Impact Of Various Risk Factors Research Articles

Exploring determinants of basic childhood vaccination coverage in Bangladesh: a generalized Poisson regression analysis

IntroductionChildhood vaccination is crucial for safeguarding children against potentially life-threatening diseases. This study aims to investigate the significant factors influencing vaccination coverage among children aged 12–59 months in Bangladesh.MethodsThe study utilizes cross-sectional data from the 2017–18 Bangladesh Demographic and Health Survey. A Kruskal–Wallis test is employed in bivariate analysis to identify significant predictors associated with childhood immunizations. A generalized Poisson regression model is applied to assess the impact of various risk factors on children’s incomplete vaccination status.ResultsChildren born in the Sylhet division show lower chances of receiving immunizations. Additionally, children whose mothers are younger, have no education or only primary education, and are unemployed, are less likely to be fully vaccinated. Furthermore, children born into smaller families, first birth, those whose mothers had access to media, and those who received more than four antenatal visits during pregnancy are more likely to have received all recommended vaccines.ConclusionImplementing targeted interventions to improve childhood vaccination coverage, particularly among vulnerable populations such as young and uneducated mothers with middle-income status, is crucial. Enhancing media access, promoting the utilization of antenatal care at health care facilities, and raising awareness about the benefits of vaccination can help ensure optimal vaccination coverage among children in Bangladesh.

Colon Cancer With Bladder Invasion: A Single Center Experience.

The aim of our study was to investigate the outcome of colon cancer with bladder invasion after surgical intervention. Between 2011 and 2022, a total of 41 patients diagnosed with colon cancer and bladder invasion underwent surgical procedures at Taichung Veterans General Hospital. The impact of various risk factors on overall survival (OS) was assessed using Kaplan-Meier analyses and Cox proportional hazards models. Among the enrolled patients, 21 underwent radical cystectomy, while 20 underwent partial cystectomy. Twelve had tumors located in the rectum, 19 in the sigmoid colon, and 10 in both the rectum and sigmoid colon. The median OS was 71.8 months in stage 2, 50.8 months in stage 3, and 11.2 months in stage 4 (p=0.061). Median OS was 71.8 months in patients with negative surgical margins and 10.5 months in those with positive surgical margins (p=0.003). In multivariate regression analysis, positive surgical margins [hazard ratio (HR)=3.64, 95% confidence interval (CI)=1.28-10.34, p=0.015] and emergency operations (HR=4.57, 95%CI=1.34-15.55, p=0.015) significantly impacted OS. Complete resection of colon cancer with bladder invasion can yield excellent oncologic outcomes. The decision between partial and radical cystectomy should balance surgical margin clearance and the preservation of quality of life. Both surgical margin involvement and emergency operations are independent risk factors for OS.

Efficacy of various extent of resection on survival rates of patients with pilocytic astrocytoma: based on a large population

Pilocytic astrocytoma (PA) is classified as a Grade I benign neuroglial tumor. The extent of surgical resection is a critical factor influencing the prognosis for patients with PA. In prior researches of PA, the extent of surgical resection is generally categorized into GTR, STR and biopsy. In some researches on brain tumor surgeries, the extent of resection also includes GTL. There is no existing research specifically comparing the efficacy of GTR versus GTL in PA treatment. In this study, the data we used are from the SEER database. We categorized the extent of resection into GTL, GTR, STL, STR, biopsy, and no surgery based on SEER classification of surgical procedures, to investigate the impact of extent of resection on PA patient survival. A multivariate logistic regression model was utilized to acquire odds ratios (OR) for different extent of resection. Survival outcomes across different extent of resection (GTL, GTR, STL, STR, biopsy, no surgery) were assessed using Kaplan–Meier survival curve analysis, with curve comparisons conducted via log-rank tests. The impact of various risk factors on survival was assessed using the Cox proportional hazards model. The hazard ratio (HR) was employed to quantify the influence of one or more factors on overall survival throughout the follow-up period. Multivariate Cox analysis revealed that age, tumor location, extent of resection, as well as the application of radiotherapy and chemotherapy, all significantly impacted prognosis. Compared to GTL, GTR did not significantly increase the risk of mortality (HR 1.17; 95% CI 0.73–1.86, p = 0.5). Furthermore, there was no statistically significant difference between the Kaplan–Meier survival curves of the two groups (p = 0.18). We employed propensity score matching (PSM) to balance the differences in baseline characteristics of patients receiving chemotherapy or radiotherapy. A total of 4429 patients were included in this study. Age, diagnosis period, race, tumor size, and tumor location as influential on the extent of resection. Age, tumor location, extent of resection, and application of radiotherapy and chemotherapy influenced the survival of PA patients. The Kaplan–Meier survival curves revealed that the long-term survival rate for GTR is slightly higher than that for GTL. The PSM analysis revealed that the application of radiotherapy and chemotherapy was associated with the reduction of overall survival in PA patients. In conclusion, there was no significant difference in survival between GTR and GTL, so GTR with less damage was preferred. The application of radiotherapy and chemotherapy can reduce overall survival of patients with PA.

Assessing the relative importance of vitamin D deficiency in cardiovascular health.

Previous research has suggested a potential link between vitamin D (VD) deficiency and adverse cardiovascular health outcomes, although the findings have been inconsistent. This study investigates the association between VD deficiency and cardiovascular disease (CVD) within the context of established CVD risk factors. We utilized a Random Forest model to predict both CVD and VD deficiency risks, using a dataset of 1,078 observations from a rural Chinese population. Feature importance was evaluated using SHapley Additive exPlanations (SHAP) to discern the impact of various risk factors on the model's output. The results showed that the model for CVD prediction achieved a high accuracy of 87%, demonstrating robust performance across precision, recall, and F1 score metrics. Conversely, the VD deficiency prediction model exhibited suboptimal performance, with an accuracy of 52% and lower precision, recall, and F1 scores. Feature importance analysis indicated that traditional risk factors such as systolic blood pressure, diastolic blood pressure, age, body mass index, and waist-to-hip ratio significantly influenced CVD risk, collectively contributing to 70% of the model's predictive power. Although VD deficiency was associated with an increased risk of CVD, its importance in predicting CVD risk was notably low. Similarly, for VD deficiency prediction, CVD risk factors such as systolic blood pressure, glucose levels, diastolic blood pressure, and body mass index emerged as influential features. However, the overall predictive performance of the VD deficiency prediction model was weak (52%), indicating the absence of VD deficiency-related risk factors. Ablation experiments confirmed the relatively lower importance of VD deficiency in predicting CVD risk. Furthermore, the SHAP partial dependence plot revealed a nonlinear relationship between VD levels and CVD risk. In conclusion, while VD deficiency appears directly or indirectly associated with increased CVD risk, its relative importance within predictive models is considerably lower when compared to other risk factors. These findings suggest that VD deficiency may not warrant primary focus in CVD risk assessment and prevention strategies, however, further research is needed to explore the causal relationship between VD deficiency and CVD risk.

Evaluating risk factors in recurrent pregnancy loss: A prospective cohort study and its impact on live birth outcomes

Recurrent pregnancy loss (RPL) affects 1–2 % of all couples trying to conceive and is a challenging heterogeneous condition. This study aimed to evaluate the prevalence and impact of various risk factors in patients suffering from RPL. We performed a prospective cohort study including patients at the tertiary RPL Unit in the Capital Region of Denmark between 1st January 2000 and 1st January 2023. The main outcome of the study was the first pregnancy after referral and whether the pregnancy was ongoing at least to the 22nd gestational week. A total of 2555 patients were included in the study, out of whom 1892 patients achieved a pregnancy after referral to the RPL Unit. This resulted in 1103 live births (58.3 %) and 718 pregnancy losses (37.9 %). Maternal age, BMI, smoking status and the number of prior pregnancy losses were negatively correlated with the likelihood of achieving pregnancy. Furthermore, maternal age, prior pregnancy losses, antiphospholipid syndrome (APS) and uterine malformations were associated with reduced birth rates. Patients with secondary RPL had a higher birth rate compared to those with primary RPL, and patients with APS treated with low-molecular-weight heparin (LMWH) demonstrated a significantly increased birth rate compared to untreated APS patients. These findings suggest that certain risk factors significantly impact the likelihood of achieving pregnancy and live birth following RPL, which can be used in patient guidance.

Оценка хозяйственных рисков при реализации технологий угледобычи в современных условиях недропользования

Introduction. This paper presents research in the field of methodology of assessment and monitoring of associated under ground coalmining risks in order to level their impact on the resulting technical and economic indicators of production and economic activities in modern conditions of subsoiluse. The functioning of technological systems of coal mining enterprises at the present stage of subsurface use occurs in a highly dynamic and highly variable functional environment with a fair degree of uncertainty, which is generated by a significant variety of parameters and characteristics of the initial mining, geological and mining engineering environment, which, in turn, generates the emergence of various groups and risk factors for subsurface use. The established procedures and methods of risk forecasting currently do not give satisfactory results due to the globalization of world markets and high volatility of prices for coal products. Leveling the negative degree of influence of the risk component on the resulting indicators – indicators of technical and economic activity can be achieved through the introduction of an operational system for assessing and monitoring various groups of risk factors. Materials and methods. For the purpose of evaluation, it is proposed to use the methodological and methodological foundations of the method called “vector norms”, which involves the use of Affine space, the constituent areas of compromises and the introduction of utility estimates. A complete model representation of the assessment and monitoring of the impact of various risk factors of subsurface use, taking into account their clustering and ranking, is presented. The algorithmic support of this method is reduced to the following components-iterations: 1. Formation of criteria-based assessment matrices of various factors of subsurface use risk groups. 2. Assignment of optima to evaluation criteria. 3. In order to ensure the legality of the use and implementation of mathematical procedures and operations, the reduction of multi-dimensional evaluation criteria to a relative form, taking into account the assigned optima. 4. Formation of the objective function of the “norm of the vector” (integral indicator) and the development of a procedure for selecting the optimal option. Since the use of the methodological and methodological foundations of the method called “vector norms” allows us to form quantitative estimates of the presented factors-types of risk of subsurface use, this makes it possible to implement the clustering procedure or ranking of a selected set of coal mining enterprises in conjunction with existing risk areas. Results. Quite high values of correlation coefficients were obtained with a significant closeness of the relationship of inversely proportional dependencies of generalizing integral indicators of the degree of risk and the level of achievement of planned indicators and development of production capacity with the level of operational profitability from the conduct of production and economic activities of coal mining enterprises with a directly proportional dependence on the operating costs of mining 1t of coal. Discussion. Сomplete model representation of the assessment and monitoring of the impact of various risk factors of subsurface use, taking into account their clustering and ranking, is presented. As a practical component of the research, variable series of areas of integral degree of risk in the functional environment of Kuzbass coal mines are presented. The use of software modules for correlation and regression analysis, taking into account three-year retrospective dynamics, made it possible to establish the legality and objectivity of the proposed methodological apparatus for integrated risk assessment of the implementation of coal mining technologies in modern conditions of subsurface use. Conclusion. The results of the implementation of the theoretical components of the methodology and model representations of the developed conceptual foundations for the integrated risk assessment of the implementation of coal mining technologies in modern conditions of subsurface use, taking into account five-year retrospective dynamics, showed that in the Kuznetsk basin there was a steady tendency to reduce the cluster of coal mines, which is characterized by high risks of carrying out production and economic activities in the presence of a disproportion of resource potential (the emergent part). The accompanying processes of formation of this trend are manifested in a quantitative increase in the functional units of the rating cluster of group 2B with an average resource potential and inherent moderate risk. It is within this cluster that strategies for prioritizing investments for the development and renewal of technological systems and structures of coal mining are being formed, since only they are able to provide the fastest possible return on invested funds. Resume. The article presents the results of research in the field of methodology for assessing and monitoring the risks associated with underground coal mining in order to level out their impact on the resulting technical and economic indicators of production and economic activity in modern conditions of subsoil use. The research results can be useful in the implementation of coal mining technology in modern conditions of subsoil use.

Quantifying the Impact of Risk Factors on Direct Compensation Property Damage in Canadian Automobile Insurance

This study presents a statistical analysis assessing the impact of various risk factors on direct compensation property damage (DCPD) claims in private passenger vehicle accidents. Using automobile insurance data in Ontario, Canada for the decade years period between 2003 and 2012, a statistical model of property damage was explored via a generalized linear binary logit mixed model and considered the imbalance between the classes of insureds. The results indicate that several risk factors have a significant impact on the likelihood of DCPD claims, including usage, training, outstanding loss, and incurred loss. The effects of these risk factors were observed under the weights — the number of trials used to generate each success proportion — in the different classes of insureds. The generalized linear mixed models (GLMMs) analysis provides a powerful tool for quantifying the impact of risk factors on binary outcomes, which are called DCPD claims and property damage (PD) claims covered by third-party liability (TPL) insurance. These models can also inform insurance underwriting and policy design, focusing on identifying the most significant risk factors. The performance metrics calculated by considering the class imbalance in binary outcomes verify the resulting model’s ability to accurately predict classes. The F1 score, an evaluation metric to measure the performance of classification, was calculated as 0.934. In addition, PR AUC, which is the area under the Precision-Recall (PR) curve, was computed as 0.953. These high scores indicate that the resulting model performs well in the classification. The other metrics also support the classification accuracy of this model. The findings of the analysis can help insurers better understand the underlying drivers of property damages and develop more accurate and effective strategies for risk mitigation. Furthermore, this study highlights the importance of developing class-specific risk assessment models to account for the imbalance across different classes.

Evaluating the Effectiveness of Risk Management Strategies in the Indian Mutual Fund Industry

The study will employ a mixed-method approach, combining quantitative analysis of historical fund performance data with qualitative assessment of risk management processes and policies adopted by mutual fund companies. By examining key risk metrics such as volatility, beta, and sharpe ratio, the research aims to assess the impact of risk management strategies on the overall performance of mutual fund schemes in the dynamic and rapidly growing Indian mutual fund industry. As with any investment vehicle, mutual funds are subject to various risks that can impact investor returns, prompting mutual fund companies to employ various risk management strategies to mitigate these risks. This study seeks to evaluate the effectiveness of these strategies by analyzing different techniques employed by mutual fund companies, with the goal of identifying best practices for minimizing the impact of various risk factors on fund performance. The findings will provide valuable insights for both mutual fund companies and investors, aiding in understanding the effectiveness of risk management strategies in mitigating investment risks. By identifying and promoting best practices in risk management, this research aims to contribute to the development and sustainability of the mutual fund sector in India. Keywords: Risk management, mutual fund, market stability, investment risk

Risk Assessment in Sustainable Production: Utilizing a Hybrid Evaluation Model to Identify the Waste Factors in Steel Plate Manufacturing

In the realm of industrial development, steel has consistently played a pivotal role due to its extensive applications. This research aims to refine the process of steel plate manufacturing, focusing on reducing waste as a critical step towards embracing sustainable development and aligning with the Sustainable Development Goals (SDGs). Our approach integrates a hybrid analytical model grounded in Failure Mode and Effects Analysis (FMEA) to thoroughly investigate the waste-producing elements in steel plate production. The methodology of this study is structured in a three-pronged approach, as follows: Initially, it involves meticulous on-site inspections across various factories to pinpoint potential sources of waste. Subsequently, we employ the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method to intricately analyze the interconnectedness and impact of various risk factors. The final phase utilizes the Performance Calculation technique within the Integrated Multiple Multi-Attribute Decision-Making (PCIM-MADM) framework for aggregating and evaluating risk scores. This multifaceted approach aids in establishing the priorities for corrective actions aimed at waste reduction. Our findings present innovative solutions for identifying and mitigating critical waste factors, contributing to a more efficient and sustainable steel manufacturing process. These strategies promise scalability and adaptability for broader industrial applications and provide critical insights into resource optimization. This research directly supports the objectives of SDG 9, which focuses on building resilient infrastructure and promoting sustainable industrialization. Furthermore, it resonates with SDG 12, advocating for sustainable consumption and production patterns. By enhancing the efficiency and cost effectiveness of steel plate production, this study significantly contributes to minimizing waste and elevating the sustainability of industrial practices.

Factors that increase the rate of periprosthetic dislocation after reverse shoulder arthroplasty

IntroductionReverse shoulder arthroplasty (RSA) is considered one of the greatest technological innovations in shoulder reconstruction surgery, as evidenced by the fact its growth rate of usage is greatest among all shoulder arthroplasties. However, like all arthroplasties, a post-surgical complication often arises. One of these complications, periprosthetic dislocation (PPD), requires revision and poses, therefore, a burden on both patients and healthcare providers. While PPD is understood to be a complication of RSA, it is unclear to what extent certain risk factors and co-morbidities predispose patients to post-RSA PPD. The purpose of this study was to identify and evaluate the impact of specific risk factors and co-morbidities that contribute to the development of PPD following RSA.MethodsIn this retrospective study, we used the Nationwide Inpatient Sample (NIS) database from 2016–2019 to analyze the prevalence and impact of various risk factors and co-morbidities on the incidence of PPD following RSA. A univariate and subsequent multivariate logistic regression model was made to provide a descriptive association between variables that impact the rates of PPD after RSA.ResultsThe NIS database identified 59,925 patients, 1,000 of whom experienced a PPD while the remaining 58,825 were placed in the non-PPD group (controls). The PPD group consisted predominantly of females (53.10%) and Caucasians (86.30%). There was a higher incidence of tobacco-related disorders (P = 0.003), obesity (P < 0.001), morbid obesity (P < 0.001), liver cirrhosis (P < 0.001), and Parkinson’s disease (PD) (P < 0.001) in PPD patients compared to controls. Young patients had a 1.89-fold increased odds (OR: 1.89, 95% CI [1.58, 2.26], P < 0.001), patients with tobacco-related disorders had decreased odds (OR: 0.80, 95% CI [0.67, 0.97], P = 0.02), morbidly obese patients had 1.50 times the odds (OR: 1.50, 95% CI [1.14, 1.97]), liver cirrhosis patients had 2.67-fold increased odds (OR: 2.67, 95% CI [1.55, 4.60], P < 0.001), and Parkinson’s disease patients had 2.66 times the odds (OR: 2.66, 95% CI [1.78, 3.96], P < 0.001) to develop PPD following RSA compared to patients who did not have the corresponding condition.ConclusionsPatients with specific risk factors and co-morbidities are predisposed to developing PPD after RSA. Risk factors that were found to be associated with a higher incidence of PPD are gender (female), race (Caucasian), and age (young patients). Analysis revealed the history of tobacco-related disorder, obesity, morbid obesity, liver cirrhosis, and Parkinson’s disease increased the odds of developing PPD following RSA. These findings can inform both healthcare providers and patients to improve RSA surgical outcomes and tailor post-surgery recovery programs to fit the patient’s needs.

Impact of Various Risk Factors on the Positive Fecal Immunochemical Test for Colorectal Cancer in the Iranian Population.

Background: Colorectal cancer (CRC) is the most prevalent cancer with high mortality worldwide. We aimed to evaluate the incidence of CRC based on the positive fecal immunochemical test (FIT) result in the Iranian population. Methods: The present study was conducted on the health assessment data recorded in the SINA (Integrated Health Information System) in 2018 and 2019 from individuals who had participated in the national program, including asymptomatic people aged 50-69 years or had risk factors of CRC such as family or past personal history of CRC as well as symptomatic individuals, for the early detection and prevention of CRC in Mashhad, Iran. Results: The study participants included 140,463 eligible individuals, of whom 8258 (5.88%) and 145 (2.21%) were positive for FIT and diagnosed with colon cancer, respectively. Unfortunately, only 654 people had undergone colonoscopy. Our results indicated that age, fast food intake (≥two units per day), family history of CRC in first or second-degree relatives, some gastrointestinal diseases such as inflammatory bowel disease (IBD) and CRC, as well as bleeding per anus, constipation, abdominal cramp, and losing body weight were associated with increased risk of positive FIT. However, some other factors, including having a hard job, physical activity, and Iranian nationality (compared to non-Iranians), were associated with a low risk of positive FIT screening tests for CRC. Conclusion: A high number of high-risk persons in Mashhad were positive for the FIT test in 2018-2019, and many of them were diagnosed with CRC, according to the colonoscopy results. Therefore, screening is highly recommended as the first step in the early detection of CRC.

Predicting mortality in brain stroke patients using neural networks: outcomes analysis in a longitudinal study

In this study, Neural Networks (NN) modelling has emerged as a promising tool for predicting outcomes in patients with Brain Stroke (BS) by identifying key risk factors. In this longitudinal study, we enrolled 332 patients form Imam hospital in Ardabil, Iran, with mean age: 77.4 (SD 10.4) years, and 50.6% were male. Diagnosis of BS was confirmed using both computerized tomography scan and magnetic resonance imaging, and risk factor and outcome data were collected from the hospital’s BS registry, and by telephone follow-up over a period of 10 years, respectively. Using a multilayer perceptron NN approach, we analysed the impact of various risk factors on time to mortality and mortality from BS. A total of 100 NN classification algorithm were trained utilizing STATISTICA 13 software, and the optimal model was selected for further analysis based on their diagnostic performance. We also calculated Kaplan–Meier survival probabilities and conducted Log-rank tests. The five selected NN models exhibited impressive accuracy ranges of 81–85%. However, the optimal model stood out for its superior diagnostic indices. Mortality rate in the training and the validation data set was 7.9 (95% CI 5.7–11.0) per 1000 and 8.2 (7.1–9.6) per 1000, respectively (P = 0.925). The optimal model highlighted significant risk factors for BS mortality, including smoking, lower education, advanced age, lack of physical activity, a history of diabetes, all carrying substantial importance weights. Our study provides compelling evidence that the NN approach is highly effective in predicting mortality in patients with BS based on key risk factors, and has the potential to significantly enhance the accuracy of prediction. Moreover, our findings could inform more effective prevention strategies for BS, ultimately leading to better patient outcomes.

Risk factors for malignant oral mucosal lesion development (literature review). Part 1. Endogenous and biological factors

Relevance. Oral mucosal cancer (OMC) is the sixteenth most common cancer worldwide. The high mortality rate is mainly due to the asymptomatic course of the disease in the early stages and late detection when the tumour process poorly responds to treatment. Determining the impact of various risk factors and establishing their relationship are necessary to prevent and diagnose malignant oral mucosal lesions in the early stages.Purpose. Based on the modern literature, the study aimed to determine the impact value of various internal and external risk factors on malignant oral mucosal lesion development and assess the risk factors’ relationship.Material and methods. The research material included the analysis of literature from databases – Elsevier, PubMed, Elibrary, Google Academy, Medline and Cyberleninka. The study included literature sources in Russian and English.Results. Based on modern literature, we have determined endogenous and biological risk factors for malignant oral mucosal lesion development. The study noted the high role of microbiome changes and the presence of dysbiosis in patients with malignant neoplasms and proved the direct involvement of Candida fungi in carcinogenesis. The development of oral mucosal cancer and the presence and severity of oral yeast colonization and human papillomavirus infection showed a positive correlation. Chronic oral diseases, which are susceptible to malignant transformation or contribute to the development of carcinomas, have been identified, and their relationship has been established with biological risk factors, age, sex of the patient and duration of the disease course.Conclusion. The studies considered in this part of the review prove the influence of endogenous and biological factors on the development of malignant neoplasms of the oral cavity and determine their relationship. However, many mechanisms remain unexplored to date. Effective primary and secondary prevention implementation needs improvement and the development of a multidisciplinary approach to research methodology, study the complex impact of all groups of risk factors on the development of malignant oral mucosal lesions.

Secular trends and attributable risk factors of esophageal cancer deaths among non-elderly adults based on Global Burden of Disease Study.

Esophageal cancer (EC) poses a persistent threat to the health of non-elderly adults. This study aims to elucidate the temporal trends of EC-related mortality and investigate the impact of various risk factors on such deaths in the age group of 20-59years, spanning 3 decades. Data on EC deaths were acquired from the Global Burden of Disease, Injuries, and Risk Factors (GBD) study. We employed estimated average percentage change (EAPC) and linear mixed-effects (LME) models to analyze mortality trends and pertinent risk factors for EC. Between 1990 and 2019, EC mortality showed a downward trend, and the global number of deaths from EC among non-elderly adults surged by 24.37%. During this period, mortality rates saw an increase in only two regions-the Caribbean and Western Sub-Saharan Africa (EAPCs > 0). For male deaths, smoking and alcohol use emerged as the primary risk factors, while high body mass index (BMI) stood out as the main risk factor for female deaths. Furthermore, the LME model identified male sex, advancing age, alcohol use, smoking, and chewing tobacco as factors associated with an additional rise in EC deaths. EC continues to exert a substantial toll on mortality among young and middle-aged adults globally. Implementing targeted interventions are significant in alleviating the burden of this disease within this population.

Trend of blood pressure changes among children from 2012 to 2022: findings from student health surveillance in Eastern China.

The primary objective of this study is to examine the secular trends in blood pressure levels from 2012 to 2022 in eastern China. Additionally, to compare two standards [International Blood Pressure Reference for Children and Adolescents (ICBP) and the National Blood Pressure Reference for Chinese Han Children and Adolescents (CCBP)], we calculate the 95th percentile of blood pressure levels for students in developed regions (ECCBP). Secondly, the study aims to investigate potential contributors to elevated blood pressure, including sex, age, behaviors, and mental health. Lastly, the study seeks to estimate the total population aged 7-18 years with elevated blood pressure in Eastern China based on three references. The data used in this study were obtained from the Student Health Surveillance program in Jiangsu Province, which has been collecting data since 2012. Trained project members, skilled nurses, and doctors measured anthropometric variables. Additionally, online student questionnaires were administered in 2017, 2019, and 2021 to collect personal information behavior patterns, and mental health. The study examined blood pressure changes in 123 013 children and adolescents in Eastern China from 2012 to 2022. Significant increases were observed in systolic blood pressure (SBP) and pulse pressure difference. Prevalence of elevated blood pressure followed a similar trend with ECCBP and CCBP, ranging from 17.2%/16.3% (2012-2015) to 11.6%/14.6% (2020-2022). Notably, BP with ICBP showed a significant increase in both prevalence and population, from 12.6% [6 713 679, 95% confidence interval (CI): 6 708 931 to 6 718 427] to 14.5% (7 004 208, 95% CI: 6 999 411 to 7 009 004). The study further emphasizes the significant impact of various risk factors on elevated blood pressure among children and adolescents, particularly the detrimental effect of depression on blood pressure, with the odds ratios (OR) in 2021 being 1.310 (95% CI, 1.290-1.330) for ECCBP, 1.239 (95% CI, 1.223-1.255) for CCBP, and 1.189 (95% CI, 1.176-1.202) for ICBP. The study revealed significant changes in the population and prevalence of elevated blood pressure in Eastern China from 2012 to 2022. The findings indicate a decline in the prevalence of elevated blood pressure (referred to as CCBP or ECCBP), while highlighting an increasing trend in elevated blood pressure (referred to as ICBP). Untreated high blood pressure can lead to serious cardiovascular diseases in adulthood, underscoring the importance of early prevention and management, particularly through nonpharmacological methods and regular monitoring for students in Eastern China. Raising awareness among educators, parents, and healthcare providers about the association between mental health and elevated blood pressure is essential.

Assessing of sustainable construction quality in Iraq under conditions of risk factors

The area generally and Iraq specifically suffers in the current period from a lot of political and economic conditions which leads to the emergence of many risk factors and uncertainty in construction projects. In addition to the nature of the climate and the lack of organizational and technical programs and scheduled and continuous preventive maintenance programs in addition to the risks of terrorism and wars. The aim of the study is to assess the extent of the impact of various risk factors on construction facilities and roads for the purpose of increasing the ability of those facilities to confront these risks through managing them and applying selected criteria from the elements of sustainable construction. A questionnaire was prepared to identify the risk factors that may exist in building and construction projects, and after the risk groups were identified through the questionnaire form and personal interviews with the project participants, those groups were analyzed using the structural equation model in the program (PLS -SEM). The results showed that the ecological, economic, political, technical and social risk factors have a clear impact on the quality of sustainable construction of infrastructure projects in Iraq, and thus a clear influence on the project objectives (cost, duration and quality).

Contributing Factors of Diabetes Mellitus among Patients with Gout (Results of the Long-Term Prospective Study)

It is assumed that the risk of developing type 2 diabetes mellitus (T2DM) in patients with gout is influenced by both generally accepted risk factors and factors related to gout. The aim of the study was to evaluate the impact of various risk factors for T2DM in patients with gout. A total of 444 patients (49 women, 395 men) ≥18 years old with gout and without DM were included. The duration of observation was 5.66 [2.69; 7.64] years. To identify the factors associated with the risk of developing T2DM, multivariate logistic regression was used, which included sex; T2DM in relatives; insufficient physical activity; unbalanced diet; age ≥ 45 years; ≥4 attacks per year; presence of tophi; BMI ≥30 kg/m2; allopurinol, febuxostat, glucocorticoids, diuretics, metformin, colchicine; GFR < 60 mL/min/1.73 m2; serum uric acid level (sUA) ≥ 420 µmol/L and ≥ 480 µmol/L. T2DM developed in 108 (24.3%) patients. According to the multivariate model, the presence of ≥4 attacks of arthritis per year increased the risk of T2DM (OR = 5.23; 95% CI: 2.98–9.19; p = 0.0001); presence of tophi (OR = 2.61; 95% CI: 1.50–4.54; p = 0.001); sUA ≥ 480 µmol/L (OR = 2.26; 95% CI: 1.02–5.00; p = 0.144); diuretics (OR = 2.35; 95% CI: 1.19–4.64; p = 0.014). Febuxostat (OR = 0.31; 95% CI: 0.11–0.84; p = 0.022) and metformin (OR = 0.49; 95% CI: 0.21–1.16; p = 0.107) reduced the risk of developing T2DM. Risk of T2DM in patients with gout is associated with high incidence of arthritis attacks, MK ≥ 480 μmol/L, hypertension, diuretic use, and febuxostat and metformin reduces risk.

Prediction of Multimorbidity in Brazil: Latest Fifth of a Century Population Study.

Multimorbidity is characterized by the co-occurrence of 2 or more chronic diseases and has been a focus of the health care sector and health policy makers due to its severe adverse effects. This paper aims to use the latest 2 decades of national health data in Brazil to analyze the effects of demographic factors and predict the impact of various risk factors on multimorbidity. Data analysis methods include descriptive analysis, logistic regression, and nomogram prediction. The study makes use of a set of national cross-sectional data with a sample size of 877,032. The study used data from 1998, 2003, and 2008 from the Brazilian National Household Sample Survey, and from 2013 and 2019 from the Brazilian National Health Survey. We developed a logistic regression model to assess the influence of risk factors on multimorbidity and predict the influence of the key risk factors in the future, based on the prevalence of multimorbidity in Brazil. Overall, females were 1.7 times more likely to experience multimorbidity than males (odds ratio [OR] 1.72, 95% CI 1.69-1.74). The prevalence of multimorbidity among unemployed individuals was 1.5 times that of employed individuals (OR 1.51, 95% CI 1.49-1.53). Multimorbidity prevalence increased significantly with age. People over 60 years of age were about 20 times more likely to have multiple chronic diseases than those between 18 and 29 years of age (OR 19.6, 95% CI 19.15-20.07). The prevalence of multimorbidity in illiterate individuals was 1.2 times that in literate ones (OR 1.26, 95% CI 1.24-1.28). The subjective well-being of seniors without multimorbidity was 15 times that among people with multimorbidity (OR 15.29, 95% CI 14.97-15.63). Adults with multimorbidity were more than 1.5 times more likely to be hospitalized than those without (OR 1.53, 95% CI 1.50-1.56) and 1.9 times more likely need medical care (OR 1.94, 95% CI 1.91-1.97). These patterns were similar in all 5 cohort studies and remained stable for over 21 years. A nomogram model was used to predict multimorbidity prevalence under the influence of various risk factors. The prediction results were consistent with the effects of logistic regression; older age and poorer participant well-being had the strongest correlation with multimorbidity. Our study shows that multimorbidity prevalence varied little in the past 2 decades but varies widely across social groups. Identifying populations with higher rates of multimorbidity prevalence may improve policy making around multimorbidity prevention and management. The Brazilian government can create public health policies targeting these groups, and provide more medical treatment and health services to support and protect the multimorbidity population.

Factors that pre-determine the main subtypes of ischemic stroke in middle-aged and senior women

Introduction. Brain health and active longevity are affected by a number of stroke risk factors. We should identify their relative impact on the main subtypes of ischemic stroke (IS) in middle-aged and senior women to consider prevention and management strategies.&#x0D; Objective. To assess prevalence of isolated and combined factors that may contribute with a high probability to development of the various IS subtypes in women aged 4574 years.&#x0D; Materials and methods. The study included 348 female patients aged 4574 years including 145 inpatients with carotid IS (main group) from Neurology Department 2, the Research Center of Neurology, and 203 women with cognitive disorders due to the chronic cerebral ischemia (controls). To assess the impact of various risk factors on the main IS subtypes, we generated multivariate predictive models using logistic regression and the Wald test.&#x0D; Results. Predictive modeling of atherothrombotic IS demonstrated that type 2 diabetes mellitus increases IS risk by over 5 times (odds ratio [OR] = 5.961; 95% confidence interval [CI] 1.10232.257; р = 0.038); internal carotid artery stenosis, by 7 times (OR = 7.187; 95% CI 1.82728.273; р = 0.005); history of transient ischemic attacks (TIA), by 61 times (OR = 61.442; 95% CI 7.673491.998; р 0.001); excessive alcohol intake, by 49 times (OR = 49,382; 95% CI 4.557535.121; р = 0.001); and HTN severity, by 4 times (OR = 4.445; 95% CI 2.3318.476; р 0.001). Predictive modeling of cardioembolic IS demonstrated that post-infarction cardiosclerosis increases IS risk by over 118 times (OR = 118.025; 95% CI 5.2102673.796; р = 0.003), atrial fibrillation, by 108 times (OR = 108.493; 95% CI 24.312484.159; р 0.001), history of TIA, by over 71 times (OR = 71.558; 95% CI 7.945644.535; р 0.001); and HTN severity, by over 3 times (OR = 3.957; 95% CI 2.0697.566; р 0.001). Predictive modeling of lacunar IS demonstrated that type 2 diabetes mellitus increases IS risk by 8 times (OR = 8.324; 95% CI 1.92336.041; р = 0.005), history of IS, by over 8 times (OR = 8.99; 95% CI 1.77245.598; р = 0.008); and HTN severity, by 7 times (OR = 7.139; 95% CI 3.49114.599; р 0.001).&#x0D; Conclusion. We identified a number of risk factors that may contribute to the development of the main IS subtypes in middle-aged and senior women.

Developing an Individual Neurosurgical Strategy in Patients With a Two-Level Cervical Degenerative Disc Disease

Background: Little is written about substantiated clinical and biometric indications for dynamic stabilization, rigid fixation, and their combinations in patients with two-level degenerative disease of the cervical intervertebral discs (IVD).Objective: To study the risk factors for poor outcomes of two-segment interventions (total disk arthroplasty, TDA; anterior cervical discectomy and fusion, ACDF; and their combination) in patients with two-level degenerative diseases of the cervical IVD; to develop a custom clinical and instrumental assessment strategy for future interventions.Materials and methods: We retrospectively analyzed the outcomes in 118 patients with a two-level degenerative disease of the cervical IVD, who underwent TDA (n = 37), ACDF (n = 41), and their combination (n = 40) from 2005 to 2015. After this analysis, we built a mixed effects logistic regression model to identify and assess the impact of various risk factors on poor clinical outcomes in each intervention.Results: TDA correlated with favorable outcomes in patients with cervical lordosis over 12 °; I–III grade IVD changes according to Pfirrmann scale; I–II grade facet joints (FJ) changes according to Pathria criteria; no FJ tropism; segmental movements amplitude &gt; 8 °; interbody space height ≤ 6 mm, and with no central spinal stenosis/spine interventions. Favorable ACDF outcomes may be achieved in patients with cervical lordosis ≥ 7 °; more than III grade IVD changes according to Pfirrmann scale; more than II grade changes in FJ according to Pathria criteria; segmental movements amplitude ≤ 8 °; interbody space height &lt; 6 mm. FJ tropism, central spinal stenosis, and history of spine interventions do not affect ACDF outcomes.Conclusions: An individual approach to TDA, ACDF, and their combination as well as comprehensive preoperative clinical and instrumental assessment in patients with a two-level degenerative IVD disease contribute to the effective resolution of existing neurological symptoms, which reduced the pain severity in the cervical region and upper limbs, improve the patients’ functional status and quality of life in the late postoperative period, and reduce the number of postoperative complications and reinterventions.