Magnitude Of Risk Factors Research Articles

Community-based intervention for prevention and management of chronic obstructive pulmonary disease in Nepal (COBIN-P trial): study protocol for a cluster-randomized controlled trial

BackgroundChronic obstructive pulmonary disease (COPD) is one of the leading causes of death worldwide and the commonest of non-communicable diseases (NCDs) in Nepal. Risk factors like indoor and outdoor air pollution, a high prevalence of smoking, and the lack of awareness of COPD make it a serious public health concern. However, no attempt has been made in Nepal to estimate its burden and address the disease at the community level.MethodThis study aims to evaluate the effect of a community-based health educational intervention administered by Female Community Health Volunteers (FCHVs) on the prevention and management of COPD. An open-label, two-group, community-based, cluster-randomized controlled trial will be implemented in the semi-urban area of Pokhara Metropolitan city (former Lekhnath Municipality) located in the Kaski district of Nepal. The estimated sample size of the intervention will be 1143. The unit of randomization is the ward (administrative unit) of the study area. The follow-up survey will be conducted immediately after 12 months of FCHVs-led interventions. The difference in the rate of decline of forced expiratory volume in 1 s (FEV1) and FEV1/FVC (forced vital capacity) ratio are the primary outcomes and the change in the proportion of modifiable risk factors of COPD, health-related quality of life scores, and change in knowledge of COPD will be secondary outcomes.DiscussionThis study will estimate the burden of COPD, the magnitude of risk factors and generate evidence to mobilize community health workers for COPD prevention and management at the community level in Nepal.Trial registrationClinicalTrials.gov NCT03797768. Registered on January 9, 2019.

RISK FACTORS IN PULMONARY TUBERCULOSIS TREATMENT FAILURE

Pulmonary tuberculosis (TB) is a global health problem and has become the leading cause of death. Tuberculosis eradication is inhibited due to the tendency of patients to not complete the TB treatment. The purpose of this study was to determine the relationship between knowledge, nutritional status, oral medication adherence, and family support as risk factors for pulmonary tuberculosis treatment failure. The design of this study is that of case-control, and this study involved samples of pulmonary TB patients who were declared not cured after treatment (14 people), and control samples of pulmonary TB patients who were declared cured (28 people). The data were obtained through measurements of nutritional status and interviews, while treatment failure was based on data from the TB 01 form. Data was analysed using univariable and bivariable analyses, and the magnitude of risk factors was based on the odds ratio (OR) and 95% confidence interval (CI). The results showed that the factors associated with failure of pulmonary TB treatment are knowledge (p = 0.022; OR = 6.6; 95% CI = 1.48 - 29.36), nutritional status (p = 0.005; OR = 9.16; 95% CI = 2.11 - 39.85), and medication adherence (p = 0.003; OR =11.0; 95% CI = 2.37 - 54.14), whereas the unrelated factor is family support (p = 0.47). It is recommended to provide counselling, nutritional guidance, medication assistance, and family support to patients during the treatment period for pulmonary tuberculosis. Keywords: treatment failure, knowledge, nutritional status, compliance

RELATIONSHIP BETWEEN CHILD NUTRITION STATUS, FATHER'S LAST EDUCATION LEVEL ANDMOTHER'S LAST EDUCATION LEVEL WITH STUDENT LEARNING OUTCOMES SDN PLOSOREJO 1 PLOSOREJO VILLAGE RANDUBLATUNG BLORA REGENCY

The problems studied in this study are how respondents describe based on the nutritional status of the child, the last level of education of the father, the last level of education of the mother, and the student's learning outcomes, whether there is a relationship between the child's nutritional status, the father's last level of education, and the mother's last level of education with student learning outcomes. The purpose of this study was to find out the respondent's picture based on the child's nutritional status, the father's last level of education, the mother's last level of education, the mother's last level of education, the mother's final education level, the student's learning outcome, and the relationship between the child's nutritional status, the father's last level of education, and the mother's last level of education with the student's learning outcomes. This type of research is an analytic survey with a case control design. The population is all elementary school students in grades 4, 5 and 6 who are in Plosorejo I Elementary School, a total of 85 children. The sample was 62, consisting of 31 case groups and 31 control groups. Sampling technique with restrictions. The instruments used in this study are stepped on scales (seca), microtoise, class list books, student raport books. Bivariate analysis with Chi Square statistical test and to find out the magnitude of risk factors used Odds Ratio analysis. The results stated that the nutritional status (BB /TB) of students in grades 4, 5, and 6 of Plosorejo I elementary school was mostly normal, in the case group by 87.1% and the control group by 61.2%, the nutritional status (TB/U) was mostly normal, in the case group by 74.2% and the control group by 67.8%, the father's last education level was mostly elementary school, in the case group by 25.8% and the control group by 38.8%, and the last level of education of the mother partly also graduated from elementary school, in the case group by 35.4% and in the control group by 42%. From the results of statistical tests showed that there was a significant relationship between nutritional status (BB/TB) and learning outcomes (p value=0.040 and OR=4,623), there was no significant association between nutritional status (TB/U) and student learning outcomes (p value=0.780 and OR=1,369), no relationship of father's last education level with student learning outcomes (p value=0.786 and OR=0.744), and there was no significant association between the mother's last level of education and the student's learning outcomes (p value=0.057 and OR=0.291). The conclusion that can be taken is that there is a significant relationship between nutritional status (BB / TB) with learning outcomes, no significant association between nutritional status (TB / U) with student learning outcomes, no relationship of paternal education level with student learning outcomes, and no significant relationship between maternal education level and student learning outcomes.

Magnitude of risk factors and in-hospital mortality of stroke in Ethiopia: a systematic review and meta-analysis

BackgroundThe morbidity and mortality of stroke is disproportionately high in developing countries owing to the poor health care system and poor neurologic interventions. Though a number of studies were conducted to estimate the in-hospital mortality rate of stroke in Ethiopia, the lack of a nationwide study that determines the overall magnitude of risk factors and in-hospital mortality rate of stroke is an important research gap. Meta-analysis is key to improve the accuracy of estimates through the use of more data sets. Thus, this study was aimed to determine the overall magnitude of risk factors and in-hospital mortality rate of stroke in Ethiopia.MethodsThis study was conducted following the PRISMA checklist. We searched from Google Scholar, PubMed, Science Direct, Web of Science, CINAHL, and Cochrane Library databases for studies. Each of the original studies was assessed using a tool for the risk of bias adapted for cross-sectional studies. Data were pooled and a random effect meta-analysis model was fitted to provide the overall magnitude of risk factors and in-hospital mortality rate of stroke. Also, the subgroup analyses were performed to examine how the in-hospital mortality rate varies across different groups of studies.ResultsIn this study, the overall magnitude of hypertension, diabetes mellitus, and atrial fibrillation among stroke patients were 47% (95%CI: 40–54), 8% (95CI%:6–12), and 10% (95%CI: 5–19), respectively. The overall in-hospital mortality of stroke in Ethiopia was 18% (95%:14–22). The highest magnitude of in-hospital mortality of stroke was observed in SNNPR and the lowest was noted in Tigray region. In addition, the magnitude of the in-hospital mortality rate of stroke was 15.1% (95%CI: 11.3–19.4), and 19.6%(95%CI: 14.1–25.7), among studies published before and after 2016, respectively.ConclusionsOur pooled result showed that nearly one-fifth of stroke patients have died during hospitalization. The most common risk factor of stroke among the included studies was hypertension followed by atrial fibrillation and diabetes mellitus. There is a need for a better understanding of the factors associated with high blood pressure, especially in countries with a high risk of stroke.

ARE THERE SIDE-TO-SIDE DIFFERENCES IN KNEE MORPHOLOGY IN PATIENTS WITH BILATERAL PATELLAR INSTABILITY

Introduction It is not known if there are side-to-side differences in knee morphology in patients with bilateral patellar instability (BPI). Such knowledge would help to answer the question whether similar treatment and prognosis could be expected for both knees in patients with BPI. The purpose of our study was to evaluate and compare anatomic / morphologic risk factors between knees in patients with BPI. Materials and Methods Of 294 patients who underwent surgical stabilization for patellar instability (2008-2017), 32 patients were identified who underwent staged or simultaneous bilateral surgery. This formed the study cohort. Demographic data, mechanism of initial injury and first knee side to be symptomatic were recorded. Radiographs and MRI of these 64 knees were evaluated for trochlear dysplasia (trochlear depth), patellar height (Caton-Deschamps index, Insall-Salvati ratio), patellar tilt, TT-TG distance, sulcus angle (cartilaginous and bony) and trochlear bump (cartilaginous and bony). The number and percentage of knees with pathologic values for measured risk factors were analyzed. For each risk factor, 15% side-to-side differences were considered significant. Statistical correlation was calculated between the time of presentation (first symptomatic knee) and magnitude of risk factors. All measurements were repeated after a 3-week interval and ICC was calculated to determine intraobserver reliability. Results The mean age of 32 patients was 14.6 years. 17/32 patients were females. 29 patients had staged surgery with mean interval of 21 months between surgeries; 3 patients had simultaneous surgery on each knee. Patients with BPI had multiple risk factors. 22/32 patients (69%) had the same Dejour type of trochlear dysplasia. For each measured risk factor, the number and percentage of patients with 15% or more side-to-side differences is shown (Table 1). There were significant side-to-side differences in patellar height ratios, TT-TG distance, and trochlear bump. The timing of presentation did not correlate with increased risk factors, i.e, the knee that presented earlier did not have increased risk factors compared to contralateral knee. ICC showed excellent intraobserver reliability. Conclusion There were significant side-to-side differences between knees in patients with BPI. Treatment and prognosis should be based on anatomic risk factors for each knee in patients with BPI. [Table: see text]

Systematic review of early risk factors for life-course-persistent, adolescence-limited, and late-onset offenders in prospective longitudinal studies.

This paper builds on our previous systematic review of prospective longitudinal studies and examines the early risk factors associated with life-course persistent offending (LCP), adolescence-limited (AL) and late-onset (LO) offending. Out of the 55 prospective longitudinal studies which theoretically could possess the relevant information, only four provided information about risk factors associated with the different offending types. An additional three provided data so that relevant analyses could be conducted. The results suggested that there was little evidence that specific early risk factors were associated with specific offending types. There was also limited evidence that specific risk factors predicted specific offending types when criminal career duration was included in the definitions of LCP, AL, and LO offending. However, LCP offenders tended to have a greater number of risk factors, and the magnitude of these was somewhat greater than for AL offenders, who in turn tended to have more risk factors (and of a greater magnitude) than LO offenders. LCP and AL offenders may differ more in degree (in the number and magnitude of risk factors) than in kind (in the specific risk factors that are predictive). Importantly, as the potential criminal career duration was increased in defining the offending types, those with longer careers tended to have more risk factors, but, LCP and AL offenders were not predicted by different risk factors. Much more research is needed on risk factors for offending types defined according to criminal career durations.

Tools for visualizing and integrating pest risk assessment ratings and uncertainties*

The application of pest risk analysis (PRA) decision‐support schemes, such as that used by the European and Mediterranean Plant Protection Organization (EPPO), generates many ratings for likelihood or magnitude of risk factors, each with an associated uncertainty. In accordance with the international standard ISPM 11 (FAO, 2004), questions have been devised to assess the key elements of pest risk in the four main sections of pest risk assessment: Entry, Establishment, Spread and Impact. After completing each section, risk assessors are required to give a summary rating and an uncertainty score for that section. The large number of question ratings and uncertainty scores make the task of summarizing each section and its uncertainty quite difficult. Two graphical tools have been developed to aid this task: the PRA Risk score and uncertainty visualizer (Visualizer) and the Rule‐based matrix model (RBMM). The Visualizer presents a case summary graph on a single page in such a way that the risk assessors and peer reviewers can see rating scores and uncertainties in a pictorial manner; the RBMM integrates all the individual questions in the assessment through a hierarchy of rules that attempt to mimic the logic used by the assessors and are arranged in the form of a flow chart to give an overall rating with an accompanying expression of uncertainty.

Corporatization of Pain Medicine: Implications for Widening Pain Care Disparities

The current health care system in the United States is structured in a way that ensures that more opportunity and resources flow to the wealthy and socially advantaged. The values intrinsic to the current profit-oriented culture are directly antithetical to the idea of equitable access. A large body of literature points to disparities in pain treatment and pain outcomes among vulnerable groups. These disparities range from the presence of disproportionately higher numbers and magnitude of risk factors for developing disabling pain, lack of access to primary care providers, analgesics and interventions, lack of referral to pain specialists, longer wait times to receive care, receipt of poor quality of pain care, and lack of geographical access to pharmacies that carry opioids. This article examines the manner in which the profit-oriented culture in medicine has directly and indirectly structured access to pain care, thereby widening pain treatment disparities among vulnerable groups. Specifically, the author argues that the corporatization of pain medicine amplifies disparities in pain outcomes in two ways: 1) directly through driving up the cost of pain care, rendering it inaccessible to the financially vulnerable; and 2) indirectly through an interface with corporate loss-aversion/risk management culture that draws upon irrelevant social characteristics, thus worsening disparities for certain populations. Thus, while financial vulnerability is the core reason for lack of access, it does not fully explain the implications of corporate microculture regarding access. The effect of corporatization on pain medicine must be conceptualized in terms of overt access to facilities, providers, pharmaceuticals, specialty services, and interventions, but also in terms of the indirect or covert effect of corporate culture in shaping clinical interactions and outcomes.

Evidence-Based Public Health: A Fundamental Concept for Public Health Practice

Despite the many accomplishments of public health, a greater attention to evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about a decade ago. Key components of EBPH include making decisions on the basis of the best available scientific evidence, using data and information systems systematically, applying program-planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Three types of evidence have been presented on the causes of diseases and the magnitude of risk factors, the relative impact of specific interventions, and how and under which contextual conditions interventions were implemented. Analytic tools (e.g., systematic reviews, economic evaluation) can be useful in accelerating the uptake of EBPH. Challenges and opportunities (e.g., political issues, training needs) for disseminating EBPH are reviewed. The concepts of EBPH outlined in this article hold promise to better bridge evidence and practice.

MODELING SURVIVAL: APPLICATION OF THE ANDERSEN–GILL MODEL TO YELLOWSTONE GRIZZLY BEARS

Wildlife ecologists often use the Kaplan-Meier procedure or Cox proportional hazards model to estimate survival rates, distributions, and magnitude of risk factors. The Andersen–Gill formulation (A–G) of the Cox proportional hazards model has seen limited application to mark–resight data but has a number of advantages, including the ability to accommodate left-censored data, time-varying covariates, multiple events, and discontinuous intervals of risks. We introduce the A–G model including structure of data, interpretation of results, and assessment of assumptions. We then apply the model to 22 years of radiotelemetry data for grizzly bears (Ursus arctos) of the Greater Yellowstone Grizzly Bear Recovery Zone in Montana, Idaho, and Wyoming, USA. We used Akaike's Information Criterion (AICc) and multi-model inference to assess a number of potentially useful predictive models relative to explanatory covariates for demography, human disturbance, and habitat. Using the most parsimonious models, we generated risk ratios, hypothetical survival curves, and a map of the spatial distribution of high-risk areas across the recovery zone. Our results were in agreement with past studies of mortality factors for Yellowstone grizzly bears. Holding other covariates constant, mortality was highest for bears that were subjected to repeated management actions and inhabited areas with high road densities outside Yellowstone National Park. Hazard models developed with covariates descriptive of foraging habitats were not the most parsimonious, but they suggested that high-elevation areas offered lower risks of mortality when compared to agricultural areas.

VIII. Special Considerations for Different Population Groups

Therapeutic recommendations in this report are based heavily on evidence from controlled clinical trials. Nonetheless, randomized clinical trials have not been carried out to address all therapeutic questions pertaining to all age groups, both sexes, and different racial/ethnic groups. Consequently, ATP III recommendations for various groups often must be made by combining what has been learned from clinical trials with other lines of evidence such as epidemiological findings. Fortunately, a large number of clinical trials have produced a very large set of consistent results that allow for considerable confidence in projections of benefits and drawbacks of cholesterol-lowering therapy in groups that have not been subject to clinical trials. In the discussion to follow, the ATP III panel has crafted its recommendations for different population groups from general evidence statements and general recommendations developed in previous sections. No attempt will be made to grade the category and strength of evidence for all recommendations made in this section. Men of middle-age (35-65 years) are at increasing risk for CHD as they progressively age. Up to one-third of all new CHD events and about one-fourth of all CHD deaths occur in middle-aged men.1017 Most of the excess risk for CHD morbidity and mortality in middle-aged men can be explained by the major risk factors—cholesterol disorders, hypertension, and cigarette smoking.10,11 Men are predisposed to abdominal obesity, which makes them particularly susceptible to the metabolic syndrome. Consequently, metabolic risk factors (elevated cholesterol and triglycerides, low HDL cholesterol, and elevated blood pressure) appear earlier in men than women. Table VIII.1-1 summarizes factors to consider when applying ATP III guidelines to middle-aged men. View this table: Table VIII.1-1. Special Considerations for Cholesterol Management in Middle-Aged Men CHD is a major cause of death in women as well as men and it ultimately kills as many women as men.1017 However, …

The "big three" cardiovascular risk factors among American blacks and Hispanics.

Today's chronic diseases require "treatment" by shifting control of the outcome from the provider back to the individual and the environment in which one functions. There is a strong need to consider the individual in the context of ethnicity and culture, which express themselves in the prevalence and magnitude of risk factors, the biological impact of risk factors and expression of disease, and the potential for control of unhealthy behaviors. Educational and screening programs related to the risk factors of cigarette smoking, hypertension, and cholesterol must be structured so that recommended life-style changes are compatible with the individual's cultural values and beliefs.