Effects Of Known Risk Factors Research Articles

Population-based cohort across stroke life course in India-The NIMHANS-NH-SKAN stroke project: A study protocol.

Stroke is a leading cause of death and disability worldwide. In India, it is the fourth leading cause of death and fifth leading cause of disability, posing a major public health concern. National surveys reveal an increasing trend in stroke risk factors such as tobacco use, physical activity, alcohol use, hypertension, and dyslipidemia. However, knowledge regarding the combined effect of these risk factors and their various combinations is limited. Understanding the individual, combined, and synergistic effects of known risk factors, along with new risk factors, is essential to address gaps in stroke epidemiology. This study aims to examine the effect of various risk factors of acute stroke and their association with stroke occurrence and its outcomes (survival, disability and quality of life). This retrospective-prospective cohort will be conducted in one taluka of Kolara district and two urban wards of Bengaluru with a total population of ~400,000. All stroke-free individuals above 30 years of age ~200,000 individuals in the selected sites will be participants of stroke-free period and all first ever stroke patients in the community will be part of stroke and post-stroke period respectively. The study subjects will be recruited through a complete house-to-house survey at baseline and undergo annual follow-ups during the stroke-free period, with specific assessments at defined time points during the stroke and post-stroke period for a period of one year. Efforts are implemented to minimize loss to follow-up, including community engagement, a helpline number, and hospital-based surveillance. This large population-based cohort study addressing stroke epidemiology in the country, is one -of-its-kind, attempting to fill certain critical gaps in the natural history, management, and outcomes of stroke in India. This research has the potential to provide important insights into the effect of novel risk factors of stroke and various combinations of risk factors of stroke. Furthermore, the development of a stroke risk predictability calculator will add value to the existing Indian National Programme for Prevention & Control of Non-Communicable Diseases (NP-NCD) and offers a model for similar countries once developed.

Mediators of the association between depression and migraine: a mendelian randomization study.

An association between depression and migraine has been reported in observational studies; however, conventional observational studies are prone to bias. This study aims to investigate the causal relationship between depression and migraine and to quantify the mediating effects of known risk factors. We applied two-sample Mendelian randomization and utilized single nucleotide polymorphisms as genetic instruments for exposure (depression) and mediators (sleep traits). We utilized summary data on genome-wide association studies for depression, sleep-related traits mediators and migraine. For depression, genome-wide association studies (depression) were utilized as a test cohort for the primary analysis. Moreover, genome-wide association studies (major depressive disorder) were utilized to test the stability of the results for the validation cohort. IVW and MR-Egger regression were applied to test the heterogeneity, and Cochran's Q statistics were calculated to quantitatively evaluate the heterogeneity. MR-PRESSO analyses were utilized to examine and correct possible horizontal pleiotropy through removing outliers, and leave-one-out analyses were utilized to identify outlier SNPs. Genetically predicted depression was associated with migraine (OR = 1.321, 95% CI: 1.184-1.473, p < 0.001). Furthermore, risk factors insomnia was associated with migraine risk (OR = 1.766, 95% CI: 1.120-2.784, p = 0.014). The mediator insomnia accounted for 19.5% of the total effect of depression on migraine. These results support a potential causal effect of depression on migraine, partly mediated by insomnia. Therefore, the enhancement of sleep quality and difficulty in falling asleep may reduce the migraine burden occasioned by depression.

Impact of the COVID-19 Pandemic on Childhood Lead Testing and Blood Lead Levels

ObjectiveTo evaluate the effect of the COVID-19 pandemic on childhood lead testing and blood lead levels. MethodsA retrospective analysis of lead tests and results was performed across 3 urban medical centers during the pre-COVID-19 (March 10, 2019–March 9, 2020) and COVID-19 (March 10, 2020–March 10, 2022) periods. Interrupted time series analysis with quasi-Poisson regression was used to evaluate changes in lead testing between study periods. The relationship between sociodemographic features with detectable (≧2 µg/dL) and elevated (≧3.5 µg/dL) blood lead levels (BLLs) was assessed with multivariable logistic regression. ResultsAmong a total of 16,364 lead tests across 10,362 patients, weekly testing rates significantly decreased during COVID-19 (relative risk (RR) 0.64, 95% (confidence interval) CI 0.53–0.78). Census tracts with the greatest proportion of pre-1950s housing had a stronger association with detectable BLLs during the COVID-19 period (pre-COVID-19 adjusted odds ratio (aOR) 1.73, 95% CI 1.35–2.20; aOR 2.58, 95% CI 2.13–3.12; interaction P value .014). When limited to 1 year following COVID-19 (March 10, 2020–March 10, 2021), the association between both elevated BLLs (pre-COVID-19: aOR 1.49, 95% CI 0.87–2.53; COVID-19: aOR 3.51, 95% CI 1.98–6.25; interaction P value .032) and detectable BLLs with pre-1950s housing were greater during the COVID-19 period (pre-COVID-19: aOR 1.73, 95% CI 1.35–2.20; COVID-19: aOR 2.56, 95% CI 1.95–3.34; interaction P value .034). ConclusionsThe COVID-19 pandemic led to a significant reduction in lead surveillance and magnified the effect of known risk factors for lead exposure. Concerted clinical, public health, and community advocacy are needed to address care gaps and excess cases of lead poisoning.

The application of the Limberg flap repair technique in the surgical treatment of pilonidal sinus disease.

Pilonidal sinus disease (PNSD) challenged surgeons for decades. Limberg flap repair (LFR) is a common treatment for PNSD. The purpose of this study was to observe the effect and risk factors of LFR in PNSD. A retrospective study was conducted on the PNSD patients who visited two medical centers and four departments in the People's Liberation Army General Hospital and were taking LFR treatment between 2016 and 2022. The risk factors, the effect of the operation, and complications were observed. The effects of known risk factors on the surgical results were compared. There were 37 PNSD patients: male/female ratio of 35:2, average age: 25.1 ± 7.9 years. Average BMI: 25.2 ± 4.0kg/m2 , average wound healing time: 15.4 ± 3.4 days. 30 patients (81.0%) healed in stage one and 7 (16.3%) had postoperative complications. Only 1 patient (2.7%) had a recurrence while others were healed after dressing-changing. There was no significant difference in age, BMI, preoperative debridement history, preoperative sinus classification, Wound area, Negative pressure drainage tube, prone time (<3d) and treatment effect. Squat defecate and premature defecation were associated with treatment effect, and they were independent predictors of treatment effect in the multivariate analysis. LFR has a stable therapeutic outcome. Compared with other skin flaps, the therapeutic effect of this flap is not significantly different, but the design is simple and is not affected by the known risk factors before operation. However, it is necessary to avoid the influence of two independent risk factors, squatting defecation and premature defecation, on the therapeutic effect.

Complex roles of TGF-β signaling pathways in lung development and bronchopulmonary dysplasia.

As survival of extremely preterm infants continues to improve, there is also an associated increase in bronchopulmonary dysplasia (BPD), one of the most significant complications of preterm birth. BPD development is multifactorial resulting from exposure to multiple antenatal and postnatal stressors. BPD has both short-term health implications and long-term sequelae including increased respiratory, cardiovascular, and neurological morbidity. Transforming growth factor β (TGF-β) is an important signaling pathway in lung development, organ injury, and fibrosis and is implicated in the development of BPD. This review provides a detailed account on the role of TGF-β in antenatal and postnatal lung development, the effect of known risk factors for BPD on the TGF-β signaling pathway, and how medications currently in use or under development, for the prevention or treatment of BPD, affect TGF-β signaling.

Mortality Rates in Femoral Neck Fractures Treated With Arthroplasty in South Africa.

ObjectivesTo investigate the mortality rate for neck of femur fractures treated with arthroplasty at a tertiary level unit in South Africa and to evaluate the effect of known risk factors for mortality in neck of femur fractures treated with arthroplasty in the South African context.DesignRetrospective cohort study. The main outcome was to determine mortality rates during in hospital stay, at 3 months, 6 months 1 year post surgery. The secondary outcome was to determine factors influencing mortality at 30 days, 6 months and 12 months post-surgery.ResultsMortality rate was 3.3% in hospital, 5.6% at 30 days and 26.7% at 1 year. Age >79, ASA score >3, and cementing of the femur had statistically increased mortality risk (P < .001). Average length of hospital stay was 12.3 ± 5.1 days (range 3.0-41.0 days) with 73% of patients discharged back to pre-hospital home.ConclusionMortality rates after femur neck fracture arthroplasty in South Africa are slightly higher at 1 year compared to international data. However, the rates are comparably low during hospital stay, 30 day and at 6 months post-surgical intervals.

Evaluation of gender differences in postoperative sore throat and hoarseness following the use of Ambu AuraGain laryngeal mask: the randomised controlled LadyLAMA trial study protocol

IntroductionPostoperative sore throat (POST) is a comparatively minor but very common side effect of general anaesthesia with a supraglottic airway device. The patient considers these side effects a mirror of...

Comparison of Low-Dose Direct Oral Anticoagulants for Patients

Evidence on the efficacy and safety of low-dose direct oral anticoagulant (DOAC) in older patients with nonvalvular atrial fibrillation is still scarce. We conducted a single-center prospective registry of patients with nonvalvular atrial fibrillation treated with DOACs: the DIRECT registry (n=2,216; follow-up, 407 ± 388 days, UMIN000033283). The whole population was divided into 2 groups: the older group (age ≥80 years, n=548) versus the younger group (age <80 years, n=1,668). Primary safety and efficacy end points were major bleeding according to the International Society on Thrombosis and Haemostasis criteria, and stroke or systemic embolism (SSE), respectively. Effects of known risk factors and low-dose DOAC on major bleeding and SSE were assessed using a multivariable Cox proportional hazards model. In the older group, low-dose DOAC was associated with lower bleeding events (hazard ratio 0.279, 95% confidence interval 0.087 to 0.892, p=0.031) but was not associated with increased SSE (p=0.894). In the younger group, low-dose DOAC was neither associated with risk of major bleeding nor SSE (both p>0.05). In conclusion, in older patients, low-dose DOAC was associated with reduced risk of major bleeding without compromising its efficacy.

The Interrelationship Between Empathy and Adverse Childhood Experiences and Their Impact on Juvenile Recidivism

Low empathy has been implicated in antisocial, aggressive, and criminal behavior, especially among adolescents. Less understood is the extent to which empathy is amenable to treatment, and whether an improvement in empathy can mitigate the deleterious effects of known risk factors, such as childhood maltreatment. A sample of 11,000 serious juvenile offenders in long-term residential placement is leveraged to examine whether over cumulative traumatic exposure, measured by the adverse childhood experience (ACE) score, is associated with the initial level of empathy at admission to a residential program, and whether changes in empathy during treatment moderate the impact of ACEs on juvenile recidivism. Results show youth with higher ACE scores have less empathy at admission and both ACEs and empathy predict recidivism. Most importantly, large gains in empathy are able to dampen the effect of ACEs on recidivism.

Heterogenous Effect of Risk Factors on Breast Cancer across the Breast Density Categories in a Korean Screening Population.

We evaluated the heterogeneity of the effect of known risk factors on breast cancer development based on breast density by using the Breast Imaging-Reporting and Data System (BI-RADS). In total, 4,898,880 women, aged 40–74 years, who participated in the national breast cancer screening program in 2009–2010 were followed up to December 2018. Increased age showed a heterogeneous association with breast cancer (1-year hazard ratio (HR) = 0.92, 1.00 (reference), 1.03, and 1.03 in women with BI-RADS density category 1, 2, 3, and 4, respectively; P-heterogeneity < 0.001). More advanced age at menopause increased breast cancer risk in all BI-RADS categories. This was more prominent in women with BI-RADS density category 1 but less prominent in women in other BI-RADS categories (P-heterogeneity = 0.009). In postmenopausal women, a family history of breast cancer, body mass index ≥ 25 kg/m2, and smoking showed a heterogeneous association with breast cancer across all BI-RADS categories. Other risk factors including age at menarche, menopause, hormone replacement therapy after menopause, oral contraceptive use, and alcohol consumption did not show a heterogeneous association with breast cancer across the BI-RADS categories. Several known risk factors of breast cancer had a heterogeneous effect on breast cancer development across breast density categories, especially in postmenopausal women.

Examining the intersection of race/ethnicity and sexual orientation on suicidal ideation and suicide attempt among adolescents: Findings from the 2017 Youth Risk Behavior Survey

Although some studies have examined factors associated with suicidal behaviors, few studies have examined the intersection of sexual orientation and race/ethnicity on suicidal behaviors among adolescents. The objective of this study is to examine the intersection of sexual orientation and race/ethnicity on suicidal ideation and suicide attempt. We hypothesized that controlling for the effects of known risk factors for suicidal behaviors, there will be an interaction effect between sexual orientation and race/ethnicity on suicidal behaviors. Data for this study came from the 2017 Youth Risk Behavior Surveillance System. A sample of 13,697 adolescents aged 14–18 years (51.8% female) was analyzed using binary logistic regression. Of the 13,697 adolescents, 17.7% reported suicidal ideation and 7.7% made at least one suicide attempt during the past 12 months. In the multivariate logistic regression models, non-White sexual minority adolescents are less likely to report suicidal ideation. However, Hispanic lesbian/gay adolescents had 1.71 times higher odds of making a suicide attempt. Odds of suicide attempt are 1.2 times higher for Black or African American bisexual adolescents and American Indian/Native Hawaiian/Pacific Islander bisexual adolescents had 2.44 times higher odds of making a suicide attempt. Other significant predictors of suicidal behaviors include a history of sexual assault, a victim of bullying, depression, cigarette smoking, misuse of prescription pain medication, and illicit drug use. The findings of the present study extend past research on the intersection of sexual orientation and race/ethnicity on mental health problems among adolescents including suicidal behaviors.

Childhood maltreatment as a risk factor for cancer: findings from a population-based survey of Canadian adults

BackgroundChildhood maltreatment (CM) is an established risk factor for various mental and substance use disorders. This study adds to existing evidence that CM may also be a risk factor for cancer.MethodsBased on data from a sample of 9783 men and 12,132 women from the 2012 Canadian Community Health Survey - Mental Health (CCHS-MH), this analysis explores mediated associations between cancer in adulthood and different levels of exposure to three types of CM—childhood physical abuse (CPA), childhood sexual abuse (CSA), and childhood exposure to intimate partner violence (CEIPV). “Cancer” was defined as an affirmative response to either of these questions: “Do you have cancer?” or “Have you ever been diagnosed with cancer?” The potential mediators were: smoking, depression, alcohol abuse/dependence, life stress, obesity, and physical activity.ResultsFor women, but not men, having experienced CM was significantly associated with a cancer diagnosis in adulthood, even when effects due to age and socio-demographic characteristics were controlled. Smoking, life stress, depression, and alcohol abuse/dependence reduced the strength of the association between CM and cancer in women. However, most associations remained statistically significant when controlling for effects due to these behavioural and other mediators. Evidence indicated a “dose-response” relationship, in that the likelihood of reporting cancer increased with the number of abuse types (CPA, CSA, CEIPV) reported, and with the severity of CPA.ConclusionsThe analyses suggest an association between CM and cancer in women, even when the effects of known risk factors were taken into account. The association was graded, becoming stronger as CM exposure increased. Implications for the provision of cancer screening and other health care services to women with histories of CM to reduce health disparities are discussed.

Encephalography guidance of anesthesia to alleviate geriatric syndromes (Engages-Canada) study in cardiac surgery patients: a pragmatic, randomized clinical trial

Introduction Postoperative delirium (POD) is a syndrome characterized by an acute onset of fluctuating confusion, disorganization and inattention. POD is frequent in the cardiac surgery population (incidence between 11-50%), and associated to complications such as increased risk of falls, prolonged hospital stay, functional decline and increased morbidity and mortality. Risk factors for POD are often non-modifiable, such as age, male sex, underlying cognitive or psychiatric conditions, while risk factors more specific to the cardiac surgery population include the type of surgery, cardiopulmonary bypass time, transfusions, and mechanical ventilation time15-18. Recent studies suggest that the use of a processed EEG for titration of anesthesia may reduce the incidence of POD. Burst suppression, or the pathological patterns of high-voltage electrical activity alternating with periods of quiescence may be associated with POD. Our primary objective is to demonstrate whether guiding anesthesia depth using an EEG monitor to avoid episodes burst suppression can result in a decreased incidence and severity of delirium in the cardiac surgery population. Secondly, we want to examine contributing risk factors and sequelae of delirium. Methods ENGAGES-Canada is an ongoing multi-center, double-blinded, randomized controlled trial across 4 Canadian sites. Patients included are those over the age of 60 scheduled for elective cardiac surgery with cardiopulmonary bypass. Exclusion criteria are pre-operative delirium, illiteracy, history of awareness, and planned surgery within five days of index surgery. Using an anesthesia protocol for EEG-guided anesthesia to avoid burst suppression, patients are randomized to the intervention or the control group (non-utilization of the monitor). The primary outcome is defined as the incidence of postoperative delirium, assessed using the Confusion Assessment Method (CAM) or CAM-ICU, coupled with chart review from day 1 to 5. Secondary outcomes include the effect of known risk factors on the incidence of delirium and 30-day and 1-year patient-reported outcomes of health-related quality of life and prevention of falls. Results Current enrollment includes 600 patients, out of a target population of 1200. An interim analysis was performed at 570 patients. The incidence of delirium across all subjects was 17.5% when considering CAM alone. Patients in the EEG-blinded group spent more cumulative time in burst suppression than those guided by EEG: median 317 seconds versus 136 seconds in the blind and guided groups respectively. Discussion ENGAGES-CANADA is the first RCT to examine whether avoidance of burst suppression using EEG guidance can decrease the incidence and severity of delirium in a cardiac surgery population.

Gestational age at delivery of twins and perinatal outcomes: a cohort study in Aberdeen, Scotland.

Background: Twin pregnancy is associated with a threefold increase in perinatal death compared to singletons. The objective of this study was to determine the risk of perinatal death in twins by week of gestation and to quantify the effect of known risk factors. Methods: A cohort analysis was performed using data from the Aberdeen Maternity and Neonatal Databank (AMND). The exposure was gestational age at delivery and the primary outcome was perinatal death. Adjusted hazard ratios (aHRs) for perinatal death according to gestational age at delivery were determined by multivariate Cox proportional hazards regression modelling with robust standard errors to account for clustering in the twin infants. Confounders and risk factors quantified and adjusted for in the model included maternal age, smoking, parity, marital status and year of birth. Kaplan-Meier time to event analysis was used to determine the differences in survival according to chorionicity and assisted reproduction technologies (ART) conception status. Results: The population comprised of 7,420 twin babies born between 1950 and 2013 in the Grampian area of Northern Scotland. There were 272 stillbirths in the cohort (3.67%) and 273 neonatal deaths (3.68%). Compared to delivery at 37-38 weeks, delivery before 37 weeks was associated with a 2-fold increase in perinatal death. Monochorionic twins had a 2-fold increase in perinatal death compared to dichorionic twins (aHR 2.15, 95% CI 1.60-2.90). Twins conceived by ART did not have a greater risk of perinatal death compared to those naturally conceived (aHR 1.21, 95% CI 0.87-1.68) Conclusion: This study suggests that delivery of twins at 37-38 weeks is associated with the lowest risk of perinatal death.

Gestational age at delivery of twins and perinatal outcomes: a cohort study in Aberdeen, Scotland.

Background: Twin pregnancy is associated with a threefold increase in perinatal death compared to singletons. The objective of this study was to determine the risk of perinatal death in twins by week of gestation and to quantify the effect of known risk factors. Methods: A cohort analysis was performed using data from the Aberdeen Maternity and Neonatal Databank (AMND). The exposure was gestational age at delivery and the primary outcome was perinatal death. Adjusted hazard ratios (aHRs) for perinatal death according to gestational age at delivery were determined by multivariate Cox proportional hazards regression modelling with robust standard errors to account for clustering in the twin infants. Confounders and risk factors quantified and adjusted for in the model included maternal age, smoking, parity, marital status and year of birth. Kaplan-Meier time to event analysis was used to determine the differences in survival according to chorionicity and assisted reproduction technologies (ART) conception status. Results: The population comprised of 7,420 twin babies born between 1950 and 2013 in the Grampian area of Northern Scotland. There were 272 stillbirths in the cohort (3.67%) and 273 neonatal deaths (3.68%). Compared to delivery at 37-38 weeks, delivery before 37 weeks was associated with a 2-fold increase in perinatal death. Monochorionic twins had a 2-fold increase in perinatal death compared to dichorionic twins (aHR 2.15, 95% CI 1.60-2.90). Twins conceived by ART did not have a greater risk of perinatal death compared to those naturally conceived (aHR 1.21, 95% CI 0.87-1.68) Conclusion: This study suggests that delivery of twins at 37-38 weeks is associated with the lowest risk of perinatal death.

Gestational age at delivery of twins and perinatal outcomes: a cohort study in Aberdeen, Scotland.

Background: Twin pregnancy is associated with a threefold increase in perinatal death compared to singletons. The objective of this study was to determine the risk of perinatal death in twins by week of gestation and to quantify the effect of known risk factors. Methods: A cohort analysis was performed using data from the Aberdeen Maternity and Neonatal Databank (AMND). The exposure was gestational age at delivery and the primary outcome was perinatal death. Adjusted hazard ratios (aHRs) for perinatal death according to gestational age at delivery were determined by multivariate Cox proportional hazards regression modelling with robust standard errors to account for clustering in the twin infants. Confounders and risk factors quantified and adjusted for in the model included maternal age, smoking, parity, marital status and year of birth. Kaplan-Meier time to event analysis was used to determine the differences in survival according to chorionicity and assisted reproduction technologies (ART) conception status. Results: The population comprised of 7,420 twin babies born between 1950 and 2013 in the Grampian area of Northern Scotland. There were 272 stillbirths in the cohort (3.67%) and 273 neonatal deaths (3.68%). Compared to delivery at 37-38 weeks, delivery at or beyond 39 weeks was associated with a significant increase in perinatal death (aHR 2.00 [95% CI 1.45-2.78]). Monochorionic twins had a 2-fold increase in perinatal death compared to dichorionic twins (aHR 2.15, 95% CI 1.60-2.90). Twins conceived by ART did not have a greater risk of perinatal death compared to those naturally conceived (aHR 1.21, 95% CI 0.87-1.68) Conclusion: This study suggests that delivery of twins at 37-38 weeks is associated with the lowest risk of perinatal death.

Interaction Effect Between Breast Density and Reproductive Factors on Breast Cancer Risk in Korean Population.

BackgroundThis study was conducted to explore the effect of known risk factors, focusing on risk factors including age at menarche, age at menopause, number of children, family history of breast cancer, and age at first birth according to breast density, in consideration of interaction among East-Asian women.MethodsCase-control study with 2,123 cases and 2,121 controls with mammographic density was conducted. Using the mammographic film, breast density was measured using Breast Imaging-Reporting and Data System. To identify the association of selected reproductive factors including age at menarche, age at menopause, number of children, family history of breast cancer, and age at first birth according to breast density, stratified analysis was conducted according to breast density groups and interaction effects was assessed. The results were presented with adjusted OR and 95% CIs.ResultsSignificant interaction effect between age at first birth and breast density on breast cancer (P = 0.048) was observed. Women with age at first birth ≥ 28 years old showed increased breast cancer risk in extremely dense breast group (≥ 75%) (OR = 1.627, 95% CI = 1.190–2.226). However, women with fatty breast (< 50%) and heterogeneously dense breast (50%–75%) did not show an increased association. Age at menarche, age at menopause, number of children, and family history of breast cancer did not show significant interaction with breast cancer and similar risk patterns were observed.ConclusionsAge at first birth showed significant interaction with breast density on breast cancer risk. Further studies considering biologically plausable model between exposure, intermediate outcomes and breast cancer risk with prospective design need to be undertaken in East Asian women.

Abstract P2-08-56: Effects of young age on prognosis in patients with node-negative tumors 2 cm or smaller breast cancer

Abstract Background It is still controversial to consider age as a prognostic factor into the treatment strategy of patients with T1N0M0 breast cancer. Aim The main purpose of this study was to evaluate the effect of age on recurrence risk in patients diagnosed with T1N0M0 breast cancer as well as compare the prognosis of young aged patients(YA,≤40 years old) to non-young aged patients(non-YA,&amp;gt;40 years old) by using a propensity score matching(PSM) analysis. Methods 365 patients with T1N0M0 breast cancer diagnosed between 2003 and 2016 who received surgery in Sun Yat-sen Memorial Hospital Breast Cancer Center were included.The recurrence free survival (RFS) and risk factors for recurrence were identified by using Kaplan-Meier method and Cox proportional hazards models. PSM was then used to reduce the confounding effect of known risk factors on prognosis and then to compare 5-year RFS rates in patients between two age groups. Results After a median follow up of 79 months, 54 patients developed recurrences and 5-year RFS was 87.6%. YA patients had lower RFS estimates (80.6%), compared to patients diagnosed in a later age (89.1% if older than 40-years old; P = 0.049). YA patients tended to have Her-2 positive, TNBC tumors, higher rate of Ki-67 expression and nuclear grade tumor. At multivariate analysis, Her-2 positive (HR 2.115; 95% CI 1.103-4.055, p=0.024) and TNBC (HR 2.963; 95% CI 1.485-5.914, p=0.002) resulted independent prognostic factors of patient with T1N0M0 breast cancer. In the subgroup analysis, we found significant poor RFS for YA patients with Her-2 positive breast cancer compared to the older counterparts(p=0.006) and YA patients were associated with significantly higher rates of the locoregional recurrence rather than metastasis(p=0.004), especially in first 5 years after diagnosis. After PSM, the baseline level and treatment status including tumor size, grade, HR status, Her-2 status, Ki67 expression breast surgery type and systemic adjuvant treatment(AST) of patients in the two age groups tended to be equal. As result, we found significant difference in the 5-year RFS between two age groups(p=0.008). Conclusion Based on equal treatment condition, young age at presentation conferred a worse prognosis in patients with T1N0M0 breast cancer is independent on other pathological features. Citation Format: Zhong W, Tan L, You N, Wang Y, Liang G, Liu Z, Ling Y, Tian Z, Gong C. Effects of young age on prognosis in patients with node-negative tumors 2 cm or smaller breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-56.

The Relationship Between Risk Factors and Alcohol and Marijuana Use Outcomes Among Concurrent Users: A Comprehensive Examination of Protective Behavioral Strategies

Among college samples, both alcohol and marijuana protective behavioral strategies (PBS) have been shown to mediate the effects of known risk factors (i.e., sex, age at substance use onset, college substance use beliefs, substance use motives, and impulsivity-like traits) on alcohol and marijuana outcomes. However, it is unknown whether PBS use would operate similarly for both substances among concurrent users. The present study examined which risk factors relate to alcohol/marijuana outcomes via alcohol/marijuana PBS use among a large group of concurrent alcohol/marijuana users. Participants were college students who consumed both alcohol and marijuana at least 1 day in the previous month (n = 2,034; 69.08% female). Across both substances, PBS use significantly mediated the effects of sex (women reported higher PBS use), age at first use (having an older age at first use was associated with more PBS use), and college substance use beliefs (higher beliefs was associated with lower PBS use). Unique to alcohol outcomes, alcohol PBS use significantly mediated the effects of negative urgency, social motives, and enhancement motives (all associated with lower PBS use). Unique to marijuana outcomes, marijuana PBS use mediated the effects of coping, expansion (both associated with lower PBS use), and conformity motives (associated with more PBS use). Our results suggest that PBS for both alcohol and marijuana can help explain why some risk factors are associated with alcohol/marijuana outcomes. Taken together, PBS use seems to be an important intervention target for alcohol/marijuana concurrent users.

Possible Causes of Discordance in Refraction in Monozygotic Twins: Nearwork, Time Outdoors and Stochastic Variation.

To evaluate the impact of differences in nearwork and time spent outdoors on difference in refraction in monozygotic (MZ) twins. Data on MZ twins aged 7 to 18 years from the Guangzhou Twin Eye Study were used in this analysis. A standard questionnaire was administered by personal interview to estimate time spent on nearwork and time spent outdoors. Spherical equivalent (SE) was measured by autorefraction under cycloplegia. The interaction between age and nearwork or time spent outdoors was also estimated. A total of 490 MZ twin pairs (233 male and 257 female) were eligible in this analysis, the mean age was 13.14 ± 2.49. In the mixed-effects model, nearwork difference was a risk factor of discordance in myopic SE (β = -0.11 diopter (D)/h, P = 0.009), the overall association between time outdoors difference and SE discordance was not significant (β = -0.89 (D)/h, P = 0.120) although an interaction between time spent outdoors difference and age was detected (β = 0.07 (D)/h, P = 0.002). Furthermore, difference in nearwork and time outdoors explained about 1.8% and 2.5% of the variation in SE discordance, respectively. Given the very marked genetic similarity of MZ twins, and the small effects of known risk factors on SE discordance, we suggest that the SE discordance across MZ twins largely results from stochastic variations at the genomic or epigenetic levels, or from uncollected environmental factors.