Higher General Risk Research Articles

Development of a brief scoring system to predict any-cause mortality in patients hospitalized with COVID-19 infection.

Patients hospitalized with COVID-19 infection are at a high general risk for in-hospital mortality. A simple and easy-to-use model for predicting mortality based on data readily available to clinicians in the first 24 hours of hospital admission might be useful in directing scarce medical and personnel resources toward those patients at greater risk of dying. With this goal in mind, we evaluated factors predictive of in-hospital mortality in a random sample of 100 patients (derivation cohort) hospitalized for COVID-19 at our institution in April and May, 2020 and created potential models to test in a second random sample of 148 patients (validation cohort) hospitalized for the same disease over the same time period in the same institution. Two models (Model A: two variables, presence of pneumonia and ischemia); (Model B: three variables, age > 65 years, supplemental oxygen ≥ 4 L/min, and C-reactive protein (CRP) > 10 mg/L) were selected and tested in the validation cohort. Model B appeared the better of the two, with an AUC in receiver operating characteristic curve analysis of 0.74 versus 0.65 in Model A, but the AUC differences were not significant (p = 0.24. Model B also appeared to have a more robust separation of mortality between the lowest (none of the three variables present) and highest (all three variables present) scores at 0% and 71%, respectively. These brief scoring systems may prove to be useful to clinicians in assigning mortality risk in hospitalized patients.

Abstract # 3234 The role of neutrophil granulocytes in immune-to-brain communication during LPS-induced systemic versus lung inflammation

Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r = −0.73, p < 0.0001), IL6/IL10 (r = −0.38, p = 0.01), IL1β/IL10 (r = −0.44, p = 0.004) and TNFα/IL10 (r = −0.41; p = 0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r = −0.25, p = 0.43; IL6/IL10: r = 0.12, p = 0.70; IL1 β/IL10: r = 0.05, p = 0.87; TNFα/IL10: r = 0.10; p = 0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p < 0.05). Without cytokine glucocorticoid feedback, a pregnant woman's ability to regulate inflammation is limited, potentially contributing to adverse maternal and infant outcomes.

Decision-making in daily life and in tourism

This article seeks to measure the potential risk tolerance in tourism and to determine whether individuals’ rationality in daily life is consistent with their choice of destination for foreign travel. Findings of the research, carried out among Israeli students, indicate such a consistency: individuals with higher general risk aversion also have higher risk aversion in tourism. These results can give tourism service providers greater insight into how tourists make decisions, thus enabling them to offer destinations that are personally adapted to the travel experience and general risk tolerance of tourists.

Lifestyle-associated risk for cardiovascular diseases among doctors and nurses working in a medical college hospital in Tamil Nadu, India.

Context:Globally, about 17 million people die of cardiovascular diseases (CVDs) every year and a substantial number of these deaths are attributed to four major risk factors namely unhealthy diet, physical inactivity, tobacco consumption, and alcohol consumption. Doctors and nurses often have a sedentary lifestyle.Aims:This study aimed at assessing the lifestyle-associated risk for CVDs among doctors and nurses in a medical college hospital.Setting and Design:Cross-sectional study among 250 doctors and nurses, selected using a stratified random sampling, working at a medical college hospital in Tamil Nadu.Subjects and Methods:After consenting, each participant answered a questionnaire comprising questions pertaining to the sociodemographic characteristics as well as lifestyle-related risk factors. Risk was categorized into low, moderate, and high based on general risk factors, physical activity risk factors, and dietary risk factors separately.Statistical Analysis:Descriptive statistics and Chi-square analysis were used to analyze the data.Results:It was found that 31.2% of all study subjects and 49.2% of doctors were at high general risk for CVDs; 30.4% of all study subjects and 42.1% of doctors were at high physical activity-related risk for CVDs; 14.4% of all study subjects and 19.8% of all doctors were at high dietary pattern-related risk for CVDs. Advancing age is a statistically significant risk factor across all risk groups.Conclusions:Doctors are at a higher risk for CVDs as compared to nurses as well as the general population.

Perioperative management of delirium and dementia in the geriatric surgical patient

Older adults undergo operations as our population ages. Increasing life expectancy and disease burden, along with decreased functional status and organ reserve, place the elderly surgical patient at higher general risk in the perioperative state. In particular, these patients have more diseases including dementia and medications that put them specifically at higher risk of delirium. This overview describes the diagnosis, pathophysiology, and treatment of delirium and its interface with depression and dementia, and explains aging changes based on the picture of perioperative management in surgical interventions. Today, surgeons must be equipped to attend the geriatric patient's needs. Early recognition of comorbidities such as dementia and delirium as well as speedy and competent therapeutic treatment can limit consequences and impact.

Immune dysregulation and glucocorticoid resistance in minority and low income pregnant women

Chronic prenatal stress contributes to poor birth outcomes for women and infants. Importantly, poor birth outcomes are most common among minority and low income women. To investigate underlying mechanisms, we tested the hypothesis that chronic stress related to minority or low income status is associated with glucocorticoid resistance as indicated by disruption in the cytokine-glucocorticoid feedback circuit. Home visits were conducted during which 3rd trimester pregnant women completed stress and depression surveys and provided blood for pro- and anti-inflammatory cytokines. Saliva was collected 5 times the preceding day for diurnal cortisol levels. For statistical analyses, women were grouped 3 ways, by race, income, and the presence or absence of either of those risk factors; this last group was labeled high or low general risk. Immune regulation was evaluated by evidence of a functioning negative feedback relationship between cytokines and cortisol. Of 96 participants, 18 were minority, 22 of low income, and 29 either minority or low income (high general risk). Pearson partial correlation identified a significant negative relationship between cortisol area under the curve (AUC) and pro- to anti-inflammatory cytokine ratios in the low general risk women (i.e., Caucasian, higher income) including IFNγ/IL10 (r=-0.73, p<0.0001), IL6/IL10 (r=-0.38, p=0.01), IL1β/IL10 (r=-0.44, p=0.004) and TNFα/IL10 (r=-0.41; p=0.005); no such correlations existed in the high general risk women (i.e., minority, low income) for (IFNγ/IL10: r=-0.25, p=0.43; IL6/IL10: r=0.12, p=0.70; IL1 β/IL10: r=0.05, p=0.87; TNFα/IL10: r=0.10; p=0.75), suggestive of glucocorticoid resistance. Cortisol levels throughout the day also were higher in minority and high general risk groups (p<0.05). Without cytokine glucocorticoid feedback, a pregnant woman's ability to regulate inflammation is limited, potentially contributing to adverse maternal and infant outcomes.

The Seasonal Risk for Deliberate Self-Harm

Groups at seasonal risk for deliberate self-harm (DSH) vary according to their geographic location. It is unknown, however, if seasonal risk factors for DSH are associated with place of birth or place of residence as these are confounded in all studies to date. In order to disaggregate place of birth from place of residence we examined general and seasonal risk factors for DSH in three different population birth groups living in Western Australia: Australian Aborigines, Australian born non-Aborigines, and UK migrants. We found Aborigines are at much higher general risk for DSH than non-Aborigines, but are not at seasonal risk, whereas non-Aboriginal Australians and UK migrants are. For UK migrants, this is only found for females. For all groups at seasonal risk this peaks during the austral (southern hemisphere) spring/summer. Furthermore, non-Aboriginal Australians and UK migrants show a consistent pattern of increased case fatality with increasing age. In contrast, case fatality does not increase with age among Australian Aborigines. Overall, despite living in the same environment, the three birth groups show different patterns of seasonal risk for DSH. In particular, the sex difference found between UK migrants and non-Aboriginal Australian birth groups suggests that predisposition toward seasonal risk for DSH is established early in life, but when present this is expressed according to local conditions.