Weak Risk Factors Research Articles

A Multivariate Logistic Regression Analysis of Risk Factors for Peri-implant Bone Loss.

To evaluate multiple risk factors of peri-implant bone loss. A case-control study was conducted on patients who had received dental implants treatment from January 2018 to December 2021. Implants with bone loss were included in the case group, and implants with no bone loss were included in the control group. Risk factors including history of periodontitis, abutment connection type, implant surface, diameter, location, three-dimensional position, opposing dentition, adjacent teeth, prosthetic type, retention type and custom abutment were evaluated. A multivariate logistic regression model was used to evaluate these risk factors, providing corresponding odds ratios (ORs) with 95% confidence intervals (CIs). A total of 776 implants in 479 patients were included in the analysis. The number of implants in the case group and the control group were 84 and 692, respectively. Cement-retained prostheses (OR=2.439, 95%CI=1.241-4.795) and nonplatform switch design (OR=2.055, 95%CI=1.167-3.619) were identified as weak risk factors. Horizontal deviation (OR=4.177, 95%CI=2.265-7.703) was a moderate risk factor. Vertical deviation (OR=10.107, 95%CI=5.280-19.347) and implants located in the mandibular molar region (OR=10.427, 95%CI=1.176-92.461) were considered high risk factors. Implants in the molar region, cement retained, non-platform switch design, and poor three-dimensional implant positioning are identified as significant risk factors for peri-implant bone loss.

Genetic Validation of Psoriasis Phenotyping in UK Biobank Supports the Utility of Self-Reported Data and Composite Definitions for Large Genetic and Epidemiological Studies

Genetic Validation of Psoriasis Phenotyping in UK Biobank Supports the Utility of Self-Reported Data and Composite Definitions for Large Genetic and Epidemiological Studies

The genetic risk of gestational diabetes in South Asian women.

South Asian women are at increased risk of developing gestational diabetes mellitus (GDM). Few studies have investigated the genetic contributions to GDM risk. We investigated the association of a type 2 diabetes (T2D) polygenic risk score (PRS), on its own, and with GDM risk factors, on GDM-related traits using data from two birth cohorts in which South Asian women were enrolled during pregnancy. 837 and 4372 pregnant South Asian women from the SouTh Asian BiRth CohorT (START) and Born in Bradford (BiB) cohort studies underwent a 75-g glucose tolerance test. PRSs were derived using genome-wide association study results from an independent multi-ethnic study (~18% South Asians). Associations with fasting plasma glucose (FPG); 2 hr post-load glucose (2hG); area under the curve glucose; and GDM were tested using linear and logistic regressions. The population attributable fraction (PAF) of the PRS was calculated. Every 1 SD increase in the PRS was associated with a 0.085 mmol/L increase in FPG ([95% confidence interval, CI=0.07-0.10], p=2.85×10-20); 0.21 mmol/L increase in 2hG ([95% CI=0.16-0.26], p=5.49×10-16); and a 45% increase in the risk of GDM ([95% CI=32-60%], p=2.27×10-14), independent of parental history of diabetes and other GDM risk factors. PRS tertile 3 accounted for 12.5% of the population's GDM alone, and 21.7% when combined with family history. A few weak PRS and GDM risk factors interactions modulating FPG and GDM were observed. Taken together, these results show that a T2D PRS and family history of diabetes are strongly and independently associated with multiple GDM-related traits in women of South Asian descent, an effect that could be modulated by other environmental factors.

Aetiological, clinical and therapeutic prognostic factors for the evolution of deep vein thrombosis followed up with serial venous Doppler ultrasound.

Deep vein thrombosis (DVT) is a dynamic process that can be followed up with Doppler ultrasound (DUS). To evaluate the role of certain factors that can influence the evolution of DVT. In 121 DVT patients (mean age 58.19 ± 14.47 years; 30 with no venous thromboembolism (VTE) identifiable risk factors (RF), 31 with weak RF, 30 with moderate RF and 30 with strong RF), DUS was performed at admission and after 1, 3, 6, 12 and 24 months. Favourable evolution was defined as complete resolution of thrombus, whereas unfavourable evolution was defined as incomplete resolution, thrombosis recurrence or post-thrombotic syndrome. Complete thrombus resolution was found at 1 month (M1) in 24.8% of patients, at 6 months (M6) in 49.6% and at 24 months (M24) in 61.2% of patients. Favourable evolution was seen in younger patients at M1 and M3 (P = 0.004 and P = 0.045) and in cases with earlier treatment (P < 0.0001). In proximal DVT, the risk of non-favourable evolution was higher (4.05 times at M3, 4.23 times at M6 and 4.29 times at M12). Patients with moderate RF had an earlier favourable evolution (40% at M1, 56.67% at M6 and 70% at M24), and patients with strong RF had the lowest rate of thrombus regression (20% at M1, 36.67% at M6 and 43.33% at M24). DVT evolution can last up to 24 months. Older age, strong VTE RF, proximal DVT localisation and late start of therapy constitute unfavourable evolutive prognosis. These cases need closer clinical and DUS monitoring to prevent complications.

Rationale and design of a study on D-dimer use to stratify patients after a first unprovoked venous thromboembolism for their risk of recurrence: extended low-dose Apixaban given only to patients with positive D-dimer results

Optimal duration of anticoagulation in patients with a first venous thromboembolism (VTE) is still uncertain. Extended anticoagulant treatment beyond the first 3 to 6 months is recommended in patients with unprovoked VTE for their high risk of recurrence, provided the risk of bleeding during anticoagulation is not high. Recent meta-analyses indicated that only one-third of these patients have a recurrence 10 years after anticoagulation is stopped, whereas the risk of major bleeding is consistent and persistent during anticoagulation. We designed the prospective, multicenter Apidulcis study to test whether serial D-dimer measurements, using commercial assays with predefined sex-specific cutoffs (350 ng/mL and 500 ng/mL for men and women, respectively, for assays expressing results as fibrinogen equivalent units), may be useful to stratify patients for the risk of recurrence. Those presenting positive D-dimer results, considered at higher risk, will receive low dose Apixaban, 2.5 mg tablets BID for 18 months, whereas those with persistently negative D-dimer results, considered at lower risk, will remain without anticoagulant treatment. Outpatients with a first VTE (unprovoked or associated with weak risk factors), aged 18 to 74 years, who have already received anticoagulation for at least 12 months are eligible for the study.

Does Body Mass Index Confer Risk for Future Suicidal Thoughts and Behaviors? A Meta-analysis of Longitudinal Studies.

Body mass index (BMI) outside of the "normal" range is commonly cited as a predictor of adverse health outcomes and has been identified as a potential risk factor for suicidal thoughts and behaviors (STBs). This meta-analysis provides a descriptive and quantitative summary of the literature evaluating the longitudinal relationship between BMI/weight status and STBs. The longitudinal literature examining the relationship between BMI/weight status and STBs is small and methodologically constrained. Within the existing literature, BMI and weight status are generally weak or nonsignificant risk factors for STBs. It is possible that body weight has a complex relationship with physical and mental health, including STBs, which may not be possible to accurately capture with a singular metric such as BMI. BMI and weight status do not appear to robustly predict STBs, at least within the methodological constraints of the existing literature.

Frequency of venous thromboembolism risk factors in hospitalized patients with pulmonary embolism in routine Russian practice

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Ryazan State Medical University Despite advances in the diagnosis and treatment of Pulmonary Embolism (PE), it remains one of the most common causes of death among cardiovascular diseases. Purpose. To study the prevalence of the Venous Thromboembolism (VTE) risk factors (RFs) among patients with PE in the typical Regional Vascular Centers in Russia. Materials and Methods. The study was conducted within the framework of the Russian SIRENA Register. А retro- and prospective analysis of the clinical cases (n = 107, median age 63 (52-74) years, 39.3% of men) of PE treated at the Regional Vascular Centers from 01 May 2018 to 31 May 2019 (13 months) was performed. Results. It was revealed that 72.9% of patients had multiple RFs. The average number of strong RFs per PE patient is 1.1, moderate RFs – also 1.1, weak RFs - 2.4. Strong (± moderate and weak) RFs were registered in 26.2% of patients. The most common strong RFs is a history of VTE (22.4% of the PE cohort). Moderate (± low) RFs were observed in 31.8% of PE cases. The most common moderate RFs is malignant neoplasms (17.8%, n = 19; 7 out of 19 had metastases, 5 out of 19 received chemotherapy). In the 40.2% of patients, only weak RFs were identified. The most prevalent were arterial hypertension (70.1%), old age (59.8%) and obesity (46.7%). As a result, 6.5% of PE patients did not have any RFs, and 67.3% of PE patients did not have reversible RFs. Сonclusion. A high frequency and multiple character of VTE RFs were registered in PE patients in routine clinical practice. The greatest frequency is common cardiovascular RFs, which allows to consider VTE as part of the cardiovascular continuum. In a small number of PE patients, no known VTE RFs were detected, which determines the need to study other possible conditions that contribute to the PE development. Two-thirds of patients do not have reversible VTE RFs, which leads to the need for active anticoagulant prevention of PE in these patients.

ANMCO statement: Arterial and venous thromboembolism: what implications for clinical practice?

Acute myocardial infarction, stroke, peripheral arterial disease and pulmonary embolism share thrombosis as a common mechanism. Some well-known risk factors for arterial thromboembolism are recognized as "weak risk factors" of venous one, too. Arterial and venous thrombosis share also some pathophysiological mechanisms, including inflammation, endothelial damage, and hypercoagulability. It is likely, thus, that any disease related to arterial and venous thrombosis belong to the same "pan-vascular syndrome", that constitutes itself a chronic, recurrent inflammatory disease. According to the available data, there are elements for implementing an omni-comprehensive cardiovascular evaluation after an episode of venous thromboembolism, requiring the investigations, in addition to the known unrecognized prothrombotic conditions, also of indirect signs and risk factors for a possible arterial thromboembolic event. Large, prospective studies are needed to establish the more appropriate therapeutic strategies in this context.The aim of the present statement is to make aware all the physicians involved in the management of arterial and venous diseases and to provide some tools for evaluating the implications of related major risk factors. Thus, it could be possible to lay the foundation for a reduction of total cardiovascular risk, in terms of primary and secondary prevention of arterial and venous thromboembolism.

Past and Recent Salted Fish and Preserved Food Intakes Are Weakly Associated with Nasopharyngeal Carcinoma Risk in Adults in Southern China

Chinese-style salted fish intake in early life is considered an established risk factor for nasopharyngeal carcinoma (NPC). However, results for adult intakes of salted fish and preserved foods are inconsistent. The aim of this study was to ascertain the relations of Chinese-style hard and soft salted fish and preserved food intakes with NPC risk. We conducted a population-based case-control study in southern China with 2554 NPC cases identified through a rapid case ascertainment system and 2648 healthy controls, frequency-matched on age, sex, and area. Subjects (aged 20-74 y) were interviewed via a food-frequency questionnaire, including information on portion size. Data were also collected on alcohol consumption and potential confounders. Food intake was grouped into 3-5 energy-adjusted intake levels during adulthood (10 y prior) and adolescence (16-18 y). For childhood (at age 10 y), intake frequency of selected food items was collected. Multivariate-adjusted ORs with 95% CIs were estimated via logistic regression. We found no association between NPC and intake of hard Chinese-style salted fish during adulthood, and an increased risk at the highest level of intake during adolescence (OR: 1.19; 95% CI: 1.03, 1.39). In contrast, we found a decreased risk for the middle intake level of soft salted fish during adulthood (OR: 0.68; 95% CI: 0.57, 0.81) and adolescence (OR: 0.71; 95% CI: 0.59, 0.85). Preserved foods showed contrasting risk profiles, e.g., the highest adult intake level of salted egg (OR: 1.51; 95% CI: 1.22, 1.87) and fermented black beans (OR: 0.67; 95% CI: 0.56, 0.80). Associations with NPC were weaker than previously reported, e.g., for weekly childhood intake of salted fish (OR: 1.56; 95% CI: 1.24, 1.97). Hard and soft salted fish have different risk profiles. Salted fish and other preserved foods were at most weak risk factors for NPC in all periods and may play a smaller role in NPC occurrence than previously thought.

Haptoglobin phenotypes with weak antioxidant capacity increase risk factors of cardiovascular disease in Ghanaian HIV-infected patients on highly active antiretroviral therapy.

Highly active antiretroviral therapy (HAART) has considerably reduced HIV/AIDS-related morbidity and mortality; however, the therapy has been associated with the development of cardiovascular disease (CVD), and genetic predisposition factors may aggravate disease outcome. This study was aimed at investigating the relationship between haptoglobin phenotypes and risk factors of CVD in HIV patients. A total of 105 HIV sero-positive patients on HAART and 75 HIV-infected HAART-naïve individuals were enrolled in the study. Socio-demographics and clinical characteristics of the participants were obtained using a well-structured questionnaire. Lipid profile, lactate dehydrogenase (LDH) and haptoglobin (Hp) phenotypes were analysed from serum whiles haemoglobin (Hb) level, CD4+ cell count and HIV viral RNA load were determined using whole blood. Atherogenic index of plasma (AIP) was significantly higher in patients on HAART than the naïve group (P<0.05). Age, BMI, visceral fat, systolic blood pressure LDH and lipid variables strongly and positively correlated with AIP (P<0.05), with the exception of HDL-c (P<0.001) which showed a negative correlation. HAART was associated with hypertension (χ2 =4.33, P=0.037), hypercholesterolaemia (χ2 =10.99, P<0.001), elevated LDL-c (χ2 = 10.30, P<0.001) and decreased HDL-c (χ2 =3.87, P=0.09). Hp2-2 and Hp0 collectively was strongly associated with hypertension (OR=2.54, P=0.011), obesity (OR=5.97, P<0.001) and hypercholesterolaemia (OR=2.99, P<0.001). HIV/AIDS patients on HAART expressing Hp phenotypes with weak antioxidant capacity have an increased risk of developing CVD.

Hamstring and Ankle Flexibility Deficits Are Weak Risk Factors for Hamstring Injury in Professional Soccer Players: A Prospective Cohort Study of 438 Players Including 78 Injuries

Background: Hamstring injuries remain a significant injury burden in sports such as soccer that involve high-speed running. It has repeatedly been identified as the most common noncontact injury in elite male soccer, representing 12% of all injuries. As the incidence of hamstring injuries remains high, investigations are aimed at better understanding how to prevent hamstring injuries. Stretching to improve flexibility is commonly used in elite-level sports, but risk factor studies have reported contradicting results, leading to unclear conclusions regarding flexibility as a risk factor for hamstring injuries. Purpose: To investigate the association of lower limb flexibility with the risk of hamstring injuries in professional soccer players. Study Design: Cohort study; Level of evidence, 2. Methods: All teams (n = 18) eligible to compete in the premier soccer league in Qatar (Qatar Stars League [QSL]) underwent a comprehensive musculoskeletal assessment during their annual periodic health evaluation at Aspetar Orthopaedic and Sports Medicine Hospital in Doha, Qatar. Variables included passive knee extension and ankle dorsiflexion range of motion. A clustered multivariate Cox regression analysis was used to identify associations with the risk of hamstring injuries. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity. Results: A total of 438 unique players (72.4% of all QSL players) competed for 601 player-seasons (148 players competed both seasons) and sustained 78 hamstring injuries. Passive knee extension range of motion (hazard ratio [HR], 0.97 [95% CI, 0.95-0.99]; P = .008) and ankle dorsiflexion range of motion (HR, 0.93 [95% CI, 0.88-0.99]; P = .02) were independently associated with the injury risk. The absolute differences between the injured and uninjured players were 1.8° and 1.4 cm, respectively, with small effect sizes (d < 0.2). The ROC curve analyses showed an area under the curve of 0.52 for passive knee extension and 0.61 for ankle dorsiflexion, indicating failed to poor combined sensitivity and specificity of the 2 strength variables identified in the multivariate Cox regression analysis. Conclusion: This study identified deficits in passive hamstring and ankle dorsiflexion range of motion as weak risk factors for a hamstring injury. These findings have little clinical value in predicting the risk of future hamstring injuries, and test results must therefore be interpreted cautiously in athletic screening.

An association between residual vein thrombosis and subclinical atherosclerosis: Cross-sectional study

BackgroundThe association between venous and arterial thrombotic disorders is still unclear. We assessed the association between residual vein thrombosis (RVT) and subclinical atherosclerosis in a cohort of patients with unprovoked (or associated with weak risk factors) proximal deep-vein thrombosis (DVT). MethodsIn a multicenter cross-sectional study, consecutive patients over 40years free from atherosclerotic disorders received the ultrasound assessment of the leg vein system and that of carotid arteries approximately three months after an episode of proximal DVT. In each center the evaluation was done by two independent assessors. The presence of RVT was defined as the incompressibility of at least 4mm in either the popliteal or the common femoral vein, and that of subclinical atherosclerosis as the presence of increased (>0.9mm) intima-media tickness (IMT) and/or carotid plaques. ResultsOut of 252 patients (mean age, 67; males, 53%; unprovoked, 77%), the presence of RVT was found in 139 (55.2%). An increased IMT was shown in 76 (54.7%) patients with and in 35 (31.0%) without RVT (p<0.001). At least one carotid plaque was found in 80 (57.6%) patients with and in 36 (31.9%) without RVT (p<0.001). After adjusting for the baseline characteristics, the odds ratio of subclinical atherosclerosis (increased IMT and/or carotid plaques) was 2.8 (95% CI, 1.6 to 4.7). ConclusionThe ultrasound detection of RVT after an episode of proximal DVT that is either unprovoked or triggered by weak risk factors is associated with a higher prevalence of subclinical atherosclerosis. These findings may have implications for patient prognosis.

Hamstring and Quadriceps Isokinetic Strength Deficits Are Weak Risk Factors for Hamstring Strain Injuries

Background: A hamstring strain injury (HSI) has become the most common noncontact injury in soccer. Isokinetic muscle strength deficits are considered a risk factor for HSIs. However, underpowered studies with small sample sizes unable to determine small associations have led to inconclusive results regarding the role of isokinetic strength and strength testing in HSIs. Purpose: To examine whether differences in isokinetic strength measures of knee flexion and extension represent risk factors for hamstring injuries in a large cohort of professional soccer players in an adequately powered study design. Study Design: Cohort study; Level of evidence, 2. Methods: A total of 614 professional soccer players from 14 teams underwent isokinetic strength testing during preseason screening. Testing consisted of concentric knee flexion and extension at 60 deg/s and 300 deg/s and eccentric knee extension at 60 deg/s. A clustered multiple logistic regression analysis was used to identify variables associated with the risk of HSIs. Receiver operating characteristic (ROC) curves were calculated to determine sensitivity and specificity. Results: Of the 614 players, 190 suffered an HSI during the 4 seasons. Quadriceps concentric strength at 60 deg/s (odds ratio [OR], 1.41; 95% CI, 1.03-1.92; P = .03) and hamstring eccentric strength at 60 deg/s (OR, 1.37; 95% CI, 1.01-1.85; P = .04) adjusted for bodyweight were independently associated with the risk of injuries. The absolute differences between the injured and uninjured players were 6.9 N·m and 9.1 N·m, with small effect sizes (d < 0.2). The ROC analyses showed an area under the curve of 0.54 and 0.56 for quadriceps concentric strength and hamstring eccentric strength, respectively, indicating a failed combined sensitivity and specificity of the 2 strength variables identified in the logistic regression models. Conclusion: This study identified small absolute strength differences and a wide overlap of the absolute strength measurements at the group level. The small associations between lower hamstring eccentric strength and lower quadriceps concentric strength with HSIs can only be considered as weak risk factors. The identification of these risk factors still does not allow the identification of individual players at risk. The use of isokinetic testing to determine the association between strength differences and HSIs is not supported.

Study of cardiovascular risk factor profile among first-degree relatives of patients with premature coronary artery disease at Kota, Rajasthan, India

Background: Traditional cardiovascular risk factors are strong predictors of an increased likelihood for premature CHD. Considering the benefits of risk factors᾿ management, it is imperative to find and treat them before looking for more unknown and weak risk factors. The objectives of the study was to determine the distribution of cardiovascular risk factors in first degree relatives of the patients with premature coronary artery disease. Methods: The study was conducted under the department of Preventive and Social Medicine and patients were enrolled from the Department of Cardiology of GMC Hospital, Kota to screen the first- degree relatives of the patients suffering from premature CAD, for the presence of risk factors. For the purpose of study, 200 consecutive patients admitted in the cardiac care units of GMC Hospital, Kota with the primary diagnosis of premature coronary artery disease were enrolled. These patients’ 643 first-degree relatives, who were in the coronary age group were included in the study. Inclusion criteria were age (25 years and above), residence (residing within Jaipur city) were enrolled for the purpose of the study. Results: Out of total 643 study subjects approximately half were in middle age group (31-50 years). 66.9% of the relatives of CAD patients were males and females represented 33.1% of the study population. 66% of the first-degree relatives of the patients suffering from premature CAD were from Social class II, III and IV. approximately 50% of first degree relatives of CAD patients were bearing 1 or more CAD risk factors. Hypertension was present in 29.7 % of the relatives suffering from Premature CAD. Diabetes mellitus and high lipid levels affected 13.0 % and 10.1 % relatives respectively. 47.5% of the relatives were either obese or leading a sedentary life style while 27.7% were smokers. Conclusions: Premature Coronary Heart Disease is a public health problem. However, there is lack of effective and intensive treatments of well-defined traditional risk factors and prevention methods for the majority of the patients experiencing premature CHD. In sum, there is still plenty of room for improvement of risk management in India.

Abstract 19336: Reported Stroke Rates in Patients With Nonvalvular Atrial Fibrillation in North America are Lower Than Those Cited in ESC and AHA Guidelines

Background: Anticoagulants (OAC) decrease ischemic stroke rates in patients with atrial fibrillation (AF) but increase the risk of bleeding. The risk of ischemic stroke where the absolute benefit of anticoagulation outweighs the bleeding risk has been shown to be 1-2% per year. The American Heart Association/American College of Cardiology/Heart Rhythm Society and the European Society of Cardiology (ESC) guidelines have adopted the CHA2DS2-VASc stroke risk score; their recommendations assume the scheme’s point scores correspond to fixed stroke rates. However, reported rates of stroke vary widely across cohorts, placing in question the generalizability of guideline recommendations. Objective: To contrast the reported rates of stroke in North American (NA) patients with AF who do not take OAC with the Danish AF cohort used to create the ESC guidelines. Methods: We conducted a systematic review to identify all cohort studies and randomized controlled trials including patients with non-valvular AF not treated with OAC. We excluded studies that enrolled only patients undergoing surgical procedures or cardioversion, or only patients with specific comorbidities such as prior stroke or kidney disease. Results: Of the 3,552 studies screened, we identified 13 eligible NA studies representing 137,652 patients. Larger and more contemporary cohorts generally had lower stroke rates (Table). When weighted by number of subjects, the NA cohorts’ ischemic stroke rate averaged 1.88% per year, whereas the Danish cohort had a rate of 4.66% per year. Conclusions: Large variation exists in stroke rates across putatively representative cohorts. This may reflect true differences in rates or methodologic differences among studies. These differences could change the point score threshold for recommending OAC in lower risk regions. Reexamining the net benefit of OAC in patients with a CHA2DS2-VASc score of 1 or 2 seems warranted, particularly for those with weak 1-point risk factors.

D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study

AbstractThe optimal duration of anticoagulation in patients with venous thromboembolism (VTE) is uncertain. We investigated whether persistently negative D-dimers in patients with vein recanalization or stable thrombotic burden can identify subjects at low recurrence risk. Outpatients with a first VTE (unprovoked or associated with weak risk factors) were eligible after at least 3 months (12 in those with residual thrombosis) of anticoagulation. They received serial D-dimer measurements using commercial assays with predefined age/sex-specific cutoffs and were followed for up to 2 years. Of 1010 patients, anticoagulation was stopped in 528 (52.3%) with persistently negative D-dimer who subsequently experienced 25 recurrences (3.0% pt-y; 95% confidence interval [CI], 2.0-4.4%). Of the remaining 482 patients, 373 resumed anticoagulation and 109 refused it. Recurrent VTE developed in 15 patients (8.8% pt-y; 95% CI, 5.0-14.1) of the latter group and in 4 of the former (0.7% pt-y; 95% CI, 0.2-1.7; hazard ratio = 2.92; 95% CI, 1.87-9.72; P = .0006). Major bleeding occurred in 14 patients (2.3% pt-y; 95% CI, 1.3-3.9) who resumed anticoagulation. Serial D-dimer measurement is suitable in clinical practice for the identification of VTE patients in whom anticoagulation can be safely discontinued. This study was registered at clinicaltrials.gov as #NCT00954395.

Maternal and Hospital Characteristics of Non-Medically Indicated Deliveries Prior to 39 Weeks

Non-medically indicated (NMI) deliveries prior to 39 weeks increase the risk of neonatal mortality, excess morbidity, and health care costs. The study's purpose was to identify maternal and hospital characteristics associated with NMI deliveries prior to 39 weeks. The study included 207,775 births to women without a previous cesarean and 38,316 births to women with a previous cesarean, using data from Florida's 2006-2007 linked birth certificate and inpatient record file. Adjusted risk ratios (ARR) and 95 % confidence intervals (CI) for characteristics were calculated using generalized estimating equation for multinomial logistic regression. Among women without a previous cesarean, NMI deliveries occurred in 18,368 births (8.8 %). Non-medically indicated inductions were more likely in women who were non-Hispanic white (ARR: 1.41, 95 % CI 1.31-1.52), privately-insured (ARR: 1.42, 95 % CI 1.26-1.59), and delivered in hospitals with <500 births per year. Non-medically indicated primary cesareans were more likely in women who were older than 35 years (ARR: 2.96, 95 % CI 2.51-3.50), non-Hispanic white (ARR: 1.44, 95 % CI 1.30-1.59), and privately-insured (ARR: 1.43, 95 % CI 1.17-1.73). Non-medically indicated primary cesareans were also more likely to occur in hospitals with <30 % nurse-midwife births, <500 births per year, and in large metro areas. Among women with previous cesarean, NMI repeat cesareans occurred in 16,746 births (43.7 %). Only weak risk factors were identified for NMI repeat cesareans. The risk factors identified varied by NMI outcome. This information can be used to inform educational campaigns and identify hospitals that may benefit from quality improvement efforts.

A New Look at Weak State Conditions and Genocide Risk

AbstractWe present a rational choice model depicting a regime’s incentive to allocate resources to fighting rebels and killing civilians when it perceives an internal threat to its political or territorial control. The model guides our empirical inquiry of risk factors for genocide onset. Based on logit methods applied to a pooled sample of 155 countries over the period 1955–2006, we find that key variables highlighted in the theoretical model elevate genocide risk. Specifically, measures of threat, anocratic Polity scores, new state status, and low income significantly increase genocide risk, which we interpret as consistent with weak state perspectives on mass atrocity. Moreover, the threat measures matter even after controlling for internal war and the anocracy result holds even after removing components of the Polity dataset that are “contaminated” with factional violence, including genocide. Extensions of the empirical analysis to a variety of alternative measures, variables, and estimators show the robustness of weak state risk factors for genocide.

Triage and protocol recommendations for the parasitology laboratory based on an epidemiological investigation of parasite diagnostics in Ontario laboratories.

A study was performed using a subset of Ontario laboratory parasitology data, with three objectives: to describe parasitic infections in Ontario; to identify risk factors for acquiring a parasitic infection using routinely collected information; and to use this information to assess current protocols for parasite testing in laboratories and, in turn, to propose alternatives to optimize the allocation of laboratory resources. All parasitology records from January 4, 2010 to September 14, 2010 were reviewed descriptively and risk factor analyses were performed using information collected from requisitions. These results were used to develop preliminary alternative protocols, which considered high-throughput screening tests and inclusion/exclusion criteria for ova and parasite testing; these were then retrospectively analyzed with the dataset to determine appropriateness. Of the 29,260 records analyzed, 10% were multiple samples from single patients submitted on the same day, of which 98% had the same result. Three percent of all parasite tests were positive, with the most prevalent parasites being (in ascending order) Dientamoeba fragilis, Giardia lamblia, Cryptosporidium species and Entamoeba histolytica/dispar. Age and sex were found to be weak risk factors, while rural living was found to be a moderate risk factor for D fragilis, G lamblia and Cryptosporidium infections. The strongest risk factor was travel history, especially for nonendemic parasites. The retrospective analysis of six alternative protocols identified four that may be more efficient than current procedures. The present study demonstrated that current protocols may be redundant and can be optimized to target prevalent parasites and populations with high risk factors.

Warfarin for Prevention of Thrombosis Among Long-Term Care Residents with Atrial Fibrillation: Evidence of Continuing Low Use Despite Consideration of Stroke and Bleeding Risk

ObjectivesThe aims of the study were to evaluate usage rates of warfarin in stroke prophylaxis and the association with assessed stages of stroke and bleeding risk in long-term care (LTC) residents with atrial fibrillation (AFib).MethodsA cross-sectional analysis of two LTC databases (the National Nursing Home Survey [NNHS] 2004 and an integrated LTC database: AnalytiCare) was conducted. The study involved LTC facilities across the USA (NNHS) and within 19 states (AnalytiCare). It included LTC residents diagnosed with AFib (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] diagnostic code 427.3X). Consensus guideline algorithms were used to classify residents by stroke risk categories: low (none or 1+ weak stroke risk factors), moderate (1 moderate), high (2+ moderate or 1+ high). Residents were also classified by number of risk factors for bleeding (0–1, 2, 3, 4+). Current use of warfarin was assessed. A logistic regression model predicted odds of warfarin use associated with the stroke and bleeding risk categories.ResultsThe NNHS and AnalytiCare databases had 1,454 and 3,757 residents with AFib, respectively. In all, 34 % and 45 % of residents with AFib in each respective database were receiving warfarin. Only 36 % and 45 % of high-stroke-risk residents were receiving warfarin, respectively. In the logistic regression model for the NNHS data, when compared with those residents having none or 1+ weak stroke risk and 0–1 bleeding risk factors, the odds of receiving warfarin increased with stroke risk (odds ratio [OR] = 1.93, p = 0.118 [1 moderate risk factor]; OR = 3.19, p = 0.005 [2+ moderate risk factors]; and OR = 8.18, p ≤ 0.001 [1+ high risk factors]) and decreased with bleeding risk (OR = 0.83, p = 0.366 [2 risk factors]; OR = 0.47, p ≤ 0.001 [3 risk factors]; OR = 0.17, p ≤ 0.001 [4+ risk factors]). A similar directional but more constrained trend was noted for the AnalytiCare data: only 3 and 4+ bleeding risk factors were significant.ConclusionsThe results from two LTC databases suggest that residents with AFib have a high risk of stroke. Warfarin use increased with greater stroke risk and declined with greater bleeding risk; however, only half of those classified as appropriate warfarin candidates were receiving guideline-recommended anticoagulant prophylaxis.