Importance Of Individual Risk Factors Research Articles

Personalized Injury Reduction Strategies in Sports Medicine: Lessons Learned from Advances in Breast Cancer Treatment: A Clinical Commentary.

Injury rates across sport have risen over the past twenty years, despite increased efforts in training and injury prevention. The rise in injury rates suggest that current approaches to estimating injury risk and risk management are not effective. One factor limiting progress is the inconsistency in screening, risk assessment, and risk management strategies to guide injury mitigation approaches. How can sports physical therapists identify and apply lessons learned from other healthcare fields to improve athlete injury risk and risk management strategies? Breast cancer mortality has consistently decreased over the last 30 years, largely attributed to advances in personalizing the prevention and treatment strategies which include modifiable and non-modifiable factors when assessing risk, the transition to personalized medicine, and the systematic approach used to investigate individual risk factors. Three critical phases have facilitated the identification and importance of individual risk factors and developing targeted, personalized strategies for breast cancer risk including: 1) Establishing the potential relationship between factors and outcomes; 2) Prospectively investigate the strength and direction of the relationship; 3) Investigating if intervening on identified factors alters prognosis. Applying lessons learned from other healthcare fields could improve shared decision making between the clinician and athlete concerning risk assessment and management. Examples include calculating only non-modifiable risk, creating individualized screening schedules based on risk assessment, or calculating the influence of each intervention on the athlete's injury risk. A systematic approach to identify and intervene on risk is needed to improve athlete outcomes.

Risk factors associated with poor pain outcomes following primary knee replacement surgery: Analysis of data from the clinical practice research datalink, hospital episode statistics and patient reported outcomes as part of the STAR research programme.

Identify risk factors for poor pain outcomes six months after primary knee replacement surgery. Observational cohort study on patients receiving primary knee replacement from the UK Clinical Practice Research Datalink, Hospital Episode Statistics and Patient Reported Outcomes. A wide range of variables routinely collected in primary and secondary care were identified as potential predictors of worsening or only minor improvement in pain, based on the Oxford Knee Score pain subscale. Results are presented as relative risk ratios and adjusted risk differences (ARD) by fitting a generalized linear model with a binomial error structure and log link function. Information was available for 4,750 patients from 2009 to 2016, with a mean age of 69, of whom 56.1% were female. 10.4% of patients had poor pain outcomes. The strongest effects were seen for pre-operative factors: mild knee pain symptoms at the time of surgery (ARD 18.2% (95% Confidence Interval 13.6, 22.8), smoking 12.0% (95% CI:7.3, 16.6), living in the most deprived areas 5.6% (95% CI:2.3, 9.0) and obesity class II 6.3% (95% CI:3.0, 9.7). Important risk factors with more moderate effects included a history of previous knee arthroscopy surgery 4.6% (95% CI:2.5, 6.6), and use of opioids 3.4% (95% CI:1.4, 5.3) within three months after surgery. Those patients with worsening pain state change had more complications by 3 months (11.8% among those in a worse pain state vs. 2.7% with the same pain state). We quantified the relative importance of individual risk factors including mild pre-operative pain, smoking, deprivation, obesity and opioid use in terms of the absolute proportions of patients achieving poor pain outcomes. These findings will support development of interventions to reduce the numbers of patients who have poor pain outcomes.

THE ECONOMIC EXPLAINABILITY OF MACHINE LEARNING AND STANDARD ECONOMETRIC MODELS-AN APPLICATION TO THE U.S. MORTGAGE DEFAULT RISK

This study aims to bridge the gap between two perspectives of explainability−machine learning and engineering, and economics and standard econometrics−by applying three marginal measurements. The existing real estate literature has primarily used econometric models to analyze the factors that affect the default risk of mortgage loans. However, in this study, we estimate a default risk model using a machine learning-based approach with the help of a U.S. securitized mortgage loan database. Moreover, we compare the economic explainability of the models by calculating the marginal effect and marginal importance of individual risk factors using both econometric and machine learning approaches. Machine learning-based models are quite effective in terms of predictive power; however, the general perception is that they do not efficiently explain the causal relationships within them. This study utilizes the concepts of marginal effects and marginal importance to compare the explanatory power of individual input variables in various models. This can simultaneously help improve the explainability of machine learning techniques and enhance the performance of standard econometric methods.

Cost of Equity of Coal-Fired Power Generation Projects in Poland: Its Importance for the Management of Decision-Making Process

Our knowledge of discount rates plays an important role both in the discounted cash flow decision-making process and in the later phases of a project’s lifetime. It is useful than both for management and cash-flow monitoring purposes at operating stages. Investors putting money into power generation projects expect an appropriate rate of return to compensate them for a minimum acceptable real return available in the market (risk-free rate of interest) and the project’s specific risk. Due to its essential nature in the financial and economic evaluation of projects (it is the only parameter that reflects the risk), it is reasonable to assume that investors would also be interested in constituent components of that indicator. The discount rate is one parameter in the discounted cash flow analysis that takes into account the risk of a venture. Further, the previous research in this area has focused mainly on the dimension of this variable, and the structure of this parameter has not been dealt with any other studies. The proposed idea of this study met the expectations of the industry—it aimed to present a typical project implemented in the energy industry, a relatively simple methodology that allowed estimating the components within the cost of equity capital of the enterprise. In the power generation sector, one can find various types of discount rates—assessed for multiple technologies, at different development stages, and expressed differently. Owing to the know-how and decades-long experience, coal-fired power projects’ remarks may be a good benchmark for alternative low carbon technologies. That is why, in this work, a discount rate for valuing investment in new coal-fired power projects was evaluated. This assessment was made on the “bare-bones” assumption, meaning evaluations at 100% equity, after-tax, in constant (real) currency units. The analysis of the discount rate structure was performed by applying the procedure of the classical sensitivity analysis having the accuracy of key input parameters. Finally, the risk factors within the risk-adjusted discount rate were calculated. The obtained results showed the importance of individual risk factors within the risk-adjusted discount rate used in coal energy projects, which would enable a more pragmatic approach to controlling this parameter by decision-makers and understanding the risk.

Risk factors for contrast-induced acute kidney injury (CI-AKI): protocol for systematic review and meta-analysis

IntroductionIdentifying the patients who are at risk for contrast-induced acute kidney injury (CI-AKI), which is defined as an increase in serum creatinine after exposure to contrast media, is a critical...

Factors associated with choosing the emergency department as the primary access point to health care: a Canadian population cross-sectional study

Approximately 4.3 million Canadians are without a primary care physician, of which 13% choose the emergency department (ED) as their regular access point to health care. We sought to identify factors associated with preferential ED use over other health services. We hypothesized that socioeconomic barriers (i.e., employment, health status, education) to primary care would also prevent access to ED alternatives. Data from the Canadian Community Health Survey, 2007 to 2008, were analysed (N=134,073; response rate 93.5%). Our study population comprised 14,091 individuals identified without a primary care physician. Socioeconomic variables included employment, health, and education. Covariates included chronic health conditions, immigrant status, gender, age, and mental health. Prevalence estimates and 95% confidence intervals (CIs) for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. The sample comprised 57.2% males from across Canada. Employment (OR 0.73 [95% CI: 0.59-0.90]), good health (OR 0.73 [95% CI 0.57-0.88]), and post-secondary education (OR 0.68 [95% CI 0.53-0.88]) reduced respondents use of the ED. The reduced odds of ED use were independent of chronic conditions, mental health, gender, poor mobility, province, and age. Low socioeconomic status dictates preferential ED use in those without a primary care physician. Specific policy and system development targeting this at-risk population are indicated to alter ED use patterns in this population.

Global and regional effects of potentially modifiable risk factors associated with acute stroke in 32 countries (INTERSTROKE): a case-control study

Stroke is a leading cause of death and disability, especially in low-income and middle-income countries. We sought to quantify the importance of potentially modifiable risk factors for stroke in different regions of the world, and in key populations and primary pathological subtypes of stroke. We completed a standardised international case-control study in 32 countries in Asia, America, Europe, Australia, the Middle East, and Africa. Cases were patients with acute first stroke (within 5 days of symptom onset and 72 h of hospital admission). Controls were hospital-based or community-based individuals with no history of stroke, and were matched with cases, recruited in a 1:1 ratio, for age and sex. All participants completed a clinical assessment and were requested to provide blood and urine samples. Odds ratios (OR) and their population attributable risks (PARs) were calculated, with 99% confidence intervals. Between Jan 11, 2007, and Aug 8, 2015, 26 919 participants were recruited from 32 countries (13 447 cases [10 388 with ischaemic stroke and 3059 intracerebral haemorrhage] and 13 472 controls). Previous history of hypertension or blood pressure of 140/90 mm Hg or higher (OR 2·98, 99% CI 2·72-3·28; PAR 47·9%, 99% CI 45·1-50·6), regular physical activity (0·60, 0·52-0·70; 35·8%, 27·7-44·7), apolipoprotein (Apo)B/ApoA1 ratio (1·84, 1·65-2·06 for highest vs lowest tertile; 26·8%, 22·2-31·9 for top two tertiles vs lowest tertile), diet (0·60, 0·53-0·67 for highest vs lowest tertile of modified Alternative Healthy Eating Index [mAHEI]; 23·2%, 18·2-28·9 for lowest two tertiles vs highest tertile of mAHEI), waist-to-hip ratio (1·44, 1·27-1·64 for highest vs lowest tertile; 18·6%, 13·3-25·3 for top two tertiles vs lowest), psychosocial factors (2·20, 1·78-2·72; 17·4%, 13·1-22·6), current smoking (1·67, 1·49-1·87; 12·4%, 10·2-14·9), cardiac causes (3·17, 2·68-3·75; 9·1%, 8·0-10·2), alcohol consumption (2·09, 1·64-2·67 for high or heavy episodic intake vs never or former drinker; 5·8%, 3·4-9·7 for current alcohol drinker vs never or former drinker), and diabetes mellitus (1·16, 1·05-1·30; 3·9%, 1·9-7·6) were associated with all stroke. Collectively, these risk factors accounted for 90·7% of the PAR for all stroke worldwide (91·5% for ischaemic stroke, 87·1% for intracerebral haemorrhage), and were consistent across regions (ranging from 82·7% in Africa to 97·4% in southeast Asia), sex (90·6% in men and in women), and age groups (92·2% in patients aged ≤55 years, 90·0% in patients aged >55 years). We observed regional variations in the importance of individual risk factors, which were related to variations in the magnitude of ORs (rather than direction, which we observed for diet) and differences in prevalence of risk factors among regions. Hypertension was more associated with intracerebral haemorrhage than with ischaemic stroke, whereas current smoking, diabetes, apolipoproteins, and cardiac causes were more associated with ischaemic stroke (p<0·0001). Ten potentially modifiable risk factors are collectively associated with about 90% of the PAR of stroke in each major region of the world, among ethnic groups, in men and women, and in all ages. However, we found important regional variations in the relative importance of most individual risk factors for stroke, which could contribute to worldwide variations in frequency and case-mix of stroke. Our findings support developing both global and region-specific programmes to prevent stroke. Canadian Institutes of Health Research, Heart and Stroke Foundation of Canada, Canadian Stroke Network, Health Research Board Ireland, Swedish Research Council, Swedish Heart and Lung Foundation, The Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland (Sweden), AstraZeneca, Boehringer Ingelheim (Canada), Pfizer (Canada), MSD, Chest, Heart and Stroke Scotland, and The Stroke Association, with support from The UK Stroke Research Network.

LO078: The immigrant effect: a barrier to accessing primary and emergency department care - a Canadian population cross-sectional study

Introduction: In 2011, Canada had a foreign-born population of about 6,775,800 people. They represented 20.6% of the total population, the highest proportion among the G8 countries. Immigrants encounter significant barriers to accessing primary healthcare. This is thought to be due to lower education level, employment status and the healthy immigrant effect. Our objective was to assess in an immigrant population without a primary care physician, would similar socioeconomic barriers also prevent access to the emergency department. Methods: Data regarding individuals’ ≥12 years of age from the Canadian Community Health Survey, 2007 to 2008 were analyzed (N=134,073, response rate 93%). Our study population comprised 15,554 individuals identified without a primary care physician who used emergency department care. Socioeconomic variables included employment, health status, and education. Covariates included chronic health conditions, mobility, gender, age, and mental health. Prevalence estimates and confidence intervals for each variable were calculated. Weighted logistic regression models were constructed to evaluate the importance of individual risk factors and their interactions after adjustment for relevant covariates. Model parameters were estimated by the method of maximum likelihood. The Wald statistic was employed to test the significance of individual variables or interaction terms in relation to ED choice. Results: Our study population included 1,767 immigrants and 13,787 Canadian born respondents from across Canada without a primary care physician (57.3% male). Immigrants were less likely to use the emergency department then Canadian born respondents (Odds Ratio 0.4759 (95%CI 0.396-0.572). Adjusting for health, education or employment had no effect on this reduced access (Odds Ratio 0.468 (95%CI 0.378-0.579). Conclusion: In a Canadian population without a primary care physician, immigrants access the emergency department less then Canadian born respondents. However this effect is independent of previously reported social and economic barriers. Immigration status is an important but complex component of racial and ethnic disparity in access to care. Specific policy and system development targeting this at risk population are required to allow for equal access to healthcare.

Relative importance of risk factors for coronary heart disease – The Hordaland Homocysteine Study

Objectives. The aim was to rank coronary heart disease (CHD) risk factors according to their importance in predicting CHD morbidity and mortality using a scale-independent statistical approach. Design. We studied 15 515 community-dwelling adults in a population-based cohort established during 1992–93 in Western Norway. Participants were 40–42 and 65–67 years old at baseline and were followed through 2006. Endpoints were non-fatal/fatal acute myocardial infarction (AMI) and CHD death. Each factor was rank transformed and scaled to the range 0–5 before estimation of Cox models. Hazard ratios (HR) may thus be interpreted as HR per quintile increment for each factor, and the magnitude of the HR was used to rank the risk factors according to strength. Results. Total cholesterol and triglycerides were important risk factors for both CHD death and non-fatal/fatal AMI only in the middle-aged group. Risk factors were generally stronger in the middle-aged, except total homocysteine which was significantly associated with CHD death in the oldest group only. The only significant difference between men and women was found for single living which was an important risk factor for non-fatal/fatal AMI in middle-aged women but not in middle-aged men. Conclusions. We have demonstrated a simple method for direct and scale-independent comparison of the strength of both categorical and continuous risk factors. The importance of individual risk factors differed substantially between the two age groups.

Social support and risk-adjusted mortality in a frail older population.

The objective of this study was to test the hypothesis that social support is an important predictor of mortality in a frail older population receiving formal long-term care services. The analysis is based on 3138 individuals enrolled in 28 Programs of All-Inclusive Care for the Elderly (PACE). Information about the enrollees is obtained from dataPACE. Semiparametric Cox proportional hazards models are estimated to assess the importance of individual risk factors, program effect, and social support. The introduction of the social support variables into the mortality model containing the sociodemographic, health needs, and the PACE-site indicator variables results in a significant improvement of the overall model fit. Several social support variables are statistically significant predictors of mortality. Controlling for all participant and caregiver characteristics, participants whose caregiver is a spouse have a significantly lower risk of mortality (hazard ratio = 0.63) compared with those whose caregiver is not a spouse. Furthermore, caregivers' assistance with meals confers a significantly lower risk of morality (hazard ratio = 0.66) compared with no assistance with meals. This study shows that certain aspects of informal caregiving are important factors enhancing survival in a population of frail, nursing home-certifiable individuals enrolled in a health program that already provides extensive services, including personal care, chores, and meals. Further research to better differentiate between the affective versus the instrumental dimensions of social support is needed to guide programs on how to balance the use of resources to provide both the necessary formal services and the support for the informal caregivers.

Risk factors in acquired faecal incontinence

Acquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing. Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple). These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.

Risk Factors in Acquired Faecal Incontinence

Acquired faecal incontinence arising in the non-elderly population is a common and often devastating condition. We conducted a retrospective cohort analysis in 629 patients (475 female) referred to a tertiary centre, to determine the relative importance of individual risk factors in the development of faecal incontinence, as demonstrated by abnormal results on physiological testing. Potential risk factors were identified in all but 6% of patients (7 female, 32 male). In women, the principal risk factor was childbirth (91%), and in most cases at least one vaginal delivery had met with complications such as perineal injury or the need for forceps delivery. Of the males, half had undergone anal surgery and this was the only identified risk factor in 59%. In many instances, assignment of cause was hampered by a long interval between the supposed precipitating event and the development of symptoms. Abnormalities of anorectal physiology were identified in 76% of males and 96% of females (in whom they were more commonly multiple). These findings add to evidence that occult damage to the continence mechanism, especially through vaginal delivery and anal surgery, can result in subsequent faecal incontinence, sometimes after an interval of many years.

Diabetes and other coronary heart disease risk equivalents

The close association between diabetes and cardiovascular disease suggests that current predictions of a massive increase in the prevalence of type 2 diabetes foreshadow an equally daunting rise in the incidence of vascular disease. The limited cardiovascular benefits obtained by glucose-lowering treatments, although perhaps not surprising, indicate that other cardiovascular risk factors must be given serious consideration as therapeutic targets. The impressive reductions in the number of vascular events observed in diabetic patients, albeit in small patient populations, participating in various drug trials amply justify such an approach. A necessary prerequisite, however, is a clear understanding of the clinical importance of individual risk factors to the occurrence of vascular disease in type 2 diabetic patients. This would appear essential for defining treatment strategies in the face of a bewildering array of potential therapeutic targets. The present review considers recent studies that have assessed the predictive value of risk factors against a diabetic background.

Spinal troubles in sewage workers: epidemiological data and work disability due to low back pain.

To determine the prevalence of spinal troubles (i.e., neck, upper back and low back pain) in a population of sewage workers, and to establish the effect of sociodemographic, work-related, physical, and psychosocial factors on the reported work disability due to low back pain (LBP) during the previous 12 months. Data from 255 sewage workers were obtained by standardized questionnaire, structured interview, and standardized physical examination. Data on the prevalence of neck, upper back and low back pain were obtained with the use of the Nordic Questionnaire. The level of disability was assessed from a modified Low-Back Outcome Scale. Work history included physical factors and job perception based on a modified Work APGAR Score. Other questionnaires recorded the psychosocial aspects of the work environment. In addition, we compared the risk factors between sewage workers who had been prevented from doing their normal work, at any time during the preceding 12 months, as a result of LBP (n = 92), and those without any history of work disability during the previous 12 months (n = 157). The 12-month prevalence rates of neck, upper back and low back pain were 52.4%, 54.8%, and 72.8%, respectively. The prevalence of spinal troubles increased with age. Work disability during the preceding 12 months due to LBP was significantly positively associated with age, disability, the weekly duration of stooping and lifting 5 years previously and higher abnormal illness-behavior scores (odds ratio between 1.26 and 0.94). Moreover, when adjusted for age, the results showed that the subjects in the work disability group were more likely to report higher pain intensities, decreased participation in sports activities, higher levels of physical impairment, the belief that their LBP was related to the physical demands of their job, and a lack of drive (P < 0.05). This study revealed a high incidence of spinal troubles among sewage workers. In a multidisciplinary approach, we demonstrated that not one factor alone but a combination of sociodemographic, work-related and psychosocial factors have shown associations with work disabilities due to LBP. Additional studies evaluating the relative importance of individual risk factors are warranted.

Public perceptions and self-reported prevalence of osteoporosis in South Australia.

The self-reported prevalence of, and attitudes to and perceptions of, osteoporosis in the South Australian community were assessed using data collected as part of the 1995 South Australian Health Omnibus Survey (household interviews)--a clustered, self-weighting, multistage sample of households in metropolitan and country centers. The self-reported prevalence was 4.8 (95% CI: 3.7-5.8) and 1.4% (95% CI: 0.8-2.0) for women (n = 1531) and men (n = 1485) respectively. For individuals with osteoporosis, calcium was the favored treatment (52%), while 33% of women were on hormone replacement therapy. An appropriate definition of osteoporosis was given by 62% of women and 37% of men. The main risk factors were reported as lack of calcium and age. There was a significant association between knowledge of the definition of osteoporosis and identification of correct risk factors. A high perceived risk of osteoporosis was reported in 23% of women and 7% of men. Osteoporosis risk was assessed as higher in those who did not adopt recognized prevention measures. Perception of risk was not related to the individual's own risk factors. Self-reported prevalence of osteoporosis significantly underestimates the likely true prevalence and general awareness and knowledge is much lower for men than women. The importance of individual risk factors for osteoporosis are not understood by the general community.

Do Physicians' Beliefs About Coronary Risk Factors Account for Poor Screening and Treatment Rates?

The authors hypothesized that the widely observed low rates of coronary risk factor screening and treatment among cardiologists could be due to lack of belief in the importance of risk factors. They performed an audit of 160 randomly selected medical records of patients with coronary artery disease and surveyed the attending physicians' ranking of importance of individual risk factors to determine the extent of risk factor screening and treatment done by these physicians. Screening and treatment rates for individual risk factors were highly variable but generally well below expected. There was no correlation among rank orders of screening rates, treatment rates, and physician-rated importance of each risk factor. These results suggest that lack of belief in risk factor importance does not explain failure of physicians to screen for and treat risk factors in coronary patients.