewed articles and grey literature. METHOD: Articles were screened and extracted onto a charting sheet and findings were summarised descriptively. Articles were included if published in English and related to primary and social care using data from national primary care databases. RESULTS: The search yielded 4010 articles. Twenty-seven were included. Six articles used the term 'social care need', although related terminology was identified including 'need factors', 'social support', and 'social care support'. Articles mainly focused on specific components of social care need, including levels of social care usage or service utilisation and costs incurred to social care, primary care, and other providers in addressing needs. A limited range of database variables were found measuring social care need. CONCLUSION: Further research is needed on how social care need has been defined in a UK context and captured in primary care big databases. There is potential scope to broaden the definition of social care need, which captures social service needs and wider social needs.

Development and Validation of Population Clusters for Integrating Health and Social Care: Protocol for a Mixed Methods Study in Multiple Long-Term Conditions (Cluster-Artificial Intelligence for Multiple Long-Term Conditions).

BACKGROUND: Multiple long-term health conditions (multimorbidity) (MLTC-M) are increasingly prevalent and associated with high rates of morbidity, mortality, and health care expenditure. Strategies to address this have primarily focused on the biological aspects of disease, but MLTC-M also result from and are associated with additional psychosocial, economic, and environmental barriers. A shift toward more personalized, holistic, and integrated care could be effective. This could be made more efficient by identifying groups of populations based on their health and social needs. In turn, these will contribute to evidence-based solutions supporting delivery of interventions tailored to address the needs pertinent to each cluster. Evidence is needed on how to generate clusters based on health and social needs and quantify the impact of clusters on long-term health and costs. OBJECTIVE: We intend to develop and validate population clusters that consider determinants of health and social care needs for people with MLTC-M using data-driven machine learning (ML) methods compared to expert-driven approaches within primary care national databases, followed by evaluation of cluster trajectories and their association with health outcomes and costs. METHODS: The mixed methods program of work with parallel work streams include the following: (1) qualitative semistructured interview studies exploring patient, caregiver, and professional views on clinical and socioeconomic factors influencing experiences of living with or seeking care in MLTC-M; (2) modified Delphi with relevant stakeholders to generate variables on health and social (wider) determinants and to examine the feasibility of including these variables within existing primary care databases; and (3) cohort study with expert-driven segmentation, alongside data-driven algorithms. Outputs will be compared, clusters characterized, and trajectories over time examined to quantify associations with mortality, additional long-term conditions, worsening frailty, disease severity, and 10-year health and social care costs. RESULTS: The study will commence in October 2021 and is expected to be completed by October 2023. CONCLUSIONS: By studying MLTC-M clusters, we will assess how more personalized care can be developed, how accurate costs can be provided, and how to better understand the personal and medical profiles and environment of individuals within each cluster. Integrated care that considers "whole persons" and their environment is essential in addressing the complex, diverse, and individual needs of people living with MLTC-M. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/34405.

Recovery from sauna bathing favorably modulates cardiac autonomic nervous system.

OBJECTIVE: Sauna bathing is becoming a common activity in many countries and it has been linked to favorable health outcomes. However, there is limited data on the heart rate (HR) and heart rate variability (HRV) responses to an acute sauna exposure. DESIGN: We conducted a single-group, longitudinal study utilizing a pre-post design to examine acute effects of sauna bathing on the autonomic nervous system as reflected by HRV. A total of 93 participants (mean [SD] age: 52.0 [8.8] years, 53.8% males) with cardiovascular risk factors were exposed to a single sauna session (duration: 30 min; temperature: 73 °C; humidity: 10-20%) and data on HRV variables were collected before, during and after sauna. RESULTS: Time and frequency-domain HRV variables were significantly modified (p < 0.001) by the single sauna session, with most of HRV variables tending to return near to baseline values after 30 min recovery. Resting HR was lower at the end of recovery (68/min) compared to pre-sauna (77/min). A sauna session transiently diminished the vagal component, whereas the cooling down period after sauna decreased low frequency power (p < 0.001) and increased high frequency power in HRV (p < 0.001), favorably modulating the autonomic nervous system balance. CONCLUSIONS: This study demonstrates that a session of sauna bathing induces an increase in HR. During the cooling down period from sauna bathing, HRV increased which indicates the dominant role of parasympathetic activity and decreased sympathetic activity of cardiac autonomic nervous system. Future randomized controlled studies are needed to show if HR and HRV changes underpins the long-term cardiovascular effects induced by regular sauna bathing.

Sauna bathing is associated with reduced cardiovascular mortality and improves risk prediction in men and women: a prospective cohort study.

BACKGROUND: Previous evidence indicates that sauna bathing is related to a reduced risk of fatal cardiovascular disease (CVD) events in men. The aim of this study was to investigate the relationship between sauna habits and CVD mortality in men and women, and whether adding information on sauna habits to conventional cardiovascular risk factors is associated with improvement in prediction of CVD mortality risk. METHODS: Sauna bathing habits were assessed at baseline in a sample of 1688 participants (mean age 63; range 53-74 years), of whom 51.4% were women. Multivariable-adjusted hazard ratios (HRs) were calculated to investigate the relationships of frequency and duration of sauna use with CVD mortality. RESULTS: A total of 181 fatal CVD events occurred during a median follow-up of 15.0 years (interquartile range, 14.1-15.9). The risk of CVD mortality decreased linearly with increasing sauna sessions per week with no threshold effect. In age- and sex-adjusted analysis, compared with participants who had one sauna bathing session per week, HRs (95% CIs) for CVD mortality were 0.71 (0.52 to 0.98) and 0.30 (0.14 to 0.64) for participants with two to three and four to seven sauna sessions per week, respectively. After adjustment for established CVD risk factors, potential confounders including physical activity, socioeconomic status, and incident coronary heart disease, the corresponding HRs (95% CIs) were 0.75 (0.52 to 1.08) and 0.23 (0.08 to 0.65), respectively. The duration of sauna use (minutes per week) was inversely associated with CVD mortality in a continuous manner. Addition of information on sauna bathing frequency to a CVD mortality risk prediction model containing established risk factors was associated with a C-index change (0.0091; P = 0.010), difference in - 2 log likelihood (P = 0.019), and categorical net reclassification improvement (4.14%; P = 0.004). CONCLUSIONS: Higher frequency and duration of sauna bathing are each strongly, inversely, and independently associated with fatal CVD events in middle-aged to elderly males and females. The frequency of sauna bathing improves the prediction of the long-term risk for CVD mortality.

Short-term effects of Finnish sauna bathing on blood-based markers of cardiovascular function in non-naive sauna users.

Emerging evidence suggests that sauna bathing is associated with reduced risk of cardiovascular and all-cause mortality events. However, the biochemical pathways by which sauna bathing might confer its effects on cardiovascular function are not certain. We aimed to study the acute effects of Finnish sauna bathing on various blood-based cardiovascular biomarkers. The study included 102 non-naive sauna users (54% male) with mean age of 51.9 years, who had at least one cardiovascular risk factor. Participants underwent a 30-min single sauna session (mean temperature, 73 °C). Biochemical profiling was conducted before, immediately after sauna and 30-min post-sauna. Overall median N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (n = 20 participants) was 46.0 ng/L before sauna exposure, which increased to 50.5 ng/l immediately after sauna (median change, + 12.00%; p < 0.001) and remained persistent at 30-min post-sauna (median change from pre-sauna to post-30-min sauna, + 13.93%; p < 0.001). The changes were more evident in males compared with females. There were no significant changes in overall levels of high sensitivity C-reactive protein, creatine kinase, high sensitivity troponin I, and creatine kinase-MBm. However, levels of creatine kinase increased in males (median change immediately after sauna, + 2.99%; p = 0.024). Levels of NT-proBNP increased after sauna exposure. The increase in levels of creatine kinase was more evident in males. Long-term interventional studies are warranted to evaluate if these biomarkers are involved in pathways underlying the associations of sauna bathing with cardiovascular outcomes.

Sauna bathing reduces the risk of stroke in Finnish men and women: A prospective cohort study.

OBJECTIVE: To assess the association between frequency of sauna bathing and risk of future stroke. METHODS: Baseline habits of sauna bathing were assessed in 1,628 adult men and women aged 53-74 years (mean age, 62.7 years) without a known history of stroke in the Finnish Kuopio Ischemic Heart Disease prospective cohort study. Three sauna bathing frequency groups were defined: 1, 2-3, and 4-7 sessions per week. Hazard ratios (HRs) (95% confidence intervals [CIs]) were estimated for incident stroke. RESULTS: During a median follow-up of 14.9 years, 155 incident stroke events were recorded. Compared with participants who had one sauna bathing session per week, the age- and sex-adjusted HR (95% CI) for stroke was 0.39 (0.18-0.83) for participants who had 4-7 sauna sessions per week. After further adjustment for established cardiovascular risk factors and other potential confounders, the corresponding HR (95% CI) was 0.39 (0.18-0.84) and this remained persistent on additional adjustment for physical activity and socioeconomic status at 0.38 (0.18-0.81). The association between frequency of sauna bathing and risk of stroke was not modified by age, sex, or other clinical characteristics (p for interaction > 0.10 for all subgroups). The association was similar for ischemic stroke but modest for hemorrhagic stroke, which could be attributed to the low event rate (n = 34). CONCLUSIONS: This long-term follow-up study shows that middle-aged to elderly men and women who take frequent sauna baths have a substantially reduced risk of new-onset stroke.

Acute effects of sauna bathing on cardiovascular function.

Emerging evidence suggests beneficial effects of sauna bathing on the cardiovascular system. However, the effects of sauna bathing on parameters of cardiovascular function and blood-based biomarkers are uncertain. We aimed to investigate whether sauna bathing induces changes in arterial stiffness, blood pressure (BP), and several blood-based biomarkers. We conducted an experimental study including 102 participants (mean age (SD): 51.9 (9.2) years, 56% male) who had at least one cardiovascular risk factor. Participants were exposed to a single sauna session (duration: 30 min; temperature: 73 °C; humidity: 10-20%). Cardiovascular as well as blood-based parameters were collected before, immediately after, and after 30-min recovery. Mean carotid-femoral pulse wave velocity was 9.8 (2.4) m/s before sauna and decreased to 8.6 (1.6) m/s immediately after sauna (p < 0.0001). Mean systolic BP decreased after sauna exposure from 137 (16) to 130 (14) mmHg (p < 0.0001) and diastolic BP from 82 (10) to 75 (9) mmHg (p < 0.0001). Systolic BP after 30 min recovery remained lower compared to pre-sauna levels. There were significant changes in hematological variables during sauna bathing. Plasma creatinine levels increased slightly from sauna until recovery period, whereas sodium and potassium levels remained constant. This study demonstrates that sauna bathing for 30 min has beneficial effects on arterial stiffness, BP, and some blood-based biomarkers. These findings may provide new insights underlying the emerging associations between sauna bathing and reduced risk of cardiovascular outcomes.

Sauna exposure leads to improved arterial compliance: Findings from a non-randomised experimental study.

Background Heat therapy has been suggested to improve cardiovascular function. However, the effects of hot sauna exposure on arterial compliance and the dynamics of blood flow and pressure have not been well documented. Thus, we investigated the short-term effects of sauna bathing on arterial stiffness and haemodynamics. Design The design was an experimental non-randomised study. Methods There were 102 asymptomatic participants (mean age, 51.9 years) who had at least one cardiovascular risk factor. Participants were exposed to a single sauna session (duration: 30 min; temperature: 73℃; humidity: 10-20%). Pulse wave velocity, augmentation index, heart rate, blood pressure, mean arterial pressure, pulse pressure, augmented pressure and left ventricular ejection time were assessed before, immediately after, and 30 min after a single sauna session. Results Sauna bathing led to reductions in pulse wave velocity, blood pressure, mean arterial pressure and left ventricular ejection time. Mean pulse wave velocity value before sauna was 9.8 m/s and decreased to 8.6 m/s immediately after sauna bathing ( p < 0.001 for difference), and was 9.0 m/s after the 30-minute recovery period ( p < 0.001 for analysis of variance). Systolic blood pressure was 137 mm Hg before sauna bathing, decreasing to 130 mm Hg after sauna ( p < 0.001), which remained sustained during the 30-minute recovery phase ( p < 0.001 for analysis of variance). After a single sauna session, diastolic blood pressure decreased from 82 to 75 mm Hg, mean arterial pressure from 99.4 to 93.6 mm Hg and left ventricular ejection time from 307 to 278 m/s ( p < 0.001 for all differences). Pulse pressure was 42.7 mm Hg before the sauna, 44.9 mm Hg immediately after the sauna, and reduced to 39.3 mm Hg after 30-minutes recovery ( p < 0.001 for analysis of variance). Heart rate increased from 65 to 81 beats/min post-sauna ( p < 0.001); there were no significant changes for augmented pressure and pulse pressure amplification. Conclusion This study shows that pulse wave velocity, systolic blood pressure, diastolic blood pressure, mean arterial pressure, left ventricular ejection time and diastolic time decreased immediately after a 30-minute sauna session. Decreases in systolic blood pressure and left ventricular ejection time were sustained during the 30-minute recovery phase.

Sauna Bathing and Incident Hypertension: A Prospective Cohort Study.

BACKGROUND: Sauna bathing is associated with reduced cardiovascular risk, but the mechanisms underlying this beneficial effect are not entirely understood. We aimed to assess the relationship between sauna bathing and risk of incident hypertension. METHODS: Frequency of sauna bathing was ascertained using questionnaires in the Kuopio Ischemic Heart Disease Study, a prospective cohort study conducted in Eastern Finland that comprised a population-based sample of 1,621 men aged 42 to 60 years without hypertension at baseline. The incidence of hypertension was defined as a physician diagnosis of hypertension, systolic blood pressure (SBP) >140 mm Hg, diastolic blood pressure >90 mm Hg, or use of antihypertensive medication. RESULTS: During a median follow-up of 24.7 years, 251 incident cases (15.5%) were recorded. In Cox regression analysis adjusted for baseline age, smoking, body mass index, and SBP; compared to participants reporting 1 sauna session per week, the hazard ratio for incident hypertension in participants reporting 2 to 3 sessions and 4 to 7 sessions was 0.76 (95% confidence interval: 0.57-1.02) and 0.54 (0.32-0.91), respectively. The corresponding hazard ratios were similar after further adjustment for glucose, creatinine, alcohol consumption, heart rate, family history of hypertension, socioeconomic status, and cardiorespiratory fitness: 0.83 (95% confidence interval: 0.59-1.18) and 0.53 (0.28-0.98), respectively. CONCLUSIONS: Regular sauna bathing is associated with reduced risk of hypertension, which may be a mechanism underlying the decreased cardiovascular risk associated with sauna use. Further epidemiological and experimental studies could help elucidate the effects of sauna bathing on cardiovascular function.

Association between sauna bathing and fatal cardiovascular and all-cause mortality events.

IMPORTANCE: Sauna bathing is a health habit associated with better hemodynamic function; however, the association of sauna bathing with cardiovascular and all-cause mortality is not known. OBJECTIVE: To investigate the association of frequency and duration of sauna bathing with the risk of sudden cardiac death (SCD), fatal coronary heart disease (CHD), fatal cardiovascular disease (CVD), and all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS: We performed a prospective cohort study (Finnish Kuopio Ischemic Heart Disease Risk Factor Study) of a population-based sample of 2315 middle-aged (age range, 42-60 years) men from Eastern Finland. Baseline examinations were conducted from March 1, 1984, through December 31, 1989. EXPOSURES: Frequency and duration of sauna bathing assessed at baseline. RESULTS: During a median follow-up of 20.7 years (interquartile range, 18.1-22.6 years), 190 SCDs, 281 fatal CHDs, 407 fatal CVDs, and 929 all-cause mortality events occurred. A total of 601, 1513, and 201 participants reported having a sauna bathing session 1 time per week, 2 to 3 times per week, and 4 to 7 times per week, respectively. The numbers (percentages) of SCDs were 61 (10.1%), 119 (7.8%), and 10 (5.0%) in the 3 groups of the frequency of sauna bathing. The respective numbers were 89 (14.9%), 175 (11.5%), and 17 (8.5%) for fatal CHDs; 134 (22.3%), 249 (16.4%), and 24 (12.0%) for fatal CVDs; and 295 (49.1%), 572 (37.8%), and 62 (30.8%) for all-cause mortality events. After adjustment for CVD risk factors, compared with men with 1 sauna bathing session per week, the hazard ratio of SCD was 0.78 (95% CI, 0.57-1.07) for 2 to 3 sauna bathing sessions per week and 0.37 (95% CI, 0.18-0.75) for 4 to 7 sauna bathing sessions per week (P for trend = .005). Similar associations were found with CHD, CVD, and all-cause mortality (P for trend ≤.005). Compared with men having a sauna bathing session of less than 11 minutes, the adjusted hazard ratio for SCD was 0.93 (95% CI, 0.67-1.28) for sauna bathing sessions of 11 to 19 minutes and 0.48 (95% CI, 0.31-0.75) for sessions lasting more than 19 minutes (P for trend = .002); significant inverse associations were also observed for fatal CHDs and fatal CVDs (P for trend ≤.03) but not for all-cause mortality events. CONCLUSIONS AND RELEVANCE: Increased frequency of sauna bathing is associated with a reduced risk of SCD, CHD, CVD, and all-cause mortality. Further studies are warranted to establish the potential mechanism that links sauna bathing and cardiovascular health.