Changes in Doppler blood flow velocity in middle cerebral artery in response to airborne sound in low- and high-risk human fetuses.

PubMed

Dobrijević, Lj J; Ljubić, Aleksandar; Sovilj, Mirjana; Ribarić-Jankes, Ksenija; Miković, Zeljko; Cerović, Nikola

2009-10-01

To examine fetal auditory perception in low- and high-risk pregnancies in period from 27 to 31 weeks gestational age with the aim to establish diagnostic parameters in prenatal detection of the degree of hearing development in a fetus. Method of prenatal hearing screening was applied on 80 women divided in two groups: Control group (C=22), consisted of pregnant women with low-risk pregnancies, and Experimental group (E=58), consisted of pregnant women with high-risk pregnancies (pregnancies with diagnosis of: preterm delivery, hypertension and/or intrauterine growth restriction (IUGR), diabetes). PHS was applied in period from 27 to 31 weeks gestational age. Brain circulation changes in fetal middle cerebral artery (MCA) caused by defined sound stimulus, as the indicator of fetal auditory reactions, were registered on Doppler ultrasound apparatus. After visualization of MCA, a sound stimulus was delivered. The stimulus consisted of one defined sound which is a digitally produced sound with the intensity of 90 dB, frequency range of 1500-4500 Hz, and duration of 0.2s (click) and it was presented only once. Measurements in observed artery were taken before (baseline) and after defined sound stimulation. Results showed that the absolute and relative difference in Pulsatility index (baseline and after sound stimulation) were greater for the high-risk group compared to the low-risk group (absolute difference: mean=0.36 vs mean=0.36) (relative difference: mean = ∼ 18% vs mean = ∼ 12%). When the low-risk group and the three high-risk group mean pairs were compared using multiple t-test, the diabetic group differed from the low-risk and two other high-risk groups; the low-risk and the two other high-risk groups did not differ from each other. Fetuses from pregnancies with diagnosis of diabetes demonstrated the most expressive reactibility and significantly higher absolute and relative changes of Pi values (absolute difference: mean=0.54, relative difference: mean=25.49%). The values of Pulsatility index (Pi) registered by PHS in low- and high-risk pregnancies may be used as differential and diagnostic parameters in fetal auditory perception examination. Fetuses from pregnancies with diagnosis of diabetes demonstrated significantly higher absolute and relative changes of Pi values compared to other groups of examined fetuses.

Imaging frontostriatal function in ultra-high-risk, early, and chronic schizophrenia during executive processing.

PubMed

Morey, Rajendra A; Inan, Seniha; Mitchell, Teresa V; Perkins, Diana O; Lieberman, Jeffrey A; Belger, Aysenil

2005-03-01

Individuals experiencing prodromal symptoms of schizophrenia (ultra-high-risk group) demonstrate impaired performance on tasks of executive function, attention, and working memory. The neurobiological underpinnings of such executive deficits in ultra-high-risk individuals remains unclear. We assessed frontal and striatal functions during a visual oddball continuous performance task, in ultra-high-risk, early, and chronic schizophrenic patients with the use of functional magnetic resonance imaging. Cross-sectional case-control design. Community; outpatient clinic. Patients Fifty-two individuals (control, n = 16; ultra-high risk, n = 10; early, n = 15; chronic, n = 11) from a referred clinical sample and age- and sex-matched control volunteers underwent scanning. Percentage of active voxels and percentage signal change calculated for the anterior cingulate gyrus (ACG), middle frontal gyrus (MFG), inferior frontal gyrus (IFG), basal ganglia, and thalamus. Performance on the visual oddball task was measured with percentage of hits and d' (a measure based on the hit rate and the false-alarm rate). The ultra-high-risk group showed significantly smaller differential activation between task-relevant and task-irrelevant stimuli in the frontal regions (ACG, IFG, MFG) than the control group. Frontostriatal activation associated with target stimuli in the early and chronic groups was significantly lower than the control group, while the ultra-high-risk group showed a trend toward the early group. Our findings suggest that prefrontal function begins to decline before the onset of syndromally defined illness and hence may represent a vulnerability marker in assessing the risk of developing psychotic disorders among ultra-high-risk individuals.

Obstetric outcomes of patients with abortus imminens in the first trimester.

PubMed

Evrenos, Ayşe Nur; Cakir Gungor, Ayse Nur; Gulerman, Cavidan; Cosar, Emine

2014-03-01

We aimed to find out the effect of abortus imminens (AI) on obstetric outcomes of pregnancies which continued beyond the 24th week of gestation. In this prospective study, 309 patients with AI were divided into high-risk group (with a risk factor for spontaneous abortus) (n = 92) and low-risk group (without a risk factor) (n = 217). The control group (n = 308) was chosen randomly. In AI group, preterm delivery, preterm premature rupture of membranes (PPROM), cesarean section (C/S) delivery, postpartum uterine atony and need of a neonatal intensive care unit (NICU) rates were significantly higher than control group. Gestational diabetes mellitus, PPROM, still birth, low APGAR scores were seen more frequently in the high-risk patients than in the control group. Furthermore in the high-risk group, preterm delivery, malpresentation, C/S delivery and need of NICU were increased much more than in the low-risk group. Gestational hypertension/preeclampsia, oligo/polyhydramniosis, intrauterine growth retardation, placenta previa, abruption of placenta, chorioamnionitis, congenital abnormalities, delivery induction, cephalopelvic disproportion, fetal distress and manual removal of placenta were not different among the groups. Patients with AI history, especially with high-risk factors can have adverse obstetric and neonatal results. So their antenatal follow-up has to be done cautiously for the early signs and symptoms of these complications.

Safety and efficacy of periprocedural anticoagulation with enoxaparin in patients undergoing peripheral endovascular revascularization.

PubMed

Brodmann, Marianne; Dorr, A; Hafner, F; Gary, T; Froehlich, H; Kvas, E; Deutschmann, H; Pilger, E

2014-07-01

Periprocedural anticoagulation is primarily used in endovascular procedures to prevent acute reocclusion of the target vessel, but periprocedural anticoagulation might also have an impact on long-term outcome. Consecutive bleeding events are feared complications. Despite changes in peripheral endovascular revascularizations (EVRs), the periprocedural management has remained unchanged for years. Unfractionated heparin is still the treatment of choice during and immediately after EVR. We performed a prospective, single-center, open-label phase III study comparing 2 different regimes of enoxaparin peri-interventional to peripheral EVR stratified into low- and high-risk groups according to the acute and long-term reocclusion risk due to their vessel morphology. In both groups, 0.5 mg/kg of enoxaparin as a bolus was administered intravenously 10 to 15 minutes before the start of the procedure. In the low-risk group, 40 mg of enoxaparin were administered once daily for 7 days; whereas in the high-risk group, 1 mg/kg of enoxaparin was administered subcutaneously (sc) 2 times a day for 48 hours after the procedure and afterward 40 mg of enoxaparin was administered sc once daily for 5 days. For the analysis of the per protocol population, 44 patients remained in the low-risk group and 140 in the high-risk group. Concerning the primary safety end point, a total of 25 (13.59%) bleeding events occurred until day 30; 5 (11.36%) of them in the low-risk group and 20 (14.29%) in the high-risk group (P = .809 for low vs high risk). None of the bleeding events observed were major according to Thrombolysis In Myocardial Infarction criteria. Concerning our primary efficacy end point, none of the patients showed an acute reocclusion classified as a significant decrease in ankle-brachial index (ABI) or elevated peak systolic velocity ratio confirmed by duplex sonography until day 30. Concerning the second end point of prevention of chronic reobstruction, at day 180 ABI has decreased in the low-risk group from mean 0.94 at day 30 to mean 0.89 and from 1.28 at day 30 to 0.85 after 6 months in the high-risk group. No significant reobstruction was found in the low-risk group, whereas 5 significant reobstruction events were objectified in the high-risk group, all of them in the femoropopliteal arterial segment at day 180. We conclude that low-molecular-weight heparin either in a low-dose or high-dose regime during a peripheral EVR is safe concerning bleeding complications and acute reobstructions. The long-term follow-up showed no significant difference between our high- and low-risk groups concerning reobstruction. The periprocedural anticoagulation seems to have no influence on the long-term patency rate after peripheral EVR. © The Author(s) 2013.

[Assessment of nutritional risk among in-school adolescents from Cantabria].

PubMed

De-Rufino Rivas, P M; Antolín Guerra, O; Casuso Ruiz, I; Mico Diaz, C; Amigo Lanza, T; Noriega Borge, M J; Santamaría Pablos, A; Sobaler Castañeda, S; Jaen Canser, P; Carrasco Martinez, M; Salcines Medrano, R; Rivero Benito, L A; Redondo Figuero, C

2014-03-01

To analyse nutritional risk, by age and sex, among primary and secondary education adolescents from Cantabria. a cross-sectional study was carried out, analysing a sample of 1101 adolescents: 568 (51.6%) were men and 533 (48.4%) were women, aged 12 to 17, attending 16 different primary and secondary education centres in Cantabria, by means of a Krece Plus questionnaire. A high percentage of adolescents with a high nutritional risk (35%) can be observed. Men show a high nutritional risk slightly higher than women (37.8% male vs 32.1% female). Moreover, the high nutritional risk experiences a notable increase as young people get older. Significant statistical differences can be seen both in male and female groups, and as a global group. In all three cases, the nutritional risk distribution in the youngest group is very similar (35.2-35.8% in male, 27.9-29.7% in female, 31.7-32.7% in the global group); whereas in elder adolescents, those values are practically doubled (57.1% in male, 69.0% in female, y 62.2% in the global group). Results are alarming mainly given the high percentage of adolescents with a high nutritional risk. Men and older adolescents are the groups in which high nutritional risk is more evident. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Validation of 1-hour post-thyroidectomy parathyroid hormone level in predicting hypocalcemia

PubMed Central

2014-01-01

Background Prior work by our group suggested that a single one hour post-thyroidectomy parathyroid hormone (1 hr PTH) level could accurately stratify patients into high and low risk groups for the development of hypocalcemia. This study looks to validate the safety and efficacy of a protocol based on a 1 hr PTH threshold of 12 pg/ml. Study design Retrospective analysis of consecutive cohort treated with standardized protocol. Methods One hundred and twenty five consecutive patients underwent total or completion thyroidectomy and their PTH level was drawn 1-hour post operatively. Based on our previous work, patients were stratified into either a low risk group (PTH < 12 pg/ml) or a high risk group (PTH ≥ 12 pg/ml). Patients in the high risk group were immediately started on prophylactic calcium carbonate (5–10 g/d) and calcitriol (0.5-1.0 mcg/d). The outcomes were then reviewed focusing mainly on how many low risk patients developed hypocalcemia (false negative rate), and how many high risk patients failed prophylactic therapy. Results Thirty one patients (25%) were stratified as high risk, and 94 (75%) as low risk. Five (16%) of the high risk patients became hypocalcemic despite prophylactic therapy. Two of the low risk group became hypocalcemic, (negative predictive value = 98%). None of the hypocalcemic patients had anything more than mild symptoms. Conclusions A single 1-hour post-thyroidectomy PTH level is a very useful way to stratify thyroidectomy patients into high and low risk groups for development of hypocalcemia. Early implementation of oral prophylactic calcium and vitamin D in the high risk patients is a very effective way to prevent serious hypocalcemia. Complex protocols requiring multiple calcium and PTH measurements are not required to guide post-thyroidectomy management. PMID:24476535

Association between high risk for preterm birth and changes in gingiva parameters during pregnancy-a prospective cohort study.

PubMed

Kruse, Anne Brigitte; Kuerschner, Anja C; Kunze, Mirjam; Woelber, Johan P; Al-Ahmad, Ali; Wittmer, Annette; Vach, Kirstin; Ratka-Krueger, Petra

2018-04-01

The objective of this study was to investigate clinical and microbiological gingival changes during pregnancy in women without periodontal disease. Additionally, these parameters were to be compared in women with high risk for preterm birth and women with a normal course of pregnancy. Group I consisted of 40 subjects at high risk for preterm birth, while group II involved 49 subjects with a normal course of pregnancy. The control group (III) was made up of 50 non-pregnant women. Clinical parameters (plaque index, gingival index, probing pocket depths, gingival swelling, bleeding on probing) and microbiological changes were monitored during pregnancy and 2-4 weeks after parturition. In the high-risk preterm group (I), 19 women could be included in data analysis. This group was compared to 41 women in the normal pregnancy group (II) and 50 non-pregnant women (III). Gingival inflammation was significantly higher in women with high risk for preterm birth (I) compared to non-risk pregnant women (II, p < 0.05). In addition, in this group (I), the subgingival amounts of Fusobacterium nucleatum (> 10 5 ) were found to be significantly higher after childbirth compared to non-pregnant women (p < 0.05). Even without having periodontal disease, women with high risk for preterm birth showed worse clinical values compared to non-risk pregnant and non-pregnant women and an increased detection of Fusobacterium nucleatum after delivery. High risk for preterm birth might be associated with the occurrence of increased gingival inflammation.

HIV-related high risk sexual behaviors and practices among women in Bogotá, Colombia.

PubMed

Míguez-Burbano, M J; Angarita, I; Shultz, J M; Shor-Posner, G; Klaskala, W; Duque, J L; Lai, H; Londoño, B; Baum, M K

2000-01-01

Determinants associated with high-risk sexual behaviors were investigated in 1,133 sexually active women in Bogotá, Colombia. A self-administered questionnaire was completed by two groups of women: 721 representing the general population (GP), and 412 commercial sex workers (CSWs). High-risk sexual behaviors for HIV/AIDS were evident in both groups. Nevertheless, consistent condom use was reported by only 6% of the GP group, as compared to 67% of the CSWs. Failure to recognize high-risk routes for HIV infection was indicated in 69% of the GP women for anal sex, and by the majority of both groups for intercourse during menses (56% GP women and 54% CSWs). Multivariate analysis revealed that education level, actual age, and age of first sex experience were significant predictors of high-risk sexual practices. The necessity for educational programs regarding high-risk sexual practices and risk of HIV/ AIDS is evident for HIV/AIDS prevention.

Trends in high-risk sexual behaviors among general population groups in China: a systematic review.

PubMed

Cai, Rui; Richardus, Jan Hendrik; Looman, Caspar W N; de Vlas, Sake J

2013-01-01

The objective of this review was to investigate whether Chinese population groups that do not belong to classical high risk groups show an increasing trend of engaging in high-risk sexual behaviors. We systematically searched the English and Chinese literature on sexual risk behaviors published between January 1980 and March 2012 in PubMed and the China National Knowledge Infrastructure (CNKI). We included observational studies that focused on population groups other than commercial sex workers (CSWs) and their clients, and men who have sex with men (MSM) and quantitatively reported one of the following indicators of recent high-risk sexual behavior: premarital sex, commercial sex, multiple sex partners, condom use or sexually transmitted infections (STIs). We used generalized linear mixed model to examine the time trend in engaging in high-risk sexual behaviors. We included 174 observational studies involving 932,931 participants: 55 studies reported on floating populations, 73 on college students and 46 on other groups (i.e. out-of-school youth, rural residents, and subjects from gynecological or obstetric clinics and premarital check-up centers). From the generalized linear mixed model, no significant trends in engaging in high-risk sexual behaviors were identified in the three population groups. Sexual risk behaviors among certain general population groups have not increased substantially. These groups are therefore unlikely to incite a STI/HIV epidemic among the general Chinese population. Because the studied population groups are not necessarily representative of the general population, the outcomes found may not reflect those of the general population.

Trends in High-Risk Sexual Behaviors among General Population Groups in China: A Systematic Review

PubMed Central

Cai, Rui; Richardus, Jan Hendrik; Looman, Caspar W. N.; de Vlas, Sake J.

2013-01-01

Background The objective of this review was to investigate whether Chinese population groups that do not belong to classical high risk groups show an increasing trend of engaging in high-risk sexual behaviors. Methods We systematically searched the English and Chinese literature on sexual risk behaviors published between January 1980 and March 2012 in PubMed and the China National Knowledge Infrastructure (CNKI). We included observational studies that focused on population groups other than commercial sex workers (CSWs) and their clients, and men who have sex with men (MSM) and quantitatively reported one of the following indicators of recent high-risk sexual behavior: premarital sex, commercial sex, multiple sex partners, condom use or sexually transmitted infections (STIs). We used generalized linear mixed model to examine the time trend in engaging in high-risk sexual behaviors. Results We included 174 observational studies involving 932,931 participants: 55 studies reported on floating populations, 73 on college students and 46 on other groups (i.e. out-of-school youth, rural residents, and subjects from gynecological or obstetric clinics and premarital check-up centers). From the generalized linear mixed model, no significant trends in engaging in high-risk sexual behaviors were identified in the three population groups. Discussion Sexual risk behaviors among certain general population groups have not increased substantially. These groups are therefore unlikely to incite a STI/HIV epidemic among the general Chinese population. Because the studied population groups are not necessarily representative of the general population, the outcomes found may not reflect those of the general population. PMID:24236121

Maternal and foetal outcome of 206 high risk pregnancy cases in border guard hospital, dhaka.

PubMed

Shapla, N R; Islam, M A; Shahida, S M; Parveen, Z; Lipe, Y S

2015-04-01

This observational study was carried out to identify the various types of high risk pregnancy and to determine the maternal and foetal outcome. The study was carried out on 206 pregnant high risk women in the Gynecology and Obstetrics department of Border Guard Hospital, Dhaka from January 2012 to December 2012. During mentioned period among 598 pregnant women 206 high risk pregnancy cases were randomly selected. Pregnant women (gestational age from 34 weeks upto 40 weeks) having medical condition and pregnancy related high risk factors were included and uncomplicated pregnancy, pregnancy before 37 weeks, post dated pregnancy were excluded from this study. Data was collected from semi structured history sheet and data analysis done by percentage. High risk pregnant women were grouped into three. Group A and Group B includes pregnant women having medical condition before and during pregnancy respectively. Group C consists of pregnant women had pregnancy related high risk issues. Among 206 high risk pregnancy cases majority 47.57% women had medical condition during pregnancy, 31.55% patient had medical condition before pregnancy. Among them majority 30.58% of the patient suffered from pregnancy induced hypertension, 15.04% patients suffered from gestational Diabetes Mellitus and premature rupture of membranes were 12.13%. In this study majority 43.68% of high risk pregnant patients were in age group of 30-35 years, 19.90% pregnant women were in age group of >35 years and 19.40% were in age group of upto 20 years. Among study groups maximum 65.04% of the patients were multiparous. Among 206 study population 60.19% high risk pregnant women were at term at the time of delivery and 39.8% women delivered their babies preterm. Caesarean section was done in 69.41% of high risk pregnant women. After delivery majority 77.66% women had no complication, only 10.19%, 8.25%, 2.91% and 0.97% high risk pregnant women suffered from fever, UTI, abdominal wound infection and post partum hemorrhage respectively. In this study, among 206 pregnancy cases 91.31% of the neonates had Apgar score >7 and 8.61% neonates had Apgar score <7%, 33.49% neonates had low birth weight and premature 39.80%. During the study period no maternal and neonatal death were observed.

Psychosocial Characteristics Associated with Both Antiretroviral Therapy Adherence and Risk Behaviors in Women Living with HIV

PubMed Central

Spangler, Sydney; Higgins, Melinda; Dalmida, Safiya George; Sharma, Sanjay

2015-01-01

The purpose of this study was to identify key psychosocial characteristics of HIV-infected women who exhibit different levels of both ART adherence and risk behaviors. We analyzed baseline data from 193 predominately African American HIV-infected women participating in a behavioral clinical trial. Women were categorized into high/low groups based on levels of adherence and risky behaviors. There was a significant interaction effect for internal motivation for adherence. Women at high risk for poor health and transmitting HIV (low adherence/high risk group) had the lowest levels of internal motivation and also reported more difficult life circumstances. Gender roles, caretaking and reliance on men for economic and other support may promote external versus internal motivation as well as riskier behaviors in this group. The highest levels of internal motivation were found in those with High Adherence/High Risk behaviors. This group was highly knowledgeable about HIV and had the lowest VL. Compared to others, this group seems to tolerate risky behaviors given their high level of adherence. Adherence and risk reduction behaviors are key to individual and public health. Motivation and risk compensation should be addressed when providing interventions to women living with HIV. PMID:26452670

Validation of Preoperative Risk Grouping of the Selection of Patients Most Likely to Benefit From Neoadjuvant Chemotherapy Before Radical Cystectomy.

PubMed

Moschini, Marco; Soria, Francesco; Klatte, Tobias; Wirth, Gregory J; Özsoy, Mehmet; Gust, Killian; Briganti, Alberto; Roupret, Morgan; Susani, Martin; Haitel, Andrea; Shariat, Shahrokh F

2017-04-01

The aim of this study was to validate the value of preoperative patient characteristics in prognosticating survival after radical cystectomy (RC) to guide treatment decisions regarding neoadjuvant systemic treatment. We evaluated a single cohort of 449 consecutive patients treated with RC for bladder cancer. Patients treated with neoadjuvant therapy were excluded from the study cohort (n = 24). Patients were stratified based on preoperative characteristics into 2 risk groups. The high-risk group included patients harboring clinically non-organ-confined disease (≥ cT3), hydroureteronephrosis, lymphovascular invasion, or variant histology (micropapillary, neuroendocrine, sarcomatoid, or plasmacytoid variants on transurethral resection). The low-risk group included patients with cT2 disease without any of the aforementioned features. Survival expectancies after surgery were evaluated using competing risk and Kaplan-Meier analyses. We identified 153 (44.6%) low-risk and 190 (55.4%) high-risk patients. The majority of high-risk patients had only 1 high-risk feature (n = 111; 58.4%); the most common high-risk feature was preoperative hydroureteronephrosis (n = 107; 56.3%). The majority of low-risk patients were upstaged at time of RC (n = 118; 70.6%), whereas a pathologic downstage occurred only in 27 high-risk patients (14.2%). Cancer-specific mortality-free rates at 5 years after RC were 77.4% versus 64.4% for low-risk versus high-risk patients, respectively. We confirm that preoperative risk features can stratify patients with muscle-invasive bladder cancer into differential risk groups regarding survival. Decision-making regarding neoadjuvant systemic therapy administration is likely to be improved by integrating clinical stage, lymphovascular invasion, variant histology, and hydroureteronephrosis. Copyright © 2016 Elsevier Inc. All rights reserved.

Incidence of Subclinical Hypothyroidism and Hypothyroidism in Early Pregnancy.

PubMed

Akram, Frida Hosseini; Johansson, Bengt; Möllerström, Gunnar; Landgren, Britt-Marie; Stavreus-Evers, Anneli; Skjöldebrand-Sparre, Lottie

2017-11-01

Untreated and subclinical hypothyroidism (SCH) has been associated with adverse pregnancy complications such as increased risk of miscarriage, hypertension, preeclampsia, and preterm delivery. However, in Sweden, screening for thyroid dysfunction during pregnancy is only recommended for women with a high risk of thyroid disease. Therefore, the aim of this study was to determine the incidence of clinical and SCH in women in the first trimester of pregnancy. In this prospective study, 1298 pregnant women were divided into three groups: one unselected general screening group (n = 611), one low-risk group comprising women without risk factors for thyroid disorder (n = 511), and one high-risk group comprising women with an inheritance or suspicion of thyroid disease or undergoing treatment for thyroid disease (n = 88). Serum was obtained up to gestational week 13, and thyrotropin (TSH) was analyzed. The incidences of thyroid dysfunction in the three screening groups were 9.8% in the general screening group, 9.6% in the low-risk group, and 10.2%, p = 0.948, in the high-risk group. In the women with known hypothyroidism on levothyroxine treatment, 50.6% had serum TSH levels above 2.0 mIU/L. High-risk screening is not useful in predicting which women are at risk of thyroid disease in early pregnancy since ∼10% of women with SCH or hypothyroidism could not be diagnosed in this way.

Targeting Persons With or At High Risk for Chronic Obstructive Pulmonary Disease by State-based Surveillance

PubMed Central

Pleasants, Roy A.; Heidari, Khosrow; Wheaton, Anne G.; Ohar, Jill A.; Strange, Charlie; Croft, Janet B.; Liao, Winston; Mannino, David M.; Kraft, Monica

2015-01-01

The Behavioral Risk Factor Surveillance System (BRFSS) survey is used to estimate chronic obstructive pulmonary disease (COPD) prevalence and could be expanded to describe respiratory symptoms in the general population and to characterize persons with or at high risk for the disease. Tobacco duration and respiratory symptom questions were added to the 2012 South Carolina BRFSS. Data concerning sociodemographics, chronic illnesses, health behaviors, and respiratory symptoms were collected in 9438 adults ≥ 35 years-old. Respondents were categorized as having COPD, high risk, or low risk for the disease. High risk was defined as no self-reported COPD, ≥ 10 years’ tobacco use, and ≥ 1 respiratory symptom (frequent productive cough or shortness of breath (SOB), or breathing problems affecting activities). Prevalence of self-reported and high-risk COPD were 9.1% and 8.0%, respectively. Overall, 17.3%, 10.6%, and 5.2% of all respondents reported activities limited by breathing problems, frequent productive cough, and frequent SOB, respectively. The high-risk group was more likely than the COPD group to report a productive cough and breathing problems limiting activities as well as being current smokers, male, and African-American. Health impairment was more severe in the COPD than the high-risk group, and both were worse than the low-risk group. Conclusions Persons at high risk for COPD share many, but not all, of the characteristics of persons diagnosed with the disease. Additional questions addressing smoking duration and respiratory symptoms in the BRFSS identifies groups at high risk for having or developing COPD who may benefit from smoking cessation and case-finding interventions. PMID:26367193

Unification of favourable intermediate-, unfavourable intermediate-, and very high-risk stratification criteria for prostate cancer.

PubMed

Zumsteg, Zachary S; Zelefsky, Michael J; Woo, Kaitlin M; Spratt, Daniel E; Kollmeier, Marisa A; McBride, Sean; Pei, Xin; Sandler, Howard M; Zhang, Zhigang

2017-11-01

To improve on the existing risk-stratification systems for prostate cancer. This was a retrospective investigation including 2 248 patients undergoing dose-escalated external beam radiotherapy (EBRT) at a single institution. We separated National Comprehensive Cancer Network (NCCN) intermediate-risk prostate cancer into 'favourable' and 'unfavourable' groups based on primary Gleason pattern, percentage of positive biopsy cores (PPBC), and number of NCCN intermediate-risk factors. Similarly, NCCN high-risk prostate cancer was stratified into 'standard' and 'very high-risk' groups based on primary Gleason pattern, PPBC, number of NCCN high-risk factors, and stage T3b-T4 disease. Patients with unfavourable-intermediate-risk (UIR) prostate cancer had significantly inferior prostate-specific antigen relapse-free survival (PSA-RFS, P < 0.001), distant metastasis-free survival (DMFS, P < 0.001), prostate cancer-specific mortality (PCSM, P < 0.001), and overall survival (OS, P < 0.001) compared with patients with favourable-intermediate-risk (FIR) prostate cancer. Similarly, patients with very high-risk (VHR) prostate cancer had significantly worse PSA-RFS (P < 0.001), DMFS (P < 0.001), and PCSM (P = 0.001) compared with patients with standard high-risk (SHR) prostate cancer. Moreover, patients with FIR and low-risk prostate cancer had similar outcomes, as did patients with UIR and SHR prostate cancer. Consequently, we propose the following risk-stratification system: Group 1, low risk and FIR; Group 2, UIR and SHR; and Group 3, VHR. These groups have markedly different outcomes, with 8-year distant metastasis rates of 3%, 9%, and 29% (P < 0.001) for Groups 1, 2, and 3, respectively, and 8-year PCSM of 1%, 4%, and 13% (P < 0.001) after EBRT. This modified stratification system was significantly more accurate than the three-tiered NCCN system currently in clinical use for all outcomes. Modifying the NCCN risk-stratification system to group FIR with low-risk patients and UIR with SHR patients, results in modestly improved prediction of outcomes, potentially allowing better personalisation of therapeutic recommendations. © 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.

Value of high-risk HPV-DNA testing in the triage of ASCUS.

PubMed

Silverloo, Iréne; Andrae, Bengt; Wilander, Erik

2009-01-01

OBJECTIVE. Atypical squamous cells of undetermined significance (ASCUS) cells, occurring in organized cytological screening, may be either high-risk human papillomavirus (HPV) positive or negative. To refine the assessment of women with ASCUS, a high-risk HPV-DNA test is recommended as triage in Sweden. A total of 197 consecutive women (mean age 39 years, range 21-60) with a diagnosis of ASCUS from the primary screening were selected for triage. Their cervical smears were collected and evaluated by using conventional cytological examination in combination with a high-risk HPV-DNA test (hybrid capture 2). The women were categorized into four groups: Group A, Cytology + /HPV + ; Group B, Cytology-/HPV + ; Group C, Cytology + /HPV-; and Group D, Cytology-/ HPV-. Women within Groups A-C were admitted for colposcopy and cervical biopsy. The women in Group D were considered as a low-risk group for tumor development, and were re-examined after three years in the next round of the organized screening. In women in Group A (n=58) the prevalence of histological verified CIN2-3 was 41%, in Group B (n=41) 20%, and in Group C (n=9) 0%. In Group D (n=89), repeated primary screening three years later revealed CIN2-3 in two biopsies from 74 women studied (<3%). The prevalence of a high-risk HPV infection decreased with age in women with ASCUS. It was 74% in women <30 years and 19% in women > or =50 years. Adding a high-risk HPV test in secondary screening increased the identification of women with CIN2-3 lesions by 33% in comparison with repeat cytology (p=0.01). The clinical significance of the ASCUS diagnosis varied with age of the women.

Screening strategies for thyroid disorders in the first and second trimester of pregnancy in China.

PubMed

Yang, Hong; Shao, Minglong; Chen, Liangmiao; Chen, Qingshou; Yu, Lechu; Cai, Lingqiao; Lin, Zhenzhen; Zhang, Chi; Lu, Xuemian

2014-01-01

Thyroid dysfunction during pregnancy is associated with multiple adverse outcomes, but whether all women should be screened for thyroid disorders during pregnancy remains controversial. To evaluate the effectiveness of the targeted high risk case-finding approach for identifying women with thyroid dysfunction during the first and second trimesters of pregnancy. Levels of thyroid stimulating hormone (TSH), free thyroxine (FT4), and thyroid peroxidase antibodies (TPOAb) were measured in 3882 Chinese women during the first and second trimester of pregnancy. All tested women were divided into the high risk or non-high risk groups, based on their history, findings from physical examination, or other clinical features suggestive of a thyroid disorder. Diagnosis of thyroid disorders was made according to the standard trimester-specific reference intervals. The prevalence of thyroid disorders in each group was determined, and the feasibility of a screening approach focusing exclusively on high risk women was evaluated to estimate the ability of finding women with thyroid dysfunction. The prevalence of overt hypothyroidism or hyperthyroidism in the high risk group was higher than in the non-high risk group during the first trimester (0.8% vs 0, χ2 = 7.10, p = 0.008; 1.6% vs 0.2%, χ2 = 7.02, p = 0.008, respectively). The prevalence of hypothyroxinemia or TPOAb positivity was significantly higher in the high risk group than in the non-high risk group during the second trimester (1.3% vs 0.5%, χ2 = 4.49, p = 0.034; 11.6% vs 8.4%, χ2 = 6.396, p = 0.011, respectively). The total prevalence of hypothyroidism or hyperthyroidism and the prevalence of subclinical hypothyroidism or hyperthyroidism were not statistically different between the high risk and non-high risk groups, for either the first or second trimester. The high risk screening strategy failed to detect the majority of pregnant women with thyroid disorders. Therefore, we recommend universal screening of sTSH, FT4, and TPOAb during the first trimester and second trimester of pregnancy.

Unethical for the sake of the group: risk of social exclusion and pro-group unethical behavior.

PubMed

Thau, Stefan; Derfler-Rozin, Rellie; Pitesa, Marko; Mitchell, Marie S; Pillutla, Madan M

2015-01-01

This research tested the idea that the risk of exclusion from one's group motivates group members to engage in unethical behaviors that secure better outcomes for the group (pro-group unethical behaviors). We theorized that this effect occurs because those at risk of exclusion seek to improve their inclusionary status by engaging in unethical behaviors that benefit the group; we tested this assumption by examining how the effect of exclusion risk on pro-group unethical behavior varies as a function of group members' need for inclusion. A 2-wave field study conducted among a diverse sample of employees working in groups (Study 1) and a constructive replication using a laboratory experiment (Study 2) provided converging evidence for the theory. Study 1 found that perceived risk of exclusion from one's workgroup predicted employees' engagement in pro-group unethical behaviors, but only when employees have a high (not low) need for inclusion. In Study 2, compared to low risk of exclusion from a group, high risk of exclusion led to more pro-group (but not pro-self) unethical behaviors, but only for participants with a high (not low) need for inclusion. We discuss implications for theory and the management of unethical behaviors in organizations. (c) 2015 APA, all rights reserved.

Adherence to drug-drug interaction alerts in high-risk patients: a trial of context-enhanced alerting.

PubMed

Duke, Jon D; Li, Xiaochun; Dexter, Paul

2013-05-01

Drug-drug interaction (DDI) alerting is an important form of clinical decision support, yet physicians often fail to attend to critical DDI warnings due to alert fatigue. We previously described a model for highlighting patients at high risk of a DDI by enhancing alerts with relevant laboratory data. We sought to evaluate the effect of this model on alert adherence in high-risk patients. A 6-month randomized controlled trial involving 1029 outpatient physicians was performed. The target interactions were all DDIs known to cause hyperkalemia. Alerts in the intervention group were enhanced with the patient's most recent potassium and creatinine levels. The control group received unmodified alerts. High -risk patients were those with baseline potassium >5.0 mEq/l and/or creatinine ≥1.5 mg/dl (132 μmol/l). We found no significant difference in alert adherence in high-risk patients between the intervention group (15.3%) and the control group (16.8%) (p=0.71). Adherence in normal risk patients was significantly lower in the intervention group (14.6%) than in the control group (18.6%) (p<0.01). In neither group did physicians increase adherence in patients at high risk. Physicians adhere poorly to hyperkalemia-associated DDI alerts even in patients with risk factors for a clinically significant interaction, and the display of relevant laboratory data in these alerts did not improve adherence levels in the outpatient setting. Further research is necessary to determine optimal strategies for conveying patient-specific DDI risk.

Validation of the Wound, Ischemia, foot Infection (WIfI) classification system in nondiabetic patients treated by endovascular means for critical limb ischemia.

PubMed

Beropoulis, Efthymios; Stavroulakis, Konstantinos; Schwindt, Arne; Stachmann, Arne; Torsello, Giovanni; Bisdas, Theodosios

2016-07-01

The Society for Vascular Surgery Lower Extremity Guidelines Committee developed the Wound, Ischemia, foot Infection (WIfI) a classification system to predict the amputation risk in patients with critical limb ischemia (CLI). A number of published studies have already evaluated its prognostic value. However, most of the included patients were diabetic, and the validation was done independent of the revascularization procedure. This single-center study evaluated the prognostic value of WIfI stages in nondiabetic patients treated by endovascular means. A retrospective analysis was performed of prospectively collected data of nondiabetic patients treated by endovascular means between January 2013 and September 2014. All patients were classified according to their wound status, ischemia index, and extent of foot infection to four classes: very low risk, low risk, moderate risk, and high risk. Comorbidities and vascular lesions for each group were analyzed. The prognostic value of WIfI was analyzed based on the amputation-free survival, overall survival rate, and freedom from amputation at 12 months. Data from 302 CLI patients treated in the study period were reviewed. A total of 219 patients (73%) underwent an endovascular intervention, and among them, 126 nondiabetic patients (58%) were enrolled in this study. Most patients were classified as low risk (33%), and the prevalence of very low-risk, moderate-risk, and very high-risk patients was 23%, 23%, and 21%, respectively. The modified Edifoligide for the Prevention of Infrainguinal Vein Graft Failure (PREVENT III) score was statistically significantly higher in the high-risk group (5.2 ± 2.4) than in the very low-risk, low-risk, and moderate-risk groups (4.3 ± 2.5, 3.5 ± 2.3, 4.5 ± 2.2, respectively; P = .048). One major amputation (1%) was performed during the hospital stay in a high-risk patient. Mean follow-up was 14 ± 8 months. The amputation-free survival at 12 months was 87%, 81%, 81%, and 62%, in the very low-risk, low-risk, moderate risk, and very high-risk groups, respectively (P = .106). The difference was statistically significant between the very low-risk and high-risk groups (hazard ratio, 3.4; 95% confidence interval, 1.1-10.3; P = .029). A similar trend was also observed for 1-year survival between the very low-risk and the high-risk groups (87%, 84%, 81%, 65%; P = .166). The amputation rate during the follow-up time was 0%, 2% (n = 6), 3% (n = 5), and 12% (n = 9) for the very low-risk, low-risk, moderate-risk, and very high-risk groups, respectively (P = .033). The WIfI classification system predicted the amputation risk and survival in this highly selected group of nondiabetic CLI patients treated by endovascular means, with a statistically significant difference between very low-risk and high-risk patients already at 1 year. Copyright © 2016 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Treatment Strategies in Octogenarians with Early-Stage, High-Risk Breast Cancer

PubMed Central

Mamtani, Anita; Gonzalez, Julie J.; Neo, Dayna T.; Friedman, Robb S.; Recht, Abram; Hacker, Michele R.; Sharma, Ranjna

2018-01-01

Background Octogenarians with early-stage breast cancer often have low-risk tumor biology. However, optimal treatment strategies for those with high-risk biology remain unclear. Methods We reviewed the records of women ages 80–89 years with biopsy-proven, Stage I–II invasive breast cancer who were referred for surgical evaluation from January 2001 through December 2010. High-risk was defined as human epidermal growth factor receptor-positive (HER2+), triple-negative (TN), or histologic grade 3 disease. Results Among 178 patients, 40 (22%) were high-risk: 12 were grade 1–2 (10 HER2 +, 2 TN); 28 were grade 3 (7 HER2+, 6 TN, 15 estrogen receptor-positive (ER+)/HER2−). The high-risk group had larger tumors and more often had ductal histology and lymphovascular invasion than the low-risk group and was more likely to undergo mastectomy (18 vs. 5%, p = 0.02), radiotherapy (55 vs. 36%, p = 0.03), and chemotherapy (10 vs. 0%, p = 0.002). Endocrine therapy use was similar among ER+ patients in both groups. The four patients in the high-risk group given chemotherapy were HER2+ and received trastuzumab-based regimens, without any reported toxicities. At median follow-up of 67 months, 10% of the high-risk group had a recurrence (3 distant-only, 1 simultaneous locoregional and distant in a patient treated with mastectomy without radiotherapy). Conclusions Tailored locoregional and systemic therapy resulted in low incidence of failure in these octogenarians with high-risk cancers with low morbidity. Modern adjuvant therapies should be considered for elderly women with high-risk cancers in the absence of significant comorbidities. PMID:29427213

Minimally invasive aortic valve replacement in high risk patient groups

PubMed Central

Lewis, Harriet; Benedetto, Umberto; Caputo, Massimo; Angelini, Gianni; Vohra, Hunaid A.

2017-01-01

Minimally invasive aortic valve replacement (AVR) aims to preserve the sternal integrity and improve postoperative outcomes. In low risk patients, this technique can be achieved with comparable mortality to the conventional approach and there is evidence of possible reduction in intensive care and hospital length of stay, transfusion requirement, renal dysfunction, improved respiratory function and increased patient satisfaction. In this review, we aim to asses if these benefits can be transferred to the high risk patient groups. We therefore, discuss the available evidence for the following high risk groups: elderly patients, re-operative surgery, poor lung function, pulmonary hypertension, obesity, concomitant procedures and high risk score cohorts. PMID:28740685

Children of psychotic mothers. An evaluation of 1-year-olds on a test of object permanence.

PubMed

Gamer, E; Gallant, D; Grunebaum, H

1976-03-01

Fifteen 1-year-old infants at high risk for later psychopathologic behavior were tested on the Piaget Object Scale. Their performance was compared to that of a matched group of controls at low risk. Results indicate a trend in the high-risk group toward lowered object scale performance. Affective styles were found to vary between the groups. The high-risk infants, particularly those with low scores on the object scale, demonstrated more intense anxiety.

A model to predict the onset of non-alcoholic fatty liver disease within 2 years in elderly adults.

PubMed

Lin, Ya-Jie; Gao, Xi-Mei; Pan, Wei-Wei; Gao, Shuai; Yu, Zhen-Zhen; Xu, Ping; Fan, Xiao-Peng

2017-10-01

Non-alcoholic fatty liver disease (NAFLD) is a common cause of chronic hepatitis, which leads to cirrhosis and hepatocellular carcinoma. However, it is difficult to identify subjects at high risk for NAFLD onset. This study aims to construct a model to predict the onset of NAFLD within 2 years in elderly adults. This study included and followed 3378 initial NAFLD-free subjects aged 60 years or over for 2 years, which were randomly divided into a training set and a validation set. NAFLD was diagnosed on ultrasound. Clinical and laboratory data were recorded at baseline. A model was constructed in the training set to predict the onset of NAFLD and validated in the validation set. Body mass index, hemoglobin, fasting blood glucose, and triglycerides were identified as predictors for the onset of NAFLD. A risk score (R) was calculated by them. It classified the subjects into low-risk group (R ≤ -2.88), moderate-risk group (-2.88 < R ≤ -1.26), and high-risk group (R > -1.26). In the training set, 4.68% of the participants in the low-risk group, 11.59% of the participants in the moderate-risk group, and 31.02% of the participants in the high-risk group developed NAFLD. In the validation set, 5.84% of the participants in the low-risk group, 10.57% of the participants in the moderate-risk group, and 29.44% of the participants in the high-risk group developed NAFLD. This study developed a model to predict the onset of NAFLD in elderly adults, which might provide indications for intervention to these subjects. © 2017 Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.

Influence of risk grouping on therapeutic decisions in patients with anaplastic thyroid carcinoma.

PubMed

Sun, Chuanzheng; Li, Chao; Hu, Zedong; Li, Xiaojiang; He, Jiehua; Song, Ming; Li, Guojun; Zhang, Fenghua; Li, Qiuli

2015-04-01

We investigated prognostic factors in 42 anaplastic thyroid carcinoma (ATC) patients from a single institution over a 30-year period and explored the use of risk grouping to guide therapeutic decisions. Univariable and multivariable differences in overall survival (OS) were evaluated using the Kaplan-Meier method and the log-rank test as well as Cox proportional hazards model. Risk grouping in making therapeutic decisions for ATC patients was explored. The 1- and 3-year OS rates were 28.6 % and 18.5 %, respectively. Univariate analysis indicated that 4 pre-therapeutic factors of patients were related to poorer prognoses: age ≥ 55 years, white blood cell count ≥ 10.0 × 10(9)/L, blood platelet count ≥ 300.0 × 10(9)/L and advanced clinical tumor-node-metastasis stage. These factors were used to calculate the risk indices. Patients with total risk index scores of no more than 1 were considered to be in the low-risk group, and patients with scores ≥ 2 were considered to be in the high-risk group. The patients in the low-risk group had significantly better 1- and 3-year OS rates (90.9 % and 63.6 %, respectively) than those in the high-risk group (6.5 % and 3.2 %, respectively). Risk group and therapeutic regimen were the 2 factors that independently influenced survival according to multivariable analysis. Surgery that was combined with postoperative radiotherapy significantly benefited the patients in the low-risk group rather than the patients in the high-risk group. Risk grouping was a helpful tool of evaluating the prognoses and guiding the treatment of ATC patients.

Advanced non-alcoholic steatohepatitis cirrhosis: A high-risk population for pre-liver transplant portal vein thrombosis.

PubMed

Stine, Jonathan G; Argo, Curtis K; Pelletier, Shawn J; Maluf, Daniel G; Caldwell, Stephen H; Northup, Patrick G

2017-01-28

To examine if liver transplant recipients with high-risk non-alcoholic steatohepatitis (NASH) are at increased risk for pre-transplant portal venous thrombosis. Data on all liver transplants in the United States from February 2002 through September 2014 were analyzed. Recipients were sorted into three distinct groups: High-risk (age > 60, body mass index > 30 kg/m 2 , hypertension and diabetes), low-risk and non-NASH cirrhosis. Multivariable logistic regression models were constructed. Thirty-five thousand and seventy-two candidates underwent liver transplantation and of those organ recipients, 465 were transplanted for high-risk and 2775 for low-risk NASH. Two thousand six hundred and twenty-six (7.5%) recipients had pre-transplant portal vein thrombosis; 66 (14.2%) of the high-risk NASH group had portal vein thrombosis vs 328 (11.8%) of the low-risk NASH group. In general, all NASH recipients were less likely to be male or African American and more likely to be obese. In adjusted multivariable regression analyses, high-risk recipients had the greatest risk of pre-transplant portal vein thrombosis with OR = 2.11 (95%CI: 1.60-2.76, P < 0.001) when referenced to the non-NASH group. Liver transplant candidates with high-risk NASH are at the greatest risk for portal vein thrombosis development prior to transplantation. These candidates may benefit from interventions to decrease their likelihood of clot formation and resultant downstream hepatic decompensating events. Prospective study is needed.

Prevalence of High-Risk Sexual Behaviors Among Monoracial and Multiracial Groups from a National Sample: Are Multiracial Young Adults at Greater Risk?

PubMed

Landor, Antoinette M; Halpern, Carolyn Tucker

2016-02-01

The present study compared the prevalence and variation in high-risk sexual behaviors among four monoracial (i.e., White, African American, Asian, Native American) and four multiracial (i.e., White/African American, White/Asian, White/Native American, African American/Native American) young adults using Wave IV data (2008-2009) from the National Longitudinal Study of Adolescent to Adult Health (N = 9724). Findings indicated differences in the sexual behavior of monoracial and multiracial young adults, but directions of differences varied depending on the monoracial group used as the referent and gender. Among males, White/African Americans had higher risk than Whites; White/Native Americans had higher risk than Native Americans. Otherwise, multiracial groups had lower risk or did not differ from the single-race groups. Among females, White/Native Americans had higher risk than Whites; White/African Americans had higher risk than African Americans. Other comparisons showed no differences or had lower risk among multiracial groups. Variations in high-risk sexual behaviors underscore the need for health research to disaggregate multiracial groups to better understand health behaviors and outcomes in the context of experiences associated with a multiracial background, and to improve prevention strategies.

Use of the Wound, Ischemia, foot Infection classification system in hemodialysis patients after endovascular treatment for critical limb ischemia.

PubMed

Tokuda, Takahiro; Hirano, Keisuke; Sakamoto, Yasunari; Mori, Shisuke; Kobayashi, Norihiro; Araki, Motoharu; Yamawaki, Masahiro; Ito, Yoshiaki

2017-12-07

The Wound, Ischemia, foot Infection (WIfI) classification system is used to predict the amputation risk in patients with critical limb ischemia (CLI). The validity of the WIfI classification system for hemodialysis (HD) patients with CLI is still unknown. This single-center study evaluated the prognostic value of WIfI stages in HD patients with CLI who had been treated with endovascular therapy (EVT). A retrospective analysis was performed of collected data on CLI patients treated with EVT between April 2007 and December 2015. All patients were classified according to their wound status, ischemia index, and extent of foot infection into the following four groups: very low risk, low risk, moderate risk, and high risk. Comorbidities and vascular lesions in each group were analyzed. The prognostic value of the WIfI classification was analyzed on the basis of the wound healing rate and amputation-free survival at 1 year. This study included 163 consecutive CLI patients who underwent HD and successful endovascular intervention. The rate of the high-risk group (36%) was the highest among the four groups, and the proportions of very-low-risk, low-risk, and moderate-risk patients were 10%, 18%, and 34%, respectively. The mean follow-up duration was 784 ± 650 days. The wound healing rates at 1 year were 92%, 70%, 75%, and 42% in the very-low-risk, low-risk, moderate-risk, and high-risk groups, respectively (P <.01). A similar trend was observed for the 1-year amputation-free survival among the groups (76%, 58%, 61%, and 46%, respectively; P = .02). The WIfI classification system predicted the wound healing and amputation risks in a highly selected group of HD patients with CLI treated with EVT, with a statistically significant difference between high-risk patients and other patients. Copyright © 2017 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.

Responses to false physiological feedback in individuals with panic attacks and elevated anxiety sensitivity.

PubMed

Story, Tyler J; Craske, Michelle G

2008-09-01

Participants with elevated anxiety sensitivity and a history of panic attacks were compared to a low anxiety comparison group with respect to physiological and subjective reactivity to false heart-rate feedback and reactivity to a priming procedure. Whereas accurate heart-rate feedback elicited minimal responses, participants across groups showed significant physiological and subjective responses to false feedback. High risk and low risk participants did not differ in heart-rate responses to false feedback, though panic attack frequency did predict physiological and subjective reactions to false feedback in the high risk group. Self-reported nonspecific anxiety was significantly higher in high risk female participants than in low risk female participants, while males did not different in general subjective anxiety. However, high risk participants reported more panic-specific symptoms during the false feedback task than low risk participants, regardless of the sex of the participant. Therefore, although the experimental paradigm appeared to trigger nonspecific anxiety in high risk female participants, panic attack symptoms in reaction to the task were specific to risk group, not sex, and consistent with hypotheses. Surprisingly, the priming procedure did not influence physiological or subjective responses to false feedback in either group. These results raise additional questions regarding the process and impact of interception in individuals with panic attacks, and suggest that false perception of internal changes may contribute to risk for panic disorder when exposed to believable cues.

Craniofacial and upper airway morphology in pediatric sleep-disordered breathing and changes in quality of life with rapid maxillary expansion.

PubMed

Katyal, Vandana; Pamula, Yvonne; Daynes, Cathal N; Martin, James; Dreyer, Craig W; Kennedy, Declan; Sampson, Wayne J

2013-12-01

The association between pediatric sleep-disordered breathing caused by upper airway obstruction and craniofacial morphology is poorly understood and contradictory. The aims of this study were to evaluate the prevalence of children at risk for sleep-disordered breathing, as identified in an orthodontic setting by validated screening questionnaires, and to examine associations with their craniofacial and upper airway morphologies. A further aim was to assess the change in quality of life related to sleep-disordered breathing for affected children undergoing rapid maxillary expansion to correct a palatal crossbite or widen a narrow maxilla. A prospective case-control study with children between 8 and 17 years of age (n = 81) at an orthodontic clinic was undertaken. The subjects were grouped as high risk or low risk for sleep-disordered breathing based on the scores from a validated 22-item Pediatric Sleep Questionnaire and the Obstructive Sleep Apnea-18 Quality of Life Questionnaire. Variables pertaining to a screening clinical examination, cephalometric assessment, and dental cast analysis were tested for differences between the 2 groups at baseline. Ten children who underwent rapid maxillary expansion were followed longitudinally until removal of the appliance approximately 9 months later with a repeated Obstructive Sleep Apnea-18 Quality of Life Questionnaire. All data were collected blinded to the questionnaire results. The frequency of palatal crossbite involving at least 3 teeth was significantly higher in the high-risk group at 68.2%, compared with the low-risk group at 23.2% (P <0.0001). Average quality of life scores in the high-risk group indicated reduced quality of life related to sleep-disordered breathing by 16% compared with children in the low-risk group at baseline (P <0.0001). Cephalometrically, mean inferior airway space, posterior nasal spine to adenoidal mass distance, and adenoidal mass to soft palate distance were reduced in the high-risk group compared with the low-risk group by 1.87 mm (P <0.03), 2.82 mm (P <0.04), and 2.13 mm (P <0.03), respectively. The mean maxillary intercanine, maxillary interfirst premolar, maxillary interfirst molar, mandibular intercanine, and mandibular interfirst premolar widths were reduced in the high-risk group compared with the low-risk group by 4.22 mm (P <0.0001), 3.92 mm (P <0.0001), 4.24 mm (P <0.0001), 1.50 mm (P <0.01), and 1.84 mm (P <0.01), respectively. Children treated with rapid maxillary expansion showed an average improvement of 14% in quality of life scores in the high-risk group compared with the low-risk group, which showed a slight worsening in quality of life related to sleep-disordered breathing by an average of 1% (P <0.04), normalizing the quality of life scores in the high-risk children to the baseline scores compared with the low-risk group. Children at high risk for sleep-disordered breathing are characterized by reduced quality of life, reduced nasopharyngeal and oropharyngeal sagittal dimensions, palatal crossbite, and reduced dentoalveolar transverse widths in the maxillary and mandibular arches. No sagittal or vertical craniofacial skeletal cephalometric predictors were identified for children at high risk for sleep-disordered breathing. In the short term, rapid maxillary expansion might aid in improvement of the quality of life for children with a narrow maxilla in the milder end of the sleep-disordered breathing spectrum. Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

Validation of MASCC Score for Risk Stratification in Patients of Hematological Disorders with Febrile Neutropenia.

PubMed

Taj, M; Nadeem, M; Maqsood, S; Shah, T; Farzana, T; Shamsi, T S

2017-09-01

The purpose of this study is to evaluate the association of MASCC score (Multinational Association for Supportive Care in Cancer Score) in patients with febrile neutropenia (as resultant treatment of hematological disorders) for risk assessment of morbidity and mortality. Patients presenting with Febrile Neutropenia from November 2011 till December 2013 were enrolled in the study. Initially all patients were hospitalized and their MASCC score was calculated, however those with high risk stayed in hospital till full ANC recovery while low risk group was discharged earlier and keenly followed as out-patient while being on prophylactic oral antibiotics. The MASCC risk-index score was calculated and patients with risk score >21 were regarded as low-risk while <21 were labeled as high-risk. On the basis of 226 febrile neutropenia patient 132(58.4 %) were categorized as low risk while 94(41.5 %) as high risk patients according to MASCC risk index score. In low risk group 123(93 %) had uncomplicated infection while 9(7 %) had complicated infections. There was no mortality documented in low risk group while eight patients died in high risk group. In this study we correctly predicted outcome of 123(93 %) low risk group patients. The study had positive predictive value of 93 % with both sensitivity and specificity of 65 and 75 % respectively. The MASCC risk score is a valuable tool in determining the outcome in patients with febrile neutropenia.

HIV risk perception and preexposure prophylaxis interest among a heterosexual population visiting a sexually transmitted infection clinic.

PubMed

Khawcharoenporn, Thana; Kendrick, Sabrina; Smith, Kimberly

2012-04-01

Low perception of HIV risk despite behaviors associated with increased risk is thought to be a contributing factor for a higher prevalence of HIV in blacks than other groups in the United States. We sought to determine HIV risk perception and its impact on safer sex practices and interest in preexposure prophylaxis (PrEP). From August 1 to October 31, 2010, an anonymous survey was conducted at a sexually transmitted infection clinic asking questions about demographics, risk behaviors, and PrEP interest. Participants were categorized into high-risk, moderate-risk, and low-risk groups according to predefined HIV risk characteristics. Only heterosexual high-risk participants were further assessed for their risk perception, condom use and PrEP interest. There were 494 participants; 63% male, 70% blacks, 88% heterosexual; 83% were categorized into the high-risk group. Of the 359 heterosexual high-risk participants, 301 (84%) perceived themselves at no or low-risk. Rates of consistent condom use with vaginal, oral, and anal sex were low (<20%) in this group despite high levels of knowledge about HIV transmission risks. Rates of condom use were not affected by risk perception. No interest in PrEP was associated with low education level (adjusted odds ratio 4.97; p=0.02) and low risk perception. These findings suggest that despite having knowledge about HIV transmission risks, the majority of high-risk participants did not recognize their risks and used condoms with low frequency. Low risk perception and low education level may impact PrEP interest. Enhanced interventions are needed to improve HIV risk perception, safer sex practices, and knowledge about PrEP.

Who Will Experience the Most Alcohol Problems in College? The Roles of Middle and High School Drinking Tendencies.

PubMed

Scaglione, Nichole M; Mallett, Kimberly A; Turrisi, Rob; Reavy, Racheal; Cleveland, Michael J; Ackerman, Sarah

2015-10-01

Previous work examining college drinking tendencies has identified a disproportionately small (20%), but uniquely high-risk group of students who experience nearly 50% of the reported alcohol-related consequences (i.e., the multiple repeated consequences, or MRC, group). With the goal of reducing drinking-related consequences later in college, this study sought to identify potential MRC group members in their first semester by examining: (i) early-risk subgroups based on analysis of early-risk screening constructs (e.g., age of drinking onset, middle school alcohol exposure, high school drinking, and consequences); and (ii) their association with MRC criteria early in the first semester of college. A random sample of 2,021 first-year college student drinkers (56% female) completed a web-based drinking survey in their first semester on campus. Latent class analysis revealed 4 early-risk subgroups: (i) an early-onset risk group who endorsed early age of drinking onset and engaged in heavy middle and high school drinking (10%); (ii) a late-onset risk group who engaged in weekend drinking and drunkenness and experienced 6 or more unique consequences as seniors in high school (32%); (iii) an early-onset limited risk group who only endorsed early age of onset and middle school drinking (3%); and (iv) a minimal risk group who did not engage in any early-risk behaviors (55%). Members of both the early- and late-onset risk groups had significantly higher odds of MRC membership in their first semester of college (9.85 and 6.79 greater, respectively). Results suggest age of onset, middle and high school drinking and drunkenness, and frequency of unique consequences could be particularly useful in brief screening tools. Further, findings support early screening and prevention efforts for MRC membership prior to college matriculation. Copyright © 2015 by the Research Society on Alcoholism.

Effect of Precede-Proceed Model on Preventive Behaviors for Type 2 Diabetes Mellitus in High-Risk Individuals.

PubMed

Moshki, Mahdi; Dehnoalian, Atefeh; Alami, Ali

2017-04-01

This study sought to assess the effect of precede-proceed model on preventive behaviors for type 2 diabetes mellitus (DM) in high-risk individuals. In this semi-experimental study, 164 high-risk individuals for type 2 DM were selected and were randomly divided into two groups of intervention and control ( n = 85). Educational intervention was performed as a single session face-to-face instruction for 1.5 hr for the intervention group participants. Data were collected before (baseline) and immediately and 1 month after the intervention in the two groups. The mean score of predisposing (knowledge) factors ( p = .001), reinforcing factors ( p = .001), and enabling factors ( p = .02) were significantly different at baseline and 1 month after the intervention in the intervention group compared with the control group ( p < .05). A significant improvement occurred in the nutritional habits of high-risk participants in the intervention group at 1 month after the intervention compared with controls ( p = .001). The precede-proceed model can be effective for promoting the preventive behaviors for type 2 DM in high-risk individuals.

AIMS baby movement scale application in high-risk infants early intervention analysis.

PubMed

Wang, Y; Shi, J-P; Li, Y-H; Yang, W-H; Tian, Y-J; Gao, J; Li, S-J

2016-05-01

We investigated the application of Alberta Infant Motor Scale (AIMS) in screening motor development delay in the follow-up of high-risk infants who were discharged from NICU, to explain the state of infants' motor development and propose early individualized intervention. The study design was a randomized, single-blind trial by selecting patients between April 2015 and November 2015 in our hospital, children nerve recovery branch clinics and 77 cases of high-risk infants. We randomly divided the patients into observation group (39 cases) and control group (38 cases). To evaluate the application with AIMS, observation group was based on evaluation results for the first time to give rehabilitation training plan making, early intervention, control group according to the growth and development milestone in order to guide parents to take family training interval of 3 months. While comparing the two groups of high-risk infants before the intervention, the months of age, gender, risk factors, it was found that the AIMS scores, each position AIMS scores did not show a significant difference in percentile (p>0.05). There was also no significant difference between two groups in the seat and stand AIMS scores before and after intervention (p>0.05). However, the comparison of two groups of high-risk infants after intervention in comparison showed that the observation group supine AIMS scores and AIMS scores were significantly higher than the control group (p<0.05). Prone position AIMS scores observation group was also significantly higher than that of the control group (p<0.01). The corresponding percentile for two groups after the intervention of AIMS scores was less than 10% of cases, which was significantly lower in the observation group (p<0.01). AIMS can predict the development delay in high-risk infants, for improving the early hypernymic diagnosis and intervention.

Lifestyle and accidents among young drivers.

PubMed

Gregersen, N P; Berg, H Y

1994-06-01

This study covers the lifestyle component of the problems related to young drivers' accident risk. The purpose of the study is to measure the relationship between lifestyle and accident risk, and to identify specific high-risk and low-risk groups. Lifestyle is measured through a questionnaire, where 20-year-olds describe themselves and how often they deal with a large number of different activities, like sports, music, movies, reading, cars and driving, political engagement, etc. They also report their involvement in traffic accidents. With a principal component analysis followed by a cluster analysis, lifestyle profiles are defined. These profiles are finally correlated to accidents, which makes it possible to define high-risk and low-risk groups. The cluster analysis defined 15 clusters including four high-risk groups with an average overrisk of 150% and two low-risk groups with an average underrisk of 75%. The results are discussed from two perspectives. The first is the importance of theoretical understanding of the contribution of lifestyle factors to young drivers' high accident risk. The second is how the findings could be used in practical road safety measures, like education, campaigns, etc.

Can an educational application increase risk perception accuracy amongst patients attending a high-risk breast cancer clinic?

PubMed

Keohane, D; Lehane, E; Rutherford, E; Livingstone, V; Kelly, L; Kaimkhani, S; O'Connell, F; Redmond, H P; Corrigan, M A

2017-04-01

To design, develop and test the effect of an educational initiative to improve risk perception amongst patients attending a high-risk breast cancer clinic. This was achieved through three objectives - 1. identifying an optimal method of presenting risk data, 2. designing and building a risk application, and 3. testing the ability of the application to successfully modify patients perceived risk of cancer. A mobile application was developed for this project using best practice methods for displaying risk information. Patients (n = 84) were randomly allocated into two groups - 'Control' or 'Treatment'. Both groups underwent standard risk counseling while the application was employed in the 'Treatment' group. The patients were surveyed before their session, immediately after and six weeks later. Increases in accuracy were seen in both groups with larger increases demonstrated in the 'Treatment' group with 'Personal 10 Year Risk' statistically significant ('Control' group increase from 21% to 48% vs the 'Treatment' group increase from 33% to 71% - p = 0.003). This project demonstrated trends towards improved risk perception, however mixed logistic regression was unable to show a 30% difference between groups. Numerical literacy and understanding of risk were identified as issues amongst the general population. Overestimating risk remains high amongst attendees. Using mobile applications to convey risk information to patients is a new and evolving area with a corresponding paucity of data. We have demonstrated its potential and emphasised the importance of designing how this information is communicated to patients in order to make it understandable and meaningful. Copyright © 2017 Elsevier Ltd. All rights reserved.

The Seoul Metropolitan Lifestyle Intervention Program and Metabolic Syndrome Risk: A Retrospective Database Study

PubMed Central

Choo, Jina; Yoon, Seok-Jun; Ryu, Hosihn; Park, Mi-Suk; Lee, Hyang Sook; Park, Yoo Mi; Lim, Do-Sun

2016-01-01

Since 2011, the Seoul Metabolic Syndrome Management (SMESY) program has been employed as a community-wide, lifestyle modification intervention in Seoul, Korea. We aimed to determine if the SMESY intervention would be significantly associated with improvements in metabolic syndrome (MetS) risk factors. This retrospective database study included data from 25,449 participants aged 30–64 years between 1 January 2013 and 30 June 2013. In the SMESY program, 3 risk-stratified groups by the number of MetS factors were followed for 12 months with different intensity and timeframe of intervention. Among the high-(n = 7116) and moderate-risk groups (n = 14,762), all MetS factors (except triglycerides among the moderate-risk group) as well as MetS z-scores significantly improved over 12 months (all p < 0.05). Among the low-risk group (n = 3571), all factors aggravated significantly over 12 months (all p < 0.05). We observed temporal associations between the implementation of the SMESY program and improvements in MetS risk factors. However, such improvements differed by risk-stratified group, being most robust for the high-risk group, modest for the moderate-risk group, and aggravated for the low-risk group. Thus, more intensive interventions targeting different risk-stratified groups are needed, given a better understanding of the increase in risk factors observed in the low-risk group. PMID:27384576

Screening for ovarian cancer in women with varying levels of risk, using annual tests, results in high recall for repeat screening tests

PubMed Central

2011-01-01

Background We assessed ovarian cancer screening outcomes in women with a positive family history of ovarian cancer divided into a low-, moderate- or high-risk group for development of ovarian cancer. Methods 545 women with a positive family history of ovarian cancer referred to the Ovarian Screening Service at the Royal Marsden Hospital, London from January 2000- December 2008 were included. They were stratified into three risk-groups according to family history (high-, moderate- and low-risk) of developing ovarian cancer and offered annual serum CA 125 and transvaginal ultrasound screening. The high-risk group was offered genetic testing. Results The median age at entry was 44 years. The number of women in the high, moderate and low-risk groups was 397, 112, and 36, respectively. During 2266 women years of follow-up two ovarian cancer cases were found: one advanced stage at her fourth annual screening, and one early stage at prophylactic bilateral salpingo-oophorectomy (BSO). Prophylactic BSO was performed in 138 women (25.3%). Forty-three women had an abnormal CA125, resulting in 59 repeat tests. The re-call rate in the high, moderate and low-risk group was 14%, 3% and 6%. Equivocal transvaginal ultrasound results required 108 recalls in 71 women. The re-call rate in the high, moderate, and low-risk group was 25%, 6% and 17%. Conclusion No early stage ovarian cancer was picked up at annual screening and a significant number of re-calls for repeat screening tests was identified. PMID:22112691

High-risk drinking is associated with dyslipidemia in a different way, based on the 2010-2012 KNHANES.

PubMed

Kwon, Yu-Jin; Kim, Sung-Eun; Park, Byoung-Jin; Bae, Jang-Whan; Kang, Hee-Taik

2016-05-01

The Alcohol Use Disorders Identification Test (AUDIT) questionnaire is a simple and useful method for the early detection of hazardous and harmful drinking. In this study, we examined the association between alcohol drinking pattern and dyslipidemia in Korean adults. This cross-sectional study included 14,308 participants who took part in the 2010-2012 Korean National Health and Nutrition Examination Survey. We categorized alcohol drinking patterns into three groups. We classified dyslipidemia into hypercholesterolemia, hypertriglyceridemia, hypo-HDL-cholesterolemia, hyper-LDL-cholesterolemia, and hyper-non-HDL-cholesterolemia. Of those who participated, 25.1% of men and 4.8% of women were high-risk drinkers. Compared with the low-risk group, Odd Ratios for hypercholesterolemia and hypertriglyceridemia in the high-risk group were 1.198 (1.001-1.434) and 1.979 (1.622-2.413) for men. Odd Ratios for hypo-HDL-cholesterolemia in the high-risk group was 0.351 (0.279-0.441) in men and 0.413 (0.291-0.586) in women. Compared with the low-risk participants, the high-risk group was associated with higher prevalence and increased risk for hyper-LDL-cholesterolemia in both sexes (1.541 [1.467-1.913] for men and 1.631 [1.034-2.575] for women). High-risk drinking was associated with higher risk for hypertriglyceridemia and hyper-LDL-cholesterolemia in both sexes and hypercholesterolemia in men but lower risk for hypo-HDL-cholesterolemia in both sexes. Copyright © 2016 Elsevier B.V. All rights reserved.

Optimal combination treatment and vascular outcomes in recent ischemic stroke patients by premorbid risk level.

PubMed

Park, Jong-Ho; Ovbiagele, Bruce

2015-08-15

Optimal combination of secondary stroke prevention treatment including antihypertensives, antithrombotic agents, and lipid modifiers is associated with reduced recurrent vascular risk including stroke. It is unclear whether optimal combination treatment has a differential impact on stroke patients based on level of vascular risk. We analyzed a clinical trial dataset comprising 3680 recent non-cardioembolic stroke patients aged ≥35 years and followed for 2 years. Patients were categorized by appropriateness levels 0 to III depending on the number of the drugs prescribed divided by the number of drugs potentially indicated for each patient (0=none of the indicated medications prescribed and III=all indicated medications prescribed [optimal combination treatment]). High-risk was defined as having a history of stroke or coronary heart disease (CHD) prior to the index stroke event. Independent associations of medication appropriateness level with a major vascular event (stroke, CHD, or vascular death), ischemic stroke, and all-cause death were analyzed. Compared with level 0, for major vascular events, the HR of level III in the low-risk group was 0.51 (95% CI: 0.20-1.28) and 0.32 (0.14-0.70) in the high-risk group; for stroke, the HR of level III in the low-risk group was 0.54 (0.16-1.77) and 0.25 (0.08-0.85) in the high-risk group; and for all-cause death, the HR of level III in the low-risk group was 0.66 (0.09-5.00) and 0.22 (0.06-0.78) in the high-risk group. Optimal combination treatment is related to a significantly lower risk of future vascular events and death among high-risk patients after a recent non-cardioembolic stroke. Copyright © 2015 Elsevier B.V. All rights reserved.

Effect of low-dose aspirin on primary prevention of cardiovascular events in Japanese diabetic patients at high risk.

PubMed

Okada, Sadanori; Morimoto, Takeshi; Ogawa, Hisao; Sakuma, Mio; Soejima, Hirofumi; Nakayama, Masafumi; Sugiyama, Seigo; Jinnouchi, Hideaki; Waki, Masako; Doi, Naofumi; Horii, Manabu; Kawata, Hiroyuki; Somekawa, Satoshi; Soeda, Tsunenari; Uemura, Shiro; Saito, Yoshihiko

2013-01-01

Benefit of low-dose aspirin for primary prevention of cardiovascular events in diabetes remains controversial. The American Diabetes Association (ADA), the American Heart Association (AHA), and the American College of Cardiology Foundation (ACCF) recommend aspirin for high-risk diabetic patients: older patients with additional cardiovascular risk factors. We evaluated aspirin's benefit in Japanese diabetic patients stratified by cardiovascular risk. In the JPAD trial, we enrolled 2,539 Japanese patients with type 2 diabetes and no history of cardiovascular disease. We randomly assigned them to aspirin (81-100 mg daily) or no aspirin groups. The median follow-up period was 4.4 years. We stratified the patients into high-risk or low-risk groups, according to the US recommendation: age (older; younger) and coexisting cardiovascular risk factors. The risk factors included smoking, hypertension, dyslipidemia, family history of coronary artery disease, and proteinuria. Most of the patients were classified into the high-risk group, consisting of older patients with risk factors (n=1,804). The incidence of cardiovascular events was higher in this group, but aspirin did not reduce cardiovascular events (hazard ratio [HR], 0.83; 95% confidence interval [CI]: 0.58-1.17). In the low-risk group, consisting of older patients without risk factors and younger patients (n=728), aspirin did not reduce cardiovascular events (HR, 0.55; 95% CI: 0.23-1.21). These results were unchanged after adjusting for potential confounding factors. Low-dose aspirin is not beneficial in Japanese diabetic patients at high risk.

Lifestyle Risk Factors Predict Disability and Death in Healthy Aging Adults

PubMed Central

Chakravarty, Eliza F.; Hubert, Helen B.; Krishnan, Eswar; Bruce, Bonnie B.; Lingala, Vijaya B.; Fries, James F.

2011-01-01

Background Associations between modifiable health risk factors during middle age with disability and mortality in later life are critical to maximizing longevity while preserving function. Positive health effects of maintaining normal weight, routine exercise, and non-smoking are known for the short and intermediate term. We studied the effects of these risk factors into advanced age. Methods A cohort of 2,327 college alumnae ≥60 years was followed annually (1986–2005) by questionnaires addressing health risk factors, history, and Health Assessment Questionnaire disability (HAQ-DI). Mortality data were ascertained from the National Death Index. Low, medium, and high risk groups were created based upon the number (0, 1, ≥2) of health risk factors (overweight, smoking, inactivity) at baseline. Disability and mortality for each group were estimated from unadjusted data and regression analyses. Multivariable survival analyses estimated time to disability or death. Results Medium and high-risk groups had higher disability than the low risk group throughout the study (p<0.001). Low-risk subjects had onset of moderate disability delayed 8.3 years compared with high-risk. Mortality rates were higher in the high risk group (384 versus 247 per 10,000 person-years). Multivariable survival analyses showed the number of risk factors to be associated with cumulative disability and increased mortality. Conclusions Seniors with fewer behavioral risk factors during middle age have lower disability and improved survival. These data document that the associations of lifestyle risk factors upon health continue into the ninth decade. PMID:22269623

Improving antenatal risk assessment in women exposed to high risks.

PubMed

Perry, Natasha; Newman, Louise K; Hunter, Mick; Dunlop, Adrian

2015-01-01

Antenatal substance use and related psychosocial risk factors are known to increase the likelihood of child protection involvement; less is known about the predictive nature of maternal reflective functioning (RF) in this population. This preliminary study assessed psychosocial and psychological risk factors for a group of substance dependent women exposed to high risks in pregnancy, and their impact on child protection involvement. Pregnant women on opiate substitution treatment (n = 11) and a comparison group (n = 15) were recruited during their third trimester to complete measures of RF (Pregnancy Interview), childhood trauma, mental health and psychosocial assessments. At postnatal follow-up, RF was reassessed (Parent Development Interview - Revised Short Version) and mother-infant dyads were videotaped to assess emotional availability (EA). Child protection services were contacted to determine if any concerns had been raised for infant safety. Significant between-group differences were observed for demographics, psychosocial factors, trauma and mental health symptoms. Unexpectedly, no significant differences were found for RF or EA between groups. Eight women in the 'exposed to high risks' group became involved with child protection services. Reflective functioning was not significantly associated with psychosocial risk factors, and therefore did not mediate the outcome of child protection involvement. Women 'exposed to high risks' were equally able to generate a model of their own and their infants' mental states and should not be seen within a deficit perspective. Further research is required to better understand the range of risk factors that predict child protection involvement in high risk groups. © The Author(s) 2013.

Targeted cardiopulmonary resuscitation training focused on the family members of high-risk patients at a regional medical center: A comparison between family members of high-risk and no-risk patients.

PubMed

Han, Kap Su; Lee, Ji Sung; Kim, Su Jin; Lee, Sung Woo

2018-05-01

We developed a hospital-based cardiopulmonary resuscitation (CPR) training model focused on the target population (family members of patients with potential risks for cardiac arrest) and compared the outcome of CPR training between target and non-target populations for validity. Family members of patients in training were divided into three groups on the basis of patients' diseases, as follows: 1) the cardio-specific (CS) risk group, including family members of patients with cardiac disease at risk of cardiac arrest; 2) the cardiovascular (CV) risk group, including family members of patients with risk factors for cardiovascular disease; and 3) the no-risk group. Pre- and posttraining surveys and skill tests as well as a post-training 3-month telephone survey were conducted. Educational outcomes were analyzed. A total of 203 family members were enrolled into 21 CPR training classes. The CS group (n=88) included elderly persons and housewives with a lower level of education compared with the CV (n=79) and no-risk groups (n=36). The CS group was motivated by healthcare professionals and participated in the training course. The CS, CV, and no-risk groups showed improvements in knowledge, willingness to perform CPR, and skills. Despite the older age and lower level of education in the CS group, the effects of education were similar to those in the other groups. A high rate of response and secondary propagation of CPR training were observed in the CS group. Family members of patients with heart disease could be an appropriate target population for CPR training, particularly in terms of recruitment and secondary propagation. Targeted intervention may be an effective training strategy to improve bystander CPR rates.

Serum miRNA levels are related to glucose homeostasis and islet autoantibodies in children with high risk for type 1 diabetes.

PubMed

Åkerman, Linda; Casas, Rosaura; Ludvigsson, Johnny; Tavira, Beatriz; Skoglund, Camilla

2018-01-01

Micro RNAs (miRNAs) are promising disease biomarkers due to their high stability. Their expression in serum is altered in type 1 diabetes, but whether deviations exist in individuals with high risk for type 1 diabetes remains unexplored. We therefore assessed serum miRNAs in high-risk individuals (n = 21) positive for multiple islet autoantibodies, age-matched healthy children (n = 17) and recent-onset type 1 diabetes patients (n = 8), using Serum/Plasma Focus microRNA PCR Panels from Exiqon. The miRNA levels in the high-risk group were similar to healthy controls, and no specific miRNA profile was identified for the high-risk group. However, serum miRNAs appeared to reflect glycemic status and ongoing islet autoimmunity in high-risk individuals, since several miRNAs were associated to glucose homeostasis and autoantibody titers. High-risk individuals progressing to clinical disease after the sampling could not be clearly distinguished from non-progressors, while miRNA expression in the type 1 diabetes group deviated significantly from high-risk individuals and healthy controls, perhaps explained by major metabolic disturbances around the time of diagnosis.

College students' drinking patterns: trajectories of AUDIT scores during the first four years at university.

PubMed

Johnsson, Kent O; Leifman, Anders; Berglund, Mats

2008-01-01

Changes in AUDIT score trajectories were examined in a student population during their first 4 years at a university, including high-risk consumers and a subsample of low-risk consumers. 359 students were selected for the present study, comprising all high-risk consumers (the 27% with highest scores, i.e. 11 for males and 7 for females) and a randomized sample of low-risk consumers (n = 177 and 182, respectively). The Alcohol Use Disorder Identification Test (AUDIT) was used as screening instrument. Trajectory analyses were made using a semiparametric group-based model. In the low-AUDIT group, five distinct trajectories were identified: three stable non-risky consumption groups (83%) and two increasing groups (17%; from non-risky to risky). In the high-AUDIT group, three groups were identified: two stable high groups (58%) and one decreasing group (from risky to non-risky consumption; 41%). In the integrated model, stable risky consumption comprised 16% of the total sample, decreasing consumption 11%, increasing consumption comprised 13% and stable non-risky consumption 60% of the sample. Gender influenced the trajectories. The pattern of changes in risk consumption is similar to that found in corresponding US studies. (c) 2008 S. Karger AG, Basel

Lung cancer screening with low-dose helical CT in Korea: experiences at the Samsung Medical Center.

PubMed

Chong, Semin; Lee, Kyung Soo; Chung, Myung Jin; Kim, Tae Sung; Kim, Hojoong; Kwon, O Jung; Choi, Yoon-Ho; Rhee, Chong H

2005-06-01

To determine overall detection rates of lung cancer by low-dose CT (LDCT) screening and to compare histopathologic and imaging differences of detected cancers between high- and low-risk groups, this study included 6,406 asymptomatic Korean adults with >or=45 yr of age who underwent LDCT for lung cancer screening. All were classified into high- (>or=20 pack-year smoking; 3,353) and low-risk (3,053; <20 pack-yr smoking and non-smokers) groups. We compared CT findings of detected cancers and detection rates between high- and low-risk. At initial CT, 35% (2,255 of 6,406) had at least one or more non-calcified nodule. Lung cancer detection rates were 0.36% (23 of 6,406). Twenty-one non-small cell lung cancers appeared as solid (n=14) or ground-glass opacity (GGO) (n=7) nodules. Cancer likelihood was higher in GGO nodules than in solid nodules (p<0.01). Fifteen of 23 cancers occurred in high-risk group and 8 in low-risk group (p=0.215). Therefore, LDCT screening help detect early stage of lung cancer in asymptomatic Korean population with detection rate of 0.36% on a population basis and may be useful for discovering early lung cancer in low-risk group as well as in high-risk group.

Blunted neural response to anticipation, effort and consummation of reward and aversion in adolescents with depression symptomatology.

PubMed

Rzepa, Ewelina; Fisk, Jennifer; McCabe, Ciara

2017-03-01

Neural reward function has been proposed as a possible biomarker for depression. However, how the neural response to reward and aversion might differ in young adolescents with current symptoms of depression is as yet unclear. Thirty-three adolescents were recruited, 17 scoring low on the Mood and Feelings Questionnaire (low risk group) and 16 scoring high (high risk group). Our functional magnetic resonance imaging task measured; anticipation (pleasant/unpleasant cue), effort (achieve a pleasant taste or avoid an unpleasant taste) and consummation (pleasant/unpleasant tastes) in regions of interest; ventral medial prefrontal cortex, pregenual cingulate cortex, the insula and ventral striatum. We also examined whole brain group differences. In the regions of interest analysis we found reduced activity in the high risk group in the pregenual cingulate cortex during anticipation and reduced pregenual cingulate cortex and ventral medial prefrontal cortex during effort and consummation. In the whole brain analysis we also found reduced activity in the high risk group in the prefrontal cortex and the precuneus during anticipation. We found reduced activity in the hippocampus during the effort phase and in the anterior cingulate/frontal pole during consummation in the high risk group. Increased anhedonia measures correlated with decreased pregenual cingulate cortex activity during consummation in the high risk group only. Our results are the first to show that adolescents with depression symptoms have blunted neural responses during the anticipation, effort and consummation of rewarding and aversive stimuli. This study suggests that interventions in young people at risk of depression, that can reverse blunted responses, might be beneficial as preventative strategies.

Fibrinogen-thrombin collagen patch reinforcement of high-risk colonic anastomoses in rats

PubMed Central

Suárez-Grau, Juan Manuel; Bernardos García, Carlos; Cepeda Franco, Carmen; Mendez García, Cristina; García Ruiz, Salud; Docobo Durantez, Fernando; Morales-Conde, Salvador; Padillo Ruiz, Javier

2016-01-01

AIM To evaluate the effectiveness of human fibrinogen-thrombin collagen patch (TachoSil®) in the reinforcement of high-risk colon anastomoses. METHODS A quasi-experimental study was conducted in Wistar rats (n = 56) that all underwent high-risk anastomoses (anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group (24 rats) and treatment group (24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil® (a piece of TachoSil® was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil® group and control group, respectively (P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage (P > 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups (P = 0.066). CONCLUSION In our study, the use of TachoSil® was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil® has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions. PMID:27721926

Salivary progesterone and cervical length measurement as predictors of spontaneous preterm birth.

PubMed

Maged, Ahmed M; Mohesen, Mohamed; Elhalwagy, Ahmed; Abdelhafiz, Ali

2015-07-01

To evaluate the efficacy of salivary progesterone, cervical length measurement in predicting preterm birth (PTB). Prospective observational study included 240 pregnant women with gestational age (GA) 26-34 weeks classified into two equal groups; group one are high risk for PTB (those with symptoms of uterine contractions or history of one or more spontaneous preterm delivery or second trimester abortion) and group 2 are controls. There was a highly significant difference between the two study groups regarding GA at delivery (31.3 ± 3.75 in high risk versus 38.5 ± 1.3 in control), cervical length measured by transvaginal ultrasound (24.7 ± 8.6 in high risk versus 40.1 ± 4.67 in control) and salivary progesterone level (728.9 ± 222.3 in high risk versus 1099.9 ± 189.4 in control; p < 0.001). There was a statistically significant difference between levels of salivary progesterone at different GA among the high risk group (p value 0.035) but not in low risk group (p value 0.492). CL measurement showed a sensitivity of 71.5% with 100% specificity, 100% PPV, 69.97% NPV and accuracy of 83%, while salivary progesterone showed a sensitivity of 84% with 90% specificity, 89.8% PPV, 85.9% NPV and accuracy of 92.2%. The measurement of both salivary progesterone and cervical length are good predictors for development of PTB.

[Relationship between Ghrelin polymorphism and serum lipoprotein levels in Han Chinese with or without coronary heart disease risk factors].

PubMed

Xie, Xuan; Zhang, Jing; Wang, Yu-huan; Wang, Jun-hong; Zhang, Chun-hong; Ni, Hong-yan; Yuan, Xiao-hong

2008-04-01

To investigate the relationship between polymorphism of Ghrelin gene and serum levels of lipoprotein in Han Chinese with or without coronary heart disease (CHD) risk factors. PCR restriction fragment length polymorphism assay was used to detect the distribution of genotypes of Ghrelin gene in 225 Han Chinese (40 to 69 years-old) with CHD risk factors, 78 subjects without CHD risk factors served as normal controls. Serum levels of total cholesterol (TC), triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C) and very low-density lipoprotein (VLDL) were measured to analyze the relationship with the polymorphism of Ghrelin gene. Ghrelin genotype frequencies of AA, AG, GG (0.975, 0.025, 0.00 in control group and 0.956, 0.040, 0.004 in the high-risk group, all P > 0.05) as well as the allele frequencies of A, G (0.987, 0.013 in control group and 0.976, 0.024 in the high-risk group, all P > 0.05) were similar between the groups. HDL-C levels of the Arg/Gln carriers were significantly lower than those of Arg/Arg carriers in control group and in the high-risk group (all P < 0.05). Arg/Gln carriers were associated lower HDL-C levels in Han Chinese.

The risk typology of healthcare access and its association with unmet healthcare needs in Asian Americans.

PubMed

Jang, Yuri; Park, Nan Sook; Yoon, Hyunwoo; Huang, Ya-Ching; Rhee, Min-Kyoung; Chiriboga, David A; Kim, Miyong T

2018-01-01

Using data from the 2015 Asian American Quality of Life Survey (N = 2,609), latent profile analysis was conducted on general (health insurance, usual place for care and income) and immigrant-specific (nativity, length of stay in the U.S., English proficiency and acculturation) risk factors of healthcare access. Latent profile analysis identified a three-cluster model (low-risk, moderate-risk and high-risk groups). Compared with the low-risk group, the odds of having an unmet healthcare need was 1.52 times greater in the moderate-risk group and 2.24 times greater in the high-risk group. Challenging the myth of model minority, the present sample of Asian Americans demonstrates its vulnerability in access to healthcare. Findings also show the heterogeneity in healthcare access risk profiles. © 2017 John Wiley & Sons Ltd.

Illness, at-risk and resilience neural markers of early-stage bipolar disorder.

PubMed

Lin, Kangguang; Shao, Robin; Geng, Xiujuan; Chen, Kun; Lu, Rui; Gao, Yanling; Bi, Yanan; Lu, Weicong; Guan, Lijie; Kong, Jiehua; Xu, Guiyun; So, Kwok-Fai

2018-05-21

Current knowledge on objective and specific neural markers for bipolar risk and resilience-related processes is lacking, partly due to not subdividing high-risk individuals manifesting different levels of subclinical symptoms who possibly possess different levels of resilience. We delineated grey matter markers for bipolar illness, genetic high risk (endophenotype) and resilience, through comparing across 42 young non-comorbid bipolar patients, 42 healthy controls, and 72 diagnosis-free, medication-naive high-genetic-risk individuals subdivided into a combined-high-risk group who additionally manifested bipolar risk-relevant subsyndromes (N = 38), and an asymptomatic high-risk group (N = 34). Complementary analyses assessed the additional predictive and classification values of grey matter markers beyond those of clinical scores, through using logistic regression and support vector machine analyses. Illness-related effects manifested as reduced grey matter volumes of bilateral temporal limbic-striatal and cerebellar regions, which significantly differentiated bipolar patients from healthy controls and improved clinical classification specificity by 20%. Reduced bilateral cerebellar grey matter volume emerged as a potential endophenotype and (along with parieto-occipital grey matter changes) separated combined-high-risk individuals from healthy and high-risk individuals, and increased clinical classification specificity by approximately 10% and 27%, respectively, while the relatively normalized cerebellar grey matter volumes in the high-risk sample may confer resilience. The cross-validation procedure was not performed on an independent sample using independently-derived features. The BD group had different age and sex distributions than some other groups which may not be fully addressable statistically. Our framework can be applied in other measurement domains to derive complete profiles for bipolar patients and at-risk individuals, towards forming strategies for promoting resilience and preclinical intervention. Copyright © 2018 Elsevier B.V. All rights reserved.

Relationship Between Wind Instrument Playing Habits and Symptoms of Temporomandibular Disorders in Non-Professional Musicians.

PubMed

Nishiyama, Akira; Tsuchida, Erisa

2016-01-01

In this study, we focused on the habits of wind instrumentalists as well as the presence of playing instruments, and investigated associations between the risk of temporomandibular disorders (TMD) and playing wind instruments in non-professional musicians. Seventy-two non-professional players of wind instruments (instrument group) (mean(SD), 20.0(1.1) y; 42 women) and 66 non-players (control group) (22.0(2.6) y; 45 women) participated in this study. Factors were investigated using questionnaires (a screening questionnaire for TMD, instrument playing habits, years of experience, and time played per day). The prevalence of a high risk of TMD was not significantly different between the instrument group (29.2%) and control group (21.2%). In the instrument group, the frequency of subjects who felt mouthpiece pressure in the high risk of TMD group (47.6%) was significantly greater than that in the low risk of TMD group (21.6%). Mouthpiece pressure was found to be a significant factor contributing to a high risk of TMD (odds ratio, 3.31; 95% CI, 1.12-9.79). This study suggests that pressure from the mouthpiece was one of the contributing factors related to a high risk of TMD in non-professional wind instrument players.

Cannabis use in children with individualized risk profiles: Predicting the effect of universal prevention intervention.

PubMed

Miovský, Michal; Vonkova, Hana; Čablová, Lenka; Gabrhelík, Roman

2015-11-01

To study the effect of a universal prevention intervention targeting cannabis use in individual children with different risk profiles. A school-based randomized controlled prevention trial was conducted over a period of 33 months (n=1874 sixth-graders, baseline mean age 11.82). We used a two-level random intercept logistic model for panel data to predict the probabilities of cannabis use for each child. Specifically, we used eight risk/protective factors to characterize each child and then predicted two probabilities of cannabis use for each child if the child had the intervention or not. Using the two probabilities, we calculated the absolute and relative effect of the intervention for each child. According to the two probabilities, we also divided the sample into a low-risk group (the quarter of the children with the lowest probabilities), a moderate-risk group, and a high-risk group (the quarter of the children with the highest probabilities) and showed the average effect of the intervention on these groups. The differences between the intervention group and the control group were statistically significant in each risk group. The average predicted probabilities of cannabis use for a child from the low-risk group were 4.3% if the child had the intervention and 6.53% if no intervention was provided. The corresponding probabilities for a child from the moderate-risk group were 10.91% and 15.34% and for a child from the high-risk group 25.51% and 32.61%. School grades, thoughts of hurting oneself, and breaking the rules were the three most important factors distinguishing high-risk and low-risk children. We predicted the effect of the intervention on individual children, characterized by their risk/protective factors. The predicted absolute effect and relative effect of any intervention for any selected risk/protective profile of a given child may be utilized in both prevention practice and research. Copyright © 2015 Elsevier Ltd. All rights reserved.

Risk perception and choice of place of birth in women with high risk pregnancies: A qualitative study.

PubMed

Lee, Suzanne; Ayers, Susan; Holden, Des

2016-07-01

Objective To examine the perception of risk among a group of women with high risk pregnancies who were either planning to give birth in hospital, or at home despite medical advice to the contrary. The intention was to consider differences and similarities between the groups to examine how perception of risk relates to choice of place of birth. Design Qualitative study using semi-structured interviews. Setting Maternity department in a hospital in South East England. Participants Twenty-six women with high risk pregnancies, at least 32 weeks pregnant. Half were planning hospital births and half homebirths. Measurements and findings Semi-structured interviews to investigate women's understanding and assessment of risk. Results were analysed using thematic analysis. Five themes emerged: understanding of situation; judgement of risk; reassuring factors; impact of risk; and coping with risk. Women from both groups had some understanding of the implications of their medical/obstetric conditions. They displayed concerns about their babies' wellbeing. Women planning homebirths assessed their risks as lower and expressed less concerns than women planning hospital births. Women planning hospital births more frequently described following professional advice. Key conclusions Risk perception is individual and subjective. Women with high risk pregnancies who plan to give birth at home perceive risk differently to women who plan hospital births. Implications for practice Healthcare professionals working with women with high risk pregnancies should be aware of the potential for differences in definitions and perceptions of risk within this group. Copyright © 2016 Elsevier Ltd. All rights reserved.

Antisocial Behavior and Victimization Over 2-Year Follow-Up in Subgroups of Childhood Arrestees.

PubMed

van Domburgh, Lieke; Geluk, Charlotte; Jansen, Lucres; Vermeiren, Robert; Doreleijers, Theo

2016-10-01

Not only are childhood onset offenders at high risk of becoming serious persistent offenders, they are also at high risk of becoming victimized themselves. Furthermore, studies in the general population suggest that a combined perpetrator-victim group can be distinguished from a perpetrator-only and a victim-only group on individual and family risk factors. The current study investigated the co-occurrence of offending and victimization among first-time arrestees and the 2-year predictive value of previously found clusters of dynamic risk factors of offending. Childhood first-time arrestees ( N = 308; M age = 10.3, SD = 1.45) were clustered into three groups based on dynamic risk factors of offending in the individual, peer, school, and family domains: a pervasive high, an externalizing intermediate, and a low problem group. Police records and self-report data on re-offending and victimization of these children were collected over a 2-year follow-up period. Compared with the low problem group, the prevalence of re-offending was higher in both the externalizing intermediate group and the pervasive high group. The pervasive high group was most likely to display co-occurring future antisocial behavior and victimization. These findings emphasize that attention should be paid to victimization in addition to future antisocial behavior, especially if additional internalizing and family problems are present. Furthermore, the differences in re-offending and victimization between subgroups of childhood onset offenders stress the need for specific interventions tailored to the risk profile of a child.

Reduction of travellers' diarrhoea by WC/rBS oral cholera vaccine in young, high-risk travellers.

PubMed

Torrell, Josep Ma Ramon; Aumatell, Cristina Masuet; Ramos, Sergi Morchon; Mestre, Laura Gavaldà; Salas, Carme Micheo

2009-06-19

A bidirectional cohort study investigates whether pre-travel vaccination with whole cell/recombinant B subunit inactivated, killed oral cholera vaccine reduces the incidence of diarrhoea in young adult travellers to high-risk areas. Risk of travellers' diarrhoea was assessed according to destination and reason for travel in high-risk travellers of a travel clinic in Barcelona, Spain. Those at high-risk between January and December 2005 were advised on water/food safety and hygiene. High-risk travellers between January and December 2006 were additionally vaccinated with WC/rBS oral cholera vaccine. Data regarding diarrhoea were gathered by structured telephone interview or e-mailed questionnaire following the travellers' return. The incidence of diarrhoea in the group vaccinated with WC/rBS oral cholera vaccine (n=321) was 17.4%, compared with 39.7% in the non-vaccinated group (n=337) (adjusted risk ratio 0.40). The first episode was significantly shorter in the vaccinated group (mean 2.3 days) than in the non-vaccinated group (mean 3.8 days) (p<0.001). The protective effect of the WC/rBS oral cholera vaccine was 57% in the young, high-risk travellers. Vaccination with the WC/rBS oral cholera vaccine as well as food safety and hygiene advice could offer effective means of reducing the risk of diarrhoea while abroad.

Association of spiritual/religious coping with depressive symptoms in high- and low-risk pregnant women.

PubMed

Vitorino, Luciano M; Chiaradia, Raíssa; Low, Gail; Cruz, Jonas Preposi; Pargament, Kenneth I; Lucchetti, Alessandra L G; Lucchetti, Giancarlo

2018-02-01

To investigate the role of spiritual/religious coping (SRC) on depressive symptoms in high- and low-risk pregnant women. Spiritual/religious coping is associated with physical and mental health outcomes. However, only few studies investigated the role of these strategies during pregnancy and whether low- and high-risk pregnant women have different coping mechanisms. This study is a cross-sectional comparative study. This study included a total of 160 pregnant women, 80 with low-risk pregnancy and 80 with high-risk pregnancy. The Beck Depression Inventory, the brief SRC scale and a structured questionnaire on sociodemographic and obstetric aspects were used. General linear model regression analysis was used to identify the factors associated with positive and negative SRC strategies in both groups of pregnant women. Positive SRC use was high, whereas negative SRC use was low in both groups. Although we found no difference in SRC strategies between the two groups, negative SRC was associated with depression in women with high-risk pregnancy, but not in those with low-risk pregnancy. Furthermore, positive SRC was not associated with depressive symptoms in both groups. Results showed that only the negative SRC strategies of Brazilian women with high-risk pregnancies were associated with worsened mental health outcomes. Healthcare professionals, obstetricians and nurse midwives should focus on the use of negative SRC strategies in their pregnant patients. © 2017 John Wiley & Sons Ltd.

Early sex differences are not autism-specific: A Baby Siblings Research Consortium (BSRC) study.

PubMed

Messinger, Daniel S; Young, Gregory S; Webb, Sara Jane; Ozonoff, Sally; Bryson, Susan E; Carter, Alice; Carver, Leslie; Charman, Tony; Chawarska, Katarzyna; Curtin, Suzanne; Dobkins, Karen; Hertz-Picciotto, Irva; Hutman, Ted; Iverson, Jana M; Landa, Rebecca; Nelson, Charles A; Stone, Wendy L; Tager-Flusberg, Helen; Zwaigenbaum, Lonnie

2015-01-01

The increased male prevalence of autism spectrum disorder (ASD) may be mirrored by the early emergence of sex differences in ASD symptoms and cognitive functioning. The female protective effect hypothesis posits that ASD recurrence and symptoms will be higher among relatives of female probands. This study examined sex differences and sex of proband differences in ASD outcome and in the development of ASD symptoms and cognitive functioning among the high-risk younger siblings of ASD probands and low-risk children. Prior to 18 months of age, 1824 infants (1241 high-risk siblings, 583 low-risk) from 15 sites were recruited. Hierarchical generalized linear model (HGLM) analyses of younger sibling and proband sex differences in ASD recurrence among high-risk siblings were followed by HGLM analyses of sex differences and group differences (high-risk ASD, high-risk non-ASD, and low-risk) on the Mullen Scales of Early Learning (MSEL) subscales (Expressive and Receptive Language, Fine Motor, and Visual Reception) at 18, 24, and 36 months and Autism Diagnostic Observation Schedule (ADOS) domain scores (social affect (SA) and restricted and repetitive behaviors (RRB)) at 24 and 36 months. Of 1241 high-risk siblings, 252 had ASD outcomes. Male recurrence was 26.7 % and female recurrence 10.3 %, with a 3.18 odds ratio. The HR-ASD group had lower MSEL subscale scores and higher RRB and SA scores than the HR non-ASD group, which had lower MSEL subscale scores and higher RRB scores than the LR group. Regardless of group, males obtained lower MSEL subscale scores, and higher ADOS RRB scores, than females. There were, however, no significant interactions between sex and group on either the MSEL or ADOS. Proband sex did not affect ASD outcome, MSEL subscale, or ADOS domain scores. A 3.2:1 male:female odds ratio emerged among a large sample of prospectively followed high-risk siblings. Sex differences in cognitive performance and repetitive behaviors were apparent not only in high-risk children with ASD, but also in high-risk children without ASD and in low-risk children. Sex differences in young children with ASD do not appear to be ASD-specific but instead reflect typically occurring sex differences seen in children without ASD. Results did not support a female protective effect hypothesis.

Personality prototype as a risk factor for eating disorders.

PubMed

Sanchez-Guarnido, Antonio J; Pino-Osuna, Maria J; Herruzo-Cabrera, Francisco J

2015-01-01

To establish whether the risk of suffering from an eating disorder (ED) is associated with the high-functioning, undercontrolled, or overcontrolled personality prototype groups. The Revised NEO Personality Inventory (NEO-PI-R) and the Eating Disorder Inventory 2 (EDI-2) were administered to 69 patients diagnosed as suffering from EDs (cases) and 89 people free of any ED symptoms (control group). A cluster analysis was carried out to divide the participants into three groups based on their scores in the Big Five personality dimensions. A logistic regression model was then created. Participants in the undercontrolled group had a risk of suffering from an ED 6.517 times higher than those in the high-functioning group (p = 0.019; odds ratio [OR] = 6.517), while those in the overcontrolled subgroup had a risk of ED 15.972 times higher than those in the high-functioning group. Two personality subtypes were identified in which the risk of EDs was six times higher (the undercontrolled group) and almost 16 times higher (the overcontrolled group). Prevention and treatment programs for ED could benefit from focusing on the abovementioned personality profiles.

Decision Tree Identified Risk Groups with High Suicidal Ideation in South Korea: A Population-Based Study.

PubMed

Kim, Hyun Kyung; Kim, Ji Young; Kim, Jong Hyen; Hyoung, Hee Kyoung

2016-01-01

The aim of this study was to identify risk groups with high suicidal ideation among South Korean adults. A descriptive cross-sectional design was adopted using secondary data from the 2011 Korea National Health and Nutrition Examination Survey (KNHANES). A total of 5,963 adults aged 19 years and older who participated in the 2011 KNHANES served as participants. The prevalence of suicidal ideation and its related factors, including physical, psychological, health behavioral, and sociodemographic characteristics, were examined. Descriptive statistics and a decision tree were used for data analysis. Nine groups with high suicidal ideation were identified. The coexistence of depression and high levels of stress increased the prevalence of suicidal ideation. The highest risk group was widowed or divorced adults with depression and high levels of stress, and 82.5% of these participants had suicidal ideation (the prevalence rate of this group was 5.7 times higher than the mean suicidal ideation prevalence rate in this study). Public health nurses and community mental health professionals should recognize risk groups with high suicidal ideation, and target these groups when implementing preventive interventions. © 2015 Wiley Periodicals, Inc.

Metabolic Syndrome Risk Profiles Among African American Adolescents

PubMed Central

Fitzpatrick, Stephanie L.; Lai, Betty S.; Brancati, Frederick L.; Golden, Sherita H.; Hill-Briggs, Felicia

2013-01-01

OBJECTIVE Although African American adolescents have the highest prevalence of obesity, they have the lowest prevalence of metabolic syndrome across all definitions used in previous research. To address this paradox, we sought to develop a model of the metabolic syndrome specific to African American adolescents. RESEARCH DESIGN AND METHODS Data from the National Health and Nutrition Examination Survey (2003–2010) of 822 nonpregnant, nondiabetic, African American adolescents (45% girls; aged 12 to 17 years) who underwent physical examinations and fasted at least 8 h were analyzed. We conducted a confirmatory factor analysis to model metabolic syndrome and then used latent profile analysis to identify metabolic syndrome risk groups among African American adolescents. We compared the risk groups on probability of prediabetes. RESULTS The best-fitting metabolic syndrome model consisted of waist circumference, fasting insulin, HDL, and systolic blood pressure. We identified three metabolic syndrome risk groups: low, moderate, and high risk (19% boys; 16% girls). Thirty-five percent of both boys and girls in the high-risk groups had prediabetes, a significantly higher prevalence compared with boys and girls in the low-risk groups. Among adolescents with BMI higher than the 85th percentile, 48 and 36% of boys and girls, respectively, were in the high-risk group. CONCLUSIONS Our findings provide a plausible model of the metabolic syndrome specific to African American adolescents. Based on this model, approximately 19 and 16% of African American boys and girls, respectively, are at high risk for having the metabolic syndrome. PMID:23093663

[Selective preimplantation pathological evaluation in renal transplantation: a single center's experience].

PubMed

Peng, F H; Chen, J J; Peng, L K; Xie, X B; Lan, G B; Yu, S J; Wang, Y; Tang, X T; Dai, H L; Gao, C; Fang, C H

2018-01-16

Objective: To summarize the clinical data of pre-implantation biopsy donors in our hospital and explore the clinical characteristics of those donors in pathological high-risk, and to provide references for the selective histological evaluation of extended criteria donor kidneys. Methods: We retrospectively reviewed the clinical data and pre-implantation renal pathologic score of donors from January 1, 2015 to May 1, 2017.During this period, 247 cases of donation after citizen's death (DCD) occurred.After clinical evaluation and selective machine perfusion( Lifeport) evaluation, 30 cases of pre-implantation pathological evaluation were performed.According to Remuzzi scores, donors were divided into low-risk and high-risk group.Nine cases of low-risk group (bilateral kidney's Remuzzi score ≤3) and 16 cases of high-risk group (bilateral or unilateral kidney's Remuzzi score ≥4, severe glomerular micro-thrombi or severe tubular necrosis) were included.Five cases of donors were excluded due to only unilateral renal pathological result available.Both high-risk and low-risk groups' clinical data, including sex, age, height, body weight, body mass index, proteinuria, hematuria, urinary glucose, baseline or admission serum creatinine, serum creatinine before procurement, history of hypertension and/or diabetes mellitus, cardiopulmonary resuscitation or not, with or without the history of shock, urine output prior to acquisition, macroscopical manifestations of donor kidney, cause of death were statistically analyzed. Results: The donors' baseline serum creatinine/upper limit of normal serum creatinine range in high-risk group were significantly higher than that in low-risk group [(129.8±42.2)% vs(92.4±30.5)%, P =0.029]. The poor macroscopical manifestations of donor kidneys were significantly more frequent in high-risk group than that in low-risk group (12/16 vs 0/9, P = 0). No significant differences between two groups were found regarding their age, height, weight, BMI, proteinuria, hematuria, urine glucose, pre-procure creatinine level, history of hypertension and/or diabetes mellitus, cause of death and so on ( P >0.05). Conclusions: After clinical evaluation and selective Lifeport evaluation, donor grafts of whose baseline serum creatinine levels increased beyond normal range and of whose grafts' macroscopical manifestations were poor, should undergo pre-implantation pathological evaluation further.Also, it is reasonable to perform pre-implantation biopsy in cases of equivocal results after Lifeport evaluation.This will be beneficial to identify histological high-risk donors and also be predictive to allocate the grafts.

Assessment of Occupational Health and Safety for a Gas Meter Manufacturing Plant

NASA Astrophysics Data System (ADS)

Korkmaz, Ece; Iskender, Gulen; Germirli Babuna, Fatos

2016-10-01

This study investigates the occupational health and safety for a gas meter manufacturing plant. The risk assessment and management study is applied to plastic injection and mounting departments of the factory through quantitative Fine Kinney method and the effect of adopting 5S workplace organization procedure on risk assessment is examined. The risk assessment reveals that there are 17 risks involved; 14 grouped in high risk class (immediate improvement as required action); 2 in significant (measures to be taken as required action) and one in possible risk class (monitoring as required action). Among 14 high risks, 4 can be reduced by 83 % to be grouped under possible class when 5S is applied. One significant risk is observed to be lowered by 78 % and considered as possible risk due to the application of 5S. As a result of either 67 or 50 % reductions in 7 high risks, these risks are converted to be members of significant risk group after 5S implications.

From palmistry to anthropometry: can 2nd to 4th digit length (2D:4D) predict the risk of prostate cancer?

PubMed

Salomão, Layla; Figueiredo, Rui Teófilo; Oliveira Santos, Rafael; Damião, Ronaldo; da Silva, Eloisio Alexsandro

2014-01-01

The 2nd to 4th digit length (2D:4D) is inversely related to androgen exposure during the fetal period, which may represent a risk factor for several steroid-related diseases. We aimed to evaluate the relationship between 2D:4D ratio and the risk of developing prostate cancer (PCa). We assessed the 2D:4D ratio of 474 men >40 years old, stratified into three groups: group 1 (n = 222) patients with PCa, group 2 (n = 82) subjects with high risk of PCa, and group 3 (n = 170) men with low risk of PCa. Subjects were submitted to a digital picture of the ventral surface of the right hand and 2nd and 4th fingers measurements were determined by the distance from the proximal crease to the tip using computer-assisted analysis. The mean serum prostate-specific antigen level was 7.5 ng/ml in the high-risk group and 0.92 ng/ml in the low-risk group (p < 0.05). The mean 2D:4D ratios were 0.96 ± 0.04, 0.97 ± 0.04 and 0.96 ± 0.04 for the PCa, high-risk and low-risk groups, respectively, and no difference was found among the three groups (p = 0.12). Anthropometry of the hand using the 2D:4D ratio is not a predictor of PCa. 2013 S. Karger AG, Basel.

Teaching Art to High Risk Groups.

ERIC Educational Resources Information Center

Rossol, Monona

The role of art therapy is considered in working with such high risk groups as the institutionalized, mentally retarded, elderly, visually impaired, physically handicapped, asthmatic, hyper- and hypo-active children, hearing impaired, and patients on mind altering drugs. The special risks of infectious diseases (such as serum hepatitis), and…

Efficacy Trial of a Brief Cognitive-Behavioral Depression Prevention Program for High-Risk Adolescents: Effects at 1- and 2-Year Follow-Up

ERIC Educational Resources Information Center

Stice, Eric; Rohde, Paul; Gau, Jeff M.; Wade, Emily

2010-01-01

Objective: To evaluate the effects of a brief group cognitive-behavioral (CB) depression prevention program for high-risk adolescents with elevated depressive symptoms at 1- and 2-year follow-up. Method: In this indicated prevention trial, 341 at-risk youths were randomized to a group CB intervention, group supportive expressive intervention, CB…

Infective Endocarditis in Patients With Bicuspid Aortic Valve or Mitral Valve Prolapse.

PubMed

Zegri-Reiriz, Isabel; de Alarcón, Arístides; Muñoz, Patricia; Martínez Sellés, Manuel; González-Ramallo, Victor; Miro, Jose M; Falces, Carles; Gonzalez Rico, Claudia; Kortajarena Urkola, Xabier; Lepe, José Antonio; Rodriguez Alvarez, Regino; Reguera Iglesias, Jose Maria; Navas, Enrique; Dominguez, Fernando; Garcia-Pavia, Pablo

2018-06-19

There is little information concerning infective endocarditis (IE) in patients with bicuspid aortic valve (BAV) or mitral valve prolapse (MVP). Currently, IE antibiotic prophylaxis (IEAP) is not recommended for these conditions. This study sought to describe the clinical and microbiological features of IE in patients with BAV and MVP and compare them with those of IE patients with and without IEAP indication, to determine the potential benefit of IEAP in these conditions. This analysis involved 3,208 consecutive IE patients prospectively included in the GAMES (Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España) registry at 31 Spanish hospitals. Patients were classified as high-risk IE with IEAP indication (high-risk group; n = 1,226), low- and moderate-risk IE without IEAP indication (low/moderate-risk group; n = 1,839), and IE with BAV (n = 54) or MVP (n = 89). BAV and MVP patients had a higher incidence of viridans group streptococci IE than did high-risk group and low/moderate-risk group patients (35.2% and 39.3% vs. 12.1% and 15.0%, respectively; all p < 0.01). A similar pattern was seen for IE from suspected odontologic origin (14.8% and 18.0% vs. 5.8% and 6.0%; all p < 0.01). BAV and MVP patients had more intracardiac complications than did low/moderate-risk group (50% and 47.2% vs. 30.6%, both p < 0.01) patients and were similar to high-risk group patients. IE in patients with BAV and MVP have higher rates of viridans group streptococci IE and IE from suspected odontologic origin than in other IE patients, with a clinical profile similar to that of high-risk IE patients. Our findings suggest that BAV and MVP should be classified as high-risk IE conditions and the case for IEAP should be reconsidered. Copyright © 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Early somatosensory processing in individuals at risk for developing psychoses.

PubMed

Hagenmuller, Florence; Heekeren, Karsten; Theodoridou, Anastasia; Walitza, Susanne; Haker, Helene; Rössler, Wulf; Kawohl, Wolfram

2014-01-01

Human cortical somatosensory evoked potentials (SEPs) allow an accurate investigation of thalamocortical and early cortical processing. SEPs reveal a burst of superimposed early (N20) high-frequency oscillations around 600 Hz. Previous studies reported alterations of SEPs in patients with schizophrenia. This study addresses the question whether those alterations are also observable in populations at risk for developing schizophrenia or bipolar disorders. To our knowledge to date, this is the first study investigating SEPs in a population at risk for developing psychoses. Median nerve SEPs were investigated using multichannel EEG in individuals at risk for developing bipolar disorders (n = 25), individuals with high-risk status (n = 59) and ultra-high-risk status for schizophrenia (n = 73) and a gender and age-matched control group (n = 45). Strengths and latencies of low- and high-frequency components as estimated by dipole source analysis were compared between groups. Low- and high-frequency source activity was reduced in both groups at risk for schizophrenia, in comparison to the group at risk for bipolar disorders. HFO amplitudes were also significant reduced in subjects with high-risk status for schizophrenia compared to healthy controls. These differences were accentuated among cannabis non-users. Reduced N20 source strengths were related to higher positive symptom load. These results suggest that the risk for schizophrenia, in contrast to bipolar disorders, may involve an impairment of early cerebral somatosensory processing. Neurophysiologic alterations in schizophrenia precede the onset of initial psychotic episode and may serve as indicator of vulnerability for developing schizophrenia.

Early somatosensory processing in individuals at risk for developing psychoses

PubMed Central

Hagenmuller, Florence; Heekeren, Karsten; Theodoridou, Anastasia; Walitza, Susanne; Haker, Helene; Rössler, Wulf; Kawohl, Wolfram

2014-01-01

Human cortical somatosensory evoked potentials (SEPs) allow an accurate investigation of thalamocortical and early cortical processing. SEPs reveal a burst of superimposed early (N20) high-frequency oscillations around 600 Hz. Previous studies reported alterations of SEPs in patients with schizophrenia. This study addresses the question whether those alterations are also observable in populations at risk for developing schizophrenia or bipolar disorders. To our knowledge to date, this is the first study investigating SEPs in a population at risk for developing psychoses. Median nerve SEPs were investigated using multichannel EEG in individuals at risk for developing bipolar disorders (n = 25), individuals with high-risk status (n = 59) and ultra-high-risk status for schizophrenia (n = 73) and a gender and age-matched control group (n = 45). Strengths and latencies of low- and high-frequency components as estimated by dipole source analysis were compared between groups. Low- and high-frequency source activity was reduced in both groups at risk for schizophrenia, in comparison to the group at risk for bipolar disorders. HFO amplitudes were also significant reduced in subjects with high-risk status for schizophrenia compared to healthy controls. These differences were accentuated among cannabis non-users. Reduced N20 source strengths were related to higher positive symptom load. These results suggest that the risk for schizophrenia, in contrast to bipolar disorders, may involve an impairment of early cerebral somatosensory processing. Neurophysiologic alterations in schizophrenia precede the onset of initial psychotic episode and may serve as indicator of vulnerability for developing schizophrenia. PMID:25309363

Risk stratification of childhood medulloblastoma in the molecular era: the current consensus.

PubMed

Ramaswamy, Vijay; Remke, Marc; Bouffet, Eric; Bailey, Simon; Clifford, Steven C; Doz, Francois; Kool, Marcel; Dufour, Christelle; Vassal, Gilles; Milde, Till; Witt, Olaf; von Hoff, Katja; Pietsch, Torsten; Northcott, Paul A; Gajjar, Amar; Robinson, Giles W; Padovani, Laetitia; André, Nicolas; Massimino, Maura; Pizer, Barry; Packer, Roger; Rutkowski, Stefan; Pfister, Stefan M; Taylor, Michael D; Pomeroy, Scott L

2016-06-01

Historical risk stratification criteria for medulloblastoma rely primarily on clinicopathological variables pertaining to age, presence of metastases, extent of resection, histological subtypes and in some instances individual genetic aberrations such as MYC and MYCN amplification. In 2010, an international panel of experts established consensus defining four main subgroups of medulloblastoma (WNT, SHH, Group 3 and Group 4) delineated by transcriptional profiling. This has led to the current generation of biomarker-driven clinical trials assigning WNT tumors to a favorable prognosis group in addition to clinicopathological criteria including MYC and MYCN gene amplifications. However, outcome prediction of non-WNT subgroups is a challenge due to inconsistent survival reports. In 2015, a consensus conference was convened in Heidelberg with the objective to further refine the risk stratification in the context of subgroups and agree on a definition of risk groups of non-infant, childhood medulloblastoma (ages 3-17). Published and unpublished data over the past 5 years were reviewed, and a consensus was reached regarding the level of evidence for currently available biomarkers. The following risk groups were defined based on current survival rates: low risk (>90 % survival), average (standard) risk (75-90 % survival), high risk (50-75 % survival) and very high risk (<50 % survival) disease. The WNT subgroup and non-metastatic Group 4 tumors with whole chromosome 11 loss or whole chromosome 17 gain were recognized as low-risk tumors that may qualify for reduced therapy. High-risk strata were defined as patients with metastatic SHH or Group 4 tumors, or MYCN-amplified SHH medulloblastomas. Very high-risk patients are Group 3 with metastases or SHH with TP53 mutation. In addition, a number of consensus points were reached that should be standardized across future clinical trials. Although we anticipate new data will emerge from currently ongoing and recently completed clinical trials, this consensus can serve as an outline for prioritization of certain molecular subsets of tumors to define and validate risk groups as a basis for future clinical trials.

Risk stratification of childhood medulloblastoma in the molecular era: The Current Consensus

PubMed Central

Ramaswamy, Vijay; Remke, Marc; Bouffet, Eric; Bailey, Simon; Clifford, Steven C.; Doz, Francois; Kool, Marcel; Dufour, Christelle; Vassal, Gilles; Milde, Till; Witt, Olaf; von Hoff, Katja; Pietsch, Torsten; Northcott, Paul A.; Gajjar, Amar; Robinson, Giles W.; Padovani, Laetitia; André, Nicolas; Massimino, Maura; Pizer, Barry; Packer, Roger; Rutkowski, Stefan; Pfister, Stefan M.; Taylor, Michael D.; Pomeroy, Scott L.

2016-01-01

Historical risk stratification criteria for medulloblastoma rely primarily on clinicopathological variables pertaining to age, presence of metastases, extent of resection, histological subtypes and in some instances individual genetic aberrations such as MYC and MYCN amplification. In 2010, an international panel of experts established consensus defining four main subgroups of medulloblastoma (WNT, SHH, Group 3 and Group 4) delineated by transcriptional profiling. This has led to the current generation of biomarker-driven clinical trials assigning WNT tumors to a favorable prognosis group in addition to clinicopathological criteria including MYC and MYCN gene amplifications. However, outcome prediction of non-WNT subgroups is a challenge due to inconsistent survival reports. In 2015, a consensus conference was convened in Heidelberg with the objective to further refine the risk stratification in the context of subgroups and agree on a definition of risk groups of non-infant, childhood medulloblastoma (ages 3–17). Published and unpublished data over the past five years were reviewed, and a consensus was reached regarding the level of evidence for currently available biomarkers. The following risk groups were defined based on current survival rates: low risk (>90% survival), average (standard) risk (75–90% survival), high risk (50–75% survival) and very high risk (<50% survival) disease. The WNT subgroup and non-metastatic Group 4 tumors with whole chromosome 11 loss or whole chromosome 17 gain were recognized as low risk tumors that may qualify for reduced therapy. High-risk strata were defined as patients with metastatic SHH or Group 4 tumors, or MYCN amplified SHH medulloblastomas. Very high-risk patients are Group 3 with metastases or SHH with TP53 mutation. In addition, a number of consensus points were reached that should be standardized across future clinical trials. Although we anticipate new data will emerge from currently ongoing and recently completed clinical trials, this consensus can serve as an outline for prioritization of certain molecular subsets of tumors to define and validate risk groups as a basis for future clinical trials. PMID:27040285

De-stigmatising human papillomavirus in the context of cervical cancer: a randomised controlled trial.

PubMed

Kwan, Tracy T C; Tam, Kar-Fai; Lee, Peter W H; Lo, Sue S T; Chan, Karen K L; Ngan, Hextan Y S

2010-12-01

To identify the components of a human papillomavirus (HPV) message contributing to reducing the stigma of HPV in cervical cancer. 294 ethnic Chinese women attending a community-based clinic in Hong Kong were randomly allocated to read one of three written HPV messages: Group 'lr+hrHPV': low-risk and high-risk HPVs facts, Group 'hrHPV': high-risk HPV facts only and Group 'ds+hrHPV': high-risk HPV facts and de-stigmatising components, namely being anti-stereotypical, motivational and low in complexity. Main outcome measures were high-risk HPV-related sexual stigma, knowledge, attitude towards message, and intention to be HPV-tested measured by self-administered questionnaires immediately before and after reading. Message allocation had a significant effect on sexual stigma (F = 5.219, p = 0.006). Participants who read message ds+hrHPV showed the least stigma, and were significantly less likely to believe that high-risk HPV infection implicated promiscuity, non-monogamy or that monogamy offered complete protection against high-risk HPV. The genital HPV-focused message was more stigmatising than cervical cancer-focused messages. Of all participants, 93% (237/254) and 97% (260/269) indicated a positive intention to be HPV-tested before and after reading, respectively. There were no between-group differences noted in terms of knowledge and intention to be HPV-tested before or after reading. Our findings show that an HPV message containing specific de-stigmatising components may reduce public stigma towards high-risk HPV. Also, focusing solely on high-risk HPV in the context of cervical cancer helps to avoid the stigmatising effect of genital warts from tainting perceptions about high-risk HPV infection. Copyright © 2010 John Wiley & Sons, Ltd.

Risk perception and public concerns of electromagnetic waves from cellular phones in Korea.

PubMed

Kim, Kyunghee; Kim, Hae-Joon; Song, Dae Jong; Cho, Yong Min; Choi, Jae Wook

2014-05-01

In this study, the difference between the risk perception of electromagnetic waves from cellular phones and the risk perception of other factors such as environment and food was analyzed. The cause of the difference in the psychological and social factors that affect the group with high risk perception of electromagnetic waves was also analyzed. A questionnaire survey on the risk perception of electromagnetic waves from cellular phones was carried out on 1001 subjects (men and women) over the age of 20. In the group with high risk perception of electromagnetic waves from cellular phones, women had higher risk perception than men. Logistic regression analysis, where the group with high risk perception of electromagnetic waves and the group with low risk perception were used as dependent variables, indicated that the risk perception of electromagnetic waves in women was 1.815 times statistically significantly higher than the risk perception of men (95% CI: 1.340-2.457). Also, high risk perception of electromagnetic waves from cellular phones was observed when the subjects considered that they had more personal knowledge (OR: 1.416, 95% CI: 1.216-1.648), that the seriousness of the risk to future generations was high (OR: 1.410, 95% CI: 1.234-1.611), and their outrage for the occurrence of accidents related to electromagnetic waves was high (OR: 1.460, 95% CI: 1.264-1.686). The results of this study need to be sufficiently considered and reflected in designing the risk communication strategies and communication methods for the preventive measures and advice on electromagnetic waves from cellular phones. © 2014 Wiley Periodicals, Inc.

Influence of Early Intervention on the Social Relationship Between Mother and Infant.

ERIC Educational Resources Information Center

Mills, Pamela Jean

The study was conducted to determine the impact of day care intervention on the relationship between 60 mothers and their infants, 30 infants being at high risk for progressive, developmental retardation. Ss were divided into three groups: the high risk experimental group (HRE), the infants which were in the day care program; the high risk control…

Mid-childhood outcomes of infant siblings at familial high-risk of autism spectrum disorder.

PubMed

Shephard, Elizabeth; Milosavljevic, Bosiljka; Pasco, Greg; Jones, Emily J H; Gliga, Teodora; Happé, Francesca; Johnson, Mark H; Charman, Tony

2017-03-01

Almost 20% of infants with an older sibling with autism spectrum disorder (ASD) exhibit ASD themselves by age 3 years. The longer-term outcomes of high-risk infants are less clear. We examined symptoms of ASD, attention-deficit/hyperactivity disorder (ADHD) and anxiety, language, IQ, and adaptive behaviour at age 7 years in high- and low-risk children prospectively studied since the first year of life. Clinical outcomes were compared between high-risk children who met diagnostic criteria for ASD at age 7 (HR-ASD-7 group, n = 15), high-risk children without ASD (HR-Non-ASD-7 group, n = 24), and low-risk control children (LR group, n = 37). Diagnostic stability between age 3 and 7 years was moderate, with five children who did not meet diagnostic criteria for ASD at age 3 years being assigned the diagnosis at age 7, and three children showing the opposite pattern. The HR-ASD-7 group showed elevated ADHD and anxiety symptoms and had lower adaptive behaviour scores than LR controls. The HR-Non-ASD-7 group had higher repetitive behaviour, lower adaptive functioning and elevated scores on one anxiety subscale (Separation Anxiety) compared to LR controls, but evidence for subclinical ASD symptoms (the broader autism phenotype, BAP) was limited in the group as a whole, although we identified a subgroup with elevated ASD traits. The difficulties experienced by high-risk siblings at school-age extend beyond ASD symptoms. The pattern of difficulties exhibited by the HR-ASD-7 group may inform our understanding of developmental trajectories of co-occurring psychopathology in ASD. Autism Res 2017, 10: 546-557. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

Neoadjuvant luteinizing-hormone-releasing hormone agonist plus low-dose estramustine phosphate improves prostate-specific antigen-free survival in high-risk prostate cancer patients: a propensity score-matched analysis.

PubMed

Koie, Takuya; Mitsuzuka, Koji; Yoneyama, Takahiro; Narita, Shintaro; Kawamura, Sadafumi; Kaiho, Yasuhiro; Tsuchiya, Norihiko; Tochigi, Tatsuo; Habuchi, Tomonori; Arai, Yoichi; Ohyama, Chikara; Yoneyama, Tohru; Tobisawa, Yuki

2015-10-01

The optimal treatment for high-risk prostate cancer (Pca) remains to be established. We previously reported favorable biochemical recurrence-free survival (BRFS) in high-risk Pca patients treated with a neoadjuvant therapy comprising a luteinizing-hormone-releasing hormone (LHRH) agonist plus low dose estramustine phosphate (EMP) (LHRH+EMP) followed by radical prostatectomy (RP). In the present study, we used a retrospective design via propensity score matching to elucidate the clinical benefit of neoadjuvant LHRH+EMP for high-risk Pca. The Michinoku Urological Cancer Study Group database contained data for 1,268 consecutive Pca patients treated with RP alone at 4 institutions between April 2000 and March 2011 (RP alone group). In the RP alone group, we identified 386 high-risk Pca patients. The neoadjuvant LHRH+EMP group included 274 patients with high-risk Pca treated between September 2005 and November 2013 at Hirosaki University. Neoadjuvant LHRH+EMP therapy included LHRH and EMP administration at a dose of 280 mg/day for 6 months before RP. The outcome measures were overall survival (OS) and BRFS. The propensity score-matched analysis indicated 210 matched pairs from both groups. The 5-year BRFS rates were 90.4 and 65.8 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P < 0.0001). The 5-year OS rates were 100 and 96.1 % for the neoadjuvant LHRH+EMP and RP alone groups, respectively (P = 0.110). Although the present study was not randomized, neoadjuvant LHRH+EMP therapy followed by RP appeared to reduce the risk of biochemical recurrence. A prospective randomized study is warranted to determine the clinical implications of the neoadjuvant therapy described here.

[Sexually-transmitted infection in a high-risk group from Montería, Colombia].

PubMed

Alvis, Nelson; Mattar, Salim; Garcia, Jair; Conde, Edwin; Diaz, Alberto

2007-01-01

Identifying the main aetiological agents of sexually transmitted infections (STI) in a high-risk population from the city of Montería, Colombia. The population consisted of 69 sex-workers (high-risk group) and 16 housewives (low-risk group) living in the city of Montería. Specimens were cultured by standard microbiological methods and by the AMPLICOR CT/NG molecular technique. Patients were aged 18-44 (26.1 average age). It was determined that 17,4% of the high-risk population were positive for G. vaginalis, 15,9 % for C. trachomatis, 4,3 % for N. gonorrhoeae and 2,9 % for T. vaginalis and Candida albicans and, in the low-risk population, 56,3 % for G. vaginalis, 12,5 % for C. trachomatis, 6,3 % for N. gonorrhoeae and 12,5 % for C. albicans. It was found that 70 % of the sex-workers had 5-10 sexual relationships per week, 10 % 11-15 per week and 20 % 16-20 per week (average above 1 000 annual partners). 15,4 % of the sex-workers did not use protection during their sexual relationships. The high rates of infection found in the populations studied presume a high risk of transmission, making it a priority to intervene in these groups to prevent the spread of HIV and STI.

Using risk-adjustment models to identify high-cost risks.

PubMed

Meenan, Richard T; Goodman, Michael J; Fishman, Paul A; Hornbrook, Mark C; O'Keeffe-Rosetti, Maureen C; Bachman, Donald J

2003-11-01

We examine the ability of various publicly available risk models to identify high-cost individuals and enrollee groups using multi-HMO administrative data. Five risk-adjustment models (the Global Risk-Adjustment Model [GRAM], Diagnostic Cost Groups [DCGs], Adjusted Clinical Groups [ACGs], RxRisk, and Prior-expense) were estimated on a multi-HMO administrative data set of 1.5 million individual-level observations for 1995-1996. Models produced distributions of individual-level annual expense forecasts for comparison to actual values. Prespecified "high-cost" thresholds were set within each distribution. The area under the receiver operating characteristic curve (AUC) for "high-cost" prevalences of 1% and 0.5% was calculated, as was the proportion of "high-cost" dollars correctly identified. Results are based on a separate 106,000-observation validation dataset. For "high-cost" prevalence targets of 1% and 0.5%, ACGs, DCGs, GRAM, and Prior-expense are very comparable in overall discrimination (AUCs, 0.83-0.86). Given a 0.5% prevalence target and a 0.5% prediction threshold, DCGs, GRAM, and Prior-expense captured $963,000 (approximately 3%) more "high-cost" sample dollars than other models. DCGs captured the most "high-cost" dollars among enrollees with asthma, diabetes, and depression; predictive performance among demographic groups (Medicaid members, members over 64, and children under 13) varied across models. Risk models can efficiently identify enrollees who are likely to generate future high costs and who could benefit from case management. The dollar value of improved prediction performance of the most accurate risk models should be meaningful to decision-makers and encourage their broader use for identifying high costs.

Smooth pursuit eye movements in 1,087 men: effects of schizotypy, anxiety, and depression.

PubMed

Smyrnis, Nikolaos; Evdokimidis, Ioannis; Mantas, Asimakis; Kattoulas, Emmanouil; Stefanis, Nicholas C; Constantinidis, Theodoros S; Avramopoulos, Dimitrios; Stefanis, Costas N

2007-05-01

Individuals with schizotypal personality disorder or high scores in questionnaires measuring schizotypy are at high risk for the development of schizophrenia and they also share some of the same phenotypic characteristics such as eye-tracking dysfunction (ETD). The question arises whether these individuals form a distinct high-risk group in the general population or whether schizotypy and ETD co-vary in the general population with no distinct cutoff point for a high-risk group. A large sample of military conscripts aged 18-25 were screened using oculomotor, cognitive and psychometric tools for the purposes of a prospective study on predisposing factors for the development of psychosis. Schizotypy measured using the perceptual aberration scale (PAS) and the schizotypal personality questionnaire (SPQ), anxiety and depression, measured using the Symptom Checklist 90-R, had no effect on pursuit performance in the total sample. Small groups of individuals with very high scores in schizotypy questionnaires were then identified. These groups were not mutually exclusive. The high PAS group had higher root-mean-square error scores (a quantitative measure for pursuit quality) than the total sample, and the high disorganized factor of SPQ group had lower gain and higher saccade frequencies in pursuit than the total sample. The presence of significant differences in pursuit performance only for predefined high schizotypy groups favors the hypothesis that individuals with high schizotypy might present one or more high-risk groups, distinct from the general population, that are prone to ETD as that observed in schizophrenia.

The primary prevention of asthma in children study: design of a multifaceted prevention program.

PubMed

Kuiper, Sandra; Maas, Tanja; van Schayck, Constant P; Muris, Jean W M; Schönberger, Huub J A M; Dompeling, Edward; Gijsbers, Barbara; van Weel, Chris; Knottnerus, J André

2005-06-01

The PREVASC study addresses the primary prevention of asthma in infants and small children. The objective of this study is to investigate whether a multifaceted prenatally started intervention strategy in high-risk infants leads to a decrease in the occurrence of (severe) asthma and whether a refinement of the prevention strategy leads to an increase in the adherence to the prevention program. The primary prevention program includes house dust mite impermeable bed coverings, education on breast feeding, hypoallergenic feeding, timing of introduction of solid food and smoking cessation. A total of 888 infants were prenatally included. By the time of inclusion the mothers were 3-7 months pregnant. About 27 infants were excluded from the study and 18 dropped out. Of the remaining 843 infants 535 had a first-degree familial predisposition of asthma (high-risk group), whereas a reference group of 308 (162 boys) infants was not predisposed for asthma in the first-degree (low-risk group). To evaluate the (cost-)effectiveness of the preventive intervention, 222 (118 boys) infants of the high-risk group allocated to the intervention group and 221 (112 boys) allocated to a control group are followed up. The low-risk infants served as controls to evaluate the predictive value of high risk (first-degree familial predisposition of asthma). The infants are followed from the prenatal stage until they reach the age of 6 yr. The remaining 92 high-risk infants were included in an optimized randomized-clinical adherence trial (RCAT). Of these 92 infants, 45 (20 boys) were allocated to an intervention group and 47 (24 boys) to a control group. Until now all infants have been followed for at least 1 yr.

Multiple Peer Group Self-Identification and Adolescent Tobacco Use

PubMed Central

Fuqua, Juliana L.; Gallaher, Peggy E.; Unger, Jennifer B.; Trinidad, Dennis R.; Sussman, Steve; Ortega, Enrique; Johnson, C. Anderson

2014-01-01

Associations between peer group self-identification and smoking were examined among 2,698 ethnically diverse middle school students in Los Angeles who self-identified with groups such as Rockers, Skaters, and Gamers. The sample was 47.1% male, 54.7% Latino, 25.4% Asian, 10.8% White, 9.1% Other ethnicity, and 59.3% children of immigrant parents. Multiple group self-identification was common: 84% identified with two or more groups and 65% identified with three or more groups. Logistic regression analyses indicated that as students endorsed more high-risk groups, the greater their risk of tobacco use. A classification tree analysis identified risk groups based on interactions among ethnicity, gender, and group self-identification. Psychographic targeting based on group self-identification could be useful to design more relevant smoking prevention messages for adolescents who identify with high-risk peer groups. PMID:22458850

Maturation of body and breathing movements in 24-33 week-old fetuses threatening to deliver prematurely.

PubMed

Kisilevsky, B S; Hains, S M; Low, J A

1999-05-01

Maturation of spontaneous fetal body and breathing movements of 24- to 33-week-old fetuses in 168 pregnancies threatening to deliver prematurely were examined on the basis of newborn outcome (premature compromised, premature healthy, term healthy). Maturation of fetuses in 60 low-risk pregnancies delivering as healthy full-term infants served as a normative comparison group. Each fetus was observed for 30 min; the amount of body and breathing movements were noted and an estimation of amniotic fluid volume was made. The pattern of behavioural maturation was similar for all outcome groups; with advancing gestation there was a decrease in body movements and an increase in breathing movements. Both reduced activity levels and advanced behaviours were observed in the high-risk outcome groups. The high-risk fetuses had reduced levels of body movements which increased with better outcome and, an earlier onset of increased amounts of breathing, occurring at 30 weeks in contrast to 33 weeks for the comparison group. In the presence of ruptured membranes, those high-risk fetuses who were born prematurely had less breathing compared to those who delivered at term. Similar maturation patterns among high- and low-risk outcome groups suggests normal/typical functional development in the high-risk fetal groups. The observed differential behaviours were associated with prematurity and most likely associated with events leading to premature labour.

Effect of Variation in Diacylglycerol Kinase Eta (DGKH) Gene on Brain Function in a Cohort at Familial Risk of Bipolar Disorder

PubMed Central

Whalley, Heather C; Papmeyer, Martina; Romaniuk, Liana; Johnstone, Eve C; Hall, Jeremy; Lawrie, Stephen M; Sussmann, Jessika E; McIntosh, Andrew M

2012-01-01

Several lines of evidence indicate that the diacylglycerol kinase eta (DGKH) gene is implicated in the etiology of bipolar disorder (BD). However, the functional neural mechanisms of DGKH's risk association remain unknown. Therefore, we examined the effects of three haplotype-tagging risk variants in DGKH (single nucleotide polymorphisms rs9315885, rs1012053, and rs1170191) on brain activation using a verbal fluency functional magnetic resonance imaging task. The subject groups consisted of young individuals at high familial risk of BD (n=81) and a comparison group of healthy controls (n=75). Individuals were grouped based on risk haplotypes described in previous studies. There was a significant risk haplotype*group interaction in the left medial frontal gyrus (BA10, involving anterior cingulate BA32), left precuneus, and right parahippocampal gyrus. All regions demonstrated greater activation during the baseline condition than sentence completion. Individuals at high familial risk for BD homozygous for the DGKH risk haplotype demonstrated relatively greater activation (poor suppression) of these regions during the task vs the low-risk haplotype subjects. The reverse pattern was seen for the control subjects. These findings suggest that there are differential effects of the DGKH gene in healthy controls vs the bipolar high-risk group, which manifests as a failure to disengage default-mode regions in those at familial risk carrying the risk haplotype. PMID:22048461

Nonsuicidal Self-Injury and Suicidal Behavior: A Latent Class Analysis among Young Adults

PubMed Central

Hamza, Chloe A.; Willoughby, Teena

2013-01-01

Although there is a general consensus among researchers that engagement in nonsuicidal self-injury (NSSI) is associated with increased risk for suicidal behavior, little attention has been given to whether suicidal risk varies among individuals engaging in NSSI. To identify individuals with a history of NSSI who are most at risk for suicidal behavior, we examined individual variability in both NSSI and suicidal behavior among a sample of young adults with a history of NSSI (N = 439, Mage = 19.1). Participants completed self-report measures assessing NSSI, suicidal behavior, and psychosocial adjustment (e.g., depressive symptoms, daily hassles). We conducted a latent class analysis using several characteristics of NSSI and suicidal behaviors as class indicators. Three subgroups of individuals were identified: 1) an infrequent NSSI/not high risk for suicidal behavior group, 2) a frequent NSSI/not high risk for suicidal behavior group, and 3) a frequent NSSI/high risk for suicidal behavior group. Follow-up analyses indicated that individuals in the ‘frequent NSSI/high risk for suicidal behavior’ group met the clinical-cut off score for high suicidal risk and reported significantly greater levels of suicidal ideation, attempts, and risk for future suicidal behavior as compared to the other two classes. Thus, this study is the first to identity variability in suicidal risk among individuals engaging in frequent and multiple methods of NSSI. Class 3 was also differentiated by higher levels of psychosocial impairment relative to the other two classes, as well as a comparison group of non-injuring young adults. Results underscore the importance of assessing individual differences in NSSI characteristics, as well as psychosocial impairment, when assessing risk for suicidal behavior. PMID:23544113

Cardiovascular risk determination: discrepancy between total cholesterol evaluation and two compound laboratory indices in Norway.

PubMed Central

Berg, J E; Høstmark, A T

1994-01-01

OBJECTIVE--To compare group classification of cardiovascular risk by two compound laboratory indices with classification according to the serum total cholesterol concentration alone. DESIGN--Healthy employees were defined as low and high cardiovascular risk subjects according to their total cholesterol concentration or two compound indices of blood lipid components-the total cholesterol: high density lipoprotein (HDL) cholesterol ratio and an atherogenic index defined as ([total cholesterol-HDL cholesterol]*[apolipoprotein B])/([HDL cholesterol]*[apolipoprotein A-I]). Cut off values to distinguish between low and high risk subjects were as follows: total cholesterol 6.5 mmol/l, HDL cholesterol 0.9 mmol/l, apolipoprotein A = 1.8 g/l, and apolipoprotein B = 1.3 g/l. These gave total: HDL cholesterol ratio and atherogenic index cut off values of 7.2 and 4.5 respectively. SETTING--An occupational health service in a non-manufacturing company in Norway. PARTICIPANTS--A total of 112 male and 117 female employees. The mean body mass index values were 25.6 and 23.6 kg/m2 and the mean ages 39.8 and 40.1 years in men and women respectively. Those with cardiovascular, diabetic, or renal diseases were excluded. MEAN OUTCOME MEASURES--Serum total cholesterol, HDL cholesterol, apolipoproteins A-I and B, lipid peroxidation, blood pressure, smoking, physical activity, and fruit, vegetables, and salt in the diet were determined. RESULTS--The cut off values allocated 19%, 7%, and 40% as high risk subjects according to total cholesterol, total: HDL cholesterol, and the atherogenic index respectively. The mean age was two to four years higher in the high risk groups. Cardiovascular risk in siblings and no reported physical activity were more prevalent in those high risk groups defined by the compound indices than by total cholesterol alone, as was a high body mass index and a measure of lipid peroxidation. Grouping according to total cholesterol failed to allocate heavy smokers mainly to the high risk group. Diet variables did not demarcate clearly between indices. CONCLUSIONS--There is considerable variability in classification into high and low risk subjects when using the total cholesterol concentration alone compared with compound risk indices. Smoking was more prevalent in the high risk groups defined by the compound indices than by total cholesterol. These findings call for caution when total cholesterol is used to estimate cardiovascular risk in epidemiological studies, and even more so at individual counselling in occupational or primary health care settings. PMID:7964330

Seropositivity of Toxoplasmosis in Pregnant Women by ELISA at Minia University Hospital, Egypt.

PubMed

Kamal, Amany M; Ahmed, Azza K; Abdellatif, Manal Z M; Tawfik, Mohamed; Hassan, Ebtesam E

2015-10-01

Toxoplasmosis is considered as an important risk factor for bad obstetric history (BOH) and one of the major causes of congenitally acquired infections. The present study aimed to estimate the seropositivity of T. gondii infection and associated risk factors among the attendees of high risk pregnancy and low risk antenatal care clinic of Minia Maternity and Pediatric University Hospital, Minia, Egypt. The study was carried out from April 2013 to April 2014 through 2 phases, the first phase was case-control study, and the second phase was follow-up with intervention. A total of 120 high risk pregnant and 120 normal pregnant females were submitted to clinical examinations, serological screening for anti-Toxoplasma IgM and IgG antibodies by ELISA, and an interview questionnaire. Seropositive cases were subjected to spiramycin course treatment. The results showed that the seroprevalence of toxoplasmosis in high-risk pregnancy group was 50.8%, which was significantly different from that of normal pregnancy group (P<0.05). Analysis of seropositive women in relation to BOH showed that abortion was the commonest form of the pregnancy wastage (56.5%). The high prevalence of T. gondii seropositive cases was observed in the age group of 21-30 years. Post-delivery adverse outcome was observed in 80.3% of high-risk pregnancy group compared to 20% of normal pregnancy group. There was a statistically significant relationship between seropositivity and living in rural area, low socioeconomic level, and undercooked meat consumption (P<0.05). Serological screening for anti-Toxoplasma antibodies should be routine tests especially among high-risk pregnant women.

Reduced mortality in high-risk coronary patients operated off pump with preoperative intraaortic balloon counterpulsation.

PubMed

Etienne, Pierre Yves; Papadatos, Spiridon; Glineur, David; Mairy, Yves; El Khoury, Elie; Noirhomme, Philippe; El Khoury, Gebrine

2007-08-01

Preoperative intraaortic balloon pump (IABP) counterpulsation has better outcomes compared with perioperative or postoperative insertion in critical patients, and off-pump surgical procedures have been advocated to reduce mortality in high-risk patients. However, some surgeons are reluctant to perform beating heart operations in specific patient subgroups, including those with unstable angina or patients with low ejection fraction, because of their possible perioperative hemodynamic instability. We evaluated combined beating heart procedures and preoperative IABP in selected high-risk patients and compared our results with the predictive European System for Cardiac Operative Risk Evaluation (EuroSCORE) model. Fifty-five high-risk patients with a mean logistic EuroSCORE of 24 were prospectively enrolled and then divided into emergency (group 1, n = 25) and nonemergency (group 2, n = 30) groups. IABP was inserted immediately before operation in group 1 and the day before the procedure in group 2. Compared with the EuroSCORE predictive model, a dramatic decrease in mortality occurred in both groups. Group I predicted mortality was 36.8%, and observed was 20%; and group 2 predicted mortality was 15.2% and observed was 0%. No specific complications from the use of IABP were encountered. During mid-term (2 years) follow-up, no patient died from a cardiac cause or required percutaneous coronary intervention or subsequent reoperation due to incomplete revascularization. The combined use of preoperative intraaortic counterpulsation and beating heart intervention allows complete revascularization in high-risk patients with a important reduction in operative mortality and excellent mid-term results.

Ethnic differences in risk factors and total risk of cardiovascular disease based on the Norwegian CONOR study.

PubMed

Rabanal, Kjersti S; Lindman, Anja S; Selmer, Randi M; Aamodt, Geir

2013-12-01

Risk of cardiovascular disease varies between ethnic groups and the aim of this study was to investigate differences in cardiovascular risk factors, and total cardiovascular risk between ethnic groups in Norway. Cross-sectional study using data from the Cohort of Norway (CONOR). A sample of 62,145 participants, 40-65 years of age, originating from 11 geographical regions, were included in our study. Self-reported variables, blood samples and physical measurements were used to estimate age- and time-adjusted mean values of cardiovascular risk factors for different ethnic groups. The 10-year risks of cardiovascular mortality and cardiovascular events were calculated using the Framingham and NORRISK risk models. We observed differences between ethnic groups for cardiovascular risk factors and both Framingham and NORRISK risk scores. NORRISK showed significant differences by ethnicity in women only. Immigrants from the Indian subcontinent had the lowest high-density lipoprotein (HDL) levels, the highest levels of blood glucose, triglycerides, total cholesterol/HDL ratio, waist hip ratio and diabetes prevalence. Immigrants from the former Yugoslavia had the highest Framingham scores, high blood pressure, high total cholesterol/HDL ratio, overweight measures and smoking. Low cardiovascular risk was observed among East Asian immigrants. The previously reported excess cardiovascular risk among immigrants from the Indian subcontinent was supported in this study. We also showed that immigrants from the former Yugoslavian countries had a higher total 10-year risk of cardiovascular events than other ethnic groups. This study adds information about ethnic groups in Norway which needs to be addressed in further research and targeted prevention strategies.

[Community nursing intervention in population with high-risk coronary heart disease in Hengyang].

PubMed

Huang, Yanjin; Chen, Jia; Zeng, Ying; Liu, Dan; He, Guoping

2014-10-01

To explore the effect of community nursing intervention on awareness regarding primary prevention knowledge, self-management, and risk factors for coronary heart disease (CHD) in Hengyang City, Hunan Province. A total of 120 individuals at high risk of CHD were recruited and divided into a control group and an intervention group. The intervention group was given the health knowledge lecture and individual community nursing intervention. The control group was given the routine management. Before and after the intervention, all of the recruiters were evaluated by the awareness on primary prevention knowledge, self-management and risk factors for CHD. Before the intervention, there was no significant difference in the demographic data, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups (P>0.05). After the intervention, the cognitive levels regarding primary prevention knowledge, the self-management and the risk factors for CHD between the 2 groups changed. In the intervention group, the cognitive level was significantly increased (P<0.05); the self management score was improved; the systolic blood pressure, BMI, and the levels of fasting glucose, TC and low density lipoprotein-cholesterol were significantly decreased and the level of high density lipoprotein-cholesterol was significantly increased (P<0.05). There was no significant difference in the above-mentioned parameters between before and after intervention in the control group (P>0.05). The cognitive levels regarding primary prevention knowledge and self-management for CHD can be improved effectively by community nursing intervention in high-risk population of CHD, and the risk factors for CHD can also be reduced.

Association between obesity and cardiometabolic health risk in Asian-Canadian sub-groups.

PubMed

Nie, Jason X; Ardern, Chris I

2014-01-01

To quantify and compare the association between the World Health Organizations' Asian-specific trigger points for public health action ['increased risk': body mass index (BMI) ≥23 kg/m2, and; 'high risk': BMI ≥27.5 kg/m2] with self-reported cardiovascular-related conditions in Asian-Canadian sub-groups. Six cycles of the Canadian Community Health Survey (2001-2009) were pooled to examine BMI and health in Asian sub-groups (South Asians, Chinese, Filipino, Southeast Asians, Arabs, West Asians, Japanese and Korean; N = 18 794 participants, ages 18-64 y). Multivariable logistic regression, adjusting for demographic, lifestyle characteristics and acculturation measures, was used to estimate the odds of cardiovascular-related health (high blood pressure, heart disease, diabetes, 'at least one cardiometabolic condition') outcomes across all eight Asian sub-groups. Compared to South Asians (OR = 1.00), Filipinos had higher odds of having 'at least one cardiometabolic condition' (OR = 1.29, 95% CI: 1.04-1.62), whereas Chinese (0.63, 0.474-0.9) and Arab-Canadians had lower odds (0.38, 0.28-0.51). In ethnic-specific analyses (with 'acceptable' risk weight as the referent), 'increased' and 'high' risk weight categories were the most highly associated with 'at least one cardiometabolic condition' in Chinese ('increased': 3.6, 2.34-5.63; 'high': 8.9, 3.6-22.01). Compared to normal weight South Asians, being in the 'high' risk weight category in all but the Southeast Asian, Arab, and Japanese ethnic groups was associated with approximately 3-times the likelihood of having 'at least one cardiometabolic condition'. Differences in the association between obesity and cardiometabolic health risks were seen among Asian sub-groups in Canada. The use of WHO's lowered Asian-specific BMI cut-offs identified obesity-related risks in South Asian, Filipino and Chinese sub-groups that would have been masked by traditional BMI categories. These findings have implications for public health messaging, especially for ethnic groups at higher odds of obesity-related health risks.

42 CFR 51d.6 - How will applications be evaluated and awarded?

Code of Federal Regulations, 2010 CFR

2010-10-01

... information regarding its impact. Applicant has identified any high risk groups or populations with special... cultural groups, lower income populations). This documentation of need shall include the extent of physical... addresses the needs of any high risk groups or populations with special concerns identified in the...

Revised simulation model does not predict rebound in gonorrhoea prevalence where core groups are treated in the presence of antimicrobial resistance.

PubMed

Trecker, Molly A; Hogan, Daniel J; Waldner, Cheryl L; Dillon, Jo-Anne R; Osgood, Nathaniel D

2015-06-01

To determine the effects of using discrete versus continuous quantities of people in a compartmental model examining the contribution of antimicrobial resistance (AMR) to rebound in the prevalence of gonorrhoea. A previously published transmission model was reconfigured to represent the occurrence of gonorrhoea in discrete persons, rather than allowing fractions of infected individuals during simulations. In the revised model, prevalence only rebounded under scenarios reproduced from the original paper when AMR occurrence was increased by 10(5) times. In such situations, treatment of high-risk individuals yielded outcomes very similar to those resulting from treatment of low-risk and intermediate-risk individuals. Otherwise, in contrast with the original model, prevalence was the lowest when the high-risk group was treated, supporting the current policy of targeting treatment to high-risk groups. Simulation models can be highly sensitive to structural features. Small differences in structure and parameters can substantially influence predicted outcomes and policy prescriptions, and must be carefully considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Prophylactic central neck lymphadenectomy in high risk patients with T1 or T2 papillary thyroid carcinoma: is it useful?

PubMed

Delogu, Daniele; Pisano, Ilia Patrizia; Pala, Carlo; Pulighe, Fabio; Denti, Salvatore; Cossu, Antonio; Trignano, Mario

2014-01-01

The aim of this study was to evaluate the role of prophylactic central neck lymph node dissection in high risk patients with T1 or T2 papillary thyroid cancer. Seventy-three patients who had undergone total thyroidectomy for papillary thyroid cancer smaller than 4cm, without cervical lymphadenopathy and prophylactic central neck lymph node dissection were included. Patients were divided in two groups: low risk patients (group A) and high risk patients (group B). High risk patients were considered those with at least one of the followings: male sex, age ≥ 45 years, and extracapsular or extrathyroid disease. Statistical significant differences in persistent disease, recurrence and complications rates between the two groups were studied. Persistence of the disease was observed in one case in group A (5.9%) and in three cases in group B (5.4%), while thyroid cancer recurrence was registered in zero and two (3.6%) cases respectively. One single case (5.9%) of transitory recurrent laryngeal nerve damage was reported in group A and none in group B, while transitory hypoparathyroidism was observed in 2 (3.6%) patients in group A, and 1 (1.8%) patient in group B. Permanent recurrent laryngeal nerve damage was observed in one patient in group A, while permanent hypoparathyroidism was registered in one case in group B. Logistic regression evidenced that multifocality was the only risk factor significantly related to persistence of disease and recurrence. Our results suggests that prophylactic central neck lymph node dissection can be safely avoided in patients with T1 or T2 papillary thyroid cancer, except in those with multifocal disease. Cancer, Central neck, Cervical, Lymphadenectomy, Lymph nodes, Papillary carcinoma, Thyroid.

Epidemiological and economic impact of pandemic influenza in Chicago: Priorities for vaccine interventions

PubMed Central

Dorratoltaj, Nargesalsadat; Marathe, Achla; Swarup, Samarth; Eubank, Stephen G.

2017-01-01

The study objective is to estimate the epidemiological and economic impact of vaccine interventions during influenza pandemics in Chicago, and assist in vaccine intervention priorities. Scenarios of delay in vaccine introduction with limited vaccine efficacy and limited supplies are not unlikely in future influenza pandemics, as in the 2009 H1N1 influenza pandemic. We simulated influenza pandemics in Chicago using agent-based transmission dynamic modeling. Population was distributed among high-risk and non-high risk among 0–19, 20–64 and 65+ years subpopulations. Different attack rate scenarios for catastrophic (30.15%), strong (21.96%), and moderate (11.73%) influenza pandemics were compared against vaccine intervention scenarios, at 40% coverage, 40% efficacy, and unit cost of $28.62. Sensitivity analysis for vaccine compliance, vaccine efficacy and vaccine start date was also conducted. Vaccine prioritization criteria include risk of death, total deaths, net benefits, and return on investment. The risk of death is the highest among the high-risk 65+ years subpopulation in the catastrophic influenza pandemic, and highest among the high-risk 0–19 years subpopulation in the strong and moderate influenza pandemics. The proportion of total deaths and net benefits are the highest among the high-risk 20–64 years subpopulation in the catastrophic, strong and moderate influenza pandemics. The return on investment is the highest in the high-risk 0–19 years subpopulation in the catastrophic, strong and moderate influenza pandemics. Based on risk of death and return on investment, high-risk groups of the three age group subpopulations can be prioritized for vaccination, and the vaccine interventions are cost saving for all age and risk groups. The attack rates among the children are higher than among the adults and seniors in the catastrophic, strong, and moderate influenza pandemic scenarios, due to their larger social contact network and homophilous interactions in school. Based on return on investment and higher attack rates among children, we recommend prioritizing children (0–19 years) and seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies. Based on risk of death, we recommend prioritizing seniors (65+ years) after high-risk groups for influenza vaccination during times of limited vaccine supplies. PMID:28570660

Rate dependent effects of acute nicotine on risk taking in young adults are not related to ADHD diagnosis

PubMed Central

Ryan, Katherine K.; Dube, Sarahjane L.; Potter, Alexandra S.

2012-01-01

Beneficial effects of nicotine on cognition and behavioral control are hypothesized to relate to the high rates of cigarette smoking in Attention-Deficit/Hyperactivity Disorder (ADHD). Given that ADHD is associated with both impulsivity and elevated risk taking, we hypothesized that nicotine modulates risk taking, as it does impulsivity. 26 non-smoking young adults (15 controls with normal impulsivity and 11 ADHD with high impulsivity) received 7 mg transdermal nicotine, 20 mg oral mecamylamine, and placebo on separate days, followed by the Balloon Analogue Risk Task (BART). Statistical analyses found no group differences in baseline risk taking. Reexamination of the data using a median split on baseline risk taking, to create high (HRT) and low (LRT) risk taking groups, revealed significant effects of nicotinic drugs that differed by group. Nicotine reduced risk taking in HRT and mecamylamine increased risk taking in LRT. This finding supports the hypothesis that nicotinic receptor function modulates risk taking broadly, beyond those with ADHD, and is consistent with rate dependent cholinergic modulation of other cognitive functions. Further, the results demonstrate that high impulsivity is separable from high risk taking in young adults with ADHD, supporting the utility of these differential behavioral phenotypes for neurobiological studies. PMID:23159875

[Treatment results with ALL-BFM-95 protocol in children with acute lymphoblastic leukemia in Hungary].

PubMed

Müller, Judit; Kovács, Gábor; Jakab, Zsuzsanna; Rényi, Imre; Galántai, Ilona; Békési, Andrea; Kiss, Csongor; Nagy, Kálmán; Kajtár, Pál; Bartyik, Katalin; Masát, Péter; Magyarosy, Edina

2005-01-09

In Hungary children (from 1 to 18 years of age) with de novo acute lymphoblastic leukemia were treated from January 1996 to October 2002, according to protocol ALL-BFM-95. The aim of this study was to evaluate the experience with this protocol, the treatment results according to the risk groups and to compare the Hungarian data with the international results. Patients were stratified into 3 risk groups, based on initial white blood cell count, age, immunology, cytogenetics and response to treatment: standard, medium and high risk group. Three hundred sixty eight children entered the study (male-female ratio was 1.27:1, median age 6 years and 4 months). 110 (29.9%) children were in the standard, 210 (57.1%) in the medium and 48 (13%) in the high risk group. Duration of the chemotherapy was 2 years, except of the boys in the standard risk group, their maintenance therapy was 1 year longer. The overall complete remission rate was 93.2%. 20 (5.4%) children died in induction and 5 (1.4%) were non-responders. The 5-year overall survival for all patients was 78.5%, in the standard risk group 93.2%, in the medium risk group 78.4% and in the high risk group 44.5% with a minimum follow up of 1.19 years and median follow up of 4.85 years. From the 368 patients 272 (73.9%) are still in their first complete clinical remission and other 18 children are alive after relapse. In 14.7% of the patients relapse was diagnosed; the most common site was the bone marrow. In one patient second malignancy occurred. The 5-year event free survival for all patients was 72.6%, in the standard risk group 87.6%, in the medium risk group 72.1% and in the high risk group 39.9%. The treatment outcome of children with acute lymphoblastic leukemia improved remarkably over the last decades. 78% of children suffering from acute lymphoblastic leukemia could be cured with the ALL-BFM-95 protocol. The Hungarian results are comparable to those achieved by other leukaemia study groups in the world regarding the ALL-BFM-95 protocol.

Contemporary Primary Prevention Aspirin Use by Cardiovascular Disease Risk: Impact of US Preventive Services Task Force Recommendations, 2007-2015: A Serial, Cross-sectional Study.

PubMed

Van't Hof, Jeremy R; Duval, Sue; Walts, Adrienne; Kopecky, Stephen L; Luepker, Russell V; Hirsch, Alan T

2017-10-03

No previous study has evaluated the impact of past US Preventive Services Task Force statements on primary prevention (PP) aspirin use in a primary care setting. The aim of this study was to evaluate temporal changes in PP aspirin use in a primary care population, stratifying patients by their 10-year global cardiovascular disease risk, in response to the 2009 statement. This study estimated biannual aspirin use prevalence using electronic health record data from primary care clinics within the Fairview Health System (Minnesota) from 2007 to 2015. A total of 94 270 patient encounters had complete data to estimate a 10-year cardiovascular disease risk score using the 2013 American College of Cardiology/American Heart Association global risk estimator. Patients were stratified into low- (<10%), intermediate- (10-20%), and high- (≥20%) risk groups. Over the 9-year period, PP aspirin use averaged 43%. When stratified by low, intermediate and high risk, average PP aspirin use was 41%, 63%, and 73%, respectively. Average PP aspirin use decreased after the publication of the 2009 US Preventive Services Task Force recommendation statement: from 45% to 40% in the low-risk group; from 66% to 62% in the intermediate-risk group; and from 76% to 73% in the high-risk group, before and after the guideline. Publication of the 2009 US Preventive Services Task Force recommendation was not associated with an increase in aspirin use. High risk PP patients utilized aspirin at high rates. Patients at intermediate risk were less intensively treated, and patients at low risk used aspirin at relatively high rates. These data may inform future aspirin guideline dissemination. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Trajectories of perceived discrimination from adolescence to emerging adulthood and substance use among Hispanic youth in Los Angeles.

PubMed

Unger, Jennifer B; Soto, Daniel W; Baezconde-Garbanati, Lourdes

2016-02-01

Previous studies have documented associations between perceptions of racial/ethnic discrimination and adverse health outcomes among Hispanics and other minority groups. However, these studies have not examined change in perceived discrimination over the lifecourse and whether trajectories of perceived discrimination affect outcomes differently. This study of 2722 Hispanic students identified trajectories of perceived discrimination from 9th grade through emerging adulthood (approximately ages 14-23), and compared these trajectory groups on substance use outcomes. Four distinct trajectory groups were identified: (1) low and stable discrimination, (2) increasing discrimination, (3) initially high but decreasing discrimination, and (4) high and stable discrimination. Compared with the low and stable discrimination group, the groups that experienced higher levels of discrimination were at higher risk of cigarette, alcohol, marijuana, and hard drug use. Specifically, the group with increasing discrimination (group 2) had a higher risk of alcohol, marijuana, and hard drug use; the group with initially high but decreasing discrimination (group 3) had a higher risk of cigarette smoking and alcohol use; and the group with high and stable discrimination (group 4) had a higher risk of alcohol, marijuana, and hard drug use. Results indicate that experiencing discrimination during adolescence, emerging adulthood, or both, regardless of whether the discrimination increases or decreases, could place Hispanic youth at risk for substance use. Health education programs are needed to help Hispanic youth learn effective skills to cope with discrimination without resorting to substance use. Copyright © 2015 Elsevier Ltd. All rights reserved.

Infectious complications in children with acute lymphoblastic leukemia treated with the Taiwan Pediatric Oncology Group protocol: A 16-year tertiary single-institution experience.

PubMed

Li, Meng-Ju; Chang, Hsiu-Hao; Yang, Yung-Li; Lu, Meng-Yao; Shao, Pei-Lan; Fu, Chun-Min; Chou, An-Kuo; Liu, Yen-Lin; Lin, Kai-Hsin; Huang, Li-Min; Lin, Dong-Tsamn; Jou, Shiann-Tarng

2017-10-01

Infection is a major complication in pediatric patients with acute lymphoblastic leukemia during chemotherapy. In this study, the infection characteristics were determined and risk factors analyzed based on the Taiwan Pediatric Oncology Group (TPOG) acute lymphoblastic leukemia (ALL) protocol. We retrospectively reviewed fever events during chemotherapy in 252 patients treated during two consecutive clinical trials at a single institution between 1997 and 2012. Patients were classified as standard, high, and very high risk by treatment regimen according to the TPOG definitions. We analyzed the characteristics and risk factors for infection. Fever occurred in 219 patients (86.9%) with a mean of 2.74 episodes per person. The fever events comprised 64% febrile neutropenia, 39% clinically documented infections, and 44% microbiologically documented infections. The microbiologically documented infections were mostly noted during the induction phase and increased in very high risk patients (89 vs. 24% and 46% in standard-risk and high-risk patients, respectively). Younger age and higher risk (high-risk and very high risk groups) were risk factors for fever and microbiologic and bloodstream infections. Female gender and obesity were additive risk factors for urinary tract infection (odds ratios = 3.52 and 3.24, P < 0.001 and P = 0.004, respectively). Infections developed primarily during the induction phase, for which younger age and higher risk by treatment regimen were risk factors. Female gender and obesity were additive risk factors for urinary tract infection. © 2017 Wiley Periodicals, Inc.

Environmental Risk Assessment: Spatial Analysis of Chemical Hazards and Risks in South Korea

NASA Astrophysics Data System (ADS)

Yu, H.; Heo, S.; Kim, M.; Lee, W. K.; Jong-Ryeul, S.

2017-12-01

This study identified chemical hazard and risk levels in Korea by analyzing the spatial distribution of chemical factories and accidents. The number of chemical factories and accidents in 5-km2 grids were used as the attribute value for spatial analysis. First, semi-variograms were conducted to examine spatial distribution patterns and to identify spatial autocorrelation of chemical factories and accidents. Semi-variograms explained that the spatial distribution of chemical factories and accidents were spatially autocorrelated. Second, the results of the semi-variograms were used in Ordinary Kriging to estimate chemical hazard and risk level. The level values were extracted from the Ordinary Kriging result and their spatial similarity was examined by juxtaposing the two values with respect to their location. Six peaks were identified in both the hazard and risk estimation result, and the peaks correlated with major cities in Korea. Third, the estimated hazard and risk levels were classified with geometrical interval and could be classified into four quadrants: Low Hazard and Low Risk (LHLR), Low Hazard and High Risk (LHHR), High Hazard and Low Risk (HHLR), and High Hazard and High Risk (HHHR). The 4 groups identified different chemical safety management issues in Korea; relatively safe LHLR group, many chemical reseller factories were found in HHLR group, chemical transportation accidents were in the LHHR group, and an abundance of factories and accidents were in the HHHR group. Each quadrant represented different safety management obstacles in Korea, and studying spatial differences can support the establishment of an efficient risk management plan.

Sexual risk trajectories among MSM in the United States: implications for pre-exposure prophylaxis delivery

PubMed Central

Pines, Heather A.; Gorbach, Pamina M.; Weiss, Robert E.; Shoptaw, Steve; Landovitz, Raphael J.; Javanbakht, Marjan; Ostrow, David G.; Stall, Ron D.; Plankey, Michael

2014-01-01

Background Despite evidence supporting pre-exposure prophylaxis (PrEP) efficacy, there are concerns regarding the feasibility of widespread PrEP implementation among men who have sex with men (MSM). To inform the development of targeted PrEP delivery guidelines, we characterized sexual risk trajectories among HIV-negative MSM. Methods At semiannual visits from 2003–2011, HIV-negative MSM (N=419) participating in the Multicenter AIDS Cohort Study provided data on sexual risk behaviors since their last visit. Based on reported behaviors, participants were assigned a sexual risk behavior (SRB) score at each visit as follows: (0) no insertive or receptive anal intercourse (IAI/RAI), (1) no unprotected IAI/RAI (UIAI/URAI), (2) only UIAI, (3) URAI with 1 HIV-negative partner, (4) condom-serosorting, (5) condom-seropositioning, and (6) no seroadaptive behaviors. Group-based trajectory modeling was used to examine SRB scores (<4 vs. ≥4) and identify groups with distinct sexual risk trajectories. Results Three sexual risk trajectory groups were identified: low risk (N=264; 63.0%), moderate risk (N=96; 22.9%; mean duration of consecutive high risk intervals~1 year), and high risk (N=59; 14.1%; mean duration of consecutive high risk intervals~2 years). Compared to low risk group membership, high risk group membership was associated with younger age (in years) (adjusted odds ratio [AOR]=0.92, 95% confidence interval [CI]: 0.88–0.96), being White (AOR=3.67, 95% CI: 1.48–9.11), earning an income ≥$20,000 (AOR=4.98, 95% CI: 2.13–11.64), distress/depression symptoms (CESD≥16) (AOR=2.36, 95% CI: 1.14–4.92), and substance use (AOR=2.00, 95% CI: 1.01–3.97). Conclusion Screening for the socio-demographic and behavioral factors described above may facilitate targeted PrEP delivery during high risk periods among MSM. PMID:24378726

Risk of obstructive sleep apnea in obese and non-obese women with polycystic ovary syndrome and healthy reproductively normal women

PubMed Central

Mokhlesi, Babak; Scoccia, Bert; Mazzone, Theodore; Sam, Susan

2011-01-01

Objective To study the risk for obstructive sleep apnea (OSA) in a group of non-obese and obese PCOS and control women. Women with polycystic ovary syndrome (PCOS) are at high risk for obstructive sleep apnea (OSA). Whether this risk is independent of obesity is not clear. Design/Patients/Interventions/Main Outcome Measures In a prospective study, 44 women with PCOS and 34 control women completed the Berlin questionnaire for assessment of OSA risk. All women underwent fasting determination of androgens, glucose and insulin. Results Women with PCOS were more obese compared to control women (p=0.02). However, there were no differences in BMI once subjects were divided into non-obese (PCOS n=17 and control n=26) and obese (PCOS n=26 and control n=8) groups. Women with PCOS had higher prevalence of high risk OSA compared to control women on the Berlin questionnaire (47% vs. 15%, P<0.01). However, none of the non-obese PCOS and control women screened positive for high risk OSA. Among the obese group, the risk did not differ between groups (77% vs. 63%, P= 0.65). Conclusions Our findings indicate that even though the risk for OSA in PCOS is high, it is related to the high prevalence of severe obesity. The risk for OSA among non-obese women with PCOS is very low. However, our findings are limited by lack of polysomnographic confirmation of OSA. PMID:22264851

Coronary risk assessment by point-based vs. equation-based Framingham models: significant implications for clinical care.

PubMed

Gordon, William J; Polansky, Jesse M; Boscardin, W John; Fung, Kathy Z; Steinman, Michael A

2010-11-01

US cholesterol guidelines use original and simplified versions of the Framingham model to estimate future coronary risk and thereby classify patients into risk groups with different treatment strategies. We sought to compare risk estimates and risk group classification generated by the original, complex Framingham model and the simplified, point-based version. We assessed 2,543 subjects age 20-79 from the 2001-2006 National Health and Nutrition Examination Surveys (NHANES) for whom Adult Treatment Panel III (ATP-III) guidelines recommend formal risk stratification. For each subject, we calculated the 10-year risk of major coronary events using the original and point-based Framingham models, and then compared differences in these risk estimates and whether these differences would place subjects into different ATP-III risk groups (<10% risk, 10-20% risk, or >20% risk). Using standard procedures, all analyses were adjusted for survey weights, clustering, and stratification to make our results nationally representative. Among 39 million eligible adults, the original Framingham model categorized 71% of subjects as having "moderate" risk (<10% risk of a major coronary event in the next 10 years), 22% as having "moderately high" (10-20%) risk, and 7% as having "high" (>20%) risk. Estimates of coronary risk by the original and point-based models often differed substantially. The point-based system classified 15% of adults (5.7 million) into different risk groups than the original model, with 10% (3.9 million) misclassified into higher risk groups and 5% (1.8 million) into lower risk groups, for a net impact of classifying 2.1 million adults into higher risk groups. These risk group misclassifications would impact guideline-recommended drug treatment strategies for 25-46% of affected subjects. Patterns of misclassifications varied significantly by gender, age, and underlying CHD risk. Compared to the original Framingham model, the point-based version misclassifies millions of Americans into risk groups for which guidelines recommend different treatment strategies.

On the association between sexual attraction and adolescent risk behavior involvement: Examining mediation and moderation.

PubMed

Busseri, Michael A; Willoughby, Teena; Chalmers, Heather; Bogaert, Anthony F

2008-01-01

On the basis of a large-scale survey of high-school youth, the authors compared adolescents reporting exclusively heterosexual, mostly heterosexual, bisexual, and predominately same-sex attraction based on high-risk involvement across a range of risk behaviors. Bisexual and same-sex attracted groups were characterized by heightened high-risk involvement relative to the other two groups. Mediation analysis was used to determine whether these group disparities were explained by a set of normative predictive factors spanning multiple life domains. Differences among a combined exclusively/mostly heterosexual attraction group and both the bisexual and same-sex attraction groups were attenuated (66% and 50%, respectively) after incorporating the hypothesized intervening predictive factors, providing evidence of partial mediation. Primary mediators included intrapersonal (attitudes toward risk-taking; academic orientation), interpersonal (peer victimization; parental relationships; unstructured activities), and environmental (substance availability) factors. Mediation results were consistent across participant age and sex. Implications, limitations, and directions for future research are discussed. Copyright (c) 2008 APA.

SBRT for the Primary Treatment of Localized Prostate Cancer: The Effect of Gleason Score, Dose and Heterogeneity of Intermediate Risk on Outcome Utilizing 2.2014 NCCN Risk Stratification Guidelines.

PubMed

Bernetich, Matthew; Oliai, Caspian; Lanciano, Rachelle; Hanlon, Alexandra; Lamond, John; Arrigo, Stephen; Yang, Jun; Good, Michael; Feng, Jing; Brown, Royce; Garber, Bruce; Mooreville, Michael; Brady, Luther W

2014-01-01

To report an update of our previous experience using stereotactic body radiation therapy (SBRT) for the primary treatment of prostate cancer, risk stratified by the updated National Comprehensive Cancer Network (NCCN) version 2.2014, reporting efficacy and toxicity in a community hospital setting. From 2007 to 2012, 142 localized prostate cancer patients were treated with SBRT using CyberKnife. NCCN guidelines Version 2.2014 risk groups analyzed included very low (20%), low (23%), intermediate (35%), and high (22%) risk. To further explore group heterogeneity and to comply with new guidelines, we separated our prior intermediate risk group into favorable intermediate and unfavorable intermediate groups depending on how many intermediate risk factors were present (one vs. > one). The unfavorable intermediate group was further analyzed in combination with the high risk group as per NCCN guidelines Version 2.2014. Various dose levels were used over the years of treatment, and have been categorized into low dose (35 Gy, n = 5 or 36.25 Gy, n = 107) and high dose (37.5 Gy, n = 30). All treatments were delivered in five fractions. Toxicity was assessed using radiation therapy oncology group criteria. Five-year actuarial freedom from biochemical failure (FFBF) was 100, 91.7, 95.2, 90.0, and 86.7% for very low, low, intermediate and high risk patients, respectively. A significant difference in 5 year FFBF was noted for patients with Gleason score (GS) ≥8 vs. 7 vs. 5/6 (p = 0.03) and low vs. high dose (p = 0.05). T-stage, pretreatment PSA, age, risk stratification group, and use of ADT did not affect 5-year FFBF. Multivariate analysis revealed GS and dose to be the most predictive factors for 5-year FFBF. Our experience with SBRT for the primary treatment of localized prostate cancer demonstrates favorable efficacy and toxicity comparable to the results reported for IMRT in literature. GS remains the single most important pretreatment predictor of outcome.

Uptake of prenatal screening for chromosomal anomalies: impact of test results in a previous pregnancy.

PubMed

Spencer, Kevin

2002-12-01

To assess whether the uptake of prenatal screening for trisomy 21 in a subsequent pregnancy is influenced by being classified in the 'increased risk' or 'not at increased risk' group in the first pregnancy. District General Hospital Maternity Unit. Amongst a group of women attending for maternity care at this hospital, the maternity records were examined to find women having at least two pregnancies. Any prenatal screening record for each pregnancy was retrieved from the prenatal screening database. Prenatal screening for trisomy 21 was by a combination of maternal serum alpha-fetoprotein (AFP) and free beta-human chorionic gonadotrophin (beta-hCG) in the second trimester and by maternal serum free beta-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency (NT) thickness in the first trimester. Women were stratified according to their trisomy 21 risk into an 'increased risk' group (1: <250 in the second trimester and 1: <300 in the first trimester) or 'not at increased risk' group based on their first pregnancy. In a second pregnancy, the records were examined to see if the mother accepted prenatal screening in the second pregnancy. The rate of acceptance of screening in a subsequent pregnancy, depending on whether 'at increased risk' or 'not at increased risk' in the first pregnancy, was examined using chi square tests. In the second trimester study, 4601 women were identified with two pregnancies during the study period. Of these, 4559 women had prenatal screening in a subsequent pregnancy. Initially, 273 women were identified in the high-risk group, and of these 252 (92.3%) elected to have prenatal screening in a subsequent pregnancy. This compared with 4307 of 4328 (99.5%) women in the low-risk group. In the first trimester study, 1077 women were identified with two pregnancies during the study period. Of these, 1072 had prenatal screening in a subsequent pregnancy. Initially, 60 women were identified in the high-risk group, and of these 56 (93.3%) elected to have prenatal screening in a subsequent pregnancy. This compared with 1016 of 1017 (99.9%) in the low-risk group. Statistically, there was no difference between the rate of declining prenatal screening in a second pregnancy amongst those in the high-risk group in a first pregnancy or those in the low-risk group (p = 0.429 for second trimester screening and p = 0.794 for first trimester screening). Similarly, no difference could be demonstrated between rates when screening in the first or second trimester (p = 0.961) for those in the high-risk group. Despite the understandable anxiety associated with being identified in the high-risk group (as a false positive finding) in a previous pregnancy, this did not seem to deter women from accepting prenatal screening in a subsequent pregnancy. Copyright 2002 John Wiley & Sons, Ltd.

Psychological characteristics in high-risk MSM in China

PubMed Central

2012-01-01

Background Men who have sex with men (MSM) have become a high-risk group of HIV infection in China. To date, little is known regarding the behavioral, social and psychological characteristics in Chinese MSM, which makes the implementation of preventive and therapeutic strategies for this high-risk subpopulation of people extremely difficult. Methods A total of 714 questionnaires were retrieved from the database of a Chinese government-sponsored National Key Research Project titled "Risk Analysis and Strategic Prevention of HIV Transmission from MSM to the General Population in China". The respondents were categorized into a high-risk group and a control group. Their behavioral, social and psychological characteristics were comparatively analyzed. Results Of the 714 MSM analyzed, 59 (8.26%) had high-risk homosexual behaviors. This sub-group of MSM had a higher in-marriage rate, a higher monthly income, heavier alcohol consumption and more serious problems with sexual abuse in childhood, intentional suicide attempts and mistaken assumption on condom's role in protecting HIV infection, as compared with the control group (P < 0.05). In contrast, the two groups did not differ significantly the sexual orientation, level of education, types of profession, drug use, condom use and experience of social stigma and discrimination (P > 0.05). A vast majority of the individuals in both behavior categories expressed support of legally protected gay clubs as well as gay marriage legislation in China. There was a strong correlation between high-risk behaviors and sexual abuse in childhood, alcohol drinking, income level and a mistaken belief in perfect HIV protection through the use of condoms. Conclusions MSM with and without high-risk homosexual behaviors have different social and psychological characteristics, which should be taken into account when implementing behavioral and therapeutic interventions aimed at preventing HIV/AIDS transmission among MSM as well as from MSM to the general population in China. PMID:22264355

Evaluation of community health screening participants' knowledge of cardiovascular risk factors.

PubMed

Mooney, Leslie A; Franks, Amy M

2009-01-01

To assess knowledge of cardiovascular disease (CVD) risk factors among a group of health screening participants and to compare knowledge between participants with high and low CVD risk. Cross-sectional pilot study. Jonesboro, AR, during June 2007. 121 adult volunteers participating in a community health screening. 34-item self-administered written questionnaire. Ability to identify CVD risk factors and healthy values for CVD risk factors and the differences in these abilities between participants with high and low CVD risk. Participants demonstrated good knowledge of traditional CVD risk factors such as high blood pressure, high cholesterol, lack of exercise, and overweight or obese status. Knowledge of other CVD risk factors and healthy values for major CVD risk factors was limited. Participants with high CVD risk were significantly more likely to correctly identify high triglycerides as a CVD risk factor and to identify healthy values for fasting blood glucose and total cholesterol compared with participants with low CVD risk. Overall, participants lacked knowledge of the risk factor status and healthy values for many CVD risk factors. Participants with high CVD risk may have better knowledge of some CVD risk factors than participants with low CVD risk. These findings highlight the need for more education to improve knowledge in both risk groups.

Prophylactic Groin Wound Vacuum-assisted Therapy in Vascular Surgery Patients at Enhanced Risk for Postoperative Wound Infection.

PubMed

Pesonen, Luke O; Halloran, Brian G; Aziz, Abdulhameed

2018-01-01

Vascular groin wounds have higher than expected surgical site infection (SSI) rates and some patients are at enhanced risk. The Wiseman et al. paper suggests an objective scoring system that identifies patients at enhanced risk of postdischarge SSI. We hypothesize that prophylactic groin wound vacuum-assisted closure (VAC) therapy in enhanced risk patients will decrease SSI and readmission and the Wiseman model provides potential evidence that enhanced risk patients can be objectively identified. A single institution, retrospective analysis was conducted from January 2013 to September 2016 utilizing procedure codes to identify patients with wound VACs placed in the operating room. Two distinct groups were identified. The first was a wound complication patient group with 15 limbs (13 patients) with a groin wound VAC placed within 45 days postoperatively for groin wound complications. Eleven of these limbs had the VAC placed at readmission. The second group was a prophylactic patient group that included 8 limbs (7 patients) who received a VAC prophylactically placed in the enhanced risk wounds. These wounds were determined to be enhanced risk based on clinical criteria judged by the operating surgeon such as a large overhanging panniculus and/or one of several ongoing medical issues. We calculated a Wiseman score for all patients, determined total cost of the readmissions, and determined 30-day postsurgical SSI incidence for the prophylactic VAC group. Per the Wiseman scores, 9 limbs with postoperative complications were high risk and 3 limbs were moderate/high risk. Eleven limbs had a VAC placed at readmission with an average readmission cost of $8876.77. For the prophylactic group, 8 limbs were high risk with no observed postdischarge SSI in the first 30 days from surgery. The Wiseman scores showed close correlation between the retrospective high and moderate/high risk groups versus the prophylactic VAC group (31.5 ± 7.3 vs. 32 ± 5.5, P = 0.87). The Wiseman scores showed objective validation in the prognosis of anticipating groin wound breakdown. Our initial results suggest that prophylactic groin wound VAC placement for enhanced risk vascular surgery patients may proactively decrease wound morbidity, decrease readmission secondary to groin wound complications, and provide some cost benefit. Copyright © 2017 Elsevier Inc. All rights reserved.

Impact of GOLD groups of chronic pulmonary obstructive disease on surgical complications.

PubMed

Kim, Hyung-Jun; Lee, Jinwoo; Park, Young Sik; Lee, Chang-Hoon; Lee, Sang-Min; Yim, Jae-Joon; Yoo, Chul-Gyu; Kim, Young Whan; Han, Sung Koo; Choi, Sun Mi

2016-01-01

Chronic obstructive pulmonary disease (COPD) is associated with increased postoperative complications. Recently, the Global Initiative for Chronic Obstructive Lung Disease (GOLD) classified COPD patients into four groups based on spirometry results and the severity of symptoms. The objective of this study was to evaluate the impact of GOLD groups on postoperative complications. We reviewed the medical records of COPD patients who underwent preoperative spirometry between April and August 2013 at a tertiary hospital in Korea. We divided the patients into GOLD groups according to the results of spirometry and self-administered questionnaires that assessed the symptom severity and exacerbation history. GOLD groups, demographic characteristics, and operative conditions were analyzed. Among a total of 405 COPD patients, 70 (17.3%) patients experienced various postoperative complications, including infection, wound, or pulmonary complications. Thoracic surgery, upper abdominal surgery, general anesthesia, large estimated blood loss during surgery, and longer anesthesia time were significant risk factors for postoperative complications. Patients in high-risk group (GOLD groups C or D) had an increased risk of postoperative complications compared to those in low-risk group (GOLD groups A or B). COPD patients in GOLD groups representing a high exacerbation risk have an increased risk of postoperative complications compared to those with low risk.

A new look at the International Duration Evaluation of Adjuvant therapy (IDEA) classification-Defining novel predictive and prognostic markers in stage III colon cancer.

PubMed

Margalit, Ofer; Mamtani, Ronac; Yang, Yu-Xiao; Reiss, Kim A; Golan, Talia; Halpern, Naama; Aderka, Dan; Giantonio, Bruce; Shacham-Shmueli, Einat; Boursi, Ben

2018-04-23

The International Duration Evaluation of Adjuvant therapy (IDEA) pooled analysis compared 3 to 6 months of adjuvant chemotherapy for stage III colon cancer. The overarching goal was to reduce chemotherapy-related toxicity, mainly oxaliplatin-induced neuropathy. Patients were classified into low-risk and high-risk groups, suggesting that low-risk patients may be offered only 3 months of treatment. We aimed to evaluate the benefit of monotherapy versus doublet chemotherapy in low and high IDEA risk groups. Using the National Cancer Database (2004-2014), we identified 56,728 low-risk and 47,557 high-risk individuals with stage III colon cancer, according to the IDEA classification. We used multivariate Cox regression to evaluate the magnitude of survival differences between IDEA risk groups, according to treatment intensity (doublet versus monotherapy). In a secondary analysis, we examined the prognostic and predictive value of subgroups of age, tumour sidedness and lymph node ratio (LNR). Low and high IDEA risk groups derived similar benefit from doublet adjuvant chemotherapy as compared with monotherapy, with hazard ratios (HRs) of 0.83 (95% confidence interval [CI] 0.79-0.86) and 0.80 (95% CI 0.78-0.83), respectively. The only subpopulations that did not benefit from doublet chemotherapy were low-risk patients older than 72 years (HR = 0.95, 95% CI 0.90-1.01) and high-risk patients older than 85 years (HR = 0.90, 95% CI 0.77-1.05). LNR and tumour sidedness were shown as additional prognostic, but not predictive, factors within the IDEA risk groups. IDEA risk classification per se does not predict for treatment benefit from doublet chemotherapy in stage III colon cancer. However, omission of oxaliplatin can be considered in IDEA low-risk patients older than 72 years. Copyright © 2018 Elsevier Ltd. All rights reserved.

Differences in the distribution of risk factors for stroke among the high-risk population in urban and rural areas of Eastern China.

PubMed

Mi, Te; Sun, Shangwen; Du, Yifeng; Guo, Shougang; Cong, Lin; Cao, Mingfeng; Sun, Qinjian; Sun, Yi; Qu, Chuanqiang

2016-05-01

Considering the program of screening for risk factors of stroke in Eastern China, the aim of this study was to compare the distribution differences in risk factors for stroke among the high-risk population living in urban and rural areas. A total of 231,289 residents were screened and basic information collected. Risk factors for stroke among the high-risk population were compared between the urban and rural groups. A total of 117,776 high-risk residents from urban areas and 113,513 from rural areas were included in the analysis. The prevalence of hypertension was much higher in rural areas (73.3%) than that in urban areas (64.1%). Dyslipidemia (48.9% vs. 26.9%), sport lack (46.6% vs. 31.6%), diabetes mellitus (21.3% vs. 16.5%), and atrial fibrillation (18.7% vs. 9.8%) were more prevalent in the urban group, while smoking (26.5% vs. 28.8%), previous stroke (10.1% vs. 16.9%), and transient ischemic attack (20.9% vs. 24.6%) were less prevalent. Among the population at high risk of stroke, there were significant differences in the distribution of the following risk factors between the urban and rural groups: hypertension, atrial fibrillation, dyslipidemia, lack of physical exercise, and a previous stroke.

Herd-level bovine tuberculosis risk factors: assessing the role of low-level badger population disturbance.

PubMed

Wright, David M; Reid, Neil; Ian Montgomery, W; Allen, Adrian R; Skuce, Robin A; Kao, Rowland R

2015-08-17

Bovine TB (bTB) is endemic in Irish cattle and has eluded eradication despite considerable expenditure, amid debate over the relative roles of badgers and cattle in disease transmission. Using a comprehensive dataset from Northern Ireland (>10,000 km(2); 29,513 cattle herds), we investigated interactions between host populations in one of the first large-scale risk factor analyses for new herd breakdowns to combine data on both species. Cattle risk factors (movements, international imports, bTB history, neighbours with bTB) were more strongly associated with herd risk than area-level measures of badger social group density, habitat suitability or persecution (sett disturbance). Highest risks were in areas of high badger social group density and high rates of persecution, potentially representing both responsive persecution of badgers in high cattle risk areas and effects of persecution on cattle bTB risk through badger social group disruption. Average badger persecution was associated with reduced cattle bTB risk (compared with high persecution areas), so persecution may contribute towards sustaining bTB hotspots; findings with important implications for existing and planned disease control programmes.

Personalized treatment of women with early breast cancer: a risk-group specific cost-effectiveness analysis of adjuvant chemotherapy accounting for companion prognostic tests OncotypeDX and Adjuvant!Online.

PubMed

Jahn, Beate; Rochau, Ursula; Kurzthaler, Christina; Hubalek, Michael; Miksad, Rebecca; Sroczynski, Gaby; Paulden, Mike; Bundo, Marvin; Stenehjem, David; Brixner, Diana; Krahn, Murray; Siebert, Uwe

2017-10-16

Due to high survival rates and the relatively small benefit of adjuvant therapy, the application of personalized medicine (PM) through risk stratification is particularly beneficial in early breast cancer (BC) to avoid unnecessary harms from treatment. The new 21-gene assay (OncotypeDX, ODX) is a promising prognostic score for risk stratification that can be applied in conjunction with Adjuvant!Online (AO) to guide personalized chemotherapy decisions for early BC patients. Our goal was to evaluate risk-group specific cost effectiveness of adjuvant chemotherapy for women with early stage BC in Austria based on AO and ODX risk stratification. A previously validated discrete event simulation model was applied to a hypothetical cohort of 50-year-old women over a lifetime horizon. We simulated twelve risk groups derived from the joint application of ODX and AO and included respective additional costs. The primary outcomes of interest were life-years gained, quality-adjusted life-years (QALYs), costs and incremental cost-effectiveness (ICER). The robustness of results and decisions derived were tested in sensitivity analyses. A cross-country comparison of results was performed. Chemotherapy is dominated (i.e., less effective and more costly) for patients with 1) low ODX risk independent of AO classification; and 2) low AO risk and intermediate ODX risk. For patients with an intermediate or high AO risk and an intermediate or high ODX risk, the ICER is below 15,000 EUR/QALY (potentially cost effective depending on the willingness-to-pay). Applying the AO risk classification alone would miss risk groups where chemotherapy is dominated and thus should not be considered. These results are sensitive to changes in the probabilities of distant recurrence but not to changes in the costs of chemotherapy or the ODX test. Based on our modeling study, chemotherapy is effective and cost effective for Austrian patients with an intermediate or high AO risk and an intermediate or high ODX risk. In other words, low ODX risk suggests chemotherapy should not be considered but low AO risk may benefit from chemotherapy if ODX risk is high. Our analysis suggests that risk-group specific cost-effectiveness analysis, which includes companion prognostic tests are essential in PM.

Comparison of the Mini Mental State Examination and depressive symptoms between high cardiovascular risk and healthy community elderly groups

PubMed Central

da Costa, Amanda Lucas; Varela, Juliana Santos; Mazetti, Osmar; Restelatto, Luciane; Costa, Andry Fitterman; Godinho, Claudia; Camozzato, Ana Luiza; Picon, Paulo D.; Chaves, Márcia L.

2008-01-01

The aging of the population is a universal phenomenon with direct consequences upon the public health system. One of the main repercussions of the growth in this sector of the population is the increased prevalence of disorders such as dementia and depression which are very frequent among the elderly. The relationship between cardiovascular risk factors, dementia and depression have been addressed in many recent investigations. Objectives To evaluate the relationship of cognitive performance and depressive symptoms with cardiovascular risk in the elderly. Methods 94 high cardiovascular risk elderly patients and 160 healthy community elderly were evaluated cross-sectionally. The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used as the main measures. The cutoff for presence of depression was 6 on the GDS. Results The high cardiovascular risk elderly group showed significantly lower scores on the MMSE (p<0.001) and was significantly associated to depression (p<0.001), independently of education. The logistic regression analysis for depression as the dependent variable, age and group (healthy community or high cardiovascular risk elderly) were kept in the final equation. Higher age (Odds Ratio=0.92; 95% CI 0.86–0.98) and high cardiovascular risk elderly (OR=2.99; 95% CI 1.36–6.59) were associated to depression. Conclusions The present findings corroborate the different cognitive performance of elderly with high cardiovascular risk factors and the association of depressive symptoms with this group. PMID:29213588

Comparison of the Mini Mental State Examination and depressive symptoms between high cardiovascular risk and healthy community elderly groups.

PubMed

da Costa, Amanda Lucas; Varela, Juliana Santos; Mazetti, Osmar; Restelatto, Luciane; Costa, Andry Fitterman; Godinho, Claudia; Camozzato, Ana Luiza; Picon, Paulo D; Chaves, Márcia L

2008-01-01

The aging of the population is a universal phenomenon with direct consequences upon the public health system. One of the main repercussions of the growth in this sector of the population is the increased prevalence of disorders such as dementia and depression which are very frequent among the elderly. The relationship between cardiovascular risk factors, dementia and depression have been addressed in many recent investigations. To evaluate the relationship of cognitive performance and depressive symptoms with cardiovascular risk in the elderly. 94 high cardiovascular risk elderly patients and 160 healthy community elderly were evaluated cross-sectionally. The Mini Mental State Examination (MMSE) and the Geriatric Depression Scale (GDS-15) were used as the main measures. The cutoff for presence of depression was 6 on the GDS. The high cardiovascular risk elderly group showed significantly lower scores on the MMSE (p<0.001) and was significantly associated to depression (p<0.001), independently of education. The logistic regression analysis for depression as the dependent variable, age and group (healthy community or high cardiovascular risk elderly) were kept in the final equation. Higher age (Odds Ratio=0.92; 95% CI 0.86-0.98) and high cardiovascular risk elderly (OR=2.99; 95% CI 1.36-6.59) were associated to depression. The present findings corroborate the different cognitive performance of elderly with high cardiovascular risk factors and the association of depressive symptoms with this group.

Genetic Correlates of Spirituality/Religion and Depression: A Study in Offspring and Grandchildren at High and Low Familial Risk for Depression

PubMed Central

Anderson, Micheline R.; Miller, Lisa; Wickramaratne, Priya; Svob, Connie; Odgerel, Zagaa; Zhao, Ruixin; Weissman, Myrna M.

2017-01-01

Rationale Possible genetic correlates of spirituality and depression have been identified in community samples. We investigate some of the previously identified candidates in a sample of families at both high and low-risk for depression. Method Offspring and grandchildren of individuals at high and low-risk for depression, participating in a multi-wave thirty-year longitudinal study, were assessed for seven SNPS drawn from four single gene candidates associated with systems implicated in both depression and spirituality: Serotonin (5-HT1B and 5-HT2A), Dopamine (DRD2), Oxytocin (OT) and Monoamine Vesicular Transporter (VMAT1). Results Dopamine (DRD2) Serotonin (5-HT1B), their Transporter (VMAT1) and Oxytocin (OXTR) were positively associated with a high level of importance of spirituality or religion (S/R) in the group at low familial risk for depression. DRD2 minor allele was associated with both lifetime major depressive disorder (MDD) and spirituality in the low-risk group for depression. No SNPs were related to S/R in the group at high familial risk for depression. OXTR was associated with lifetime MDD in the full sample. Conclusion Genes for dopamine, serotonin, their vesicular transporter, and oxytocin may be associated with S/R in people at low familial risk for depression. Genes for dopamine may be associated both with S/R and increased risk for depression in people at low-risk for depression, suggesting a common pathway or physiology to mild to moderate depression. MDD is associated with oxytocin across risk groups. In the high-risk group, phenotypic expression of S/R may be suppressed. Implications The shared association of DRD2 by S/R and depression, generally found to be inversely related, calls for further research on their common physiological pathways, and the phenotypic expression of these pathways based upon use and environment. Prevention for offspring at high familial risk for depression might include support for the development of child spirituality. PMID:29057276

The priority group index: a proposed new method incorporating high risk and population burden to identify target populations for public health interventions.

PubMed

Zhang, Bo; Cohen, Joanna E; OʼConnor, Shawn

2014-01-01

Selection of priority groups is important for health interventions. However, no quantitative method has been developed. To develop a quantitative method to support the process of selecting priority groups for public health interventions based on both high risk and population health burden. Secondary data analysis of the 2010 Canadian Community Health Survey. Canadian population. Survey respondents. We identified priority groups for 3 diseases: heart disease, stroke, and chronic lower respiratory diseases. Three measures--prevalence, population counts, and adjusted odds ratios (OR)--were calculated for subpopulations (sociodemographic characteristics and other risk factors). A Priority Group Index (PGI) was calculated by summing the rank scores of these 3 measures. Of the 30 priority groups identified by the PGI (10 for each of the 3 disease outcomes), 7 were identified on the basis of high prevalence only, 5 based on population count only, 3 based on high OR only, and the remainder based on combinations of these. The identified priority groups were all in line with the literature as risk factors for the 3 diseases, such as elderly people for heart disease and stroke and those with low income for chronic lower respiratory diseases. The PGI was thus able to balance both high risk and population burden approaches in selecting priority groups, and thus it would address health inequities as well as disease burden in the overall population. The PGI is a quantitative method to select priority groups for public health interventions; it has the potential to enhance the effective use of limited public resources.

[Effect of Huangqi injection on short-term prognosis in children with acute lymphoblastic leukemia].

PubMed

Yan, Pei-Hua; Yan, Mei; Wang, Xue-Mei; Wang, Shu-Hong

2014-02-01

To investigate the effect of Huangqi injection on the short-term prognosis in childhood with acute lymphoblastic leukemia (ALL). A retrospective analysis was performed on the clinical data of 105 children newly diagnosed with ALL between January 2009 and December 2012. These children were randomly divided into treatment group (18 low-risk cases, 7 medium-risk cases, and 24 high-risk cases) and control group (21 low-risk cases, 7 medium-risk cases, 28 high-risk cases). Both groups were given remission induction therapy based on the levels of risk. Throughout the remission induction therapy, the treatment group also received Huangqi injection (0.5-1.0 mL/kg per day) by intravenous infusion, while the control group was given 0.9% sodium chloride injection instead. The two groups were compared in terms of distribution of prognostic factors and complete remission (CR) rate after remission induction therapy, as well as the incidence of minimal residual disease (MDR) (≥ 10(-4) and < 10(-4)) among all patients in the two groups on day 19 of remission induction therapy and among B-ALL patients in the two groups when achieving a CR at the end of remission induction therapy. Of the 105 children with ALL, 99 had B-ALL, and 6 had T-ALL. There were no significant differences in the distribution of prognostic factors between the two groups (P>0.05). The overall CR rate of 105 patients was 79%; there was no significant difference in CR rate between the treatment and control groups (82% vs 77%; P>0.05); also, no significant differences were found between the two groups in the CR rates among high-, medium-, and low-risk cases (P>0.05). On day 19 of remission induction therapy, the incidence of MRD≥10(-4) in the treatment group was significantly lower than that in the control group (69% vs 95%; P<0.05); among 80 children with B-ALL who achieved a CR (43 cases in the control group and 37 cases in the treatment group), the incidence of MRD≥10-4 was significantly lower in the treatment group than in the control group (27% vs 58%; P<0.05); in both circumstances above, the high- and low-risk cases in the treatment group had a significantly lower incidence of MRD≥10(-4) than the control group (P<0.05). Huangqi injection combined with chemotherapy has an enhanced anti-tumor effect and can improve the short-term prognosis and clinical outcome in children with ALL.

Retrospective analysis of 616 air-rescue trauma cases related to the practice of extreme sports.

PubMed

Gosteli, Gaël; Yersin, Bertrand; Mabire, Cédric; Pasquier, Mathieu; Albrecht, Roland; Carron, Pierre-Nicolas

2016-07-01

Extreme sports (ESs) are increasingly popular, and accidents due to ESs sometimes require helicopter emergency medical services (HEMSs). Little is known about their epidemiology, severity, specific injuries and required rescue operations. Our aims were to perform an epidemiological analysis, to identify specific injuries and to describe the characteristic of prehospital procedures in ES accidents requiring HEMSs. This is a retrospective study, reviewing all rescue missions dedicated to ESs provided by HEMS REGA Lausanne, from 1 January 1998 to 31 December 2008. ES were classified into three categories of practice, according to the type of risk at the time of the fall. Among the 616 cases meeting inclusion criteria, 219 (36%) were clearly high-risk ES accidents; 69 (11%) and 328 (53%) were related to potential ES, but with respectively low or indeterminate risk at the time of the fall. In the high-risk ES group, the median age was 32 years and 80% were male. Mortality at 48h was 11%, almost ten times higher than in the other two groups. The proportion of potentially life-threatening injuries (the National Advisory Committee for Aeronautics (NACA) score≥4) was 39% in the high-risk ES group and 13% in the other two groups. Thirty per cent of the cases in the high-risk ES group presented an Injury Severity Score (ISS) >15, compared with 7% in the other groups. Thoracolumbar vertebral fractures were the most common injuries with 32% of all cases having at least one, involving the T12-L2 junction in 56% of cases. The other most frequent injuries were traumatic brain injuries (16%), rib fractures (9%), pneumothorax (8%) and femoral (7%), cervical (7%), ankle (5%) and pelvic (5%) fractures. Median time on site for rescue teams was higher in the confirmed high-risk ES group, with 50% of prehospital missions including at least one environmental difficulty. High-risk ESs led to high-energy accidents, characterized by a large proportion of severe injuries and axial traumas (spine, thorax, pelvis and proximal femur). We identified a considerable percentage of thoracolumbar vertebral fractures, mainly in the T12-L2 junction. HEMSs dedicated to high-risk ESs implied longer and more complex interventions. Copyright © 2016 Elsevier Ltd. All rights reserved.

Prevalence of hepatitis C virus infection among high-risk groups in Iran: a systematic review and meta-analysis.

PubMed

Nematollahi, S; Ayubi, E; Almasi-Hashiani, A; Mansori, K; Moradi, Y; Veisani, Y; Jenabi, E; Gholamaliei, B; Khazaei, S

2018-06-20

Determination of the true burden of hepatitis C virus (HCV) infection among high-risk groups relies heavily on occurrence measures such as prevalence, which are vital for implementation of preventive action plans. Nevertheless, up-to-date data on the prevalence of HCV infection remain scarce in Iran. This study aimed to review the relevant literature systematically and determine the pooled prevalence of HCV infection among high-risk groups in Iran. Systematic review & meta-analysis. In 2016, electronic scientific databases including PubMed, Scopus, Web of Science and local databases were searched using a detailed search strategy with language restricted to English and Farsi. The reference lists of the studies included in this review were also screened. Data were reviewed and extracted independently by two authors. A random effects model was used to estimate the pooled prevalence. Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression. In total, 1817 records were identified in the initial search, and 46 records were included in the meta-analysis. The overall prevalence of HCV among high-risk groups was 32.3%. The prevalence was 41.3% in injection drug users (IDUs), 22.9% in prisoners, 16.2% in drug-dependent individuals and 24.6% in drug-dependent prisoners. Subgroup and meta-regression analyses revealed that geographical location and year of publication were the probable sources of heterogeneity. This meta-analysis found a high prevalence of HCV among high-risk groups in Iran, particularly among IDUs. There is a need for prevention strategies to reduce the burden of HCV infection among high-risk groups, particularly IDUs. Copyright © 2018 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

[Occupational differences in exposure to hazardous work conditions].

PubMed

Marinacci, Chiara; d'Errico, A; Cardano, M; Perini, F; Costa, G

2005-01-01

Few studies have been aimed at describing organizational and psychosocial conditions of the Italian workforce by occupational group, and they have been mainly conducted within specific occupations. The present study aimed at identifying specific groups of occupations which have unfavourable profiles from the point of view of exposure to specific organizational factors and psychosocial risks, and to physical, chemical and ergonomic risks, and analyzing their distribution by worker age. The analysis was conducted on a sample of 4,195 workers in the Piedmont Region who were members of the CGIL Trade Union (Italian General Confederation of Labour), who answered a self-administered questionnaire in 2000, aimed at assessing chemical, physical, and ergonomic risks, accidents, and psychosocial factors connected with work organization and work tasks. Psychosocial risks were assessed via three scales aimed at measuring the degree of control, psychophysical demands, and worker satisfaction. The proportion of workers exposed to the above mentioned risks was analysed according to occupational group. This group was then compared with all other groups taken together, according to prevalence of high strain condition (combination of high demand and low control) and HSUR condition (High Strain Unfairly Rewarded; combination of high strain and low satisfaction). Among males aged 25-44 years, restricted to the occupation groups with more than ten workers in high strain condition, significantly higher proportions of stress were observed in leather workers and shoemakers, paper factory workers, rubber workers, crane and bridge crane operators, plastic workers, painters, transport drivers and carpenters. For many of these groups, excesses were confirmed for the HSUR condition. Among subjects aged over 44 years, a higher risk for high strain was confirmed in rubber workers, transport drivers and carpenters. In addition, machine tool operators, assembly line and mechanical workers in this age group were exposed to higher risk of stress. In younger women there was a significantly higher risk of both high strain and HSUR conditions in workers employed in the rubber, plastic and the food industries, and in machine tool workers. Such excess risk was confirmed in the latter three categories also among older women. In general, the proportion of male workers classified as working in high strain conditions decreased as age increased, while in women it remained stable. The study allowed evaluation of the differential impact of exposure to physical, chemical, and psychosocial risk factors among occupational groups, thus contributing to the identification and classification of exhausting jobs. The results further showed, particularly among men, a smaller proportion of older workers, compared to younger ones, exposed to harmful physical, chemical, ergonomic and psychosocial conditions, indicating a possible propensity of companies to adapt workplace conditions, organization and internal mobility to worker age.

The impact of numeracy on reactions to different graphic risk presentation formats: An experimental analogue study.

PubMed

Wright, Alison J; Whitwell, Sophia C L; Takeichi, Chika; Hankins, Matthew; Marteau, Theresa M

2009-02-01

Numeracy, the ability to process basic mathematical concepts, may affect responses to graphical displays of health risk information. Displays of probabilistic risk information using grouped dots are easier to understand than displays using dispersed dots. However, dispersed dots may better convey the randomness with which health threats occur, so increasing perceived susceptibility. We hypothesized that low numeracy participants would better understand risks presented using grouped dot displays, while high numeracy participants would have good understanding, regardless of display type. Moreover, we predicted that dispersed dot displays, in contrast to grouped dot displays, would increase risk perceptions and worry only for highly numerate individuals. One hundred and forty smokers read vignettes asking them to imagine being at risk of Crohn's disease, in a 2(display type: dispersed/grouped dots) x 3(risk magnitude: 3%/6%/50%) x 2(numeracy: high/low) design. They completed measures of risk comprehension, perceived susceptibility and worry. More numerate participants had better objective risk comprehension, but this effect was not moderated by display type. There was marginally significant support for the predicted numeracy x display type interaction for worry about Crohn's disease, but not for perceived susceptibility to the condition. Dispersed dot displays somewhat increase worry in highly numerate individuals, but only numeracy influenced objective risk comprehension. The most effective display type for communicating risk information will depend on the numeracy of the population and the goal(s) of the communication.

Observed changes in cardiovascular risk factors among high-risk middle-aged men who received lifestyle counselling: a 5-year follow-up.

PubMed

Siren, Reijo; Eriksson, Johan G; Vanhanen, Hannu

2016-12-01

To examine the long-term impact of health counselling among middle-aged men at high risk of CVD. An observational study with a 5-year follow-up. All men aged 40 years in Helsinki have been invited to a visit to evaluate CVD risk from 2006 onwards. A modified version of the North Karelia project risk tool (CVD risk score) served to assess the risk. High-risk men received lifestyle counselling based on their individual risk profile in 2006 and were invited to a follow-up visit in 2011. Of the 389 originally high-risk men, 159 participated in the follow-up visits in 2011. Based on their follow-up in relation the further risk communication, we divided the participants into three groups: primary health care, occupational health care and no control visits. Lifestyle and CVD risk score change. All groups showed improvements in lifestyles. The CVD risk score decreased the most in the group that continued the risk communication visits in their primary health care centre (6.1 to 4.8 [95% CI -1.6 to -0.6]) compared to those who continued risk communication visits in their occupational health care (6.0 to 5.4 [95% CI -1.3 to 0.3]), and to those with no risk communication visits (6.0 to 5.9 [95% CI -0.5 to 0.4]). These findings indicate that individualized lifestyle counselling improves health behaviour and reduces total CVD risk among middle-aged men at high risk of CVD. Sustained improvement in risk factor status requires ongoing risk communication with health care providers. KEY POINTS Studies of short duration have shown that lifestyle changes reduce the risk of cardiovascular disease among high-risk individuals. Sustaining these lifestyle changes and maintaining the lower disease risk attained can prove challenging. Cardiovascular disease (CVD) risk assessment and individualized health counselling for high-risk men, when implemented in primary health care, have the potential to initiate lifestyle changes that support risk reduction. Attaining a sustainable reduction in CVD risk requires a willingness to engage in risk-related communication from both health care providers and the individual at high risk.

Use of screening tests to assess cancer risk and to estimate the risk of adult T-cell leukemia/lymphoma.

PubMed Central

Yanagawa, T; Tokudome, S

1990-01-01

We developed methods to assess the cancer risks by screening tests. These methods estimate the size of the high risk group adjusted for the characteristics of screening tests and estimate the incidence rates of cancer among the high risk group adjusted for the characteristics of the tests. A method was also developed for selecting the cut-off point of a screening test. Finally, the methods were applied to estimate the risk of the adult T-cell leukemia/lymphoma. PMID:2269244

Brain structure in people at ultra-high risk of psychosis, patients with first-episode schizophrenia, and healthy controls: a VBM study.

PubMed

Nenadic, Igor; Dietzek, Maren; Schönfeld, Nils; Lorenz, Carsten; Gussew, Alexander; Reichenbach, Jürgen R; Sauer, Heinrich; Gaser, Christian; Smesny, Stefan

2015-02-01

Early intervention research in schizophrenia has suggested that brain structural alterations might be present in subjects at high risk of developing psychosis. The heterogeneity of regional effects of these changes, which is established in schizophrenia, however, has not been explored in prodromal or high-risk populations. We used high-resolution MRI and voxel-based morphometry (VBM8) to analyze grey matter differences in 43 ultra high-risk subjects for psychosis (meeting ARMS criteria, identified through CAARMS interviews), 24 antipsychotic-naïve first-episode schizophrenia patients and 49 healthy controls (groups matched for age and gender). Compared to healthy controls, resp., first-episode schizophrenia patients had reduced regional grey matter in left prefrontal, insula, right parietal and left temporal cortices, while the high-risk group showed reductions in right middle temporal and left anterior frontal cortices. When dividing the ultra-high-risk group in those with a genetic risk vs. those with attenuated psychotic symptoms, the former showed left anterior frontal, right caudate, as well as a smaller right hippocampus, and amygdala reduction, while the latter subgroup showed right middle temporal cortical reductions (each compared to healthy controls). Our findings in a clinical psychosis high-risk cohort demonstrate variability of brain structural changes according to subgroup and background of elevated risk, suggesting frontal and possibly also hippocampal/amygdala changes in individuals with genetic susceptibility. Heterogeneity of structural brain changes (as seen in schizophrenia) appears evident even at high-risk stage, prior to potential onset of psychosis. Copyright © 2014 Elsevier B.V. All rights reserved.

Comparison of a Stratified Group Intervention (STarT Back) With Usual Group Care in Patients With Low Back Pain: A Nonrandomized Controlled Trial.

PubMed

Murphy, Susan E; Blake, Catherine; Power, Camillus K; Fullen, Brona M

2016-04-01

A nonrandomized controlled trial. This study aims to explore the effectiveness of group-based stratified care in primary care. Stratified care based on psychosocial screening (STarT Back) has demonstrated greater clinical and cost-effectiveness in patients with low back pain. However, low back pain interventions are often delivered in groups and evaluating this system of care in a group setting is important. Patients were recruited from 60 general practices and linked physiotherapy services. A new group stratified intervention was compared with a historical nonstratified control group. Patients stratified as low, medium and high risk were offered risk-matched group care. Consenting participants completed self-report measures of functional disability (primary outcome measure), pain, psychological distress, and beliefs. The historical control received a generic group intervention. Analysis was by intention to treat. In total, 251 patients in the new stratified intervention and 332 in the historical control were included in the primary analysis at 12 weeks. The mean age of patients was 43 ± 10.98 years. Overall adjusted mean changes in the RMDQ scores were higher in the stratified intervention than in the control arm at 12-week follow-up (P = 0.028). Exploring the risk groups, individually the high-risk stratified group, demonstrated better outcome over the controls (P = 0.031). The medium-risk stratified intervention demonstrated equally good outcomes (P = 0.125), and low-risk stratified patients, despite less intervention, did as well as the historical controls (P = 0.993). Stratified care delivered in a group setting demonstrated superior outcomes in the high-risk patients, and equally good outcomes for the medium and low-risk groups. This model, embedded in primary care, provides an early and effective model of chronic disease management and adds another dimension to the utility of the STarT Back system of care. 2.

A clinical score to predict the need for intraaortic balloon pump in patients undergoing coronary artery bypass grafting.

PubMed

Miceli, Antonio; Duggan, Simon M J; Capoun, Radek; Romeo, Francesco; Caputo, Massimo; Angelini, Gianni D

2010-08-01

There is no accepted consensus on the definition of high-risk patients who may benefit from the use of intraaortic balloon pump (IABP) in coronary artery bypass grafting (CABG). The aim of this study was to develop a risk model to identify high-risk patients and predict the need for IABP insertion during CABG. From April 1996 to December 2006, 8,872 consecutive patients underwent isolated CABG; of these 182 patients (2.1%) received intraoperative or postoperative IABP. The scoring risk model was developed in 4,575 patients (derivation dataset) and validated on the remaining patients (validation dataset). Predictive accuracy was evaluated by the area under the receiver operating characteristic curve. Mortality was 1% in the entire cohort and 18.7% (22 patients) in the group which received IABP. Multivariable analysis showed that age greater than 70 years, moderate and poor left ventricular dysfunction, previous cardiac surgery, emergency operation, left main disease, Canadian Cardiovascular Society 3-4 class, and recent myocardial infarction were independent risk factors for the need of IABP insertion. Three risk groups were identified. The observed probability of receiving IABP and mortality in the validation dataset was 36.4% and 10% in the high-risk group (score >14), 10.9% and 2.8% in the medium-risk group (score 7 to 13), and 1.7% and 0.7% in the low-risk group (score 0 to 6). This simple clinical risk model based on preoperative clinical data can be used to identify high-risk patients who may benefit from elective insertion of IABP during CABG. Copyright 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Meta-Analysis of Longitudinal Cohort Studies of Suicide Risk Assessment among Psychiatric Patients: Heterogeneity in Results and Lack of Improvement over Time

PubMed Central

Large, Matthew; Kaneson, Muthusamy; Myles, Nicholas; Myles, Hannah; Gunaratne, Pramudie; Ryan, Christopher

2016-01-01

Objective It is widely assumed that the clinical care of psychiatric patients can be guided by estimates of suicide risk and by using patient characteristics to define a group of high-risk patients. However, the statistical strength and reliability of suicide risk categorization is unknown. Our objective was to investigate the odds of suicide in high-risk compared to lower-risk categories and the suicide rates in high-risk and lower-risk groups. Method We located longitudinal cohort studies where psychiatric patients or people who had made suicide attempts were stratified into high-risk and lower-risk groups for suicide with suicide mortality as the outcome by searching for peer reviewed publications indexed in PubMed or PsychINFO. Electronic searches were supplemented by hand searching of included studies and relevant review articles. Two authors independently extracted data regarding effect size, study population and study design from 53 samples of risk-assessed patients reported in 37 studies. Results The pooled odds of suicide among high-risk patients compared to lower-risk patients calculated by random effects meta-analysis was of 4.84 (95% Confidence Interval (CI) 3.79–6.20). Between-study heterogeneity was very high (I2 = 93.3). There was no evidence that more recent studies had greater statistical strength than older studies. Over an average follow up period of 63 months the proportion of suicides among the high-risk patients was 5.5% and was 0.9% among lower-risk patients. The meta-analytically derived sensitivity and specificity of a high-risk categorization were 56% and 79% respectively. There was evidence of publication bias in favour of studies that inflated the pooled odds of suicide in high-risk patients. Conclusions The strength of suicide risk categorizations based on the presence of multiple risk factors does not greatly exceed the association between individual suicide risk factors and suicide. A statistically strong and reliable method to usefully distinguish patients with a high-risk of suicide remains elusive. PMID:27285387

A novel risk classification system for 30-day mortality in children undergoing surgery

PubMed Central

Walter, Arianne I.; Jones, Tamekia L.; Huang, Eunice Y.; Davis, Robert L.

2018-01-01

A simple, objective and accurate way of grouping children undergoing surgery into clinically relevant risk groups is needed. The purpose of this study, is to develop and validate a preoperative risk classification system for postsurgical 30-day mortality for children undergoing a wide variety of operations. The National Surgical Quality Improvement Project-Pediatric participant use file data for calendar years 2012–2014 was analyzed to determine preoperative variables most associated with death within 30 days of operation (D30). Risk groups were created using classification tree analysis based on these preoperative variables. The resulting risk groups were validated using 2015 data, and applied to neonates and higher risk CPT codes to determine validity in high-risk subpopulations. A five-level risk classification was found to be most accurate. The preoperative need for ventilation, oxygen support, inotropic support, sepsis, the need for emergent surgery and a do not resuscitate order defined non-overlapping groups with observed rates of D30 that vary from 0.075% (Very Low Risk) to 38.6% (Very High Risk). When CPT codes where death was never observed are eliminated or when the system is applied to neonates, the groupings remained predictive of death in an ordinal manner. PMID:29351327

The effects of adding group-based lifestyle counselling to individual counselling on changes in plasma glucose levels in a randomized controlled trial: the Inter99 study.

PubMed

Lau, C; Vistisen, D; Toft, U; Tetens, I; Glümer, C; Pedersen, O; Jørgensen, T; Borch-Johnsen, K

2011-12-01

This study aimed to assess whether group-based lifestyle counselling offered to a high-risk population subgroup had any effect beyond individual multifactorial interventions on fasting plasma glucose (FPG) and 2-h plasma glucose (2hPG) changes. In a population-based study of 6784 participants, 4053 were determined to be at high risk based on a risk estimate of ischaemic heart disease or the presence of risk factors (smoking, hypertension, hypercholesterolaemia, obesity, impaired glucose tolerance). Of these subjects, 90% were randomized to high-intensity intervention (group A) and 10% to low-intensity intervention (group B). All participants went through health examinations, risk assessments and individual lifestyle counselling. Participants in group A were further offered group-based lifestyle counselling. The intervention was repeated after 1 and 3 years. A total of 2738 participants free of diabetes at baseline (1999-2001) and with at least one FPG and/or 2hPG measurement during 5 years of follow-up were included in the analyses. Differences in changes of plasma glucose between groups A and B were analyzed using multilevel linear regression. For FPG, crude 5-year changes were significantly different between the two groups (group A: -0.003 mmol/L vs group B: -0.079 mmol/L; P=0.0427). After adjusting for relevant confounders, no differences in FPG changes were observed (P=0.116). Also, no significant differences in the 5-year changes in 2hPG between the two groups were observed (group A: - 0.127 mmol/L vs group B: -0.201 mmol/L; P=0.546). Offering additional group-based intervention to a high-risk population subgroup had no clinical effects on changes in plasma glucose beyond those of individualized multifactorial interventions. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

[Clinical use of statins and cholesterol goals in patients with several cardiovascular risk factors].

PubMed

Gómez-Belda, Ana; Rodilla, Enrique; Albert, Amparo; García, Luis; González, Carmen; Pascual, José M

2003-10-25

Our goal was to determine the number of patients who achieve low-density lipoprotein cholesterol (LDL-c) targets according to new guidelines. Descriptive and transversal study of patients from a cardiovascular clinic. LDL-c was calculated and targets were established according the NCEP-ATP III. 1,811 patients (46% males, 54% females) were studied. 35% of these were high-risk patients (group 1: coronary risk > 20% at 10 years), 19% were intermediate-risk patients (group 2: coronary risk 10-20% at 10 years) and 46% were low-risk patients (group 3: coronary risk < 10% at 10 years). Overall, 58% of patients achieved target LDL-c levels, yet success rates were 26% among group 1 patients, 51% among group 2 patients, and 86% among group 3 patients (p = 0.001, for differences between groups). Statin treatment was significantly related to achieving target LDL-c levels in group 1 patients (OR = 1.7; 95% CI, 1.2-2.4; p = 0.007). In group 1.41% of patients had LDL-c levels > 130 mg/dl without receiving lipid-lowering drugs. Although an overall 58% patients achieve target LDL-C levels, only one of four high-risk patients have LDL-c levels < 100 mg/dl, and statin treatment is a determining factor to achieve this goal. These findings indicate that a more aggressive treatment with statins is needed in secondary prevention.

Using 'WeChat' online social networking in a real-world needs analysis of family members of youths at clinical high risk of psychosis.

PubMed

Zhang, TianHong; Xu, LiHua; Tang, YingYing; Cui, HuiRu; Li, HuiJun; Wei, YanYan; Xu, YangYang; Jiang, LiJuan; Zhu, YiKang; Li, ChunBo; Jiang, KaiDa; Xiao, ZePing; Wang, JiJun

2018-04-01

The argument surrounding the safety and effectiveness of interventions for the population of individuals at a clinical high risk of developing psychosis has been ongoing for the past 30 years. However, few studies have assessed the needs of this special young population, who are struggling with the recent onset of psychotic symptoms. The sample consisted of 171 family members of 108 clinical high-risk individuals included from the ShangHai at Risk for Psychosis research programme. A 'WeChat' group was established to provide mutual support. There were 22,007 valid messages sent within the group between 1 April 2015 and 27 June 2016. Chat records were subsequently analysed to determine the needs of families during intervention at the early stages of psychosis. Families of clinical high-risk individuals were highly involved in the entire medical process, and the major concerns of the families of clinical high-risk individuals focused on both functional recovery and medication. The themes of 'take medication', 'go to school' and 'study in school' were often discussed within the group. A family-focused intervention targeting functional recovery and real-time professional explanations of medication would meet the major needs of families of Chinese clinical high-risk individuals.

[Oral health status of women with normal and high-risk pregnancies].

PubMed

Chaloupka, P; Korečko, V; Turek, J; Merglová, V

2014-01-01

The aim of this study was to compare the oral health status of women with normal pregnancies and those with high-risk pregnancies. A total of 142 women in the third trimester of pregnancy were randomly selected for this study. The pregnant women were divided into two groups: a normal pregnancy group (group F, n = 61) and a high-risk pregnancy group (group R, n = 81). The following variables were recorded for each woman: age, general health status, DMF index, CPITN index, PBI index, amounts of Streptococcus mutans in the saliva and dental treatment needs. The data obtained were analysed statistically. The Mann-Whitney test, Kruskal-Wallis test and chi square test were used, and p-values less than 0.05 were considered statistically significant. The two-sided t-test was used to compare the two cohorts. Women with high-risk pregnancies showed increased values in all measured indices and tests, but there were no statistically significant differences between the two groups in the DMF index, CPITN index and amounts of Streptococcus mutans present in the saliva. Statistically significant differences were detected between the two groups for the PBI index and dental treatment needs. In group F, the maximum PBI index value was 2.9 in group F and 3.8 in group R. Significant differences were found also in mean PBI values. Out of the entire study cohort, 94 women (66.2%) required dental treatment, including 52% (n = 32) of the women with normal pregnancies and 77% (n = 62) of the women with high-risk pregnancies. This study found that women with complications during pregnancy had severe gingivitis and needed more frequent dental treatment than women with normal pregnancies.

[Resilient or Risk Group? Psychological Burden at Unaccompanied Refugee Minors (URM) in Germany].

PubMed

Rücker, Stefan; Büttner, Peter; Lambertz, Birgit; Karpinski, Norbert; Petermann, Franz

2017-04-01

Resilient or Risk Group? Psychological Burden at Unaccompanied Refugee Minors (URM) in Germany Unaccompanied minors (umA in German) are considered as a risk group for psychological disorders. In international studies a high prevalence for trauma, anxiety, and depression were reported. A sample of N = 52 unaccompanied minors living in Germany was questioned on symptom severity as well as stress experience with the Refugee Health Screening-15. More than each second unaccompanied minor shows clinically relevant symptom severity and stress experience. In age-specific analyses the highest stress levels were found among the youngest unaccompanied minors. Therefore, specifically adapted settings for care should be applied for this high-risk group.

Relation of the aortic stiffness with the GRACE risk score in patients with the non ST-segment elevation myocardial infarction

PubMed Central

Omer, Gedikli; Gokhan, Aksan; Adem, Uzun; Sabri, Demircan; Korhan, Soylu

2014-01-01

Background: Current guidelines recommend clinical risk scoring systems for the patients diagnosed and determinated treatment strategy with in Non-ST-elevation elevation myocardial infarction (NSTEMI). Previous studies demonstrated association between aortic elasticity properties, stiffness and severity CAD. However, the associations between Aortic stiffness, elasticity properties and clinical risk scores have not been investigated. In the present study we have evaluated the relation between the Global Registry of Acute Coronary Events (GRACE) risk score and aortic stiffness in patients with NSTEMI. Method: We prospectively analyzed 87 consecutive patients with NSTEMI. Aortic elastic parameter and stiffness parameter were calculated from the echocardiographically derived thoracic aortic diameters (mm/m2), and the measurement of pulse pressure obtained by cuff sphygmomanometry. We have categorized the patients in to two groups as low ((n = 45) (GRACE risk score ≤ 140)) and high ((n = 42) (GRACE risk score > 140)) risk group according to GRACE risk score and compare the both groups. Results: Table 1 shows baseline characteristics of patients. Our study showed that Aortic strain was significantly low (3.5 ± 1.4, 7.9 ± 2.3 respectively, p < 0.001) and aortic stiffness index was significantly high (3.9 ± 0.38; 3 ± 0.35, respectively, p < 0.001) in the high risk group values compared to those with low risk group. The aortic stiffness index was the only independent predictor of GRACE risk score (OR: 119.390; 95% CI: 2.925-4872.8; p = 0.011) in multivariate analysis. Conclusion: We found a significant correlation between aortic stiffness, impaired elasticity and GRACE risk score. Aortic stiffness index was the only independent variable of the high GRACE risk score. The inclusion of aortic stiffness into the GRACE risk score could allow improved risk classification of patients with ACS at admission and this may be important in the diagnosis, follow up and treatment of the patients. PMID:25356178

Relation of the aortic stiffness with the GRACE risk score in patients with the non ST-segment elevation myocardial infarction.

PubMed

Omer, Gedikli; Gokhan, Aksan; Adem, Uzun; Sabri, Demircan; Korhan, Soylu

2014-01-01

Current guidelines recommend clinical risk scoring systems for the patients diagnosed and determinated treatment strategy with in Non-ST-elevation elevation myocardial infarction (NSTEMI). Previous studies demonstrated association between aortic elasticity properties, stiffness and severity CAD. However, the associations between Aortic stiffness, elasticity properties and clinical risk scores have not been investigated. In the present study we have evaluated the relation between the Global Registry of Acute Coronary Events (GRACE) risk score and aortic stiffness in patients with NSTEMI. We prospectively analyzed 87 consecutive patients with NSTEMI. Aortic elastic parameter and stiffness parameter were calculated from the echocardiographically derived thoracic aortic diameters (mm/m(2)), and the measurement of pulse pressure obtained by cuff sphygmomanometry. We have categorized the patients in to two groups as low ((n = 45) (GRACE risk score ≤ 140)) and high ((n = 42) (GRACE risk score > 140)) risk group according to GRACE risk score and compare the both groups. Table 1 shows baseline characteristics of patients. Our study showed that Aortic strain was significantly low (3.5 ± 1.4, 7.9 ± 2.3 respectively, p < 0.001) and aortic stiffness index was significantly high (3.9 ± 0.38; 3 ± 0.35, respectively, p < 0.001) in the high risk group values compared to those with low risk group. The aortic stiffness index was the only independent predictor of GRACE risk score (OR: 119.390; 95% CI: 2.925-4872.8; p = 0.011) in multivariate analysis. We found a significant correlation between aortic stiffness, impaired elasticity and GRACE risk score. Aortic stiffness index was the only independent variable of the high GRACE risk score. The inclusion of aortic stiffness into the GRACE risk score could allow improved risk classification of patients with ACS at admission and this may be important in the diagnosis, follow up and treatment of the patients.

Evaluation of two prognostic indices for adult T cell leukemia/lymphoma in the subtropical endemic area, Okinawa, Japan.

PubMed

Tamaki, Keita; Morishima, Satoko; Nomura, Shogo; Nishi, Yukiko; Nakachi, Sawako; Kitamura, Sakiko; Uchibori, Sachie; Tomori, Shouhei; Hanashiro, Taeko; Shimabukuro, Natsuki; Tedokon, Iori; Morichika, Kazuho; Taira, Naoya; Tomoyose, Takeaki; Miyagi, Takashi; Karimata, Kaori; Ohama, Masayo; Yamanoha, Atsushi; Tamaki, Kazumitsu; Hayashi, Masaki; Uchihara, Jun-Nosuke; Ohshiro, Kazuiku; Asakura, Yoshitaka; Kuba-Miyara, Megumi; Karube, Kennosuke; Fukushima, Takuya; Masuzaki, Hiroaki

2018-05-17

Aggressive adult T-cell leukemia/lymphoma (ATL) has an extremely poor prognosis and is hyperendemic in Okinawa, Japan. This study evaluated two prognostic indices (PIs) for aggressive ATL, the ATL-PI and Japan Clinical Oncology Group (JCOG)-PI, in a cohort from Okinawa. The PIs were developed using two different Japanese cohorts that included few patients from Okinawa. The endpoint was overall survival (OS). Multivariable Cox regression analyses in the cohort of 433 patients revealed that all seven factors for calculating each PI were statistically significant prognostic predictors. Three-year OS rates for ATL-PI were 35.9% (low-risk, n=66), 10.4% (intermediate-risk, n=256), and 1.6% (high-risk, n=111), and those for JCOG-PI were 22.4% (moderate-risk, n=176) and 5.3% (high-risk, n=257). The JCOG-PI moderate-risk group included both the ATL-PI low- and intermediate-risk groups. ATL-PI more clearly identified the low-risk patient subgroup than JCOG-PI. To evaluate the external validity of the two PIs, we also assessed prognostic discriminability among 159 patients who loosely met the eligibility criteria of a previous clinical trial. Three-year OS rates for ATL-PI were 34.5% (low-risk, n=42), 9.2% (intermediate-risk, n=109), and 12.5% (high-risk, n = 8). Those for JCOG-PI were 22.4% (moderate-risk, n=95) and 7.6% (high-risk, n=64). The low-risk ATL-PI group had a better prognosis than the JCOG-PI moderate-risk group, suggesting that ATL-PI would be more useful than JCOG-PI for establishing and examining novel treatment strategies for ATL patients with a better prognosis. In addition, strongyloidiasis, previously suggested to be associated with ATL-related deaths in Okinawa, was not a prognostic factor in this study. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

A Metaanalysis of Perceptual Organization in Schizophrenia, Schizotypy, and Other High-Risk Groups Based on Variants of the Embedded Figures Task

PubMed Central

Panton, Kirsten R.; Badcock, David R.; Badcock, Johanna C.

2016-01-01

Current research on perceptual organization in schizophrenia frequently employs shapes with regularly sampled contours (fragmented stimuli), in noise fields composed of similar elements, to elicit visual abnormalities. However, perceptual organization is multi-factorial and, in earlier studies, continuous contours have also been employed in tasks assessing the ability to extract shapes from a background. We conducted a systematic review and meta-analysis of studies using closed-contour stimuli, including the Embedded Figures Test (EFT) and related tasks, both in people with schizophrenia and in healthy schizotypes and relatives, considered at increased risk for psychosis. Eleven studies met the selection criteria for inclusion in the meta-analysis, including six that used a between-groups study design (i.e., perceptual organization abilities of schizophrenia/high-risk groups were compared to healthy or clinical controls), and five that treated schizophrenia symptoms or schizotypy traits and indices of perceptual organization as continuous variables. Effect sizes and heterogeneity statistics were calculated, and the risk of publication bias was explored. A significant, moderate effect for EFT performance was found with studies that compared performance of schizophrenia/high-risk groups to a healthy or patient comparison group (d = −0.523, p < 0.001). However, significant heterogeneity was also found amongst the schizotypy, but not schizophrenia studies, as well as studies using accuracy, but not reaction time as a measure of performance. A non-significant correlation was found for the studies that examined schizophrenia symptoms or schizotypy traits as continuous variables (r = 0.012, p = 0.825). These results suggest that deficits in perceptual organization of non-fragmented stimuli are found when differences between schizophrenia/high-risk groups and comparison groups are maximized. These findings should motivate further investigation of perceptual organization abilities with closed-contour stimuli both in schizophrenia and high-risk groups, which is pertinent to current initiatives to improve the assessment and treatment of cognition in schizophrenia. PMID:26941688

A Metaanalysis of Perceptual Organization in Schizophrenia, Schizotypy, and Other High-Risk Groups Based on Variants of the Embedded Figures Task.

PubMed

Panton, Kirsten R; Badcock, David R; Badcock, Johanna C

2016-01-01

Current research on perceptual organization in schizophrenia frequently employs shapes with regularly sampled contours (fragmented stimuli), in noise fields composed of similar elements, to elicit visual abnormalities. However, perceptual organization is multi-factorial and, in earlier studies, continuous contours have also been employed in tasks assessing the ability to extract shapes from a background. We conducted a systematic review and meta-analysis of studies using closed-contour stimuli, including the Embedded Figures Test (EFT) and related tasks, both in people with schizophrenia and in healthy schizotypes and relatives, considered at increased risk for psychosis. Eleven studies met the selection criteria for inclusion in the meta-analysis, including six that used a between-groups study design (i.e., perceptual organization abilities of schizophrenia/high-risk groups were compared to healthy or clinical controls), and five that treated schizophrenia symptoms or schizotypy traits and indices of perceptual organization as continuous variables. Effect sizes and heterogeneity statistics were calculated, and the risk of publication bias was explored. A significant, moderate effect for EFT performance was found with studies that compared performance of schizophrenia/high-risk groups to a healthy or patient comparison group (d = -0.523, p < 0.001). However, significant heterogeneity was also found amongst the schizotypy, but not schizophrenia studies, as well as studies using accuracy, but not reaction time as a measure of performance. A non-significant correlation was found for the studies that examined schizophrenia symptoms or schizotypy traits as continuous variables (r = 0.012, p = 0.825). These results suggest that deficits in perceptual organization of non-fragmented stimuli are found when differences between schizophrenia/high-risk groups and comparison groups are maximized. These findings should motivate further investigation of perceptual organization abilities with closed-contour stimuli both in schizophrenia and high-risk groups, which is pertinent to current initiatives to improve the assessment and treatment of cognition in schizophrenia.

Risk strata-based therapy and outcome in stage Ib-IIa carcinoma cervix: single-centre ten-year experience.

PubMed

Kundargi, Rajshekar S; Guruprasad, B; Rathod, Praveen Shankar; Shakuntala, Pn; Shobha, K; Pallavi, Vr; Uma Devi, K; Bafna, Ud

2013-01-01

To review the outcome of stage (Ib, IIa), cervical cancer patients were primarily treated with radical hysterectomy and risk-based postoperative therapy. Between January 2001 and December 2011, 601 cases underwent surgery followed by tailored therapy. Patients were classified into low risk (pelvic lymph node negative, tumour less than 4 cm, no evidence of lympho-vascular invasion, less than one-third of thickness of surgical stoma involved), intermediate risk (positive lympho-vascular space invasion, tumour size more than 4 cm, and deep invasion of cervical stroma), and high risk (pelvic lymph node involved, positive parametrial, or vaginal margins) groups. Postoperative adju-vant therapy in the form of radiotherapy alone to those with intermediate risk and chemo-radiotherapy to those with high risk was given to patients. The median follow-up was 60 months. The majority of patients had intermediate risk. The overall event-free survival (EFS) at five years was 74.37%, with EFS of 86.5% in those from the low-risk group, 73% in those from the intermediate-risk group, and 64% in those from the high-risk group. In conclusion, risk strata-based adjuvant postoperative therapy is able to provide a favourable outcome in patients with stage Ib-IIa cervical cancer with a nearly 11% improvement in survival compared with historical control.

Personal, Family, and Social Functioning among Older Couples Concordant and Discordant for High-Risk Alcohol Consumption

PubMed Central

Moos, Rudolf H.; Schutte, Kathleen K.; Brennan, Penny L.; Moos, Bernice S.

2010-01-01

Aims This study compares the personal, family, and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption. Design, Participants, Measurements Three groups of couples were identified at baseline and followed 10 years later: (1) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (N = 54), (2) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (N = 38), and (3) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (N = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family, and social functioning. Findings Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking, and, for husbands, their wives’ level of drinking. Conclusions High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking. PMID:20883458

Personal, family and social functioning among older couples concordant and discordant for high-risk alcohol consumption.

PubMed

Moos, Rudolf H; Schutte, Kathleen K; Brennan, Penny L; Moos, Bernice S

2011-02-01

This study compares the personal, family and social functioning of older husbands and wives concordant or discordant for high-risk alcohol consumption and identifies predictors of changes in concordance and high-risk consumption. Three groups of couples were identified at baseline and followed 10 years later: (i) concordant couples in which husbands and wives engaged in low-risk alcohol consumption (n = 54); (ii) concordant couples in which husbands and wives engaged in high-risk alcohol consumption (n = 38); and (iii) discordant couples in which one partner engaged in high-risk alcohol consumption and the other partner did not (n = 75). At each follow-up, husbands and wives completed an inventory that assessed their personal, family and social functioning. Compared to the low-risk concordant group, husbands and wives in the high-risk concordant group were more likely to rely on tension-reduction coping, reported more friend approval of drinking, and were less involved in religious activities; however, they did not differ in the quality of the spousal relationship. The frequency of alcohol consumption declined among husbands in discordant couples, but not among husbands in concordant couples. Predictors of high-risk drinking included tension-reduction coping, friend approval of drinking and, for husbands, their wives' level of drinking. High-risk and discordant alcohol consumption do not seem to be linked to decrements in family functioning among older couples in long-term stable marriages. The predictors of heavy alcohol consumption among older husbands and wives identify points of intervention that may help to reduce their high-risk drinking. © 2010 Society for the Study of Addiction. No claim to US government works.

The patient perspective: utilizing focus groups to inform care coordination for high-risk medicaid populations.

PubMed

Sheff, Alex; Park, Elyse R; Neagle, Mary; Oreskovic, Nicolas M

2017-07-25

Care coordination programs for high-risk, high-cost patients are a critical component of population health management. These programs aim to improve outcomes and reduce costs and have proliferated over the last decade. Some programs, originally designed for Medicare patients, are now transitioning to also serve Medicaid populations. However, there are still gaps in the understanding of what barriers to care Medicaid patients experience, and what supports will be most effective for providing them care coordination. We conducted two focus groups (n = 13) and thematic analyses to assess the outcomes drivers and programmatic preferences of Medicaid patients enrolled in a high-risk care coordination program at a major academic medical center in Boston, MA. Two focus groups identified areas where care coordination efforts were having a positive impact, as well as areas of unmet needs among the Medicaid population. Six themes emerged from the focus groups that clustered in three groupings: In the first group (1) enrollment in an existing medical care coordination programs, and (2) provider communication largely presented as positive accounts of assistance, and good relationships with providers, though participants also pointed to areas where these efforts fell short. In the second group (3) trauma histories, (4) mental health challenges, and (5) executive function difficulties all presented challenges faced by high-risk Medicaid patients that would likely require redress through additional programmatic supports. Finally, in the third group, (6) peer-to-peer support tendencies among patients suggested an untapped resource for care coordination programs. Programs aimed at high-risk Medicaid patients will want to consider programmatic adjustments to attend to patient needs in five areas: (1) provider connection/care coordination, (2) trauma, (3) mental health, (4) executive function/paperwork and coaching support, and (5) peer-to-peer support.

Safe Reentry for False Aneurysm Operations in High-Risk Patients.

PubMed

Martinelli, Gian Luca; Cotroneo, Attilio; Caimmi, Philippe Primo; Musica, Gabriele; Barillà, David; Stelian, Edmond; Romano, Angelo; Novelli, Eugenio; Renzi, Luca; Diena, Marco

2017-06-01

In the absence of a standardized safe surgical reentry strategy for high-risk patients with large or anterior postoperative aortic false aneurysm (PAFA), we aimed to describe an effective and safe approach for such patients. We prospectively analyzed patients treated for PAFA between 2006 and 2015. According to the preoperative computed tomography scan examination, patients were divided into two groups according to the anatomy and extension of PAFA: in group A, high-risk PAFA (diameter ≥3 cm) developed in the anterior mediastinum; in group B, low-risk PAFA (diameter <3 cm) was situated posteriorly. For group A, a safe surgical strategy, including continuous cerebral, visceral, and coronary perfusion was adopted before resternotomy; group B patients underwent conventional surgery. We treated 27 patients (safe reentry, n = 13; standard approach, n = 14). Mean age was 60 years (range, 29 to 80); 17 patients were male. Mean interval between the first operation and the last procedure was 4.3 years. Overall 30-day mortality rate was 7.4% (1 patient in each group). No aorta-related mortality was observed at 1 and 5 years in either group. The Kaplan-Meier overall survival estimates at 1 and 5 years were, respectively, 92.3% ± 7.4% and 73.4% ± 13.4% in group A, and 92.9% ± 6.9% and 72.2% ± 13.9% in group B (log rank test, p = 0.830). Freedom from reoperation for recurrent aortic disease was 100% at 1 year and 88% at 5 years. The safe reentry technique with continuous cerebral, visceral, and coronary perfusion for high-risk patients resulted in early and midterm outcomes similar to those observed for low-risk patients undergoing conventional surgery. Copyright © 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Polycyclic Aromatic Hydrocarbons Concentrations in Drinking Water in Villages along the Huai River in China and Their Association with High Cancer Incidence in Local Population.

PubMed

Pan, En Chun; Sun, Hong; Xu, Qiu Jin; Zhang, Qin; Liu, Lin Fei; Chen, Xiao Dong; Xu, Yan

2015-01-01

This study aims to evaluate the carcinogenic risk of PAHs in the drinking water of counties along the Huai River in China and study their associations with high cancer incidence in local population. We investigated 20 villages with high cancer incidence rates as the risk group and 20 villages with low rates as the control group. Water samples from each village were collected in the winter and summer seasons to analyze the concentrations of 16 PAHs. The carcinogenic risks of the PAHs were calculated for each village using a health risk assessment approach. Results showed that PAHs concentrations in 27.2% of the water samples were higher than the allowable values in China. However, no significant difference in water PAHs concentrations was observed between the risk and control groups (P > 0.05), and no correlation was found between water PAHs concentrations and cancer incidence in these villages. The average upper bound carcinogenic risks were less than 1 × 10(-4) in both groups. In conclusion, PAHs were present in the drinking water of the studied villages, but their carcinogenic risks remained within acceptable limits. PAHs in local drinking water might not be the major environmental cause of the high cancer incidences.

Polycyclic Aromatic Hydrocarbons Concentrations in Drinking Water in Villages along the Huai River in China and Their Association with High Cancer Incidence in Local Population

PubMed Central

Pan, En chun; Sun, Hong; Xu, Qiu jin; Zhang, Qin; Liu, Lin fei; Chen, Xiao dong; Xu, Yan

2015-01-01

This study aims to evaluate the carcinogenic risk of PAHs in the drinking water of counties along the Huai River in China and study their associations with high cancer incidence in local population. We investigated 20 villages with high cancer incidence rates as the risk group and 20 villages with low rates as the control group. Water samples from each village were collected in the winter and summer seasons to analyze the concentrations of 16 PAHs. The carcinogenic risks of the PAHs were calculated for each village using a health risk assessment approach. Results showed that PAHs concentrations in 27.2% of the water samples were higher than the allowable values in China. However, no significant difference in water PAHs concentrations was observed between the risk and control groups (P > 0.05), and no correlation was found between water PAHs concentrations and cancer incidence in these villages. The average upper bound carcinogenic risks were less than 1 × 10−4 in both groups. In conclusion, PAHs were present in the drinking water of the studied villages, but their carcinogenic risks remained within acceptable limits. PAHs in local drinking water might not be the major environmental cause of the high cancer incidences. PMID:26688818

Reduced dopamine response to amphetamine in subjects at ultra-high risk for addiction.

PubMed

Casey, Kevin F; Benkelfat, Chawki; Cherkasova, Mariya V; Baker, Glen B; Dagher, Alain; Leyton, Marco

2014-07-01

Not everyone who tries addictive drugs develops a substance use disorder. One of the best predictors of risk is a family history (FH) of substance use problems. In part, this might reflect perturbed mesolimbic dopamine responses. We measured amphetamine-induced changes in [(11)C]raclopride binding in 1) high-risk young adults with a multigenerational FH of substance use disorders (n = 16); 2) stimulant drug-naïve healthy control subjects with no known risk factors for addiction (n = 17); and 3) subjects matched to the high-risk group on personal drug use but without a FH of substance use problems (n = 15). Compared with either control group, the high-risk young adults with a multigenerational FH of substance use disorders exhibited smaller [(11)C]raclopride responses, particularly within the right ventral striatum. Past drug use predicted the dopamine response also, but including it as a covariate increased the group differences. Together, the results suggest that young people at familial high risk for substance use disorders have decreased dopamine responses to an amphetamine challenge, an effect that predates the onset of addiction. © 2013 Society of Biological Psychiatry Published by Society of Biological Psychiatry All rights reserved.

The Effects of Multisensory Structured Language Instruction on Native Language and Foreign Language Aptitude Skills of At-Risk High School Foreign Language Learners.

ERIC Educational Resources Information Center

Sparks, Richard; And Others

1992-01-01

A multisensory structured language (MSL) approach was utilized with two groups of at-risk high school students (n=63), taught in either English and Spanish (MSL/ES) or Spanish only. Foreign language aptitude improved for both groups and native language skills for the MSL/ES group. A group receiving traditional foreign language instruction showed…

Early Educational Intervention, Early Cumulative Risk, and the Early Home Environment as Predictors of Young Adult Outcomes Within a High-Risk Sample

PubMed Central

Pungello, Elizabeth P.; Kainz, Kirsten; Burchinal, Margaret; Wasik, Barbara H.; Sparling, Joseph J.; Ramey, Craig T.; Campbell, Frances A.

2009-01-01

The extent to which early educational intervention, early cumulative risk, and the early home environment were associated with young adult outcomes was investigated in a sample of 139 young adults (age 21) from high-risk families enrolled in randomized trials of early intervention. Positive effects of treatment were found for education attainment, attending college, and skilled employment; negative effects of risk were found for education attainment, graduating high school, being employed and avoiding teen parenthood. The home mediated the effects of risk for graduating high school, but not being employed or teen parenthood. Evidence for moderated mediation was found for educational attainment; the home mediated the association between risk and educational attainment for the control group, but not the treated group. PMID:20331676

Systemic connective tissue features in women with fibromuscular dysplasia.

PubMed

O'Connor, Sarah; Kim, Esther Sh; Brinza, Ellen; Moran, Rocio; Fendrikova-Mahlay, Natalia; Wolski, Kathy; Gornik, Heather L

2015-10-01

Fibromuscular dysplasia (FMD) is a non-atherosclerotic disease associated with hypertension, headache, dissection, stroke, and aneurysm. The etiology is unknown but hypothesized to involve genetic and environmental components. Previous studies suggest a possible overlap of FMD with other connective tissue diseases that present with dissections and aneurysms. The aim of this study was to investigate the prevalence of connective tissue physical features in FMD. A total of 142 FMD patients were consecutively enrolled at a single referral center (97.9% female, 92.1% of whom had multifocal FMD). Data are reported for 139 female patients. Moderately severe myopia (29.1%), high palate (33.1%), dental crowding (29.7%), and early-onset arthritis (15.6%) were prevalent features. Classic connective features such as hypertelorism, cleft palate, and hypermobility were uncommon. The frequency of systemic connective tissue features was compared between FMD patients with a high vascular risk profile (having had ⩾1 dissection and/or ⩾2 aneurysms) and those with a standard vascular risk profile. A history of spontaneous pneumothorax (5.9% high risk vs 0% standard risk) and atrophic scarring (17.6% high risk vs 6.8% standard risk) were significantly more prevalent in the high risk group, p<0.05. High palate was observed in 43.1% of the high risk group versus 27.3% in the standard risk group, p=0.055. In conclusion, in a cohort of women with FMD, there was a prevalence of moderately severe myopia, high palate, dental crowding, and early-onset osteoarthritis. However, a characteristic phenotype was not discovered. Several connective tissue features such as high palate and pneumothorax were more prominent among FMD patients with a high vascular risk profile. © The Author(s) 2015.

Systemic Connective Tissue Features in Women with Fibromuscular Dysplasia

PubMed Central

O’Connor, Sarah; Kim, Esther S. H.; Brinza, Ellen; Moran, Rocio; Fendrikova-Mahlay, Natalia; Wolski, Kathy; Gornik, Heather L.

2016-01-01

Background Fibromuscular Dysplasia (FMD) is an non-atherosclerotic disease associated with hypertension, headache, dissection, stroke, and aneurysm. The etiology is unknown but hypothesized to involve genetic and environmental components. Previous studies suggest a possible overlap of FMD with other connective tissue diseases that present with dissections and aneurysms. The aim of this study was to investigate the prevalence of connective tissue physical features in FMD. Methods and Results 142 FMD patients were consecutively enrolled at a single referral center (97.9% female, 92.3% had multifocal FMD). Data are reported for 139 female patients. Moderately severe myopia (29.1%), high palate (33.1%), dental crowding (29.7%), and early onset arthritis (15.6%) were prevalent features. Classic connective features such as hypertelorism, cleft palate, and hypermobility were uncommon. Frequency of systemic connective tissue features was compared between FMD patients with a high vascular risk profile (having had ≥1 dissection and/or ≥2 aneurysms) and those with a standard vascular risk profile. History of spontaneous pneumothorax (5.9% high risk vs. 0% standard risk) and atrophic scarring (17.3% high risk vs. 6.8% standard risk) were significantly more prevalent in the high risk group, p<0.05. High palate was observed in 43.1% of the high risk group vs. 27.3% in the standard risk group, p=0.055. Conclusions In a cohort of women with FMD, there was a prevalence of moderately severe myopia, high palate, dental crowding, and early onset osteoarthritis. However, a characteristic phenotype was not discovered. Several connective tissue features such as high palate and pneumothorax were more prominent among FMD patients with a high vascular risk profile. PMID:26156071

Korean immigrants' knowledge of heart attack symptoms and risk factors.

PubMed

Hwang, Seon Y; Ryan, Catherine J; Zerwic, Julie Johnson

2008-02-01

This study assessed the knowledge of heart attack symptoms and risk factors in a convenience sample of Korean immigrants. A total of 116 Korean immigrants in a Midwestern metropolitan area were recruited through Korean churches and markets. Knowledge was assessed using both open-ended questions and a structured questionnaire. Latent class cluster analysis and Chi-square tests were used to analyze the data. About 76% of the sample had at least one self-reported risk factor for cardiovascular disease. Using an open-ended question, the majority of subjects could only identify one symptom. In the structured questionnaire, subjects identified a mean of 5 out of 10 heart attack symptoms and a mean of 5 out of 9 heart attack risk factors. Latent class cluster analysis showed that subjects clustered into two groups for both risk factors and symptoms: a high knowledge group and a low knowledge group. Subjects who clustered into the risk factor low knowledge group (48%) were more likely than the risk factor high knowledge group to be older than 65 years, to have lower education, to not know to use 911 when a heart attack occurred, and to not have a family history of heart attack. Korean immigrants' knowledge of heart attack symptoms and risk factors was variable, ranging from high to very low. Education should be focused on those at highest risk for a heart attack, which includes the elderly and those with risk factors.

Outcomes of men with an elevated prostate-specific antigen (PSA) level as their sole preoperative intermediate- or high-risk feature.

PubMed

Faisal, Farzana A; Sundi, Debasish; Pierorazio, Phillip M; Ball, Mark W; Humphreys, Elizabeth B; Han, Misop; Epstein, Jonathan I; Partin, Alan W; Carter, H Ballentine; Bivalacqua, Trinity J; Schaeffer, Edward M; Ross, Ashley E

2014-12-01

To investigate the post-prostatectomy and long-term outcomes of men presenting with an elevated pretreatment prostate-specific antigen (PSA) level (>10 ng/mL), but otherwise low-risk features (biopsy Gleason score ≤6 and clinical stage ≤T2a). PSA-incongruent intermediate-risk (PII) cases were defined as those patients with preoperative PSA >10 and ≤20 ng/mL but otherwise low-risk features, and PSA-incongruent high-risk (PIH) cases were defined as men with PSA >20 ng/mL but otherwise low-risk features. Our institutional radical prostatectomy database (1992-2012) was queried and the results were stratified into D'Amico low-, intermediate- and high risk, PSA-incongruent intermediate-risk and PSA-incongruent high-risk cases. Prostate cancer (PCa) features and outcomes were evaluated using appropriate comparative tests. Multivariable analyses were adjusted for age, race and year of surgery. Of the total cohort of 17 608 men, 1132 (6.4%) had PII-risk disease and 183 (1.0%) had PIH-risk disease. Compared with the low-risk group, the odds of upgrading at radical prostatectomy (RP) were 2.20 (95% CI 1.93-2.52; P < 0.001) for the PII group and 3.58 (95% CI 2.64-4.85; P < 0.001) for the PIH group, the odds of extraprostatic disease at RP were 2.35 (95% CI 2.05-2.68; P < 0.001) for the PII group and 6.68 (95% CI 4.89-9.15; P < 0.001) for the PIH group, and the odds of positive surgical margins were 1.97 (95% CI 1.67-2.33; P < 0.001) for the PII group and 3.54 (95% CI 2.50-4.95, P < 0.001) for the PIH group. Compared with low-risk disease, PII-risk disease was associated with a 2.85-, 2.99- and 3.32-fold greater risk of biochemical recurrence (BCR), metastasis and PCa-specific mortality, respectively, and PIH-risk disease was associated with a 5.32-, 6.14- and 7.07-fold greater risk of BCR, metastasis and PCa-specific mortality, respectively (P ≤ 0.001 for all comparisons). For the PII group, the higher risks of positive surgical margins, upgrading, upstaging and BCR were dependent on PSA density (PSAD): men in the PII group who had a PSAD <0.15 ng/mL/g were not at higher risk compared with those in the low-risk group. Men in the PII group with a PSAD ≥0.15 ng/mL/g and men in the PIH group were more likely to have an anterior component of the dominant tumour (59 and 64%, respectively) compared with those in the low- (35%) and intermediate-risk group (39%) and those in the PII-risk group with PSAD <0.15 ng/mL/g (29%). Men with PSA >20 ng/mL or men with PSA >10 and ≤20 ng/mL with a PSAD ≥0.15 ng/mL/g, but otherwise low-risk PCa, are at greater risk of adverse pathological and oncological outcomes and may be inappropriate candidates for active surveillance. These men are at greater risk of having anterior tumours that are undersampled at biopsy, so if treatment is deferred, ancillary testing such as anterior zone sampling or magnetic resonance imaging should be strongly encouraged. Men with elevated PSA levels >10 and ≤20 ng/mL but low PSAD have outcomes similar to those in the low-risk group, and consideration of surveillance is appropriate in these cases. © 2014 The Authors. BJU International © 2014 BJU International.

High-risk borderline ovarian tumors: analysis of clinicopathological features and prognostic impact of different follow-up strategies.

PubMed

Lorusso, Domenica; Ratti, Martina; Ditto, Antonino; Raspagliesi, Francesco

2014-01-01

Borderline ovarian tumors (BOTs) represent 10-20% of all epithelial ovarian malignancies. Most of them are comparable to benign cysts but a high-risk group has been recognized. The aim of the study was to analyze different follow-up strategies in high-risk patients. Patients with BOT treated at our institution from 1992 to 2011 were retrospectively reviewed. Clinicopathological features influencing prognosis were analyzed and two different follow-up strategies compared [6-month laparoscopic look (LPS-look): group A vs. ultrasound/CA-125 evaluation: group B]. 70 patients with high-risk BOTs were identified. After a median progression-free survival (PFS) of 43 months, 27% of patients experienced recurrences. Six months after diagnosis, 26 high-risk patients were submitted to LPS-look: at surgery, 6 out of 10 patients presenting evidence of disease were optimally debulked while in the remaining 4, only biopsies were performed. No difference in PFS was registered between group A and B patients, nevertheless a significant increase in PFS was registered among completely versus incompletely debulked patients with evidence of disease at laparoscopy. Clinical follow-up remains the gold standard for BOTs. These very preliminary data seem to suggest that LPS-look may have an impact on the secondary PFS in a subgroup of high-risk patients. © 2014 S. Karger AG, Basel.

Intermittent Oxygen Inhalation with Proper Frequency Improves Overall Health Conditions and Alleviates Symptoms in a Population at High Risk of Chronic Mountain Sickness with Severe Symptoms

PubMed Central

Feng, Bin; Xu, Wei-Hao; Gao, Yu-Qi; Liu, Fu-Yu; Li, Peng; Zheng, Shan-Jun; Gai, Lu-Yue; Zhang, Gang

2016-01-01

Background: Oxygen inhalation therapy is essential for the treatment of patients with chronic mountain sickness (CMS), but the efficacy of oxygen inhalation for populations at high risk of CMS remains unknown. This research investigated whether oxygen inhalation therapy benefits populations at high risk of CMS. Methods: A total of 296 local residents living at an altitude of 3658 m were included; of which these were 25 diagnosed cases of CMS, 8 cases dropped out of the study, and 263 cases were included in the analysis. The subjects were divided into high-risk (180 ≤ hemoglobin (Hb) <210 g/L, n = 161) and low-risk (Hb <180 g/L, n = 102) groups, and the cases in each group were divided into severe symptom (CMS score ≥6) and mild symptom (CMS score 0-5) subgroups. Severe symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group (A group) or oxygen intake 7 times/week group (D group); mild symptomatic population of either high- or low-risk CMS was randomly assigned to no oxygen intake group (A group), oxygen intake 2 times/week group (B group), and 4 times/week group (C group). The courses for oxygen intake were all 30 days. The CMS symptoms, sleep quality, physiological biomarkers, biochemical markers, etc., were recorded on the day before oxygen intake, on the 15th and 30th days of oxygen intake, and on the 15th day after terminating oxygen intake therapy. Results: A total of 263 residents were finally included in the analysis. Among these high-altitude residents, CMS symptom scores decreased for oxygen inhalation methods B, C, and D at 15 and 30 days after oxygen intake and 15 days after termination, including dyspnea, palpitation, and headache index, compared to those before oxygen intake (B group: Z = 5.604, 5.092, 5.741; C group: Z = 4.155, 4.068, 4.809; D group: Z = 6.021, 6.196, 5.331, at the 3 time points respectively; all P < 0.05/3 vs. before intake). However, dyspnea/palpitation (A group: Z = 5.003, 5.428, 5.493, both P < 0.05/3 vs. before intake) and headache (A group: Z = 4.263, 3.890, 4.040, both P < 0.05/3 vs. before intake) index decreased significantly also for oxygen inhalation method A at all the 3 time points. Cyanosis index decreased significantly 30 days after oxygen intake only in the group of participants administered the D method (Z = 2.701, P = 0.007). Tinnitus index decreased significantly in group A and D at 15 days (A group: Z = 3.377, P = 0.001, D group: Z = 3.150, P = 0.002), 30 days after oxygen intake (A group: Z = 2.836, P = 0.005, D group: Z = 5.963, P < 0.0001) and 15 days after termination (A group: Z = 2.734, P = 0.006, D group: Z = 4.049, P = 0.0001), and decreased significantly in the group B and C at 15 days after termination (B group: Z = 2.611, P = 0.009; C group: Z = 3.302, P = 0.001). In the population at high risk of CMS with severe symptoms, oxygen intake 7 times/week significantly improved total symptom scores of severe symptoms at 15 days (4 [2, 5] vs. 5.5 [4, 7], Z = 2.890, P = 0.005) and 30 days (3 [1, 5] vs. 5.5 [2, 7], Z = 3.270, P = 0.001) after oxygen intake compared to no oxygen intake. In the population at high risk of CMS with mild symptoms, compared to no oxygen intake, oxygen intake 2 or 4 times/week did not improve the total symptom scores at 15 days (2 [1, 3], 3 [1, 4] vs. 3 [1.5, 5]; χ2= 2.490, P = 0.288), and at 30 days (2 [0, 4], 2 [1, 4.5] vs. 3 [2, 5]; χ2= 3.730, P = 0.155) after oxygen intake. In the population at low risk of CMS, oxygen intake did not significantly change the white cell count and red cell count compared to no oxygen intake, neither in the severe symptomatic population nor in the mild symptomatic population. Conclusions: Intermittent oxygen inhalation with proper frequency might alleviate symptoms in residents at high altitude by improving their overall health conditions. Administration of oxygen inhalation therapy 2–4 times/week might not benefit populations at high risk of CMS with mild CMS symptoms while administration of therapy 7 times/week might benefit those with severe symptoms. Oxygen inhalation therapy is not recommended for low-risk CMS populations. PMID:27231170

APOL1 risk variants, race, and progression of chronic kidney disease.

PubMed

Parsa, Afshin; Kao, W H Linda; Xie, Dawei; Astor, Brad C; Li, Man; Hsu, Chi-yuan; Feldman, Harold I; Parekh, Rulan S; Kusek, John W; Greene, Tom H; Fink, Jeffrey C; Anderson, Amanda H; Choi, Michael J; Wright, Jackson T; Lash, James P; Freedman, Barry I; Ojo, Akinlolu; Winkler, Cheryl A; Raj, Dominic S; Kopp, Jeffrey B; He, Jiang; Jensvold, Nancy G; Tao, Kaixiang; Lipkowitz, Michael S; Appel, Lawrence J

2013-12-05

Among patients in the United States with chronic kidney disease, black patients are at increased risk for end-stage renal disease, as compared with white patients. In two studies, we examined the effects of variants in the gene encoding apolipoprotein L1 (APOL1) on the progression of chronic kidney disease. In the African American Study of Kidney Disease and Hypertension (AASK), we evaluated 693 black patients with chronic kidney disease attributed to hypertension. In the Chronic Renal Insufficiency Cohort (CRIC) study, we evaluated 2955 white patients and black patients with chronic kidney disease (46% of whom had diabetes) according to whether they had 2 copies of high-risk APOL1 variants (APOL1 high-risk group) or 0 or 1 copy (APOL1 low-risk group). In the AASK study, the primary outcome was a composite of end-stage renal disease or a doubling of the serum creatinine level. In the CRIC study, the primary outcomes were the slope in the estimated glomerular filtration rate (eGFR) and the composite of end-stage renal disease or a reduction of 50% in the eGFR from baseline. In the AASK study, the primary outcome occurred in 58.1% of the patients in the APOL1 high-risk group and in 36.6% of those in the APOL1 low-risk group (hazard ratio in the high-risk group, 1.88; P<0.001). There was no interaction between APOL1 status and trial interventions or the presence of baseline proteinuria. In the CRIC study, black patients in the APOL1 high-risk group had a more rapid decline in the eGFR and a higher risk of the composite renal outcome than did white patients, among those with diabetes and those without diabetes (P<0.001 for all comparisons). Renal risk variants in APOL1 were associated with the higher rates of end-stage renal disease and progression of chronic kidney disease that were observed in black patients as compared with white patients, regardless of diabetes status. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).

APOL1 Risk Variants, Race, and Progression of Chronic Kidney Disease

PubMed Central

Parsa, Afshin; Kao, W.H. Linda; Xie, Dawei; Astor, Brad C.; Li, Man; Hsu, Chi-yuan; Feldman, Harold I.; Parekh, Rulan S.; Kusek, John W.; Greene, Tom H.; Fink, Jeffrey C.; Anderson, Amanda H.; Choi, Michael J.; Wright, Jackson T.; Lash, James P.; Freedman, Barry I.; Ojo, Akinlolu; Winkler, Cheryl A.; Raj, Dominic S.; Kopp, Jeffrey B.; He, Jiang; Jensvold, Nancy G.; Tao, Kaixiang; Lipkowitz, Michael S.; Appel, Lawrence J.

2014-01-01

BACKGROUND Among patients in the United States with chronic kidney disease, black patients are at increased risk for end-stage renal disease, as compared with white patients. METHODS In two studies, we examined the effects of variants in the gene encoding apolipoprotein L1 (APOL1) on the progression of chronic kidney disease. In the African American Study of Kidney Disease and Hypertension (AASK), we evaluated 693 black patients with chronic kidney disease attributed to hypertension. In the Chronic Renal Insufficiency Cohort (CRIC) study, we evaluated 2955 white patients and black patients with chronic kidney disease (46% of whom had diabetes) according to whether they had 2 copies of high-risk APOL1 variants (APOL1 high-risk group) or 0 or 1 copy (APOL1 low-risk group). In the AASK study, the primary outcome was a composite of end-stage renal disease or a doubling of the serum creatinine level. In the CRIC study, the primary outcomes were the slope in the estimated glomerular filtration rate (eGFR) and the composite of end-stage renal disease or a reduction of 50% in the eGFR from baseline. RESULTS In the AASK study, the primary outcome occurred in 58.1% of the patients in the APOL1 high-risk group and in 36.6% of those in the APOL1 low-risk group (hazard ratio in the high-risk group, 1.88; P<0.001). There was no interaction between APOL1 status and trial interventions or the presence of baseline proteinuria. In the CRIC study, black patients in the APOL1 high-risk group had a more rapid decline in the eGFR and a higher risk of the composite renal outcome than did white patients, among those with diabetes and those without diabetes (P<0.001 for all comparisons). CONCLUSIONS Renal risk variants in APOL1 were associated with the higher rates of end-stage renal disease and progression of chronic kidney disease that were observed in black patients as compared with white patients, regardless of diabetes status. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.) PMID:24206458

Resilience Associated with Self-Disclosure and Relapse Risks in Patients with Alcohol Use Disorders.

PubMed

Yamashita, Ayako; Yoshioka, Shin-Ichi

2016-12-01

The aim of this study was to clarify the self-disclosure and risks of relapse associated with promoting resilience of patients with alcohol use disorders (AUD) and participating in self-help groups. An anonymous, self-administered questionnaire survey was administered to 48 patients with AUD and participating in self-help groups; this questionnaire consisted of basic attributes, a bidimensional resilience scale to assess both innate and acquired resilience factors, a scale to assess depth of self-disclosure, and a scale assessing relapse risks. We conducted an evaluation by dividing the respondents into a high group and low group based on their median values for both innate and acquired resilience. Innate/acquired resilience had a mutually reinforcing relationship, and, compared with the low resilience group, the high resilience group had significantly reduced risks for relapses and resulted in deeper self-disclosure. Patients with high resilience had lower risk of alcohol relapse and deeper self-disclosure. The results suggest that one way of supporting patients with AUD in recovery is assisting them in building personal relationships with others and in deepening self-disclosure in a setting where they can relax, thus promoting their natural ability to recover.

Different psychological effects of cannabis use in adolescents at genetic high risk for schizophrenia and with attention deficit/hyperactivity disorder (ADHD).

PubMed

Hollis, Chris; Groom, Madeleine J; Das, Debasis; Calton, Tim; Bates, Alan T; Andrews, Hayley K; Jackson, Georgina M; Liddle, Peter F

2008-10-01

Controversy exists regarding whether young people at risk for schizophrenia are at increased risk of adverse mental effects of cannabis use. We examined cannabis use and mental health functioning in three groups of young people aged 14-21; 36 non-psychotic siblings of adolescents with schizophrenia (genetic high risk group), 25 adolescents with attention deficit hyperactivity disorder (ADHD) and 72 healthy controls. The groups were sub-divided into 'users' and 'non-users' of cannabis based on how often they had used cannabis previously. Mental health functioning was quantified by creating a composite index derived from scores on the Schizotypal Personality Questionnaire (SPQ), Strengths and Difficulties Questionnaire (SDQ) and Global Assessment of Function (GAF). A significant positive association between cannabis use and mental health disturbance was confined to young people at genetic high risk for schizophrenia. To determine whether the relationship was specific to particular dimensions of mental health function, a second composite index was created based on scores from the SPQ Disorganisation and SDQ hyperactivity-inattention sub-scales. Again, there was a significant positive association between cannabis use and factor scores which was specific to the genetic high risk group. There was a trend for this association to be negative in the ADHD group (p=0.07). The findings support the view that young people at genetic high risk for schizophrenia are particularly vulnerable to mental health problems associated with cannabis use. Further research is needed to investigate the basis of relationships between cannabis and mental health in genetically vulnerable individuals.

Off-pump coronary surgery: surgical strategy for the high-risk patient.

PubMed

Van Belleghem, Y; Caes, F; Maene, L; Van Overbeke, H; Moerman, A; Van Nooten, G

2003-02-01

In a retrospective study, we compared two groups of consecutive patients operated by the same team during the year 2000 for coronary artery disease with the use of extracorporeal circulation (group 1, n=230) or on the beating heart using the Octopus II plus stabiliser (group 2, n=228). High-risk patients were identified by a EuroSCORE plus 6. EuroSCORE definitions and predicted risk models were utilized to compare the variables of the groups. There were no significant differences between the preoperative variables of the groups in age, gender, left ventricular function, diabetes and peripheral vascular and renal disease as is indicated by the Euroscore (resp. 4.7/5.1 p=0.107). Calcification of the ascending aorta and chronic obstructive lung disease were statistically significant more prevalent in the beating heart group. No differences in preoperative variables in the high-risk patients group (Euroscore 8.5/8.1 p=0.356) except for calcification of the ascending aorta. All patients underwent a full revascularisation through a midline sternotomy. Significant more distal anastomoses were performed in group 1 (3.7 per patient (1-6)) with regard to group 2 (2.9 per patient (1-6)). Anesthesia, postoperative treatment and follow up were equal for both groups. A significant lower incidence of atrial fibrillation (p=0.010), shorter ICU stay (p=0.031) and renal insufficiency (p=0.033) was reported in group 2. In the low risk group, we could not diagnose any difference between the two groups, except for atrial fibrillation. The benefits of the beating heart surgery however were more pronounced in the high-risk patient as is indicated by a significant reduction of the ICU stay by 1 day (3.5d/2.5d (p=0.028)), better preservation of the renal function (p=0.017) and a significant reduction of the length of hospital stay by more than two days (p=0.040). A lower incidence of atrial fibrillation, however not significant. In our experience, beating heart surgery is a safe alternative for conventional coronary heart surgery. High-risk patients do benefit most from this technique. It became our first choice in the elderly patient and patients presenting with higher co-morbidities.

Impact of Patient Navigation Interventions on Timely Diagnostic Follow Up for Abnormal Cervical Screening.

PubMed

Paskett, Electra D; Dudley, Donald; Young, Gregory S; Bernardo, Brittany M; Wells, Kristen J; Calhoun, Elizabeth A; Fiscella, Kevin; Patierno, Steven R; Warren-Mears, Victoria; Battaglia, Tracy A

2016-01-01

As part of the Patient Navigation Research Program, we examined the effect of patient navigation versus usual care on timely diagnostic follow-up, defined as clinical management for women with cervical abnormalities within accepted time frames. Participants from four Patient Navigation Research Program centers were divided into low- and high-risk abnormality groups and analyzed separately. Low-risk participants (n = 2088) were those who enrolled with an initial Pap test finding of atypical squamous cells of undetermined significance (ASCUS) with a positive high-risk human papillomavirus (HPV) serotype, atypical glandular cells, or low-grade squamous intraepithelial lesion (LGSIL). High-risk participants were those with an initial finding of high-grade squamous intraepithelial lesion (HGSIL) (n = 229). A dichotomous outcome of timely diagnostic follow-up within 180 days was used for the low-risk abnormality group and timely diagnostic follow-up within 60 days for the high-risk group, consistent with treatment guidelines. A logistic mixed-effects regression model was used to evaluate the intervention effect using a random effect for study arm within an institution. A backward selection process was used for multivariable model building, considering the impact of each predictor on the intervention effect. Low-risk women in the patient navigation arm showed an improvement in the odds of timely diagnostic follow-up across all racial groups, but statistically significant effects were only observed in non-English-speaking Hispanics (OR 5.88, 95% CI 2.81-12.29). No effect was observed among high-risk women. These results suggest that patient navigation can improve timely diagnostic follow-up among women with low-risk cervical abnormalities, particularly in non-English-speaking Hispanic women.

The FRIENDS Emotional Health Program for Minority Groups at Risk

ERIC Educational Resources Information Center

Iizuka, Cristina A.; Barrett, Paula M.; Gillies, Robyn; Cook, Clayton R.; Miller, Debbie

2014-01-01

Background: Despite the existence of evidence-based interventions for promoting mental health in children, the number of children at risk remains high. One of the reasons is that such interventions are not reaching specific groups at risk such as low socioeconomic status and ethnic minority groups. This study evaluated an adaptation of a…

A balanced hazard ratio for risk group evaluation from survival data.

PubMed

Branders, Samuel; Dupont, Pierre

2015-07-30

Common clinical studies assess the quality of prognostic factors, such as gene expression signatures, clinical variables or environmental factors, and cluster patients into various risk groups. Typical examples include cancer clinical trials where patients are clustered into high or low risk groups. Whenever applied to survival data analysis, such groups are intended to represent patients with similar survival odds and to select the most appropriate therapy accordingly. The relevance of such risk groups, and of the related prognostic factors, is typically assessed through the computation of a hazard ratio. We first stress three limitations of assessing risk groups through the hazard ratio: (1) it may promote the definition of arbitrarily unbalanced risk groups; (2) an apparently optimal group hazard ratio can be largely inconsistent with the p-value commonly associated to it; and (3) some marginal changes between risk group proportions may lead to highly different hazard ratio values. Those issues could lead to inappropriate comparisons between various prognostic factors. Next, we propose the balanced hazard ratio to solve those issues. This new performance metric keeps an intuitive interpretation and is as simple to compute. We also show how the balanced hazard ratio leads to a natural cut-off choice to define risk groups from continuous risk scores. The proposed methodology is validated through controlled experiments for which a prescribed cut-off value is defined by design. Further results are also reported on several cancer prognosis studies, and the proposed methodology could be applied more generally to assess the quality of any prognostic markers. Copyright © 2015 John Wiley & Sons, Ltd.

Diagnosis and Management of High Risk Group for Gastric Cancer

PubMed Central

Yoon, Hyuk; Kim, Nayoung

2015-01-01

Gastric cancer is associated with high morbidity and mortality worldwide. To reduce the socioeconomic burden related to gastric cancer, it is very important to identify and manage high risk group for gastric cancer. In this review, we describe the general risk factors for gastric cancer and define high risk group for gastric cancer. We discuss strategies for the effective management of patients for the prevention and early detection of gastric cancer. Atrophic gastritis (AG) and intestinal metaplasia (IM) are the most significant risk factors for gastric cancer. Therefore, the accurate selection of individuals with AG and IM may be a key strategy for the prevention and/or early detection of gastric cancer. Although endoscopic evaluation using enhanced technologies such as narrow band imaging-magnification, the serum pepsinogen test, Helicobacter pylori serology, and trefoil factor 3 have been evaluated, a gold standard method to accurately select individuals with AG and IM has not emerged. In terms of managing patients at high risk of gastric cancer, it remains uncertain whether H. pylori eradication reverses and/or prevents the progression of AG and IM. Although endoscopic surveillance in high risk patients is expected to be beneficial, further prospective studies in large populations are needed to determine the optimal surveillance interval. PMID:25547086

Relationships between coronary heart disease risk factors and serum ionized calcium in Kennedy Space Center Cohort

NASA Technical Reports Server (NTRS)

Goodwin, Lisa Ann; Frey, Mary Anne Bassett; Merz, Marion P.; Alford, William R.

1987-01-01

Kennedy Space Center (KSC) employees are reported to be at high risk for coronary heart disease (CHD). Risk factors for CHD include high serum total cholesterol levels, low levels of high-density lipoprotein cholesterol (HDLC), elevated triglyceride, smoking, inactivity, high blood pressure, being male, and being older. Higher dietary and/or serum calcium Ca(++) may be related to a lower risk for CHD. Fifty men and 37 women participated. Subjects were tested in the morning after fasting 12 hours. Information relative to smoking and exercise habits was obtained; seated blood pressures were measured; and blood drawn. KCS men had higher risk values than KCS women as related to HDLC, triglycerides, systolic blood pressure, and diastolic blood pressure. Smoking and nonsmoking groups did not differ for other risk factors or for serum Ca(++) levels. Exercise and sedentary groups differed in total cholesterol and triglyceride levels. Serum Ca(++) levels were related to age, increasing with age in the sedentary group and decreasing in the exercisers, equally for men and women. It is concluded that these relationships may be significant to the risk of CHD and/or the risk of bone demineralization in an aging population.

Sex Differences in Children with Autism Spectrum Disorder Identified within a High-Risk Infant Cohort

ERIC Educational Resources Information Center

Zwaigenbaum, Lonnie; Bryson, Susan E.; Szatmari, Peter; Brian, Jessica; Smith, Isabel M.; Roberts, Wendy; Vaillancourt, Tracy; Roncadin, Caroline

2012-01-01

Sex differences were examined in 3-year-olds with autism spectrum disorders (ASD) ascertained from a high-risk cohort, and high- and low-risk comparison groups. Participants included 319 high-risk siblings and 129 low-risk controls. Eighty-five siblings were diagnosed with ASD, including 57 of 176 boys (32.4%) and 28 of 143 girls (19.6%), implying…

Factors associated with alcohol consumption among medical cannabis patients with chronic pain.

PubMed

Davis, Alan K; Walton, Maureen A; Bohnert, Kipling M; Bourque, Carrie; Ilgen, Mark A

2018-02-01

Chronic pain is the most common reason for medical cannabis certification. Data regarding alcohol use and risky drinking among medical cannabis patients with pain is largely unknown. Therefore, we examined the prevalence and correlates of alcohol use and risky drinking in this population. Participants completed surveys regarding demographics, pain-related variables, anxiety, cannabis use, and past six-month alcohol consumption. Alcohol use groups were defined using the AUDIT-C [i.e., non-drinkers, low-risk drinkers, and high-risk drinkers (≥4 for men and ≥3 for women)] and compared on demographic characteristics, pain measures, anxiety, and cannabis use. Overall, 42% (n=330/780) were non-drinkers, 32% (n=251/780) were low-risk drinkers, and 26% (n=199/780) were high-risk drinkers. Compared to non-drinkers, low- and high-risk drinkers were significantly younger whereas a larger proportion of low-risk drinkers reported being African-American compared to non- or high-risk drinkers. High-risk drinkers reported significantly lower pain severity/interference compared to the other groups; high-risk drinkers were also less likely to be on disability compared to other groups. A multinomial logistic regression showed that patients reporting lower pain severity and less disability had greater odds of being classified a high-risk drinker. High-risk drinking appears common among medical cannabis patients. Future research should examine whether such use is concurrent or consecutive, and the relationship of such co-use patterns to consequences. Nevertheless, individuals treating patients reporting medical cannabis use for pain should consider alcohol consumption, with data needed regarding the efficacy of brief alcohol interventions among medical cannabis patients. Copyright © 2017 Elsevier Ltd. All rights reserved.

Development of gastric cancer in nonatrophic stomach with highly active inflammation identified by serum levels of pepsinogen and Helicobacter pylori antibody together with endoscopic rugal hyperplastic gastritis.

PubMed

Watanabe, Mika; Kato, Jun; Inoue, Izumi; Yoshimura, Noriko; Yoshida, Takeichi; Mukoubayashi, Chizu; Deguchi, Hisanobu; Enomoto, Shotaro; Ueda, Kazuki; Maekita, Takao; Iguchi, Mikitaka; Tamai, Hideyuki; Utsunomiya, Hirotoshi; Yamamichi, Nobutake; Fujishiro, Mitsuhiro; Iwane, Masataka; Tekeshita, Tatsuya; Mohara, Osamu; Ushijima, Toshikazu; Ichinose, Masao

2012-12-01

This study aimed to elucidate groups at high risk of developing cancer among patients with serologically identified Helicobacter pylori infection and nonatrophic stomach. Annual endoscopy was performed for a mean of 5.4 years in 496 asymptomatic middle-aged men who were H. pylori antibody-positive and pepsinogen (PG) test-negative. Subjects were stratified according to the activity of H. pylori-associated gastritis measured by serum levels of PG and H. pylori antibody, and/or by endoscopic findings of rugal hyperplastic gastritis (RHG), and cancer development was investigated. During the study period, seven cases of cancer developed in the cohort (incidence rate, 261/100,000 person-years), with 85.7% developing in the group showing a PGI/II ratio ≤ 3.0, reflecting active inflammation-based high PGII levels. Cancer incidence was significantly higher in this group (750/100,000 person-years) than in groups with less active gastritis. Furthermore, cancer incidence for this group was significantly higher in the subgroup with high H. pylori antibody titers than in the low-titer subgroup. Meanwhile, endoscopic findings revealed that 11.7% of subjects showed RHG reflecting localized highly active inflammation, and cancer risk was significantly higher in patients with RHG than in patients without. Combining the two serum tests and endoscopic examination for RHG allowed identification of subjects with more active gastritis and higher cancer risk. No cancer development was observed in these high-risk subjects after H. pylori eradication. Subjects with highly active gastritis identified by the two serological tests and endoscopic RHG constitute a group at high risk of cancer development with H. pylori-infected nonatrophic stomach. Copyright © 2012 UICC.

Ethnic Differences in HIV Risk Behaviors Among Methadone-Maintained Women Receiving Contingency Management for Cocaine Use Disorders

PubMed Central

Barry, Danielle; Weinstock, Jeremiah; Petry, Nancy M.

2008-01-01

Objective To identify ethnic differences in HIV risk behaviors among cocaine using women receiving methadone maintenance for opioid dependence, and to evaluate the efficacy of contingency management (CM) for cocaine use disorders in reducing HIV risk behaviors. Methods African American (N=47), Hispanic (N=47), and White women (N = 29) were randomized to standard methadone treatment or standard methadone treatment plus a CM intervention. They completed the HIV Risk Behavior Scale (HRBS) indicating frequency of drug use and sexual behaviors across the lifetime, in the month before baseline, and in the 3 months following clinical trial participation. Ethnic group differences and the effect of CM on change in HIV risk behaviors between baseline and follow-up were evaluated. Results White women reported significantly higher lifetime rates of risky drug use and sexual behaviors on the HRBS than African American women; neither group differed significantly from Hispanic women. No ethnic group differences in HIV risk behaviors were identified in the month prior to baseline. At follow-up, African American women reported fewer high-risk drug use behaviors than White or Hispanic women, and Hispanic women reported more high-risk sexual behaviors than White or African American women. CM was associated with reduction in high-risk drug use behaviors regardless of ethnicity, but did not affect high-risk sexual behaviors. Conclusions White women receiving methadone maintenance engage in more lifetime HIV risk behaviors than African American women. CM for cocaine use reduces risky drug use behaviors, but certain ethnic groups may benefit from additional targeted HIV prevention efforts. PMID:18684571

Utilization of 3-month yoga program for adults at high risk for type 2 diabetes: a pilot study.

PubMed

Yang, Kyeongra; Bernardo, Lisa M; Sereika, Susan M; Conroy, Molly B; Balk, Judy; Burke, Lora E

2011-01-01

Various modes of physical activity, combined with dieting, have been widely recommended to prevent or delay type 2 diabetes. Among these, yoga holds promise for reducing risk factors for type 2 diabetes by promoting weight loss, improving glucose levels and reducing blood pressure and lipid levels. This pilot study aimed to assess the feasibility of implementing a 12-week yoga program among adults at high risk for type 2 diabetes. Twenty-three adults (19 Whites and 4 non-Whites) were randomly assigned to the yoga intervention group or the educational group. The yoga group participated in a 3-month yoga intervention with sessions twice per week and the educational group received general health educational materials every 2 weeks. All participants completed questionnaires and had blood tests at baseline and at the end of 3 months. Effect sizes were reported to summarize the efficacy of the intervention. All participants assigned to the yoga intervention completed the yoga program without complication and expressed high satisfaction with the program (99.2%). Their yoga session attendance ranged from 58.3 to 100%. Compared with the education group, the yoga group experienced improvements in weight, blood pressure, insulin, triglycerides and exercise self-efficacy indicated by small to large effect sizes. This preliminary study indicates that a yoga program would be a possible risk reduction option for adults at high risk for type 2 diabetes. In addition, yoga holds promise as an approach to reducing cardiometabolic risk factors and increasing exercise self-efficacy for this group.

Obstructive Sleep Apnea Syndrome is Associated with Metabolic Syndrome among Adolescents and Youth in Beijing: Data from Beijing Child and Adolescent Metabolic Syndrome Study

PubMed Central

Qu, Xiao-Xue; Esangbedo, Issy C; Zhang, Xiu-Juan; Liu, Shu-Jun; Li, Lian-Xia; Gao, Shan; Li, Ming

2015-01-01

Background: Obstructive sleep apnea (OSA) syndrome has a negative impact on the health of millions of adolescents and youth. The aim of this study was to evaluate the associations of OSA syndrome with obesity and cardiometabolic risk factors among adolescents and youth at risk for metabolic syndrome (MS). Methods: A total of 558 subjects aged 14–28 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome Study. Each underwent a 2-h oral glucose tolerance test (OGTT), echocardiography, and liver ultrasonography. Anthropometric measures, blood levels of glucose, lipids, and liver enzymes were assessed. Subjects with high or low risk for OSA were identified by Berlin Questionnaire (BQ). Results: Among the subjects in obesity, 33.7% of whom were likely to have OSA by BQ. Subjects with high risk for OSA had higher neck and waist circumference and fat mass percentage compared to those with low risk for OSA (P < 0.001). Moreover, significant differences in levels of lipids, glucose after OGTT, and liver enzymes, as well as echocardiographic parameters were found between the two groups with high or low risk for OSA (P < 0.05). The rates of nonalcoholic fatty liver disease (71.0% vs. 24.2%), MS (38.9% vs. 7.0%), and its components in high-risk group were significantly higher than in low-risk group. Conclusions: The prevalence of OSA by BQ was high in obese adolescents and youth. A high risk for OSA indicates a high cardiometabolic risk. Mechanisms mediating the observed associations require further investigation. PMID:26315072

Obstructive Sleep Apnea Syndrome is Associated with Metabolic Syndrome among Adolescents and Youth in Beijing: data from Beijing Child and Adolescent Metabolic Syndrome Study.

PubMed

Qu, Xiao-Xue; Esangbedo, Issy C; Zhang, Xiu-Juan; Liu, Shu-Jun; Li, Lian-Xia; Gao, Shan; Li, Ming

2015-09-05

Obstructive sleep apnea (OSA) syndrome has a negative impact on the health of millions of adolescents and youth. The aim of this study was to evaluate the associations of OSA syndrome with obesity and cardiometabolic risk factors among adolescents and youth at risk for metabolic syndrome (MS). A total of 558 subjects aged 14-28 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome Study. Each underwent a 2-h oral glucose tolerance test (OGTT), echocardiography, and liver ultrasonography. Anthropometric measures, blood levels of glucose, lipids, and liver enzymes were assessed. Subjects with high or low risk for OSA were identified by Berlin Questionnaire (BQ). Among the subjects in obesity, 33.7% of whom were likely to have OSA by BQ. Subjects with high risk for OSA had higher neck and waist circumference and fat mass percentage compared to those with low risk for OSA (P < 0.001). Moreover, significant differences in levels of lipids, glucose after OGTT, and liver enzymes, as well as echocardiographic parameters were found between the two groups with high or low risk for OSA (P < 0.05). The rates of nonalcoholic fatty liver disease (71.0% vs. 24.2%), MS (38.9% vs. 7.0%), and its components in high-risk group were significantly higher than in low-risk group. The prevalence of OSA by BQ was high in obese adolescents and youth. A high risk for OSA indicates a high cardiometabolic risk. Mechanisms mediating the observed associations require further investigation.

Can genetic risk information for age-related macular degeneration influence motivation to stop smoking? A pilot study

PubMed Central

Rennie, C A; Stinge, A; King, E A; Sothirachagan, S; Osmond, C; Lotery, A J

2012-01-01

Aims Smoking can increase the risk of macular degeneration and this is more than additive if a person also has a genetic risk. The purpose of this study was to examine whether knowledge of genetic risk for age-related macular degeneration (AMD) could influence motivation to quit smoking. Methods A questionnaire-based study of hypothetical case scenarios given to 49 smokers without AMD. Participants were randomly allocated to a generic risk, high genetic risk, or low genetic risk of developing AMD scenario. Results Forty-seven percent knew of the link between smoking and eye disease. In all, 76%, 67%, and 46% for the high risk, generic, and low risk groups, respectively, would rethink quitting (Pfor trend=0.082). In all, 67%, 40%, and 38.5%, respectively, would be likely, very likely, or would definitely quit in the following month (Pfor trend=0.023). Few participants (<16% of any group) were very likely to or would definitely attend a quit smoking session with no difference across groups. In all, 75.5% of participants would consider taking a genetic test for AMD. Conclusion In this pilot study, a trend was seen for the group given high genetic risk information to be more likely to quit than the generic or low genetic risk groups. Participants were willing to take a genetic test but further work is needed to address the cost benefits of routine genetic testing for risk of AMD. More generic risk information should be given to the public, and health warnings on cigarette packets that ‘smoking causes blindness' is a good way to achieve this. PMID:22037055

Inflammation as a Risk of Developing Chronic Kidney Disease in Rheumatoid Arthritis.

PubMed

Kochi, Masako; Kohagura, Kentaro; Shiohira, Yoshiki; Iseki, Kunitoshi; Ohya, Yusuke

2016-01-01

The relationship between chronic inflammation and the incidence of chronic kidney disease (CKD) remained not-clear in patients with rheumatoid arthritis (RA). This study aims to examine the relationship between persistently high C-reactive protein (CRP), a marker of inflammation, and the incidence of CKD in RA. We retrospectively examined the relationship between the levels of CRP and incidence of CKD in 345 RA patients. The outcome of interest was incidence of CKD, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 and/or positive dipstick testing for proteinuria for ≥3 months. We defined high CRP, as >3.0 mg/L. On the basis of three measurements of CRP for 6-months period, patients were divided into three groups: group 1, including patients with no high CRP values; group 2, patients with transient high CRP values (once or twice) and group 3, patients with persistently high CRP values. During a median follow-up period of 89 months, 14% of all patients developed CKD. The cumulative incidence of CKD was 7% in group 1, 14% in group 2 and 22% in group 3 (P = 0.008, log-rank test). In a multivariate analysis, including classical risk factors for CKD, persistently high CRP was an independent predictor of the incidence of CKD (hazard ratio, 3.00; 95% confidence interval, 1.23-8.53; P = 0.01). Persistently high CRP was a significant risk factor for the incidence of CKD. Results suggest that persistent inflammation is a marker for the high risk of CKD in RA.

Different pathological features and prognosis in gastric cancer patients coming from high-risk and low-risk areas of Italy.

PubMed

Marrelli, Daniele; Pedrazzani, Corrado; Corso, Giovanni; Neri, Alessandro; Di Martino, Marianna; Pinto, Enrico; Roviello, Franco

2009-07-01

To compare clinicopathological features and long-term outcome in gastric cancer patients coming from high-risk and low-risk areas of Italy. Better survival rates have been reported from countries with higher incidence of gastric cancer. Data regarding 829 patients coming from Tuscany (group A) and 143 patients coming from Southern Italy (group B) were analyzed. Mean follow-up time was 56 +/- 57 months; it was 85 +/- 63 months in surviving patients or not tumor-related deaths. Prognostic factors were investigated by multivariate analysis with Cox proportional hazard model after verifying the assumption of proportionality of the risk associated with covariates. Lauren diffuse-mixed histotype, younger age, extended lymphadenectomy, and advanced stages were more common in group B. Gastric cancer-related 10-year survival probability was 48% in group A versus 29% in group B (log-rank test: P < 0.001). By multivariate analysis, geographic area was confirmed as a significant prognostic factor (hazard ratio for group B vs. group A: 1.52, 95% confidence interval: 1.12-2.06, P = 0.006). The influence of this factor on long-term survival was independent from other clinical, surgical, and pathologic factors, and was notable in neoplasms involving the serosa (10-year survival probability: 15% in group A vs. 3% in group B, log-rank test: P = 0.005). Patients coming from low-risk area of Italy showed distinct pathologic features, more advanced stage, and worse prognosis when compared with patients coming from high-risk area. These findings may be indicative of different tumor biology, and may contribute to partly explain worldwide geographic variability in prognosis reported in different series.

Do adolescents who are night owls have a higher risk of dental caries? - a case-control study.

PubMed

Lundgren, A-M; Öhrn, K; Jönsson, B

2016-08-01

The aim was to evaluate the association between circadian rhythm and the risk of caries in adolescents, as well as their dietary and toothbrushing habits. A group of 196 adolescents (15 and 16 years old) were divided into two equal groups based on caries risk (case = high risk; and control = low risk). Before their dental examinations, they were asked to complete a questionnaire. The questionnaire included questions on circadian rhythm, dietary and oral self-care habits, and demographic variables. The participants were divided into three circadian types: evening types who are alert in the evening and tired in the morning; morning types who are the opposite; and neutral types who are neither particularly alert in the evening nor extremely tired in the morning. The most common sleep-cycle group type was neutral (50%). After this came evening types (37%) and finally morning types (13%). Morning and neutral types reported more frequently than evening types that they had breakfast every morning and brushed their teeth twice a day. More evening types were categorized as at high risk of caries. Circadian rhythm, breakfast habits and toothbrushing frequency were associated with a high risk of caries. The predicted probability of being at high risk of caries was almost four times higher for evening types than for morning types (OR 3.8; 95% CI 1.3-10.9). Adolescents who belonged to the evening circadian rhythm group brushed their teeth more seldom, ate breakfast less regularly and had a higher risk of caries than morning types. A patient's circadian rhythm should be considered when planning oral health education for adolescents with a high risk of caries. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

[Comparison of the present and previously used protocol of risk stratification in children with acute lymphoblastic leukemia].

PubMed

Glodkowska, Eliza; Bialas, Agnieszka; Jackowska, Teresa

2007-01-01

Acute lymphoblastic leukaemia (ALL) is one of the most common cancers in children. In Poland, since November 2002 a new protocol of risk stratification has been recommended for assessment of risk factors and for choosing therapy regimens. assessment of accuracy of protocol ALL-IC 2002 in comparison to previously used risk stratification protocols. ALL was diagnosed in 100 children (44 girls, 56 boys; 1-18 years of age) in the Department of Pediatric Hematology and Oncology, Warsaw Medical University, over the period from November 2002 to November 2006. According to the ALL-IC 2002 protocol the patients were divided into three risk groups: SR-standard, IR-intermediate and HR-high. The stratification was by age, leukocyte count, cytogenetic changes, early response to prednisone therapy and bone marrow remission. In the previously used risk stratification protocols-BFM-90, only hepatosplenomegaly and the number of blasts in peripheral blood (PB) were considered, and the patients were divided into three risk groups: low (LRG<0.8), medium (MRG) and high (HRG>1.2). out of the 100 patients qualified for treatment regimens according to the ALL-IC 2002 protocol, 97 entered remission, 11 died and 3 had a relapse. Under the ALL-IC 2002 protocol these children were stratified into the following groups: SR-31%, IR-44% and HR-25%. In the previously used stratification, there would be 26% children in low, 46% in the medium and 28% in the high risk group. According to the BFM-90 protocol 18/31 (58%) and 16/44 (36%) patients from the SR and IR groups respectively would be given more intensive treatment. On the other hand 11/44 (25%) and 14/25 (56%) patients from the IR and HR groups respectively would be given less intensive treatment. 1. ALL-IC 2002 protocol in comparison with the previously used protocol BFM-90, changes the qualification of children with ALL for the SR, IR and HR risk groups. This is linked to basic change of treatment protocol, adequate to severity of disease. 2. Children with ALL qualified according to protocol BFM-90 for moderate risk group (IR) constitute a mixed group in the ALL-IC 2002 classification. Part of the children was moved to the standard risk group (SR), part to high risk group (HR), and the rest remains in the intermediate risk category (IR). 3. Further studies are needed on stratification validity according to ALL-IL 2002 and on the need of further modification (eg assessment of additional factors) in order to decide on the best treatment, adequate to severity of disease.

Effect of circulating exosomes from transition cows on Madin-Darby bovine kidney cell function.

PubMed

Crookenden, M A; Walker, C G; Peiris, H; Koh, Y; Almughlliq, F; Vaswani, K; Reed, S; Heiser, A; Loor, J J; Kay, J K; Meier, S; Donkin, S S; Murray, A; Dukkipati, V S R; Roche, J R; Mitchell, M D

2017-07-01

The greatest risk of metabolic and infectious disease in dairy cows is during the transition from pregnancy to lactating (i.e., the transition period). The objective of this experiment was to determine the effects of extracellular vesicles (microvesicles involved in cell-to-cell signaling) isolated from transition cows on target cell function. We previously identified differences in the protein profiles of exosomes isolated from cows divergent in metabolic health status. Therefore, we hypothesized that these exosomes would affect target tissues differently. To investigate this, 2 groups of cows (n = 5/group) were selected based on the concentration of β-hydroxybutyrate and fatty acids in plasma and triacylglycerol concentration in liver at wk 1 and 2 postcalving. Cows with high concentrations of β-hydroxybutyrate, fatty acids, and triacylglycerol were considered at increased risk of clinical disease during the transition period (high-risk group; n = 5) and were compared with cows that had low concentrations of the selected health indicators (low-risk group; n = 5). At 2 time points during the transition period (postcalving at wk 1 and 4), blood was sampled and plasma exosomes were isolated from the high-risk and low-risk cows. The exosomes were applied at concentrations of 10 and 1 µg/mL to 5 × 10 3 Madin-Darby bovine kidney cells grown to 50% confluence in 96-well plates. Results indicate a numerical increase in cell proliferation when exosomes from high-risk cows were applied compared with those from low-risk cows. Consistent with an effect on cell proliferation, quantitative reverse transcriptase PCR indicated a trend for upregulation of 3 proinflammatory genes (granulocyte colony-stimulating factor, ciliary neurotrophic factor, and CD27 ligand) with the application of high-risk exosomes, which are involved in cellular growth and survival. Proteomic analysis indicated 2 proteins in the low-risk group that were not identified in the high-risk group (endoplasmin and catalase), which may also be indicative of the metabolic state of origin. It is likely that the metabolic state of the transition cow affects cellular function through exosomal messaging; however, more in-depth research into cross-talk between exosomes and target cells is required to determine whether exosomes influence Madin-Darby bovine kidney cells in this manner. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Risk Comparison among Youth Who Report Sex with Same-Sex versus Both-Sex Partners

ERIC Educational Resources Information Center

Moon, Martha W.; Fornili, Katherine; O'Briant, Amanda L.

2007-01-01

This article examines risk behavior among youth attending support groups for sexual minority youth in Richmond, Virginia, using a structured survey, with particular attention to partner selection and its relationship to risk. Within this generally high-risk group, youth reporting sex partners of both sexes had significantly higher risk profiles,…

Phenotypic effects of subclinical paratuberculosis (Johne's disease) in dairy cattle.

PubMed

Pritchard, Tracey C; Coffey, Mike P; Bond, Karen S; Hutchings, Mike R; Wall, Eileen

2017-01-01

The effect of subclinical paratuberculosis (or Johne's disease) risk status on performance, health, and fertility was studied in 58,096 UK Holstein-Friesian cows with 156,837 lactations across lactations 1 to 3. Low-, medium-, and high-risk group categories were allocated to cows determined by a minimum of 4 ELISA milk tests taken at any time during their lactating life. Lactation curves of daily milk, protein, and fat yields and protein and fat percentage, together with log e -transformed somatic cell count, were estimated using a random regression model to quantify differences between risk groups. The effect of subclinical paratuberculosis risk groups on fertility, lactation-average somatic cell count, and mastitis were analyzed using linear regression fitting risk group as a fixed effect. Milk yield losses associated with high-risk cows compared with low-risk cows in lactations 1, 2, and 3 for mean daily yield were 0.34, 1.05, and 1.61kg; likewise, accumulated 305-d yields were 103, 316, and 485kg, respectively. The total loss was 904kg over the first 3 lactations. Protein and fat yield losses associated with high-risk cows were significant, but primarily a feature of decreasing milk yield. Similar trends were observed for both test-day and lactation-average somatic cell count measures with higher somatic cell counts from medium- and high-risk cows compared with low-risk cows, and differences were in almost all cases significant. Likewise, mastitis incidence was significantly higher in high-risk cows compared with low-risk cows in lactations 2 and 3. Whereas the few significant differences between risk groups among fertility traits were inconsistent with no clear trend. These results are expected to be conservative, as some animals that were considered negative may become positive after the timeframe of this study, particularly if the animal was tested when relatively young. However, the magnitude of milk yield losses together with higher somatic cell counts and an increase in mastitis incidence should motivate farmers to implement the appropriate control measures to reduce the spread of the disease. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Trends in the knowledge, attitudes and practices of travel risk groups towards prevention of malaria: results from the Dutch Schiphol Airport Survey 2002 to 2009

PubMed Central

2012-01-01

Background Previous studies investigating the travellers’ knowledge, attitudes and practices (KAP) profile indicated an important educational need among those travelling to risk destinations. Initiatives to improve such education should target all groups of travellers, including business travellers, those visiting friends and relatives (VFRs), and elderly travellers. Methods In the years 2002 to 2009, a questionnaire-based survey was conducted at the Dutch Schiphol Airport with the aim to study trends in KAP of travel risk groups towards prevention of malaria. The risk groups last-minute travellers, solo-travellers, business travellers, VFRs and elderly travellers were specifically studied. Results A total of 3,045 respondents were included in the survey. Travellers to destinations with a high risk for malaria had significantly more accurate risk perceptions (knowledge) than travellers to low-risk destinations. The relative risk for malaria in travellers to high-risk destinations was probably mitigated by higher protection rates against malaria as compared with travellers to low risk destinations. There were no significant differences in intended risk-taking behaviour. Trend analyses showed a significant change over time in attitude towards more risk-avoiding behaviour and towards higher protection rates against malaria in travellers to high-risk destinations. The KAP profile of last-minute travellers substantially increased their relative risk for malaria, which contrasts to the slight increase in relative risk of solo travellers, business travellers and VFRs for malaria. Conclusions The results of this sequential cohort survey in Dutch travellers suggest an annual 1.8% increase in protection rates against malaria coinciding with an annual 2.5% decrease in intended risk-seeking behaviour. This improvement may reflect the continuous efforts of travel health advice providers to create awareness and to propagate safe and healthy travel. The KAP profile of last-minute travellers, in particular, substantially increased their relative risk for malaria, underlining the continuous need for personal protective measures and malaria chemoprophylaxis for this risk group. PMID:22642661

Joint Attention Initiation with and without Positive Affect: Risk Group Differences and Associations with ASD Symptoms

PubMed Central

Gangi, Devon N.; Ibañez, Lisa V.; Messinger, Daniel S.

2014-01-01

Infants at risk for Autism Spectrum Disorders (ASD) may have difficulty integrating smiles into initiating joint attention (IJA) bids. A specific IJA pattern, anticipatory smiling, may communicate preexisting positive affect when an infant smiles at an object and then turns the smile toward the social partner. We compared the development of anticipatory smiling at 8, 10, and 12 months in infant siblings of children with ASD (high-risk siblings) and without ASD (low-risk siblings). High-risk siblings produced less anticipatory smiling than low-risk siblings, suggesting early differences in communicating preexisting positive affect. While early anticipatory smiling distinguished the risk groups, IJA not accompanied by smiling best predicted later severity of ASD-related behavioral characteristics among high-risk siblings. High-risk infants appear to show lower levels of motivation to share positive affect with others. However, facility with initiating joint attention in the absence of a clear index of positive affective motivation appears to be central to the prediction of ASD symptoms. PMID:24281421

Effect of auricular pellet acupressure on antioxidative systems in high-risk diabetes mellitus.

PubMed

Liu, Chi-Feng; Yu, Lee-Fen; Lin, Chia-Hsien; Lin, Song-Chow

2008-04-01

Free radicals and lipid peroxides, both of which are easily formed in the diabetic state, play an important role in the development of diabetic complications. Antioxidative therapy may help prevent diabetic complications caused by lipoperoxidation and free-radical formation in diabetes mellitus (DM). A number of findings suggest that oxidative stress exists in persons with high-risk DM. Auricular pellet acupressure has reportedly been an effective treatment method for a variety of medical conditions, including anxiety, juvenile myopia, essential hypertension, and senile vascular dementia. However, its effects on antioxidative enzymes have not been elucidated. We therefore evaluated the impact of auricular pellet acupressure on antioxidative status in persons with high-risk DM. Our study involved 69 persons with high-risk DM, who were allocated either to undergo acupressure as active treatment for the experimental group or to a control group. The experimental group in the study received auricular pellet acupressure three times daily for 5 consecutive days. After a 2-day rest period, the procedure was performed on the contralateral ear. Acupressure was performed twice on each ear, with each application followed by its application to the contralateral ear, over a total treatment period of 20 days. The control groups did not undergo auricular pellet acupressure. At the end of the 20-day period of treatment of the experimental group, blood was collected from all of the study participants for assay of serum superoxide dismutase (SOD) and catalase concentrations, as was also done for the control group. Serum concentrations of SOD (p < 0.05) and catalase (p < 0.0001) were significantly higher in the experimental group than in the control group. Our findings suggest that auricular pellet acupressure can increase the concentration of antioxidative enzymes in persons with high-risk DM.

Development of reading and phonological skills of children at family risk for dyslexia: a longitudinal analysis from kindergarten to sixth grade.

PubMed

Dandache, Sophie; Wouters, Jan; Ghesquière, Pol

2014-11-01

The main focus of this article is to develop a better understanding of the developmental trajectories of literacy and phonological skills within Dutch-speaking children. Children at high and low risk for dyslexia were followed and compared at four different moments: kindergarten and first, third and sixth grades. Three groups were then compared: (1) dyslexic readers; (2) normal readers at high risk for dyslexia; and (3) normal readers at low risk for dyslexia. Children diagnosed with dyslexia scored lower than high-risk normal readers on phonological awareness (PA), rapid automatized naming (RAN), verbal short-term memory and literacy skills. Normal readers at high risk scored between both groups, confirming that dyslexia is to be considered as a continuum rather than an all-or-none condition. Growth analyses showed that the three groups evolved similarly on all measures except for phoneme deletion and literacy measures. Finally, solely PA and RAN explained a significant amount of variance in the evolution of reading skills. Copyright © 2014 John Wiley & Sons, Ltd.

[Study on the status and related socio-psychological factors of maternal depression among high-risk pregnancy women in Harbin city].

PubMed

Xie, Ya-chun; Yuan, Hong-wei; Zhuang, Ru-jin; Han, Cong-hui; Liu, Shu-hong; Chen, Su-fen; Fu, Zhi-wei; Wang, Zhi-ming; Qiao, Su-zhen; Guo, Lin; Zhang, Hui-ying

2012-06-01

This study aimed to investigate the depression status among high-risk pregnancy women, and to analyze its relevant social and psychological factors. A total of 42 high-risk pregnancy women and 40 normal pregnancy women in a teaching hospital in Harbin city were followed up at time points of 32 - 36 weeks pregnancy, one week before labor, one week postpartum, and six weeks postpartum, respectively. During follow-up, the basic situation, social psychosocial factors of pregnancy women were collected and the depression of pregnancy women was measured by self-designed questionnaire and self-rating depression scale. The Edinburgh Postnatal Depression Scale (EPDS) was applied at timepoint of one week postpartum. Single factor analysis and the unconditional multivariate logistic regression were applied for analyzing the on the related social-psychosocial factors among high-risk pregnancy women. The age of high-risk pregnancy women was (31.0±5.6), and the age of normal pregnancy women was (30.5±3.8) (t=0.169, P>0.05). The results showed that the depression rate in high-risk pregnancy women was 45.2% (19/42), which was 25.0% (10/40) in normal pregnancy women, the difference was significant (χ2=3.671, P=0.045). The depression rates at different time points were 30.9% (13/42), 42.9% (18/42), 23.8% (10/42), 26.2% (11/42) in high-risk pregnancy women respectively, and 25.0% (10/40), 15.0% (6/40), 20.0% (8/40), 17.5% (7/40) in the control group respectively, the difference of the depression rates among groups at one week before labor was significant (χ2=7.680, P<0.01), the difference among groups at 32-36 weeks pregnancy (χ2=0.133, P=0.80), at one week postpartum (χ2=0.174, P=0.79) and at six weeks postpartum (χ2=0.903, P=0.43) were not significant. At one week postpartum and six weeks postpartum periods, the EPDS depression rate were 12.5% (4/32), 30.4% (7/23) in case group respectively, 8.3% (3/36), 22.9% (8/35) in control group respectively, the difference were not significant (χ2=0.319, 0.416, P=0.573, 0.519). There were significantly associations between the depression mood of one week before labor and the depressive symptoms of six weeks postpartum in both groups (r=0.824, 0.677, both P values were <0.05). The risk factors for maternal depression among high-risk pregnancy women were not ready for production (OR=2.73, P<0.01) and fearing of childbirth safety (OR=2.89, P<0.01). The depression date of high-risk pregnancy was high, especially at the time point one week before labor. Risk factors of maternal depression among high-risk pregnancy were "not ready for production" and "fear of childbirth safety".

Brief Report: The Development of Compliance in Toddlers At-Risk for Autism Spectrum Disorder

ERIC Educational Resources Information Center

Ekas, Naomi V.; McDonald, Nicole M.; Pruitt, Megan M.; Messinger, Daniel S.

2017-01-01

Parents of children with autism spectrum disorder (ASD) report concerns with child compliance. The development of compliance in 24-, 30-, and 36-month-old high-risk children with ASD outcomes (n = 21), high-risk children without ASD (n = 49), and low-risk children (n = 41) was examined. The High-Risk/ASD group showed greater passive noncompliance…

Predict value of adiponectin for coronary atherosclerosis plaques according to computed tomography angiography in an asymptomatic population.

PubMed

Gan, Lu; Yang, Li; Yan, Guangtao

2018-05-25

The association between serum adiponectin levels and coronary atherosclerosis plaque characteristics in asymptomatic populations is unclear. To examine the predictive value of serum adiponectin levels for coronary high risk plaques as detected by computed tomography angiography (CTA). This was a cross-sectional study. All patients were divided into high risk plaque group and non high risk plaque group. The FRS was calculated for each patient. CTA was performed for each patient. Adiponectin levels were measured by flow fluorescence immunmicrobead assay (FFIA). Receiver-operating characteristic (ROC) curves and multivariate analysis was used to determine the predictive value of adiponectin for high risk plaques. The high risk plaque group showed lower adiponectin levels than non high risk plaque group (median, 7.27 vs. 8.51 μg/ml, P = 0.003). The multivariate analysis showed that age (OR = 2.62, 95%CI: 1.51-4.56, P = 0.001), hyperlipidemia (OR = 1.89, 95%CI: 1.07-3.36, P = 0.029), high-density lipoprotein cholesterol (HDL-C) (OR = 0.46, 95%CI: 0.24-0.87, P = 0.02), the ratio of total cholesterol to high-density lipoproteincholesterol (TC/HDL-C) (OR = 0.69, 95%CI: 0.50-0.94, P = 0.02), apolipoprotein B (apoB) (OR = 3.08, 95%CI: 1.50-6.32, P = 0.002), and adiponectin (OR = 0.37, 95%CI: 0.19-0.74, P = 0.005) were independently associated with the presence of high risk plaques. AUC of the multivariate model for high-risk plaques was 0.728 (95%CI: 0.627-0.783). Sensitivity was 74.9%, specificity was 60.2%, the positive predictive value was 65.3%, and the negative predictive value was 70.6%. Decreased adiponectin levels were associated with the presence of high-risk plaques in asymptomatic populations at low to intermediate FRS. Adiponectin can play an important role in plaque screening before coronary CTA. Copyright © 2018 Elsevier Inc. All rights reserved.

Predicting outcome in acute severe ulcerative colitis: comparison of the Travis and Ho scores using UK IBD audit data.

PubMed

Lynch, R W; Churchhouse, A M D; Protheroe, A; Arnott, I D R

2016-06-01

Acute severe ulcerative colitis is categorised using the Truelove & Witts criteria. The Travis and the Ho scores are calculated following 72 h of steroid treatment to identify patients at risk of failing steroid therapy who require colectomy or second-line medical therapy. To compare the Travis and the Ho scores in a large unselected cohort to determine which might be more clinically relevant. We analysed 3049 patients with ulcerative colitis from the 2010 round of the UK IBD audit of which 984 had acute severe ulcerative colitis. 420 patients had sufficient data for analysis. Patients were allocated into either a Travis high- or low-risk group and either a Ho high-, intermediate- or low-risk group. We assessed whether further medical or surgical intervention and outcomes varied between groups. High-risk patients in Travis and the Ho groups, when compared to lower risk groups, were more likely to fail steroid therapy: 64.5% (131/203) vs. 38.7% (84/217) (P < 0.0001) for Travis and 66.2% (96/145) vs. 46.7% (85/182) vs. 36.6% (34/93) (P < 0.0001) for Ho. They were also more likely to undergo surgery 34.0% (69/203) vs. 9.7% (21/217) for Travis and 33.1% (48/145) vs. 17.0% (31/182) vs. 11.8% (11/93) (P < 0.0001) for Ho. Travis high patients were more likely to be refractory to second-line medical therapy: 44.6% (37/83) vs. 20.0% (9/45) (P = 0.01). Patients identified as high risk using the Travis or the Ho scoring systems are more likely to be resistant to IV steroids and require surgery. Risk of surgery in both high-risk populations is lower than previously reported. © 2016 John Wiley & Sons Ltd.

Antibiotic treatment of bacterial vaginosis in pregnancy: multiple meta-analyses and dilemmas in interpretation.

PubMed

Varma, Rajesh; Gupta, Janesh K

2006-01-01

There is considerable evidence to show an association between genital tract infections, such as bacterial vaginosis (BV), and preterm delivery (PTD). Meta-analyses to date have shown screening and treating BV in pregnancy does not prevent PTD. This casts doubt on a cause and effect relationship between BV and PTD. However, the meta-analyses reported significant clinical, methodological and statistical heterogeneity of the included studies. We therefore undertook a repeat meta-analysis, included recently published trials, and applied strict criteria on data extraction. We meta-analysed low and high-risk pregnancies separately. We found that screening and treating BV in low-risk pregnancies produced a statistically significant reduction in spontaneous PTD (RR 0.73; 95% CI 0.55-0.98). This beneficial effect was not observed in high-risk or combined risk groups. The differences in antibiotic sensitivity between high and low risk groups may suggest differing causal contributions of the infectious process to PTD. The evidence, along with prior knowledge of differing predisposing factors and prognosis between these risk groups, supports the hypothesis that PTD in high and low risk pregnant women are different entities and not linear extremes of the same syndrome.

Predictive value for cardiovascular events of common carotid intima media thickness and its rate of change in individuals at high cardiovascular risk - Results from the PROG-IMT collaboration.

PubMed

Lorenz, Matthias W; Gao, Lu; Ziegelbauer, Kathrin; Norata, Giuseppe Danilo; Empana, Jean Philippe; Schmidtmann, Irene; Lin, Hung-Ju; McLachlan, Stela; Bokemark, Lena; Ronkainen, Kimmo; Amato, Mauro; Schminke, Ulf; Srinivasan, Sathanur R; Lind, Lars; Okazaki, Shuhei; Stehouwer, Coen D A; Willeit, Peter; Polak, Joseph F; Steinmetz, Helmuth; Sander, Dirk; Poppert, Holger; Desvarieux, Moise; Ikram, M Arfan; Johnsen, Stein Harald; Staub, Daniel; Sirtori, Cesare R; Iglseder, Bernhard; Beloqui, Oscar; Engström, Gunnar; Friera, Alfonso; Rozza, Francesco; Xie, Wuxiang; Parraga, Grace; Grigore, Liliana; Plichart, Matthieu; Blankenberg, Stefan; Su, Ta-Chen; Schmidt, Caroline; Tuomainen, Tomi-Pekka; Veglia, Fabrizio; Völzke, Henry; Nijpels, Giel; Willeit, Johann; Sacco, Ralph L; Franco, Oscar H; Uthoff, Heiko; Hedblad, Bo; Suarez, Carmen; Izzo, Raffaele; Zhao, Dong; Wannarong, Thapat; Catapano, Alberico; Ducimetiere, Pierre; Espinola-Klein, Christine; Chien, Kuo-Liong; Price, Jackie F; Bergström, Göran; Kauhanen, Jussi; Tremoli, Elena; Dörr, Marcus; Berenson, Gerald; Kitagawa, Kazuo; Dekker, Jacqueline M; Kiechl, Stefan; Sitzer, Matthias; Bickel, Horst; Rundek, Tatjana; Hofman, Albert; Mathiesen, Ellisiv B; Castelnuovo, Samuela; Landecho, Manuel F; Rosvall, Maria; Gabriel, Rafael; de Luca, Nicola; Liu, Jing; Baldassarre, Damiano; Kavousi, Maryam; de Groot, Eric; Bots, Michiel L; Yanez, David N; Thompson, Simon G

2018-01-01

Carotid intima media thickness (CIMT) predicts cardiovascular (CVD) events, but the predictive value of CIMT change is debated. We assessed the relation between CIMT change and events in individuals at high cardiovascular risk. From 31 cohorts with two CIMT scans (total n = 89070) on average 3.6 years apart and clinical follow-up, subcohorts were drawn: (A) individuals with at least 3 cardiovascular risk factors without previous CVD events, (B) individuals with carotid plaques without previous CVD events, and (C) individuals with previous CVD events. Cox regression models were fit to estimate the hazard ratio (HR) of the combined endpoint (myocardial infarction, stroke or vascular death) per standard deviation (SD) of CIMT change, adjusted for CVD risk factors. These HRs were pooled across studies. In groups A, B and C we observed 3483, 2845 and 1165 endpoint events, respectively. Average common CIMT was 0.79mm (SD 0.16mm), and annual common CIMT change was 0.01mm (SD 0.07mm), both in group A. The pooled HR per SD of annual common CIMT change (0.02 to 0.43mm) was 0.99 (95% confidence interval: 0.95-1.02) in group A, 0.98 (0.93-1.04) in group B, and 0.95 (0.89-1.04) in group C. The HR per SD of common CIMT (average of the first and the second CIMT scan, 0.09 to 0.75mm) was 1.15 (1.07-1.23) in group A, 1.13 (1.05-1.22) in group B, and 1.12 (1.05-1.20) in group C. We confirm that common CIMT is associated with future CVD events in individuals at high risk. CIMT change does not relate to future event risk in high-risk individuals.

Robotic high-intensity focused ultrasound (rHIFU) for the prostate cancer treatment

NASA Astrophysics Data System (ADS)

Solovov, Vyacheslav; Shaplygin, Leonid; Vozdvizhenskiy, Mikhail

2012-11-01

Introduction & Objectives: rHIFU shows a successful treatment for localized prostate cancer (PC). Here we explored the effectiveness of the rHIFU treatment for the prostate cancer, hormone-resistant prostate cancer (HRPC) and failure after external beam radiotherapy (EBRT) and radical prostatectomy (RPE). Materials & Methods: 748 patients were treated in our center between Sep 2007 - February 2012: 137 - hormone-resistance (median time before hormone-resistance 25 months), 286 - received neoadjuvant hormone therapy 6 months, 293 - no treatment before HIFU, 32 - after the EBRT failure. 667 patients underwent TURP+rHIFU, 81 only rHIFU (volume prostate <40cc). Mean follow-up is 38 months (range 3-52). All patients were divided into 3 groups: low risk progression (Gleason <7, stage T1-2N0M0, PSA<20, n= 465), high risk progression - (Gleason ≤9, stage T2-3N0M0, PSA <60, n= 251), after EBRT and RPE failure (n= 39). The mean age of the whole group of patients were 70 (52-89) years, mean prostate volume - 39 (5,5-108) cc. Results: Median PSA level 12 months after rHIFU treatment were 0,04 (0-2,24) ng/ml - low risk group, for high risk group - 0,5 (0-48,4) ng/ml, with failure after EBRT and RPE- 0,5 (0-3,2) ng/ml; 36 months after rHIFU treatment were 0,5 (0,02-3,6) ng/ml - low risk group, for high risk group - 3,2 (0-21,38) ng/ml, with failure after EBRT and RPE - 1,7 (0-9,8) ng/ml. Patients with low risk had 4,5% of progression, with high risk PC - 25%, with failure after EBRT and RPE - 19,6%. Kaplan-Meir analyses of the total group indicated that the risk of progression after 1 year follow-up was 10%, the risk of progression was 23% after 4 years of follow-up. Complications: incontinence I - 17,5%, incontinence II - 7,7%, stricture - 18,2%, fistula - 0,3 %. Conclusions: Our experience shows that rHIFU ablation is safe, minimally invasive, effective treatment with moderate side effects for the PC, hormone-resistant prostate cancer, rHIFU also may be used as a salvage therapy after EBRF. Further studies are required.

Apparent diffusion coefficient on magnetic resonance imaging (MRI) in bladder cancer: relations with recurrence/progression risk

PubMed Central

Kikuchi, Ken; Shigihara, Takeshi; Hashimoto, Yuko; Miyajima, Masayuki; Haga, Nobuhiro; Kojima, Yoshiyuki; Shishido, Fumio

2017-01-01

Abstract AIMS: To evaluate the relationship between the apparent diffusion coefficient (ADC) value for bladder cancer and the recurrence/progression risk of post-transurethral resection (TUR). METHODS: Forty-one patients with initial and non-muscle-invasive bladder cancer underwent MRI from 2009 to 2012. Two radiologists measured ADC values. A pathologist calculated the recurrence/progression scores, and risk was classified based on the scores. Pearson’s correlation was used to analyze the correlations of ADC value with each score and with each risk group, and the optimal cut-off value was established based on receiver operating characteristic (ROC) curve analysis. Furthermore, the relationship between actual recurrence / progression of cases and ADC values was examined by Unpaird U test. RESULTS: There were significant correlations between ADC value and the recurrence score as well as the progression score (P<0.01, P<0.01, respectively). There were also significant correlations between ADC value and the recurrence risk group as well as progression risk group (P=0.042, P<0.01, respectively). The ADC cut-off value on ROC analysis was 1.365 (sensitivity 100%; specificity 97.4%) for the low and intermediate recurrence risk groups, 1.024 (sensitivity 47.4%; specificity 100%) for the intermediate and high recurrence risk groups, 1.252 (sensitivity 83.3%; specificity 81.3%) for the low and intermediate progression risk groups, and 0.955 (sensitivity 87.5%; specificity 63.2%) between the intermediate and high progression risk groups. The difference between the ADC values of the recurrence and nonrecurrence group in Unpaired t test was significant (P<0.05). CONCLUSION: ADC on MRI in bladder cancer could potentially be useful, non-invasive measurement for estimating the risks of recurrence and progression. PMID:28680010

Gender disparities in the association between socio-demographics and non-communicable disease risk factors among adults with disabilities in Shanghai, China.

PubMed

Zhang, Youran; Chen, Gang; Zhang, Qi; Lu, Jun; Yu, Huijiong

2018-01-01

Non-communicable disease (NCD) risk factors can co-exist with disability and cause a greater burden on the health status of adults with disabilities. A lack of egalitarian social policies in China may result in gender disparities in the NCD risk factors of adults with disabilities. However, little is known about the gender disparities in the association between socio-demographics and NCD risk factors among adults with disabilities in China; consequently, we examined this association among adults with disabilities in Shanghai, China. We used the health examination data of 44,896 adults with disabilities in Shanghai in 2014. Descriptive analyses and logistic regression models were conducted to estimate gender disparities in the association between socio-demographics, disability characteristics, and four selected NCD risk factors among adults with disabilities-including high blood pressure, high blood glucose, high blood lipids, and being overweight. We estimated marginal effects (MEs) on NCD risk factors between gender and other confounders. Women with disabilities were about 11.6 percentage points more likely to suffer from high blood lipids and less likely to develop the other three risk factors than men were. The association of age group, residence permit, education level, marital status, and disability type with health outcomes varied by gender among adults with disabilities. The difference in age effects between men and women was more pronounced in older age groups. Urban residence was associated with less risk of high blood pressure risk among women (Δ ME  =  - 0.035, p  < 0.01), but no significant difference in other NCD risk factors. Education remained a major protective factor against high blood pressure, high blood glucose and being overweight among women with disabilities ( MEs  < 0, p  < 0.05); however, this did not hold for men. The difference in marriage effects between men and women was observed in high blood lipids (Δ ME  =  - 0.048 for the married group and -0.054 for the divorced or widowed group) and overweight individuals (Δ ME  =  - 0.091 for the married group and -0.114 for the divorced or widowed group). Women with intellectual disabilities or mental disabilities reported worse health conditions than men did. Preventive strategies and interventions on NCD risk factors for adults with disabilities should take into account gender disparities in these socio-demographic effects. Rural women or poorly educated women with disabilities can be a vulnerable population that requires more health education and promotion strategies. Health education for caregivers of women with intellectual or mental disabilities may also play a vital role in preventing their NCD risk factors.

Framingham risk score for estimation of 10-years of cardiovascular diseases risk in patients with metabolic syndrome.

PubMed

Jahangiry, Leila; Farhangi, Mahdieh Abbasalizad; Rezaei, Fatemeh

2017-11-13

There are a few studies evaluating the predictive value of Framingham risk score (FRS) for cardiovascular disease (CVD) risk assessment in patients with metabolic syndrome in Iran. Because of the emerging high prevalence of CVD among Iranian population, it is important to predict its risk among populations with potential predictive tools. Therefore, the aim of the current study is to evaluate the FRS and its determinants in patients with metabolic syndrome. In the current cross-sectional study, 160 patients with metabolic syndrome diagnosed according to the National Cholesterol Education Adult Treatment Panel (ATP) III criteria were enrolled. The FRS was calculated using a computer program by a previously suggested algorithm. Totally, 77.5, 16.3, and 6.3% of patients with metabolic syndrome were at low, intermediate, and high risk of CVD according to FRS categorization. The highest prevalence of all of metabolic syndrome components were in low CVD risk according to the FRS grouping (P < 0.05), while the lowest prevalence of these components was in high CVD risk group (P < 0.05). According to multiple logistic regression analysis, high systolic blood pressure (SBP) and fasting serum glucose (FSG) were potent determinants of intermediate and high risk CVD risk of FRS scoring compared with low risk group (P < 0.05). In the current study, significant associations between components of metabolic syndrome and different FRS categorization among patients with metabolic syndrome were identified. High SBP and FSG were associated with meaningfully increased risk of CVD compared with other parameters. The study is not a trial; the registration number is not applicable.

Finding Groups Using Model-based Cluster Analysis: Heterogeneous Emotional Self-regulatory Processes and Heavy Alcohol Use Risk

PubMed Central

Mun, Eun-Young; von Eye, Alexander; Bates, Marsha E.; Vaschillo, Evgeny G.

2010-01-01

Model-based cluster analysis is a new clustering procedure to investigate population heterogeneity utilizing finite mixture multivariate normal densities. It is an inferentially based, statistically principled procedure that allows comparison of non-nested models using the Bayesian Information Criterion (BIC) to compare multiple models and identify the optimum number of clusters. The current study clustered 36 young men and women based on their baseline heart rate (HR) and HR variability (HRV), chronic alcohol use, and reasons for drinking. Two cluster groups were identified and labeled High Alcohol Risk and Normative groups. Compared to the Normative group, individuals in the High Alcohol Risk group had higher levels of alcohol use and more strongly endorsed disinhibition and suppression reasons for use. The High Alcohol Risk group showed significant HRV changes in response to positive and negative emotional and appetitive picture cues, compared to neutral cues. In contrast, the Normative group showed a significant HRV change only to negative cues. Findings suggest that the individuals with autonomic self-regulatory difficulties may be more susceptible to heavy alcohol use and use alcohol for emotional regulation. PMID:18331138

Tryptophan Depletion and Emotional Processing in Healthy Volunteers at High Risk for Depression

PubMed Central

Feder, Adriana; Skipper, Jamie; Blair, James R.; Buchholz, Katherine; Mathew, Sanjay J.; Schwarz, Markus; Doucette, John T.; Alonso, Angelique; Collins, Katherine A.; Neumeister, Alexander; Charney, Dennis S.

2014-01-01

Background Studies in depressed patients have demonstrated the presence of emotional bias toward negative stimuli, as well as dysregulated brain serotonin function. The present study compared the effects of acute tryptophan depletion (ATD) on both an emotional processing and a planning task in never-depressed healthy volunteers at high and low familial risk for depression. Methods Young adults with no personal psychiatric history were stratified into two groups based on family history (n = 25). Participants were enrolled in a randomized, double-blind, placebo-controlled crossover ATD study and completed the affective go/no-go and Tower of London tasks once during each condition. Results There was a significant treatment by valence by group interaction on the affective go/no-go, driven primarily by a greater frequency of inappropriate responses to sad than to happy distracters in the high-risk group during ATD. No group differences were observed on the Tower of London. Conclusions Asymptomatic individuals at high familial risk for depression showed abnormalities in emotional processing while undergoing experimentally induced tryptophan depletion. These findings support emotional processing disturbances as potential trait-level abnormalities associated with the risk of mood disorder. PMID:21377656

Comparison of a sentinel lymph node mapping algorithm and comprehensive lymphadenectomy in the detection of stage IIIC endometrial carcinoma at higher risk for nodal disease.

PubMed

Ducie, Jennifer A; Eriksson, Ane Gerda Zahl; Ali, Narisha; McGree, Michaela E; Weaver, Amy L; Bogani, Giorgio; Cliby, William A; Dowdy, Sean C; Bakkum-Gamez, Jamie N; Soslow, Robert A; Keeney, Gary L; Abu-Rustum, Nadeem R; Mariani, Andrea; Leitao, Mario M

2017-12-01

To determine if a sentinel lymph node (SLN) mapping algorithm will detect metastatic nodal disease in patients with intermediate-/high-risk endometrial carcinoma. Patients were identified and surgically staged at two collaborating institutions. The historical cohort (2004-2008) at one institution included patients undergoing complete pelvic and paraaortic lymphadenectomy to the renal veins (LND cohort). At the second institution an SLN mapping algorithm, including pathologic ultra-staging, was performed (2006-2013) (SLN cohort). Intermediate-risk was defined as endometrioid histology (any grade), ≥50% myometrial invasion; high-risk as serous or clear cell histology (any myometrial invasion). Patients with gross peritoneal disease were excluded. Isolated tumor cells, micro-metastases, and macro-metastases were considered node-positive. We identified 210 patients in the LND cohort, 202 in the SLN cohort. Nodal assessment was performed for most patients. In the intermediate-risk group, stage IIIC disease was diagnosed in 30/107 (28.0%) (LND), 29/82 (35.4%) (SLN) (P=0.28). In the high-risk group, stage IIIC disease was diagnosed in 20/103 (19.4%) (LND), 26 (21.7%) (SLN) (P=0.68). Paraaortic lymph node (LN) assessment was performed significantly more often in intermediate-/high-risk groups in the LND cohort (P<0.001). In the intermediate-risk group, paraaortic LN metastases were detected in 20/96 (20.8%) (LND) vs. 3/28 (10.7%) (SLN) (P=0.23). In the high-risk group, paraaortic LN metastases were detected in 13/82 (15.9%) (LND) and 10/56 (17.9%) (SLN) (%, P=0.76). SLN mapping algorithm provides similar detection rates of stage IIIC endometrial cancer. The SLN algorithm does not compromise overall detection compared to standard LND. Copyright © 2017 Elsevier Inc. All rights reserved.

Neoadjuvant/adjuvant treatment of high-risk retinoblastoma: a report from the German Retinoblastoma Referral Centre.

PubMed

Künkele, Annette; Wilm, Josephine; Holdt, Markus; Lohmann, Dietmar; Bornfeld, Norbert; Eggert, Angelika; Temming, Petra; Schulte, Johannes H

2015-07-01

Retinoblastoma can extend beyond the structures of the eye, where cells can enter the bloodstream and cause metastases. Various types of protocols for adjuvant treatment risk-adapted according to histopathological risk factors are used worldwide. Between 1997 and 2009, 420 children were diagnosed with retinoblastoma at the German Retinoblastoma Referral Centre and risk factors were assessed. Patients with post-laminar optic nerve infiltration or choroid or minor scleral invasion received six courses of adjuvant chemotherapy using vincristine, etoposide, carboplatin and cyclophosphamide (group 1). Patients with microscopic extension beyond the sclera to the resection margin of the optic nerve or potential spread due to vitrectomy received chemotherapy plus orbital radiotherapy (group 2). Neoadjuvant chemotherapy was performed in patients with local extraocular invasion detected on MRI. Following this protocol, 42 of the 420 patients and 21 referred from other centres showed high-risk histopathological factors qualifying for adjuvant therapy (57 in group 1 and 6 in group 2). Seven of the 63 patients received neoadjuvant and adjuvant treatment. During a mean follow-up of 5.8 (range 0.4-15.4) years, one of six patients in group 2 developed metastases and died. No patients died from toxicity. The 5-year overall survival was 100% for group 1 and 80% for group 2. This retrospective single-site study reveals a 10% incidence of high-risk features in children with retinoblastoma diagnosed at the German Retinoblastoma Referral Centre. Overall survival rates of 98.3% underline the safety of this adjuvant chemotherapy protocol and its efficiency in preventing metastasis. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Protecting the unprotected: mixed-method research on drug use, sex work and rights in Pakistan's fight against HIV/AIDS.

PubMed

Mayhew, S; Collumbien, M; Qureshi, A; Platt, L; Rafiq, N; Faisel, A; Lalji, N; Hawkes, S

2009-04-01

To investigate the nature and extent of human rights abuses against three vulnerable groups (injecting drug users (IDUs) and male and female sex workers), to understand the social and sexual linkages between them and to examine how protecting their rights could enhance the impact of HIV prevention policies. In-depth interviews were carried out with 38 high-risk respondents (IDUs and female, male and transgender sex workers) and a bio-behavioural survey was performed of 813 IDU/sex worker respondents in Rawalpindi. People in all vulnerable groups interacted both sexually and socially. All groups experienced human rights abuses by state and non-state actors which increased their HIV risk. Non-state actors, including relations and sex worker clients, are responsible for verbal, physical and sexual violence. State actors (particularly police) perpetrate harassment, exploitation and abuse of all vulnerable groups with impunity. Health service providers fail to provide adequate services for vulnerable groups. High levels of discrimination and abuse of human dignity of all groups studied were revealed. This violates their physical and mental integrity and also leads to an increased risk of HIV. The sexual and social interactions between groups mean that human rights abuses experienced by one high-risk group can increase the risk of HIV both for them and other groups. The protection of human rights needs to become an integral part of a multisector response to the risk of HIV/AIDS by state and non-state agencies. The Government of Pakistan should work at both legal and programme levels to protect the rights of, and minimise discrimination against, groups vulnerable to HIV in order to reduce the potential for the spread of HIV before the epidemic takes hold.

Neural activation during risky decision-making in youth at high risk for substance use disorders.

PubMed

Hulvershorn, Leslie A; Hummer, Tom A; Fukunaga, Rena; Leibenluft, Ellen; Finn, Peter; Cyders, Melissa A; Anand, Amit; Overhage, Lauren; Dir, Allyson; Brown, Joshua

2015-08-30

Risky decision-making, particularly in the context of reward-seeking behavior, is strongly associated with the presence of substance use disorders (SUDs). However, there has been little research on the neural substrates underlying reward-related decision-making in drug-naïve youth who are at elevated risk for SUDs. Participants comprised 23 high-risk (HR) youth with a well-established SUD risk phenotype and 27 low-risk healthy comparison (HC) youth, aged 10-14. Participants completed the balloon analog risk task (BART), a task designed to examine risky decision-making, during functional magnetic resonance imaging. The HR group had faster reaction times, but otherwise showed no behavioral differences from the HC group. HR youth experienced greater activation when processing outcome, as the chances of balloon explosion increased, relative to HC youth, in ventromedial prefrontal cortex (vmPFC). As explosion probability increased, group-by-condition interactions in the ventral striatum/anterior cingulate and the anterior insula showed increasing activation in HR youth, specifically on trials when explosions occurred. Thus, atypical activation increased with increasing risk of negative outcome (i.e., balloon explosion) in a cortico-striatal network in the HR group. These findings identify candidate neurobiological markers of addiction risk in youth at high familial and phenotypic risk for SUDs. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Effects of relaxation on depression levels in women with high-risk pregnancies: a randomised clinical trial 1

PubMed Central

de Araújo, Wanda Scherrer; Romero, Walckiria Garcia; Zandonade, Eliana; Amorim, Maria Helena Costa

2016-01-01

ABSTRACT Objective: to analyse the effects of relaxation as a nursing intervention on the depression levels of hospitalised women with high-risk pregnancies. Methods: a randomised clinical trial realised in a reference centre for high-risk pregnancies. The sample consisted of 50 women with high-risk pregnancies (25 in the control group and 25 in the intervention group). The Benson relaxation technique was applied to the intervention group for five days. Control variables were collected using a predesigned form, and the signs and symptoms of depression were evaluated using the Edinburgh Postnatal Depression Scale (EPDS). The Statistical Package for Social Sciences (SPSS), version 20.0, was used with a significance level of 5%. The Wilcoxon and paired t-tests were used to evaluate depression levels between two timepoints. Using categorical data, the McNemar test was used to analyse differences in depression severity before and after the intervention. Results: depression levels decreased in the intervention group five days after the relaxation technique was applied (4.5 ± 3, p<0.05) compared with the levels at the first timepoint (10.3±5.9). Conclusion: as a nursing intervention, relaxation was effective in decreasing the symptoms of depression in hospitalised women with high-risk pregnancies. PMID:27627126

Validation of the Choking Risk Assessment and Pneumonia Risk Assessment for adults with Intellectual and Developmental Disability (IDD).

PubMed

Sheppard, Justine Joan; Malandraki, Georgia A; Pifer, Paula; Cuff, Jill; Troche, Michelle; Hemsley, Bronwyn; Balandin, Susan; Mishra, Avinash; Hochman, Roberta

2017-10-01

Risk assessments are needed to identify adults with intellectual and developmental disability (IDD) at high risk of choking and pneumonia. To describe the development and validation of the Choking Risk Assessment (CRA) and the Pneumonia Risk Assessment (PRA) for adults with IDD. Test items were identified through literature review and focus groups. Five-year retrospective chart reviews identified a positive choking group (PCG), a negative choking group (NCG), a positive pneumonia group (PPG), and a negative pneumonia group (NPG). Participants were tested with the CRA and PRA by clinicians blind to these testing conditions. The CRA and PRA differentiated the PCG (n=93) from the NCG (n=526) and the PPG (n=63) from the NPG (n=209) with high specificity (0.91 and 0.92 respectively) and moderate to average sensitivity (0.53 and 0.62 respectively). Further analyses revealed associations between clinical diagnoses of dysphagia and choking (p=0.043), and pneumonia (p<0.001). The CRA and PRA are reliable, valid risk indicators for choking and pneumonia in adults with IDD. Precautions for mitigating choking and pneumonia risks can be applied selectively thus avoiding undue impacts on quality of life and unnecessary interventions for low risk individuals. Copyright © 2017 Elsevier Ltd. All rights reserved.

Timing of Biochemical Failure and Distant Metastasis for Low, Intermediate, and High Risk Prostate Cancer after Radiotherapy

PubMed Central

Morgan, Peter B.; Hanlon, Alexandra L.; Horwitz, Eric M.; Buyyounouski, Mark K.; Uzzo, Robert G.; Pollack, Alan

2007-01-01

Condensed Abstract The timing of biochemical failure and distant metastasis after radiotherapy for low, intermediate and high-risk prostate cancer was determined. The patterns of failure suggest that the majority of early failures were due to subclinical micrometastases present at diagnosis, whereas a late wave of metastasis at 10–12 years in every risk group was consistent with tumor spread from local persistence of disease. Background The relationship of prostate cancer risk group stratification and the timing of biochemical failure (BF) and distant metastasis (DM) is not well defined. We sought to differentiate early failures due to subclinical micrometastasis at presentation from late failures due to local persistence. Methods A total of 1833 men with clinically localized prostate cancer treated with 3D-conformal radiotherapy with or without short-term androgen deprivation were retrospectively analyzed. The interval hazard rates of DM and BF, using ASTRO and Phoenix (Nadir+2) definitions, were determined for men with low, intermediate, and high risk disease. Results Median follow-up was 67 months. Multivariate analysis showed that increasing risk group was independently associated with higher ASTRO BF (P<.0001) and Nadir+2 BF (P<.0001). The preponderance (87%) of ASTRO BF occurred ≤4 years after RT, while Nadir+2 BF was more evenly spread over years 1–12, with 43% at >4 years. The hazard of Nadir+2 BF persisted in years 8–12 in all risk groups. The interval hazard function for DM appeared to be biphasic (early and late peaks) for intermediate and high risk patients, but no distinct early wave was evident for low risk patients. Conclusions ASTRO BF underestimates late BF due to backdating. Local persistence of disease is suggested by delayed Nadir+2 BF and subsequent late DM in every risk group. The paucity of early DM among those with low risk tumors supports the hypothesis that occult micrometastases contributed to the early wave. PMID:17520705

Evaluation of positive surgical margins in patients undergoing robot-assisted and open radical prostatectomy according to preoperative risk groups.

PubMed

Suardi, Nazareno; Dell'Oglio, Paolo; Gallina, Andrea; Gandaglia, Giorgio; Buffi, Nicolò; Moschini, Marco; Fossati, Nicola; Lughezzani, Giovanni; Karakiewicz, Pierre I; Freschi, Massimo; Lucianò, Roberta; Shariat, Shahrokh F; Guazzoni, Giorgio; Gaboardi, Franco; Montorsi, Francesco; Briganti, Alberto

2016-02-01

Recent studies showed that robot-assisted radical prostatectomy (RARP) represents an oncologically safe procedure in patients with prostate cancer (PCa), where the rate of positive surgical margins (PSMs) might be lower in patients treated with RARP as compared with that of those undergoing the open approach (open RP [ORP]). The aim of this study is to analyze the rate of PSMs according to preoperative risk groups in a large cohort of patients treated with RARP and ORP in a single institution with standardized surgical technique and pathological examination. We evaluated 6,194 consecutive patients with PCa undergoing either ORP (71.1%) or RARP (28.9%) between 1992 and 2014. Logistic regression analyses were used to test the association between type of surgery and PSMs in each preoperative risk group (low vs. intermediate vs. high) after adjusting for confounders. Overall, 21.6% patients had PSMs. RARP was associated with a lower rate of PSMs in low-risk (11.5 vs. 15.4%, P = 0.01), intermediate-risk (18.9 vs. 23.5%, P = 0.008), and high-risk patients (19.7 vs. 30.1%, P<0.001). In multivariable analyses, after stratification according to risk group categories, no difference in PSMs between RARP and ORP was observed for low-risk (odds ratio [OR] = 0.87, P = 0.46) and intermediate-risk patients (OR = 0.84, P = 0.19). Conversely, RARP was associated with lower odds of PSMs in high-risk patients (OR = 0.69, P = 0.04). Similar results were observed when our analyses were repeated after accounting for pathological characteristics, in patients treated between 2006 and 2014 and in a cohort of men treated by high-volume surgeons (all P≤ 0.03). The introduction of RARP at our institution led to a significant reduction in the risk of PSMs in patients with PCa with high-risk disease. Copyright © 2016 Elsevier Inc. All rights reserved.

[Complications of intrathecal baclofen therapy].

PubMed

Paskhin, D L; Dekopov, A V; Tomsky, A A; Isagulyan, E D; Salova, E M

To analyze complications of intrathecal baclofen therapy and identify high-risk groups. We implanted 52 pumps to spastic patients for chronic intrathecal baclofen infusion. Two groups of patients were distinguished: 23 patients with spinal spasticity (group 1) and 29 patients with cerebral spasticity (group 2). The mean patient age was 37.2±14.6 years in group 1 and 17.3±10.3 years in group 2. Surgery was performed according to a standard procedure. A Medstream (Codman) pump was implanted in 10 cases, and a Synchromed II (Medtronic) pump was implanted in the remaining 42 cases. Complications developed in 12 (23%) patients. We divided complications into 3 groups: baclofen underdose, baclofen overdose, and others. Insufficiency of intrathecal therapy was observed in 7 cases, which was caused by catheter migration (5 cases) and pump dysfunction (2 cases). In one case, baclofen overdose was observed after air travel. Other complications included 4 cases of persistent peri-implant seroma and infectious complications. Groups with a high risk of complications were identified based on an analysis of the results. Patients with severe dystonia of the trunk muscles have an increased risk of spinal catheter migration. Pronounced communicating hydrocephalus is associated with the risk of cerebrospinal fluid leak through a catheter shaft channel. Weakness of the axial musculature can lead to progression of scoliotic deformity. In some cases, chronic intrathecal baclofen therapy can be accompanied by various complications. This technique should be carefully used in patients from high-risk groups.

Formal thought disorder in people at ultra-high risk of psychosis

PubMed Central

Weinstein, Sara; Stahl, Daniel; Day, Fern; Valmaggia, Lucia; Rutigliano, Grazia; De Micheli, Andrea; Fusar-Poli, Paolo; McGuire, Philip

2017-01-01

Background Formal thought disorder is a cardinal feature of psychosis. However, the extent to which formal thought disorder is evident in ultra-high-risk individuals and whether it is linked to the progression to psychosis remains unclear. Aims Examine the severity of formal thought disorder in ultra-high-risk participants and its association with future psychosis. Method The Thought and Language Index (TLI) was used to assess 24 ultra-high-risk participants, 16 people with first-episode psychosis and 13 healthy controls. Ultra-high-risk individuals were followed up for a mean duration of 7 years (s.d.=1.5) to determine the relationship between formal thought disorder at baseline and transition to psychosis. Results TLI scores were significantly greater in the ultra-high-risk group compared with the healthy control group (effect size (ES)=1.2), but lower than in people with first-episode psychosis (ES=0.8). Total and negative TLI scores were higher in ultra-high-risk individuals who developed psychosis, but this was not significant. Combining negative TLI scores with attenuated psychotic symptoms and basic symptoms predicted transition to psychosis (P=0.04; ES=1.04). Conclusions TLI is beneficial in evaluating formal thought disorder in ultra-high-risk participants, and complements existing instruments for the evaluation of psychopathology in this group. Declaration of interests None. Copyright and usage © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license. PMID:28713586

The effect of group counseling based on self-awareness skill on sexual risk-taking among girl students in Gorgan, Iran: a randomized trial.

PubMed

Kabiri, Golnoosh; Ziaei, Tayebe; Aval, Masumeh Rezaei; Vakili, Mohammad Ali

2017-09-15

Background Sexual puberty in adolescents occurs before their mental and emotional maturity and exposes them to high-risk sexual behaviors. Because sexual risk-taking occurs before adolescents become involved in a sexual relationship, this study was conducted to identify the effect of group counseling based on self-awareness skill on sexual risk-taking among female high school students in Gorgan in order to suggest some preventative measures. Methods The present parallel study is a randomized field trial conducted on 96 girl students who were studying in grades 10, 11 and 12 of high school with an age range of 14-18 years old. Sampling was done based on a multi-stage process. In the first stage, through the randomized clustering approach, four centers among six health centers were selected. In the second stage, 96 samples were collected through consecutive sampling. Finally, the samples were divided into two intervention and control groups (each one having 48 subjects) through the simple randomized approach. It has to be noted that no blinding was done in the present study. The data were collected using a demographic specifications form and the Iranian Adolescents Risk-Taking Scale (IARS). The consultation sessions based on self-awareness skill were explained to an intervention group through 60-min sessions over 7 weeks. The pretest was conducted for both groups and the posttest was completed 1 week and 1 month after the intervention by the intervention and control groups. Finally, after the loss of follow-up/drop out, a total of 80 subjects remained in the study; 42 subjects in the intervention group and 38 subjects in the control group. Data analyses were done using SPSS v.16 along with the Freidman non-parametric test and the Mann-Whitney and Wilcoxon tests. Results The results showed that the sexual risk-taking mean scores in the intervention group (10.54 ± 15.64) were reduced by applying 1-week (8.03 ± 12.82) and 1-month (4.91 ± 10.10) follow-ups after the intervention. This reduction was statistically significant (p = 14%). However, no statistically significant difference was observed in the control group. Conclusion Group counseling based on self-awareness skill decreased the sexual risk-taking in girl students of the high school. As prevention is prior to treatment, this method could be proposed as the prevention of high-risk sexual behavior to healthcare centers and educational environments and non-government organizations (NGOs) interacting with adolescents.

A community faith centre based screening and educational intervention to reduce the risk of type 2 diabetes: A feasibility study.

PubMed

Willis, A; Roshan, M; Patel, N; Gray, L J; Yates, T; Davies, M; Khunti, K

2016-10-01

People of South Asian origin experience higher rates of diabetes and complications of diabetes compared to white Europeans. Therefore, it is important to identify those with undiagnosed diabetes and those at high risk of developing diabetes, in order to intervene with lifestyle intervention to reduce risk and prevent complications. We conducted a study to assess the feasibility of delivering a faith centre based pathway for screening and referral to group education for high risk individuals to increase screening uptake and reduce diabetes risk. Opportunistic screening and early intervention strategy for people at risk of diabetes and cardiovascular disease in local faith centres. The screening consisted of a diabetes risk assessment tool and a near patient test for HbA1c. Participants found to be at high risk of diabetes (HbA1c 6-6.4%/42-46mmol/mol) were offered a 'Walking Away from Diabetes' group educational intervention aimed at increasing exercise levels and reducing diabetes risk. 252 participants were screened during four screening events. 202 participants (80.2%) gave consent for their data to be included in the analysis. 72.4% of participants were found to have a high diabetes risk score. 32 participants (15.8%) had a HbA1c result (6-6.4%/42-46mmol/mol). Eight participants (4.0%) had a (HbA1c ⩾6.5%/⩾47mmol/mol). Of those eligible for the diabetes prevention education programme, 18 participants (56.3%) attended. This study confirms that screening followed by group education within faith centre settings is feasible and acceptable to participants. The strategies chosen were effective in achieving a high screening yield and high uptake of group education. Crown Copyright © 2016. Published by Elsevier Ireland Ltd. All rights reserved.

Superior survival of unmanipulated haploidentical hematopoietic stem cell transplantation compared with chemotherapy alone used as post-remission therapy in adults with standard-risk acute lymphoblastic leukemia in first complete remission.

PubMed

Yan, Chen-Hua; Jiang, Qian; Wang, Jing; Xu, Lan-Ping; Liu, Dai-Hong; Jiang, Hao; Chen, Huan; Zhang, Xiao-Hui; Liu, Kai-Yan; Huang, Xiao-Jun

2014-09-01

We wanted to compare the efficacy of haploidentical hematopoietic stem cell transplantation (HSCT) with chemotherapy alone in adults with standard-risk acute lymphoblastic leukemia (ALL) in first complete remission (CR1). One hundred thirty-eight consecutive adult patients with standard-risk ALL in CR1 were retrospectively investigated. Of these patients, 59 received chemotherapy alone (group A) and 79 received unmanipulated haploidentical HSCT (group B). Cumulative incidence of relapse at 5 years in group A was significantly higher than that in group B (66.3% versus 29.9%, P < .0001). Overall and disease-free survival in group A were significantly inferior to group B (P < .0001). Moreover, multivariate analyses demonstrated that central nervous system leukemia (P = .002), T cell immunophenotype (P = .044), expression of E2A-PBX1 (P = .007), and positive minimal residual disease after the first cycle of consolidation (P = .004) were correlated with relapse. Patients with 1 of 4 risk factors were assigned to the high-risk group. Otherwise, patients without risk factors were assigned to the low-risk group. In the high-risk group, HSCT had lower relapse rates and superior DFS compared with chemotherapy (P < .05), but in the low-risk group, there were no differences between HSCT and chemotherapy (P > .05). This study is the first to demonstrate that compared with chemotherapy alone, haploidentical HSCT is a better postremission therapy in adults with standard-risk ALL in CR1. Moreover, based on the 4 risk factors, the establishment of risk stratification could identify the subgroup of patients with a higher risk of relapse in adults with standard-risk ALL in CR1. Furthermore, risk stratification-directed postremission therapies using haploidentical HSCT or chemotherapy alone not only reduce relapse rate but also avoid unnecessary treatment-related mortality and improve survival. Copyright © 2014 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Comparison of human papillomavirus infection and cervical cytology in women using copper-containing and levonorgestrel-containing intrauterine devices.

PubMed

Lekovich, Jovana P; Amrane, Selma; Pangasa, Misha; Pereira, Nigel; Frey, Melissa K; Varrey, Aneesha; Holcomb, Kevin

2015-05-01

To investigate whether there is a difference in cervical cytology and high-risk human papillomavirus (HPV) infection clearance between levonorgestrel- and copper-containing intrauterine device (IUD) users. The electronic medical record system was searched by the appropriate procedural code for IUD insertion for all patients undergoing IUD placement during the study period (January 31, 2005 to January 31, 2012). Patients who received treatment for cervical dysplasia, had their IUDs removed, or conceived during the study period were excluded. High-risk HPV and cervical cytology results immediately preceding and after IUD placement were obtained. One hundred fifty patients had a copper-containing and 152 patients a levonorgestrel-containing IUD placed. The groups were comparable in terms of age, body mass index, duration of follow-up, and percentage of smokers. Sixty-six patients were high-risk HPV-positive before IUD insertion (30 in copper compared with 36 in the levonorgestrel IUD group, P=.4), and the groups had similar follow-up times (364.1±26.3 compared with 357.2±29.7 days, respectively, between the IUD placement and a repeat Pap test with high-risk HPV cotesting, P=.2). Of those, 21 (70%; 95% confidence interval [CI] 53.6-86.4%) cleared the infection after copper-containing IUD placement compared with 15 (42%; 95% CI 25.6-57.8%) in the levonorgestrel group (P=.04). There were only two (1.7%) new high-risk HPV infections in the copper compared with eight (6.9%) in the levonorgestrel group (P=.056). Our data suggest that levonorgestrel-containing IUD could be associated with decreased high-risk HPV infection clearance and possibly increased acquisition compared with the copper-containing IUD. II.

Trends in Respiratory Syncytial Virus and Bronchiolitis Hospitalization Rates in High-Risk Infants in a United States Nationally Representative Database, 1997–2012

PubMed Central

Doucette, Abigail; Jiang, Xiaohui; Fryzek, Jon; Coalson, Jenna; McLaurin, Kimmie; Ambrose, Christopher S.

2016-01-01

Background Respiratory syncytial virus (RSV) causes significant pediatric morbidity and is the most common cause of bronchiolitis. Bronchiolitis hospitalizations declined among US infants from 2000‒2009; however, rates in infants at high risk for RSV have not been described. This study examined RSV and unspecified bronchiolitis (UB) hospitalization rates from 1997‒2012 among US high-risk infants. Methods The Kids’ Inpatient Database (KID) infant annual RSV (ICD-9 079.6, 466.11, 480.1) and UB (ICD-9 466.19, 466.1) hospitalization rates were estimated using weighted counts. Denominators were based on birth hospitalizations with conditions associated with high-risk for RSV: chronic perinatal respiratory disease (chronic lung disease [CLD]); congenital airway anomalies (CAA); congenital heart disease (CHD); Down syndrome (DS); and other genetic, metabolic, musculoskeletal, and immunodeficiency conditions. Preterm infants could not be identified. Hospitalizations were characterized by mechanical ventilation, inpatient mortality, length of stay, and total cost (2015$). Poisson and linear regression were used to test statistical significance of trends. Results RSV and UB hospitalization rates were substantially elevated for infants with higher-risk CHD, CLD, CAA and DS without CHD compared with all infants. RSV rates declined by 47.0% in CLD and 49.7% in higher-risk CHD infants; no other declines in high-risk groups were observed. UB rates increased in all high-risk groups except for a 22.5% decrease among higher-risk CHD. Among high-risk infants, mechanical ventilation increased through 2012 to 20.4% and 13.5% of RSV and UB hospitalizations; geometric mean cost increased to $31,742 and $25,962, respectively, and RSV mortality declined to 0.9%. Conclusions Among high-risk infants between 1997 and 2012, RSV hospitalization rates declined among CLD and higher-risk CHD infants, coincident with widespread RSV immunoprophylaxis use in these populations. UB hospitalization rates increased in all high-risk groups except higher-risk CHD, suggesting improvement in the health status of higher-risk CHD infants, potentially due to enhanced surgical interventions. Mechanical ventilation use and RSV and UB hospitalization costs increased while RSV mortality declined. PMID:27050095

Defining the Intrinsic Cardiac Risks of Operations to Improve Preoperative Cardiac Risk Assessments.

PubMed

Liu, Jason B; Liu, Yaoming; Cohen, Mark E; Ko, Clifford Y; Sweitzer, Bobbie J

2018-02-01

Current preoperative cardiac risk stratification practices group operations into broad categories, which might inadequately consider the intrinsic cardiac risks of individual operations. We sought to define the intrinsic cardiac risks of individual operations and to demonstrate how grouping operations might lead to imprecise estimates of perioperative cardiac risk. Elective operations (based on Common Procedural Terminology codes) performed from January 1, 2010 to December 31, 2015 at hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program were studied. A composite measure of perioperative adverse cardiac events was defined as either cardiac arrest requiring cardiopulmonary resuscitation or acute myocardial infarction. Operations' intrinsic cardiac risks were derived from mixed-effects models while controlling for patient mix. Resultant risks were sorted into low-, intermediate-, and high-risk categories, and the most commonly performed operations within each category were identified. Intrinsic operative risks were also examined using a representative grouping of operations to portray within-group variation. Sixty-six low, 30 intermediate, and 106 high intrinsic cardiac risk operations were identified. Excisional breast biopsy had the lowest intrinsic cardiac risk (overall rate, 0.01%; odds ratio, 0.11; 95% CI, 0.02 to 0.25) relative to the average, whereas aorto-bifemoral bypass grafting had the highest (overall rate, 4.1%; odds ratio, 6.61; 95% CI, 5.54 to 7.90). There was wide variation in the intrinsic cardiac risks of operations within the representative grouping (median odds ratio, 1.40; interquartile range, 0.88 to 2.17). A continuum of intrinsic cardiac risk exists among operations. Grouping operations into broad categories inadequately accounts for the intrinsic cardiac risk of individual operations.

Aiming for more relevant HIV risk reduction: a black feminist perspective for enhancing HIV intervention for low-income African American women.

PubMed

Gentry, Quinn M; Elifson, Kirk; Sterk, Claire

2005-06-01

The purpose of this study was to examine how various living conditions impact the context within which low-income African American women engage in a diverse range of high-risk behavior that increases their risk for HIV infection. The study, based on 2 years of ethnographic fieldwork, analyzed the living conditions of 45 African American women at risk for HIV infection in a high-risk neighborhood in Atlanta, Georgia. A black feminist perspective guided the study's analytical framework as a way to extend knowledge about the social conditions, the social interactions, and the meaning of high-risk behavior in the lives of African American women. Using black feminist theory and the constant comparison method, two groups emerged: "street" women and "house" women. Street women were defined as the absolute homeless, the rooming housed, and the hustling homeless. House women were defined as the family housed, the heads of household, and the steady-partner housed. Results reveal that various types of living arrangements place women at risk in different ways and suggest that low-income African American women at high risk for HIV infection-a group often considered homogeneous-have unique "within group" needs that must be addressed in HIV prevention intervention research.

Baseline placental growth factor levels for the prediction of benefit from early aspirin prophylaxis for preeclampsia prevention.

PubMed

Moore, Gaea S; Allshouse, Amanda A; Winn, Virginia D; Galan, Henry L; Heyborne, Kent D

2015-10-01

Placental growth factor (PlGF) levels early in pregnancy are lower in women who ultimately develop preeclampsia. Early initiation of low-dose aspirin reduces preeclampsia risk in some high risk women. We hypothesized that low PlGF levels may identify women at increased risk for preeclampsia who would benefit from aspirin. Secondary analysis of the MFMU High-Risk Aspirin study including singleton pregnancies randomized to aspirin 60mg/d (n=102) or placebo (n=72), with PlGF collected at 13w 0d-16w 6d. Within the placebo group, we estimated the probability of preeclampsia by PlGF level using logistic regression analysis, then determined a potential PlGF threshold for preeclampsia prediction using ROC analysis. We performed logistic regression modeling for potential confounders. ROC analysis indicated 87.71pg/ml as the threshold between high and low PlGF for preeclampsia-prediction. Within the placebo group high PlGF weakly predicted preeclampsia (AUC 0.653, sensitivity/specificity 63%/66%). We noted a 2.6-fold reduction in preeclampsia with aspirin in the high-PlGF group (12.15% aspirin vs 32.14% placebo, p=0.057), but no significant differences in preeclampsia in the low PlGF group (21.74% vs 15.91%, p=0.445). Unlike other studies, we found that high rather than low PlGF levels were associated with an increased preeclampsia risk. Low PlGF neither identified women at increased risk of preeclampsia nor women who benefitted from aspirin. Further research is needed to determine whether aspirin is beneficial in women with high PlGF, and whether the paradigm linking low PlGF and preeclampsia needs to be reevaluated. High-risk women with low baseline PlGF, a risk factor for preeclampsia, did not benefit from early initiation of low-dose aspirin. Copyright © 2015 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

Surgical resection versus liver transplantation for hepatocellular carcinoma within the Hangzhou criteria: a preoperative nomogram-guided treatment strategy.

PubMed

Li, Yang; Ruan, Dan-Yun; Jia, Chang-Chang; Zhao, Hui; Wang, Guo-Ying; Yang, Yang; Jiang, Nan

2017-10-15

With the expansion of surgical criteria, the comparative efficacy between surgical resection (SR) and liver transplantation (LT) for hepatocellular carcinoma is inconclusive. This study aimed to develop a prognostic nomogram for predicting recurrence-free survival of hepatocellular carcinoma patients after resection and explored the possibility of using nomogram as treatment algorithm reference. From 2003 to 2012, 310 hepatocellular carcinoma patients within Hangzhou criteria undergoing resection or liver transplantation were included. Total tumor volume, albumin level, HBV DNA copies and portal hypertension were included for constructing the nomogram. The resection patients were stratified into low- and high-risk groups by the median nomogram score of 116. Independent risk factors were identified and a visually orientated nomogram was constructed using a Cox proportional hazards model to predict the recurrence risk for SR patients. The low-risk SR group had better outcomes compared with the high-risk SR group (3-year recurrence-free survival rate, 71.1% vs 35.9%; 3-year overall survival rate, 89.8% vs 78.9%, both P<0.001). The high-risk SR group was associated with a worse recurrence-free survival rate but similar overall survival rate compared with the transplantation group (3-year recurrence-free survival rate, 35.9% vs 74.1%, P<0.001; 3-year overall survival rate, 78.9% vs 79.6%, P>0.05). This nomogram offers individualized recurrence risk evaluation for hepatocellular carcinoma patients within Hangzhou criteria receiving resection. Transplantation should be considered the first-line treatment for high-risk patients. Copyright © 2017 The Editorial Board of Hepatobiliary & Pancreatic Diseases International. Published by Elsevier B.V. All rights reserved.

An early-biomarker algorithm predicts lethal graft-versus-host disease and survival

PubMed Central

Hartwell, Matthew J.; Özbek, Umut; Holler, Ernst; Major-Monfried, Hannah; Reddy, Pavan; Aziz, Mina; Hogan, William J.; Ayuk, Francis; Efebera, Yvonne A.; Hexner, Elizabeth O.; Bunworasate, Udomsak; Qayed, Muna; Ordemann, Rainer; Wölfl, Matthias; Mielke, Stephan; Chen, Yi-Bin; Devine, Steven; Jagasia, Madan; Kitko, Carrie L.; Litzow, Mark R.; Kröger, Nicolaus; Locatelli, Franco; Morales, George; Nakamura, Ryotaro; Reshef, Ran; Rösler, Wolf; Weber, Daniela; Yanik, Gregory A.; Levine, John E.; Ferrara, James L.M.

2017-01-01

BACKGROUND. No laboratory test can predict the risk of nonrelapse mortality (NRM) or severe graft-versus-host disease (GVHD) after hematopoietic cellular transplantation (HCT) prior to the onset of GVHD symptoms. METHODS. Patient blood samples on day 7 after HCT were obtained from a multicenter set of 1,287 patients, and 620 samples were assigned to a training set. We measured the concentrations of 4 GVHD biomarkers (ST2, REG3α, TNFR1, and IL-2Rα) and used them to model 6-month NRM using rigorous cross-validation strategies to identify the best algorithm that defined 2 distinct risk groups. We then applied the final algorithm in an independent test set (n = 309) and validation set (n = 358). RESULTS. A 2-biomarker model using ST2 and REG3α concentrations identified patients with a cumulative incidence of 6-month NRM of 28% in the high-risk group and 7% in the low-risk group (P < 0.001). The algorithm performed equally well in the test set (33% vs. 7%, P < 0.001) and the multicenter validation set (26% vs. 10%, P < 0.001). Sixteen percent, 17%, and 20% of patients were at high risk in the training, test, and validation sets, respectively. GVHD-related mortality was greater in high-risk patients (18% vs. 4%, P < 0.001), as was severe gastrointestinal GVHD (17% vs. 8%, P < 0.001). The same algorithm can be successfully adapted to define 3 distinct risk groups at GVHD onset. CONCLUSION. A biomarker algorithm based on a blood sample taken 7 days after HCT can consistently identify a group of patients at high risk for lethal GVHD and NRM. FUNDING. The National Cancer Institute, American Cancer Society, and the Doris Duke Charitable Foundation. PMID:28194439

Information Seeking about Global Climate Change among Adolescents: The Role of Risk Perceptions, Efficacy Beliefs and Parental Influences

PubMed Central

Mead, Erin; Roser-Renouf, Connie; Rimal, Rajiv N.; Flora, June A.; Maibach, Edward W.; Leiserowitz, Anthony

2012-01-01

Global climate change is likely to have significant impacts on public health. Effective communication is critical to informing public decision making and behavior to mitigate climate change. An effective method of audience segmentation, the risk perception attitude (RPA) framework has been previously tested with other health behaviors and classifies people into 4 groups on the basis of their perceptions of risk and beliefs about personal efficacy. The 4 groups – indifference (low risk, weak efficacy), proactive (low risk, strong efficacy), avoidance (high risk, weak efficacy), and responsive (high risk, strong efficacy) – are hypothesized to differ in their self-protective behaviors and in their motivations to seek information. In this paper, we extend the RPA framework in two ways. First, we use it at the household level to determine whether parental classifications into the 4 groups are associated with their teenage children’s classification into the same 4 groups. Second, we predict adolescent information-seeking behaviors on the basis of their and their parents’ membership in the 4 RPA groups. Results (N = 523 parent-adolescent pairs) indicated that parental membership in the 4 RPA groups was significantly associated with children’s membership in the same 4 groups. Furthermore, the RPA framework was a significant predictor of adolescent information-seeking: those in the responsive and avoidance groups sought more information on climate change than the indifference group. Family communication on global warming was positively associated with adolescents’ information-seeking. Implications for interventions are discussed. PMID:22866024

Periconceptional use of folic acid and risk of miscarriage - findings of the Oral Cleft Prevention Program in Brazil.

PubMed

Vila-Nova, Camila; Wehby, George L; Queirós, Fernanda C; Chakraborty, Hrishkesh; Félix, Temis M; Goco, Norman; Moore, Janet; Gewehr, Eduardo V; Lins, Lorene; Affonso, Carla M C; Murray, Jeffrey C

2013-07-01

We report on the risk of miscarriage with high- and low-dosage periconceptional folic acid (FA) supplementation from a double-blind randomized clinical trial for prevention of orofacial cleft recurrence in Brazil. Women at risk of recurrence of orofacial clefts in their offspring were randomized into high (4 mg/day) and low (0.4 mg/day) doses of FA supplementation. The women received the study pills before pregnancy, and supplementation continued throughout the first trimester. Miscarriage rates were compared between the two FA groups and with the population rate. A total of 268 pregnancies completed the study protocol, with 141 in the 4.0-mg group and 127 in the 0.4-mg group. The miscarriage rate was 14.2% in the low-dose FA group (0.4 mg/day) and 11.3% for the high-dose group (4 mg/day) (P=0.4877). These miscarriage rates are not significantly different from the miscarriage rate in the Brazilian population, estimated to be around 14% (P=0.311). These results indicate that high-dose FA does not increase miscarriage risk in this population and add further information to the literature on the safety of high FA supplementation for prevention of birth defect recurrence.

Use of the plasma triglyceride/high-density lipoprotein cholesterol ratio to identify cardiovascular disease in hypertensive subjects.

PubMed

Salazar, Martin R; Carbajal, Horacio A; Espeche, Walter G; Aizpurúa, Marcelo; Leiva Sisnieguez, Carlos E; Leiva Sisnieguez, Betty C; March, Carlos E; Stavile, Rodolfo N; Balbín, Eduardo; Reaven, Gerald M

2014-10-01

This analysis evaluated the hypothesis that the plasma triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) concentration ratio can help identify patients with essential hypertension who are insulin-resistant, with the cardiovascular disease (CVD) risk profile associated with that defect. Data from a community-based study developed between 2003 and 2012 were used to compare CVD risk factors and outcome. Plasma TG/HDL-C cut-points of 2.5 (women) and 3.5 (men) subdivided normotensive (n = 574) and hypertensive (n = 373) subjects into "high" and "low" risk groups. Metabolic syndrome criteria (MetS) were also used to identify "high" and "low" risk groups. The baseline cardio-metabolic profile was significantly more adverse in 2003 in "high" risk subgroups, irrespective of BP classification or definition of risk (TG/HDL-C ratio vs. MetS criteria). Crude incidence of combined CVD events increased across risk groups, ranging from 1.9 in normotensive-low TG/HDL-C subjects to 19.9 in hypertensive-high TG/HDL-C ratio individuals (P for trends <.001). Adjusted hazard ratios for CVD events also increased with both hypertension and TG/HDL-C. Comparable findings were seen when CVD outcome was predicted by MetS criteria. The TG/HDL-C concentration ratio and the MetS criteria identify to a comparable degree hypertensive subjects who are at greatest cardio-metabolic risk and develop significantly more CVD.

Effects of Rational-Emotive Health Education Program on HIV risk perceptions among in-school adolescents in Nigeria.

PubMed

Onyechi, Kay Chinonyelum Nwamaka; Eseadi, Chiedu; Okere, Anthony U; Otu, Mkpoikanke Sunday

2016-07-01

Exploring beliefs about personal risk for human immunodeficiency virus (HIV) infection is essential to understanding what motivates people to engage in behaviors that reduce or increase their risk of HIV infection. Therefore, the current study's objective was to examine the effects of a Rational-Emotive Health Education Program (REHEP) on HIV risk perceptions among in-school adolescents in Anambra State, Nigeria.Forty-four participants were identified as having high-risk perceptions about HIV infection through a self-report questionnaire and met the inclusion criteria. The treatment process was guided by a REHEP manual and consisted of 8 weeks of full intervention and 2 weeks of follow-up meetings that marked the end of intervention. The study used repeated measures analysis of variance to assess improvements in individual participants and across control and treatment group risk perceptions after the intervention.HIV risk perceptions of in-school adolescents did not differ across the treatment and control groups at baseline. Through REHEP, HIV risk perceptions significantly reduced in the treatment group compared to those in the control group. REHEP had significant effect on HIV risk perceptions of in-school adolescents exposed to treatment group, despite their sex. Religious background did not determine the significant effect of REHEP on HIV risk perceptions of in-school adolescents in the treatment group.Follow-up studies that would use a REHEP to assist client population from other parts of the country to promote HIV risk reduction, especially among those with high-risk behavior, are needed in Nigeria.

Effects of Rational-Emotive Health Education Program on HIV risk perceptions among in-school adolescents in Nigeria

PubMed Central

Onyechi, Kay Chinonyelum Nwamaka; Eseadi, Chiedu; Okere, Anthony U.; Otu, Mkpoikanke Sunday

2016-01-01

Abstract Exploring beliefs about personal risk for human immunodeficiency virus (HIV) infection is essential to understanding what motivates people to engage in behaviors that reduce or increase their risk of HIV infection. Therefore, the current study's objective was to examine the effects of a Rational-Emotive Health Education Program (REHEP) on HIV risk perceptions among in-school adolescents in Anambra State, Nigeria. Forty-four participants were identified as having high-risk perceptions about HIV infection through a self-report questionnaire and met the inclusion criteria. The treatment process was guided by a REHEP manual and consisted of 8 weeks of full intervention and 2 weeks of follow-up meetings that marked the end of intervention. The study used repeated measures analysis of variance to assess improvements in individual participants and across control and treatment group risk perceptions after the intervention. HIV risk perceptions of in-school adolescents did not differ across the treatment and control groups at baseline. Through REHEP, HIV risk perceptions significantly reduced in the treatment group compared to those in the control group. REHEP had significant effect on HIV risk perceptions of in-school adolescents exposed to treatment group, despite their sex. Religious background did not determine the significant effect of REHEP on HIV risk perceptions of in-school adolescents in the treatment group. Follow-up studies that would use a REHEP to assist client population from other parts of the country to promote HIV risk reduction, especially among those with high-risk behavior, are needed in Nigeria. PMID:27442633

Insomnia, Nightmares, and Chronotype as Markers of Risk for Severe Mental Illness: Results from a Student Population.

PubMed

Sheaves, Bryony; Porcheret, Kate; Tsanas, Athanasios; Espie, Colin A; Foster, Russell G; Freeman, Daniel; Harrison, Paul J; Wulff, Katharina; Goodwin, Guy M

2016-01-01

To group participants according to markers of risk for severe mental illness based on subsyndromal symptoms reported in early adulthood and evaluate attributes of sleep across these risk categories. An online survey of sleep and psychiatric symptomatology (The Oxford Sleep Survey) was administered to students at one United Kingdom university. 1403 students (undergraduate and postgraduate) completed the survey. The median age was 21 (interquartile range = 20-23) and 55.60% were female. The cross-sectional data were used to cluster participants based on dimensional measures of psychiatric symptoms (hallucinations, paranoia, depression, anxiety, and (hypo)mania). High, medium, and low symptom groups were compared across sleep parameters: insomnia symptoms, nightmares, chronotype, and social jet lag. Insomnia symptoms, nightmares frequency, and nightmare-related distress increased in a dose-response manner with higher reported subsyndromal psychiatric symptoms (low, medium, and high). The high-risk group exhibited a later chronotype (mid sleep point for free days) than the medium- or low-risk group. The majority of participants (71.7%) in the high-risk group screened positive for insomnia and the median nightmare frequency was two per 14 days (moderately severe pathology). Insomnia, nightmares, and circadian phase delay are associated with increased subsyndromal psychiatric symptoms in young people. Each is a treatable sleep disorder and might be a target for early intervention to modify the subsequent progression of psychiatric disorder. © 2016 Associated Professional Sleep Societies, LLC.

Impact of stress and mitigating information on evaluations, attributions, affect, disciplinary choices, and expectations of compliance in mothers at high and low risk for child physical abuse.

PubMed

De Paúl, Joaquín; Asla, Nagore; Pérez-Albéniz, Alicia; de Cádiz, Bárbara Torres-Gómez

2006-08-01

The objective is to know if high-risk mothers for child physical abuse differ in their evaluations, attributions, negative affect, disciplinary choices for children's behavior, and expectations of compliance. The effect of a stressor and the introduction of mitigating information are analyzed. Forty-seven high-risk and 48 matched low-risk mothers participated in the study. Mothers' information processing and disciplinary choices were examined using six vignettes depicting a child engaging in different transgressions. A four-factor design with repeated measures on the last two factors was used. High-risk mothers reported more hostile intent, global and internal attributions, more use of power assertion discipline, and less induction. A risk group by child transgression interaction and a risk group by mitigating information interaction were found. Results support the social information-processing model of child physical abuse, which suggests that high-risk mothers process child-related information differently and use more power assertive and less inductive disciplinary techniques.

Epidemiological investigation of physique situation for birth high-risk children aged 9-15 years in Chengdu, Southwest China.

PubMed

Xiong, F; Yang, F; Huo, T Z; Li, P; Mao, M

2014-01-01

As the intrauterine environment can effect children's growth and development, this study aimed to explore the relationship between birth high-risk and physique situation of 9 to 15-year-old children by cross-sectional investigation, and to provide clues for the monitoring, prevention, and treatment of growth deviation in children. This study recruited 7,194 students aged 9 to 15 years in primary and junior schools. Their parents were asked to complete the birth situation questionnaire. Measurements included height, weight, and body mass index (BMI). Birth high-risk infant was defined according to the gestational age and birth weight. Growth deviation was classified as underweight, short stature, overweight, and obesity. The prevalence of all kinds of growth deviations in preterm, full-term, and post-term birth groups were similar, the same as the physique situation at school age among both sexes. The incidence of small for gestational age (SGA) was 6.23%, when at school age, part of SGA had catch-up growth. However, the prevalence of underweight and short stature for SGA was highest in three groups. The weight and height at school age in SGA group was less than that in appropriate for gestational age (AGA) and large for gestational age (LGA) groups. The prevalence of overweight and obesity for LGA and macrosomia were highest in three groups. At school age, the weight in macrosomia and LGA groups was higher than that in the other groups. Longitudinal height and weight development and growth of children with birth high-risk are different from normal children. In order to improve healthy situation, more attention should be paid to height and weight development of those children with birth high-risk at school age, even in pre-school age. Prevention may already begin during pregnancy.

Children with suspected craniosynostosis: a cost-effectiveness analysis of diagnostic strategies.

PubMed

Medina, L Santiago; Richardson, Randy R; Crone, Kerry

2002-07-01

Our purpose was to evaluate the clinical and economic impact of three evaluation strategies in children at different risks of craniosynostosis. A decision-analytic and cost-effectiveness model was constructed to compare three evaluation in strategies in children with suspected synostosis: no imaging, radiography (if abnormal, followed by three-dimensional CT [3D CT]), and 3D CT. Three risk groups were analyzed on the basis of the prevalence (pretest probability) of disease: low (completly healthy children; prevalence, 34/100,000), intermediate (healthy children with head deformity; prevalence, 1/115), and high risk (children with syndromic craniofacial disorders [i.e., Crouzon's syndrome or Apert's syndrome]; prevalence, 9-10/10). Test performance (sensitivity and specificity) of the evaluation strategies was obtained from the literature. Costs (not charge) estimates were obtained from the hospital cost-accounting database and from the Medicaid fee schedule. In the low-risk group, the radiographic and 3D CT strategies resulted in a cost per quality-adjusted life year (QALY) gained of more than $560,000. In the intermediate-risk group, the radiographic strategy resulted in a cost per QALY gained of $54,600. Three-dimensional CT was more effective than the two other strategies but at a higher cost-hence, with a cost per QALY gained of $374,200. In the high-risk group, 3D CT was the most effective strategy with a cost per QALY gained of $33,800. Less experienced radiologists and poor-quality studies increased the evaluation cost per QALY gained for all of the risk groups because of decreased effectiveness. Radiologic screening of completely healthy children (low risk) for synostosis is not warranted because of the high cost per QALY gained of the radiographic and 3D CT strategies. In healthy children with head deformity (intermediate risk), the radiographic strategy had a reasonable cost per QALY gained. Three-dimensional CT was more effective but had a high cost per QALY gained. In children with syndromic craniofacial disorders (high risk), 3D CT was the most effective strategy and had a reasonable cost per QALY gained. Selection of children with suspected craniosynostosis based on their risk group and use of the most appropriate evaluation strategy could maximize clinical and economic outcomes for these patients.

[Cross-sectional study on high-normal blood pressure and chronic kidney disease in occupational physical examination population in Changsha].

PubMed

Cao, Xia; Xie, Xiumei; Xu, Guo; Yuan, Hong; Chen, Zhiheng

2014-06-01

To investigate the relationship between high-normal blood pressure and chronic kidney disease (CKD) in occupational physical examination population in Changsha. With a convenient sampling method, a cross-sectional survey of representative sample of 11 274 white collar workers was conducted in Changsha between March 2011 and May 2011 in a large comprehensive hospital. All subjects were assigned into 4 groups: a normal blood pressure group, a high-normal blood pressure group, an undiagnosed hypertension group, and a diagnosed hypertension group. Anthropometry, blood pressure, blood sample and urine sample were measured with standard instruments and methodology for all the subjects. Multiple logistic regression analysis was used to identify risk factors for CKD. The prevalence of CKD in the normal blood pressure, high-normal blood pressure, undiagnosed hypertension, and diagnosed hypertension were 3.31%, 6.60%, 11.78%, and 17.35%, respectively. The prevalence of CKD in males was significantly higher than that in females (P<0.01). For males with high-normal blood pressure, the CKD risk was significantly greater (OR, 1.30; 95% CI:1.03 - 1.63) than those with optimal blood pressure. The logistic regression analysis showed that there was an additive effect of hyperuricemia on CKD risk in men with high-normal blood pressure compared with men with optimal blood pressure (OR, 2.25; 95% CI, 1.59 - 3.19; P<0.05). The prevalence of CKD in people with the high-normal blood pressure is 6.60% in occupational physical examination population in Changsha. CKD is a high risk for men with highnormal blood pressure and hyperuricemia is an independent risk factor.

[Genetic tests in oncology: from identification of high risk groups to therapy].

PubMed

Sgambato, Alessandro; Ripani, Maurizio; Romano Spica, Vincenzo

2010-01-01

The development of genetic epidemiology in oncology has made possible more frequent analysis of high risk groups, allowing the development of promising susceptibility indicators. The main public health implications include screening and new perspectives for pharmacogenetics and nutrigenomics. The study of genetic variants allows the evaluation of individual risk of developing a disease and has important implications in primary and secondary prevention programs. The analysis of somatic mutations present in tumour cells may contribute to selecting the optimal treatment on an individual basis and to reducing the occurrence of adverse effects of chemotherapy. The authors give a summary of the state of the art of this field and analyze the potential applications of genetic tests in oncology, from identification of high risk groups to defining individualized therapies with particular emphasis on implications for prevention.

Treating Aggression in High-Risk Adolescent Girls: A Preliminary Evaluation

ERIC Educational Resources Information Center

Hoffman, Sue; Cummings, Anne L.; Leschied, Alan W.

2004-01-01

This pilot study examined whether aggressive responses and attitudes of high-risk adolescent girls would decrease after a group treatment that focused on the specific needs of aggressive adolescent girls. Twelve girls, aged 12-16 years from two residential facilities, participated in eight, one-hour group sessions. Results indicated a…

Assessment of fetal well-being in cattle by ultrasonography in normal, high-risk, and cloned pregnancies

PubMed Central

Buczinski, Sébastien; Fecteau, Gilles; Lefebvre, Réjean C.; Smith, Lawrence C.

2011-01-01

This study determined ultrasonographic parameters of fetuses and uterine adnexa in late pregnancy in normal, cloned, and high-risk pregnancies in relation to perinatal and neonatal outcome. Ten cows with normal pregnancies (CONTROL, mean pregnancy length 273 d), 10 sick cows with potentially compromised pregnancies (HIGH-RISK, mean pregnancy length 267 d), and 10 heifers with cloned pregnancies (CLONED, mean pregnancy length 274 d) were examined at more than 260 d of gestation. There was no difference in mean fetal heart rates among the groups. The cloned calves were heavier (57 ± 8 kg) than calves from CONTROL group (36 ± 7 kg), and calves from HIGH-RISK group (37 ± 13 kg) (P = 0.003). The diameter of the thoracic aorta was positively correlated (R = 0.62) with fetal birth weight in the CONTROL group (P = 0.01). Fetal activity was not associated with survival. The results suggest that transabdominal ultrasonographic assessment of the fetal well-being may serve as a potential tool for evaluation of the fetoplacental unit. PMID:21532817

Effect of regular oral intake of aspirin during pregnancy on pregnancy outcome of high-risk pregnancy-induced hypertension syndrome patients.

PubMed

Liu, F-M; Zhao, M; Wang, M; Yang, H-L; Li, L

2016-12-01

The aim of this study is to analyze the effect of 100 mg/d regular oral intake of aspirin during pregnancy on high-risk pregnancy-induced hypertension syndrome patients. We consecutively selected 98 cases high-risk pregnancy-induced hypertension syndrome patients. After obtaining the informed consent of the patients, we randomly divided the patients into aspirin group (50 cases) and placebo group (48 cases). The oral intake of aspirin lasted from the final diagnosis of pregnancy to antepartum time, and was taken before sleep. The bleeding index was closely detected and we stop taking aspirin when necessary. The comparison of clinical outcome showed that the incidents of pregnancy-induced hypertension syndrome, pre-eclampsia and eclampsia of aspirin group were significantly lower than that of the placebo group (p<0.05). Comparing the complications of fetus perinatal period, the difference was not statistically significant (p>0.05). 100 mg/d regular oral intake of aspirin during pregnancy is safe, effective and worthy of generalization to high-risk pregnancy-induced hypertension syndrome patients.

Standard cardiovascular disease risk algorithms underestimate the risk of cardiovascular disease in schizophrenia: evidence from a national primary care database.

PubMed

McLean, Gary; Martin, Julie Langan; Martin, Daniel J; Guthrie, Bruce; Mercer, Stewart W; Smith, Daniel J

2014-10-01

Schizophrenia is associated with increased cardiovascular mortality. Although cardiovascular disease (CVD) risk prediction algorithms are widely in the general population, their utility for patients with schizophrenia is unknown. A primary care dataset was used to compare CVD risk scores (Joint British Societies (JBS) score), cardiovascular risk factors, rates of pre-existing CVD and age of first diagnosis of CVD for schizophrenia (n=1997) relative to population controls (n=215,165). Pre-existing rates of CVD and the recording of risk factors for those without CVD were higher in the schizophrenia cohort in the younger age groups, for both genders. Those with schizophrenia were more likely to have a first diagnosis of CVD at a younger age, with nearly half of men with schizophrenia plus CVD diagnosed under the age of 55 (schizophrenia men 46.1% vs. control men 34.8%, p<0.001; schizophrenia women 28.9% vs. control women 23.8%, p<0.001). However, despite high rates of CVD risk factors within the schizophrenia group, only a very small percentage (3.2% of men and 7.5% of women) of those with schizophrenia under age 55 were correctly identified as high risk for CVD according to the JBS risk algorithm. The JBS2 risk score identified only a small proportion of individuals with schizophrenia under the age of 55 as being at high risk of CVD, despite high rates of risk factors and high rates of first diagnosis of CVD within this age group. The validity of CVD risk prediction algorithms for schizophrenia needs further research. Copyright © 2014 Elsevier B.V. All rights reserved.

Longitudinal analysis of time, engagement, and achievement in at-risk versus non-risk students.

PubMed

Greenwood, C R

1991-05-01

This longitudinal study investigated the effects of time spent in academic instruction and time engaged on elementary students' academic achievement gains. Three groups were compared over grades as follows: (a) an at-risk experimental group of low-socioeconomic status (SES) students for whom teachers implemented classwide peer tutoring (CWPT) beginning with the second semester of first grade continuing through Grade 3; (b) an equivalent at-risk control group; and (c) a non-risk comparison group of students of average- to high-SES. In both the control and comparison groups, teachers employed conventional instructional practices over Grades 1 through 3. Results indicated significant group differences in the time spent in academic instruction, engagement, and gains on the subtests of the Metropolitan Achievement Test that favored the experimental and comparison groups over the control group. Implications include the effectiveness of CWPT for at-risk students and the continuing vulnerability of at-risk students whose daily instructional programs provide less instructional time and foster lower levels of active academic engagement.

Effective Communication with the Impulsive Risk Taker: Hypotheses from Four Focus Groups.

ERIC Educational Resources Information Center

Valenti, J. M.; Ferguson, M. A.

A study investigated how impulsiveness affects perceptions of risks, and examined message strategies that might be effective in reaching risk-takers. Twenty-two undergraduate subjects who scored high on a risk-taking measure/survey participated in one of four 60-90 minute focus groups in which participants discussed their health, their concerns…

Targeted outreach hepatitis B vaccination program in high-risk adults: The fundamental challenge of the last mile.

PubMed

Mangen, M-J J; Stibbe, H; Urbanus, A; Siedenburg, E C; Waldhober, Q; de Wit, G A; van Steenbergen, J E

2017-05-31

The aim of this study was to evaluate the cost-effectiveness of the on-going decentralised targeted hepatitis B vaccination program for behavioural high-risk groups operated by regional public health services in the Netherlands since 1-November-2002. Target groups for free vaccination are men having sex with men (MSM), commercial sex workers (CSW) and hard drug users (HDU). Heterosexuals with a high partner change rate (HRP) were included until 1-November-2007. Based on participant, vaccination and serology data collected up to 31-December-2012, the number of participants and program costs were estimated. Observed anti-HBc prevalence was used to estimate the probability of susceptible individuals per risk-group to become infected with hepatitis B virus (HBV) in their remaining life. We distinguished two time-periods: 2002-2006 and 2007-2012, representing different recruitment strategies and target groups. Correcting for observed vaccination compliance, the number of future HBV-infections avoided was estimated per risk-group. By combining these numbers with estimates of life-years lost, quality-of-life losses and healthcare costs of HBV-infections - as obtained from a Markov model-, the benefit of the program was estimated for each risk-group separately. The overall incremental cost-effectiveness ratio of the program was €30,400/QALY gained, with effects and costs discounted at 1.5% and 4%, respectively. The program was more cost-effective in the first period (€24,200/QALY) than in the second period (€42,400/QALY). In particular, the cost-effectiveness for MSM decreased from €20,700/QALY to €47,700/QALY. This decentralised targeted HBV-vaccination program is a cost-effective intervention in certain unvaccinated high-risk adults. Saturation within the risk-groups, participation of individuals with less risky behaviour, and increased recruitment investments in the second period made the program less cost-effective over time. The project should therefore discus how to reduce costs per risk-group, increase effects or when to integrate the vaccination in regular healthcare. Copyright © 2017 Elsevier Ltd. All rights reserved.

Early alveolar and systemic mediator release in patients at different risks for ARDS after multiple trauma.

PubMed

Raymondos, Konstantinos; Martin, Michael U; Schmudlach, Tanja; Baus, Stefan; Weilbach, Christian; Welte, Tobias; Krettek, Christian; Frink, Michael; Hildebrand, Frank

2012-02-01

Alveolar IL-8 has been reported to early identify patients at-risk to develop ARDS. However, it remains unknown how alveolar IL-8 is related to pulmonary and systemic inflammation in patients predisposed for ARDS. We studied 24 patients 2-6h after multiple trauma. Patients with IL-8 >200 pg/ml in bronchoalveolar lavage (BAL) were assigned to the group at high risk for ARDS (H, n = 8) and patients with BAL IL-8 <200 pg/ml to the group at low risk for ARDS (L, n = 16). ARDS developed within 24h after trauma in 5 patients at high and at least after 1 week in 2 patients at low risk for ARDS (p = 0.003). High-risk patients had also increased BAL IL-6, TNF-α, IL-1β, IL-10 and IL-1ra levels (p<0.05). BAL neutrophil counts did not differ between patient groups (H vs. L, 12% (3-73%) vs. 6% (2-32%), p = 0.1) but correlated significantly with BAL IL-8, IL-6 and IL-1ra. High-risk patients had increased plasma levels of pro- but not anti-inflammatory mediators. The enhanced alveolar and systemic inflammation associated with alveolar IL-8 release should be considered to identify high-risk patients for pulmonary complications after multiple trauma to adjust surgical and other treatment strategies to the individual risk profile. Copyright © 2011 Elsevier Ltd. All rights reserved.

Understanding Risk-taking Behavior in Bullies, Victims, and Bully Victims Using Cognitive- and Emotion-Focused Approaches.

PubMed

Poon, Kean

2016-01-01

Bullying and risky behavior are two common problems among adolescents and can strongly affect a youth's overall functioning when both coexist. Some studies suggest that bullying in adolescence may promote risky behavior as a coping strategy to deal with victimization related stress. Other studies consider bullying as an outcome of high-risk behavior. Despite the association between the two is well-established, no study has examined the risk-taking patterns among bullying groups (i.e., bully, victim, and bully victim). This study attempted to elucidate the potential relationships between bullying and risk-taking by addressing the two models: a cognitive-focused model and an emotion-focused model of risk taking, and to clarify how adolescents' characteristics in risk taking associate with bullying outcomes. Method: 136 Chinese adolescents (Mean Age = 14.5, M = 65, F = 71) were recruited and grouped according to bullying identity: Bully ( n = 27), Victim ( n = 20), Bully victim ( n = 37) and Control ( n = 52). Cognitive Appraisal of Risky Events (CARE) questionnaire was used to measure participants' expectancies about the risks, benefits and involvement associated with risky activities. Cambridge Gambling Task (CGT) was administered to capture the emotion-laden process in risk taking. Results: Cognitively, Bully was associated with an overestimation of risk while Victim was associated with an underestimation of risk and overrated benefit. Bully victim exhibited a unique pattern with an overestimation of benefit and risk. All study groups projected higher involvement in risky behavior. Behaviorally, both Bully and Bully victim were associated with high risk modulation whereas Victim was associated with impulsive decision-making. Interestingly, compared with bully, bully victim had significantly higher bullying scores, suggesting a wider range and more frequent bullying activities. In conclusion, Bully maybe a group of adolescents that is vigilant in situational deliberation and risk modulation while Victims with high impulsivity, are more likely to place themselves in risky situations. Bully victims presented the combined pattern of the two pure groups and associated with the highest risk-taking propensity. Better picture of risk taking pattern associated with different groups was illustrated, allowing better matching for future prevention and intervention program for distinct bullying individuals.

Understanding Risk-taking Behavior in Bullies, Victims, and Bully Victims Using Cognitive- and Emotion-Focused Approaches

PubMed Central

Poon, Kean

2016-01-01

Bullying and risky behavior are two common problems among adolescents and can strongly affect a youth’s overall functioning when both coexist. Some studies suggest that bullying in adolescence may promote risky behavior as a coping strategy to deal with victimization related stress. Other studies consider bullying as an outcome of high-risk behavior. Despite the association between the two is well-established, no study has examined the risk-taking patterns among bullying groups (i.e., bully, victim, and bully victim). This study attempted to elucidate the potential relationships between bullying and risk-taking by addressing the two models: a cognitive-focused model and an emotion-focused model of risk taking, and to clarify how adolescents’ characteristics in risk taking associate with bullying outcomes. Method: 136 Chinese adolescents (Mean Age = 14.5, M = 65, F = 71) were recruited and grouped according to bullying identity: Bully (n = 27), Victim (n = 20), Bully victim (n = 37) and Control (n = 52). Cognitive Appraisal of Risky Events (CARE) questionnaire was used to measure participants’ expectancies about the risks, benefits and involvement associated with risky activities. Cambridge Gambling Task (CGT) was administered to capture the emotion-laden process in risk taking. Results: Cognitively, Bully was associated with an overestimation of risk while Victim was associated with an underestimation of risk and overrated benefit. Bully victim exhibited a unique pattern with an overestimation of benefit and risk. All study groups projected higher involvement in risky behavior. Behaviorally, both Bully and Bully victim were associated with high risk modulation whereas Victim was associated with impulsive decision-making. Interestingly, compared with bully, bully victim had significantly higher bullying scores, suggesting a wider range and more frequent bullying activities. In conclusion, Bully maybe a group of adolescents that is vigilant in situational deliberation and risk modulation while Victims with high impulsivity, are more likely to place themselves in risky situations. Bully victims presented the combined pattern of the two pure groups and associated with the highest risk-taking propensity. Better picture of risk taking pattern associated with different groups was illustrated, allowing better matching for future prevention and intervention program for distinct bullying individuals. PMID:27965603

Community health workers, social support and cervical cancer screening among high-risk groups in rural Mexico.

PubMed

Elliott, Patrick F; Belinson, Suzanne E; Ottolenghi, Emma; Smyth, Kathleen; Belinson, Jerome L

2013-11-01

Rural Mexico has a low screening prevalence and high burden of cervical cancer. One strategy to increase screening coverage utilizes community health workers (CHWs) to recruit high-risk women and address barriers. We conducted a systematic cross-sectional survey of 196 women residing in Chiapas, Mexico who were recruited by either CHWs or traditional means for screening. This analysis compares 110 rural women's risk factors, attitudes and knowledge of cervical cancer and socioeconomic factors stratified by type of recruitment. Women who were informed of screening by CHWs were more likely to be of high risk sub-groups and report higher scores of social support but were also more likely to endorse difficulty with access and fatalistic attitudes about cancer. Utilizing CWHs results in increased screening among high-risk women and increased social support for screening among rural women, addressing a significant barrier, but may have limited effects on other barriers.

Endogenous Groups and Dynamic Selection in Mechanism Design*

PubMed Central

Madeira, Gabriel A.; Townsend, Robert M.

2010-01-01

We create a dynamic theory of endogenous risk sharing groups, with good internal information, and their coexistence with relative performance, individualistic regimes, which are informationally more opaque. Inequality and organizational form are determined simultaneously. Numerical techniques and succinct re-formulations of mechanism design problems with suitable choice of promised utilities allow the computation of a stochastic steady state and its transitions. Regions of low inequality and moderate to high wealth (utility promises) produce the relative performance regime, while regions of high inequality and low wealth produce the risk sharing group regime. If there is a cost to prevent coalitions, risk sharing groups emerge at high wealth levels also. Transitions from the relative performance regime to the group regime tend to occur when rewards to observed outputs exacerbate inequality, while transitions from the group regime to the relative performance regime tend to come with a decrease in utility promises. Some regions of inequality and wealth deliver long term persistence of organization form and inequality, while other regions deliver high levels of volatility. JEL Classification Numbers: D23,D71,D85,O17. PMID:20107614

The 2005 British Columbia Smoking Cessation Mass Media Campaign and short-term changes in smoking.

PubMed

Gagné, Lynda

2007-01-01

The objective of this study was to evaluate the impact of the 2005 British Columbia Ministry of Health Smoking Cessation Mass Media Campaign on short-term smoking behavior. National cross-sectional data are used with a quasi-experimental approach to test the impact of the campaign. Findings indicate that prevalence and average number of cigarettes smoked per day deviated upward from trend for the rest of Canada (P = .08; P = .01) but not for British Columbia. They also indicate that British Columbia smokers in lower risk groups reduced their average daily consumption of cigarettes over and above the 1999-2004 trend (-2.23; P = .10), whereas smokers in the rest of Canada did not, and that British Columbia smokers in high-risk groups did not increase their average daily consumption of cigarettes over and above the 1999-2004 trend, whereas smokers in the rest of Canada did (2.97; P = .01). The overall poorer performance of high-risk groups is attributed to high exposure to cigarette smoking, which reduces a smoker's chances of successful cessation. In particular, high-risk groups are by definition more likely to be exposed to smoking by peers, but are also less likely to work in workplaces with smoking bans, which are shown to have a substantial impact on prevalence. Results suggest that for mass media campaigns to be more effective with high-risk groups, they need to be combined with other incentives, and that more prolonged interventions should be considered.

Effects of a culturally adapted lifestyle intervention on cardio-metabolic outcomes: a randomized controlled trial in Iraqi immigrants to Sweden at high risk for Type 2 diabetes.

PubMed

Siddiqui, Faiza; Kurbasic, Azra; Lindblad, Ulf; Nilsson, Peter M; Bennet, Louise

2017-01-01

Middle-Eastern immigrants constitute a growing proportion of the Swedish population and are at high risk for Type 2 diabetes. This calls for a more proactive preventive approach for dealing with diabetes risk in this target group. The aim was to test the effect of a culturally adapted lifestyle intervention programme on changes in lifestyle habits and cardio-metabolic outcomes comparing an intervention group with a control group receiving usual care. Citizens of Malmö, Sweden born in Iraq and at high risk for Type 2 diabetes (n=636) were invited. Participation rate was 15.1%. In all, 96 participants were randomized to the intervention group (n=50) or to the control group (n=46). The intervention group was offered seven group sessions addressing healthy diet and physical activity including one cooking class. Changes in body weight, physical activity levels and cardio-metabolic outcomes were evaluated using linear mixed-effects models. The mean follow-up time was 3.9 and 3.5months in the intervention and control groups, respectively. The drop-out rate from baseline to the last visit was 30.0% in the intervention group (n=15) and 30.4% in the control group (n=14). The mean insulin sensitivity index increased significantly at follow-up in the intervention group compared to the control group (10.9% per month, p=0.005). The intervention group also reached a significant reduction in body weight (0.4% per month, p=0.004), body mass index (0.4% per month, p=0.004) and LDL-cholesterol (2.1% per month, p=0.036) compared to the control group. In total, 14.3% in the intervention group reached the goal to lose ≥5% of body weight versus none in the control group. This culturally adapted lifestyle intervention programme shows a beneficial effect on insulin action, body weight reduction, as well as LDL-cholesterol reduction, in Middle-Eastern immigrants. The programme adapted to resources in primary health care provides tools for improved primary prevention and reduced cardio-metabolic risk in this high-risk group for Type 2 diabetes. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Metabolic syndrome and cardiovascular risk among institutionalized patients with schizophrenia receiving long term tertiary care.

PubMed

Seow, Lee Seng Esmond; Chong, Siow Ann; Wang, Peizhi; Shafie, Saleha; Ong, Hui Lin; Subramaniam, Mythily

2017-04-01

Metabolic syndrome (MetS) and cardiovascular risk are highly prevalent among individuals with schizophrenia. This study aimed to determine the cardiometabolic profile and the associated risk factors in a group of institutionalized patients with schizophrenia or schizoaffective disorder receiving prolonged hospital care in the only tertiary psychiatric institution in Singapore. Patients residing in long stay wards who were hospitalized for a minimum period of 1year were recruited. Fasting blood sample was collected to obtain levels of blood glucose, total cholesterol, high-density lipoprotein (HDL) and triglycerides. Waist circumference, blood pressure, height and weight were also measured. The prevalence of MetS and the 10-year cardiovascular risk were determined. This inpatient group had a mean age of 56.1years and an average length of hospitalization of 8.8years. The prevalence of MetS in this group was 51.9% and 26.9% based on the AHA/NHLBI and modified NCEP ATP III criteria respectively. Those in the high risk BMI category and those who had pre-existing diabetes had higher odds of MetS. Their 10-year cardiovascular risk was estimated at 12.8%, indicating intermediate risk based on the Framingham risk function. Despite the low smoking rate in this group of inpatients, their cardiovascular risk appeared to be relatively high possibly due to old age and age-related conditions such as hypertension and low HDL. While literature has found the use of atypical antipsychotic medications to increase the risk of MetS, we did not find any significant association. Additionally, the duration of hospitalization did not affect the rate of MetS in our sample. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Therapeutic hypothermia and pressure ulcer risk in critically ill intensive care patients: A retrospective study.

PubMed

Ahtiala, Maarit; Laitio, Ruut; Soppi, Esa

2018-06-01

To examine the role of therapeutic hypothermia in pressure ulcer development in critically ill patients. Retrospective study in a mixed intensive care unit over 2010-2013. The incidences of pressure ulcers among patients treated with therapeutic hypothermia (n = 148) and the non-hypothermia patient population (n = 6197) were compared. Patients treated with hypothermia developed more pressure ulcers (25.0%) than the non-hypothermia group 6.3% (p < 0.001). More patients in the hypothermia group were rated as the high pressure ulcer risk group, as defined by the modified Jackson/Cubbin (mJ/C) risk score ≤29 than the rest of the patients. Among the therapeutic hypothermia patients more pressure ulcers tended to emerge in the lower risk group (mJ/C score ≥30) (p = 0.056). Intensive care mortality was higher in the hypothermia (24.3%) than the non-hypothermia group (9.3%, p < 0.0001). Patients treated with therapeutic hypothermia should be considered at high risk for pressure ulcer development and should be managed accordingly. The hypothermia may not as such increase the risk for pressure ulcers, but combined with the severity of the underlying illness, may be more likely. The pressure ulcer risk in this patient group cannot be reliably assessed by the Jackson/Cubbin risk scale. Copyright © 2018 Elsevier Ltd. All rights reserved.

The effect of graphical and numerical presentation of hypothetical prenatal diagnosis results on risk perception.

PubMed

Siegrist, Michael; Orlow, Pascale; Keller, Carmen

2008-01-01

To evaluate various formats for the communication of prenatal test results. In study 1 (N=400), female students completed a questionnaire assessing risk perception, affect, and perceived usefulness of prenatal test results. A randomized, 2 (risk level; low, high) x 4 (format; ratio with numerator 1, ratio with denominator 1000, Paling Perspective Scale, pictograms) design was used. Study 2 (N=200) employed a 2 (risk level; low, high) x 2 (format; Paling Perspective Scale, risk comparisons in numerical format) design. In study 1, the Paling Perspective Scale resulted in a higher level of perceived risk across different risk levels compared with the other formats. Furthermore, participants in the low-risk group perceived the test results as less risky compared with participants in the high-risk group (P < 0.001) when the Paling Perspective Scale was used. No significant differences between low and high risks were observed for the other 3 formats. In study 2, the Paling Perspective Scale evoked higher levels of perceived risks relative to the numerical presentation of risk comparisons. For both formats, we found that participants confronted with a high risk perceived test results as more risky compared with participants confronted with a low risk. The Paling Perspective Scale resulted in a higher level of perceived risk compared with the other formats. This effect must be taken into account when choosing a graphical or numerical format for risk communication.

Survival outcomes of patients with germ cell tumors treated with high-dose chemotherapy for refractory or relapsing disease.

PubMed

Zschäbitz, Stefanie; Distler, Florian A; Krieger, Benjamin; Wuchter, Patrick; Schäfer-Eckart, Kerstin; Jenzer, Maximilian; Hohenfellner, Markus; Dreger, Peter; Haag, Georg Martin; Jäger, Dirk; Pahernik, Sascha; Grüllich, Carsten

2018-04-27

Male patients with metastatic germ cell tumors can be cured in up to 96% of cases depending on stage and IGCCCG prognosis group. Treatment in relapse consists of conventional or high-dose chemotherapy (HDCT) with autologous stem cell transplantation (ASCT) combined with local treatment modalities. Most patients were classified as poor risk according to IGCCCG ( n = 24; 52%) and as intermediate ( n = 12), high ( n = 16), or very high risk ( n = 9) at time of first relapse according to IPFSG criteria. In 67% of patients ( n = 31) HDCT/ASCT was performed as first salvage treatment in relapse or for primary refractory disease following first line chemotherapy. In 46% of patients ( n = 21) progressive disease was documented after mobilization and prior to HDCT/ASCT. Median progression free survival (mPFS) was 7.4 months (95% confidence interval (CI): 1.3-13.6) while median overall survival (mOS) was 22.2 months (95% CI: 8.9-35.5). When stratified for IPFSG risk group, mPFS ( p < 0.001) and mOS ( p = 0.009) differed significantly between risk groups (very low vs. low vs. intermediate vs. high vs. very high). Metastases to liver/bone/brain and platinum refractory disease were independent risk factors for inferior PFS ( p = 0.024; p = 0.008) but not OS. Forty-six patients treated with HDCT/ASCT at the university clinics in Heidelberg and Nuremberg between 2000-2016 were identified and analyzed. Data was collected retrospectively. HDCT/ASCT offers a potential curative strategy for patients with relapsed GCT. Improvement is still needed in patients with intermediate, high, and very high IPFSG risk group.

Clinical outcome of statin plus ezetimibe versus high-intensity statin therapy in patients with acute myocardial infarction propensity-score matching analysis.

PubMed

Ji, Mi Seon; Jeong, Myung Ho; Ahn, Young Keun; Kim, Sang Hyung; Kim, Young Jo; Chae, Shung Chull; Hong, Taek Jong; Seong, In Whan; Chae, Jei Keon; Kim, Chong Jin; Cho, Myeong Chan; Rha, Seung-Woon; Bae, Jang Ho; Seung, Ki Bae; Park, Seung Jung

2016-12-15

It is unclear whether simvastatin-ezetimibe could be an alternative therapy to high-intensity statin therapy in high-risk patients. The aim of this study was to compare the clinical outcomes of simvastatin-ezetimibe and high-intensity statin therapy in patients with acute myocardial infarction (AMI), and especially in those with high-risk factor. A total of 3520 AMI patients in the KAMIR (Korea Acute Myocardial Infarction Registry) were classified into simvastatin-ezetimibe group (n=1249) and high-intensity statin group (n=2271). Multivariate analysis and propensity-score matching analysis were performed. The primary endpoint was major adverse cardiac events (MACE) at 12-months follow-up. In overall AMI patients, MACE occurred in 116 patients (9.3%) in simvastatin-ezetimibe group and 116 patients (5.1%) in high-intensity statin group. The difference in MACE between groups was driven by repeat revascularization (5.9% vs. 2.2%). After propensity matching analysis, simvastatin-ezetimibe was associated with a higher incidence of MACE than high-intensity statin therapy (adjusted hazard ratio: 3.090, 95% confidence interval: 1.715 to 5.566, p<0.001). However, in patients with high-risk factors, such as diabetes, old age, or heart failure, simvastatin-ezetimibe had similar incidence of MACE compared with high-intensity statin therapy in further adjusted analysis. In overall AMI patients, high-intensity statin therapy had better clinical outcomes than simvastatin-ezetimibe. However, in patients with high-risk factor, simvastatin-ezetimibe had comparable clinical outcomes to high-intensity statin therapy. Therefore, simvastatin-ezetimibe could be used as an alternative to high-intensity statin therapy in such patients. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Factors Influencing Cancer Risk Perception in High Risk Populations: A Systematic Review

PubMed Central

2011-01-01

Background Patients at higher than average risk of heritable cancer may process risk information differently than the general population. However, little is known about clinical, demographic, or psychosocial predictors that may impact risk perception in these groups. The objective of this study was to characterize factors associated with perceived risk of developing cancer in groups at high risk for cancer based on genetics or family history. Methods We searched Ovid MEDLINE, Ovid Embase, Ovid PsycInfo, and Scopus from inception through April 2009 for English-language, original investigations in humans using core concepts of "risk" and "cancer." We abstracted key information and then further restricted articles dealing with perceived risk of developing cancer due to inherited risk. Results Of 1028 titles identified, 53 articles met our criteria. Most (92%) used an observational design and focused on women (70%) with a family history of or contemplating genetic testing for breast cancer. Of the 53 studies, 36 focused on patients who had not had genetic testing for cancer risk, 17 included studies of patients who had undergone genetic testing for cancer risk. Family history of cancer, previous prophylactic tests and treatments, and younger age were associated with cancer risk perception. In addition, beliefs about the preventability and severity of cancer, personality factors such as "monitoring" personality, the ability to process numerical information, as well as distress/worry also were associated with cancer risk perception. Few studies addressed non-breast cancer or risk perception in specific demographic groups (e.g. elderly or minority groups) and few employed theory-driven analytic strategies to decipher interrelationships of factors. Conclusions Several factors influence cancer risk perception in patients at elevated risk for cancer. The science of characterizing and improving risk perception in cancer for high risk groups, although evolving, is still relatively undeveloped in several key topic areas including cancers other than breast and in specific populations. Future rigorous risk perception research using experimental designs and focused on cancers other than breast would advance the field. PMID:21595959

Triglyceride-to-HDL-cholesterol ratio and metabolic syndrome as contributors to cardiovascular risk in overweight patients.

PubMed

Marotta, Teodoro; Russo, Barbara F; Ferrara, L Aldo

2010-08-01

Insulin resistance increases cardiovascular risk of obese patients. Triglyceride to high-density lipoprotein cholesterol ratio (TG/HDL) >or=3.0 (in mg/dl) is a marker of insulin resistance in overweight persons. We aimed at assessing cardiovascular risk profile in 301 overweight elderly Neapolitan outpatients, according to TG/HDL ratio and metabolic syndrome (MS), diagnosed by National Cholesterol Education Program (NCEP) and International Diabetes Federation (IDF) criteria. TG/HDL ratio was >or=3.0 in 97 patients (group A) and <3.0 in 204 (group B). Overall, 93-97% of group A patients and 38-51% of group B patients had MS, depending on the diagnostic criterion. Group A patients with MS had significantly higher waist-to-hip ratio, total and non-HDL cholesterol than group B patients with MS. In group B, MS and non-MS patients had similar waist-to-hip ratio, blood pressure, total and non-HDL cholesterol. Ten year coronary risk, calculated by the Framingham equations (n = 243), was 10.3 +/- 5% in group B, non-MS patients; 13.1 +/- 6% in group B, MS patients; 19.9 +/- 8% in group A (F = 32.8; P < 0.001). At the multiple regression analysis, TG/HDL ratio was associated with coronary risk (r(2) = 0.227) more closely than gender, blood pressure, waist-to-hip ratio, non HDL cholesterol, and MS considered as a whole. A separate regression analysis showed that the logarithmically transformed TG/HDL ratio, an index of the HDL cholesterol esterification rate, is also associated with coronary risk (r(2) = 0.252). Thus, TG/HDL ratio could help to characterize high-risk overweight patients deserving a special therapeutic effort. Cardiovascular risk profile of insulin-sensitive patients, identified by lower values of this parameter, is only moderately affected by MS.

Clinical characteristics of high plasma adiponectin and high plasma leptin as risk factors for arterial stiffness and related end-organ damage.

PubMed

Kohara, Katsuhiko; Ochi, Masayuki; Okada, Yoko; Yamashita, Taiji; Ohara, Maya; Kato, Takeaki; Nagai, Tokihisa; Tabara, Yasuharu; Igase, Michiya; Miki, Tetsuro

2014-08-01

The relationship between plasma levels of adiponectin and cardiovascular events is inconclusive. We evaluated the clinical characteristics of people with high plasma adiponectin and high plasma leptin levels. Thousand seven hundred participants recruited from visitors to the Anti-Aging Doc were divided into four groups by combining the bipartiles of plasma adiponectin and leptin levels in men and women separately: AL, high adiponectin and high leptin; Al, high adiponectin and low leptin; al, low adiponectin and low leptin; aL, low adiponectin and high leptin. Body composition, including visceral fat area and thigh muscle cross-sectional area (CSA), brachial-ankle pulse wave velocity (baPWV), periventricular hyperintensity, and urinary albumin excretion, were determined. Twenty percent of the studied population fell within the AL group. This group had a significantly higher visceral fat area than the Al group. Thigh muscle CSA was lowest in the AL group among groups. baPWV, brain white matter lesions, and albuminuria findings in the AL group were significantly higher than those of the Al group. Multiple and logistic regression analyses with confounding parameters further confirmed that plasma adiponectin was not an independent determinant for brain and renal small vessel-related disease. These findings suggest that the plasma level of adiponectin alone is not enough for the risk stratification of cardiovascular disease. Leptin resistance associated with skeletal muscle loss in addition to obesity may need to be addressed to identify high risk people with high plasma adiponectin levels. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The FRIENDS emotional health program for minority groups at risk.

PubMed

Iizuka, Cristina A; Barrett, Paula M; Gillies, Robyn; Cook, Clayton R; Miller, Debbie

2014-02-01

Despite the existence of evidence-based interventions for promoting mental health in children, the number of children at risk remains high. One of the reasons is that such interventions are not reaching specific groups at risk such as low socioeconomic status and ethnic minority groups. This study evaluated an adaptation of a school-based psychosocial program for nonreferred students aged 11 to 12 years attending a multicultural school from a low socioeconomic status area. The FRIENDS Program was adapted for a multicultural population. A quasi-experimental design was used, involving a pre/post-test, to evaluate the impact of the intervention on participants' outcomes on the Strengths and Difficulties Questionnaire (SDQ). Participants were divided into 2 categories ("at risk"/"not at risk") based on their scores in the SDQ at pre-test. Post-test data were collected to evaluate the overall effectiveness and acceptability of the program. Analyses showed significant improvement for the group initially identified as "at risk," with 30% of the students being no longer at risk after the intervention. Most students rated the intervention as being highly acceptable and useful. Adaptations to existing evidence-based programs for implementation with specific minority groups at risk represents a promising approach to promote emotional health in children. © 2014, American School Health Association.

Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients: A Randomized Clinical Trial.

PubMed

Hernández, Gonzalo; Vaquero, Concepción; Colinas, Laura; Cuena, Rafael; González, Paloma; Canabal, Alfonso; Sanchez, Susana; Rodriguez, Maria Luisa; Villasclaras, Ana; Fernández, Rafael

2016-10-18

High-flow conditioned oxygen therapy delivered through nasal cannulae and noninvasive mechanical ventilation (NIV) may reduce the need for reintubation. Among the advantages of high-flow oxygen therapy are comfort, availability, lower costs, and additional physiopathological mechanisms. To test if high-flow conditioned oxygen therapy is noninferior to NIV for preventing postextubation respiratory failure and reintubation in patients at high risk of reintubation. Multicenter randomized clinical trial in 3 intensive care units in Spain (September 2012-October 2014) including critically ill patients ready for planned extubation with at least 1 of the following high-risk factors for reintubation: older than 65 years; Acute Physiology and Chronic Health Evaluation II score higher than 12 points on extubation day; body mass index higher than 30; inadequate secretions management; difficult or prolonged weaning; more than 1 comorbidity; heart failure as primary indication for mechanical ventilation; moderate to severe chronic obstructive pulmonary disease; airway patency problems; or prolonged mechanical ventilation. Patients were randomized to undergo either high-flow conditioned oxygen therapy or NIV for 24 hours after extubation. Primary outcomes were reintubation and postextubation respiratory failure within 72 hours. Noninferiority margin was 10 percentage points. Secondary outcomes included respiratory infection, sepsis, and multiple organ failure, length of stay and mortality; adverse events; and time to reintubation. Of 604 patients (mean age, 65 [SD, 16] years; 388 [64%] men), 314 received NIV and 290 high-flow oxygen. Sixty-six patients (22.8%) in the high-flow group vs 60 (19.1%) in the NIV group were reintubation (absolute difference, -3.7%; 95% CI, -9.1% to ∞); 78 patients (26.9%) in the high-flow group vs 125 (39.8%) in the NIV group experienced postextubation respiratory failure (risk difference, 12.9%; 95% CI, 6.6% to ∞) [corrected]. Median time to reintubation did not significantly differ: 26.5 hours (IQR, 14-39 hours) in the high-flow group vs 21.5 hours (IQR, 10-47 hours) in the NIV group (absolute difference, -5 hours; 95% CI, -34 to 24 hours). Median postrandomization ICU length of stay was lower in the high-flow group, 3 days (IQR, 2-7) vs 4 days (IQR, 2-9; P=.048). Other secondary outcomes were similar in the 2 groups. Adverse effects requiring withdrawal of the therapy were observed in none of patients in the high-flow group vs 42.9% patients in the NIV group (P < .001). Among high-risk adults who have undergone extubation, high-flow conditioned oxygen therapy was not inferior to NIV for preventing reintubation and postextubation respiratory failure. High-flow conditioned oxygen therapy may offer advantages for these patients. clinicaltrials.gov Identifier: NCT01191489.

Hearing loss among high-risk newborns admitted to a tertiary Neonatal Intensive Care Unit.

PubMed

Khairy, May Ahmed; Abuelhamed, Walaa Alsharany; Ahmed, Radwa Sayed; El Fouly, Hedayet El Sayed; Elhawary, Ismail Mohamed

2018-07-01

The aim of this work is to identify the most significant risk factors for hearing impairment in high risk neonates hospitalized at our Neonatal Intensive Care Unit (NICU) and to assess the sensitivity of hearing screening tests. This study involved 260 neonates admitted to a tertiary NICU; they were classified into two groups; 150 preterm and 110 full terms with risk factors for hearing loss. The hearing screening tests performed were transient evoked otoacoustic emissions (TEOAEs) and the automated auditory brainstem response (AABR). Forty-eight preterm neonates (32%) and 30 full term neonates (27.3%) had pathological AABR. In preterm group, mechanical ventilation more than five days, sepsis, usage of aminoglycosides, loop diuretics, vancomycin alone or in combination with aminoglycosides and prolonged duration of admission were considered risk factors of hearing affection whereas in full term group mechanical ventilation more than five days was the risk factor of hearing affection (p<.05). The prevalence of hearing loss is highest among high risk neonates and TEOAE and AABR were found to be reliable screening tools. Use of ototoxic drugs and mechanical ventilation for more than five days were significant risk factors for hearing loss in our study population.

Enterobius vermicularis and risk factors in healthy Norwegian children.

PubMed

Bøås, Håkon; Tapia, German; Sødahl, John A; Rasmussen, Trond; Rønningen, Kjersti S

2012-09-01

The prevalence of Enterobius vermicularis in neighboring countries of Norway show large variation. The goal of this study was to investigate the prevalence among Norwegian children and possible risk factors. The children were participants in "Environmental Triggers of Type 1 Diabetes: the MIDIA study." The study involved 2 groups with different genetic risks of type 1 diabetes: A high-risk group carries the Human Leukocyte Antigen genotype conferring the highest risk for type 1 diabetes and a nonhigh-risk group consisting of children without this genotype. Scotch tape samples were collected on 3 consecutive days and examined by light microscopy. A total of 18% (72/395) of children were positive for E. vermicularis. The highest prevalence (34%) was in children 6-11 years of age. Only 2 children were prior known positives. Increased number of siblings was linked to more infections, and there were fewer infections in the children with the high-risk genotype. E. vermicularis is a common parasite in Norwegian children. The likelihood of E. vermicularis infection depends on family size and prevalence increases with age. The reduced number of infections in the children carrying the high-risk genotype for type 1 diabetes is intriguing and should be investigated further.

Factors differentiating callous-unemotional children with and without conduct problems.

PubMed

Wall, Tina D; Frick, Paul J; Fanti, Kostas A; Kimonis, Eva R; Lordos, Alexandros

2016-08-01

Callous-unemotional (CU) traits are a risk factor for a severe, aggressive, and persistent pattern of conduct problems (CP). This study investigated characteristics that might differentiate children with elevated CU traits with and without CP in an effort to identify factors that may reduce the risk for CP in children with limited prosocial emotions. Utilizing a sample of 1,366 children from Cyprus, five groups were identified for further study based on latent profile analysis: low-risk (67.2%), high-CP/low-CU (7.9%), high-CU (9.4%), moderate-CP/CU (8.4%), and high-CP/CU (7.2%). The identified groups were compared on behavioral and social measures. There were significant main effects of group for: impulsivity and executive functioning; parenting; and connectedness to school. The high-CU group had significantly lower hyperactivity-impulsivity and executive functioning deficits, significantly higher self-regulation, and their mothers reported more maternal involvement and positive parenting than those in the high-CP/CU group. Also, the high-CU group showed more school connectedness than those in the high-CP/CU group. These findings highlight several factors in the child and in his or her social environment that are associated with CU traits in the absence of serious CP and that may suggest targets for intervention for youth who may lack prosocial emotions. © 2016 Association for Child and Adolescent Mental Health.

Genetic risk for neurodegenerative disorders, and its overlap with cognitive ability and physical function.

PubMed

Hagenaars, Saskia P; Radaković, Ratko; Crockford, Christopher; Fawns-Ritchie, Chloe; Harris, Sarah E; Gale, Catharine R; Deary, Ian J

2018-01-01

Neurodegenerative disorders are associated with impaired cognitive function and worse physical health outcomes. This study aims to test whether polygenic risk for Alzheimer's disease, Amyotrophic Lateral Sclerosis (ALS), or frontotemporal dementia (FTD) is associated with cognitive function and physical health in the UK Biobank, a cohort of healthy individuals. Group-based analyses were then performed to compare the top and bottom 10% for the three neurodegenerative polygenic risk scores; these groups were compared on the cognitive and physical health variables. Higher polygenic risk for AD, ALS, and FTD was associated with lower cognitive performance. Higher polygenic risk for FTD was also associated with increased forced expiratory volume in 1s and peak expiratory flow. A significant group difference was observed on the symbol digit substitution task between individuals with high polygenic risk for FTD and high polygenic risk for ALS. The results suggest some overlap between polygenic risk for neurodegenerative disorders, cognitive function and physical health.

A novel multiple marker bioassay utilizing HE4 and CA125 for the prediction of ovarian cancer in patients with a pelvic mass

PubMed Central

Moore, Richard G.; McMeekin, D. Scott; Brown, Amy K.; DiSilvestro, Paul; Miller, M. Craig; Allard, W. Jeffrey; Gajewski, Walter; Kurman, Robert; Bast, Robert C.; Skates, Steven J.

2012-01-01

Introduction Patients diagnosed with epithelial ovarian cancer (EOC) have improved outcomes when cared for at centers experienced in the management of EOC. The objective of this trial was to validate a predictive model to assess the risk for EOC in women with a pelvic mass. Methods Women diagnosed with a pelvic mass and scheduled to have surgery were enrolled on a multicenter prospective study. Preoperative serum levels of HE4 and CA125 were measured. Separate logistic regression algorithms for premenopausal and postmenopausal women were utilized to categorize patients into low and high risk groups for EOC. Results Twelve sites enrolled 531 evaluable patients with 352 benign tumors, 129 EOC, 22 LMP tumors, 6 non EOC and 22 non ovarian cancers. The postmenopausal group contained 150 benign cases of which 112 were classified as low risk giving a specificity of 75.0% (95% CI 66.9-81.4), and 111 EOC and 6 LMP tumors of which 108 were classified as high risk giving a sensitivity of 92.3% (95% CI=85.9-96.4). The premenopausal group had 202 benign cases of which 151 were classified as low risk providing a specificity of 74.8% (95% CI=68.2--80.6), and 18 EOC and 16 LMP tumors of which 26 were classified as high risk, providing a sensitivity of 76.5% (95% CI=58.8--89.3). Conclusion An algorithm utilizing HE4 and CA125 successfully classified patients into high and low risk groups with 93.8% of EOC correctly classified as high risk. This model can be used to effectively triage patients to centers of excellence. PMID:18851871

A Focus Group Exploration of Automated Case-Finders to Identify High-Risk Heart Failure Patients Within an Urban Safety Net Hospital.

PubMed

Patterson, Mark E; Miranda, Derick; Schuman, Greg; Eaton, Christopher; Smith, Andrew; Silver, Brad

2016-01-01

Leveraging "big data" as a means of informing cost-effective care holds potential in triaging high-risk heart failure (HF) patients for interventions within hospitals seeking to reduce 30-day readmissions. Explore provider's beliefs and perceptions about using an electronic health record (EHR)-based tool that uses unstructured clinical notes to risk-stratify high-risk heart failure patients. Six providers from an inpatient HF clinic within an urban safety net hospital were recruited to participate in a semistructured focus group. A facilitator led a discussion on the feasibility and value of using an EHR tool driven by unstructured clinical notes to help identify high-risk patients. Data collected from transcripts were analyzed using a thematic analysis that facilitated drawing conclusions clustered around categories and themes. From six categories emerged two themes: (1) challenges of finding valid and accurate results, and (2) strategies used to overcome these challenges. Although employing a tool that uses electronic medical record (EMR) unstructured text as the benchmark by which to identify high-risk patients is efficient, choosing appropriate benchmark groups could be challenging given the multiple causes of readmission. Strategies to mitigate these challenges include establishing clear selection criteria to guide benchmark group composition, and quality outcome goals for the hospital. Prior to implementing into practice an innovative EMR-based case-finder driven by unstructured clinical notes, providers are advised to do the following: (1) define patient quality outcome goals, (2) establish criteria by which to guide benchmark selection, and (3) verify the tool's validity and reliability. Achieving consensus on these issues would be necessary for this innovative EHR-based tool to effectively improve clinical decision-making and in turn, decrease readmissions for high-risk patients.

Family history and oral health: findings from the Dunedin Study

PubMed Central

Shearer, Dara M; Thomson, W. Murray; Caspi, Avshalom; Moffitt, Terrie E; Broadbent, Jonathan M; Poulton, Richie

2011-01-01

Context The effects of the oral health status of one generation on that of the next within families are unclear. Objective To determine whether parental oral health history is a risk factor for oral disease. Methods Oral examination and interview data were collected during the age-32 assessments in the Dunedin Study. Parental data were also collected on this occasion. The sample was divided into two familial-risk groups for caries/tooth loss (high risk and low risk) based on parents’ self-reported history of tooth loss at the age-32 assessment interview. Main outcome measures Probands’ dental caries and tooth loss status at age 32, together with lifelong dental caries trajectory (age 5–32). Results Caries/tooth-loss risk analysis was conducted for 640 proband-parents groups. Referent groups were the low-familial-risk groups. After controlling for confounding factors (sex, episodic use of dental services, socio-economic status and plaque trajectory), the prevalence ratio (PR) for having lost 1+ teeth by age 32 for the high-familial-risk group was 1.41 (95% confidence interval [CI] 1.05, 1.88) and the rate ratio for DMFS at age 32 was 1.41 (95% CI 1.24, 1.60). In the high-familial-risk group, the PR of following a high caries trajectory was 2.05 (95% CI 1.37, 3.06). Associations were strongest when information was available about both parents’ oral health. Nonetheless, when information was available for one parent only, associations were significant for some proband outcomes. Conclusions People with poor oral health tend to have parents with poor oral health. Family/parental history of oral health is a valid representation of the intricacies of the shared genetic and environmental factors that contribute to an individual’s oral health status. Associations were strongest when data from both parents can be obtained. PMID:22022823

The evaluation of acute physiology and chronic health evaluation II score, poisoning severity score, sequential organ failure assessment score combine with lactate to assess the prognosis of the patients with acute organophosphate pesticide poisoning.

PubMed

Yuan, Shaoxin; Gao, Yusong; Ji, Wenqing; Song, Junshuai; Mei, Xue

2018-05-01

The aim of this study was to assess the ability of acute physiology and chronic health evaluation II (APACHE II) score, poisoning severity score (PSS) as well as sequential organ failure assessment (SOFA) score combining with lactate (Lac) to predict mortality in the Emergency Department (ED) patients who were poisoned with organophosphate.A retrospective review of 59 stands-compliant patients was carried out. Receiver operating characteristic (ROC) curves were constructed based on the APACHE II score, PSS, SOFA score with or without Lac, respectively, and the areas under the ROC curve (AUCs) were determined to assess predictive value. According to SOFA-Lac (a combination of SOFA and Lac) classification standard, acute organophosphate pesticide poisoning (AOPP) patients were divided into low-risk and high-risk groups. Then mortality rates were compared between risk levels.Between survivors and non-survivors, there were significant differences in the APACHE II score, PSS, SOFA score, and Lac (all P < .05). The AUCs of the APACHE II score, PSS, and SOFA score were 0.876, 0.811, and 0.837, respectively. However, after combining with Lac, the AUCs were 0.922, 0.878, and 0.956, respectively. According to SOFA-Lac, the mortality of high-risk group was significantly higher than low-risk group (P < .05) and the patients of the non-survival group were all at high risk.These data suggest the APACHE II score, PSS, SOFA score can all predict the prognosis of AOPP patients. For its simplicity and objectivity, the SOFA score is a superior predictor. Lac significantly improved the predictive abilities of the 3 scoring systems, especially for the SOFA score. The SOFA-Lac system effectively distinguished the high-risk group from the low-risk group. Therefore, the SOFA-Lac system is significantly better at predicting mortality in AOPP patients.

Should health insurers target prevention of cardiovascular disease?: a cost-effectiveness analysis of an individualised programme in Germany based on routine data

PubMed Central

2014-01-01

Background Cardiovascular diseases are the main cause of death worldwide, making their prevention a major health care challenge. In 2006, a German statutory health insurance company presented a novel individualised prevention programme (KardioPro), which focused on coronary heart disease (CHD) screening, risk factor assessment, early detection and secondary prevention. This study evaluates KardioPro in CHD risk subgroups, and analyses the cost-effectiveness of different individualised prevention strategies. Methods The CHD risk subgroups were assembled based on routine data from the statutory health insurance company, making use of a quasi-beta regression model for risk prediction. The control group was selected via propensity score matching based on logistic regression and an approximate nearest neighbour approach. The main outcome was cost-effectiveness. Effectiveness was measured as event-free time, and events were defined as myocardial infarction, stroke and death. Incremental cost-effectiveness ratios comparing participants with non-participants were calculated for each subgroup. To assess the uncertainty of results, a bootstrapping approach was applied. Results The cost-effectiveness of KardioPro in the group at high risk of CHD was €20,901 per event-free year; in the medium-risk group, €52,323 per event-free year; in the low-risk group, €186,074 per event-free year; and in the group with known CHD, €26,456 per event-free year. KardioPro was associated with a significant health gain but also a significant cost increase. However, statistical significance could not be shown for all subgroups. Conclusion The cost-effectiveness of KardioPro differs substantially according to the group being targeted. Depending on the willingness-to-pay, it may be reasonable to only offer KardioPro to patients at high risk of further cardiovascular events. This high-risk group could be identified from routine statutory health insurance data. However, the long-term consequences of KardioPro still need to be evaluated. PMID:24938674

[Anticoagulant therapy in patients with permanent atrial fibrillation - evidence based medicine and clinical practice].

PubMed

Bozić, Ivona; Capkun, Vesna; Bozić, Dorotea; Karabuva, Svjetlana; Caljkusić, Kresimir; Trgo, Gorana; Carević, Vedran; Fabijanić, Damir

2013-01-01

Objective of study was to assess the concordance of the tromboprophylactic treatment in patients with permanent atrial fibrillation (pAF) with guidelines of the European Society of Cardiology. Prospective cross-sectional study consecutivelly included 674 patients (400 S59%C male) discharged from cardiology department with the diagnosis pAF. The thromboembolic risk (TE) has been established according to CHA2DS2-VASc score, whereas the bleeding risk has been assessed according to HAS-BLED score. 578 (86%) belonged to the group of high, 57 (8%) to the group of moderate, and 39 (6%) patients to the group of low TE risk. 601 (89%) patients received thromboprophylaxis: 310 (46%) warfarin, 258 (38%) acetylsalicylic acid, and 33 (5%) patients clopidogrel. Warfarin has been prescribed to 47% of patients with high, 49% of patients with moderate and to 26% of patients with low TE risk (P=0.03). Acetylsalicylic acid (ASA) has equally been prescribed to patients of all TE risk groups: low, moderate and high (39% vs. 39% vs.38%/o; P=0.998). ASA (P<0.001) and warfarin (P=0.007) have been used more frequently in the group of patients with high bleeding risk, in which the same incidence of warfarin and ASA administration has been registered (53% vs. 47%; P=0.416). Age > or =75 has been an independent predictor of non-administration (OR 1.7; 95% CI 1.2-2.4; P=0.003), whereas the history of stroke was for warfarin administration (OR 0.47; 95% CI 0.29-0.76; P-0.002). In prescribing thromboprophylaxis to patients with pAF, cardiologists do not observe the recommended clinical guidelines. Despite nonexistence of contraindications, a significant number of patients with high TE risk has not been administered warfarin. At the same time, warfarin has been administered to the patients with low TE risk, exposing them unnecessarily to the undesired effect of anticoagulant treatment.

Introduction of high risk pregnancy care in rural Cameroon: health service research approach.

PubMed

Leke, R J; Nasah, B T; Mtango, F D

1988-05-01

A 3-year study (1982-1985) in Cameroon showed that high-risk pregnancy identification and care could successfully be introduced in rural communities through inexpensive training and supervision of local nurses, particularly when motivation for use of antenatal clinics (ANCs) was provided by the local Community Women's Organization (CWO). 11 communities, all rural except Tsinga, were randomly allocated to Groups I (control) or II. A retrospective baseline survey of ANCs showed that high-risk pregnancy detection had been nonexistent. For both groups, nurses were given 2-week training courses on high-risk identification and family planning. The registers for recording prenatal consultations and deliveries were modified to include recording of risk factors. Special forms were created for reporting on each high-risk case thus identified. These forms proved more difficult for the nurses to complete than the registers. For Group II communities, CWO leaders were recruited to urge women to attend ANCs. 2548 cases of high-risk pregnancy (21.9% of pregnancies) were identified on the special forms, although the number of cases identified in clinic registers was consistently higher. Posttest attendance at ANCs was higher than pretest and significantly higher in areas where CWO motivation had been used. Major risk factors in the identified cases were grand multiparity, teenage pregnancy and previous complicated obstetrics history, although semiurban Tsinga had less grand multiparity and teenage pregnancy and more obesity, diabetes, hypertension and preclampsia. Only 23.4% of the identified cases delivered in the clinics, showing the need for more comprehensive maternal service programs. Since only 5% of the high-risk pregnancy population accepted modern contraceptives after delivery, research is needed on the determinants.

Contribution of extended family history in assessment of risk for breast and colon cancer.

PubMed

Solomon, Benjamin L; Whitman, Todd; Wood, Marie E

2016-09-01

Family history is important for identifying candidates for high risk cancer screening and referral for genetic counseling. We sought to determine the percentage of individuals who would be eligible for high risk cancer screening or genetic referral and testing if family history includes an extended (vs limited) family history. Family histories were obtained from 626 women at UVMMC associated mammography centers from 2001 to 2002. ACS guidelines were used to determine eligibility for high risk breast or colon cancer screening. Eligibility for referral for genetic counseling for hereditary breast and colon cancer was determined using the Referral Screening Tool and Amsterdam II screening criteria, respectively. All family histories were assessed for eligibility by a limited history (first degree relatives only) and extended history (first and second degree relatives). Four hundred ninety-nine histories were eligible for review. 18/282 (3.6 %) and 62/123 (12 %) individuals met criteria for high risk breast and colon cancer screening, respectively. 13/18 (72 %) in the high risk breast cancer screening group and 12/62 (19 %) in the high risk colon cancer screening group met criteria based upon an extended family history. 9/282 (1.8 %) and 31/123 (6.2 %) individuals met criteria for genetic counseling referral and testing for breast and colon cancer, respectively. 2/9 (22 %) of individuals in the genetic breast cancer screening group and 21/31 (68 %) individuals in the genetic colon cancer screening group met criteria based upon extended family history. This is one of the first studies to suggest that first degree family history alone is not adequate for identification of candidates for high risk screening and referral for genetic counseling for hereditary breast and colon cancer syndromes. A larger population is needed to further validate this data.

Impact of the Prevention Plan on Employee Health Risk Reduction

PubMed Central

Edington, Dee W.; Bég, Sami

2010-01-01

Abstract This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P ≤ 0.01 and 1 at P ≤ 0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P < 0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P < 0.001). (Population Health Management 2010;13:275–284) PMID:20879909

Impact of the prevention plan on employee health risk reduction.

PubMed

Loeppke, Ronald; Edington, Dee W; Bég, Sami

2010-10-01

This study evaluated the impact of The Prevention Plan™ on employee health risks after 1 year of integrated primary prevention (wellness and health promotion) and secondary prevention (biometric and lab screening as well as early detection) interventions. The Prevention Plan is an innovative prevention benefit that provides members with the high-tech/high-touch support and encouragement they need to adopt healthy behaviors. Support services include 24/7 nurse hotlines, one-on-one health coaching, contests, group events, and employer incentives. Specifically, we analyzed changes in 15 health risk measures among a cohort of 2606 employees from multiple employer groups who completed a baseline health risk appraisal, blood tests, and biometric screening in 2008 and who were reassessed in 2009. We then compared the data to the Edington Natural Flow of risks. The cohort showed significant reduction in 10 of the health risks measured (9 at P≤ 0.01 and 1 at P≤0.05). The most noticeable changes in health risks were a reduction in the proportion of employees with high-risk blood pressure (42.78%), high-risk fasting blood sugar (31.13%), and high-risk stress (24.94%). There was an overall health risk transition among the cohort with net movement from higher risk levels to lower risk levels (P<0.01). There was a net increase of 9.40% of people in the low-risk category, a decrease of 3.61% in the moderate-risk category, and a 5.79% decrease in the high-risk category. Compared to Edington's Natural Flow model, 48.70% of individuals in the high-risk category moved from high risk to moderate risk (Natural Flow 31%), 46.35% moved from moderate risk to low risk (Natural Flow 35%), 15.65% moved from high risk to low risk (Natural Flow 6%), and 87.33% remained in the low-risk category (Natural Flow 70%) (P<0.001).

Data mining model using simple and readily available factors could identify patients at high risk for hepatocellular carcinoma in chronic hepatitis C.

PubMed

Kurosaki, Masayuki; Hiramatsu, Naoki; Sakamoto, Minoru; Suzuki, Yoshiyuki; Iwasaki, Manabu; Tamori, Akihiro; Matsuura, Kentaro; Kakinuma, Sei; Sugauchi, Fuminaka; Sakamoto, Naoya; Nakagawa, Mina; Izumi, Namiki

2012-03-01

Assessment of the risk of hepatocellular carcinoma (HCC) development is essential for formulating personalized surveillance or antiviral treatment plan for chronic hepatitis C. We aimed to build a simple model for the identification of patients at high risk of developing HCC. Chronic hepatitis C patients followed for at least 5 years (n=1003) were analyzed by data mining to build a predictive model for HCC development. The model was externally validated using a cohort of 1072 patients (472 with sustained virological response (SVR) and 600 with nonSVR to PEG-interferon plus ribavirin therapy). On the basis of factors such as age, platelet, albumin, and aspartate aminotransferase, the HCC risk prediction model identified subgroups with high-, intermediate-, and low-risk of HCC with a 5-year HCC development rate of 20.9%, 6.3-7.3%, and 0-1.5%, respectively. The reproducibility of the model was confirmed through external validation (r(2)=0.981). The 10-year HCC development rate was also significantly higher in the high-and intermediate-risk group than in the low-risk group (24.5% vs. 4.8%; p<0.0001). In the high-and intermediate-risk group, the incidence of HCC development was significantly reduced in patients with SVR compared to those with nonSVR (5-year rate, 9.5% vs. 4.5%; p=0.040). The HCC risk prediction model uses simple and readily available factors and identifies patients at a high risk of HCC development. The model allows physicians to identify patients requiring HCC surveillance and those who benefit from IFN therapy to prevent HCC. Copyright © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

[Relationships between prevalence of youth risk behaviors and sleep duration among Japanese high school students].

PubMed

Kataoka, Chie; Nozu, Yuji; Kudo, Masako; Sato, Yuki; Kubo, Motoyoshi; Nakayama, Naoko; Iwata, Hideki; Watanabe, Motoi

2014-01-01

This study aimed to clarify relationships between prevalence of risk behaviors and sleep duration among Japanese high school students. Data from a national survey, the Japan Youth Risk Behavior Survey 2011 (the subjects were 9,778 students: 5,027 males, 4,751 females, in the first grade to the third grade of 102 schools randomly selected among high schools throughout Japan) was used for this analysis. We focused on nine items of risk behavior in JYRBS: "lack of vigorous physical activity," "skipping breakfast," "current cigarette use," "current alcohol use," "lifetime thinner use," "ever had sexual intercourse," "rarely or never wore seatbelts," "in a physical fight," and "seriously considered attempting suicide." Students with less than six hours of sleep duration accounted for approximately 40% of males and females. The odds ratios of prevalence of each of the nine risk behaviors were calculated on the basis of the group "six hours or more and less than eight hours" of sleep, whose prevalence of risk behaviors was the lowest. In the group with "four hours or more and less than six hours," the odds ratios of "lack of vigorous physical activity" and "skipping breakfast" for both males and females were significantly high. Furthermore, in the group with shorter sleep duration of "less than four hours," the odds ratios of all nine risk behaviors for males (odds ratios: 1.47-3.28) and eight risk behaviors (except for "rarely or never wore seatbelts") for females (1.54-4.68) were significantly high. On the other hand, in the group with long sleep duration of "10 hours or more," the odds ratios of "current cigarette use" and "lifetime thinner use" for both males and females were significantly high. It was shown that short sleep duration of less than six hours and long sleep duration of 10 hours or more related to the prevalence of youth risk behaviors among Japanese high school students. It was suggested that sleep duration should be considered as an important category of youth risk behaviors.

Traditional and Nontraditional Cardiovascular Risk Factors in Comorbid Insomnia and Sleep Apnea

PubMed Central

Luyster, Faith S.; Kip, Kevin E.; Buysse, Daniel J.; Aiyer, Aryan N.; Reis, Steven E.; Strollo, Patrick J.

2014-01-01

Objectives: Insomnia and sleep apnea frequently co-occur and are independently associated with an increased risk of cardiovascular disease, but little is known about cardiovascular disease risk among individuals with comorbid insomnia and sleep apnea. The current study examined traditional risk factors and a physiologic biomarker of cardiovascular risk in comorbid insomnia and sleep apnea. Design: Community-based participatory research study. Participants: The sample comprised 795 participants without preexisting cardiovascular disease from the Heart Strategies Concentrating On Risk Evaluation (Heart SCORE) study. Measurements and Results: Participants were assessed for symptoms of insomnia and sleep apnea risk, as well as for presence of obesity, smoking, a sedentary lifestyle, hypertension, dyslipidemia, and diabetes. Baseline resting brachial artery diameter was measured by B-mode ultrasonography. A total of 138 participants (17.4%) met criteria for insomnia syndrome alone, 179 (22.5%) were at high risk for sleep apnea alone, 95 (11.9%) reported both insomnia syndrome and high sleep apnea risk, and 383 (48.2%) reported having neither insomnia nor sleep apnea symptoms Both high sleep apnea risk alone and comorbid insomnia and high sleep apnea risk groups had greater frequencies of obesity, sedentary lifestyle, hypertension, and three or more traditional cardiovascular risk factors and significantly larger brachial artery diameters than the insomnia alone group and those without insomnia or sleep apnea symptoms. No differences in traditional cardiovascular risk factors or brachial artery diameter were found between the high sleep apnea risk and comorbid groups. Conclusions: These findings suggest that sleep apnea is a major contributor to cardiovascular risk and co-occurring insomnia does not appear to add to this risk. Citation: Luyster FS; Kip KE; Buysse DJ; Aiyer AN; Reis SE; Strollo PJ. Traditional and nontraditional cardiovascular risk factors in comorbid insomnia and sleep apnea. SLEEP 2014;37(3):593-600. PMID:24587583

Comparing 2 Adhesive Methods on Skin Integrity in the High-Risk Neonate.

PubMed

Boswell, Nicole; Waker, Cheryl L

2016-12-01

Nurses have a primary role in promoting neonatal skin integrity and skin care management of the critically ill neonate. Adhesive products are essential to secure needed medical devices but can be a significant factor contributing to skin breakdown. Current literature does not offer a definitive answer regarding which products most safely and effectively work to secure needed devices in the high-risk neonatal population. To determine which adhesive method is best practice to safely and effectively secure lines/tubes in the high-risk neonate population. The only main effect that was significant was age group with mean skin scores. Subjects in the younger group (24-28 weeks) had higher skin scores than in the older group (28-34 weeks), validating that younger gestations are at higher risk of breakdown with the use of adhesives. The findings did not clearly identify which product was superior to secure tubes and lines, or was the least injurious to skin of the high-risk neonate. Neither a transparent dressing only or transparent dressing over hydrocolloid method clearly demonstrated an advantage in the high-risk, preterm neonate. Anecdotal comments suggested staff preferred the transparent dressing over hydrocolloid method as providing better adhesive while protecting skin integrity. The findings validated that younger gestations are at higher risk of breakdown with the use of adhesives and therefore require close vigilance to maintain skin integrity.

The relationship between health risks and health and productivity costs among employees at Pepsi Bottling Group.

PubMed

Henke, Rachel M; Carls, Ginger S; Short, Meghan E; Pei, Xiaofei; Wang, Shaohung; Moley, Susan; Sullivan, Mark; Goetzel, Ron Z

2010-05-01

To evaluate relationships between modifiable health risks and costs and measure potential cost savings from risk reduction programs. Health risk information from active Pepsi Bottling Group employees who completed health risk assessments between 2004 and 2006 (N = 11,217) were linked to medical care, workers' compensation, and short-term disability cost data. Ten health risks were examined. Multivariate analyses were performed to estimate costs associated with having high risk, holding demographics, and other risks constant. Potential savings from risk reduction were estimated. High risk for weight, blood pressure, glucose, and cholesterol had the greatest impact on total costs. A one-percentage point annual reduction in the health risks assessed would yield annual per capita savings of $83.02 to $103.39. Targeted programs that address modifiable health risks are expected to produce substantial cost reductions in multiple benefit categories.

Alternative evaluation metrics for risk adjustment methods.

PubMed

Park, Sungchul; Basu, Anirban

2018-06-01

Risk adjustment is instituted to counter risk selection by accurately equating payments with expected expenditures. Traditional risk-adjustment methods are designed to estimate accurate payments at the group level. However, this generates residual risks at the individual level, especially for high-expenditure individuals, thereby inducing health plans to avoid those with high residual risks. To identify an optimal risk-adjustment method, we perform a comprehensive comparison of prediction accuracies at the group level, at the tail distributions, and at the individual level across 19 estimators: 9 parametric regression, 7 machine learning, and 3 distributional estimators. Using the 2013-2014 MarketScan database, we find that no one estimator performs best in all prediction accuracies. Generally, machine learning and distribution-based estimators achieve higher group-level prediction accuracy than parametric regression estimators. However, parametric regression estimators show higher tail distribution prediction accuracy and individual-level prediction accuracy, especially at the tails of the distribution. This suggests that there is a trade-off in selecting an appropriate risk-adjustment method between estimating accurate payments at the group level and lower residual risks at the individual level. Our results indicate that an optimal method cannot be determined solely on the basis of statistical metrics but rather needs to account for simulating plans' risk selective behaviors. Copyright © 2018 John Wiley & Sons, Ltd.

Public Perception of Extreme Cold Weather-Related Health Risk in a Cold Area of Northeast China.

PubMed

Ban, Jie; Lan, Li; Yang, Chao; Wang, Jian; Chen, Chen; Huang, Ganlin; Li, Tiantian

2017-08-01

A need exists for public health strategies regarding extreme weather disasters, which in recent years have become more frequent. This study aimed to understand the public's perception of extreme cold and its related health risks, which may provide detailed information for public health preparedness during an extreme cold weather event. To evaluate public perceptions of cold-related health risk and to identify vulnerable groups, we collected responses from 891 participants in a face-to-face survey in Harbin, China. Public perception was measured by calculating the score for each perception question. Locals perceived that extreme cold weather and related health risks were serious, but thought they could not avoid these risks. The significant difference in perceived acceptance level between age groups suggested that the elderly are a "high health risk, low risk perception" group, meaning that they are relatively more vulnerable owing to their high susceptibility and low awareness of the health risks associated with extreme cold weather. The elderly should be a priority in risk communication and health protective interventions. This study demonstrated that introducing risk perception into the public health field can identify vulnerable groups with greater needs, which may improve the decision-making of public health intervention strategies. (Disaster Med Public Health Preparedness. 2017;11:417-421).

Approach to inguinal hernia in high-risk geriatric patients: Should it be elective or emergent?

PubMed

Işıl, Rıza Gürhan; Yazıcı, Pınar; Demir, Uygar; Kaya, Cemal; Bostancı, Özgür; İdiz, Ufuk Oğuz; Işıl, Canan Tülay; Demircioğlu, Mahmut Kaan; Mihmanlı, Mehmet

2017-03-01

Elderly patients are more prone to have inguinal hernia due to weakened abdominal musculature. However, surgical repair of inguinal hernia (SRIH) may not be performed or may be delayed due to greater risk in presence of comorbidities. Present study is investigation of outcome of elective and emergency SRIH in geriatric patients. Records of total of 384 high-risk (American Society of Anesthesiology classification III-IV) patients aged >65 years who underwent SRIH between January 2010 and December 2014 were reviewed. Patients were divided into 2 groups according to procedure type: elective (Group EL) or emergency (Group EM). Demographic features and surgical and postoperative period data of 2 groups were recorded and compared. Demographic data were similar, but number of ASA IV patients was greater in Group EM. Frequency of intestinal resection was significantly greater in emergency surgery group (1% vs 21%; p<0.01). Length of hospital stay (1.3 days vs 7.9 days; p<0.01) and intensive care unit stay (0.17 days vs 4.04 days; p<0.01) were also greater in Group EM. Morbidity (1% vs 24%; p<0.01) and mortality (0.3% vs 11%; p<0.01) were also significantly higher in Group EM compared to elective SRIH group. Emergency inguinal hernia surgery is associated with significantly higher morbidity and mortality compared with elective SRIH in high-risk geriatric patients. Elective hernia repair in these patients should be considered to reduce risk of need for intestinal resection as well as length of hospital stay.

Joint trajectories of depression and perfectionism across adolescence and childhood risk factors.

PubMed

Vaillancourt, Tracy; Haltigan, John D

2018-05-01

The codevelopment of symptoms of depression and socially prescribed perfectionism across adolescence (age 12-17) and non-age-overlapping childhood predictors (age 10-11) of joint trajectory group membership were examined in a sample of 700 Canadian youth. Results indicated that most adolescents (75.8%) followed a trajectory of low depression symptoms (low stable), whereas 15.7% followed an increasing trajectory (increasing), and 8.5% followed a trajectory that began high and decreased over time (high decreasing). More girls than boys were found in the increasing and high decreasing depression trajectories. Adolescents followed three distinct trajectories of socially prescribed perfectionism: 41.6% were in a low stable group, 40.5% in a moderate increasing group, and 17.9% in a high increasing group. Eight percent followed a high-risk dual trajectory of increasing depression and high increasing socially prescribed perfectionism. This joint trajectory was predicted by being bullied, anxious, and relationally aggressive (compared to the low-risk trajectory of low stable depression and perfectionism) at ages 10 and 11. These same predictors, along with poorer family functioning and lower family income, differentiated the joint high decreasing depression/high increasing perfectionism group from the low/low joint group, which comprised of 3.8% of the sample. The developmental progression was best characterized as depression leading to socially prescribed perfectionism. Implications for clinical practice are discussed.

[Comparing the Application of Hema-Obs RSS to 250 Pregnancies from Obstetrics/Hematology Consultation in Centro Hospitalar São João, Portugal with the Application of Galit Sarig RSS to 90 Pregnancies from Rambam Health Care Campus, Israel].

PubMed

Salselas, Ana; Pestana, Inês; Bischoff, Francisco; Guimarães, Mariana; Andrade, Joaquim Aguiar

2015-01-01

Pregnant women with thromboembolic diseases, previous thrombotic episodes or thrombophilia family history were supervised in a multidisciplinary Obstetrics/ Hematology consultation in Centro Hospitalar São João EPE, Porto, Portugal. For the evaluation and medication of these women, a risk stratification scale was used. The aim of this study was to validate a Risk Stratification Scale and thromboprophylaxis protocol by means of comparing it with a similar scale, developed and published by Sarig. We have compared: The distribution, by risk groups, obtained through the application of the two scales on pregnant women followed at Centro Hospitalar São João, Porto, Portugal, consultation; the sensibility and specificity for each one of the scales (DeLong scale, applied to Receiver Operating Characteristic) curves; the outcomes in pregnancies followed in Hospital São João, Porto, PortugalResults: According to our Hema-Obs risk stratification scale, 29% were allocated to low-risk, 47% to high-risk and 24% to very-high-risk groups. According to Galit Sarig risk stratification scale, 24% were considered low-risk, 53% moderate, 16% high-risk and 7% as very high-risk group. In our study we observed 9% of spontaneous abortions, in comparison with 18% in the Galit Sarig cohort. From the application of Receiver Operating Characteristic curve to both risk stratification scales, the results of the calculated areas were 58,8% to our Hema-Obs risk stratification scale and 38,7% to Galit Sarig risk stratification scale, with a Delong test significancie of p = 0.0006. We concluded that Hema-Obs risk stratification scale is an effective support for clinical monitoring of therapeutic strategies.

Relationship between CHA2DS2-VASc score and atrial electromechanical function in patients with paroxysmal atrial fibrillation: A pilot study.

PubMed

Vatan, Mehmet Bülent; Yılmaz, Sabiye; Ağaç, Mustafa Tarık; Çakar, Mehmet Akif; Erkan, Hakan; Aksoy, Murat; Demirtas, Saadet; Varım, Ceyhun; Akdemir, Ramazan; Gündüz, Hüseyin

2015-11-01

CHA2DS2-VASc score is the most widely preferred method for prediction of stroke risk in patients with atrial fibrillation. We hypothesized that CHA2DS2-VASc score may represent atrial remodeling status, and therefore echocardiographic evaluation of left atrial electromechanical remodeling can be used to identify patients with high risk. A total of 65 patients who had documented diagnosis of paroxysmal atrial fibrillation (PAF) were divided into three risk groups according to the CHA2DS2-VASc score: patients with low risk (score=0, group 1), with moderate risk (score=1, group 2), and with high risk score (score ≥2, group 3). We compared groups according to atrial electromechanical intervals and left atrium mechanical functions. Atrial electromechanical intervals including inter-atrial and intra-atrial electromechanical delay were not different between groups. However, parameters reflecting atrial mechanical functions including LA phasic volumes (Vmax, Vmin and Vp) were significantly higher in groups 2 and 3 compared with group 1. Likewise, LA passive emptying volume (LATEV) in the groups 2 and 3 was significantly higher than low-risk group (14.12±8.13ml/m(2), 22.36±8.78ml/m(2), 22.89±7.23ml/m(2), p: 0.031). Univariate analysis demonstrated that Vmax, Vmin and Vp were significantly correlated with CHA2DS2-VASc score (r=0.428, r=0.456, r=0.451 and p<0.001). Also, LATEV (r=0.397, p=0.016) and LA active emptying volume (LAAEV) (r=0.281, p=0.023) were positively correlated with CHA2DS2-VASc score. In the ROC analysis, Vmin≥11ml/m(2) has the highest predictive value for CHA2DS2-VASc score ≥2 (88% sensitivity and 89% specificity; ROC area 0.88, p<0.001, CI [0.76-0.99]). Echocardiographic evaluation of left atrial electromechanical function might represent a useful method to identify patients with high risk. Copyright © 2015 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

Brief Cognitive-Behavioral Depression Prevention Program for High-Risk Adolescents Outperforms Two Alternative Interventions: A Randomized Efficacy Trial

ERIC Educational Resources Information Center

Stice, Eric; Rohde, Paul; Seeley, John R.; Gau, Jeff M.

2008-01-01

In this depression prevention trial, 341 high-risk adolescents (mean age = 15.6 years, SD = 1.2) with elevated depressive symptoms were randomized to a brief group cognitive-behavioral (CB) intervention, group supportive-expressive intervention, bibliotherapy, or assessment-only control condition. CB participants showed significantly greater…

Characterizing violence in health care in British Columbia.

PubMed

Kling, Rakel N; Yassi, Annalee; Smailes, Elizabeth; Lovato, Chris Y; Koehoorn, Mieke

2009-08-01

The high rate of violence in the healthcare sector supports the need for greater surveillance efforts. The purpose of this study was to use a province-wide workplace incident reporting system to calculate rates and identify risk factors for violence in the British Columbia healthcare industry by occupational groups, including nursing. Data were extracted for a 1-year period (2004-2005) from the Workplace Health Indicator Tracking and Evaluation database for all employee reports of violence incidents for four of the six British Columbia health authorities. Risk factors for violence were identified through comparisons of incident rates (number of incidents/100,000 worked hours) by work characteristics, including nursing occupations and work units, and by regression models adjusted for demographic factors. Across health authorities, three groups at particularly high risk for violence were identified: very small healthcare facilities [rate ratios (RR) = 6.58, 95% CI =3.49, 12.41], the care aide occupation (RR = 10.05, 95% CI = 6.72, 15.05), and paediatric departments in acute care hospitals (RR = 2.22, 95% CI = 1.05, 4.67). The three high-risk groups warrant targeted prevention or intervention efforts be implemented. The identification of high-risk groups supports the importance of a province-wide surveillance system for public health planning.

Psychosocial predictors of cannabis use in adolescents at risk.

PubMed

Hüsler, Gebhard; Plancherel, Bernard; Werlen, Egon

2005-09-01

This research has tested a social disintegration model in conjunction with risk and protection factors that have the power to differentiate relative, weighted interactions among variables in different socially disintegrated groups. The model was tested in a cross-sectional sample of 1082 at-risk youth in Switzerland. Structural equation analyses show significant differences between the social disintegration (low, moderate, high) groups and gender, indicating that the model works differently for groups and for gender. For the highly disintegrated adolescents results clearly show that the risk factors (negative mood, peer network, delinquency) are more important than the protective factors (family relations, secure sense of self). Family relations lose all protective value against negative peer influence, but personal variables, such as secure self, gain protective power.

Defining Survivorship Trajectories Across Patients With Solid Tumors: An Evidence-Based Approach.

PubMed

Dood, Robert L; Zhao, Yang; Armbruster, Shannon D; Coleman, Robert L; Tworoger, Shelley; Sood, Anil K; Baggerly, Keith A

2018-06-02

Survivorship involves a multidisciplinary approach to surveillance and management of comorbidities and secondary cancers, overseen by oncologists, surgeons, and primary care physicians. Optimal timing and coordination of care, however, is unclear and often based on arbitrary 5-year cutoffs. To determine high- and low-risk periods for all tumor types that could define when survivorship care might best be overseen by oncologists and when to transition to primary care physicians. In this pan-cancer, longitudinal, observational study, excess mortality hazard, calculated as an annualized mortality risk above a baseline population, was plotted over time. The time this hazard took to stabilize defined a high-risk period. The percent morality elevation above age- and sex-matched controls in the latter low-risk period was reported as a mortality gap. The US population-based Surveillance, Epidemiology, and End Results database defined the cancer population, and the US Census life tables defined controls. Incident cases of patients with cancer were separated into tumor types based on International Classification of Diseases for Oncology definitions. Population-level data on incident cancer cases was compared with the general US population. Overall mortality and cause of death were reported on observed cancer cases. A total of 2 317 185 patients (median age, 63 years; 49.8% female) with 66 primary tumor types were evaluated. High-risk surveillance period durations ranged from less than 1 year (breast, prostate, lip, ocular, and parathyroid cancers) up to 19 years (unspecified gastrointestinal cancers). The annualized mortality gap, representing the excess mortality in the stable period, ranged from a median 0.26% to 9.33% excess annual mortality (thyroid and hypopharyngeal cancer populations, respectively). Cluster analysis produced 6 risk cluster groups: group 1, with median survival of 16.2 (5th to 95th percentile range [PR], 10.7-40.2) years and median high-risk period of 2.5 (PR, 0-5.0) years; group 2, 8.3 (PR, 5.1-23.3) and 2.5 (PR, 4.0-8.0) years; group 3, 2.8 (PR, 1.4-3.7) and 7.0 (PR, 6.0-11.1) years; group 4, 1.6 (PR, 1.5-1.8) and 6.0 (PR, 5.1-11.4) years; group 5, 0.8 (PR, 0.5-1.2) and 0.8 (PR, 0.5-1.2) years; and group 6, 0.5 (PR, 0.4-0.8) and 12.0 (PR, 9.3-12.9) years, respectively. Subanalyses of selected tumor types in these groups revealed that stratifying on stage and histologic type can change the risk cluster and guidance for care. These findings indicate that a standardized 5-year surveillance period is inadequate for some cancers while excessive for others. High-risk cancers require the most resources with the longest high-risk period, highest persistent baseline mortality risk, and longest period of primary cancer mortality, all arguing for longer follow-up with an oncologist in these cancers.

Reassessment of the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer treated using radical prostatectomy.

PubMed

Narita, Shintaro; Mitsuzuka, Koji; Tsuchiya, Norihiko; Koie, Takuya; Kawamura, Sadafumi; Ohyama, Chikara; Tochigi, Tatsuo; Yamaguchi, Takuhiro; Arai, Yoichi; Habuchi, Tomonori

2015-11-01

To assess the risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer patients treated using radical prostatectomy. We retrospectively reviewed the medical records of 1268 men with prostate cancer treated using radical prostatectomy without neoadjuvant therapy. The association between various risk factors and biochemical recurrence was then statistically evaluated. The Kaplan-Meier method, log-rank tests and Cox proportional hazards models were used for statistical analysis. In the intermediate-risk group, 96 patients (14.5%) experienced biochemical recurrence during a median follow up of 41 months. In the intermediate-risk group, preoperative prostate-specific antigen level, prostate volume and prostate-specific antigen density were significant preoperative risk factors for biochemical recurrence, whereas other factors including age, primary Gleason 4, clinical stage >T2 and percentage of positive biopsies were not. In multivariate analysis, higher preoperative prostate-specific antigen level and density, and a smaller prostate volume were independent risk factors for biochemical recurrence in the intermediate-risk group. Biochemical recurrence-free survival of patients in the intermediate-risk group with a higher prostate-specific antigen level and density (≥15 ng/mL, ≥0.6 ng/mL/cm(3), respectively), and lower prostate volume (≤10 mL) was comparable with that of high-risk group individuals (P = 0.632, 0.494 and 0.961, respectively). Preoperative prostate-specific antigen, prostate volume and prostate-specific antigen density are significant risk factors for biochemical recurrence in D'Amico intermediate-risk prostate cancer patients treated using radical prostatectomy. Using these variables, a subset of the intermediate-risk patients can be identified as having equivalent outcomes to high-risk patients. © 2015 The Japanese Urological Association.

Amerindian women of the Brazilian Amazon and STD.

PubMed

Brito, E B; Silva, I D C; Stávale, J N; Taromaru, E; Menezess, R C; Martins, S J

2006-01-01

Papanicolaou tests, PCR for HPV, C. trachomatis, HSV-1/2 and N. gonorrhoea, and Hybrid Capture II were performed for high- and low-risk HPV groups during screening for cervical cancer in 49 women of the Parakana tribe. Cytological diagnoses of HPV were suggested in three samples: PCR showed 12 (22.4%) cases of DNA positive HPV, 16 (1), 18 (2), 58 (3), 39 (1), 61 (1), 33 (1), 35 (1), unknown (2), and HCII analyzed 48 samples: 19 positive (39.58%) for the high-risk group and four (18.33%) for the low-risk group. The prevalence of HPV was 42.85% (p = 0.001) by molecular biology methods. The largest viral load was 1588.11 pg/ml for HPV 39 in a 16-year-old. PCR was positive for C. trachomatis and negative for HSV-1/2 and N. gonorrhoea. Parakana women present a high risk for the development of cervical cancer.

Autonomic dysfunction assessed by EZSCAN and subclinical atherosclerosis.

PubMed

Sun, Jichao; Zhang, Yinfei; Xu, Baihui; Lv, Xiaofei; Ding, Lin; Chen, Ying; Sun, Wanwan; Lu, Jieli; Xu, Min; Bi, Yufang; Ning, Guang

2014-09-01

The present study aimed to explore the association between autonomic dysfunction and measurements of atherosclerosis in a middle-aged and elderly Chinese population. A population-based cross-sectional study was performed in Shanghai, China, from March to August 2010, with 5076 participants included in the analysis. Autonomic function was assessed by a novel EZSCAN test based on sudomotor function analysis. Carotid intima-media thickness (CIMT) was measured using B-mode ultrasonography and brachial-ankle pulse wave velocity (ba-PWV) was measured using an autonomic device. Participants were divided into three groups based on EZSCAN values: Group 1: EZSCAN 0-24; Group 2, EZSCAN 25-49; and Group 3, EZSCAN 50-100. These groups denoted autonomic dysfunction risk groups as follows: no risk, moderate risk and high risk, respectively. The prevalence of elevated CIMT and ba-PWV increased markedly with increasing EZSCAN values (elevated CIMT 7.4%, 17.5%, and 29.7%, elevated ba-PWV 3.2%, 19.7%, and 36.5%, in Groups 1, 2, and 3, respectively; both Ptrend < 0.0001). Logistic regressions revealed that EZSCAN values ≥50 were associated with a non-significantly higher risk of elevated CIMT (odds ratio [OR] = 1.43; 95% confidence interval [CI] 0.98-2.07) and a significantly higher risk of elevated ba-PWV (OR = 2.16; 95% CI 1.25-3.71) compared with EZSCAN values <25, after controlling for conventional risk factors. A higher EZSCAN value (≥50), an index of high autonomic dysfunction risk, was associated with an increased risk of elevated ba-PWV and CIMT. Such associations were partially explained by traditional atherosclerotic risk factors. © 2014 Ruijin Hospital, Shanghai Jiaotong University School of Medicine and Wiley Publishing Asia Pty Ltd.

AIDS knowledge and high risk behaviors in the chronic mentally ill.

PubMed

Katz, R C; Watts, C; Santman, J

1994-08-01

Chronic mentally ill adults are a high risk group for AIDS. In the present study, we used a questionnaire to assess AIDS knowledge, attitudes, and risk behaviors in 54 men and women who were clients at a "drop in" center for mentally ill adults. Most of the subjects were suffering from schizophrenia and about one-third of them had co-existing drug problems. Results showed widespread misunderstandings about AIDS transmission, high risk groups, and practices. Many of the subjects had been treated for STDs such as syphilis and gonorrhea and were engaging in behaviors that increased their vulnerability to AIDS. These include casual sex, anal sex, sex with an IV drug user, or sex in exchange for money, drugs, or a place to sleep. Subjects expressed a moderately high level of concern about acquiring AIDS/HIV, and 15% of those tested (5/33) said they already had the illness. We observed a significant correlation between misinformation about AIDS and the frequency of high risk behaviors. We also detected ambivalence about using condoms and i.v. drugs. Although males and females did not differ in AIDS knowledge or risk behaviors, the AIDS knowledge of both groups was significantly lower than a comparison sample of public high school students. Taken together, the results underscore the immediate need for comprehensive AIDS assessment, education, and prevention in this segment of the population.

Value of EZSCAN parameters for diabetes screening in Chinese.

PubMed

Lin, Yanhui; Chen, Zhiheng; Guo, Xu; Deng, Yulin

2017-05-23

To study the parameters of EZSCAN as a screening tool for diabetes in Chinese. A total of 6,270 subjects participated in the study. All subjects underwent tests of EZSCAN, fasting plasma glucose (FPG), oral glucose tolerance test and HbA 1c . 1. All subjects were divided into 4 groups: the normal group, sugar metabolic abnormalities as low-risk group, middle-risk group and high-risk group. The difference of diabetes incidence among the 4 groups was statistically significant. With the increase of EZSCAN score, the prevalence of diabetes increased significantly. But there is no statistically difference between the low-risk group and the middle-risk group. 2. After adjustment for other variables, there is significantly positive relationship among EZSCAN risk score and the risk of diabetes. Meanwhile there is no statistically difference between the low-risk group and the middle-risk group. 3. The cut-off point of EZSCAN for diabetes was 44.5% with the sensitivity was 73.2% which was higher than of FPG and HbA 1c . As EZSCAN-diabetes risk score increases, the risk of diabetes increases. EZSCAN can be used as a tool for screening for diabetes. At the best screening diabetes cut-off point value 44.5%, the sensitivity is higher than traditional method of FPG and HbA 1c . Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management.

PubMed

Good, Elin; Länne, Toste; Wilhelm, Elisabeth; Perk, Joep; Jaarsma, Tiny; de Muinck, Ebo

2016-09-01

Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Cross-sectional retrospective study. Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects. © The European Society of Cardiology 2016.

The association of prenatal nutrition and educational services with low birth weight rates in a Florida program.

PubMed Central

Taren, D L; Graven, S N

1991-01-01

Nutrition services and education, provided as components of normal prenatal care, have a key role in preventing preterm delivery and low birth weight (LBW). To determine the influence of these components on a woman's risk of having a LBW infant, the authors examined groups of patients who were receiving the services. Bivariate analyses were made of 9,024 prenatal charts of single births. Most women received nutrition education, prescriptions for nutrient supplements, screenings for anemia, and dietary assessments. A greater proportion of the women at high risk received the interventions than did women at lower risk. The presence of educational components and assays for anemia were associated with a lower risk of a LBW delivery in the total group and in the high risk groups. PMID:1908594

Homocysteine levels and treatment effect in the PROspective Study of Pravastatin in the Elderly at Risk.

PubMed

Drewes, Yvonne M; Poortvliet, Rosalinde K E; Blom, Jeanet W; de Ruijter, Wouter; Westendorp, Rudi G J; Stott, David J; Blom, Henk J; Ford, Ian; Sattar, Naveed; Wouter Jukema, J; Assendelft, Willem J J; de Craen, Anton J M; Gussekloo, Jacobijn

2014-02-01

To assess the effect of preventive pravastatin treatment on coronary heart disease (CHD) morbidity and mortality in older persons at risk for cardiovascular disease (CVD), stratified according to plasma levels of homocysteine. A post hoc subanalysis in the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER), started in 1997, which is a double-blind, randomized, placebo-controlled trial with a mean follow-up of 3.2 years. Primary care setting in two of the three PROSPER study sites (Netherlands and Scotland). Individuals (n = 3,522, aged 70-82, 1,765 male) with a history of or risk factors for CVD were ranked in three groups depending on baseline homocysteine level, sex, and study site. Pravastatin (40 mg) versus placebo. Fatal and nonfatal CHD and mortality. In the placebo group, participants with a high homocysteine level (n = 588) had a 1.8 higher risk (95% confidence interval (CI) = 1.2-2.5, P = .001) of fatal and nonfatal CHD than those with a low homocysteine level (n = 597). The absolute risk reduction in fatal and nonfatal CHD with pravastatin treatment was 1.6% (95% CI = -1.6 to 4.7%) in the low homocysteine group and 6.7% (95% CI = 2.7-10.7%) in the high homocysteine group (difference 5.2%, 95% CI = 0.11-10.3, P = .046). Therefore, the number needed to treat (NNT) with pravastatin for 3.2 years for benefit related to fatal and nonfatal CHD events was 14.8 (95% CI = 9.3-36.6) for high homocysteine and 64.5 (95% CI = 21.4-∞) for low homocysteine. In older persons at risk of CVD, those with high homocysteine are at highest risk for fatal and nonfatal CHD. With pravastatin treatment, this group has the highest absolute risk reduction and the lowest NNT to prevent fatal and nonfatal CHD. © 2014, Copyright the Authors. Journal compilation © 2014, The American Geriatrics Society.

An After-School Counseling Program for High-Risk Middle School Students

ERIC Educational Resources Information Center

Kruczek, Theresa; Alexander, Charlene M.; Harris, Kevin

2005-01-01

There are a number of middle school students who experience difficulty making the transition from childhood to early adolescence and may be described as high-risk. This article describes an after-school program designed to promote healthy identity and adaptive personal choice behaviors in a high-risk group of middle school students.

Dating Violence among High School Students in Southeastern North Carolina

ERIC Educational Resources Information Center

Kim-Godwin, Yeoun Soo; Clements, Carrie; McCuiston, Ashley M.; Fox, Jane A.

2009-01-01

Adolescents are a high-risk group for dating violence. Using the Youth Risk Behavior Survey data, this study examined the associations among dating violence (including physical dating violence [PDV] and sexual dating violence [SDV]) and selected health risk behaviors among 375 and 372 high school students, in 2005 and 2007, respectively, in…

Health-risk appraisal with or without disease management for worksite cardiovascular risk reduction.

PubMed

Maron, David J; Forbes, Barbara L; Groves, Jay R; Dietrich, Mary S; Sells, Patrick; DiGenio, Andres G

2008-01-01

Worksite health promotion programs use health risk appraisal (HRA) surveys to identify employees at increased risk, then provide a range of interventions to encourage high-risk individuals to improve their health. Our objective was to determine how the intensity of intervention after HRA affected cardiovascular risk after 1 year, comparing individual follow-up counseling with environmental supports. 133 employees of Vanderbilt University with cardiovascular risk factors were randomly assigned to worksite HRA plus targeted disease management (DM group) or HRA plus information about worksite health promotion programs (HRA group). The DM group received longitudinal individualized counseling for risk reduction, whereas the HRA group members received one feedback session about their risk factors and information about free worksite health promotion programs. The main outcome measure was the difference between groups in the change in average Framingham risk score from baseline to 1 year. There was no significant baseline difference between groups in the Framingham risk score. Among DM participants, the mean (SD) Framingham risk score decreased by 22.6%; among HRA participants, the mean score rose by 4.3% (P = .017 for the difference between groups). In this study of employees with cardiovascular risk factors, HRA followed by individual counseling was more effective than providing information about free worksite health promotion programs.

Postmolar gestational trophoblastic neoplasia: beyond the traditional risk factors.

PubMed

Bakhtiyari, Mahmood; Mirzamoradi, Masoumeh; Kimyaiee, Parichehr; Aghaie, Abbas; Mansournia, Mohammd Ali; Ashrafi-Vand, Sepideh; Sarfjoo, Fatemeh Sadat

2015-09-01

To investigate the slope of linear regression of postevacuation serum hCG as an independent risk factor for postmolar gestational trophoblastic neoplasia (GTN). Multicenter retrospective cohort study. Academic referral health care centers. All subjects with confirmed hydatidiform mole and at least four measurements of β-hCG titer. None. Type and magnitude of the relationship between the slope of linear regression of β-hCG as a new risk factor and GTN using Bayesian logistic regression with penalized log-likelihood estimation. Among the high-risk and low-risk molar pregnancy cases, 11 (18.6%) and 19 cases (13.3%) had GTN, respectively. No significant relationship was found between the components of a high-risk pregnancy and GTN. The β-hCG return slope was higher in the spontaneous cure group. However, the initial level of this hormone in the first measurement was higher in the GTN group compared with in the spontaneous recovery group. The average time for diagnosing GTN in the high-risk molar pregnancy group was 2 weeks less than that of the low-risk molar pregnancy group. In addition to slope of linear regression of β-hCG (odds ratio [OR], 12.74, confidence interval [CI], 5.42-29.2), abortion history (OR, 2.53; 95% CI, 1.27-5.04) and large uterine height for gestational age (OR, 1.26; CI, 1.04-1.54) had the maximum effects on GTN outcome, respectively. The slope of linear regression of β-hCG was introduced as an independent risk factor, which could be used for clinical decision making based on records of β-hCG titer and subsequent prevention program. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

Compliance with the 2009 Royal College of Obstetricians and Gynaecologists guidelines for venous thromboembolic disease prophylaxis in pregnancy and postpartum period in Uruguay.

PubMed

Grille, Sofía; Vitureira, Gerardo; Morán, Rosario; Retamosa, Lucía; Alonso, Valeria; Gómez, Luis M; Quartara, Federico; Feldman, Florencia; López, Valentina; Turcatti, Paola; Castro, Viviana; Sosa, Leonardo; Guillermo, Cecilia; Díaz, Lilián; Stevenazzi, Mariana

2018-04-01

: Venous thromboembolism remains as one of the leading causes of maternal death. Prevention of venous thromboembolism in the obstetric population is challenging as recommendations for prophylaxis have low grade of evidence. Risk factors and prophylaxis guidelines have been highlighted by Royal College of Obstetricians and Gynaecologists. In 2014, we developed a written alert following this guidelines to guide thromboprophylaxis. The aim of this study is to assess recommendations compliance. This study was conducted at University-Hospital in Uruguay from January 2014 to December 2016. A total of 1035 women were enrolled and stratified in high, intermediate or low risk based on Royal College of Obstetricians and Gynaecologists guidelines. Thromboprophylaxis was recommended for women at intermediate and high risk. Women were followed up to assess symptomatic thromboembolism or haemorrhagic complications. A total of 309 were pregnant and 731 puerperal. Median age was 24 (19-29) years old. Of them, 3.0% (n = 31) were at high risk and 35.4% (n = 366) at intermediate risk. All high-risk women received prophylaxis with low-molecular-weight heparin. Of the 366 intermediate-risk women, 52.7% received prophylaxis. Venous thromboembolism was developed in only one woman of the intermediate group, who had received prophylaxis. Bleeding complications were not observed. Awareness of the thrombotic risk, as conferred by an easy and suitable risk assessment, has the potential to improve venous thromboembolism prophylaxis in pregnant and puerperal women. We have a good guidelines compliance with the written alert in the high-risk women group. However, we have to improve low-molecular-weight heparin indication in intermediate-risk group, especially in postcaesarean women.

Renin-Angiotensin-Aldosterone Genotype Influences Ventricular Remodeling in Infants with Single Ventricle

PubMed Central

Mital, Seema; Chung, Wendy K.; Colan, Steven D.; Sleeper, Lynn A.; Manlhiot, Cedric; Arrington, Cammon B.; Cnota, James F.; Graham, Eric M.; Mitchell, Michael E.; Goldmuntz, Elizabeth; Li, Jennifer S.; Levine, Jami C.; Lee, Teresa M.; Margossian, Renee; Hsu, Daphne T.

2011-01-01

Background We investigated the effect of polymorphisms in the renin-angiotensin-aldosterone system (RAAS) genes on ventricular remodeling, growth, renal function and response to enalapril in infants with single ventricle. Methods and Results Single ventricle infants enrolled in a randomized trial of enalapril were genotyped for polymorphisms in 5 genes: angiotensinogen, angiotensin-converting enzyme, angiotensin II type 1 receptor, aldosterone synthase, and chymase. Alleles associated with RAAS upregulation were classified as risk alleles. Ventricular mass, volume, somatic growth, renal function using estimated glomerular filtration rate (eGFR), and response to enalapril were compared between patients with ≥2 homozygous risk genotypes (high-risk), and those with <2 homozygous risk genotypes (low-risk) at two time points - before the superior-cavopulmonary-connection (pre-SCPC) and at age 14 months. Of 230 trial subjects, 154 were genotyped: 38 were high-risk, 116 were low-risk. Ventricular mass and volume were elevated in both groups pre-SCPC. Ventricular mass and volume decreased and eGFR increased after SCPC in the low-risk (p<0.05) but not the high-risk group. These responses were independent of enalapril treatment. Weight and height z-scores were lower at baseline and height remained lower in the high-risk group at 14 months especially in those receiving enalapril (p<0.05). Conclusions RAAS-upregulation genotypes were associated with failure of reverse remodeling after SCPC surgery, less improvement in renal function, and impaired somatic growth, the latter especially in patients receiving enalapril. RAAS genotype may identify a high-risk subgroup of single ventricle patients who fail to fully benefit from volume unloading surgery. Follow-up is warranted to assess longterm impact. Clinical Trial Registration Clinical Trials.gov Identifier NCT00113087 PMID:21576655

The risk-adjusted vision beyond casemix (DRG) funding in Australia. International lessons in high complexity and capitation.

PubMed

Antioch, Kathryn M; Walsh, Michael K

2004-06-01

Hospitals throughout the world using funding based on diagnosis-related groups (DRG) have incurred substantial budgetary deficits, despite high efficiency. We identify the limitations of DRG funding that lack risk (severity) adjustment for State-wide referral services. Methods to risk adjust DRGs are instructive. The average price in casemix funding in the Australian State of Victoria is policy based, not benchmarked. Average cost weights are too low for high-complexity DRGs relating to State-wide referral services such as heart and lung transplantation and trauma. Risk-adjusted specified grants (RASG) are required for five high-complexity respiratory, cardiology and stroke DRGs incurring annual deficits of $3.6 million due to high casemix complexity and government under-funding despite high efficiency. Five stepwise linear regressions for each DRG excluded non-significant variables and assessed heteroskedasticity and multicollinearlity. Cost per patient was the dependent variable. Significant independent variables were age, length-of-stay outliers, number of disease types, diagnoses, procedures and emergency status. Diagnosis and procedure severity markers were identified. The methodology and the work of the State-wide Risk Adjustment Working Group can facilitate risk adjustment of DRGs State-wide and for Treasury negotiations for expenditure growth. The Alfred Hospital previously negotiated RASG of $14 million over 5 years for three trauma and chronic DRGs. Some chronic diseases require risk-adjusted capitation funding models for Australian Health Maintenance Organizations as an alternative to casemix funding. The use of Diagnostic Cost Groups can facilitate State and Federal government reform via new population-based risk adjusted funding models that measure health need.

Lung dose and the potential risk of death in postoperative radiation therapy for non-small cell lung cancer: A study using the method of stratified grouping.

PubMed

Heo, Jaesung; Noh, O Kyu; Kim, Hwan-Ik; Chun, Mison; Cho, Oyeon; Park, Rae Woong; Yoon, Dukyong; Oh, Young-Taek

2018-04-19

Postoperative radiation therapy may have a detrimental effect on survival in patients with non-small cell lung cancer. We investigated the association of the lung radiation dose with the risk of death in patients treated with postoperative radiation therapy. We analyzed 178 patients with non-small cell lung cancer who received postoperative radiation therapy. The mean lung dose was calculated from dose-volume data, and we categorized patients into the high and low lung dose groups using 2 different methods; (1) simple grouping using the median lung dose of all patients, and (2) stratified grouping using the median lung dose of each subgroup sharing the same confounders. We compared clinical variables, and survival between the high and low lung dose groups. In the simple grouping, there were no significant differences in survivals between the high and low lung dose groups. After stratification, the overall survival of low lung dose group was significantly longer than that of high lung dose group (5-year survival, 60.1% vs. 35.3%, p = 0.039). On multivariable analyses, the lung dose remained a significant prognostic factor for overall survival (hazard ratio, HR = 2.08, p = 0.019). The lung dose was associated with the risk of death in patients with non-small cell lung cancer having the same confounders. Further studies evaluating the risk of death according to the lung dose will be helpful to administer more precise and individualized postoperative radiation therapy. Copyright © 2018 Elsevier B.V. All rights reserved.

Nutritional status and nutrition risk screening in hospitalized children in New Zealand.

PubMed

Moeeni, Vesal; Walls, Tony; Day, Andrew S

2013-09-01

Children requiring hospitalization are at risk of malnutrition. This study aimed to define the nutritional status of paediatric inpatients in comparison with healthy children and to compare and contrast the feasibility and validity of three nutritional risk screening (NRS) tools in the hospitalized children. A total of 162 children admitted to Christchurch Hospital were assessed along with a similar group of healthy children. Their nutritional state was assessed and classified using standard criteria. The NRS tools were applied, and patients were classified into low-, medium- and high-risk groups. The feasibility and validity of the tools were assessed. Under-nutrition was more frequent in the inpatient group (9.9% vs. 3.7%; p = 0.04), whereas both groups had similar rates of overweight/obesity. NRS tools were able to identify between 81% and 100% of the malnourished patients in the medium- to high-risk groups. Undernourished patients had longer hospital stay than well-nourished patients. Hospitalized children have higher rates of under-nutrition than healthy children in NZ. The three NRS tools were able to identify children at nutritional risk with differing utility. In this setting, STRONGkids was the most reliable tool. ©2013 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

Effects of baseline risk information on social and individual choices.

PubMed

Gyrd-Hansen, Dorte; Kristiansen, Ivar Sønbø; Nexøe, Jørgen; Nielsen, Jesper Bo

2002-01-01

This article analyzes preferences for risk reductions in the context of individual and societal decision making. The effect of information on baseline risk is analyzed in both contexts. The results indicate that if individuals are to imagine that they suffer from 1 low-risk and 1 high-risk ailment, and are offered a specified identical absolute risk reduction, a majority will ceteris paribus opt for treatment of the low-risk ailment. A different preference structure is elicited when priority questions are framed as social choices. Here, a majority will prefer to treat the high-risk group of patients. The preference reversal demonstrates the extent to which baseline risk information can influence preferences in different choice settings. It is argued that presentation of baseline risk information may induce framing effects that lead to nonoptimal resource allocations. A solution to this problem may be to not present group-specific baseline risk information when eliciting preferences.

Gray matter volume and rapid decision-making in major depressive disorder.

PubMed

Nakano, Masayuki; Matsuo, Koji; Nakashima, Mami; Matsubara, Toshio; Harada, Kenichiro; Egashira, Kazuteru; Masaki, Hiroaki; Takahashi, Kanji; Watanabe, Yoshifumi

2014-01-03

Reduced motivation and blunted decision-making are key features of major depressive disorder (MDD). Patients with MDD show abnormal decision-making when given negative feedback regarding a reward. The brain mechanisms underpinning this behavior remain unclear. In the present study, we examined the association between rapid decision-making with negative feedback and brain volume in MDD. Thirty-six patients with MDD and 54 age-, sex- and IQ-matched healthy subjects were studied. Subjects performed a rapid decision-making monetary task in which participants could make high- or low-risk choices. We compared between the 2 groups the probability that a high-risk choice followed negative feedback. In addition, we used voxel-based morphometry (VBM) to compare between group differences in gray matter volume, and the correlation between the probability for high-risk choices and brain volume. Compared to the healthy group, the MDD group showed significantly lower probabilities for high-risk choices following negative feedback. VBM analysis revealed that the MDD group had less gray matter volume in the right medial prefrontal cortex and orbitofrontal cortex (OFC) compared to the healthy group. The right OFC volume was negatively correlated with the probability that a high-risk choice followed negative feedback in patients with MDD. We did not observe these trends in healthy subjects. Patients with MDD show reduced motivation for monetary incentives when they were required to make rapid decisions following negative feedback. We observed a correlation between this reduced motivation and gray matter volume in the medial and ventral prefrontal cortex, which suggests that these brain regions are likely involved in the pathophysiology of aberrant decision-making in MDD. © 2013.

At-risk depressive symptoms and alcohol use trajectories in adolescence: a person-centred analysis of co-occurrence.

PubMed

Willoughby, Teena; Fortner, Adrian

2015-04-01

Long-term longitudinal studies that examine whether there are distinct trajectories of at-risk depressive symptoms and alcohol use across the high school years (e.g., high co-occurrence) are rare in normative samples of adolescent boys and girls; yet, this assessment is of critical importance for developing effective prevention and intervention strategies. Moreover, the role of self-regulation and novelty-seeking behavior in differentiating among distinct subgroups of adolescents is not clear. To address these gaps, the present study sought to identify subgroups of adolescent boys and girls that indicated at-risk trajectories across the high school years for both depressive symptoms and alcohol use, and examined the role of delay of gratification and novelty seeking at baseline in differentiating among the subgroups. Canadian adolescents (N = 4,412; 49 % female) were surveyed at four time points (grades 9, 10, 11, and 12). Parallel process latent class growth analyses revealed four distinct subgroups for both boys and girls, encompassing high co-occurrence, depressive symptoms only, alcohol use only, and low co-occurrence. Across gender, delay of gratification at baseline differentiated among the four subgroups, with the High Co-Occurrence Group group scoring the lowest and the Low Co-Occurrence Group the highest. Lower novelty-seeking scores at baseline were associated more with being in the Depressive Symptoms Only Group relative to the other groups, particularly the Alcohol Use Only Group for boys. Thus, delay of gratification and novelty seeking may be useful in identifying youth at risk for co-occurring depressive symptoms and alcohol use trajectories, as well as at-risk trajectories for only one of these behaviors.

UK NHS pilot study on cell-free DNA testing in screening for fetal trisomies: factors affecting uptake.

PubMed

Gil, M M; Giunta, G; Macalli, E A; Poon, L C; Nicolaides, K H

2015-01-01

This study reports on the clinical implementation of cell-free DNA (cfDNA) testing, contingent on the results of the combined test, in screening for fetal trisomies 21, 18 and 13 in two UK National Health Service hospitals. Women with a combined-test risk of ≥ 1:100 (high risk) were offered the options of chorionic villus sampling (CVS), cfDNA testing or no further testing and those with a risk of 1:101 to 1:2500 (intermediate risk) were offered cfDNA or no further testing. The objective of the study was to examine the factors affecting patient decisions concerning their options. Combined screening was performed in 6651 singleton pregnancies in which the risk for trisomies was high in 260 (3.9%), intermediate in 2017 (30.3%) and low in 4374 (65.8%). Logistic regression analysis was used to determine which factors among maternal characteristics, fetal nuchal translucency thickness (NT) and risk for trisomies were significant predictors of opting for CVS in the high-risk group and opting for cfDNA testing in the intermediate-risk group. In the high-risk group, 104 (40.0%) women opted for CVS; predictors for CVS were increasing fetal NT and increasing risk for trisomies, while the predictor against CVS was being of Afro-Caribbean racial origin (r = 0.366). In the intermediate-risk group, 1850 (91.7%) women opted for cfDNA testing; predictors for cfDNA testing were increasing maternal age, increasing risk for trisomies and university education, while predictors against cfDNA testing were being of Afro-Caribbean racial origin, smoking and being parous (r = 0.105). This study has identified factors that can influence the decision of women undergoing combined screening in favor of or against CVS and in favor of or against cfDNA testing. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

Evaluation of Low- Versus High-dose Valganciclovir for Prevention of Cytomegalovirus Disease in High-risk Renal Transplant Recipients.

PubMed

Gabardi, Steven; Asipenko, Natalya; Fleming, James; Lor, Kevin; McDevitt-Potter, Lisa; Mohammed, Anisa; Rogers, Christin; Tichy, Eric M; Weng, Renee; Lee, Ruth-Ann

2015-07-01

Despite proven efficacy of prolonged cytomegalovirus (CMV) prophylaxis using valganciclovir 900 mg/day, some centers use 450 mg/day due to reported success and cost savings. This multicenter, retrospective study compared the efficacy and safety of 6 months of low-dose versus high-dose valganciclovir prophylaxis in high-risk, donor-positive/recipient-negative, renal transplant recipients (RTR). Two hundred thirty-seven high-risk RTR (low-dose group = valganciclovir 450 mg/day [n = 130]; high-dose group = valganciclovir 900 mg/day [n = s7]) were evaluated for 1-year CMV disease prevalence. Breakthrough CMV, resistant CMV, biopsy-proven acute rejection (BPAR), graft loss, opportunistic infections (OI), new-onset diabetes after transplantation (NODAT), premature valganciclovir discontinuation, renal function and myelosuppression were also assessed. Patient demographics and transplant characteristics were comparable. Induction and maintenance immunosuppression were similar, except for more early steroid withdrawal in the high-dose group. Similar proportions of patients developed CMV disease (14.6% vs 24.3%; P = 0.068); however, controlling CMV risk factor differences through multivariate logistic regression revealed significantly lower CMV disease in the low-dose group (P = 0.02; odds ratio, 0.432, 95% confidence interval, 0.211-0.887). Breakthrough and resistant CMV occurred at similar frequencies. There was no difference in renal function or rates of biopsy-proven acute rejection, graft loss, opportunistic infections, or new-onset diabetes after transplantation. The high-dose group had significantly lower mean white blood cell counts at months 5 and 6; however, premature valganciclovir discontinuation rates were similar. Low-dose and high-dose valganciclovir regimens provide similar efficacy in preventing CMV disease in high-risk RTR, with a reduced incidence of leukopenia associated with the low-dose regimen and no difference in resistant CMV. Low-dose valganciclovir may provide a significant cost avoidance benefit.

NCCN Guidelines as a Model of Extended Criteria for Lung Cancer Screening.

PubMed

McKee, Brady J; Regis, Shawn; Borondy-Kitts, Andrea K; Hashim, Jeffrey A; French, Robert J; Wald, Christoph; McKee, Andrea B

2018-04-01

Background: This review assessed the performance of patients in NCCN high-risk group 2 in a clinical CT lung screening (CTLS) program. Methods: We retrospectively reviewed screening results for all patients from our institution undergoing clinical CTLS from January 2012 through December 2016, with follow-up through June 2017. To qualify for screening, patients had to meet the NCCN Guidelines high-risk criteria for CTLS, have a physician order for screening, be asymptomatic, be lung cancer-free for 5 years, and have no known metastatic disease. We compared demographics and screening performance of NCCN high-risk groups 1 and 2 across >4 rounds of screening. Screening metrics assessed included rates of positive and suspicious examinations, significant incidental and infectious/inflammatory findings, false negatives, and cancer detection. We also compared cancer stage and histology detected in each NCCN high-risk group. Results: A total of 2,927 individuals underwent baseline screening, of which 698 (24%) were in NCCN group 2. On average, group 2 patients were younger (60.6 vs 63.1 years), smoked less (38.8 vs 50.8 pack-years), had quit longer (18.1 vs 6.3 years), and were more often former smokers (61.4% vs 44.2%). Positive and suspicious examination rates, false negatives, and rates of infectious/inflammatory findings were equivalent in groups 1 and 2 across all rounds of screening. An increased rate of cancer detection was observed in group 2 during the second annual (T2) screening round (2.7% vs 0.5%; P =.005), with no difference in the other screening rounds: baseline (T0; 2% vs 2.3%; P =.61), first annual (T1; 1.2% vs 1.7%; P =.41), and third annual and beyond (≥T3; 1.2% vs 1.1%; P =1.00). Conclusions: CTLS appears to be equally effective in both NCCN high-risk groups. Copyright © 2018 by the National Comprehensive Cancer Network.

Fear of predation drives stable and differentiated social relationships in guppies

PubMed Central

Heathcote, Robert J. P.; Darden, Safi K.; Franks, Daniel W.; Ramnarine, Indar W.; Croft, Darren P.

2017-01-01

Social relationships can have important consequences for fitness in animals. Whilst numerous studies have shown that individuals often join larger groups in response to perceived predation risk (i.e. fear of predation), the importance of predation risk in driving the formation and stability of social relationships within groups has been relatively ignored. We experimentally tested how predation threat influenced fine-scale social network structure using Trinidadian guppies (Poecilia reticulata). When perceived predation risk was high, individuals developed stable and more differentiated social ties compared to when perceived risk was low. Intriguingly, social differentiation coincided with shoals being somewhat smaller under high-perceived risk, suggesting a possible conflict between forming stable social relationships and larger social groups. Individuals most at risk of predation (large and bold individuals) showed the most exaggerated responses in several social measures. Taken together, we provide the first experimental evidence that proximate risk of predation can increase the intensity of social relationships and fine-scale social structure in animal populations. PMID:28150706

Fear of predation drives stable and differentiated social relationships in guppies.

PubMed

Heathcote, Robert J P; Darden, Safi K; Franks, Daniel W; Ramnarine, Indar W; Croft, Darren P

2017-02-02

Social relationships can have important consequences for fitness in animals. Whilst numerous studies have shown that individuals often join larger groups in response to perceived predation risk (i.e. fear of predation), the importance of predation risk in driving the formation and stability of social relationships within groups has been relatively ignored. We experimentally tested how predation threat influenced fine-scale social network structure using Trinidadian guppies (Poecilia reticulata). When perceived predation risk was high, individuals developed stable and more differentiated social ties compared to when perceived risk was low. Intriguingly, social differentiation coincided with shoals being somewhat smaller under high-perceived risk, suggesting a possible conflict between forming stable social relationships and larger social groups. Individuals most at risk of predation (large and bold individuals) showed the most exaggerated responses in several social measures. Taken together, we provide the first experimental evidence that proximate risk of predation can increase the intensity of social relationships and fine-scale social structure in animal populations.

Children with Elevated Psychosocial Risk Load Benefit Most from a Family-Based Preventive Intervention: Exploratory Differential Analyses from the German "Strengthening Families Program 10-14" Adaptation Trial.

PubMed

Bröning, Sonja; Baldus, Christiane; Thomsen, Monika; Sack, Peter-Michael; Arnaud, Nicolas; Thomasius, Rainer

2017-11-01

While the effectiveness of substance use prevention programs such as the Strengthening Families Program 10-14 (SFP) has been demonstrated in the USA, European SFP adaptations have not replicated these sizable effects. Following the rationale of the risk moderation hypothesis positing that elevated risk groups may benefit more from a preventive intervention than lower-risk groups, we reanalyzed evaluation data from a randomized controlled trial testing the adapted German version of SFP (SFP-D). We hypothesized a differential impact of risk status on intervention results. The study employed a minimal control condition. Of the N = 292 participating children, 73.5% qualified as at-risk because they lived in a deprived urban district, and 26.5% qualified as high risk because they additionally scored as "difficult" in the German Strengths and Difficulty Questionnaire (parents' reports using gender- and age-specific German norms). Outcomes were children's self-reports on substance use, mental health, family functioning, and quality of life. Data were analyzed with repeated measures linear mixed models and relative risk analyses. The high-risk group in the SFP-D condition achieved the best results compared with all other groups, especially in mental health and quality of life. Relative risk analyses on tobacco [alcohol] abstinence showed that an additional percentage of 29.8% [16.0%] of high-risk children in nonabstinent controls would have remained abstinent if they had participated in SFP-D. We conclude that risk load influences the impact of substance use prevention programs and discuss to what extent differential analyses can add value to prevention research.

The function of credibility in information processing for risk perception.

PubMed

Trumbo, Craig W; McComas, Katherine A

2003-04-01

This study examines how credibility affects the way people process information and how they subsequently perceive risk. Three conceptual areas are brought together in this analysis: the psychometric model of risk perception, Eagly and Chaiken's heuristic-systematic information processing model, and Meyer's credibility index. Data come from a study of risk communication in the circumstance of state health department investigations of suspected cancer clusters (five cases, N = 696). Credibility is assessed for three information sources: state health departments, citizen groups, and industries involved in each case. Higher credibility for industry and the state directly predicts lower risk perception, whereas high credibility for citizen groups predicts greater risk perception. A path model shows that perceiving high credibility for industry and state-and perceiving low credibility for citizen groups-promotes heuristic processing, which in turn is a strong predictor of lower risk perception. Alternately, perceiving industry and the state to have low credibility also promotes greater systematic processing, which consistently leads to perception of greater risk. Between a one-fifth and one-third of the effect of credibility on risk perception is shown to be indirectly transmitted through information processing.

Projective risk variables in early adolescence and subsequent disinhibitory psychopathology.

PubMed

af Klinteberg, Britt; Johansson, Sven-Erik; Gacono, Carl; Alm, Per Olof

2008-01-01

The objective was to examine early adolescent projective risk indicators for the development of antisocial behaviour as related to adult personality traits, psychopathy, and violent behaviour over the life span. Assessment data included Rorschach (Rr) ratings (at age 11-14 years), personality inventories (EPQ-I and KSP scales), and a shortened Psychopathy Check List (PCL) (administered at age 32-40 years), obtained from a group of 199 male subjects; and smoking habits (at age 36-44 years) obtained from 125 of those subjects. Results, controlled for intelligence, indicated that the high and very high risk groups, as determined by level of total Rr risk scores, were (1) significantly higher on self-rated IVE Impulsiveness, the anxiety-related KSP Muscular Tension, and nonconformity traits, as compared to the low Rr risk group--the very high risk group also scoring significantly higher on the EPQ Psychoticism scale, related to aggressiveness and cruelty; (2) higher on clinically rated PCL total sum and factor scores; and (3) they were overrepresented among Ss with subsequent violent offence, and Ss with heavy smoking habits. The results are discussed in terms of the possible usefulness of psychodynamic oriented cognitive-emotional indicators in the search for underlying mechanisms in the development of disinhibitory psychopathology.

Characterizing high school students who play drinking games using latent class analysis.

PubMed

Borsari, Brian; Zamboanga, Byron L; Correia, Christopher; Olthuis, Janine V; Van Tyne, Kathryne; Zadworny, Zoe; Grossbard, Joel R; Horton, Nicholas J

2013-10-01

Heavy alcohol use and its associated negative consequences continue to be an important health issue among adolescents. Of particular concern are risky drinking practices such as playing drinking games. Although retrospective accounts indicate that drinking game participation is common among high school students, it has yet to be assessed in current high school students. Utilizing data from high school students who reported current drinking game participation (n=178), we used latent class analysis to investigate the negative consequences resulting from gaming and examined underlying demographic and alcohol-related behavioral characteristics of students as a function of the resultant classes. Three classes of "gamers" emerged: (1) a "lower-risk" group who had a lower probability of endorsing negative consequences compared to the other groups, (2) a "higher-risk" group who reported that they experienced hangovers and difficulties limiting their drinking, got physically sick, and became rude, obnoxious, or insulting, and (3) a "sexual regret" group who reported that they experienced poor recall and unplanned sexual activity that they later regretted. Although the frequency of participating in drinking games did not differ between these three groups, results indicated that the "lower-risk" group consumed fewer drinks in a typical gaming session compared to the other two groups. The present findings suggest that drinking games are common among high school students, but that mere participation and frequency of play are not necessarily the best indicators of risk. Instead, examination of other constructs such as game-related alcohol consumption, consequences, or psychosocial variables such as impulsivity may be more useful. Copyright © 2013 Elsevier Ltd. All rights reserved.

Did our current initial treatment practice change after EAU/ESPU vesicoureteral reflux risk grouping?

PubMed

Tokat, Eda; Gurocak, Serhat; Ure, Iyimser; Acar, Cenk; Sınık, Zafer; Tan, Mustafa Ozgur

2018-06-02

The "European Association of Urology (EAU) Guidelines on Vesicoureteral Reflux (VUR) in Children (September 2012)" established risk classification by analyzing and defining risk factors for each patient. In this study we aimed to investigate how our initial treatment procedures were affected by EAU/ESPU guideline vesicoureteral reflux risk grouping and to compare the early clinical results of treatments performed before and after the risk classification in our patients with VUR. 334 renal units with regular clinical follow-up who were treated owing to VUR (vesicoureteral reflux) between years 2009 and 2017 were retrospectively reviewed. Preoperative clinical parameters such as grade and laterality of reflux, presence of renal scar, initial and follow-up treatments, findings of medical treatment and surgical procedures were analyzed. The initial medical and surgical methods were compared by categorizing patients according to risk groups before and after 2013. Mean age and follow-up duration were 71.4(6-216) months and 47(4-141) months, respectively. Among the preoperative parameters, only high EAU risk group (p = 0.01) and treating lower urinary tract symptoms (p < 0.001) were determining the postoperative success rates significantly, while age, sex, and presence of renal scar at DMSA were not affecting the success of treatment significantly. While no significant difference in medical and surgical treatment rates is observed after risk grouping system in low risk group, the percentages of patients who are treated with surgical methods initially were significantly decreased in moderate and high risk groups (p = 0.002 and p = 0.012, respectively). We determined that VUR risk grouping did not change clinical success significantly in all risk groups. Despite the fact that EAU/ESPU VUR risk classification changed our current practice in terms of initial treatment method, this different approach did not seem to affect early clinical success positively. There is still an absolute need for studies with larger sample size and long-term follow-up to reach more reliable results. Therapeutic. Level 4. Copyright © 2018 Elsevier Inc. All rights reserved.

Are current UK National Institute for Health and Clinical Excellence (NICE) obesity risk guidelines useful? Cross-sectional associations with cardiovascular disease risk factors in a large, representative English population.

PubMed

Tabassum, Faiza; Batty, G David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35-97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women.

Are Current UK National Institute for Health and Clinical Excellence (NICE) Obesity Risk Guidelines Useful? Cross-Sectional Associations with Cardiovascular Disease Risk Factors in a Large, Representative English Population

PubMed Central

Tabassum, Faiza; Batty, G. David

2013-01-01

The National Institute for Health and Clinical Excellence (NICE) has recently released obesity guidelines for health risk. For the first time in the UK, we estimate the utility of these guidelines by relating them to the established cardiovascular disease (CVD) risk factors. Health Survey for England (HSE) 2006, a population-based cross-sectional study in England was used with a sample size of 7225 men and women aged ≥35 years (age range: 35–97 years). The following CVD risk factor outcomes were used: hypertension, diabetes, total and high density lipoprotein cholesterol, glycated haemoglobin, fibrinogen, C-reactive protein and Framingham risk score. Four NICE categories of obesity were created based on body mass index (BMI) and waist circumference (WC): no risk (up to normal BMI and low/high WC); increased risk (normal BMI & very high WC, or obese & low WC); high risk (overweight & very high WC, or obese & high WC); and very high risk (obese I & very high WC or obese II/III with any levels of WC. Men and women in the very high risk category had the highest odds ratios (OR) of having unfavourable CVD risk factors compared to those in the no risk category. For example, the OR of having hypertension for those in the very high risk category of the NICE obesity groupings was 2.57 (95% confidence interval 2.06 to 3.21) in men, and 2.15 (1.75 to 2.64) in women. Moreover, a dose-response association between the adiposity groups and most of the CVD risk factors was observed except total cholesterol in men and low HDL in women. Similar results were apparent when the Framingham risk score was the outcome of interest. In conclusion, the current NICE definitions of obesity show utility for a range of CVD risk factors and CVD risk in both men and women. PMID:23844088

Serum C-reactive protein (CRP) as a simple and independent prognostic factor in extranodal natural killer/T-cell lymphoma, nasal type.

PubMed

Li, Ya-Jun; Li, Zhi-Ming; Xia, Yi; Huang, Jia-Jia; Huang, Hui-Qiang; Xia, Zhong-Jun; Lin, Tong-Yu; Li, Su; Cai, Xiu-Yu; Wu-Xiao, Zhi-Jun; Jiang, Wen-Qi

2013-01-01

C-reactive protein (CRP) is a biomarker of the inflammatory response, and it shows significant prognostic value for several types of solid tumors. The prognostic significance of CRP for lymphoma has not been fully examined. We evaluated the prognostic role of baseline serum CRP levels in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL). We retrospectively analyzed 185 patients with newly diagnosed ENKTL. The prognostic value of the serum CRP level was evaluated for the low-CRP group (CRP≤10 mg/L) versus the high-CRP group (CRP>10 mg/L). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were evaluated and compared with the newly developed prognostic model. Patients in the high-CRP group tended to display increased adverse clinical characteristics, lower rates of complete remission (P<0.001), inferior progression-free survival (PFS, P = 0.001), and inferior overall survival (OS, P<0.001). Multivariate analysis demonstrated that elevated serum CRP levels, age >60 years, hypoalbuminemia, and elevated lactate dehydrogenase levels were independent adverse predictors of OS. Based on these four independent predictors, we constructed a new prognostic model that identified 4 groups with varying OS: group 1, no adverse factors; group 2, 1 factor; group 3, 2 factors; and group 4, 3 or 4 factors (P<0.001). The novel prognostic model was found to be superior to both the IPI in discriminating patients with different outcomes in the IPI low-risk group and the KPI in distinguishing between the low- and intermediate-low-risk groups, the intermediate-low- and high-intermediate-risk groups, and the high-intermediate- and high-risk groups. Our results suggest that pretreatment serum CRP levels represent an independent predictor of clinical outcome for patients with ENKTL. The prognostic value of the new prognostic model is superior to both IPI and KPI.

Serum C-Reactive Protein (CRP) as a Simple and Independent Prognostic Factor in Extranodal Natural Killer/T-Cell Lymphoma, Nasal Type

PubMed Central

Xia, Yi; Huang, Jia-Jia; Huang, Hui-Qiang; Xia, Zhong-Jun; Lin, Tong-Yu; Li, Su; Cai, Xiu-Yu; Wu-Xiao, Zhi-Jun; Jiang, Wen-Qi

2013-01-01

Background C-reactive protein (CRP) is a biomarker of the inflammatory response, and it shows significant prognostic value for several types of solid tumors. The prognostic significance of CRP for lymphoma has not been fully examined. We evaluated the prognostic role of baseline serum CRP levels in patients with extranodal natural killer (NK)/T-cell lymphoma (ENKTL). Methods We retrospectively analyzed 185 patients with newly diagnosed ENKTL. The prognostic value of the serum CRP level was evaluated for the low-CRP group (CRP≤10 mg/L) versus the high-CRP group (CRP>10 mg/L). The prognostic value of the International Prognostic Index (IPI) and the Korean Prognostic Index (KPI) were evaluated and compared with the newly developed prognostic model. Results Patients in the high-CRP group tended to display increased adverse clinical characteristics, lower rates of complete remission (P<0.001), inferior progression-free survival (PFS, P = 0.001), and inferior overall survival (OS, P<0.001). Multivariate analysis demonstrated that elevated serum CRP levels, age >60 years, hypoalbuminemia, and elevated lactate dehydrogenase levels were independent adverse predictors of OS. Based on these four independent predictors, we constructed a new prognostic model that identified 4 groups with varying OS: group 1, no adverse factors; group 2, 1 factor; group 3, 2 factors; and group 4, 3 or 4 factors (P<0.001). The novel prognostic model was found to be superior to both the IPI in discriminating patients with different outcomes in the IPI low-risk group and the KPI in distinguishing between the low- and intermediate-low-risk groups, the intermediate-low- and high-intermediate-risk groups, and the high-intermediate- and high-risk groups. Conclusions Our results suggest that pretreatment serum CRP levels represent an independent predictor of clinical outcome for patients with ENKTL. The prognostic value of the new prognostic model is superior to both IPI and KPI. PMID:23724031

Childhood leukaemia in areas with different radon levels: a spatial and temporal analysis using GIS.

PubMed

Kohli, S; Noorlind Brage, H; Löfman, O

2000-11-01

To evaluate the relation between exposure to ground radon levels and leukaemia among children using existing population and disease registers. Ecological correlation study. The county of Ostergötland in Sweden. Every child born in the county between 1979 and 1992 was mapped to the property centroid coordinates by linking addresses in the population and property registers. Population maps were overlaid with radon maps and exposure at birth and each subsequent year was quantified as high, normal, low or unknown. This was analysed with data from the tumour registry. Standardised mortality ratios (SMRs) were calculated using the age and sex specific rates for Sweden for the year 1995. 90 malignancies occurred among 53 146 children (498 887 person years) who formed the study population. SMRs for acute lymphatic leukaemia (ALL) among children born in high, normal and low risk areas were 1.43, 1.17 and 0.25 respectively. The relative risk for the normal risk group and high risk group as compared with the low risk group was 4.64 (95% CI 1.29, 28.26) and 5. 67 (95% CI 1.06, 42.27). The association between ALL and continued residence at normal or high risk areas showed a similar trend. No association between radon risk levels and any other malignancy was seen. Children born in and staying at areas where the risk from ground radon has been classified as low are less likely to develop ALL than those born in areas classified as normal and high risk.

Assessment of the 10-year risk of coronary heart disease events for Qatar Petroleum's firefighters and non-firefighter staff in Qatar.

PubMed

Mochtar, I; Hooper, R W

2012-02-01

Coronary heart disease is a major public health problem worldwide and firefighters may be at particular occupational risk. In a cross-sectional study in Ras Laffan Industrial City, Qatar, we assessed the 10-year risk of coronary heart disease events for 369 Qatar Petroleum staff at their periodic medical examination. The subjects of the study (all males) were divided into firefighters and non-firefighters groups. Based on the Framingham risk score calculations, 69.9% of the subjects were categorized as low risk, 27.1% as intermediate risk and 2.9% as high risk. None of the firefighters was categorized as high risk, 15.5% were intermediate and the rest were low risk. In the whole group, low high-density lipoprotein cholesterol was the most prevalent risk factor (68.8%), followed by hypertension (32.0%) and smoking (15.4%). The mean risk of developing coronary heart disease in firefighters [6.5% (SD 3.7%)] was significantly lower than in non-firefighters 19.5% (SD 6.5%)].

Heart rate variability analysis based on time-frequency representation and entropies in hypertrophic cardiomyopathy patients.

PubMed

Clariá, F; Vallverdú, M; Baranowski, R; Chojnowska, L; Caminal, P

2008-03-01

In hypertrophic cardiomyopathy (HCM) patients there is an increased risk of premature death, which can occur with little or no warning. Furthermore, classification for sudden cardiac death on patients with HCM is very difficult. The aim of our study was to improve the prognostic value of heart rate variability (HRV) in HCM patients, giving insight into changes of the autonomic nervous system. In this way, the suitability of linear and nonlinear measures was studied to assess the HRV. These measures were based on time-frequency representation (TFR) and on Shannon and Rényi entropies, and compared with traditional HRV measures. Holter recordings of 64 patients with HCM and 55 healthy subjects were analyzed. The HCM patients consisted of two groups: 13 high risk patients, after aborted sudden cardiac death (SCD); 51 low risk patients, without SCD. Five-hour RR signals, corresponding to the sleep period of the subjects, were considered for the analysis as a comparable standard situation. These RR signals were filtered in the three frequency bands: very low frequency band (VLF, 0-0.04 Hz), low frequency band (LF, 0.04-0.15 Hz) and high frequency band (HF, 0.15-0.45 Hz). TFR variables based on instantaneous frequency and energy functions were able to classify HCM patients and healthy subjects (control group). Results revealed that measures obtained from TFR analysis of the HRV better classified the groups of subjects than traditional HRV parameters. However, results showed that nonlinear measures improved group classification. It was observed that entropies calculated in the HF band showed the highest statistically significant levels comparing the HCM group and the control group, p-value < 0.0005. The values of entropy measures calculated in the HCM group presented lower values, indicating a decreasing of complexity, than those calculated from the control group. Moreover, similar behavior was observed comparing high and low risk of premature death, the values of the entropy being lower in high risk patients, p-value < 0.05, indicating an increase of predictability. Furthermore, measures from information entropy, but not from TFR, seem to be useful for enhanced risk stratification in HCM patients with an increased risk of sudden cardiac death.

Sleep, daily activity rhythms and postpartum mood: A longitudinal study across the perinatal period.

PubMed

Krawczak, Elizabeth M; Minuzzi, Luciano; Simpson, William; Hidalgo, Maria Paz; Frey, Benicio N

2016-01-01

Women with a diagnosis of bipolar and major depressive disorders are at higher risk to develop postpartum depression. The primary objective of this longitudinal study was to determine whether daily activity rhythms and sleep parameters differ between women with and without a history of a mood disorder across the perinatal period. A secondary objective was to determine whether changes in these parameters were associated with postpartum mood. In total, 33 women were included in this study, 15 of which had a history of a mood disorder (high-risk group) and 18 who did not (low-risk group). Sleep and daily rhythms were assessed subjectively and objectively during the third trimester (≥26 weeks gestation) and again at 6-12 weeks postpartum. Mood was also assessed at both time points. Women in the high-risk group showed greater subjective daily rhythms and sleep disturbances across the perinatal period. Objective sleep efficiency was worse in the high-risk group in the postpartum period. Changes in both subjective daily rhythms and objective sleep efficiency were predictive of changes in depressive symptoms across the perinatal period. These findings encourage the development of preventative therapeutics to ensure circadian rhythm and sleep stability throughout the perinatal period.

Slightly elevated high-sensitivity C-reactive protein (hsCRP) concentrations are associated with carotid atherosclerosis in women with varying degrees of glucose tolerance.

PubMed

Prahl, Ulrica; Wikstrand, John; Bergström, Göran M L; Behre, Carl Johan; Hulthe, Johannes; Fagerberg, Björn

2010-11-01

We examined whether high-sensitivity C-reactive protein (hsCRP) ≥2.0 mg/L was associated with increased intima-media thickness (IMT), plaque burden, and plaque echolucency in carotid arteries. Women (n = 635) from a population sample of 64-year-old females with varying degrees of glucose tolerance underwent risk factor assessment, measurement of hsCRP, and ultrasound examinations of the carotid arteries. Participants with hsCRP levels ≥2.0 mg/L had elevated carotid bulb IMT independently of other cardiovascular risk factors compared with those with hsCRP <2.0 mg/L. The participants with plaques in the highhsCRP group had larger total plaque area compared to those with plaque in the lower hsCRP group. Plaque echolucency did not differ between groups. High-sensitivity CRP levels ≥2.0 mg/L were accompanied by elevated IMT in the carotid bulbs independently of other cardiovascular risk factors. Total plaque area was larger among women with plaques in the high hsCRP group versus the lower hsCRP group.

Relationships as Risk: High risk sex, Substance Abuse, and Violence among Hispanic Men who have Sex with Men

PubMed Central

De Santis, Joseph P.; Vasquez, Elias Provencio; Deleon, Diego A.; Gonzalez-Guarda, Rosa M.

2012-01-01

Background Men who have sex with men (MSM) experience a number of health disparities including high rates of HIV from high risk sex. High rates of HIV infection are related to high risk sexual behaviors and multiple sexual partners. High rates of HIV infection in this population also may be related to high risk sexual behaviors that occur within the context of primary relationships. However, relatively little is know about about relationships among Hispanic MSM. In addition, little is known about the factors that contribute to risk within these primary relationships. Aims The purpose of this study is to use qualitative methods to explore the factors responsible for high risk sexual behavior within primary relationships among Hispanic MSM. Methods Twenty Hispanic MSM were recruited from various community sites in South Florida to participate in auditotaped focus groups. Data from the focus groups were transcribed and analyzed using content analysis. Data were collected until saturation was achieved. Results Participants identified a number of topics that contribute to risk: drugs/alcohol as risk, outside sex as risk, concealment of HIV infection, violence as risk, consensual and non-consensual sexual violence, and absent family support. Participants also described the relationship of sexual risk, substance abuse, and violence in the context of Hispanic MSM relationships. Conclusions The results of the study provided some important clinical implications for clinicians providing care to Hispanic MSM. From the results of this study, directions for future research focused on the relationships of Hispanic MSM are evident. PMID:25242861

The impact of youth, family, peer and neighborhood risk factors on developmental trajectories of risk involvement from early through middle adolescence.

PubMed

Wang, Bo; Deveaux, Lynette; Li, Xiaoming; Marshall, Sharon; Chen, Xinguang; Stanton, Bonita

2014-04-01

Few studies have analyzed the development course beginning in pre-/early adolescence of overall engagement in health-risk behaviors and associated social risk factors that place individuals in different health-risk trajectories through mid-adolescence. The current longitudinal study identified 1276 adolescents in grade six and followed them for three years to investigate their developmental trajectories of risk behaviors and to examine the association of personal and social risk factors with each trajectory. Group-based trajectory modeling was applied to identify distinctive trajectory patterns of risk behaviors. Multivariate multinomial logistic regression analyses were performed to examine the effects of the personal and social risk factors on adolescents' trajectories. Three gender-specific behavioral trajectories were identified for males (55.3% low-risk, 37.6% moderate-risk, increasing, and 7.1% high-risk, increasing) and females (41.4% no-risk, 53.4% low-risk, increasing and 5.2% moderate to high-risk, increasing). Sensation-seeking, family, peer, and neighborhood factors at baseline predicted following the moderate-risk, increasing trajectory and the high-risk, increasing trajectory in males; these risk factors predicted following the moderate to high-risk, increasing trajectory in females. The presence of all three social risk factors (high-risk neighborhood, high-risk peers and low parental monitoring) had a dramatic impact on increased probability of being in a high-risk trajectory group. These findings highlight the developmental significance of early personal and social risk factors on subsequent risk behaviors in early to middle adolescence. Future adolescent health behavior promotion interventions might consider offering additional prevention resources to pre- and early adolescent youth who are exposed to multiple contextual risk factors (even in the absence of risk behaviors) or youth who are early-starters of delinquency and substance use behaviors in early adolescence. Copyright © 2014. Published by Elsevier Ltd.

Fish Oil and Microalga Omega-3 as Dietary Supplements: A Comparative Study on Cardiovascular Risk Factors in High-Fat Fed Rats.

PubMed

Haimeur, Adil; Mimouni, Virginie; Ulmann, Lionel; Martineau, Anne-Sophie; Messaouri, Hafida; Pineau-Vincent, Fabienne; Tremblin, Gérard; Meskini, Nadia

2016-09-01

Dietary supplementation with marine omega-3 polyunsaturated fatty acids (n-3 PUFA) can have beneficial effects on a number of risk factors for cardiovascular disease (CVD). We compared the effects of two n-3 PUFA rich food supplements (freeze-dried Odontella aurita and fish oil) on risk factors for CVD. Male rats were randomly divided into four groups of six animals each and fed with the following diets: control group (C) received a standard diet containing 7 % lipids; second group (HF high fat) was fed with a high-fat diet containing 40 % lipids; third group (HFFO high fat+fish oil) was fed with the high-fat diet supplemented with 0.5 % fish oil; and fourth group (HFOA high fat+O. aurita) received the high-fat diet supplemented with 12 % of freeze-dried O. aurita. After 8 weeks rats fed with the high-fat diet supplemented with O. aurita displayed a significantly lower bodyweight than those in the other groups. Both the microalga and the fish oil significantly reduced insulinemia and serum lipid levels. O. aurita was more effective than the fish oil in reducing hepatic triacyglycerol levels and in preventing high-fat diet-induced steatosis. O. aurita and fish oil also reduced platelet aggregation and oxidative status induced by high fat intake. After an OA supplementation, the adipocytes in the HFOA group were smaller than those in the HF group. Freeze-dried O. aurita showed similar or even greater biological effects than the fish oil. This could be explained by a potential effect of the n-3 PUFA but also other bioactive compounds of the microalgae.

Impact of Patient Reminders on Papanicolaou Test Completion for High-Risk Patients Identified by a Clinical Decision Support System.

PubMed

MacLaughlin, Kathy L; Kessler, Maya E; Komandur Elayavilli, Ravikumar; Hickey, Branden C; Scheitel, Marianne R; Wagholikar, Kavishwar B; Liu, Hongfang; Kremers, Walter K; Chaudhry, Rajeev

2018-05-01

A clinical decision support system (CDSS) for cervical cancer screening identifies patients due for routine cervical cancer screening. Yet, high-risk patients who require more frequent screening or earlier follow-up to address past abnormal results are not identified. We aimed to assess the effect of a complex CDSS, incorporating national guidelines for high-risk patient screening and abnormal result management, its implementation to identify patients overdue for testing, and the outcome of sending a targeted recommendation for follow-up. At three primary care clinics affiliated with an academic medical center, a reminder recommending an appointment for Papanicolaou (Pap) testing or Pap and human papillomavirus cotesting was sent to high-risk women aged 18 through 65 years (intervention group) identified by CDSS as overdue for testing. Historical control patients, who did not receive a reminder, were identified by CDSS 1 year before the date when reminders were sent to the intervention group. Test completion rates were compared between the intervention and control groups through a generalized estimating equation extension. Across the three sites, the average completion rate of recommended follow-up testing was significantly higher in the intervention group at 23.7% (61/257) than the completion rate at 3.3% (17/516) in the control group (p < 0.001). A CDSS with enhanced capabilities to identify high-risk women due for cervical cancer testing beyond routine screening intervals, with subsequent patient notification, has the potential to decrease cervical precancer and cancer by improving adherence to guideline-compliant follow-up and needed treatment.

Haloperidol dose combined with dexamethasone for PONV prophylaxis in high-risk patients undergoing gynecological laparoscopic surgery: a prospective, randomized, double-blind, dose-response and placebo-controlled study.

PubMed

Joo, Jin; Park, Yong Gyu; Baek, Jungwon; Moon, Young Eun

2015-07-08

Low-dose haloperidol is known to be effective for the prevention of postoperative nausea and vomiting (PONV). However, precise dose-response studies have not been completed, especially in patients at high risk for PONV who require combination therapy. This study sought to identify which dose of haloperidol 1mg or 2mg could be combined with dexamethasone without adverse effects in high-risk patients undergoing gynecological laparoscopic surgery. Female adults (n = 150) with three established PONV risk factors based on Apfel's score were randomized into one of three study groups. At the end of anesthesia, groups H0, H1, and H2 were given intravenous (IV) saline, haloperidol 1 mg, and haloperidol 2 mg, respectively. All patients were given dexamethasone 5 mg during the induction of anesthesia. The overall early (0-2 h) and late (2-24 h) incidences of nausea, vomiting, rescue anti-emetic administration, pain, and adverse effects (cardiac arrhythmias and extrapyramidal effects) were assessed postoperatively. The sedation score was recorded in the postanesthesia care unit (PACU). The total incidence of PONV over 24 h was significantly lower in groups H1 (29 %) and H2 (24 %) than in group H0 (54 %; P = 0.003), but there was no significant difference between groups H1 and H2. In the PACU, group H2 had a higher sedation score than groups H1 and H0 (P < 0.001). For high-risk PONV patients undergoing gynecological laparoscopic surgery, when used with dexamethasone, 1-mg haloperidol was equally effective as 2 mg in terms of preventing PONV with the less sedative effect. ClinicalTrials.gov ( NCT01639599 ).

Association between carotid intima-media thickness and fasting blood glucose level: A population-based cross-sectional study among low-income adults in rural China.

PubMed

Gao, Liu; Bai, Lingling; Shi, Min; Ni, Jingxian; Lu, Hongyan; Wu, Yanan; Tu, Jun; Ning, Xianjia; Wang, Jinghua; Li, Yukun

2017-11-01

Carotid intima-media thickness (CIMT) is an established predictor of cardiovascular disease and stroke. We aimed to identify the association between CIMT and blood glucose, as well as the risk factors associated with increased CIMT in a low-income Chinese population. Stroke-free and cardiovascular disease-free residents aged ≥45 years were recruited. B-mode ultrasonography was carried out to measure CIMT. There were 2,643 participants (71.0%) in the normal group, 549 (14.7%) in the impaired fasting glucose group and 533 (14.3%) in the diabetes mellitus group. The determinants of increased CIMT were older age; male sex; low education; hypertension; smoking; high levels of systolic blood pressure, fasting blood glucose and low-density lipoprotein cholesterol; and low levels of diastolic blood pressure, triglycerides and high-density lipoprotein cholesterol, after adjusting for covariates. Age and hypertension were the common risk factors for increased CIMT in all three groups. Furthermore, male sex, smoking and high low-density lipoprotein cholesterol level were positively associated with the mean CIMT in the normal group; high triglycerides levels were negatively associated with the mean CIMT in the impaired fasting glucose group; and alcohol consumption was an independent risk factor for mean CIMT in the diabetes mellitus group. Hypertension was the greatest risk factor for increased CIMT. These findings suggest that it is crucial to manage and control traditional risk factors in low-income populations in China in order to decelerate the recent dramatic increase in stroke incidence, and to reduce the burden of stroke. © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Percutaneous ultrasound-guided renal biopsy in supine antero-lateral position: a new approach for obese and non-obese patients.

PubMed

Gesualdo, Loreto; Cormio, Luigi; Stallone, Giovanni; Infante, Barbara; Di Palma, Anna Maria; Delli Carri, Paolo; Cignarelli, Mauro; Lamacchia, Olga; Iannaccone, Salvatore; Di Paolo, Salvatore; Morrone, Luigi; Aucella, Filippo; Carrieri, Giuseppe

2008-03-01

Percutaneous ultrasound (US)-guided renal biopsy is the gold standard in the evaluation of renal diseases, but some patients, such as the obese, may not be eligible for this procedure. Aim of this study was to determine the feasibility, efficacy and safety of US-guided percutaneous renal biopsy in supine antero-lateral position (SALP) in high-risk patients (BMI > 30 and/or respiratory difficulty), as well as to compare the overall outcome of SALP with that of traditional prone position (PP) in low-risk patients (BMI < or = 30/no respiratory difficulty). One hundred and ten consecutive patients scheduled for native kidney biopsy were recruited. Ninety low-risk patients were randomized following a permuted block randomization list to receive either US-guided renal biopsy in PP (Group 1) or SALP (Group 2), whereas 20 high-risk patients received US-guided renal biopsy in SALP (Group 3) and were our observational cohort study. Comfort compliance and breathing difficulty in each group were evaluated by the Visual Analogue Scale (VAS). Bleeding complications were evaluated through US renal scanning. Mean operating time was 7 min. Comfort compliance and breathing difficulty were significantly better for SALP in both low- and high-risk patients; there were no significant differences in pain after biopsy among the three groups. Bleeding complications were slightly higher in Group 1. Diagnostic yield was similar in all groups. SALP is reliable, minimally invasive, easy, highly successful, timesaving and almost free from severe side-effects. A better VAS score for breathing difficulty and comfort compliance characterizes this procedure, making it particularly suitable for obese patients.

Evaluation of Promotional Materials To Promote Low-Dose Computed Tomography (LDCT) Screening to High-Risk Consumers and Health Care Providers.

PubMed

Hudson, Janella N; Quinn, Gwendolyn P; Wilson, Lauren E; Simmons, Vani N

2017-03-11

Low-dose computed tomography (LDCT) screening is a promising screening modality for increasing the detection rate of early stage lung cancers among high-risk individuals. Despite being recommended by the US Preventative Services Task Force, uptake of LDCT remains low. The objective of the current study was to gather feedback from high-risk consumers and health care providers on LDCT promotional materials. Focus group discussions were conducted with high-risk individuals (8 focus groups; N = 38) and primary care providers (9 focus groups; N = 23). Participants reviewed existing LDCT promotional materials to assess their perceptions of media materials created to publicize LDCT. Data were analyzed using the constant comparative method. Several key themes emerged from focus groups that can be used to inform development of future LDCT promotional materials. High-risk (HR) participants expressed greater receptivity for promotional materials that did not further stigmatize lung cancer and/or smoking and expressed preferences for materials that clearly outlined the risks/benefits of screening. Primary care providers (PCPs) offered suggestions to facilitate the referral process such as diagnostic codes and requested a design that clearly outlined eligibility criteria. A clear and thorough explanation of LDCT eligibility, cost, harms, and benefits was of chief importance for both PCP and HR audiences. Given that PCPs and HR audiences are not well informed on the specifics of LDCT screening eligibility and insurance coverage, creating provider and patient education opportunities will aid in shared decision-making opportunities. Promotional materials that meet the needs of the target audience are needed to facilitate discussions of risks/benefits of screening with HR individuals.

Transvaginal ultrasonographic measurement of cervical length in asymptomatic high-risk women with a short cervical length in the previous pregnancy.

PubMed

Crane, J M G; Hutchens, D

2011-07-01

To determine if asymptomatic women at high risk of preterm delivery who had a short cervical length in their previous pregnancy and delivered at term are at increased risk of having a short cervical length in their next pregnancy, and whether they are at increased risk of preterm birth. This retrospective cohort study included high-risk (those with a history of spontaneous preterm birth, uterine anomaly or excisional treatment for cervical dysplasia) asymptomatic women who were pregnant with a singleton gestation delivering between April 2003 and March 2010, who had had a previous pregnancy and who had transvaginal ultrasonographic cervical length measurement performed at 16-30 weeks' gestation in both pregnancies. Comparison was among women who had a short cervical length (< 3.0 cm) in their previous pregnancy but delivered at term in that pregnancy (Short Term Group), women with a history of a normal cervical length (≥ 3.0 cm) in their previous pregnancy delivering at term (Long Term Group), and women who had a short cervical length (< 3.0 cm) in their previous pregnancy delivering preterm (Short Preterm Group). Primary outcomes were spontaneous preterm birth at < 37 weeks' gestation and cervical length. Secondary outcomes were spontaneous preterm birth at < 35 weeks and < 32 weeks, low birth weight, maternal outcomes and neonatal morbidity. A total of 62 women were included. Women in the Short Term Group were more likely to have a short cervical length in their next pregnancy compared with those in the Long Term Group (10/23 (43.5%) vs. 4/26 (15.4%), respectively) but not as likely as women in the Short Preterm Group (9/13 (69.2%); P=0.003). Women in the Short Term Group were not at an increased risk of spontaneous preterm birth at < 37 weeks in the next pregnancy compared with women in the Long Term Group (2/23 (8.7%) vs. 2/26 (7.7%), respectively), but women in the Short Preterm Group were at an increased risk (6/13 (46.2%); P<0.0001). Compared with women in the Short Term and Long Term groups, women in the Short Preterm Group were also at an increased risk of threatened preterm labor (6/23 (26.1%) and 4/26 (15.4%) vs. 9/13 (69.2%), respectively; P=0.002) and of receiving corticosteroids for fetal lung maturation (6/23 (26.1%) and 4/26 (15.4%) vs. 11/13 (84.6%), respectively; P<0.0001). Although high-risk asymptomatic women with a short cervical length in their previous pregnancy who delivered at term are at increased risk of having a short cervix in their next pregnancy, they are not at increased risk of preterm birth. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.

Systematic review with meta-analysis: the incidence of advanced neoplasia after polypectomy in patients with and without low-risk adenomas.

PubMed

Hassan, C; Gimeno-García, A; Kalager, M; Spada, C; Zullo, A; Costamagna, G; Senore, C; Rex, D K; Quintero, E

2014-05-01

Patients with one to two tubular adenomas <1 cm in size without high-grade dysplasia (low-risk group) are considered at low risk for colorectal cancer. However, it is uncertain whether they have the same risk of subsequent advanced neoplasia as those with no neoplasia at baseline colonoscopy. To compare incidence of metachronous advanced neoplasia between patients in the low-risk adenoma group and those without neoplasia at index colonoscopy. Relevant publications were identified by MEDLINE/EMBASE and other databases for the period 1992-2013. Studies comparing the incidence of post-polypectomy advanced neoplasia (adenomas ≥10 mm/high-grade dysplasia/villous or cancer) between the low-risk group and patients without colorectal neoplasia at the first colonoscopy were included. Detection rates for advanced neoplasia at endoscopic surveillance were extracted. Study quality was ascertained according to Newcastle-Ottawa Scale. Forest plot was produced based on random-effect models. Inter-study heterogeneity was assessed using the I(2) statistic. Seven studies provided data on 11 387 patients. Mean surveillance periods ranged between 2 and 5 years. Altogether, 267 patients with post-polypectomy advanced neoplasia were detected in the two groups. The incidence of advanced neoplasia was 1.6% (119/7308) in those without neoplasia and 3.6% (148/4079) in those with low-risk adenoma, respectively, corresponding to a relative risk of 1.8 (95% CI: 1.3-2.6). Inter-study heterogeneity was only moderate (I(2) : 37%). No publication bias was present. Patients with low-risk adenomas at baseline had a higher risk of metachronous advanced neoplasia than the group with no adenomas at baseline, though the absolute risk was low in both groups. © 2014 John Wiley & Sons Ltd.

Risk Factors Associated with Rebleeding in Patients with High Risk Peptic Ulcer Bleeding: Focusing on the Role of Second Look Endoscopy.

PubMed

Kim, Sung Bum; Lee, Si Hyung; Kim, Kyeong Ok; Jang, Byung Ik; Kim, Tae Nyeun; Jeon, Seong Woo; Kwon, Joong Goo; Kim, Eun Young; Jung, Jin Tae; Park, Kyung Sik; Cho, Kwang Bum; Kim, Eun Soo; Kim, Hyun Jin; Park, Chang Keun; Park, Jeong Bae; Yang, Chang Heon

2016-02-01

Re-bleeding after initial hemostasis in peptic ulcer bleeding can be life threatening. Identification of factors associated with re-bleeding is important. The aims of this study were to determine incidence of rebleeding in patients with high risk peptic ulcer bleeding and to evaluate factors associated with rebleeding. Among patients diagnosed as upper gastrointestinal hemorrhage at seven hospitals in Daegu-Gyeongbuk, and one hospital in Gyeongnam, South Korea, from Feb 2011 to Dec 2013, 699 patients diagnosed as high risk peptic ulcer bleeding with Forrest classification above llb were included. The data were obtained in a prospective manner. Among 699 patients, re-bleeding occurred in 64 (9.2 %) patients. Second look endoscopy was significantly more performed in the non-rebleeding group than the rebleeding group (81.8 vs 62.5 %, p < 0.001). In multivariate analysis, use of non-steroidal anti-inflammatory agents, larger transfusion volume (≥5 units), and non-performance of second look endoscopy were found as risk factors for rebleeding in high risk peptic ulcer bleeding. In our study, rebleeding was observed in 9.2 % of patients with high risk peptic ulcer bleeding. Performance of second look endoscopy seems to lower the risk of rebleeding in high risk peptic ulcer bleeding patients and caution should be paid to patients receiving high volume transfusion and on medication with NSAIDs.

A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, 2005-2008.

PubMed

Balcázar, Héctor G; de Heer, Hendrik; Rosenthal, Lee; Aguirre, Melissa; Flores, Leticia; Puentes, Flor A; Cardenas, Victor M; Duarte, Maria O; Ortiz, Melchor; Schulz, Leslie O

2010-03-01

The high prevalence of cardiovascular disease (CVD) in the Hispanic population of the United States, together with low rates of health insurance coverage, suggest a potential cardiovascular health crisis. The objective of Project HEART (Health Education Awareness Research Team) was to promote behavior changes to decrease CVD risk factors in a high-risk Hispanic border population. Project HEART took place from 2005 through 2008 as a randomized community trial with a community-based participatory research framework using promotores de salud (community health workers). A total of 328 participants with at least 1 CVD risk factor were selected by randomizing 10 US Census tracts in El Paso, Texas, to either the experimental or the control group. The experimental group (n = 192) was assigned to a series of 8 health classes using the Su Corazón, Su Vida curriculum. After 2 months of educational sessions, the group was followed for 2 months. The control group (n = 136) was given basic educational materials at baseline, and no other intervention was used. Main outcomes of interest included changes in health behaviors and clinical measures. Participants in the experimental group showed more awareness of CVD risk factors, more confidence in the control of these factors, and improved dietary habits (ie, lower salt and cholesterol intake, better weight-control practices) compared with the control group. Total cholesterol was 3% lower in the experimental than in the control participants, and nonhigh-density lipoprotein cholesterol and low-density lipoprotein cholesterol were both 5% lower. The HEART trial suggests that community health education using promotores de salud is a viable strategy for CVD risk reduction in a Hispanic border community.

Compassion fatigue, burnout, and compassion satisfaction among Colorado child protection workers.

PubMed

Conrad, David; Kellar-Guenther, Yvonne

2006-10-01

The goal of this study was to understand better the risk of compassion fatigue (the trauma suffered by the helping professional) and burnout (emotional exhaustion, depersonalization, and reduced sense of personal accomplishment), and the potential for compassion satisfaction (the fulfillment from helping others and positive collegial relationships) among Colorado county child protection staff using the Compassion Satisfaction/Fatigue Self-Test [Figley, C. R., & Stamm, B. H. (1996). Psychometric review of Compassion Fatigue Self-Test. In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 127-130). Lutherville, MD: Sidran Press]. An additional goal was to test the relationship of these three constructs to each other. A self-report instrument developed by Stamm and Figley was used to measure the risk of compassion fatigue and burnout and the potential for compassion satisfaction among 363 child protection staff participating in a secondary trauma training seminar. Participants were significantly more likely to have high risk of compassion fatigue, extremely low risk of burnout, and good potential for compassion satisfaction. Participants with high compassion satisfaction had lower levels of compassion fatigue (p=.000; mean=35.73 high compassion satisfaction group, mean=43.56 low group) and lower levels of burnout (p=.000; mean=32.99 high compassion satisfaction group, mean=41.69 low group). Approximately 50% of Colorado county child protection staff suffered from "high" or "very high" levels of compassion fatigue. The risk of burnout was considerably lower. More than 70% of staff expressed a "high" or "good" potential for compassion satisfaction. We believe compassion satisfaction may help mitigate the effects of burnout.

Oral health status of women with high-risk pregnancies.

PubMed

Merglova, Vlasta; Hecova, Hana; Stehlikova, Jaroslava; Chaloupka, Pavel

2012-12-01

The aim of this study was to investigate the oral health status of women with high-risk pregnancies. A case-control study of 142 pregnant women was conducted. The case group included 81 pregnant women with high-risk pregnancies, while 61 women with normal pregnancies served as controls. The following variables were recorded for each woman: age, general health status, DMF, CPITN, and PBI index, amounts of Streptococcus mutans in the saliva and dental treatment needs. The Mann-Whitney test, Kruskal-Wallis test, t-test and chi-squared test were used for statistical analyses. Statistically significant differences were detected between the PBI indices and dental treatment needs of the two groups. Out of the entire study cohort, 77% of the women in the case group and 52% of the women in the control group required dental treatment. In this study, women with complications during pregnancy had severe gingivitis and needed more frequent dental treatment than those in the control group.

Parent Training with High-Risk Immigrant Chinese Families: A Pilot Group Randomized Trial Yielding Practice-Based Evidence

ERIC Educational Resources Information Center

Lau, Anna S.; Fung, Joey J.; Ho, Lorinda Y.; Liu, Lisa L.; Gudino, Omar G.

2011-01-01

We studied the efficacy and implementation outcomes of a culturally responsive parent training (PT) program. Fifty-four Chinese American parents participated in a wait-list controlled group randomized trial (32 immediate treatment, 22 delayed treatment) of a 14-week intervention designed to address the needs of high-risk immigrant families.…

Determinants of Parental Acceptance of the H1N1 Vaccine

ERIC Educational Resources Information Center

Hilyard, Karen M.; Quinn, Sandra Crouse; Kim, Kevin H.; Musa, Don; Freimuth, Vicki S.

2014-01-01

Although designated as a high-risk group during the 2009-2010 H1N1 pandemic, only about 40% of U.S. children received the vaccine, a relatively low percentage compared with high-risk groups in seasonal influenza, such as the elderly, whose vaccine rates typically top 70%. To better understand parental decision making and predictors of acceptance…

Suicidal ideation and suicide attempts among Hispanic subgroups in the United States: 1991–1992 and 2001–2002

PubMed Central

Baca-Garcia, Enrique; Perez-Rodriguez, M. Mercedes; Keyes, Katherine M.; Oquendo, Maria A.; Hasin, Deborah S.; Grant, Bridget F.; Blanco, Carlos

2010-01-01

Objective To compare the prevalence of suicidal ideation/attempts among Hispanic subgroups in the US in 1991–1992 and 2001–2002, and identify high-risk groups. Method Data were drawn from the 1991–1992 National Longitudinal Alcohol Epidemiologic Survey (NLAES, n=42,862) and the 2001–2002 National Epidemiological Survey on Alcohol and Related Conditions (NESARC,n=43,093), two nationally representative surveys of individuals aged 18 years and older. Results 1) Puerto Ricans are the Hispanic ethnic subgroup with the highest rates of suicide attempts; 2) 45- to 64-year-old Puerto Rican women are a high- risk group for suicide attempts; 3) Over the 10 year period between the two surveys, the lifetime prevalence of suicide attempts significantly increased among 18- to 24-year-old Puerto Rican women and Cuban men, and among 45- to 64-year-old Puerto Rican men. Conclusion Hispanics in the US are not a homogeneous group. We identify high-risk groups among Hispanics. Specific interventions for subgroups of Hispanics at high risk for suicidal behaviors may be required. PMID:20937507

Differentiating the levels of risk for muscle dysmorphia among Hungarian male weightlifters: a factor mixture modeling approach.

PubMed

Babusa, Bernadett; Czeglédi, Edit; Túry, Ferenc; Mayville, Stephen B; Urbán, Róbert

2015-01-01

Muscle dysmorphia (MD) is a body image disturbance characterized by a pathological preoccupation with muscularity. The study aimed to differentiate the levels of risk for MD among weightlifters and to define a tentative cut-off score for the Muscle Appearance Satisfaction Scale (MASS) for the identification of high risk MD cases. Hungarian male weightlifters (n=304) completed the MASS, the Exercise Addiction Inventory, and specific exercise and body image related questions. For the differentiation of MD, factor mixture modeling was performed, resulting in three independent groups: low-, moderate-, and high risk MD groups. The estimated prevalence of high risk MD in this sample of weightlifters was 15.1%. To determine a cut-off score for the MASS, sensitivity and specificity analyses were performed and a cut-off point of 63 was suggested. The proposed cut-off score for the MASS can be useful for the early detection of high risk MD. Copyright © 2014 Elsevier Ltd. All rights reserved.

TOO COOL FOR SCHOOL? VIOLENCE, PEER STATUS, AND HIGH SCHOOL DROPOUT*

PubMed Central

Staff, Jeremy; Kreager, Derek A.

2014-01-01

Research shows that peer status in adolescence is positively associated with school achievement and adjustment. However, subculture theories of juvenile delinquency and school-based ethnographies suggest that (1) disadvantaged boys are often able to gain some forms of peer status through violence and (2) membership in violent groups undermines educational attainment. Building on these ideas, we use peer network data from the National Longitudinal Study of Adolescent Health (Add Health) to examine whether peer status within highly violent groups increases male risks of high school dropout. Consistent with the subcultural argument, we find that disadvantaged boys with high status in violent groups are at much greater risks of high school dropout than other students. PMID:25484458

Effect of postoperative goal-directed therapy in cancer patients undergoing high-risk surgery: a randomized clinical trial and meta-analysis.

PubMed

Gerent, Aline Rejane Muller; Almeida, Juliano Pinheiro; Fominskiy, Evgeny; Landoni, Giovanni; de Oliveira, Gisele Queiroz; Rizk, Stephanie Itala; Fukushima, Julia Tizue; Simoes, Claudia Marques; Ribeiro, Ulysses; Park, Clarice Lee; Nakamura, Rosana Ely; Franco, Rafael Alves; Cândido, Patricia Inês; Tavares, Cintia Rosa; Camara, Ligia; Dos Santos Rocha Ferreira, Graziela; de Almeida, Elisangela Pinto Marinho; Filho, Roberto Kalil; Galas, Filomena Regina Barbosa Gomes; Hajjar, Ludhmila Abrahão

2018-05-23

Perioperative goal-directed hemodynamic therapy (GDHT) has been advocated in high-risk patients undergoing noncardiac surgery to reduce postoperative morbidity and mortality. We hypothesized that using cardiac index (CI)-guided GDHT in the postoperative period for patients undergoing high-risk surgery for cancer treatment would reduce 30-day mortality and postoperative complications. A randomized, parallel-group, superiority trial was performed in a tertiary oncology hospital. All adult patients undergoing high-risk cancer surgery who required intensive care unit admission were randomly allocated to a CI-guided GDHT group or to a usual care group. In the GDHT group, postoperative therapy aimed at CI ≥ 2.5 L/min/m 2 using fluids, inotropes and red blood cells during the first 8 postoperative hours. The primary outcome was a composite endpoint of 30-day all-cause mortality and severe postoperative complications during the hospital stay. A meta-analysis was also conducted including all randomized trials of postoperative GDHT published from 1966 to May 2017. A total of 128 patients (64 in each group) were randomized. The primary outcome occurred in 34 patients of the GDHT group and in 28 patients of the usual care group (53.1% vs 43.8%, absolute difference 9.4 (95% CI, - 7.8 to 25.8); p = 0.3). During the 8-h intervention period more patients in the GDHT group received dobutamine when compared to the usual care group (55% vs 16%, p < 0.001). A meta-analysis of nine randomized trials showed no differences in postoperative mortality (risk ratio 0.85, 95% CI 0.59-1.23; p = 0.4; p for heterogeneity = 0.7; I 2  = 0%) and in the overall complications rate (risk ratio 0.88, 95% CI 0.71-1.08; p = 0.2; p for heterogeneity = 0.07; I 2  = 48%), but a reduced hospital length of stay in the GDHT group (mean difference (MD) - 1.6; 95% CI - 2.75 to - 0.46; p = 0.006; p for heterogeneity = 0.002; I 2  = 74%). CI-guided hemodynamic therapy in the first 8 postoperative hours does not reduce 30-day mortality and severe complications during hospital stay when compared to usual care in cancer patients undergoing high-risk surgery. www.clinicaltrials.gov , NCT01946269 . Registered on 16 September 2013.

Elective neck irradiation on ipsilateral side in patients with early tongue cancer for high-risk group with late cervical lymph node metastasis.

PubMed

Ito, Yoshiyuki; Fuwa, Nobukazu; Kikuchi, Yuzo; Yokoi, Norio; Hamajima, Nobuyuki; Morita, Kozo

2006-01-01

A prospective study was performed to assess the efficacy of elective neck irradiation (ENI) on the ipsilateral side in patients with early tongue cancer among a high-risk group with late cervical lymph node metastasis. Patients in the high-risk group had T2-tumors, excluding superficials or T1-tumors > or =19 mm in maximal diameter with invasion or ulcer. Between February 1989 and October 1997, 70 patients with tongue cancer of Stages I and II were enrolled in the present study (ENI group: 31, non-ENI group: 39). In a combination therapy of external beam irradiation and brachytherapy, the standard dose of interstitial brachytherapy for primary tumors was approximately 60 Gy. Irradiation was initiated with a 9-MeV electron beam at a dose of 50 Gy on the ipsilateral side of the neck only when the day of brachytherapy approached. Three patients (9.7%) in the ENI group had neck lymph node metastasis as did 5 (12.8%) in the non-ENI group (p= 0.684). In patients with ulceration, the incidence of subsequent lymph node metastasis was significantly higher (p=0.029). Neck lymph node metastasis occurred in 2 (16.7%) of 12 patients with ulcers in the ENI group and in 2 (66.7%) of 3 with ulcers in the non-ENI group. Although we could not demonstrate the significant efficacy of ENI in the high-risk group in this study, ENI decreased the neck lymph node metastasis. In addition, our results suggested that ENI particularly inhibits cervical lymph node metastasis in tongue tumor patients with ulcers.

[Prevalence of risk factors and mechanisms of transmission of acute viral hepatitis type B and C in Bucharest municipality: 2001-2008].

PubMed

Ion-Nedelcu, Niculae; Iordăchescu, Corina; Gherasim, Patricia; Mihailovici, Rodica; Dragomirescu, Cornelia; Dumitrache-Marian, Ruxanda; Moculescu, Cristina

2009-01-01

Analysis of risk factors for achieving clinically overt hepatitis B and hepatitis C in the population of Bucharest municipality. retrospective and descriptive study on hospital patients cohort. Cases - in the study have been enrolled all acute viral hepatitis B and C confirmed by the two infectious diseases university clinics of Bucharest municipality, during the time interval 2001-2008, among the residents of the municipality. Infection risk factors - for every case of hepatitis B and hepatitis C with the simptoms onset placed during the time interval 2001-2008, it was associated "the most plausible" risk factor, detected by case investigation. For contemplation of control strategies the risk factors were stratified by mechanisms of virus transmission and by age groups. The analysis consists mainly in statistical comparing of cases prevalence in each etiology by risk factors and mechanisms of visus transmission. Patients cohort included 1440 hepatitis B cases and 227 hepatitis C cases, respectively. The most prevalent individual risk factor in hepatitis B was the sexual contact with multiple partners (51,0%) while in hepatitis C the use of ilegal injectable drugs (46,3%). The prevalences of hepatitis B and hepatitis C cases by the four mechanisms of virus transmmission were similar (p = 0,52). For both etiologies the high risk behaviours represented the principal mechanism of virus transmission (64,1% in hepatitis B and 63,4% in hepatitis C, respectively); additionaly, for both etiologies the most prevalent mechanisms of virus transmission by age groups were indentically, namely: (a) consumption of medical services in the age group 55+ years, (b) high risk behaviours in the age group 13-54 years and (c) contact with case or virus carrier in the age group 0-12 years, respectively. in the time period 2001 - 2008 the structure by mechanisms of virus transmission in hepatitis B and hepatitis C cases reported in the population of Bucharest municipaly was statistically similar, for both etiologies the most prevalent mechanism (> 60%) was represented by high risk behaviours. This reality strongly suggests that additionaly to the current strategies for prevention of the infection with hepatitic visuses B and C, the decisive strategy to control of the two infection needs to be extended with an effective education satelite focused on high risk groups.

Prevalence of human papillomavirus infection of the anal canal in women: A prospective analysis of high-risk populations.

PubMed

Kost, Bernd P; Hofmann, Jörg; Stoellnberger, Susanne; Bergauer, Florian; Blankenstein, Thomas; Alba-Alejandre, Irene; Stein, Angela; Stuckart, Claudia; Weizsäcker, Katharina; Mylonas, Ioannis; Mahner, Sven; Gingelmaier, Andrea

2017-04-01

Infection with certain types of human papillomavirus (HPV) has been associated with the development of cervical and anal cancer. Worldwide, the incidence of anal cancer has increased markedly. The present study aimed to evaluate the prevalence of HPV infection of the uterine cervix and anal canal in human immunodeficiency virus (HIV)- and non-HIV-infected risk populations. Cervical and anal HPV swabs and cytology samples were collected from 287 patients at the University Hospital of Munich, Germany between 2011 and 2013. Patients were divided into HIV-negative controls (G1) and two risk groups, including HIV-negative patients with cytological abnormalities of the cervix (G2) and HIV-infected patients (G3). Data, including clinical parameters, were analysed. The risk groups had significantly more positive results for HPV in the anus (71.03 and 83.15% for G2 and G3, respectively), as compared with G1. The predominant HPV genotypes found in the anus were high-risk HPV genotypes, which were significantly correlated with concomittant cervical HPV findings. In the risk groups, a significant association between the cytological findings and HPV detection in the cervix was found, while the results of the anus revealed no significance. The results of the present study suggested that the prevalence of HPV infection in the anal canal of risk populations is high. Furthermore, patients with abnormal cervical cytology results and HIV-infected women, irrespective of their individual cervical findings, may have a risk of concomittant anal high-risk HPV infection. Based on the predominant HPV genotypes found in the study, HPV vaccination could reduce the incidence of anal cancer. Nevertheless, high-risk patients should be intensively screened for anal squamous intraepithelial abnormalities to avoid invasive cancer stages.

Prevalence of human papillomavirus infection of the anal canal in women: A prospective analysis of high-risk populations

PubMed Central

Kost, Bernd P.; Hofmann, Jörg; Stoellnberger, Susanne; Bergauer, Florian; Blankenstein, Thomas; Alba-Alejandre, Irene; Stein, Angela; Stuckart, Claudia; Weizsäcker, Katharina; Mylonas, Ioannis; Mahner, Sven; Gingelmaier, Andrea

2017-01-01

Infection with certain types of human papillomavirus (HPV) has been associated with the development of cervical and anal cancer. Worldwide, the incidence of anal cancer has increased markedly. The present study aimed to evaluate the prevalence of HPV infection of the uterine cervix and anal canal in human immunodeficiency virus (HIV)- and non-HIV-infected risk populations. Cervical and anal HPV swabs and cytology samples were collected from 287 patients at the University Hospital of Munich, Germany between 2011 and 2013. Patients were divided into HIV-negative controls (G1) and two risk groups, including HIV-negative patients with cytological abnormalities of the cervix (G2) and HIV-infected patients (G3). Data, including clinical parameters, were analysed. The risk groups had significantly more positive results for HPV in the anus (71.03 and 83.15% for G2 and G3, respectively), as compared with G1. The predominant HPV genotypes found in the anus were high-risk HPV genotypes, which were significantly correlated with concomittant cervical HPV findings. In the risk groups, a significant association between the cytological findings and HPV detection in the cervix was found, while the results of the anus revealed no significance. The results of the present study suggested that the prevalence of HPV infection in the anal canal of risk populations is high. Furthermore, patients with abnormal cervical cytology results and HIV-infected women, irrespective of their individual cervical findings, may have a risk of concomittant anal high-risk HPV infection. Based on the predominant HPV genotypes found in the study, HPV vaccination could reduce the incidence of anal cancer. Nevertheless, high-risk patients should be intensively screened for anal squamous intraepithelial abnormalities to avoid invasive cancer stages. PMID:28454426

Prevalence by Computed Tomographic Angiography of Coronary Plaques in South Asian and White Patients With Type 2 Diabetes Mellitus at Low and High Risk Using Four Cardiovascular Risk Scores (UKPDS, FRS, ASCVD, and JBS3).

PubMed

Gobardhan, Sanjay N; Dimitriu-Leen, Aukelien C; van Rosendael, Alexander R; van Zwet, Erik W; Roos, Cornelis J; Oemrawsingh, Pranobe V; Kharagjitsingh, Aan V; Jukema, J Wouter; Delgado, Victoria; Schalij, Martin J; Bax, Jeroen J; Scholte, Arthur J H A

2017-03-01

The aim of this study was to explore the association between various cardiovascular (CV) risk scores and coronary atherosclerotic burden on coronary computed tomography angiography (CTA) in South Asians with type 2 diabetes mellitus and matched whites. Asymptomatic type 2 diabetic South Asians and whites were matched for age, gender, body mass index, hypertension, and hypercholesterolemia. Ten-year CV risk was estimated using different risk scores (United Kingdom Prospective Diabetes Study [UKPDS], Framingham Risk Score [FRS], AtheroSclerotic CardioVascular Disease [ASCVD], and Joint British Societies for the prevention of CVD [JBS3]) and categorized into low- and high-risk groups. The presence of coronary artery calcium (CAC) and obstructive coronary artery disease (CAD; ≥50% stenosis) was assessed using coronary CTA. Finally, the relation between coronary atherosclerosis on CTA and the low- and high-risk groups was compared. UKPDS, FRS, and ASCVD showed no differences in estimated CV risk between 159 South Asians and 159 matched whites. JBS3 showed a significant greater absolute CV risk in South Asians (18.4% vs 14.2%, p <0.01). Higher presence of CAC score >0 (69% vs 55%, p <0.05) and obstructive CAD (39% vs 27%, p <0.05) was observed in South Asians. South Asians categorized as high risk, using UKPDS, FRS, and ASCVD, showed more CAC and CAD compared than whites. JBS3 showed no differences. In conclusion, asymptomatic South Asians with type 2 diabetes mellitus more frequently showed CAC and obstructive CAD than matched whites in the population categorized as high-risk patients using UKPDS, FRS, and ASCVD as risk estimators. However, JBS3 seems to correlate best to CAC and CAD in both ethnicity groups compared with the other risk scores. Copyright © 2016 Elsevier Inc. All rights reserved.

Strategy for distribution of influenza vaccine to high-risk groups and children.

PubMed

Longini, Ira M; Halloran, M Elizabeth

2005-02-15

Despite evidence that vaccinating schoolchildren against influenza is effective in limiting community-level transmission, the United States has had a long-standing government strategy of recommending that vaccine be concentrated primarily in high-risk groups and distributed to those people who keep the health system and social infrastructure operating. Because of this year's influenza vaccine shortage, a plan was enacted to distribute the limited vaccine stock to these groups first. This vaccination strategy, based on direct protection of those most at risk, has not been very effective in reducing influenza morbidity and mortality. Although it is too late to make changes this year, the current influenza vaccine crisis affords the opportunity to examine an alternative for future years. The alternative plan, supported by mathematical models and influenza field studies, would be to concentrate vaccine in schoolchildren, the population group most responsible for transmission, while also covering the reachable high-risk groups, who would also receive considerable indirect protection. In conjunction with a plan to ensure an adequate vaccine supply, this alternative influenza vaccination strategy would help control interpandemic influenza and be instrumental in preparing for pandemic influenza. The effectiveness of the alternative plan could be assessed through nationwide community studies.

[The PreFord Study. A prospective cohort study to evaluate the risk of a cardiovascular event (overall-collective) as well as a prospective, randomized, controlled, multicentre clinical intervention study (high-risk-collective) on primary prevention of cardiovascular diseases in the Ford Motor Company employees in Germany].

PubMed

Gysan, D B; Latsch, J; Bjarnason-Wehrens, B; Albus, C; Falkowski, G; Herold, G; Mey, E; Heinzler, R; Montiel, G; Schneider, C A; Stützer, H; Türk, S; Weisbrod, M; Predel, H G

2004-02-01

The PreFord Study is a multicenter prospective cohort study to evaluate guideline based risk management on primary prevention of cardiovascular diseases. Furthermore a randomised controlled trial (RCT) will be designed to analyse the effect of a special intervention program. 40,000 employees of the Ford Motor Company, Visteon Company and Deutz Company in Germany will be included, monitored for ten years and the following primary endpoints will be investigated: 1. evaluation and comparison of established and newly developed risk-scores, 2. the relative impact of single and combined cardiovascular risk factors on cardiovascular diseases, 3. the influence of a novel occupationally integrated ambulant rehabilitation program in combination with a guideline oriented optimal drug therapy within a high risk group on the primary endpoint: risk reduction by, 4. the influence of this intervention on secondary endpoints: death, myocardial infarction and stroke, combined appearance of angina pectoris and hospitalisation, occurrence of cerebral circulatory disorder and hospitalisation, occurrence of peripheral occlusive arterial disease and hospitalisation and single cardiovascular risk factors and cost-benefit-analysis. Beginning with an cross sectional study there will be a systemic screening of cardiovascular risk profiles, of anthropometric data and different lifestyle-factors. Based on these data participants will be differentiated into three risk-groups according to the risk score of the European Society of Cardiology (risk of a lethal primary acute cardiovascular event: I < or = 1%; II > 1-< 5% and III > or = 5%). In the following longitudinal study different strategies will be applied: Group I: low risk (< 0.5% per year): repetition of the investigation after five and ten years. Group II: middle risk, (0.6% to 1.4% per year), repetition of the investigation every two years, instruction of the patients general practitioner (GP) with respect to a risk factor oriented and evidence based treatment. Group III: high risk, (> 1.5% per year or >15% within the next 10 years) will be randomised into two interventional groups. The first one, the intervention-group "PreFord" will perform an occupational integrated rehabilitation program (2,5-3 hours twice a week, for 15 weeks according to the BAR guidelines) with a following engagement in heart-groups and an annual repetition of the check-ups. The second group, the "classic" intervention-group will be treated evidence based in cooperation with their GP. As a result of this long term interventional study efficient, area wide implementable and economically feasible prevention concepts with special regards to operational healthcare will be developed and evaluated. Core elements will be exercise- and lifestyle-oriented concepts as well as guideline-based pharmacotherapy.

Schizophrenia in High-Risk Children: Sex Differences in Predisposing Factors.

ERIC Educational Resources Information Center

Mednick, Sarnoff A.; And Others

Reported is a research program to observe children at high risk for schizophrenia and explore possibilities of prevention. Characteristics of the high risk group (n=207) observed during 1962 are discussed, and a theory which suggests that schizophrenia is an evasion of life is explained. Among results of a diagnostic assessment conducted 10 years…

On the Association between Sexual Attraction and Adolescent Risk Behavior Involvement: Examining Mediation and Moderation

ERIC Educational Resources Information Center

Busseri, Michael A.; Willoughby, Teena; Chalmers, Heather; Bogaert, Anthony F.

2008-01-01

On the basis of a large-scale survey of high-school youth, the authors compared adolescents reporting exclusively heterosexual, mostly heterosexual, bisexual, and predominately same-sex attraction based on high-risk involvement across a range of risk behaviors. Bisexual and same-sex attracted groups were characterized by heightened high-risk…

Shear-reducing insoles to prevent foot ulceration in high-risk diabetic patients.

PubMed

Lavery, Lawrence A; LaFontaine, Javier; Higgins, Kevin R; Lanctot, Dan R; Constantinides, George

2012-11-01

To enhance the learner's competence with knowledge of the effectiveness of shear-reducing insoles for prevention of foot ulceration in patients with high-risk diabetes. This continuing education activity is intended for physicians and nurses with an interest in skin and wound care. After participating in this educational activity, the participant should be better able to:1. Demonstrate knowledge of foot ulceration risk, risk factors, incidence, and prevention.2. Apply knowledge gained from reviewing this study and a literature review about the use of shear-reducing insoles to patient scenarios. The objective of this study was to evaluate the effectiveness of a shear-reducing insole compared with a standard insole design to prevent foot ulceration in high-risk patients with diabetes. A total of 299 patients with diabetic neuropathy and loss of protective sensation, foot deformity, or history of foot ulceration were randomized into a standard therapy group (n = 150) or a shear-reducing insole group (n = 149). Patients were evaluated for 18 months. Standard therapy group consisted of therapeutic footwear, diabetic foot education, and regular foot evaluation by a podiatrist. The shear-reducing insole group included a novel insole designed to reduce both pressure and shear on the sole of the foot. Insoles were replaced every 4 months in both groups. The primary clinical outcome was foot ulceration. The authors used Cox proportional hazards regression to evaluate time to ulceration. There were 2 significant factors from the Cox regression model: insole treatment and history of a foot complication. The standard therapy group was about 3.5 times more likely to develop an ulcer compared with shear-reducing insole group (hazard ratio, 3.47; 95% confidence interval, 0.96-12.67). These results suggest that a shear-reducing insole is more effective than traditional insoles to prevent foot ulcers in high-risk persons with diabetes.

Individuals at high risk for suicide are categorically distinct from those at low risk.

PubMed

Witte, Tracy K; Holm-Denoma, Jill M; Zuromski, Kelly L; Gauthier, Jami M; Ruscio, John

2017-04-01

Although suicide risk is often thought of as existing on a graded continuum, its latent structure (i.e., whether it is categorical or dimensional) has not been empirically determined. Knowledge about the latent structure of suicide risk holds implications for suicide risk assessments, targeted suicide interventions, and suicide research. Our objectives were to determine whether suicide risk can best be understood as a categorical (i.e., taxonic) or dimensional entity, and to validate the nature of any obtained taxon. We conducted taxometric analyses of cross-sectional, baseline data from 16 independent studies funded by the Military Suicide Research Consortium. Participants (N = 1,773) primarily consisted of military personnel, and most had a history of suicidal behavior. The Comparison Curve Fit Index values for MAMBAC (.85), MAXEIG (.77), and L-Mode (.62) all strongly supported categorical (i.e., taxonic) structure for suicide risk. Follow-up analyses comparing the taxon and complement groups revealed substantially larger effect sizes for the variables most conceptually similar to suicide risk compared with variables indicating general distress. Pending replication and establishment of the predictive validity of the taxon, our results suggest the need for a fundamental shift in suicide risk assessment, treatment, and research. Specifically, suicide risk assessments could be shortened without sacrificing validity, the most potent suicide interventions could be allocated to individuals in the high-risk group, and research should generally be conducted on individuals in the high-risk group. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Are air-conditioning maintenance personnel at increased risk of Legionellosis?

PubMed

Goldman, W D; Marr, J S

1980-07-01

We surveyed by use of medical questionnaires and blood tests 21 maintenance workers involved with cleaning and servicing cooling towers and evaporative condensers at a large company to determine the frequency of pneumonia and antibody levels against Legionella pneumophila serogroup 1. The 21 high-risk workers were compared with 27 low-risk workers, persons who were not directly involved in service or maintenance for the company. The overall prevalence of titers greater than or equal to 128 for the 21 high-risk workers was 19.0% compared with 22.2% for the low-risk group. There were no significant differences in the history of pneumonia between these groups. Possible explanations for these findings are discussed.

Cancer-specific mortality, cure fraction, and noncancer causes of death among diffuse large B-cell lymphoma patients in the immunochemotherapy era.

PubMed

Howlader, Nadia; Mariotto, Angela B; Besson, Caroline; Suneja, Gita; Robien, Kim; Younes, Naji; Engels, Eric A

2017-09-01

Survival after the diagnosis of diffuse large B-cell lymphoma (DLBCL) has been increasing since 2002 because of improved therapies; however, long-term outcomes for these patients in the modern treatment era are still unknown. Using Surveillance, Epidemiology, and End Results data, this study first assessed factors associated with DLBCL-specific mortality during 2002-2012. An epidemiologic risk profile, based on clinical and demographic characteristics, was used to stratify DLBCL cases into low-, medium-, and high-risk groups. The proportions of DLBCL cases that might be considered cured in these 3 risk groups was estimated. Risks of death due to various noncancer causes among DLBCL cases versus the general population were also calculated with standardized mortality ratios (SMRs). Overall, 8274 deaths were recorded among 18,047 DLBCL cases; 76% of the total deaths were attributed to DLBCL, and 24% were attributed to noncancer causes. The 10-year survival rates for the low-, medium-, and high-risk groups were 80%, 60%, and 36%, respectively. The estimated cure proportions for the low-, medium-, and high-risk groups were 73%, 49%, and 27%, respectively; however, these cure estimates were uncertain because of the need to extrapolate the survival curves beyond the follow-up time. Mortality risks calculated with SMRs were elevated for conditions including vascular diseases (SMR, 1.3), infections (SMR, 3.1), gastrointestinal diseases (SMR, 2.5), and blood diseases (SMR, 4.6). These mortality risks were especially high within the initial 5 years after the diagnosis and declined after 5 years. Some DLBCL patients may be cured of their cancer, but they continue to experience excess mortality from lymphoma and other noncancer causes. Cancer 2017;123:3326-34. © 2017 American Cancer Society. © 2017 American Cancer Society.

Gambling Responsibly: Who Does It and To What End?

PubMed

Hing, Nerilee; Sproston, Kerry; Tran, Katherine; Russell, Alex M T

2017-03-01

Numerous responsible gambling (RG) strategies are promoted to assist consumers to "gamble responsibly". However, consumer adoption of RG strategies, how this varies by gambler risk group, and whether usage is associated with non-problematic gambling are largely unknown. This study aimed to (1) determine how use of RG-related strategies differs amongst regular gamblers by gambler risk group; and (2) identify RG-related strategies whose usage predicts non-problem/low risk gambling. Regular Australian gamblers on high-risk products (N = 860), recruited through gambling venues and an online wagering operator, were surveyed about their use of RG strategies promoted on the website of their jurisdiction's main RG agency. Knowledge of RG strategies was reasonably high amongst all gambler risk groups, but lower-risk groups were more likely to use RG strategies. A logistic regression correctly predicted 82.1 % of lower-risk gamblers and 77.2 % of higher-risk gamblers. Predictors of lower-risk gambling included: greater confidence in their understanding of RG; endorsement of lower gambling expenditure and frequency limits; fewer erroneous gambling beliefs; being less likely to gamble to win money, challenge their skills/beat the odds, or forget about worries and stresses; and being more likely to gamble for pleasure/entertainment. Lower-risk gamblers were more likely to set a money limit in advance of gambling and to balance their gambling with other activities. These findings contribute to understanding which strategies are favoured by different risk groups, and which are associated with safer levels of gambling. They can guide consumer information aimed at enhancing RG consumption and future research on RG consumption.

[Preventive efficacy of ondansetron and granisetron for postoperative nausea and vomiting in high risk patients].

PubMed

Quan, Xiang; Zhu, Bo; Ye, Tie-hu

2011-08-01

To compare the efficacy of ondansetron and granisetron in the prevention of postoperative nausea and vomiting (PONV) in high-risk patients. Totally 200 patients with three key risk factors for PONV (female, non-smoking and postoperative opioid use) were equally randomized into ondansetron group and granisetron group. Ondansetron (4 mg) or granisetron (3 mg) was intravenously administered upon the completion of surgery. The episodes of nausea and vomiting were observed for 24 hours after surgery. A significantly greater proportion of patients in granisetron group achieved a complete response (i.e., no PONV or rescue medication) during the first 24 hours postoperatively versus those in ondansetron group (62.6% vs. 46.9%, respectively; P=0.048). There were no significant differences in terms of postoperative nausea incidences (42.9% vs. 34.3%, respectively), postoperative vomiting incidences (25.5% vs. 20.2%, respectively) and postoperative rescue anti-emetics incidences (19.4% vs. 15.2%, respectively) (P>0.05). Granisetron is more effective than ondansetron in preventing PONV in high-risk patients during the first 24 hours postoperatively.

[GST genes expression as prognostic factor in papillary thyroid cancer].

PubMed

Gonçalves, Antonio Jose; Monte, Osmar; Morari, Eliane Cristina; Ward, Laura Sterian; Nakasako, Diana Shimoda; Nieto, Juliana; Nakai, Marianne Yumi

2009-01-01

Analyze the relationship between the AMES classification and molecular factors from Glutation-S-Transferase System, specifically the GSTT1 and GSTM1 in patients with well differentiated thyroid cancer. Samples of thyroid tissue of 66 patients with papillary thyroid carcinoma were obtained (53 women and 13 men). Patients were divided in two groups (high and low risk) according to the AMES classification. In each group, presence of the null genotype of both GST enzymes system was studied. These results were compared with the AMES classification. Samples were obtained in the operating room immediately after thyroidectomy, placed in cryotubes, immersed in liquid nitrogen and stored in a freezer at -80 masculineC. DNA of this enzymes was extracted by the fenol-cloroformium method. There were 17 high risk patients and 49 low risk patients. The null genotype of the high risk group was 5.8% and in the other group was 6.1%. There was no relationship between absence of genes GSTT1 and GSTM1 and prognosis of the papillary thyroid carcinoma when compared to the AMES classifications.

[CEA, CA-19-9 and il-8, sTNFRII and sil-2R in persons at high risk of colorectal cancer].

PubMed

Grotowski, Maciej; Wojtuń, Stanisław

2003-04-01

The aim of the study was to determine whether elevated concentrations of CEA, CA19-9, IL-8, sTNFRII and sIL-2R occur in persons at high risk of colorectal cancer. A group of 37 persons at high risk of colorectal cancer and 40 healthy subjects (control group) were included into this study. In both groups IL-8, sTNFRII and sIL-2R concentrations were measured by ELISA method (R&D Systems Minneapolis, USA). In the group of persons at high risk of colorectal cancer CEA and CA19-9 concentrations were determined using MEIA kits (Abbott Laboratories, USA). Using the 95th percentiles of the distribution in the control group the upper normal limits of IL-8, sTN-FRII and sIL-2R values were calculated. The cut-off value for CEA was 3 ng/ml and that for CA 19-9 was 37 U/ml. The incidence of elevated concentrations of the studied factors and concentrations of CEA and CA19-9 was compared. The association was assessed of elevated concentrations of the studied factors and CEA and CA19-9 with the results of histological examination of pathological changes in the colon and rectum. In the group of persons at high risk of colorectal cancer only CEA concentration was elevated in 2.7%. The percentages of persons with elevated concentrations of IL-8, sIL-2R and sTNFRII were 29.7, 8.1 and 18.9%, respectively. The percentage of persons with elevated concentrations of IL-8 and sTNFRII was higher in comparison with the percentage of persons with elevated concentrations of CEA and CA19-9 (p < 0.05). Pathological lesions in the colon and rectum were detected in 16 persons (43.2%). High-grade dysplasia was detected in 11 cases. Elevated concentration of IL-8 always accompanied high-grade dysplasia in ulcerative colitis. The concentrations of IL-8 were significantly higher in high-grade dysplasia (23.7 pg/ml, SD +/- 7.53) than in cases of its absence (18.9 pg/ml, SD +/- 3.53) (p < 0.05). The obtained results of preliminary studies with IL-8 in persons at high risk of colorectal cancer require a confirmation in population studies.

Addressing the issue of falls off playground equipment: an empirically-based intervention to reduce fall-risk behaviors on playgrounds.

PubMed

Morrongiello, Barbara A; Matheis, Shawn

2007-08-01

The present study evaluated the impact of an intervention to reduce fall-risk behaviors on playgrounds among children 6-11 years of age. Children completed posters indicating risky playground behaviors they would and would not do. In the intervention group, video and audio presentations were used to expose children to injury occurrences so that injury vulnerability was communicated in a fear-evoking way. In the control group, children only completed the pre- and post-intervention measures. Significant decreases in intentions to risk-take were obtained in the intervention, but not the control group. Effectiveness did not vary with children's age or sex, but was greater for those scoring high in sensation-seeking. A fear-appeals approach proved successful to reduce intended fall-risk behaviors, particularly for children high in sensation-seeking whose risk-taking is motivated by affect arousal.

Advances in Risk Classification and Treatment Strategies for Neuroblastoma

PubMed Central

Pinto, Navin R.; Applebaum, Mark A.; Volchenboum, Samuel L.; Matthay, Katherine K.; London, Wendy B.; Ambros, Peter F.; Nakagawara, Akira; Berthold, Frank; Schleiermacher, Gudrun; Park, Julie R.; Valteau-Couanet, Dominique; Pearson, Andrew D.J.

2015-01-01

Risk-based treatment approaches for neuroblastoma have been ongoing for decades. However, the criteria used to define risk in various institutional and cooperative groups were disparate, limiting the ability to compare clinical trial results. To mitigate this problem and enhance collaborative research, homogenous pretreatment patient cohorts have been defined by the International Neuroblastoma Risk Group classification system. During the past 30 years, increasingly intensive, multimodality approaches have been developed to treat patients who are classified as high risk, whereas patients with low- or intermediate-risk neuroblastoma have received reduced therapy. This treatment approach has resulted in improved outcome, although survival for high-risk patients remains poor, emphasizing the need for more effective treatments. Increased knowledge regarding the biology and genetic basis of neuroblastoma has led to the discovery of druggable targets and promising, new therapeutic approaches. Collaborative efforts of institutions and international cooperative groups have led to advances in our understanding of neuroblastoma biology, refinements in risk classification, and stratified treatment strategies, resulting in improved outcome. International collaboration will be even more critical when evaluating therapies designed to treat small cohorts of patients with rare actionable mutations. PMID:26304901

Outcome of focused pre-Ramadan education on metabolic and glycaemic parameters in patients with type 2 diabetes mellitus.

PubMed

El Toony, Lobna F; Hamad, Dina Ali; Omar, Omar Mohammed

2018-04-25

Ramadan fasting is associated with the risk of acute complications including hypoglycaemia. Therefore, patients' education before Ramadan and follow up during Ramadan is essential for safe fasting. To evaluate the effect of pre-Ramadan education program on biochemical parameters and the risk of hypoglycaemia in patients with type 2 diabetes mellitus. A prospective interventional controlled design was carried out on 320 Muslim patients with type 2 diabetes. They were divided into 2 groups; the control group (n = 200) who received standard diabetic care and the intervention group (n = 120) who received focused individualized diabetic education sessions before Ramadan. The study was carried out on 3 phases (before, during and after Ramadan). Post-education change of hypoglycaemia risk and biochemical parameters during Ramadan fasting were the primary outcomes. Fasting blood glucose decreased significantly during, and after Ramadan in both groups (P < 0.001). Hypoglycaemia during fasting occurred in 4.1% of patients in the intervention group vs. 19.5% in the control group. Post Ramadan reduction of HbA1c < 7% increased statistically significantly in the intervention group (from 20.8% of patients before Ramadan to 55.8% after Ramadan). Low-density lipoprotein cholesterol decreased in the intervention group (P = 0.024). The body weight of the patients did not significantly change in both groups. There was a significant impact of pre-Ramadan educational program on reduction of hypoglycaemic risk and other acute complications, reduction of low-density lipoprotein cholesterol and improvement of high-density lipoprotein cholesterol. Therefore, it is recommended for the fasting patients especially those with high and very high risk during Ramadan. Copyright © 2018. Published by Elsevier Ltd.

Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study.

PubMed

Parry, S; Denehy, L; Berney, S; Browning, L

2014-03-01

(1) To determine the ability of the Melbourne risk prediction tool to predict a pulmonary complication as defined by the Melbourne Group Scale in a medically defined high-risk upper abdominal surgery population during the postoperative period; (2) to identify the incidence of postoperative pulmonary complications; and (3) to examine the risk factors for postoperative pulmonary complications in this high-risk population. Observational cohort study. Tertiary Australian referral centre. 50 individuals who underwent medically defined high-risk upper abdominal surgery. Presence of postoperative pulmonary complications was screened daily for seven days using the Melbourne Group Scale (Version 2). Postoperative pulmonary risk prediction was calculated according to the Melbourne risk prediction tool. (1) Melbourne risk prediction tool; and (2) the incidence of postoperative pulmonary complications. Sixty-six percent (33/50) underwent hepatobiliary or upper gastrointestinal surgery. Mean (SD) anaesthetic duration was 377.8 (165.5) minutes. The risk prediction tool classified 84% (42/50) as high risk. Overall postoperative pulmonary complication incidence was 42% (21/50). The tool was 91% sensitive and 21% specific with a 50% chance of correct classification. This is the first study to externally validate the Melbourne risk prediction tool in an independent medically defined high-risk population. There was a higher incidence of pulmonary complications postoperatively observed compared to that previously reported. Results demonstrated poor validity of the tool in a population already defined medically as high risk and when applied postoperatively. This observational study has identified several important points to consider in future trials. Copyright © 2013 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

Reduced sleep quality in healthy girls at risk for depression

PubMed Central

CHEN, MICHAEL C.; BURLEY, HANNAH W.; GOTLIB, IAN H.

2011-01-01

SUMMARY Depression is characterized by sleep difficulties, but the extent to which subjective and objective sleep disturbances precede depression are unclear. This study was designed to examine perceptions of sleep quality in addition to actigraphy- and diary-measured sleep variables in healthy girls at low and high familial risk for major depressive disorder. Forty-four healthy daughters and their mothers completed a week of daily sleep diary and actigraphy; 24 girls had mothers with no history of psychopathology (low risk, mean age 14.92 years), and 20 girls had mothers with recurrent depression during the daughter’s lifetime (high risk, mean age 14.12 years). All daughters had no current or past psychopathology. High-risk girls reported significantly poorer subjective sleep quality than did low-risk girls (P = 0.001). The two groups of participants did not differ in actigraphy- or diary-measured sleep duration, onset latency or snooze duration. Healthy girls at high familial risk for depression report poorer sleep quality than do girls at low risk for depression, despite the absence of group differences in objective sleep disturbances as measured by actigraphy or daily diary. This pattern of findings may reflect a broader cognitive or physiological phenotype of risk for depression. PMID:21702865

Longtime napping is associated with cardiovascular risk estimation according to Framingham risk score in postmenopausal women.

PubMed

Li, Feng; Sun, Kan; Lin, Diaozhu; Qi, Yiqin; Li, Yan; Yan, Li; Ren, Meng

2016-09-01

Menopause can affect the physiological timing system, which could result in circadian rhythm changes and development of napping habits. Whether longtime napping in postmenopausal women is associated with cardiovascular disease is, however, still debated. The present study aims to investigate this association. We conducted a population-based study in 4,616 postmenopausal Chinese women. Information on sleep duration was self-reported. The Framingham General Cardiovascular Risk Score was calculated and used to identify participants at high risk of coronary heart disease (CHD). Increased daytime napping hours were positively associated with cardiovascular disease risk factors in postmenopausal women, such as age, waist circumference, systolic blood pressure, triglycerides, fasting glucose, postload glucose, and hemoglobin A1C (all P for trend <0.05). The prevalence of high risk of CHD increased with daytime napping hours, and was 3.7%, 4.3%, and 6.9% in the no daytime napping group, the 0.1 to 1 hour group, and the more than 1 hour group, respectively (P for trend = 0.005). Compared with the no daytime napping group, postmenopausal women with daytime napping more than 1 hour had higher risk of CHD in both univariate (odds ratio 1.94, 95% CI, 1.29-2.95) and multivariate (odds ratio 1.61, 95% CI, 1.03-2.52) logistic regression analyses. No statistically significant association was detected between night sleeping hours and high risk of CHD in postmenopausal participants. Daytime napping is positively associated with estimated 10-year CHD risk in postmenopausal Chinese women.

Risk and Protective Factors in Gifted Children with Dyslexia

ERIC Educational Resources Information Center

van Viersen, Sietske; de Bree, Elise H.; Kroesbergen, Evelyn H.; Slot, Esther M.; de Jong, Peter F.

2015-01-01

This study investigated risk and protective factors associated with dyslexia and literacy development, both at the group and individual level, to gain more insight in underlying cognitive profiles and possibilities for compensation in high-IQ children. A sample of 73 Dutch primary school children included a dyslexic group, a gifted-dyslexic group,…

Sexual abuse prevention with high-risk males: the roles of victim empathy and rape myths.

PubMed

Schewe, P A; O'Donohue, W

1993-01-01

The outcome of two sexual abuse prevention programs, one emphasizing victim empathy and the other stressing modifying rape myths, was evaluated with high-risk males. Sixty-eight high-risk males, as determined by self-reported likelihood of committing sexual abuse, were randomly assigned to an empathy-treatment, a facts-treatment, or a no-treatment control group. Treatment effects were assessed using subjects' pre- and post-treatment scores on the Likelihood of Sexually Abusing scale, the Rape Empathy Scale, the Acceptance of Interpersonal Violence scale, the Adversarial Sexual Beliefs Scale, and a test of self-reported sexual arousal to forced versus consenting sex. In addition, posttest scores on an Asch-type conformity measure were obtained. Results of validity checks indicated that high-risk subjects differed from low-risk subjects on a number of rape-related variables, that the victim-empathy condition increased subjects' empathy, and that subjects found both treatments to be credible and helpful. Comparisons between the empathy-, facts-, and no-treatment group contraindicated the practice of dispelling rape myths as a method of preventing rape among high-risk males.

Heart-type Fatty Acid Binding Protein in the Assessment of Acute Pulmonary Embolism.

PubMed

Qian, Hai-Yan; Huang, Ji; Yang, Yue-Jin; Yang, Yan-Min; Li, Zhi-Zhong; Zhang, Jing-Mei

2016-12-01

To explore the predictive value of heart-type fatty acid binding protein (H-FABP) in the stratification and prognosis of patients with acute pulmonary embolism (APE). According to risk stratification, 69 patients with APE admitted into the emergency department within 24 hours after onset were divided into the following 3 groups: high-risk group, moderate-risk group and low-risk group. H-FABP- and cardiac troponin I (cTNI)-positive rates of all groups were analyzed and compared, and the correlation between major adverse events (death, endotracheal intubation and cardiopulmonary resuscitation) and the cardiac markers (heart rate, arterial partial pressure of oxygen, right ventricular dimension, pulmonary arterial pressure, etc.) during the in-hospital period were statistically analyzed. Then the prognosis (death, embolic pulmonary hypertension, right heart failure and recurrence of APE) at 6 months after onset of APE was followed-up on and compared between groups. The admission time of high-risk group patients was earlier than non-high-risk group (7.1 ± 2.9 versus 13.5 ± 6.7 versus 15.2 ± 10.7 hours, P = 0.001), had larger right ventricular dimension (33.1 ± 10.4 versus 26.7 ± 7.3 versus 20.5 ± 8.9mm, P = 0.002) and higher pulmonary arterial pressure (45.8 ± 14.6 versus 29.4 ± 13.9 versus 23.1 ± 12.6mmHg, P = 0.001). The major adverse events during in-hospital period, including death, endotracheal intubation and cardiopulmonary resuscitation, were more prevalent in the high-risk group than those in the other 2 risk groups. Further analysis indicated that the positive rate of H-FABP was remarkably higher than cTNI (52/69, 75.4% versus 28/69, 40.6%, P = 0.003). The H-FABP (r = 0.881, P = 0.020) was significantly correlated to the major adverse events; however, this was not so regarding cTNI (r = 0.115, P = 0.059). At 6 months after onset of APE, the follow-up data indicated that cTNI and H-FABP were both significantly correlated with the major adverse events. The positive rate of H-FABP was higher than cTNI during the 24 hours after the onset of APE. The H-FABP was significantly correlated to the major adverse events during hospitalization and to the primary prognosis at 6 months after onset of APE. Copyright © 2016 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Predicting Long-Term Outcomes in Pleural Infections. RAPID Score for Risk Stratification.

PubMed

White, Heath D; Henry, Christopher; Stock, Eileen M; Arroliga, Alejandro C; Ghamande, Shekhar

2015-09-01

Pleural infections are associated with significant morbidity and mortality. The recently developed RAPID (renal, age, purulence, infection source, and dietary factors) score consists of five clinical factors that can identify patients at risk for increased mortality. The objective of this study was to further validate the RAPID score in a diverse cohort, identify factors associated with mortality, and provide long-term outcomes. We evaluated a single-center retrospective cohort of 187 patients with culture-positive pleural infections. Patients were classified by RAPID scores into low-risk (0-2), medium-risk (3-4), and high-risk (5-7) groups. The Social Security Death Index was used to determine date of death. All-cause mortality was assessed at 3 months, 1 year, 3 years, and 5 years. Clinical factors and comorbid conditions were evaluated for association. Three-month mortality for low-, medium-, and high-risk groups was 1.5, 17.8, and 47.8%, respectively. Increased odds were observed among medium-risk (odds ratio, 14.3; 95% confidence interval, 1.8-112.6; P = 0.01) and high-risk groups (odds ratio, 53.3; 95% confidence interval, 6.8-416.8; P < 0.01). This trend continued at 1, 3, and 5 years. Factors associated with high-risk scores include gram-negative rod infections, heart disease, diabetes, cancer, lung disease, and increased length of stay. When applied to a diverse patient cohort, the RAPID score predicts outcomes in patients up to 5 years and may aid in long-term risk stratification on presentation.

Neural reactivity to reward in school-age offspring of depressed mothers.

PubMed

Wiggins, Jillian Lee; Schwartz, Karen T G; Kryza-Lacombe, Maria; Spechler, Philip A; Blankenship, Sarah L; Dougherty, Lea R

2017-05-01

Identifying neural profiles predictive of future psychopathology in at-risk individuals is important to efficiently direct preventive care. Alterations in reward processing may be a risk factor for depression. The current study characterized neural substrates of reward processing in children at low- and high-risk for psychopathology due to maternal depression status. Children with (n=27) and without (n=19) maternal depression (ages 5.9-9.6 years) performed a monetary incentive delay task in which they received rewards, if they successfully hit a target, or no reward regardless of performance, during fMRI acquisition. Multiple dorsal prefrontal, temporal, and striatal regions showed significant Group (high- vs. low-risk)×Performance (hit vs. miss)×Condition (no reward vs. reward) interactions in a whole-brain analysis. All regions exhibited similar patterns, whereby the high-risk group showed blunted activation differences between trials with vs. without rewards when participants hit the target. Moreover, high-risk children showed activation differences between trials with vs. without rewards in the opposite direction, compared to the low-risk group, when they missed the target. This study had a modest sample size, though larger than existing studies. Children with maternal depression are at elevated risk for future psychopathology, yet not all experience clinically significant symptoms; longitudinal research is necessary to fully track the pathway from risk to disorder. Children of depressed mothers exhibited attenuated neural activation differences and activation patterns opposite to children without depressed mothers. Our findings may provide targets for hypothesis-driven preventive interventions and lead to earlier identification of individuals at risk. Copyright © 2017 Elsevier B.V. All rights reserved.

Risk sensitivity as an evolutionary adaptation

NASA Astrophysics Data System (ADS)

Hintze, Arend; Olson, Randal S.; Adami, Christoph; Hertwig, Ralph

2015-02-01

Risk aversion is a common behavior universal to humans and animals alike. Economists have traditionally defined risk preferences by the curvature of the utility function. Psychologists and behavioral economists also make use of concepts such as loss aversion and probability weighting to model risk aversion. Neurophysiological evidence suggests that loss aversion has its origins in relatively ancient neural circuitries (e.g., ventral striatum). Could there thus be an evolutionary origin to risk aversion? We study this question by evolving strategies that adapt to play the equivalent mean payoff gamble. We hypothesize that risk aversion in this gamble is beneficial as an adaptation to living in small groups, and find that a preference for risk averse strategies only evolves in small populations of less than 1,000 individuals, or in populations segmented into groups of 150 individuals or fewer - numbers thought to be comparable to what humans encountered in the past. We observe that risk aversion only evolves when the gamble is a rare event that has a large impact on the individual's fitness. As such, we suggest that rare, high-risk, high-payoff events such as mating and mate competition could have driven the evolution of risk averse behavior in humans living in small groups.

Utilization of small changes in serum creatinine with clinical risk factors to assess the risk of AKI in critically lll adults.

PubMed

Cruz, Dinna N; Ferrer-Nadal, Asunción; Piccinni, Pasquale; Goldstein, Stuart L; Chawla, Lakhmir S; Alessandri, Elisa; Belluomo Anello, Clara; Bohannon, Will; Bove, Tiziana; Brienza, Nicola; Carlini, Mauro; Forfori, Francesco; Garzotto, Francesco; Gramaticopolo, Silvia; Iannuzzi, Michele; Montini, Luca; Pelaia, Paolo; Ronco, Claudio

2014-04-01

Disease biomarkers require appropriate clinical context to be used effectively. Combining clinical risk factors, in addition to small changes in serum creatinine, has been proposed to improve the assessment of AKI. This notion was developed in order to identify the risk of AKI early in a patient's clinical course. We set out to assess the performance of this combination approach. A secondary analysis of data from a prospective multicenter intensive care unit cohort study (September 2009 to April 2010) was performed. Patients at high risk using this combination approach were defined as an early increase in serum creatinine of 0.1-0.4 mg/dl, depending on number of clinical factors predisposing to AKI. AKI was defined and staged using the Acute Kidney Injury Network criteria. The primary outcome was evolution to severe AKI (Acute Kidney Injury Network stages 2 and 3) within 7 days in the intensive care unit. Of 506 patients, 214 (42.2%) patients had early creatinine elevation and were deemed at high risk for AKI. This group was more likely to subsequently develop the primary endpoint (16.4% versus 1.0% [not at high risk], P<0.001). The sensitivity of this grouping for severe AKI was 92%, the specificity was 62%, the positive predictive value was 16%, and the negative predictive value was 99%. After adjustment for Sequential Organ Failure Assessment score, serum creatinine, and hazard tier for AKI, early creatinine elevation remained an independent predictor for severe AKI (adjusted relative risk, 12.86; 95% confidence interval, 3.52 to 46.97). Addition of early creatinine elevation to the best clinical model improved prediction of the primary outcome (area under the receiver operating characteristic curve increased from 0.75 to 0.83, P<0.001). Critically ill patients at high AKI risk, based on the combination of clinical factors and early creatinine elevation, are significantly more likely to develop severe AKI. As initially hypothesized, the high-risk combination group methodology can be used to identify patients at low risk for severe AKI in whom AKI biomarker testing may be expected to have low yield. The high risk combination group methodology could potentially allow clinicians to optimize biomarker use.

The Human Immunodeficiency Virus Endemic: Maintaining Disease Transmission in At-Risk Urban Areas.

PubMed

Rothenberg, Richard B; Dai, Dajun; Adams, Mary Anne; Heath, John Wesley

2017-02-01

A study of network relationships, geographic contiguity, and risk behavior was designed to test the hypothesis that all 3 are required to maintain endemicity of human immunodeficiency virus (HIV) in at-risk urban communities. Specifically, a highly interactive network, close geographic proximity, and compound risk (multiple high-risk activities with multiple partners) would be required. We enrolled 927 participants from two contiguous geographic areas in Atlanta, GA: a higher-risk area and lower-risk area, as measured by history of HIV reporting. We began by enrolling 30 "seeds" (15 in each area) who were comparable in their demographic and behavioral characteristics, and constructed 30 networks using a chain-link design. We assessed each individual's geographic range; measured the network characteristics of those in the higher and lower-risk areas; and measured compound risk as the presence of two or more (of 6) major risks for HIV. Among participants in the higher-risk area, the frequency of compound risk was 15%, compared with 5% in the lower-risk area. Geographic cohesion in the higher-risk group was substantially higher than that in the lower-risk group, based on comparison of geographic distance and social distance, and on the extent of overlap of personal geographic range. The networks in the 2 areas were similar: both areas show highly interactive networks with similar degree distributions, and most measures of network attributes were virtually the same. Our original hypothesis was supported in part. The higher and lower-risk groups differed appreciably with regard to risk and geographic cohesion, but were substantially the same with regard to network properties. These results suggest that a "minimum" network configuration may be required for maintenance of endemic transmission, but a particular prevalence level may be determined by factors related to risk, geography, and possibly other factors.

Healthy co-twins of patients with affective disorders show reduced risk-related activation of the insula during a monetary gambling task.

PubMed

Macoveanu, Julian; Miskowiak, Kamilla; Kessing, Lars V; Vinberg, Maj; Siebner, Hartwig R

2016-01-01

Healthy first-degree relatives of patients with affective disorders are at increased risk for affective disorders and express discrete structural and functional abnormalities in the brain reward system. However, value-based decision making is not well understood in these at-risk individuals. We investigated healthy monozygotic and dizygotic twins with or without a co-twin history of affective disorders (high-risk and low-risk groups, respectively) using functional MRI during a gambling task. We assessed group differences in activity related to gambling risk over the entire brain. We included 30 monozygotic and 37 dizygotic twins in our analysis. Neural activity in the anterior insula and ventral striatum increased linearly with the amount of gambling risk in the entire cohort. Individual neuroticism scores were positively correlated with the neural response in the ventral striatum to increasing gambling risk and negatively correlated with individual risk-taking behaviour. Compared with low-risk twins, the high-risk twins showed a bilateral reduction of risk-related activity in the middle insula extending into the temporal cortex with increasing gambling risk. Post hoc analyses revealed that this effect was strongest in dizygotic twins. The relatively old average age of the mono- and dizygotic twin cohort (49.2 yr) may indicate an increased resilience to affective disorders. The size of the monozygotic high-risk group was relatively small (n = 13). The reduced processing of risk magnitude in the middle insula may indicate a deficient integration of exteroceptive information related to risk-related cues with interoceptive states in individuals at familial risk for affective disorders. Impaired risk processing might contribute to increased vulnerability to affective disorders.

Individualized Fracture Risk Feedback and Long-term Benefits After 10 Years.

PubMed

Wu, Feitong; Wills, Karen; Laslett, Laura L; Riley, Malcolm D; Oldenburg, Brian; Jones, Graeme; Winzenberg, Tania

2018-02-01

This study aimed to determine if beneficial effects of individualized feedback of fracture risk on osteoporosis preventive behaviors and bone mineral density observed in a 2-year trial were sustained long-term. This was a 10-year follow-up of a 2-year RCT in 470 premenopausal women aged 25-44 years, who were randomized to one of two educational interventions (the Osteoporosis Prevention and Self-Management Course [OPSMC] or an osteoporosis information leaflet) and received tailored feedback of their relative risk of fracture in later life (high versus normal risk groups). Bone mineral density of lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry. Physical activity, dietary calcium intake, calcium and vitamin D supplements, and smoking status were measured by questionnaires. From 2 to 12 years, the high-risk group had a smaller decrease in femoral neck bone mineral density (β=0.023, 95% CI=0.005, 0.041 g/cm 2 ) but similar lumbar spine bone mineral density change as the normal-risk group. They were more likely to use calcium (relative risk=1.66, 95% CI=1.22, 2.24) and vitamin D supplements (1.99, 95% CI=1.27, 3.11). The OPSMC had no effects on bone mineral density change. Both high-risk (versus normal-risk) and the OPSMC groups (versus leaflet) had a more favorable pattern of smoking behavior change (relative risk=1.85, 95% CI=0.70, 4.89 and relative risk=2.27, 95% CI=0.86, 6.01 for smoking cessation; relative risk=0.33, 95% CI=0.13, 0.80 and relative risk=0.28, 95% CI=0.10, 0.79 for commenced or persistent smoking). Feedback of high fracture risk to younger women was associated with long-term improvements in osteoporosis preventive behaviors and attenuated femoral neck bone mineral density loss. Therefore, this could be considered as a strategy to prevent osteoporosis. Australian New Zealand Clinical Trials Registry (ANZCTR) NCT00273260. Copyright © 2018 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Reconnecting Youth: A Peer Group Approach to Building Life Skills.

ERIC Educational Resources Information Center

Eggert, Leona L.; Nicholas, Liela J.; Owen, Linda M.

The Reconnecting Youth (RY) program offers a carefully designed, research-validated model for building strength and competence in at-risk students, transforming risk into resilience. This manual was written to assist group leaders in implementing the RY program. The overall purpose of the program is to reach high-risk youth, who are on a potential…

Cost analysis of gentamicin-impregnated collagen sponges in preventing sternal wound infection post cardiac surgery.

PubMed

Joshi, V; Vaja, R; Richens, D

2016-01-01

The use of antibiotic-impregnated sponges (Collatamp) during cardiac surgery is controversial. We analysed the cost-effectiveness of its selective use in patients at high-risk of sternal wound infection (SWI). Postoperative costs were analysed in two groups of patients undergoing heart surgery between 2011 and 2013: those with SWI (group 1) and in high-risk patients without SWI (group 2). The potential cost of gentamicin-impregnated collagen sponges (GCS) use in high-risk patients was compared with our current practice. We identified 1,251 patients with at least one recognised risk factor for developing SWI in this period. Of these, 18 developed SWI (incidence 1.4%). The median postoperative cost per patient without SWI was £9,617. The additional cost per patient incurred by SWI was £4,860.75. The annual additional cost for treating patients with SWI was £43,749. With a 50% reduction in SWI, the annual additional cost of treating these patients would be reduced to £21,873. The cost of GCS is £80 per patient. Adding this to £21,873 gives a potential total cost of £71,913 in the treated high-risk cohort. In our practice the annual cost of treating SWI in high-risk patients without use of GCS is lower than the annual cost of using GCS in all high-risk patients (£43,749 versus £71,913) if it produces a 50% reduction in SWI. The reduction in the incidence of SWI poses no economic benefit when the cost of the product is factored in.

Three-month posttreatment prostate-specific antigen level as a biomarker of treatment response in patients with intermediate-risk or high-risk prostate cancer treated with androgen deprivation therapy and radiotherapy.

PubMed

Bryant, Alex K; D'Amico, Anthony V; Nguyen, Paul L; Einck, John P; Kane, Christopher J; McKay, Rana R; Simpson, Daniel R; Mundt, Arno J; Murphy, James D; Rose, Brent S

2018-05-04

Prostate-specific antigen (PSA) measurement after definitive radiotherapy (RT) and androgen deprivation therapy for localized prostate cancer has been proposed as an early prognostic biomarker. In the current study, the authors investigated the association between 3-month post-RT PSA level and biochemical progression-free survival (bPFS), prostate cancer-specific survival (PCSS), and overall survival (OS). A total of 5783 patients with intermediate-risk or high-risk localized prostate cancer who were diagnosed between 2000 and 2015 and treated with RT and androgen deprivation therapy were identified from Veterans Affairs data. Patients were divided into groups based on 3-month post-RT PSA values: <0.10 ng/mL, 0.10 to 0.49 ng/mL, and ≥0.50 ng/mL. The effect of the 3-month PSA group on bPFS, PCSS, and OS was evaluated in multivariable Cox models adjusting for potential confounders. There were 2651 patients with intermediate-risk and 3132 with high-risk disease; approximately 11% had a 3-month PSA level of ≥0.50 ng/mL. A higher 3-month PSA level was found to be strongly associated with each outcome; compared with patients in the group with a 3-month PSA value <0.10 ng/mL, the authors noted greater hazards for the patients with a 3-month PSA value ≥0.50 ng/mL (hazard ratio for bPFS: 5.23; PCSS: 3.97; and OS: 1.50 [P<.001 for all]) and the patients with a 3-month PSA value of 0.10 to 0.49 ng/mL (hazard ratio for bPFS: 2.41 [P<.001]; PCSS: 2.29 [P<.001]; and OS: 1.21 [P = .003]). When analyzed separately, the 3-month PSA level was found to be predictive of OS in the high-risk group (P<.001) but not the intermediate-risk group (P = .21). The 3-month post-RT PSA level appears to be a strong prognostic biomarker for bPFS, PCSS, and OS in patients with intermediate-risk and high-risk prostate cancer, particularly those with high-risk disease. The 3-month PSA measurement may augment clinical decision making and holds promise as a potential surrogate endpoint in clinical trials. Cancer 2018. © 2018 American Cancer Society. © 2018 American Cancer Society.

Community Emergency Response Team (CERT) Training of High-Risk Teens in the Community of Watts, South Los Angeles, 2013-2014.

PubMed

Ossey, Shamika; Sylvers, Sharon; Oksuzyan, Sona; Smith, Lisa V; Frye, Douglas; Family, Leila; Scott, Jannah; King, Jan B

2017-10-01

The Community Emergency Response Team (CERT) concept was initially developed for adult members of the community to help prepare for disasters and minimize damage when disasters occur. CERTs also served as a tool for building community capacity and self-sufficiency by supporting a diverse group of people working together in dealing with challenges affecting their communities. The novel approach to CERTs described here sought to involve high-risk youth from low-socioeconomic status communities in CERTs and first aid and cardiopulmonary resuscitation (CPR) training to help them build ties with communities, stay off the streets, and become leaders in the community. It also helped to provide different perspectives on life, while building more resilient communities better prepared to minimize damage when a disaster strikes. After the successful launch of the first high-risk teen CERT cohort in Watts (27 CERT-trained and 14 first aid/CPR-trained), the project was expanded to other community groups and organizations. Seven additional cohorts underwent CERT and first aid/CPR training in 2013 through 2014. This initiative increased CERT visibility within South Los Angeles. New partnerships were developed between governmental, nongovernmental, and community-based organizations and groups. This model can be used to expand CERT programs to other communities and organizations by involving high-risk teens or other high-risk groups in CERT training. (Disaster Med Public Health Preparedness. 2017;11:605-609).

Non-Rhabdomyosarcoma Soft Tissue Sarcomas in Children: A Surveillance, Epidemiology, and End Results Analysis Validating COG Risk Stratifications

DOE Office of Scientific and Technical Information (OSTI.GOV)

Waxweiler, Timothy V., E-mail: timothy.waxweiler@ucdenver.edu; Rusthoven, Chad G.; Proper, Michelle S.

Purpose: Non-rhabdomyosarcoma soft tissue sarcomas (NRSTS) are a heterogeneous group of sarcomas that encompass over 35 histologies. With an incidence of ∼500 cases per year in the United States in those <20 years of age, NRSTS are rare and therefore difficult to study in pediatric populations. We used the large Surveillance, Epidemiology, and End Results (SEER) database to validate the prognostic ability of the Children's Oncology Group (COG) risk classification system and to define patient, tumor, and treatment characteristics. Methods and Materials: From SEER data from 1988 to 2007, we identified patients ≤18 years of age with NRSTS. Data for age, sex,more » year of diagnosis, race, registry, histology, grade, primary size, primary site, stage, radiation therapy, and survival outcomes were analyzed. Patients with nonmetastatic grossly resected low-grade tumors of any size or high-grade tumors ≤5 cm were considered low risk. Cases of nonmetastatic tumors that were high grade, >5 cm, or unresectable were considered intermediate risk. Patients with nodal or distant metastases were considered high risk. Results: A total of 941 patients met the review criteria. On univariate analysis, black race, malignant peripheral nerve sheath (MPNST) histology, tumors >5 cm, nonextremity primary, lymph node involvement, radiation therapy, and higher risk group were associated with significantly worse overall survival (OS) and cancer-specific survival (CSS). On multivariate analysis, MPNST histology, chemotherapy-resistant histology, and higher risk group were significantly poor prognostic factors for OS and CSS. Compared to low-risk patients, intermediate patients showed poorer OS (hazard ratio [HR]: 6.08, 95% confidence interval [CI]: 3.53-10.47, P<.001) and CSS (HR: 6.27; 95% CI: 3.44-11.43, P<.001), and high-risk patients had the worst OS (HR: 13.35, 95% CI: 8.18-21.76, P<.001) and CSS (HR: 14.65, 95% CI: 8.49-25.28, P<.001). Conclusions: The current COG risk group stratification for children with NRSTS has been validated with a large number of children in the SEER database.« less

Patterns of recurrence and outcomes in surgically treated women with endometrial cancer according to ESMO-ESGO-ESTRO Consensus Conference risk groups: Results from the FRANCOGYN study Group.

PubMed

Bendifallah, Sofiane; Ouldamer, Lobna; Lavoue, Vincent; Canlorbe, Geoffroy; Raimond, Emilie; Coutant, Charles; Graesslin, Olivier; Touboul, Cyril; Collinet, Pierre; Daraï, Emile; Ballester, Marcos

2017-01-01

The purpose of this study was to analyse the endometrial cancer (EC) patterns of recurrence based on a large French multicentre database according to ESMO-ESGO-ESTRO classification. Data of women with histologically proven EC who received primary surgical treatment between January 2001 and December 2012 were retrospectively abstracted from seven institutions with prospectively maintained databases. The endpoints were recurrence, recurrence free survival (RFS) and overall survival (OS). Time to the first EC recurrence in a specific site was evaluated by using cumulative incidence analysis (Gray's test). Data from 829 women were analysed in whom recurrences were observed in 176 (21%) with a median and mean time to recurrence of 13 and 19.5months, respectively. High (35%) and high-intermediate risk groups (16%) were associated with higher recurrence rates compared with low (9%) and intermediate (9%) risk patients (p<0.0001). Women with high risk EC had a higher 5-year cumulative incidence of distant recurrence (20.7%) than women with high-intermediate, intermediate and low risk EC (5.6%, 3.5%, 3.3%), (p<0.001), respectively. Women with high risk and high-intermediate risk EC had a higher 5-year cumulative incidence of loco-regional recurrence (24.3% and 16.6%, respectively) than women with intermediate and low risk EC (6.6% and 6.5%, respectively), (p<0.001). We report specific time and site patterns of first recurrence according to the ESMO/ESGO/ESTRO classification. Sites and hazard rates for recurrence differ widely between subgroups over time. Defining patterns of EC recurrence may provide useful information for developing follow-up recommendations and designing therapeutic approaches. Copyright © 2016 Elsevier Inc. All rights reserved.

Design of a syndemic based intervention to facilitate care for men who have sex with men with high risk behaviour: the syn.bas.in randomized controlled trial.

PubMed

Achterbergh, Roel C A; van der Helm, Jannie J; van den Brink, Wim; de Vries, Henry J C

2017-06-06

Men who have sex with men (MSM) constitute a risk group for sexual transmitted infections (STIs), including HIV. Despite counselling interventions, risk behaviour remains high. Syndemic theory holds that psychosocial problems often co-occur, interact and mutually reinforce each other, thereby increasing high risk behaviours and co-occurring diseases. Therefore, if co-occurring psychosocial problems were assessed and treated simultaneously, this might decrease high risk behaviour and disease. An open label randomized controlled trial will be conducted among 150 MSM with high risk behaviour recruited from the STI clinic of Amsterdam. Inclusion criteria are: HIV negative MSM with two STI and/or PEP treatment in the last 24 months, or HIV positive MSM with one STI in the last 24 months. All participants get questionnaires on the following syndemic domains: ADHD, depression, anxiety disorder, alexithymia and sex- and drug addiction. Participants in the control group receive standard care: STI screenings every three months and motivational interviewing based counselling. Participants in the experimental group receive standard care plus feedback based on the results of the questionnaires. All participants can be referred to co-located mental health or addiction services. The primary outcome is help seeking behaviour for mental health problems and/or drug use problems. The secondary outcomes are STI incidence and changes in sexual risk behaviour (i.e. condom use, number of anal sex partners, drug use during sex). This study will provide information on syndemic domains among MSM who show high risk behaviour and on the effect of screening and referral on help seeking behaviour and health (behaviour) outcomes. Trial Registration at clinicaltrail.gov, identifier NCT02859935 .

Development of fine motor skills is associated with expressive language outcomes in infants at high and low risk for autism spectrum disorder.

PubMed

Choi, Boin; Leech, Kathryn A; Tager-Flusberg, Helen; Nelson, Charles A

2018-04-12

A growing body of research suggests that fine motor abilities are associated with skills in a variety of domains in both typical and atypical development. In this study, we investigated developmental trajectories of fine motor skills between 6 and 24 months in relation to expressive language outcomes at 36 months in infants at high and low familial risk for autism spectrum disorder (ASD). Participants included 71 high-risk infants without ASD diagnoses, 30 high-risk infants later diagnosed with ASD, and 69 low-risk infants without ASD diagnoses. As part of a prospective, longitudinal study, fine motor skills were assessed at 6, 12, 18, and 24 months of age and expressive language outcomes at 36 months using the Mullen Scales of Early Learning. Diagnosis of ASD was determined at the infant's last visit to the lab (18, 24, or 36 months) using the Autism Diagnostic Observation Schedule. Hierarchical linear modeling revealed that high-risk infants who later developed ASD showed significantly slower growth in fine motor skills between 6 and 24 months, compared to their typically developing peers. In contrast to group differences in growth from age 6 months, cross-sectional group differences emerged only in the second year of life. Also, fine motor skills at 6 months predicted expressive language outcomes at 3 years of age. These results highlight the importance of utilizing longitudinal approaches in measuring early fine motor skills to reveal subtle group differences in infancy between ASD high-risk and low-risk infant populations and to predict their subsequent language outcomes.

Electrophoresis of tear proteins as a new diagnostic tool for two high risk groups for dry eye: computer users and contact lens wearers.

PubMed

Chiva, Andreea

2011-08-15

Dry eye is the most prevalent condition seen by the ophthalmologist, in particular in elderly. The identification of new common risk factors (computer use and contact lens wear) extends the disease among the young people. The early diagnosis of dry eye is essential, but difficult, because the biochemical changes in tear film usually occur before any detectable signs. Due its advantages, electrophoresis of tear proteins could be an important tool for diagnosis of tear film impairment in high risk groups for dry eye. The role of tear proteins electrophoresis in early diagnosis of dry eye related to computer use and contact lens wear, as well as the biochemical changes in these high risk groups are presented. This review will summarize the actual data concerning the electrophoretic changes of tear proteins in computer users and contact lens wearers, two common high risk groups for dry eye. Electrophoresis of tear proteins using automated system Hyrys-Hydrasys SEBIA France is an important tool for early diagnosis of tear film alterations and monitoring of therapy. The quantification of many proteins in a single analysis using a small quantity of unconcentrated reflex tears is the main advantage of this technique. Electrophoresis of tear proteins should became a prerequisite, in particular for computer users less than 3 h/day, as well as at prescribing contact lenses.

Testing for HIV and sexually transmissible infections within a mainly online sample of gay men who engage in group sex.

PubMed

Prestage, G P; Hudson, J; Jin, F; Corrigan, N; Martin, P; Grulich, A E; McInnes, D

2009-02-01

Group sex among gay men has been associated with other HIV risk behaviours. Gay men who engage in group sex may be at increased risk of infection with HIV and other sexually transmitted infections (STI). The Three or More Study (TOMS) of group sex among gay men utilised an anonymous, self-completed survey about participants' most recent occasion of group sex with other men and in-depth interviews with a small number of these survey participants. The 436 men who reported having engaged in group sex within the previous month were included in these analyses. Among 436 men who engaged in group sex within the previous month, 32.5% reported unprotected anal intercourse (UAI) with non-regular, mostly HIV non-seroconcordant partners at this recent group sex encounter (GSE) and the majority reported other sex practices that are risk factors for STI other than HIV. Over one-third reported having been tested for HIV or other STI since their last GSE; those who had engaged in UAI at the GSE were more likely to have been tested (p = 0.008). Men who had a doctor with whom they were able to discuss their group sex activities had received a broader range of STI tests (p = 0.003). Sex practices that risk the transmission of STI were common within this high-risk sample, whereas awareness of risk and the need for testing was high but not universal. Frank discussion with doctors of patients' group sex behaviour also enhanced decisions about adequate testing. Gay men in group sex networks are an appropriate priority for sexual health screening.

Long-term effects of self-control on alcohol use and sexual behavior among urban minority young women.

PubMed

Griffin, Kenneth W; Scheier, Lawrence M; Acevedo, Bianca; Grenard, Jerry L; Botvin, Gilbert J

2012-01-01

High risk alcohol use and sexual behaviors peak in young adulthood and often occur in the same individuals. Alcohol use has been found to impair decision-making and contribute to high risk sexual activity. However, the association between alcohol use and risky sexual behavior may also reflect enduring individual differences in risk taking, sociability, self-control, and related variables. Both behaviors can serve similar functions related to recreation, interpersonal connection, and the pursuit of excitement or pleasure. The present study examined the extent to which high risk drinking and sexual behavior clustered together in a sample of urban minority young adult women, a demographic group at elevated risk for negative outcomes related to sexual health. We tested whether psychosocial functioning measured at the beginning of high school predicted classes of risk behaviors when girls were tracked longitudinally into young adulthood. Latent class analysis indicated three distinct profiles based on high risk drinking and sexual behavior (i.e., multiple sex partners) in young adulthood. The largest class (73% of the sample) reported low levels of risky drinking and sexual behavior. The next largest class (19%) reported high risk drinking and low risk sexual behavior, and the smallest class (8%) reported high levels of both behaviors. Compared to women from other racial/ethnic groups, black women were more likely to be categorized in the high risk drinking/low risk sex class. Multinomial logistic regression indicated that self-control in adolescence had a broad and enduring protective effect on risk behaviors eight years later and was associated with a greater probability of being in the low risk drinking/low risk sex class. Findings are discussed in terms of understanding the phenotypic expressions of risk behavior as they relate to early psychosocial development and the long-term protective function of self-control in reducing high risk drinking and sexual behaviors.

Long-Term Effects of Self-Control on Alcohol Use and Sexual Behavior among Urban Minority Young Women

PubMed Central

Griffin, Kenneth W.; Scheier, Lawrence M.; Acevedo, Bianca; Grenard, Jerry L.; Botvin, Gilbert J.

2011-01-01

High risk alcohol use and sexual behaviors peak in young adulthood and often occur in the same individuals. Alcohol use has been found to impair decision-making and contribute to high risk sexual activity. However, the association between alcohol use and risky sexual behavior may also reflect enduring individual differences in risk taking, sociability, self-control, and related variables. Both behaviors can serve similar functions related to recreation, interpersonal connection, and the pursuit of excitement or pleasure. The present study examined the extent to which high risk drinking and sexual behavior clustered together in a sample of urban minority young adult women, a demographic group at elevated risk for negative outcomes related to sexual health. We tested whether psychosocial functioning measured at the beginning of high school predicted classes of risk behaviors when girls were tracked longitudinally into young adulthood. Latent class analysis indicated three distinct profiles based on high risk drinking and sexual behavior (i.e., multiple sex partners) in young adulthood. The largest class (73% of the sample) reported low levels of risky drinking and sexual behavior. The next largest class (19%) reported high risk drinking and low risk sexual behavior, and the smallest class (8%) reported high levels of both behaviors. Compared to women from other racial/ethnic groups, black women were more likely to be categorized in the high risk drinking/low risk sex class. Multinomial logistic regression indicated that self-control in adolescence had a broad and enduring protective effect on risk behaviors eight years later and was associated with a greater probability of being in the low risk drinking/low risk sex class. Findings are discussed in terms of understanding the phenotypic expressions of risk behavior as they relate to early psychosocial development and the long-term protective function of self-control in reducing high risk drinking and sexual behaviors. PMID:22470274

Ethnic Variations in Prevalence of High-Risk Sexual Behaviors Among Asian and Pacific Islander Adolescents in Hawaii

PubMed Central

Kameoka, Velma A.

2009-01-01

Objectives. We examined ethnic variations in high-risk sexual behaviors among Asian and Pacific Islander (API) adolescents in comparison with White adolescents. Methods. We obtained data from the 2003 Hawaii Youth Risk Behavior Survey on 4953 students in grades 9 through 12. We conducted χ2 and logistic regression analyses on these data to examine the prevalence of high-risk sexual behaviors among Japanese, Filipino, Native Hawaiian, and White adolescents. Results. We found significant ethnic variation in prevalence of high-risk sexual behaviors among API adolescents. Relative to White adolescents, Native Hawaiian adolescents were most likely to engage in lifetime sexual intercourse, recent sexual intercourse, and sexual initiation before age 13 years; Japanese adolescents were least likely to engage in these behaviors. Filipino adolescents were least likely to use substances before last sexual intercourse and condoms during last sexual intercourse. Conclusions. Our findings suggest divergent patterns of risk among API ethnic groups, underscoring the heterogeneity of API subgroups and emphasizing the need for health disparities research on disaggregated API ethnic groups. The findings of such research should be used to design ethnically relevant interventions aimed at mitigating the negative health consequences of high-risk sexual behaviors. PMID:19106424

Case Study: Hidden Complexity of Medicines Use: Information Provided by a Person with Intellectual Disability and Diabetes to a Pharmacist

ERIC Educational Resources Information Center

Flood, Bernadette; Henman, Martin C.

2015-01-01

People with intellectual disabilities may be "invisible" to pharmacists. They are a complex group of patients many of whom have diabetes. Pharmacists may have little experience of the challenges faced by this high risk group of patients who may be prescribed high risk medications. This case report details information supplied by Pat, a…

Is safety of childhood growth hormone therapy related to dose? Data from a large observational study.

PubMed

Sävendahl, Lars; Pournara, Effie; Pedersen, Birgitte Tønnes; Blankenstein, Oliver

2016-05-01

Concerns have been raised of increased mortality risk in adulthood in certain patients who received growth hormone treatment during childhood. This study evaluated the safety of growth hormone treatment in childhood in everyday practice. NordiNet(®) International Outcome Study (IOS) is a noninterventional, observational study evaluating safety and effectiveness of Norditropin(®) (somatropin; Novo Nordisk A/S, Bagsvaerd, Denmark). Long-term safety data (1998-2013) were collected on 13 834 growth hormone treated pediatric patients with short stature. Incidence rates (IRs) of adverse events (AEs) defined as adverse drug reactions (ADRs), serious ADRs (SADRs), and serious AEs (SAEs) were calculated by mortality risk group (low/intermediate/high). The effect of growth hormone dose on IRs and the occurrence of cerebrovascular AEs were investigated by the risk group. We found that 61.0% of patients were classified as low-risk, 33.9% intermediate-risk, and 5.1% high-risk. Three hundred and two AEs were reported in 261 (1.9%) patients during a mean (s.d.) treatment duration of 3.9 (2.8) years. IRs were significantly higher in the high- vs the low-risk group (high risk vs low risk-ADR: 9.11 vs 3.14; SAE: 13.66 vs 1.85; SADR: 4.97 vs 0.73 events/1000 patient-years of exposure; P < 0.0001 for all). Except for SAEs in the intermediate-risk group (P = 0.0486) in which an inverse relationship was observed, no association between IRs and growth hormone dose was found. No cerebrovascular events were reported. We conclude that safety data from NordiNet(®) IOS do not reveal any new safety signals and confirm a favorable overall safety profile in accordance with other pediatric observational studies. No association between growth hormone dose and the incidence of AEs during growth hormone treatment in childhood was found. © 2016 European Society of Endocrinology.

Effect of Rehabilitation Intensity on Mortality Risk After Stroke.

PubMed

Hsieh, Cheng-Yang; Huang, Hsiu-Chen; Wu, Darren Philbert; Li, Chung-Yi; Chiu, Meng-Jun; Sung, Sheng-Feng

2018-06-01

To determine the relation between rehabilitation intensity and poststroke mortality. Retrospective cohort study. Nationwide claims data. From Taiwan's National Health Insurance claims databases, patients (N=6737; mean age, 66.9y; 40.3% women) hospitalized between 2001 and 2013 for a first-ever stroke who had mild to moderate stroke and survived the first 90 days of stroke were enrolled. The intensity of rehabilitation therapy within 90 days after stroke was categorized into low, medium, or high based on the tertile distribution of the number of rehabilitation sessions. Long-term all-cause mortality. The Cox proportional hazard models with Bonferroni correction were used to assess the association between rehabilitation intensity and mortality, adjusting for age, comorbidities, stroke severity, and other covariates. Patients in the high-intensity group were younger but had a higher burden of comorbidities and greater stroke severity. During follow-up, the high-intensity group was associated with a significantly lower adjusted risk (hazard ratio [HR], .73; 95% confidence interval [CI], .63-.84) of mortality than the low-intensity group, whereas the medium-intensity group carried a similar risk of mortality (HR, 0.94; 95% CI, 0.84-1.06) compared with the low-intensity group. This association was not modified by stroke severity. Among patients with mild to moderate stroke severity, high-intensity rehabilitation therapy within the first 90 days was associated with a lower mortality risk than low-intensity therapy. Efforts to promote high-intensity rehabilitation therapy for this group of patients with stroke should be encouraged. Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Incidence of macroscopically occult neoplasias in Barrett's esophagus: are random biopsies dispensable in the era of advanced endoscopic imaging?

PubMed

Pohl, Juergen; Pech, Oliver; May, Andrea; Manner, Hendrik; Fissler-Eckhoff, Annette; Ell, Christian

2010-11-01

The gold standard for endoscopic surveillance of Barrett's esophagus (BE) includes targeted biopsies (TBs) from abnormalities as well as stepwise four-quadrant biopsies (4QBs) for detection of invisible high-grade intraepithelial neoplasias (HGINs) or early carcinomas (ECs). In a large mixed BE population, we investigated the rate of HGINs/ECs that are macroscopically occult to enhanced visualization with high-resolution endoscopy plus acetic acid chromoendoscopy. From January 2007 to December 2009, 701 consecutive BE patients were enrolled in a prospective study at a tertiary referral center. Of these, 406 patients had a history of HGIN/EC (high-risk group) and 295 patients did not (low-risk group). In 701 patients, 459 TBs and 5,485 4QBs were obtained. Altogether, 92 patients with 132 lesions containing HGINs/ECs were detected. For the diagnosis of HGINs/ECs, patient-related sensitivity and specificity rates of endoscopic imaging with TBs were 96.7 and 66.5%, with a positive and negative predictive value of 30.4 and 99.3%, respectively. In the high-risk group, 4QBs identified three additional patients (3.3%) with macroscopically occult HGINs/ECs. In the low-risk group, no HGINs/ECs were identified with either biopsy approach. Advanced endoscopic imaging identifies the vast majority of BE patients with early neoplasias, and the additive effect of 4QB is minimal. Therefore, in low- and high-risk patients, limiting endoscopic surveillance to guided biopsies is justified in specialized high-volume centers with permanent quality control. However, we do not advocate abandoning 4QB outside this setting.

Factors Affecting the Selection of Patients on Waiting List: A Single Center Study.

PubMed

Can, Ö; Kasapoğlu, U; Boynueğri, B; Tuğcu, M; Çağlar Ruhi, B; Canbakan, M; Murat Gökçe, A; Ata, P; İzzet Titiz, M; Apaydın, S

2015-06-01

There is an increasing gap between organ supply and demand for cadaveric transplantation in our country. Our aim was to evaluate factors affecting selection of patients on waiting list at our hospital. Patients who have been waiting on list and who were transplanted were compared in order to find factors, which affected the selection of patients. Non-parametric Mann-Whitney U test was used for comparison and cox regression analysis was used to find the risk factors that decrease the probability of transplantation in this retrospective case-control study. Patients in the transplanted group were significantly younger, had relatively lower body mass index than the awaiting group. Cardiovascular diseases were more in the awaiting group than the transplanted group. There was no patient with diabetes in transplanted group, despite fifteen diabetic patients were in the awaiting group. Selected patients had lower immunologic risk with regard to peak panel reactive antibody levels. No significant difference was found for gender, hypertension, hyperlipidemia, viral serology, time spent on dialysis and on waiting list between two groups. With cox regression analysis female gender, older age, diabetes mellitus, high body mass index, positive hepatitis B serology and high levels of peak class 1-2 peak panel reactive antibody positivity were found as risk factors that decrease the probability of transplantation. A tendency for selection of low risk patients was found with this study. Time and energy consuming complications and short allograft survival after transplantation in high risk patients and the scarcity of cadaveric pool in our country may contribute to this tendency. Copyright © 2015 Elsevier Inc. All rights reserved.

Childhood leukaemia in areas with different radon levels: a spatial and temporal analysis using GIS

PubMed Central

Kohli, S; Noorlind, B; Lofman, O

2000-01-01

OBJECTIVES—To evaluate the relation between exposure to ground radon levels and leukaemia among children using existing population and disease registers.
DESIGN—Ecological correlation study.
SETTING—The county of Östergötland in Sweden.
METHODS—Every child born in the county between 1979 and 1992 was mapped to the property centroid coordinates by linking addresses in the population and property registers. Population maps were overlaid with radon maps and exposure at birth and each subsequent year was quantified as high, normal, low or unknown. This was analysed with data from the tumour registry. Standardised mortality ratios (SMRs) were calculated using the age and sex specific rates for Sweden for the year 1995.
RESULTS—90 malignancies occurred among 53 146 children (498 887 person years) who formed the study population. SMRs for acute lymphatic leukaemia (ALL) among children born in high, normal and low risk areas were 1.43, 1.17 and 0.25 respectively. The relative risk for the normal risk group and high risk group as compared with the low risk group was 4.64 (95% CI 1.29, 28.26) and 5.67 (95% CI 1.06, 42.27). The association between ALL and continued residence at normal or high risk areas showed a similar trend. No association between radon risk levels and any other malignancy was seen.
CONCLUSION—Children born in and staying at areas where the risk from ground radon has been classified as low are less likely to develop ALL than those born in areas classified as normal and high risk.


Keywords: leukaemia; cancer; radon; ionising radiation; Geographic Information Systems PMID:11027195

Use of plasma triglyceride/high-density lipoprotein cholesterol ratio to identify increased cardio-metabolic risk in young, healthy South Asians.

PubMed

Flowers, Elena; Molina, César; Mathur, Ashish; Reaven, Gerald M

2015-01-01

Prevalence of insulin resistance and associated dyslipidaemia [high triglyceride (TG) and low high-density lipoprotein cholesterol (HDL-C) concentrations] are increased in South Asian individuals; likely contributing to their increased risk of type-2 diabetes and cardiovascular disease. The plasma concentration ratio of TG/HDL-C has been proposed as a simple way to identify apparently healthy individuals at high cardio-metabolic risk. This study was carried out to compare the cardio-metabolic risk profiles of high-risk South Asian individuals identified by an elevated TG/HDL-C ratio versus those with a diagnosis of the metabolic syndrome. Body mass index, waist circumference, blood pressure, and fasting plasma glucose, insulin, TG, and HDL-C concentrations were determined in apparently healthy men (n=498) and women (n=526). The cardio-metabolic risk profile of "high risk" individuals identified by TG/HDL-C ratios in men (≥ 3.5) and women (≥2.5) was compared to those identified by a diagnosis of the metabolic syndrome. More concentrations of all cardio-metabolic risk factors were significantly higher in "high risk" groups, identified by either the TG/HDL-C ratio or a diagnosis of the metabolic syndrome. TG, HDL-C, and insulin concentrations were not significantly different in "high risk" groups identified by either criterion, whereas plasma glucose and blood pressure were higher in those with the metabolic syndrome. Apparently healthy South Asian individuals at high cardio-metabolic risk can be identified using either the TG/HDL-C ratio or the metabolic syndrome criteria. The TG/HDL-C ratio may be used as a simple marker to identify such individuals.

The Dose-Volume Relationship of Small Bowel Irradiation and Acute Grade 3 Diarrhea During Chemoradiotherapy for Rectal Cancer

DOE Office of Scientific and Technical Information (OSTI.GOV)

Robertson, John M.; Lockman, David; Yan Di

Purpose: Previous work has found a highly significant relationship between the irradiated small-bowel volume and development of Grade 3 small-bowel toxicity in patients with rectal cancer. This study tested the previously defined parameters in a much larger group of patients. Methods and Materials: A total of 96 consecutive patients receiving pelvic radiation therapy for rectal cancer had treatment planning computed tomographic scans with small-bowel contrast that allowed the small bowel to be outlined with calculation of a small-bowel dose-volume histogram for the initial intended pelvic treatment to 45 Gy. Patients with at least one parameter above the previously determined dose-volumemore » parameters were considered high risk, whereas those with all parameters below these levels were low risk. The grade of diarrhea and presence of liquid stool was determined prospectively. Results: There was a highly significant association with small-bowel dose-volume and Grade 3 diarrhea (p {<=} 0.008). The high-risk and low-risk parameters were predictive with Grade 3 diarrhea in 16 of 51 high-risk patients and in 4 of 45 low-risk patients (p = 0.01). Patients who had undergone irradiation preoperatively had a lower incidence of Grade 3 diarrhea than those treated postoperatively (18% vs. 28%; p = 0.31); however, the predictive ability of the high-risk/low-risk parameters was better for preoperatively (p = 0.03) than for postoperatively treated patients (p = 0.15). Revised risk parameters were derived that improved the overall predictive ability (p = 0.004). Conclusions: The highly significant dose-volume relationship and validity of the high-risk and low-risk parameters were confirmed in a large group of patients. The risk parameters provided better modeling for the preoperative patients than for the postoperative patients.« less

Radical prostatectomy--long-term oncological outcome from a community hospital.

PubMed

Tol-Fakkar, Maria; Hermansson, Carl Gustaf; Hugosson, Jonas; Pedersen, Knud; Aus, Gunnar

2003-01-01

Radical prostatectomy has recently been shown to prolong cancer-specific survival compared to watchful waiting in patients with localized prostate cancer. Most patients who seek medical advice for this disease are treated in hospitals in which the operation is performed relatively infrequently. The aim of this study is to report the oncological outcome at intermediate- to long-term follow-up after radical prostatectomy performed in a community hospital. A total of 148 patients underwent radical prostatectomy at Ryhov County Hospital between 1985 and 1997. Patients without T3 tumours, prostate-specific antigen (PSA) >10 ng/ml or poorly differentiated tumours were judged to be in a low-risk group, those with one risk factor to be in an intermediate group and those with two or more factors to be in a high-risk group. The projected biochemical disease free- and cancer-specific survival rates were compared between these risk groups. Median follow-up was 96 months for surviving patients. Patients in the low- and intermediate risk groups had equal 10-year PSA-free survival rates of 68.8%, while that in the high-risk group was only 19.3% (9-year data). Corresponding cancer-specific survival rates were 93% and 84%, respectively. The oncological outcome seems comparable to that reported in the literature, even when the operation is performed in a low-volume community-based setting.

Differential Response to Exercise in African Americans with High Levels of Inflammation.

PubMed

Kretzschmar, Jan; Babbitt, Dianne M; Diaz, Keith M; Feairheller, Deborah L; Sturgeon, Kathleen M; Perkins-Ball, Amanda M; Williamson, Sheara T; Ling, Chenyi; Grimm, Heather; Brown, Michael D

2017-01-01

Systemic inflammation, measured by C-reactive protein (CRP), is an important risk factor for cardiovascular disease (CVD) and mortality. We investigated whether aerobic exercise training (AEXT) affects African Americans with high inflammation (HI) the same way it does African Americans with low inflammation (LI) in terms of CVD risk factors. 23 African Americans with CRP levels <3 mg/L (LI) and 14 African Americans with CRP ≥3 mg/L (HI) underwent six months of AEXT. Participants were sedentary, non-diabetic, non-smoking, with clinical blood pressure <160/100 mm Hg, were non-hyperlipidemic, had no signs of cardiovascular, renal, or pulmonary disease, and were not on medication. Measures included CD62E+ endothelial microparticles (EMPs), a measure of early stage endothelial dysfunction, as well as lipid and glucose profile, aerobic fitness, body composition, and blood pressure. The LI group improved aerobic fitness by 10%, body mass index by 3%, and plasma triglycerides by 20%, with no change being observed in HI group for these variables. The HI group improved fasting plasma glucose levels by 10%, with no change occurring in the LI group. Both groups improved CD62E+ EMPs by 38% and 59% for the LI and HI group, respectively. A standard AEXT intervention differentially affected CVD risk factors among African Americans with high and low inflammation. This may indicate that, in African Americans with high inflammation, AEXT alone may not be enough to reap the same benefits as their low-inflammation peers in terms of CVD risk modification.

[Importance of the clinical profile in the postmenopausal osteoporosis screening by densitometry].

PubMed

Bigler, J M; Abetel, G; Krieg, M A; Wimpfheimer, C; Burnand, B; Thiébaud, D; Burckhardt, P

1996-08-06

In order to test the impact of a given risk profile on the incidence of osteoporosis which could justify BMD measurement, and that of a low risk profile which could render it unnecessary, BMD was measured in 217 women under 72 in whom menopause had occurred at least 6 years previously and who corresponded to one of the two following profiles: high risk (A, n = 102) = BMI < 27 kg/m2, with no estrogen replacement treatment, and with at least one of the following risk factors: BMI < 20, early menopause, positive family history, no dairy products associated with tobacco consumption (> 10 cigarettes/day for > 20 years and/or alcohol consumption of > 0.5 l wine/day during > 10 years, corticotherapy of > 6 months, rickets, anorexia nervosa. Low risk (B, n = 115) = absence of characteristics of group A, BMI > 27 kg/m2 with (B+, n = 24) or without estrogen therapy (B-, n = 91). BMD was measured by DXA in 4 centers using Lunar or Hologic equipment. Results were expressed in % of the mean of the respective young adult control groups. As expected, BMD was significantly different in these two subgroups of the population. Osteoporosis was diagnosed (BMD < 75% = < -2.5 SD, according to WHO) in 72% of group A, and in 17% (B+) and 19% (B-) respectively of group B. There was no difference between the various risk factors in group A concerning their impact on BMD, but concerning incidence, low BMI and early menopause were the most frequent. The high risk profile of group A seems to justify densitometry, since it leads to the diagnosis of osteoporosis in over 70%. However, the protective profile of group B does not exclude osteoporosis (risk still 20%); only in severe obesity (BMI > 33) does it drop to 1%.

To Bleed or Not to Bleed. A Prediction Based on Individual Gene Profiling Combined With Dose-Volume Histogram Shapes in Prostate Cancer Patients Undergoing Three-Dimensional Conformal Radiation Therapy

DOE Office of Scientific and Technical Information (OSTI.GOV)

Valdagni, Riccardo; Scientific Directorate, Fondazione IRCCS-Istituto Nazionale dei Tumori, Milano; Rancati, Tiziana

2009-08-01

Purpose: The main purpose of this work was to try to elucidate why, despite excellent rectal dose-volume histograms (DVHs), some patients treated for prostate cancer exhibit late rectal bleeding (LRB) and others with poor DVHs do not. Thirty-five genes involved in DNA repair/radiation response were analyzed in patients accrued in the AIROPROS 0101 trial, which investigated the correlation between LRB and dosimetric parameters. Methods and Materials: Thirty patients undergoing conformal radiotherapy with prescription doses higher than 70 Gy (minimum follow-up, 48 months) were selected: 10 patients in the low-risk group (rectal DVH with the percent volume of rectum receiving moremore » than 70 Gy [V70Gy] < 20% and the percent volume of rectum receiving more than 50 Gy [V50Gy] < 55%) with Grade 2 or Grade 3 (G2-G3) LRB, 10 patients in the high-risk group (V70Gy > 25% and V50Gy > 60%) with G2-G3 LRB, and 10 patients in the high-risk group with no toxicity. Quantitative reverse-transcriptase polymerase chain reaction was performed on RNA from lymphoblastoid cell lines obtained from Epstein-Barr virus-immortalized peripheral-blood mononucleated cells and on peripheral blood mononucleated cells. Interexpression levels were compared by using the Kruskal-Wallis test. Results: Intergroup comparison showed many constitutive differences: nine genes were significantly down-regulated in the low-risk bleeder group vs. the high-risk bleeder and high-risk nonbleeder groups: AKR1B1 (p = 0.019), BAZ1B (p = 0.042), LSM7 (p = 0.0016), MRPL23 (p = 0.015), NUDT1 (p = 0.0031), PSMB4 (p = 0.079), PSMD1 (p = 0.062), SEC22L1 (p = 0.040), and UBB (p = 0.018). Four genes were significantly upregulated in the high-risk nonbleeder group than in the other groups: DDX17 (p = 0.048), DRAP1 (p = 0.0025), RAD23 (p = 0.015), and SRF (p = 0.024). For most of these genes, it was possible to establish a cut-off value that correctly classified most patients. Conclusions: The predictive value of sensitivity and resistance to LRB of the genes identified by the study is promising and should be tested in a larger data set.« less

Adverse Childhood Experiences and Young Adult Health Outcomes among Youth Aging Out of Foster Care.

PubMed

Rebbe, Rebecca; Nurius, Paula S; Courtney, Mark E; Ahrens, Kym R

2018-04-27

Former youth in foster care (YFC) are at greater risk of chronic health conditions than their peers. Although research in general population samples has demonstrated a dose-response relationship between adverse childhood experiences (ACEs) and adult health outcomes, few studies have conducted similar analyses in highly stress-exposed populations such as YFC. This paper uses person-centered latent class analysis (LCA) methods to examine the relationship between different profiles of ACE exposures and divergent health trajectories amongst this high-risk population. Data are from longitudinal research that followed transition-age YFC from age 17-26 (N =732). Using three subgroups previously identified by their ACEs histories, Complex, Environmental, and Lower Adversity groups, we applied group mean statistics to test for differences between the groups for physical and sexual health outcomes in young adulthood. In contrast to prior research demonstrating that the Environmental group was at the highest risk of criminal behavior outcomes, for most of the physical and sexual health risk outcomes evaluated in this paper, the Complex Adversity group had the highest risk. This study demonstrates that there are subgroups of YFC which each have a distinct profile of risk in young adulthood, with the Complex group being at highest risk of the physical and sexual health risk outcomes evaluated. Findings strongly suggest the need for targeted strategies to promote screening for ACEs and chronic health conditions, linkage to adult healthcare, and continuity of care for adolescents and young adults in foster care to offset these trajectories. Copyright © 2018. Published by Elsevier Inc.

Drug use, sexual risk behaviour and sexually transmitted infections among swingers: a cross-sectional study in The Netherlands.

PubMed

Spauwen, Laura W L; Niekamp, Anne-Marie; Hoebe, Christian J P A; Dukers-Muijrers, Nicole H T M

2015-02-01

Recreational drug use has been found to be associated with high-risk sexual behaviour and with sexually transmitted infections (STI). This study is the first to assess the prevalence of drug use among swingers (heterosexuals who, as a couple, practise mate swapping or group sex, and/or visit sex clubs for couples), and its association with high-risk sexual behaviour and STI. We recruited individuals who self-identified as swingers and visited our STI clinic (from 2009 to 2012, South Limburg, The Netherlands). Participants (n=289; median age 45 years; 49% female) filled in a self-administered questionnaire on their sexual and drug use behaviour while swinging, over the preceding 6 months. We assessed associations between sexual behaviour, drug use and STI diagnoses (Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG), syphilis, HIV and hepatitis B) using logistic regression analyses. Overall, the prevalence of CT and/or NG was 13%. No other STIs were observed. Seventy-nine percent of swingers reported recreational drug use (including alcohol and use of erectile dysfunction drugs); 46% of them reported multiple drug use. Recreational drug use excluding alcohol and erectile dysfunction drugs (reported by 48%) was associated with high-risk behaviours in men and women. Drug use was independently associated with STI in female swingers, especially those who practice group sex. High rates of multiple drug use, as well as risky sexual behaviour and STIs among swingers, warrant paying more attention to this key population in prevention and care, as they are a risk group that is generally under-recognised and underserved in care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Pressure ulcers prevention efficacy of an alternating pressure air mattress in elderly patients: E²MAO a randomised study.

PubMed

Sauvage, P; Touflet, M; Pradere, C; Portalier, F; Michel, J-M; Charru, P; Passadori, Y; Fevrier, R; Hallet-Lezy, A-M; Beauchêne, F; Scherrer, B

2017-06-02

Our aim was to compare Axtair One, an alternating pressure air mattress (APAM), with a viscoelastic foam mattress (VFM) in elderly patients at moderate to high risk of developing pressure ulcers (PUs). A randomised, controlled, superiority, parallel-group, open-label, multicentre study, was conducted, between February 2012 and March 2015, in nine French, medium- and long-term stay facilities. Eligible patients were aged 70 and over, had no PUs on enrolment, were bedridden for at least 15 hours per day, had reduced mobility, an absent or minimal positioning capability, a Braden score <14, a nutritional status score >12 and a Karnofsky score <40%. The primary endpoint was the appearance of PUs over a 30-day monitoring period. The primary objective was to demonstrate a 50% reduction in instantaneous risk of PUs in the APAM versus the VFM group. Secondary objectives were to determine if preventive care was less frequent in the APAM group, the instantaneous relative risk of PUs (hazard ratio) was constant over time and the comfort experienced was higher in the APAM group and to verify the uniformity of the preventive benefit of an APAM, regardless of the level of exposure to major risk factors for PUs. We randomised 76 patients (39 in the APAM group and 37 in the VFM group). The groups were comparable on enrolment and throughout the study. The cumulative risk of PUs was estimated at 6.46% [95% confidence interval (CI): 1.64; 23.66] in the APAM group and at 38.91% [95% CI: 24.66; 57.59] in the VFM group, p=0.001 (log-rank test). The adjusted hazard ratio according to the Cox model with four prognostic factors for the appearance of PUs was 7.57 [95% CI: 1.67; 34.38, p=0.009]. Preventive care proved to be equivalent in both groups. The only risk factor significantly associated with an increased risk of PUs was the type of mattress (VFM). The comfort and tolerance perceived by the patients were both high and similar in the two groups. The constancy over time of the preventive benefit of an APAM could not be verified because of the lack of a sufficient number of events (appearance of PUs) in the APAM group. The APAM was superior to a VFM for preventing PUs in elderly patients, bedridden for more than 15 hours per day, severely dependent, at moderate-to high-risk of PUs, with an instantaneous risk for the appearance of PUs 7.57 times greater in the VFM group than in the APAM group. This study provides descriptive information and evidence for practice.

Environmental arsenic exposure of schoolchildren in a former tin mining and smelting community of southern Thailand.

PubMed

Vitayavirasak, Banjong; Rakwong, Kittiya; Chatchawej, Warangkana

2005-01-01

Risk behavior and environmental sources of exposure to arsenic for 10-year-old schoolchildren were studied in a high exposure area and a low exposure area of Ron Phibun Subdistrict, Ron Phibun District, Nakhon Si Thammarat Province and compared to those in a control area. Arsenic concentrations of surface soil, ambient air and drinking water to which subjects in the high exposure group, the low exposure group and the control group were exposed, were significantly different (p < 0.05). Similarly, urinary concentrations of total arsenic and the sum of inorganic arsenic and its metabolites were significantly higher in the study groups than the control group. The arsenic content of locally grown agricultural produce was small with the exception of freshwater snails (Sinotaia ingallsiana). Drinking water and surface soil were found to be the main sources of exposure. The exposure was mediated by the subjects' risk behavior, such as playing with soil and no hand-washing before eating. The estimated cancer risk from arsenic for the schoolchildren in the study area was between 10(-5)-10(-6) which meant that their risk of developing cancer was probable. Measures to reduce the cancer risk are recommended.

Cognitive and behavioural dispositions in offspring at high risk for alcoholism.

PubMed

Kumar, Rajesh; Kumar, Keshav Janakiprasad; Benegal, Vivek

2018-06-01

Offspring with family history of alcoholism are considered to be at high risk for alcoholism. The present study sought to expand our understanding of cognitive and behavioural dispositions associated with executive control and self-regulation in alcohol naïve offspring with and without family history of alcoholism. Sample comprised of alcohol naive offspring in two groups: (i) at high risk (n = 34) and (ii) at low risk for alcoholism (n = 34). Both groups were matched on age (+/-1 year), education (+/-1 year) and gender. Measures used were: Mini-International Neuropsychiatric Interview, Family Interview for Genetic Studies, Socio-demographic Data Sheet, Annett's Handedness Questionnaire, Barratt's Impulsiveness Scale-version 11, Digit Span Test, Spatial Span Test, Tower of London, Wisconsin Card Sorting Test, Iowa Gambling Task (IGT) and Game of Dice Task (GDT). Results showed that alcohol naive offspring at high risk for alcoholism reported significantly high impulsivity and demonstrated significant differences on executive functions and decision making tasks. Correlation analysis revealed that high impulsivity was significantly associated with poor performance on explicit decision making task (GDT) and executive function task (WCST). There was no significant correlation between two decision making tasks (IGT and GDT) in both groups and performance on IGT was not significantly associated with impulsivity and executive functions. The present study indicates cognitive and behavioural dispositions in alcohol naive offspring at high risk for alcoholism and support the sub-optimal balance between reflective and impulsive system responsible for addiction. Furthermore, present study supports separability between two different types of decision making tasks. Copyright © 2018 Elsevier B.V. All rights reserved.

Risk classification of highly sensitive troponin I predict presence of vulnerable plaque assessed by dual source coronary computed tomography angiography.

PubMed

Liu, Ting; Wang, Guan; Li, Peiling; Dai, Xu

2017-11-01

Patients presenting to the emergency department with acute chest pain, negative conventional troponin and electrocardiogram require serial testing to rule out acute coronary syndrome (ACS). We studied the association of highly sensitive troponin (hsTn) I with vulnerable plaque features as detected by coronary dual source computed tomography angiography (DSCTA) and determined whether hsTn I at the time of presentation combined with early DSCTA could improve classification of patients as high-risk or low risk for ACS. We included 220 patients with acute chest pain, negative electrocardiogram and conventional troponin who underwent DSCTA and had hsTn I measured at the time of presentation. The patients were categorized as having hsTn I below the limit of detection (low risk), intermediate and above the 99th percentile (high risk). Readers assessed DSCTA qualitatively for the presence of significant CAD (≥50% stenosis), calcified and non-calcified coronary plaque, and vulnerable plaque features (positive remodeling, low CT attenuation plaque, napkin-ring sign, spotty calcium). The mean age of the population was 50.3 ± 8.2 years (43% women). ACS during the index hospitalization occurred in 36 (16.3%) patients (myocardial infarction n = 8, unstable angina pectoris n = 28). HsTn I was below the limit of detection, intermediate, and above 99th percentile in 39 (17.7%), 139 (86.9%), and 42 (19.1%) patients, respectively. Across the categories of low risk, intermediate and high risk of hsTn I, there was increase in prevalence of ≥50% stenosis (0, 11.5, and 61.9% of patients; p < 0.001), any plaque (35.9, 51.1, and 85.7% of patients; p < 0.001) and high-risk plaque (0, 36.0, and 85.7% of patients; p < 0.001). None of the patients in low risk HsTn I group had ACS. ACS occurred in 10.1% of the intermediate hsTn I group and in 52.3% of the patients with high risk hsTnI group. Severity of stenosis and presence of vunerable plaque as detected by DSCTA are associated with increasing levels of hsTn I. DSCTA at the time of presentation with the assessment for both stenosis and high-risk plaque improved the diagnostic accuracy for ACS in the intermediate hsTn I group patients.

A Proposed Set of Metrics to Reduce Patient Safety Risk From Within the Anatomic Pathology Laboratory

PubMed Central

Banks, Peter; Brown, Richard; Laslowski, Alex; Daniels, Yvonne; Branton, Phil; Carpenter, John; Zarbo, Richard; Forsyth, Ramses; Liu, Yan-hui; Kohl, Shane; Diebold, Joachim; Masuda, Shinobu; Plummer, Tim

2017-01-01

Background: Anatomic pathology laboratory workflow consists of 3 major specimen handling processes. Among the workflow are preanalytic, analytic, and postanalytic phases that contain multistep subprocesses with great impact on patient care. A worldwide representation of experts came together to create a system of metrics, as a basis for laboratories worldwide, to help them evaluate and improve specimen handling to reduce patient safety risk. Method: Members of the Initiative for Anatomic Pathology Laboratory Patient Safety (IAPLPS) pooled their extensive expertise to generate a list of metrics highlighting processes with high and low risk for adverse patient outcomes. Results: Our group developed a universal, comprehensive list of 47 metrics for patient specimen handling in the anatomic pathology laboratory. Steps within the specimen workflow sequence are categorized as high or low risk. In general, steps associated with the potential for specimen misidentification correspond to the high-risk grouping and merit greater focus within quality management systems. Primarily workflow measures related to operational efficiency can be considered low risk. Conclusion: Our group intends to advance the widespread use of these metrics in anatomic pathology laboratories to reduce patient safety risk and improve patient care with development of best practices and interlaboratory error reporting programs. PMID:28340232

A Proposed Set of Metrics to Reduce Patient Safety Risk From Within the Anatomic Pathology Laboratory.

PubMed

Banks, Peter; Brown, Richard; Laslowski, Alex; Daniels, Yvonne; Branton, Phil; Carpenter, John; Zarbo, Richard; Forsyth, Ramses; Liu, Yan-Hui; Kohl, Shane; Diebold, Joachim; Masuda, Shinobu; Plummer, Tim; Dennis, Eslie

2017-05-01

Anatomic pathology laboratory workflow consists of 3 major specimen handling processes. Among the workflow are preanalytic, analytic, and postanalytic phases that contain multistep subprocesses with great impact on patient care. A worldwide representation of experts came together to create a system of metrics, as a basis for laboratories worldwide, to help them evaluate and improve specimen handling to reduce patient safety risk. Members of the Initiative for Anatomic Pathology Laboratory Patient Safety (IAPLPS) pooled their extensive expertise to generate a list of metrics highlighting processes with high and low risk for adverse patient outcomes. : Our group developed a universal, comprehensive list of 47 metrics for patient specimen handling in the anatomic pathology laboratory. Steps within the specimen workflow sequence are categorized as high or low risk. In general, steps associated with the potential for specimen misidentification correspond to the high-risk grouping and merit greater focus within quality management systems. Primarily workflow measures related to operational efficiency can be considered low risk. Our group intends to advance the widespread use of these metrics in anatomic pathology laboratories to reduce patient safety risk and improve patient care with development of best practices and interlaboratory error reporting programs. © American Society for Clinical Pathology 2017.

Mothers’ Trajectories of Depressive Symptoms Across Mexican-Origin Adolescent Daughters’ Transition to Parenthood

PubMed Central

Updegraff, Kimberly A.; Perez-Brena, Norma J.; Umaña-Taylor, Adriana J.; Jahromi, Laudan B.; Harvey-Mendoza, Elizabeth C.

2013-01-01

This study draws from a life-course perspective in examining trajectories of mothers’ depressive symptoms across their adolescent daughters’ adjustment to parenthood in 204 Mexican-origin families using latent class growth analysis. Four distinct trajectories were identified based on mothers’ depressive symptoms prior to the birth and 10 and 24 months postpartum. Two trajectories were characterized by stable levels of depressive symptoms but were differentiated in their levels of symptoms (i.e., High/Stable and Low/Stable). The remaining two trajectories were characterized by changes from pre- to post-birth, with one group exhibiting increases in depressive symptoms (i.e., Low/Post-Birth Increase) and the other group characterized by decreases in depressive symptoms (i.e., Low/Post-Birth Decrease). Consistent with a risk and resilience perspective, mothers with more disadvantaged socioeconomic circumstances and fewer intrapersonal resources (i.e., self-esteem, ethnic identity affirmation) were more likely to be members of the High/Stable group. In addition, daughters of mothers in the High/Stable group were more likely to have lower self-esteem as compared to daughters in the other three groups. Collectively, these findings suggested that the High/Stable group was at risk for adjustment difficulties from the third trimester to two years postpartum. In contrast, membership in the Low/Post-Birth Decrease trajectory group was associated with lower depressive symptoms and higher self-esteem for mothers and daughters. Findings point to the need to identify mothers who are at risk for depressive symptoms during their adolescent daughters’ pregnancy and offer prevention and intervention programs that reduce risks and enhance protective factors. PMID:23750520

Effect of Prepregnancy Alcohol Consumption on Postpartum Relationship Satisfaction and Divorce among Norwegian Mothers

PubMed Central

Mellingen, Sonja; Torsheim, Torbjørn; Thuen, Frode

2015-01-01

This study assessed the effect of prepregnancy level of alcohol use among mothers on relationship breakups with young children at 36 months after birth and the extent to which relationship satisfaction (RS) throughout the postpartum period could mediate any association between alcohol use and divorce. The data were part of the Norwegian Mother and Child Cohort Study, and analyses of the present article were based on a total of 69,117 mothers divided into low-, medium-, and high-risk consumption groups. All the three groups experienced a decrease in RS, but the largest effect was observed for the high-risk group. Mothers in this group had 55% higher odds for divorce as compared to the low-risk group. The findings supported a conceptual model whereby the effects of alcohol use on divorce were mediated through lowered RS. PMID:26740743

Pattern of galectins expression in actinic cheilitis with different risks of malignant transformation.

PubMed

Lopes, Maria Luiza Diniz de Sousa; Nonaka, Cassiano Francisco Weege; Queiroz, Lélia Maria Guedes; de Souza, Lélia Batista; Miguel, Márcia Cristina da Costa; da Silveira, Éricka Janine Dantas

2016-09-01

Actinic cheilitis (AC) is a chronic inflammatory lesion that in some situations can turn into squamous cell carcinoma of the lip. The molecular mechanisms involved in this process are not yet completely understood. This study aimed to investigate the expression pattern of galectins in actinic cheilitis according to the histopathological grading. Immunoexpression of galectin-1, galectin-3, galectin-7, and galectin-9 was semiquantitatively analyzed in 65 cases of actinic cheilitis graded as low risk (n = 40) or high risk (n = 25) of malignant transformation. Association between the location of the galectins in the cellular compartments and histopathological grading was analyzed. Galectin-1 was mainly observed in the cell cytoplasm, and was elevated (score 3) in 60% of cases, regardless of the histopathological grade (P > 0.05). Galectin-3 expression was higher in high-risk group than in the low-risk group (P < 0.05), with a predominant expression in the cytoplasm and nucleus of low-risk (67.5%), and only in the cytoplasm of high-risk cases (60%) (P < 0.05). Galectin-7 expression did not show significant differences between low-risk and high-risk groups (P > 0.05). With respect to galectin-9, 89.2% of cases were positive, showing decrease in median of scores as there was an increase in histological grade (P < 0.001), with predominant expression in the nucleus and cytoplasm. This study is the first indication of galectins involvement in the pathogenesis and morphologic progression of actinic cheilitis, particularly galectin-3 and galectin-9. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Analysis of risk factors for persistent infection of asymptomatic women with high-risk human papilloma virus.

PubMed

Shi, Nianmin; Lu, Qiang; Zhang, Jiao; Li, Li; Zhang, Junnan; Zhang, Fanglei; Dong, Yanhong; Zhang, Xinyue; Zhang, Zheng; Gao, Wenhui

2017-06-03

This study aims to prevent persistentinfection, reduce the incidence of cervical cancer, and improve women's health by understanding the theoretical basis of the risk factors for continuous infection of asymptomatic women with high-risk human papilloma virus (HPV) strains via information collected, which includes the persistent infection rate and the most prevalent HPV strain types of high risk to asymptomatic women in the high-risk area of cervical cancer in Linfen, Shanxi Province. Based on the method of cluster sampling, locations were chosen from the industrial county and agricultural county of Linfen, Shanxi Province, namely the Xiangfen and Quwo counties. Use of the convenience sampling (CS) method enables the identification of women who have sex but without symptoms of abnormal cervix for analyzing risk factors of HPV-DNA detection and performing a retrospective questionnaire survey in these 2 counties. Firstly, cervical exfoliated cell samples were collected for thin-layer liquid-based cytology test (TCT), and simultaneously testing high-risk type HPV DNA, then samples with positive testing results were retested to identify the infected HPV types. The 6-month period of testing was done to derive the 6-month persistent infection rate. The retrospective survey included concepts addressed in the questionnaire: basic situation of the research objects, menstrual history, marital status, pregnancy history, sexual habits and other aspects. The questionnaire was divided into a case group and a comparison group, which are based on the high-risk HPV-DNA testing result to ascertain whether or not there is persistent infection. Statistical analysis employed Epidate3.1 software for date entry, SPSS17.0 for date statistical analysis. Select statistic charts, Chi-Square Analysis, single-factor analysis and multivariate Logistic regression analysis to analyze the protective factors and risk factors of high-risk HPV infection. Risk factors are predicted by using the classification tree. 3000 women participated in the study. The high-risk type HPV infection rate was 8.7%, the persistent infection rate was 7.5%. The persistent infection rates for the 2 age groups (ages 18-26 and 27-30) were 6.9% and 8.7%. The persistent infection rates of Xiangfen county were 7.4% and 7.4% respectively, and those of Quwo county were 7.8% and 11.6% respectively; there was no significant difference between each pair of groups. Single risk-factor analysis showed that first-time sex at age under 20, high school/technical secondary school education or above, multiple sexual partners, having more than 2 sexual partners in the past 6 months, oral sex, and colitis are the risk factors of high-risk type HPV infection. Multivariate analysis showed that the number of sexual partners, smoking and oral sex had an effect on HPV infection. The risk of HPV infection from smoking was 5.0-fold higher, and the risk of HPV infection from oral sex was 6.1-fold higher. Having more than 2 sexual partners increase the risk of HPV infection. By the predicated model analysis, the probability of HPV conveyed by oral sex was 14.8%; if the sexual companion number was zero or more than 2 without oral sex, the probability of HPV infection was 12.1%; if there was one sexual partner who smokes without oral sex, the probability of infection was 18.6%; if there was one sexual partner who does not smoke and without oral sex, the probability of infection was 3.6%. The persistent infection rate of asymptomatic women for high-risk type HPV is lower than those women in all ages. High-risk type HPV infection risk factors include the number of sexual partners, oral sex and smoking. Thus, young women may be able to reduce the risk of infection with high-risk type HPV by reducing the number of sexual partners, forming a correct sexual life habit, and avoiding smoking.

Analysis of indoor air pollutants checklist using environmetric technique for health risk assessment of sick building complaint in nonindustrial workplace

PubMed Central

Syazwan, AI; Rafee, B Mohd; Juahir, Hafizan; Azman, AZF; Nizar, AM; Izwyn, Z; Syahidatussyakirah, K; Muhaimin, AA; Yunos, MA Syafiq; Anita, AR; Hanafiah, J Muhamad; Shaharuddin, MS; Ibthisham, A Mohd; Hasmadi, I Mohd; Azhar, MN Mohamad; Azizan, HS; Zulfadhli, I; Othman, J; Rozalini, M; Kamarul, FT

2012-01-01

Purpose To analyze and characterize a multidisciplinary, integrated indoor air quality checklist for evaluating the health risk of building occupants in a nonindustrial workplace setting. Design A cross-sectional study based on a participatory occupational health program conducted by the National Institute of Occupational Safety and Health (Malaysia) and Universiti Putra Malaysia. Method A modified version of the indoor environmental checklist published by the Department of Occupational Health and Safety, based on the literature and discussion with occupational health and safety professionals, was used in the evaluation process. Summated scores were given according to the cluster analysis and principal component analysis in the characterization of risk. Environmetric techniques was used to classify the risk of variables in the checklist. Identification of the possible source of item pollutants was also evaluated from a semiquantitative approach. Result Hierarchical agglomerative cluster analysis resulted in the grouping of factorial components into three clusters (high complaint, moderate-high complaint, moderate complaint), which were further analyzed by discriminant analysis. From this, 15 major variables that influence indoor air quality were determined. Principal component analysis of each cluster revealed that the main factors influencing the high complaint group were fungal-related problems, chemical indoor dispersion, detergent, renovation, thermal comfort, and location of fresh air intake. The moderate-high complaint group showed significant high loading on ventilation, air filters, and smoking-related activities. The moderate complaint group showed high loading on dampness, odor, and thermal comfort. Conclusion This semiquantitative assessment, which graded risk from low to high based on the intensity of the problem, shows promising and reliable results. It should be used as an important tool in the preliminary assessment of indoor air quality and as a categorizing method for further IAQ investigations and complaints procedures. PMID:23055779

Analysis of indoor air pollutants checklist using environmetric technique for health risk assessment of sick building complaint in nonindustrial workplace.

PubMed

Syazwan, Ai; Rafee, B Mohd; Juahir, Hafizan; Azman, Azf; Nizar, Am; Izwyn, Z; Syahidatussyakirah, K; Muhaimin, Aa; Yunos, Ma Syafiq; Anita, Ar; Hanafiah, J Muhamad; Shaharuddin, Ms; Ibthisham, A Mohd; Hasmadi, I Mohd; Azhar, Mn Mohamad; Azizan, Hs; Zulfadhli, I; Othman, J; Rozalini, M; Kamarul, Ft

2012-01-01

To analyze and characterize a multidisciplinary, integrated indoor air quality checklist for evaluating the health risk of building occupants in a nonindustrial workplace setting. A cross-sectional study based on a participatory occupational health program conducted by the National Institute of Occupational Safety and Health (Malaysia) and Universiti Putra Malaysia. A modified version of the indoor environmental checklist published by the Department of Occupational Health and Safety, based on the literature and discussion with occupational health and safety professionals, was used in the evaluation process. Summated scores were given according to the cluster analysis and principal component analysis in the characterization of risk. Environmetric techniques was used to classify the risk of variables in the checklist. Identification of the possible source of item pollutants was also evaluated from a semiquantitative approach. Hierarchical agglomerative cluster analysis resulted in the grouping of factorial components into three clusters (high complaint, moderate-high complaint, moderate complaint), which were further analyzed by discriminant analysis. From this, 15 major variables that influence indoor air quality were determined. Principal component analysis of each cluster revealed that the main factors influencing the high complaint group were fungal-related problems, chemical indoor dispersion, detergent, renovation, thermal comfort, and location of fresh air intake. The moderate-high complaint group showed significant high loading on ventilation, air filters, and smoking-related activities. The moderate complaint group showed high loading on dampness, odor, and thermal comfort. This semiquantitative assessment, which graded risk from low to high based on the intensity of the problem, shows promising and reliable results. It should be used as an important tool in the preliminary assessment of indoor air quality and as a categorizing method for further IAQ investigations and complaints procedures.

Population groups in dietary transition

PubMed Central

Wändell, Per E.

2013-01-01

Background Little is known about the effects of dietary acculturation in minority groups in the Nordic countries, including immigrants from non-Western societies. Methods A search was performed in Medlin33e/PubMed and SweMed+ for articles published in 1990–2011. Results A total of 840 articles were identified, with a final 32 articles used to tabulate results which were included in the primary analysis. High rates of vitamin D deficiency (23 articles) were found in immigrants of non-Western origin; deficiency rates were very high among both pregnant and non-pregnant women, and also among children, with young children of immigrant parents showing 50 times higher risk for rickets when compared to children of indigenous parents. The risk of iron deficiency (two articles) was high among immigrant women, while the results were inconclusive regarding children. High rates of dental caries (seven articles) were found among pre-school and younger school children of immigrant origin, while the risk of caries was not as evident among older children. In a secondary analysis, including 48 articles (results not tabulated), overweight and obesity (14 articles) were seen in many immigrant groups, resulting in a high prevalence of diabetes (2 review articles from a total of 14 original articles) and incidence of coronary heart disease (CHD; seven articles). For hypertension (three articles), dyslipidemia (four articles), and dietary patterns among immigrants (10 articles), the results were contradictory. Conclusions Risk of vitamin D deficiency is alarmingly high in the Nordic countries among immigrants of non-Western origin, especially among women. Dental caries is high among immigrant children aged 0–7 years due to a higher intake of sugary products. Overweight and obesity, associated with a higher risk of diabetes and CHD, are prevalent in many immigrant groups and need further attention. PMID:24106456

Building skills of recovering women drug users to reduce heterosexual AIDS transmission.

PubMed Central

Schilling, R F; el-Bassel, N; Schinke, S P; Gordon, K; Nichols, S

1991-01-01

Although most women infected with HIV are intravenous drug users, some contact the virus through sexual contact with IV drug users. To reach at-risk women, public health officials must develop a range of prevention strategies. One approach, skills training, holds promise as a means of altering risk-related sexual behavior. In this study, 91 women methadone patients were pretested and randomly assigned to an information-only control control group or a skills-building intervention group. Skills-building intervention consisted of five sessions of small groups in which participants identified their own high risk sexual behaviors, discussed their negative associations with condoms, and practiced skills which involved asking partners to use condoms. Compared with members of the control group, respondents in the intervention group reported that they initiated discussion of sexual issues with their partners more frequently, felt more comfortable talking with them about safer sex, and reported using and carrying condoms more frequently. The high rates of attendance and program retention by skills-building participants suggest that such groups may be supportive and useful in the design of risk reduction and drug abuse treatment programs. The modest outcomes of this study underscore the difficulty of altering risk behavior but also serve as a basis for future AIDS prevention studies. PMID:1905051

Improving STD testing behavior among high-risk young adults by offering STD testing at a vocational school.

PubMed

Spauwen, Laura W L; Hoebe, Christian J P A; Brouwers, Elfi E H G; Dukers-Muijrers, Nicole H T M

2011-09-30

Chlamydia trachomatis infection (CT) is the most prevalent bacterial STD. Sexually active adolescents and young adults are the main risk group for CT. However, STD testing rates in this group are low since exposed individuals may not feel at risk, owing-at least in part-to the infection's largely asymptomatic nature. Designing new testing environments that are more appealing to young people who are most at risk of acquiring chlamydia can be an important strategy to improve overall testing rates. Here we evaluate the effect of a school-based sexual health program conducted among vocational school students, aiming to obtain better access for counseling and enhance students' STD testing behavior. Adolescents (median age 19 years) attending a large vocational school were provided with sexual health education. Students filled in a questionnaire measuring CT risk and were offered STD testing. Using univariate and multivariate analysis, we assessed differences between men and women in STD-related risk behavior, sexual problems, CT testing behavior and determinants of CT testing behavior. Of 345 participants, 70% were female. Of the 287 sexually active students, 75% were at high risk for CT; one third of women reported sexual problems. Of sexually active participants, 61% provided a self-administered specimen for STD testing. Independent determinants for testing included STD related symptoms and no condom use. All CT diagnoses were in the high-CT-risk group. In the high-risk group, STD testing showed an increased uptake, from 27% (previous self-reported test) to 65% (current test). CT prevalence was 5.7%. Vocational school students are a target population for versatile sexual health prevention. When provided with CT testing facilities and education, self selection mechanisms seemed to increase CT testing rate dramatically in this high-CT-risk population expressing sexual problems. Considering the relative ease of testing and treating large numbers of young adults, offering tests at a vocational school is feasible in reaching adolescents for STD screening. Although cost-effectiveness remains an issue counseling is effective in increasing test rates.

[Impact of fall risk and fear of falling on mobility of independently living senior citizens transitioning to frailty: screening results concerning fall prevention in the community].

PubMed

Anders, J; Dapp, U; Laub, S; von Renteln-Kruse, W

2007-08-01

There is a strong relation between mobility, walking safety and living independently in old age. People with walking problems suffer from fear of falling and tend to restrict their mobility and performance level in the community environment--even before falls occur. This study was planned to test the validity and prognostic value of a fall risk screening instrument ("Sturz-Risiko-Check") that has already shown its feasibility, acceptance and reliability, targeting independently living senior citizens. The study sample was recruited from a sheltered housing complex in Hamburg (with written consent). Persons with need of professional care ("Pflegestufe" in Germany) were excluded. The residents were asked to fill in the multidimensional questionnaire ("Sturz-Risiko- Check"). In a second step, a trained nurse asked the participants in a phone call about their competence in the instrumental activities of daily living (I-ADL mod. from Lawton, Brody 1969) and about their usual mobility performance level (e.g. frequency and distance of daily walks, use of public transport). According to the number and weight of self-reported risk factors for falling, three groups: "low fall risk", "medium fall risk" and "high fall risk" were classified. Finally, this classification was re-tested after one year, asking for falls and fall related injuries. A total of 112 senior citizens without need of personal care, living in a sheltered housing facility were asked to participate. Acceptance was high (76.1%). Self-reported data from 79 participants concerning falls, fall-risk, mobility and instrumental activities of daily living were included in the statistical analyses. Mean age was 78 (64 to 93) years and associated by a high percentage of women (75.9%) in this sample. The older participants reported 0 to 13 different factors (mean 5) related to a high risk of future falls. Most participants (78.5%) quit cycling because of fear of falling. There was a high incidence in the study sample and over the three risk groups of chronic disorders like cardiac failure (75.9%) and disturbed vision or hearing (64.6%). According to the rising risk of falling over the three risk groups (low, medium and high), there were symptoms of fast functional decline or frailty like diminished walking speed (6.3 vs 36.8 vs 72.0%), sarcopenia (failed chairrise test: 0 vs 18.4 vs 28%) or already perceived fall events (0 vs 5.3 vs 56.0%) and ongoing restriction in basic activities. Those results were proven by the data on fall frequencies after one year (follow-up). We found an increase in falls over all three risk groups (12.5 vs 31.6 vs 28%) with fall-related severe injuries (fractures) in two persons classified in the high fall-risk group. The results of the fall-risk screening were useful to classify groups with different probability to fall in the near future. Fear-offalling and symptoms of frailty were related to an increasing risk of falling and loss of mobility and autonomy in still independently living senior citizens. The fall-risk screening instrument ("Sturz-Risiko-Check" questionnaire) was useful and valid to predict risk of falling and functional decline in independently living senior citizens transitioning to frailty. This screening will be part of a prevention approach in the City of Hamburg to offer primary and secondary prevention interventions adapted to special target groups of community- dwelling elder people (robust in contrast to frail elderly). The implementation should be accompanied by training sessions for physicians in the primary care sector and health improvement programmes for elder citizens.

Intercessory prayer and cardiovascular disease progression in a coronary care unit population: a randomized controlled trial.

PubMed

Aviles, J M; Whelan, S E; Hernke, D A; Williams, B A; Kenny, K E; O'Fallon, W M; Kopecky, S L

2001-12-01

To determine the effect of intercessory prayer, a widely practiced complementary therapy, on cardiovascular disease progression after hospital discharge. In this randomized controlled trial conducted between 1997 and 1999, a total of 799 coronary care unit patients were randomized at hospital discharge to the intercessory prayer group or to the control group. Intercessory prayer, ie, prayer by 1 or more persons on behalf of another, was administered at least once a week for 26 weeks by 5 intercessors per patient. The primary end point after 26 weeks was any of the following: death, cardiac arrest, rehospitalization for cardiovascular disease, coronary revascularization, or an emergency department visit for cardiovascular disease. Patients were divided into a high-risk group based on the presence of any of 5 risk factors (age = or >70 years, diabetes mellitus, prior myocardial infarction, cerebrovascular disease, or peripheral vascular disease) or a low-risk group (absence of risk factors) for subsequent primary events. At 26 weeks, a primary end point had occurred in 25.6% of the intercessory prayer group and 29.3% of the control group (odds ratio [OR], 0.83 [95% confidence interval (CI), 0.60-1.14]; P=.25). Among high-risk patients, 31.0% in the prayer group vs 33.3% in the control group (OR, 0.90 [95% CI, 0.60-1.34]; P=.60) experienced a primary end point. Among low-risk patients, a primary end point occurred in 17.0% in the prayer group vs 24.1% in the control group (OR, 0.65 [95% CI, 0.20-1.36]; P=.12). As delivered in this study, intercessory prayer had no significant effect on medical outcomes after hospitalization in a coronary care unit.

Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations.

PubMed

Tosteson, Anna N A; Burge, Russel T; Marshall, Deborah A; Lindsay, Robert

2008-09-01

To evaluate the cost-effectiveness of osteoporosis treatments for women at high fracture risk and estimate the population-level impact of providing bisphosphonate therapy to all eligible high-risk US women. Fractures, healthcare costs, and quality-adjusted life-years (QALYs) were estimated over 10 years using a Markov model. No therapy, risedronate, alendronate, ibandronate, and teriperatide (PTH) were compared among 4 risk groups. Sensitivity analyses examined the robustness of model results for 65-year-old women with low bone density and previous vertebral fracture. Women treated with a bisphosphonate experienced fewer fractures and more QALYs compared with no therapy or PTH. Total costs were lowest for the untreated cohort, followed by risedronate, alendronate, ibandronate, and PTH in all risk groups except women aged 75 years with previous fracture. The incremental cost-effectiveness of risedronate compared with no therapy ranged from cost saving for the base case to $66,722 per QALY for women aged 65 years with no previous fracture. Ibandronate and PTH were dominated in all risk groups. (A dominated treatment has a higher cost and poorer outcome.) Treating all eligible women with a bisphosphonate would cost an estimated additional $5563 million (21% total increase) and would result in 390,049 fewer fractures (35% decrease). In the highest risk group, the additional cost of therapy was offset by other healthcare cost savings. Osteoporosis treatment of high-risk women is cost-effective, with bisphosphonates providing the most benefit at lowest cost. For highest risk women, costs are offset by savings from fracture prevention.

The Effect of State Regulations on Motor Vehicle Fatalities for Younger and Older Drivers: A Review and Analysis

PubMed Central

Grabowski, David C.; Morrisey, Michael A.

2001-01-01

Policymakers have had a long-standing interest in improving the motor vehicle safety of both younger and older drivers. Although younger and older drivers share the distinction of having more crashes and fatalities per mile driven than other age groups, the problems posed by these two groups stem from different origins and manifest in different ways. A number of state-level policies and regulations may affect the number of motor vehicle crashes and fatalities in these two high-risk groups. A critical review of the existing literature in regard to the risk factors and the effects of various policy measures on motor vehicle crashes in these two high-risk populations provides direction for policymakers and high-priority areas of interest for the research community. PMID:11789116

The Joint Effects of Risk Status, Gender, Early Literacy and Cognitive Skills on the Presence of Dyslexia among a Group of High-Risk Chinese Children

ERIC Educational Resources Information Center

Wong, Simpson W. L.; McBride-Chang, Catherine; Lam, Catherine; Chan, Becky; Lam, Fanny W. F.; Doo, Sylvia

2012-01-01

This study sought to examine factors that are predictive of future developmental dyslexia among a group of 5-year-old Chinese children at risk for dyslexia, including 62 children with a sibling who had been previously diagnosed with dyslexia and 52 children who manifested clinical at-risk factors in aspects of language according to testing by…

Anxiety and Attentional Bias to Threat in Children at Increased Familial Risk for Autism Spectrum Disorder

ERIC Educational Resources Information Center

Milosavljevic, Bosiljka; Shephard, Elizabeth; Happé, Francesca G.; Johnson, Mark H.; Charman, Tony

2017-01-01

Anxiety and threat bias were examined in 6-8-year-old children at familial-risk for Autism Spectrum Disorder (ASD) and low-risk (LR, n = 37) controls. The high-risk (HR) group was divided into those who met diagnostic criteria for ASD (HR-ASD, n = 15) and those who did not (HR-non ASD, n = 24). The HR-ASD group had highest levels of…

Problematic Dichotomization of Risk for Intensive Care Unit (ICU)-Acquired Invasive Candidiasis: Results Using a Risk-Predictive Model to Categorize 3 Levels of Risk From a Multicenter Prospective Cohort of Australian ICU Patients.

PubMed

Playford, E Geoffrey; Lipman, Jeffrey; Jones, Michael; Lau, Anna F; Kabir, Masrura; Chen, Sharon C-A; Marriott, Deborah J; Seppelt, Ian; Gottlieb, Thomas; Cheung, Winston; Iredell, Jonathan R; McBryde, Emma S; Sorrell, Tania C

2016-12-01

 Delayed antifungal therapy for invasive candidiasis (IC) contributes to poor outcomes. Predictive risk models may allow targeted antifungal prophylaxis to those at greatest risk.  A prospective cohort study of 6685 consecutive nonneutropenic patients admitted to 7 Australian intensive care units (ICUs) for ≥72 hours was performed. Clinical risk factors for IC occurring prior to and following ICU admission, colonization with Candida species on surveillance cultures from 3 sites assessed twice weekly, and the occurrence of IC ≥72 hours following ICU admission or ≤72 hours following ICU discharge were measured. From these parameters, a risk-predictive model for the development of ICU-acquired IC was then derived.  Ninety-six patients (1.43%) developed ICU-acquired IC. A simple summation risk-predictive model using the 10 independently significant variables associated with IC demonstrated overall moderate accuracy (area under the receiver operating characteristic curve = 0.82). No single threshold score could categorize patients into clinically useful high- and low-risk groups. However, using 2 threshold scores, 3 patient cohorts could be identified: those at high risk (score ≥6, 4.8% of total cohort, positive predictive value [PPV] 11.7%), those at low risk (score ≤2, 43.1% of total cohort, PPV 0.24%), and those at intermediate risk (score 3-5, 52.1% of total cohort, PPV 1.46%).  Dichotomization of ICU patients into high- and low-risk groups for IC risk is problematic. Categorizing patients into high-, intermediate-, and low-risk groups may more efficiently target early antifungal strategies and utilization of newer diagnostic tests. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass.

PubMed

Kapoor, Poonam Malhotra; Magoon, Rohan; Rawat, Rajinder Singh; Mehta, Yatin; Taneja, Sameer; Ravi, R; Hote, Milind P

2017-01-01

There has been a constant emphasis on developing management strategies to improve the outcome of high-risk cardiac patients undergoing surgical revascularization. The performance of coronary artery bypass surgery on an off-pump coronary artery bypass (OPCAB) avoids the risks associated with extra-corporeal circulation. The preliminary results of goal-directed therapy (GDT) for hemodynamic management of high-risk cardiac surgical patients are encouraging. The present study was conducted to study the outcome benefits with the combined use of GDT with OPCAB as compared to the conventional hemodynamic management. Patients with the European System for Cardiac Operative Risk Evaluation ≥3 scheduled for OPCAB were randomly divided into two groups; the control and GDT groups. The GDT group included the monitoring and optimization of advanced parameters, including cardiac index (CI), systemic vascular resistance index, oxygen delivery index, stroke volume variation; continuous central venous oxygen saturation (ScVO 2 ), global end-diastolic volume, and extravascular lung water (EVLW), using FloTrac™ , PreSep™ , and EV-1000 ® monitoring panels, in addition to the conventional hemodynamic management in the control group. The hemodynamic parameters were continuously monitored for 48 h in Intensive Care Unit (ICU) and corrected according to GDT protocol. A total of 163 patients consented for the study. Seventy-five patients were assigned to the GDT group and 88 patients were in the control group. In view of 9 exclusions from the GDT group and 12 exclusions from control group, 66 patients in the GDT group and 76 patients in control group completed the study. The length of stay in hospital (LOS-H) (7.42 ± 1.48 vs. 5.61 ± 1.11 days, P < 0.001) and ICU stay (4.2 ± 0.82 vs. 2.53 ± 0.56 days, P < 0.001) were significantly lower in the GDT group as compared to control group. The duration of inotropes (3.24 ± 0.73 vs. 2.89 ± 0.68 h, P = 0.005) was also significantly lower in the GDT group. The two groups did not differ in duration of ventilated hours, mortality, and other complications. The parameters such as ScVO 2 , CI, and EVLW had a strong negative and positive correlation with the LOS-H with r values of - 0.331, -0.319, and 0.798, respectively. The study elucidates the role of a goal-directed hemodynamic optimization for improved outcome in high-risk cardiac patients undergoing OPCAB.

The Association Between Suicidal Behavior, Attentional Control, and Frontal Asymmetry

PubMed Central

Thompson, Catherine; Ong, Elsie Li Chen

2018-01-01

It can be difficult to identify those at risk of suicide because suicidal thoughts are often internalized and not shared with others. Yet to prevent suicide attempts it is crucial to identify suicidal thoughts and actions at an early stage. Past studies have suggested that deficits in attentional control are associated with suicide, with the argument that individuals are unable to inhibit negative thoughts and direct resources away from negative information. The current study aimed to investigate the association of suicidal behavior with neurological and behavioral markers, measuring attentional bias and inhibition in two Stroop tasks. Fifty-four participants responded to the color of color words in a standard Stroop task and the color of positive, negative, and neutral words in an emotional Stroop task. Electroencephalographic (EEG) activity was recorded from frontal areas during each task and at resting. Participants were separated into a low-risk and high-risk group according to their self-reported suicidal behavior. Participants in the high-risk group showed slower response times in the color Stroop and reduced accuracy to incongruent trials, but faster response times in the emotional Stroop task. Response times to the word “suicide” were significantly slower for the high-risk group. This indicates an attentional bias toward specific negative stimuli and difficulties inhibiting information for those with high levels of suicidal behavior. In the emotional Stroop task the high-risk group showed reduced activity in leftward frontal areas, suggesting limitations in the ability to regulate emotional processing via the left frontal regions. The findings support the argument that deficits in attentional control are related to suicidal behavior. The research also suggests that under certain conditions frontal asymmetry may be associated with suicidal behavior. PMID:29593586

Respiratory Syncytial Virus Genomic Load and Disease Severity Among Children Hospitalized With Bronchiolitis: Multicenter Cohort Studies in the United States and Finland

PubMed Central

Hasegawa, Kohei; Jartti, Tuomas; Mansbach, Jonathan M.; Laham, Federico R.; Jewell, Alan M.; Espinola, Janice A.; Piedra, Pedro A.; Camargo, Carlos A.

2015-01-01

Background. We investigated whether children with a higher respiratory syncytial virus (RSV) genomic load are at a higher risk of more-severe bronchiolitis. Methods. Two multicenter prospective cohort studies in the United States and Finland used the same protocol to enroll children aged <2 years hospitalized for bronchiolitis and collect nasopharyngeal aspirates. By using real-time polymerase chain reaction analysis, patients were classified into 3 genomic load status groups: low, intermediate, and high. Outcome measures were a length of hospital stay (LOS) of ≥3 days and intensive care use, defined as admission to the intensive care unit or use of mechanical ventilation. Results. Of 2615 enrolled children, 1764 (67%) had RSV bronchiolitis. Children with a low genomic load had a higher unadjusted risk of having a length of stay of ≥3 days (52%), compared with children with intermediate and those with high genomic loads (42% and 51%, respectively). In a multivariable model, the risk of having a length of stay of ≥3 days remained significantly higher in the groups with intermediate (odds ratio [OR], 1.43; 95% confidence interval [CI], 1.20–1.69) and high (OR, 1.58; 95% CI, 1.29–1.94) genomic loads. Similarly, children with a high genomic load had a higher risk of intensive care use (20%, compared with 15% and 16% in the groups with low and intermediate genomic loads, respectively). In a multivariable model, the risk remained significantly higher in the group with a high genomic load (OR, 1.43; 95% CI, 1.03–1.99). Conclusion. Children with a higher RSV genomic load had a higher risk for more-severe bronchiolitis. PMID:25425699

Development of a modified prognostic index for patients with aggressive adult T-cell leukemia-lymphoma aged 70 years or younger: possible risk-adapted management strategies including allogeneic transplantation.

PubMed

Fuji, Shigeo; Yamaguchi, Takuhiro; Inoue, Yoshitaka; Utsunomiya, Atae; Moriuchi, Yukiyoshi; Uchimaru, Kaoru; Owatari, Satsuki; Miyagi, Takashi; Taguchi, Jun; Choi, Ilseung; Otsuka, Eiichi; Nakachi, Sawako; Yamamoto, Hisashi; Kurosawa, Saiko; Tobinai, Kensei; Fukuda, Takahiro

2017-07-01

Adult T-cell leukemia-lymphoma is a distinct type of peripheral T-cell lymphoma caused by human T-cell lymphotropic virus type I. Although allogeneic stem cell transplantation after chemotherapy is a recommended treatment option for patients with aggressive adult T-cell leukemia-lymphoma, there is no consensus about indications for allogeneic stem cell transplantation because there is no established risk stratification system for transplant eligible patients. We conducted a nationwide survey of patients with aggressive adult T-cell leukemia-lymphoma in order to construct a new, large database that includes 1,792 patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who were diagnosed between 2000 and 2013 and received intensive first-line chemotherapy. We randomly divided patients into two groups (training and validation sets). Acute type, poor performance status, high soluble interleukin-2 receptor levels (> 5,000 U/mL), high adjusted calcium levels (≥ 12 mg/dL), and high C-reactive protein levels (≥ 2.5 mg/dL) were independent adverse prognostic factors used in the training set. We used these five variables to divide patients into three risk groups. In the validation set, median overall survival for the low-, intermediate-, and high-risk groups was 626 days, 322 days, and 197 days, respectively. In the intermediate- and high-risk groups, transplanted recipients had significantly better overall survival than non-transplanted patients. We developed a promising new risk stratification system to identify patients aged 70 years or younger with aggressive adult T-cell leukemia-lymphoma who may benefit from upfront allogeneic stem cell transplantation. Prospective studies are warranted to confirm the benefit of this treatment strategy. Copyright© 2017 Ferrata Storti Foundation.

Prevention of heterotopic bone formation with early post operative irradiation in high risk patients undergoing total hip arthroplasty: comparison of 10. 00 Gy vs 20. 00 Gy schedules

DOE Office of Scientific and Technical Information (OSTI.GOV)

Anthony, P.; Keys, H.; Evarts, C.M.

1987-03-01

Prior studies have demonstrated the effectiveness of postoperative radiation therapy (RT) to the hip area following total hip replacement (THR) surgery in preventing the development of heterotopic bone formation in patients considered to be at high risk for development of this complication. Previously, patients received 20.00 Gy in 10 fractions (fx) over 2 weeks, beginning as soon postop as medically feasible (usually post-op day 2). In an effort to reduce hospital stay and risk of secondary malignancy, a prospective treatment program was initiated April 1982 using a reduced dose of 10.00 Gy in 5 fx over 5-7 days. As ofmore » February 1984, 46 consecutive hips determined to be at high risk were treated with this reduced dose. Prior studies have demonstrated that heterotopic bone is always radiographically evident by 8 weeks. Of the 46 hips, 41 had been evaluated with the minimum required 8 week follow-up X ray. Twenty-five of these hips, 61%, had a mean long term follow-up of 12 months. It historical control group, consisting of 54 consecutive high risk post-THR's, was shown to have a 68.5% incidence of heterotopic bone. The 20.00 Gy group, when RT was started by post-op day 5, demonstrated a 3.2% incidence, compared to 4.9% in the 10.00 Gy group. Complication rates were also comparable in the two RT groups, 19.4% and 7.3% respectively; 10.00 Gy is apparently as effective as 20.00 Gy in preventing heterotopic bone formation in high risk post-THR patients.« less

Volume of hospital is important for the prognosis of high-risk patients with nonvariceal upper gastrointestinal bleeding (NVUGIB).

PubMed

Choi, Jin Woo; Jeon, Seong Woo; Kwon, Jung Gu; Lee, Dong Wook; Ha, Chang Yoon; Cho, Kwang Bum; Jang, Byung Ik; Park, Jung Bae; Park, Youn Sun

2017-08-01

Nonvariceal upper gastrointestinal bleeding (NVUGIB) is a potentially life-threatening hospital emergency requiring hemodynamic stabilization and resuscitation. This study is carried out to determine whether hospital volume can influence outcome in patients with NVUGIB. This is a retrospective study with a prospective cohort database (KCT 0000514. cris.nih.go.kr). Eight teaching hospitals were divided into two different groups: high-volume centers (HVC, ≥60 NVUGIB patients/year, four clinics) and low-volume centers (LVC, <60 NVUGIB patients/year, four clinics). Baseline characteristics of patients, risk stratification, and outcomes between hospitals of different volumes were compared. From February 2011 to December 2013, a total of 1584 NVUGIB patients enrolled in eight clinics were retrospectively reviewed. The main outcome measurements consisted of continuous bleeding after treatment, re-bleeding, necessity for surgical/other retreatments, and death within 30 days. Similar baseline characters for patients were observed in both groups. There was a significant difference in the incidence of poor outcome between the HVC and LVC groups (9.06 vs. 13.69%, P = 0.014). The incidence rate of poor outcome in high-risk patients (Rockall score ≥8) in HVC was lower than that in high-risk patients in LVC (16.07 vs. 26.92%, P = 0.048); however, there was no significant difference in poor outcome in the lower-risk patients in either group (8.72 vs. 10.42%, P = 0.370). Significant correlation between hospital volume and outcome in NVUGIB patients was observed. Referral to HVC for the management of high-risk NVUGIB patients should be considered in clinical practice.

Child Behavior Checklist Profiles of Children and Adolescents with and at High Risk for Developing Bipolar Disorder

ERIC Educational Resources Information Center

Giles, Lisa L.; DelBello, Melissa P.; Stanford, Kevin E.; Strakowski, Stephen M.

2007-01-01

In order to recognize behavioral patterns in children and adolescents at risk for developing bipolar disorder, this study examined Child Behavior Checklist (CBCL) profiles of bipolar offspring both with (BD group) and without ("at-risk" or AR group) bipolar disorder themselves. The BD youth had three CBCL subscale T scores greater than…

Psychological profiles and emotional regulation characteristics of women engaged in risk-taking sports.

PubMed

Cazenave, Nicolas; Le Scanff, Christine; Woodman, Tim

2007-12-01

We investigated the psychological profiles and emotional regulation characteristics of women involved in risk-taking sports. The research sample (N=180) consisted of three groups of women engaged in: (1) non-risk sports (N=90); (2) risk-taking sports for leisure purposes (N=53); or (3) risk-taking sports as professionals (N=37). Each participant completed five questionnaires, the Sensation Seeking Scale, the Bem Sex Role Inventory, the Barratt Impulsiveness Scale, Risk & Excitement Inventory, and the Toronto Alexithymia Scale. The results revealed significant differences between the groups' profiles. Of particular interest are the differences that exist between the profiles of Group 2 (escape profile, masculine gender identity, and high scores on sensation seeking, impulsivity, alexithymia) and Group 3 (compensation profile, androgynous gender identity, average score on sensation seeking, and low scores on impulsivity, alexithymia). We propose that the professional woman might be considered a model for preventing destructive risk-taking behaviors.

Educational status and cardiovascular risk profile in Indians

PubMed Central

Reddy, K. Srinath; Prabhakaran, Dorairaj; Jeemon, Panniyammakal; Thankappan, K. R.; Joshi, Prashant; Chaturvedi, Vivek; Ramakrishnan, Lakshmy; Ahmed, Farooque

2007-01-01

The inverse graded relationship of education and risk factors of coronary heart disease (CHD) has been reported from Western populations. To examine whether risk factors of CHD are predicted by level of education and influenced by the level of urbanization in Indian industrial populations, a cross-sectional survey (n = 19,973; response rate, 87.6%) was carried out among employees and their family members in 10 medium-to-large industries in highly urban, urban, and periurban regions of India. Information on behavioral, clinical, and biochemical risk factors of CHD was obtained through standardized instruments, and educational status was assessed in terms of the highest educational level attained. Data from 19,969 individuals were used for analysis. Tobacco use and hypertension were significantly more prevalent in the low- (56.6% and 33.8%, respectively) compared with the high-education group (12.5% and 22.7%, respectively; P < 0.001). However, dyslipidemia prevalence was significantly higher in the high-education group (27.1% as compared with 16.9% in the lowest-education group; P < 0.01). When stratified by the level of urbanization, industrial populations located in highly urbanized centers were observed to have an inverse graded relationship (i.e., higher-education groups had lower prevalence) for tobacco use, hypertension, diabetes, and overweight, whereas in less-urbanized locations, we found such a relationship only for tobacco use and hypertension. This study indicates the growing vulnerability of lower socioeconomic groups to CHD. Preventive strategies to reduce major CHD risk factors should focus on effectively addressing these social disparities. PMID:17923677

Impact of a microRNA MIR137 Susceptibility Variant on Brain Function in People at High Genetic Risk of Schizophrenia or Bipolar Disorder

PubMed Central

Whalley, Heather C; Papmeyer, Martina; Romaniuk, Liana; Sprooten, Emma; Johnstone, Eve C; Hall, Jeremy; Lawrie, Stephen M; Evans, Kathryn L; Blumberg, Hilary P; Sussmann, Jessika E; McIntosh, Andrew M

2012-01-01

A recent ‘mega-analysis' combining genome-wide association study data from over 40 000 individuals identified novel genetic loci associated with schizophrenia (SCZ) at genome-wide significance level. The strongest finding was a locus within an intron of a putative primary transcript for microRNA MIR137. In the current study, we examine the impact of variation at this locus (rs1625579, G/T; where T is the common and presumed risk allele) on brain activation during a sentence completion task that differentiates individuals with SCZ, bipolar disorder (BD), and their relatives from controls. We examined three groups of individuals performing a sentence completion paradigm: (i) individuals at high genetic risk of SCZ (n=44), (ii) individuals at high genetic risk of BD (n=90), and (iii) healthy controls (n=81) in order to test the hypothesis that genotype at rs1625579 would influence brain activation. Genotype groups were assigned as ‘RISK−' for GT and GG individuals, and ‘RISK+' for TT homozygotes. The main effect of genotype was significantly greater activation in the RISK− individuals in the posterior right medial frontal gyrus, BA 6. There was also a significant genotype*group interaction in the left amygdala and left pre/postcentral gyrus. This was due to differences between the controls (where individuals with the RISK− genotype showed greater activation than RISK+ subjects) and the SCZ high-risk group, where the opposite genotype effect was seen. These results suggest that the newly identified SCZ locus may influence brain activation in a manner that is partly dependent on the presence of existing genetic susceptibility for SCZ. PMID:22850735

A risk/cost analysis of alternative screening intervals for occupational tuberculosis infection.

PubMed

Nicas, M

1998-02-01

The Centers for Disease Control and Prevention (CDC) recommends that new health care employees receive a baseline skin test for Mycobacterium tuberculosis (M. tb) infection and that testing be repeated periodically. However, CDC does not explain the quantitative basis for its suggested screening intervals. This article examines the efficacy of alternative screening intervals for workers subject to different annual rates of M. tb infection and estimates the costs. An equation is developed for the cumulative risk of tuberculosis (TB) at 12 years given a specified annual rate of infection (ARI), screening interval, and a combined proportion (p) of successful skin testing and antibiotic prophylaxis. Equations for total cost of screening and cost per disease case prevented are provided. Results assume: (a) costs of $10 per skin test and $10,000 per TB disease case; (b) p = 0.88; and (c) and acceptable cumulative TB risk of 1 per 1000. For ARIs that might be deemed low (0.2% to 0.5%) and medium (1%), CDC screening intervals of 12 months and 6-12 months, respectively, minimize the cost per disease case prevented but permit residual disease risks greater than 1 per 1000. Recommended screening intervals are (i) 6 months for low-risk employee groups and (ii) 3 months for medium- and high-risk (e.g., ARIs of > or = 5%) groups. Interval (i) limits risk to 1 per 1000 and is approximately 50% shorter than the CDC interval for a low-risk group. Interval (ii), which is 67% shorter than the CDC interval for medium-risk groups but equal to that recommended for high-risk groups, permits a risk above 1 per 1000, but is likely the shortest feasible interval.

Failure of ganciclovir prophylaxis to completely eradicate CMV disease in renal transplant recipients treated with intense anti-rejection immunotherapy.

PubMed

Isenberg, A L; Shen, G K; Singh, T P; Hahn, A; Conti, D J

2000-06-01

Ganciclovir prophylactic regimens have been shown to be effective in renal transplant recipients at risk for primary (donor seropositive/recipient seronegative) and secondary (recipient seropositive) cytomegalovirus (CMV) disease. However, in addition to serologic factors, the type and intensity of the administered immunosuppression is a strong risk factor for CMV disease. Since January 1995, we have utilized a potent immunosuppressive protocol selectively in recipients at high risk for immunologic graft loss, defined as retransplant recipients, recipients with delayed graft function, non-Caucasian recipients, and recipients suffering from acute rejection. Between January 1995 and December 1996, 110 consecutive renal transplants were performed in recipients who were either CMV seropositive or received an allograft from a CMV-seropositive donor. All recipients received ganciclovir prophylactic therapy for 3 months post-transplant. Group I (N = 43) consisted of recipients at high-immunologic risk for graft loss as defined above. These recipients were treated with an intense anti-rejection immunotherapeutic regimen consisting of Cellcept, Neoral, and prednisone, with the frequent addition of antilymphocyte antibody therapies and intravenous methylprednisolone. The remaining 67 recipients (group II) were treated with a less intense immunotherapeutic regimen consisting of azathioprine, Neoral, and prednisone. The incidence and severity of CMV disease and the patient and allograft survival were compared. The incidence of CMV syndrome was greater in group I (28%) compared with group II (7%), and was statistically significant (p < 0.05). The 1-yr patient and graft survival were similar, 95 and 91%, respectively, for group I compared with 97 and 97%, respectively, for group II. These data suggest that 3 months of ganciclovir prophylactic therapy is significantly less effective for the prevention of CMV disease in renal transplant recipients at high risk for acute rejection treated with an intense immunotherapeutic regimen. These data suggest that more effective prevention of CMV disease in these high-risk recipients will require the addition of other anti-viral agents, such as immunoglobulin preparation to the prophylactic regimen.

Genous™ endothelial progenitor cell capturing stent vs. the Taxus Liberté stent in patients with de novo coronary lesions with a high-risk of coronary restenosis: a randomized, single-centre, pilot study

PubMed Central

Beijk, Marcel A.M.; Klomp, Margo; Verouden, Niels J.W.; van Geloven, Nan; Koch, Karel T.; Henriques, José P.S.; Baan, Jan; Vis, Marije M.; Scheunhage, Esther; Piek, Jan J.; Tijssen, Jan G.P.; de Winter, Robbert J.

2010-01-01

Aims The purpose of this study was to evaluate the GenousTM endothelial progenitor cell capturing stent vs. the Taxus Liberté paclitaxel-eluting stent in patients with de novo coronary lesions with a high-risk of coronary restenosis. Methods and results We randomly assigned 193 patients with lesions carrying a high risk of restenosis to have the Genous stent or the Taxus stent implanted. Lesions were considered high risk of restenosis if one of the following applied: chronic total occlusion, lesion length >23 mm, vessel diameter <2.8 mm, or any lesion in a diabetic patient. At 1-year, the rate of the primary end point, target vessel failure (TVF), was 17.3% in the Genous stent group when compared with 10.5% in the Taxus stent group [risk difference (RD) 6.8%, 95% CI −3.1 to 16.7%], a difference predominantly due to a higher incidence of repeat revascularization in patients treated with the Genous stent. In contrast, no stent thrombosis was observed in the Genous stent group compared to 4 stent thromboses in the Taxus stent group (RD −4.2%; 95% CI −10.3 to 0.3%). Repeat angiography between 6 and 12 months in a subgroup of patients showed a significantly higher late loss in the Genous stent compared with the Taxus stent (1.14 ± 0.64 and 0.55 ± 0.61 mm). Conclusion In patients with lesions carrying a high risk of restenosis, the Genous stent resulted in a non-significant higher rate of TVF compared with the Taxus stent mainly due to more repeat revascularizations in the Genous stent group. There were four stent thromboses with Taxus stent, none with the Genous stent. PMID:19933225

Endogenous fluorescence emission of the ovary

NASA Astrophysics Data System (ADS)

Utzinger, Urs; Kirkpatrick, Nathaniel D.; Drezek, Rebekah A.; Brewer, Molly A.

2005-03-01

Epithelial ovarian cancer has the highest mortality rate among the gynecologic cancers. Early detection would significantly improve survival and quality of life of women at increased risk to develop ovarian cancer. We have constructed a device to investigate endogenous signals of the ovarian tissue surface in the UV C to visible range and describe our initial investigation of the use of optical spectroscopy to characterize the condition of the ovary. We have acquired data from more than 33 patients. A table top spectroscopy system was used to collect endogenous fluorescence with a fiberoptic probe that is compatible with endoscopic techniques. Samples were broken into five groups: Normal-Low Risk (for developing ovarian cancer) Normal-High Risk, Benign, and Cancer. Rigorous statistical analysis was applied to the data using variance tests for direct intensity versus diagnostic group comparisons and principal component analysis (PCA) to study the variance of the whole data set. We conclude that the diagnostically most useful excitation wavelengths are located in the UV. Furthermore, our results indicate that UV B and C are most useful. A safety analysis indicates that UV-C imaging can be conducted at exposure levels below safety thresholds. We found that fluorescence excited in the UV-C and UV-B range increases from benign to normal to cancerous tissues. This is in contrast to the emission created with UV-A excitation which decreased in the same order. We hypothesize that an increase of protein production and a decrease of fluorescence contributions of the extracellular matrix could explain this behavior. Variance analysis also identified fluctuation of fluorescence at 320/380 which is associated with collagen cross link residues. Small differences were observed between the group at high risk and normal risk for ovarian cancer. High risk samples deviated towards the cancer group and low risk samples towards benign group.

Predicting complication risk in spine surgery: a prospective analysis of a novel risk assessment tool.

PubMed

Veeravagu, Anand; Li, Amy; Swinney, Christian; Tian, Lu; Moraff, Adrienne; Azad, Tej D; Cheng, Ivan; Alamin, Todd; Hu, Serena S; Anderson, Robert L; Shuer, Lawrence; Desai, Atman; Park, Jon; Olshen, Richard A; Ratliff, John K

2017-07-01

OBJECTIVE The ability to assess the risk of adverse events based on known patient factors and comorbidities would provide more effective preoperative risk stratification. Present risk assessment in spine surgery is limited. An adverse event prediction tool was developed to predict the risk of complications after spine surgery and tested on a prospective patient cohort. METHODS The spinal Risk Assessment Tool (RAT), a novel instrument for the assessment of risk for patients undergoing spine surgery that was developed based on an administrative claims database, was prospectively applied to 246 patients undergoing 257 spinal procedures over a 3-month period. Prospectively collected data were used to compare the RAT to the Charlson Comorbidity Index (CCI) and the American College of Surgeons National Surgery Quality Improvement Program (ACS NSQIP) Surgical Risk Calculator. Study end point was occurrence and type of complication after spine surgery. RESULTS The authors identified 69 patients (73 procedures) who experienced a complication over the prospective study period. Cardiac complications were most common (10.2%). Receiver operating characteristic (ROC) curves were calculated to compare complication outcomes using the different assessment tools. Area under the curve (AUC) analysis showed comparable predictive accuracy between the RAT and the ACS NSQIP calculator (0.670 [95% CI 0.60-0.74] in RAT, 0.669 [95% CI 0.60-0.74] in NSQIP). The CCI was not accurate in predicting complication occurrence (0.55 [95% CI 0.48-0.62]). The RAT produced mean probabilities of 34.6% for patients who had a complication and 24% for patients who did not (p = 0.0003). The generated predicted values were stratified into low, medium, and high rates. For the RAT, the predicted complication rate was 10.1% in the low-risk group (observed rate 12.8%), 21.9% in the medium-risk group (observed 31.8%), and 49.7% in the high-risk group (observed 41.2%). The ACS NSQIP calculator consistently produced complication predictions that underestimated complication occurrence: 3.4% in the low-risk group (observed 12.6%), 5.9% in the medium-risk group (observed 34.5%), and 12.5% in the high-risk group (observed 38.8%). The RAT was more accurate than the ACS NSQIP calculator (p = 0.0018). CONCLUSIONS While the RAT and ACS NSQIP calculator were both able to identify patients more likely to experience complications following spine surgery, both have substantial room for improvement. Risk stratification is feasible in spine surgery procedures; currently used measures have low accuracy.

Selective Perioperative Administration of Pasireotide is More Cost-Effective Than Routine Administration for Pancreatic Fistula Prophylaxis.

PubMed

Denbo, Jason W; Slack, Rebecca S; Bruno, Morgan; Cloyd, Jordan M; Prakash, Laura; Fleming, Jason B; Kim, Michael P; Aloia, Thomas A; Vauthey, Jean-Nicolas; Lee, Jeffrey E; Katz, Matthew H G

2017-04-01

In a randomized trial, pasireotide significantly decreased the incidence and severity of postoperative pancreatic fistula (POPF). Subsequent analyses concluded that its routine use is cost-effective. We hypothesized that selective administration of the drug to patients at high risk for POPF would be more cost-effective. Consecutive patients who did not receive pasireotide and underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) between July 2011 and January 2014 were distributed into groups based on their risk of POPF using a multivariate recursive partitioning regression tree analysis (RPA) of preoperative clinical factors. The costs of treating hypothetical patients in each risk group were then computed based upon actual institutional hospital costs and previously published relative risk values associated with pasireotide. Among 315 patients who underwent pancreatectomy, grade B/C POPF occurred in 64 (20%). RPA allocated patients who underwent PD into four groups with a risk for grade B/C POPF of 0, 10, 29, or 60% (P < 0.001) on the basis of diagnosis, pancreatic duct diameter, and body mass index. Patients who underwent DP were allocated to three groups with a grade B/C POPF risk of 14, 26, or 44% (P = 0.05) on the basis of pancreatic duct diameter alone. Although the routine administration of pasireotide to all 315 patients would have theoretically saved $30,892 over standard care, restriction of pasireotide to only patients at high risk for POPF would have led to a cost savings of $831,916. Preoperative clinical characteristics can be used to characterize patients' risk for POPF following pancreatectomy. Selective administration of pasireotide only to patients at high risk for grade B/C POPF may maximize the cost-efficacy of prophylactic pasireotide.

Who participates in the Dutch Chlamydia screening? A study on demographic and behavioral correlates of participation and positivity.

PubMed

Op de Coul, Eline L M; Götz, Hannelore M; van Bergen, Jan E A M; Fennema, Johannes S A; Hoebe, Christian J P A; Koekenbier, Rik H; Pars, Lydia L; van Ravesteijn, Sander M; van der Sande, Marianne A B; van den Broek, Ingrid V F

2012-02-01

In the Netherlands, an Internet-based Chlamydia Screening Implementation was initiated in 3 regions, aiming to reduce population prevalence by annual testing and treatment of people aged 16 to 29 years. We studied who was reached in the first screening round by relating participation and chlamydia positivity to sociodemographic and sexual risk factors. Data from the 2008/2009 screening round were analyzed (261,025 screening invitations, 41,638 participants). Participation rates were adjusted for the sexually active population. Sociodemographic and behavioral correlates of screening participation and positivity were studied by (multilevel) logistic regression models. The overall adjusted participation rate in the first screening round was 19.5% (95% confidence interval, 19.4-19.7) among sexually active people (women, 25%; men, 13%). Sociodemographic factors associated with lower participation were male gender (odds ratio [OR], male 1 vs. female 1.8), young age (OR, 16-19 1 vs. older groups 1.7-2.1), non-Dutch origin (OR between 0.7-0.9), lower education (OR, low 1 vs. high 1.4), high community risk level (0.8), and low socioeconomic status (0.9). Behavioral factors associated with lower participation were a long-standing relationship (0.7) and no reported history or symptoms of sexually transmitted infections (no symptoms, 0.4-0.6) . Factors most strongly related to higher Ct positivity were young age (OR, 1 vs. older groups 0.5-0.8), non-Dutch origin (1.4-2.8), non-Dutch steady partner (1.9-2.7), residence in a high-risk area (1.4-1.5), lower education (high, 0.3-0.5), and a history or symptoms of sexually transmitted infection (no symptoms, 0.4-0.6). Sociodemographic factors associated with lower participation were also associated with higher Ct positivity, showing that high-risk demographic groups are more difficult to mobilize than low-risk groups. Independent of this, higher behavioral risk levels were associated with higher participation rates, suggesting self-selection for screening based on the persons' risk (perception) in both low- and high community risk groups. Our study shows the complexity of the process, including individual and community factors that also interact, when screening for chlamydia.

Maternal Vocal Feedback to 9-Month-Old Infant Siblings of Children with ASD

PubMed Central

Talbott, Meagan R.; Nelson, Charles A.; Tager-Flusberg, Helen

2016-01-01

Infant siblings of children with autism spectrum disorder display differences in early language and social communication skills beginning as early as the first year of life. While environmental influences on early language development are well documented in other infant populations, they have received relatively little attention inside of the infant sibling context. In this study, we analyzed home video diaries collected prospectively as part of a longitudinal study of infant siblings. Infant vowel and consonant-vowel vocalizations and maternal language-promoting and non-promoting verbal responses were scored for 30 infant siblings and 30 low risk control infants at 9 months of age. Analyses evaluated whether infant siblings or their mothers exhibited differences from low risk dyads in vocalization frequency or distribution, and whether mothers’ responses were associated with other features of the high risk context. Analyses were conducted with respect to both initial risk group and preliminary outcome classification. Overall, we found no differences in infants’ consonant-vowel vocalizations, the frequency of overall maternal utterances, or the distribution of mothers’ response types. Both groups of infants produced more vowel than consonant-vowel vocalizations, and both groups of mothers responded to consonant-vowel vocalizations with more language-promoting than non-promoting responses. These results indicate that as a group, mothers of high risk infants provide equally high quality linguistic input to their infants in the first year of life and suggest that impoverished maternal linguistic input does not contribute to high risk infants’ initial language difficulties. Implications for intervention strategies are also discussed. PMID:26174704

Value of Nonrigid Registration of Pre-Procedure MR with Post-Procedure CT After Radiofrequency Ablation for Hepatocellular Carcinoma

DOE Office of Scientific and Technical Information (OSTI.GOV)

Park, Juil; Lee, Jeong Min, E-mail: jmlshy2000@gmail.com, E-mail: jmsh@snu.ac.kr; Lee, Dong Ho

PurposeTo evaluate the value of pre-radiofrequency ablation (RFA) MR and post-RFA CT registration for the assessment of the therapeutic response of hepatocellular carcinoma (HCC).Materials and MethodsA total of 178 patients with single HCC who received RFA as an initial treatment and had available pre-RFA MR and post-RFA CT images were included in this retrospective study. Two independent readers (one experienced radiologist, one inexperienced radiologist) scored the ablative margin (AM) of treated tumors on a four-point scale (1, residual tumor; 2, incomplete AM; 3, borderline AM; 4, sufficient AM), in two separate sessions: (1) visual comparison between pre-and post-RFA images; (2)more » with addition of nonrigid registration for pre- and post-RFA images. Local tumor progression (LTP) rates between low-risk (response score, 3–4) and high-risk groups (1–2) were analyzed using the Kaplan–Meier method at each interpretation session.ResultsThe patients’ reassignments after using the registered images were statistically significant for inexperienced reader (p < 0.001). In the inexperienced reader, LTP rates of low- and high-risk groups were significantly different with addition of registered images (session 2) (p < 0.001), but not significantly different in session 1 (p = 0.101). However, in the experienced reader, LTP rates of low- and high-risk groups were significantly different in both interpretation sessions (p < 0.001). Using the registered images, the cumulative incidence of LTP at 2 years was 3.0–6.6%, for the low-risk group, and 18.6–27.8% for the high-risk group.ConclusionRegistration between pre-RFA MR and post-RFA CT images may allow better assessment of the therapeutic response of HCC after RFA, especially for inexperienced radiologists, helping in the risk stratification for LTP.« less

The Relationship Between Functional Movement, Balance Deficits, and Previous Injury History in Deploying Marine Warfighters.

PubMed

de la Motte, Sarah J; Lisman, Peter; Sabatino, Marc; Beutler, Anthony I; OʼConnor, Francis G; Deuster, Patricia A

2016-06-01

Screening for primary musculoskeletal injury (MSK-I) is costly and time-consuming. Both the Functional Movement Screen (FMS) and the Y-Balance Test (YBT) have been shown to predict future MSK-I. With a goal of optimizing the efficiency of primary MSK-I screening, we studied associations between performance on the FMS and YBT and whether history of MSK-I influenced FMS and YBT scores. In total, 365 deploying Marines performed the FMS and YBT as prescribed. Composite and individual scores were each categorized as high risk or low risk using published injury thresholds: High-risk FMS included composite scores ≤14 and right-to-left (R/L) asymmetry for Shoulder Mobility, In-Line Lunge, Straight Leg Raise, Hurdle Step, or Rotary Stability. High-risk YBT consisted of anterior, posteromedial, and/or posterolateral R/L differences >4 cm and/or composite differences ≥12 cm. Pearson's χ tests evaluated associations between: (a) all FMS and YBT risk groups and (b) previous MSK-I and all FMS and YBT risk groups. Marines with high-risk FMS were twice as likely to have high-risk YBT posteromedial scores (χ = 10.2, p = 0.001; odds ratio [OR] = 2.1, 95% confidence interval [CI] = 1.3-3.2). History of any MSK-I was not associated with high-risk FMS or high-risk YBT. However, previous lower extremity MSK-I was associated with In-Line Lunge asymmetries (χ = 9.8, p = 0.002, OR = 2.2, 95% CI = 1.3-3.6). Overall, we found limited overlap in FMS and YBT risk. Because both methods seem to assess different risk factors for injury, we recommend FMS and YBT continue to be used together in combination with a thorough injury history until their predictive capacities are further established.

Protocol for the 'e-Nudge trial': a randomised controlled trial of electronic feedback to reduce the cardiovascular risk of individuals in general practice [ISRCTN64828380

PubMed Central

Holt, Tim A; Thorogood, Margaret; Griffiths, Frances; Munday, Stephen

2006-01-01

Background Cardiovascular disease (including coronary heart disease and stroke) is a major cause of death and disability in the United Kingdom, and is to a large extent preventable, by lifestyle modification and drug therapy. The recent standardisation of electronic codes for cardiovascular risk variables through the United Kingdom's new General Practice contract provides an opportunity for the application of risk algorithms to identify high risk individuals. This randomised controlled trial will test the benefits of an automated system of alert messages and practice searches to identify those at highest risk of cardiovascular disease in primary care databases. Design Patients over 50 years old in practice databases will be randomised to the intervention group that will receive the alert messages and searches, and a control group who will continue to receive usual care. In addition to those at high estimated risk, potentially high risk patients will be identified who have insufficient data to allow a risk estimate to be made. Further groups identified will be those with possible undiagnosed diabetes, based either on elevated past recorded blood glucose measurements, or an absence of recent blood glucose measurement in those with established cardiovascular disease. Outcome measures The intervention will be applied for two years, and outcome data will be collected for a further year. The primary outcome measure will be the annual rate of cardiovascular events in the intervention and control arms of the study. Secondary measures include the proportion of patients at high estimated cardiovascular risk, the proportion of patients with missing data for a risk estimate, and the proportion with undefined diabetes status at the end of the trial. PMID:16646967

Relationships Between Perceived Family Gambling and Peer Gambling and Adolescent Problem Gambling and Binge-Drinking.

PubMed

Zhai, Zu Wei; Yip, Sarah W; Steinberg, Marvin A; Wampler, Jeremy; Hoff, Rani A; Krishnan-Sarin, Suchitra; Potenza, Marc N

2017-12-01

The study systematically examined the relative relationships between perceived family and peer gambling and adolescent at-risk/problem gambling and binge-drinking. It also determined the likelihood of at-risk/problem gambling and binge-drinking as a function of the number of different social groups with perceived gambling. A multi-site high-school survey assessed gambling, alcohol use, presence of perceived excessive peer gambling (peer excess-PE), and family gambling prompting concern (family concern-FC) in 2750 high-school students. Adolescents were separately stratified into: (1) low-risk, at-risk, and problem/pathological gambling groups; and, (2) non-binge-drinking, low-frequency-binge-drinking, and high-frequency-binge-drinking groups. Multinomial logistic regression showed that relative to each other, FC and PE were associated with greater likelihoods of at-risk and problem/pathological gambling. However, only FC was associated with binge-drinking. Logistic regression revealed that adolescents who endorsed either FC or PE alone, compared to no endorsement, were more likely to have at-risk and problem/pathological gambling, relative to low-risk gambling. Adolescents who endorsed both FC and PE, compared to PE alone, were more likely to have problem/pathological gambling relative to low-risk and at-risk gambling. Relative to non-binge-drinking adolescents, those who endorsed both FC and PE were more likely to have low- and high-frequency-binge-drinking compared to FC alone or PE alone, respectively. Family and peer gambling individually contribute to adolescent at-risk/problem gambling and binge-drinking. Strategies that target adolescents as well as their closely affiliated family and peer members may be an important step towards prevention of harm-associated levels of gambling and alcohol use in youths.

Effects of methamphetamine abuse and serotonin transporter gene variants on aggression and emotion-processing neurocircuitry

PubMed Central

Payer, D E; Nurmi, E L; Wilson, S A; McCracken, J T; London, E D

2012-01-01

Individuals who abuse methamphetamine (MA) exhibit heightened aggression, but the neurobiological underpinnings are poorly understood. As variability in the serotonin transporter (SERT) gene can influence aggression, this study assessed possible contributions of this gene to MA-related aggression. In all, 53 MA-dependent and 47 control participants provided self-reports of aggression, and underwent functional magnetic resonance imaging while viewing pictures of faces. Participants were genotyped at two functional polymorphic loci in the SERT gene: the SERT-linked polymorphic region (SERT-LPR) and the intron 2 variable number tandem repeat polymorphism (STin2 VNTR); participants were then classified as having high or low risk for aggression according to individual SERT risk allele combinations. Comparison of SERT risk allele loads between groups showed no difference between MA-dependent and control participants. Comparison of self-report scores showed greater aggression in MA-dependent than control participants, and in high genetic risk than low-risk participants. Signal change in the amygdala was lower in high genetic risk than low-risk participants, but showed no main effect of MA abuse; however, signal change correlated negatively with MA use measures. Whole-brain differences in activation were observed between MA-dependent and control groups in the occipital and prefrontal cortex, and between genetic high- and low-risk groups in the occipital, fusiform, supramarginal and prefrontal cortex, with effects overlapping in a small region in the right ventrolateral prefrontal cortex. The findings suggest that the investigated SERT risk allele loads are comparable between MA-dependent and healthy individuals, and that MA and genetic risk influence aggression independently, with minimal overlap in associated neural substrates. PMID:22832817

The impact of the combination of income and education on the incidence of coronary heart disease in the prospective Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort study.

PubMed

Lewis, Marquita W; Khodneva, Yulia; Redmond, Nicole; Durant, Raegan W; Judd, Suzanne E; Wilkinson, Larrell L; Howard, Virginia J; Safford, Monika M

2015-12-29

We investigated the association between income-education groups and incident coronary heart disease (CHD) in a national prospective cohort study. The REasons for Geographic And Racial Differences in Stroke study recruited 30,239 black and white community-dwelling adults between 2003 and 2007 and collected participant-reported and in-home physiologic variables at baseline, with expert adjudicated CHD endpoints during follow-up. Mutually exclusive income-education groups were: low income (annual household income <$35,000)/low education (< high school), low income/high education, high income/low education, and high income/high education. Cox models estimated hazard ratios (HR) for incident CHD for each exposure group, examining differences by age group. At baseline, 24,461 participants free of CHD experienced 809 incident CHD events through December 31, 2011 (median follow-up 6.0 years; interquartile range 4.5-7.3 years). Those with low income/low education had the highest incidence of CHD (10.1 [95% CI 8.4-12.1]/1000 person-years). After full adjustment, those with low income/low education had higher risk of incident CHD (HR 1.42 [95% CI: 1.14-1.76]) than those with high income/high education, but findings varied by age. Among those aged <65 years, compared with those reporting high income/high education, risk of incident CHD was significantly higher for those reporting low income/low education and low income/high education (adjusted HR 2.07 [95% CI 1.42-3.01] and 1.69 [95% CI 1.30-2.20], respectively). Those aged ≥ 65 years, risk of incident CHD was similar across income-education groups after full adjustment. For younger individuals, low income, regardless of education, was associated with higher risk of CHD, but not observed for ≥ 65 years. Findings suggest that for younger participants, education attainment may not overcome the disadvantage conferred by low income in terms of CHD risk, whereas among those ≥ 65 years, the independent effects of income and education are less pronounced.

Fecal Microbiota Differences According to the Risk of Advanced Colorectal Neoplasms.

PubMed

Yang, Hyo-Joon; Kwon, Min-Jung; Chang, Yoosoo; Song, Seul-Ki; Ahn, Kwang-Sung; Kim, Han-Na; Yun, Yeojun; Kim, Hyung-Lae; Park, Dong Il

2018-02-09

This study aimed to compare differences in the fecal microbiota according to the risk of advanced colorectal neoplasia (ACN) based on a risk-score model in a large Korean cohort. Stool samples were collected from 1122 health screening recipients: 404 enrolled in the average risk (AR) group, 514 in the moderate risk (MR) group, and 204 in the high risk (HR) group, in accordance with their risk of ACN. The fecal microbiota was characterized using pyrosequencing of the V3-V4 region of the 16S rRNA genes. The overall microbial diversity was significantly reduced with an increased risk of ACN [false discovery rate (FDR), P<0.001], and the composition was significantly different between the risk groups (Bonferroni corrected, P<0.05). On taxonomic comparison, 6 of 11 phyla and 39 of 88 genera were significantly different among the risk groups (all FDR P<0.05). These included under-representation of Bacteroides, Ruminococcus, and Bifidobacterium, and over-representation of Prevotella and Fusobacterium with an increased risk of ACN. In particular, we observed that the unknown genus of Ruminococcaceae were relatively abundant (16.2%) in the AR group and significantly depleted with an increased risk of ACN (13.5% in the HR group; FDR P<0.001). These findings support the hypothesis that the fecal microbiota is different according to the risk of ACN. An unknown genus of Ruminococcaceae, as novel potential butyrate producers, might have a possible role in colorectal tumorigenesis in the Korean population.

Assessing the role of syringe dispensing machines and mobile van outlets in reaching hard-to-reach and high-risk groups of injecting drug users (IDUs): a review

PubMed Central

Islam, Md Mofizul; Conigrave, Katherine M

2007-01-01

Reaching hard-to-reach and high-risk injecting drug users (IDUs) is one of the most important challenges for contemporary needle syringe programs (NSPs). The aim of this review is to examine, based upon the available international experience, the effectiveness of syringe vending machines and mobile van/bus based NSPs in making services more accessible to these hard-to-reach and high-risk groups of IDUs. A literature search revealed 40 papers/reports, of which 18 were on dispensing machines (including vending and exchange machines) and 22 on mobile vans. The findings demonstrate that syringe dispensing machines and mobile vans are promising modalities of NSPs, which can make services more accessible to the target group and in particular to the harder-to-reach and higher-risk groups of IDUs. Their anonymous and confidential approaches make services attractive, accessible and acceptable to these groups. These two outlets were found to be complementary to each other and to other modes of NSPs. Services through dispensing machines and mobile vans in strategically important sites are crucial elements in continuing efforts in reducing the spread of HIV and other blood borne viruses among IDUs. PMID:17958894

Disparities in staging prostate magnetic resonance imaging utilization for nonmetastatic prostate cancer patients undergoing definitive radiation therapy.

PubMed

Ajayi, Ayobami; Hwang, Wei-Ting; Vapiwala, Neha; Rosen, Mark; Chapman, Christina H; Both, Stefan; Shah, Meera; Wang, Xingmei; Agawu, Atu; Gabriel, Peter; Christodouleas, John; Tochner, Zelig; Deville, Curtiland

2016-01-01

There is growing evidence supporting incorporating multiparametric (mp) magnetic resonance imaging (MRI) scans into risk stratification, active surveillance, and treatment paradigms for prostate cancer. The purpose of our study was to determine whether demographic disparities exist in staging MRI utilization for prostate cancer patients. An institutional database of 705 nonmetastatic prostate cancer patients treated with radiation therapy from 2005 through 2013 was used to identify patients undergoing versus not undergoing pretreatment diagnostic prostate mpMRI. Uni- and multivariable logistic regression evaluated the relationship of clinical and demographic characteristics with MRI utilization. All demographic variables assessed, except the other race category, were significantly associated with MRI utilization (all P < .05), including age (odds ratio [OR], 0.92), black race (OR, 0.51), poverty (OR, 0.53), closer distance to radiation facility (OR, 1.79), and nonprivate primary insurance (OR, 0.57) on univariable analysis, while clinical stage T3 (OR, 3.37) was the only clinical characteristic. On multivariable analysis stratified by D'Amico risk group, age remained significant across all risk groups, whereas the black versus white racial (OR, 0.21; 95% confidence interval, 0.08-0.55) and nonprivate versus private insurance type (OR, 0.37; 95% confidence interval, 0.16-0.86) disparities persisted in the low-risk group. Clinical stage T3 remained associated in the high-risk group. For race specifically, the percentages of whites, blacks, and others undergoing MRI in the overall cohort and by risk group were, respectively: overall, 80% (343/427), 68% (156/231), and 85% (40/47); low risk, 86%, 56%, and 63%; intermediate risk, 79%, 72%, and 95%; and high risk, 72%, 72%, and 100%. In this urban, academic center cohort, older patients across all risk groups and black or nonprivate insurance patients in the low risk group were less likely to undergo staging prostate MRI scans. Further research should investigate these differences to ensure equitable utilization across all demographic groups considering the burden of prostate cancer disparities.

Population-Level Effects of Human Papillomavirus Vaccination Programs on Infections with Nonvaccine Genotypes

PubMed Central

Soldan, Kate; Lehtinen, Matti; Beddows, Simon; Brisson, Marc; Brotherton, Julia M.L.; Chow, Eric P.F.; Cummings, Teresa; Drolet, Mélanie; Fairley, Christopher K.; Garland, Suzanne M.; Kahn, Jessica A.; Kavanagh, Kimberley; Markowitz, Lauri; Pollock, Kevin G.; Söderlund-Strand, Anna; Sonnenberg, Pam; Tabrizi, Sepehr N.; Tanton, Clare; Unger, Elizabeth; Thomas, Sara L.

2016-01-01

We analyzed human papillomavirus (HPV) prevalences during prevaccination and postvaccination periods to consider possible changes in nonvaccine HPV genotypes after introduction of vaccines that confer protection against 2 high-risk types, HPV16 and HPV18. Our meta-analysis included 9 studies with data for 13,886 girls and women ≤19 years of age and 23,340 women 20–24 years of age. We found evidence of cross-protection for HPV31 among the younger age group after vaccine introduction but little evidence for reductions of HPV33 and HPV45. For the group this same age group, we also found slight increases in 2 nonvaccine high-risk HPV types (HPV39 and HPV52) and in 2 possible high-risk types (HPV53 and HPV73). However, results between age groups and vaccines used were inconsistent, and the increases had possible alternative explanations; consequently, these data provided no clear evidence for type replacement. Continued monitoring of these HPV genotypes is important. PMID:27648688

HIV/AIDS interventions in Bangladesh: what can application of a social exclusion framework tell us?

PubMed

Khosla, Nidhi

2009-08-01

Bangladesh has maintained a low HIV prevalence (of less than 1%) despite multiple risk factors. However, recent serological surveillance data have reported very high levels of HIV infection among a subgroup of male injecting drug-users (IDUs). This suggests that an HIV/AIDS epidemic could be imminent in Bangladesh. Although biomedical and behavioural change projects are important, they do not address the root causes of observed risky behaviours among 'high-risk' groups. In Bangladesh, these groups include sex workers, IDUs, males who have sex with males, and the transgender population-hijra-who are all excluded groups. Using a social exclusion framework, this paper analyzed existing literature on HIV in Bangladesh to identify social, economic and legal forces that heighten the vulnerability of such excluded groups to HIV/AIDS. It found that poverty and bias against women are major exclusionary factors. The paper presents areas for research and for policy action so that the social exclusion of high-risk groups can be reduced, their rights protected, and an HIV epidemic averted.

Substance abuse precedes internet addiction

PubMed Central

Lee, Young Sik; Han, Doug Hyun; Kim, Sun Mi; Renshaw, Perry F.

2015-01-01

The purpose of the current study was to evaluate possible overlapping substance abuse and internet addiction in a large, uniformly sampled population, ranging in age from 13 to 18 years. Participants (N=73,238) in the current study were drawn from the 6th Korea Youth Risk Behavior Web-based Survey (KYRBWS-V) for students from 400 middle schools and 400 high schools in 16 cities within South Korea. Of adolescent internet users, 85.2% were general users (GU), 11.9% were users with potential risk for internet addiction (PR), and 3.0% were users with high risk for internet addiction (HR). There was a difference in the number of students with alcohol drinking among the GU, PR, and HR groups (20.8% vs 23.1% vs 27.4%). There was a difference in the number of students who smoked among the GS, PR, and HR groups (11.7% vs 13.5% vs 20.4%). There was a difference in the number of students with drug use among the GU, PR, and HR groups (1.7% vs 2.0% vs 6.5%). After adjusting for sex, age, stress, depressed mood, and suicidal ideation, smoking may predict a high risk for internet addiction (OR=1.203, p=0.004). In addition, drug use may predict a high risk for internet addiction (OR=2.591, p<0.001). Because students with a high risk for internet addiction have vulnerability for addictive behaviors, co-morbid substance abuse should be evaluated and, if found, treated in adolescents with internet addiction. PMID:23384457

Risk Prediction Models of Locoregional Failure After Radical Cystectomy for Urothelial Carcinoma: External Validation in a Cohort of Korean Patients

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ku, Ja Hyeon; Kim, Myong; Jeong, Chang Wook

2014-08-01

Purpose: To evaluate the predictive accuracy and general applicability of the locoregional failure model in a different cohort of patients treated with radical cystectomy. Methods and Materials: A total of 398 patients were included in the analysis. Death and isolated distant metastasis were considered competing events, and patients without any events were censored at the time of last follow-up. The model included the 3 variables pT classification, the number of lymph nodes identified, and margin status, as follows: low risk (≤pT2), intermediate risk (≥pT3 with ≥10 nodes removed and negative margins), and high risk (≥pT3 with <10 nodes removed ormore » positive margins). Results: The bootstrap-corrected concordance index of the model 5 years after radical cystectomy was 66.2%. When the risk stratification was applied to the validation cohort, the 5-year locoregional failure estimates were 8.3%, 21.2%, and 46.3% for the low-risk, intermediate-risk, and high-risk groups, respectively. The risk of locoregional failure differed significantly between the low-risk and intermediate-risk groups (subhazard ratio [SHR], 2.63; 95% confidence interval [CI], 1.35-5.11; P<.001) and between the low-risk and high-risk groups (SHR, 4.28; 95% CI, 2.17-8.45; P<.001). Although decision curves were appropriately affected by the incidence of the competing risk, decisions about the value of the models are not likely to be affected because the model remains of value over a wide range of threshold probabilities. Conclusions: The model is not completely accurate, but it demonstrates a modest level of discrimination, adequate calibration, and meaningful net benefit gain for prediction of locoregional failure after radical cystectomy.« less

Comparison of two instruments for assessing risk of postoperative nausea and vomiting.

PubMed

Kapoor, Rachna; Hola, Eric T; Adamson, Robert T; Mathis, A Scott

2008-03-01

Two instruments for assessing patients' risk of postoperative nausea and vomiting (PONV) were compared. The existing protocol (protocol 1) assessed PONV risk using 16 weighted risk factors and was used for both adults and pediatric patients. The new protocol (protocol 2) included a form for adults and a pediatric-specific form. The form for adults utilized the simplified risk score, calculated using a validated, nonweighted, 4-point scale, and categorized patients' risk of PONV as low, moderate, or high. The form for pediatric patients used a 7-point, non-weighted scale and categorized patients' risk of PONV as moderate or high. A list was generated of all patients who had surgery during August 2005, for whom protocol 1 was used, and during April 2006, for whom protocol 2 was used. Fifty patients from each time period were randomly selected for data analysis. Data collected included the percentage of the form completed, the development of PONV, the number of PONV risk factors, patient demographics, and the appropriateness of prophylaxis. The mean +/- S.D. number of PONV risk factors was significantly lower in the group treated according to protocol 2 ( p = 0.001), but fewer patients in this group were categorized as low or moderate risk and more patients were identified as high risk (p < 0.001). More patients assessed by protocol 2 received fewer interventions than recommended (p < 0.001); however, the frequency of PONV did not significantly differ between groups. Implementation of a validated and simplified PONV risk-assessment tool appeared to improve form completion rates and appropriate risk assessment; however, the rates of PONV remained similar and fewer patients received appropriate prophylaxis compared with patients assessed by the existing risk-assessment tool.

An evaluation of venous thromboembolic risk in acutely ill medical patients immobilized at home: the AT-HOME Study.

PubMed

Haas, Sylvia K; Hach-Wunderle, Viola; Mader, Frank H; Ruster, Katherine; Paar, Wilhelm D

2007-01-01

Many risk factors for venous thromboembolism (VTE) in hospitalized medical patients are also present in medical outpatients. VTE prevention represents an important challenge for physicians treating patients at home. The AT-HOME study was a prospective cross-sectional observational study designed to assess awareness of the risk of VTE in immobilized acutely ill medical outpatients among German physicians, many of whom were participating in a national Continuing Medical Education (CME) program designed to raise awareness of VTE. The study involved 1210 medical patients who were acutely confined to bed at home. Physicians performed a subjective assessment of VTE risk, which was rated on a 10-point scale (1 = very low risk; 10 = very high risk). The risk of VTE was also assessed retrospectively by using a scorecard developed for use in hospitalized medical patients. Of the 1210 patients, 198 (16%) had risk scores of 0-4, 319 (26%) had scores of 5 or 6, and 693 (57%) had scores > or =7. Overall, 966 patients (80%) received thromboprophylaxis. The proportion of patients receiving thromboprophylaxis was 0% to 47% in risk score groups 0-4, 76% to 85% in groups 5 and 6, and 90% to 100% in risk score groups 7-10. In the retrospective assessment of VTE risk, 74% of patients were at high risk, 15% were at intermediate risk, and 11% were at low risk. The proportions of patients receiving thromboprophylaxis in these groups were 87%, 61%, and 55%, respectively. The involvement of physicians in educational activities focusing on VTE awareness appeared to create awareness of the risks of VTE in acutely ill medical outpatients.

Can RSScan footscan(®) D3D™ software predict injury in a military population following plantar pressure assessment? A prospective cohort study.

PubMed

Franklyn-Miller, Andrew; Bilzon, James; Wilson, Cassie; McCrory, Paul

2014-03-01

Injury in initial military training is common with incidences from 25 to 65% of recruits sustaining musculoskeletal injury. Risk factors for injury include extrinsic factors such as rapid onset of high volume training, but intrinsic factors such as lower limb biomechanics and foot type. Prediction of injury would allow more effective training delivery, reduce manpower wastage and improve duty of care to individuals by addressing potential interventions. Plantar pressure interpretation of footfall has been shown to reflect biomechanical intrinsic abnormality although no quantifiable method of risk stratification exists. To identify if pressure plate assessment of walking gait is predictive of injury in a military population. 200 male subjects commencing Naval Officer training were assessed by plantar pressure plate recording, of foot contact pressures. A software interpretation, D3D™, stratified the interpretation to measure 4 specific areas of potential correction. Participants were graded as to high, medium and low risk of injury and subsequently followed up for injury through their basic training. Seventy two percent of all injuries were attributed to subjects in the high and medium risk of injury as defined by the risk categorization. 47% of all injuries were sustained in the high-risk group. Participants categorized in the high-risk group for injury were significantly more likely to sustain injury than in medium or low groups (p<0.001, OR 5.28 with 95% CI 2.88, 9.70). Plantar pressure assessment of risk for overuse lower limb injury can be predictive of sustaining an overuse injury in a controlled training environment. Copyright © 2013 Elsevier Ltd. All rights reserved.

The influence of mechanical vibration on local and central balance control.

PubMed

Ehsani, Hossein; Mohler, Jane; Marlinski, Vladimir; Rashedi, Ehsan; Toosizadeh, Nima

2018-04-11

Fall prevention has an indispensable role in enhancing life expectancy and quality of life among older adults. The first step to prevent falls is to devise reliable methods to identify individuals at high fall risk. The purpose of the current study was to assess alterations in local postural muscle and central sensory balance control mechanisms due to low-frequency externally applied vibration among elders at high fall risk, in comparison with healthy controls, as a potential tool for assessing fall risk. Three groups of participants were recruited: healthy young (n = 10; age = 23 ± 2 years), healthy elders (n = 10; age = 73 ± 3 years), and elders at high fall risk (n = 10; age = 84 ± 9 years). Eyes-open and eyes-closed upright standing balance performance was measured with no vibration, 30 Hz, and 40 Hz vibration of Gastrocnemius muscles. When vibratory stimulation was applied, changes in local-control performance manifested significant differences among the groups (p < 0.01). On average between conditions, we observed 97% and 92% less change among high fall risk participants when compared to healthy young and older adults, respectively. On the other hand, vibration-induced changes in the central-control performance were not significant between groups (p ≥ 0.19). Results suggest that local-control deficits are responsible for balance behavior alterations among elders at high fall risk and healthy individuals. This observation may be attributable to deterioration of short-latency reflexive loop in elders at high fall risk. On the other hand, we could not ascribe the balance alterations to problems related to central nervous system performance or long-latency responses. Copyright © 2018 Elsevier Ltd. All rights reserved.

Awareness of preventive medication among women at high risk for breast cancer and their willingness to consider transdermal or oral tamoxifen: a focus group study.

PubMed

Karavites, Lindsey C; Allu, Subhashini; Khan, Seema A; Kaiser, Karen

2015-11-09

Despite demonstrated efficacy, acceptance of selective estrogen receptor modulators (SERMs), such as tamoxifen, for breast cancer risk reduction remains low. Delivering SERMs via local transdermal therapy (LTT) could significantly reduce systemic effects and therefore may increase acceptance. We aim to assess women's knowledge of breast cancer prevention medications and views on LTT of SERMs. Focus groups were conducted with healthy women identified through the comprehensive breast center of a large urban cancer institution. Group discussions covered risk perceptions, knowledge of and concerns about risk reducing medications. Participants reported their perceived risk for breast cancer (average, below/above average), preference for SERMs in a pill or gel form, risk factors, and prior physician recommendations regarding risk-reducing medicines. Participants' breast cancer risk was estimated using tools based on the Gail Model. Trained personnel examined all qualitative results systematically; risk perceptions and preferred method of medication delivery were tallied quantitatively. Four focus groups (N = 32) were conducted. Most participants had at least a college degree (78.2 %) and were of European (50 %) or African ancestry (31 %). The majority (72 %) were at elevated risk for breast cancer; approximately half of these women perceived themselves to be at elevated risk. Few participants had prior knowledge of preventive medications. The women noted a number of concerns about LTT, including dosage, impact on day-to-day life, and side effects; nonetheless, over 90 % of the women stated they would prefer LTT to a pill. Awareness of preventive medications was low even in a highly educated sample of high-risk women. If given a choice in the route of administration, most women preferred a gel to a pill, anticipating fewer side effects. Future work should focus on demonstrating equivalent efficacy and reduced toxicity of topical over oral medications and on raising awareness of chemopreventive options for breast cancer.

The impact of direct-to-consumer marketing of cancer genetic testing on women according to their genetic risk.

PubMed

Lowery, Jan T; Byers, Tim; Axell, Lisen; Ku, Lisa; Jacobellis, Jillian

2008-12-01

To assess the impact of direct-to-consumer marketing for genetic testing among women of varying genetic risk for breast and ovarian cancer. Telephone surveys were conducted with 315 women in Denver, Colorado, one target audience for the Myriad BRACAnalysis ad campaign. Genetic risk was determined from personal and family history and grouped by probability of having a BRCA1/2 mutation (low <5%, moderate 5-<10%, high > or =10%). High-risk women were more knowledgeable about BRACAnalysis and more likely to recall the media ads than were low-risk women (60 vs. 39%, P < 0.01). After seeing the ads, about 40% of women were more interested in testing and about 10% expressed increased worry about developing breast or ovarian cancer. Women across all risk groups overstated the benefits and appropriateness of testing. An equal percentage of high- and low-risk women (51 and 60%) felt that they would benefit from genetic testing. The campaign effectively reached a large audience. Concern about breast cancer was not appreciably increased. A large percentage of low-risk women (not candidates for testing) expressed interest in testing, suggesting the campaign was too broad. A campaign targeted at high-risk women, who may benefit from testing might be preferred.

High-risk multiple myeloma: a multifaceted entity, multiple therapeutic challenges.

PubMed

Muchtar, Eli; Magen, Hila; Gertz, Morie A

2017-06-01

The term high-risk multiple myeloma is aimed to identify a heterogeneous group of patients who are more likely to progress and die early of their disease. Therefore, recognition of these patients is crucial. With the increase in the number of treatment options, the outcome for high-risk patients has probably improved, although the true extent of this improvement remains unknown, due to both the heterogeneous components of high-risk disease and its under-representation in clinical trials. In this article, we review the definitions of high-risk disease, emphasizing the fact that no single definition can represent the entire high-risk population. In the second part, we review the treatment options available for the management of high-risk myeloma as well as our general approach for high-risk disease. In light of the poor prognosis associated with high-risk myeloma, even in the current era, new approaches for the management of this subset of patients are needed.

Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients.

PubMed

van Brunschot, Sandra; Hollemans, Robbert A; Bakker, Olaf J; Besselink, Marc G; Baron, Todd H; Beger, Hans G; Boermeester, Marja A; Bollen, Thomas L; Bruno, Marco J; Carter, Ross; French, Jeremy J; Coelho, Djalma; Dahl, Björn; Dijkgraaf, Marcel G; Doctor, Nilesh; Fagenholz, Peter J; Farkas, Gyula; Castillo, Carlos Fernandez Del; Fockens, Paul; Freeman, Martin L; Gardner, Timothy B; Goor, Harry van; Gooszen, Hein G; Hannink, Gerjon; Lochan, Rajiv; McKay, Colin J; Neoptolemos, John P; Oláh, Atilla; Parks, Rowan W; Peev, Miroslav P; Raraty, Michael; Rau, Bettina; Rösch, Thomas; Rovers, Maroeska; Seifert, Hans; Siriwardena, Ajith K; Horvath, Karen D; van Santvoort, Hjalmar C

2018-04-01

Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior.

PubMed

D'Amico, Elizabeth J; Houck, Jon M; Tucker, Joan S; Ewing, Brett A; Pedersen, Eric R

2017-09-01

Homeless young adults exhibit high rates of alcohol and other drug (AOD) use and sexual risk behaviors. This study is a secondary analysis of data collected in a randomized clinical trial of AWARE, a new 4 session group motivational interviewing intervention. AWARE mainly focused on alcohol use and sexual risk behavior given focus group feedback. We used sequential coding to analyze how the group process affected both AOD use and sexual risk behavior at 3-month follow up among homeless young adults by examining facilitator behavior and participant change talk (CT) and sustain talk (ST). We analyzed 57 group session digital recordings of 100 youth (69% male, 74% heterosexual, 28% non-Hispanic white, 23% African American, 26% Hispanic, 23% multiracial/other; mean age 21.75). Outcomes included importance and readiness to change AOD use and risky sexual behavior, AOD use and consequences, number of partners and unprotected sex, and condom self-efficacy. Sequential analysis indicated that facilitator open-ended questions and reflections of CT increased Group CT. Group CT was associated with a lower likelihood of being a heavy drinker 3 months later; Group ST was associated with decreased readiness and confidence to change alcohol use. There were no associations with CT or ST for drug use or risky sexual behavior. Facilitator speech and peer responses were related to CT and ST during the group sessions with this high risk population, which were then associated with individual changes for alcohol use. Further research is needed to explore associations with drug use and sexual risk behavior. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Children First Study: how an educational program in cardiovascular prevention at school can improve parents' cardiovascular risk.

PubMed

Fornari, Luciana S; Giuliano, Isabela; Azevedo, Fernanda; Pastana, Adriana; Vieira, Carolina; Caramelli, Bruno

2013-04-01

To evaluate whether a multidisciplinary educational program (EP) in cardiovascular prevention (CVP) for children could improve the Framingham cardiovascular risk (FCR) of their parents after one year. This was a prospective community-based study in Brazil during 2010 that randomized students aged 6 to 10 years old to two different approaches to receiving healthy lifestyle information. The control group received written educational material (EM) for their parents about healthy lifestyle. The intervention group received the same EM for parents, and children were exposed to a weekly EP in CVP with a multidisciplinary health team. At onset and end of the study, we collected data from parents and children (weight, height, arterial blood pressure, and laboratory tests). We studied 197 children and 323 parents. Analyzing the parents' FCR we found that 9.3% of the control group and 6.8% of the intervention group had more than a 10% year risk of cardiovascular heart disease (CHD) over the next 10 years. After the children's EP for the year, the intervention group had a reduction of 91% in the intermediate/high FCR group compared with a 13% reduction in the control group, p = 0.002). In the same way, analyzing the FCR of all parents, there was a reduction of the average risk in the intervention group (3.6% to 2.8% respectively, p < 0.001) compared with the control group (4.4% to 4.4%, p = 0.98). An educational program in cardiovascular prevention directed at school-age children can reduce the FCR risk of their parents, especially in the intermediate/high risk categories.

Advances in Risk Classification and Treatment Strategies for Neuroblastoma.

PubMed

Pinto, Navin R; Applebaum, Mark A; Volchenboum, Samuel L; Matthay, Katherine K; London, Wendy B; Ambros, Peter F; Nakagawara, Akira; Berthold, Frank; Schleiermacher, Gudrun; Park, Julie R; Valteau-Couanet, Dominique; Pearson, Andrew D J; Cohn, Susan L

2015-09-20

Risk-based treatment approaches for neuroblastoma have been ongoing for decades. However, the criteria used to define risk in various institutional and cooperative groups were disparate, limiting the ability to compare clinical trial results. To mitigate this problem and enhance collaborative research, homogenous pretreatment patient cohorts have been defined by the International Neuroblastoma Risk Group classification system. During the past 30 years, increasingly intensive, multimodality approaches have been developed to treat patients who are classified as high risk, whereas patients with low- or intermediate-risk neuroblastoma have received reduced therapy. This treatment approach has resulted in improved outcome, although survival for high-risk patients remains poor, emphasizing the need for more effective treatments. Increased knowledge regarding the biology and genetic basis of neuroblastoma has led to the discovery of druggable targets and promising, new therapeutic approaches. Collaborative efforts of institutions and international cooperative groups have led to advances in our understanding of neuroblastoma biology, refinements in risk classification, and stratified treatment strategies, resulting in improved outcome. International collaboration will be even more critical when evaluating therapies designed to treat small cohorts of patients with rare actionable mutations. © 2015 by American Society of Clinical Oncology.

[Pregnancy and congenital heart disease].

PubMed

Manso, Begoña; Gran, Ferrán; Pijuán, Antonia; Giralt, Gemma; Ferrer, Queralt; Betrián, Pedro; Albert, Dimpna; Rosés, Ferrán; Rivas, Nuria; Parra, Montserrat; Girona, Josep; Farrán, Inmaculada; Casaldáliga, Jaume

2008-03-01

Since the creation of the Adult Congenital Heart Disease Units and of the High Obstetric Risk Units, there has been increasing interest in hemodynamic and obstetric outcomes in pregnant woman with congenital heart disease. Retrospective descriptive study of 56 women with congenital heart disease aged (mean [range]) 25 (18-40) years, who experienced a total of 84 pregnancies between January 1992 and August 2006. The women were divided into three pregnancy risk groups: A, low-risk; B, moderate-risk, and C, high-risk. The incidence of complications during pregnancy was 1.6%, 15%, and 20% in groups A, B, and C, respectively; the incidence during the puerperium was 2%, 23%, and 50%, respectively; and maternal mortality was 0%, 7.6%, and 25%, respectively. Overall, 69 children were born, and the prematurity rates in the three groups were 11%, 15%, and 100%, respectively. The following risk factors were studied: pulmonary hypertension, cyanosis, arrhythmia, left ventricular outflow tract obstruction, right ventricular dilatation, systemic right ventricle, and anticoagulation therapy. The risk factor most significantly associated with maternal or fetal morbidity or mortality was found to be pulmonary hypertension. Risk stratification in pregnant women with congenital heart disease provides prognostic information that can help multidisciplinary teams to target care to achieve the best results.

Amygdalar volumetric correlates of social anxiety in offspring of parents with bipolar disorder.

PubMed

Park, Min-Hyeon; Garrett, Amy; Boucher, Spencer; Howe, Meghan; Sanders, Erica; Kim, Eunjoo; Singh, Manpreet; Chang, Kiki

2015-11-30

The prevalence of social anxiety disorder is high in offspring of parents with bipolar disorder (BD) and anxiety may be a significant risk factor in these youth for developing BD. We compared social anxiety symptoms between BD offspring with mood symptoms (high-risk group for developing BD I or II: HR) and healthy controls (HC). We also explored the correlations between the amygdalar volumes and social anxiety symptoms in the HR group with high social anxiety scores (HRHSA) due to the potential involvement of the amygdala in the pathophysiology of both BD and social anxiety. Youth participating in the study included 29h and 17HC of comparable age and gender. To assess social anxiety symptoms, we used the Multidimensional Anxiety Scale for Children (MASC) social anxiety subscale. The HR group's MASC social anxiety score was significantly higher than that of the HC group. Among the 29h, 17 subjects (58.6%) showed high social anxiety and they were classified as the HRHSA group. No significant difference was observed in amygdalar volume between the HRHSA and HC groups. However, there were significant negative correlations between amydalar volumes and MASC social anxiety score in the HRHSA group. These findings have implications for the link between amygdalar structure and both anxiety and mood control. This link may serve to implicate high social anxiety as a risk marker for future BD development. Copyright © 2015. Published by Elsevier Ireland Ltd.

HIV-risk characteristics in community corrections.

PubMed

Clark, C Brendan; McCullumsmith, Cheryl B; Waesche, Matthew C; Islam, M Aminul; Francis, Reginald; Cropsey, Karen L

2013-01-01

Individuals in the criminal justice system engage in behaviors that put them at high risk for HIV. This study sought to identify characteristics of individuals who are under community corrections supervision (eg, probation) and at risk for HIV. Approximately 25,000 individuals under community corrections supervision were assessed for HIV risk, and 5059 participants were deemed high-risk or no-risk. Of those, 1519 exhibited high sexual-risk (SR) behaviors, 203 exhibited injection drug risk (IVR), 957 exhibited both types of risk (SIVR), and 2380 exhibited no risk. Sociodemographic characteristics and drug of choice were then examined using univariate and binary logistic regression. Having a history of sexual abuse, not having insurance, and selecting any drug of choice were associated with all forms of HIV risk. However, the effect sizes associated with the various drugs of choice varied significantly by group. Aside from those common risk factors, very different patterns emerged. Female gender was a risk factor for the SR group but was less likely to be associated with IVR. Younger age was associated with SR, whereas older age was associated with IVR. Black race was a risk factor for SR but had a negative association with IVR and SIVR. Living in a shelter, living with relatives/friends, and being unemployed were all risk factors for IVR but were protective factors for SR. Distinct sociodemographic and substance use characteristics were associated with sexual versus injection drug use risk for individuals under community corrections supervision who were at risk for HIV. Information from this study could help identify high-risk individuals and allow tailoring of interventions.

The triglyceride to high-density lipoprotein ratio identifies children who may be at risk of developing cardiometabolic disease.

PubMed

Bailey, Daniel P; Savory, Louise A; Denton, Sarah J; Davies, Ben R; Kerr, Catherine J

2014-08-01

It is important to develop simple, reliable methods to identify high-risk individuals who may benefit from intervention. This study investigated the association between the triglyceride to high-density lipoprotein cholesterol (TG/HDL) ratio and cardiometabolic risk, cardiorespiratory fitness and physical activity in children. Anthropometric, biochemical parameters, cardiorespiratory fitness and accelerometry determined physical activity were assessed in 155 children (80 girls) from 10 to 14 years of age from Bedfordshire, UK. Participants were grouped into high and low TG/HDL ratio groups, according to published thresholds. MANCOVA and logistic regression were used in the analysis. Cardiometabolic risk factor levels were significantly higher in participants with a high TG/HDL ratio (p < 0.05). The odds of having high waist circumference (OR = 13.99; 95% CI 2.93, 69.25), elevated systolic blood pressure (5.27; 1.39, 20.01), high non-HDL cholesterol (19.47; 4.42, 85.81) and ≥2 cardiometabolic risk factors (15.32; 3.10, 75.79) were higher in participants with a high TG/HDL ratio. The TG/HDL ratio values were significantly lower in those with high cardiorespiratory fitness (p = 0.01), but there was no association with physical activity. These findings support the use of the TG/HDL ratio to identify children with cardiometabolic risk factors who may be at risk of developing cardiometabolic disease. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

[Response and prognosis of patients with multiple myeloma induced by PAD/TAD].

PubMed

Zeng, Tianmei; He, Haiyan; Shi, Haotian; Xi, Hao; Du, Juan; Zhang, Chunyang; Jiang, Hua; Fu, Weijun; Zhou, Fan; Hou, Jian

2015-03-17

To evaluate the impact of cytogenetic grouping and autologous stem cell transplantation on the prognosis of patients with multiple myeloma (MM) induced by PAD (velcade+epirubicin+dexamethasone) and TAD (thalidomide+epirubicin+dexamethasone). A total of 191 patients with a definite diagnosis of MM were enrolled from May 2008 to December 2013 into this prospective study. They were non-randomly induced by PAD (n = 132) or TAD (n = 59) plus autologous stem cell transplantation or chemotherapy. Response and survival rates were also analyzed between two groups. The overall response rates of PAD and TAD groups were 84.4% (108/128) and 69.5% (41/59) (P = 0.011) respectively. The very good partial remission (VGPR) rates were 70.3% (90/128) and 32.2% (19/59) (P < 0.001) and near complete remission/complete remission (nCR/CR) rates 68.0% (87/128) and 25.4% (15/59) respectively (P < 0.001). Both progression-free survival (PFS) and overall survival (OS) showed no significant inter-group difference (P = 0.223, 0.989). The survival analysis of PAD group showed that FISH high-risk group had shorter PFS and OS than FISH low-risk group (15.2 vs 19.1 months for PFS, P = 0.098; 41.2 months vs non-attaining for OS, P = 0.017). In FISH high-risk group, patients consolidated with autologous stem cell transplantation showed longer PFS than those with chemotherapy (17.8 vs 14.6 months, P = 0.029) while the OS showed no difference (P = 0.840). In FISH low-risk group, no difference were observed in PFS and OS between patients with consolidation therapies alone (P = 0.131, 0.294). The response rates are higher in patients induced by PAD than by TAD. After PAD induction, cytogenetic grouping may further distinguish the prognosis of MM patients. For FISH high-risk patients, their PFS is prolonged by autologous stem cell transplantation.

The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction.

PubMed

Lee, Hyuk; Seo, Min Jae; Choi, Tae Young

2016-05-01

Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The ability to control smartphone use was evaluated with the Motive Scale for Smartphone Regulation. We used the Parents' Concerns for Children's Smartphone Activities Scale to measure parental monitoring and supervision of adolescents' smartphone activities. The Korean Smartphone Addiction Proneness Scale classified subjects into high risk and non-high risk for smartphone addiction, according to total scores. Forty six participants (14%) were high risk for smartphone addiction. The high risk group performed the HDJ-S for two weeks, and the same scales were subsequently assessed. After performing the HDJ-S, the total scores of the Korean Smartphone Addiction Proneness Scale decreased significantly in the high risk group (P < 0.001). There was a significant increase in the total scores of the Parents' Concerns for Children's Smartphone Activities Scale in the high risk group between baseline and following two weeks of treatment (P < 0.05). The HDJ-S was effective for adolescents with smartphone addiction and increased the parents' concerns for their children's smartphone activities. We suggested that HDJ-S would be considered as a treatment and prevention for smartphone addiction.

The Effect of Home-based Daily Journal Writing in Korean Adolescents with Smartphone Addiction

PubMed Central

2016-01-01

Despite the benefits of smartphones, many adverse effects have emerged. However, to date, there was no particular approach to treat or prevent smartphone addiction. The aim of this study was to evaluate the therapeutic effectiveness of a home-based daily journal of smartphone use (HDJ-S) in Korean adolescents. Three hundred thirty five middle school students participated in this study. The severity of smartphone addiction was measured using the Korean Smartphone Addiction Proneness Scale. The ability to control smartphone use was evaluated with the Motive Scale for Smartphone Regulation. We used the Parents’ Concerns for Children’s Smartphone Activities Scale to measure parental monitoring and supervision of adolescents’ smartphone activities. The Korean Smartphone Addiction Proneness Scale classified subjects into high risk and non-high risk for smartphone addiction, according to total scores. Forty six participants (14%) were high risk for smartphone addiction. The high risk group performed the HDJ-S for two weeks, and the same scales were subsequently assessed. After performing the HDJ-S, the total scores of the Korean Smartphone Addiction Proneness Scale decreased significantly in the high risk group (P < 0.001). There was a significant increase in the total scores of the Parents’ Concerns for Children’s Smartphone Activities Scale in the high risk group between baseline and following two weeks of treatment (P < 0.05). The HDJ-S was effective for adolescents with smartphone addiction and increased the parents’ concerns for their children’s smartphone activities. We suggested that HDJ-S would be considered as a treatment and prevention for smartphone addiction. PMID:27134499

Gender and racial differences for suicide attempters and ideators in a high-risk community corrections population.

PubMed

McCullumsmith, Cheryl B; Clark, C Brendan; Perkins, Adam; Fife, Jessaka; Cropsey, Karen L

2013-01-01

Community corrections populations are a high-risk group who carry multiple suicide risk factors. To identify factors correlated with historical suicide attempts and ideation among African-American men, African-American women, White men, and White women in a community corrections population. Self-report data from 18,753 enrollees in community corrections were analyzed. Multinomial logistic regression analyses were conducted to determine associations between historical suicidal ideation and attempts among the four demographic groups. Participants with historical suicide attempts tended to be younger, White, female, be taking psychotropic medication, have a history of physical or sexual abuse, and meet criteria for dependence on alcohol, amphetamines, cocaine, opioids, or sedatives. Five variables were commonly associated with suicide attempts for all four race/gender groups: younger age, being on disability or retirement, taking psychotropic medication, history of sexual or physical abuse, and cocaine dependence. Other demographic variables had race or gender specificities as risk factors for suicide attempts. Participants had high rates of historical suicide attempts with unique correlates differentiating attempters from ideators among different racial and gender groups. Cocaine dependence was universal predictor of suicide attempts, while other substance dependencies show specific racial and gender profiles associated with suicide attempts.

Building electronic forms for elderly program: integrated care model for high risk elders in Hong Kong.

PubMed

Yiu, Rex; Fung, Vicky; Szeto, Karen; Hung, Veronica; Siu, Ricky; Lam, Johnny; Lai, Daniel; Maw, Christina; Cheung, Adah; Shea, Raman; Choy, Anna

2013-01-01

In Hong Kong, elderly patients discharged from hospital are at high risk of unplanned readmission. The Integrated Care Model (ICM) program is introduced to provide continuous and coordinated care for high risk elders from hospital to community to prevent unplanned readmission. A multidisciplinary working group was set up to address the requirements on developing the electronic forms for ICM program. Six (6) forms were developed. These forms can support ICM service delivery for the high risk elders, clinical documentation, statistical analysis and information sharing.

Association between Obesity and Cardiometabolic Health Risk in Asian-Canadian Sub-Groups

PubMed Central

Nie, Jason X.; Ardern, Chris I.

2014-01-01

Objectives To quantify and compare the association between the World Health Organizations’ Asian-specific trigger points for public health action [‘increased risk’: body mass index (BMI) ≥23 kg/m2, and; ‘high risk’: BMI ≥27.5 kg/m2] with self-reported cardiovascular-related conditions in Asian-Canadian sub-groups. Methods Six cycles of the Canadian Community Health Survey (2001–2009) were pooled to examine BMI and health in Asian sub-groups (South Asians, Chinese, Filipino, Southeast Asians, Arabs, West Asians, Japanese and Korean; N = 18 794 participants, ages 18–64 y). Multivariable logistic regression, adjusting for demographic, lifestyle characteristics and acculturation measures, was used to estimate the odds of cardiovascular-related health (high blood pressure, heart disease, diabetes, ‘at least one cardiometabolic condition’) outcomes across all eight Asian sub-groups. Results Compared to South Asians (OR = 1.00), Filipinos had higher odds of having ‘at least one cardiometabolic condition’ (OR = 1.29, 95% CI: 1.04–1.62), whereas Chinese (0.63, 0.474–0.9) and Arab-Canadians had lower odds (0.38, 0.28–0.51). In ethnic-specific analyses (with ‘acceptable’ risk weight as the referent), ‘increased’ and ‘high’ risk weight categories were the most highly associated with ‘at least one cardiometabolic condition’ in Chinese (‘increased’: 3.6, 2.34–5.63; ‘high’: 8.9, 3.6–22.01). Compared to normal weight South Asians, being in the ‘high’ risk weight category in all but the Southeast Asian, Arab, and Japanese ethnic groups was associated with approximately 3-times the likelihood of having ‘at least one cardiometabolic condition’. Conclusion Differences in the association between obesity and cardiometabolic health risks were seen among Asian sub-groups in Canada. The use of WHO’s lowered Asian-specific BMI cut-offs identified obesity-related risks in South Asian, Filipino and Chinese sub-groups that would have been masked by traditional BMI categories. These findings have implications for public health messaging, especially for ethnic groups at higher odds of obesity-related health risks. PMID:25222283

Assessment of risk of type 2 diabetes using the Indian Diabetes Risk Score in an urban slum of Pune, Maharashtra, India: a cross-sectional study.

PubMed

Patil, Reshma S; Gothankar, Jayashree S

2016-04-01

The urban poor is a group that is known to be vulnerable to adoption of a more urbanized lifestyle that places them at a higher risk for diabetes. Individuals who are unaware of their disease status are more prone to micro- and macrovascular complications. Hence, it is necessary to detect this large pool of undiagnosed participants with diabetes and offer them early therapy. The aim of this study was to use the Indian Diabetes Risk Score, developed by the Madras Diabetes Research Foundation (MDRF-IDRS), to assess the prevalence of people at high risk for developing diabetes, and the correlation with known risk factors. A cross-sectional study was conducted in the field practice area of the urban health training centre of a private medical college in Pune, Maharashtra. A total of 425 participants aged 20 years and above were screened for risk factors, including age, waist circumference, family history of diabetes and physical activity. Random testing of the blood glucose level of participants with a high risk score was carried out using a glucometer. Statistical analysis of the data was performed by using the chi-squared test and logistic regression analysis. The prevalence of people at high risk of diabetes was 36.55%. Among high-risk participants on univariate analysis, primary education (P = 0.004), lower socioeconomic class (P = 0.002), less physical activity (P< 0.001) and high waist circumference (P < 0.001) were major contributing factors, while in the moderate-risk group, lower socioeconomic class and high waist circumference were the prominent risk factors for diabetes. Multivariate analysis showed that higher education, moderate to vigorous activity and high waist circumference were significantly associated with risk status. Out of 140 high-risk participants, 68 (49%) had a random capillary blood glucose level of 110 mg/dL or above. As the prevalence of people at high risk for diabetes was high, lifestyle changes and awareness regarding risk factors is needed to take control of the diabetes in the study population.

The 3′UTR signature defines a highly metastatic subgroup of triple-negative breast cancer

PubMed Central

Wang, Lei; Hu, Xin; Wang, Peng; Shao, Zhi-Ming

2016-01-01

Triple-negative breast cancer (TNBC) is a highly heterogeneous disease with an aggressive clinical course. Prognostic models are needed to chart potential patient outcomes. To address this, we used alternative 3′UTR patterns to improve postoperative risk stratification. We collected 327 publicly available microarrays and generated the 3′UTR landscape based on expression ratios of alternative 3′UTR. After initial feature filtering, we built a 17-3′UTR-based classifier using an elastic net model. Time-dependent ROC comparisons and Kaplan–Meier analyses confirmed an outstanding discriminating power of our prognostic model for TNBC patients. In the training cohort, 5-year event-free survival (EFS) was 78.6% (95% CI 71.2–86.0) for the low-risk group, and 16.3% (95% CI 2.3–30.4) for the high-risk group (log-rank p<0.0001; hazard ratio [HR] 8.29, 95% CI 4.78–14.4), In the validation set, 5-year EFS was 75.6% (95% CI 68.0–83.2) for the low-risk group, and 33.2% (95% CI 17.1–49.3) for the high-risk group (log-rank p<0.0001; HR 3.17, 95% CI 1.66–5.42). In conclusion, the 17-3′UTR-based classifier provides a superior prognostic performance for estimating disease recurrence and metastasis in TNBC patients and it may permit personalized management strategies. PMID:27494850