Combination Of Multiple Risk Factors Research Articles

2446. Effect of the Implementation of a Fluconazole Prophylaxis Protocol on the Incidence of Invasive Fungal Infection in High-Risk Neonates

Abstract Background Invasive fungal infection (IFI) is one of the most important causes of morbidity and mortality in the neonatal intensive care unit. International societies have supported the use of fluconazole prophylaxis for neonates weighing < 1000 grams, but administration to other high-risk patients remains controversial. An institutional fluconazole prophylaxis guideline was implemented in December 2020 to include two other groups of neonates. Methods One hundred thirty infants who were admitted at the NICU from January 2020 to January 2022 and fulfilled one of the following criteria: weight of < 1000 grams (Group A), weight of ≤1500 grams and on broad-spectrum antibiotics (Group B), or weight of >1500 grams and on prolonged nil per os (NPO) (Group C) were included in the study. They were divided into two groups: those who were born prior to the implementation of the protocol (January to December 2020) and not given fluconazole prophylaxis, and those born after (January 2021 to January 2022) and given prophylaxis. The primary outcome was the development of IFI. Results A total of 130 infants were included in this study with 21 (5 control, 16 prophylaxis), 69 (28 control, 41 prophylaxis), and 40 (16 control, 24 prophylaxis) patients in Groups A, B, and C, respectively. There were no significant differences in the development of IFI among the groups (Group A: control - 40%, prophylaxis - 62%; Group B: control - 21.4%, prophylaxis - 22%; Group C: control - 29.2%, prophylaxis 31.5%) with a p-value of > 0.05. The presence of a central vascular access line, endotracheal tube, placement on NPO, histamine H2-blockers, and necrotizing enterocolitis were associated with the development of IFI. Candida parapsilosis comprised 60% of isolates. All isolates had 100% susceptibility to fluconazole. Jaundice developed in 3.7% of patients given fluconazole, with elevations in AST, ALT, and TB. Incidence of fungal infection in high-risk neonates There were no significant differences in the development of IFI among the three high-risk groups, with p-value of > 0.05. Conclusion Invasive fungal infection remains a heavy burden to high-risk neonates. The protocol at present does not significantly prevent the occurrence of IFI. There is a need to revise the protocol to include the presence of a combination of multiple risk factors (central line, endotracheal tube, prolonged NPO, H2-blockers, and necrotizing enterocolitis) before initiating fluconazole prophylaxis. Disclosures All Authors: No reported disclosures

Older People Living Alone: A Predictive Model of Fall Risk.

Falls in older people are a result of a combination of multiple risk factors. There are few studies involving predictive models in a community context. The aim of this study was to determine the validation of a new model for predicting fall risk in older adults (65+) living alone in community dwellings (n = 186; n = 117) with a test-retest reliability study. We consider in the predictive model the significant factors emerged from the bivariate analysis: age, zone, social community resources, physical exercise, self-perception of health, difficulty to keep standing, difficulty to sit and get up from a chair, strain to see, use of technical devices, hypertension and number of medications. The final model explained 28.5% of the risk of falling in older adults living alone in community dwellings. The AUC = 0.660 (se = 0.065, IC 95% 0.533-0.787, p = 0.017). The predictive model developed revealed a satisfactory discriminatory performance of the model and can contribute to clinical practice, with respect to the evaluation of risk of falling in this frailty group and preventing falls.

Influence of analytic methods, data sources, and repeated measurements on the population attributable fraction of lifestyle risk factors

Population attributable risk (PAR%) reflects the preventable fraction of disease. However, PAR% estimates of cancer have shown large variation across populations, methods, data sources, and timing of measurements. Three statistical methods to estimate PAR% were identified from a systematic literature review: the Levin’s formula, the comparative incidence rate method, and the comparative risk assessment method. We compared the variations in PAR% of postmenopausal breast cancer in the Nurses’ Health Study to evaluate the influence by method choice, source of prevalence data, use of single vs repeated exposure measurements, and potential joint effects of obesity, alcohol, physical activity, fruit and vegetable intake. Across models of the three methods, the estimated PAR% using repeated measurements were higher than that using baseline measurement; overall PAR% for the baseline, simple update, and cumulative average models were 13.8%, 21.1%, 18.6% by Levin’s formula; 13.7%, 28.0%, 31.2% by comparative risk assessment; and 17.4%, 25.2%, 29.3% by comparative incidence rate method. The estimated PAR% of the combination of multiple risk factors was higher than the product of the individual PAR%: 18.9% when assuming independence and 31.2% when considering the risk factors jointly. The three methods provided similar PAR% based on the same data source, timing of measurements, and target populations. However, sizable increases in the PAR% were observed for repeated measures over a single measure and for calculations based on achieving all recommendations jointly rather than individually.

Inequality in smoking and related risk factors for smoking in expectant mothers - a nationwide Danish register-based study.

Foetuses exposed to smoking during pregnancy are disadvantaged due to numerous adverse obstetric outcomes. This study aimed to examine 1) inequality in maternal smoking between subgroups of pregnant women and 2) significant risk factors of maternal smoking. Data were collected from Danish registries. Trends in maternal smoking within each study period, T1 (2000-2002) and T2 (2014-2016), were investigated by Poisson regression calculating prevalence proportion ratios, and trends between study periods were studied by adding an interaction term. The significance of risk factors for maternal smoking (low age, low education, living alone and having a moderate/severe mental health condition) were studied by interaction analysis on the additive scale. The prevalence of maternal smoking decreased from 21% in 2000 to 7% in 2016. Decreases were found in all subgroups of maternal age, cohabitation status, educational level and mental health condition. However, large differences in smoking prevalence between subgroups were found, and inequality in maternal smoking increased from 2000 to 2016. The probability of maternal smoking increased with the addition of risk factors, and positive additive interactions were found for almost all combinations of multiple risk factors. Our results provide knowledge on risk factors and increasing levels of inequality in maternal smoking which points to a need for targeted interventions in relation to maternal smoking for subgroups of pregnant women in future smoking cessation programmes and in antenatal care.

Ventricular fibrillation during carotid endarterectomy and bailout stenting: a case report

BackgroundCarotid artery manipulation is not a special technique but reports of intraoperative ventricular fibrillation are rare. The risk of fatal arrhythmias may be hidden behind routine surgical techniques and anesthetic management. We focused on QT prolongation and QT dispersion.Case presentationA 77-year-old man underwent carotid endarterectomy and bailout stenting. Although there were no obvious preoperative risk factors for intraoperative ventricular tachyarrhythmia, ventricular fibrillation (VF) had occurred during a maneuver of the carotid artery under hypercapnia. QTc was prolonged from 317 ms before surgery to 458 ms before the onset of VF. QTc dispersion between leads II and III was also increased to 50 ms. Hypomagnesemia was noted after resuscitation by electrical defibrillation, adrenaline, and noradrenaline.ConclusionsWe considered that the combination of multiple risk factors led to the development of ventricular fibrillation. It should be noted that carotid artery manipulation has the potential to cause arrhythmias.

MicroRNA 155:145 ratio as a marker of atherogenic tilt manifested across different age groups and risk factor profiles

Abstract Funding Acknowledgements Type of funding sources: None. Background Differential expression of microRNAs is critical in the genesis and progression of atherosclerosis. MiR145 has atheroprotective role through improved homeostasis of smooth muscle cells (SMC). MiR155 is pro-atherogenic due to its suppression of Bcl6, which antagonises NF-κB and modulates macrophages. Purpose Our purpose was to determine if the differential expression of miR 155 & 145 (expressed as miR 155:145 ratio) across various age groups and risk factor profiles correlates with atherosclerotic cardiovascular disease (ASCVD). Materials and Methods This observational cross-sectional study was done between Feb"19 & Jan"20 on 108 patients divided equally into 3 age groups: <18, 18-45 & >45yrs. Family history (of ASCVD or risk factors) and risk factor profile were assessed in all 3 groups; and in the latter two, presence or absence of ASCVD was additionally evaluated by coronary angiogram and/or carotid IMT. MiR155 & 145 were measured in all by RT-PCR, & the results were then compared after calculating the ratio. Results miR 155:145 ratio was significantly increased in <18yrs aged subjects with a positive family history(p = 0.001). Multivariate regression analysis revealed a significant positive correlation of miR155:145 with family history of risk factors or ASCVD in this group(p < 0.001). In the 18-45yrs age group, the miR 155:145 ratio was found to be significantly increased in patients with diabetes(p = 0.037) and significant coronary artery disease(CAD) as determined by Syntax score(p < 0.001). In multivariate regression analysis, a significant positive correlation was found between miR 155:145 and Syntax score(p < 0.001) – a ratio of 155:145 > 1 implied a greater chance of CAD, with increased numerical values correlating with increased severity of disease as evidenced by Syntax score; and a ratio < 1 decreased the chances of significant CAD considerably. A positive association was also discovered for this ratio with hypertension, diabetes, tobacco exposure and a combination of multiple risk factors, but none of them were statistically significant. In the age group of >45 yrs, regression analysis revealed a statistically insignificant positive association of the miR 155:145 ratio with Syntax score, hypertension, dyslipidaemia and a combination of risk factors. Conclusion MiR 155:145, when >1, can point towards an ‘atherogenic tilt’, and greater increase in the ratio numerically may denote more severe disease, as indicated by a positive association with Syntax Score. This atherogenic tilt occurs very early in life, even before 18 years with significant family history. Above 18 years, with addition of other risk factors, this tilt is further compounded, and correlated well with Syntax score and such risk factors. Therefore, miR 155:145 ratio may help in identifying the individuals at risk for development of clinically significant CAD and can be utilised for development of future therapeutic strategies as well as prognostication. Abstract Figure 1 Abstract Figure 2

An Evaluation of Multiple Behavioral Risk Factors for Cancer in a Working Class, Multi-Ethnic Population

Behavioral risk factors for cancer tend to cluster within individuals, which can compound risk beyond that associated with the individual risk factors alone. There has been increasing attention paid to the prevalence of multiple risk factors (MRF) for cancer, and to the importance of designing interventions that help individuals reduce their risks across multiple behaviors simultaneously. The purpose of this paper is to develop methodology to identify an optimal linear combination of multiple risk factors (score function) which would facilitate evaluation of cancer interventions.

Impact of the COVID⁃19 outbreak on depression and anxiety among perinatal women in Wuhan

Objective: To evaluate the effect and analysis of coronavirus disease 2019 (COVID‑19) on depression and anxiety of perinatal women in Wuhan. Methods: A total of 176 perinatal women were selected, who were delivered in Renmin Hospital of Wuhan University from January 24 to March 29, 2020. The general information of the patients was evaluated. The anxiety self‑assessment scale (SAS) and depression self‑assessment (SDS) were used before delivery. The Edinburgh Postpartum Depression Scale (EPDS) was used to assess depression from 10 days to 14 days after delivery. The main factors affecting maternal depression and anxiety were investigated and analyzed. Results: During the outbreak of COVID‑19, the incidence of anxiety (SAS score ≥50) was 47.73% (84 cases), and the incidence of depression (SDS score ≥0.5) was 54.55% (96 cases) before delivery. The incidence of depression (EPDS score≥0.5) was 44.89% (79 cases) after delivery. The prenatal SAS score was related to depression after delivery ( r =0.641, P <0.001), and the prenatal SDS score was also related to depression after delivery ( r =0.740, P <0.001). Logistic analysis indicated that worrying about the risk of COVID‑19 infection ( OR =3.816, 95% CI :1.688⁃8.627, P =0.001), poor sleep quality ( OR =2.448, 95% CI : 1.053~5.694, P =0.038) and dyspnea in mask ( OR =2.464, 95% CI : 1.009⁃6.014, P =0.048) were the main risk factors for postpartum depression in pregnant women during outbreak of COVID‑19. Conclusion: The outbreak of COVID‑19 increased the incidence of maternal depression and anxiety during perinatal period, which was significantly related to the combination of multiple risk factors caused by the outbreak of COVID‑19. These provide an effective prevention strategy for preventing the postpartum depression during the outbreak of COVID‑19. © 2021, Editorial Board of Medical Journal of Wuhan University. All right reserved.

Farnesoid X Receptor Agonists as Therapeutic Target for Cardiometabolic Diseases.

Cardiometabolic diseases are characterized as a combination of multiple risk factors for cardiovascular disease (CVD) and metabolic diseases including diabetes mellitus and dyslipidemia. Cardiometabolic diseases are closely associated with cell glucose and lipid metabolism, inflammatory response and mitochondrial function. Farnesoid X Receptor (FXR), a metabolic nuclear receptor, are found to be activated by primary BAs such as chenodeoxycholic acid (CDCA), cholic acid (CA) and synthetic agonists such as obeticholic acid (OCA). FXR plays crucial roles in regulating cholesterol homeostasis, lipid metabolism, glucose metabolism, and intestinal microorganism. Recently, emerging evidence suggests that FXR agonists are functional for metabolic syndrome and cardiovascular diseases and are considered as a potential therapeutic agent. This review will discuss the pathological mechanism of cardiometabolic disease and reviews the potential mechanisms of FXR agonists in the treatment of cardiometabolic disease.

Endangered Municipalities ? Case Study of Three Small and Critically Indebted Czech Municipalities

AbstractThis paper addresses the issue of Czech small critically indebted municipalities, which has been neglected in the European discourse after successful European consolidation reforms. The Czech Republic is one of the Central European countries where there is no relevant debate on the mandatory amalgamation of small municipalities that are often faced with a combination of multiple risk factors.This paper aims to analyze a sample of the Czech municipalities that are threatened by a combination of their small size and critical indebtedness. A research of the sample focuses on a) the identification of the reasons for critical indebtedness, b) the impact of critical indebtedness on the delivery of services and local democracy and c) the options and strategies to overcome the issues related to critical indebtedness.Methodologically, the paper is a multiple-case study of three small critically indebted municipalities of the Karlovy Vary region, which was considered the worst region in 2012 in terms of the share of critically indebted municipalities, with several long-term critically indebted municipalities on its territory. Based on the media monitoring and economic criteria, the municipalities of Prameny, Bublava and Nebanice have been chosen.The main finding of our research is the identification of so-called endangered chains: 1) small municipalities with low revenues resulting in 2) limited administrative and expert capacity that contributes to 3) a mistake in a large investment project resulting in 4) the economic collapse of the municipality that endangers the provision of services, and in the case of 5) insufficient social capital this can lead to agony of local self-government and the collapse of the municipality. According to the findings, the examined municipalities of Nebanice and Bublava correspond to the chain link 4, and in the case of Prameny it is possible to speak about the chain link 5.

A Comparative Study on Monotherapy with Metformin, Vit-B3, Vit- D, Chromium Piconilate and Lifestyle Modification in development of Type II Diabetes Mellitus in the Metabolic Syndrome Patients

Background: Metabolic syndrome is a combination of multiple risk factors that increases an individual chance of developing cardiovascular or type II diabetes mellitus and most of people with metabolic syndrome have Insulin resistance, which elevates the risk of developing Type II diabetes mellitus. While the pathogenesis of the metabolic syndrome and each of its components is complex and not well understood, central obesity and insulin resistance are acknowledged as important causative factors. Most scrutinized literature was collected from different sources including PubMed. This study was carried out at Govt. Chhattisgarh Institute of medical sciences Bilaspur. Aim: To compare the incidence of progression of metabolic syndrome into type II diabetes mellitus in patient who were put on one of the following treatments along with lifestyle modification :- Metformin, Chromium Piconilate ,Vitamin –D3 and Niacin (Vitamin. - B3).Methods: The objective of this study recruited 250 patient, aged between 35 to 60 years, who fulfilled the inclusion and exclusion criteria of Metabolic syndrome as per study design. Results: 250 Participants was enrolled during 3 years of the study. 125 (50 %) male and 125 (50 %) Female were found metabolic syndrome. A total (8%) of patient were found incidence of progression of metabolic syndrome into Type II Diabetes Mellitus. In different group as Metformin group-(0%), Niacin group (6%), Vit-D3 group (0%), Chromium Piconilate group (16 %) and (18%) in the lifestyle modification group. Conclusions: Metformin and Vit- D3 can reverse the effects of metabolic syndrome due to its broad effects on many of the components of metabolic syndrome; thus preventing diabetes and heart disease.

Orthopaedic complications of falls in elderly patients: a brief review

Falls are frequent and often cause morbidity, mortality, and disability that require regular nursing. Most of these falls are associated with one or more identifiable risk factors, such as weakness, unsteady gait, confusion and medication use. Usually, it occurs due to a combination of multiple risk factors, such as imbalance, degenerative diseases, porotic bone, and metabolic disturbances. Though in the orthopaedic field, falls will most often result in injury such as femoral neck and proximal humerus fractures, all other parts of the body may also be affected due to various mechanisms of injury. As a disabling phenomenon, fractures due to falls in elderly may then proceed to series of complications, from early to late complications, from local (such as nonunion, muscle atrophy, disuse osteoporosis, etc) to systemic complications (such as pressure sores, pneumonia, ulcers, urinary tract infection, ileus, etc). Therefore, prevention will play a critical role in this particular situation.

Newborn Risk Factors for Subsequent Physical Abuse Hospitalizations.

To describe the prevalence of risk factors for abuse and newborns' risks for physical abuse hospitalizations during early infancy. We created a nationally representative US birth cohort using the 2013 and 2014 Nationwide Readmissions Databases. Newborns were characterized by demographics, prematurity or low birth weight (LBW), intrauterine drug exposure, and medical complexity (including birth defects). Newborns were tracked for 6 months from their birth hospitalization, and subsequent abuse hospitalizations were identified by using International Classification of Diseases, Ninth Revision codes. We calculated adjusted relative risks (aRRs) with multiple logistic regression, and we used classification and regression trees to identify newborns with the greatest risk for abuse on the basis of combinations of multiple risk factors. There were 3 740 582 newborns in the cohort. Among them, 1247 (0.03%) were subsequently hospitalized for abuse within 6 months. Among infants who were abused, 20.4% were premature or LBW, and 4.1% were drug exposed. Premature or LBW newborns (aRR 2.16 [95% confidence interval (CI): 1.87-2.49]) and newborns who were drug exposed (aRR 2.86 [95% CI: 2.15-3.80]) were independently at an increased risk for an abuse hospitalization, but newborns with medical complexity or noncardiac birth defects were not. Publicly insured preterm or LBW newborns from rural counties had the greatest risk for abuse hospitalizations (aRR 9.54 [95% CI: 6.88-13.23]). Publicly insured newborns who were also preterm, LBW, or drug exposed constituted 5.2% of all newborns, yet they constituted 18.5% of all infants who were abused. Preterm or LBW newborns and newborns who were drug exposed, particularly those with public insurance and residing in rural counties, were at the highest risk for abuse hospitalizations. Effective prevention directed at these highest-risk newborns may prevent a disproportionate amount of abuse.

The Individual and Combined Effects of Multiple Factors on the Risk of Soft Tissue Non-contact Injuries in Elite Team Sport Athletes.

Aim: Relationships between athlete monitoring-derived variables and injury risk have been investigated predominantly in isolation. The aim of this study was to evaluate the individual and combined effects of multiple factors on the risk of soft-tissue non-contact injuries in elite team sport athletes.Methods: Fifty-five elite Australian footballers were prospectively monitored over two consecutive seasons. Internal and external training load was quantified using the session rating of perceived exertion and GPS/accelerometry, respectively. Cumulative load and acute-to-chronic workload ratios were derived using rolling averages and exponentially weighted moving averages. History of injuries in the current and previous seasons was recorded along with professional experience, weekly musculoskeletal screening, and subjective wellness scores for individual athletes. Individual and combined effects of these variables on injury risk were evaluated with generalized linear mixed models.Results: High cumulative loads and acute-to-chronic workload ratios were associated with increased risk of injuries. The effects for measures derived using exponentially weighted moving averages were greater than those for rolling averages. History of a recent injury, long-term experience at professional level, and substantial reductions in a selection of musculoskeletal screening and subjective wellness scores were associated with increased risk. The effects of high cumulative loads were underestimated by ~20% before adjusting for previous injuries, whereas the effects of high acute-to-chronic workload ratios were overestimated by 10–15%. Injury-prone players, identified via player identity in the mixed model, were at > 5 times higher risk of injuries compared to robust players (hazard ratio 5.4, 90% confidence limits 3.6–12) despite adjusting for training load and previous injuries. Combinations of multiple risk factors were associated with extremely large increases in risk; for example, a hazard ratio of 22 (9.7–52) was observed for the combination of high acute load, recent history of a leg injury, and a substantial reduction in the adductor squeeze test score.Conclusion: On the basis of our findings with an elite team of Australian footballers, the information from athlete monitoring practices in team sports should be interpreted collectively and used as a part of the injury prevention decision-making process along with consideration of individual differences in risk.

Animal Models of Diverticulosis: Review and Recommendations.

Diverticulosis is a structural alteration of the colon tissue characterized by the development of pouch-like structures called diverticula. It afflicts a significant portion of the population in Western countries, with a higher prevalence among the elderly. Diverticulosis is believed to be the result of a synergetic interaction between inherent tissue weakness, diet, colonic microstructure, motility, and genetic factors. A validated etiology has, however, not yet been established. Non-surgical treatment is currently lacking due to this poor understanding, and surgical colon resection is the only long-term solution following recurrent complications. With rising prevalence, the burden of diverticulosis on patients and hospital resources has increased over the past several years. More efficient and less invasive treatment approaches are, thus, urgently needed. Animal models of diverticulosis are crucial to enable a preclinical assessment and evaluation of such novel approaches. This review discusses the animal models of diverticulosis that have been proposed to date. The current models require either a significant amount of time to develop diverticulosis, present a relatively low success rate, or seriously deteriorate the animals' systemic health. Recommendations are thus provided to address these pitfalls through the selection of a suitable animal and the combination of multiple risk factors for diverticulosis.

Cancer incidence attributable to lifestyle and environmental factors in Alberta in 2012: summary of results.

Estimates of the proportion of cancer cases that can be attributed to modifiable risk factors are not available for Canada and, more specifically, Alberta. The purpose of this study was to estimate the total proportion of cancer cases in Alberta in 2012 that could be attributed to a set of 24 modifiable lifestyle and environmental risk factors. We estimated summary population attributable risk estimates for 24 risk factors (smoking [both passive and active], overweight and obesity, inadequate physical activity, diet [inadequate fruit and vegetable consumption, inadequate fibre intake, excess red and processed meat consumption, salt consumption, inadequate calcium and vitamin D intake], alcohol, hormones [oral contraceptives and hormone therapy], infections [Epstein-Barr virus, hepatitis B and C viruses, human papillomavirus, Helicobacter pylori], air pollution, natural and artificial ultraviolet radiation, radon and water disinfection by-products) by combining population attributable risk estimates for each of the 24 factors that had been previously estimated. To account for the possibility that individual cancer cases were the result of a combination of multiple risk factors, we subtracted the population attributable risk for the first factor from 100% and then applied the population attributable risk for the second factor to the remaining proportion that was not attributable to the first factor. We repeated this process in sequential order for all relevant exposures. Overall, an estimated 40.8% of cancer cases in Alberta in 2012 were attributable to modifiable lifestyle and environmental risk factors. The largest proportion of cancers were estimated to be attributable to tobacco smoking, physical inactivity and excess body weight. The summary population attributable risk estimate was slightly higher among women (42.4%) than among men (38.7%). About 41% of cancer cases in Alberta may be attributable to known modifiable lifestyle and environmental risk factors. Reducing the prevalence of these factors in the Alberta population has the potential to substantially reduce the provincial cancer burden.

Usefulness of a decision tree model for the analysis of adverse drug reactions: Evaluation of a risk prediction model of vancomycin-associated nephrotoxicity constructed using a data mining procedure.

Several publications concerning decision tree (DT) analysis in medical fields have recently demonstrated its usefulness for defining prognostic factors in various diseases. However, there are minimal reports on the predictors of adverse drug reactions. We attempted to use DT analysis to discover combinations of multiple risk factors that would increase the risk of nephrotoxicity associated with vancomycin (VCM). To demonstrate the usefulness of DT analysis, we compared its predictive performance with that of multiple logistic regression analysis. A single-centre, retrospective study was conducted at Hokkaido University Hospital. A total of 592 patients, who received intravenous administrations of VCM between November 2011 and April 2016, were enrolled. Nephrotoxicity was defined as an increase in serum creatinine of ≥0.5mg/dL or a ≥50% increase in serum creatinine from the baseline. Risk factors for VCM nephrotoxicity were extracted from previous reports. In the DT analysis, a chi-squared automatic interaction detection algorithm was constructed. For evaluating the established algorithms, a 10-fold cross validation method was adopted to calculate the misclassification risk of the model. Moreover, to compare the accuracy of the DT analysis, multiple logistic regression analysis was conducted. Eighty-seven (14.7%) patients developed nephrotoxicity. A VCM trough concentration of ≥15.0mg/L, concomitant medication (vasopressor drugs and furosemide), and a duration of therapy ≥14days were extracted to build the DT model, in which the patients were divided into 6 subgroups based on variable rates of nephrotoxicity, ranging from 4.6 to 69.6%. The predictive accuracies of the DT and logistic regression models were similar (87.3%, respectively), indicating that they were accurate. This study suggests the usefulness of DT models for the evaluation of adverse drug reactions.

Long noncoding RNA variations in cardiometabolic diseases.

Cardiometabolic diseases are characterized as a combination of multiple risk factors for cardiovascular disease (CVD) and metabolic diseases including diabetes mellitus, dyslipidemia, hypertension and abdominal obesity. This cluster of abnormalities individually and interdependently leads to atherosclerosis and CVD morbidity and mortality. In the past decade, genome-wide association studies (GWASs) have identified a series of cardiometabolic disease-associated variants that can collectively explain a small proportion of the variability. Intriguingly, the susceptibility variants imputed from GWASs usually do not reside in the coding regions, suggesting a crucial role of the noncoding elements of the genome. In recent years, emerging evidence suggests that noncoding RNA (ncRNA) is functional for physiology and pathophysiology of human diseases. These include microRNAs and long noncoding RNAs (lncRNAs) that are now implicated in human diseases. The ncRNAs can interact with each other and with proteins, to interfere gene expressions, leading to the development of many human disorders. Although evidence suggests the functional role of lncRNAs in cardiometabolic traits, the molecular mechanisms of gene regulation underlying cardiometabolic diseases remain to be better defined. Here, we summarize the recent discoveries of lncRNA variations in the context of cardiometabolic diseases.

The Impact of Multiple Risk Factors on Young Children's Cognitive and Behavioural Development

The paper maps out 10 risk factors measuring deficits in parent–child interaction, family–child interaction and the home environment. The prevalence of risk factor combinations is quantified using theUKMillennium Cohort Study data. In 2001, 28 per cent of families with young children were facing two or more risk factors at age 9–10 months old. Each combination of multiple risk factors accounted for a very small proportion of allMCSfamilies. Specific risk factors were associated with particular developmental outcomes at age 5 and with changes from age 3 to age 5, but all leading to worse outcomes. The great diversity of risk‐factor combinations and their very small prevalence make the tasks of identifying such families and defining eligibility for support very difficult for policy‐makers. These results support the large body of policy literature advocating early intervention to improve children's development.

The Impact of Age and Alzheimer’s Disease Risk Factors on Memory Performance over Time

Aim: To identify early neurocognitive markers in individuals with a risk for developing Alzheimer’s disease by virtue of a family history of Alzheimer’s disease or APOE-4 carrier status. Materials &amp; methods: A longitudinal design was implemented to examine verbal memory performance (i.e., list learning and story memory) in 21 healthy, nonimpaired individuals. Results: A statistically significant age by risk-factor interaction effect was observed for both total recall and long-term storage of the Buschke Selective Reminding Test. Participants with a risk factor for Alzheimer’s disease exhibited a significant decline in performance with increasing age in contrast to participants without a risk factor. Conclusion: These findings extend the understanding of how the combination of multiple risk factors may contribute to early memory decline in healthy, nonimpaired individuals and can help inform early intervention efforts.