Variety Of Risk Factors Research Articles

Prevalence and Risk Factors of Hepatitis B, Hepatitis C and HIV Viruses Among People Who Use Drugs (PWUD) in Kabul, Health Care Facilities

Background: Human immunodeficiency virus (HIV), hepatitis B (HBV) and C (HCV) viruses infect millions of people around the world. People who use drugs (PWUD) are at high risk of such viral diseases and could be the source of these infections to other people. Shared needle, unsafe extra-marital sexual contact, skin popping and other risky behaviors are well-known risk factors for the prevalence of these infections among PWUD worldwide. There is no valid information regarding the danger and rate of the above-mentioned viral infections and associated risk factors among PWUD referred to healthcare facilities in Kabul, Afghanistan for the treatment and support. Objectives: The main objective of this study was to determine the prevalence and risk factors of HBV, HCV, and HIV among PWUD in Kabul, healthcare facilities. Methods: This study was conducted in 7 public and private healthcare facilities at the primary care level in Kabul, which provides social support and medical care to PWUD. All patients who referred to the healthcare facilities from May 2016 to October 2016 and signed the consent were included in this study. Results: Out of 410 PWUD, 15 (3.7%) were positive for the HBV surface antigen (HBsAg), 45 (11%) were positive for HCV antibody, and one (0.2%) was positive for HIV antibody. Among the risk factor variables studied, the administration of drugs by injection was considered the most important for HCV (OR = 3.80, P < 0.01) and viral infections among PWUD (OR = 5.40, P < 0.01). Conclusions: This study draws attention to the high prevalence and spread of viral hepatitis among PWUD in Kabul, Afghanistan. The prevalence of HCV and HBV was higher among PWUD compared to general populations, and drug use via injection was an important risk factor for transmitting viral infections. Based on our results, active preventive programs focusing on educational campaigns targeted at the youth populations should be undertaken in Afghanistan. Further studies, especially among PWUD living without shelter in Kabul and other major cities of Afghanistan, are recommended in order to better analyze the dangers among drug addicts in Afghanistan.

DISTRIBUTION AND FREQUENCY OF BEHAVIORAL RISK FACTORS AMONG STUDENTS

The health status of the population for the last few years is connected with increased frequency and severity of chronic non-infectious diseases, including diseases of blood circulation, respiratory diseases, diabetes, cancers, psychosis and traumatism. They are at the base of the disease-related mortality and the researching of this problem show the existence of common risk factors which are related with the life style. A feature of the non-infectious diseases is their massive appearance as a result of many reasons and exposure to risk factors with a long-term impact. Throughout their lives, people are exposed to many factors which are affecting their health. Most of the behavioral risk factors increase the probable appearance of adversely health events and the opportunity of developing a particular disease. Among the variety of risk factors in our modern society basically stand out as follows: smoking, alcohol and psychoactive drugs abuse, psychosocial stress, irrational nutrition, unhealthy sexual behavior and self-healing. The risk factors do not occur in isolation one from another and do not impact alone so one factor in many cases is connected with more than one disease and the diseases appear and develop as a result of interaction of many reasons and predisposing factors. That is why controllable and modifiable risk factors deserve a special attention as a part of behavioral health determinants. The spread of behavioral risk factors among young people, including students is a current issue. We can see an increase of frequency of these factors, decrease of the starting age of use and abuse of the listed substances and increase of their weight on population level. The object of this study are the students of Ruse University “Angel Kanchev” and their exposure to three risk factors-smoking, use of alcohol and psychoactive substances, as we are analyzing their frequency among the studied population and to what extend they are distributed among the students. In this study we are following the contemporary attitude to specific behavioral risk factors and their current characteristics, we are studying the preconditions leading to use of psychotropic substances among students and we are defining the combination of the studied risk factors and to what extent they are distributed among the population. The expectations of this study were that it would help to evaluate correctly the distribution of these behavioral risk factors among this young population. This can be helpful in developing of prevention and intervention programs for limiting of chronic non-infectious diseases and of their negative influence on the socio-economic development.

Distinct mortality patterns at 0\u20132\u2009days versus the remaining neonatal period: results from population-based assessment in the Indian state of Bihar

BackgroundThe objectives of this study were to understand the differences in mortality rate, risk factors for mortality, and cause of death distribution in three neonatal age sub-groups (0–2, 3–7, and 8–27 days) and assess the change in mortality rate with previous assessments to inform programmatic decision-making in the Indian state of Bihar, a large state with a high burden of newborn deaths.MethodsDetailed interviews were conducted in a representative sample of 23,602 live births between January and December 2016 (96.2% participation) in Bihar state. We estimated the neonatal mortality rate (NMR) for the three age sub-groups and explored the association of these deaths with a variety of risk factors using a hierarchical logistic regression model approach. Verbal autopsies were conducted using the PHMRC questionnaire and the cause of death assigned using the SmartVA automated algorithm. Change in NMR from 2011 to 2016 was estimated by comparing it with a previous assessment.ResultsThe NMR 0–2-day, 3–7-day, and 8–27-day mortality estimates in 2016 were 24.7 (95% CI 21.8–28.0), 13.2 (11.1 to 15.7), 5.8 (4.4 to 7.5), and 5.8 (4.5 to 7.5) per 1000 live births, respectively. A statistically significant reduction of 23.3% (95% CI 9.2% to 37.3) was seen in NMR from 2011 to 2016, driven by a reduction of 35.3% (95% CI 18.4% to 52.2) in 0–2-day mortality. In the final regression model, the highest odds for mortality in 0–2 days were related to the gestation period of ≤ 8 months (OR 16.5, 95% CI 11.9–22.9) followed by obstetric complications, no antiseptic cord care, and delivery at a private health facility or home. The 3–7- and 8–27-day mortality was driven by illness in the neonatal period (OR 10.33, 95% CI 6.31–16.90, and OR 4.88, 95% CI 3.13–7.61, respectively) and pregnancy with multiple foetuses (OR 5.15, 95% CI 2.39–11.10, and OR 11.77, 95% CI 6.43–21.53, respectively). Birth asphyxia (61.1%) and preterm delivery (22.1%) accounted for most of 0–2-day deaths; pneumonia (34.5%), preterm delivery (33.7%), and meningitis/sepsis (20.1%) accounted for the majority of 3–7-day deaths; meningitis/sepsis (30.6%), pneumonia (29.1%), and preterm delivery (26.2%) were the leading causes of death at 8–27 days.ConclusionsTo our knowledge, this is the first study to report a detailed neonatal epidemiology by age sub-groups for a major Indian state, which has highlighted the distinctly different mortality rate, risk factors, and causes of death at 0–2 days versus the rest of the neonatal period. Monitoring mortality at 0–2 and 3–7 days separately in the traditional early neonatal period of 0–7 days would enable more effective programming to reduce neonatal mortality.

Impact of substance use and other risk factor exposures on conviction rates by people with a psychotic illness and other mental disorders

To examine the impact of substance use and other risk factors on conviction rates in people with a psychotic illness (PI) and other mental disorders (OMD) compared to those with no mental illness (NMI). This research is part of a longitudinal record-linked whole-population study of 467,945 children born in Western Australia (WA) between 1980 and 2001. This cohort was identified through linkages between the WA psychiatric case register, WA corrective services data and other state-wide registers. We assessed 184,147 individuals born during 1983-1991 to explore the impact of exposure to a variety of risk factors on conviction rates. People with PI and OMD had higher conviction rates than those with NMI, with unadjusted incidence rate ratios (IRR) of 3.98 (95% CI 3.67-4.32) for PI and 3.18 (95% CI 3.03-3.34) for OMD. Adjusting for substance use reduced the rates by 60% in PI and 30% in OMD: IRRs 1.59 (95% CI 1.45-1.74) and 2.24 (2.12-2.37), respectively. Minimal change was seen when adjusting for other potential risk factors (including socio-demographics, victimisation and parental offending), with adjusted IRRs 1.58 (95% CI 1.43-1.74) for PI and 1.90 (95% CI 1.80-2.02) for OMD. Our analysis shows people with a mental illness have higher rates of conviction than those with NMI. Substance use has a major impact on this rate. Results suggest the need for a greater investment in programs addressing the issue of comorbid substance use with a view to reduce the rate of convictions in this population.

Improving midterm results justify the continued use of bare-metal stents for endovascular therapy for chronic mesenteric ischemia

ObjectiveThe objective of this study was to evaluate the contemporary results of interventions in the celiac axis (CA) and superior mesenteric artery (SMA) for chronic mesenteric ischemia (CMI) and factors associated with patency and symptom-free survival. MethodsA retrospective review of patients with CMI treated with angioplasty and stenting with bare-metal stents from 2003 to 2014 was conducted. Demographic, history, risk factor, preoperative testing, and technical variables were collected and subject to univariate analysis, with end points of patency loss. The patients were divided into early (2003-2008) and late (2009-2014) groups to compare early and contemporary results. Correlates of patency were then subject to further univariate and multivariable analysis. ResultsFrom 2003 to 2014, there were 150 patients (39 men, 111 women; age, 70.7 ± 11.1 years) with CMI who underwent interventions on the CA (56 vessels) and the SMA (133 vessels); 38 patients had both CA and SMA intervention. Primary patency for the CA was 86% (95% confidence interval [CI], 73-99) at 1 year and 66% (95% CI, 46-87) 3 years; for the SMA, primary patency was 81% (95% CI, 72-89) at 1 year and 69.0% (95% CI, 58-81) at 3 years. Increased age was associated with improved results in the SMA (hazard ratio [HR], 0.96; 95% CI, 0.92-1.00; P = .028). Chronic total occlusion in the SMA conferred worse patency compared with stenosis (HR, 2.38; 95% CI, 1.03-5.47; P = .042), and younger patients (<70 years) had a higher proportion of SMA occlusion (38.9% vs 22.8; P = .045). In the SMA, comparing early (2003-2008; 68 patients) vs late (2009-2014; 65 patients), primary patency was better in the late experience (3 years, 59% vs 77%; P = .016). The late cohort was older (early, 68.1 ± 12.5 years vs 72.5 ± 9.7 years; P = .024). The late cohort had a higher incidence of ostial flaring of the stent (early, 44.1%; late, 72.3%; P < .001). Multivariable analysis revealed only ostial flaring to be associated with improved patency in the SMA (HR, 0.29; 95% CI, 0.12-0.69; P = .006). ConclusionsIntervention for CMI has acceptable midterm results, and with experience and adoption of newer techniques, the results appear to be improving. Patients older than 70 years have better results than younger patients, and this may reflect a more malignant presentation in the younger patients. Ostial flaring proved to be the single factor on multivariate analysis associated with improved patency and was adopted in the late group. These data support the continued use of bare-metal stents in the treatment of CMI.

Prevalence and pattern of risk factors for non-communicable diseases in urban population of Jaipur, Rajasthan

Background: Majority of the risk factors for NCDs are measurable and modifiable thus continuous surveillance of the levels and pattern of these risk factors is of fundamental importance. Taking cognizance of Jaipur city rapidly adopting to metropolitan culture; this study may mark an important milestone in surveillance activities and setting preventive priorities for NCDs in the state of Rajasthan. Aim of the study is to measure prevalence and associated variables of major risk factors for NCDs in the age group of 25-64 years.Methods: It is a cross sectional, descriptive study, conducted on 1454 person aged 25 to 64 years, residing in Jaipur city, from 1st June 2012 to 31st December 2013, using two steps of ‘standard WHO STEPS structured instrument’. Categorical data were expressed in form of percentage. Chi-square test was used to analyse difference in proportions. Continuous data were summarized in form of mean and SD. The differences in means were analysed by student’s t test.Results: At least one risk factor was present in all persons moreover 35% had multiple risk factors. Multiple risk factors were present even in 20% of relatively young adults (25-34 years). Tobacco and alcohol consumption was seen in 28% and 29% respectively. Standard of living index was associated with obesity, hypertension and low physical activity but not with alcohol use, smoking and daily consumption of fruit &amp; vegetable. Male consumed more alcohol, indulged in less physical activity and smoked more than twelve times than females.Conclusions: Educating younger population for healthy lifestyle adoption and focused educational intervention with strict enforcement of existing laws will be helpful in controlling this epidemic of NCD.

Weight Misperception in Young Adults: Race and Gender Based Disparities (P04-108-19)

ObjectivesThe purpose of this study was to explore the extent of weight misperception in college students. MethodsA 21-item electronic survey was sent to undergraduate students in selected general education classes at a Midwestern University. The survey was tested for face, content, & construct validity. Based on a power analysis (99% confidence level & 5% margin of error), 643 completed surveys were required to ensure adequate external validity for the entire population of students in the University (n = 20,000). ResultsA total of 1145 students completed the survey (response rate = 77%). Majority were White (76%), females (65%), 18–20 years (72%), first or second year students (69%), pursuing a non-health related degree (60%). Based on BMI, 34% were overweight. When asked about weight perception- 37% felt they were overweight, 50% were attempting to lose weight, but the majority (65%) did not believe their body weight was a health problem & did not have their waist circumference assessed in the past year (78%). Based on actual BMI & perceived weight, all participants were grouped into four distinct categories [true negative (53%) = normal BMI/accurate weight perception; false negative (8%) = high BMI/weight underestimation; false positive (12%) = normal BMI/weight overestimation; & true positive (27%) = high BMI/accurate weight perception]. Statistically significant differences were observed based on age, gender, & race in weight misperception with younger, females, & Hispanic students more likely to overestimate their weight & older, black, & male students more likely to underestimate their weight (P < 0.05). Older white students were least likely to have weight related misperception. In regression analysis weight misperception was a significant predictor of weight loss attempts (even if weight loss was not required) & the belief that body weight was a major health problem. Academic major & general health status were additional significant predictors of body weight & weight misperception. ConclusionsWeight misperception has been shown to be associated with a variety of risk factors (e.g., unhealthy weight loss methods & eating disorders). Evidence-based educational interventions tailored to the unique population of college students should be implemented for appropriate weight management. Funding SourcesNo funding was received for this study.

Monitoring Progression of Ductal Carcinoma In Situ Using Photoacoustics and Contrast-Enhanced Ultrasound

Breast cancer is the leading form of cancer in women, accounting for approximately 41,400 deaths in 2018. While a variety of risk factors have been identified, physical exercise has been linked to reducing both the risk and aggressiveness of breast cancer. Within breast cancer, ductal carcinoma in situ (DCIS) is a common finding. However, less than 25% of DCIS tumors actually progress into invasive breast cancer, resulting in overtreatment. This overtreatment is due to a lack of predictive precursors to assess aggressiveness and development of DCIS. We hypothesize that tissue oxygenation and perfusion measured by photoacoustic and contrast-enhanced ultrasound imaging, respectively, can predict DCIS aggressiveness. To test this, 20 FVB/NJ and 20 SV40Tag mice that genetically develop DCIS-like breast cancers were divided evenly into exercise and control groups and imaged over the course of 6 weeks. Tissue oxygenation was a predictive precursor to invasive breast cancer for FVB/NJ mice (P = 0.015) in the early stages of tumor development. Meanwhile, perfusion results were inconclusive (P > 0.2) as a marker for disease progression. Moreover, voluntary physical exercise resulted in lower weekly tumor growth and significantly improved median survival (P = 0.014).

Oestradiol: any role in cardiovascular risk factors in female centenarians of Hainan?

BackgroundPrevious studies reported that low level of oestradiol (E2) was associated with higher risk of cardiovascular disease (CVD). However, little study examined the relationship between E2 and CVD in longevous women, which were deficient in serum E2 for the post-menopausal status. Therefore, this study aims to explore the association between E2 and CVD risk factors in a group of female centenarians of Hainan, China.MethodsA total of 413 female centenarians (aged from 100 to 115) from China Hainan Centenarian Cohort Study (CHCCS) were enrolled in this study. Home interviews were conducted to collected data on demographic characteristics, health-related lifestyles, and anthropometrics. The level of serum E2 was assessed in the Clinical Laboratory of Hainan branch of PLA General Hospital. The variables of CVD risk factors, including blood pressures, lipids and blood glucose, were measured through standard procedures.ResultsSignificant negative correlations between levels of serum E2 and TC, HDL-C, and LDL-C were observed in this study. Compared with the highest group of E2, the odds ratio and 95% confidence intervals of high LDL-C in groups 3, 2 and 1 were OR1.94 (CI0.82–4.62), OR3.61 (CI1.27–10.25) and OR9.29 (CI2.08–41.53), respectively. Similarly, the prevalence of hypertension was decreased with the increase of serum E2. The odds ratio and 95% confidence intervals of stage-2 hypertension in groups 3, 2 and 1 versus highest E2 group were OR1.34 (CI0.49–3.72), OR1.36 (CI0.47–3.99) and OR1.38 (CI0.45–4.20), respectively.ConclusionsThis study examined the relationship between E2 and CVD risk factors in a group of community-based female centenarians. A negative correlations between serum E2 levels and CVD risk factors, i.e. high level of LDL-C, TC, and hypertension were observed in this population. Besides, the level of serum E2 is also negatively correlated with HDL-C. Further studies on the correlation between serum E2 and CVD risk factors, especially dyslipidemia, in longevous and post-menopausal women are warranted.

Evaluation of a method to indirectly adjust for unmeasured covariates in the association between fine particulate matter and mortality

BackgroundIndirect adjustment via partitioned regression is a promising technique to control for unmeasured confounding in large epidemiological studies. The method uses a representative ancillary dataset to estimate the association between variables missing in a primary dataset with the complete set of variables of the ancillary dataset to produce an adjusted risk estimate for the variable in question. The objective of this paper is threefold: 1) evaluate the method for non-linear survival models, 2) formalize an empirical process to evaluate the suitability of the required ancillary matching dataset, and 3) test modifications to the method to incorporate time-varying exposure data, and proportional weighting of datasets. MethodsWe used the association between fine particle air pollution (PM2.5) with mortality in the 2001 Canadian Census Health and Environment Cohort (CanCHEC, N = 2.4 million, 10-years follow-up) as our primary dataset, and the 2001 cycle of the Canadian Community Health Survey (CCHS, N = 80,630) as the ancillary matching dataset that contained confounding risk factor information not available in CanCHEC (e.g., smoking). The main evaluation process used a gold-standard approach wherein two variables (education and income) available in both datasets were excluded, indirectly adjusted for, and compared to true models with education and income included to assess the amount of bias correction. An internal validation for objective 1 used only CanCHEC data, whereas an external validation for objective 2 replaced CanCHEC with the CCHS. The two proposed modifications were applied as part of the validation tests, as well as in a final indirect adjustment of four missing risk factor variables (smoking, alcohol use, diet, and exercise) in which adjustment direction and magnitude was compared to models using an equivalent longitudinal cohort with direct adjustment for the same variables. ResultsAt baseline (2001) both cohorts had very similar PM2.5 distributions across population characteristics, although levels for CCHS participants were consistently 1.8–2.0 μg/m3 lower. Applying sample-weighting largely corrected for this discrepancy. The internal validation tests showed minimal downward bias in PM2.5 mortality hazard ratios of 0.4–0.6% using a static exposure, and 1.7–3% when a time-varying exposure was used. The external validation of the CCHS as the ancillary dataset showed slight upward bias of −0.7 to −1.1% and downward bias of 1.3–2.3% using the static and time-varying approaches respectively. ConclusionsThe CCHS was found to be fairly well representative of CanCHEC and its use in Canada for indirect adjustment is warranted. Indirect adjustment methods can be used with survival models to correct hazard ratio point estimates and standard errors in models missing key covariates when a representative matching dataset is available. The results of this formal evaluation should encourage other cohorts to assess the suitability of ancillary datasets for the application of the indirect adjustment methodology to address potential residual confounding.

Corporate Governance: A Study on Shengzhen Airlines Scandals

The purpose of this study is to explore the relationship between profitability and corporate governance of Shenzhen Airlines. I picked out the five samples and study the relationship of the corporate governance and scandal, corporate governance and bankruptcy or Altman Z, the relationship between corporate governance and performance, the relationship between corporate governance and Tobin Q, the relationship between corporate governance and the relationship between macroeconomics, this study used 2009 to 2013 years in a row in its annual report from the enterprise to obtain the second-hand data for research. The dependent variable of the relationship between corporate regulation and risk factor variables such as ROA, 'ROE, Tobin's Q, AltmanZ, GDP per capital, unemployment rate and exchange rate. Correlation and regression results were obtained by using SPSS to observe the significance level of risk and profit. Based on the results obtained, the regression analysis shows that only three of the seven factors, ROA, Tobin's Q and AltmanZ, have the greatest impact on the profit margin.

Emotional and Behavioral Problems among Left-Behind Children in Indonesia.

Background:The number of migrant workers in Indonesia has been increasing over the years. Most of the migrant workers are females with children, creating a huge number of left-behind children (LBC). The issue of LBC has become important to discuss because LBC tends to experience more emotional and behavioral problems than non-LBC. The aim of this study was to assess and compare emotional and behavioral problems between LBC and non-LBC in Indonesia. This paper analyzes data from a project by the Community Mental Health Research Group from the Faculty of Psychology, Universitas Indonesia, held in 2015 − 2016.Materials and MethodsParticipants were 629 adolescents: 359 LBC and 270 non-LBC. The data were acquired in a cross-sectional study conducted in rural Indonesia. Data on emotional and behavioral problems were assessed with Strength and Difficulties Questionnaire, while data related to risk factor variables were collected using multidimensional scale of perceived social support, the 6-item De Jong Gierveld Loneliness Scale, and Inventory of Parent and Peer Attachment. The data were analyzed with descriptive statistics and multiple regression analysis.Results:The prevalence of emotional and behavioral problems in LBC was 28.4% compared to 21% among non-LBC. Peer attachment, communication, social support, and loneliness were identified as factors that impact the emotional and behavioral problems among LBC.Conclusions:LBC has more emotional and behavioral problems than non-LBC. Comprehensive understanding of various protective and risk factors is needed to provide impactful interventions for LBC.

Gendered perceptions of osteoporosis: implications for youth prevention programs.

The presentation of osteoporosis as a woman's disease in prevention information influences how osteoporosis is perceived and how prevention information is internalized and applied. Using the Health Belief Model as a framework, gendered perceptions of osteoporosis were investigated in Canadian young adults to inform the design of prevention programs. A combination of the Osteoporosis Health Belief Scale (OHBS) and semi-structured interviews were used to explore participants' perceptions of osteoporosis severity, susceptibility, and motivation to engage in prevention activities. Sixty multiethnic men and women aged 17-30 years living in Hamilton, Ontario, Canada participated in the study. While the findings from the OHBS indicated that both genders scored high for self-efficacy, the results from the qualitative interviews showed ambivalent attitudes toward prevention behaviors, indicating a disconnect between quantitative and qualitative findings. Perceptions related to severity and susceptibility revealed that while osteoporosis was generally viewed as a woman's disease, perceived individual risk of disease was a negotiation between larger gender constructs of osteoporosis and a variety of risk factors. This study indicates that osteoporosis prevention programs should consider actively acknowledging gendered and youth-based conceptions of osteoporosis in order to increase prevention behaviors in the whole population to reduce future disease.

Peripheral neuropathy in patients with human immunodeficiency viral infection at a tertiary hospital in Ghana

Peripheral neuropathy (PN) is the most frequent neurological complication in people living with HIV/AIDS. Neurological damage was identified to not only be caused by the viral infection itself but also through neurotoxic antiretroviral therapy (ART). PN is associated with a variety of risk factors; however, detailed knowledge is scarce for sub-Saharan African populations, bearing among the highest HIV/AIDS infection burden.In a cross-sectional study, we assessed the prevalence of PN in 525 adult outpatients suffering from HIV/AIDS and admitted to the largest tertiary hospital in Ghana. Through a detailed questionnaire and clinical examination including neurologic assessment and laboratory blood sample testing, this study investigated associations of PN with demographic and health determinants and identified risk factors associated with sensory neuropathy.The prevalence of PN in the Ghanaian cohort was 17.7% and increased odd ratios (OR) when patients were taller (> 1.57 m; OR = 3.84; 95% CI 1.38–10.66) or reached the age > 34 years (p = 0.124). Respondents with longer education duration had significantly less PN (≥ 9 years of education; OR = 0.49; 95% CI 0.26–0.92). The study also identified significant association of PN to both waist and hip girth and neutrophil counts. Curiously, higher adjusted odd ratios (aOR) of PN of patients under ART treatment were observed when CD4 lymphocytes were elevated (aOR = 0.81; 95% CI 0.36–1.83 and aOR = 2.17; 95% CI 0.93–5.05, for 300 and 600 counts, respectively). For patients on ART, an increase of 10 CD4 cell count units increased their chance of developing PN by 1% (aOR = 1.01; 95% CI 1.00 to 1.03).Despite current drug application regulations, prevalence of PN is still unacceptably high in sub-Saharan African populations. Reduction in chronic morbidity through a health system with routine monitoring, early diagnosis and prompt intervention, and effective case management can improve people living with HIV/AIDS’ quality of life.

Explainable AI in Healthcare

The traditional cardiology prediction model includes factors like age, total cholesterol, HDL cholesterol, smoking, blood pressure, and diabetes. But the machine algorithms turned up a wider array of factors in their models, including: COPD, severe mental illness, prescription of oral corticosteroids, triglyceride levels, atrial fibrillations, chronic kidney disease, and rheumatoid arthritis. Allowing machines to learn risk factors in a huge number of patients makes for better predictions of heart attacks. Machine-learning significantly improves accuracy of cardiovascular risk prediction, increasing the number of patients identified who could benefit from preventive treatment, while avoiding unnecessary treatment of others. However, the use of machine learning algorithms has been limited due to the lack of interpretability of more complex models, reducing the trust of users in the model. The solution to the limitation of the ‘black-box’ nature of machine-learning algorithms, in particular neural networks, which are difficult to interpret, the inherent complexity in how the risk factor variables are interacting and their independent effects on the outcome is achieved through explainable AI.

Total cholesterol variability and risk of atrial fibrillation: A nationwide population-based cohort study.

BackgroundLong-term variability of cardiometabolic risk factors have been suggested as the risk factors for cardiovascular disease and mortality. However, the effect of long-term variability of total cholesterol (TC) on incident atrial fibrillation (AF) has not been examined.Methods and findingsWe explored whether visit-to-visit TC variability are associated with the risk of incident AF in 160,165 Korean adults, using the population-based Korean National Health Insurance Service–Health Screening Cohort (NHIS-HEALS) database, over a median duration of 8.4 years. TC variability was measured as coefficients of variance (TC-CV), standard deviation (TC-SD), and variability independent of the mean (TC-VIM). Kaplan–Meier analysis demonstrated a decreased disease-free probability in the highest quartile group of TC variability compared to that in the other groups. In the multivariate Cox proportional hazard analysis, the risk of AF increased significantly in the highest quartile group of TC variability. After multivariate adjustment for confounding variables including mean TC levels, the hazard ratio for incident AF was 1.15 (95% confidence interval 1.05–1.25; P = 0.0035) when comparing the highest with the lowest TC variability quartile (TC-CV). These relationships were consistent with TC variability defined using TC-SD or TC-VIM. Subgroup analyses, including age, sex, body mass index, and cardiometabolic disorders, showed similar results.ConclusionsThe present study is the first to demonstrate that high TC variability was associated with an increased risk of AF.

Maternal body mass index moderates antenatal depression effects on infant birthweight

Obesity and depression are two common medical problems that pregnant women present with in antenatal care. Overweight and obesity at the beginning of the pregnancy, and excessive weight gain during pregnancy, are independent explanatory variables for fetal birthweight and independent risk factors for giving birth to a large for gestational age (LGA) infant. However, the effect of co-morbid depression has received little attention. This study set out to investigate if maternal body mass index (BMI) in early pregnancy moderates antenatal depression effects on infant birthweight. 3965 pregnant women participated in this longitudinal cohort study, where cases (n = 178) had Edinburgh Postnatal Depression Scale (EPDS) score ≥ 17 in gestational week 17 or 32, and remaining women (n = 3787) were used as controls. The influence of maternal BMI and antenatal depressive symptoms on standardized birthweight was evaluated by analysis of covariance, with adjustment for relevant confounders. Depressed women with BMI 25.0 kg/m2 or more gave birth to infants with significantly greater standardized birthweight than non-depressed overweight women, whereas the opposite pattern was noted in normal weight women (BMI by antenatal depressive symptoms interaction; F(1,3839) = 6.32; p = 0.012. The increased birthweight in women with co-prevalent overweight and depressive symptoms was not explained by increased weight gain during the pregnancy. Maternal BMI at the beginning of pregnancy seems to influence the association between antenatal depressive symptoms and infant birthweight, but in opposite directions depending on whether the pregnant women is normal weight or overweight. Further studies are needed to confirm our finding.

Prevalence of risk factors for denture stomatitis in complete denture wearers

Aim: The prevalence of denture stomatitis and the relationship with its risk factors was evaluated via secondary data from 62 complete denture (CD) wearers, between 2015 and 2017. Methods: The data was stored in an Excel database and was analyzed using the statistics software STATA/SE 12.0. A descriptive analysis was performed taking into account a categorization of the clinical variables according to risk factor in 4 domains: CD usage, systemic health, hygiene habits, and usage habits. The association amongst the denture stomatitis and risk factors variables was tested by the Chi-square test and the results were statistically significant at p-values &lt;0.05. Results: The CD wearers participants were composed by a majority of elderly (80.64%) and women (72.78%); with 45.16% having been using the current denture for more than 10 years and another 74.19% related a continuous usage. Diabetes and hypertension were related by 83.87% and 67.74%, respectively, with 87.10% using medication. Although 75.80% reported cleaning their dentures 3 times per day or more, and 59.68% considered their oral hygiene very good, 50% of the complete dentures showed dirtiness and clinical signs of Denture Stomatitis were present in 30.64% of the patients. Despite of the evaluated sample shows many risk factors for the development of the disease, an association between the variables was not observed. Conclusion: Considering the high prevalence of the disease in the studied sample, preventive and educational measures on denture usage and hygiene must be reinforced in order to maintain the oral health of the edentulous patients.

Racial disparities in presentation and outcomes of paediatric autoimmune hepatitis.

Most studies on autoimmune hepatitis (AIH) in children are in predominantly Caucasian cohorts. Paediatric AIH in African Americans (AA) is understudied, with a dearth of clinical predictors of outcome, often leading to serious complications and even mortality. The aim of the study was to define disease presentation, progression, response to therapy and outcomes in paediatric AIH in a well-defined, large, single centre, demographically diverse population. We conducted a review of patients with AIH who were followed at this tertiary liver transplant centre. Clinical and laboratory covariates were assessed with regard to disease presentation, progression and outcomes in AA vs Non-AA children. African Americans patients constituted 42% of this cohort. At 1-year follow-up, AA children were receiving significantly higher doses of steroids compared to non-AA. More AA presented with end-stage liver disease (ESLD) with high immunoglobulin G and GGT:platelet ratio. After adjusting for other risk factor variables like gender, age at presentation and ESLD, AA children were at 4.5 times higher risk for significant outcome liver transplant/death within the first 12months of presentation. Post-transplant, recurrent AIH was seen in 50% of AA vs 8% in non-AA. African American patients with AIH are more likely to present with ESLD and have an increased early risk for transplantation with high likelihood of disease recurrence post-transplantation. Studies are needed to delineate factors such as inherent biology, genetics and access to care. Early referral and tailored immunosuppressive regimens are required for AA patients with AIH.

Breast cancer risk prediction in women aged 35\u201350\u2009years: impact of including sex hormone concentrations in the Gail model

BackgroundModels that accurately predict risk of breast cancer are needed to help younger women make decisions about when to begin screening. Premenopausal concentrations of circulating anti-Müllerian hormone (AMH), a biomarker of ovarian reserve, and testosterone have been positively associated with breast cancer risk in prospective studies. We assessed whether adding AMH and/or testosterone to the Gail model improves its prediction performance for women aged 35–50.MethodsIn a nested case-control study including ten prospective cohorts (1762 invasive cases/1890 matched controls) with pre-diagnostic serum/plasma samples, we estimated relative risks (RR) for the biomarkers and Gail risk factors using conditional logistic regression and random-effects meta-analysis. Absolute risk models were developed using these RR estimates, attributable risk fractions calculated using the distributions of the risk factors in the cases from the consortium, and population-based incidence and mortality rates. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory accuracy of the models with and without biomarkers.ResultsThe AUC for invasive breast cancer including only the Gail risk factor variables was 55.3 (95% CI 53.4, 57.1). The AUC increased moderately with the addition of AMH (AUC 57.6, 95% CI 55.7, 59.5), testosterone (AUC 56.2, 95% CI 54.4, 58.1), or both (AUC 58.1, 95% CI 56.2, 59.9). The largest AUC improvement (4.0) was among women without a family history of breast cancer.ConclusionsAMH and testosterone moderately increase the discriminatory accuracy of the Gail model among women aged 35–50. We observed the largest AUC increase for women without a family history of breast cancer, the group that would benefit most from improved risk prediction because early screening is already recommended for women with a family history.