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Sample records for preoperative risk factors

  1. Preoperative evaluation and risk factors of lung cancer.

    PubMed

    Gaballo, Annarita; Corbo, Giuseppe M; Valente, Salvatore; Ciappi, Giuliano

    2004-01-01

    Based on a review of the literature on resectable lung cancer, pulmonary risk factors before, during and after surgery are discussed. The role of preoperative evaluation in order to determine the patient ability to withstand radical resection is considered. Spirometric indexes as forced expired volume (FEV1) and diffusing lung carbon monoxide capacity (DLCO) should be measured first. If FEV1 and DLCO are > 60% of predicted, patients are at low risk for complications and can undergo pulmonary resection. However, if FEV1 and DLCO are <60% of predicted, further evaluation with a quantitative lung scan is required. If predicted postoperative values for FEV1 and DLCO are >40%, patients can undergo lung resection, otherwise exercise testing is necessary. If the latter shows maximal oxygen uptake (VO2max) of > 15ml/Kg, surgery can be performed; if VO2max is <15 ml/Kg, patients are inoperable.

  2. Preoperative risk factors of malnutrition for cardiac surgery patients

    PubMed Central

    Donata, Ringaitienė; Dalia, Gineitytė; Vaidas, Vicka; Tadas, Žvirblis; Jūratė, Šipylaitė; Algimantas, Irnius; Juozas, Ivaškevičius

    2016-01-01

    Background. Malnutrition (MN) is prevalent in cardiac surgery, but there are no specific preoperative risk factors of MN. The aim of this study is to assess the clinically relevant risk factors of MN for cardiac surgery patients. Materials and methods. The nutritional state of the patients was evaluated one day prior to surgery using a bioelectrical impedance analysis phase angle (PA). Two groups of patients were generated according to low PA: malnourished and well nourished. Risk factors of MN were divided into three clinically relevant groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. Variables in each different group were entered into separate multivariate logistic regression models. Results. A total of 712 patients were included in the study. The majority of them were 65-year old men after a CABG procedure. Low PA was present in 22.9% (163) of patients. The analysis of disease-related factors of MN revealed the importance of heart functions (NYHA IV class OR: 3.073, CI95%: 1.416–6.668, p = 0.007), valve pathology (OR: 1.825, CI95%: 1.182–2.819, p = 0.007), renal insufficiency (OR: 4.091, CI95%: 1.995–8.389, p < 0.001) and body mass index (OR: 0.928, CI95%: 0.890–0.968, p < 0.001). Laboratory values related to MN were levels of haemoglobin (OR: 0.967, CI95%: 0.951–0.983, p < 0.001) and C-reactive protein (OR: 1.015, CI95%: 1.002–1.028, p = 0.0279). The lifestyle variables that qualified as risk factors concerned the intake of food (OR: 3.030, CI95%: 1.353–6.757, p = 0.007) and mobility (OR: 2.770, CI95%: 1.067–7.194, p = 0.036). Conclusions. MN risk factors comprise three different clinical groups: psychosocial and lifestyle factors, laboratory findings and disease-associated factors. The patients who are most likely to be malnourished are those with valve pathology, severe imparted heart function, insufficient renal function and high inflammatory markers. Also these patients have decreased mobility

  3. Preoperative risk factors in total thyroidectomy of substernal goiter

    PubMed Central

    Bove, Aldo; Di Renzo, Raffaella Maria; D’Urbano, Gauro; Bellobono, Manuela; Addetta, Vincenzo D’; Lapergola, Alfonso; Bongarzoni, Giuseppe

    2016-01-01

    The definition of substernal goiter (SG) is based on variable criteria leading to a considerable variation in the reported incidence (from 0.2% to 45%). The peri- and postoperative complications are higher in total thyroidectomy (TT) for SG than that for cervical goiter. The aim of this study was to evaluate the preoperative risk factors associated with postoperative complications. From 2002 to 2014, 142 (8.5%; 98 women and 44 men) of the 1690 patients who underwent TT had a SG. We retrospectively evaluated the following parameters: sex, age, histology, pre- and retrovascular position, recurrence, and extension beyond the carina. These parameters were then related to the postoperative complications: seroma/hematoma, transient and permanent hypocalcemia, transient and permanent laryngeal nerve palsy, and the length of surgery. The results were further compared with a control group of 120 patients operated on in the same period with TT for cervical goiter. All but two procedures were terminated via cervicotomy, where partial sternotomies were required. No perioperative mortality was observed. Results of the statistical analysis (Student’s t-test and Fisher’s exact test) indicated an association between recurrence and extension beyond the carina with all postoperative complications. The group that underwent TT of SG showed a statistically significant higher risk for transient hypocalcemia (relative risk =1.767 with 95% confidence interval: 1.131–2.7605, P=0.0124, and need to treat =7.1) and a trend toward significance for transient recurrent laryngeal nerve palsy (relative risk =6.7806 with 95% confidence interval: 0.8577–53.2898, P=0.0696, and need to treat =20.8) compared to the group that underwent TT of cervical goiter. TT is the procedure to perform in SG even if the incidence of complications is higher than for cervical goiters. The major risk factors associated with postoperative complications are recurrence and extension beyond the carina. In the

  4. Right ventricular failure after left ventricular assist device insertion: preoperative risk factors.

    PubMed

    Santambrogio, Luisa; Bianchi, Tiziana; Fuardo, Marinella; Gazzoli, Fabrizio; Veronesi, Roberto; Braschi, Antonio; Maurelli, Marco

    2006-08-01

    Right ventricular failure after left ventricular assist device placement is the major concern on weaning from cardiopulmonary bypass and it is one of the most serious complications in the postoperative period. This complication has a poor prognosis and is generally unpredictable. The identification of pre-operative risk factor for this serious complication is incomplete yet. In order to determine pre-operative risk for severe right ventricular failure after left ventricular assist device support we analyzed preoperative hemodynamics, laboratory data and characteristics of 48 patients who received Novacor (World Heart Corp., Ottawa, ON, Canada). We compared the data from the patients who developed right ventricular failure and the patients who did not. Right ventricular failure occurred in 16% of the patients. There was no significant difference between the groups in demographic characteristics. We identified as preoperative risk factors the pre-operative low mean pulmonary artery and the impairment of hepatic and renal function on laboratory data. Our results confirm in part the findings of the few previous studies. This information may be useful for the patient selection for isolated left ventricular assist device implantation, but other studies are necessary before establishing criteria for patient selection for univentricular support universally accepted.

  5. Sacral Insufficiency Fractures After Preoperative Chemoradiation for Rectal Cancer: Incidence, Risk Factors, and Clinical Course

    SciTech Connect

    Herman, Michael P.; Kopetz, Scott; Bhosale, Priya R.; Eng, Cathy; Skibber, John M.; Rodriguez-Bigas, Miguel A.; Feig, Barry W.; Chang, George J.; Delclos, Marc E.; Krishnan, Sunil; Crane, Christopher H.; Das, Prajnan

    2009-07-01

    Purpose: Sacral insufficiency (SI) fractures can occur as a late side effect of pelvic radiation therapy. Our goal was to determine the incidence, risk factors, and clinical course of SI fractures in patients treated with preoperative chemoradiation for rectal cancer. Materials and Methods: Between 1989 and 2004, 562 patients with non-metastatic rectal adenocarcinoma were treated with preoperative chemoradiation followed by mesorectal excision. The median radiotherapy dose was 45 Gy. The hospital records and radiology reports of these patients were reviewed to identify those with pelvic fractures. Radiology images of patients with pelvic fractures were then reviewed to identify those with SI fractures. Results: Among the 562 patients, 15 had SI fractures. The 3-year actuarial rate of SI fractures was 3.1%. The median time to SI fractures was 17 months (range, 2-34 months). The risk of SI fractures was significantly higher in women compared to men (5.8% vs. 1.6%, p = 0.014), and in whites compared with non-whites (4% vs. 0%, p = 0.037). On multivariate analysis, gender independently predicted for the risk of SI fractures (hazard ratio, 3.25; p = 0.031). Documentation about the presence or absence of pain was available for 13 patients; of these 7 (54%) had symptoms requiring pain medications. The median duration of pain was 22 months. No patient required hospitalization or invasive intervention for pain control. Conclusions: SI fractures were uncommon in patients treated with preoperative chemoradiation for rectal cancer. The risk of SI fractures was significantly higher in women. Most cases of SI fractures can be managed conservatively with pain medications.

  6. Risk factors for aerobic bacterial conjunctival flora in preoperative cataract patients.

    PubMed

    Hoshi, S; Hashida, M; Urabe, K

    2016-11-01

    PurposeTo investigate the relationship between the background of preoperative cataract patients and bacterial conjunctival flora.MethodsA total of 990 cataract patients who had completed preoperative examinations in 2007 and 2008 were included. Patients using topical antibiotics at the preoperative examination or having a history of intraocular surgery were excluded. Conjunctival cultures had been preoperatively obtained. Patient characteristics were investigated via medical records. Risk factors for conjunctival flora of seven typical bacteria were analyzed by univariate and multivariate analyses.ResultsThe detection rate of alpha-hemolytic streptococci and Enterococcus faecalis increased with age (P=0.044 and P=0.002, respectively). The detection rate of Gram-negative bacilli was higher among patients with oral steroid use or lacrimal duct obstruction (P=0.038 and P=0.002, respectively). The detection rate of Corynebacterium species was higher among older patients and men, and lower among patients with glaucoma eye drop use (P<0.001, P=0.012 and P=0.001, respectively). The detection rate of methicillin-susceptible coagulase-negative Staphylococci was higher among men and lower among patients with a surgical history in other departments (P=0.003 and P=0.046, respectively). The detection rate of methicillin-resistant coagulase-negative Staphylococci (MR-CNS) was higher among patients with oral steroid use, a visit history to ophthalmic facilities, or a surgical history in other departments (P=0.002, P=0.037 and P<0.001, respectively).ConclusionsElderly patients, men, patients with lacrimal duct obstruction or immunosuppressed patients are more likely to be colonized by pathogens that cause postoperative endophthalmitis. Moreover, MR-CNS colonization was associated with healthcare-associated infection.

  7. Preoperative Assessment of Serum Albumin Level as Risk Factor for Morbidity Following Routine Oncological Surgery.

    PubMed

    Bhuiyan, M U

    2016-04-01

    This cross-sectional observational study was to establish the preoperative assessment of serum albumin level as indicator for morbidity following cancer surgery and to reduce the incidence of related postoperative complications. Therefore this study was undertaken to assess the morbidity associated with low serum level albumin and identify it as a risk factor following cancer surgery in Bangladeshi population. This study included 312 patients with malignancy who were waiting for surgery or within 60 days of postoperative period were enrolled for the study from indoor of surgical oncology department, National Institute of Cancer Research & Hospital (NICR&H), Dhaka, Bangladesh. Then the patients were submitted for further study to evaluate the preoperative fitness in terms of nutritional assessment - both clinical and biological especially serum albumin level. All the clinical (pre & post-operative including complication, if any), investigation findings were recorded accordingly. Statistical correlation was discovered between BMI and morbidity but no statistical correlation was found between WL >10% and major surgical complications of either infectious or noninfectious origin (p=NS). Conversely, a substantial statistical correlation was found between Hb% or albumin <30gm/l and major surgical complications (either infectious or noninfectious) (p<0.001). The serum albumin level below 30gm/l is a significant risk factor for oncological postoperative major complications (MC).

  8. Pre-operative and anaesthesia-related risk factors for mortality in equine colic cases.

    PubMed

    Proudman, C J; Dugdale, A H A; Senior, J M; Edwards, G B; Smith, J E; Leuwer, M L; French, N P

    2006-01-01

    Mortality rates for horses that have undergone emergency abdominal surgery are higher than for other procedures. Here, multivariable modelling of data from 774 surgical colic cases is used to identify pre-operative and anaesthesia-related variables associated with intra- and post-operative mortality. Intra-operative mortality was significantly (P<0.05), and positively associated with heart rate and packed cell volume (PCV) at admission, and negatively associated with the severity of pain. Post-operative mortality increased with increasing age and PCV at admission. Draught horses, Thoroughbreds and Thoroughbred-cross horses carried a significantly worse prognosis. We detected a small but significant variability in the risk of intra-operative death amongst referring veterinary surgeons. Different anaesthetic induction agents, inhalation maintenance agents and the use, or not, of intermittent positive pressure ventilation had no significant effect on risk of death. We conclude that cardiovascular compromise, level of pain, age, and breed are all associated with the risk of mortality in equine surgical colic cases.

  9. Pre-operative urinary tract infection: is it a risk factor for early surgical site infection with hip fracture surgery? A retrospective analysis

    PubMed Central

    Khalfaoui, Mahdi Y; Veravalli, Karunakar; Evans, D Alun

    2017-01-01

    Objective The aims of the current study were to determine whether pre-operative urinary tract infections in patients presenting acutely with neck of femur fractures resulted in a delay to surgery and whether such patients were at increased risk of developing post-operative surgical site infections. Design A retrospective review of all patients presenting with a neck of femur fracture, at a single centre over a one-year period. The hospital hip fracture database was used as the main source of data. Setting UK University Teaching Hospital Participants All patients (n = 460) presenting across a single year study period with a confirmed hip fracture. Outcome measures The presence of pre-operative urinary tract infection, the timing of surgical intervention, the occurrence of post-operative surgical site infection and the pathogens identified. Results A total of 367 patients were operated upon within 24 hours of admission. Urinary infections were the least common cause of delay. A total of 99 patients (21.5%) had pre-operative urinary tract infection. Post-operatively, a total of 57 (12.4%) patients developed a surgical site infection. Among the latter, 31 (54.4%) did not have a pre-operative urinary infection, 23 (40.4%) patients had a pre-operative urinary tract infection, 2 had chronic leg ulcers and one patient had a pre-operative chest infection. Statistically, there was a strong relationship between pre-operative urinary tract infection and the development of post-operative surgical site infection (p-value: 0.0005). Conclusion The results of our study indicate that pre-operative urinary tract infection has a high prevalence amongst those presenting with neck of femur fractures, and this is a risk factor for the later development of post-operative surgical site infection. PMID:28321316

  10. Preoperative risk factors of postoperative delirium after transurethral prostatectomy for benign prostatic hyperplasia

    PubMed Central

    Tai, Sheng; Xu, Lingfan; Zhang, Li; Fan, Song; Liang, Chaozhao

    2015-01-01

    The aim of this observational study was to investigate the occurrence of post operation delirium in the elderly patients undergoing the transurethral prostatectomy and to identify these factors associated with the delirium. 485 patients, undergoing the transurethral prostatectomy, were selected. Demographics, medical, cognitive and functional data, IPSS and NIH-CPSI score were collected as predictors for delirium. After surgery, the patients were divided on the basis of delirium onset within one week observation period, and the delirium was diagnosed by the Confusion Assessment Method. Totally, 21.23% (103) subjects were identified as the delirium and it lasted 2.9 ± 0.8 days. Patients with post operation delirium were significantly older and single, widowed and divorced, had a previous history of prehospitalization, were with the poor International Prostate Symptom Score (IPSS) and National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) score, were more impaired in the instrumental activities of daily living (IADL), and had poor clock drawing test (CDT) and geriatric depression scale (GDS) score. Age, marital status, IPSS and NIH-CPIS score, cognitive and functional status and previous history of hospitalization are the predictors of post operation delirium. Our study has implications in preventing delirium via an early and targeted evaluation. PMID:26064386

  11. Risk Stratification For Axillary Lymph Node Metastases in Breast Cancer Patients: What Clinicopathological and Radiological Factors of Primary Breast Cancer Can Predict Preoperatively Axillary Lymph Node Metastases?

    PubMed

    Yun, Seong Jong; Sohn, Yu-Mee; Seo, Mirinae

    2017-03-01

    This study was to investigate clinicopathological features including immunohistochemical subtype and radiological factors of primary breast cancer to predict axillary lymph node metastasis (ALNM) and preoperative risk stratification.From June 2004 to May 2014, 369 breast cancer patients (mean age, 54.7 years; range, 29-82 years) who underwent surgical axillary node sampling were included. Two radiologists retrospectively reviewed clinicopathological features, initial mammography, and initial breast ultrasonography (US). Univariate and multivariate logistic regression analyses were used to evaluate associations between ALNM and variables. Odds ratio with 95% confidence interval and risk of ALNM were calculated.Among 369 patients, 117 (31.7%) had ALNM and 252 (68.3%) had no ALNM revealed surgically. On multivariate analysis, four factors showed positive association with ALNM: the presence of symptoms (P < 0.001), triple-negative breast cancer subtype (P = 0.001), mass size on US (>10 mm, P < 0.001), and Breast Imaging Reporting and Data System category on US (≥4c, P < 0.001). The significant risk of ALNM was particularly seen in patients with two or more factors (2, P = 0.013; 3, P < 0.001; 4, P < 0.001).The estimated risks of ALNM increased in patients with two, three, and four factors with odds ratios of 5.5, 14.3, and 60.0, respectively.The presence of symptoms, triple-negative breast cancer subtype, larger size mass on US (>10 mm), and higher Breast Imaging Reporting and Data System category on US (≥4c) were positively associated with ALNM. Radiologically, US findings are significant factors that can affect the decision making process regarding ALNM. Based on risk stratification, the possibility of ALNM can be better predicted if 2 or more associated factors existed preoperatively.

  12. Preoperative, intraoperative and postoperative risk factors for anastomotic leakage after laparoscopic low anterior resection with double stapling technique anastomosis

    PubMed Central

    Kawada, Kenji; Sakai, Yoshiharu

    2016-01-01

    Anastomotic leakage (AL) is one of the most devastating complications after rectal cancer surgery. The double stapling technique has greatly facilitated intestinal reconstruction especially for anastomosis after low anterior resection (LAR). Risk factor analyses for AL after open LAR have been widely reported. However, a few studies have analyzed the risk factors for AL after laparoscopic LAR. Laparoscopic rectal surgery provides an excellent operative field in a narrow pelvic space, and enables total mesorectal excision surgery and preservation of the autonomic nervous system with greater precision. However, rectal transection using a laparoscopic linear stapler is relatively difficult compared with open surgery because of the width and limited performance of the linear stapler. Moreover, laparoscopic LAR exhibits a different postoperative course compared with open LAR, which suggests that the risk factors for AL after laparoscopic LAR may also differ from those after open LAR. In this review, we will discuss the risk factors for AL after laparoscopic LAR. PMID:27433085

  13. Acute Pre-operative Infarcts and Poor Cerebrovascular Reserve are Independent Risk Factors for Severe Ischemic Complications Following Direct Extracranial-Intracranial Bypass for Moyamoya Disease

    PubMed Central

    Pulling, T. Michael; Rosenberg, Jarrett; Marks, Michael P.; Steinberg, Gary K.; Zaharchuk, Greg

    2015-01-01

    Background and Purpose Severe ischemic changes are a rare but devastating complication following direct superficial temporal artery to middle cerebral artery (STA MCA) bypass in Moyamoya patients. This study was undertaken to determine whether pre-operative MR imaging and/or cerebrovascular reserve (CVR) assessment using reference standard stable xenon enhanced computed tomography (xeCT) could predict such complications. Materials and Methods Among all adult patients receiving direct bypass at our institution between 2005 and 2010 who received a clinically interpretable xeCT examination, we identified index cases (patients with >15 ml post-operative infarcts) and control cases (patients without post-operative infarcts and without transient or permanent ischemic symptoms). Differences between groups were evaluated using the Mann Whitney test. Univariate and multivariate generalized linear model regression were employed to test predictors of post-operative infarct. Results Six index cases were identified and compared with 25 controls. Infarct size in the index cases was 95±55 ml. Four of six index cases (67%), but no control patients, had pre-operative acute infarcts. Baseline CBF was similar, but CVR was significantly lower in the index cases compared with control cases. For example, in the anterior circulation, median CVR was 0.4% (range: −38.0% to 16.6%) in index vs. 26.3% (range: −8.2% to 60.5%) in control patients (p=0.003). Multivariate analysis demonstrated that the presence of a small pre-operative infarct (regardless of location) and impaired CVR were independent, significant predictors of severe post-operative ischemic injury. Conclusion Acute infarcts and impaired CVR on pre operative imaging are independent risk factors for severe ischemic complications following STA MCA bypass in Moyamoya disease. PMID:26564435

  14. Analysis of Preoperative Metabolic Risk Factors Affecting the Prognosis of Patients with Esophageal Squamous Cell Carcinoma: The Fujian Prospective Investigation of Cancer (FIESTA) Study.

    PubMed

    Peng, Feng; Hu, Dan; Lin, Xiandong; Chen, Gang; Liang, Binying; Zhang, Hejun; Dong, Xiaoqun; Lin, Jinxiu; Zheng, Xiongwei; Niu, Wenquan

    2017-02-01

    Some metabolic factors have been shown to be associated with an increased risk of esophageal cancer; however the association with its prognosis is rarely reported. Here, we assessed the prediction of preoperative metabolic syndrome and its single components for esophageal cancer mortality by analyzing a subset of data from the ongoing Fujian prospective investigation of cancer (FIESTA) study. Between 2000 and 2010, patients who underwent three-field lymphadenectomy were eligible for inclusion. Blood/tissue specimens, demographic and clinicopathologic data were collected at baseline. Metabolic syndrome is defined by the criteria proposed by Chinese Diabetes Society. In this study, analysis was restricted to esophageal squamous cell carcinoma (ESCC) due to the limited number of other histological types. The median follow-up in 2396 ESCC patients (males/females: 1822/574) was 38.2months (range, 0.5-180months). The multivariate-adjusted hazard ratio (HR) of metabolic syndrome for ESCC mortality was statistically significant in males (HR, 95% confidence interval, P: 1.45, 1.14-1.83, 0.002), but not in females (1.46, 0.92-2.31, 0.107). For single metabolic components, the multivariate-adjusted HRs were significant for hyperglycemia (1.98, 1.68-2.33, <0.001) and dyslipidemia (1.41, 1.20-1.65, <0.001) in males and for hyperglycemia (1.76, 1.23-2.51, <0.001) in females, independent of clinicopathologic characteristics and obesity. In tree-structured survival analysis, the top splitting factor in both genders was tumor-node-metastasis stage, followed by regional lymph node metastasis. Taken together, our findings demonstrate that preoperative metabolic syndrome was a significant independent predictor of ESCC mortality in males, and this effect was largely mediated by glyeolipid metabolism disorder.

  15. Pre-operative factors indicating risk of multiple operations versus a single operation in women undergoing surgery for screen detected breast cancer.

    PubMed

    O'Flynn, E A M; Currie, R J; Mohammed, K; Allen, S D; Michell, M J

    2013-02-01

    We aim to identify preoperative factors at diagnosis which could predict whether women undergoing wide local excision (WLE) would require further operations. 1593 screen-detected invasive and non-invasive breast cancers were reviewed. Age, presence of ductal carcinoma in situ (DCIS), invasive cancer size on mammography, mammographic sign, tumour type, grade and confidence of the radiologist in malignancy were compared. 83%(1315/1593) of women had a WLE. Of these, 70%(919/1315) had a single operation, and 30%(396/1315) multiple operations. These included repeat WLE to clear margins (60%(238/396)), mastectomy (34%(133/396)) and axillary dissection (6%(25/396)). The presence of mammographic microcalcification, lobular carcinoma and grade 2 malignancy on core biopsy were independent risk factors for multiple operations on multivariate analysis. Women with mammographic DCIS >30 mm were 3.4 times more likely to undergo repeat surgery than those with smaller foci. The multidisciplinary team should pay particular attention to these factors when planning surgery.

  16. Risk factors associated with inferior alveolar nerve injury after extraction of the mandibular third molar--a comparative study of preoperative images by panoramic radiography and computed tomography.

    PubMed

    Hasegawa, T; Ri, S; Shigeta, T; Akashi, M; Imai, Y; Kakei, Y; Shibuya, Y; Komori, T

    2013-07-01

    In this study we investigated the relationships among the risk factors for inferior alveolar nerve injury (IANI), and the difference between preoperative imaging findings on panoramic radiographs and computed tomography (CT), by univariate and multivariate analyses. We determined the following to be significant variables by multivariate analysis: panoramic radiographic signs, such as the loss of the white line of the inferior alveolar canal or the diversion of the canal; excessive haemorrhage during extraction; and a close relationship of the roots to the IAN (type 1 cases) on CT examination. CT findings of type 1 were associated with a significantly higher risk (odds ratio 43.77) of IANI. In addition, many panoramic findings were not consistent with CT findings (275 of 440 teeth; 62.5%). These results suggest that CT findings may be able to predict the development of IANI more accurately than panoramic findings. Panoramic radiography alone did not provide sufficiently reliable images required for predicting IANI. Therefore, when the panoramic image is suggestive of a close relationship between the impacted tooth and the IAN, CT should be recommended as a means of conducting further investigations.

  17. Risk factors for complications after ileocolonic resection for Crohn’s disease with a major focus on the impact of preoperative immunosuppressive and biologic therapy: A retrospective international multicentre study

    PubMed Central

    Spinelli, Antonino; Suzuki, Yasuo; Saad-Hossne, Rogerio; Teixeira, Fabio Vieira; de Albuquerque, Idblan Carvalho; da Silva, Rodolff Nunes; de Barcelos, Ivan Folchini; Takeuchi, Ken; Yamada, Akihiro; Shimoyama, Takahiro; da Silva Kotze, Lorete Maria; Sacchi, Matteo; Danese, Silvio; Kotze, Paulo Gustavo

    2015-01-01

    Background Author note: TY, AS, YS, FVT and PGK designed the study. All authors did data collection and gave scientific contribution to the study design and discussion. TY, AS and PGK drafted the article. All authors read and approved the final version of the manuscript.In the era of biologic agents, risk factors for complications following resection for Crohn’s disease have not been fully identified. In particular, the association of preoperative use of immunosuppressive and biologic agents with the incidence of complications after resection remains to be elucidated. Aim This retrospective multicentre study aimed to identify risk factors for complications after ileocolonic resection for Crohn’s disease, with a major focus on the impact of preoperative immunosuppressive and biologic therapy. Methods A total of 231 consecutive patients who underwent ileocolonic resections for active Crohn’s disease in seven inflammatory bowel disease referral centres from three countries (Japan, Brazil and Italy) were included. The following variables were investigated as potential risk factors: age at surgery, gender, behaviour of Crohn’s disease (perforating vs. non-perforating disease), smoking, preoperative use (within eight weeks before surgery) of steroids, immunosuppressants and biologic agents, previous resection, blood transfusion, surgical procedure (open vs. laparoscopic approach), and type of anastomosis (side-to-side vs. end-to-end). Postoperative complications occurring within 30 days after surgery were recorded. Results The rates of overall complications, intra-abdominal sepsis, and anastomotic leak were 24%, 12% and 8%, respectively. Neither immunosuppressive nor biologic therapy prior to surgery was significantly associated with the incidence of overall complications, intra-abdominal sepsis or anastomotic leak. In multivariate analysis, blood transfusion, perforating disease and previous resection were significant risk factors for overall complications (odds

  18. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic

    PubMed Central

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care. PMID:27812286

  19. Preoperative IABP in high risk patients undergoing CABG.

    PubMed

    Theologou, T; Field, M L

    2011-01-01

    A recent international consensus conference on the reduction in mortality in cardiac anesthesia and intensive care included intraoperative aortic balloon pump among the ancillary (i.e. non-surgical) drugs/techniques/strategies that might influence survival rates in patients undergoing cardiac surgery. The consensus conferences state that "Pre-operative intraoperative aortic balloon pump might reduce 30-day mortality in elective high risk patients undergoing coronary artery bypass surgery unless specifically contraindicated". The authors of this "expert opinion" presents their insights into the use of the preoperative intraoperative aortic balloon pump and conclude that based on available limited randomized controlled trials and clinical experience preoperative intraoperative aortic balloon pump saves lives in unstable patients.

  20. Development, Functioning, and Effectiveness of a Preoperative Risk Assessment Clinic.

    PubMed

    Tariq, Hassan; Ahmed, Rafeeq; Kulkarni, Salil; Hanif, Sana; Toolsie, Omesh; Abbas, Hafsa; Chilimuri, Sridhar

    2016-01-01

    Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care. Although there are several constraints in the development of PAT clinics, with increasing awareness about the usefulness of pre-operative risk assessments, growing bodies of literature, and evidence-based guidelines, these clinics are becoming a medical necessity for the improvement of perioperative care.

  1. Preoperative patient assessment: Identifying patients at high risk.

    PubMed

    Boehm, O; Baumgarten, G; Hoeft, A

    2016-06-01

    Postoperative mortality remains alarmingly high with a mortality rate ranging between 0.4% and 4%. A small subgroup of multimorbid and/or elderly patients undergoing different surgical procedures naturally confers the highest risk of complications and perioperative death. Therefore, preoperative assessment should identify these high-risk patients and stratify them to individualized monitoring and treatment throughout all phases of perioperative care. A "tailored" perioperative approach might help further reduce perioperative morbidity and mortality. This article aims to elucidate individual morbidity-specific risks. It further suggests approaches to detect patients at the risk of perioperative complications.

  2. Preoperative Nutritional Therapy Reduces the Risk of Anastomotic Leakage in Patients with Crohn's Disease Requiring Resections

    PubMed Central

    Guo, Zhen; Guo, Dong; Gong, Jianfeng; Zhu, Weiming; Zuo, Lugen; Sun, Jing; Li, Ning; Li, Jieshou

    2016-01-01

    Background. The rate of anastomotic leakage is high in surgeries for Crohn's disease, and therefore a temporary diverting stoma is often needed. We conducted this study to investigate whether preoperative nutritional therapy could reduce the risk of anastomotic leakage while decreasing the frequency of temporary stoma formation. Methods. This was a retrospective study. Patients requiring bowel resections due to Crohn's disease were reviewed. The rate of anastomotic leakage and temporary diverting stoma was compared between patients who received preoperative nutritional therapy and those on a normal diet before surgery. Possible predictive factors for anastomotic leakage were also analyzed. Results. One hundred and fourteen patients undergoing 123 surgeries were included. Patients in nutritional therapy (NT) group had a significantly lower level of C-reactive protein on the day before surgery. Patients in NT group suffered less anastomotic leakage (2.3% versus 17.9%, P = 0.023) and less temporary diverting stoma (22.8% versus 40.9%, P = 0.036). Serum albumin of the day before surgery ≤35 g/L and preoperative nutritional therapy were identified as factors which independently affected the rate of anastomotic leakage. Conclusion. Preoperative nutritional therapy reduced the risk of anastomotic leakage and the frequency of temporary diverting stoma formation in patients with Crohn's disease requiring resections. PMID:26858749

  3. Preoperative factors affecting the outcome of unruptured posterior circulation aneurysm surgery.

    PubMed

    Eftekhar, Behzad; Morgan, Michael Kerin

    2011-01-01

    We retrospectively investigated preoperative variables contributing to adverse surgical outcome for repair of unruptured posterior circulation aneurysms on data collected prospectively between October 1989 and March 2010. Putative risk factors including age, sex, smoking status, positive family history, modified Rankin Score prior to the surgery, size of the aneurysm, specific site (basilar caput and trunk, vertebral artery and posterior inferior cerebellar artery), midline location, presence of calcium, thrombus or irregularity in the aneurysm on preoperative imaging, associated arteriovenous malformation and preoperative coiling were investigated using regression analyses. In a total of 121 operations, surgical mortality and morbidity was 16.3%. For patients with aneurysms less than 9mm this rate was 3.2%. Among the investigated variables we found that size, calcification of the aneurysm and age were each predictors of surgical outcome of unruptured posterior circulation aneurysms.

  4. [Reducing postoperative morbidity and mortality with preoperative risk evaluation and with refined perioperative medical care].

    PubMed

    Uchida, Kanji

    2012-05-01

    Reducing postoperative morbidity and mortality is important not only for patients' outcome but for reduction of financial burden on society. Precise and accurate preoperative evaluation of surgical risk factors is crucial to plan appropriate postoperative allocation of medical resources. American Society of Anesthesiologists physical status is a traditional measure to describe preoperative risk of patients undergoing surgery. In the last decade, several scoring systems with better sensitivity and specificity were reported and validated. Charlson Age-comorbidity Index, Physiological and Operative Severity Score for the Enumeration of Mortality and Morbidity (POSSUM) are frequently used scoring systems. Several lines of evidence indicate that negligence of medical caregivers cause substantial numbers of errors to patients and often leads to severe complications or deaths. Full compliances to surgical checklists and implementation of medical team will help reduce these errors and lead to better patients' postoperative outcomes.

  5. A Pre-operative Risk Model for Post-operative Pneumonia following Coronary Artery Bypass Grafting

    PubMed Central

    Strobel, Raymond J.; Liang, Qixing; Zhang, Min; Wu, Xiaoting; Rogers, Mary A. M.; Theurer, Patricia F.; Fishstrom, Astrid B.; Harrington, Steven D.; DeLucia, Alphonse; Paone, Gaetano; Patel, Himanshu J.; Prager, Richard L.; Likosky, Donald S.

    2016-01-01

    Background Post-operative pneumonia is the most prevalent of all hospital-acquired infections following isolated coronary artery bypass grafting (CAB). Accurate prediction of a patient’s risk of this morbid complication is hindered by its low relative incidence. In an effort to support clinical decision-making and quality improvement, we developed a pre-operative prediction model for post-operative pneumonia following CAB. Methods We undertook an observational study of 16,084 patients undergoing CAB between Q3 2011 – Q2 2014 across 33 institutions participating in the Michigan Society of Thoracic and Cardiovascular Surgeons – Quality Collaborative. Variables related to patient demographics, medical history, admission status, comorbid disease, cardiac anatomy and the institution performing the procedure were investigated. Logistic regression via forwards stepwise selection (p < 0.05 threshold) was utilized to develop a risk prediction model for estimating the occurrence of pneumonia. Traditional methods were employed to assess the model’s performance. Results Post-operative pneumonia occurred in 3.30% of patients. Multivariable analysis identified 17 pre-operative factors, including: demographics, laboratory values, comorbid disease, pulmonary and cardiac function, and operative status. The final model significantly predicted the occurrence of pneumonia, and performed well (C-statistic: 0.74). These findings were confirmed via sensitivity analyses by center and clinically important sub-groups. Conclusions We identified 17 readily obtainable pre-operative variables associated with post-operative pneumonia. This model may be used to provide individualized risk estimation and to identify opportunities to reduce a patient’s pre-operative risk of pneumonia through pre-habilitation. PMID:27261082

  6. Preoperative Carcinoembryonic Antigen and Prognosis of Colorectal Cancer. An Independent Prognostic Factor Still Reliable

    PubMed Central

    Li Destri, Giovanni; Rubino, Antonio Salvatore; Latino, Rosalia; Giannone, Fabio; Lanteri, Raffaele; Scilletta, Beniamino; Di Cataldo, Antonio

    2015-01-01

    To evaluate whether, in a sample of patients radically treated for colorectal carcinoma, the preoperative determination of the carcinoembryonic antigen (p-CEA) may have a prognostic value and constitute an independent risk factor in relation to disease-free survival. The preoperative CEA seems to be related both to the staging of colorectal neoplasia and to the patient's prognosis, although this—to date—has not been conclusively demonstrated and is still a matter of intense debate in the scientific community. This is a retrospective analysis of prospectively collected data. A total of 395 patients were radically treated for colorectal carcinoma. The preoperative CEA was statistically compared with the 2010 American Joint Committee on Cancer (AJCC) staging, the T and N parameters, and grading. All parameters recorded in our database were tested for an association with disease-free survival (DFS). Only factors significantly associated (P < 0.05) with the DFS were used to build multivariate stepwise forward logistic regression models to establish their independent predictors. A statistically significant relationship was found between p-CEA and tumor staging (P < 0.001), T (P < 0.001) and N parameters (P = 0.006). In a multivariate analysis, the independent prognostic factors found were: p-CEA, stages N1 and N2 according to AJCC, and G3 grading (grade). A statistically significant difference (P < 0.001) was evident between the DFS of patients with normal and high p-CEA levels. Preoperative CEA makes a pre-operative selection possible of those patients for whom it is likely to be able to predict a more advanced staging. PMID:25875542

  7. Heart disease - risk factors

    MedlinePlus

    Heart disease - prevention; CVD - risk factors; Cardiovascular disease - risk factors; Coronary artery disease - risk factors; CAD - risk ... a certain health condition. Some risk factors for heart disease you cannot change, but some you can. ...

  8. Preoperative Risk Levels and Vascular Access in Transcatheter Aortic Valve Implantation-A Single-Institute Analysis.

    PubMed

    Kawaguchi, Akira T; Collet, Jean Philippe; Cluzel, Philippe; Makri, Ralouka; Laali, Mojgan; DeFrance, Catherine; Furuya, Hiroyuki; Murakami, Akira; Leprince, Pascal

    2017-02-01

    Although transcatheter aortic valve implantation (TAVI) has been indicated for patients with high surgical risk, indications for or against the procedure become more difficult as vascular access becomes more proximal and/or invasive in order to accommodate patients with even higher risks. We compared preoperative factors including the European System for Cardiac Operative Risk Evaluation (EuroSCORE) and Society of Thoracic Surgeons Predicted Risk of Mortality (STS) score with postoperative survival in 195 patients undergoing TAVI during 2.5 years (January 2010 to June 2012), when vascular access routes were developed from iliofemoral (IL/Fm access, n = 149), axillo-clavicular, apical, and direct aortic approaches (alternative access, n = 46). Logistic regression analyses showed that alternative access was associated with reduced 30-day survival (P = 0.024), while high surgical risk (>15% in both EuroSCORE and STS score) was associated with reduced 1-year survival (P = 0.046). Thus, patients treated via IL/Fm access had acceptable outcome regardless of preoperative risk levels while patients with low surgical risk (<15%) had favorable outcome irrespective of access route. Since the remaining patients with combined risk factors, high preoperative risk level (>15%) requiring alternative access, had a prohibitive risk in our experience, they might have been considered untreatable or not amenable even to TAVI and offered medical or alternative managements.

  9. Routine preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting.

    PubMed

    Vohra, Hunaid A; Briffa, Norman P

    2005-01-01

    The beneficial effects of intraaortic balloon pump (IABP) in coronary artery bypass graft surgery with cardiopulmonary bypass have been reported. However, whether preoperative insertion of IABP in high-risk off-pump coronary artery bypass grafting (OPCAB) has any beneficial effects remains to be established. We report our experience of preoperative insertion of IABP in OPCAB.

  10. A Preoperative Personalized Risk Assessment Calculator for Elderly Ovarian Cancer Patients undergoing Primary Cytoreductive Surgery

    PubMed Central

    Barber, Emma L; Rutstein, Sarah; Miller, William C; Gehrig, Paola A

    2015-01-01

    Objective Cytoreductive surgery for ovarian cancer has higher rates of postoperative complication than neoadjuvant chemotherapy followed by surgery. If patients at high risk of postoperative complication were identified preoperatively, primary therapy could be tailored. Our objective was to develop a predictive model to estimate the risk of major postoperative complication after primary cytoreductive surgery among elderly ovarian cancer patients. Methods Patients who underwent primary surgery for ovarian cancer between 2005-2013 were identified from the National Surgical Quality Improvement Project. Patients were selected using primary procedure CPT codes. Major complications were defined as grade 3 or higher complications on the validated Claviden-Dindo scale. Using logistic regression, we identified demographic and clinical characteristics predictive of postoperative complication. Results We identified 2,101 ovarian cancer patients of whom 35.9% were older than 65. Among women older than 65, the rate of major postoperative complication was 16.4%. Complications were directly associated with preoperative laboratory values (serum creatinine, platelets, white blood cell count, hematocrit), ascites, white race, and smoking status, and indirectly associated with albumin. Our predictive model had an area under receiver operating characteristic curve of 0.725. In order to not deny patients necessary surgery, we chose a 50% population rate of postoperative complication which produced model sensitivity of 9.8% and specificity of 98%. Discussion Our predictive model uses easily and routinely obtained objective preoperative factors to estimate the risk of postoperative complication among elderly ovarian cancer patients. This information can be used to assess risk, manage postoperative expectations, and make decisions regarding initial treatment. PMID:26432038

  11. Preoperative Laboratory Testing in Patients Undergoing Elective, Low-Risk Ambulatory Surgery

    PubMed Central

    Benarroch-Gampel, Jaime; Sheffield, Kristin M.; Duncan, Casey B.; Brown, Kimberly M.; Han, Yimei; Townsend, Courtney M.; Riall, Taylor S.

    2012-01-01

    Background Routine preoperative laboratory testing for ambulatory surgery is not recommended. Methods Patients who underwent elective hernia repair (N = 73,596) were identified from the National Surgical Quality Improvement Program (NSQIP) database (2005–2010). Patterns of preoperative testing were examined. Multivariate analyses were used to identify factors associated with testing and postoperative complications. Results A total of 46,977 (63.8%) patients underwent testing, with at least one abnormal test recorded in 61.6% of patients. In patients with no NSQIP comorbidities (N = 25,149) and no clear indication for testing, 54% received at least one test. In addition, 15.3% of tested patients underwent laboratory testing the day of the operation. In this group, surgery was done despite abnormal results in 61.6% of same day tests. In multivariate analyses, testing was associated with older age, ASA (American Society of Anesthesiologists) class >1, hypertension, ascites, bleeding disorders, systemic steroids, and laparoscopic procedures. Major complications (reintubation, pulmonary embolus, stroke, renal failure, coma, cardiac arrest, myocardial infarction, septic shock, bleeding, or death) occurred in 0.3% of patients. After adjusting for patient and procedure characteristics, neither testing nor abnormal results were associated with postoperative complications. Conclusions Preoperative testing is overused in patients undergoing low-risk, ambulatory surgery. Neither testing nor abnormal results were associated with postoperative outcomes. On the basis of high rates of testing in healthy patients, physician and/or facility preference and not only patient condition currently dictate use. Involvement from surgical societies is necessary to establish guidelines for preoperative testing. PMID:22868362

  12. Risk Factors

    MedlinePlus

    ... has been linked to some cancers: Links between air pollution and cancer risk have been found. These include ... between lung cancer and secondhand tobacco smoke , outdoor air pollution, and asbestos . Drinking water that contains a large ...

  13. Preoperative Pain, Symptoms, and Psychological Factors related to Higher Acute Pain Trajectories during Hospitalization for Total Knee Arthroplasty

    PubMed Central

    Lindberg, Maren Falch; Miaskowski, Christine; Rustøen, Tone; Rosseland, Leiv Arne; Paul, Steven M.

    2016-01-01

    Objectives Unrelieved postoperative pain after total knee arthroplasty (TKA) is a significant problem. This longitudinal study investigated how preoperative pain intensity, as well as a comprehensive list of preoperative and perioperative factors, influenced the severity of acute average and worst pain after TKA. Methods Prior to surgery, 203 patients completed a demographic questionnaire, Lee Fatigue Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, and Brief Illness Perception Questionnaire. Brief Pain Inventory was completed prior to surgery as well as through postoperative days (POD) 0 to 4. Clinical data were extracted from medical records. Results Several factors were associated with higher levels of preoperative and postoperative pain. Lower preoperative average and worst pain intensity scores were associated with increases in average and worst postoperative pain from POD1 to POD4. A higher number of comorbidities, higher C-reactive protein values, and higher pain interference with function were associated with higher preoperative levels of average pain. Older age, higher fatigue levels, and higher scores on identity and emotional responses to osteoarthritis (OA) were associated with higher preoperative levels of worst pain. Lower perceived consequences of OA were associated with higher pain from POD1 to POD4. Males and patients with lower preoperative scores for average pain had higher worst pain following surgery. Discussion Patients at higher risk for more severe postoperative pain can be identified through an assessment of pain and other risk factors identified in this study. Future research needs to test the efficacy of interventions that modify patients’ perceptions of living with OA and pain intensity before surgery on short and long term postoperative outcomes. PMID:27583551

  14. Preoperative Computed Tomography to Predict and Stratify the Risk of Severe Pancreatic Fistula After Pancreatoduodenectomy.

    PubMed

    Sandini, Marta; Bernasconi, Davide Paolo; Ippolito, Davide; Nespoli, Luca; Baini, Melissa; Barbaro, Salvatore; Fior, Davide; Gianotti, Luca

    2015-08-01

    The aim of this article is to assess whether measures of abdominal fat distribution, visceral density, and antropometric parameters obtained from computed tomography (CT) may predict postoperative pancreatic fistula (POPF) occurrence.We analyzed 117 patients who underwent pancreatoduodenectomy (PD) and had a preoperative CT scan as staging in our center. CT images were processed to obtain measures of total fat volume (TFV), visceral fat volume (VFV), density of spleen, and pancreas, and diameter of pancreatic duct. The predictive ability of each parameter was investigated by receiver-operating characteristic (ROC) curves methodology and assessing optimal cutoff thresholds. A stepwise selection method was used to determine the best predictive model.Clinically relevant (grades B and C) POPF occurred in 24 patients (20.5%). Areas under ROC-curves showed that none of the parameters was per se significantly predictive. The multivariate analysis revealed that a VFV >2334 cm, TFV >4408 cm, pancreas/spleen density ratio <0.707, and pancreatic duct diameter <5 mm were predictive of POPF. The risk of POPF progressively increased with the number of factors involved and age.It is possible to deduce objective information on the risk of POPF from a simple and routine preoperative radiologic workup.

  15. Preoperative androgen deprivation therapy for localized prostate cancer: Delayed biochemical recurrence in high-risk disease

    PubMed Central

    Pal, Sumanta K.; Ruel, Nora; Voglezang, Nicholas; Chang, Mark; Wilson, Timothy G.; Jones, Jeremy O.; Yuh, Bertram

    2016-01-01

    Background The role of preoperative androgen deprivation therapy (ADT) for localized prostate cancer is controversial; prospective assessments have yielded varying results. We sought to define a subset of patients with a higher likelihood of benefit from preoperative ADT. Methods An institutional database including consecutive patients receiving definitive surgery for localized prostate cancer was interrogated. Patients recorded as having received preoperative ADT were matched in a 1:2 fashion to patients who had not received prior ADT. Patients were matched on the basis of clinicopathologic characteristics, use of adjuvant treatment strategies, and duration of PSA follow-up. Time to biochemical recurrence (TTBR) was compared using the Kaplan-Meier method and log-rank test for the overall study population and in subsets defined by D’Amico risk. Results No significant differences in clinicopathologic characteristics were noted between recipients (n=101) and matched non-recipients (n=196) of preoperative ADT. Although not statistically significant, positive surgical margin rates, seminal vesicle invasion and extracapsular extension were less frequent in patients receiving preoperative ADT. Furthermore, a lesser incidence of perioperative complications was noted in this group (7.4% v 18.4%). No significant differences were noted in TTBR between recipients and non-recipients of preoperative ADT in the overall study population. However, amongst patients with high-risk disease, TTBR was significantly longer in those patients who had received preoperative ADT (P=0.004). Conclusions The data presented herein suggest a potential benefit with preoperative ADT in patients with high-risk localized prostate cancer. Consideration should be given to enriching for this subset in preoperative studies of novel endocrine therapies. PMID:24342128

  16. Is extended preoperative antibiotic prophylaxis for high-risk patients necessary before percutaneous nephrolithotomy?

    PubMed Central

    Park, Alyssa M.; Bauman, Tyler M.; Larson, Jeffrey A.; Vetter, Joel M.; Benway, Brian M.; Desai, Alana C.

    2016-01-01

    Purpose The goal of this study was to compare the rate of systemic inflammatory response syndrome (SIRS) in high-risk patients undergoing percutaneous nephrolithotomy (PCNL) between patients who received 7, 2, or 0 days of preoperative antibiotics. Materials and Methods We retrospectively reviewed a series of consecutive PCNLs performed at our institution. Patients with infected preoperative urine cultures were excluded. High-risk patients were defined as those with a history of previous urinary tract infection (UTI), hydronephrosis, or stone size ≥2 cm. Patients were treated with 7, 2, or 0 days of preoperative antibiotic prophylaxis prior to PCNL. All patients received a single preoperative dose of antibiotics within 60 minutes of the start of surgery. Fisher exact test was used to compare the rate of SIRS by preoperative antibiotic length. Results Of the 292 patients identified, 138 (47.3%) had sterile urine and met high-risk criteria, of which 27 (19.6%), 39 (28.3%), and 72 (52.2%) received 7, 2, and 0 days of preoperative antibiotics, respectively. The 3 groups were similar in age, sex, and duration of surgery (p>0.05). There was no difference in the rate of SIRS between the groups, with 1 of 27 (3.7%), 2 of 39 (5.1%) and 3 of 72 patients (4.2%) meeting criteria in the 7, 2, and 0 days antibiotic groups (p=~1). Conclusions Extended preoperative antibiotic prophylaxis was not found to reduce the risk of SIRS after PCNL in our institutional experience of high-risk patients. For these patients, a single preoperative dose of antibiotics is sufficient. PMID:27847915

  17. Preoperative Anxiety in Patients With Myasthenia Gravis and Risk for Myasthenic Crisis After Extended Transsternal Thymectomy: A CONSORT Study.

    PubMed

    Zou, Jianyong; Su, Chunhua; Lun, Xueping; Liu, Weibing; Yang, Weiling; Zhong, Beilong; Zhu, Haoshuai; Lei, Yiyan; Luo, Honghe; Chen, Zhenguang

    2016-03-01

    A thymectomy can ameliorate the symptoms of myasthenia gravis (MG) and prevent the progression of ocular MG (OMG) to generalized MG (GMG). However, postoperative myasthenic crisis (POMC) is a serious post-thymectomy complication. Preoperative anxiety (POA) is common but typically neglected in MG patients. The association of POA with POMC has not yet been examined.From June 2007 to December 2013, 541 cases of MG were admitted to the First Affiliated Hospital of Sun Yat-sen University (Guangzhou, China). All cases underwent extended transsternal thymectomy (ETT). The clinical and pathological characteristics of these patients, including POA and POMC, were analyzed.A total of 179 patients experienced POA and 67 patients experienced POMC. Patients with POA were more likely to have POMC, a thymoma, and an ectopic thymus. Univariate analysis showed that POMC correlated with POA, presence of an ectopic thymus, dose of pyridostigmine bromide (PYR), presence of a thymoma, MGFA stage, preoperative myasthenic crisis, and postoperative pneumonia. Multivariate logistic regression analysis showed that the independent risk factors for POMC were POA, preoperative myasthenic crisis, higher dose of PYR, and postoperative pneumonia.Our results suggest that clinicians should consider the risk factors for POMC-especially preoperative anxiety-before performing a thymectomy in patients with MG.

  18. Prevalence and factors associated with preoperative anxiety in children aged 5-12 years 1

    PubMed Central

    de Moura, Louise Amália; Dias, Iohanna Maria Guimarães; Pereira, Lilian Varanda

    2016-01-01

    Abstract Objective: to estimate the prevalence and factors associated with preoperative anxiety in children who wait for outpatient surgery. Method: cross-sectional analysis of baseline data of a prospective cohort study that investigates the predictors of postoperative pain in children aged 5-12 years submitted to inguinal and umbilical hernia repair. It was selected 210 children, which were interviewed in the preoperative holding area of a general hospital. Anxiety was evaluated using the modified Yale Preoperative Anxiety Scale (mYPAS). Sociodemographic and clinical variables were analyzed as exposure and anxiety (mYPAS final score>30) as outcome. Logistic regression was used to identify factors associated with preoperative anxiety. Results: forty-two percent (42.0%) of children presented preoperative anxiety (CI95%: 35.7%-48.6%), with mean scores equal to 30.1 (SD=8.4). Factors associated with preoperative anxiety were: age group of 5-6 years (OR=2.28; p=0.007) and socioeconomic status classified as class C (OR=2.39; p=0.016). Conclusion: the evaluation of children who wait for outpatient surgery should be multidimensional and comprise information on age and socioeconomic status, in order to help in the identification and early treatment of preoperative anxiety. PMID:27305179

  19. Stage II/III rectal cancer with intermediate response to preoperative radiochemotherapy: Do we have indications for individual risk stratification?

    PubMed Central

    2010-01-01

    Background Response to preoperative radiochemotherapy (RCT) in patients with locally advanced rectal cancer is very heterogeneous. Pathologic complete response (pCR) is accompanied by a favorable outcome. However, most patients show incomplete response. The aim of this investigation was to find indications for risk stratification in the group of intermediate responders to RCT. Methods From a prospective database of 496 patients with rectal adenocarcinoma, 107 patients with stage II/III cancers and intermediate response to preoperative 5-FU based RCT (ypT2/3 and TRG 2/3), treated within the German Rectal Cancer Trials were studied. Surgical treatment comprised curative (R0) total mesorectal excision (TME) in all cases. In 95 patients available for statistical analyses, residual transmural infiltration of the mesorectal compartment, nodal involvement and histolologic tumor grading were investigated for their prognostic impact on disease-free (DFS) and overall survival (OS). Results Residual tumor transgression into the mesorectal compartment (ypT3) did not influence DFS and OS rates (p = 0.619, p = 0.602, respectively). Nodal involvement after preoperative RCT (ypN1/2) turned out to be a valid prognostic factor with decreased DFS and OS (p = 0.0463, p = 0.0236, respectively). Persistent tumor infiltration of the mesorectum (ypT3) and histologic tumor grading of residual tumor cell clusters were strongly correlated with lymph node metastases after neoadjuvant treatment (p < 0.001). Conclusions Advanced transmural tumor invasion after RCT does not affect prognosis when curative (R0) resection is achievable. Residual nodal status is the most important predictor of individual outcome in intermediate responders to preoperative RCT. Furthermore, ypT stage and tumor grading turn out to be additional auxiliary factors. Future clinical trials for risk-adapted adjuvant therapy should be based on a synopsis of clinicopathologic parameters. PMID:20388220

  20. Pulmonary function changes and its influencing factors after preoperative brace treatment in patients with adolescent idiopathic scoliosis

    PubMed Central

    Ran, Bo; Fan, Yuxin; Yuan, Feng; Guo, Kaijin; Zhu, Xiaodong

    2016-01-01

    Abstract Background: The aim of the study was to retrospectively investigate the changes in pulmonary function and its influencing factors in patients with adolescent idiopathic scoliosis (AIS) undergoing preoperative brace treatment or not. Methods: Total 237 AIS patients (43 boys, 194 girls) who underwent operations and had a complete record of pulmonary function tests were enrolled and were divided into preoperative brace treatment group (brace treatment group, n = 60) and without preoperative brace treatment group (control group, n = 177). The pulmonary function parameters were compared between the 2 groups. Multiple linear regression analysis was performed to explore whether the variables, including age at operation, height, coronal Cobb's angle of main curve, number of involved vertebrae, sagittal Cobb's angle of thoracic curve, brace treatment time per day and brace treatment duration, influenced pulmonary function in the brace treatment group. Results: No significant differences were observed in both predicted and actually measured value of forced vital capacity (FVC) and predicted value of forced expiratory volume in 1 s (FEV1) between 2 groups (P > 0.05), but actually measured FEV1, the percentage of actually measured and predicted value of FVC (FVC%) and FEV1 (FEV1%) were significantly lower in the brace treatment group than those in the control group (P < 0.05). Importantly, the above changes in actually measured FEV1 and FEV1% were obvious in AIS patients presented with a main thoracic curve (P < 0.05), but not in patients with a primary thoracolumbar/lumbar curve. Multiple linear regression analysis indicated that only the sagittal Cobb's angle of the thoracic curve was positively, but preoperative brace treatment duration was negatively associated with both the FVC% and FEV1% (P < 0.05). Conclusion: Preoperative brace treatment may deteriorate pulmonary function in AIS patients with thoracic curve. The small sagittal Cobb angle and

  1. Preoperative factors and early complications associated with hemiarthroplasty and total hip arthroplasty for displaced femoral neck fractures.

    PubMed

    Miller, Christopher P; Buerba, Rafael A; Leslie, Michael P

    2014-06-01

    Displaced femoral neck fractures are common injuries in the elderly individuals. There is controversy about the best treatment with regard to total hip arthroplasty (THA) versus hemiarthroplasty. This study uses the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database to evaluate the preoperative risk factors associated with the decision to perform THA over hemiarthroplasty. We also evaluate the risk factors associated with postoperative complications after each procedure. Patients older than 50 years undergoing hemiarthroplasty or THA after fracture in the NSQIP database from 2007 to 2010 were compared to each other in terms of preoperative medical conditions, postoperative complications, and length of stay. Multivariate logistic regression models were used to adjust for preoperative risk factors for undergoing a THA versus a hemiarthroplasty and for complications after each procedure. In all, 783 patients underwent hemiarthroplasty and 419 underwent THA for fracture. Hemiarthroplasty patients had longer hospital stays. On multivariate logistic regression, the only significant predictor for having a THA after fracture over hemiarthroplasty was being aged 50 to 64 years. The patient characteristics/comorbidities that favored having a hemiarthroplasty were age >80 years, hemiplegia, being underweight, having a dependent functional status, being on dialysis, and having an early surgery. High body mass index, American Society of Anesthesiologists (ASA) class, gender, and other comorbidities were not predictors of having one procedure over another. Disseminated cancer and diabetes were predictive of complications after THA while being overweight, obese I, or a smoker were protective. High ASA class and do-not-resuscitate status were significant predictors of complications after a hemiarthroplasty. This study identified clinical factors influencing surgeons toward performing either THA or hemiarthroplasty for elderly patients

  2. Preoperative risk score predicting 90-day mortality after liver resection in a population-based study.

    PubMed

    Chang, Chun-Ming; Yin, Wen-Yao; Su, Yu-Chieh; Wei, Chang-Kao; Lee, Cheng-Hung; Juang, Shiun-Yang; Chen, Yi-Ting; Chen, Jin-Cherng; Lee, Ching-Chih

    2014-09-01

    The impact of important preexisting comorbidities, such as liver and renal disease, on the outcome of liver resection remains unclear. Identification of patients at risk of mortality will aid in improving preoperative preparations. The purpose of this study is to develop and validate a population-based score based on available preoperative and predictable parameters predicting 90-day mortality after liver resection using data from a hepatitis endemic country.We identified 13,159 patients who underwent liver resection between 2002 and 2006 in the Taiwan National Health Insurance Research Database. In a randomly selected half of the total patients, multivariate logistic regression analysis was used to develop a prediction score for estimating the risk of 90-day mortality by patient demographics, preoperative liver disease and comorbidities, indication for surgery, and procedure type. The score was validated with the remaining half of the patients.Overall 90-day mortality was 3.9%. Predictive characteristics included in the model were age, preexisting cirrhosis-related complications, ischemic heart disease, heart failure, cerebrovascular disease, renal disease, malignancy, and procedure type. Four risk groups were stratified by mortality scores of 1.1%, 2.2%, 7.7%, and 15%. Preexisting renal disease and cirrhosis-related complications were the strongest predictors. The score discriminated well in both the derivation and validation sets with c-statistics of 0.75 and 0.75, respectively.This population-based score could identify patients at risk of 90-day mortality before liver resection. Preexisting renal disease and cirrhosis-related complications had the strongest influence on mortality. This score enables preoperative risk stratification, decision-making, quality assessment, and counseling for individual patients.

  3. Preoperative intra-aortic balloon pumping in high-risk cardiac surgery patients.

    PubMed

    Moon, Chooza

    2012-01-01

    Intra-aortic balloon pumping increases myocardial oxygen supply and decreases myocardial oxygen demand by inflation and deflation of the balloon. This leads to increased perfusion of the coronary arteries during diastole. This technology has been used for critically ill cardiac patients for more than 30 years. The literature suggests that preoperative use of an intra-aortic balloon pump can be effective in high-risk coronary artery bypass grafting patients. Preoperative benefits of this technology may yield positive outcomes in terms of hemodynamic effect, decreased length of stay in both the intensive care unit and the hospital, and the reduction of complications. However, the intra-aortic balloon pump must be used with a profound understanding of proper mechanism and function, monitoring, and observation for potential complications. This requires excellent critical care nursing management.

  4. CDH1 methylation in preoperative peritoneal washes is an independent prognostic factor for gastric cancer

    PubMed Central

    Yu, Qi-Ming; Wang, Xin-Bao; Luo, Jun; Wang, Shi; Fang, Xian-Hua; Yu, Jiang-Liu; Ling, Zhi-Qiang

    2012-01-01

    Background and Objectives To investigate the clinical value of CDH1 methylation in preoperative peritoneal washes (PPW) from gastric cancer patients. Methods CDH1 methylation was detected by real-time methylation specific-PCR in tumor tissues and corresponding PPW from 92 gastric cancer patients, gastric mucosa from 40 chronic gastritis patients and 48 normal persons. Results CDH1 methylation was found in 75 of 92 (81.5%) gastric cancer tissues, which significantly correlated with size, growth pattern, differentiation, lymphatic invasion, venous invasion, invasion depth, lymph node metastasis, distant metastasis, and TNM stage of tumor (all P < 0.05), but its relationship to age, gender, tumor site, and H. pylori infection was not found (all P > 0.05). The percentage of CDH1 methylation in PPW was 48.9%, of which the Aζ value of ROC curve was 0.8 compared to that in gastric cancer tissues. Kaplan–Meier analysis showed that there was a significant difference in disease-free survival (DFS) between the patients with or without methylated CDH1 in their PPW (χ2 = 109.64, P < 0.000). Cox regression analysis revealed CDH1 methylation in PPW was an independent risk factor for gastric cancer patients, with a remarkable decrease in DFS after postoperative 30 months. Conclusions Methylated CDH1 in PPW predicts poor prognosis for gastric cancer patients. J. Surg. Oncol. 2012; 106:765–771. © 2012 Wiley Periodicals, Inc. PMID:22514028

  5. Multivariate analysis of factors associated with kyphotic deformity after laminoplasty in cervical spondylotic myelopathy patients without preoperative kyphotic alignment

    PubMed Central

    Cao, JunMing; Zhang, JingTao; Yang, DaLong; Yang, Liu; Shen, Yong

    2017-01-01

    The risk factors of post-laminoplasty kyphosis in patients with cervical spondylotic myelopathy (CSM) without preoperative kyphotic alignment are not well known. This study aimed to compare clinical and radiological data between patients with or without post-laminoplasty kyphosis and to investigate the factors associated with post-laminoplasty kyphosis in CSM patients without preoperative kyphotic alignment. Patients (n = 194) who received unilateral expansive open-door cervical laminoplasty with miniplate fixation and completed a 1-year follow-up were enrolled. Patients were grouped according to whether they suffered from postoperative kyphosis (P) or not (NP). Postoperative kyphosis was observed in 21 (10.8%) patients. The recovery rates of the Japanese Orthopaedic Association scores at the 1-year follow-up in the P group were inferior to those in the NP group (31.9% vs. 65.2%, P < 0.001). Logistic regression with post-laminoplasty kyphosis as the dependent variable showed independent risks associated with an increased C2–7 sagittal vertical axis (SVA, odds ratio [OR] = 1.085, 95% confidence interval [CI] = 1.025–1.203, P = 0.015), destroyed facet joints (OR = 1.132, 95% CI = 1.068–1.208, P < 0.001), and cephalad vertebral level undergoing laminoplasty (CVLL, OR = 2.860, 95% CI = 1.164–6.847, P = 0.021). These findings suggest that CVLL, C2–7 SVA, and destroyed facet joints are associated with kyphosis after laminoplasty in CSM patients without preoperative kyphotic alignment. PMID:28240309

  6. Ectasia risk factors in refractive surgery

    PubMed Central

    Santhiago, Marcony R; Giacomin, Natalia T; Smadja, David; Bechara, Samir J

    2016-01-01

    This review outlines risk factors of post-laser in situ keratomileusis (LASIK) ectasia that can be detected preoperatively and presents a new metric to be considered in the detection of ectasia risk. Relevant factors in refractive surgery screening include the analysis of intrinsic biomechanical properties (information obtained from corneal topography/tomography and patient’s age), as well as the analysis of alterable biomechanical properties (information obtained from the amount of tissue altered by surgery and the remaining load-bearing tissue). Corneal topography patterns of placido disk seem to play a pivotal role as a surrogate of corneal strength, and abnormal corneal topography remains to be the most important identifiable risk factor for ectasia. Information derived from tomography, such as pachymetric and epithelial maps as well as computational strategies, to help in the detection of keratoconus is additional and relevant. High percentage of tissue altered (PTA) is the most robust risk factor for ectasia after LASIK in patients with normal preoperative corneal topography. Compared to specific residual stromal bed (RSB) or central corneal thickness values, percentage of tissue altered likely provides a more individualized measure of biomechanical alteration because it considers the relationship between thickness, tissue altered through ablation and flap creation, and ultimate RSB thickness. Other recognized risk factors include low RSB, thin cornea, and high myopia. Age is also a very important risk factor and still remains as one of the most overlooked ones. A comprehensive screening approach with the Ectasia Risk Score System, which evaluates multiple risk factors simultaneously, is also a helpful tool in the screening strategy. PMID:27143849

  7. Tumor Volume Reduction Rate After Preoperative Chemoradiotherapy as a Prognostic Factor in Locally Advanced Rectal Cancer

    SciTech Connect

    Yeo, Seung-Gu; Kim, Dae Yong; Park, Ji Won; Oh, Jae Hwan; Kim, Sun Young; Chang, Hee Jin; Kim, Tae Hyun; Kim, Byung Chang; Sohn, Dae Kyung; Kim, Min Ju

    2012-02-01

    Purpose: To investigate the prognostic significance of tumor volume reduction rate (TVRR) after preoperative chemoradiotherapy (CRT) in locally advanced rectal cancer (LARC). Methods and Materials: In total, 430 primary LARC (cT3-4) patients who were treated with preoperative CRT and curative radical surgery between May 2002 and March 2008 were analyzed retrospectively. Pre- and post-CRT tumor volumes were measured using three-dimensional region-of-interest MR volumetry. Tumor volume reduction rate was determined using the equation TVRR (%) = (pre-CRT tumor volume - post-CRT tumor volume) Multiplication-Sign 100/pre-CRT tumor volume. The median follow-up period was 64 months (range, 27-99 months) for survivors. Endpoints were disease-free survival (DFS) and overall survival (OS). Results: The median TVRR was 70.2% (mean, 64.7% {+-} 22.6%; range, 0-100%). Downstaging (ypT0-2N0M0) occurred in 183 patients (42.6%). The 5-year DFS and OS rates were 77.7% and 86.3%, respectively. In the analysis that included pre-CRT and post-CRT tumor volumes and TVRR as continuous variables, only TVRR was an independent prognostic factor. Tumor volume reduction rate was categorized according to a cutoff value of 45% and included with clinicopathologic factors in the multivariate analysis; ypN status, circumferential resection margin, and TVRR were significant prognostic factors for both DFS and OS. Conclusions: Tumor volume reduction rate was a significant prognostic factor in LARC patients receiving preoperative CRT. Tumor volume reduction rate data may be useful for tailoring surgery and postoperative adjuvant therapy after preoperative CRT.

  8. [Preoperative analysis in rhinoplasty].

    PubMed

    Nguyen, P S; Bardot, J; Duron, J B; Levet, Y; Aiach, G

    2014-12-01

    Preoperative analysis in rhinoplasty consists in analyzing individual anatomical and functional characteristics without losing sight of the initial requirements of the patient to which priority should be given. The examination is primarily clinical but it also uses preoperative photographs taken at specific accurate angles. Detecting functional disorders or associated general pathologies, which will reduce the risk of complications. All of these factors taken into account, the surgeon can work out a rhinoplasty plan which he or she will subsequently explain to the patient and obtain his or her approbation.

  9. Risk Factors and Prevention

    MedlinePlus

    ... atherosclerosis (“clogged” arteries) and High Blood Pressure . Preventing Arrhythmias and Heart Disease Prevent heart disease by lowering ... cholesterol, diabetes, and thyroid disease. Risk Factors For Arrhythmias and Heart Disease The following conditions can increase ...

  10. Preoperative factors and outcome after lunate decompression for Kienböck's disease.

    PubMed

    Condit, D P; Idler, R S; Fischer, T J; Hastings, H

    1993-07-01

    Preoperative factors and outcome were studied after lunate decompression for Kienböck's disease. Twenty-three patients treated with radial shortening or scaphoid-trapezium-trapezoid fusion were evaluated. The mean follow-up was 59 months. Neither good nor excellent outcomes were found with either lunate-preserving procedure when the preoperative radioscaphoid angle was greater than 60 degrees. Outcomes in the radial shortening osteotomy group were superior to those in the group treated with scaphoid-trapezium-trapezoid fusion. Lunate collapse was not prevented by either treatment method. Lunate index, carpal height, and staging did not correlate with outcome. Measurement of radioscaphoid angle provides predictive information regarding the outcome of stage III (Decoulx/Lichtman) Kienböck's disease treated with radial shortening or scaphoid-trapezium-trapezoid fusion.

  11. The influence of preoperative psychological factors on weight loss after bariatric surgery: A preliminary report.

    PubMed

    Lai, Carlo; Aceto, Paola; Petrucci, Ilaria; Castelnuovo, Gianluca; Callari, Cosimo; Giustacchini, Piero; Sollazzi, Liliana; Mingrone, Geltrude; Bellantone, Rocco; Raffaelli, Marco

    2016-11-15

    Aim of this study was to investigate relationship between preoperative psychological factors and % total weight loss after gastric bypass. 76 adult patients scheduled for bariatric surgery were preoperatively asked to complete anxiety and depression Hamilton scales and Toronto Alexithymia Scale. At 3- and 6-month follow-up, body weight was assessed. At 6-month follow-up, alexithymic patients showed a poorer % total weight loss compared with non-alexithymic patients (p = .017), and moderately depressed patients showed a lower % total weight loss compared with non-depressed patients (p = .011). Focused pre- and postoperative psychological support could be useful in bariatric patients in order to improve surgical outcome.

  12. Risk Factors for Tuberculosis

    PubMed Central

    Narasimhan, Padmanesan; Wood, James; MacIntyre, Chandini Raina; Mathai, Dilip

    2013-01-01

    The risk of progression from exposure to the tuberculosis bacilli to the development of active disease is a two-stage process governed by both exogenous and endogenous risk factors. Exogenous factors play a key role in accentuating the progression from exposure to infection among which the bacillary load in the sputum and the proximity of an individual to an infectious TB case are key factors. Similarly endogenous factors lead in progression from infection to active TB disease. Along with well-established risk factors (such as human immunodeficiency virus (HIV), malnutrition, and young age), emerging variables such as diabetes, indoor air pollution, alcohol, use of immunosuppressive drugs, and tobacco smoke play a significant role at both the individual and population level. Socioeconomic and behavioral factors are also shown to increase the susceptibility to infection. Specific groups such as health care workers and indigenous population are also at an increased risk of TB infection and disease. This paper summarizes these factors along with health system issues such as the effects of delay in diagnosis of TB in the transmission of the bacilli. PMID:23476764

  13. Development of a new outcome prediction model for Chinese patients with penile squamous cell carcinoma based on preoperative serum C-reactive protein, body mass index, and standard pathological risk factors: the TNCB score group system

    PubMed Central

    Li, Jing; Mi, Qi-Wu; Chen, Xiao-Feng; Zhao, Qi; Li, Yong-Hong; Chen, Jie-Ping; Deng, Chuang-Zhong; Ye, Yun-Lin; Zhong, Ming-Zhu; Liu, Zhuo-Wei; Qin, Zi-Ke; Lin, Xiang-Tian; Liang, Wei-Cong; Han, Hui; Zhou, Fang-Jian

    2016-01-01

    Purpose To determine the predictive value and feasibility of the new outcome prediction model for Chinese patients with penile squamous cell carcinoma. Results The 3-year disease-specific survival (DSS) was 92.3% in patients with < 8.70 mg/L CRP and 54.9% in those with elevated CRP (P < 0.001). The 3-year DSS was 86.5% in patients with a BMI < 22.6 Kg/m2 and 69.9% in those with a higher BMI (P = 0.025). In a multivariate analysis, pathological T stage (P < 0.001), pathological N stage (P = 0.002), BMI (P = 0.002), and CRP (P = 0.004) were independent predictors of DSS. A new scoring model was developed, consisting of BMI, CRP, and tumor T and N classification. In our study, we found that the addition of the above-mentioned parameters significantly increased the predictive accuracy of the system of the American Joint Committee on Cancer (AJCC) anatomic stage group. The accuracy of the new prediction category was verified. Methods A total of 172 Chinese patients with penile squamous cell cancer were analyzed retrospectively between November 2005 and November 2014. Statistical data analysis was conducted using the nonparametric method. Survival analysis was performed with the log-rank test and the Cox proportional hazard model. Based on regression estimates of significant parameters in multivariate analysis, a new BMI-, CRP- and pathologic factors-based scoring model was developed to predict disease-specific outcomes. The predictive accuracy of the model was evaluated using the internal and external validation. Conclusion The present study demonstrated that the TNCB score group system maybe a precise and easy to use tool for predicting outcomes in Chinese penile squamous cell carcinoma patients. PMID:26980738

  14. Factors associated with preoperative anxiety levels of Turkish surgical patients: from a single center in Ankara

    PubMed Central

    Erkilic, Ezgi; Kesimci, Elvin; Soykut, Cem; Doger, Cihan; Gumus, Tülin; Kanbak, Orhan

    2017-01-01

    Background Preoperative anxiety and stress are undoubtedly a difficult experience in patients undergoing elective surgery. These unpleasant sensations depend on several factors. The objective of this study was to evaluate the preoperative anxiety levels in a sample of Turkish population, as well as the underlying causes using the Spielberger State-Trait Anxiety Inventory (STAI anxiety) scale. Methods The study was conducted according to the Declaration of Helsinki and was approved by the local ethical committee. All participants gave written informed consent upon having received detailed information on the study. Upon entry in the study, state and trait anxiety questionnaires were completed by 186 patients scheduled for elective surgery. The influencing factors in regard to age, sex, educational status and others were also reported. Results There was a statistically significant positive correlation between state and trait anxiety scores in this Turkish population. While the most important predictive factors that affected state-STAI scores were age, sex and duration of sleep the night before surgery; educational status and age were the best predictors for determining the variation in trait-STAI scores. Conclusion The factors affecting anxiety levels in different populations might vary among different countries. Interestingly, in this sample of Turkish population, the trait anxiety levels were found to be higher from state-anxiety levels, especially in women and less educated people. Thus, doubts about operation and anesthesia are overlooked. This could be attributed to the low to intermediate life standards of people admitted to our hospital. PMID:28280304

  15. Preoperative anemia and postoperative outcomes after hepatectomy

    PubMed Central

    Tohme, Samer; Varley, Patrick R.; Landsittel, Douglas P.; Chidi, Alexis P.; Tsung, Allan

    2015-01-01

    Background Preoperative anaemia is associated with adverse outcomes after surgery but outcomes after liver surgery specifically are not well established. We aimed to analyze the incidence of and effects of preoperative anemia on morbidity and mortality in patients undergoing liver resection. Methods All elective hepatectomies performed for the period 2005–2012 recorded in the American College of Surgeons' National Surgical Quality Improvement Program (ACS-NSQIP) database were evaluated. We obtained anonymized data for 30-day mortality and major morbidity (one or more major complication), demographics, and preoperative and perioperative risk factors. We used multivariable logistic regression models to assess the adjusted effect of anemia, which was defined as (hematocrit <39% in men, <36% in women), on postoperative outcomes. Results We obtained data for 12,987 patients, of whom 4260 (32.8%) had preoperative anemia. Patients with preoperative anemia experienced higher postoperative major morbidity and mortality rates compared to those without anemia. After adjustment for predefined variables, preoperative anemia was an independent risk factor for postoperative major morbidity (adjusted OR 1.21, 1.09–1.33). After adjustment, there was no significant difference in postoperative mortality for patients with or without preoperative anemia (adjusted OR 0.88, 0.66–1.16). Conclusion Preoperative anemia is independently associated with an increased risk of major morbidity in patients undergoing hepatectomy. Therefore, it is crucial to readdress preoperative blood management in anemic patients prior to hepatectomy. PMID:27017165

  16. Preoperative evaluation of cardiac risk by means of atrial pacing and thallium 201 scintigraphy

    SciTech Connect

    Stratmann, H.G.; Mark, A.L.; Walter, K.E.; Williams, G.A. )

    1989-10-01

    Atrial pacing and thallium 201 scintigraphy were done in 61 patients with known or suspected coronary artery disease referred for evaluation of cardiac risk before elective vascular surgery. All patients had noncardiac limitations precluding performance of an adequate exercise stress test. Before atrial pacing all were considered to be at low risk of a postoperative cardiac event based on assessment of clinical parameters. Vascular surgery was subsequently performed in 47 patients. In these patients, pacing-induced ST segment depression greater than or equal to 1 mm occurred in 18, a fixed perfusion defect occurred in 11, and a reversible defect occurred in six. Two of the six patients with reversible perfusion defects had preoperative coronary angiography; both had significant coronary artery disease (one or more lesions greater than or equal to 50%). Two patients (one of whom had a reversible perfusion defect) underwent preoperative coronary revascularization and tolerated subsequent vascular surgery well. All other patients received only medical therapy. None of the 47 patients undergoing vascular surgery had a postoperative cardiac event (unstable angina, congestive heart failure, myocardial infarction, or cardiac death). Of the 14 patients in whom vascular surgery was deferred or canceled, surgery was canceled for noncardiac reasons in seven. Six of these seven patients had a normal perfusion scan; none had a reversible perfusion defect or marked (greater than or equal to 2 mm) ST segment depression. No cardiac event occurred during a 3-month period after atrial pacing in any of these patients. Six of the remaining seven patients had reversible perfusion defects.

  17. Managing Multiple Risk Factors.

    DTIC Science & Technology

    1998-09-01

    cardiovascular disease among black women can be better controlled through the use of a stress reduction intervention that reduces the sympathetic nervous...All participants will have high normal (130/80) or mild hypertension and at least two additional risk factors for cardiovascular disease (e.g

  18. [Risk Factor Analysis of Pneumonia after Cardiovascular Surgery].

    PubMed

    Maekawa, Yoshiyuki; Abe, Shuichi; Nakamura, Ken; Uchida, Tetsuro; Sadahiro, Mitsuaki; Morikane, Keita

    2016-08-01

    Pneumonia is a major and life-threatening complication after cardiovascular surgery. The objective of our study was to describe epidemiology, clinical characteristics, and risk factors of pneumonia after cardiovascular surgery. From January 2007 to December 2011, 511 consecutive patients (age 67.3±11.9;336 men, 175 women) were enrolled in this study. Pneumonia was diagnosed according to Centers of Disease Control and Prevention surveillance criteria for healthcare associated infection. Data collection included preoperative, intraoperative, and post-operative variables. The overall incidence of pneumonia was 72 cases(14.0%). The mortality in pneumonia group was significantly higher than that in non-pneumonia group (16.6% vs 4.3%, Odds ratio 4.4 p<0.001). Multi-logistic analysis revealed that elderly patient, preoperative congestive heart failure, preoperative hemodialysis, and operation of the thoracic aorta were independent risk factors for pneumonia after cardiovascular surgery.

  19. Preoperative predictive factors for gallbladder cholesterol polyp diagnosed after laparoscopic cholecystectomy for polypoid lesions of gallbladder

    PubMed Central

    Lee, Hyojin; Park, Inseok; Cho, Hyunjin; Gwak, Geumhee; Yang, Keunho; Bae, Byung-Noe; Kim, Hong-Ju; Kim, Young Duk

    2016-01-01

    Backgrounds/Aims We investigated patients' clinical and radiological data to determine preoperative factors that predict cholesterol gallbladder (GB) polyps of large size, which can be helpful for decision on further diagnostic tools. Methods In this study, we retrospectively analyzed 126 patients who underwent laparoscopic cholecystectomy for GB polyps >10 mm diagnosed preoperatively by abdominal ultrasonography between February 2002 and February 2016 in Department of Surgery, Sanggye Paik Hospital. Patients were divided into non-cholesterol polyps group and cholesterol polyps group, based on the postoperative pathologic diagnosis. Clinical and radiological data, such as gender, age, body weight, height, body mass index (BMI), laboratory findings, size, number and shape of the polypoid lesions, and presence of the concurrent GB stone were compared between the two groups. Results Of the 126 cases, 73 had cholesterol polyps (57.9%) and 53 cases were non-cholesterol polyps (42.1%). The younger age (<48.5 years), size of polyp <13.25 mm and multiple polyps were independent predictive variables for cholesterol polyps, with odd ratios (OR) of 2.352 (p=0.045), 5.429 (p<0.001) and 0.472 (p<0.001), respectively. Conclusions Age, size and polyp number were used to predict cholesterol GB polyp among polypoid lesions of the gallbladder >10 mm. For cases in which these factors are not applicable, it is strongly recommended to evaluate further diagnostic tools, such as computed tomography, endoscopic ultrasonography and tumor markers. PMID:28261697

  20. Breast cancer risk factors

    PubMed Central

    Ciszewski, Tomasz; Łopacka-Szatan, Karolina; Miotła, Paweł; Starosławska, Elżbieta

    2015-01-01

    Breast cancer is the most frequently diagnosed neoplastic disease in women around menopause often leading to a significant reduction of these women's ability to function normally in everyday life. The increased breast cancer incidence observed in epidemiological studies in a group of women actively participating in social and professional life implicates the necessity of conducting multidirectional studies in order to identify risk factors associated with the occurrence of this type of neoplasm. Taking the possibility of influencing the neoplastic transformation process in individuals as a criterion, all the risk factors initiating the process can be divided into two groups. The first group would include inherent factors such as age, sex, race, genetic makeup promoting familial occurrence of the neoplastic disease or the occurrence of benign proliferative lesions of the mammary gland. They all constitute independent parameters and do not undergo simple modification in the course of an individual's life. The second group would include extrinsic factors conditioned by lifestyle, diet or long-term medical intervention such as using oral hormonal contraceptives or hormonal replacement therapy and their influence on the neoplastic process may be modified to a certain degree. Identification of modifiable factors may contribute to development of prevention strategies decreasing breast cancer incidence. PMID:26528110

  1. Risk Factors for Eating Disorders

    ERIC Educational Resources Information Center

    Striegel-Moore, Ruth H.; Bulik, Cynthia M.

    2007-01-01

    The authors review research on risk factors for eating disorders, restricting their focus to studies in which clear precedence of the hypothesized risk factor over onset of the disorder is established. They illustrate how studies of sociocultural risk factors and biological factors have progressed on parallel tracks and propose that major advances…

  2. Evaluation of Hemoglobin A1c Criteria to Assess Preoperative Diabetes Risk in Cardiac Surgery Patients

    PubMed Central

    Saberi, Sima; Zrull, Christina A.; Patil, Preethi V.; Jha, Leena; Kling-Colson, Susan C.; Gandia, Kenia G.; DuBois, Elizabeth C.; Plunkett, Cynthia D.; Bodnar, Tim W.; Pop-Busui, Rodica

    2011-01-01

    Abstract Objective Hemoglobin A1c (A1C) has recently been recommended for diagnosing diabetes mellitus and diabetes risk (prediabetes). Its performance compared with fasting plasma glucose (FPG) and 2-h post-glucose load (2HPG) is not well delineated. We compared the performance of A1C with that of FPG and 2HPG in preoperative cardiac surgery patients. Methods Data from 92 patients without a history of diabetes were analyzed. Patients were classified with diabetes or prediabetes using established cutoffs for FPG, 2HPG, and A1C. Sensitivity and specificity of the new A1C criteria were evaluated. Results All patients diagnosed with diabetes by A1C also had impaired fasting glucose, impaired glucose tolerance, or diabetes by other criteria. Using FPG as the reference, sensitivity and specificity of A1C for diagnosing diabetes were 50% and 96%, and using 2HPG as the reference they were 25% and 95%. Sensitivity and specificity for identifying prediabetes with FPG as the reference were 51% and 51%, respectively, and with 2HPG were 53% and 51%, respectively. One-third each of patients with prediabetes was identified using FPG, A1C, or both. When testing A1C and FPG concurrently, the sensitivity of diagnosing dysglycemia increased to 93% stipulating one or both tests are abnormal; specificity increased to 100% if both tests were required to be abnormal. Conclusions In patients before cardiac surgery, A1C criteria identified the largest number of patients with diabetes and prediabetes. For diagnosing prediabetes, A1C and FPG were discordant and characterized different groups of patients, therefore altering the distribution of diabetes risk. Simultaneous measurement of FGP and A1C may be a more sensitive and specific tool for identifying high-risk individuals with diabetes and prediabetes. PMID:21854260

  3. [Cardiovascular risk factors in women].

    PubMed

    Cengel, Atiye

    2010-03-01

    It is estimated that at least 80% of patients with cardiovascular disease (CVD) have conventional risk factors and optimization of these risk factors can reduce morbidity and mortality due to this disease considerably. Contemporary women have increased burden of some of these risk factors such as obesity, metabolic syndrome and smoking. Turkish women have a worse CV risk profile than Turkish men in some aspects. Risk stratification systems such as Framingham have a tendency of underestimating the risk in women. Coronary artery disease remains in vessel wall for a longer period of time in women; therefore obstructive disease appear later in their lifespan necessitating risk stratification systems for estimating their lifetime risk.

  4. Risk Factor Assessment Branch (RFAB)

    Cancer.gov

    The Risk Factor Assessment Branch (RFAB) focuses on the development, evaluation, and dissemination of high-quality risk factor metrics, methods, tools, technologies, and resources for use across the cancer research continuum, and the assessment of cancer-related risk factors in the population.

  5. Utility of preoperative in vitro platelet function tests for predicting bleeding risk in patients undergoing functional endoscopic sinus surgery

    PubMed Central

    Lee, A-Jin; Kim, Sang-Gyung

    2016-01-01

    Background It is necessary to predict the bleeding risk in patients undergoing functional endoscopic sinus surgery (FESS). To evaluate the adequacy of primary hemostasis, preoperative hemostatic screening tests are used. In the present study, we determined whether there is a positive correlation between prolonged closure time (CT) with collagen/epinephrine (CT-epi), prothrombin time (PT), international normalized ratio (INR), activated partial thromboplastin time (aPTT) and bleeding during FESS. Patients and methods We reviewed the medical records of 90 patients without bleeding histories who had undergone FESS from March 2013 to June 2014. More than 200 mL of blood loss was defined as moderate bleeding during surgery. With respect to bleeding during surgery, we determined the sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) of CT-epi, PT, INR and aPTT. Results Of the 90 patients, 17 (18.9%) patients had preoperative prolonged CT values and three (17.6%) patients had bleeding. In comparison, five (6.8%) of the 73 (81.1%) patients who had undergone FESS with preoperative normal PFA values experienced bleeding (P=0.171). On the other hand, patients with prolonged PT values (2, 2.2%), prolonged INR values (3, 3.3%) or prolonged PTT values (1, 1.1%) had no bleeding episode. Preoperative CT had low sensitivity (44.4%) and PPV (23.5%). Conclusion During preoperative period, the hemostatic screening may not be helpful to detect the bleeding tendency in adult patients undergoing FESS. Routine measurement of CT-epi, PT, INR and aPTT for preoperative screening may not be recommended for FESS patients. PMID:27799837

  6. Pediatric rhinitis risk factors

    PubMed Central

    Ji, Yaofeng; Liu, Yin; Yang, Na

    2016-01-01

    Rhinitis is a common global disorder that impacts on the quality of life of the sufferer and caregivers. Treatment for pediatric rhinitis is empirical and does not include a detailed history of the allergy triggers or allergy testing. Thus, allergen avoidance advice is not tailored to the child's sensitivities, which may result in adenoid hypertrophy. However, infant onset rhinitis, especially its relationship with respiratory viruses, remains to be further clarified. Rhinitis basically involves inflammation of the upper nasal lining, presenting typically with symptoms of runny nose (rhinorrhea), nasal blockage, and/or sneezing. While not typically fatal, it does impose significant health, psychological, and monetary burden to its sufferers, and is thus considered a global health problem. Previous findings showed that immunotherapy had significant clinical efficacy in children with allergic rhinitis. The present review article aims to highlight recent perspectives pertaining to the rhinitis risk factors especially in pediatric patients. PMID:27698737

  7. Infantile esotropia: risk factors associated with reoperation

    PubMed Central

    Magli, Adriano; Rombetto, Luca; Matarazzo, Francesco; Carelli, Roberta

    2016-01-01

    The aim of this study was to identify clinical and demographic factors associated with misalignment after first surgery performed on children affected by infantile esotropia to evaluate the reoperation rate. A retrospective study was carried out, analyzing data from 525 children who underwent bilateral medial recti recession, bilateral lateral recti resection, and inferior oblique recession and anteroposition by the same surgeon (AM). Postoperative evaluation included assessment of motor alignment at approximately 3 months, 6 months, 1 year, and 5 years. Statistical analysis was performed with a logistical regression model in which the dependent variable was the presence/absence of reoperation. We found that late surgery (after 3 years of age) and a family history of strabismus are associated with a higher risk of reoperation, while some clinical factors, including some classically associated with worst motor outcome as preoperative angle, dissociated vertical deviation, and amblyopia, did not influence the incidence of reoperation in infantile esotropia. Male patients and patients with hyperopia in preoperative examinations have a significantly decreased reoperation rate. PMID:27799735

  8. Risk factors analysis of consecutive exotropia

    PubMed Central

    Gong, Qianwen; Wei, Hong; Zhou, Xu; Li, Ziyuan; Liu, Longqian

    2016-01-01

    Abstract To evaluate clinical factors associated with the onset of consecutive exotropia (XT) following esotropia surgery. By a retrospective nested case-control design, we reviewed the medical records of 193 patients who had undergone initial esotropia surgery between 2008 and 2015, and had follow-up longer than 6 months. The probable risk factors were evaluated between groups 1 (consecutive XT) and 2 (non-consecutive exotropia). Pearson chi-square test and Mann–Whitney U test were used for univariate analysis, and conditional logistic regression model was applied for exploring the potential risk factors of consecutive XT. Consecutive exotropia occurred in 23 (11.9%) of 193 patients. Patients who had undergone large bilateral medial rectus recession (BMR) (P = 0.017) had a high risk of developing consecutive XT. Oblique dysfunction (P = 0.001), adduction limitation (P = 0.000) were associated with a high risk of consecutive XT, which was confirmed in the conditional logistic regression analysis. In addition, large amount of BMR (6 mm or more) was associated with higher incidence of adduction limitation (P = 0.045). The surgical methods and preoperative factors did not appear to influence the risk of developing consecutive XT (P > 0.05). The amount of surgery could be optimized to reduce the risk of consecutive XT. The presence of oblique overaction and postoperative adduction limitation may be associated with a high risk of consecutive XT, which may require close supervision, and/or even earlier operation intervention. PMID:27977611

  9. Risk factors for postoperative complications in total thyroidectomy

    PubMed Central

    Caulley, Lisa; Johnson-Obaseki, Stephanie; Luo, Lindy; Javidnia, Hedyeh

    2017-01-01

    Abstract Thyroid cancer incidence is increasing, and with it, an increase in total thyroidectomy. There are limited studies comparing outcomes in total thyroidectomy performed in the inpatient versus outpatient setting. The objective of this study was to perform a comparative analysis of risk factors and outcomes of postoperative morbidity and mortality in total thyroidectomy performed as an inpatient versus outpatient surgery. Retrospective cohort study of data from the 2005 to 2014 multi-institutional, risk-adjusted American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. A multivariate regression model with corresponding odds ratios and 95% confidence intervals was used to determine 30-day morbidity and mortality after total thyroidectomies, and also risk factors of postoperative outcomes. From 2005 to 2014, 40,025 total thyroidectomies were performed (48.5% inpatient, 51.5% outpatient). The 30-day complication rate for all total thyroidectomies was 7.74%. Multivariate logistic regression analysis was performed to control for potential confounding variables. Preoperative factors that affected complications rates for inpatient thyroidectomies included: age ≥70, non-Caucasian race, dependent functional status, history of congestive heart failure, smoking history, bleeding disorder, wound infection, and preoperative sepsis (P < 0.05). In addition, preoperative factors affecting complications in thyroidectomy performed as an outpatient surgery included malignant thyroid pathology (P  0.05). We identified a subset of preoperative conditions that affect risk of complications after total thyroidectomy. Recommendations for patient selection for outpatient total thyroidectomies should be modified to account for pre-existing conditions that increase the risk of postoperative morbidity. PMID:28151852

  10. Preoperative Albumin to Globulin Ratio (AGR) as Prognostic Factor in Renal Cell Carcinoma

    PubMed Central

    He, Xiaobo; Guo, Shengjie; Chen, Dong; Yang, Guangwei; Chen, Xin; Zhang, Yijun; He, Qiuming; Qin, Zike; Liu, Zhuowei; Xue, Yunfei; Zhang, Meng; Liu, Ruiwu; Zhou, Fangjian; Han, Hui; Yao, Kai

    2017-01-01

    Background: Malnutrition and systemic inflammatory response are frequently associated with prognosis in patients with several types of cancer, including renal cell carcinoma (RCC). The study is aimed to investigate the ability of preoperative serum albumin to globulin ratio (AGR) to predict the long-term mortality of RCC patients. Methods: The study is a retrospective study of an unselected cohort of 895 RCC patients who underwent a curative radical or partial nephrectomy at the Department of Urology in the Sun Yat-Sen University Cancer Center between January 2000 and December 2012 and had documented preoperative serum total protein and albumin (ALB) levels. The preoperative AGR was calculated as the ratio of ALB to (total protein-ALB) and its association with other clinical indices was assessed using survival analysis. Results: Low preoperative AGR was associated with older population, lower hemoglobin, higher total protein, lower ALB, lower body mass index and advanced stage. The univariate and multivariate Cox analyses demonstrated that preoperative AGR was an independent prognostic indicator of overall survival (OS) (hazard ratio (HR): 0.63, 95% confidence interval (CI): 0.43 to 0.93, P=0.022). In addition, patients with low preoperative AGR at pT1-2, pT3-4, pN0, pN1, pM0 and pM1 stages had significantly shorter OS than patients with high preoperative AGR. Conclusion: Preoperative AGR is a proven objective, reproducible, inexpensive survival predictor of RCC patients following surgical resection and should be considered for routine clinical use. PMID:28243330

  11. Epidermal growth factor receptor as a predictor of tumor downstaging in locally advanced rectal cancer patients treated with preoperative chemoradiotherapy

    SciTech Connect

    Kim, Jun-Sang . E-mail: k423j@cnu.ac.kr; Kim, Jin-Man; Li, Shengjin; Yoon, Wan-Hee; Song, Kyu-Sang; Kim, Ki-Hwan; Yeo, Seung-Gu; Nam, Ji Sook; Cho, Moon-June

    2006-09-01

    Purpose: To examine retrospectively whether levels of epidermal growth factor receptor (EGFR) expression can predict tumor downstaging after preoperative chemoradiotherapy in patients with locally advanced rectal cancer. Methods and Materials: A total of 183 patients with rectal cancer (cT3-T4 or N+) were enrolled in this study. Preoperative chemoradiotherapy consisted of 50.4 Gy of pelvic radiation with concurrent 5-fluorouracil and leucovorin bolus intravenous chemotherapy in 94 patients or oral capecitabine and leucovorin in 89 patients. EGFR expression in pretreatment paraffin-embedded tumor biopsy specimens was assessed by immunohistochemistry. EGFR expression was determined from the intensity and extent of staining. Tumor downstaging was defined as a reduction of at least one T-stage level. Results: Tumor downstaging occurred in 97 patients (53%), and the tumors showed a pathologic complete response in 27 patients (15%). Positive EGFR expression was observed in 140 (76%) of 183 patients. EGFR expression levels were low in 113 patients (62%) and high in 70 patients (38%). On logistic regression analysis, the significant predictive factor for increased tumor downstaging was a low level of EGFR expression and preoperative chemotherapy using oral capecitabine (odds ratio, 0.437; p 0.012 vs. odds ratio, 3.235; p < 0.001, respectively). Conclusion: A high level of EGFR expression may be a significant predictive molecular marker for decreased tumor downstaging after preoperative chemoradiotherapy in locally advanced rectal cancer.

  12. Effect of Preoperative Risk Group Stratification on Oncologic Outcomes of Patients with Adverse Pathologic Findings at Radical Prostatectomy

    PubMed Central

    Jang, Won Sik; Kim, Lawrence H. C.; Yoon, Cheol Yong; Rha, Koon Ho; Choi, Young Deuk; Hong, Sung Joon; Ham, Won Sik

    2016-01-01

    Background Current National Comprehensive Cancer Network guidelines recommend postoperative radiation therapy based only on adverse pathologic findings (APFs), irrespective of preoperative risk group. We assessed whether a model incorporating both the preoperative risk group and APFs could predict long-term oncologic outcomes better than a model based on APFs alone. Methods We retrospectively reviewed 4,404 men who underwent radical prostatectomy (RP) at our institution between 1992 and 2014. After excluding patients receiving neoadjuvant therapy or with incomplete pathological or follow-up data, 3,092 men were included in the final analysis. APFs were defined as extraprostatic extension (EPE), seminal vesicle invasion (SVI), or a positive surgical margin (PSM). The adequacy of model fit to the data was compared using the likelihood-ratio test between the models with and without risk groups, and model discrimination was compared with the concordance index (c-index) for predicting biochemical recurrence (BCR) and prostate cancer-specific mortality (PCSM). We performed multivariate Cox proportional hazard model and competing risk regression analyses to identify predictors of BCR and PCSM in the total patient group and each of the risk groups. Results Adding risk groups to the model containing only APFs significantly improved the fit to the data (likelihood-ratio test, p <0.001) and the c-index increased from 0.693 to 0.732 for BCR and from 0.707 to 0.747 for PCSM. A RP Gleason score (GS) ≥8 and a PSM were independently associated with BCR in the total patient group and also each risk group. However, only a GS ≥8 and SVI were associated with PCSM in the total patient group (GS ≥8: hazard ratio [HR] 5.39 and SVI: HR 3.36) and the high-risk group (GS ≥8: HR 6.31 and SVI: HR 4.05). Conclusion The postoperative estimation of oncologic outcomes in men with APFs at RP was improved by considering preoperative risk group stratification. Although a PSM was an

  13. Thyroid Cancer Risk Factors

    MedlinePlus

    ... common than normal in children who lived near Chernobyl, the site of a 1986 nuclear plant accident ... exposure was much, much lower than that around Chernobyl. A higher risk of thyroid cancer has not ...

  14. Stroke - risk factors

    MedlinePlus

    ... a higher risk. Diseases such as cancer, chronic kidney disease, and some types of arthritis. Weak areas in an artery wall or abnormal arteries and veins . Pregnancy. Both during and in the weeks right after ...

  15. Patient-related risk factors that predict poor outcome after total hip replacement.

    PubMed Central

    MacWilliam, C H; Yood, M U; Verner, J J; McCarthy, B D; Ward, R E

    1996-01-01

    OBJECTIVE: To identify factors associated with poor outcome after total hip replacement (THR) surgery. DATA SOURCES: This article is the first to present results from the American Medical Group Association (AMGA) THR consortium. STUDY DESIGN: The outcomes evaluated were pain and physical function. Eight patient risk factors were evaluated. These included the age, sex, race, marital status, and education of the patient; whether the patient had polyarticular disease or other comorbid conditions; and the patient's preoperative pain and physical function score. DATA COLLECTION: Data were collected from patients using AMGA-approved, self-administered questionnaires preoperatively and at six weeks, three months, six months, one year, and two years postoperatively. PRINCIPAL FINDINGS: Of the patient risk factors studied, race, education, number of comorbid conditions, and preoperative Health Status Questionnaire (HSQ) score were found to be associated with poor outcome. These risk factors were found to have an effect on both pain and physical function at six months postoperatively. Patients with higher preoperative scores were found to have higher postoperative scores, but substantially fewer of these patients received any benefit from their surgery. For each 10-point increase in preoperative score, patients could expect at least a 6-point decrease in postoperative improvement. CONCLUSIONS: Our study indicates that preoperative status is an important predictor of outcome for THR. PMID:8943994

  16. The PER (Preoperative Esophagectomy Risk) Score: A Simple Risk Score to Predict Short-Term and Long-Term Outcome in Patients with Surgically Treated Esophageal Cancer

    PubMed Central

    Reeh, Matthias; Metze, Johannes; Uzunoglu, Faik G.; Nentwich, Michael; Ghadban, Tarik; Wellner, Ullrich; Bockhorn, Maximilian; Kluge, Stefan; Izbicki, Jakob R.; Vashist, Yogesh K.

    2016-01-01

    Abstract Esophageal resection in patients with esophageal cancer (EC) is still associated with high mortality and morbidity rates. We aimed to develop a simple preoperative risk score for the prediction of short-term and long-term outcomes for patients with EC treated by esophageal resection. In total, 498 patients suffering from esophageal carcinoma, who underwent esophageal resection, were included in this retrospective cohort study. Three preoperative esophagectomy risk (PER) groups were defined based on preoperative functional evaluation of different organ systems by validated tools (revised cardiac risk index, model for end-stage liver disease score, and pulmonary function test). Clinicopathological parameters, morbidity, and mortality as well as disease-free survival (DFS) and overall survival (OS) were correlated to the PER score. The PER score significantly predicted the short-term outcome of patients with EC who underwent esophageal resection. PER 2 and PER 3 patients had at least double the risk of morbidity and mortality compared to PER 1 patients. Furthermore, a higher PER score was associated with shorter DFS (P < 0.001) and OS (P < 0.001). The PER score was identified as an independent predictor of tumor recurrence (hazard ratio [HR] 2.1; P < 0.001) and OS (HR 2.2; P < 0.001). The PER score allows preoperative objective allocation of patients with EC into different risk categories for morbidity, mortality, and long-term outcomes. Thus, multicenter studies are needed for independent validation of the PER score. PMID:26886613

  17. Risk factors for periodontal disease.

    PubMed

    Genco, Robert J; Borgnakke, Wenche S

    2013-06-01

    Risk factors play an important role in an individual's response to periodontal infection. Identification of these risk factors helps to target patients for prevention and treatment, with modification of risk factors critical to the control of periodontal disease. Shifts in our understanding of periodontal disease prevalence, and advances in scientific methodology and statistical analysis in the last few decades, have allowed identification of several major systemic risk factors for periodontal disease. The first change in our thinking was the understanding that periodontal disease is not universal, but that severe forms are found only in a portion of the adult population who show abnormal susceptibility. Analysis of risk factors and the ability to statistically adjust and stratify populations to eliminate the effects of confounding factors have allowed identification of independent risk factors. These independent but modifiable, risk factors for periodontal disease include lifestyle factors, such as smoking and alcohol consumption. They also include diseases and unhealthy conditions such as diabetes mellitus, obesity, metabolic syndrome, osteoporosis, and low dietary calcium and vitamin D. These risk factors are modifiable and their management is a major component of the contemporary care of many periodontal patients. Genetic factors also play a role in periodontal disease and allow one to target individuals for prevention and early detection. The role of genetic factors in aggressive periodontitis is clear. However, although genetic factors (i.e., specific genes) are strongly suspected to have an association with chronic adult periodontitis, there is as yet no clear evidence for this in the general population. It is important to pursue efforts to identify genetic factors associated with chronic periodontitis because such factors have potential in identifying patients who have a high susceptibility for development of this disease. Many of the systemic risk factors

  18. [Preeclampsia as cardiovascular risk factor].

    PubMed

    Heida, Karst Y; Franx, Arie; Bots, Michiel L

    2013-01-01

    Cardiovascular diseases (CVD) are the primary cause of death in women. Guidelines for identifying high-risk individuals have been developed, e.g. the Dutch Guideline on Cardiovascular Risk Management. In the most recent version of this guideline, diabetes mellitus (DM) and rheumatoid arthritis (RA) are cited as cardiovascular risk factors; therefore, individuals with these conditions are identified as being at high risk. As with DM and RA, there is strong evidence that the experience of having a hypertensive disorder during pregnancy is a cardiovascular risk factor. This is particularly the case for early preeclampsia, which constitutes a 7-fold increased risk of ischemic heart disease. However, in the Netherlands, there are no guidelines and there is no consensus on how to screen or treat these women. Trial evidence is therefore urgently needed to substantiate the value of cardiovascular risk management for those women with a history of hypertension during pregnancy.

  19. The influence of preoperative risk stratification on fast-tracking patients after pulmonary resection.

    PubMed

    Bryant, Ayesha S; Cerfolio, Robert J

    2008-02-01

    Fast-tracking protocols or postoperative care computerized algorithms have been shown to reduce hospital length of stay and reduce costs; however, not all patients can be fast-tracked. Certain patient characteristics may put patients at increased risk to fail fast-tracking. Additionally some patients have multiple risk factors that have an additive effect that puts them at an even increased risk to fail fast-tracking, and more importantly, to significant morbidity. It is a mistake to force these protocols on all patients because it can lead to increased complications, readmissions, and low patient and family satisfaction. By carefully analyzing surgical results via accurate prospective databases, the types of patients who fail fast-tracking and the reasons they fail can be identified. Once these characteristics are pinpointed, specific changes to the postoperative algorithm can be implemented, and these alterations can lead to improved outcomes. The authors have shown that by using pain pumps instead of epidurals in elderly patients we can improve outcomes and still fast-track octogenarians with minimal morbidity and high-patient satisfaction. We have also shown that the increased use of physical therapy and respiratory treatments (important parts of the care of all patients after pulmonary resection, but a limited resource in most hospitals) may also lead to improved surgical results for those who have low FEV1% and DLco%. Further studies are needed. Although fast-tracking protocols cannot be applied to all, the vast majority of patients who undergo elective pulmonary resection, even those at high risk, can undergo safe, efficient, and cost-saving care via preset postoperative algorithms. When the typical daily events are convened each morning and the planned date of discharge is frequently communicated with the patient and family before surgery and each day in the hospital, most patients can be safely fast-tracked with high satisfaction and outstanding results.

  20. Analysis of risk factors for pharyngocutaneous fistula after total laryngectomy with particular focus on nutritional status.

    PubMed

    Mattioli, F; Bettini, M; Molteni, G; Piccinini, A; Valoriani, F; Gabriele, S; Presutti, L

    2015-10-01

    Pharyngocutaneous fistula (PCF) is the most common complication following total laryngectomy and the most difficult to manage. It often causes increased morbidity, delays starting adjuvant therapy, prolongs hospitalisation, increases treatment costs and reduces the quality of life (QoL). The objective of this study is to analyse the predisposing factors and the most important nutritional parameters related to the development of PCF in patients undergoing total laryngectomy and to suggest medical alternatives that might improve results. We performed a retrospective study of 69 patients who underwent either primary or salvage total laryngectomy in our department between January 2008 and January 2012. Risk factors for fistula formation were analysed including tumour characteristics (histology, grading, AJCC stage), treatment (primary or salvage surgery, extent of resection, flap reconstruction, preoperative radiotherapy), comorbidity and nutritional status (preoperative haemoglobin, albumin and prealbumin levels and their changes during hospitalisation). Twenty-four patients developed a PCF (overall incidence 34.8%). Fistula formation was significantly higher in patients with diabetes, preoperative malnutrition (identified from low preoperative albumin and prealbumin levels). After specific nutritional evaluation and support, no patient developed a PCF. Risk factors for PCF formation are extensively treated in the literature but identification of high-risk patients is still controversial. Our study demonstrates that nutritional status of the patient, assessed by preoperative albumin, is also an important risk factor for PCF formation in addition to classical factors. Maintenance of a normal perioperative nutritional status can be helpful to avoid this complication.

  1. Elevated preoperative plasma D-dimer levels and the incidence of venous thromboembolism in Japanese females with gynecological cancer.

    PubMed

    Kodama, Junichi; Seki, Noriko; Fukushima, Chikako; Kusumoto, Tomoyuki; Nakamura, Keiichiro; Hongo, Atsushi; Hiramatsu, Yuji

    2013-01-01

    The purpose of the present study was to determine the incidence of increased levels of D-dimer and associated factors in preoperative patients with gynecological cancer. Furthermore, we determined the incidence and risk factors associated with preoperative venous thromboembolism (VTE). Overall, 456 patients with invasive gynecological cancer scheduled to undergo surgery were recruited. Preoperative plasma D-dimer levels were measured and patients whose plasma D-dimer concentration exceeded the pre-set cut-off value underwent computed tomography scanning. The incidence of elevated D-dimer and VTE was identified as significantly higher in patients with ovarian cancer. Multivariate analysis revealed that advanced age, low hemoglobin levels and elevated C-reactive protein (CRP) levels were independent factors for preoperative elevations in plasma D-dimer levels. Advanced age was an independent risk factor for preoperative VTE. Massive ascites and the presence of co-morbidities were independent risk factors for preoperative VTE in ovarian cancer. Advanced age and stage were independent risk factors for preoperative VTE in endometrial cancer. Advanced age was an independent risk factor for preoperative VTE in cervical cancer. Plasma D-dimer levels and the incidence of preoperative VTE were higher in patients with ovarian cancer compared with those with other gynecological cancers. Advanced age, low hemoglobin levels and elevated CRP levels were significant factors associated with elevated plasma D-dimer levels and age was an independent risk factor for preoperative VTE in gynecological cancer.

  2. Salivary Gland Cancer: Risk Factors

    MedlinePlus

    ... continue reading this guide. ‹ Salivary Gland Cancer - Medical Illustrations up Salivary Gland Cancer - Screening › f t k ... Net Guide Salivary Gland Cancer Introduction Statistics Medical Illustrations Risk Factors Screening Symptoms and Signs Diagnosis Subtypes ...

  3. Hidden Risk Factors for Women

    MedlinePlus

    ... previous history of clots in the legs (deep vein thrombosis) and livedo reticularis, a mottled purplish discoloration of the skin. “Risk factors are cumulative,” Dr. Kittner adds. “Reducing even one ...

  4. Preoperative evaluation and comprehensive risk assessment for children with Down syndrome.

    PubMed

    Lewanda, Amy Feldman; Matisoff, Andrew; Revenis, Mary; Harahsheh, Ashraf; Futterman, Craig; Nino, Gustavo; Greenberg, Jay; Myseros, John S; Rosenbaum, Kenneth N; Summar, Marshall

    2016-04-01

    Down syndrome is a common chromosome disorder affecting all body systems. This creates unique physiologic concerns that can affect safety during anesthesia and surgery. Little consensus exists, however, on the best way to evaluate children with Down syndrome in preparation for surgery. We review a number of salient topics affecting these children in the perioperative period, including cervical spine instability, cardiovascular abnormalities, pulmonary hypertension, upper airway obstruction, hematologic disturbances, prematurity, low birth weight, and the use of supplements and alternative therapies. Recommendations include obtaining a complete blood count to detect an increased risk for bleeding or stroke, and cardiology evaluation to identify patients with pulmonary hypertension, as well as undiagnosed or residual heart disease. Pediatric cardiac anesthesiologists and intensivists should be involved as needed. The potential for cervical spine instability should be considered, and the anesthesiologist may wish to have several options available both for the medications and equipment used. The child's family should always be asked if he or she is on any nutritional supplements, as some products marketed to families may have secondary effects such as inhibition of platelet function. Using this evaluation in presurgical planning will allow physicians to better consider the individual circumstances for their patients with Down syndrome. Our goal was to optimize patient safety by choosing the most appropriate setting and perioperative personnel, and to mitigate those risk factors amenable to intervention.

  5. Cardiac risk factors: environmental, sociodemographic, and behavioral cardiovascular risk factors.

    PubMed

    Anthony, David; George, Paul; Eaton, Charles B

    2014-06-01

    Several environmental exposures are associated with increased risk of coronary heart disease (CHD). Exposure to secondhand smoke may increase the risk by as much as 25% to 30%. Exposure to third hand smoke, residual components of tobacco smoke that remain in the environment after a cigarette is extinguished, also appears to increase risk. These residual components can remain in rooms and automobiles for up to 30 years and enter the body through the skin or via inhalation or ingestion. Exposure to particulate matter air pollution from automobile emissions, power plants, and other sources is yet another environmental risk factor for CHD, resulting in tens of thousands of deaths annually in the United States. Exposure to other environmental toxins, particularly bisphenol A and phthalates, also has been linked to CHD. There are sociodemographic risks for CHD, with numerous studies showing that lower socioeconomic status is associated with higher risk. Behavioral risk factors include poor diet, such as frequent consumption of fast food and processed meals; sleep disturbance; and psychological stress, particularly related to marital or work issues. Finally, although high alcohol consumption is associated with increased CHD risk, moderate alcohol consumption (ie, less than 1 to 2 drinks/day), particularly of wine and possibly beer, appears to reduce the risk.

  6. [Perception of reproductive risk factors].

    PubMed

    Salinas-Martinez, A M; Martínez-Sanchez, C; Pérez-Segura, J

    1993-01-01

    The objective of this study was to identify risk perception on several factors related to reproductive health, with the goal of implementing an educational intervention based on detected needs. 405 women between 12 and 44 years were interviewed at home. 62.2% perceived the risk of pregnancy at 17 years and younger; 78.8% the risk of pregnancy at 35 years and older; 76.6% the risk of parity of 5 and higher; and 55.1% the risk of birth interval of 2 years and less. 60.5% recognized family history of birth defects, 80.2% age 35 years and older, and 84.4% rubella during pregnancy, as risk factors for newborns with congenital malformations. 27.7% identified history of a low birth weight and 61.0% birth interval of 1 year and less, as risk factors for low birth weight. The majority perceived the risk of tobacco, alcohol and drugs consumption during pregnancy, diseases with no treatment and deficient nutrition. There was an inconsistent influence of social and obstetric variables on risk perception. No linear correlation was detected. Health educators should recognize differences on knowledge and behavior of future receptors before an educational intervention starts.

  7. Preoperative lymphocyte count is a favorable prognostic factor of disease-free survival in non-small-cell lung cancer.

    PubMed

    Zhang, Jian; Huang, Shao-Hong; Li, Hui; Li, Yun; Chen, Xiu-Ling; Zhang, Wei-Qing; Chen, Hui-Guo; Gu, Li-Jia

    2013-03-01

    Recently, the prognostic value of cancer-related inflammatory response has been revealed. Previous studies showed that peripheral neutrophils and lymphocytes had significant impact on the prognosis of advanced and early-node-negative non-small-cell lung cancer (NSCLC). The purpose of this study was to investigate the prognostic value of preoperative lymphocyte and neutrophil counts in patients with NSCLC who underwent lobectomy and lymph node dissection and adjuvant chemotherapy. Retrospective analyses were performed to examine the impact of preoperative peripheral lymphocyte and neutrophil counts on disease-free survival (DFS) and overall survival (OS) and to analyze the relationships of these factors to clinicopathological factors. A total of 142 patients with NSCLC were evaluated of which 57 (40.1 %) patients had local recurrence or metastasis. Multivariate analyses revealed that peripheral lymphocyte count was an independent favorable prognostic factor of DFS (hazard ratio 0.548; 95 % confidence interval 0.351-0.857; P = 0.008) but not OS (P = 0.164). The maximum logrank statistical value was 9.504 (P = 0.002) when the cutoff value of lymphocyte was 1,800 mm(-3). The median DFS was 318.0 days (95 % confidence interval 226.0-410.0) for lymphocyte ≤1,800 mm(-3) group and 669.0 days (95 % confidence interval 0.0-1,431.0) for lymphocyte >1,800 mm(-3) group. Low lymphocyte count was related with lymphatic invasion (P = 0.012) and recurrence of NSCLC (P = 0.022). Peripheral neutrophil count had no impact on DFS or OS when analysis included all the 142 patients. Preoperative peripheral lymphocyte count, which is related with lymphatic invasion, is an independent favorable prognostic factor of DFS in patients with NSCLC who underwent lobectomy and lymph node dissection and adjuvant chemotherapy.

  8. Preoperative psychosocial characteristics may predict body image and sexuality two years after risk-reducing mastectomy: a prospective study

    PubMed Central

    Johansson, Hemming; Brandberg, Yvonne

    2017-01-01

    Background Risk-reducing mastectomy (RRM) in patients at high risk has become more available and the rates of both bilateral (BRRM) and contralateral (CRRM) procedures are increasing. For women opting for RRM, psychosocial well-being, body image and sexuality are known to be important patient-reported outcomes. The aim of the present study was to investigate baseline health-related quality of life (HRQoL) and emotional distress (anxiety and depression) as predictors of body image and sexuality two years after RRM in women undergoing CRRM and BRRM. Methods This is a prospective cohort study including consecutive women opting for BRRM and breast cancer patients considering CRRM at Karolinska University Hospital during 1998–2010. The women were given a set of questionnaires to be completed at baseline before RRM (The Medical Outcomes Study 36-Item Short Form, The Hospital Anxiety and Depression Scale, and The Sexual Activity Questionnaire) and two years after RRM (all the above-mentioned questionnaires along with The Body Image Scale). Mean scores for all questionnaires were analysed using linear regression models and adjusted for age at RRM as well as calendar year. Results In total, 253 patients consented to participate in the study. Response rate at baseline and 2 years was 88% and 71%, respectively. In the BRRM group (healthy women), preoperative HRQoL and emotional distress were associated with body image and sexual problems two years after the procedure. No similar associations were found for the patients with breast cancer who underwent CRRM. Conclusions The current study suggests that preoperative HRQoL and emotional distress may predict body image and sexual problems two years after RRM in healthy women, but not in breast cancer patients. Baseline psychosocial characteristics may be useful to identify women at risk for long-term body image and sexual problems following BRRM, but not among breast cancer patients opting for CRRM. PMID:28210554

  9. Identification of Factors for the Preoperative Prediction of Tumour Subtype and Prognosis in Patients with T1 Lung Adenocarcinoma

    PubMed Central

    Zhang, Yong-Kui; Chai, Zhen-da; Hu, Xiao-fei; Tan, Lin-lin; Wang, Zhao-yu; Chen, Zhi-jun

    2016-01-01

    Aims. Identification of factors that can predict the subtypes of lung adenocarcinoma preoperatively is important for selecting the appropriate surgical procedure and for predicting postoperative survival. Methods. We retrospectively evaluated 87 patients with lung adenocarcinomas ≤30 mm. Results. Preoperative radiological findings, serum CEA level, serum microRNA-183 (miR-183) level, and tumour size differed significantly between patients with adenocarcinoma in situ (AIS) or minimally invasive adenocarcinoma (MIA) and those with invasive adenocarcinoma (IAC). Receiver operating characteristic curves and univariate analysis revealed that patients who were older than 57 years or had a pure solid nodule or a tumour with mixed ground-glass opacity (mGGO), a tumour >11 mm, a serum CEA level >2.12 ng/mL, or a serum miR-183 level >1.233 (2−ΔΔCt) were more likely to be diagnosed with IAC than with AIS or MIA. The combination of all five factors had an area under the curve of 0.946, with a sensitivity of 89.13% and a specificity of 95.12%. Moreover, patients with a cut-off value >0.499 for the five-factor combination had poor overall survival. Conclusions. The five-factor combination enables clinicians to distinguish AIS or MIA from IAC, thereby aiding in selecting the appropriate treatment, and to predict the prognosis of lung adenocarcinoma patients. PMID:28115792

  10. Preoperative predictive factors for intensive care unit admission after pulmonary resection*

    PubMed Central

    Pinheiro, Liana; Santoro, Ilka Lopes; Perfeito, João Aléssio Juliano; Izbicki, Meyer; Ramos, Roberta Pulcheri; Faresin, Sonia Maria

    2015-01-01

    Objective: To determine whether the use of a set of preoperative variables can predict the need for postoperative ICU admission. Methods: This was a prospective observational cohort study of 120 patients undergoing elective pulmonary resection between July of 2009 and April of 2012. Prediction of ICU admission was based on the presence of one or more of the following preoperative characteristics: predicted pneumonectomy; severe/very severe COPD; severe restrictive lung disease; FEV1 or DLCO predicted to be < 40% postoperatively; SpO2 on room air at rest < 90%; need for cardiac monitoring as a precautionary measure; or American Society of Anesthesiologists physical status ≥ 3. The gold standard for mandatory admission to the ICU was based on the presence of one or more of the following postoperative characteristics: maintenance of mechanical ventilation or reintubation; acute respiratory failure or need for noninvasive ventilation; hemodynamic instability or shock; intraoperative or immediate postoperative complications (clinical or surgical); or a recommendation by the anesthesiologist or surgeon to continue treatment in the ICU. Results: Among the 120 patients evaluated, 24 (20.0%) were predicted to require ICU admission, and ICU admission was considered mandatory in 16 (66.6%) of those 24. In contrast, among the 96 patients for whom ICU admission was not predicted, it was required in 14 (14.5%). The use of the criteria for predicting ICU admission showed good accuracy (81.6%), sensitivity of 53.3%, specificity of 91%, positive predictive value of 66.6%, and negative predictive value of 85.4%. Conclusions: The use of preoperative criteria for predicting the need for ICU admission after elective pulmonary resection is feasible and can reduce the number of patients staying in the ICU only for monitoring. PMID:25750672

  11. Multiple Pre-operative and Intra-operative Factors Predict Early Fistula Thrombosis in the Hemodialysis Fistula Maturation Study

    PubMed Central

    Farber, Alik; Imrey, Peter B.; Huber, Thomas S.; Kaufman, James M.; Kraiss, Larry W.; Larive, Brett; Li, Liang; Feldman, Harold I.

    2015-01-01

    OBJECTIVES Early thrombosis (ET) contributes to autogenous arteriovenous fistula (AVF) failure. We studied patients undergoing AVF placement in the Hemodialysis Fistula Maturation (HFM) Study, a prospective, observational cohort study, using a nested case-control analysis to identify pre-operative and intra-operative predictors of ET. METHODS ET cases were compared to controls who were matched on gender, age, diabetes, dialysis status, and surgeon fistula volume. ET was defined as thrombosis diagnosed by physical exam or ultrasound within 18 days of AVF creation. Conditional logistic regression models were fit to identify risk factors for ET. RESULTS Thirty-two ET cases (5.3%) occurred among 602 study participants; 198 controls were matched. ET was associated with female gender (OR=2.75, CI 1.19–6.38, P=0.018), fistula location (forearm vs. upper arm) (OR=2.76, CI 1.05–7.23, P=0.039), feeding artery (radial vs. brachial) (OR=2.64, CI 1.03–6.77, P=0.043) and arterial diameter (OR=1.52, CI 1.02–2.26, P=0.039, per mm smaller). Draining vein diameter was nonlinearly associated with ET, with highest risk in 2–3 mm veins. Surprisingly, ET risk was lower in diabetics (OR=0.19, CI 0.07–0.47, P=0.0004), lower with less nitroglycerin-mediated brachial artery dilatation (NMD%) (OR=0.42, CI 0.20–1.92, P=0.029 for each 10% lower) and higher with lower carotid-femoral pulse wave velocity (OR=1.49, CI 1.02–2.20, P=0.041, for each m/sec lower). Intraoperative protamine use was associated with a higher ET risk (OR 3.26, CI 1.28-∞, P=0.038). Surgeon’s intraoperative perceptions were associated with ET: surgeons’ greater concern about maturation success (likely, marginal, unlikely) was associated with higher thrombosis risk (OR 8.09, CI 4.03-∞, p<0.0001, per category change), as were absence vs. presence of intraoperative thrill (OR 21.0, CI 5.07-∞, P=0.0002) and surgeons’ reported frustration during surgery (OR 6.85, CI 2.70-∞, P=0.0004). Reduced extent

  12. [Risk factors for arterial disease].

    PubMed

    Madoery, Roberto; Rubin, Graciela; Luquez, Hugo; Luquez, Cecilia; Cravero, Cecilia

    2004-01-01

    The risk factors of arterial disease (FREA) predict a future damage over the vascular system of the human body. Its detection are considered a key for the diagnostic as well as for the preventive and even curative strategies. For a long time, scientist considered those factors originated as a consecuence of large studies during the middle of the last century, with current validity up to our days. A simple classification spoke of them as traditionals. Further investigations described the so called new or emergents.factors that where joint together accordingly to their actions: coagulation factors, psicosocial, inflamatories and infectious. A recent classification, taking into account the type of impact, divided them into; causatives, predisposals and conditionals. Also, it was described a mechanism, the oxidative power, with consecuences over the endothelium, in the last part of the process. Before, another mechanism was described: the insulin resistance and the hiperinsulinism, bases for the Metabolic Syndrome, that includes a number of traditional risk factors.

  13. Environmental risk factors for osteoporosis

    SciTech Connect

    Goyer, R.A.; Korach, K.S. ); Epstein, S. ); Bhattacharyya, M. ); Pounds, J. )

    1994-04-01

    Environmental risk factors for osteoporosis were reviewed at a conference held at the National Institute for Environmental Health Sciences 8-9 November 1993. The conference was co-sponsored by the National Institute of Arthritis and Musculoskeletal and Skin Disease and the NIH Office of Research in Women's Health. The objective of the conference was to review what is known about risk factors for osteoporosis and to identify gaps in the present state of knowledge that might be addressed by future research. The conference was divided into two broad themes. The first session focused on current knowledge regarding etiology, risk factors, and approaches to clinical and laboratory diagnosis. This was followed by three sessions in which various environmental pollutants were discussed. Topics selected for review included environmental agents that interfere with bone and calcium metabolism, such as the toxic metals lead, cadmium, aluminum, and fluoride, natural and antiestrogens, calcium, and vitamin D.

  14. PRA in Design: Increasing Confidence in Pre-Operational Assessments of Risks (Results of a Joint NASA/NRC Workshop)

    NASA Technical Reports Server (NTRS)

    Youngblood, Robert; Dezfuli, Homayoon; Siu, Nathan

    2010-01-01

    In late 2009, the National Aeronautics and Space Administration (NASA) and the U.S. Nuclear Regulatory Commission (NRC) jointly organized a workshop to discuss technical issues associated with application of risk assessments to early phases of system design. The workshop, which was coordinated by the Idaho National Laboratory, involved invited presentations from a number of PRA experts in the aerospace and nuclear fields and subsequent discussion to address the following questions: (a) What technical issues limit decision-makers' confidence in PRA results, especially at a pre-operational phase of the system life cycle? (b) What is being done to address these issues'? (c) What more can be done ? The workshop resulted in participant observations and suggestions on several technical issues, including the pursuit of non-traditional approaches to risk assessment and the verification and validation of risk models. The workshop participants also identified several important non-technical issues, including risk communication with decision makers, and the integration of PRA into the overall design process.

  15. PRA In Design: Increasing Confidence in Pre-operational Assessments of Risks (Results of a Joint NASA/ NRC Workshop)

    SciTech Connect

    Robert Youngblood

    2010-06-01

    In late 2009, the National Aeronautics and Space Administration (NASA) and the U.S. Nuclear Regulatory Commission (NRC) jointly organized a workshop to discuss technical issues associated with application of risk assessments to early phases of system design. The workshop, which was coordinated by the Idaho National Laboratory, involved invited presentations from a number of PRA experts in the aerospace and nuclear fields and subsequent discussion to address the following questions: (a) What technical issues limit decision-makers’ confidence in PRA results, especially at a preoperational phase of the system life cycle? (b) What is being done to address these issues? (c) What more can be done? The workshop resulted in participant observations and suggestions on several technical issues, including the pursuit of non-traditional approaches to risk assessment and the verification and validation of risk models. The workshop participants also identified several important non-technical issues, including risk communication with decision makers, and the integration of PRA into the overall design process.

  16. Preoperative maximal flow rate may be a predictive factor for the outcome of tension-free vaginal tape procedure for stress urinary incontinence.

    PubMed

    Paick, Jae-Seung; Kim, Soo Woong; Ku, Ja Hyeon; Oh, Seung-June; Son, Hwancheol; Park, Jae Young

    2004-01-01

    This study examined factors potentially predicting on the outcome of the tension-free vaginal tape procedure for stress urinary incontinence. A total of 60 women (aged 35-71 years, mean 57) with at least follow-up of 2 years were included in the study. The tension-free vaginal tape procedure was performed under local anesthesia except in two patients. At the latest follow-up 50 (83.3%) were cured of stress urinary incontinence. Two patients had new-onset urge symptoms without urge incontinence episodes. Multivariate regression analysis showed maximal flow rate to be associated with 0.9-fold risk of the failure; no other parameters had statistical significance. Our results confirm the feasibility and safety of the tension-free vaginal tape procedure and demonstrate that preoperative low maximal flow rate may be associated with the failure of the tension-free vaginal tape procedure.

  17. Preoperative Plasma Fibrinogen Level as a Significant Prognostic Factor in Patients With Localized Renal Cell Carcinoma After Surgical Treatment.

    PubMed

    Lee, Hakmin; Lee, Sang Eun; Byun, Seok-Soo; Kim, Hyeon Hoe; Kwak, Cheol; Hong, Sung Kyu

    2016-01-01

    We sought to investigate the association of preoperative fibrinogen levels with clinicopathologic outcomes after surgical treatment of nonmetastatic renal cell carcinoma. We reviewed the records of 1511 patients who had their fibrinogen levels measured preceding surgery. The associations between preoperative fibrinogen level and risk of adverse clinicopathologic outcomes were tested using the multivariate logistic regression and multiple Cox-proportional hazards model, respectively. Based on plasma fibrinogen levels, we stratified the patients into 2 groups with a cut-off value of 328  mg/dL. Kaplan-Meier analysis showed significantly inferior survival outcomes in progression-free (P < 0.001), cancer-specific (P < 0.001), and overall survival (P < 0.001). In multivariate analyses, a high fibrinogen level (≥328  mg/dL) was significantly related to a higher Fuhrman grade (hazard ratio [HR] 1.374, P = 0.006) and a larger tumor size (≥7  cm) (HR 2.364, P < 0.001). Multivariate Cox analysis also revealed that a high preoperative fibrinogen level is a significant predictor for poor disease progression (HR 1.857, P < 0.001), cancer-specific survival (HR 3.608, P = 0.003), and overall survival (HR 1.647, P = 0.027). Increased plasma fibrinogen levels were significantly associated with poor pathological features and worse survival outcomes in patients with nonmetastatic renal cell carcinoma after surgical treatment. Further evaluations such as prospective randomized trials are needed to understand the underlying mechanism for these associations.

  18. The Preoperative Neurological Evaluation

    PubMed Central

    Probasco, John; Sahin, Bogachan; Tran, Tung; Chung, Tae Hwan; Rosenthal, Liana Shapiro; Mari, Zoltan; Levy, Michael

    2013-01-01

    Neurological diseases are prevalent in the general population, and the neurohospitalist has an important role to play in the preoperative planning for patients with and at risk for developing neurological disease. The neurohospitalist can provide patients and their families as well as anesthesiologists, surgeons, hospitalists, and other providers guidance in particular to the patient’s neurological disease and those he or she is at risk for. Here we present considerations and guidance for the neurohospitalist providing preoperative consultation for the neurological patient with or at risk of disturbances of consciousness, cerebrovascular and carotid disease, epilepsy, neuromuscular disease, and Parkinson disease. PMID:24198903

  19. [Preoperative screening and nutritional support of nutritional deficiencies].

    PubMed

    Zazzo, J-F

    2004-01-01

    Nutritional deficiencies have to be considered as an independent risk factor for postoperative morbidity. Peri-operative nutritional support reduce this risk in elective abdominal surgery for cancer and cardiac surgery. Preoperative nutritional support for 7-10 days reduce postoperative complications in undernourished patients by 10% but is not operant when administered after surgery. Enteral route is as effective. Recent studies using immunonutrients conclude that a short preoperative oral intake is able to reduce complications even in well-nourished patients. Then, a preoperative nutritional screening must be routinely performed leading to a nutritional programme.

  20. Risk factors for Down syndrome.

    PubMed

    Coppedè, Fabio

    2016-12-01

    Down syndrome (DS) originates, in most of the cases (95 %), from a full trisomy of chromosome 21. The remaining cases are due to either mosaicism for chromosome 21 or the inheritance of a structural rearrangement leading to partial trisomy of the majority of its content. Full trisomy 21 and mosaicism are not inherited, but originate from errors in cell divisions during the development of the egg, sperm or embryo. In addition, full trisomy for chromosome 21 should be further divided into cases of maternal origin, the majority, and cases of paternal origin, less than 10 %. Among cases of maternal origin, a further stratification should be performed into errors that have occurred or originated during the first meiotic division in the maternal grandmother's body and errors that occurred later in life during the second maternal meiotic division. This complex scenario suggests that our understanding of the risk factors for trisomy 21 should take into account the above stratification as it reflects different individuals and generations in which the first error has occurred. Unfortunately, most of the available literature is focused on maternal risk factors, and the only certain risk factors for the birth of a child with DS are advanced maternal age at conception and recombination errors, even though the molecular mechanisms leading to chromosome 21 nondisjunction are still a matter of debate. This article critically reviews the hypotheses and the risk factors which have been suggested to contribute to the birth of a child with DS, including folate metabolism, dietary, lifestyle, environmental, occupational, genetic and epigenetic factors, with focus on maternal and paternal risk factors, and taking into account the possible contribution of the maternal grandmother and that of the developing trisomic embryo, in a complex scenario depicting the birth of a child with DS as the result of complex gene-environment interactions and selection processes involving different

  1. Sexual harassment: identifying risk factors.

    PubMed

    O'Hare, E A; O'Donohue, W

    1998-12-01

    A new model of the etiology of sexual harassment, the four-factor model, is presented and compared with several models of sexual harassment including the biological model, the organizational model, the sociocultural model, and the sex role spillover model. A number of risk factors associated with sexually harassing behavior are examined within the framework of the four-factor model of sexual harassment. These include characteristics of the work environment (e.g., sexist attitudes among co-workers, unprofessional work environment, skewed sex ratios in the workplace, knowledge of grievance procedures for sexual harassment incidents) as well as personal characteristics of the subject (e.g., physical attractiveness, job status, sex-role). Subjects were 266 university female faculty, staff, and students who completed the Sexual Experience Questionnaire to assess the experience of sexual harassment and a questionnaire designed to assess the risk factors stated above. Results indicated that the four-factor model is a better predictor of sexual harassment than the alternative models. The risk factors most strongly associated with sexual harassment were an unprofessional environment in the workplace, sexist atmosphere, and lack of knowledge about the organization's formal grievance procedures.

  2. Risk factors and classifications of hilar cholangiocarcinoma.

    PubMed

    Suarez-Munoz, Miguel Angel; Fernandez-Aguilar, Jose Luis; Sanchez-Perez, Belinda; Perez-Daga, Jose Antonio; Garcia-Albiach, Beatriz; Pulido-Roa, Ysabel; Marin-Camero, Naiara; Santoyo-Santoyo, Julio

    2013-07-15

    Cholangiocarcinoma is the second most common primary malignant tumor of the liver. Perihilar cholangiocarcinoma or Klatskin tumor represents more than 50% of all biliary tract cholangiocarcinomas. A wide range of risk factors have been identified among patients with Perihilar cholangiocarcinoma including advanced age, male gender, primary sclerosing cholangitis, choledochal cysts, cholelithiasis, cholecystitis, parasitic infection (Opisthorchis viverrini and Clonorchis sinensis), inflammatory bowel disease, alcoholic cirrhosis, nonalcoholic cirrhosis, chronic pancreatitis and metabolic syndrome. Various classifications have been used to describe the pathologic and radiologic appearance of cholangiocarcinoma. The three systems most commonly used to evaluate Perihilar cholangiocarcinoma are the Bismuth-Corlette (BC) system, the Memorial Sloan-Kettering Cancer Center and the TNM classification. The BC classification provides preoperative assessment of local spread. The Memorial Sloan-Kettering cancer center proposes a staging system according to three factors related to local tumor extent: the location and extent of bile duct involvement, the presence or absence of portal venous invasion, and the presence or absence of hepatic lobar atrophy. The TNM classification, besides the usual descriptors, tumor, node and metastases, provides additional information concerning the possibility for the residual tumor (R) and the histological grade (G). Recently, in 2011, a new consensus classification for the Perihilar cholangiocarcinoma had been published. The consensus was organised by the European Hepato-Pancreato-Biliary Association which identified the need for a new staging system for this type of tumors. The classification includes information concerning biliary or vascular (portal or arterial) involvement, lymph node status or metastases, but also other essential aspects related to the surgical risk, such as remnant hepatic volume or the possibility of underlying disease.

  3. Estimating mortality risk in preoperative patients using immunologic, nutritional, and acute-phase response variables.

    PubMed Central

    Christou, N V; Tellado-Rodriguez, J; Chartrand, L; Giannas, B; Kapadia, B; Meakins, J; Rode, H; Gordon, J

    1989-01-01

    We measured the delayed type hypersensitivity (DTH) skin test response, along with additional variables of host immunocompetence in 245 preoperative patients to determine which variables are associated with septic-related deaths following operation. Of the 14 deaths (5.7%), 12 were related to sepsis and in 2 sepsis was contributory. The DTH response (p less than 0.00001), age (p less than 0.0002), serum albumin (p less than 0.003), hemoglobin (p less than 0.02), and total hemolytic complement (p less than 0.03), were significantly different between those who died and those who lived. By logistic regression analysis, only the DTH skin test response (log likelihood = 41.7, improvement X2 = 6.24, p less than 0.012) and the serum albumin (log likelihood = 44.8, improvement X2 = 17.7, p less than 0.001) were significantly and independently associated with the deaths. The resultant probability of mortality calculation equation was tested in a separate validation group of 519 patients (mortality = 5%) and yielded a good predictive capability as assessed by (1) X2 = 0.08 between observed and expected deaths, NS; (2) Goodman-Kruskall G statistic = 0.673) Receiver-Operating-Characteristic (ROC) curve analysis with an area under the ROC curve, Az = 0.79 +/- 0.05. We conclude that a reduced immune response (DTH skin test anergy) plus a nutritional deficit and/or acute-phase response change are both associated with increased septic-related deaths in elective surgical patients. PMID:2472781

  4. Progression of localised Wilms' tumour during preoperative chemotherapy is an independent prognostic factor: a report from the SIOP 93-01 nephroblastoma trial and study.

    PubMed

    Ora, Ingrid; van Tinteren, Harm; Bergeron, Christophe; de Kraker, Jan

    2007-01-01

    The SIOP nephroblastoma clinical trials have previously demonstrated that preoperative chemotherapy is advantageous for patients with nephroblastoma (Wilms' tumour). However, some primary tumours increase in size during preoperative chemotherapy, and to investigate the clinical relevance of this progression we studied the patient cohort with increasing tumours included in the SIOP 93-01 study (June 1993 to June 2000). Patients were considered eligible if they had a confirmed localised Wilms' tumour that had been measured in at least two dimensions at diagnosis and before surgery. Tumour response to preoperative chemotherapy was defined according to criteria set by the World Health Organisation (WHO). Patient characteristics in the different response groups were compared and related to event-free survival and overall survival. Patient records were studied regarding compliance with protocol. Tumour progression during preoperative chemotherapy was observed in 57 of 1090 patients (5%) with localised Wilms' tumours. In those cases, the tumours were significantly smaller at diagnosis and were more often stage III (p=0.05) and associated with high risk histopathology (p=0.03). After adjustment for stage and risk group, progression was proved to be correlated with poorer event-free and overall survival (hazard ratio 1.9, p=0.026 and 3.2, p=0.002 respectively). In summary, progression of localised Wilms' tumours is rarely seen in patients during preoperative chemotherapy. However, independent of stage distribution and histopathological risk group, those whose tumours do increase in size have poorer event-free and overall survival.

  5. What is the utility of preoperative frailty assessment for risk stratification in cardiac surgery?

    PubMed

    Bagnall, Nigel Mark; Faiz, Omar; Darzi, Ara; Athanasiou, Thanos

    2013-08-01

    A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether frailty scoring can be used either separately or combined with conventional risk scores to predict survival and complications. Five hundred and thirty-five papers were found using the reported search, of which nine cohort studies represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. There is a paucity of evidence, as advanced age is a criterion for exclusion in most randomized controlled trials. Conventional models of risk following cardiac surgery are not calibrated to accurately predict the outcomes in the elderly and do not currently include frailty parameters. There is no universally accepted definition for frailty, but it is described as a physiological decline in multiple organ systems, decreasing a patient's capacity to withstand the stresses of surgery and disease. Frailty is manifest clinically as deficits in functional capacity, such as slow ambulation and impairments in the activities of daily living (ADL). Analysis of predictive models using area under receiver operating curves (AUC) suggested only a modest benefit by adding gait speed to a Society of Thoracic Surgeons (STS score)-Predicted Risk of Mortality or Major Morbidity (PROM) risk score (AUC 0.04 mean difference). However, a specialist frailty assessment tool named FORECAST was found to be superior at predicting adverse outcomes at 1 year compared with either EuroSCORE or STS score (AUC 0.09 mean difference). However, risk models incorporating frailty parameters require further validation and have not been widely adopted. Routine collection of objective frailty measures such as 5-metre walk time and ADL assessment will help to provide data to develop new risk-assessment models to facilitate risk stratification and

  6. Predictive and prognostic factors in definition of risk groups in endometrial carcinoma.

    PubMed

    Sorbe, Bengt

    2012-01-01

    Background. The aim was to evaluate predictive and prognostic factors in a large consecutive series of endometrial carcinomas and to discuss pre- and postoperative risk groups based on these factors. Material and Methods. In a consecutive series of 4,543 endometrial carcinomas predictive and prognostic factors were analyzed with regard to recurrence rate and survival. The patients were treated with primary surgery and adjuvant radiotherapy. Two preoperative and three postoperative risk groups were defined. DNA ploidy was included in the definitions. Eight predictive or prognostic factors were used in multivariate analyses. Results. The overall recurrence rate of the complete series was 11.4%. Median time to relapse was 19.7 months. In a multivariate logistic regression analysis, FIGO grade, myometrial infiltration, and DNA ploidy were independent and statistically predictive factors with regard to recurrence rate. The 5-year overall survival rate was 73%. Tumor stage was the single most important factor with FIGO grade on the second place. DNA ploidy was also a significant prognostic factor. In the preoperative risk group definitions three factors were used: histology, FIGO grade, and DNA ploidy. Conclusions. DNA ploidy was an important and significant predictive and prognostic factor and should be used both in preoperative and postoperative risk group definitions.

  7. [Responsibility of the anaesthetist in preoperative risk management. Comments on the legal implications of medical publications in this field].

    PubMed

    Bock, R-W; Dudziak, R; Wilke, H J

    2004-06-01

    There is an increasing number of publications in the medical literature which address the medical and legal obligations of a specialist in a given field. These articles, mostly editorials, seek to delineate the optimal course of treatment based on the current state of the art and science of medicine. However, we believe that the unreflected adoption of these often highly theoretical ideas and suggestions carries its own dangers. For one thing, there is the threatening financial crisis in the public health system. In addition, the feasibility of implementing these suggestions in routine medical and surgical practice is questionable. Last but not least, suggestions and guidelines for preoperative risk management by, for instance, Lingnau and Strohmenger 2002 cross the well established boundaries of the various medical and surgical specialties, which obviously demands careful deliberations among the specialties involved. So far, few specialty boards have seen fit to act on these suggestions. Our article on the medical and legal responsibilities of the anaesthesiologist in perioperative risk management restates the aforementioned concerns. We attempt to point out medical and legal points of controversy. In particular, we caution against the ever present danger of a bona fide adoption of visionary guidelines as the "standard of care" by both medical and legal experts. We feel that it is imperative to carefully evaluate editorial comments and suggestions, however well meaning, in the light of established teaching and practice, lest these comments and suggestions become the basis of an unjustified determination of a physicians innocence or guilt in a court of law.

  8. Preoperative administration of 0.2% chlorhexidine mouthrinse reduces the risk of bacteraemia associated with intra-alveolar tooth extraction.

    PubMed

    Ugwumba, Chinedu U; Adeyemo, Wasiu L; Odeniyi, Olalekan M; Arotiba, Godwin T; Ogunsola, Folasade T

    2014-12-01

    The aim of the study was to investigate the effect of preoperative 0.2% chlorhexidine mouthwash on the risk of bacteraemia following routine intra-alveolar tooth extraction. The study was a randomized controlled clinical study of 101 subjects who underwent intra-alveolar dental extractions under local anaesthesia. Subjects were randomly assigned to either chlorhexidine or a control group. The chlorhexidine group had 0.2% chlorhexidine mouthwash administered for 1 min before any dental manipulation, and the control group had a mouthrinse of sterile water. Blood samples were collected at baseline, 1 min and 15 min after the dental extractions. Subculture and further identification of the isolated bacteria were performed by conventional microbiological techniques. There was a statistically significant difference in the incidence of bacteraemia between the control group (52.4%) and chlorhexidine group (27.1%) (P = 0.012). Bacteraemia was most frequently detected at 1 min after extraction (33.3%). Of the 30 subjects who had positive blood culture at 1 min, bacteraemia persisted in 8 (26.7%) of the subjects after 15 min. Bacteria isolated included Staphylococcus aureus, Actinomycetes naesulendi, Prevotella species, Streptococcus spp., and Acinetobacter iwoffii. Routine use of 0.20% chlorhexidine mouthwash before dental extraction is recommended to reduce the risk of bacteraemia following tooth extraction.

  9. Risk factors for postoperative complications following oral surgery

    PubMed Central

    SHIGEISHI, Hideo; OHTA, Kouji; TAKECHI, Masaaki

    2015-01-01

    Objective The objective of this study was to clarify significant risk factors for postoperative complications in the oral cavity in patients who underwent oral surgery, excluding those with oral cancer. Material and Methods This study reviewed the records of 324 patients who underwent mildly to moderately invasive oral surgery (e.g., impacted tooth extraction, cyst excision, fixation of mandibular and maxillary fractures, osteotomy, resection of a benign tumor, sinus lifting, bone grafting, removal of a sialolith, among others) under general anesthesia or intravenous sedation from 2012 to 2014 at the Department of Oral and Maxillofacial Reconstructive Surgery, Hiroshima University Hospital. Results Univariate analysis showed a statistical relationship between postoperative complications (i.e., surgical site infection, anastomotic leak) and diabetes (p=0.033), preoperative serum albumin level (p=0.009), and operation duration (p=0.0093). Furthermore, preoperative serum albumin level (<4.0 g/dL) and operation time (≥120 minutes) were found to be independent factors affecting postoperative complications in multiple logistic regression analysis results (odds ratio 3.82, p=0.0074; odds ratio 2.83, p=0.0086, respectively). Conclusion Our results indicate that a low level of albumin in serum and prolonged operation duration are important risk factors for postoperative complications occurring in the oral cavity following oral surgery. PMID:26398515

  10. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee

    PubMed Central

    Eka, Aleeson

    2015-01-01

    Despite advancements and improvements in methods for preventing infection, periprosthetic joint infection (PJI) is a significant complication following total joint arthroplasty (TJA). Prevention is the most important strategy to deal with this disabling complication, and prevention should begin with identifying patient-related risk factors. Medical risk factors, such as morbid obesity, malnutrition, hyperglycemia, uncontrolled diabetes mellitus, rheumatoid arthritis (RA), preoperative anemia, cardiovascular disorders, chronic renal failure, smoking, alcohol abuse and depression, should be evaluated and optimized prior to surgery. Treating patients to get laboratory values under a specified threshold or cessation of certain modifiable risk factors can decrease the risk of PJI. Although significant advances have been made in past decades to identify these risk factors, there remains some uncertainty regarding the risk factors predisposing TJA patients to PJI. Through a review of the current literature, this paper aims to comprehensively evaluate and provide a better understanding of known medical risk factors for PJI after TJA. PMID:26539450

  11. Preoperative therapy with pazopanib in high-risk soft tissue sarcoma: a phase II window-of-opportunity study by the German Interdisciplinary Sarcoma Group (GISG-04/NOPASS)

    PubMed Central

    Ronellenfitsch, Ulrich; Dimitrakopoulou-Strauss, Antonia; Jakob, Jens; Kasper, Bernd; Nowak, Kai; Pilz, Lothar R; Attenberger, Ulrike; Gaiser, Timo; Egerer, Gerlinde; Fröhling, Stefan; Derigs, Hans-Günter; Schwarzbach, Matthias; Hohenberger, Peter

    2016-01-01

    Introduction For resectable soft tissue sarcoma (STS), radical surgery, usually combined with radiotherapy, is the mainstay of treatment and the only potentially curative modality. Since surgery is often complicated by large tumour size and extensive tumour vasculature, preoperative treatment strategies with the aim of devitalising the tumour are being explored. One option is treatment with antiangiogenic drugs. The multikinase inhibitor pazopanib, which possesses pronounced antiangiogenic effects, has shown activity in metastatic and unresectable STS, but has so far not been tested in the preoperative setting. Methods and analysis This open-label, multicentre phase II window-of-opportunity trial assesses pazopanib as preoperative treatment of resectable STS. Participants receive a 21-day course of pazopanib 800 mg daily during wait time for surgery. Major eligibility criteria are resectable, high-risk adult STS of any location, or metachronous solitary STS metastasis for which resection is planned, and adequate organ function and performance status. The trial uses an exact single-stage design. The primary end point is metabolic response rate (MRR), that is, the proportion of patients with >50% reduction of the mean standardised uptake value (SUVmean) in post-treatment compared to pre-treatment fluorodeoxyglucose positron emission tomography CT. The MRR below which the treatment is considered ineffective is 0.2. The MRR above which the treatment warrants further exploration is 0.4. With a type I error of 5% and a power of 80%, the sample size is 35 evaluable patients, with 12 or more responders as threshold. Main secondary end points are histopathological and MRI response, resectability, toxicity, recurrence-free and overall survival. In a translational substudy, endothelial progenitor cells and vascular epithelial growth factor receptor are analysed as potential prognostic and predictive markers. Ethics and dissemination Approval by the ethics committee II

  12. Weighing of risk factors for penetrating keratoplasty graft failure: application of Risk Score System

    PubMed Central

    Tourkmani, Abdo Karim; Sánchez-Huerta, Valeria; De Wit, Guillermo; Martínez, Jaime D.; Mingo, David; Mahillo-Fernández, Ignacio; Jiménez-Alfaro, Ignacio

    2017-01-01

    AIM To analyze the relationship between the score obtained in the Risk Score System (RSS) proposed by Hicks et al with penetrating keratoplasty (PKP) graft failure at 1y postoperatively and among each factor in the RSS with the risk of PKP graft failure using univariate and multivariate analysis. METHODS The retrospective cohort study had 152 PKPs from 152 patients. Eighteen cases were excluded from our study due to primary failure (10 cases), incomplete medical notes (5 cases) and follow-up less than 1y (3 cases). We included 134 PKPs from 134 patients stratified by preoperative risk score. Spearman coefficient was calculated for the relationship between the score obtained and risk of failure at 1y. Univariate and multivariate analysis were calculated for the impact of every single risk factor included in the RSS over graft failure at 1y. RESULTS Spearman coefficient showed statistically significant correlation between the score in the RSS and graft failure (P<0.05). Multivariate logistic regression analysis showed no statistically significant relationship (P>0.05) between diagnosis and lens status with graft failure. The relationship between the other risk factors studied and graft failure was significant (P<0.05), although the results for previous grafts and graft failure was unreliable. None of our patients had previous blood transfusion, thus, it had no impact. CONCLUSION After the application of multivariate analysis techniques, some risk factors do not show the expected impact over graft failure at 1y. PMID:28393027

  13. Risk factors for persistent diarrhoea.

    PubMed

    Shahid, N S; Sack, D A; Rahman, M; Alam, A N; Rahman, N

    1988-10-22

    With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks.

  14. Risk factors for persistent diarrhoea.

    PubMed Central

    Shahid, N. S.; Sack, D. A.; Rahman, M.; Alam, A. N.; Rahman, N.

    1988-01-01

    With a systematically sampled population of children aged under 5 attending this centre for diarrhoeal disease research during 1983-5 a retrospective analysis of persistent diarrhoea (defined as greater than 14 days' duration) was performed to identify the possible risk factors for this syndrome. Of the 4155 children included in the analysis, 410 (10%) gave a history of persistent diarrhoea. A comparison with children with acute diarrhoea matched for age showed that 11 factors were correlated with persistent diarrhoea, and strongly associated factors were stools with blood or mucus, or both, lower respiratory tract infection, malnutrition, vitamin A deficiency, and antibiotic use before presentation. The peak age was 2 years, and there was no sex difference. Deaths occurred more often in the group with persistent diarrhoea. Although Shigella spp, Campylobacter jejuni, and Giardia lamblia were frequently identified, their rates of isolation were not significantly higher among patients with persistent diarrhoea. No seasonal variation was observed in the rates of persistent diarrhoea. Although the introduction of family food to the diet was associated with higher rates, this factor was difficult to separate from the age dependent risks. PMID:3142603

  15. Psychological factors as risk factors for poor hip function after total hip arthroplasty

    PubMed Central

    Benditz, Achim; Jansen, Petra; Schaible, Jan; Roll, Christina; Grifka, Joachim; Götz, Jürgen

    2017-01-01

    Recovery after total hip arthroplasty (THA) is influenced by several psychological aspects, such as depression, anxiety, resilience, and personality traits. We hypothesized that preoperative depression impedes early functional outcome after THA (primary outcome measure). Additional objectives were perioperative changes in the psychological status and their influence on perioperative outcome. This observational study analyzed depression, anxiety, resilience, and personality traits in 50 patients after primary unilateral THA. Hip functionality was measured by means of the Harris Hip Score. Depression, state anxiety, and resilience were evaluated preoperatively as well as 1 and 5 weeks postoperatively. Trait anxiety and personality traits were measured once preoperatively. Patients with low depression and anxiety levels had significantly better outcomes with respect to early hip functionality. Resilience and personality traits did not relate to hip functionality. Depression and state anxiety levels significantly decreased within the 5-week stay in the acute and rehabilitation clinic, whereas resilience remained at the same level. Our study suggests that low depression and anxiety levels are positively related to early functionality after THA. Therefore, perioperative measurements of these factors seem to be useful to provide the best support for patients with risk factors. PMID:28260910

  16. Preoperative Evaluation for Noncardiac Surgery.

    PubMed

    Cohn, Steven L

    2016-12-06

    This issue provides a clinical overview of preoperative evaluation for noncardiac surgery, focusing on risk factors, elements of evaluation, medication management, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  17. Ventilator associated pneumonia following liver transplantation: Etiology, risk factors and outcome

    PubMed Central

    Siniscalchi, Antonio; Aurini, Lucia; Benini, Beatrice; Gamberini, Lorenzo; Nava, Stefano; Viale, Pierluigi; Faenza, Stefano

    2016-01-01

    AIM: To determine the incidence, etiology, risk factors and outcome of ventilator-associated pneumonia (VAP) in patients undergoing orthotopic liver transplantation (OLT). METHODS: This retrospective study considered 242 patients undergoing deceased donor OLT. VAP was diagnosed according to clinical and microbiological criteria. RESULTS: VAP occurred in 18 (7.4%) patients, with an incidence of 10 per 1000 d of mechanical ventilation (MV). Isolated bacterial etiologic agents were mainly Enterobacteriaceae (79%). Univariate logistic analysis showed that model for end-stage liver disease (MELD) score, pre-operative hospitalization, treatment with terlipressin, Child-Turcotte-Pugh score, days of MV and red cell transfusion were risk factors for VAP. Multivariate analysis, considering significant risk factors in univariate analysis, demonstrated that pneumonia was strongly associated with terlipressin usage, pre-operative hospitalization, days of MV and red cell transfusion. Mortality rate was 22% in the VAP group vs 4% in the group without VAP. CONCLUSION: Our data suggest that VAP is an important cause of nosocomial infection during postoperative period in OLT patients. MELD score was a significant risk factor in univariate analysis. Multiple transfusions, treatment with terlipressin, preoperative hospitalization rather than called to the hospital while at home and days of MV constitute important risk factors for VAP development. PMID:27358784

  18. Environmental Risk Factors for ARDS

    PubMed Central

    Moazed, Farzad; Calfee, Carolyn S.

    2014-01-01

    The acute respiratory distress syndrome (ARDS) remains a major cause of morbidity and mortality in critically ill patients. Over the past several decades, alcohol abuse and cigarette smoke exposure have been identified as risk factors for the development of ARDS. The mechanisms underlying these relationships are complex and remain under investigation but are thought to involve pulmonary immune impairment as well as alveolar epithelial and endothelial dysfunction. This review summarizes the epidemiologic data supporting links between these exposures and ARDS susceptibility and outcomes and highlights key mechanistic investigations that provide insight into the pathways by which each exposure is linked to ARDS. PMID:25453414

  19. Women's Heart Disease: Heart Disease Risk Factors

    MedlinePlus

    ... this page please turn JavaScript on. Feature: Women's Heart Disease Heart Disease Risk Factors Past Issues / Winter 2014 Table ... or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk ...

  20. Heart Disease Risk Factors You Can Control

    MedlinePlus

    ... and Stroke Heart disease risk factors you can control Did you know? In women, high triglycerides combined ... information on Heart disease risk factors you can control Read more from womenshealth.gov Heart Disease Fact ...

  1. Skin Cancer: Biology, Risk Factors & Treatment

    MedlinePlus

    ... turn Javascript on. Feature: Skin Cancer Skin Cancer: Biology, Risk Factors & Treatment Past Issues / Summer 2013 Table ... Articles Skin Cancer Can Strike Anyone / Skin Cancer: Biology, Risk Factors & Treatment / Timely Healthcare Checkup Catches Melanoma ...

  2. Risk factors identified for certain lymphoma subtypes

    Cancer.gov

    In a large international collaborative analysis of risk factors for non-Hodgkin lymphoma (NHL), scientists were able to quantify risk associated with medical history, lifestyle factors, family history of blood or lymph-borne cancers, and occupation for 11

  3. Configurations of Common Childhood Psychosocial Risk Factors

    ERIC Educational Resources Information Center

    Copeland, William; Shanahan, Lilly; Costello, E. Jane; Angold, Adrian

    2009-01-01

    Background: Co-occurrence of psychosocial risk factors is commonplace, but little is known about psychiatrically-predictive configurations of psychosocial risk factors. Methods: Latent class analysis (LCA) was applied to 17 putative psychosocial risk factors in a representative population sample of 920 children ages 9 to 17. The resultant class…

  4. Modifying Risk Factors: Strategies That Work Diabetes Mellitus.

    PubMed

    Stryker, Louis S

    2016-08-01

    An estimated 29.1 million Americans are currently diagnosed with diabetes, and this number is expected to increase to 48.3 million Americans by 2050. Correspondingly, the present burden of diabetes among patients undergoing total joint arthroplasty is significant and rising. Diabetes as a chronic condition is a well-established risk factor for complication after total joint arthroplasty. A growing body of evidence also indicates that hyperglycemia in the perioperative period, and not the diagnosis of diabetes alone, is similarly associated with increased complication risk. As a result, a coordinated approach to preoperative screening and optimization, combined with judicious perioperative glycemic control, may present an opportunity to improve outcomes, reduce complications, and avoid complication-related costs for patients undergoing total joint arthroplasty.

  5. Preoperative lymphocyte count is an independent prognostic factor in node-negative non-small cell lung cancer.

    PubMed

    Kobayashi, Naohiro; Usui, Shingo; Kikuchi, Shinji; Goto, Yukinobu; Sakai, Mitsuaki; Onizuka, Masataka; Sato, Yukio

    2012-02-01

    A number of prognostic factors have been reported in non-small cell lung cancer (NSCLC). Although lymph node metastasis is the most poorly predictive value in completely resected NSCLC, a significant number of patients have a fatal recurrence even in node-negative curative NSCLC. Recently inflammatory response has been shown as a predictive value in NSCLC. Neutrophils and lymphocytes play an important role in cancer immune response. In this study, we retrospectively examined the impact of preoperative peripheral neutrophil and lymphocyte counts on survival, and investigated the relationships of these factors to clinicopathological factors in node-negative NSCLC. A total 237 patients were evaluated. When the cut-off value of neutrophil count was 4500 mm(-3) with a maximum log-rank statistical value, overall 5-year survival rates were 79.7% for the low-neutrophil-count group and 69.5% for the high-neutrophil-count group (P=0.04). When the cut-off value of lymphocyte count was 1900 mm(-3) with a maximum log-rank statistical value, overall survival rates were 67.9% for the low-lymphocyte group and 87.7% for the high-lymphocyte group (P<0.001). High-neutrophil-counts were associated with tumor size (P=0.002) and pleural invasion (P<0.001). Low-lymphocyte-counts were correlated with vascular invasion (P=0.018) and recurrence of NSCLC (P=0.01). Multivariate analysis showed that the lymphocyte count was an independent prognostic factor (hazard ratio: 3.842; 95% confidence interval: 1.827-8.078; P<0.001), but the neutrophil count was not (P=0.185). We conclude that a peripheral lymphocyte count, which is associated with vascular invasion, is an independent prognostic factor in node-negative NCSLC.

  6. Risk factors for gallbladder contractility after cholecystolithotomy in elderly high-risk surgical patients

    PubMed Central

    Wang, Tao; Luo, Hao; Yan, Hong-tao; Zhang, Guo-hu; Liu, Wei-hui; Tang, Li-jun

    2017-01-01

    Objective Cholecystolithiasis is a common disease in the elderly patient. The routine therapy is open or laparoscopic cholecystectomy. In the previous study, we designed a minimally invasive cholecystolithotomy based on percutaneous cholecystostomy combined with a choledochoscope (PCCLC) under local anesthesia. Methods To investigate the effect of PCCLC on the gallbladder contractility function, PCCLC and laparoscope combined with a choledochoscope were compared in this study. Results The preoperational age and American Society of Anesthesiologists (ASA) scores, as well as postoperational lithotrity rate and common biliary duct stone rate in the PCCLC group, were significantly higher than the choledochoscope group. However, the pre- and postoperational gallbladder ejection fraction was not significantly different. Univariable and multivariable logistic regression analyses indicated that the preoperational thickness of gallbladder wall (odds ratio [OR]: 0.540; 95% confidence interval [CI]: 0.317–0.920; P=0.023) and lithotrity (OR: 0.150; 95% CI: 0.023–0.965; P=0.046) were risk factors for postoperational gallbladder ejection fraction. The area under receiver operating characteristics curve was 0.714 (P=0.016; 95% CI: 0.553–0.854). Conclusion PCCLC strategy should be carried out cautiously. First, restricted by the diameter of the drainage tube, the PCCLC should be used only for small gallstones in high-risk surgical patients. Second, the usage of lithotrity should be strictly limited to avoid undermining the gallbladder contractility and increasing the risk of secondary common bile duct stones. PMID:28138229

  7. Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors

    PubMed Central

    Tolone, Salvatore; Gualtieri, Giorgia; Savarino, Edoardo; Frazzoni, Marzio; de Bortoli, Nicola; Furnari, Manuele; Casalino, Giuseppina; Parisi, Simona; Savarino, Vincenzo; Docimo, Ludovico

    2016-01-01

    Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication. PMID:27933133

  8. Pre-operative clinical and instrumental factors as antireflux surgery outcome predictors.

    PubMed

    Tolone, Salvatore; Gualtieri, Giorgia; Savarino, Edoardo; Frazzoni, Marzio; de Bortoli, Nicola; Furnari, Manuele; Casalino, Giuseppina; Parisi, Simona; Savarino, Vincenzo; Docimo, Ludovico

    2016-11-27

    Gastroesophageal reflux disease (GERD) is nowadays a highly prevalent, chronic condition, with 10% to 30% of Western populations affected by weekly symptoms. Many patients with mild reflux symptoms are treated adequately with lifestyle modifications, dietary changes, and low-dose proton pump inhibitors (PPIs). For those with refractory GERD poorly controlled with daily PPIs, numerous treatment options exist. Fundoplication is currently the most commonly performed antireflux operation for management of GERD. Outcomes described in current literature following laparoscopic fundoplication indicate that it is highly effective for treatment of GERD; early clinical studies demonstrate relief of symptoms in approximately 85%-90% of patients. However it is still unclear which factors, clinical or instrumental, are able to predict a good outcome after surgery. Virtually all demographic, esophagogastric junction anatomic conditions, as well as instrumental (such as presence of esophagitis at endoscopy, or motility patterns determined by esophageal high resolution manometry or reflux patterns determined by means of pH/impedance-pH monitoring) and clinical features (such as typical or atypical symptoms presence) of patients undergoing laparoscopic fundoplication for GERD can be factors associated with symptomatic relief. With this in mind, we sought to review studies that identified the factors that predict outcome after laparoscopic total fundoplication.

  9. Hepatectomy for hepatocellular carcinoma larger than 10 cm: preoperative risk stratification to prevent futile surgery

    PubMed Central

    Lim, Chetana; Compagnon, Philippe; Sebagh, Mylène; Salloum, Chady; Calderaro, Julien; Luciani, Alain; Pascal, Gérard; Laurent, Alexis; Levesque, Eric; Maggi, Umberto; Feray, Cyrille; Cherqui, Daniel; Castaing, Denis; Azoulay, Daniel

    2015-01-01

    Objectives Appropriate patient selection is important to achieving good outcomes and obviating futile surgery in patients with huge (≥10 cm) hepatocellular carcinoma (HCC). The aim of this study was to identify independent predictors of futile outcomes, defined as death within 3 months of surgery or within 1 year from early recurrence following hepatectomy for huge HCC. Methods The outcomes of 149 patients with huge HCCs who underwent resection during 1995–2012 were analysed. Multivariate logistic regression analysis was performed to identify preoperative independent predictors of futility. Results Independent predictors of 3-month mortality (18.1%) were: total bilirubin level <34 μmol/l [P = 0.0443; odds ratio (OR) 16.470]; platelet count of <150 000 cells/ml (P = 0.0098; OR 5.039), and the presence of portal vein tumour thrombosis (P = 0.0041; OR 5.138). The last of these was the sole independent predictor of 1-year recurrence-related mortality (17.2%). Rates of recurrence-related mortality at 3 months and 1 year were, respectively, 6.3% and 7.1% in patients with Barcelona Clinic Liver Cancer (BCLC) stage A disease, 12.5% and 14% in patients with BCLC stage B disease, and 37.8% (P = 0.0002) and 75% (P = 0.0002) in patients with BCLC stage C disease. Conclusions According to the present data, among patients submitted to hepatectomy for huge HCC, those with a high bilirubin level, low platelet count and portal vein thrombosis are at higher risk for futile surgery. The presence of portal vein tumour thrombosis should be regarded as a relative contraindication to surgery. PMID:25980326

  10. Risk factors for postoperative cerebrospinal fluid leak and meningitis after expanded endoscopic endonasal surgery.

    PubMed

    Ivan, Michael E; Iorgulescu, J Bryan; El-Sayed, Ivan; McDermott, Michael W; Parsa, Andrew T; Pletcher, Steven D; Jahangiri, Arman; Wagner, Jeffrey; Aghi, Manish K

    2015-01-01

    Postoperative cerebrospinal fluid (CSF) leak is a serious complication of transsphenoidal surgery, which can lead to meningitis and often requires reparative surgery. We sought to identify preoperative risk factors for CSF leaks and meningitis. We reviewed 98 consecutive expanded endoscopic endonasal surgeries performed from 2008-2012 and analyzed preoperative comorbidities, intraoperative techniques, and postoperative care. Univariate and multivariate analyses were performed. The most common pathologies addressed included pituitary adenoma, Rathke cyst, chordoma, esthesioneuroblastoma, meningioma, nasopharyngeal carcinoma, and squamous cell carcinoma. There were 11 CSF leaks (11%) and 10 central nervous system (CNS) infections (10%). Univariate and multivariate analysis of preoperative risk factors showed that patients with non-ideal body mass index (BMI) were associated with higher rate of postoperative CSF leak and meningitis (both p<0.01). Also, patients with increasing age were associated with increased CSF leak (p = 0.03) and the length of time a lumbar drain was used postoperatively was associated with infection in a univariate analysis. In addition, three of three endoscopic transsphenoidal surgeries combined with open cranial surgery had a postoperative CSF leak and CNS infection rate which was a considerably higher rate than for transsphenoidal surgeries alone or surgeries staged with open cases (p<0.01 and p=0.04, respectively) In this series of expanded endoscopic transsphenoidal surgeries, preoperative BMI remains the most important preoperative predictor for CSF leak and infection. Other risk factors include age, intraoperative CSF leak, lumbar drain duration, and cranial combined cases. Risks associated with complex surgical resections when combining open and endoscopic approaches could be minimized by staging these procedures.

  11. Adverse Drug Effects and Preoperative Medication Factors Related to Perioperative Low-Dose Ketamine Infusions.

    PubMed

    Schwenk, Eric S; Goldberg, Stephen F; Patel, Ronak D; Zhou, Jon; Adams, Douglas R; Baratta, Jaime L; Viscusi, Eugene R; Epstein, Richard H

    2016-01-01

    High-dose opioid administration is associated with significant adverse events. Evidence suggests that low-dose ketamine infusions improve perioperative analgesia over conventional opioid management, but usage is highly variable. Ketamine's adverse drug effects (ADEs) are well known, but their prevalence during low-dose infusions in a clinical setting and how often they lead to infusion discontinuation are unknown. The purposes of this study were 3-fold: (1) to identify patient factors associated with initiation of ketamine infusions during spine surgery, (2) to identify specific spine procedures in which ketamine has been used most frequently, and (3) to identify ADEs associated with postoperative ketamine infusions and which ADEs most frequently led to discontinuation. Spine surgery was chosen because of its association with moderate to severe pain and a relatively high use of ketamine infusions in this population at our hospital.

  12. What Are the Risk Factors for Eye Cancer?

    MedlinePlus

    ... and Prevention What Are the Risk Factors for Eye Cancer? A risk factor is anything that affects ... or no known risk factors. Risk factors for eye melanoma Race/ethnicity The risk of intraocular melanoma ...

  13. Association between pathologic response in metastatic lymph nodes after preoperative chemoradiotherapy and risk of distant metastases in rectal cancer: An analysis of outcomes in a randomized trial

    SciTech Connect

    Bujko, Krzysztof . E-mail: bujko@coi.waw.pl; Michalski, Wojciech M.S.; Kepka, Lucyna; Nowacki, Marek P.; Nasierowska-Guttmejer, Anna; Tokar, Piotr; Dymecki, Dariusz; Pawlak, Mariusz; Lesniak, Tadeusz; Richter, Piotr; Wojnar, Andrzej; Chmielik, Ewa

    2007-02-01

    Purpose: To compare 5 x 5 Gy preoperative radiotherapy with immediate surgery vs. preoperative chemoradiotherapy (50.4 Gy, 5-fluorouracil, leucovorin) with delayed surgery in a randomized trial for cT3-T4 low-lying rectal cancer. Despite the downstaging effect of chemoradiotherapy, similar long-term outcomes were observed in both groups. Methods: The Cox model was used to evaluate the prognostic value of ypTN ('yp' denotes that pathologic classification was performed after initial multimodality therapy) categories and the surgical margin status in 291 patients. Results: Disease-free survival (DFS) (hazard ratio [HR] 1.05, 95% confidence interval [CI], 0.73-1.51), distant metastases (HR, 1.17; 95% CI, 0.77-1.78), and local control (HR, 1.45; 95% CI, 0.74-2.84) were similar in both arms. The ypN status was the only independent prognostic factor for DFS (p < 0.001). An interaction (p = 0.016) between N stage and the assigned treatment was demonstrated. For ypN-negative patients, DFS was similar in both arms (HR, 0.83, 95% CI, 0.47-1.48); however, for ypN-positive patients, DFS was worse in the chemoradiotherapy arm (HR, 1.73; 95% CI, 1.07-2.77). The 4-year (median follow-up) DFS rate in N-positive patients was 51% in the 5 x 5-Gy arm vs. 25% in the chemoradiotherapy arm. The corresponding 4-year rates for the incidence of local recurrence and distant metastases were 14% vs. 27% (HR, 1.95; 95% CI, 0.78-4.86) and 38% vs. 68% (HR, 2.05; 95% CI, 1.21-3.48). Conclusion: N-positive disease after chemoradiotherapy indicates radiochemoresistance. N-positive disease after 5 x 5 Gy RT includes both radiosensitive and radioresistant tumors, because the interval between radiotherapy and surgery was too short for radiosensitive cancer to undergo necrosis. Thus, the greater risk of distant metastases recorded in the chemoradiotherapy arm suggests that radiochemoresistance of nodal metastases from rectal cancer is associated with a high potential for developing distant metastases.

  14. Preoperative posterior tilt of at least 20° increased the risk of fixation failure in Garden-I and -II femoral neck fractures

    PubMed Central

    Dolatowski, Filip C; Adampour, Mina; Frihagen, Frede; Stavem, Knut; Erik Utvåg, Stein; Hoelsbrekken, Sigurd Erik

    2016-01-01

    Background and purpose It has been suggested that preoperative posterior tilt of the femoral head may increase the risk of fixation failure in Garden-I and -II femoral neck fractures. To investigate this association, we studied a cohort of 322 such patients. Patients and methods Patients treated with internal fixation between 2005 and 2012 were retrospectively identified using hospital records and the digital image bank. 2 raters measured the preoperative posterior tilt angle and categorized it into 3 groups: < 10°, 10–20°, and ≥ 20°. The inter-rater reliability (IRR) was determined. Patients were observed until September 2013 (with a minimum follow-up of 18 months) or until failure of fixation necessitating salvage arthroplasty. The risk of fixation failure was assessed using competing-risk regression analysis, adjusting for time to surgery. Results Patients with a posterior tilt of ≥ 20° had a higher risk of fixation failure: 19% (8/43) as compared to 11% (14/127) in the 10–20° category and 6% (9/152) in the < 10° category (p = 0.03). Posterior tilt of ≥ 20° increased the risk of fixation failure, with an adjusted hazard ratio of 3.4 (95% CI: 1.3–8.9; p = 0.01). The interclass correlation coefficient for angular measurements of posterior tilt was 0.90 (95% CI: 0.87–0.92), and the IRR for the categorization of posterior tilt into 3 groups was 0.76 (95% CI: 0.69–0.81). Interpretation Preoperative posterior tilt of ≥ 20° in Garden-I and -II femoral neck fractures increased the risk of fixation failure necessitating salvage arthroplasty. The reliability of the methods that we used to measure posterior tilt ranged from good to excellent. PMID:26937557

  15. Suicide Risk Factors in Alcohol Abuse.

    ERIC Educational Resources Information Center

    Motto, Jerome A.

    1980-01-01

    A current focus in evaluating suicide risk is the "clinical model" approach, which determines those factors associated with high risk for suicide. The sociological factors identified as estimators of suicide risk included impaired health, job instability, multiple unit residence, no change in living setting, and modest financial resources. (JAC)

  16. Family Factors Predicting Categories of Suicide Risk

    ERIC Educational Resources Information Center

    Randell, Brooke P.; Wang, Wen-Ling; Herting, Jerald R.; Eggert, Leona L.

    2006-01-01

    We compared family risk and protective factors among potential high school dropouts with and without suicide-risk behaviors (SRB) and examined the extent to which these factors predict categories of SRB. Subjects were randomly selected from among potential dropouts in 14 high schools. Based upon suicide-risk status, 1,083 potential high school…

  17. Elevated Preoperative Serum Hs-CRP Level as a Prognostic Factor in Patients Who Underwent Resection for Hepatocellular Carcinoma.

    PubMed

    Liu, Yu-Bin; Ying, Jie; Kuang, Su-Juan; Jin, Hao-Sheng; Yin, Zi; Chang, Liang; Yang, Hui; Ou, Ying-Liang; Zheng, Jiang-Hua; Zhang, Wei-Dong; Li, Chuan-Sheng; Jian, Zhi-Xiang

    2015-12-01

    To evaluate the effects of preoperative highly sensitive C-reactive protein (Hs-CRP) in serum on the prognostic outcomes of patients with hepatocellular carcinoma (HCC) following hepatic resection in Chinese samples.From January 2004 to December 2008, a total of 624 consecutive HCC patients who underwent hepatic resection were incorporated. Serum levels of Hs-CRP were tested at preoperation via a collection of venous blood samples. Survival analyses adopted the univariate and multivariate analyses.In our study, among the 624 screened HCC patients, 516 patients were eventually incorporated and completed follow-up. Positive correlations were found regarding preoperative serum Hs-CRP level and tumor size, Child-Pugh class, or tumor stage (all P < 0.0001). Patients with recurrence outcomes and nonsurvivors had increased Hs-CRP levels at preoperation (both P < 0.0001). When compared to the Hs-CRP-normal group, the overall survival (OS) and recurrence-free survival rates were evidently decreased in the Hs-CRP-elevated group. Further, preoperative serum Hs-CRP level might be having possible prediction effect regarding survival and recurrence of HCC patients after hepatic section in the multivariate analysis.Preoperative increased serum Hs-CRP level was an independent prognostic indicator in patients with HCC following hepatic resection in Chinese samples.

  18. Risk Factors for Complications After Esophageal Cancer Resection

    PubMed Central

    Viklund, Pernilla; Lindblad, Mats; Lu, Ming; Ye, Weimin; Johansson, Jan; Lagergren, Jesper

    2006-01-01

    Objective: To identify risk factors for complications after resection for esophageal or cardia cancer. Summary Background Data: Knowledge of risk factors for complications after esophageal resection for cancer is sparse, and prospective population-based studies are lacking. Methods: A prospective, nationwide, population-based study was conducted in Sweden in April 2, 2001 through December 31, 2003. Details about tumor characteristics and stage, surgical procedures, and complications were collected prospectively from the Swedish Esophageal and Cardia Cancer register. Medical records and specific charts from surgical procedures, histopathology reports, and intensive care units were continuously scrutinized. Multivariable logistic regression analyses were used to estimate relative risks and their 95% confidence intervals. Results: Among 275 patients undergoing surgical resection for esophageal or cardia cancer, 122 (44%) had at least one predefined complication. Operation by low-volume surgeons (<5 operations annually) were followed by more anastomotic leakages than those by surgeons with higher volume (odds ratio, 7.86; 95% confidence interval, 2.13–29.00). Hand-sewn and stapled anastomoses did not differ regarding risk of anastomotic leakage. Among cardia cancer patients, transthoracic approach resulted in more respiratory complications compared with transhiatal (abdominal only) approach (odds ratio, 4.78; 95% confidence interval, 1.66–13.76). Older age, adjuvant oncologic therapy, and higher preoperative bleeding volume nonsignificantly increased the risks of complications, while no influence of sex or tumor stage was found. Conclusions: High-volume esophageal surgeons seem to lower the risk of anastomotic leakage. More large-scale studies are warranted to establish the roles of the other potentially important risk factors suggested in our study. PMID:16432353

  19. Pathologic Nodal Classification Is the Most Discriminating Prognostic Factor for Disease-Free Survival in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy and Curative Resection

    SciTech Connect

    Kim, Tae Hyun; Chang, Hee Jin; Kim, Dae Yong

    2010-07-15

    Purpose: We retrospectively evaluated the effects of clinical and pathologic factors on disease-free survival (DFS) with the aim of identifying the most discriminating factor predicting DFS in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection. Methods and Materials: The study involved 420 patients who underwent preoperative CRT and curative resection between August 2001 and October 2006. Gender, age, distance from the anal verge, histologic type, histologic grade, pretreatment carcinoembryonic antigen (CEA) level, cT, cN, cStage, circumferential resection margin, type of surgery, preoperative chemotherapy, adjuvant chemotherapy, ypT, ypN, ypStage, and tumor regression grade (TRG) were analyzed to identify prognostic factors associated with DFS. To compare the discriminatory prognostic ability of four tumor response-related pathologic factors (ypT, ypN, ypStage, and TRG), the Akaike information criteria were calculated. Results: The 5-year DFS rate was 75.4%. On univariate analysis, distance from the anal verge, histologic type, histologic grade, pretreatment CEA level, cT, circumferential resection margin, type of surgery, preoperative chemotherapeutic regimen, ypT, ypN, ypStage, and TRG were significantly associated with DFS. Multivariate analysis showed that the four parameters ypT, ypN, ypStage, and TRG were, consistently, significant prognostic factors for DFS. The ypN showed the lowest Akaike information criteria value for DFS, followed by ypStage, ypT, and TRG, in that order. Conclusion: In our study, ypT, ypN, ypStage, and TRG were important prognostic factors for DFS, and ypN was the most discriminating factor.

  20. Risk Factors For Diabetic Polyneuropathy

    PubMed Central

    KAPLAN, Yüksel; KURT, Semiha; KARAER ÜNALDI, Hatice; ERKORKMAZ, Ünal

    2014-01-01

    Introduction The aim of this study was to investigate the risk factors for distal symmetric sensory-motor polyneuropathy (DSP) in patients with type 2 diabetes mellitus (DM). Method Sixty seven patients with type 2 DM (33 males and 34 females) were included in the study. In addition to a detailed neurological examination, the Michigan Neuropathy Screening Instrument was administered to all patients and their total neuropathy scores were calculated. Nerve conduction examinations were performed for all patients. Results The mean age of the patients was 52.83±.87 years. The mean glycosylated hemoglobin (HbA1C) value was 8.56±2.07% (normal: 3–6.5%). The total neuropathy score significantly correlated with diabetes duration, hypertension, retinopathy, and HbA1C. Conclusion This study confirms the previous reports regarding the association of neuropathy with poor glycaemic control and duration of the disease. The association of neuropathy with retinopathy and hypertension is important.

  1. Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery

    PubMed Central

    Tominaga, Hiroyuki; Setoguchi, Takao; Kawamura, Hideki; Kawamura, Ichiro; Nagano, Satoshi; Abematsu, Masahiko; Tanabe, Fumito; Ishidou, Yasuhiro; Yamamoto, Takuya; Komiya, Setsuro

    2016-01-01

    Abstract Surgical site infection (SSI) after spine instrumentation is difficult to treat, and often requires removal of instrumentation. The removal of instrumentation after spine surgery is a severe complication that can lead to the deterioration of activities of daily living and poor prognosis. Although there are many reports on SSI after spine surgery, few reports have investigated the risk factors for the removal of instrumentation after spine surgery SSI. This study aimed to identify the risk factors for unavoidable removal of instrumentation after SSI of spine surgery. We retrospectively reviewed 511 patients who underwent spine surgery with instrumentation at Kagoshima University Hospital from January 2006 to December 2014. Risk factors associated with SSI were analyzed via multiple logistic regression analysis. Parameters of the group that needed instrumentation removal were compared with the group that did not require instrumentation removal using the Mann–Whitney U and Fisher's exact tests. The posterior approach was used in most cases (453 of 511 cases, 88.6%). SSI occurred in 16 of 511 cases (3.14%) of spine surgery with instrumentation. Multivariate logistic regression analysis identified 2 significant risk factors for SSI: operation time, and American Society of Anesthesiologists physical status classification ≥ 3. Twelve of the 16 patients with SSI (75%) were able to keep the instrumentation after SSI. Pseudarthrosis occurred in 2 of 4 cases (50%) after instrumentation removal. Risk factors identified for instrumentation removal after spine SSI were a greater number of past surgeries, low preoperative hemoglobin, high preoperative creatinine, high postoperative infection treatment score for the spine, and the presence of methicillin-resistant Staphylococcus aureus. In these high risk cases, attempts should be made to decrease the risk factors preoperatively, and careful postoperative monitoring should be conducted. PMID:27787365

  2. Pressure ulcer prevalence and risk factors during prolonged surgical procedures.

    PubMed

    Primiano, Mike; Friend, Michael; McClure, Connie; Nardi, Scott; Fix, Lisa; Schafer, Marianne; Savochka, Kathlyn; McNett, Molly

    2011-12-01

    Pressure ulcer formation related to positioning while in the OR increases the length of hospital stay and hospital costs, but there is little evidence documenting how positioning devices used in the OR influence pressure ulcer development when examined with traditional risk factors. The aim of this prospective cohort study was to identify the prevalence of and risk factors associated with pressure ulcer development among patients undergoing surgical procedures lasting longer than three hours. Participants included all adult same-day admission patients scheduled for a three-hour surgical procedure during an eight-month period (N = 258). Data were gathered preoperatively, intraoperatively, and postoperatively on pressure ulcer risk factors. Bivariate analyses indicated that the type of positioning (ie, heels elevated) (χ(2) = 7.897, P = .048), OR bed surface (ie, foam table pad) (χ(2) = 15.848, P = .000), skin assessment in the postanesthesia care unit (χ(2) = 41.652, P = .000), and male gender (χ(2) = 6.984, P = .030) were associated with pressure ulcer development. Logistic regression analyses indicated that the use of a foam pad (β = 2.691, P = .024) and a lower day-one Braden score (β = .244, P = .003) were predictive of pressure ulcers.

  3. Risk Factors for Anterior Cruciate Ligament Injury

    PubMed Central

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra; Beynnon, Bruce D.

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) are immediately disabling and are associated with long-term consequences, such as posttraumatic osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 2 of a 2-part series, highlights what is known and still unknown regarding hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors for ACL injury. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in parts 1 and 2. Twenty-one focused on hormonal, genetic, cognitive function, previous injury, and extrinsic risk factors. Conclusions: Several risk factors are associated with increased risk of suffering ACL injury—such as female sex, prior reconstruction of the ACL, and familial predisposition. These risk factors most likely act in combination with the anatomic factors reviewed in part 1 of this series to influence the risk of suffering ACL injury. PMID:23016083

  4. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders.

    PubMed

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Liu, Sen; Yang, Sidong; Ding, Wenyuan

    2017-02-01

    The purpose of this study was to explore incidence and risk factors of adjacent segment disease (ASD) following posterior decompression and instrumented fusion for degenerative lumbar disorders, and hope to provide references in decision making and surgical planning for both spinal surgeon and surgically treated patients.By retrieving the medical records from January 2011 to December 2013 in our hospital, 237 patients were retrospectively reviewed. According to the occurrence of ASD at follow up, patients were divided into 2 groups: ASD and N-ASD group. To investigate risk values for the occurrence of ASD, 3 categorized factors were analyzed statistically: Patient characteristics: age, sex, body mass index (BMI), bone mineral density (BMD), duration. Surgical variables: surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, intraoperative superior facet joint violation. Radiographic parameters: preoperative lumbar lordosis, preoperative angular motion at adjacent segment, preoperative adjacent segment disc degeneration, preoperative paraspinal muscle degeneration.Postoperative ASD was developed in 15 of 237 patients (6.3%) at final follow up. There was no statistically significant difference between the 2 groups in patient characteristics of age, sex composition, BMD, duration, while the BMI was higher in ASD group than that in N-ASD group. There was no difference in surgical variables of surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, while intraoperative superior facet joint violation was more common in ASD group than that in N-ASD group. There was no difference in radiographic parameters of preoperative lumbar lordosis, preoperative paraspinal muscle degeneration, while preoperative adjacent segment disc degeneration were more severe in ASD group than that in N-ASD group. The Logistic regression analysis revealed that, BMI >25 kg/m, preoperative disc degeneration, and superior facet joint

  5. Incidence and risk factors of adjacent segment disease following posterior decompression and instrumented fusion for degenerative lumbar disorders

    PubMed Central

    Wang, Hui; Ma, Lei; Yang, Dalong; Wang, Tao; Liu, Sen; Yang, Sidong; Ding, Wenyuan

    2017-01-01

    Abstract The purpose of this study was to explore incidence and risk factors of adjacent segment disease (ASD) following posterior decompression and instrumented fusion for degenerative lumbar disorders, and hope to provide references in decision making and surgical planning for both spinal surgeon and surgically treated patients. By retrieving the medical records from January 2011 to December 2013 in our hospital, 237 patients were retrospectively reviewed. According to the occurrence of ASD at follow up, patients were divided into 2 groups: ASD and N-ASD group. To investigate risk values for the occurrence of ASD, 3 categorized factors were analyzed statistically: Patient characteristics: age, sex, body mass index (BMI), bone mineral density (BMD), duration. Surgical variables: surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, intraoperative superior facet joint violation. Radiographic parameters: preoperative lumbar lordosis, preoperative angular motion at adjacent segment, preoperative adjacent segment disc degeneration, preoperative paraspinal muscle degeneration. Postoperative ASD was developed in 15 of 237 patients (6.3%) at final follow up. There was no statistically significant difference between the 2 groups in patient characteristics of age, sex composition, BMD, duration, while the BMI was higher in ASD group than that in N-ASD group. There was no difference in surgical variables of surgical strategy, number of fusion level, surgery segment, surgery time, blood loss, while intraoperative superior facet joint violation was more common in ASD group than that in N-ASD group. There was no difference in radiographic parameters of preoperative lumbar lordosis, preoperative paraspinal muscle degeneration, while preoperative adjacent segment disc degeneration were more severe in ASD group than that in N-ASD group. The Logistic regression analysis revealed that, BMI >25 kg/m2, preoperative disc degeneration, and superior

  6. Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients

    PubMed Central

    Gillen, Jacob R.; Isbell, James M.; Michaels, Alex D.; Lau, Christine L.

    2015-01-01

    Abstract Background: Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing non-cardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not been clearly defined. Therefore, the purpose of this study was to investigate risk factors associated with CAUTIs in patients undergoing cardiac procedures. Methods: All patients undergoing cardiac surgery at a single institution from 2006 through 2012 (4,883 patients) were reviewed. Patients with U.S. Centers for Disease Control (CDC) criteria for CAUTI were identified from the hospital's Quality Assessment database. Pre-operative, operative, and post-operative patient factors were evaluated. Univariate and multivariable analyses were used to identify significant correlations between perioperative characteristics and CAUTIs. Results: There were 55 (1.1%) documented CAUTIs in the study population. On univariate analysis, older age, female gender, diabetes mellitus, cardiogenic shock, urgent or emergent operation, packed red blood cell (PRBC) units transfused, and intensive care unit length of stay (ICU LOS) were all significantly associated with CAUTI [p<0.05]. On multivariable logistic regression, older age, female gender, diabetes mellitus, and ICU LOS remained significantly associated with CAUTI. Additionally, there was a significant association between CAUTI and 30-d mortality on univariate analysis. However, when controlling for common predictors of operative mortality on multivariable analysis, CAUTI was no longer associated with mortality. Conclusions: There are several identifiable risk factors for CAUTI in patients undergoing cardiac procedures. CAUTI is not independently associated with increased mortality, but it does serve as a marker of sicker patients more likely to die from other comorbidities or complications. Therefore, awareness of the high-risk nature of these patients should lead to

  7. The preoperative alkaline phosphatase-to-platelet ratio index is an independent prognostic factor for hepatocellular carcinoma after hepatic resection

    PubMed Central

    Yu, Ya-Qun; Li, Jun; Liao, Yan; Chen, Qian; Liao, Wei-Jia; Huang, Jian

    2016-01-01

    Abstract A simple, inexpensive, and readily available prognostic index is highly needed to accurately predict the prognosis of hepatocellular carcinoma (HCC). This study aimed to develop a simple prognostic index using routine laboratory tests, alkaline phosphatase-to-platelet count ratio index (APPRI), to predict the likelihood of postoperative survival in HCC patients. A total of 246 patients with HCC undergoing curative resection were retrospectively analyzed. Cutoff point for APPRI was calculated using receiver operating characteristic curve analysis, and then the patients were divided into the low-APPRI group (APPRI ≤ 4.0) and the high-APPRI group (APPRI > 4.0). The influences of APPRI on disease-free survival (DFS) and overall survival (OS) were tested by the Kaplan–Meier method, and multivariate analysis using Cox regression. Elevated APPRI was associated with age, cirrhosis, and aspartate aminotransferase (AST) in HCC. Univariate analysis showed that APPRI > 4.0, tumor size >6 cm, multiple tumors, Barcelona-clinic liver cancer stages B to C, and AST > 40 U/L were significant predictors of worse DFS and OS. A multivariate analysis suggested that APPRI > 4.0 was an independent factor for DFS (hazard ratio [HR] = 1.689; 95% confidence interval [CI], 1.139–2.505; P = 0.009) and OS (HR = 1.664; 95% CI, 1.123–2.466; P = 0.011). Preoperative APPRI > 4.0 was a powerful prognostic predictor of adverse DFS and OS in HCC after surgery. The APPRI may be a promising prognostic marker for HCC after surgical resection. PMID:28002346

  8. Preoperative CA125 and fibrinogen in patients with endometrial cancer: a risk model for predicting lymphovascular space invasion

    PubMed Central

    2017-01-01

    Objective The aim of this study was to build a model to predict the risk of lymphovascular space invasion (LVSI) in women with endometrial cancer (EC). Methods From December 2010 to June 2013, 211 patients with EC undergoing surgery at Shanghai First Maternity and Infant Hospital were enrolled in this retrospective study. Those patients were divided into a positive LVSI group and a negative LVSI group. The clinical and pathological characteristics were compared between the two groups; logistic regression was used to explore risk factors associated with LVSI occurrence. The threshold values of significant factors were calculated to build a risk model and predict LVSI. Results There were 190 patients who were negative for LVSI and 21 patients were positive for LVSI out of 211 patients with EC. It was found that tumor grade, depth of myometrial invasion, number of pelvic lymph nodes, and International Federation of Gynecology and Obstetrics (FIGO) stage (p<0.05) were associated with LVSI occurrence. However, cervical involvement and age (p>0.05) were not associated with LVSI. Receiver operating characteristic (ROC) curves revealed that the threshold values of the following factors were correlated with positive LVSI: 28.1 U/mL of CA19-9, 21.2 U/mL of CA125, 2.58 mg/dL of fibrinogen (Fn), 1.84 U/mL of carcinoembryonic antigen (CEA) and (6.35×109)/L of white blood cell (WBC). Logistic regression analysis indicated that CA125 ≥21.2 (p=0.032) and Fn ≥2.58 mg/dL (p=0.014) were significantly associated with LVSI. Conclusion Positive LVSI could be predicted by CA125 ≥21.2 U/mL and Fn ≥2.58 mg/dL in women with EC. It could help gynecologists better adapt surgical staging and adjuvant therapies. PMID:27894164

  9. Clinical Risk Factors for Primary Graft Dysfunction after Lung Transplantation

    PubMed Central

    Lee, James C.; Kawut, Steven M.; Shah, Rupal J.; Localio, A. Russell; Bellamy, Scarlett L.; Lederer, David J.; Cantu, Edward; Kohl, Benjamin A.; Lama, Vibha N.; Bhorade, Sangeeta M.; Crespo, Maria; Demissie, Ejigayehu; Sonett, Joshua; Wille, Keith; Orens, Jonathan; Shah, Ashish S.; Weinacker, Ann; Arcasoy, Selim; Shah, Pali D.; Wilkes, David S.; Ware, Lorraine B.; Palmer, Scott M.; Christie, Jason D.

    2013-01-01

    Rationale: Primary graft dysfunction (PGD) is the main cause of early morbidity and mortality after lung transplantation. Previous studies have yielded conflicting results for PGD risk factors. Objectives: We sought to identify donor, recipient, and perioperative risk factors for PGD. Methods: We performed a 10-center prospective cohort study enrolled between March 2002 and December 2010 (the Lung Transplant Outcomes Group). The primary outcome was International Society for Heart and Lung Transplantation grade 3 PGD at 48 or 72 hours post-transplant. The association of potential risk factors with PGD was analyzed using multivariable conditional logistic regression. Measurements and Main Results: A total of 1,255 patients from 10 centers were enrolled; 211 subjects (16.8%) developed grade 3 PGD. In multivariable models, independent risk factors for PGD were any history of donor smoking (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.2–2.6; P = 0.002); FiO2 during allograft reperfusion (OR, 1.1 per 10% increase in FiO2; 95% CI, 1.0–1.2; P = 0.01); single lung transplant (OR, 2; 95% CI, 1.2–3.3; P = 0.008); use of cardiopulmonary bypass (OR, 3.4; 95% CI, 2.2–5.3; P < 0.001); overweight (OR, 1.8; 95% CI, 1.2–2.7; P = 0.01) and obese (OR, 2.3; 95% CI, 1.3–3.9; P = 0.004) recipient body mass index; preoperative sarcoidosis (OR, 2.5; 95% CI, 1.1–5.6; P = 0.03) or pulmonary arterial hypertension (OR, 3.5; 95% CI, 1.6–7.7; P = 0.002); and mean pulmonary artery pressure (OR, 1.3 per 10 mm Hg increase; 95% CI, 1.1–1.5; P < 0.001). PGD was significantly associated with 90-day (relative risk, 4.8; absolute risk increase, 18%; P < 0.001) and 1-year (relative risk, 3; absolute risk increase, 23%; P < 0.001) mortality. Conclusions: We identified grade 3 PGD risk factors, several of which are potentially modifiable and should be prioritized for future research aimed at preventative strategies. Clinical trial registered with www.clinicaltrials.gov (NCT

  10. Risk Factors for Hospital Readmission after Radical Gastrectomy for Gastric Cancer: A Prospective Study

    PubMed Central

    Huang, Dong-Dong; Pang, Wen-Yang; Lou, Neng; Chen, Bi-Cheng; Chen, Xiao-Lei; Yu, Zhen; Shen, Xian

    2015-01-01

    Background Hospital readmission is gathering increasing attention as a measure of health care quality and a potential cost-saving target. The purpose of this prospective study was to determine risk factors for readmission within 30 days of discharge after gastrectomy for patients with gastric cancer. Methods We conducted a prospective study of patients undergoing radical gastrectomy for gastric cancer from October 2013 to November 2014 in our institution. The incidence, cause and risk factors for 30-day readmission were determined. Results A total of 376 patients were included in our analysis without loss in follow-up. The 30-day readmission rate after radical gastrectomy for gastric cancer was 7.2% (27of 376). The most common cause for readmission included gastrointestinal complications and postoperative infections. On the basis of multivariate logistic regression analysis, preoperative nutritional risk screening 2002 score ≥ 3 was an independent risk factor for 30-day readmission. Factors not associated with a higher readmission rate included a history of a major postoperative complication during the index hospitalization, prolonged primary length of hospital stay after surgery, a history of previous abdominal surgery, advanced age, body mass index, pre-existing cardiopulmonary comorbidities, American Society of Anesthesiology grade, type of resection, extent of node dissection and discharge disposition. Conclusions Readmission within 30 days of discharge after radical gastrectomy for gastric cancer is common. Patients with nutritional risk preoperatively are at high risk for 30-day readmission. Preoperative optimization of nutritional status of patients at nutritional risk may effectively decrease readmission rates. PMID:25915547

  11. Developmental Risk Factors for Sexual Offending.

    ERIC Educational Resources Information Center

    Lee, Joseph K. P.; Jackson, Henry J.; Pattison, Pip; Ward, Tony

    2002-01-01

    A study involving 64 Australian sex offenders and 33 non-sex offenders found childhood emotional abuse and family dysfunction, childhood behavior problems, and childhood sexual abuse were developmental risk factors for paraphilia. Emotional abuse and family dysfunction was found to be a risk factor for pedophilia, exhibitionism, rape, or multiple…

  12. Risk Factor Intervention for Health Maintenance

    ERIC Educational Resources Information Center

    Breslow, Lester

    1978-01-01

    Risk factors for disease consist of personal habits such as cigarette smoking and excessive alcohol consumption, and bodily characteristics such as hypertension and high serum cholesterol. Progress in identifying, quantifying, and controlling risk factors is opening the way to the prevention of disease. (BB)

  13. Risk factors across the eating disorders

    PubMed Central

    Hilbert, Anja; Pike, Kathleen; Goldschmidt, Andrea; Wilfley, Denise; Fairburn, Christopher; Dohm, Faith-Anne; Walsh, Timothy; Weissman, Ruth Striegel

    2016-01-01

    This study sought to examine risk and onset patterns in anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED). Women with AN (n=71), BN (n=66), BED (n=160) and non-psychiatric controls (n=323) were compared retrospectively on risk factors, symptom onset, and diagnostic migration. Eating disorder groups reported greater risk exposure than non-psychiatric controls. AN and BED differed on premorbid personality/behavioral problems, childhood obesity, and family overeating. Risk factors for BN were shared with AN and BED. Dieting was the most common onset symptom in AN, whereas binge eating was most common in BN and BED. Migration between AN and BED was rare, but more frequent between AN and BN and between BN and BED. AN and BED have distinct risk factors and onset patterns, while BN shares similar risk factors and onset patterns with both AN and BED. Results should inform future classification schemes and prevention programs. PMID:25103674

  14. What Are the Risk Factors?

    MedlinePlus

    ... at some workplaces that increase risk include asbestos, arsenic, diesel exhaust, and some forms of silica and ... For more information, visit Lung Cancer Prevention. Also, arsenic in drinking water (primarily from private wells) can ...

  15. Symptomatic spinal metastasis: A systematic literature review of the preoperative prognostic factors for survival, neurological, functional and quality of life in surgically treated patients and methodological recommendations for prognostic studies

    PubMed Central

    Nater, Anick; Martin, Allan R.; Sahgal, Arjun; Choi, David

    2017-01-01

    Purpose While several clinical prediction rules (CPRs) of survival exist for patients with symptomatic spinal metastasis (SSM), these have variable prognostic ability and there is no recognized CPR for health related quality of life (HRQoL). We undertook a critical appraisal of the literature to identify key preoperative prognostic factors of clinical outcomes in patients with SSM who were treated surgically. The results of this study could be used to modify existing or develop new CPRs. Methods Seven electronic databases were searched (1990–2015), without language restriction, to identify studies that performed multivariate analysis of preoperative predictors of survival, neurological, functional and HRQoL outcomes in surgical patients with SSM. Individual studies were assessed for class of evidence. The strength of the overall body of evidence was evaluated using GRADE for each predictor. Results Among 4,818 unique citations, 17 were included; all were in English, rated Class III and focused on survival, revealing a total of 46 predictors. The strength of the overall body of evidence was very low for 39 and low for 7 predictors. Due to considerable heterogeneity in patient samples and prognostic factors investigated as well as several methodological issues, our results had a moderately high risk of bias and were difficult to interpret. Conclusions The quality of evidence for predictors of survival was, at best, low. We failed to identify studies that evaluated preoperative prognostic factors for neurological, functional, or HRQoL outcomes in surgical patients with SSM. We formulated methodological recommendations for prognostic studies to promote acquiring high-quality evidence to better estimate predictor effect sizes to improve patient education, surgical decision-making and development of CPRs. PMID:28225772

  16. Risk Factors for Anterior Cruciate Ligament Injury

    PubMed Central

    Smith, Helen C.; Vacek, Pamela; Johnson, Robert J.; Slauterbeck, James R.; Hashemi, Javad; Shultz, Sandra

    2012-01-01

    Context: Injuries to the anterior cruciate ligament (ACL) of the knee are immediately debilitating and can cause long-term consequences, including the early onset of osteoarthritis. It is important to have a comprehensive understanding of all possible risk factors for ACL injury to identify individuals who are at risk for future injuries and to provide an appropriate level of counseling and programs for prevention. Objective: This review, part 1 of a 2-part series, highlights what is known and still unknown regarding anatomic and neuromuscular risk factors for injury to the ACL from the current peer-reviewed literature. Data Sources: Studies were identified from MEDLINE (1951–March 2011) using the MeSH terms anterior cruciate ligament, knee injury, and risk factors. The bibliographies of relevant articles and reviews were cross-referenced to complete the search. Study Selection: Prognostic studies that utilized the case-control and prospective cohort study designs to evaluate risk factors for ACL injury were included in this review. Results: A total of 50 case-control and prospective cohort articles were included in the review, and 30 of these studies focused on neuromuscular and anatomic risk factors. Conclusions: Several anatomic and neuromuscular risk factors are associated with increased risk of suffering ACL injury—such as female sex and specific measures of bony geometry of the knee joint, including decreased intercondylar femoral notch size, decreased depth of concavity of the medial tibial plateau, increased slope of the tibial plateaus, and increased anterior-posterior knee laxity. These risk factors most likely act in combination to influence the risk of ACL injury; however, multivariate risk models that consider all the aforementioned risk factors in combination have not been established to explore this interaction. PMID:23016072

  17. Risk factors for pulmonary complications after percutaneous nephrolithotomy

    PubMed Central

    Yu, Jihion; Choi, Jae Moon; Lee, Joonho; Kwon, Koo; Kong, Yu-Gyeong; Seo, Hyungseok; Hwang, Jai-Hyun; Park, Hyung Keun; Kim, Young-Kug

    2016-01-01

    Abstract Although percutaneous nephrolithotomy is minimally invasive, it is associated with several complications, including extravasation of fluid and urine, the need for a blood transfusion, and septicemia. However, little is known about pulmonary complications after this procedure. Therefore, we aimed to evaluate the risk factors for and outcomes of pulmonary complications after percutaneous nephrolithotomy. All consecutive patients who underwent percutaneous nephrolithotomy between 2001 and 2014 were identified and divided into group A (no clinically significant pulmonary complications) and group B (clinically significant pulmonary complications). Preoperative and intraoperative variables and postoperative outcomes were evaluated. Independent risk factors for postoperative pulmonary complications were evaluated by univariate and multivariate logistic regression analyses. The study included 560 patients: 378 (67.5%) in group A and 182 (32.5%) in group B. Multivariate logistic regression analysis revealed that the independent risk factors for pulmonary complications after percutaneous nephrolithotomy were a higher body mass index (odds ratio = 1.062, P = 0.026), intraoperative red blood cell transfusion (odds ratio = 2.984, P = 0.012), and an intercostal surgical approach (odds ratio = 3.046, P < 0.001). Furthermore, the duration of hospital stay was significantly longer (8.4 ± 4.3 days vs 7.6 ± 3.4 days, P = 0.010) and the intensive care unit admission rate was significantly higher [13 (7.1%) vs 1 (0.3%), P < 0.001] in group B than in group A. Risk factors for pulmonary complications after percutaneous nephrolithotomy were a higher body mass index, intraoperative red blood cell transfusion, and an intercostal surgical approach. Postoperative pulmonary complications were associated with poor outcomes. These results may provide useful information for the perioperative management of pulmonary complications after

  18. Carcinoembryonic Antigen as a Predictor of Pathologic Response and a Prognostic Factor in Locally Advanced Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy and Surgery

    SciTech Connect

    Park, Ji Won; Lim, Seok-Byung Kim, Dae Yong; Jung, Kyung Hae; Hong, Yong Sang; Chang, Hee Jin; Choi, Hyo Seong; Jeong, Seung-Yong

    2009-07-01

    Purpose: To evaluate the role of serum carcinoembryonic antigen (CEA) as a predictor of response to preoperative chemoradiotherapy (CRT) and prognostic factor for rectal cancer. Materials and Methods: The study retrospectively evaluated 352 locally advanced rectal cancer patients who underwent preoperative CRT followed by surgery. Serum CEA levels were determined before CRT administration (pre-CRT CEA) and before surgery (post-CRT CEA). Correlations between pre-CRT CEA levels and rates of good response (Tumor regression grade 3/4) were explored. Patients were categorized into three CEA groups according to their pre-/post-CRT CEA levels (ng/mL) (Group A: pre-CRT CEA {<=} 3; B: pre-CRT CEA >3, post-CRT CEA {<=}3; C: pre- and post-CRT CEA >3 ng/mL), and their oncologic outcomes were compared. Results: Of 352 patients, good responses were achieved in 94 patients (26.7%). The rates of good response decreased significantly as the pre-CRT CEA levels became more elevated (CEA [ng/mL]: {<=}3, 36.4%; 3-6, 23.6%; 6-9, 15.6%; >9, 7.8%; p < 0.001). The rates of good response were significantly higher in Group A than in Groups B and C (36.4% vs. 17.3% and 14.3%, respectively; p < 0.001). The 3-year disease-free survival rate was significantly better in Groups A and B than in Group C (82% and 79% vs. 57%, respectively; p = 0.005); the CEA grouping was identified as an independent prognostic factor (p = 0.025). Conclusions: In locally advanced rectal cancer patients, CEA levels could be of clinical value as a predictor of response to preoperative CRT and as an independent prognostic factor after preoperative CRT and curative surgery.

  19. [Risk factors of main cancer sites].

    PubMed

    Uleckiene, Saule; Didziapetriene, Janina; Griciūte, Liudvika Laima; Urbeliene, Janina; Kasiulevicius, Vytautas; Sapoka, Virginijus

    2008-01-01

    Cancer prevention is a system of various measures devoted to avoid this disease. Primary cancer prevention means the identification, avoidance, or destruction of known risk factors. The main risk factors are smoking, diet, alcohol consumption, occupational factors, environmental pollution, electromagnetic radiation, infection, medicines, reproductive hormones, and lack of physical activity. Approximately one-third of cancers can be avoided by implementing various preventive measures. The aim of this article was to acquaint medical students, family doctors with risk factors of main cancer sites (lung, breast, colorectal, and prostate).

  20. Seismic Risk Perception compared with seismic Risk Factors

    NASA Astrophysics Data System (ADS)

    Crescimbene, Massimo; La Longa, Federica; Pessina, Vera; Pino, Nicola Alessandro; Peruzza, Laura

    2016-04-01

    The communication of natural hazards and their consequences is one of the more relevant ethical issues faced by scientists. In the last years, social studies have provided evidence that risk communication is strongly influenced by the risk perception of people. In order to develop effective information and risk communication strategies, the perception of risks and the influencing factors should be known. A theory that offers an integrative approach to understanding and explaining risk perception is still missing. To explain risk perception, it is necessary to consider several perspectives: social, psychological and cultural perspectives and their interactions. This paper presents the results of the CATI survey on seismic risk perception in Italy, conducted by INGV researchers on funding by the DPC. We built a questionnaire to assess seismic risk perception, with a particular attention to compare hazard, vulnerability and exposure perception with the real data of the same factors. The Seismic Risk Perception Questionnaire (SRP-Q) is designed by semantic differential method, using opposite terms on a Likert scale to seven points. The questionnaire allows to obtain the scores of five risk indicators: Hazard, Exposure, Vulnerability, People and Community, Earthquake Phenomenon. The questionnaire was administered by telephone interview (C.A.T.I.) on a statistical sample at national level of over 4,000 people, in the period January -February 2015. Results show that risk perception seems be underestimated for all indicators considered. In particular scores of seismic Vulnerability factor are extremely low compared with house information data of the respondents. Other data collected by the questionnaire regard Earthquake information level, Sources of information, Earthquake occurrence with respect to other natural hazards, participation at risk reduction activities and level of involvement. Research on risk perception aims to aid risk analysis and policy-making by

  1. Vehicle emission unit risk factors for transportation risk assessments

    SciTech Connect

    Biwer, B.M.; Butler, J.P.

    1999-12-01

    When the transportation risk posed by shipments of hazardous chemical and radioactive materials is being assessed, it is necessary to evaluate the risks associated with both vehicle emissions and cargo-related risks. Diesel exhaust and fugitive dust emissions from vehicles transporting hazardous shipments lead to increased air pollution, which increases the risk of latent fatalities in the affected population along the transport route. The estimated risk from these vehicle-related sources can often by as large or larger than the estimated risk associated with the material being transported. In this paper, data from the US Environmental Protection Agency's Motor Vehicle-Related Air Toxics Study are first used to develop latent cancer fatality estimates per kilometer of travel in rural and urban areas for all diesel truck classes. These unit risk factors are based on studies investigating the carcinogenic nature of diesel exhaust. With the same methodology, the current per=kilometer latent fatality risk factor used in transportation risk assessment for heavy diesel trucks in urban areas is revised and the analysis expanded to provide risk factors for rural areas and all diesel truck classes. These latter fatality estimates may include, but are not limited to, cancer fatalities and are based primarily on the most recent epidemiological data available on mortality rates associated with ambient air PM-10 concentrations.

  2. Factors predictive of obstructive sleep apnea in patients undergoing pre-operative evaluation for bariatric surgery and referred to a sleep laboratory for polysomnography

    PubMed Central

    Duarte, Ricardo Luiz de Menezes; Magalhães-da-Silveira, Flavio José

    2015-01-01

    Objective: To identify the main predictive factors for obtaining a diagnosis of obstructive sleep apnea (OSA) in patients awaiting bariatric surgery. Methods: Retrospective study of consecutive patients undergoing pre-operative evaluation for bariatric surgery and referred for in-laboratory polysomnography. Eight variables were evaluated: sex, age, neck circumference (NC), BMI, Epworth Sleepiness Scale (ESS) score, snoring, observed apnea, and hypertension. We employed ROC curve analysis to determine the best cut-off value for each variable and multiple linear regression to identify independent predictors of OSA severity. Results: We evaluated 1,089 patients, of whom 781 (71.7%) were female. The overall prevalence of OSA-defined as an apnea/hypopnea index (AHI) ≥ 5.0 events/h-was 74.8%. The best cut-off values for NC, BMI, age, and ESS score were 42 cm, 42 kg/m2, 37 years, and 10 points, respectively. All eight variables were found to be independent predictors of a diagnosis of OSA in general, and all but one were found to be independent predictors of a diagnosis of moderate/severe OSA (AHI ≥ 15.0 events/h), the exception being hypertension. We devised a 6-item model, designated the NO-OSAS model (NC, Obesity, Observed apnea, Snoring, Age, and Sex), with a cut-off value of ≥ 3 for identifying high-risk patients. For a diagnosis of moderate/severe OSA, the model showed 70.8% accuracy, 82.8% sensitivity, and 57.9% specificity. Conclusions: In our sample of patients awaiting bariatric surgery, there was a high prevalence of OSA. At a cut-off value of ≥ 3, the proposed 6-item model showed good accuracy for a diagnosis of moderate/severe OSA. PMID:26578136

  3. Concussion risk factors and strategies for prevention.

    PubMed

    Kerr, Hamish A

    2014-12-01

    Concussion in children is frequently related to participation in sports. It requires a traumatic event to occur that transmits acceleration to the brain. Some children may have intrinsic risk factors that place them at greater risk for this type of injury. Comorbidities such as attention-deficit/hyperactivity disorder, migraine headaches, and mood disorders may place athletes at increased risk of more severe injury. A previous concussion is probably the most important influence on risk for future injury. Extrinsic risk factors include coaching techniques, officiating, and choice of sport. Helmet choice does not diminish concussion risk, nor does the use of mouth guards. Education of athletes, coaches, parents, and physicians is very important in improving recognition of potential concussive injury and helping child athletes and their parents understand the risks involved in sport participation.

  4. Cardiovascular disease and modifiable cardiometabolic risk factors.

    PubMed

    Cannon, Christopher P

    2007-01-01

    Cardiovascular disease (CVD) is the leading cause of death in the United States and many parts of the world. Potentially modifiable risk factors for CVD include tobacco use, physical inactivity, hypertension, elevated low-density lipoprotein cholesterol, and a cluster of interrelated metabolic risk factors. Over the last several decades, efforts to prevent or treat CVD risk factors have resulted in significantly lower rates of CVD-related mortality. However, many patients never achieve adequate control of CVD risk factors even when these factors have been identified. In addition, the growing prevalence of obesity and type 2 diabetes mellitus (DM) threatens to undermine the improvements in CVD that have been achieved. In the United States, approximately two thirds of adults are overweight or obese, and even modest excess body weight is associated with a significantly increased risk of CVD-related mortality. Lifestyle interventions to promote weight loss reduce the risk of CVD-related illness but are difficult for patients to sustain over long periods of time. The increased incidence of obesity has also contributed to significant increases in the prevalence of other important CVD risk factors, including hypertension, dyslipidemia, insulin resistance, and type 2 DM. Pharmacologic therapies are currently available to address individual CVD risk factors, and others are being evaluated, including endocannabinoid receptor antagonists, inhibitors of peroxisome proliferator-activated receptor subtypes alpha and gamma, and several agents that modulate the activity of glucagon-like peptide-1. The new agents have the potential to significantly improve several CVD risk factors with a single medication and may provide clinicians with several new strategies to reduce the long-term risk of CVD.

  5. Atherosclerosis risk factors in systemic lupus erythematosus.

    PubMed

    Agarwal, Surabhi; Elliott, Jennifer R; Manzi, Susan

    2009-08-01

    Cardiovascular disease (CVD) has emerged as a leading cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Growing evidence suggests that inflammation plays a key role in the pathogenesis of atherosclerosis from initial endothelial dysfunction to rupture of atheromatous plaques. The increased frequency of atherosclerosis in SLE is likely due to a complex interplay among traditional risk factors, disease-related factors such as medications and disease activity, and inflammatory and immunogenic factors. Identification of these novel risk factors will lead to a better understanding of CVD pathogenesis and may also provide targets for potential treatment strategies. When caring for SLE patients, clinicians should be aware of the increased CVD risk and treat the known modifiable risk factors in addition to controlling disease activity and inflammation.

  6. Pre-operative anaemia.

    PubMed

    Clevenger, B; Richards, T

    2015-01-01

    Pre-operative anaemia is a relatively common finding, affecting a third of patients undergoing elective surgery. Traditionally associated with chronic disease, management has historically focused on the use of blood transfusion as a solution for anaemia in the peri-operative period. Data from large series now suggest that anaemia is an independent risk associated with poor outcome in both cardiac and non-cardiac surgery. Furthermore, blood transfusion does not appear to ameliorate this risk, and in fact may increase the risk of postoperative complications and hospital length of stay. Consequently, there is a need to identify, diagnose and manage pre-operative anaemia to reduce surgical risk. Discoveries in the pathways of iron metabolism have found that chronic disease can cause a state of functional iron deficiency leading to anaemia. The key iron regulatory protein hepcidin, activated in response to inflammation, inhibits absorption of iron from the gastrointestinal tract and further reduces bioavailability of iron stores for red cell production. Consequently, although iron stores (predominantly ferritin) may be normal, the transport of iron either from the gastrointestinal tract or iron stores to the bone marrow is inhibited, leading to a state of 'functional' iron deficiency and subsequent anaemia. Since absorption from the gastrointestinal tract is blocked, increasing oral iron intake is ineffective, and studies are now looking at the role of intravenous iron to treat anaemia in the surgical setting. In this article, we review the incidence and impact of anaemia on the pre-operative patient. We explain how anaemia may be caused by functional iron deficiency, and how iron deficiency anaemia may be diagnosed and treated.

  7. Risk Factors for Severity and Type of the Hip Fracture

    PubMed Central

    Cauley, Jane A.; Lui, Li-Yung; Genant, Harry K.; Salamone, Loran; Browner, Warren; Fink, Howard A.; Cohen, Peter; Hillier, Teresa; Bauer, Doug C.; Cummings, Steven R.

    2009-01-01

    More severe hip fractures such as displaced femoral neck (FN) fractures and unstable intertrochanteric (IT) fractures lead to poorer outcomes, but risk factors for severe fractures have not been studied. To identify risk factors for severe types of hip fracture, we performed a prospective cohort study and obtained preoperative hip radiographs from women who sustained an incident hip fracture (excluding traumatic fractures). A single radiologist scored the severity of FN fractures by the Garden System: grades I and II, undisplaced; grades III and IV, displaced. The severity of IT hip fractures was rated by the Kyle System: grades I and II, stable; grades III and IV, unstable. A total of 249 women had FN fractures: 75 (30%) were undisplaced. A total of 213 women had IT fractures: 59 (28%) were stable. Both types of hip fracture increased with age, but older age was even more strongly associated with more severe hip fractures. Low BMD was more strongly related to undisplaced FN fractures (p interaction BMD × FN type, p = 0.0008) and stable IT fractures (p interaction BMD × IT type, p = 0.04). Similar findings were observed for estimated volumetric BMD and hip geometric parameters. Corticosteroid use was only associated with displaced FN fractures, and Parkinson's disease was only associated with stable IT fractures. Little difference was reported in the self-reported circumstances surrounding each type of fracture. In conclusion, the lower the BMD, the greater the likelihood of experiencing a hip fracture that is less displaced and more stable. PMID:19113930

  8. Glaucoma history and risk factors.

    PubMed

    McMonnies, Charles W

    Apart from the risk of developing glaucoma there is also the risk that it is not detected and irreversible loss of vision ensues. Some studies of methods of glaucoma diagnosis have examined the results of instrument-based examinations with great if not complete reliance on objective findings in arriving at a diagnosis. The very valuable advances in glaucoma detection instrument technologies, and apparent increasing dependence on them, may have led to reduced consideration of information available from a patient history in those studies. Dependence on objective evidence of glaucomatous pathology may reduce the possibility of detecting glaucoma suspects or patients at risk for becoming glaucoma suspects. A valid positive family history of glaucoma is very valuable information. However, negative family histories can often be unreliable due to large numbers of glaucoma cases being undiagnosed. No evidence of family history is appropriate rather than no family history. In addition the unreliability of a negative family history is increased when patients with glaucoma fail to inform their family members. A finding of no family history can only be stated as no known family history. In examining the potential diagnostic contribution from a patient history, this review considers, age, frailty, race, type and degree of refractive error, systemic hyper- and hypotension, vasospasm, migraine, pigmentary dispersion syndrome, pseudoexfoliation syndrome, obstructive sleep apnea syndrome, diabetes, medication interactions and side effects, the degree of exposure to intraocular and intracranial pressure elevations and fluctuations, smoking, and symptoms in addition to genetics and family history of the disease.

  9. Preoperative factors affecting length of stay after elective ACDF with and without corpectomy: a multivariate analysis of an academic center cohort

    PubMed Central

    Basques, Bryce A.; Bohl, Daniel D.; Golinvaux, Nicholas S.; Gruskay, Jordan A.; Grauer, Jonathan N.

    2014-01-01

    Study Design Retrospective cohort study of 183 patients who underwent elective anterior cervical discectomy and fusion (ACDF) at a single institution over a two-year period. Objective To determine which preoperative factors were independently associated with a prolonged hospital length of stay (LOS) following ACDF. Summary of Background Data ACDF has become the most common treatment modality for addressing cervical spine pathology. Extended LOS following ACDF is associated with increased costs and complications. There is a lack of conclusive data for factors affecting LOS after ACDF. This study aims to create a multivariate model to determine the association of various patient and operative characteristics with LOS after ACDF. Methods Patients who underwent elective ACDF at a single academic institution between January 2011 and February 2013 were identified using billing records. Their charts were reviewed to collect variables available preoperatively such as patient demographics, comorbidities, and surgery planned. Patients were categorized as normal or extended LOS, with extended LOS defined as LOS > 75th percentile. A multivariate logistic regression was used to determine which factors were independently associated with extended LOS. Results A total of 183 ACDF patients were identified. The average LOS for this cohort was 2.0 ± 2.5 days (Mean ± Standard Deviation). Extended LOS was defined as ≥ 3 days. Multivariate analysis revealed that preoperative factors independently associated with extended LOS were history of non-spinal malignancy (Odds Ratio [OR] = 4.9), history of pulmonary disease (OR = 4.0), and procedures that included corpectomy (OR = 4.5). Conclusion Patients with a history of non-spinal malignancy or pulmonary disease, as well as patients who underwent corpectomy, were more likely to have an extended LOS (ORs 4.0–4.9). Of significant note, other factors that one might expect to be associated with extended LOS did not independently predict

  10. Risk Factors in Adolescent Hypertension

    PubMed Central

    Ewald, D. Rose; Haldeman, Lauren A.

    2016-01-01

    Hypertension is a complex and multifaceted disease, with many contributing factors. While diet and nutrition are important influences, the confounding effects of overweight and obesity, metabolic and genetic factors, racial and ethnic predispositions, socioeconomic status, cultural influences, growth rate, and pubertal stage have even more influence and make diagnosis quite challenging. The prevalence of hypertension in adolescents far exceeds the numbers who have been diagnosed; studies have found that 75% or more go undiagnosed. This literature review summarizes the challenges of blood pressure classification in adolescents, discusses the impact of these confounding influences, and identifies actions that will improve diagnosis and treatment outcomes. PMID:27335997

  11. Cardiovascular risk factor investigation: a pediatric issue

    PubMed Central

    Rodrigues, Anabel N; Abreu, Glaucia R; Resende, Rogério S; Goncalves, Washington LS; Gouvea, Sonia Alves

    2013-01-01

    Objectives To correlate cardiovascular risk factors (e.g., hypertension, obesity, hypercholesterolemia, hypertriglyceridemia, hyperglycemia, sedentariness) in childhood and adolescence with the occurrence of cardiovascular disease. Sources A systematic review of books and selected articles from PubMed, SciELO and Cochrane from 1992 to 2012. Summary of findings Risk factors for atherosclerosis are present in childhood, although cardiovascular disease arises during adulthood. This article presents the main studies that describe the importance of investigating the risk factors for cardiovascular diseases in childhood and their associations. Significant rates of hypertension, obesity, dyslipidemia, and sedentariness occur in children and adolescents. Blood pressure needs to be measured in childhood. An increase in arterial blood pressure in young people predicts hypertension in adulthood. The death rate from cardiovascular disease is lowest in children with lower cholesterol levels and in individuals who exercise regularly. In addition, there is a high prevalence of sedentariness in children and adolescents. Conclusions Studies involving the analysis of cardiovascular risk factors should always report the prevalence of these factors and their correlations during childhood because these factors are indispensable for identifying an at-risk population. The identification of risk factors in asymptomatic children could contribute to a decrease in cardiovascular disease, preventing such diseases as hypertension, obesity, and dyslipidemia from becoming the epidemics of this century. PMID:23515212

  12. HUMAN PROSTATE CANCER RISK FACTORS

    EPA Science Inventory

    Prostate cancer has the highest prevalence of any non-skin cancer in the human body, with similar likelihood of neoplastic foci found within the prostates of men around the world regardless of diet, occupation, lifestyle, or other factors. Essentially all men with circulating an...

  13. Psychological Risk Factors in Headache

    PubMed Central

    Nicholson, Robert A.; Houle, Timothy T.; Rhudy, Jamie L.; Norton, Peter J.

    2008-01-01

    Headache is a chronic disease that occurs with varying frequency and results in varying levels of disability. To date, the majority of research and clinical focus has been on the role of biological factors in headache and headache-related disability. However, reliance on a purely biomedical model of headache does not account for all aspects of headache and associated disability. Using a biopsychosocial framework, the current manuscript expands the view of what factors influence headache by considering the role psychological (i.e., cognitive and affective) factors have in the development, course, and consequences of headache. The manuscript initially reviews evidence showing that neural circuits responsible for cognitive–affective phenomena are highly interconnected with the circuitry responsible for headache pain. The manuscript then reviews the influence cognitions (locus of control and self-efficacy) and negative affect (depression, anxiety, and anger) have on the development of headache attacks, perception of headache pain, adherence to prescribed treatment, headache treatment outcome, and headache-related disability. The manuscript concludes with a discussion of the clinical implications of considering psychological factors when treating headache. PMID:17371358

  14. [Midwives' perception of reproductive risk factors].

    PubMed

    García-Barrios, C; Castañeda-Camey, X; Romero-Guerrero, X; González-Hernández, D; Langer-Glas, A

    1993-01-01

    Midwives in rural areas of the State of Morelos are one of the most important resources used by rural women for health care of pregnancy, delivery and the puerperium. This work was aimed at identifying midwives perceptions of pregnant women's risk factors, in order to include this knowledge in reproductive health programs which articulate institutional and traditional health systems. We applied a questionnaire to all midwives in the Municipalities of Ocuituco, yecapixtla and Zacualpan, Morelos (n = 35). Four key informants were selected and interviewed. These instruments enabled us to measure variability in perception of risk factors. Knowledge of risk factors is defective among midwives. Previous training made a big difference. Sixty three per cent of midwives who attended training courses are better qualified from an academic medicine point of view. Only 28.7 per cent of non-trained midwives (43% for both groups), indicating that sociocultural aspects prevail over technical training in midwives perceptions of reproductive risk factors.

  15. Behavioral Risk Factors for AIDS among Adolescents.

    ERIC Educational Resources Information Center

    Millstein, Susan G.

    This document examines the incidence of Acquired Immune Deficiency Syndrome (AIDS) among adolescents in the United States and identifies several risk factors for AIDS among this population. It classifies adolescents' risk for contracting human immunodeficiency virus (HIV) infection by the degree to which adolescents engage in behaviors that are…

  16. Osteoporosis Risk Factors in Eighth Grade Students.

    ERIC Educational Resources Information Center

    Lysen, Victoria C.; Walker, Robert

    1997-01-01

    Presents findings from food frequency questionnaires and surveys of 138 Midwestern eighth-grade student-parent pairs. The study examined the incidence of modifiable and nonmodifiable osteoporosis risk factors and compared gender differences. Data analysis indicated that many adolescents possessed several modifiable and nonmodifiable risk factors…

  17. Preoperative Chemotherapy in Patients With Intermediate-Risk Rectal Adenocarcinoma Selected by High-Resolution Magnetic Resonance Imaging: The GEMCAD 0801 Phase II Multicenter Trial

    PubMed Central

    Brown, Gina; Estevan, Rafael; Salud, Antonieta; Montagut, Clara; Maurel, Joan; Safont, Maria Jose; Aparicio, Jorge; Feliu, Jaime; Vera, Ruth; Alonso, Vicente; Gallego, Javier; Martin, Marta; Pera, Miguel; Sierra, Enrique; Serra, Javier; Delgado, Salvadora; Roig, Jose V.; Santos, Jesus; Pericay, Carles

    2014-01-01

    Background. The need for preoperative chemoradiation or short-course radiation in all T3 rectal tumors is a controversial issue. A multicenter phase II trial was undertaken to evaluate the efficacy and safety of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab in patients with intermediate-risk rectal adenocarcinoma. Methods. We recruited 46 patients with T3 rectal adenocarcinoma selected by magnetic resonance imaging (MRI) who were candidates for (R0) resection located in the middle third with clear mesorectal fascia and who were selected by pelvic MRI. Patients received four cycles of neoadjuvant capecitabine and oxaliplatin combined with bevacizumab (final cycle without bevacizumab) before total mesorectal excision (TME). In case of progression, preoperative chemoradiation was planned. The primary endpoint was overall response rate (ORR). Results. On an intent-to-treat analysis, the ORR was 78% (n = 36; 95% confidence interval [CI]: 63%–89%) and no progression was detected. Pathologic complete response was observed in nine patients (20%; 95% CI: 9–33), and T downstaging was observed in 48%. Forty-four patients proceeded to TME, and all had R0 resection. During preoperative therapy, two deaths occurred as a result of pulmonary embolism and diarrhea, respectively, and one patient died after surgery as a result of peritonitis secondary to an anastomotic leak (AL). A 13% rate of AL was higher than expected. The 24-month disease-free survival rate was 75% (95% CI: 60%–85%), and the 2-year local relapse rate was 2% (95% CI: 0%–11%). Conclusion. In this selected population, initial chemotherapy results in promising activity, but the observed toxicity does not support further investigation of this specific regimen. Nevertheless, these early results warrant further testing of this strategy in an enriched population and in randomized trials. PMID:25209376

  18. Risk factors associated with venous thromboembolism in patients undergoing spine surgery.

    PubMed

    Piper, Keaton; Algattas, Hanna; DeAndrea-Lazarus, Ian A; Kimmell, Kristopher T; Li, Yan Michael; Walter, Kevin A; Silberstein, Howard J; Vates, G Edward

    2017-01-01

    OBJECTIVE Patients undergoing spinal surgery are at risk for developing venous thromboembolism (VTE). The authors sought to identify risk factors for VTE in these patients. METHODS The American College of Surgeons National Surgical Quality Improvement Project database for the years 2006-2010 was reviewed for patients who had undergone spinal surgery according to their primary Current Procedural Terminology code(s). Clinical factors were analyzed to identify associations with VTE. RESULTS Patients who underwent spinal surgery (n = 22,434) were identified. The rate of VTE in the cohort was 1.1% (pulmonary embolism 0.4%; deep vein thrombosis 0.8%). Multivariate binary logistic regression analysis revealed 13 factors associated with VTE. Preoperative factors included dependent functional status, paraplegia, quadriplegia, disseminated cancer, inpatient status, hypertension, history of transient ischemic attack, sepsis, and African American race. Operative factors included surgery duration > 4 hours, emergency presentation, and American Society of Anesthesiologists Class III-V, whereas postoperative sepsis was the only significant postoperative factor. A risk score was developed based on the number of factors present in each patient. Patients with a score of ≥ 7 had a 100-fold increased risk of developing VTE over patients with a score of 0. The receiver-operating-characteristic curve of the risk score generated an area under the curve of 0.756 (95% CI 0.726-0.787). CONCLUSIONS A risk score based on race, preoperative comorbidities, and operative characteristics of patients undergoing spinal surgery predicts the postoperative VTE rate. Many of these risks can be identified before surgery. Future protocols should focus on VTE prevention in patients who are predisposed to it.

  19. Cancer associated thrombosis: risk factors and outcomes.

    PubMed

    Eichinger, Sabine

    2016-04-01

    Deep vein thrombosis of the leg and pulmonary embolism are frequent diseases and cancer is one of their most important risk factors. Patients with cancer also have a higher prevalence of venous thrombosis located in other parts than in the legs and/or in unusual sites including upper extremity, splanchnic or cerebral veins. Cancer also affects the risk of arterial thrombotic events particularly in patients with myeloproliferative neoplasms and in vascular endothelial growth factor receptor inhibitor recipients. Several risk factors need to interact to trigger thrombosis. In addition to common risk factors such as surgery, hospitalisation, infection and genetic coagulation disorders, the thrombotic risk is also driven and modified by cancer-specific factors including type, histology, and stage of the malignancy, cancer treatment and certain biomarkers. A venous thrombotic event in a cancer patient has serious consequences as the risk of recurrent thrombosis, the risk of bleeding during anticoagulation and hospitalisation rates are all increased. Survival of cancer patients with thrombosis is worse compared to that of cancer patients without thrombosis, and thrombosis is a leading direct cause of death in cancer patients.

  20. Dry Eye Following Phacoemulsification Surgery and its Relation to Associated Intraoperative Risk Factors

    PubMed Central

    Sahu, P. K.; Das, G. K.; Malik, Aman; Biakthangi, Laura

    2015-01-01

    Purpose: The purpose was to study dry eye following phacoemulsification surgery and analyze its relation to associated intra-operative risk factors. Materials and Methods: A prospective observational study was carried out on 100 eyes of 100 patients without preoperative dry eye. Schirmer's Test I, tear meniscus height, tear break-up time, and lissamine green staining of cornea and conjunctiva were performed preoperatively and at 5 days, 10 days, 1-month, and 2 months after phacoemulsification surgery, along with the assessment of subjective symptoms, using the dry eye questionnaire. The correlations between these values and the operating microscope light exposure time along with the cumulative dissipated energy (CDE) were investigated. Results: There was a significant deterioration of all dry eye test values following phacoemulsification surgery along with an increase in subjective symptoms. These values started improving after 1-month postoperatively, but preoperative levels were not achieved till 2 months after surgery. Correlations of dry eye test values were noted with the operating microscope light exposure time and CDE, but they were not significant. Conclusion: Phacoemulsification surgery is capable of inducing dry eye, and patients should be informed accordingly prior to surgery. The clinician should also be cognizant that increased CDE can induce dry eyes even in eyes that were healthy preoperatively. In addition, intraoperative exposure to the microscopic light should be minimized. PMID:26692720

  1. Risk Factors for Homelessness Among US Veterans

    PubMed Central

    Tsai, Jack; Rosenheck, Robert A.

    2015-01-01

    Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans. PMID:25595171

  2. Risk Factors for Cerebral Venous Thrombosis.

    PubMed

    Silvis, Suzanne M; Middeldorp, Saskia; Zuurbier, Susanna M; Cannegieter, Suzanne C; Coutinho, Jonathan M

    2016-09-01

    Cerebral venous thrombosis (CVT) is a rare thrombotic disorder involving the cerebral veins and dural sinuses. In contrast to more common sites of venous thromboembolism (VTE), such as the legs and lungs, CVT mainly affects young adults and children, and women are affected three times more often than men. Although presenting symptoms are variable, headache is usually the first symptom, often in combination with focal neurologic deficits and epileptic seizures. The primary therapy for CVT consists of heparin followed by oral anticoagulation for at least 3 to 6 months. The mortality in the acute phase is 5 to 10% and a substantial proportion of survivors suffer from long-term disabilities. A large number of risk factors have been linked to CVT, although the scientific evidence for an association varies considerably between risk factors. Some risk factors, such as hereditary thrombophilia, correspond with risk factors for more common sites of VTE, whereas others, such as head trauma, are specific to CVT. In most patients, at least one risk factor can be identified. In this review, we provide an overview of the risk factors for CVT.

  3. Vascular Risk Factors: Imaging and Neuropathologic Correlates

    PubMed Central

    Knopman, David S.; Roberts, Rosebud

    2010-01-01

    Cerebrovascular disease plays an important role in cognitive disorders in the elderly. Cerebrovascular disease and Alzheimer’s disease interact on several levels, one important level being the overlap in risk factors. The major vascular risk factors such as diabetes and impaired glycemic control, hypertension, obesity and hyper- or dyslipidemia have been associated both with Alzheimer’s disease and vascular dementia. The purpose of this review is to consider the context in which vascular dementia is diagnosed, place the pathophysiological consequences of cerebrovascular disease on cognition in the context of clinical and pathological Alzheimer’s disease, and then to consider the evidence for the role of major vascular risk factors in late-life cognitive impairment, changes in brain imaging and neuropathological changes. Midlife diabetes mellitus, hypertension and obesity are established risk factors for clinically defined Alzheimer’s disease as well as vascular dementia. The basis for these relationships could either be that the risk factors lead to microvascular brain disease, promote Alzheimer pathology or both. The associations of late-life onset diabetes mellitus, hypertension and obesity with cognitive impairment are either attenuated or reversed. The role of vascular risk factors in midlife should be the focus of public health efforts to reduce the burden of late-life cognitive impairment. PMID:20182020

  4. Risk factors for homelessness among US veterans.

    PubMed

    Tsai, Jack; Rosenheck, Robert A

    2015-01-01

    Homelessness among US veterans has been a focus of research for over 3 decades. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this is the first systematic review to summarize research on risk factors for homelessness among US veterans and to evaluate the evidence for these risk factors. Thirty-one studies published from 1987 to 2014 were divided into 3 categories: more rigorous studies, less rigorous studies, and studies comparing homeless veterans with homeless nonveterans. The strongest and most consistent risk factors were substance use disorders and mental illness, followed by low income and other income-related factors. There was some evidence that social isolation, adverse childhood experiences, and past incarceration were also important risk factors. Veterans, especially those who served since the advent of the all-volunteer force, were at greater risk for homelessness than other adults. Homeless veterans were generally older, better educated, and more likely to be male, married/have been married, and to have health insurance coverage than other homeless adults. More studies simultaneously addressing premilitary, military, and postmilitary risk factors for veteran homelessness are needed. This review identifies substance use disorders, mental illness, and low income as targets for policies and programs in efforts to end homelessness among veterans.

  5. Modifiable risk factors for schizophrenia and autism--shared risk factors impacting on brain development.

    PubMed

    Hamlyn, Jess; Duhig, Michael; McGrath, John; Scott, James

    2013-05-01

    Schizophrenia and autism are two poorly understood clinical syndromes that differ in age of onset and clinical profile. However, recent genetic and epidemiological research suggests that these two neurodevelopmental disorders share certain risk factors. The aims of this review are to describe modifiable risk factors that have been identified in both disorders, and, where available, collate salient systematic reviews and meta-analyses that have examined shared risk factors. Based on searches of Medline, Embase and PsycINFO, inspection of review articles and expert opinion, we first compiled a set of candidate modifiable risk factors associated with autism. Where available, we next collated systematic-reviews (with or without meta-analyses) related to modifiable risk factors associated with both autism and schizophrenia. We identified three modifiable risk factors that have been examined in systematic reviews for both autism and schizophrenia. Advanced paternal age was reported as a risk factor for schizophrenia in a single meta-analysis and as a risk factor in two meta-analyses for autism. With respect to pregnancy and birth complications, for autism one meta-analysis identified maternal diabetes and bleeding during pregnancy as risks factors for autism whilst a meta-analysis of eight studies identified obstetric complications as a risk factor for schizophrenia. Migrant status was identified as a risk factor for both autism and schizophrenia. Two separate meta-analyses were identified for each disorder. Despite distinct clinical phenotypes, the evidence suggests that at least some non-genetic risk factors are shared between these two syndromes. In particular, exposure to drugs, nutritional excesses or deficiencies and infectious agents lend themselves to public health interventions. Studies are now needed to quantify any increase in risk of either autism or schizophrenia that is associated with these modifiable environmental factors.

  6. Defining Incidence and Risk Factors of Venous Thromboemolism after Hepatectomy

    PubMed Central

    Ejaz, Aslam; Spolverato, Gaya; Kim, Yuhree; Lucas, Donald L.; Lau, Brandyn; Weiss, Matthew; Johnston, Fabian M.; Kheng, Marian; Hirose, Kenzo; Wolfgang, Christopher L.; Haut, Elliott; Pawlik, Timothy M.

    2014-01-01

    Background The incidence of venous thromboembolism (VTE) among patients undergoing hepatic surgery is poorly defined, leading to varied use of VTE prophylaxis among surgeons. We sought to define the incidence of VTE after liver surgery and identify risk factors associated with VTE. Methods Incidence of VTE and associated risk factors within 90 days of hepatic resection between 2006 and 2012 at a major academic center was analyzed. Risk factors for VTE were identified using univariate and multivariate analyses. Results A total of 599 patients were included in the study cohort; 30 (5.0 %) had a prior history of VTE. The indications for surgery were malignant (90.8 %) and benign lesions (9.2 %). The majority of patients underwent a minor hepatectomy (<3 Couinaud segments; n =402, 67.1 %) while 195 (32.6 %) patients underwent a major hepatectomy (≥3 Couinaud segments). Three hundred seven (51.3 %) patients were started on VTE chemoprophylaxis preoperatively with 407 (67.8 %) patients receiving VTE chemoprophylaxis within 24 h of surgery. Twenty-eight (4.7 %) patients developed VTE; 20 (3.3 %) had deep venous thrombosis (DVT), 11 (1.8 %) had pulmonary embolism (PE), and three (0.5 %) developed both DVTand PE. Among the VTE patients, 23 (82.1 %) had received VTE chemoprophylaxis. On multivariate analyses, history of VTE (odds ratio [OR] 4.51, 95 % confidence interval [CI] 1.81–17.22, P =0.03), prolonged operative time (OR 1.17 per additional hour, 95 % CI 1.04–1.32, P =0.009), and increased length of stay (LOS) (OR 1.07, 95 % CI 1.02–1.12, P =0.01) were independent risk factors for VTE. Conclusion VTE within 90 days of hepatic resection is common, occurring in nearly one in 20 patients. Most VTE events occurred among patients who received current best practice prophylaxis for VTE. More aggressive strategies to identify and reduce the risk of VTE in patients at highest risk of VTE, including those with a history of VTE, extended operative time, and prolonged LOS

  7. [Aflatoxins--health risk factors].

    PubMed

    Miliţă, Nicoleta Manuela; Mihăescu, Gr; Chifiriuc, Carmen

    2010-01-01

    Aflatoxins are secondary metabolites produced by a group of strains, mainly Aspergillus and Penicillium species. These mycotoxins are bifurano-coumarin derivatives group with four major products B1, B2, G1 and G2 according to blue or green fluorescence emitted in ultraviolet light and according to chromatographic separation. After metabolism of aflatoxin B1 and B2 in the mammalian body, result two metabolites M1 and M2 as hydroxylated derivatives of the parent compound. Aflatoxins have high carcinogenic potential, the most powerful carcinogens in different species of animals and humans. International Agency for Research on Cancer has classified aflatoxin B1 in Group I carcinogens. The target organ for aflatoxins is the liver. In chronic poisoning, aflatoxin is a risk to health, for a long term causing cancer (hepatocellular carcinoma), and in acute intoxications aflatoxin is lethal. This work purpose to discuss aflatoxins issue: the synthesis, absorption and elimination of aflatoxins, the toxicity mechanisms, and measures to limit the content of aflatoxins in food

  8. Bone metastasis risk factors in breast cancer

    PubMed Central

    Pulido, Catarina; Vendrell, Inês; Ferreira, Arlindo R; Casimiro, Sandra; Mansinho, André; Alho, Irina; Costa, Luís

    2017-01-01

    Bone is the single most frequent site for bone metastasis in breast cancer patients. Patients with bone-only metastasis have a fairly good prognosis when compared with patients with visceral disease. Nevertheless, cancer-induced bone disease carries an important risk of developing skeletal related events that impact quality of life (QoL). It is therefore particularly important to stratify patients according to their risk of developing bone metastasis. In this context, several risk factors have been studied, including demographic, clinicopathological, genetic, and metabolic factors. Most of them show conflicting or non-definitive associations and are not validated for clinical use. Nonetheless, tumour intrinsic subtype is widely accepted as a major risk factor for bone metastasis development and luminal breast cancer carries an increased risk for bone disease. Other factors such as gene signatures, expression of specific cytokines (such as bone sialoprotein and bone morphogenetic protein 7) or components of the extracellular matrix (like bone crosslinked C-telopeptide) might also influence the development of bone metastasis. Knowledge of risk factors related with bone disease is of paramount importance as it might be a prediction tool for triggering the use of targeted agents and allow for better patient selection for future clinical trials. PMID:28194227

  9. Cannabis use motives and personality risk factors.

    PubMed

    Hecimovic, Karen; Barrett, Sean P; Darredeau, Christine; Stewart, Sherry H

    2014-03-01

    According to the model of substance abuse of Conrod, Pihl, Stewart, and Dongier (2000), four personality factors (i.e., anxiety sensitivity [AS], introversion/hopelessness [I/H], sensation seeking [SS], and impulsivity [IMP]) are associated with elevated risk for substance use/misuse, with each personality factor being related to preference for particular drugs of abuse (e.g., AS with anxiolytics). However, cannabis use has not been consistently linked to any one of these personality factors. This may be due to the heterogeneity in cannabis use motives. The present study explored the association between these four personality risk factors and different cannabis use motives. Cannabis users completed an interview about their motives for cannabis use as well as the self-report Substance Use Risk Profile Scale (SURPS; Woicik, Conrod, Stewart, & Pihl, 2009), which measures the four personality risk factors. Results showed that AS was associated with conformity motives and I/H was associated with coping motives for cannabis use. SS was positively associated with expansion motives and IMP was associated with drug availability motives. Thus, personality risk factors in the model of Conrod et al. (2000) are associated with distinct cannabis use motives in a pattern consistent with theory.

  10. Sunburn risk factors at Galveston beaches.

    PubMed

    Shoss-Glaich, Adrienne B; Uchida, Tatsuo; Wagner, Richard F

    2004-07-01

    Although the beach is a well-recognized environment for sunburn injury, specific risk factors for sunburn and their interactions are poorly understood. In this epidemiologic study, variables related to sunburn injury at the beach were analyzed. Beachgoers exposed to more than 4 hours of sun at the beach were significantly more likely to sunburn compared with those with less exposure. Other significant sunburn risk factors were lack of sunscreen use or use of sunscreen with a Sun Protection Factor of 15 or less and Fitzpatrick Skin Types I and II. Reasonable sunburn avoidance strategies should include limiting duration of sun exposure to fewer than 4 hours per day.

  11. Risk factors for and assessment of constipation.

    PubMed

    Chapman, Sherree; Hungerford, Catherine

    2015-04-01

    Constipation commonly occurs in older people, particularly in hospital or residential care settings, and leads to decreased quality of life and increased healthcare costs. Despite its frequency, however, nurses often overlook the condition. One possible reason for this may be the lack of appropriate tools or scales for nurses to assess risk factors for developing constipation. This article identifies, from the academic literature, 14 risk factors for developing constipation in older people. These factors are then considered in light of four common constipation assessment charts. The article concludes by arguing the need for more comprehensive assessment tools to, firstly, identify risk factors; and, secondly, support the implementation of appropriate preventative strategies that will enable better health outcomes for older people.

  12. Pectoralis major myocutaneous flap for head and neck reconstruction: risk factors for fistula formation.

    PubMed

    Leite, A K N; de Matos, L L; Belli, M; Kulcsar, M A V; Cernea, C R; Garcia Brandão, L; Pinto, F R

    2014-12-01

    The pectoralis major myocutaneous flap (PMMF) is a safe and versatile flap used widely for head and neck cancer reconstructions, but one of the major and most feared complications is oro- or pharyngocutaneous fistula. Herein, we attempt to establish risk factors for fistula formation in reconstructions of mucosal defects in the head and neck using PMMF through retrospective analysis of PMMF performed during 3 years at a single institution, with a total of 84 procedures. There were 69 men and 15 women, with a mean age of 59.5 years. There were 15 cases of partial flap loss, two total flap losses and 31 fistulas. The independent risk factors for fistula formation were preoperative serum hemoglobin < 13 g/dl, preoperative serum albumin < 3.4 g/dl and hypopharynx reconstruction. The PMMF is still a very useful flap and this is the first multivariate analysis analysing risk factors for fistula formation. These findings are helpful in selecting patients with elevated risk of fistula formation, and therefore preventive measures can be undertaken to avoid potentially serious complications.

  13. Tuberculosis: distribution, risk factors, mortality.

    PubMed

    Kochi, A

    1994-10-01

    About a century after Koch's discovery of the TB bacilli the tuberculosis epidemic which had appeared to be under control was again recognized as a major global health threat. The decline in the epidemic in this century had been largely through the improved living standards and, eventually, the availability and use of effective antibiotics. While tuberculosis gradually disappeared from the health agenda in the western world it remained a big killer throughout the century and in 1992 an estimated 2.7 million TB deaths occurred; 30 million will die from TB during the 1990s if current trends are not reversed. The annual number of new cases will increase from 7.5 million estimated in 1990 to more than 10 million in the year 2000. The main factors for this increase are demographic forces, population movements, the HIV epidemic and increasing drug resistance. The impact of the HIV epidemic is already felt in many sub-Saharan African countries and now threatens Asia where almost two-thirds of the world's TB infected population live and where HIV is spreading. Tuberculosis has also reemerged as a major public health problem in industrialized countries due to international migration, the breakdown of health services, including TB services etc. The control of the epidemic can only be through a concerted action to reinstate TB as priority among health concerns, reflected in national and international resources. A coalition of public and private supporters must be mobilized to support the effort to fight the disease. Governments, non-governmental organizations, the business community, refugee organizations, medical institutions, and other UN agencies are invited to join with WHO in this effort.

  14. Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors.

    PubMed

    Gonçalves, Bruna; Ferreira, Carina; Alves, Carlos Tiago; Henriques, Mariana; Azeredo, Joana; Silva, Sónia

    2016-11-01

    Vulvovaginal candidiasis (VVC) is an infection caused by Candida species that affects millions of women every year. Although Candida albicans is the main cause of VVC, the identification of non-Candida albicans Candida (NCAC) species, especially Candida glabrata, as the cause of this infection, appears to be increasing. The development of VVC is usually attributed to the disturbance of the balance between Candida vaginal colonization and host environment by physiological or nonphysiological changes. Several host-related and behavioral risk factors have been proposed as predisposing factors for VVC. Host-related factors include pregnancy, hormone replacement, uncontrolled diabetes, immunosuppression, antibiotics, glucocorticoids use and genetic predispositions. Behavioral risk factors include use of oral contraceptives, intrauterine device, spermicides and condoms and some habits of hygiene, clothing and sexual practices. Despite a growing list of recognized risk factors, much remains to be elucidated as the role of host versus microorganisms, in inducing VVC and its recurrence. Thus, this review provides information about the current state of knowledge on the risk factors that predispose to VVC, also including a revision of the epidemiology and microbiology of VVC, as well as of Candida virulence factors associated with vaginal pathogenicity.

  15. Perioperative risk factors in patients with liver disease undergoing non-hepatic surgery

    PubMed Central

    Pandey, Chandra Kant; Karna, Sunaina Tejpal; Pandey, Vijay Kant; Tandon, Manish; Singhal, Amit; Mangla, Vivek

    2012-01-01

    The patients with liver disease present for various surgical interventions. Surgery may lead to complications in a significant proportion of these patients. These complications may result in considerable morbidity and mortality. Preoperative assessment can predict survival to some extent in patients with liver disease undergoing surgical procedures. A review of literature suggests nature and the type of surgery in these patients determines the peri-operative morbidity and mortality. Optimization of premorbid factors may help to reduce perioperative mortality and morbidity. The purpose of this review is to discuss the effect of liver disease on perioperative outcome; to understand various risk scoring systems and their prognostic significance; to delineate different preoperative variables implicated in postoperative complications and morbidity; to establish the effect of nature and type of surgery on postoperative outcome in patients with liver disease and to discuss optimal anaesthesia strategy in patients with liver disease. PMID:23494910

  16. What Are the Risk Factors for Chronic Myeloid Leukemia?

    MedlinePlus

    ... What Are the Risk Factors for Chronic Myeloid Leukemia? A risk factor is something that affects a ... Myeloid Leukemia Be Prevented? More In Chronic Myeloid Leukemia About Chronic Myeloid Leukemia Causes, Risk Factors, and ...

  17. What Are the Risk Factors for Chronic Lymphocytic Leukemia?

    MedlinePlus

    ... What Are the Risk Factors for Chronic Lymphocytic Leukemia? A risk factor is something that affects a ... Lymphocytic Leukemia Be Prevented? More In Chronic Lymphocytic Leukemia About Chronic Lymphocytic Leukemia Causes, Risk Factors, and ...

  18. What Are the Risk Factors for Thymus Cancer?

    MedlinePlus

    ... and Prevention What Are the Risk Factors for Thymus Cancer? A risk factor is anything that affects ... Cancer? Can Thymus Cancer Be Prevented? More In Thymus Cancer About Thymus Cancer Causes, Risk Factors, and ...

  19. What Are the Risk Factors for Kidney Cancer?

    MedlinePlus

    ... and Prevention What Are the Risk Factors for Kidney Cancer? A risk factor is anything that affects ... not cancer). Other risk factors Family history of kidney cancer People with a strong family history of ...

  20. Risk Factors for Recurrent Lumbar Disc Herniation

    PubMed Central

    Huang, Weimin; Han, Zhiwei; Liu, Jiang; Yu, Lili; Yu, Xiuchun

    2016-01-01

    Abstract Recurrent lumbar disc herniation (rLDH) is a common complication following primary discectomy. This systematic review aimed to investigate the current evidence on risk factors for rLDH. Cohort or case-control studies addressing risk factors for rLDH were identified by search in Pubmed (Medline), Embase, Web of Science, and Cochrane library from inception to June 2015. Relevant results were pooled to give overall estimates if possible. Heterogeneity among studies was examined and publication bias was also assessed. A total of 17 studies were included in this systematic review. Risk factors that had significant relation with rLDH were smoking (OR 1.99, 95% CI 1.53–2.58), disc protrusion (OR 1.79, 95% CI 1.15–2.79), and diabetes (OR 1.19, 95% CI 1.06–1.32). Gender, BMI, occupational work, level, and side of herniation did not correlate with rLDH significantly. Based on current evidence, smoking, disc protrusion, and diabetes were predictors for rLDH. Patients with these risk factors should be paid more attention for prevention of recurrence after primary surgery. More evidence provided by high-quality observational studies is still needed to further investigate risk factors for rLDH. PMID:26765413

  1. High risk factors of pancreatic carcinoma.

    PubMed

    Camara, Soriba Naby; Yin, Tao; Yang, Ming; Li, Xiang; Gong, Qiong; Zhou, Jing; Zhao, Gang; Yang, Zhi-Yong; Aroun, Tajoo; Kuete, Martin; Ramdany, Sonam; Camara, Alpha Kabinet; Diallo, Aissatou Taran; Feng, Zhen; Ning, Xin; Xiong, Jiong-Xin; Tao, Jing; Qin, Qi; Zhou, Wei; Cui, Jing; Huang, Min; Guo, Yao; Gou, Shan-Miao; Wang, Bo; Liu, Tao; Olivier, Ohoya Etsaka Terence; Conde, Tenin; Cisse, Mohamed; Magassouba, Aboubacar Sidiki; Ballah, Sneha; Keita, Naby Laye Moussa; Souare, Ibrahima Sory; Toure, Aboubacar; Traore, Sadamoudou; Balde, Abdoulaye Korse; Keita, Namory; Camara, Naby Daouda; Emmanuel, Dusabe; Wu, He-Shui; Wang, Chun-You

    2016-06-01

    Over the past decades, cancer has become one of the toughest challenges for health professionals. The epidemiologists are increasingly directing their research efforts on various malignant tumor worldwide. Of note, incidence of cancers is on the rise more quickly in developed countries. Indeed, great endeavors have to be made in the control of the life-threatening disease. As we know it, pancreatic cancer (PC) is a malignant disease with the worst prognosis. While little is known about the etiology of the PC and measures to prevent the condition, so far, a number of risk factors have been identified. Genetic factors, pre-malignant lesions, predisposing diseases and exogenous factors have been found to be linked to PC. Genetic susceptibility was observed in 10% of PC cases, including inherited PC syndromes and familial PC. However, in the remaining 90%, their PC might be caused by genetic factors in combination with environmental factors. Nonetheless, the exact mechanism of the two kinds of factors, endogenous and exogenous, working together to cause PC remains poorly understood. The fact that most pancreatic neoplasms are diagnosed at an incurable stage of the disease highlights the need to identify risk factors and to understand their contribution to carcinogenesis. This article reviews the high risk factors contributing to the development of PC, to provide information for clinicians and epidemiologists.

  2. Psychological Factors Linked to Risk Perception

    NASA Astrophysics Data System (ADS)

    Armaş, I.; Creãu, R. Z.; Stǎnciugelu, I.

    2012-04-01

    Risks are mental models, which allow people to cope with dangerous phenomena (Renn, 2008; Jasanoff, 1998). The term "risk" refers to the likelihood of an adverse effect resulting from an event. The aim of the present study is to identify the psychological factors that are most predictive of risk perception in relation with age, gender, educational level and socio-economical status. Earthquake hazard was considered, because it is an emerging danger for Bucharest. 80% of the laypeople sample are waiting for this event to happen in the next three years. By integrating all the research data, it was attempted to build a risk profile of the investigated population, which could be used by institutions responsible for earthquake risk mitigation situations in Bucharest. This research appealed to the social learning Rotter (1966), auto-effectiveness Bandura (1977; 1983), and anxiety and stress theories. We used psychological variables that measured stress, personal effectiveness and the belief in personal control. The multi-modal risk perception questionnaire was structured on a 49 items sequence. The sample was composed of 1.376 participants recruited on a voluntary basis. The characteristics of risk (like probability and magnitude, time scales) are perceived differently according to psychological factors that play a role also in biases in people's ability to draw inferences from probabilistic information (like cognitive dissonance). Since the 1970's, it has been argued that those who perceive life's events as being beyond their locus of control (external locus of control) are significantly more anxious and less adapted. In this research, strongest associations and significant differences were obtained between sex, age and income categories with Stress vulnerability factor and the External Locus of Control factor. The profile of the low risk perceiver is that of a young, more educated, male individual with a higher self- efficacy level and an internal locus of control.

  3. Risk and Protective Factors and Achievement of Children At Risk.

    ERIC Educational Resources Information Center

    Krasner, Diane

    A study was done to identify social, economic, and childhood characteristics of high and low achieving children living in adverse environmental conditions, and to test the association between achievement and specific risk and protective factors. In addition, the study identified the most powerful model for predicting achievement by comparing…

  4. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials†.

    PubMed

    Pilarczyk, Kevin; Boening, Andreas; Jakob, Heinz; Langebartels, Georg; Markewitz, Andreas; Haake, Nils; Heringlake, Matthias; Trummer, Georg

    2016-01-01

    In contrast to the results of previous studies, recent randomized controlled trials (RCTs) failed to show a benefit of prophylactic aortic counterpulsation in high-risk patients undergoing cardiac surgery. The present analysis aims to redefine the effects of this treatment modality in the light of this new evidence. MEDLINE, EMBASE, CENTRAL/CCTR, Google Scholar and reference lists of relevant articles were searched for full-text articles of RCTs in English or German. Assessments for eligibility, relevance, study validity and data extraction were performed by two reviewers independently using prespecified criteria. The primary outcome was hospital mortality. A total of nine eligible RCTs with 1171 patients were identified: 577 patients were treated preoperatively with intra-aortic balloon pump (IABP) and 594 patients served as controls. The pooled odds ratio (OR) for hospital mortality (22 hospital deaths in the intervention arm, 54 in the control group) was 0.381 (95% CI 0.230-0.629; P < 0.001). The pooled analyses of five RCTs including only patients undergoing isolated on-pump coronary artery bypass grafting (n[IABP] = 348, n[control] = 347) also showed a statistically significant improvement in mortality for preoperative IABP implantation (fixed-effects model: OR 0.267, 95% CI 0.129-0.552, P < 0.001). The pooled OR for hospital mortality from two randomized off-pump trials was 0.556 (fixed-effects model, 95% CI 0.207-1.493, P = 0.226). Preoperative aortic counterpulsation was associated with a significant reduction in low cardiac output syndrome (LCOS) in the total population (fixed-effects model: OR 0.330, 95% CI 0.214-0.508, P < 0.001) as well as in the subgroup of CAGB patients (fixed-effects model: OR 0.113, 95% CI 0.056-0.226, P < 0.001), whereas there was no benefit in the off-pump population (fixed-effects model: OR 0.555, 95% CI 0.209-1.474, P = 0.238). Preoperative IABP implantation was associated with a reduction of intensive care unit (ICU) stay in

  5. Epidemiology, prognosis, and risk factors in mastocytosis.

    PubMed

    Brockow, Knut

    2014-05-01

    This article updates current knowledge about epidemiology, prognosis, and risk factors for major complications in mastocytosis. A prevalence of mastocytosis of 1 in 10000 inhabitants has been reported, but underdiagnosis is assumed. The prognosis for cutaneous and indolent systemic mastocytosis is excellent. For more advanced forms of disease, prognostic parameters have been identified. A high extent of skin involvement, increased basal serum tryptase values, and extensive blistering are risk factors for severe mast cell activation episodes in children, whereas these associations seem to be less strong or nonexistent for anaphylaxis and osteoporosis in adult patients with indolent systemic mastocytosis.

  6. Risk factors for perioperative hyperglycemia in primary hip and knee replacements

    PubMed Central

    Jämsen, Esa; Nevalainen, Pasi I; Eskelinen, Antti; Kalliovalkama, Jarkko; Moilanen, Teemu

    2015-01-01

    Background and purpose Background and purpose — Perioperative hyperglycemia has been associated with adverse outcomes in several fields of surgery. In this observational study, we identified factors associated with an increased risk of hyperglycemia following hip and knee replacement. Patients and methods Patients and methods — We prospectively monitored changes in glucose following primary hip and knee replacements in 191 patients with osteoarthritis. Possible associations of patient characteristics and operation-related factors with hyperglycemia (defined as glucose > 7.8 mmol/L in 2 consecutive measurements) and severe hyperglycemia (glucose > 10 mmol/L) were analyzed using binary logistic regression with adjustment for age, sex, operated joint, and anesthesiological risk score. Results Results — 76 patients (40%) developed hyperglycemia, and 48 of them (25% of the whole cohort) had severe hyperglycemia. Glycemic responses were similar following hip replacement and knee replacement. Previously diagnosed diabetes was associated with an increased risk of hyperglycemia and severe hyperglycemia, compared to patients with normal glucose metabolism, whereas newly diagnosed diabetes and milder glucose metabolism disorders had no effect. In patients without previously diagnosed diabetes, increased values of preoperative glycosylated hemoglobin (HbA1c) and fasting glucose on the day of operation were associated with hyperglycemia. Higher anesthesiological risk score—but none of the operation-related factors analyzed—was associated with an increased risk of hyperglycemia. Interpretation Interpretation — Perioperative hyperglycemia is common in primary hip and knee replacements. Previously diagnosed diabetes is the strongest risk factor for hyperglycemia. In patients with no history of diabetes, preoperative HbA1c and fasting glucose on the day of operation can be used to stratify the risk of hyperglycemia. PMID:25409255

  7. Risk Factors for Recurrent Lumbar Disc Herniations

    PubMed Central

    2014-01-01

    The most common complication after lumbar discectomy is reherniation. As the first step in reducing the rate of recurrence, many studies have been conducted to find out the factors that may increase the reherniation risk. Some reported factors are age, sex, the type of lumbar disc herniation, the amount of fragments removed, smoking, alcohol consumption and the length of restricted activities. In this review, the factors studied thus far are summarized, excepting factors which cannot be chosen or changed, such as age or sex. Apart from the factors shown here, many other risk factors such as diabetes, family history, history of external injury, duration of illness and body mass index are considered. Few are agreed upon by all. The reason for the diverse opinions may be that many clinical and biomechanical variables are involved in the prognosis following operation. For the investigation of risk factors in recurrent lumbar disc herniation, large-scale multicenter prospective studies will be required in the future. PMID:24761206

  8. Preoperative Psychological Preparation of Children

    PubMed Central

    Güleç, Ersel; Özcengiz, Dilek

    2015-01-01

    Surgery and anaesthesia are significant sources of anxiety for children. In the preoperative period, reducing anxiety helps in preventing the negative consequences that may occur after surgery. The predetermined high-risk children in terms of the development of anxiety play an important role in reducing the negative consequences. Recently featured approaches are modelling and coping techniques, although many techniques are used in the preoperative psychological preparation. The use of computer programs in this area may facilitate important achievements, and it needs to support new studies to be performed. PMID:27366525

  9. Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: A retrospective case-control study.

    PubMed

    Tominaga, Hiroyuki; Setoguchi, Takao; Kawamura, Hideki; Kawamura, Ichiro; Nagano, Satoshi; Abematsu, Masahiko; Tanabe, Fumito; Ishidou, Yasuhiro; Yamamoto, Takuya; Komiya, Setsuro

    2016-10-01

    Surgical site infection (SSI) after spine instrumentation is difficult to treat, and often requires removal of instrumentation. The removal of instrumentation after spine surgery is a severe complication that can lead to the deterioration of activities of daily living and poor prognosis. Although there are many reports on SSI after spine surgery, few reports have investigated the risk factors for the removal of instrumentation after spine surgery SSI. This study aimed to identify the risk factors for unavoidable removal of instrumentation after SSI of spine surgery. We retrospectively reviewed 511 patients who underwent spine surgery with instrumentation at Kagoshima University Hospital from January 2006 to December 2014. Risk factors associated with SSI were analyzed via multiple logistic regression analysis. Parameters of the group that needed instrumentation removal were compared with the group that did not require instrumentation removal using the Mann-Whitney U and Fisher's exact tests. The posterior approach was used in most cases (453 of 511 cases, 88.6%). SSI occurred in 16 of 511 cases (3.14%) of spine surgery with instrumentation. Multivariate logistic regression analysis identified 2 significant risk factors for SSI: operation time, and American Society of Anesthesiologists physical status classification ≥ 3. Twelve of the 16 patients with SSI (75%) were able to keep the instrumentation after SSI. Pseudarthrosis occurred in 2 of 4 cases (50%) after instrumentation removal. Risk factors identified for instrumentation removal after spine SSI were a greater number of past surgeries, low preoperative hemoglobin, high preoperative creatinine, high postoperative infection treatment score for the spine, and the presence of methicillin-resistant Staphylococcus aureus. In these high risk cases, attempts should be made to decrease the risk factors preoperatively, and careful postoperative monitoring should be conducted.

  10. Risk factors associated with provoked pulmonary embolism

    PubMed Central

    Gjonbrataj, Endri; Kim, Ji Na; Gjonbrataj, Juarda; Jung, Hye In; Kim, Hyun Jung; Choi, Won-Il

    2017-01-01

    Background/Aims This study aimed to investigate the risk factors associated with provoked pulmonary embolism (PE). Methods This retrospective cohort study included 237 patients with PE. Patients that had transient risk factors at diagnosis were classified as having provoked PE, with the remaining patients being classified as having unprovoked PE. The baseline clinical characteristics and factors associated with coagulation were compared. We evaluated the risk factors associated with provoked PE. Results Of the 237 PE patients, 73 (30.8%) had provoked PE. The rate of respiratory failure and infection, as well as the disseminated intravascular coagulation score and ratio of right ventricular diameter to left ventricular diameter were significantly higher in patients with provoked PE than in those with unprovoked PE. The protein and activity levels associated with coagulation, including protein C antigen, protein S antigen, protein S activity, anti-thrombin III antigen, and factor VIII, were significantly lower in patients with provoked PE than in those with unprovoked PE. Multivariate analysis showed that infection (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.4 to 7.4) and protein S activity (OR, 0.97; 95% CI, 0.95 to 0.99) were significantly associated with provoked PE. Conclusions Protein S activity and presence of infection were important factors associated with provoked PE. We should pay attention to the presence of infection in patients with provoked PE. PMID:27097772

  11. Biological risk factors for deep vein trombosis.

    PubMed

    Vayá, Amparo; Mira, Yolanda; Martínez, Marcial; Villa, Piedad; Ferrando, Fernando; Estellés, Amparo; Corella, Dolores; Aznar, Justo

    2002-01-01

    Hypercoagulable states due either to inherited or acquired thrombotic risk factors are only present in approximately half of cases of DVT, but the causes in the other half, remain unknown. The importance of biological risk factors such as hyperlipidemia, hypofibrinolysis and hemorheological alterations in the pathogenesis of DVT has not been well established. In order to ascertain whether the above mentioned biological factors are associated with DVT and could constitute independent risk factors, we carried out a case-control study in 109 first DVT patients in whom inherited or acquired thrombophilic risk factors had been ruled out and 121 healthy controls age (42+/-15 years) and sex matched. From all the biological variables analyzed (cholesterol, triglycerides, glucose, fibrinogen, erythrocyte aggregation, hematocrit, plasma viscosity and PAI-1) only fibrinogen concentration reached a statistically significant difference on the comparison of means (290+/-73 mg/dl in cases vs 268+/-58 mg/dl in controls, p<0.05). After this continuous variables were dichotomized according to our reference values, the percentage of cases with cholesterolemia >220 mg/dl, hematocrit >45% and fibrinogen >300 mg/dl was higher in cases than in controls: 38% vs 22%; p<0.01; 43% vs 27%; p<0.05; 36% vs 23%; p<0.05, respectively. The percentage of cases with PAI-1 values >30 ng/ml, 37% vs 25% was borderline significant; p=0.055. Multivariate logistic regression analysis showed that cholesterolemia >220 mg/dl and fibrinogen >300 mg/dl constitute independent predictors of venous thrombotic risk. The adjusted OR's were 2.03 (95% CI; 1.12-3.70) for cholesterolemia and 1.94 (95% CI; 1.07-3.55) for fibrinogen. When these two variables combined DVT risk rose about fourfold (3.96; p<0.05). Our results suggest that hypercholesterolemia and hyperfibrinogenemia should be added to the list of known DVT risk factors and we recommend adopting measures to decrease these variables in the population with a

  12. Risk Factors for Depression in Early Adolescence

    ERIC Educational Resources Information Center

    MacPhee, Angela R.; Andrews, Jac J. W.

    2006-01-01

    The purpose of this study was to identify salient risk factors for depression in early adolescence from a group of common predictors. The following nine predictors were examined: (1) perceived quality of peer relationships, (2) perceived parental nurturance, (3) perceived parental rejection, (4) self-esteem, (5) body image, (6) pubertal status,…

  13. Environmental Risk Factors in Hospital Suicide

    ERIC Educational Resources Information Center

    Lieberman, Daniel Z.; Resnik, Harvey L.P.; Holder-Perkins, Vicenzio

    2004-01-01

    Suicide of hospitalized patients is the most common sentinel event reviewed by The Joint Commission on Accreditation of Healthcare Organizations. Shorter lengths of stay, sicker patients, and higher patient to staff ratios challenge the ability of the hospital to maintain safety. Risk factors associated with the physical environment of the…

  14. Risk Factors for Rural Residential Fires

    ERIC Educational Resources Information Center

    Allareddy, Veerasathpurush; Peek-Asa, Corinne; Yang, Jingzhen; Zwerling, Craig

    2007-01-01

    Context and Purpose: Rural households report high fire-related mortality and injury rates, but few studies have examined the risk factors for fires. This study aims to identify occupant and household characteristics that are associated with residential fires in a rural cohort. Methods: Of 1,005 households contacted in a single rural county, 691…

  15. Infants at Risk: Perinatal and Neonatal Factors.

    ERIC Educational Resources Information Center

    Lipsitt, Lewis P.

    1979-01-01

    Reviews studies of infant behavior and development. Delineates a behavioral hypothesis relating prenatal and neonatal risk factors in infancy to crib death. The mutual dependence of experience and neurostructural development suggests that infancy is a period of critical learning experiences. (Author/RH)

  16. Risk Factors for Domestic Violence in Curacao

    ERIC Educational Resources Information Center

    van Wijk, N. Ph. L.; de Bruijn, J. G. M.

    2012-01-01

    One out of three people (25% of men, 38% of women) in Curacao have experienced some form of domestic violence at some point in their adult lives. The most significant risk factors for domestic violence in Curacao are the female gender, a young age, low education, and experiencing domestic violence victimization in childhood. Divorce, single…

  17. Risk Factors for Paternal Physical Child Abuse

    ERIC Educational Resources Information Center

    Lee, Shawna J.; Guterman, Neil B.; Lee, Yookyong

    2008-01-01

    Objective: This study uses the developmental-ecological framework to examine a comprehensive set of paternal factors hypothesized to be linked to risk for paternal child abuse (PCA) among a diverse sample of fathers. Attention was given to fathers' marital status and their race/ethnicity (White, African American, and Hispanic). Methods: Interviews…

  18. Risk factors for osteoporosis and associated fractures.

    PubMed Central

    Kelsey, J L

    1989-01-01

    Established risk factors for osteoporosis and associated fractures are increasing age, female sex, white race, removal of the ovaries at an early age, prolonged immobility, and prolonged use of corticosteroids. Obesity and use of estrogen replacement therapy are protective. Factors that probably or possibly increase risk in postmenopausal white women include a low calcium intake, cigarette smoking, and, at least for hip fractures, use of long half-life psychotrophic drugs and heavy alcohol consumption. Factors probably or possibly associated with a decreased risk include ingestion of vitamin D and its metabolites, fluoride levels of 2 ppm or more in drinking water, moderate physical activity, pregnancies and breast feeding, use of thiazide diuretics, and progestogens. Some evidence suggests that calcium intake and physical activity at young ages may be important determinants of peak bone mass. Few studies have been undertaken in males and blacks, although at least some risk factors in males may be similar to those in females. Preventive efforts may be aimed at increasing peak bone mass at young ages, preventing bone loss in postmenopausal women, and preventing fractures and their adverse consequences in older people with osteoporosis. PMID:2517695

  19. Risk Factors for Smoking Behaviors among Adolescents

    ERIC Educational Resources Information Center

    Chung, Sung Suk; Joung, Kyoung Hwa

    2014-01-01

    Many students in Korea begin to use tobacco and develop a regular smoking habit before they reach adulthood. Yet, little is known about various signs contributing to the transition of the student smoking behaviors. This study used a national sample to explore and compare risk factors for smoking behaviors. Three types of smoking behaviors were…

  20. Child sexual assault: risk factors for girls.

    PubMed

    Butler, Amy C

    2013-09-01

    To identify prospectively measured risk factors of sexual assault (SA) among girls age 17 and younger. The data come from the Panel Study of Income Dynamics and are derived from interviews with 1,087 girls, their primary caregivers, and household heads. The data were collected from the girls' first year of life through their early twenties. Factors measured during childhood were used to predict whether the girls experienced a subsequent first sexual assault before the age of 18. Prospectively measured risk factors associated with subsequent child SA included the absence of one or both parents, maternal education less than college, family income below 400% of the federal poverty threshold, low caregiver warmth, child internalizing and externalizing behaviors, impulsivity, low achievement scores, and having been classified by their school as needing special education. Girls with behavioral health problems and learning challenges are at heightened risk for sexual assault. Research on behavioral health consequences of SA should control for preexisting SA risk factors to more accurately estimate the impact of child SA on subsequent behavioral health.

  1. Risk Factors and Prodromal Eating Pathology

    ERIC Educational Resources Information Center

    Stice, Eric; Ng, Janet; Shaw, Heather

    2010-01-01

    Prospective studies have identified factors that increase risk for eating pathology onset, including perceived pressure for thinness, thin-ideal internalization, body dissatisfaction, dietary restraint, and negative affect. Research also suggests that body dissatisfaction and dietary restraint may constitute prodromal stages of the development of…

  2. Oral cancer risk factors in New Zealand.

    PubMed

    Yakin, Muhammed; Gavidi, Ratu Osea; Cox, Brian; Rich, Alison

    2017-03-03

    Oral cancer constitutes the majority of head and neck cancers, which are the fifth most common malignancy worldwide, accounting for an estimated 984,430 cases in 2012. Between 2000 and 2010, there were 1,916 cases of OSCC in New Zealand with a male to female ratio of 1.85:1, and an age-standardised incidence rate of 42 persons per 1,000,000 population. This article presents an overview of the main risk factors for oral and oropharyngeal cancers and their prevalence in New Zealand. Alcohol consumption is the most prevalent risk factor in New Zealand, followed by tobacco. Given the high prevalence of these two risk factors and their synergistic effect, it is important for doctors and dentists to encourage smoking cessation in smokers and to recommend judicious alcohol intake. Research is needed to determine the prevalence of use of oral preparations of tobacco and water-pipe smoking in New Zealand, especially due to changing demography and increases in migrant populations. UV radiation is also an important risk factor. Further investigations are also needed to determine the prevalence of oral and oropharyngeal cancers attributable to oncogenic HPV infection.

  3. [Sexual risk factors among European young people].

    PubMed

    Calatrava, María; López-Del Burgo, Cristina; de Irala, Jokin

    2012-05-05

    The sexual transmission of the human immunodeficiency virus (HIV) and other sexually transmitted infections (STI) in Europe are still rising. In order to prioritize STI prevention strategies in Europe, it is important to describe the prevalence of different sexual risk factors for STIs among European young people. We carried out a systematic review of published articles and studies performed by European institutions. A total of 21 articles and 10 studies were identified. The data shows an increase in early sexual initiation and the number of sexual partners. Young people who use condoms inconsistently ranged from 15 to 20%. The observed risk factors are: unawareness about other STIs different from HIV, being in favour of casual sex, wrongly believing that some measures are effective in avoiding HIV, not being aware of the risks from having multiple sexual partners and unawareness about the sexual transmission of HIV. The data suggests the need to improve the information addressed to youth.

  4. Physiology of in-situ arterial revascularization in coronary artery bypass grafting: Preoperative, intraoperative and postoperative factors and influences

    PubMed Central

    Ferguson Jr, T Bruce

    2016-01-01

    Surgical revascularization with coronary artery bypass grafting (CABG) has become established as the most effective interventional therapy for patients with moderately severe and severe stable ischemic heart disease (SIHD). This recommendation is based on traditional 5-year outcomes of mortality and avoidance of myocardial infarction leading to reintervention and/or cardiac death. However, these results are confounded in that they challenge the traditional CABG surgical tenets of completeness of anatomic revascularization, the impact of arterial revascularization on late survival, and the lesser impact of secondary prevention following CABG on late outcomes. Moreover, the emergence of physiologic-based revascularization with percutaneous cardiovascular intervention as an alternative strategy for revascularization in SIHD raises the question of whether there are similar physiologic effects in CABG. Finally, the ongoing ISCHEMIA trial is specifically addressing the importance of the physiology of moderate or severe ischemia in optimizing therapeutic interventions in SIHD. So it is time to address the role that physiology plays in surgical revascularization. The long-standing anatomic framework for surgical revascularization is no longer sufficient to explain the mechanisms for short-term and long-term outcomes in CABG. Novel intraoperative imaging technologies have generated important new data on the physiologic blood flow and myocardial perfusion responses to revascularization on an individual graft and global basis. Long-standing assumptions about technical issues such as competitive flow are brought into question by real-time visualization of the physiology of revascularization. Our underestimation of the impact of Guideline Directed Medical Therapy, or Optimal Medical Therapy, on the physiology of preoperative SIHD, and the full impact of secondary prevention on post-intervention SIHD, must be better understood. In this review, these issues are addressed through

  5. Preoperative neutrophil-to-lymphocyte ratio and tumor-related factors to predict lymph node metastasis in patients with pancreatic ductal adenocarcinoma (PDAC)

    PubMed Central

    Tao, Lianyuan; Zhang, Lingfu; Peng, Ying; Tao, Ming; Li, Gang; Xiu, Dianrong; Yuan, Chunhui; Ma, Chaolai; Jiang, Bin

    2016-01-01

    As a poor prognosis indicator in patients with pancreatic ductal adenocarcinoma (PDCA), lymph node (LN) metastasis is of great importance in treatment. Present study was performed to evaluate the predictive value of preoperative neutrophil-to-lymphocyte ratio (NLR), Platelet-to-lymphocyte ratio (PLR) and possible clinical parameters on the LN metastasis in PDCA patients. A total of 159 operable patients with PDCA were enrolled in our study. The clinical utility of NLR and other clinical parameters was evaluated by receiver operating characteristic (ROC) curves. Overall survival analysis indicated that LN metastasis is an independent prognostic factor. The logistic analysis was used to determine the independent parameters associated with LN metastasis. Ideal cutoff values for predicting LN metastasis are 2.12 for NLR and 130.96 for PLR according to the ROC curve. Multivariate analyses indicate that NLR (HR 2.588; 95% CI 1.246-5.376; P = 0.011), CA125 (HR 6.348; 95% CI 2.056-19.594; P = 0.001) and CA19-9 (HR 2.738; 95% CI 1.151-6.515; P = 0.023) are associated significantly with LN metastasis independently. Preoperative NLR, CA125 and CA19-9 are useful biomarkers for the prediction of LN metastasis in PDCA patients. PMID:27494847

  6. Chronic disease risk factors among hotel workers

    PubMed Central

    Gawde, Nilesh Chandrakant; Kurlikar, Prashika R.

    2016-01-01

    Context: Non-communicable diseases have emerged as a global health issue. Role of occupation in pathogenesis of non-communicable diseases has not been explored much especially in the hospitality industry. Aims: Objectives of this study include finding risk factor prevalence among hotel workers and studying relationship between occupational group and chronic disease risk factors chiefly high body mass index. Settings and Design: A cross-sectional study was conducted among non-managerial employees from classified hotels in India. Materials and Methods: The study participants self-administered pre-designed pilot-tested questionnaires. Statistical analysis used: The risk factor prevalence rates were expressed as percentages. Chi-square test was used for bi-variate analysis. Overweight was chosen as ‘outcome’ variable of interest and binary multi-logistic regression analysis was used to identify determinants. Results: The prevalence rates of tobacco use, alcohol use, inadequate physical activity and inadequate intake of fruits and vegetables were 32%, 49%, 24% and 92% respectively among hotel employees. Tobacco use was significantly common among those in food preparation and service, alcohol use among those in food service and security and leisure time physical activity among front office workers. More than two-fifths (42.7%) were overweight. Among the hotel workers, those employed in food preparation and security had higher odds of 1.650 (CI: 1.025 – 2.655) and 3.245 (CI: 1.296 – 8.129) respectively of being overweight. Conclusions: Prevalence of chronic disease risk factors is high among hotel workers. Risk of overweight is significantly high in food preparation and security departments and workplace interventions are necessary to address these risks PMID:27390474

  7. Prenatal risk factors for childhood CKD.

    PubMed

    Hsu, Christine W; Yamamoto, Kalani T; Henry, Rohan K; De Roos, Anneclaire J; Flynn, Joseph T

    2014-09-01

    Development of CKD may be programmed prenatally. We sought to determine the association of childhood CKD with prenatal risk factors, including birth weight, maternal diabetes mellitus (DM), and maternal overweight/obesity. We conducted a population-based, case-control study with 1994 patients with childhood CKD (<21 years of age at diagnosis) and 20,032 controls in Washington state. We linked maternal and infant characteristics in birth records from 1987 to 2008 to hospital discharge data and used logistic regression analysis to assess the association of prenatal risk factors with childhood CKD. The prevalence of CKD was 126.7 cases per 100,000 births. High birth weight and maternal pregestational DM associated nominally with CKD, with respective crude odds ratios (ORs) of 1.17 (95% confidence interval [95% CI], 1.03 to 1.34) and 1.97 (95% CI, 1.15 to 3.37); however, adjustment for maternal confounders attenuated these associations to 0.97 (95% CI, 0.79 to 1.21) and 1.19 (95% CI, 0.51 to 2.81), respectively. The adjusted ORs for CKD associated with other prenatal factors were 2.88 (95% CI, 2.28 to 3.63) for low birth weight, 1.54 (95% CI, 1.13 to 2.09) for maternal gestational DM, 1.24 (95% CI, 1.05 to 1.48) for maternal overweight, and 1.26 (95% CI, 1.05 to 1.52) for maternal obesity. In subgroup analysis by CKD subtype, low birth weight and maternal pregestational DM associated significantly with increased risk of renal dysplasia/aplasia. Low birth weight, maternal gestational DM, and maternal overweight/obesity associated significantly with obstructive uropathy. These data suggest that prenatal factors may impact the risk of CKD. Future studies should aim to determine if modification of these factors could reduce the risk of childhood CKD.

  8. Environmental risk factors for heart disease.

    PubMed

    O'Toole, Timothy E; Conklin, Daniel J; Bhatnagar, Aruni

    2008-01-01

    In this review, we discuss current evidence linking environmental pollutants to cardiovascular disease (CVD). Extensive evidence indicates that environmental factors contribute to CVD risk, incidence, and severity. Migrant studies show that changes in the environment could substantially alter CVD risk in a genetically stable population. Additionally, CVD risk is affected by changes in nutritional and lifestyle choices. Recent studies in the field of environmental cardiology suggest that environmental toxins also influence CVD. Exposure to tobacco smoke is paradigmatic of such environmental risk and is strongly and positively associated with increased cardiovascular morbidity and mortality. In animal models of exposure, tobacco smoke induces endothelial dysfunction and prothrombotic responses and exacerbates atherogenesis and myocardial ischemic injury. Similar mechanism may be engaged by other pollutants or food constituents. Several large population-based studies indicate that exposure to fine or ultrafine particulate air pollution increases CVD morbidity and mortality, and the plausibility of this association is supported by data from animal studies. Exposure to other chemicals such as polyaromatic hydrocarbons, aldehydes, and metals has also been reported to elevate CVD risk by affecting atherogenesis, thrombosis, or blood pressure regulation. Maternal exposure to drugs, toxins, and infection has been linked with cardiac birth defects and premature CVD in later life. Collectively, the data support the notion that chronic environmental stress is an important determinant of CVD risk. Further work is required to assess the magnitude of this risk fully and to delineate specific mechanisms by which environmental toxins affect CVD.

  9. Susceptibility and risk factors in periodontal disease.

    PubMed

    Kinane, D F

    2000-10-01

    Epidemiological studies demonstrate a high prevalence of advanced destruction but also that relatively few individuals in each age group account for most of the advanced periodontal disease. The available data suggest that three quarters of advanced periodontal disease could be prevented by targeting an effective preventive strategy on the 28% of individuals especially at risk. Questions remain regarding: 1) whether an acceptable cost-effective preventive strategy can be devised; and 2) whether it is possible to establish a simple method of identifying the 'at risk' group. The various risk factors are numerous and include systemic diseases, smoking, drug therapy, hormonal disturbances and genetic factors as well as the more mundane factors such as plaque control and socio-economic and education and attitude factors. Aside from these factors, many patients present with periodontal disease and have no discernible predisposition other than possibly genetic, for which we can not currently test, and for the vast majority of patients there would appear to be no other alternative to periodic thorough examination for all patients, early treatment of all periodontal lesions and appropriate dental health education.

  10. Risk factors and their identification second part: study designs for identification of risk factors.

    PubMed

    Balkau, B; Eschwege, E

    1995-06-01

    This is the second a series of three articles which reviews the identification of risk factors of a disease, here: diabetes or complications of diabetes. In the first of the series [1], we gave the definition of a risk factor, along with measures of its force-relative risk and odds ratio, followed by the epidemiological definitions of the diseases: diabetes, coronary heart disease and hypertension. Risk factors were further discussed and we completed the discussion by some observations on the bias which can arise from a study or from its analysis, which can lead the researcher to the wrong conclusion. In this second article we define the three types of epidemiological studies which are used to determine whether factors are associated with a disease: observational or cross-sectional studies, cohort studies and casecohort studies. Examples are provided of each of these study types; their advantages and disadvantages are discussed. The final paper will provide some examples of the identification of risk factors from the literature. The first example involves diabetes and pancreatic cancer, the second birth weight and non-insulin dependent diabetes. Having found an association between a risk factor and diabetes, we will discuss whether it can be considered to be a risk factor, and if so whether it is likely to be a cause of the disease.

  11. Major Risk Factors for Heart Disease: High Blood Cholesterol

    MedlinePlus

    ... Major Risk Factors for Heart Disease High Blood Cholesterol High blood cholesterol is another major risk factor for heart disease ... can do something about. The higher your blood cholesterol level, the greater your risk for developing heart ...

  12. What Are the Risk Factors for Breast Cancer in Men?

    MedlinePlus

    ... and Prevention What Are the Risk Factors for Breast Cancer in Men? A risk factor is anything that ... old when they are diagnosed. Family history of breast cancer Breast cancer risk is increased if other members ...

  13. Clinically Silent Preoperative Brain Injuries Do Not Worsen with Surgery in Newborns with Congenital Heart Disease

    PubMed Central

    Block, AJ; McQuillen, PS; Chau, V; Glass, H; Poskitt, KJ; Barkovich, AJ; Esch, M; Soulikias, W; Azakie, A; Campbell, A; Miller, SP

    2010-01-01

    Objective Preoperative brain injury, particularly stroke and white matter injury (WMI), is common in newborns with congenital heart disease (CHD). The objective of this study was to determine the risk of hemorrhage or extension of preoperative brain injury with cardiac surgery. Methods This dual-center prospective cohort study recruited 92 term newborns: 62 with transposition of the great arteries (TGA), and 30 with single ventricle physiology from two tertiary referral centers. Newborns underwent brain MRI scans before and after cardiac surgery. Results Brain injury was identified in 40 (43%) newborns on the preoperative MRI scan (median five days of life): stroke in 23, WMI in 21, and intraventricular hemorrhage in 7. None of the brain lesions presented clinically with overt signs or seizures. Preoperative brain injury was associated with balloon atrial septostomy (BAS) (P=0.003) and lowest SaO2 (P=0.007); in a multivariable model, only the effect of BAS remained significant when adjusting for lowest SaO2. On postoperative MRI in 78 newborns (median 21 days of life), none of the preoperative lesions showed evidence of extension or hemorrhagic transformation (0/40 [95% CI: 0-7%]). The presence of preoperative brain injury was not a significant risk factor for acquiring new injury on the postoperative MRI (P=0.8). Conclusion Clinically silent brain injuries identified preoperatively in newborns with CHD, including stroke, have a low risk of progression with surgery and cardiopulmonary bypass, and should therefore not delay clinically indicated cardiac surgery. In this multi-center cohort, BAS remains an important risk factor for preoperative brain injury, particularly stroke. PMID:20434174

  14. Factors Affecting Ejection Risk in Rollover Crashes

    PubMed Central

    Funk, James R.; Cormier, Joseph M.; Bain, Charles E.; Wirth, Jeffrey L.; Bonugli, Enrique B.; Watson, Richard A.

    2012-01-01

    Ejection greatly increases the risk of injury and fatality in a rollover crash. The purpose of this study was to determine the crash, vehicle, and occupant characteristics that affect the risk of ejection in rollovers. Information from real world rollover crashes occurring from 2000 – 2010 was obtained from the National Automotive Sampling System (NASS) in order to analyze the effect of the following parameters on ejection risk: seatbelt use, rollover severity, vehicle type, seating position, roof crush, side curtain airbag deployment, glazing type, and occupant age, gender, and size. Seatbelt use was found to reduce the risk of partial ejection and virtually eliminate the risk of complete ejection. For belted occupants, the risk of partial ejection risk was significantly increased in rollover crashes involving more roof inversions, light trucks and vans (LTVs), and larger occupants. For unbelted occupants, the risk of complete ejection was significantly increased in rollover crashes involving more roof inversions, LTVs, far side occupants, and higher levels of roof crush. Roof crush was not a significant predictor of ejection after normalizing for rollover severity. Curtain airbag deployment was associated with reduced rates of partial and complete ejection, but the effect was not statistically significant, perhaps due to the small sample size (n = 89 raw cases with curtain deployments). A much greater proportion of occupants who were ejected in spite of curtain airbag deployment passed through the sunroof and other portals as opposed to the adjacent side window compared to occupants who were ejected in rollovers without a curtain airbag deployment. The primary factors that reduce ejection risk in rollover crashes are, in generally decreasing order of importance: seatbelt use, fewer roof inversions, passenger car body type, curtain airbag deployment, near side seating position, and small occupant size. PMID:23169130

  15. Psychosocial risk factors for coronary heart disease.

    PubMed

    Glozier, Nick; Tofler, Geoffrey H; Colquhoun, David M; Bunker, Stephen J; Clarke, David M; Hare, David L; Hickie, Ian B; Tatoulis, James; Thompson, David R; Wilson, Alison; Branagan, Maree G

    2013-08-05

    In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and CHD. Perceived chronic job strain and shift work are associated with a small absolute increased risk of developing CHD, but there is limited evidence regarding their effect on the prognosis of CHD. Evidence regarding a relationship between CHD and job (in)security, job satisfaction, working hours, effort-reward imbalance and job loss is inconclusive. Expert consensus is that workplace programs aimed at weight loss, exercise and other standard cardiovascular risk factors may have positive outcomes for these risk factors, but no evidence is available regarding the effect of such programs on the development of CHD. Social isolation after myocardial infarction (MI) is associated with an adverse prognosis. Expert consensus is that although measures to reduce social isolation are likely to produce positive psychosocial effects, it is unclear whether this would also improve CHD outcomes. Acute emotional stress may trigger MI or takotsubo ("stress") cardiomyopathy, but the absolute increase in transient risk from an individual stressor is low. Psychosocial stressors have an impact on CHD, but clinical significance and prevention require further study. Awareness of the potential for increased cardiovascular risk among populations exposed to natural disasters and other conditions of extreme stress may be useful for emergency services response planning. Wider public access to defibrillators should be available where large populations gather, such as sporting venues and airports, and as part of the response

  16. Risk Factors for Perioperative Anxiety in Laparoscopic Surgery

    PubMed Central

    Ulucanlar, Haluk; Ay, Ahmet; Ozden, Mustafa

    2014-01-01

    Background and Objectives: Our aim is to investigate the anxiety status of the patient before elective cholecystectomy and to analyze the relation between the level of anxiety for a given operation type (laparoscopic and open cholecystectomy) and the corresponding demographic and social data. Methods: A total of 333 patients undergoing cholecystectomy due to cholelithiasis were included in the study; 218 patients (66.1%) received laparoscopic cholecystectomy and 115 patients (33.9%) were treated with open cholecystectomy. The Beck Anxiety Inventory was given to all patients to be completed. We evaluated levels of anxiety in 3 groups as follows: 0 to 15, low to mild anxiety; 16 to 25, moderate anxiety; 26 to 63, severe anxiety. The following patient information remained confidential and was recorded: age and sex, associated disease, civil status, educational status, having open/laparoscopic cholecystectomy, previous knowledge of the operation, job status, economic status, health insurance, and having a child in need of care. Results: The following criteria were determined: the most determinant factors in differentiating between the score groups were having a low level of education, being of the female sex, being single, and having laparoscopic operation; the factors of being a homemaker and over the age of 25 years were determined to have significant effects. Conclusions: When analyzing the results that may appear during the intraoperative and postoperative period, understanding preoperative anxiety, analyzing the risk factors in depth, and taking the necessary precautions are all considerations that need to be the primary objectives of operators who are involved with laparoscopic, endoscopic, and robotic surgery. PMID:25392610

  17. Clinical Risk Factors for Portopulmonary Hypertension

    PubMed Central

    Kawut, Steven M.; Krowka, Michael J.; Trotter, James F.; Roberts, Kari E.; Benza, Raymond L.; Badesch, David B.; Taichman, Darren B.; Horn, Evelyn M.; Zacks, Steven; Kaplowitz, Neil; Brown, Robert S.; Fallon, Michael B.

    2010-01-01

    Portopulmonary hypertension affects up to 6% of patients with advanced liver disease, but the predictors and biologic mechanism for the development of this complication are unknown. We sought to determine the clinical risk factors for portopulmonary hypertension in patients with advanced liver disease. We performed a multicenter case-control study nested within a prospective cohort of patients with portal hypertension recruited from tertiary care centers. Cases had a mean pulmonary artery pressure >25 mm Hg, pulmonary vascular resistance >240 dynes · second · cm−5, and pulmonary capillary wedge pressure ≤ 15 mm Hg. Controls had a right ventricular systolic pressure < 40 mm Hg (if estimable) and normal right-sided cardiac morphology by transthoracic echocardiography. The study sample included 34 cases and 141 controls. Female sex was associated with a higher risk of portopulmonary hypertension than male sex (adjusted odds ratio =2.90, 95% confidence interval 1.20-7.01, P = 0.018). Autoimmune hepatitis was associated with an increased risk (adjusted odds ratio = 4.02, 95% confidence interval 1.14-14.23, P = 0.031), and hepatitis C infection was associated with a decreased risk (adjusted odds ratio =0.24, 95% confidence interval 0.09-0.65, P =0.005) of portopulmonary hypertension. The severity of liver disease was not related to the risk of portopulmonary hypertension. Conclusion Female sex and autoimmune hepatitis were associated with an increased risk of portopulmonary hypertension, whereas hepatitis C infection was associated with a decreased risk in patients with advanced liver disease. Hormonal and immunologic factors may therefore be integral to the development of portopulmonary hypertension. PMID:18537192

  18. Juvenile respiratory papillomatosis: risk factors for severity.

    PubMed

    Rodier, Caroline; Lapointe, Annie; Coutlée, François; Mayrand, Marie-Hélène; Dal Soglio, Dorothée; Roger, Michel; Trottier, Helen

    2013-08-01

    Juvenile recurrent respiratory papillomatosis is caused mainly by human papillomavirus genotypes 6 or 11, acquired at birth or during pregnancy from an infected mother. Recurrent respiratory papillomatosis is characterized by recurring warts growing most commonly in the larynx. Multiple surgical procedures and the risk of airway obstruction contribute to the devastating impact of this disease. Some children will go into remission after a few surgeries whereas others will require repeated interventions over several years. Further understanding of the risk factors associated with severity may contribute to tailored treatments. A retrospective study of cases diagnosed between January 1995 and December 2008 was conducted to study determinants of severe forms of juvenile recurrent respiratory papillomatosis. Demographic and clinical variables were abstracted from children's medical charts and mothers' delivery charts. Viral factors (HPV genotyping and viral load) were studied from archived biopsies. Specific HLA class II alleles and killer-cell immunoglobulin-like receptors genes were tested from saliva samples. Logistic regression was performed to identify risk factors for severity. Overall, 31 pediatric cases of recurrent respiratory papillomatosis were identified. The only significant factor associated with severe forms of recurrent respiratory papillomatosis was the maternal history of condylomas during pregnancy (OR: 12.05 [P=0.05]). The analysis failed to identify risk factors that could be used clinically to identify recurrent respiratory papillomatosis cases likely to take a severe course. Although too early to determine, vaccination against the HPV types involved most commonly in recurrent respiratory papillomatosis may provide the best hope to prevent severe forms of this disease.

  19. Psychological risk factors for chronic post-surgical pain after inguinal hernia repair surgery: a prospective cohort study.

    PubMed

    Powell, R; Johnston, M; Smith, W C; King, P M; Chambers, W A; Krukowski, Z; McKee, L; Bruce, J

    2012-04-01

    A significant proportion of patients experience chronic post-surgical pain (CPSP) following inguinal hernia surgery. Psychological models are useful in predicting acute pain after surgery, and in predicting the transition from acute to chronic pain in non-surgical contexts. This is a prospective cohort study to investigate psychological (cognitive and emotional) risk factors for CPSP after inguinal hernia surgery. Participants were asked to complete questionnaires before surgery and 1 week and 4 months after surgery. Data collected before surgery and 1 week after surgery were used to predict pain at 4 months. Psychological risk factors assessed included anxiety, depression, fear-avoidance, activity avoidance, catastrophizing, worry about the operation, activity expectations, perceived pain control and optimism. The study included 135 participants; follow-up questionnaires were returned by 119 (88.1%) and 115 (85.2%) participants at 1 week and 4 months after surgery respectively. The incidence of CPSP (pain at 4 months) was 39.5%. After controlling for age, body mass index and surgical variables (e.g. anaesthetic, type of surgery and mesh type used), lower pre-operative optimism was an independent risk factor for CPSP at 4 months; lower pre-operative optimism and lower perceived control over pain at 1 week after surgery predicted higher pain intensity at 4 months. No emotional variables were independently predictive of CPSP. Further research should target these cognitive variables in pre-operative psychological preparation for surgery.

  20. Pharmacogenetic Study in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Polymorphisms in Thymidylate Synthase, Epidermal Growth Factor Receptor, GSTP1, and DNA Repair Genes

    SciTech Connect

    Paez, David; Salazar, Juliana; Pare, Laia; Pertriz, Lourdes; Targarona, Eduardo; Rio, Elisabeth del; Barnadas, Agusti; Marcuello, Eugenio; Baiget, Montserrat

    2011-12-01

    Purpose: Several studies have been performed to evaluate the usefulness of neoadjuvant treatment using oxaliplatin and fluoropyrimidines for locally advanced rectal cancer. However, preoperative biomarkers of outcome are lacking. We studied the polymorphisms in thymidylate synthase, epidermal growth factor receptor, glutathione S-transferase pi 1 (GSTP1), and several DNA repair genes to evaluate their usefulness as pharmacogenetic markers in a cohort of 128 rectal cancer patients treated with preoperative chemoradiotherapy. Methods and Materials: Blood samples were obtained from 128 patients with Stage II-III rectal cancer. DNA was extracted from the peripheral blood nucleated cells, and the genotypes were analyzed by polymerase chain reaction amplification and automated sequencing techniques or using a 48.48 dynamic array on the BioMark system. The germline polymorphisms studied were thymidylate synthase, (VNTR/5 Prime UTR, 2R G>C single nucleotide polymorphism [SNP], 3R G>C SNP), epidermal growth factor receptor (Arg497Lys), GSTP1 (Ile105val), excision repair cross-complementing 1 (Asn118Asn, 8092C>A, 19716G>C), X-ray repair cross-complementing group 1 (XRCC1) (Arg194Trp, Arg280His, Arg399Gln), and xeroderma pigmentosum group D (Lys751Gln). The pathologic response, pathologic regression, progression-free survival, and overall survival were evaluated according to each genotype. Results: The Asterisk-Operator 3/ Asterisk-Operator 3 thymidylate synthase genotype was associated with a greater response rate (pathologic complete remission and microfoci residual tumor, 59% in Asterisk-Operator 3/ Asterisk-Operator 3 vs. 35% in Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk-Operator 3; p = .013). For the thymidylate synthase genotype, the median progression-free survival was 103 months for the Asterisk-Operator 3/ Asterisk-Operator 3 patients and 84 months for the Asterisk-Operator 2/ Asterisk-Operator 2 and Asterisk-Operator 2/ Asterisk

  1. Risk Factors for Stone Recurrence after Percutaneous Nephrolithotomy

    NASA Astrophysics Data System (ADS)

    Krambeck, Amy E.; Rangel, Laureano J.; LeRoy, Andrew J.; Patterson, David E.; Gettman, Matthew T.

    2008-09-01

    Recent studies have demonstrated more than 30% of percutaneous nephrolithotomy (PCNL) patients will experience a stone recurrence over a 20 year period. The goal of our study was to identify risk factors for stone recurrence after PCNL. Chart review identified 754 patients treated with PCNL for urolithiasis from March of 1983 to July 1984 at our institution. Of this cohort, 87 patients continued to receive medical care at our clinic and had been evaluated within the last 5 years. Of the 87 patients, 80 had recent radiographic imaging. Average follow-up was 19.2 years and 32 (40.0%) experienced at least 1 stone recurrence. There was no difference in preoperative BMI (p = 0.453) or change in BMI (p = 0.964) between patients that did and did not have a stone recurrence. Renal stone location (p = 0.605) and stone size (p = 0.238) were not predictive of recurrence. Patients with calcium oxalate monohydrate stones were less likely to recur (38.7% vs. 41.6%, p = 0.004) and those with calcium oxalate dihydrate (COD) were more likely to recur (31.1% vs. 19.6%, p = 0.006) compared to other compositions. Diabetes mellitus was not associated with recurrent stones (p = 0.810). Those patients with residual stones or fragments <3 mm were more likely to recur and to recur earlier than patients rendered entirely stone free at time of PCNL (p = 0.015). Stone recurrences were associated with the late development of renal insufficiency (25% vs. 2.1%, p = 0.002). In conclusion, stone composition, as well as the presence of residual fragments was associated with recurrent symptomatic stone events after PCNL. Recurrent stone events were significantly associated with the risk of developing renal insufficiency, further stressing the need for complete stone clearance at time of PCNL.

  2. [Elevated blood pressure as cardiovascular risk factor].

    PubMed

    Kowalewski, Wiesław; Hebel, Kazimiera

    2013-01-01

    Cardiovascular diseases for decades have been and still are the main and current health problem of the Polish society and there are many reasons for these diseases. Hypertension is one of the major risk factors for developing cardiovascular disease. The factors significantly increasing risk the of cardiovascular disease are in addition to high blood pressure, smoking (also passive), high blood fats (cholesterol and its HDL, LDL fractions as well as triglyceride levels, obesity, lack of exercise, diabetes and hereditary features. Other important factors which play an important role are external factors such as e.g. environmental pollution, lifestyle, stress. Prediction of cardiovascular disease should start from the evaluation of the fetal period because low birth weight may be a risk of coronary heart disease, hypertension, obesity or diabetes in adulthood. The authors of the referred tests showed that the level of blood pressure observed during childhood is closely associated with the level of blood pressure in adults and is also dependent on the body weight. Since the issue of the effects of high pressure on the cardiovascular system is inherent in the issue of the metabolic syndrome, it should be mentioned also that another causative factor may be an irregularity in the removal of urine from the body and the amount of insulin. The control of hypertension is a complex problem, at least in view of the wide range of adverse factors affecting the human body: hypertension is often either a constituent of other lesions. Therefore, it is difficult to treat high blood pressure in the strict sense; more often it is a combination therapy based on pharmacology caused for other reasons.

  3. Risk Factors for Urosepsis in Older Adults

    PubMed Central

    Peach, Brian C.; Garvan, Gerard J.; Garvan, Cynthia S.; Cimiotti, Jeannie P.

    2016-01-01

    Objective: To identify factors that predispose older adults to urosepsis and urosepsis-related mortality. Method: A systematic search using PubMed and CINAHL databases. Articles that met inclusion criteria were assessed using the Strengthening the Reporting of OBservational studies in Epidemiology (STROBE) criteria and were scored on a 4-point Likert-type scale. Results: A total of 180 articles were identified, and six met inclusion criteria. The presence of an internal urinary catheter was associated with the development of urosepsis and septic shock. Although a number of factors were examined, functional dependency, number of comorbidities, and low serum albumin were associated with mortality across multiple studies included in this review. Discussion: Little scientific evidence is available on urosepsis, its associated risk factors, and those factors associated with urosepsis-related mortality in older adults. More research is warranted to better understand urosepsis in this vulnerable population in an effort to improve the quality of patient care. PMID:28138493

  4. Parkinson's disease: evidence for environmental risk factors.

    PubMed

    Kieburtz, Karl; Wunderle, Kathryn B

    2013-01-01

    Parkinson's disease (PD) has no known cause. Although recent research has focused particularly on genetic causes of PD, environmental causes also play a role in developing the disease. This article reviews environmental factors that may increase the risk of PD, as well as the evidence behind those factors. Enough evidence exists to suggest that age has a causal relationship to PD. Significant evidence exists that gender, tobacco use, and caffeine consumption are also associated with the development of PD. Other environmental factors (pesticide exposure, occupation, blood urate levels, NSAID use, brain injury, and exercise) have limited or conflicting evidence of a relationship to PD. Future research must not neglect the impact of these environmental factors on the development of PD, especially with respect to potential gene-environment interactions.

  5. Dynamic risk factors: the Kia Marama evaluation.

    PubMed

    Hudson, Stephen M; Wales, David S; Bakker, Leon; Ward, Tony

    2002-04-01

    Risk assessment is an essential part of clinical practice. Each of the three aspects of risk (static, stable, and acute dynamic) are important at various points of contact between the man and the systems that are responsible for providing service. Dynamic factors, the typical treatment and supervision targets, have received less research attention than static factors. This paper examined the extent to which pretreatment, posttreatment and change scores were associated with reoffending among men incarcerated for sexually molesting. The results were generally supportive of change in prooffending attitudes as the key to not reoffending and suggested that the perspective-taking component of empathy and the use of fantasy may be important mechanisms. Affect scales generally failed to show any relationship with reoffending, outside decreases in trait and suppressed anger. Moreover, these data suggest that we could improve our assessments and treatment through increased sensitivity to offense pathways.

  6. Familial risk factors favoring drug addiction onset.

    PubMed

    Zimić, Jadranka Ivandić; Jukić, Vlado

    2012-01-01

    This study, primarily aimed at identification of familial risk factors favoring drug addiction onset, was carried out throughout 2008 and 2009. The study comprised a total of 146 addicts and 134 control subjects. Based on the study outcome, it can be concluded that in the families the addicts were born into, familial risk factors capable of influencing their psychosocial development and favoring drug addiction onset had been statistically more frequently encountered during childhood and adolescence as compared to the controls. The results also indicated the need for further research into familial interrelations and the structure of the families addicts were born into, as well as the need for the implementation of family-based approaches to both drug addiction prevention and therapy.

  7. [Risk factors of fatal outcome in pancreatonecrosis].

    PubMed

    Romanov, É I; Zubeev, P S; Ryzhov, M K; Bodrov, A A

    2014-01-01

    The article analyzed risk factors after operations for pancreatonecrosis in order to predict a course of the disease and carefully plan the treatment. It was revealed that the lethality level depended on different factors: the sex, age, a period of admission to the hospital, prevalence of necrotic suppurative process and severity of operative trauma. The authors made a conclusion of radical change to treatment approach. The open operations should be reduced at the expense of introduction of low-invasive methods of treatment in the case of pancreatonecrosis.

  8. Risk factors for amyotrophic lateral sclerosis

    PubMed Central

    Ingre, Caroline; Roos, Per M; Piehl, Fredrik; Kamel, Freya; Fang, Fang

    2015-01-01

    Amyotrophic lateral sclerosis (ALS) is the most common motor neuron disease. It is typically fatal within 2–5 years of symptom onset. The incidence of ALS is largely uniform across most parts of the world, but an increasing ALS incidence during the last decades has been suggested. Although recent genetic studies have substantially improved our understanding of the causes of ALS, especially familial ALS, an important role of non-genetic factors in ALS is recognized and needs further study. In this review, we briefly discuss several major genetic contributors to ALS identified to date, followed by a more focused discussion on the most commonly examined non-genetic risk factors for ALS. We first review factors related to lifestyle choices, including smoking, intake of antioxidants, physical fitness, body mass index, and physical exercise, followed by factors related to occupational and environmental exposures, including electromagnetic fields, metals, pesticides, β-methylamino-L-alanine, and viral infection. Potential links between ALS and other medical conditions, including head trauma, metabolic diseases, cancer, and inflammatory diseases, are also discussed. Finally, we outline several future directions aiming to more efficiently examine the role of non-genetic risk factors in ALS. PMID:25709501

  9. Risk factors for atherosclerosis in young individuals.

    PubMed

    Misra, A

    2000-06-01

    Atherosclerosis starts in childhood, and is accelerated in some individuals. A cluster of clinical and biochemical factors constitute the risk profile for many of them, perhaps most important being metabolic insulin resistance syndrome. Insulin resistance and its components for children and adolescents, especially obesity and dyslipidemia, are generators of hypertension, glucose intolerance and complications of atherosclerosis in adulthood. Some individuals are genetically predisposed, particularly those with the family history of such disorders. For many subjects, there is 'tracking' of metabolic and lifestyle factors from early age to adulthood. Several new risk factors of atherosclerosis (e.g. level of lipoprotein (a), procoagulant state, hyperhomocysteinemia, low birth weight and adverse in-utero environment, and possibly inflammatory markers) are current and potentially future areas of research concerning children and young individuals. Definition of and research on new and hitherto not investigated factors and formulation of strategies to neutralize the known factors are of paramount importance for primary prevention of atherosclerosis. Simple and effective measures for prevention include increasing awareness of the diseases, maintenance of ideal body weight, regular physical exercise, avoidance of smoking and chewing of tobacco, eating a balanced diet, and early periodic monitoring of blood pressure and metabolic status. These measures, starting from childhood, should be applied to all and in particular to the susceptible offspring, predisposed individuals, and populations.

  10. Maternal Risk Factors for Neonatal Necrotizing Enterocolitis

    PubMed Central

    March, Melissa I.; Gupta, Munish; Modest, Anna M.; Wu, Lily; Hacker, Michele R.; Martin, Camilia R.; Rana, Sarosh

    2015-01-01

    Objective This study aimed to investigate the relationship between maternal hypertensive disease and other risk factors and the neonatal development of necrotizing enterocolitis (NEC). Methods This was a retrospective case control study of infants with NEC from 2008 to 2012. The primary exposure of interest was maternal hypertensive disease, which has been hypothesized to put infants at risk for NEC. Other variables collected included demographics, pregnancy complications, medications, and neonatal hospital course. Data was abstracted from medical records. Results 28 cases of singleton neonates with NEC and 81 matched controls were identified and analyzed. There was no significant difference in the primary outcome. Fetuses with an antenatal diagnosis of growth restriction were more likely to develop NEC (p=0.008). Infants with NEC had lower median birth weight than infants without NEC (p=0.009). Infants with NEC had more late-onset sepsis (p=0.01) and mortality before discharge (p=0.001). Conclusions The factors identified by this case-control study that increased the risk of neonatal NEC included intrauterine growth restriction and lower neonatal birth weight. The primary exposure, hypertensive disease, did not show a significantly increased risk of neonatal NEC, however there was a nearly two-fold difference observed. Our study was underpowered to detect the observed difference. PMID:25162307

  11. Identification of Commercial Items Risk Factors

    DTIC Science & Technology

    2003-03-01

    profitable ) commercial customer-base. This means that the commercial vendors have several customers and their products are manufactured to meet more...NAVAL POSTGRADUATE SCHOOL Monterey, California THESIS Approved for public release; distribution is unlimited IDENTIFICATION OF COMMERCIAL ITEMS...of Commercial Items Risk Factors 6. AUTHOR(S) 5. FUNDING NUMBERS 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) Naval Postgraduate School

  12. Perinatal Risk Factors for Mild Motor Disability

    ERIC Educational Resources Information Center

    Hands, Beth; Kendall, Garth; Larkin, Dawne; Parker, Helen

    2009-01-01

    The aetiology of mild motor disability (MMD) is a complex issue and as yet is poorly understood. The aim of this study was to identify the prevalence of perinatal risk factors in a cohort of 10-year-old boys and girls with (n = 362) and without (n = 1193) MMD. Among the males with MMD there was a higher prevalence of postpartum haemorrhage,…

  13. Management of patients with risk factors

    PubMed Central

    Waldfahrer, Frank

    2013-01-01

    This review addresses concomitant diseases and risk factors in patients treated for diseases of the ears, nose and throat in outpatient and hospital services. Besides heart disease, lung disease, liver disease and kidney disease, this article also covers disorders of coagulation (including therapy with new oral anticoagulants) and electrolyte imbalance. Special attention is paid to the prophylaxis, diagnosis and treatment of perioperative delirium. It is also intended to help optimise the preparation for surgical procedures and pharmacotherapy during the hospital stay. PMID:24403970

  14. [Risk factors for cesarean section: epidemiologic approach].

    PubMed

    Trujillo Hernández, B; Tene Pérez, C E; Ríos Silva, M

    2000-07-01

    The increase in frequency of cesareans that has been noted through 70's, not diminished--like it was expected--perinatal morbidity and mortality. The most important indications to cesarean are distocias, previous cesarean and fetal stress. In 1998 frequency of cesarean deliveries in our hospital was 35% of the pregnancy attended. The claim of this study was to determine risks factors to cesarean in our hospital. A case-control study was performed, selecting 165 cases (cesareans) and 328 controls (via vaginal). It was determined OR of the risks factors and atribuible fraction. Data were analyzed by X2. The most important indications to cesarean delivery were: distocias (39%, n = 64); previous cesarean (23%, n = 41) and fetal stress (11%, n = 21). There was not significative differences in age, height and rupture membrane time in both groups. History of cesarean delivery gave major risk to another surgical intervention (OR = 12.7, p = < 0.0001, atribuible fraction 92%). Nuliparous (OR = 6.6, p < 0.00000, atribuible fraction 85%), second gestation (OR = 1.8, p = 0.002) or history of abortion (OR = 1.8, p = 0.04) were factors mainly associated to cesarean delivery. We concluded that the precise 'medications of this surgical intervention specially in nuliparous or previous cesarean delivery cases must be replanteated to diminish its elevated frequency.

  15. Gangrenous cholecystitis: mortality and risk factors.

    PubMed

    Önder, Akın; Kapan, Murat; Ülger, Burak Veli; Oğuz, Abdullah; Türkoğlu, Ahmet; Uslukaya, Ömer

    2015-02-01

    As a serious complication of cholelithiasis, gangrenous cholecystitis presents greater mortality than noncomplicated cholecystitis. The aim of this study was to specify the risk factors on mortality. 107 consecutive patients who underwent surgery due to gangrenous cholecystitis between January 1997 and October 2011 were investigated retrospectively. The study included 60 (56.1%) females and 47 (43.9%) males, with a mean age of 60.7 ± 16.4 (21-88) years. Cardiovascular diseases were the most frequently accompanying medical issues (24.3%). Thirty-six complications (33.6%) developed in 29 patients, and surgical site infection was proven as the most common. Longer delay time prior to hospital admission, low white blood cell count, presence of diabetes mellitus, higher blood levels of aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase and total bilirubin, pericholecystic fluid in abdominal ultrasonography, and conversion from laparoscopic surgery to open surgery were identified as risk factors affecting mortality (P < 0.001, P = 0.001, P = 0.044, P = 0.005, P = 0.049, P = 0.009, P = 0.022, P = 0.011, and P = 0.004, respectively). Longer delay time prior to hospital admission and low white blood cell count were determined as independent risk factors affecting mortality.

  16. [Perioperative risk factors and anesthetic management of patients for carotid endarterectomy].

    PubMed

    Niinai, H; Nakagawa, I; Shima, T; Kubota, M; Yamada, K; Kamiya, T; Yoshida, A; Yasuda, T

    1997-05-01

    Data from the records of 142 patients for carotid endarterectomy at Chugoku Rosai General Hospital between 1983 and 1995, were evaluated concerning perioperative risk factors and anesthetic management. As a preoperative anesthetic risk, the incidence of hypertension was the commonest (76%), and there was a significant incidence of ischemic heart disease (18%). Fentanyl and isoflurane have been used for anesthesia recently and the patients were closely observed and cared in the intensive care unit postoperatively. In order to prevent cerebral ischemia during the occlusion of the internal carotid artery, we measured somatosensory evoked potential as well as jugular venous oxygen saturation, and used near infrared spectophotometry. As a result, postoperative mortality and morbidity were 0% and 2%, respectively. The candidates for CEA have potentially high perioperative risks, and it is important to evaluate the coexisting diseases and to select proper anesthetic technic and monitors.

  17. Cervical lordotic alignment following posterior spinal fusion for adolescent idiopathic scoliosis: reciprocal changes and risk factors for malalignment.

    PubMed

    Hayashi, Kazunori; Toyoda, Hiromitsu; Terai, Hidetomi; Suzuki, Akinobu; Hoshino, Masatoshi; Tamai, Koji; Ohyama, Shoichiro; Nakamura, Hiroaki

    2017-01-27

    OBJECTIVE Numerous reports have been published on the effectiveness and safety of correction of the coronal Cobb angle and thoracolumbar sagittal alignment in patients with adolescent idiopathic scoliosis (AIS). Suboptimal sagittal alignment, such as decreased thoracic kyphosis (TK), after corrective surgery, is a possible cause of lumbar or cervical spinal degeneration and junctional malalignment; however, few reports are available on reciprocal changes outside of the fused segments, such as the cervical lordotic angle (CLA). This study aimed to investigate the relationship between the perioperative CLA and other radiographic factors or clinical results in AIS, and to identify independent risk factors of postoperative cervical hyperkyphosis. METHODS A total of 51 AIS patients who underwent posterior spinal fusion with the placement of pedicle screw (PS) constructs at thoracic levels were included in the study. Clinical and radiographic follow-up of patients was conducted for a minimum of 2 years, and the postoperative course was evaluated. The authors measured and identified the changes in the CLA and other radiographic parameters using whole-spine radiography, with the patient in the standing position, performed immediately before surgery, 2 weeks after surgery, and 2 years after surgery. The postoperative cervical hyperkyphosis group included patients whose CLA at 2-year follow-up was smaller than -10°. The reciprocal changes of the CLA and other parameters were also investigated. Univariate and multivariate analyses were conducted to determine the associated risk factors for postoperative cervical hyperkyphosis. RESULTS This study comprised 48 females and 3 males (mean age 16.0 years). The mean follow-up period was 47 months (range 24-90 months). The main coronal thoracic curve was corrected from 54.6° to 16.4°, and the mean correction rate was 69.8% at 2 years. The CLA significantly increased from the mean preoperative measurement (-5.4° ± 14°) to the 2

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

    PubMed Central

    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.

    2015-01-01

    Objective 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). Patients and Methods 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. Results 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

  19. Risk factors for malaria in UK travellers.

    PubMed

    Moore, David A; Grant, Alison D; Armstrong, Margaret; Stümpfle, Richard; Behrens, Ron H

    2004-01-01

    After observing an apparent increase in severe falciparum malaria among travellers returning from The Gambia to the United Kingdom (UK) in the last quarter of 2000, we conducted a case-control study to investigate risk factors for malaria. The study participants had visited The Gambia between 1 September and 31 December 2000, travelling with the largest UK tour operator serving this destination. The main outcome measures were risk factors associated with malaria. Forty-six cases and 557 controls were studied. Eighty-seven percent of all participants reported antimalarial use (41% chloroquine/proguanil, 31% mefloquine). On univariate analysis the strongest risk factors for disease were: early calendar period of visit, longer duration of stay, non-use of antimalarial prophylaxis, non-use of mefloquine, lack of room air-conditioning, less use of insect repellent, prior visit to another malarial area and accommodation in 'hotel X'. After adjustment in multivariate analysis, use of mefloquine remained strongly protective (odds ratios, OR 0.13 [95% confidence intervals, 95% CI 0.04-0.40]), and the strongest independent risk factors for malaria were early calendar period (OR 5.19 [2.35-11.45] for 1 September to 9 November 2000 versus 10 November to 31 December 2000), prior visit to another malarial area (OR 3.27 [1.41-7.56]), main accommodation in 'hotel X' (OR 3.24 [1.51-6.97]) and duration of stay (OR 2.05 per extra week [1.42-2.95]). Neither any use, nor > 90% adherence to chloroquine/proguanil were protective (adjusted OR for any use 0.57 [0.27-1.21], P = 0.14). We concluded mefloquine use was strongly protective against malaria (87% protective efficacy), whereas chloroquine/proguanil, which is no longer recommended but remains widely used, was less than half as effective (43% protective efficacy). Waning efficacy of chloroquine/proguanil may have contributed to the observed increase in malaria among travellers to The Gambia in 2000. Local factors may also influence

  20. Risk Factors for Osteonecrosis of the Jaws

    PubMed Central

    Barasch, A.; Cunha-Cruz, J.; Curro, F.A.; Hujoel, P.; Sung, A.H.; Vena, D.; Voinea-Griffin, A.E.; Beadnell, Steven; Craig, Ronald G.; DeRouen, Timothy; Desaranayake, Ananda; Gilbert, Ann; Gilbert, Gregg H.; Goldberg, Ken; Hauley, Richard; Hashimoto, Mariko; Holmes, Jon; Latzke, Brooke; Leroux, Brian; Lindblad, Anne; Richman, Joshua; Safford, Monika; Ship [deceased], Jonathan; Thompson, Van P.; Williams, O. Dale; Yin, Wanrong

    2011-01-01

    Case reports and cohort studies have linked bisphosphonate therapy and osteonecrosis of the jaws (ONJ), but neither causality nor specific risks for lesion development have been clearly established. We conducted a 1:3 case-control study with three dental Practice-based Research Networks, using dentist questionnaires and patient interviews for collection of data on bisphosphonate therapy, demographics, co-morbidities, and dental and medical treatments. Multivariable logistic regression analyses tested associations between bisphosphonate use and other risk factors with ONJ. We enrolled 191 ONJ cases and 573 controls in 119 dental practices. Bisphosphonate use was strongly associated with ONJ (odds ratios [OR] 299.5 {95%CI 70.0-1282.7} for intravenous [IV] use and OR = 12.2 {4.3-35.0} for oral use). Risk markers included local suppuration (OR = 7.8 {1.8-34.1}), dental extraction (OR = 7.6 {2.4-24.7}), and radiation therapy (OR = 24.1 {4.9-118.4}). When cancer patients (n = 143) were excluded, bisphosphonate use (OR = 7.2 {2.1-24.7}), suppuration (OR = 11.9 {2.0-69.5}), and extractions (OR = 6.6 {1.6-26.6}) remained associated with ONJ. Higher risk of ONJ began within 2 years of bisphosphonate initiation and increased four-fold after 2 years. Both IV and oral bisphosphonate use were strongly associated with ONJ. Duration of treatment > 2 years; suppuration and dental extractions were independent risk factors for ONJ. PMID:21317246

  1. Early-life factors and endometriosis risk

    PubMed Central

    Upson, Kristen; Sathyanarayana, Sheela; Scholes, Delia; Holt, Victoria L.

    2015-01-01

    Objective To study early-life factors in relation to endometriosis risk in adulthood. Design Population-based case-control study. Setting Women’s Risk of Endometriosis (WREN) study was conducted among female enrollees ages 18-49 years of a large, integrated healthcare system in western Washington State. Patients Cases (n=310) were women diagnosed for the first time with endometriosis between years 1996-2001 and controls (n=727) were women without a diagnosis of endometriosis randomly selected from the healthcare system population. Interventions None. Main outcome measures Adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the associations between intrauterine diethylstilbestrol (DES) exposure, maternal smoking, mother’s age at delivery, firstborn status, birth weight, fetal number, prematurity, and regular soy formula feeding during infancy and endometriosis were estimated using unconditional logistic regression, adjusting for frequency matching and confounding variables. Information on early-life factors was ascertained retrospectively by in-person interview, with information on maternal DES use and regular soy formula feeding directly gathered from the participant’s mother or other family member. Results We observed that women who were regularly fed soy formula as infants had over twice the risk of endometriosis compared to unexposed women (aOR 2.4, 95% CI: 1.2-4.9). Our data also suggested increased endometriosis risk with prematurity (aOR 1.7, 95% CI: 0.9-3.1) and maternal use of DES (OR 2.0, 95% CI: 0.8-4.9, adjusting only for frequency matching variables), although these confidence intervals included the null. Conclusion Our results support the hypothesis that disruption of development during fetal and infant periods may increase the risk of endometriosis in adulthood. PMID:26211883

  2. [Subjective perception of maladjustment risk factors].

    PubMed

    Salomone, M; Romano, L; Esposito, A; Nigro, E; Boggia, B; Napolano, E; Carbone, U

    2007-01-01

    Maladjustment at work results from organizational and relational features of the work, the so-called fourth type factors; they include working hours, ways and contents of working activities, and horizontal and vertical business relations. The study reports the percentage of sensed disturbing factors in workers with maladjustment and disaffection at work. Data have been taken from 1382 white collars, 1117 males and 265 females, observed from January 2006 to June 2007 for Health Surveillance. Maladjustment prevalence was higher in females than in males. As individual variables, ageing and family care increased the prevalence of maladjustment among females, whilst a higher prevalence of maladjustment were found in youngest and unmarried males. A very different perception of work harmfulness were found between sexes. As risk factors, female have denounced more wear and tear and authoritarian management; male denounced physical strain.

  3. Pancreatic cellular injury after cardiac surgery with cardiopulmonary bypass: frequency, time course and risk factors.

    PubMed

    Nys, Monique; Venneman, Ingrid; Deby-Dupont, Ginette; Preiser, Jean-Charles; Vanbelle, Sophie; Albert, Adelin; Camus, Gérard; Damas, Pierre; Larbuisson, Robert; Lamy, Maurice

    2007-05-01

    Although often clinically silent, pancreatic cellular injury (PCI) is relatively frequent after cardiac surgery with cardiopulmonary bypass; and its etiology and time course are largely unknown. We defined PCI as the simultaneous presence of abnormal values of pancreatic isoamylase and immunoreactive trypsin (IRT). The frequency and time evolution of PCI were assessed in this condition using assays for specific exocrine pancreatic enzymes. Correlations with inflammatory markers were searched for preoperative risk factors. One hundred ninety-three patients submitted to cardiac surgery were enrolled prospectively. Blood IRT, amylase, pancreatic isoamylase, lipase, and markers of inflammation (alpha1-protease inhibitor, alpha2-macroglobulin, myeloperoxidase) were measured preoperatively and postoperatively until day 8. The postoperative increase in plasma levels of pancreatic enzymes and urinary IRT was biphasic in all patients: early after surgery and later (from day 4 to 8 after surgery). One hundred thirty-three patients (69%) experienced PCI, with mean IRT, isoamylase, and alpha1-protease inhibitor values higher for each sample than that in patients without PCI. By multiple regression analysis, we found preoperative values of plasma IRT >or=40 ng/mL, amylase >or=42 IU/mL, and pancreatic isoamylase >or=20 IU/L associated with a higher incidence of postsurgery PCI (P < 0.005). In the PCI patients, a significant correlation was found between the 4 pancreatic enzymes and urinary IRT, total calcium, myeloperoxidase, alpha1-protease inhibitor, and alpha2-macroglobulin. These data support a high prevalence of postoperative PCI after cardiac surgery with cardiopulmonary bypass, typically biphasic and clinically silent, especially when pancreatic enzymes were elevated preoperatively.

  4. Risk factors for transient dysfunction of gas exchange after cardiac surgery

    PubMed Central

    Rodrigues, Cristiane Delgado Alves; Moreira, Marcos Mello; Lima, Núbia Maria Freire Vieira; de Figueirêdo, Luciana Castilho; Falcão, Antônio Luis Eiras; Petrucci, Orlando; Dragosavac, Desanka

    2015-01-01

    Objective A retrospective cohort study was preformed aiming to verify the presence of transient dysfunction of gas exchange in the postoperative period of cardiac surgery and determine if this disorder is linked to cardiorespiratory events. Methods We included 942 consecutive patients undergoing cardiac surgery and cardiac procedures who were referred to the Intensive Care Unit between June 2007 and November 2011. Results Fifteen patients had acute respiratory distress syndrome (2%), 199 (27.75%) had mild transient dysfunction of gas exchange, 402 (56.1%) had moderate transient dysfunction of gas exchange, and 39 (5.4%) had severe transient dysfunction of gas exchange. Hypertension and cardiogenic shock were associated with the emergence of moderate transient dysfunction of gas exchange postoperatively (P=0.02 and P=0.019, respectively) and were risk factors for this dysfunction (P=0.0023 and P=0.0017, respectively). Diabetes mellitus was also a risk factor for transient dysfunction of gas exchange (P=0.03). Pneumonia was present in 8.9% of cases and correlated with the presence of moderate transient dysfunction of gas exchange (P=0.001). Severe transient dysfunction of gas exchange was associated with patients who had renal replacement therapy (P=0.0005), hemotherapy (P=0.0001), enteral nutrition (P=0.0012), or cardiac arrhythmia (P=0.0451). Conclusion Preoperative hypertension and cardiogenic shock were associated with the occurrence of postoperative transient dysfunction of gas exchange. The preoperative risk factors included hypertension, cardiogenic shock, and diabetes. Postoperatively, pneumonia, ventilator-associated pneumonia, renal replacement therapy, hemotherapy, and cardiac arrhythmia were associated with the appearance of some degree of transient dysfunction of gas exchange, which was a risk factor for reintubation, pneumonia, ventilator-associated pneumonia, and renal replacement therapy in the postoperative period of cardiac surgery and cardiac

  5. Preoperative protein profiles in cerebrospinal fluid in elderly hip fracture patients at risk for delirium: A proteomics and validation study

    PubMed Central

    Westhoff, Dunja; Witlox, Joost; van Aalst, Corneli; Scholtens, Rikie M.; de Rooij, Sophia E.; van Munster, Barbara C.; de Jonghe, Jos F.M.; Houdijk, Alexander P.J.; Eikelenboom, Piet; van Westerloo, David J.; van de Beek, Diederik; van Gool, Willem A.; Koenderman, Leo

    2015-01-01

    Background A neuroinflammatory response is suggested to play an important role in delirium, a common complication in older hospitalized patients. We examined whether hip fracture patients who develop postoperative delirium have a different proteome in cerebrospinal fluid (CSF) prior to surgery. Methods Patients (≥ 75 years) were admitted for hip fracture surgery. CSF was collected during spinal anaesthesia; proteins were separated using gel electrophoresis and identified with mass spectrometry. We compared the proteome of patients with and without postoperative delirium. Findings were validated in an independent, comparable cohort using immuno-assays. Results In the derivation cohort 53 patients were included, 35.8% developed postoperative delirium. We identified differences in levels of eight CSF proteins between patients with and without subsequent delirium: complement factor C3, contactin-1, fibulin-1 and I-beta-1,3-N-acetylglucosaminyltransferase were significantly lower in patients with postoperative delirium, while neural cell adhesion molecule-2, fibrinogen, zinc-α-2-glycoprotein and haptoglobin levels were significantly higher. In the validation cohort 21.2% of 52 patients developed postoperative delirium. Immuno-assays confirmed contactin-1 results although not statistically significant. Complement factor C3 was significantly higher in patients with postoperative delirium. Conclusion Our results show the complexity of pathophysiological mechanisms involved in delirium and emphasizes the need of independent validation of findings. General significance This study highlights the challenges and inconsistent findings in studies of delirium, a serious complication in older patients. We analysed proteins in CSF, the most proximal fluid to the brain. All patients were free from delirium at the time of sampling. PMID:26675981

  6. Risk factors for asthma: is prevention possible?

    PubMed

    Beasley, Richard; Semprini, Alex; Mitchell, Edwin A

    2015-09-12

    Asthma is one of the most common diseases in the world, resulting in a substantial burden of disease. Although rates of deaths due to asthma worldwide have reduced greatly over the past 25 years, no available therapeutic regimens can cure asthma, and the burden of asthma will continue to be driven by increasing prevalence. The reasons for the increase in asthma prevalence have not been defined, which limits the opportunities to develop targeted primary prevention measures. Although associations are reported between a wide range of risk factors and childhood asthma, substantiation of causality is inherently difficult from observational studies, and few risk factors have been assessed in primary prevention studies. Furthermore, none of the primary prevention intervention strategies that have undergone scrutiny in randomised controlled trials has provided sufficient evidence to lead to widespread implementation in clinical practice. A better understanding of the factors that cause asthma is urgently needed, and this knowledge could be used to develop public health and pharmacological primary prevention measures that are effective in reducing the prevalence of asthma worldwide. To achieve this it will be necessary to think outside the box, not only in terms of risk factors for the causation of asthma, but also the types of novel primary prevention strategies that are developed, and the research methods used to provide the evidence base for their implementation. In the interim, public health efforts should remain focused on measures with the potential to improve lung and general health, such as: reducing tobacco smoking and environmental tobacco smoke exposure; reducing indoor and outdoor air pollution and occupational exposures; reducing childhood obesity and encouraging a diet high in vegetables and fruit; improving feto-maternal health; encouraging breastfeeding; promoting childhood vaccinations; and reducing social inequalities.

  7. Patient Risk Factors for Mechanical Wound Complications and Postoperative Infections after Elective Open Intestinal Resection

    PubMed Central

    Chang, Wei Chao; Turner, Akiva; Imon, Michael; Dyda, Anthony

    2016-01-01

    Background Few studies focused on the construction of preoperative patient surgical risk profile using only patients’ personal, social history, and comorbidity profiles. Objective To identify risk factors for mechanical wound complications and postoperative infections in patients’ preoperative profiles. Design Quantitative retrospective cohort study using 2009–2011 Health Care Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) databases. Patients 56,853 patients who underwent elective open intestinal resection. Measurements Predictors of mechanical wound complications and postoperative infections in patients’ personal, social history, and comorbidity profiles. Results Patients age 18–39 were more likely to suffer mechanical wound complications compared to patients age 65–79 (OR = 1.9, 95% CI [1.5, 2.4], p < .01) and to patients age 80 and over (OR = 2.9, 95% CI [2.2, 3.8], p < .01). Patients age 18–39 were also more likely to suffer postoperative infections compared to patients age 65–79 (OR = 1.4, 95% CI [1.1, 1.6], p < .01) and to patients age 80 and over (OR = 2.0, 95% CI [1.6, 2.6], p < .01). Other most significant predictors included male gender, fluid and electrolyte disorders, pulmonary circulation disorders, and weight loss, as well as patients with comorbidities. All statistically significant predictors with positive estimates for postoperative infections were also statistically significant predictors of mechanical wound complications. Conclusions Individual patient risk profile can be constructed using preoperative patient profiles for improving perioperative care coordination and patient care quality. Postoperative infections were associated with mechanical wound complications in patients undergoing elective open intestinal resection. PMID:27833511

  8. Parkinson's disease: A risk factor for osteoporosis.

    PubMed

    Malochet-Guinamand, Sandrine; Durif, Franck; Thomas, Thierry

    2015-12-01

    Parkinson's disease is the most common neurodegenerative disease after Alzheimer's disease. On the long term, it may be complicated by various musculoskeletal problems, such as osteoporotic fractures, that have significant socioeconomic consequences. Indeed, patients suffering from Parkinson's disease have a higher fracture risk, particularly hip fracture risk, than other subjects of the same age because of both a higher risk of falls and lower bone mineral density. Bone loss in Parkinson's disease may be associated with the severity and duration of the disease. We review here the different suspected mechanisms of accelerated bone loss in Parkinson's disease, amongst which weight loss and reduced mobility appear to play key roles. Antiparkinsonian drugs, particularly levodopa, may also be associated with decreased bone mineral density as a result of hyperhomocysteinaemia. We discuss the role of other nutritional deficiencies, such as vitamin B12, folate or vitamin K. In conclusion, it seems necessary to screen for and treat osteoporosis in this at-risk population, while actions to prevent falls are still disappointing. A better understanding of the factors explaining bone loss in this population would help implementing preventive actions.

  9. Risk Factors for Parenteral Nutrition–associated Liver Disease Following Surgical Therapy for Necrotizing Enterocolitis

    PubMed Central

    Duro, Debora; Mitchell, Paul D.; Kalish, Leslie A.; Martin, Cami; McCarthy, Maggie; Jaksic, Tom; Dunn, James; Brandt, Mary L.; Nobuhara, Kerilyn K.; Sylvester, Karl G.; Moss, R. Lawrence; Duggan, Christopher

    2012-01-01

    Objective The aim of the study was to prospectively determine risk factors for the development of parenteral nutrition–associated liver disease (PNALD) in infants who underwent surgery for necrotizing enterocolitis (NEC), the most common cause of intestinal failure in children. Patients and Methods From February 2004 to February 2007, we diagnosed 464 infants with NEC, of whom 180 had surgery. One hundred twenty-seven patients were available for full analysis. PNALD was defined as serum direct bilirubin ≥2 mg/dL or ALT ≥2× the upper limit of normal in the absence of sepsis after ≥14 days of exposure to PN. Median Results Median gestational age was 26 weeks and 68% were boys. Seventy percent of the cohort developed PNALD and the incidence of PNALD varied significantly across the 6 study sites, ranging from 56% to 85% (P=0.05). Multivariable logistic regression analysis identified small-bowel resection or creation of jejunostomy (odds ratio [OR] 4.96, 95% confidence interval [CI] 1.97–12.51, P = 0.0007) and duration of PN in weeks (OR 2.37, 95% CI 1.56–3.60, P < 0.0001) as independent risk factors for PNALD. Preoperative exposure to PN was also associated with the development of PNALD; the risk of PNALD was 2.6 (95% CI 1.5–4.7; P = 0.001) times greater in patients with ≥4 weeks of preoperative PN compared with those with less preoperative PN use. Breast milk feedings, episodes of infection, and gestational age were not related to the development of PNALD. Conclusions The incidence of PNALD is high in infants with NEC undergoing surgical treatment. Risk factors for PNALD are related to signs of NEC severity, including the need for small-bowel resection or proximal jejunostomy, as well as longer exposure to PN. Identification of these and other risk factors can help in the design of clinical trials for the prevention and treatment of PNALD and for clinical assessment of patients with NEC and prolonged PN dependence. PMID:21464752

  10. Epidemiology and risk factors for invasive candidiasis

    PubMed Central

    Yapar, Nur

    2014-01-01

    The number of immunosuppressive patients has increased significantly in recent years. These patients are at risk for opportunistic infections, especially fungal infections. Candidiasis is one of the most frequent fungal infections determined in these immunosuppressive patients and its epidemiology has changed over the last two decades. Recently, new antifungal agents and new therapy strategies such as antifungal prophylaxis, secondary prophylaxis, and preemptive therapy have come into use. These changes resulted in the alteration of Candida species causing invasive infections. The incidence of Candida albicans was decreased in many countries, especially among patients with immunosuppressive disorders, while the incidence of species other than C. albicans was increased. In this review, incidence, risk factors, and species distribution of invasive candidiasis are discussed. PMID:24611015

  11. Assessing risk factors for periodontitis using regression

    NASA Astrophysics Data System (ADS)

    Lobo Pereira, J. A.; Ferreira, Maria Cristina; Oliveira, Teresa

    2013-10-01

    Multivariate statistical analysis is indispensable to assess the associations and interactions between different factors and the risk of periodontitis. Among others, regression analysis is a statistical technique widely used in healthcare to investigate and model the relationship between variables. In our work we study the impact of socio-demographic, medical and behavioral factors on periodontal health. Using regression, linear and logistic models, we can assess the relevance, as risk factors for periodontitis disease, of the following independent variables (IVs): Age, Gender, Diabetic Status, Education, Smoking status and Plaque Index. The multiple linear regression analysis model was built to evaluate the influence of IVs on mean Attachment Loss (AL). Thus, the regression coefficients along with respective p-values will be obtained as well as the respective p-values from the significance tests. The classification of a case (individual) adopted in the logistic model was the extent of the destruction of periodontal tissues defined by an Attachment Loss greater than or equal to 4 mm in 25% (AL≥4mm/≥25%) of sites surveyed. The association measures include the Odds Ratios together with the correspondent 95% confidence intervals.

  12. Perinatal epidemiological risk factors for preeclampsia.

    PubMed

    Bobić, Mirna Vuković; Habek, Dubravko; Habek, Jasna Čerkez

    2015-03-01

    In the present study, the impact of the potential perinatal epidemiological factors on preeclampsia development was assessed. This clinical study included 55 pregnant women with preeclampsia and control group of 50 healthy pregnant women. Positive family history of cardiovascular disease, diabetes mellitus or thromboembolic disease was recorded in 50% of women with preeclampsia versus 28% of control group women. Positive personal history of this disease was recorded in 15% of women with preeclampsia, whereas all control group women had negative personal history of preeclampsia. Dietary habits, i.e. the intake of meat and meat products, fruit and vegetables, coffee and alcohol drinks were similar in the two groups, without statistically significant differences. The women with preeclampsia and control women reported comparable habits; there was no difference in the consumption of meat, fruit, vegetables, coffee and alcohol, smoking, use of folate and oral hormonal contraception before pregnancy, or in physical activity as the potential risk factors for preeclampsia in current pregnancy. However, personal and family history of vascular disease proved to be significant risk factors for the occurrence of preeclampsia, emphasizing the need of lifestyle and dietary modifications with healthy dietary habits, while avoiding adverse habits in pregnancy.

  13. Internet Abuse Risk Factors among Spanish Adolescents.

    PubMed

    Carballo, José L; Marín-Vila, María; Espada, José P; Orgilés, Mireia; Piqueras, José A

    2015-11-27

    Empirical evidence has revealed various factors that contribute to the development and maintenance of Internet abuse. The aim of this paper was to analyze, on a sample of Spanish adolescents, the relationship between Internet abuse and: (1) Personal and interpersonal risk factors, including social skills in both virtual and real-life contexts; (2) Drug use. A total of 814 high school students aged between 13 and 17 participated in this study, and were divided into two groups: Internet Abusers (IA = 173) and Non-Internet Abusers (NIA = 641). Questionnaires were used to analyze Internet and drug use/abuse, as well as social skills, in virtual and real contexts. Various interpersonal risk factors (family and group of friends) were also assessed. IA showed a more severe pattern of Internet and drug use, as well as poorer social skills in both contexts. Moreover, their groups of friends appeared more likely to become involved in risky situations related to Internet and drug abuse. Both IA and NIA showed more adaptive social skills in the virtual context than in the real one. There is a need for further research to build on these findings, with a view to designing specific preventive programs that promote responsible Internet use.

  14. [Risk factors and pathogenesis of Hashimoto's thyroiditis].

    PubMed

    Paknys, Gintaras; Kondrotas, Anatolijus Juozas; Kevelaitis, Egidijus

    2009-01-01

    The aim of this review is to summarize the current knowledge on Hashimoto's thyroiditis and its pathogenesis and to introduce the readers to the basic concept of autoimmune thyroid disease. Hashimoto's thyroiditis and Graves' disease are different expressions of a basically similar autoimmune process, and the clinical appearance reflects the spectrum of the immune response in a particular patient. During this response, cytotoxic autoantibodies, stimulatory autoantibodies, blocking autoantibodies, or cell-mediated autoimmunity may be observed. Persons with classic Hashimoto's thyroiditis have serum antibodies reacting with thyroglobulin and thyroid peroxidase. These antibodies (particularly antibodies against thyroid peroxidase) are complement-fixing immunoglobulins and may be cytotoxic. In addition, many patients have cell-mediated immunity directed against thyroid antigens. Cell mediated-immunity is also a feature of experimental thyroiditis induced in animals by injection of thyroid antigen with adjuvants. Hashimoto's thyroiditis is predominantly the clinical expression of cell-mediated immunity leading to destruction of thyroid cells, which in its severest form causes thyroid failure. The significance of genetic component and nongenetic risk factors (pregnancy, drugs, age, sex, infection, and irradiation) in the development of Hashimoto's thyroiditis is also reviewed. Epidemiologic studies have demonstrated that the genetic component is important in the pathogenesis of Hashimoto's thyroiditis, although the pattern of inheritance is non-Mendelian and is likely to be influenced by subtle variations in the functions of multiple genes. Nongenetic risk factors (environmental factors) are also etiologically important, because the concordance rate in monozygotic twins is below 1.

  15. Behavior Risk Factors Among Russian Students.

    PubMed

    Anischenko, Aleksander; Arhangelskaya, Anna; Klenov, Michael; Burdukova, Ekaterina; Ogarev, Valrii; Ignatov, Nikolay; Osadchenko, Irina; Gurevich, Konstantin

    2017-01-01

    Purpose To analyze the prevalence of risk factors among Russian students. Methods In this study, 834 students were included from five Federal universities which were localized in four Federal regions of Russian Federation. Future doctors, school teachers, and wellness trainers were included in this study. Students were specifically asked about smoking, physical activity International Physical Activity Questionnaire (IPAQ), and food preference. Waist, hip, weight, and height were measured. Results The region of study and ethnic group were not influenced with respect to age and body mass index ( p > .1), while all other factors had a significant influence ( p < .05). High levels of smoking, hypodynamia, and motivation to intake of unhealthy food were found in medical students in comparison with those in future teachers and wellness instructors ( p < .05). The indicators of central obesity (due to levels of body mass index and waist-hip ratio) were found in medical students. Perspective Special programs to prevent the most common behavior risk factors in future medical doctors have to be designed.

  16. [Risk factors and protective factors of the insanities].

    PubMed

    Clément, Jean-Pierre

    2007-12-01

    The Alzheimer's disease (AD) is multifactorial. How to explain this group of very heterogeneous factors? Many of them can be considered as biopsychosocial risk factors. In other words, the risk factors, in link with the physiological functioning and a physiopathology, are difficultly dissociable of contingencies of psychological and/or social nature. The vital lead could be the stress bound to these variables, be it biological or psychosocial. It remains to ask the question of the preventive efficiency of treatments to relieve the impact of the traumatizing events of life that entail a depressive state or a state of posttraumatic stress. The hippocamp has to be the object of a quite particular attention. AD is a disease of the adaptation. This integrative model combines three vulnerabilities: a genetic vulnerability which would be there to dictate the type of lesions, their localization and the age of occurence; a psychobiographic vulnerability corresponding to a personality with inadequate mechanisms of defence, precarious adaptability in front of the adversity, weak impact strength and biography built on events of life during childhood, then during the grown-up life of traumatic nature, with a psychosocial environment insufficiently auxiliary; a neuroendocrinologic vulnerability which would base on a deregulation of the corticotrope axis, acquired during its infantile maturation, hampered by too premature stress. It would lead to a bad biological adaptability in stress later, at the origin of the observable lesions in the insanities.

  17. Preoperative widespread pain sensitization and chronic pain after hip and knee replacement: a cohort analysis

    PubMed Central

    Wylde, Vikki; Sayers, Adrian; Lenguerrand, Erik; Gooberman-Hill, Rachael; Pyke, Mark; Beswick, Andrew D.; Dieppe, Paul; Blom, Ashley W.

    2015-01-01

    Abstract Chronic pain after joint replacement is common, affecting approximately 10% of patients after total hip replacement (THR) and 20% of patients after total knee replacement (TKR). Heightened generalized sensitivity to nociceptive input could be a risk factor for the development of this pain. The primary aim of this study was to investigate whether preoperative widespread pain sensitivity was associated with chronic pain after joint replacement. Data were analyzed from 254 patients receiving THR and 239 patients receiving TKR. Pain was assessed preoperatively and at 12 months after surgery using the Western Ontario and McMaster Universities Osteoarthritis Pain Scale. Preoperative widespread pain sensitivity was assessed through measurement of pressure pain thresholds (PPTs) at the forearm using an algometer. Statistical analysis was conducted using linear regression and linear mixed models, and adjustments were made for confounding variables. In both the THR and TKR cohort, lower PPTs (heightened widespread pain sensitivity) were significantly associated with higher preoperative pain severity. Lower PPTs were also significantly associated with higher pain severity at 12 months after surgery in the THR cohort. However, PPTs were not associated with the change in pain severity from preoperative to 12 months postoperative in either the TKR or THR cohort. These findings suggest that although preoperative widespread pressure pain sensitivity is associated with pain severity before and after joint replacement, it is not a predictor of the amount of pain relief that patients gain from joint replacement surgery, independent of preoperative pain severity. PMID:25599300

  18. Environmental and genetic risk factors in obesity.

    PubMed

    Hebebrand, Johannes; Hinney, Anke

    2009-01-01

    Because of its high prevalence and the associated medical and psychosocial risks, research into the causes of childhood obesity has experienced a tremendous upswing. Formal genetic data based on twin, adoption, and family studies lead to the conclusion that at least 50% of the interindividual variance of the body mass index (BMI; defined as weight in kilograms divided by height in meters squared) is due to genetic factors. As a result of the recent advent of genome-wide association studies, the first polygenes involved in body weight regulation have been detected. Each of the predisposing alleles explain a few hundred grams of body weight. More polygenes will be detected in the near future, thus for the first time allowing in-depth analyses of gene-gene and gene-environment interactions. They also will enable developmental studies to assess the effect of such alleles throughout childhood and adulthood. The recent increase in obesity prevalence rates illustrates the extreme relevance of environmental factors for body weight. Similar to polygenes, the effect sizes of most such environmental factors are likely to be small, thus rendering their detection difficult. In addition, the validation of the true causality of such factors is not a straightforward task. Important factors are socioeconomic status and television consumption. The authors conclude by briefly assessing implications for treatment and prevention of childhood obesity.

  19. Risk Factors for Relapse of Human Brucellosis

    PubMed Central

    Hasanjani Roushan, Mohammad Reza; Moulana, Zahra; Afshar, Zeinab Mohseni; Ebrahimpour, Soheil

    2016-01-01

    Background & Propose: Brucellosis is serious disease around the world, especially in underdeveloped countries. Relapse is major problem in therapy of brucellosis. This study aimed to evaluate risk factors of relapse after treatment in patients. Methods: It is a descriptive-analytic study from 1990 to 2014, in Ayatolla Rohani hospital in Babol, Iran. We studied 980 patients with brucellosis. The studied community included patients infected with brucellosis and the required information was gathered based on their hospital files. The base for recognizing Malta fever were clinical symptoms and Para-clinical sign congruent with infection like as, titer SAT>1:320 and 2-ME>1:160. Patients with relapse and patients without relapse were placed separately in two groups. The data were statistically compared with Spss 16, by Chi-square and Cox–regression tests. Results: Based on this study, treatment regimen is a preventive factor (P=0.000). Moreover, Based on some statistical methods, regimens no. 3 and 4 were introduce preventive factors (P=0.001) and (P=0.004). It should also be noted that findings the same statistical model, factors like gender, age, residence, professional contacts, complications and delay in treatment were also analyzed but none of them are considered as preventive factors. Conclusion: Based our finding, we suggest aminoglycosides (gentamicin or streptomycin with doxycycline) are associated with lower rate of relapse in brucellosis. PMID:26925907

  20. Risk factors for Indian kala-azar.

    PubMed

    Ranjan, Alok; Sur, Dipika; Singh, Vijay P; Siddique, Niyamat A; Manna, Byomkesh; Lal, Chandra S; Sinha, Prabhat K; Kishore, Kamal; Bhattacharya, Sujit K

    2005-07-01

    A case-control study was conducted to understand the risk factors associated with kala-azar in disease-endemic areas of Bihar, India. A total of 134 kala-azar cases treated at the Rajendra Memorial Research Institute of Medical Sciences in Patna and 406 healthy controls selected randomly from the neighborhoods of cases in their native villages were included in the study. Univariate analysis showed that education, a history of other diseases in the previous year, a history of kala-azar in the family, type of walls in houses, presence of a granary inside houses, presence of vegetation around houses, bamboo trees near houses, and irregular spraying around houses with DDT were risk factors. Multivariate analysis showed that a history of other diseases in the previous year (odds ratio [OR] = 3.6, P = 0.002), a history of kala-azar in the family (OR = 1.8, P = 0.03), mud-plastered walls in houses, (OR = 2.4, P = 0.0001], a granary inside houses (OR = 4.3, P = 0.0001), presence of bamboo trees around houses (OR = 2.3, P = 0.001), and houses not sprayed with DDT in the past six months (OR = 3.4, P = 0.0001) were significant risk factors for kala-azar. These results will be useful in developing kala-azar control programs for identifying intervention strategies such as better housing, regular and proper insecticide spraying, and promoting health awareness to the community residing in disease-endemic areas for reducing transmission and incidence of this disease.

  1. Risk factors for anthracycline-associated cardiotoxicity

    PubMed Central

    Patel, Roshan; Pan, Xueliang; Timmers, Cynthia Dawn; Pilarski, Robert; Shapiro, Charles L.; Lustberg, Maryam B.

    2016-01-01

    Purpose Carbonyl reductase (CBR) catalyzes anthracycline metabolism, and single nucleotide polymorphisms (SNPs) in CBR impact metabolic efficiency. In pediatric patients, homo-zygosity for the major allele (G) in the CBR3 gene was associated with increased risk of anthracycline cardiotoxicity. We hypothesized that CBR SNPs contribute to cardiotoxicity in adults Methods We retrospectively identified female breast cancer patients in the Columbus Breast Tissue Bank Registry treated with adriamycin and cytoxan (AC) from 2003 to 2012. We selected patients who developed cardiomyopathy, defined as a drop in ejection fraction to <50 % or >15 % decrease from pre-therapy. Univariate and multivariate logistic regressions were performed to identify cardiotoxicity risk factors. SNPs were genotyped, and frequency of the major allele (G)/minor allele (A) of the CBR3 and CBR1 genes was calculated. Results We identified 52 cases of cardiotoxicity after AC and 110 controls. Multivariate analysis showed that trastuzumab (p=0.009), diabetes (p=0.05), and consumption of >8 alcoholic drinks/week (p=0.024) were associated with higher cardiotoxicity risk. Moderate alcohol consumption (<8 drinks/week) was associated with lower risk (p=0.009). No association was identified between CBR SNPs and cardiotoxicity (CBR1 p= 0.261; CBR3 p=0.556). Conclusions This is the first study to evaluate SNPs in the CBR pathway as predictors of AC cardiotoxicity in adults. We did not observe any significant correlation between cardiotoxicity and SNPs within the CBR pathway. Further investigation into CBR SNPs in a larger adult sample is needed. Additional exploration into genomic predictors of anthracycline cardiotoxicity may allow for the development of preventative and therapeutic strategies for those at risk. PMID:26563179

  2. [Patient's Risk Factors for Perioperative Aspiration Pneumonia].

    PubMed

    Ishikawa, Teruhiko; Isono, Shiroh

    2016-01-01

    This article reviews patient's own risk factors for perioperative aspiration pneumonia. Maintaining the function of the lower esophageal sphincter (LES), the airway protective reflex, and the oral hygiene are the most important to prevent the pneumonia. The LES is adversely affected by excessive stomach distention, some medication given in perioperative periods, and habitual smoking, as well as pathological status such as esophageal hiatus hernia and achalasia. Postapoplectic patients may have insufficient airway protective reflex including swallowing and laryngeal reflex. It is emphasized that the perioperative oral care is increasing in its importance for the prevention of aspiration pneumonia.

  3. [Cardiovascular risk factors in Tlemcen (Algeria)].

    PubMed

    Latifa, Boukli Hacène; Kaouel, Meguenni

    2007-01-01

    Cardiovascular risk factors were studied in a random representative sample of the urban community of Tlemcen, aged 20 years or older. The study included 805 subjects (participation rate: 72%). This study showed a high prevalence of hypertension (32.7%), diabetes (16.1%), cigarette smoking (17.1%, but 36.8% among men), blood cholesterol levels > 6.2 mmol/L (6.3%) and obesity (19.2% and significantly higher in women than in men: 27.9% vs 10.5%). These results show that the prevalence of hypertension is very high among women, reaching levels observed in industrialized countries.

  4. Hepatocellular carcinoma: Epidemiology, risk factors and pathogenesis

    PubMed Central

    Gomaa, Asmaa Ibrahim; Khan, Shahid A; Toledano, Mireille B; Waked, Imam; Taylor-Robinson, Simon D

    2008-01-01

    Hepatocellular carcinoma (HCC) is the commonest primary malignant cancer of the liver in the world. Given that the burden of chronic liver disease is expected to rise owing to increasing rates of alcoholism, hepatitis B and C prevalence and obesity-related fatty liver disease, it is expected that the incidence of HCC will also increase in the foreseeable future. This article summarizes the international epidemiology, the risk factors and the pathogenesis of HCC, including the roles of viral hepatitis, toxins, such as alcohol and aflatoxin, and insulin resistance. PMID:18666317

  5. Psychopathy as a risk factor for violence.

    PubMed

    Hare, R D

    1999-01-01

    As a result of Kansas v Hendricks, many sex offenders in the U.S. are likely to be civilly committed to mental institutions for indefinite periods, and many others with histories of violent offenses may also be so committed. It therefore becomes critical for mental health professionals to understand the risk factors for re-offending that put the public in jeopardy. The most reliable of these factors is psychopathy, which will here be defined, along with its differentiation from the more commonly diagnosed antisocial personality disorder. The assessment of psychopathy, its relationship to crime--especially, to violent crime, its (non-) responsiveness to the usual treatment, and an outline of a potentially more effective one, are presented. Finally, and particularly in view of its widely accepted validity, the potential for abuse of the PCL-R and :SV are noted.

  6. Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy.

    PubMed

    Kimmell, Kristopher T; Jahromi, Babak S

    2015-05-01

    OBJECT Patients undergoing craniotomy are at risk for developing venous thromboembolism (VTE). The safety of anticoagulation in these patients is not clear. The authors sought to identify risk factors predictive of VTE in patients undergoing craniotomy. METHODS The authors reviewed a national surgical quality database, the American College of Surgeons National Surgical Quality Improvement Program. Craniotomy patients were identified by current procedural terminology code. Clinical factors were analyzed to identify associations with VTE. RESULTS Four thousand eight hundred forty-four adult patients who underwent craniotomy were identified. The rate of VTE in the cohort was 3.5%, including pulmonary embolism in 1.4% and deep venous thrombosis in 2.6%. A number of factors were found to be statistically significant in multivariate binary logistic regression analysis, including craniotomy for tumor, transfer from acute care hospital, age ≥ 60 years, dependent functional status, tumor involving the CNS, sepsis, emergency surgery, surgery time ≥ 4 hours, postoperative urinary tract infection, postoperative pneumonia, on ventilator ≥ 48 hours postoperatively, and return to the operating room. Patients were assigned a score based on how many of these factors they had (minimum score 0, maximum score 12). Increasing score was predictive of increased VTE incidence, as well as risk of mortality, and time from surgery to discharge. CONCLUSIONS Patients undergoing craniotomy are at low risk of developing VTE, but this risk is increased by preoperative medical comorbidities and postoperative complications. The presence of more of these clinical factors is associated with progressively increased VTE risk; patients possessing a VTE Risk Score of ≥ 5 had a greater than 20-fold increased risk of VTE compared with patients with a VTE score of 0.

  7. Aortic valve replacement in the elderly. Risk factors and long-term results.

    PubMed Central

    Tseng, E E; Lee, C A; Cameron, D E; Stuart, R S; Greene, P S; Sussman, M S; Watkins, L; Gardner, T J; Baumgartner, W A

    1997-01-01

    underwent AVR scored comparably to their age-matched population norms in seven of eight dimensions of overall health. The exception is mental health. CONCLUSIONS: Aortic valve replacement in the elderly can be performed with acceptable mortality. Significant preoperative risk factors for early mortality include poor left ventricular function and preoperative pacemaker insertion. Predictors of late mortality include chronic obstructive pulmonary disease and urgency of operation. These results stress the importance of operating on the elderly with aortic valve disease; both long-term survival and functional recovery are excellent. Images Figure 9. PMID:9230820

  8. What Are the Risk Factors for Acute Lymphocytic Leukemia?

    MedlinePlus

    ... and Prevention What Are the Risk Factors for Acute Lymphocytic Leukemia? A risk factor is something that affects your ... this is unknown. Having an identical twin with ALL Someone who has an identical twin who develops ...

  9. What Are the Risk Factors for Vulvar Cancer?

    MedlinePlus

    ... is anything that changes a person's chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking ...

  10. What Are the Risk Factors for Gastrointestinal Stromal Tumors?

    MedlinePlus

    ... Gastrointestinal Stromal Tumors Be Prevented? Gastrointestinal Stromal Tumor (GIST) Causes, Risk Factors, and Prevention What Are the ... few known risk factors for gastrointestinal stromal tumors (GISTs). Being older These tumors can occur in people ...

  11. What Are the Risk Factors for Childhood Leukemia?

    MedlinePlus

    ... Prevention What Are the Risk Factors for Childhood Leukemia? A risk factor is anything that affects a ... of leukemia. Having a brother or sister with leukemia Siblings (brothers and sisters) of children with leukemia ...

  12. What Are the Risk Factors for Uterine Sarcoma?

    MedlinePlus

    ... such as smoking, drinking, or diet. Some factors influence risk more than others. But risk factors don' ... the disease. Written by References The American Cancer Society medical and editorial content team Our team is ...

  13. Incidence And Risk Factors For 30-Day Readmissions After Hip Fracture Surgery

    PubMed Central

    Martin, Christopher T; Gao, Yubo; Pugely, Andrew J.

    2016-01-01

    Background Unplanned hospital readmission following orthopedic procedures results in significant expenditures for the Medicare population. In order to reduce expenditures, hospital readmission has become an important quality metric for Medicare patients. The purpose of the present study is to determine the incidence and risk factors for 30-day readmissions after hip fracture surgery. Methods Patients over the age of 18 years who underwent hip fracture surgery, including open reduction internal fixation (ORIF), intramedullary nailing, hemi-arthroplasty, or total hip arthroplasty, between the years 2012 and 2013 were identified from the American College of Surgeons National Surgical Quality improvement Program (NSQIP) database. Overall, 17,765 patients were identified. Univariate and multivariate analyses were performed in order to determine patient and surgical factors associated with 30-day readmission. Results There were 1503 patients (8.4%) readmitted within 30-days of their index procedure. Of the patients with a reason listed for readmission, 27.4% were for procedurally related reasons, including wound complications (16%), peri-prosthetic fractures (4.5%) and prosthetic dislocations (6%). 72.6% of readmissions were for medical reasons, including sepsis (7%), pneumonia (14%), urinary tract infection (6.3%), myocardial infarction (2.7%), renal failure (2.7%), and stroke (2.3%). In the subsequent multivariate analysis, pre-operative dyspnea, COPD, hypertension, disseminated cancer, a bleeding disorder, pre-operative hematocrit of <36, pre-operative creatinine of >1.2, an ASA class of 3 or 4, and the operative procedure type were each independently associated with readmissions risk (p<0.05 for each). Conclusions The overall rate of readmission following hip fracture surgery was moderate. Surgeons should consider discharge optimization in the at risk cohorts identified here, particularly patients with multiple medical comorbidities or an elevated ASA class, and

  14. AEG-1 expression is an independent prognostic factor in rectal cancer patients with preoperative radiotherapy: a study in a Swedish clinical trial

    PubMed Central

    Gnosa, S; Zhang, H; Brodin, V P; Carstensen, J; Adell, G; Sun, X-F

    2014-01-01

    Background: Preoperative radiotherapy (RT) is widely used to downstage rectal tumours, but the rate of recurrence varies significantly. Therefore, new biomarkers are needed for better treatment and prognosis. It has been shown that astrocyte elevated gene-1 (AEG-1) is a key mediator of migration, invasion, and treatment resistance. Our aim was to analyse the AEG-1 expression in relation to RT in rectal cancer patients and to test its radiosensitising properties. Methods: The AEG-1 expression was examined by immunohistochemistry in 158 patients from the Swedish clinical trial of RT. Furthermore, we inhibited the AEG-1 expression by siRNA in five colon cancer cell lines and measured the survival after irradiation by colony-forming assay. Results: The AEG-1 expression was increased in the primary tumours compared with the normal mucosa independently of the RT (P<0.01). High AEG-1 expression in the primary tumour of the patients treated with RT correlated independently with higher risk of distant recurrence (P=0.009) and worse disease-free survival (P=0.007). Downregulation of AEG-1 revealed a decreased survival after radiation in radioresistant colon cancer cell lines. Conclusions: The AEG-1 expression was independently related to distant recurrence and disease-free survival in rectal cancer patients with RT and could therefore be a marker to discriminate patients for distant relapse. PMID:24874474

  15. Epigenetic Risk Factors in PTSD and Depression

    PubMed Central

    Raabe, Florian Joachim; Spengler, Dietmar

    2013-01-01

    Epidemiological and clinical studies have shown that children exposed to adverse experiences are at increased risk for the development of depression, anxiety disorders, and posttraumatic stress disorder (PTSD). A history of child abuse and maltreatment increases the likelihood of being subsequently exposed to traumatic events or of developing PTSD as an adult. The brain is highly plastic during early life and encodes acquired information into lasting memories that normally subserve adaptation. Translational studies in rodents showed that enduring sensitization of neuronal and neuroendocrine circuits in response to early life adversity are likely risk factors of life time vulnerability to stress. Hereby, the hypothalamic-pituitary-adrenal (HPA) axis integrates cognitive, behavioral, and emotional responses to early-life stress and can be epigenetically programed during sensitive windows of development. Epigenetic mechanisms, comprising reciprocal regulation of chromatin structure and DNA methylation, are important to establish and maintain sustained, yet potentially reversible, changes in gene transcription. The relevance of these findings for the development of PTSD requires further studies in humans where experience-dependent epigenetic programing can additionally depend on genetic variation in the underlying substrates which may protect from or advance disease development. Overall, identification of early-life stress-associated epigenetic risk markers informing on previous stress history can help to advance early diagnosis, personalized prevention, and timely therapeutic interventions, thus reducing long-term social and health costs. PMID:23966957

  16. Vascular risk factors, cognitive decline, and dementia.

    PubMed

    Duron, E; Hanon, Olivier

    2008-01-01

    Dementia is one of the most important neurological disorders in the elderly. Aging is associated with a large increase in the prevalence and incidence of degenerative (Alzheimer's disease) and vascular dementia, leading to a devastating loss of autonomy. In view of the increasing longevity of populations worldwide, prevention of dementia has turned into a major public health challenge. In the past decade, several vascular risk factors have been found to be associated with vascular dementia but also Alzheimer's disease. Some longitudinal studies, have found significant associations between hypertension, diabetus mellitus, and metabolic syndrome, assessed at middle age, and dementia. Studies assessing the link between hypercholesterolemia, atrial fibrillation, smoking, and dementia have given more conflicting results. Furthermore, some studies have highlighted the possible protective effect of antihypertensive therapy on cognition and some trials are evaluating the effects of statins and treatments for insulin resistance. Vascular risk factors and their treatments are a promising avenue of research for prevention of dementia, and further long-term, placebo-controlled, randomized studies, need to be performed.

  17. Risk factors for male breast cancer.

    PubMed

    Mabuchi, K; Bross, D S; Kessler, I I

    1985-02-01

    To investigate risk factors in male breast cancer, a case-control study of 52 histologically diagnosed cases and 52 controls--matched for age, race, marital status, and hospital--was conducted in 5 U.S. metropolitan areas. Cases were significantly more likely to be Jewish than were the controls, supporting earlier suggestions of an increased risk in Jewish males. A significant association of male breast cancer with mumps infections at age 20 years or older, along with the possible association with antecedent testicular injury and the excess frequency of mumps orchitis among cases, suggests that testicular factors may be important in the development of breast cancer among males. An increased frequency of breast cancer among persons who have worked in blast furnaces, steel works, and rolling mills is of interest because of the possible testicular effect of high environmental temperatures. The observed association between breast cancer and a prior history of swollen breast is difficult to interpret because of potential recall bias, and a possible relationship with military service needs further confirmation.

  18. Occupational risk factors for Wilms' tumor

    SciTech Connect

    Bunin, G.; Kramer, S.; Nass, C.; Meadows, A.

    1986-09-01

    A matched case-control study of Wilms' tumor investigated parental occupational risk factors. Cases diagnosed in 1970-1983 were identified through a population-based tumor registry and hospital registries in the Greater Philadelphia area. Controls were selected by random digit dialing and were matched to cases on race, birth date (+/- 3 years), and the area code and exchange of the case's telephone number at diagnosis. Parents of 100 matched pairs were interviewed by telephone. Parents of patients and controls were generally similar in demographic characteristics, except that mothers differed in religion. Published schemes were used to group jobs into clusters of similar exposures and to determine exposures from industry and job title. Analyses were done for preconception, pregnancy, and postnatal time periods. More case than control fathers had jobs in a cluster that includes machinists and welders (odds ratios (ORs) = 4.0-5.7, p less than or equal to 0.04). Paternal exposures to lead, silver, tin, and iron (some exposures of this cluster) were associated with Wilms' tumor in some analyses, with moderate odds ratios (ORs = 1.5-3.4). In general, the highest odds ratios were found for the preconception period among the genetic (prezygotic) cases. No maternal job clusters or exposures gave significantly elevated odds ratios. These results support a previous finding that lead is a risk factor, but not radiation, hydrocarbon, or boron exposures.

  19. Postprandial hypertriglyceridemia as a coronary risk factor.

    PubMed

    Borén, Jan; Matikainen, Niina; Adiels, Martin; Taskinen, Marja-Riitta

    2014-04-20

    Postprandial hypertriglyceridemia is now established as an important risk factor for cardiovascular disease (CVD). This metabolic abnormality is principally initiated by overproduction and/or decreased catabolism of triglyceride-rich lipoproteins (TRLs) and is a consequence of predisposing genetic variations and medical conditions such as obesity and insulin resistance. Accumulation of TRLs in the postprandial state promotes the retention of remnant particles in the artery wall. Because of their size, most remnant particles cannot cross the endothelium as efficiently as smaller low-density lipoprotein (LDL) particles. However, since each remnant particle contains approximately 40 times more cholesterol compared with LDL, elevated levels of remnants may lead to accelerated atherosclerosis and CVD. The recognition of postprandial hypertriglyceridemia in the clinical setting has been severely hampered by technical difficulties and the lack of established clinical protocols for investigating postprandial lipemia. In addition, there are currently no internationally agreed management guidelines for this type of dyslipidemia. Here we review the mechanism for and consequences of excessive postprandial hypertriglyceridemia, epidemiological evidence in support of high triglycerides and remnant particles as risk factors for CVD, the definition of hypertriglyceridemia, methods to measure postprandial hypertriglyceridemia and apolipoproteins and, finally, current and future treatment opportunities.

  20. Gene variants as risk factors for gastroschisis

    PubMed Central

    Yang, Wei; Schultz, Kathleen; Tom, Lauren; Lin, Bin; Carmichael, Suzan L.; Lammer, Edward J.; Shaw, Gary M.

    2016-01-01

    In a population‐based case‐control study in California of 228 infants, we investigated 75 genetic variants in 20 genes and risk of gastroschisis with regard to maternal age, race/ethnicity, vitamin use, and smoking exposure. We hypothesized that genes related to vascular compromise may interact with environmental factors to affect the risk of gastroschisis. Haplotypes were constructed for 75 gene variants using the HaploView program. Risk for gastroschisis associated with each gene variant was calculated for both the homozygotes and the heterozygotes, with the homozygous wildtypes as the referent. Risks were estimated as odds ratios (ORs) with 95% confidence intervals (CIs) by logistic regression. We found 11 gene variants with increased risk and four variants with decreased risk of gastroschisis for heterozygous (ORh) or homozygous variants (ORv) genotypes. These included NOS3 (rs1036145) ORh = 0.4 (95% CI: 0.2–0.7); NOS3 (rs10277237) ORv = 2.7 (95% CI: 1.3–6.0); ADD1 (rs12503220) ORh = 2.9 (95% CI: 1.6–5.4), GNB3 (rs5443) ORh = 0.2 (95% CI: 0.1–0.5), ORv = 0.4 (95% CI: 0.2–0.9); ICAM1 (rs281428) ORv = 6.9 (95% CI: 2.1–22.9), ICAM1 (rs3093030) ORv = 2.6 (95% CI: 1.2–5.6); ICAM4 (rs281438) ORv = 4.9 (95% CI: 1.4–16.6), ICAM5 (rs281417) ORh = 2.1 (95% CI: 1.1–4.1), ORv = 4.8 (95% CI: 1.7–13.6); ICAM5 (rs281440) ORh = 23.7 (95% CI: 5.5–102.5), ORv = 20.6 (95% CI: 3.4–124.3); ICAM5 (rs2075741) ORv = 2.2 (95% CI: 1.1–4.4); NAT1 ORv = 0.3 (95% CI: 0.1–0.9). There were additional associations between several gene variants and gastroschisis among women aged 20–24 and among mothers with and without vitamin use. NOS3, ADD1, ICAM1, ICAM4, and ICAM5 warrant further investigation in additional populations and with the interaction of additional environmental exposures. © 2016 Wiley Periodicals, Inc. PMID:27616475

  1. Key systemic and environmental risk factors for implant failure.

    PubMed

    Dawson, Dolphus R; Jasper, Samuel

    2015-01-01

    Dental implants are an important treatment option for patients interested in replacing lost or missing teeth. Although a robust body of literature has reviewed risk factors for tooth loss, the evidence for risk factors associated with dental implants is less well defined. This article focuses on key systemic risk factors relating to dental implant failure, as well as on perimucositis and peri-implantitis.

  2. Preoperative biliary drainage in Perihilar Cholangiocarcinoma: Identifying patients who require percutaneous drainage after failed endoscopic drainage

    PubMed Central

    Wiggers, Jimme K; Koerkamp, Bas Groot; Coelen, Robert J; Rauws, Erik A; Schattner, Mark A; Nio, C Yung; Brown, Karen T; Gonen, Mithat; van Dieren, Susan; van Lienden, Krijn P; Allen, Peter J; Besselink, Marc GH; Busch, Olivier RC; D’Angelica, Michael I; DeMatteo, Robert P; Gouma, Dirk J; Kingham, T Peter; Jarnagin, William R; van Gulik, Thomas M

    2016-01-01

    Background and study aims Preoperative biliary drainage is often initiated with endoscopic retrograde cholangiopancreatography (ERCP) in patients with potentially resectable perihilar cholangiocarcinoma (PHC), but additional percutaneous transhepatic catheter (PTC) drainage is frequently required. This study aimed to develop and validate a prediction model to identify patients with a high risk of inadequate ERCP drainage. Patients and Methods Patients with potentially resectable PHC and preoperative (attempted) ERCP drainage were included from two specialty center cohorts between 2001 and 2013. Indications for additional PTC drainage were failure to place an endoscopic stent, failure to relieve jaundice, cholangitis, or insufficient drainage of the future liver remnant. A prediction model was derived from the European cohort and externally validated in the USA cohort. Results 108 of 288 patients (38%) required additional preoperative PTC after inadequate ERCP drainage. Independent risk factors for additional PTC were proximal biliary obstruction on preoperative imaging (Bismuth 3 or 4) and pre-drainage total bilirubin level. The prediction model identified three subgroups: patients with a low risk of 7%, a moderate risk of 40%, and a high risk of 62%. The high-risk group consisted of patients with a total bilirubin level above 150 μmol/L and Bismuth 3a or 4 tumours, who typically require preoperative drainage of the angulated left bile ducts. The prediction model had good discrimination (AUC 0.74) and adequate calibration in the external validation cohort. Conclusions Selected patients with potentially resectable PHC have a high risk (62%) of inadequate preoperative ERCP drainage requiring additional PTC. These patients might do better with initial PTC instead of ERCP. PMID:26382308

  3. Genetic factors affecting dental caries risk.

    PubMed

    Opal, S; Garg, S; Jain, J; Walia, I

    2015-03-01

    This article reviews the literature on genetic aspects of dental caries and provides a framework for the rapidly changing disease model of caries. The scope is genetic aspects of various dental factors affecting dental caries. The PubMed database was searched for articles with keywords 'caries', 'genetics', 'taste', 'diet' and 'twins'. This was followed by extensive handsearching using reference lists from relevant articles. The post-genomic era will present many opportunities for improvement in oral health care but will also present a multitude of challenges. We can conclude from the literature that genes have a role to play in dental caries; however, both environmental and genetic factors have been implicated in the aetiology of caries. Additional studies will have to be conducted to replicate the findings in a different population. Identification of genetic risk factors will help screen and identify susceptible patients to better understand the contribution of genes in caries aetiopathogenesis. Information derived from these diverse studies will provide new tools to target individuals and/or populations for a more efficient and effective implementation of newer preventive measures and diagnostic and novel therapeutic approaches in the management of this disease.

  4. Risk Factors for the Development of Parastomal Hernia after Radical Cystectomy

    PubMed Central

    Donahue, Timothy F.; Bochner, Bernard H.; Sfakianos, John P.; Kent, Matthew; Bernstein, Melanie; Hilton, William M.; Cha, Eugene K.; Yee, Alyssa M.; Dalbagni, Guido; Vargas, Hebert A.

    2014-01-01

    Purpose Parastomal hernia (PH) is a frequent complication from stoma formation after radical cystectomy (RC). We sought to determine the prevalence and risk factors for developing PH following RC. Material and Methods Retrospective study of 433 consecutive patients who underwent open RC and ileal conduit between 2006-2010. Postoperative cross-sectional imaging studies performed for routine oncologic follow-up (n=1736) were evaluated for PH, defined as radiographic evidence of protrusion of abdominal contents through the abdominal wall defect created by forming the stoma. Univariable and multivariable Cox regression analyses were used to determine clinical and surgical factors associated with PH. Results Complete data were available for 386 patients with radiographic PH occurring in 136. The risk of developing a PH was 27% (95% CI 22-33%) and 48% (95% CI 42-55%) at 1 and 2 years. Clinical diagnosis of PH was documented in 93 patients and 37 were symptomatic. Of 16 patients with clinical PH referred for repair, 8 had surgery. On multivariable analysis, female gender (HR=2.25, 95%CI 1.58-3.21; p<0.0001), higher BMI (HR=1.08 per unit increase 95%CI 1.05-1.12; p<0.0001), and lower preoperative albumin (HR=0.43 per g/dl, 95%CI 0.25-0.75; p=0.003) were significantly associated with PH. Conclusions The overall risk of radiographic evidence of PH approached 50% at 2 years. Female gender, higher BMI, and lower preoperative albumin were most associated with developing PH. Identifying those at greatest risk may allow for prospective surgical maneuvers at the time of initial surgery, such as placement of prophylactic mesh in selected patients, to prevent the occurrence of PH. PMID:24384155

  5. Risk factors of uveitis in ankylosing spondylitis

    PubMed Central

    Sun, Li; Wu, Rui; Xue, Qin; Wang, Feng; Lu, Peirong

    2016-01-01

    Abstract Background: Uveitis is the most common extra-articular manifestation in patients with ankylosing spondylitis (AS). The prevalence and characteristics of uveitis in AS have been studied in previous literatures, whereas its associated risk factors have not been clarified. Therefore, this study analyzed the risk factors of uveitis in patients with AS. Methods: A total of 390 patients with AS who fulfilled the modified New York criteria were enrolled from January to December in 2015. The history of uveitis was accepted only if diagnosed by ophthalmologists. The medical records of the patients were retrospectively reviewed and associated information was collected, such as disease duration, HLA-B27, and the number of peripheral arthritis. Hip-joint lesion was identified by imaging examination. Meanwhile, biochemical examinations were performed to determine the patient's physical function. Results: Of 390 patients with AS (80.5% male, mean age 33.3 years), 38 (9.7%) had experienced 1 or more episodes of uveitis. The incidence rate for hip-joint lesion was obviously higher for patients with uveitis than the nonuveitis group (44.7% vs 22.2%; P < 0.01). The number of peripheral arthritis was also larger for the uveitis group than nonuveitis group (2.18 ± 0.23 vs 0.55 ± 0.04; P < 0.001). Meanwhile, patients with uveitis had a significantly higher level of antistreptolysin O (ASO) and circulating immune complex (CIC) than those without (P < 0.05 and P < 0.0001, respectively). However, there were no significant differences in disease duration, HLA-B27, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) between the 2 groups. Binary logistic regression results showed that ASO (OR = 12.2, 95% CI:3.6–41.3, P < 0.01) and the number of peripheral arthritis (OR = 4.1, 95%CI:2.6–6.3, P < 0.01) are significantly associated with uveitis in AS. Conclustion: This study provides some evidence that hip-joint lesion, the number of

  6. Risk Factors of Sudden Infant Death Syndrome and Risk Factors for Sleep Disturbances

    ERIC Educational Resources Information Center

    Kelmanson, Igor A.

    2011-01-01

    Relationship between major risk factors of sudden infant death syndrome (SIDS) and sleep disorders in the infants is the subject of review and discussion. Improper micro-environmental characteristics (especially poor environmental organisation and lack of developmental stimulation), pre-term delivery and/or infant low birth weight, prone sleep…

  7. Risk Factors and Treatment for Hemorrhage after Pancreaticoduodenectomy: A Case Series of 423 Patients

    PubMed Central

    Gao, Feng; Li, Jianguo; Quan, Shengwei; Li, Fujun; Ma, Donglai

    2016-01-01

    The study aimed to investigate the risk factors of postpancreatectomy hemorrhage (PPH) after pancreaticoduodenectomy (PD). A retrospective analysis of 423 patients who underwent PD between January 2008 and January 2014 was conducted. The overall incidence and all-cause mortality of PPH were 9.9% (42/423) and 2.1% (9/423), respectively. Independent risk factors of early PPH were revascularization (odds ratio (OR) = 6.786; 95% confidence interval (95% CI): 1.785–25.792; P = 0.005), history of abdominal surgery (OR = 5.009; 95% CI: 1.968–12.749; P = 0.001), and preoperative albumin levels (OR = 4.863; 95% CI: 1.962–12.005; P = 0.001). Independent risk factors of late PPH included postoperative pancreatic leakage (OR = 4.696; 95% CI: 1.605–13.740; P = 0.005), postoperative biliary fistula (OR = 6.096; 95% CI: 1.575–23.598; P = 0.009), postoperative abdominal infection (OR = 4.605; 95% CI: 1.108–19.144; P = 0.036), revascularization (OR = 9.943; 95% CI: 1.900–52.042; P = 0.007), history of abdominal surgery (OR = 8.790; 95% CI: 2.779–27.806; P < 0.001), and preoperative albumin levels (OR = 5.563; 95% CI: 1.845–16.776; P = 0.002). PMID:27975049

  8. Dysbiosis a risk factor for celiac disease.

    PubMed

    Girbovan, Anamaria; Sur, Genel; Samasca, Gabriel; Lupan, Iulia

    2017-04-01

    Celiac disease remains one of the most challenging pathologies of the small intestine. It involves multiple pathogenic pathways and there are no disease-changing pharmacological agents available against it yet. The term microbiota refers to the community of microorganisms that inhabit a particular region of the body. Normal gut microbiota has a vital role in maintaining the intestinal homeostasis and promoting health. Celiac disease is associated with microbiota alteration, especially with an increase in the number of Gram-negative bacteria and a decrease in the number of Gram-positive bacteria. There is a strong relationship between intestinal dysbiosis and celiac disease, and recent studies are aimed at determining whether the celiac disease is a risk factor for dysbiosis or dysbiosis is for celiac disease. Therefore, the aim of this review was to assess the latest findings regarding the gut microbiota and its impact on the celiac disease, including therapeutic aspects.

  9. Biomarkers, genetics, and risk factors for concussion.

    PubMed

    Finnoff, Jonathan T; Jelsing, Elena J; Smith, Jay

    2011-10-01

    It is estimated that between 1.6 and 3.8 million concussions occur annually in the United States. Although frequently regarded as benign, concussions can lead to multiple different adverse outcomes, including prolonged postconcussive symptoms, chronic traumatic encephalopathy, cognitive impairment, early onset dementia, movement disorders, psychiatric disorders, motor neuron disease, and even death. Therefore it is important to identify individuals with concussion to provide appropriate medical care and minimize adverse outcomes. Furthermore, it is important to identify individuals who are predisposed to sustaining a concussion or to having an adverse outcome after concussion. This article will discuss the current research on serum biomarkers for concussion, genetic influence on concussion, risk factors associated with concussion predisposition and poor outcome, and practical suggestions for the application of this information in clinical practice.

  10. Birth defects: Risk factors and consequences.

    PubMed

    Oliveira, Camila Ive Ferreira; Fett-Conte, Agnes Cristina

    2013-06-01

    Birth defects (BDs) or congenital anomalies include all structural and functional alterations in embryonic or fetal development resulting from genetic, environmental or unknown causes, which result in physical and/or mental impairment. BDs occur in about 3% of newborn babies and in most cases of pregnancy loss. BDs are a very complex and heterogeneous group of single or multiple changes that, in most cases, are of unknown etiology. Among the risk factors are advanced maternal and paternal ages, parental consanguinity, teratogenic agents such as infectious agents and drugs, and poor nutrition, in particular folic acid deficiency. One of the consequences of these defects is the high death rate within the first year of life. Information on BDs is becoming increasingly more important throughout the world so that preventive measures can be taken. Knowledge of BDs enables the development of therapeutic and preventive strategies besides adequate genetic counseling.

  11. [Burnout syndrome: a "true" cardiovascular risk factor].

    PubMed

    Cursoux, Pauline; Lehucher-Michel, Marie-Pascale; Marchetti, Hélène; Chaumet, Guillaume; Delliaux, Stéphane

    2012-11-01

    The burnout syndrome is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment in individuals professionally involved with others. The burnout syndrome is poorly recognized, particularly in France, as a distinct nosology from adaptation troubles, stress, depression, or anxiety. Several tools quantifying burnout and emotional exhaustion exist, the most spread is the questionnaire called Maslach Burnout Inventory. The burnout syndrome alters cardiovascular function and its neuroregulation by autonomic nervous system and is associated with: increased sympathetic tone to heart and vessels after mental stress, lowered physiological post-stress vagal rebound to heart, and lowered arterial baroreflex sensitivity. Job strain as burnout syndrome seems to be a real independent cardiovascular risk factor. Oppositely, training to manage emotions could increase vagal tone to heart and should be cardio-protective.

  12. Risk factors and prevention of venous thromboembolism.

    PubMed

    Storti, S; Crucitti, P; Cina, G

    1996-01-01

    In the last 20 years within the clinical research on venous thromboembolism a major objective was to identify and develop increasingly effective and safe methods of prevention. This trend is justified by the high incidence of thromboembolism as well as by the relevant mortality for acute pulmonary embolism and postphlebitic sequels of difficult treatment. A significant contribution to the rational application of methods of prevention was given by the knowledge of risk factors. Together with acquired risks, as surgery, age, malignant tumors, in the last 30 years some conditions of thrombophilia were identified. They are caused by deficiencies in coagulation inhibitors (antithrombin III, protein C, protein S) or other alteration of the anticoagulation system as resistance to activated protein C or antiphospholipid antibodies. The primary prophylaxis of venous thromboembolism is aimed at the prevention of thrombosis by pharmacologic methods able to oppose the procoagulant alterations while avoiding hemorrhagic complications. The physical methods tend to reduce the stasis in the veins of the lower extremities. Subcutaneous calcium heparin at the dose of 5000 U twice or three times a day is the most common pharmacologic method used. It was shown to be safe and effective especially in postoperative prophylaxis of venous thromboembolism in general surgery. More recently, low molecular weight heparin fractions have been introduced. As compared to standard heparin they have the advantage of a single daily dose and a better efficacy in some groups of patients, as those undergoing hip replacement. Among the substances under clinical experimentation, dermatan sulfate seems promising. Most common physical prevention methods consist in the use of elastic graduated compression stockings and systems of intermittent pneumatic calf compression. The former can be used also in presence of a hemorrhagic risk as in neurosurgery. The latter have shown a good efficacy in increasing flow

  13. Epidemiology and risk factors for kidney cancer

    PubMed Central

    Chow, Wong-Ho; Dong, Linda M.; Devesa, Susan S.

    2010-01-01

    After over two decades of increasing rates, kidney cancer incidence trends worldwide show signs of plateauing or decreases in recent years. In the United States, rates for renal cell cancer, the predominant form of kidney cancer in adults, continue to rise but mainly for early stage tumors. Incidence rates for renal pelvis cancer have declined, while kidney cancer mortality rates overall have leveled. These patterns are consistent with reports of incidental diagnosis and downward shift of tumor stage and size in clinical series. The changing prevalence of known risk factors for renal cell cancer, including cigarette smoking, obesity, and hypertension, may also be influencing the incidence trends, although their relative impact may differ in various populations,. Evidence is accumulating to suggest an etiologic role for physical activity, alcohol consumption, occupational exposure to trichloroethylene, and high parity among women, but causal conclusions are not yet supported. Genetic susceptibility and its interaction with environmental exposures are believed to influence renal cell cancer risk, but limited studies based on candidate gene approaches have not produced conclusive results. Large consortium efforts employing genome-wide scanning technology are underway, which hold promise for novel discoveries in renal carcinogenesis. PMID:20448658

  14. Risk factors for baclofen pump infection in children: a multivariate analysis.

    PubMed

    Spader, Heather S; Bollo, Robert J; Bowers, Christian A; Riva-Cambrin, Jay

    2016-06-01

    OBJECTIVE Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis. METHODS Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study. The primary end point was infection. Potential risk factors investigated included preoperative (i.e., demographics, body mass index [BMI], gastrostomy tube, tracheostomy, previous spinal fusion), intraoperative (i.e., surgeon, antibiotics, pump size, catheter location), and postoperative (i.e., wound dehiscence, CSF leak, and number of revisions) factors. Univariate analysis was performed, and a multivariate logistic regression model was created to identify independent risk factors for infection. RESULTS A total of 254 patients were evaluated. The overall infection rate was 9.8%. Univariate analysis identified young age, shorter height, lower weight, dehiscence, CSF leak, and number of revisions within 6 months of pump placement as significantly associated with infection. Multivariate analysis identified young age, dehiscence, and number of revisions as independent risk factors for infection. CONCLUSIONS Young age, wound dehiscence, and number of revisions were independent risk factors for infection in this pediatric cohort. A low BMI and the presence of either a gastrostomy or tracheostomy were not associated with infection and may not be contraindications for this procedure.

  15. Risk Factors for Erosion of Artificial Urinary Sphincters: A Multicenter Prospective Study

    PubMed Central

    Brant, William O.; Erickson, Bradley A.; Elliott, Sean P.; Powell, Christopher; Alsikafi, Nejd; McClung, Christopher; Myers, Jeremy B.; Voelzke, Bryan B.; Smith, Thomas G.; Broghammer, Joshua A.

    2015-01-01

    OBJECTIVE To evaluate the short- to medium-term outcomes after artificial urinary sphincter (AUS) placement from a large, multi-institutional, prospective, follow-up study. We hypothesize that along with radiation, patients with any history of a direct surgery to the urethra will have higher rates of eventual AUS explantation for erosion and/or infection. MATERIALS AND METHODS A prospective outcome analysis was performed on 386 patients treated with AUS placement from April 2009 to December 2012 at 8 institutions with at least 3 months of follow-up. Charts were analyzed for preoperative risk factors and postoperative complications requiring explantation. RESULTS Approximately 50% of patients were considered high risk. High risk was defined as patients having undergone radiation therapy, urethroplasty, multiple treatments for bladder neck contracture or urethral stricture, urethral stent placement, or a history of erosion or infection in a previous AUS. A total of 31 explantations (8.03%) were performed during the follow-up period. Overall explantation rates were higher in those with prior radiation and prior UroLume. Men with prior AUS infection or erosion also had a trend for higher rates of subsequent explantation. Men receiving 3.5-cm cuffs had significantly higher explantation rates than those receiving larger cuffs. CONCLUSION This outcomes study confirms that urethral risk factors, including radiation history, prior AUS erosion, and a history of urethral stent placement, increase the risk of AUS explantation in short-term follow-up. PMID:25109562

  16. Cancer of the Prostate Risk Assessment (CAPRA) Preoperative Score Versus Postoperative Score (CAPRA-S): ability to predict cancer progression and decision-making regarding adjuvant therapy after radical prostatectomy.

    PubMed

    Seo, Won Ik; Kang, Pil Moon; Kang, Dong Il; Yoon, Jang Ho; Kim, Wansuk; Chung, Jae Il

    2014-09-01

    The University of California, San Francisco, announced in 2011 Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score which included pathologic data, but there were no results for comparing preoperative predictors with the CAPRA-S score. We evaluated the validation of the CAPRA-S score in our institution and compare the result with the preoperative progression predictor, CAPRA score. Data of 130 patients were reviewed who underwent radical prostatectomy for localized prostate cancer from 2008 to 2013. Performance of CAPRA-S score in predicting progression free probabilities was assessed through Kaplan Meier analysis and Cox proportional hazards regression test. Additionally, prediction probability was compared with preoperative CAPRA score by logistic regression analysis. Comparing CAPRA score, the CAPRA-S score showed improved prediction ability for 5 yr progression free survival (concordance index 0.80, P = 0.04). After risk group stratification, 3 group model of CAPRA-S was superior than 3 group model of CAPRA for 3-yr progression free survival and 5-yr progression free survival (concordance index 0.74 vs. 0.70, 0.77 vs. 0.71, P < 0.001). Finally the CAPRA-S score was the more ideal predictor concerned with adjuvant therapy than the CAPRA score through decision curve analysis. The CPARA-S score is a useful predictor for disease progression after radical prostatectomy.

  17. Perioperative mortality after pneumonectomy: analysis of risk factors and review of the literature

    PubMed Central

    Swartz, Daniel E.; Lachapelle, Kevin; Sampalis, John; Mulder, David S.; Chiu, Ray C.-J.; Wilson, James

    1997-01-01

    Objective To determine risk factors for perioperative death associated with pneumonectomy. Design A retrospective case-control study in which a perioperative death group was compared with a survivor group, and a review of the English literature on the subject. Setting The Montreal General Hospital, a tertiary-care teaching institution. Patients and intervention Ninety-two consecutive patients who underwent pneumonectomy between April 1989 and 1994. Main outcome measures The effects of age, sex, smoking history, tumour size, type and stage, pulmonary function, cardiovascular risks, comorbidity, preoperative blood values and volume of fluids administered perioperatively. Values from the literature were reported for comparison. Results The perioperative death rate was 10.9%. Selection bias and in-hospital values reported in the literature have underestimated the death rate, with actual rates ranging from 7% to 11%. Age (odds ratio 2.48, p = 0.04), the presence of 1 or more comorbid diseases (odds ratio 7.92, p = 0.05) and amount of fluids given in the first 12 hours postoperatively (odds ratio 2.21, p = 0.06) were found to be significant risk factors for death. Multivariate logistic regression demonstrated that the volume of fluids given remains an independent risk factor whereas age and comorbid disease are dependent variables. Conclusions The results were consistent with previously reported death rates and risk factors. Patient age and concomitant disease are not modifiable risk factors, but perioperative fluid administration and other means to prevent postpneumonectomy pulmonary edema may reduce the perioperative death rate. PMID:9416253

  18. Risk Factors for Posterior Capsule Rupture and Vitreous Loss during Phacoemulsification

    PubMed Central

    Zare, Mohammad; Javadi, Mohammad-Ali; Einollahi, Bahram; Baradaran-Rafii, Ali-Reza; Feizi, Sepehr; Kiavash, Victoria

    2009-01-01

    Purpose To determine the rate and risk factors of vitreous loss during phacoemulsification in patients with cataracts operated by ophthalmology residents and fellows at Labbafinejad Medical Center. Methods This prospective descriptive study included consecutive patients with cataracts undergoing phacoemulsification over a one year period. All patients were operated under local or general anesthesia using the divide and conquer technique. Preoperatively, all patients underwent a complete ocular examination including measurement of visual acuity, slitlamp biomicroscopy, intraocular pressure measurement, and dilated funduscopy. Main outcome measures included the rate of posterior capsular rupture and vitreous loss as well as associated risk factors such as surgical experience, ocular and systemic conditions, and type and severity of the cataract. Results Overall, 767 eyes of 767 patients with mean age of 63.7±10.3 (range, 25–91) years were operated. The overall rate of vitreous loss was 7.9% which was 5-fold greater in the hands of residents as compared to fellows. Among different factors, older age, female sex, small pupil, small capsulorrhexis, presence of pseudoexfoliation, and high myopia were significantly associated with vitreous loss. The highest rate of vitreous loss occurred in patients with dense nuclear cataracts. Conclusion Considering the higher rate of vitreous loss in patients operated by ophthalmology residents; patients with known risk factors for vitreous loss should better be operated by more experienced surgeons. PMID:23198076

  19. Personalized Predictive Modeling and Risk Factor Identification using Patient Similarity.

    PubMed

    Ng, Kenney; Sun, Jimeng; Hu, Jianying; Wang, Fei

    2015-01-01

    Personalized predictive models are customized for an individual patient and trained using information from similar patients. Compared to global models trained on all patients, they have the potential to produce more accurate risk scores and capture more relevant risk factors for individual patients. This paper presents an approach for building personalized predictive models and generating personalized risk factor profiles. A locally supervised metric learning (LSML) similarity measure is trained for diabetes onset and used to find clinically similar patients. Personalized risk profiles are created by analyzing the parameters of the trained personalized logistic regression models. A 15,000 patient data set, derived from electronic health records, is used to evaluate the approach. The predictive results show that the personalized models can outperform the global model. Cluster analysis of the risk profiles show groups of patients with similar risk factors, differences in the top risk factors for different groups of patients and differences between the individual and global risk factors.

  20. Risk Factors for Scleral Buckle Removal: A Matched, Case-Control Study

    PubMed Central

    Covert, Douglas J.; Wirostko, William J.; Han, Dennis P.; Lindgren, Kevin E.; Hammersley, Jill A.; Connor, Thomas B.; Kim, Judy E.

    2008-01-01

    Purpose To identify preoperative, perioperative, and postoperative risk factors for scleral buckle (SB) removal. Methods A retrospective, consecutive, matched, case-control study. Cases included all patients undergoing SB removal between 1988 and 2007 at a single academic center. Case patients were matched against 4 randomly selected control patients who underwent SB implantation during the same year as the case patients. Odds ratios (ORs) were calculated for each factor investigated. Results Forty cases of SB removal and 148 matched control cases were identified. Three cases of SB removal were omitted from analysis because of incomplete records. Factors associated with SB removal for any reason, according to univariate analysis, included concurrent globe-penetrating injury at the time of SB placement (OR, 24; 95% confidence interval [CI], 2.9–200), concurrent pars plana vitrectomy (PPV) (OR, 17.3; CI, 4.9–61), diabetes mellitus (DM) (OR, 7.3; CI, 1.8–30), prior long-term topical ocular therapy (OR, 4.3; CI, 1.7–11), and subsequent ocular procedures (OR, 3.4; CI, 1.5–7.5). Factors independently associated with SB removal according to multivariate analysis included concurrent globe-penetrating injury (OR, 27.3; CI, 1.7–426), concurrent PPV (OR, 11.3; CI, 2.9–45), DM (OR, 8.9; CI, 1.3–58), and subsequent ocular procedures (OR, 3.9; CI, 1.4–11). Factors that did not alter SB removal risk included patient age; sex; and type, size, or location of buckling elements used. Conclusions Awareness of these risk factors may be valuable for the surgical planning of retinal detachment repair in patients at higher risk for subsequent SB removal and for risk stratification subsequent to SB implantation. PMID:19277232

  1. Knowledge of risk factors for diabetes or cardiovascular disease (CVD) is poor among individuals with risk factors for CVD

    PubMed Central

    Dunstan, Libby; Busingye, Doreen; Reyneke, Megan; Orgill, Mary; Cadilhac, Dominique A.

    2017-01-01

    Background There is limited evidence on whether having pre-existing cardiovascular disease (CVD) or risk factors for CVD such as diabetes, ensures greater knowledge of risk factors important for motivating preventative behaviours. Our objective was to compare knowledge among the Australian public participating in a health check program and their risk status. Methods Data from the Stroke Foundation ‘Know your numbers’ program were used. Staff in community pharmacies provided opportunistic health checks (measurement of blood pressure and diabetes risk assessment) among their customers. Participants were categorised: 1) CVD ± risk of CVD: history of stroke, heart disease or kidney disease, and may have risk factors; 2) risk of CVD only: reported having high blood pressure, high cholesterol, diabetes or atrial fibrillation; and 3) CVD risk free (no CVD or risk of CVD). Multivariable logistic regression analyses were performed including adjustment for age and sex. Findings Among 4,647 participants, 12% had CVD (55% male, 85% aged 55+ years), 47% were at risk of CVD (40% male, 72% 55+ years) and 41% were CVD risk free (33% male, 27% 55+ years). Participants with CVD (OR: 0.66; 95% CI: 0.55, 0.80) or risk factors for CVD (OR: 0.65; 95% CI: 0.57, 0.73) had poorer knowledge of the risk factors for diabetes/CVD compared to those who were CVD risk free. After adjustment, only participants with risk factors for CVD (OR: 0.80; 95% CI: 0.69, 0.93) had poorer knowledge. Older participants (55+ years) and men had poorer knowledge of diabetes/CVD risk factors and complications of diabetes. Conclusions Participants with poorer knowledge of risk factors were older, more often male or were at risk of developing CVD compared with those who were CVD risk free. Health education in these high risk groups should be a priority, as diabetes and CVD are increasing in prevalence throughout the world. PMID:28245267

  2. First Births among Adolescent Girls: Risk and Protective Factors.

    ERIC Educational Resources Information Center

    Kalil, Ariel; Kunz, James

    1999-01-01

    Survey administered to 958 girls studied effects of sociodemographic risk factors for adolescent nonmarital childbearing. Analysis showed adolescents girls who experienced five or more sociodemographic risk factors were 16 times more likely to experience a nonmarital childbirth during their teenage years. Under similar levels of risk, adolescent…

  3. Heart Disease Risk Factors for Children and Teenagers

    MedlinePlus

    ... called risk factors . Some risk factors can be changed, treated, or modified, and some cannot. Many risk ... would not date someone who smokes. Be a role model for your child. If you ... aging, gender, lifestyle, and illness. Obesity in children is dangerous ...

  4. Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty.

    PubMed

    Alvarez, Andrew P; Demzik, Alysen L; Alvi, Hasham M; Hardt, Kevin D; Manning, David W

    2016-01-01

    Background. Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services (CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients. Methods. We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon's National Surgical Improvement Program Database (ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI. Results. 1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6-2.7), chronic steroid use (OR 2.0, 95% CI 1.2-3.2), ages 60-69 (OR 1.5, 95% CI 1.0-2.1), 70-79 (OR 2.0, 95% CI 1.4-2.9), and ≥80 (OR 2.3, 95% CI 1.5-3.6), ASA Classes 3-5 (OR 1.5, 95% CI 1.2-1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3-2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI 1.3-2.4). Conclusions. In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement.

  5. Risk factors of jet fuel combustion products.

    PubMed

    Tesseraux, Irene

    2004-04-01

    Air travel is increasing and airports are being newly built or enlarged. Concern is rising about the exposure to toxic combustion products in the population living in the vicinity of large airports. Jet fuels are well characterized regarding their physical and chemical properties. Health effects of fuel vapors and liquid fuel are described after occupational exposure and in animal studies. Rather less is known about combustion products of jet fuels and exposure to those. Aircraft emissions vary with the engine type, the engine load and the fuel. Among jet aircrafts there are differences between civil and military jet engines and their fuels. Combustion of jet fuel results in CO2, H2O, CO, C, NOx, particles and a great number of organic compounds. Among the emitted hydrocarbons (HCs), no compound (indicator) characteristic for jet engines could be detected so far. Jet engines do not seem to be a source of halogenated compounds or heavy metals. They contain, however, various toxicologically relevant compounds including carcinogenic substances. A comparison between organic compounds in the emissions of jet engines and diesel vehicle engines revealed no major differences in the composition. Risk factors of jet engine fuel exhaust can only be named in context of exposure data. Using available monitoring data, the possibilities and limitations for a risk assessment approach for the population living around large airports are presented. The analysis of such data shows that there is an impact on the air quality of the adjacent communities, but this impact does not result in levels higher than those in a typical urban environment.

  6. Lifestyle decreases risk factors for cardiovascular diseases.

    PubMed

    Slavícek, Jaroslav; Kittnar, Otomar; Fraser, Gary E; Medová, Eva; Konecná, Jana; Zizka, Robert; Dohnalová, Alena; Novák, Vladimir

    2008-12-01

    The morbidity and mortality of cardiovascular diseases is high in the developed countries. The lifestyle changes are capable to decrease it by 50%. The aim of the present study was to measure the parameters of some risk factors before and after a one-week NEW START rehabilitative retreat. 1349 volunteers, 320 men, 1029 woman, mean age 51 +/- 14.5 (SD) years participated in 30 rehabilitative retreats from 1999-2006 in the Czech Republic, using a low-fat, low-energy, lacto-ovo-vegetarian diet and exercise, in a stress-free environment. Body weight, height, BMI, blood pressure, heart rate, serum cholesterol and blood glucose were measured. Body weight decreased in 1223 measured persons from 71.2 +/- 14.38 (SD) to 70.6 +/- 14.02 kg (p<0.0001), BMI (1,046 measured persons) from 25.1 +/- 4.60 (SD) to 24.8+4.49 (SD) kg/m2 (p<0.0001), systolic blood pressure (1,218 persons) from 129.8 +/- 23.02 (SD) to 123.8 +/- 21.52 (SD) mmHg (p<0.0001), diastolic blood pressure (1210 persons) from 79.8 +/- 12.7 (SD) to 77.5 +/- 11.6 (SD) mmHg (p<0.0001), serum cholesterol (998 persons) from 4.86 +/- 0.95 (SD) to 4.32 +/- 0.77 (SD) mmol (p<0.0001), blood glucose (544 persons) from 4.31 +/- 1.59 (SD) to 3.88 +/- 1.33 (SD) mmol (p<0.0001). Heart rate was not significantly decreased. The parameters were lower in lacto-ovo vegetarians and Seventh-day Adventists than in controls who never observed the diet and avail the lifestyle programs. The parameters were nonsignificantly changed one year after finishing the retreat in the sample of 68 persons showing the positive effect of retreats. Our results showed, that the intake of a low-fat, low-energy diet, over the course of one week in a stress-free environment, had positive impact on the risk factors of cardiovascular diseases.

  7. Epidemiology, environmental risk factors and genetics of Parkinson's disease.

    PubMed

    Delamarre, Anna; Meissner, Wassilios G

    2017-02-08

    Parkinson's disease (PD) is a frequent neurodegenerative disease with a premotor phase that lasts several years. Risk factors that have been linked to PD are tobacco, caffeine, black tea, pesticides and calcium channel blockers. Some risk factors may be due to inverse causality (e.g. changes in personality during the premotor phase). The genetics of PD are complex with a contribution of Mendelian (e.g. SNCA, LRRK2, Parkin, Pink1,…) and non-Mendelian factors (e.g. single nucleotide polymorphisms). Glucocerebrosidase gene mutations (Gaucher disease) are currently the strongest genetic risk factor for PD. Studying risk factors will help to better understand the pathogenesis of PD.

  8. Colorectal (Colon) Cancer: What Are the Risk Factors?

    MedlinePlus

    ... Cancer Home What Are the Risk Factors for Colorectal Cancer? Language: English Español (Spanish) Recommend on Facebook Tweet Share Compartir Your risk of getting colorectal cancer increases as you get older. More than 90% ...

  9. What Are the Risk Factors for Myelodysplastic Syndromes?

    MedlinePlus

    ... Environmental risk factors, such as radiation and certain chemicals, have been linked to MDS. High-dose radiation exposure (such as surviving an atomic bomb blast or nuclear reactor accident) increases the risk of developing MDS. Long- ...

  10. Risk Factors Associated with Overdose among Bahraini Youth.

    ERIC Educational Resources Information Center

    Al Ansari, Ahmed M.; Hamadeh, Randah R.; Matar, Ali M.; Marhoon, Huda; Buzaboon, Bana Y.; Raees, Ahmed G.

    2001-01-01

    Study aimed to identify risk factors, such as family pathology and psychosocial stress, of overdose suicide attempts among Bahraini youth. Stresses from living in a non-intact family; interpersonal relationships mainly with the opposite sex; unemployment; and school performance emerged as main risk factors. Previously identified factors, such as…

  11. Clinician Perceptions of Childhood Risk Factors for Future Antisocial Behavior

    ERIC Educational Resources Information Center

    Koegl, Christopher J.; Farrington, David P.; Augimeri, Leena K.

    2009-01-01

    We asked 176 mental health clinicians to list factors that place a child at risk for engaging in future antisocial behavior. Participants were randomly assigned to do this in relationship to boys and girls. Listed factors were then coded into broad item categories using the Early Assessment Risk Lists (EARL). Of the 1,695 factors listed, 1,476…

  12. Clinical risk factors for the development of consecutive exotropia: a comparative clinical study

    PubMed Central

    Taylan Sekeroglu, Hande; Erkan Turan, Kadriye; Karakaya, Jale; Sener, Emin Cumhur; Sanac, Ali Sefik

    2016-01-01

    AIM To compare a group of patients with consecutive exotropia with patients who had ≤10 prism diopters (PD) esotropia or no deviation postoperatively in terms of probable clinical risk factors for the development of consecutive exotropia. METHODS The study recruited fourteen patients who developed consecutive exodeviation during follow-up period after the correction of esotropia who were categorized as group 1 and thirty-one patients who had still ≤10 PD esotropia or no deviation at the final visit that were considered as group 2. Clinical risk factors leading the development of consecutive deviation were analyzed as the main outcome measures. RESULTS The mean age of patients was 4.57±3.11y in group 1 and 5.10±3.52y in group 2 (P=0.634). There was no significant difference of preoperative near and distant deviations among two groups (P=0.835, 0.928 respectively). The mean amount of medial rectus recession and lateral rectus resection was similar in both groups (P=0.412, 0.648 respectively). Convergence insufficiency and neurological diseases were more frequent in group 1 (P=0.007, 0.045). Accompanying neurological disease was found to be as a significant factor increasing the risk of the development of consecutive exotropia significantly [odds ratios (OR): 5.75 (1.04-31.93)]. CONCLUSION Accompanying neurological disease appears to be a significant clinical risk factor for the development of consecutive exodeviation during postoperative follow-up after the correction of esotropia. However, larger studies are needed in order to interpret the results to the clinical practice and to ascertain other concurrent risk factors. PMID:27366693

  13. Clinical risk factors and periventricular leucomalacia.

    PubMed

    Trounce, J Q; Shaw, D E; Levene, M I; Rutter, N

    1988-01-01

    Two hundred infants of below 1501 g at birth were regularly examined with real time ultrasound using a 7.5 MHz transducer. Abnormalities were categorized as periventricular haemorrhage (PVH) (n = 107) or periventricular leucomalacia (PVL), with or without PVH (n = 52). Of the group with PVL, 25 had the appearances of prolonged flare without cavitation. Prospective assessments of up to 50 potential clinical risk factors were made wherever possible on each infant including stratification of all blood gas and systolic blood pressure data. Multivariate logistic regression analyses confirmed a strong correlation between immaturity and PVH but this was not found in cases of PVL. Independent variables associated with PVL included pneumothorax, maximum bilirubin concentration, surgery, and the proportion of time the infant's PaCO2 remained above 7 kPa. There was a very strong inverse correlation between anaemia and PVL. Systolic blood pressure data were carefully analysed and there was no relation between either hypotension or antepartum haemorrhage and the development of PVL.

  14. Perimenstrual symptoms: prevalence and risk factors.

    PubMed

    Logue, C M; Moos, R H

    1986-01-01

    This article provides an overview of information on the prevalence of perimenstrual symptoms. Overall, at least 40% of women experience some cyclical perimenstrual symptoms. Although most women rate their symptoms as mild, approximately 2%-10% report severe symptoms. Prospective studies of perimenstrual symptoms indicate that retrospective reports are reasonably accurate among women who experience moderate to severe symptoms. However, among the majority of women with few or minimal symptoms, retrospective reports may amplify the cyclicity of variation in comparison to concurrent reports. A variety of risk factors are associated with patterns of symptom reporting and may provide clues to the etiology of perimenstrual symptoms and help to identify women most vulnerable to them. A woman's age and cycle characteristics are predictors of the type and severity of perimenstrual symptoms she experiences. In addition, a history of affective illness may be associated with increased reporting of perimenstrual symptoms. Future research should focus on developing new diagnostic criteria for subtypes of perimenstrual syndromes, exploring positive symptoms and experiences associated with the menstrual cycle, and formulating holistic treatment approaches that view perimenstrual syndromes as psychosomatic conditions.

  15. Seasonal variations of selected cardiovascular risk factors.

    PubMed

    Kelly, Gregory S

    2005-12-01

    This article reviews research on selected biomarkers of cardiovascular risk - cholesterol and other lipids, C-reactive protein (CRP), fibrinogen, homocysteine - in the attempt to determine the existence of a predictable seasonal chronobiological pattern of variation. Studies dating as far back as the 1930s have reported seasonal variations in cholesterol levels. Statistically significant seasonal changes in lipid levels have been found in individuals irrespective of the country where the research has been conducted, and irrespective of the age, sex, ethnicity, and baseline lipid levels of the study subjects. While not all studies have been in complete agreement on either the amplitude (degree of seasonal change) or month/s of highest lipid levels, a strong winter/summer difference has been found in most studies. Existing evidence for an independent effect of season in variation of CRP is weak. Studies have consistently reported significant seasonal variations in fibrinogen levels. While other biological factors clearly interact to affect fibrinogen variability, seasonality appears to be an independent source of variability. Evidence from several studies points to a lack of seasonal variability in homocysteine levels. Although seasonal variability is just one source of periodicity influencing biological function and assessments in clinical practice, for some biomarkers, including lipids and fibrinogen, it is a source of variability that warrants consideration prior to a decision to treat and in assessing response to interventions.

  16. Risk factors for rhabdomyolysis following doxylamine overdose.

    PubMed

    Jo, Young-Il; Song, Jong-Oh; Park, Jung-Hwan; Koh, Soon-Young; Lee, Seung-Min; Seo, Tae-Ho; Lee, Jong-Ho

    2007-08-01

    The objective of this prospective study was to identify risk factors for developing rhabdomyolysis in patients with doxylamine overdose. Patients who were admitted to a university teaching hospital between July 2000 and September 2005 due to doxylamine overdose were recruited. Demographic information, clinical variables, and laboratory data were investigated. Twenty-seven (M/F 12/15, age 33.2 +/-13.1 years) patients were enrolled. Sixteen (59%) of 27 patients developed rhabdomyolysis and three (19%) of 16 patients with rhabdomyolysis also developed acute renal failure. Patients who developed rhabdomyolysis differed from those who did not in the amount of doxylamine ingested, initial serum creatitnine and arterial pH. In multivariate regression analysis, the only reliable predictor of rhabdomyolysis was the amount of doxylamine ingested (P = 0.039). The amount of doxylamine ingested (>/= 20 mg/kg) predicted the development of rhabdomyolysis with a sensitivity of 81%, a specificity of 82%, a positive predictive value of 87%, and a negative predictive value of 75%.In conclusion, rhabdomyolysis following doxylamine overdose was common, occurring in 87% of patients who ingested more than 20 mg/kg. The amount of doxylamine ingested was the only reliable predictor for developing rhabdomyolysis following doxylamine overdose.

  17. Risk Factors for Survival following Open Surgical Repair of Ruptured Abdominal Aortic Aneurysms: A 13-Year Experience

    PubMed Central

    Ozen, Anil; Hanedan, Muhammet Onur; Songur, Çetin Murat; Boysan, Emre; Unal, Ertekin Utku; Mola, Serkan; Erkengel, Halil Ibrahim; Kubat, Emre; Iscan, Zafer; Tutun, Ufuk; Sarıtas, Ahmet; Birincioglu, Cemal Levent

    2015-01-01

    Background: Surgical treatment of a ruptured abdominal aorta aneurysm (RAAA) continues to present a significant challenge to surgeons. There are some patient factors such as age and gender that cannot be changed, and comorbid conditions can be optimized but not eliminated. The purpose of this study was to identify the risk factors affecting high mortality after the surgical repair of an RAAA. Methods: Data on 121 patients who underwent surgical repair for RAAAs between January 1997 and June 2011 in our institution were collected retrospectively. All the patients had been diagnosed by computed tomography (CT) scans, and intraoperative extra-luminal blood was visualized intraoperatively. Variables studied comprised demographic data; preoperative, operative, and postoperative data; and the causes of mortality. Multivariate regression analysis was used to determine the predictors of mortality. Results: One hundred eight (89.2%) patients were male and 13 (10.7%) were female at an average age of 68.9 ± 10.5 years. Totally, 121 patients underwent surgery for RAAAs. Fifty-four patients had aortic tube grafts, 32 aortobiiliac grafts, 20 aortobifemoral grafts, 1 aortoiliac graft, and 1 aortofemoral graft for the replacement of the RAAAs. Seven patients had only surgical exploration. Operative mortality was 41.3% (50 patients). The factors associated with mortality were preoperative shock, free blood, positive inotropic agent, hematocrit value, and need for blood and plasma. In the multivariate analysis, preoperative shock and positive inotropic agents were found to be significant as the predictors of death (OR: 19.8, 95%CI: 3.2-122.8 and OR: 8.6, 95% CI: 2.9-26.3, respectively). Conclusion: This study revealed that the preoperative clinical findings affected the mortality associated with RAAAs. PMID:26697083

  18. The Evaluation of Risk Factors for Postoperative Infectious Complications after Percutaneous Nephrolithotomy

    PubMed Central

    Yang, Tian; Liu, Shenghua; Wang, Lujia

    2017-01-01

    This study was to evaluate the risk factors of infectious complications after percutaneous nephrolithotomy (PCNL) and build a prediction tool for postoperative complications based on the risk factors. A total of 110 male (67.1%) and 54 female (32.9%) patients who underwent PCNL for renal stones between 2010 and 2014 in our institute were included. A detailed clinical information and laboratory results were obtained from patients. Systemic inflammatory response syndrome (SIRS) and postoperative fever were recorded after PCNL surgery. In all, 45 cases (27.4%) developed SIRS and fever was observed in 20 cases (12.2%). In multivariate analysis, stone size (odds ratio, OR = 1.471, p = 0.009) and urine white blood cell (WBC) (OR = 1.001, p = 0.007) were related to the development of SIRS. Stone size (OR = 1.644, p = 0.024), urine WBC (OR = 1.001, p = 0.002) and serum albumin (OR = 0.807, p = 0.021) were associated with postoperative fever. We concluded that patients with larger stone size and preoperative urinary tract infection might have a higher risk of developing SIRS and fever after operation, while a high-normal level of serum albumin might be the protective factor for postoperative fever. PMID:28261611

  19. Non-dietary environmental risk factors in prostate cancer

    PubMed Central

    Ferrís-i-Tortajada, J; Berbel-Tornero, O; Garcia-i-Castell, J; López-Andreu, J.A.; Sobrino-Najul, E; Ortega-García, J.A.

    2016-01-01

    Introduction The aim is to update and disclose the main environmental risk factors, excluding dietary factors, involved in the etiopathology of prostate cancer. Materials and methods Bibliographic review of the last 25 years of non-dietary environmental risk factors associated with prostate cancer between 1985 and 2010, obtained from MedLine, CancerLit, Science Citation Index and Embase. The search profiles were Environmental Risk Factors/Tobacco/Infectious-Inflammatory Factors/Pesticides/Vasectomy/Occupational Exposures/ Chemoprevention Agents/Radiation and Prostate Cancer. Results While some non-dietary environmental risk factors increase the risk of acquiring the disease, others decrease it. Of the former, it is worth mentioning exposal to tobacco smoke, chronic infectious-inflammatory prostatic processes and occupational exposure to cadmium, herbicides and pesticides. The first factors that reduce the risk are the use of chemopreventive drugs (Finasterida, Dutasteride) and exposure to ultraviolet solar radiation. With the current data, a vasectomy does not influence the risk of developing the disease. Conclusions The slow process of prostate carcinogenesis is the final result of the interaction of constitutional risk and environmental factors. Non-dietary environmental factors play an important role in the etiopathology of this disease. To appropriately assess the risk factors, extensive case studies that include all the possible variables must be analyzed. PMID:21439685

  20. Exposure to an atomic bomb explosion is a risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

    PubMed

    Nakashima, Y; Takeishi, K; Guntani, A; Tsujita, E; Yoshinaga, K; Matsuyama, A; Hamatake, M; Maeda, T; Tsutsui, S; Matsuda, H; Ishida, T

    2015-01-01

    Esophagectomy, one of the most invasive of all gastrointestinal operations, is associated with a high frequency of postoperative complications and in-hospital mortality. The purpose of the present study was to determine whether exposure to the atomic bomb explosion at Hiroshima in 1945 might be a preoperative risk factor for in-hospital mortality after esophagectomy in esophageal cancer patients. We thus reviewed the outcomes of esophagectomy in 31 atomic bomb survivors with esophageal cancer and 96 controls (also with cancer but without atomic bomb exposure). We compared the incidences of postoperative complications and in-hospital mortality. Of the clinicopathological features studied, mean patient age was significantly higher in atomic bomb survivors than in controls. Of the postoperative complications noted, atomic bomb survivors experienced a longer mean period of endotracheal intubation and higher incidences of severe pulmonary complications, severe anastomotic leakage, and surgical site infection. The factors associated with in-hospital mortality were exposure to the atomic bomb explosion, pulmonary comorbidities, and electrocardiographic abnormalities. Multivariate analysis revealed that exposure to the atomic bomb explosion was an independent significant preoperative risk factor for in-hospital mortality. Exposure to the atomic bomb explosion is thus a preoperative risk factor for in-hospital death after esophagectomy to treat esophageal cancer.

  1. Early biliary complications following pancreaticoduodenectomy: prevalence and risk factors

    PubMed Central

    Malgras, Brice; Duron, Sandrine; Gaujoux, Sébastien; Dokmak, Safi; Aussilhou, Béatrice; Rebours, Vinciane; Palazzo, Maxime; Belghiti, Jacques; Sauvanet, Alain

    2016-01-01

    Background Early biliary complications (EBC) following pancreaticoduodenectomy (PD) are poorly known. This study aimed to assess incidence, predictive factors, and treatment of EBC including bilio-enteric stricture, transient jaundice, biliary leak, and cholangitis. Method From 2007 to 2011, 352 patients underwent PD. Statistical analysis including logistic regression was performed to determine EBC predictive factors. Results 49 patients (14%) developed 51 EBC, including 7(2%) bilio-enteric strictures, 15(4%) transient jaundices, 9(3%) biliary leaks, and 20(6%) cholangitis with no mortality and a 18% reoperation rate. In multivariate analysis, male gender, benign disease, malignancy with preoperative chemoradiation, and common bile duct (CBD) diameter ≤5 mm were predictive of EBC. Of the 7 strictures, all were associated with CBD ≤5 mm and 5(71%) required reoperation. Transient jaundice resolved spontaneously in all 15 cases. Among 8 patients with serum bilirubin level >50 μmol/L (3 mg/dL) at POD3, 7(88%) developed bilio-enteric stricture. Biliary leak resolved spontaneously in 5(56%); otherwise, it required reoperation. Cholangitis recurred after antibiotics discontinuation in 5(25%). Conclusions EBC following PD do not increase mortality. EBC are more frequent with male gender, benign disease, malignancy with preoperative chemoradiation, and CBD ≤5 mm. Transient jaundice or cholangitis has a favorable outcome, whereas bilio-enteric stricture or biliary leak can require reintervention. PMID:27037207

  2. Inferring the Interactions of Risk Factors from EHRs

    PubMed Central

    Goodwin, Travis; Harabagiu, Sanda M.

    2016-01-01

    The wealth of clinical information provided by the advent of electronic health records offers an exciting opportunity to improve the quality of patient care. Of particular importance are the risk factors, which indicate possible diagnoses, and the medications which treat them. By analysing which risk factors and medications were mentioned at different times in patients’ EHRs, we are able to construct a patient’s clinical chronology. This chronology enables us to not only predict how new patient’s risk factors may progress, but also to discover patterns of interactions between risk factors and medications. We present a novel probabilistic model of patients’ clinical chronologies and demonstrate how this model can be used to (1) predict the way a new patient’s risk factors may evolve over time, (2) identify patients with irregular chronologies, and (3) discovering the interactions between pairs of risk factors, and between risk factors and medications over time. Moreover, the model proposed in this paper does not rely on (nor specify) any prior knowledge about any interactions between the risk factors and medications it represents. Thus, our model can be easily applied to any arbitrary set of risk factors and medications derived from a new dataset. PMID:27595044

  3. Environmental risk factors and allergic bronchial asthma.

    PubMed

    D'Amato, G; Liccardi, G; D'Amato, M; Holgate, S

    2005-09-01

    The prevalence of allergic respiratory diseases such as bronchial asthma has increased in recent years, especially in industrialized countries. A change in the genetic predisposition is an unlikely cause of the increase in allergic diseases because genetic changes in a population require several generations. Consequently, this increase may be explained by changes in environmental factors, including indoor and outdoor air pollution. Over the past two decades, there has been increasing interest in studies of air pollution and its effects on human health. Although the role played by outdoor pollutants in allergic sensitization of the airways has yet to be clarified, a body of evidence suggests that urbanization, with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases observed in most industrialized countries, and there is considerable evidence that asthmatic persons are at increased risk of developing asthma exacerbations with exposure to ozone, nitrogen dioxide, sulphur dioxide and inhalable particulate matter. However, it is not easy to evaluate the impact of air pollution on the timing of asthma exacerbations and on the prevalence of asthma in general. As concentrations of airborne allergens and air pollutants are frequently increased contemporaneously, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of allergic respiratory allergy and bronchial asthma. Pollinosis is frequently used to study the interrelationship between air pollution and respiratory allergy. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. By attaching to the surface of pollen grains and of plant-derived particles of paucimicronic size, pollutants could modify not only the morphology of these antigen-carrying agents but also their allergenic

  4. Potentially modifiable risk factors for atrial fibrillation following lung resection surgery: a retrospective cohort study.

    PubMed

    Lee, S H; Ahn, H J; Yeon, S M; Yang, M; Kim, J A; Jung, D M; Park, J H

    2016-12-01

    Atrial fibrillation is the most frequent arrhythmia after thoracic surgery and is associated with increased hospital costs, morbidity and mortality. In this study, we aimed to identify potentially modifiable risk factors for postoperative atrial fibrillation following lung resection surgery and to suggest possible measures to reduce risk. We retrospectively reviewed the medical records of 4731 patients who underwent lobectomy or more major lung resection over a 6-year period. Patients who developed atrial fibrillation postoperatively and required treatment were included in the postoperative atrial fibrillation group, while the remaining patients were assigned to the non-postoperative atrial fibrillation group. Risk factors for postoperative atrial fibrillation were analysed by multivariate analysis and propensity score matching. Overall, 12% of patients developed postoperative atrial fibrillation. Potentially modifiable risk factors for postoperative atrial fibrillation were excessive alcohol consumption (odds ratio (OR) = 1.48, 95% CI 1.08-2.02, p = 0.0140), red cell transfusion (2.70(2.13-3.43), p < 0.0001), use of inotropes (1.81(1.42-2.31), p < 0.0001) and open (vs. thoracoscopic) surgery (1.59(1.23-2.05), p < 0.0001). Compared with inotrope use, vasopressor administration was not related to postoperative atrial fibrillation. Use of steroids or thoracic epidural anaesthesia did not reduce the incidence of postoperative atrial fibrillation. We conclude that high alcohol consumption, red cell transfusion, use of inotropes and open surgery are potentially modifiable risk factors for postoperative atrial fibrillation. Pre-operative alcohol consumption needs to be addressed. Avoiding red cell transfusion and performing lung resection via video-assisted thoracoscopic surgery may reduce the incidence of postoperative atrial fibrillation and the administration of vasopressors rather than inotropes is preferred.

  5. A behaviour risk factor survey in Jamaica.

    PubMed

    Figueroa, J P; Fox, K; Minor, K

    1999-03-01

    A population based probability sample of 958 persons (454 males and 504 females) aged 15 to 49 years was surveyed in Jamaica in late 1993 for lifestyle and behaviour risk factors. Demographic characteristics of the sample were comparable to the general population, 60% of persons visited a private doctor the last time that they were ill. Based on self-reporting, 18% of the women and 8% of the men were hypertensive and 4.8% of the women and 3.3% of the men were diabetic. 26% of the men and 8% of the women had never had their blood pressure taken. 40% of the women had never had a Papanicolaou smear, 29% had never had a breast examination and 33% said that they were overweight compared with 18% of men. Smoking cigarettes and marijuana was more common among men (36%) than women (11%), as were drinking alcohol (79% of men, 41% of women) and heavy alcohol use (30% of men, 9% of women). Injuries requiring medical attention in the previous five years were reported by 40% of the men and 15% of the women. 34% of the men and 12% of the women regularly carried a weapon and 18% of the sample had participated in or witnessed at least one violent act in the previous month. Most of the people interviewed used a contraceptive method; 10% were not sexually active. Significantly more men than women had two or more sexual partners in the previous year (54% vs 17%, p < 0.001) or reported ever having a sexually transmitted disease (29% vs 9%, p < 0.001). Younger persons were more sexually active and more likely to use condoms during their most recent sexual intercourse. Higher socio-economic status and educational level generally had a more positive effect on health behaviour. This survey provides vital information relevant to planning health promotion campaigns and assessing their success.

  6. Apolipoprotein E: Risk factor for Alzheimer disease

    SciTech Connect

    Tsai, M.S.; Thibodeau, S.N.; Tangalos, E.G.; Petersen, R.C.; Kokmen, E.; Smith, G.E.; Schaid, D.J.; Ivnik, R.J. )

    1994-04-01

    The apolipoprotein E gene (APOE) has three common alleles (E2, E3, and E4) that determine six genotypes in the general population. In this study, the authors examined 77 patients with late-onset Alzheimer disease (AD), along with an equal number of age- and sex-matched controls, for an association with the APOE-E4 allele. They show that the frequency of this allele among AD patients was significantly higher than that among the control population (.351 vs. .130, P = .000006). The genotype frequencies also differed between the two groups (P = .0002), with the APOE-E4/E3 genotype being the most common in the AD group and the APOE-E3/E3 being the most common in the control group. In the AD group, homozygosity for E4 was found in nine individuals, whereas none was found in the control group. The odds ratio for AD, when associated with one or two E4 alleles, was 4.6 (95% confidence interval [CI] 1.9-12.3), while the odds ratio for AD, when associated with heterozygosity for APOE-E4, was 3.6 (05% CI 1.5-9.8). Finally, the median age at onset among the AD patients decreased from 83 to 78 to 74 years as the number of APOE-E4 alleles increased from 0 to 1 to 2, respectively (test for trend, P = .001). The data, which are in agreement with recent reports, suggest that the APOE-E4 allele is associated with AD and that this allelic variant may be an important risk factor for susceptibility to AD in the general population. 30 refs., 5 tabs.

  7. Substantial contribution of extrinsic risk factors to cancer development

    PubMed Central

    Wu, Song; Powers, Scott; Zhu, Wei; Hannun, Yusuf A

    2015-01-01

    Summary Recent research has highlighted a strong correlation between tissue-specific cancer risk and the lifetime number of tissue-specific stem cell divisions. Whether such correlation implies a high unavoidable intrinsic cancer risk has become a key public health debate with dissemination of the ‘bad luck’ hypothesis. Here we provide evidence that intrinsic risk factors contribute only modestly (<10~30%) to cancer development. First, we demonstrate that the correlation between stem-cell division and cancer risk does not distinguish between the effects of intrinsic and extrinsic factors. Next, we show that intrinsic risk is better estimated by the lower bound risk controlling for total stem cell divisions. Finally, we show that the rates of endogenous mutation accumulation by intrinsic processes are not sufficient to account for the observed cancer risks. Collectively, we conclude that cancer risk is heavily influenced by extrinsic factors. These results carry immense consequences for strategizing cancer prevention, research, and public health. PMID:26675728

  8. Independent risk factors for hypoxemia after surgery for acute aortic dissection

    PubMed Central

    Sheng, Wei; Yang, Hai-Qin; Chi, Yi-Fan; Niu, Zhao-Zhuo; Lin, Ming-Shan; Long, Sun

    2015-01-01

    Objectives: To determine risk factors associated with postoperative hypoxemia after surgery for acute type A aortic dissection. Methods: We retrospectively analyzed the clinical data of 192 patients with acute type A aortic dissection who underwent surgery in Qingdao Municipal Hospital, Medical College of Qingdao University, Qingdao, China between January 2007 and December 2013. Patients were divided into hypoxemia group (n=55) [arterial partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ≤200 mm Hg] and non-hypoxemia group (n=137) [PaO2/FiO2 >200 mm Hg]. Perioperative clinical data were analyzed and compared between the 2 groups. Results: The incidence of postoperative hypoxemia after surgery for acute aortic dissection was 28.6% (55/192). Perioperative death occurred in 13 patients (6.8%). Multivariate regression identified body mass index (BMI) >25 kg/m2 (OR=21.929, p=0.000), deep hypothermic circulatory arrest (DHCA) (OR=11.551, p=0.000), preoperative PaO2/FiO2 ≤300 mm Hg (OR=7.830, p=0.000) and blood transfusion >6U in 24 hours postoperatively (OR=12.037, p=0.000) as independent predictors of postoperative hypoxemia for patients undergoing Stanford A aortic dissection surgery. Conclusion: Our study demonstrated that BMI >25 kg/m2, DHCA, preoperative PaO2/FiO2 ≤300 mm Hg, and blood transfusion in 24 hours postoperatively >6U were independent risk factors of the hypoxemia after acute type A aortic dissection aneurysm surgery. PMID:26219444

  9. Radiation effects: Modulating factors and risk assessment -- an overview.

    PubMed

    Wakeford, R

    2012-01-01

    Following low dose or low dose-rate exposures to ionising radiation, the principal resulting radiation-related risk is cancer. Site-specific cancer risk models have been developed that describe how the radiation-induced risk of a particular cancer type varies with the relevant tissue-specific absorbed dose of radiation. The degree of risk will also be determined by the radiation quality and the dose-rate, factors that will vary between types of radiation and cancer. Risk models also include a number of intrinsic factors that modify the radiation-related excess risk - sex, age at exposure, time since exposure, and attained age - although not all these factors enter into each site-specific model. Of some importance is how the radiation-related excess risk is transferred between populations when background incidence rates differ. For most cancer types, expert groups consider that the radiation-related excess risk in a population depends, to some extent, upon the background incidence rate, and therefore that radiation interacts with at least some of the major risk factors that determine the background risk for a person. For example, the radiation-induced risk of lung cancer depends on the degree of individual exposure to tobacco smoke, but the implicit assumption of the currently accepted risk transfer models is that interactions are a general feature of radiation-related cancer risk.

  10. Slow Gait Speed and Rapid Renal Function Decline Are Risk Factors for Postoperative Delirium after Urological Surgery

    PubMed Central

    Sato, Tendo; Okamoto, Teppei; Yamamoto, Hayato; Hosogoe, Shogo; Tobisawa, Yuki; Yoneyama, Tohru; Hashiba, Eiji; Yoneyama, Takahiro; Hashimoto, Yasuhiro; Koie, Takuya; Hirota, Kazuyoshi; Ohyama, Chikara

    2016-01-01

    Objectives The aim of this study was to identify risk factors associated with postoperative delirium in patients undergoing urological surgery. Methods We prospectively evaluated pre- and postoperative risk factors for postoperative delirium in consecutive 215 patients who received urological surgery between August 2013 and November 2014. Preoperative factors included patient demographics, comorbidities, and frailty assessment. Frailty was measured by handgrip strength, fatigue scale of depression, fall risk assessment, and gait speed (the timed Get-up and Go test). Postoperative factors included types of anesthesia, surgical procedure, renal function and serum albumin decline, blood loss, surgery time, highest body temperature, and complications. Uni- and multivariate logistic regression analyses were performed to assess pre- and postoperative predictors for the development of postoperative delirium. Results Median age of this cohort was 67 years. Ten patients (4.7%) experienced postoperative delirium. These patients were significantly older, had weak handgrip strength, a higher fall risk assessment score, slow gait speed, and greater renal function decline compared with patients without delirium. Multivariate analysis revealed slow gait speed (>13.0 s) and rapid renal function decline (>30%) were independent risk factors for postoperative delirium. Conclusions Slow gait speed and rapid renal function decline after urological surgery are significant factors for postoperative delirium. These data will be helpful for perioperative patient management. This study was registered as a clinical trial: UMIN: R000018809. PMID:27145178

  11. The Role of Unknown Risk Factors in Myocardial Infarction

    PubMed Central

    Ali, Rafighdoust Abbas; Asadollah, Mirzaee; Hossien, Rafigdoust Amir

    2010-01-01

    Background Atherosclerosis of coronary arteries is the most common cause of myocardial infarction (MI), which is initiated from childhood and progresses gradually by aging. Several risk factors influence its progress, and are categorized as classic, traditional and novel factors. The role of unknown risk factors is becoming increasingly more significant recently. The aim of this study is to underscore the novel risk factors despite the importance of classic factors and consider these factors for future studies. Methods This is a prospective study on 180 myocardial infarction cases, conducted in the cardiology ward and CCU of Imam-Reza hospital (Mashad-IRAN). A number of risk factors identified and evaluated in these patients included: hyperlipidemia, hypertension, diabetes, smoking, activity, stress, hair of external ear canal and ear lobe crease, age, and sex. Then patients without any risk factor or with one or two risk factors were distinguished. Results The majority of our patients were old men in the age range of 60 - 69 years. Amongst all patients 42.2% were smokers, 68.3% were type A personality group, 19% were active, 81% were physically inactive, 37.2% had hairy ear canal, 35% had hypertension, 21.1% were diabetic, 14.4% had hyperlipidemia and 30% had positive family history of myocardial infarction. Of great interest was the fact that of the patients whose case was studied, many did not have any risk factor or in some cases had only one. Conclusions In regard of increasing rate of cardiovascular diseases and myocardial infarction even amongst the young population, and because of considerable need to improve vascular risk detection, much research over the past decade has focused on identification of novel atherosclerotic risk factors, and some of these new risk factors are identified and some may be unknown. Amongst the new risk factors, inflammation has an important role, other risk factors that must be assessed are homocysteine, serum amyloid, and

  12. [Risk factors for destructive periodontitis. I. Behavioral and acquired factors (literature review)].

    PubMed

    Gera, István

    2004-02-01

    Dental plaque is a necessary but not sufficient etiologic factor of the destructive periodontal disease. The manifestation of periodontal destruction is influenced by a wide variety of risk factors and determinants. In the introduction the terminology of different etiologic and risk factors are discussed in general. Than the risk factors and determinants of destructive periodontitis are overviewed. In the first part the acquired and behavioral factors and determinates are discussed. Among the local factors the role of the individual oral hygiene, the specificity of subgingival dental plaque the plaque retentive factors and occlusal traumatism are discussed. The hormonal, the acquired immunological factors, osteoporosis and the age are discussed as systemic risk factors and determinants. Among the behavioral factors smoking, psychological stress and socio-economic factors are covered. The second part is going to cover the genetic predisposing factors.

  13. Minimum graft size calculated from preoperative recipient status in living donor liver transplantation.

    PubMed

    Marubashi, Shigeru; Nagano, Hiroaki; Eguchi, Hidetoshi; Wada, Hiroshi; Asaoka, Tadafumi; Tomimaru, Yoshito; Tomokuni, Akira; Umeshita, Koji; Doki, Yuichiro; Mori, Masaki

    2016-05-01

    Small-for-size graft syndrome is an inevitable complication in living donor liver transplantation (LDLT). We hypothesized that graft weight (GW) measured after graft procurement is one of the variables predicting postoperative graft function. A total of 138 consecutive recipients of adult-to-adult LDLT between March 1999 and October 2014 were included in this study. We investigated the factors associated with small-for-size-associated graft loss (SAGL) to determine the GW required for each patient. Both preoperatively assessed and postoperatively obtained risk factors for SAGL were analyzed in univariate and multivariate logistic regression analysis. Twelve (8.8%) of the transplant recipients had SAGL. In multivariate logistic regression analyses using preoperatively assessed variables, the preoperative Model for End-Stage Liver Disease (MELD) score (P < 0.001) and actual GW/recipient standard liver volume (SLV) ratio (P = 0.008) were independent predictors of SAGL. The recommended graft volume by preoperative computed tomography volumetry was calculated as SLV × (1.616 × MELD + 0.344)/100/0.85 (mL) [MELD ≥ 18.2], or SLV × 0.35 (mL) [MELD < 18.2]. The required allograft volume in LDLT can be determined by the preoperative MELD score of the recipient, and patients with higher MELD scores require larger grafts or deceased donor whole liver transplant to avoid SAGL. Liver Transplantation 22 599-606 2016 AASLD.

  14. Risk factors for major amputation in hospitalised diabetic foot patients.

    PubMed

    Namgoong, Sik; Jung, Suyoung; Han, Seung-Kyu; Jeong, Seong-Ho; Dhong, Eun-Sang; Kim, Woo-Kyung

    2016-03-01

    Diabetic foot ulcers are the main cause of non-traumatic lower extremity amputation. The objective of this study was to evaluate the risk factors for major amputation in diabetic foot patients. Eight hundred and sixty diabetic patients were admitted to the diabetic wound centre of the Korea University Guro Hospital for foot ulcers between January 2010 and December 2013. Among them, 837 patients were successfully monitored until complete healing. Ulcers in 809 patients (96·7%) healed without major amputation and those in 28 patients (3·3%) healed with major amputation. Data of 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology and serology were collected from patients in the two groups and compared. Among the 88 potential risk factors, statistically significant differences between the two groups were observed in 26 risk factors. In the univariate analysis, which was carried out for these 26 risk factors, statistically significant differences were observed in 22 risk factors. In a stepwise multiple logistic analysis, six of the 22 risk factors remained statistically significant. Multivariate-adjusted odds ratios were 11·673 for ulcers penetrating into the bone, 8·683 for dialysis, 6·740 for gastrointestinal (GI) disorders, 6·158 for hind foot ulcers, 0·641 for haemoglobin levels and 1·007 for fasting blood sugar levels. The risk factors for major amputation in diabetic foot patients were bony invasions, dialysis, GI disorders, hind foot locations, low levels of haemoglobin and elevated fasting blood sugar levels.

  15. Behaviour Problems and Adults with Down Syndrome: Childhood Risk Factors

    ERIC Educational Resources Information Center

    McCarthy, J.

    2008-01-01

    Background: Studies of people with intellectual disability suggest that several individual characteristics and environmental factors are associated with behaviour disorder. To date there are few studies looking at risk factors within specific syndromes and the relationship between early risk markers and later behaviour disorder. The key aim of the…

  16. Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors

    DTIC Science & Technology

    2007-10-01

    AD_________________ Award Number: DAMD17-02-1-0387 TITLE: Modifiable Risk Factors for Lymphedema ...Final 3. DATES COVERED 1 Oct 2004 – 30 Sep 2007 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Modifiable Risk Factors for Lymphedema in Breast...axillary lymph nodes removed were followed for the development of arm lymphedema . Participants completed a baseline interview and subsequent

  17. Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors

    DTIC Science & Technology

    2006-10-01

    AD_________________ Award Number: DAMD17-02-1-0387 TITLE: Modifiable Risk Factors for Lymphedema ...Annual 3. DATES COVERED 1 Oct 2005 – 30 Sep 2006 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Modifiable Risk Factors for Lymphedema in Breast...Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Lymphedema of the arm is a consequence of breast cancer

  18. Risk Factors for Attempting Suicide in Heroin Addicts

    ERIC Educational Resources Information Center

    Roy, Alec

    2010-01-01

    In order to examine risk factors for attempting suicide in heroin dependent patients, a group of 527 abstinent opiate dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. It was found that 207 of the 527…

  19. Suicide in Peacekeepers: Risk Factors for Suicide versus Accidental Death

    ERIC Educational Resources Information Center

    Thoresen, Siri; Mehlum, Lars

    2006-01-01

    To investigate risk factors for suicide in veterans of peacekeeping, 43 suicides and 41 fatal accidents in Norwegian peacekeepers (1978 to 1995) were compared in a psychological autopsy study. Mental health problems were the most important risk factor for suicide. Both living alone and the break-up of a love relationship contributed uniquely to…

  20. Risk Factors for Osteoporosis Among Middle-Aged Women

    ERIC Educational Resources Information Center

    Turner, Lori W.; Wallace, Lorraine Silver; Perry, Blake Allen; Bleeker, Jeanne

    2004-01-01

    Objective: To investigate the risk factors for osteoporosis among a sample of middle-aged women. Methods: Adipose tissue and bone mineral density levels at the left femur, lumbar spine, and total body were assessed using dual-energy x-ray absorptiometry (DXA). Subjects (n=342) were surveyed regarding a variety of osteoporosis-related risk factors.…

  1. Identification of Early Risk Factors for Developmental Delay

    ERIC Educational Resources Information Center

    Delgado, Christine E. F.; Vagi, Sara J.; Scott, Keith G.

    2007-01-01

    Statewide birth certificate and preschool exceptionality records were integrated to identify risk factors for developmental delay (DD). Epidemiological methods were used to investigate both individual-level and population-level risk for DD associated with a number of child and maternal factors. Infants born with very low birth weight were at the…

  2. Suicide Clusters: A Review of Risk Factors and Mechanisms

    ERIC Educational Resources Information Center

    Haw, Camilla; Hawton, Keith; Niedzwiedz, Claire; Platt, Steve

    2013-01-01

    Suicide clusters, although uncommon, cause great concern in the communities in which they occur. We searched the world literature on suicide clusters and describe the risk factors and proposed psychological mechanisms underlying the spatio-temporal clustering of suicides (point clusters). Potential risk factors include male gender, being an…

  3. Risk factors of postoperative pancreatic fistula in patients after distal pancreatectomy: a systematic review and meta-analysis.

    PubMed

    Peng, Yun-Peng; Zhu, Xiao-Le; Yin, Ling-Di; Zhu, Yi; Wei, Ji-Shu; Wu, Jun-Li; Miao, Yi

    2017-03-15

    Postoperative pancreatic fistula (POPF) is a common complication following distal pancreatectomy (DP). However, the risk factors of this complication in patients after DP still remain controversial. The aim of our study is to estimate the association between potential risk factors and POPF. Relevant articles published up to June 21, 2016 were identified via PubMed, EMBASE, Web of Science, and The Cochrane Library. Studies that examined the risk factors of POPF following DP were enrolled. 20 articles (2070 patients) were finally included in this study. The pooled data suggested that patients with soft pancreas, higher Body Mass Index (BMI), blood transfusion, elevated intraoperative blood loss, and longer operative time had a decreased risk for POPF. However, age, gender, malignant pathology, types of stump closure, octreotide therapy, history of diabetes and chronic pancreatitis, splenectomy, multiorgan resection, main duct ligation, preoperative serum albumin levels, PGA felt wrapping, and extended lymphadenectomy could not be regarded as risk factors for POPF. Our analytic data demonstrated that pancreas texture, BMI, blood transfusion, intraoperative blood loss, and operative time were clinical predictor for POPF. This study may assist surgeons to screen patients with high risk of POPF and select appropriate treatment measures.

  4. Environmental Influences and Perinatal Risk Factors in High Risk Children.

    ERIC Educational Resources Information Center

    Lindgren, Scott D.; And Others

    Children in a longitudinal high-risk infant follow-up program were evaluated at age 5 to determine whether they demonstrated behavior problems or cognitive deficits exceeding expectations based on conditions in their home environments. Normal expectations were determined through regression analyses on a group of age-matched controls. All high-risk…

  5. Risk factors associated with injuries in thoroughbred horses.

    PubMed

    Mohammed, H O; Hill, T; Lowe, J

    1991-11-01

    A case-control study was conducted on Thoroughbred horses to identify factors associated with the risk of breakdown on racetracks. A total of 310 cases (breakdowns) were identified from the Horse Identification Department records kept by the chief examining veterinarian of New York Racing Association. For each case, two control horses were selected randomly from the Daily Racing Form Inc. records. Multiple logistic regression analysis was used to identify and quantify the risk of factors associated with breakdown, while simultaneously controlling for the effect of other putative factors. Factors associated with risk of breakdown were: track (horses raced on Saratoga racetrack were at a lesser risk of breakdown), track composition/condition (turf tracks had a lower risk compared to dirt), number of seasons in race, racing in a later race, number of starts per year, the total number of starts, season (summer had a higher risk than winter or spring) and age of the horse.

  6. Early results and complications of colorectal laparoscopic surgery and analysis of risk factors in 492 operated cases.

    PubMed

    Santoro, Emanuele; Carboni, Fabio; Ettorre, Giuseppe Maria; Lepiane, Pasquale; Mancini, Pietro; Santoro, Roberto; Santoro, Eugenio

    2010-12-01

    This study aimed to evaluate the early results of colorectal laparoscopic surgery with special attention to surgical and medical complications. The risk factors of such surgery are also investigated on the basis of a large series of operated cases: the preoperative knowledge of such factors could guide the operative program and the postoperative treatment with reduction of complications and improvement of the outcome. Between 1998 and 2008, 492 patients had been submitted to colorectal laparoscopic surgery by the same team: 387 for cancer and 105 for benign disease. All colorectal surgical operations are included in the series. No selection of the patients was made: laparoscopy was performed in all cases accepting the procedure. Several risk factors have been analysed in cases of fistula (age, pathology sex, type of the operation, cancer stages, preoperative radiochemotherapy, stool diversion and team experience) and in cases of medical complications (age, pathology, cancer stages and type of operation). The overall results in this series of laparoscopic colorectal operated cases are similar to other results published at present by the main surgical Department all over the world; no mortality and low number of medical (2.4%) and surgical complications (9.3%), with no differences also with the best open surgery series. Complete or partial conversion to open surgery was required in few cases (1.2%) and same others (1.4%) were operated again for bleeding or sudden anastomotic leakage. Regarding the risk factors in such surgery, a good correlation has been discovered between anastomotic leakage and the team experience, the age over 70 of the patients, the rectal tumour site in man, the advanced tumour stages, the previous radiochemotherapy, while medical complications seem to depend on advanced patients age and advanced cancer stages. Laparoscopic colorectal surgery at present is going to be considered the gold standard in the large majority of colorectal diseases

  7. Cardiovascular risk factor knowledge and risk perception among HIV-infected adults

    PubMed Central

    Cioe, Patricia A.; Crawford, Sybil L.; Stein, Michael D.

    2013-01-01

    Cardiovascular disease (CVD) has emerged as a major cause of morbidity and mortality in HIV-infected adults. Research in non-infected populations has suggested that knowledge of CVD risk factors significantly influences perceptions of risk. This cross-sectional study describes CVD risk factor knowledge and risk perception in HIV-infected adults. We recruited 130 HIV-infected adults (mean age = 48 years, 62% male, 56% current smokers, mean years since HIV diagnosis, 14.7). The mean CVD risk factor knowledge score was fairly high. However, controlling for age, CVD risk factor knowledge was not predictive of perceived risk (F[1,117] = 0.13, p > .05). Estimated risk and perceived risk were weakly, but significantly, correlated, r(126) = .24, p = .01. HIV-infected adults are at increased risk for CVD. Despite having adequate risk factor knowledge, CVD risk perception was inaccurate. Improving risk perception and developing CVD risk reduction interventions for this population are imperative. PMID:24070645

  8. [Risk factors for teeth aplasia and hypoplasia in cleft lip and palate children].

    PubMed

    Korolenkova, M V; Starikova, N V; Ageeva, L V

    2016-01-01

    The aim of the study was to assess the significance of environmental risk factors for teeth aplasia and hypoplasia in cleft lip and palate children. Two hundred and forty-seven cleft lip and palate (CLP) children were enrolled in the study including 105 (42.5%) with bilateral CLP and 57.5% with unilateral CLP. The mean age was 11.2±4.9 years. Teeth condition was assessed clinically and radiologically. The impact of risk factors for teeth anomalies was analyzed by retrospective data obtained from computer database (absence of preoperative orthopedic treatment, palatal defects after primary palatoplasty and type of primary procedures). Surgical trauma by early periosteoplasty (at the age of 3-4 months), excessive scarring and tissue traction due to absence of early orthopedic treatment and palatal defect were associated with significantly higher incidence of incisors hypoplasia (both developmental enamel defects and microdentia) and aplasia of central incisors not seen in the other study subgroups. Incisors aplasia and hypoplasia in CLP patients do not always have disembryogenic origin but may depend on external environmental factors, including surgical trauma.

  9. Non-pharmacological modification of cardiac risk factors: Part 1.

    PubMed

    Eagles, C J; Gulati, R; Martin, U

    1996-10-01

    Many factors influence whether a person will develop coronary heart disease. Genetic predisposition, gender and advanced age are recognized risk factors for the development of coronary heart disease over which we have little control. On the other hand, high serum cholesterol, cigarette smoking, high blood pressure, excessive body weight and long-term physical inactivity are key risk factors over which we have considerable control. In many cases cardiac risk factors can be modified without resorting to pharmacological intervention. Current evidence suggests that individuals who follow a diet which is low in saturated fats and cholesterol, lose weight, stop cigarette smoking and take regular aerobic exercise will significantly reduce their risk of developing coronary heart disease. In addition, patients who already have evidence of coronary heart disease may improve their symptoms and prognosis by similar life-style changes. In the first of two parts, we review the role of exercise in modifying cardiac risk factors.

  10. Risk factors of patients with and without postoperative nausea (PON).

    PubMed

    Dienemann, Jacqueline; Hudgens, Amanda N; Martin, Dana; Jones, Holly; Hunt, Ronald; Blackwell, Richard; Norton, H James; Divine, George

    2012-08-01

    This purpose of this analysis was to study risk factors of postoperative nausea (PON) and their strength. Data were obtained during the screening phase of a controlled clinical trial of aromatherapy for PON. In a sample of 1151 postsurgical subjects, 301 (26.2%) reported PON. Significant risk factors identified in the order of odds ratios for nausea were female gender, gastrointestinal surgery, use of volatile anesthesia gases, history of PON, history of motion sickness, and use of opioids after surgery. Although still over 1.0, the risk factors of length of surgery over 1 hour and gynecologic surgery had the lowest odds ratios. Likelihood of nausea increased significantly with the number of significant risk factors (P<.0001). Administration of preventive antiemetic medication also increased with the number of significant risk factors (P<.0001). Among 301 subjects reporting nausea, 49 (16.28%) received preventive medication. Despite prevention efforts, PON remains a substantial side effect for many surgical patients.

  11. Cardiovascular risk factors for acute stroke: Risk profiles in the different subtypes of ischemic stroke

    PubMed Central

    Arboix, Adrià

    2015-01-01

    Timely diagnosis and control of cardiovascular risk factors is a priority objective for adequate primary and secondary prevention of acute stroke. Hypertension, atrial fibrillation and diabetes mellitus are the most common risk factors for acute cerebrovascular events, although novel risk factors, such as sleep-disordered breathing, inflammatory markers or carotid intima-media thickness have been identified. However, the cardiovascular risk factors profile differs according to the different subtypes of ischemic stroke. Atrial fibrillation and ischemic heart disease are more frequent in patients with cardioembolic infarction, hypertension and diabetes in patients with lacunar stroke, and vascular peripheral disease, hypertension, diabetes, previous transient ischemic attack and chronic obstructive pulmonary disease in patients with atherothrombotic infarction. This review aims to present updated data on risk factors for acute ischemic stroke as well as to describe the usefulness of new and emerging vascular risk factors in stroke patients. PMID:25984516

  12. Future directions in Alzheimer's disease from risk factors to prevention.

    PubMed

    Imtiaz, Bushra; Tolppanen, Anna-Maija; Kivipelto, Miia; Soininen, Hilkka

    2014-04-15

    The increase in life expectancy has resulted in a high occurrence of dementia and Alzheimer's disease (AD). Research on AD has undergone a paradigm shift from viewing it as a disease of old age to taking a life course perspective. Several vascular, lifestyle, psychological and genetic risk factors influencing this latent period have been recognized and they may act both independently and by potentiating each other. These risk factors have consequently been used to derive risk scores for predicting the likelihood of dementia. Despite population differences, age, low education and vascular risk factors were identified as key factors in all scoring systems. Risk scores can help to identify high-risk individuals who might benefit from different interventions. The European Dementia Prevention Initiative (EDPI), an international collaboration, encourages data sharing between different randomized controlled trials. At the moment, it includes three large ongoing European trials: Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), Prevention of Dementia by Intensive Vascular Care (preDIVA), and Multidomain Alzheimer Prevention study (MAPT). Recently EDPI has developed a "Healthy Aging through Internet Counseling in Elderly" (HATICE) program, which intends to manage modifiable risk factors in an aged population through an easily accessible Internet platform. Thus, the focus of dementia research has shifted from identification of potential risk factors to using this information for developing interventions to prevent or delay the onset of dementia as well as identifying special high-risk populations who could be targeted in intervention trials.

  13. Children at risk: 2. Risk Factors and Clinic Utilization

    DTIC Science & Technology

    1989-03-27

    health services utilization. develop more robust models of risk, and increase the effectiveness of our efforts directed towards prevention and...mental health services ( Tuckman and Regan, 1967; Novack it is vitally important that the various ways of measuring et al., 1975). Possibly, parental...related to clinic clinics than later-born children ( Tuckman and Regan, 1967). attrition have been conducted, it is not clear that such studies Possibly

  14. Risk Factors for Acute Leukemia in Children: A Review

    PubMed Central

    Belson, Martin; Kingsley, Beverely; Holmes, Adrianne

    2007-01-01

    Although overall incidence is rare, leukemia is the most common type of childhood cancer. It accounts for 30% of all cancers diagnosed in children younger than 15 years. Within this population, acute lymphocytic leukemia (ALL) occurs approximately five times more frequently than acute myelogenous leukemia (AML) and accounts for approximately 78% of all childhood leukemia diagnoses. Epidemiologic studies of acute leukemias in children have examined possible risk factors, including genetic, infectious, and environmental, in an attempt to determine etiology. Only one environmental risk factor (ionizing radiation) has been significantly linked to ALL or AML. Most environmental risk factors have been found to be weakly and inconsistently associated with either form of acute childhood leukemia. Our review focuses on the demographics of childhood leukemia and the risk factors that have been associated with the development of childhood ALL or AML. The environmental risk factors discussed include ionizing radiation, non-ionizing radiation, hydrocarbons, pesticides, alcohol use, cigarette smoking, and illicit drug use. Knowledge of these particular risk factors can be used to support measures to reduce potentially harmful exposures and decrease the risk of disease. We also review genetic and infectious risk factors and other variables, including maternal reproductive history and birth characteristics. PMID:17366834

  15. Subclinical neuropathy in diabetic patients: a risk factor for bilateral lower limb neurological deficit following spinal anesthesia?

    PubMed

    Angadi, Darshan S; Garde, Ajit

    2012-02-01

    Total knee arthroplasty performed under spinal or general anesthesia is a common successful orthopedic procedure. Nonetheless, in patients with diabetes mellitus this procedure can present unique challenges to orthopedic surgeon and anesthesiologist alike. We describe a case of an elderly male diabetic patient who developed bilaterally symmetrical lower limb neurological deficit following an uneventful total knee arthroplasty performed under spinal anesthesia. Postoperative nerve conduction study with electromyography confirmed symmetrical extensive denervation of lower limb muscles, including low-voltage fibrillation potentials and positive sharp waves. These findings were consistent with a preexisting neuropathy, thereby suggesting a subclinical neuropathy as a potential risk factor for this neurological complication. Our case highlights the fact that patients with longstanding comorbidities, namely peripheral vascular disease and diabetes mellitus, may be at an increased risk of neurological injury following regional anesthesia. Hence, we believe that preoperative evaluation of diabetic patients should include neurophysiological studies to identify subclinical neuropathy and minimize the risk of neurological injury.

  16. Identification of high-risk factors as indicators for adjuvant therapy in stage II colon cancer patients treated at a single institution

    PubMed Central

    YAMAGUCHI, KEIZO; OGATA, YUTAKA; AKAGI, YOSHITO; SHIROUZU, KAZUO

    2013-01-01

    Although post-operative adjuvant chemotherapy (ACT) is only recommended for patients with stage II colon cancer who are at a high risk of recurrence, the definition of high risk remains unclear. The present study aimed to identify the risk factors for recurrence, which may also be indicators for adjuvant therapy, using a retrospective analysis of clinicopathological data obtained from stage II colon cancer patients who had undergone a curative resection. The present study also investigated the effects of ACT in patients who displayed the risk factors for recurrence. Univariate and multivariate analyses of the data collected from 377 stage II colon cancer patients, treated at Kurume University Hospital (Fukuoka, Japan) between 1982 and 2005, was conducted in order to determine and compare the risk factors for recurrence between the 163 patients who had undergone adjuvant therapy and the 214 patients who had not undergone adjuvant therapy. The risk factors for recurrence in patients who had not undergone adjuvant therapy were a serum carcinoembryonic antigen (CEA) level that was twice the cut-off value and pre-operative bowel obstruction. Adjuvant therapy provided no benefit to patients who presented with neither risk factor, but significantly decreased the recurrence rate in patients presenting with one or both risk factors. Based on these findings, serum CEA levels of twice the cut-off value and pre-operative bowel obstruction were proposed as indicators in the assessment for adjuvant chemotherapy following a curative resection for stage II colon cancer. These results warrant further clinical study of ACT in patients with one or both risk factors. PMID:24137386

  17. Immunogenetic Risk and Protective Factors for Juvenile Dermatomyositis in Caucasians

    PubMed Central

    Mamyrova, Gulnara; O’Hanlon, Terrance P.; Monroe, Jason B.; Carrick, Danielle Mercatante; Malley, James D.; Adams, Sharon; Reed, Ann M.; Shamim, Ejaz A.; James‐Newton, Laura; Miller, Frederick W.; Rider, Lisa G.

    2007-01-01

    Objective To define the relative importance of MHC Class II alleles and peptide binding motifs as risk and protective factors for juvenile dermatomyositis (DM) and to compare these to HLA associations in adult DM. Methods DRB1 and DQA1 typing was performed in 142 Caucasian patients with juvenile DM, and compared to HLA typing from 193 patients with adult DM and 797 race‐matched controls. Random Forests classification and multiple logistic regression assessed the relative importance of the HLA associations. Results The HLA DRB1*0301 allele was a primary risk factor (Odds Ratio [OR] 3.9), while DQA1*0301 (OR 2.8), DQA1*0501 (OR 2.1), and homozygosity of DQA1*0501 (OR 3.2) were additional risk factors for juvenile DM. These risk factors were not present in adult DM without defined autoantibodies. DQA1 *0201 (OR 0.37), *0101 (OR 0.38), and *0102 (OR 0.51) were identified as novel protective factors for juvenile DM, the latter two being shared with adult DM. The peptide binding motif DRB1 9EYSTS13 was a risk factor and DQA1 motifs F25, S26 and 45(V/A) W (R/K)47 were protective. Random Forests classification analysis revealed DRB1*0301 (Relative Importance [RI] 100%) had higher relative importance than DQA1*0301 (RI 57%), DQA1*0501 (RI 42%), or the peptide binding motifs among risk factors for juvenile DM. In a logistic regression model, DRB1*0301 and DQA*0201 were the strongest risk and protective factors, respectively, for juvenile DM. Conclusion DRB1*0301 has higher relative importance than DQA1*0501 as a risk factor for juvenile DM. DQA1*0301 has been identified as a new HLA risk factor for juvenile DM. Three DQA1 alleles are newly identified protective factors for juvenile DM. PMID:17133612

  18. Clinician perceptions of childhood risk factors for future antisocial behavior.

    PubMed

    Koegl, Christopher J; Farrington, David P; Augimeri, Leena K

    2009-07-01

    We asked 176 mental health clinicians to list factors that place a child at risk for engaging in future antisocial behavior. Participants were randomly assigned to do this in relationship to boys and girls. Listed factors were then coded into broad item categories using the Early Assessment Risk Lists (EARL). Of the 1,695 factors listed, 1,476 (87%) could be unambiguously classified under one discrete EARL factor category, providing support for the structure of the tools. Children's own antisocial behavior was seen as the most important factor, followed by experiencing abuse and having antisocial peers. In some cases, participants emphasized different risk factors for boys (e.g., having antisocial attitudes) and girls (e.g., low coping ability). The findings highlight the need to pay attention to client characteristics in developing risk assessment protocols and support continued efforts to bridge the gap between scientific research and clinical practice.

  19. Intensive risk factor control in stroke prevention

    PubMed Central

    2013-01-01

    Stroke prevention is an urgent priority because of the aging of the population and the steep association of age and risk of stroke. Direct costs of stroke are expected to more than double in the US between 2012 and 2030. By getting everything right, patients can reduce the risk of stroke by 80% or more; however, getting everything right is a tall order. Roughly in order of importance, this requires smoking cessation, maintenance of a healthy weight, a Cretan Mediterranean diet, blood pressure control, lipid-lowering drugs, appropriate use of antiplatelet agents and anticoagulants, and appropriate carotid endarterectomy and stenting. A new approach called “treating arteries instead of targeting risk factors” appears promising but requires validation in randomized trials. PMID:24167723

  20. Risk factors for fracture in adult kidney transplant recipients

    PubMed Central

    Naylor, Kyla L; Zou, Guangyong; Leslie, William D; Hodsman, Anthony B; Lam, Ngan N; McArthur, Eric; Fraser, Lisa-Ann; Knoll, Gregory A; Adachi, Jonathan D; Kim, S Joseph; Garg, Amit X

    2016-01-01

    AIM: To determine the general and transplant-specific risk factors for fractures in kidney transplant recipients. METHODS: We conducted a cohort study of all adults who received a kidney-only transplant (n = 2723) in Ontario, Canada between 2002 and 2009. We used multivariable Cox proportional hazards regression to determine general and transplant-specific risk factors for major fractures (proximal humerus, forearm, hip, and clinical vertebral). The final model was established using the backward elimination strategy, selecting risk factors with a P-value ≤ 0.2 and forcing recipient age and sex into the model. We also assessed risk factors for other fracture locations (excluding major fractures, and fractures involving the skull, hands or feet). RESULTS: There were 132 major fractures in the follow-up (8.1 fractures per 1000 person-years). General risk factors associated with a greater risk of major fracture were older recipient age [adjusted hazard ratio (aHR) per 5-year increase 1.11, 95%CI: 1.03-1.19] and female sex (aHR = 1.81, 95%CI: 1.28-2.57). Transplant-specific risk factors associated with a greater risk of fracture included older donor age (5-year increase) (aHR = 1.09, 95%CI: 1.02-1.17) and end-stage renal disease (ESRD) caused by diabetes (aHR = 1.72, 95%CI: 1.09-2.72) or cystic kidney disease (aHR = 1.73, 95%CI: 1.08-2.78) (compared to glomerulonephritis as the reference cause). Risk factors across the two fracture locations were not consistent (major fracture locations vs other). Specifically, general risk factors associated with an increased risk of other fractures were diabetes and a fall with hospitalization prior to transplantation, while length of time on dialysis, and renal vascular disease and other causes of ESRD were the transplant-specific risk factors associated with a greater risk of other fractures. CONCLUSION: Both general and transplant-specific risk factors were associated with a higher risk of fractures in kidney transplant

  1. Dating violence among college students: the risk and protective factors.

    PubMed

    Kaukinen, Catherine

    2014-10-01

    The research review synthesizes the knowledge base on risk and protective factors for dating violence while highlighting its relevance to violence against college women. In particular, the review highlights the personal, family, relationship, and behavioral factors that heighten the risk of dating violence victimization and perpetration while also noting the methodological limitations of the current body of empirical research and identifying directions for future academic work. Researchers have identified the correlation between risky health and behavioral factors and dating violence, most often modeling these as part of the etiology of dating violence among college students. Less often have scholars explored these as co-occurring risk factors. This approach to dating violence may be used to develop meaningful and impactful interventions to reduce the incidence and prevalence of college dating violence while also addressing the other health risk behaviors that impact academic success and place students' well-being at risk.

  2. Other Possible Heart Disease Risk Factors

    MedlinePlus

    ... and anxiety Negative emotions like depression, stress, and anxiety can raise your risk of developing heart disease . Researchers aren't exactly sure why this is. Perhaps these emotions lead to unhealthy ways of coping, such as smoking, drink too much, or eating high-fat foods — ...

  3. Assessment of cardiovascular risk factors in menopausal Argentinian women.

    PubMed

    Etchegoyen, G S; Ortiz, D; Goya, R G; Sala, C; Panzica, E; Sevillano, A; Dron, N

    1995-01-01

    The cardiovascular risk factor profile was assessed in a population sample consisting of 60 nonmenopausal (control) and 100 menopausal women from different cities in Buenos Aires Province, Argentina. Each subject was individually interviewed and asked to complete a specially designed questionnaire aimed at identifying cardiovascular risk factors. A clinical general and gynecological examination including blood pressure and anthropometric measurements as well as a Papanicolaou smear were performed. The most prevalent risk factor in the menopausal group was low physical activity (87% of the subjects), followed by nervous complaints (67%), obesity (64%), familial antecedents of cardiovascular disease (CVD; 38%) and hypertension (33%). Other risk factors assessed showed a level of prevalence below 10%. In the control group, a tobacco smoking habit was the CVD risk factor with the highest prevalence (47%). Nervous complaints also showed a high prevalence (48%). Most menopausal patients (77%) had a cardiovascular risk index (RI) level between 1.5 and 4.0, whereas 17% of these subjects had an RI greater than 4.0 (high-risk patients). The present study reveals that, in the studied community, the menopause is associated with increased levels of both estrogen-dependent and psychosocial risk factors for CVD.

  4. Risk factors for sexually transmitted infections among young adolescents.

    PubMed

    Lepusić, Dubravko; Radović-Radovcić, Sandra

    2013-06-01

    Significant numbers of adolescents are initiating sexual activity at age 17 and younger. Little is known about this younger population of adolescents. This includes risk or protective factors for sexual activity and sexually transmitted infection (STI) acquisition. To safeguard all adolescents from the consequences of risky sexual behaviors, and to insure age appropriate and effective interventions, further study is critical to address risky behaviors specific to early adolescents. This study was a retrospective chart review of 155 sexually active adolescent girls. Students were divided into those who never had a documented STI and those who had 1 or more STIs. Data were collected from a sexual history questionnaire. These data were grouped into risk or protective domains. Domains were made up of 5 items of protective factors, 3 items of peer risks, 2 items of family risks, and 7 items of individual risks. STI outcomes were compared to these characteristics. One hundred fifty-five sexually active adolescents were studied. A univariate and multivariate analysis of risk and protective factors for testing positive for an STI demonstrated that high levels of protective factors reduced the risk of STIs. This suggests that STI prevention programs should focus on increasing protective factors among young adolescents in addition to reducing risk factors.

  5. Knowledge of Stroke Risk Factors among Stroke Survivors in Nigeria

    PubMed Central

    Moses, Taritei

    2016-01-01

    Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke—whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk factor) was assessed using open-ended questionnaire. Data were treated with descriptive statistics and logistic regression analysis. Results. Sixty-nine stroke survivors (male = 72.5%; mean ± SD age = 49.7 ± 10.6 years) participated in the study. Thirty-four (49.4%) participants had knowledge of stroke risk factors. Only educational level was significantly associated with knowledge and participants with tertiary educational qualification were about 48 times (odds ratio = 48.5; CI = 7.6–309.8; P < 0.0001) more likely to be knowledgeable than those with no education. Conclusion. Less than half of the participants had knowledge of stroke risk factors. Participants with tertiary education were significantly more knowledgeable than those with lower educational qualifications. Effective means of educating stroke survivors on stroke risk factors should be identified and adopted. PMID:27882262

  6. Risk factors and their identification. Third Part: Examples.

    PubMed

    Balkau, B; Eschwege, E

    1995-10-01

    This is the final of a series of three articles in Diabete & Metabolisme which reviews the identification of risk factors of a disease, here: diabetes or complications of diabetes. In the first of the series [1], we gave the definition of a risk factor, along with measures of its force-relative risk and odds ratio, followed by the epidemiological definitions of the diseases: diabetes, coronary heart disease and hypertension. Risk factors were further discussed and we completed the discussion by some observations on the bias which can arise from a study or from its analysis, which can lead the researcher to the wrong conclusion. The three types of epidemiological studies which are used to determine whether factors are associated with a disease: observational or cross-sectional studies, cohort studies and case-cohort studies are described in the second of the series [2]. Examples were provided of each of these study types and their advantages and disadvantages were discussed. This final paper provides some examples of the study types and the identification of risk factors from the literature. The first examples involve diabetes and pancreatic cancer, the second birth weight and non-insulin dependent diabetes. Having found an association between a risk factor and a disease, we then discuss whether it can be considered to be a risk factor, and if so and whether it is likely to be a cause of the disease.

  7. Modifiable lifestyle risk factors for Alzheimer's disease.

    PubMed

    Flicker, Leon

    2010-01-01

    There is increasing evidence that some lifestyle factors are linked to the development of Alzheimer's disease. Many of these are potentially modifiable and include smoking, physical activity, education, social engagement, cognitive stimulation, and diet. Modification of most of these factors has other health advantages, increasing the potential benefits of modifying the individual's lifestyle. Unfortunately, most of the current evidence is based on observational data, and where human trials have been performed they have used surrogate outcomes rather than the development of Alzheimer's disease. For many of these modifiable lifestyle factors, such trials may never be performed, and an individual's choice may need to be based on the available evidence.

  8. Foot blister risk factors in an ROTC summer camp population.

    PubMed

    Patterson, H S; Woolley, T W; Lednar, W M

    1994-02-01

    Data that establish risk factors for foot blister morbidity among ROTC cadets at summer camp are presented. The subjective blister attack rate was 42.1 per 100 cadets. Women had a relative risk of 1.6 that of men (p < 0.001). Cadets with a history of blisters in the 2 years before camp had an increased relative risk of blister formation. Cadets who reported wearing their boots less than 20 hours per week during the 2 weeks immediately before camp had elevated risk. Other factors are examined. These data suggest that the foot must become conditioned to its footwear to prevent blister formation.

  9. Risk Factors for Hispanic Male Intimate Partner Violence Perpetration.

    PubMed

    Mancera, Bibiana M; Dorgo, Sandor; Provencio-Vasquez, Elias

    2015-04-19

    The literature review analyzed 24 studies that explored male intimate partner violence (IPV) perpetration risk factors among men, in particular Hispanics, using the socioecological model framework composed of four socioecological levels for violence prevention. Six databases were reviewed within the EBSCO search engine for articles published from 2000 to 2014. Articles reviewed were specific to risk factors for IPV perpetration among Hispanic men, focusing particularly on Mexican American men. Many key factors have previously been associated with risk for IPV perpetration; however, certain determinants are unique to Hispanics such as acculturation, acculturation stress, and delineated gender roles that include Machismo and Marianismo. These risk factors should be incorporated in future targeted prevention strategies and efforts and capitalize on the positive aspects of each to serve as protective factors.

  10. Postoperative trunk shift in Lenke 1 and 2 curves: how common is it? and analysis of risk factors.

    PubMed

    Trobisch, Per D; Samdani, Amer F; Pahys, Joshua M; Cahill, Patrick J

    2011-07-01

    The goal of surgical treatment for adolescent idiopathic scoliosis (AIS) is to achieve a solid fusion in a balanced spine. While many previous studies analyzed coronal balance, there is a paucity of studies that comment on postoperative trunk shift, which has shown to have impact on clinical outcome. The purpose of this retrospective, multicenter data analysis was to analyze the incidence of postoperative trunk shift in patients with surgical treatment for AIS. We conducted a retrospective, multicenter data analysis of 1,555 patients with AIS. Patients with a Lenke type 1 or 2 curve pattern and a minimum follow-up of 24 months after surgery were included. A >2 cm deviation of the trunk in relation to the pelvis was considered positive trunk shift. A subanalysis was performed to identify potential risk factors for trunk shift. 273 patients meeting the inclusion criteria were analyzed. While the preoperative prevalence of trunk shift was surgically reduced from 29.3 to 13.6%, 24 patients (8.8%) with postoperative trunk shift had not had preoperative trunk shift, and the trunk shift was considered iatrogenic. Undercorrection of the lumbar curve was identified as potential risk factor, whereas thoracic correction, coronal balance, angulation and translation of the lowest instrumented vertebra did not seem to influence postoperative trunk shift. Iatrogenic postoperative trunk shift has an incidence of 8.8% in the surgical treatment of AIS.

  11. Analysis of Risk Factors for Cerebral Microinfarcts after Carotid Endarterectomy and the Relevance of Delayed Cerebral Infarction

    PubMed Central

    Gwon, Jun Gyo; Cho, Yong-Pil; Kang, Dong-Wha; Han, Youngjin; Noh, Minsu

    2017-01-01

    Background and Purpose Carotid endarterectomy (CEA) is performed to prevent cerebral infarction, but a common side effect is cerebral microinfarcts. This study aimed to identify the variables related to the production of microinfarcts during CEA as well as determine their association with delayed postoperative infarction. Methods This was a retrospective review of data collected prospectively from 548 patients who underwent CEA. The clinical characteristics of the patients and the incidence rates and causes of microinfarcts were analyzed. Microinfarcts were diagnosed by diffusion-weighted magnetic resonance imaging. The presence of delayed postoperative infarction was compared between microinfarct-positive and microinfarct-negative groups. Results In total, 76 (13.86%) patients were diagnosed with microinfarcts. Preoperative neurological symptoms were significantly related to the incidence of microinfarcts [odds ratio (OR)=2.93, 95% confidence interval (CI)=1.72–5.00, p<0.001]. Shunt insertion during CEA was the only significant procedure-related risk factor (OR=1.42, 95% CI=1.00–2.19, p=0.05). The presence of microinfarcts did not significantly increase the incidence of delayed postoperative infarction (p=0.204). Conclusions In the present study, risk factors for microinfarcts after CEA included preoperative symptoms and intraoperative shunt insertion. Microinfarcts were not associated with delayed postoperative infarction. PMID:27730766

  12. Critical factors and paths influencing construction workers' safety risk tolerances.

    PubMed

    Wang, Jiayuan; Zou, Patrick X W; Li, Penny P

    2016-08-01

    While workers' safety risk tolerances have been regarded as a main reason for their unsafe behaviors, little is known about why different people have different risk tolerances even when confronting the same situation. The aim of this research is to identify the critical factors and paths that influence workers' safety risk tolerance and to explore how they contribute to accident causal model from a system thinking perceptive. A number of methods were carried out to analyze the data collected through interviews and questionnaire surveys. In the first and second steps of the research, factor identification, factor ranking and factor analysis were carried out, and the results show that workers' safety risk tolerance can be influenced by four groups of factors, namely: (1) personal subjective perception; (2) work knowledge and experiences; (3) work characteristics; and (4) safety management. In the third step of the research, hypothetical influencing path model was developed and tested by using structural equation modeling (SEM). It is found that the effects of external factors (safety management and work characteristics) on risk tolerance are larger than that of internal factors (personal subjective perception and work knowledge & experiences). Specifically, safety management contributes the most to workers' safety risk tolerance through its direct effect and indirect effect; while personal subjective perception comes the second and can act as an intermedia for work characteristics. This research provides an in-depth insight of workers' unsafe behaviors by depicting the contributing factors as shown in the accident causal model developed in this research.

  13. Risk factors for poor outcomes in patients with open-globe injuries

    PubMed Central

    Page, Rita D; Gupta, Sumeet K; Jenkins, Thomas L; Karcioglu, Zeynel A

    2016-01-01

    Purpose The aim of this study was to identify the risk factors that are predictive of poor outcomes in penetrating globe trauma. Patients and methods This retrospective case series evaluated 103 eyes that had been surgically treated for an open-globe injury from 2007 to 2010 at the eye clinic of the University of Virginia. A total of 64 eyes with complete medical records and at least 6 months of follow-up were included in the study. Four risk factors (preoperative best-corrected visual acuity [pre-op BCVA], ocular trauma score [OTS], zone of injury [ZOI], and time lapse [TL] between injury and primary repair) and three outcomes (final BCVA, monthly rate of additional surgeries [MRAS], and enucleation) were identified for analysis. Results Pre-op BCVA was positively associated with MRAS, final BCVA, and enucleation. Calculated OTS was negatively associated with the outcome variables. No association was found between TL and ZOI with the outcome variables. Further, age and predictor variable-adjusted analyses showed pre-op BCVA to be independently positively associated with MRAS (P=0.008) and with final BCVA (P<0.001), while the calculated OTS was independently negatively associated with final BCVA (P<0.001), but not uniquely associated with MRAS (P=0.530). Conclusion Pre-op BCVA and OTS are best correlated with prognosis in open-globe injuries. However, no conventional features reliably predict the outcome of traumatized eyes. PMID:27536059

  14. Risk factors of acute kidney injury after orthotopic liver transplantation in China

    PubMed Central

    Zongyi, Yin; Baifeng, Li; Funian, Zou; Hao, Li; Xin, Wang

    2017-01-01

    In this study, we determined the risk factors for acute kidney injury (AKI) following orthotopic liver transplantation (OLT) in China. We collected 5074 donation after cardiac death (DCD) OLT recipients who underwent surgery between January 1, 2010, and December 31, 2015, in 86 academic hospitals or transplant centers in China. Univariate and multivariate analyses were used to investigate the criticality of donor, graft, or recipient variables in the development of post-OLT AKI. In all, 4482 patients were included (median age, 49.31 years). Post-OLT AKI occurred in 3.97% patients, and 73.6% of all OLT patients were male. The 1- and 5-year cumulative survival rates (CSRs) of the AKI group were 33.95% and 25.24%, respectively, compared with 86.34% and 70.05%, respectively, of the non-AKI group (P < 0.001). The independent risk factors for post-OLT AKI were blood loss, cold ischemia time, warm ischemia time, preoperative serum creatinine, the treatment period with dopamine, overexposure to calcineurin inhibitor, and combined mycophenolate mofetil use (P < 0.05). These had a high prediction accuracy for post-OLT AKI (area under the curve [AUC] = 0.740). PMID:28134286

  15. Suggested connections between risk factors of intracranial aneurysms: a review.

    PubMed

    Cebral, Juan R; Raschi, Marcelo

    2013-07-01

    The purpose of this article is to review studies of aneurysm risk factors and the suggested hypotheses that connect the different risk factors and the underlying mechanisms governing the aneurysm natural history. The result of this work suggests that at the center of aneurysm evolution there is a cycle of wall degeneration and weakening in response to changing hemodynamic loading and biomechanic stress. This progressive wall degradation drives the geometrical evolution of the aneurysm until it stabilizes or ruptures. Risk factors such as location, genetics, smoking, co-morbidities, and hypertension seem to affect different components of this cycle. However, details of these interactions or their relative importance are still not clearly understood.

  16. Risk factors for developing hepatocellular carcinoma in Egypt.

    PubMed

    Omar, Ashraf; Abou-Alfa, Ghassan K; Khairy, Ahmed; Omar, Heba

    2013-12-01

    Hepatocellular carcinoma (HCC) is a common disorder worldwide and ranks 2nd and 6th most common cancer among men and women in Egypt. HCC has a rising incidence in Egypt mostly due to high prevalence of viral hepatitis and its complications. Proper management requires the interaction of multidisciplinary HCC clinic to choose the most appropriate plan. The different modalities of treatment include resection (surgery or transplantation), local ablation, chemoembolization, radioembolization and molecular targeted therapies. This paper summarizes both the environmental and host related risk factors of HCC in Egypt including well-established risk factors such as hepatitis virus infection, aflatoxin, as well as possible risk factors.

  17. Capsaicinoids Modulating Cardiometabolic Syndrome Risk Factors: Current Perspectives

    PubMed Central

    2016-01-01

    Capsaicinoids are bioactive nutrients present within red hot peppers reported to cut ad libitum food intake, to increase energy expenditure (thermogenesis) and lipolysis, and to result in weight loss over time. In addition it has shown more benefits such as improvement in reducing oxidative stress and inflammation, improving vascular health, improving endothelial function, lowering blood pressure, reducing endothelial cytokines, cholesterol lowering effects, reducing blood glucose, improving insulin sensitivity, and reducing inflammatory risk factors. All these beneficial effects together help to modulate cardiometabolic syndrome risk factors. The early identification of cardiometabolic risk factors can help try to prevent obesity, hypertension, diabetes, and cardiovascular disease. PMID:27313880

  18. Viral factors in influenza pandemic risk assessment

    PubMed Central

    Lipsitch, Marc; Barclay, Wendy; Raman, Rahul; Russell, Charles J; Belser, Jessica A; Cobey, Sarah; Kasson, Peter M; Lloyd-Smith, James O; Maurer-Stroh, Sebastian; Riley, Steven; Beauchemin, Catherine AA; Bedford, Trevor; Friedrich, Thomas C; Handel, Andreas; Herfst, Sander; Murcia, Pablo R; Roche, Benjamin; Wilke, Claus O; Russell, Colin A

    2016-01-01

    The threat of an influenza A virus pandemic stems from continual virus spillovers from reservoir species, a tiny fraction of which spark sustained transmission in humans. To date, no pandemic emergence of a new influenza strain has been preceded by detection of a closely related precursor in an animal or human. Nonetheless, influenza surveillance efforts are expanding, prompting a need for tools to assess the pandemic risk posed by a detected virus. The goal would be to use genetic sequence and/or biological assays of viral traits to identify those non-human influenza viruses with the greatest risk of evolving into pandemic threats, and/or to understand drivers of such evolution, to prioritize pandemic prevention or response measures. We describe such efforts, identify progress and ongoing challenges, and discuss three specific traits of influenza viruses (hemagglutinin receptor binding specificity, hemagglutinin pH of activation, and polymerase complex efficiency) that contribute to pandemic risk. DOI: http://dx.doi.org/10.7554/eLife.18491.001 PMID:27834632

  19. Incidence of underlying biliary neoplasm in patients after major hepatectomy for preoperative benign hepatolithiasis

    PubMed Central

    Park, Hyeong Min; Cho, Chol Kyoon; Koh, Yang Seok; Kim, Hee Joon; Park, Eun Kyu

    2016-01-01

    Backgrounds/Aims Despite hepatolithiasis being a risk factor for biliary neoplasm including cholangiocarcinoma, the incidence of underlying biliary neoplasm is unknown in patients with preoperative benign hepatolithiasis. The aim of this study was to evaluate the incidence of underlying biliary neoplasm in patients who underwent major hepatectomy for preoperative benign hepatolithiasis. Methods Between March 2005 and December 2015, 73 patients who underwent major hepatectomy for preoperative benign hepatolithiasis were enrolled in this study. The incidence and pathological differentiation of concomitant biliary neoplasm were retrospectively determined by review of medical records. Postoperative complications after major hepatectomy were evaluated. Results Concomitant biliary neoplasm was pathologically confirmed in 20 patients (27.4%). Biliary intraepithelial neoplasia (BIN) was detected in 12 patients (16.4%), and 1 patient (1.4%) had intraductal papillary mucinous neoplasm (IPMN), as the premalignant lesion. Cholangiocarcinoma was pathologically confirmed in 7 patients (9.6%). Preoperative imaging of the 73 patients revealed biliary stricture at the first branch of bile duct in 31 patients (42.5%), and at the second branch of bile duct in 39 patients (53.4%). Postoperative complications developed in 14 patients (19.1%). Almost all patients recovered from complications, including intra-abdominal abscess (9.6%), bile leakage (4.1%), pleural effusion (2.7%), and wound infection (1.4%). Only 1 patient (1.4%) died from aspiration pneumonia. Conclusions The incidence of underlying biliary neoplasm was not negligible in the patients with hepatolithiasis, despite meticulous preoperative evaluations. PMID:28261696

  20. A Bayesian Approach to Identifying New Risk Factors for Dementia

    PubMed Central

    Wen, Yen-Hsia; Wu, Shihn-Sheng; Lin, Chun-Hung Richard; Tsai, Jui-Hsiu; Yang, Pinchen; Chang, Yang-Pei; Tseng, Kuan-Hua

    2016-01-01

    Abstract Dementia is one of the most disabling and burdensome health conditions worldwide. In this study, we identified new potential risk factors for dementia from nationwide longitudinal population-based data by using Bayesian statistics. We first tested the consistency of the results obtained using Bayesian statistics with those obtained using classical frequentist probability for 4 recognized risk factors for dementia, namely severe head injury, depression, diabetes mellitus, and vascular diseases. Then, we used Bayesian statistics to verify 2 new potential risk factors for dementia, namely hearing loss and senile cataract, determined from the Taiwan's National Health Insurance Research Database. We included a total of 6546 (6.0%) patients diagnosed with dementia. We observed older age, female sex, and lower income as independent risk factors for dementia. Moreover, we verified the 4 recognized risk factors for dementia in the older Taiwanese population; their odds ratios (ORs) ranged from 3.469 to 1.207. Furthermore, we observed that hearing loss (OR = 1.577) and senile cataract (OR = 1.549) were associated with an increased risk of dementia. We found that the results obtained using Bayesian statistics for assessing risk factors for dementia, such as head injury, depression, DM, and vascular diseases, were consistent with those obtained using classical frequentist probability. Moreover, hearing loss and senile cataract were found to be potential risk factors for dementia in the older Taiwanese population. Bayesian statistics could help clinicians explore other potential risk factors for dementia and for developing appropriate treatment strategies for these patients. PMID:27227925

  1. Breast cancer risk assessment using genetic variants and risk factors in a Singapore Chinese population

    PubMed Central

    2014-01-01

    Introduction Genetic variants for breast cancer risk identified in genome-wide association studies (GWAS) in Western populations require further testing in Asian populations. A risk assessment model incorporating both validated genetic variants and established risk factors may improve its performance in risk prediction of Asian women. Methods A nested case-control study of female breast cancer (411 cases and 1,212 controls) within the Singapore Chinese Health Study was conducted to investigate the effects of 51 genetic variants identified in previous GWAS on breast cancer risk. The independent effect of these genetic variants was assessed by creating a summed genetic risk score (GRS) after adjustment for body mass index and the Gail model risk factors for breast cancer. Results The GRS was an independent predictor of breast cancer risk in Chinese women. The multivariate-adjusted odds ratios (95% confidence intervals) of breast cancer for the second, third, and fourth quartiles of the GRS were 1.26 (0.90 to 1.76), 1.47 (1.06 to 2.04) and 1.75 (1.27 to 2.41) respectively (P for trend <0.001). In addition to established risk factors, the GRS improved the classification of 6.2% of women for their absolute risk of breast cancer in the next five years. Conclusions Genetic variants on top of conventional risk factors can improve the risk prediction of breast cancer in Chinese women. PMID:24941967

  2. A Systematic Review of Risk Factors for Intimate Partner Violence

    PubMed Central

    Capaldi, Deborah M.; Knoble, Naomi B.; Shortt, Joann Wu; Kim, Hyoun K.

    2012-01-01

    A systematic review of risk factors for intimate partner violence was conducted. Inclusion criteria included publication in a peer-reviewed journal, a representative community sample or a clinical sample with a control-group comparison, a response rate of at least 50%, use of a physical or sexual violence outcome measure, and control of confounding factors in the analyses. A total of 228 articles were included (170 articles with adult and 58 with adolescent samples). Organized by levels of a dynamic developmental systems perspective, risk factors included: (a) contextual characteristics of partners (demographic, neighborhood, community and school factors), (b) developmental characteristics and behaviors of the partners (e.g., family, peer, psychological/behavioral, and cognitive factors), and (c) relationship influences and interactional patterns. Comparisons to a prior review highlight developments in the field in the past 10 years. Recommendations for intervention and policy along with future directions for intimate partner violence (IPV) risk factor research are presented. PMID:22754606

  3. Risk factors for small for gestational age infants.

    PubMed

    McCowan, Lesley; Horgan, Richard P

    2009-12-01

    There are many established risk factors for babies who are small for gestational age (SGA) by population birth weight centiles (usually defined as <10th centile). The confirmed maternal risk factors include short stature, low weight, Indian or Asian ethnicity, nulliparity, mother born SGA, cigarette smoking and cocaine use. Maternal medical history of: chronic hypertension, renal disease, anti-phospholipid syndrome and malaria are associated with increased SGA. Risk factors developing in pregnancy include heavy bleeding in early pregnancy, placental abruption, pre-eclampsia and gestational hypertension. A short or very long inter-pregnancy interval, previous SGA infant or previous stillbirth are also risk factors. Paternal factors including changed paternity, short stature and father born SGA also contribute. Factors associated with reduced risk of SGA or increased birth weight include high maternal milk consumption and high intakes of green leafy vegetables and fruit. Future studies need to investigate risk factors for babies SGA by customised centiles as these babies have greater morbidity and mortality than babies defined as SGA by population centiles.

  4. Strongyloides stercoralis: Global Distribution and Risk Factors

    PubMed Central

    Schär, Fabian; Trostdorf, Ulf; Giardina, Federica; Khieu, Virak; Muth, Sinuon; Marti, Hanspeter; Vounatsou, Penelope; Odermatt, Peter

    2013-01-01

    Background The soil-transmitted threadworm, Strongyloides stercoralis, is one of the most neglected among the so-called neglected tropical diseases (NTDs). We reviewed studies of the last 20 years on S. stercoralis's global prevalence in general populations and risk groups. Methods/Principal Findings A literature search was performed in PubMed for articles published between January 1989 and October 2011. Articles presenting information on infection prevalence were included. A Bayesian meta-analysis was carried out to obtain country-specific prevalence estimates and to compare disease odds ratios in different risk groups taking into account the sensitivities of the diagnostic methods applied. A total of 354 studies from 78 countries were included for the prevalence calculations, 194 (62.4%) were community-based studies, 121 (34.2%) were hospital-based studies and 39 (11.0%) were studies on refugees and immigrants. World maps with country data are provided. In numerous African, Asian and South-American resource-poor countries, information on S. stercoralis is lacking. The meta-analysis showed an association between HIV-infection/alcoholism and S. stercoralis infection (OR: 2.17 BCI: 1.18–4.01; OR: 6.69; BCI: 1.47–33.8), respectively. Conclusions Our findings show high infection prevalence rates in the general population in selected countries and geographical regions. S. stercoralis infection is prominent in several risk groups. Adequate information on the prevalence is still lacking from many countries. However, current information underscore that S. stercoralis must not be neglected. Further assessments in socio-economic and ecological settings are needed and integration into global helminth control is warranted. PMID:23875033

  5. Occupational risk factors for developing tuberculosis.

    PubMed

    Rosenman, K D; Hall, N

    1996-08-01

    We sought to assess whether there is an increased risk of tuberculosis among individuals who work in certain industries or occupations. A case-referent study of 149 male tuberculosis (TB) patients reported to the New Jersey Health Department from 1985 to 1987 and 290 referents was performed. Standardized interviews were conducted via the telephone or in person. Increased risk of TB was highest in heavy drinkers (OR = 3.33, 95% CL 1.99-5.59) and those who had a history of living with someone who had a history of TB (OR = 10.92, 95% CL 4.92-24.22). Occupations and industries associated with elevated risk for TB included: four silica-using industries-quarrying (OR = 3.96, 95% CL 0.36-44.02), pottery and related products (OR = 1.99, 95% CL 0.49-8.06), nonmetallic mineral and stone products (OR = 4.00, 95% CL 0.72-22.10), and ship and boat building and repair (OR = 1.84, 95% CL 0.76-4.43); hospitals (OR = 2.10, 95% CL 1.08-4.10); light truck drivers (OR = 2.49, 95% CL 1.30-4.77); agriculture (OR = 2.31, 95% CL 0.82-6.50); eating and drinking establishments (OR = 2.83, 95% CL 1.11-7.20); and janitors/cleaners (OR = 2.00, 95% CL 0.63-6.31). Except for janitors/cleaners, these elevated odds ratios remained for the above occupations/industries after controlling for alcohol or a history of having lived with someone with tuberculosis. Limitations of the study include a poor response rate (38%) and the exclusion of women from the study.

  6. Assessing absolute changes in breast cancer risk due to modifiable risk factors.

    PubMed

    Quante, Anne S; Herz, Julia; Whittemore, Alice S; Fischer, Christine; Strauch, Konstantin; Terry, Mary Beth

    2015-07-01

    Clinical risk assessment involves absolute risk measures, but information on modifying risk and preventing cancer is often communicated in relative terms. To illustrate the potential impact of risk factor modification in model-based risk assessment, we evaluated the performance of the IBIS Breast Cancer Risk Evaluation Tool, with and without current body mass index (BMI), for predicting future breast cancer occurrence in a prospective cohort of 665 postmenopausal women. Overall, IBIS's accuracy (overall agreement between observed and assigned risks) and discrimination (AUC concordance between assigned risks and outcomes) were similar with and without the BMI information. However, in women with BMI > 25 kg/m(2), adding BMI information improved discrimination (AUC = 63.9 % and 61.4 % with and without BMI, P < 0.001). The model-assigned 10-year risk difference for a woman with high (27 kg/m(2)) versus low (21 kg/m(2)) BMI was only 0.3 % for a woman with neither affected first-degree relatives nor BRCA1 mutation, compared to 4.5 % for a mutation carrier with three such relatives. This contrast illustrates the value of using information on modifiable risk factors in risk assessment and in sharing information with patients of their absolute risks with and without modifiable risk factors.

  7. Pre-operative respiratory evaluation and management of patients for upper abdominal surgery.

    PubMed Central

    Davies, J. M.

    1991-01-01

    Patients presenting for surgery, be it on an elective or emergency basis, do so in the hope that the anesthetic will be without risk. Yet complications which arise are not always due to anesthesia. More often, the surgical process and factors intrinsic to the patient are major determinants of outcome. Pre-operative assessment allows review of the patient and the proposed surgery, and formation of a plan of management for the pre-, intra-, and post-operative anesthetic care. This paper provides an overview of the pre-operative assessment and management of patients who are to undergo upper abdominal surgery, with the aim of minimizing their risk of post-operative pulmonary complications. In particular, factors which contribute to the development of post-operative respiratory problems are described. PMID:1814053

  8. Perineal skin injury: extrinsic environmental risk factors.

    PubMed

    Faria, D T; Shwayder, T; Krull, E A

    1996-08-01

    Little research has been performed to evaluate factors that may exacerbate perineal skin injury in the adult population. But extensive research has been done and knowledge has been gained from studies with diaper dermatitis in infants. Our objectives in writing this article are to define the anatomical area affected, the terms used, and to review the available literature for diaper dermatitis in infants, elucidating the similarities and differences between diaper dermatitis in infants and perineal dermatitis in adults. The six extrinsic environmental factors that have been identified and extensively studied in diaper dermatitis are skin wetness, urine, ammonia, feces, local skin pH and microorganisms. Although the complex interactions of the six factors are still not totally defined, we do know that to prevent perineal skin injury, it is helpful to prevent excessive skin hydration, minimize the interaction of urine and feces, minimize local microorganisms, and maintain skin near its physiologic pH. In general, the six extrinsic factors can be extrapolated and applied to the care of adults. Further research in adult fecal enzymes and pH is still necessary.

  9. Quantifying Cardiometabolic Risk Using Modifiable Non–Self-Reported Risk Factors

    PubMed Central

    Marino, Miguel; Li, Yi; Pencina, Michael J.; D’Agostino, Ralph B.; Berkman, Lisa F.; Buxton, Orfeu M.

    2014-01-01

    Background Sensitive general cardiometabolic risk assessment tools of modifiable risk factors would be helpful and practical in a range of primary prevention interventions or for preventive health maintenance. Purpose To develop and validate a cumulative general cardiometabolic risk score that focuses on non–self-reported modifiable risk factors such as glycosylated hemoglobin (HbA1c) and BMI so as to be sensitive to small changes across a span of major modifiable risk factors, which may not individually cross clinical cut off points for risk categories. Methods We prospectively followed 2,359 cardiovascular disease (CVD)-free subjects from the Framingham offspring cohort over a 14–year follow-up. Baseline (fifth offspring examination cycle) included HbA1c and cholesterol measurements. Gender–specific Cox proportional hazards models were considered to evaluate the effects of non–self-reported modifiable risk factors (blood pressure, total cholesterol, high–density lipoprotein cholesterol, smoking, BMI, and HbA1c) on general CVD risk. We constructed 10–year general cardiometabolic risk score functions and evaluated its predictive performance in 2012–2013. Results HbA1c was significantly related to general CVD risk. The proposed cardiometabolic general CVD risk model showed good predictive performance as determined by cross-validated discrimination (male C-index=0.703, 95% CI=0.668, 0.734; female C-index=0.762, 95% CI=0.726, 0.801) and calibration (lack-of-fit χ2=9.05 [p=0.338] and 12.54 [p=0.128] for men and women, respectively). Conclusions This study presents a risk factor algorithm that provides a convenient and informative way to quantify cardiometabolic risk based on modifiable risk factors that can motivate an individual’s commitment to prevention and intervention. PMID:24951039

  10. Psychosocial Risk Factors Contributing to Adolescent Suicidal Ideation.

    ERIC Educational Resources Information Center

    Harter, Susan; Marold, Donna B.

    1994-01-01

    Presents evidence for a model of risk factors, including depression, hopelessness, lack of social support, and negative self-evaluations, that contribute to suicidal ideation among normative and clinically depressed adolescents. (HTH)

  11. NIH study confirms risk factors for male breast cancer

    Cancer.gov

    Pooled data from studies of about 2,400 men with breast cancer and 52,000 men without breast cancer confirmed that risk factors for male breast cancer include obesity, a rare genetic condition called Klinefelter syndrome, and gynecomastia.

  12. Gestational Diabetes a Risk Factor for Postpartum Depression

    MedlinePlus

    ... html Gestational Diabetes a Risk Factor for Postpartum Depression: Study It found chances increased even more if woman had suffered an earlier bout of depression To use the sharing features on this page, ...

  13. What Are the Risk Factors for Lung Carcinoid Tumors?

    MedlinePlus

    ... others. Risk factors for lung carcinoid tumors include: Gender Lung carcinoids occur more often in women than ... would like to unsubscribe/opt out from our communications, please follow this link: http://www.cancer.org/ ...

  14. Risk factors for urosepsis following percutaneous nephrolithotomy: role of 1 week of nitrofurantoin in reducing the risk of urosepsis.

    PubMed

    Kumar, Santosh; Bag, Sanand; Ganesamoni, Raguram; Mandal, Arup K; Taneja, Neelam; Singh, Shrawan Kumar

    2012-02-01

    The purpose of this study was to analyze the various risk factors for urosepsis following percutaneous nephrolithotomy (PNL) and to study the role of 1-week nitrofurantoin before PNL in reducing the risk of urosepsis. All patients undergoing PNL from April 2007 to November 2008 were prospectively included and grouped into four cohorts according to the following inclusion criteria: group A: stones ≤ 2.5 cm, no hydronephrosis, sterile urine; group B: diabetes mellitus, serum creatinine > 2 mg/dl, positive urine culture, stag horn stones, presence of nephrostomy or simultaneous bilateral PNL; group C: stones ≥ 2.5 cm and/or hydronephrosis, sterile urine; group D: similar to group C, but received nitrofurantoin 100 mg bid for 7 days before operation. Preoperative urine culture, intraoperative renal pelvic urine culture and stone cultures were obtained. Fever > 380°C and leukocyte counts > 12,000 were considered as systemic inflammatory response syndrome (SIRS). Endotoxemia was assessed in serum samples. A total of 205 patients were included in the study and grouped into four cohorts as group A (n = 50), group B (n = 54), group C (n = 53) and group D (n = 48). Overall 23% patients had positive renal pelvic urine and/or stone culture, 25% had endotoxemia and 34% developed SIRS. Female gender, chronic renal failure, anemia, hydronephrosis, stones larger than 2.5 cm and prolonged surgery were found to be risk factors associated with urosepsis. Nitrofurantoin prophylaxis resulted in decreased culture positivity (30.2 vs. 8.3%, odds ratio 0.36, p = 0.087), endotoxemia (41.9 vs. 17.5%, odds ratio 0.22, p = 0.001) and SIRS (49 vs. 19%, odds ratio 0.31, p = 0.01). In conclusion, female gender, chronic renal failure, anemia, hydronephrosis, stones larger than 2.5 cm and prolonged surgery were risk factors for urosepsis. Nitrofurantoin is beneficial in the prevention of endotoxemia and urosepsis especially in patients with larger stones and hydronephrosis.

  15. Revised ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management. Implications for preoperative clinical evaluation.

    PubMed

    Guarracino, F; Baldassarri, R; Priebe, H J

    2015-02-01

    Each year, an increasing number of elderly patients with cardiovascular disease undergoing non-cardiac surgery require careful perioperative management to minimize the perioperative risk. Perioperative cardiovascular complications are the strongest predictors of morbidity and mortality after major non-cardiac surgery. A Joint Task Force of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) has recently published revised Guidelines on the perioperative cardiovascular management of patients scheduled to undergo non-cardiac surgery, which represent the official position of the ESC and ESA on various aspects of perioperative cardiac care. According to the Guidelines effective perioperative cardiac management includes preoperative risk stratification based on preoperative assessment of functional capacity, type of surgery, cardiac risk factors, and cardiovascular function. The ESC/ESA Guidelines discourage indiscriminate routine preoperative cardiac testing, because it is time- and cost-consuming, resource-limiting, and does not improve perioperative outcome. They rather emphasize the importance of individualized preoperative cardiac evaluation and the cooperation between anesthesiologists and cardiologists. We summarize the relevant changes of the 2014 Guidelines as compared to the previous ones, with particular emphasis on preoperative cardiac testing.

  16. Risk Factors for Violence and Relational Aggression in Adolescence

    ERIC Educational Resources Information Center

    Herrenkohl, Todd I.; McMorris, Barbara J.; Catalano, Richard F.; Abbott, Robert D.; Hemphill, Sheryl A.; Toumbourou, John W.

    2007-01-01

    Analyses examined risk factors for seventh- and ninth-grade youth categorized as nonoffenders, physically violent, relationally aggressive, and both violent and relationally aggressive. Bivariate and multivariate results showed that relationally aggressive youth were elevated on most risks above levels for nonoffenders but lower than those for…

  17. Preterm Birth: An Overview of Risk Factors and Obstetrical Management

    ERIC Educational Resources Information Center

    Stewart, Amanda; Graham, Ernest

    2010-01-01

    Preterm birth is the leading cause of neonatal mortality and a major public health concern. Risk factors for preterm birth include a history of preterm birth, short cervix, infection, short interpregnancy interval, smoking, and African-American race. The use of progesterone therapy to treat mothers at risk for preterm delivery is becoming more…

  18. Individual-Level Risk Factors of Incarcerated Youth

    ERIC Educational Resources Information Center

    Pyle, Nicole; Flower, Andrea; Fall, Anna Mari; Williams, Jacob

    2016-01-01

    This systematic review sought to understand the individual characteristics of incarcerated youth within the major risk factor domains identified by the U.S. Office of Juvenile Justice and Delinquency Prevention (OJJDP). A comprehensive search of the literature from 1979 to 2013 identified 85 articles of individual-level risk characteristics that…

  19. Cardiovascular Disease Risk Factors among Emerging Adults in College

    ERIC Educational Resources Information Center

    Abshire, Demetrius Alexander

    2014-01-01

    The purpose of this dissertation was to examine factors associated with cardiovascular disease (CVD) risk among emerging adults in college aged 18-25 years. CVD risks that develop during this period often persist into adulthood making it an ideal time to target CVD prevention. The specific aims of this dissertation were to 1) explore perceptions…

  20. Integratively Assessing Risk and Protective Factors for Adolescent Suicide

    ERIC Educational Resources Information Center

    Gutierrez, Peter M.

    2006-01-01

    This article briefly reviews key issues in adolescent suicide risk assessment and proposes that assessing risk and protective factors in combination has the best probability of informing the field's understanding of this complex problem. Several newer measures are described along with summaries of their psychometric properties. A recommended…

  1. Identification of Early Risk Factors for Learning Disabilities.

    ERIC Educational Resources Information Center

    Stanton-Chapman, Tina L.; Chapman, Derek A.; Scott, Keith G.

    2001-01-01

    A study involving 244,610 children (ages 6-8) investigated birth risk factors for learning disabilities. Very low birth weight, low 5- minute Apgar score, and low maternal education were associated with highest individual-level risk. Low maternal education, late or no prenatal care, and tobacco use were associated with highest population-level…

  2. Identification of Early Risk Factors for Language Impairment.

    ERIC Educational Resources Information Center

    Stanton-Chapman, Tina L.; Chapman, Derek A.; Bainbridge, Nicolette L.; Scott, Keith G.

    2002-01-01

    This study investigated birth risk factors for school-identified specific language impairment among 244,619 students. Very low birth weight, low 5-min Apgar scores, late or no prenatal care, high birth order and low maternal education were associated with high individual-level risk, and low maternal education and unmarried mothers were associated…

  3. Familial and Temperamental Risk Factors for Social Anxiety Disorder

    ERIC Educational Resources Information Center

    Hirshfeld-Becker, Dina R.

    2010-01-01

    Social anxiety disorder (SAD) is a common disorder that can lead to significant impairment. In this chapter, the author provides background on the disorder and reviews hypothesized familial and temperamental risk factors. In particular, it highlights the Massachusetts General Hospital (MGH) Longitudinal Study of Children at Risk for Anxiety, now…

  4. Hyperuricemia as a risk factor for cardiovascular disease: clinical review.

    PubMed

    Gudiño Gomezjurado, Álvaro

    2016-11-15

    Cardiovascular diseases are one of the most important causes of morbidity and mortality worldwide. Several risk factors have been associated with the development of these pathologies. However, there is controversy about whether hyperuricemia is an independent risk factor for developing cardiovascular disease. To answer this question, we performed a recent literature review of relevant published material to assess the association of hyperuricemia with four major cardiovascular diseases: hypertension, coronary heart disease, heart failure and atrial fibrillation.

  5. Multigenerational Breast Cancer Risk Factors in African-American Women

    DTIC Science & Technology

    1997-10-01

    psychosocial, reproductive, genetic and lifestyles ) related to disease risk. Cases were matched by ethnicity and age to two cancer-free women participating in a...Breast Cancer; African American, Lifestyles , Psychosocial 24 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY CLASSIFICATION 19. SECURITY...have shown risk factors such as age; socio-economic class; race/ethnicity; lifestyle ; and reproductive factors increase a woman’s chance of developing

  6. Modifiable Risk Factors for Lymphedema in Breast Caner Survivors

    DTIC Science & Technology

    2005-10-01

    AD Award Number: DAMD17-02-1-0387 TITLE: Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors PRINCIPAL INVESTIGATOR: Mary Anne Rossing...2005 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Modifiable Risk Factors for Lymphedema in Breast Cancer Survivors 5b. GRANT NUMBER DAMD17-02-1-0387 5c...Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Lymphedema of the arm is a consequence of breast cancer treatment that can result in substantial

  7. Identification of Risk Factors for Chronic Posttraumatic Stress Disorder (PTSD)

    DTIC Science & Technology

    2008-07-01

    Disorder , 1% for Panic Disorder , 3% for Social Phobia, 1% for Obsessive Compulsive Disorder , 2% for Generalized Anxiety Disorder , 5% for Alcohol Abuse...Award Number: W81XWH-061-0573 TITLE: Identification of Risk Factors for Chronic Posttraumatic Stress Disorder (PTSD) PRINCIPAL INVESTIGATOR: M...CONTRACT NUMBER Identification of Risk Factors for Chronic Posttraumatic Stress Disorder (PTSD) 5b. GRANT NUMBER W81XWH-06-1-0573 5c. PROGRAM

  8. Is Military Deployment a Risk Factor for Maternal Depression?

    DTIC Science & Technology

    2013-01-01

    Naval Health Research Center Is Military Deployment A Risk Factor for Maternal Depression ? Stacie Nguyen Cynthia A. LeardMann Besa Smith...Sylvester Road San Diego, California 92106-3521 Original Articles Is Military Deployment a Risk Factor for Maternal Depression ? Stacie Nguyen, MPH...Tyler C. Smith, PhD,1 for the Millennium Cohort Study Team Abstract Background: Maternal depression is a common condition among new mothers that can

  9. Central Leptin Gene Therapy to Reduce Breast Cancer Risk Factors

    DTIC Science & Technology

    2006-03-01

    W81XWH-04-1-0701 TITLE: Central Leptin Gene Therapy to Reduce Breast Cancer Risk Factors PRINCIPAL INVESTIGATOR: Urszula T. Iwaniec...CONTRACT NUMBER Central Leptin Gene Therapy to Reduce Breast Cancer Risk Factors 5b. GRANT NUMBER W81XWH-04-1-0701 5c. PROGRAM ELEMENT NUMBER...control of obesity through centrally administered, recombinant adeno-associated virus leptin gene (rAAV-lep) therapy will decrease the incidence of

  10. Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) is a predictor on postoperative outcomes of hepatocellular carcinoma

    PubMed Central

    Cheng, JiWen; Zhao, Pu; Liu, JiangBo; Liu, Xi; Wu, XuanLin

    2016-01-01

    Abstract Preoperative aspartate aminotransferase-to-platelet ratio index (APRI) has been identified as a biochemical marker for histological fibrogenesis and fibrosis in cirrhosis and prognosis of hepatocellular carcinoma (HCC). Whether preoperative APRI can predict postoperative short-term outcomes has not been studied. The purpose of this study was to investigate the ability of preoperative APRI to predict short-term outcomes following liver resection for HCC. APRI was evaluated in 360 patients undergoing liver resection for HCC. The receiver operating characteristic curve analysis was conducted to determine the cutoff value of the APRI in predicting postoperative morbidity. Univariate and multivariate analysis was performed to identify the risk factors for postoperative outcomes. The correlation of the preoperative APRI value with clinicopathological parameters was also examined. We found that the optimal cutoff value of the APRI was set at 9.5 for postoperative complications. APRI was an independent risk factor for overall complications by univariate and multivariate analyses. HCC patients with elevated APRI (>9.5) had a worse liver function and significantly higher postoperative complication rate. In conclusion, preoperative APRI is a useful biochemical marker to predict postoperative outcomes in HCC patients. PMID:27902606

  11. Evaluation of Preoperative and Intraoperative RBC Transfusion Practices at Maputo Central Hospital, Mozambique

    PubMed Central

    Burke, Zachary; Chen, James; Conceicao, Celson; Hoffman, Risa; Miller, Lee; Taela, Atanasio; DeUgarte, Daniel

    2013-01-01

    BACKGROUND The purpose of this study was to evaluate preoperative and intraoperative blood transfusion practices in Hospital Central (Maputo, Mozambique) and estimate the number of potentially avoidable transfusions. STUDY DESIGN AND METHODS A retrospective cohort study was performed. Age, comorbidities, hemoglobin, the potential for blood loss, and units of packed red blood cell (RBC) transfusions were recorded. Preoperative transfusions were evaluated to determine whether they met criteria established by the Mozambican Ministry of Health as well as proposed guidelines based on more restrictive protocols. Avoidable blood transfusions were defined as those preoperative transfusions that were not indicated based on these guidelines. Multivariate logistic regression was used to identify factors that predicted transfusion. RESULTS Two-hundred and five patients (age range: 0.1 - 86 years) underwent surgery in the main operating room during the two-week study period. Overall, thirty-five (17%) patients received sixty-eight transfusions. Of these, thirty-six transfusions were given preoperatively and thirty-two were given intraoperatively. Thirty-six percent of preoperative transfusions were avoidable according to national guidelines. Ninety-two percent were avoidable using more restrictive guidelines. The primary predictors of preoperative blood transfusion were lower hemoglobin (odd's ratio 0.390 / 1 g/dl; p<0.0001) and the potential for blood loss (odd's ratio 3.73; p=0.0410). CONCLUSIONS Adherence to existing hemoglobin thresholds recommended by national blood transfusion guidelines could significantly reduce the number of transfusions and the association risk of transfusion-transmissible infections. Adoption of more restrictive guidelines is recommended to further improve blood transfusion utilization and further reduce the transmission risk of HIV and hepatitis. PMID:23692441

  12. [Anemia as a surgical risk factor].

    PubMed

    Moral García, Victoria; Ángeles Gil de Bernabé Sala, M; Nadia Diana, Kinast; Pericas, Bartolomé Cantallops; Nebot, Alexia Galindo

    2013-07-01

    Perioperative anemia is common in patients undergoing surgery and is associated with increased morbidity and mortality and a decreased quality of life. The main causes of anemia in the perioperative context are iron deficiency and chronic inflammation. Anemia can be aggravated by blood loss during surgery, and is most commonly treated with allogeneic transfusion. Moreover, blood transfusions are not without risks, once again increasing patient morbidity and mortality. Given these concerns, we propose to review the pathophysiology of anemia in the surgical environment, as well as its treatment through the consumption of iron-rich foods and by oral or intravenous iron therapy (iron sucrose and iron carboxymaltose). In chronic inflammatory anemia, we use erythropoiesis-stimulating agents (erythropoietin alpha) and, in cases of mixed anemia, the combination of both treatments. The objective is always to reduce the need for perioperative transfusions and speed the recovery from postoperative anemia, as well as decrease the patient morbidity and mortality rate.

  13. Risk Factors for Progression of Chronic Kidney Disease

    PubMed Central

    Staples, Amy; Wong, Craig

    2010-01-01

    Purpose of Review Provides an overview of the identified risk factors for chronic kidney disease (CKD) progression emphasizing the pediatric population. Recent findings Over the past ten years, there have been significant changes to our understanding and study of pre-terminal kidney failure. Recent refinements in the measurement of glomerular filtration rate (GFR) and GFR estimating equations are important tools for identification and association of risk factors for CKD progression in children. In pediatric CKD, lower level of kidney function at presentation, higher levels of proteinuria, and hypertension are known markers for a more rapid decline in GFR. Anemia and other reported risk factors from the pre-genomic era have need for further study and validation. Genome-wide association studies have identified genetic loci which have provided novel genetic risk factors for CKD progression. Summary With cohort studies of children with CKD becoming mature, they have started to yield important refinements to the assessment of CKD progression. While many of the traditional risk factors for renal progression will certainly be assessed, such cohorts will be important for evaluating novel risk factors identified by genome-wide studies. PMID:20090523

  14. Dietary Factors and the Risk of Thyroid Cancer: A Review

    PubMed Central

    Choi, Wook Jin

    2014-01-01

    In the past few decades, the incidence of thyroid cancer has rapidly increased worldwide. Thyroid cancer incidence is relatively high in regions where the population's daily iodine intake is insufficient. While low dietary iodine has been considered as a risk factor for thyroid cancer development, previous studies found controversial results across different food types. Among different ethnic groups, dietary factors are influenced by various dietary patterns, eating habits, life-styles, nutrition, and other environmental factors. This review reports the association between dietary factors and thyroid cancer risk among ethnic groups living in different geologic regions. Iodine-rich food such as fish and shellfish may provide a protective role in populations with insufficient daily iodine intake. The consumption of goitrogenic food, such as cruciferous vegetables, showed a positive association with risk. While considered to be a risk factor for other cancers, alcohol intake showed a protective role against thyroid cancer. High consumption of meat such as chicken, pork, and poultry showed a positive association with the risk, but dairy products showed no significant association. Regular use of multivitamins and dietary nitrate and nitrite also showed a positive association with thyroid cancer risk. However, the study results are inconsistent and investigations into the mechanism for how dietary factors change thyroid hormone levels and influence thyroid function are required. PMID:25136535

  15. Individual and Co-occurring SNAP Risk Factors

    PubMed Central

    Balto, Julia M.; Ensari, Ipek; Hubbard, Elizabeth A.; Khan, Naiman; Barnes, Jennifer L.

    2016-01-01

    Background: Smoking, poor nutrition, excess alcohol consumption, and insufficient physical activity underlie most preventable causes of morbidity in the general population and may be associated with comorbidities and health outcomes in multiple sclerosis (MS). However, the frequency of co-occurrence of these risk factors in people with MS remains unclear. Methods: Sixty-nine individuals with MS completed self-report measures of smoking status, nutrition, alcohol use, physical activity levels, and sociodemographic and clinical characteristics. The data were analyzed using t tests and χ2 analyses. Results: Poor diet was the most common risk factor, with 85.5% of the sample not meeting dietary guidelines. Of participants with two risk factors, 90.3% were not meeting dietary and physical activity guidelines. Seventy-three percent of women were not meeting physical activity guidelines, compared with 38% of men (χ2 = 7.5, P < .01). There were also differential rates by sex of the most commonly co-occurring risk factors: 65% of women reported the co-occurrence of insufficient physical activity and poor diet, compared with 38% of men (χ2 = 4.2, P = .05). Conclusions: These results indicate that 85.5% of the sample was not meeting nutrition guidelines, 90.3% of participants with two risk factors reported the co-occurrence of poor diet and insufficient levels of physical activity, and physical activity levels and the total number of risk factors varied across sex. PMID:27999524

  16. Diabetic Nephropathy: New Risk Factors and Improvements in Diagnosis.

    PubMed

    Tziomalos, Konstantinos; Athyros, Vasilios G

    2015-01-01

    Diabetic nephropathy is the leading cause of end-stage renal disease. Patients with diabetic nephropathy have a high cardiovascular risk, comparable to patients with coronary heart disease. Accordingly, identification and management of risk factors for diabetic nephropathy as well as timely diagnosis and prompt management of the condition are of paramount importance for effective treatment. A variety of risk factors promotes the development and progression of diabetic nephropathy, including elevated glucose levels, long duration of diabetes, high blood pressure, obesity, and dyslipidemia. Most of these risk factors are modifiable by antidiabetic, antihypertensive, or lipid-lowering treatment and lifestyle changes. Others such as genetic factors or advanced age cannot be modified. Therefore, the rigorous management of the modifiable risk factors is essential for preventing and delaying the decline in renal function. Early diagnosis of diabetic nephropathy is another essential component in the management of diabetes and its complications such as nephropathy. New markers may allow earlier diagnosis of this common and serious complication, but further studies are needed to clarify their additive predictive value, and to define their cost-benefit ratio. This article reviews the most important risk factors in the development and progression of diabetic nephropathy and summarizes recent developments in the diagnosis of this disease.

  17. Anesthetic considerations in diabetic patients. Part I: preoperative considerations of patients with diabetes mellitus.

    PubMed

    Kadoi, Yuji

    2010-10-01

    Diabetes mellitus is an increasingly common disease that affects people of all ages, resulting in significant morbidity and mortality. Diabetic patients require perioperative care more frequently than their nondiabetic counterparts. The major risk factors for diabetics undergoing surgery are the associated end-organ diseases: cardiovascular disease, autonomic neuropathy, joint collagen tissue, and immune deficiency. Physicians need to pay extra attention to preoperative and preprocedure evaluation and treatment of these diseases to ensure optimal perioperative management.

  18. Optimising renal cancer patients for nephron-sparing surgery: a review of pre-operative considerations and peri-operative techniques for partial nephrectomy.

    PubMed

    Ertemi, Hani; Khetrapal, Pramit; Pavithran, Nevil M; Mumtaz, Faiz

    2017-02-03

    Nonmodifiable factors including pre-operative renal function and amount of healthy renal tissue preserved are the most important predictive factors that determine renal function after partial nephrectomy. Ischaemia time is an important modifiable risk factor and cold ischaemia time should be used if longer ischaemia time is anticipated. New techniques may have a role in maximising postoperative kidney function, but more robust studies are required to understand their potential benefits and risks.

  19. Coming to Terms With Risk Factors for Eating Disorders: Application of Risk Terminology and Suggestions for a General Taxonomy

    ERIC Educational Resources Information Center

    Jacobi, Corinna; Hayward, Chris; de Zwaan, Martina; Kraemer, Helena C.; Agras, W. Steward

    2004-01-01

    The aims of the present review are to apply a recent risk factor approach (H. C. Kraemer et al., 1997) to putative risk factors for eating disorders, to order these along a timeline, and to deduce general taxonomic questions. Putative risk factors were classified according to risk factor type, outcome (anorexia nervosa, bulimia nervosa,…

  20. Risk factor for ischemic-type biliary lesion after ABO-incompatible living donor liver transplantation

    PubMed Central

    Bang, Jun Bae; Kim, Bong-Wan; Kim, Young Bae; Wang, Hee-Jung; Lee, Hyun Yeong; Sim, Joohyun; Kim, Taegyu; Lee, Kyeong Lok; Hu, Xu-Guang; Mao, Wei

    2016-01-01

    AIM: To evaluate the risk factors for ischemic-type biliary lesion (ITBL) after ABO-incompatible (ABO-I) adult living donor liver transplantation (ALDLT). METHODS: Among 141 ALDLTs performed in our hospital between 2008 and 2014, 27 (19%) were ABO-I ALDLT and 114 were ABO-identical/compatible ALDLT. In this study, we extensively analyzed the clinico-pathological data of the 27 ABO-I recipients to determine the risk factors for ITBL after ABO-I ALDLT. All ABO-I ALDLT recipients underwent an identical B-cell depletion protocol with preoperative rituximab, plasma exchange (PE), and operative splenectomy. The median follow-up period after transplantation was 26 mo. The clinical outcomes of the 27 ABO-I ALDLT recipients were compared with those of 114 ABO-identical/compatible ALDLT recipients. RESULTS: ITBL occurred in four recipients (14.8%) between 45 and 112 d after ABO-I ALDLT. The overall survival rates were not different between ABO-I ALDLT and ABO-identical/compatible ALDLT (P = 0.303). Among the ABO-I ALDLT recipients, there was no difference between patients with ITBL and those without ITBL in terms of B-cell and T-cell count, serum isoagglutinin titers, number of PEs, operative time and transfusion, use of graft infusion therapy, or number of remnant B-cell follicles and plasma cells in the spleen. However, the perioperative NK cell counts in the blood of patients with ITBL were significantly higher than those in the patients without ITBL (P < 0.05). Preoperative NK cell count > 150/μL and postoperative NK cell count > 120/μL were associated with greater relative risks (RR) for development of ITBL (RR = 20 and 14.3, respectively, P < 0.05). CONCLUSION: High NK cell counts in a transplant recipient’s blood are associated with ITBL after ABO-I ALDLT. Further research is needed to elucidate the molecular mechanism of NK cell involvement in the development of ITBL. PMID:27570428

  1. Risk Factors for Postoperative Urinary Tract Infections in Patients Undergoing Total Joint Arthroplasty

    PubMed Central

    Demzik, Alysen L.; Alvi, Hasham M.; Hardt, Kevin D.; Manning, David W.

    2016-01-01

    Background. Urinary tract infections (UTIs) are the most common minor complication following total joint arthroplasty (TJA) with incidence as high as 3.26%. Bladder catheterization is routinely used during TJA and the Centers for Medicare and Medicaid Services (CMS) has recently identified hospital-acquired catheter associated UTI as a target for quality improvement. This investigation seeks to identify specific risk factors for UTI in TJA patients. Methods. We retrospectively studied patients undergoing TJA for osteoarthritis between 2006 and 2013 in the American College of Surgeon's National Surgical Improvement Program Database (ACS-NSQIP). A univariate analysis screen followed by multivariate logistic regression identified specific patient demographics, comorbidities, preoperative laboratory values, and operative characteristics independently associated with postoperative UTI. Results. 1,239 (1.1%) of 115,630 TJA patients we identified experienced a postoperative UTI. The following characteristics are independently associated with postoperative UTI: female sex (OR 2.1, 95% CI 1.6–2.7), chronic steroid use (OR 2.0, 95% CI 1.2–3.2), ages 60–69 (OR 1.5, 95% CI 1.0–2.1), 70–79 (OR 2.0, 95% CI 1.4–2.9), and ≥80 (OR 2.3, 95% CI 1.5–3.6), ASA Classes 3–5 (OR 1.5, 95% CI 1.2–1.9), preoperative creatinine >1.35 (OR 1.8, 95% CI 1.3–2.6), and operation time greater than 130 minutes (OR 1.8, 95% CI 1.3–2.4). Conclusions. In this large database query, postoperative UTI occurs in 1.1% of patients following TJA and several variables including female sex, age greater than 60, and chronic steroid use are independent risk factors for occurrence. Practitioners should be aware of populations at greater risk to support efforts to comply with CMS initiated quality improvement. PMID:28018678

  2. Surgical site infection complicating internal fixation of fractures: incidence and risk factors.

    PubMed Central

    Thanni, Lateef O. A.; Aigoro, Nofiu O.

    2004-01-01

    BACKGROUND: There is a dearth of data on surgical site infections (SSIs) complicating internal fixation of fractures from Nigeria. AIMS: To determine the incidence and risk factors for SSIs following internal fixation of fracture. METHODS: A cohort of 90 patients with long bone fractures that were stabilized internally with metallic devices was studied prospectively and retrospectively. RESULTS: The incidence of SSI was 12%. The isolated organisms were Staphylococcus aureus in four patients, Pseudomonas spp. in three, and Escherichia coli in one patient. Diabetes mellitus and perioperative transfusion with allogeneic blood were not predictive of SSI. Duration of operation longer than 120 minutes was a strong predictor (OR 2.25, 95% CL 0.48-10.16). Other risk factors were male sex (OR 2.01, 95% CL 0.44-10.45), injury-operation interval less than six months (OR 2.00, 95% CL 0.22-46.08), fracture fixation with plates and screws (OR 1.51, 95% CL 0.36-6.40), white blood cell count (WBC) less than 5,000 per cumm (OR 1.50, 95% CL 0.15-16.37), preoperative urinary catheterization (OR 1.48, 95% CL 0.00-16.19), and postoperative urinary catheterization (OR 1.24, 95% CL 0.29-5.00). CONCLUSION: The incidence of SSI after internal fixation of long bone fractures in our centers is 12%, and this is within the previously reported range. Use of plates and screws, WBC less than 5,000 per cumm, and perioperative urinary catheterization are important risk factors. PMID:15303412

  3. Lifestyle and health-related risk factors and risk of cognitive aging among older veterans.

    PubMed

    Yaffe, Kristine; Hoang, Tina D; Byers, Amy L; Barnes, Deborah E; Friedl, Karl E

    2014-06-01

    Lifestyle and health-related factors are critical components of the risk for cognitive aging among veterans. Because dementia has a prolonged prodromal phase, understanding effects across the life course could help focus the timing and duration of prevention targets. This perspective may be especially relevant for veterans and health behaviors. Military service may promote development and maintenance of healthy lifestyle behaviors, but the period directly after active duty has ended could be an important transition stage and opportunity to address some important risk factors. Targeting multiple pathways in one intervention may maximize efficiency and benefits for veterans. A recent review of modifiable risk factors for Alzheimer's disease estimated that a 25% reduction of a combination of seven modifiable risk factors including diabetes, hypertension, obesity, depression, physical inactivity, smoking, and education/cognitive inactivity could prevent up to 3 million cases worldwide and 492,000 cases in the United States. Lifestyle interventions to address cardiovascular health in veterans may serve as useful models with both physical and cognitive activity components, dietary intervention, and vascular risk factor management. Although the evidence is accumulating for lifestyle and health-related risk factors as well as military risk factors, more studies are needed to characterize these factors in veterans and to examine the potential interactions between them.

  4. Factors that modify risks of radiation-induced cancer

    SciTech Connect

    Fabrikant, J.I.

    1988-11-01

    The collective influence of biologic and physical factors that modify risks of radiation-induced cancer introduces uncertainties sufficient to deny precision of estimates of human cancer risk that can be calculated for low-dose radiation in exposed populations. The important biologic characteristics include the tissue sites and cell types, baseline cancer incidence, minimum latent period, time-to-tumor recognition, and the influence of individual host (age and sex) and competing etiologic influences. Physical factors include radiation dose, dose rate, and radiation quality. Statistical factors include time-response projection models, risk coefficients, and dose-response relationships. Other modifying factors include other carcinogens, and other biological sources (hormonal status, immune status, hereditary factors).

  5. Metabolic factors and genetic risk mediate familial type 2 diabetes risk in the Framingham Heart Study

    PubMed Central

    Raghavan, Sridharan; Porneala, Bianca; McKeown, Nicola; Fox, Caroline S.; Dupuis, Josée; Meigs, James B.

    2015-01-01

    Aims/hypothesis Type 2 diabetes mellitus in parents is a strong determinant of diabetes risk in their offspring. We hypothesise that offspring diabetes risk associated with parental diabetes is mediated by metabolic risk factors. Methods We studied initially non-diabetic participants of the Framingham Offspring Study. Metabolic risk was estimated using beta cell corrected insulin response (CIR), HOMA-IR or a count of metabolic syndrome components (metabolic syndrome score [MSS]). Dietary risk and physical activity were estimated using questionnaire responses. Genetic risk score (GRS) was estimated as the count of 62 type 2 diabetes risk alleles. The outcome of incident diabetes in offspring was examined across levels of parental diabetes exposure, accounting for sibling correlation and adjusting for age, sex and putative mediators. The proportion mediated was estimated by comparing regression coefficients for parental diabetes with (βadj) and without (βunadj) adjustments for CIR, HOMA-IR, MSS and GRS (percentage mediated = 1 – βadj / βunadj). Results Metabolic factors mediated 11% of offspring diabetes risk associated with parental diabetes, corresponding to a reduction in OR per diabetic parent from 2.13 to 1.96. GRS mediated 9% of risk, corresponding to a reduction in OR per diabetic parent from 2.13 to 1.99. Conclusions/interpretation Metabolic risk factors partially mediated offspring type 2 diabetes risk conferred by parental diabetes to a similar magnitude as genetic risk. However, a substantial proportion of offspring diabetes risk associated with parental diabetes remains unexplained by metabolic factors, genetic risk, diet and physical activity, suggesting that important familial influences on diabetes risk remain undiscovered. PMID:25619168

  6. [Environmental and genetic risk factors for endometrial carcinoma].

    PubMed

    Sénéchal, Claire; Cottereau, Edouard; de Pauw, Antoine; Elan, Camille; Dagousset, Isabelle; Fourchotte, Virginie; Gauthier-Villars, Marion; Lae, Marick; Stoppa-Lyonnet, Dominique; Buecher, Bruno

    2015-03-01

    In France, endometrial cancer is at the first rank of gynecological cancers for cancer incidence, before ovarian and cervical cancers. In fact, the number of incident cases has been estimated to 7275 for the year 2012; the number of death due to endometrial cancer to 2025. This cancer is hormone-dependent and endogenous (reproductive factors) or exogenous (oral combined contraceptives, hormone replacement therapy) causes of exposition to estrogens are the major environmental risk factors for both types of endometrial cancers: type I or well-differentiated endometrioid adenocarcinomas; and type II including all other histological types: papillary serous adenocarcinomas, clear cell adenocarcinomas and carcinosarcomas, also known as malignant mixed Mullerian tumor, MMMT. Obesity, diabetes mellitus and adjuvant treatment of breast cancer with tamoxifen are also associated with an increased risk of endometrial cancer. Genetic factors may also be implicated in the pathogenesis of endometrial cancer either as "minor genetic factors" (susceptibility factors), which remain largely unknown and are responsible for the increased observed risk in relatives of women affected with endometrial cancer; or as major genetic factors responsible for hereditary forms and namely for Lynch syndrome whose genetic transmission is of autosomic dominant type. The appropriate recognition of Lynch syndrome is of critical importance because affected patients and their relatives should benefit from specific care. The aims of this review is to describe major environmental and genetic risk factors for endometrial cancer with specific attention to most recent advances in this field and to describe recommendations for care of at-risk women.

  7. Mid-adulthood risk factor profiles for CKD.

    PubMed

    McMahon, Gearoid M; Preis, Sarah R; Hwang, Shih-Jen; Fox, Caroline S

    2014-11-01

    Early identification of CKD risk factors may allow risk factor modification and prevention of CKD progression. We investigated the hypothesis that risk factors are present ≥30 years before the diagnosis of CKD in a case-control study using data from the Framingham Offspring Study. Patients with incident CKD (eGFR≤60 ml/min per 1.73 m2) at examination cycles 6, 7, and 8 were age- and sex-matched 1:2 to patients without CKD at baseline (examination 5). CKD risk factors were measured at each examination cycle. Logistic regression models, adjusted for age, sex, and time period, were constructed to compare risk factor profiles at each time point between cases and controls. During follow-up, 441 new cases of CKD were identified and matched to 882 controls (mean age 69.2 years, 52.4% women). Those who ultimately developed CKD were more likely to have hypertension (odds ratio [OR], 1.76; 95% confidence interval [CI], 1.23 to 2.51), obesity (OR, 1.71; 95% CI, 1.14 to 2.59), and higher triglyceride levels (OR, 1.43; 95% CI, 1.12 to 1.83) 30 years before CKD diagnosis, and were more likely to have hypertension (OR, 1.38; 95% CI, 1.07 to 1.79), higher triglyceride levels (OR, 1.35; 95% CI, 1.11 to 1.64), lower HDLc (OR, 0.89; 95% CI, 0.81 to 0.97), and diabetes (OR, 2.90; 95% CI, 1.59 to 5.29) 20 years before CKD diagnosis. These findings demonstrate that risk factors for CKD are identifiable ≥30 years before diagnosis and suggest the importance of early risk factor identification in patients at risk for CKD.

  8. DEPRESSION AS A RISK FACTOR FOR OSTEOPOROSIS

    PubMed Central

    Cizza, Giovanni; Primma, Svetlana; Csako, Gyorgy

    2009-01-01

    Osteoporosis is a major public health threat. Multiple studies have reported an association between depression and low bone mineral density, but a causal link between these two conditions is disputed. Here we review the endocrine and immune alterations secondary to depression that might affect bone mass. We also discuss the possible role of poor lifestyle in the etiology of osteoporosis in subjects with depression and the potential effect of antidepressants on bone loss. We propose that depression induces bone loss and osteoporotic fractures, primarily via specific immune and endocrine mechanisms, with poor lifestyle habits and use of specific antidepressants also potential contributory factors. PMID:19747841

  9. CARDIOVASCULAR RISK AND ASSOCIATED FACTORS IN ADOLESCENTS.

    PubMed

    do Prado Junior, Pedro Paulo; de Faria, Franciane Rocha; de Faria, Eliane Rodrigues; Franceschini, Sylvia do Carmo Castro; Priore, Silvia Eloiza

    2015-08-01

    Introducción: los cambios en el estilo de vida están relacionados con la exposición temprana de los adolescentes a las comorbilidades asociadas a la enfermedad cardiovascular. Estas condiciones pueden tener consecuencias en la edad adulta. Objetivo: determinar la prevalencia de riesgo cardiovascular y factores asociados en las tres fases de la adolescencia. Métodos: estudio transversal que incluye a adolescentes de 10-19 años en la ciudad de Viçosa, distribuidos en tres fases. Se evaluaron las pruebas de laboratorio, el índice de masa corporal clasificadas en Z-score, según el sexo y la edad, y el porcentaje de grasa corporal, clasificados por sexo. Se utilizó la prueba de chi-cuadrado, la partición de chi-cuadrado con corrección de Bonferroni y la regresión de Poisson. El nivel de significación fue < 0,05. El proyecto fue aprobado por el Comité de Ética en Investigación de la UFV en humanos. Resultados: el sobrepeso, la grasa corporal, el perfil lipídico, el comportamiento sedentario y la historia de enfermedades cardiovasculares en la familia fueron los factores de riesgo cardiovascular más prevalentes entre los adolescentes. Los adolescentes tenían tasas más altas de sobrepeso y grasa. En cuanto a las etapas, la inicial mostró un mayor porcentaje de individuos con comportamiento sedentario, sobrepeso y colesterol total y LDL en comparación con otras fases. Los individuos con cambios en el estado nutricional eran más propensos a desarrollar hipertensión, cambios en el colesterol total, LDL, triglicéridos, insulina, HOMA y HDL bajo, en comparación con los individuos sanos. Conclusiones: los factores de riesgo cardiovascular se han observado en personas cada vez más jóvenes y son factores importantes para identificar una población en riesgo.

  10. [Occupational risk factors and medical prevention in corrections officers].

    PubMed

    Mennoial, Nunzio Valerio; Napoli, Paola; Battaglia, Andrea; Candura, Stefano M

    2014-01-01

    In Italy, the Law n. 395/1990 defines the tasks and attributions of prison officers. According to the article 25 of the Legislative Decree n. 81/2008, the occupational physician should participate to risk assessment, and carry out the sanitary surveillance. This report analyzes the various tasks of prison staff, identifies the risk factors, and discusses the preventive strategies, including workers formation and education. Biological agents and work-related stress are the main risk factors, as a consequence of prison overcrowding, personnel shortage and work organization complexity. In his preventive action, and particularly in formulating the judgment on work fitness, the occupational physician often clashes with inadequate ministerial funding.

  11. A review of cardiovascular risk factors in US military personnel.

    PubMed

    McGraw, Leigh K; Turner, Barbara S; Stotts, Nancy A; Dracup, Kathleen A

    2008-01-01

    As the civilian population exhibits increasing trends in major cardiovascular (CV) risk factors in younger age groups, the US military is observing similar trends. These worrisome developments are seen even in young adulthood. Despite the need for a fit, combat-ready force, increases in CV risk are increasingly evident in the military population. This review provides an overview of coronary artery disease in the young and the prevalence of risk factors in the military population. With increases in current military operations in an acutely stressful environment, the role of stress and the manifestation of CV disease are also examined.

  12. Maternal environmental risk factors for congenital hydrocephalus: a systematic review.

    PubMed

    Kalyvas, Aristotelis V; Kalamatianos, Theodosis; Pantazi, Mantha; Lianos, Georgios D; Stranjalis, George; Alexiou, George A

    2016-11-01

    OBJECTIVE Congenital hydrocephalus (CH) is one of the most frequent CNS congenital malformations, representing an entity with serious pathological consequences. Although several studies have previously assessed child-related risk factors associated with CH development, there is a gap of knowledge on maternal environmental risk factors related to CH. The authors have systematically assessed extrinsic factors in the maternal environment that potentially confer an increased risk of CH development. METHODS The Cochrane Library, MEDLINE, and EMBASE were systematically searched for works published between 1966 and December 2015 to identify all relevant articles published in English. Only studies that investigated environmental risk factors concerning the mother-either during gestation or pregestationally-were included. RESULTS In total, 13 studies (5 cohorts, 3 case series, 3 case-control studies, 1 meta-analysis, and 1 case report) meeting the inclusion criteria were identified. Maternal medication or alcohol use during gestation; lifestyle modifiable maternal pathologies such as obesity, diabetes, or hypertension; lack of prenatal care; and a low socioeconomic status were identified as significant maternal environmental risk factors for CH development. Maternal infections and trauma to the mother during pregnancy have also been highlighted as potential mother-related risk factors for CH. CONCLUSIONS Congenital hydrocephalus is an important cause of serious infant health disability that can lead to health inequalities among adults. The present study identified several maternal environmental risk factors for CH, thus yielding important scientific information relevant to prevention of some CH cases. However, further research is warranted to confirm the impact of the identified factors and examine their underlying behavioral and/or biological basis, leading to the generation of suitable prevention strategies.

  13. Heritable risk factors associated with language impairments

    PubMed Central

    Barry, J G; Yasin, I; Bishop, D V M

    2007-01-01

    There is a strong genetic contribution to children’s language and literacy impairments. The aim of this study was to determine which aspects of the phenotype are familial by comparing 34 parents of probands with language/literacy impairments and 33 parents of typically developing probands. The parents responded to questionnaires regarding previous history for language/reading impairment and participated in psychometric testing. The psychometric test battery consisted of tests assessing non-verbal IQ, short-term memory, articulation, receptive grammar, reading abilities and spelling. Self-report measures demonstrated a higher prevalence of language and literacy impairments in parents of affected probands (32%) compared with parents of unaffected probands (6%). The two groups of parents differed significantly in their performance on the non-word repetition, oromotor and digit span tasks. Non-word repetition gave the best discrimination between the parent groups even when the data from the parents who actually were impaired as ascertained by direct testing or self-report were removed from the analyses. This suggests that non-word repetition serves as a marker of a family risk for language impairment. The paper concludes with a discussion of issues associated with ascertainment of specific language impairment (SLI). PMID:17233642

  14. Risk factors for sensorineural hearing loss in children.

    PubMed

    Núñez-Batalla, Faustino; Trinidad-Ramos, Germán; Sequí-Canet, José Miguel; Alzina De Aguilar, Valentín; Jáudenes-Casaubón, Carmen

    2012-01-01

    In the last decade, tremendous progress has been made very rapidly in the development of Early Hearing Detection and Intervention (EHDI) systems as a major public health initiative. The percentage of infants screened annually in Spain has increased significantly since the EHDI systems have expanded to all autonomic regions. Historically, high risk indicators have been used for the identification of infants who should receive audiological evaluation but who live in geographic locations where universal hearing screening is not yet available, to help identify infants who pass neonatal screening but are at risk of developing delayed-onset hearing loss and to identify infants who may have passed neonatal screening but have mild forms of permanent hearing loss. In this review, the standard risk factors for hearing loss are analysed and the risk factors known to be associated with late onset or progressive hearing loss are identified. The recommendation for infants with a risk factor that may be considered as low risk is to perform at least one audiology assessment by 24-30 months. In contrast, for an infant with risk factors known to be associated with late onset or progressive hearing loss (such as cytomegalovirus infection or family history), early and more frequent assessment is appropriate. All infants should have an objective standardised screening of global development with a validated assessment tool at 9, 18 and 24-30 months of age or at any time if the health care professional or the family is concerned.

  15. Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

    PubMed Central

    Søreide, Kjetil; Labori, Knut Jørgen

    2016-01-01

    Abstract Background: Pancreas surgery has developed into a fairly safe procedure in terms of mortality, but is still hampered by considerable morbidity. Among the most frequent and dreaded complications are the development of a post-operative pancreatic fistula (POPF). The prediction and prevention of POPF remains an area of debate with several questions yet to be firmly addressed with solid answers. Methods: A systematic review of systematic reviews/meta-analyses and randomized trials in the English literature (PubMed/MEDLINE, Cochrane library, EMBASE) covering January 2005 to December 2015 on risk factors and preventive strategies for POPF. Results: A total of 49 systematic reviews and meta-analyses over the past decade discussed patient, surgeon, pancreatic disease and intraoperative related factors of POPF. Non-modifiable factors (age, BMI, comorbidity) and pathology (histotype, gland texture, duct size) that indicates surgery are associated with POPF risk. Consideration of anastomotic technique and use of somatostatin-analogs may slightly modify the risk of fistula. Sealant products appear to have no effect. Perioperative bleeding and transfusion enhance risk, but is modifiable by focus on technique and training. Drains may not prevent fistulae, but may help in early detection. Early drain-amylase may aid in detection. Predictive scores lack uniform validation, but may have a role in patient information if reliable pre-operative risk factors can be obtained. Conclusions: Development of POPF occurs through several demonstrated risk factors. Anastomotic technique and use of somatostatin-analogs may slightly decrease risk. Drains may aid in early detection of leaks, but do not prevent POPF. PMID:27216233

  16. Analysis of Risk Factors for Conversion from Off-Pump to On-Pump Coronary Artery Bypass Graft

    PubMed Central

    Lim, Junghyeon; Lee, Won Yong; Ra, Yong Joon; Jeong, Jae Han; Ko, Ho Hyun

    2017-01-01

    Background Off-pump coronary artery bypass (OPCAB) is performed worldwide, but significant risks are associated with conversion to on-pump surgery. Therefore, we evaluated the composite outcomes between an OPCAB group and a conversion group. Methods From January 2008 to December 2012, 100 consecutive patients underwent OPCAB at Hallym University Sacred Heart Hospital, of whom 84 underwent OPCAB without adverse events (OPCAB group), and 16 were converted to on-pump surgery (conversion group). Early morbidity, early and long-term mortality, and major adverse cardiac and cerebrovascular events (MACCEs) were the primary and long-term composite endpoints. Results The mean follow-up period was 55±26 months, with 93% of the patients completing follow-up. The composite outcomes in the OPCAB and conversion groups were as follows: early morbidity, 2.3% versus 12.5%; early mortality, 4.7% versus 0%; long-term mortality, 14.3% versus 25.0%; and MACCEs, 14.3% versus 18.8%, respectively. No composite endpoints showed statistically significant differences. Preoperative acute myocardial infarction (AMI) was identified as an independent risk factor for conversion (p=0.025). Conclusion The conversion group showed no statistically significant differences in early mortality and morbidity, MACCEs, or long-term mortality compared with the OPCAB group. The preoperative diagnosis of AMI was associated with an increased number of conversions to on-pump surgery. PMID:28180098

  17. Risk factors for depressive symptoms during pregnancy: a systematic review.

    PubMed

    Lancaster, Christie A; Gold, Katherine J; Flynn, Heather A; Yoo, Harim; Marcus, Sheila M; Davis, Matthew M

    2010-01-01

    The purpose of this study was to evaluate risk factors for antepartum depressive symptoms that can be assessed in routine obstetric care. We evaluated articles in the English-language literature from 1980 through 2008. Studies were selected if they evaluated the association between antepartum depressive symptoms and > or =1 risk factors. For each risk factor, 2 blinded, independent reviewers evaluated the overall trend of evidence. In total, 57 studies met eligibility criteria. Maternal anxiety, life stress, history of depression, lack of social support, unintended pregnancy, Medicaid insurance, domestic violence, lower income, lower education, smoking, single status, and poor relationship quality were associated with a greater likelihood of antepartum depressive symptoms in bivariate analyses. Life stress, lack of social support, and domestic violence continued to demonstrate a significant association in multivariate analyses. Our results demonstrate several correlates that are consistently related to an increased risk of depressive symptoms during pregnancy.

  18. [Protective and family risk factors related to adolescent drug use].

    PubMed

    Cid-Monckton, Patricia; Pedrão, Luiz Jorge

    2011-06-01

    This cross-sectional and quantitative study aimed to verify the family's protective and risk factors related to drugs use in adolescents, considering the interaction patterns developed in the family, their degree of adaptability and vulnerability. Participants in this study were 80 female adolescents, from the 1st to 4th grade of high school, who answered a questionnaire. The most relevant risk and protective factors that would influence the situation were established, such as patterns of interaction, degree of adaptability, way of coping with problems, family resources and values. The major risk factors that emerged were the way people confront problems and, within these, lack of religious support and professional support, besides communication difficulties within families. The lowest risks were values, such as personal effort. The results highlight that nurses should assume psychosocial interventions as part of their role, especially among school-age children as, thus, they would be acting as agents in the prevention of drugs use.

  19. Cardiovascular risk factors in young adults: a literature review.

    PubMed

    Tran, Dieu-My T; Zimmerman, Lani M

    2015-01-01

    This extensive literature review focuses on cardiovascular risk factors in young adults, with an emphasis on hyperlipidemia and hypertension. Multiple studies have confirmed that hyperlipidemia and hypertension during young adulthood are associated with coronary heart disease (CHD) in later decades, and CHD is one type of cardiovascular disease. The primary risk factors identified in the literature that are predictive of CHD are age; gender; race/ethnicity; smoking status; high blood pressure; and elevated lipid levels, especially low-density lipoprotein cholesterol. The current guidelines are insufficient to address screening and treatment in young adults with cardiovascular risk factors. Future studies are warranted to confirm the extent of cardiovascular risks in young adults, which can then be targeted to this population for prevention and intervention strategies.

  20. Shared Risk Factors in Cardiovascular Disease and Cancer

    PubMed Central

    Koene, Ryan J.; Prizment, Anna E.; Blaes, Anne; Konety, Suma H.

    2016-01-01

    Cardiovascular disease (CVD) and cancer are the two leading causes of death worldwide. Although commonly thought of as two separate disease entities, CVD and cancer possess various similarities and possible interactions, including a number of similar risk factors (e.g. obesity, diabetes), suggesting a shared biology for which there is emerging evidence. While chronic inflammation is an indispensible feature of the pathogenesis and progression of both CVD and cancer, additional mechanisms can be found at their intersection. Therapeutic advances, despite improving longevity, have increased the overlap between these diseases, but there are now millions of cancer survivors at risk of developing CVD. Cardiac risk factors have a major impact on subsequent treatment-related cardiotoxicity. In this review, we explore the risk factors common to both CVD and cancer, highlighting the major epidemiologic studies and potential biological mechanisms that account for them. PMID:26976915

  1. Some risk factors for the progression of periodontal disease.

    PubMed

    Skaleric, U; Kovac-Kavcic, M

    2000-01-01

    Inflammatory periodontal disease is one of the most common diseases of mankind. Gingival inflammation is widespread, but advanced periodontitis is limited to relatively small subgroups of the population. Gingivitis is initiated by microbial plaque deposits on the dento-gingival interface but progression to periodontitis is modified by several environmental, behavioural, biological and health care variables. This paper reviews the reports dealing with some risk factors for periodontal disease published in recent years and compares the data with findings in a Ljubljana population. It is concluded that male smokers with lower education and low frequency of tooth brushing represent a risk population for progression of periodontal disease. Marital status and body mass need further study to be proved as risk factors for periodontitis. A socioecological model proposed by Hansen et al. (1993) should be used for understanding the interplay of different risk factors for progression of periodontal disease.

  2. Sensitivity of risk estimates to wildlife bioaccumulation factors in ecological risk assessment

    SciTech Connect

    Karustis, C.G.; Brewer, R.A.

    1995-12-31

    The concept of conservatism in risk assessment is well established. However, overly conservative assumptions may result in risk estimates that incorrectly predict remediation goals. Therefore, realistic assumptions should be applied in risk assessment whenever possible. A sensitivity analysis was performed on conservative (i.e. bioaccumulation factor = 1) and scientifically-derived wildlife bioaccumulation factors (BAFs) utilized to calculate risks during a terrestrial ecological risk assessment (ERA). In the first approach, 100% bioaccumulation of contaminants was assumed to estimate the transfer of contaminants through the terrestrial food chain. In the second approach, scientifically-derived BAFs were selected from the literature. For one of the measurement species selected, total risks calculated during the first approach were higher than those calculated during the second approach by two orders of magnitude. However, potential risks due to individual contaminants were not necessarily higher using the conservative approach. Potential risk due to contaminants with low actual bioaccumulation were exaggerated while potential risks due to contaminants with greater than 100% bioaccumulation were underestimated. Therefore, the use of a default of 100% bioaccumulation (BAF = 1) for all contaminants encountered during an ERA could result in cases where contaminants are incorrectly identified as risk drivers, and the calculation of incorrect ecological risk-based cleanup goals. The authors suggest using site-specific or literature-derived BAFs whenever possible and realistic BAF estimates, based upon factors such as log K{sub ow}, when BAFs are unavailable.

  3. Analysis of correlative risk factors for C5 palsy after anterior cervical decompression and fusion

    PubMed Central

    Wang, Haiying; Zhang, Xu; Lv, Bing; Ding, Wenyuan; Shen, Yong; Yang, Dalong; Bai, Zhilong

    2015-01-01

    Background: It has been reported that C5 palsy is a potential complication of both anterior and posterior cervical spine surgery, although several mechanisms of C5 palsy following posterior cervical surgery have been proposed, few reports about correlative risk factors have been elaborated on C5 palsy after anterior cervical decompression and fusion (ACDF). Objective: The purpose of this study was to investigate the correlative risk factors of C5 palsy after anterior cervical decompression and fusion. Methods: This is a retrospective study. A total of 161 patients (108 males and 53 females) who underwent ACDF between 2007 and 2012 were included in this study. C5 palsy is characterized by deltoid and/or biceps brachii weakness. The patients were divided into two groups: one that had experienced C5 palsy (group A) and the other one had not (group B). In both groups, the age, gender, duration of disease, diagnosis, No. of surgical levels, cervical curvature correction, occupying rate of spinal canal at C4/5, diameter of the C4/5 foramen, intervertebral height variation, decompression width and preoperative high-signal intensity zone (HIZ) of spinal cord in T2-weighted MRI at C4/5 were measured and evaluated. The risk factors of C5 palsy were detected with logistic regression analysis. Results: There were no significant differences in age, gender, duration of disease, diagnosis, No. of surgical levels, rate of spinal canal at C4/5 and HIZ of spinal cord in T2-weighted MRI at C4/5. Cervical curvature correction, diameter of the C4/5 foramen, intervertebral height variation and decompression width had significant differences between the two groups (P<0.05). Logistic regression analysis revealed that cervical curvature, diameter of the C4/5 foramen, intervertebral height and decompression width were the pivotal risk factors for the incidence of C5 palsy. Conclusion: For patients with ACDF, greater cervical curvature correction, narrow diameter of the C4/5 foramen

  4. Risk Factors for Acute Kidney Injury after Coronary Artery Bypass Surgery and Its Detection Using Neutrophil Gelatinase-Associated Lipocalin

    PubMed Central

    Onk, Oruç Alper; Onk, Didem; Ozcelik, Fatih; Gunay, Murat; Turkmen, Kultigin

    2016-01-01

    Introduction Acute kidney injury (AKI) is an important complication of cardiac surgery due to its high mortality. The aim of the present study was to detect the factors leading to AKI in patients who underwent coronary artery bypass surgery (CABS) and also to determine the optimal timing for detecting AKI using the biomarker neutrophil gelatinase-associated lipocalin (NGAL). Materials and Methods The records of 375 patients who underwent CABS were reviewed in this case-control study. Ejection fraction (EF), common carotid artery intima-media thickness (CCA-IMT) and cross-clamp (C-C) time of the patients were recorded. Blood samples were taken from all patients on preoperative day 1 as well as 6, 12, 24, 36, 48 h and 7 days after operation. Biochemical parameters were studied in patients with and without AKI. Results According to the Risk Injury Failure Loss End Stage criteria, 24 patients had renal risk, 17 had injury and 4 had failure. Postoperative 24-hour serum creatinine levels indicated the risk of renal dysfunction for only 4 patients in the AKI group. CCA-IMT, C-C time, haematocrit (HCT) and preoperative interleukin-6 levels were significantly higher in the AKI group than in the non-AKI group. Postoperative 6- and 12-hour NGAL levels in the AKI group correlated with postoperative 36-hour serum creatinine levels. The optimal cut-off values for postoperative 6- and 12-hour NGAL test were 310 and 283 ng/ml, respectively. The area under the curve was higher in the 12-hour NGAL test (p < 0.0086). Conclusion The number of stenotic coronary arteries, EF, CCA-IMT and HCT are all important risk factors. Early postoperative NGAL results were highly specific for the early recognition of AKI. PMID:27275158

  5. Risk Factors of Attempted Suicide in Bipolar Disorder

    ERIC Educational Resources Information Center

    Cassidy, Frederick

    2011-01-01

    Suicide rates of bipolar patients are among the highest of any psychiatric disorder, and improved identification of risk factors for attempted and completed suicide translates into improved clinical outcome. Factors that may be predictive of suicidality in an exclusively bipolar population are examined. White race, family suicide history, and…

  6. UNRECOGNIZED OR POTENTIAL RISK FACTORS FOR CHILDHOOD CANCER

    EPA Science Inventory

    Traditional epidemiological studies suggest that the contribution of environmental agents to childhood cancer may be minor. However, epidemiological methods can only seldom identify ca