Accumulation Of Multiple Risk Factors Research Articles

ASSOCIATION OF URIC ACID WITH COMPONENTS OF METABOLIC SYNDROME AT A TERTIARY CARE CENTRE IN BENGALURU

Background: Metabolic syndrome (MetS) is also known as syndrome X, insulin resistance syndrome is dened as a group of disease developed due to accumulation of multiple risk factors that includes resistance to insulin, dyslipidemia, abdominal obesity and hypertension. Metabolic syndrome, is associated not only with type 2 diabetes mellitus and cardiovascular disease, but also with many other systemic disorders such as cerebrovascular accident, chronic lung disease and fatty liver disease. Hyperuricemia (above 7.0 mg/dL in men and 6.0 mg/dL in women) has been reported to be closely related to diabetes, hypertension, obesity, renal function decline, and cardiovascular disease, most of which are principal contributors in the development and progression of MetS. The study aimed to assess the associations of serum uric acid with the components of MetS. Methods: This cross-sectional study was conducted in the hospitals attached to Bangalore medical college and research Institute. 110 patients with metabolic syndrome who satised the inclusion criteria were included. Data was collected in the form of history, clinical examination, and relevant investigations. Statistical analysis was performed using SPSS software, p value of <0.5 being signicant Results: The mean age of the study participants was found to be 51.55+7.760 years of age. 62.7% of the study participants were males The mean serum uric acid level of the study participants was found to be 6.325+2.7910. 41.82% of the study participants who had metabolic syndrome had hyperuricemia. The association was found to be statistically signicant between hyperuricemia and hypertension, central obesity, low HDL, high FBS among the study participants. Conclusions: Serum uric acid is closely associated with metabolic syndrome and its components. Serum uric acid can also be considered as a mandatory investigation in patients who has any of the ve components of metabolic syndrome

Community-based service requests and utilization among pregnant women incarcerated in jail.

Pregnant incarcerated women represent a unique population in the criminal justice system that has been largely overlooked in terms of their service-related needs. The present study examines 241 pregnant incarcerated women's service requests and preincarceration service utilization related to material help (e.g., food, housing), mental health (e.g., counseling), family services (e.g., home-visiting nurses), and health care (e.g., insurance). A subsample (n = 74) also provided information about service utilization following their release from jail. Analyses examined request and utilization patterns in relation to other sociodemographic risk experiences. Results show that specific risk factors such as age, as well as the accumulation of multiple risk factors, served as barriers to requesting and accessing community-based services. The present study illuminates unique challenges pregnant incarcerated women experience requesting and utilizing services. The results support the use of a gender-responsive, trauma-informed approach to better address the needs of these women. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Visceral Fat-Reducing Effect and Safety of Continuous Consumption of Beverage Containing Resistant Maltodextrin: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Clinical Trial.

Obesity is regarded as a global concern with increasing prevalence, most notably in developed countries. Metabolic syndrome is a predictor of cardiovascular disease and type 2 diabetes mellitus and is defined as the accumulation of multiple risk factors caused by abdominal visceral obesity. Resistant maltodextrin (RMD) is a soluble dietary fiber that has been shown to reduce visceral fat in long-term clinical trials when continuously administered at 10 g, three times daily. Herein, we evaluated the effects of long-term consumption of 5 g RMD three times daily. A total of 140 healthy adults were randomly assigned to two intervention groups for a 12-wk randomized, double-blind, placebo-controlled, parallel-group trial. Participants ingested a test beverage containing 5 g RMD or a placebo beverage without RMD. Interviews, anthropometric measurements, physiological examination, blood tests, and urinalyses were conducted at baseline and every 4 wk during the trial. Computed tomography scans were performed at baseline and at the end of week 8 and 12. Results showed that abdominal visceral fat area (VFA) significantly decreased in the test group from 105.33±26.83 cm2 at baseline to 101.15±24.33 cm2 at week 12. Further, a significant difference was observed in the VFA between the test and control groups (p<0.05), confirming the function of continuous RMD consumption in reducing abdominal visceral fat. Furthermore, neither serious adverse events nor adverse clinical findings were observed in the blood or urine tests following consumption of RMD, suggesting that continuous consumption of RMD containing beverages is safe.

ACCUMULATION OF DEMENTIA RISK FACTORS ALTERS BRAIN REGIONS OF EPISODIC MEMORY: AN FMRI ANALYSIS

Longitudinal research suggests that genetic, lifestyle, and environmental factors enhance one's risk for developing Alzheimer's disease and related dementias (ADRD). However, it is not known how an accumulation of multiple risk factors alters brain function. One barrier to this research is that increased risk for ADRD affects the cerebrovascular system, thus decoupling neural activity from the fMRI blood oxygen level dependent (BOLD) signal. Previous studies that have found an association between risks for ADRD and brain activity suffer challenges in interpretation because the BOLD signal was not calibrated, likely leading to an overestimation of such associations. We hypothesized that as the number of ADRD risk factors increase, brain regions within the medial temporal lobes and the default mode network (DMN) would exhibit altered brain activity during an episodic memory retrieval task. To reduce the influence of non-neural influences on the BOLD signal, several steps were taken to calibrate fMRI BOLD activity. Participants ranged in age from 50 to 70 years. Participants were recruited with varying levels of risk for dementia and from this initial screening a dementia risk score was calculated. They also underwent a neuropsychological battery to screen out possible dementia. Using fMRI, brain activity was assessed while participants completed a memory task by viewing a pair of pictures, followed by an alternative-forced-choice test, where participants viewed a picture cue and had to determine which of four pictures was paired with the cue. After correcting the fMRI BOLD signal, whole-brain analyses revealed that increased dementia risk was negatively associated with brain activity in the hippocampus—a task positive region—and was positively associated with the lateral parietal cortex—a task negative region. We found evidence that adults with an accumulation of risk factors for dementia exhibit decreased modulation of brain activity in critical regions underlying episodic memory. These findings call into question previous studies that did not calibrate the BOLD signal and found compensatory hyperactivity in these regions. Instead, cumulative risk likely represents early dysfunction of the default mode and brain regions underlying episodic memory.

Analysis of risk factors for central lymph node metastasis in papillary thyroid microcarcinoma

Objective: To analyze the risk factors of lymph node metastasis in central region of patients with papillary thyroid microcarcinoma (PTMC). To evaluate the reliability of different risk factors on the prognosis of cervical lymph node metastasis in PTMC patients, and to provide the clinical support for PTMC in the central area. Methods: The clinical data of 700 patients with PTMC treated with surgery from January 2015 to July 2017 were analyzed retrospectively. Risk factors for lymph node metastasis in central region were analyzed by single factor analysis, multivariate Logistic regression analysis and receiver operating characteristic curve (ROC) curve. Results: Central lymph node metastasis (CLNM) rate was 48.29% (338/700). Multifactor analysis indicated that age≤45 years old, male, multifocality, capsule invasion, the tumor calcification and tumor diameter ≥5 mm were independent risk factors for CLNM in patients with PTMC. In the risk prediction of CLNM, the optimal critical value of diameter prediction was 7 mm and the area under the curve (AUC) of ROC=0.647. The optimal threshold for age prediction was 41 years old and AUC=0.597. Single factor analysis for ROC curve showed that gender factor AUC=0.588, tumor number factor AUC=0.627, tumor location factor AUC=0.613. and calcification factor AUC=0.603. The ROC curve of multiple risk factors was analyzed according to age, gender, diameter, location, number of cancer foci and calcification, and AUC=0.768. Conclusions: Age less than 45 years old, male, multiple cancer foci, focal invasion and capsule invasion, calcification, and tumor diameter ≥5 mm are independent risk factors for CLNM of PTMC. With an accumulation of multiple risk factors, CLNM risk increases, and central lymph node dissection should be recommend.

Understanding Child Outcomes within a Multiple Risk Model: Examining Parental Incarceration

The risks in children’s lives often co-occur and overlap in time. The purpose of this study is to examine the impact of parental incarceration within a multiple risk model that allows for the control of other prominent risk factors in a child’s life. The impact of four primary parental risk factors (parental mental illness, parental substance use, parental mental illness, and poverty) on seven child outcomes (school failure, criminal behaviors, being arrested, behavioral difficulties, emotional difficulties, alcohol use, and drug use) was examined. The study utilizes a statistical analysis that is rarely seen in social work research and helps the researcher to better understand the individual contributions of various risk factors. The accumulation of multiple risk factors in a child’s life was found to significantly increase the likelihood that several negative outcomes would occur. The research, however, suggests further that this is an over simplification of the phenomenon and that specific risk factors are more likely to contribute to specific child outcomes.

Finding Hope in Hopeless Environments

IntroductionThe majority (75%) of lifetime cases of mental, emotional, and behavioral disorders start by age 24 (1,2). These disorders result from complex interactions of personal and ecological risk and protective factors, which have potential to alter children's developmental trajectories and course outcomes. Adolescence is a time when influences outside home expand, but when family resources and early childhood experiences are still important. The harmful or protective impact of these influences have potential to alter course trajectory by affecting adolescent education, health and risk taking behavior that influence future morbidity and mortality.Pessimistic predictions about future reflect a sense of hopelessness and/or learned helplessness and are associated with an increased risk for many of mental, emotional, and behavioral disorders seen in adolescence and young adulthood. Previous studies have identified individual and environmental characteristics of youth with pessimistic predictions about future (3-5). Hopelessness is often associated with poverty, which results in accumulation of multiple risk factors. However, poverty does not always result in poor health and developmental outcomes, as financial capital is only one of valuable resources in human ecology and it is not only determinant of health (6). The AAP Policy Statement for Child Rights and Health Equity recognizes other forms of human capital (personal, social, environmental, educational) that contribute to a child's health and well-being (7).The identification of risk factors and their association with poor outcomes do not explain those youth who are resilient and have good outcomes despite their exposure to risk factors (8). Resiliency is the human capacity to face, overcome, and even be strengthened by adversities of life (9). It may be explained by impact of alternate forms of human capital, which mitigate effects of low financial capital. Resiliency in adolescence and young adulthood has been associated with youth, family and environmental characteristics such as intellectual resources, optimistic future orientation, presence of caring relationships with positive adult role models, and opportunities to succeed (10, 11).Hope is a form of personal capital that correlates with and predicts rates of many outcomes, including academic achievement, initiation of early sexual activity, and violence perpetration. Figure 1 shows a pictorial representation of correlates of hope found in previous studies (3-5,12-15). Snyder proposed a similar definition of hope, consisting of three components: goals, agency, and pathways. Agency refers to a person's self-appraisal of their capacity to change outcomes and to plan (pathways) for goal attainment and adjust those plans when faced with barriers (16).Goal achievement results in positive self-esteem and a feeling of competency, which affects degree of hope in future goal-directed behavior. If youth encounter barriers, such as those inherent in economic disadvantage, that result in repeated failures, self- esteem suffers and future possibilities may seem limited. Whether hope is measured with a scale or inferred through predictions of future, level of hope in a child or adolescent correlates with concurrent risk factors and behaviors and is predictive of future morbidity and mortality.This study uses elements of human capital investment as a framework to analyze individual and contextual contributions to adolescent hope, or those with an optimistic future orientation. The hypothesis is that multiple forms of human capital (social, environmental, educational, economic) promote hope regardless of economic disadvantage.MethodsData for this study are from National Longitudinal Study of Adolescent Health (Add Health). Add Health is largest, most comprehensive longitudinal survey of adolescents in United States. …

Childhood Cumulative Risk and Obesity: The Mediating Role of Self-Regulatory Ability

We tested whether early childhood risk exposures are related to weight gain in adolescence and evaluate an underlying mechanism, self-regulatory behavior, for the risk-obesity link. Cumulative risk exposure to 9 sociodemographic (eg, poverty), physical (eg, substandard housing), and psychosocial (eg, family turmoil) stressors was assessed in 244 nine-year-old children. BMI was calculated at age 9 and then 4 years later. At age 9, children's ability to delay gratification as an index of self-regulatory behavior was assessed. Path analyses were then estimated to evaluate our mediational model (Cumulative risk → Self-regulation → BMI) over a 4-year period in a prospective, longitudinal design. Nine-year-old children exposed to a greater accumulation of multiple risk factors show larger gains in adiposity over the next four year period, net of their initial BMI. These gains in BMI during early adolescence are largely accounted for by deteriorated self-regulatory abilities among children facing more cumulative risks. Early childhood risk exposure leads to larger gains in BMI in adolescence. Given the importance of childhood adiposity to the development of obesity later in life, understanding the underlying mechanisms that link early experience to weight gain is an essential task. Deficiencies in self-regulation in response to chronic stress appears to be an important agent in the obesity epidemic.

Evolution of the clinical presentation of men undergoing radical prostatectomy for high-risk prostate cancer

Study Type – Prognosis cohort series (multi-centre) Level of Evidence 4 What's known on the subject? and What does the study add? Men with high-risk prostate cancer experience recurrence, metastases and death at a higher rate in the prostate cancer population. This study adds greater than 20-year data regarding the continued evolution of high-risk prostate cancer toward high-Gleason disease as the sole determinant of high-risk status prior to radical prostatectomy. It validates the accumulation of multiple-risk factors as a poor prognostic indicator in a radical prostatectomy population and demonstrates long-term cancer specific outcomes, extending the findings demonstrated by previous publications. OBJECTIVE • To investigate the outcomes and potential effect of improved longitudinal screening in men presenting with high-risk (advanced clinical stage [>T2b], Gleason score 8–10 or prostate-specific antigen [PSA] level >20 ng/mL) prostate cancer (PC). PATIENTS AND METHODS • The Institutional Review Board approved, Institutional Radical Prostatectomy Database (1992–2010) was queried for men with high-risk PC based on D'Amico criteria. • Year of surgery was divided into two cohorts: the Early PSA Era (EPE, 1992–2000) and the Contemporary PSA Era (CPE, 2001–2010). • PC features and outcomes were evaluated using appropriate comparative tests. RESULTS • In total, 667 men had high-risk PC in the EPE and 764 in the CPE. • In the EPE, 598 (89.7%) men presented with one high-risk feature; 173 (29.0%) men had a Gleason score of 8–10 on biopsy. In the CPE, 717 (93.9%) men presented with one high-risk feature (P= 0.004) and 494 (68.9%) men had a Gleason score of 8–10. • At 10 years, biochemical-free survival (BFS) was 44.1% and 36.4% in the EPE and CPE, respectively (P= 0.04); metastases-free survival (MFS) was 77.1% and 85.1% (P= 0.6); and PC-specific survival (CSS) was 83.3% and 96.2% (P= 0.5). • BFS, MFS and CSS were worse for men with more than one high-risk feature in both eras. CONCLUSIONS • Over the PSA era, an increasing percentage of men with high-risk PC were categorized by a biopsy Gleason score of 8–10. • The accumulation of multiple high-risk features increases the risk of biochemical recurrence, the development of metastases and death from PC. • BFS, MFS and CSS are stable over the PSA era for these men. The balance between a greater proportion of men having high Gleason disease and a greater proportion with small, less advanced tumours may explain the stability in MFS and CSS over time.

An ecological perspective on cumulative school and neighborhood risk factors related to achievement

Most educational reform programs, including No Child Left Behind, operate from the perspective that gaps in academic achievement can be reduced by improvements in the educational process directed by school administrators and teachers. This perspective ignores the ecological context in which underachieving schools are typically embedded. Using a developmental approach, we show that school-wide achievement of elementary school children in New York City, the nation's largest public school system, is better characterized by the accumulation of multiple risk factors within schools and within the neighborhoods where they are situated. School risk factors include teacher experience, teacher and student mobility, teacher absences, and school building quality. Neighborhood risk factors include proportion in poverty, parental educational attainment, proportion of single parents, housing quality, residential crowding, and neighborhood deterioration. Cumulative risk within each of these ecological domains, as well as their interaction, is significantly associated with school-wide achievement.

Coronary Risk Factor Profile and Prognostic Factors for Young Japanese Patients Undergoing Coronary Revascularization

The prevalence of coronary artery disease (CAD) is increasing in young adults. Risk factor profiling will help to prevent heart attacks in young patients. This study aimed to analyze the risk factor profile and predictors of major cardiovascular events (MACE) in young CAD patients. From the Coronary REvascularization Demonstrating Outcome study in the Kyoto (CREDO-Kyoto) registry of Japanese patients undergoing their first coronary revascularization, 6,320 patients with complete data for all variables for statistical analyses were divided into younger (< or =55 years; n=898; 14.3%) and older (>55 years; n=5,422; 85.7%) patients. The risk factors that were more prevalent in the younger patients than in the older patients included: male sex, body mass index of >25 kg/m(2), current smoker, family history of CAD, dyslipidemia and metabolic syndrome-like risk factor accumulation. Multivariate analyses revealed that chronic kidney disease (CKD) was the only significant predictor of MACE, the composite of cardiovascular death, myocardial infarction and cerebrovascular accident, in the younger patients. Importance of CKD as a prognostic factor was consistently shown by a multivariate analysis in the older patients. Accumulation of multiple risk factors is prevalent and CKD is associated with MACE in young Japanese CAD patients.

Insulin Enhancement of Cytokine-Induced Coagulation/Inflammation-Related Gene Transcription in Hepatocytes

Hyperinsulinemia is a known risk factor for cardiovascular events, but its molecular basis is not completely understood. In this study, we examined the effects of insulin alone, or insulin and proinflammatory cytokines, on the expression of inflammation/coagulation-related genes in hepatocytes. We found that, in the HepG2 human hepatocyte cell line, insulin stimulated the transcriptional activity of plasminogen activator inhibitor 1 (PAI-1), fibrinogen-gamma and C-reactive protein (CRP) genes in time- and dose-dependent manners. These effects were completely inhibited by MAP kinase inhibitor PD98059, but not by PI3 kinase inhibitor wortmannin. As previously reported, proinflammatory cytokines like interleukin 1beta and interleukin 6 showed stimulatory effects on the expression of these genes, and we now found that the combination of insulin and the cytokines showed more than additive effects in most cases. Interleukin 1beta and insulin also cooperatively increased the endogenous mRNA level of PAI-1. These results suggest that the coexistence of high insulin and cytokines may induce inflammation and hypercoagulation in a synergistic manner. This may partly explain why the accumulation of multiple risk factors, especially hyperinsulinemia caused by insulin resistance and enhanced production of proinflammatory cytokines, results in inflammation, thrombosis, and cardiovascular events in metabolic syndrome.

Prevalence of metabolic syndrome compared between native Japanese and Japanese-Americans

Metabolic syndrome is a condition characterized by the accumulation of multiple risk factors for atherosclerosis. Japanese-Americans in the U.S. have a more rapid and intense progression of atherosclerosis than native Japanese in Japan due to a westernization of their lifestyle. We investigated the prevalence of metabolic syndrome between 416 native Japanese (194 men and 222 women) in Hiroshima and 574 Japanese-Americans (217 men and 357 women) in Los Angeles, aged 30–89 years. According to the criteria proposed by the Japanese Society of Internal Medicine, the prevalence was 13.9 and 2.7% for native Japanese men and women, and 32.7 and 3.4% for Japanese-American men and women, respectively. According to the IDF or AHA/NHLBI criteria, the prevalence was 20.1 and 6.3%, and 38.7 and 4.5%, or 13.4 and 14.4%, and 30.9 and 27.7%, respectively. Thus, the prevalence of metabolic syndrome in men was significantly higher in Japanese-American than in native Japanese by all the three criteria. However, the prevalence in women was similar between native Japanese and Japanese-American by the Japanese and IDF criteria, whereas it was significantly higher in Japanese-American than in native Japanese by the AHA/NHLBI criteria. This report demonstrates that a westernization of lifestyle can increase the prevalence of metabolic syndrome among Japanese-Americans as compared to native Japanese.

Cumulative Risk and Low-Income Children's Language Development

This study utilized an electronic data linkage method to examine the effects of risk factors present at birth on language development in preschool. The Preschool Language Scale-3 (PLS-3) was administered to 853 low-income children, and cumulative risk data were abstracted from linked birth records. At least one risk factor was present in 94% of this sample, while 39% were exposed to three or more risk factors. On average, a girl's PLS-3 Total Score decreased by 2.3 points with each risk factor; the average decrease for boys was 1.1 point per risk factor. The accumulation of multiple risk factors thus appears to increase the negative effects of poverty. Researchers are encouraged to use historical administrative data sets to support prevention and early identification efforts.

Contribution of a missense mutation (Trp64Arg) in beta3-adrenergic receptor gene to multiple risk factors in Japanese men with hyperuricemia.

Epidemiological data reveal that hyperuricemia is a risk factor of atherosclerosis. The risk is possibly caused by a link between hyperuricemia and insulin resistance-related metabolic syndrome. Recently it has been proposed that a missense mutation (Trp64Arg) in the beta3-adrenergic receptor (beta3-AR) gene may contribute to the accumulation of multiple risk factors related to insulin resistance. The present study was undertaken to further clarify an association between the Trp64Arg mutation and the metabolic syndrome in 47 Japanese men with hyperuricemia, who are substantially at high risk of atherosclerosis. One patient (2%) had the homozygous mutation, 12 (26%) were heterozygous for the mutation, and 31 (72%) had no mutation found by the PCR-RFLP analysis. The Trp64Arg mutation was not related to past maximal body mass index (BMI), BMI and waist/hip ratio. The subjects with the heterozygous mutation showed a slightly higher incidence of impaired glucose tolerance and diabetes mellitus in the 75 g oral glucose challenge (67%), as compared with those without the mutation (39%). Serum insulin response at 60 min and the sum of serum insulin in the glucose challenge were greater in the former subjects than those in the latter subjects (P=0.041 and 0.076, respectively). An increase in serum lipoprotein(a) was also observed in the subjects with the heterozygous mutation, but the Trp64Arg mutation was not associated with other dyslipidemia, blood pressure or ischemic changes on the electrocardiogram. These results indicate that the heterozygous mutation of Trp64Arg in the beta3-AR gene partly contributes to the accumulation of multiple risk factors in male subjects with hyperuricemia. A larger prospective study is necessary to elucidate a possible role of the Trp64Arg mutation in atherosclerotic diseases in future.