Effects Of Individual Risk Factors Research Articles

The Effect of Preeclampsia on Adverse Maternal Outcomes in Women With Placental Abruption at a Large Urban Hospital in Tennessee From 2019 to 2022 [ID 2683655

INTRODUCTION: Placental abruption is associated with increased pregnancy-related morbidity and mortality. Few studies have explored the effect of individual risk factors for placental abruption on outcomes. Our study evaluates the association of preeclampsia and maternal morbidity in patients with placental abruption. METHODS: We conducted a retrospective case–control study to evaluate the association of preeclampsia with adverse maternal outcomes in the setting of placental abruption. Univariate analyses were used to determine the relationship between preeclampsia and known adverse maternal outcomes of placental abruption. Multivariate logistic regression was then used to evaluate the relationship between preeclampsia and each significantly associated outcome, adjusting for factors including body mass index, gestational age, mode of delivery, race, trauma, diabetes, placental location, cocaine and tobacco use, prior cesarean sections, year of delivery, and parity. Significance was assessed at an alpha of 0.05. RESULTS: Of 147 singleton pregnancies complicated by placental abruption from 2019 to 2022, 37 (25.2%) were complicated by preeclampsia. No significant differences were found between groups in incidence of acute kidney injury, disseminated intracellular coagulation, cesarean delivery, fetal demise, preterm birth, or low birth weight. On adjusted multivariable regression, we found preeclampsia increased the odds of maternal transfusion requirement (adjusted odds ratio [aOR] 3.55; 95% CI: 1.2, 10.4) and postoperative hospital stay greater than 2 days (aOR 4.05; 95% CI: 1.5, 11.2). CONCLUSION: Preeclampsia was an independent predictor of need for blood transfusion and increased duration of hospital stay in patients with placental abruption. Recognition of preeclampsia as an independent risk factor for these outcomes may allow medical optimization, increased preparedness, and lead to decreased pregnancy-related morbidity.

Association of Oxygen Therapy with the Natural Disease Progression of Cystic Fibrosis: A Multi-State Model of the European Cystic Fibrosis Society Patient Registry.

Association between dependence on oxygen therapy (OT) and natural disease progression in people with cystic fibrosis (pwCF) has not been estimated yet. The aim of this study is to understand the prognosis for pwCF on OT, evaluating how the transition probabilities from being alive without lung transplantation (LTx) to LTx and to death, and from being alive after LTx to death change in pwCF with and without OT. We used 2008-2017 data from the 35-country European CF Society Patient Registry. A multi-state model was fitted to assess the effects of individual risk factors on transition probabilities. We considered 48,343 pwCF aged from 6 to 50 years. OT (HR 5.78, 95% CI: 5.32-6.29) and abnormal FEV1 (HR 6.41, 95% CI: 5.28-7.79) were strongly associated with the probability of having LTx; chronic infection with Burkholderia cepacia complex (HR 3.19, 95% CI: 2.78-3.67), abnormal FEV1 (HR 5.00, 95% CI: 4.11-6.08) and the need for OT (HR 4.32, 95% CI: 3.93-4.76) showed the greatest association with the probability of dying without LTx. Once pwCF received LTx, OT (HR 1.75, 95% CI: 1.41-2.16) and abnormal FEV1 (HR 1.63, 95% CI: 1.18-2.25) were the main factors associated with the probability of dying. An association of gross national income with the probability of receiving LTx and with the probability of dying without LTx was also found. Oxygen therapy is associated with poor survival in pwCF with and without LTx; harmonization of CF care throughout European countries and minimization of the onset of pulmonary gas exchange abnormalities using all available means remains of paramount importance.

Effect of Disease Severity, Age of Child, and Clinic No-Shows on Unscheduled Healthcare Use for Childhood Asthma at an Academic Medical Center.

This study examines the influence of various individual demographic and risk factors on the use of unscheduled healthcare (emergency and inpatient visits) among pediatric outpatients with asthma over three retrospective timeframes (12, 18, and 24 months) at an academic health center. Out of a total of 410 children who visited an academic medical center for asthma outpatient care between 2019 and 2020, 105 (26%) were users of unscheduled healthcare for childhood asthma over the prior 12 months, 131 (32%) over the prior 18 months, and 147 (36%) over the prior 24 months. multiple logistic regression (MLR) analysis of the effect of individual risk factors revealed that asthma severity, age of child, and clinic no-shows were statistically significant predictors of unscheduled healthcare use for childhood asthma. Children with higher levels of asthma severity were significantly more likely to use unscheduled healthcare (compared to children with lower levels of asthma severity) across all three timeframes. Likewise, children with three to four clinic no-shows were significantly more likely to use unscheduled healthcare compared to children with zero clinic no-shows in the short term (12 and 18 months). In contrast, older children were significantly less likely to use unscheduled healthcare use compared to younger children in the longer term (24 months). By virtue of its scope and design, this study provides a foundation for addressing a need identified in the literature for short- and long-term strategies for improving supported self-management and reducing unscheduled healthcare use for childhood asthma at the patient, provider, and organizational levels, e.g., (1) implementing telehealth services for asthma outpatient care to reduce clinic no-shows across all levels of asthma severity in the short term; (2) developing a provider-patient partnership to enable patient-centered asthma control among younger children with higher asthma severity in the long term; and (3) identifying hospital-community linkages to address social risk factors influencing clinic no-shows and unscheduled healthcare use among younger children with higher asthma severity in the long term.

A proposed fetal risk scoring system for gestational diabetes to assist in optimising timing of delivery


 
 
 
 Background. The pathophysiology of gestational diabetes, which is related to abnormal gluocose tolerance and hyperinsulinaemia, renders standard fetal monitoring models ineffective, insufficient and inappropriate, as these models revolve around detecting and prognosticating on placenta-mediated disease rather than increased metabolic rates due to hyperinsulinaemia, functional hypoxia and ischaemic trophoblastic thresholds. To improve perinatal morbidity and mortality in gestational diabetes, there is therefore a need to introduce new prognostic parameters and scoring systems.
 Objectives. A proposed risk scoring system has been developed, based on our previous studies, to risk-categorise patients with gestational diabetes in terms of fetal outcome in view of the fact that the pathophysiology of gestational diabetes is not recognised by standard monitoring models, which revolve around placental insufficiency rather than metabolic anomalies.Methods. Patients with diabetes from four case-control studies were combined to form a total sample of 159 cases for validation of the risk scoring system. Univariate logistic regression analysis was used to assess the effect of individual risk factors with proposed cut-offs on adverse pregnancy outcome. The diagnostic accuracy of the total summative score was assessed by computing the area under the receiver operating characteristic (ROC) curve.
 Results. Four potential parameters were identified to risk-categorise fetuses in a pregnancy complicated by gestational diabetes, i.e. the myocardial performance index (MPI), the E/A ratio (early diastolic filling/late diastolic filling, a marker of diastolic dysfunction), increasing fetal weight (macrosomia), and an increased amniotic fluid index. The total score, obtained by summation of the composite scores for these parameters, ranged from 0 to 11. The total score performed as an excellent predictor of adverse outcome, evidenced by an ROC area under the curve of 0.94. A cut-point of 6 on the score confers a sensitivity of 84.2% and specificity of 90.2% for predicting adverse outcome.
 Conclusion. To our knowledge, this is the first gestational diabetes scoring system proposed to predict an adverse outcome.
 
 
 

Factors influencing fatal vehicle-involved crash consequence metrics at spatio-temporal hotspots in South Korea: application of GIS and machine learning techniques

ABSTRACT Studies have employed several techniques to identify the effect of individual risk factors influencing crashes at hotspot locations. Nevertheless, as crashes are sometimes influenced by a combination of risk factors, identifying the chains of factors collectively contributing to fatal crashes at hotspot locations could provide added insights for improving traffic safety. By employing fatal crash data from Korea, this study identifies hotspots with increasing (critical) and decreasing (diminishing) temporal trends using a spatio-temporal hotspot analysis tool in GIS. Further, a machine learning technique is employed to explore the chains of factors influencing the number of vehicles and the number of casualties involved in fatal crashes at intersections and midblocks in each hotspot type identified. In general, results showed that minibuses/vans and construction vehicles were mainly at fault for fatal single-vehicle pedestrian-involved crashes. While many casualties and vehicles are likely to be involved in crashes at midblocks during the daytime regardless of the hotspot type, the nighttime variable was particularly associated with large casualty-size crashes at critical intersection hotspots. Further, while reckless driving was mostly associated with single-vehicle crashes at intersections in diminishing hotspots, pedestrian protection, and improper centreline crossing violations were more pronounced at midblocks in diminishing hotspots. This analysis identified groups of factors that could be collectively controlled to improve road safety and proposed countermeasures to mitigate fatal crashes on roadways.

A study on the probabilistic quantification of heavy-truck crash risk under the influence of multi-factors

In order to manage and reduce a specific risk, its quantitative analysis is necessary. The key objective of this study is to illustrate the prevalence of multi-factors in fatal crashes involving heavy trucks and to quantify the crash risk under the influence of multi-factors. Data from a recent, nationally representative sample of fatal crashes was investigated to identify the risk factors contributing to crash causations and a novel risk index was obtained to develop a criterion for crash risk quantification. Then, based on the mutual information theory, the mutual dependence between risk factors was calculated to quantify the crash risk under different risk factor combinations. The results reveal that most heavy-truck fatal crashes are the result of co-occurring multi-factors rather than a single factor, and are mainly caused by simultaneous occurrence of two or three contributing factors. Moreover, crash risk increases with the increase of the number of risk factors influencing the driver. Furthermore, multi-factor interaction between certain risk factors, such as environmental and vehicular factors, makes incremental contribution to the crash risk by further increasing the crash probability. Specifically, when driver’s aberrant behaviors (errors and/or violations) are exposed to both environmental and vehicular factors, driver’s likelihood of being involved in a fatal crash increases significantly. This suggests that in addition to the number of risk factors, the crash risk also depends on the multi-factor interactions between different risk factors. Therefore, the effects of individual risk factors should be controlled at the outset to prevent the incremental effects of multi-factors on crash risk, in turn enabling risk minimization..

Type 2 diabetes mellitus increases risk of erectile dysfunction independent of obesity and dyslipidemia: A Mendelian randomization study.

The causal effects of individual risk factors of metabolic syndrome on erectile dysfunction (ED) are still unclear. To evaluate the causal effect of risk factors of metabolic syndrome on ED through Mendelian randomization (MR). Data for risk factors were obtained from multiple databases with 173,082-757,601 individuals, and that for ED were collected from a genome-wide association study including 223,805 Europeans. We performed univariate MR analysis using inverse-variance weighted, MR-Egger, weighted-median, weighted mode methods and multivariable MR analysis to evaluate the total and direct causal effects. The univariable MR supported that type 2 diabetes mellitus (odds ratios [OR]=1.14, 95% confidence intervals [CI]: 1.08-1.21, p<0.001) and body mass index (BMI) (OR=1.27, 95% CI: 1.12-1.44, p<0.001) were associated with ED. After excluding the SNPs associated with BMI and other risk factors, the results of multivariable MR for T2D (OR=1.15, 95% CI: 1.05-1.25, p=0.001) remained consistent. However, the results of multivariable MR provided limited evidence for the causality between BMI and ED (OR=1.06, 95% CI: 0.88-1.29, p=0.532). For systolic blood pressure and lipid components (low-density lipoprotein, high-density lipoprotein and triglycerides), both univariable and multivariable MR failed to offer sufficient evidence to confirm their causal effect on ED. T2D showed a direct causal effect on ED independent of obesity and dyslipidemia.

Emerging risk factors and the disease pattern in Turkey: an analysis based on burden of diseases

Knowledge about the burden of disease and injury alone is not sufficient for health improvement and for defining and evolving policies and strategies. In many low and middle income countries, the impacts of chronic diseases are increasing gradually each year. Anticipating, understanding and reducing the impact of chronic diseases on human health is of great importance. The aim of this paper was to assess the main risk factors in chronic diseases in a developing country and to identify the effects of individual risk factors on burden of disease by using comparative risk assessment methodology. The first BoD study in 2003 revealed that the high systolic blood pressure was ranked first and the prevention of high systolic blood pressure would prevent 108.468 of 430.459 deaths in Turkey. Smoking was at the second rank and prevention of smoking would prevent 54.699 deaths while control of cholesterol level within the normal limits would prevent 49.029 deaths. It is also indicated that adequate levels of physical activity would prevent 45.120 deaths and that consumption of the recommended amount of fruits and vegetables would prevent 38.734 deaths. In the 2013 study, smoking ranked first, followed by nutritional risks at the second rank followed by high BMI, high blood pressure and high sugar level respectively. Smoking, high blood pressure, obesity and tobacco use are the most important problems among the preventable deaths and disability in Turkey. It can be concluded that Turkey now resembles the pattern seen in developed countries and some developing countries with low mortality.

Impact of Multiple Risk Factors on Vaccination Inequities: Analysis in Indian Infants Over 2 Decades

Several authors have explored the effect of individual risk factors on vaccination inequity in Indian infants. This study explores the combined impact of >1 risk factor on the probability of full vaccination. The proportion of fully vaccinated infants (aged 1-2 years) was calculated from the National Family Health Survey conducted during 1997-1998 (National Family Health Survey-2, n=10,211), 2005-2006 (National Family Health Survey-3, n=9,582), and 2015-2016 (National Family Health Survey-4, n=48,715). Full vaccination was defined as receiving Bacille Calmette‒Guerin (1 dose); diphtheria, pertussis, tetanus (3 doses); oral polio (3 doses); and measles (1 dose) vaccines. The association between full vaccination status and 6 factors (infant sex, birth order, family wealth status, maternal education level, residence type, and religion) was analyzed individually, followed by the combined impact of ≥1 of the first 4, using logistic regression models. The AORs for full vaccination in the 3 surveys, respectively, were 1.09, 1.13, and 1.00 for male versus female infants; 0.68, 0.71, and 0.88 for birth order >1 versus birth order 1; 1.54, 1.96, and 1.20 for greater wealth versus lowest wealth stratum; 2.21, 2.27, and 1.27 for any maternal education versus none; 1.08, 1.10, and 1.08 for Hindu versus other religion; and 1.51, 1.10, and 0.88 for urban versus rural residence. The respective ORs of full vaccination in the 3 surveys by the number of risk factors were as follows: 1.26, 1.54, and 1.27 for 3 risk factors; 2.41, 3.23, and 1.68 for 2 risk factors; 4.42, 6.45, and 2.18 for 1 risk factor; and 7.32, 9.84, and 2.61 for no risk factor. The presence of multiple risk factors had a cumulative negative impact on infant vaccination in India. Despite an improvement over 2 decades, significant inequities persist. This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

P0386OUTCOMES OF PAUCI-IMMUNE CRESCENTIC GLOMERULONEPHRITIS BASED ON THE INTERNATIONAL HISTOPATHOLOGICAL CLASSIFICATION AND RECENTLY PROPOSED RENAL RISK SCORE IN ADULTS: A SINGLE CENTER STUDY

Abstract Background and Aims Pauci-immune crescentic glomerulonephritis is rare form of glomerulonephritis that frequently presents as rapidly progressive renal failure. The histopathological classification proposed by Berden a decade earlier described difference in the outcomes of patients in the focal, crescentic, mixed and sclerotic category with best prognosis for focal and worst for sclerotic group. The newly proposed renal risk score (Brix SR at al.) takes into account both the histopathological parameters (% of normal glomeruli, tubular atrophy and interstitial fibrosis) and clinical parameter (eGFR) which influence outcome in these patients. Present study was undertaken to determine outcomes of pauci-immune crescentic glomerulonephritis based on both of these prognostic systems and also to determine effect of individual risk factors on renal outcome. Method 64 patients diagnosed as pauci-immune crescentic glomerulonephritis from January 2013 to December 2018 were retrospectively analyzed. There histopathological slides were reviewed for percentage normal glomeruli, extent of interstitial fibrosis and tubular atrophy and biopsies were also grouped according to histopathological classification into focal, crescentic, mixed and sclerotic categories. The clinical parameters including serum creatinine, eGFR at time of biopsy and follow-up, and status of ANCA positivity were obtained from electronic records. Renal biopsies were scored based on renal risk score depending on the % of normal glomeruli (&amp;gt;25%,10-25% and &amp;lt;10%), percentage of tubular atrophy and interstitial fibrosis(≤25%,&amp;gt;25%) and eGFR(&amp;gt;15ml/min,≤15ml/min) into 3 risk categories. Results There were 61 adult patients and 3 pediatric patients. Two patient with insufficient glomeruli (&amp;lt;7) on biopsy and 8 patients without follow-up were excluded. A total of 51 adult patients were included of which 28 were male and 23 females. The mean age was 51.2±15.7 years. The mean serum creatinine at the time of biopsy was 7.05±4.57 mg/dl and the mean eGFR was 13.6±12.16 ml/min/1.73m2. There were 33 ANCA positive and 18 ANCA negative(35%) cases. Distribution of patients according to Berden’s histopathological classification was focal(4), crescentic(29), mixed(12) and sclerotic(6). The distribution of patients into risk categories based on renal risk score was low(8),medium(23) and high(20). Univariate Cox regression analysis showed that eGFR at biopsy (p 0.024), % IFTA (p 0.001) and % normal glomeruli in biopsy (p 0.023) are predictors of ESRD. Multivariate Cox regression analysis including age, eGFR, % IFTA and % normal glomeruli in biopsy also confirmed IFTA (p&amp;lt;0.001) and % normal glomeruli in biopsy (p 0.018) as significant predictors of ESRD. When % normal glomeruli was replaced by Berden’s histopathological classed it didn’t reach statistical significance to predict ESRD. Kaplan-Meier survival analysis for histological categories showed best renal survival in focal group and worst in sclerotic group (Log-Rank p=0.046). Kaplan-Meier analysis for the renal risk categories showed best survival in low risk group followed by medium and high risk groups respectively (Log-Rank p=0.002). Kaplan-Meier survival analysis was also done for percentage of normal glomeruli, IFTA and renal function. Conclusion In our study of Pauci-immune crescentic glomerulonpehritis ANCA was negative in 35% cases. Percentage of normal glomeruli, IFTA and eGFR at time of biopsy were important histopathological and clinical risk factors influencing renal survival in these patients. Results of our study validate that recently proposed renal risk score is a better predictor of survival (p=0.002) as compared to histological classification proposed by Berden (p=0.046).

Coronavirus Disease (COVID-19): Implications for Cardiovascular and Socially At-risk Populations.

Dennison Himmelfarb and Baptiste discuss the implications of coronavirus disease (COVID-19) for cardiovascular and socially at-risk populations COVID-19 is an infectious respiratory disease caused by the newly discovered pathogen, SARS-CoV-2, a novel RNA-dependent RNA polymerase betacoronavirus that is thought to derive from bats At this time, there are no specific vaccines or treatments for COVID-19 The best way to prevent and slow transmission is to be well informed about the COVID-19 virus, the disease it causes, and how it spreads

A systematic review and meta-analysis of risk factors for unruptured intracranial aneurysm growth.

Many risk factors are associated with the growth of unruptured intracranial aneurysm; however, the effects of these risk factors on intracranial aneurysm growth remain poorly understood. Here, we performed a meta-analysis to evaluate the effects of these risk factors on intracranial aneurysm growth, incorporating different data types to provide comprehensive estimates of individual effects. We searched the Cochrane Library, PubMed, Embase, and Web of Science for cohort studies analyzing risk factors for aneurysm growth prior to January 10, 2019. The hazard ratio (HR) and odds ratio (OR) with its 95% confidence interval (CI) were calculated to assess the effect of individual risk factors on intracranial aneurysm growth. Both univariate analysis (UVA) and multivariate analysis (MVA) were performed. Two reviewers independently assessed the quality of the trials and the associated data. All statistical analyses were performed using standard statistical procedures provided in Review Manager 5.2. We included 23 studies (N = 7208 participants) in this meta-analysis. A total of 944 patients (13.1%) experienced intracranial aneurysm growth during their follow-up times. Aneurysm size and smoking may have significant effects on the growth of intracranial aneurysm, with pooled ORs of 2.73 (95% CI 2.21-3.36; P < 0.00001) and 1.45 (95% CI 1.07-1.98; P = 0.02) respectively. However, our results indicated that subarachnoid hemorrhage (SAH) had a negative effect on the growth of intracranial aneurysm (OR 0.64; 95% CI 0.48-0.86; P = 0.003). Other risk factors such as irregular shape of intracranial aneurysm, female sex, and multiple aneurysms were inconsistent across studies due to differences in data types and effect estimates. Our meta-analysis identified aneurysm size and smoking as independent risk factors for the growth of intracranial aneurysm, while prior SAH had a negative effect on the growth of intracranial aneurysm. The roles of other risk factors for intracranial aneurysm growth were inconsistent, with further research necessary to assess fully the roles of these factors in disease outcomes.

Individual risk factors impact on the development of dentoalveolar anomalies in children

Dental anomalies and deformities belong to the group of major dental diseases and are characterized by high prevalence. To reduce the incidence of dental anomalies, early detection of risk factors is necessary. AIM: to study the effect of individual risk factors on the development of anomalies in the dental-maxillary system during the period of early interchangeable bite. It was established that in the period of early replaceable bite, risk factors for development were found in 54.24% of the examined children. To assess the degree of influence of various factors on the development of anomalies in the dental system in children, absolute, relative, and attributive risk values were calculated for 254 children of 7 years old. The absolute risk of the occurrence of dental anomalies in children with artificial and early mixed feeding was 79.16%, and the absolute risk in children with natural feeding was 64.6%. The relative risk of tooth-jaw anomalies in children with artificial and early mixed feeding was 2.08. Attributable risk - 28.55%. For effective preventive measures, the group of controlled risk factors is of the greatest interest. These are factors that can be eliminated, weaken or increase the resistance of the child's body to their action. Eliminating the bad habits of sucking fingers and various items, the risk of anomalies in the dental system is reduced by 20.38%. Introduction to the diet of tough food reduces the likelihood of development of dental-maxillary anomalies in children by 16.86%. Thus, the studied risk factors influence the formation of the dental system.

The Influence of Risk Factors on Preschoolers’ Spanish Vocabulary Development in the Context of Spanish Instruction

ABSTRACTResearch Findings: This longitudinal study investigated the Spanish vocabulary development of dual-language-learning (DLL) children (N = 150) from Spanish-speaking, low-income, predominantly immigrant homes who were enrolled in a state-funded preschool program that provided instruction in Spanish. Children’s Spanish vocabulary trajectories were examined, as were patterns of co-occurring risk. In addition, the relation of individual and cumulative risk factors at preschool entry on Spanish vocabulary development was explored. Findings reveal that, on average, children’s receptive Spanish vocabulary skills, which started below age-level norms at the beginning of the preschool year, grew to surpass age-level norms by the end of the year. These gains were made despite children facing, on average, eight risk factors. The investigation of patterns of co-occurring risk and the effect of individual risk factors on Spanish vocabulary outcomes reveal that some social risk factors, such as having an unemployed parent, might function as a protective factor in this population. Practice or Policy: This study paves the way for future work in determining the role of native-language instruction for supporting language growth among DLL children. In addition, it expands the research literature on the nature and influence of social and economic risks in this population of children.

Malnutrition and non-communicable diseases among Bangladeshi women: an urban\u2013rural comparison

Background/Objectives:This study aims at examining the urban–rural differentials in the effects of socioeconomic predictors on underweight and obesity of ever-married women in Bangladesh. The effect of malnutrition and other risk factors on non-communicable diseases is also examined.Subjects/Methods:The information regarding nutritional status, socioeconomic and demographic background, and non-communicable diseases of ever-married women was extracted from the nationally representative, cross-sectional Bangladesh Demographic and Health Survey (BDHS 2011) data set. Both bivariate (χ2 test) and multivariate (multinomial logistic regression model) analyses were performed in determining the risk factors of malnutrition. The effect of malnutrition and associated risk factors on non-communicable diseases was determined using binary logistic regression models.Results:The overall prevalence as well as the effects of individual risk factors of malnutrition differ in urban and rural settings. Regional differentials in the prevalence of underweight were statistically significant only for rural areas. In rural and urban settings, women from households with poor economic status were 67% (odds ratio (OR) 0.33, 95% CI 0.26–0.43) and 81% (OR=0.19, 95% CI 0.13–0.29) less likely to be overweight, respectively, with respect to those from affluent households. Women from the Rangpur division were significantly more likely to suffer from anemia (OR=1.41, 95% CI 1.13–1.77) and hypertension (OR=1.67, 95% CI 1.19–2.34) than those from the Sylhet division (reference division). With respect to those considered as underweight, women who were categorized as overweight were 0.47 (OR=0.53, 95% CI 0.43–0.65) times less likely to suffer from anemia, and 1.83 (OR=2.83, 95% CI 1.99–4.02) and 1.70 (OR=2.70, 95% CI 2.09–3.50) times more likely to suffer from diabetes and hypertension, respectively.Conclusions:Rural–urban differentials in the effects of individual risk factors of malnutrition were observed. Wealth status of households and nutritional status of women showed significant effect on the prevalence of anemia, diabetes and hypertension.

Towards sustainable mining (part II): Accounting for mine reclamation and post reclamation care liabilities

Valuation of mining investment opportunities typically focuses on revenues (i.e., amount of ore, mineral grade, and commodity prices), pre-production capital expenditures (CAPEX), and recurring operating expenditures (OPEX). Less emphasis is generally placed on longer-term costs that are harder to quantify, such as decommissioning, closure, and reclamation. Less emphasis still is placed on valuation of the very long term (or perpetual) costs of post-reclamation care (PRC) and long-term management (LTM) that should follow mine closure and reclamation, primarily due to technical and environmental uncertainties and the widespread practice of discounting, which renders the present value of distant future costs virtually nil particularly when typically high discount rates are used. Following on from the discussion of mine asset valuation in Part I (Espinoza and Rojo, 2017) of this two-part dissertation on sustainable mining, Part II discusses the inherent issues with the current practice of valuing project opportunities and accounting for PRC liabilities and LTM within the mining sector. The paper argues that mining sustainably starts with recognizing all potential future liabilities (routine and non-routine) through the life of a mine, ensuring that sufficient funds are available to address these liabilities, and investing these funds appropriately. Decoupled net present value (DNPV) analysis, which separates risk from the time value of money and treats risks as a cost to the project, is presented as a robust alternative to current accounting practices. This method can identify the effects of individual risk factors on the value of a project. A hypothetical example taken from the mining literature is used to compare the DNPV method with net present value (NPV) and modern asset pricing (MAP) analysis, and clearly illustrates the unsustainable consequences of using risk adjusted discount rates to value long term mining investments.

Abstract P259: Social and Biological Correlates of Elevated Blood Pressure in Afro-Caribbean Youth: Effect of Individual Risk Factors and Risk Factor Clustering

Background: We aimed to estimate the relative risk for elevated blood pressure (BP ≥ 120/80 mmHg) for cardiovascular disease (CVD) risk factors among Afro-Caribbean youth in Jamaica and to evaluate the association between clustering of risk factors and elevated BP. Methods: We analysed data from 898 young adults, 18-20 years old (409 males; 489 females) from the Jamaica 1986 Birth Cohort Study. BP was measured with a mercury sphygmomanometer after the participant had been seated for 5 minutes. Anthropometric measurements were done and venous blood obtained to measure fasting glucose, lipids and insulin. Data on socioeconomic status (SES) were obtained via questionnaire. CVD risk factor status was defined using standard cut-points or the upper quintile of the distribution. Insulin resistance was estimated using the Homeostasis Model Assessment (HOMA-IR). Relative risks were computed using odds ratios (OR) from logistic regression models. Results: Prevalence of elevated BP was 30% among males and 13% among females (p&lt;0.001). In multivariable logistic regression models, modifiable risk factors independently associated with elevated BP among males were: central obesity (OR 4.7, 95%CI 1.6 - 13.7), high glucose (OR 1.9, CI 1.1 - 3.1) and high HOMA-IR (OR 2.33, CI 1.1 - 5.1); among females associated factors were: high triglycerides (OR 2.2, CI 1.1 - 4.1), high HOMA-IR (OR 2.4, CI 1.1 - 5.0) and SES (OR 3.6, CI 1.03 - 12.8 [moderate vs high household possessions]; OR 1.87 CI 0.5 - 7.2 [low vs high]). Among males, having any one of central obesity, high glucose, high triglycerides or high HOMA-IR was associated with a two-fold increase in the odds of elevated BP, while having three or four factors was associated with a seven-fold increase in the odds. Among females, having any one of the four factors above was associated with two-fold higher odds, while having three or four factors was associated with a three-fold higher odds. Conclusion: Factors associated with elevated BP among Jamaican young adults include measures of obesity and insulin resistance, with significant differences by sex. Lower SES was associated with elevated BP among females. Clustering of risk factors was associated with markedly higher odds of elevated BP among males, but less so among females.

A Bayesian network framework for project cost, benefit and risk analysis with an agricultural development case study

Successful implementation of major projects requires careful management of uncertainty and risk. Yet such uncertainty is rarely effectively calculated when analysing project costs and benefits. This paper presents a Bayesian Network (BN) modelling framework to calculate the costs, benefits, and return on investment of a project over a specified time period, allowing for changing circumstances and trade-offs. The framework uses hybrid and dynamic BNs containing both discrete and continuous variables over multiple time stages. The BN framework calculates costs and benefits based on multiple causal factors including the effects of individual risk factors, budget deficits, and time value discounting, taking account of the parameter uncertainty of all continuous variables. The framework can serve as the basis for various project management assessments and is illustrated using a case study of an agricultural development project.

Abstract 17510: The First Prediction Model for Response to Autologous Bone Marrow-derived Mononuclear Cells After Myocardial Infarction Based on the REPAIR-AMI Trial

Background: Administration of autologous bone marrow-derived mononuclear cells (BM-MNC) resulted in favorable outcomes after myocardial infarction (MI) compared to placebo in the REPAIR-AMI trial. Pre-clinical studies have shown that individual risk factors negatively influence cell function. To date, it is not known how these risk factors modify treatment effect in clinical trials and if potential (non-)responders can be identified. Aim: To investigate the effect of individual risk factors on functional outcome after BM-MNC therapy and to establish a prediction model for treatment response in patients with MI. Methods: Data from the REPAIR-AMI trial were used, consisting of 186 patients who had complete baseline and follow-up measurements. We performed univariable and multivariable linear regression with 18 predefined baseline characteristics using the difference in baseline EF and after 4 months (ΔEF4) as primary outcome. Our main goal was to identify interaction terms of predictors with BM-MNC treatment; i.e. effect modifiers of treatment response. An individual estimate of treatment effect over placebo (ΔΔEF4) was created by extrapolating an ‘untreated’ reference value for ΔEF4, based on the placebo-arm and comparing it to the observed value after treatment. Treatment response was defined as a ΔΔEF4 of &gt;5% (so 5% over a predicted placebo value). Discrimination was quantified by the area under the ROC-curve (AUC). Results: The predictors age, weight, baseline EF and ESV showed an interaction with cell treatment in multivariable analysis with backward selection. Subsequently, the prediction model for individual ΔΔEF4 included age (-0.18/year, p=0.008), weight (+0.16/kg, p=0.01), baseline EF (-0.46/%, p=0.0001) and ESV (-0.09/ml, p=0.06). The predictive capacity for response to therapy showed an AUC of 79.2% (95% CI 69.7-88.6), which retained 74.8% (95% CI 65.0-84.5) after shrinkage. Conclusion: Response to BM-MNC administration after MI is influenced by age, weight, and baseline cardiac parameters. Using these continuous predictors, potential treatment responders can be accurately identified. Interestingly, an adverse risk-factor profile was associated with greater response, with potential implications for future patient selection.

Risk of postoperative urinary tract infections following midurethral sling operations in women undergoing hysterectomy.

Urinary tract infections (UTIs) are the most common complication following hysterectomy and mid-urethral sling procedures (MUS). As a MUS is often placed at the time of hysterectomy, we sought to determine if the addition of an MUS procedure significantly increases the risk of UTI in the first 30 days following hysterectomy. This retrospective cohort study utilizes the National Surgical Quality Improvement Program (NSQIP) data bank for the years 2006-2012. The database collects data on all enrolled patients preoperatively and in the first 30 days postoperatively. The database was searched using procedural codes for various types of hysterectomies and MUS procedures. We assessed the incidence of postoperative UTIs following hysterectomy (HYST) only, MUS only, and hysterectomy combined with MUS (HYST + MUS). Adjusted logistic regression analyses were performed to evaluate the effects of individual risk factors and models of interaction. The NSQIP cohort included 3,757 in the HYST + MUS group, 9,851 in the MUS-only group, and 57,398 in the HYST-only group. The rates of postoperative UTI, which was the most common postoperative morbidity, were 5.3, 3.4, and 2.5 % respectively. Multivariate logistic regression analysis showed a persistent significant increase in rates of UTI (p < 0.001) between the MUS + HYST group and the HYST-only group. This significance was not maintained between the MUS-only group and the MUS + HYST group. Data from the NSQIP databank indicate that performing an MUS in combination with hysterectomy nearly doubles the risk of postoperative UTI over a hysterectomy alone.