Contribution Of Potential Risk Factors Research Articles

Longitudinal Cognitive Outcomes in Children With HIV in Zambia: 2-Year Outcomes From the HIV-Associated Neurocognitive Disorders in Zambia (HANDZ) Study.

To describe longitudinal outcomes and predictors of cognitive outcomes in children with HIV in Zambia. Multiple studies have shown that children with HIV are at risk for impaired cognition. However, there are limited data on longitudinal cognitive outcomes in children with HIV. We conducted a prospective cohort study of 208 perinatally infected children with HIV ages 8-17 years, all treated with antiretroviral therapy, and 208 HIV-exposed uninfected controls. Participants were followed for 2 years. Cognition was assessed with a custom NIH Toolbox Cognition Battery, and tests were combined to generate a Summary Cognition Score (SCS). The contribution of potential risk factors to outcomes was explored using regression models and group-based trajectory modeling. HIV was strongly associated with lower SCS at baseline [β-14, 95% confidence interval (CI): -20 to -7, P < 0.001]. Change scores over time were similar between groups, but poorer average performance in children with HIV persisted at the 2-year follow-up visit (adjusted β = -11, 95% CI: -22 to -0.3, P = 0.04). Other than HIV, the strongest predictors of baseline SCS included socioeconomic status index (β =3, 95% CI: 1, 5, P = 0.004), history of growth stunting (β=-14, 95% CI: -23 to -6, P = 0.001), history of CD4 count below 200 (β = -19, 95% CI: -35 to -2, P = 0.02), and history of World Health Organization stage 4 disease (β = -10, 95% CI: -19 to -0.2, P = 0.04). In the group-based trajectory model, HIV+ status predicted membership in the lowest performing trajectory group (odds ratio 2.5, 95% CI: 1.2 to 5.1, P = 0.01). Children with HIV are at risk of poor cognitive outcomes, despite chronic treatment with antiretroviral therapy.

Risk factors of prostate cancer

Prostate cancer is characterized by high morbidity and mortality rates. According to the World Health Organization data, 1.2 million cases of the disease and 358,000 deaths because of prostate cancer were recorded in 2018. This nosology takes the second place in the structure of oncological morbidity, and the sixth place in the structure of cancer-associated mortality. A large number of works have been devoted to the study of the etiopathogenesis of prostate cancer. In this review, we attempted to summarize some of the results of studies of risk factors for this disease. The article analyzes the results of studies on the possible impact on the development of the disease of both biological factors (age, race, the presence of certain genetic polymorphisms), and lifestyle-related factors (nutrition, obesity, alcohol use, smoking). Despite the urgency of the problem and the huge number of studies conducted, up to date, only for a number of unmodifiable factors, such as age, race, heredity, their unconditional role in the development of prostate cancer have proved. There is no clarity regarding the significance of the role of modifiable, factors, including behavioral, in the development of the disease. The data from the studies are contradictory and not very convincing. Further research in this direction is necessary to get information about the contribution of potential risk factors to the etiopathogenesis of prostate cancer.

Evaluation of the Degenerative Changes of the Distal Intervertebral Discs after Internal Fixation Surgery in Adolescent Idiopathic Scoliosis.

Study DesignRetrospective study.PurposeLumbar intervertebral disc degeneration is an important cause of low back pain.Overview of LiteratureSpinal fusion is often reported to have a good course for adolescent idiopathic scoliosis (AIS). However, many studies have reported that adjacent segment degeneration is accelerated after lumbar spinal fusion. Radiography is a simple method used to evaluate the orientation of the vertebral column. magnetic resonance imaging (MRI) is the method most often used to specifically evaluate intervertebral disc degeneration. The Pfirrmann classification is a well-known method used to evaluate degenerative lumbar disease. After spinal fusion, an increase in stress, excess mobility, increased intra-disc pressure, and posterior displacement of the axis of motion have been observed in the adjacent segments.Methodswe retrospectively secured and analyzed the data of 15 patients (four boys and 11 girls) with AIS who underwent a spinal fusion surgery. We studied the full-length view of the spine (anterior-posterior and lateral) from the X-ray and MRI obtained from all patients before surgery. Postoperatively, another full-length spine X-ray and lumbosacral MRI were obtained from all participants. Then, pelvic tilt, sacral slope, curve correction, and fused and free segments before and after surgery were calculated based on X-ray studies. MRI images were used to estimate the degree to which intervertebral discs were degenerated using Pfirrmann grading system. Pfirrmann grade before and after surgery were compared with Wilcoxon signed rank test. While analyzing the contribution of potential risk factors for the post-spinal fusion Pfirrmann grade of disc degeneration, we used generalized linear models with robust standard error estimates to account for intraclass correlation that may have been present between discs of the same patient.ResultsThe mean age of the participant was 14 years, and the mean curvature before and after surgery were 67.8 and 23.8, respectively (p<0.05). During the median follow-up of 5 years, the mean degree of the disc degeneration significantly increased in all patients after surgery (p<0.05) with a Pfirrmann grade of 1 and 2.8 in the L2–L3 before and after surgery, respectively. The corresponding figures at L3–L4, L4–L5, and L5–S1 levels were 1.28 and 2.43, 1.07 and 2.35, and 1 and 2.33, respectively. The lower was the number of free discs below the fusion level, the higher was the Pfirrmann grade of degeneration (p<0.001). Conversely, the higher was the number of the discs fused together, the higher was the Pfirrmann grade.Conclusions we observed that the disc degeneration aggravated after spinal fusion for scoliosis. While the degree of degeneration as measured by Pfirrmann grade was directly correlated by the number of fused segments, it was negatively correlated with the number of discs that remained free below the lowermost level of the fusion.

Limited prognostic value of the 2004 International Union Against Cancer staging classification for adrenocortical carcinoma

Adrenocortical carcinoma (ACC) is a rare malignancy, and it was only in 2004 that the International Union Against Cancer (UICC) defined TNM criteria and published the first staging classification. However, to date, the prognostic value of the proposed classification has not been evaluated. The German ACC Registry comprising 492 patients was searched for patients who were diagnosed between 1986 and 2007 with detailed information on primary diagnosis and a minimum follow-up of 6 months. Patients were assigned to UICC tumor stage, and disease-specific survival (DSS) was assessed. In addition, the contribution of potential risk factors for DSS was evaluated. In total, 416 patients with a mean follow-up of 36 months met the inclusion criteria (stage I, n=23 patients; stage II, n=176 patients; stage III, n=67 patients; stage IV, n=150 patients). Kaplan-Meier analysis revealed a stage-dependent DSS. However, DSS in patients with stage II ACC did not differ significantly from DSS in patients with stage III ACC (hazard ratio, 1.38; 95% confidence interval, 0.89-2.16). Furthermore, patients who had stage IV ACC without distant metastases had an improved DSS compared with patients who had metastatic disease (P=.004). An analysis of different potential risk factors for defining stage III ACC revealed important roles in DSS for tumor infiltration in surrounding tissue, venous tumor thrombus (VTT), and positive lymph nodes; whereas tumor invasion in adjacent organs carried a prognosis similar to that of infiltration in surrounding tissue only. The 2004 UICC staging classification for ACC has significant limitations. On the basis of the current analysis, a revised classification with superior prognostic accuracy is proposed (the European Network for the Study of Adrenal Tumors classification). In this system, stage III ACC is defined by the presence of positive lymph nodes, infiltration of surrounding tissue, or VTT; and stage IV ACC is restricted to patients with distant metastasis.

Effect of Weight, Sleep Duration, and Comorbid Sleep Disorders on Behavioral Outcomes in Children With Sleep-Disordered Breathing

To assess the relative contribution of potential risk factors for adverse neurobehavioral outcomes in children referred for evaluation of sleep-disordered breathing (SDB), including weight, mean sleep duration, and comorbid sleep disorders. Medical record review. Academic pediatric medical center. Clinical sample of 235 children aged 3 to 18 years undergoing overnight polysomnography for symptoms of SDB. History of behavioral, emotional, and academic problems and Child Behavior Checklist (CBCL) scores. More than half (56%) of the sample was overweight or at risk for overweight, more than one-third (36%) was classified as being short sleepers, and almost half (49%) had at least 1 additional sleep diagnosis. Forty-seven percent had a history of behavioral problems and 23% had a reported diagnosis of attention-deficit/hyperactivity disorder. There were no significant differences in CBCL scores based on any measure of SDB disease severity. Increased weight was associated with increased internalizing CBCL scores in a dose-dependent fashion (P = .003), while short sleepers were more likely to have elevated externalizing scores (P < .001). Overall, the strongest predictor of adverse behavioral outcomes was the presence of at least 1 additional sleep diagnosis (P < .001). The relationship between SDB and parent-reported behavioral outcomes in children is complex. In addition to SDB-related impairments, clinicians should consider the relative contributions of being overweight, insufficient sleep, and comorbid sleep disorders when assessing behavior in these children.

Problem Behaviour and Associated Risk Factors in Young Children

AbstractThere is increasing concern about the number of preschool children displaying problem behaviour. This study examines the relative contribution of potential risk factors, particularly those related to families, to problem behaviour in the lives of a sample of western Sydney three- to five-year-old children. Problem behaviour was assessed using the Child Behavior Checklist (Achenbach &amp; Edelbrock, 1991), encompassing measures of anxious, depressed, uncommunicative, obsessive, somatic complaint, social withdrawal, hyperactive, aggressive, and delinquent behaviours. Particularly salient risk factors associated with problem behaviour were found to be children's behaviour when very young (an indicant of temperament), personal stress in parents associated with concerns about the family and economic worries, and parenting characterised by guilt and anxiety.

Lipid risk factor correlates of ischemic heart disease as diagnosed by myocardial perfusion scintigraphy.

Patients with known coronary artery disease frequently change their lifestyles (e.g., diet, exercise, and smoking habit) after the diagnosis is made. Such changes can alter lipid risk factor levels and obscure etiologic risk factor associations with the presence of coronary artery disease. It is therefore preferable to determine the contribution of potential risk factors before the diagnosis of coronary artery disease has been established. In this trial, we used stress nuclear myocardial perfusion imaging to diagnose coronary artery disease in patients presenting for evaluation of chest pain. Two groups of age- and sex-matched patients were identified: a normal group (patients with no evidence of coronary artery disease), and an abnormal group (patients whose scans indicated the presence of significant coronary artery disease due to either fixed or reversible perfusion defects). Blood samples were drawn before scanning and analyzed for lipid risk factors. Compared to the normal group, the abnormal group had higher levels of triglycerides (189±91 vs. 135±51 mg/dL, p=0.003), lower levels of high-density lipoprotein cholesterol (39±9 vs. 45±14 mg/dL, p=0.037), and higher levels of small, dense low-density lipoprotein (LDL(3)) (42±18 vs. 32±13 mg/dL, p=0.007). Total cholesterol, low-density lipoprotein, and lipoprotein(a) levels were similar between groups. These findings suggest that ischemic heart disease, as assessed by myocardial perfusion scintigraphy, is more closely associated with the low high-density lipoprotein/high triglyceride syndrome than with increased low-density lipoprotein or total cholesterol levels. (c) 2000 by CHF, Inc.

Factors Related to The Occurrence of Hyperglycemia in Patients Receiving Total Parenteral Nutrition

LEARNING OUTCOME: To identify the relative contribution of potential risk factors commonly thought to cause hyperglycemia in total parenteral nutrition (TPN).The purpose of this study was to identify the relative contribution of potential risk factors commonly thought to cause hyperglycemia in patients fed by TPN. Potential risk factors for hyperglycemia were recorded and evaluated on 98 adult subjects receiving TPN. Forty-nine subjects were hyperglycemic, defined as the occurrence of blood glucose greater than or equal to 200 mg/dL for two consecutive days. Data from each of the 49 hyperglycemic subjects was compared with data from 49 subjects who did not become hyperglycemic. Occurrence of (or presence of) potential risk factors were recorded for hyperglycemic and normoglycemic subjects over the two day period when hyperglycemia occurred. Multiple logistic regression was used to determine the predictive value and relative risk of excess glucose infusion rate, the presence of infection, diabetes (type I or II), excess calories provided by TPN and steroid medication in predicting occurrence of hyperglycemia. Scatterplots and correlation coefficients were used to test for independent associations. Among the potential risk factors, presence of diabetes (type I or II) and steroids were most predictive of hyperglycemia. A patient with diabetes (type I or II) receiving steroids had a 98% predicted probability to develop hyperglycemia. Diabetic patients receiving TPN and steroids should be closely monitored for hyperglycemia.