Combined Effects Of Risk Factors Research Articles

Development assessment of HIV exposed children aged 6–18 months: a cohort study from North India

ABSTRACTHIV exposed children are vulnerable to developmental delay irrespective of their HIV status due to combined effect of risk factors like poverty, prenatal drug exposure, stress and chronic illness in family and malnutrition. This cohort study assessed the development of 50 HIV exposed children aged 6–18 months at a Pediatric Centre of Excellence in HIV care in India. The development was assessed using Development Assessment Scale for Indian Infants (DASII) at enrolment, 3 and 6 months later. The development quotient (DQ) scores and proportion of children with developmental delay (DQ ≤ 70) were compared among two sub-groups, HIV infected (HI) and HIV exposed uninfected (HEU) children. The various social and clinical factors affecting development were studied by univariate and multivariate analysis. Prevalence of developmental delay was 2.4% in the HEU (n = 41), and 33.3% in HI (n = 9). The DQ of HI was significantly lower than that of HEU at all three assessments. The DQ of HI were also significantly lower compared to the HEU at ages 12.1–18 months (83.37 ± 20.73 vs 94.68 ± 5.13, p = 0.005) and 18.1–24 months (84.55 ± 15.35 vs 94.63 ± 5.86, p = 0.006) respectively. The development of HEU was adversely affected by lower socioeconomic status and presence of wasting. In addition, development of HI was also adversely influenced by presence of stunting and opportunistic infections, advanced disease stage and shorter ART duration. We conclude that with optimum care, HEU can have a normal development, while a considerable proportion of HI may continue to have delayed development.

The organization of medical care for patients with chronic viral hepatitis in the Republic Sakha (Yakutia)

Aim. To identify the risk factors for primary liver cancer in patients with chronic viral hepatitis in the Republic of Sakha (Yakutia) and develop an organizational model of treatment and prevention of viral hepatitis and primary liver cancer. Methods. Clinical, epidemiological and molecular biological methods were used. Results. There is a high prevalence of chronic viral hepatitis B, C and D in the Republic of Sakha (Yakutia), as well as their distant adverse outcomes. Disclosed the problem of the combined effects of risk factors for primary liver cancer in people indigenous nationality of the Republic of Sakha (Yakutia), mostly male, living in rural areas, which is the simultaneous replication of hepatitis viruses B, C and D in patients with genetically predisposed changes in the activity of alcohol dehydrogenase and aldehyde dehydrogenase. The modernization of the training algorithms of patients for liver transplantation and management of patients with cirrhosis and liver cancer in the outcome of chronic viral hepatitis, liver transplantation is justified from a related donor with a high level of specific antibodies of patients with primary liver cancer, as well as phasing held medical diagnostic and organizational and methodological measures. Created was an annual Republican «liver-school» for physicians, gastroenterologists, internists, pediatricians, epidemiologists, introduced the publication of conference materials for use on the entire territory of the Republic of Sakha (Yakutia). Conclusion. Multi-component structural-functional model of service prevention and control of viral hepatitis has allowed to develop a program to address the medical and social protection of different groups of the population to create a unified register «Chronic viral hepatitis in the Republic of Sakha (Yakutia)», as well as long-term programs for complex vaccine prophylactics and modernization of services for prevention and control of viral hepatitis.

Genetics of alcoholic and nonalcoholic pancreatitis

To provide an expert review and expert perspective on important advances related to the genetics of acute and chronic pancreatitis. Provocative new studies highlight the interplay between genetic, developmental, and environmental factors. Key findings include the relationship between pancreas divisum and CFTR mutations, the role of trypsin in acute and recurrent acute pancreatitis, and the discovery of a pancreatitis modifier gene on the X chromosome that provides new clues to why the vast majority of patients with alcoholic pancreatitis are men. Pancreatic genetics is complex, linked to the multiplicative and modifying effects of multiple interacting genetic, structural, and environmental factors. Clinical interpretation will require disease modeling and simulation to understand the combined effect of risk factors that alone are neither sufficient nor necessary to cause disease, and to design treatment strategies that prevent the development of advanced chronic pancreatitis - which by definition is irreversible.

Risk of coronary heart disease is associated with triglycerides and high-density lipoprotein cholesterol in women and non–high-density lipoprotein cholesterol in men

Although the physiologic interrelationships between triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) are not fully understood, studies typically are adjusted for one when one is examining the role of the other. If the mechanism of coronary heart disease (CHD) risk is mediated through the other, then controlling for the second factor may mask the true effect of the first. We investigated the relationship between the combined effect of increased (↑) TG and decreased (↓) HDL-C compared with isolated ↑TG or isolated ↓HDL-C on CHD risk in men and women and compared these TG/HDL-C categories to non-HDL cholesterol (non-HDL-C). Subjects (936 women and 746 men) from the San Luis Valley Study were grouped on the basis of 4 sex-specific NCEP-ATP III cutpoints (↑TG ≥150 mg/dL, and ↓HDL-C, <40 and <50 mg/dL for men and women, respectively). Descriptive statistics and survival analyses were used. The reference group was ↓TG/↑HDL-C (TG <150, and HDL-C >50 and >40 mg/dL for women and men, respectively). Non-HDL-C was analyzed as a continuous variable. Among women, all groups had greater risk of CHD compared with the ↓TG/↑HDL-C reference in univariate analysis: ↓TG/↓HDL-C HR= 2.82 [95% confidence interval 1.12-7.1], ↑TG/↑HDL-C HR= 3.82 [1.50-9.74], ↑TG/↓HDL-C HR= 4.32 [1.91-9.80]. The risk remained significant in the ↓TG/↓HDL-C group (HR= 3.27 [1.26-8.50] and marginally significant in other groups in multivariable analysis. Neither ↑TG nor ↓HDL-C was related to CHD risk in men. Non-HDL cholesterol was significantly related to CHD in men but not in women. The CHD risk associated with ↓HDL-C in women was >2- to 4-fold elevated depending on TG levels. Non-HDL cholesterol was a significant predictor of CHD in men. Examining the combined effects of risk factors that share physiologic pathways may reveal important associations that can be otherwise obscured. Further dissection of gender specific pathways that affect HDL-C and TG and non-HDL cholesterol are important in understanding CHD risk.

The scientific assessment of combined effects of risk factors: different approaches in experimental biosciences and epidemiology

The analysis of combined effects of substances or risk factors has been a subject to science for more than a century. With different goals, combined effect analysis was addressed in almost all experimental biosciences. The major theoretical foundation can be traced back to two distinct origins. First, to the work by the pharmacologist Loewe on the concept of concentration additivity and second to the biometrician Bliss and the concept of independent action. In the search for a general solution and a unified terminology the interrelations of the concepts have extensively been studied and experimental findings reviewed. Meanwhile there seems to be consensus in experimental sciences that each concept has its role in predicting combined effect of agents and both are used for hazard und risk management. In contrast, epidemiologists describe combined effects mainly in terms of interactions in regression models. Although this approach started from a probabilistic model equivalent to the concept of independent action this origin is rarely acknowledged and effect summation is usually the preferred concept nowadays. Obscure biological meaning, the scale dependency of interaction terms as well as unavoidable residual confounding are taken as reasons why no new insights in combined effect analysis are likely to occur from epidemiology. In this paper we sketch the history of ideas and the state of the arts in combined effect analysis. We point to differences and common grounds in experimental biosciences and epidemiology.

Preoperative cardiopulmonary risk assessment as predictor of early noncancer and overall mortality after radical prostatectomy

Objectives To evaluate the capability of the preoperative cardiopulmonary risk assessment to predict early noncancer and overall mortality after radical prostatectomy for clinically localized prostate cancer. Methods In 444 consecutive radical prostatectomy patients, the American Society of Anesthesiologists Physical Status classification and the presence of cardiac insufficiency (New York Heart Association classification), angina pectoris (Canadian Cardiovascular Society classification), diabetes, hypertension, history of thromboembolism, and chronic obstructive or restrictive pulmonary disease were assessed. Kaplan-Meier time-event curves and Mantel-Haenszel hazard ratios were estimated for noncancer (other deaths were censored) and overall mortality. Cox proportional hazard models were used to analyze possible combined effects of risk factors. Results During an average follow-up of 4.7 years, 36 patients died: 15 of noncancer causes, 14 of prostate cancer, 6 of other cancers, and 1 in a car accident. The comorbidity scores for American Society of Anesthesiologists Physical Status classification, New York Heart Association classification, and Canadian Cardiovascular Society classification and combinations between the latter two scores were significantly associated with early noncancer mortality in a dose-response pattern. Furthermore, patients with chronic obstructive pulmonary disease were at increased risk. The association with overall mortality was less strong. Conclusions The preoperative cardiopulmonary risk assessment may be used as a predictor of early noncancer and overall mortality after radical prostatectomy and should be evaluated further as a source of prognostic information in surgical oncology.

Predicting recovery from idiopathic sudden hearing loss

The probability of recovery from idiopathic sudden hearing loss depends on many factors, including patient age, presence of vertigo, audiogram type at diagnosis, and electronystagmographic test results. The authors present a model for calculating the probability of patient recovery based on the combined effects of risk factors determined for these variables. Data collected from 123 patients with "profound" or "moderate" sudden hearing losses are used to illustrate the model. Interrelationships among the prognostic factors and their relative importances in predicting hearing recovery are discussed.