Impact Of Related Risk Factors Research Articles

On the Natural History of Coronary Artery Disease: A Longitudinal Nationwide Serial Angiography Study.

Background The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events. Methods and Results All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angiogram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43-1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69-4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34-0.39), increasing to 8.1% and 4.01 (95% CI, 3.89-4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women. Conclusions Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.

The Genetic Association Identified Between Intervertebral Disc Degeneration and Associated Risk Factors Based on a Systems Biology Approach

Genetic cross-over study of intervertebral disc degeneration (IDD) and its associated risk factors. The purpose is to identify molecular biomarkers that may be involved in the IDD process and to provide effective recommendations in combination with drug analysis via systems biology methods. The pathogenesis and genetic links of IDD are still unclear. Related research is mainly based on a single data set or gene, and the impact of related risk factors on IDD is often ignored. Identifying disease-associated biomarkers and therapeutic targets through a systems biology approach that Integrative network-based gene and multi-omics analysis. In this study, the differential expression of genes was analyzed through NCBI datasets, followed by enrichment analysis. The central protein was identified through the establishment of protein-protein interaction (PPI) network. Key genes were screened out by VENN diagram and reasonable suggestions were put forward based on gene-chemical drug analysis. The IDD database analysis revealed 669 differentially expressed genes (DEGs) which were 22, 26, 168, 5, 38, 36, and 16 common DEGs with AG, SM, DEP, NAD, CED, OB, and HFD, respectively. GO and KEGG enrichment analysis may reveal the pathway by which these DEGs were involved. PPI network identified 10 central proteins including CCNB1, RETN, HMMR, BUB1, MPO, OIP5, HP, KIF11, BUB1B, and CDC25A. Three key genes BUB1, BUB1B, and CCNB1 were screened out and their expression might be related to the pathogenesis of IDD. According to the three chemical Dexamethasone, Nicotine, and Resvera-trol obtained from the analysis of genes-chemical drugs, reasonable treatment suggestions were put forward. Genetic association between IDD and risk factors in the general population was revealed by association network. Important gene-related molecular pathways and chemical drugs closely related to IDD have been found. Further study can provide guidance for the treatment and prognosis of IDD.Level of Evidence: N/A.

Seroprevalence of Bartonella henselae and Bartonella quintana Infection and Impact of Related Risk Factors in People from Eastern Slovakia.

The genus Bartonella is a rapidly expanding group of ubiquitous bacteria that occur mainly in different animal species, but some can also be transmitted to humans. Three species, B. henselae, B. bacilliformis, and B. quintana, are responsible for the majority of human cases. The severity of the clinical symptoms often depends on the immune status of the patient, but others factors such as the species of the pathogen, virulence factors, and bacterial load also can play an important role. As the information on the occurrence of bartonellosis in the human population in Slovakia is absent, the aim of our pilot study was to determine the seroprevalence against B. henselae and B. quintana in the population of people living in Eastern Slovakia, and to identify the impact of related risk factors. Of 536 people included in the study, 126 (23.5%) showed positivity for anti-B. henselae antibodies and 133 (24.8%) against B. quintana. A statistically higher prevalence was confirmed only in the case of B. quintana in women regardless of the risk group. In analyzing the risk factors, we found significant differences between B. henselae seropositive and seronegative groups only in uric acid levels and serum creatinine, both, however, clinically irrelevant. Significant, but clinically irrelevant differences were observed also in alanine aminotransferase (ALT) levels and creatinine in people seropositive to B. quintana.

Development of Predictive Informatics Tool Using Electronic Health Records to Inform Personalized Evidence-Based Pressure Injury Management for Veterans with Spinal Cord Injury

Pressure injuries (PrI) are serious complications for many with spinal cord injury (SCI), significantly burdening health care systems, in particular the Veterans Health Administration. Clinical practice guidelines (CPG) provide recommendations. However, many risk factors span multiple domains. Effective prioritization of CPG recommendations has been identified as a need. Bioinformatics facilitates clinical decision support for complex challenges. The Veteran's Administration Informatics and Computing Infrastructure provides access to electronic health record (EHR) data for all Veterans Health Administration health care encounters. The overall study objective was to expand our prototype structural model of environmental, social, and clinical factors and develop the foundation for resource which will provide weighted systemic insight into PrI risk in veterans with SCI. The SCI PrI Resource (SCI-PIR) includes three integrated modules: (1) the SCIPUDSphere multidomain database of veterans' EHR data extracted from October 2010 to September 2015 for ICD-9-CM coding consistency together with tissue health profiles, (2) the Spinal Cord Injury Pressure Ulcer and Deep Tissue Injury Ontology (SCIPUDO) developed from the cohort's free text clinical note (Text Integration Utility) notes, and (3) the clinical user interface for direct SCI-PIR query. The SCI-PIR contains relevant EHR data for a study cohort of 36,626 veterans with SCI, representing 10% to 14% of the U.S. population with SCI. Extracted datasets include SCI diagnostics, demographics, comorbidities, rurality, medications, and laboratory tests. Many terminology variations for non-coded input data were found. SCIPUDO facilitates robust information extraction from over six million Text Integration Utility notes annually for the study cohort. Visual widgets in the clinical user interface can be directly populated with SCIPUDO terms, allowing patient-specific query construction. The SCI-PIR contains valuable clinical data based on CPG-identified risk factors, providing a basis for personalized PrI risk management following SCI. Understanding the relative impact of risk factors supports PrI management for veterans with SCI. Personalized interactive programs can enhance best practices by decreasing both initial PrI formation and readmission rates due to PrI recurrence for veterans with SCI.

Orthopaedic surgeons\u2019 perceptions of frailty and frailty screening

BackgroundOver the past decade, there has been significant growth in the awareness and understanding of fragility among orthopaedic surgeons in the context of osteoporotic fractures and with it, improvements in the recognition and management of fragility fractures. Emerging as a major clinical and research focus in aged care is the concept of frailty and its associations with fragility, sarcopenia, falls and rehabilitation. Currently, research is lacking on how orthopaedic surgeons perceive frailty and the role of frailty screening. A baseline understanding of these perceptions is needed to inform integration of frailty identification and management for patient optimization in orthopaedic practices, as well as research and education efforts of patients and healthcare professionals in orthopaedic contexts.MethodsWe used an exploratory design guided by qualitative description to conduct 15 semi-structured telephone and in-person interviews across three orthopaedic surgeon subgroups (Registrars, Junior Consultants, and Senior Consultants). Data collection and analysis occurred iteratively and was guided by thematic saturation.ResultsOrthopaedic surgeons have a disparate understanding of frailty. Between colleagues, frailty is often referred to non-specifically to suggest a general state of risk to the patient. Frailty screening is regarded positively but its specific utility in orthopaedic environments is questioned. Easy-to-administer frailty screening tools that are not exclusive assessments of functional status are viewed most satisfactorily. However these tools are rarely used.ConclusionsThere is little understanding among orthopaedic surgeons of frailty as a phenotype. Beliefs around modifiability of frailty were dissimilar as were the impact of related risk factors, such a cognitive status, chronic disease, social isolation, and environmental influences. This in turn may significantly impact on the occurrence and treatment outcomes of fragility fracture, a common orthopaedic problem in older populations. This study highlights need for knowledge translation efforts (e.g. education) to achieve cohesive understanding of frailty among health professionals.

Risk factors for group B streptococcus early-onset disease: an Italian, area-based, case-control study

Purpose: Intrapartum antibiotic prophylaxis (IAP) prevents group B streptococcus (GBS) early-onset disease (EOD). No European study evaluates the relative impact of risk factors (RFs) for EOD after a screening-based strategy and widespread IAP use We aimed to evaluate the risks of EOD in an Italian region where a screening-based strategy for preventing EOD was implemented.Materials and methods: Cases of EOD born at or above 35 weeks’ gestation were reviewed and matched with controls.Results: There were 109 cases of EOD among 532,154 live births. Most cases had negative GBS prenatal screening (56/91, 61.5%) and were unexposed to IAP (86/109, 78.9%). At multivariate analysis, GBS bacteriuria (OR = 6.99), positive prenatal screening (OR = 13.7) and maternal intrapartum fever (OR = 188.3) were associated with an increased risk of EOD, whereas intrapartum beta-lactam antibiotics were associated with a decreased risk of EOD (≥4 h: OR = 0.008; <4 h: OR = 0.04). Neonates born to nonfebrile, GBS positive pregnant women, receiving beta-lactam antibiotics had very low probability of EOD, particularly if IAP was adequate.Conclusions: GBS positive prenatal screening, GBS bacteriuria and intrapartum fever are associated with EOD. Intrapartum beta-lactam antibiotics reduce the probability of EOD in neonates born to nonfebrile mothers.

Differing impact of clinical factors on the risk of fracture in younger and older women in the general population and an osteoporosis clinic population.

This study assesses whether the impact of classical risk factors for fracture due to osteoporosis is different in women aged 80+ and women aged 60-79. Since most prior research on the contribution of risk factors is based on patients below 80years of age, this study aims to fill this knowledge gap to increase the accuracy of risk assessment in the oldest old. Retrospective, observational cohort study using Swedish national health register data and BMD data from osteoporosis clinics. Women aged at least 60 were identified from a random sample of the general population and from the BMD databases and allocated to two populations representing patients at different stages of risk assessment. The relative impact of risk factors on fracture risk was assessed using multivariate competing risk regression with fracture as outcome and death as competing event. A total of 163,329 women were included from the general population (52,499 aged 80+) and 22,378 from the BMD databases (4563 aged 80+). The clinical risk factors with relatively highest effect on fracture risk in the older patients were prior fracture and hip T-score below - 2.5 SD. Other included risk factors showed lower impact in the older compared to the younger strata. This study confirms our understanding of the key risk factors for fracture: age, prior fracture, and a low T-score. Regarding remaining risk factors, risk assessment which fits younger women may not be suited for the 80+ strata as many common risk factors are less predictive in the older compared to the younger cohort.

Factors influencing traffic accident frequencies on urban roads: A spatial panel time-fixed effects error model.

China's rapid urbanization and high traffic accident frequency have received many researchers’ attention. It is important to reveal how urban infrastructures and other risk factors affects the traffic accident frequency. A growing amount of research has examined the local risk factors impact on traffic accident frequency at certain time. Some studies considered these spatial influences but overlooked the temporal correlation/heterogeneity of traffic accidents and related risk factors. This study explores risk factors’ influence on urban traffic accidents frequency while considering both the spatial and temporal correlation/heterogeneity of traffic accidents. The study area is split into 100 equally sized rectangle traffic analysis zones (TAZs), and the urban traffic accident frequency and attributes in each TAZ are extracted. The linear regression model, spatial lag model (SLM), spatial error model (SEM) and time-fixed effects error model (T-FEEM) are established and compared respectively. The proposed methodologies are illustrated using ten-month traffic accident data from the urban area of Guiyang City, China. The results reveal that the time-fixed effects error model, which considers both spatial and temporal correlation/heterogeneity of traffic accidents, is superior to other models. More traffic accidents will happen in those TAZs that have more hospitals or schools. Moreover, hospitals have a greater influence on traffic accidents than schools. Because of the location in the margin of the city, those TAZs that have passenger stations have more traffic accidents. This study provides policy makers with more detailed characterization about the impact of related risk factors on traffic accident frequencies, and it is suggested that not only the spatial correlation/heterogeneity but also the temporal correlation/heterogeneity should be taken into account in guiding traffic accident control of urban area.

Risk factors of separation-related behaviours in Australian retrievers

Separation-related behaviours are reported in an estimated 14–29% of companion dogs. To investigate risk factors for these behaviours, owners were asked to complete a questionnaire, largely based on the Canine Behavioural Assessment and Research Questionnaire (C-BARQ), to report the behaviour of golden retrievers (n = 266) and Labrador retrievers (n = 247). Statistical analysis identified significant correlations between separation-related behaviour (SRB) scores with a group of traits including attachment and attention-seeking behaviour (rs = 0.43, P < 0.001), excitability (rs = 0.38, P < 0.001), non-social fear (rs = 0.34, P < 0.001), and touch sensitivity (rs = 0.32, P < 0.001). Logistic regression analysis identified source of acquisition, age, breed, sex and neuter status as significant predictors of the presence of SRB. SRB was more likely to be present in dogs acquired from pet shops and shelters than in those from service organisations or breeders. SRB was most likely to be seen in castrated males and least likely to be seen in intact males Future research should focus on the relative impact of risk factors we have identified here. This will facilitate early recognition of behavioural predictors, and prompt owners to seek professional help to alleviate distress in their dogs.

Incidence and Risk Factors for Development of Third and Fourth Degree Perineal Tears: A Four Year Experience in a Single Saudi Center

Background: Vaginal delivery is a physiological process that holds multiple complications. Perineal trauma and vaginal laceration is considered a common complication associated with vaginal delivery. Well established risk factors, recognized by the Royal College of Obstetricians and Gynecologists, are ethnicity, birth weight over 4 kg, persistent occipital posterior position, nulliparity, induction of labor, shoulder dystocia, instrumental delivery. There are other risk factors that were suggested in the literature but data are conflicting, such as Prolonged second stage of labor, episiotomy and obesity Objectives: This study aimed to evaluate third and fourth degree tears rates and the impact of related risk factors on perineal tears in a single Saudi center. Study Design: A retrospective observational cohort study. Methods: This retrospective cohort study analyzed all vaginal deliveries from January 2011 to December 2015 in Security Forces Hospital, Riyadh, Saudi Arabia. The Hospital has around 6000 deliveries per year. Data were extracted from dedicated database software for antenatal care through Hospital System (Medical Record Viewer- MRV) and from Midwife Head Nurse daily record system. Results: During the period of interest 28325 records were identified. Caesarean section was performed in 7322 of them (25.8%). Of the remaining 21003 records, 20300 were included in the study according to the inclusion criteria mentioned above. 56 patients (0.28%) had a severe perineal tear because of delivery and were included in group A (Study Group). Group B (Control Group) consisted of remaining 20244 patients. Univariate analysis indicated the following as risk factors for severe perineal tears: gestational age >40 weeks, nulliparity, moderate/ severe obesity, instrumental delivery, shoulder dystocia, pushing stage >90 min, birth weight >4 kg, head circumference at birth >34 cm and length at birth >50 cm. Risk factors still significant in the final multivariate model were moderate/severe obesity (OR=2.8, CI=1.3-6.1), instrumental delivery (OR=2.6, CI=1.2-5.6) and birth weight (OR=1.1/hg, CI=1.1-1.2). Conclusions: Moderate/severe obesity, vacuum delivery and fetal weight resulted as independent risk factors for severe obstetrical tears.

Relative Impact of Risk Factors, Thwarted Belongingness, and Perceived Burdensomeness on Suicidal Ideation in Veteran Service Members.

We tested the associations between individualized risk factors, empirically validated constructs specific to suicide risk (i.e., thwarted belongingness and perceived burdensomeness, and two methods for conceptualizing suicidal ideation based on Suicide Index Score (SIS) and overall severity score of the Beck Scale for Suicide Ideation [BSS]). The current study included a sample of 134 suicidal Veterans who were recruited from an inpatient psychiatry unit of a Veterans Affairs Medical Center. Participants completed the BSS, Interpersonal Needs Questionnaire, Outcome Questionnaire-45.2, Alcohol Use Disorder Identification Test, Drug Abuse Screening Test, and abbreviated versions of the Posttraumatic Stress Disorder Checklist-Military version (PCL-M) and Insomnia Severity Index. We used ordinary least squares regression with bootstrapping to conduct analyses due to the skewed distributions observed in the suicidal ideation outcomes. Thwarted belongingness was the only statistically significant correlate of the SIS, indicating a stronger desire to be dead than alive as Veterans perceived themselves as being increasingly disconnected and isolated from others (B = 0.36, standard error [SE] = 0.01, p = 0.005). In contrast, greater overall severity scores on the BSS were associated with higher ratings on the PCL-M (B = 0.21, SE = 0.07, p = 0.02) and for thwarted belongingness (B = 0.27, SE = 0.09, p = 0.04). Problematic alcohol use was significantly associated with lower overall severity scores (B = -.27, SE = 1.17, p < 0.001). Findings may inform clinical strategies for conceptualizing and targeting factors associated with suicidal risk.

A New Metric for Quantifying the Relative Impact of Risk Factors on Loss of Working Life Illustrated in a Population of Working Dogs.

In a resource-limited world, organisations attempting to reduce the impact of health or behaviour issues need to choose carefully how to allocate resources for the highest overall impact. However, such choices may not always be obvious. Which has the biggest impact? A large change to a small number of individuals, or a small change to a large number of individuals? The challenge is identifying the issues that have the greatest impact on the population so potential interventions can be prioritised. We addressed this by developing a score to quantify the impact of health conditions and behaviour problems in a population of working guide dogs using data from Guide Dogs, UK. The cumulative incidence of different issues was combined with information about their impact, in terms of reduction in working life, to create a work score. The work score was created at population-level to illustrate issues with the greatest impact on the population and to understand contributions of breeds or crossbreeds to the workforce. An individual work deficit score was also created and means of this score used to illustrate the impact on working life within a subgroup of the population such as a breed, or crossbreed generation. The work deficit scores showed that those removed for behavioural issues had a greater impact on the overall workforce than those removed for health reasons. Additionally trends over time illustrated the positive influence of interventions Guide Dogs have made to improve their workforce. Information highlighted by these scores is pertinent to the effort of Guide Dogs to ensure partnerships are lasting. Recognising that the scores developed here could be transferable to a wide variety of contexts and species, most notably human work force decisions; we discuss possible uses and adaptations such as reduction in lifespan, quality of life and yield in production animals.

The Epidemiology of Irritable Bowel Syndrome in the US Military: Findings from the Millennium Cohort Study.

OBJECTIVES:Functional gastrointestinal disorders occur more frequently among deployed veterans, although studies evaluating the relative impact of risk factors, including stress and antecedent infectious gastroenteritis (IGE), are limited. We examined risk factors for new-onset irritable bowel syndrome (IBS) among active duty participants in the military's Millennium Cohort Study.METHODS:Medical encounter data from 2001 to 2009, limited to Cohort members on active duty, were used to identify incident IBS cases (any and highly probable). IGE was identified using medical encounter or self-report. Covariate data were obtained from the Millennium Cohort Study surveys and analyzed using Cox proportional hazards methods.RESULTS:Overall, 41,175 Cohort members met the eligibility criteria for inclusion and 314 new-onset cases of IBS were identified among these. Significant risk factors (adjusted hazard ratio, 95% confidence interval) included antecedent IGE (2.05, 1.53–2.75), female gender (1.96, 1.53–2.52), number of life stressors (1: 1.82, 1.37–2.41; 2: 2.86, 2.01–4.06; 3+: 6.69, 4.59–9.77), and anxiety syndrome (1.74, 1.17–2.58). Limited to highly probable IBS, a stronger association with antecedent IGE was observed, particularly when based on medical encounter records (any IGE: 2.20, 1.10–4.43; medical encounter IGE only: 2.84, 1.33–6.09). Precedent anxiety or depression and IGE interacted with increased IBS risk compared with IGE alone.CONCLUSIONS:These results confirm previous studies on the association between sociodemographic or life stressors and IBS. IGE was significantly associated with IBS risk. Whether deployed or not, US service members often encounter repeated exposure to high levels of stress, which, combined with other environmental factors such as IGE, may result in long-term debilitating functional gastrointestinal disorders.

Abstract 275: A Prediction Model for Acute Heart Failure Outcomes

Objectives: The Cox proportional hazard (PH) model is commonly used to evaluate the relative impact of risk factors on the baseline hazard of events in reference population. However Cox PH is limited in its ability to incorporate time dependent variables. While building models with fixed cycle lengths, where variable like medical history changes due to treatment intervention, a risk equation could help us better. Parameter risk equations, like Framingham Heart Study equations, can account for the shape of the baseline event rate which enables the estimation of future risk. The purpose of this study is to develop a set of risk equations that account for clinical evidence and biomarkers for acute heart failure (HF) patients to estimate time to discharge, time to in-hospital mortality, time to readmission and time to post-discharge mortality following an HF hospitalization Methods: We utilized data from the placebo arm population from Pro-B Type natriuretic peptide Outpatient Tailored Chronic heart failure Therapy (PROTECT) study to develop the risk equations. For each outcome, determining the best risk equation involved two steps, (a) selecting the appropriate underlying distribution, and (b) choosing the right set of risk-factors. Various distributions considered including Weibull, exponential, piecewise exponential, logistic, log normal and gamma distribution. The final distribution was chosen based on model fit and its AIC score. A variety of risk factors were considered including patient characteristics, relevant biomarkers and medical history. The best risk factors were chosen based on clinical relevance, systematic literature review, and how they performed on a maximum likelihood ratio test for the chosen distribution. The predicted value for each outcome was compared to observed values from PROTECT for internal validity and Efficacy and Safety of Relaxin for the Treatment of Acute Heart Failure (RELAX-AHF) study for external validity. Results: The gamma, Weibull, piecewise exponential and exponential distributions were selected for the time to discharge, in-hospital mortality, hospital readmission and post-discharge mortality, respectively. The key risk factors included gender, age, SBP, heart rate, ProBNP, GFR, NYHA class, in-hospital diuretic dosage, medication usage and cardiovascular comorbidities. The internal and external validity are confirmed by comparing predicted and observed values from PROTECT and RELAX-AHF study respectively. The predicted and observed LOS is 12.6 and 10.5 days. Although the predicted and observed 30 day post-discharge mortality are 1.20% and 3.30%, the difference between predicted and observed all-cause mortality is 0.1 (11.40% vs 11.3%). Conclusions: Since risk factors (i.e SBP and BNP) that change over time were identified as important risk-factors, parametric risk equations were superior to cox PH model.

Beating the Odds: Impact of the Economic Recession on Young People in the UK

Beating the Odds: Impact of the Economic Recession on Young People in the UK

Risk factors for transmission of foot-and-mouth disease during an outbreak in southern England in 2007

During an outbreak of foot-and-mouth disease (FMD) in southern England in 2007, a case-control study was conducted to identify risk factors for infection and to investigate the relative impact of...

Liver Transplantation for Hepatitis C Viral Infection in Children: An Analysis of the UNOS Experience in Comparison to Adults

Introduction: While end-stage liver disease from Hepatitis C Virus (HCV) is the leading indication for orthotopic liver transplantation (OLT) for adults in the US, it rarely leads to transplantation in children. Furthermore, HCV infection in the pediatric population follows a unique course. Very little data exists, however, regarding liver transplantation for children with HCV Aims: 1) Compare graft and patient survival in pediatric versus adult HCV transplant recipients. 2) Determine the impact of re-transplantation for recurrent disease on patient and graft survival in children. 3) Identify independent risk factors associated with worsened graft and patient survival in the pediatric HCV liver transplant recipients. Methods: The United Network for Organ Sharing (UNOS) database of liver transplant recipients from September 30, 1987 through February 20, 2009 was queried. Patients receiving OLT for HCV associated liver disease (acute hepatic failure and cirrhosis) were selected. Patients with any comorbid liver disease were excluded. Children in this group were defined as 21 or younger at transplant. Graft and patient survival were calculated via the Kaplan-Meier method, with comparison between groups made by log-rank test. The relative impact of risk factors on graft and patient survival were calculated using a Cox Regression model. All statistical computations were performed with SPSS version 15.0 (Chicago, Illinois). Results: A total of 18,961 first-time OLT's were performed for HCV-associated liver disease (94 pediatric, 18,867 adult). Of these, 941 patients were re-transplanted for recurrence: 18 children (19.1%) vs. 923 adults (4.9%). Children experienced significantly shorter graft survival after first transplant in comparison to adults (2792 days vs. 3346 days mean survival, p=0.045). Mean patient survival was, however, similar between the two groups after first transplant (4196 vs 3816 days, p=0.468). Re-transplantation did not adversely impact graft or patient survival in the pediatric HCV recipients. Mean graft survival was 2792, 1873, and 1500 days, after first, second, and third transplants, respectively (p=0.847-0.996). Mean patient survival was 4196, 1982, and 1499 days after first, second, and third time transplants (p=0.197-0.921). No independent risk factors for worsened patient or graft survival were identified by Cox regression. Conclusions: While pediatric OLT recipients with HCV have worsened graft survival in comparison to their adult counterparts, patient survival is similar. Furthermore, re-transplantation for recurrent disease in children is a safe option not associated with worsened graft or patient survival. Further study is necessary to identify risk factors for OLT in this population.

Relative impact of risk factors for deep vein thrombosis and pulmonary embolism: a population-based study.

To assess the potential impact of controlling risk factors on the incidence of venous thromboembolism by estimating the population attributable risk (defined as the percentage of all cases of a disease in a population that can be "attributed" to a risk factor) for deep vein thrombosis and pulmonary embolism associated with venous thromboembolism risk factors. Using data from a population-based, nested, case-control study of the 625 Olmsted County, Minnesota, residents with a definite first lifetime deep vein thrombosis or pulmonary embolism diagnosed during the 15-year period 1976 to 1990 and 625 unaffected Olmsted County residents matched for age and sex, we developed a conditional logistic regression model appropriate to the matched case-control study design and then estimated attributable risk for the risk factors individually and collectively. Fifty-nine percent of the cases of venous thromboembolism in the community could be attributed to institutionalization (current or recent hospitalization or nursing home residence). Hospitalization for surgery (24%) and for medical illness (22%) accounted for a similar proportion of the cases, while nursing home residence accounted for 13%. The individual attributable risk estimates for malignant neoplasm, trauma, congestive heart failure, central venous catheter or pacemaker placement, neurological disease with extremity paresis, and superficial vein thrombosis were 18%, 12%, 10%, 9%, 7%, and 5%, respectively. Together, the 8 risk factors accounted for 74% of disease occurrence. Factors associated with institutionalization independently account for more than 50% of all cases of venous thromboembolism in the community. Greater emphasis should be placed on prophylaxis for hospitalized medical patients. Other recognized risk factors account for about 25% of all cases of venous thromboembolism, while the remaining 25% of cases are idiopathic.