Influence Of Potential Risk Factors Research Articles

Empirische Validierung eines Modells zur Ätiologie gestörten Essverhaltens bei jugendlichen Mädchen: Welche Rolle spielen die Ergebnisse von Körpervergleichen?

Aim of this study was the empirical validation of an etiologic model on disturbed eating behavior by means of structural equation modeling. The model under consideration by Schutz and colleagues explains the influence of potential risk factors, especially body comparisons, on disturbed eating. 136 female sixth graders from secondary schools in Thuringia filled out questionnaires on their eating behavior, on the variables stated in the model and on the subjective meaning of their body weight. The model is supported by our data analyses. Particularly BMI and self esteem have a strong influence on body comparisons. The impact of body comparisons on disturbed eating is mediated by body dissatisfaction. An important addition to the model can be seen in the inclusion of the subjective effect of body comparisons into the model which has been neglected in research so far.

Amniotic fluid embolism-risk factors, maternal and neonatal outcomes

Objective. To investigate demographic characteristics, risk factors, maternal and neonatal outcomes of all cases of amniotic fluid embolism that occurred in New Jersey during 1997–2005.Methods. Information was derived from a perinatal linked dataset provided by the MCH-Epidemiology Program in the New Jersey Department of Health. Bivariate analysis for dichotomous variables used the Chi-square test. Stepwise logistic regression models were created to assess the influence of potential risk factors and p value < 0.05 considered statistically significant.Results. Forty-five cases of amniotic fluid embolism were identified among 1,004,116 deliveries, for a prevalence rate of 1 in 22,313 pregnancies. Statistically, significant association was found with multifetal pregnancy, caesarean section, placenta previa, placental abruption, eclampsia and cervical laceration. The rate of maternal complications such as coagulopathy, seizures, neurological damage, shock and cardiac arrest were significantly greater in the cases as compared with the overall study population. Neonatal morbidity was significant as demonstrated by higher NICU admissions and neonatal intubation rates and lower 5-min Apgar scores.Conclusions. Significant correlation was identified between historically reported risk factors and amniotic fluid embolism. The fetal and maternal mortality rates were lower compared with previous studies, attributed both to improvements in perinatal healthcare and reporting of ‘milder’ cases.

Asthma, lung function and sensitization in school children with a history of bronchiolitis

The purpose of the present retrospective study was to investigate the association of school-age asthma with acute-bronchiolitis and examine the influence of potential risk factors. One hundred and eighty-nine children aged 7.5 +/- 2.2 years consecutively hospitalized for respiratory syncytial virus (RSV)-positive acute bronchiolitis during infancy were evaluated by clinical examination and measurement of peak expiratory flow (PEFR), spirometry, IgE and skin-prick testing. Their pulmonary function was compared with that of 60 non-asthmatic matched controls. Of the entire cohort 57.1% were diagnosed as asthmatic. PEFR, the 1-second forced expiratory volume and forced expiratory flow of 50% vital capacity of children with a history of acute bronchiolitis were statistically significantly lower than in the control group (all P < 0.001). All the aforementioned measurements of children with/without asthma were also significantly lower than controls, while values of asthmatics were significantly lower than those of non-asthmatics. The incidence of asthma in childhood was independently associated with breast-feeding <3 months (adjusted odds ratio [aOR], 8.4; 95% confidence interval [CI]: 3.1-22.4), at least one positive skin prick test (aOR, 7.1; 95%CI: 2.8-18.1), male gender (aOR, 5.0; 95%CI: 2.2-11.5), evidence of moisture in the home environment (aOR, 2.9; 95%CI: 1.3-6.3) and presence of more than one house-resident smoking indoors (aOR, 4.9; 95%CI: 1.8-9.2). Children with a history of RSV-bronchiolitis during infancy have an increased risk for developing asthma in childhood, which was independently associated with male gender, breast-feeding <3 months, living in a home environment with moisture damage and/or tobacco smoke by two or more residents and sensitization to at least one aeroallergen. Children with a history of RSV bronchiolitis in infancy had lower spirometry in comparison to matched control group. The difference was more marked for asthmatic ones but remained significant even for non-asthmatic children.

Desmoid Tumors in a Dutch Cohort of Patients With Familial Adenomatous Polyposis

Desmoid tumors are a severe extracolonic manifestation in familial adenomatous polyposis (FAP). Identification of risk factors might be helpful in the management of FAP patients with such tumors. The aim of this study was to assess potential risk factors for the development of desmoids in a cohort of Dutch FAP patients. The medical records of 735 FAP patients were analyzed for the occurrence of desmoids. Relative risks and survival times were calculated to assess the influence of potential risk factors (female sex, family history, mutation site, abdominal surgery, and pregnancy) on desmoid development. Desmoid tumors were identified in 66 of the 735 patients (9%). The cumulative risk of developing desmoids was 14%. No correlation was found between specific adenomatous polyposis coli mutation sites and desmoid development. Patients with a positive family history for desmoids had a significant increased risk to develop this tumor (30% vs 6.7%, P < .001). No association was found between female sex or pregnancy and desmoid development. Most desmoid patients (95%) had undergone previous abdominal surgery. In a substantial proportion of patients with an ileorectal anastomosis, it was impossible to convert the ileorectal anastomosis to an ileal pouch-anal anastomosis as a result of desmoid development. A positive family history of desmoids is an evident risk factor for developing desmoids. Most desmoids develop after colectomy. No correlation was found between desmoids and the adenomatous polyposis coli gene mutation site, female sex, and pregnancy. Ileal pouch-anal anastomosis is the appropriate type of surgery in FAP patients with a positive family history for desmoids.

Incidence and predictors of severe bleeding during warfarin treatment

Optimal warfarin prescription requires correct, individualized assessment of the warfarin-related bleeding risk, which randomised controlled trials may underestimate . Observational studies have reported a range of bleeding risks that differ 40-fold. This variation may be caused by time trends, variation in bleeding definition and study subject selection. We investigated the incidence of, and risk factors for severe bleeding in un-selected warfarin-treated patients from Sweden. Between 2001 and 2005, 40 centres recruited warfarin-naïve patients commencing warfarin therapy and followed them prospectively with continuous registration of clinical data. The primary outcome was severe bleeding, according to the WHO universal definition of severe adverse drug reactions. The influence of potential risk factors was investigated by means of a Cox proportional-hazards model. A total of 1523 patients contributed 1276 warfarin-exposed patient-years. The incidence of first-time severe bleeding was 2.3 per 100 patient-years (95% confidence interval 1.4 to 3.1). Male sex and use of drugs potentially interacting with warfarin were the only independent risk factors of severe bleeding, with hazard ratios of 2.8 and 2.3, respectively. Age, target International Normalized Ratio (INR), time spent outside target INR range, and warfarin dose requirement were not significantly associated with bleeding risk. The risk of severe bleeding in a large naturalistic, prospective cohort of first-time warfarin users was lower than reported in some previous reports. Male gender was an independent predictor of severe bleeding as was the receipt of warfarin-interacting medications at the onset of anticoagulation therapy. Further studies are required to evaluate the effect these findings may have on the quality of current risk-benefit analysis involved in warfarin prescription.

Long-term Clinical Evaluation of Tapered Multi-threaded Implants: Results and Influences of Potential Risk Factors

This prospective study evaluated the long-term performance of tapered screw implants placed in patients with a variety of potentially compromising clinical variables. Sixty patients were treated with 218 implants; each case included one or more potential risk factors associated with increased rates of implant failure, peri-implant bone loss or clinical complications in the dental literature: short implants (23%), comorbid conditions (25%), maxillary implants (61%), immediate loading (88.5%), placement into extraction sockets (91%), and partial edentulism (97%). The implants were restored with a variety of prostheses. Marginal bone changes were calculated utilizing periapical radiographs taken at placement and at all subsequent appointments utilizing a standardized paralleling device and a 1-mm measurement grid. Mean clinical follow-up was 67.5 (range: 1-94) months for implants and 60 (range: 15-74) months for prostheses. Four implants failed to integrate and were immediately replaced by wide-diameter implants. Eight prostheses sustained porcelain fracture (n = 7) or cement failure (n = 1) and were replaced. No peri-implant marginal bone loss was observed for 98% of the implants; the remaining 2% exhibited 1 mm of bone loss. Cumulative survival rates were 98.2% for implants and 96.3% for prostheses after 5 years of clinical loading. Concerns that tapered implant designs may be more prone to crestal bone loss than cylinder designs are unsupported by the results of this study. Tapered implants maintained integration and marginal bone levels despite the presence of one or more potentially compromising variables.

Frequency and risk factors of severe hypoglycaemia in insulin‐treated Type 2 diabetes: a cross‐sectional survey

The reported risk of severe hypoglycaemia in insulin-treated Type 2 diabetes is highly variable and few studies have evaluated the influence of risk factors. We assessed the incidence and the influence of potential risk factors for severe hypoglycaemia in a questionnaire survey in subjects with insulin-treated Type 2 diabetes receiving currently recommended multifactorial intervention. Consecutive patients with insulin-treated Type 2 diabetes (n = 401) completed a questionnaire about occurrence of hypoglycaemia in the past, hypoglycaemia awareness and socio-demographic factors. A zero-inflated negative binomial model was used to assess the influence of potential risk factors on the rate of severe hypoglycaemia. The overall incidence of severe hypoglycaemia in the preceding year was 0.44 episodes/person year. Sixty-six (16.5%) patients had experienced at least one event. The risk of any episode of severe hypoglycaemia positively correlated with impaired hypoglycaemia awareness, being married and long duration of diabetes. The risk of repeated episodes of severe hypoglycaemia positively correlated with the presence of peripheral neuropathy, while long duration of diabetes prior to insulin treatment and treatment with angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor antagonists (ARBs) were associated with reduced risk. C-peptide concentration and HbA1c were not associated with the risk of severe hypoglycaemia. In this cohort of insulin-treated Type 2 diabetic patients, the incidence of severe hypoglycaemia is higher than reported in most studies, corresponding to about one-third of that in Type 1 diabetes. Impaired hypoglycaemia awareness is the most important risk factor for severe hypoglycaemia.

Risk stratification in acute coronary syndromes—does the TIMI risk score work in unselected cases?

Management of patients with an acute coronary syndrome (ACS) requires accurate risk stratification to guide appropriate therapy. To assess the utility of the TIMI risk score in stratifying patients with possible ACS in routine clinical practice. Prospective observational study. We recruited 869 consecutive patients with a diagnosis of possible ACS attending the acute medical receiving unit of a district general hospital. The main outcome measures were recurrent myocardial infarction, urgent revascularization, and all-cause mortality. TIMI risk score was calculated for each patient, and each was also assigned a risk group based on electrocardiogram (ECG) changes and troponin levels only. After follow-up, Cox univariate and multivariate regression was used to evaluate the influence of potential risk factors on duration of event-free survival, and likelihood ratio tests to assess the fit of the models. Increasing TIMI risk score was associated with increased risk of events (p<0.001), as was higher risk group from ECG plus troponin stratification (p<0.001). The likelihood ratio comparison favoured the TIMI risk score (difference 13.910, 5 degrees of freedom, p = 0.016). The TIMI risk score is a valid tool for risk stratification in unselected cases with possible acute coronary syndrome. It is superior to ECG changes and troponin alone, although this simpler method also achieves good risk stratification.

Emergency endovascular treatment for ruptured abdominal aortic aneurysm and the risk of spinal cord ischemia

Spinal cord ischemia is a rare complication after open surgical repair for ruptured abdominal aortic aneurysms (rAAA). The use of emergency endovascular aortic aneurysm repair (eEVAR) is increasing, and paraplegia has been observed in a few patients. The objective of this study was to assess the incidence and pathogenesis of spinal cord ischemia after eEVAR in greater detail. This was a retrospective analysis of patients who had eEVAR for rAAA in three hospitals in The Netherlands and Belgium during a 3-year study period that ended in February 2004. The use of aortouniiliac devices combined with a femorofemoral crossover bypass was the preferred technique. Patients with postoperative symptoms of spinal cord ischemia were identified and the influence of potential risk factors was assessed. These factors included the presence of common iliac artery aneurysms necessitating device limb extension to the external iliac artery with associated overlapping the hypogastric artery, the prolonged interruption of bilateral hypogastric artery arterial inflow during the procedure (defined "functional aortic occlusion time" >30 minutes), and the occurrence of preoperative hemodynamic shock. Thirty-five patients were treated by EVAR and they constituted the study group. The first-month mortality in the study group with EVAR was 23%. Four patients (11.5%) with EVAR developed paraplegia postoperatively; the unilateral or bilateral hypogastric artery in all four patients became occluded during the procedure. In the other 31 patients who did not have paraplegia, the unilateral or bilateral hypogastric arteries became occluded in 14 patients (45%). This constituted a significant difference in the prevalence of hypogastric artery occlusion in patients with or without paraplegia (P = .04). The functional aortic occlusion time was prolonged in all four patients with paraplegia and in five without spinal cord ischemia (P = .0003). All four patients with spinal cord ischemia presented with hemodynamic shock. This factor did not reach a significant difference from nonparaplegic patients. Emergency EVAR continues to be a promising approach to reduce the high mortality of rAAA, but the incidence of spinal cord ischemia after endovascular treatment of rAAA was worrisome. Although the pathogenesis is most likely multifactorial, interruption of the hypogastric artery inflow appeared to have significant influence. In patients with aneurysmatic common iliac arteries, any effort should be made to minimize hypogastric occlusion time during the procedure and to maintain hypogastric artery inflow afterwards, either by the use of a bell-bottom iliac extension or by electing open repair.

Incidence, risk factors, and heritability estimates of hind limb lameness caused by hip dysplasia in a birth cohort of Boxers

To determine incidence, risk factors, and heritability estimates of hind limb lameness caused by hip dysplasia in a birth cohort of Boxers. 1733 Boxers from 325 litters. Status of Boxers with respect to clinical signs of canine hip dysplasia (cCHD) was registered during an 8-year period. Survival analysis accounted for dogs lost to follow-up. Effective heritability for developing cCHD was estimated by use of a proportional hazard model on the basis of the Weibull distribution. Parametric survival models were developed to identify the influence of potential risk factors. Cumulative hazard rate for cCHD from 7 weeks to 8 years of age was 8.5%. Dogs that were kept on a floor covered with a slippery material were 1.6 times as likely to develop cCHD, compared with dogs kept on a nonslippery floor. Risk of cCHD doubled in dogs from litters with a high preweaning mortality rate. Dogs that were neutered at 6 months prior to a diagnosis of CHD were 1.5 times as likely to develop cCHD, compared with sexually intact dogs. Dogs >5 years of age were 1.8 times as likely to develop cCHD, compared with younger dogs. Estimated effective heritability of cCHD was 0.11. In terms of the risk of cCHD in progeny, mean estimated breeding value (EBV) of the 10 best and 10 worst sires was -0.32 and 0.42, respectively. Registration of Boxers that develop cCHD may provide a strategy for disease prevention. In addition to diagnostic evaluation of radiographs, sire EBVs provide useful information for breeding selection decisions.

Second transplant for acute and chronic leukemia relapsing after first HLA-identical sibling transplant.

Treatment options for persons with leukemia relapsing after allogeneic transplantation are limited. We analyzed the outcome of 279 patients with acute and chronic leukemia, who relapsed after HLA-identical sibling transplantation and received a second allogeneic transplant. The influence of potential risk factors on treatment-related mortality (TRM), relapse, treatment failure (relapse or death) and overall survival after second transplantation were assessed using proportional-hazards regression. The cumulative incidences (95% confidence interval) of relapse and TRM at 5 years were 42 (36-48)% and 30 (24-36)%, respectively. The 5-year probabilities of both overall and leukemia-free survival were 28 (23-34)%. In multivariate analyses, risks of treatment failure and mortality were lower in younger patients (< or =20 years) and patients who relapsed after 6 months from first transplantation. Risks of relapse were lower in patients who relapsed after 6 months from first transplantation and in complete remission prior to second transplantation. Risks of relapse were higher after reduced-intensity conditioning regimens. Any potential advantage of using a different matched related donor for a second transplantation is not supported by these data. Although age, disease status and conditioning regimen are important, duration of remission after first transplantation appear to be the most important determinant of outcome.

New occurrence and recurrence of neoplasms within 5 years of a screening colonoscopy.

The fear that colorectal adenomas were missed on initial colonoscopy or that new adenomas have developed is often a rationale for repeating a colonoscopic examination. The aim of this study was to delineate risk factors associated with recurrence of colorectal adenomas after an initial baseline screening colonoscopy. The study population comprised 875 subjects who underwent a baseline screening colonoscopy followed by a second examination 1-5 yr later. Multiple logistic regression was used to assess the influence of potential risk factors on the occurrence or recurrence of colorectal adenomas, the strength of the influence being expressed as an OR with a 95% CI. Colorectal adenomas were detected in 484 of all patients (55%) at baseline colonoscopy. Within a 1- to 5-yr time interval, 181 patients (37%) had recurrent adenomas (adenomas were removed during the first colonoscopy) and 73 patients (19%) had newly developed adenomas (adenomas were absent on the first colonoscopy). The occurrence of adenomas at baseline screening colonoscopy was the only factor associated with an increased risk for the recurrence of adenomas at follow-up (OR = 2.51, 95% CI = 1.77-3.55). Recurrence was associated with multiple baseline adenomas (4.45, 2.98-6.64) and baseline adenomas larger than 1 cm (2.62, 1.99-3.11). Recurrence was not associated with histology type or family history of colorectal cancer. There was a significant trend for adenomas to recur in the same proximal or distal segment as the baseline adenomas (p = 0.02). Colon adenomas tend to recur with greater frequency if the adenomas removed at baseline were either large or multiple. Although patients with large adenomas or multiple adenomas at baseline screening colonoscopy are at a 2.6- to 4.5-fold risk for recurrence of adenomas, the rate of de novo adenoma formation in patients without baseline adenomas may be large enough to warrant repeat colonoscopy at some time in the future. The exact timing of the follow-up colonoscopy needs to be determined.

New occurrence and recurrence of neoplasms within 5 years of a screening colonoscopy

OBJECTIVE: The fear that colorectal adenomas were missed on initial colonoscopy or that new adenomas have developed is often a rationale for repeating a colonoscopic examination. The aim of this study was to delineate risk factors associated with recurrence of colorectal adenomas after an initial baseline screening colonoscopy. METHODS: The study population comprised 875 subjects who underwent a baseline screening colonoscopy followed by a second examination 1–5 yr later. Multiple logistic regression was used to assess the influence of potential risk factors on the occurrence or recurrence of colorectal adenomas, the strength of the influence being expressed as an OR with a 95% CI. RESULTS: Colorectal adenomas were detected in 484 of all patients (55%) at baseline colonoscopy. Within a 1- to 5-yr time interval, 181 patients (37%) had recurrent adenomas (adenomas were removed during the first colonoscopy) and 73 patients (19%) had newly developed adenomas (adenomas were absent on the first colonoscopy). The occurrence of adenomas at baseline screening colonoscopy was the only factor associated with an increased risk for the recurrence of adenomas at follow-up (OR = 2.51, 95% CI = 1.77–3.55). Recurrence was associated with multiple baseline adenomas (4.45, 2.98–6.64) and baseline adenomas larger than 1 cm (2.62, 1.99–3.11). Recurrence was not associated with histology type or family history of colorectal cancer. There was a significant trend for adenomas to recur in the same proximal or distal segment as the baseline adenomas ( p = 0.02). CONCLUSIONS: Colon adenomas tend to recur with greater frequency if the adenomas removed at baseline were either large or multiple. Although patients with large adenomas or multiple adenomas at baseline screening colonoscopy are at a 2.6- to 4.5-fold risk for recurrence of adenomas, the rate of de novo adenoma formation in patients without baseline adenomas may be large enough to warrant repeat colonoscopy at some time in the future. The exact timing of the follow-up colonoscopy needs to be determined.

Heart involvement and HIV infection in African patients: Determinants of survival

In Africa, recent studies have reported that HIV may exhibit a cardiac tropism. The purpose of this study was to determine if clinical features, sex, age at onset, biological or echocardiographic variables have any influence on survival of African HIV-infected patients and AIDS progression. One hundred and fifty seven consecutive HIV-seropositive patients without cardiac lesions and no other AIDS-defining illnesses underwent physical, electrocardiographic and Doppler echocardiographic examinations at the Heart of Africa Cardiovascular Centre, Lomo Medical, Kinshasa, Congo, between July 1987 and July 1994. Odds ratios were calculated to assess the influence of potential risk factors on cardiac lesions, opportunistic diseases, and death outcomes. Cardiac lesions had occurred in 87 patients (55%) during 7-year follow up. The onset of heart involvement was associated with a protection against opportunistic comorbidity. In multiple regression model, cardiac mass/volume ratio, body temperature, deceleration time, body mass index and socio-economic status were each independently associated with AIDS outcome. In a multivariate analysis the lowest socioeconomic status and the pericardial effusion were the independent predictors of death. The higher CD4 count and cardiac lesions outcome were connected with slower progression to AIDS. Dilated cardiomyopathy was associated with longer survival.

Risk assessment in determining systemic reactivity to honeybee stings in beekeepers.

The use of laboratory tests as a reliable method for risk assessment in determining the systemic reactivity of beekeepers to honeybee stings has proven unsatisfactory. This study was conducted to evaluate the usefulness of a structured questionnaire as a supplement to bee venom-specific IgE data in the prediction of systemic sting reactions of 78 beekeepers to honeybee stings. Participants in previous studies completed a questionnaire concerning potential risk factors of systemic sting reactions. Serum bee venom IgE was measured by CAP-RAST. Skin prick tests were performed with standardized bee venom extracts prior to the beekeeping season. Venom challenges were performed using unintentional field stings. A new questionnaire concerning sting reactions during the recent beekeeping season was sent to the beekeepers after it had ended. A multiple logistic regression analysis was done to evaluate the influence of potential risk factors upon systemic bee sting reactions. Four variables were significant. The pre-season presence of serum bee venom-specific IgE at concentrations exceeding 1.0 kU/L increased the risk of systemic reactions 12-fold. The risk was 10-fold if nasal or respiratory symptoms had occurred while working at hives. When the years spent in beekeeping were fewer than eight the risk of systemic sting reaction was 9-fold, any previous systemic reaction increased the risk 8-fold. The use of more detailed patient histories in combination with laboratory tests may markedly improve the reliability of risk assessment.

Epidermal dysplasia and neoplasia in kidney transplant recipients

Background: Established data confirm an increased incidence of skin cancer, mainly squamous cell carcinoma (SCC), in long-term kidney transplant recipients (KTRs). Objective: Our purpose was to investigate prospectively the type and frequency of neoplastic and preneoplastic skin lesions in KTRs during the first 3 years of immunosuppression, as well as the influence of potential risk factors. Methods: Eighty-one consecutive KTRs were examined every 6 months during the first 3 years after transplantation. All survival analyses were performed with the EGRET statistical software package. Results: After a median follow-up of 34 months, 25 skin cancers developed in 12 patients; the basal cell carcinoma (BCC) SCC ratio was 3.1:1. The cumulative risk of skin cancer developing after 3 years of graft survival was 18.1%. Only age at the time of transplantation ( p = 0.005) and occupational sun exposure ( p = 0.048) had statistical significance as risk factors. Conclusion: In carefully supervised KTRs, a high incidence of cutaneous malignancy, mainly BCC, exists in the early posttransplant period. Sun exposure and the patient's age at the time of transplantation seem to be the most important risk factors.

Risk factors for benign breast disease: a case-control study of discordant twins.

The influences of potential risk factors for benign breast disease were assessed using women twins in a matched pair design. Two groups of cases from the Kaiser-Permanente Twin Registry were considered: 1) 90 pairs of female twins in which one twin reported a history of benign breast disease confirmed by biopsy and her twin reported no history of benign breast disease, and 2) 48 pairs of female twins in which the case had clinically diagnosed fibrocystic benign breast disease and her twin was free of disease at examination and reported no history of the disease. Results were similar in these two samples. A significant positive association was found between benign breast disease and coffee consumption. Oral contraceptive use and greater body mass were inversely associated with benign breast disease after controlling for possible confounding variables by matched-pairs multiple logistic analysis. All associations were stronger for monozygotic than for dizygotic pairs. Twin pairs discordant for disease provide an excellent sample in which to assess the importance of potential risk factors while controlling for early environmental and genetic backgrounds.