Relative Importance Of Risk Factors Research Articles

Incidence of hearing loss and importance of risk factors in the neonatal intensive care unit

Purpose:To assess the incidence of neonatal hearing loss in a neonatal intensive care unit and the relative importance of risk factors for hearing imparement in a neonatal intensive care unit which the Joint Committee on Infant Hearing(JCIH) had recommended. Methods:One thousand, two hundred and one newborns admitted to the Good Moonhwa Intensive Care Unit from May 2003 to December 2005 were assesed using the automated auditory brainstem response(AABR). The screening was performed on those aged more than 36 weeks and weighing more than 2,200 g. We divided the infants into two groups, ‘pass’ and ‘refer’. The ‘refer’ group were retested one month later, and if classified as ‘refer’ during the retest, were referred to a hearing impairment clinic. Results:From the 1,201 neonates, 1,187(98.8 percent) passed the test and 14(1.2 percent) failed. 293(24.4 percent) of the 1,201 neonates had a risk factor for hearing impairment; 282(96.2 percent) passed the test and 11(3.8 percent) failed. The group with risk factors were shown to have a higher incidence of hearing loss(P

Sex Differences of Risk Factors for Acute Myocardial Infarction in Japanese Patients

Acute myocardial infarction (AMI) is prevalent and has serious consequences including re-infarction and death. Although the risk factors for AMI have been extensively studied in Western countries, they are less well documented in Japan. To determine the risk factors for AMI, we performed a case-control study in unselected patients with AMI. Risk factors were assessed in 1,925 consecutive patients with a first AMI (age, 28-103 years old; men, 1,353; women, 572), who were admitted to one of the major institutes in Japan, and in 2,279 age-and sex-matched population-based controls. Hypertension (odds ratio (OR), 4.80; 95% confidence interval (CI), 3.80 to 5.95; p < 0.01), diabetes (OR, 3.44; 95% CI, 2.50 to 4.75; p < 0.01), current smoking (OR, 3.39; 95% CI, 2.78 to 4.18; p < 0.01), family history (OR, 1.84; 95% CI, 1.30 to 2.62; p < 0.01), and hypercholesterolemia (OR, 1.28; 95% CI, 1.00 to 1.62; p < 0.05) were all independent risk factors for AMI. However, obesity (OR, 1.13; 95% CI, 0.92 to 1.50; NS) was not. Hypertension (OR, 4.80; 95% CI, 3.80 to 6.02; p < 0.01), current smoking (OR, 4.00; 95% CI, 3.02 to 5.00; p < 0.01), and diabetes (OR, 2.9; 95% CI, 2.00 to 4.04; p < 0.01) were all independent risk factors for AMI in men. In contrast, only current smoking (OR, 8.22; 95% CI, 3.98 to 18.88; p < 0.01), diabetes (OR, 6.12; 95% CI, 3.78 to 12.02; p < 0.01), and hypertension (OR, 5.04; 95% CI, 2.92 to 7.52; p < 0.01) were independent risk factors for AMI in women. Hypercholesterolemia was an independent risk factor for AMI in men (OR, 1.52; 95% CI, 1.00 to 1.98; p < 0.05), but not in women. Hypertension, diabetes, current smoking, family history and hypercholesterolemia are associated with AMI in Japanese patients, and the importance of the risk factors for AMI differs between men and women. Hypertension, current smoking, diabetes and family history are the most important risk factors in men, whereas current smoking, diabetes, hypertension and family history are the most important risk factors in women. Hypercholesterolemia is an independent risk factor for AMI in men, but not in women. To the best of our knowledge, this is the first clinical study to define the relative importance of risk factors for AMI in Japanese patients.

Newborn Hearing Screening: Effectiveness, Importance of High-Risk Factors, and Characteristics of Infants in the Neonatal Intensive Care Unit and Well-Baby Nursery

In contrast to the recommendations of the Joint Committee on Infant Hearing, neonatal hearing screening programs are still not universally available, and many countries implement elective screening in high-risk newborns. To assess the failure rates of neonates in hearing screening and the relative importance of risk factors for hearing impairment, both in neonatal intensive care units and in well-baby nursery neonates. The impact on cost-effectiveness is also evaluated. In the current study, 25,288 newborns were assessed; 23,574 were full-term newborns in the well-baby nursery and 1,714 neonates were in neonatal intensive care units. All neonates had a general examination (including assessment for congenital anomalies and related history) and were assessed using transient evoked otoacoustic emissions. All newborns were older than 36 weeks at examination and thus had reliable transient evoked otoacoustic emissions. From the 23,574 full-term neonates in the well-baby nursery, 23,123 (98.1%) passed the test and 451 failed (1.9%). Fifty-three of the 23,574 neonates (0.2%) had a risk factor for hearing impairment; 44 (83%) passed the test and 9 failed (17%). Family history of congenital hearing loss and congenital anomalies were the most frequent risk factors for hearing loss. From the 1,714 neonates in neonatal intensive care units, 1,590 (93%) passed the test and 124 failed (7%). Two hundred thirty-two of the 1,714 neonates (14%) had a risk factor for hearing impairment; 205 (88%) passed the test and 27 failed (12%). In neonatal intensive care unit neonates, toxic levels of ototoxic drugs, mechanical ventilation for more than 24 hours, prematurity, and low birth weight were the most frequent risk factors for hearing loss. Congenital anomalies/syndromes were the most important risk factors for failing screening in both the neonatal intensive care unit and the well-baby nursery, as they showed the highest risk of failing hearing screening. The second most important factor in neonatal intensive care unit newborns was low birth weight, and the third was prematurity in relation to the possibility of failing hearing screening. The present study found 575 neonates failing hearing screening of 25,288 tested newborns (2.3%). The fact that 78% of newborns who failed hearing screening were in the well-baby nurseries further supports the necessity of universal hearing screening instead of selective screening in neonatal intensive care units, even with the obvious impact on cost-effectiveness. Even if limited funding lead to selective screening in neonatal intensive care units, this should not be applied to high-risk newborns but to all neonatal intensive care unit neonates. Continuous assessment of risk factors and the related possibility of failing hearing screening are of paramount importance in designing hearing screening programs and refining the respective criteria.

Prevalence, outcome and risk for falling in 155 ambulatory patients with rheumatic disease

AbstractAim: Older people are at greater risk of falls and fall‐related adverse outcomes. Risk for falls is multifactorial, and relative importance of risk factors (RF) may vary according to the population studied. Although several population studies identify musculoskeletal factors as one of many RFs, there have been few studies of falls in populations with rheumatic disease. In this study we aim to assess the incidence of falls, prevalence of falls RFs and outcomes of falls in an ambulatory population with rheumatic disease.Methods: Using a retrospective cohort study design, consecutive patients attending rheumatology outpatient clinics completed a self‐administered falls questionnaire that investigated falls within the previous 12 months, risk for falling and fear of falling.Results: One hundred and fifty‐five patients, with a mean age of 59.7 years (SD 15.0) completed the survey. Seventy‐six patients (49%) reported one or more falls in the previous 12 months. Fifty‐eight (76.3%) reported an adverse outcome which included fracture in 12 (15.8%) and hospital attendance or admission in 20 (26.7%). Fear of falling was also common, being reported in 81 (52.3%) patients. Moderately or severe fear of falling was reported in 26 (16.8%) among the whole group and in 10% of the 78 patients who had not yet experienced a fall.Conclusions: The findings of this study highlight the high incidence of falls and fear of falling in patients with rheumatic disease and identify groups likely to be at higher risk. These patients should be considered for falls prevention programs that have been shown to reduce falls risk and improve self‐efficacy.

Gender differences in the contributions of risk factors to depressive symptoms among the elderly persons dwelling in a community, Japan

To examine the relative importance of risk factors associated with depressive symptoms and gender differences in exposure to the risk factors among the elderly persons living in the community. The data came from the Minamifurano-town Aging Study, a community-based sample of non-institutionalized elderly persons aged 65 years or older. Of the 731 eligible subjects, 665 were assessed for four domains of the potential risk factors (demographic characteristics, health and disability, stress, and social networks) and depressive symptoms according to the 30-item Geriatric Depression Scale (GDS). The mean overall GDS-score was 10.9 (SD 6.2), 10.2 (SD 6.0) in men and 11.6 (SD 6.4) in women. The stress domain in men and the health and disability domain in women contributed most to the explanation of the variation in the GDS-score. 'Stress' for men and 'health and disability status' for women were important factors associated with depressive symptoms. Future studies should determine whether modification of these factors may prevent depression among the elderly persons living in the community.

An evidence-based assessment of risk factors for the progression of ocular hypertension and glaucoma

Purpose To critically review the existing literature concerning risk factors for progression of ocular hypertension and glaucoma to assist in assigning levels of risk for individual patients. Design Evidence-based review. Methods A panel of physicians specializing in treatment of glaucoma patients was convened to critically analyze published population-based studies of ocular hypertension and glaucoma progression. The strength of evidence in support of reported risk factors was weighed. Results Many putative risk factors for progression of ocular hypertension or glaucoma have been reported in the literature. The risk factors most strongly supported by evidence are higher intraocular pressure (IOP), greater cup-to-disk ratio, thinner central corneal measurement, and older age. Black race does not appear to be an independent risk factor, although black individuals tend to have thinner corneas, greater cup-to-disk ratios, and higher IOP, which increase their risk. The limited number of studies in which other suspected risk factors are reported prevents drawing firm conclusions about their importance at this time. Conclusions Only a subset of patients with ocular hypertension will eventually develop glaucoma. Decisions regarding the implementation and extent of therapy for ocular hypertension can be difficult and require an understanding of the relative importance of risk factors for progression. This review discusses the strength of evidence supporting reported risk factors and may be useful in assessing the risk for progression of individual patients.

Risk factors for low bone mineral density and the 6-year rate of bone loss among premenopausal and perimenopausal women.

Risk factors that are associated with lower bone mineral density (BMD) may not necessarily be associated with increased bone loss among premenopausal and perimenopausal women. We determined risk factors for lower premenopausal and perimenopausal BMD while simultaneously determining risk factors for increased 6-year rate of bone loss among women aged 24-50 years within a population-based prospective cohort study. BMD of the lumbar spine and femoral neck, reported as t scores, were measured five times within the 6-year study among 614 women who were between the ages of 24 and 44 in 1992/1993. Rates of bone loss were calculated from the repeated BMD measurements. Risk factors for lower BMD over time at the lumbar spine included history of any fracture ( P=0.005). The major risk factor for lower BMD over time at the femoral neck was family history of osteoporosis ( P<0.002). The major protective factor for greater BMD over time at both skeletal sites was additional body weight ( P<0.0001). Other protective factors for greater BMD over time at the femoral neck were modest alcohol consumption ( P=0.0002) and high-school sports participation ( P=0.002). Risk factors for greater bone loss at either skeletal site included postmenopausal status ( P<0.0001 at the lumbar spine; P=0.01 at the femoral neck), and the reporting of a reproductive cancer ( P<0.0001 at the lumbar spine; P=0.0008 at the femoral neck). Body weight was protective against bone loss at both skeletal sites ( P<0.0001). Baseline age, calcium intake, smoking, and current physical activity were not associated with BMD or bone loss. The understanding of the relative importance of risk factors for both low BMD and bone loss may assist in the identification of women at greater risk for subsequent low postmenopausal BMD.

Relative importance of risk factors concerning the introduction and spread of classical swine fever and foot-and-mouth disease in Germany

Abstract. This paper describes the results of an expert survey in Germany to obtain the relative importance of risk factors for the introduction and spread of classical swine fever (CSF) and foot-and-mouth disease (FMD). 41 experts from five different fields were interviewed face-to-face, and 151 questionnaires were sent to experts working in the veterinary departments of five selected German federal states. In the questionnaire, experts were asked to estimate and rank situations presenting various degrees of danger. These situations were created by the respective risk factors being either "present" or "not present". The relative importance of each single risk factor was evaluated on the basis of Conjoint Analysis. The results of Conjoint Analysis were subjected to Cluster Analysis to determine whether the similarities in the experts' evaluation of risk situations might have been influenced by their working in the same field or in the same region. The evaluation of the risk factors indicates that for the introduction of CSF and FMD the import of livestock was seen as a great risk with relative importance at 26.1 % / 27.0 % (interview / questionnaire) for CSF and 25.3 % / 27.7 % for FMD, respectively. For CSF, wild boars present an additional risk at 26.8 % / 20.8 %. The danger of spreading both animal diseases rests in indirect contacts in connection with high animal density (32.8 % / 26.9 % for CSF and 39.5 % / 40.9 % for FMD). Animal trade at 27.2 % / 29.3 % was also seen as a danger for the spread of FMD. Cluster Analysis did not show any influence by mutual external conditions. Results were validated by comparing to findings in the literature.

INTER-HEART: A global study of risk factors for acute myocardial infarction

Background Although declines in mortality rates have occurred in most developed countries, increases are being seen in developing countries. Our knowledge of risk factors for acute myocardial infarction (AMI) is largely derived from studies in the former. Applicability of these results to other populations is unknown. The objectives of INTER-HEART are to determine the association between risk factors and AMI within populations defined by ethnicity and/or geographic region and to assess the relative importance of risk factors across these populations. Methods INTER-HEART is a study of 14,000 cases of AMI and 16,000 matched control patients from 46 countries, which was conducted with a standardized protocol. Questionnaires were translated into 11 languages; physical measurements were obtained, and 20 mL of blood was drawn and shipped frozen to a central laboratory in Canada. The study will evaluate the importance of conventional and emerging risk factors within each geographic region and whether their impact varies by region. Results INTER-HEART is sponsored by the World Health Organization and the World Heart Federation and has received funding from several peer-reviewed agencies and many different pharmaceutical companies. A vanguard phase (February 1999 to 2000) enrolled 4000 subjects from 41 countries. Full data collection started in April 2000 and is expected to be completed by October 2002. Conclusions Several years of targeted work have allowed the development of the concepts that were tested in the pilot studies. This has ensured the feasibility of INTER-HEART. This study has the potential to have a major impact in developing a worldwide strategy for cardiovascular disease prevention, especially in developing countries and nonwhite populations. (Am Heart J 2001;141:711-21.)

Risk Assessment for Surgical Site Infections Following Total Hip and Total Knee Prostheses

The purpose of the study was to assess the relative importance of risk factors for surgical site infections (SSI) following total hip and total knee prostheses in the Netherlands. In the period 1996-99 63 hospitals in the Netherlands registered SSI after 36,629 orthopedic operations. Total hip and total knee prostheses were analyzed in detail. The results of our study showed that a long preoperative stay was a risk factor for deep SSIs after both procedures. A dirty or contaminated wound and a serious systemic condition were risk factors for deep SSIs after total hip prostheses. If post-discharge surveillance was carried out, more SSIs were found, for total knee prostheses more than twice as many. Independent risk factors for SSIs after total hip prostheses were a contaminated/dirty wound and for total knee prostheses a short operation duration. The authors conclude that surveillance of surgical site infections following total hip and total knee prostheses revealed different risk factors for (deep) SSIs.

Survival Analysis of Risk Factors for Recidivism in Child Abuse and Neglect

The objective of this study was to examine, in an ecological context, the relative importance of risk factors for chronic recidivism in child abuse/neglect (CA/N). Survival analysis of multiple referrals to Child Protective Services (CPS), supplemented by neural network analysis, shows that a constellation of risk and other factors are associated with the likelihood of recidivism of CA/N. Caregivers distinguish families with multiple referrals by their history of abuse or neglect as children, abuse or neglect that began at an early age, having children with developmental delays, and having multiple victims in the family. Time to rereferral decreases with an increasing number of prior referrals, and there is a marked difference in the time to the first rereferral when compared to subsequent rereferrals. This indicates that referral to CPS reflects conditions that increase the likelihood of additional referrals to CPS. Administrative factors account for some of the variance in multiple referrals.

Risk assessment for surgical-site infections in orthopedic patients.

To assess the relative importance of risk factors for surgical-site infections (SSIs) in orthopedic patients and thereby determine which risk factors to monitor in the national surveillance of SSI in The Netherlands. Reanalysis of data on SSI and associated risk factors from two surveillance projects on nosocomial infections, carried out in 1992 and 1993 in The Netherlands: Project Surveillance Nosocomial Infections in the region of Utrecht (PSZU) and the first Project Surveillance Surgical Wound Infections (SWIFT-1). Odds ratios (ORs) were calculated for age, gender, preoperative stay, and the number of operations. In addition, in PSZU, other nosocomial infections, and, in SWIFT-1, prophylactic antibiotics, acute surgery, and wound contamination were studied. The study was confined to hospitalized orthopedic patients (PSZU, 4,872; SWIFT-1, 6,437). In PSZU, the following ORs were significant in a multivariate model: age 0-44 years, 1.0; 45-64 years, 1.6; 65-74 years, 4.7; and 75-99 years, 6.0. For a preoperative stay over 4 days, the OR was 3.3 (95% confidence interval [CI95], 2.5-4.0), and for multiple surgery, 2.5 (CI95, 1.9-3.0). For females, the OR was 0.8 (not significant). The same model applied to SWIFT-1 gave similar ORs. Adjustment for additional nosocomial infections (PSZU) decreased the ORs for ages over 65 years remarkably. The OR for additional nosocomial infections in patients under 65 years of age was 15.6 (CI95, 4.3-57.4). Adjustment for prophylactic antibiotics, acute surgery, and wound-contamination class (SWIFT-1) did not influence the ORs of the original model, but showed that wound-contamination class was an important risk factor. Age, additional nosocomial infections, wound-contamination class, preoperative stay, and the number of operations were identified as important risk factors for SSI in Dutch orthopedic patients.

Toward a clinical model of suicidal behavior in psychiatric patients.

Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study. Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed. Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters. The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.

Do They Grow Out of It? Long-Term Outcomes of Childhood Disorders

Back to table of contents Previous article Next article Book Forum: DEVELOPMENTAL PSYCHOPATHOLOGYFull AccessDo They Grow Out of It? Long-Term Outcomes of Childhood DisordersJENNIFER BREMER, M.D., JENNIFER BREMERSearch for more papers by this author, M.D., Boston, Mass.Published Online:1 May 1998https://doi.org/10.1176/ajp.155.5.701AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail What happens to children with psychiatric disorders as they grow up? Do they grow out of it as the title asks? The importance of this book lies in both the critical questions it addresses and the concise, scientific nature of its answers.Some of the foremost experts in their fields present data on outcomes of childhood attention deficit hyperactivity disorder (ADHD), comorbidity with ADHD, conduct disorder, depression, suicidal behavior, anxiety disorders, obsessive-compulsive disorder, pervasive developmental disorder, and speech and language disorders. The authors look at the factors that influence outcome, including several therapies, medications, developmental factors, and social factors. The answer to the title's question about outcomes, of course, varies for each disorder and according to risk factors.Framed by chapters on research issues and clinical implications of longitudinal research, the text abounds with descriptions of outcome studies, generally including the research designs. Although the copious data and the disparate styles of the authors make the text somewhat dense and disjointed, they also make for an exceptional reference.The book's extensive data on outcomes will prove an essential resource to the clinician in guiding clinical decisions. By understanding the relative importance of risk factors and diagnoses to outcome, the clinician can better establish priorities for treatments. For example, in “Suicidal Behavior,” Cynthia Pfeffer describes substance use as a leading risk factor for completed suicide in depressed children, increasing the risk of suicide fourfold. This information would lead a clinician to focus on substance use issues in a depressed child.The book also offers information that will be important in helping families and children understand the course of illness. For example, in “Childhood Anxiety Disorders,” Diane Maj~cher and Mark Pollack report data indicating that children under 11 years old are three times more vulnerable to posttraumatic stress disorder (PTSD) than older children and that 60% of children exposed to a sniper had PTSD symptoms a month later. Such information can help normalize early PTSD symptoms after acute trauma in young children.In the final chapter, “Clinical Issues in Longitudinal Research,” Gabrielle Weiss presents colorful vignettes of children with ADHD followed for 15 years. The choice of professions and of mates helped these children grow into successful adults and cope with their illnesses. In describing Weiss's vignettes in the preface, the editor says, “These histories leave an indelible picture of people struggling courageously and creatively to adapt and succeed despite adversities. They teach all of us the true meaning of long-term outcome of childhood disorders” (p. xv). By ending with these vignettes, Hechtman leads the reader to contemplate the natural next question: How do some children grow out of it?edited by Lily Hechtman, M.D., F.R.C.P.C. Washington, D.C., American Psychiatric Press, 1996, 263 pp., $40.00. FiguresReferencesCited byDetailsCited byNone Volume 155Issue 5 May 1998Pages 701-701 Metrics PDF download History Published online 1 May 1998 Published in print 1 May 1998

Concerns and Misconceptions about Cardiovascular Disease Risk Factors: A Focus Group Evaluation with Low-Income Hispanic Women

Fivefocus groups were conducted with Hispanic women (primarily of Mexican American heritage) from low-income neighborhoods in San Jose, California, to learn about their knowledge of cardiovascular disease (CVD) riskfactors, the relative importance of risk factors, and ideas about effective CVD risk-reduction programs. Despite language barriers and economic disadvantages, women were highly aware of heart disease and described it as a health priority. However, they articulated many misconceptions about CVD and experienced multiple barriers to healthy lifestyles. The most frequently mentioned risk factor was poor nutrition, especially high dietary fat (mentioned 543 times). The next most frequently mentioned risk factors were physical inactivity (127 times), obesity (86 times), and smoking (78 times). Few women viewed CVD as a progressive, chronic process; few associated obesity with heart disease; andfew emphasized the importance of hypertension and diabetes as primary CVD risk factors.

Relative Importance of Risk Sources in Insurance Systems

Actuaries, and other managers of uncertainty, identify factors in modeling insurance risks because they believe (1) that these factors affect the outcome of a risk or (2) that the factors can be managed, thus allowing analysts a degree of control over the insurance system. This paper shows how to use a statistical measure, the coefficient of determination, for quantifying the relative importance of a source of uncertainty. With a quantitative measure of relative importance, risk managers can sharpen their intuition about the relative importance of risk factors and become better custodians of financial security systems. This paper shows that the coefficient of determination is intuitively appealing in assessing the effectiveness of basic risk management techniques including risk exchange, pooling, and financial risk management. A single source common to all risks reduces the effectiveness of a pool; the risk measure quantifies the relative importance of this common source. The coefficient of determination is shown to have roots in the economics as well as the statistics literature. This connection provides further motivation for using the coefficient of determination and also suggests alternative measures for quantifying relative importance. The risk measure is useful in multivariate situations in which several factors affect a risk simultaneously. The paper illustrates this usefulness by considering a pool of policies that is subject to mortality, a common disaster, and a common investment environment.

Introduction of contagious animal diseases into The Netherlands: elicitation of expert opinions

This paper describes an experiment aimed at the derivation of information on Foot-and-Mouth Disease, Classical and African Swine Fever, Swine Vesicular Disease, Newcastle Disease and Avian Influenza to be used in an economic model to simulate introduction of a virus into the Netherlands. Several elicitation techniques, including three-point estimation, Conjoint analysis and ELI were used in the experiment. Three-point estimation (asking for minimum, most likely, and maximum values) was used to derive information concerning the length of the High Risk Period (HRP), during which the virus may spread freely. Conjoint analysis is widely used in marketing and consumer science and was used in this experiment to elicit the relative importance of risk factors which may introduce disease into the Netherlands (such as import of livestock, import of animal products, etc.). The ELI-technique (ELIcitation of uncertain knowledge) originates from the area of mathematical psychology and was used to derive information on the expected number of outbreaks of the diseases under consideration in European countries. The experiment was conducted with 43 (out of 50) invited people, all involved in or related to disease control in one way or another. The participants expected, for all diseases, the longest HRP in countries of eastern Europe. Import of livestock was evaluated as the most important risk factor for all diseases under consideration. Most outbreaks within the next five years were expected to occur in countries of eastern Europe, the smallest number in the Netherlands and the Scandinavian countries. Results especially showed that Conjoint analysis and ELI are useful tools to help quantify subjective knowledge. These subjective elicitation methods may not reveal the `Golden Standard' but as long as `objective' predictive information is not available, use of these tools may be valuable to enhance quality of input and output of economic simulation models to support policy-making in the prevention and control of contagious animal diseases.

Risk factors for acute myocardial infarction in Indians: a case-control study

South Asians who have settled overseas and those in urban India have an increased risk of ischaemic heart disease (IHD). Reasons for this increased risk are unclear. Most studies have been based on migrants to western nations, so their findings may not apply to most south Asians, who live in their own countries. Therefore, we assessed the relative importance of risk factors for IHD among South Asians in Bangalore, India. We conducted a prospective hospital-based case-control study of 200 Indian patients with a first acute myocardial infarction (AMI) and 200 age and sex matched controls. We recorded prevalence of the following risk factors for IHD: diet, smoking, alcohol use, socioeconomic status, waist to hip ratio (WHR), blood glucose, serum insulin, oral glucose tolerance test, and lipid profile. The most important predictor of AMI was current smoking (odds ratio [OR] 3.6, p < 0.001) of cigarettes or beedis (a local form of tobacco), with individuals who currently smoked 10 or more per day having an OR of 6.7 (p < 0.001). History of hypertension and of overt diabetes mellitus were also independent risk factors (OR 2.69 [p = 0.001] and 2.64 [p = 0.004], respectively). Among all individuals, fasting blood glucose was a strong predictor of risk over the entire range, including at values usually regarded as normal (OR adjusted for smoking, hypertension, and WHR 1.62 for 1 SD increase, p < 0.001). Abdominal obesity (as measured by WHR) was also a strong independent predictor across the entire range of measures (OR adjusted for smoking, hypertension, and blood glucose 2.24 for 1 SD increase; p < 0.001). Compared with individuals with no risk factors, individuals with multiple risk factors had greatly increased risk of AMI (eg, OR of 10.6 for the group with smoking and elevated glucose). Lipid profile was not associated with AMI. In univariate analyses, higher socioeconomic (income) status (OR 0.32, p = 0.005 highest vs lowest; OR 0.75 middle vs lowest) and vegetarianism (OR = 0.55, p = 0.006), seemed to be protective. The impact of vegetarianism was closely correlated with blood glucose and WHR. Smoking cessation, treatment of hypertension, and reduction in blood glucose and central obesity (perhaps through dietary modification) may be important in preventing IHD in Asian Indians.

Eliciting the relative importance of risk factors concerning contagious animal diseases using conjoint analysis: a preliminary survey report

Conjoint analysis is a technique well known in marketing research to elicit consumer preferences and opinions. This paper describes the results of an experiment which explores the potential application of conjoint analysis in the field of veterinary epidemiology and economics. In this experiment, the method of conjoint analysis was used to elicit the opinion of experts about the relative importance of risk factors concerning contagious animal diseases. Diseases studied were: African Swine Fever (ASF), Classical Swine Fever (CSF), Foot-and-Mouth Disease (FMD), Swine Vesicular Disease (SVD), Newcastle Disease (NCD) and Avian Influenza (AI). Risk factors included were import of livestock, import of animal products, feeding of swill, tourists, returning livestock trucks and air. The conjoint analysis technique was used to draw up a questionnaire which was handed out during the 7th ISVEE held at Nairobi, Kenya, from 15 to 19 August 1994. According to the experts approached, the factors ‘import of livestock’ and ‘import of animal products’ were the major sources of risk for all diseases. For ASF, CSF and FMD, the risk factor ‘swill feeding’ ranked third. For FMD and the two poultry diseases NCD and AI, only the risk factor ‘air’ was important. Overall conclusion was that conjoint analysis could be a useful method for eliciting the opinion of experts about risk factors concerning contagious animal diseases. In further research, special attention should be given to the selection of experts and the presentation of the conjoint questions.

Risk assessment after acute upper gastrointestinal haemorrhage.

The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorizes patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. A total of 4185 cases of acute upper gastrointestinal haemorrhage over the age of 16 identified over a four month period in 1993 and 1625 cases identified subsequently over a three month period in 1994 were included in the study. It was found that age, shock, comorbidity, diagnosis, major stigmata of recent haemorrhage, and rebleeding are all independent predictors of mortality when assessed using multiple logistic regression. A numerical score using these parameters has been developed that closely follows the predictions generated by logistical regression equations. Haemoglobin, sex, presentation (other than shock), and drug therapy (non-steroidal anti-inflammatory drugs and anticoagulants) are not represented in the final model. When tested for general applicability in a second population, the scoring system was found to reproducibly predict mortality in each risk category. In conclusion, a simple numerical score can be used to categorize patients presenting with acute upper gastrointestinal haemorrhage by risk of death. This score can be used to determine case mix when comparing outcomes in audit and research and to calculate risk standardised mortality. In addition, this risk score can identify 15% of all cases with acute upper gastrointestinal haemorrhage at the time of presentation and 26% of cases after endoscopy who are at low risk of rebleeding and negligible risk of death and who might therefore be considered for early discharge or outpatient treatment with consequent resource savings.