Risk Factors For Transition Research Articles

Epidemiology, risk factors, outcomes, and role of Serpin A3 as a biomarker for transition of acute kidney injury to chronic kidney disease in critically ill patients

BackgroundSeveral studies have suggested a causal link between acute kidney injury and the consequent development of chronic kidney disease. The severity, frequency, and duration of acute injury are key factors in this process.AimsThis study aimed to determine the epidemiology and outcomes of AKI to CKD transition in critically ill adult patients and to study the role of Serpin-A3 in the early recognition of AKI to CKD transition.MethodsIn this prospective observational study, a total of 252 patients attending Assiut University Hospitals Critical Care Unit and developed AKI during their stay were recruited. Serum and urinary Serpin A3 were measured by ELISA Kit. Complete blood picture, kidney function tests, urine analysis, serum electrolytes (serum sodium, potassium, calcium, phosphorus, and magnesium), liver function test, coagulation profile, C-reactive protein, 24-h urinary protein or urinary albumin/creatinine ratio, abdominal ultrasound were assessed for all the recruited participants. Follow-up was done for three consecutive months and after 3 months using serum creatinine, BUN, and serum potassium.ResultsIt was found that old age is a risk factor for CKD following AKI, i.e., with 1-year increase in the patient’s age, there was 3% increase in the chance of transition. Significant association was found between rate of comorbidity and transition status. Also, cases with either infection or IV radio contrast exposure were 2.8 and 6.5 times more liable for transition. Cases with transition in this study had significantly higher renal function parameters. Higher median levels of Serpin A3 either serum or urinary was reported in transition patients. Improvement was reported in two-third of those without transition, and higher mortality rate was recorded in those without transition.ConclusionThe frequency of transition was 20%. Older age, male gender, cardiac and CVS disease, the presence of infection, higher BUN and creatinine level, higher median K and PO4 levels, and higher median levels of Serpin A3 are risk factors for transition from AKI to CKD.

Implementing net zero affordable housing — towards a human-centred approach

This paper reviews the UK Net Zero Strategy in conjunction with the decarbonisation of the affordable housing sector, with a focus on the key stakeholders involved in the decar- bonisation process. Viewing it from a socio-ŋtechnical perspective, this paper discusses three overarching groups of people in delivering low-carbon affordable housing — affordable housing providers, the supply chain and residents — highlights the range of issues and factors that policymakers should be considering; provides sign-posts to evidence; and discusses some critical gaps, barriers and transition risk factors in delivering net zero policies and potential mitigating strategies that can be learned from exemplary projects. The conclusion of this paper proposes a preliminary structure for a five-step place-based, human-centred framework to implement net zero in the affordable housing sector, emphasising the importance of long-term legislative certainty and funding, localised decision-making with stakeholder engagement, including approaches such as communities of practice, a soft landings framework, and developing monitoring and evaluation matrices.

Enhancing Financial Risk Management: Utilizing Machine Learning in Climate Risk Model Benchmarking

This paper investigates the convergence of machine learning (ML) and climate risk modeling in the financial industry, focusing on applying ML methods to improve the validation of climate risk models. In light of the growing significance of precisely evaluating and controlling climate-related risks within the financial sector, conventional models demonstrate their inadequacies in confronting the intricacies and unpredictability of climate change. By conducting an extensive analysis of bottom-up and top-down modeling methodologies, this research emphasizes using machine learning algorithms to bolster the reliability of financial risk assessments, control non-linearities, and enhance predictive accuracy. The innovative applications of ML in scenario analysis, stress testing, and model performance evaluation on out-of-sample data are explored, along with the difficulties of model validation. This paper enhances the ongoing discussion on improving frameworks for climate risk modeling by highlighting emerging trends and best practices in integrating physical and transition risk factors. The results emphasize the critical importance of machine learning in revolutionizing financial risk management approaches to more effectively navigate the uncertainties associated with climate change.

Transition from BOS to RAS impairs prognosis after lung transplantation—CLAD subtype analysis by CT volumetry

BackgroundChronic lung allograft dysfunction (CLAD), subclassified into bronchiolitis obliterans syndrome (BOS) or restrictive allograft syndrome (RAS), limits survival after lung transplantation. Information concerning transition from BOS to RAS is limited. We aimed to characterize the lung volume change after BOS diagnosis by computed tomography (CT) volumetry and to determine the incidence, risk factors and clinical significance of BOS to RAS transition.MethodsCT volumetry measurements were performed from 63 patients with CLAD initially classified as BOS by CT volumetry. BOS patients with lung volume remaining >85% of baseline were classified as persistent BOS, whereas BOS patients whose lung volume permanently decreased to ≤85% of baseline were classified as BOS to RAS transition.ResultsDuring follow-up (median 9.8 years) eight patients (12.7%) were classified as BOS to RAS transition, which decreased recipient (p = 0.004) and graft survival (p = 0.020) in comparison to patients with persistent BOS. Opacities on chest imaging preceded BOS to RAS transition in 88% of patients. Opacities on chest imaging at BOS diagnosis and early CLAD diagnosis after transplantation were risk factors for transition.ConclusionBased on lung volume decrease measured by CT volumetry, a small proportion of BOS patients transitioned to RAS which had an adverse effect on recipient and graft survival.

Five-year longitudinal study of frailty prevalence and course assessed using the Kihon Checklist among community-dwelling older adults in Japan

The aim of this study was to analyze the 5-year natural course of frailty status assessed with the Kihon Checklist (KCL) and the risk factors of transition towards frailty in community-dwelling older adults. We used the data from the postal KCL survey conducted by the municipal government between 2011 and 2016. The sample of the current study consisted of 551 older adults (265 men and 286 women) aged 65–70 years in 2011. The median KCL score increased from 2 (interquartile range 1–3) in 2011 to 3 (1–5) in 2016 (p < 0.001). Hence, the prevalence of frailty increased from 8.0 to 12.3% (p < 0.001). Regarding the 5-year transitions in frailty status, 68.3% of participants remained unchanged, while 21.4% transitioned towards a worse frailty status, and 10.3% towards an improved status. Of the 507 respondents who were robust or prefrail at the baseline, 44 experienced a transition towards frailty, indicating that the 5-year incidence of frailty was 8.7%. These 44 individuals had higher body mass indexes (BMI) and lower physical activity scores on the KCL than others (p < 0.05), the latter of which was an independent predictor of transition toward frailty in the multivariate analysis. This study was the first to evaluate the 5-year natural course of frailty status assessed using the KCL in community-dwelling elderly adults, in which the prevalence of frailty increased by 4.3%. To prevent transition towards frailty, maintaining optimal physical activity is recommended.

Risk Factors for Progression from Subclinical to Clinical Phase of Psoriatic Arthritis: A Case-Control Study.

IntroductionThe objective of this study is to identify the potential risk factors for progression from subclinical to clinical psoriatic arthritis (PsA).MethodsA retrospective, longitudinal, case–control study was conducted at a single hospital, including 25 patients with clinically confirmed PsA in the case group and 137 controls without confirmed PsA. All patients in both groups had a medical history of subclinical PsA. Various baseline covariates were collected from all patients when they had a status of subclinical PsA. Univariate, multivariate, stratified, and interaction analyses were employed to identify potential risk factors of transiting to clinical PsA from subclinical PsA.ResultsIn multivariate logistic regression analysis, older age (OR 10.15, 95% CI 2.79–36.91, p = 0.00), alcohol drinking (OR 3.43, 95% CI 1.17–10.12, p = 0.03), elevated high-sensitivity C-reactive protein (hs-CRP) (OR 1.05, 95% CI 1.01–1.09, p = 0.03) were identified as risk factors for transition from subclinical to clinical PsA. Stratified and logistic regression analyses suggest a significant interaction between age and fatty liver. For patients aged less than 45 years old, the association between fatty liver and clinical PsA was statistically significant.ConclusionsOlder age, alcohol drinking, elevated hs-CRP, and the presence of fatty liver at less than 45 years old appear to increase the risk of transition from subclinical to clinical PsA. These findings call for a need to manage these risk factors.

Importance of long-term follow-up after endoscopic management for upper tract urothelial carcinoma and factors leading to surgical management.

Patients undergoing endoscopic management for upper tract urothelial carcinoma often progress to definitive therapy with radical nephroureterectomy. This study examined the rate of progression as well as risk factors for transitions in treatment over time. Retrospective review at two institutions identified patients undergoing endoscopic management for upper tract urothelial carcinoma. Patients were assessed for progression to radical nephroureterectomy. Baseline characteristics were compared using Chi square analysis. Kaplan-Meier method analyzed the probability of patients not progressing to radical nephroureterectomy. Cox proportional hazards identified factors associated with progression to radical nephroureterectomy. Eighty-one patients had endoscopic management alone and 89 progressed to radical nephroureterectomy. The two groups had similar age, histories of bladder cancer, and Charlson comorbidity index. Positive urinary cytology, ureteroscopic visualization, and biopsy grade were higher in those progressing to RNU (p < 0.001). Hazard modeling demonstrated higher rates of progression to radical nephroureterectomy with positive biopsy (HR 11.8, 95% CI 2.4-59.5, p = 0.003) or visible lesion on ureteroscopy (HR 8.4, 95% CI 3.0-23.9, p < 0.001). Patients with a higher Charlson comorbidity index were less likely to have radical nephroureterectomy. On Kaplan-Meier modeling, the probability of not undergoing radical nephroureterectomy at 2years and 5years was 50% and 20%, respectively. Patients who progress to radical nephroureterectomy after endoscopic management have fewer comorbid conditions and changes in disease status including visible lesions on ureteroscopy and positive biopsies. The high rate of progression to radical nephroureterectomy reinforces the need for long-term follow-up of these patients.

Abstract MP60: Do Adults With Metabolic Healthy Obesity Maintain Their Health Over Time? Results From The Atherosclerosis Risk In Communities (ARIC) Study

Background: Obesity is a heterogeneous condition, and there is debate about whether adults with “metabolically healthy obesity” (MHO) are protected from health complications. It is also unclear if MHO is a transient state. Objective: To examine transition from the MHO to metabolically unhealthy obese (MUO) phenotype during 6 years of follow-up among middle-aged adults. Methods: We conducted a prospective analysis of 9,672 adults in the ARIC Study who were free of cardiovascular disease (CVD) at Visit 2 (1990-1992) and attended Visit 4 (1996-1998). Obesity phenotypes were cross-classified using two body mass index subgroups 18.5-29.9 kg/m 2 (non-obese) and ≥ 30 kg/m 2 (obese). The NCEP Adult Treatment Panel III criteria were used to define metabolic health (without waist circumference). We used logistic regression to evaluate risk factors for transition from MHO at Visit 2 to MUO at Visit 4 among those with MHO at Visit 2(N=692). Results: At baseline (mean age 57, 21% black, 57% female), 18%, 54%, 7%, and 21% were metabolically healthy non-obese, metabolically unhealthy non-obese, MHO, and MUO, respectively. More adults with the MHO phenotype transitioned to MUO (48.3%) than maintained MHO status (43.4%) during the 6-year period). Most (71%) of those who transitioned from MHO to MUO were women. Adults with higher waist-to-hip ratio were more likely to transition to MUO (HR 2.67, 95% CI 1.09-6.58) than those who maintained their metabolic health during follow-up. (Table) . Conclusions: Almost 50% of adults who are MHO will transition to higher cardiometabolic risk over 6 years. High waist-to-hip ratio, lower socioeconomic status and smoking were linked to greater likelihood of transition to MUO. Persons with MHO should receive early behavioral interventions to prevent worsening metabolic health.

The impact of APC polymorphisms on the transition from polyps to colorectal cancer (CRC).

The purpose of this study was to investigate the function of APC polymorphisms (D1822V and E1317Q) on the transition from polyps to colorectal cancer (CRC). 259 patients with polyps were included in the study. APC polymorphisms were genotyped via polymerase chain reaction (PCR) and subsequent sequencing. χ2 test was performed to analyze the relationship of APC polymorphisms or CRC occurrence with clinical features. COX regression was used to find out risk factors for CRC. Hazard ratio (HR) and 95% confidence interval (CI) represented the risk of CRC. Clinical information on sex, regular physical activity, smoking history, alcohol use and polyps types was recorded. Neither D1822V nor E1317Q polymorphism was associated with these factors. In following analysis, we found significant difference in the frequency of males between CRC and non-CRC patients (87.4% vs. 58.7%, P<0.001). Distinct difference in the distribution of D1822V polymorphism was also observed between CRC and non-CRC patients (P=0.001). In COX analysis, sex was identified as a risk factor for transition from polyps to CRC (HR=2.442, 95%CI=1.281-4.654). D1822V polymorphism tended to inhibit the transition process (HR=0.286, 95%CI=0.170-0.480). However, E1317Q seemed to have no significant effect on this process (HR=1.042, 95%CI=0.676-1.606). In a word, APC D1822V polymorphism has strong effect on the transition from polyps to CRC.

Which factors can we control the transition from mild cognitive impairment to dementia?

Mild cognitive impairment (MCI) is a clinical condition in the transitional stage between healthy aging and dementia. In this study, we investigated the risk factors and the development of dementia in MCI patients.Seventy six patients who diagnosed MCI, according to the Petersen criteria, over sixty-years old, and risk factors in transition to dementia were investigated. Neurological examinations, laboratory tests, systemic comorbidities, mini-mental state examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scale of the patients every 3–6 months were investigated. Dementia developed in 44.7% of MCI patients. Vascular risk factors were the most prominent risk factors in the transition from MCI to dementia (p = 0.000).Increased vascular risk factors and advancing age in MCI patients accelerate the transition to dementia. Therefore, modifiable vascular risk factors, which are significant factors in the transition to dementia, should be controlled and these patients should be closely monitored.

Pricing Climate Risk

I exploit a new dataset from Four Twenty Seven and identify physical climate risk factors that can explain the variation in global individual stock returns. North American stocks are currently exposed to an extreme rainfall factor and an overall climate risk factor. European and Japanese stocks are currently exposed to an extreme rainfall factor, a heat stress factor, and an overall climate risk factor. I assess the pricing of policy related to these risks by drawing on new data from the Transition Pathway Initiative that summarises publicly-available information on a firm's emissions and targets. Physical climate risk and transition risk factors cannot explain the returns of portfolios sorted on standard accounting variables (such as investment, momentum and profitability), and vice-versa. However, a quality factor can explain both climate-related and non-climate-related portfolios. Climate risks may be mispriced and quality captures a confounding association between the environment and the zoo of factors used to explain asset returns.

Oral Candidal Carriage Among Patients with Oral Potential Malignant Disorders: A Case-Control Study

Objective: To determine the prevalence of Candida species in the saliva of patients with clinically suspected oral potentially malignant disorders (OPMD) and healthy cohorts. Material and Methods: Unstimulated saliva was collected from patients with OPMD (n=100) and age and sex matched healthy subjects (n=170). The samples were inoculated onto Sabouraud Dextrose Agar and incubated for a week. The colonies of the isolates were enumerated using a colony counter. The isolates were identified using standard phenotypic methods. The significance of oral candidal carriage was calculated using Independent T test. Odds and Risk ratio was calculated using Pearson’s Chi-square test. Results: Oral candida carriage was present in 51% of patients with OPMD while healthy cohorts had a prevalence of 20.6%. A good statistical significance was observed for the prevalence of oral candidal carriage for patients with OPMD in comparison to healthy cohorts (p=0.013). Significant Odds and risk ratio was observed for the prevalence of Candida species among OPMD. Majority of the isolates in both groups were C. albicans . Colony forming units were high among patients with OPMD. Conclusion: A significant association of oral candidal carriage to oral potentially malignant disorders in comparison to healthy cohorts was observed. Candidal species may be potent risk factor for transition of OPMD to oral Squamous Cell Carcinoma.

F126. PATHWAYS FROM SPEECH ILLUSIONS TO PSYCHOTIC SYMPTOMS IN SUBJECTS AT ULTRA-HIGH RISK FOR PSYCHOSIS: COMBINING AN EXPERIMENTAL PARADIGM OF ABERRANT EXPERIENCES WITH NETWORK ANALYSIS

BackgroundOne of the oldest and most influential theories of psychosis formation states that delusions arise in an attempt to explain unusual experiences, including perceptual aberrations. The White Noise Task by Galdos et al (2011) was developed as an experimental task to assess the tendency to attribute meaning to random perceptual stimuli: speech illusions in white noise. Studies to date have demonstrated that speech illusions as assessed with the White Noise Task are associated with a composite measure of positive symptoms in patients with psychotic disorders (Galdos et al, 2011; Catalan et al, 2014). However, findings in non-clinical samples have been inconsistent: one study found an association with a composite measure of subclinical positive symptoms, including support for a relation with familial psychosis liability (Galdos et al, 2011), whereas other studies did not find any association in non-clinical samples or only partly (Catalan et al, 2014; Rimvall et al, 2016; Pries et al, 2017). The current study aims to further examine whether speech illusions as assessed with the White Noise Task are indicative of psychosis liability and to explore specific symptomatic pathways.MethodsWe conducted symptom-based network analyses in Ultra-High Risk (UHR) subjects participating in the European network of national networks studying gene-environment interactions in schizophrenia project (EU-GEI, 2014; www.eu-gei.eu). Psychotic symptoms were assessed with the Brief Psychiatric Rating Scale (BPRS). Transition to clinical psychosis was assessed with the Comprehensive Assessment of At Risk Mental State (CAARMS). We used a conservative measure of speech illusions, as described in Catalan et al (2014).ResultsThe current sample consisted of 339 UHR subjects, of which 9.1% (N=31) experienced speech illusions. Preliminary network analyses in cross-sectional baseline data showed potential pathways from speech illusions to delusional ideation, through hallucinatory experiences. We also found evidence of prospective relations between speech illusions at baseline and transition to clinical psychosis. Pathways ran via baseline psychotic symptoms and affective symptoms, as well as a ‘direct’ pathway.DiscussionAs far as we are aware, this is the first study combining an experimental measure of aberrant experiences with symptom-based network analysis. Although the current reported findings are preliminary and exploratory, they tentatively support a relation between speech illusions as assessed with the White Noise Task and psychosis liability. This relation may be dependent on sample composition, and not generalizable to the general population as a whole. Future studies may benefit from focusing on more detailed trajectories of both susceptibility to speech illusions and course of (sub)clinical psychotic symptom severity in subjects with increased risk for psychosis, with use of more frequent, short assessment periods and inclusion of environmental risk factors for transition to clinical disorder.

Outcomes, rates and predictors of transition of isolated Raynaud's phenomenon: a systematic review and meta-analysis.

Published studies lack clear indicators of risk and predictors of transition from Raynaud's phenomenon (Rp) to connective tissue diseases (CTDs). Therefore, we aimed to study the outcomes, rates and predictors of transition to CTDs in patients with Rp. A sensitive search was developed in Medline and Embase. Observational studies reporting incidence and risk factors of transition from Rp to a CTD were analysed by two independent reviewers. The main outcome was the rate of transition to a CTD; the secondary outcome was the evaluation of predictors. Of 856 articles captured, 7 selected studies met the inclusion criteria. A total of 4051 patients with primary Rp (pRp) and 1220 transitions to overt CTDs were recorded. The mean incidence rate of transition from pRp to a CTD was 2.65/100 person-years (standard error [SE] 1.2, 95% confidence interval [CI] 0.44-5.73). A total of 657 patients with suspected secondary Rp (ssRp) had antinuclear antibodies (ANAs) and/or capillary abnormalities; 188 transitions to CTDs were recorded, the mean incidence rate of transition from ssRp to CTD was 11.01/100 person-years (SE 4.0, 95% CI 0.11-22.12), and 135 transitions to systemic sclerosis (SSc), giving a mean incidence rate of transition from ssRp to SSc of 5.7/100 person-years (SE 2.19, 95% CI 1.02-13.19). With respect to patients with pRp, having ANAs without capillary abnormalities was associated with a risk for developing a CTD (pooled relative risks [RR] 7.63, 95% CI 2.87-20.29), whereas capillary abnormalities without ANAs resulted in a weaker risk of CTD transition (RR 5.53, 95% CI 1.45-21.06). The coexistence of ANAs and abnormal capillaroscopy significantly increased the risk of transition to CTD (RR 16.96, 95% CI 6.61-43.55). A low incidence rate of transition from pRp to overt CTD was found. In spite of a possible study selection bias, ssRp appears to have a strong risk of transition to a CTD when there is concomitant presence of ANAs and abnormal capillaroscopy.

Risk factors of transition from mild cognitive impairment to Alzheimer's disease and death: A cohort study

BackgroundKnowledge of risk factors is essential for developing strategies that prevent or minimise transitions from mild cognitive impairment (MCI) to Alzheimer's disease (AD) and death. The aim of this study was to assess risk factors for progression to AD and death among Chinese individuals with cognitive impairment. MethodsWe conducted a multisite, population-based cohort study on 437 community-dwelling elderly MCI residents in Taiyuan, China from 2010 to 2014. MCI, AD, death from AD and death from a cause other than AD were specified as disease states during the natural history of dementia. Transition-specific Cox model was fitted and hazard ratio (HR) with 95% confidence intervals (CIs) was estimated. ResultsAnalyses showed that risk factors played different roles in affecting transitions to AD and death. Risk factors for transition from MCI to AD were being female (HR: 1.82; 95%CI: 1.20–2.77), older age (HR: 3.09; 95%CI: 1.81–5.25), reading occasionally (HR: 1.79; 95%CI: 1.11–2.89), current smoking (HR: 1.74; 95%CI: 1.15–2.65), light–moderate alcohol drinker (HR: 2.24; 95%CI: 1.42–3.53), cerebrovascular disease (HR: 2.70; 95%CI: 1.68–4.34), hyperlipidemia (HR: 1.87; 95%CI: 1.16–3.02) and diabetes (HR: 1.81; 95%CI: 1.18–2.77). Only cerebrovascular disease (HR: 3.04; 95%CI: 1.22–7.58) was a significant risk factor for transition from MCI to death from a cause other than AD. Older age (HR: 10.68; 95%CI: 1.16–97.93) and low level education (HR: 0.14; 95%CI: 0.05–0.44) were significant predictors for transition from AD to death from a cause other than AD. ConclusionsParticipants with advanced age, low-level education, history of harmful alcohol consumption or smoking, cerebrovascular disease, hyperlipidemia, diabetes or who were female were at increased risk of transitioning to AD or death. Strategies to control modifiable risk factors in specific disease stage should be implemented to decrease the conversion to AD or death among Chinese patients with MCI.

Abstract WP370: Cerebral Microbleeds Play an Important Role in Turning Recurrent Stroke Towards Intracranial Hemorrhage in Patients With First-ever Ischemic Stroke/Transient Ischemic Attack

Background and Purpose: After ischemic stroke (IS) or transient ischemic attack (TIA), use of an antithrombotic agent to prevent recurrence is mandatory. However, antithrombotic agents rarely cause intracranial hemorrhage (ICH), frequently resulting in worse outcomes than recurrent IS. Cerebral microbleeds (CMBs) have been reported as a useful marker for finding ICH-prone patients. This retrospective study aimed to investigate the significance of CMB in the development of ICH in first-ever IS/TIA patients. Methods: The data source was our consecutive patient registry between 2005 and 2015. Patients with stroke/TIA admitted to our hospital more than twice (first as first-ever IS/TIA and second or later as recurrent IS/TIA or ICH) and underwent head MRI including T2*-weighted imaging on the first admission were extracted. Clinical characteristics including use of antithrombotic therapy and distribution of CMB on the first and second admissions were compared between recurrent IS/TIA and ICH groups. Distribution of CMB was divided into deep, lobar, or both. Results: In total, 708 IS/TIA patients (second stroke: 640 IS/TIA; 68 ICH) were extracted. The ICH group showed a longer period until second stroke (1,062 days vs. 817 days, p=0.022) and higher mean NIHSS score (14.8 vs. 6.1, p&lt;0.001) on second admission than the IS/TIA group. On first admission, the ICH group had a higher frequency of CMB (72.1% vs. 49.5%, p&lt;0.001) and lower frequency of cardioembolism (14.7% vs. 25.8%, p=0.044) than the IS/TIA group. About half of hemorrhages occurred in similar locations of the CMB depicted on first admission. A higher frequency of ICH was observed in patients with deep CMB (11.3% vs. 5.6%, p=0.022) or both deep and lobar CMBs (17.4% vs. 5.6%, p&lt;0.001) than in those without CMB. Use of anticoagulants was a significant risk factor for transition from first IS/TIA to second ICH (odds ratio [95% confidence interval]: 3.75 [1.30-10.8], adjusted by sex, age, type of first stroke, and CMB location). Conclusions: This study found IS/TIA patients with CMB are at high risk of ICH compared to patients without CMB. Preventive antithrombotic treatment particularly use of anticoagulants for CI/TIA patients with CMB should be provided under careful monitoring for the risk of hemorrhage.

Early referral and comorbidity as possible causes of the declining transition rate in subjects at clinical high risk for psychosis

A clinical high risk (CHR) for psychosis is regarded as the state of being at risk of developing psychosis. However, the rate of transition to psychosis among CHR subjects has been declining over time. We aimed to investigate the effects of the possible causes of the declining transition rate. A total of 129 CHR subjects were divided into two groups according to the date of enrollment: the 2005-2009 group and the 2009-2013 group. Baseline demographic and clinical characteristics, including medication prescription, were compared. The duration of untreated prodromal positive symptoms (DUPP) was used to account for early referral. The transition rate to psychosis in the 2009-2013 group was significantly lower than that in the 2005-2009 group (χ2 = 4.664, P = 0.031), although the risk factors of transition, intelligence quotient and prodromal positive symptoms did not differ between the two groups. When the DUPP was added to the follow-up duration, the between-group difference in the transition rates was no longer significant; however, the P-value was low (χ2 = 2.761, P = 0.097). After adjusting for axis II comorbidities other than schizotypal personality disorder, the effect of group division on the transition rate disappeared; however, the P-value was also low (P = 0.072). The mean olanzapine equivalent dose and the proportion of subjects prescribed with antidepressant or anxiolytic did not differ between the two groups. Early referral and axis II comorbidities other than schizotypal personality disorder were associated with the declining transition rate.

Bone-density testing interval and transition to osteoporosis in patients with rheumatoid arthritis.

Although BMD testing is routinely performed in RA patients, the interval between BMD tests has not been determined. We retrospectively recruited 360 consecutive female patients with RA, who underwent repeated BMD testing, with a mean age of 53.7 ± 10.2years and a mean follow-up duration of 7.4 ± 5.0years. We stratified the study participants into five groups based on their baseline T-score range. The testing interval was defined as the estimated time for 10% of patients in each subgroup to transition to osteoporosis. Competing-risk analyses were performed with sensitivity analysis by menopausal status and risk factors for transition to osteoporosis. At baseline, 15% of screened patients had osteoporosis, and during follow-up, that proportion increased to 24.8%. The estimated BMD testing interval for 10% of patients to develop osteoporosis was 9.6years for those with normal BMD, 7.6years for those with mild osteopenia, 4.7years for those with moderate osteopenia, and 2.1years for those with severe osteopenia. No significant risk factor for transition to osteoporosis was identified in this cohort. Our data indicate that osteoporosis will develop in less than 10% of female RA patients during rescreening intervals of approximately 9years for those with normal bone density at baseline, 7years for those with mild osteopenia, 4years for those with moderate osteopenia, and 2years for those with severe osteopenia at baseline. BMD interval in RA patients could be adjusted according to their baseline BMD T-scores.

TRANSITION TO STAGE D HEART FAILURE AMONG STABLE OUTPATIENTS WITH SYSTOLIC HEART FAILURE

Incidence rates and risk factors for transition to Stage D heart failure (HF) among patients with stable, Stage C HF with reduced ejection fraction (HFrEF) have not been reported. We evaluated 3-year transition to clinically determined Stage D HF, after accounting for competing mortality, in 919

Gender differences in risk factors for transition from mild cognitive impairment to Alzheimer’s disease: A CREDOS study

BackgroundWomen are subject to a disproportionate burden from Alzheimer’s disease (AD) and sex differences exist in treatment response and prognosis of the disease. Yet gender-specific risk factors have not been widely studied. We aimed to investigate gender-specific risk factors for AD in subjects with mild cognitive impairment (MCI). MethodsParticipants (n=294) with MCI were recruited from a nationwide, prospective cohort study of dementia and were followed for a median (range) of 13.8 (6.0–36.0) months. Sex-stratified associations of progression to AD with baseline characteristics were explored. ResultsSeventy-four individuals (25.2%) developed incident dementia (67AD) during follow-up. Significant risk factors for probable AD differed by sex. In men, the significant risk factors were severe periventricular white matter hyperintensities, and poorer global cognitive function. In women, older age, clinically significant depressive symptoms at baseline, and positive APOE ε4 alleles were the significant risk factors. ConclusionsRisk factors for progression from MCI to probable AD differed in men and women. These results may translate to gender-specific preventative or therapeutic strategies for patients with MCI.