No-risk Groups Research Articles

Low geriatric nutritional risk index predicts poor prognosis in patients with cirrhosis: a retrospective study.

Malnutrition, which increases the risk of liver disease-related events and mortality, is a serious complication in cirrhosis. This study aimed to investigate whether the geriatric nutritional risk index (GNRI) could predict the long-term prognosis in patients with cirrhosis. We retrospectively evaluated 266 patients with cirrhosis and classified them into two groups based on baseline GNRI scores: risk (≤98, n = 104) and no-risk groups (>98, n = 162). The cumulative survival rates were compared between the two groups in patients with compensated and decompensated cirrhosis, respectively. Cox proportional hazards regression analysis was used to identify significant and independent factors associated with mortality. The median observation period was 54.9 (33.6-61.7) months and 65 (24.4%) liver disease-related deaths occurred during the follow-up period. The GNRI scores significantly and inversely correlated with Child-Pugh score (r = -0.579), model for end-stage liver disease score (r = -0.286), and Mac-2 binding protein glycosylation isomer (r = -0.494). Multivariate analysis identified low GNRI as a significant and independent factor associated with mortality [overall cohort: hazard ratio (HR), 0.926; p < 0.001; compensated cirrhosis: HR, 0.947; p = 0.003; decompensated cirrhosis: HR, 0.923; p < 0.001]. The risk group demonstrated significantly lower cumulative survival rates than the no-risk group in overall cohort, and patients with compensated and decompensated cirrhosis (p < 0.001, <0.001, and = 0.013, respectively). Low GNRI was associated with poor long-term prognosis in both patients with compensated and decompensated cirrhosis. Therefore, the GNRI is a simple and useful tool for predicting prognosis and modifying the nutritional status in patients with cirrhosis.

Analyzing Suicide Risk From Linguistic Features in Social Media: Evaluation Study.

BackgroundEffective suicide risk assessments and interventions are vital for suicide prevention. Although assessing such risks is best done by health care professionals, people experiencing suicidal ideation may not seek help. Hence, machine learning (ML) and computational linguistics can provide analytical tools for understanding and analyzing risks. This, therefore, facilitates suicide intervention and prevention.ObjectiveThis study aims to explore, using statistical analyses and ML, whether computerized language analysis could be applied to assess and better understand a person’s suicide risk on social media.MethodsWe used the University of Maryland Suicidality Dataset comprising text posts written by users (N=866) of mental health–related forums on Reddit. Each user was classified with a suicide risk rating (no, low, moderate, or severe) by either medical experts or crowdsourced annotators, denoting their estimated likelihood of dying by suicide. In language analysis, the Linguistic Inquiry and Word Count lexicon assessed sentiment, thinking styles, and part of speech, whereas readability was explored using the TextStat library. The Mann-Whitney U test identified differences between at-risk (low, moderate, and severe risk) and no-risk users. Meanwhile, the Kruskal-Wallis test and Spearman correlation coefficient were used for granular analysis between risk levels and to identify redundancy, respectively. In the ML experiments, gradient boost, random forest, and support vector machine models were trained using 10-fold cross validation. The area under the receiver operator curve and F1-score were the primary measures. Finally, permutation importance uncovered the features that contributed the most to each model’s decision-making.ResultsStatistically significant differences (P<.05) were identified between the at-risk (671/866, 77.5%) and no-risk groups (195/866, 22.5%). This was true for both the crowd- and expert-annotated samples. Overall, at-risk users had higher median values for most variables (authenticity, first-person pronouns, and negation), with a notable exception of clout, which indicated that at-risk users were less likely to engage in social posturing. A high positive correlation (ρ>0.84) was present between the part of speech variables, which implied redundancy and demonstrated the utility of aggregate features. All ML models performed similarly in their area under the curve (0.66-0.68); however, the random forest and gradient boost models were noticeably better in their F1-score (0.65 and 0.62) than the support vector machine (0.52). The features that contributed the most to the ML models were authenticity, clout, and negative emotions.ConclusionsIn summary, our statistical analyses found linguistic features associated with suicide risk, such as social posturing (eg, authenticity and clout), first-person singular pronouns, and negation. This increased our understanding of the behavioral and thought patterns of social media users and provided insights into the mechanisms behind ML models. We also demonstrated the applicative potential of ML in assisting health care professionals to assess and manage individuals experiencing suicide risk.

Aterm Pregnancy Woman with Human Immunodeficiency Virus Infection and Antiretroviral Therapy as Risk Factor of High Caspase-3 Expression in Placenta

Aim: To determine whether term pregnant women with human immunodeficiency virus infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta. Methods: This cross-sectional analytical study was conducted at Sanglah General Hospital, Denpasar, and affiliated hospitals. Subjects were termed pregnant women with HIV (+) who received a minimum of six months of antiretroviral therapy as a risk group and pregnant women with HIV (-) as a non-risk group. Caspase-3 expression was assessed by immunohistochemical examination of placental tissue. The cut-off value for caspase-3 levels was determined by constructing a receiver operating characteristics (ROC) curve. The difference in proportion was assessed by the chi-square test, and the prevalence ratio (PR) was reported. The significance of this study was p&lt;0.05. Results: Each 20 pregnant women were included in the risk and no-risk groups. There was no difference in age, gestational age, parity, and body mass index (BMI) between the two groups. The mean expression of caspase-3 was significantly higher HIV (+) group than in the HIV (-) group (162.62 vs. 105.83; p = 0.000). The selected cut-off value of Caspase-3 was 127.05, with a sensitivity of 75% and a specificity of 75%. After classification, a significantly higher proportion of Caspase-3 expression was found in the HIV (+) group than in the HIV (-) group (75% vs. 25%; p=0.002). Pregnant women with HIV (+) and receiving antiretroviral therapy for a minimum of six months had a three times higher chance of having a high Caspase-3 prevalence than pregnant women who were not (RP=3.0; 95% CI = 1.348 – 6.678). Conclusion: Pregnant women with HIV infection who received antiretroviral therapy have a high Caspase-3 expression in the placenta.

Aterm Pregnant Women with Human Immunodeficiency Virus Infection Which Receive Antiretroviral Therapy Combination of Nucleoside Analogue Reverse Transcriptase Inhibitor as A Risk Factor of High Expression of Apoptosis Including Factors

Aim: To determine whether term pregnant women with human immunodeficiency virus infection who received antiretroviral therapy had high apoptosis inducing factor expression in the placenta. Methods: This cross-sectional analytical study was conducted at Sanglah General Hospital, Denpasar, and educational network hospitals. Subjects collected were termed pregnant women with HIV (+) who received antiretroviral therapy (ART) 6 months as a risk group and pregnant women with HIV (-) as a non-risk group. AIF expression was assessed by immunohistochemical examination of placental tissue. The AIF expression cut-off value was determined by constructing a receiver operating characteristics (ROC) curve. The chi-square test assessed the difference in proportion by displaying the prevalence ratio (RP) results. The significance of this study was p&lt;0.05. Results: 40 pregnant women were included in the risk and no-risk groups. There was no difference in age, gestational age, parity and BMI in the two groups. The mean AIF expression was significantly higher in the group with HIV (+) (162±52.5) ​​than HIV (-) (126.75±61.4), p-value = 0.003. The cut-off value of AIF expression was 112.50, with a sensitivity of 80% and a specificity of 45%. After classification, a significantly higher proportion of AIF expression was found in the HIV (+) group (42.5%) than in the HIV (-) group (27.5%) with p=0.038. Pregnant women with HIV (+) and receiving antiretroviral therapy for six months had a 4.6 times higher chance of having a high AIF prevalence than pregnant women who were not infected with HIV (RP=4.63; 95% CI=1.023 – 21.004). Conclusion: Term pregnant women with HIV infection who received antiretroviral therapy had high AIF expression in the placenta.

The Geriatric Nutritional Risk Index Predicts Postoperative Outcomes in Bladder Cancer: A Propensity Score-Matched Analysis.

The Geriatric Nutritional Risk Index (GNRI) is a simple screening tool to predict nutrition-related risk of morbidity and mortality in older patients. We assessed whether preoperative GNRI was associated with 30-day complications after radical cystectomy (RC). Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified patients 65 years or older who underwent RC for the treatment of bladder cancer between 2007 and 2019. Patients were dichotomized into at-risk (GNRI ≤98) or no-risk (GNRI >98) groups. Using propensity score matching, the 2 groups were compared for baseline differences and 30-day outcomes. We evaluated GNRI as an independent predictor of postoperative complications using multivariable logistic regression analysis. We identified 2,926 patients eligible for analysis. After propensity score matching, patients in the at-risk GNRI group had higher rates of any complication (p=0.017), blood transfusion (p=0.002), extended length of stay (p=0.004) and nonhome discharge (p <0.001). Multivariable logistic regression analysis revealed that a decreasing GNRI is an independent prognostic factor for mortality (OR 1.05, 95% CI 1.01-1.08, p=0.009), blood transfusion (OR 1.03, 95% CI 1.02-1.04, p <0.001), pneumonia (OR 1.04, 95% CI 1.01-1.07, p=0.013), extended length of stay (OR 1.03, 95% CI 1.02-1.05, p <0.001) and nonhome discharge (OR 1.04, 95% CI 1.03-1.06, p <0.001). We demonstrate that nutritional status evaluated by GNRI predicts 30-day complications after RC.

Geriatric Nutritional Risk Index as a Tool to Evaluate Impact of Malnutrition Risk on Mortality in Adult Patients with Polytrauma

Background: Identification of malnutrition is especially important in severely injured patients, in whom hypermetabolism and protein catabolism following traumatic injury worsen their nutritional condition. The geriatric nutritional risk index (GNRI), based on serum albumin level and the current body weight/ideal body weight ratio, is useful for identifying patients with malnutrition in many clinical conditions. This study aimed to explore the association between admission GNRI and mortality outcomes of adult patients with polytrauma. Methods: From 1 January 2009 to 31 December 2019, a total of 348 adult patients with polytrauma, registered in the trauma database of a level I trauma center, were recognized and categorized into groups of death (n = 71) or survival (n = 277) and into four nutritional risk groups: a high-risk group (GNRI < 82, n = 87), a moderate-risk group (GNRI 82 to <92, n = 144), a low-risk group (GNRI 92–98, n = 59), and a no-risk group (GNRI > 98, n = 58). Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for mortality. The mortality outcomes of patients at various nutritional risks were compared to those of patients in the no-risk group. Results: The comparison between the death group (n = 71) and the survival group (n = 277) revealed that there was no significant difference in gender predominance, age, pre-existing comorbidities, injury mechanism, systolic blood pressure, and respiratory rate upon arrival at the emergency room. A significantly lower GNRI and Glasgow Coma Scale score but higher injury severity score (ISS) was observed in the death group than in the survival group. Multivariate logistic regression analysis revealed that Glasgow Coma Scale (GCS), odds ratio (OR), 0.88; 95% confidence interval (CI), 0.83–0.95; p < 0.001), ISS (OR, 1.07; 95% CI, 1.04–1.11; p < 0.001), and GNRI (OR, 0.94; 95% CI, 0.91–0.97; p < 0.001) were significant independent risk factors for mortality in these patients. The mortality rates for the high-risk, moderate-risk, low-risk, and no-risk groups were 34.5%, 20.1%, 8.5%, and 12.1%, respectively. Unlike patients in the moderate-risk and low-risk groups, patients in the high-risk group had a significantly higher death rate than that of those in the no-risk group. Conclusions: This study revealed that the GNRI may serve as a simple, promising screening tool to identify the high risk of malnutrition for mortality in adult patients with polytrauma.

Targeted cardiopulmonary resuscitation training focused on the family members of high-risk patients at a regional medical center: A comparison between family members of high-risk and no-risk patients.

We developed a hospital-based cardiopulmonary resuscitation (CPR) training model focused on the target population (family members of patients with potential risks for cardiac arrest) and compared the outcome of CPR training between target and non-target populations for validity. Family members of patients in training were divided into three groups on the basis of patients' diseases, as follows: 1) the cardio-specific (CS) risk group, including family members of patients with cardiac disease at risk of cardiac arrest; 2) the cardiovascular (CV) risk group, including family members of patients with risk factors for cardiovascular disease; and 3) the no-risk group. Pre- and posttraining surveys and skill tests as well as a post-training 3-month telephone survey were conducted. Educational outcomes were analyzed. A total of 203 family members were enrolled into 21 CPR training classes. The CS group (n=88) included elderly persons and housewives with a lower level of education compared with the CV (n=79) and no-risk groups (n=36). The CS group was motivated by healthcare professionals and participated in the training course. The CS, CV, and no-risk groups showed improvements in knowledge, willingness to perform CPR, and skills. Despite the older age and lower level of education in the CS group, the effects of education were similar to those in the other groups. A high rate of response and secondary propagation of CPR training were observed in the CS group. Family members of patients with heart disease could be an appropriate target population for CPR training, particularly in terms of recruitment and secondary propagation. Targeted intervention may be an effective training strategy to improve bystander CPR rates.

Vancomycin-associated nephrotoxicity: a critical appraisal of risk with high-dose therapy

The recent emergence of meticillin-resistant Staphylococcus aureus (MRSA) strains with reduced susceptibility to vancomycin has prompted clinicians to prescribe vancomycin therapy targeting high trough concentrations (15–20mg/L). Relevant studies (n=12) analysing the occurrence of nephrotoxicity with high-dose therapy were reviewed. Most studies were retrospective and the temporal relationship between elevated trough levels and development of nephrotoxicity was unclear, precluding a definitive cause–effect analysis. Available data suggest an association between vancomycin trough level and risk of nephrotoxicity as a function of intensity and duration of therapy (>7 days), compounded by concomitant receipt of nephrotoxins, vasopressor therapy and underlying physiological impairment. In separate studies in which a high trough concentration was measured prior to the onset of nephrotoxicity, the frequency of occurrence was 21–28% in patients with concomitant risks compared with 7% in patients without risks. A similar comparison between risk and no-risk groups who attained a standard trough concentration (10–15mg/L) indicates the rates of occurrence as 9–21% vs. 2%. Onset of nephrotoxicity ranged from 4 days to 8 days from the start of therapy. The degree of renal dysfunction was modest, with a reported decrease of 35–45% in creatinine clearance from baseline. Resolution occurred in >70% of patients by the time of discharge. Future studies should detail clearly the temporal relationship between drug exposure and onset of nephrotoxicity, confounding risk factors, extent of injury and time course of recovery, and should also determine the relative risk versus benefit of high-dose vancomycin versus alternative agents.

The Influence of Schizophrenia-Related Neuregulin-1 Polymorphisms on Sensorimotor Gating in Healthy Males

Neuregulin-1 (NRG1) variations have been shown to modulate schizophrenia candidate endophenotypes related to brain structure and function. The objective of this cross-sectional genetic association study was to determine the relationship of six core single-nucleotide polymorphisms within the NRG1 gene identified as promising schizophrenia risk genes (rs6994992, SNP8NRG221132, SNP8NRG241930, rs3924999, rs2439272 and rs10503929) to prepulse inhibition (PPI) of the acoustic startle reflex, a well validated schizophrenia endophenotype. PPI was tested in a highly homogeneous study entry cohort (n = 445) of carefully screened healthy, young male army conscripts originating from the Greek LOGOS project (Learning on Genetics of Schizophrenia Spectrum). The QTPHASE from the UNPHASED package was used for the association analysis of each single-nucleotide polymorphisms or haplotype data. Reduced PPI, particularly at 75-dB_120-msec and 85-dB_60-msec trials, was related to the SNP8NRG241930 G allele and especially the rs6994992 T allele and rs2439272 C allele. Haplotype analysis followed up by risk versus no-risk groups Analysis of variance confirmed that the rs10503929 and rs3924999 SNPs were also associated with PPI reductions, when combined with rs2439272. We provide solid evidence for a role of NRG1 risk genotype variations in PPI reductions in a large and demographically and genetically highly homogeneous cohort of healthy young males. These results further validate NRG1 as a candidate gene for the schizophrenia and spectrum disorders and improve our understanding of its functional mechanisms within the human brain because they suggest an influence of the gene in the neural substrate mediating sensorimotor gating.

Self-Reported Health Risks Linked to Health Plan Cost and Age Group

Studies of private sector employee populations have shown an association between health-risk factors and healthcare costs. Few studies have been conducted on large, public sector employee populations. The objective of the current study was to quantify health plan costs associated with individual tobacco, obesity, and physical inactivity risks in Arkansas's state employee plan. De-identified medical and pharmacy claim costs incurred October 1, 2004-February 28, 2006 were linked with results from self-reported health-risk assessments (HRA) completed August 1, 2006-October 31, 2006. High- and no-risk groups were defined on the basis of cigarette use, BMI, and days/week of moderate physical activity. Annualized costs were compared between groups and across ages. Data were analyzed in September 2007. Of the eligible adults (n=77,774), 56% (n=43,461) voluntarily accessed and completed an Internet-based HRA and had claims data-linked for analyses. Average annual costs across the eligible population totaled $3205. Respondents with high risks incurred greater annual costs ($4432) than those with no risks ($2382). Costs were greater among those with one or more risks, compared with no risks, and increased with age. The greatest average annual cost was for people aged 55-64 years in the high-risk group, who had a 2.2-fold higher cost than those aged 55-64 years in the no-risk group ($7233 versus $3266). Healthcare costs increased with age and were differentially higher for those who used tobacco, were obese, or were physically inactive. The financial viability of the healthcare system is at risk, particularly in plans with a high proportion of adults with health-risk factors.

Classification of surgical procedures for epidemiologic assessment of sporadic Creutzfeldt-Jakob Disease transmission by surgery

In this preparatory phase of a case-control study, we propose and evaluate a new tool for classifying surgical procedures (SPs) in categories useful for epidemiologic research on surgical transmission of sporadic Creutzfeldt-Jakob disease (sCJD). All SPs reported to the Swedish National Hospital Discharge Registry in the period 1974-2002, and undergone by 212 Swedish patients with registered diagnosis of CJD at death, hospital discharge or notification, in the period 1987-2002, 1060 age-, sex- and residence-matched controls and 1340 randomly chosen population controls, were reclassified into one of six categories of hypothetical transmission risk level. For that purpose the following two attributes were used: non-disposable instruments involved; and highest assigned ad-hoc risk level for four tissues or anatomical structures contacting such instruments. A total of 1170 different SP codes were reclassified as follows: 3.1% in the high-risk, 59.1% in the lower-risk, 24.4% in the lowest-risk, and 2.1% in the no-risk groups, with 11.3% procedures negatively defined by rubric as "other than..." being assigned to two spurious diluted-high and diluted-lower risk categories. The high-risk group mainly comprised neurosurgical (53%) and ophthalmic (39%) procedures. Sensitivity of neurosurgery and of ophthalmic surgery excluding neurosurgery, for the high- and diluted-high risk vs. other categories was 46% and 84%, while specificity was 98% and 95%, respectively. Sensitivity analysis based on these indices revealed that non-significant odds ratio effects of 1.4 and 1.3 for neurosurgery and ophthalmic surgery corresponded to statistically significant values of 5.1 after reclassification. This classification might contribute to quantify effects masked by use of body-system SP-categories in case-control studies on sCJD transmission by surgery.

Association between Lifestyle-Disease Diagnosis or Risk Status and Medical Care Costs in a Japanese Corporation

This study examined the differences in medical care costs among (1) individuals who carried the diagnosis of selected lifestyle diseases (diabetes mellitus, hypertension, and hyperlipidemia), (2) individuals whose levels of risks (blood glucose, blood pressure, and total cholesterol) satisfied the diagnosis guidelines yet who did not carry the diagnoses, (3) individuals who had these risks but whose risk levels were not high enough to satisfy the diagnosis guidelines, and (4) individuals without the risks. A one-time cross-sectional design was used. Health checkup data and medical-claims data obtained from the fiscal year 2000 were examined for correlations. A total of 3292 employees aged 34 years and older were selected from the entire employee population of 6543 in a Japanese corporation. Employees younger than 34 years old were excluded because their clinical risk data were not available. On the basis of their absence or presence of diagnoses (obtained from medical claims) and underlying risk levels (obtained from health checkups), employees were categorized into (1) the diagnosed group, (2) the extremely high-risk group, (3) the high-risk group, or (4) the no-risk group. Reimbursement points on medical care claims were summed for each individual during the study period and multiplied by 10 to calculate the total medical care costs, as each point in the reimbursement request form represents 10 yen. The high-cost case analysis was used. First, the high costs were determined as the costs at or above the 90th percentile. The diagnosis or risk status was examined in its relation to the newly created dichotomous variable (whether the medical costs were at or above the threshold or were lower than the threshold) by using a chi2 test. Furthermore, excluding the diagnosed group, a chi2 test was performed to examine the relationships between the levels of risk and the likelihood of incurring any medical care costs (use vs. nonuse). Approximately 15% of employees were already diagnosed with at least one of the three diseases (the diagnosed group; n = 490). One-quarter of employees had at least one risk that was high enough to be diagnosed with the corresponding disease if they had sought medical care (the extremely high-risk group; n = 809). There were 1343 employees in the high-risk group and 650 employees in the no-risk group. The diagnosed group had much higher chances of incurring medical care costs at or above the 90th percentile than did any other risk or no-risk group. No difference among the three risk or no-risk groups was found in mean medical care costs or in the likelihood of any use of medical care services after controlling for the effect of diagnosis. In a Japanese employee population, the diagnosis status of diabetes mellitus, hyperlipidemia, and hypertension was found to be associated with higher medical care costs while risk levels for the diseases were not in a 1-year time period.

Physicians Should Report Cases of Acquired Immune Deficiency Syndrome

In the two years since the first cases of the acquired immune deficiency syndrome (AIDS) were reported, AIDS has become an important and continually increasing public health problem. The distribution of cases is clearly not random; social, medical, sexual, and geographic characteristics powerfully influence the risk of its occurrence. The patient described in this issue of theArchivesby Kalish et al (see p 2310) is a member of two of the high-risk groups: homosexual men and hemophiliacs. Although cases with multiple risk factors are unique and interesting (this patient represents the only one of the first 1,902 reported) falling in both of these two risk groups, it is the other cases—the aggregate of cases in risk groups and the outlying cases in no-risk groups—that provide the epidemiologic data on which to base case-control studies and laboratory investigations. It is probably through such studies that the elusive cause of AIDS