Impact Of Multiple Risk Factors Research Articles

Cumulative ecological risk and cyberbullying among college students: a chain mediation model.

Cyberbullying among college students has been receiving increased research attention. Previous studies have focused primarily on the impact of a single risk factor on cyberbullying among college students. However, individual behavior is influenced by multiple ecosystems simultaneously, including family, school, and peers. To explore the effects of a single risk factor alone is not in line with the reality of everyday life, and the effect of the single risk factor can often be overestimated. Therefore, this study aimed to explore the impact of multiple risk factors, namely cumulative ecological risk, on cyberbullying, while analyzing the mediating roles of belief in a just world and moral disengagement. A survey was conducted among 805 college students from two universities in Hebei Province, China, using the cumulative ecological risk questionnaire, the cyberbullying scale, the belief in a just world scale, and the moral disengagement scale. The results showed that: (a) Cumulative ecological risk was positively correlated with moral disengagement and cyberbullying, and negatively correlated with belief in a just world. Belief in a just world was negatively correlated with moral disengagement and cyberbullying. Moral disengagement was positively correlated with cyberbullying; (b) Belief in a just world partially mediated the relationship between cumulative ecological risk and cyberbullying; (c) Moral disengagement partially mediated the relationship between cumulative ecological risk and cyberbullying; (d) Belief in a just world and moral disengagement played a chain mediating role between cumulative ecological risk and college students' cyberbullying. This study provides valuable insight for the reduction of cyberbullying behavior among college students, and offers suggestions on how to create a more favorable online environment.

Rapid seismic risk assessment method for museum exhibition halls based on seismic safety of artifacts

Seismic safety of the museum artifacts has become increasingly more important as museums have continued to build their collections. Although the seismic risk of artifacts can be assessed through experimental analysis, numerical simulation or machine learning, these methods generally require specialized research tools and complex theoretical knowledge and are therefore not readily applicable in engineering practice. In the practical conservation for museum artifacts, risk decision-makers prefer to be provided with a simple method that allows them to straightforwardly and swiftly assess the seismic risk. Further, there is no universal standard approach to comprehensively assess the seismic risk of all artifacts in museum exhibition halls based on the consideration of the impact of multiple risk factors. In this study, we developed an easy-to-apply method for the rapid seismic risk assessment of museum exhibition halls. We discussed the adverse effects of several major risk factors that cause seismic failure of artifacts, then presented the proposed method in detail. Three exhibition halls in China served as representative cases to evaluate the method. This work can provide a valuable reference for museum exhibition halls as a rapid analytical means to assess seismic risk.

Spatial pattern and environmental drivers of breast cancer incidence in Chinese women.

Breast cancer (BC) had the highest incidence of all cancers in Chinese women. However, studies on spatial pattern and environmental drivers of BC were still lacked as they were either limited in a small area or few considered the comprehensive impact of multiple risk factors. In this study, we firstly performed spatial visualization and the spatial autocorrelation analysis based on Chinese women breast cancer incidence (BCI) data of 2012-2016. Then, we explored the environmental drivers related to BC by applying univariate correlation analysis and geographical detector model. We found that the BC high-high clusters were mainly distributed in the eastern and central regions, such as Liaoning, Hebei, Shandong, Henan, and Anhui Provinces. The BCI in Shenzhen was significantly higher than other prefectures. Urbanization rate (UR), per capita GDP (PGDP), average years of school attainment (AYSA), and average annual wind speed (WIND) had higher explanatory power on spatial variability of the BCI. PM10, NO2, and PGDP had significant nonlinear enhanced effect on other factors. Besides, normalized difference vegetation index (NDVI) was negatively associated with BCI. Therefore, high socioeconomic status, serious air pollution, high wind speed, and low vegetation cover were the risk factors for BC. Our study may able to provide evidence for BC etiology research and precise identification of areas requiring focused screening.

Impact of Multiple Factors on the Incidence of Developmental Dysplasia of the Hip: Risk Assessment Tool.

Background and Objectives: Developmental dysplasia of the hip (DDH) is one of the most common musculoskeletal conditions in children. If not treated, it leads to disability, gait abnormalities, limb shortening, and chronic pain. Our study aims to determine the impact of multiple risk factors on the incidence of DDH and to develop an interactive risk assessment tool. Materials and Methods: We conducted a retrospective cohort study in the Outpatient Clinic for Children of the Medical University of Warsaw Hospital. The Graf classification system was used for universal ultrasonographic screening. In total, 3102 infants met the eligibility criteria. Results: The incidence of DDH in the study group was 4.45%. The incidence of DDH in the Warsaw population, Poland, during the study period was 3.73 to 5.17 (95% CI). According to the multivariate analysis, the risk factors for DDH were birth weight (OR = 2.17 (1.41–3.32)), week of delivery (OR = 1.18 (1.00–1.37)), female sex (OR = 8.16 (4.86–13.71)), breech presentation (OR = 5.92 (3.37–10.40)), physical signs of DDH (25.28 (8.77–72.83)) and positive family history in siblings (5.74 (2.68–12.31)). Our results support the recent hypothesis that preterm infants (<37 weeks) have a lower rate of DDH. Conclusions: A multivariate logistic regression predictive model was used to build the risk calculator. The DDH risk calculator will be evaluated in a prospective validation study.

The Impact of Common Epidemiological Factors on Gray and White Matter Volumes in Magnetic Resonance Imaging-Is Prevention of Brain Degeneration Possible?

Introduction: The aim of the study was to evaluate the impact of multiple risk factors (age, diabetes, hypertension, hyperlipidemia, BMI, smoking, alcohol) on the gray and white matter volumes as well as on the burden of white matter hyperintensities (WMH).Material and Methods: The study group consisted of 554 subjects (age range: 50–69 yrs, F/M: 367/187) recruited from the larger cohort of the Polish fraction of the Prospective Urban Rural Epidemiological (PURE) study. The participants answered questionnaires about their lifestyle, underwent physical and psychological examination (MoCA test), laboratory blood tests followed by brain MRI. Volumetric measurements of the total gray matter (GMvol), total white matter (WMvol) and WHM (WMHvol) normalized to the total intracranial volume were performed using the Computational Anatomy Toolbox 12 (CAT12) and Statistical Parametric Maps 12 (SPM12) based on 3D T1-weighted sequence. The influence of risk factors was assessed using multiple regression analysis before and after correction for multiple comparisons.Results: Older age was associated with lower GMvol and WMvol, and higher WMHvol (p < 0.001). Smaller GMvol volume was associated with higher WMHvol (p < 0.001). Higher WMHvol was associated with hypertension (p = 0.01) and less significantly with hyperlipidemia (only before correction p = 0.03). Diabetes, abnormal BMI, smoking and alcohol intake did not have any significant impact on GMvol, WMvol or WMHvol (p > 0.05). MoCA score was not influenced by any of the factors.Conclusions: Gray matter loss is strongly associated with the accumulation of WMH which seems to be potentially preventable by maintaining normal blood pressure and cholesterol levels.

Perceived Healthcare Access among Persons with and without HIV Who Use Illicit Stimulants: The Role of Cumulative Risk

Background: Persons who use stimulant drugs have greater morbidity and mortality relative to non-users. HIV infection has the potential to contribute to even great disparity in health outcomes among persons who use stimulants. These health disparities likely result in part due to poorer access to healthcare. Our study used a cumulative risk model to examine the impact of multiple risk factors on healthcare access in a sample of persons with and without HIV who use stimulants. Method: Our sample included 453 persons who reported recent use of illicit stimulants (102 HIV+, 351 HIV-). Participants completed clinical interviews, questionnaires, and a rapid oral HIV test. We constructed an 8-item cumulative risk index that included factors related to socioeconomic status, homelessness, legal history, and substance use. Results: Participants with HIV (PHW) were older than participants without HIV and more likely to have health insurance. Participants with and without HIV reported similar prior treatment utilization, but PWH reported better healthcare access and lower cumulative risk scores. Regression analyses showed cumulative risk was a significant predictor of healthcare access (β = −0.20, p < 0.001) even after controlling for age, HIV status, and health insurance status. We did not observe an interaction of HIV status by cumulative risk. Conclusions: Access to care among persons who use stimulants, both with and without HIV, is negatively impacted by the accumulation of risk factors from a number of different domains. Understanding the cumulative effects of these factors is critical for developing interventions to facilitate access to care, thus reducing health disparities and improving health outcomes.

IMPACT OF RISK FACTORS ON THE EPIDEMIOLOGICAL PREVALENCE OF GIARDIA LAMBLIA ASSEMBLAGES IN KAFRELSHEIKH GOVERNORATE, CAIRO, EGYPT

Although the incidence of Giardia lamblia increased, data regarding its possible associatedrisk factors are scares. The study investigated the genetic diversity of humans G. lamblia positiveisolates in kafrelsheikh Governorate, and the impact of multiple risk factors on prevalence.A total of 300 fecal samples were collected from patients attended Kafrelsheikh Universityover a period of one year. Amplification and RFLP analysis of β-giardin gene were usedto identify the G. lamblia multiple assemblages.The results showed that, PCR amplification showed 63/300 (21%) positive samples, of them,12 assemblages A (19.1%) and 52 assemblages B (80.9%). On univariate analysis, there werestatistical significant correlation among giardiasis and age group, sex, hand-washing, milktype, flatulence, vomiting, and animal contact (p = 0.028, 0.006, 0.005, 0.02, 0.000, 0.002 &0.000, respectively). On Multivariate logistic regression analysis showed that children from 2-6 years, adults (< 18 years), females, hand-washing, boiled milk, vomiting, flatulence and animalcontact were independent risk factors for giardiasis (p = 0.01, 0.02, 0.007, 0.05, 0.03,0.000, 0.002 & 0.000, respectively).

IMPACT OF RISK FACTORS ON THE EPIDEMIOLOGICAL PREVALENCE OF GIARDIA LAMBLIA ASSEMBLAGES IN KAFRELSHEIKH GOVERNORATE, CAIRO, EGYPT

Although the incidence of Giardia lamblia increased, data regarding its possible associatedrisk factors are scares. The study investigated the genetic diversity of humans G. lamblia positiveisolates in kafrelsheikh Governorate, and the impact of multiple risk factors on prevalence.A total of 300 fecal samples were collected from patients attended Kafrelsheikh Universityover a period of one year. Amplification and RFLP analysis of β-giardin gene were usedto identify the G. lamblia multiple assemblages.The results showed that, PCR amplification showed 63/300 (21%) positive samples, of them,12 assemblages A (19.1%) and 52 assemblages B (80.9%). On univariate analysis, there werestatistical significant correlation among giardiasis and age group, sex, hand-washing, milktype, flatulence, vomiting, and animal contact (p = 0.028, 0.006, 0.005, 0.02, 0.000, 0.002 &0.000, respectively). On Multivariate logistic regression analysis showed that children from 2-6 years, adults (< 18 years), females, hand-washing, boiled milk, vomiting, flatulence and animalcontact were independent risk factors for giardiasis (p = 0.01, 0.02, 0.007, 0.05, 0.03,0.000, 0.002 & 0.000, respectively).

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.

Prevalence and factors associated with parental concerns about development detected by the Parents’ Evaluation of Developmental Status (PEDS) at 6-month, 12-month and 18-month well-child checks in a birth cohort

ObjectivesEarly identification of developmental vulnerability is vital. This study aimed to estimate the prevalence of moderate or high developmental risk on the Parents' Evaluation of Developmental Status (PEDS) at 6-month,...

Less is more: Testing financial integration using identification-robust asset pricing models

We revisit financial market integration and study the impact of multiple risk factors and model specification on inference. Our tests exploit a method correct in finite sample that jointly assesses coefficient significance and detects identification problems. Results on four countries show that multiple sources of risk in international asset pricing models lead to lack of identification and spurious inference. We find that domestic factor models are well identified which is not the case for global and international models. Nonetheless, domestic models do not provide a base for testing financial market integration. Given that constraint, the best-identified international model includes few factors and reveals that financial integration varies over time and across countries.

Physical Fighting Among Male and Female Adolescents of Military Families: Results From a Representative Sample of High School Students.

The impact of family military involvement on adolescent mental health and substance abuse is well established, but little is known about other behavioral health outcomes such as physical fighting. We assessed the relationship between family military involvement and physical fighting in a representative sample of 3,928 high school students. Weighted logistic regression was used to determine whether adolescents from military families had higher odds of fighting and fighting on school property compared with adolescents of non-military families after controlling for demographics, substance use, depressive symptoms, and bullying victimization. We also assessed the cumulative impact of multiple risk factors on fighting outcomes. Overall, 23.5% of high school students reported physical fighting and 7.0% reported physical fighting at school. Youth from military families had higher odds of physical fighting (adjusted odds ratios [AOR] = 1.69; 95% confidence interval [CI] = [1.27, 2.25]) and physical fighting on school property (AOR = 1.98; 95% CI = [1.16, 3.39]). In models stratified by gender, family military involvement remained independently associated with physical fighting and physical fighting at school for males (AOR = 1.74; 95% CI = [1.15, 2.65] and AOR = 2.21; 95% CI = [1.03, 4.74]) and females (AOR = 1.65; 95% CI = [1.11, 2.45] and AOR = 1.88; 95% CI = [1.01, 3.50]). The odds of engaging in each physical fighting outcome increased as the cumulative number of risk factors increased. School-based interventions aimed at addressing fighting should be tailored to fit the unique needs of adolescents in military families, particularly those with additional risk factors.

Report: The Impact of Multiple Risk Factors on Young Children's Development

Report: The Impact of Multiple Risk Factors on Young Children's Development

Overall and cause-specific mortality in HIV-positive subjects compared to the general population.

IntroductionEmerging non-AIDS related causes of death have been observed in HIV-positive subjects in industrialized countries. We aimed to analyze overall and cause-specific excess of mortality of HIV-positive patients compared to the general population and to assess the effect of prognostic factors.Material and MethodsWe used generalized linear models with Poisson error structure to estimate overall and cause-specific excess of mortality in HIV-positive patients from 2004 to 2012 in the cohort of the Spanish Network of HIV Research (CoRIS), compared to Spanish general population and to assess the impact of multiple risk factors. We investigated differences between short-term and long-term risk factors effects on excess of mortality. Multiple Imputation by Chained Equations was used to deal with missing data.ResultsIn 9162 patients there were 363 deaths, 16.0% were non-AIDS malignancies, 10.5% liver and 0.3% cardiovascular related. Excess mortality was 1.20 deaths per 100 person years (py) for all-cause mortality, 0.16 for liver, 0.10 for non-AIDS malignancies and 0.03 for cardiovascular. Short-term (first-year follow-up) excess Hazard Ratio (eHR) for global mortality for baseline AIDS was 4.27 (95% CI 3.06–6.01) and 1.47 (95% CI 0.95–2.27) for HCV coinfection; long-term (subsequent follow-up) eHR for baseline AIDS was 0.88 (95% CI 0.58–1.35) and 4.48 (95% CI 2.71–7.42) for HCV coinfection. Lower CD4 count and higher viral load at entry, lower education, being male and over 50 years were predictors for overall excess mortality. Excess of liver mortality was higher in patients with CD4 counts at entry below 200 cells compared to those above 350 (eHR: 6.49, 95% CI 1.21–34.84) and in HCV-coinfected patients (eHR: 3.85, 95% CI 0.85– 17.37), although it was borderline significant. Patients over 50 years old (eHR: 5.55, 95%CI 2.4–12.85) and HCV coinfected (eHR: 5.81, 95% CI 2.6–13) showed a higher risk of non-AIDS malignancies mortality excess. Excess of cardiovascular mortality was related with HCV coinfection (eHR: 6.68, 95% CI 1.25–35.73).ConclusionsOur results show overall, liver, non-AIDS malignancies and cardiovascular excess of mortality associated with being HIV-positive, despite improvements in HIV disease management and antiretroviral therapies. Differential short-term and long-term effect of AIDS before entry and HCV coinfection was found for overall mortality.

Less is More: Evidence from International Asset Pricing Models

We revisit financial market integration and study the impact of multiple risk factors and model specification on inference. Our tests exploit a method correct in finite sample that jointly assesses coefficient significance and detects identification problems. Results on four countries show that multiple sources of risk in international asset pricing models lead to lack of identification and spurious inference. We find that domestic factor models are well identified which is not the case for global and international models. Nonetheless, domestic models do not provide a base for testing financial market integration. Given that constraint, the best-identified international model includes few factors and reveals that financial integration varies over time and across countries.

The Impact of Multiple Risk Factors on Young Children's Cognitive and Behavioural Development

The paper maps out 10 risk factors measuring deficits in parent–child interaction, family–child interaction and the home environment. The prevalence of risk factor combinations is quantified using theUKMillennium Cohort Study data. In 2001, 28 per cent of families with young children were facing two or more risk factors at age 9–10 months old. Each combination of multiple risk factors accounted for a very small proportion of allMCSfamilies. Specific risk factors were associated with particular developmental outcomes at age 5 and with changes from age 3 to age 5, but all leading to worse outcomes. The great diversity of risk‐factor combinations and their very small prevalence make the tasks of identifying such families and defining eligibility for support very difficult for policy‐makers. These results support the large body of policy literature advocating early intervention to improve children's development.

Common and Unique Risk Factors and Comorbidity for 12-Month Mood and Anxiety Disorders among Canadians

To explore the common and unique risk factors for mood and anxiety disorders. What sociodemographic, psychological, and physical risk factors are associated with mood and anxiety disorders and their comorbidities? What is the impact of multiple risk factors? Data from the Canadian Community Health Survey: Mental Health and Well-Being were analyzed. Appropriate sampling weights and bootstrap variance estimation were employed. Multiple logistic regression was used to estimate odds ratios and confidence intervals. The annual prevalence of any mood disorder was 5.2%, and of any anxiety disorder 4.7%. Major depressive episode was the most prevalent mood and anxiety disorder (4.8%), followed by social phobia, panic disorder, mania, and agoraphobia. Among people with mood and anxiety disorders, 22.4% had 2 or more disorders. Risk factors common to mood and anxiety disorders were being young, having lower household income, being unmarried, experiencing greater stress, having poorer mental health, and having a medical condition. Unique risk factors were found: major depressive episode and social phobia were associated with being born in Canada; panic disorder was associated with being Caucasian; lower education was associated with panic and agoraphobia; and poor physical health was associated with mania and agoraphobia. People who were young, unmarried, not fully employed, and had a medical condition, greater stress, poorer self-rated mental health, and dissatisfaction with life, were more likely to have a comorbid mood and (or) anxiety disorder. As the number of common risk factors increases, the probability of having mood and anxiety disorders also increases. Common and unique risk factors exist for mood and anxiety disorders. Risk factors are additive in increasing the likelihood of disease.

Pharmacologic Prevention of Microvascular and Macrovascular Complications in Diabetes Mellitus

Observational epidemiologic data indicate that lower blood glucose levels, blood pressure (BP), and lipid parameters are associated with a lower incidence of micro- and macrovascular complications in people with diabetes. While no threshold for this effect is discernible in these observational studies, intervention studies do not mirror this finding. The earliest glycemia target study in type 2 diabetes mellitus, UKPDS, demonstrated unequivocal benefits of tight glucose control on microvascular complications, but needed a prolonged follow-up to demonstrate a benefit on macrovascular outcomes and mortality. Recently, three major studies, ACCORD, ADVANCE, and VADT, evaluated the impact of attaining euglycemia (ACCORD) or near-euglycemia (ADVANCE, VADT) in older patients with diabetes and high cardiovascular (CV) risk. None of these studies, either individually or on pooled analysis, demonstrated any reduction in all-cause or CV mortality, although the meta-analyses revealed 15-17% reductions in the incidence of non-fatal myocardial infarction in those exposed to tight glucose control. A higher mortality was observed in the intensive glucose control arm of ACCORD, resulting in the premature termination of the glucose-lowering component of this study. Also, the occurrence of hypoglycemic episodes (total and major) was significantly higher in the intensive glucose control arm. ADVANCE and ACCORD also had BP-lowering components. While data from ADVANCE demonstrated a benefit of routine use of a combination of perindopril and indapamide, with a decline in all-cause mortality, CV mortality, and new-onset microalbuminuria, reducing systolic BP to <120 mmHg in ACCORD did not result in any incremental benefits over a systolic BP<140 mmHg. A residual CV risk observed in people with diabetes even after low-density lipoprotein (LDL) cholesterol lowering has led to trials evaluating additional therapy with fibric acid derivatives to reduce triglyceride levels. The lipid-lowering arm of ACCORD failed to demonstrate any benefit of add-on therapy with fibric acid derivatives to LDL-lowering treatment with HMG-CoA reductase inhibitors (statins) on vascular outcomes in patients with diabetes. However, data from earlier studies, and also from the subgroup analysis of ACCORD, indicate a probable benefit of adding treatment with fibric acid derivatives to individuals with persistently elevated triglyceride levels despite statin therapy. The most compelling evidence comes from studies assessing the impact of multiple risk factors - glucose, BP, and cholesterol. Studies like the Steno study unequivocally demonstrate the benefit of aggressive control of all three parameters on vascular outcomes in patients with diabetes. In conclusion, attempts to achieve euglycemia in older patients with type 2 diabetes with co-morbidities are not associated with any survival benefit, but may reduce the occurrence of non-fatal CV events. There is a significant risk of major hypoglycemia with this approach, thereby probably limiting its utility to younger patients with new-onset disease. Similarly, lowering systolic BP below 120 mmHg in high CV risk people with diabetes is associated with significant excess adverse events, limiting the utility of such an intervention. However, a clear benefit, which is also cost effective, is observed with strategies for multiple risk-factor control, which should be universally adopted in clinical practice.

An Ecological Model for Premature Infant Feeding

Premature infants are at increased risk for poor health, feeding difficulties, and impaired mother-infant interaction, leading to developmental delay. Social-environmental risks, such as poverty or minority status, compound these biological risks, placing premature infants in double jeopardy. Guided by an ecological model, the Hospital-Home Transition: Optimizing Prematures' Environment intervention combines the auditory, tactile, visual, and vestibular intervention with participatory guidance provided by a nurse and community advocate to address the impact of multiple risk factors on premature infants' development.

Enhancing the Measurement of Health Disparities for Vulnerable Populations

This article presents a mechanism for tracking and reporting health disparities data that are based on a general model of vulnerability. We briefly discuss the origins of this model and describe its focus on the cumulative impact of multiple risk factors on health-related outcomes. We then demonstrate how the model can be applied to inform the collection and reporting of health disparities data by providing three examples. Since national and state datasets contain information on a wide range of risk factors, researchers and policy makers would benefit from examining the multiple risks that affect vulnerable populations simultaneously, as we have demonstrated in the three examples. These examples suggest that the determinants of health and healthcare problems are multifactorial and that they can be studied in an integrative approach using risk profiles. This research methodology can strengthen our existing knowledge of health disparities and aid in the recognition of points of intervention to successfully improve health and healthcare for vulnerable populations.