Modifiable risk factors for stroke, dementia and late-life depression: a systematic review and DALY-weighted risk factors for a composite outcome

Link: https://jnnp.bmj.com/content/early/2025/03/21/jnnp-2024-334925.long

Excerpt:

Abstract

Background At least 60% of stroke, 40% of dementia and 35% of late-life depression (LLD) are attributable to modifiable risk factors, with great overlap due to shared pathophysiology. This study aims to systematically identify overlapping risk factors for these diseases and calculate their relative impact on a composite outcome.

Methods A systematic literature review was performed in PubMed, Embase and PsycInfo, between January 2000 and September 2023. We included meta-analyses reporting effect sizes of modifiable risk factors on the incidence of stroke, dementia and/or LLD. The most relevant meta-analyses were selected, and disability-adjusted life year (DALY) weighted beta (β)-coefficients were calculated for a composite outcome. The β-coefficients were normalised to assess relative impact.

Results Our search yielded 182 meta-analyses meeting the inclusion criteria, of which 59 were selected to calculate DALY-weighted risk factors for a composite outcome. Identified risk factors included alcohol (normalised β-coefficient highest category: −34), blood pressure (130), body mass index (70), fasting plasma glucose (94), total cholesterol (22), leisure time cognitive activity (−91), depressive symptoms (57), diet (51), hearing loss (60), kidney function (101), pain (42), physical activity (−56), purpose in life (−50), sleep (76), smoking (91), social engagement (53) and stress (55).

Conclusions This study identified overlapping modifiable risk factors and calculated the relative impact of these factors on the risk of a composite outcome of stroke, dementia and LLD. These findings could guide preventative strategies and serve as an empirical foundation for future development of tools that can empower people to reduce their risk of these diseases.

Author(s): http://orcid.org/0009-0002-6540-480XJasper Senff1,2,3,4,5, http://orcid.org/0000-0003-3204-0309Reinier Willem Pieter Tack1,2,3,4,5, Akashleena Mallick1,2,3,4, Leidys Gutierrez-Martinez1,2,3,4, Jonathan Duskin1,2,3,4, Tamara N Kimball1,2,3,4,6, Benjamin Y Q Tan1,2,3,4,7, Zeina N Chemali1,2,8, Amy Newhouse1,9, Christina Kourkoulis1,2,3,4, Cyprien Rivier10,11, Guido J Falcone10,11, Kevin N Sheth10,11, Ronald M Lazar12, Sarah Ibrahim13,14,15,16,17, Aleksandra Pikula14,15,16,17, Rudolph E Tanzi1, Gregory L Fricchione8, Hens Bart Brouwers5, Gabriel J E Rinkel5, Nirupama Yechoor1,2,3,4, Jonathan Rosand1,2,3,4, Christopher D Anderson1,2,3,4,6, Sanjula D Singh1,2,3,4

https://doi.org/10.1136/jnnp-2024-334925

Publication Date: April 2025

Publication Site: Journal of Neurology, Neurosurgery, & Psychiatry

BRCA1, BRCA2, and Associated Cancer Risks and Management for Male Patients

Link: https://jamanetwork.com/journals/jamaoncology/article-abstract/2821594

Excerpt:

Importance  Half of all carriers of inherited cancer-predisposing variants in BRCA1 and BRCA2 are male, but the implications for their health are underrecognized compared to female individuals. Germline variants in BRCA1 and BRCA2 (also known as pathogenic or likely pathogenic variants, referred to here as BRCA1/2 PVs) are well known to significantly increase the risk of breast and ovarian cancers in female carriers, and knowledge of BRCA1/2 PVs informs established cancer screening and options for risk reduction. While risks to male carriers of BRCA1/2 PVs are less characterized, there is convincing evidence of increased risk for prostate cancer, pancreatic cancer, and breast cancer in males. There has also been a rapid expansion of US Food and Drug Administration–approved targeted cancer therapies, including poly ADP ribose polymerase (PARP) inhibitors, for breast, pancreatic, and prostate cancers associated with BRCA1/2 PVs.

Observations  This narrative review summarized the data that inform cancer risks, targeted cancer therapy options, and guidelines for early cancer detection. It also highlighted areas of emerging research and clinical trial opportunities for male BRCA1/2 PV carriers. These developments, along with the continued relevance to family cancer risk and reproductive options, have informed changes to guideline recommendations for genetic testing and strengthened the case for increased genetic testing for males.

Conclusions and Relevance  Despite increasing clinical actionability for male carriers of BRCA1/2 PVs, far fewer males than female individuals undergo cancer genetic testing. Oncologists, internists, and primary care clinicians should be vigilant about offering appropriate genetic testing to males. Identifying more male carriers of BRCA1/2 PVs will maximize opportunities for cancer early detection, targeted risk management, and cancer treatment for males, along with facilitating opportunities for risk reduction and prevention in their family members, thereby decreasing the burden of hereditary cancer.

Author(s): Heather H. Cheng, MD, PhD1,2Jeffrey W. Shevach, MD3Elena Castro, MD, PhD4et al

JAMA Oncol. 2024;10(9):1272-1281.

doi:10.1001/jamaoncol.2024.2185

Publication Date: July 25, 2024

Publication Site: JAMA Oncology

Fecal Immunochemical Test Screening and Risk of Colorectal Cancer Death

Link: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821348

Graphic:

Excerpt:

Key Points

Question  What is the colorectal cancer mortality benefit of screening with fecal immunochemical tests (FITs)?

Findings  In this nested case control study of 10 711 individuals, completing a FIT to screen for colorectal cancer was associated with a reduction in risk of dying from colorectal cancer of approximately 33% overall, and there was a 42% lower risk for left colon and rectum cancers. FIT screening was also associated with lower risk of colorectal cancer death among non-Hispanic Asian, non-Hispanic Black, and non-Hispanic White people.

Meaning  This study provides US community-based evidence that suggests FIT screening lowers the risk of dying from colorectal cancer and supports the strategy of population-based screening using FIT.

Author(s): Chyke A. Doubeni, MD, MPH1,2Douglas A. Corley, MD, PhD3Christopher D. Jensen, PhD3et al

Publication Date: July 19, 2024

Publication Site: JAMA Netw Open. 

2024;7(7):e2423671.

doi:10.1001/jamanetworkopen.2024.23671

Modeling the Casualty Exposures in Epidemics

Link: https://ar.casact.org/modeling-the-casualty-exposures-in-epidemics/

Graphic:

Excerpt:

A casualty actuary might be forgiven for thinking that illness and disease are what those “other” actuaries worry about.

Though risk of illness is usually considered the province of the life-health actuary, a session at the 2017 CAS Annual Meeting in Anaheim, California, showed how epidemics can affect property-casualty risks. The session also described how to approach modeling those exposures.

….

Milliman actuary Cody Webb, FCAS, began by demonstrating how big the insurance gap is, particularly in developing nations. He explained that the spectrum of losses ranges from minuscule (loss of a single strand of hair) to catastrophic (sudden, instant death) and can affect a single person or every entity in the universe across eons. But the insurable losses share some traits, Webb said, including:

  • a large number of similar exposures.
  • a definite loss, driven by some sort of accident.
  • the ability to create an affordable premium to reimburse after such a loss.
  • the ability to accurately quantify the amount of loss sustained. This is the most important shared trait.

In showing a chart of property-casualty insurance as a percentage of GDP — with the wealthier countries better insured than others — Webb noted that insurance companies need to “quantify and develop products that meet all criteria of insurability.” (See chart below.)

Author(s): James P. Lynch

Publication Date: 16 Jan 2018

Publication Site: Actuarial Review, Casualty Actuarial Society

The Surging Cost of Insurance

Link: https://www.bloomberg.com/news/videos/2024-12-06/the-surging-cost-of-insurance-wall-street-week-video

Graphic:

Description.

Insurance prices have surged across America in the past two years, with homeowner’s insurance climbing 21%, while CPI rose just 5%. (Source: Bloomberg)

Jerry Theodorou of R Street Institute is interviewed about Florida homeowners insurance.

Author(s): Wall St. Week

Publication Date: 6 Dec 2024

Publication Site: Bloomberg TV

From a Simple Test to Open Heart Surgery: How a Cardiac Screening Saved George’s Life

Link: https://www.chestercountyhospital.org/news/health-eliving-blog/2020/february/how-cardiac-screening-saved-georges-life

Graphic:

Excerpt:

George, who is 51 years old, has been a police officer in Chester County for 31 years. He has lived a life of action — which comes with some feelings of invincibility. “As a police officer, there are times we think we are indestructible,” he explains.

Because of his active lifestyle — and no signs of heart problems whatsoever — heart disease was the furthest thing from George’s mind. “I walked anywhere from 6 to 8 hours a day. I was never winded, never tired, and I had no numbness. All of those telltale signs of heart disease — I never got any of them,” George explains.

Through a collaboration between Chester County Hospital and local police departments, George was offered a free cardiac risk screening for first responders. Despite zero signs of heart disease, he figured he might as well take advantage. Little did he know, he would end up having open-heart surgery just a few months later.

Publication Date: 10 Feb 2020

Publication Site: Chester County Hospital, Penn Medicine blog

TD Was Convenient for Criminals

Link: https://www.bloomberg.com/opinion/articles/2024-10-14/td-was-convenient-for-criminals?srnd=undefined

Excerpt:

But TD Bank’s problem — which led to the largest AML-failures penalty ever — was not just about ignoring red flags. The more fundamental problem is that TD Bank tried to do its anti-money-laundering compliance on the cheap, and the prosecutors and regulators hate that. The Justice Department says:

[The TD Bank Global Anti-Money Laundering (GAML) group]’s budget was a primary driver of its decisions about projects, hiring, staffing, and technology enhancements throughout the relevant period. GAML executives strove to maintain what TD Bank Group referred to as a “flat cost paradigm” or “zero expense growth paradigm,” meaning that each department’s budget, including GAML’s, was expected to remain flat year-over-year, despite consistent growth in TD Bank Group’s revenue over the relevant period. This budgetary pressure originated with senior bank executives and was achieved within GAML and US-AML by [its chief AML officer] and [its Bank Secrecy Act officer], both of whom touted their abilities to operate within the “flat cost paradigm without compromising risk appetite” in their self-assessments. GAML’s base and project expenditures on USAML were less in fiscal year 2021 than they were in fiscal year 2018 and were not sufficient to address AML deficiencies including substantial backlogs of alerts across multiple workstreams, despite TDBNA’s profits increasing approximately 26% during the same period. In 2019, [the chief AML officer] referred to the Bank’s “historical underspend” on compliance in an email to the Group senior executive responsible for the enterprise AML budget, yet the US-AML budget essentially stayed flat. GAML and US-AML employees explained to the Offices that budgetary restrictions led to systemic deficiencies in the Bank’s transaction monitoring program and exposed the Bank to potential legal and regulatory consequences.

That, I think, is why the fine was so big. The message that this case is meant to send to banks is “if your compliance team wants more money to build a better AML program, you’d better give it to them, because otherwise we will fine you orders of magnitude more money than you would have spent.” The attorney general said:

TD Bank chose profits over compliance, in order to keep its costs down.

That decision is now costing the bank billions of dollars in criminal and civil penalties.

The deputy attorney general added:

We are putting down a clear marker on what we expect from financial institutions — and the consequences for failure.

When it comes to compliance, there are really only two options: invest now – or face severe consequences later.

As I’ve said before, a corporate strategy that pursues profits at the expense of compliance isn’t a path to riches; it’s a path to federal prosecution.

One job of a bank is to stop crime, which means that banks employ thousands of people who essentially work for the US Department of Justice. But the Department of Justice has no direct control over how many of those people there are, how much they get paid or what resources they have. Law enforcement agencies cannot directly set the banks’ budgets for anti-money-laundering programs, even though those budgets really are part of law enforcement. It is, perhaps, a frustrating situation: The Justice Department would like banks to spend more money catching criminals, and it can’t quite make them.

Except obviously it can. The Justice Department can’t directly set banks’ AML budgets, but it can do it indirectly, and it just did. If you are a bank compliance officer and you want to hire 2,000 people and get some shiny new computers, you can go to your regulators and say “do we need to spend this money on AML,” and they will say “that would be better,” and you will go to your chief executive officer with a transcript of the TD Bank press conference, and you will get whatever you want. 

Author(s): Matt Levine

Publication Date: 14 Oct 2024

Publication Site: Bloomberg

Dangers firefighters face include higher cancer risks

Link: https://www.upi.com/Health_News/2024/05/10/firefighters-face-cancer-dangers/8411715363541/

Excerpt:

Compared to the general public, firefighters have a 9% higher rate of certain cancers, likely due to their exposure to high levels of carcinogens released into the air as buildings burn. The incidence of multiple myeloma — the first cancer Perez developed — is about 50% higher in firefighters than in the general population.

….

Dr. C. Ola Landgren has been researching links between occupational exposures and multiple myeloma for a number of years — particularly in first responders such as firefighters. At Memorial Sloan Kettering Cancer Center in New York and the National Cancer Institute, Landgren began to recognize patterns.

In New York, for example, Landgren had three myeloma patients who lived on the same block on Staten Island. Their houses had been covered by dust after the World Trade Center towers fell in 2001.

“Myeloma has a precursor condition known as MGUS, which is more common in the population, allowing us to identify risks earlier,” Landgren said. “We’ve actually observed higher rates of MGUS in first responders compared to the general population.”

MGUS — which stands for monoclonal gammopathy of undetermined significance — has also been linked to pesticide use among farmers and exposure to Agent Orange among veterans of the Vietnam War. Levels also were higher in firefighters, police officers and construction workers who were on-site immediately after the 9/11 attacks.

Author(s): Lori Saxena, HealthDay News

Publication Date:

Publication Site:

Collision Course

Link: https://nymag.com/intelligencer/article/staged-car-crashes-insurance-fraud.html

Graphic:

Excerpt:

There’s a narrow path to such ostentation for the non-famous and non-college-interested who mock the idea of an actual job. Mize found his muse in the con and his ability to rope others into it. Here’s how they say it happened: He struck when you wanted cash. When totems of the middle class were slipping from reach. When you needed a down payment. To pay off credit cards. To start a business. When asking your parents for money made you feel like a failure. When you were suffocated by medical bills, neither earning enough to pay nor poor enough for government help.

Yet money alone doesn’t completely explain why the people closest to Mize entered the ring. Mize had a way of making himself your center of gravity, the one from whom you wanted approval, mentorship, love. Mize could be fun, even thrilling. But getting all that meant pleasing him. And pleasing him meant fraud.

Author(s): Lauren Smiley

Publication Date: 3 Oct 2022

Publication Site: NY Mag

Few Nursing Facility Residents and Staff Have Received the Latest COVID-19 Vaccine

Link: https://www.kff.org/medicaid/issue-brief/few-nursing-facility-residents-and-staff-have-received-the-latest-covid-19-vaccine/

Graphic:

Excerpt:

Uptake of the current COVID-19 vaccine is higher in non-profit facilities than in for-profit or government facilities (Figure 2). The percentage of nursing facility residents who received the updated vaccine is 46% in non-profit facilities compared with 35% in for-profit facilities and 43% in government facilities. Uptake of the fall 2022 vaccine was also highest in non-profit facilities and lowest in for-profit facilities. Rates of vaccine uptake for nursing facility staff were low in all types of facilities with minimal variation across facility types (data not shown).

Author(s): Priya Chidambaram and Alice Burns

Publication Date: 13 Feb 2024

Publication Site: KFF, Medicaid

Staffing shortages, poor infection control plague nursing homes

Link: https://www.upi.com/Health_News/2024/03/01/nursing-home-staffing-shortage/8751709302182/

Excerpt:

Although the pandemic has ended, staffing shortages and employee burnout still plague U.S. nursing homes, a new government report finds.

But the problems didn’t end there: The report, issued Thursday by the Inspector General’s Office at the U.S. Department of Health and Human Services, showed that infection-control procedures were still sorely lacking at many facilities.

Not only that, COVID-19 booster vaccination rates remain far lower than they should be, with only 38% of residents and 15% of staff up-to-date on their shots, according to a recent KFF report.

Author(s): Robin Foster

Publication Date: 1 Mae 2024

Publication Site: UPI

‘Fourth Wave’ of Opioid Epidemic Crashes Ashore, Propelled by Fentanyl and Meth

Link:https://kffhealthnews.org/news/article/fourth-wave-opioid-epidemic-fentanyl-millennium-health-report/

Excerpt:

The United States is knee-deep in what some experts call the opioid epidemic’s “fourth wave,” which is not only placing drug users at greater risk but is also complicating efforts to address the nation’s drug problem.

These waves, according to a report out today from Millennium Health, began with the crisis in prescription opioid use, followed by a significant jump in heroin use, then an increase in the use of synthetic opioids like fentanyl.

The latest wave involves using multiple substances at the same time, combining fentanyl mainly with either methamphetamine or cocaine, the report found. “And I’ve yet to see a peak,” said one of the co-authors, Eric Dawson, vice president of clinical affairs at Millennium Health, a specialty laboratory that provides drug testing services to monitor use of prescription medications and illicit drugs.

The report, which takes a deep dive into the nation’s drug trends and breaks usage patterns down by region, is based on 4.1 million urine samples collected from January 2013 to December 2023 from people receiving some kind of drug addiction care.

Its findings offer staggering statistics and insights. Its major finding: how common polysubstance use has become. According to the report, an overwhelming majority of fentanyl-positive urine samples — nearly 93% — contained additional substances. “And that is huge,” said Nora Volkow, director of the National Institute on Drug Abuse at the National Institutes of Health.

Author(s): Colleen DeGuzman

Publication Date: 21 Feb 2024

Publication Site: KFF Health News