Effects Of Multiple Risk Factors Research Articles

Mexican American adolescents' profiles of risk and mental health: A person-centered longitudinal approach

Although Mexican American adolescents experience multiple risk factors in their daily lives, most research examines the influences of risk factors on adjustment independently, ignoring the additive and interactive effects of multiple risk factors. Guided by a person-centered perspective and utilizing latent profile analysis, this study identified Mexican American fifth graders' (N = 749) risk profiles based on family, peer, and socio-cultural risk factors and examined the relations of these risk profiles to mental health symptomatology in seventh grade. Results revealed three distinct profiles that differed quantitatively and qualitatively. Profiles were then linked to levels of mental health symptomatology, with youth in the highest risk profile displaying the most symptoms. Youth in two other risk profiles displayed lower levels. The findings suggest that Mexican American youth develop within distinct risk contexts that differ in their relations to adjustment. Such findings inform prevention/intervention efforts aimed at reducing mental health problems in adolescence.

Fc gamma receptor IIIa polymorphisms in advanced colorectal cancer patients correlated with response to anti-EGFR antibodies and clinical outcome

BackgroundAnti-EGFR monoclonal antibodies have shown efficacy in the treatment of metastatic colorectal cancer (mCRC). One of the mechanism is the antibody-dependent cell-mediated cytotoxicity (ADCC) in which Fc region of the antibody binds to the Fc gamma receptors (FcγR) expressed by immune cells. The present study investigated the association between single nucleotide polymorphisms of FcγRIIa and FcγRIIIa and clinical outcome in mCRC treated with anti-EGFR antibodies.MethodsSeventy-four consecutive patients with mCRC were analyzed. The genotypes for FcγRIIa-131 histidine (H)/arginine (R), FcγRIIIa-158 valine (V)/phenylanaline (F) polymorphisms were evaluated by directly sequencing. Multiplex allele-specific polymerase chain reaction was performed for FcγRIIIa-158 valine (V)/phenylanaline (F). Correlations between FcγR polymorphisms, baseline patient and tumor features were studied by contingency tables and the chi-square test. The Kaplan-Meier product limit method was applied to the progression-free survival (PFS) curves. Univariate analysis was performed with the log-rank test. Cox proportional-hazards regression was used to analyze the effect of multiple risk factors on PFS.ResultsFcγRIIIa polymorphisms were significantly associated with response to anti-EGFR-based therapy in 49 patients with kras wt tumors (p=0.035). There was not association with response for FcγRIIa polymorphisms. Furthermore, obtained results suggested that prognosis is particularly unfavorable for patients carrying the FcγRIIIa-158F/F genotype (median PFS V/V, V/F, F/F: 18.2 vs 17.3 vs 9.4 months). No prognostic ability was identified for FcγRIIa polymorphisms.ConclusionsIn mCRC patients the presence of FcγRIIIa-F can predict resistance to anti-EGFR therapy and unfavorable prognosis.

Risk Factors for Breast Cancer for Women Aged 40 to 49 Years

Identifying risk factors for breast cancer specific to women in their 40s could inform screening decisions. To determine what factors increase risk for breast cancer in women aged 40 to 49 years and the magnitude of risk for each factor. MEDLINE (January 1996 to the second week of November 2011), Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (fourth quarter of 2011), Scopus, reference lists of published studies, and the Breast Cancer Surveillance Consortium. English-language studies and systematic reviews of risk factors for breast cancer in women aged 40 to 49 years. Additional inclusion criteria were applied for each risk factor. Data on participants, study design, analysis, follow-up, and outcomes were abstracted. Study quality was rated by using established criteria, and only studies rated as good or fair were included. Results were summarized by using meta-analysis when sufficient studies were available or from the best evidence based on study quality, size, and applicability when meta-analysis was not possible. Data from the Breast Cancer Surveillance Consortium were analyzed with proportional hazards models by using partly conditional Cox regression. Reference groups for comparisons were set at U.S. population means. Sixty-six studies provided data for estimates. Extremely dense breasts on mammography or first-degree relatives with breast cancer were associated with at least a 2-fold increase in risk for breast cancer. Prior breast biopsy, second-degree relatives with breast cancer, or heterogeneously dense breasts were associated with a 1.5- to 2.0-fold increased risk; current use of oral contraceptives, nulliparity, and age 30 years or older at first birth were associated with a 1.0- to 1.5-fold increased risk. Studies varied by measures, reference groups, and adjustment for confounders, which could bias combined estimates. Effects of multiple risk factors were not considered. Extremely dense breasts and first-degree relatives with breast cancer were each associated with at least a 2-fold increase in risk for breast cancer in women aged 40 to 49 years. Identification of these risk factors may be useful for personalized mammography screening. National Cancer Institute.

How to manage HIV-infected patients with chronic kidney disease in the HAART era

As human immunodeficiency virus (HIV)-infected patients now live longer while receiving highly active antiretroviral therapy (HAART), chronic kidney disease (CKD) has emerged as a significant cause of morbidity and mortality among urban HIV population. Risk factors associated with CKD in such HIV-infected population include aging, hypertension, diabetes mellitus, co-infection with hepatitis C virus, low CD4 cell count, and high HIV viral load. Clinical experience has shown that HIV-infected individuals often have one or more concurrent risk factors for CKD. The cumulative effect of multiple risk factors on the development of CKD should be noted in this population. Glomerular disease directly related to HIV infection, so-called HIV-associated nephropathy, remains an important cause of CKD among limited HIV population of African descent. The impact of exposure to nephrotoxic antiretroviral agents on the development of kidney disease is both an old and a new concern. In particular, the association of tenofovir with kidney disease has been an area of great interest. The findings regarding tenofovir's adverse effect on long-term kidney function vary among studies. Early identification and treatment of kidney disease is imperative for reducing the burden of patients requiring dialysis in HIV-infected populations. Periodic monitoring of urinary albumin excretion, tubular parameters such as low-molecular-weight proteinuria, and the estimated glomerular filtration rate may be useful for early diagnosis of patients at risk for incident CKD. This review focuses on recent developments in epidemiology, risk factors, identification, estimation, and management of CKD in HIV-infected population in the HAART era.

The effects of multiple pre- and perinatal risk factors on the occurrence of cerebral palsy. A Norwegian register based study

Aims To examine the effects of multiple risk factors on cerebral palsy (CP). Materials/methods For 176,591 Norwegian infants born 1996–98 and surviving the early neonatal period, data on a number of potential pre- and perinatal risk factors (RFs) for CP were available in the Medical Birth Registry of Norway. For 241 children with CP detailed clinical data were available in the Norwegian CP registry. Results In children born at term, 31% had no RF, and none had five or more, while in children born preterm, 9% had no RF in addition to prematurity ( p < 0.001 vs. term), and 5% had five or more ( p < 0.02 vs. term). In both groups, few children shared the same combination of RFs. Interdependent sequences were more often observed among children born preterm than at term ( p < 0.001 vs. term). The most detrimental effect was observed for the combination of maternal disease and low 5-min Apgar score, registered in 11.2% of children with CP. The combination of maternal disease and premature birth had an interaction contrast ratio of 9.25 (CI: 3.56; 14.94), which may be consistent with biological interaction. Conclusions The majority of children with CP born at term most likely had an antenatal or single cause, suggesting individual susceptibility to an injury. The majority of children born preterm, had combinations or sequences of antenatal and perinatal risk factors as the most likely cause of CP.

Should Heart Transplant Recipients With Early Graft Failure Be Considered for Retransplantation?

The purpose of this study was to determine if orthotopic heart transplantation performed within 90 days of an initial heart transplant (re-Tx) should be a contraindication to retransplantation based on inferior outcomes when compared with primary orthotopic heart transplantation recipients (control). De-identified data were obtained from the United Network for Organ Sharing. The study population included all adult heart transplant recipients greater than 18 years old from 1995 to 2008 (n=26,804). Multivariable regression was performed in order to assess the simultaneous effect of multiple risk factors on posttransplant graft failure (PTGF) at 90 days. Secondary outcomes of interest included infection, stroke, and dialysis during the transplant hospitalization as well as primary nonfunction of the graft at 90 days. Among the study cohort, there were 90 (0.34%) re-Tx patients. Median survival in this group was 1.6 years compared with 10.5 years for controls. Unadjusted PTGF, infection, dialysis, and primary nonfunction were significantly higher (p<0.001) in the re-Tx group. After risk adjustment, however, PTGF (p=0.545), infection (p=0.696), dialysis (p=0.664), stroke (p=0.115), and primary nonfunction (p=0.531), did not differ significantly between the 2 groups. When controlling for pretransplant recipient characteristics, retransplantation within 90 days of a previous transplant is not associated with increased morbidity or mortality. However, unadjusted overall survival was significantly worse in the re-Tx group. This suggests that although retransplantation at 90 days alone is not a risk factor for inferior outcomes, given the significant comorbidities of these patients, the indications for retransplantation within 90 days are rare and must be critically examined.

Preoperative positive urine cytology is a risk factor for subsequent development of bladder cancer after nephroureterectomy in patients with upper urinary tract urothelial carcinoma

To determine the independent risk factors of bladder recurrence in patients with upper urinary tract urothelial carcinoma (UUT-UC). A total of 364 patients underwent nephroureterectomy (NUx) for UUT-UC between January 2005 and April 2009 in Okayama University and 17 affiliated hospitals. Patients with concomitant bladder cancer were excluded from the analysis. The clinicopathologic data for the remaining 288 patients with UUT-UC were retrospectively reviewed. Median follow-up after NUx was 20.2 months. The following variables were evaluated for any association with bladder recurrence: sex, age, tumor stage, tumor grade, venous invasion, lymphatic invasion, tumor location, multifocality, surgical modalities, time of ligation of the ureter, and preoperative urine cytology. The significance of each variable was tested univariately using the log-rank test. The simultaneous effects of multiple risk factors were estimated by multiple regression analysis using the Cox proportional hazards model. Bladder recurrence occurred in 103 patients (35.8%). Median time to first bladder recurrence was 6.9 months. Significant risk factors for bladder recurrences on univariate analysis were tumor location (P = 0.046) and preoperative positive urine cytology (P < 0.001). Multivariate analysis revealed that preoperative urine cytology positive was significant for bladder recurrence (HR: 1.977; 95% CI: 1.310-2.983, P = 0.001). Risk factor for subsequent development of bladder cancer after NUx was preoperative positive urine cytology.

Examining the joint effect of multiple risk factors using exposure risk profiles: lung cancer in nonsmokers.

BackgroundProfile regression is a Bayesian statistical approach designed for investigating the joint effect of multiple risk factors. It reduces dimensionality by using as its main unit of inference the exposure profiles of the subjects that is, the sequence of covariate values that correspond to each subject.ObjectivesWe applied profile regression to a case–control study of lung cancer in nonsmokers, nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort, to estimate the combined effect of environmental carcinogens and to explore possible gene–environment interactions.MethodsWe tailored and extended the profile regression approach to the analysis of case–control studies, allowing for the analysis of ordinal data and the computation of posterior odds ratios. We compared and contrasted our results with those obtained using standard logistic regression and classification tree methods, including multifactor dimensionality reduction.ResultsProfile regression strengthened previous observations in other study populations on the role of air pollutants, particularly particulate matter ≤ 10 μm in aerodynamic diameter (PM10), in lung cancer for nonsmokers. Covariates including living on a main road, exposure to PM10 and nitrogen dioxide, and carrying out manual work characterized high-risk subject profiles. Such combinations of risk factors were consistent with a priori expectations. In contrast, other methods gave less interpretable results.ConclusionsWe conclude that profile regression is a powerful tool for identifying risk profiles that express the joint effect of etiologically relevant variables in multifactorial diseases.

Assessment of Cardiovascular Risk

Atherosclerotic cardiovascular disease (CVD) is the most common cause of death worldwide. Usually atherosclerosis is caused by the combined effects of multiple risk factors. For this reason, most guidelines on the prevention of CVD stress the assessment of total CVD risk. The most intensive risk factor modification can then be directed towards the individuals who will derive the greatest benefit. To assist the clinician in calculating the effects of these multiple interacting risk factors, a number of risk estimation systems have been developed. This review address several issues regarding total CVD risk assessment: Why should total CVD risk be assessed? What risk estimation systems are available? How well do these systems estimate risk? What are the advantages and disadvantages of the current systems? What are the current limitations of risk estimation systems and how can they be resolved? What new developments have occurred in CVD risk estimation?

Influence of Risk on Hiding Time by Balearic Lizards (Podarcis lilfordi): Predator Approach Speed, Directness, Persistence, and Proximity

Cost–benefit models predict that hiding time in refuge increases with predation risk. Studies of diverse prey confirm this prediction for various single risk factors, but much less is known regarding joint effects of variation in multiple factors. For single risk factors, we predicted that Balearic lizards (Podarcis lilfordi) hide longer after faster and more direct approaches by predators and when predators attack persistently or remain close to the refuge. We predicted that effects of approach speed on hiding time would interact with those of directness of approach and predator proximity to the refuge. We simulated attacking predators by approaching lizards ourselves. Predictions for all single risk factors were confirmed: hiding time was greater after faster and more direct approaches, second than first attacks, and when an investigator stood closer to the refuge. These findings agree with those for other prey that are ecologically and phylogenetically diverse, suggesting that optimality theory is broadly applicable to refuge use. The predictions of interaction of approach speed were confirmed for both directness of approach and predator proximity, but the interaction between approach speed and predator proximity was opposite that predicted. Knowledge of the shapes of curves relating joint risks to hiding time are needed to use optimality theory to predict joint effects of multiple risk factors, but these shapes are unknown. Comparative studies are needed to detect quantitative effects of ecological and phylogenetic differences on hiding time.

Ocular artery thrombosis as an initial presentation of a prothrombin G20210A mutation

The G20210A mutation in the prothrombin gene is an established risk factor for venous thrombosis. There is controversy as to the role played by this mutation in arterial thrombotic disease. We present the case of a 56-year-old man who presented with a central retinal artery occlusion of the left eye. Evaluation revealed hypercholesterolemia, smoking, and heterozygosity for the prothrombin G20210A mutation. The literature concerning hereditary thrombophilia and retinal artery occlusion was reviewed. The synergistic effect of multiple risk factors is emphasized. Screening for hereditary thrombophilia should be considered, regardless of patient age. The prothrombin G20210A mutation may be associated with central retinal artery occlusion.

Youth suicide attempts and the dose–response relationship to parental risk factors: a population-based study

There is a lack of specific knowledge about the dose-response effect of multiple parental risk factors for suicide attempts among children and adolescents. The aim of this study was to determine the dose-response effect of multiple parental risk factors on an offspring's risk for suicide attempt. We designed a population-based two-generation nested case-control study and used Danish register data. A population of 403 431 individuals born between 1983 and 1989 was sampled. Among these, 3465 (0.8%) were registered as having had a suicide attempt. Twenty controls were matched to each case and a link to the offspring's biological parents was established. There was a dose-response relationship between the number of exposures and the risk of suicide attempts, with the increased risk seeming to be a multiplicative effect. Parental suicide, suicide attempt, psychiatric illness and low level of income were all significant independent risk factors for offspring's suicide attempts. Knowledge of the effect of multiple risk factors on the likelihood of suicide attempts in children and adolescents is important for risk assessment. Dose-response effects of multiple parental risk factors are multiplicative, but it is rare for children and adolescents to be exposed to multiple parental risk factors simultaneously. Nevertheless, they should be considered along with the offspring's own multiple risk factors in determining the overall risk of a suicide attempt. Further research incorporating both parental and offspring's risk factors is indicated to determine the overall dose-response effect of multiple risk factors.

310 THE EFFECT OF THE EARLY LIGATION OF THE URETER IN NEPHROURETECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA

You have accessJournal of UrologyUrothelial Cancer: Medical & Surgical Therapy1 Apr 2010310 THE EFFECT OF THE EARLY LIGATION OF THE URETER IN NEPHROURETECTOMY FOR UPPER URINARY TRACT UROTHELIAL CARCINOMA Yasuyuki Kobayashi, Shinya Uehara, Toyohiko Watanabe, Takashi Saika, Yasutomo Nasu, and Hiromi Kumon Yasuyuki KobayashiYasuyuki Kobayashi More articles by this author , Shinya UeharaShinya Uehara More articles by this author , Toyohiko WatanabeToyohiko Watanabe More articles by this author , Takashi SaikaTakashi Saika More articles by this author , Yasutomo NasuYasutomo Nasu More articles by this author , and Hiromi KumonHiromi Kumon More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.374AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Early ligation of the ureter distal to the tumor site during surgery is recommended at the aim of reduce subsequent bladder tumor development. However, this matter has not been determined. To validate the oncological benefits of early ligation of the ureter in nephrouretectomy for upper urinary tract urothelial carcinoma (UUT-UC). METHODS A total of 229 patients underwent nephroureterectomy for UUT-UC between January 2005 and December 2007. The clinicopathologic data for the remaining 205 patients with UUT-UC were retrospectively reviewed. In a total of 76 of 205 patients, early ligation of the ureter during surgery was performed. We defined early ligation of the ureter as ligating the ureter immediately after the ligation of the renal artery. The following variables were evaluated for association with the bladder recurrence: sex, age, tumor stage, tumor grade, venous invasion, lymphatic invasion, tumor location, multifocality, surgical technique, time of ligation of the ureter and preoperative cytology. The significance of each variable was tested univariately with the log-rank test. The simultaneous effects of multiple risk factors were estimated by multiple regression analysis by using the Cox proportional hazards model. RESULTS The median follow-up after nephroureterectomy was 16.6 months (range 0.3 to 38.8 months). Bladder tumor recurrence occurred in 82 patients (40.0%). Significant risk factors for bladder recurrnce on univariate analysis were time of ligation of the ureter (p=0.0383), preoperative urine cytology positive (p=0.0317) and tumor location (p=0.0352). Multivariate analysis revealed that time of ligation of the ureter, tumor location and preoperative cytology positive were significant for bladder recurrence. CONCLUSIONS Risk factors of subsequent development of bladder cancer after nephrouretctomy were time of ligation of the ureter, tumor location and preoperative cytology positive. The possibility that early ligation of the ureter during operation contributes to reduce the risk of subsequent development of bladder cancer after nephrouretectomy was showed. Okayama, Japan© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e123 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Yasuyuki Kobayashi More articles by this author Shinya Uehara More articles by this author Toyohiko Watanabe More articles by this author Takashi Saika More articles by this author Yasutomo Nasu More articles by this author Hiromi Kumon More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Air Pollution and Risk Factors Related to Respiratory Illness in Schoolchildren in the Niger-Delta

ISEE-0585 Background and Objective: Association of childhood respiratory illness with air pollution has been widely reported in developed but not in developing countries. Warri and its surrounding municipal areas in Delta State, Nigeria is the location of petrochemical complexes and the region has long standing issues of industrial and traffic pollution, socio-economic deprivation and ill-health of its residents. This study was aimed to investigate association between self-reported respiratory symptoms and exposure to ambient air pollution and other risk factors in 7–14 years old school children in and around Warri town. Methods: A cross-sectional questionnaire survey was carried out among 1,397 school children of low socio-economic status. Exposure to air pollution was assessed by self-reported measures as well as objective methods including traffic counts, distance of schools to major streets, particulate matter and carbon-monoxide measurements. Associations between health and risk factors were examined at individual and ecological level in a multiple regression analysis. Results: Road traffic was associated with increased risks of wheeze, night cough and phlegm in the last 12 months. Suggestive associations were found between overcrowding and wheeze and nose problems; owning pets and nose problem and diagnosed asthma; and environmental tobacco smoke and phlegm and nose problem, after adjustment for other explanatory variables. When viewed in terms of the pollutant mix from different sources, at the aggregate level, there was a relatively consistent suggestion of higher rates of health outcomes in areas classified as being more polluted than those classified as being relatively unpolluted. Conclusion: The effects of multiple risk factors on school-age children in the Niger-Delta are indicative of possible additional effects of ambient air pollution especially on respiratory symptoms, over and above any attributable to personal and household effects. These are of public health importance and merit practicable interventions.

CD4(+)CD45RA(+)CXCR4 (+) lymphocytes are inversely associated with progression in stages I-III melanoma patients.

The chemokine receptor CXCR4 was described as an independent predictor of poor prognosis in primary human melanoma. To investigate on a possible role of CXCR4 expression on peripheral blood lymphocytes (PBL) subsets, 195 patients with melanoma were evaluated for correlations between PBL subsets CXCR4 expressing and clinicopathological and prognostic features. One hundred ninety-five patients with stages I-III melanoma were enrolled in this study. Lymphocytes subsets were assayed by the direct fluorescence method for whole blood and staining with fluorochrome-conjugated monoclonal antibodies. Correlations between PBL subsets, baseline patient, and tumor features were studied by contingency tables and the chi(2) test. The Kaplan-Meier product limit method was applied to plot disease-free- and overall-survival curves. Univariate analysis was performed with the log-rank test. Cox proportional-hazards regression was used to analyze the effect of multiple risk factors on disease-free survival (DFS). Melanoma patients characterized by CD4(+)CD45RA(+)CXCR4(+) higher than 25% of PBL showed a longer DFS. Conversely, CD4(+)CD45RA(+)CXCR4(+) <25% increased the risk of relapse. The 5-year DFS rate was 76% for patients with CD4(+)CD45RA(+)CXCR4(+) lymphocytes <25% of PBL, and 94% for patients with CD4(+)CD45RA(+)CXCR4(+) >25% (p = 0.030 at log-rank test). Univariate and multivariate analysis for DFS confirmed the prognostic value of the CD4(+)CD45RA(+)CXCR4(+) lymphocytes. Although further studies are needed to better define the involved subpopulation, the detection of cellular subset CD4(+)CD45RA(+)CXCR4(+) is an easy and feasible evaluation of melanoma patients in concomitance with the established melanoma prognostic markers.

122 Long-term risks after radiotherapy (RT) for testicular cancer (TC)

Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT).To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case–control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients.Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character.CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy.

120 Radiotherapy

Venous thromboembolism (VTE) is a frequent complication in patients with acute lymphoblastic leukemia (ALL). A significant proportion of patients develop cerebral venous thrombosis (CVT).To investigate risk factors for and the clinical course of CVT in ALL patients, we describe all cases of CVT which occurred in a well-defined cohort of 240 adults, treated for newly diagnosed ALL in the HOVON (Dutch-Belgian Hemato-Oncology Cooperative Group)-37 study. We conducted a nested case–control study to explore the relevance of early symptoms and risk factors for CVT in ALL patients.Nine of 240 patients developed CVT (4%). CVT occurred during or shortly after L-asparaginase therapy (in 8 cases) and shortly after intrathecal methotrexate injections (in all cases) during cycle I of remission induction treatment. CVT was associated with prior headache and seizures. In 5 of 9 patients with CVT, headache before the diagnosis of CVT occurred within 3 days after lumbar puncture and initially had a postural character.CVT is relatively common in adult ALL patients. Our data suggest that CVT in adult ALL patients results from the additive effects of multiple risk factors, with a particular role for asparaginase and the effects of lumbar punctures for intrathecal therapy.

Identifying Vulnerable Subpopulations for Climate Change Health Effects in the United States

Climate change can be expected to have differential effects on different subpopulations. Biological sensitivity, socioeconomic factors, and geography may each contribute to heightened risk for climate-sensitive health outcomes, which include heat stress, air pollution health effects, extreme weather event health effects, water-, food-, and vector-borne illnesses. Particularly vulnerable subpopulations include children, pregnant women, older adults, impoverished populations, people with chronic conditions and mobility and cognitive constraints, outdoor workers, and those in coastal and low-lying riverine zones. For public health planning, it is critical to identify populations that may experience synergistic effects of multiple risk factors for health problems, both related to climate change and to other temporal trends, with specific geographic factors that convey climate-related risks.

Factors Associated With Prolonged Recovery After the Fontan Operation

Mortality and major morbidity after the Fontan operation is low in the current era. However, factors contributing to prolonged postoperative recovery are not clearly understood. Data on all patients admitted to the cardiac intensive care unit (CICU) after a Fontan operation between June 2001 and December 2005 were retrospectively analyzed. We excluded all patients who died, required Fontan takedown, or required ECMO. The study cohort was further divided into a prolonged recovery group that included patients with >75%ile for duration of mechanical ventilation or pleural drainage, and a standard recovery group which included all other patients. A multivariable logistic regression model was used to compare demographic, anatomic, and physiological variables between the prolonged and standard recovery groups. There were 226 Fontan operations performed. Of the study population (n=218), the median age was 2.61 years (1.0 to 31.9 years) and weight was 12.45 kg (8.4 to 77.5 kg). The most common diagnosis was hypoplastic left heart syndrome (n=80, 36.7%). A systemic right atrioventricular valve was present in 139 (63.7%). The lateral tunnel fenestrated Fontan was the most common surgery (n=195, 89.4%). Within the study population, 81 (38%) patients meet criteria for prolonged recovery. Univariate risk factors for prolonged recovery included higher preoperative PVR (P=0.033), longer bypass times (P=0.009), higher postbypass lactate level (P=0.017), higher postoperative central venous (P<0.001) common atrial pressure (P=0.042), inotropic score (P<0.001), and need for greater volume resuscitation during the 24 postoperative hours (>75% for the entire group; P<0.001). In a multivariable model, need for greater volume resuscitation (OR 2.81, 95% CI 1.30, 6.05) was the only independent risk factor for prolonged outcome after the Fontan operation. High volume expansion in the early postoperative period is an independent risk factor for prolonged recovery. The need for high volume expansion may represent the compound effects of multiple risk factors including preoperative hemodynamics and a marked systemic inflammatory response to surgery and cardiopulmonary bypass, which in turn may mediate prolonged recovery.

Risk factors associated with neuroendocrine tumors: A U.S.‐based case–control study

Carcinoids are rare neuroendocrine tumors (NETs); however, their incidence has significantly increased in the United States over the past 30 years. Little is known about the epidemiology of these cancers and their associated risk factors. We evaluated the independent effects of multiple risk factors associated with NETs arising at 5 disease sites (small intestine, stomach, lung, pancreas and rectum). We conducted a retrospective, hospital-based, case-control study involving 740 patients with histologically confirmed NETs and 924 healthy controls. Information on different risk factors was collected, and unconditional logistic regression analysis was used to determine adjusted odds ratios (AORs) and 95% confidence interval (CI) by the maximum-likelihood method. Smoking and alcohol consumption were not associated with NETs development in either men or women. However, a family history of cancer was a significant risk factor for all NETs. A long-term history of diabetes mellitus was a significant risk factor for gastric NETs (AOR = 5.6; 95% CI, 2.1-14.5), particularly in women (AOR = 8.4; 95% CI, 1.9-38.1). Diabetes modified the risk among women with a positive family history of cancer for the development of gastric NETs (AOR = 52.2; 95% CI, 5.5-491.5). Our results suggest that the risk of NETs may mostly explained by genetic factors. The increased risk of gastric NETs in women with both diabetes and a positive family history of cancer suggest that women may have a greater genetic susceptibility to NETs than men.