Modifiable and non-modifiable risk factors of early-onset colorectal cancer: National Health Interview Survey analysis.

BACKGROUND AND AIMS: Although the incidence of colorectal cancer (CRC) diagnosed in individuals younger than 50 years, early-onset CRC (EO-CRC), is rapidly increasing, the risk factors for EO-CRC are still being identified. This study aimed to confirm the modifiable and non-modifiable characteristics identified as risk factors for EO-CRC. METHODS: This cross-sectional study used 2004-2018 National Health Interview Survey (NHIS) data, which provides comprehensive health information gathered from national annual household interview surveys. Demographic, clinical, and behavioral characteristics of EO-CRC patients were compared with those without. In addition, their non-age-related characteristics (gender, race/ethnicity, region, body mass index [BMI], alcohol consumption, and smoking status) were compared with individuals with average-onset CRC (AO-CRC). For both comparisons, multivariable logistic regression analyses were performed. RESULTS: We identified 156 patients with EO-CRC, 204,846 with non-CRC, and 1972 with AO-CRC. Comparison between the EO-CRC and the non-CRC groups showed that higher odds of having EO-CRC was associated with older age (Odds Ratio [OR]=1.11, 95 % CI=1.08-1.14, p<0.001), living in the Midwest (vs. South) (OR=1.64, 95 % CI=1.06-2.55, p=0.03), and history of alcohol consumption (vs. lifetime abstainer) (OR=2.09, 95 % CI=1.01-4.36, p=0.049). Lower odds of having EO-CRC were associated with being Hispanic (OR=0.43, 95 % CI=0.22-0.84, p=0.01) or Asian (OR=0.38, 95 % CI=0.16-0.92, p=0.03) (vs. non-Hispanic White) and having moderate or vigorous physical activities (vs. no activity) (OR=0.58, 95 % CI=0.34-0.999, p=0.0496 and OR=0.34; 95 % CI=0.21-0.55, p<0.0001, respectively). Compared with patients with AO-CRC, patients with EO-CRC were more likely to be Hispanic (vs. non-Hispanic White) (OR=2.21, 95 % CI=1.13-4.33, p=0.02). CONCLUSION: This study verified several modifiable (i.e., alcohol consumption and physical activity) and non-modifiable (i.e., race/ethnicity) risk factors while also discovering a new factor (i.e., geographical region) associated with EO-CRC.

Novel Fatty Acid Biomarkers in Psoriasis and the Role of Modifiable Factors: Results from the METHAP Clinical Study.

Psoriasis is a chronic, immune-mediated skin condition with significant metabolic complications. Although lipid metabolism is linked to its pathogenesis, reliable biomarkers and the impact of modifiable factors remain underexplored. The aim of the present study was to identify potential biomarkers, study the affected metabolic networks, and assess the role of dietary and lifestyle factors in psoriasis. Plasma samples from 56 patients with psoriasis and 49 healthy controls were analyzed, as part of the Metabolic Biomarkers in Hashimoto's Thyroiditis and Psoriasis (METHAP) clinical trial. Using Gas Chromatography-Mass Spectrometry 23 fatty acids and their ratios were quantified, revealing significant changes in psoriasis. Specifically, lower levels of α-linoleic acid (C18:3n3), linoleic acid (C18:2n6), and gamma-linolenic acid (C18:3n6) were observed along with higher levels of eicosatrienoic acid (C20:3n3), eicosapentaenoic acid (C20:5n3), and erucic acid (C22:1n9). Total polyunsaturated fatty acids (PUFA) were significantly decreased, and the ratio of saturated to total fatty acids (SFA/Total) was increased in psoriasis (p-values < 0.0001). Linear regression identified α-linoleic acid, linoleic acid, eicosatrienoic acid, and eicosapentaenoic acid as potential biomarkers for psoriasis, adjusting for demographic, dietary, and lifestyle confounders. Network analysis revealed key contributors in the metabolic reprogramming of psoriasis. These findings highlight the association between psoriasis and fatty acid biomarkers of inflammation, insulin resistance and micronutrients deficiency, suggesting their potency in disease management.

Modifiable and Non-Modifiable Factors That Affect Human Milk Oligosaccharides Composition.

Human milk, the gold standard in infant nutrition, is a unique fluid that provides essential nutrients such as lactose, lipids, proteins, and free oligosaccharides. While its primary role is nutritional, it also protects against pathogens. This protection mainly comes from immunoglobulins, with human milk oligosaccharides (HMOs) providing additional support by inhibiting pathogen binding to host cell ligands. The prebiotic and immune-modulatory activity of HMOs strongly depends on their structure. Over 200 individual structures have been identified so far, with the composition varying significantly among women. The structure and composition of HMOs are influenced by factors such as the Lewis blood group, secretor status, and the duration of nursing. HMO profiles are heavily influenced by maternal phenotypes, which are defined based on the expression of two specific fucosyltransferases. However, recent data have shown that HMO content can be modified by various factors, both changeable and unchangeable, including diet, maternal age, gestational age, mode of delivery, breastfeeding frequency, and race. The first part of this overview presents the historical background of these sugars and the efforts by scientists to extract them using the latest chromatography methods. The second part is divided into subchapters that examine modifiable and non-modifiable factors, reviewing the most recent articles on HMO composition variations due to specific reasons and summarizing potential future challenges in conducting these types of studies.

Associations of modifiable factors with risk of irritable bowel syndrome.

Background: Modifiable factors were found to be associated with the risk of irritable bowel syndrome (IBS) in observational studies, but whether these associations are causal is uncertain. We conducted a Mendelian randomization (MR) study to systematically explore the causal associations of modifiable factors with IBS. Methods: Summary-level statistical data for IBS was obtained from a genome-wide association study (GWAS) meta-analysis of UK Biobank (40,548 cases and 293,220 controls) and the international collaborative Bellygenes initiative (12,852 cases and 139,981 controls). Genetic instruments associated with the exposures at the genome-wide significance (p < 5 × 10-8) level were selected from previous GWASs. Mendelian randomization was performed using inverse-variance weighted (IVW) method, supplemented with several sensitivity analyses to evaluate potentially causal relationships between identified contributing factors and IBS. Furthermore, we applied another database from FinnGen (8,116 IBS cases and 276,683 controls) to testify the reliability of the significant associations. Results: Seven convincing modifiable factors were significantly associated with IBS after correction for multiple testing. Genetically predicted smoking initiation (OR = 1.12, 95% CI = 1.06-1.18, p = 1.03 × 10-4), alcohol consumption (OR = 0.47, 95% CI = 0.34-0.64, p = 3.49 × 10-6), sedentary behavior (OR = 1.17, 95% CI = 1.07-1.28, p = 4.02 × 10-4), chronotype (OR = 0.92, 95% CI = 0.88-0.96, p = 4.42 × 10-4), insomnia (OR = 1.19, 95% CI = 1.15-1.24, p = 7.59 × 10-19), education (OR = 0.80, 95% CI = 0.74-0.88, p = 5.34 × 10-7), and visceral adiposity (OR = 1.15, 95% CI = 1.06-1.24, p = 7.96 × 10-4). We additionally identified several suggestive factors, including serum magnesium, serum phosphorus, physical activity, lifetime smoking, intelligence, lean body mass, and body mass index (BMI). After pooling the effect estimates from FinnGen, the associations remained significant except for chronotype. Conclusion: This MR analysis verified several modifiable risk factors for IBS, thus prevention strategies for IBS should be considered from multiple perspectives on these risk factors.

Combined Effect of Outdoor Time and Other Modifiable Factors on Myopia Incidence Among Children and Adolescents - 9 PLADs, China, 2020.

What is already known about this topic?: Myopia has been identified as a significant emerging challenge and policy priority among children and adolescents in China by the Ministry of Education and seven other departments. Limited research has been conducted to investigate the collective impact of outdoor time and other modifiable factors on the incidence of myopia. What is added by this report?: This study provides support for the protective effect of combining increased outdoor time with other prevention strategies in reducing the incidence of myopia. The results indicate the presence of a dose-response relationship. What are the implications for public health practice?: To effectively prevent myopia, it is important to implement comprehensive interventions that encompass various aspects such as outdoor time, eye-use habits, eye-use environments, and lifestyle modifications.

Prevalence of Risk Factors for Hypertension Among Faculty at an Urban University in Uganda.

Purpose: Hypertension is a major contributor to morbidity and mortality worldwide. Many people however are not aware of their possession of risk factors for hypertension. There is a paucity of literature in Uganda describing the risk profile of faculty at public universities. The purpose of this study was to determine the prevalence of hypertension risk factors among university teaching staff. Methods: This study was conducted among faculty at Makerere University in Uganda. The modified World Health Organization STEP-wise approach for non-communicable disease surveillance was used in data collection. Hypertension was defined as having a systolic blood pressure of ≥140mmHg and/or a diastolic blood pressure of ≥90mmHg, or being on antihypertensive medications. Participants were enrolled from the faculty lists by proportionate to size systematic sampling until the sample size for each college was obtained. Data was collected from January to March 2018. Multivariate logistic regression was used to determine factors associated with hypertension. Results: A total of 141 participants were recruited into the study. The prevalent risk factors for hypertension include physical inactivity (78.7%), overweight (46.8%), obesity (20.6%), addition of extra salt to food (46.8%), current alcohol consumption (33.3%), history of smoking (10.6%), inadequate fruit and vegetable servings per day (100%), family history of hypertension (40.4%) and a family history of diabetes (22.7%). Hypertension was prevalent at 26.2% (95% CI 18.94-33.46%). The risk factors significantly associated with hypertension included a family history of hypertension (p=0.009), obesity (p=0.008) and male gender (p = 0.029). Conclusion: The prevalence of known hypertension risk factors among university teaching staff in urban Uganda is high. Majority of these risk factors are modifiable highlighting the need for continuous screening as well as introduction of prevention and health promotion strategies to reduce the risk burden.

Modifiable factors associated with cognitive performance in Chinese adolescents: a national environment-wide association study.

Growing evidence exists about the candidate factors of childhood cognitive performance, but mainly limited to single-exposure studies. We sought to systematically and simultaneously identify and validate a wide range of potential modifiable factors for childhood cognitive performance. We used data from five waves of data from the China Family Panel Studies (CFPS-2010, 2012, 2014, 2016 and 2018). Our analytical sample was restricted to those children aged 2-5 at baseline with valid exposure information. A total of 80 modifiable factors were identified. Childhood cognitive performance was assessed using vocabulary and mathematics test at wave 5. We used an environment-wide association study (EnWAS) to screen all exposure-outcome associations independently and used the least absolute shrinkage and selection operator (LASSO) variable selection algorithm to identify factors associated with cognitive performance. Multivariable linear model was then used to evaluate causal relationships between identified factors and cognitive performance. Of the 1305 participants included in the study (mean ± SD, 3.5 ± 1.1 years age at baseline, 45.1% girls). Eight factors were retained in the LASSO regression analysis. Six factors across community characteristics (percentage of poverty in the community; percentage of children in the community), household characteristics (family size), child health and behaviors (mobile internet access), parenting behaviors and cognitive enrichment (parental involvement in child' s education), and parental wellbeing (paternal happiness) domains were significantly associated with childhood cognition. Using a three-stage approach, this study validates several actionable targets for improving childhood cognitive performance.

Identifying modifiable factors associated with COVID-19 vaccine hesitancy and acceptance among cancer patients in Jordan.

Introduction: Vaccines stand amongst the most effective medical interventions for the management of infectious diseases, and are pivotal tools for public health. The acceptance of vaccines is heavily influenced by perceptions of efficacy, safety and other modifiable factors. Purpose: This cross-sectional study sought to identify and examine the modifiable factors that can help address COVID-19 vaccine hesitancy and acceptance among cancer patients. Methods: The study was conducted between February and April 2021 using an online survey questionnaire comprising of four domains. The survey was administered to cancer patients in Jordan. Results: Among the 1,029 cancer patients who completed the online questionnaire (response rate= 73%), 58% (n=597) expressed willingness (intent) to take the vaccine. Notably, 72.5% (n=433) of those intending to take the vaccine were currently undergoing treatment. Knowledge and awareness played a significant role, with 54.3% considering them essential for vaccine acceptance. Fear of infection significantly influenced vaccine acceptance (p<0.001), with 66.8% expressing concern about potential infections. Peer encouragement was also a crucial factor, as 82.4% regarded it as an important driver for influencing vaccine acceptance (p<0.001). Conclusion: Peer encouragement, awareness, and fear emerged as the primary modifiable factors associated with greater vaccine acceptance by patients with active malignancies. Study results suggest that providing personalized and tailored information about vaccinations, focusing on safety and potential interactions with cancer and its treatment, are potentially excellent strategies for improving vaccine acceptance among cancer patients.

Impact of Action Taken in Response to Stillbirth Audit: A Success Story.

Objectives: Study the impact of intra-facility interventions on the modifiable factors causing stillbirths (SB), using point-of-care quality improvement (POCQI) methodology. Material and Methods: Stillbirth data during the 9 months pre-intervention period were reviewed to identify the common preventable causes. Two interventions, namely, ultrasound at 34-36 weeks gestation and intrapartum monitoring on a common customized labor chart for all health-care providers, were done. Post-intervention data were collected to observe the impact of the interventions. Results: The stillbirth rate reduced from 212/5940 deliveries (35.7/1000) in the pre-intervention period to 165/5993 deliveries (27.7/1000) in the post-intervention period (p = 0.011). The intra-facility failure to identify FGR significantly reduced in the post-intervention group (p = 0.033), leading to 63% (RR 0.37) reduction in its risk. Using a common customized labor chart led to a significant decline in the inadequate monitoring as a provider-related cause of stillbirth (p < 0.001) leading to its 42% decline as contributor to modifiable cause of SB (RR 0.48). Conclusion: Reviewing the perinatal death surveillance response (PDSR) data, identifying gaps in care, and using improvement methodology for instituting corrective measures play an important role in reducing intramural stillbirths.

Depression and Associated Factors among Family Caregivers of Children with Disabilities: Analysis of Intergenerational Differences.

Family caregivers of children with disabilities might face high risks of depression, whereas the existing literature focused more on parents neglecting grandparents. This study investigated 380 parents and 108 grandparents of children with disabilities to identify depression and associated factors. Descriptive statistics, Chi-square test, Mann-Whitney U test, and multivariable logistic regression were performed to describe the participants' characteristics and risks of depression and identify significant factors. Results showed that parents (35.5%) had higher risks of depression than grandparents (32.4%), but statistical differences were not found. Children's sleep problems (AOR = 1.751, 95%CI = 1.019, 3.008), harmonious family relationships (AOR = 0.694, 95%CI = 0.569, 0.846), and better barrier-free construction (AOR = 0.742, 95%CI = 0.568, 0.970) were significantly associated with depression among parents. As for grandparents, higher education (AOR = 4.108, 95%CI = 1.526, 11.057) and caring for children who experience frequent mood swings (AOR = 2.242, 95%CI = 1.161, 4.329) were associated with higher risks of depression. Further, house ownership (AOR = 0.167, 95%CI = 0.031, 0.887), higher family cohesion (AOR = 0.545, 95%CI = 0.297, 1.000), and better barrier-free construction (AOR = 0.401, 95%CI = 0.185, 0.869) were associated with lower odds of depression. Therefore, both parents and grandparents of children with disabilities had high risks of depression and thus required urgent attention. Healthcare providers and policymakers should develop and implement interventions considering intergenerational differences to reach optimal efficiency.

Causes of obesity: a review.

Obesity research is advancing swiftly, but the increase in obesity prevalence is faster. Over the past three decades, researchers have found that biopsychosocial factors determine weight gain much more than personal choices and responsibility. Various genes have found to predispose people to obesity by interacting with our obesogenic environment. In this review, we discuss the impact of physical inactivity, excessive caloric intake, intrauterine environment, postnatal influences, insufficient sleep, drugs, medical conditions, socioeconomic status, ethnicity, psychosocial stress, endocrine disrupting chemicals and the gastrointestinal microbiome, on the occurrence of obesity.

Modifiable factors for benign salivary gland neoplasms: A Mendelian randomization study.

BACKGROUND: Observational studies have found associations between smoking, alcohol, radiation, body mass index (BMI), periodontitis, and the hazard of benign salivary gland neoplasms (BSGNs). Nevertheless, the etiology of BSGNs remains unclear. This study aims to assess the causal association between these modifiable factors and the BSGNs. METHODS: Genetic instruments associated with exposures at the genome-wide significance level were selected from corresponding genome-wide association studies. The summary statistics for BSGNs were obtained from the FinnGen consortium (2445 cases and 340,054 controls). The inverse variance-weighted method was used as the primary analysis, and several sensitivity analyses were performed to test the reliability. RESULTS: Genetically predicted higher lifetime smoking index (odds ratio [OR] = 2.10, p = 0.012) and BMI (OR = 1.58, p = 2.29 × 10-5 ) were associated with elevated risk of BSGNs, whereas other exposures do not. Sensitivity analyses showed consistency. The causal effect of the lifetime smoking index became more significant after adjusting for BMI (OR = 2.89, p = 0.005) and alcohol consumption (OR = 2.49, p = 0.002). A slight negative association emerged for alcohol consumption with adjustment for cigarettes per day (OR = 0.53, p = 0.034) but disappeared when adjusting for cigarettes per day and BMI. CONCLUSION: This study supports the independent causal role of lifetime smoking index and BMI in BSGNs risk.

Longitudinal modifiable risk and protective factors of internet gaming disorder: A systematic review and meta-analysis.

Background and aims: The study aims to thoroughly understand the causal and precedent modifiable risk or protective factors for Internet Gaming Disorder (IGD), a newly defined and prevalent mental disorder. Methods: We performed a systematic review on quality-designed longitudinal studies based on five online databases: MEDLINE, PsycINFO, Embase, PubMed, and Web of Science. Studies were included in the meta-analysis if they addressed IGD, adopted longitudinal, prospective, or cohort study designs, presented modifiable factors of IGD, and reported the effect sizes for correlations. Pooled Pearson's correlations were calculated using the random effects model. Results: Thirty-nine studies with 37,042 subjects were included. We identified 34 modifiable factors, including 23 intrapersonal factors (e.g., gaming time, loneliness, etc.), 10 interpersonal factors (e.g., peer relationship, social support, etc.), and 1 environmental factor (i.e., school engagement). Age, the male ratio, study region, and study years were significant moderators. Discussion and conclusions: Intrapersonal factors were stronger predictors than interpersonal and environmental factors. It may imply that individual-based theories are more powerful to explain the development of IGD. Longitudinal research on the environmental factors of IGD was lacking; more studies are warranted. The identified modifiable factors would help to guide effective interventions for IGD reduction and prevention.

Predictive value of hypercholesterolemia, vegetarian diet, and hypertension for incident dementia among elderly Taiwanese individuals with low educational levels.

Objective: Early management of modifiable dementia-related factors is seen as a novel approach to preventing dementia onset; however, these efforts are often hindered by the complexity of interactions among these factors. In addition, different modifiable dementia-related factors may contribute to different etiologies of dementia. Design: The current study investigated the effects of common modifiable dementia-related factors on prediction of incident dementia, dementia of the Alzheimer's type (DAT), and vascular dementia (VaD). Methods: Vascular- and lifestyle-related factors were used as predictors of incident dementia, DAT, and VaD among 1,285 elderly individuals without obvious signs of dementia or mild cognitive impairment. Cox proportional hazard models were used to evaluate the risks associated with each modifiable factor. Results: After controlling for factors other than stroke-related factors, hypercholesterolemia was correlated with a relatively low risk of all-cause incident dementia and DAT, whereas a vegetarian diet was correlated with an elevated risk of all-cause incident dementia and VaD. Hypertension was correlated with incident VaD. After controlling for stroke-related factors, a vegetarian diet was correlated with an elevated risk of all-cause dementia. A history of myocardiac infarction and the use of anti-platelet medication were, respectively, associated with a reduced risk of DAT and elevated risk of VaD. The use of anti-hypertensives was associated with a reduced risk of all-cause dementia, whereas the use of anti-lipid agents was associated with slow progression DAT (i.e. exceeding the average conversion time). Hypercholesterolemia was associated with an elevated risk for slow progression DAT. Conclusion: These findings could perhaps be used as clinical markers in predicting and preventing incident dementia, DAT, and VaD.

Molecular Changes in Cells of Patients with Type 2 Diabetes Mellitus Depending on Changes in Glycemia Level in the Context of Lifestyle-An Overview of the Latest Scientific Discoveries.

Diabetes mellitus is a significant health problem for medicine and economics. In 80-90% of cases, it is type 2 diabetes (T2DM). An essential aspect for people with T2DM is to control blood glucose levels and avoid significant deviations. Modifiable and non-modifiable factors influence the incidence of hyperglycemia and, sometimes, hypoglycemia. The lifestyle modifiable factors are body mass, smoking, physical activity, and diet. These affect the level of glycemia and impact molecular changes. Molecular changes affect the cell's primary function, and understanding them will improve our understanding of T2DM. These changes may become a therapeutic target for future therapy of type 2 diabetes, contributing to increasing the effectiveness of treatment. In addition, the influence of external factors (e.g., activity, diet) on each domain of molecular characterization has gained importance towards a better understanding of their role in prevention. In the current review, we aimed to collect scientific reports on the latest research about modifiable factors connected with the style of life which affect the glycemic level in the context of molecular discoveries.

Incorporation of concussion history as part of the LIfestyle for BRAin Health (LIBRA) modifiable factors risk score and associations with cognition in older former National Football League players.

OBJECTIVE: Investigate associations between the LIfestyle for BRAin Health (LIBRA) risk score with odds of mild cognitive impairment (MCI) diagnosis and cognitive function, incorporating concussion history. METHODS: Former National Football League (NFL) players (N = 1050; mean age = 64.8 ± 9.0-years) completed initial testing for integration of concussion history into LIBRA scores (i.e., modified-LIBRA) and completed the Brief Test of Adult Cognition by Telephone (BTACT). Modified-LIBRA score (including concussion history) associations with odds of MCI and cognitive dysfunction were assessed via logistic and linear regression. RESULTS: The highest quartile LIBRA scores were six times more likely to have a diagnosis of MCI compared to the lowest quartile (OR = 6.27[3.61, 10.91], p < 0.001). Modified-LIBRA scores significantly improved model fit for odds of MCI above original LIBRA scores (χ2 (1) = 7.76, p = 0.005) and accounted for a greater fraction of variance in executive function (ΔR2  = 0.02, p = 0.003) and episodic memory (ΔR2  = 0.02, p = 0.002). CONCLUSIONS: Modified-LIBRA score, incorporating concussion history, may help monitoring risk status in former contact sport athletes, by targeting modifiable, lifestyle-related risk factors.

Investigating modifiable pathways in psoriasis: A Mendelian randomization study.

BACKGROUND: Potentially modifiable risk factors have previously been investigated only in conventional observational studies. OBJECTIVE: To assess whether genetically predicted exposures to modifiable factors are associated with the risk of psoriasis. METHODS: Two-sample Mendelian randomization (MR) analysis. RESULTS: An increased risk of psoriasis was noted for genetically predicted lifetime smoking index (odds ratio [OR]MR-IVW = 2.11; 95% confidence interval [CI], 1.28-3.51), childhood (OR MR-IVW = 1.40; 95% CI, 1.14-1.71) and adult body mass index (OR MR-IVW = 1.63; 95% CI, 1.32-2), waist (OR IVW = 1.86; 95% CI, 1.31-2.64), and hip circumference (OR MR-IVW = 1.55; 95% CI, 1.15-2.07). Protective association was also reported between genetically predicted longer sleep duration (OR MR-IVW = 0.56; 95% CI 0.37-0.84) and increased years of education (OR MR-IVW = 0.78; 95% CI, 0.62-0.98). This effect of education persisted in multivariable MR after adjusting for genetic predictors of smoking and adult body mass index (ORMVMR-IVW = 0.72; 95% CI, 0.56-0.92). LIMITATIONS: It was not possible to stratify for psoriasis severity. CONCLUSION: Smoking cessation and prevention of obesity are important strategies for decreasing the incidence of psoriasis. Similarly, targeting education inequality is expected to lead further to reductions in cases of psoriasis.

Anxiety and Depressive Symptoms in Patients with COPD: Modifiable Explanatory Factors.

Anxiety and depressive symptoms affect up to 80% of people with chronic obstructive pulmonary disease (COPD). To reduce this symptom burden, clinicians should target modifiable explanatory factors while accounting for nonmodifiable explanatory factors of these symptoms. The purpose of this secondary data analysis was to examine which modifiable factors explain anxiety and depressive symptoms in COPD. This secondary data analysis of 1,760 COPD patients used multiple regression to explain anxiety and depressive symptoms from sets of modifiable patient characteristics and demographic controls. Clinically significant symptoms of anxiety or depression presented in 29.6% (n = 526) of participants, and 20.6% (n = 363) had both. Significant modifiable explanatory factors of both disorder symptoms were perceived functional status, functional capacity, psychosocial impact, symptom self-management, and significant symptoms for the other. Somatic symptom burden and dyspnea explained anxiety and depressive symptoms, respectively. Addressing these modifiable factors may reduce anxiety and depressive symptoms in patients with COPD.

The relationship between clinical examination measures and ultrasound measures of fascia thickness surrounding trunk muscles or lumbar multifidus fatty infiltrations: An exploratory study.

Patients with chronic low back pain (CLBP) exhibit remodelling of the lumbar soft tissues such as muscle fatty infiltrations (MFI) and fibrosis of the lumbar multifidus (LuM) muscles, thickness changes of the thoracolumbar fascia (TLF) and perimuscular connective tissues (PMCT) surrounding the abdominal lateral wall muscles. Rehabilitative ultrasound imaging (RUSI) parameters such as thickness and echogenicity are sensitive to this remodelling. This experimental laboratory study aimed to explore whether these RUSI parameters (LuM echogenicity and fascia thicknesses), hereafter called dependent variables (DV) were linked to independent variables (IV) such as (1) other RUSI parameters (trunk muscle thickness and activation) and (2) physical and psychological measures. RUSI measures, as well as a clinical examination comprising physical tests and psychological questionnaires, were collected from 70 participants with LBP. The following RUSI dependent variables (RUSI-DV), measures of passive tissues were performed bilaterally: (1) LuM echogenicity (MFI/fibrosis) at three vertebral levels (L3/L4, L4/L5 and L5/S1); (2) TLF posterior layer thickness, and (3) PMCT thickness of the fasciae between subcutaneous tissue thickness (STT) and external oblique (PMCTSTT/EO ), between external and internal oblique (PMCTEO/IO ), between IO and transversus abdominis (PMCTIO/TrA ) and between TrA and intra-abdominal content (PMCTTrA/IA ). RUSI measures of trunk muscle's function (thickness and activation), also called measures of active muscle tissues, were considered as independent variables (RUSI-IV), along with physical tests related to lumbar stability (n = 6), motor control deficits (n = 7), trunk muscle endurance (n = 4), physical performance (n = 4), lumbar posture (n = 2), and range of motion (ROM) tests (n = 6). Psychosocial measures included pain catastrophizing, fear-avoidance beliefs, psychological distress, illness perceptions and concepts related to adherence to a home-based exercise programme (physical activity level, self-efficacy, social support, outcome expectations). Six multivariate regression models (forward stepwise selection) were generated, using RUSI-DV measures as dependent variables and RUSI-IV/physical/psychosocial measures as independent variables (predictors). The six multivariate models included three to five predictors, explaining 63% of total LuM echogenicity variance, between 41% and 46% of trunk superficial fasciae variance (TLF, PMCTSTT/EO ) and between 28% and 37% of deeper abdominal wall fasciae variance (PMCTEO/IO , PMCTIO/TrA and PMCTTrA/IA ). These variables were from RUSI-IV (LuM thickness at rest, activation of IO and TrA), body composition (percent fat) and clinical physical examination (lumbar and pelvis flexion ROM, aberrant movements, passive and active straight-leg raise, loaded-reach test) from the biological domain, as well as from the lifestyle (physical activity level during sports), psychological (psychological distress-cognitive subscale, fear-avoidance beliefs during physical activities, self-efficacy to exercise) and social (family support to exercise) domains. Biological, psychological, social and lifestyle factors each accounted for substantial variance in RUSI-passive parameters. These findings are in keeping with a conceptual link between tissue remodelling and factors such as local and systemic inflammation. Possible explanations are discussed, in keeping with the hypothesis-generating nature of this study (exploratory). However, to impact clinical practice, further research is needed to determine if the most plausible predictors of trunk fasciae thickness and LuM fatty infiltrations have an effect on these parameters.

Cancers Attributable to Modifiable Risk Factors: A Road Map for Prevention.

The implementation of primary and secondary preventive strategies is based on the evidence generated by cancer epidemiology, where the identification of risk factors and the description of their prevalence are fundamental to derive estimates on the burden of cancer from different etiologies, typically expressed as the population attributable fraction, which corresponds to the proportion of a cancer that may be prevented by controlling a given risk factor. However, even when cancer finds its etiology in modifiable factors, its prevention through the control of those factors is not always feasible, or it remains suboptimal despite the possibility of reducing the burden. We reviewed selected associations between modifiable risk factors and cancer, including tobacco smoking, occupational exposures, infections, air pollution, alcohol, and diet and obesity, and illustrated examples of both successes and failures in cancer control, underlying how current understanding of the avoidable causes of cancer is incomplete.